European Nutrition and Health Report 2009, National report - Portugal

National Reports 351 18 (men) and 14 (women). Some 46% of men and 67% of women never smoked and 80% declared that they want to quit smoking [Polakowska et al., 2005]. Conclusions The nutritional and health status of the Polish population is determined by dietary habits strongly influenced by market transformation. Due to changes in consumer habits and low level of physical activity, the prevalence of overweight and obesity is increasing. The diet of Polish consumers, including low-income population, in general is improperly balanced. In the case of minerals’ consumption, excessive daily intake of sodium can be seen as a big challenge for public health nutrition. The most important change in health status is the decrease of morbidity and mortality ratios from cardiovascular diseases. The prevalence of another cause of premature mortality – smoking – is one of the highest in Europe, however in men and young adult women it is showing a decline. The Polish population of 38.8 million is strongly differentiated by social, demographical and regional factors. This implies the need to conduct further research and monitoring of food intake in different subpopulation groups as well as to implement education and information programs aimed at changing food consumption patterns. 11.17 Portugal17 Introduction The present report compiles the most relevant data published between 2000 and 2008 which were not included in the ENHR 2009 main text. Household Food and Nutrient Availability Following the household food and beverages availability data computed under the DAFNE project, the household availability of energy, nutrient and other food components retrieved from the 2000 Portuguese Household Budget Survey (HBS) are shown in table 11.52 [Rodrigues, 2007]. Two diet-quality scores (compliance with the WHO population dietary goals and adherence to the Mediterranean food pattern) were computed in order to compare Portuguese regions [Rodrigues et al., 2007] (table 11.53). Food and Nutrient Intake In the absence of a National Dietary Survey (the only one was carried out in 1980), the food and nutrient intake information was retrieved from several different studies 17 Rodrigues S, Pinhão S, Silva Ferreira L, Lopes C, Ramos E, Vaz Almeida MD; Faculty of Food Science and Nutrition from Porto University, Portugal. E-Mail [email protected] 352 Elmadfa that have been conducted in the context of particular scientific research but mostly in restricted geographical areas and rarely at the national level. Children and Adolescents. In the ENHR 2009 main text, data on children’s food intake was retrieved from Moreira et al. [2005] and the EpiTeen Study [Ramos, 2008]. Moreira et al. [2007] evaluated the diet of 4,845 children (6 to 12 years old) using a 24-hour recall and compared groups according to BMI distribution (non-overweight vs. overweight; table 11.54). The Health Behaviour in School-Aged Children Study [Matos et al., 2006] evaluated a national representative sample of 4,877 children (11 to 16 years old) by asking participants how much fruit, vegetables, soft drinks and sugar products they usually eat (table 11.55). Adults and Elderly. In the main text of the ENHR 2009, data on this subject comes from the EPI Porto study [Lopes et al., 2006], a study on the health and nutrition situation in the city of Porto that evaluated 18to 92-year-old subjects from 1999 to 2003 using a validated semiquantitative food frequency questionnaire. The whole report of this study can be found at http://higiene.med.up.pt/consumoalimentarporto/home. Nutritional Status Children and Adolescents. Self-reported weight and height data collected within the National Health Survey 2005/2006 [INE/INSA, 2008] allowed the computation of Table 11.52. Household energy, nutrient and other food component availability (per person/day) in Portugal, 2000 [source: Rodrigues, 2007] Energy, kcal 2,249 Protein, %E 16 Lipid, %E 34 Carbohydrates, %E 47 Alcohol, %E 3 MUFA, %E 13 PUFA, %E 8 SFA, %E 9 Cholesterol, mg 196 Sugars, %E 16 Fiber, g 20 Sodium, mg 6,573 From food/beverages, mg 2,638 From table/cooking salt, mg 3,935 National Reports 353 Table 11.53. Diet-quality scores (based on per person per day household availability) by Portuguese region in 2000 [source: Rodrigues et al., 2007] Household diet quality North Center Lisbon area Alentejo Algarve Azores Madeira Portugal MAI1 (median) 2.26 2.34 1.77 2.37 2.21 1.67 2.79 2.09 % families with Low ≤2 42.0 41.6 57.3 38.6 43.7 62.0 28.5 47.1 Intermediate 2–4 39.1 38.8 32.0 41.2 37.9 30.9 43.2 36.6 High ≥4 18.8 19.7 10.7 20.1 18.4 7.1 28.3 16.2 HDIr2 (median) 4.00 4.00 4.00 4.00 4.00 4.00 5.00 4.00 % families with Low ≤4 61.3 56.6 65.6 57.2 63.8 66.1 42.0 61.4 Intermediate 5–6 33.2 36.5 31.5 37.1 30.5 30.4 48.3 33.6 High ≥7 5.5 6.9 2.9 5.7 5.7 3.5 9.8 4.9 1 Mediterranean Adequacy Index proposed by Alberti-Fidanza et al. [1999], evaluating adherence to Mediterranean food pattern (may vary from 0 to positive infinite and the reference value of good adherence is ≥4). 2 Healthy Diet Indicator revised from the one proposed by Huijbregts et al. [1997], evaluating compliance with WHO population goals (may vary from 1 to 11, the higher the score the better the compliance). Table 11.54. Nutrient intake in Portuguese children (6–12 years old) by gender and presence of overweight [source: Moreira et al., 2007] Girls Boys overweight overweight no yes no yes Energy, kcal 2,316 ± 699 2,325 ± 802 2,525 ± 938 2,518 ± 825 Total fat, %E 35.3 ± 6.7 35.4 ± 6.9 35.1 ± 6.9 35.3 ± 6.8 SFA, %E 12.8 ± 3.4 12.8 ± 3.1 12.7 ± 3.3 12.8 ± 3.6 MUFA, %E 14.6 ± 3.5 14.7 ± 3.6 14.6 ± 3.5 14.7 ± 3.4 PUFA, %E 5.0 ± 1.7 5.0 ± 1.6 4.9 ± 1.7 5.0 ± 1.7 Proteins, %E 16.6 ± 3.7 17.0 ± 3.8 16.6 ± 3.8 16.9 ± 4.0 Carbohydrates, %E 49.2 ± 7.8 48.7 ± 8.1 49.4 ± 8.0 48.8 ± 8.0 Sugars, %E 22.1 ± 7.0 22.4 ± 7.3 22.7 ± 7.2 22.3 ± 7.4 Fiber, g 18.1 ± 8.7 17.7 ± 7.9 19.4 ± 10.6 18.5 ± 8.3 Calcium, mg 1,065 ± 450 1,053 ± 447 1,129 ± 506 1,144 ± 633 354 Elmadfa BMI distribution among Portuguese children and adolescents (table 11.56). Several other studies have also reported data on the BMI of Portuguese children and adolescents (table 11.57). Biochemical data for Portuguese children is very scarce. Pedrosa et al. [2008] have evaluated 61 children in order to identify cardiovascular disease risk (table 11.58). Adults and Elderly. Self-reported weight and height data collected for the last National Health Survey of 2005/2006 [INE/INSA, 2008] allowed the computation of the Body Mass Index group’s proportion among Portuguese adults and elderly (table 11.59). Some other studies have also reported data on the body mass index of Portuguese adults and elderly (table 11.60). Adults’ biochemical data for adults is shown in the ENHR 2009 main text [source: Instituto de Alimentação Becel, 2001]. Length of Breastfeeding To complement data on breastfeeding which is included in the ENHR 2009 main text, two additional tables are included. Length of breastfeeding within the NHS 2005/2006 [INE/INSA, 2008] by women (aged 15+ years) with children <5 years old in 2006 is shown in tables 11.61 and 11.62. Conclusion Portugal still lacks nutrition-related data collected at the national level and therefore most information is supplied by Household Budget Surveys and Food Balance Sheets. This is a strong limitation to identify associations between food intake, nutritional and health status and undermines national policies in this field. Table 11.55. Food intake in Portuguese children (% eating at least one portion/day) by gender and age [source: Matos et al., 2006] Gender Age, years boys girls 11 13 15 16 Fruit 49.7 47.6 51.9 45.4 38.2 34.1 Vegetables 22.0 28.2 29.7 27.5 23.7 17.2 Soft drinks 31.3 23.8 25.9 25.4 27.4 34.1 Chocolates/cakes/sweets 22.0 23.9 23.0 23.7 22.8 21.9 National Reports 355 Table 11.56. BMI of Portuguese children and adolescents by age groups (using the IOTF criteria) Age group years Underweight, % (BMI <18.5 kg/m2) Normal range, % (BMI ≥18.5 and <25 kg/m2) Overweight % (BMI ≥25 and <30 kg/m2) Obese,% (BMI ≥30 kg/m2) total men women total men women total men women total men women 6–9 9.70 10.32 9.09 49.01 50.07 47.99 24.30 25.03 23.60 16.99 14.58 19.32 10–14 7.45 7.75 7.13 65.03 61.49 68.70 20.85 24.40 17.19 6.66 6.36 6.98 15–17 5.62 4.52 6.68 76.21 72.22 80.02 15.30 18.91 11.84 2.87 4.35 1.46 Source: Data computed on purpose for this report by the Portuguese National Statistics Institute (INE) from the database of the National Health Survey 2005/2006. INE, INSA. Table 11.57. BMI of Portuguese children and adolescents by age groups (all studies using the Cole criteria, with the exception of Ramos e Barros 2007 who have used the IOTF criteria) Age years n and method of data collection Place and year of data collection Overweight, % Obesity, % Reference total female male total female male 3–6 2,400 measured Coimbra (2001) 16.9 20.4 13.6 6.7 6.9 6.5 Rito, 2004 6–10 1,225 measured Sintra (2004) 23.0 – – 12.6 – – Ferreira and Marques-Vidal, 2008 6–10 2,384 measured Madeira (2004/2005) 19.2 22.6 16.1 11.1 10.7 11.4 Sousa et al., 2006 6–12 4,845 measured National (2002/2003) – 20.9 18.5 – 11.9 10.3 Moreira et al., 2007 7–9 905 measured Aveiro (2006) 20.0 21.4 18.6 8.1 9.6 6.6 Pedrosa et al., 2006 7–9 3,044 measured National (2002/2003) – 24.1 22.2 – – – Moreira et al., 2005 10–15 819 measured Porto – 23.8 30.9 – – – Ribeiro et al., 2006 11 1,176 self-reported National (2003) – 17.7 26.5 – 2.2 6.2 Yngve et al., 2007 13 2,161 measured Porto – 18.8 20.8 – 5.7 6.6 Ramos and Barros, 2007 11–16 7,400 self-reported National (2005/2006) 15.2 14.9 15.6 2.8 2.7 2.8 Matos et al., 2006 10–18 3,013 measured Lisbon and region (2000/2002) – 19.7 17.4 – 4.7 5.3 Marques-Vidal et al., 2008 356 Elmadfa 11.18 Romania18 Demographics Romania’s population was 21.58 million inhabitants in 2006 (51.3% females). People aged 0–14 years made up 15.4%, while those aged ≥65 years made up 14.7% of the total population. A decline in fertility (from 1.5 to 1.3 births per woman), a decline in birth rate (from 11.4 to 10.2/1,000 inhabitants), and an increase in the death rate (from 11.6 to 12.0/1,000) also occurred between 1992 and 2006 [NIS, 2006]. Life Expectancy The average life expectancy in Romania increased from 71.25 years in 2000 to 72.7 years in 2006 (69.2 years for men and 76.2 years for women), 6 years below the EU average (78.5 years in 2005) and 7 years below the average for the EU countries prior to May 2004 (79.7 years in 2005) [Vladescu et al., 2008]. Infant, Child, and Maternal Mortality Infant and maternal mortalities are among the highest in the European Region despite a large decline in maternal mortality since 1990. The infant death rate decreased from 26.9 (in 1990) to 13.9 infant deaths per 1,000 live births (in 2006) respectively [NIS, 2006]. The mortality rate under 5 years of age decreased from 34.3 per 1,000 live births (in 1990) to 16.5 per 1,000 live births (in 2006). Moreover, maternal mortality rates also decreased dramatically from 83.6 per 100,000 live births in 1990 to 32.8 and 15.5 in 2000 and 2006 respectively. Health Status and Main Causes of Death During the past decades, the morbidity and mortality patterns have changed, an increased prevalence of chronic diseases being observed. Lately, in 2006, the main causes of death [WHO Regional Office for Europe, 2007] were cardiovascular diseases 18 Vlad M; Institute of Public Health Cluj-Napoca, Cluj-Napoca, Romania. E-Mail mvlad1212@yahoo. com Table 11.58. Biochemical markers of Portuguese children (7–9 years old) [source: Pedrosa et al., 2008] Biochemical markers Mean ± SD Total cholesterol, mg/dl 167.4 ± 26.9 LDL, mg/dl 105.6 ± 23.7 HDL, mg/dl 50.4 ± 9.9 Triglycerides, mg/dl 71.7 ± 39.5