Assessment of dietary intake in

Różnice w zdrowiu w populacji Polski 29 września 1 października211 Warszawa Health differences in Polish population 29 September 1 October 211 Warsaw, Poland Assessment of dietary intake in Polish population: PONS study

Różnice w zdrowiu w populacji Polski 29 września 1 października211 Warszawa Health differences in Polish population 29 September 1 October 211 Warsaw, Poland Authors: Rafał Ilow - Department of Food Science and Dietetics, Wrocław Medical University, 1 Nankiera St., 5-14 Wroclaw, Poland Bożena Regulska-Ilow, Dorota Różańska - Department of Dietetics, Wrocław Medical University, 34 Parkowa St., 51-616 Wrocław, Poland Katarzyna Zatońska - Department of Social Medicine, Wrocław Medical University, 44 Bujwida St., 5-345 Wroclaw, Poland Mahshid Dehghan, Xiaohe Zhang - Population Health Research Institute, Department of Medicine, McMaster University, Hamilton, Canada Andrzej Szuba - Department of Internal Medicine, Wrocław Medical University, 213 Borowska St., 5-556 Wroclaw, Poland Lars Vatten - The Norwegian University of Science and Technology, Faculty of Medicine, Department of Public Health, University Medical Center 97476788, 7491 Trondheim, Norway Marta Mańczuk, ń Witold Zatoński ń - The Maria Skłodowska-Curie Cancer Center and Institute of Oncology, Department of Cancer Epidemiology and Prevention, 5 Roentgena St., 2-781 Warsaw, Poland

INTERHEART, S. Yusuf et al. Lancet 24, 364, 937-952 2

Materials and Methods Daily energy, macro, and micro-nutrients intakes were estimated using Food Frequency Questionnaire (FFQ) PONS FFQ was constructed based on a previously developed and validated FFQ for the Poland arm of PURE study PONS FFQ included d 55 items A nutrient food database was constructed based on USDA and Poland s food composition table Daily intake of 43 nutrients was calculated Daily intake of foods and nutrients was computed at Population Health Research Institute (PHRI) at McMaster University, Hamilton, Canada 3

Study population Overall, 3862 men and women (129 men and 2572 woman) aged 45 to 64 years from świętokrzyskiei t k ki voivodeship enrolled in the study Urban/Rural participants were; 268 urban inhabitants (894 men and 1786 women) 1182 rural inhabitants (396 men and 786 women) Mean (SD) age was: Men 55.8 (5.4) y.o. Women 55.5 (5.3) y.o. Urban 56.1 (5.2) y.o. Rural 54.3 (5.3) y.o. 4

Results 5

Nutrient Unit Daily nutrient intake Urban Rural Men Women Men Women Mean (SD) Mean (SD) Mean (SD) Mean (SD) Energy kcal 14 (422) a, b 138 (454) a 1375 (395) 131 (359) b Protein g/day 62.2 (19.) a 6.4 (22.1) 59.7 (16.5) 58.1 (16.5) a Fat g/day 51.8 (19.3) a, b 46.3 (19.1) a, c 5.6 (16.7) c, d 46.4 (15.7) b, d SFA g/day 16.9 (6.4) a, b 15.6 (6.4) a, c 16.8 (5.8) c, d 15.6 (5.5) b, d MUFA g/day 19.1 (7.8) a, b 16.6 (7.4) a, c 18.7 (6.4) c, d 16.6 (5.9) b, d PUFA g/day 9.5 (4.) a, b 8.1 (3.8) a, c 9.1 (3.4) c, d 8.1 (3.) b, d Cholesterol mg/day 226.7 (99.7) a, b 24.7 (99.8) a, c 224.6 (8.8) c, d 2.3 (75.1) b, d Carbohydrate g/day 176.6 (56.2) a, b 168.3 (61.5) a 175.5 (57.4) 168.5 (5.4) b Fiber g/day 16.3 (5.8) 16.3 (7.2) 16.2 (5.6) 16.1 (5.2) 6

Comparing estimated daily energy intake between PONS and PURE studies 25 288,5 2 1334,8 kc cal/d 15 1 5 Energy PONS PURE 7

Comparing estimated daily macro-nutrients intake between PONS and PURE studies 3 281,5 25 2 171, g/d 15 1 6,3 78,3 75,4 48, 5 protein fat carbohydrate PONS PURE 8

Daily mineral intake Mineral Mean (SD) Urban Rural Men Women Men Women % of % of % of % of Mean (SD) participants Mean (SD) participants Mean (SD) under EAR under EAR participants under EAR participants under EAR Calcium mg 665.8 (278.) 92.7% 76.8 (318.5) 91.3% 648.8 (258.5) 92.9% 696.4 (278.2) 9.7% Iron mg 15.4 (6.5).% 13.8 (6.1).% 15.2 (5.4).% 13.9 (4.3).% Magnesium mg 221.7 (69.2) 9.7% 222.8 (82.9) 67.7% 211.3 (61.) 93.9% 216.1 (59.6) 69.8% Phosphorus mg 91.9 (297.6) 6.5% 926.5 (354.3) 6.3% 86.9 (266.7) 8.6% 893. (28.2) 5.6% Potassium mg 247 (764) 96.6% 2512 (965) 96.7% 2417 (671) 99.2% 2465 (672) 98.3% Sodium mg 2594 (911) 2.7% 2296 (869) 6.8% 2521 (731) 2.% 2314 (658) 4.8% Zinc mg 7. (2.3) 79.4% 6.8 (2.5) 43.7% 6.7 (2.) 83.1% 6.6 (1.9) 47.2% Copper mg 2.1 (1.6).7% 1.8 (1.) 2.3% 2.1 (1.).3% 1.9 (.9) 1.4% Selenium µg 83.4 (28.3) 3.4% 77.3 (31.3) 4.7% 77.7 (25.2) 3.5% 72.9 (23.6) 5.6% EAR Estimated Average Requirement 9

Daily vitamin intake Urban Rural Men Women Men Women Vitamin Mean (SD) % of participants under EAR Mean (SD) % of participants under EAR Mean (SD) % of participants under EAR Mean (SD) % of participants under EAR Vit. C mg 81.5 (47.4) 4) 48.1% 84.7 (57.4) 34.7% 77.1 (4.) ) 46.5% 81.4 (43.3) 3) 35.5% 5% Vit. B 1 mg 1.3 (.4) 27.5% 1.1 (.5) 19.7% 1.2 (.4) 31.8% 1.1 (.4) 18.7% Vit. B 2 mg 1.5 (.6) 11.3% 1.6 (.6) 4.3% 1.5 (.5) 14.4% 1.5 (.5) 3.2% Vit. B 3 mg 18.7 (6.) 54% 5.4% 17.5 (6.7) 47% 4.7% 18. (4.9) 43% 4.3% 17. (4.6) 31% 3.1% Vit. B 5 mg 3.7 (1.3) 79.4% 3.8 (1.5) 77.7% 3.5 (1.1) 81.1% 3.7 (1.2) 77.6% Vit. B 6 mg 1.6 (.6) 26.4% 1.6 (.7) 24.% 1.5 (.5) 27.5% 1.5 (.5) 19.5% Folate total µg 283 (94.6) 57.2% 271 (12.4) 66.3% 271 (85.3) 65.2% 265 (8.2) 67.3% Vit. B 12 µg 5.9 (7.) 9.1% 5.6 (4.2) 8.1% 5.6 (3.8) 1.9% 5.8 (4.8) 8.% Vit. A IU 8452 (4513) - 9627 (7185) - 8459 (3533) - 9194 (453) - Vit. A µg_ RAE 882 (733) - 913 (573) - 859 (45) - 913 (497) - Vit. E mg 5.4 (2.3) 93.2% 5. (2.4) 88.8% 5.1 (2.) 96.2% 4.9 (1.8) 89.2% EAR Estimated Average Requirement 1

Percentage of energy from macronutrients: PONS study Men Urban Women Urban 45,9% 17,9% 46,4% 18,7% 33,% 31,7% Men Rural Women Rural 46,1% 17,6% 46,9% 18,% 33,1% 31,9% protein fat carbohydrate protein fat carbohydrate 11

Comparing % energy from macronutrients between PONS and PURE studies PONS PURE 46,4% 18,2% 15,1% 48,1% 32,2% 32,1% protein fat carbohydrate protein fat carbohydrate 12

Daily intake of nutrients by sex 13

Daily intake of total fat and fatty acids by sex 6 51,4 5 46,3 g/d 4 3 16,9 15,6 18,9 16,6 2 94 9,4 81 8,1 1 Lipid Total total fat SFA MUFA PUFA Men Women For all comparisons P<.1 14

Daily intake of protein and carbohydrate by sex 61,4 59,7 176,2 168,3 6 18 16 5 14 g/d 4 g/d 12 1 3 8 2 6 4 1 2 Protein For all comparisons P<.1 Men Women Carbohydrate Men Women 15

Daily intake of minerals by sex 275 25 2571,5 16 231,8 14 15,4 13,9 225 2 12 175 1 mg/d 15 125 mg/d 8 6,9 6,7 1 75 5 25 66,6 73,6 6 4 2 2,1 1,9 Calcium Sodium For all comparisons P<.1 Men Women Iron Zinc Copper Men Women 16

Daily intake of water-soluble vitamins by sex 2 18 18,5 17,4 Women Men 16 14 mg/d 12 1 8 6 4 2 1,3 1,1 3,6 3,8 1,6 1,6 Vitamin B1 Vitamin B3 Vitamin B5 Vitamin B6 For all comparisons P<.1 17

Daily intake of water-soluble vitamins by sex 9 8,1 83,7 279,3 3 269,3 8 25 7 mg/d 6 5 4 µg/d 2 15 3 1 2 1 5 Vitamin C Folate totalt Men Women Men Women For all comparisons P<.5 18

Daily intake of fat-soluble vitamins by sex 9495 5,4 1 8454 5,5 4,9 9 5, 8 45 4,5 7 4, 6 3,5 5 3, 2,5 4 2, 3 1,5 2 1, 1,5, Vitamin A Vitamin E Men Women Men Women For all comparisons P<.1 19 IU/d mg/d

Daily nutrient ti tintake by age 2

Daily intake of total fat and fatty acids by age 5 45 4 35 49,9 46,7 45-54 y.o. 55-64 y.o. 3 g/d 25 2 16,6 18,1 15,6 16,9 15 1 5 8,9 8,3 For all comparisons P<.1 Fat SFA MUFA PUFA 21

Daily intake of protein and carbohydrate by age 61,2 59,6 175,2 168, 6 18 16 5 14 g/d 4 g/d 12 1 3 8 2 6 1 4 2 Protein For all comparisons P<.5 45-54 y.o. 55-64 y.o. Carbohydrate 45-54 y.o. 55-64 y.o. 22

Daily intake of some minerals by age 7 6 76 678 6,9 6,7 45-54 y.o. 7, 55-64 y.o. 6, 5 5, mg/d 4 mg/d 4, 3 2 3, 2, 2, 1,9 1 1, Calcium For all comparisons P<.5, Zinc Copper 23

Daily intake of some vitamins by age 18, 17,5 9 8 7 85,6 8,4 18, 16, 14, 6 12, mg/d 5 4 mg/d 1, 8 8, 3 6, 2 1 4, 2, 12 1,2 12 1,2, Vitamin C Vitamin B1 Vitamin B3 45-54 y.o. 55-64 y.o. For all comparisons P<.1 24

Daily intake of nutrients and level of education 25

Daily intake of macronutrients by level of education * 1 vs 2 173,4 17,7 171,5 18 163, 16 14 12 g/d 1 8 6 4 2 55,7 * 1 vs 2, 3, 4 * 59,4 6,5 61,3 45,4 1 vs 2, 4 48,9 47,7 48,6 protein fat carbohydrate primary (1) trade (2) secondary (3) university (4) 26

Daily intake of fatty acids by level of education 22 2 18 16 15,2 * 1 vs 4 * 16,1 15,9 16,3 * 2 vs 1, 3 17,9 16,5 17,2 17,6 g/d 14 12 * 2 vs 1, 3, 4 1 83 8,3 8,9 85 8,5 85 8,5 8 6 4 2 SFA MUFA PUFA primary (1) trade (2) secondary (3) university (4) 27

Daily intake of magnesium and sodium by level of education 25 2 * 4 vs 1, 2, 3 * 1 vs 3 * 2 vs 1, 3, 4 225 7 3 24,2 216,1 219,6 225,7 25 2316,5 2488,1 2394, 2349,4 mg/y 15 1 mg/d 2 15 1 5 5 magnesium sodium primary (1) trade (2) secondary (3) university (4) 28

Daily intake of Vitamin C by level of education 9 8 71,2 77,1 81,88 88,7 * 4 vs 1, 2, 3 * 1 vs 3 7 mg/d 6 5 4 3 2 1 vitamin C primary (1) trade (2) secondary (3) university (4) 29

Nutrients hypertension & hypercholesterolemia 3

Daily sodium intake in normotensive and hypertensive participants p <.1 p <.1 3 2316,7 2291,11 2559,1 2577,1 25 (mg g/d) 2 15 1 p >.5 p >.5 5 women men normotensive hypertensive 31

Comparison of PUFA/SFA (P/S) and % energy from PUFA to total blood cholesterol level 6,6,57,55 6, 5,8 5,7,5 5,,4 4,,3 3,,2 2,,1 1,, P/S < 19 mg% 19 mg% PUFA: Polyunsaturated Fatty Acids SFA: Saturated Fatty Acids For all comparisons P<.1, % energy PUFA < 19 mg% 19 mg% 32

Comparison of PUFA/SFA and % energy intake from PUFA to blood LDL level,56,55 5,8 5,7,6 6,,5 5,,4 4,,3 3,,2 2, 1,1 1,, PUFA/SFA, % energy PUFA < 115mg% 115mg% < 115mg% 115mg% For all comparisons P<.5 33

Conclusions Some participants had lower intake of energy, macronutrients, minerals and vitamins i than Polish recommendations Gender, age and level of education had a significant impact on dietary macronutrient intake Place of residence had no significant influence on dietary macronutrient intake We observed significant differences on daily intake of some vitamins and minerals by gender, age, level of education, and place of residence 34