To summarise our present knowledge on the Mediterranean diet in secondary prevention of CHD.

Review of literature.

Adult coronary patients.

CHD patients at high risk of cardiac death.

The two main causes of death in these patients are sudden cardiac death (SCD) and chronic heart failure (CHF). The main mechanism underlying recurrent cardiac events is coronary thrombosis resulting from atherosclerotic plaque erosion or ulceration. The occurrence of thrombosis is usually associated with plaque weakness in relation to high lipid content of the lesion where cholesterol only represents a very small part compared with other lipids (i.e. fatty acids). Thus, the three main aims of the preventive strategy are to prevent coronary thrombosis, malignant ventricular arrhythmia and the development of left ventricular dysfunction (and CHF) and finally to minimise the risk of plaque erosion and ulceration. There is now a consensus about recommending the Mediterranean diet pattern for the secondary prevention of CHD because no other dietary pattern has been successfully tested so far in these patients. The most important aspect, in contrast with the pharmacological prevention of CHD (including cholesterol lowering), is that the Mediterranean diet results in a striking effect on survival.

The traditional Mediterranean diet is effective in reducing both coronary atherosclerosis/thrombosis and the risk of fatal complications such as SCD and heart failure.

The growing interest in maintaining good health status through optimal nutrition has boosted the launch of a number of functional foods on the market. The objective of the present study was to theoretically evaluate the nutritional relevance of incorporating selected enriched foods in the diet.

A 28 d dietary plan, designed to be balanced under the recommended macronutrients criteria, was used as a basal diet. Some conventional foods were exchanged with foods enriched in fibre, calcium, iodine, vitamins A, D, E or n-3 fatty acids.

Nutritional composition of basal and modified diets was derived and compared to the Spanish recommended intakes (RI).

The basal diet covered the recommendations for fibre and calcium with mean intake of 28 g and 1241 mg, respectively. The current intake of salt, if iodized, or bread elaborated with this salt, allowed reaching the daily intake of iodine every day, with a mean supply of 216 μg/d and 278 μg/d, respectively. The deficient supply of vitamin E in the basal diet (mean = 8 mg/d) was covered by including enriched margarine and dairy products (mean = 15 mg/d). The low n-3 fatty acids intake in the basal diet (1·1 g/d) increased up to 1·9 g/d after the use of enriched margarine, butter and biscuits and soya drink instead of milk.

In order to improve the accomplishment of the RI iodine, vitamin E and n-3 fatty acids, interesting strategies dealing with the incorporation of enriched foods in the diet were successfully initiated.

To develop a ‘fruit self-efficacy’ (FSE) instrument and a ‘vegetable self-efficacy’ (VSE) instrument for secondary-school students in the Netherlands and to test the reliability and validity of these instruments.

Methodological research.

Seven secondary schools in the Netherlands.

Students (11–19 years of age) completed the two instruments in the classroom (n 466). Out of the original subject group, 106 students completed the instruments a second time.

The relevance of the twenty-two items of the two developed instruments was evaluated on two occasions by four experts. This procedure resulted in seventeen items for both instruments. Further analysis was carried out on the basis of the secondary-school students’ answers. Factor analysis identified two unidimensional instruments. Cronbach's α was 0·94 for the FSE instrument and 0·95 for the VSE instrument. The intra-class correlation coefficient between the test and the retest for both instruments varied between 0·33 and 0·84 (P < 0·05), depending on how the tests were taken (during class or on the student's own initiative), and the order in which the tests were completed (started or finished with a different instrument used for similar research). The correlation between FSE and fruit consumption was 0·41 (P < 0·01) and between VSE and vegetable consumption was 0·32 (P < 0·01).

The two instruments are sufficiently reliable and valid to assess the FSE and VSE of secondary-school students in the Netherlands. Further research, in which the predominant ethnic minorities in the Netherlands are sufficiently represented, is required to confirm this conclusion.

To monitor growth trends in young children in order to ascertain success (or otherwise) in halting the rapid rise in childhood obesity prevalence, and to assess the suitability of using routinely measured data for this purpose.

Retrospective serial cross-sectional analyses of the proportion of obese children (logistic regression) and BMI standard deviation score (linear regression/maps) were undertaken. BMI coverage was calculated as percentage of sample with data (‘usual’), percentage of total births and percentage of census values. BMI was standardised for age and sex (British reference data set).

Metropolitan Leeds, UK.

Children aged 3 to 6 years. Weight, height, sex, age and postcode data were collected from Primary Care Trust records.

Data were collected on 42 396 children, of whom 13 020 (31 %) were excluded due to missing data/data problems. Seventy-two per cent of 3-year-olds and 92 % of 5-year-olds had data recorded (‘usual’ coverage). From 1998 to 2003 there was a significant increase in the proportion of obese children (4·5 % to 6·6 %; P < 0·001); children were 1·5 times more likely to be obese in 2003 than in 1998.

Childhood obesity rose significantly between 1998 and 2003. Routinely measured data are an important means of monitoring population-level obesity trends, although more effort is required to reduce the quantity of data-entry errors, for relatively low marginal cost.

To evaluate the relationship between egg consumption and CHD and stroke mortality using the Third National Health and Nutrition Examination Survey 1988–1994 (NHANES III) and follow-up survey.

A cross-sectional survey using a stratified, multi-stage probability sample was analysed, adjusting for survey design. Egg consumption was obtained from the FFQ and separated into categories of egg intake. Hazard ratios (HR) were calculated for CHD and stroke mortality using multivariate Cox regression models.

A health and nutrition survey conducted in the USA from 1988 to 1994 with follow-up through 31 December 2000.

The study population included men and women who were free of CVD and had completed a FFQ at baseline.

Multivariate models adjusting for health, lifestyle and dietary factors indicated that ‘high’ egg consumption (≥7 times/week v. <1 time/week) was not associated with significantly increased CHD mortality (HR = 1·13, 95 % CI 0·61, 2·11 (men); HR = 0·92, 95 % CI 0·27, 3·11 (women)). There was a statistically significant inverse association between ‘high’ egg consumption and stroke mortality among men (HR = 0·27, 95 % CI 0·10, 0·73), but the estimate was imprecise because of sparse data. We did not observe a statistically significant positive association between ‘high’ egg consumption and CHD or stroke mortality in analyses restricted to individuals with diabetes, but these analyses may be limited due to the small number of diabetics.

We did not find a significant positive association between egg consumption and increased risk of mortality from CHD or stroke in the US population. These results corroborate the findings of previous studies.

To describe the association of socio-economic, demographic and lifestyle characteristics with three eating patterns identified among low-income adults living in the Rio de Janeiro metropolitan area, Brazil.

Data were obtained in a population-based cross-sectional study. The analysed patterns were: (i) ‘Mixed’, in which diverse foods had similar factor loadings; (ii) ‘Western’, which included items with high energy density; and (iii) ‘Traditional’, which relied in rice and beans, traditional staple foods in Brazil. Hierarchical logistic analysis was performed to estimate the association between the independent variables and each one of the dietary patterns. The variables that presented statistical significance <0·20 in the univariate analysis (χ2 test) were included in the multivariate models.

Duque de Caxias, a low-income area in the Rio de Janeiro metropolitan region, Brazil.

Adults (n 1009) aged 20 to 65 years (339 men and 670 women).

The ‘Mixed’ pattern was positively associated with smoking (OR = 1·58, 95 % CI 1·00, 2·48 for current smoking v. those who never smoked). The ‘Western’ pattern was positively associated with family income (OR = 3·00, 95 % CI 1·81, 4·97 for those with monthly per capita family income ≥1·0 v. <0·5 times the official Brazilian minimum wage) and inversely associated with family food insecurity (OR = 0·55, 95 % CI 0·36, 0·84). The ‘Traditional’ pattern was associated with family food insecurity (OR = 1·79, 95 % CI 1·27, 2·51).

The results support previous findings relating improvement in economic conditions to reduced adherence to the traditional Brazilian food consumption pattern based on the combination of rice and beans.

To investigate the role of severe physical violence during pregnancy (SPVP) between intimate partners in early cessation of exclusive breast-feeding (EBF).

A health services survey. The revised Conflict Tactics Scale was used to characterize SPVP; premature breast-feeding cessation was identified using a current status data approach, which was based on the information reported from food recall during the preceding 7 d. The cumulative hazard function was estimated by complementary log–log transformation models, which allowed the ensuing estimation of early breast-feeding cessation rates in different age groups and the ratio of rates of weaning between women exposed and not exposed to violence.

Five large public primary health-care facilities of Rio de Janeiro, Brazil.

The sample comprised 811 randomly selected mothers of children under 5 months of age who were waiting to be consulted.

SPVP is an independent risk factor of cessation of EBF since, after controlling for socio-economic, demographic, reproductive and lifestyle variables, women exposed to violence presented an incidence density that was 31 % higher than those who were not exposed (hazard ratio = 1·30, 95 % CI 1·01, 1·69).

The findings corroborate the hypothesis that SPVP is an important risk factor for EBF. This indicates the need for incentives to adequately train health-care personnel in dealing with lactating women in order to gain a broader view of breast-feeding beyond the biological aspects of lactation, including the maternal psychological dimension.

Obesity levels are rising in almost all parts of the world, including the UK. School food offers children in Great Britain between 25 % and 33 % of their total daily energy, with vending typically offering products high in fat, salt or sugar. Government legislation of 2007 to improve the quality of school food now restricts what English schools can vend. In assessing the effect of this legislation on the quality of English secondary-school vending provision, the response of schools to these effects is explored through qualitative data.

A longitudinal postal and visit-based inventory survey of schools collected vending data during the academic year 2006–2007 (pre-legislation), 2007–2008 and 2008–2009 (both post-legislation). Interviews with school staff explored issues of compliance. Product categorisation and analysis were carried out by product type, nutrient profiling and by categories of foods allowed or prohibited by the legislation.

English secondary schools.

A representative sample of 279 schools including sixty-two researcher-visited inventory schools participated in the research.

School vending seems to have moved towards compliance with the new standards – now drinks vending predominates and is largely compliant, whereas food vending is significantly reduced and is mostly non-compliant. Sixth form vending takes a disproportionate share of non-compliance. Vending has declined overall, as some schools now perceive food vending as uneconomic. Schools adopting a ‘whole-school’ approach appeared the most successful in implementing the new standards.

Government legislation has achieved significant change towards improving the quality of English school vending, with the unintended consequence of reducing provision.

To examine the associations between lifestyle factors and active commuting to school in Spanish adolescents.

Cross-sectional study. Lifestyle factors (overall/extracurricular physical activity, television viewing, reading as a hobby, sleep duration, breakfast/fruit intake, smoking and alcohol intake) as well as mode and duration of commuting to school were self-reported. Active commuters were defined as those adolescents who walked or cycled to school.

Secondary schools in Madrid, Spain.

Adolescents (n 2029) aged 13 to 17 years.

Similar percentages of adolescent boys (57·6 %) and girls (56·1 %) were classified as active commuters to school (P = 0·491). The analysis showed that only adequate sleep duration (OR = 1·35, 95 % CI 1·11, 1·66; P = 0·003) and breakfast consumption (OR = 0·66, 95 % CI 0·49, 0·87; P = 0·004) were independently associated with active commuting to school.

Only those behaviours that occur immediately before commuting to school (sleep and breakfast) are associated with active commuting in Spanish adolescents.

To compare the relative validity of food group intakes derived from a comprehensive self-administered diet history questionnaire (DHQ) and a brief-type DHQ (BDHQ) developed for the assessment of Japanese diets during the previous month using semi-weighed dietary records (DR) as a reference method.

Between November 2002 and September 2003, a 4 d DR (covering four non-consecutive days), a DHQ (150-item semi-quantitative questionnaire) and a BDHQ (fifty-eight-item fixed-portion-type questionnaire) were completed four times (once per season) at 3-month intervals.

Three areas in Japan: Osaka, Nagano and Tottori.

Ninety-two Japanese women aged 31–69 years and ninety-two Japanese men aged 32–76 years.

Median food group intakes were estimated well for approximately half of the food groups. No statistically significant differences were noted between a 16 d DR and the first DHQ (DHQ1) or between the DR and the first BDHQ (BDHQ1) in fifteen (44 %) and fifteen (52 %) food items for women and in fourteen (41 %) and sixteen (55 %) food items for men, respectively, indicating that both questionnaires estimated median values reasonably well. Median Spearman's correlation coefficients with the DR were 0·43 (range: −0·09 to 0·77) for DHQ1 and 0·44 (range: 0·14 to 0·82) for BDHQ1 in women, with respective values of 0·44 (range: 0·08 to 0·87) and 0·48 (range: 0·22 to 0·83) in men, indicating reasonable ranking ability. Similar results were observed for mean values of the four DHQ and BDHQ.

In terms of food intake estimates, both the DHQ and the BDHQ showed reasonable validity.

To identify food acquisition patterns in Brazil and relate them to the sociodemographic characteristics of the household.

A cross-sectional national Household Budget Survey (HBS). Principal component factor analysis was used to derive food patterns (factors) on the basis of the acquisition of food classified into thirty-two food groups.

The source of data originates from the 2002–2003 HBS carried out by the Brazilian Institute of Geography and Statistics between June 2002 and July 2003 using a representative sample of all Brazilian households.

A total of 48 470 households allocated into 443 strata of households that were geographically and socio-economically homogeneous as a study unit.

We identified two patterns of food acquisition. The first, named ‘dual’, was characterized by dairy, fruit, fruit juice, vegetables, processed meat, soft drinks, sweets, bread and margarine, and by inverse correlations with Brazilian staple foods. In contrast, the second pattern, named ‘traditional’, was characterized by rice, beans, manioc, flour, milk and sugar. The ‘dual’ pattern was associated with higher household educational level, income and the average age of adults on the strata, whereas the ‘traditional’ presented higher loadings in less-educated households and in the rural setting.

Dietary patterns described here suggest that policies and programmes to promote healthy eating need to consider that healthy and non-healthy foods may be integral in the same pattern.

To examine the accuracy of maternal ability to classify their children's weight status correctly using a verbal and a visual classification instrument and to detect significant correlates of maternal misperceptions.

Cross-sectional study.

Primary schools in four counties from north, west, central and south Greece.

A representative sample of 1858 primary-school children aged 9–13 years was examined. Two different instruments to assess maternal perceptions of their children's weight status, i.e. a verbal and a visual one, were used.

Verbal and visual maternal underestimation rates of children's weight status were 15·0 % and 41·3 %, respectively. The frequency of underestimation was much higher among overweight and obese children for both instruments. The highest underestimation rates of 87·9 % and 82·1 % in overweight and obese boys, respectively, were obtained with the visual instrument. Multiple logistic regression modelling revealed that the likelihood of both verbal and visual maternal underestimation of their children's weight status was significantly higher for overweight mothers and for those with a lower educational level. Furthermore, children's male gender and a nanny or someone other than the mother as the child's primary caregiver were found to increase the odds of visual and verbal maternal underestimation of children's weight status, respectively.

The present study showed that the verbal instrument used to assess maternal perceptions of their children's weight status was more accurate compared with the visual one. However, both instruments showed that a considerable number of overweight and obese boys had their weight status underestimated by their mothers. Educating mothers to classify their children's weight status correctly might be a key factor for the implementation of successful childhood obesity prevention initiatives.

The aim of the present study was to investigate the relationship between area-level socio-economic status and healthy and less healthy eating behaviours among adolescents and to determine whether the relationship between area-level socio-economic status and dietary behaviours was related to the relevant attitudes and environments.

Data were collected as part of Youth’07, a nationally representative survey of the health and well-being of New Zealand youth.

New Zealand secondary schools, 2007.

A total of 9107 secondary-school students in New Zealand.

Students from more deprived areas perceived more supportive school environments and cared as much about healthy eating as students in more affluent areas. However, these students were significantly more likely to report consuming fast food, soft drinks and chocolates.

Addressing area-level socio-economic disparities in healthy eating requires addressing the availability, affordability and marketing of unhealthy snack foods, particularly in economically deprived areas.

To compare and evaluate the reliability of several indexes of adherence to the Mediterranean diet.

The ten indexes included in the analysis were: Mediterranean Diet Score (MDS), Mediterranean Score (MS), Dietary Score (DS), Mediterranean-Dietary Quality Index (Med-DQI), Mediterranean Dietary Pattern adherence index (MDP), Mediterranean Adequacy Index (MAI), Mediterranean Style Dietary Pattern Score (MSDPS), Mediterranean food pattern PREDIMED Study (MeDiet-PREDIMED), relative Mediterranean diet (rMED) and Cardioprotective Mediterranean diet index. Factor analysis using the correlations between indexes was applied. The correlation with factors and the reliability coefficient were calculated.

A total of 324 healthy undergraduates at the University of Barcelona, Spain, were surveyed.

The highest correlations were observed between MDP adherence index and MAI (0·82); MAI and MSDPS (0·80); and MDS and rMED (0·77). Factor analysis showed a hidden common factor that explained over 70 % of the variability (71·03 %). This factor is understood as ‘adherence to the Mediterranean diet’. The indexes that showed the highest correlation with this factor were Med-DQI (0·85), MDS (0·84), rMED (0·80) and MAI (0·80). These indexes showed acceptable performance in measuring the adherence to the Mediterranean diet. The components that correlated strongly with this factor were monounsaturated-to-saturated fatty acid ratio (MS ratio), fruit and vegetables. Furthermore, a second common factor was found explaining 18 % of the variability. This second factor is highly positive related to dairy products and lean meat, and negative related to MS ratio.

The indexes showed satisfactory performance in assessing adherence to the Mediterranean diet. However, in order to improve the reliability and concordance between the indexes, further studies are required to select the components, the number of components, and the scoring criteria of the indexes to improve their internal consistency.

To assess the relationship between diet and disease, consideration of whole-diet indices may be more informative than single-nutrient intake. The present study was conducted to report the relationship among dietary diversity score (DDS), obesity and abdominal adiposity among female university students.

Cross-sectional study.

Isfahan, Iran.

A representative sample of 289 healthy female students aged 18–28 years was selected randomly from Isfahan University of Medical Sciences, Iran. Usual dietary intake was assessed using a validated semi-quantitative FFQ. DDS was calculated according to the scoring of the five food groups based on the US Department of Agriculture Food Guide Pyramid. This is a score of diet variety, and shows the diversity of the consumed diet. Participants were categorised on the basis of quartile cut-off points of DDS. Potential confounders such as age, total energy intake and physical activity were considered in all the analyses.

The means (sd) of BMI and waist circumference were 25·9 (sd 5·1) kg/m2 and 85·5 (sd 14) cm, respectively. The probability of obesity decreased with quartiles of DDS (OR among quartiles: 1·00, 0·41, 0·31 and 0·21, P = 0·03; this was the same for abdominal adiposity: 1·00, 0·55, 0·36 and 0·21, P = 0·02). Those in the lowest quartile of the DDS had the highest risk for being overweight.

There were inverse associations among DDS, obesity and abdominal adiposity among the female students of Isfahan University. Further prospective investigations are needed to confirm this finding.

To investigate the intakes of sugar-sweetened beverages (SSB), fruit and vegetables (FV) among adolescents and their parents and to explore differences in the perceived availability by gender and parental education.

Baseline data from the HEIA (HEalth In Adolescents) study.

Data on intake of SSB were collected assessing frequency and amounts, whereas consumption of FV was assessed on the basis of frequency. Further, perceived availability at home and at school (taken from home) was reported.

Participants were 1528 Norwegian adolescents aged 11 years, as well as 1200 mothers and 1057 fathers.

The adolescents’ intake of SSB was low on weekdays but doubled during weekend days. This pattern was observed among parents as well. There were significant differences in intake between boys, girls, mothers and fathers, except for vegetables. Fathers reported the lowest frequency of FV intake. Compared with adolescents, mothers reported lower availability of SSB and higher availability of FV. Compared with their sons, fathers reported higher availability of vegetables and lower availability of sugar-sweetened fruit drinks at school. Significant differences in adolescents’ intake of SSB and in the perceived availability of both SSB and FV by parental education were found.

The intake of SSB was higher during weekend days than during weekdays, whereas the frequency of FV intake was low. Differences in adolescents’ perceived availability of both SSB and FV on the basis of parental education were found, whereas the differences in intake were significant only for SSB. Increasing parental awareness of availability and their potential as role models across parental gender and educational level could improve adolescents’ dietary habits.

To develop a method to validate an FFQ for reported intake of episodically consumed foods when the reference instrument measures short-term intake, and to apply the method in a large prospective cohort.

The FFQ was evaluated in a sub-study of cohort participants who, in addition to the questionnaire, were asked to complete two non-consecutive 24 h dietary recalls (24HR). FFQ-reported intakes of twenty-nine food groups were analysed using a two-part measurement error model that allows for non-consumption on a given day, using 24HR as a reference instrument under the assumption that 24HR is unbiased for true intake at the individual level.

The National Institutes of Health–AARP Diet and Health Study, a cohort of 567 169 participants living in the USA and aged 50–71 years at baseline in 1995.

A sub-study of the cohort consisting of 2055 participants.

Estimated correlations of true and FFQ-reported energy-adjusted intakes were 0·5 or greater for most of the twenty-nine food groups evaluated, and estimated attenuation factors (a measure of bias in estimated diet–disease associations) were 0·4 or greater for most food groups.

The proposed methodology extends the class of foods and nutrients for which an FFQ can be evaluated in studies with short-term reference instruments. Although violations of the assumption that the 24HR is unbiased could be inflating some of the observed correlations and attenuation factors, results suggest that the FFQ is suitable for testing many, but not all, diet–disease hypotheses in a cohort of this size.

To identify pledges made by the food industry to change food marketing to children worldwide, examine their content and discuss their potential to reduce the harmful effects of food marketing to children.

A search for pledges and specific commitments made by participating companies and a content analysis of their scope and criteria used to define the marketing covered or excluded.

Global.

Food industry pledges.

Between 2005 and 2009, the food industry developed thirteen pledges on food marketing to children, involving fifty-two food companies. Two of the pledges were global, two were regional and nine applied to specific countries. Three were specific to the soft drinks industry and to the fast-food industry, with the rest being food industry wide. Ten of the pledges required companies to publish individual commitments; a total of eighty-two such commitments were published, many of which extended beyond the minimum standards set in the pledges. All pledges included definitions of children and child-targeted media, as well as the communication channels and marketing techniques covered, and permitted companies to set criteria for foods that are exempted from any restrictions. There were many similarities between the pledges and individual commitments; however, there were also many differences.

The development of pledges on food marketing to children in such a short span of time is impressive. However, limitations and inconsistencies in the pledges and commitments suggest that the food industry has a long way to go if its pledges are to comprehensively reduce the exposure and power of marketing to children.

To describe the lunchtime choices and nutritional intake of primary-school-aged children in England 4 months after the introduction of interim food-based standards for school lunches.

Cross-sectional 2 d weighed food records collected in January and February 2007.

Six primary schools in Sheffield, England.

One hundred and twenty-three pupils aged 8–10 years.

Vegetables (81 % v. 8 %) and cakes and biscuits (43 % v. 23 %) were chosen more frequently by pupils consuming a school lunch, while fruit (40 % v. 36 %), meat products (18 % v. 14 %), confectionery (72 % v. 0 %), savoury snacks (69 % v. 0 %) and drinks not meeting the school food standards (40 % v. 0 %) were chosen more often by pupils eating a packed lunch. Mean energy intake was lower in the school lunch group compared with the packed lunch group (1402 (sd 573) v. 2192 (sd 619), P = 0·005). Nutrient density (per MJ energy) was significantly better in school meals for key nutrients including protein (9·8 (sd 2·7) v. 6·3 (sd 1·9) g), fat (7·4 (sd 2·7) v. 10·6 (sd 2·8) g), NSP (2·8 (sd 1·3) v. 1·1 (sd 0·4) g), vitamin A (151·3 (sd 192·8) v. 69·1 (sd 55·6) μg), folate (29·6 (sd 11·6) v. 17·0 (sd 7·0) μg), iron (1·3 (sd 0·3) v. 0·9 (sd 0·3) mg) and zinc (1·1 (sd 0·4) v. 0·7 (sd 0·3) mg).

Schools were largely compliant with the interim food-based standards for school meals 4 months after their introduction. Within the context of the new standards, children taking a school lunch are more likely to eat a more nutritious lunch, in terms of less high-fat/salt/sugar foods and nutrient density. The introduction of nutrient-based standards is warranted. Efforts to improve the lunchtime intake of children taking a packed lunch are also required.

Supplements are an important source of micronutrient intake, which, unless taken into account, can misclassify individuals with regard to levels of nutrient exposure. A label-based vitamin and mineral supplements (ViMiS) database was developed to contain manufacturers’ information and to enter supplement use by participants in the European Prospective Investigation into Cancer and Nutrition in Norfolk (EPIC-Norfolk). The ViMiS database contains information on all ingredients, broken down into nutrient information in order to be combined with nutrient intake derived from food consumption.

Development of the ViMiS database and cross-sectional analysis of supplement use in a population-based study.

Men and women aged 40–79 years from the general population participating in the EPIC-Norfolk study between 1993 and 1997, with data available from 7 d diet diaries (7dDD).

A subset of 19 330 participants with available 7dDD and known supplement status.

To date, the ViMiS database includes 2066 supplements, which altogether contain 16 586 ingredients, with a median of eleven nutrient/ingredients per supplement. Forty per cent of the cohort took a supplement, of which cod liver oil was the most common (24·5 %).

The ViMiS database provides a flexible tool for estimating total nutrient intake. The high prevalence of supplement use in the general population indicates that supplement use needs to be taken into account when examining the relationship of intake of particular nutrients to health outcomes.