Dietary Patterns in Overweight and Obese Subjects with Obstructive Sleep Apnea

Transkrypt

1 original papers Adv Clin Exp Med 2010, 19, 6, ISSN X Copyright by Wroclaw Medical University Monika Bronkowska, Marcin Gołecki 2, Justyna Słomian 1, Anna Markiewicz 1, Jolanta Mikołajczak 1, Monika Kosacka 2, Irena Porębska 2, Renata Jankowska 2, Jadwiga Biernat 1 Dietary Patterns in Overweight and Obese Subjects with Obstructive Sleep Apnea Ocena podaży podstawowych składników odżywczych oraz grup produktów w całodziennych racjach pokarmowych otyłych osób z rozpoznanym obturacyjnym bezdechem sennym 1 Division of Human Nutrition, Department of Food Storage and Technology, Wrocław University of Environmental and Life Sciences, Poland 2 Lower Silesian Pulmonary Center, Department and Clinic of Pulmonology and Lung Cancers, Wrocław Medical University, Poland Abstract Objectives. The aim of the study was to evaluate selected nutrients and food product groups in the daily food intake of obese patients diagnosed with obstructive sleep apnea (OSA). Material and Methods. The eating habits of 93 patients, including 22 women and 71 men, were evaluated from 2006 to The 72-hour dietary recall method and diet history were used to evaluate dietary intake. Results. The study showed that the food intake of women and men differ greatly with regard to the individual supply of energy and major nutrients. Analyses demonstrated an incorrect diet structure in patients with OSA in terms of the percentages of energy derived from fats, protein and carbohydrates. In the average food ration of the men and women surveyed the percentages of energy derived from fat, protein and carbohydrates reached 37%, 17.5% and % respectively. The analyzed diets were found to include a high percentage of meat and meat, as well as of eggs. The diets were also characterized by a low content of cereal, vegetables, fruits, milk and dairy. The study also involved determining BMI values for all the patients under scrutiny. The entire surveyed group of patients diagnosed with OSA was characterized by incorrect BMI values. Conclusions. The mean energy intake of the surveyed patients with OSA was close to the recommended healthy level, yet its dietary structure is incorrect (Adv Clin Exp Med 2010, 19, 6, ). Key words: obstructive sleep apnea, selected nutrients, daily food rations, obese patients. Streszczenie Cel pracy. Ocena podaży podstawowych składników odżywczych oraz grup produktów w całodziennych racjach pokarmowych otyłych osób z rozpoznanym obturacyjnym bezdechem śródsennym. Badania przeprowadzono w grupie 22 kobiet oraz 71 mężczyzn. Wyniki. Na podstawie analizy ilościowej wykazano duże zróżnicowanie w indywidualnej podaży energii oraz głównych składników odżywczych. Stwierdzono także niewłaściwą strukturę diet chorych na OBS pod względem procentowego udziału energii pochodzącej z białka, tłuszczu i węglowodanów. W średniej racji pokarmowej badanych kobiet i mężczyzn udział energii pochodzącej z tłuszczu, białka i węglowodanów wynosił odpowiednio 37; 17,5 i 46,8 50,2%. W ocenie ilościowej oszacowano także spożycie poszczególnych grup produktów spożywczych. Wykazano duży udział w diecie mięsa i jego przetworów, jaj, innych tłuszczów, a mały warzyw, owoców, produktów zbożowych oraz mleka i jego przetworów. Badanej grupie obliczono także wskaźnik BMI. Wśród badanych osób żadna nie charakteryzowała się prawidłowym wskaźnikiem BMI (Adv Clin Exp Med 2010, 19, 6, ). Słowa kluczowe: obturacyjny bezdech senny, składniki odżywcze, całodzienne racje pokarmowe.

2 710 M. Bronkowska et al. Rational nutrition is a fundamental determinant of health status. Understood as supplying a person with energy and all nutrients, it allows vitality to be maintained for years. It is also an indispensable element in the prevention of many chronic noninfectious diseases, including atherosclerosis, diabetes, hypertension, obstructive sleep apnea and obesity. In the last thirty years studies have demonstrated a close relationship between obesity and breathing disorders (dyspnea) during sleep. Epidemiologically, the key risk factor for the obstructive sleep apnea syndrome (OSA syndrome) is obesity. The occurrence of organic complications that result independently from both obesity and the apnea syndrome points to the strength of that relationship [1 3] The incidence of sleep apnea in obese persons is higher than in the population as a whole. It seems to have been proven that the simultaneous occurrence of obesity and the OSA syndrome is a special risk factor in the development of arterial hypertension [4]. Obstructive sleep apnea is the most frequently occurring syndrome among breathing disorders during sleep. The recent growing interest in that disease has been mainly due to its negative impact on human health. In Poland, research on the OSA syndrome has been sparse. In one epidemiological study, the incidence of the sleep apnea syndrome was shown to be higher in men than in women between the ages of 40 and 70 years [5]. The present study was aimed at evaluating the eating habits of obese patients diagnosed with obstructive sleep apnea, with consideration given to food product groups in their daily food intake. Material and Methods From 2006 to 2008, the eating habits of 93 patients, including 22 women and 71 men were evaluated; all the patients had been diagnosed with OSA and were being treated at the Lower Silesian Pulmonary Center in Wrocław, Poland. Food intake assessment was carried out on data collected using the 72-hour recall method. In the quantitative evaluation, use was made of the Photo Album of Products and Dishes elaborated at the National Food and Nutrition Institute [6]. Food rations were analyzed with Energia v. 2 software, containing a database created by the authors based on Tables of the Nutritional Value of Chosen Food Products [7] and The Composition and Nutritive Value of Dishes [8], setting forth the energy value and levels of 11 nutrients (energy, total protein, plant-derived protein, animal-derived protein, total carbohydrates, dietary fiber, total fats, saturated fatty acids, monounsaturated fatty acids, polyunsaturated fatty acids, cholesterol, Keys index). Assessment of the eating habits of the participating patients was carried out using Polish recommendations [9] in the weighted form, taking into account the respective percentages of women and men aged between 26 and 60 and those over 60 years of age. The authors adopted the recommendations of WHO [10] and national publications [11] regarding the intake of fatty acids: the recommended percentage of total energy intake derived from saturated fatty acids (SFA) should be 8%; from monounsaturated fatty acids (MUFA) 11%; and from polyunsaturated fatty acids (PU- FA) 6%. The Keys index of diet atherogenicity was calculated from the formula [1.35 (2 %en. from SFA %en. from PUFA) cholesterol mg/1000 kcal] [12]. The results are presented in Tables 1 and 2 in the form of mean value, median, standard deviation as well as maximal and minimal values. The results obtained were divided according to the percent of correspondence with the recommendations in the health-promoting model, i.e. ranges of 0 30%, 30 50%, 50 70%, 70 90%, %, % and over 130%; with the % range acknowledged as appropriate and consistent with recommendations. Calculations of groups of food in individual diets were also performed using Energia v. 2 software with the database described above. The patients consumption of groups of food (g/day) in the weighted form was compared with the model food rations proposed by Turlejska [13], whose recommendations are presented in terms of the main in a given group [13]. The calculations were based on the following conversion factors: 100 g of flour was assumed to correspond to 135 g of bread; 100 ml of milk to 10 g of aged cheese and 15 g of fresh white cheese; and 100 g of meat to 70 g of cured meat [13]. BMI was assessed on the basis of the height and weight of the respondents. On account of the group s diversity, the results obtained for women and men were not subjected to statistical analyses. Results and Discussion The mean age of the examined population was 57.7 years (62.3 years in the group of women and 56.2 years in the group of men). It is worth noting that approximately 82% of the patients were over 50 years of age. All the subjects had been diagnosed with OSA. The strongest degree of the

3 Dietary Patterns in Obese Subjects with OSA 711 disorder was observed in 59.2% of the patients; a moderate degree in 30.6%, and a mild degree in 10.2%. For 73.5% of the subjects, it was the first hospital stay linked with OSA treatment; for 22.4% of the group it had been less than six months since the last hospitalization. In the population surveyed, 51% of the people originated from a city; 22.4% were from a town with fewer than 50,000 inhabitants; and 26.5% were from rural areas. Over half the patients (55.1%) lived with their spouses and children; the rate among men was higher (67.6%). In terms of education, the surveyed population was diversified: 4.1% had only primary education; 22.4% had vocational education; 51.0% had secondary education; and 22.4% had higher education. A majority of the women surveyed (58.3%) and close to half the men (48.6%) had secondary education. Among the patients examined, 49% were living on a retirement pension. The majority of the women (66.7%) were retirement/social pensioners, and 25% did not work. Among the men, 21.6% were white-collar workers, and 13.5% had light physical jobs. In addition, 10.8% of the male group were persons running their own small businesses. In the case of 75.0% of the women and 91.9% of the men, OSA treatment was being conducted by means of the CPAP method the most common, non-invasive and highly effective method used to eliminate apnea, using devices that generate positive air pressure in the respiratory airways. Weight reduction was recommended for all the patients. A lack of irregularities in rest metabolism and thermogenesis observed in conjunction with OSA indicates that, apart from physiological factors, an increase in body mass since the appearance of OSA symptoms is likely to result from patients improper lifestyle e.g. a syndrome of compulsive food consumption during night awakenings, and low physical activity connected with (among other things) feeling of drowsiness and stress [14]. It may be concluded, therefore, that in this group of patients the high incidence of overweight and obesity is affected to a great extent by improper eating habits. For these patients, in the process of both losing weight and maintaining a reduced body mass, properly balancing the diet in terms of the levels of particular nutrients is of the outmost significance [15]. The study indicated that the food rations of women and men differ greatly in terms of energy supply and the levels of major nutrients. The mean energy value of the diets of women with OSA was lower than the Recommended Dietary Allowances (RDA), i.e. 73.1% (Table 1). A slightly higher energy value was found in the men s group: 82.2% of the RDA (Table 2). An assessment of the patients diets in relation to the recommended norms revealed that only 17.8% of women and 19.8% of the men were in the correct range (90 110%) of the RDA for energy intake. In 43.7% of the women s diets and 39.7% of the men s, analyses revealed energy deficiencies at levels from 50% to 90% of the RDA (Tables 3 and 4). It has been claimed that persons consuming high-energy diets are especially at risk of developing overweight and obesity [16]. In the current study, an excessive energy supply over 110% of the RDA was observed in 12.6% of the women s diets (Table 3) and in 31.8% of the men s (Table 4). Energy intake close to the current RDA (84.5%) was also demonstrated in a survey conducted in 2001 (the Pol MONICA BIS study) in Warsaw and the former Tarnobrzeskie Province (Poland) [17]. The energy value of the food rations of women and men were1702 kcal and kcal respectively, and were similar to the findings of the current study. Despite the excessive supply of meat and meat (women: 147.6% of the RDA, men: 214.4% of the RDA) and eggs (women: 154.4% of the RDA, men: 185.6% of the RDA) demonstrated in the study, the high energy value of the patients diets was additionally affected by a low intake of other food groups (Fig. 1 and 2). Analyses revealed an incorrect diet structure among patients with OSA in terms of the percentage of energy derived from protein, fats and carbohydrates. In the case of obese people, the high contribution of energy derived from fats was especially unfavorable: In both the women s and men s groups it was approximately 37%, as compared to the recommended level of 25%. The average diet of the men and women surveyed was also characterized by a low level of energy from carbohydrates: %. Incorrect values were also demonstrated with respect to protein-derived energy, which was too high in both groups in the study, reaching 17.5%. Similar results were obtained by Niedworok et al. [16], who evaluated the eating habits of obese women at the age of and over 60. They demonstrated that in each age group the women s diets were characterized by an energy level lower than the RDA. In the group of women over 60 years of age and with a BMI > 30, the intake of fat exceeded the recommended value and accounted for 36.2% of the total energy intake. Carbohydrates accounted for 50% of the total energy intake. A similar high level of energy derived from fats (37.8%) and proteins (16.1%)was observed by Przysławski [18] in the diets of obese women in the post-menopausal period.

4 712 M. Bronkowska et al. Table 1. Energy and basic nutrients in the diets of overweight and obese women diagnosed with obstructive sleep apnea (n = 22) Tabela 1. Energia i podstawowe składniki odżywcze w racjach pokarmowych otyłych kobiet z rozpoznanym obturacyjnym bezdechem sennym (n = 22) Energy and nutrients (Wartość energetyczna i składniki odżywcze) Mean value (Średnia) Standard deviation (Odchylenie standardowe) Min. (Min.) Max (Maks) Median (Mediana) Recommended Dietary Allowances (RDA) (Zalecane spożycie) Level of meeting of the RDA [%] (% realizacji zalecanego spożycia) Energy [MJ] (Wartość energetyczna [MJ]) Energy [kcal] (Wartość energetyczna [kcal]) Total protein [g] (Białko ogółem [g]) Plant-derived protein [g] (Białko roślinne [g]) Animal-derived protein [g] (Białko zwierzęce [g]) Total carbohydrates [g] (Węglowodany ogółem [g]) Dietary fiber [g] (Błonnik pokarmowy [g]) Total fats [g] (Tłuszcze ogółem [g]) Saturated fatty acids [g] (Nasycone kwasy tłuszczowe [g]) Monounsaturated fatty acids [g] (Jednonienasycone kwasy tłuszczowe [g]) Polyunsaturated fatty acids [g] (Wielonienasycone kwasy tłuszczowe [g]) Cholesterol [mg] (Cholesterol [mg]) Keys Index (Wskaźnik Keysa)

5 Dietary Patterns in Obese Subjects with OSA 713 Table 2. Energy and basic nutrients in the diets of overweight and obese men diagnosed with obstructive sleep apnea (n = 71) Tabela 2. Energia i podstawowe składniki odżywcze w racjach pokarmowych otyłych mężczyzn z rozpoznanym obturacyjnym bezdechem sennym (n = 71) Energy and nutrients (Wartość energetyczna i składniki odżywcze) Mean value (Średnia) Standard deviation (Odchylenie standardowe) Min. (Min.) Max (Maks) Median (Mediana) Recommended Dietary Allowances (RDA) (Zalecane spożycie) Level of meeting of the RDA [%] (% realizacji zalecanego spożycia) Energy [MJ] (Wartość energetyczna [MJ]) Energy [kcal] (Wartość energetyczna [kcal]) Total protein [g] (Białko ogółem [g]) Plant-derived protein [g] (Białko roślinne [g]) Animal-derived protein [g] (Białko zwierzęce [g]) Total carbohydrates [g] (Węglowodany ogółem [g]) Dietary fiber [g] (Błonnik pokarmowy [g]) Total fats [g] (Tłuszcze ogółem [g]) Saturated fatty acids [g] (Nasycone kwasy tłuszczowe [g]) Monounsaturated fatty acids [g] (Jednonienasycone kwasy tłuszczowe [g]) Polyunsaturated fatty acids [g] (Wielonienasycone kwasy tłuszczowe [g]) Cholesterol [mg] (Cholesterol [mg]) Keys Index (Wskaźnik Keysa)

6 714 M. Bronkowska et al. Table 3. Diets eaten by overweight and obese women diagnosed with obstructive sleep apnea (n = 22) compared to the recommended daily values of energy and nutrients Tabela 3. Podział racji pokarmowych otyłych kobiet z rozpoznanym obturacyjnym bezdechem sennym (n = 22) na frakcje procentowej realizacji zaleceń na energię i składniki odżywcze [%] % group > 130 Energy [kcal] (Wartość energetyczna [kcal]) Total protein [g] (Białko ogółem [g]) Plant-derived protein [g] (Białko roślinne [g]) Animal-derived protein [g] (Białko zwierzęce [g]) Total carbohydrates [g] (Węglowodany ogółem [g]) Dietary fiber [g] (Błonnik pokarmowy [g]) Total fats [g] (Tłuszcze ogółem [g]) Saturated fatty acids [g] (Nasycone kwasy tłuszczowe [g]) Monounsaturated fatty acids [g] (Jednonienasycone kwasy tłuszczowe [g]) Polyunsaturated fatty acids [g] (Wielonienasycone kwasy tłuszczowe [g]) Cholesterol [mg] (Cholesterol [mg]) % group % group % group % group % group % group % group % group % group % group % group In the current study of OSA patients, analyses showed an excessive intake of fat among the women and men: 107.3% and % of the RDA respectively (Tables 1 and 2). Similar findings were also obtained when evaluating the patients food rations in terms of meeting the RDA for the intake of fat (Tables 3 and 4). In 48.3% of the food rations of the women and 65.9% of the men s, assays demonstrated an excessive supply of fat; in 40% of the food rations of women and 57.7% of the men s, fat intake exceeded 130% of the RDA (Tables 3 and 4). The diets of the patients studied were also characterized by a very high supply of saturated fatty acids (SFA). A higher intake of SFA was found in the women s group: 129.3% of the RDA (Table 1). Among the men, the intake of saturated fatty acids was slightly lower, accounting for 129% of the recommended level (Table 2). The analysis of the patients diets in relation to the RDA showed that only a negligible percentage of the women s food rations (9.2%) were at a correct level (90 110%) of the recommended dietary allowances for SFA, whereas 71.4% were at a level exceeding 110% of the RDA (Table 3). Corresponding results were recorded in the men s group: In 74.4% of diets, the supply of SFA was over 110% of the recommended level (Table 4). A similar intake of saturated fatty acids i.e. from 12 to 16% of the daily energy supply has been observed in Greece [19] and Spain [20]. Excessive intake of saturated fatty acids intensifies hyperinsulinemia and consequently insulin resistance and hyperglycemia, thus contributing to an increasing body mass [21]. There is a positive correlation between the level of fats and SFA in a diet and the level of dietary cholesterol. In our study, it was only in the women s group that the average food ration was within the recommended allowances for cholesterol: 76.9% of the RDA (Table 1). In the men s group, the mean level of dietary cholesterol exceeded the recommended value (Table 2), constituting 123.9% of the RDA. The intake of cholesterol exceeded 110% of the recommended daily intake in 21.6% of the women s diets and 38.9% of the men s (Tables 3 and 4). In contrast, the correct supply of cholesterol was observed in merely 9.2% of the women s food rations and in 14% of the men s (Tables 3 and 4).

7 Dietary Patterns in Obese Subjects with OSA 715 Table 4. Diets eaten by overweight and obese men diagnosed with obstructive sleep apnea (n = 71) compared to the recommended daily values of energy and nutrients Tabela 4. Podział racji pokarmowych otyłych mężczyzn z rozpoznanym obturacyjnym bezdechem sennym (n = 71) na frakcje procentowej realizacji zaleceń na energię i składniki odżywcze [%] % group > 130 Energy [kcal] (Wartość energetyczna [kcal]) Total protein [g] (Białko ogółem [g]) Plant-derived protein [g] (Białko roślinne [g]) Animal-derived protein [g] (Białko zwierzęce [g]) Total carbohydrates [g] (Węglowodany ogółem [g]) Dietary fiber [g] (Błonnik pokarmowy [g]) Total fats [g] (Tłuszcze ogółem [g]) Saturated fatty acids [g] (Nasycone kwasy tłuszczowe [g]) Monounsaturated fatty acids [g] (Jednonienasycone kwasy tłuszczowe [g]) Polyunsaturated fatty acids [g] (Wielonienasycone kwasy tłuszczowe [g]) Cholesterol [mg] (Cholesterol [mg]) % group % group % group % group % group % group % group % group % group % group % group The high supply of SFA and excessive intake of cholesterol demonstrated in the diets of patients diagnosed with OSA resulted mainly from high consumption of meat, meat and eggs. High consumption of meat, meat and eggs was higher in the men s diets (214.4% of the recommended level) than in the women s (147.6%) (Figures 1 and 2). This is undoubtedly due to the incorrect nutritional habits that often observed in Polish families as well as to a preference for highfat meat. Analyses demonstrated that butter contributed little to the levels of SFA and cholesterol in the diets of patients suffering from OSA (Figures 1 and 2). The level of monounsaturated fatty acids (MUFA) in the diets of the surveyed patients was correct, accounting for 91.7% and 111.3% of the recommended levels in the case of women and men, respectively (Tables 1 and 2). However, only 4.2% of the women and 22.2% of the men were meeting the recommended allowances at a level of %, whereas in 66.7% of the women s diets and 36.2% of the men s the supply of MUFA was lower than 90% of the recommended level (Tables 3 and 4). In a work evaluating the nutritive value of diets in the Wielkopolska Province (Poland), Przysławski et al. [22] reported a similar intake of monounsaturated fatty acid as in the current study (13 14% of energy intake). Assessments of the daily food rations of the patients with OSA demonstrated a very high diversity in the intake of polyunsaturated fatty acids, i.e. from 3.1 to 17.3 g/day in the women s group (Table 1) and from 1.5 to 36.6 g/day in the men s group (Table 2). The mean intake of PUFA in the daily diet was 83.5% of the recommended level among the women and 90.7% of the recommended level among the men (Tables 1 and 2). The analysis of the diets showed that 13.3% of the women and 14.1% of the men were meeting the recommended allowances at a level of %, while 60.9% of the women and 44.9% of the men had PUFA intake levels below 90% of the recommended level (Tables 3 and 4). In the aforementioned study of diets in the Wielkopolska Province, Przysławski et al. [22] found a similar percentage of polyun-

8 716 M. Bronkowska et al. g tested women badane kobiety the proposed model food ration dzienna modelowa racja pokarmowa cereal produkty zbożowe na mąkę milk and dairy mleko i produkty mleczne na mleko eggs jaja meat and meat mięso, wędliny, ryby na mięso butter masło other fats inne tłuszcze food grupy produktów 70.6 potatoes ziemniaki vegetables and fruits warzywa i owoce leguminous dry and nuts strączkowe suche i orzechy 45.0 sugar and sweets cukier i słodycze na cukier Fig. 1. Groups of food in the daily food rations of overweight and obese women diagnosed with obstructive sleep apnea (n = 22) compared with the proposed model diet Ryc. 1. Grupy produktów w racjach pokarmowych otyłych kobiet z rozpoznanym obturacyjnym bezdechem śródsennym (n = 22) w porównaniu z dzienną modelową racją pokarmową saturated fatty acids (PUFA) to the finding in the current study (4.1% and 5.2% of total energy, respectively). It was observed that in the group of patients investigated, the source of MUFA and PUFA were soft margarines used for spreading on bread, and oils. The total protein intake was found to be high among both the women and men in the study: and 119.9% of the RDA, respectively. Only 17.5% of the women and 19.6% of the men had protein intake in the range of % of the RDA, while 33.6% of the women and 59.2% of the men exceeded 110% of the recommended level of protein (Tables 3 and 4). In the diets of both groups the predominating protein was that of animal origin over 110% of the recommended level was found in at least % of the food rations of both women and men (Tables 3 and 4). In addition, it was observed that only 2.8% of the men in the study had animalderived protein intake levels within the range of % of the recommended level (Table 4). The supply of protein of plant origin in the average diet of both groups was below the recommended allowance: 87.1% of the RDA among the women (Table 1) and 99% among the men (Table 2). The high intake of protein was attributed to the high consumption of meat, cured meat and eggs by the surveyed patients. Simultaneously, insufficient amounts of plant in their diets cereal, legumes and vegetables meant that the contribution of animal protein to the pool of total protein was substantially higher than the adopted recommended values (Figures 1 and 2). A high supply of total protein 86.7 g and animal protein in particular was also observed in a study by Grygiel et al. in the daily food rations of women with visceral obesity [23]. A high protein intake has also been observed in a number of other countries, e.g. in Greece (13.2%) [19] and Brazil (14.2%) [24]. The results of the WOBASZ survey [25] examining the quality of nutrition in the Polish population indicated that as few as 48.5% of women and 49.5% of men were complying with recommended allowances for the supply of energy derived from protein. The other half of the population had pro-

9 Dietary Patterns in Obese Subjects with OSA 717 g ,1 800 tested men badani mężczyźni ,7 538,2 464,2 428 the proposed model food ration dzienna modelowa racja pokarmowa , ,4 238,2 157,3 140, ,7 16,0 14,1 27,3 22,7 26,6 49,1 2,75 19,8 21,1 0 cereal produkty zbożowe na mąkę milk and dairy mleko i produkty mleczne na mleko eggs jaja meat and meat mięso, wędliny, ryby na mięso butter masło other fats inne tłuszcze food grupy produktów potatoes ziemniaki vegetables and fruits warzywa i owoce leguminous dry and nuts strączkowe suche i orzechy sugar and sweets cukier i słodycze na cukier Fig. 2. Groups of food in the daily food rations of overweight and obese men diagnosed with obstructive sleep apnea (n = 71) compared with the proposed model diet Ryc. 2. Grupy produktów w racjach pokarmowych otyłych mężczyzn z rozpoznanym obturacyjnym bezdechem śródsennym (n = 71) w porównaniu z dzienną modelową racją pokarmową tein intake levels that were either excessive or deficient. Similar protein levels were also observed in other works [26 28]. The evaluation of daily food rations of the women and men surveyed in the current study demonstrated considerable deviations from the adopted recommended allowances for carbohydrates (Tables 1 and 2). The mean carbohydrate intake in the diets of the women and men were ,1% of the recommended level. In addition, it was found that in 83.3% of the women s diets and 78.1% of the men s, the level of carbohydrates was below 90% of the recommended dietary allowances (Tables 3 and 4). It was found that the insufficient supply of carbohydrates was accompanied by an inadequate intake of dietary fiber (Tables 1 and 2). Among the women, the average dietary fiber intake was at 58.8% of the recommended level, and the fiber intake levels of 37.7% of them were 30 50% of the RDA (Table 3). Higher fiber intake was found in diets of men: The average was 60.7% of the recommended level, and 8.2% of them had fiber intake levels within the correct range of % of the RDA (Table 4). The low levels of carbohydrates and dietary fiber in the food rations of the patients with OSA was observed to result from low consumption of cereals, fruits and vegetables, potatoes, legumes and nuts. In the entire surveyed population, the analyses also indicated a low intake of sugar and sweets, not exceeding 43% of the level recommended in the model daily food ration (Figs. 1 and 2). Excessive consumption of fats, proteins and cholesterol and a simultaneously low supply of carbohydrates and dietary fiber was also observed in the diets of obese women and men aged years surveyed in a study conducted by Ostrowska et al. [21]. Investigations point to insufficient intake of dietary fiber in practically all age groups of the Polish population. This results from low consumption not only of vegetables and fruits, but also of coarsegrained cereal, groats and legumes [29]. The survey conducted also included a determination of the atherogenicity of the patients diets, calculated by means of the Keys index. The mean value of that index the diets of the women and men examined was higher than that recommended in the Recommended Dietary Allowances: 42.2 among the women (127.9% of recommended value) and 48.4 among the men (156.1% of recommended value) (Tables 1 and 2). Other authors investigations confirm that the diets of

10 718 M. Bronkowska et al. different populations in Poland are characterized by considerable atherogenicity: The mean Keys index in the diets of women from Wrocław and Legnica was 38.5, and that of women from Kraków was A similar tendency has been observed in diets of the Polish men [30 31]. The current study also determined BMI values for all the participating patients. BMI values indicative of overweight i.e were reported in 16.7% of the surveyed women and 13.5% of the men. BMI values indicative of obesity over 29.9 were found in 83.3% of the women and 86.5% of the men. Investigations conducted among residents of Lublin, Poland, (n = 1214) found overweight in 37.3% of the respondents and obesity in 25.6%. In a survey carried out under the CINDI WHO program amongst residents of Łódź, Poland, overweight was reported in 30.5% and obesity in 9% of the respondents [32]. The authors concluded that: 1. The mean energy intake among the OSA patients surveyed in the current study was on the border of the level in the adopted Recommended Dietary Allowances, yet its dietary structure was incorrect. Analyses demonstrated an excessive level of energy derived from fats and proteins, and a low level of energy derived from carbohydrates. 2. Analyses also demonstrated insufficient levels of plant-derived protein and dietary fiber in the patients daily food ration. 3. The average diet of the participants in the study was characterized by high atherogenicity resulting from excessive intake of saturated fatty acids. 4. Analyses of the participants diets showed a high intake of meat, meat and eggs. The diets were also characterized by low levels of cereal, vegetables, fruits, milk and dairy. 5. The OSA study group is characterized by abnormal BMI values. The experimental procedure was approved by the Commission of Bioethics at Wroclaw Medical University (KB-28/2008). References [1] Wolk R, Kara T, Komers VK: Sleep-disordered breathing and cardiovascular disease. Circulation 2003, 108, [2] Young T, Finn L, Austin D, Peterson A: Menopausal status and sleep-disordered breathing in the Wisconsin Subject Cohort Study. Am Resp Care Med 1995, 152, [3] Zieliński J, Pływaczewski R, Bednarek M: Zaburzenia oddychania w czasie snu. Wydawnictwo Lekarskie PZWL, Warszawa [4] Regulski M: Zaburzenia oddychania w czasie snu u pacjentów z cukrzycą. Przew Lek 2003, 11/12, [5] Bielicki P, Byśkiniewicz K, Chazan R: Rodzinne występowanie obturacyjnego bezdechu podczas snu. Pneum Alerg Pol 2007, 75, supl. 1, [6] Szponar L, Wolnicka K, Rychlik E: Album fotografii produktów i potraw. IŻŻ, Warszawa [7] Kunachowicz H, Nadolna I, Przygoda B, Iwanow K: Tabele wartości odżywczej produktów spożywczych. Prace IŻŻ, nr 85, Warszawa, [8] Nadolna I, Kunachowicz H, Iwanow K: Potrawy skład i wartość odżywcza. Prace IŻŻ, Warszawa, [9] Ziemlański Ś: Normy żywienia człowieka. Fizjologiczne podstawy.pzwl, Warszawa [10] World Health Organization, Diet, nutrition and the prevention of chronic disease. Report of joint WHO/FAO Expert Consultation. Technical Report Series, No 916, Geneva [11] Paradowski L, Kempiński R: Nutrition and chronic diseases of developed communities. Adv Clin Exp Med 2003, 12, supl. 1, [12] Rywik S, Broda G: Stan zdrowia ludności Warszawy w roku Inst Kardiol, Warszawa [13] Turlejska H, Pelznar U, Szponar L, Konecka-Maryjek E: Zasady racjonalnego żywienia zalecane racje pokarmowe dla wybranych grup ludności w zakładach żywienia zbiorowego. ODiDK Sp. z o.o., Gdańsk [14] Traviss KA, Barr SI, Fleming JA, Ryan CF: Lifestyle related weight gain in obese men with newly dignosed obstructive sleep apnea. J Am Diet Assoc 2002, 102, 5: [15] Ostrowska L, Stefańska E, Czapska D, Karczewski J: Ocena dziennych racji pokarmowych grupy osób z nadwagą i otyłością. Bromat Chem Toksykol 2003, 36, 2: [16] Niedworok E, Całyniuk B, Szczepańska E, Żurawińska T, Dul L: Struktura spożycia wybranych składników odżywczych w dwóch grupach wiekowych kobiet w aspekcie wystąpienia otyłości. Bromat Chem Toksykol 2003, supl.: [17] Rywik S, Broda G: Stan zdrowia ludności byłego województwa tarnobrzeskiego w roku Inst. Kardiol., Warszawa [18] Przysławski J, Grygiel B: Estimation of nutrition manner of obese women perimenopausal and postmenopausal period. Żyw Człow Metab 2003, 30, [19] Moschandreas J, Kafatos A: Food and nutrient intakes of Greek (Cretan) adults. Recent data for food-based dietary guidelines in Greece. B J Nutr 1999, 81, Suppl. 2, S71 S76. [20] Schröder H, Marrugat J, Elosua R, Covas MI: Relationship between body mass index, serum cholesterol, leisure time physical activity, and diet in a Mediterranean Southern Europe population. B J Nutr 2003, 90,

11 Dietary Patterns in Obese Subjects with OSA 719 [21] Ostrowska L, Stefańska E, Czapska D, Karczewski J: Wpływ żywienia osób z nadwagą lub otyłością na ich parametry lipidowe i gospodarkę węglowodanową. Bromat Chem Toksykol 2003, supl.: [22] Przysławski J, Gertig H, Bolesławska I, Duda G, Maruszewska M, Nowak J: Nutritional value of diets reconstituted in laboratory of workers employed in public or private sector in the Wielkopolska region. Żyw Człow Metab 1999, 26, [23] Grygiel B, Przysławski J, Schlegel-Zawadzka M: Ocena poziomu spożycia białka oraz wybranych witamin z grupy B, u kobiet z otyłością wisceralną i gynoidalną. Bromat Chem Toksykol 2005, supl.: [24] Fraire RD, Carloso MA, Shinzato AR, Ferreira SR: Nutritional status of Japanese-Brazilian subjects: comparision across gender and generation. B J Nutr 2003, 89, [25] Waśkiewicz A, Piotrowski W, Sygnowska E, Broda G, Drygas W, Zdrojewski T, Kozakiewicz K, Tykarski A, Biela U: Quality of nutrition and health knowledge in subjects with diagnosed cardiovascular diseases in the Polish population National Multicentre Health Survey (WOBASZ). Kardiol Pol 2008, 66, [26] Bronkowska M, Żechałko-Czajkowska A: Nutritional patterns of 40-year-old women from Wrocław in the aspect of the risk of Cardiovascular diseases. Part I. Intake of selected nutrients and groups of food. Pol J Food Nutr Sci 2006, 15/56, 1, [27] Bronkowska M, Wyka J, Żechałko-Czajkowska A: Zastosowanie analizy skupień w ocenie sposobu żywienia i stanu zdrowia dorosłych mieszkańców Wrocławia. Ann Acad Med Siles 2006, 60, suppl. 95, [28] Zahorska-Markiewicz B: Otyłość. Poradnik dla lekarzy. Wydawnictwo Archi-Plus, Warszawa [29] Przysławski J, Gertig H: Żywieniowe czynniki rozwoju niektórych chorób cywilizacyjnych. Żyw Człow Metab 1997, 24, 3, [30] Ilow R, Regulska-Ilow B, Szymczak J: Ocena sposobu żywienia kobiet z Legnicy i okolic. Cz. II. Ocena ilościowa. Bromat Chem Toksykol 1998, 31, 1, [31] Piórecka B, Jagielski P, Żwirska J, Piskorz A, Brzostek T, Schlegel-Zawadzka M: Wpływ żywienia na występowanie wybranych metabolicznych czynników ryzyka chorób układu krążenia wśród mieszkanek Krakowa. Rocz PZH 2007, 58, 1, [32] Kornacewicz-Jach Z, Przybycień K, Chomicz J, Pieczul-Mróz, Karwat B, Gorący J: Zagrożenie chorobami układu krążenia u kobiet. Przegl Menopauz 2003, 5, Address for correspondence: Monika Bronkowska Division of Human Nutrition Department of Food Storage and Technology Wrocław University of Environmental and Life Sciences Norwida Wrocław Poland monika.bronkowska@wnoz.up.wroc.pl Conflict of interest: None declared Received: Revised: Accepted: