Search Results (20)

Background/Objectives: To prevent nutritional depletion and impaired weight status in infants, targeted public health policies and prevention programs based on scientific evidence are needed. This study provides an overview of the dietary patterns and feeding behavior of infants in Croatia as part of the National Food Consumption Survey on Infants and Children. Methods: This cross-sectional study was conducted following the EU Menu methodology and included 322 healthy infants (54% boys; aged 3 months up to 12 months) from Croatia. Two-day dietary records were collected and analyzed using NutriCro 2.0 software. Results: The daily energy intake of infants was on average 886 ± 219 kcal, mainly from carbohydrates (47.0%), followed by fat (41.6%) and protein (9.9%). The main sources of energy and macronutrients were milk and dairy products, grains, grain products, potatoes and tubers and the fruit food group. One third of infants were breastfed, and more than 70% of infants were introduced to complementary foods. Parents started complementary feeding at the age of 5.37 ± 0.82 months, mostly with vegetables. Breastfeeding was associated with higher energy intake, especially in infants younger than 6 months, while formula feeding was associated with lower energy intake. The multivariate regression models showed age-related interactions that attenuated the patterns for energy and macronutrient intake. Conclusions: The study emphasizes that milk and dairy products are the main source of energy and macronutrients. The study highlights the important role of breastfeeding in promoting higher energy intake in early infancy and the decreasing effect of infant formula consumption with age. These results can be used as a basis for health policies, programs and strategies that address infant feeding habits in Croatia. Full article

This study is the first to examine the diet and nutritional status of the adult vegetarian and semi-vegetarian population in Serbia, using data from the EFSA EU Menu Food Consumption Survey 2017–2022. The survey included 314 participants (63 vegans, 192 lacto-ovo vegetarians, 50 pescatarians, and 9 flexitarians), aged 18–74 years (166 women and 148 men, with no gender differences in dietary patterns) across all regions of Serbia. Collected data included anthropometrics (BMI) and intake of energy, macronutrients, and specific food groups (assessed through two 24 h dietary recalls). The study revealed multiple nutritional shortcomings across all three dietary patterns. The most significant was an insufficient protein intake (especially among vegans, but also among non-vegans), connected with an unsatisfactory protein quantity, quality, and availability in plant sources. There was also a high fat intake (particularly from omega-6 and trans-fats-rich sources), especially among non-vegans (but also among vegans), while the intake of omega-3 sources was low. Non-vegans consumed less carbohydrates, fiber, vegetables, and fruit, but more sweets, beverages, and alcohol. Our findings highlight the need for improved nutritional education of vegetarians/semi-vegetarians in Serbia and the development of national food system-based guidelines for this population. Full article

This study offers a comprehensive analysis of the anthropometric and nutritional status among Serbian adults aged 18–64 years, using the data from the EFSA EU Menu food consumption survey conducted between 2017 and 2022. Based on a nationally representative sample of 1139 participants, this research utilized validated 24 h dietary recalls and anthropometric measurements. The results indicate significant dietary imbalances, characterized by a heavy reliance on energy-dense foods, such as grains, fats, and meat, with an underrepresentation of fruits, vegetables, and dairy. Men exhibited a higher total energy intake, obtaining more energy from meat and fats, while women consumed more fruits and vegetables but often did not meet the recommended protein intake. Approximately 67.8% participants had a insufficient dietary fiber intake, and 15.4% did not meet the protein recommendations, particularly women. Anthropometric measurements showed a high prevalence of overweight and obesity, especially among men. These findings highlight critical deficits in dietary adequacy and, from a clinical practice perspective, underscore the necessity for the formulation of policies, targeted public health strategies aimed at improving dietary habits, and provide evidence for the development of national dietary guidelines and clinical guidelines to support preventive healthcare strategies, especially in the management of diet-related conditions, such as obesity and metabolic disorders. Full article

Background: Nutritional status in childhood is associated with a number of short- and long-term health effects. The rising prevalence of childhood obesity highlights the necessity of understanding dietary patterns in children. The study provides an assessment of energy and macronutrient intake and food categories’ contribution to energy intake in Croatian primary school children, according to BMI status. Methods: To assess dietary habits, results of the National Food Consumption Survey on Infants and Children based on EU Menu methodology (OC/EFSA/DATA/2016/02 CT3) were used. The sample included 476 children, aged 6 to under 10 years. Results: Results indicated that one in four children was overweight or obese (27.7%). In total, the mean energy intake was 1598.4 ± 380.3 kcal/day, with 30.7% of the children above the recommended energy intake. Cereals, cereal products, and potato food category were the primary sources of energy, which is in line with the recommendations, with protein and fat intakes exceeding recommended levels. Substantial contribution of sweets and low contribution of fruits and vegetables were observed across all BMI categories, with the difference in energy contribution of fruits (p = 0.041) and vegetables (p = 0.033). The meat, poultry, fish, and eggs category were the contributors to energy intake from protein and fat, in the majority of BMI groups. Conclusions: In the obese group, higher energy intake from certain food subgroups was recorded, stressing the need for a more detailed dietary assessment. The study’s cross-sectional design limits causal inferences, indicating a need for future longitudinal research to better understand the dynamics of dietary patterns and BMI status in primary school children. Full article

Background: The SI.Menu study offers the latest data on the dietary intake of Slovenian adolescents aged 10 to 17. The purpose of this study is to comprehensively assess their dietary intake (energy and nutrients) and compare their food intakes with dietary recommendations for healthy and sustainable diets. Methods: The cross-sectional epidemiological dietary study SI.Menu (March 2017–April 2018) was conducted on a representative sample of Slovenian adolescents aged 10 to 17 years (n = 468) (230 males and 238 females). Data on dietary intake were gathered through two non-consecutive 24 h recalls, in line with the European Food Safety Authority (EFSA) EU Menu methodology. The repeated 24 h Dietary Recall (HDR) and Food Propensity Questionnaire (FPQ) data were combined to determine the usual intakes of nutrients and food groups, using the Multiple Source Method (MSM) program. Results: Adolescents’ diets significantly deviate from dietary recommendations, lacking vegetables, milk and dairy products, nuts and seeds, legumes, and water, while containing excessive meat (especially red meat) and high-sugar foods. This results in insufficient intake of dietary fibre, and nutrients such as vitamin D, folate, and calcium. Conclusions: The dietary intake of Slovenian adolescents does not meet healthy and sustainable diet recommendations. This study provides an important insight into the dietary habits of Slovenian adolescents that could be useful for future public health strategies. Full article

Background and objectives: Increasing rates of adult overweight (60.7% population) and diet-related cardiovascular diseases (52% population) in Serbia alarmingly call for a change in dietary patterns. To be able to identify problems and solutions, harmonized and comparable food consumption data are needed. The European Food Safety Authority (EFSA) provided support and guidance, through the EU Menu program, for conducting the Serbian National Food Consumption Survey on adults from 10 to 74 years old, including pregnant women and vegetarians in the period of 2017–2022. This work gives an overview of the quantity, energy intake, and distribution across different food groups, which are all basic parameters of dietary patterns, aiming at comparing the actual diet with recommendations—the EAT Lancet Commission Report. Methods: Food consumption data were collected from 3018 participants: 856 adolescents aged 10–17 years, 1155 adults aged 18–64 years, 581 elderly subjects aged 65–74 years, 145 pregnant women, and 281 vegetarians, using two inconsecutive days repeated 24 h dietary recall. The advanced nutritional software, Diet Assess and Plan (DAP), was applied for data storage, processing, and reporting, while the Serbian Food composition database was used as a resource for food composition information of the foods and recipes consumed in the survey. Results: In the adult population, quantitatively, the most consumed foods are as follows: vegetable and vegetable products (312 g/day), milk and milk products (247.7 g/day), fruit and fruit products (245.7 g/day), grain and grain products (215.8 g/day), and meat and meat products (166.08 g/day). Liquids—water and non-milk beverages—were consumed 1511 g/day on average. However, the mean distribution of energy intake differs significantly. The main source of energy comes from grain and grain products (637.5 kcal/day (29.3%TE)), meat and meat products (355.4 kcal/day (16.3%TE)), fats and oils (271 kcal/day (12.4%TE)), and milk and milk products (261.3 kcal/day (12%TE)). Discussion: The energy distribution and consumed quantities of some food groups indicate that actual diet, comprised of processed grains, meat, and fatty food, is not meeting reference healthy diet recommended in EAT Lancet Commission Report, and present a risk factor for the development of overweight, obesity, and diet-related cardiovascular diseases in the Serbian population. Full article

Celiac disease is a systemic autoimmune disease that occurs in genetically predisposed individuals and means a lifelong intolerance to gluten, which is found in wheat, barley, rye and oats, and leads to inflammatory changes in the lining of the small intestine. This is not a rare disease; it occurs in about 1% of the population. Recently, there has been a noticeable increase in the number and assortment of gluten free foods, which is marked with a crossed grain symbol or “gluten free” wording. The labeling, presentation and content of gluten in food intended for people intolerant to gluten is prescribed by the EU Regulation 828/2014 which has been harmonized in Serbian regulation. Gluten content not exceeding 20 mg/kg or 100 mg/kg justifies “gluten free” and “very low gluten” claims, respectively. The aim of this study was to assess gluten content in grain-based “gluten free” foods. Sixty samples of various grain-based food products (flour, bread, pasta, breakfast cereals and snacks, mainly made from corn, rice, buckwheat and millet) were analyzed using a commercially available sandwich ELISA test RIDASCREEN^® Gliadin (R-Biopharm AG, Darmstadt, Germany). Gluten was not detected (<5.0 mg/kg) in 75% of the samples, 10% had gluten content up to 20 mg/kg, while 8% slightly exceeded the limit for gluten free products (22.0–24.0 mg/kg), which could be tolerated taking into account measurement uncertainty. One flour (52.0 mg/kg), one snack (58.0 mg/kg) and one pasta sample (96.6 mg/kg) had gluten concentrations at the levels requiring “low gluten content” product labeling instead of “gluten free” displayed on their packages. Furthermore, one snack product reached 196 mg/kg of gluten. The labeled composition of this product did not indicate the presence of raw materials that are natural sources of gluten. If true, this implicates cross contamination. The presented results indicate that there is a need for continuous education and rise of awareness among producers of gluten free food as well as improved efficiency of market control. Although the restaurants that offer a gluten free menu are nowadays a rarity in Serbia, they too should be included in control programs. Full article

Tracking food intakes using a mobile app can be an effective approach for some individuals, but it is crucial to consider their personal preferences and health status before adopting this method. Personalized nutrition apps can also serve as an efficient tool for collecting, analysing, and reporting dietary data to support dietary surveys, such as EU Menu by the European Food Safety Authority (EFSA). However, developing an easy-to-use and efficient app requires several essential components. This work presents the insights gained during the development of Eatvisor, a personalized nutrition mobile app. In Slovenia, there was a lack of such tools tailored to national food choices, dietary habits, and recommendations. The app utilizes a food composition database (FCDB) developed in Slovenia; however, the database had many missing compositional data for generic and branded foods. To address this issue, an in-house database management system (DBMS) was developed to support the compilation of different types of data from various sources, such as foreign FCDBs, GS1 Global Data Synchronisation Network (GDSN), database of waste streams, and crowdsourcing, while adhering to the food standards of CEN and respecting the FAIR (Findable, Accessible, Interoperable, Reusable) principles. It is worth emphasizing that compiling a FCDB is a complex task that requires up-to-date knowledge and technical solutions to streamline and expedite the process. Specifically, the DBMS was integrated with semantic resources for organizing knowledge about food (FNS-Harmony ontology linked with FoodOn), as well as food-related regulatory issues. Additionally, methodologies were developed to support missing data imputation in a semi-automated way, and DBMS was designed to manage missing dietary recommendations in a machine-readable format. Moreover, DBMS allows collecting and linking data and knowledge required for personalized advising, including food composition data, biomarker reference intervals, and tailored dietary advice, for both domain experts and machines. Finally, this work evaluates DBMS from the perspective of the data and knowledge required for the development of a personalized nutrition mobile app, such as Eatvisor. The results suggest that DBMS can effectively support the development of a personalized nutrition app, and the methods used can serve as a framework for developing similar apps in other regions. Full article

Harmonized and standardized collection, processing, and analysis of individual dietary data is essential for nutrition assessment and informed policy decision making. To underpin the harmonization of food consumption data collection methodologies and the development of a common, comprehensive European food consumption database, the European Food Safety Authority (EFSA) supported 36 child and/or adult dietary surveys in 18 EU Member States and four Balkan pre-accession countries through the EU Menu Project. Given the lack of relevant and harmonized research and data on food and nutrition in the Balkan region, CENM-IMR and CAPNUTRA scientists focused their activities on capacity building in nutrition research, particularly on the creation of a contemporary, harmonized research infrastructure (RI) that meets European standards. The EFSA EU Menu methodology has been implemented in the Balkans through the adaptation and use of an innovative, comprehensive tool for the standardized collection of food consumption and dietary intake assessment data, the Diet Assess and Plan (DAP). DAP has the essential features of an RI needed to strengthen public health surveillance, monitoring, evaluation, and nutrition research; this is a unique example of a standardized and harmonized tool for assessing dietary intake, i.e., collecting data on food and nutrition in the Balkan region and beyond. It is a concurrent tool for large-scale nutritional epidemiological studies and represents one of the new technologies for dietary intake assessment. National dietary surveys were conducted from 2017 to 2023 among adults aged 10 to 74 years (in Bosnia and Herzegovina, Montenegro, and Serbia) and children aged three months to nine years (in Montenegro, North Macedonia, and Serbia). The collected data on food consumption are internationally comparable with other European countries under the EU Menu Program. The data collected will be used for dietary and exposure risk assessment, establishment of national nutrient reference values, as a basis for the development of food-based dietary guidelines, a tool to provide evidence and infrastructure for public health nutrition policy decisions, and for tailored pathways to transform the food system in the Balkans towards a more nutrition-sensitive and sustainable system. Full article

The Serbian National Food Consumption Survey on adults from 10 to 74 years old, including pregnant women and vegetarians, was conducted in compliance with the EFSA EU Menu project support and guidance from 2017 to 2022. Valid data were collected from a total of 3018 participants with 856 adolescents aged 10 to 17 years, 1155 adults aged 18 to 64, 581 elderly subjects aged 65 to 74 years, 145 pregnant women, and 281 persons following a vegetarian diet. Data collection was conducted using a national Survey Pack designed for the project, including the following: a general questionnaire, an age-appropriate Food Propensity Questionnaire, an International Physical Activity Questionnaire, and 24 h dietary recall. The advanced nutritional platform Diet Assess and Plan (DAP) was applied for data storage, processing, and the creation of the final dataset for transfer to EFSA. The Serbian food composition database was used and updated during the project as a resource of food information for all foods and recipes that were consumed by the study cohort. Regardless of age and gender category, the majority (56%) of adults had normal weight according to the Body Mass Index, while 21% were overweight, and 15.5% were underweight. The average daily energy intake was 2178.72 kcal, while overall contributions of carbohydrates, protein, and fat to the total energy intake were 43.37%, 15.47%, and 41.16%, respectively. The proportions of macronutrient intake deviated from the dietary reference values, particularly for fat, which was often too high, where sunflower oil was the major source of fat in diets. Out of the 3018 participants, 98% had breakfast, 99% had lunch, and 95% had dinner, while approx. 80% had snacks between main meals. The highest energy intake was recorded during lunch, 706.5 kcal (32% TE). The survey results provide valuable insight into the nutritional status and dietary habits of adults from 10 to 74 years old living in Serbia. The Serbian food consumption database serves as an evidence platform for decision-making processes in public health nutrition policies and strategies, diet monitoring, exposure risk assessments, and interventions targeting identified nutritional challenges in particular population groups. Harmonized data are part of the EFSA comprehensive food consumption database. Full article

Salt intake above 5 g/day correlates with prevalence of hypertension and cardiovascular diseases (CVD). CVD, the leading cause of mortality and morbidity in Europe, account for 45% of all deaths, while, in Serbia in 2021, CVD accounted for 47.3%. The objective was to investigate salt content labelled on meat products from the Serbian market and estimate dietary exposure to salt from meat products in the Serbian population using consumption data. Data on salt content were collected from 339 meat products and classified in eight groups. Consumption data were collected using the EFSA EU Menu methodology (2017–2021) from 576 children and 3018 adults (145 pregnant women) in four geographical regions of Serbia. The highest salt content was in dry fermented sausages and dry meat, average 3.78 ± 0.37 g/100 g and 4.40 ± 1.21 g/100 g, respectively. The average intake of meat products is 45.21 ± 39.0 g/day and estimated daily salt intake from meat products per person is 1.192 g, which is 24% of the daily recommended amount. The actual meat product consumption and content of salt in meat products in Serbia present a risk factor for development of CVD and related comorbidities. A targeted strategy, policy and legislation for salt reduction are needed. Full article

Inadequate iron intake and iron deficiency are recognised as a public health problem in the population at large, and particularly in specific subpopulations. Dietary iron intake was analysed using data of the national Slovenian food consumption study, SI.Menu (n = 1248 subjects; 10–74 years), while iron status was evaluated with laboratory analyses of blood haemoglobin, serum ferritin, and iron concentration in samples, collected in the Nutrihealth study (n = 280, adults). The estimated daily usual population-weighted mean iron intakes ranged from 16.0 mg in adults and the elderly to 16.7 in adolescents, and were lower in females for all three age groups. The main dietary iron sources in all the age groups were bread and bakery products, meat (products), fruit, and vegetables. The highest prevalence of haemoglobin anaemia was observed in females aged 51–64 years (6.7%). Critically depleted iron stores (ferritin concentration < 15 µg/L) were particularly found in premenopausal females (10.1%). Factors influencing low haemoglobin, ferritin, and iron intake were also investigated. We observed significant correlations between iron status with meat and fish intake, and with iron intake from meat and fish, but not with total iron intake. We can conclude that particularly premenopausal females are the most fragile population in terms of inadequate iron intake and iron deficiency, which should be considered in future research and public health strategies. Full article

Incomparable and insufficiently detailed information on dietary intakes are common challenges associated with dietary assessment methods. Being a European Union country, Slovenia is expected to conduct national food consumption studies in line with harmonised EU Menu methodology. The present study aimed to describe the methodology and protocols in the Slovenian nationally representative dietary survey SI.Menu 2017/18, and to assess population dietary habits with respect to food consumption and energy and macronutrient intakes. While the study targeted various population groups, this report is focused on adults. A representative sample of participants was randomly selected from the Central Register of Population according to sex, age classes and place of residency, following a two-stage stratified sampling procedure. Information on food consumption was collected with two non-consecutive 24-h dietary recalls using a web-based Open Platform for Clinical Nutrition (OPEN) software. Data were complemented with a food propensity questionnaire to adjust for usual intake distribution. Altogether, 364 adults (18–64 years) and 416 elderlies (65–74 years) were included in the data analyses. Study results highlighted that observed dietary patterns notably differ from food-based dietary guidelines. Typical diets are unbalanced due to high amounts of consumed meat and meat products, foods high in sugar, fat and salt, and low intake of fruits and vegetables and milk and dairy products. Consequently, the energy proportion of carbohydrates, proteins, and to some extent, free sugars and total fats, as well as intake of dietary fibre and total water deviates from the reference values. Age and sex were significantly marked by differences in dietary intakes, with particularly unfavourable trends in adults and men. Study results call for adoption of prevention and public health intervention strategies to improve dietary patterns, taking into account population group differences. In addition, all developed protocols and tools will be useful for further data collection, supporting regular dietary monitoring systems and trend analyses. Full article

The Serbian Food Consumption Survey among 1–9-year-old-children was conceptualized and conducted in compliance with the principles, established protocols, and guidelines of the EU Menu project between 2017 and 2021. Valid data were collected for 576 individuals (290 1–3-year-old toddlers and 276 3–9-year-old children). Regardless of age and gender category, the majority (68.80%) of children had normal weights according to the Body Mass Index-for-age classification system. The median daily energy intake was 1406.71 kcal with no differences between the settlement types. The overall median contributions of carbohydrates, protein, and fat to the total energy intake were 47.54%, 14.06%, and 37.88%, respectively. The proportions of the macronutrient intake deviated from the dietary reference values with compliance to the recommendations being particularly poor for fat and fiber. The consumption of energy-dense food groups such as meat and meat products, fat and oil, sugar, and confections was more pronounced among older children. The survey results provide a valuable insight into the nutritional status and dietary habits of toddlers and children 1–9 years old living in Serbia. They may serve as an evidence platform for public health programs, a valuable asset for decision-makers, and a reliable reference to guide nutritional policies, diet monitoring, and interventions targeting this population group in the future. Full article

Vitamin B12 deficiency poses a health concern, especially in vulnerable populations. Dietary vitamin B12 intake was obtained by two 24 h dietary recalls and food propensity questionnaires in a representative Slovenian cross-sectional food consumption survey, SI.Menu (n = 1248 subjects; 10–74 years). For a subgroup of 280 participants, data on serum vitamin B12 were available through the Nutrihealth study. The estimated usual population-weighted mean daily vitamin B12 intakes were 6.2 µg (adults), 5.4 µg (adolescents), and 5.0 µg (elderly). Lower intakes were observed in females. Inadequate daily vitamin B12 intake (<4 µg) was detected in 37.3% of adolescents, 31.7% of adults, and 58.3% elderlies. The significant predictors for inadequate daily vitamin B12 intake were physical activity score in all age groups, sex in adolescents and adults, financial status and smoking in elderly, and employment in adults. Meat (products), followed by milk (products), made the highest vitamin B12 contribution in all age groups. In adolescents, another important vitamin B12 contributor was cereals. The mean population-weighted serum vitamin B12 levels were 322.1 pmol/L (adults) and 287.3 pmol/L (elderly). Low serum vitamin B12 concentration (<148 nmol/L) and high serum homocysteine (>15 µmol/L) were used as criteria for vitamin B12 deficiency. The highest deficiency prevalence was found in elderlies (7.0%), particularly in males (7.9%). Factors associated with high serum homocysteine were also investigated. In conclusion, although vitamin B12 status was generally not critical, additional attention should be focused particularly to the elderly. Full article