First results of the food propensity questionnaire on seldom eaten foods
The food propensity questionnaire consists of several questions, including several foods and food groups often relevant from a risk perspective, but whose usual intake can difficultly be estimated using dietary recall or records. The question always started with “How often has your child consumed the following foods since the introduction of complementary foods (for children ≤ 18 months) or in the last 12 months (for children > 18 months)?”
For a better overview, the answering categories were simplified (Table 2).
Table 2
Frequency categories as asked in the questionnaire and as aggregated for analysis
Category in the questionnaire
|
Category in the analysis
|
Never
|
never consumed
|
Less than once a month
|
rarely consumed
|
1-3 times a month
|
once a week
|
frequently consumed
|
2-3 times a week
|
4-5 times a week
|
6-7 times a week
|
no comment
|
no comment
|
The analyses were performed looking at the EFSA age groups: infants (<12 month), toddlers (12 month to <36 month) and children (>36 month) (15). If analyses were performed regarding influence of socio-economic status, these variables were taken from the KiGGS dataset. The presented data refer to sample1.
a) Complementary food
All complementary foods are mostly consumed by infants (22-68% consumers), a little by toddlers (5-29% consumers) and rarely by children (0-3% consumers).
Even though the cereals presented in figure 6 are considered to be rarely consumed in Germany it should be noted that for all of the complementary foods more than 6% (up to 37% for rice-based complementary food as ready-to-eat or up to 18% for corn-based complementary food as ready-to-eat) of the infants consuming it least once a week. A supplementary table “Consumption frequency of complementary food, differentiated for the different kind of cereal bases” shows the detailed data. See supplementary table_1.xlsx. Most infant consumers can be found for rice-based complementary food as ready-to-eat: 41% consume it frequently (37% even once a week) and 27% consume it rarely whereas 15% of the toddlers are frequent consumers of rice-based complementary food as ready-to-eat and 14% consume it rarely.
Millet- and corn- based complementary food as ready-to-eat is not consumed that frequently: 19% of the infants are frequent consumers of millet-based complementary food (and 13% are rare consumers) and only 6% of the toddlers consume it frequently whilst 7% consume it rarely.
Complementary food as powder/flakes is used a little less frequently for nearly all kind of cereals asked for. Rice-based complementary powder/flakes are consumed frequently by 26% of the infants and 7% of the toddlers, millet-based complementary powder/flakes are frequently consumed by 26% of the infants and 11% of the toddlers and corn-based complementary powder/flakes are frequently consumed by 14% of the infants and by only 3% of the toddlers.
The most consumers of rice cake can be found in between the toddlers, followed by children and infants. Nevertheless, if they consume it, infants consume it more frequently. From the 58% infant consumers: 27% consume it frequently and 31% rarely. Looking at the toddlers: 22% of them consume it frequently and 45% rarely. As for the children: 12% of them consume it frequently and 49% rarely.
b) Dairy substitutes (soya drink, rice drink, oat drink) and other soya-based products
Study participants do not seem to consume dairy substitute drinks very frequently. The maximum are 7% of the children consuming soya-drink and 7% of the toddlers consuming oat-drink. For other soya-based products (e.g. tofu, desserts, custard, soya sauce) there are 22% of the toddlers and 18% of the children consuming them (Figure 7).
Oat drink seems to be the most common consumed substitute drink with more than 4% frequent consumers (mostly once a week) and 3% rare consumers for the toddlers and more than 1% frequent consumers and 5% rare consumers for the children. Soya based substitute drink follows with 5% rare consumers for the children and 3% for the toddlers and even nearly 3% frequent consumers for the children. Other soya-based products e.g. tofu on the other hand are consumed more often, at least by toddlers and children.
A supplementary table “Consumption frequency of different dairy substitute drinks and other soya based products, differentiated for the three age groups” shows the detailed data. See supplementary table_2.xlsx.
As the use of dairy substitutes may be influenced by socio-economic status (SES), we had a closer look on this influence for each substitute. It is visible, that children from families with higher SES consume more often soya-based substitute milk as families with lower (p<0.00005) and middle SES (p<0.015). We saw no significant influence by SES for consumption of rice drinks. The consumption of oat-drink was higher from children from families with middle (p<0.048) or higher SES (p<0.016) than by families with lower SES. For soya-based products, the range goes from 7% consumers for families with lower SES to 30% consumers for families with higher SES. It can be seen as well that the higher the parents’ education level, the higher the consumption of soya-based substitutes (lower SES to middle SES p<0.006, middle SES to higher SES p<0.0005). A supplementary table “Consumption frequency of dairy substitute drinks and other soya products, differentiated for socio-economic status” shows the detailed data. See supplementary table_3.xlsx.
c) Special meat and sausage products (game, sheep/lamb, ostrich, rabbit, horse)
Consumption differences due to age and migration background are presented here. Looking at the age differences first in figure 8.
Infants seem no big consumers of these types of meat (from 0% for ostrich and horse to 9% for game meat). Toddlers and children seem to consume game meat more often but most of the time rarely. There are 4% toddlers and children that consume sheep/lamb meat frequently. They eat it mostly once a week and some consumers as well 2-3 times a week. For all the other meat and sausage products, there are less consumers, and it is consumed mostly less than once a month. There are around 30% of toddlers and children consuming game meat. 27% of the children and 32% of the toddlers consume lamb/sheep meat. 13% of the toddlers and 16% of the children consume rabbit meat. Whereas horse meat and ostrich meat are nearly not consumed (and therefore not displayed here).
A supplementary table “Consumption frequency of the different types of special meat and sausage products, differentiated for the three age groups” shows the detailed data. See supplementary table_4.xlsx.
As the migration background may influence the type of meat consumed, analyses were performed taking into account the migration background (Figure 9). Participants were classified as “with migration background” if one or both of the parents was not born in Germany. It can be seen that only for game meat and sheep/lamb meat there is a visible difference in consumption frequency. Even though game meat is consumed most often rarely, if it is consumed, it is more often consumed by participants without migration background (31% consumers vs. 17% consumers with migration background (p<0.0005)). Whereas for lamb/sheep meat the relation is inverse (p<0.0005). 45% of participants with migration background consume lamb/sheep meat rarely or frequently. Only 20% of participants without migration background consume this meat. There are 6% of the participants with migration background that consume it even once a week and 1% that consume it 4-5 times a week. Ostrich, horse or rabbit meat are consumed rarely and there are no differences regarding the migration background.
A supplementary table “Consumption frequency of special meat and sausage products, differentiated by migration status” shows the detailed data. See supplementary table_5.xlsx.
d) Offal
Offal is known as a very seldom eaten food but often contains high levels of several contaminants and hence can be relevant for risk assessment. Results from KiESEL confirm that infants, toddlers or children seldom eat offal (Figure 10). Only liver from pork, beef or veal and poultry liver seem to be eaten. If it is eaten, then nearly always less than once a month and more often by toddlers and children. Only 2% of the infants eat pork, beef or veal liver and do this less than once a month. Some other offal from pork, beef and veal (e.g. heart, lungs and stomach) are eaten by 4% of the toddlers and 3% children but mostly less than once a month. (Figure 10)
A supplementary table “Non-consumers of offal from different animals differentiated for the three age groups” shows the detailed data. See supplementary table_6.xlsx.
e) Fish and other marine animals
In the questionnaire, participants were asked about their consumption of 14 different fish and marine animal species. The questions with more than 10% consumers are presented in Figure 11. A supplementary table “Consumption frequency of fish and marine animals differentiated for the three age groups” shows the detailed data of each asked fish or other marine animal. See supplementary table_7.xlsx.
Infants do not seem to eat the fish species asked for very often. Most likely, they eat cold smoked fish (14% consumers, mostly less than once a month). For all the other chosen fish species there are 0-3% infant consumers only. For toddlers and children most of the consumers can be found for canned tuna and shrimps/prawns. There are 39-44% consumers of canned tuna and 2-5% of them are frequent consumers (toddlers and children, respectively). For shrimps and prawns we found similar results even though toddlers seem to eat them slightly more frequently than children. However, there are a little less consumers for shrimps and prawns than for canned tuna. Toddlers and children as well seem to like cold smoked fish (37-40% consumers for toddlers and children, respectively). Even though most of them consume it less than once a month, there are around 5% toddlers who consume it once a week and 1% of the children even 2-3 times a week. Hot smoked fish, e.g. stremel salmon or smoked mackerel, follows in the list of the most popular fishes with 27-33% consumers (toddlers and children, respectively) but it is mostly consumed less than once a month. Mussels, squid and halibut show 89-17% consumers as well.
f) Tea and tea products
Tea is presented in three groups: 1. three different types of fennel tea and ready-to-drink tea especially for children, 2. other herbal teas, 3. Rooibos tea, green tea and black tea. A supplementary table “Consumption frequency of tea and tea products, differentiated for the three age groups” shows the detailed data of each tea separately. See supplementary table_8.xlsx.
1. Baby fennel tea (loose or tea bag), baby fennel tea (instant), other fennel tea and ready-to-drink tea
Infants and toddlers mostly consume baby fennel tea (instand and ready-to-drink). Toddlers and children mostly consume other fennel tea (figure 12). One quarter of the infants are frequent consumers of baby fennel tea (loose or tea bag). 8% of the infants drink it even nearly every day. 13% of the infants are frequent consumers of instant baby fennel tea as well. Most of them consume it 2-3 times a week but 5% of the infants consume it nearly every day. This applies to 2% of the toddlers and 1% of the children as well. Nearly 40% of the toddlers and children drink other fennel tea. For the infants there are 27% other fennel tea consumers all together and 18% of them frequent consumers (3% consume it nearly every day). 11% of the toddlers and 8% of the children are frequent consumers of other fennel tea and they consume it most often several times a week. Ready-to-drink tea especially for children is not consumed very often. There are no more than 10% consumers (toddlers) and it is mostly consumed rarely, nevertheless there are 3% of the infants who consume it nearly every day.
We wondered whether the socio-economic status of the families had an influence on the choice of fennel tea. Statistical significant differences existed only for baby fennel tea (instant). Families with middle and higher SES (7% and 4% consumers, respectively) consume it, whereas 25% of the families with lower SES consume it. Differences in consumption frequencies for fennel tea (instant) are significant between families with lower and higher SES (p<0.0005) and between families with lower and middle SES (p<0.0005). Most of them with lower SES drink it frequently (16%), 5% drink it nearly every day.
2. Herbal teas (peppermint, camomile and melissa)
Infants consume peppermint tea or melissa tea rarely (Figure 13). For peppermint tea there are only 2% consumers (mostly less than once a month) and for melissa tea there are 4% less frequent and 2% frequent consumers. These melissa tea numbers are similar for toddlers and children. Peppermint tea, on the other hand, is more popular with toddlers and children (22% and 40% consumers, respectively). There are even 11% of the children that consume it frequently, most of them once a week. 21% of the infants, 31% of the toddlers and 42% of the children consume camomile tea, most of them rarely. Nevertheless, there are between 8-11% who drink it frequently, the little ones mostly 2-3 times a week, the older ones mostly once a week.
Looking at the social-economic influence we only see significant values in camomile tea: The most consumers of camomile tea are from families with lower SES (46% consumers) and 20% of them consume it frequently. The differences in consumption frequencies were shown between higher and middle SES to lower SES (p< 0.005 and p< 0.002, respectively).
3. Rooibos tea, green tea and black tea
KiESEL-participants do not consume rooibos tea, green tea or black tea very often (Figure 14). Green tea is consumed the less, by only 3% of the toddlers and children. 3%, 7%, 13% of the infants, toddlers and children, respectively, consume black tea. It is consumed most often less than once a month or 1-3 times a month, but there are 2% of the children who drink it nearly every day. The consumption of rooibos tea is similar to the consumption of black tea. If it is consumed frequently, then mostly once a week.
Concerning the socio economic background of the participants, black tea was consumed more by families with lower SES in comparison with middle SES (p<0.002) and also in comparison with higher SES (p<0.0005). 18% of the participants with lower SES are consumers of black tea and 6% of them consume it even frequently (1% drink it nearly every day). Whereas families with higher SES show 4% consumers and families with middle SES show 9% consumers.
A supplementary table “Consumption of tea, differentiated for socio-economic status (SES)” shows the detailed data of each tea and tea product separately. See supplementary table_9.xlsx.
For some of the tea species migration status might play a role as well. For other fennel tea (p<0.0005) the participants without migration background show a significant higher consumption. For baby fennel tea (instant), there are no significant differences for participants with or without migration background. Peppermint tea (p<0.022) and melissa tea (p<0.001) were consumed more by participants without migration status. Whereas camomile tea shows higher consumption for participants with migration status (p<0.0005). The consumption of Rooibos tea shows no significant differences between both groups. Participants with migration status also show higher percentages for consumption of green tea (p<0.049) and black tea (p<0.0005). Especially the percentages of frequent consumers are higher for participants with migration status (1.6% for green tea and 10.2% for black tea). For black tea, there are only around 4% consumers of the participants without migration status whereas around 24% of the participants with migration status consume black tea (3.8% of them consume black tea nearly every day). A supplementary table “consumption of tea and tea products, differentiated for migration background” shows the detailed data of each tea and tea product separately. See supplementary table_10.xlsx.
As for regional differences (categorization of regions in KiESEL see the supplementary table_11): In the north-western part exists the highest percentages of black tea consumers. This difference is significant for all regions (16%, eastern part p<0.0015; Northrhine-Westphalia p<0.021; Bavaria/Baden-Württemberg p<0.038) except for the middle of Germany (11%). The participants in north-west also drink it most frequently: 5% drink it 2-3-times a week, 2% drink it nearly every day.
g. Diverse foods and food groups
In these questions we asked for many different items. We choose the following food items to have a closer look at.
1. Sunflower seeds, other oilseeds, poppy seeds and dried fruits
Infants mostly do not eat sunflower seeds or other oilseeds (70% non-consumers, figure 15). If they eat them, they eat them rarely (mostly less than once a month). Poppy seeds are eaten even less often (87% non-consumers). Toddlers and children eat sunflower seeds and other oilseeds more often. Around 1/3 of the toddlers eat them rarely and 35% (for other oil seeds) - 43% (for sunflower seeds) eat them frequently (most frequently once a week or 2-3 times a week). Children eat them even more often. Around 40% eat them rarely and another 33% (for oilseeds) - 41% (for sunflower seeds) eat them frequently (again mostly once a week or 2-3 times a week). Poppy seeds are eaten bit less frequent. 87% of the infants and about 50% of the toddlers and children do not eat them. Around 40% of the toddlers and children eat them rarely and around 10% eat them frequently (most often once a week). Dried fruits are consumed rarely by 12% of infants and 86% do not eat them at all. 2% of the infants had a frequent consumption of dried fruits. Only 1/4 of the toddlers and 1/3 of the children do not eat dried fruits; 43-46% (toddlers and children, respectively) eat dried fruits rarely and 31-24% eat them frequently (mostly once a week or 2-3 times a week). 5% of the toddlers and 3% of the children eat dried fruits nearly every day. (Figure 15)
A supplementary table “Consumption frequency of sunflower seeds, other oilseeds, poppy seeds and dried fruit, differentiated for the three age groups” shows the detailed data. See supplementary table_12.xlsx.
2. Sweeteners, products with stevia, calorie-reduced drinks
Sweeteners are only consumed by around 5% of the toddlers and children (not at all by infants) and mostly less than once a month (figure 16). Only 0.4% of the infants consume food sweetened with stevia (less than once a month); 4% of the toddlers and 6% of the children consume it rarely and 2% consume it frequently (mostly once a week or 2-3 times a week). Calorie-reduced soft drinks were nearly not consumed by infants whereas around 8% of the toddlers and 21% of the children are calorie-reduced soft-drink consumers. 6% of the children consume it even frequently (around 1% nearly every day).
A supplementary table “Consumption frequency of sweeteners, foods sweetened with stevia, calorie-reduced soft drinks and energy drinks, differentiated for the three age groups” shows the detailed data. See supplementary table_13.xlsx.
Focused on all consumers there are no differences in the frequency of consumption of calorie-reduced soft drinks for all three socio-economic statuses. Nevertheless, it shows that the percentages of frequent consumers are higher for participants from families with lower SES (11% for families with lower SES, 4% for families with middle SES and 1% for families with higher SES). Nearly all daily calorie-reduced soft drink consumers are from families with lower SES. Participants from families with middle or higher SES consume soft drinks with sweeteners mostly less than once a month or 1-3 times a month (Table 3).
Table 3
Influence of socio-economic status for consumption frequency of calory-reduced soft drinks
|
|
socio-economic status (SES)
|
|
|
|
low
|
middle
|
high
|
total
|
calorie-reduced softdrinks
|
never
|
83.80%
|
85.20%
|
83.80%
|
84.70%
|
< once a month
|
1.70%
|
6.70%
|
12.60%
|
7.30%
|
1-3 times a month
|
3.50%
|
3.90%
|
1.60%
|
3.30%
|
once a week
|
3.50%
|
2.80%
|
0.40%
|
2.40%
|
2-3 times a week
|
2.90%
|
0.90%
|
0.40%
|
1.10%
|
4-5 times a week
|
0.00%
|
0.30%
|
0.00%
|
0.20%
|
6-7 times a week
|
4.60%
|
0.10%
|
0.00%
|
0.80%
|
no comment
|
0.00%
|
0.00%
|
1.20%
|
0.30%
|
Differences in frequently consumption of calorie-reduced soft drinks were significant for participants with lower SES and middle SES (p<0.003). Due to the low number of cases, frequently consumers of calorie-reduced soft drinks with higher SES were not included in these analysis.
Results for energy drink consumption surprised as 1.6% of the children (>3 years old) already consumed it. All of them consumed it less than once a month. Two thirds of those who already consumed it are from families with lower SES.
3. Rocket salad and fresh spinach
Infants quasi do not eat rocket salad and fresh spinach (as salad). There are only 3% rocket salad consumers and if they eat it, then most often less than once a month (figure 17). Around one third of the toddlers and children eat rocket salad (mostly less than once a month). Around 3% eat it once a week. Fresh spinach is eaten even less. Only 12% of the toddlers and children consume it (mostly less than once a month).
4. Dark chocolate
Infants rarely eat dark chocolate (figure 18). Only 12% consume it and they consume it less than once a month. There are more than 50% consumers in both age groups and 7% of the toddlers and 8% of the children eat dark chocolate even frequently (mostly once a week).
A supplementary table for rocket salad, spinach and dark chocolate shows the detailed data. See supplementary table_14.xlsx. Tables of analysis for all the other food items that are not described in this manuscript can be found in the supplementary table “Consumption frequency of other seldom eaten foods”. See supplementary table_15.xlsx.