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German food composition database for dietary evaluations in children and adolescents
ARTICLE IN PRESS JOURNAL OF FOOD COMPOSITION AND ANALYSIS Journal of Food Composition and Analysis 20 (2007) 63–70 www.elsevier.com/locate/jfca
Report
German food composition database for dietary evaluations in children and adolescents Wolfgang Sichert-Hellert, Mathilde Kersting, Christa Chahda, Ruth Scha¨fer, Anja Kroke1 Forschungsinstitut fu¨r Kindererna¨hrung, Rheinische Friedrich-Wilhelms-Universita¨t, Bonn, D-44225 Dortmund, Heinstu¨ck 11, Germany Received 8 March 2006; received in revised form 30 May 2006; accepted 31 May 2006
Abstract Dietary assessment and evaluation in infancy and childhood is of nutritional importance, of specific interest in the prevention of chronic diseases in later life, and Food Composition Databases (FCDB) are an important prerequisite, in particular FCDB that include a large variety of commercial, composite food products. We therefore developed a FCDB known as LEBTAB, which contains foods consumed by infants, children and adolescents in Germany. LEBTAB is divided into 23 basic food groups and currently contains a total of about 6000 items: 936 basic food items and more than 5000 commercial brands/composite foods, of which 27% are infant foods. Commercial food products have a total of 47,500 data entries for various ingredients. In contrast to many other FCDB, the nutrient content (38 nutrients) of commercial food products is calculated by way of a recipe simulation process using listed ingredients, and includes information on fortified nutrients. Children in Germany today consume predominantly commercial food products; knowledge of the ingredients, fortification or nutrient content of these foods is of particular interest. Unfortunately, only limited information on the composition of commercial food products is available. Therefore, the recipe simulation procedure based on information from food labels or manufacturers helps to overcome these shortcomings. In addition, in order to analyse changes in nutrient intake over time, the tracking of modifications made to food items is a necessary special feature of those FCDB which aim to keep up with the rapidly changing food market. r 2006 Elsevier Inc. All rights reserved. Keywords: Food composition database FCDB; Commercial food products; Infant food; Infants; Children; Adolescents
1. Introduction Dietary assessment and evaluation in childhood is of particular nutritional importance and of specific interest in the prevention of chronic diseases in later life, and at the same time challenging for methodological considerations. Nutritional requirements and food patterns change more during infancy and childhood than later in life. Moreover, both Abbreviations: DONALD, Dortmund Nutritional and Anthropometric Longitudinally Designed Study; FCDB, food composition databases; LEBTAB, food and nutrient database in DONALD Corresponding author. Tel.: +49 231 79 22 10 14; fax: +49 231 71 15 81. E-mail address: [email protected] (W. Sichert-Hellert). 1 WS-H analyzed the data, drafted, and edited the manuscript. CC and RS did the recipe simulations and were responsible for the data entry. MK and AK contributed significantly to the discussion and to the critical revision of the manuscript. 0889-1575/$ - see front matter r 2006 Elsevier Inc. All rights reserved. doi:10.1016/j.jfca.2006.05.004
dietary habits and the composition of basic and commercial food products also change with time. For instance, the composition of commercial foods for infants and young children has been influenced by European food regulations. Convenience foods and eating outside the home (fast food) often replace traditional homemade foods. To assess energy and nutrient intake, whether for later comparison with recommendations, or for investigating associations with biochemical parameters or anthropometric measurements, a database that stores information on the food items consumed and their nutrient content, as well as on changes in the composition of these foods over time, e.g., changes in the fortification of breakfast cereals for children, is needed. In the DOrtmund Nutritional and Anthropometric Longitudinally Designed (DONALD) Study (Kroke et al., 2004), which began in 1985, dietary intake in healthy infants, children and adolescents is measured using 3-day weighed dietary records. To evaluate the effect of age and
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time trends on food and nutrient intake, a specific food and nutrient database named LEBTAB has been developed. Here, we present a report on establishing and maintaining this database and give examples of results from dietary analyses carried out with the present version. 2. Methods 2.1. Food consumption measurement The DONALD Study is a longitudinal (open cohort) study collecting detailed data on diet, metabolism, growth and development in healthy subjects between infancy and adulthood (3 month–18 years), every 3 months in the first year of life, every six months in the second year and every twelve months thereafter. The DONALD Study is exclusively observational and non-invasive as approved by the International Scientific Committee of the Research Institute of Child Nutrition. Details of the study have been described elsewhere (Kroke et al., 2004). The parents of the infant and child participants, or the older subjects themselves, keep 3-day weighed dietary records, i.e., weigh and record all foods and fluids consumed, as well as
leftovers, using electronic food scales provided by the Institute. Ingredients for composite dishes are recorded separately, e.g., potatoes, carrots, meat and oil for a homeprepared baby food dish, or breakfast cereal (‘‘7-fruit’’, fortified, Kellogg), milk and raw apple for breakfast. Product information on packaging, labels, etc., as well as information on any supplements (tablets, pills) consumed, are also collected and evaluated with the dietary records by the study’s dieticians. In particular, information on the type and amount of ingredients, nutrient information and fortification is used to simulate recipes and to generate data on the nutrient content of commercial food products. 2.2. Database structure The basic features of LEBTAB originated as a computer program written in FORTRAN programming language in 1985 (PERKIN ELMER COMPUTER with RELIANCE database program). This was modified and enhanced over time to an ORACLEs database. SASs procedures (Version 8.02) were used to access the data for further evaluation. A 4-digit alphanumeric code identifies each item in the database in a hierarchical order (Table 1),
Table 1 Main food groups in LEBTAB, number, and percentages of items within food groups First placeholder
Food group
A B C D E
Dairy products: milk, yoghurt, etc. Dairy products: cheese Egg products Meat products, sausages Fish and shellfish products Animal origin: subtotal
F G H I K L M N
N
%
275 113 14 232 106 740
4.6 1.9 0.2 3.9 1.8 12.4
Fats and oils Cereal grains, breakfast cereals, pasta Baked products: breads, bread rolls, etc. Baked products: cakes, biscuits, etc. Potato products Vegetable products Fruit products, nuts Juices Plant origin: Subtotal
149 453 470 322 43 149 119 139 1844
2.5 7.6 7.9 5.4 0.7 2.5 2.0 2.3 30.9
O P Q Z
Beverages Sweets Soups, sauces, gravy Fast food Others: Subtotal
542 423 216 366 1547
9.1 7.1 3.6 6.1 25.9
U Y
Dietary supplements (per 100 g) Dietary supplements (per capsule/tablet) Supplements: subtotal
27 191 218
0.5 3.2 3.7
S T V W
Baby Baby Baby Baby Baby
194 361 50 1015 1620
3.3 6.1 0.8 17.0 27.1
Total a
Foods for Special Medical Purposes.
food: infant formulae, follow on formulae, FSMPa fruit, vegetables, juices, instant beverages milk-cereal-products mixed dishes: ready to eat food: subtotal
5969
100
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with the food group in position 1, sub-groups in positions 2 and 3, and individual items or brand names in position 4. Specific information about each item is stored for documentation: (a) the date of entry, (b) the manufacturer in the case of commercial products, (c) the former item code in LEBTAB in the case of newer versions of a food item, e.g., due to changes in fortification or reduced fat content and (d) the addition of special ingredients (e.g., artificial sweeteners, pro-, prebiotics, iodized salt). Due to the specific focus on infants and young children in the DONALD Study, the items ‘‘milk’’/‘‘water’’ have multiple entries but identical constituents in LEBTAB, i.e., different codes distinguish whether milk/water is used as a
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drink or in the course of food preparation, for instance for the preparation of bottle feed or cereal milk pap as weaning food. 2.3. Nutrient storage Every food item is described by 14 macronutrients and 24 micronutrients (Table 2), and its energy, monounsaturated fatty acid content, and niacin equivalents are calculated during analyses. The nutrient content of staple foods is taken from standard nutrient tables in the following order of preference: firstly, German food composition data for foods in general (Deutsche Lebensmittelchemie, 2000) and for specific milk products (Renner
Table 2 Example of the nutrient content of a fortified food item (GWQ0 ¼ 7-fruit breakfast cereal with fortified vitamin C, iron, and magnesium) in LEBTAB Value per 100 ga 321 13.0 9.8 0 4.6 0.7 1.9 2.0 2.1 0 59.9 0.1 10.5 3.3 7.2 0 28.8 584 49.0 150 284 8.0 2.4 0.4 2.3 5.5 126 759 2.4 0.39 0.14 0.27 2.6 2.9 75 48.0 0 6.4 1.0 9.2 0 a
Unit kcal g g g g g g g g mg g g g g g g mg mg mg mg mg mg mg mg mg mg mg mg mg mg mg mg mg mg mg mg mg mg mg mg mg
Nutrient
Fortification
b
Energy Water Protein, total Protein, animal Fat, total lipids Fatty acids, total saturated Linoleic acid Fatty acids, total polyunsaturated Fatty acids, total mono-unsaturatedb Cholesterol Carbohydrate, total Added sugars, total Dietary fibre, total Fibre, water-soluble Fibre, non-water-soluble Alcohol, ethyl Sodium Potassium Calcium Magnesium Phosphorus Iron Zinc Copper Manganese Iodine Vitamin A, retinol equivalents Carotene, beta Vitamin E, alpha-tocopherol Thiamin Riboflavin Pyridoxin Niacin Niacin equivalentsb Folate, dietary folate equivalents Vitamin C, total ascorbic acid Vitamin D Vitamin K (phylloquinone) Pantothenic acid Biotin Vitamin B12
Yesc Yesc
Yesc
Edible portion, rounded values, significant digits according to (Greenfield and Southgate, 2003). Calculated [ ¼ protein (g)/6; assuming 6 g protein in a usual diet containing 60 mg tryptophan equivalent to 1 mg niacin equivalent] (DGE, 2002). c See Recipe (Table 3). b
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and Renz-Schauen, 1996) is incorporated. However, almost no food has been completely analysed for all the nutrient constituents required by LEBTAB. The two most commonly missing nutrients are vitamins D and K. Thereafter, the United States (USDA, 2004), Danish (Møller et al., 2002) and British food composition tables (Holland et al., 1992) are consulted for completion of missing values. Finally, nutrient information still missing is imputed from similar food items. LEBTAB does not allow any missing values. The nutrient content of basic food items (e.g., cereals, vegetables, dairy products) is entered into LEBTAB directly, together with the source of the data into the LEBTAB subset ‘‘documentation’’ (Fig. 1). Amounts are given per 100 g edible portion or, in the case of supplements, per ‘‘dose’’, e.g., per pill, capsule, drop or tablespoon.
2.4. Recipe simulation In the case of composite foods, particularly commercial food products (e.g., baby mixed dishes, milk-cereal mixtures for infants, cakes, ice cream, frozen pizza, hamburgers) nutrient constituents are generated by use of recipes or recipe simulation (Schakel et al., 1997). Our dieticians use the labelled ingredients and, if available, labelled nutrient information (Table 3). As the ingredients are listed on the label in decreasing order of their weight in the final product, this sequence allows quantitative estimations of their amounts. Sometimes, an ingredient by itself constitutes a complex food made up of various other ingredients and therefore also requires a recipe. All ingredients enter a specific ‘‘recipe’’ subset of LEBTAB together with the food code (Fig. 1). The estimated/ calculated nutrient content of a food is allowed to deviate from the labelled content by a margin of 75%. For longitudinal analysis of the DONALD Study data, LEBTAB is continuously being updated with any new foods recorded by the participants. A new food or a commercial food product that already exists in the database but has undergone a change in composition (e.g., new ingredients, fortification) leads to a new entry, with a new simulation if necessary and a new food code. Three-monthly back-ups of previous LEBTAB versions are stored. 2.5. Fortification
Fig. 1. Data entry and recipe simulation process in LEBTAB and LEBTAB subsets.
Fortified nutrients are usually mentioned on the product label. However, labelled amounts refer to the total content, i.e., the sum of natural and fortified nutrients present in the food for the duration of the product’s shelf life. In our simulation process, labelled amounts of fortified nutrients
Table 3 Result of a recipe simulation for a fortified food item (GWQ0 ¼ 7-fruit breakfast cereal with vitamin C, iron, and magnesium) Code recipe
Code ingredient
Ingredients item labelled
Amount simulated, g/100 g unless labelled
GWQ0 GWQ0 GWQ0 GWQ0 GWQ0 GWQ0 GWQ0 GWQ0 GWQ0 GWQ0 GWQ0 GWQ0 GWQ0 GWQ0 GWQ0 GWQ0 GWQ0
GCA0 GC40 GC50 GC60 MFE0 MFB0 MFG0 MFH0 GDB0 LCF0 MFA0 MGK0 MGA0 MGC0 JVC0 JMG0 JFE0
Rolled oats Whole wheat, flaked Whole rye, flaked Whole barley, flaked Raisins Dates Apples, dried, sulphurised, uncooked Banana, chips Corn flakes, non-fortified Soybeans, mature seeds, roasted, without salt Apricots, dried, sulphurised, uncooked Sunflower, seed kernels, dried Peanuts, dry-roasted, without salt Hazelnuts, dry-roasted, without salt Vitamin C Magnesium Iron
18.0 16.5 15.0 12.0 10.0 6.0 6.0 6.0 3.0 2.0 2.0 2.0 1.0 0.5 48.0 mga 150.0 mga 8.0 mga
a
Due to fortification labelled amounts are inserted after the recipe has been calculated.
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are treated as ingredients (see, for example, vitamin C, magnesium and iron in Tables 2 and 3). If there is no such data, the manufacturer is asked for additional specifications. As ingredients, fortified nutrients are also stored with their amounts in the ‘‘recipe’’ subset. In case of differences between calculated nutrients from the simulation and labelled nutrient figures, calculated values are overwritten with the labelled ones. Nutrient contents stored in LEBTAB refer to raw ingredients. To account for loss of vitamins during food preparation, standard factors (DGE, 2002) are applied for evaluation of the dietary records.
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The unique features of LEBTAB described above have been valuable for specific analyses of the DONALD Study data, including a consideration of age-dependent nutrient intake in comparison to references, intake of specific food groups (water, vegetables) or products (supplements), time trend analyses of nutrient intake, the impact of fortification on vitamin intake, examination of risk scenarios (pesticide residues, acrylamide, tap water contaminants), development of dietary guidelines, validation of weighed records (urinary analytes) and for a nationwide representative study of food intake in infants (VELS Study) (Table 5). 4. Discussion
3. Results Between 1985 and 2005, a total of 9700 dietary records from 1160 participants of the DONALD Study were collected, 41% of which come from the age groups under 4 years of age. At present, LEBTAB Version 06/2005 contains a total of 5969 food items (5751 not including supplements) (Table 1). Basic food items make up only a minority (16%) of total items. On average, at least 1 new food item occurs in each new 3-day dietary record, i.e., over 650 new foods are added to LEBTAB per year. Among the 23 basic food groups, the four baby-food groups (infant formula; fruit, vegetables, juices, instant beverages; milk-cereal products; mixed dishes: ready-toeat) make up a total of 1620 items (27%; Table 1) this is considerably more than in other FCDB (Table 4). As a result of product modifications, some commercial foods, e.g., infant formulae, have up to four different entries (and therefore different food codes). The group of Ready-to-eat baby meals is currently the largest food group in LEBTAB, followed by Beverages (including 80 brands of mineral water), Baked Products, Sweets and Fast Food (Table 1). A total of 1895 commercial food products (38% of total commercial products) were fortified with from 1 to 15 nutrients per product (maximum: 23 nutrients in some infant formulae). The majority of the fortified products were found in the Baby-food groups (n ¼ 990). The total amount of data stored is much higher than the number of food items in the basic section. In the subset ‘‘recipe’’ used to calculate composite foods and commercial food products, there are 47,530 data entries (food ingredients: 69%; fortified nutrients as ingredients: 31%).
Because of changes in dietary habits in combination with new commercial food products being brought onto the market and new emphasis in epidemiological research, development and maintenance of Food Composition Databases (FCDB) is an increasingly challenging task (Greenfield and Southgate, 2003), particularly with regards to children. As the consumption of pre-prepared (convenience) foods (e.g., baby food jars, food marketing targeted at children, deep frozen foods, or foods eaten away from home e.g., at kindergarten and school and in fast-food restaurants) continues to increase, the knowledge of mothers, carers and especially of children and adolescents, about the composition of the food items they are consuming continues to decline. Additionally, the food market is constantly changing, leading to a growing diversity of available foods. In our experience, mothers and children are eager to use new products, as shown by the presence of at least 1 new (mostly commercial) food product per 3-day dietary record. In Germany the range of commercial weaning foods and special toddler foods is still increasing despite the more than 600 individual items already on offer. The range of food products targeted at children tripled between 1997 and 2001, and 40% of those products were fortified. Therefore, dietary evaluation in early childhood is a challenge for FCDB. With regards to the diversity of dietary habits in adolescents, for example, in 1996, so-called ‘‘alcopops’’ (i.e., mixtures of juices with wine, beer or spirits especially designed for adolescents and young adults) were launched onto the market, and by 2004 more than 60 different brands were available (Warentest, 2004).
Table 4 Total number of baby/infantfood items contained in FCDB of various countries No. of items
Comments
Country (Reference)
0 3 3 35 94 582 1618
No items Human milk only Human milk only Infant formulae, baby food, human milk Infant formulae, baby food, human milk Including 50 infant formulae Including 193 infant formulae
Switzerland (Bundesamt, 2003) Denmark (Møller et al., 2002) Germany (DeutscheLebensmittelchemie, 2000) The Netherlands (Nevo, 1993) Great Britain (Holland et al., 1992) USA (USDA, 2004) Germany LEBTAB
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Table 5 Evaluations of food and nutrient intake by particular LEBTAB features together with DONALD Study food intake data Scientific aspects Age and time trends: Nutrient intake, age and sex differences, comparison with references Time trends Food consumption: Consumption of water and beverages
Sugar intake and nutrient dilution Fortification: Fortification time trends Over-fortification Supplement consumption
Risk scenarios: Pesticide residues Acrylamide Water contaminants VELS Study Food based dietary guidelines: Development
Prerequisites (reference)
Age specific food groups (Alexy et al., 2003) Time dependent changes in products (Alexy and Kersting, 2003) Food specifications: Tap water, mineral water, water for tea/coffee, juices, soft drinks, mineral water brands (Sichert-Hellert and Kersting, 2004a) Added sugars in commercial food from ingredients in the RECIPE subset (Alexy et al., 2002) Brand specific fortified food with stored levels of fortification; RECIPE subset with fortification data; Producer specific and time dependent changes in products (Sichert-Hellert and Kersting, 2004b) Brand specific supplements; Time dependent changes in supplements (Sichert-Hellert and Kersting, 2004c) RECIPE sub data base with ingredients; Brand specific commercial infant food items (Hilbig et al., 2004) Detailed water items (see above) (Hilbig et al., 2002; Banasiak et al., 2005) Aggregation of basic foods in groups based on ingredients from the RECIPE subset (Kersting et al., 2005)
Metabolism: Glycaemic index, glycaemic load Drinking habits Protein intake, renal acid load and bones Renal acid load
Ingredients in the RECIPE subset (Buyken et al., 2005) Food specification (see above) (Manz et al., 2002) Ingredients in the RECIPE subset (Alexy et al., 2005) Ingredients in the RECIPE subset (Remer et al., 2003)
Validation: Intake vs. 24 h urinary analytes
Mineral content of all food items (Remer et al., 2003)
4.1. Strengths of the database In contrast to other FCDB, LEBTAB is characterized mainly by:
the inclusion of food items preferably consumed by infants, children and adolescents, the estimation of the composition of commercial food items by recipe simulation to comply with modern food habits, a single combined composition table for foods and dietary supplements, the quantification of fortified nutrients in products and dietary supplements, and the compilation of longitudinal food composition data.
Participants of the DONALD Study keep original product information, an essential component of our recipe simulation process. This elaborate methodology makes it possible to keep LEBTAB up-to-date for diverse research questions, or to link these data to biochemical and anthropometric parameters, e.g., in epidemiological research on obesity (see Table 5). The disaggregation of
composite food is also an important characteristic of LEBTAB, e.g., for the evaluation of the study participants’ food consumption patterns, for the design and modification of Food Based Dietary Guidelines (Guthrie and Smallwood, 2003) or for the assessment of exposure to chemicals in food (Lambe, 2002). In all cases LEBTAB has proved to be of value (Table 5). The German Food Composition and Nutrient Tables (DGE, 2002) are the main source of nutrient data for LEBTAB and these data have also been used by other FCDB-compilers. Moreover, the official German nutrient database ‘‘BundesLebensmittelSchlu¨ssel’’ BLS (Dehne et al., 1999) is also based on the German Food Composition and Nutrient Tables (DGE, 2002), but neither includes current data on commercial infant food nor on single brand fortified products, supplements, or recipe information (Deutsche Lebensmittelchemie, 2000; Dehne et al., 1999). Food composition tables from other countries, e.g., Great Britain, Denmark, the Netherlands or Switzerland have only small numbers of infant food items (o100), and although the USDA food tables comprise more than 500 items, LEBTAB includes more than three times as many infant food items (see Table 4). Most of the food consumed
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today is processed and contains many ingredients, but the manufacturers treat their recipes like closely guarded secrets. It is therefore mandatory to calculate nutrient content via recipe simulation. Infants only consume a restricted variety of foods and estimating the nutrient content of their diet is therefore more important than in later life. Against this background, LEBTAB data was employed in a multi-centre dietary survey in infants and young children in Germany (VELS) (Banasiak et al., 2005), and the procedures used for LEBTAB could be a model for other FCDB-compilers.
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English, and the new food group classification systems EUROCODE and EFG (Euro Food Groups) have been added. In conclusion, LEBTAB is an example of how increasing demands from an ever-changing food market can be overcome in dietary intake evaluations in paediatric age groups. Despite being tightly linked to the DONALD Study, LEBTAB has proven to be of value for other studies as well, and could be used as an example for other FCDB compilers. Acknowledgement
4.2. Weaknesses of the database LEBTAB was mainly designed to evaluate dietary information assessed within the DONALD Study. Therefore, the range of foods may not be representative of the food supply or food habits throughout Germany. However, commercial food products are usually equally distributed throughout the country. There are some general weaknesses of FCDB that have to be considered when interpreting estimated/calculated nutrient intake data. Scarce product information complicates (valuable) nutrient calculation. For example, the fatty acid profile (e.g., a-linolenic acid) of commercial food products depends on the type of oil used, but this is often not specified on the label. In other cases, manufacturers use processed foods as ingredients (e.g., milk proteins for infant formulae), the nutrient content of which is not available. Finally, even the labelled nutrient content may not be valid. Investigations conducted in the United States of the iron and folate content of fortified breakfast cereals revealed quantities of 120% or more of the label value in 21 out of 29 products analysed, and in 8 products analyzed values exceeded declared values by 150% or more (Whittaker et al., 2001). This reflects the common practice in the United States of over-fortifying to prevent the government from seizing products found to have lower quantities of nutrients than officially declared. 4.3. Perspectives Modern food products contain more and more food additives, often in multiple combinations. Especially in the diet of children, food additives are a sensitive topic. To our knowledge, none of the FCDB currently available contain information on food additives in commercial products. We have therefore begun to add data on food additives to LEBTAB. To date, about 300 different substances have been stored. Food additives are treated in the same way as fortified nutrients described above. They enter the ‘‘recipe’’ subset for storage, but the amount is set to zero allowing qualitative evaluations only. This is because quantitative information for a given commercial product is rarely available. In order for LEBTAB to be valuable for researchers outside German speaking countries, the German food descriptions have recently been translated into
The DONALD Study is supported by the Ministry of Science and Research North Rhine-Westphalia, Germany. We are very grateful to Nadina Karaolis-Danckert for proof-reading the manuscript. References Alexy, U., Kersting, M., 2003. Time trends in the consumption of dairy foods in German children and adolescents. European Journal of Clinical Nutrition 57, 1331–1337. Alexy, U., Sichert-Hellert, W., Kersting, M., 2002. Fortification masks nutrient dilution due to added sugars in the diet of children and adolescents. Journal of Nutrition 132, 2785–2791. Alexy, U., Kersting, M., Sichert-Hellert, W., 2003. Trends in dietary intake of vitamins A, C, and E in German children and adolescentsresults of the DONALD Study. International Journal for Vitamin and Nutrition Research 73, 335–342. Alexy, U., Remer, T., Manz, F., Neu, C.M., Schoenau, E., 2005. Longterm protein intake and dietary potential renal acid load are associated with bone modeling and remodeling at the proximal radius in healthy children. American Journal of Clinical Nutrition 82, 1107–1114. Banasiak, U., Heseker, H., Sieke, C., Sommerfeld, C., Vohmann, C., 2005. Estimation of the dietary intake of pesticide residues based on new consumption data for children. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 48, 84–98. Bundesamt, 2003. Schweizer Na¨hrwerttabellen. Bundesamt fu¨r Gesundheit und Eidgeno¨ssische Technische Hochschule Zu¨rich, Schweizer Vereinigung fu¨r Erna¨hrung, Zollikofen. Buyken, A.E., Dettmann, W., Kersting, M., Kroke, A., 2005. Glycaemic index and glycaemic load in the diet of healthy schoolchildren: trends from 1990 to 2002, contribution of different carbohydrate sources and relationships to dietary quality. British Journal of Nutrition 94, 796–803. Dehne, L.I., Klemm, C., Henseler, G., Hermann-Kunz, E., 1999. The German Food Code and Nutrient Data Base (BLS II.2). European Journal of Epidemiology 15, 355–359. DGE, 2002. Reference values for nutrient intake. Umschau Braus GmbH Publ., Frankfurt/Main. Greenfield, H., Southgate, D.A.T., 2003. Food Composition Data: Production, Management and Use. Retrieved 2006: http://www.fao. org/infoods/publications_en.stm. Guthrie, J.F., Smallwood, D.M., 2003. Evaluating the effects of the Dietary Guidelines for Americans on consumer behavior and health: methodological challenges. Journal of the American Dietetic Association 103, S42–S49. Hilbig, A., Kersting, M., Sichert-Hellert, W., 2002. Measured consumption of tap water in German infants and young children as background for potential health risk assessments: data of the DONALD Study. Food Additives and Contaminants 19, 829–836. Hilbig, A., Freidank, N., Kersting, M., Wilhelm, M., Wittsiepe, J., 2004. Estimation of the dietary intake of acrylamide by German infants,
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children and adolescents as calculated from dietary records and available data on acrylamide levels in food groups. International Journal Hygiene Environmental Health 207, 463–471. Holland, B., Welch, A.A., Unwin, I.D., Buss, D.H., Paul, A.A., Southgate, D.A.T., 1992. The composition of foods. Royal Soc Chemistry, Cambridge. Kersting, M., Alexy, U., Clausen, K., 2005. Using the concept of food based dietary guidelines to develop an optimized mixed diet (OMD) for German children and adolescents. Journal of Paediatric and Gastroenterology Nutrition 40, 301–308. Kroke, A., Manz, F., Kersting, M., Remer, T., Sichert-Hellert, W., Alexy, U., Lentze, M., 2004. The DONALD Study: History, current status and future perspectives. European Journal of Nutrition 43, 45–54. Lambe, J., 2002. The use of food consumption data in assessments of exposure to food chemicals including the application of probabilistic modelling. Proceedings of the Nutrition Society 61, 11–18. Manz, F., Wentz, A., Sichert-Hellert, W., 2002. The most essential nutrient: defining the adequate intake of water. Journal of Pediatrics 141, 587–592. Møller, A., Saxholt, E., Christensen, A.T., Hartkopp, H.B., 2002. Danish Food Composition Databank. Retrieved August, 2004: http:// www.foodcomp.dk/. Nevo, 1993. Nevo Tabel. Nederlands voedingsstoffenbestand. Voorlichtingsbureau voor de Voeding, Den Haag. Remer, T., Dimitriou, T., Manz, F., 2003. Dietary potential renal acid load and renal net acid excretion in healthy, free-living children
and adolescents. American Journal of Clinical Nutrition 77, 1255–1260. Renner, E., Renz-Schauen, A., 1996. Nutrition Composition Tables of Milk and Dairy Products. Verl. M. Drahten, Giessen. Schakel, S.F., Buzzard, I.M., Gebhardt, S.E., 1997. Procedures for estimating nutrient values for food composition databases. Journal of Food Composition and Analysis 10, 102–114. Sichert-Hellert, W., Kersting, M., 2004a. Home-made carbonated water and the consumption of water and other beverages in German children and adolescents: results of the DONALD Study. Acta Paediatrica 93, 1583–1587. Sichert-Hellert, W., Kersting, M., 2004b. Fortifying food with folic acid improves folate intake in German infants, children and Adolescents. Journal of Nutrition 134, 2685–2690. Sichert-Hellert, W., Kersting, M., 2004c. Vitamin and mineral supplements use in German children and adolescents between 1986 and 2003: results of the DONALD Study. Annals of Nutrition and Metabolism 48, 414–419. USDA, 2004. National Nutrient Database for Standard Reference. Release 16-1. Retrieved March, 2006: http://www.nal.usda.gov/fnic/ foodcomp/search/. Warentest, 2004. Alcopops. Su¨X, trendy, fatal. Test 03/2004. Retrieved April, 2005: http://www.stiftung-warentest.de/online/essen_trinken/ test/1160612/1160612.html. Whittaker, P., Tufaro, P.R., Rader, J.I., 2001. Iron and folate in fortified cereals. Journal of the American College of Nutrition 20, 247–254.
Report
German food composition database for dietary evaluations in children and adolescents Wolfgang Sichert-Hellert, Mathilde Kersting, Christa Chahda, Ruth Scha¨fer, Anja Kroke1 Forschungsinstitut fu¨r Kindererna¨hrung, Rheinische Friedrich-Wilhelms-Universita¨t, Bonn, D-44225 Dortmund, Heinstu¨ck 11, Germany Received 8 March 2006; received in revised form 30 May 2006; accepted 31 May 2006
Abstract Dietary assessment and evaluation in infancy and childhood is of nutritional importance, of specific interest in the prevention of chronic diseases in later life, and Food Composition Databases (FCDB) are an important prerequisite, in particular FCDB that include a large variety of commercial, composite food products. We therefore developed a FCDB known as LEBTAB, which contains foods consumed by infants, children and adolescents in Germany. LEBTAB is divided into 23 basic food groups and currently contains a total of about 6000 items: 936 basic food items and more than 5000 commercial brands/composite foods, of which 27% are infant foods. Commercial food products have a total of 47,500 data entries for various ingredients. In contrast to many other FCDB, the nutrient content (38 nutrients) of commercial food products is calculated by way of a recipe simulation process using listed ingredients, and includes information on fortified nutrients. Children in Germany today consume predominantly commercial food products; knowledge of the ingredients, fortification or nutrient content of these foods is of particular interest. Unfortunately, only limited information on the composition of commercial food products is available. Therefore, the recipe simulation procedure based on information from food labels or manufacturers helps to overcome these shortcomings. In addition, in order to analyse changes in nutrient intake over time, the tracking of modifications made to food items is a necessary special feature of those FCDB which aim to keep up with the rapidly changing food market. r 2006 Elsevier Inc. All rights reserved. Keywords: Food composition database FCDB; Commercial food products; Infant food; Infants; Children; Adolescents
1. Introduction Dietary assessment and evaluation in childhood is of particular nutritional importance and of specific interest in the prevention of chronic diseases in later life, and at the same time challenging for methodological considerations. Nutritional requirements and food patterns change more during infancy and childhood than later in life. Moreover, both Abbreviations: DONALD, Dortmund Nutritional and Anthropometric Longitudinally Designed Study; FCDB, food composition databases; LEBTAB, food and nutrient database in DONALD Corresponding author. Tel.: +49 231 79 22 10 14; fax: +49 231 71 15 81. E-mail address: [email protected] (W. Sichert-Hellert). 1 WS-H analyzed the data, drafted, and edited the manuscript. CC and RS did the recipe simulations and were responsible for the data entry. MK and AK contributed significantly to the discussion and to the critical revision of the manuscript. 0889-1575/$ - see front matter r 2006 Elsevier Inc. All rights reserved. doi:10.1016/j.jfca.2006.05.004
dietary habits and the composition of basic and commercial food products also change with time. For instance, the composition of commercial foods for infants and young children has been influenced by European food regulations. Convenience foods and eating outside the home (fast food) often replace traditional homemade foods. To assess energy and nutrient intake, whether for later comparison with recommendations, or for investigating associations with biochemical parameters or anthropometric measurements, a database that stores information on the food items consumed and their nutrient content, as well as on changes in the composition of these foods over time, e.g., changes in the fortification of breakfast cereals for children, is needed. In the DOrtmund Nutritional and Anthropometric Longitudinally Designed (DONALD) Study (Kroke et al., 2004), which began in 1985, dietary intake in healthy infants, children and adolescents is measured using 3-day weighed dietary records. To evaluate the effect of age and
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time trends on food and nutrient intake, a specific food and nutrient database named LEBTAB has been developed. Here, we present a report on establishing and maintaining this database and give examples of results from dietary analyses carried out with the present version. 2. Methods 2.1. Food consumption measurement The DONALD Study is a longitudinal (open cohort) study collecting detailed data on diet, metabolism, growth and development in healthy subjects between infancy and adulthood (3 month–18 years), every 3 months in the first year of life, every six months in the second year and every twelve months thereafter. The DONALD Study is exclusively observational and non-invasive as approved by the International Scientific Committee of the Research Institute of Child Nutrition. Details of the study have been described elsewhere (Kroke et al., 2004). The parents of the infant and child participants, or the older subjects themselves, keep 3-day weighed dietary records, i.e., weigh and record all foods and fluids consumed, as well as
leftovers, using electronic food scales provided by the Institute. Ingredients for composite dishes are recorded separately, e.g., potatoes, carrots, meat and oil for a homeprepared baby food dish, or breakfast cereal (‘‘7-fruit’’, fortified, Kellogg), milk and raw apple for breakfast. Product information on packaging, labels, etc., as well as information on any supplements (tablets, pills) consumed, are also collected and evaluated with the dietary records by the study’s dieticians. In particular, information on the type and amount of ingredients, nutrient information and fortification is used to simulate recipes and to generate data on the nutrient content of commercial food products. 2.2. Database structure The basic features of LEBTAB originated as a computer program written in FORTRAN programming language in 1985 (PERKIN ELMER COMPUTER with RELIANCE database program). This was modified and enhanced over time to an ORACLEs database. SASs procedures (Version 8.02) were used to access the data for further evaluation. A 4-digit alphanumeric code identifies each item in the database in a hierarchical order (Table 1),
Table 1 Main food groups in LEBTAB, number, and percentages of items within food groups First placeholder
Food group
A B C D E
Dairy products: milk, yoghurt, etc. Dairy products: cheese Egg products Meat products, sausages Fish and shellfish products Animal origin: subtotal
F G H I K L M N
N
%
275 113 14 232 106 740
4.6 1.9 0.2 3.9 1.8 12.4
Fats and oils Cereal grains, breakfast cereals, pasta Baked products: breads, bread rolls, etc. Baked products: cakes, biscuits, etc. Potato products Vegetable products Fruit products, nuts Juices Plant origin: Subtotal
149 453 470 322 43 149 119 139 1844
2.5 7.6 7.9 5.4 0.7 2.5 2.0 2.3 30.9
O P Q Z
Beverages Sweets Soups, sauces, gravy Fast food Others: Subtotal
542 423 216 366 1547
9.1 7.1 3.6 6.1 25.9
U Y
Dietary supplements (per 100 g) Dietary supplements (per capsule/tablet) Supplements: subtotal
27 191 218
0.5 3.2 3.7
S T V W
Baby Baby Baby Baby Baby
194 361 50 1015 1620
3.3 6.1 0.8 17.0 27.1
Total a
Foods for Special Medical Purposes.
food: infant formulae, follow on formulae, FSMPa fruit, vegetables, juices, instant beverages milk-cereal-products mixed dishes: ready to eat food: subtotal
5969
100
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with the food group in position 1, sub-groups in positions 2 and 3, and individual items or brand names in position 4. Specific information about each item is stored for documentation: (a) the date of entry, (b) the manufacturer in the case of commercial products, (c) the former item code in LEBTAB in the case of newer versions of a food item, e.g., due to changes in fortification or reduced fat content and (d) the addition of special ingredients (e.g., artificial sweeteners, pro-, prebiotics, iodized salt). Due to the specific focus on infants and young children in the DONALD Study, the items ‘‘milk’’/‘‘water’’ have multiple entries but identical constituents in LEBTAB, i.e., different codes distinguish whether milk/water is used as a
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drink or in the course of food preparation, for instance for the preparation of bottle feed or cereal milk pap as weaning food. 2.3. Nutrient storage Every food item is described by 14 macronutrients and 24 micronutrients (Table 2), and its energy, monounsaturated fatty acid content, and niacin equivalents are calculated during analyses. The nutrient content of staple foods is taken from standard nutrient tables in the following order of preference: firstly, German food composition data for foods in general (Deutsche Lebensmittelchemie, 2000) and for specific milk products (Renner
Table 2 Example of the nutrient content of a fortified food item (GWQ0 ¼ 7-fruit breakfast cereal with fortified vitamin C, iron, and magnesium) in LEBTAB Value per 100 ga 321 13.0 9.8 0 4.6 0.7 1.9 2.0 2.1 0 59.9 0.1 10.5 3.3 7.2 0 28.8 584 49.0 150 284 8.0 2.4 0.4 2.3 5.5 126 759 2.4 0.39 0.14 0.27 2.6 2.9 75 48.0 0 6.4 1.0 9.2 0 a
Unit kcal g g g g g g g g mg g g g g g g mg mg mg mg mg mg mg mg mg mg mg mg mg mg mg mg mg mg mg mg mg mg mg mg mg
Nutrient
Fortification
b
Energy Water Protein, total Protein, animal Fat, total lipids Fatty acids, total saturated Linoleic acid Fatty acids, total polyunsaturated Fatty acids, total mono-unsaturatedb Cholesterol Carbohydrate, total Added sugars, total Dietary fibre, total Fibre, water-soluble Fibre, non-water-soluble Alcohol, ethyl Sodium Potassium Calcium Magnesium Phosphorus Iron Zinc Copper Manganese Iodine Vitamin A, retinol equivalents Carotene, beta Vitamin E, alpha-tocopherol Thiamin Riboflavin Pyridoxin Niacin Niacin equivalentsb Folate, dietary folate equivalents Vitamin C, total ascorbic acid Vitamin D Vitamin K (phylloquinone) Pantothenic acid Biotin Vitamin B12
Yesc Yesc
Yesc
Edible portion, rounded values, significant digits according to (Greenfield and Southgate, 2003). Calculated [ ¼ protein (g)/6; assuming 6 g protein in a usual diet containing 60 mg tryptophan equivalent to 1 mg niacin equivalent] (DGE, 2002). c See Recipe (Table 3). b
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and Renz-Schauen, 1996) is incorporated. However, almost no food has been completely analysed for all the nutrient constituents required by LEBTAB. The two most commonly missing nutrients are vitamins D and K. Thereafter, the United States (USDA, 2004), Danish (Møller et al., 2002) and British food composition tables (Holland et al., 1992) are consulted for completion of missing values. Finally, nutrient information still missing is imputed from similar food items. LEBTAB does not allow any missing values. The nutrient content of basic food items (e.g., cereals, vegetables, dairy products) is entered into LEBTAB directly, together with the source of the data into the LEBTAB subset ‘‘documentation’’ (Fig. 1). Amounts are given per 100 g edible portion or, in the case of supplements, per ‘‘dose’’, e.g., per pill, capsule, drop or tablespoon.
2.4. Recipe simulation In the case of composite foods, particularly commercial food products (e.g., baby mixed dishes, milk-cereal mixtures for infants, cakes, ice cream, frozen pizza, hamburgers) nutrient constituents are generated by use of recipes or recipe simulation (Schakel et al., 1997). Our dieticians use the labelled ingredients and, if available, labelled nutrient information (Table 3). As the ingredients are listed on the label in decreasing order of their weight in the final product, this sequence allows quantitative estimations of their amounts. Sometimes, an ingredient by itself constitutes a complex food made up of various other ingredients and therefore also requires a recipe. All ingredients enter a specific ‘‘recipe’’ subset of LEBTAB together with the food code (Fig. 1). The estimated/ calculated nutrient content of a food is allowed to deviate from the labelled content by a margin of 75%. For longitudinal analysis of the DONALD Study data, LEBTAB is continuously being updated with any new foods recorded by the participants. A new food or a commercial food product that already exists in the database but has undergone a change in composition (e.g., new ingredients, fortification) leads to a new entry, with a new simulation if necessary and a new food code. Three-monthly back-ups of previous LEBTAB versions are stored. 2.5. Fortification
Fig. 1. Data entry and recipe simulation process in LEBTAB and LEBTAB subsets.
Fortified nutrients are usually mentioned on the product label. However, labelled amounts refer to the total content, i.e., the sum of natural and fortified nutrients present in the food for the duration of the product’s shelf life. In our simulation process, labelled amounts of fortified nutrients
Table 3 Result of a recipe simulation for a fortified food item (GWQ0 ¼ 7-fruit breakfast cereal with vitamin C, iron, and magnesium) Code recipe
Code ingredient
Ingredients item labelled
Amount simulated, g/100 g unless labelled
GWQ0 GWQ0 GWQ0 GWQ0 GWQ0 GWQ0 GWQ0 GWQ0 GWQ0 GWQ0 GWQ0 GWQ0 GWQ0 GWQ0 GWQ0 GWQ0 GWQ0
GCA0 GC40 GC50 GC60 MFE0 MFB0 MFG0 MFH0 GDB0 LCF0 MFA0 MGK0 MGA0 MGC0 JVC0 JMG0 JFE0
Rolled oats Whole wheat, flaked Whole rye, flaked Whole barley, flaked Raisins Dates Apples, dried, sulphurised, uncooked Banana, chips Corn flakes, non-fortified Soybeans, mature seeds, roasted, without salt Apricots, dried, sulphurised, uncooked Sunflower, seed kernels, dried Peanuts, dry-roasted, without salt Hazelnuts, dry-roasted, without salt Vitamin C Magnesium Iron
18.0 16.5 15.0 12.0 10.0 6.0 6.0 6.0 3.0 2.0 2.0 2.0 1.0 0.5 48.0 mga 150.0 mga 8.0 mga
a
Due to fortification labelled amounts are inserted after the recipe has been calculated.
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are treated as ingredients (see, for example, vitamin C, magnesium and iron in Tables 2 and 3). If there is no such data, the manufacturer is asked for additional specifications. As ingredients, fortified nutrients are also stored with their amounts in the ‘‘recipe’’ subset. In case of differences between calculated nutrients from the simulation and labelled nutrient figures, calculated values are overwritten with the labelled ones. Nutrient contents stored in LEBTAB refer to raw ingredients. To account for loss of vitamins during food preparation, standard factors (DGE, 2002) are applied for evaluation of the dietary records.
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The unique features of LEBTAB described above have been valuable for specific analyses of the DONALD Study data, including a consideration of age-dependent nutrient intake in comparison to references, intake of specific food groups (water, vegetables) or products (supplements), time trend analyses of nutrient intake, the impact of fortification on vitamin intake, examination of risk scenarios (pesticide residues, acrylamide, tap water contaminants), development of dietary guidelines, validation of weighed records (urinary analytes) and for a nationwide representative study of food intake in infants (VELS Study) (Table 5). 4. Discussion
3. Results Between 1985 and 2005, a total of 9700 dietary records from 1160 participants of the DONALD Study were collected, 41% of which come from the age groups under 4 years of age. At present, LEBTAB Version 06/2005 contains a total of 5969 food items (5751 not including supplements) (Table 1). Basic food items make up only a minority (16%) of total items. On average, at least 1 new food item occurs in each new 3-day dietary record, i.e., over 650 new foods are added to LEBTAB per year. Among the 23 basic food groups, the four baby-food groups (infant formula; fruit, vegetables, juices, instant beverages; milk-cereal products; mixed dishes: ready-toeat) make up a total of 1620 items (27%; Table 1) this is considerably more than in other FCDB (Table 4). As a result of product modifications, some commercial foods, e.g., infant formulae, have up to four different entries (and therefore different food codes). The group of Ready-to-eat baby meals is currently the largest food group in LEBTAB, followed by Beverages (including 80 brands of mineral water), Baked Products, Sweets and Fast Food (Table 1). A total of 1895 commercial food products (38% of total commercial products) were fortified with from 1 to 15 nutrients per product (maximum: 23 nutrients in some infant formulae). The majority of the fortified products were found in the Baby-food groups (n ¼ 990). The total amount of data stored is much higher than the number of food items in the basic section. In the subset ‘‘recipe’’ used to calculate composite foods and commercial food products, there are 47,530 data entries (food ingredients: 69%; fortified nutrients as ingredients: 31%).
Because of changes in dietary habits in combination with new commercial food products being brought onto the market and new emphasis in epidemiological research, development and maintenance of Food Composition Databases (FCDB) is an increasingly challenging task (Greenfield and Southgate, 2003), particularly with regards to children. As the consumption of pre-prepared (convenience) foods (e.g., baby food jars, food marketing targeted at children, deep frozen foods, or foods eaten away from home e.g., at kindergarten and school and in fast-food restaurants) continues to increase, the knowledge of mothers, carers and especially of children and adolescents, about the composition of the food items they are consuming continues to decline. Additionally, the food market is constantly changing, leading to a growing diversity of available foods. In our experience, mothers and children are eager to use new products, as shown by the presence of at least 1 new (mostly commercial) food product per 3-day dietary record. In Germany the range of commercial weaning foods and special toddler foods is still increasing despite the more than 600 individual items already on offer. The range of food products targeted at children tripled between 1997 and 2001, and 40% of those products were fortified. Therefore, dietary evaluation in early childhood is a challenge for FCDB. With regards to the diversity of dietary habits in adolescents, for example, in 1996, so-called ‘‘alcopops’’ (i.e., mixtures of juices with wine, beer or spirits especially designed for adolescents and young adults) were launched onto the market, and by 2004 more than 60 different brands were available (Warentest, 2004).
Table 4 Total number of baby/infantfood items contained in FCDB of various countries No. of items
Comments
Country (Reference)
0 3 3 35 94 582 1618
No items Human milk only Human milk only Infant formulae, baby food, human milk Infant formulae, baby food, human milk Including 50 infant formulae Including 193 infant formulae
Switzerland (Bundesamt, 2003) Denmark (Møller et al., 2002) Germany (DeutscheLebensmittelchemie, 2000) The Netherlands (Nevo, 1993) Great Britain (Holland et al., 1992) USA (USDA, 2004) Germany LEBTAB
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Table 5 Evaluations of food and nutrient intake by particular LEBTAB features together with DONALD Study food intake data Scientific aspects Age and time trends: Nutrient intake, age and sex differences, comparison with references Time trends Food consumption: Consumption of water and beverages
Sugar intake and nutrient dilution Fortification: Fortification time trends Over-fortification Supplement consumption
Risk scenarios: Pesticide residues Acrylamide Water contaminants VELS Study Food based dietary guidelines: Development
Prerequisites (reference)
Age specific food groups (Alexy et al., 2003) Time dependent changes in products (Alexy and Kersting, 2003) Food specifications: Tap water, mineral water, water for tea/coffee, juices, soft drinks, mineral water brands (Sichert-Hellert and Kersting, 2004a) Added sugars in commercial food from ingredients in the RECIPE subset (Alexy et al., 2002) Brand specific fortified food with stored levels of fortification; RECIPE subset with fortification data; Producer specific and time dependent changes in products (Sichert-Hellert and Kersting, 2004b) Brand specific supplements; Time dependent changes in supplements (Sichert-Hellert and Kersting, 2004c) RECIPE sub data base with ingredients; Brand specific commercial infant food items (Hilbig et al., 2004) Detailed water items (see above) (Hilbig et al., 2002; Banasiak et al., 2005) Aggregation of basic foods in groups based on ingredients from the RECIPE subset (Kersting et al., 2005)
Metabolism: Glycaemic index, glycaemic load Drinking habits Protein intake, renal acid load and bones Renal acid load
Ingredients in the RECIPE subset (Buyken et al., 2005) Food specification (see above) (Manz et al., 2002) Ingredients in the RECIPE subset (Alexy et al., 2005) Ingredients in the RECIPE subset (Remer et al., 2003)
Validation: Intake vs. 24 h urinary analytes
Mineral content of all food items (Remer et al., 2003)
4.1. Strengths of the database In contrast to other FCDB, LEBTAB is characterized mainly by:
the inclusion of food items preferably consumed by infants, children and adolescents, the estimation of the composition of commercial food items by recipe simulation to comply with modern food habits, a single combined composition table for foods and dietary supplements, the quantification of fortified nutrients in products and dietary supplements, and the compilation of longitudinal food composition data.
Participants of the DONALD Study keep original product information, an essential component of our recipe simulation process. This elaborate methodology makes it possible to keep LEBTAB up-to-date for diverse research questions, or to link these data to biochemical and anthropometric parameters, e.g., in epidemiological research on obesity (see Table 5). The disaggregation of
composite food is also an important characteristic of LEBTAB, e.g., for the evaluation of the study participants’ food consumption patterns, for the design and modification of Food Based Dietary Guidelines (Guthrie and Smallwood, 2003) or for the assessment of exposure to chemicals in food (Lambe, 2002). In all cases LEBTAB has proved to be of value (Table 5). The German Food Composition and Nutrient Tables (DGE, 2002) are the main source of nutrient data for LEBTAB and these data have also been used by other FCDB-compilers. Moreover, the official German nutrient database ‘‘BundesLebensmittelSchlu¨ssel’’ BLS (Dehne et al., 1999) is also based on the German Food Composition and Nutrient Tables (DGE, 2002), but neither includes current data on commercial infant food nor on single brand fortified products, supplements, or recipe information (Deutsche Lebensmittelchemie, 2000; Dehne et al., 1999). Food composition tables from other countries, e.g., Great Britain, Denmark, the Netherlands or Switzerland have only small numbers of infant food items (o100), and although the USDA food tables comprise more than 500 items, LEBTAB includes more than three times as many infant food items (see Table 4). Most of the food consumed
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today is processed and contains many ingredients, but the manufacturers treat their recipes like closely guarded secrets. It is therefore mandatory to calculate nutrient content via recipe simulation. Infants only consume a restricted variety of foods and estimating the nutrient content of their diet is therefore more important than in later life. Against this background, LEBTAB data was employed in a multi-centre dietary survey in infants and young children in Germany (VELS) (Banasiak et al., 2005), and the procedures used for LEBTAB could be a model for other FCDB-compilers.
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English, and the new food group classification systems EUROCODE and EFG (Euro Food Groups) have been added. In conclusion, LEBTAB is an example of how increasing demands from an ever-changing food market can be overcome in dietary intake evaluations in paediatric age groups. Despite being tightly linked to the DONALD Study, LEBTAB has proven to be of value for other studies as well, and could be used as an example for other FCDB compilers. Acknowledgement
4.2. Weaknesses of the database LEBTAB was mainly designed to evaluate dietary information assessed within the DONALD Study. Therefore, the range of foods may not be representative of the food supply or food habits throughout Germany. However, commercial food products are usually equally distributed throughout the country. There are some general weaknesses of FCDB that have to be considered when interpreting estimated/calculated nutrient intake data. Scarce product information complicates (valuable) nutrient calculation. For example, the fatty acid profile (e.g., a-linolenic acid) of commercial food products depends on the type of oil used, but this is often not specified on the label. In other cases, manufacturers use processed foods as ingredients (e.g., milk proteins for infant formulae), the nutrient content of which is not available. Finally, even the labelled nutrient content may not be valid. Investigations conducted in the United States of the iron and folate content of fortified breakfast cereals revealed quantities of 120% or more of the label value in 21 out of 29 products analysed, and in 8 products analyzed values exceeded declared values by 150% or more (Whittaker et al., 2001). This reflects the common practice in the United States of over-fortifying to prevent the government from seizing products found to have lower quantities of nutrients than officially declared. 4.3. Perspectives Modern food products contain more and more food additives, often in multiple combinations. Especially in the diet of children, food additives are a sensitive topic. To our knowledge, none of the FCDB currently available contain information on food additives in commercial products. We have therefore begun to add data on food additives to LEBTAB. To date, about 300 different substances have been stored. Food additives are treated in the same way as fortified nutrients described above. They enter the ‘‘recipe’’ subset for storage, but the amount is set to zero allowing qualitative evaluations only. This is because quantitative information for a given commercial product is rarely available. In order for LEBTAB to be valuable for researchers outside German speaking countries, the German food descriptions have recently been translated into
The DONALD Study is supported by the Ministry of Science and Research North Rhine-Westphalia, Germany. We are very grateful to Nadina Karaolis-Danckert for proof-reading the manuscript. References Alexy, U., Kersting, M., 2003. Time trends in the consumption of dairy foods in German children and adolescents. European Journal of Clinical Nutrition 57, 1331–1337. Alexy, U., Sichert-Hellert, W., Kersting, M., 2002. Fortification masks nutrient dilution due to added sugars in the diet of children and adolescents. Journal of Nutrition 132, 2785–2791. Alexy, U., Kersting, M., Sichert-Hellert, W., 2003. Trends in dietary intake of vitamins A, C, and E in German children and adolescentsresults of the DONALD Study. International Journal for Vitamin and Nutrition Research 73, 335–342. Alexy, U., Remer, T., Manz, F., Neu, C.M., Schoenau, E., 2005. Longterm protein intake and dietary potential renal acid load are associated with bone modeling and remodeling at the proximal radius in healthy children. American Journal of Clinical Nutrition 82, 1107–1114. Banasiak, U., Heseker, H., Sieke, C., Sommerfeld, C., Vohmann, C., 2005. Estimation of the dietary intake of pesticide residues based on new consumption data for children. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 48, 84–98. Bundesamt, 2003. Schweizer Na¨hrwerttabellen. Bundesamt fu¨r Gesundheit und Eidgeno¨ssische Technische Hochschule Zu¨rich, Schweizer Vereinigung fu¨r Erna¨hrung, Zollikofen. Buyken, A.E., Dettmann, W., Kersting, M., Kroke, A., 2005. Glycaemic index and glycaemic load in the diet of healthy schoolchildren: trends from 1990 to 2002, contribution of different carbohydrate sources and relationships to dietary quality. British Journal of Nutrition 94, 796–803. Dehne, L.I., Klemm, C., Henseler, G., Hermann-Kunz, E., 1999. The German Food Code and Nutrient Data Base (BLS II.2). European Journal of Epidemiology 15, 355–359. DGE, 2002. Reference values for nutrient intake. Umschau Braus GmbH Publ., Frankfurt/Main. Greenfield, H., Southgate, D.A.T., 2003. Food Composition Data: Production, Management and Use. Retrieved 2006: http://www.fao. org/infoods/publications_en.stm. Guthrie, J.F., Smallwood, D.M., 2003. Evaluating the effects of the Dietary Guidelines for Americans on consumer behavior and health: methodological challenges. Journal of the American Dietetic Association 103, S42–S49. Hilbig, A., Kersting, M., Sichert-Hellert, W., 2002. Measured consumption of tap water in German infants and young children as background for potential health risk assessments: data of the DONALD Study. Food Additives and Contaminants 19, 829–836. Hilbig, A., Freidank, N., Kersting, M., Wilhelm, M., Wittsiepe, J., 2004. Estimation of the dietary intake of acrylamide by German infants,
ARTICLE IN PRESS 70
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children and adolescents as calculated from dietary records and available data on acrylamide levels in food groups. International Journal Hygiene Environmental Health 207, 463–471. Holland, B., Welch, A.A., Unwin, I.D., Buss, D.H., Paul, A.A., Southgate, D.A.T., 1992. The composition of foods. Royal Soc Chemistry, Cambridge. Kersting, M., Alexy, U., Clausen, K., 2005. Using the concept of food based dietary guidelines to develop an optimized mixed diet (OMD) for German children and adolescents. Journal of Paediatric and Gastroenterology Nutrition 40, 301–308. Kroke, A., Manz, F., Kersting, M., Remer, T., Sichert-Hellert, W., Alexy, U., Lentze, M., 2004. The DONALD Study: History, current status and future perspectives. European Journal of Nutrition 43, 45–54. Lambe, J., 2002. The use of food consumption data in assessments of exposure to food chemicals including the application of probabilistic modelling. Proceedings of the Nutrition Society 61, 11–18. Manz, F., Wentz, A., Sichert-Hellert, W., 2002. The most essential nutrient: defining the adequate intake of water. Journal of Pediatrics 141, 587–592. Møller, A., Saxholt, E., Christensen, A.T., Hartkopp, H.B., 2002. Danish Food Composition Databank. Retrieved August, 2004: http:// www.foodcomp.dk/. Nevo, 1993. Nevo Tabel. Nederlands voedingsstoffenbestand. Voorlichtingsbureau voor de Voeding, Den Haag. Remer, T., Dimitriou, T., Manz, F., 2003. Dietary potential renal acid load and renal net acid excretion in healthy, free-living children
and adolescents. American Journal of Clinical Nutrition 77, 1255–1260. Renner, E., Renz-Schauen, A., 1996. Nutrition Composition Tables of Milk and Dairy Products. Verl. M. Drahten, Giessen. Schakel, S.F., Buzzard, I.M., Gebhardt, S.E., 1997. Procedures for estimating nutrient values for food composition databases. Journal of Food Composition and Analysis 10, 102–114. Sichert-Hellert, W., Kersting, M., 2004a. Home-made carbonated water and the consumption of water and other beverages in German children and adolescents: results of the DONALD Study. Acta Paediatrica 93, 1583–1587. Sichert-Hellert, W., Kersting, M., 2004b. Fortifying food with folic acid improves folate intake in German infants, children and Adolescents. Journal of Nutrition 134, 2685–2690. Sichert-Hellert, W., Kersting, M., 2004c. Vitamin and mineral supplements use in German children and adolescents between 1986 and 2003: results of the DONALD Study. Annals of Nutrition and Metabolism 48, 414–419. USDA, 2004. National Nutrient Database for Standard Reference. Release 16-1. Retrieved March, 2006: http://www.nal.usda.gov/fnic/ foodcomp/search/. Warentest, 2004. Alcopops. Su¨X, trendy, fatal. Test 03/2004. Retrieved April, 2005: http://www.stiftung-warentest.de/online/essen_trinken/ test/1160612/1160612.html. Whittaker, P., Tufaro, P.R., Rader, J.I., 2001. Iron and folate in fortified cereals. Journal of the American College of Nutrition 20, 247–254.