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Table 1 Summary of all studies identified to assess saturated fat: design, population studied, and dietary assessment instruments used and details of validation and/or reproducibility. Studies were selected to be included in this review based on the following two criteria: (1) the instrument was tested for validity and (2) the instrument was used in more than two countries simultaneously which represent a range of European regions

From: A systematic review of methods to assess intake of saturated fat (SF) among healthy European adults and children: a DEDIPAC (Determinants of Diet and Physical Activity) study

Authors/Study Population Countries Instrument(s) Macronutrient intake Tested for validity > 2 countries/country range
Bondia-Pons et al. [35] Adults/Men
Age range not reported
(n = 160)
5 (Denmark, Finland Germany, Italy, Spain) 3-day record SFA (% energy) was calculated by converting food consumption into corresponding nutrient intake using validated nutrition software from each country
Other macronutrients (% energy): Protein, Carbohydrates, Fat, MUFA, PUFA
  X
EPIC [14, 36,37,38,39] Adults
35–70 years
(n = 519,978)
10 (Denmark, England, France, Germany, Greece, Italy, the Netherlands, Norway, Spain, Sweden) FFQa
24-HDR
SFA (g/day) was calculated from 24-HDR data using EPIC Nutrient DataBase (ENDB) created to aid cross-country harmonisation of data [73]
Other macronutrients: Total Fat, MUFA, PUFA
Origin of fat: animal, plant, unknown/mixed
F&V intake [23]
SSBs intake [74]
X [63]
Belgium, the Czech Republic, France, the Netherlands and Norway
X
Esteve et al. [40] Adults/Controls
Age range not reported
(n = 2736)
4 (France, Italy, Spain, Switzerland) FFQ SFA (g/day) was calculated using an ad hoc food-composition table compiled by INSERM on the basis of those published by McCance and Widdowson and revised by Paul and Southgate
Other macronutrients:
Protein (Total / Animal / Vegetable), Carbohydrates, Fibers, Total lipids, MUFA, PUFA
  X
Food Habits in Later Life [27, 41] Adults/Elderly
70+ years
(n = 453)
2 (Greece, Sweden) FFQ SFA (g/day) was calculated using validated nutrition software (NUTTAB 1995), which is based on Australian FCTs modified to include additional Greek dishes and Swedish foods
Other macronutrients: MUFA, PUFA, Carbohydrate, Protein
Food sources:
Olives, Olive oil, Other oil, Butter, Margarine
[As Swedish data did not have a separate oil/fats food group because they were included in various recipes/dishes, they were unable to identify the quantity of oil/fat used in dishes in order to generate this food group and thus excluded the Swedish data when analysing fat intake]
  
Food4Me [42,43,44] Adults
(n = 5562)
17–79 years
7 (Ireland, the Netherlands Spain, Greece, UK, Poland, Germany) FFQ (Web-based) SFA (% total energy), SFA (g)
Nutritional composition and portion sizes were calculated from the 2008–2010 National Adult Nutrition Survey (NANS) database [43]
Other macronutrients: MUFA, PUFA, Carbohydrates, Protein
F&V intake [23]
SSBs intake [74]
X [42, 43]
UK
Comparison with EPIC-Norfolk FFQ using a sample of 117 participants [43]
Reproducibility tested using test-retest (n = 100) on 2 occasions 4 weeks apart [42]
Validated using a 4-day weighed food record [42]
X
HAPIEE [45] Adults
(n = 28,947)
3 (Russia, Poland, Czech Republic) FFQ Saturated fat (g/day).
McCance and Widdowson’s
FCD
Other macronutrients (g/day): Total carbohydrate, Protein, Total fat, PUFA, Trans fat
Food sources: Animal fats and oils
X [75]
UK
Based on the Whitehall II questionnaire. Validated against a 7-day diet diary and biomarkers of nutrient intake by Brunner et al. [75]
Assessed by energy-adjusted correlations, mean or median differences, and exact level of agreement.
 
IMMIDIET [31, 46] Adults
26–65 years
(n = 802)
3 (Belgium, England, Italy) FFQ Total saturated lipids (% kcal/day) was calculated using Nutrition Analysis of FFQ (NAF), a computer programme used to convert the questionnaire dietary data into frequencies of consumption and average daily quantities of foods (energy and nutrients consumed). NAF was linked to the McCance FCT, the Italian FCT for Epidemiological studies, and the Dutch NEVO and Flemish-Belgian Nubel FCTs
SF sub-types: myristic (C14), plamitic (C16), stearic (C18), arachidic (C20)
Other macronutrients: unsaturated fats
Food sources (food product groups used in dietary pattern analysis) (g/day): Starches, Cabbages and root vegetables, Leafy vegetables and tomatoes, Fruit and fruit or vegetable juices, Dairies, Cheese, Pasta and rice, Red meat and processed products, White meat and products, Fishes, Mollusks, Vegetable oils, Olive oil, Nuts and pizza, Sweets and sugars, Snacks, Chocolate coffee and tea, Mayonnaise, Alcoholic drinks
X [31]
Belgium.
UK and Netherlands FFQ validated as part of the EPIC study.
Belgian FFQ was validated by Van Dongen et al. [31]
X
North/South Food consumption project [34, 47] Adults
18–64 years
(n = 1379)
2 (Northern Ireland, Republic of Ireland) 7-day record SFA (g/day), SFA (% energy), and % contribution of the major food groups to SFA, were calculated by analysing food using WISP, which used the McCance and Widdowson’s Composition of Foods 5th Edition, and also included additional data (including analysis of recipes of composite dishes, manufacturer’s data on Irish foods and new products).
Other macronutrients (g):
Protein, Fat, Carbohydrate, Total sugars
Food sources (contribution to daily fat intake):
Meat and meat products. Butter spreading fats and oils, Biscuit cakes pastries and puddings, Milk and yoghurt, Potatoes and potato products, Sugars preserves confectionary and savoury snacks, Vegetables and vegetable dishes including pulses, Breads and rolls, Cheese, Eggs and egg dishes, Fish and fish dishes, Flours grains starches rice pasta and savouries, Soups sauces and miscellaneous foods, Creams ice-creams and chilled desserts
  
Parfitt et al. [48] Adults/Students
18–32 years
(n = 48)
2 (England, Italy) 5 or 7-day record SF (% of total fat) was calculated by converting food consumption into corresponding nutrient intake with validated nutrition software from each country: England: Salford Microdiet version 7, a computer software based on and updated from McCance and Widdowson’s FCTs,Italy: Foodometer, computer software, using data from the Italian National Institute of Nutrition
Other macronutrients: MUFA, PUFA
  
PURE [32, 49] Adults
30–70 years
>  154,000 men and women in the PURE study on a whole.
3 European.
4 LIC: Zimbabwe, Bangladesh, India, and Pakistan; 10 MIC: South Africa, Brazil, Argentina, Colombia, Chile, Poland, China, Malaysia, Iran, and Turkey; and 3 HIC: Canada, Sweden, and UAE.
FFQ SFA (g/day) was calculated from the Polish version of the FFQ using a master international nutrient database which has been created primarily based on the United States Department of Agriculture (Washington, D.C.) FCD and modified appropriately with reference to local FCT, and supplemented with recipes of locally eaten mixed dishes
Other macronutrients: Protein, Fat, Carbohydrate, MUFA, PUFA
X [49]
Poland.
To validate the shortened FFQ, a convenience sample (n = 146) of the PURE study participants in an urban (n = 73) and rural (n = 73) setting were recruited. The FFQ administered twice, approx. 1 year apart.
X
Seven Countries Study [50, 51] Adults/Men
40–59 years at enrolment
70–89 years at 30 year follow up [50]
(n ≈ 11,500)
7 (Finland, Greece, Italy, Japan, The Netherlands, USA, Yugoslavia) Cross-check dietary history method SF (g) were calculated for each cohort using information obtained from buying food products representing the average daily intake in a cohort and analysing for composition of SF [51]
SF (% energy) was calculated using computerised versions of local food tables [50]
Other macronutrients: Protein (% energy), MUFA (% energy), PUFA (% energy), Carbohydrate (% energy), Fibre (g/1000 kcal) F&V intake [23]
Tested for reproducibility only. [64]
The reproducibility of food intake was investigated in repeated surveys carried out three and 12 months after the initial survey, by Bloemberg et al. [64]
X
SENECA [52, 53] Adults/Elderly
(n ≈ 2600)
70–75 years
12 (Belgium, Denmark, France, Greece, Hungary, Italy, Netherlands, Norway, Poland, Portugal, Spain, Switzerland) Modified dietary history method comprising a 3-day estimated record and meal-based frequency checklist SFA (% energy)
Foods were translated into nutrients by using country-specific food-composition tables [52]
Other macronutrients: PUFA, Protein, Fibre
F&V intake [23]
SSBs intake [74]
X [65]
Validated against a 3-day weighed record [65].
X
Van Diepen et al. [54] Adults/Students
Age range not reported
(n = 185)
2 (Greece, the Netherlands) 24-HDR SFA (% energy) was calculated using ‘Food Processor 7.40, a computer software of which had the addition of Greek and Dutch recipes. It used estimated levels of intake
Other macronutrients: MUFA, PUFA, Fibre, Protein, Carbohydrates
  
Van Oostrom et al. [55] Adults
20–55 years
(n = 94)
2 (The Netherlands, Spain) 3-day record SF (g) and SF (% energy) were calculated using validated nutrition software from each country: The Netherlands: Dutch Nutrient Database Spain: Nutrition tables for Spain.
Other macronutrients: Total fat, MUFA, PUFA, Carbohydrates, Protein
  
WHO-MONICA EC/MONICA Project optional nutrition study [33, 56] Adults
45–64 years
(n = 7226)
9 (Northern Ireland (Belfast), UK (Cardiff), Denmark, Finland, Belgium, Germany, France, Italy, Spain)
4 (Sub-study comprising of Germany, Finland, France and Northern Ireland)
2 (Sub study comprising of France and Northern Ireland)
3-day and 7-day records Food consumption was converted into corresponding nutrient intake using validated nutrition software from each country [76];SFA (g) were calculated by Evans et al... [56];SFA (% energy) was calculated by Winkler et al. [76] using local FCT from the 4 countries
Other macronutrients: PUFA, MUFA, Carbohydrates, Protein
  X
ZENITH [57] Adults/Elderly
55–87 years
(n = 387)
3 (France, Italy, Northern Ireland) 4-day recall method SFA (g/day) was calculated using food consumption data were converted into energy, macro- and micronutrients using relevant FCTs for each country. For foods and nutrients not available in the FCTs, these were assigned the compositions of similar foods derived from other databanks
Other macronutrients: Total fat, MUFA, PUFA, Carbohydrates, Fibre, Protein
  X
HELENA [28, 29, 58, 59] Adolescents
12–17 years
(n = 3000)
9 (Austria, Belgium, France, Germany, Greece, Hungary, Italy, Sweden, Spain) 24-HDR SFA (% of total fat) was calculated by using the German Food Code and Nutrient Data Base (Bundeslebensmittelschlussel, BLS, Version II.3.1) [59]
Other macronutrients: Carbohydrates, Protein, Fat, PUFA, MUFA, Fibre Correlations between food groups and fatty acid intake (SFA, PUFA and MUFA) examined [59]
F&V intake [23]
SSBs intake [74]
X [58, 67]
24-HDR evaluated by Vereecken et al. [58, 67]
Intakes of energy and eight nutrient components calculated using different FCTs approaches were compared [66]
X
EYHS [60] Children
9 years, 15 years
(n = 2182)
2 (Sweden, Estonia) 24 HDR supplemented with a 2-day record SF (% energy) was calculated using validated nutrition software from each country: Sweden: Nutrient intake data were analysed in Sweden using the Swedish FCD PC-kost (maintained by the Swedish National Food Administration), Estonia: The Finnish FCD Micro-Nutrica 2.0 (modified and translated into the Estonian language at Tallinn University of Technology, Department of Food Processing)
Other macronutrients: Protein, Carbohydrate, Fat, MUFA, PUFA, Fibre
  
IDEFICS [30, 61] Children
(n = 16,864)
2–9 years
[14,972 children proxies completed the FFQ.
14,863 recall interviews completed]
8 (Belgium, Cyprus, Estonia, Germany Hungary, Italy, Spain, Sweden) FFQ
24-HDR
Linking to country-specific FTCs, and using the SACINA data daily intake (g/day) of all food groups the ratio of unsaturated to saturated fats was calculated [61]
F&V intake [23]
SSBs intake [74]
X [67,68,69,70,71]
SACINA is based on the YANA-C instrument validated as part of the HELENA study by Vereecken et al. [67]
SACINA was validated by Börnhorst et al. [68] using the doubly labelled water technique
The CEHQ-FFQ has been validated using 2 24-HDRs [71]
The reproducibility of CEHQ-FFQ has been examined by Lanfer et al. [69], and the validity by Huybrechts et al. [70]
X
Piqueras et al. [62] Children
(n = 176)
4 years
3 (Spain, Germany, Hungary) FFQ SF (g) and SF (% energy) were calculated using the program CESNID and the database used for the nutrient analysis was the 3rd edition of CESNIDs food tables X [72]
Sweden
FFQ based on one used in MONICA which was validated by Johanasson et al. [72]
X
  1. FFQ Food Frequency Questionnaire, 24-HDR 24 h dietary recall, F&V Fruit and Vegetable, SSBs Sugar-Sweetened Beverages, MUFA Monounsaturated Fatty Acids, PUFA Polyunsaturated Fatty Acids, EPIC European Prospective Investigation into Cancer and Nutrition, EYHS European Youth Heart Study, HELENA Healthy Lifestyle in Europe by Nutrition in Adolescence, HAPIEE Health, Alcohol and Psychosocial factors in Eastern Europe, IDEFICS Identification and prevention of Dietary- and lifestyle-induced health EFfects In Children and infantS, PURE Prospective Urban Rural Epidemiology, SENECA Survey in Europe on Nutrition and the Elderly; a Concerted Action, WHO-MONICA The World Health Organization Multinational MONItoring of trends and determinants in CArdiovascular disease, ZENITH Zinc Effects on Nutrient/nutrient Interactions and Trends in Health and Aging
  2. aEPIC FFQs were country-specific, and as a result are not discussed in the review