ROCZNIKI PAŃSTWOWEGO ZAKŁADU HIGIENY · mineral compounds may be from 20 to over 200 g in a litre...

ISSN 0035-7715

ROCZNIKIPAŃSTWOWEGOZAKŁADU HIGIENY

Quarterly2016Volume 67Number 1

EDITOR and PUBLISHER:NATIONAL INSTITUTE OF PUBLIC HEALTH– NATIONAL INSTITUTE OF HYGIENEWarsaw, Poland

ANNALSOF THE NATIONALINSTITUTE OF HYGIENE

ROCZNIKI PAŃSTWOWEGO ZAKŁADU HIGIENY[ANNALS OF THE NATIONAL INSTITUTE OF HYGIENE]

Volume 67 2016 Number 1

ORIGINAL ARTICLES

Natural mineral bottled waters available on the Polish market as a source of minerals for the consumers. Part 1. Calcium and magnesium.A. Gątarska, E. Tońska, J. Ciborska .................................................................................................................................. 1

Nutritional knowledge, diet quality and breast or lung cancer risk: a case-control study of adults from Warmia and Mazury region in Poland.I. Hawrysz, B. Krusińska, M.A. Słowińska, L. Wądołowska, A. Czerwińska, M. Biernacki ............................................. 9

Qualitative evaluation of diets of students at the University of the Third Age at Koszalin University of Technology. M. Kwiatkowska, Z. Walczak ............................................................................................................................................ 17

Frequency of consumption of foods rich in calcium and vitamin D among school-age children.M. Kostecka ...................................................................................................................................................................... 23

Association between general self-efficacy level and use of dietary supplements in the group of American football players.M. Gacek ........................................................................................................................................................................ 31

Relationship between diet and physical activity level in adolescents from post-grammar schools.A. Dmitruk, I. Kunicka, H. Popławska, W. Hołub ............................................................................................................ 37

Evaluation of selected dietary behaviours of students according to gender and nutritional knowledge.K. Zaborowicz, J. Czarnocińska, G. Galiński, P. Kaźmierczak, K. Górska, P. Durczewski ............................................. 45

Nutrition of students from dietetics profile education in the Siedlce University of Natural Sciences and Humanities compared with students from other academic centres. K. Kowalcze, Z. Turyk, M. Drywień ................................................................................................................................. 51

Evaluation of dietary intake of vitamins and minerals in 13-15-years-old boys from a sport school in Warsaw.B. Szczepańska, J. Malczewska-Lenczowska, B. Wajszczyk ............................................................................................. 59

Association of occupational stress factors on nicotine dependence among patients visiting dental care unit of Indo-Tibetian border police force station in India.K.S. Sandhu, V. Arora, N. Gupta, P. Gupta, M. Raja, N. Mehta ...................................................................................... 69

Tobacco smokers and electronic cigarettes users among Polish universities students.M.K. Zarobkiewicz, E. Wawryk-Gawda, M.M. Woźniakowski, M.A. Sławiński, B. Jodłowska-Jędrych ......................... 75

Impact of health and nutrition risks perception on the interest in pro-healthy food on the example of bread.M. Jeżewska-Zychowicz ................................................................................................................................................... 81

In memoriam: Professor Wiesław Magdzik, MD - Nestor of Polish Epidemiology (1932-2015).D. Naruszewicz-Lesiuk, A. Zieliński ................................................................................................................................. 89

Instruction for authors .................................................................................................................................................. 93

Abstracts and full texts open access: http://wydawnictwa.pzh.gov.pl/roczniki_pzh/roczniki

http://wydawnictwa.pzh.gov.pl/roczniki_pzh/

Rocz Panstw Zakl Hig 2016;67(1):1-8

* Corresponding author: Anna Gątarska, Uniwersytet Warmińsko-Mazurski w Olsztynie, Wydział Nauki o Żywności, Katedra Towaroznawstwa i Badań Żywności, Pl. Cieszyński 1, 10-957 Olsztyn, Poland, phone: +48 895234139, Fax +48 89 5233554, e-mail: [email protected]

© Copyright by the National Institute of Public Health - National Institute of Hygiene

ORIGINAL ARTICLE

NATURAL MINERAL BOTTLED WATERS AVAILABLE ON THE POLISH MARKET AS A SOURCE OF MINERALS FOR THE CONSUMERS.

PART 1. CALCIUM AND MAGNESIUM

Anna Gątarska1*, Elżbieta Tońska1, Joanna Ciborska2

1Department of Commodity Science and Food Research, Faculty of Food Science, University of Warmia and Mazury in Olsztyn, Poland

2Human Nutrition Department, Faculty of Food Science, University of Warmia and Mazury in Olsztyn, Poland

ABSTRACTBackground. Natural mineral waters may be an essential source of calcium, magnesium and other minerals. In bottled waters, minerals occur in an ionized form which is very well digestible. However, the concentration of minerals in under-ground waters (which constitute the material for the production of bottled waters) varies. In view of the above, the type of water consumed is essential.Objective. The aim of the study was to estimate the calcium and magnesium contents in products available on the market and to evaluate calcium and magnesium consumption with natural mineral water by different consumer groups with an as-sumed volume of the consumed product. Material and methods. These represented forty different brands of natural mineral available waters on Polish market. These waters were produced in Poland or other European countries. Among the studied products, about 30% of the waters were imported from Lithuania, Latvia, Czech Republic, France, Italy and Germany. The content of calcium and magnesium in mineral waters was determined using flame atomic absorption spectrometry in an acetylene-air flame. Further determinations were carried out using atomic absorption spectrometer - ICE 3000 SERIES-THERMO-England, equipped with a GLITE data station, background correction (a deuterium lamp) as well as other cathode lamps. Results. Over half of the analysed natural mineral waters were medium-mineralized. The natural mineral waters available on the market can be characterized by a varied content of calcium and magnesium and a high degree of product mineralization does not guarantee significant amounts of these components. Among the natural mineral waters available on the market, only a few feature the optimum calcium-magnesium proportion (2:1). Considering the mineralization degree of the studied products, it can be stated that the largest percentage of products with significant calcium and magnesium contents can be found in the high-mineralized water group.Conclusions. For some natural mineral waters, the consumption of 1 litre daily may ensure the recommended intake levels of calcium and magnesium in some consumer groups to a considerable degree. For 1-3 -year-old children it is recom-mended to consume less than 1 litre daily of natural mineral waters containing an excess of 700 mg of calcium and 80 mg of magnesium in 1 litre.

Key words: natural mineral water, minerals, calcium, magnesium, daily intake

STRESZCZENIEWprowadzenie. Naturalne wody mineralne należą do produktów, które mogą stanowić istotne źródło wapnia, magnezu czy innych związków mineralnych. Składniki mineralne w wodach butelkowanych występują w formie zjonizowanej, co daje dobrą ich przyswajalność. Niemniej jednak stężenie składników mineralnych w wodach podziemnych stanowiących surowiec do produkcji wód butelkowanych jest bardzo zróżnicowane. Wobec powyższego istotne znaczenie ma jaką wodę butelkowaną spożywamy.Cel. Celem badań było oznaczenie zawartości wapnia i magnezu w badanych wodach oraz ocena pobrania wapnia i magnezu z naturalną wodą mineralną przez różne grupy konsumentów przy założonej ilości spożywanego produktu. Materiał i metody. Materiał badawczy stanowiły naturalne wody mineralne (o różnym stopniu zmineralizowania), 40 różnych marek, dostępne na polskim rynku. Badane produkty były wyprodukowane w Polsce, jak i pochodziły z innych

A. Gątarska, E. Tońska, J. Ciborska2 No 1

krajów europejskich. Wśród badanych produktów około 30% stanowiły naturalne wody mineralne pochodzące z Litwy, Łotwy, Czech, Francji, Włoch i Niemiec. Ponad połowę badanych produktów stanowiły wody średniozmineralizowane. Zawartość wapnia i magnezu w wodach mineralnych oznaczano techniką płomieniowej spektrometrii absorpcji atomowej (ASA) w płomieniu acetylen-powietrze. Oznaczenia wykonano przy użyciu spektrometru absorpcji atomowej – ICE 3000 SERIES - THERMO - Anglia, wyposażonego w stację danych GLITE, korekcję tła (lampa deuterowa) oraz odpowiednie lampy katodowe. Wyniki. Naturalne wody mineralnych dostępne na polskim rynku charakteryzują się zróżnicowaną zawartością wapnia i ma-gnezu, a wysoki stopień mineralizacji produktu nie zawsze gwarantuje znaczące ilości tych składników. Spośród naturalnych wód mineralnych występujących na rynku zaledwie kilka charakteryzuje się optymalną proporcją wapnia do magnezu (2:1). Uwzględniając stopień mineralizacji badanych produktów można stwierdzić, że największy odsetek produktów o znaczącej zawartości wapnia i magnezu występuje w grupie wód mineralnych wysokozmineralizowanych. Wnioski. W przypadku części naturalnych wód mineralnych spożycie w ilości 1 litra dziennie może w znacznym stopniu zapewnić zalecane pobranie wapnia i magnezu dla wybranych grup konsumentów. Odnośnie naturalnych wód mineralnych o zawartości powyżej: 700 mg wapnia lub 80 mg magnezu w jednym litrze zaleca się spożycie w grupie dzieci w wieku 1-3 lat w ilości odpowiednio mniejszej niż 1 litr dziennie.

Słowa kluczowe: naturalna woda mineralna, składniki mineralne, wapń, magnez, dzienne pobranie

INTRODUCTION

A proper supply of mineral compounds, including calcium and magnesium, is very important for the proper development and functioning of the human body. These components play important physiological roles, for exam-ple, they constitute the material for bones, influence the course of metabolic processes and regulate the water-elec-trolyte balance [2, 7, 13, 27]. Many studies have shown that a deficiency in these components in diets increases the likelihood of the occurrence of many illnesses [11, 19].

Natural mineral waters may be an essential source of calcium, magnesium and other minerals [3, 10, 24, 29]. An amount such as 150 mg of calcium and 50 mg of magnesium in one litre of water is recognized as significant [2, 28]. In bottled waters, minerals occur in an ionized form which is very well digestible [20 – 23]. Moreover, other studies have shown that the bioavaila-bility of calcium and magnesium from natural mineral waters is comparable to that of milk [8, 9, 21].

The Polish bottled water market is very well-de-veloped and offers a dozen products, both of national origin and imported. Pursuant to a valid Regulation of the Minister of Health on natural mineral waters, spring waters and potable waters [25], which is compatible with the regulations of the European Union [5], natural mineral waters are distinguished among other bottled waters due to their mineral composition stability as well as properties of physiological importance with a benefi-cial effect on human health. However, the concentration of minerals in underground waters (which constitute the material for the production of bottled waters) varies. De-pending on geological conditions, the mineral composi-tion and occurrence of gases in the rocky environment, especially carbon dioxide, the overall content of soluble mineral compounds may be from 20 to over 200 g in a litre of water [1, 14, 15]. In view of the above, the type

of water consumed is essential. When making a choice of this type of product, consumers usually do not pay attention to mineral composition or nutritional value of a purchased product and often rely on their habits or sensory properties. However, the sensory properties of waters result from their chemical composition [18].

Among the minerals of bottled waters, special attention should be paid to calcium and magnesium. Previous studies have shown that bottled waters, inclu-ding natural mineral waters, are one of the main drinks consumed by children and youth [6, 16, 17]. Although the recommendations regarding sufficient daily water consumption in the form of drinks and other food pro-ducts for children and adults are from 1250 mL to over 2 litres/day, depending on population group [12], the results of previous investigations show that consumers drink considerably less [4].

The aim of the study was to estimate the calcium and magnesium contents in products available on the Polish market and to evaluate calcium and magnesium consumption with natural mineral water by different consumer groups with an assumed volume of the con-sumed product. For this reason the study was focused on determination of the following: • the real content of calcium, magnesium in the stu-

died products, • the percentage of calcium and magnesium intake

with natural mineral water in comparison with the Recommended Dietary Allowances (RDA) of these components in different age groups.

MATERIAL AND METHODS

Forty different types of bottled natural mineral water available on the Polish market were the study material. These represented forty different brands of natural mine-

Calcium and magnesium in natural mineral bottled waters. 3No 1

compounds. These values are as follows: for calcium from 4.48 to 314.36 mg/L, while for magnesium from 2.90 to 118.22 mg/L (Table 1). At such a wide volume range of these components, selection of a product by a consumer is of importance for nutrition. According to the current regulations, natural mineral waters are classified as low-mineralised, medium-mineralized and high-mineralised [25]. Over half (52%) of the waters were medium-mineralized, i.e. with the declared total

Table 1. Calcium and magnesium content in natural mineral waters

Trade name of productContent of

minerals, mg/LRatio

Ca:MgCa Mg

Low-mineralized natural mineral watersArtic 90.61 8.23 11:1Bolle 4.48 2.90 2:1Dobrowianka 65.77 21.50 3:1Evian 79.27 21.66 4:1Fonta de Medici 96.54 15.81 6:1Kropla Beskidu 47.58 12.61 4:1Neptunas 45.42 5.96 8:1Salinger 60.58 3.75 17:1Vilsa 59.53 3.46 17:1

Medium-mineralized natural mineral watersAugustowianka 66.37 26.16 2:1Cisowianka 136.48 21.29 6:1Everest 23.93 8.40 3:1Food & Joy Natural Mineral Water 166.69 17.24 10:1Grodziska Tesco 96.54 30.01 3:1Jurajska 78.31 37.63 2:1Kinga Pienińska 98.49 12.59 8:1Krystynka 171.53 50.13 3:1Magnesja 43.47 114.52 1:3Nałęczowianka 103.55 24.51 4:1Naturalna Woda Mineralna Sudety (Carrefour) 129.15 14.37 9:1

Naturalna woda mineralna Kaufland 117.80 29.69 4:1Perrier 185.71 4.84 38:1Polanica Tesco 121.83 12.47 10:1Polaris 110.19 15.59 7:1San Pellegrino 216.03 41.39 5:1Ustronianka 100.30 16.81 6:1Veroni Mineral 88.27 9.55 9:1Wielka Pieniawa 214.23 23.81 9:1Wielka Wieniecka 104.87 26.50 4:1Zdroje Piwniczna 123.70 47.85 3:1

High-mineralized natural mineral watersBorjomi 43.48 1:1Darida 50.02 2:1Kryniczanka 314.36 5:1Muszyna Skarb Życia 227.57 4:1Muszyna Tesco Cechini 288.05 5:1Muszynianka 198.40 2:1Naturalna Woda Miner. Piotr i Paweł 216.42 3:1

Staropolanka 230.56 5:1Wysowianka 110.49 3:1Źródła Muszyny 138.29 2:1

ral available waters on Polish market. These waters were produced in Poland or other European countries. Among the studied products, about 30% of the waters were from Lithuania, Latvia, Czech Republic, France, Italy and Germany. Experimental samples were taken randomly. An individual sample consisted of two package units of studied water originating from different production lots.

The content of calcium and magnesium in mineral waters was determined using flame atomic absorption spectrometry (ASA) in an acetylene-air flame. Further determinations were carried out using atomic absorption spectrometer - ICE 3000 SERIES-THERMO-England, equipped with a GLITE data station, background correc-tion (a deuterium lamp) as well as other cathode lamps at a wave length of 422.7 nm and 285.2 nm suitable for calcium and magnesium. Calcium and magnesium contents were determined using the AAS validated methods. The applied concentrations of the Ca and Mg standard solutions covered the measurement range of the analytical method, which was characterised by the linearity of the calibration curves. The limits of the me-asurement range assumed for calcium and magnesium, the formula and the co-efficient of the standard curve were as follows:Ca – 0.5-4.0 y= 0.0455x+0.0055 0.9995Mg – 0.05-0.8 y=1.1205x+0.058 0.9953

The likelihood ratio of the analytical methods was verified with an analysis of a certified reference material (Institute of Nuclear Chemistry and Technology). The following results were obtained: for calcium (g/kg) – certified value 5.82±0.5, determined value 5.78±0.58, recovery 99.1% and for magnesium (g/kg) - certified value 2.24±0.17, determined value 2.1±0.15, recovery 98.7%.

When determining the calcium content, a 10% wa-ter solution of lanthanum chloride was added to all the solutions under analysis, at a volume that would ensure a final concentration of La+3 of 0.5% [26]. Due to the influence of the present carbon dioxide on the accuracy of analyses, carbonated natural mineral waters were subject to de-carbonation prior to analyses.

The evaluation of minerals intake was carried out according to the Recommended Dietary Allowances [27]. Moreover, the daily consumption of natural mine-ral water was assumed at the level of 1 litre. The factors influencing component bioavailability in the body were not taken into account since they were not the focus of the study. The statistical analysis of results was carried out using Statistica 12 (StatSoft, USA).

RESULTS AND DISCUSSION

Calcium and magnesium content in the studied products The natural mineral waters available on the mar-

ket feature a wide variation in the content of mineral


content of minerals from 500 to 1500 mg per litre. Low--mineralised and high mineralized products were in the minority of all the analysed natural mineral waters and constituted 23% and 25%, respectively (Table 1).

When analysing product composition with regard to the degree of their mineralisation, it is clear that none of the products representing the low-mineralised natural mineral water group features a significant calcium or magnesium level (above 150 mg/L or 50 mg/L), respec-tively (Table 1). However, at the same time, this group of products is represented by waters in which the contents of determined minerals are higher in comparison with the values obtained for medium-mineralised or even high-mineralised natural mineral waters (Figure 1 a, b). Examples of this include: Artic and Fonta de Medici, in which the content of calcium is over twice higher than in some waters of higher degree of mineralisation (e.g. Magnesia, Borjomi). From among medium-minerali-sed natural mineral waters present on the market, only about 24% contain a significant content of calcium and only 14% contain a significant content of magnesium (Table 1). However, high-mineralised waters are mostly products with a significantly high content of calcium and magnesium (Table 1).

It should be underlined that the total content of all mineral compounds constitutes the general degree of mineralisation of a given bottled water, both cations and anions. Therefore, a higher degree of water mineralisa-tion is not directly connected with a higher content of calcium or magnesium compounds which are essential for the human body. In some natural high-mineralised bottled waters available on the market, a high degree of mineralisation results from a particularly high con-tent of sodium with a lower content of calcium and magnesium (based on the manufacturer’s data). Such

mineral composition is characteristic of Borjomi and Darida bottled waters. From a nutritional point of view, the calcium-magnesium ratio is essential for optimal utilisation of minerals in the body. The optimum value of this ratio should be 2:1 (Ca:Mg) [28]. From among natural mineral waters available on the market, only a few feature the optimum calcium-magnesium propor-tion (Table 1).

Calcium and magnesium intake with natural mineral water in comparison with the RDA in different age group of consumers

An adequate supply of calcium and magnesium is essential in every age. However, particularly high growth in the demand for these components occurs up to the age of 12-13 [28]. The determination of calcium and magnesium content in waters and the assumption of a daily consumption of the product at a volume of 1 litre allows for the estimation of a given water percentage in the RDA of a given mineral.

Among natural low-mineralised waters available on the market, all products provide calcium in an amount of below 20% of the amount recommended for children aged 1-3 years (Table 2). In older children and other population age groups, these products supply even lower levels of the Recommended Dietary Allowance of this component. In the group of medium mineralised waters, only 28% (six products) provide calcium at 20% or more in reference to the Recommended Dietary Allowance for the youngest group of children in 1 litre of consumed product (Table 3). However, only two products (San Pellegino, Wielka Pieniawa) can be regarded as an equally good source of this component in the nutrition of older children aged 10 years old. In case of a higher demand for calcium (persons above 10 years of age), the

Mediana 25%-75% Min-Maks Mg_N Mg_S Mg_W

0

20

40

60

80

100

120

140

Con

tent

of m

agne

sium

, m

g/l

N - low-mineralized natural mineral waterS – medium-mineralized natural mineral waterW- high-mineralized natural mineral water

Figure 1b. Magnesium content in natural mineral water

Mediana 25%-75% Min-Maks Ca_N Ca_S Ca_W

0

50

100

150

200

250

300

350

Con

tent

of c

alci

um ,

mg/

l

N - low-mineralized natural mineral waterS – medium-mineralized natural mineral waterW- high-mineralized natural mineral water

Figure 1a. Calcium content in natural mineral water


consumption of 1 litre of medium-mineralized mineral water supplies only about a dozen percent of the RDA of this component to the body (Table 3). In more than 50% of high-mineralised waters, the content of calcium is above 150 mg/L. These waters constitute a significant source of this mineral for children up to 10 years of age, and two of these waters (Kryniczanka, Muszyna Tesco Cechini), can cover even higher demands for this component (1300 mg/day), i.e. they provide at least 20% of the reference amount of this component when consumed at 1 litre per day (Table 4).

When analysing the low-mineralised natural waters available on the market as a source of magnesium, three products can be distinguished which contain higher magnesium contents (Dąbrowianka, Evian, Fonta de Medici). The consumption of 1 litre daily of these wa-ters provides about 20% of the Recommended Dietary Allowance only in children aged 1-3 years (Table 5). The remaining products at the same mineralisation level consumed in such a quantity can supply magnesium in only several to a dozen percent of the RDA. Among the medium-mineralized waters available on the market, the

Table 2. The percentage of the Recommended Dietary Allowances (RDA) for calcium at the assumed consumption of 1 litre of low- mineralized natural mineral water

Trade name of product

Children Girls Boys Woman MenAge (years)

1-3 4-6 7-9 10-12 13-15 16-18 10-12 13-15 16-18 19-30 31-50 51-65 19-30 31-50 51-65

Artic 12.94 9.06 9.06 6.97 6.97 6.97 6.97 6.97 6.97 9.06 9.06 7.55 9.06 9.06 9.06Bolle 0.64 0.44 0.44 0.34 0.34 0.34 0.34 0.34 0.34 0.44 0.44 0.37 0.44 0.44 0.44Dobrowianka 9.50 6.58 6.58 5.06 5.06 5.06 5.06 5.06 5.06 6.58 6.58 5.48 6.58 6.58 6.58Evian 11.32 7.93 7.93 6.10 6.10 6.10 6.10 6.10 6.10 7.93 7.93 6.61 7.93 7.93 7.93Fonta de Medici 13.79 9.65 9.65 7.43 7.43 7.43 7.43 7.43 7.43 9.65 9.65 8.05 9.65 9.65 9.65Kropla Beskidu 6.80 4.76 4.76 3.66 3.66 3.66 3.66 3.66 3.66 4.76 4.76 3.97 4.76 4.76 4.76Neptunas 6.48 4.54 4.54 3.49 3.49 3.49 3.49 3.49 3.49 4.54 4.54 3.79 4.54 4.54 4.54Salinger 8.65 6.06 6.06 4.66 4.66 4.66 4.66 4.66 4.66 6.06 6.06 5.05 6.06 6.06 6.06Vilsa 8.50 5.95 5.95 4.58 4.58 4.58 4.58 4.58 4.58 5.95 5.95 4.96 5.95 5.95 5.95

Table 3. The percentage of the Recommended Dietary Allowances (RDA) for calcium at the assumed consumption of 1 litre of medium- mineralized natural mineral water


Children Girls Boys Woman MenAge (yeras)

1-3 4-6 7-9 10-12 13-15 16-18 10-12 13-15 16-18 19-30 31-50 51-65 19-30 31-50 51-65

Augustowianka 9.48 6.64 6.64 5.11 5.11 5.11 5.11 5.11 5.11 6.64 6.64 5.53 6.64 6.64 6.64Cisowianka 19.50 13.65 13.65 10.50 10.50 10.50 10.50 10.50 10.50 13.65 13.65 11.37 13.65 13.65 13.65Everest 3.42 2.39 2.39 1.84 1.84 1.84 1.84 1.84 1.84 2.39 2.39 1.99 2.39 2.39 2.39Food&Joy Natural Mineral Water

23.81 16.67 16.67 12.82 12.82 12.82 12.82 12.82 12.82 16.67 16.67 13.89 16.67 16.67 16.67

Grodziska Tesco 13.79 9.65 9.65 7.43 7.43 7.43 7.43 7.43 7.43 9.65 9.65 8.05 9.65 9.65 9.65Jurajska 11.19 7.83 7.83 6.02 6.02 6.02 6.02 6.02 6.02 7.83 7.83 6.53 7.83 7.83 7.83Kinga Pienińska 14.07 9.85 9.85 7.58 7.58 7.58 7.58 7.58 7.58 9.85 9.85 8.21 9.85 9.85 9.85Krystynka 24.50 17.15 17.15 13.19 13.19 13.19 13.19 13.19 13.19 17.15 17.15 14.29 17.15 17.15 17.15Magnesja 6.21 4.35 4.35 3.34 3.34 3.34 3.34 3.34 3.34 4.35 4.35 3.62 4.35 4.35 4.35Nałęczowianka 14.79 10.36 10.36 7.97 7.97 7.97 7.97 7.97 7.97 10.36 10.36 8.63 10.36 10.36 10.36Naturalna Woda Mineralna Sudety (Carrefour)

18.45 12.92 12.92 9.93 9.93 9.93 9.93 9.93 9.93 12.92 12.92 10.76 12.92 12.92 12.92

Naturalna Woda Mineral. Kaufland 16.83 11.78 11.78 9.06 9.06 9.06 9.06 9.06 9.06 11.78 11.78 9.82 11.78 11.78 11.78

Perrier 26.43 18.57 18.57 14.29 14.29 14.29 14.29 14.29 14.29 18.57 18.57 15.48 18.57 18.57 18.57Polanica Tesco 17.40 12.18 12.18 9.37 9.37 9.37 9.37 9.37 9.37 12.18 12.18 10.15 12.18 12.18 12.18Polaris 15.74 11.02 11.02 8.46 8.46 8.46 8.46 8.46 8.46 11.02 11.02 9.18 11.02 11.02 11.02San Pellegrino 30.86 21.60 21.60 16.62 16.62 16.62 16.62 16.62 16.62 21.60 21.60 18.00 21.60 21.60 21.60Ustronianka 14.33 10.03 10.03 7.72 7.72 7.72 7.72 7.72 7.72 10.03 10.03 8.36 10.03 10.03 10.03Veroni Mineral 12.61 8.83 8.83 6.79 6.79 6.79 6.79 6.79 6.79 8.83 8.83 7.36 8.83 8.83 8.83Wielka Pieniawa 30.60 21.42 21.42 16.48 16.48 16.48 16.48 16.48 16.48 21.42 21.42 17.85 21.42 21.42 21.42Wielka Wieniecka 14.98 10.49 10.49 8.07 8.07 8.07 8.07 8.07 8.07 10.49 10.49 8.74 10.49 10.49 10.49Zdroje Piwniczna 17.67 12.37 12.37 9.52 9.52 9.52 9.52 9.52 9.52 12.37 12.37 10.31 12.37 12.37 12.37


Table 4. The percentage of the Recommended Dietary Allowances (RDA) for calcium at the assumed consumption of 1 litre of high- mineralized natural mineral water

Trade name of productChildren Girls Boys Woman Men

Age (years)1-3 4-6 7-9 10-12 13-15 16-18 10-12 13-15 16-18 19-30 31-50 51-65 19-30 31-50 51-65

Borjomi 6.21 4.35 4.35 3.34 3.34 3.34 3.34 3.34 3.34 4.35 4.35 3.62 4.35 4.35 4.35Darida 7.15 5.00 5.00 3.85 3.85 3.85 3.85 3.85 3.85 5.00 5.00 4.17 5.00 5.00 5.00Kryniczanka 44.91 31.44 31.44 24.18 24.18 24.18 24.18 24.18 24.18 31.44 31.44 26.20 31.44 31.44 31.44Muszyna Skarb Życia 32.51 22.76 22.76 17.51 17.51 17.51 17.51 17.51 17.51 22.76 22.76 18.96 22.76 22.76 22.76Muszyna Tesco Cechini 41.15 28.81 28.81 22.16 22.16 22.16 22.16 22.16 22.16 28.81 28.81 24.00 28.81 28.81 28.81Muszynianka 28.34 19.84 19.84 15.26 15.26 15.26 15.26 15.26 15.26 19.84 19.84 16.53 19.84 19.84 19.84Naturalna Woda Mineralna Piotr i Paweł 30.92 21.64 21.64 16.65 16.65 16.65 16.65 16.65 16.65 21.64 21.64 18.04 21.64 21.64 21.64

Staropolanka 32.94 23.06 23.06 17.74 17.74 17.74 17.74 17.74 17.74 23.06 23.06 19.21 23.06 23.06 23.06Wysowianka 15.78 11.05 11.05 8.50 8.50 8.50 8.50 8.50 8.50 11.05 11.05 9.21 11.05 11.05 11.05Źródła Muszyny 19.76 13.83 13.83 10.64 10.64 10.64 10.64 10.64 10.64 13.83 13.83 11.52 13.83 13.83 13.83

Table 5. The percentage of the Recommended Dietary Allowances (RDA) for magnesium at the assumed consumption of 1 litre of low- mineralized natural mineral water



1-3 4-6 7-9 10-12 13-15 16-18 10-12 13-15 16-18 19-30 31-50 51-65 19-30 31-50 51-65Artic 10.29 6.33 6.33 3.43 2.29 2.29 3.43 2.00 2.00 2.65 2.57 2.57 2.06 1.96 1.96Bolle 3.63 2.23 2.23 1.21 0.81 0.81 1.21 0.71 0.71 0.94 0.91 0.91 0.73 0.69 0.69Dobrowianka 26.88 16.54 16.54 8.96 5.97 5.97 8.96 5.24 5.24 6.94 6.72 6.72 5.38 5.12 5.12Evian 27.08 16.66 16.66 9.03 6.02 6.02 9.03 5.28 5.28 6.99 6.77 6.77 5.42 5.16 5.16Fonta de Medici 19.76 12.16 12.16 6.59 4.39 4.39 6.59 3.86 3.86 5.10 4.94 4.94 3.95 3.76 3.76Kropla Beskidu 15.76 9.70 9.70 5.25 3.50 3.50 5.25 3.08 3.08 4.07 3.94 3.94 3.15 3.00 3.00Neptunas 7.45 4.58 4.58 2.48 1.65 1.65 2.48 1.45 1.45 1.92 1.86 1.86 1.49 1.41 1.41Salinger 4.69 2.88 2.88 1.56 1.04 1.04 1.56 0.91 0.91 1.21 1.17 1.17 0.94 0.89 0.89Vilsa 4.33 2.66 2.66 1.44 0.96 0.96 1.44 0.84 0.84 1.12 1.08 1.08 0.87 0.82 0.82

Table 6. The percentage of the Recommended Dietary Allowances (RDA) for magnesium at the assumed consumption of 1 litre of medium- mineralized natural mineral water



1-3 4-6 7-9 10-12 13-15 16-18 10-12 13-15 16-18 19-30 31-50 51-65 19-30 31-50 51-65Augustowianka 32.70 20.12 20.12 10.90 7.27 7.27 10.90 6.38 6.38 8.44 8.18 8.18 6.54 6.23 6.23Cisowianka 26.61 16.38 16.38 8.87 5.91 5.91 8.87 5.19 5.19 6.87 6.65 6.65 5.32 5.07 5.07Everest 10.50 6.46 6.46 3.50 2.33 2.33 3.50 2.05 2.05 2.71 2.63 2.63 2.10 2.00 2.00Food&Joy Natural Mineral Water 21.55 13.26 13.26 7.18 4.79 4.79 7.18 4.20 4.20 5.56 5.39 5.39 4.31 4.10 4.10

Grodziska Tesco 37.57 23.08 23.08 12.50 8.34 8.34 12.50 7.32 7.32 9.68 9.38 9.38 7.50 7.15 7.15Jurajska 47.04 28.95 28.95 15.68 10.45 10.45 15.68 9.18 9.18 12.14 11.76 11.76 9.41 8.96 8.96Kinga Pienińska 15.74 9.68 9.68 5.25 3.50 3.50 5.25 3.07 3.07 4.06 3.93 3.93 3.15 3.00 3.00Krystynka 62.66 38.56 38.56 20.89 13.93 13.93 20.89 12.23 12.23 16.17 15.66 15.66 12.53 11.94 11.94Magnesja 143.15 88.09 88.09 47.72 31.81 31.81 47.72 27.93 27.93 36.94 35.79 35.79 28.63 27.27 27.27Nałęczowianka 30.64 18.85 18.85 10.21 6.81 6.81 10.21 5.98 5.98 7.91 7.66 7.66 6.13 5.84 5.84Naturalna woda mineralna Sudety (Carrefour)

17.96 11.05 11.05 5.99 3.99 3.99 5.99 3.50 3.50 4.64 4.49 4.49 3.59 3.42 3.42

Naturalna woda mineral. Kaufland 37.11 22.84 22.84 12.37 8.25 8.25 12.37 7.24 7.24 9.58 9.29 9.29 7.42 7.07 7.07

Perrier 6.05 3.72 3.72 2.10 1.34 1.34 2.10 1.18 1.18 1.56 1.51 1.51 1.21 1.15 1.15Polanica Tesco 15.59 9.59 9.59 5.20 3.46 3.46 5.20 3.04 3.04 4.02 3.90 3.90 3.12 2.97 2.97Polaris 19.49 11.99 11.99 6.78 4.33 4.33 6.78 3.80 3.80 5.03 4.87 4.87 3.90 3.71 3.71San Pellegrino 51.74 31.84 31.84 17.25 11.50 11.50 17.25 10.09 10.09 13.35 12.93 12.93 10.45 9.85 9.85Ustronianka 21.01 12.93 12.93 7.00 4.70 4.70 7.00 4.10 4.10 5.42 5.25 5.25 4.20 4.00 4.00Veroni Mineral 11.94 7.35 7.35 3.98 2.65 2.65 3.98 2.33 2.33 3.08 2.98 2.98 2.39 2.27 2.27Wielka Pieniawa 29.76 18.32 18.32 9.92 6.61 6.61 9.92 5.81 5.81 7.68 7.44 7.44 5.95 5.67 5.67Wielka Wieniecka 33.13 20.38 20.38 11.04 7.36 7.36 11.04 6.46 6.46 8.55 8.28 8.28 6.63 6.31 6.31Zdroje Piwniczna 59.81 36.81 36.81 19.94 13.29 13.29 19.94 11.67 11.67 15.44 14.95 14.95 11.96 11.39 11.39


Table 7. The percentage of the Recommended Dietary Allowances (RDA) for magnesium at the assumed consumption of 1 litre of high-mineralized natural mineral water

Trade name of productChildren Girls Boys Woman Men

Age (years)1-3 4-6 7-9 10-12 13-15 16-18 10-12 13-15 16-18 19-30 31-50 51-65 19-30 31-50 51-65

Borjomi 38.06 23.42 23.42 12.69 8.46 8.46 12.69 7.43 7.43 9.82 9.52 9.52 7.61 7.25 7.25Darida 31.86 19.61 19.61 10.62 7.08 7.08 10.62 6.22 6.22 8.22 7.97 7.97 6.37 6.07 6.07Kryniczanka 81.40 50.09 50.09 27.13 18.09 18.09 27.13 15.88 15.88 21.01 20.35 20.35 16.28 15.50 15.50Muszyna Skarb Życia 68.54 68.54 68.54 22.85 15.23 15.23 22.85 13.37 13.37 17.69 17.13 17.13 13.71 13.05 13.05Muszyna Tesco Cechini 75.71 46.59 46.59 25.24 16.83 16.83 25.24 14.77 14.77 19.54 18.93 18.93 15.14 14.42 14.42Muszynianka 147.78 90.94 90.94 49.26 32.84 32.84 49.26 28.83 28.83 38.14 36.94 36.94 29.56 28.15 28.15Naturalna Woda Mineralna Piotr i Paweł 87.96 54.13 54.13 29.32 19.55 19.55 29.32 17.16 17.16 22.70 21.99 21.99 17.59 16.75 16.75

Staropolanka 58.59 36.05 36.05 19.53 13.02 13.02 19.53 11.43 11.43 15.12 14.65 14.65 11.72 11.16 11.16Wysowianka 44.05 27.11 27.11 14.68 9.79 9.79 14.68 8.59 8.59 11.37 11.01 11.01 8.81 8.39 8.39Źródła Muszyny 69.94 43.04 43.04 23.31 15.54 15.54 23.31 13.65 13.65 18.05 17.48 17.48 13.99 13.32 13.32

majority of products when consumed at 1 litre daily to a significant degree cover the Recommended Dietary Allowance determined for children aged 1-3 years (Table 6). For higher demands for this component, in children between 4 and 9 years of age, only about 50% of products at medium mineralisation degree consump-tion of the assumed quantity of water will supply enough calcium to meet at least 20% of RDA. For adults with high demand (420 mg/day/person) for this component, Magnesja, a medium-mineralized water, can constitute a significant amount of magnesium. This product, along with Muszynianka, a high-mineralised water, is a rich source of magnesium, whose consumption covers up to about 30% of the RDA for this age group. Due to the high content of magnesium in both above-mentioned products, their consumption in the assumed amount is not recommended for children aged below 3 years since it would cause an excessive supply of this component. The recommendations of the Institute of Mother and Child concerning the nutrition of 1-3 -year-old children include the use of low-carbonated water to prevent the intake of excessive levels of mineral elements com-pared to the daily recommended intake. However, the composition of natural mineral water products available on the market is highly varied. The majority of the water products, including those with declared general high--carbonation levels, are characterised by a low content of both calcium and magnesium. Therefore, although eliminating the use of highly-mineralised waters in the nutrition of small children is not excluded, products with contents above of 700 mg Ca/L and 80 mg Mg/L water should be excluded or limited. It is therefore essential to analyse information provided on product packaging and to adjust the consumed amounts to the consumer’s age. The consumption of other high-mineralised waters in the assumed amounts covers the Recommended Die-tary Allowance for magnesium for about 20% to 70% in children up to 9 years of age (Table 7). Moreover, the majority of these products consumed at 1 litre daily

will also be a significant source of this component – at a level of 20 - 30% RDA particularly for 10-12-year olds.

Based on the results of other investigators, only about 13% of university students drink high-mineralised bottled water, which can provide an particularly essen-tial source of calcium and magnesium [4]. Moreover, the choice of an adequate mineral composition of bottled water is particularly important in diagnosing calcium supply deficiencies in a diet [19].

CONCLUSIONS

1. The natural mineral waters available on the Polish market can be characterised by a varied content of calcium and magnesium and a high degree of pro-duct mineralisation, although they do not always guarantee significant amounts of these components.

2. Considering the mineralisation degree of the studied products, it can be stated that the largest percentage of products with significant contents of calcium and magnesium can be found in the high-mineralised water group.

3. For some natural mineral waters, the consumption of 1 litre daily may ensure the recommended intake levels of calcium and magnesium in some consumer groups to a considerable degree.

4. For 1-3 -year-old children it is recommended to consume less than 1 litre daily of natural mineral waters containing an excess of 700 mg of calcium and 80 mg of magnesium in 1 litre.

Conflict of interestThe authors declare no conflict of interest.

REFERENCES

1. Astel, A., Michalski, R., Łyko, A., Jabłońska-Czapla, M., Bigus, K., Szopa, S., Kwiecińska, A.: Characterization of


bottled mineral waters marketed in Poland using hierar-chical cluster analysis. J Geoch Explor 2014;143:136-145.

2. Błaszczyk U., Tuszyński T.: Mineral waters and their meaning in wholesome prophylaxis. Lab 2007;4:20-23 (in Polish).

3. Derkowska-Sitarz M., Adamczyk-Lorenc A.: Influence of minerals dissolved in drinking waters on human organism. Pr Nauk Inst Górn Polit Wroc Górnictwo i Geologia. Seria: Studia i Materiały 2008;123(34):39-48 (in Polish).

4. Drywień M., Nadolna A.: Assessment of mineral bottled water as a source of selected minerals among students. Rocz Panstw Zakl Hig 2012; 63(3):347-352 (in Polish) [PMID: 23173340; http://www.ncbi.nlm.nih.gov/pub-med/23173340].

5. Directive of the European Parliament and the Council No. 2009/54/EC of 18 June 2009 on the exploitation and marketing of natural mineral waters.

6. Gątarska A.: Bottled water in the diet of preschoolers. Tow. Probl. Jakości /Polish J. Com. Sci. 2015;2(43):43-47.

7. Grober U.: Nutritional microelements. Metabolic tuning – prophylaxis – theraphy. MedPharm Polska Wrocław 2010: 159-164 (in Polish).

8. Heaney R.P.: Quantifying human calcium absorption using pharmacokinetic metods. J Nutr 2003;133:1224-1226.

9. Heaney R.P.: Absorbability and utility of calcium in mineral waters. Am J Clin Nutr 2006;84:371-374.

10. Hoffmann M.: Mineral waters as a source of selec-ted mineral elements in a diet Żyw Człow Metab 2007;34(1/2):348-352 (in Polish, English abstract).

11. Januszko O., Madej D., Postaleniec E., Brzozowska A., Pietruszka B., Kałuża J.: Minerals intake from drink-ing water by young women. Rocz Panstw Zakl Hig 2012;63(1):43-50 (in Polish) [PMID: 22642069; http://www.ncbi.nlm.nih.gov/pubmed/22642069].

12. Jarosz M., Szponar L., Rychlik E., Wierzejska R.: Woda i elektrolity. W: Normy żywienia dla populacji polskiej. Red. M. Jarosz, IŻiŻ, Warszawa, 2012, 143-153 (in Polish)

13. Kiss S.A., Forster T., Dongo A.: Absorption and effect of the magnesium content of a mineral water In the human body. J Am Coll Nutr 2004;23:758-762.

14. Krzych Ł., J., Błońska-Fajfrowska B., Kuła A., Misik D.: Characteristics of bottled waters available for purchase in the Silesia region. Rocz Panstw Zakl Hig 2010;61(1):37-43 (in Polish) [PMID: 20803898; http://www.ncbi.nlm.nih.gov/pubmed/20803898].

15. Latour T., Czajka K., Sziwa D.: The water of natural ori-gin as products in helping dietetic nutrition. Żyw Człow Metab 2006;33(3):229-234 (in Polish, English abstract).

16. Łoboda D., Gawęcki J.: Intake of liquids in the diet of a chosen group of teenagers and their body content. Probl Hig Epidemiol 2011;92(1):83-88 (in Polish, English abstract).

17. Marcinowska U., Gałeczka M., Kukowa K., Kania M., Lau K., Jaśko-Ochojska J.: Changes in beverage consumption among youth. Probl Hig Epidemiol 2014; 95(4): 907-911 (in Polish, English abstract).

18. Marcussen, H., Holm, P.E., Hansen, H.C.B.: Composi-tion, flavor, chemical food safety, and consumer prefe-rences of bottled water. Compr Rev Food Sci Food Saf 2013;12(4):333-352.

19. Markiewicz R., Borawska M.H., Socha K., Gutowska A: Calcium and magnesium in diets of people from Podlasie region. Bromat Chem Toksykol 2009;42(3):629-635 (in Polish, English abstract).

20. Masenjka K.: Natural mineral waters and health. Farm. Glasnik 2010;66(5):285-293.

21. Miele E., Staiano A., Ummarino D., Auricchio S.: Mineral content of bottled waters: Implications for health and disease. It J Pediatr 2007;33(1):41-47.

22. Nakamura, E., Tai, H., Uozumi, Y., Nakagawa, K., Mat-sui, T.: Magnesium absorption from mineral water decreases with increasing quantities of magnesium per serving in rats. Nutr Res 2012;32(1):59-65.

23. Petraccia L., Liberati G., Giuseppe Mosciullo S., Grassi M., Fraioli A.: Water, mineral waters and health. Clin Nutr 2006;25,377-385.

24. Pietruszka B., Kołłajtis-Dołowy A.: Oligocene and bottled water as a source of sodium in everyday diet of adults. Pol J Food Nutr Sci 2007;57:247-252.

25. Rozporządzenie Ministra Zdrowia z dnia 31 marca 2011 r. w sprawie naturalnych wód mineralnych, wód źródlanych i wód stołowych. Dz. U. nr 85, poz. 466 z dnia 7.05.2011 r. (in Polish).

26. Whiteside P., Miner B., Pye Unicam Atomic Absorption Data Book. Pye Unicam LTD. Cambridge, 1984, En-gland.

27. Wojtasik A., Jarosz M., Stoś K.: Składniki mineralne, W: Normy żywienia dla populacji polskiej. Red. M. Jarosz, IŻiŻ, Warszawa 2012, 123-142 (in Polish).

28. Wojtaszek T. : Prophilactic - wholesome function mineral waters. J. Elementol. 2006;11:119-126 (in Polish, English abstract).

29. Wynn E., Raetz E., Burchardt P.: The composition of mineral waters sourced from Europe and North America in respect to bone health. Composition of mineral water optimal for bone. Br J Nutr 2009;101:1195-1199.

Received: 08.10.2015Accepted: 22.01.2016



*Corresponding author: Iwona Hawrysz, Katedra Żywienia Człowieka, Uniwersytet Warmińsko-Mazurski w Olsztynie, Słoneczna 45F, 10-719 Olsztyn, Poland, phone: +48 89 523-55-15, e-mail: [email protected]


ORIGINAL ARTICLE

NUTRITIONAL KNOWLEDGE, DIET QUALITY AND BREAST OR LUNG CANCER RISK: A CASE-CONTROL STUDY OF ADULTS FROM WARMIA AND MAZURY REGION IN POLAND

Iwona Hawrysz1*, Beata Krusińska1, Małgorzata Anna Słowińska1, Lidia Wądołowska1, Anna Czerwińska2, Maciej Biernacki3

1 Department of Human Nutrition, University of Warmia and Mazury in Olsztyn, Poland2Independent Public Complex Tuberculosis and Lung Diseases in Olsztyn, Poland

3Department of Surgery, University of Warmia and Mazury in Olsztyn, Poland

ABSTRACTBackground. Knowledge on proper nutrition favours the creation of pro-healthy nutritional behaviours of people. Studies related to the nutritional knowledge of adults, diet quality and incidence of breast or lung cancers are limited.Objective. Analysis of the relationship between the level of nutritional knowledge, diet quality and risk of breast cancer in women or lung cancer in men from the Warmia and Mazury region in Poland.Material and methods. The study was carried out in 202 subjects aged 23-80 years, including 107 women (17 cases of breast cancer) and 95 men (54 cases of lung cancer) from the Warmia and Mazury region in Poland. Nutritional knowledge was evaluated with the Questionnaire of Eating Behaviours (QEB), including 25 statements. Based on the frequency of the consumption of 16 food items, two diet quality indices were created: the pro-Healthy-Diet-Index-8 (pHDI-8) and the non-Healthy-Diet-Index-8 (nHDI-8). The values of pHDI-8 and nHDI-8 were calculated on the basis of the sum of the daily frequency of consumption of the selected food items and expressed as times/day. The Odds Ratio (OR) of both breast cancer or lung cancer in relation to the level of nutritional knowledge was calculated based on a logistic regression analysis.Results. The incidence of breast or lung cancer in the bottom, middle and upper tertile of nutritional knowledge was 57.6%, 32.6% and 15.8%, respectively. As nutritional knowledge grew in the subsequent tertiles, pHDI-8 was on the increase (2.63 vs. 3.78 vs. 4.22 times/day) and n-HDI-8 was on the decrease (1.32 vs. 1.21 vs. 0.94 times/day). In the upper tertile of nutritional knowledge, the Odds Ratio for the incidence of breast or lung cancers varied from 0.06 (95% CI: 0.02; 0.17; p<0.05, with adjustment for cancer type and age) to 0.17 (95% CI: 0.04; 0.69; p<0.05, with adjustment for age and sex) when compared to the bottom tertile (OR=1.00). In the middle tertile of nutritional knowledge, the Odds Ratio of both cancers varied from 0.27 (95% CI: 0.12; 0.62, p<0.05, with adjustment for cancer type and age) to 0.35 (95% CI: 0.18; 0.71, p<0.05, variables without adjustment) when compared to the bottom tertile.Conclusions. A higher level of nutritional knowledge was associated with the higher quality of a pro-healthy diet and lower risk of breast cancer in women or lung cancer in men. In contrast, a lower level of nutritional knowledge was associated with a lower diet quality and a higher risk of both types of cancers.

Key words: nutritional knowledge, diet quality, breast cancer, lung cancer

STRESZCZENIEWprowadzenie. Wiedza na temat prawidłowego żywienia sprzyja kształtowaniu prozdrowotnych zachowań żywieniowych ludzi. Badania dotyczące wiedzy żywieniowej osób dorosłych w powiązaniu z jakością diety oraz częstością występowania raka piersi lub płuc są ograniczone.Cel. Analiza zależności między poziomem wiedzy żywieniowej, jakością diety i ryzykiem raka piersi u kobiet lub płuc u mężczyzn z regionu Warmii i Mazur w Polsce.Materiał i metody. Badania przeprowadzono wśród 202 osób w wieku 23-80 lat, w tym u 107 kobiet (17 przypadków raka piersi) i 95 mężczyzn (54 przypadki raka płuc) z regionu Warmii i Mazur. Wiedzę żywieniową respondentów oceniono za pomocą zestawu 25 stwierdzeń na temat żywności i żywienia z kwestionariusza o akronimie QEB. Na podstawie częstości spożycia 16 grup żywności utworzono dwa indeksy jakości diety: Indeks Prozdrowotnej Diety (pHDI-8) i Indeks Niezdrowej Diety (nHDI-8). Indeksy pHDI-8 i nHDI-8 obliczono przez sumowanie dziennej częstości spożycia odpowiednich grup

I. Hawrysz, B. Krusińska, M.A. Słowińska et al.10 No 1

żywności i wyrażono jako krotność/dzień. Za pomocą regresji logistycznej obliczono iloraz szans (OR) wystąpienia raka piersi lub płuc w relacji do poziomu wiedzy żywieniowej.Wyniki. Występowanie raka piersi lub płuc w dolnym, środkowym i górnym tercylu wiedzy żywieniowej wynosiło odpo-wiednio 57,6%, 32,6% i 15,8%. Wraz ze wzrostem wiedzy żywieniowej w kolejnych tercylach rósł wskaźnik pHDI-8 (2,63 vs 3,78 vs 4,22 krotność/dzień) oraz malał wskaźnik n-HDI-8 (1,32 vs 1,21 vs 0,94 krotność/dzień). W górnym tercylu wiedzy żywieniowej iloraz szans wystąpienia raka piersi lub płuc wynosił od 0,06 (95% CI: 0,02; 0,17; p<0,05, z adjustacją na rodzaj raka i wiek) do 0,17 (95% CI: 0,04; 0,69; p<0,05, z adjustacją na wiek i płeć) w porównaniu z dolnym tercylem (OR=1,00). W środkowym tercylu wiedzy żywieniowej ryzyko obu raków wynosiło od 0,27 (95% CI: 0,12; 0,62, p<0,05, z adjustacją na rodzaj raka i wiek) do 0,35 (95% CI: 0,18; 0,71 p<0,05, zmienne nieadjustowane) w porównaniu z dolnym tercylem.Wnioski. Większy poziom wiedzy żywieniowej był związany z lepszą jakością prozdrowotną diety i mniejszym ryzykiem wystąpienia raka piersi u kobiet lub płuc u mężczyzn. Z kolei mniejszy poziom wiedzy żywieniowej był związany z gorszą jakością diety i większym ryzykiem wystąpienia obu raków.

Słowa kluczowe: wiedza żywieniowa, jakość diety, rak piersi, rak płuc

INTRODUCTION

On average, 38 million people die due to chronic non communicable diseases all around the world. Most deaths are caused by: cardiovascular diseases (17.5 million), cancers (8.2 million), respiratory diseases (4 million) and diabetes (1.5 million) [25]. In the Polish population, the most prevalent types of cancer are: in men – lung cancer (20%), prostate cancer (14%) and colon cancer (12%), and in women – breast cancer (20%), colon cancer (10%) and lung cancer (9%) [14].

The aetiology of breast and lung cancer is not yet completely known in spite of many studies [2, 10]. Therefore, the identification of risk factors becomes par-ticularly important. Reduction of the incidence of breast or lung cancer is feasible mainly due to the avoidance of modifiable risk factors. An expert report, which was published by the World Cancer Research Fund (WCRF) and American Institute for Cancer Research (AICR) [24] in 2007, identified foods which can be associated with the risk of development of breast or lung cancer. The relationship, however, has not yet been confirmed and requires further studies.

The primary condition for the success of a nutritio-nal policy is an increase in the public awareness of the relationship between nutrition and health. Nutritional education increases the level of knowledge of society and enables a conscious selection of food [3]. This favours the creation of desirable, pro-healthy views, at-titudes and nutritional human behaviour [11]. There are limited studies on the relationship between the level of adult nutritional knowledge, diet quality and incidence of breast or lung cancer. No relevant studies have been performed in the northern and eastern region of Poland.

The aim of the study was evaluation of the rela-tionship between the level of nutritional knowledge, diet quality and risk of breast cancer in women or lung cancer in men from the Warmia and Mazury region.


SubjectsThe study was carried out from July 2013 to Sep-

tember 2014. The study in women was performed at the Hospital of the Ministry of Internal Affairs with Warmia and Mazury Oncology Centre in Olsztyn and the Centre for Prevention and Diagnostics of Breast Diseases in Olsztyn. The study in men was performed at the Independent Public Complex Tuberculosis and Lung Diseases in Olsztyn and in selected health clinics of the lung diseases diagnostics in the Warmia and Mazury region.

The inclusion criteria to the study were related to examinations which were performed within the last 6 months and which included: in women – an ultrasound (USG) and/or mammogram, in men – X-ray examina-tion and/or computed tomography of the thorax and/or bronchoscopy. The exclusion criteria to the study were: (i) the coexistence of cancer(s) other than breast/lung cancer, (ii) nonmalignant cancers, (iii) age below 18 years, (iiii) place of residence outside the Warmia and Mazury region, (iiiii) pregnancy in women. Patients with positive biopsy results or/and of a histopathology were included into the “cancer” group, and with a con-firmed negative result – to the “control” group.

Finally, the study was carried out in 202 subjects aged 23-80 years, including 107 women (17 cases of breast cancers) and 95 men (54 cases of lung cancer) from the Warmia and Mazury region of Poland. The characteristics of the study subjects are provided in Table 1. The study was approved by the Bioethics Com-mittee of the Faculty of Medical Sciences, University of Warmia and Mazury in Olsztyn on 2 October 2013 (Resolution No. 29/2013). Written consent to participate in the study was required.

Nutritional knowledgeData on nutritional knowledge was collected with

the Questionnaire of Eating Behaviours (QEB), which

Nutritional knowledge and cancer risk: a case-control study. 11No 1

was developed by the Sections of Behavioural Con-ditions of Nutrition, Committee of Human Nutrition Science, Polish Academy of Sciences [22]. The Qu-estionnaire included twenty-five statements related to nutritional knowledge. The reliability of all statements was confirmed with the Cronbach’s alpha analysis. A respondent was provided with three options with regard to each statement on food and nutrition, and they inc-luded: “I agree”, “I don’t agree”, “I have no opinion”. Each correct answer was scored with 1, and a wrong answer and “I have no opinion” were scored with 0. The sum of points was calculated for each respondent (range: 0-25). Based on the sum, the respondents were divided into 3 tertiles of nutritional knowledge:• bottom tertile <11 points,• middle tertile from 11 to 15 points,• upper tertile >15 points.

Frequency of food consumptionFrequency of food consumption was defined with

the Questionnaire of Eating Behaviours. Respondents were asked to specify the habitual frequency of the consumption of 16 selected foods which were consumed on average within the last year. They were provided with 6 categories of the answer, which were converted

into daily frequency (times/day): “never” (0), 1-3 times a month (0.06), once a week (0.14), several times a week (0.5), once a day (1), several times a day (2) [22]. Two diet quality indices were created by summing up the daily frequency of the consumption of the selected food items:• pro-Healthy-Diet-Index-8 (pHDI-8; range: 0-16

times/day) – which included 8 food items: fruit, ve-getables, wholemeal bread, fermented milk drinks (yoghurt, kefir, etc.), milk (including flavoured milk), cottage cheese (including cream cheese), fish or fish-based dishes, legumes-based dishes;

• non-Healthy-Diet-Index-8 (nHDI-8; range: 0-16 times/day) – which included 8 food items: sweets or confectionery, fried food, alcoholic beverages, sweetened carbonated drinks, canned: meat, fish and vegetables-meat, instant or ready-to-eat con-centrated soups, fast food, energy drinks.

Data analysisThe normality of variables was verified with the

Kolmogorov-Smirnov test. The means and standard de-viations (SDs) were calculated for the frequency of con-sumption of each food item, as well as both diet quality indexis. All variables were logarithmically transformed

Table 1. Characteristics of the sample

Characteristics Total Control Cancern % n % n %

Total sample number 202 100 131 64.8 71 35.2SexFemale 107 52.5 90 68.7 17 23.9Male 95 47.5 41 31.3 54 76.1Size of place of residenceVillage 53 26.2 25 19.1 28 39.4Town <20,000 35 17.3 19 14.5 16 22.6Town 20,000–100,000 50 24.8 35 26.7 15 21.1City >100,000 64 31.7 52 39.7 12 16.9EducationPrimary or lower secondary school 37 18.3 7 5.3 30 42.3Higher secondary school 120 59.4 83 63.4 37 52.1High school 45 22.3 41 31.3 4 5.6Physical activity at work#

Low 43 21.3 32 24.4 11 15.5Average 71 35.2 57 43.5 14 19.7Above averageNot employed

3652

17.825.7

2814

21.410.7

838

11.353.5

Physical activity in leisure time‡

Low 47 23.3 27 20.6 20 28.2Average 125 61.9 81 61.8 44 62.0Above average 30 14.8 23 17.6 7 9.8

n – sample number, % – sample percentage, #Physical activity at work: “low” – more than 70% of working time spent sedentary, “aver-age” – approx. 50% of working time spent sedentary and 50% of working time spent in an active manner, “above average” – approx. 70% of working time spent in an active manner or physical work related to great exertion, ‡Physical activity in leisure time: “low” – sedentary for most of the time, watching TV, reading books, walking 1-2 hours per week, “average” – walking, bike riding, gymnastics, gardening, light physical activity performed 2-3 hours per week, “above average” – bike riding, jogging, gardening, sport activities involving physi-cal exertion performed more than 3 hours weekly.


before the analysis was performed. The differences be-tween the groups were verified with ANOVA. A logistic regression analysis was used. The Odds Ratio (OR) and 95% confidence interval (95% CI) were calculated. The significance of OR was verified with Wald’s statistics. The reference group included subjects within the bottom tertile of nutritional knowledge (OR=1.00). The logistic regression analysis included the following confounders: age (a continuous variable), sex (a categorical variable), cancer type (a categorical variable). Five models were created: Model 1 – crude, without adjustment for con-founding factors, Model 2 – variables adjusted for age, Model 3 – variables adjusted for age and sex, Model 4 – variables adjusted for cancer type, Model 5 – variables adjusted for cancer type and age.

For all tests, p<0.05 was considered as significant. The statistical analysis was performed with STATI-STICA software (version 10.0 PL; StatSoft Inc., USA, Tulsa; StatSoft Polska, Kraków).

RESULTS

The incidence of breast or lung cancers in the bot-tom, middle and upper tertiles of nutritional knowledge was 57.6%, 32.6% and 15.8%, respectively (Table 2).

As nutritional knowledge grew in their consecu-tive tertiles, pHDI-8 significantly increased (2.63 vs. 3.78 vs. 4.22 times/day, respectively) (Table 2). In the

upper tertile of nutritional knowledge, in comparison to the middle or bottom tertile, a significantly higher frequency of consumption of fruit (0.95 vs. 0.88 vs. 0.64 times/day; respectively; p=0.004), vegetables (1.05 vs. 0.81 vs. 0.53 times/day, respectively; p<0.001), wholemeal bread (0.63 vs. 0.49 vs. 0.36 times/day, re-spectively; p=0.015) was found. In the upper tertile vs. bottom tertile of nutritional knowledge, a significantly more frequent consumption of fermented milk drinks (0.58 vs. 0.27 times/day, respectively; p<0.001) and cottage cheese (0.32 vs. 0.19, respectively; p=0.001) was found. With an increase of nutritional knowledge, in their consecutive tertiles, a significant decrease of nHDI-8 (1.32 vs. 1.21 vs. 0.94 times/day, respectively) was found (Table 2). In the upper tertile of nutritional knowledge, in comparison to the middle tertile or bot-tom tertile, a significantly less frequent consumption of sweetened carbonated drinks (0.04 vs. 0.11 vs. 0.15 times/day, respectively; p=0.003), canned: meat, fish or vegetables-meat (0.05 vs. 0.07 vs. 0.10 times/day, respectively; p<0.001), instant or ready-to-eat concen-trated soups (0.03 vs. 0.07 vs. 0.07 times/day, respec-tively; p=0.049) and fast food (0.02 vs. 0.03 vs. 0.03 times/day, respectively; p=0.036) was found. In the upper tertile vs. bottom tertile of nutritional knowledge, a significantly less frequent consumption of alcoholic beverages (0.07 vs. 0.16; p=0.021) and energy drinks (0.00 vs. 0.01; p=0.010) was shown.

Table 2. Frequency of the consumption of selected foods (times/day) in relation to nutritional knowledge

TotalNutritional knowledge

pFood items Bottom tertile Middle tertile Upper tertile

Percentage of cancer cases (%) 35.2 57.6b 32.6c 15.8bc <0.001pro-Healthy Diet Index – pHDI-8# 3.57±1.91 2.63ab±1.45 3.78a±1.85 4.22b±2.09 <0.001Fruit 0.83±0.60 0.64ab±0.54 0.88a±0.57 0.95b±0.65 0.004Vegetables 0.80±0.53 0.53ab±0.36 0.81ac±0.50 1.05bc±0.62 <0.001Wholemeal bread 0.49±0.61 0.36b±0.57 0.49±0.62 0.63b±0.63 0.015Fermented milk drinks 0.45±0.50 0.27ab±0.30 0.49a±0.53 0.58b±0.58 NSMilk 0.45±0.49 0.43±0.50 0.49±0.46 0.43±0.51 NSCottage cheese 0.30±0.36 0.19ab±0.22 0.36a±0.41 0.32b±0.36 NSFish or fish-based dishes 0.15±0.17 0.12±0.12 0.17±0.18 0.17±0.19 NSLegumes-based dishes 0.09±0.13 0.08±0.14 0.10±0.12 0.08±0.12 NSnon-Healthy Diet Index – nHDI-8# 1.17±0.79 1.32b±0.93 1.21c±0.72 0.94bc±0.70 0.028Sweets or confectionery 0.46±0.50 0.50±0.51 0.50±0.53 0.37±0.41 NSFried food 0.32±0.25 0.30±0.24 0.31±0.23 0.35±0.30 NSAlcoholic beverages 0.11±0.20 0.16b±0.27 0.11±0.18 0.07b±0.11 NSSweetened carbonated drinks 0.10±0.23 0.15b±0.30 0.11c±0.21 0.04bc±0.15 0.003Canned: meat, fish or vegetable-meat 0.07±0.11 0.10b±0.12 0.07±0.11 0.05b±0.11 <0.001Instant or ready-to-eat concentrated soups 0.06±0.15 0.07±0.16 0.07±0.18 0.03±0.10 0.049Fast foods 0.03±0.03 0.03±0.04 0.03±0.03 0.02±0.03 0.036Energy drinks 0.01±0.02 0.01b±0.02 0.01c±0.02 0.00bc±0.01 NS

# mean±standard deviation, p – significance level of ANOVA (after logarithmic data transformation before analysis), NS – insignificant differences, aa, ... cc – significant differences in pairs at p<0.05


In the upper tertile of nutritional knowledge, the ORs of the incidence of breast cancer or lung cancer varied from 0.06 (95% CI: 0.02; 0.17; p<0.05, with ad-justment for cancer type and age) to 0.17 (95% CI: 0.04; 0.69; p<0.05, with adjustment for age and sex) when compared to the bottom tertile (OR=1.00) (Table 3). In the middle tertile of nutritional knowledge, the ORs of the incidence of breast cancer or lung cancer varied from 0.27 (95% CI: 0.12; 0.62, p<0.05, with adjustment for cancer type and age) to 0.35 (95% CI: 0.18; 0.71, p<0.05, variables without adjustment) when compared to the bottom tertile.

DISCUSSION

Results of our studies have shown an inverse rela-tionship between the level of nutritional knowledge and the incidence of breast cancer in women or lung cancer in men. We also found an inverse relationship between the incidence of these cancers and the pro-healthy diet quality index, as well as many pro-healthy foods. There was also evidence of a positive relationship between the incidence of these cancers, a non-healthy diet index and many non-healthy food items.

The inverse relationship between the level of nutri-tional knowledge and risk of breast cancer in women or lung cancer in men in our studies can be explained with the relationship between nutritional knowledge and the diet quality. The author’s study has shown that a higher level of nutritional knowledge was associated with a higher overall diet quality (measured as the diet quality index) and more frequent consumption of pro-healthy foods including: fruit, vegetables, wholemeal bread, fermented milk drinks, cottage cheese. These results are similar to those reported by other authors, which have shown the protective role of fruit and vegetables in the development of breast or lung cancer [9, 12, 23]. There are, however, studies on the risk of lung cancer which did not show any positive role of fruit and vegetables [26]. Skuladottir et al. [18] noticed a tendency for a lower risk of mortality among people who consumed

more fruit and vegetables. This protective effect of fruit and vegetables can be contributed to their high content of bioactive compounds with a potential beneficial effect on health. Based on the results of many studies, experts of the WCRF/AICR report stated that fruit and also foods containing carotenoids probably decrease the risk of lung cancer [24]. Experts also stated that supplementation in smokers with beta-carotene taken as a single component is a well-recognized risk factor of lung cancer [24]. This report pointed out that there was no sufficient evidence showing the beneficial influence of the consumption of cereal products, dairy products, legumes, poultry and fish on the incidence of breast or lung cancer.

The author’s study has shown that a lower level of nutritional knowledge was associated with a lower overall diet quality and more frequent consumption of non-healthy foods such as: alcoholic beverages, sweetened carbonated drinks, canned: meat, fish or vegetables-meat, instant or ready-to-eat concentrated soups, fast food and energy drinks. Our results are consistent with the results of Taylor et al. [20], who stated that consumption of processed meat increased the risk of development of breast cancer by 64%. In Spain, studies on lung cancer showed an inverse relationship between meat consumption and the risk of cancer [7]. In Uruguay, it was found out that consumption of spirits significantly increased the risk of lung adenocarcinoma [6]. International EPIC studies [21] did not show any significant relationship between alcohol consumption and the risk of breast cancer. The WCRF/AICR report [24] showed that consumption of alcohol is a factor which increases the risk of breast cancer, and in the case of lung cancer, there is no evidence of its negative influence. Our results have shown that consumption of sweetened carbonated drinks and fast food adversely affected the risk of both cancers. This is confirmed by epidemiological studies, which linked a low-sugar and low-fat diet with a lower incidence of cancer and an increased human lifespan, whereas an excess of calories increased the risk of cancer and shortened lifespan [13].

Table 3. Odds Ratio and 95% Confidence Interval (95% CI) of the incidence of breast cancer in women or lung cancer in men in relation to nutritional knowledge

Odds Ratio (95% CI)Nutritional knowledge

Bottom tertile Middle tertile Upper tertileModel 1 1.00 0.35*(0.18;0.71) 0.14*(0.06;0.34)Model 2 1.00 0.30*(0.13;0.67) 0.07*(0.02;0.22)Model 3 1.00 0.62 (0.25;1.56) 0.17*(0.04;0.69)Model 4 1.00 0.32*(0.16;0.66) 0.11*(0.05;0.29)Model 5 1.00 0.27*(0.12;0.62) 0.06*(0.02;0.17)

Model 1 – variables without adjustment, Model 2 – variables adjusted for age, Model 3 – variables adjusted for age and sex, Model 4 – variables adjusted for cancer type, Model 5 – variables adjusted for cancer types and age, ٭significance level of the Wald test p<0.05


The author’s study has shown a significant rela-tionship between nutritional knowledge and the overall impact of pro-healthy and non-healthy food, which, as a consequence, affects the risk of breast cancer in women or lung cancer in men. The results of the author’s stu-dies are consistent with the results of studies on breast cancer in women from France. It was observed that an “Alcohol/Western” pattern was associated with a higher risk of breast cancer, and a “Healthy/Mediterranean” pattern was linked to a lower risk of cancer [4]. Similar results were obtained by De Stefanii et al. [5] in the context of the incidence of lung cancer in men from Uruguay. The “High meat” pattern increased the risk of lung cancer by three times, whereas the “Antioxidants” pattern reduced this risk.

The author’s studies have confirmed that nutritional knowledge affected the incidence of breast cancer in women or lung cancer in men. The knowledge obtained in youth affects the behaviour and nutritional attitude of adults. Researchers share the view that prevention of cancer should start in schools [15]. Behaviour ad-opted in childhood appears to have a strong influence on adults’ health-related activities [19]. It was reported that the nutritional education of adults resulted in their willingness to improve their nutritional pattern even after the first meeting [16], and as a consequence of nutritional intervention, elderly people increased con-sumption of fruit, vegetables and foods rich in calcium [1]. The results of the author’s study have shown that nutritional knowledge had a great impact on food con-sumption and, as a result, on health. Many adults are aware of the relationship between nutrition and the risk of cancer. However, they often do not have knowledge on the diet quality, foods and their components and the increasing risk of disease [8]. There is evidence that nutritional education in women with breast cancer may be beneficial for health, as this can result in an increase in the consumption of fruits and vegetables and lead to a reduction in the consumption of meat [17].

CONCLUSIONS

A higher level of nutritional knowledge was asso-ciated with a higher pro-healthy diet quality and lower risk of breast cancer in women or lung cancer in men. In contrast, a lower level of nutritional knowledge was associated with a lower diet quality and a higher risk of both types of cancers. It may be suggested that nutritional education focused on pro-healthy foods and knowledge on non-healthy foods may play an important role in prevention of both types of cancer.


REFERENCES

1. Bernstein M.A., Nelson M.E., Tucker K.L., Layne J., Johnson E., Nuernberger A., Castaneda C., Judge J.O., Buchner D., Fitarone Singh M.: A home-based nutrition intervention to increase consumption of fruits, vegeta-bles, and calcium-rich foods in community dwelling elders. J Am Diet Assoc 2002;102(10):1421-1427.

2. Bogusz R., Charzyńska-Gula M., Majewska A., Ga-łęziowska E.: Knowledge of breast cancer prevention among peri-menopausal women. Med Og Nauk Zdr 2013;19(4):523-529 (in Polish).

3. Commission of the European Communities Green Paper: Promoting healthy diets and physical activity: a European dimension for the prevention of overweight, obesity and chronic diseases. COM(2005)657 final. Available from: http://ec.europa.eu/health/ph_determinants/life_style/nutrition/documents/nutrition_gp_en.pdf

4. Cottet V., Touvier M., Fournier A., Touillaud M.S, Lafay L., Clavel-Chapelon F., Boutron-Ruault M-CH.: Postme-nopausal Breast Cancer Risk And Dietary Patterns In The E3N-EPIC Prospective Cohort Study. Am J Epidemiol 2009;170(10):1257-1267.

5. De Stefani E., Boffetta P., Ronco A.L., Deneo-Pellegrini H., Acosta G., Gutiérrez L.P., Mendilaharsu M.: Nutrient patterns and risk of lung cancer: A factor analysis in Uruguayan men. Lung Cancer 2008;61:283-291.

6. De Stefani E., Correa P., Deneo-Pellegrini H., Boffetta P., Gutiérrez L.P., Ronco A., Brennan P., Mendilaharsu M.: Alcohol intake and risk of adenocarcinoma of the lung: A case-control study in Uruguay. Lung Cancer 2002;38:9-14.

7. Dosil-Díaz O., Ruano-Ravina A., Gestal-Otero J.J., Barros-Dios J.M.: Meat and fish consumption and risk of lung cancer: A case–control study in Galicia, Spain. Cancer Lett 2007;252:115-122.

8. Harnack L., Block G., Subar A., Lane S.: Cancer Preven-tion-Related Nutrition Knowledge, Beliefs, and Attitudes of U.S. Adults: 1992 NHIS Cancer Epidemiology Sup-plement. J Nutr Educ 1998;30(3):131-138.

9. Hirose K., Tajima K., Hamajima N., Inoue M., Takezaki T., Kuroishi T., Yoshida M., Tokudome S.: A Large-Scale Hospital Based Case – Control Study Of Risk Factors Of Breast Cancer According To Menopausal Status. Jpn J Cancer Res 1995;86(2):146-154.

10. Kosacka M., Jankowska R.: The epidemiology of lung cancer. Pneumonol Alergol Pol 2007;75:76-80 (in Po-lish).

11. Kozłowska-Wojciechowska M., Uramowska-Żyto B., Jarosz A., Makarewicz-Wujec M., Impact of school children’s nutrition education on the knowledge and nutritional behavior of their parents. Rocz Panstw Zakl Hig 2002;53(3):253-258 (in Polish) [PMID: 12621880; http://www.ncbi.nlm.nih.gov/pubmed/12621880].

12. Kruk J.: Fruits and vegetables consumption and the risk of breast cancer. Wspolczesna Onkol 2006;10(5):224-230 (in Polish).

13. Meynet O., Ricci J.-E.: Caloric restriction and cancer: molecular mechanisms and clinical implications. Trends Mol Med 2014;20(8):419-427.


14. Potrykowska A., Strzelecki Z., Szymborski J., Witkowski J.: Cancer incidence and mortality versus the demograph-ic situation of Poland. In: Didkowska J.: Forecasts of the development of cancer diseases in Poland. Warsaw, The Government Population Council, 2014 (in Polish).

15. San Turgay A., Sari D., Türkistanlı E.C.: Knowledge, attitudes, risk factors, and early detection of cancer re-levant to the schoolteachers in Izmir, Turkey. Prev Med 2005;40(6):636-641.

16. Savoie M.R., Mispireta M., Rankin L.L., Neill K., LeBlanc H., Christofferson D.: Intention to Change Nutrition-Re-lated Behaviors in Adult Participants of a Supplemental Nutrition Assistance Program–Education. J Nutr Educ Behav 2015;47(1):81-85.

17. Schiavon C.C., Vieira F.G.K., Ceccatto V., de Liz S., Cardoso A.L., Sabel C., Gonzalez-Chica D.A., da Silva E.L., Galvan D., Crippa C.G., Di Pietro P.F.: Nutrition Education Intervention for Women With Breast Cancer: Effect on Nutritional Factors and Oxidative Stress. J Nutr Educ Behav 2015;47(1):2-9.

18. Skuladottir H., Tjoenneland A., Overvad K., Stripp C., Olsen J.H.: Does high intake of fruit and vegetables im-prove lung cancer survival? Lung Cancer 2006;51:267-273.

19. Smith C., Roberts C., Nutbeam D., Macdonald G.: The health promoting school: progress and future challen-ges in Welsh secondary schools. Health Promot Int 1992;7(3):171-179.

20. Taylor E.F., Burley V.J., Greenwood D.C., Cade J.E.: Meat consumption and risk of breast cancer in the UK Women’s Cohort Study. Br J Cancer 2007; 96:1139-1146.

21. Tjønneland A., Christensen J., Olsen A., Stripp C., Thom-sen B.L., Overvad K., Peeters P.H.M., van Gils C., Bas Bueno-de-Mesquita H., Ockĕ M.C., Thiebaut A., Four-nier A., Clavel-Chapelon F., Berrino F., Palli D., Tumino

R., Panico S., Vineis P., Agudo A., Ardanaz E., Martinez--Garcia C., Amiano P., Navarro C., Quirós J.R., Key T.J., Reeves G., Khaw K-T., Bingham S., Trichopoulou A., Trichopoulos D., Naska A., Nagel G., Chang-Clau-de J., Boeing H., Lahmann P.H., Manjer J., Wirfält E., Hallmans G., Johansson I., Lund E., Skeie G., Hjartåker A., Ferrari P., Slimani N., Kaaks R., Riboli E.: Alcohol intake and breast cancer risk: the European Prospective Investigation into Cancer and Nutrition (EPIC), Cancer Causes Control 2007;18:361-373.

22. Wądołowska L., Krusińska B.: Procedure for the devel-opment of nutritional data from the questionnaire QEB (in Polish). Available from: http://www.uwm.edu.pl/edu/lidiawadolowska/ (accessed 05.06.2015).

23. Wang Y., Li F., Wang Z., Qiu T., Shen Y., Wang M.: Fruit and vegetable consumption and risk of lung cancer: A dose-response meta-analysis of prospective cohort stu-dies. Lung Cancer 2015;88(2):124-130.

24. World Cancer Research Fund / American Institute for Cancer Research. Food, Nutrition, Physical Activity, and the Prevention of Cancer: a Global Perspective. Washington DC: AICR, 2007.

25. World Health Organization. Available from: http://www.who.int/mediacentre/factsheets/fs355/en/ (accessed 05.06.2015).

26. Zabłocka-Słowińska K., Prescha A., Pieczyńska J., Wyka J., Gołecki M., Kosacka M., Porębska I., Grajeta H., Jankowska R., Biernat J.: Assessment of vegetable and fruit intake in patients with lung cancer and in healthy subjects. Probl Hig Epidemiol 2012;93(4):838-843 (in Polish).




*Corresponding author: Zbigniew Walczak, Koszalin University of Technology, Department of Biochemistry and Biotechnology, Raclawicka Street 15-17, 75-620 Koszalin, Poland, phone: +48 510094095, e-mail: [email protected]


ORIGINAL ARTICLE

QUALITATIVE EVALUATION OF DIETS OF STUDENTS AT THE UNIVERSITY OF THE THIRD AGE AT KOSZALIN UNIVERSITY

OF TECHNOLOGY

Małgorzata Kwiatkowska1, Zbigniew Walczak1, 2*

1Nicolaus Copernicus School Cluster No. 1 in Koszalin, 75-620 Koszalin, Wladyslaw Anders street 30, Poland2Department of Biochemistry and Biotechnology, Koszalin University of Technology,

Raclawicka street 15-17, 75-620 Koszalin, Poland

ABSTRACTBackground. Nutrition plays an important role in the elderly stage of life. A proper proportion of the individual nutritional ingredients in a diet may positively impact the ageing body. This positive influence consists in slowing down the undesired and unfavourable physiological alterations leading inevitably to the general weakness of the body.Objective. The aim of the paper was to perform a qualitative analysis with the Starzyńska scoring system for diets, the daily food rations (DFR), among students of the University of the Third Age at the Koszalin University of Technology (Poland). Material and methods. The studied materials consisted of the 7-day current records made by 79 students (16 males and 63 females) of the University of the Third Age at the Koszalin University of Technology and the measurements of body weight, height and waistline. The records were qualitatively evaluated with Starzyńska’s test.Results. It was found that approximately half of the students were overweight or obese. The majority consumed the recom-mended number of meals. About 44% of the students consumed animal protein with all meals. Milk and cheese were ingested daily with at least two meals by approximately 11% of the students. Fruit and vegetables are eaten on a daily basis by about 60% of the students. Almost 40% ate wholegrain bread, groats, and dried legumes. The statistical analysis of the means for the points of individual indicators did not reveal any statistically significant difference between women and men (p>0.05).Conclusions. Approximately ¾ of the evaluated diets were inaccurately formulated and required radical modification. The low frequency of animal protein, milk and cheese, wholegrain bread, groats and dried legume consumption may result in deficiencies in certain nutrients. Nutritional education is recommended, focusing on the correct way to formulate meals. The recorded level of overweight and obesity in the students indicates a need for a quantitative assessment of consumption considering, among others, the energy input in their diets.

Key words: score evaluation, Starzyńska’s method, diets of the elderly

STRESZCZENIEWprowadzenie. Żywienie odgrywa istotną rolę w wieku podeszłym. Odpowiedni udział poszczególnych składników pokarmowych w diecie może pozytywnie oddziaływać na starzejący się organizm. Pozytywne oddziaływanie polega na spowalnianiu niekorzystnych zmian fizjologicznych prowadzących nieuchronnie do ogólnego osłabienia organizmu. Cel. Celem pracy była jakościowa ocena diet (całodziennych racji pokarmowych) uczestników Uniwersytetu Trzeciego Wieku Politechniki Koszalińskiej metodą punktową według Starzyńskiej. Materiał i metody. Materiał stanowiły zapisy siedmiodniowego bieżącego notowania od 79 uczestników (16 mężczyzn i 63 kobiety) Uniwersytetu Trzeciego Wieku Politechniki Koszalińskiej oraz pomiary masy, wysokości ciała i obwodu talii. Zapiski poddano ocenie jakościowej testem Starzyńskiej. Wyniki. Stwierdzono, że około połowa słuchaczy charakteryzowała się nadwagą i otyłością. Większość spożywa zalecaną ilość posiłków. Około 44% słuchaczy spożywa białko zwierzęce w wszystkich posiłkach. Mleko i sery spożywa codziennie przynajmniej w dwóch posiłkach około 11% słuchaczy. Warzywa i owoce codziennie w 3 i 2 posiłkach spożywa większość słuchaczy. W postaci surowej warzywa i owoce spożywa codziennie około 60% słuchaczy. Niecałe 40% słuchaczy spo-żywa codziennie razowe pieczywo, kasze i strączkowe suche. Analiza statystyczna średnich dla punktów poszczególnych wyróżników nie wykazała istotnie statystycznej różnicy pomiędzy kobietami i mężczyznami (p>0.05).Wnioski. Około ¾ ocenionych diet jest źle skomponowanych i wymaga gruntownych zmian. Wykazana niska częstotliwość spożywania białka pochodzenia zwierzęcego, mleka i serów oraz pieczywa razowego, kasz i strączkowych suchych może

M. Kwiatkowska, Z. Walczak18 No 1

prowadzić do niedoborów określonych składników pokarmowych. Zaleca się edukację żywieniową w zakresie prawidłowe-go komponowania posiłków. Odnotowany poziom nadwagi i otyłości u słuchaczy wskazuje na potrzebę ilościowej oceny spożycia uwzględniając między innymi podaż energii w ich dietach.

Słowa kluczowe: ocena punktowa, metoda Starzyńskiej, diety osób starszych

INTRODUCTION

The elderly are a heterogeneous group of people in terms of health. Some of them, with good physical and intellectual capacities, prevent their own social exclu-sion by creating associations for seniors. These persons undertake social, cultural or intellectual activities in such groups. The Universities of the Third Age are one of such organizations providing educational services and satisfying the psychosocial and health needs of students [10].

However, negative physiological changes take place in an aging body at the cell, tissue and organ levels. These alterations inevitably lead to the general weakness of the body and the presence of chronic diseases [19]. Lifestyle significantly impacts health status, namely, such factors as physical activity and nutrition. In itself, nutrition is an important determinant of both the proper development and maintenance of each living organism in a good condition. By providing the proper dose of energy and all essential nutrients, it is possible to delay many unfavourable changes in the human body pro-gressing with age [8]. The lack of a varied diet results in not all of the nutrients being delivered in sufficient amounts [15]. Higher-calorie foods should constitute a minor part of the overall diet. The predominant part should consist of products rich in minerals, vitamins and trace elements [7]. Therefore, elderly people should pay extra attention to ensuring that their daily food contains a proper amount of protein, carbohydrates, fats, vitamins and minerals according to the current standards and health status [6]. Regular research on nutrition in this age group will enable identifying nutritional errors [21] which, in turn, will indicate how to modify the diets to secure the input of all essential nutrients according to health status [1].

The aim of this paper was to perform a qualitative analysis with the Starzyńska scoring system for the diets, the daily food rations (DFR), of students of the University of the Third Age at the Koszalin University of Technology in Poland.


The materials consisted of the data obtained by recording the food intake for seven days on a report sheet. The records of the food intake for seven conse-cutive days were taken in spring 2015. An analysis was

performed of the records obtained from 79 students, i.e. 16 males and 63 females of the University of the Third Age at the Koszalin University of Technology. A quali-tative assessment using the Starzyńska scoring system was used to verify the degree of nutritional correctness with which the diets, over seven consecutive days, were formulated (daily food rations) [4]. This assessment included the number of meals, frequency of animal protein, milk and cheese, fruit and vegetables, bread, groats and dried legume consumption. Furthermore, the degree of nutrition of the studied group of students was determined with the basic anthropomorphic parameters (height, body weight, and waistline) and Quetelet’s in-dex, namely, BMI (Body Mass Index) was calculated: [body weight (kg)]:[height B-v (m2)]. Body weight and height measurements were taken in the morning before the first meal with a Seca 711 mechanical medical co-lumn scale and the waistline was measured with Seca 203 tape measures. The anthropometric examinations were performed according to the generally approved standards in anthropometry. BMI interpretation was performed according to the WHO classification (Ta-ble 1) [23]. The statistical analysis of anthropometric parameters and point differences for the individual discriminants, depending on the gender, was carried out with Mann-Whitney’s U test and the Statistica PL 10 software package [20]. The confidence level of p=0.05 was assumed for all calculations.

Table 1. BMI classification [22]Interpretation of the indicator BMI [kg/m2]

Underweight <18.50Standard 18.5–24.99

Overweight 25.0–29.99Obesity I° 30.0–34.99Obesity II° 35.0–39.99Obesity III° > 40

RESULTS

The data for the average age, waistline circumfe-rence, height, body weight and body mass index (BMI) of the students is given in Table 2. A detailed analysis of the waistline circumference and the BMI of the stu-dents are presented in Table 3. As the data indicates, the average age of the respondents was about 66 years. The average height was 1.65 m, and the average body weight was approximately 72 kg. In analysing the data

Diets of the University of the Third Age students. 19No 1

by gender, it is clear that the men were taller and heavier than the women. The statistical analysis revealed that height significantly distinguished the males from the females (p<0.05). When the waistline measurements were analysed in a detailed manner, it was shown that approximately ¾ of the assessed students were at risk of metabolic derangements and complications. The BMI values, when analysed specifically, demonstrated that the problem of quantitative malnourishment did not affect this group of people, although it was found that about half of the students were overweight or obese. Considering the gender, it was shown that obesity and overweight were more common among the men than the women.

Table 3. A detailed analysis of the waistline circumference and the BMI of the students

Total / n=79 Men / n=16 Women / n=63n (%) n (%) n (%)

Waist ≥80x/ ≥94xx 57 (72.15) 12 (75.00) 45 (71.42)BMI (<18.5) - - -BMI (18.5-24.99) 40 (50.63) 4 (25.00) 36 (57.14)BMI (25-29.99) 26 (32.92) 8 (50.00) 18 (28.58)BMI (30-34.99) 13 (16.45) 4 (25.00) 9 (14.28)BMI (35-39.99) - - -BMI (>40) - - -

x - women , xx - men

The numerical values representing the qualitative assessment, performed with Starzyńska’s method, of the daily food rations over seven consecutive days among the students are compiled in Table 4 and the interpreta-tion of the results is given in Table 5. As the data reveals, over a half of the students consumed the recommended number of meals a day. This is reflected by the high number of points recorded for this discriminant (4.27 out of 5). Almost half of all respondents (both men and wo-men) consumed animal protein products at each meal. It was found, however, that the level of milk and cheese consumption was very low. Since only approximately 14% of the women eat these products daily with two

meals, the number of points was merely 1.54 out of 5 for the whole group of students. Fruit and vegetables were consumed with at least 3 and 2 meals, respectively, by almost 80% of the respondents. However, these food products were commonly a part of 2 rather than 3 meals in the total population while approximately 11% of the population consumed them more rarely. The average number of points for this discriminant was 2.91 out of 5. Over a half of the students ate raw fruit and vegeta-bles. Considering the gender, men more often consumed these products in a raw form than women. The average score for this discriminant was 3.36 out of 5. The daily consumption of fibre source products was reported in less than 40% of the students, of whom such products were eaten daily more often by women than men. The average number of points for this discriminant was 2.00 out of 5. The statistical analysis of the means for the scores of individual discriminants did not reveal any statistical difference between women and men (p>0.05). The detailed analysis of the scores (Table 5) demonstrated that none of the 7-day menus was scored as good while almost ¾ of the evaluated 7-day menus of all the students had an excessively high number of errors, indicating the need to reformulate them.

DISCUSSION

A diet with an incorrectly balanced energy content results in disorders such as malnourishment or excessive fat tissue accumulation, i.e. overweight and obesity [22]. Among the students of the University of the Third Age at the Koszalin University of Technology, qualitative malnourishment was not observed, similar to the studies by Krajewska-Pędzik et al. [11]. In assessing the nutri-tional status of 66 female students, the authors did not record any persons at risk of malnutrition. An excessive accumulation of fat tissue due to a positive energy ba-lance leads to overweight and obesity. This is associated with hyperlipidaemia, type-2 diabetes and arterial hy-pertension [12, 16]. The BMI evaluation performed by

Table 2. Characteristics of the studentsTotal / n=79 Men / n=16 Women / n=63

SD Min. Max. Med. SD Min. Max. Med. SD Min. Max. Med.Age

(years) 66.09 5.28 57.00 75.00 65.00 62.75 4.34 57.00 67.00 63.5 68.00 5.03 63.00 75.00 66.00

Hight (m) 1.65 0.07 1.53 1.76 1.65 1.72* 0.02 1.69 1.76 1.73 1.61 0.05 1.53 1.70 1.64

Weight (kg) 72.68 12.20 59.00 91.00 69.50 81.37 10.78 69.50 91.00 82.5 67.71 10.53 59.00 90.00 66.00

Waist (cm) 92.27 11.09 74.00 114.00 92.00 101.25 9.91 92.00 114.00 99.5 87.14 8.45 74.00 98.00 88.00

BMI (kg/m2) 26.27 2.72 23.33 31.14 25.09 27.21 2.93 24.33 30.07 27.21 25.74 2.67 23.33 31.14 24.53

* statistically significant difference; significance level p=0.05


Krajewska-Pędzik et al. [11] among the students of the University of the Third Age in Szczecin found obesity in 38.4% of all examined females. First degree obesity was found in approximately 30% of the students of the University of the Third Age in Szczecin. Similar to the previous study, second or third degree obesity was not demonstrated among the students in the study perfor-med by Krajewska-Pędzik et al. [11]. Together with a waistline increase of over 80 cm in women and 94 cm in men, the risk of metabolic disorders and complications increases proportionally to the waistline circumference [9]. The previous study revealed that roughly ¾ of the students were affected with this problem. However, identifying overweight and obesity amount seniors using the body mass index (BMI) is associated with a risk of overestimating the number of individuals with

this problem. This results from the fact that, together with age, the proportion of lean body mass decreases and is replaced by fat tissue. Moreover, a reduction in the body weight in this group should be attempted very cautiously, as negative consequences may follow, such as a further decrease in lean body mass and a reduction in bone density [16].

According to the current nutritional recommenda-tions for the elderly, the number of meals per day should range between four and six and their volume should be small [3]. In contrast to these studies, Krajewska-Pędzik et al. [11], while analysing the number of meals of the students, showed that about 90% of them consumed 4-5 meals per day and 3.3% of the women reported having three or less meals per day.

Table 4. Diet assessment of students according to Starzyńska’s method

Distinguishing feature Max

number of points

number of obtained points

People who obtained a certain number of points

Total Men Women pTotal Men Women

n % n % n %Number of meals during the day as planned in the diet:- 4-5- 3- <3

530

4.27 4.00 4.42 p>0.05 5326-

67.0832.91

-

88-

5050

4518-

71.4228.57

-Number of meals in which there are products containing animal proteins:- in all meals- in 75% of all meals- in a smaller number of meals

530

2.63 2.75 2.57 p>0.05 351727

44.3021.5134.17

88-

5050-

27927

42.8514.2842.85

Frequency of consumption of milk or cheese:- every day in 2 meal- every day in at least 1 meal and in 2 meals every other day- less often

520

1.54 1.00 1.85 p>0.05 94426

11.3955.6932.91

-88

-5050

93618

14.2857.1428.57

Frequency of consumption of raw vegetables and fruits:- every day in at least 3 meals- every day in at least 2 meals- less often

520

2.91 2.75 3.00 p>0.05 31399

39.2449.3611.39

412-

2575-

27279

42.8542.8514.28

Frequency of consumption of raw vegetables and fruits:- every day- on 75% of days- less often

520

3.36 3.75 3.14 p>0.05 48922

60.7511.3927.84

12-4

75-

25

36918

57.1414.2828.57

Frequency of consumption of wholemeal bread, groats and dry legumes:- every day at least one of the aforementioned products- on 75% of days at least one of the aforementioned products- less often

520

2.00 1.75 2.14 p>0.05 31444

39.245.0655.69

448

252550

27-

36

42.85-

57.14Max. 30

Total 16.71 16.00 17.12* statistically significant difference; significance level α=0.05

Table 5. Interpretation of the results using Starzyńska’s method

Number of obtained points Diet evaluation Conclusion Number of diets % of diets

Total Men Women Total Men Women28-30 good no mistakes - - - - - -21-27 satisfactory mistakes can be eliminated 18 - 18 22.78 - 28.5712-20 without ratings of zero only satisfactory significant mistakes 4 4 - 5.06 25.00 -< 12 failing not possible to be corrected 57 12 45 72.16 75.00 71.43

Total 79 16 63 100 100 100

Diets of the University of the Third Age students. 21No 1

Animal protein, as a nutrient, plays an important role in the elderly. Its deficiency in the consumed foods translates into a progressive loss of muscle mass and, thus, a reduction in fitness. The current recommen-dations stipulate the intake of 1.0 – 1.2 g of animal protein per kilogram of body weight to maintain lean body mass. For more intensive physical activity, it is advised to administer protein at a dose of 1.2 – 1.5 g per kilogram body weight, except for persons with a severe stage of renal failure [24]. The studies demonstrated that less than 50% of the examined students consumed this nutrient with all meals. Studies by other authors have shown that the protein intake in this age group is insufficient [17]. Milk and dairy products are the main source of calcium in the diet and a proper amount of this element helps to maintain optimal bone mass and prevents osteoporosis. In addition, the correct intake of calcium reduces blood pressure, decreases the risk of hypertension and prevents colon tumours [14]. Despite all of this, a significant reduction in the intake of this group of foods is observed among elderly people [18]. Previous studies confirmed a low frequency of milk and dairy product consumption. Among the students, only 58% of the women declared taking milk and da-iry products daily in their diet. Markiewicz et al. [14] demonstrated that the intake of calcium with the diet did not cover the standards recommended for this age group. Fruit and vegetables constitute an important food group in human nutrition. Krajewska-Pędzik et al. [11] showed that 70% of the female students of the University of the Third Age in Szczecin consumed fruit daily and 78% did so with vegetables. Previous studies also revealed a high proportion of the students who consumed fruit and vegetables on a daily basis. Among the elderly people, there is a continuous deficiency of dietary fibre intake, which was confirmed by the studies carried out by, for example, Ilow et al. [5], Stawarska et al. [21], and Różańska et al. [17]. Previous studies have also confirmed a low frequency of consumption of foods as the source of this nutrient.

The individual situation of elderly people related to their health status, treatments for chronic diseases, social exclusion and financial situation are often causes of in-correct nutrition in this social group [1, 16]. The results of this study demonstrate that the daily food rations for a vast majority of the students are incorrectly composed. The inappropriate intake of specific groups of foods may be associated with an unfavourable nutritional status re-corded based on the BMI values in the examined group. Even though quantitative malnutrition was not found, the demonstrated incorrect intake of certain groups of food products may result in deficiencies in specific nutrients and, thus, lead to qualitative malnourishment [2, 13, 25]. The progressive physiological alterations that occur in the body with age, together with an inap-

propriate intake of nutrients, may adversely impact the biological aging of the human body [1].

CONCLUSIONS

1. Approximately ¾ of the diets taken by the students were incorrectly composed and required profound changes.

2. The demonstrated low frequency of animal protein, milk and cheese, wholegrain bread, groats and dried legume consumption may result in the deficiencies of specific nutrients.

3. The recorded levels of overweight and obesity among the students points to the need for a quan-titative assessment of consumption, including the intake of energy in their diets.

4. The results of 7-day consumption records kept by the students indicates that there is room for nutritional education, with a special emphasis on the correct composition of daily meals.


REFERENCES

1. Brończyk-Puzoń A., Bieniek J.: Nutrition elderly based on nutritional standards amendment Institute of Food and Nutrition for the Polish population of 2012 years. Nowa Medycyna 2013;4:151-155 (in Polish).

2. Brzozowska A., Sicińska E., Roszkowski W.: Rola folianów w żywieniu osób starszych [The role of fo-late in nutrition of the elderly]. Rocz Panstw Zakl Hig 2004;55(2):159-164 (in Polish) [PMID: 15493348; http://www.ncbi.nlm.nih.gov/pubmed/15493348].

3. Gabrowska E., Spodaryk M.: Nutrition guidelines for the elderly. Gerontol Pol 2006;14(2):57-62 (in Polish).

4. Gronowska-Senger A.: Assessment of nutrition. In: Gawęcki J. eds. Human Nutrition. Basics of Nutrition Sciences. Warszawa, PWN, 2010 (in Polish).

5. Ilow R., Regulska-Ilow B., Biernat J., Kowalisko A.: The assessment of dietary intake of the selected groups from Lower Silesia population 50-year-old. Bromat Chem Toksykol 2007;40(3):293-298 (in Polish).

6. Jabłoński E., Kaźmierczak U.: Nutrition in the elderly. Gerontol Pol 2005;13(1)48-54 (in Polish).

7. Jarosz M.: Nutrition Standards for the Polish population - amendment. Warszawa, Instytut Żywności i Żywienia, 2012 (in Polish).

8. Jurczak I., Barylski M., Irzmański R.: The importance of diet in the elderly - an important aspect of preven-tive health care or irrelevant daily regine? Geriatria 2011;5:127-133 (in Polish).

9. Kinalska K, Popławska-Kita A., Telejko B., Kinalski M., Zonenberg A.: Obesity and carbohydrate metabolism.


Endokrynologia, Otyłość, Zaburzenia Przemiany Materii 2006;2(3):94-101 (in Polish).

10. Kozieł D., Trafiałek E.: Assessing the influence of the studying at the University of the Third Age on life satis-faction of elderly people. Gerontol Pol 2007;15(3):104-108 (in Polish).

11. Krajewska-Pędzik A., Ratajczak J., Stępień-Słodkowska M.: Evaluation of nutrition of the university of the third age participants. Aktywność Ruchowa Ludzi w Różnym Wieku 2014;1-4(21-24):83-91 (in Polish).

12. Kvamme JM., Holmen J., Wilsgaard T., Florholmen J., Midthjell K., Jacobsen BK.: Body mass index and mor-tality in elderly men and women: the Tromso and HUNT studies. J Epidemiol Community Health 2011;66(7):611-7.

13. Madej D., Borowska K., Bylinowska J., Szybalska A., Pietruszka B.: Dietary intakes of iron and zinc assessed in a selected group of the elderly: are they adequate? Rocz Panstw Zakl Hig 2013;64(2):97-104 [PMID: 23987077; http://www.ncbi.nlm.nih.gov/pubmed/23987077].

14. Markiewicz R., Borawska M.H., Socha K., Gutowska A.: Calcium and magnesium in diets of people from Podlasie region. Bromat Chem Toksykol 2009;42(3):629-635 (in Polish).

15. Niedźwiedzka E. Wądołowska L.: Analysis of food intake variety in relation to the socio-economic status of elderly Polish citizens. Probl Hig Epidemiol 2010;91(4):576-584 (in Polish).

16. Ożga E., Małgorzewicz S.: Assessment of nutritional status of the elderly. Geriatria 2013;7:98-103 (in Polish).

17. Różańska D., Wyka J., Biernat J.: Food intake of elderly inhabitants of a small town – Twardogora. Probl Hig Epidemiol 2013;94(3):494-502 (in Polish).

18. Sikora E., Pysz M., Leszczyńska T.: Changes in daily supply of basic groups of food products in households of pensioners in the years from 1989 to 2004. Żywność.

Nauka. Technologia. Jakość 2009;5(66):132-147 (in Polish).

19. Skiba M., Kusa-Podkańska M., Wysokińska-Miszczuk J.: The influence of the oral condition on the menthal and physical well-being of elderly people. Gerontol Pol 2005;13(4):250-254 (in Polish).

20. StatisticaPL Version 10, 64-Bit. Licencja AGAP207E-324303AR-P. 2015. StatSoft Polska, Kraków

21. Stawarska A, Tokarz A., Kolczewska M.: Energy value and basic ingredients in diet of elderly people from se-lected Warsaw social associations. Part II. Bromat Chem Toksykol 2008;41(4)4:987-991 (in Polish).

22. Waksmańska W., Woś H., Mikulska M.: Overweight, obesity, malnutrition in Poland and worldwide. Probl Hig Epidemiol 2013;94(4):710-713.

23. World Health Organization. Obesity: preventing and managing the global epidemic: WHO Technical Report Series 894. WHO Geneva 2000.

24. Wieczorek K.T.: Most recent recommendations for pro-tein consumption by the elderly formulated based on the analysis of the research group PROT-AGE. Materials Conference Second National Scientific Conference “Nu-trition gerontological – Challenges and Opportunities”. Wydawnictwo Naukowe Uniwersytetu Medycznego im. Karola Marcinkowskiego w Poznaniu, Poznań, 2014:12 (in Polish).

25. Wyka J., Biernat J.: Porównanie sposobu żywienia ludzi starszych w latach 1990 i 2006 [The comparison of food patterns of the elder people in 1990 and 2006]. Rocz Panstw Zakl Hig 2009;60(2);159-162 (in Polish) [PMID: 19803446; http://www.ncbi.nlm.nih.gov/pub-med/19803446]




*Corresponding author: Małgorzata Kostecka, University of Life Sciences in Lublin, Faculty of Food Science and Biotechnology, Department of Chemistry, Akademicka street 15, 20-950 Lublin, Poland, phone: +48 81 4456846; e- mail: [email protected]


ORIGINAL ARTICLE

FREQUENCY OF CONSUMPTION OF FOODS RICH IN CALCIUM AND VITAMIN D AMONG SCHOOL-AGE CHILDREN

Małgorzata Kostecka1*

1University of Life Sciences in Lublin, Faculty of Food Science and Biotechnology, Department of Chemistry, Lublin, Poland

ABSTRACTBackground. Calcium is one of the most important minerals for the human body which is essential for healthy bones and teeth. Vitamin D has hormone-like properties in the human body. It is supplied with the diet, but it is also synthesized by the body under exposure to UV radiation. Vitamin D controls calcium and phosphorus metabolism and is responsible for bone modeling and mineralization.Objective. The objective of this study was to evaluate eating habits and food preferences of school-age children meet the demand for calcium and vitamin D, and estimate the frequency of consumption of foods rich in these nutrients. Material and methods. A total of 197 parents of 7- to 9-year-olds attending randomly selected primary schools in Lublin and Świdnik were asked to fill out a questionnaire designed by the authors. The results were processed by the Chi-squared test in the Excel application.Results. Considerable differences in the consumption of milk and dairy products were observed between age groups. In the group of 7-year-olds, 57.5% of children drank milk and ate dairy products at least once a day, whereas in the group of 9-year-olds, only 16.6% of children ate dairy products at least once a day. The intake of foods rich in vitamin D was equally low among the surveyed children. Conclusions. School-age children may be at risk of calcium and vitamin D deficiencies due to low consumption of milk, dairy products and fish, and inadequate vitamin D supplementation. Parents should be educated about nutrition to change the family’s eating habits.

Key words: calcium, vitamin D, children, dietary supplements

STRESZCZENIEWprowadzenie. Wapń jest składnikiem mineralnym niezbędnym do prawidłowego funkcjonowania organizmu, jest podstawowym materiałem budulcowym kości i zębów. Witamina D w organizmie ludzkim ma właściwości hormonu, jej źródło stanowią światło słoneczne, pokarm, suplementacja. Pełni bardzo ważną funkcję w organizmie człowieka, wpływa regulująco na gospodarkę wapniowo-fosforanową oraz modelowanie i mineralizację kości.Cel. Celem badań była ocena nawyków i preferencji żywieniowych dzieci szkolnych pod kątem pokrycia zapotrzebowania na wapń i witaminę D oraz ocena częstości spożycia produktów bogatych w te składniki odżywcze. Materiał i metody. Badania przeprowadzono za pomocą autorskiego kwestionariusza ankiety wśród 197 rodziców dzieci w wieku 7-9 lat uczęszczających do losowo wybranych szkół podstawowych w Lublinie i Świdniku. Przeprowadzono analizę otrzymanych wyników testem chi-kwadrat oraz w programie Excel.Wyniki. Zauważono znaczące różnice w spożyciu mleka i jego przetworów pomiędzy grupami wiekowymi. Wśród 7 latków 57,5 % dzieci piło mleko i spożywało produkty mleczne co najmniej raz dziennie, natomiast w grupie 9 latków tylko 16,6% dzieci przynajmniej 1 raz w ciągu dnia spożywało produkt nabiałowy. Stwierdzono również niską konsumpcję produktów będących źródłem witaminy D.Wnioski. Dzieci w wieku szkolnym mogą stanowić grupę ryzyka zagrożoną występowaniem niedoborów wapnia i witaminy D, co jest konsekwencją niskiego spożycia mleka i produktów mlecznych, ryb oraz brakiem odpowiedniej suplementacji witaminą D. Konieczna jest edukacja żywieniowa rodziców prowadząca do zmiany sposobu żywienia w rodzinie.

Słowa kluczowe: wapń, witamina D, dzieci, suplementy diety

M. Kostecka 24 No 1

INTRODUCTION

Calcium is an essential nutrient for healthy body function. The total calcium content of the human body is estimated at 1.4-1.66% of body weight, 99% of which is accumulated in bones in the form of hydroxyapati-tes produced during osteogenesis [15]. Calcium is the basic building material in bones and teeth, and it plays a very important role in regulating various cell activi-ties. Calcium ions control neuromuscular excitability, blood clotting, transport across plasma membranes, enzymatic reactions and the release of hormones and neurotransmitters [17].

Calcium is supplied with the diet, but it may not be absorbed in quantities that adequately meet the body’s nutrient requirements for a variety of reasons. Hypocal-cemia, or the drop in serum Ca concentrations below 84 mg/l, can lead to overstimulation of nerves and muscles, tetany seizures, Parkinson’s disease symptoms, sensory loss, anxiety and psychosis [14, 22].

Calcium absorption in the gastrointestinal tract is influenced by various factors and substances that sti-mulate and inhibit this process, including vitamin D3, magnesium, phosphorus, inulin, sugars, amino acids, casein phosphopeptides, short-chain fatty acids, fiber and oxalic acid [9, 10].

Bone mineralization in children requires calcium and phosphorus. Mother’s milk or modified milk are the only sources of calcium for infants and small children. According to the recommendations of the European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN), the Ca:P ratio for healthy bone growth is 1.4-2.0 : 1. Daily calcium demand is determi-ned by the child’s age and is estimated at 400 mg/day up to 6 months of age, 800 mg/day up to 10 years of age, and 1200-1500 mg/day in children older than 10 years [24]. The recommended daily allowances (RDA) for adults were estimated in metabolic studies aiming to achieve a daily balance, namely to ensure that amount of calcium supplied with the diet makes up for the loss of calcium which is excreted with feces, urine and sweat. Daily loss of calcium with feces is estimated at 100 to 130 mg [2], with urine – at 150 mg, with sweat – 15 mg [23], and total endogenous losses reach 265-295 mg per day. Daily demand for calcium has been set at 1000 mg by the European Food Safety Authority (EFSA) [19].

Milk and dairy products meet calcium requirements in around 75%. Diets deficient in protein and phospho-rus as well as diets highly abundant in those nutrients reduce the availability of calcium and decrease bone mass. The calcium-to-protein ratio (mg calcium/1 g protein) is very important in the diet, and it ranges from 33 to 36 for milk and cheese. Excessive intake of dietary protein can promote the loss of calcium when the above

ratio is below 20. For most foods of plant and animal origin, excluding cabbage, the calcium-to-protein ratio is significantly below 20 [37].

Dietary calcium is absorbed in the proximal part of the small intestine in the presence of vitamin D. Lactase deficiency inhibits the absorption of calcium from milk and dairy products. Unbalanced diets, inte-stinal absorption disorders, chronic diarrhea and bowel inflammations can disrupt bone formation in children and lead to osteoporosis in both children and adults.

The density and calcium content of bones begin to increase at the end of adolescence. According to recent research, peak bone mass is achieved at the age of around 30 years. Peak bone mass is determined by both endogenous (genes, race, sex) and exogenous factors (diet, physical activity, nutritional status, phar-macological treatment, chronic diseases). Bone tissue is lost progressively with age due to the disappearance of bone trabeculae and bone resorption near the marrow cavity. Women lose 35-50% of cancellous bone mass and 25-30% of cortical bone mass, and men – 15-45% and 5-15%, respectively. Insufficient peak bone mass increases the risk of osteoporosis in later life [20, 28].

The main source of calcium are dairy products, followed by grain products, fruit and vegetables. Meat is characterized by low calcium concentrations and high phosphorus levels, and it does not cover even minimal demand for calcium. Products of plant origin such as soybeans, runner beans, kale, sunflower, sesame and hazelnuts contain significant amounts of calcium, but they are also rich in fiber, oxalates and phytates which inhibit calcium absorption in the gastrointestinal tract [11].

Vitamin D has hormone-like properties in the human body. It is supplied with the diet, but it is also synthesized by the body under exposure to UV radiation. Vitamin D controls calcium and phosphorus metabolism and is responsible for bone modeling and mineraliza-tion. Vitamin D deficiency has serious implications for the body’s physiological balance, and it increases the risk of many chronic diseases [34, 356]. According to recent research, diseases linked to low levels of vitamin D have reached pandemic proportions and pose a threat to public health [17, 30]. The main causes of the growing incidence of vitamin D deficiency in children include less time spent outdoors, use of sunscreen products and decreased intake of foods rich in vitamin D, in particular fish and functional foods [31]. According to estimates, 50% of people in highly industrialized countries do not consume adequate amounts of vitamin D, and 10% of consumers are deficient in this vital nutrient. Vitamin D is involved in the proliferation and differentiation of immune system cells, and vitamin D deficiency in children and adolescents was found to be correlated with hypersensitivity to selected allergens [18, 30].

Consumption of foods rich in calcium and vitamin D by school-age children. 25No 1

Vitamin D deficiency is a global problem that should be addressed through pharmacological supple-mentation, in particular when serum calcidiol levels drop below 50 nmol/l (20 ng/ml) [6]. There are no clear recommendations with regard to a daily dose of vitamin D that would guarantee optimal calcidiol levels in the blood. An increase in serum calcidiol levels from 50 to 80 nmol/l (20 to 32 ng/ml) leads to a 45-65% impro-vement in the effectiveness of calcium transport in the intestines [12, 33].

The objective of this study was to evaluate eating habits and food preferences of school-age children meet the demand for calcium and vitamin D, and estimate the frequency of consumption of foods rich in these nutrients.


The study was performed with the use of a ques-tionnaire developed by the author. The questionnaire was addressed to the parents of children aged 7 to 9 years attending primary schools in Lublin and Świdnik. Primary schools situated in residential districts were selected at random, and their students were included in the study upon the principal’s prior consent. From the group of 500 prospective subjects, 197 parents agreed to participate in the survey, correctly filled in and returned the questionnaires.

The questionnaire was divided into two parts. The first part consisted of closed-ended questions about the child’s health, body mass, height, the family’s financial status and the number of family members. Based on the anthropometric data measured by the parents, the chil-dren’s nutritional status was determined by calculating Cole’s index [16]. The second part of the questionnaire contained 25 open-ended questions concerning the child’s nutritional habits, eating preferences, frequency of consuming meals and various food products, and the quantity and type of beverages in the children’s diet. Selected questions addressed the amount of milk and dairy products in the children’s daily diet and their consumption frequency. The parents were also asked about the children’s physical activity levels, type and duration of physical activity, the number of hours spent on outdoor activities, the use of sunscreen creams and nutritional supplements, in particular vitamin D.

The results were processed in the Excel application. The answers to questions concerning the children’s consumption of milk and dairy products, gender, age, nutritional status and the number of children in the family were processed by the chi-squared test. Critical values of Ca

2 were read from the chi-squared distri-bution table at a significance level of α=0.05 and (r-1)(k-1) degrees of freedom.

The surveyed sample consisted of 197 parents, in-cluding 51 (26%) parents of children aged 9 years, 73 parents (37%) of children aged 7 years, and 73 parents (37%) of children aged 8 years (Table 1). The majority of children were girls (55.3%) and children with at least one sibling (64%). Only 11.6% of the surveyed subjects evaluated their financial status as poor, whereas the remaining parents claimed to have a good and very good financial standing. The children’s nutritional status was calculated with the use of Cole’s index based on the classification system proposed by McLaren (Table 2).

Table 1. Average height and weight of children in the eva-luated groups, per age category.

DemographicsParameter (number of children) n (73) n (73) n (51)

Age [years] 7 8 9Average height [cm] ± SD 118±9 128±11 136±12Average weight [kg] ± SD 24±3.3 28±5.6 33±5.1

Table 2. The children’s nutritional status proposed by McLa-ren

Cole’s index Nutritional status Girlsn = 109

Boysn = 88

> 120% obesity - -110-120% overweight 14 1690-110% standard 75 5985-90% mild malnutrition 9 775-85% moderate malnutrition 11 6< 75% severe malnutrition – –

RESULTS

The results indicate that most 7-year-olds ate 3 or more meals per day, but 20.5% of the subjects from that group ate only 2 meals per day, and those children were statistically more likely to be mildly to moderately undernourished. The percentage of children consuming 4 and 5 meals per day increased with age.

Lunch was the meal that was most frequently eaten by all children. A total of 191 children always had lunch, and half of them ate lunch both at home and in school, regardless of gender and age. There was a predominance of children from families with 2 and more children in the group of students who ate lunch in school. Breakfast was eaten regularly by 88% of the surveyed children, and it consisted mostly of sandwiches (n=123), cereal with milk (n=78) and dairy products containing sugar (n=93). Cereals with milk and milk soups were the most popular breakfast foods in the youngest group, regardless of gender. Ninety percent of the respondents were provided with second breakfast packed for school, mostly sandwiches (n=134), fruit (n=45), fruit juice or nectar (n=101), sweet pastry (n=68) and vegetables

M. Kostecka 26 No 1

(n=27) (Table 3). Dinner was the least regular meal, and 15% of girls and 11% of boys skipped dinner, mostly because they had a late lunch or went to sleep early.

In the analyzed population, differences in milk con-sumption were noted between age groups. In general, the consumption of pure milk decreased with age (Table 4). In the group of 7-year-olds, 57.5% of children drank milk and ate dairy products at least once a day, whereas in the group of 9-year-olds, only 16.6% of children ate dairy products at least once a day and, according to the parents, more often on school days than on weekends.

Table 4. Frequency of milk and dairy product consumption, per age group

Age How often does your child drink milk and eat dairy products? n

7 years

a) daily, during one meal 33b) daily, during two meals 9c) every other day 19d) once a week 8e) never 4

8 years


9 years


No differences were observed between boys and girls. In the group of 9-year-olds, differences resulting from the number of children in the family were noted. Milk and dairy products were more often served in large families (mostly at breakfast) than in families with one child. The children’s nutritional status and the family’s financial situation did not influence the frequency of milk and dairy product consumption (x2<x2

α).The children’s preferences regarding calcium-rich

products changed with age (Figure 1). Milk and yo-gurt were most popular with 8-year-olds, whereas 7-year-olds showed a preference for ripened cheese and processed cheese. Children were least likely to opt for fermented milks, such as natural yogurt and kefir, whereas flavored milk was the most popularly selected food. The family’s financial standing was not correlated with the consumption of milk and dairy products, but children from more affluent families more often ate yogurt and flavored cream cheese products (x2>x2

α).In the analyzed population, the average consump-

tion of milk and dairy products was determined at 321±125 g/day. It was highest among 7-year-old girls and lowest among 9-year-old boys.

Calcium deficiencies can be effectively remedied with mineral water enriched with this nutrient. Ac-cording to questionnaire data, children did not drink fruit juice supplemented with calcium. In the analyzed population, daily fluid intake reached 1550 ± 350 ml regardless of sex or age. Most children reached for fruit nectar (73.1%), carbonated fruit drinks (53.8%),

Table 3. Most popular foods and dishes subject to gender and ageGirls Boys

7 year-olds (n)

8 year-olds(n)

9 year-olds(n)

7 year-olds(n)

8year-olds(n)

9 year olds(n)

BreakfastSandwiches 19 24 26 17 26 11Cereals with milk 24 10 9 17 12 6Yoghurt/cream cheese 17 15 16 13 15 17Fruit 3 7 6 1 5 2Other (pasta, dumplings) 2 3 1 2 4 3

Second breakfast (elevenses)Sandwiches 27 24 18 20 24 21Teacakes/donuts 9 16 11 8 14 10Sweets 7 10 10 9 13 11Cakes 4 7 5 2 8 3Fruit 12 8 6 7 9 3Fruit juice/nectar 19 17 15 23 11 16Vegetables 3 4 1 6 8 5Lunch/dinner at school 23 33 22 25 30 17Lunch/dinner at home 23 24 20 19 26 19

Late dinner/supperSandwiches 17 20 19 15 21 13Salads 8 11 9 7 5 6Sweets/cakes/pastry 3 5 1 4 2 6Cereals with milk/milk porridge/groats 17 15 4 10 7 8Hot supper 9 21 15 10 14 17


tea (43.1%), flavored mineral water (37%) and mineral water (33%). Mineral water and flavored mineral water were chosen more frequently by children who were more physically active than children who were not involved in any forms of physical activity outside of school, but no differences were observed between the sexes or age groups.

The children’s average intake of mineral water (most children had a preference for regional brands with medium mineral levels, such as Nałeczowianka and Cisowianka) ranged from 280±90 ml in girls to 450±120 ml in boys, which translates into daily Ca2+ intake of 30.8±9.9 to 58.5±15.6 mg.

The consumption of phytate-rich foods, which can reduce the availability of dietary calcium, was very low in the analyzed population. Only 11 children ate legumes, soybeans and chickpeas in the amount of 1 serving per week. Oatmeal was more popular, mostly in the form of porridge or muesli, and it was consumed by 22 children at 1-2 servings per week. No differ-ences were observed between genders or age groups, but students from families with 2 or more children ate porridge more frequently. Products rich in oxalates, such as rhubarb, figs, berries, nuts, whole-grain bread, cocoa and chocolate milk, were consumed sporadically.

Outdoor activities can boost vitamin D synthesis in the skin due to increased exposure to sunlight. Children from all age groups spent an average of 1.5 hours ± 25 minutes outdoors every day. Boys from all age groups played outdoors 30 minutes longer than girls on average. Prolonged physical activity, such as riding a bicycle or playing ball for 2-3 hours, was declared by 23.3% of 7-year-olds, 33% of 8-year-olds and 27.4% of 9-year-olds. The study was carried out in spring when most children play outdoors between 2 p.m. and 6 p.m., which should support optimal vitamin D synthesis in the skin.

In the studied population, only 23.3% of children liked fish, preferably fried or smoked. One serving of fish per week was the norm for 43.1% of the surveyed

subjects, whereas only 20% of the children ate fish more than once a week. Ripened cheese and eggs were the most frequently consumed sources of vitamin D in the studied population. In this study, only 21.9% of 7-year-olds, 17.8% of 8-year-olds and 15.7% of 9-year-olds received vitamin D supplements in winter months.

DISCUSSION

Calcium and vitamin D are mutually dependent nutrients that are vital for bone health. In children and adolescents, calcium and vitamin D deficiencies, in particular in periods of intensive growth, decrease peak bone mass, which compromises age-related involution and can lead to the achievement of the bone fracture threshold at an earlier age. Milk and low-processed dairy products should be the main source of calcium and vitamin D in children’s diets. Two daily servings of milk and 2 daily servings of dairy products should supply 800-1000 mg of calcium. In this study, only 9.1% of children consumed the recommended amount of calcium-rich products covering their minimum daily requirements for this nutrient. Ripened cheese, a popu-lar food in all age groups, is abundant in calcium, but also fat, including saturated fat, as well as phosphorus. Frequent cheese consumption can contribute to weight gain and lower the availability of calcium. In Poland, the daily consumption of milk and dairy products among children and adolescents aged 10-18 years is estimated at 413.5 g/person [3].

According to the literature, the consumption of ripened cheese, processed cheese and fruit-flavored yogurt continues to increase in Poland at the expense of pure milk. Szczepaniak et al. [32] studied 787 secondary school students in the area of Mrągowo, Sosnowiec and Kępno to demonstrate very low consumption of pure milk (only 14% of respondents) and a significant increase in the popularity of ripened cheese and yogurt.

Figure 1. Dairy products most frequently chosen depending on the age of the children (the ability to choose multiple answers)

Figure 1. Dairy products most frequently chosen depending on the age of the children (the ability to choose multiple answers)

other

kefir

cheese yogurt

milk

0

10

20

30

40

50

7 8

9

number of replies

age

M. Kostecka 28 No 1

Wądołowska et al. [35] evaluated school children’s preferences and frequency of milk and dairy product consumption. The cited authors surveyed 1498 school children (820 girls and 678 boys aged 15 to 19 years) from selected regions in northern, central and eastern Poland. The respondents had a clear preference for fruit--flavored fermented milk beverages and ripened cheese. The students’ choices of dairy products were based mainly on the product’s quality, its sensory attributes and, less frequently, nutritional value. No significant differences in factors influencing the respondents’ choices were observed between genders.

The results of a national survey confirmed that the age-related decrease in the consumption of pure milk is probably the main factor responsible for the low die-tary intake of calcium among children and adolescents [25]. Children are increasingly likely to eat calcium--deficient diets due to lower intake of dairy products and growing popularity of foods containing substances that reduce calcium absorption by even 50% [27]. Cal-cium deficiencies were noted in groups of pre-school children [26] and school students [4] characterized by low consumption of milk and dairy products. Calcium intake was inadequate regardless of sex and season [5].

A study conducted in the United States confirmed that frequent consumption of sweetened beverages befo-re the age of 5 years could be responsible for the limited intake of pure milk among adolescents and adults [1].

According to the recommendations formulated as part of the Polish program for the prevention of vitamin D deficiency [7], children and adolescents aged 2-18 years should receive vitamin D supplements in the amount of 10 µg/day (400 IU) between October and March as well as in the remaining months of the year when exposure to sunlight is insufficient to promote vitamin D synthesis in the skin. Only around 20% of the surveyed children received single-vitamin and multi--vitamin supplements containing vitamin D, mostly in the daily amount of 3±2 µg. The diets of the remaining children were not supplemented, the parents were not aware of the need for supplementation, and they had never discussed such an option with their pediatrician.

It is generally believed that 15 minutes of daily sun exposure with 18% of body surface area without sun-block protection provides adequate amounts of vitamin D, but at Poland’s latitude, this is only effective from April to October between 10 a.m. and 3 p.m. In the remaining months of the year (November to March), the children’s diet should be the main source source of vitamin D.

In the summer months, 68.8% of girls and 60.2% of boys had sunscreen applied before playing outdoors in the sun. The parents used sunscreen products to protect their children against harmful effects of UV radiation or protect children with hypersensitive skin. Children are

particularly exposed to the harmful effects of sunlight and UV radiation on the skin, therefore, sunscreen use should be accompanied by oral supplementation with vitamin D [29]. According to research, creams with SPF15 block vitamin D synthesis in 99% and products with SPF8 – in 92%.

Recent studies of European populations aged 1-18 years also revealed severe vitamin D deficiency regar-dless of the respondents’ age or region of origin [8, 13].

The children evaluated in this study were charac-terized by average levels of physical activity. In every age group, more than 20% of children were reluctant to become involved in any form of exercise, which is a very worrying phenomenon that could be exacerbated with age and, together with an unbalanced diet, contri-bute to weight gain in the future. Similar results were reported by Marcysiak et al. [21] in a study of primary and secondary school students in the Ciechanów county. Nearly 30% of the surveyed population from all age groups had a sedentary lifestyle and preferred to spend their free time using a computer or watching television.

More than half of the parents surveyed in this study (56.3%) showed an interest in the role that calcium and vitamin D play in healthy growth, whereas 25.7% of the respondents did not recognize the importance of healthy nutrition and were not willing to expand their knowledge in that area. The issue was more likely to attract the attention of mothers than fathers and of pa-rents of single children. The parents’ attitudes were not influenced by the family’s financial standing.

CONCLUSIONS

1. The consumption of calcium-rich foods, in particular milk and dairy products, was low in the analyzed population.

2. Mineral water can be an additional source of calcium, but it covers less than 10% of the daily demand for this nutrient.

3. The surveyed children did not have a preference for foods rich in vitamin D. The use of sunscreen cream can also lower vitamin D synthesis in the skin under exposure to sunlight.

4. Only less than 20% of the surveyed children received vitamin D supplements, and most parents were of the opinion that only infant and toddler diets required supplementation with vitamin D.

5. Parents and caretakers require comprehensive nutri-tional education in order to effectively change the eating habits of the entire family.

Conflict of interestThe Author declare no conflict of interest.


REFERENCES

1. Bethany A.Y., Rachel K. J.: New school meal regulations and consumption of flavored milk in ten US elementary schools, 2010 and 2013. Prev Chronic Dis 2015;12:E166. doi: 10.5888/pcd12.150163.

2. Buchowski M. S., Aslam M., Dossett C., Dorminy C., Choi L., Acra, S.: Effect of dairy and nondairy calcium on fecal fat excretion in lactose digester and maldigester obese adults. Int J Obes 2009;34:127-135.

3. Cais-Sokolińska D., Borski K.: Intake of calcium conta-ined in milk and dairy products in diets of children and teenagers in Poland in view of other European countries. Acta Sci Pol Technol 2010;9(3):351-362.

4. Charzewska J., Chwojnowska Z., Wajszczyk B.: The risk of shortages of some minerals and vitamins in the diet of schoolchildren around the aged of pubertal [in] Malnutrition and public health. Januszewicz P., Mazur A., Socha J. (red). Wyd. Uniw. Rzeszów 2011:36-46 (in Polish).

5. Czech A., Kęska A.: The nutrient content of rations kin-dergarten in the spring and autumn. Żyw Człow Metab 2007;34(1/2):567-571 (in Polish).

6. Dawson-Hughes B., Heaney R.P., Holick M.F., Lips P., Meunier P.J., Vieth R.: Estimates of optimal vitamin D status. Osteoporos Int 2005;16:713-716.

7. Dobrzyńska A. i Zespół Ekspertów: Polish recommenda-tions for the prevention of vitamin D deficiency – 2009. Pol Merk Lek 2010;28(164):130-133 (in Polish).

8. Doets E.L., de Wit L.S., Dhonukshe-Rutten R.A., Cave-laars A.E.J.M., Raats M.M., Timotijevic L., Brzozowska A., Wijnhoven T.M.A., Pavlovic M., Totland T.H.: Current micronutrient recommendations in Europe: Towards understanding their differences and similarities. Eur J Nutr 2008;47:17-40.

9. Dolińska B., Mikulska A., Ryszka F.: Calcium absorp-tion promoters. Ann Acad Med Siles 2008;64:89-95 (in Polish).

10. Dolińska B., Woźniak D., Ryszka F.: Calcium absorption in the intestine. Farm Przegl Nauk 2009;10:35-38 (in Polish).

11. Gowin E., Ignaszak-Szczepaniak M., Horst-Sikorska W.: Malnourished but obese. Farm Współ 2010;3:124-128 (in Polish).

12. Grygiel-Górniak B., Puszczewicz M.: Vitamin D – new look in medicine and reumatology. Post Hig Med Dośw 2014;68:359-368 (in Polish).

13. Kaganov B., Caroli M., Mazur A., Singhal A., Vania A.: Suboptimal micronutrient intake among children in Europe. Nutrients 2015;7(5):3524-3535.

14. Kanahara M., Kai H., Okamura T., Wada T., Suda K., Imaizumi T., Sagawa K.: Usefulness of high-concentra-tion calcium chloride solution for correction of activated partial thromboplastin time (APTT) in patients with high-hematocrit value. Thromb Res 2008;121: 781-785.

15. Kovesdy C.P., Kuchmak O., Lu J.L., Kalantar-Zadeh K.: Outcomes associated with serum calcium level in men with non-dialysis-dependent chronic kidney disease. Clin J Am Soc Nephrol 2010;5:468-476.

16. Książyk J.: Anthropometric evaluation of nutritional status. Stand Med 2007,4:499-503 (in Polish).

17. Lappe J.M.: The Role of vitamin D in human health: A paradigm shift complementary. Health Pract Rev 2011;16:58-72.

18. Lin R., White J.H.: The pleiotropic action of vitamin D. BioEssays 2008;26:21-28.

19. Lorenc R.S., Karczmarewicz E.: The importance of pro-per supply of calcium for the overall health of the body. Medycyna 2000;29/30:14–19 (in Polish).

20. Lorenc R.S., Karczmarewicz E.: The importance of calci-um and vitamin D to optimize bone mass and preventing and treating osteoporosis in children. Pediatr Wsp Gastrol Hepatol Żyw Dziecka 2001;3(2):105-109 (in Polish).

21. Marcysiak, M., Zagroba, M., Ostrowska, B., Wiśniew-ska, E., Marcysiak, M., Skotnicka-Klonowicz, G.: Physical activity and nutritional behaviors of children and adolescents in Ciechanów county. Probl Pielęg 2010;18(2):176-183 (in Polish).

22. Markiewicz R., Borawska M.H., Socha K., Gutowska A.: Calcium and magnesium in the diets of older people from the region of Podlasie. Bromat Chem Toksykol 2009;42(3):629-635 (in Polish).

23. Massey L.K.: Is caffeine a risk factor for bone loss in the elderly? Am J Clin Nutr 2001; 74:569-570.

24. NIH Consensus Development Panel on Optimal Calcium Intake. Optimal calcium intake. JAMA 1994,272:1942-1947.

25. Ołtarzewski M., Szponar L., Rychlik E.: Calcium intake among children and adolescents in Poland. Żyw Człow Metab 2003;30(1-2):278-283 (in Polish).

26. Orkusz A., Włodarczyk A.: Evaluation of nutritional stan-dards in kindergartens based on ten-day menus. Nauki Inżynierskie i Technologie/Uniwersytet Ekonomiczny we Wrocławiu 2014;1(12):72-81 (in Polish).

27. Pettifor J.M.: Calcium and vitamin D metabolism in children in developing countries. Ann Nutr Metab 2014;64(2):15-22.

28. Prentice A.: Diet, nutrition and the prevention of oste-oporosis. Pub Health Nutr 2004;7(1A):227-243.

29. Rhodes L.E., Webb A.R., Berry J.L., Felton S.J., Mar-janovic E.J., Wilkinson J.D., Vail A., Kift R.: Sunlight exposure behaviour and vitamin D status in photosen-sitive patients: longitudinal comparative study with healthy individuals at U.K. latitude. Br J Dermatol 2014; 171(6):1478-1486.

30. Rowicka G., Strucińska M., Ambroszkiewicz J.: Vitamin D status in children with allergies to cow’s milk protein. Dev Period Med. 2012;16(4):307-312 (in Polish).

31. Strucińska M., Rowicka G., Dyląg H., Riahi A., Bzikow-ska A.: Dietary intake of vitamin D in obese children aged 1-3 years. Rocz Panstw Zakl Hig 2015;66(4):353-360 [PMID: 26656417; http://www.ncbi.nlm.nih.gov/pubmed/26656417].

32. Szczepaniak B., Górecka D., Flaczyk E.: Nutritional be-haviors and the consumption of milk and dairy products among adolescents from various regions of Poland. Żyw Człow Metab 2003;1(30):588-592 (in Polish).

M. Kostecka 30 No 1

33. Szponar L., Ołtarzewski M.: Nutritional risk fac-tors for disorders of calcium-phosphate. Stand Med 2007;4(3):322-329 (in Polish).

34. Tukaj C.: The appropriate level of vitamin D condition of health. Post Hig Med Dośw 2008;62:502-510 (in Polish).

35. Wądołowska L., Babicz-Zielińska E., Schlegel-Za-wadzka M., Przysławski J., Czarnocińska J.: Preferen-ces, consumption and choice factors for milk and its products among school children. Pol J Food Nutr Sci 2002;2(11/52):81-86.

36. Wranicz J., Szostak-Węgierek D.: Health outcomes of vitamin D. Part II. Role in prevention of diseases. Rocz Panstw Zakl Hig 2014;65(4):273-279 [PMID: 25526571; http://www.ncbi.nlm.nih.gov/pubmed/25526571].

37. Zmarlicki S.: Dairy and dairy products as a source of calcium. Przem Spoż 2009;63(10):42-46 (in Polish).




*Address for correspondence: Maria Gacek, Department of Sports Medicine and Human Nutrition, University School of Physical Education, Al. Jana Pawla II 78, 31-571 Krakow, Poland, phone: +48 12 683 14 45, fax +48 12 683 12 23, e-mail: [email protected]


ORIGINAL ARTICLE

ASSOCIATION BETWEEN GENERAL SELF-EFFICACY LEVEL AND USE OF DIETARY SUPPLEMENTS IN THE GROUP

OF AMERICAN FOOTBALL PLAYERS

Maria Gacek1*

1Department of Sports Medicine and Human Nutrition, University School of Physical Education, Krakow, Poland

ABSTRACTBackground. Increased nutritional demands of athletes should be covered with a variable well-balanced diet, supported by dietary supplements stimulating synthesis of energy, development of muscle mass and strength, and improving physical capacity.Objective. The aim of this study was to analyze an association between the level of general self-efficacy and dietary supple-ment use among Polish athletes practicing American football on a competitive basis.Material and methods. The study included the group of 100 athletes (20-30 years of age, mean 24.27±2.76 years) who practiced American football on a competitive basis. The popularity of various dietary supplements was determined with an original survey, and the level of general self-efficacy with General Self-Efficacy Scale (GSES) by Schwarzer et al. Statistical analysis, conducted with Statistica 10.0 PL software, included intergroup comparisons with the Chi-square test.Results. Isotonic drinks (74%), vitamin (65%) and mineral supplements (50%) and protein concentrates (53%) turned out to be the most popular ergogenic supplements among the American footballers. The group of less popular supplements included caffeine and/or guarana (44%), joint supporting supplements (40%), BCAA amino acids (39%), creatine (36%), carbohy-drate concentrates (30%) and omega-3 fatty acids (30%). Analysis of a relationship between the popularity of ergogenic supplements and general self-efficacy showed that the athletes presenting with lower levels of this trait used multivitamin supplements significantly more often than did the persons characterized by lower self-efficacy levels (p<0.05).Conclusions. The popularity of some dietary supplements varied depending on the general self-efficacy level of the ath-letes; the popularity of vitamins was significantly higher among the sportsmen who presented with lower levels of this trait.

Key words: ergogenic substances, athletes, American football, general self-efficacy

STRESZCZENIE Wstęp. Różnorodna i zbilansowana dieta powinna służyć pokryciu zwiększonych potrzeb żywieniowych sportowców, a jej uzupełnieniem mogą być żywieniowe środki wspomagające, stymulujące generowanie energii, rozwój masy i siły mięśniowej oraz poprawiające wydolność fizyczną.Cel. Celem badań była ocena zależności między poczuciem własnej uogólnionej skuteczności a stosowaniem żywieniowych środków wspomagających w grupie polskich sportowców uprawiających futbol amerykański. Materiał i metody. Badania przeprowadzono w grupie 100 polskich zawodników (20-30 lat, średnia 24,27±2,76) wyczy-nowo trenujących futbol amerykański. Stosowanie żywieniowych środków wspomagających oceniono w oparciu o przygo-towany kwestionariusz. Do pomiaru poczucia uogólnionej skuteczności wykorzystano standaryzowaną Skalę Uogólnionej Własnej Skuteczności (GSES) wg Schwarzera i wsp. Analizę wyników przeprowadzono za pomocą testu Chi2 w programie Statistica 10.0 Pl. Wyniki. Spośród środków ergogenicznych, polscy zawodnicy wyczynowo trenujący futbol amerykański najczęściej przyjmowali: napoje izotoniczne (74%), preparaty witaminowe (65%) i mineralne (50%) oraz odżywki białkowe (53%). W mniejszym odsetku stosowali: kofeinę i/ lub guaranę (44%), środki ochraniające stawy (40%), aminokwasy BCAA (39%), kreatynę (36%), odżywki węglowodanowe (30%) oraz preparaty omega-3 (30%). Ocena stosowania środków ergogenicz-nych w zależności od poczucia własnej skuteczności wykazała, że mężczyźni o niskim nasileniu samoskuteczności istotnie częściej przyjmowali preparaty multiwitaminowe niż zawodnicy o wysokim jej nasileniu (p<0,05).

M. Gacek32 No 1

Wnioski. Stosowanie niektórych żywieniowych środków wspomagających było zróżnicowane w zależności od poczucia własnej uogólnionej skuteczności zawodników, ze wskazaniem na częstsze przyjmowanie preparatów witaminowych przez sportowców o niższym nasileniu samoskuteczności.

Słowa kluczowe: środki ergogeniczne, sportowcy, futbol amerykański, poczucie własnej uogólnionej skuteczności

INTRODUCTION

Increased demand of athletes, associated with their enhanced metabolism and exposure to oxidative stress, should be covered with a well-balanced diet containing appropriate amounts of energetic, structural and regula-tory compounds. Greater demand for protein, especially in athletes practicing speed/strength and purely strength disciplines, and for carbohydrates, specific for enduran-ce sports, is associated with increased requirements for vitamin B complex, antioxidants and some minerals. Equally important is adequate repletion of fluids, being a significant determinant of exercise capacity [5, 31, 40].

Rational diet can also include supplements stimula-ting synthesis of energy, development of muscle mass and strength, and improving physical capacity [32]. So-dium bicarbonate, caffeine and creatine are supplements with scientifically proven efficiency, both according to the classification of the Medical Commission of the International Olympic Committee [24] and the Austra-lian Institute of Sport [5]. Moreover, caffeine, creatine, isotonic drinks, proteins and carbohydrates are recom-mended as supplements by the Medical Commission of the Polish Olympic Committee [44]. Other compounds are classified as substances with limited or non-proven scientifically efficiency [24, 44]. The list of supplements with established efficiency published by the Australian Institute of Sport includes isotonic drinks, liquid meals, sport gels and bars, antioxidants, zinc with vitamin C, multivitamin and mineral supplements (among them iron and calcium), glycerol and glucosamine [5]. Due to its buffering properties, supplementation with sodium bicarbonate is efficient in athletes practicing strength/endurance and speed/endurance disciplines [26, 35, 42]. In turn, caffeine was shown to modulate function of the central nervous system and prevent fatigue [1], and creatine is known to promote muscle mass and strength gains, and improves physical capacity [4, 9].

Health-oriented behaviors, including nutritional behaviors, are determined by a wide spectrum of so-cioeconomic, cultural and personality-related factors [39]. The sense of general self-efficacy is one of the personality-related determinants of health culture [8, 25]. It is self-efficacy which allows one to predict his/her intentions and activities in various spheres, inclu-ding health- and nutrition-related behaviors [8, 25]. In this context, self-efficacy should be considered a key component of a modern, processual model of change in

health-oriented behaviors, among them in dietary habits. Consequently, this study was undertaken to determine the role of general self-efficacy as a predictor of dietary supplement use in a group of Polish athletes.

The aim of this study was to analyze an association between the level of general self-efficacy, an important personality trait, and dietary supplement use among Polish athletes practicing American football on a com-petitive basis.


The study included the group of 100 young men (20-30 years of age, mean 24.27±2.76 years) who practiced American football on a competitive basis in three Polish clubs: ‘Warsaw Eagles’, ‘Krakow King’ and ‘Wilki Łódzkie’. The participants were either stu-dents (45%) or professionally active employees with higher (23%), secondary (28%) or vocational education (4%). They have been practicing American football for three years on average and declared being in very good (70%) or good health (30%). The athletes participated in 1-2 training sessions per day, five times per week on average; mean duration of a single training session was two hours. The analysis of recently determined somatic parameters of the athletes showed that their mean body mass index (BMI) and body fat mass were 27.14 kg/m2 (±2.06), and 14.5% (±2.13), respectively.

The study was based on an original dietary sup-plement use questionnaire. Use of dietary supplements was evaluated in following categories: yes (regularly or periodically) and no (never). Prior to the proper study, the questionnaire was validated in a group of 23 individuals, with a retest after 6 weeks. Psychometric assessment revealed high reproducibility of results obtained with the instrument. McNemar’s Chi-square test did not show significant differences between the test and retest results for any of the statements (p>0.05). The level of general self-efficacy was determined with General Self-Efficacy Scale (GSES) by Schwarzer et al. [25]. The scale includes 10 statements that are scored in such way that the higher the global GSES score (ranging from 10 to 40 points), the stronger the sense of self-efficacy. Based on the median of the raw GSES score for our sample, we classified the participants as presenting with lower (n=50) and higher (n=50) levels of self-efficacy. Median stands at 31. Other descriptive

Association between self-efficacy and use of dietary supplements by football players. 33No 1

statistics in GSES scale have shown that: X=31.25; SD=3.15; Min=22; Max=40. Statistical analysis was conducted with STATISTICA 10.0 PL software. The distributions of dietary supplements use among the individuals with higher and lower self-efficacy levels were compared with the Chi-square test. The results were considered significant at p<0.05.

RESULTS

Isotonic drinks (74%), vitamin (65%) and mineral supplements (50%) turned out to be the most frequently (regularly or periodically) used ergogenic supplements in our group. Approximately a half of the athletes used protein concentrates (53%), and somewhat lower frac-tion (39%) declared using branched-chain amino acids (BCAA). Similarly high percentages of the respondents used creatine (36%) and carbohydrate concentrates (30%). The use of protein-carbohydrate concentrates was declared by 25% of the surveyed sportsmen, and the use of carbohydrate-protein and carbohydrate bars by 18% and 17%, respectively. Supplements containing omega-3 fatty acids were used by 30% of the footbal-

lers, joint support supplements by 40%, and caffeine and/or guarana by 44%. The group of the least popular supplements included ginseng (14%), L-carnitine (8%), CLA (8%), sodium bicarbonate (6%), HMB (4%) and MCT (4%). It should also be highlighted that majority of athletes were using dietary supplements periodically (90%), and only for 10% of them it was regular habit.

Analysis of a relationship between the popularity of ergogenic supplements and general self-efficacy showed that the athletes presenting with lower levels of this trait used multivitamin supplements significantly more often (regularly or periodically) than did the persons characte-rized by lower self-efficacy (76.0% vs. 55.5%; p<0.05). The popularity of other dietary supplements among the examined footballers was not modulated significantly by their self-efficacy levels (p>0.05) (Table 1).

DISCUSSION

Our study revealed that dietary supplements are quite popular among athletes who practice American football on a competitive basis. Furthermore, we sho-wed that the popularity of various supplements varies considerably. Isotonic drinks, vitamin and mineral supplements turned out to be the most often used supplements in our group. Importantly, the popularity of vitamin supplements, the most important group of ergogenic substances, varied depending on the general self-efficacy of the athletes.

High popularity of ergogenic supplements among sportspersons was previously documented both in Po-land [11, 16] and abroad: in Australia (87.50% of the athletes) [12], Canada (88.40%) [14], Iran (66.70%) [41] and other countries [3, 23].

The use of isotonic drinks, that turned out to be the most popular ergogenic supplements in our group of athletes, is justified taking into account their important role in fluid repletion, maintenance of water-electrolyte and acid-base balance during physical exercise, and stimulation of post-exercise regeneration of glycogen [5, 33, 40]. Also the frequent use of vitamin and mineral supplements by our respondents seems reasonable in the context of the vital role they play in sports nutrition [40]. Vitamin B complex is involved in the metabolic processes associated with regeneration of protein struc-ture and glycogen reserve, as well as in the synthesis of energy. This makes it an important determinant of psychophysical capacity of the athletes [40]. In turn, antioxidant vitamins increase antioxidative potential of cells and protect them against the consequences of enhanced oxidative stress. The latter results from peroxidation of lipids and is frequently observed in sportspersons, especially among the representatives of endurance disciplines. The important role of minerals

Table 1. Use of ergogenic supplements (%) (regularly or periodically) among Polish athletes practicing American football on a competitive basis, stratified according to their general self-efficacy level

Supplement type Overall

General self-efficacy

(GSES) Chi2 p

High LowVitamin supplements 65.0 55.5 76.0 4.69 0.0303Mineral supplements 50.0 42.5 58.7 2.58 0.1076Protein concentrates 53.0 55.5 50.0 0.30 0.5790Carbohydrate concentrates 30.0 33.3 26.0 0.62 0.4293

Protein-carbohydrate concentrates 25.0 27.7 21.7 0.48 0.4856

Isotonic drinks 74.0 68.5 782. 1.86 0.1724Carbohydrate-protein bars 18.0 16.6 19.5 0.14 0.7072

Carbohydrate bars 17.0 16.6 17.3 0.009 0.9234Amino acids (BCAA) 39.0 44.4 32.6 1.47 0.2251Creatine 36.0 40.7 30.4 1.15 0.2831L-carnitine 8.0 5.5 10.8 0.95 0.3287HMB 4.0 5.5 2.1 0.78 0.3768Omega-3 fatty acids 30.0 31.4 28.2 0.12 0.7258Joint support supplements 40.0 40.7 39.1 0.62 0.8698

Caffeine and/or guarana 44.0 40.7 47.8 0.50 0.4768CLA 8.0 5.5 10.8 0.95 0.3287Sodium bicarbonate 6.0 3.7 8.7 1.10 0.2932MCT 4.0 3.7 4.3 0.02 0.8700Ginseng 14.0 9.2 19.5 2.19 0.1381

p – significance of differences between the subsets of athletes presenting with different self-efficacy levels (high vs. low), determined on the Chi-square test

M. Gacek34 No 1

stems from their involvement in regulation of water--electrolyte and acid-base balance, neuromuscular excitability and hematopoiesis [5, 32, 40]. Increased demand of athletes for some vitamins and minerals, vital role of the latter during strenuous exercise, and previously documented deficiency of specific regulatory components, such as calcium [17, 36, 43], iron [30], magnesium [10] and some elements of the vitamin B complex [34, 43] among sportspersons, justify their periodical supplementation in this group. Also the other recently published studies showed that vitamins and minerals are the most popular supplements among sport-spersons [13, 16, 41]. Many of our American footballers declared using supplements promoting muscle mass and strength gains, such as protein concentrates, BCAA and creatine. The popularity of these supplements among our respondents likely reflected their attempts to opti-mize the training effects, since previous studies showed that the abovementioned substances are vital for exer-cise capacity [2, 22]. Similar fraction of the examined athletes declared using caffeine-based supplements. In contrast, carbohydrate concentrates were less popular in our group. The relatively high popularity of caffe-ine, a known modulator of psychophysical capacity, should be interpreted positively, especially taking into account the efficiency of this supplement documented in previous studies [1]. Beneficial effects of caffeine, including improvement of precision, were previously observed in a group of football players [15]. Also the use of carbohydrate and carbohydrate-protein concentrates, as well as carbohydrate bars, is reasonable due to the established role of carbohydrates in energetic processes, post-exercise regeneration of glycogen reserve and im-provement of exercise capacity, especially during long training sessions [6, 27]. The relatively low popularity of these supplements among our American footballers might reflect their limited knowledge with regards to effective methods of supporting physical exercise. This observation is consistent with the data published by other authors, who observed that the content of carbo-hydrates in the energetic pool of athletes is relatively low [37]. Previous studies showed that amino acids play an important role in supporting exercise capacity [2, 7, 22, 29]. The relatively high popularity of amino acids among our athletes is consistent with the results published previously by other authors [41].

Furthermore, this study showed that general self--efficacy determines the popularity of some ergogenic supplements among American footballers. We showed that the athletes presenting with lower self-efficacy levels significantly more often used vitamin supple-ments, a group of ergogenic substances with established efficiency. Taking into account that in previous studies the athletes characterized by lower self-efficacy were demonstrated to undertake less rational dietary choices

[18], the fact that such persons showed a tendency to more frequent use of vitamin supplements should be in-terpreted positively, as a way to counterbalance potential deficiency of these nutrients. The association between lower self-efficacy and less rational dietary choices was observed not only among athletes [18, 21], but also in other population groups [19, 20, 28, 38].

Rationalization of a diet and dietary supplement use among athletes requires monitoring thereof, and should be adjusted for personality traits of the subjects, including their general self-efficacy.

CONCLUSIONS

1. American football players were shown to use dietary supplements, especially isotonic drinks, vitamin and mineral supplements.

2. The popularity of some ergogenic substances varied depending on the general self-efficacy of the ath-letes; the popularity of vitamins was significantly higher among the sportsmen who presented with lower levels of this personality dimension.

Conflict of interestThe author declares no conflict of interest.

REFERENCES

1. Astorino T., Roberson D.: Efficacy of acute caffeine ingestion for short-term high-intensity exercise per-formance: a systematic review. J Strength Cond Res 2010;24(1):257-265.

2. Blomstrand E., Eliasson J., Karlsson H., Köhnke R.: Branched-chain amino acids activate key enzymes in protein synthesis after physical exercise. J Nutr 2006;136(Suppl 1):269-273.

3. Braun H., Koehler K., Geyer H., Kleiner J., Mester J., Schanzer W.: Dietary supplement use among elite young German athletes. Int J Sport Nutr Exerc Metab 2009;19:97-109.

4. Buford T., Kreider R., Stout J., Greenwood M., Campbell B., Spano M., Ziegenfuss T., Lopez H., Landis J., Antonio J.: International Society of Sports Nutrition position stand: creatine supplementation and exercise. J Int Soc Sports Nutr 2007;4:6 doi: 10.1186/1550-2783-4-6.

5. Burke L., Deakin V.: Clinical Sports Nutrition. McGraw--Hill Medical, NY United States 2010.

6. Burke L., Hawley J., Wong S., Jeukendrup A.: Car-bohydrates for training and competition. J Sports Sci 2011;29(Suppl 1):17-27.

7. Cermak N., Res P., de Groot L., Saris W., van Loon L.: Protein supplementation augments the adaptive response of skeletal muscle to resistance-type exercise training: a meta-analysis. Am J Clin Nutr 2012;96(6):1454-1464.

Association between self-efficacy and use of dietary supplements by football players. 35No 1

8. Chiang L., Kuo Y., Lin C.: A concept analysis of self-ef-ficacy. Hu Li Za Zhi 2004;51(2):67-72.

9. Cooper R., Naclerio F., Allgrove J., Jimenez A.: Creatine supplementation with specific view to exercise/sports performance: an update. J Int Soc Sports Nutr 2012;9:33.

10. Czaja J., Lebiedzińska A., Marszałł M., Szefer P.: Eva-luation for magnesium and vitamin B6 supplementation among Polish elite athletes. Rocz Panstw Zakl Hig 2011;62(4):413-418 (in Polish) [PMID: 22435297; http://www.ncbi.nlm.nih.gov/pubmed/22435297] .

11. Czaja J., Lebiedzińska A., Szefer P.: Eating habits and diet supplementation of Polish middle- and long-distance representative runners in years 2004-2005. Rocz Panstw Zakl Hig 2008;59(1):67-74 (in Polish) [PMID: 18666624; http://www.ncbi.nlm.nih.gov/pubmed/18666624].

12. Dascombe B., Karunaratna M., Cartoon J., Fergie B., Goodman C.: Nutritional supplementation habits and perceptions of elite athletes within a state-based sporting institute. J Sci Med Sport 2010;13:274-280.

13. Darvishi L., Askari G., Hariri M., Bahreynian M., Ghi-asvand R., Ehsani S., Mashhadi N., Rezai P., Khorvash F.: The use of nutritional supplements among male collegiate athletes. Int J Prev Med 2013;4(Suppl 1):68-72.

14. Erdman K., Fung T., Doyle-Baker P., Verhoef M., Re-imer R.: Dietary supplementation of high-performance Canadian athletes by age and gender. Clin J Sport Med 2007;17(6):458-464.

15. Foskett A., Ali A., Gant N.: Caffeine enhances cognitive function and skill performance during simulated soccer activity. Int J Sport Nutr Exerc Metab 2009;19(4):410-423.

16. Frączek B., Gacek M., Grzelak A.: Nutritional support of physical abilities in a professional athletes’ group. Probl Hig Epidemiol 2012;93(4):817-823 (in Polish).

17. Gacek M.: Evaluation of consumption of selected nu-trients in a group of hockey players during the preparation period. Rocz Panstw Zakl Hig 2010;61(3):259-264 (in Polish) [PMID: 21365861; http://www.ncbi.nlm.nih.gov/pubmed/21365861].

18. Gacek M.: Some individual differences as dietary pat-tern predictors for team sports contestants in the light of recommendations for athletes. Monografie 23, AWF Kraków 2013 (in Polish).

19. Gacek M.: Selected individual differences as predictors of milk product consumption in a group of perimenopausal women in the light of health hazards. Przegl Menopauz 2013;4:300-306.

20. Gacek M.: Selected individual differences as determining factors of cereal product, fruit and vegetable consumption among perimenopausal women, in light of health hazards. Przegl Menopauz 2013;5:385-391.

21. Gacek M., Frączek B.: Nutritional evaluation of junior football players depending on the global level of self- efficacy of the athletes. Med Sportiva 2013;17(2):72-75.

22. Gleeson M.: Interrelationship between physical activity and branched-chain amino acids. J Nutr 2005;135(6):1591-1595.

23. Goston J., Correia M.: Intake of nutritional supplements among people exercising in gyms and influencing factors. Nutrition 2010;26(6):604-611.

24. Jegier A. (ed.): Approved and forbidden support of exer-cise capacity in humans. PTMS, Łódź 2007. (in Polish)

25. Juczyński Z.: Measurement tools in health promotion and health psychology. PTP, Warszawa 2009. (in Polish)

26. Kilding A., Overton C., Gleave J.: Effects of caffeine, sodium bicarbonate, and their combined ingestion on high-intensity cycling performance. Int J Sport Nutr Exerc Metab 2012;22(3):175-183.

27. Kovacs M.: Carbohydrate intake and tennis: are there benefits? Br J Sports Med 2006;40:5.

28. Kreausukon P., Gellert P., Lippke S., Schwarzer R.: Plan-ning and self-efficacy can increase fruit and vegetable consumption: a randomized controlled trial. J Behav Med 2012;35(4):443-451.

29. Kreider R., Campbell B.: Protein for exercise and reco-very. Phys Sportsmed 2009;37(2):13-21.

30. Malczewska J., Stupnicki R., Szczepańska B.: Prevalence of iron deficiency among master class athletes. Wych Fiz Sport, 2009;53(2):93-98 (in Polish).

31. Maughan R., Burke L., Coyle E. (eds.): Food, Nutrition and Sports Performance; IOC Consensus Conference on Sports Nutrition. Routledge, London 2004.

32. Maughan R., King D., Lea T.: Dietary supplements. J Sports Sci 2004;22(1):95-113.

33. Maughan R., Shirreffs S.: Nutrition and hydration con-cerns of the female football player. Br J Sports Med 2007;41(Suppl. 1):60-63.

34. Mbemba F., Massamba A., Bazolo P., Babela J., Senga P.: Congolese high level football player’s nutrition during precompetition. Sci Sports 2006;21(3):131-136.

35. McNaughton L., Siegler J., Midgley A.: Ergogenic effects of sodium bicarbonate. Curr Sports Med Rep 2008;7(4):230-236.

36. Noda Y., Iide K., Masuda R., Kishida R., Nagata A., Hirakawa F., Yoshimura Y., Imamura H.: Nutrient intake and blood iron status of male collegiate soccer players. Asia Pac J Clin Nutr 2009;18(3):344-350.

37. Ono M., Kennedy E., Reeves S., Cronin L.: Nutrition and culture in professional football. A mixed method appro-ach. Appetite 2012;58(1):98-104.

38. Pearson N., Ball K., Crawford D.: Predicators of changes in adolescents’ consumption of fruits, vegetables and energy-dense snacks. Br J Nutr 2011;105(5):795-803.

39. Remick A., Polivy J., Pliner P.: Internal and external mo-derators of the effect of variety on food intake. Psychol Bull 2009;135(3):434-451.

40. Rodriguez N. R., DiMarco N. M., Langley S.: Position of the American Dietetic Association, Dietitians of Canada, and the American College of Sports Medicine: Nutrition and athletic performance. J Am Diet Assoc 2009;109(3):509-527.

41. Saeedi P., Nasir M., Taib M., Hazizi A., Vafa M., Foro-ushani A.: Nutritional supplement use among fitness club participants in Tehran, Iran. Appetite 2013;60:20-26.

42. Spriet L., Perry C., Talanian J.: Legal pre-event nutri-tional supplements to assist energy metabolism. Essays Biochem 2008;44:27-43.

43. Wierniuk A., Włodarek D.: Estimation of energy and nutritional intake of young men practicing aerobic sports. Rocz Panstw Zakl Hig 2013;64(2):143-148

M. Gacek36 No 1

[PMID: 23987084; http://www.ncbi.nlm.nih.gov/pub-med/23987084].

44. Use of dietary supplements and functional foods in sport. Recommendations for Polish sports associations. Consensus of the Center for Sports Medicine (CSM) and

Medical Commission of the Polish Olympic Committee (POC), Warszawa 2012 (in Polish).




*Corresponding author: Agnieszka Dmitruk, Józef Piłsudski University of Physical Education in Warsaw, Faculty of Physical Education and Sport in Biała Podlaska, Department of Biology and Anatomy, Biała Podlaska, Poland, phone: +48 83 3428738, e-mail: [email protected]


ORIGINAL ARTICLE

RELATIONSHIP BETWEEN DIET AND PHYSICAL ACTIVITY LEVEL IN ADOLESCENTS FROM POST-GRAMMAR SCHOOLS

Agnieszka Dmitruk1*, Izabela Kunicka1, Helena Popławska1, Wojciech Hołub2

1Józef Piłsudski University of Physical Education in Warsaw, Faculty of Physical Education and Sport in Biała Podlaska, Department of Biology and Anatomy, Biała Podlaska, Poland

2Józef Piłsudski University of Physical Education in Warsaw, Faculty of Tourism and Health in Biała Podlaska, Department of Cosmetology, Biała Podlaska, Poland

ABSTRACTIntroduction. Appropriate diet and physical activity are vital determinants of psychophysical development in children and adolescents.Objective. The aim of the study was to analyse an association between dietary habits and physical activity levels of ado-lescents from post-grammar schools.Material and methods. The study included 110 girls and 65 boys between 16 and 19 years of age from two post-grammar schools in Biała Podlaska in Poland. They were subjected to a diagnostic survey providing information on their diet (num-ber of meals a day, their regularity, frequency of bread, dairy, meat, fish, sweet, fruit, vegetable and fast food consumption, preferred ways of food processing). Physical activity levels were determined with the International Physical Activity Ques-tionnaire – Short Form (IPAQ-SF). Based on these data, the respondents were stratified to high, moderate and low physical activity groups. Due to small number of participants presenting with low physical activity levels, we did not include this group in further analyses. The significance of differences in the dietary habits of adolescents presenting with high and moderate physical activity levels was verified with the χ2 test.Results. Most girls and boys presented with high levels of physical activity. However, we did not find an evident relationship between dietary habits and physical activity levels. Girls from high and moderate physical activity groups differed solely in terms of the number of daily meals, frequency of meat and sweet consumption, and significant intergroup differences observed among boys pertained to the frequencies of whole-wheat bread, meat and fast food consumption. The abovemen-tioned food products were consumed more often by girls and boys presenting with high physical activity levels.Conclusions. The dietary mistakes observed in physically active adolescents from post-secondary schools justify intensi-fication of their dietary education programs.

Key words: diet, physical activity, girls, boys

STRESZCZENIEWprowadzenie. Prawidłowe odżywianie i aktywność fizyczna to podstawowe czynniki wpływające na rozwój psychofi-zyczny dzieci i młodzieży.Cel. Celem pracy była ocena sposobu odżywiania się młodzieży szkół ponadgimnazjalnych w zależności od poziomu aktywności fizycznej.Materiał i metody. Badaniami objęto 110 dziewcząt i 65 chłopców w wieku 16-19 lat z dwóch szkół ponadgimnazjalnych w Białej Podlaskiej. Wśród młodzieży przeprowadzono sondaż diagnostyczny, który dostarczył informacji o sposobie od-żywiania się badanych (liczbie i regularności spożywania posiłków, częstości spożycia pieczywa, produktów mlecznych, mięsa, ryb, słodyczy, owoców i warzyw, żywności typu „fast food” i sposobu obróbki kulinarnej). Aktywność fizyczną oce-niono poprzez zastosowanie Międzynarodowego Kwestionariusza Aktywności Fizycznej IPAQ (forma krótka). Umożliwiło to podział dziewcząt i chłopców na grupy o dużej, średniej i małej aktywności fizycznej. Ze względu na małą liczebność badanych o małej aktywności fizycznej wyniki tych osób nie były poddawane dalszym analizom. Istotność statystyczną różnic w sposobie odżywiania się młodzieży o dużej i średniej aktywności fizycznej oceniono testem χ2.

A. Dmitruk, I. Kunicka, H. Popławska et al.38 No 1

Wyniki. Większość badanych dziewcząt i chłopców charakteryzowała się dużą aktywnością fizyczną. Nie można natomiast jednoznacznie stwierdzić, że występuje zależność pomiędzy sposobem odżywiania a poziomem aktywności fizycznej. U dziewcząt istotność statystyczna różnic pomiędzy grupą o dużej i średniej aktywności fizycznej wystąpiła tylko w przy-padku: liczby spożywanych posiłków, częstości spożywania mięsa i słodyczy; u chłopców natomiast w częstości spożywania pieczywa razowego, mięsa i żywności typu „fast food”. U dziewcząt, jak i u chłopców, częstsze spożywanie produktów z wyżej wymienionych grup wystąpiło u badanych o dużej aktywności fizycznej.Wnioski. Stwierdzone nieprawidłowości w sposobie odżywiania się, przy dużej aktywności fizycznej młodzieży ponad-gimnazjalnej, wskazują na potrzebę zwiększenia edukacji żywieniowej badanych dziewcząt i chłopców.

Słowa kluczowe: sposób żywienia, aktywność fizyczna, dziewczęta, chłopcy

INTRODUCTION

Physical activity and rational diet constitute vital determinants of health. However, a tendency to redu-ce physical activity level in favor of passive ways of spending free time have been observed recently [2, 3, 14], along with unfavorable nutritional behaviors, such as non-varied diets, deficient in minerals and vitamins. Usually, such diets are based on high-calorie products with low nutritional values [15, 20, 23].

Optimal frequency and intensity of physical activity for school children and adolescents have been a subject of many published guidelines. American National Asso-ciation for Sport and Physical Education recommends at least 60 minutes of physical activity daily, optimally each day of the week [6]. Also according to WHO and European Community, to promote healthy growth, children and adolescents should undertake at least 60 minutes of moderate or intense activity each day, opti-mally in form of endurance exercises, improving agility and strength of various muscle groups [31]. However, the report published by the National Institute of Public Health – National Institute of Hygiene suggests that a considerable proportion of adolescents in Poland do not undertake the recommended amount of physical activity. The number of physically active individuals decreases with age, especially among girls. In 2010, appropriate levels of physical activity were presented by no more than 4% of girls from the oldest age group (17-18 years). However, there is a potential for improvement, as an increase in the proportion of regularly exercising individuals has been documented among the youngest boys and girls [30].

Too low level of physical activity, inappropriate diet and resultant overweight and obesity may affect psycho-physical development of children and adolescents and lead to many diseases of the adulthood, such as diabetes mellitus, cardiovascular disorders and osteoporosis [11, 13, 22]. This may exert unfavorable effect on psycho-social functioning of an individual [8, 18]. Therefore, despite many previous studies dealing with the problem in question, social awareness with regards to beneficial effects of a rational diet and regular physical activity

still should be a subject of continuous monitoring and improvement.

The aim of the study was to analyze the diets of 16- to 18-year-old pupils; specifically we studied an association between physical activity levels of the study participants, their nutritional behaviors and consump-tion of selected food products.


The study included 110 girls and 65 boys between 16 and 19 years of age from two post-grammar vocatio-nal schools in Biała Podlaska. 65% of girls and 72% of boys commuted to schools from local villages.

All participants were subjected to a diagnostic su-rvey with the questionnaire determining their dietary ha-bits and frequency of consuming selected food products.

Physical activity levels were determined with the International Physical Activity Questionnaire – Short Form (IPAQ-SF) [7]. The questionnaire included 7 statements regarding various types of physical activity associated with daily living, work and recreation. We determined the time spent sitting, walking and perfor-ming moderate and vigorous physical activities. Each type of physical activity was expressed in MET-min/week, by multiplying the intensity coefficient for a given activity by the number of days the activity was done during the week and the amount of time spent in this activity in minutes per day. On the basis of these data, the respondents were stratified to high, moderate and low physical activity groups, in line with the IPAQ methodology [7]. However, due to small number of par-ticipants presenting with low physical activity levels (5 girls and 7 boys), we did not include this group in further analyses. Eventually, the study included two groups of boys and girls, characterized by high (Group 1) and moderate (Group 2) physical activity levels.

The groups were compared in terms of their dietary habits, with statistical significance of differences veri-fied with the χ2 test. All calculations were carried out with a Statistica 11 package.

Relationship between diet and physical activity in adolescents. 39No 1

RESULTS

A survey with the International Physical Activity Questionnaire (IPAQ) enabled us to stratify girls and boys to groups characterized by high and moderate physical activity levels. 70% of girls and 69.2% of boys presented with high levels of physical activity, and remaining 25.5% of girls and 20.0% of boys were qualified to moderate physical activity group.

The data on dietary habits of girls and boys presen-ting with high and moderate levels of physical activity are summarized in Tables 1 and 2.

Table 1. Dietary habits of girls, stratified according to their physical activity levels

ParameterGroup 1 Group 2

χ2 pn % n %

Number of meals a day1-2 13 16.9 0 0.0

11.830 0.018*3 20 26.0 9 32.14 23 29.9 15 53.65 11 14.3 4 14.3

more than 5 10 13.0 0 0.0Having breakfast

yes 49 63.6 18 64.30.003 0.951

no 28 36.4 10 35.7Having a hot meal during the day

yes 59 76.6 21 75.00.029 0.863

no 18 23.4 7 25.0Time of the last meal of the day

5.00-6.00 P.M. 19 24.7 7 25.04.306 0.1167.00-8.00 P.M. 29 37.7 5 17.9

after 8.00 P.M. 29 37.7 16 57.1Preferred way of food processing

cooking 50 64.9 15 53.6

1.471 0.689frying 19 24.7 9 32.1

roasting 7 9.1 3 10.7grilling 1 1.3 1 3.6

Types of consumed beveragesjuices. nectars 10 13.0 5 17.9

2.430 0.296sweetened beverages 35 45.5 8 28.6water 32 41.6 15 53.6

Snacking between mealsyes 52 67.5 21 75.0

0.540 0.462no 25 32.5 7 25.0

* significant difference at p≤0.05

Most girls, especially those from moderate physical activity group (Group 2), declared having 4 meals a day. Female respondents presenting with high and moderate physical activity levels differed significantly in terms of the declared numbers of daily meals (p=0.018). In con-trast, we did not find significant intergroup differences in the number of daily meals consumed by boys from high and moderate physical activity groups. Irrespective of their physical activity level, most male respondents declared having 3 or 4 meals a day.

Table 2. Dietary habits of boys, stratified according to their physical activity levels

ParameterGroup 1 Group 2

χ2 pn % n %

Number of meals a day1-2 4 8.9 2 15.4

2.960 0.5643 16 35.6 5 38.54 12 26.7 4 30.85 5 11.1 2 15.4

more than 5 8 17.8 0 0.0Having breakfast

yes 31 68.9 11 84.61.249 0.264

no 14 31.1 2 15.4Having a hot meal during the day

yes 33 73.3 12 92.32.088 0.148

no 12 26.7 1 7.7Time of the last meal of the day

5.00-6.00 P.M. 2 4.4 2 15.42.220 0.3297.00-8.00 P.M. 20 44.4 4 30.8

after 8.00 P.M. 23 51.1 7 53.8Preferred way of food processing

cooking 15 33.3 5 38.5

0.975 0.807frying 21 46.7 6 46.2

roasting 6 13.3 2 15.4grilling 3 6.7 0 0.0

Types of consumed beveragesjuices. nectars 9 20.0 2 15.4

1.425 0.490sweetened beverages 23 51.1 9 69.2water 13 28.9 2 15.4

Snacking between mealsyes 38 84.4 13 100.0

2.299 0.129no 7 15.6 0 0.0

Having breakfast before school is a vital component of appropriate diet. The majority of our respondents, more often boys than girls, declared having breakfast before school; the proportion of boys having breakfast before school was higher in Group 2. Moreover, this group included larger proportion of boys who declared having a hot meal during the day.

We also asked our respondents about the time they usually had their last meal of the day. Most adolescents had their last meal very late, after 8.00 P.M. The largest proportion of girls and boys who chose this answer presented with moderate levels of physical activity.

Nearly half of boys from both groups pointed to frying as their preferred way of food processing. In contrast, majority of girls from both groups (64.9% and 53.6% of the respondents from Group 1 and Group 2, respectively) preferred cooking over frying.

The largest proportion of boys, both those from high and moderate physical activity groups, preferred sweetened beverages. Such beverages were particularly popular among boys from Group 2. Water, the most commonly recommended type of beverage for chil-dren and adolescents, was more popular among boys presenting with high physical activity levels. 53.6% of girls overall pointed to water as their preferred beverage


type. However, detailed analysis showed that female respondents from Group 1 preferred both sweetened beverages (45.5%) and water (41.6%). None of these intergroup differences reached the threshold of statisti-cal significance.

The majority of participants, more often boys than girls, declared having snacks between meals. Snacking was more prevalent among individuals from Group 2 (as declared by 100% and 75% of boys and girls, re-spectively).

Only varied diet may cover the demand for all essen-tial nutrients. Therefore, we asked our respondents how often they included whole-wheat bread, dairy products, meat, fish, vegetables, fruits, fast foods and sweets in their diets. The results for girls and boys from high and moderate physical activity groups are presented in Tables 3 and 4.

Most respondents declared consuming whole-wheat bread. Girls, irrespective of their physical activity levels,

Table 3. Frequency of selected food product consumption among girls, stratified according to their physical activity levels

Food product group

Group 1 Group 2χ2 p

n % n %Whole-wheat bread

every day 15 19.5 8 28.6

6.298 0.1783-4 times a week 18 23.4 1 3.61-2 times a week 25 32.5 9 32.1

less often 9 11.7 4 14.3not at all 10 13.0 6 21.4

Dairy productsevery day 15 19.5 5 17.9



Meatevery day 31 40.3 5 17.9

7.869 0.049*3-4 times a week 27 35.1 9 32.11-2 times a week 13 16.9 11 39.3


Fishevery day 0 0.0 0 0.0



Vegetables and fruitsevery day 21 27.3 8 28.6



Fast foodsevery day 0 0.0 0 0.0



Sweetsevery day 18 23.4 3 10.7

19.849 0.005**3-4 times a week 24 31.2 14 50.01-2 times a week 19 24.7 0 0.0


** significant difference at p≤0.01

Table 4. Frequency of selected food product consumption among boys, stratified according to their physical activity levels

Food product group

Group 1 Group 2χ2 p

n % n %Whole-wheat bread

every day 11 24.4 1 7.7



Dairy productsevery day 15 33.3 6 46.2



Meatevery day 27 60.0 3 23.1

11.631 0.020*3-4 times a week 16 35.6 6 46.11-2 times a week 2 4.4 2 15.4


Fishevery day 0 0.0 0 0.0



Vegetables and fruitsevery day 20 44.4 5 38.5



Fast foodsevery day 10 22.2 0 0.0



Sweetsevery day 14 31.1 2 15.4



* significant difference at p≤0.05; ** significant difference at p≤0.01


usually consumed this type of bread 1-2 times a week. In contrast, the two groups of boys varied in terms of their frequencies of whole-wheat bread consumption. While the largest proportion of boys from high physical activity group consumed whole-wheat bread 3-4 times a week, individuals presenting with moderate levels of physical activity usually chose answer “less often than once a week”. The χ2 test showed that this intergroup difference in the frequency of whole-wheat bread con-sumption was statistically significant. We did not obse-rve significant intergroup differences in the frequencies milk and dairy consumption. Most girls, irrespective of their physical activity levels, declared consuming milk and dairy 3-4 times a week. Boys from moderate physical activity group consumed dairy products sli-ghtly more often than their peers presenting with high physical activity levels, typically every day (46.2%).

In both girls and boys, physical activity turned out to be a significant determinant of the frequency of meat consumption. The largest proportions of individuals

presenting with high physical activity levels (40.3% and 60.0% of girls and boys, respectively) declared that they consumed meat every day. In contrast, such high frequencies of meat consumption were declared by only 17.9% and 23.1% of girls and boys from moderate physical activity groups, respectively.

Girls from high physical activity group usually con-sumed fish 1-2 times a week, whereas those presenting with moderate physical activity levels declared that they ate fish less often than once a week. Most boys, irrespective of their physical activity levels, declared consuming fish 1-2 times a week.

Vegetables and fruits should be included in everyday diet of children and adolescents. However, such high frequencies of fruit and vegetable consumption were declared by only 27.3% and 28.5% of girls from high and moderate physical activity groups, respectively. The situation was somehow better in the case of boys: daily intake of vegetables and fruits was declared by

0

10

20

30

40

50

60

70

yes, to lose weight yes, to improve health no, never

%

group 1 group 2

χ2 = 4,979p = 0,173

Figure 1. Use of weight-loss diets among girls, stratified according to their physical activity levels.

0

10

20

30

40

50

60

70

80

90

yes, to lose w eight yes, to improve health no, never

%

group 1 group 2

χ2 = 0,427p = 0,808

Figure 2. Use of weight-loss diets among boys, stratified according to their physical activity levels.


44.4% and 38.5% of male respondents from Group 1 and Group 2, respectively.

Growing popularity of the so-called fast foods is a negative tendency observed among Polish adolescents. We showed that this type of food was more often prefer-red by boys, especially those from high physical activity group. More than 20% of male respondents presenting with high physical activity levels declared consuming fast foods every day, and more than 35% of them did so 3-4 times a week. Boys from moderate physical activity group usually consumed fast foods less often than once a week. These intergroup differences turned out to be statistically significant. Girls presenting with different physical activity levels did not differ significantly in terms of their frequencies of fast food consumption; the most often declared frequencies of fast food con-sumption were “1-2 times a week” and “less often than once a week”.

Growing popularity of sweets in the diet of children and adolescents is with no doubt unfavorable from a health perspective. We showed that sweets were more often preferred by individuals from high physical acti-vity groups. Up to 23.4% of girls presenting with high physical activity levels and only 10.7% of those from moderate physical activity group declared consuming sweets every day. Similarly, daily consumption of sweets was declared by up to 31.1% and only 15.4% of boys presenting with high and moderate physical activity levels, respectively. Moreover, we observed that a large proportion of girls from moderate physical activity group (39.9%) consumed sweets less often than once a week. The intergroup differences in the frequen-cy of sweet consumption turned out to be statistically significant solely in the case of girls.

Due to growing popularity of Western patterns of extremely slim silhouette, many young people start various types of weight-loss plans. Such practices were declared by most girls included in our study (64.9% and 64.3% of female respondents from high and moderate physical activity groups, respectively). The principal motivation behind switching to a weight-loss diet was reduction of body weight. Boys practiced slimming diets less often than girls, usually to improve their health. We did not find significant differences in the frequency of practicing weight-loss diets by boys presenting with different physical activity levels (Figures 1 and 2).

DISCUSSION

Physical activity is an integral component of human health. However, the amount of physical activity under-taken by adolescents worldwide is far from satisfactory [1, 4, 12], and Polish youth do not differ in this matter from their peers from other European countries [27,

29]. Nevertheless, some adolescent populations were reported to present with moderate or even high levels of physical activity [5, 26].

Our study showed that a considerable proportion of Polish adolescents (approximately 70%) presented with high levels of physical activity. However, direct compa-rison between our findings and the results published by other authors may be hindered due to differences in the methodology of physical activity assessment.

Aside from physical activity, also a rational diet constitutes a significant determinant of heath. Many previous studies showed that individuals presenting with higher physical activity levels more often declare adhe-rence to the rules of healthy eating [17, 26]. However, also an opposite tendency was reported, as analyses of nutritional behaviors presented by adolescent athletes revealed many mistakes, such as insufficient number of daily meals, exercising in a fasted state, too frequent consumption of sweets, fast foods, snacks (e.g. crisps, salty sticks), and drinking sweetened carbonated beve-rages [9, 10, 19].

We did not find an evident relationship between dietary habits and physical activity levels. Girls presen-ting with moderate levels of physical activity declared having larger number of meals per day than their peers from high physical activity group. In contrast, we did not observe significant intergroup differences in the numbers of daily meals declared by boys presenting with different physical activity levels (typically three meals per day). Similar numbers of meals in a day were declared by boys and girls participating in the study conducted by Sitko et al. [25], as well as by girls examined by Piotrowska et al. [21].

Having the first meal before school is an important component of appropriate diet. However, up to one-third of girls participating in our study did not eat breakfast. In boys, this problem was observed mostly in high physical activity group. Wanat et al. [28] showed that more than 50% of grammar school pupils do not eat breakfast. According to Sitko et al. [25], this problem is more prevalent among girls than in boys, as well as among the secondary school pupils (40% as compared to 18% of adolescents from grammar schools). Also the fact that a considerable proportion of our participants ate dinner late should be considered alarming. More than 50% of boys from both groups and 57.1% of girls from Group 2 declared having their last meal of the day later than at 8.00 P.M.. This phenomenon is increasingly reported among adolescents, both in Poland and in other European countries [21, 24].

Another vital problem is snacking between meals, especially consumption of high-calorie products with low nutritional values. The proportion of respondents who declared having snacks between main meals was higher in moderate physical activity groups (up to 100%


of boys). According to Szczerbiński et al. [26], snacking between meals is more common among boys than in girls. While the proportion of boys who declared eating between meals decreased with an increase in physical activity index (UIAF), the opposite situation was ob-served in girls, in whom the prevalence of snacking between meals was higher in the group presenting with the highest levels of physical activity.

Another unfavorable dietary habit documented in our study is repletion of fluids with widespread and highly advertised sweetened beverages. The vast majority of girls and boys participating in our study declared their preference to this type of beverages. Water was the second most popular beverage among our respondents. The only exception pertained to girls from moderate physical activity group who pointed to water as their preferred beverage. Previously Lagow-ska et al. [16] showed that water is the most popular beverage among Polish adolescents; according to these authors, water was preferred by adolescent athletes and least popular among participants presenting with low physical activity levels. In turn, subjects characterized by moderate levels of physical activity declared their preference to sweetened beverages, alcohol and energy drinks. Extremely high popularity of sweetened carbo-nated beverages, including cola-type beverages, was also reported by Szczerbiński et al. [26], especially in the case of girls and boys presenting with the lowest values of physical activity index.

Also the type of ingested foods and the frequency of their consumption are important components of ap-propriate diet. Therefore, we analyzed the frequencies of whole-wheat bread, milk, dairy, meat, fish, vegetable and fruit consumption among our respondents. The level of physical activity turned out to be associated with the frequency of whole-wheat bread consumption among boys, and determined the frequency of meat consumption in both sexes. The abovementioned food products were generally more popular among girls and boys presenting with high levels of physical activity. These findings are consistent with the data published by Szczerbiński et al. [26]. According to these authors, higher levels of physical activity are associated with greater adherence of adolescents to the rules of healthy eating, namely more frequent consumption of fruits, vegetables, milk and dairy products. In the same study, an increase in physical activity index was associated with a decrease in the proportion of boys who declared eating sweets and fast foods. Similar phenomenon was also reported by Lagowska et al. [16], who showed that fast foods were most popular among pupils presenting with low physical activity levels, and least often consu-med by adolescent athletes. However, we observed the opposite phenomenon, as individuals presenting with high levels of physical activity declared consuming

sweets and fast foods more often than their peers from moderate physical activity group.

CONCLUSIONS

1. This study did not show an evident association be-tween dietary habits and physical activity levels of adolescent girls and boys. Physical activity turned out to be a significant determinant of dietary habits solely in the case of whole-wheat bread, meat and fast food consumption among boys and ingestion of meat and sweets among girls.

2. We identified a number of dietary mistakes, such as not having breakfast, eating late, snacking between meals and consumption of sweetened beverages.

3. Altogether, these findings justify intensification of dietary education programs for adolescent boys and girls.


REFERENCES

1. Armstrong N.: Children are still fit, but not active! Educ Health 2011;29;3:43-45.

2. Basterfield I., Pearce M.S., Parkinson K.N., Adamson A.J., Reilly J.J.: Longitudinal study of physical ac-tivity and sedentary behavior in children. Pediatrics 2011;127:24-30.

3. Biddle S.J., Soos I., Hamar P., Sandor I., Simonek J., Karsai I.: Physical activity and sedentary behaviors in youth: Data from three Central-Eastern European coun-tries. Eur J Sport Sci 2009;9 295-301.

4. Brodersen N.H., Steptoe A., Boniface D.R., Wardle J.: Trends in physical activity and sedentary behaviour in adolescence: ethnic and socioeconomic differences. Br J Sport Med 2007;41:140-144.

5. Charkiewicz A., Charkiewicz W., Szpak A.: Ocena spo-sobu żywienia i aktywności fizycznej uczniów Zespołu Szkół Gastronomicznych w Białymstoku [Evaluation of nutrition and physical activity of students in Gas-tronomic School in Bialystok]. Rocz Panstw Zakl Hig 2009;60,1:65-68 (in Polish) [PMID: 19579772; http://www.ncbi.nlm.nih.gov/pubmed/19579772].

6. Corbin C.B., Welk G.J., Corbin W.R., Welk K.A.: Con-cepts of fitness and wellness: A comprehensive lifestyle approach (8th. ed.). New York, McGraw Hill, 2009.

7. Craig C.L., Marshall A.L., Siøstrom M., Bauman A.E., Booth M.L., Ainsworth B.E., Pratt M., Ekelund U., Yngve A., Sallis J.F., Oja P.: International Physical Activity Questionnaire: 12-country reliability and validity. Med Sci Sport Exerc 2003;35:1385-1395.

8. Dong C., Sanchez L.E., Price R.A.: Relationship of obe-sity to depression: a family based study. Int J Obes Relat Metab Disord 2004;28:790-795.


9. Gacek M.: Wiedza i zachowania żywieniowe młodzieży uprawiającej sport w Szkole Mistrzostwa Sportowego w Krakowie [Knowledge and nutritional behaviours among youth practising sports at School of Sports Championship in Cracow]. Rocz Panstw Zakl Hig 2007;58,4:641-648 (in Polish) [PMID: 18578346; http://www.ncbi.nlm.nih.gov/pubmed/18578346].

10. Gacek M.: Zwyczaje żywieniowe grupy osób wyczynowo uprawiających siatkówkę [Eating habits of a group of professional volleyball players]. Rocz Panstw Zakl Hig 2011;42,1:77-82 (in Polish) [PMID: 21735984; http://www.ncbi.nlm.nih.gov/pubmed/21735984].

11. Finer N.: Obesity. Clin Med 2003; 3:15-19.12. Kantomaa M.T., Tammelin T.H., Näyhä S., Taanila A.M.:

Adolescents` physical activity in relation to family inco-me and parents` education. Prev Med 2007;44:410-415.

13. Lee J.M., Okumura M.J., Davis M.M., Herman W.H., Gurney J.G.: Prevalence and determinants of insulin resistance among U.S. adolescents: a population – based study. Diabetes Care 2006;29:2427-2432.

14. Lee S., Burgenson C., Fulton J., Spain C.: Physical education and physical activity: results from the school health policies and programs study 2006. J School Health 2007;8:435-463.

15. Libuda L., Alexy U., Kersting M.: Time trends in dietary fat intake in a sample of German children and adolescents between 2000 and 2010: not quantity, but quality is the issue. Br J Nutr 2014;111:141-150.

16. Łagowska K., Woźniewicz M., Jeszka J.: Porównanie nawyków żywieniowych młodzieży z uwzględnieniem płci oraz poziomu aktywności fizycznej [Comparison of eating habits among students with admitted sex and level of physical activity]. Rocz Panstw Zakl Hig 2011;62,3:335-342 (in Polish) [PMID: 22171526; http://www.ncbi.nlm.nih.gov/pubmed/22171526].

17. Marcysiak M., Zagroba M., Ostrowska B., Wiśniewska E., Marcysiak M., Skotnicka-Klonowicz G.: Physical activity versus nutritional habits of children and teenagers. Probl Pielęg 2010;18(9):176-183 (in Polish).

18. McCaffery J.M., Niaura R., Todaro J.F., Swan G.E., Carmelli D.: Depressive symptoms and metabolic risk in adult male twins enrolled in the National Heart, Lung, and Blood Institute twin study. Psychosom Med 2003;65:490-497.

19. Nazarewicz R., Babicz-Zielińska E.: Wybrane wskaź-niki stanu odżywienia oraz upodobania żywieniowe młodzieży szkoły baletowej [Selected indexes of the nutritional status and food habits among young ballet dancers]. Rocz Panstw Zakl Hig 2000;51,1:393-401 (in Polish) [PMID: 11286090; http://www.ncbi.nlm.nih.gov/pubmed/11286090].

20. Piernas C., Popkin B.M.: Increased portion sizes from energy-dense foods affect total energy intake at eating occasions in US children and adolescents: patterns and trends by age group and socio-demographic characteri-stics, 1977-2006. Am J Clin Nutr 2011;94:1324-1332.

21. Piotrowska E., Żechałko-Czajkowska A., Biernat J., Mikołajczak J.: Ocena wybranych cech stylu życia

kształtujących stan zdrowia 16-18 letnich dziewcząt. Cz. II. Zwyczaje żywieniowe [Evaluation of selected features of the lifestyle being conducive to the state of heath of 16-18 years old girls. Part II. Nutritional habits]. Rocz Panstw Zakl Hig 2009;60,2:151-157 (in Polish) [PMID: 19803445; http://www.ncbi.nlm.nih.gov/pubmed/19803445].

22. Przybylski P., Antonowicz D., Kurowska M., Kozłowska M.: Correlations between blood pressure and selected anthropometric parameters in overweight and obese 16-18-year-old students with and without metabolic syndrome family risk factors - a pilot study. Probl Hig Epidemiol 2010;91(1):28-33 (in Polish).

23. Rampersaud G.C., Pereira M.A., Girard B.L., Adams J., Metzl J.D.: Review – breakfast habits, nutritional status, body weight, and academic performance in children and adolescents. J Am Diet Assoc 2005;105:743-760.

24. Samuelsen G.: Dietary habits and nutritional status in adolescents over Europe. An overview of cur-rent studies in the Nordic countries. Eur J Clin Nutr 2000;54(suppl 1):21-28.

25. Sitko D., Wojtaś M., Gronowska-Senger A.: Sposób ży-wienia młodzieży gimnazjalnej i licealnej [Food patterns of youth from gymnasium and lyceum]. Rocz Panstw Zakl Hig 2012;63,3:319-327 (in Polish) [PMID: 23173337; http://www.ncbi.nlm.nih.gov/pubmed/23173337].

26. Szczerbiński R., Karczewski J.K., Siemienkowicz J.: Wybrane zachowania żywieniowe w zależności od aktywności fizycznej młodzieży w wielu 14-16 lat w Północno-Wschodniej Polsce na przykładzie Powiatu Sokólskiego [Selected nourishment habits depending on physical activity of 14-16 year-old teenagers in the North-Eastern Poland on the example of Sokólski district]. Rocz Panstw Zakl Hig 2010:61(1):83-86 (in Polish) [PMID: 20803905; http://www.ncbi.nlm.nih.gov/pubmed/20803905].

27. Świderska-Kopacz J., Marcinkowski J.T., Jankowski K.: Health behaviour of secondary school pupils and its chosen determinants. Part V. Physical activity. Probl Hig Epidemiol 2008;89(2):246-250 (in Polish).

28. Wanat G., Grochowska-Niedworok E., Kardas M., Ca-łyniuk B.: Irregular eating habits and correlated health threats among junior high school pupils. Hygeia Public Health 2011;46(3):381-384 (in Polish).

29. Witana K., Szpak A.: Socio-economic determinants of physical activity of the Bialystok high school students. Probl Hig Epidemiol 2009;90(1):42-46 (in Polish).

30. Wojtyniak B., Goryński P., Moskalewicz B. (red.): Health status of Polish population and its determinants. National Institute of Public Health – National Institute of Hygiene, Warsaw, 2012 (in Polish).

31. Woynarowska B.: Physical activity of children and youth. Polskie Forum Profilaktyki Chorób Układu Krążenia (PFP) 2008;3(12):5 (in Polish).




*Corresponding author: Katarzyna Zaborowicz, Uniwersytet Przyrodniczy w Poznaniu, Katedra Higieny Żywienia Człowieka, Poznan University of Life Sciences, Department of Human Nutrition and Hygiene, Wojska Polskiego street 31, 60-624 Poznan, Poland, phone: +48 61 8466057, Fax. +48 61 8487332, e-mail: [email protected]


ORIGINAL ARTICLE

EVALUATION OF SELECTED DIETARY BEHAVIOURS OF STUDENTS ACCORDING TO GENDER AND NUTRITIONAL KNOWLEDGE

Katarzyna Zaborowicz1*, Jolanta Czarnocińska1, Grzegorz Galiński1, Paulina Kaźmierczak1, Karolina Górska1, Paweł Durczewski1

1Poznan University of Life Sciences, Department of Human Nutrition and Hygiene, Wojska Polskiego street 31, Poznan, Poland

ABSTRACTIntroduction. Nutrition is a factor influencing physical and mental fitness. In this study we examine the lifestyle of university students and its impact on nutritional errors.Objective. To evaluate the dietary behaviours of students taking into account gender and nutritional knowledge.Material and methods. Using a QEB questionnaire, we were able to evaluate dietary behaviours and nutritional knowledge of respondents. Our analysis was conducted on data obtained from 456 students. Results. We found that nutritional knowledge for women was 34.7% satisfactory and 34.7% good. In contrast, nutritional knowledge for men varied, amounting to 40.2% satisfactory and 25.1% good. The number of meals and their regular consumption did not depend on gender or the nutritional knowledge of students, however, significant differences were recorded for the types of snacks they eat. A greater number of women than men snacked on sweets and biscuits, nuts and seeds, while in the case of salty snacks an opposite trend was observed. A higher level of nutritional knowledge correlated with the number of students snacking on fruit and vegetables instead of salty snacks. Moreover, it was observed that health-promoting behaviours such as not adding sugar to beverages and not adding salt to dishes were more common with women and individuals with a higher level of nutritional knowledge.Conclusions. Women more frequently snack on sweets, biscuits, nuts and seeds. More men snack on salty snacks, add sugar to beverages and add salt to dishes. Individuals with insufficient nutritional knowledge more frequently snack on salty snacks rather than fruit. Students with insufficient nutritional knowledge more often commit nutritional errors.

Key words: dietary behaviours, students, nutritional knowledge, gender

STRESZCZENIEWprowadzenie. Prawidłowe żywienie jest głównym czynnikiem wpływającym na zachowanie zdrowia oraz sprawności fizycznej i umysłowej. Czynnik ten nabiera szczególnego znaczenia w przypadku młodzieży akademickiej, z powodu wielu błędów żywieniowych, wynikających ze zmiany stylu życia studiującej młodzieży.Cel. Ocena wybranych zachowań żywieniowych studentów w zależności od ich płci i wiedzy żywieniowej.Materiał i metody. Badania przeprowadzono wśród 456 studentów, wykorzystując kwestionariusz QEB, który umożliwiał ocenę zachowań żywieniowych i wiedzy żywieniowej respondentów.Wyniki. Wykazano, iż po 34,7% kobiet charakteryzowało się dostateczną i dobrą wiedzą żywieniową. Odsetki dla mężczyzn były różne, wynosząc odpowiednio 40,2% i 25,1%. Liczba posiłków i regularność ich spożywania nie zależały od płci i wiedzy żywieniowej studentów. Odnotowano istotne różnice w rodzaju pojadanej żywności. Więcej kobiet niż mężczyzn pojadało cukierki i ciastka, orzechy i nasiona, a w przypadku słonych przekąsek zaobserwowano sytuację odwrotną. Wraz ze wzrostem poziomu wiedzy żywieniowej zwiększała się liczba studentów pojadających owoce i warzywa, zaś malała w odniesieniu do słonych przekąsek. Zaobserwowano ponadto, że zachowania prozdrowotne związane ze słodzeniem na-pojów i dosalaniem potraw dotyczyły przede wszystkim kobiet i osób o większej wiedzy żywieniowej.Wnioski. Kobiety częściej pojadają cukierki, ciastka, orzechy i nasiona. Więcej mężczyzn pojada słone przekąski, słodzi napoje i dosala potrawy. Osoby o niedostatecznej wiedzy żywieniowej rzadziej pojadają owoce, a częściej słone przekąski. Studenci popełniają błędy żywieniowe, których podłożem może być niewystarczająca wiedza żywieniowa.

Słowa kluczowe: zachowania żywieniowe, studenci, wiedza żywieniowa, płeć

K. Zaborowicz, J. Czarnocińska, G. Galiński et al.46 No 1

INTRODUCTION

Adequately balanced diets and regular physical activity are factors that benefit mental and physical health [12, 14]. Previous reports have evaluated the nutritional habits and behaviours of young individu-als, as well as the errors they make concerning food and nutrition. Young people, including students, are individuals particularly at risk of the consequences of inappropriate dietary behaviours. It is believed that university students commit many nutritional errors due to changes in lifestyle. This may include moving away from the family home, irregular meals, long hours spent studying, frequently taking part-time jobs, and their willingness to make the most of life while they are young. Therefore, students are more likely to pay less attention to the amounts and quality of food they consume. A student’s diet may include energy-packed products, such as chocolate bars, chocolates, biscuits, as well as fried products or fast food. They also tend to use instant foods, in which preparation takes only minutes.

A lifestyle containing nutritional errors and limited physical activity can cause a deterioration of health [13, 17]. It is also observed that young women striving to attain a desirable figure start to apply restrictive diets, thus eliminating nutritionally valuable foods from their daily menus. A highlighted issue related to poor mental and physical health is the insufficient basic knowledge of food and nutrition among some young people. More than a decade ago, the family home was the only source of nutritional knowledge. It was parents, most frequently the mother, who were responsible for the selection of food products and preparation of dishes, passing on their knowledge and modifying eating habits in their children. The curricula of elementary or secondary schools only occasionally included nutrition education. Thus the present-day generation of students may have insufficient knowledge and awareness concerning food

and nutrition, which otherwise would help them apply a proper model of nutrition [7].

The aim of this study was to evaluate selected die-tary behaviours of students, including the number of meals, snacking or types of snacks, taking into account their gender and nutritional knowledge.


The survey was conducted with the participation of 456 students, including 277 women and 179 men. The mean age of respondents was 23 years old. Respondents were selected in an arbitrary manner with the subject area of studies adopted by students as the inclusive criterion. One third of students studied humanities, one third life and the other third engineering sciences. A large proportion of respondents lived in the country (36%), towns with 20,000 -100,000 inhabitants (30%), lived with their families (68%) and defined their finan-cial situation as average (69%) (Table 1).

The survey was conducted using the Questionnaire of Eating Behaviour (QEB), developed by the Team of Behavioral Determinants of Nutrition, the Committee of Human Nutrition Sciences of Polish Academy of Sciences, which was the basis for the new version of the questionnaire denoted with the acronym KomPAN [2]. The questionnaire made it possible, among other things, to evaluate selected dietary behaviours and nutritional knowledge of students. Dietary behaviours were evaluated using closed questions, while nutritional knowledge was assessed using 26 true or false questions concerning food and nutrition. One point was awarded for a correct answer. Next, the points were added, and on the basis of the score, respondents were classified to one of three groups. The groups with insufficient (0-10 points), satisfactory (11-15 points) and good (16-26 points) nutritional knowledge were identified, comprising 32.2%, 36.9% and 30.9% respondents. Re-

Table 1. Characteristics of population in students sampleParameters Total Women Men

Sample size 456 277 179Age (in full years) 23.1 22.9 23.3Residence (% sample) village town <20 thousand inhabitants town 20-100 thousand inhabitants city >100 thousand inhabitants

36.019.130.014.9

34.719.132.813.4

38.019.025.717.3

Living conditions (% sample) alone with family with multi-generation family

14.767.517.8

14.467.218.4

15.168.216.7

Financial situation evaluated by respondents (% sample) below average average above average

11.268.620.2

7.976.615.5

16.256.427.4

Dietary behaviours of students according to gender and nutritional knowledge. 47No 1

sults were verified statistically using three tests: Chi2, Kolmogorov-Smirnov and Kruskal-Wallis.

RESULTS

Table 2 presents the results concerning nutritional knowledge of students. Among women 34.7% respon-dents had equally satisfactory and good knowledge. Among men 40.3% respondents had satisfactory nu-tritional knowledge, while 25.1% had good nutritional knowledge. A significantly higher standard of nutritio-nal knowledge, in terms of the score, was recorded in the case of women, while average nutritional knowledge of all female and male students turned out to be satis-factory.

Statistical analysis showed no significant differen-ces in nutritional behaviours of the respondents, such as the number of meals, their regular consumption as well as the incidence and frequency of snacking with consideration to gender or nutritional knowledge of students (tables 3-4). In contrast, statistically significant differences were observed in the type of snacks they

ate. Significantly more women than men consumed sweets and biscuits (57.6% vs. 45.5%) as well as nuts and seeds (11.1% vs. 3.7%), while more men than wo-men declared the consumption of salty snacks (26.1% vs. 14.3%). It was also shown that a greater number of men than women add sugar to hot beverages and add salt to served dishes.

The results show statistically significant differences in snacking on fruit and vegetables in a standard of nu-tritional knowledge dependent manner. As many as 59% individuals with good nutritional knowledge snacked on fruit. Slightly fewer respondents, almost 54%, with satisfactory nutritional knowledge also declared snac-king on these products. Almost 23% of the participants with good nutritional knowledge snacked on vegetables. Moreover, it was observed that approximately 28% of individuals with insufficient nutritional knowledge snacked on salty snacks. These percentages were mar-kedly lower among individuals with satisfactory and good nutritional knowledge.

Analysis also showed statistically significant dif-ferences in the percentage of individuals who added sugar to hot beverages. Notably, the greatest number,

Table 2. Nutritional knowledge among students depending on their genderParameters Total Women Men p

Categories of nutritional knowledge (% sample) insufficient satisfactory good

32.236.930.9

30.634.734.7

34.640.325.1

NS

Standard of nutritional knowledge (score) 13.1 13.6 12.3 <0.01NS - not statistically significant

Table 3. Dietary behaviour of students depending on their genderParameters Total Women Men p

Number of meals 3.78 3.76 3.80 NSEating meals (% sample) irregular regular, but only some regular

34.650.714.7

32.152.015.9

38.648.612.8

NS

Snacking (% sample) no yes

23.077.0

21.778.3

25.174.9

NS

Snacking frequency 0.98 0.95 1.03 NSSnacking on fruit (% sample) 51.0 52.5 48.5 NSSnacking on vegetables (% sample) 14.8 12.9 17.9 NSSnacking on yoghurts/cheese (% sample) 38.8 35.9 43.3 NSSnacking on sweets/biscuits (% sample) 53.0 57.6 45.5 <0.05Snacking on salty snacks (% sample) 18.8 14.3 26.1 <0.01Snacking on nuts/seeds (% sample) 8.3 11.1 3.7 <0.05Adding sugar to hot beverages (% sample) no yes, one teaspoon yes, at least two teaspoons

38.632.928.5

44.832.822.4

29.033.038.0

<0.001

Adding salt to dishes (% sample) no yes, but only sometimes yes

47.040.112.9

52.036.111.9

39.146.414.5

<0.05

NS - not statistically significant


almost 44% respondents, who did not add sugar to hot beverages, were individuals with insufficient nutritio-nal knowledge. Among individuals with satisfactory nutritional knowledge, slightly below 34% respon-dents did not add sugar to hot beverages, while good nutritional knowledge accounted for 39%. Over 50% of individuals in the satisfactory and good nutritional knowledge groups did not add salt to served dishes while individuals with insufficient nutritional knowledge was approximately 37%.

DISCUSSION

The results presented in this study corroborate a num-ber of other reports. The subject of dietary behaviours among different age groups has recently become a hot area of study. As previously shown, poor nutritional habits are influenced by socioeconomic factors such as professional and financial status of parents, their educa-tional background, cultural or religious customs or the role of family [8]. This is observed together with the different components of university student life: irregular lifestyle, resulting among other things from the timetable of classes at the university; a change in residence; a lack of student cafeterias; stress; a hectic lifestyle; jobs taken during non-class time; inappropriate habits and eating behaviours adopted from their family homes; meeting energy requirements by consuming energy-packed snacks or the use of stimulants [16]. Ansari et al. [1] in their study recorded that women in Poland consume

sweets and biscuits more frequently than men, but they also consume fruit, salads and vegetables more often. Kowalska [10] in her study observed that a frequent problem among students is connected with irregular consumption of meals, particularly breakfast. It was also shown that women ate four meals a day more often than men. Our study confirm the results of Kowalska, that it is women rather than men who more frequently consume fruit and sweets. Investigations conducted at the Silesian University of Medicine in Katowice by Li-kus et al. [11] showed that almost 1/2 students snacked between meals. This study showed that among university students, individuals that have a habit of snacking may be as high as 75%. Female and male students of the Wroclaw University of Life Sciences were asked about their dietary preferences concerning salty dishes and the frequency of adding salt to served dishes. Male students more frequently preferred salty dishes – approximately 53% of the group in comparison to female students – approximately 31%. Every third male student declared adding salt to served dishes. Among female students, as many as 79% respondents did not add salt to served dishes [19]. In addition, this study confirmed the fact that men more frequently prefer salty dishes and add salt to served dishes than women. Also Frąckiewicz et al. [5] observed among other significantly higher intake of dietary fiber (by 25%), potassium (by 21.3%) and NaCl (by 31.1%) in obese participants than in people with adequate body mass. In study of Kosicka-Gębska and Gębski [9] only 1% of respondents claimed that they do not consumed salty snacks. Among the people

Table 4. Dietary behaviour of students depending on their knowledge on nutritionParameters Insufficient Satisfactory Good p

Number of meals 3.66 3.78 3.89 NSeating meals (% sample) irregular regular, but only some regular

38.845.615.6

34.550.614.9

30.556.013.5

NS

Snacking (% sample) no yes

19.780.3

23.276.8

26.273.8

NS

Snacking frequency 1.00 0.97 0.97 NSSnacking on fruit (% sample) 41.0 53.5 59.0 <0.05Snacking on vegetables (% sample) 12.8 10.1 22.9 <0.05Snacking on yoghurts/cheese (% sample) 35.9 40.3 40.0 NSSnacking on sweets/biscuits (% sample) 53.8 58.9 44.8 NSSnacking on salty snacks (% sample) 28.2 17.8 9.5 <0.01Snacking on nuts/seeds (% sample) 10.3 7.8 6.7 NSAdding sugar to hot beverages (% sample) no yes, one teaspoon yes, at least two teaspoons

43.521.135.4

33.936.929.2

39.040.420.6

<0.01

Adding salt to dishes (% sample) no yes, but only sometimes yes

37.442.220.4

51.239.39.5

51.839.09.2

<0.01

NS - not statistically significant

Dietary behaviours of students according to gender and nutritional knowledge. 49No 1

consuming them, 27% did so with a frequency of once a week, and 26% - 2-3 times a month. Also in study of Czerwińska and Czerniawska [4] was observed that the mean sodium intake exceeded many times the recom-mendations. Men added more salt to meals than women, and they also ate salty products more often. The main source of sodium was salt added during preparation of meals (women) or processed food (men). Cieślik et al. [3] in their study pointed to the barely satisfactory standard of nutritional knowledge among secondary school stu-dents, which results among other things from inadequate nutrition education. Those authors also reported that girls had a better nutritional knowledge than boys, which is confirmed by our current study. This may be connected with the fact that many young women value appearance and fitness and thus have tendencies to implement spe-cific diets. Gacek [6] found a positive effect of nutrition education on selected nutrition parameters among female students. Female respondents showed an improvement in dietary behaviours, particularly in terms of regularity of meals, as well as avoidance of fast food. Rasińska [15] published results indicating the standard of knowledge and eating habits among students. Studies showed that respondents despite of their knowledge on principles of appropriate nutrition do not apply them in their everyday lives. Moreover, they are fully aware that their behaviour concerning nutrition may have a negative effect on their health. Young people, most frequently indicated a lack of time and inconvenient timetables as the cause of this situation. The above mentioned studies confirmed also that women follow principles of appropriate nutrition more frequently than men. Also in a study by Wyka and Żechałko-Czajkowska [19] the standard of nutritional knowledge of female students was very low.

This study and the analysis of literature sources indicate that the nutritional errors reported in many studies constitute a group of factors increasing the risk of civilization diseases [7, 10, 11, 16]. At present, these diseases pose one of the greatest health problems, especially in more economically developed and rapidly developing countries such as Poland [18]. This again confirms that it is necessary to publicise knowledge on food and nutrition in different social groups. Additional knowledge about the habits and dietary behaviours of specific groups will lead to ways for improved health.

CONCLUSIONS

1. Students from the study group have a low standard of nutritional knowledge. As few as 1/3 of university students have a good standard of knowledge on food and nutrition.

2. Women from the study group more frequently than men snack on sweets and biscuits as well as nuts and

seeds. Men more frequently snack on salty snacks, add salt to served dishes and add sugar to hot bev-erages.

3. Respondents with a poorer nutritional knowledge snack less frequently on fruit and vegetables, and snack more frequently on salty snacks, add salt to served dishes and add sugar to hot beverages.

4. Students from the study group were found to make nutritional errors as a result of insufficient nutritional knowledge.


REFERENCES

1. Ansari W.E., Stock C., Mikolajczyk R.T.: Relationships between food consumption and living arrangements among university students in four European countries - A cross-sectional study. Nutr J 2012;11:28.

2. Beliefs and Eating Habits Questionnaire. Available from: http://www.knozc.pan.pl/images/Kwestionariusz_Kom-PAN.pdf

3. Cieślik E., Siembida A., Kuś A., Folcik A., Kopeć A.: Influence of nutritional education of high school students on prevention of nutrition-related diseases. Probl Hig Epidemiol 2014;95(4):927-933 (in Polish).

4. Czerwińska D., Czerniawska A.: Sodium intake includ-ing salt as its source in selected Warsaw population. Rocz Panstw Zakl Hig 2007;58(1):205-210 (in Po-lish) [PMID: 17711112 http://www.ncbi.nlm.nih.gov/pubmed/17711112].

5. Frąckiewicz J., Hamułka J., Wawrzyniak A., Górnicka M.: Students nutrients intake and risk of cardiovascular diseases. Rocz Panstw Zakl Hig 2009;60(3):269-274 (in Polish) [PMID: 20063698; http://www.ncbi.nlm.nih.gov/pubmed/20063698].

6. Gacek M.: An attempt to evaluate the education of nour-ishment among female students of Academy of Physical Education in Cracow. Now Lek 2007;76(1):25-28 (in Polish).

7. Gutkowska K., Ozimek I.(eds).: Behaviour of young con-sumers in the food market. SGGW, Warszawa 2008;24-41 (in Polish).

8. Jarosz M., Wolnicka K., Kłosowska J.: Environmental factors associated with prevalence of overweight and obesity among children and adolescents. Post Nauk Med 2011;9:770-777 (in Polish).

9. Kosicka-Gębska M., Gębski J.: Salty snacks in the diet of young consumers. Bromat Chem Toksykol 2012;45(3):733–738 (in Polish).

10. Kowalska A.: Nutrition habits of students of Univer-sity of Economics in Wroclaw. Rocz Panstw Zakl Hig 2010;61(3):277-282 (in Polish) [PMID: 21365864; http://www.ncbi.nlm.nih.gov/pubmed/21365864].

11. Likus W., Milka D., Bajor G., Jachacz-Łopata M., Dorzak B.: Dietary habits and physical activity in students from the Medical University of Silesia in Poland. Rocz Panstw


Zakl Hig 2013;64(4):317-324 [PMID: 24693717; http://www.ncbi.nlm.nih.gov/pubmed/24693717].

12. Łaszek M., Nowacka A., Gawron-Skarbek A., Szatko F.: Negative behavior patterns of students. Part II. Phys-ical activity and eating habits. Probl Hig Epidemiol 2011;92(3):461-465 (in Polish).

13. Malara B., Góra-Kupilas K., Jośko J.: Nutrition and other elements of lifestyle of students of the Silesian University of Technology – a preliminary report. Zdr Publ 2006;116(1):132-134 (in Polish).

14. Pilch W., Janiszewska R., Makuch R., Mucha D., Pałka T.: Rational nutrition and its influence on health. Hygeia Public Health 2011;46(2):244-248 (in Polish).

15. Rasińska R.: Dietary habits of students depending on the gender. Now Lek 2012;81(4):354-359 (in Polish).

16. Szczuko M., Seidler T.: Nutrition mode and nourishment status of WUT students in Szczecin as compared to different academic centres in Poland. Rocz Panstw Zakl Hig 2010;61(3):295-306 (in Polish) [PMID: 21365867; http://www.ncbi.nlm.nih.gov/pubmed/21365867] .

17. Uramowska-Żyto B., Kozłowska-Wojciechowska M., Jarosz A., Makarewicz-Wujec M.: Dietary and life-style habits of university students in Poland-empirical study. Rocz Panstw Zakl Hig 2004;55(2):171-179

(in Po lish) [PMID: 15493350; http://www.ncbi.nlm.nih.gov/pubmed/15493350].

18. Walentukiewicz A., Łysak A., Wilk B.: Assessment of students’ nutrition in context of prevention of civilization diseases. Probl Hig Epidemiol 2014;95(3):772-777 (in Polish).

19. Wyka J., Żechałko-Czajkowska A.: Nutritional knowl-edge, lifestyle and food groups intake in the group or the first year students of Agricultural University in Wroclaw. Rocz Panstw Zakl Hig 2006;57(4):381-388 (in Polish) [PMID: 17713201 http://www.ncbi.nlm.nih.gov/pubmed/17713201].




*Corresponding author: Katarzyna Kowalcze, Katedra Dietetyki i Oceny Żywności, Wydział Nauk Przyrodniczych, Uniwersytet Przyrodniczo-Humanistyczny w Siedlcach, ul. B. Prusa 14, 08-110 Siedlce, Poland, phone: +48 25 643 13 24, e-mail: [email protected]


ORIGINAL ARTICLE

NUTRITION OF STUDENTS FROM DIETETICS PROFILE EDUCATION IN THE SIEDLCE UNIVERSITY OF NATURAL SCIENCES

AND HUMANITIES COMPARED WITH STUDENTS FROM OTHER ACADEMIC CENTRES

Katarzyna Kowalcze1* Zofia Turyk2, Małgorzata Drywień1

1Department of Health Sciences, Faculty of Natural Sciences, Siedlce University of Natural Sciences and Humanities, Boleslawa Prusa street 14, 08-110 Siedlce, Poland

2Department of Bioengineering and Animal Husbandry, Faculty of Natural Sciences, Siedlce University of Natural Sciences and Humanities, Boleslawa Prusa street 14, 08-110 Siedlce, Poland

ABSTRACTBackground. Appropriate nutrition in humans is one of the most important factors affecting normal development, nutritional status and keeping healthy. University students can be overburdened with responsibilities arising from their studies which may result in abnormal diet/nutrition and decrease their levels of physical activity. Objective. To determine and assess nutrition and eating habits for selected female students studying nutrition at the Siedlce University of Natural Sciences & Humanities (UPH), compared with young people from other academic centres also study-ing nutrition and having a similar education profile.Material and methods. A diagnostic survey was undertaken anonymously on 100 female student subjects using a propri-etary questionnaire. Students were undergraduates at the UPH during their 2nd and 3rd year. Results. Dietetics students considered that the practical application of proper nutrition principles is very important. Nev-ertheless, 44% assessed themselves to follow abnormal diets; 58% declared they ate whole grains frequently whereas 58% and 65% respectively consumed fruit and vegetables daily. Dietary irregularities were identified, particularly in how often fish was eaten, where 46% either never ate fish or did so only occasionally. Subjects preferred lean cuts of poultry meat (65%), and the most common cooking practice was frying (52%).Conclusions. Subjects did not follow dietary recommendations, although responses varied in the different academic centres. Despite learning from their studies about normal nutritional requirements it seems that, to large degree, students follow eating habits acquired during their childhoods in the home.

Key words: diet, eating habits, students, nutrition

STRESZCZENIEWprowadzenie. Prawidłowe żywienie jest jednym z najważniejszych czynników wpływających na właściwy rozwój czło-wieka, stan odżywienia i utrzymanie dobrego stanu zdrowia. Młodzież akademicka, jest nadmiernie obciążona obowiązkami wynikającymi z nauki, co może skutkować zmniejszoną aktywnością fizyczną oraz nieprawidłowym żywieniem. Cel. Poznanie i ocena sposobu żywienia oraz wybranych zachowań żywieniowych studentek kierunku dietetyka Uniwer-sytetu Przyrodniczo - Humanistycznego (UPH) w Siedlcach na tle młodzieży z innych ośrodków akademickich kierunków związanych z dietetyką lub o zbliżonym profilu nauczania. Materiał i metody. Anonimowe badania, przeprowadzono metodą sondażu diagnostycznego, z wykorzystaniem autorskiego kwestionariusza ankiety. Badania objęły grupę 100 studentek drugiego i trzeciego roku studiów na kierunku dietetyka UPH w Siedlcach. Wyniki. Studentki dietetyki dużą wagę przywiązywały do praktycznego stosowania zasad prawidłowego żywienia. Jednak 44% ankietowanych własny sposób żywienia oceniło jako nieprawidłowy. 56% badanych deklarowała częste spożywanie produktów pełnoziarnistych, 58% spożywanie owoców każdego dnia i 65% spożywanie warzyw każdego dnia. Stwierdzo-no nieprawidłowości w sposobie żywienia, zwłaszcza w odniesieniu do częstotliwości spożycia ryb; 46% badanych nie

K. Kowalcze, Z. Turyk, M. Drywień52 No 1

spożywała ryb lub spożywała je okazjonalnie. Studentki preferowały chude gatunki mięsa, w tym drób (65%), a najczęściej stosowaną obróbkę kulinarną było smażenie (52%).Wnioski. Przeprowadzane badania, dowodzą, że sposób żywienia odbiega od rekomendacji dla badanej grupy wiekowej, choć w różnym zakresie w poszczególnych ośrodkach akademickich. Można przypuszczać, że niezależnie od zdobywanej podczas studiów wiedzy na temat prawidłowego żywienia, wpływ na nie w znaczącym stopniu mogą mieć nawyki i zwy-czaje żywieniowe nabyte w domu rodzinnym.

Słowa kluczowe: sposób żywienia, zachowania żywieniowe, studentki dietetyki

INTRODUCTION

Appropriate nutrition is one of the most important factors affecting normal human development, nutri-tional status and keeping healthy [7]. By appropriate/normal nutrition, it is primarily meant that this consists of having correct eating habits, number of daily meals and menu, thus delivering the required energy needs and nutrients for healthy development [9]. Many factors, including gender, affects normal eating habits [20].

University students tend to be over-burdened du-ring their course studies which can result in decreased physical activity and inappropriate nutrition. Because of the irregular nature of their course work, preparing regular meals can also be problematical. Numerous stu-dies have demonstrated the close relationship between nutrition, including eating habits, and the development of diet-related disease [6, 15, 26]. When starting out, students very often, change residence and either need to prepare their own meals by usually adopting eating habits learned from the family home [19] or by using college catering facilities.

The study aim was to determine and assess diets and eating habits of dietetic female students attending the UPH in Siedlce compared with young people from other academic centres studying similar subjects.


An anonymous survey was undertaken in November 2013 on 100 undergraduate female subjects in their second and third years studying dietetics at the Siedlce University of Natural Sciences & Humanities (UPH). The study diagnostic tool was an in-house prepared questionnaire that had been verified by a previous study trial, including standard question and answer choices. Questions were on the number and regularity of me-als consumed daily as well as rates of eating selected products and dishes; snacking between meals was also covered. The results were statistically analysed using an Excel 2003 spreadsheet.

RESULTS

A significant proportion of subjects ate 3 - 4 meals daily, that always included breakfast and every third person ate 5 meals daily (Table 1). The most common place for eating meals was the family home. The time spent for preparing meals in nearly half the study sub-jects was 15 minutes. It should however be noted that 38% subjects did not have sufficient time to properly prepare meals.

Students attempted to apply the principles of ap-propriate nutrition into practice, which was confirmed by consumption rates of foodstuffs that provide dietary fibre, including whole-grain products (over 50%), raw vegetables (65%) and fruit (58%); Table 2. It is of concern however, that only 60% declared eating groats occasionally or several times a week, whilst 1:10 never did so at all.

A dietary source of complete protein was cottage cheese and rennet cheese (Table 2). However, con-

Table 1. Mealtime rates and places of eating for Dietetics Students

Analysed variable Percentage surveyed(%)

Number of daily meals1-23-4≥ 5

36730

Breakfast eating rates Daily Irregularly

6733

Last daily mealtime2-3 hours before sleepJust before sleep

6931

When eating mealsBecause hungryWhen rememberedRegularly

501733

The most common place of mealsBar restaurantFast food outletStudent canteenHome

00694

Preparation meal timeInsufficient timeUp to 15 minutesLonger

3846160

Nutrition and eating habits of university students. 53No 1

sumption rates of these products was low, as more than 70% subjects only ate them several times weekly or just occasionally. Over 80% subjects did not eat fish as recommended, with over 40% eating fish once weekly and 11% more than once weekly. Another source of complete protein was meat and dairy products. Subjects mostly chose poultry (over 60%) as their lean meat, but it is worth noting that only one in ten ate meat daily and every fourth student consumed them occasionally, whilst 8% did not eat meat or dairy products. However, cold meats featured in the daily diet of 70% of these subjects.

One of the most common nutritional/dietary errors was found to be snacking between meals as well as at night, which occurred at differing rates but applied to half the subjects. The most frequent snacks being; sweets, fruit and nuts. Some however, never snacked between meals (Figure 1). Sweets in fact were found to be the most commonly consumed snack, which were chosen daily by 6% subjects, several times weekly by 18% and a few times monthly by 22% (Figure 2).

Table 3 shows the students’ self-esteem. A positive assessment was observed in nearly 40% whilst every fourth subject considered their eating habits as inappro-priate. Nearly one in five subjects had a problem with this assessment (17%).

Table 2. Chosen dietary lifestyle behaviour of Dietetics Students

Analysed variable Percentage surveyed(%)

Rates of eating wholemeal breadDailySeveral times weeklyOccasionallyNever

17392519

Rates of eating groatsDailySeveral times weeklyOnce weeklyOccasionallyNever

422263810

Rates of eating cream cheesesDailySeveral times weeklyOccasionallyNever

8344810

Rates of eating rennet cheeseDailySeveral times weeklyOccasionallyNever

10403911

Rates of eating eggs (weekly)4 or more2-3 weeklyBelow 2 Never

245415 7

Rates of eating fresh fruitDailySeveral times weeklyNever

582913

Rates of eating fresh vegetablesDailySeveral times weeklyNever

652213

Rates of eating pulsesDailySeveral times weeklyOccasionallyNever

3195622

Rates of eating potatoesDaily2-3 times weeklyOccasionallyNever

7013314

Rates of eating fishSeveral times weeklyOnce weeklyOccasionallyNever

1143415

Rates of eating meatDaily5-6 weekly2-3 weeklyOccasionallyNever

102038248

Preferred meat typesPoultryVeal/beef/pork

6535

Rates of eating cold meatsDailyOnce weeklyOccasionallyNever

6613119

Preferred cooking methodsFrying Boiling Roasting

522325

Preferred seasoningsSaltPepperHerbsMaggi/vegeta

45435124

Figure 1. Snacking in-between meals by Dietetics Students

Figure 2. Frequency of snacking by Dietetics Students

14%

46%

31%

9%

not snacking

sweets

fruits

peanuts

22%

18%

6%

54%

several times a month several times a week daily not snack on sweets



Over 70% of students occasionally ate fast-food with more than 10% once weekly and only 7% admit-ting to more. The vast majority (nearly 80%) also had not eaten any instant foodstuffs. Our study showed that 70% of students rated their physical activity as high and moderate, and almost 30% as being poor or very low. Almost 60% of students stated that they never drink sodas (fizzy drinks) and only 6% did so daily (Tab. 4). Five glasses of mineral water was drunk by every fifth subject and more than half drank 4-5 glasses daily whilst every fourth consumed 2-3 glasses per day. Mineral water was in fact drunk by all subjects. Every 1:5 sub-ject drank over 5 glasses of mineral water daily, over half drank 4-5 daily whilst a quarter drank 2-3. Nobody was ever found not to drink mineral water daily. Few subjects ate soup, with only 1:5 doing so daily whilst 1:3 never ate soup.

Table 4. Selected eating habits of Dietetics Students

Amounts of liquids consumed Percentage surveyed(%)

Water (daily) More than 5 glasses4-5 glasses 2-3 glasses

225325

Fizzy drinks

DailySeveral times weeklySeveral times monthlyNever

6132457

Milk (daily)2 glasses1 glassNever

82666

Fermented dairy drinks

DailySeveral times monthlyNever

472528

Soups

Daily2-3 times weeklyOccasionally Never

20361330

A large majority of dietetic students did not smoke cigarettes (over 80%), but occasionally drank alcohol (approximately 60%), with only a small proportion



14%

46%

31%

9%

not snacking

sweets

fruits

peanuts

22%

18%

6%

54%

several times a month several times a week daily not snack on sweets


Table 3. Dietary and lifestyle self-assessment Analysed variable Percentage surveyed

(%)Dietary assessmentNormalAbnormalUnable to define

394417

Health assessmentVery goodGoodBad

25732

Declared physical activityVery highHighModerateLowVery low

42544207

Nightime snackingNeverOccasionallySometimesOften

5020246

Eating instant foodsYesNo

2377

Eating fast foodsDailySeveral times weeklyOnce weeklyOccasionallyNever

0712747

Smoking tobaccoSmokerNon-smoker

1684

Alcohol consumptionAbstinentSeveral times weeklyOnce weeklyOccasionally

952462

Drinking coffee (cups per day)≥ 5 2 - 410

5193343

Figure 3. Dietary profiles of Dietetics Students

69%

11%

15% 3% 2%

Doesn't apply Low carbohydrate High protein Low in calories Herbalife

Figure 3. Dietary profiles of Dietetics Students


being abstinent (9%). Our findings showed that over 40% of students did not drink coffee, but every third drank one cup daily. Regarding dieting, almost 70% of the dietetic students from UPH did not follow any diets, whilst the remainder said they preferred high-protein or low carbohydrate diets. Over 70% declared that they never use any form of dietary supplements. Those taking supplements, had minerals coming mainly from vitamin and mineral preparations (22%) and slightly more than 10% were using formulations containing omega 3 (Figure 4). We found that every third student studying dietetics always paid attention to the food-stuff’s composition (Figure 5) that they wished to buy, having read the label first; only slightly more than half

did so occasionally.

DISCUSSION

One of the basic principles of appropriate nutrition is having regular and sufficient meals for delivering

energy and essential nutrients to the body in a systematic way, thus facilitating good health [26]. Recommenda-tions published in Poland on the principles of healthy eating specify eating at least three meals daily and eating fruit between meals [6, 27]. Similar recommendations have been published by the Institute of Food and Nu-trition recommending eating five daily meals. Studies however show that only 1:5 adult Poles adopt this [6, 28], whilst at least three daily meals are eaten by 82% adults, and 12% do so several times weekly [28].

Our study showed that the vast majority of UPH students eat an adequate number of meals throughout the day, consistent with the Charkiewicz et al. study [5] which had demonstrated 63% of dietetic students from Bialystok doing so. However, a study by Sen et al. [22] on dietary behaviour of students at the University of Wroclaw Faculty of Nutrition Sciences showed higher rates of students consuming the recommended number (3 to 5) meals of above 85%.

Dietetics subjects declared high intake rates of dietary fibre rich foodstuffs; whole wheat bread, fresh fruits and vegetables. These food groups are extremely valuable from a nutritional point of view, but other studies have showed smaller consumption rates. In the aforementioned Sen et al. [22] study, only 1:3 students at the University of Life Sciences ate whole grains and, unlike our study, they observed vegetables con-sumption rates of (55%). There was, however a similar consumption of fruit (54%). The Siedlce students were also reluctant to eat groats. This was also observed in a study by Szczodrowska and Krysiak [24], where groats were consumed by only 3% of college students survey-ed in Lodz, whilst the study by Bieżanowska-Kopeć et al. [3] demonstrated that 90% of their subjects did not eat groats. In studies by Szczuko and Seidler [25], on a group University of Technology students in Szczecin, abnormal eating habits were also observed, amongst which were the insufficient intakes of milk and dairy products, fruit, vegetables and grain products. In addi-tion, female subjects consumed excess sugar and sweets.

When considering the dietary source of animal protein, then low intake rates of cottage cheese, rennet cheese and fish appeared were observed in our subjects. This was confirmed by a survey of Warsaw University of Agriculture [18] students, which found that fish was only eaten twice weekly by 19.6% students in accordan-ce with recommendations. The Sen et al. study found that only one in ten subjects surveyed from the Wroclaw UP Faculty of Nutrition ate fish several times a week [22]. Our study demonstrated similar once weekly fish consumption rates to a study by Myszkowska-Ryciak et al. [18] which focused on second year students from the Faculty of Human Nutrition and Consumption at the Warsaw University of Life Sciences (SGGW).

Figure 4. Dietary supplement intake profiles of Dietetics Students

Figure 5. Frequency of reading foodstuff labels by Dietetics Students.

72%

20%

2% 11%

3%

Not suplemmentation

Magnesium and vit.B6

Magnesium and Calcium

Acid omega3

Folic acid

30%

58%

12%

Always Sometimes Never




72%

20%

2% 11%

3%

Not suplemmentation

Magnesium and vit.B6

Magnesium and Calcium

Acid omega3

Folic acid

30%

58%

12%

Always Sometimes Never



Poultry was seen the be the most frequently eaten meat by the UPH subjects which was likewise an ob-served feature for other university students. Indeed the Wroclaw UP study showed that 82% subjects chose poultry in their diets [22]. Despite the fact that lean meat cuts were most frequently chosen in other studies [13, 22], as in ours, it should be noted that adverse ways cooking tended to be preferred; often university students chose frying with added cooking salt and herbs.

Another detrimental and frequently observed eating habit was snacking between meals ie. eating food for re-asons other than just feeling hungry. Almost half of our study subjects snacked on sweets and third on fruit. This has been often remarked upon in other studies. A study by Misiarz et al. [17] found that only 35% of students did not declare snacking between meals, and likewise did every tenth UP Wroclaw student [22]. In the latter study, of those that snacked, the most frequently mentioned foodstuffs were fruits (40%) and sweets (41%). A study on Lodz University of Technology students from the Faculty of Food Sciences by Szczodrowska and Krysiak [24] found that ‘healthy snacks’ (ie. fruit and yogurt) were eaten by respectively 60% and 48% respondents. In a study by Szponar and Krzyszycha [26] on Medical University of Lublin students, sweets were snacked on a few times a day by every fifth student, whilst more than half snacked on sweets a few times weekly and 17% did so once a daily. It appears that snacking is still a common problem, even among students with a seemingly adequate knowledge of nutrition.

By self-evaluating their diet and nutrition, the die-tetic students have enabled to establish that only just over a third consider their nutrition to be normal, whilst a large proportion view their nutrition very critically. A study on Poznan students showed that 53.4% considered their nutrition to be abnormal, whilst 46.6% regarded theirs as being appropriate [20]. For surveyed students from the Lodz Faculty of Health Sciences, almost 24% declared their diet as being inappropriate, whilst 26% were unable to make any assessment [24]. Almost all students considered their health to be good or very good in research by Górska-Kłęk et al. [8].

Eating fast/junk food rarely can be regarded as a favourable trend in most of our student subjects. Simi-larly, for students of the Medical University of Lublin, more than 80% declared eating junk food only few times a month and less frequently instant foodstuffs [26]. Wroclaw Medical Academy students also did not prefer fast-foods and only ate them occasionally (41%) or not at all (33%), whilst 41% of University of Life Sciences students ate them less often than a few times monthly [22].

In updating the 2012 Nutrition Pyramid, experts from the Warsaw Food and Nutrition Institute recom-mend regular daily physical activity of at least 30

minutes, or preferably 60 minutes. In the present study we demonstrated that a significant group of students do physical activity. A similar finding was observed by Szczodrowska et al. [24], who investigated young people studying food and human nutrition trends in Lodz, where moderate and high physical activity levels was declared by more than 50% subjects.

Given the amounts and variety of beverages drunk in our study, intakes of carbonated/fizzy drinks were at healthy low levels, where 80% subjects drank them only a few times a month or not at all. In studies by Myszkowska-Ryciak et al. [18] however, 65% subjects declared avoiding carbonated beverages in their diets. In terms of milk consumption, our student subjects came out less favourably than those from other universities; 1/3 of the former drinking milk every day whilst other studies [18, 22] demonstrated significantly higher rates for students at the University of Wroclaw and Warsaw University of Life Sciences; respectively 70% and 54%.

An important part of a healthy lifestyle is to avoid drinking alcohol and smoking cigarettes. According to the World Health Organization, smoking is currently the most serious risk factor for health and is a major cause of premature mortality in developed countries. Bearing this in mind, the UPH students thus carry a low risk because most do not smoke and drink alcohol occasio-nally, with more than three-quarters not drinking or only occasionally drinking coffee. As a result, they compare favourably to other study subjects. Górska-Kłęk et al. [8] assessed the lifestyles of students from Wroclaw and showed that 40% were addicted to smoking cigarettes and nearly 50% drank alcohol several times a month, whilst more than 30% of students do not drink coffee but half did so at 1 cup daily. A significant majority of our UPH subjects did not use any alternative diets to adopting a normal diet. Also diets for improving body shape were not popular in students from the Poznan university, where only 1:4 students undertook such diets [20]. In contrast a study by Semeniuk [21], showed that alternative diets, mainly reduction ones, were adopted by more than half of Lublin college students.

It should be remembered that unjustified supple-mentation may interfere with the physiological balance in the body, causing even poisoning, but as shown by some studies, it is common in students in more than 38% students of the Warsaw University of Life Sciences [23]. These findings are similar to the CBOS report, which showed that such supplementation were undertaken by over a third of adult Poles (36%) [28]. A study on Warsaw University of Life Sciences students, showed that more than 30% use dietary supplements, and that most do so at least once daily. Bujko et al. [4] reported that as many as 60% of Warsaw University of Life Sciences students use dietary supplements and more than half (61%) students of dietetics at the University


of Life Sciences in Poznan also admitted their use [1]. Nearly half of all women (46%) take tablets of dietary vitamin supplements [16]. In a study by Bieżanowska--Kopeć et al. [2], regular nutrient supplementation of dietary intake was declared by 11 to 26% of students at the Agricultural University of Krakow.

One way of supplying nutrition education is on the labels of foodstuff products. Our research has shown that every third student always reads the label and half do so sometimes. According to Misiarz et al. [14], 70% medical students read food labels whilst 50% do so who study non-medical subjects. The presented study has demonstrated that most Siedlce subjects ate the re-commended number of meals and considered that eating breakfast daily to be very important; the most common dietary errors were low intake rates of milk and dairy products and legumes/pulses. Another mistake was an excessive intake of fried foods, despite the students being aware of the principles of appropriate nutrition but always not putting it into practice.

CONCLUSIONS

1. Our study, as well as others on diet/nutrition in dietetics students, shows that their diet differs, in varying degrees to dietary recommendations for this age group.

2. Despite the knowledge acquired during their studies on appropriate nutrition, students as expected, sho-wed that eating habits learned from the family home had the greatest effect on their diet.

REFERENCES

1. Białas S., Duda G., Saran A.: Ocena spożycia przez studentów składników mineralnych pochodzących z ra-cji pokarmowych i suplementów. Żyw Człow Metab 2005;32(supl.1, cz. II):1304-1310.

2. Bieżanowska-Kopeć R., Leszczyńska T., Kopeć A.: Su-plementacja diety studentów wyższych uczelni woje-wództwa małopolskiego witaminami i/lub składnikami mineralnymi. Żywność Nauka Technologia Jakość, 2010;4(71):132–140.

3. Bieżanowska-Kopeć R., Stańczyk A., Kopeć A., Leszczyń-ska T.: Częstotliwość spożycia wybranych produktów bogatych w przeciwutleniacze przez studentów wyższych uczelni województwa małopolskiego. Bromat Chem Toksykol 2012:3,1082–1086.

4. Bujko J., Myszkowska-Ryciak J., Nitka I.: Ocena spożycia składników mineralnych wśród studentów SGGW w Warszawie. Żyw Człow Metab 2005;32,655-659.

5. Charkiewicz W., Markiewicz R., Borawska M: Ocena sposobu żywienia studentek dietetyki Uniwersytetu Medycznego w Białymstoku. Bromat Chem Toksykol 42,2009;3:699–703.

6. Falkowska M.: Raport CBOS – komunikat z badań: Nawyki żywieniowe i upodobania kulinarne Polaków – październik 2000. www:cbos.pl, (accessed: 17.11.2007.)

7. Gawęcki J., Hryniewiecki L.: Żywienie człowieka. Pod-stawy nauki o żywieniu. Wyd. PWN, Warszawa 1998.

8. Górska-Kłęk L., Mełeszko K., Berner E.: Prozdrowotne elementy stylu życia studentów Akademii Wychowania Fizycznego i Uniwersytetu Ekonomicznego. Acta Bio--Optica et Informatica Medica 4/2011;17:268–274

9. Jarosz M.: Normy żywienia człowieka. Podstawy pre-wencji otyłości i chorób niezakaźnych. PZWL, Warsza-wa, 2008.

10. Jarosz M.: Suplementy diety a zdrowie. Porady lekarzy i dietetyków. PZWL Warszawa, 2008.

11. Jarosz M. (red): Zasady prawidłowego żywienia dzieci i młodzieży oraz wskazówki dotyczące zdrowego stylu życia. IŻŻ, Warszawa, 2008.

12. Jarosz M. (red): Praktyczny podręcznik dietetyki, IŻŻ, Warszawa, 2010.

13. Korzeniowska-Ginter R.: Technologiczne i surowcowe uwarunkowania sposobu żywienia studentów akademii. Bromat Chem Toksykol 2009;3:743–746.

14. Krejpcio Z., Staniek H., Chmielewska A.: Ocena po-wszechności spożycia suplementów diety w wybranych grupach studentów. Prob Hig Epidemiol 2013;94(3):622-625.

15. Lisiecki T.: Żywienie jako przejaw stylu życia młodzieży rozpoczynającej studia. Wych Fiz 2004;10:10-14

16. Lisicki T.: Żywienie przejawem stylu życia studentów rozpoczynających studia [Nutrition as indication of first year students’ life styles]. Rocz Panstw Zakl Hig 2010;61(3):283-287 (in Polish) [PMID: 21365865; http://www.ncbi.nlm.nih.gov/pubmed/21365865].

17. Misiarz M., Malczyk E., Zołoteńka-Synowiec M., Rydelek J., Sobota O.: Ocena zachowań żywieniowych studentów kierunków medycznych i niemedycznych z wojewódz-twa świętokrzyskiego. Piel Zdr Publ 2013;3:265-272.

18. Myszkowska-Ryciak J., Kraśniewska A., Harton A., Gajewska D.: Porównanie wybranych zachowań żywie-niowych studentek Akademii Wychowania Fizycznego i Szkoły Głównej Gospodarstwa Wiejskiego w Warszawie. Probl Hig Epidem 2011;91(4):931-934.

19. Przybulewska K., Janda K.: Badania ankietowe doty-czące sytuacji bytowej oraz zwyczajów żywieniowych studentów [Questionnaire studies on the vital situation and nutritional habits of students]. Rocz Panstw Zakl Hig 2004;55(4):347-356 (in Polish) [PMID: 19097585; http://www.ncbi.nlm.nih.gov/pubmed/19097585].

20. Rasińska R.: Nawyki żywieniowe studentów w zależno-ści od płci. Nowiny Lekarskie 2012;81(4):354–359.

21. Semeniuk W.: Zwyczaje żywieniowe studentów z Uniwersytetu Przyrodniczego w Lublinie stosujących diety alternatywne. Żywność Nauka Technologia Jakość 2009;4(65):227-235.

22. Seń M., Zacharczuk A., Lintowska A.: Zachowania ży-wieniowe studentów wybranych uczelni wrocławskich a wiedza na temat skutków zdrowotnych nieprawidłowego żywienia. Piel Zdr Publ 2012;2(2):113–123.

23. Sigłowa A.,1Bertrandt B., Conder M., Bertrandt K., Li-siecka A., Kubiak P., Urbańska A.: Suplementacja diety


wśród studentów. Żywność Nauka Technologia Jakość, 2009;4(65):236- 249.

24. Szczodrowska A., Krysiak W.: Analiza wybranych zwy-czajów żywieniowych oraz aktywności fizycznej stu-dentów łódzkich szkół wyższych. Probl Hig Epidemiol 2013;94(3):518-521.

25. Szczuko M., Seidler T.: Sposób żywienia a stan odży-wienia studentów ZUT w Szczecinie na tle młodzieży z innych ośrodków akademickich w Polsce [Nutrition mode and nourishment status of WUT students in Szc-zecin as compared to different academical centres in Poland]. Rocz Panstw Zakl Hig 2010;61(3):295-306 (in

Polish) [PMID: 21365867; http://www.ncbi.nlm.nih.gov/pubmed/21365867].

26. Szponar B., Krzyszycha R.: Ocena sposobu odżywiania studentów Uniwersytetu Medycznego w Lublinie w roku akademickim 2007–2008. Bromat Chem Toksykol 2009,2:111–116.

27. Zasady Prawidłowego Żywienia. Instytut Żywności i Żywienia, Warszawa 2009.

28. Zachowania żywieniowe Polaków. CBOS. Komunikat z badań, nr 115/2014.




*Corresponding author: Beata Szczepańska, Department of Nutrition Physiology, Institute of Sport, Trylogii street 2/16,01-982 Warsaw, Poland, phone: +48 22 569 99 48 12; +48 692 152 260, fax +48 22 569 99 06, e-mail: [email protected]


ORIGINAL ARTICLE

EVALUATION OF DIETARY INTAKE OF VITAMINS AND MINERALSIN 13-15-YEAR-OLD BOYS FROM A SPORT SCHOOL IN WARSAW

Beata Szczepańska1*, Jadwiga Malczewska-Lenczowska1, Bożena Wajszczyk2

1 Department of Nutrition Physiology, Institute of Sport, Warsaw, Poland2 Independent Unit of Nutritional Epidemiology and Dietary Recommended Intakes, National Food and Nutrition

Institute, Warsaw, Poland

ABSTRACTBackground. Insufficient intake of vitamins and minerals, in teenagers engaged in physical activity increases the risk of health disorders.Objective. The aim of this study was to evaluate selected vitamins and minerals intake in 13-15 -year-old boys from sport school.Material and methods. The study of dietary intake was conducted among 44 boys from the School of Sport Championship (SSC). Nutritional data was collected using 24-hour recall for 3 days of week. Daily intake of minerals: sodium, potassium, calcium, phosphorus, magnesium, iron, zinc, copper, iodine and vitamins: A, E, D, B1, B2, B6, B12, C, folate and niacin was estimated. The probability of insufficient intake of nutrients in relation to the standard levels: Estimated Average Require-ment (EAR) or Adequate Intake (AI) as well as excessive intake of them in relation to the Tolerable Upper Intake Level (UL) were assessed.Results. The highest percentage of insufficient intake concerned vitamin D (100%), potassium (69%), folate (53%), and calcium (50%), slightly lower of magnesium (27%), vitamins C (24%) and E (15%). The risk of inadequate intake of other minerals: sodium, copper, iron, zinc, phosphorus, iodine and vitamins: B6, B1, B2, A, B12, niacin, was relatively lower and amounted from 0.3% to 5.4%. The disturbingly high probability of exceeding the UL for sodium (99.5%) was observed.Conclusions. A significant disproportion between the mean intake and the percentage of inadequate diets indicates a large diversity in the intake of vitamins and minerals in the group of studied boys, what was the reason of unbalanced diet. The insufficient intake concerns especially vitamin D, potassium, folate, calcium and a lesser extent magnesium, vitamins C and E. Sodium intake was disturbingly high. In order to avoid nutritional mistakes in the future education on the rational nutrition among students, their parents, and teachers is necessary.

Key words: nutrition mode, micronutrients, male, adolescents, physical activity

STRESZCZENIEWprowadzenie. Niewystarczające spożycie witamin i składników mineralnych wśród, nastoletniej młodzieży obciążonej wysiłkiem fizycznym zwiększa ryzyko wystąpienia zaburzeń w stanie zdrowia. Cel. Ocena spożycia witamin i składników mineralnych przez trenujących chłopców w wieku gimnazjalnym.Materiał i metody. Badaniami objęto 44 chłopców w wieku 13-15 lat ze szkoły mistrzostwa sportowego. Dane o spożyciu zebrano na podstawie wywiadów z ostatnich 24 godzin poprzedzających badanie, z 3 dni tygodnia. Obliczono spożycie składników mineralnych: sodu, potasu, wapnia, fosforu, magnezu, żelaza, cynku, miedzi, jodu oraz witamin: A, E, D, B1, B2, B6, B12, C, niacyny i folianów. Ponadto oceniono prawdopodobieństwo niedoborowego spożycia składników pokarmowych w relacji do poziomów norm średniego zapotrzebowania grupy (EAR) lub wystarczającego spożycia (AI), oraz nadmiernego ich spożycia w stosunku do najwyższego tolerowanego poziomu spożycia (UL).Wyniki. Najwyższe ryzyko niedostatecznego spożycia dotyczyło witaminy D (100%), potasu (69%), folianów (53%) i wapnia (50%), natomiast nieco niższe, magnezu (27%), witamin: C (24%) i E (15%). Ryzyko niedostatecznego spożycia pozostałych składników mineralnych: sodu, miedzi, żelaza, cynku, fosforu, jodu i witamin: B6, B1, B2, A, B12, niacyny było stosunkowo niższe i mieściło się w zakresie od 0,3% do 5,4%. W badanej grupie stwierdzono niepokojąco wysokie praw-dopodobieństwo przekroczenia normy UL na sód (99,5%).Wnioski. Znaczna dysproporcja między średnim spożyciem a odsetkiem diet niedoborowych, świadczy o dużym zróż-nicowaniu spożycia witamin i składników mineralnych w badanej grupie chłopców co było przyczyną niezbilansowania

B. Szczepańska, J. Malczewska-Lenczowska, B. Wajszczyk60 No 1

diety. Ryzyko niedostatecznego spożycia dotyczyło w szczególności witaminy D, potasu, folianów, wapnia, a w mniejszym stopniu magnezu, witaminy C i E. Niepokojąco wysokie było spożycie sodu. W celu uniknięcia błędów żywieniowych w przyszłości, istnieje potrzeba edukacji uczniów oraz ich rodziców i nauczycieli w zakresie racjonalnego żywienia.

Słowa kluczowe: sposób żywienia, mikroskładniki odżywcze, chłopcy, młodzież, aktywność fizyczna

INTRODUCTION

Teenagers engaged in sports are a group of increased nutritional demands. It stems not only from growth and development, but also from high physical activity [2, 35, 43]. The proper nutrition is an important factor that determines full use of genetically determined develop-ment and improves physical capacities. Dietary mistakes reduce the normal development processes and influence on the decline of motor skills, reduce concentration and increase susceptibility to fatigue; thereby they increase the risk of malnutrition, dehydration, exhaustion, injury and trauma [15, 24, 48]. On the one hand, the literature on the nutritional habits of teenagers practicing sport [6, 32, 37] and inactive teenagers [19, 27] indicates abnor-mal eating habits, irregular meals, and their insufficient daily number. On the other hand, research related to nutrients intake of not training teenagers of 11 to 15 years old [3, 13, 22, 40] and some studies on youth engaged in sport have shown abnormalities in intakes of vitamins and minerals [1, 14, 38, 47]. Therefore, it seemed purposeful to undertake this type of study. The purpose of this study was to evaluate the eating habits among boys practicing sports, aged 13-15 years.


Respondents: 44 healthy secondary school students of the School of Sport Championship (SSC) in district of Bielany in Warsaw, Poland. The study group consisted of 56% the whole male peers population of the school. The characteristics of the respondents and their nutri-tional status were described in the earlier paper [39]. The adolescents were practicing sport 10 hours a week, on average. The study was conducted during the school year in autumn and in winter. The level of food intake was evaluated based on three individual interviews (2 school days and one day-off) related to the intake over the last 24 hours prior to the evaluation.

The volume of the consumed servings was evaluated using the “Album of photographs of food products and dishes” [41]. The calculations took into account the occasional intake of supplements, mainly in the form of sports drinks. The mean daily intake of minerals (sodium, potassium, calcium, phosphorus, magnesium, iron, zinc, copper, iodine) and vitamins (A, E, D, B1, B2,

B6, B12, C, niacin, folate) was calculated with computer software “DIETA 5” [9], which contains current tables of composition as well as nutrition values [21] and up-to-date nutritional standards [17]. For the micronu-trients analysed, the value of the mean daily intake and the prevalence of inadequate intakes were calculated. Nutrient deficiency was evaluated with the probability method in reference to the existing standard levels; Estimated Average Requirement (EAR) (vitamins: A, D, B1, B2, B6, B12, C, niacin, folate, minerals: calcium, phosphorus, magnesium, iron, zinc, copper and iodine) or Adequate Intake (AI) (vitamin E, sodium, potassium). In addition to sodium and zinc, for which exceeding of the Tolerable Upper Intake Level (UL) was established, the probability of excessive amounts of these nutrients in relation to the UL value was evaluated. Deficiency in iron intake was evaluated based on percentile distri-bution of iron intake.

RESULTS

The mean daily intake of minerals and vitamins in students’ diet and the risk of inadequate intakes of the selected nutrients have been presented in Table 1.

The mean intake of minerals and vitamins by the boys exceeded the relevant standards levels EAR or AI, except for vitamin D and potassium, for which the suitable reference levels were not reached and percent-age implement standards were respectively 31.6% and 93.8%. Assessment of the risk of inadequate intakes estimated by the probability method indicates that the highest percentage of deficient diets for all examined nutrients concerned vitamin D (100%), followed by potassium (69%). Deficient intake of folate and cal-cium was found in nearly half of the students. A large percentage of boys also showed a deficient intake of magnesium, vitamin C and vitamin E, which concerned approximately 27%, 24%, 15% of respondents, respec-tively. For other vitamins and minerals deficient intake concerned a small percentage of students (fluctuated in the range of 0.3% to 5.4%).

DISCUSSION

Mean daily intake of vitamin D amounted to 3.2 µg/day, which met the Polish standard at the EAR value only in

Intake of vitamins and minerals in 13-15-years-old boys. 61No 1

32%. The results of these studies reflect rather general situation; a similarly low intake (3.09 µg/day) was reported in the study of boys from Warsaw aged 11-15 years [7]. An even lower intake of vitamin D – that of 2.01 µg/day – was recorded in the studies of secondary school students from the Warsaw district of Bemowo [36]. Inadequate intake of vitamin D was also indicated by results of the studies conducted in nine European countries: Belgium, Denmark, France, Poland, Spain, the Netherlands, the United Kingdom, Germany, and Serbia [28]. These studies revealed that the mean daily intake of vitamin D with unsupplemented diets among boys aged 11-17 years (n=3240) was too low and it fell within the range from 1.9 µg/day (n=393) in France to 4.8 µg/day (n=295) in Poland. Similarly to our studies, the percentage of subjects with mean intake of vitamin D below the EAR level in the respective countries was high, and it fell within the range from 72.2% in Poland to 100% in France and Spain, whilst it must be noted that in those studies, the standard value at the EAR level (5.6 µg/d) was almost twice lower that is the currently ap-plicable standard in Poland for the corresponding male age group. Comparing the present results to the studies of Spanish boys practicing skiing (aged 10-18 years), the average daily intake of vitamin D was higher and it amounted to 5.6 µg/day, while in the same age group of students who were not practicing any sports, the intake

of this vitamin was that of 3.8 µg/day [26]. On the other hand, among teenage Spanish football players (age 13-19 years), dining at a hotel buffet or at college resi-dence, the intake of vitamin D amounted to 3.2 µg/day and 5.9 µg/day, respectively, while the intake below the standard AI level (5 µg/day) was found in 88% and 28% of the study subjects, respectively [14]. The data mentioned above indicate that the intake of vitamin D with a diet among adolescent boys, regardless of their physical activity, was insufficient not only in Poland, but also in other countries, what was noted by a team of experts who pointed out the need to supplement vitamin D intake in all age groups, and who published guidelines for supplementation of vitamin D for the Central Europe, as relating to prevention of its deficiencies [31]. Vitamin D favours the absorption of calcium and phosphorus in the intestine, thus stimulates the differentiation of osteoclasts, resorption of calcium from the bones and activates the mineralisation of the bone matrix [29]. In the light of that, a suitable nutrition state of vitamin D is particularly important during pubescence, since the bone remodelling is at its highest level in that period of growth [25]. Optimum accumulation of inorganic bone matter within the period of puberty and early adulthood is crucial in ensuring an attainment of a sufficiently high peak bone mass and, thus, decreasing the risk of osteoporosis in later life [33]. The qualitative analysis

Table 1. The mean (X± SD) daily intake of minerals and vitamins and the prevalence of inadequate intakes in the diets of the boys, estimated by means of the probability method (n=44)

Vitamins and Minerals Mean values X± SD Range Risk of inadequate intake (%)

in relation to EAR or AI EAR or AI

Sodium (mg) 5528.2±1705.7 1983.8 - 9237.9 0.3 1500Potassium2 (mg) 4410.7±1356.2 2016.9 – 8079.9 69.2 4700Calcium1 (mg) 1334.8±754.0 178.0 – 3640.8 50.0 1100Phosphorus2 (mg) 1853.9±626.7 694.7 – 3604.9 5.1 1050Magnesium (mg) 396.0±114.3 155.2 – 678.9 26.8 340Iron (mg) 15.9±5.3 7.1 – 33.6 - 8Zinc 2 (mg) 13.6±4.0 6.8 – 24.0 4.8 8.5Copper (mg) 1.56±0.46 0.59 – 2.60 0.6 0.7Iodine2 (µg) 185.7±67.5 39.7 – 356.0 5.4 95Vitamin A (retinol equivalent)1 (µg) 1619.4±1207.5 281.4 – 6451.1 3.9 630Vitamin E5 (mg) 16.1± 7.9 3.1 – 53.1 15.1 10Vitamin D1 (µg) 3.2 ± 1.5 0.9 – 8.3 100.0 10Vitamin B1

3 (mg) 2.2± 0.8 1.0 – 4.5 1.0 1.0Vitamin B2

4 (mg) 2.6± 1.1 0.9 – 6.2 1.6 1.1Niacin 2 (mg) 24.3 ± 8.9 9.3 – 52.4 2.6 12Vitamin B6

6 (mg) 2.8± 1.0 1.3 – 5.6 0.5 1.1Vitamin C6 mg 150.4± 107.1 17.4 – 538.2 23.9 65Folate 2 (µg) 349.1± 122.2 95.0 – 684.0 52.6 330Vitamin B12

4 (µg) 5.2± 3.9 1.3 – 23.5 5.2 2.01exponential transformation α=0.22exponential transformation α =0.33333exponential transformation α =0.1254 exponential transformation α =0.15exponential transformation α =0.256logarithmic transformation


of menus showed that the inadequate intake of vitamin D in diet was caused by a very low consumption of fish, average 4.2 g/day.

Another nutrient with a high risk of inadequate inta-ke in the studied group of secondary school students was potassium. It has been shown that approximately 2/3 of the boys consumed this nutrient in amounts below the AI level value (Table 1), despite the fact that its mean intake of 4411 mg/day accounted for 94% of potassium standard. This indicates a large diversity in the intake of this nutrient in the studied group of boys. However, it is worth noting that according to standards in Poland before 2008, the daily requirement of potassium intake was significantly lower and it amounted to 2500 mg in 13-15-year-old boys, because it was defined at the level of the minimum standard of daily intake, and for this reason, meeting standards for this nutrient in the studied nutritional portions in select social groups ranged from 120-145% [48]. The average intake of potassium, which was lower than that observed in our study, amounted to 2786 mg/day, was established among 13-14-year-old secondary school students from the Warsaw district of Bemowo [36]; whereas among students of both genders, aged 11-13 years from five different Warsaw schools, the intake of this nutrient in the group of subjects who were consuming their lunches at school, was 2419 mg/day and those who did not eat at school 2218 mg/day [45]. A similarly low intake of potassium, at the level of 2441 mg/day, was shown among younger overweight and obese boys aged 10-12 years from the region of the Malopolska Poland [44]. Inadequate intake of potas-sium was also indicated in the European studies which revealed that the intake of this nutrient fell within the range from 2529 mg/day in the United Kingdom up to 3899 mg/day in Germany; while the intake below the EAR level (2325 mg/day for 11-14-year-old boys and 2625 mg/day for 15-17-year-old boys) was referred to the range from 9.5% of the subjects in the Netherlands up to 49.6% of the boys in the United Kingdom [28]. The intake of potassium, which was lower than that observed in the present study, was also found among teenage (12-18 year-olds) Flemish sprinters, whose intake of this nutrient as part of an unsupplemented diet was that of 3616 mg/day [1]. The quoted results of the studies conducted in Poland and in other European countries revealed that the studied group of boys from SSC was characterised by higher mean intake of potas-sium despite the fact that the diet of approximately 2/3 of them was inadequate in reference to this nutrient. A diet low in fruit and vegetables, wholegrain cereals, milk and dairy products results in a low intake of potassium, what has been observed in the analysed menus. Some of the boys were not consume these products at all.

The third nutrient in terms of the prevalence of inadequate intake, which are related to more than half

of the subjects from the SSC, are folate, despite the fact that a mean daily intake (349.1 µg/d) constituted 106% of the EAR value (Table 1). It was due to insufficient quantity of fruit and vegetables in the diet. An even higher incidence of folate deficiency (73.7%) in diets of Warsaw boys at the age of 11-15 years has been in-dicated by the studies conducted by Charzewska et al. [7]. In order to compare, in European studies, the lowest mean daily intake of folate, at the level of 166 µg/day, was established among boys at the age of 11-17 years in Spain, while the highest - at the level of 381 µg/day – was noted in Germany; whereas the percentage of the subjects with inadequate intake of this vitamin was lower than that detected in our study, as it fell within the range from 4.7% in Denmark to 38% in Spain, which resulted from use of more than twice lower standard at the EAR level (150 µg) [28]. A too low mean intake of folate has also been shown among Spanish adolescents practicing skiing (156 µg/d) and among participants not practicing any sport (143 µg/d) [26]. A higher intake of folate, similar to that observed in our studies, was found in a group of Spanish football players fed at a hotel and in the canteen of the college residence, and it amounted to 317 µg/day and 308µg/day, respectively, whereas the percentage of persons with inadequate intake of this nu-trient in reference to the Recommended Dietary Intake (RDA) (400 µg/day) was higher in the present study and it amounted to 75.8% and 82.8%, respectively [14].

A high percentage of inadequate intake of folate among young secondary school students may result in concern, because these compounds are necessary for the correct development of all body cells and for the proper functioning of the nervous and the haematopoietic sys-tems [18], and so persistent deficits of this vitamin may lead to disturbances in normal growth processes and they may negatively affect the general health condition.

Another nutrient, in which prevalence of inadequate intake related to half of the SSC students is calcium, despite the fact that mean daily intake of this element met the standard at the EAR level in 121% (Table 1). The reason for this was too low consumption of milk and dairy products by the respondents. In other studies of Warsaw students at the age of 11-15 years, the average calcium intake was significantly lower than that one observed in our study, and it amounted to 854.5 mg/day, what was 78% of the AI (1300 mg/day) [7]. For this group, it was also showed that the percentage of the boys with inadequate intake of this nutrient (82.2%) was higher than that in a present study. A lower intake of calcium (708 mg/day), which met the standards at the AI (1300 mg/day) only in 64%, was shown among 13-14-year-old boys from the Warsaw district of Bemo-wo [36]. A similarly low intake of calcium amounting to 713 mg has been shown in boys aged of 13-15 years in another study, while an intake of this nutrient amounting


to below 66.7% of the standard in safe level of intake, related to 54% of the study subjects [10]. Previous stu-dies in adolescents in Poland also revealed low intake of calcium ranging between 570-760 mg/day among boys aged of 11-15 years [3]. When interpreting results regarding intake of calcium, it should be considered that the binding standards of nutrition for the Polish population, as amended in 2012, the AI (1300 mg/day) was replaced with a lower level of EAR (1100 mg/day), what should be taken into account, when comparing results. European studies reveal that calcium intake in a group of boys at the age of 11-17 years fell within the range from 742 mg/day in Poland to 1487 mg/day in Germany, what was below the EAR value (750 mg/day); furthermore, this nutrient was shown to be consumed within the range from 5% of the subjects in Denmark to 57.3% of the subjects in Poland [28]. When compa-red with adolescents who engage in increased physical activity, among Flemish sprinters aged 12-18 years, the mean daily intake of calcium amounted to 958 mg/day [1], while among Spanish skiers at the age of 10-18 years, it was that of 1032 mg/day [26], and among Spanish football players fed at a hotel and at the college residence canteen, it amounted to 1095 mg/day and 1335 mg/day, respectively, whereas an inadequate intake of this nutrient below the AI standard (1300 mg/day) was shown in 66.6% and 41.4% subjects, respectively [14]. Inadequate intake of calcium occurring at a such large scale within the pubescence period is seriously alarming, because it is not conducive to achieving high peak bone mass and consequently, it increases risk of occurrence of osteoporosis in the future, particularly in connection with inadequate intake of vitamin D, what was shown for all subjects.

Metabolism of calcium is also crucially affected by magnesium, the inadequate intake of which related to approximately 27% of the studied boys from the SSC, even though the mean daily intake of this nutrient was relatively high, amounting to 396 mg/day, what met the standard at the level of 116% (Table 1). A daily intake of magnesium (285.5 mg/day) which was lower than the one observed in our study, was also demonstrated in other group of Warsaw boys aged of 11-15 years, what then resulted in a higher percentage (53.5%) of persons who run the risk of incurring a deficiency of this element [7]. An even lower mean intake of magne-sium by the boys in the same age group, which ranged from 191 mg/day to 290 mg/day, was shown in Poland in the years 1989-1997 [3]. Studies conducted in Eu-rope revealed the lowest average magnesium intake among boys at the age of 11-17 years, amounted to 227 mg/day has been shown in the United Kingdom, and the highest amounted to 531 mg/day in Germany. Consequently, the percentage of teenage subjects with an intake of this nutrient maintained below the EAR

(230 mg/day and 250 mg/day, respectively for the age group of 11-14 years and 15-17 years) in these countries was noted at the level of 58.1% and 1.7%, respectively [28]. To compare with the results of the studies among adolescents (aged 13-19 years) engaged in increased physical activity, the average magnesium intake among boys practicing football and fed at a hotel was that of 256 mg/day, and 338 mg/day among football players eating in the canteen at the college residence; while an intake below the RDA was demonstrated in 100% and 45% of the respondents, respectively [14]. However, among teenage Spanish skiers (aged 10-18 years), the mean magnesium intake amounted to 217 mg/day, while in their peers who were not practicing any sports, it was that of 204 mg/day [26].

Other nutrients in terms of their risk of inadequate intake, which related to approximately 24% and 15% of the adolescent students from the SSC, are vitamins C and E, respectively. For comparison, in the studies among boys from other Warsaw secondary schools, an inadequate intake of these vitamins affected a signifi-cantly higher percentage of subjects: 67% and 47%, respectively [12]. However, in the studies conducted by Charzewska et al., an inadequate intake of vitamin C was shown among 42% of the boys [7]. In our studies, the mean daily intake of vitamin C and E amounted to 150.4 mg/day and 16.1 mg/day, respectively, and si-gnificantly exceeded the currently applicable standards for these nutrients. For the sake of a comparison, inter-national studies conducted in other European countries indicated that the mean daily intake of vitamin C was diverse and it ranged from 71 mg/day in the Netherlands to 203 mg/day in Germany, whereas the average daily intake of vitamin E ranged from 6.9 mg/day in Denmark to 18.6 mg/day in Germany, and an inadequate intake of vitamin C ranged from 0.4% of teenagers in Germany to 7,5 % in Poland, followed by an insufficient intake of vitamin E ranging from 1.8% of study subjects in Germany to 38% in Denmark [28]. However, it should be noted that in evaluating an inadequate intake, lower standard levels were used than in the presented studies students and in the aforementioned Warsaw teenagers [7, 12]. In European studies of vitamin C, the EAR ranged from 22 to 25 mg/day depending on age, and for vitamin E the AI amounted to 6 mg of α-TE/day (equ-ivalent of α-tocopherol). The mean daily intake for these vitamins among Spanish teenagers engaging in skiing practice and in the subjects who were not practicing any sports in the case of vitamin C amounted to: 108 mg/day and 88 mg/day, respectively, and in the case of vitamin E to 7.3 mg/day and 6.5 mg/day, respectively [26], while in football players of the same nationality, it was recorded at 7.9 mg of α-TE/day for the subjects fed at a hotel and 13.5 mg of α-TE/day for the users of the canteen at the college residence [14].


In the case of remaining select micronutrients, their inadequate intake related to an insignificant percentage of the students (it ranged from 0.3% to 5.4%).

An average intake of other vitamins: A, B1, B2, B6 B12 and niacin, significantly exceeded of the EAR value within the range from 215% to 261%, and their inade-quate intake related to a low percentage of the subjects and it ranged from 0.5% to 5.2% (Table 1).

Also in the studies of 5th and the 6th grade students of elementary schools [46], as in the case of adole-scents attending Warsaw secondary and high schools [36], the average intake of these vitamins exceeded the EAR within the range from 100% to 215%, although it should be noted that the inadequate intake of these vitamins referred to a significantly higher percentage of 12-13-year-old boys, ranging from 28% in the case of riboflavin to 51% in the case of thiamine [46]. However, among 13-year-old boys from Szczecin with BMI≥90 of a percentile, only a mean intake of vitamin A was com-pliant with the standard at the level of the recommended intake, but in reference to other vitamins, as B1, B2, B6, PP, it was below the standard [16]. In the case of vitamin A, it has been observed in several studies that its intake was high with a diet, frequently exceeding 1000 µg [20, 26, 30, 36]. Augustyniak and Brzozowska emphasise that in the years 1980-1997 the intake of vitamin A among boys from Warsaw and Poznan was always higher or equal to standards at the safe consumption level [3]. Different results were obtained in studies conducted in teenage Spanish football players fed at a hotel and at the college residence. In those groups, the mean intake of vitamin A covered the RDA standard in 86% and 82%, respectively, and the intake of this vitamin below the RDA was established in approximately 64% and 76% of the subjects, respectively [14]. Similarly among Spanish sprinters aged 12-18 years, only approximately 43% of them achieved the recommended daily intake of vitamin A [1]. Against the background of the quoted study results and in reference to the applicable nutrition standards, the intake of vitamins: A, B1, B2, B6 B12 and niacin in the studied group of boys from the SSC may be recognised as normal.

The average daily intake of phosphorus by the boys from the SSC met the EAR in 177%, whereas only 5% of the subjects consumed this element below this value. According to the reference literature published in 1990-2000, the intake of phosphorus by Polish adolescents was higher than the recommended standards, and the degree of their implementation for this element in food rations for the boys, remained at 150% of standard level [3]. Similarly in the studies of children and adolescents from the region of Biala Podlaska, the mean intake of phosphorus (1317 mg/day) in 13-15-year-old boys exceeded the standard at the safe level of intake, while 97% of the subjects consumed this element within the

range of 90-110% of the norm and above [10]. Accor-ding to Szponar et al., the mean intake of phosphorus in Poland amounts to 1208 mg/day, while among boys and adult males it is calculated at 1441 mg/day so in general, there are no nutritional deficits of this nutrient [17, 40]. Comparing with the results of the studies on physically active adolescents, an intake of phosphorus with unsupplemented diets in Flemish sprinters (aged of 12-18 years) amounted to 1636 mg/day, what was lower than the value observed in the present studies, while the consumption of this nutrient in approximately 97% of them was in compliance with the standards at the Recommended Daily Intake (RDI) level [1]. Con-sumption of highly processed food contributes to high content of phosphorus in a diet and to an inadequate proportion between calcium and phosphorus. The weight ratio of calcium to phosphorus obtained in the studies from mean values of their daily intake by the secondary school subjects amounted to1:1.4, while the ratio based on the standards was that of 1:1. Although many studies indicate that high phosphorus intake of is unfavourable for bones in persons whose proportion of Ca to P in the diet is very low, at the same time, it is pointed out that a high intake of this element does not bear a negative consequences on the calcium balance in healthy people, if the consumption of calcium is adequate [23]. However, in our study, a high intake of phosphorus in daily food rations was accompanied by a relatively high percentage of an inadequate calcium intake, which may increase the risk of lower absorption of this element, and thereby also the risk of worse bone mineralisation.

A high intake with diet has also been observed in the case of sodium. In the studied students group of SSC, the mean daily intake of this element exceeded the AI value by over 3.5 times, which calculates into 13.8 g of salt. According to the recommendations of the World Health Organization, a maximum intake of salt should not exceed 5 g/day [11]. An excessive intake of salt may lead to an increased risk of occurrence of hypertension, stroke, myocardial infarction and development of gastric cancer [11]. An increased amount of sodium in a diet also causes an increased excretion of calcium with urine, thus raising the risk of occurrence of nephrolithiasis [18]. In the light of reference literature, the results of the present study are not isolated, since other studies also revealed too high intake of sodium among adolescents [8, 36, 44, 45, 46]. However, according to the American Dietetic Association Dietitians of Canada and the Ame-rican College of Sports Medicine, the requirement for sodium in many endurance athletes is higher than the UL (2300 mg/day, what corresponds to 5.75 g of salt) in the case of this element. Sodium is a critical electrolyte for athletes, especially for those who sweat profusely [2]. The study of adult athletes found that mean daily


intake of sodium exceeds up to seven times a minimum standard for consumption this nutrient [4, 5].

All of the boys subjected to our study showed an in-take of sodium which exceeds UL, while the probability that this level is not exceeded is only that of 0.5%. Con-sequently, such a high intake of this element by the boys from the SSC should be recognised as excessive, even considering their increased requirement for sodium, which is related to their heightened physical activity. A nearly twice higher than recommended intake of iodine, which was observed in present study, probably results from the high content of salt in the consumed diets.

Exceeded UL was also shown in the case of zinc in 7% of the studied boys from the SSC in Warsaw. It is not an isolated case, since exceeding the UL of zinc has also been observed in 4% of the students aged 11-15 years attending various Warsaw schools, but it has been emphasised that the risk of exceeding this level as a result of consumed food is minimal [7]. The mean daily intake of zinc revealed in our study amounted to 13.6 mg/day, what corresponded to 160% of the EAR value, and an inadequate intake of this element related only to 4.8% of the students. The average intake of zinc amounted to 7.6 mg and 9.8 mg, what was lower than that observed in our study, and a significantly higher percentage of the studied boys with inadequate intake of this element (48.3% and 34.9%) have been revealed in the studies of 5th and 6th grade students of Warsaw elementary schools [46] and, respectively, of Warsaw students at the age of pubescence [7]. A low intake of zinc was also established in the study of boys aged 10-12 years from the region of the Malopolska, whose intake of this element in spring time was 7.5 mg/day, and in autumn it amounted to 7.3 mg/day, but in 81% and 87% of the subjects, respectively, the intake of this element was below 66.7% of the standard at the safe level of intake [44]. In European studies, the lowest intake of zinc among boys at the age of 11-17 years amounting to 8.4 mg/day was observed in the United Kingdom, and the highest of 14.7 mg/day was noted in Germany [28]. However, among athletes, Spanish teenage skiers consumed 12.1 mg of zinc per day, while the subjects who were not practicing any sports and who belonged to the same age group consumed 11.8 mg of this ele-ment per day [26]. The presented data indicate that the secondary school students participating in our studies consumed relatively high amounts of zinc, which makes the risk of its deficit very low.

An average intake of copper with diet met the standard in 223%, whereas an inadequate intake of this mineral related only to 0.6% of boys attending the SSC (Table 1). A twice lower amount of copper at the level of 0.8 mg was shown in the studies of daily food rations of 5th and 6th grade students of various Warsaw elementary schools, whereby the percentage of boys with inade-

quate intake of this element amounted to 20.5% [46]. Similarly, a much lower intake of copper than the one noted in the present study was observed among 10-12 year-old boys from the region of Malopolska, amounting to 0.9 mg/day in springtime and 0.8 mg/day in autumn. An intake of this element below 66.7% of the bottom threshold value of the recommended range of safe intake has been found in 65% and 77% of them, respectively [44]. A content of copper (1.07 mg), which was lower than that observed in our studies, was also established in the daily food rations of the boys attending early grades of Szczecin secondary schools [16] and from the secondary school in Warsaw [36]. In European studies, a mean daily intake of this nutrient in unsupplemented diets among boys aged 11-17 years fell within the range from 1.04 mg to 2.60 mg [28].

Table 2 presents the percentile of iron intake from the food in the studied group of the boys.

Table 2. Percentile of iron intake from food by 13-15-year old boys

Percentile p5 p10 p30 p50 p70 p90 p95Percentile intake (mg) 8.4 9.3 12.2 14.8 18.3 23.0 26.1

The mean daily intake of iron (15.9 mg) by the stu-dents of the SSC was higher than the EAR value, which currently amounts to 8 mg for this age group (Table 1). Only 5% of the students consumed iron in amounts lower than 8.4 mg (5 percentile) and only one boy had an inadequate intake of iron (7.08 mg/day) (Table 2). The results of previous studies indicate that the mean daily iron intake among Polish adolescents who do not practice sports as well as in adult males is relatively high and it approximately amounts to 15 mg [34, 40], whereas in other European countries it ranges from 11.0 mg to 16.7 mg daily [42], which has been confirmed by the results of the present study. However, it is worth noting that in other Polish studies related to Warsaw adolescents aged of 11-15 years, an inadequate intake of iron occurred in higher prevalence, as it referred to approximately 1/3 of the subjects [7].

CONCLUSIONS

1. A significant disproportion between the mean intake and the percentage of inadequate diets indicates a large diversity in the intake of vitamins and minerals in the studied group of boys.

2. Analysis of nutrition mode indicates abnormalities in the intake of many vitamins and minerals.

3. The highest percentage of insufficient intake con-cerned vitamin D (100%), potassium (69%), folate (53%), and calcium (50%). The lower percentage of


respondents indicates a deficient intake of magne-sium (27%), vitamin C (24%), and E (15%). The disturbingly high percentage of respondents with excessive sodium intake (99.5%) was noticed.

4. The revealed abnormalities indicate an incorrect quantitative and qualitative composition of diet products.

5. Noticeable nutritional mistakes increase the risk of the vitamins and minerals deficiencies and an excess of sodium. The study results indicate the need for education on the rational nutrition among the stu-dents their parents, and teachers.

Conflict of interestThe authors declares no conflict of interest.

AcknowledgementsThe study was performed as o project (No G.2.6) entitled “Evaluation of nutrition pupils from a sport--school in Warsaw” financed by the Institute of Sport, Warsaw, Poland.

REFERENCES

1. Aerenhouts D., Hebbelinck M., Poortmans J.R., Clarys P.: Nutritional habits of Flemish adolescent sprint ath-letes. Int J Sport Nutr Exerc Metab 2008;18(5):509-523.

2. American Dietetic Association, Dietitians of Canada, American College of Sports Medicine, Rodriguez N.R., DiMarco N.M., Langley S.: Nutrition and Athletic Per-formance. Position Statement of the American Dietetic Association, Dietitians of Canada, and the American College of Sports Medicine. Med Sci Sports Exerc 2009;41(3):709-31.

3. Augustyniak U., Brzozowska A.: Sposób żywienia mło-dzieży w Polsce na podstawie piśmiennictwa z ostatnich 10 lat (1990-2000) [Nutrient intake of the adolescents in Poland - ten years literature review (1990-2000)]. Rocz Panstw Zakl Hig 2002;53(4):399-406 (in Po-lish) [PMID: 12664668; http://www.ncbi.nlm.nih.gov/pubmed/12664668].

4. Chalcarz W., Merkiel S., Mikołajczak A., Nowak E.: Vitamin and mineral intake in football players on the day before match, the match day and the following day. Bromat Chem Toksykol 2008;41(3):681-685 (in Polish).

5. Chalcarz W., Merkiel S., Tyma M.: Vitamin and mineral intake in mountain cyclist. Bromat Chem Toksykol 2008;41(3):686-689 (in Polish).

6. Chalcarz W., Radzimirska-Graczyk M.: Jakościowy spo-sób żywienia dzieci i młodzieży uprawiających szermier-kę. Część II. Przerwy między posiłkami, charakterystyka dojadania [Nutritional habits in children and adolescents practicing fencing. Part II. Characteristics of eating be-tween meals]. Rocz Panstw Zakl Hig 2010;61(1):71-74 (in Polish) [PMID: 20803903; http://www.ncbi.nlm.nih.gov/pubmed/20803903].

7. Charzewska J., Chojnowska Z., Wajszczyk B. et al.: The risk of deficiency some minerals and vitamins in the diet of schoolchildren aged around puberty. In: Januszewicz P., Mazur A., Socha J. (eds.) Public Health part II. Mal-nutrition and public health. Wydawnictwo Uniwersytetu Rzeszowskiego, Rzeszów, 2011 (in Polish).

8. Charzewska J., Wajszczyk B., Chojnowska Z., Rogals-ka-Niedźwiedź M., Chabros E.: Nutritional risk factors for chronic non-communicable diseases in children and adolescents. In: Jarosz M. eds. Obesity, physical activity, health Poles. Diagnosis of nutritional status, physical activity and dietary risk factors for obesity and chronic non-communicable diseases in Poland (1960-2005). IŻŻ, Warszawa, 2006 (in Polish).

9. Computer software “Dieta 5.0” for planning and ongoing evaluation of feeding individual. IŻŻ, Warszawa, 2010.

10. Czeczelewski J., Raczyńska B.: Zawartość wapnia i fosforu w całodziennych racjach pokarmowych dzie-ci i młodzieży z powiatu bialskiego [Calcium and phosphorous content in a daily rations of adolescents from Biała Podlaska District]. Rocz Panstw Zakl Hig 2005;56(3):229-236 (in Polish) [PMID: 6433229; http://www.ncbi.nlm.nih.gov/pubmed/16433229].

11. Diet, Nutrition and the Prevention of Chronic Diseases. Report of the Joint WHO/FAO Expert Consultation, Rome 2003.

12. Dybkowska E., Waszkiewicz-Robak B., Piekot E.: Eval-uation of vitamins A, C and E content in diets of adoles-cents living in Warsaw, Poland. Rocz Panstw Zakl Hig 2014;65(1):21-25 [PMID: 24964575; http://www.ncbi.nlm.nih.gov/pubmed/24964575].

13. Energy and nutrient intake in the European Union (on the basis of the national data) European Nutrition and Health Report 2004. in: Elmadfa J., Weichselbaum E. (eds.) Forum Nutr Basel, Karger, 2005.

14. Garrido G., Webster A.L., Chamorro M.: Nutritional adequacy of different menu settings in elite Spanish adolescent soccer players. Int J Sport Nutr Exerc Metab 2007;17(5):421-432.

15. Gawęcki J., Hryniewiecki L. (eds.): Human nutrition. Basics of Food Science. Żywienie człowieka. Podstawy nauki o żywieniu. PWN, Warszawa, 2010 (in Polish).

16. Goluch-Koniuszy Z., Friedrich M., Radziszewska M.: Ocena sposobu żywienia i stanu odżywienia oraz proz-drowotna edukacja żywieniowa dzieci w okresie skoku pokwitaniowego z terenu miasta Szczecin [Evaluation of nutrition mode and nutritional status and prohealth education of children during the period of pubertal spurt in the city of Szczecin]. Rocz Panstw Zakl Hig 2009;60(2):143-149 (in Polish) [PMID: 19803444; http://www.ncbi.nlm.nih.gov/pubmed/19803444].

17. Jarosz M. eds. Nutrition norms for the Polish population - amendment. IŻŻ, Warszawa, 2012 (in Polish).

18. Jarosz M., Szponar L., Rychlik E.: Water and electrolytes. In.: Jarosz M., Bułhak-Jachymczyk B. (eds.): Polish die-tary reference intakes. Principles of prevention of obesity and non-communicable diseases. PZWL, Warszawa, 2008 (in Polish).

19. Kołłajtis-Dołowy A., Pietruszka B., Waszczeniuk-Uliczka M., Chmara-Pawlińska R.: Some of the nutritional habits


among children 14-16 years old in Warsaw. Żyw Człow Metab 2003;30(1/2):182-187 (in Polish).

20. Kolmaga A., Godala M.,Trafalska E.: The assessment of the intake of vitamins and minerals from the diet and dietary supplements in a group of 12-13-year-old children from the Lodz schools. Żyw Człow Metab 2009;36(1):40-47 (in Polish).

21. Kunachowicz H, Nadolna I, Przygoda B. Iwanow K.: Food Composition Tables. Warszawa, PZWL, 2005 (in Polish).

22. Lambert J., et al.: Dietary intake and nutritional sta-tus of children and adolescents in Europe. Brit J Nutr 2004;92(Suppl. 2):174-211.

23. Lee A.W., Cho S.S.: Association between phosphorus intake and bone health in the NHANES population. Nu-trition Journal 2015; 14:28. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4389665/ (accessed 16.06.2015)

24. Leonkiewicz M, Gacek M., Frączek B.: Knowledge and nutritional behavior of young people in sport - a necessity for education. In Wolska-Adamczyk A. (eds.): The importance of rational nutrition in health education. WSIiZ, Warszawa, 2015 (in Polish).

25. MacKelvie K.J., Khan K.M., McKay H.A.: Is there a cri-tical period for bone response to weight-bearing exercise in children and adolescents? a systematic review. Br J Sports Med 2002;36(4):250-257.

26. Mariscal-Arcas M., Monteagudo C., Hernandez-Elizon-do J., Benhammou S., Lorenzo M.L., Olea-Serrano F.: Differences in food intake and nutritional habits between Spanish adolescents who engage in ski activity and those who do not. Nutr Hosp 2015;31(2):936-943.

27. Mędrela-Kuder E.: Błędy żywieniowe dziewcząt w wie-ku gimnazjalnym a ryzyko wystąpienia u nich zaburzeń odżywiania [Dietary errors of junior high school girls and the risk of disorders of dietary origin]. Rocz Panstw Zakl Hig 2009;60(1):39-42 (in Polish) [PMID: 19579768; http://www.ncbi.nlm.nih.gov/pubmed/19579768 ].

28. Mensink G. B. M., Fletcher R., Gurinovic M., Huybrechts I., Lafay L., Serra-Majem L., Szponar L., Tetens I., Ver-kaik-Kloosterman J., Baka A., Stephen A.M.: Mapping low intake of micronutrients across Europe. Br J Nutr 2013;110(4):755-773.

29. Myszka M, Klinger M.: The immunomodulatory role of Vitamin D. Postepy Hig Med Dosw 2014;68:865-878 (in Polish).

30. Ostrowska A., Szewczyński J., Gajewska M.: Nutritive value of daily food rations of students of secondary scho-ols in mazowieckie province. Part II. Mineral elements and vitamins. Żyw Człow Metab 2003;30:367-371 (in Polish).

31. Płudowski P., Karczmarewicz E., Bayer M., Carter G., Chlebna-Sokół D., Czech-Kowalska J., et al.: Practical guidelines for the supplementation of vitamin D and the treatment of deficits in Central Europe - recommended vitamin D intakes in the general population and groups at risk of vitamin D deficiency. Endokrynol Pol 2013;64 (4):239-246.

32. Radzimirska-Graczyk M., Chalcarz W.: Jakościowy spo-sób żywienia dzieci i młodzieży uprawiających szermier-

kę. Część I. Spożywanie posiłków [Nutritional habits in children and adolescents practicing fencing. Part 1. Meal consumption]. Rocz Panstw Zakl Hig 2009;60(4):385-388 (in Polish) [PMID: 20361570; http://www.ncbi.nlm.nih.gov/pubmed/20361570].

33. Rizzoli R., Bianchi M.L., Garabédian M., McKay H.A., Moreno L.A.: Maximizing bone mineral mass gain during growth for the prevention of fractures in the adolescents and the elderly. Bone 2010;46(2):294–305.

34. Rogalska-Niedźwiedź M., Charzewska J., Wajszczyk B., Chabros E., Chwojnowska Z., Lachowicz A.: Nutritional factors of anemia in adolescents. Żyw Człow Metab 1995;22:299-311 (in Polish).

35. Shirreffs S.M., Sawka M.N.: Fluid and electrolyte needs for training, competition, and recovery. J Sports Sci 2011;29(S1):S39-S46.

36. Sitko D., Wojtaś M., Gronowska-Senger A.: Sposób ży-wienia młodzieży gimnazjalnej i licealnej [Food patterns of youth from gymnasium and lyceum]. Rocz Panstw Zakl Hig 2012;63(3):319-327 (in Po lish) [PMID: 23173337; http://www.ncbi.nlm.nih.gov/pubmed/23173337].

37. Szczepańska B., Malczewska-Lenczowska J., Gajewski J.: The nutritional habits among teenagers 13-15 years old from competitive sport-oriented school in Warsaw. Żyw Człow Metab 2007;34 (1/2):578-586 (in Polish).

38. Szczepańska B., Malczewska-Lenczowska J., Wajszczyk B.: Evaluation of nutrition mode of 13-15-year-old girl students from sports junior high school in Warsaw. Oce-na spożycia witamin i składników mineralnych przez dziewczęta z warszawskiego gimnazjum sportowego. Probl Hig Epidemiol 2011;92(3):644-647 (in Polish).

39. Szczepańska B., Wajszczyk P., Malczewska-Lenczowska J.: Nutritional status and nutrition among 13-15 year-old boys from competitive sport oriented junior high school in Warsaw. MONZ 2013;19(4):539-543 (in Polish).

40. Szponar L., Sekuła W., Rychlik E., Ołtarzewski M., Fi-gurska K.: Household Food Consumption and Anthropo-metric Survey. Warszawa, National Food and Nutrition Institute (IŻŻ) 101, Warszawa, 2003 (in Polish).

41. Szponar L., Wolnicka K., Rychlik E.: Album produktów i potraw o zróżnicowanej wielkości porcji. [Album of photographs of food products and dishes], IŻŻ, Warsza-wa, 96, 2000 (in Polish).

42. Viñas B.R., Ribas Barba L., Ngo J., Gurinovic M., No-vakovic R., Cavelaars A., de Groot L.C., van’t Veer P., Matthys C., Serra Majem L.: Projected prevalence of inadequate nutrient intakes in Europe. Ann Nutr Metab 2011;59(2-4):84-95.

43. Whiting S.J., Barabash W.A.: Dietary reference intakes for the micronutrients: considerations for physical acti-vity. Appl Physiol Nutr Metab 2006;31(1):80-85.

44. Wielgos B., Leszczyńska T., Kopeć A., Cieślik E., Piąt-kowska E., Pysz M.: Ocena pokrycia zapotrzebowania na składniki mineralne przez dzieci w wieku 10-12 lat z re-gionu Małopolski [Assessment of intake of minerals with daily diets by children aged 10-12 years from Malopolska region]. Rocz Panstw Zakl Hig 2012;63(3):329-337 (in Polish) [PMID: 23173338; http://www.ncbi.nlm.nih.gov/pubmed/23173338].


45. Wolnicka K., Jaczewska-Schuetz J., Taraszewska A.: Ocena wartości odżywczej całodziennych racji po-karmowych dzieci uczęszczających do warszawskich szkół podstawowych [Evaluation of nutritive value of daily food rations consumed by children attending to primary schools in Warsaw]. Rocz Panstw Zakl Hig 2012;63(4):447-453 (in Polish) [PMID: 23631266; http://www.ncbi.nlm.nih.gov/pubmed/23631266].

46. Wolnicka K., Taraszewska A.: Assessment of the vitamin and mineral content in the daily food intake of pupils from primary schools in Warsaw. Probl Hig Epidemiol 2012;93:408-413 (in Polish).

47. Ziegler P.J., Nelson J.A., Jonnalagadda S.S.: Nutritional and physiological status of US national figure skaters. Int J Sport Nutr. 1999;9:345-360.

48. Ziemlański Ś. (ed.): Polish dietary reference intakes. Physiological basis. Normy żywienia człowieka. Fizjo-logiczne podstawy. PZWL, Warszawa, 2001 (in Polish).

Received: 15.08.2015.Accepted: 15.01.2016



*Corresponding author: Karandeep Singh Sandhu, Department of Public Health Dentistry, Swami Devi Dyal Hospital and Dental College, Barwala, Panchkula, Haryana, India, phone: +91 9888641818,e-mail: [email protected]


ORIGINAL ARTICLE

ASSOCIATION OF OCCUPATIONAL STRESS FACTORS ON NICOTINE DEPENDENCE AMONG PATIENTS VISITING DENTAL CARE UNIT OF INDO-TIBETIAN BORDER POLICE FORCE STATION IN INDIA

Karandeep Singh Sandhu1*, Vikram Arora1, Nidhi Gupta1, Preety Gupta1, Mitali Raja1, Nishant Mehta1

1Department of Public Health Dentistry, Swami Devi Dyal Hospital and Dental College, Barwala, Panchkula, Haryana, India

ABSTRACTBackground. Tobacco use is the foremost preventable cause of death and disease in the world today and work strain might be related with nicotine dependence by its provoking effect.Objective. To assess the association between occupational stress and nicotine dependence.Material and methods. A cross sectional survey was conducted among 200 subjects visiting a satellite dental clinic of Swami Devi Dyal Hospital and Dental College, Barwala, Panchkula, India. Nicotine dependence was measured using the Fagerstrom Test for Nicotine Dependence (FTND). The extent of the stress factors experienced at work was assessed us-ing the Effort-Reward Imbalance scale (ERI). Chi-square test and multiple logistic regression analysis were employed for statistical analysis. Confidence level and level of significance were set at 95% and 5% respectively.Results. The results of bivariate analysis revealed association of occupational stress with age, marital status, educational status, level of nicotine dependence, frequency of cigarette smoking and religious attendance. However, multivariate analysis elicited the significant association of occupational stress with only two variables, level of nicotine dependence and frequency of smoking.Conclusion. Occupational stress was found to be associated with nicotine dependence in the present study implying a need of other tranquil measures to be incorporated for the relief of work related stress.

Key words: nicotine dependence, occupational stress, smoking

INTRODUCTION

Tobacco use is a serious public health challenge in several regions of the world. It has assumed the dimension of an epidemic resulting in enormous disa-bility, disease and death [13]. It is a multi-dimensional addiction that includes psychological, physiological and behavioural dependence on nicotine [17]. Globally, the total number of tobacco-attributable deaths from ischaemic heart disease, lung cancer and other dise-ases is projected to rise from 5.4 million in 2004 to 8.3 million in 2030 [7].

In India an estimated 65% of all men and 33% of all women use some form of tobacco. Tobacco related cancers in India accounts for 42% of all male deaths and 18.3% of all female deaths. The prevalence of smoking

among men and women differs substantially: 35% of men and 3% of women smoke, while both use smoke--less tobacco products to approximately the same extent

[9].Various administrative measures were taken to pro-hibit tobacco smoking in public places and regulate the sale of tobacco products and their advertisements [10].

Nicotine dependence and the degree of that depen-dence are determined by individual and psychosocial factors as well as combinations of these factors [2]. Smoking has been used as a coping strategy for dealing with work stress [15, 23]. Therefore the degree of ci-garette consumption shed light on the potential stress experienced at work.

“The Fagerstrom Test for Nicotine Dependence” is an internationally recognized and statistically vali-dated instrument for assessing the degree of nicotine

K.S. Sandhu, V. Arora, N. Gupta et al.70 No 1

dependence in smokers. By using this test it is possible to obtain more detailed information about survey par-ticipants smoking behaviour than simply asking them to provide their smoking status [1].

The effort-reward imbalance model provides a the-oretical approach to assessing the psychosocial stress experienced at work as measured by the Effort-Reward Imbalance (ERI) scale [20, 24]. The model claims that an imbalance between high efforts and low rewards may cause a state of emotional distress [12]. A possible relationship between reducing job stress and successful smoking was reported by some investigators. Therefore workplace smoking cessation programs should take into account of the influence of job stress on nicotine dependence. However, there are few reports that deal with influence of job stress on nicotine dependence of smokers at the workplace.

Hence, this study was conducted to determine whe-ther there is an association between the experiences of occupational stress and nicotine dependence measured by the Fagerstrom Test for Nicotine Dependence among patients visiting dental care unit of Indo Tibetian Bor-der Police (ITBP) Force station at Panchkula, district Haryana, India.


Study design, study population, study area and study duration

A cross sectional descriptive study was conducted among 200 patients visiting dental care unit at Indo Ti-betian Border Police Force station, Panchkula, district Haryana in the March 2015.

Ethical clearance, official permission and informed consent

The protocol of the study was approved by the ethical and review board of Swami Devi Dyal Hospi-tal and Dental College, Panchkula, Haryana, India. Official permission to conduct the study was obtained from higher authorities of Indo Tibetian Border Police Force station, Panchkula. Written Informed consent was obtained from all the study participants.

Inclusion criteriaSubjects with habit of smoking since last six months

were included in the study.

Exclusion criteriaSubjects who were uncooperative and underwent

any medical treatment from last six months were exc-luded from the study.

Study ProformaSociodemographic information of subjects was

obtained. Nicotine dependence was measured using the Fagerstrom Test for Nicotine Dependence (FTND). It consists of six questions regarding the degree of ci-garette consumption and the inability to abstain from nicotine use. Each response was given a score and the total score ranges from 0 to 10 [11, 22].

The occupational stress was measured using the German version of the Effort Reward Imbalance and Ill Health (ERI) scale which consists of three subsca-les: “Effort”, “Reward”, and “Overcommitment”. To evaluate the effort-reward imbalance experienced by study participants, only the scores of effort and reward scales were needed [19].

The effort-reward imbalance model defines stress-ful experiences at work as an imbalance between high effort expanded and low reward received. “Effort” is evaluated by measuring work demands. Three trans-mitters are considered to be sources of a “reward”: money, esteem, and career opportunities. The response options for the “effort” scale are: “Disagree,” “Agree, but I am not at all distressed,”, “Agree, I am very di-stressed”. The “reward” scale include 11 items asses-sing the extrinsic components of occupational rewards and contains questions pertaining to opportunities for advancement, employee appreciation, salary and job security. Participants with no superiors have the options to respond with “Not applicable”. The ERI analysis was conducted as follows: If the participants disagreed with a statement, their response was assigned a value of 0. If the participants agreed with a statement but did not experience any stress, their response was assigned a value of 1. The greater the level of stress experienced, the greater the value up to 4. The ERI is, therefore, a five-point Likert scale. When interpreting the values, the higher the sum score of the “effort” and “reward” subscales, the greater the level of occupational stress. Values over 1 indicate an imbalance between effort and reward. The reliability and validity of the “effort,” “reward,” and “Over commitment” subscales as well as of the “effort-reward ratio” have been demonstrated in many studies. The internal consistency and validity of these scales in our study was estimated to be 0.84 to 0.85 for effort, 0.80 to 0.92 for reward [19].

Pretesting of questionnaire A pilot study of the questionnaire was carried out

on 30 patients who were not the part of the study and visited dental care unit for dental treatment. Problems encountered during this period were noted and appro-priate modifications were made taking into account the comments and suggestion received by the responder as a whole. The reliability of questionnaire was ana-lysed using Cronbach’s alpha which was found to be

Occupational stress and nicotine dependence in dental care patients. 71No 1

acceptable (0.82). Face validity indicates whether the instrument appears to be assessing the desired qualities. When face validity was assessed, it was observed that 92% of the participants found the questionnaire to be easy. Mean content validity ratio was calculated as 0.87 based on the opinions expressed by a panel of total six academicians.

Data collection All the eligible subjects visiting the dental care unit

at Indo Tibetian Border Police Force station, Panchkula, district Haryana during the month of March 2015 were informed and explained about the study and were asked to fill the questionnaires. Confidentiality and anonymity of the respondents were assured. A response rate of 100% was obtained.

Statistical analysis The data was thoroughly checked and errors were

corrected before the data analysis. All analysis was done using the statistical package of social sciences 17.0 software (SPSS Inc., Chicago IL). Chi-square test was applied and logistic regression model was calculated using all socio demographic variables. All reported probability values (p values) are based on two-sided tests and compared to a significance level of 5%.

RESULTS

A total of 200 subjects participated in the cross--sectional survey. The mean age of initiation of cigarette smoking was 19.1 ± (6.25).

Table 1 depicts the occupational stress among study subjects who were smokers and visited the dental care unit at Panchkula district, Haryana. The level of stress is directly proportional to age, as the age advances the level of stress also increases. The higher level of stress was reported among the age group of 55 years and above. A statistically significant difference was observed among married and unmarried subjects with unmarried individuals showing higher level of stress (p<0.001). 84.6% of subjects who were unmarried had more stress than married subjects (47.9%). Considering the educational status, higher level of stress was found among those who were 12th Grade qualified (86.4%) than the subjects who were graduates (72.1%) follo-wed by the subjects who were Post-graduates (48.6%). Based on the official status, the higher level of stress was reported among constables (77.4%) as compared to officers (62.5%) and head constables (62.1%). Out of 138 subjects (85.5%) who smoked more than 5 cigaret-tes per day had stress. Subjects who visited a religious place less than once a week were having higher level of stress (77.3%).

Table 1. Distribution of study subjects by occupational stress

VariablesNo stress Stress

χ2 P-valueTotaln (%)n % n %

Age groups (years)18 - 24 14 63.6 8 36.4

8.57 0.001*

22 (11)25 - 34 37 39.4 57 60.6 94 (47)35 - 44 8 22.3 28 77.7 36 (18)45 - 54 6 16.7 30 83.3 36 (18)

55 & above 1 8.3 11 91.7 12 (6)Marital status

married 50 52.1 46 47.930.4 0.011*

96 (48)unmarried 16 15.4 88 84.6 104 (52)

Educational qualification12th Grade Qualified 6 13.6 38 86.4

19.2 0.05*44 (22)

Graduates 24 27.9 62 72.1 86 (43)Post- Graduates 36 51.4 34 48.6 70 (35)

Official statusConstables 14 22.6 48 77.4

4.41 0.35362 (31)

Head constables 22 37.9 36 62.1 58 (29)Officers 30 37.5 50 62.5 80 (40)

Frequency of smoking

>5 cigarettes/day 20 14.5 118 85.5 69.0 0.031*

138 (69)

<5 cigarettes/day 46 74.2 16 25.8 62 (31)Religious attendance

<Once a week 29 22.7 99 77.317.2 0.022*

128 (64)> Once a week 37 51.4 35 48.6 72 (36)

Total 66 33.0 134 67.0 200 (100)Test applied: Chi-square test, *indicates statistically significant difference.


Table 2 depicts the level of nicotine dependence among study subjects. The level of nicotine depen-dence is directly proportional to age as the nicotine dependence increases with the increase in age. The high level of nicotine dependence was reported among the age group of 35-44 years and 45-54 years. Considering the marital status, a statistically significant difference was observed among married and unmarried subjects with high level of nicotine dependence (8.6%) among unmarried. Based on the educational qualification, the high level of nicotine dependence (13.6%) was seen among the subjects who qualified in Grade 12 followed by graduates and post-graduates. Based on the official status, constables (12.9%) and head constables (10.3%) had high level of nicotine dependence.

A statistically significant difference was seen among the subjects who visited the religious place less than once a week and more than once a week regarding alcohol and smoking use.

Table 3 shows the results of multiple logistic regres-sion analysis which reveals the significant association of level of nicotine dependence and frequency of smoking with occupational stress. Those with occupational stress had greater nicotine dependence and more frequent habit of smoking.

Table 2. Level of nicotine dependence among study subjects

VariablesLevel of nicotine dependence, n (%)

χ2 p-valueVery low/Low (0-4)

Medium (5)

High / Very high (6-10)

Age groups (years)18 - 24 14 (63.6) 8 (36.4) 0 (0.0)

37.7 0.001*

25 - 34 21(22.3) 71 (75.6) 2 (2.1)35 - 44 10 (27.8) 23 (63.9) 3 (8.3)45 - 54 5 (13.9) 25 (69.4) 6 (16.7)

55 & above 0 (0.0) 9 (75.0) 3 (25.0)

Marital statusUnmarried* 14 (13.5) 81 (77.9) 9 (8.6)

15.5 0.001* Married 36 (37.5) 55 (57.3) 5 (5.2)

Educational qualificationGrade 12 Qualified 2 (4.6) 36 (81.8) 6 (13.6)

29.9 0.001*Graduates 16 (18.6) 64 (74.4) 6 (7.0)Post-graduates 32 (45.7) 36 (51.4) 2 (2.9)

Official statusConstables 2 (3.2) 52 (83.9) 8 (12.9)

68.2 0.001*Head constables 4 (6.9) 48 (82.8) 6 (10.3)Officers 44 (55.0) 36 (45.0) 0 (0.0)

Occupational stress (E/R>1)Stress (E/R>1) 26 (19.4) 96 (71.6) 12 (9.0)

8.10 0.017*Without stress 24 (36.4) 40 (60.6) 2 (3.0)

Frequency of smoking>5 cigarettes/day 13(9.4) 111(80.5) 14 (10.1)

59.6 0.001*<5 cigarettes/day 37(59.4) 25(40.3) 14 (7.0)

Total 50 (25.0) 136 (68.0) 14 (7.0)*Unmarried refers to being single or ever married but divorced or separated.Test applied: Chi square test, *indicates statistically significant difference.

Table 3. Odds ratio (OR) and 95% confidence interval (CI) for occupational stress according to multiple logistic regression

Independent variables Occupational stressOR (95% CI)

Age group: < 30 years / > 30 years

0.150 (0.110-1.595)

Marital status: unmarried/married

2.510 (1.764- 12.277)

Educational status: Grade 12 / Graduate and above

1.511 (0.083-1.584)

Occupational status constable / officers

3.789 (2.533- 35.604)

Frequency of smoking : <5/>5 0.816* (0.613- 2.513)

Level of nicotine dependence: low or medium / high

1.287* (0.89-2.345)

Religious attendance: Yes / No

0.544(0.213-1.445)

* indicates statistically significant difference

DISCUSSION

Stress is an important factor influencing the efficacy and satisfaction of individual in modern day occupa-tional settings. This study investigates the influence

Occupational stress and nicotine dependence in dental care patients. 73No 1

of occupational stress factors on nicotine dependence among patients visiting dental care unit of ITBP For-ce station, Panchkula, District Haryana. In our study highest level of work stress was found among the age group of 55 years and above which is consistent with the study done by Gershon et al. [5] who found that the most important risk factors associated with perceived work stress among police officers in the US aged ≥50 years were maladaptive coping behaviours (e.g. excessive drinking or problem gambling) and exposure to critical incidents (e.g. shooting).

Rank also impacted significantly on the experien-ce of occupational stress. Constables (compared with other ranks) more frequently experienced stress because of job demands, crime-related stressors and lack of support. Furthermore, the fact that members with the rank of Inspector or higher less frequently experienced crime-related stress than constables can be explained by the fact that they are less involved with operational work [6].

In our study, the higher level of stress was found among the subjects who were unmarried as compared to married subjects. Increased stress levels associated with increased working hours indicate an area where stress awareness and management training may able to target with good impact [14].

In our study, the percentages of participants who smoked the first cigarette within 30 minutes after they woke up (71%) and participants reluctant to give up first cigarette in the morning (55.2%) were also higher than those of general population which is in consistent with the study done by Wang et al. [25] with 75% participants who smoked first cigarette within 30 minutes and 52.8% participants who were reluctant to give up first cigarette.

It was found in the present study that level of nico-tine dependence increases as the age increases. Level of nicotine dependence was found to be directly pro-portional to the age of the participants [18].

In the present study it was found that subjects who were highly qualified tends to show less nicotine de-pendence. Higher level of education was a protective factor against nicotine dependence may be explained by the fact that those with a higher level of education are aware of the risks of smoking and belong to the group of people among whom smoking is less common [21].

In the present study, subjects who were unmarried reported higher level of nicotine dependence than mar-ried individuals. A possible explanation for the finding that being married is a protective factor against nicotine dependence is the fact that people who are in relation-ship tend to take more care of each other [4].

The findings our study reported that being religious is a protective factor against nicotine dependence. The-se findings correspond to those of Blay et al. [3], who found that those who visited church regularly reduced

the odds of being a tobacco user by 51%. Our findings were in line with the other military international stu-dies. McLaughlin et al. [16], evaluated outpatients at a military medical center and found that compared to the general US population, a higher percentage of military outpatients attends religious services once a week or more, which was also found in our study. Fontana and Rosenheck [8] also evaluated military veterans and found that religious faith was an important predictor of mental health services use. It is therefore possible to assert that religious affiliation is associated with the decrease in frequency of tobacco consumption.

The limitations of this study include cross-sectional design, small sample size and use of self- administe-red questionnaires which could be biased as there are probability that the individuals over or under estimate their responses. Social desirability also seemed to play a major role in the response behaviour of the participants. The number of independent variables studied for their association with nicotine dependence had to be limited. An excess of parameters in the data would have lead to unstable regression coefficient estimates.

Finally, although several possible confounding factors were controlled in the analyses, there are other important factors that we were not able to take into account in this study. For, example many work related factors such as smoking behaviour among colleagues can also have an effect on the relation between work stress and smoking.

CONCLUSIONS

The findings of our study reported that not being religious, and being unmarried and having a lower level of education are significant risk factors for ni-cotine dependence. This study suggests an association between occupational stress and nicotine dependence and implies that smoking cessation programmes may benefit from taking into account the modification of stressful condition of work environment.


REFERENCES

1. Batra A.: Biological and psychosocial determinants of tobacco dependence and potential treatment options. Darmstadt: Steinkopff; 2000.

2. Batra V., Patkar A.A., Berrettini W.H., Weinstein S.P., Leone F.T.: The genetic determinants of smoking. Chest 2003;123:1730-1739.

3. Blay S.L., Batista A.D., Andreoli S.B., Gastal F.L.: The relationship between religiosity and tobacco, alcohol


use, and depression in an elderly community population. American J Geriatr Psychiatry 2008;16:934-943.

4. Broms U., Silventoinen K., Lahelma E., Koskenvuo M., Kaprio J.: Smoking cessation by socioeconomic status and marital status: The contribution of smoking behaviour and family background. Nicotine Tob Res 2003;6:447-455.

5. Collins P.A., Gibbs A.C.C.: Stress in police officers: a study of the origins, prevalence and severity of stress--related symptoms within a county police force. Occup Med 2003;53:256-264.

6. Channa S.M., Gururaj G., Chaturvedi S.K., Prabha.S.C.: Occupational stress and mental health of Police Personnel in India. New Delhi: NIMHANS publication; 1996.

7. Danaei G., Ding E.L., Mozaffarian D., Taylor B., Rehm J., Murray C.J.L., Ezzati M.: The Preventable causes of death in the United States: comparative risk assessment of dietary, lifestyle, and metabolic risk factors. PLoS Med 2009;6:e1000058.

8. Fontana A., Rosenheck R.: Trauma, change in strength of religious faith, and mental health service use among ve-terans treated for PTSD. J Nerv Ment Dis 2004;192:579-584.

9. Government of India. Report of the Expert Committee on the Economics of Tobacco. New Delhi: Ministry of Health and Family Planning (MOHFW); 2001.

10. Government of India. The Cigarettes and Other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distri-bution) Act, and rules framed there under; 2003.

11. Heatherton T.F., Kozlowski L.T., Frecker R.C., Fager-strom K.L.: The Fagerstrom Test for Nicotine Dependen-ce: a revision of the Fagerstrom Tolerance Questionnaire. Br J Addict 1991;86:1119-1127.

12. Hourani L.L., Yuan H., Bray R.M., Vincus A.A.: Psycho-social correlates of nicotine dependence among men and women in the U.S. Naval services. Addictive Behaviors 1999;24:521-536.

13. Inoue T.: Cigarette smoking as a risk factor of coronary artery disease and its effects on platelet function. Tob Induc Dis 2004;2:27-33.

14. Kim,G.S., Cho W.J., Lee C.Y.: The Relationship of work Stress and Family Stress to the Self- Rated Health of Women Employed in the Industrial sector in Korea. Public Health Nursing 2005;22:389-397.

15. Kouvonen A., Kivimäki M., Virtanen M., Pentti J., Vahtera J.: Work stress, smoking status, and smoking intensity: an observational study of 46,190 employees. J Epidemiol Community Health 2005;59:63-69.

16. McLaughlin S.S., McLaughlin A.D., Slyke J.A.: Faith and religious beliefs in an outpatient military population, Southern Medical Journal 2010;103:527-531.

17. Mokdad A.H., Marks J.S., Stroup D.F., Gerberding J.D.: Actual causes of death in the United States, 2000. JAMA 2004;291:1238-1245.

18. Ota A., Yasuda N., Okamoto Y., Kobayashi Y., Sugihara Y., Koda S., Kawakami N., Ohara H.: Relationship of job stress with nicotine dependence of smokers - a cross sectional study of female nurses in a general hospital. J Occup Health 2004;46:220-224

19. Peter R.: Berufliche Gratifikationskrisen und Gesundheit [Effort-reward imbalance and ill health]. Physiotherapeut 2002;47:386-398.

20. Rödel A., Siegrist J., Hessel A., Brähler E.: Fragebogen zur Messung beruflicher Gratifikationskrisen. Psycho-metric test of the questionnaire measuring effort-reward imbalance at work in a representative German sample. Zeitschrift für Differentielle und Diagnostische Psycho-logie 2004;25:277-238.

21. Rutten F.L.J., Augustson E.M., Moser R.P., Burke B.E., Hesse B.W.: Smoking knowledge and behaviour in the United States: Sociodemographic, smoking status, and geographic patterns. Nicotine Tob Res 2008;10:1559-1570.

22. Schnoll R.A., Rothman R.L., Wielt D.B.: A Randomized Pilot Study of Cognitive-Behavioral Therapy Versus Basic Health Education for Smoking Cessation Among Cancer Patients. Ann Behav Med 2005;30:1–11.

23. Schwarzer R.: Psychologie des Gesundheitsverhaltens. The Psychology of Health Behaviour. 2nd ed. Göttingen: Hogrefe; 1996.

24. Siegrist J., Rödel A.: Work stress and health risk behavior. Scand J Work Environ Health 2006;32:473-48.

25. Wang Z., Bao Y., Yans S., Lian Z., Jia Z., Liu Z.: An In-vestigation of cigarettes smoking behavior and nicotine dependence among Chinese methamphetamine users in two Provinces. Biomed Res Int 2014;2014:175205.




*Corresponding author: Ewelina Wawryk-Gawda, Chair and Department of Histology and Embryology with Experimental Cytology Unit, Medical University of Lublin, Radziwiłłowska street 11, 20-080 Lublin, Poland, phone: +48 81448 6156, e-mail: [email protected]


ORIGINAL ARTICLE

TOBACCO SMOKERS AND ELECTRONIC CIGARETTES USERS AMONG POLISH UNIVERSITIES STUDENTS

Michał K. Zarobkiewicz1, Ewelina Wawryk-Gawda1*, Mateusz M. Woźniakowski1, Mirosław A. Sławiński1, Barbara Jodłowska-Jędrych1

1Chair and Department of Histology and Embryology with Experimental Cytology Unit, Medical University of Lublin, Radziwiłłowska Street 11, 20-080 Lublin, Poland

ABSTRACTBackground. Electronic cigarettes (e-cigarettes) are small battery-powered electronic devices, heating the liquid to produce vapour – in most cases the latter contains nicotine and several flavourings. E-cigarettes are highly advertised across the media, mainly as healthy substitute to conventional cigarettes, aid in quitting smoking addiction or way of circumventing ban on smoking in public places. Objective. The aim of study was obtaining epidemiological data on cigarette smoking and electronic cigarette usage among Polish universities students.Material and methods. Students of different Polish state universities were asked to fill a self-prepared survey on cigarette-smoking and electronic cigarette usage. 1068 fulfilled questionnaires were gathered. The population was divided into two subgroups – medical universities’ students (n=545) and non-medical universities students (n=523). Results. 23.78% of respondents declared current smoking while 57.0% admitted ever smoking. The mean duration of smoking among current smokers was 4.17 ± 2.53 years. 56.30% of current smokers tried quitting at least once. 31.46% of students declared ever using e-cigarettes (37.28% (n=195) among non-medical universities’ students and 25.87% (n=141) among medical universities’ students and 8.33% current usage. Among the latter 52.81% admitted simultaneous smoking. 26.97% of current e-cigarettes’ users declared having experienced side effects of e-cigarettes. 42.70% (n=456) of respondents viewed e-cigarettes as safer than conventional cigarettes, this group comprises of 40.54% (n=212) non-medical and 44.77% (n=244) medical universities’ students. 85.39% (n=912) of students viewed e-cigarettes as generally unhealthy, there were 83.56% (n=437) non-medical and 87.16% (n=475) medical universities’ students among this group.Conclusions. The frequency of e-cigarettes usage resembles current status in many Western countries. Collected data shows high frequency of e-cigarettes usage and conventional cigarettes smoking among students (also medical universities’ stu-dents). The situation requires intensive preventive measures to limit and reduce the popularity of tobacco products along with modern equivalents like electronic cigarettes.

Key words: electronic cigarettes, e-cigarettes, smoking, smoking cessation, nicotine dependence, university students

STRESZCZENIEWprowadzenie. Elektroniczne papierosy (e-papierosy) są niewielkimi urządzeniami elektronicznymi, zasilanymi bateriami. Po ogrzaniu płynu zawartego w papierosie utworzona zostaje para, zawierającą określona ilość nikotyny i substancji zapa-chowych. E-papierosy są szeroko reklamowane na całym świecie, najczęściej jako zdrowsza alternatywa dla tradycyjnych papierosów, pomoc w rzucaniu nałogu tytoniowego lub sposób na ominięcie zakazu palenia w miejscach publicznych.Cel. Celem badania było uzyskanie danych epidemiologicznych dotyczących palenia papierosów oraz używania e-papie-rosów przez studentów polskich publicznych uczelni wyższych.Materiał i metody. Studenci wielu polskich publicznych uczelni wyższych zostali poproszeni o wypełnienie autorskiego formularza ankietowego na temat palenia papierosów oraz użytkowania e-papierosów. Do analizy użyto 1068 prawidłowo wypełnionych formularzy ankiety. Grupa respondentów została podzielona na dwie podgrupy – studentów uniwersytetów medycznych (n=545) oraz niemedycznych (n=523).Wyniki. Wśród ankietowanych 23.78% zadeklarowało aktywne palenie w momencie wypełniania ankiety, 57.0% przyznało się do palenia papierosów kiedykolwiek w przeszłości. Średnia długość nałogu obecnych palaczy wynosi 4.17 ± 2.53 lat.

M.K. Zarobkiewicz, E. Wawryk-Gawda, M.M. Woźniakowski et al.76 No 1

56.30% obecnych palaczy próbowało przynajmniej raz rzucić nałóg. 31.46% ankietowanych deklarowało użycie e-papie-rosów przynajmniej jeden raz. Wśród nich 37.28% (n=195) stanowili studenci uczelni niemedycznych i 25.87% (n=141) studenci uczelni medycznych. 8.33% badanych używa ich obecnie, pośród nich 52.81% zadeklarowało jednoczasowe palenie tradycyjnych papierosów. 26.97% obecnych użytkowników e-papierosów deklarowało odczuwanie przynajmniej raz skutków ubocznych korzystania z tych urządzeń. 42.70% (n=456) badanych uważa e-papierosy za bezpieczniejsze dla zdrowia od tradycyjnych papierosów, na tą grupę przypada 40.54% (n=212) studentów uczelni niemedycznych oraz 44.77% (n=244) medycznych. 85.39% ankietowanych (n=912) uważa e-papierosy za niekorzystne dla zdrowia, z czego 83.56% (n=437) to studenci uczelni niemedycznych i 87.16% (n=475) medycznych.Wnioski. Odsetek populacji polskich studentów używających e-papierosy jest zbliżony do wyników uzyskanych przez badaczy w wielu krajach zachodnich. Dane te wskazują na częste używanie e-papierosów i papierosów tradycyjnych wśród studentów, w tym także studentów uczelni medycznych. Wymagają one podjęcia intensywnych działań prewencyjnych, ukierunkowanych na ograniczenie popularności wyrobów tytoniowych oraz ich nowoczesnych odpowiedników.

Słowa kluczowe: elektroniczne papierosy, e-papierosy, palenie, rzucanie palenia, uzależnienie od nikotyny, studenci

INTRODUCTION

In 1912 German physician and researcher Isaac Adler published his monograph on lung cancer, stating that its incidence is constantly growing and connecting this with tobacco and alcohol abuse as possible causes [1]. Since then numerous articles on health risks related to cigarette smoking as well as its epidemiology have been published and therefore it is well established how harmful cigarettes are. Since more than 10 years we face a new problem connected to the nicotine addiction – electronic cigarettes (e-cigarettes). These are small battery-powered electronic devices, composed of atomi-zer, liquid-filled tank, mouthpiece and casing. Heating element (primary part of atomizer) is responsible for creating vapour from the liquid that is to be inhaled or hold in mouth by the user. E-cigarettes are highly advertised across the media, mainly as healthy substi-tute to conventional cigarettes, aid in quitting smoking addiction or way of circumventing ban on smoking in public places [3, 13, 19]. The expenditures on adverts are even rising – from 6.4m USD in 2011 to 18.3m USD in 2012 in the USA [15] and from 1.7m GBP in 2010 to 13.1m GBP in 2012 in the UK [3]. With growing popularity, according to Action on Smoking and Health currently about 2.6 million people in United Kingdom use e-cigarettes even special term for e-cigarettes’ usage was created: vaping [5]. The popularity of e-cigarettes raises questions about their safety as well as shows a need for both experimental and epidemiological studies. In a 2014 survey study consisting of 821 young (16-17 yrs) Irish 23.8% admitted to ever use e-cigarettes [6]. In 2012 a survey was conducted in Great Britain on 3538 current and 579 ex-smokers and revealed that about one fifth is currently using and about one third has ever used e-cigarettes. The three most popular reasons for e-cigarettes’ usage were health concerns, cutting down and quitting smoking [10]. In another survey based

study Brose et al. revealed that daily use of e-cigarettes correlated with frequency of quitting attempts but not with successful cessations [9].

In our study we investigated conventional and electronic cigarettes usage among Polish universities’ students to explore the epidemiology of e-cigarettes’ usage and cigarette smoking as well as associated fac-tors. Currently only very limited data on the usage of e-cigarettes is available.


A self-prepared online questionnaire composed of 32 questions about usage and knowledge about e--cigarettes was presented to students of various Polish universities. Data was collected from March to June 2015. Respondents were asked to fulfil the forms via Facebook groups associated with their studies. The stu-dy was anonymous and voluntary. Respondents received no financial gratification for their effort. 1068 people correctly completed the survey. The group was further divided into medical universities students (n=545) and non-medical universities students (n=523), the latter group consists of all Polish state universities (except medical) and polytechnics. Average age of respondent was 21.72 ± 2.10 yrs. (minimum: 18 yrs., maximum: 39 yrs., median: 21 yrs.), women comprise 75.00% (n=801) while men 25.00% (n=267).

Respondents were asked about their current status in terms of tobacco smoking and e-cigarettes usage as well as the former and the latter in the past. The group of ever smokers had additional questions about quitting: reasons, frequency, aids and smoking history: duration, number of cigarettes smoked a day. At the end of the survey the respondents answered questions on their attitude towards smoking and e-cigarettes usage in public places.

Tobacco and electronic cigarettes smokers among students. 77No 1

Statistical analysisCollected statistical data was analysed with Stati-

stica 10 Software (StatSoft, USA). The level of signifi-cance was set at p<0.05 and calculated using Pearson’s Chi2 test (for current smokers, people who ever tried smoking, smoking occasions, quitting aids, quitting reasons, e-cigarettes’ usage), U Mann-Whitney’s test (for smoking duration, quitting frequency, e-cigarettes’ safety, e-cigarettes’ usage in public).

RESULTS

Demography31.18% (n=333) of respondents came from villages,

25.84% (n=276) from cities with more than 250,000 inhabitants, the rest from towns and smaller cities. Re-spondents came from 51 Polish state universities and polytechnics. About 50% of respondents comprises of students of six Polish high schools - Medical University of Lublin, Warsaw Medical University, Medical Uni-versity of Białystok, Nicolaus Copernicus University (Toruń), Maria Curie-Skłodowska University (Lublin) and John Paul II Catholic University of Lublin.

Cigarette-smoking57.30% (n=612) admitted having ever smoked ciga-

rettes, this number comprises of 62.90% of non-medical universities’ students (n=329) and 51.93% of medical universities’ students (n=283). The statistically impor-tant difference of e-cigarettes usage between students of medical and non-medical universities was observed with p=0.00029. 23.78% (n=254) of respondents dec-lared smoking currently – this comprises of 30.02% of non-medical universities’ students (n=157) and 17.80%

(n=97) medical universities’ students (p=0.00000). Mean duration of smoking habit among the whole group was 4.17 ± 2.53 years, among non-medical universities’ students: 4.27 ± 2.49 years, among medical universities’ students: 4.00 ± 2.59 years (p=0.31). The most common occasions for cigarettes’ smoking among tested students are: party (n=210), stressful moments (n=169), hang-out with friends (n=166), breaks between classes (n=152), on morning (n=79), before going to bed (n=71), during conversation (n=60). The difference between medical and non-medical universities’ students was not statisti-cally relevant (p>0.05).

Quitting smoking56.30% (n=143) of current smokers tried quitting

at least once, 31.10% (n=79) have not tried, but is plan-ning to, 11.42% (n=29) have not tried nor is planning to, 3 people had omitted this question. Comparison of quitting frequency between medical and non-medical universities’ students is listed in Table 1. The most com-mon aid for quitting smoking was progressive reduction of cigarettes’ number smoked daily (n=108). Others were at most half as popular: switching to e-cigarettes (n=51), physical activity (n=43), pharmaceutical aid (n=31), relatives and friends support (n=26), meditation (n=6). No statistically significant difference between two tested groups was observed (p>0.05). Quitting re-asons chosen by current smokers in their past attempts are listed in Table 2.

E-cigarettes’ usage31.46% (n=336) of respondents admitted having

ever used e-cigarettes, 37.28% (n=195) among non-me-dical universities’ students and 25.87% (n=141) among medical universities’ students (p=0.00006). 8.33%

Table 1. Frequency of quitting attempts - differences among groups

Total Non-medical universities' students

Medical universities' students

p value (U Mann-Whitney’s test)

Only once 44 28 (18.06%) 16 (16.67%)

0.9602More than once 99 60 (38.71%) 39 (40.63%)Not even once but is planning to 79 49 (31.61%) 30 (31.25%)Not even once and is not planning to 29 18 (11.61%) 11 (11.46%)

In brackets: percentage of medical/non-medical universities’ students (smokers) who chose this answer.

Table 2. Reasons for quitting chosen by current smokers

Total Non-medical universities' students


p value (Pearson’s Chi2 test)

Health issues 116 63 (40.13%) 53 (54.64%) 0.0240Aesthetic reasons 73 44 (28.03%) 29 (29.90%) 0.7488Somebody's influence 28 17 (10.83%) 11 (11.34%) 0.8992Social advert in media 2 0 (0.00%) 2 (2.06%) 0.0709Financial reasons 108 66 (42.04%) 42 (43.30%) 0.8435Other 45 28 (17.83%) 17 (17.53%) 0.9501

In brackets: percentage of medical/non-medical universities’ students (smokers) who chose this answer. Bold: correlation statistically significant.


(n=89) declared current usage of e-cigarettes: 12.43% (n=65) among non-medical universities’ students and 4.40% (n=24) among medical universities students (p<0.00001). 93.26% (n=83) of current e-cigarettes’ users admitted having ever smoked conventional ci-garettes, 6.74% (n=6) of these users have not smoked conventional cigarettes before (p<0.00001). 52.81% (n=47) of current e-cigarettes’ users simultaneously smoke conventional cigarettes, this number make up 18.50% of smokers. Occasions for e-cigarettes’ usage are listed in Table 3.

E-cigarettes’ safety and public usage26.97% (n=24) of current e-cigarettes’ users had

experienced side effects of e-cigarettes, most frequently mentioned (listed according to frequency): headache, mucous membranes dryness, nausea, cough, dyspno-ea, sore throat, vertigo. 42.70% (n=456) considered e-cigarettes as safer than conventional cigarettes, this group comprises of 40.54% (n=212) of non-medical and 44.77% (n=244) of medical universities’ students (p=0.4012). 85.39% (n=912) of respondents believed e-cigarettes are generally unhealthy, there were 83.56% (n=437) non-medical and 87.16% (n=475) medical universities’ students among this group (p=0.0848). 47.28% (n=505) stand for ban on e-cigarettes’ usage in public places (44.93% (n=235) non-medical and 49.54% (n=270) medical universities’ students, (p=0.0173)). Respondent’s opinion on e-cigarettes’ usage in public places is listed in Table 4.

DISCUSSION

Despite numerous research on tobacco smoking and nicotine addiction new questions still emerge. New form of delivery has been implemented: e-cigarette and as it is relatively new matter a lot of gaps in knowled-ge needs to be filled, alongside with epidemiological studies on e-cigarettes’ usage in different populations. The danger related to tobacco smoking is well known since decades, unfortunately e-cigarettes’ influence on human health has not been so comprehensively studied. Although they are considered safer, it is not fully legi-timated by scientific research. It should be therefore positively seen that most of respondents do not fully trust e-cigarettes and believes that although they may be safer than conventional cigarettes they still establish danger to human health. The safety of electronic ci-garettes would be hard to establish firmly as there are dozens of different liquid with different additives. Bahl et al. [7] has tested 41 liquids for their cytotoxicity on cell lines and concluded that it depends mostly on used flavourings and can range from none to well-marked. Romagna et al. [18] compared cytotoxicity of e-ciga-rettes and conventional cigarettes vapour on cell lines, the results showed significantly lesser cytotoxicity of electronic cigarettes’ vapour, although it was still present, the latter results were later acknowledged by Farsalinos et al. [11].

Percentage of e-cigarettes’ users among students of Polish universities is currently low, we can howe-ver assume that it will grow over time, mainly due to increasing marketing and advertising of e-cigarettes’. White et al. [23] compared rate of e-cigarettes ever-use among New Zealand adolescents in 2010 and 2014 and

Table 3. Occasions for e-cigarettes’ usage listed by total number of current users who chose them.

Occasion Total Non-medical universities' students


p value (Pearson’s Chi2 test)

Party 53 39 (60.00%) 14 (58.33%) 0.8869Stressful moments 50 35 (53.85%) 15 (62.50%) 0.4653Hang-out with friends 54 43 (66.15%) 11 (45.83%) 0.0816Breaks between classes 46 36 (55.38%) 10 (41.67%) 0.2504On morning 42 32 (49.23%) 10 (41.67%) 0.5258Before going to bed 52 41 (63.08%) 11 (45.83%) 0.1430During conversation 45 34 (52.31%) 11 (45.83%) 0.5877

In brackets: percentage of medical/non-medical universities’ students (e-cigarettes’ users) who chose this answer.

Table 4. Opinion on e-cigarette’s usage in public places

Opinion Total Non-medical universities' students


p value (U Mann-Whitney’s test)

Definitely positive 22 15 (2.87%) 7 (1.28%)

0.0341Rather positive 47 23 (4.40%) 24 (4.40%)Neutral 560 292 (55.83%) 268 (49.17%)Rather negative 321 146 (27.92%) 175 (32.11%)Definitely negative 118 47 (8.99%) 71 (13.03%)

In brackets: percentage of medical/non-medical universities’ students (e-cigarettes’ users) who chose this answer.

Tobacco and electronic cigarettes smokers among students. 79No 1

found it tripled. Babineau et al. [6] studied e-cigarettes’ usage among youth in Ireland (aged 16-17 years) with similar results in terms of percentage of people who ever tried e-cigarettes but more than twice lower percentage of current users. Saddleson et al. [20] in a sample of American college students revealed almost twice higher percentage of current e-cigarettes’ users and slightly higher ever-use rate.

As the safety and long term risk related to e-ciga-rettes is not verified similar security measures should be applied to marketing, sales and usage of them as to conventional cigarettes. Blaser et al. [8] asked 40 Swiss experts about their opinion on e-cigarettes’ legislation. The consensus was found: the e-cigarettes’ should be available on market, but should be sold only to adults, advertising should be strictly limited and usage pro-hibited everywhere where smoking is illegal. Almost 25% of active smokers in young and educated popu-lation must be seen as highly inappropriate. Although different studies from Europe and USA [4, 14] shows similar results still there are studies showing much lower rates of smoking [2, 16]. Polish epidemiological studies reveals even worse situation as Piotrowska et al. [17] reported almost 50% of girls aged 16-18 years to be active smokers (32% daily). Comparable smoking rate was noted among students of one of Polish life sciences universities with 27% of women and 40% of men smoking [21]. On the other hand only 10% of stu-dents of another Polish life sciences university reported active smoking at the time the survey took place [12], comparable results were obtained by Sygit [22] with almost 16% of boys and 11% of girls aged 15-19 years from rural areas admitted to active smoking. Before mentioned difference can be attributed to slightly youn-ger population included in those two studies (both had respondents between 10 and 20 years old). The problem of tobacco smoking should not be left and needs to be addressed as soon as possible. As our study revealed there are two main reasons for quitting – financial and health issues – therefore educational program about health risk associated with smoking should be imple-mented as well as further increase in price of cigarettes with illegal tobacco market fighting are needed.

CONCLUSIONS

Cigarettes and e-cigarettes are popular among students of different Polish universities and therefore a long term effort should be planned to improve the situ-ation and prevent increase in e-cigarettes’ popularity, especially among adolescents. The study proved that the knowledge of health risk related to smoking is not enough to prevent people from smoking and therefore legal regulations should be implemented, especially

regarding usage of e-cigarettes in public places as well as among youth.

Conflict of interestThe authors declare that there is no conflict of interests regarding the publication of this paper.

REFERENCES

1. Adler I.: Primary Malignant Growths of the Lungs and Bronchi. London: Longmans, Green, and Company; 1912.

2. Albayrak S., Ergun A.: Smoking and Desire to Quit Smoking Behavior in a Sample of Turkish Adolescents. J Addict Nurs 2015;26(1):41-46.

3. Andrade de M., Hastings G., Angus K.: Promotion of electronic cigarettes: tobacco marketing reinvented? BMJ 2013 Dec 21;347(dec20 1):f7473-f7473.

4. Arrazola R.A., Singh T., Corey C.G., Husten C.G., Neff L.J., Apelberg B.J., Bunnell R.E., Choiniere C.J., King B.A.,Cox S., McAfee T., Caraballo R.S., Centers for Disease Control and Prevention (CDC): Tobacco use among middle and high school students – United States, 2011-2014. MMWR Morb Mortal Wkly Rep 2015;64(14):381–385.

5. ASH: Use of electronic cigarettes in Great Britain. Available from: http://www.ash.org.uk/files/documents/ASH_891.pdf (accessed 26.06.2015).

6. Babineau K., Taylor K., Clancy L.: Electronic Cigarette Use among Irish Youth: A Cross Sectional Study of Prevalence and Associated Factors. PLOS ONE. 2015 May 27;10(5):e0126419.

7. Bahl V., Lin S., Xu N., Davis B., Wang Y., Talbot P.: Comparison of electronic cigarette refill fluid cytotox-icity using embryonic and adult models. Reprod Toxicol 2012;34(4):529-537.

8. Blaser J., Cornuz J.: Experts’ consensus on use of elec-tronic cigarettes: a Delphi survey from Switzerland. BMJ Open 2015;5(4):e007197.

9. Brose L.S., Hitchman S.C., Brown J., West R., McNeill A.: Is the use of electronic cigarettes while smoking as-sociated with smoking cessation attempts, cessation and reduced cigarette consumption? A survey with a 1-year follow-up: E-cigarettes, cessation, attempts, reduction. Addiction 2015;110(7):1160-1168.

10. Brown J., West R., Beard E., Michie S., Shahab L., McNe-ill A.: Prevalence and characteristics of e-cigarette users in Great Britain: Findings from a general population survey of smokers. Addict Behav 2014;39(6):1120-1125.

11. Farsalinos K., Romagna G., Allifranchini E., Ripamonti E., Bocchietto E., Todeschi S., Tsiapras D., Kyrzopoulos S., Voudris V: Comparison of the cytotoxic potential of cigarette smoke and electronic cigarette vapour extract on cultured myocardial cells. Int J Environ Res Public Health 2013; 10(10):5146-5162.

12. Górnicka M., Pindral J., Hamulka J., Wawrzyniak A.: Ocena spożycia witamin antyoksydacyjnych przez stu-dentów SGGW w Warszawie. [Evaluation of antioxidant


vitamins intake by students of Warsaw University of Life Science] Rocz Panstw Zakl Hig 2011;62(4):396-402 (in Polish) [PMID: 22435294; http://www.ncbi.nlm.nih.gov/pubmed/22435294].

13. Grana R.A., Ling P.M.: Smoking revolution: a content analysis of electronic cigarette retail websites. Am J Prev Med 2014;46(4):395-403.

14. Ibisevic M., Avdic A., Osmanovic E., Kadric N., Avdic S.: Cigarette smoking among students at the University of Tuzla. Med Arch 2015;69(2):127-129.

15. Kim A.E., Arnold K.Y., Makarenko O.: E-cigarette Adver-tising Expenditures in the U.S., 2011–2012. Am J Prev Med 2014;46(4):409-412.

16. Obaid H.A., Hassan M.A., Mahdy N.H., ElDisouky M.I., Alzarba F.E., Alnayeemi S.R., Rillera M.C. Al Mazrooei B.S: Tobacco use and associated factors among school students in Dubai, 2010: intervention study. East Mediterr Health J 2015;20(12):765-773.

17. Piotrowska E., Żechałko-Czajkowska A., Biernat J., Mikołajczak J.: Ocena wybranych cech stylu życia ksz-tałtujących stan zdrowia 16-18 letnich dziewcząt. Cz. I. Stosowanie różnych diet, aktywność fizyczna, palenie papierosów i picie alkoholu [Assessment of selected features of the lifestyle being conduicive to the state of health of 16-18 year old girls. Part I. Dieting, physical ac-tivity, smoking and drinking alcohol]. Rocz Panstw Zakl Hig 2009;60(1):51-57 (in Polish) [PMID: 19579770; http://www.ncbi.nlm.nih.gov/pubmed/19579770].

18. Romagna G., Allifranchini E., Bocchietto E., Todeschi S., Esposito M., Farsalinos K.E.: Cytotoxicity evaluation of electronic cigarette vapor extract on cultured mammalian

fibroblasts (ClearStream-LIFE): comparison with tobac-co cigarette smoke extract. Inhal Toxicol 2013;25(6):354-361.

19. Rooke C., Amos A.: News media representations of elec-tronic cigarettes: an analysis of newspaper coverage in the UK and Scotland. Tob Control 2014;23(6):507-512.

20. Saddleson M.L., Kozlowski L.T., Giovino G.A., Hawk L.W., Murphy J.M., MacLean M.G., Goniewicz M.L., Homish G.G., Wrotniak B.H., Mahoney M.C.: Risky behaviors, e-cigarette use and susceptibility of use among college students. Drug Alcohol Depend 2015;149:25-30.

21. Seidler T., Szczuko M.: Ocena sposobu żywienia stu-dentów Akademii Rolniczej w Szczecinie w 2006 roku. Cz. III. Spożycie kawy, herbaty, alkoholu i palenie pa-pierosów [Nutrition mode evaluation among University of Agriculture students in Szczecin in 2006. Part III. Coffee, tea, alcohol, smoking]. Rocz Panstw Zakl Hig 2009;60(3):241-245 (in Polish) [PMID: 20063694; http://www.ncbi.nlm.nih.gov/pubmed/20063694].

22. Sygit K.: Wybrane zachowania ryzykowne dla zdrowia problemem współczesnej młodzieży ze środowiska wiej-skiego. Prz Med Uniw Rzesz Inst Leków 2015;13(2):153-164.

23. White J., Li J., Newcombe R., Walton D.: Tripling use of electronic cigarettes among new Zealand adolescents be-tween 2012 and 2014. J Adolesc Health 2015;56(5):522-528.




Corresponding author: Marzena Jeżewska-Zychowicz, Department of Organization and Consumption Economics, Faculty of Human Nutrition and Consumer Sciences, Warsaw University of Life Sciences (SGGW), Nowoursynowska street 159c, 02-766 Warsaw, Poland, Tel. +4822 5937131, Fax +4822 5937147, e-mail: [email protected]


ORIGINAL ARTICLE

IMPACT OF HEALTH AND NUTRITION RISKS PERCEPTION ON THE INTEREST IN PRO-HEALTHY FOOD ON THE EXAMPLE OF BREAD

Marzena Jeżewska-Zychowicz1*

1Department of Organization and Consumption Economics, Faculty of Human Nutrition and Consumer Sciences, Warsaw University of Life Sciences (SGGW), Warsaw, Poland

ABSTRACTBackground. Bread is a basic food product in the diet of a majority of people. It is a good source of energy and it is also abundant in carbohydrates. Simultaneously, because it is consumed on a large scale by Polish people, it provides large amounts of salt and some additives like preservative and raising agents. The perception of the risk influences the choice of food and impacts eating behaviors. However, it is still unknown if there is an impact of perceived risk on the choice and the consumption of bread.Objective. The objective of the research was to assess the importance of perceived health and nutrition risk in conditioning the willingness to buy bread with decreased amounts of salt and bread without preservative and raising agents.Material and methods. Empirical research was conducted in October 2014 in a group of 1.014 adult consumers, with the use of the method of interview. The questions covered the following issues: the frequency of white and wholemeal bread consumption, the willingness to consume bread with reduced salt content and one produced without the preservatives and raising agents, the self-assessment of health and socio-demographic characteristics of respondents. To evaluate the perceived health and nutrition risks modification of Health Concern Scale was used. Opinions on the tendency to purchase both kind of breads were compared taking into account socio-demographic characteristics, health risk, nutrition risk and frequency of eating white and wholemeal bread. To determine the differences ANOVA and Tukey post hoc test at the significance level of p <0.05 were used. The relations between variables were assessed using Pearson’s correlation coefficient.Results. There was a higher tendency to consume bread without preservatives and raising agents than with low salt content. Women, people over 55 years old, and people who often consume white bread were characterized by higher willingness to consume bread with reduced salt content. People with higher education, aged over 45 years, and those who rarely consumed wholemeal bread were more willing to eat bread without additives. The greater was the nutrition and health risk perceived by the person, the greater was the willingness to consume both types of bread.Conclusions. The importance of perceived risks in conditioning consumers’ willingness to eat healthy food shows that the educational campaigns informing about risky behaviors may promote behavioral change towards a more favorable food choice.

Key words: consumer, health risk, nutrition risk, consumer behaviors

STRESZCZENIEWprowadzenie. Pieczywo jest podstawowym produktem w diecie większości ludzi. Jest dobrym źródłem energii i węglo-wodanów. Jednocześnie z powodu dużej konsumpcji pieczywa w Polsce, dostarcza ono dużo soli i może zawierać różne dodatki technologiczne, w tym dodatki konserwujące oraz spulchniające. Percepcja ryzyka związanego ze sposobem żywienia i zdrowiem oddziałuje na wybór żywności, także wykazuje związek z zachowaniami żywieniowymi. Brakuje natomiast badań na temat wpływu postrzeganego ryzyka na wybór i konsumpcję pieczywa. Cel. Celem badania była ocena związku między postrzeganym ryzykiem zdrowotnym i żywieniowym a skłonnością do nabywania pieczywa o obniżonej zawartości soli oraz pieczywa bez dodatków konserwujących i spulchniających.Materiał i metody. Badanie empiryczne przeprowadzono w październiku 2014 roku w grupie 1014 dorosłych konsumen-tów z wykorzystaniem metody wywiadu. W pytaniach uwzględniono następujące kwestie: częstość spożywania jasnego i ciemnego pieczywa, zamiar spożywania pieczywa o obniżonej zawartości soli oraz pieczywa bez konserwantów i środków spulchniających, samoocenę zdrowia i cechy socjodemograficzne badanych. Do oceny odczuwanego ryzyka zdrowotnego i żywieniowego wykorzystano modyfikację Skali Troski o Zdrowie (Health Concern Scale). Opinie na temat skłonności do

M. Jeżewska-Zychowicz82 No 1

nabywania pieczywa przedstawiono w postaci wartości średniej i odchylenia standardowego, a następnie porównywano je po uwzględnieniu cech socjodemograficznych, ryzyka zdrowotnego i żywieniowego oraz częstości spożywania pieczywa jasnego i ciemnego. Do stwierdzenia różnic wykorzystano jednoczynnikową analizę wariancji oraz test post hoc Tukeya przy poziomie istotności p<0,05. Związek między zmiennymi oceniono za pomocą współczynnika korelacji Pearsona.Wyniki. Stwierdzono większą skłonność do spożywania pieczywa bez dodatków konserwujących i spulchniających niż z obniżoną zawartością soli. Kobiety, osoby w wieku powyżej 55 lat oraz osoby często spożywające pieczywo jasne cha-rakteryzowała większa skłonność do spożywania pieczywa o obniżonej zawartości soli. Osoby z wykształceniem wyższym, w wieku powyżej 45 lat oraz osoby rzadko spożywające pieczywo ciemne deklarowały większą skłonność do spożywania pieczywa bez dodatków. Im większe ryzyko żywieniowe i zdrowotne dostrzegały osoby, tym wykazywały większą skłonność do spożywania obydwu rodzajów pieczywa.Wnioski. Istotne znaczenie postrzeganego ryzyka żywieniowego i zdrowotnego w warunkowaniu gotowości konsumentów do spożywania żywności o podwyższonych walorach zdrowotnych pokazuje, że kampanie edukacyjne informujące o ryzy-kownych zachowaniach mogą skutecznie promować zmianę w kierunku wyboru żywności bardziej korzystnej dla zdrowia.

Słowa kluczowe: konsument, ryzyko zdrowotne, ryzyko żywieniowe, zachowania konsumenckie

INTRODUCTION

Consumers perceive greater extent of risks caused by external factors over which they have no control, than individual factors or ones associated with their behavior or lifestyle [25]. And so, diet related diseases which represent a relatively high risk in the assessment of consumers are not regarded as a significant source of danger. By contrast, new technologies used in food production, and diseases caused by the presence of che-mical substances are attributed greater risk than exists in reality. Consumers’ awareness of the links between health, nutrition, and food is an important factor in their perception of risk [17].

According to consumers the risks associated with the food product is one of the most important factors in food selection and consumption [5]. However, the per-ception of risk associated with the nutritional habits also impacts the food choices, especially the choice of food which is intended to limit the occurrence of the adverse consequences of incorrect diet. In addition, perceived risk is linked with dietary behavior, both favorable and not favorable to health [9]. However, strong correlation between perceived risks and benefits of one’s behavior is ascertained. Behaviors that provide many benefits are perceived as less risky and vice versa [7, 12].

Bread is a basic food product in the diet of a majority of people. Although it is an excellent source of energy and it is abundant in carbohydrates, it is characterized by a poor quantity and quality of proteins and in the case of white bread by a low content of dietary fiber. Simultaneously, due to large consumption among Polish population, it provides large amounts of salt and some additives like preservative and raising agents. Whereas is known that the perception of risk influences the choice of food and is also connected with eating behaviours, it is still unknown if the perceived risk has an impact on habits related to bread consumption.

The objective of the research was to assess the importance of perceived health and nutrition risk in conditioning the willingness to buy bread with decre-ased amounts of salt and bread without preservative and raising agents. Also socio-demographic characteristics and the frequency of eating white and wholemeal bread were included as differentiating variables.


Empirical research was conducted in October 2014 in a group of 1.014 adult consumers with the usage of computer assisted personal interview (CAPI). Selection of the sample from the sampling address of GUS met the requirement of representativeness of the Polish general population for people over 21 years old with respect to age, gender, and size of their place of residence. Only people meeting the criterion of recruitment, which was making their own food purchases or taking part in ma-king food purchases were qualified for the interview. The structure of the respondents is presented in Table. 1.

Respondents determined the frequency of consump-tion of white and wholemeal bread on a 7-point scale, where 1 - I do not know, 2 - never, 3 - 1–2 times a month, 4 - 1–2 times a week, 5 - 3–5 times a week, 6 - once a day, 7 - several times during the day. During the data analysis the answers were grouped into 3 categories, namely 1 - 1–2 times a month or less frequently; 2 - 1–5 times a week, 3 – once a day or more often.

The willingness of the respondents to consume the two kinds of bread, i.e. bread with reduced salt content and bread produced without the preservatives and raising agents, was determined on the 5-point scale, where 1 - no, 2 - rather no, 3 - neither yes nor so 4 - rather yes, 5 - yes.

In order to evaluate the perceived health risk some statements from the Health Concern Scale [15] and other concerning fiber issues were used, namely: “I am concerned about: 1/ gaining weight; 2/ risk for high

Health and nutrition risks perception. 83No 1

blood pressure, 3/ risk for coronary heart disease; 4/ getting digestive problems”. To evaluate the perceived nutrition risk three statements were utilized : “I am concerned about: 1/ getting many calories; 2/ getting too little fiber in my food; 3/ getting a lot of salt in my food”. The respondents expressed their opinions on these statements on the 5-point scale, where 1 - no, 2 - rather no, 3 - neither yes nor no, 4 - rather yes, 5 - yes.

The respondents assessed their health condition by selecting one of three answers: “I have no major health problems”; “Sometimes I experience minor ailments”; “I remain under the care of a doctor”.

The questionnaire also contains questions about socio-demographic characteristics of respondents, in-cluding gender, age, education, place of residence and opinion about their family’s income.

Statistical analysisOpinions on the willingness to consume both types

of bread were presented as the mean value and standard deviation. Then the mean values were compared taking into consideration gender, age, education, place of re-sidence and opinions about income.

In order to calculate the health risk index the sum of the ratings marked on the scales on the health risks was calculated (range: 4 - 20 points). Then using the tercile distribution intervals indicating low health risk (1st tercile -10 points or less), medium risk (2nd tercile - 11 - 13 points) and high health risks (3rd tercile - 14 points and more) were extracted. Similarly, the sum of the nutrition risk assessments was computed (range: 3 - 15 points) Intervals indicating nutrition risk were extracted: low (3 - 7 points), medium (8 - 10 points) and high nutrition risk (11 - 15 points).

The analysis of variance (ANOVA) and Tukey post hoc test at the significance level of p<0.05 were used to determine the differences between variables. The rela-

tions between variables were assessed using Pearson’s correlation coefficient. To perform statistical analysis IBM SPSS Statistics, version 22.0, was used.

RESULTS

The study participants were characterized by a hi-gher willingness to consume bread produced without the addition of preservatives or raising agents than bread with reduced salt content. The average scores ranging between ratings 3 (neither yes nor no) and 4 (rather yes) indicate a rather low interest in such proposals of modification of bread aiming at increasing its health values. Nevertheless, in the case of both products the large standard deviations reflect a large amount of variations in the group that is being studied (Table 2).

In the case of bread with decreased salt content women proved to be significantly more willing to consu-ming it than men. Moreover, people aged over 55 years were more willing to consume it compared with those aged under 35. Within the group aged 25 years and less the distributions of responses in relation to the mean were most polarized. People claiming that their family income is adequate for some needs were more willing to it such bread compared with those who acknowledged their income as insufficient. Participants’ education and their place of residence did not statistically differ mean values expressing willingness to consume bread with lower salt content (Table 2).

In the case of bread produced without the use of preservatives and raising agents respondents with higher education turned out to be significantly more prone to consuming it compared to other people, similarly parti-cipants aged over 45 years were more prone compared to those aged under 25 and same with those living in cities up to 100 thousand residents as compared with residents

Table 1. Socio-demographic characteristics of respondents (%)Socio-demographic characteristics Groups of respondents Numbers (%)

Genderfemale 552 54.4male 462 45.6

Place of residencerural area 373 36.8town below100 thousand inhabitants 314 31.0town above 100 thousand inhabitants 327 32.2

Educationlower than secondary 294 29.0secondary 465 45.9academic 255 25.1

Age

25 years and less 204 20.226 - 35 years 208 20.536 - 45 years 189 18.646 - 55 years 146 14.4more than 55 years 267 26.3

Opinion on incomeinsufficient 202 19.9sufficient for some needs 578 57.0sufficient for all needs 234 23.1


Table 2. Willingness to eat pro-healthy bread according to socio-demographic characteristics (mean value; standard devia-tion)

Socio-demographic characteristics Bread with decreased salt content Bread without addition of preservatives and raising agents

Total 3.4 ± 1.1 3.9 ± 1.1Genderfemalemale

3.6a ± 1.13.3a ± 1.2

4.0 ± 1.13.8 ± 1.1

Education lower than secondarysecondary academic

3.4 ± 1.23.4 ± 1.13.5 ± 1.1

3.9a ± 1.13.9b ± 1.14.1ab ± 1.0

Age25 years and less26 – 35 years36 – 45 years46 – 55 yearsMore than 55 years

3.3a ± 1.23.3b ± 1.23.5 ± 1.23.5 ± 1.1

3.7ab ± 1.0

3.7ab ± 1.23.9 ± 1.03.9 ± 1.14.0a ± 1.04.0b ± 1.0

Place of residencerural area town below100 thousand inhabitantstown above 100 thousand inhabitants

3.4 ± 1.23.5 ± 1.13.5 ± 1.2

3.8a ± 1.14.0a ± 1.13.9 ± 1.0

Opinion on incomeinsufficientsufficient for some needssufficient for all needs

3.3a ± 1.23.5a ± 1.13.4 ± 1.2

3.9 ± 1.23.9 ± 1.13.9 ± 1.0

x ± SD – mean value ± standard deviation (5-point scale, where 1 – no, 2 – rather no, 3 – neither yes nor no, 4 – rather yes, 5 - yes) a,b – mean value in each table box with the same superscript differ significantly –Tukey post-hoc test at p<0.05

Table 3. Willingness to eat pro-healthy bread according to selected opinions of the population (mean value; standard de-viation)

Selected opinions of the population Bread with decreased salt content Bread without addition of preservatives and raising agents

Frequency of white bread eating1-2 times a month or more seldom 1-5 times a weekonce a day or more often

3.3a ± 1.23.5a ± 1.03.7a ± 1.1

3.9 ± 1.14.0 ± 1.04.0 ± 1.1

Frequency of wholemeal bread eating1-2 times a month or more seldom 1-5 times a weeonce a day or more often

3.8a ± 1.13.5a ± 1.03.2a ± 1.2

4.1a ± 1.13.9 ± 1.03.8a ± 1.1

Self-assessment of healthI have no major health problems Sometimes I experience minor ailmentsI remain under the care of a doctor

3.3ab ± 1.23.6a ± 1.13.7b ± 1.1

3.9 ± 1.14.0 ± 1.04.0 ± 1.0

Perceived health risklow medium high

3.1a ± 1.33.4a ± 1.13.8a ± 1.0

3.8a ± 1.23.9 ± 1.04.0a ± 1.0

Perceived nutrition risk low medium high

3.0a ± 1.33.5a ± 1.03.8a ± 1.0

3.8a ± 1.23.9 ± 1.04.0a ± 1.1

x ± SD – mean value ± standard deviation (5-point scale, where 1 – no, 2 – rather no, 3 – neither yes nor no, 4 – rather yes, 5 - yes) a,b – mean value in each table box with the same superscript differ significantly –Tukey post-hoc test at p<0.05

of the villages. As in the case of bread with decreased salt content in the youngest group the distributions of responses in relation to the mean of willingness to eat bread without preservatives and raising agents were

most polarized. Gender and opinion on income did not statistically differ mean values expressing a tendency to eat bread without the addition of preservatives and raising agents (Table 2).


The more often the study participants ate white bread, the more prone they were to eating bread with lower salt content. In the case of the bread without addi-tives, no significant differences was found. In contrast, the more often respondents ate wholemeal bread, the smaller was their willingness to consume bread with decreased salt content. People who eat wholemeal bread once a day or more frequently were characterized by significantly lower willingness to consume bread witho-ut the addition of preservatives and raising agents than those who ate such bread 1-2 times a month or more seldom. Those who reported lack of health problems declared lower tendency to eat bread with reduced salt content than people who declared the occurrence of any health problems (Table 3).

The greater health and nutrition risks associated with their way of eating was perceived by the subjects, the greater was their willingness to consume bread with reduced salt content. In the case of bread without the addition of preservatives and raising agents significant differences characterized only the opinions of those with extreme risk perception. Both people who perceived low health and nutrition risk were characterized by lower willingness to consume this bread compared with those declaring high risk. Simultaneously, the larger standard deviations inform that those perceived low nutrition and health risks presented more polarized opinions expressing their willingness to eat both kinds of bread in comparison with others (Table 3).

Opinions on the assessment of their health, frequen-cy of eating white and wholemeal bread and the health and nutritional risk showed stronger bilateral correla-tions with the willingness to eat bread with reduced salt content than bread without the addition of preservatives and raising agents (Figure 1).

The strongest correlations were observed in the case of perceived health and nutrition risks and the

willingness to eat bread with decreased salt content. The higher the perceived risks were connected with the gre-ater willingness to eat such bread. This result confirms that respondents were aware of the relationship between high salt intake and potential health risks.

DISCUSSION

The choice of food is conditioned not only by factors related to the food but also those connected solely with the consumer, including their knowledge and attitudes [28, 29]. On the one hand, past experience related to food, on the other hand the consumer’s beliefs shaped by a variety of messages may have vast influence on one’s willingness to consume innovative products. A higher willingness to consume bread produced without the addition of preservatives or raising agents than bread with reduced salt content may result from having little experience with products with reduced salt content [27], but also from giving the vital importance to the taste of the product when making a choice [4, 6, 16]. Webster [27] research showed that information on the reduced salt content without the opportunity to try the product, contributed to a lower acceptance of its taste. Greater willingness to consume bread with no additives which prolongs its durability and improves its structure may result from the increased importance of bread’s natural-ness for consumers [1, 19]. Furthermore, the quality of bread which can be found on the market is evaluated by consumers quite negatively [13] and thus, preservatives and raising agents used so far may be deemed insuffi-cient to obtain a good quality of bread. The growing awareness of the negative health consequences due to the use of different technological additives is also the explanation of the results [11, 26].

Figure 1. Correlations between selected opinions of respondents and declared willingness to eat pro-healthy bread (Pearson’s correlation coefficient at * p= 0.05; ** p =0.01).

4

Figure 1. Correlations between selected opinions of respondents and declared willingness to eat pro-healthy bread (Pearson’s correlation coefficient at * p= 0.05; ** p =0.01).

Self-assessment of health

Frequency of white bread eating

Frequency of wholemeal bread

eating

Willingness to eat bread

with decreased

salt content

Perceived nutrition risk

Perceived health risk

Willingness to eat bread without

addition of preservatives and raising

agents

0.113*

-0.153**

0.243**

0.359**

0.348**

0.059

-0.067*

0.150**

0.133**

0.121**

0.454**


Previous studies have shown the importance of socio-demographic characteristics in conditioning not only nutritional behaviours [28, 29] but also the accep-tance of products with modified composition [3, 10, 14], which is also confirmed by the results obtained in this study. Older people were significantly more likely to consume both products. In the case of gender and income evaluation significant differences for bread with reduced salt content were indicated. The place of residence and education level differed significantly the willingness to eat bread without preservatives and raising agents. Thus, socio-demographic characteristics of people who are willing to accept both modification has confirmed the diverse importance of this group of variables in conditioning the beliefs, attitudes and behaviors [2]. Bearing in mind the reported differences, it can be said that women, the elderly and the more prosperous people showed more interest in pro-health modifications of food, which is confirmed in other studies [10, 18].

Past experience with food determine its choice to a large extent, which can be linked to a greater sense of security, but also to the habitual behavior [23]. In the survey, the frequency of eating white and wholemeal bread differed the willingness of the respondents to consume breads modified in its composition, but only in the case of the lower content of salt. The more often the respondents ate white bread, the more willing they were to eating bread with low salt content, while more frequent consumption of wholemeal bread was followed by the lower tendency to consume this kind of bread. A conclusion can be drawn from the obtained results that individuals consuming wholemeal bread should also accept the reduction of the salt content in bread, because they exhibit similar socio-demographic charac-teristics. Among them there are more women, people better educated and people with higher incomes [10, 18]. The factor that can explain the lower willingness to consume bread with low salt content among those fre-quently consuming wholemeal bread is their generally better health [24] who reported no health problems were characterized by lower willingness to consume bread with low salt content.

The perception of nutrition and health risks showed a stronger relationship with the presence of salt than of preservatives and raising agents in bread. The greater was the perceived health and nutrition risk related to nutritional habits, the more eager were the participants to consume bread with reduced salt content. People who perceived low health and nutrition risk were characte-rized by lower willingness to consume bread without addition of preservatives and raising agents compared with those declaring high health and nutrition risk . The importance of risk, both associated with food, as well as with one’s own eating habits in conditioning of

food choices was indicated in previous studies [8, 21, 22]. People tend to accept the risks resulting from con-suming new products, if it is under their control. This phenomenon may explain why they expect more labels that are understandable for them [7, 20].

CONCLUSIONS

1. The high perceived risks contributed to greater wil-lingness to purchase bread with decreased contents of salt and one without preservative and raising agents. Moreover, perceived risks determined the tendency to eat bread with increased health benefits stronger than the health self-assessment and the frequency of bread consumption.

2. Women, people with higher education, and those more positively assessing their income were more willing to consume products with increased health benefits.

3. The importance of perceived risks in conditioning consumers’ willingness to eat healthy food shows that the educational campaigns informing about risky behaviors may promote behavioral change towards a more favorable food choice.

Conflict of interestThe author declares no conflict of interest.

AcknowledgementsThis work was supported by the Project No POIG.01.03.01-14-041/12 “Bioproducts”, innovative technologies of pro-health bakery products and pasta with reduced caloric value co-financed by the Europe-an Regional Development Fund under the Innovative Economy Operational Programme 2007–2013.

REFERENCES

1. Arvola A., Lähteenmäki L., Dean M., Vassallo M., Winkel-mann M., Claupein E., Saba A., Shepherd R.: Consumers’ beliefs about whole and refined grain products in UK, Italy and Finland. J Cereal Sci 2007;46:197-206. doi: 10.1016/j.jcs.2007.06.001.

2. Bäckström A., Prittila-Backman A.-M., Tuorila H.: Willingness to try new foods as predicted by social representations and attitude and trait scales. Appetite 2004;43:75-83. doi: 10.1016/j.appet.2004.03.004.

3. Bech-Larsen T., Grunert K.G.: The perceived healthiness of functional foods: a conjoint study of Danish, Finnish and American consumers’ perception of functional foods. Appetite 2003;49:9-14. doi: 10.1016/S0195--6663(02)00171-X.

4. Berg C., Jonsson I., Conner M., Lissner L.: Perceptions and reasons for choice of fat- and fibre-containing foods


by Swedish Schoolchildren. Appetite 2003;40:61-67. doi: 10.1016/S0195-6663(02)00142-3.

5. Bruhn C.M.: Enhancing consumer acceptance of new processing technologies. Innov Food Sci Emerg Technol 2007;8(4):555-558. doi: 10.1016/j.ifset.2007.04.006.

6. Calderelli V., Benassi M., Matioli G.: Substitution of hydrogenated fat by soy oil in the elaboration of flaxse-ed bread and evaluation of sensory acceptance. Ciencia Tecnol Alime 2008;28(3):668-674.

7. Costa-Font J., Mossialos E.: Is dread of genetically modified food associated with the consumers demand for information? Appl Econ Lett 2005;12:859-863. doi: 10.1080/13504850500365830.

8. Costa-Font M., Gil J.M., Trail B.W.: Consumer accep-tance, valuation of and attitudes towards genetically modified food: Review and implications for food policy. Food Policy 2008;33(2):99-111. doi: 10.1016/j.food-pol.2007.07.002.

9. Czarnocińska J., Jeżewska-Zychowicz M., Babicz-Ziel-ińska E., Kowalkowska J., Wądołowska L.: Attitudes towards food, nutrition, and health and nutritional be-haviours of girls and young women in Poland. Olsztyn, Wyd. UWM, 2013 (in Polish).

10. Dean M., Shepherd R., Arvola A., Vassallo M., Winkel-mann M., Claupein E., Lähteenmäki L., Raats M.M., Saba A.: Consumer perceptions of healthy cereal products and production methods. J Cereal Sci 2007;46:188-196. doi: 10.1016/j.jcs.2007.06.007.

11. Dewettinck K., Van Bockstaele F., Kühne B, Van de Walle D., Courtens T.M., Gellynck X.: Nutritional value of bread: Influence of processing, food interaction and consumer perception. J Cereal Sci 2008;48:243-257. doi: 10.1016/j.jcs.2008.01.003.

12. Finucane M.L., Holup J.L.: Psychosocial and cultu-ral factors affecting the perceived risk of genetically modified food: an overview of the literature. Soc Sci Med 2005;60(7):1603-1612. doi: 10.1016/j.socsci-med.2004.08.007.

13. Gellynck X., Kuhne B., Van Bockstaele F., Van de Wal-le D., Dewettinck K.: Consumer perception of bread quality. Appetite 2009;53:16-23. doi: 10.1016/j.ap-pet.2009.04.002.

14. Jeżewska-Zychowicz M., Babicz-Zielińska E., Laskowski W.: Consumer on the market of innovative food. Wybrane uwarunkowania. Warszawa, Wydawnictwo SGGW, 2009 (in Polish).

15. Kähkönen P., Tuorila H., Rita H.: How information enhances acceptability of a low-fat spread. Food Qual Prefer 1996;7(2):87-94.

16. Lambert J.L., Le-Bail A., Zuniga R., Van-Haesendonck I., Van-Zeveren E., Rosell M.C., Collar C., Curic D., Galic K. I., Sikora M.: The attitudes of European consumers toward innovation in bread; interest of the consumers toward selected quality attributes. J Sens Stud 2009;24(2):204-219. doi: 10.1011/j.1745--459X.2009.00203.x.

17. McCarthy M., Brennan M., Kelly A.L., Ritson C., de Boer M., Thompson N.: Who is at risk and what do they know? Segmenting a population on their food safety knowled-ge. Food Qual Prefer 2007;18:205-217. doi: 10.1016/j.foodqual.2005.10.002.

18. Mialon V.S., Clark M.R., Leppard P.I., Cox, D.N.: The effect of dietary fibre information on consumer responses to breads and ‘‘English” muffins: A cross-cultural study. Food Qual Prefer 2002;13(1):1-12.

19. Pohjanheimo T., Paasovaara R., Luomala H., Sandell M.: Food choice motives and bread liking of consumers embracing hedonistic and traditional values. Appetite 2010;54:170-180. doi: 10.1016/j.appet.2009.10.004.

20. Rollin F., Kennedy J., Wills J.: Consumers and new food technologies. Trends Food Sci Technol 2011;22:99-111. doi: 10.1016/j.tifs.2010.09.001.

21. Ronteltap A., Van Trijp J.C.M., Renes R.J., Frewer L.J.: Consumer acceptance of technology-based food innova-tions: lessons for the future of nutrigenomics. Appetite 2007;49:1-17. doi: 10.1016/j.appet.2007.02.002.

22. Siegrist M., Stampfli N., Kastenholz H., Keller C.: Perce-ived risks and perceived benefits of different nanotechno-logy foods and nanotechnology food packaging. Appetite 2008;51(2):283-290. doi: 10.1016/j.appet.2008.02.020.

23. Van’t Riet J., Sijtsema S.J., Dagevos H., De Bruijn G-J.: The importance of habits in eating behavior. An overview and recommendations for future research. Appetite 2011;57:585-596. doi: 10.1016/j.appet.20119.07.010.

24. Vassallo M., Saba A., Arvola A., Dean M., Messina F., Winkelmann M.: Willingness to use functional breads: applying the health belief model across four European countries. Appetite 2009;52:452-460. doi: 10.1016/j.appet.2008.12.008.

25. Verbeke W.: Functional foods: consumer willingness to compromise on taste and health. Food Qual Prefer 2006;17:126-131. doi: 10.1016/j.foodqual.2005.03.003.

26. Vulicevic I.R., Abdel-Aal E.S.M., Mittal G.S., Lu X.: Qu-ality and storage life of par-baked frozen breads. Food Sci Technol 2004;37:205-213.

27. Webster J.: Reformulating food products for health: con-text and key issues for moving forward in Europe. Ava-ilable from: http://ec.europa.eu/health/nutrition_physi-cal_activity/docs/ev20090714_wp_en.pdf (20.06.2011).

28. Wozniak A., Artych M., Wawrzyniak A.: Nutritional beha-viours and body self-perception in Polish pupils attending middle-school. Rocz Panstw Zakl Hig 2014;65(4):331-336 [PMID: 25526579; http://www.ncbi.nlm.nih.gov/pubmed/25526579].

29. Zaborowicz K., Czarnocinska J., Wadolowska L., Kow-alkowska J., Jezewska-Zychowicz M., Babicz-Zielinska E., Sobas K., Kozirok W.: The effect of girls attitudes towards the health benefits of food on selected dietary characteristics. The GEBahealth Project. Rocz Panstw Zakl Hig 2015;66(1):69-75 [PMID: 25813076; http://www.ncbi.nlm.nih.gov/pubmed/25813076].




IN MEMORIAM

PROFESSOR WIESŁAW MAGDZIK, MD – NESTOR OF POLISH EPIDEMIOLOGY

(1932 – 2015)

Danuta Naruszewicz-Lesiuk1, Andrzej Zieliński1

1National Institute of Public Health - National Institute of Hygiene, Department of Epidemiology, Chocimska street 24, 00-791 Warsaw, Poland

On 29 November 2015, in Warsaw died Professor Wiesław Magdzik MD, a prominent epidemiolo-gist, former Director of the National Institute of Hygiene (NIH), greatly meritorious for substan-tive improvement of the standards of sanitary-epi-demiological service in Poland. For many years,

he was on the editorial board of the journal Przegląd Epidemiologiczny (Epidemiological Review).

Wiesław Magdzik was born in Warsaw on February 1, 1932 in a family of high school teachers. In 1950 he graduated from Stefan Batory high school in Warsaw. He obtained Diploma of Physician in 1956 after medical studies at the Sanitary-Epidemiological Section of the Medical Academy (Medical School) in Warsaw. Even before graduation was employed at the National Institute of Hygiene at the request of professor Jan Kostrzewski, the founder of the Department of Epidemiology.

In the period from October 1958 to October 1960 he served, as sanitary inspector at the Ministry of In-terior. From November 1960 to February 1962 he was employed as an epidemiologist at the District Sanita-ry-Epidemiological Station in Warsaw. At this period, in 1961 he obtained degree of specialization in epide-miology. In 1962, he took the post of the Head of the Central Sanitary and Epidemiological Columns within Ministry of Health and Social Welfare.

Since August 1965, until his retirement professor Magdzik was employed in the Department of Epide-miology at the National Institute of Hygiene. At the period 1970-1978 he was seconded to the Ministry of Health where finally he served as the Director of the Department of Sanitary Inspection.

In 1979 following the retirement of professor Jan Kostrzewski, he was offered by the Director of the

National Institute of Hygiene, professor Włodzimierz Kuryłowicz, position of the head of the Department of Epidemiology there.

In the National Institute of Hygiene, in addition to directing the Department of Epidemiology in 1980-1981, he served as deputy director of the NIH managing the Microbiological and Epidemiological Division of the Institute, and since March 1981 to the end of 1990 he was the Director of the NIH.

As the head of the Institute he summed up the results of the implementation of the Inter-MR-12 Pro-gramme “Effects of environmental pollution on human health and life,” coordinated by the NIH in 1976-1980. In 1986-1990 he oversaw the implementation of the Central Research and Development Plan CPBR 11.12: “Preventing the adverse health effects of environmental pollution of man”.

Very prestigious and time consuming task to su-pervise the implementation of these programs did not prevent him to put in order the internal affairs of the Institute. The most urgent was to ensure the material condition of the Institute, especially the poor state of aging buildings requiring immediate repair, including the roof structure. For the time of renovation some departments and laboratories had to be moved from the premises belonging to the NIH, while maintaining their services and scientific activities. It required very difficult logistical operations.

In these improvised conditions, to the surprise of the supervisory authorities for NIH, the Institute has complied with the scheduled work. Despite numerous difficulties - eg. renovations had to take into account requirements of the conservation officer - the renovation was finished successfully in planed term. All the units returned to the former premises.

Wiesław Magdzik considered as his duty to conti-nue the founding mission of the Epidemiology Institute established in 1918 as a center for research and training for sanitary and epidemiological services of the country. Therefore, he promoted close cooperation between the

D. Naruszewicz-Lesiuk, A. Zieliński90 No 1

National Institute of Hygiene and Sanitary-Epidemio-logical Stations across the country. Institute developed opportunities for colleagues from the regional institu-tions to specialize in the field of epidemiology, hygiene, and in public health. The Institute has organized training courses, and internships. It also prepared course mate-rials and books. Wiesław Magdzik has proven himself in many fields of work - but above all he was an epi-demiologist. Besides a specialization in epidemiology also obtained a specialization in infectious diseases. In 1965 he defended his doctoral thesis: “Controlled vaccination against typhoid. Epidemiological evaluation of comparable groups of individuals vaccinated with various vaccines“ under supervision of Professor dr Jan Kostrzewski. Habilitation (dozent degree) he obtained on the basis of the dissertation: “Epidemiological eva-luation of the consequences of viral hepatitis” from the NIH Scientific Council in March 1971.

In this paper W. Magdzik showed that the preven-tion and control of hepatitis in Poland was inefficient and required a fundamental change. The concept of improving this situation presented later in the project “The prevention and control of hepatitis in the years 1976-1980”. The program submitted to the Department of Sanitary Inspection of the Ministry of Health has been subject of a broad debate among specialists. In February 23, 1973 government approved the program to be implemented in the country. Implementation of the practical application of this program in Poland contributed over several years to reduce the incidence of hepatitis B by more than thirty percentage points. Recognition of the results of W. Magdzik in the field of prevention of hepatitis prompted WHO to use his experience in setting program for prevention of hepatitis A and B in Mongolia between 1979 and 1990.

As an epidemiologist practitioner he took part in the field control of various epidemics in Poland and abroad. Of particular importance was his participation in the control of the epidemic of smallpox in Gdansk in 1962. and in Wroclaw in 1963. In 1974. participated on behalf of the WHO Regional Office for South-East Asia (SEARO) in the program of smallpox eradication. He worked in the state of Bihar, in the districts of Haz-aribagh and Dhanbad. In 1976 WHO awarded to him the Medal of the Bifurcated Needle.

In his lifelong career as an epidemiologist he was particularly interested in the problems of immunization - therefore also took a large part in the implementation in Poland vaccination against poliomyelitis. In 2001 he published book “The eradication of poliomyelitis - im-plementation and perspectives”. In 2002 he took part in the conference organized at the NIH 8.10.2002 r. on the occasion of the signing of the certificate of eradication of poliomyelitis in the European Region in Copenhagen on 21.06.2002 r.

At that time W. Magdzik published article “Pos-sibility of smallpox reemerging as the result of bioter-roristic attack” in Przeglad Epidemiologiczny 2002;56, Suppl.3, pp. 5-11.

One of his former graduate students (W. Magdzik supervised 8 doctoral theses) still working at the station of Sanitary-Epidemiological Inspection summed up briefly this activity: “he realized the importance and executed the use of cold chain distribution of vaccines and raised effective sterilization to the rank of a lead-ing problem within health care system – it was the key to improve the epidemiological situation of infectious diseases in Poland “.

In recent years, often we hear the term - transla-tion, translator – to define the person who brings to the public in an understandable way the specialized research results, sometimes very sophisticated studies of a fundamental nature. Such an ability to translate had Wiesław Magdzik. He used them for the purpose to help people working in prevention of infectious diseases in local posts to acquire that knowledge in a form available to them. As an example may serve the following elaborations: “Information about the acquired immunodeficiency syndrome AIDS”, 1984 (co-author A. Nowosławski), “Spongiform encephalopathy prion diseases in humans”, 2001 and “Is there a risk related to protein BSE prion” (co-author J. Ślusarczyk).

Wiesław Magdzik published 240 works, of which 46 concerned immunization. Many was devoted to the introduction of new vaccines, discussed the issue of safety of vaccinations and potential adverse effects. On the initiative of W. Magdzik the collective book “Vac-cinology” was published in 2005. It was edited by W. Magdzik, D. Naruszewicz-Lesiuk and A. Zieliński. Its expanded and updated second edition was published in 2007. Also on the initiative of W. Magdzik and edited by him was “Prevention of and control of infectious and parasitic diseases” 1982. Out of 7 subsequent editions, first 5 were edited by W. Magdzik, the last one in 2004.

Particularly noteworthy is the book collectively edited by J. Kostrzewski, W. Magdzik and D. Narusze-wicz-Lesiuk: “Infectious diseases and their control on Polish territory in the twentieth century” issued by PZWL in 2001. This is the last book, which involved participation of professor J. Kostrzewski.

In 2002, Wiesław Magdzik retired from his main place of employment - the NIH. But in this same year in September, was hired by the University of Antwerp for the International Team set up by the European Com-mission to develop rules of conduct diseases control against hepatitis A and hepatitis B. The Team was active until August 2005. By the end of the academic year 2009-2010 W. Magdzik lectured in School of Arts and Sciences in Kielce and in the King Władysław Jagiełło School of Public Health in Lublin.

In memoriam: Professor Wieslaw Magdzik (1932-2015) 91No 1

In 2010, professor W. Magdzik had an accident, the consequences of which have resulted in difficulties in walking, which markedly reduced his activities and caused his withdrawal from active participation in the teaching.

In 2006, he published retrospective vision of his professional life in memoirs „My flirt with medicine”.

How W. Magdzik was perceived in the Institute, which bound his professional life over may years of fruitful work? Professor Jan K. Ludwicki stated in the laudation at a meeting of the Scientific Council of the NIH, on October 11.2005: “But for us, I mean the staff of the National Institute of Hygiene and also myself, the most important was the work of Professor Wiesław Magdzik as Director of the National Institute of Hygiene in perhaps the most difficult period of the Institute, except for the Second World War, ie. in 1980-1990. In the dark days of martial law and ubiquitous repression Professor Wiesław Magdzik managed with remarkable agility to protect acting NIH underground solidarity against repression. I know well that the experience of this period was for Professor very bitter and not by all properly appreciated.”

Professor Wiesław Magdzik died suddenly on November 29, 2015. The funeral Mass was held on December 9, 2015 in the Church of St. Stanislaus Kostka in Zoliborz - after which the ashes were placed in the family grave at the Municipal Cemetery North in Warsaw, Poland.

On behalf of the staff and the Scientific Council of the NIH farewell speech delivered professor Mirosław Wysocki, director of the NIH. In his final statement he said: “He was a friendly to people, good colleague who respected people, helped and supported them with the advice - but mainly mobilized colleagues to find their places in the profession and in the community. Certainly, in this regard, he passed with the highest grade exam as a student of Professor Jan Kostrzewski. From now his person and his work at the National Institute of Hy-giene is a history - but history, which includes prestige both of our Institute, and of the entire epidemiological service in the country. Professor, buddy, friend you will remain in our memory. We bid farewell: Wiesław Magdzik, rest in peace.”


INSTRUCTION FOR AUTHORS

Quarterly Roczniki Państwowego Zakładu Higieny [Annals of the National Institute of Hygiene] is the peer-reviewed scientific journal that publishes original articles, reviews, short communications, letters to the editor and book reviews. Journal is devoted to the studies concerning scientific problems of food and water safety, nutrition, environmen-tal hygiene, toxicology and risk assessment, public health and other related areas.Since 2013, Volume 64, number 1 all the papers are published in English.

Articles for publication in the Roczniki Państwowego Zakładu Higieny (Rocz Panstw Zakl Hig) should be sent to the following address:Roczniki Państwowego Zakładu HigienyNarodowy Instytut Zdrowia Publicznego - Państwowy Zakład Higieny24 Chocimska street, 00-791 Warsaw, Polandor e-mailed: [email protected]

RULES FOR THE ACCEPTANCE OF THE MANUSCRIPTS

Editorial policy and basic information

Only high scientific quality articles complying with the scope of the journal will be considered for the publica-tion.

Copyright. All the copyrights to the articles published in the Roczniki Państwowego Zakładu Higieny are reserved for the publisher: the National Institute of Public Health – National Institute of Hygiene. It means that after article is published the authors transfer the copyright to the publisher and cannot publish this article or its parts elsewhere for commercial purposes without the written permission from the publisher.

License Creative Commons. Submitting the manuscript to Editorial Office means that the Authors declares that they have read the full text of the Creative Commons Attribution – Non Commercial 3.0 Poland license (CC-BY-NC) available at: http://creativecommons.org/licenses/by-nc/3.0/pl/deed.en.

Ethics. Clinical articles should comply with the generally accepted ethical standards and the Helsinki Declara-tion. For animal experiments reported in the articles the author(s) must obtain the acceptance by the relevant local Ethics Commission.

Conflict of interest. Conflict of interest exists if authors or their institutions have financial or personal relation-ships with other people or organizations that could inappropriately influence their actions. Such relationships should be disclosed to the publisher. All authors should provide a signed statement of their conflict of interest as a part of the author’s statement form.

Transparency. Openness of information on any party contributing to preparation of a publication (content related, financial, etc. input) is proof of ethical attitude of a researcher and of high editorial standards.

“Ghostwriting” and “guest authorship” are indications of scientific dishonesty and all cases will be exposed and adequate institutions will be informed. “Ghostwriting” is a situation where a person contributes significantly to a publication and is not disclosed as one of the authors or named in the acknowledgments and “guest author-ship” is a situation where an author’s contribution is insignificant or nonexistent and he is still listed as author/co-author of a publication.The editor requires from the authors of the articles that they reveal the contribution of individual authors to the manuscript, i.e. who is the author of the concept and study design, data/material collection, study/analysis, performance, statistical analysis, interpretation of the results, manuscript development etc. Authors of the manu-

94 No 1

script should provide “Authors’ statement” form signed by the all authors. Also the information concerning the sources of financial support to the study presented in the submitted manuscript should be provided.

Peer review procedure for manuscripts

1. The manuscripts submitted to the Roczniki Państwowego Zakładu Higieny undergo preliminary evaluation in the editorial office to determine whether the topic is within the scope of the journal and to evaluate the adherence to the journal format, as well as to the rules of acceptance. In cases when the above prerequisites are not met the manuscript is not qualified, and the corresponding author is informed.

2. Following the positive preliminary evaluation the paper is directed for peer review to at least two independent and recognized experts representing the scientific experience in the field covered by the manuscript and affiliated in the different institution than the institution(s) where the authors have been affiliated. The reviewers must ensure independence and lack of conflict of interests.

3. During the entire reviewing the double-blind review process is maintained.4. The review in the written form is forwarded to the corresponding author with the accompanying

statement suggesting status of the paper as: “accepted”, “accepted after revisions” or “not accepted”. The Review form is available on the journal’s website: http://wydawnictwa.pzh.gov.pl/roczniki_pzh/for-reviewers.

5. The list of reviewers is published once a year in the fourth issue of each volume and is available on the journal’s website: http://wydawnictwa.pzh.gov.pl/roczniki_pzh/reviewers

Submission of manuscripts

For the publication the following attachments must be submitted:1. Cover letter, in which the corresponding author applies for the publication of the paper in the Roczniki

Państwowego Zakładu Higieny. The cover letter, signed by the corresponding author, should contain the name of the institution where he is affiliated, address, phone and fax numbers, e-mail. The corresponding author is requested to suggest two or three potential reviewers (including their affiliations and e-mails) from institutions other than the author’s one.

2. Author(s)’ statement, signed by all authors, stating that the manuscript complies with the general rules set for the scientific articles and was not published and/or submitted for publication elsewhere and will not be send for publication to the other journal, and there is no infringement of property rights to any interested third parties. In the case of experiments on animals the approval of the relevant ethics commission is required. The clinical studies must be accompanied by the written statement, signed by the authors confirming that the research was conducted in accordance with the Helsinki Declaration. The contribution of the individual authors to preparation of a publication should be specified. All authors are required to sign the statement of their conflict of interest as a part of the author’s statement form.Author’s statement form is available on the journal’s website: http://wydawnictwa.pzh.gov.pl/roczniki_pzh/media/Authors_statement.pdf

3. Manuscript. Text of the manuscript, tables and figures (in the separate files) should be sent by the e-mail: [email protected].

Arrangement of manuscripts

Manuscripts submitted for publication should be typed by the editor Microsoft Word using Times New Roman 12 font and 1.5 space between lines on A4 paper size.

Title page. It should contain the title of the paper in English and, the name(s) and surname(s) of the author(s), the complete name(s) of the institution(s) where the work was performed, address of the corresponding author’s institution, phone and/or fax numbers and the e-mail inserted at the bottom of the title page. If appropriate, the number and the title of the project under which the study has been carried out should also be given on this page as a footnote.

95No 1

Abstract. It should contain 250-300 words and consist of the following sections: Background, Objective, Material and methods, Results, Discussion and Conclusions. The abstract of a review should not be divided into sections.

Keywords. Should be placed after the abstract. 3-6 words or short phrases according to the MeSH (Medical Subject Headings Index Medicus) catalogue available at www.nlm.nih.gov/mesh/meshhome.htmlPolish authors are asked to attach the abstract and keywords also in Polish language.

Text. The text of the manuscript should be divided into the following sections: Introduction, Material and methods, Results, Discussion, Conclusions, Acknowledgements, References.

Introduction. It should contain the scientific rationale and the aim of the study or in the case of a review the purpose of the article. Only references related to the paper should be cited.

Material and methods. This section should provide detailed information on the subject of the study, methods, chemicals, apparatus and techniques used in sufficiently exhaustive way to enable readers to repeat the experiments or observations. For generally known methods references should be given together with name of the methods or statistical analysis used in the study. For new or substantially modified methods detailed descriptions are to be added. In the case of experimental studies on laboratory animals, the information should be provided on the approval by a local Ethics Commission, or in the case of clinical studies that they have been performed with the ethical standards according to the Helsinki Declaration.

Results. These should be presented in a logical sequence in the text, the same applies to the tables and figures. The data from the tables and figures should not be repeated in the text, where only the most important observations from the studies are to be summarized. The place where the tables, figures or photographs should appear in the text should be indicated.

Discussion. Emphasize the new and important aspects of the results and a comprehensive interpretation of the results obtained against the background of results obtained by other authors. Quotations should be restricted to those with immediate relevance to the author’s findings.

Conclusions. They should be stated precisely in points or descriptively and should be logically connected with the aims stated in the introduction. Statements and conclusions not derived from own observations should be avoided. If a hypothesis is proposed it must be stated clearly.

Acknowledgements. These should be placed directly after the Conclusion section. One or more statements should specify: (1) persons who contributed substantially to the study but cannot be regarded as authorship, such as technical assistants, statisticians, data collectors etc. Their assistance should be acknowledged for the sake of transparency. It must be clear that they are not responsible for the final version of the article. You must ensure you have the consent of all the persons named in the acknowledgements; (2) all sources of financial and material support, which should specify the nature of the support. The recommended form is: “This work was supported by: (name of the organization, project number etc.)”; (3) relationships that may pose the conflict of interest.

References. References should be presented in alphabetical order, according to author’s names. Each position in the list of references should start from the new line and contain: consecutive number, author’s (authors’) surname(s) and initials of name(s) (written in italic), full title of the paper, official journal title abbreviation (according to the List of Journals Indexed in Index Medicus), year, volume, the first and the last page number of the paper. When quoting them in the text only the number of the reference should be given in square brackets. If the article or book has a DOI number (‘Digital Object Identifier’ number unique to the publication), it should be included in the references. The titles of the cited papers in other language than English should be also translated into English [and given in square brackets]. The information on the original language should be given in the brackets after the page numbers, for example: (in Polish). The examples of reference style are given below:

96 No 1

Article in a periodical:1. Snopczyński T., Struciński P., Góralczyk K., Czaja K., Hernik A., Korcz W., Kucharska A., Ludwicki

J.K.: Zastosowanie metody QuEChERS w połączeniu z chromatografią gazową z detektorem wychwy-tu elektronów (GC-ECD) w analizie pozostałości pestycydów w żywności [Application of the QuECh-ERS method coupled with gas chromatography with electron capture detection (GC-ECD) in analysis of pesticide residues in food]. Rocz Panstw Zakl Hig 2011;62(2):145-151 (in Polish).

2. Lopes M.C., Giudici K.V., Marchioni D.M., Fisberg R.M., Martini L.A.: Relationships between n-3 polyunsaturated fatty acid intake, serum 25 hydroxyvitamin D, food consumption, and nutritional status among adolescents. Nutr Res 2015;35(8):681-688.

3. Shridhar G., Rajendra N., Murigendra H., Shridevi P., Prasad M., Mujeeb M.A., Arun S., Neeraj D., Vikas S., Suneel D., Vijay K.: Modern diet and its impact on human health. J Nutr Food Sci 2015;5:6 doi:10.4172/2155-9600.1000430.

4. Wu M., Yu G., Cao Z., Wu D., Liu K., Deng S., Huang J., Wang B., Wang Y.: Characterization and human exposure assessment of organophosphate flame retardants in indoor dust from several microenviron-ments of Beijing, China. Chemosphere 2015, doi:10.1016/j.chemosphere.2015.12.111.

Books and chapter in a book:5. Riley D.M., Fishbeck P.S.: History of methylene chloride in consumer products. In: Salem H., Olajos

E.J. (eds.). Toxicology in Risk Assessment. London, Taylor & Francis, 2000.

Legislative acts:6. Commission Regulation (EC) No 1881/2006 of 19 December 2006 setting maximum levels for certain

contaminants in foodstuffs. Off J EU L 364, 20.12.2006.

Internet source:7. The Rapid Alert System for Food and Feed (RASFF) Portal. Available https://webgate.ec.europa.eu/

rasff-window/portal (accessed 18.10.2010)

Tables. These should be printed on separate sheets and numbered using Arabic numerals. The title should be place directly above each table. Tables should always be cited in the text in consecutive numerical order. Each column in tables should have a brief heading, more extensive explanation should be given below the table, if necessary. The number of tables should be limited to indispensable for the documentation of results.

Figures and photographs. These should be numbered in Arabic numerals according to the sequence of their appearance in the text. Figures should be made by computer technique and the titles should be placed below the figures. Photographs must be of high quality, digital format is preferred.Tables, figures or photographs should be cited in the text in consecutive numerical order in the following way: (Table 1), (Figure 1), (Photo 1).

Abbreviations, symbols, units. Generally known and used abbreviations may be left unexplained, others must be explained at the first use in the text. Metric SI units are recommended, however also other generally used units are accepted.

General information

The editor reserves the right for introducing the editorial corrections in the manuscript which will not influence the scientific contents of the article without prior informing the author.Publication of the papers in the quarterly Roczniki Państwowego Zakładu Higieny is free of charge.

ROCZNIKI PAŃSTWOWEGO ZAKŁADU HIGIENY · mineral compounds may be from 20 to over 200 g in a litre...

Documents

Transcript of ROCZNIKI PAŃSTWOWEGO ZAKŁADU HIGIENY · mineral compounds may be from 20 to over 200 g in a litre...