Social desirability trait influences on self-reported dietary measures among diverse participants in a multicenter multiple risk factor trial

Night-time eating and body weight status among US adults, 2007-2016

BACKGROUND

The present study assessed the relationship between night-time eating and body weight status among US adults, using in-person 24-h dietary recall data from a nationally representative survey.

METHODS

Individual-level data (n = 23 003) came from the 2007-2016 National Health and Nutrition Examination Survey (NHANES) (five waves). Multivariate linear and logistic regressions were performed to estimate the effect of energy, sugar, fat and saturated fat intake during night-time on body mass index (BMI), obesity (BMI ≥30 kg m^-2 ), waist circumference (WC) and abdominal obesity (WC ≥88 cm in women; WC ≥102 cm in men), adjusting for daily total energy intake, physical activity, sleeping and other individual characteristics.

RESULTS

Approximately 36.5% and 56.7% of the NHANES adult participants had obesity and abdominal obesity, respectively. The proportion of energy, total fat, saturated fat and total sugar intake within the time window of 00.00 h to 05.59 h and 22.00 h to 23.59 h averaged 5.7%, 5.3%, 5.7% and 6.8%, respectively. Energy intake within the time window was not found to be associated with BMI, WC, obesity or abdominal obesity in the regression analyses. Sensitivity analyses applying alternative time windows to capture night-time eating found night-time intakes of energy, total fat, saturated fat and total sugar not to be associated BMI, WC, obesity or abdominal obesity.

CONCLUSIONS

Night-time eating was not found to be associated with body weight status in a US nationally representative adult sample. Restricting night-time food consumption alone without an overall reduction in daily caloric intake may not prevent obesity. The findings of the present study warrant replication in a future experimental study with habitual dietary behaviour measures.

Effect of Supplemental Nutrition Assistance Program–Education (SNAP-Ed) on food security and dietary outcomes

The Supplemental Nutrition Assistance Program–Education (SNAP-Ed) is the nutrition promotion component of SNAP, formerly known as food stamps. SNAP-Ed assists low-income populations in the United States improve dietary intake and reduce food insecurity through nutrition education. This narrative review summarizes current investigations of SNAP-Ed’s effectiveness at improving food security and dietary outcomes, and it can help inform future policy and implementation of the program. There was stronger evidence for SNAP-Ed as an effective means of improving food security (n = 4 reports) than for its effects on nutrition or dietary outcomes (n = 10 reports). Inconsistency in measurement tools and outcomes and a lack of strong study designs characterized the studies that sought to evaluate the effectiveness of SNAP-Ed at improving nutrition or dietary outcomes. Additional rigorous study designs in diverse population groups are needed to strengthen the evidence. In the face of reduced financial SNAP benefits, SNAP-Ed may play an important role in helping to eliminate food insecurity and improve dietary outcomes and, ultimately, the health of low-income Americans.

Effect of Supplemental Nutrition Assistance Program–Education (SNAP-Ed) on food security and dietary outcomes

The Supplemental Nutrition Assistance Program–Education (SNAP-Ed) is the nutrition promotion component of SNAP, formerly known as food stamps. SNAP-Ed assists low-income populations in the United States improve dietary intake and reduce food insecurity through nutrition education. This narrative review summarizes current investigations of SNAP-Ed’s effectiveness at improving food security and dietary outcomes, and it can help inform future policy and implementation of the program. There was stronger evidence for SNAP-Ed as an effective means of improving food security (n = 4 reports) than for its effects on nutrition or dietary outcomes (n = 10 reports). Inconsistency in measurement tools and outcomes and a lack of strong study designs characterized the studies that sought to evaluate the effectiveness of SNAP-Ed at improving nutrition or dietary outcomes. Additional rigorous study designs in diverse population groups are needed to strengthen the evidence. In the face of reduced financial SNAP benefits, SNAP-Ed may play an important role in helping to eliminate food insecurity and improve dietary outcomes and, ultimately, the health of low-income Americans.

Dietary inflammatory index and odds of coronary artery disease in a case-control study from Jordan

OBJECTIVE

The aim of this study was to examine the association between inflammatory potential diet as determined by dietary inflammatory index (DII) scores and coronary artery disease (CAD) in a population-based, case-control study of middle-aged Jordanian adults.

METHODS

In the present study, 388 patients who were referred for elective coronary angiography at Prince Hamza Hospital, Amman, were enrolled. Of these, 198 were confirmed CAD cases and 190 were CAD-free control participants. DII scores were computed from dietary intake assessed by a food frequency questionnaire. Logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs).

RESULTS

CAD cases had significantly higher DII scores, higher body mass index (BMI), higher prevalence of diabetes, lower educational attainment, and lower physical activity than the CAD-free controls. A statistically significant higher risk for CAD was observed in those with DII scores in the highest tertile than in those in the lowest (OR_tertile3vs1, 2.10; 95% CI, 1.18-3.66), after adjusting for cardiovascular risk factors. A positive association was found between higher DII and CAD risk when DII score was used as a continuous variable (OR_continuous, 1.13 per unit increase in DII corresponding to ∼11% of its range in the current study; 95% CI, 1.00-1.32).

CONCLUSIONS

The present findings, obtained in this ordanian population, add to the growing literature indicating that a proinflammatory diet is associated with higher risk for developing CAD.

Total, Fresh, Lean, and Fresh Lean Beef Consumption in Relation to Nutrient Intakes and Diet Quality among U.S. Adults, 2005⁻2016

(1) Background: This study assessed the influence of beef consumption on nutrient intakes and diet quality among U.S. adults. (2) Methods: Nationally-representative sample (n = 27,117) from 2005–2016 National Health and Nutrition Examination Survey was analyzed. First-difference estimator addressed confounding bias from time-invariant unobservables (e.g., eating habits, taste preferences) by using within-individual variations in beef consumption between 2 nonconsecutive 24 h dietary recalls. (3) Results: Approximately 54%, 39%, 12%, and 7% of U.S. adults consumed beef, lean beef, fresh beef, and fresh lean beef, respectively. Overall diet quality measured by the Health Eating Index-2015 (HEI-2015) score among beef, fresh beef, lean beef, and fresh lean beef consumers was lower than beef non-consumers. Regression analyses found that beef, fresh beef, lean beef, and fresh lean beef consumption was associated with higher daily intakes of total energy, protein, sodium, choline, iron, selenium, zinc, phosphorus, and multiple B vitamins. Beef, fresh beef, and lean beef consumption but not fresh lean beef consumption was associated with higher saturated fat intake. Beef consumption was not found to be associated with overall dietary quality measured by the HEI-2015 score. (4) Conclusions: Beef consumers may increase the intake of fresh and lean beef over total beef consumption to maximize the nutritional gains from beef portions while minimizing the resulting increases in energy, saturated fat, and sodium.

Longitudinal trajectories and prevalence of meeting dietary guidelines during the transition from adolescence to young adulthood

BACKGROUND

Establishing healthy dietary habits during adolescence and young adulthood is critical for long-term health.

OBJECTIVES

This study assessed the prevalence of meeting US Dietary Guidelines and trajectories in dietary intake for 4 MyPlate food groups during the transition from adolescence to young adulthood.

METHODS

Three waves of surveys and food frequency questionnaires were collected as part of Project EAT (Eating and Activity in Teens and Young Adults), a 15-y longitudinal study. Adolescents (n = 1177, 57% female, mean ± SD age 15.0 ± 1.5 y) were recruited in 1998-1999 in Minneapolis-St Paul, Minnesota public schools and were resurveyed twice in young adulthood at mean ± SD ages 25.3 ± 1.5 and 31.1 ± 1.5 y. The prevalence of meeting guidelines for each MyPlate food group was calculated at each time point. Mean daily servings were compared over 5 y in young adulthood through the use of paired t tests. Adjusted least-squares means were calculated to compare dietary intake in young adulthood across quartiles of adolescent intake.

RESULTS

Adolescents had the highest prevalence of meeting dietary guidelines for fruit (37% for females and 30% for males) and dairy (53% for females and 61% for males); young adults >30 y had the highest prevalence of meeting dietary guidelines for vegetables (19% for females and 8% for males) and whole grains (23% for females and 17% for males). From the mid-twenties to early thirties, vegetable intake increased, whereas dairy intake decreased. Dietary intake generally tracked over time with individuals in the lower quartiles of intake at adolescence generally continuing to have low intake in young adulthood.

CONCLUSIONS

Although the prevalence of meeting dietary guidelines for whole grains and vegetables, and daily servings of vegetables increased with age, improving intake of whole fruit, whole grains, dairy, and vegetables remains key during the transition from adolescence to young adulthood.

Diet-related inflammation and risk of prostate cancer in the California Men's Health Study

PURPOSE

The purpose of the study was to examine the relationship between proinflammatory diet and prostate cancer risk.

METHODS

Energy-adjusted Dietary Inflammatory Index (E-DII) scores were computed among 40,161 participants in the California Men's Health Study. Over 9.7 ± 3.8 years of follow-up, 2707 incident prostate cancer cases were diagnosed and categorized as low-, intermediate-, or high-risk, based on disease grade and stage. Accelerated failure-time models assessed time to diagnosis of prostate cancer. Cox proportional hazard models estimated hazard ratios (HR) and 95% confidence intervals (95% CI). Nonlinear effects of E-DII were modeled as third-order polynomials.

RESULTS

Time to prostate cancer diagnosis did not differ by E-DII quartile. The HR for high-risk prostate cancer increased in the third E-DII quartile (HRQ3 vs. Q1 = 1.36; 95% CI: 1.04-1.76), but not in the fourth (HRQ4 vs. Q1 = 0.99; 95% CI: 0.74-1.32, Ptrend = .74), suggesting a nonlinear dose-response. HR curves for prostate cancer increased exponentially above an E-DII threshold of ≈+3.0. HR curves for high-risk prostate cancer had a much steeper incline above an E-DII threshold of ≈+2.5. Curves were higher among Blacks and Whites relative to other races and among overweight or obese men. No relationship was observed between E-DII scores and intermediate- or low-risk disease.

CONCLUSIONS

Relationships between proinflammatory diet and prostate cancer risk may be nonlinear, with an increased risk above an E-DII threshold of ≈+2.5.

Cardiometabolic Health in Relation to Lifestyle and Body Weight Changes 3⁻8 Years Earlier

The degree to which individuals change their lifestyle in response to interventions differs and this variation could affect cardiometabolic health. We examined if changes in dietary intake, physical activity and weight of obese infertile women during the first six months of the LIFEstyle trial were associated with cardiometabolic health 3⁻8 years later (N = 50⁻78). Lifestyle was assessed using questionnaires and weight was measured at baseline, 3 and 6 months after randomization. BMI, blood pressure, body composition, pulse wave velocity, glycemic parameters and lipid profile were assessed 3⁻8 years after randomization. Decreases in savory and sweet snack intake were associated with lower HOMA-IR 3⁻8 years later, but these associations disappeared after adjustment for current lifestyle. No other associations between changes in lifestyle or body weight during the first six months after randomization with cardiovascular health 3⁻8 years later were observed. In conclusion, reductions in snack intake were associated with reduced insulin resistance 3⁻8 years later, but adjustment for current lifestyle reduced these associations. This indicates that changing lifestyle is an important first step, but maintaining this change is needed for improving cardiometabolic health in the long-term.

Effects of a preconception lifestyle intervention in obese infertile women on diet and physical activity; A secondary analysis of a randomized controlled trial

BACKGROUND

Lifestyle changes are notoriously difficult. Since women who intend to become pregnant are more susceptible to lifestyle advice, interventions during this time window might be more effective than interventions during any other period in life. We here report the effects of the first large preconception lifestyle intervention RCT on diet and physical activity in obese infertile women.

METHODS

In total, 577 women were randomized between a six-month lifestyle intervention program (intervention group; N = 290) or prompt infertility treatment (control group; N = 287). Self-reported dietary behaviors and physical activity were assessed at baseline, three, six and twelve months after randomization. Mixed models were used to analyze differences between groups.

RESULTS

Compared to the control group, the intervention group reduced their intake of sugary drinks at three months (-0.5 glasses/day [95% C.I. = -0.9;-0.2]), of savory snacks at three (-2.4 handful/week [-3.4;-1.4]) and at six months (-1.4 handful/week [-2.6;-0.2]), and of sweet snacks at three (-2.2 portion/week [-3.3;-1.0]) and twelve months after randomization (-1.9 portion/week [-3.5;-0.4]). Also, the intervention group was more moderate to vigorous physically active at three months after randomization compared to the control group (169.0 minutes/week [6.0; 332.1]).

CONCLUSION

Our study showed that obese infertile women who followed a six-month preconception lifestyle intervention program decreased their intake of high caloric snacks and beverages, and increased their physical activity. These changes in lifestyle may not only improve women's health but their offspring's health too.

Fruit and Vegetable Intake of US Hispanics by Food Store Type: Findings from NHANES

This study examined fruit and vegetable intake by food store type shopped among US Hispanics. Using National Health and Nutrition Examination Survey 2011-2012 data, T test and chi-square tests examined differences between Hispanic consumers by food store type. Negative binomial regression analyses estimated associations between fruit and vegetable intake and food store type. Hispanics who only purchased fruits and vegetables from convenience stores were younger and more likely US born. They reported lower intakes of fruit and vegetables than individuals who purchased these foods from supermarket/grocery stores. Those who primarily purchased fruits and vegetables from supermarkets/grocery stores consumed 0.92 (p < .001) greater fruit cup equivalents and 0.26 (p = .001) greater vegetable cup equivalents than those who only purchased from convenience stores. Research on the influence of shopping in multiple food store types is needed to develop targeted in-store intervention strategies to encourage healthier food purchases. Results provide support for policy-level research such as minimum stocking requirements for healthy foods in convenience stores.

Limitations of maternal recall for measuring exclusive breastfeeding rates in South African mothers

Background

Maternal recall is most commonly used to determine exclusive breastfeeding rates. A gold standard stable isotope method is available which can determine intake of breast milk versus water from sources other than breast milk and thus objectively determine exclusive breastfeeding. The objectives of this study were to determine exclusive breastfeeding rates by both maternal recall and the objective stable isotope method and discuss the limitations and usefulness of the two methods.

Methods

The study involved 100 mother-infant pairs in a peri-urban area in Durban, South Africa and study visits took place from July 2012 to September 2014. Maternal recall of exclusive breastfeeding was carried out using the World Health Organization’s 24 hour recall of infant feeding and this was compared to the objective measurement of exclusive breastfeeding using the stable isotope technique at three time points: six weeks, three and 5.5 months. The objective measurements were carried out using two different cut off values for exclusive breastfeeding. Kappa analysis was used to quantify the relationship between maternal recall and results from the stable isotope technique for each mother-infant pair.

Results

Over reporting of exclusive breastfeeding was common at the three different time points regardless of the cut off value used to assess exclusive breastfeeding by the stable isotope technique. Kappa analysis also revealed only slight or fair agreement (K < 0.24) between reported and measured exclusive breastfeeding at all time points.

Conclusions

Maternal recall of exclusive breastfeeding is limited in accuracy and should be restricted to large scale epidemiological surveys. The more objective gold standard stable isotope method for measuring intake volumes of breast milk should be used to evaluate interventions with smaller representative samples.

Diet and self-rated health among oldest-old Chinese

INTRODUCTION

Dietary behavior is a central modifiable risk factor for human health. This study examined the longitudinal relationship between dietary habits and self-rated health among the oldest-old Chinese.

METHODS

Participants aged 80 years and above (N = 7273) were first interviewed in 1998 and followed in subsequent waves 2-3 years apart till 2011-2012 in the Chinese Longitudinal Healthy Longevity Survey. Cox proportional hazards regressions were performed to estimate the effects of dietary habits on poor self-rated health, adjusting for various individual characteristics.

RESULTS

Compared to those who rarely/never consumed fruit, vegetable, meat, egg, and soybean-derived product, participants consuming such products almost every day were 28%, 20%, 32%, 16%, and 16% less likely to report poor self-rated health during follow-up, respectively. Compared to those who rarely/never consumed fruit, meat, fish, soybean-derived product, and tea, participants consuming such products occasionally were 12%, 24%, 11%, 15%, and 14% less likely to report poor self-rated health during follow-up, respectively. Compared to those who rarely/never consumed sugar, participants consuming sugar almost every day were 14% more likely to report poor self-rated health during follow-up. The effects of dietary habits on self-rated health to some extent differed by sex.

CONCLUSIONS

Oldest-old Chinese could gain health benefit from regular consumption of fruit, vegetable, meat, fish, egg, soybean-derived product, and tea; whereas their sugar consumption may need to be reduced. Future research is warranted to establish the recommended daily nutrient allowances for the oldest-old adults and better address the nutritional needs of this vulnerable population.

Sex-Specific Associations in Nutrition and Activity-Related Risk Factors for Chronic Disease: Australian Evidence from Childhood to Emerging Adulthood

Global assessments of burden of disease suggests there are sex differences in risk factors for chronic disease, including overweight/obesity, dietary patterns and habitual physical activity. Given that prevention efforts aim to target such factors to reduce disease risk, the age at which sex differences may occur is of particular interest. Early life to young adulthood is the optimal time for intervention, with lifestyle habits typically forming during this period. This study aimed to identify the sex differences in risk factors for chronic disease during childhood (5-9 years), adolescence (10-17 years) and emerging adulthood (18-25 years) in a large population-representative Australian sample. Among children in this study (n = 739), no sex-related differences were observed. Among adolescents (n = 1304), females were more likely than males to meet daily fruit and vegetable recommendations (12.9% vs. 7.5%; OR = 1.84, 95% CI = 1.16, 2.93, p < 0.05). Among emerging adults (n = 909), females were less likely to be overweight/obese (30.1% vs. 39.8%; OR = 0.65, 95% CI = 0.44, 0.95, p < 0.05) and more likely to meet physical activity recommendations (52.1% vs. 42.3%; OR = 1.44, 95% CI = 1.01, 2.06, p < 0.05). These findings suggest that sex differences for risk factors of chronic disease occur during adolescence and emerging adulthood, although the differences are not consistent across age periods. From adolescence onwards, it appears that females exhibit lower risk factors than males and a life span approach to risk factor monitoring is warranted.

Structural Validation of a French Food Frequency Questionnaire of 94 Items

Background

Food frequency questionnaires (FFQs) are used to estimate the usual food and nutrient intakes over a period of time. Such estimates can suffer from measurement errors, either due to bias induced by respondent’s answers or to errors induced by the structure of the questionnaire (e.g., using a limited number of food items and an aggregated food database with average portion sizes). The “structural validation” presented in this study aims to isolate and quantify the impact of the inherent structure of a FFQ on the estimation of food and nutrient intakes, independently of respondent’s perception of the questionnaire.

Methods

A semi-quantitative FFQ (n = 94 items, including 50 items with questions on portion sizes) and an associated aggregated food composition database (named the item-composition database) were developed, based on the self-reported weekly dietary records of 1918 adults (18–79 years-old) in the French Individual and National Dietary Survey 2 (INCA2), and the French CIQUAL 2013 food-composition database of all the foods (n = 1342 foods) declared as consumed in the population. Reference intakes of foods (“REF_FOOD”) and nutrients (“REF_NUT”) were calculated for each adult using the food-composition database and the amounts of foods self-reported in his/her dietary record. Then, answers to the FFQ were simulated for each adult based on his/her self-reported dietary record. “FFQ_FOOD” and “FFQ_NUT” intakes were estimated using the simulated answers and the item-composition database. Measurement errors (in %), spearman correlations and cross-classification were used to compare “REF_FOOD” with “FFQ_FOOD” and “REF_NUT” with “FFQ_NUT”.

Results

Compared to “REF_NUT,” “FFQ_NUT” total quantity and total energy intake were underestimated on average by 198 g/day and 666 kJ/day, respectively. “FFQ_FOOD” intakes were well estimated for starches, underestimated for most of the subgroups, and overestimated for some subgroups, in particular vegetables. Underestimation were mainly due to the use of portion sizes, leading to an underestimation of most of nutrients, except free sugars which were overestimated.

Conclusion

The “structural validation” by simulating answers to a FFQ based on a reference dietary survey is innovative and pragmatic and allows quantifying the error induced by the simplification of the method of collection.

Measurement Errors in Dietary Assessment Using Self-Reported 24-Hour Recalls in Low-Income Countries and Strategies for Their Prevention

Securing accurate measurements of dietary intake across populations is challenging. Of the methods, self-reported 24-h recalls are often used in low-income countries (LICs) because they are quick, culturally sensitive, do not require high cognitive ability, and provide quantitative data on both foods and nutrients. Measuring intakes via 24-h recalls involves 1) collecting data on food intakes, 2) the appropriate use of relevant food-composition data for calculating nutrient intakes, and 3) statistically converting observed intakes to "usual intakes" for evaluating nutrient adequacy or relations between foods and nutrients and health outcomes. Like all dietary methods, 24-h recalls are subject to random errors that lower the precision and systematic errors that can reduce accuracy at each stage of the measurement protocol. Research has identified the potential sources of measurement errors in 24-h recall protocols and emphasized that sources of random error can be reduced by incorporating standardized quality-control procedures and collecting more than one 24-h recall per person, with the number depending on the study objective. Careful design of the initial 24-h recall protocol can take into account potential sources of systematic error, such as day of the week, season, age, etc. Other sources of systematic error (e.g., energy underreporting) can best be detected by including a reference measure (e.g., doubly labeled water to measure energy expenditure). Alternatively, 24-h recall intakes of energy can be compared with same-day weighed intakes. Nevertheless, very few studies in LICs have assessed the validity of 24-h recalls in their study settings or adopted recommended standardized protocols to mitigate random errors. Hence, efforts should be made to improve the assessment, analysis, and interpretation of self-reported 24-h recall data for population studies in LICs. Accurate and precise dietary intake data at the national level can play an essential role in informing food, nutrition, and agricultural policies; food fortification planning; and compliance to food-based dietary guidelines.

Diet quality is associated with reduced incidence of cancer and self-reported chronic disease: Observations from Alberta's Tomorrow Project

The objective of this study was to assess diet quality using the Healthy Eating Index-2005 Canada (HEI-2005-Canada) and its association with risk of cancer and chronic disease in a sample of Alberta's Tomorrow Project (ATP) participants. Food frequency questionnaires completed by 25,169 participants (38% men; mean age 50.3 (9.2)) enrolled between 2000 and 2008 were used to calculate HEI-2005-Canada scores. Data from a subset of participants (n=10,735) who reported no chronic disease at enrollment were used to investigate the association between HEI-2005-Canada score and development of self-reported chronic disease at follow-up (2008). Participants were divided into HEI-2005-Canada score quartiles. Cox proportional hazards models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for cancer and chronic disease incidence. In this cohort, mean HEI-2005-Canada scores for men and women were 50.9 and 55.5 (maximum range 0-100), respectively. In men, higher HEI-2005-Canada score (Q4 vs. Q1) was associated with lower cancer risk (HR (95% CI) 0.63 (0.49-0.83)) over the course of follow-up (mean (SD)=10.4 (2.3) years); the same was not observed in women. In contrast, higher overall HEI-2005-Canada score (Q4 vs. Q1) was associated with lower risk of self-reported chronic disease (0.85 (0.75-0.97)) in both men and women over follow-up (4.2 (2.3) years). In conclusion, in this cohort better diet quality was associated with a lower risk of cancer in men and lower risk of chronic disease in both sexes. Future studies with longer follow-up and repeated measures of diet may be helpful to elucidate sex-specific associations between dietary quality and disease outcomes.

Outcomes of a randomized controlled trial of nutrition education to promote farmers' market fruit and vegetable purchases and consumption among women enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)

Background

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides participants seasonal Farmers’ Market Nutrition Program (FMNP) vouchers to purchase fruits and vegetables (FV) at farmers’ markets and monthly cash value vouchers (CVV) redeemable at farmers’ markets. Despite the promise of FMNP vouchers and CVV for improving FV access among WIC participants, voucher redemption rates are low. This study evaluated WIC Fresh Start (WFS), a theory-driven, web-based lesson to promote FV intake, the redemption of CVV at farmers’ markets, FMNP voucher redemption, and farmers’ market-related knowledge, attitudes, and skills among women enrolled in WIC.

Methods

The lesson was evaluated in a four-arm randomized controlled trial. The setting was a large New Jersey-based WIC agency located in a densely populated, urban area. Participants (N = 744) were stratified based on FMNP voucher receipt and randomized to receive the WFS lesson or WIC online existing health education. Lesson effects on targeted outcomes were examined at posttest (2 weeks after the lesson) and 3 and 6 months after posttesting.

Results

Receipt of the WFS lesson was associated with FMNP voucher redemption (in the subset of participants preferring to speak Spanish); improvements in knowledge of the FMNP, locally grown seasonal items, seasonal items found at farmers’ markets in July, WIC-authorized farmers’ markets and food- and farmers’ market-specific knowledge; ever having purchased and intentions to purchase FV at a farmers’ market; FV food safety and preparation skills; and modest gains in the redemption of CVV at farmers’ markets. FV intake did not differ over time by trial arm.

Conclusions

Findings aid understanding of effective approaches to promote farmers’ market use and farmers’ market-related knowledge and skills among WIC participants. Further research is needed to explore factors that may explain the lack of lesson effects on FV intake.

Trial registration

NCT02565706

To what extent do food purchases reflect shoppers' diet quality and nutrient intake?

BACKGROUND

Food purchasing is considered a key mediator between the food environment and eating behavior, and food purchasing patterns are increasingly measured in epidemiologic and intervention studies. However, the extent to which food purchases actually reflect individuals' dietary intake has not been rigorously tested. This study examined cross-sectional agreement between estimates of diet quality and nutrient densities derived from objectively documented household food purchases and those derived from interviewer-administered 24-h diet recalls. A secondary aim was to identify moderator variables associated with attenuated agreement between purchases and dietary intake.

METHODS

Primary household food shoppers (N = 196) collected and annotated receipts for all household food and beverage purchases (16,356 total) over 14 days. Research staff visited participants' homes four times to photograph the packaging and nutrition labels of each purchased item. Three or four multiple-pass 24-h diet recalls were performed within the same 14-d period. Nutrient densities and Healthy Eating Index-2010 (HEI-2010) scores were calculated from both food purchase and diet recall data.

RESULTS

HEI-2010 scores derived from food purchases (median = 60.9, interquartile range 49.1-71.7) showed moderate agreement (ρc = .57, p < .0001) and minimal bias (-2.0) with HEI-2010 scores from 24-h recalls (median = 60.1, interquartile range 50.8-73.9). The degree of observed bias was unrelated to the number of food/beverage purchases reported or participant characteristics such as social desirability, household income, household size, and body mass. Concordance for individual nutrient densities from food purchases and 24-h diet recalls varied widely from ρc = .10 to .61, with the strongest associations observed for fiber (ρc = .61), whole fruit (ρc = .48), and vegetables (ρc = .39).

CONCLUSIONS

Objectively documented household food purchases yield an unbiased and reasonably accurate estimate of overall diet quality as measured through 24-h diet recalls, but are generally less useful for characterizing dietary intake of specific nutrients. Thus, some degree of caution is warranted when interpreting food purchase data as a reflection of diet in epidemiological and clinical research. Future work should examine agreement between food purchases and nutritional biomarkers.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT02073643 . Retrospectively registered.

Developing a digital photography-based method for dietary analysis in self-serve dining settings

Current population-based methods for assessing dietary intake, including food frequency questionnaires, food diaries, and 24-h dietary recall, are limited in their ability to objectively measure food intake. Digital photography has been identified as a promising addition to these techniques but has rarely been assessed in self-serve settings. We utilized digital photography to examine university students' food choices and consumption in a self-serve dining hall setting. Research assistants took pre- and post-photos of students' plates during lunch and dinner to assess selection (presence), servings, and consumption of MyPlate food groups. Four coders rated the same set of approximately 180 meals for inter-rater reliability analyses; approximately 50 additional meals were coded twice by each coder to assess intra-rater agreement. Inter-rater agreement on the selection, servings, and consumption of food groups was high at 93.5%; intra-rater agreement was similarly high with an average of 95.6% agreement. Coders achieved the highest rates of agreement in assessing if a food group was present on the plate (95-99% inter-rater agreement, depending on food group) and estimating the servings of food selected (81-98% inter-rater agreement). Estimating consumption, particularly for items such as beans and cheese that were often in mixed dishes, was more challenging (77-94% inter-rater agreement). Results suggest that the digital photography method presented is feasible for large studies in real-world environments and can provide an objective measure of food selection, servings, and consumption with a high degree of agreement between coders; however, to make accurate claims about the state of dietary intake in all-you-can-eat, self-serve settings, researchers will need to account for the possibility of diners taking multiple trips through the serving line.

Breakfast Skipping, Anxiety, Exercise, and Soda Consumption are Associated with Diet Quality in Mexican College Students

ABSTEACT Despite the reported poor dietary habits and risk of weight gain in college students, they remain understudied in Mexico. Mexican college students are in a rapidly changing economic environment; a shift from a traditional, homemade cuisine to a diet more heavily influenced by an industrialized culture seems to be occurring, potentially affecting the quality of their dietary intake. A health and nutrition survey was conducted among 450 Mexican college students to study the relationship between sociodemographic factors and diet quality. Dietary data were used to build macro- and micronutrient scores, dichotomized as low and normal quality. Adjusted odds (OR [95% CI]) were computed to determine the probability of low dietary quality. Breakfast skipping (5.3 [1.2, 22.7]) and risk of anxiety (2.3 [1.3, 4.4]) were associated with a greater risk of low macronutrient quality, and caloric intake < 1,800 kcal (5.8 [3.5, 9.7]), breakfast skipping (3.7 [1.4, 10.3]), vigorous exercise ≤ 1 h/wk (2.6 [1.3, 5.2]), and soda consumption > 250 mL/d (2.0 [1.2, 3.3]) with low micronutrient quality.

BMI is Associated with the Willingness to Record Diet with a Mobile Food Record among Adults Participating in Dietary Interventions

Image-based dietary assessment methods have the potential to address respondent burden and improve engagement in the task of recording for dietary interventions. The aim of this study was to assess factors associated with the willingness of adults to take images of food and beverages using a mobile food record (mFR) application. A combined sample of 212 young adults and 73 overweight and obese adults completed a 4-day mobile food record on two occasions and a follow-up usability questionnaire. About 74% of participants stated they would record using the mFR for a longer period compared with a written record (29.4 ± 69.3 vs. 16.1 ± 42.6 days respectively; p < 0.0005). Multivariable logistic regression was used to identify those who were more likely to record mFR in the top tertile (≥14 days). After adjusting for age and gender, those with a BMI ≥ 25 were 1.68 times more likely (Odds Ratio 95% Confidence Interval: 1.02-2.77) than those with BMI < 25 to state a willingness to record with the mFR for ≥ 14 days. The greater willingness of overweight and obese individuals to record dietary intake using an mFR needs further examination to determine if this translates to more accurate estimates of energy intake.

Assessment of 5-year system-wide type 2 diabetes control measures in a Southeast Asian metropolis

Background: Sparse information exists regarding the progress of the chronic care model (CCM) implementation for type 2 diabetes, at system-wide level for developing countries including Thailand.

Objective: We assessed the extent to which type 2 diabetes patients in Bangkok, Thailand report having received CCM-based services by using the Patient Assessment of Chronic Illness Care (PACIC).

Methods: One thousand type 2 diabetes patients from 64 healthcare facilities throughout Bangkok were randomly selected, data about the extent they have received CCM-based services, their dietary, physical activity, medication-taking behaviors, body mass index (BMI), and blood sugar control status were collected by a set of structured questionnaires and medical record abstraction.

Results: PACIC and self-management scores for patients receiving care from public hospitals and health centers were significantly higher than those from private hospitals. Being the primary care unit (PCU)-where the CCM implementation has been enforced since 2008 was significantly associated with higher PACIC scores for public hospitals. This was not the case for private hospitals. PCU status was significantly associated with better selfmanagement scores for patients in both public and private hospitals. However, variations in PACIC and selfmanagement scores did not reflect to BMI or glycemic control outcomes of the patients.

Conclusion: There is encouraging evidence of progress of CCM implementation for type 2 diabetes patients in Bangkok, Thailand. This had also resulted in improved self-management, but not physiological or metabolic outcomes.

Parental misclassification of child overweight/obese status: The role of parental education and parental weight status

Childhood overweight and obesity is a major public health challenge for policymakers in many countries. As the most common supervisors of children's activities, parents have a potentially important role to play in obesity prevention. However, a precondition for parents to improve their children's diets, encourage them to be more physically active, or take them to see a doctor about their weight is for the parent to first recognize that their child is overweight or obese. This paper examines the extent of parental misclassification of child weight status, and its correlates, focusing on the role of parental education and the parent's own obesity status. We find evidence that, among non-obese parents, those who are better-educated report their child's weight status more accurately, but among obese parents, the better-educated are 45.18% more likely than parents with lower secondary education to give a false negative report of their child's overweight/obesity; this may reflect social desirability bias.

Missing data in FFQs: making assumptions about item non-response

OBJECTIVE

FFQs are a popular method of capturing dietary information in epidemiological studies and may be used to derive dietary exposures such as nutrient intake or overall dietary patterns and diet quality. As FFQs can involve large numbers of questions, participants may fail to respond to all questions, leaving researchers to decide how to deal with missing data when deriving intake measures. The aim of the present commentary is to discuss the current practice for dealing with item non-response in FFQs and to propose a research agenda for reporting and handling missing data in FFQs.

RESULTS

Single imputation techniques, such as zero imputation (assuming no consumption of the item) or mean imputation, are commonly used to deal with item non-response in FFQs. However, single imputation methods make strong assumptions about the missing data mechanism and do not reflect the uncertainty created by the missing data. This can lead to incorrect inference about associations between diet and health outcomes. Although the use of multiple imputation methods in epidemiology has increased, these have seldom been used in the field of nutritional epidemiology to address missing data in FFQs. We discuss methods for dealing with item non-response in FFQs, highlighting the assumptions made under each approach.

CONCLUSIONS

Researchers analysing FFQs should ensure that missing data are handled appropriately and clearly report how missing data were treated in analyses. Simulation studies are required to enable systematic evaluation of the utility of various methods for handling item non-response in FFQs under different assumptions about the missing data mechanism.

Family Affluence and the Eating Habits of 11- to 15-Year-Old Czech Adolescents: HBSC 2002 and 2014

Socioeconomic inequalities in eating habits have a profound impact on the health of adolescents. The aim of the present study was to evaluate socioeconomic disparities in the eating habits of Czech adolescents and to compare their change between 2002 and 2014. The data from the Czech Health Behavior in School-aged Children (HBSC) study conducted in 2002 and 2014 was utilized. The Family Affluence Scale (FAS) was used to assess socioeconomic disparities. Higher odds of daily consumption of fruit (2002: OR = 1.67; 2014: OR = 1.70, p < 0.001) and vegetables (2002: OR = 1.54; 2014: OR = 1.48, p < 0.001) were associated with high FAS in both genders. Adolescents with higher FAS were less likely to consume sweets (2002: OR = 0.72, p < 0.05) and more likely to eat breakfast on weekdays (2014: OR = 1.19, p < 0.05). In 2002 and 2014, the data showed lower odds of daily consumption of soft drinks (Low: OR = 0.47; Medium: OR = 0.43; High: OR = 0.41, p < 0.001), fruit (Low: OR = 0.73; Medium: OR = 0.74, p < 0.001; High: OR = 0.75, p < 0.05), sweets (Low: OR = 0.71; Medium: OR = 0.79, p < 0.001) and breakfast on weekends (High: OR = 0.70, p < 0.05), and a higher likelihood of eating breakfast on weekdays (Low: OR = 1.26, p < 0.01; Medium: OR = 1.13, p < 0.05). These findings play an important role in future public measures to improve dietary habits and decrease social inequalities in youth.

Differences in Fruit and Vegetable Intake by Race/Ethnicity and by Hispanic Origin and Nativity Among Women in the Special Supplemental Nutrition Program for Women, Infants, and Children, 2015

Introduction

The objective of this exploratory study was to determine whether fruit and vegetable consumption differed by race/ethnicity, by origin and nativity among Hispanics, and by language preference (as an indicator of acculturation) among foreign-born Hispanics.

Methods

We recruited 723 women enrolled in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) and orally administered a questionnaire containing demographic items, validated measures of food security status and social desirability trait, and the Behavioral Risk Factor Surveillance System fruit and vegetable module. Differences in intakes of 100% fruit juice, fruit, cooked or canned beans, and dark green, orange-colored, and other vegetables were assessed by using analysis of covariance with Bonferroni post hoc tests. Analyses were controlled for age, pregnancy status, breastfeeding status, food security status, educational attainment, and social desirability trait.

Results

The frequency of vegetable intake differed by race/ethnicity (cooked or canned beans were consumed more often among Hispanic than non-Hispanic black and non-Hispanic white or other participants, orange-colored vegetables were consumed more often among Hispanics than non-Hispanic black participants, and other vegetables were consumed more often among non-Hispanic white or other than among non-Hispanic black and Hispanic participants), origin (other vegetables were consumed more often among Columbian and other Hispanics than Dominican participants) and nativity (orange-colored vegetables were consumed more often among foreign-born than US-born Hispanics). Fruit and vegetable intake did not differ by language preference among foreign-born Hispanics.

Conclusion

Differences in fruit and vegetable consumption among WIC participants by race/ethnicity and by Hispanic origin and nativity may have implications for WIC nutrition policies and nutrition education efforts.

Sandwich consumption in relation to daily dietary intake and diet quality among US adults, 2003-2012

OBJECTIVES

About one half of the US adult population consumed one or more sandwiches on any given day. Sandwich consumption may profoundly influence people's calorie intake and diet quality. However, few studies have investigated the nutritional impact of sandwich consumption at the national level. We examined sandwich consumption in relation to daily dietary intake and diet quality among US adults.

STUDY DESIGN

Retrospective data analysis.

METHODS

Nationally representative sample consisting of 27,075 adults 18 years of age and above came from the National Health and Nutrition Examination Survey (NHANES) 2003-2012 waves. Sandwich consumption was identified based on the What We Eat in America Food Category and the NHANES diet combination code. First-difference estimator addressed confounding bias from time-invariant unobservables (e.g. eating habits, taste preferences) by using within-individual variations in sandwich consumption between two non-consecutive 24-h dietary recalls.

RESULTS

During 2003-2012, approximately 53.2% of US adults consumed sandwiches on any given day. Among sandwich consumers, nearly a quarter of daily total calorie intake and about a third of total fat, saturated fat, cholesterol, and sodium intake came from sandwich consumption. Men, non-Hispanic whites, young and middle-aged adults, people with higher income, and overweight/obese adults were more likely to consume sandwiches. Among those who consumed sandwiches on either but not both of the two dietary recall days, in comparison to no sandwich consumption, sandwich consumption on a dietary recall day was associated with an increase in daily intake of total energy by 98.7 kcal, total fat 6.8 g, and sodium 267.9 mg (P-value < 0.001). Statistically significant but relatively small differences were also found for other nutrients and food groups-sandwich consumption was associated with an increase in daily intake of sugar by 3.0 g (P-value < 0.01) and saturated fat 2.5 g (P-value < 0.001), a decrease in daily intake of vegetables by 8.4 g (P-value < 0.01), fruit 4.5 g (P-value < 0.05), and fibre 0.8 g (P-value < 0.001), and a decrease in the Healthy Eating Index-2010 score by 1.6 points (P-value < 0.001).

CONCLUSIONS

Consumers should prudently evaluate the calorie/nutrient content of sandwich in order to make healthier dietary choices.

Association of 6 months of exclusive breastfeeding with higher fat-free mass in infants in a low-resource setting with high HIV prevalence in South Africa

Exclusive breastfeeding for 6 months is recommended by the World Health Organisation (WHO) for optimal health and growth of infants, but it is not a common practice in South Africa. A breastfeeding counselling programme was run to inform, encourage and support mothers to exclusively breastfeed their infants for 6 months, and mother-infant pairs were invited to participate in a research project to determine breast milk intake volumes using the dose-to-mother deuterium dilution stable isotope technique. This technique yields objective measurements of breast milk intake volumes and also enables determination of exclusivity of breastfeeding, which is most frequently determined by maternal recall and can be subject to bias. Exclusivity of breastfeeding at 6 weeks, 3 months and 6 months following birth of the infants was correlated with infant fat-free mass at 12 months, which was determined by the dose-to-infant deuterium dilution stable isotope technique. Results showed that infants who were exclusively breastfed for 6 months had a higher per cent fat-free mass at 12 months compared with infants who were not exclusively breastfed for 6 months (P < 0.05). This objective determination of both breastfeeding patterns and infant body composition gives weight to the WHO recommendation of exclusive breastfeeding for 6 months as it demonstrated adequate fat-free mass in infants at 12 months, even in an area with high HIV prevalence. © 2016 John Wiley & Sons Ltd.

The effect of under-reporting of energy intake on dietary patterns and on the associations between dietary patterns and self-reported chronic disease in women aged 50–69 years

The aim of this cross-sectional study was to investigate whether under-reporting of energy intake affects derived dietary patterns and the association between dietary patterns and self-reported chronic disease. Diets of 6204 women aged 50–69 years participating in the Norwegian Breast Cancer Screening Program were assessed using a 253-item FFQ. We identified dietary patterns using principal component analysis. According to the revised Goldberg cut-off method, women with a ratio of reported energy intake:estimated BMR<1·10 were classified as low energy reporters (n 1133, 18 %). We examined the associations between dietary patterns and self-reported chronic diseases by log-binomial regression, and the results are presented as prevalence ratios (PR) and CI. ‘Prudent’, ‘Western’ and ‘Continental’ dietary patterns were identified among all reporters and plausible reporters. The PR expressing the associations between the ‘Western’ and ‘Prudent’ dietary pattern scores and self-reported chronic diseases were consistently highest among plausible reporters except for joint/muscle/skeletal disorders. The largest difference in PR among plausible v. all reporters was found for the association between the ‘Prudent’ pattern and diabetes (PR for highest v. lowest tertile: PRall reporters 2·16; 95 % CI 1·50, 3·13; Ptrend<0·001; PRplausible reporters 2·86; 95 % CI 1·81, 4·51; Ptrend<0·001). In conclusion, our results suggest that under-reporting can result in systematic error that can affect the association between dietary pattern and disease. In studies of dietary patterns, investigators ought to consider reporting effect estimates both for all individuals and for plausible reporters.

Plain Water and Sugar-Sweetened Beverage Consumption in Relation to Energy and Nutrient Intake at Full-Service Restaurants

Background: Drinking plain water, such as tap or bottled water, provides hydration and satiety without adding calories. We examined plain water and sugar-sweetened beverage (SSB) consumption in relation to energy and nutrient intake at full-service restaurants. Methods: Data came from the 2005–2012 National Health and Nutrition Examination Survey, comprising a nationally-representative sample of 2900 adults who reported full-service restaurant consumption in 24-h dietary recalls. Linear regressions were performed to examine the differences in daily energy and nutrient intake at full-service restaurants by plain water and SSB consumption status, adjusting for individual characteristics and sampling design. Results: Over 18% of U.S. adults had full-service restaurant consumption on any given day. Among full-service restaurant consumers, 16.7% consumed SSBs, 2.6% consumed plain water but no SSBs, and the remaining 80.7% consumed neither beverage at the restaurant. Compared to onsite SSB consumption, plain water but no SSB consumption was associated with reduced daily total energy intake at full-service restaurants by 443.4 kcal, added sugar intake by 58.2 g, saturated fat intake by 4.4 g, and sodium intake by 616.8 mg, respectively. Conclusion: Replacing SSBs with plain water consumption could be an effective strategy to balance energy/nutrient intake and prevent overconsumption at full-service restaurant setting.

Perspective: Randomized Controlled Trials Are Not a Panacea for Diet-Related Research

Research into the role of diet in health faces a number of methodologic challenges in the choice of study design, measurement methods, and analytic options. Heavier reliance on randomized controlled trial (RCT) designs is suggested as a way to solve these challenges. We present and discuss 7 inherent and practical considerations with special relevance to RCTs designed to study diet: 1) the need for narrow focus; 2) the choice of subjects and exposures; 3) blinding of the intervention; 4) perceived asymmetry of treatment in relation to need; 5) temporal relations between dietary exposures and putative outcomes; 6) strict adherence to the intervention protocol, despite potential clinical counter-indications; and 7) the need to maintain methodologic rigor, including measuring diet carefully and frequently. Alternatives, including observational studies and adaptive intervention designs, are presented and discussed. Given high noise-to-signal ratios interjected by using inaccurate assessment methods in studies with weak or inappropriate study designs (including RCTs), it is conceivable and indeed likely that effects of diet are underestimated. No matter which designs are used, studies will require continued improvement in the assessment of dietary intake. As technology continues to improve, there is potential for enhanced accuracy and reduced user burden of dietary assessments that are applicable to a wide variety of study designs, including RCTs.

Dietary patterns and weight change: 15-year longitudinal study in Australian adults

BACKGROUND

Dietary intake is one of the most modifiable risk factors associated with obesity. However, data on the relationship between dietary patterns and long-term weight change are limited.

PURPOSE

We therefore investigated the association between dietary patterns and 15-year weight change in a sample of 1186 Australian adults (1992-2007).

METHODS

We measured body weight and collected data on socio-demographic and lifestyle characteristics in 1992 and 2007. Applying principal component analysis to 38 food groups from a food frequency questionnaire collected at baseline, we identified two dietary patterns: 'meat-and-fat' and 'fruit-and-vegetable.' Using generalized estimating equations, multivariable regression models, stratified by sex, were adjusted for concurrent changes in socio-demographic and lifestyle variables.

RESULTS

The average increase in body weight of men in the highest tertile of the meat-and-fat pattern was more than twice that of men in the lowest tertile; mean weight change (95 % CI): 4.8 (-0.1, 9.7) kg versus 2.3 (-2.6, 7.1) kg, P-for-trend = 0.02. In contrast, average weight gain of men in the highest tertile of the fruit-and-vegetable pattern was only about half that of men in the lowest tertile; mean weight change (95 % CI): 2.9 (-2.0, 7.8) kg versus 5.4 (-1.5, 10.4) kg, P-for-trend = 0.02. Among women, dietary patterns were not related to weight change.

CONCLUSIONS

These dietary patterns predict change in body weight in men, but not in women. In this cohort, a dietary pattern high in fruit and vegetables was related to less weight gain in men than a dietary pattern high in meat and fat.

Plain water consumption in relation to energy intake and diet quality among US adults, 2005-2012

OBJECTIVE

The present study examined plain water consumption in relation to energy intake and diet quality among US adults.

METHODS

A nationally representative sample of 18 311 adults aged ≥18 years, from the National Health and Nutrition Examination Survey 2005-2012, was analysed. The first-difference estimator approach addressed confounding bias from time-invariant unobservables (e.g. eating habits, taste preferences) by using within-individual variations in diet and plain water consumption between two nonconsecutive 24-h dietary recalls.

RESULTS

One percentage point increase in the proportion of daily plain water in total dietary water consumption was associated with a reduction in mean (95% confidence interval) daily total energy intake of 8.58 (7.87-9.29) kcal, energy intake from sugar-sweetened beverages of 1.43 (1.27-1.59) kcal, energy intake from discretionary foods of 0.88 (0.44-1.32) kcal, total fat intake of 0.21 (0.17-0.25) g, saturated fat intake of 0.07 (0.06-0.09) g, sugar intake of 0.74 (0.67-0.82) g, sodium intake of 9.80 (8.20-11.39) mg and cholesterol intake of 0.88 (0.64-1.13) g. The effects of plain water intake on diet were similar across race/ethnicity, education attainment, income level and body weight status, whereas they were larger among males and young/middle-aged adults than among females and older adults, respectively. Daily overall diet quality measured by the Healthy Eating Index-2010 was not found to be associated with the proportion of daily plain water in total dietary water consumption.

CONCLUSIONS

Promoting plain water intake could be a useful public health strategy for reducing energy and targeted nutrient consumption in US adults, which warrants confirmation in future controlled interventions.

Is nutrient intake associated with physical activity levels in healthy young adults?

Objective

Both physical activity (PA) and diet are important contributors to health and well-being; however, there is limited information on the association of these behaviours and whether observed associations differ by weight. The present study aimed to evaluate whether nutrient intake is associated with PA and if this association varies by weight in young adults.

Design

Cross-sectional study to analyse the association between PA and nutrient intake.

Setting

Participants were stratified as normal weight (18·5 kg/m2<BMI <25·0 kg/m2) and overweight/obese (BMI≥25·0 kg/m2). PA level (PAL) was calculated (PAL=total daily energy expenditure/RMR) and used to stratify groups (PAL<1·6, 1·6≤PAL<1·9, PAL≥1·9).

Subjects

Adults (n407; age 27·6 (sd3·8) years, 48 % male), with BMI between 20 and 35 kg/m2, having at least two 24 h diet recalls and at least 5 d (including two weekend days) of valid, objectively measured PA data were included in the analysis.

Results

In normal-weight participants, higher PAL was associated with higher intakes of minerals (except Ca, Fe and Zn), B-vitamins and choline (Pfor trend <0·05). In the overweight/obese group, higher PAL was associated with higher intakes of fibre, K, Na and Cu (Pfor trend <0·05). These differences, however, were no longer significant after additionally controlling for total energy intake.

Conclusions

More active young adults have higher intakes of essential micronutrients. The benefits of PA may be predominantly due to a higher overall food intake while maintaining energy balance rather than a healthier diet.

Contribution of Organic Food to the Diet in a Large Sample of French Adults (the NutriNet-Santé Cohort Study)

In developed countries, the demand for organic products continues to substantially increase each year. However, little information is available regarding the level of consumption of organic food and its relative share of the whole diet. Our aim was to provide, using individual consumption data, a detailed description of organic food consumption among French adults. Conventional and organic intakes were assessed using an organic food frequency questionnaire administered to 28,245 French adults participating in the NutriNet-Santé study. P values of Student t-test or Chi-square for the difference between genders were reported. Less than 12% of the respondents reported never consuming organic food in the past year. Women consumed on average 20% organic food in their whole diet per day while men consumed an average of 18%. The proportion of vegetables consumed that came from organic sources was 31% among women and 28% among men. Overall, the estimate of the contribution of organic food from products of plant origin was higher than that from products of animal origin. Our study provides a framework for the exploration of organic consumption and its correlates and can serve as a basis for future studies investigating relationships between the level of organic food consumption and health outcomes.

Everyday distinction and omnivorous orientation: An analysis of food choice, attitudinal dispositions and social background

In recent years studies on cultural consumption have experienced a Bourdieusian renaissance. This is indicated by a growing body of research analysing distinctions in different areas of culture, and numerous studies on the homology thesis applying the concepts of distinction, field and capital. Concurrently, however, it has been argued that instead of distinctive tastes, distinction and class status are increasingly manifested by cultural omnivorousness. For a good part studies focussing on distinction in food have analysed eating out and stylization through restaurant preferences, rather than everyday food choices. In this article we investigate everyday food choices from the perspective of distinction and omnivorousness. Our analysis draws on cross-sectional quantitative data collected in 2012 among 15-64-year-old Finns (N = 2601). The article maps out the relationship between food choice frequencies, dispositions and social background with Multiple Correspondence Analysis (MCA). The results show that the consumption of fruit and vegetables, ready-meals and convenience foods were among the most divisive food choices. The first structuring dimension juxtaposed processed, fatty and sugared foods with unprocessed foods and fresh ingredients. This dimension was associated with healthiness and weight control as dispositions. On the second structuring dimension there were differences in the valuation of taste, pleasure and sociability, and a contrast between moderate and restrictive choices. Particularly the first dimension was associated with educational, occupational, and gender differences. Distinction within everyday food choices was manifested in the use of healthy and unprocessed foods and 'moderate hedonism' in contrast to more restrictive tastes.

Comparative validity of vitamin C and carotenoids as indicators of fruit and vegetable intake: a systematic review and meta-analysis of randomised controlled trials

Circulating vitamin C and carotenoids are used as biomarkers of fruit and vegetable intake in research, but their comparative validity has never been meta-analysed. PubMed, EMBASE, CENTRAL, CINAHL and Web of Science were systematically searched up to December 2013 for randomised trials of different amounts of fruit and vegetable provision on changes in blood concentrations of carotenoids or vitamin C. Reporting followed PRISMA guidelines. Evidence quality was assessed using the GRADE system. Random effects meta-analysis combined estimates and meta-regression tested for sub-group differences. In all, nineteen fruit and vegetable trials (n1382) measured at least one biomarker, of which nine (n667) included five common carotenoids and vitamin C. Evidence quality was low and between-trial heterogeneity (I2) ranged from 74 % for vitamin C to 94 % forα-carotene. Groups provided with more fruit and vegetables had increased blood concentrations of vitamin C,α-carotene,β-carotene,β-cryptoxanthin and lutein but not lycopene. However, no clear dose–response effect was observed. Vitamin C showed the largest between-group difference in standardised mean change from the pre-intervention to the post-intervention period (smd0·94; 95 % CI 0·66, 1·22), followed by lutein (smd0·70; 95 % CI 0·37, 1·03) andα-carotene (smd0·63; 95 % CI 0·25, 1·01), but all CI were overlapping, suggesting that none of the biomarkers responded more than the others. Therefore, until further evidence identifies a particular biomarker to be superior, group-level compliance to fruit and vegetable interventions can be indicated equally well by vitamin C or a range of carotenoids. High heterogeneity and a lack of dose–response suggest that individual-level biomarker responses to fruit and vegetables are highly variable.

Using Animal Models to Determine the Role of Gustatory Neural Input in the Control of Ingestive Behavior and the Maintenance of Body Weight

INTRODUCTION

Decades of research have suggested that nutritional intake contributes to the development of human disease, mainly by influencing the development of obesity and obesity-related conditions. A relatively large body of research indicates that functional variation in human taste perception can influence nutritional intake as well as body mass accumulation. However, there are a considerable number of studies that suggest that no link between these variables actually exists. These discrepancies in the literature likely result from the confounding influence of a variety of other, uncontrolled, factors that can influence ingestive behavior.

STRATEGY

In this review, the use of controlled animal experimentation to alleviate at least some of these issues related to the lack of control of experimental variables is discussed. Specific examples of the use of some of these techniques are examined.

DISCUSSION AND CONCLUSIONS

The review will close with some specific suggestions aimed at strengthening the link between gustatory neural input and its putative influence on ingestive behaviors and the maintenance of body weight.

Diet-related inflammation and oesophageal cancer by histological type: a nationwide case-control study in Sweden

PURPOSE

This project sought to test the role of diet-related inflammation in modulating the risk of oesophageal cancer.

METHODS

A nationwide population-based case-control study was conducted from 1 December 1994 through 31 December 1997 in Sweden. All newly diagnosed patients with adenocarcinoma of the oesophagus or gastroesophageal junction and a randomly selected half of patients with oesophageal squamous cell carcinoma were eligible as cases. Using the Swedish Registry of the Total Population, the control group was randomly selected from the entire Swedish population and frequency-matched on age (within 10 years) and sex. The literature-derived dietary inflammatory index (DII) was developed to describe the inflammatory potential of diet. DII scores were computed based on a food frequency questionnaire. Higher DII scores indicate more pro-inflammatory diets. Odds ratios and 95 % confidence intervals (CI) were computed to assess risk associated between DII scores and oesophageal cancer using logistic regression adjusted by potential confounders.

RESULTS

In total, 189 oesophageal adenocarcinomas, 262 gastroesophageal junctional adenocarcinomas, 167 oesophageal squamous cell carcinomas, and 820 control subjects were recruited into the study. Significant associations with DII were observed for oesophageal squamous cell carcinoma (ORQuartile4vs1 4.35, 95 % CI 2.24, 8.43), oesophageal adenocarcinoma (ORQuartile4vs1 3.59, 95 % CI 1.87, 6.89), and gastroesophageal junctional adenocarcinoma (ORQuartile4vs1 2.04, 95 % CI 1.24, 3.36). Significant trends across quartiles of DII were observed for all subtypes of oesophageal cancer.

CONCLUSIONS

Diet-related inflammation appears to be associated with an increased risk of oesophageal cancer, regardless of histological type.

The dietary inflammatory index is associated with colorectal cancer in the National Institutes of Health-American Association of Retired Persons Diet and Health Study

Diet is a strong moderator of systemic inflammation, an established risk factor for colorectal cancer (CRC). The dietary inflammatory index (DII) measures the inflammatory potential of individuals' diets. The association between the DII and incident CRC was examined, using the National Institutes of Health-American Associations of Retired Persons Diet and Health Study individuals (n 489,422) aged 50-74 years at recruitment, starting between 1995-6, and followed for a mean of 9·1 (sd 2·9) years. Baseline data from a FFQ were used to calculate the DII; higher scores are more pro-inflammatory, and lower scores are more anti-inflammatory. First, primary CRC diagnoses were identified through linkage to state cancer registries. Anatomic location and disease severity also were examined. Cox proportional hazards models estimated CRC hazard ratios (HR) and 95% CI using quartile 1 as the referent. DII quartile 4 compared to quartile 1 was associated with CRC risk among all subjects (HR 1·40, 95% CI 1·28, 1·53; P for trend < 0·01). Statistically significant associations also were observed for each anatomic site examined, for moderate and poorly differentiated tumours, and at each cancer stage among all subjects. Effects were similar when stratified by sex; however, results were statistically significant only in males. The only result reaching statistical significance in females was risk of moderately differentiated CRC tumours (DII quartile 4 v. quartile 1 HR 1·26, 95% CI 1·03, 1·56). Overall, the DII was associated with CRC risk among all subjects. The DII may serve as a novel way to evaluate dietary risk for chronic disorders associated with inflammation, such as CRC.

Pathways between acculturation and health behaviors among residents of low-income housing: the mediating role of social and contextual factors

Acculturation may influence health behaviors, yet mechanisms underlying its effect are not well understood. In this study, we describe relationships between acculturation and health behaviors among low-income housing residents, and examine whether these relationships are mediated by social and contextual factors. Residents of 20 low-income housing sites in the Boston metropolitan area completed surveys that assessed acculturative characteristics, social/contextual factors, and health behaviors. A composite acculturation scale was developed using latent class analysis, resulting in four distinct acculturative groups. Path analysis was used to examine interrelationships between acculturation, health behaviors, and social/contextual factors, specifically self-reported social ties, social support, stress, material hardship, and discrimination. Of the 828 respondents, 69% were born outside of the U.S. Less acculturated groups exhibited healthier dietary practices and were less likely to smoke than more acculturated groups. Acculturation had a direct effect on diet and smoking, but not physical activity. Acculturation also showed an indirect effect on diet through its relationship with material hardship. Our finding that material hardship mediated the relationship between acculturation and diet suggests the need to explicate the significant role of financial resources in interventions seeking to promote healthy diets among low-income immigrant groups. Future research should examine these social and contextual mediators using larger, population-based samples, preferably with longitudinal data.

Considering the value of dietary assessment data in informing nutrition-related health policy

Dietary assessment has long been known to be challenged by measurement error. A substantial amount of literature on methods for determining the effects of error on causal inference has accumulated over the past decades. These methods have unrealized potential for improving the validity of data collected for research studies and national nutritional surveillance, primarily through the NHANES. Recently, the validity of dietary data has been called into question. Arguments against using dietary data to assess diet-health relations or to inform the nutrition policy debate are subject to flaws that fall into 2 broad areas: 1) ignorance or misunderstanding of methodologic issues; and 2) faulty logic in drawing inferences. Nine specific issues are identified in these arguments, indicating insufficient grasp of the methods used for assessing diet and designing nutritional epidemiologic studies. These include a narrow operationalization of validity, failure to properly account for sources of error, and large, unsubstantiated jumps to policy implications. Recent attacks on the inadequacy of 24-h recall-derived data from the NHANES are uninformative regarding effects on estimating risk of health outcomes and on inferences to inform the diet-related health policy debate. Despite errors, for many purposes and in many contexts, these dietary data have proven to be useful in addressing important research and policy questions. Similarly, structured instruments, such as the food frequency questionnaire, which is the mainstay of epidemiologic literature, can provide useful data when errors are measured and considered in analyses.

The independent association between diet quality and body composition

Excess body weight is associated with an imbalance between energy expenditure and dietary intake but evidence on the association between diet quality and body composition remains equivocal. Rather than relying on differences in diet quality between overweight/obese and normal weight adults, this study examined the association between the Healthy Eating Index 2010 (HEI-2010) and body fatness on a continuous scale, independent of physical activity (PA). Further the association between components of the HEI-2010 and risk for overweight/obesity was explored. 407 adults (27.6 ± 3.7 years) provided at least two 24-hour diet recalls over a period of 14 days, which were used to calculate the HEI-2010. Percent body fat (BF) was assessed via dual X-ray absorptiometry and PA was determined via a multi-sensor device, worn over a period of 10 days. PA was a stronger contributor to the variability in BF than the HEI-2010 and the association between HEI-2010 and BF was significant only in men. Particularly a high consumption of protein, sodium and empty calories increased the risk for overweight/obesity. Adherence to dietary guidelines positively affects body fatness in men, independent of PA. In contrast to current dietary recommendations, the risk for overweight/obesity was increased with a higher protein intake.

Healthy eating norms and food consumption

BACKGROUND/OBJECTIVES

Beliefs about what people think they ought to eat to be healthy ('healthy eating norms (HENs)') may be important influences on food consumption. The purpose of this study was to examine the predictive roles of normative expectations and demographics, personal values, substance use behaviours and body weight on reported food consumption among middle-aged Australians.

SUBJECTS/METHODS

A questionnaire was administered by mail to a random sample of people aged 40 years and above, drawn from the Electoral Rolls in Victoria, Australia. Part of the questionnaire contained questions about the respondents' beliefs about what should they eat to be healthy, what actually they ate, their personal values, smoking and alcohol use, as well as self-reported heights and weights and demographic characteristics.

RESULTS

Respondents' reported food consumption did not match their HENs. Demographics, smoking, body mass index (BMI) and personal values, and HENs were associated with reported consumption but the relationships differed among men and women. Generally, high energy-dense, nutrition-poor (EDNP) food consumption was negatively associated with age. Fruit and vegetable HEN and consumption was positively linked to universalist values but negatively related to smoking status among men. In contrast in women, fruit and vegetable HENs were positively related to income and education while EDNP HEN was negatively associated with age and income but positively linked to body weight and power values.

CONCLUSIONS

Reported food consumption was associated with HEN, personal values, demographics, smoking and BMI through different pathways among men and women. The implications for nutrition promotion are discussed.