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original papers
Adv Clin Exp Med 2010, 19, 6, 709–719
ISSN 1230-025X
© Copyright by Wroclaw Medical University
Monika Bronkowska, Marcin Gołecki2, Justyna Słomian1, Anna Markiewicz1,
Jolanta Mikołajczak1, Monika Kosacka2, Irena Porębska2, Renata Jankowska2,
Jadwiga Biernat1
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
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
1 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 2008. 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 46.8–50.2% respectively. The analyzed diets were found to include a high percentage of meat and meat
products, as well as of eggs. The diets were also characterized by a low content of cereal products, vegetables, fruits,
milk and dairy products. 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, 709–719).
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, 709–719).
Słowa kluczowe: obturacyjny bezdech senny, składniki odżywcze, całodzienne racje pokarmowe.
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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, to-
tal 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 (PUFA) 6%.
The Keys index of diet atherogenicity was calculated from the formula [1.35 × (2 ×%en. from
SFA –%en. from PUFA) + 1.5 × √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%,
90–110%, 110–130% and over 130%; with the
90–110% range acknowledged as appropriate and
consistent with recommendations.
Calculations of groups of food products in individual diets were also performed using “Energia
v. 2” software with the database described above.
The patients’ consumption of groups of food products (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 products 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 products [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
Dietary Patterns in Obese Subjects with OSA
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 en-
711
ergy 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 1865.4 kcal
respectively, and were similar to the findings of the
current study.
Despite the excessive supply of meat and
meat products (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:
46.8–50.2%. 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 26–60 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.
Mean value
(Średnia)
5409.3
1291.0
56.3
27.7
28.6
162.1
15.1
52.7
20.3
19.8
9.8
230.7
42.2
Energy and nutrients
(Wartość energetyczna i składniki odżywcze)
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)
14.5
162.7
4.9
9.6
6.8
20.2
5.7
64.7
10.7
13.1
21.5
419.1
1756.0
Standard deviation
(Odchylenie standardowe)
16.2
96.0
3.1
8.2
9.2
28.4
8.5
79.3
14.8
10.3
30.7
680.8
2852.5
Min.
(Min.)
70.2
603.4
17.3
36.3
29.5
88.3
27.4
290.1
51.9
14.5
171.7
10.2
16.8
16.7
47.2
13.6
149.9
24.7
26.0
53.3
94.6
52.3
1143.8
4792.5
Median
(Mediana)
1953.8
8186.4
Max
(Maks)
33
300
11.8
21.6
15.7
49.1
30
278.2
21.2
31.8
53
1767.0
7403.7
Recommended Dietary
Allowances (RDA)
(Zalecane spożycie)
Tabela 1. Energia i podstawowe składniki odżywcze w racjach pokarmowych otyłych kobiet z rozpoznanym obturacyjnym bezdechem sennym (n = 22)
Table 1. Energy and basic nutrients in the diets of overweight and obese women diagnosed with obstructive sleep apnea
(n = 22)
127.9
76.9
83.5
91.7
129.3
107.3
50.3
58.3
134.9
87.1
106.2
73.1
73.1
Level of meeting of the
RDA [%]
(% realizacji zalecanego spożycia)
712
M. Bronkowska et al.
Mean value
(Średnia)
7764.9
1853.2
81.2
40.2
40.9
217.0
18.2
76.9
25.8
30.6
13.7
371.6
48.4
Energy and nutrients
(Wartość energetyczna i składniki odżywcze)
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)
17.4
272.2
6.9
17.0
14.8
37.9
6.9
83.9
21.2
20.2
33.5
662.1
2774.2
Standard deviation
(Odchylenie standardowe)
15.7
70.9
1.5
1.5
2.4
7.9
6.6
75.4
3.0
12.6
33.1
496.3
2079.5
Min.
(Min.)
90.9
1259.0
36.6
78.2
72.8
183.6
38.4
422.0
97.2
112.9
178.1
3372.2
14129.5
Max
(Maks)
40.9
286.0
13.3
27.4
23.3
75.1
17.1
219.0
36.8
35.8
78.9
1823.1
7638.8
Median
(Mediana)
31
300
15.1
27.5
20.0
62.6
30
355.2
27.1
40.6
67.7
2255.5
9450.5
Recommended Dietary
Allowances (RDA)
(Zalecane spożycie)
Tabela 2. Energia i podstawowe składniki odżywcze w racjach pokarmowych otyłych mężczyzn z rozpoznanym obturacyjnym bezdechem sennym (n = 71)
Table 2. Energy and basic nutrients in the diets of overweight and obese men diagnosed with obstructive sleep apnea (n = 71)
156.1
123.9
90.7
111.3
129.0
122.8
60.7
61.1
150.9
99.0
119.9
82.2
82.2
Level of meeting of the
RDA [%]
(% realizacji zalecanego spożycia)
Dietary Patterns in Obese Subjects with OSA
713
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 0–30
30–50
50–70
70–90
90–110
110–130
> 130
Energy [kcal]
(Wartość energetyczna [kcal])
% group 5.0
20.9
17.8
25.9
17.8
12.6
0
Total protein [g]
(Białko ogółem [g])
% group 4.2
15.0
5.0
21.7
17.5
14.2
22.4
Plant-derived protein [g]
(Białko roślinne [g])
% group 4.2
13.3
44.2
5.0
9.2
9.2
15.0
Animal-derived protein [g]
(Białko zwierzęce [g])
% group 4.2
10.0
15.0
10.0
10.0
9.2
41.6
Total carbohydrates [g]
(Węglowodany ogółem [g])
% group 10.0
37.5
14.2
21.6
8.3
4.2
4.2
Dietary fiber [g]
(Błonnik pokarmowy [g])
% group 20.0
37.7
26.7
5.2
5.2
5.2
0
Total fats [g]
(Tłuszcze ogółem [g])
% group 5.0
5.0
10.0
18.3
13.4
8.3
40.0
Saturated fatty acids [g]
(Nasycone kwasy tłuszczowe [g])
% group 0
0
10.0
9.4
9.2
22.3
49.1
Monounsaturated fatty acids [g]
(Jednonienasycone kwasy tłuszczowe [g])
% group 5.0
10.0
36.2
15.5
4.2
17.2
12.5
Polyunsaturated fatty acids [g]
(Wielonienasycone kwasy tłuszczowe [g])
% group 15.0
17.5
9.2
19.2
13.3
9.2
16.0
Cholesterol [mg]
(Cholesterol [mg])
% group 5.0
41.7
9.2
13.3
9.2
8.3
13.3
In the current study of OSA patients, analyses showed an excessive intake of fat among the
women and men: 107.3% and 122.81% 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).
715
Dietary Patterns in Obese Subjects with OSA
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 0–30
30–50
50–70
70–90
90–110
110–130
> 130
Energy [kcal]
(Wartość energetyczna [kcal])
% group 2.8
5.9
17.2
22.5
19.8
21.9
9.9
Total protein [g]
(Białko ogółem [g])
% group 0
1.5
5.7
14.0
19.6
11.1
48.1
Plant-derived protein [g]
(Białko roślinne [g])
% group 8.7
29.6
36.6
12.7
5.5
1.4
5.5
Animal-derived protein [g]
(Białko zwierzęce [g])
% group 1.4
0
2.8
1.4
2.8
1.4
90.2
Total carbohydrates [g]
(Węglowodany ogółem [g])
% group 5.8
27.2
24.4
20.7
10.9
8.2
2.8
Dietary fiber [g]
(Błonnik pokarmowy [g])
% group 17.5
30.5
21.9
12.4
8.2
6.8
2.7
Total fats [g]
(Tłuszcze ogółem [g])
% group 4.3
2.9
2.8
12.8
11.3
8.2
57.7
Saturated fatty acids [g]
(Nasycone kwasy tłuszczowe [g])
% group 1.4
7.0
11.3
1.5
4.4
16.6
57.8
Monounsaturated fatty acids [g]
(Jednonienasycone kwasy tłuszczowe [g])
% group 5.8
7.1
9.5
13.8
22.2
8.4
33.2
Polyunsaturated fatty acids [g]
(Wielonienasycone kwasy tłuszczowe [g])
% group 8.6
5.6
12.5
18.2
14.1
10.1
30.9
Cholesterol [mg]
(Cholesterol [mg])
% group 7.3
11.4
11.2
17.2
14.0
11.2
27.7
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 products and eggs.
High consumption of meat, meat products 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 products.
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
90–110%, 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 90–110%, 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-
716
M. Bronkowska et al.
g
800.0
800
tested
women
badane
kobiety
700
579.9
600
the proposed
model food
ration
dzienna
modelowa
racja
pokarmowa
500
393.7
400
308.3
300
286.1
275.8
204.2
188.2
200
138.3
70.6
100
24.7
16.0
15.1
18.1
15.9
45.0
20.6
0.7
16.2
10.7
0
cereal
products
produkty
zbożowe
w przeliczeniu
na mąkę
milk
and dairy
products
mleko
i produkty
mleczne
w przeliczeniu
na mleko
eggs
jaja
meat
and meat
products
mięso,
wędliny, ryby
w przeliczeniu
na mięso
butter
masło
other fats
inne tłuszcze
food products
grupy produktów
potatoes
ziemniaki
vegetables
and fruits
warzywa
i owoce
leguminous
sugar
dry and nuts and sweets
strączkowe
cukier
suche
i słodycze
i orzechy w przeliczeniu
na cukier
Fig. 1. Groups of food products 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:
106.2 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 90–110% 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
50.8–91.6% 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
90–110% of the recommended level (Table 4).
The supply of protein of plant origin in the
average diet of both groups was below the rec-
ommended 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 products
and eggs by the surveyed patients. Simultaneously, insufficient amounts of plant products in their
diets – cereal products, 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-
717
Dietary Patterns in Obese Subjects with OSA
g
882,1
900
tested
men
badani
mężczyźni
800
700
600
the proposed
model food
ration
dzienna
modelowa
racja
pokarmowa
538,2
465,7
500
464,2
428
400
337,2
300
238,2
202,4
200
157,3
140,7
100
29,7
16,0
14,1
27,3
22,7
26,6
2,75 19,8
21,1
49,1
0
cereal
products
produkty
zbożowe
w przeliczeniu
na mąkę
milk
and dairy
products
mleko
i produkty
mleczne
w przeliczeniu
na mleko
eggs
jaja
meat
and meat
products
mięso,
wędliny, ryby
w przeliczeniu
na mięso
butter
masło
other fats
inne tłuszcze
food products
grupy produktów
potatoes
ziemniaki
vegetables
and fruits
warzywa
i owoce
leguminous
dry and nuts
strączkowe
suche
i orzechy
sugar
and sweets
cukier
i słodycze
w przeliczeniu
na cukier
Fig. 2. Groups of food products 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
58.3–61,1% 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 90–110% 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 con-
sumption 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 18–69
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 products, 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
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 41.9. 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. 24.9–29.9 – 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 products and eggs.
The diets were also characterized by low levels of
cereal products, vegetables, fruits, milk and dairy
products.
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).
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Address for correspondence:
Monika Bronkowska
Division of Human Nutrition
Department of Food Storage and Technology
Wrocław University of Environmental and Life Sciences
Norwida 25
50-375 Wrocław
Poland
E-mail: [email protected]
Conflict of interest: None declared
Received: 19.03.2010
Revised: 13.09.2010
Accepted: 4.10.2010