Comparative analysis of nutrition data from national, household, and individual levels: results from a WHO-CINDI collaborative project in Canada, Finland, Poland, and Spain

Do Global Dietary Nutrient Datasets Associate with Human Biomarker Assessments? A Regression Analysis

BACKGROUND

To assess the state and trends of global nutrition, our best tools are nationally representative assessments using human biomarker assays, yet these are expensive and logistically challenging. We instead often rely on more easily produced global nutrient datasets-measures of nutrients provided by the diet-as a proxy for nutritional intake and deficiency, due to their greater geographic and temporal coverage. However, the accuracy of global nutrient datasets is questionable.

OBJECTIVE

We aimed to test whether estimates of inadequate dietary intake derived from existing global nutrient datasets reliably associate with biophysical deficiency.

DESIGN

We performed linear regressions of estimates of inadequate dietary nutrient intake derived from three global nutrient datasets-Global Dietary Database, Global Nutrient Database, and Global Expanded Nutrient Supply (GENuS) model-against the existing suite of nationally representative biomarker survey data for three key nutrients of global concern in two vulnerable demographic groups: zinc, folate, and vitamin A in females of childbearing age; and zinc and vitamin A in children younger than 5 y.

RESULTS

We found significant associations (P < 0.1) for only 3 of 22 regressions between global nutrition datasets and biophysical deficiency: zinc for females of childbearing age from GENuS and Global Dietary Database, and zinc for children under 5 y from GENuS. Folate and vitamin A show no reliable relationship between nutrient datasets and independent biomarker surveys. Applying the successful models for zinc to the accompanying full datasets yield estimates of global zinc deficiency of 31%-37% for these demographic groups.

CONCLUSIONS

We found that few estimates of nutritional inadequacy from global dietary datasets are associated with more direct measures of biophysical deficiency from biomarker studies. Researchers and policymakers must be cautious when applying global nutrient datasets to questions of global health and use them for limited applications.

Individual- and supply-level macronutrient intakes are well correlated over a 50-year period (1961-2011) in 18 countries in Asia, North America, and Europe

Reliable information on dietary trends is essential. We compared individual-level dietary estimates for total energy, carbohydrate, fat, and protein intake over time with national supply data from the Global Expanded Nutrient Supply Model (186 paired estimates from 1961 to 2011, 18 countries). We hypothesized that supply data would overestimate individual measures and that the two measures would be weakly correlated. Individual- and supply-level estimates were compared using Spearman correlation coefficients and linear mixed-effect models were used to estimate the differences between measures. Overall, the correlations between individual- and supply-level measures were moderate for energy (rs = 0.34) and carbohydrate (rs = 0.39), strong for fat (rs = 0.85), and protein (rs = 0.69). Trends in total energy measured by individual-level surveys and total energy supply were positively correlated in 38.9% of countries, whereas trends in macronutrients aligned between estimates in most countries. Supply-level dietary data overestimated individual-level intakes, especially in higher income countries in Europe and in the United States. In the United States, supply-level data exceeded individual-level estimates by 26.3% to 29.9% for energy, carbohydrate, and fat, whereas protein estimates were similar between measures. In Europe, supply-level estimates overestimated individual-level intake by 19.9% for energy, 17.0% for carbohydrate, 13.7% for fat, and 7.7% for protein, whereas estimates for energy and macronutrients were similar in Asia. In Asia and lower income countries, our findings generally support the use of supply-level data in the absence of individual-level data, though this finding may be related to smaller sample size and differences in underlying national statistics that inform supply data.

Changes in energy, macronutrient, and food consumption in 47 countries over the last 70 years (1950-2019): a systematic review and meta-analysis

OBJECTIVES

We aimed to systematically examine trends in dietary energy, macronutrient, and food consumption in different geographic regions.

METHODS

We searched Medline, Embase, CINAHL, and organizations for studies and reports using individual-level dietary assessments from 1950 to 2019 (PROSPERO CRD42022302843) and quantified changes using multivariable linear mixed-effects models.

RESULTS

We identified 109 articles and reports from 47 countries, including Europe and Australasia (47% of studies), Asia (30%), Latin America (13%), the Middle East (6%), and North America (4%). In Southeast and East Asia, carbohydrate intake decreased, whereas fat consumption increased; the opposite pattern occurred in North America; and fat decreased while carbohydrate intake remained stable in Europe and Australasia. Consumption of carbohydrate and fat were stable in South Asia, Latin America, and the Middle East, but data were limited in these regions. A greater increase in national gross domestic product over time was associated with decreased carbohydrate and increased fat and protein intake. Dietary saturated fatty acid intake decreased in Northern and Eastern Europe and was stable in other regions. Changes in food varied by region; East and Southeast Asia increased meat, fish, dairy, egg, fruit, and vegetable consumption and decreased intake of grains, roots and tubers, legumes, whereas North America decreased dairy and red meat but increased eggs, nuts, poultry, and vegetable oil intake. Intakes of fruits, nuts, legumes, and roots and tubers were below recommendations in most regions.

CONCLUSIONS

Our findings indicate regional variations in dietary trends and identify countries that would benefit from nutritional policies aimed at decreasing lower-quality carbohydrate foods and increasing consumption of fruits, vegetables, nuts, legumes, and dairy.

Discrepancies between two long-term dietary datasets in the United Kingdom (UK)

Background: Studying dietary trends can help monitor progress towards healthier and more sustainable diets but longitudinal data are often confounded by lack of standardized methods. Two main data sources are used for longitudinal analysis of diets: food balance sheets on food supply (FBS) and household budget surveys on food purchased (HBS). Methods: We used UK longitudinal dietary data on food supply, provided by the Food and Agriculture Organisation (FAO) (FAO-FBS, 1961-2018), and food purchases, provided by the Department for Environment, Food and Rural Affairs (Defra) (Defra-HBS, 1942-2018). We assessed how trends in dietary change per capita compared between FAO-FBS and Defra-HBS for calories, meat and fish, nuts and pulses, and dairy, and how disparities have changed over time. Results: Estimates made by FAO-FBS were significantly higher (p<0.001) than Defra-HBS for calorie intake and all food types, except nuts and pulses which were significantly lower (p<0.001). These differences are partly due to inclusion of retail waste in FAO-FBS data and under-reporting in Defra- HBS data. The disparities between the two datasets increased over time for calories, meat and dairy; did not change for fish; and decreased for nuts and pulses. Between 1961 and 2018, both FAO-FBS and Defra-FBS showed an increase in meat intake (+23.4% and +1.4%, respectively) and a decrease in fish (-7.1% and -3.2%, respectively). Temporal trends did not agree between the two datasets for dairy, calories, and nuts and pulses. Conclusions: Our finding raises questions over the robustness of both data sources for monitoring UK dietary change, especially when used for evidence-based decision making around health, climate change and sustainability.

Discrepancies between two long-term dietary datasets in the United Kingdom (UK)

Background: Studying dietary trends can help monitor progress towards healthier and more sustainable diets but longitudinal data are often confounded by lack of standardized methods. Two main data sources are used for longitudinal analysis of diets: food balance sheets on food supply (FBS) and household budget surveys on food purchased (HBS). Methods: We used UK longitudinal dietary data on food supply, provided by the Food and Agriculture Organisation (FAO) (FAO-FBS, 1961-2018), and food purchases, provided by the Department for Environment, Food and Rural Affairs (Defra) (Defra-HBS, 1942-2018). We assessed how trends in dietary change per capita compared between FAO-FBS and Defra-HBS for calories, meat and fish, nuts and pulses, and dairy, and how disparities have changed over time. Results: Estimates made by FAO-FBS were significantly higher (p<0.001) than Defra-HBS for calorie intake and all food types, except nuts and pulses which were significantly lower (p<0.001). These differences are partly due to inclusion of retail waste in FAO-FBS data and under-reporting in Defra- HBS data. The disparities between the two datasets increased over time for calories, meat and dairy; did not change for fish; and decreased for nuts and pulses. Between 1961 and 2018, both FAO-FBS and Defra-FBS showed an increase in meat intake (+11.5% and +1.4%, respectively) and a decrease in fish (-3.3% and -3.2%, respectively) and dairy intake (-11.2% and -22.4%). Temporal trends did not agree between the two datasets for calories, and nuts and pulses. Conclusions: Our finding raises questions over the robustness of both data sources for monitoring UK dietary change, especially when used for evidence-based decision making around health, climate change and sustainability.

Discrepancies between two long-term dietary datasets in the United Kingdom (UK)

Background: Studying dietary trends can help monitor progress towards healthier and more sustainable diets but longitudinal data are often confounded by lack of standardized methods. Two main data sources are           used for longitudinal analysis of diets: food balance sheets on food supply (FBS) and household budget surveys on food purchased (HBS). Methods: We used UK longitudinal dietary data on food supply, provided by the Food and Agriculture Organisation (FAO) (FAO-FBS, 1961-2018), and food purchases, provided by Defra (Defra-HBS, 1942-2018). We assessed how trends in dietary change per capita compared between FAO-FBS and Defra-HBS for calories, meat and fish, nuts and pulses, and dairy, and how disparities have changed over time. Results: FAO-FBS estimates were significantly higher (p<0.001) than Defra-HBS for calorie intake and all food types, except nuts and pulses which were significantly lower (p<0.001). These differences are partly due to inclusion of retail waste in FAO-FBS data and under-reporting in Defra- HBS data. The disparities between the two datasets increased over time for calories, meat and dairy; did not change for fish; and decreased for nuts and pulses . Between 1961 and 2018, both FAO-FBS and Defra-FBS showed an increase in meat intake (+11.5% and +1.4%, respectively) and a decrease in fish (-3.3% and -3.2%, respectively) and dairy intake (-11.2% and -22.4%). Temporal trends did not agree between the two datasets for calories, and nuts and pulses. Conclusions: Our finding raises questions over the robustness of both data sources for monitoring UK dietary change, especially when used for evidence-based decision making around health, climate change and sustainability.

Trade and dietary preferences can determine micronutrient security in the United Kingdom

Food production, dietary choices, climate change, trade tariffs and future responses to the SARS-CoV-2 pandemic are some of the factors affecting global food security. Here we examine how micronutrient security has varied in the United Kingdom from 1961 to 2017, before Brexit, taking supply and demand driver changes into account. We also introduce future scenarios to see how a more plant-based diet and/or differing trade arrangement post-European Union exit and COVID-19 pandemic could affect the supply of nutrients. Results show that trading agreements have affected several key micronutrients during the past 60 years and are likely to be influential in a post-Brexit United Kingdom. Changes in dietary patterns, which influence how much animal- and plant-based products are consumed, have also affected micronutrient security and are likely to do so in the future with increased interest in consuming a more plant-based diet.

Worldwide dietary patterns and their association with socioeconomic data: an ecological exploratory study

Background

Dietary patterns are associated with health outcomes and environment sustainability, having socioeconomic drivers. This ecological study aims to identify dietary patterns in food availability data at the global level using multivariate statistical methodology, to associate the identified dietary patterns with socioeconomic data and to analyze the adequacy of the applied multivariate statistical methods for this purpose.

Methods

Principal Component Analysis was applied to median values of times series of food availability data of 172 UN registered countries available at FAOSTAT database in Food Balance Sheets section in a sectional manner, after calculating median values of time series for each food group and country. Principal Components were associated with socioeconomic data available from the World Bank database. Sensitivity analyses were realized to verify the stability of dietary patterns through five different times.

Results

Five principal components were identified in the median values of each time series, each characterizing a possible dietary pattern. The first one, a westernized dietary pattern, was composed of energy-dense and processed foods, foods of animal origin, alcoholic beverages, but also, albeit less, by vegetables, fruits and nuts, being associated with income, urbanization and trade liberalization. This westernized pattern was characterized more animal origin and processed foods, such as vegetable oils, alcoholic beverages and stimulants yet preserving unprocessed and regional foods. The other dietary patterns were three agricultural patterns characterized more by regional foods, especially starchy staples, and one coastal dietary pattern composed of fish and seafoods, being associated with GINI index, poverty, and female labor force. Sensitivity analyses demonstrated the stability of dietary patterns.

Conclusions

Principal Component Analysis was adequate to identify dietary patterns in food availability data. A westernized dietary pattern was identified, being associated with income, urbanization, and trade liberalization. This association did not occur for the remain of the dietary patterns identified, these being less driven by economic development.

Using imputation to provide harmonized longitudinal measures of cognition across AIBL and ADNI

To improve understanding of Alzheimer’s disease, large observational studies are needed to increase power for more nuanced analyses. Combining data across existing observational studies represents one solution. However, the disparity of such datasets makes this a non-trivial task. Here, a machine learning approach was applied to impute longitudinal neuropsychological test scores across two observational studies, namely the Australian Imaging, Biomarkers and Lifestyle Study (AIBL) and the Alzheimer's Disease Neuroimaging Initiative (ADNI) providing an overall harmonised dataset. MissForest, a machine learning algorithm, capitalises on the underlying structure and relationships of data to impute test scores not measured in one study aligning it to the other study. Results demonstrated that simulated missing values from one dataset could be accurately imputed, and that imputation of actual missing data in one dataset showed comparable discrimination (p < 0.001) for clinical classification to measured data in the other dataset. Further, the increased power of the overall harmonised dataset was demonstrated by observing a significant association between CVLT-II test scores (imputed for ADNI) with PET Amyloid-β in MCI APOE-ε4 homozygotes in the imputed data (N = 65) but not for the original AIBL dataset (N = 11). These results suggest that MissForest can provide a practical solution for data harmonization using imputation across studies to improve power for more nuanced analyses.

A systematic review of supermarket automated electronic sales data for population dietary surveillance

Context

Most dietary assessment methods are limited by self-report biases, how long they take for participants to complete, and cost of time for dietitians to extract content. Electronically recorded, supermarket-obtained transactions are an objective measure of food purchases, with reduced bias and improved timeliness and scale.

Objective

The use, breadth, context, and utility of electronic purchase records for dietary research is assessed and discussed in this systematic review.

Data sources

Four electronic databases (MEDLINE, EMBASE, PsycINFO, Global Health) were searched. Included studies used electronically recorded supermarket transactions to investigate the diet of healthy, free-living adults.

Data extraction

Searches identified 3422 articles, of which 145 full texts were retrieved and 72 met inclusion criteria. Study quality was assessed using the National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies.

Data analysis

Purchase records were used in observational studies, policy evaluations, and experimental designs. Nutrition outcomes included dietary patterns, nutrients, and food category sales. Transactions were linked to nutrient data from retailers, commercial data sources, and national food composition databases.

Conclusion

Electronic sales data have the potential to transform dietary assessment and worldwide understanding of dietary behavior. Validation studies are warranted to understand limits to agreement and extrapolation to individual-level diets.

Systematic Review Registration

PROSPERO registration no. CRD42018103470

Diet quality in the population of Norway and Poland: differences in the availability and consumption of food considering national nutrition guidelines and food market

Background

Adequate nutrition is a public health challenge due to the increase in the incidence of diet-related diseases. The aim of this study was to examine food and nutrient intakes in the light of the current dietary guidelines of Poland and Norway. This is a suitable model for studying the diet quality in countries with different degrees of government intervention in the food market, which may affect food diversity available for citizens.

Methods

The food diversity on the market was assessed using national food balance sheets. To show the actual food and nutrient intake within countries, data from 24-h recalls from the national surveys, NORKOST 3 from Norwegians and WOBASZ II from Poles, were used. In order to evaluate whether dietary patterns comply with nutritional and dietary recommendations, the Norwegian and Polish recommendations for nutrition and the national food based dietary guidelines (FBDGs) were analyzed.

Results

Significant differences between the national supplies for most food products were found. Only subtle differences in the national FBDGs and nutritional recommendations were found. Low compliance with the national FBDGs for milk, fish and sugar consumption in Poland was observed. The intakes of most nutrients were in line with the countries’ nutrition recommendations. The intakes of folate and vitamin D by both genders and the intake of iron among women, were inadequate in both countries. Calcium and magnesium intakes were below the recommended intake among the adult population of Poland, additionally, insufficient intake of potassium and thiamine was found among Polish women.

Conclusions

Despite the limited availability of certain food products on the market, the diet of Norwegians was better balanced in terms of food consumed and micronutrient intakes. The good supply of various groups of food has not, however, reduced the problem of widespread deficiency of vitamin D and folic acid in the diet, and action should be taken at national level to eliminate their inadequacy. In view of increasing risk of non-communicable diseases, low compliance with the dietary guidelines requires educational campaigns aimed at increasing dietary literacy in vulnerable groups.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-10361-3.

Global associations between macronutrient supply and age-specific mortality

Animal experiments have demonstrated that energy intake and the balance of macronutrients determine life span and patterns of age-specific mortality (ASM). Similar effects have also been detected in epidemiological studies in humans. Using global supply data and 1,879 life tables from 103 countries, we test for these effects at a macrolevel: between the nutrient supplies of nations and their patterns of ASM. We find that macronutrient supplies are strong predictors of ASM even after correction for time and economic factors. Globally, signatures of undernutrition are evident in the effects of low supply on life expectancy at birth and high mortality across ages, even as recently as 2016. However, in wealthy countries, the effects of overnutrition are prominent, where high supplies particularly from fats and carbohydrates are predicted to lead to high levels of mortality. Energy supplied at around 3,500 kcal/cap/d minimized mortality across ages. However, we show that the macronutrient composition of energy supply that minimizes mortality varies with age. In early life, 40 to 45% energy from each of fat and carbohydrate and 16% from protein minimizes mortality. In later life, replacing fat with carbohydrates to around 65% of total energy and reducing protein to 11% is associated with the lowest level of mortality. These results, particularly those regarding fats, accord both with experimental data from animals and within-country epidemiological studies on the association between macronutrient intake and risk of age-related chronic diseases.

Cassava consumption and the occurrence of cyanide in cassava in Vietnam, Indonesia and Philippines

OBJECTIVE

To make a tentative assessment of the consumption of cassava in three countries in South-east Asia and the cyanogenic potential (CNp) of the crop as a possible food safety issue.

DESIGN

We used data from the Ministry of Health in Vietnam and Statistics Authorities in Indonesia and Philippines (mean household consumption per province) to assess cassava consumption. Conversions of units were needed to facilitate the comparison of cassava consumption between countries. The most up-to-date data available regarding both cassava consumption and the CNp of cassava grown in the respective countries were assessed.

SETTINGS

Vietnam, Indonesia and Philippines.

PARTICIPANTS

Respondents from provinces in Vietnam (nineteen), Indonesia (thirty-three) and Philippines (eighty-one) were asked to complete a recall questionnaire detailing either the previous 24-h' or the 7-d' cassava consumption.

RESULTS

Among the three countries, available data indicated that the highest median cassava-consumption figures percapita were from Indonesia and the Philippines (9·01 and 7·28 g/capita per d, respectively), with Vietnam having the least (1·14 g/capita per d). Published information regarding the CNp of cassava in the three countries was limited.

CONCLUSIONS

While the findings of the present study are somewhat limited by a lack of available information regarding both the extent of cassava consumption and the CNp of cassava consumed in the three countries, it appears likely that cyanogen intake arising from cassava consumption among the three countries exceeds the FAO/WHO Provisional Maximum Tolerable Daily Intake, although any risk to public health appears limited to a minority of provinces in each country.

Trends in energy and nutrient supply in Ethiopia: a perspective from FAO food balance sheets

BACKGROUND

Ethiopia is the second-most populous country in Africa. Although most people still live in rural areas, the urban population is increasing. Generally, urbanisation is associated with a nutrition transition and an increase in risk factors for non-communicable diseases (NCDs). The objective of this study was to determine how the nutritional composition of the Ethiopian food supply has changed over the last 50 years and whether there is evidence of a nutrition transition.

METHODS

Food balance sheets for Ethiopia from 1961 to 2011 were downloaded from the FAOSTAT database and daily per capita supply for 17 commodity groupings was calculated. After appropriate coding, per capita energy and nutrient supplies were determined.

RESULTS

Per capita energy supply was 1710 kcal/d in 1961, fell to 1403 kcal/d by 1973, and increased to 2111 kcal/d in 2011. Carbohydrate was by far the greatest energy source throughout the period, ranging from 72% of energy in 1968 to 79% in 1998; however, this was mostly provided by complex carbohydrates as the contribution of sugars to energy only varied between 4.7% in 1994 and 6.7% in 2011. Energy from fat was low, ranging from 14% of energy in 1970 to 10% in 1998. Energy from protein ranged from 14% in 1962 to 11% in 1994. Per capita supplies of calcium, vitamin A, C, D, folate and other B-vitamins were insufficient and there was a low supply of animal foods.

CONCLUSIONS

The Ethiopian food supply is still remarkably high in complex carbohydrates and low in sugars, fat, protein, and micronutrients. There is little evidence yet of changes that are usually associated with a nutrition transition.

Global Health Implications of Nutrient Changes in Rice Under High Atmospheric Carbon Dioxide

A growing literature has documented that rising concentrations of carbon dioxide in the atmosphere threaten to reduce the iron, zinc, and protein content of staple food crops including rice, wheat, barley, legumes, maize, and potatoes, potentially creating or worsening global nutritional deficiencies for over a billion people worldwide. A recent study extended these previous nutrient analyses to include B vitamins and showed that, in rice alone, the average loss of major B vitamins (thiamin, riboflavin, and folate) was shown to be 17-30% when grown under higher CO2. Here, we employ the EAR cut-point method, using estimates of national-level nutrient supplies and requirements, to estimate how B vitamin dietary adequacy may be affected by the CO2-induced loss of nutrients from rice only. Furthermore, we use the global burden of disease comparative risk assessment framework to quantify one small portion of the health burden related to rising deficiency: a higher likelihood of neural tube defects for folate-deficient mothers. We find that, as a result of this effect alone, risk of folate deficiency could rise by 1.5 percentage points (95% confidence interval: 0.6-2.6), corresponding to 132 million (57-239 million) people. Risk of thiamin deficiency could rise by 0.7 points (0.3-1.1) or 67 million people (30-110 million), and riboflavin deficiency by 0.4 points (0.2-0.6) or 40 million people (22-59 million). Because elevated CO2 concentrations are likely to reduce B vitamins in other crops beyond rice, our findings likely represent an underestimate of the impact of anthropogenic CO2 emissions on sufficiency of B vitamin intake.

Forecasting future global food demand: A systematic review and meta-analysis of model complexity

Predicting future food demand is a critical step for formulating the agricultural, economic and conservation policies required to feed over 9 billion people by 2050 while doing minimal harm to the environment. However, published future food demand estimates range substantially, making it difficult to determine optimal policies. Here we present a systematic review of the food demand literature-including a meta-analysis of papers reporting average global food demand predictions-and test the effect of model complexity on predictions. We show that while estimates of future global kilocalorie demand have a broad range, they are not consistently dependent on model complexity or form. Indeed, time-series and simple income-based models often make similar predictions to integrated assessments (e.g., with expert opinions, future prices or climate influencing forecasts), despite having different underlying assumptions and mechanisms. However, reporting of model accuracy and uncertainty was uncommon, leading to difficulties in making evidence-based decisions about which forecasts to trust. We argue for improved model reporting and transparency to reduce this problem and improve the pace of development in this field.

Study of community-living Alzheimer's patients' adherence to the Mediterranean diet and risks of malnutrition at different disease stages

Background

Alzheimer’s disease (AD) is a neurodegenerative disease that is characterized by deficits in episodic memory. It is the most common form of dementia and affects 50–70% of patients with cognitive impairments over the age of 65. Elderly people are particularly susceptible to malnutrition and that risk is even higher in patients with AD. This study assessed the nutritional status of patients with AD at different stages of AD and explored how that status correlated with cognitive, functional and behavioural variables and caregiver overburden. The characteristics of the diet and the degree of adherence to the Mediterranean diet were also analysed.

Methods

This was a cross-sectional study that was representative of the general population and it was carried out in the Unit of Cognitive Disorders, Lleida, Spain. The participants were 111 subjects with AD who were aged 65 and over and still living at home. The subjects’ nutritional status was assessed using the Mini Nutritional Assessment (MNA) and Controlling Nutritional Status system. The monthly food intake was estimated using the short Food Frequency Questionnaire and adherence to the Mediterranean diet was evaluated using the Mediterranean Diet Score. The Mini Mental State Examination (MMSE), Global Deterioration Scale, Neuropsychiatric Inventory (NPI) and Zarit Burden Interview (ZBI) were also used.

Results

We found that 68% of the subjects presented with a risk of malnutrition and 19% were malnourished according to the MNA scale. Patients ate a higher quantity of meat and dairy products than recommended and fewer products from the remaining healthier food groups. Of the 111 subjects, 73% showed low adherence to the Mediterranean diet and 27% showed moderate adherence. There was a partial correlation between nutritional status and the MMSE when the data were adjusted for age and sex (r = 0, 318; p = 0.001) and inverse correlations were found for functional status (r =  − 0.283; p = 0.004) and the NPI (r =  − 0.409; p = 0.000) and ZBI scales (r =  − 0.433; p = 0.000) when they were adjusted using the same variables. The ZBI scale (OR 1.08, 95% CI [1.01–1.15]) showed an increase in the risk of malnutrition in the multivariate analysis.

Discussion

Alterations in nutritional status were more common during the advanced stages of AD and were also associated with behavioural changes and caregiver overburden. Low adherence to traditional healthy diets in Mediterranean countries and food intake profiles should be considered when managing patients with AD. Other countries can use the results to examine diets in people with AD that are high in meat and dairy and low in healthy food groups like fruit and vegetables.

ONS: an ontology for a standardized description of interventions and observational studies in nutrition

Background

The multidisciplinary nature of nutrition research is one of its main strengths. At the same time, however, it presents a major obstacle to integrate data analysis, especially for the terminological and semantic interpretations that specific research fields or communities are used to. To date, a proper ontology to structure and formalize the concepts used for the description of nutritional studies is still lacking.

Results

We have developed the Ontology for Nutritional Studies (ONS) by harmonizing selected pre-existing de facto ontologies with novel health and nutritional terminology classifications. The ONS is the result of a scholarly consensus of 51 research centers in nine European countries. The ontology classes and relations are commonly encountered while conducting, storing, harmonizing, integrating, describing, and searching nutritional studies. The ONS facilitates the description and specification of complex nutritional studies as demonstrated with two application scenarios.

Conclusions

The ONS is the first systematic effort to provide a solid and extensible formal ontology framework for nutritional studies. Integration of new information can be easily achieved by the addition of extra modules (i.e., nutrigenomics, metabolomics, nutrikinetics, and quality appraisal). The ONS provides a unified and standardized terminology for nutritional studies as a resource for nutrition researchers who might not necessarily be familiar with ontologies and standardization concepts.

Electronic supplementary material

The online version of this article (10.1186/s12263-018-0601-y) contains supplementary material, which is available to authorized users.

Greenhouse gas emissions and energy use associated with production of individual self-selected US diets

Human food systems are a key contributor to climate change and other environmental concerns. While the environmental impacts of diets have been evaluated at the aggregate level, few studies, and none for the US, have focused on individual self-selected diets. Such work is essential for estimating a distribution of impacts, which, in turn, is key to recommending policies for driving consumer demand towards lower environmental impacts. To estimate the impact of US dietary choices on greenhouse gas emissions (GHGE) and energy demand, we built a food impacts database from an exhaustive review of food life cycle assessment (LCA) studies and linked it to over 6000 as-consumed foods and dishes from 1 day dietary recall data on adults (N = 16 800) in the nationally representative 2005-2010 National Health and Nutrition Examination Survey. Food production impacts of US self-selected diets averaged 4.7 kg CO₂ eq. person^-1 day^-1 (95% CI: 4.6-4.8) and 25.2 MJ non-renewable energy demand person^-1 day^-1 (95% CI: 24.6-25.8). As has been observed previously, meats and dairy contribute the most to GHGE and energy demand of US diets; however, beverages also emerge in this study as a notable contributor. Although linking impacts to diets required the use of many substitutions for foods with no available LCA studies, such proxy substitutions accounted for only 3% of diet-level GHGE. Variability across LCA studies introduced a ±19% range on the mean diet GHGE, but much of this variability is expected to be due to differences in food production locations and practices that can not currently be traced to individual dietary choices. When ranked by GHGE, diets from the top quintile accounted for 7.9 times the GHGE as those from the bottom quintile of diets. Our analyses highlight the importance of utilizing individual dietary behaviors rather than just population means when considering diet shift scenarios.

Assessing national nutrition security: The UK reliance on imports to meet population energy and nutrient recommendations

Nutrition security describes the adequacy of the food supply to meet not only energy but also macronutrient and micronutrient requirements for the population. The aim of this study was to develop a method to assess trends in national nutrition security and the contribution of imports to nutrition security, using the UK as a case study. Food supply data from FAO food balance sheets and national food composition tables were used to estimate the nutrient content of domestically produced food, imported food and exported food. Nutrition security was defined as the total nutrient supply (domestic production, minus exports, plus imports) to meet population-level nutrient requirements. The results showed that the UK was nutrition secure over the period 1961–2011 for energy, macronutrients and key micronutrients, with the exception of total carbohydrates and fibre, which may be due to the loss of fibre incurred by processing cereals into refined products. The supply of protein exceeded population requirements and could be met with domestic production alone. Even excluding all meat there was sufficient protein for population requirements. The supply of total fat, saturated fat and sugar considerably exceeded the current dietary recommendation. As regards nutrition security in 2010, the UK was reliant on imported foods to meet energy, fibre, total carbohydrate, iron, zinc and vitamin A requirements. This analysis demonstrates the importance of including nutrients other than energy to determine the adequacy of the food supply. The methodology also provides an alternative perspective on food security and self-sufficiency by assessing the dependency on imports to meet population level nutritional requirements.

Global comparison of national individual food consumption surveys as a basis for health research and integration in national health surveillance programmes

Individual food consumption surveys (IFCS) are performed to evaluate compliance with food/nutrient intake requirements or exposure to potential harmful dietary contaminants/components. In this review, we inventoried methods and designs used in national IFCS and discussed the methodologies applied across countries. Literature searches were performed using fixed sets of search terms in different online databases. We identified IFCS in thirty-nine countries from six world continents. National IFCS systems are available in most of the high-income countries, while such surveys are scarce in low- and middle-income countries (e.g. Africa, Eastern Europe and several Asian countries). Few countries (n 9) have their national IFCS incorporated into national health and nutrition surveys, allowing the investigation of dietary-related disease outcomes. Of the integrated surveys, most have the advantage of being continuous/regular, contrary to other IFCS that are mostly erratic. This review serves as the basis to define gaps and needs in IFCS worldwide and assists in defining priorities for resource allocation. In addition, it can serve as a source of inspiration for countries that do not have an IFCS system in place yet and advocate for national IFCS to be incorporated into national health and nutrition surveys in order to create: (1) research opportunities for investigating diet-disease relationships and (2) a frame to plan and evaluate the effect of diet-related policies (e.g. promotion of local nutrient-rich foods) and of nutrition recommendations, such as food-based dietary guidelines. Countries that integrate their IFCS within their national health and nutrition survey can serve as proof-of-principle for other countries.

The water use of Indian diets and socio-demographic factors related to dietary blue water footprint

Agriculture accounts for ~90% of India's fresh water use, and there are concerns that future food production will be threatened by insufficient water supply of adequate quality. This study aimed to quantify the water required in the production of diets in India using the water footprint (WF) assessment method. The socio-demographic associations of dietary WFs were explored using mixed effects regression models with a particular focus on blue (irrigation) WF given the importance for Indian agriculture. Dietary data from ~7000 adults living in India were matched to India-specific WF data for food groups to quantify the blue and green (rainfall) WF of typical diets. The mean blue and green WF of diets was 737l/capita/day and 2531l/capita/day, respectively. Vegetables had the lowest WFs per unit mass of product, while roots/tubers had the lowest WFs per unit dietary energy. Poultry products had the greatest blue WFs. Wheat and rice contributed 31% and 19% of the dietary blue WF respectively. Vegetable oils were the highest contributor to dietary green WF. Regional variation in dietary choices meant large differences in dietary blue WFs, whereby northern diets had nearly 1.5 times greater blue WFs than southern diets. Urban diets had a higher blue WF than rural diets, and a higher standard of living was associated with larger dietary blue WFs. This study provides a novel perspective on the WF of diets in India using individual-level dietary data, and demonstrates important variability in WFs due to different food consumption patterns and socio-demographic characteristics. Future dietary shifts towards patterns currently consumed by individuals in higher income groups, would likely increase irrigation requirements putting substantial pressure on India's water resources.

Global trends in dietary micronutrient supplies and estimated prevalence of inadequate intakes

Understanding dietary patterns is vital to reducing the number of people experiencing hunger (about 795 million), micronutrient deficiencies (2 billion), and overweight or obesity (2.1 billion). We characterize global trends in dietary quality by estimating micronutrient density of the food supply, prevalence of inadequate intake of 14 micronutrients, and average prevalence of inadequate intake of these micronutrients for all countries between 1961 and 2011. Over this 50-year period, the estimated prevalence of inadequate intakes of micronutrients has declined in all regions due to increased total production of food and/or micronutrient density. This decline has been particularly strong in East and Southeast Asia and weaker in South Asia and sub-Saharan Africa. Sub-Saharan Africa is the only region where dietary micronutrient density has declined over this 50-year period. At the global level, micronutrients with the lowest levels of adequate estimated intake are calcium, iron, vitamin A, and zinc, but there are strong differences between countries and regions. Fortification has reduced the estimated prevalence of inadequate micronutrient intakes in all low-income regions, except South Asia. The food supply in many countries is still far below energy requirements, which suggests a need to increase the availability and accessibility of nutritious foods. Countries where the food energy supply is adequate show a very large variation in dietary quality, and in many of these countries people would benefit from more diverse diets with a greater proportion of micronutrient-dense foods. Dietary quality can be improved through fortification, biofortification, and agricultural diversification, as well as efforts to improve access to and use of micronutrient-dense foods and nutritional knowledge. Reducing poverty and increasing education, especially of women, are integral to sustainably addressing malnutrition.

Global Changes in Food Supply and the Obesity Epidemic

PURPOSE OF REVIEW

We explore how a global shift in the food system caused by global economic growth, increase in available food per capita and in food processing is a driver of the obesity epidemic.

RECENT FINDINGS

Economic development in most areas of the world has resulted in increased purchasing power and available per capita food. Supermarkets and a growing fast-food industry have transformed our dietary pattern. Ultra-processed food rich on sugars and saturated fat is now the major source of energy in most countries. The shift in food supply is considered a major driver of the obesity epidemic and the increasing prevalence of accompanying complications, such as type 2 diabetes, cardiovascular disease and cancer. However, the global shift might also have direct effects on the increase in type 2 diabetes, cardiovascular disease and cancer, independently of overweight and obesity. The shift in the food supply is a major driver of the obesity epidemic.

Global Expanded Nutrient Supply (GENuS) Model: A New Method for Estimating the Global Dietary Supply of Nutrients

Insufficient data exist for accurate estimation of global nutrient supplies. Commonly used global datasets contain key weaknesses: 1) data with global coverage, such as the FAO food balance sheets, lack specific information about many individual foods and no information on micronutrient supplies nor heterogeneity among subnational populations, while 2) household surveys provide a closer approximation of consumption, but are often not nationally representative, do not commonly capture many foods consumed outside of the home, and only provide adequate information for a few select populations. Here, we attempt to improve upon these datasets by constructing a new model--the Global Expanded Nutrient Supply (GENuS) model--to estimate nutrient availabilities for 23 individual nutrients across 225 food categories for thirty-four age-sex groups in nearly all countries. Furthermore, the model provides historical trends in dietary nutritional supplies at the national level using data from 1961-2011. We determine supplies of edible food by expanding the food balance sheet data using FAO production and trade data to increase food supply estimates from 98 to 221 food groups, and then estimate the proportion of major cereals being processed to flours to increase to 225. Next, we estimate intake among twenty-six demographic groups (ages 20+, both sexes) in each country by using data taken from the Global Dietary Database, which uses nationally representative surveys to relate national averages of food consumption to individual age and sex-groups; for children and adolescents where GDD data does not yet exist, average calorie-adjusted amounts are assumed. Finally, we match food supplies with nutrient densities from regional food composition tables to estimate nutrient supplies, running Monte Carlo simulations to find the range of potential nutrient supplies provided by the diet. To validate our new method, we compare the GENuS estimates of nutrient supplies against independent estimates by the USDA for historical US nutrition and find very good agreement for 21 of 23 nutrients, though sodium and dietary fiber will require further improvement.

Comparison of food and nutrient intakes between cohorts of the HAPIEE and Whitehall II studies

BACKGROUND

Differences in dietary habits have been suggested as an important reason for the large health gap between Eastern and Western European populations. Few studies have compared individual-level nutritional data directly between the two regions. This study addresses this hypothesis by comparing food, drink and nutrient intakes in four large population samples.

METHODS

Czech, Polish and Russian participants of the Health, Alcohol and Psychosocial Factors in Eastern Europe (HAPIEE) study, and British participants in the Whitehall II study, altogether 29 972 individuals aged 45-73 years, were surveyed in 2002-2005. Dietary data were collected by customised food frequency questionnaires. Reported food, drink and nutrient intake data were harmonised and compared between cohorts using multivariable adjusted quantile regression models.

RESULTS

Median fruit and vegetable intakes were lower in the pooled Eastern European sample, but not in all country cohorts, compared with British subjects. Median daily consumption of fruits were 275, 213, 130 and 256 g in the Czech, Polish, Russian and Whitehall II cohort, respectively. The respective median daily intakes of vegetables were 185, 197, 292 and 246 g. Median intakes of animal fat foods and saturated fat, total fat and cholesterol nutrients were significantly higher in the Czech, Polish and Russian cohorts compared with the British; for example, median daily intakes of saturated fatty acids were 31.3, 32.5, 29.2 and 25.4 g, respectively.

CONCLUSION

Our findings suggest that there are important differences in dietary habits between and within Eastern and Western European populations which may have contributed to the health gap between the two regions.

A Comparison of Food Supply from 1984 to 2009 and Degree of Dietary Westernization in Taiwan with Asian Countries and World Continents

OBJECTIVE

To compare quality, quantity, and trends of food supply from 1984 to 2009 and degree of food westernization in Taiwan with Asian countries and world continents by using food balance data.

METHODS

We compiled data from food balance sheets of Taiwan and Food and Agriculture Organization, including five continents and three most populated countries each in Eastern, Southern, and Southeastern Asia over the period 1984-2009. Quantity of food supply per capita was referenced to Taiwan food guides. The population-weighted means of food supply from Europe, North America, South America, and Australia and New Zealand continents in terms of energy and nutrient distributions, animal/plant sources, and sugar/alcohol contribution were used as indicators of westernization. Trends of food supply per capita of six food groups were plotted, and linear regression was applied to evaluate food changes.

FINDINGS

Taiwan's food supply provided sufficient quantity in food energy, with the lowest cereals/roots supply and rice to wheat ratio, but the highest meat and oil supplies per capita among the 10 studied Asian countries. Taiwan food supply showed the most westernization among these countries.

CONCLUSION

Food supply of Taiwan, although currently sufficient, indicated some security problems and high tendency of diet westernization.

The Inadmissibility of What We Eat in America and NHANES Dietary Data in Nutrition and Obesity Research and the Scientific Formulation of National Dietary Guidelines

The Scientific Report of the 2015 Dietary Guidelines Advisory Committee was primarily informed by memory-based dietary assessment methods (M-BMs) (eg, interviews and surveys). The reliance on M-BMs to inform dietary policy continues despite decades of unequivocal evidence that M-BM data bear little relation to actual energy and nutrient consumption. Data from M-BMs are defended as valid and valuable despite no empirical support and no examination of the foundational assumptions regarding the validity of human memory and retrospective recall in dietary assessment. We assert that uncritical faith in the validity and value of M-BMs has wasted substantial resources and constitutes the greatest impediment to scientific progress in obesity and nutrition research. Herein, we present evidence that M-BMs are fundamentally and fatally flawed owing to well-established scientific facts and analytic truths. First, the assumption that human memory can provide accurate or precise reproductions of past ingestive behavior is indisputably false. Second, M-BMs require participants to submit to protocols that mimic procedures known to induce false recall. Third, the subjective (ie, not publicly accessible) mental phenomena (ie, memories) from which M-BM data are derived cannot be independently observed, quantified, or falsified; as such, these data are pseudoscientific and inadmissible in scientific research. Fourth, the failure to objectively measure physical activity in analyses renders inferences regarding diet-health relationships equivocal. Given the overwhelming evidence in support of our position, we conclude that M-BM data cannot be used to inform national dietary guidelines and that the continued funding of M-BMs constitutes an unscientific and major misuse of research resources.

Australia's nutrition transition 1961-2009: a focus on fats

Since the 1960s, Australian diets have changed considerably, influenced by a burgeoning multicultural cuisine, increase in urbanisation and food technology advances. This has been described as a 'nutrition transition', resulting in the adoption of a Western diet pattern, with a shift away from unrefined foods towards a diet higher in both plant-derived high PUFA and total fats and refined carbohydrates. Utilising the 1961-2009 annual food supply data from the UN FAO, the present study investigated changes in the intake of macronutrient and specific fatty acid in the Australian population, including that of the PUFA linoleic acid (LA), due to its hypothesised role in inflammation and risk for obesity. Cumulative change over time for the contribution of specific nutrients to total available energy (TAE) was calculated, as was linearity of change. Over the time period analysed, the cumulative change in TAE from carbohydrate was -9.35 and +16.67 % from lipid. The cumulative change in TAE from LA was +120.48 %. Moreover, the cumulative change in the contribution of LA to total PUFA availability was +7.1 %. Utilising the average g/d per capita of LA from selected dietary sources, the change in the contribution of specific foodstuffs was assessed, with total plant oils having a cumulative change of +627.19 % to LA availability, equating to a cumulative change of +195.61 % in contribution to total LA availability. The results of the present study indicate that LA availability in Australia has increased over the previous five decades as a result of the availability of increased plant oils, as has total fat, possibly contributing to the increasing rates of obesity and obesity-associated co-morbidities.

Does the consumption of fruits and vegetables differ between Eastern and Western European populations? Systematic review of cross-national studies

BACKGROUND

Difference in fruit and vegetable consumption has been suggested as a possible reason for the large gap in cardiovascular disease (CVD) mortality rates between Eastern and Western European populations. However, individual-level dietary data which allow direct comparison across the two regions are rare. In this systematic review we aimed to answer the question whether cross-national studies with comparable individual-level dietary data reveal any systematic differences in fruit and vegetable consumption between populations in Central and Eastern Europe (CEE) and the Former Soviet Union (FSU) compared to Western Europe (WE).

METHODS

Studies were identified by electronic search of MEDLINE, EMBASE and Web of Science databases from inception to September 2014, and hand search. Studies which reported data on fruit, vegetable consumption or carotene and vitamin C intake or tissue concentrations of adult participants from both CEE/FSU and WE countries were considered for inclusion. Quality of the included studies was assessed by a modified STROBE statement. Power calculation was performed to determine the statistical significance of the comparison results.

RESULTS

Twenty-two studies fulfilled the inclusion criteria. Fruit consumption was found to be consistently lower in CEE/FSU participants compared to Western Europeans. Results on vegetable intake were less unambiguous. Antioxidant studies indicated lower concentration of beta-carotene in CEE/FSU subjects, but the results for vitamin C were not consistent.

CONCLUSION

This systematic review suggests that populations in CEE and FSU consume less fruit than Western Europeans. The difference in the consumption of fruit may contribute to the CVD gap between the two regions.

Assessing global dietary habits: a comparison of national estimates from the FAO and the Global Dietary Database

BACKGROUND

Accurate data on dietary habits are crucial for understanding impacts on disease and informing policy priorities. Nation-specific food balance sheets from the United Nations FAO provided the only available global dietary estimates but with uncertain validity.

OBJECTIVES

We investigated how FAO estimates compared with nationally representative, individual-based dietary surveys from the Global Dietary Database (GDD) and developed calibration equations to improve the validity of FAO data to estimate dietary intakes.

DESIGN

FAO estimates were matched to GDD data for 113 countries across the following 9 major dietary metrics for 30 y of data (1980-2009): fruit, vegetables, beans and legumes, nuts and seeds, whole grains, red and processed meats, fish and seafood, milk, and total energy. Both absolute and percentage differences in FAO and GDD mean estimates were evaluated. Linear regression was used to evaluate whether FAO estimates predicted GDD dietary intakes and whether this prediction varied according to age, sex, region, and time. Calibration equations were developed to adjust FAO estimates to approximate national dietary surveys validated by using randomly split data sets.

RESULTS

For most food groups, FAO estimates substantially overestimated individual-based dietary intakes by 74.5% (vegetables) and 270% (whole grains) while underestimating beans and legumes (-50%) and nuts and seeds (-29%) (P < 0.05 for each). In multivariate regressions, these overestimations and underestimations for each dietary factor further varied by age, sex, region, and time (P < 0.001 for each). Split-data set calibration models, which accounted for country-level covariates and other sources of heterogeneity, effectively adjusted FAO estimates to approximate estimates from national survey data (r = 0.47-0.80) with small SEs of prediction (generally 1-5 g/d).

CONCLUSIONS

For all food groups and total energy, FAO estimates substantially exceeded or underestimated individual-based national surveys of individual intakes with significant variation depending on age, sex, region, and time. Calibration models effectively adjusted the comprehensive, widely accessible FAO data to facilitate a more-accurate estimation of individual-level dietary intakes nationally and by age and sex.

Trade as a structural driver of dietary risk factors for noncommunicable diseases in the Pacific: an analysis of household income and expenditure survey data

Background

Noncommunicable diseases are a health and development challenge. Pacific Island countries are heavily affected by NCDs, with diabetes and obesity rates among the highest in the world. Trade is one of multiple structural drivers of NCDs in the Pacific, but country-level data linking trade, diets and NCD risk factors are scarce. We attempted to illustrate these links in five countries. The study had three objectives: generate cross-country profiles of food consumption and expenditure patterns; highlight the main ‘unhealthy’ food imports in each country to inform targeted policymaking; and demonstrate the potential of HCES data to analyze links between trade, diets and NCD risk factors, such as obesity.

Methods

We used two types of data: obesity rates as reported by WHO and aggregated household-level food expenditure and consumption from Household Income and Expenditure Survey reports. We classified foods in HIES data into four categories: imported/local, ‘unhealthy’/’healthy’, nontraditional/traditional, processed/unprocessed. We generated cross-country profiles and cross-country regressions to examine the relationships between imported foods and unhealthy foods, and between imported foods and obesity.

Results

Expenditure on imported foods was considerable in all countries but varied across countries, with highest values in Kiribati (53%) and Tonga (52%) and lowest values in Solomon Islands and Vanuatu (30%). Rice and sugar accounted for significant amounts of imported foods in terms of expenditure and calories, ranking among the top 3 foods in most countries. We found significant or near-significant associations in expenditure and caloric intake between ‘unhealthy’ and imported foods as well as between imported foods and obesity, though inferences based on these associations should be made carefully due to data constraints.

Conclusions

While additional research is needed, this study supports previous findings on trade as a structural driver of NCD risk and identifies the top imported foods that could serve as policy targets. Moreover, this analysis is proof-of-concept that the methodology is a cost-effective way for countries to use existing data to generate policy-relevant evidence on links between trade and NCDs. We believe that the methodology is replicable to other countries globally. A user-friendly Excel tool is available upon request to assist such analyses.

Environmental footprints of Mediterranean versus Western dietary patterns: beyond the health benefits of the Mediterranean diet

BACKGROUND

Dietary patterns can substantially vary the resource consumption and environmental impact of a given population. Dietary changes such as the increased consumption of vegetables and reduced consumption of animal products reduce the environmental footprint and thus the use of natural resources. The adherence of a given population to the Mediterranean Dietary Pattern (MDP) through the consumption of the food proportions and composition defined in the new Mediterranean Diet pyramid can thus not only influence human health but also the environment. The aim of the study was to analyze the sustainability of the MDP in the context of the Spanish population in terms of greenhouse gas emissions, agricultural land use, energy consumption and water consumption. Furthermore, we aimed to compare the current Spanish diet with the Mediterranean Diet and in comparison with the western dietary pattern, exemplified by the U.S.A. food pattern, in terms of their corresponding environmental footprints.

METHODS

The environmental footprints of the dietary patterns studied were calculated from the dietary make-up of each dietary pattern, and specific environmental footprints of each food group. The dietary compositions were obtained from different sources, including food balance sheets and household consumption surveys. The specific environmental footprints of food groups were obtained from different available life-cycle assessments.

RESULTS

The adherence of the Spanish population to the MDP has a marked impact on all the environmental footprints studied. Increasing adherence to the MDP pattern in Spain will reduce greenhouse gas emissions (72%), land use (58%) and energy consumption (52%), and to a lower extent water consumption (33%). On the other hand, the adherence to a western dietary pattern implies an increase in all these descriptors of between 12% and 72%.

CONCLUSIONS

The MDP is presented as not only a cultural model but also as a healthy and environmentally-friendly model, adherence to which, in Spain would have, a significant contribution to increasing the sustainability of food production and consumption systems in addition to the well-known benefits on public health.

Data harmonization and federated analysis of population-based studies: the BioSHaRE project

Abstracts

Monitoring and benchmarking population diet quality globally: a step-wise approach

INFORMAS (International Network for Food and Obesity/non-communicable diseases Research, Monitoring and Action Support) aims to monitor and benchmark the healthiness of food environments globally. In order to assess the impact of food environments on population diets, it is necessary to monitor population diet quality between countries and over time. This paper reviews existing data sources suitable for monitoring population diet quality, and assesses their strengths and limitations. A step-wise framework is then proposed for monitoring population diet quality. Food balance sheets (FBaS), household budget and expenditure surveys (HBES) and food intake surveys are all suitable methods for assessing population diet quality. In the proposed 'minimal' approach, national trends of food and energy availability can be explored using FBaS. In the 'expanded' and 'optimal' approaches, the dietary share of ultra-processed products is measured as an indicator of energy-dense, nutrient-poor diets using HBES and food intake surveys, respectively. In addition, it is proposed that pre-defined diet quality indices are used to score diets, and some of those have been designed for application within all three monitoring approaches. However, in order to enhance the value of global efforts to monitor diet quality, data collection methods and diet quality indicators need further development work.

Trends in energy and nutrient supply in Trinidad and Tobago from 1961 to 2007 using FAO food balance sheets

OBJECTIVE

Trinidad and Tobago has experienced an epidemiological transition over recent decades characterised by reduced rates of communicable diseases but rapidly increasing rates of obesity and non-communicable chronic diseases. The objective of the present study was to investigate the changes in energy and nutrient supply that have taken place in Trinidad and Tobago between 1961 and 2007.

DESIGN

Food balance sheets for each year between 1961 and 2007 were downloaded from the FAOSTAT database and daily per capita supply for seventeen food commodity groupings was calculated. After appropriate coding, energy and nutrient supply were determined using dietary analysis software.

SETTING

FAO food balance sheets for Trinidad and Tobago from 1961 to 2007.

SUBJECTS

None.

RESULTS

The food supply in 2007 provided an extra 1561 kJ (373 kcal)/capita per d than it did in 1961. Energy from carbohydrate as a percentage of total energy fell from 62% in 1961 to 57% in 2007, whereas energy from fat as a percentage of total energy increased from 26% to over 30% and now lies at the upper end of WHO recommendations. Sugars increased from 20% to over 26% of total energy and are well above WHO recommendations. When expressed on a nutrient density basis, supplies of vitamin A, folate and Ca are lower than WHO recommendations.

CONCLUSIONS

Nutritional imbalances in the Trinidadian food supply need to be addressed to combat the rise in nutrition-related chronic disease that is projected to cause increased disability and premature death in the country in the coming years.

A program needs-driven approach to selecting dietary assessment methods for decision-making in food fortification programs

BACKGROUND

Dietary assessment data are essential for designing, monitoring, and evaluating food fortification and other food-based nutrition programs. Planners and managers must understand the validity, usefulness, and cost tradeoffs of employing alternative dietary assessment methods, but little guidance exists.

OBJECTIVE

To identify and apply criteria to assess the tradeoffs of using alternative dietary methods for meeting fortification programming needs.

METHODS

Twenty-five semistructured expert interviews were conducted and literature was reviewed for information on the validity, usefulness, and cost of using 24-hour recalls, Food Frequency Questionnaires/Fortification Rapid Assessment Tool (FFQ/FRAT), Food Balance Sheets (FBS), and Household Consumption and Expenditures Surveys (HCES) for program stage-specific information needs. Criteria were developed and applied to construct relative rankings of the four methods.

RESULTS

Needs assessment: HCES offers the greatest suitability at the lowest cost for estimating the risk of inadequate intakes, but relative to 24-hour recall compromises validity.

DESIGN

HCES should be used to identify vehicles and to estimate coverage and likely impact due to its low cost and moderate-to-high validity. Baseline assessment: 24-hour recall should be applied using a representative sample. Monitoring: A simple, low-cost FFQ can be used to monitor coverage. Impact evaluation: 24-hour recall should be used to assess changes in nutrient intakes. FBS have low validity relative to other methods for all programmatic purposes.

CONCLUSIONS

Each dietary assessment method has strengths and weaknesses that vary by context and purpose. Method selection must be driven by the program's data needs, the suitability of the methods for the purpose, and a clear understanding of the tradeoffs involved.

Exposure to toxic chemicals in the diet: is the Brazilian population at risk?

In Brazil, in the last 20 years, dietary risk assessments have been conducted on pesticides, mycotoxins, food additives, heavy metals (mainly mercury), environmental contaminants (mainly DDT) and acrylamide, a compound formed during food processing. The objectives of this paper were to review these studies, discuss their limitations and uncertainties and identify the most critical chemicals that may pose a health risk to Brazilian consumers. The studies have shown that the cumulative intake of organophosphorus and carbamate pesticides by high consumers of fruits and vegetables may represent a health concern (up to 169% of the ARfD), although the benefits of consuming large portions of those foods most probably overcome the risks. High consumers of maize products may also be at risk due to the presence of fumonisin (355% of the PMTDI), a mycotoxin present at high levels in Brazilian maize. The studies conducted in the Brazilian Amazon have shown that riparian fish consumers are exposed to unsafe levels of mercury. However, this is a more complex issue, as mercury levels in the region are naturally high and the health benefits of a fish-based diet are well known. Studies conducted both in Brazil and internationally on acrylamide have shown that the exposure to this genotoxic compound, mainly from the consumption of French fries and potato chips, is of health concern. Reducing the population dietary exposure to toxic chemicals is a challenge for government authorities and food producers in all countries. Management strategies aimed at decreasing exposure to the critical chemicals identified in this review involve limiting the use or eliminating highly toxic pesticides, implementing good agricultural practices to decrease maize contamination by fumonisins, educating local fish-eating communities toward a fish diet less contaminated by mercury, and changing dietary habits concerning the consumption of fried potatoes, the main processed food containing acrylamide.

Calcium intake in the United States from dietary and supplemental sources across adult age groups: new estimates from the National Health and Nutrition Examination Survey 2003-2006

BACKGROUND

Adequate lifelong calcium intake is essential in optimizing bone health. Recent National Health and Nutrition Examination Survey data were used to quantify variation in calcium intake across adult age groups and to relate age-associated changes in calcium intake with energy intake. Additional goals were to assess differences in dietary calcium intake between supplemental calcium users and nonusers and to evaluate associations between age and calcium density in the diet.

DESIGN

This cross-sectional analysis determined calcium and energy intake for National Health and Nutrition Examination Survey respondents during 2003-2006. Diet was assessed with 24-hour recall and supplement use via questionnaire. Trends in median intakes for dietary calcium, total calcium, and energy across age categories were assessed using survey analysis methods. Nutrient density was represented using calcium to energy intake ratios.

RESULTS

The analyses included data from 9,475 adults. When compared to the 19- to 30-year age group, median dietary calcium intake was lower in the ≥81-year age group by 23% in men (P<0.001) and by 14% in women (P=0.003). These reductions coincided with 35% and 28% decreases, respectively, in median energy intake (P<0.001 for each sex). In contrast, the frequency of calcium supplement use increased (P<0.001) with age in both men and women. Yet, among female supplement users, the decline in median dietary calcium intake was greater than in nonusers (P=0.02). Calcium density in the diet significantly increased relative to age in men and women (P<0.001 for each sex); however, dietary and total calcium to energy ratios were insufficient to meet target ratios inferred by adequate intake standards after age 50 years.

CONCLUSIONS

Although supplemental calcium use and calcium density were highest in older age groups, they were not sufficient in meeting recommended levels. New approaches to increasing the frequency and level of calcium supplement use to enhance calcium density in diets may be necessary to reduce osteoporosis risk among older Americans.

Food consumption trends and drivers

A picture of food consumption (availability) trends and projections to 2050, both globally and for different regions of the world, along with the drivers largely responsible for these observed consumption trends are the subject of this review. Throughout the world, major shifts in dietary patterns are occurring, even in the consumption of basic staples towards more diversified diets. Accompanying these changes in food consumption at a global and regional level have been considerable health consequences. Populations in those countries undergoing rapid transition are experiencing nutritional transition. The diverse nature of this transition may be the result of differences in socio-demographic factors and other consumer characteristics. Among other factors including urbanization and food industry marketing, the policies of trade liberalization over the past two decades have implications for health by virtue of being a factor in facilitating the 'nutrition transition' that is associated with rising rates of obesity and chronic diseases such as cardiovascular disease and cancer. Future food policies must consider both agricultural and health sectors, thereby enabling the development of coherent and sustainable policies that will ultimately benefit agriculture, human health and the environment.

Feeding the world healthily: the challenge of measuring the effects of agriculture on health

Agricultural production, food systems and population health are intimately linked. While there is a strong evidence base to inform our knowledge of what constitutes a healthy human diet, we know little about actual food production or consumption in many populations and how developments in the food and agricultural system will affect dietary intake patterns and health. The paucity of information on food production and consumption is arguably most acute in low- and middle-income countries, where it is most urgently needed to monitor levels of under-nutrition, the health impacts of rapid dietary transition and the increasing 'double burden' of nutrition-related disease. Food availability statistics based on food commodity production data are currently widely used as a proxy measure of national-level food consumption, but using data from the UK and Mexico we highlight the potential pitfalls of this approach. Despite limited resources for data collection, better systems of measurement are possible. Important drivers to improve collection systems may include efforts to meet international development goals and partnership with the private sector. A clearer understanding of the links between the agriculture and food system and population health will ensure that health becomes a critical driver of agricultural change.

The nutrition transition in Barbados: trends in macronutrient supply from 1961 to 2003

Barbados has been experiencing increasing rates of obesity and chronic non-communicable diseases characteristic of a country in nutrition transition. However, few studies have been carried out on how precisely the diet has changed in recent decades. Our aim was to analyse the FAO food balance sheets for Barbados from 1961 to 2003 in order to characterise the changes that have taken place in the macronutrient supply of the country during that period. Annual food balance sheets were downloaded from the FAOSTAT database, and per capita supply for twelve commodity groupings was analysed for energy and macronutrient levels using WISP dietary analysis software (Tinuviel Software, Llanfechell, Anglesey, UK). The food supply in 2003 provided over 2500 kJ (about 600 kcal) more energy per capita per d than it did in 1961. Energy from carbohydrate as a percentage of total energy has fallen from 70 % in 1961 to 57 % in 2003 and is now at the lower end of WHO recommendations. Energy from fat as a percentage of total energy increased from 19 % to 28 % and now lies at the upper end of WHO recommendations. Sugars, at over 17 % of dietary energy, are well above the upper limit set by the WHO. Despite having methodological limitations associated with the use of food balance statistics, our data suggest that these imbalances need to be addressed as a matter of priority in order to try to reverse the incidence of nutrition-related chronic diseases that are projected to cause increasing disability and premature death in the country in the coming years.

Worldwide variation of adherence to the Mediterranean diet, in 1961-1965 and 2000-2003

OBJECTIVE

The present study aimed to analyse the worldwide trends of adherence to the Mediterranean diet (MD), in 1961-1965 and 2000-2003.

DESIGN

Data were obtained from the FAO food balance sheets in two periods: 1961-1965 and 2000-2003. In order to have a sample from across the world, forty-one countries were selected. The average of available energy for different food groups was calculated for all selected countries. These values were used to evaluate the adherence to the MD through a variation of Mediterranean Adequacy Index (MAI).

RESULTS

The majority of the forty-one countries in this study have tended to drift away from a Mediterranean-like dietary pattern. Mediterranean Europe and the Other Mediterranean country groups suffered a significant decrease in their MAI values. The Mediterranean European group, especially Greece, experienced the greatest decrease in MAI value. In both periods, the Other Mediterranean countries showed the highest MAI values. In an analysis by countries, Iran had the highest increase in MAI across the time periods, and Egypt occupied the first place in the ranking in 2000-2003. The Northern European group was the only one that registered an increase in MAI, although this was not statistically significant.

CONCLUSIONS

Many countries in the Mediterranean basin are drifting away from the Mediterranean dietary pattern (MDP). However, countries in Northern Europe and some other countries around the world are taking on a Mediterranean-like dietary pattern. The Other Mediterranean countries have the closest adherence to the MDP, currently and in the 1960s. Nutrition policy actions to tackle dietary westernisation and preserve the healthy prudent MDP are required.

Dietary habits in three Central and Eastern European countries: the HAPIEE study

BACKGROUND

The high cardiovascular mortality in Eastern Europe has often been attributed to poor diet, but individual-level data on nutrition in the region are generally not available. This paper describes the methods of dietary assessment and presents preliminary findings on food and nutrient intakes in large general population samples in Russia, Poland and the Czech Republic.

METHODS

The HAPIEE (Health, Alcohol and Psychosocial factors In Eastern Europe) study examined random samples of men and women aged 45-69 years at baseline in Novosibirsk (Russia), Krakow (Poland) and six Czech urban centres in 2002-2005. Diet was assessed using a food frequency questionnaire (at least 136 items); complete dietary information was available for 26,870 persons.

RESULTS

Total energy intakes among men ranged between 8.7 MJ in the Czech sample and 11.7 MJ in the Russian sample, while among women, energy intakes ranged between 8.2 MJ in the Czech sample and 9.8 MJ in the Russian sample. A Healthy Diet Indicator (HDI), ranging from a score of 0 (lowest) to 7 (highest), was developed using the World Health Organisation's (WHO) guidelines for the prevention of chronic diseases. The mean HDI scores were low, ranging from 1.0 (SD = 0.7) among the Polish subjects to 1.7 (SD = 0.8) among the Czech females. Very few subjects met the WHO recommended intakes for complex carbohydrates, pulses or nuts; intakes of saturated fatty acids, sugar and protein were too high. Only 16% of Polish subjects met the WHO recommendation for polyunsaturated fat intake. Consumption of fruits and vegetables was lower than recommended, especially among those Russian subjects who were assessed during the low intake season. Fewer than 65% of subjects consumed adequate amounts of calcium, magnesium and potassium, when compared with the United Kingdom's Reference Nutrient Intake.

CONCLUSION

This first large scale study of individual-based dietary intakes in the general population in Eastern Europe implies that intakes of saturated fat, sugar and complex carbohydrates are a cause for concern. The development of country-specific nutritional tools must be encouraged and nutritional campaigns must undergo continuing development.

Availability of Mediterranean and non-Mediterranean foods during the last four decades: comparison of several geographical areas

Objective

The purpose of the present study was to evaluate the changes in the availability of the most important food components of the traditional Mediterranean diet and other food groups in five geographical areas during a 43-year period.

Design

Ecological study with food availability data obtained from FAO food balance sheets in forty-one countries for the period 1961–1965 and 2000–2004.

Setting

Mediterranean, Northern and Central Europe, Other Mediterranean countries and Other Countries of the World were the studied areas.

Results

The main changes since the 1960s, at an availability level, were found in European areas and in Other Mediterranean countries. The greatest changes were found in Mediterranean Europe, recording high availability of non-Mediterranean food groups (animal fats, vegetable oils, sugar and meat), whereas the availability of alcoholic beverages, including wine, and legumes decreased. Despite having lost some of its typical characteristics, Mediterranean Europe has more olive oil, vegetables, fruits and fish available than other areas. Although Northern Europe has a greater availability of non-Mediterranean foods, there has been a tendency towards a decrease in availability of some of these foods and to increase Mediterranean food such as olive oil and fruits.

Conclusions

The present study suggests that European countries, especially those in the Mediterranean area, have experienced a ‘westernisation’ process of food habits, and have increasingly similar patterns of food availability (mainly non-Mediterranean food groups) among them. Measures must be taken to counteract these tendencies and to avoid their possible negative consequences. It is also crucial to find ways to promote and preserve the Mediterranean diet and its lifestyle in modern societies.

Transitions at CpG dinucleotides, geographic clustering of TP53 mutations and food availability patterns in colorectal cancer

BACKGROUND

Colorectal cancer is mainly attributed to diet, but the role exerted by foods remains unclear because involved factors are extremely complex. Geography substantially impacts on foods. Correlations between international variation in colorectal cancer-associated mutation patterns and food availabilities could highlight the influence of foods on colorectal mutagenesis.

METHODOLOGY

To test such hypothesis, we applied techniques based on hierarchical clustering, feature extraction and selection, and statistical pattern recognition to the analysis of 2,572 colorectal cancer-associated TP53 mutations from 12 countries/geographic areas. For food availabilities, we relied on data extracted from the Food Balance Sheets of the Food and Agriculture Organization of the United Nations. Dendrograms for mutation sites, mutation types and food patterns were constructed through Ward's hierarchical clustering algorithm and their stability was assessed evaluating silhouette values. Feature selection used entropy-based measures for similarity between clusterings, combined with principal component analysis by exhaustive and heuristic approaches.

CONCLUSION/SIGNIFICANCE

Mutations clustered in two major geographic groups, one including only Western countries, the other Asia and parts of Europe. This was determined by variation in the frequency of transitions at CpGs, the most common mutation type. Higher frequencies of transitions at CpGs in the cluster that included only Western countries mainly reflected higher frequencies of mutations at CpG codons 175, 248 and 273, the three major TP53 hotspots. Pearson's correlation scores, computed between the principal components of the datamatrices for mutation types, food availability and mutation sites, demonstrated statistically significant correlations between transitions at CpGs and both mutation sites and availabilities of meat, milk, sweeteners and animal fats, the energy-dense foods at the basis of "Western" diets. This is best explainable by differential exposure to nitrosative DNA damage due to foods that promote metabolic stress and chronic inflammation.