Fueling an epidemic of non-communicable disease in the Balkans: a nutritional survey of Bosnian adults
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Dietary surveys are essential for guiding national efforts to reduce the burden of non-communicable disease, but individual-level dietary data are lacking in many low- and middle-income countries. We aimed to estimate the prevalence of inadequate and excessive intakes of specific nutrients in Bosnia and Herzegovina.
A dietary survey among 853 adults using two 24-h recalls.
The majority of men (73%) and women (66%) were overweight/obese, and > 50% of participants had elevated blood pressure. Low intakes of N-3 polyunsaturated fatty acids, specifically α-linolenic acid (men: 94.4 mg/day among, women: 96.6 mg/day) and DHA + EPA (men: 18.2 mg/day, women: 16.0 mg/day), low fiber intake (women: 21.5 g/day), and high sodium (men: 3244 mg/day, women: 2291 mg/) and saturated fatty acids intakes (men: 29.2 g/day) were reported. There was also a suggestion of low intakes of vitamins A, B6, C and D (in both sexes), and of riboflavin, folate, B12 and calcium (in women).
Our findings provide initial evidence on the Bosnian population’s dietary habits and identify aspects that need attention. As the survey evolves into a continuing surveillance system, it will allow evaluation of dietary changes over time.
KeywordsDiet survey Nutrition assessment Nutrient intake Low- and middle-income countries SFA PUFA Usual nutrient intakes
This study was funded by the Department of Nutrition, Harvard T.H. Chan School of Public Health and the Institute for Statistics of the Federation on Bosnia and Herzegovina.
Compliance with ethical standards
Conflict of interest
Selma Gicevic declares that she has no conflict of interest. Audrey J. Gaskins declares that she has no conflict of interest. Teresa T. Fung declares that she has no conflict of interest. Bernard Rosner declares that he has no conflict of interest. Edin Sabanovic declares that he has no conflict of interest. Mirjana Gurinovic declares that she has no conflict of interest. Agnes Kadvan declares that she has no conflict of interest. Emir Kremic declares that he has no conflict of interest. Walter Willett declares that he has no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
- BHAS (2015) Household Budget Survey in Bosnia and Herzegovina: report. The Agency for Statistics of Bosnia and Herzegovina, SarajevoGoogle Scholar
- EFSA (2017) Dietary reference values for nutrients: summary report. EFSA supporting publication 2017Google Scholar
- EFSA Panel on Dietetic Products Nutrition, and Allergies (NDA) (2010) Scientific opinion on principles for deriving and applying Dietary Reference Values. EFSA J 8:1458Google Scholar
- FAO (2014) ICN2-second international conference on nutrition. http://www.fao.org/about/meetings/icn2/en/. Accessed Sept 2018
- FMHFBIH/IPHFBIH (2012) Federation of Bosnia and Herzegovina Adult Population Health Status Study. Federal Ministry of Health/Institute for Public Health of the Federation of Bosnia and Herzegovina, SarajevoGoogle Scholar
- Forouzanfar MH, Alexander L, Anderson HR, Bachman VF, Biryukov S, Brauer M et al (2015) Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 386:2287–2323CrossRefPubMedGoogle Scholar
- Gurinovic M, Milesevic J, Novakovic R, Kadvan A, Djekic-Ivankovic M, Satalic Z et al (2016a) Improving nutrition surveillance and public health research in Central and Eastern Europe/Balkan Countries using the Balkan Food Platform and dietary tools. Food Chem 193:173–180. https://doi.org/10.1016/j.foodchem.2015.03.103 CrossRefPubMedGoogle Scholar
- Gurinovic M, Milesevic J, Kadvan A, Nikolic M, Zekovic M, Djekic-Ivankovic M et al (2016b) Development, features and application of DIET ASSESS and PLAN (DAP) software in supporting public health nutrition research in Central Eastern European Countries (CEEC). Food Chem 238:186–194. https://doi.org/10.1016/j.foodchem.2016.09.114 CrossRefPubMedGoogle Scholar
- IOM (2001) Appendix I iron intakes and estimated percentile of the distribution of iron requirements from the continuing survey of food intakes by individuals (CSFII), 1994–1996. In: Dietary reference intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. The National Academies Press, Washington D.C, https://doi.org/10.17226/10026
- IOM (2003a) E adjustment of observed intake data to estimate the distribution of usual intakes in a group. In: Dietary reference intakes: applications in dietary planning. National Academies Press (US), Washington, D.C.Google Scholar
- IOM (2003b) Dietary reference intakes: applications in dietary planning. National Academies Press, Washington, D.C.Google Scholar
- Lachat C, Otchere S, Roberfroid D, Abdulai A, Seret FM, Milesevic J et al (2013) Diet and physical activity for the prevention of noncommunicable diseases in low- and middle-income countries: a systematic policy review. PLoS Med 10(6):e1001465. https://doi.org/10.1371/journal.pmed.1001465 CrossRefPubMedPubMedCentralGoogle Scholar
- Moshfegh A, Goldman J, Ahuja J, Rhodes D, LaComb R (2009) What we eat in America, NHANES 2005–2006: usual nutrient intakes from food and water compared to 1997 dietary reference intakes for vitamin D, calcium, phosphorus, and magnesium. US Department of Agriculture, Agricultural Research ServiceGoogle Scholar
- Pietrzik K (ed) (2012) Modern lifestyles, lower energy intake and micronutrient status. Springer, BerlinGoogle Scholar
- Rosner B (2011) Multisample reference. In: Seibert D (ed) Fundamentals of biostatistics, 7th edn. Brooks/Cole, Boston, p 566Google Scholar
- Topouchian J, Agnoletti D, Blacher J, Youssef A, Chahine MN, Ibanez I (2014) Validation of four devices: Omron M6 Comfort, Omron HEM-7420, Withings BP-800, and Polygreen KP-7670 for home blood pressure measurement according to the European Society of Hypertension International Protocol. Vasc Health Risk Manag 10:33–44PubMedPubMedCentralGoogle Scholar
- UNIEAGS (2014) A world that counts: mobilising the data revolution for sustainable development. Independent Expert Advisory Group SecretariatGoogle Scholar
- USHHS and USDA (2015) 2015–2020 Dietary Guidelines for Americans. U.S. Department of Health and Human Services and U.S. Department of AgricultureGoogle Scholar
- WHO (2008) Waist circumference and waist–hip ratio: report of a WHO expert consultation. World Health Organization, GenevaGoogle Scholar
- WHO (2010) Global recommendations on physical activity for health. World Health Organization, GenevaGoogle Scholar
- WHO (2012) Guideline: sodium intake for adults and children. World Health Organization, GenevaGoogle Scholar
- WHO (2014) European Food and Nutrition Action Plan 2015–2020. World Health Organization, CoppenhagenGoogle Scholar
- WHO (2015a) Bosnia and Herzegovina: WHO statistical profile 2012. WHO, GenevaGoogle Scholar
- WHO (2015b) Guideline: Sugars intake for adults and children. World Health Organization, GenevaGoogle Scholar
- WHO/FAO (2002) Diet, nutrition and the prevention of chronic diseases: report of a joint WHO/FAO expert consultation. World Health Organization/Food and Agriculture Organization, GenevaGoogle Scholar
- ZJZFBIH (2012) Health population survey in the Federation of Bosnia and Herzegovina. Public Health Institute FBiH, SarajevoGoogle Scholar