Who are the 'low energy reporters' in the dietary and nutritional survey of British adults?

Two new meal- and web-based interactive food frequency questionnaires: validation of energy and macronutrient intake

BACKGROUND

Meal-Q and its shorter version, MiniMeal-Q, are 2 new Web-based food frequency questionnaires. Their meal-based and interactive format was designed to promote ease of use and to minimize answering time, desirable improvements in large epidemiological studies.

OBJECTIVE

We evaluated the validity of energy and macronutrient intake assessed with Meal-Q and MiniMeal-Q as well as the reproducibility of Meal-Q.

METHODS

Healthy volunteers aged 20-63 years recruited from Stockholm County filled out the 174-item Meal-Q. The questionnaire was compared to 7-day weighed food records (WFR; n=163), for energy and macronutrient intake, and to doubly labeled water (DLW; n=39), for total energy expenditure. In addition, the 126-item MiniMeal-Q was evaluated in a simulated validation using truncated Meal-Q data. We also assessed the answering time and ease of use of both questionnaires.

RESULTS

Bland-Altman plots showed a varying bias within the intake range for all validity comparisons. Cross-classification of quartiles placed 70%-86% in the same/adjacent quartile with WFR and 77% with DLW. Deattenuated and energy-adjusted Pearson correlation coefficients with the WFR ranged from r=0.33-0.74 for macronutrients and was r=0.18 for energy. Correlations with DLW were r=0.42 for Meal-Q and r=0.38 for MiniMeal-Q. Intraclass correlations for Meal-Q ranged from r=0.57-0.90. Median answering time was 17 minutes for Meal-Q and 7 minutes for MiniMeal-Q, and participants rated both questionnaires as easy to use.

CONCLUSIONS

Meal-Q and MiniMeal-Q are easy to use and have short answering times. The ranking agreement is good for most of the nutrients for both questionnaires and Meal-Q shows fair reproducibility.

Under-reporting of energy intake in elderly Australian women is associated with a higher body mass index

OBJECTIVES

Identify the extent of under-reporting of energy intake and the characteristics associated with implausible intakes in elderly women.

DESIGN

Dietary intake was assessed using a 3-day weighed food record. Protein intake was validated by 24-hour urinary nitrogen. To examine under-reporting, participants were grouped according to their energy intake and compared to the Goldberg cut-off equation. Logistic regression was performed to assess the influence of body mass index (BMI) and social-demographic factors on under-reporting.

SETTING

Community dwelling elderly women from Perth, Western Australia.

PARTICIPANTS

217 elderly women aged 70-80 years.

RESULTS

Under-reporters had a higher physical activity level (p<0.001) compared with acceptable-reporters. The under-reporters also had a higher body weight (p=0.006), body mass index (BMI) (p=0.001), waist (p=0.011), hip circumference (p<0.001), whole body fat mass (p<0.001) and percentage body fat (p<0.001) than acceptable-reporters. Under-reporters had a significantly lower intakes of protein, fat, carbohydrate and alcohol (p<0.001) and fewer reported food items, compared with acceptable reporters. However, 24-hour urinary nitrogen was only marginally different between the two groups (p=0.053). Participants with a higher BMI were more likely to under-report their energy intake (BMI=25-29.9: odds ratio=2.98[95% CI=1.46-6.09]; BMI≥30: 5.84[2.41-14.14]).

CONCLUSION

Under-reporting energy intake in elderly women was associated with a higher BMI, body fat and higher self-reported physical activity levels. A higher BMI (≥25) appears to be most significant factor in determining if elderly women will underreport their food intake and may be related to body image. These results have implications for undertaking surveys of food intake in elderly women.

Many apples a day keep the blues away--daily experiences of negative and positive affect and food consumption in young adults

OBJECTIVES

Prior research has focused on the association between negative affect and eating behaviour, often utilizing laboratory or cross-sectional study designs. These studies have inherent limitations, and the association between positive affect and eating behaviour remains relatively unexplored. Therefore, the objective of this study was to investigate the bidirectional relationships between daily negative and positive affective experiences and food consumption in a naturalistic setting among healthy young adults.

DESIGN

Daily diary study across 21 days (microlongitudinal, correlational design).

METHODS

A total of 281 young adults with a mean age of 19.9 (± 1.2) years completed an Internet-based daily diary for 21 consecutive days. Each day they reported their negative and positive affect, and their consumption of five specific foods. Hierarchical linear modelling was used to test same-day associations between daily affect and food consumption, and next-day (lagged) associations to determine directionality. Moderating effects of BMI and gender were also examined in exploratory analyses.

RESULTS

Analyses of same-day within-person associations revealed that on days when young adults experienced greater positive affect, they reported eating more servings of fruit (p = .002) and vegetables (p < .001). Results of lagged analysis showed that fruits and vegetables predicted improvements in positive affect the next day, suggesting that healthy foods were driving affective experiences and not vice versa. Meaningful changes in positive affect were observed with the daily consumption of approximately 7-8 servings of fruit or vegetables.

CONCLUSIONS

Eating fruit and vegetables may promote emotional well-being among healthy young adults.

Contributions of processed foods to dietary intake in the US from 2003-2008: a report of the Food and Nutrition Science Solutions Joint Task Force of the Academy of Nutrition and Dietetics, American Society for Nutrition, Institute of Food Technologists, and International Food Information Council

Processed foods are an integral part of American diets, but a comparison of the nutrient contribution of foods by level of processing with the recommendations of the Dietary Guidelines for Americans regarding nutrients to encourage or to reduce has not been documented. The mean reported daily dietary intakes of these nutrients and other components were examined among 25,351 participants ≥2 y of age in the 2003-2008 NHANES to determine the contribution of processed food to total intakes. Also examined was the percent contribution of each nutrient to the total reported daily nutrient intake for each of the 5 categories of food that were defined by the level of processing. All processing levels contributed to nutrient intakes, and none of the levels contributed solely to nutrients to be encouraged or solely to food components to be reduced. The processing level was a minor determinant of individual foods' nutrient contribution to the diet and, therefore, should not be a primary factor when selecting a balanced diet.

Maternal diet, breastfeeding and adolescent body composition: a 16-year prospective study

BACKGROUND/OBJECTIVES

Overweight and obesity are becoming increasingly prevalent problems worldwide. A number of factors in early life have been found to be associated with body composition of neonates or young children but there is limited follow-up data for adolescents. This study aims to describe associations between early nutrition and body composition in adolescents.

SUBJECTS/METHODS

Birth cohort study of 415 pregnant women and their offspring (mean age 16 years). Body composition including fat mass (FM) and lean body mass (LBM) of adolescents at 16 years of age was measured by dual-energy X-ray absorptiometry. Information on maternal food and nutrients intake during the third trimester of pregnancy and breastfeeding was collected by questionnaires soon after birth.

RESULTS

A total of 264 mother-adolescents pairs were studied. Maternal antenatal meat intake was positively associated with FM of adolescents (an increase of 0.9%/portion, P<0.01). There were also positive associations between maternal energy intake (per 1000 kJ/day), fat (per 10 g/d) and protein (per 10 g/day) intake and offspring's FM (an increase of 1.3%), but these became borderline after adjustment for confounders. Breastfeeding >25 days was negatively associated with FM in adolescents (a decrease of 14%, P=0.01). These associations were independent of the significant association between maternal energy and macronutrient intakes during pregnancy and adolescent intakes at 16 years of age. No significant association was found between maternal dietary intake and lean mass in adolescents.

CONCLUSIONS

Breastfeeding may have a biological effect that is beneficial for the prevention of obesity. Conversely, higher maternal meat intake during pregnancy may increase FM in adolescents.

Assessing dietary intake: Who, what and why of under-reporting

Under-reporting of food intake is one of the fundamental obstacles preventing the collection of accurate habitual dietary intake data. The prevalence of under-reporting in large nutritional surveys ranges from 18 to 54% of the whole sample, but can be as high as 70% in particular subgroups. This wide variation between studies is partly due to different criteria used to identify under-reporters and also to non-uniformity of under-reporting across populations. The most consistent differences found are between men and women and between groups differing in body mass index. Women are more likely to under-report than men, and under-reporting is more common among overweight and obese individuals. Other associated characteristics, for which there is less consistent evidence, include age, smoking habits, level of education, social class, physical activity and dietary restraint. Determining whether under-reporting is specific to macronutrients or food is problematic, as most methods identify only low energy intakes. Studies that have attempted to measure under-reporting specific to macronutrients express nutrients as percentage of energy and have tended to find carbohydrate under-reported and protein over-reported. However, care must be taken when interpreting these results, especially when data are expressed as percentages. A logical conclusion is that food items with a negative health image (e.g. cakes, sweets, confectionery) are more likely to be under-reported, whereas those with a positive health image are more likely to be over-reported (e.g. fruits and vegetables). This also suggests that dietary fat is likely to be under-reported. However, it is necessary to distinguish between under-reporting and genuine under-eating for the duration of data collection. The key to understanding this problem, but one that has been widely neglected, concerns the processes that cause people to under-report their food intakes. The little work that has been done has simply confirmed the complexity of this issue. The importance of obtaining accurate estimates of habitual dietary intakes so as to assess health correlates of food consumption can be contrasted with the poor quality of data collected. This phenomenon should be considered a priority research area. Moreover, misreporting is not simply a nutritionist's problem, but requires a multidisciplinary approach (including psychology, sociology and physiology) to advance the understanding of under-reporting in dietary intake studies.

The use of cluster analysis to derive dietary patterns: methodological considerations, reproducibility, validity and the effect of energy mis-reporting

Over the last three decades, dietary pattern analysis has come to the forefront of nutritional epidemiology, where the combined effects of total diet on health can be examined. Two analytical approaches are commonly used: a priori and a posteriori. Cluster analysis is a commonly used a posteriori approach, where dietary patterns are derived based on differences in mean dietary intake separating individuals into mutually exclusive, non-overlapping groups. This review examines the literature on dietary patterns derived by cluster analysis in adult population groups, focusing, in particular, on methodological considerations, reproducibility, validity and the effect of energy mis-reporting. There is a wealth of research suggesting that the human diet can be described in terms of a limited number of eating patterns in healthy population groups using cluster analysis, where studies have accounted for differences in sex, age, socio-economic status, geographical area and weight status. Furthermore, patterns have been used to explore relationships with health and chronic diseases and more recently with nutritional biomarkers, suggesting that these patterns are biologically meaningful. Overall, it is apparent that consistent trends emerge when using cluster analysis to derive dietary patterns; however, future studies should focus on the inconsistencies in methodology and the effect of energy mis-reporting.

Micronutrient deficiency in obese subjects undergoing low calorie diet

Background

The prevalence of micronutrient deficiencies is higher in obese individuals compared to normal-weight people, probably because of inadequate eating habits but also due to increased demands among overweight persons, which are underestimated by dietary reference intakes (DRI) intended for the general population. We therefore evaluated the dietary micronutrient intake in obese individuals compared to a reference population and DRI recommendations. Furthermore, we determined the micronutrient status in obese subjects undergoing a standardized DRI-covering low-calorie formula diet to analyze if the DRI meet the micronutrient requirements of obese individuals.

Methods

In 104 subjects baseline micronutrient intake was determined by dietary record collection. A randomly assigned subgroup of subjects (n = 32) underwent a standardized DRI-covering low-calorie formula diet over a period of three months. Pre- and post-interventional intracellular micronutrient status in buccal mucosa cells (BMC) was analyzed, as well as additional micronutrient serum concentrations in 14 of the subjects.

Results

Prior to dietetic intervention, nutrition was calorie-rich and micronutrient-poor. Baseline deficiencies in serum concentrations were observed for 25-hydroxyvitamin-D, vitamin C, selenium, iron, as well as ß-carotene, vitamin C, and lycopene in BMC. After a three-month period of formula diet even more subjects had reduced micronutrient levels of vitamin C (serum, BMC), zinc, and lycopene. There was a significant negative correlation between lipophilic serum vitamin concentrations and body fat, as well as between iron and C-reactive protein.

Conclusions

The present pilot study shows that micronutrient deficiency occurring in obese individuals is not corrected by protein-rich formula diet containing vitamins and minerals according to DRI. In contrast, micronutrient levels remain low or become even lower, which might be explained by insufficient intake, increased demand and unbalanced dispersal of lipophilic compounds in the body.

Trial registration

The study was registered at ClinicalTrials.gov (NCT01344525). The study protocol comprises only a part of the approved trial protocol.

Bias in protein and potassium intake collected with 24-h recalls (EPIC-Soft) is rather comparable across European populations

Purpose

We investigated whether group-level bias of a 24-h recall estimate of protein and potassium intake, as compared to biomarkers, varied across European centers and whether this was influenced by characteristics of individuals or centers.

Methods

The combined data from EFCOVAL and EPIC studies included 14 centers from 9 countries (n = 1,841). Dietary data were collected using a computerized 24-h recall (EPIC-Soft). Nitrogen and potassium in 24-h urine collections were used as reference method. Multilevel linear regression analysis was performed, including individual-level (e.g., BMI) and center-level (e.g., food pattern index) variables.

Results

For protein intake, no between-center variation in bias was observed in men while it was 5.7% in women. For potassium intake, the between-center variation in bias was 8.9% in men and null in women. BMI was an important factor influencing the biases across centers (p < 0.01 in all analyses). In addition, mode of administration (p = 0.06 in women) and day of the week (p = 0.03 in men and p = 0.06 in women) may have influenced the bias in protein intake across centers. After inclusion of these individual variables, between-center variation in bias in protein intake disappeared for women, whereas for potassium, it increased slightly in men (to 9.5%). Center-level variables did not influence the results.

Conclusion

The results suggest that group-level bias in protein and potassium (for women) collected with 24-h recalls does not vary across centers and to a certain extent varies for potassium in men. BMI and study design aspects, rather than center-level characteristics, affected the biases across centers.

Electronic supplementary material

The online version of this article (doi:10.1007/s00394-011-0279-z) contains supplementary material, which is available to authorized users.

The development and evaluation of a novel Internet-based computer program to assess previous-day dietary and physical activity behaviours in adults: the Synchronised Nutrition and Activity Program for Adults (SNAPA™)

The Synchronised Nutrition and Activity Program for Adults (SNAPA™) was developed to address the need for accurate, reliable, feasible, inexpensive and low-burden methods for assessing specific dietary and physical activity behaviours in adults. Short-term test-retest reliability of SNAPA™ was assessed in forty-four adults (age 41·4 (SD17·3) years) who completed SNAPA™ twice in 1 day. Concurrent validity against direct dietary observation and combined heart rate and accelerometry was assessed in seventy-seven adults (age 34·4 (SD11·1) years). Test-retest reliability revealed no substantial systematic shifts in mean values of the outcome variables: percentage of food energy from fat (% fat), number of portions of fruit and vegetables (FV) and minutes of moderate-to-vigorous physical activity (MVPA). For lunchtime dietary intake, the mean match rate between food items reported using SNAPA™ and those observed was 81·7%, with a phantom rate of 5·6%. Pearson's correlations between SNAPA™ and the reference methods ranged from 0·27 to 0·56 for % fat, FV portions and minutes of MVPA. For % fat and FV intake, there was no fixed or proportional bias, and mean differences between the methods (SNAPA™ - reference) were 5·1% and 0 portions, respectively. For minutes of MVPA, a fixed bias of - 28 min was revealed when compared with all minutes of MVPA measured by combined heart rate and accelerometry, whereas a proportional bias (slope 1·47) was revealed when compared with minutes carried out in bouts ≥ 10 min. SNAPA™ is a promising tool for measuring specific energy balance behaviours, though further work is required to improve accuracy for physical activity behaviours.

Weight loss is coupled with improvements to affective state in obese participants engaged in behavior change therapy based on incremental, self-selected "small changes"

The aim of this study was to investigate the effects of a group behavior change intervention involving self-selected, contextualized, and mediated goal setting on anthropometric, affective, and dietary markers of health. It was hypothesized that the intervention would elicit changes consistent with accepted health recommendations for obese individuals. A rolling program of 12-week "Small Changes" interventions during 24 months recruited 71 participants; each program accommodated 10 to 13 adults (body mass index [BMI] ≥ 30 kg/m²). Fifty-eight participants completed Small Changes. Repeated measures were made at baseline, 6 and 12 weeks. Anthropometric measures included height and weight (to calculate BMI), body composition, waist circumference, and blood pressure. Affective state was monitored using relevant validated questionnaires. Dietary assessment used 3-day household measures food diaries with Schofield equations to monitor underreporting. Relevant blood measures were recorded throughout. Across the measurement period, Small Changes elicited a significant reduction in body weight (baseline, 102.95 ± 15.47 vs 12 weeks 100.09 ± 16.01 kg, P < .0005), coupled with associated significant improvements in BMI, body fat percentage, and waist circumference measures. There were additional significant positive changes in measures of affective state including general well-being (baseline, 58.92 ± 21.22 vs 12 weeks 78.04 ± 14.60, P < .0005) and total mood disturbance (baseline, 31.19 ± 34.03 vs 12 weeks 2.67 ± 24.96, P < .0005). Dietary changes that occurred were largely consistent with evidenced-based recommendations for weight management and included significant reductions in total energy intake and in fat and saturated fat as a proportion of energy. The Small Changes approach can elicit a range of health-orientated benefits for obese participants, and although further work is needed to ascertain the longevity of such effects, the outcomes from Small Changes are likely to help inform health professionals when framing the future of weight management. Long-term follow-up of Small Changes is warranted.

Sugar-sweetened beverage, sugar intake of individuals, and their blood pressure: international study of macro/micronutrients and blood pressure

The obesity epidemic has focused attention on relationships of sugars and sugar-sweetened beverages (SSBs) to cardiovascular risk factors. Here we report cross-sectional associations of SSBs, diet beverages, and sugars with blood pressure (BP) for United Kingdom and US participants of the International Study of Macro/Micronutrients and Blood Pressure. Data collected include four 24-hour dietary recalls, two 24-hour urine collections, 8 BP readings, and questionnaire data for 2696 people ages 40 to 59 years of age from 10 US/United Kingdom population samples. Associations of SSBs, diet beverages, and sugars (fructose, glucose, and sucrose) with BP were assessed by multiple linear regression. SSB intake related directly to BP, with P values of 0.005 to <0.001 (systolic BP) and 0.14 to <0.001 (diastolic BP). SSB intake higher by 1 serving per day (355 mL/24 hours) was associated with systolic/diastolic BP differences of +1.6/+0.8 mm Hg (both P<0.001) and +1.1/+0.4 mm Hg (P<0.001/<0.05) with adjustment for weight and height. Diet beverage intake was inversely associated with BP (P 0.41 to 0.003). Fructose- and glucose-BP associations were direct, with significant sugar-sodium interactions: for individuals with above-median 24-hour urinary sodium excretion, fructose intake higher by 2 SD (5.6% kcal) was associated with systolic/diastolic BP differences of +3.4/+2.2 mm Hg (both P<0.001) and +2.5/+1.7 mm Hg (both P=0.002) with adjustment for weight and height. Observed independent, direct associations of SSB intake and BP are consistent with recent trial data. These findings, plus adverse nutrient intakes among SSB consumers, and greater sugar-BP differences for persons with higher sodium excretion lend support to recommendations that intake of SSBs, sugars, and salt be substantially reduced.

[Assessment of food consumption and nutrient intake in clinical practice]

The assessment of food consumption in clinical practice is often carried out to develop and implement nutritional advice. Factors as the patient health conditions, the evolution of his/her clinical condition as well as the reasons that motivated the search for advice will guide the selection of the best method of assessment of food consumption or nutrient intake to employ. The chosen method might drive the professional to offer a food plan that aims to promote health, to prevent illness, and to alter the nutritional state of the patient. Despite the easily available national literature on methods and techniques to estimate food consumption, it is not uncommon that professionals still have doubts about what methods are the most appropriated in daily practice. This study aimed to present a critical analysis, taking into account the clinical applicability, of the food assessment methods and its characteristics.

Use of the predictive sugars biomarker to evaluate self-reported total sugars intake in the Observing Protein and Energy Nutrition (OPEN) study

BACKGROUND

A predictive biomarker for intake of total sugars was recently developed under controlled conditions. We used this biomarker to assess measurement error (ME) structure in self-reported intake of total sugars in free-living individuals.

METHODS

The Observing Protein and Energy Nutrition (OPEN) study involved 484 participants aged 40 to 69 years. Diet was assessed using two administrations of a food frequency questionnaire (FFQ) and two nonconsecutive 24-hour dietary recalls (24HDR). Two 24-hour urine samples checked for completeness were analyzed on sucrose and fructose. We applied the biomarker calibrated in a feeding study to OPEN data to assess the ME structure and the attenuation factors (AF) for intakes of absolute total sugars and sugars density for the FFQ and 24HDR.

RESULTS

The AFs for absolute sugars were similar for a single FFQ and 24HDR, but attenuation decreased with repeated 24HDRs. For sugars density, the AFs for FFQ (men: 0.39; women: 0.33) were greater than for single 24HDR (men: 0.30; women: 0.24), and similar to two 24HDRs (men: 0.41; women: 0.35). The attenuation associated with both instruments was greater in women than in men.

CONCLUSIONS

Both the FFQ and 24HDR were found to be biased; hence, incorporation of the sugars biomarker in calibration studies within the cohorts may be necessary to more reliably estimate associations of sugars and disease.

IMPACT

In this article, we propose a new dietary reference instrument based on the recently defined class of predictive biomarkers. Using sugars biomarker, we quantify ME in the FFQ- and 24HDR-reported absolute total sugars and total sugars density.

Two non-consecutive 24 h recalls using EPIC-Soft software are sufficiently valid for comparing protein and potassium intake between five European centres – results from the European Food Consumption Validation (EFCOVAL) study

The use of two non-consecutive 24 h recalls using EPIC-Soft for standardised dietary monitoring in European countries has previously been proposed in the European Food Consumption Survey Method consortium. Whether this methodology is sufficiently valid to assess nutrient intake in a comparable way, among populations with different food patterns in Europe, is the subject of study in the European Food Consumption Validation consortium. The objective of the study was to compare the validity of usual protein and K intake estimated from two non-consecutive standardised 24 h recalls using EPIC-Soft between five selected centres in Europe. A total of 600 adults, aged 45–65 years, were recruited in Belgium, the Czech Republic, France, The Netherlands and Norway. From each participant, two 24 h recalls and two 24 h urines were collected. The mean and distribution of usual protein and K intake, as well as the ranking of intake, were compared with protein and K excretions within and between centres. Underestimation of protein (range 2–13 %) and K (range 4–17 %) intake was seen in all centres, except in the Czech Republic. We found a fair agreement between prevalences estimated based on the intake and excretion data at the lower end of the usual intake distribution ( < 10 % difference), but larger differences at other points. Protein and K intake was moderately correlated with excretion within the centres (ranges = 0·39–0·67 and 0·37–0·69, respectively). These were comparable across centres. In conclusion, two standardised 24 h recalls (EPIC-Soft) appear to be sufficiently valid for assessing and comparing the mean and distribution of protein and K intake across five centres in Europe as well as for ranking individuals.

Evaluation of energy and dietary intake estimates from a food frequency questionnaire using independent energy expenditure measurement and weighed food records

Background

We have developed a food frequency questionnaire (FFQ) for the assessment of habitual diet, with special focus on the intake of fruit, vegetables and other antioxidant-rich foods and beverages. The aim of the present study was to evaluate the relative validity of the intakes of energy, food and nutrients from the FFQ.

Methods

Energy intake was evaluated against independent measures of energy expenditure using the ActiReg^® system (motion detection), whereas 7-days weighed food records were used to study the relative validity of food and nutrient intake. The relationship between methods was investigated using correlation analyses and cross-classification of participants. The visual agreement between the methods was evaluated using Bland-Altman plots.

Results

We observed that the FFQ underestimated the energy intake by approximately 11% compared to the energy expenditure measured by the ActiReg^®. The correlation coefficient between energy intake and energy expenditure was 0.54 and 32% of the participants were defined as under-reporters. Compared to the weighed food records the percentages of energy from fat and added sugar from the FFQ were underestimated, whereas the percentage of energy from total carbohydrates and protein were slightly overestimated. The intake of foods rich in antioxidants did not vary significantly between the FFQ and weighed food records, with the exceptions of berries, coffee, tea and vegetables which were overestimated. Spearman's Rank Order Correlations between FFQ and weighed food records were 0.41 for berries, 0.58 for chocolate, 0.78 for coffee, 0.61 for fruit, 0.57 for fruit and berry juices, 0.40 for nuts, 0.74 for tea, 0.38 for vegetables and 0.70 for the intake of wine.

Conclusions

Our new FFQ provides a good estimate of the average energy intake and it obtains valid data on average intake of most antioxidant-rich foods and beverages. Our study also showed that the FFQs ability to rank participants according to intake of total antioxidants and most of the antioxidant-rich foods was good.

Shortening the retention interval of 24-hour dietary recalls increases fourth-grade children's accuracy for reporting energy and macronutrient intake at school meals

BACKGROUND

Accurate information about children's intake is crucial for national nutrition policy and for research and clinical activities. To analyze accuracy for reporting energy and nutrients, most validation studies utilize the "conventional approach," which was not designed to capture errors of reported foods and amounts. The "reporting-error-sensitive approach" captures errors of reported foods and amounts.

OBJECTIVE

To extend results to energy and macronutrients for a validation study concerning retention interval (elapsed time between to-be-reported meals and the interview) and accuracy for reporting school-meal intake, the conventional and reporting-error-sensitive approaches were compared. DESIGN AND PARTICIPANTS/SETTING: Fourth-grade children (n=374) were observed eating two school meals, and interviewed to obtain a 24-hour recall using one of six interview conditions from crossing two target periods (prior 24 hours and previous day) with three interview times (morning, afternoon, and evening). Data were collected in one district during three school years (2004-2005, 2005-2006, and 2006-2007).

MAIN OUTCOME MEASURES

Report rates (reported/observed), correspondence rates (correctly reported/observed), and inflation ratios (intruded/observed) were calculated for energy and macronutrients.

STATISTICAL ANALYSES PERFORMED

For each outcome measure, mixed-model analysis of variance was conducted with target period, interview time, their interaction, and sex in the model; results were adjusted for school year and interviewer.

RESULTS

With the conventional approach, report rates for energy and macronutrients did not differ by target period, interview time, their interaction, or sex. With the reporting-error-sensitive approach, correspondence rates for energy and macronutrients differed by target period (four P values <0.0001) and the target period by interview-time interaction (four P values <0.0001); inflation ratios for energy and macronutrients differed by target period (four P values <0.0001), and inflation ratios for energy and carbohydrate differed by the target period by interview-time interaction (both P values <0.005).

CONCLUSIONS

Shortening the retention interval of dietary recalls increases accuracy for reporting energy and macronutrients. For validation studies, it is best to obtain reference information from a method that provides details about foods and amounts consumed and to use an analytic approach that captures errors of reported foods and amounts.

Under-reporting of food intake is frequent among Brazilian free-living older persons: a doubly labelled water study

The assessment of food intake is essential for the development of dietetic interventions. Accuracy is low when intake is assessed by questionnaires, the under-reporting of food intake being frequent. Most such studies, however, were performed in developed countries and there is little data about the older population of developing nations. This study aimed to verify the total energy expenditure (TEE) of independent older Brazilians living in an urban area, through the doubly labelled water (DLW) method and to compare it with the reported energy intake obtained through the application of a food frequency questionnaire (FFQ). Initially, 100 volunteers aged from 60 to 75 years had their body composition determined by dual-energy X-ray absorptiometry (DEXA). Five volunteers of each quartile of body fat percentage had their energy expenditure determined by DLW. The mean age of the subjects included in this phase of the study was 66.4 +/- 3.5 years, and ten of the subjects were men. The mean TEE was 2565 +/- 614 and 2154 +/- 339 kcal.day(-1) for men and women, respectively. The Physical Activity Level (PAL) was 1.58 +/- 0.31 and 1.52 +/- 0.22, respectively. Under-reporting of food intake was highly prevalent, with a mean percentage of reported intake in relation to measured TEE of -17.7%. Thus, under-reporting of food intake is highly prevalent among Brazilian independent older persons. The DLW method is an important tool in nutritional studies and its use is to be recommended in developing countries.

Maternal macronutrient and energy intakes in pregnancy and offspring intake at 10 y: exploring parental comparisons and prenatal effects

BACKGROUND

High maternal dietary intakes in pregnancy may lead to increased fetal growth and program neuroendocrine pathways that result in greater appetite, energy intake, and adiposity in offspring later in life. Few prospective dietary studies have explored this relation.

OBJECTIVE

The objective was to assess associations of maternal dietary intake in pregnancy and maternal and paternal dietary intake postnatally with child dietary intake and adiposity.

DESIGN

Dietary intakes of energy, protein, total fat, and carbohydrate were assessed prospectively in mothers during pregnancy, in mothers and their partners at 47 mo postnatally, and in children at 10 y (n = 5717 mother-child pairs prenatally, 5593 mother-child pairs postnatally, and 3009 father-child pairs). Child body composition was assessed at 9 and 11 y (n = 5725).

RESULTS

Maternal dietary intakes of protein, fat (when adjusted for energy intake), and carbohydrate in pregnancy were positively associated with child dietary intakes of the same nutrients, and these associations were greater than those observed for paternal dietary intake, which was not strongly associated with offspring diet. Associations of maternal prenatal-offspring intakes were stronger than those of maternal postnatal-offspring intakes for protein and fat. Greater child energy and macronutrient intakes were only associated with greater adiposity in children when adjusted for potential energy underreporting. Maternal diet during pregnancy was not associated with offspring adiposity or lean mass.

CONCLUSION

The stronger prenatal maternal associations with child dietary intake, particularly protein and fat, compared with both paternal intake associations and maternal postnatal intake associations provide some evidence for in utero programming of offspring appetite by maternal intake during pregnancy.

Anthropometric, metabolic, dietary and psychosocial profiles of underreporters of energy intake: a doubly labeled water study among overweight/obese postmenopausal women--a Montreal Ottawa New Emerging Team study

BACKGROUND/OBJECTIVES

To analyze the anthropometric, metabolic, psychosocial and dietary profiles of underreporters, identified by the doubly labeled water technique, in a well-characterized population of overweight and obese postmenopausal women.

SUBJECTS/METHODS

The study population consisted of 87 overweight and obese sedentary postmenopausal women (age: 57.7+/-4.8 years, body mass index: 32.4+/-4.6 kg/m(2)). Subjects were identified as underreporters based on the energy intake to energy expenditure ratio of <0.80. We measured (1) body composition (by dual-energy X-ray absorptiometry), (2) visceral fat (by computed tomography), (3) blood profile, (4) resting blood pressure, (5) peak oxygen consumption (VO(2 peak)), (6) total energy expenditure, (7) muscle strength and (8) psychosocial and dietary profiles.

RESULTS

Out of 87 subjects, 50 (57.5%) were identified as underreporting subjects in our cohort. Underreporters showed higher levels of body mass index, fat mass, visceral fat, hsC-reactive protein, perceived stress and percentage of energy from protein, as well as lower levels of VO(2 peak), dietary intake of calcium, fiber, iron, vitamin B-1 and 6, as well as servings of fruit and vegetables. Logistic regression analysis showed that fat mass, odd ratio 1.068 (95% confidence interval 1.009-1.130) and perceived stress, odd ratio 1.084 (95% confidence interval 1.011-1.162) were independent characteristics of underreporters.

CONCLUSIONS

Results from this study show significant differences in anthropometric, metabolic, psychosocial and dietary profiles between underreporters and non-underreporters in our cohort of overweight and obese postmenopausal women.

Differences between food group reports of low-energy reporters and non-low-energy reporters on a food frequency questionnaire

BACKGROUND

Low-energy reporters (LERs) and non-LERs differ with respect to several characteristics, including self-reported intake of foods. Limited data exist regarding food intake difference between LERs and non-LERs identified using doubly labeled water (DLW).

OBJECTIVE

In the Observing Protein and Energy Nutrition Study (September 1999-March 2000), differences were examined between food group reports of LERs and non-LERs on a food frequency questionnaire (FFQ) (n=440).

DESIGN

LERs were identified using DLW. Responses of LERs (n=220) and non-LERs (n=220) for 43 food groups on the FFQ were examined in three ways: whether they reported consuming a food group (yes/no), how frequently they reported consuming it (times per day), and the reported portion size (small, medium, or large). Analyses were adjusted for total energy expenditure from DLW.

RESULTS

LERs, compared to non-LERs, were less likely to report consumption for one food group among women (soft drinks/regular). Among men, there was no difference between LERs and non-LERs with respect to reporting consumption of food groups. Reported mean daily frequency of consumption was lower among LERs compared with non-LERs for 23 food groups among women and 24 food groups among men (18 food groups were similar in men and women). In addition, reported mean portion sizes were smaller for LERs compared with non-LERs for six food groups among women and five food groups among men (three food groups were similar in men and women). Results varied minimally by sex and body mass index.

CONCLUSIONS

LERs, compared with non-LERs, were more likely to differ regarding their reported frequency of consumption of food groups than their reported consumption (yes/no) or portion size of food groups. Results did not vary greatly by sex or body mass index. It still remains unclear whether improvement in questionnaire design or additional tools or methods would lead to a decrease in differential reporting due to LER status on an FFQ.

Misreporting of energy and micronutrient intake estimated by food records and 24 hour recalls, control and adjustment methods in practice

In order to assess nutritional adequacy, valid estimates of nutrient intake are required. One of the main errors in dietary assessment is misreporting. The objective was to review the extent, nature and determinants of misreporting in dietary assessment, how this affects reported intakes of micronutrients and how this is identified and measured, and to identify the best ways of dealing with misreporting when interpreting results. A systematic literature search was conducted for studies of misreporting of dietary intake in adults by 24 hour recalls or by estimated or weighed food records, published up to March 2008. Thirty-seven relevant studies were identified. Possible causes of misreporting were identified. Methods most used to identify misreporting were the Goldberg cut-off (46 % studies) and the doubly labelled water technique (24 % studies). The magnitude of misreporting of energy intake was similar in all three dietary assessment methods. The percentage of under-reporters was about 30 % and energy intake was underestimated by approximately 15 %. Seven papers presented usable data for micronutrient intake. Absolute intakes of Fe, Ca and vitamin C (the three micronutrients addressed in all papers) were on average 30 % lower in low-energy reporters (LER) than that in non-LER and, although results were not consistent, there was a tendency for micronutrient density to be higher in LER. Excluding underreporters or using energy adjustment methods for micronutrient intakes is discussed. Residual method of energy adjustment seems to be a good tool for practice to decrease an influence of misreporting when interpreting results of studies based on food records and 24 hour recalls.

Meal patterns among children and adolescents and their associations with weight status and parental characteristics

OBJECTIVES

To describe the meal patterns of Jena schoolchildren and their associations with children's weight status and parental characteristics.

DESIGN

Cross-sectional study.

SETTING

Twenty schools in Jena (100,000 inhabitants), south-east Germany.

SUBJECTS

A total of 2054 schoolchildren aged 7-14 years with information on BMI standard deviation score (BMI-SDS) and weight status (based on German reference values), of whom 1571 had additional information about their parents (parental education and employment status, weight status according to WHO guidelines) and meal patterns (school lunch participation rate, meal frequencies, breakfast consumption and frequency of family meals).

RESULTS

Weight status of the children was associated with weight status, education and employment status of the parents. Meal patterns were strongly dependent on children's age and parental employment. As age increased, the frequency of meal consumption, participation rate in school lunches and the number of family meals decreased. Using linear regression analysis, a high inverse association between BMI-SDS and meal frequency was observed, in addition to relationships with parental weight status and paternal education.

CONCLUSIONS

Age-specific prevention programmes should encourage greater meal frequency. The close involvement of parents is essential in any strategy for improving children's (families') diets.

More distinct food intake patterns among women than men in northern Sweden: a population-based survey

BACKGROUND

The need to promote a healthy diet to curb the current obesity epidemic has today been recognized by most countries. A prerequisite for planning and evaluating interventions on dietary intake is the existence of valid information on long-term average dietary intake in a population. Few large, population-based studies of dietary intake have been carried out in Sweden. The largest to date is the Västerbotten Intervention Program (VIP), which was initiated in 1985, with data collection still ongoing. This paper reports on the first comprehensive analyses of the dietary data and presents dietary intake patterns among over 60,000 women and men in northern Sweden during 1992-2005.

METHODS

Between 1992 and 2005, 71,367 inhabitants in Västerbotten county aged 30, 40, 50, and 60 years visited their local health care center as part of the VIP. Participants of VIP filled in an 84- or 64-item food frequency questionnaire (FFQ) and provided sociodemographic information. Complete and realistic information on consumption frequency was provided by 62,531 individuals. Food intake patterns were analyzed using K-means cluster analyses.

RESULTS

The mean daily energy intake was 6,83 (+/- 1,77) MJ among women and 8,71 (+/- 2,26) MJ among men. More than half of both women and men were classified as Low Energy Reporters (defined as individuals reporting a food intake level below the lower 95% confidence interval limit of the physical activity level). Larger variation in frequency of daily intake was seen among women than among men for most food groups. Among women, four dietary clusters were identified, labeled "Fruit and vegetables", "High fat", "Coffee and sandwich", and "Tea and ice cream". Among men, three dietary clusters were identified, labeled "Fruit and vegetables", "High fat", and "Tea, soda and cookies".

CONCLUSION

More distinct food intake patterns were seen among women than men in this study in northern Sweden. Due to large proportions of Low Energy Reporters, our results on dietary intake may not be suitable for comparisons with recommended intake levels. However, the results on food intake patterns should still be valid and useful as a basis for targeting interventions to groups most in need.

Cariogenic Bacteria as Biomarkers for Sugar Intake

Cariogenic bacteria (lactobacilli and mutans streptococci) in saliva are possible biomarkers for sugar intake. We evaluated the strength of the evidence for an association between sugar intake and the two groups of bacteria, and concluded that there is a limited to moderately scientific basis for this association. Because of many confounding factors, bacteria counts can never be used as a precise measurement of sugar intake, but might still be useful on a group level.

Under-reporting of energy intake is more prevalent in a healthy dietary pattern cluster

The aim of the present study was to determine whether under-reporting rates vary between dietary pattern clusters. Subjects were sixty-five Brazilian women. During 3 weeks, anthropometric data were collected, total energy expenditure (TEE) was determined by the doubly labelled water method and diet was measured. Energy intake (EI) and the daily frequency of consumption per 1000 kJ of twenty-two food groups were obtained from a FFQ. These frequencies were entered into a cluster analysis procedure in order to obtain dietary patterns. Under-reporters were defined as those who did not lose more than 1 kg of body weight during the study and presented EI:TEE less than 0.82. Three dietary pattern clusters were identified and named according to their most recurrent food groups: sweet foods (SW), starchy foods (ST) and healthy (H). Subjects from the healthy cluster had the lowest mean EI:TEE (SW = 0.86, ST = 0.71 and H = 0.58; P = 0.003) and EI - TEE (SW = - 0.49 MJ, ST = - 3.20 MJ and H = - 5.08 MJ; P = 0.008). The proportion of under-reporters was 45.2 (95 % CI 35.5, 55.0) % in the SW cluster; 58.3 (95 % CI 48.6, 68.0) % in the ST cluster and 70.0 (95 % CI 61.0, 79) % in the H cluster (P = 0.34). Thus, in Brazilian women, under-reporting of EI is not uniformly distributed among dietary pattern clusters and tends to be more severe among subjects from the healthy cluster. This cluster is more consistent with both dietary guidelines and with what lay individuals usually consider 'healthy eating'.

[Analysis of resting metabolic rate evaluated by indirect calorimetry in obese women with low and high caloric intake]

The aim of this study was to evaluate if obese women with the lowest values of caloric intake (CI) determined by food questionnaire also present the lowest values of resting metabolic rate (RMR), which could lead to excessive weight gain, caused by changes in energy balance. With this purpose, 77 obese women, with IMC>30 kg/m2, aged 20 to 45 years, had their physical activity level and CI evaluated. According to the values of CI obtained from food intake reports, the participants were divided in 3 groups: low (G1), medium (G2), high (G3) CI and were submitted to indirect calorimetry. Height, weight, body surface area (BSA), fat free mass and fat mass measured by bioimpedance were evaluated. The highest values of weight, BSA an fat mass were obtained in G1, as well as values above 1.2 for the CI:RMR ratio, which indicates a probable underestimation of CI. The highest values of physical activity and RMR were observed in the G3 (with high caloric intake). In conclusion, this paper shows that a tendency towards underestimation of self-reported caloric intake exists among obese women and that the maintenance of weight in some patients can be due to their low level of physical activity.

Urinary sugars biomarker relates better to extrinsic than to intrinsic sugars intake in a metabolic study with volunteers consuming their normal diet

BACKGROUND/OBJECTIVES

Sugars in diet are very difficult to measure because of the unreliability of self-reported dietary intake. Sucrose and fructose excreted in urine have been recently suggested as a biomarker for total sugars intake. To further characterize the use of this biomarker, we investigated whether urinary sugars correlated better to extrinsic compared to intrinsic sugars in the diet.

SUBJECTS/METHODS

Seven male and six female healthy participants were living for 30 days in a metabolic suite under strictly controlled conditions consuming their usual diet as assessed beforehand from four consecutive 7-day food diaries kept at home. During the 30-day study, all 24 h urine specimens were collected, validated for their completeness and analysed for sucrose and fructose.

RESULTS

The mean total sugars intake in the group was 202+/-69 g day(-1). Daily intake of extrinsic, intrinsic and milk sugars contributed 60.1, 34.4 and 5.5%, to the total sugars intake, respectively. The individuals' 30-day mean sugars excretion levels were significantly correlated with the 30-day means of extrinsic sugars (r=0.84; P<0.001) but not with the intrinsic sugars intake (r=0.43; P=0.144). In the regression, only extrinsic sugars intake explained a significant proportion of the variability in sugars excretion (adjusted R(2)=0.64; P=0.001); daily excretion of 100 mg sucrose and fructose in urine predicted 124 g of extrinsic total sugars in the diet. Using fewer urinary and dietary measurements in the analysis did not change the overall trend of the findings.

CONCLUSIONS

In this group of volunteers, sucrose and fructose in urine better correlated to extrinsic than to intrinsic sugars intake.

Psychosocial and behavioral profile and predictors of self-reported energy underreporting in obese middle-aged women

Energy underreporting is a concern with dietary intake data; therefore, subject characteristics associated with underreporting energy intake should be elucidated. Baseline self-reported dietary intake and measures of diet and weight history, life status, weight-loss readiness, psychology, eating behavior, physical activity, and self-image of obese middle-aged women (mean body mass index [calculated as kg/m(2)]=31.0) enrolled in a lifestyle weight-loss program were evaluated. Of the 155 participating, 71 women were identified as underreporting energy intake using the Goldberg cutoff values. Comparison of means between psychosocial and behavioral measures from energy underreporters and energy accurate reporters were used to help develop logistic regression models that could predict likelihood to underreport energy intake based on baseline measures. Characteristics most predictive of energy underreporting included fewer years of education (P=0.01), less-realistic weight-loss goals (P=0.02), higher perceived exercise competence (P=0.07), more social support to exercise (P=0.04), more body-shape concern (P=0.01), and higher perception of physical condition (P=0.03). These results highlight distinct psychosocial and behavioral characteristics that, at baseline, can help identify the likelihood an overweight middle-aged woman entering a weight-loss intervention will underreport energy intake. These results can help provide a framework for screening study participants for probability of energy underreporting, based on baseline psychosocial and behavioral measures. This knowledge can help researchers target at-risk subjects and, through education and training, improve the accuracy of self-reported energy intake and, ultimately, the accuracy of energy and nutrient intake relationships with health and disease.

Low energy reporting related to lifestyle, clinical, and psychosocial factors in a randomly selected population sample of Greek adults: the ATTICA Study

OBJECTIVE

Aim of the present study was to identify potential dietary, lifestyle, psychosocial and clinical correlates of underreporting in a population-based sample.

METHODS

Following a random multistage sampling, 1514 men (46+/-13 years old) and 1528 women (45+/-13 years old) from the Attica area, in Greece, participated in this study. All participants underwent a standard assessment procedure that included clinical, psychosocial and lifestyle parameters. Food consumption was assessed through a validated semi-quantitative food frequency questionnaire. The ratio of energy intake to estimated basal metabolic rate (EI/BMR) and the Goldberg cut-off points were used for the classification of subjects as low energy reporters (LERs) and non-LERs.

RESULTS

LERs represented 12.2% of the sample. This percentage was higher in obese subjects compared to overweight or normal weight (20.6 % vs. 9.9 % vs. 10.6 %, p = 0.05), as well as in women compared to men (14.6% vs. 9.9%, p<0.001). Data analysis was stratified by gender, since a significant interaction was observed between gender and LER group on several dietary parameters. Female LERs had higher Med Diet Score compared to non-LERs (30.6 +/- 8.2, 95%CI 30.2-31.04 vs. 26.9 +/- 6.3, 95%CI 26.05-27.7, p<0.001). Multiple regression analysis revealed that lower EI/BMR values were associated with younger age (p<0.001), higher BMI (p<0.001), presence of diabetes mellitus (p=0.012) and lower depression score (p=0.056) in women, whereas with younger age (p<0.001), higher BMI (p<0.001), higher education level (p=0.046) and higher anxiety score (p=0.08) in men.

CONCLUSION

Several psychosocial and clinical characteristics operate in low energy reporting in both genders. Nutrition-related professionals should be aware of these gender-specific trends in dietary assessment procedures.

Relationship of glycaemic index with cardiovascular risk factors: analysis of the National Diet and Nutrition Survey for people aged 65 and older

Objective

To identify associations between dietary glycaemic index (GI) and weight, body mass index and other risk factors for cardiovascular disease (CVD) – waist-to-hip ratio (WHR), lipoprotein fractions, triacylglycerols (TAG) and blood pressure (BP) – in an older British population.

Design

Cross-sectional dietary, anthropometric and biochemical data from the National Diet and Nutritional Survey for adults aged over 65 years were reanalysed using a hierarchical regression model. Associations between body weight, CVD risk factors, and dietary factors including GI and fibre intakes were explored among 1152 healthy older people living in the UK between 1994 and 1995.

Results

In the unadjusted model, GI was significantly and directly associated with TAG (β = 0.008 ± 0.003) and diastolic BP (β = 0.325 ± 0.164) in males. These relationships were attenuated and non-significant after adjustment for potential confounding factors. WHR (β = 0.003 ± 0.001) and TAG (β = 0.005 ± 0.002) were significantly predicted by GI in males and females combined. The association with WHR was attenuated by adjustment for sex, age, region and social class; the relationship with TAG was non-significant after adjustment for other potential dietary confounders.

Conclusion

After controlling for potential confounders, no clear links were detected between GI and body weight or other CVD risk factors. This study provides little evidence for advising the consumption of a low-GI diet in the elderly to prevent weight gain or improve other CVD risk factors.

Associations between salivary bacteria and reported sugar intake and their relationship with body mass index in women and their adolescent children

OBJECTIVE

To study associations between reported sugar intake and salivary bacteria (mutans streptococci, MS and lactobacilli, LB), and sugar intake in relation to body mass index (BMI), in women and adolescents.

DESIGN

Cross-sectional study. Habitual dietary intake was reported in a questionnaire and whole saliva samples were collected and cultivated.

SETTING

Stockholm, Sweden.

SUBJECTS

Four hundred and fourteen mothers and their 16-year-old children (57% girls).

RESULTS

Reported total sugar intake was significantly associated with LB in mothers (P = 0.001), but not in daughters and sons (P = 0.03 for mother-son interaction). When excluding lactose, the associations with LB and MS were significant in daughters (P = 0.032 and 0.005, respectively). High BMI and sugar intake from milk were independently associated with MS counts in mothers in a multiple regression model (R2 = 0.053). In daughters, sugar from beverages, candies/chocolates and fruits were all independently associated with MS counts (R2 = 0.074), whereas in sons, only mothers' MS counts were associated (R2 = 0.084). High BMI, low intake from cooked meals and high intake of candies/chocolates were all independently associated with LB in mothers (R2 = 0.076), while, except for candies/chocolates in daughters, no significant associations were found in children. BMI was significantly associated with bacteria counts in both mothers and children, whereas reported sugar intake was not.

CONCLUSION

The associations between reported sugar intake and bacteria were generally weak. In mothers and daughters, some significant associations were found, but not in sons. Bacteria counts, but not reported sugar intake, were positively associated with BMI.

Dietary transition stages based on eating patterns and diet quality among Haitians of Montreal, Canada

OBJECTIVES

To identify dietary transition stages based on dietary patterns of adult Haitians having lived in Montreal for various lengths of time, and to assess associated dietary quality.

SUBJECTS

One hundred and eighty-one Haitians aged 25-60 years were recruited by the modified random digit dialling method.

DESIGN

Socio-economic, diet and lifestyle variables were documented by questionnaire. Three non-consecutive 24-hour dietary recalls were conducted over a 3-month period. Dietary patterns were studied using cluster analysis, and their association with proportion of lifetime in Canada and with socio-economic status (SES) was examined. Diet quality criteria were micronutrient adequacy and healthfulness based on dietary recommendations of the World Health Organization.

RESULTS

Four dietary phenotypes were identified which could roughly represent stages of dietary transition or acculturation (Traditional, Pre-Western, Western and Modern). Subjects in the 'Traditional' cluster were older and had lived for a significantly lower proportion of their lifetime in Canada; they also tended to be of lower SES. Diet quality was significantly higher in the 'Traditional' than the 'Western' type, particularly with respect to healthfulness. A significantly lower proportion of subjects complying with limited intake of total fat ( < 30%) and cholesterol ( < 45%) was observed in the 'Western' compared with other diet phenotypes. Less than 15% of all subjects consumed enough dietary fibre, irrespective of diet type.

CONCLUSION

Dietary transition stages could be identified on the basis of food patterns of Haitians according to the proportion of their lifetime in Canada. Encouraging the youth to retain the traditional food culture in its positive aspects would appear relevant

High levels of low energy reporting on 24-hour recalls and three questionnaires in an elderly low-socioeconomic status population

Studies of low energy reporting in the elderly are limited, yet changes in energy balance and the incidence of chronic disease make this a critical time to assess energy intake in this population. The objective of this study was to assess low energy reporting on 24-h recalls (24HR), a FFQ, a picture sort FFQ (PSFFQ), and a meal pattern questionnaire (MPQ), and to relate low energy reporting status to personal characteristics and dietary characteristics, including the Healthy Eating Index. Monthly 24HR were completed over 6 mo, followed by 3 interviewer-administered questionnaires. The Goldberg equation was used to determine reporting status for the dietary assessment methods among older, rural, low socioeconomic status, white, African American, and Native American men and women. The relations of variables of interest to low energy reporting were considered one at a time and in multiple logistic regression models. The percentage of participants classified as accurate reporters varied from 40% (FFQ) to 63% (PSFFQ) among men and 60% (24HR, PSFFQ, MPQ) to 63% (FFQ) among women; high energy reporting was observed on the MPQ. Low energy reporters on the FFQ tended to be men and to be overweight or obese (P < 0.05). Underreporting seemed to be due to omitting foods from major food groups as well as from omitting discretionary energy foods. There was a high degree of low energy reporting in this population, particularly by men, even with six 24HR.

Estimating under-reporting of energy intake in dietary surveys using an individualised method

Under-reporting (UR) of energy intake (EI) by self-reported dietary methods is well-documented but the methods used to estimate UR in population-based studies commonly assume a sedentary lifestyle. We compared estimated UR using individualised estimates of energy requirements with a population cut-off based on minimum energy needs. UR was estimated for 1551 adults aged 19-64 years enrolled in the National Diet and Nutrition Survey. Physical activity diaries and 7 d weighed dietary records were completed concurrently. Mean daily EI (kJ/d) was calculated from the dietary records. Reported physical activity was used to assign each subject's activity level, and then to calculate estimated energy requirements (EER) from published equations. UR was calculated both as EER - EI with an adjustment for daily EER and EI variation, and also by a population method. By the individual method UR was approximately 27 % of energy needs in men and 29 % in women, with 75 % of men and 77 % of women classified as under-reporters; by the population method 80 and 88 % were classified as under-reporters respectively. When subjects who reported their eating being affected by dieting or illness during dietary recording were excluded, UR was 25 % of energy needs in both sexes. UR was higher in overweight and obese men and women compared with their lean counterparts (P < 0.001). UR of EI must be considered in dietary surveys. The EER method allows UR to be quantified and takes into account an individual's activity level. Measures of physical activity and questions to identify under-eating during dietary recording may help to evaluate secular trends in UR.

Secular trends in the association of socio-economic position with self-reported dietary attributes and biomarkers in the US population: National Health and Nutrition Examination Survey (NHANES) 1971-1975 to NHANES 1999-2002

OBJECTIVE

Recent reports suggest persistence of health disparities related to socio-economic position (SEP). To understand if diet may be a contributor to these trends, we examined secular trends in the association of diet and indicators of SEP from 1971-1975 to 1999-2002.

DESIGN

We used data from the National Health and Nutrition Examination Surveys (NHANES) I (1971-1975), II (1976-1980), III (1988-1994) and 1999-2002 to examine the independent associations of poverty income ratio (PIR) and education with diet and biomarkers of diet and disease in 25-74-year-olds (n = 36,600). We used logistic and linear regression methods to adjust for multiple covariates and survey design to examine these associations.

RESULTS

A large PIR differential in the likelihood of reporting a fruit or all five food groups and vitamin C intake, and an education differential in likelihood of obesity and carbohydrate intake, was noted in 1971-1975 but narrowed in 1999-2002 (P < 0.007). The positive association of education with intake of a fruit, vegetable or all five food groups, vitamins A and C, calcium and potassium intake remained unchanged across surveys (P < 0.001). Similarly, the positive association of PIR with the amount of foods and intakes of energy and potassium remained unchanged over three decades (P < 0.001). The education and the PIR differential in energy density, and the PIR differential in the likelihood of obesity, persisted over the period of the four surveys (P < 0.001).

CONCLUSIONS

Persistence of unfavourable dietary and biomarker profiles in Americans with low income and education suggests continued need for improvement in the quality of diets of these high-risk groups.

Accuracy of food intake reporting in obese subjects with metabolic risk factors

The aim of the present study was to determine the accuracy of reported energy intake according to a food-frequency questionnaire (FFQ) and dietary records (DR) in obese subjects with metabolic syndrome risk factors. Subjects were twenty-three men and twenty-seven women with mean BMI of 35·7 (range 30·5–43·8) kg/m2 who participated in a dietary interview based on a FFQ and completed weighed DR. Total energy expenditure was measured with the doubly labelled water method. Total energy expenditure, measured RMR and physical activity level did not differ between under-reporters (50% of the sample) and non-under-reporters. Under-reporters had lower median intake of sweets, desserts and snacks than non-under-reporters (100 V.. 161g/d (P=0·0008) and 61 V.. 128g/d (P.=0·0002) according to the FFQ and DR, respectively). The DR also showed lower energy density (6·7 (sd 1·3) V 7·9 (sd 1·6) kJ/g; P=0·0064), lower intake of sugary drinks (0 V. 167g/d; P=0·0063) and higher scores for dietary restraint (9·0 (sd 5·0) V. 6·1 (sd 3·5); P=0·0285) in under-reporters. Energy density was associated with accuracy according to the FFQ (Spearman's rank correlation coefficient (RS) 0·406; P=0·0034) and the DR (RS 0·537; P<0·0001). In multivariate analysis, consumption of bread and sweets, desserts and snacks measured by the FFQ was positively associated with accuracy (I2adjusted 0·46 (95% CI 0·32, 0·70)). According to the DR, consumption of sweets, desserts and snacks was also associated with accuracy, as was dietary restraint (inversely) (I2adjusted 0·67 (95% CI 0·54, 0·83)). In obese subjects with metabolic risk factors, intake of sweets, desserts and snacks, bread and dietary restraint were determinants of reporting accuracy.

Validation of a pre-coded food diary with energy expenditure, comparison of under-reporters v. acceptable reporters

The objective of the present study was to compare energy intake (EI) assessed from a pre-coded food diary (PFD) with energy expenditure (EE) measured by a validated position-and-movement monitor (ActiReg®; PreMed AS, Oslo, Norway) in a group of Norwegian 9-year-olds. Moreover, we examined whether and how under-reporters (UR), identified with ActiReg®, differed from acceptable reporters (AR) according to food intake and BMI. A total of fifty-one 9-year-olds completed PFD and ActiReg®. The present study showed that on average EI was underestimated by 18 % compared with EE measured by ActiReg®. The 95 % confidence limits of agreement in a Bland–Altman plot for EI and EE varied from 1·97 MJ to −4·23 MJ (sd 2) among the girls and from 0·74 MJ to −5·26 MJ (sd 2) among the boys. The Pearson correlation coefficient between EI and EE was 0·28 (P=0·05) for males and females combined. Fifty-seven per cent of the participants were classified as AR, 39 % as UR and 4 % as over-reporters with the PFD. Under-reporting of energy remains a problem with the PFD method used in a group of 9-year-olds, especially among boys. However, UR and AR did not show a systematic misreporting related to macronutrients, unhealthy foods or BMI.

Adiposity, education and weight loss effort are independently associated with energy reporting quality in the Ontario Food Survey

OBJECTIVES

To examine the associations of adiposity, dietary restraint and other personal characteristics with energy reporting quality.

DESIGN/SUBJECTS

Secondary analysis of 230 women and 158 men from the 1997/98 Ontario Food Survey.

METHODS

Energy reporting quality was estimated by ratios of energy intake (EI) to both basal metabolic rate (BMR) and total energy expenditure (TEE). Multivariate regression analyses were conducted to examine energy reporting quality between two dietary recalls and in relation to body mass index (BMI) with adjustment for potential confounders. Energy reporting quality was explored across categories of age, BMI, income, education, dieting status and food insecurity through analysis of variance (ANOVA).

RESULTS

From the ANOVA, energy reporting quality was associated with BMI group, age category and weight loss for men and women, as well as with education among women (P 0.05). EI:BMR and EI:TEE on the first and second 24-hour recalls were positively related (P < 0.0001 for men and women). A higher proportion of variance in energy reporting quality was explained for women than for men (R2 = 0.19 and 0.14, respectively).

CONCLUSIONS

Studies of diet and adiposity are probably hindered to some extent by BMI-related variation in energy reporting quality. Methods to address this issue are urgently needed if population surveys will continue to serve as the primary source of dietary intake data.

Protein intake and blood pressure in cardiovascular disease

Raised blood pressure (BP) is a major cause of CHD and the leading cause of stroke. Although BP rises with age in most populations, there are remote populations around the world where BP does not rise with age and where the high prevalence of high BP and frank hypertension seen in the UK and other Western countries in the older age-groups is not found. However, when such populations migrate to urban settings, their BPs rise, indicating that the population-wide BP problem is largely environmental in origin. Thus, a substantial body of evidence has accumulated on the importance of dietary factors in BP (Na and alcohol intakes (direct relationship) and K intake (inverse relationship)) as well as body weight (direct relationship). More recently, attention has shifted to other dietary factors that might affect BP. Data from studies of vegetarians (who tend to have lower BP than meat-eating populations) as well as clinical data on the adverse effects of protein intake in patients with renal insufficiency led to the view in Western countries that dietary (animal or total) protein had an adverse effect on BP. By contrast, studies in Japan and China suggested that dietary protein might be protective of high BP and stroke. Recent epidemiological studies have found inverse associations between dietary protein intake and BP, consistent with this view, and supported by some evidence from animal studies. Recent controlled clinical trials of soyabean supplementation have also suggested a BP-lowering effect of protein intake. Results of further large-scale epidemiological studies of protein and BP are awaited.

Under- and overreporting of energy is related to obesity, lifestyle factors and food group intakes in Jamaican adults

Objective:

Research in industrialised countries has documented a high prevalence of underreported energy intakes associated with characteristics such as obesity. This paper examines the prevalence, patterns and impact of energy under- and overreporting on diet–obesity relationships in a middle-income developing country.

Design:

A 70-item food-frequency questionnaire was used. Underreporters had reported energy intakes < 1.35 × basal metabolic rate (BMR), overreporters > 2.4 × BMR. Multinomial models were used to identify characteristics associated with implausible reporting. Intakes were compared across reporting groups to assess evidence of bias. Associations between diet and obesity were compared with and without adjustment for implausible reporting.

Setting:

Spanish Town, neighbouring the capital city of Kingston, Jamaica.

Subjects:

Eight hundred and ninety-one Jamaican adults, aged 25–75 years, were randomly recruited.

Results:

More women than men (38.6% vs. 22.5%) underreported, but more men overreported energy (23.7% vs. 16.0%). Underreporting was positively associated with obesity, special diets, smoking and age; age was inversely associated with overreporting. Underreporters estimated lower energy from potentially socially undesirable food groups (e.g. snacks) and higher intakes of ‘healthy’ foods (e.g. fruit) than did plausible reporters. For some of these food groups, significant differences in intakes among normal-weight versus obese subjects observed among plausible reporters were absent when implausible reporters were included. In models of food group–obesity associations, adjusting for implausible energy yielded more credible results that more closely resembled findings in plausible reporters.

Conclusions:

Energy under- and overreporting are highly prevalent in Jamaica. Adjusting for implausible reporting may help to reduce bias in diet–health outcome associations.

Underreporting of energy intake from a self-administered food-frequency questionnaire completed by adults in Montreal

Background:

Energy intake determined from self-reported dietary assessment methods may be underreported. Therefore, it is important that such methods be validated against another with known validity for energy intake or energy expenditure.

Methods:

We investigated potential underestimation of energy intake obtained from our semi-quantitative food-frequency questionnaire (FFQ) administered between 2000 and 2001 in the metropolitan area of Montreal, Canada. The study population included 246 adults aged 18 to 82 years. The ratio of energy intake to estimated basal metabolic rate (EI/BMR) was used to assess underreporting and physical activity was determined from self-administered questions. Comparison of the EI/BMR ratio with the Goldberg statistical cut-off allowed us to detect individuals who were low energy reporters (LERs). LERs and non-LERs were compared to determine if they differed on sociodemographic, anthropometric and lifestyle variables.

Results:

The EI/BMR ratio was 1.26 for men and 1.32 for women. LERs represented 43% of the sample of individuals. Male LERs accounted for 54% compared with 35% among females. Underreporting of energy intake was highest in men and individuals who were older, heavier, with higher body mass index and lower education level. A higher proportion of male LERs perceived their financial situation as adequate while a greater proportion of female LERs considered themselves poor.

Conclusion:

Our data suggest that underreporting of energy intake from the FFQ was considerable and may bias dietary interpretation. As this was uneven across the sample, it is crucial to recognise the characteristics of LERs in order to increase the validity of reported energy intake.

Body mass index, sex, interview protocol, and children's accuracy for reporting kilocalories observed eaten at school meals

This pilot study investigated body mass index (BMI; calculated as kg/m(2)), sex, interview protocol, and children's accuracy for reporting kilocalories. Forty 4th-grade children (20 low-BMI: >or=5th and <50th percentiles, 10 boys, 15 African American; 20 high-BMI: >or=85th percentile, 10 boys, 15 African American) were observed eating school meals (breakfast, lunch) and interviewed either that evening about the prior 24 hours or the next morning about the previous day, with 10 low-BMI (5 boys) and 10 high-BMI (5 boys) children per interview protocol. Five kilocalorie variables were analyzed using separate four-factor (BMI group, sex, race, interview protocol) analyses of variance. No effects were found for reported or matched kilocalories. More kilocalories were observed (P<0.02) and omitted (P<0.05) by high-BMI than low-BMI children. For intruded kilocalories, means were smaller (better) for high-BMI girls than high-BMI boys, but larger for low-BMI girls than low-BMI boys (interaction P<0.04); low-BMI girls intruded the most while high-BMI girls intruded the least. For interview protocol, omitted and intruded kilocalories were higher (worse), although not significantly so (P values <0.11), for interviews about the previous day than the prior 24 hours. These results illuminate relations of BMI, sex, interview protocol, and children's reporting accuracy, and are consistent with results concerning BMI and sex from studies with adults.

Children's dietary reporting accuracy over multiple 24-hour recalls varies by body mass index category

This secondary analysis investigated the influence of body mass index (BMI) category and sex on reporting accuracy during multiple 24-hour dietary recalls. On three occasions, each of 79 children (40 girls) was observed eating school meals and interviewed the next morning about the previous day's intake, with ≥ 25 days between any two consecutive occasions for a child. Using age/sex BMI percentiles, we categorized 48 children as healthy weight (≥ 5(th) percentile <85(th)), 14 as at risk of overweight (≥ 85(th) percentile <95(th)), and 17 as overweight (≥95(th) percentile). A repeated-measures analysis was conducted for each of five outcomes (number of items observed eaten, number of items reported eaten, omission rate, intrusion rate, total inaccuracy). For items observed, BMI category x trial was marginally significant (P=0.079); over trials, this outcome was stable for healthy-weight children, decreased and stabilized for at-risk-of-overweight children, and was stable and decreased for overweight children. This outcome was greatest for overweight children and least for healthy-weight children (P=0.015). For items reported, no significant effects were found. For omission rate (P=0.028) and intrusion rate (P=0.083), BMI category x trial was significant and marginally significant; over trials, both decreased for healthy-weight children, decreased and stabilized for at-risk-of-overweight children, and increased and stabilized for overweight children. Total inaccuracy decreased slightly over trials (P=0.076); this outcome was greater for boys than for girls (P=0.049). Results suggest that children's dietary reporting accuracy over multiple recalls varies by BMI category. Validation studies with adequate samples for each BMI category, sex, and race are needed.

Urinary potassium is as reliable as urinary nitrogen for use as a recovery biomarker in dietary studies of free living individuals

Twenty-four-hour urinary nitrogen (UN) is commonly used to validate dietary assessment methods. Potassium is more widespread in food than nitrogen, but the role of 24-h urinary potassium (UK) as a biomarker has been less studied and characterized. To investigate the performance of UK as a recovery biomarker compared with UN in subjects consuming their normal diet, 7 males and 6 females consumed known amounts of food based on their habitual varying diet (assessed beforehand from 4 consecutive 7-d food diaries) for 30 d in a metabolic suite. All daily urine samples and dietary duplicates were collected, and N and K were measured. Stool K was determined in 5-d pooled samples. Thirty-day mean analyzed K intake was 121.3 +/- 25.1 (mean +/- SD) mmol/d. Overall, 77 +/- 6.7% of K in the diet was excreted in urine and 18 +/- 5% in stool. Dietary K was correlated with UK (r = 0.89; P < 0.001). UN was 77.7 +/- 6.6% of N intake and was correlated with N in the diet (r = 0.87; P < 0.001). When 16 d of intake and 8 d of urine-collection measurements were randomly selected from the 30-d measurements, correlations were significant for both K (r = 0.86; P < 0.001) and N (r = 0.92; P < 0.001). The high correlations between UK and K in the diet show that UK is a reliable recovery biomarker for use in studies of dietary measurement error. Factors for use of urinary N as a recovery biomarker are also confirmed.

The feasibility and utility of grocery receipt analyses for dietary assessment

Objective

To establish the feasibility and utility of a simple data collection methodology for dietary assessment.

Design

Using a cross-sectional design, trained data collectors approached adults (~20 – 40 years of age) at local grocery stores and asked whether they would volunteer their grocery receipts and answer a few questions for a small stipend ($1).

Methods

The grocery data were divided into 3 categories: "fats, oils, and sweets," "processed foods," and "low-fat/low-calorie substitutions" as a percentage of the total food purchase price. The questions assessed the shopper's general eating habits (eg, fast-food consumption) and a few demographic characteristics and health aspects (eg, perception of body size).

Statistical Analyses Performed. Descriptive and analytic analyses using non-parametric tests were conducted in SAS.

Results

Forty-eight receipts and questionnaires were collected. Nearly every respondent reported eating fast food at least once per month; 27% ate out once or twice a day. Frequency of fast-food consumption was positively related to perceived body size of the respondent (p = 0.02). Overall, 30% of the food purchase price was for fats, oils, sweets, 10% was for processed foods, and almost 6% was for low-fat/low-calorie substitutions. Households where no one was perceived to be overweight spent a smaller proportion of their food budget on fats, oils, and sweets than did households where at least one person was perceived to be overweight (p = 0.10); household where the spouse was not perceived to be overweight spent less on fats, oils, and sweets (p = 0.02) and more on low-fat/low-calorie substitutions (p = 0.09) than did households where the spouse was perceived to be overweight; and, respondents who perceived themselves to be overweight spent more on processed foods than did respondents who did not perceive themselves to be overweight (p = 0.06).

Conclusion

This simple dietary assessment method, although global in nature, may be a useful indicator of dietary practices as evidenced by its association with perceived weight status.