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Energy intake and sources of energy intake in the European Prospective Investigation into Cancer and Nutrition

European Journal of Clinical Nutrition volume 63, pages S3–S15 (2009)Cite this article

Abstract

Objectives:

To describe energy intake and its macronutrient and food sources among 27 regions in 10 countries participating in the European Prospective Investigation into Cancer and Nutrition (EPIC) study.

Methods:

Between 1995 and 2000, 36 034 subjects aged 35–74 years were administered a standardized 24-h dietary recall. Intakes of macronutrients (g/day) and energy (kcal/day) were estimated using standardized national nutrient databases. Mean intakes were weighted by season and day of the week and were adjusted for age, height and weight, after stratification by gender. Extreme low- and high-energy reporters were identified using Goldberg's cutoff points (ratio of energy intake and estimated basal metabolic rate <0.88 or >2.72), and their effects on macronutrient and energy intakes were studied.

Results:

Low-energy reporting was more prevalent in women than in men. The exclusion of extreme-energy reporters substantially lowered the EPIC-wide range in mean energy intake from 2196–2877 to 2309–2866 kcal among men. For women, these ranges were 1659–2070 and 1873–2108 kcal. There was no north–south gradient in energy intake or in the prevalence of low-energy reporting. In most centres, cereals and cereal products were the largest contributors to energy intake. The food groups meat, dairy products and fats and oils were also important energy sources. In many centres, the highest mean energy intakes were observed on Saturdays.

Conclusions:

These data highlight and quantify the variations and similarities in energy intake and sources of energy intake among 10 European countries. The prevalence of low-energy reporting indicates that the study of energy intake is hampered by the problem of underreporting.

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Acknowledgements

The work described in this paper was carried out with the financial support of the European Commission: Public Health and Consumer Protection Directorate 1993–2004; of the Research Directorate-General 2005; Ligue contre le Cancer (France); Société 3M (France); Mutuelle Générale de l'Education Nationale; Institut National de la Santé et de la Recherche Médicale (INSERM); Institut Gustave Roussy; German Cancer Aid; German Cancer Research Center; German Federal Ministry of Education and Research; Danish Cancer Society; Health Research Fund (FIS) of the Spanish Ministry of Health; Spanish Regional Governments of Andalucía, Asturias, Basque Country, Murcia and Navarra and the Catalan Institute of Oncology; and ISCIII RETIC (RD06/0020), Spain; Cancer Research UK; Medical Research Council, UK; the Stroke Association, UK; British Heart Foundation; Department of Health, UK; Food Standards Agency, UK; the Wellcome Trust, UK; Greek Ministry of Health; Hellenic Health Foundation; Italian Association for Research on Cancer; Italian National Research Council, Regione Sicilia (Sicilian government); Associazione Iblea per la Ricerca Epidemiologica—ONLUS (Hyblean association for epidemiological research, NPO); Dutch Ministry of Health, Welfare and Sport; Dutch Prevention Funds; LK Research Funds; Dutch ZON (Zorg Onderzoek Nederland); World Cancer Research Fund (WCRF); Swedish Cancer Society; Swedish Research Council; Regional Government of Skane and the County Council of Vasterbotten, Sweden; Norwegian Cancer Society; the Norwegian Research Council; and the Norwegian Foundation for Health and Rehabilitation. We thank Sarah Somerville, Nicole Suty and Karima Abdedayem for assistance with editing and Kimberley Bouckaert and Heinz Freisling for technical assistance.

Author information

Author notes

  1. P Ferrari

    Present address: 27Current address: Data Collection and Exposure Unit (DATEX), European Food Safety Authority, Parma, Italy.,

  2. J Linseisen

    Present address: 28Current address: Data Institute of Epidemiology, Helmholtz Centre Munich, Neuherberg, Germany.,

  3. S Bingham: The author is deceased.

Authors and Affiliations

  1. National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands

    M C Ocké, S W van den Berg & H B Bueno-de-Mesquita

  2. Public Health Department of Guipuzkoa, Basque Government, San Sebastian and CIBER Epidemiología y Salud Pública (CIBERESP), Spain

    N Larrañaga

  3. Department of Preventive & Predictive Medicine, Nutritional Epidemiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy

    S Grioni

  4. Dietary Exposure Assessment Group, International Agency for Research on Cancer, Lyon, France

    P Ferrari, S Rinaldi & N Slimani

  5. Molecular and Nutritional Epidemiology Unit, ISPO, Florence, Italy

    S Salvini

  6. Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece

    V Benetou, E Moutsiou & A Trichopoulou

  7. Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany

    J Linseisen & R Kaaks

  8. Department of Clinical Sciences, Lund University, Malmö, Sweden

    E Wirfält

  9. Lifestyle and Cancer Group, International Agency for Research on Cancer, Lyon, France

    M Jenab

  10. Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark

    J Halkjær

  11. Department of Clinical Epidemiology, Aalborg Hospital, Aarhus University Hospital, Aalborg, Denmark

    M U Jakobsen

  12. Inserm, ERI 20, Institut Gustave Roussy, Villejuif, France

    M Niravong & F Clavel-Chapelon

  13. Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany

    M Bergmann

  14. Cancer Registry, Azienda Ospedaliera ‘Civile - M.P. Arezzo’, Ragusa, Italy

    C Lauria

  15. Institute for Scientific Interchange Foundation, Turin, Italy

    C Sacerdote

  16. Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, The Netherlands

    P H M Peeters

  17. Cancer Registry of Norway, Oslo, Norway

    A Hjartåker

  18. Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway

    C L Parr

  19. Department of Epidemiology, Murcia Health Council, Murcia and CIBER Epidemiología y Salud Pública (CIBERESP), Spain

    M J Tormo

  20. Andalusian School of Public Health, Granada and CIBER Epidemiología y Salud Pública (CIBERESP), Spain

    M J Sanchez

  21. Department of Surgery, Malmö University Hospital, Malmö, Sweden

    J Manjer

  22. Department of Nutritional Research, University of Umeå, Umeå, Sweden

    V Hellstrom

  23. Department of Public Health and Primary Care, MRC Centre for Nutritional Epidemiology in Cancer Prevention and Survival, University of Cambridge, Cambridge, UK

    A Mulligan & S Bingham

  24. Cancer Epidemiology Unit, University of Oxford, Oxford, UK

    E A Spencer

  25. Department of Epidemiology, Public Health and Primary Care, Imperial College, London, UK

    E Riboli

  26. Diet and Cancer Group, MRC Dunn Mitochondrial Biology Unit, Cambridge, UK

    S Bingham

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  1. M C Ocké
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  34. N Slimani
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Corresponding author

Correspondence to M C Ocké.

Additional information

Guarantor: MC Ocké.Contributors: MO carried out statistical analysis, prepared tables and figures and wrote the paper, taking into account comments from all co-authors. NS was the overall coordinator of this project and of the EPIC nutritional databases (ENDB) project. MO, NS, NL, SG, SB, PF, SS, VB, JL and EW were members of the writing group and gave input on statistical analysis, drafting of the paper and interpretation of results. The other co-authors were local EPIC collaborators involved in the collection of data, and in documenting, compiling and evaluating the subset of their national nutrient databases used in the ENDB. ER is the overall coordinator of the EPIC study. All co-authors provided comments and suggestions on the paper and approved the final version.

Appendix

Appendix

Table A1

Table a1 Minimally adjusteda mean daily intakes of total energy (kcal) by centre ordered from south to north, gender and age group
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Ocké, M., Larrañaga, N., Grioni, S. et al. Energy intake and sources of energy intake in the European Prospective Investigation into Cancer and Nutrition. Eur J Clin Nutr 63 (Suppl 4), S3–S15 (2009). https://doi.org/10.1038/ejcn.2009.72

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