BACKGROUND: The high cardiovascular mortality in Eastern Europe has often been attributed to poor diet, but individual-level data on nutrition in the region are generally not available. This paper describes the methods of dietary assessment and presents preliminary findings on food and nutrient intakes in large general population samples in Russia, Poland and the Czech Republic. METHODS: The HAPIEE (Health, Alcohol and Psychosocial factors In Eastern Europe) study examined random samples of men and women aged 45-69 years at baseline in Novosibirsk (Russia), Krakow (Poland) and six Czech urban centres in 2002-2005. Diet was assessed using a food frequency questionnaire (at least 136 items); complete dietary information was available for 26,870 persons. RESULTS: Total energy intakes among men ranged between 8.7 MJ in the Czech sample and 11.7 MJ in the Russian sample, while among women, energy intakes ranged between 8.2 MJ in the Czech sample and 9.8 MJ in the Russian sample. A Healthy Diet Indicator (HDI), ranging from a score of 0 (lowest) to 7 (highest), was developed using the World Health Organisation's (WHO) guidelines for the prevention of chronic diseases. The mean HDI scores were low, ranging from 1.0 (SD = 0.7) among the Polish subjects to 1.7 (SD = 0.8) among the Czech females. Very few subjects met the WHO recommended intakes for complex carbohydrates, pulses or nuts; intakes of saturated fatty acids, sugar and protein were too high. Only 16% of Polish subjects met the WHO recommendation for polyunsaturated fat intake. Consumption of fruits and vegetables was lower than recommended, especially among those Russian subjects who were assessed during the low intake season. Fewer than 65% of subjects consumed adequate amounts of calcium, magnesium and potassium, when compared with the United Kingdom's Reference Nutrient Intake. CONCLUSION: This first large scale study of individual-based dietary intakes in the general population in Eastern Europe implies that intakes of saturated fat, sugar and complex carbohydrates are a cause for concern. The development of country-specific nutritional tools must be encouraged and nutritional campaigns must undergo continuing development.

Department of Epidemiology and Public Health University College London London UK

Zobrazit více v PubMed

Mesle F. Mortality in Central and Eastern Europe: long-term trends and recent upturns. Demog Res. 2004;2:45–70. doi: 10.4054/DemRes.2004.S2.3. DOI

Bobak M, Marmot M. East-West mortality divide and its potential explanations: proposed research agenda. BMJ. 1996;312:421–425. PubMed PMC

Uemura K, Pisa Z. Trends in cardiovascular disease mortality in industrialized countries since 1950. World Health Stat Q. 1988;41:155–178. PubMed

Kuulasmaa K, Tunstall-Pedoe H, Dobson A, Fortmann S, Sans S, Tolonen H, Evans A, Ferrario M, Tuomilehto J. Estimation of contribution of changes in classic risk factors to trends in coronary-event rates across the WHO MONICA Project populations. Lancet. 2000;355:675–687. doi: 10.1016/S0140-6736(99)11180-2. PubMed DOI

Ness AR, Powles JW. Fruit and vegetables, and cardiovascular disease: a review. Int J Epidemiol. 1997;26:1–13. doi: 10.1093/ije/26.1.1. PubMed DOI

Rimm E, Ascherio A, Giovannucci E, Spiegelman D, Stampfer M, Willett W. Vegetable, fruit, and cereal fiber intake and risk of coronary heart disease: a review. JAMA. 1996;275:447–451. doi: 10.1001/jama.275.6.447. PubMed DOI

Bobak M, Hense HW, Kark J, Kuch B, Vojtisek P, Sinnreich R, Gostomzyk J, Bui M, von EA, Junker R, Fobker M, Schulte H, Assmann G, Marmot M. An ecological study of determinants of coronary heart disease rates: a comparison of Czech, Bavarian and Israeli men. Int J Epidemiol. 1999;28:437–444. doi: 10.1093/ije/28.3.437. PubMed DOI

Kristenson M, Zieden B, Kucinskiene Z, Elinder LS, Bergdahl B, Elwing B, Abaravicius A, Razinkoviene L, Calkauskas H, Olsson AG. Antioxidant state and mortality from coronary heart disease in Lithuanian and Swedish men: concomitant cross sectional study of men aged 50. BMJ. 1997;314:629–633. PubMed PMC

Ginter E. High cardiovascular mortality in postcommunist countries: participation of oxidative stress? Int J Vitam Nutr Res. 1996;66:183–189. PubMed

Matilainen T, Vartiainen E, Puska P, Alfthan G, Pokusajeva S, Moisejeva N, Uhanov M. Plasma ascorbic acid concentrations in the Republic of Karelia, Russia and in North Karelia, Finland. Eur J Clin Nutr. 1996;50:115–120. PubMed

Stillman S, Thomas D. The Effect of Economic Crises on Nutritional Status: Evidence from Russia. Institute for the Study of Labor. 2004.

Serra-Majem L, MacLean D, Ribas L, Brule D, Sekula W, Prattala R, Garcia-Closas R, Yngve A, Lalonde M, Petrasovits A. Comparative analysis of nutrition data from national, household, and individual levels: results from a WHO-CINDI collaborative project in Canada, Finland, Poland, and Spain. JECH. 2003;57:74–80. PubMed PMC

Zunft HJ, Ulbricht G, Pokorny J, Sekula W, Szponar L, Abaravicius JA. Nutrition, physical activity and health status in Middle and East European countries. Public Health Nutr. 1999;2:437–441. PubMed

Zaridze D, Filipchenko V, Kustov V, Serdyuk V, Duffy S. Diet and Colorectal-Cancer - Results of 2 Case-Control Studies in Russia. Eur J Cancer. 1993;29A:112–115. doi: 10.1016/0959-8049(93)90586-5. PubMed DOI

Peasey A, Bobak M, Kubinova R, Malyutina S, Pajak A, Tamosiunas A, Pikhart H, Nicholson A, Marmot M. Determinants of cardiovascular disease and other non-communicable diseases in Central and Eastern Europe: rationale and design of the HAPIEE study. BMC Publ Health. 2006;6:255–265. doi: 10.1186/1471-2458-6-255. PubMed DOI PMC

Brunner E, Stallone D, Juneja M, Bingham S, Marmot M. Dietary assessment in Whitehall II: comparison of 7 d diet diary and food-frequency questionnaire and validity against biomarkers. Br J Nutr. 2001;86:405–414. doi: 10.1079/BJN2001414. PubMed DOI

Willett WC, Sampson L, Stampfer MJ, Rosner B, Bain C, Witschi J, Hennekens CH, Speizer FE. Reproducibility and Validity of A Semiquantitative Food Frequency Questionnaire. Am J Epidemiol. 1985;122:51–65. PubMed

McCance R, Widdowson E. McCance & Widdowson's The Composition of Foods: Summary Edition. Cambridge: Royal Society of Chemistry; 2002.

Skurikhin I, Baturin A. Tables of Chemical and Energy Composition of Russian Foods [In Russian] Moscow: Deli Print; 2008.

Kunachowicz H, Nadolna I, Przybyla B, Iwanow K. Food Composition Tables. Warsaw: National Food and Nutrition Institute; 1998.

United States Department of Agriculture Nutrient Database. http://www.nal.usda.gov/fnic/foodcomp/search/

Foster-Powell K, Holt SH, Brand-Miller JC. International table of glycemic index and glycemic load values: 2002. Am J Clin Nutr. 2002;76:5–56. PubMed

Welch AA, Luben R, Khaw KT, Bingham SA. The CAFE computer program for nutritional analysis of the EPIC-Norfolk food frequency questionnaire and identification of extreme nutrient values. J Hum Nutr Diet. 2005;18:99–116. doi: 10.1111/j.1365-277X.2005.00593.x. PubMed DOI

Schofield WN. Predicting basal metabolic rate, new standards and review of previous work. Hum Nutr Clin Nutr. 1985;39:5–41. PubMed

Willett W, Stampfer MJ. Total Energy-Intake - Implications for Epidemiologic Analyses. Am J Epidemiol. 1986;124:17–27. PubMed

StataCorp. Stata Statistical Software: Release 8. StataCorp LP. 2003.

World Health Organisation. Diet, nutrition and the prevention of chronic diseases. World Health Organisation; 2003. PubMed

Cade J, Upmeier H, Calvert C, Greenwood D. Costs of a healthy diet: analysis from the UK Women's Cohort Study. Public Health Nutr. 1999;2:505–512. doi: 10.1017/S1368980099000683. PubMed DOI

Huijbregts P, Feskens E, Rasanen L, Fidanza F, Nissinen A, Menotti A, Kromhout D. Dietary pattern and 20 year mortality in elderly men in Finland, Italy, and The Netherlands: longitudinal cohort study. BMJ. 1997;315:13–17. PubMed PMC

Department of Health - Committee on Medical Aspects of Food Policy (COMA) Dietary Reference Values of Energy and Nutrients for the United Kingdom. London: HMSO; 2005.

Molarius A, Seidell JC, Kuulasmaa K, Dobson AJ, Sans S. Smoking and relative body weight: an international perspective from the WHO MONICA Project. JECH. 1997;51:252–260. PubMed PMC

Mc Kee M, Bobak M, Rose R, Shkolnikov V, Chenet L, Leon D. Patterns of smoking in Russia. Tob Control. 1998;7:22–26. doi: 10.1136/tc.7.1.22. PubMed DOI PMC

Kristal AR, Peters U, Potter JD. Is it time to abandon the food frequency questionnaire? Cancer Epidemiol Biomarkers Prev. 2005;14:2826–2828. doi: 10.1158/1055-9965.EPI-12-ED1. PubMed DOI

Bingham SA, Welch AA, McTaggart A, Mulligan AA, Runswick SA, Luben R, Oakes S, Khaw KT, Wareham N, Day NE. Nutritional methods in the European Prospective Investigation of Cancer in Norfolk. Public Health Nutr. 2001;4:847–858. doi: 10.1079/PHN2000102. PubMed DOI

Black AE, Cole TJ. Biased over- or under-reporting is characteristic of individuals whether over time or by different assessment methods. J Am Diet Assoc. 2001;101:70–80. doi: 10.1016/S0002-8223(01)00018-9. PubMed DOI

Egan MB, Fragodt A, Raats MM, Hodgkins C, Lumbers M. The importance of harmonizing food composition data across Europe. Eur J Clin Nutr. 2007;61:813–821. doi: 10.1038/sj.ejcn.1602823. PubMed DOI

Ingram DD, Thorn MD, Stinnett SS, Deev AD. U.S.S.R. and U.S. nutrient intake, plasma lipids, and lipoproteins in men ages 40-59 sampled from Lipid Research Clinics populations. Prev Med. 1985;14:264–271. doi: 10.1016/0091-7435(85)90055-6. PubMed DOI

Jensen EX, Fusch C, Jaeger P, Peheim E, Horber FF. Impact of chronic cigarette smoking on body composition and fuel metabolism. J Clin Endocrinol Metab. 1995;80:2181–2185. doi: 10.1210/jc.80.7.2181. PubMed DOI

Perkins KA. Metabolic effects of cigarette smoking. J Appl Physiol. 1992;72:401–409. PubMed

Bates CJ, Prentice A, Finch S. Gender differences in food and nutrient intakes and status indices from the National Diet and Nutrition Survey of people aged 65 years and over. Eur J Clin Nutr. 1999;53:694–699. doi: 10.1038/sj.ejcn.1600834. PubMed DOI

Wirfalt AKE, Jeffery RW. Using cluster analysis to examine dietary patterns: Nutrient intakes, gender, and weight status differ across food pattern clusters. J Am Diet Assoc. 1997;97:272–279. doi: 10.1016/S0002-8223(97)00071-0. PubMed DOI

Skurikhin I, Volgarev M. Chemical Composition of Food. Moscow: Agropromisdat; 1987.

Brainerd E, Cutler DM. Autopsy on an empire: Understanding mortality in Russia and the former soviet union. J Econ Perspect. 2005;19:107–130. doi: 10.1257/0895330053147921. DOI

Arvaniti F, Panagiotakos DB. Healthy indexes in public health practice and research: a review. Crit Rev Food Sci Nutr. 2008;48:317–327. doi: 10.1080/10408390701326268. PubMed DOI

Haveman-Nies A, Tucker KL, de Groot LC, Wilson PW, van Staveren WA. Evaluation of dietary quality in relationship to nutritional and lifestyle factors in elderly people of the US Framingham Heart Study and the European SENECA study. Eur J Clin Nutr. 2001;55:870–880. doi: 10.1038/sj.ejcn.1601232. PubMed DOI

Kesteloot H, Sans S, Kromhout D. Dynamics of cardiovascular and all-cause mortality in Western and Eastern Europe between 1970 and 2000. Eur Heart J. 2006;27:107–113. doi: 10.1093/eurheartj/ehi511. PubMed DOI

McNaughton SA, Mishra GD, Brunner EJ. Food patterns associated with blood lipids are predictive of coronary heart disease: the Whitehall II study. Br J Nutr. 2009;102:619–624. doi: 10.1017/S0007114509243030. PubMed DOI PMC

Albert MA, Glynn RJ, Ridker PM. Plasma concentration of C-reactive protein and the calculated Framingham Coronary Heart Disease Risk Score. Circulation. 2003;108:161–165. doi: 10.1161/01.CIR.0000080289.72166.CF. PubMed DOI

Ridker PM, Rifai N, Rose L, Buring JE, Cook NR. Comparison of C-reactive protein and low-density lipoprotein cholesterol levels in the prediction of first cardiovascular events. N Engl J Med. 2002;347:1557–1565. doi: 10.1056/NEJMoa021993. PubMed DOI

Flight I, Clifton P. Cereal grains and legumes in the prevention of coronary heart disease and stroke: a review of the literature. Eur J Clin Nutr. 2006;60:1145–1159. doi: 10.1038/sj.ejcn.1602435. PubMed DOI

Rychtarikova J. The Case of the Czech Republic. Determinants of the Recent Favourable Turnover in Mortality. Demog Res. 2004;Special collection 2

Kesse E, Boutron-Ruault MC, Norat T, Riboli E, Clavel-Chapelon F. Dietary calcium, phosphorus, vitamin D, dairy products and the risk of colorectal adenoma and cancer among French women of the E3N-EPIC prospective study. Int J Cancer. 2005;117:137–144. doi: 10.1002/ijc.21148. PubMed DOI

Heaney RP. Calcium, dairy products and osteoporosis. J Am Coll Nutr. 2000;19:83S–99S. PubMed

Geleijnse JM, Witteman JC, Stijnen T, Kloos MW, Hofman A, Grobbee DE. Sodium and potassium intake and risk of cardiovascular events and all-cause mortality: the Rotterdam Study. Eur J Epidemiol. 2007;22:763–770. doi: 10.1007/s10654-007-9186-2. PubMed DOI PMC

Ascherio A, Rimm EB, Hernan MA, Giovannucci EL, Kawachi I, Stampfer MJ, Willett WC. Intake of potassium, magnesium, calcium, and fiber and risk of stroke among US men. Circulation. 1998;98:1198–1204. PubMed

Ascherio A, Rimm EB, Giovannucci EL, Colditz GA, Rosner B, Willett WC, Sacks F, Stampfer MJ. A prospective study of nutritional factors and hypertension among US men. Circulation. 1992;86:1475–1484. PubMed

Abbott RD, Ando F, Masaki KH, Tung KH, Rodriguez BL, Petrovitch H, Yano K, Curb JD. Dietary magnesium intake and the future risk of coronary heart disease (the Honolulu Heart Program) Am J Cardiol. 2003;92:665–669. doi: 10.1016/S0002-9149(03)00819-1. PubMed DOI

Liao F, Folsom AR, Brancati FL. Is low magnesium concentration a risk factor for coronary heart disease? The Atherosclerosis Risk in Communities (ARIC) Study. Am Heart J. 1998;136:480–490. doi: 10.1016/S0002-8703(98)70224-8. PubMed DOI

Szostak WB, Sekula W, Figurska K. Reduction of cardiovascular mortality in Poland and changes in dietary patterns. Kardiol Pol. 2003;58:173–181. PubMed

Poledne R, Skodova Z. Changes in nutrition, cholesterol concentration, and cardiovascular disease mortality in the Czech population in the past decade. Nutrition. 2000;16:785–786. doi: 10.1016/S0899-9007(00)00390-7. PubMed DOI

Liefert W. Food security in Russia: Economic growth and rising incomes are reducing insecurity. Economic Reserach Service USDA. 2004.

Huffman SK, Rizov M. Determinants of obesity in transition economies: the case of Russia. Econ Hum Biol. 2007;5:379–391. doi: 10.1016/j.ehb.2007.07.001. PubMed DOI

Pikhart H, Bobak M, Malyutina S, Pajak A, Kubinova R, Marmot M. Obesity and education in three countries of the Central and Eastern Europe: the HAPIEE study. Cent Eur J Public Health. 2007;15:140–142. PubMed

Jahns L, Baturin A, Popkin BM. Obesity, diet, and poverty: trends in the Russian transition to market economy. Eur J Clin Nutr. 2003;57:1295–1302. doi: 10.1038/sj.ejcn.1601691. PubMed DOI

Pomerleau J, Mckee M, Robertson A, Kadziauskiene K, Abaravicius A, Vaask S, Pudule I, Grinberga D. Macronutrient and food intake in the Baltic republics. Eur J Clin Nutr. 2001;55:200–207. doi: 10.1038/sj.ejcn.1601146. PubMed DOI

The Southern European Atlantic diet and all-cause and cause-specific mortality: a European multicohort study

The Southern European Atlantic diet and depression risk: a European multicohort study

Impaired lung function and mortality in Eastern Europe: results from multi-centre cohort study

Risk and protective factors of neurocognitive disorders in older adults in Central and Eastern Europe: A systematic review of population-based studies

Dietary pattern longitudinality during 8 years in children: results from the European Longitudinal Study of Pregnancy and Childhood (ELSPAC-CZ)

Traditional Eastern European diet and mortality: prospective evidence from the HAPIEE study

Association between soft drink, fruit juice consumption and obesity in Eastern Europe: cross-sectional and longitudinal analysis of the HAPIEE study

Mediterranean diet and physical functioning trajectories in Eastern Europe: Findings from the HAPIEE study

Estimated dietary iodine intake as a predictor of placental size: evidence from the ELSPAC study

Parental heights and maternal education as predictors of length/height of children at birth, age 3 and 19 years, independently on diet: the ELSPAC study

Mediterranean diet score and total and cardiovascular mortality in Eastern Europe: the HAPIEE study

Comparison of food and nutrient intakes between cohorts of the HAPIEE and Whitehall II studies

Fruit and vegetable consumption and mortality in Eastern Europe: Longitudinal results from the Health, Alcohol and Psychosocial Factors in Eastern Europe study

Antioxidant vitamin intake and mortality in three Central and Eastern European urban populations: the HAPIEE study

WHO guidelines for a healthy diet and mortality from cardiovascular disease in European and American elderly: the CHANCES project

Fat- and fiber-related diet behavior among type 2 diabetes patients from distinct regions

Healthy diet indicator and mortality in Eastern European populations: prospective evidence from the HAPIEE cohort

Social isolation as a risk factor for inadequate diet of older Eastern Europeans

The association between APOA5 haplotypes and plasma lipids is not modified by energy or fat intake: the Czech HAPIEE study

FTO variant, energy intake, physical activity and basal metabolic rate in Caucasians. The HAPIEE study