[Hungarian diet and nutritional status survey -- the OTAP2009 study. I. Nutritional status of the Hungarian population]

Anthropometric dimensions provide reliable estimates of abdominal adiposity: A validation study

Abdominal fat accumulation is a major risk factor for cardiometabolic morbidity and mortality. The purpose of the study is to assess the possibility of developing accurate estimation equations based on body measurements to determine total abdominal (TFA), subcutaneous (SFA) and visceral fat area (VFA). Hungarian volunteers (n=198) aged between 20 and 81 years were enrolled in the study, which was conducted between July and November 2014. All persons underwent anthropometric measurements and computer tomographic (CT) scanning. Sex-specific multiple linear regression analyses were conducted in a subgroup of 98 participants to generate estimation models, then Bland-Altman's analyses were applied in the cross-validation group to compare their predictive efficiency. The variables best predicting VFA were hip circumference, calf circumference and waist-to-hip ratio (WHR) for males (R²=0.713; SEE=5602.1mm²) and sagittal abdominal diameter (SAD), WHR, thigh circumference and triceps skinfold for females (R²=0.845; SEE=3835.6mm²). The SFA prediction equation included SAD, thigh circumference and abdominal skinfold for males (R²=0.848; SEE=4124.1mm²), body mass index and thigh circumference for females (R²=0.861; SEE=5049.7mm²). Prediction accuracy was the highest in the case of TFA: hip circumference and WHR for males (R²=0.910; SEE=5637.2mm²), SAD, thigh circumference and abdominal skinfold for females (R²=0.915; SEE=6197.5mm²) were used in the equations. The results suggested that deviations in the predictions were independent of the amount of adipose tissue. Estimation of abdominal fat depots based on anthropometric traits could provide a cheap, reliable method in epidemiologic research and public health screening to evaluate the risk of cardiometabolic events.

Large increase in the prevalence of self-reported diabetes based on a nationally representative survey in Hungary

AIMS

To estimate and compare the prevalence of self-reported diabetes based on nationally representative surveys of the Hungarian adult population in 2002 (published data - Hungarostudy) and a survey in 2012.

METHODS

A cross-sectional computer-assisted telephone interview survey on a stratified representative sample of community-dwelling adults (n=1000) in 2012. To describe self-reported diabetes prevalence and its temporal changes generalized linear models were used and results were compared to figures from Hungarostudy.

RESULTS

Age standardized prevalence of self-reported type 2 diabetes was 11.7% (95%CI 10.0-13.8%) without gender or rural-urban differences in 2012. People with self-reported diabetes were older than controls (mean [SE]: 63.9 [0.9] vs. 45.9 [0.3] years, p<0.0001). The prevalence of diabetes sharply increased after 40 years of age and peaked at age 70 (27.7% [2.5], p_age*age<0.0001). The prevalence of self-reported diabetes increased by 89% (OR 1.89, 95%CI 1.53-2.32) from 6.2 to 11.7% between the two surveys with the most pronounced increase in the age group 55-64 years (from 11.6 to 24.4%).

CONCLUSIONS

We reported an alarming increase in the prevalence of self-reported type 2 diabetes in the last decade that mostly affects working age people. If this trend continues, a major public health crisis in Hungary can be envisaged.

Distinct Penetrance of Obesity-Associated Susceptibility Alleles in the Hungarian General and Roma Populations

AIMS

The aim of our study was to explore differences in genetic predisposition to obesity between the Hungarian general and Roma populations.

METHODS

A total of 1,152 samples from the Hungarian Roma population and 1,743 samples from the Hungarian general population were genotyped for 20 single nucleotide polymorphisms (SNPs) associated with the risk of obesity. Two types of multilocus genetic risk scores were constructed to estimate the combined effect of selected SNPs.

RESULTS

Risk allele frequencies differed significantly between the two populations for 11 SNPs, with no enrichment in any of the two study groups. Variants (rs1558902, rs1121980, rs9939609, and rs9941349) in the fat mass and obesity-associated (FTO) gene exhibited strong but ethnicity-independent association with obesity. Genetic risk scores showed stronger associations with obesity in the Roma population compared with the Hungarian general population; however, without significant gene-population interaction.

CONCLUSION

Differences in obesity prevalence between the Hungarian general and Hungarian Roma populations could not be explained by their distinct genetic susceptibility, rather by ethnicity-related environmental and behavioral factors. Nonetheless, particular gene-environment interactions might contribute to the distinct penetrance of the obesity-associated genetic factors in populations of different ethnic backgrounds.

Overview of the Hungarian National Youth Fitness Study

The 2012 Public Act on Education in Hungary made daily physical education (PE) a mandatory part of the school day starting in the 2012-2013 school year. This directive was linked to a significant reorganization of the Hungarian education system including a new National Core Curriculum that regulates the objectives and contents of PE. The Hungarian School Sport Federation (HSSF) recognized the opportunity and created the Strategic Actions for Health-Enhancing Physical Education or Testnevelés az Egészségfejlesztésben Stratégiai Intézkedések (TESI) project. Physical fitness assessments have been a traditional part of the Hungarian PE program; however, the TESI plan called for the use of a new health-related battery and assessment system to usher in a new era of fitness education in the country. The HSSF enlisted the Cooper Institute to assist in building an infrastructure for full deployment of a national student fitness assessment program based on the FITNESSGRAM® in Hungarian schools. The result is a new software-supported test battery, namely the Hungarian National Student Fitness Test (NETFIT), which uses health-related, criterion-referenced youth fitness standards. The NETFIT system now serves as a compulsory fitness assessment for all Hungarian schools. This article details the development process for the test battery and summarizes the aims and methods of the Hungarian National Youth Fitness Study.

A public health threat in Hungary: obesity, 2013

BACKGROUND

In Hungary, the last wide-range evaluation about nutritional status of the population was completed in 1988. Since then, only limited data were available. Our aim was to collect, analyze and present updated prevalence data.

METHODS

Anthropometric, educational and morbidity data of persons above 18 y were registered in all geographical regions of Hungary, at primary care encounters and within community settings.

RESULTS

Data (BMI, waist circumference, educational level) of 40,331 individuals (16,544 men, 23,787 women) were analyzed. Overall prevalence for overweight was 40.4% among men, 31.3% among women, while for obesity 32.0% and 31.5%, respectively. Abdominal obesity was 37.1% in males, 60.9% in females. Among men, the prevalence of overweight-obesity was: under 35 y = 32.5%-16.2%, between 35-60 y = 40.6%-34.7%, over 60 y = 44.3%-36.7%. Among women, in the same age categories were: 17.8%-13.8%, 29.7%-29.0%, and 36.9%-39.0%. Data were presented according to age by decades as well. The highest odds ratio of overweight (OR: 1.079; 95% CI [1.026-1.135]) was registered by middle educational level, the lowest odds ratio of obesity (OR: 0.500; 95% CI [0.463-0.539]) by the highest educational level. The highest proportion of obese people lived in villages (35.4%) and in Budapest (28.9%). Distribution of overweighed persons were: Budapest (37.1%), other cities (35.8%), villages (33.8%). Registered metabolic morbidities were strongly correlated with BMIs and both were inversely related to the level of urbanization. Over the previous decades, there has been a shift in the distribution of population toward being overweight and moreover obese, it was most prominent among males, mainly in younger generation.

CONCLUSIONS

Evaluation covered 0.53% of the total population over 18 y and could be very close to the proper national representativeness. The threat of obesity and related morbidities require higher public awareness and interventions.

Obesity and hypertension

The frequency of hypertension and obesity is gradually growing in Hungary. At present 68.5% of men and 78% of women are obese. Hypertension and obesity are the most important risk factors of morbidity and mortality from cardiovascular disease. The relationship between increased sympathetic activity and hypertension is well known. Waist circumference and body fat mass correlate significantly with sympathetic activity, in which hyperlipidemia plays also a role. The increased activity of renin-angiotensin-aldosterone system via its vascular and renal effects also contributes to an increase of blood pressure. Increased sympathetic activity with decreasing vagal tone accompanying the imbalance of the autonomous nervous system is independent and significant risk factor of cardiovascular events including sudden cardiac death. Orv. Hetil., 154 (44), 1736–1742.

[Metabolic effects of bariatric surgery]

Bariatric surgery managing/preventing complications of severe overweight is nowadays widely accepted as a mainstay in the treatment of morbid obesity. Its role is particularly important in type 2 diabetes developing on the base of long-standing significant overweight. The glycemic control improves within days-weeks after these surgeries, when weight loss and reduction of the visceral fat mass is barely detectable. This short term effect is probably due to an increased secretion of glucagon-like peptide and, as a consequence, an improvement in hepatic insulin sensitivity as well as the whole body glucose uptake. Besides the prolonged glucagon-like peptide effects, the favourable long term effect of these operations - lasting for 10 years even after surgery - is the decrease of visceral fat mass and elimination of harmful influence of cytokines produced by the fatty tissue. The article overviews the metabolic effects of these procedures, their undoubted advantages and potential risks.

[Hungarian Diet and Nutritional Status Survey - the OTAP2009 study. IV. Macroelement intake of the Hungarian population]

The adequate intake of minerals is basically important for healthy nutrition.

AIM AND METHOD

The Hungarian Diet and Nutritional Status Survey - joining to the European Health Interview Survey - studied the dietary habits of the Hungarian population. The present publication describes the macroelement intake.

RESULTS

The salt intake is unusually high (17.2 g in men and 12.0 g in women), the potassium intake remains well below the recommendation. These factors substantially increase the risk of cardiovascular diseases including high blood-pressure. The calcium intake stays below the recommendation except in the youngest males, the oldest men and women are at risk from this point of view. While magnesium intake suited the recommendation, the intake of phosphorus exceeded it twice.

CONCLUSIONS

Focusing on marcroelements, high sodium/salt intake represents the highest public health risk. The implementation of STOP SALT! National Salt Reducing Programme, i.e. decrease the salt content of processed food and provide proper information to the population about excessive salt consumption, should result in a beneficial change of salt intake and ameliorate the public health conditions.

[Hungarian Diet and Nutritional Status Survey -- the OTAP2009 study. V. Intake of microelements in the Hungarian population]

For a healthy status the adequate intake of microelements is vital.

AIM AND METHOD

The Hungarian Diet and Nutritional Status Survey - joining to the European Health Interview Survey - studied the dietary habits of the Hungarian population. The present paper demonstrates the microelement intake.

RESULTS

While the intake of iron, copper and zinc was sufficient in males, it was deficient in females according to the Hungarian recommendations. Especially women in their reproductive age ingested iron below the recommendation, thus representing a health risk. In comparison to earlier Hungarian data, zinc and chromium intake decreased unfavorable.

CONCLUSIONS

Since in Hungary the consumption of the whole grain products with high trace element content is traditionally low, as also reflected in the present study, it would be desirable to increase the contribution of these foods in the diet in order to enhance the intake of microelements.

Hungarian Diet and Nutritional Status Survey – The OTAP2009 study. II. Energy and macronutrient intake of the Hungarian population

The Hungarian Diet and Nutritional Status Survey is the fourth in the row of the Hungarian national dietary surveys conducted by the Institute for Food and Nutrition Science. Aims: The present study was performed to provide valid, up-to-date data on energy and nutrient intakes and dietary habits of the Hungarian adult population. Methods: The energy and nutrient intakes were calculated on validated three-day dietary records of a representative sample by age and gender of the Hungarian population aged ≥18 ys. Results: The energy percentage of fat was too high (39 E% for men and 36 E% for women), that of carbohydrate was too low (45 E% for men and 48 E% for women), whereas that of protein met the recommendation (15 E% for men and 15 E% for women). Conclusions: Reduction of the nutritional risk factors would greatly reduce the mortality and morbidity rates of nutrition-related diseases. Orv. Hetil., 2012, 153, 1057–1067.

Hungarian Diet and Nutritional Status Survey – The OTAP2009 study. III. Vitamin intake of the Hungarian population

For the healthy status the adequate intake of vitamins is essential. Aim and method: The Hungarian Diet and Nutritional Status Survey – joining to the European Health Interview Survey – studied the dietary habits of the Hungarian population. This work presents the vitamins intake. Results: The intake of all water soluble vitamins, vitamin E and D were significantly higher in men than in women. Favourable phenomena were the increased β-carotene and vitamin C intakes in men and women compared to the earlier data. Intakes of vitamin C, B1-, B2-, B6- and B12, and niacin meet the recommendations. Crucially low intakes of vitamin D and folate were calculated in both genders, particularly in the elders, mainly in case of vitamin D. Imperfect intakes of panthotenic acid and biotin were also observed. Conclusions: For maintaining the adequate vitamin supply and for prevention of vitamin deficiency, diversified nutrition, information of the population on the basic principles of healthy nutrition and availability of healthy food are essential. Orv. Hetil., 2012, 153, 1106–1117.