Gender differences in social desirability and social approval bias in dietary self-report

Developing an Instrument to Measure Self-Efficacy, Challenges and Knowledge in Oral Care among Geriatric Home Care Nurses-A Pilot Study

The role of geriatric nurses is essential in preventing oral health problems of older people with impaired daily functioning. Nurses have reported low self-efficacy with regard to oral health care practices and wish to receive more information on the topic. The main aim of this pilot study was to develop an instrument to measure the self-efficacy beliefs, challenges and knowledge of geriatric home care nurses with regard to the oral health care of older. A questionnaire was developed to evaluate geriatric home care nurses' self-efficacy beliefs, challenges and knowledge regarding the oral health care of the older people. In this case, 18 nurses participated in a one-day intervention and filled in the questionnaire before and after the intervention. The comments and questions of the nurses were analysed utilising the principles of inductive content analysis. Cronbach's alpha for the scales varied between 0.69-0.79. The interactive intervention improved both nurses' self-efficacy beliefs and oral health-related knowledge, and most of the challenges faced by nurses in older people's oral health care were diminished. Financial resources and older people's self-determination were the most common limitations to oral care. In this pilot study, we developed an instrument to measure geriatric home care nurses' self-efficacy beliefs, challenges and knowledge regarding older people's oral health care. In the future, this instrument can be validated with a larger study population.

A pilot examination of the inter-rater reliability of the 18-item Household Food Security Module between cohabiting mothers and fathers

Food insecurity, defined as the inability to access sufficient food for an active, healthy life, affects 11.1% of the US population and is primarily assessed using the United States Department of Agriculture's (USDA) 18-item Household Food Security Survey Module (HFSSM). The HFSSM is a self-report measure presumed to represent all household members, but it is unknown if cohabiting parents report food security differently. This pilot study aimed to determine (i) the inter-rater reliability of the HFSSM; (ii) the direction of any difference between responses to the HFSSM; and (iii) the item-level response similarities and differences among mothers and fathers of young children. Twenty-five pairs of low-income, food-insecure cohabiting parents of 2.5- to 10-year-old children participated in cognitive interviews assessing their level of food security using the USDA's HFSSM and completed related questionnaires. Intraclass correlations were computed to compare the responses of each dyad on the HFSSM overall and by item. Results revealed that overall report of food security was significantly but weakly correlated (r = .40, p = .02) within dyads. The majority of fathers (60%) reported higher food security scores on the HFSSM than their respective female partners. Furthermore, item-level intraclass correlations revealed that some HFSSM questions had poor reliability between cohabiting parents. This research identifies that a potential shortcoming of the HFSSM is the under-reporting of food insecurity by fathers compared with mothers within the household. These findings have implications for the utility of this measure used in national monitoring of the nation's food security.

The associations between individual plasma SFAs, serine palmitoyl-transferase long-chain base subunit 3 gene rs680379 polymorphism, and type 2 diabetes among Chinese adults

BACKGROUND

Several individual studies have shown that circulating levels of odd-chain SFAs and very-long-chain SFAs (VLSFAs) may have beneficial effects, but the results are mixed. While the dietary and metabolic factors that may influence VLSFAs are not well-known, a previous study observed associations of VLSFA concentrations with variants in serine palmitoyl-transferase long-chain base subunit 3 (SPTLC3) gene.

OBJECTIVES

We investigated the associations of individual plasma SFAs and SPTLC3 gene rs680379 polymorphism with metabolic risk factors and type 2 diabetes (T2D).

METHODS

We measured plasma SFAs using gas chromatography among 898 T2D cases and 1618 matched controls, and genotyped the SPTLC3 gene rs680379 polymorphism using the MassArray System among 1178 T2D cases and 1907 matched controls. Conditional logistic regression was used to estimate ORs and 95% CIs.

RESULTS

We found that plasma odd-chain SFAs and VLSFAs were correlated with favorable blood lipids and insulin resistance marker profiles. After multivariable adjustment, pentadecanoic acid (15:0) was inversely associated with the odds of T2D (OR per 1 SD difference: 0.63; 95% CI: 0.57, 0.70), as were measurements of 3 individual VLSFAs [arachidic acid (20:0), behenic acid (22:0), and lignoceric acid (24:0)], with ORs ranging from 0.60 to 0.72 (95% CIs ranging between 0.52 and 0.79). The associations between 3 individual VLSFAs and T2D were attenuated after further adjustment for triglycerides. Meanwhile, compared with the rs680379 GG genotype carriers, the ORs of T2D for the GA and AA genotype carriers were 0.81 (95% CI: 0.68-0.97) and 0.76 (95% CI: 0.61-0.96), respectively.

CONCLUSIONS

Plasma 15:0 and VLSFAs were inversely associated with T2D. Meanwhile, compared with the rs680379 GG genotype carriers, subjects with GA and AA genotypes were associated with decreased odds of T2D. More investigations are warranted to confirm our findings.

Dietary inflammatory potential, oxidative balance score, and risk of breast cancer: Findings from the Sister Study

Diet, inflammation, and oxidative stress may be important in breast carcinogenesis, but evidence on the role of the inflammatory and prooxidative potential of dietary patterns is limited. Energy adjusted-Dietary Inflammatory Index (E-DII™) and dietary oxidative balance score (D-OBS) were calculated for 43 563 Sister Study cohort participants who completed a Block 1998 food frequency questionnaire at enrollment in 2003-2009 and satisfied eligibility criteria. D-OBS was validated using measured F2 -isoprostanes and metabolites. High E-DII score and low D-OBS represent a more proinflammatory and prooxidant diet, respectively, and associations of quartiles of each index with breast cancer (BC) risk were estimated using multivariable Cox proportional hazards regression. There were 2619 BCs diagnosed at least 1 year after enrollment (mean follow-up 8.4 years). There was no overall association between E-DII and BC risk, whereas there was a suggestive inverse association for the highest vs lowest quartile of D-OBS (HR 0.92 [95% CI, 0.81-1.03]). The highest quartile of E-DII was associated with risk of triple-negative BC (HR 1.53 [95% CI, 0.99-2.35]). When the two indices were combined, a proinflammatory/prooxidant diet (highest tertile of E-DII and lowest tertile of D-OBS) was associated with increased risk for all BC (HR 1.13 [95% CI, 1.00-1.27]) and for triple-negative BC (1.72 [95% CI, 1.10-2.70]), compared to an antiinflammatory/antioxidant diet (lowest tertile of E-DII and highest tertile of D-OBS). Diets with increased inflammatory potential and reduced oxidative balance were positively associated with overall and triple-negative BC.

Identification of psychological correlates of dietary misreporting under laboratory and free-living environments

Errors inherent in self-reported measures of energy intake (EI) are substantial and well documented, but correlates of misreporting remain unclear. Therefore, potential predictors of misreporting were examined. In Study One, fifty-nine individuals (BMI = 26·1 (sd 3·8) kg/m2, age = 42·7 (sd 13·6) years, females = 29) completed a 14-d stay in a residential feeding behaviour suite where eating behaviour was continuously monitored. In Study Two, 182 individuals (BMI = 25·7 (sd 3·9) kg/m2, age = 42·4 (sd 12·2) years, females = 96) completed two consecutive days in a residential feeding suite and five consecutive days at home. Misreporting was directly quantified by comparing covertly measured laboratory weighed intakes (LWI) with self-reported EI (weighed dietary record (WDR), 24-h recall, 7-d diet history, FFQ). Personal (age, sex and %body fat) and psychological traits (personality, social desirability, body image, intelligence quotient and eating behaviour) were used as predictors of misreporting. In Study One, those with lower psychoticism (P = 0·009), openness to experience (P = 0·006) and higher agreeableness (P = 0·038) reduced EI on days participants knew EI was being measured to a greater extent than on covert days. Isolated associations existed between personality traits (psychoticism and openness to experience), eating behaviour (emotional eating) and differences between the LWI and self-reported EI, but these were inconsistent between dietary assessment techniques and typically became non-significant after accounting for multiplicity of comparisons. In Study Two, sex was associated with differences between LWI and the WDR (P = 0·009), 24-h recall (P = 0·002) and diet history (P = 0·050) in the laboratory, but not home environment. Personal and psychological correlates of misreporting identified displayed no clear pattern across studies or dietary assessment techniques and had little utility in predicting misreporting.

Are social desirability scales desirable? A meta-analytic test of the validity of social desirability scales in the context of prosocial behavior

Social desirability (SD) scales have been used for decades in psychology and beyond. These scales are sought to measure individuals' tendencies to present themselves overly positive in self-reports, thus allowing to control for SD biases. However, research increasingly questions the validity of SD scales, proposing that SD scales measure substantive trait characteristics rather than response bias. To provide a large-scale empirical test of the validity of SD scales, we conducted a meta-analysis (k = 41; N = 8980) on the relation between SD scale scores and prosocial behavior in economic games (where acting in a prosocial manner is highly socially desirable). If SD scales measure what they are supposed to (namely, SD bias), they should be negatively linked to prosocial behavior; if SD scales measure socially desirable traits, they should be positively linked to prosocial behavior. Unlike both possibilities, the meta-analytic correlation between SD scores and prosocial behavior was close to zero, suggesting that SD scales neither clearly measure bias nor substantive traits. This conclusion was also supported by moderation analyses considering differences in the implementation of games and the SD scales used. The results further question the validity of SD scales with the implication that scholars and practitioners should refrain from using them.

Effect of Group Contingency Type on Walking: Comparisons of Effectiveness and Cost Efficiency

Group contingency (GC) is an effective and cost-efficient strategy that can be successfully applied to technology-based interventions. This study examined the relative effectiveness and cost efficiency of three types of technology-based group contingencies on walking among adults. Seventy two students were divided into teams of three. Each team was randomly assigned to one of three GC conditions (independent, interdependent, or dependent) and underwent 66 days of technology-based group contingency intervention. Sixty five participants completed the intervention and 61 completed the follow-up assessment 2 months later. Step counts and self-reported walking activity increased after the intervention under all three conditions. The proportion of participants that met the target step counts was significantly higher under the dependent group contingency condition. However, 2 months later, intervention effects were not maintained under any condition. For cost efficiency, the increase in step count per point was significantly higher under the interdependent group contingency condition. Group cohesion and social validity (point satisfaction and point utility) were significantly higher under the dependent group contingency condition. Finally, the clinical implications and limitations of this study are discussed.

Gender Influences on Physical Activity Awareness of Adolescents and Their Parents

The imbalances between the actual physical activity (PA) of adolescents and the subjective perception both they and their parents have in this regard can play an important role in perpetuating inactive lifestyles. The aim of this study is to analyse these discrepancies by considering gender as a conditioning factor. The participants in the study were 1697 adolescents, 1244 mothers and 1052 fathers in the educational communities of 26 secondary schools located in urban environments of the Autonomous Community of Galicia (Spain). With regard to actual physical activity, a high prevalence of sedentarism (82.1%) was revealed, this being even more acute in girls (87.8%). However, the perceived levels of activity differed significantly from the actual ones with a clear general overestimation both by the adolescents and their parents. When further exploring the data, gender influences were also detected both in adolescent and parental perceptions, since the high rates of overestimation in sedentary individuals were lower in girls and, on the contrary, the low rates of underestimation in active individuals were higher in girls. Moreover, although the level of agreement between actual and perceived physical activity was low overall, with Cohen's kappa values ranging from 0.006 to 0.047, the lowest values were observed in the case of girls. In conclusion, both the adolescents and their parents were incapable of correctly assessing the actual physical activity of the former, so it seems that the general population lacks knowledge about the amount of physical activity that adolescents need to do to achieve a healthy lifestyle. Consequently, it would be advisable to implement health education campaigns and awareness-raising interventions directed to young people as well as to their parents and, in doing so, gender must be considered by establishing distinct program designs in terms of this variable.

Food Insecurity and Dietary Intake among College Students with Unlimited Meal Plans at a Large, Midwestern University

BACKGROUND

Food insecurity, a state of not being able to consistently access nutritious food due to financial constraints, has been associated with poor dietary intake among college students. The extent to which campus food resources contribute to this association is unknown.

OBJECTIVES

This study examined the association between food insecurity and dietary intake in a sample of undergraduate students with unlimited meal plans and dining hall access at a large, public Midwestern university.

DESIGN

The study design is cross-sectional. The data used are baseline data from a broader sugar-sweetened beverage intervention study that were collected using a Qualtrics survey prior to the intervention.

PARTICIPANTS/SETTING

The sample consisted of 1033 undergraduate students recruited from 3 dining halls. The data were collected in November 2018.

MAIN OUTCOME MEASURES

Food security was assessed using the 6-item Short Form Food Security Survey Module. Dietary intake was assessed using the National Cancer Institute 26-item Dietary Screener Questionnaire and the Beverage Intake Questionnaire-15.

STATISTICAL ANALYSES PERFORMED

Generalized linear regression models were used to examine differences in dietary intake by students' food security status, adjusting for students' sociodemographic characteristics.

RESULTS

In the sample, 14% of students were food-insecure. After adjusting for sociodemographic variables, food-insecure students reported 9% lower intake of fruits (P = 0.02), 9% lower intake of vegetables (P < 0.001), 10% higher intake of dairy (P = 0.002), 6% higher intake of total added sugars (P = 0.01), 10% higher intake of added sugars from sugar-sweetened beverages (P = 0.01), 4% higher intake of calcium (P = 0.01), and 4% lower intake of fiber (P = 0.01) compared with food-secure students. With respect to beverage intake, food-insecure students had 56% higher intake of total sugar-sweetened beverages (P = 0.002), which was driven by 185% higher intake of energy and sports drinks (P = 0.001), and 121% higher intake of sweetened teas (P = 0.001).

CONCLUSIONS

Despite having identical food resources within campus dining halls, there were significant differences in the diets of college students by food security status.

Feasibility and reliability of the Self Administered Children's Lifestyle Assessment (SACLA), a new tool to measure children's lifestyle behaviors: the VIF Program

Objectives

To develop a self-administered children health-related behaviors assessment, and to test its feasibility and reliability in a group of French children.

Methods

A sample of 216 children participated in the first stage of this study, dedicated to the feasibility assessment. An independent sample of 99 children participated in the assessment of reliability via questionnaire test and retest.

Results

Missing or inappropriate responses on different parts of the questionnaire ranged from 0 to 35%, more evident on the drink intake and sleep areas. Some questions in fact have been modified or removed. No problems were reported on the dimensions of physical activity habits and sedentary behaviors. The mean percentage of agreement in test-retest reliability for the questionnaire dimensions was 78% (47-99%). Overall, kappa coefficients were good.

Conclusions

This questionnaire is an acceptable and reliable instrument for assessing lifestyle habits in French children.

Dietary inflammatory index and dietary energy density are associated with menopausal symptoms in postmenopausal women: a cross-sectional study

OBJECTIVES

No previous study has evaluated the association of the dietary inflammatory index (DII) and dietary energy density (DED) with menopausal symptoms and its subclasses in postmenopausal women. The aim of this study was to evaluate the association of DII score and DED with menopausal symptoms and its subtypes in Iranian postmenopausal women.

METHODS

This cross-sectional study was conducted on 393 postmenopausal women who attended health centers in the south of Tehran, Iran. The DII score was calculated using dietary factors obtained by a validated food frequency questionnaire. DED was defined as average daily energy intake (kcal) per gram of food. The Menopause Rating Scale questionnaire was used to evaluate the menopausal symptoms. The total Menopause Rating Scale score (TMRSS) was the sum of the somatic score (SS), psychological score (PS), and urogenital score. Linear regression analysis was used to assess the association of the DII score and DED with menopausal symptoms.

RESULTS

After adjusting for covariates, participants in the highest tertile of DII score had greater SS compared to those in the lowest tertile (βDIIt3vs1= 0.032, 95% confidence interval (CI): 0.004-0.068, P = 0.04). No significant relationship was found between DII score and PS, urogenital score or TMRSS. Furthermore, higher DED was associated with greater SS (βDIIt3vs1 = 0.071, 95% CI: 0.028-0.115, P = 0.001), PS (βDIIt3vs1 = 0.065, 95% CI: 0.012-0.121, P = 0.01) and TMRSS (βDIIt3vs1 = 0.053, 95% CI: 0.017-0.088, P = 0.004).

CONCLUSION

A proinflammatory diet was associated with higher menopause-specific somatic symptoms and higher DED was positively associated with menopausal symptoms.

Associations between Family-Based Stress and Dietary Inflammatory Potential among Families with Preschool-Aged Children

Chronic stress is known to influence dietary choices, and stressed families often report poorer diet quality; however, little is known about how family-based stress is linked with dietary patterns that promote inflammation. This study investigated associations between family-based stress and the inflammatory potential of the diet among preschool-aged children and their parents. Parents (n = 212 mothers, n = 146 fathers) and children (n = 130 girls, n = 123 boys; aged 18 months to 5 years) from 241 families participating in the Guelph Family Health Study were included in the analyses. Parents reported levels of parenting distress, depressive symptoms, household chaos, and family functioning. The inflammatory potential of parents' and children's diets was quantified using the Dietary Inflammatory Index (DII^®), adjusted for total energy intake (i.e., the E-DII^TM). E-DII scores were regressed onto family stress using generalized estimating equations to account for shared variance among family clusters. Compared to those in homes with low chaos, parents in chaotic homes had significantly more proinflammatory dietary profiles (β = 0.973; 95% CI: 0.321, 1.624, p = 0.003). Similarly, compared to those in well-functioning families, parents in dysfunctional families had significantly more proinflammatory dietary profiles (β = 0.967; 95% CI: 0.173, 1.761, p = 0.02). No significant associations were found between parents' E-DII scores and parenting distress or depressive symptoms, nor were any associations found for children's E-DII scores. Results were not found to differ between males and females. Parents in chaotic or dysfunctional family environments may be at increased risk of chronic disease due to proinflammatory dietary profiles. Children's dietary inflammatory profiles were not directly associated with family stress; however, indirect connections through family food-related behaviours may exist. Future research should prioritize elucidating these mechanisms.

Measuring and Leveraging Motives and Values in Dietary Interventions

Why measure and leverage food motives and values? Every failure and every success in dietary change can be connected to motivation. Therefore, this research question naturally arises: How can food motives and values be measured and leveraged to improve diet outcomes from the individual to populations? There are four ways that food motives and values (FMVs) can assist researchers and health professionals. First, FMVs can help to create a personalized approach to dietary change. Second, FMVs can inform content for dietary interventions. Third, these FMV measures can be used in data analysis to elucidate differences in adherence and outcomes among participants. Fourth, public health nutrition messages can be tailored using information on FMVs. Each of these uses has the potential to further the literature and inform future efforts to improve diet. A central aim of our study is to provide specific examples and recommendations on how to measure and leverage FMVs. To do so, we reviewed 12 measures included in the literature citing the Food Choice Questionnaire by Steptoe, Pollard, and Wardle, which was identified as the earliest, highly cited article appearing under the search terms “food motives” AND “food values” AND “eating behavior” AND “measure”. Specific details on how articles were selected from the citing literature are described in the Methods section. We also expound on our reasoning for including the Three-Factor Eating Questionnaire, which made for 13 measures in total. Our main finding is that each measure has strengths and shortcomings to consider in using FMVs to inform nutritional recommendations at different levels.

Diet Quality Indices in the SUN Cohort: Observed Changes and Predictors of Changes in Scores Over a 10-Year Period

BACKGROUND

Dietary quality indices (DQI) are widely used in nutritional epidemiology. However, how they might change over time in a Mediterranean population is not well understood.

OBJECTIVE

To evaluate within-participant longitudinal changes in scores for nine a priori-defined DQIs: Fat Quality Index (FQI), Carbohydrate Quality Index (CQI), Pro-vegetarian Dietary Pattern (PVG), Mediterranean Diet Adherence Screener (MEDAS), Mediterranean Diet Score (MDS), Dietary Approaches to Stop Hypertension (DASH), Mediterranean-DASH Intervention for Neurodegenerative Delay Diet (MIND), Prime Diet Quality Score (PDQS) and Alternate Healthy Eating Index (AHEI-2010) in the "Seguimiento Universidad de Navarra" (SUN) cohort, a well-known Mediterranean cohort of university graduates, and to identify baseline predictors of improvement in MEDAS and AHEI-2010 after 10 years of follow-up.

DESIGN

In this longitudinal cohort study, DQI scores were calculated based on responses from a validated semiquantitative food-frequency questionnaire (FFQ).

PARTICIPANTS/SETTING

Spanish university graduates enrolled in the SUN cohort before March 2008, who completed the 10-year FFQ and reported total dietary intake at baseline and after 10 years of follow-up, included 2,244 men and 3,271 women, whose mean age at baseline was 36.3 years (standard deviation [SD], 10.7).

MAIN OUTCOME MEASURES

Main outcome measures were within-participant longitudinal changes for FQI, CQI, PVG, MEDAS, MDS, DASH, MIND, PDQS, and AHEI-2010.

STATISTICAL ANALYSES PERFORMED

Adjusted logistic regression models were used to evaluate within-participant longitudinal changes and to identify baseline predictors of improvements ≥10% in MEDAS and AHEI-2010 scores after 10 years of follow-up.

RESULTS

The comparison of the nine scores of DQI calculated at baseline and after 10 years of follow-up showed an improvement in all DQI scores except for PDQS. The greatest changes in DQIs were found for MEDAS (from 6.2 to 7.2, +22.9%) and MDS (from 4.3 to 4.4, +15.4%). The strongest predictors at baseline for ≥10% improvements in MEDAS or AHEI-2010 scores varied across indices. Being female, ≥35 years old, and more physically active at baseline were associated with improvement, whereas snacking between meals was associated with <10% improvements in both indices.

CONCLUSIONS

In this cohort, the changes in nine a priori-defined DQI scores suggested modest improvements in diet quality, in which MEDAS and MDS scores showed the largest improvements. Additional longitudinal studies, especially intervention trials with long follow-up, are warranted to establish the most appropriate DQIs to assess long-term changes in diet quality in adult populations.

The association of dietary patterns with dietary inflammatory index, systemic inflammation, and insulin resistance, in apparently healthy individuals with obesity

Inflammation is considered a key mechanism leading to obesity. Dietary patterns and certain food items influence inflammation. Few studies have investigated the contribution of major dietary patterns to biological measures of inflammation. Therefore, the present study aimed to examine the associations of different dietary patterns with dietary inflammatory index (DII), systemic inflammation, and insulin resistance (IR) in the apparently healthy obese. In this cross-sectional study, 151 abdominally obese subjects were recruited from the Northwest of Iran. Dietary intake, demographic data, anthropometric indices, and physical activity (PA) was assessed. DII scores were calculated based on a validated 168-item food frequency questionnaire (FFQ). Three dietary patterns were identified, using principal component analysis. Basal blood samples were collected to determine biochemical parameters. Linear regression test with adjusted beta estimates was applied for data analysis. Three dietary patterns were extracted as Healthy, Western, and Traditional. Body mass index (BMI) (p < 0.01) and fat mass (p < 0.001) were directly associated with the Western dietary pattern. Conversely, serum lipopolysaccharide-binding protein (LBP) (b = - 0.1, p < 0.04) was negatively associated with Healthy dietary pattern, after controlling for confounders. The Traditional pattern was found to be inversely related to DII (b = - 0.3, p < 0.001). The association was also reveresed between Traditional pattern and IR (Odds Ratio: 0.3 (95% Confidence Interval 0.1-0.9)). The results suggested that the Western dietary pattern was related to higher BMI and fat mass. In addition, the Healthy pattern was associated with decreased levels of LBP. Adherence to the Traditional dietary pattern was inversely related to DII as well as IR.

Low awareness of high sodium intake among older Chinese people

Awareness is one of the first steps in a lifestyle modification process. Since older adults are at a higher risk of hypertension, maintaining low sodium intake is of utmost importance. Yet, it is uncertain if older adults have an awareness of their sodium intake. This study aimed to explore self-perceived sodium intake among older Chinese people and compare it with various measures of sodium intake. A cross-sectional study was conducted in Hong Kong in 2015. Data were collected from 24-h urinary sodium excretion (UNa24) measurements, dietary sodium intake by 24-h diet recalls and self-perceived salt intake levels among the older Hong Kong population. Kappa statistics and a paired t-test were used to compare the different measures. Fifty-nine participants provided complete 24-h urine samples. The mean (±SD) UNa24 of participants was 2846 ± 1253 mg, of which 74.6% exceeded the recommended daily sodium intake. About 87.8% of participants with UNa24 values >2000 mg perceived their sodium intake as too little or just right. The kappa statistic between UNa24 and self-perception was insignificantly different from zero (κ = -0.003, p-value = 0.909). The UNa24 estimates were significantly higher than those estimated from the 24-h diet recalls by 1203 mg (p-value <0.001). The findings imply that the low awareness of excessive sodium intake should be raised among older people to promote a healthy intake of sodium.

Effectiveness of a Cancer Risk Prediction Tool on Lifestyle Habits: A Randomized Controlled Trial

BACKGROUND

Risk prediction models offer a promising approach to lifestyle modification. We evaluated the effect of personalized advice based on cancer risk prediction in improving five lifestyle habits (smoking, alcohol consumption, salt intake, physical activity, and body mass index) compared with standard advice without risk prediction among a Japanese general population with at least one unhealthy lifestyle habit.

METHODS

In a parallel-design, single-blind, randomized controlled trial between February 2018 and July 2019, 5984 participants aged 40-64 years with unhealthy lifestyle habits were recruited from persons covered under a life insurance policy. They were randomly assigned to an intervention or control group and received personalized or standard advice, respectively. They were also sent an invitation to participate in a lifestyle modification program aimed at improving lifestyle. Primary outcome was an improvement in lifestyle, defined as an increase in healthy lifestyle habits within 6 months.

RESULTS

The proportion of participants who improved their lifestyle within 6 months in the intervention group did not significantly differ from that in the control group (18.4% vs. 17.7%; P = 0.488). Among participants with low health literacy and two or fewer of five healthy habits, the proportion of participants subscribing to the lifestyle modification program was higher in the intervention group than in the control group.

CONCLUSIONS

Compared with standardized advice, personalized advice based on cancer risk prediction had no effect on improving lifestyle.

IMPACT

Provision of predicted cancer risk information did not induce change in unhealthy lifestyle.

Neural processing of the physical attractiveness stereotype: Ugliness is bad vs. beauty is good

The physical attractiveness stereotype (PAS) is characterized by the belief that beauty is good and ugliness is bad. Although the belief is not encouraged, people still express "beauty is good" explicitly. However, expressing that ugliness is bad is considered impolite in public. In this study, the neural underpinnings of PAS were investigated, particularly the comparison of the neural processing of ugliness is bad and beauty is good. During functional magnetic resonance imaging scanning, participants were asked to create trait-conformity judgments based on the facial attractiveness of the images. Our results showed that brain areas, including the fusiform, thalamus, anterior insula (AI), precuneus, inferior temporal gyrus, dorsal lateral prefrontal cortex (dlPFC), and dorsal medial prefrontal cortex (dmPFC) were involved in the processing of PAS. The left AI, left dlPFC, and right dmPFC showed stronger activation for ugliness is bad than for the converse. Moreover, we found a stronger connectivity between the left dlPFC and AI in terms of ugliness is bad than in the converse. Our study suggests that participants were unwilling to express the stereotype of ugliness is bad, and more mental resources were needed to control its expression than the expression of beauty is good.

Identifying the minimal important difference in patient-reported outcome measures in the field of people with severe mental illness: a pre-post-analysis of the Illness Management and Recovery Programme

Purpose

Complementary interventions for persons with severe mental illness (SMI) focus on both personal recovery and illness self-management. This paper aimed to identify the patient-reported outcome measures (PROMs) associated with the most relevant and meaningful change in persons with SMI who attended the Illness Management and Recovery Programme (IMR).

Methods

The effect of the IMR was measured with PROMs concerning recovery, illness self-management, burden of symptoms and quality of life (QoL). From the QoL measures, an anchor was chosen based on the most statistically significant correlations with the PROMs. Then, we estimated the minimal important difference (MID) for all PROMs using an anchor-based method supported by distribution-based methods. The PROM with the highest outcome for effect score divided by MID (the effect/MID index) was considered to be a measure of the most relevant and meaningful change.

Results

All PROMs showed significant pre–post-effects. The QoL measure ‘General Health Perception (Rand-GHP)’ was identified as the anchor. Based on the anchor method, the Mental Health Recovery Measure (MHRM) showed the highest effect/MID index, which was supported by the distribution-based methods. Because of the modifying gender covariate, we stratified the MID calculations. In most MIDs, the MHRM showed the highest effect/MID indexes.

Conclusion

Taking into account the low sample size and the gender covariate, we conclude that the MHRM was capable of showing the most relevant and meaningful change as a result of the IMR in persons with SMI.

Associations Between the Dietary Inflammatory Index, Brain Volume, Small Vessel Disease, and Global Cognitive Function

BACKGROUND

An inflammatory diet is related to poorer cognition, but the underlying brain pathways are unknown.

OBJECTIVE

The aim of this study was to examine associations between the Energy-Adjusted Dietary Inflammatory Index (E-DII) and brain volume, small vessel disease, and cognition in people with and without type 2 diabetes mellitus (T2DM).

DESIGN

This is a secondary cross-sectional analysis of data from the Cognition and Diabetes in Older Tasmanians study.

PARTICIPANTS/SETTINGS

This study included 641 participants (n = 326 with T2DM) enrolled between 2005 and 2011 from Tasmania, Australia.

MAIN OUTCOME MEASURES

The E-DII was computed from the 80-item Dietary Questionnaire for Epidemiological Studies, version 2. Brain volumes (gray matter, white matter, and white matter hyperintensities), infarcts, and microbleeds were obtained from magnetic resonance imaging. Global cognition was derived from a comprehensive battery of neuropsychological tests.

STATISTICAL ANALYSIS

Logistic and linear regressions were performed to examine associations between E-DII and brain measures and a global cognitive score, adjusting for demographics, energy, T2DM, mood, ambulatory activity, and cardiovascular risk factors. An E-DII × T2DM interaction term was tested in each model.

RESULTS

The mean (standard deviation) age of participants was 69.8 (7.4) years. There were no associations between the E-DII and any of the brain structural measures or global cognitive function in fully adjusted models. There was a modification effect for T2DM on the association between E-DII and gray matter volume (T2DM: β = 1.38, 95% CI -3.03 to 5.79; without T2DM: β = -4.34, 95% CI, -8.52 to -0.16), but not with any of the other outcome measures.

CONCLUSIONS

In this cross-sectional study, E-DII was not associated with brain structure or global cognition. In 1 of the 7 outcomes, a significant modification effect for T2DM was found for the associations between E-DII and gray matter. Future prospective studies are needed to clarify the associations between diet-related inflammation and brain health.

Weight Management Efforts, But Not Weight Perceptions, Are Associated with Dietary Quality among Youth and Young Adults in Canada

BACKGROUND

Efforts to lose, gain, or maintain weight are prevalent among youth and young adults, but little is known about the relationship between weight management efforts and dietary quality. Attempts to manage weight are typically driven by weight perceptions, which may also uniquely affect overall diet.

OBJECTIVE

The objective was to explore sex-stratified associations between weight management efforts and perceptions with dietary quality among youth and young adults.

DESIGN

Cross-sectional online survey data were drawn from Wave 1 (2016) of the Canada Food Study.

PARTICIPANTS/SETTING

Youth and young adults (n = 3,000), aged 16 to 30 years, were recruited from community settings in five Canadian cities and completed the online survey. The analytic sample consisted of 2,040 participants.

MAIN OUTCOME MEASURES

The Healthy Eating Index-2015 (HEI-2015) was used to characterize dietary quality among participants who completed a 24-hour recall. Respondents reported their weight change efforts over the past year and their weight perception.

STATISTICAL ANALYSES PERFORMED

Sex-stratified multiple linear regression analyses were conducted to investigate relationships between each of weight management efforts and perceptions, separately, and dietary quality, controlling for known covariates.

RESULTS

The HEI-2015 mean score was 52 of 100 possible points. Nearly one quarter of male and female respondents reported not trying to do anything about their weight, whereas 16% reported trying to maintain, 28% and 5% trying to gain, and 33% and 55% trying to lose weight, respectively. Most respondents (63% of males and 66% of females) perceived their weight as just about right. Among males, trying to gain or maintain weight were each significantly associated with higher HEI-2015 mean scores compared with not trying to manage weight (P < .01 and <.001, respectively), whereas this relationship existed only for weight maintenance among female respondents (P < .01). Weight perceptions and HEI-2015 mean scores were not significantly related.

CONCLUSIONS

Efforts to manage weight, which are commonplace among youth and young adults, are associated with dietary quality. Future behavioral research may provide insights into strategies used by youth to manage weight, guiding interventions that recognize links among weight-related behaviors, dietary quality, and other determinants of health.

The genetic architecture of the association between eating behaviors and obesity: combining genetic twin modeling and polygenic risk scores

BACKGROUND

Obesity susceptibility genes are highly expressed in the brain suggesting that they might exert their influence on body weight through eating-related behaviors.

OBJECTIVES

To examine whether the genetic susceptibility to obesity is mediated by eating behavior patterns.

METHODS

Participants were 3977 twins (33% monozygotic, 56% females), aged 31-37 y, from wave 5 of the FinnTwin16 study. They self-reported their height and weight, eating behaviors (15 items), diet quality, and self-measured their waist circumference (WC). For 1055 twins with genome-wide data, we constructed a polygenic risk score for BMI (PRSBMI) using almost 1 million single nucleotide polymorphisms. We used principal component analyses to identify eating behavior patterns, twin modeling to decompose correlations into genetic and environmental components, and structural equation modeling to test mediation models between the PRSBMI, eating behavior patterns, and obesity measures.

RESULTS

We identified 4 moderately heritable (h2 = 36-48%) eating behavior patterns labeled "snacking," "infrequent and unhealthy eating," "avoidant eating," and "emotional and external eating." The highest phenotypic correlation with obesity measures was found for the snacking behavior pattern (r = 0.35 for BMI and r = 0.32 for WC; P < 0.001 for both), largely due to genetic factors in common (bivariate h2 > 70%). The snacking behavior pattern partially mediated the association between the PRSBMI and obesity measures (βindirect = 0.06; 95% CI: 0.02, 0.09; P = 0.002 for BMI; and βindirect = 0.05; 95% CI: 0.02, 0.08; P = 0.003 for WC).

CONCLUSIONS

Eating behavior patterns share a common genetic liability with obesity measures and are moderately heritable. Genetic susceptibility to obesity can be partly mediated by an eating pattern characterized by frequent snacking. Obesity prevention efforts might therefore benefit from focusing on eating behavior change, particularly in genetically susceptible individuals.

Dietary Diversity Is Associated With Memory Status in Chinese Adults: A Prospective Study

BACKGROUND AND AIM

Subjective memory complaints are common in elderly people. Nutrition plays an important role in keeping brain health, however, the evidence on dietary diversity and subjective memory status is limited. This study aimed to investigate the effect of dietary diversity score (DDS) on memory status in Chinese adults in a prospective cohort study.

METHODS

Data of the China Health and Nutrition Survey was used in this study. A total of 4356 participants aged 50 years or older were enrolled in the analysis. DDS was calculated based on the dietary recall data collected in the wave of 2011. Information on self-report memory status (OK, good, or bad) and memory change in the past 12 months (stayed the same, improved, or deteriorated) were obtained from the wave of 2015. A memory score was calculated based on a subset of items of the Telephone Interview for Cognitive Status-modified. Multinomial logistic regression models were used to estimate the associations of DDS with memory status and memory change, and linear regression models were carried out to estimate the association between DDS and memory score.

RESULTS

In the study population, the percentages of participants who thought their memory was OK, bad, and good were 43.3, 24.3, and 32.4%, respectively. There were 1.4% of participants reported memory improvement in the past 12 months and 47.2% reported memory decline. Average memory score among participants was 12.8 ± 6.1. Compared with participants who thought their memory was OK, a higher DDS was associated with self-reported good memory (Odds Ratio [OR] 1.15, 95%CI 1.07-1.24) and inversely associated with bad memory (OR 0.82, 95%CI 0.75-0.89). In subgroup analysis, however, in participants aged 65 years and above, the association between DDS and self-reported good memory was insignificant (OR 1.09, 95%CI 0.94-1.25). Compared with participants whose memory stayed the same, higher DDS was inversely associated with memory decline (OR 0.85, 95%CI 0.80-0.91). Besides, higher DDS was associated with higher memory score (β 0.74, 95%CI 0.56-0.91).

CONCLUSION

This study revealed that higher DDS was associated with better memory status and was inversely associated with self-reported memory decline in Chinese adults.

Sleep quality and Dietary Inflammatory Index among university students: a cross-sectional study

PURPOSE

Evidence indicates that most college students face reduced sleep quality due to unhealthy dietary habits and hectic daily schedules. While the relationship between sleep quality and general health has been the subject of intensive research, little is known about the association between sleep and its relation with the inflammatory potential of the diet until recently. This study aimed to investigate the association between Energy-Adjusted Dietary Inflammatory Index (E-DII^®) scores and sleep quality in a group of students from the University of Sharjah (UOS).

METHODS

A cross-sectional study design was followed, and convenience sampling was used. Participants were assessed for sleep quality using the Pittsburgh Sleep Quality Index (PSQI), E-DII scores were derived from a semi-quantitative food frequency questionnaire (FFQ), and physical activity level was measured using the International Physical Activity Questionnaire (IPAQ). Chi-square tests and two-sample t tests were used to find an association between E-DII scores and sleep quality.

RESULTS

A total of 379 college students were included in the study of whom 64 % were female and 81% were between 18 and 21 years of age. Two-thirds of participants experienced poor sleep quality. Although results were trending in the hypothesized direction, no significant association was found between E-DII scores and sleep quality. Among the individual components of sleep quality, a direct significant association was found between E-DII scores and day dysfunction (P = 0.03).

CONCLUSIONS

These results suggest that a pro-inflammatory diet maybe related to increased day dysfunction among UOS students. Consuming a more anti-inflammatory diet may reduce daytime dysfunction. Further prospective and controlled studies are required to confirm this association, and to explore other attributes and their sequelae on sleep quality.

Inflammatory potential of the diet and risk of colorectal cancer in the European Prospective Investigation into Cancer and Nutrition study

Proinflammatory diets are associated with risk of developing colorectal cancer (CRC), however, inconsistencies exist in subsite- and sex-specific associations. The relationship between CRC and combined lifestyle-related factors that contribute toward a low-grade inflammatory profile has not yet been explored. We examined the association between the dietary inflammatory potential and an inflammatory profile and CRC risk in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. This cohort included 476,160 participants followed-up of 14 years and 5,991 incident CRC cases (3,897 colon and 2,094 rectal tumors). Dietary inflammatory potential was estimated using an Inflammatory Score of the Diet (ISD). An Inflammatory Profile Score (IPS) was constructed, incorporating the ISD, physical activity level and abdominal obesity. The associations between the ISD and CRC and IPS and CRC were assessed using multivariable regression models. More proinflammatory diets were related to a higher CRC risk, particularly for colon cancer; hazard ratio (HR) for highest versus lowest ISD quartile was 1.15 (95% confidence interval [CI] 1.04-1.27) for CRC, 1.24 (95% CI 1.09-1.41) for colon cancer and 0.99 (95% CI 0.83-1.17) for rectal cancer. Associations were more pronounced in men and not significant in women. The IPS was associated with CRC risk, particularly colon cancer among men; HRs for the highest versus lowest IPS was 1.62 (95% CI 1.31-2.01) for colon cancer overall and 2.11 (95% CI 1.50-2.97) for colon cancer in men. Our study shows that more proinflammatory diets and a more inflammatory profile are associated with higher risk of CRC, principally colon cancer and in men.

Long-term anti-inflammatory diet in relation to improved breast cancer prognosis: a prospective cohort study

Inflammation-modulating nutrients and inflammatory markers are established cancer risk factors, however, evidence regarding the association between post-diagnosis diet-associated inflammation and breast cancer survival is relatively sparse. We aimed to examine the association between post-diagnosis dietary inflammatory index (DII®) and risks of all-cause and breast cancer-specific mortality. A total of 1064 female breast cancer survivors in the Prostate, Lung, Colorectal, and Ovarian Cancer Screening (PLCO) Trial prospective cohort, were included in this analysis if they had completed the diet history questionnaire (DHQ). Energy-adjusted DII (E-DIITM) scores were calculated based on food and supplement intake. Cox regression and competing risk models were used to estimate multivariable-adjusted hazards ratios (HRs) and 95% confidence intervals (95% CIs) by E-DII tertile (T) for all-cause and breast cancer-specific mortality. With median follow-up of 14.6 years, there were 296 (27.8%) deaths from all causes and 100 (9.4%) breast cancer-specific death. The E-DII was associated with all-cause mortality (HR T3 vs T1, 1.34; 95% CI, 1.01-1.81; P trend, 0.049, Table 2) and breast cancer mortality (HR T3 vs T1, 1.47; 95% CI, 0.89-2.43; P trend, 0.13; multivariable-adjusted HR for 1-unit increment: 1.10; 95% CI: 1.00-1.22). Non-linear positive dose-response associations with mortality from all causes were identified for E-DII scores (P non-linearity < 0.05). The post-diagnosis E-DII was statistically significantly associated with mortality risk among breast cancer survivors. Long-term anti-inflammatory diet might be a means of improving survival of breast cancer survivors.

Is the public sweet on sugary beverages? Social desirability bias and sweetened beverage taxes

Social desirability bias has been documented in self-reported diet as well as in voting behavior, but not in regards to sweetened beverage consumption or sweetened beverage taxes. We find evidence that respondents in a mixed-mode opinion survey exhibit social desirability bias in both reported sweetened beverage consumption and beliefs about the health and economic benefits of sweetened beverage taxes. We do so in a study of 1704 adults residing in Seattle, Minneapolis, and the D.C. metro area. Phone respondents in our survey under-report sweetened beverage consumption by 0.63 beverages per week relative to web respondents (average web respondent consumption is 3.55 beverages per week). They also over-report their beliefs about the positive health and economic impacts of sweetened beverage taxes by 0.54 points in an 18-point index (average web respondent index score is 2.79). These differences are measured after we control for selection into survey mode by using matching methods, and we interpret them as occurring due to social desirability bias. In contrast to these findings, there is no modal difference in respondents' stated approval of sweetened beverage taxes, and so we conclude that this question is not subject to social desirability bias.

Food Insecurity Is Associated with Increased Risk of Obesity in US College Students

BACKGROUND

Food insecurity affects millions of Americans and college students are especially vulnerable. Little is known about the relation of food insecurity with weight status and dietary intake during this critical phase of emerging adulthood.

OBJECTIVES

We aimed to examine the sex-specific associations of food insecurity with obesity and dietary intake among college students. The study also explored these associations by meal plan (MP) enrollment.

METHODS

This cross-sectional study included 683 second-year students at 8 universities in the United States. Food security status and dietary intake were assessed using the USDA Adult Food Security Survey and the Dietary Screener Questionnaire, respectively. On-site anthropometrics were measured by researchers.

RESULTS

The prevalence of food insecurity at the universities ranged from 19.0% to 34.1% with a mean of 25.4% for the entire sample. Compared with high food security, marginal food security and food insecurity were associated with 3.16 (95% CI: 1.55, 6.46) and 5.13 (95% CI: 2.63, 10.00) times increased odds of obesity, respectively, exhibiting a dose-response relation. Food insecurity remained a significant predictor of obesity among both sexes after adjusting for sociodemographic variables. Food-insecure (FI) students had a significantly lower intake of fruits and vegetables and higher intake of added sugars than food-secure (FS) students. Obesity rate and added sugars consumption were higher among FI students with MPs than among FI students lacking MPs and FS students regardless of MP status. Among students with MPs, FS students had a higher intake of fruits and vegetables than FI students.

CONCLUSIONS

Food insecurity was associated with obesity and poor dietary intake among both sexes. Although MP subsidies may be a reasoned approach to combat food insecurity, it should be coupled with efforts to assist students in making healthy food choices.Registered at clinicaltrials.gov as NCT02941497.

Diet Quality Is Associated with Cardiometabolic Outcomes in Survivors of Childhood Leukemia

There is little information about how diet influences the health of childhood acute lymphoblastic leukemia (cALL) survivors. This study explores the associations between diet quality indices, cardiometabolic health indicators and inflammatory biomarkers among cALL survivors. Participants were part of the PETALE study (n = 241, median age: 21.7 years). Adherence to 6 dietary scores and caloric intake from ultra-processed foods were calculated. Multivariate logistirac regressions, Student t-tests and Mann-Whitney tests were performed. We found that 88% of adults and 46% of children adhered poorly to the Mediterranean diet, 36.9% had poor adherence to the World Health Organisation (WHO) recommendations and 76.3% had a diet to be improved according to the HEI-2015 score. On average, ultra-processed foods accounted for 51% of total energy intake. Low HDL-C was associated with a more inflammatory diet (E-DIITM score) and higher intake of ultra-processed foods. A greater E-DII score was associated with elevated insulin resistance (HOMA-IR), and consumption of ultra-processed foods was correlated with high triglycerides. Circulating levels of TNF-α, adiponectin and IL-6 were influenced by diet quality indices, while CRP and leptin were not. In conclusion, survivors of cALL have poor adherence to dietary recommendations, adversely affecting their cardiometabolic health.

Association between Dietary Inflammatory Index (DII®) and depression and anxiety in the Mashhad Stroke and Heart Atherosclerotic Disorder (MASHAD) Study population

BACKGROUND

Systemic inflammation is emerging as an important factor in the etiology of psychiatric disorders such as depression and anxiety. Therefore, the inflammatory potential of the diet may also be an etiological factor for these conditions, and this may be estimated by calculating the dietary inflammatory index (DII®) score. We aimed to investigate the association between DII score and incidence of depression and anxiety among a representative sample in northeastern Iran.

METHODS

This cross-sectional study undertook in a sub-sample of 7083 adults aged 35 to 65 years recruited as part of Mashhad stroke and heart atherosclerotic disorder (MASHAD) cohort study population, and after excluding subjects with incomplete data. All participants completed the Beck Anxiety Inventory (BAI), the Beck Depression Inventory II (BDI-II), and a validated 65-item food frequency questionnaire (FFQ). Logistic regression was used to evaluate the association between DII score and depression/anxiety score.

RESULTS

Of the study participants, 37.1% (n = 2631) were found to have mild to severe depression, and 50.5% (n = 3580) were affected by mild to severe anxiety. After adjusting for confounding factors, in women, the third (OR: 1.41, 95% CI: 1.06-1.88, p-values< 0.05) and fourth quartiles (OR: 1.37, 95% CI: 1.03-1.83, p-values< 0.05) of DII score were associated with increased risk of a high depression score compared to the first quartile of DII score.

CONCLUSION

There was a significant association between DII score and severe depression among women but not men in this Iranian population. In order to confirm the association between DII food score, depression, and anxiety, further research is required in different populations, and perhaps an intervention study.

The Effectiveness of Teaching Clinical Empathy to Medical Students: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

PURPOSE

Clinical empathy is a necessary trait to provide effective patient care, despite differences in how it is defined and constructed. The aim of this study was to examine whether empathy interventions in medical students are effective and how confounding factors potentially moderate this effect.

METHOD

The authors performed a systematic review and meta-analysis. They searched the literature published between 1948 and 2018 for randomized controlled trials that examined empathy interventions in medical students. The search (database searching, citation tracking, hand-searching relevant journals) yielded 380 studies, which they culled to 16 that met the inclusion criteria. For the meta-analysis, they used a random effects model to produce a pooled estimate of the standardized mean difference (SMD), then completed subgroup analyses.

RESULTS

The authors found evidence of the possibility of response and reporting bias. The pooled SMD was 0.68 (95% confidence interval 0.43, 0.93), indicating a moderately positive effect of students developing empathy after an intervention compared with those in the control groups. There was no evidence of publication bias, but heterogeneity was significantly high (I = 88.5%, P < .01). Subgroup analyses indicated that significant moderating factors for developing empathy were age, country, scope of empathy measurement, type of empathy intervention, and presence of rehearsal. Moderating factors with limited evidence were sex, study quality, journal impact factor, and intervention characteristics.

CONCLUSIONS

Despite heterogeneity and biases, empathy interventions in medical students are effective. These findings reinforce arguments in the literature and add considerable rigor from the meta-analysis. The authors propose a conceptual model for educators to follow when designing empathy interventions in medical students.

Preoccupation with Body Weight and Under-Reporting of Energy Intake in Female Japanese Nutrition Students

The present study aimed to examine associations between body image and under-reporting in female Japanese university students enrolled in a nutrition degree program. A total of 100 participants (aged 18-29 years) completed (1) a self-administered questionnaire including the Ben-Tovim Walker Body Attitudes Questionnaire (BAQ), (2) a dietary assessment using a brief-type self-administered diet history questionnaire (BDHQ), (3) a physical activity assessment using Bouchard's Physical Activity Record (BAR) and a tri-axial accelerometer, (4) detailed anthropometry, and (5) body composition assessment. Based on the energy intake to basal metabolic rate ratio (EI:BMR) and using a cut-off point of 1.35, 67% of participants were considered under-reporters (URs). While there was no between-group difference in BMI, URs had significantly (p < 0.05) greater percentage body fat (%BF) and trunk fat (%TF) compared with non-URs. Regression analyses indicated accuracy of body perception and a discrepancy between current and ideal weight were associated with EI:BMR, whereas the salience subscale of the BAQ was associated with reported EI. The study raises concerns regarding the validity of EI reported from young Japanese females as they are known to have a strong preoccupation with thinness, even with an acceptable BMI and health and nutritional knowledge.

A Social Desirability Item Response Theory Model: Retrieve-Deceive-Transfer

In this study, a new item response theory model is developed to account for situations in which respondents overreport or underreport their actual opinions on a positive or negative issue. Such behavior is supposed to be a result of deception and transfer mechanisms. In the proposed model, this behavior is simulated by incorporating a deception term into a multidimensional rating scale model, followed by multiplication by a transfer term, with the two operations performed by an indicator function and a transition matrix separately. The proposed model is presented in a Bayesian framework approximated by Markov chain Monte Carlo algorithms. Through a series of simulations, the parameters of the proposed model are recovered accurately. The methodology is also implemented within an online experimental study to demonstrate the methodology's application.

Intergenerational associations of dietary inflammatory index with birth outcomes and weight status at age 5 and 9: Results from the Lifeways cross-generation cohort study

BACKGROUND

Maternal diet and chronic inflammation may influence early-life offspring health. No comparative data regarding intergenerational associations between dietary inflammation and offspring growth exist.

OBJECTIVE

To investigate potential associations between parental and grandparental dietary inflammatory index (DII®) scores with offspring birth outcomes and childhood adiposity.

METHODS

This analysis of the Lifeways Study includes 1082 mother-child pairs, 333 index-child's fathers and 707 grandparents. Energy-adjusted DII (E-DII) scores were derived from a validated FFQ for all adults. Birth outcomes were abstracted from hospital records. Childhood BMI was determined at age 5 and 9. Logistic regression and mediation analyses using the PROCESS macro for SPSS were performed.

RESULTS

Higher maternal E-DII scores, reflecting a more pro-inflammatory diet, were associated with increased risk of low birthweight (LBW), BW < 2500 g (OR:1.20, 95%CI:1.02-1.47, p = 0.03). Higher maternal grandmothers' (MGM) E-DII scores were associated with increased risk of macrosomia (OR:1.35, 95% CI:1.02-1.79, p = 0.03) and with increased risk of an overweight grandchild at age 9 (OR:1.47, 95% CI:1.26-1.72, p = 0.02). Results from the mediation analyses revealed a significant total effect between MGMs' E-DII scores and grandchild's BW. Higher father's and paternal grandmothers' (PGM) E-DII scores were associated with greater risk of childhood overweight/obesity at 5 years (OR:1.03, 95%CI:1.01-1.19, p = 0.04 and OR:1.07, 95%CI:1.05-1.09, p = 0.01, respectively). The association with the PGMs' E-DII persisted at age 9 (OR:1.13, 95%CI:1.01-1.90, p = 0.04).

CONCLUSIONS

Dietary inflammation is associated with adverse offspring birth outcomes and childhood adiposity. A more pro-inflammatory maternal line diet appears to influence early-life growth, whereas paternal line dietary inflammation appears to influence childhood obesity.

Diet quality, dietary inflammatory index and body mass index as predictors of response to adjunctive N-acetylcysteine and mitochondrial agents in adults with bipolar disorder: A sub-study of a randomised placebo-controlled trial

AIMS

We aimed to explore the relationships between diet quality, dietary inflammatory potential or body mass index and outcomes of a clinical trial of nutraceutical treatment for bipolar depression.

METHODS

This is a sub-study of a randomised controlled trial of participants with bipolar depression who provided dietary intake data (n = 133). Participants received 16 weeks adjunctive treatment of either placebo or N-acetylcysteine-alone or a combination of mitochondrial-enhancing nutraceuticals including N-acetylcysteine (combination treatment). Participants were followed up 4 weeks post-treatment discontinuation (Week 20). Diet was assessed by the Cancer Council Victoria Dietary Questionnaire for Epidemiological Studies, Version 2, converted into an Australian Recommended Food Score to measure diet quality, and energy-adjusted dietary inflammatory index score to measure inflammatory potential of diet. Body mass index was also measured. Generalised estimating equation models were used to assess whether diet quality, energy-adjusted dietary inflammatory index score and/or body mass index were predictors of response to significant outcomes of the primary trial: depression symptoms, clinician-rated improvement and functioning measures.

RESULTS

In participants taking combination treatment compared to placebo, change in depression scores was not predicted by Australian Recommended Food Score, dietary inflammatory index or body mass index scores. However, participants with better diet quality (Australian Recommended Food Score) reported reduced general depression and bipolar depression symptoms (p = 0.01 and p = 0.03, respectively) and greater clinician-rated improvement (p = 0.02) irrespective of treatment and time. Participants who had a more anti-inflammatory dietary inflammatory index had less impairment in functioning (p = 0.01). Combination treatment may attenuate the adverse effects of pro-inflammatory diet (p = 0.03) on functioning. Participants with lower body mass index who received combination treatment (p = 0.02) or N-acetylcysteine (p = 0.02) showed greater clinician-rated improvement.

CONCLUSION

These data support a possible association between diet (quality and inflammatory potential), body mass index and response to treatment for bipolar depression in the context of a nutraceutical trial. The results should be interpreted cautiously because of limitations, including numerous null findings, modest sample size and being secondary analyses.

Gut microbiota plasticity is correlated with sustained weight loss on a low-carb or low-fat dietary intervention

While low-carbohydrate and low-fat diets can both lead to weight-loss, a substantial variability in achieved long-term outcomes exists among obese but otherwise healthy adults. We examined the hypothesis that structural differences in the gut microbiota explain a portion of variability in weight-loss using two cohorts of obese adults enrolled in the Diet Intervention Examining The Factors Interacting with Treatment Success (DIETFITS) study. A total of 161 pre-diet fecal samples were sequenced from a discovery cohort (n = 66) and 106 from a validation cohort (n = 56). An additional 157 fecal samples were sequenced from the discovery cohort after 10 weeks of dietary intervention. We found no specific bacterial signatures associated with weight loss that were consistent across both cohorts. However, the gut microbiota plasticity (i.e. variability), was correlated with long-term (12-month) weight loss in a diet-dependent manner; on the low-fat diet subjects with higher pre-diet daily plasticity had higher sustained weight loss, whereas on the low-carbohydrate diet those with higher plasticity over 10 weeks of dieting had higher 12-month weight loss. Our findings suggest the potential importance of gut microbiota plasticity for sustained weight-loss. We highlight the advantages of evaluating kinetic trends and assessing reproducibility in studies of the gut microbiota.

Impact of a 3-Month Anti-inflammatory Dietary Intervention Focusing on Watermelon on Body Habitus, Inflammation, and Metabolic Markers: A Pilot Study

An anti-inflammatory dietary intervention called the Inflammation Management Intervention (IMAGINE) was adapted to emphasize watermelon due to its anti-inflammatory properties. This pilot study (n = 23) tested the effect of a watermelon-enhanced IMAGINE intervention (n = 15) on body habitus and markers of inflammation and metabolism. This 3-month self-selection trial, consisting of weekly in-person classes and online education for 12 weeks, focused on incorporating watermelon into an already anti-inflammatory diet. Controls (n = 8) received basic health education via email and blogs. Measurements, including diet, anthropometrics, actigraphy, and a blood draw, were made at baseline and immediately postintervention. Linear regression analyses were conducted using intervention status as the main exposure. Post hoc analyses then ignored intervention assignment and grouped participants based on their change in their energy-adjusted Dietary Inflammatory Index (E-DIITM) score. There were no group-by-time interactions for any of the studied outcomes. However, some intervention participants' diets became more proinflammatory, and several control participants' diets became more anti-inflammatory. Those participants below the median of E-DII change (ie, more anti-inflammatory changes) showed reductions in body fat percent (-1.27% vs +0.90%, respectively, P = .01), body mass index (-0.66 vs +0.38 kg/m2, respectively, P = .06) and body weight (-0.99 vs +0.54 kg, respectively, P = .08) compared to those above the median of E-DII change. This study demonstrates that individuals who adopt a more anti-inflammatory diet containing watermelon will have improvements in body anthropometrics. Future studies should focus on increasing adherence and compliance to intervention prescriptions, exploring options to extend interventions to evaluate long-term changes, and further examining changes in inflammatory biomarkers. Clinical Trials Registration: NCT03158740.

Serum carotenoids are strongly associated with dermal carotenoids but not self-reported fruit and vegetable intake among overweight and obese women

Background

Accurate assessment of fruit and vegetable intake (FVI) is essential for public health nutrition research and surveillance. Blood carotenoid concentrations are robust biomarkers of FVI, but collecting blood samples typically is not feasible in population-based studies. Understanding how well non-invasive measures compare to blood estimates is important for advancing surveillance and evaluation. The objective of this study was to examine the associations between serum carotenoids and four non-invasive measures of FVI in overweight and obese women.

Methods

This study utilized baseline data from 157 overweight or obese women (95.5% white, mean age 58.56 years ± 9.49 years) enrolled in the Strong Hearts, Healthy Communities randomized trial, including two direct measures of carotenoids and three self-reported measures of FVI. Participants completed a fasting blood draw, dermal carotenoid scans using resonance Raman spectroscopy (RRS), a two-item FVI screener modeled after the American Heart Association’s Life’s Simple 7 “My Life Check” tool (modified AHA tool), the National Cancer Institute’s All-Day Fruit and Vegetable Screener (FVS), multiple 24-h dietary recalls, physical measurements, and demographic and health behavior questions. We analyzed blood for total carotenoids and derived total FVI estimates from self-report tools. We used multivariate linear regression models to examine associations between each non-invasive tool and serum carotenoids under four scenarios analogous to different research contexts in which varying breadths of participant data are available. We also calculated adjusted Pearson’s correlations between serum carotenoids, dermal carotenoids, and the self-reported measures.

Results

Dermal carotenoids were strongly correlated with serum carotenoids (0.71, P < 0.00067) and associated with serum carotenoids in all regression models (0.42–0.43, P < 0.002). None of the self-reported FVI measures were significantly associated with serum or dermal carotenoids in adjusted regression models or correlation analyses.

Conclusions

Compared to self-reported FVI, we found dermal carotenoids measured by RRS to be a superior method to approximate serum carotenoids among overweight and obese women. More research is needed to investigate these assessment methods in diverse populations.

Trial registration

ClinicalTrials.gov Identifier: NCT02499731, registered July 16, 2015.

Dietary Fat and the Genetic Risk of Type 2 Diabetes

PURPOSE OF REVIEW

We review recent evidence of the relationship between dietary fat intake and risk of type 2 diabetes (T2D), the role of epigenetic alterations as a mediator of this relationship, and the impact of gene-dietary fat interactions in the development of the disease. Based on the observations made, we will discuss whether there is evidence to support genetic personalization of fat intake recommendations in T2D prevention.

RECENT FINDINGS

Strong evidence suggests that polyunsaturated fatty acids (PUFA) have a protective effect on T2D risk, whereas the roles of saturated and monounsaturated fatty acids (SFA and MUFA) remain unclear. Diets enriched with PUFA vs SFA lead to distinct epigenetic alterations that may mediate their effects on T2D risk by changing gene function. However, it is not currently known which of the epigenetic alterations, if any, are causal for T2D. The current literature shows no replicated evidence of genetic variants modifying the effect of dietary fat intake on T2D risk. There is consistent evidence of a protective role of PUFA in T2D prevention. No evidence supports genetic personalization of dietary recommendations in T2D prevention.

Does the inflammatory potential of diet affect disease activity in patients with inflammatory bowel disease?

Background

Diet is an important modulator of inflammation, which is associated with inflammatory bowel disease (IBD). In this study, we examined whether the inflammatory properties of diets are associated with disease activity in patients with IBD.

Methods

A cross-sectional study was conducted on 143 IBD patients, including 32 patients with Crohn’s disease (CD) and 111 patients with ulcerative colitis (UC). Dietary intakes were assessed by a valid 168-item food frequency questionnaire (FFQ). The inflammatory potential of the diet was assessed by calculating the two scores of Dietary Inflammatory Index (DII®), and the Empirical Dietary Inflammatory Pattern (EDIP), and CD and UC disease activity were determined by the Crohn’s disease activity index (CDAI) and the Mayo score, respectively. Associations of the inflammatory indices as median and as tertiles with disease activity were analyzed using logistic regression in a univariate model and after adjusting for total energy intake (continuous), type of disease (CD and UC) and drug consumption (no drugs, single drug, and multiple drugs).

Results

Sixty-four IBD patients (44.8%) in this study had active disease.The DII® score and the EDIP did not differ significantly between active and inactive patients (− 1.45 ± 1.04 vs.− 1.20 ± 1.24; 0.56 ± 0.22 vs. 0.53 ± 0.28, respectively). After adjusting for energy intake, drug use, and IBD type, the odds (95%CIs) of active disease among patients in tertile 3 compared to those in tertile 1 were 0.84 (0.32–2.17) for DII and 1.50 (0.61–3.72) for EDIP; neither of which were statistically significantly different from the rates in tertile 1.

Conclusions

Although point estimates were in the expected direction of increased risk, the inflammatory potential of diet, assessed using DII or EDIP, was not associated with severity of disease in IBD patients. Whether diet-related inflammation affects disease activity in patients with IBD deserves further investigations.

Association between inflammatory potential of diet and odds of gestational diabetes mellitus among Iranian women

Background: The possible relationship between diet-related inflammation and the risk of gestational diabetes mellitus (GDM) requires further investigation, especially in non-Western populations. We examined the association between dietary inflammatory index (DII) scores and GDM in a case-control study conducted in Iran. Methods: This study included 122 GDM cases and 266 controls hospitalized for acute non-neoplastic diseases. Cases were pregnant women aged 18-40 years, who visited major general hospitals in different regions of Tehran. Pregnant women were screened for gestational diabetes between the 24th and 28th week of gestation with a 50-g, 1-hour glucose challenge test (GCT). Cases were diagnosed positive for GDM. Controls were pregnant women who had normal GCT test. DII scores were computed from dietary intake assessed by a previously validated 147-item food frequency questionnaire. Logistic regression models adjusted age, gestational age, energy, exercise, BMI, smoking exposure, family history of diabetes, and history of multivitamin intake were used to estimate odds ratios (ORs) and 95% confidence intervals (CI). Results: Subjects with higher DII scores (i.e. indicating a more proinflammatory diet) had a higher odd of GDM with the DII being used as both a continuous (OR = 1.20; 95% CI = 0.94-1.54) and as categorical (ORtertile 3vs1 = 2.10; 95% CI = 1.02-4.34, p-trend = .03). Conclusions: These results indicate that a proinflammatory diet, as evidenced by higher DII scores, is associated with increased odds of GDM among Iranian women.

Childhood obesity intervention studies: A narrative review and guide for investigators, authors, editors, reviewers, journalists, and readers to guard against exaggerated effectiveness claims

Being able to draw accurate conclusions from childhood obesity trials is important to make advances in reversing the obesity epidemic. However, obesity research sometimes is not conducted or reported to appropriate scientific standards. To constructively draw attention to this issue, we present 10 errors that are commonly committed, illustrate each error with examples from the childhood obesity literature, and follow with suggestions on how to avoid these errors. These errors are as follows: using self-reported outcomes and teaching to the test; foregoing control groups and risking regression to the mean creating differences over time; changing the goal posts; ignoring clustering in studies that randomize groups of children; following the forking paths, subsetting, p-hacking, and data dredging; basing conclusions on tests for significant differences from baseline; equating "no statistically significant difference" with "equally effective"; ignoring intervention study results in favor of observational analyses; using one-sided testing for statistical significance; and stating that effects are clinically significant even though they are not statistically significant. We hope that compiling these errors in one article will serve as the beginning of a checklist to support fidelity in conducting, analyzing, and reporting childhood obesity research.

Development of a Food-Based Diet Quality Score from a Short FFQ and Associations with Obesity Measures, Eating Styles and Nutrient Intakes in Finnish Twins

We constructed a food-based diet quality score (DQS) and examined its association with obesity measures, eating styles and nutrient intakes. Participants were 3592 individuals (764 dizygotic [DZ] and 430 monozygotic [MZ] twin pairs) from the FinnTwin16 study. The DQS (0–12 points) was constructed from a short 14 item food frequency questionnaire. Anthropometric measures and eating styles were self-reported. Nutrient intakes were calculated from food diaries completed in a subsample of 249 individuals (45 same-sex DZ and 60 MZ twin pairs). Twins were analyzed both as individuals and as twin pairs. The DQS was inversely associated with body mass index (β = −0.12, per one-unit increase in DQS, p < 0.001), waist circumference (β = −0.34, p < 0.001), obesity (odds ratio [OR]: 0.95, p = 0.004) and abdominal obesity (OR: 0.88, p < 0.001), independent of sex, age, physical activity and education. A higher DQS was associated with health-conscious eating, having breakfast, less snacking, fewer evening meals, and a higher frequency and regularity of eating. The DQS was positively correlated with the intakes of protein, fiber and magnesium and negatively correlated with the intakes of total fat, saturated fat and sucrose. Within twin pairs, most of the associations between the DQS with eating styles and some nutrients remained, but the DQS was not associated with obesity measures within twin pairs. The DQS is an easy-to-use tool for ranking adults according to diet quality and shows an association with obesity measures, eating styles and key nutrients in the expected direction.

The FTO genetic variants are associated with dietary intake and body mass index amongst Emirati population

BACKGROUND

The risk of obesity is determined by complex interactions between genetic and environmental factors. Little research to date has investigated the interaction between gene and food intake. The aim of the current study is to explore the potential effect of fat mass and obesity-associated protein gene (FTO) rs9939609 and rs9930506 single nucleotide polymorphism (SNP) on the pattern of food intake in the Emirati population.

METHODS

Adult healthy Emirati subjects with Body mass index (BMI) of 16-40 kg/m2 were included in the study. Genotyping for FTO rs9939609(A>T) and rs9930506(A>G) was performed using DNA from saliva samples. Subjects were categorized according to the WHO classification by calculating the BMI to compare different classes. Dietary intake was assessed by a sixty-one-item FFQ that estimated food and beverage intakes over the past year. The daily energy, macronutrient, and micronutrient consumption were computed.

RESULTS

We included 169 subjects in the final analysis (mean age 30.49± 9.1years, 57.4% females). The mean BMI of the study population was 26.19 kg/m2. Both SNPs were in Hardy Weinberg Equilibrium. The rs9939609 AA genotype was significantly associated with higher BMI (p = 0.004); the effect was significant in females (p = 0.028), but not in males (p = 0.184). Carbohydrate intake was significantly higher in AA subjects with a trend of lower fat intake compared to other genotypes. The odds ratio for the AA was 3.78 in the fourth quartile and 2.67 for the A/T in the second quartile of total carbohydrate intake, considering the first quartile as a reference (95% CI = 1.017-14.1 and 1.03-6.88, respectively). Fat intake was significantly lower in the FTO rs9930506 GG subjects. The presence of FTO rs9930506 GG genotype decreased the fat intake in subjects with FTO rs9939609 AA (p = 0.037).

CONCLUSIONS

The results of this study highlight the interaction of the FTO risk alleles on the food intake in Emirati subjects. The FTO rs9939609 AA subjects had higher carbohydrate and lower fat intake. The latter was accentuated in presence of rs9930506 GG genotype.

Who are we testing? Self-selection bias in laboratory-based eating behaviour studies

Research conducted in controlled laboratory settings plays an important role in understanding human eating behaviour. However, participant characteristics may affect motivation to participate in laboratory eating behaviour research and result in self-selection biases. First-year psychology students (n = 207, 90.8% female, m age = 18.8, m BMI = 21.9) were led to believe that they were choosing between enrolling in one of two laboratory-based studies: an 'advertising' study, or an 'advertising and food' study; the latter specified that participants would consume food and answer questions about their eating behaviour. Participants subsequently reported demographic information and completed a series of questionnaires assessing psychological characteristics hypothesised to predict self-selection in laboratory eating studies. The majority of participants preferred to participate in a study unrelated to eating over an eating-related study (70.5%, χ² (1) = 34.90, p < .001). Participants choosing the eating-related study over the non-eating study had higher self-reported external eating tendencies and positive preoccupations with food, lower negative preoccupations with food and social appearance anxiety. Participants choosing the eating related study were also more likely to be male than female, although the number of males in the study was small (n = 19) and this finding should therefore be interpreted with caution. The present study provides some evidence that in university based samples of participants there are likely self-selection biases in laboratory-based eating behaviour studies and researchers may benefit from considering the potential influence of self-selection biases when conducting eating behaviour research.

Secular trends in Dietary Inflammatory Index among adults in the United States, 1999-2014

OBJECTIVE

The objective of this study was to evaluate secular trends in Dietary Inflammatory Index (DII) scores in the United States between 1999 and 2014.

METHODS

Data from adults over 19 years from the 1999 to 2014 National Health and Nutrition Examination Survey (N = 39,191) were used. DII scores, at each 2-year cycle, were evaluated from a 24-h recall, including 26 food parameters for DII calculation. Analyses were conducted in 2018.

RESULTS

For the entire sample, there was a quadratic trend (Ptrend < 0.001), with the DII scores peaking in 2003-2004, and then decreasing during the cycles from 2005 to 2014. Similar quadratic trends (Ptrend < 0.001) were observed by age, gender, race-ethnicity, and education.

CONCLUSION

Males, non-Hispanic Blacks, younger adults, and those with less education adults had the highest DII scores (i.e., indicating the greatest inflammatory potential). The overall DII scores of the US population showed a quadratic trend from 1999 to 2014. Continued monitoring of DII changes is needed to better understand changes in the inflammatory potential of diet of American adults, and how they relate to changes in the risk of chronic disease.

Dietary Inflammatory Index and Risk of Breast Cancer Based on Hormone Receptor Status: A Case-Control Study in Korea

Breast cancer is the most common cancer in women globally, and the risk of developing breast cancer is associated with inflammation. The present study aimed to examine the association between the Dietary Inflammatory Index (DII^®) and breast cancer in Korean women and investigate whether the tumor’s hormone receptor status affects this association. In this case-control study, we enrolled 364 breast cancer patients and 364 age-matched controls. DII scores were calculated from dietary intake evaluated by a 106-item food frequency questionnaire. The DII score was significantly higher in cases than in controls. After adjusting for potential confounders, the odds ratio (OR) of breast cancer was higher in the highest DII tertile (OR = 3.68, 95% confidence interval (CI): 2.34–5.80, p for trend < 0.0001) than in the lowest tertile. We found that higher DII scores were related to an increased risk of breast cancer for estrogen receptor (ER)+/progesterone receptor (PR)+ tumors regardless of menopausal status (OR = 2.59, 95% CI: 1.37–4.88 in the highest DII category, p for trend = 0.01 for premenopausal women; OR = 11.00, 95% CI: 2.93–41.30 in the highest DII category, p for trend = 0.0004 for postmenopausal women), but not for ER−/PR− status. Our results suggested that the DII scores are positively associated with breast cancer risk in Korean women and that this relationship is more robust in ER+/PR+ tumors.