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

The effect of dietary counselling on food intakes in pregnant women at risk for gestational diabetes: a secondary analysis of a randomised controlled trial RADIEL

BACKGROUND/OBJECTIVES

The prevalence of gestational diabetes mellitus (GDM) is increasing worldwide. GDM may be prevented by improving the diets of pregnant women. The objective of this study was to evaluate the effect of dietary counselling on the diets of pregnant women at GDM risk.

SUBJECTS/METHODS

This study was a secondary analysis of a randomised controlled trial the Finnish gestational diabetes prevention study (RADIEL) in which pre-pregnant and pregnant women with previous GDM or BMI ⩾30 kg/m(2) were allocated into two groups, namely the control and the intervention groups. The control group received standard antenatal dietary counselling according to the Finnish Nutrition Recommendations. The intervention group participated in one individual dietary counselling session and one group dietary counselling session in addition to the standard counselling. This study included women who were recruited during pregnancy. To assess changes in food intake, food-intake questionnaires were collected during the first and the second trimester of pregnancy. Bootstrap type analysis of covariance was used, and 242 participants were included in the final analysis to study changes in food intake.

RESULTS

The intakes of low-fat cheese (baseline adjusted mean 0.09 times/day; 95% confidence interval (CI) 0.07, 0.24; P=0.040) and fish (baseline adjusted mean 0.28 times per week; 95% CI 0.08, 0.49; P=0.011) showed a significant increase in the intervention group compared with the control group.

CONCLUSIONS

This study showed that dietary counselling in early pregnancy can lead to modest dietary improvements in pregnant women at GDM risk.

Comparing dietary macronutrient composition and food sources between native and diasporic Ghanaian adults

BACKGROUND

Dietary acculturation may contribute to the increased burden of non-communicable diseases (NCDs) in diasporic populations of African ancestry.

OBJECTIVE

To assess nutritional composition and the contribution that traditional foods make to the diets of native and UK-dwelling Ghanaian adults.

DESIGN

An observational study of Ghanaian adults living in Accra (n=26) and London (n=57) was undertaken. Three-day food records were translated to nutrient data using culturally sensitive methods and comparisons were made for energy, macronutrients, and dietary fibre between cohorts. The contribution of traditional foods to dietary intake was measured and the foods contributing to each nutrient were identified.

RESULTS

Compared to native Ghanaians, UK-Ghanaians derived a significantly higher proportion of energy from protein (16.9±3.9 vs. 14.1±2.8%, p=0.001), fat (29.9±7.9 vs. 24.4±8.5%, p=0.005), and saturated fat (8.5±3.4 vs. 5.8±3.7%, p<0.001) and a significantly lower energy from carbohydrate (52.2±7.7 vs. 61.5±9.3%, p<0.001). Dietary fibre intake was significantly higher in the UK-Ghanaian diet compared to the native Ghanaian diet (8.3±3.1 vs. 6.7±2.2 g/1,000 kcal, p=0.007). There was significantly less energy, macronutrients, and fibre derived from traditional foods post-migration. Non-traditional foods including breakfast cereals, wholemeal bread, and processed meats made a greater contribution to nutrient intake post-migration.

CONCLUSIONS

Our findings show the migrant Ghanaian diet is characterised by significantly higher intakes of fat, saturated fat, and protein and significantly lower intakes of carbohydrate; a macronutrient profile which may promote increased risk of NCDs amongst UK-Ghanaians. These differences in the nutrient profile are likely to be modulated by the consumption of 'Western' foods observed in migrant communities.

Association of Energy Intake With the Lack of in-Person Review of Household Dietary Records: Analysis of Japan National Health and Nutrition Surveys From 1997 to 2011

Background

National surveys have demonstrated a long-term decrease in mean energy intake in Japan, despite the absence of a decrease in the prevalence of overweight and obesity. We aimed to examine whether total energy intake of survey respondents is associated with completion of an in-person review of dietary records and whether it affects the trend in mean energy intake.

Methods

We pooled data from individuals aged 20–89 years from the National Nutrition Surveys of 1997–2002 and the National Health and Nutrition Surveys of 2003–2011. We conducted a linear mixed-effects regression to estimate the association between total energy intake and the lack of an in-person review of semi-weighed household dietary records with interviewers. As some respondents did not have their dietary data confirmed, we used regression coefficients to correct their total energy intake.

Results

Compared with respondents completing an in-person review, total energy intake was significantly inversely associated with respondents not completing a review across all sex and age groups (P < 0.001). After correction of total energy intake for those not completing a review, mean energy intake in each survey year significantly increased by 2.1%–3.9% in men and 1.3%–2.6% in women (P < 0.001), but the decreasing trend in mean energy intake was sustained.

Conclusions

Total energy intake may be underestimated without an in-person review of dietary records. Further efforts to facilitate completion of a review may improve accuracy of these data. However, the increasing proportion of respondents missing an in-person review had little impact on the decreasing mean caloric intake.

A pilot study to determine whether using a lightweight, wearable micro-camera improves dietary assessment accuracy and offers information on macronutrients and eating rate

A major limitation in nutritional science is the lack of understanding of the nutritional intake of free-living people. There is an inverse relationship between accuracy of reporting of energy intake by all current nutritional methodologies and body weight. In this pilot study we aim to explore whether using a novel lightweight, wearable micro-camera improves the accuracy of dietary intake assessment. Doubly labelled water (DLW) was used to estimate energy expenditure and intake over a 14-d period, over which time participants (n 6) completed a food diary and wore a micro-camera on 2 of the days. Comparisons were made between the estimated energy intake from the reported food diary alone and together with the images from the micro-camera recordings. There was an average daily deficit of 3912 kJ using food diaries to estimate energy intake compared with estimated energy expenditure from DLW (P=0·0118), representing an under-reporting rate of 34 %. Analysis of food diaries alone showed a significant deficit in estimated daily energy intake compared with estimated intake from food diary analysis with images from the micro-camera recordings (405 kJ). Use of the micro-camera images in conjunction with food diaries improves the accuracy of dietary assessment and provides valuable information on macronutrient intake and eating rate. There is a need to develop this recording technique to remove user and assessor bias.

A review of sugar consumption from nationally representative dietary surveys across the world

BACKGROUND

Government and health organisations worldwide have recently reviewed the evidence on the role of dietary sugars in relation to health outcomes. Hence, it is timely to review current intakes of dietary sugars with respect to this guidance and as a benchmark for future surveillance.

METHODS

This review collates data from nationally representative dietary surveys across the world and reports estimates of intakes of total and added sugars, and sucrose in different population subgroups. Total sugars includes all mono- and disaccharides; namely, glucose, fructose, lactose, sucrose and maltose. Added and free sugars differ in the quantity of natural sugars included in their definitions. Free sugars include sugars naturally present in honey, syrups, fruit juices and fruit juice concentrates, whereas added sugars typically only refer to those added during processing.

RESULTS

Most countries reported intakes of total sugars, with fewer reporting intakes of added sugars and sucrose. No country reported intakes of free sugars. The available data suggest that total sugars as a percentage of energy were highest in the infant (<4 years), with mean values ranging from 20.0% to 38.4%, and decreased over the lifespan to 13.5-24.6% in adults. Intakes of added sugars were higher in school-aged children and adolescents (up to 19% of total energy) compared to younger children or adults.

CONCLUSIONS

Further research into the dietary patterns contributing to added sugars intake in children and adolescents is warranted. It would also be beneficial to policy guidance if future dietary surveys employed a uniform way of expressing sugars that is feasible to measure and has public health significance.

Diet, growth, and obesity development throughout childhood in the Avon Longitudinal Study of Parents and Children

Publications from the Avon Longitudinal Study of Parents and Children covering diet, growth, and obesity development during childhood are reviewed. Diet was assessed by food frequency questionnaires and food records. Growth data were collected by routine measurements, and in standardized clinics, body fatness was assessed by bioelectrical impedance and DXA (dual-energy X-ray absorptiometry) scans. Diets changed dramatically during the preschool period with an increase in the intake of free (added) sugars (12.3% rising to 16.4% of energy) that remained similar until adolescence. This was due to increased intake of energy-dense, nutrient-poor foods. Two periods of rapid growth were identified; infancy and mid-childhood (ages 7-11 y) and both were associated with obesity development. Diets with high energy density were associated with increasing fat mass from mid-childhood until adolescence. Genetic and dietary factors showed independent associations with increasing adiposity. At all ages studied, there were dietary inequalities related to maternal educational attainment that may influence inequalities found in obesity development. The Avon Longitudinal Study of Parents and Children has provided valuable insights into how disparities in diet and growth may affect the development of ill health in adulthood.

Dietary patterns in the Avon Longitudinal Study of Parents and Children

Publications from the Avon Longitudinal Study of Parents and Children that used empirically derived dietary patterns were reviewed. The relationships of dietary patterns with socioeconomic background and childhood development were examined. Diet was assessed using food frequency questionnaires and food records. Three statistical methods were used: principal components analysis, cluster analysis, and reduced rank regression. Throughout childhood, children and parents have similar dietary patterns. The "health-conscious" and "traditional" patterns were associated with high intakes of fruits and/or vegetables and better nutrient profiles than the "processed" patterns. There was evidence of tracking in childhood diet, with the "health-conscious" patterns tracking most strongly, followed by the "processed" pattern. An "energy-dense, low-fiber, high-fat" dietary pattern was extracted using reduced rank regression; high scores on this pattern were associated with increasing adiposity. Maternal education was a strong determinant of pattern score or cluster membership; low educational attainment was associated with higher scores on processed, energy-dense patterns in both parents and children. The Avon Longitudinal Study of Parents and Children has provided unique insights into the value of empirically derived dietary patterns and has demonstrated that they are a useful tool in nutritional epidemiology.

Amino Acid Intakes Are Inversely Associated with Arterial Stiffness and Central Blood Pressure in Women

BACKGROUND

Although data suggest that intakes of total protein and specific amino acids (AAs) reduce blood pressure, data on other cardiovascular disease risk factors are limited.

OBJECTIVE

We examined associations between intakes of AAs with known mechanistic links to cardiovascular health and direct measures of arterial stiffness, central blood pressure, and atherosclerosis.

METHODS

In a cross-sectional study of 1898 female twins aged 18-75 y from the TwinsUK registry, intakes of 7 cardioprotective AAs (arginine, cysteine, glutamic acid, glycine, histidine, leucine, and tyrosine) were calculated from food-frequency questionnaires. Direct measures of arterial stiffness and atherosclerosis included central systolic blood pressure (cSBP), mean arterial pressure (MAP), augmentation index (AI), pulse wave velocity (PWV), and intima-media thickness (IMT). ANCOVA was used to assess the associations between endpoints of arterial stiffness and intake (per quintile), adjusting for potential confounders.

RESULTS

In multivariable analyses, higher intakes of total protein and 7 potentially cardioprotective AAs were associated with lower cSBP, MAP, and PWV. Higher intakes of glutamic acid, leucine, and tyrosine were most strongly associated with PWV, with respective differences of -0.4 ± 0.2 m/s (P-trend = 0.02), -0.4 ± 0.2 m/s (P-trend = 0.03), and -0.4 ± 0.2 m/s (P-trend = 0.03), comparing extreme quintiles. There was a significant interaction between AA intakes and protein source, and higher intakes of AAs from vegetable sources were associated with lower central blood pressure and AI. Higher intakes of glutamic acid, leucine, and tyrosine from animal sources were associated with lower PWV.

CONCLUSIONS

These data provide evidence to suggest that intakes of several AAs are associated with cardiovascular benefits beyond blood pressure reduction in healthy women. The magnitude of the observed associations was similar to those previously reported for other lifestyle factors. Increasing intakes of these AAs could be an important and readily achievable way to reduce cardiovascular disease risk.

Identification of a dietary pattern associated with greater cardiometabolic risk in adolescence

BACKGROUND AND AIMS

Energy dense, high fat, low fibre diets may contribute to obesity in young people, however their relationships with other cardiometabolic risk factors are unclear. We examined associations between an 'energy-dense, high-fat and low-fibre' dietary pattern (DP) and cardiometabolic risk factors, and the tracking of this DP in adolescence.

METHODS AND RESULTS

Data was sourced from participants in the Western Australian Pregnancy (Raine) Cohort Study. At 14 and 17 y, dietary intake, anthropometric and biochemical data were measured and z-scores for an 'energy dense, high fat and low fibre' DP were estimated using reduced rank regression (RRR). Associations between DP z-scores and cardiometabolic risk factors were examined using regression models. Tracking of DP z-scores was assessed using Pearson's correlation coefficient. A 1 SD unit increase in DP z-score between 14 and 17 y was associated with a 20% greater odds of high metabolic risk (95% CI: 1.01, 1.41) and a 0.04 mmol/L higher fasting glucose in boys (95% CI: 0.01, 0.08); a 28% greater odds of a high-waist circumference (95% CI: 1.00, 1.63) in girls. An increase of 3% and 4% was observed for insulin and HOMA (95% CI: 1%, 7%), respectively, in boys and girls, for every 1 SD increase in DP z-score and independently of BMI. The DP showed moderate tracking between 14 and 17 y of age (r = 0.51 for boys, r = 0.45 for girls).

CONCLUSION

An 'energy dense, high fat, low fibre' DP is positively associated with cardiometabolic risk factors and tends to persist throughout adolescence.

Foods and dietary profiles associated with 'food addiction' in young adults

Background

It has been suggested that addictive behaviors related to consumption of specific foods could contribute to overeating and obesity. Although energy-dense, hyper-palatable foods are hypothesized to be associated with addictive-like eating behaviors, few studies have assessed this in humans.

Objective

To evaluate in young adults whether intakes of specific foods are associated with ‘food addiction’, as assessed by the Yale Food Addiction Scale (YFAS), and to describe the associated nutrient intake profiles.

Design

Australian adults aged 18–35 years were invited to complete an online cross-sectional survey including demographics, the YFAS and usual dietary intake. Participants were classified as food addicted (FAD) or non-addicted (NFA) according to the YFAS predefined scoring criteria.

Results

A total 462 participants (86% female, 73% normal weight) completed the survey, with 14.7% (n = 68) classified as FAD. The FAD group had a higher proportion of females (p = .01) and higher body mass index (p < .001) compared to NFA. Higher YFAS symptom scores were associated with higher percentage energy intake (%E) from energy-dense, nutrient-poor foods including candy, take out and baked sweet products, as well as lower %E from nutrient-dense core foods including whole-grain products and breakfast cereals. These remained statistically significant when adjusted for age, sex and BMI category (p = .001).

Conclusions

Statistically significant associations were identified between YFAS assessed food addiction and dietary intake, specifically intakes of energy-dense, nutrient-poor foods. However, the effect sizes were small limiting clinical applications. Further examination of the relationship between addictive-like eating and intake of specific foods in a nationally representative sample is warranted.

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14.7% participants met the YFAS predefined criteria for food addiction.

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Those classified as food addicted had a significantly higher body mass index.

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Higher symptom scores related to higher intakes of energy-dense nutrient-poor foods

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Lower odds of YFAS assessed food addiction with higher intakes of whole-grains.

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Higher odds of YFAS assessed food addiction with higher intakes of dietary fat.

Do Overweight Adolescents Adhere to Dietary Intervention Messages? Twelve-Month Detailed Dietary Outcomes from Curtin University's Activity, Food and Attitudes Program

Dietary components of adolescent obesity interventions are rarely evaluated with comprehensive reporting of dietary change. The objective was to assess dietary change in overweight adolescents, including adherence to dietary intervention. The dietary intervention was part of a multi-component intervention (CAFAP) targeting the physical activity, sedentary and healthy eating behaviors of overweight adolescents (n = 69). CAFAP was a staggered entry, within-subject, waitlist controlled clinical trial with 12 months of follow up. Diet was assessed using three-day food records and a brief eating behavior questionnaire. Changes in dietary outcomes were assessed using linear mixed models, adjusted for underreporting. Food record data suggested reduced adherence to dietary intervention messages over time following the intervention, despite conflicting information from the brief eating behavior questionnaire. During the intervention, energy intake was stable but favorable nutrient changes occurred. During the 12 month maintenance period; self-reported eating behaviors improved, energy intake remained stable but dietary fat and saturated fat intake gradually returned to baseline levels. Discrepancies between outcomes from brief dietary assessment methods and three-day food records show differences between perceived and actual intake, highlighting the need for detailed dietary reporting. Further, adherence to dietary intervention principles reduces over time, indicating a need for better maintenance support.

Evaluation of drinks contribution to energy intake in summer and winter

All drinks hydrate and most also provide nutrients and energy. Our objective was to evaluate the contribution of drinks to total energy intake in summer and winter. Data were obtained using the Water Balance Questionnaire (WBQ) from a sample of the general population in Athens, Greece (n = 984), 473 individuals (42 ± 18 years) in summer and 511 individuals (38 ± 20 years) in winter stratified by sex and age. The WBQ embeds a semi-quantitative food frequency questionnaire of 58 foods and the Short International Physical Activity Questionnaire. Data were analyzed for the contribution of drinks to total energy intake. In winter, total energy intake was 2082 ± 892 kcal/day; energy intake from drinks was 479 ± 286 kcal/day and energy expenditure 1860 ± 390 kcal/day. In summer, total energy intake was 1890 ± 894 kcal/day, energy intake from drinks 492 ± 499 kcal/day and energy expenditure 1830 ± 491 kcal/day. Energy intake from drinks in summer was higher than in winter (p < 0.001) and in men higher than in women in both seasons (p < 0.001 in summer, p = 0.02 in winter). Coffee, coffee drinks, milk, chocolate milk and alcoholic drinks contributed approximately 75% of energy from drinks. Fruit juice and sugar-sweetened drinks, including soft drinks and fruit juice based drinks, were consumed less frequently contributing up to 25% of drink energy intake. Drinks contribute approximately 1/4 of total energy intake depending on the energy content of the drink and frequency of consumption. Coffee, dairy and alcoholic drinks were the main energy contributors.

Assessment of energy intake in women with chronic obstructive pulmonary disease: a doubly labeled water method study

OBJECTIVES

To maintain energy balance, reliable methods for assessing energy intake and expenditure should be used in patients with chronic obstructive pulmonary disease (COPD). The purpose of this study was to validate the diet history and 7-day food diary methods of assessing energy intake (EI) using total energy expenditure (TEE) with the doubly labeled water (DLW) method (TEEDLW) as the criterion method in outpatient women with COPD.

METHODS

EI was assessed by diet history (EIDH) and a 7-day food diary (EIFD) in 19 women with COPD, using TEEDLW as the criterion method. The three methods were compared using intra-class correlation coefficients (ICC) and Bland-Altman analyses. The participants were classified according to their reporting status (EI/TEE) as valid-reporters 0.79-1.21, under-reporters < 0.79 or over-reporters > 1.21.

RESULTS

Diet history underestimated reported EI by 28%, and 7-day food diary underestimated EI by approximately 20% compared with TEEDLW. The ICC analysis showed weak agreement between TEEDLW and EIDH (ICC=-0.01; 95%CI-0.10 to 0.17) and between TEEDLW and EIFD (ICC=0.11; 95%CI -0.16 to 0.44). The Bland-Altman plots revealed a slight systematic bias for both methods. For diet history, six women (32%) were identified as valid-reporters, and for the 7-day food diary, twelve women (63%) were identified as valid-reporters. The accuracy of reported EI was only related to BMI.

CONCLUSION

The diet history and 7-day food diary methods underestimated energy intake in women with COPD compared with the DLW method. Individuals with higher BMIs are prone to underreporting. Seven-day food diaries should be used with caution in assessing EI in women with COPD.

Higher proportion of total and fat energy intake during the morning may reduce absolute intake of energy within the day. An observational study in free-living Japanese adults

BACKGROUND

Although the distribution of energy intake throughout the day appears to impact overall daily energy intake, little is known about the ad libitum distribution of energy intake.

OBJECTIVE

Our aim was to investigate associations between the distribution of energy intake during the day and subsequent or overall energy intake, and food choice in free-living adults.

DESIGN

A total of 119 women and 116 men completed 16-day semi-weighed dietary records. The longitudinal dietary intake data for each participant were analyzed using a mixed model to examine the effect of energy intake at various times of day on subsequent or overall energy intake.

RESULTS

Mean proportion of total energy intake in the morning (4:00 a.m.-10:29 a.m.), afternoon (10:30 a.m.-4:59 p.m.) and evening (5:00 p.m.-3:59 a.m.) meal was 22.6%, 33.8% and 43.6% in men, and 24.7%, 36.5%, 38.8% in women, respectively. Proportion of energy intake (%) in the morning meal was significantly and negatively associated with energy intake (kcal) in the subsequent afternoon and evening meals, and consequently in the whole day in both sexes. This significant and negative association was also observed for proportion of energy intake (%) of fat, but not of carbohydrate or protein, in both sexes. Proportion of energy intake (%) in the morning meal was negatively associated with overall energy intake (kcal) from the group of meats, fish, and eggs in both sexes, and from the group of confectioneries and soft drinks in women.

CONCLUSIONS

More energy in the morning meal may reduce energy intake, especially that from fat, in the subsequent meals, and consequently in the whole day.

Energy intake underreporting of adults in a household survey: the impact of using a population specific basal metabolic rate equation

The purpose of the present study was to identify energy intake (EI) underreporting and to estimate the impact of using a population specific equation for the basal metabolic rate (BMR) in a probability sample of adults from Niterói, Rio de Janeiro State, Brazil. A sample of 1,726 subjects participated in the study. EI was assessed by a 24-hour dietary recall and EI/BMR was computed with BMR estimated using internationally recommended equations as well as specific equations developed for the adult population of Niterói. Mean EI was 1,570.9 and 2,188.8kcal.day-1 for women and men, respectively. EI decreased with increasing age in both men and women. BMR estimated by the Brazilian equation was significantly lower than the values estimated by the international equation for all age, sex and nutritional status groups. In general, EI underreporting was found in at least 50% of the population, higher in women, and increased with increasing age and body mass index (BMI). The results of the present study confirm that EI is underreported, even when BMR is estimated using population-specific equations.

Socio-economic dietary inequalities in UK adults: an updated picture of key food groups and nutrients from national surveillance data

Socio-economic differences in diet are a potential contributor to health inequalities. The present study provides an up-to-date picture of socio-economic differences in diet in the UK, focusing on the consumption of three food groups and two nutrients of public health concern: fruit and vegetables; red and processed meat; oily fish; saturated fats; non-milk extrinsic sugars (NMES). We analysed data for 1491 adults (age ≥ 19 years) from the National Diet and Nutrition Survey 2008-2011. Socio-economic indicators were household income, occupational social class and highest educational qualification. Covariate-adjusted estimates for intakes of fruit and vegetables, red and processed meat, and both nutrients were estimated using general linear models. Covariate-adjusted OR for oily fish consumption were derived with logistic regression models. We observed consistent socio-economic gradients in the consumption of the three food groups as estimated by all the three indicators. Contrasting highest and lowest levels of each socio-economic indicator, we observed significant differences in intakes for the three food groups and NMES. Depending on the socio-economic indicator, highest socio-economic groups consumed up to 128 g/d more fruit and vegetables, 26 g/d less red and processed meat, and 2·6% points less NMES (P< 0·05 for all). Relative to lowest socio-economic groups, highest socio-economic groups were 2·4 to 4·0 times more likely to eat oily fish. No significant patterns in saturated fat consumption were apparent. In conclusion, socio-economic differences were identified in the consumption of food groups and one nutrient of public health importance. Aligning dietary intakes with public health guidance may require interventions specifically designed to reduce health inequalities.

Fresh produce consumption and the association between frequency of food shopping, car access, and distance to supermarkets

BACKGROUND

Fresh fruit and vegetables are important components of a healthy diet. Distance to a supermarket has been associated with the ability to access fresh produce.

METHODS

A randomly sampled telephone survey was conducted with the main shopper for 3000 households in New Orleans, Louisiana in 2011. Individuals were asked where and how often they shopped for groceries, frequency of consumption of a variety of foods, and whether they had access to a car. Bivariate models assessed the relationship between four outcomes: car access, distance to the store patronized by the respondent, number of monthly shopping trips, and daily servings of produce. Structural equation modeling (SEM) was used to distinguish direct and indirect effects.

RESULTS

In bivariate models, car access was positively associated with number of shopping trips and produce consumption while distance was inversely associated with shopping trips. In SEM models, produce consumption was not associated with car access or distance, but to the number of monthly shopping trips.

CONCLUSION

The frequency of shopping is associated with car access but a further distance deters it. Access to stores closer to the shopper may promote more frequent shopping and consumption of produce.

Comparative analysis of approaches for assessing energy intake underreporting by female bariatric surgery candidates

OBJECTIVE

To test six variations in the Goldberg equation for evaluating the underreporting of energy intake (EI) among obese women on the waiting list for bariatric surgery, considering variations in resting metabolic rate (RMR), physical activity, and food intake levels in group and individual approaches.

METHODS

One hundred obese women aged 20 to 45 years (33.3 ± 6.08) recruited from a bariatric surgery waiting list participated in the study. Underreporting assessment was based on the difference between reported energy intake, indirect calorimetry measurements and RMR (rEI:RMR), which is compatible with the predicted physical activity level (PAL). Six approaches were used for defining the cutoff points. The approaches took into account variances in the components of the rEI:RMR = PAL equation as a function of the assumed PAL, sample size (n), and measured or estimated RMR.

RESULTS

The underreporting percentage varied from 55% to 97%, depending on the approach used for generating the cutoff points. The ratio rEI:RMR and estimated PAL of the sample were significantly different (p = 0.001). Sixty-one percent of the women reported an EI lower than their RMR. The PAL variable significantly affected the cutoff point, leading to different proportions of underreporting. The RMR measured or estimated in the equation did not result in differences in the proportion of underreporting. The individual approach was less sensitive than the group approach.

CONCLUSION

RMR did not interfere in underreporting estimates. However, PAL variations were responsible for significant differences in cutoff point. Thus, PAL should be considered when estimating underreporting, and even though the individual approach is less sensitive than the group approach, it may be a useful tool for clinical practice.

Dietary intake in Black British adults; an observational assessment of nutritional composition and the role of traditional foods in UK Caribbean and West African diets

OBJECTIVE

Acculturation to the UK diet may contribute to the increased burden of non-communicable diseases in Black British communities. The present study aimed to assess nutritional composition and the contribution that traditional foods make to dietary intake in a group of UK-residing Caribbean and West African adults and to explore differences according to ethnicity and duration of residence.

DESIGN

Observational study. Dietary intake was assessed using multiple, standardised triple-pass 24 h recalls and analysed using a nutritional composition database. Associations between sociodemographic variables and duration of residence with dietary intake were assessed using ANCOVA.

SETTING

London, UK, October 2011-December 2012.

SUBJECTS

UK adults of Caribbean (n 50) or West African (n 83) ancestry, aged 18-75 years.

RESULTS

The Caribbean participants were older and more likely to be born in the UK. After adjusting for age, sex and ethnicity, those who had been resident in the UK for the longest duration had significantly higher intakes of energy (P<0·001), fat (P=0·002) and Na (P=0·03). The West African participants sourced significantly more energy (P=0·04), fat (P=0·02), saturated fat (P=0·02) and Na (P=0·001) from traditional cultural foods compared with the Caribbean diet, which was more reliant on 'Westernised' foods such as sugar-sweetened beverages.

CONCLUSIONS

These results are novel in demonstrating dietary acculturation in UK adults of Caribbean and West African ancestry. We have provided detailed data regarding the role of traditional foods, presenting dietary information that may guide in individualising care for patients from these communities and improve the cultural sensitivity of public health strategies.

Image-assisted dietary assessment: a systematic review of the evidence

Images captured during eating episodes provide objective information to assist in the assessment of dietary intake. Images are captured using handheld devices or wearable cameras, and can support traditional self-report or provide the primary record of dietary intake. A diverse range of image-assisted methods have been developed and evaluated but have not been previously examined together. Therefore, a review was undertaken to examine all studies that have evaluated or validated image-assisted methods of dietary assessment for assessing dietary energy intake. Identified image-assisted methods that employ similar methodologies were grouped for comparison. English-language full-text research articles published between January 1998 and November 2013 were searched using five electronic databases. A search of reference lists and associated websites was also conducted. Thirteen studies that evaluated 10 unique image-assisted methods among adults aged 18 to 70 years were included. Ten studies used handheld devices and three studies used wearable cameras. Eight studies evaluated image-based food records, two studies explored the use of images to enhance written food records, and three studies evaluated image-assisted 24-hour dietary recalls. Results indicate images enhance self-report by revealing unreported foods and identify misreporting errors not captured by traditional methods alone. Moreover, when used as the primary record of dietary intake, images can provide valid estimates of energy intake. However, image-assisted methods that rely on image analysis can be prone to underestimation if users do not capture images of satisfactory quality before all foods are consumed. Further validation studies using criterion measures are warranted. The validity among children, adolescents, and elderly persons as well as the feasibility of using image-assisted methods in large samples needs to be examined. Additional research is also needed to better understand the potential applications and pitfalls of wearable cameras.

The impact of Curtin University's activity, food and attitudes program on physical activity, sedentary time and fruit, vegetable and junk food consumption among overweight and obese adolescents: a waitlist controlled trial

Background

To determine the effects of participation in Curtin University's Activity, Food and Attitudes Program (CAFAP), a community-based, family-centered behavioural intervention, on the physical activity, sedentary time, and healthy eating behaviours of overweight and obese adolescents.

Methods

In this waitlist controlled clinical trial in Western Australia, adolescents (n = 69, 71% female, mean age 14.1 (SD 1.6) years) and parents completed an 8-week intervention followed by 12 months of telephone and text message support. Assessments were completed at baseline, before beginning the intervention, immediately following the intervention, and at 3-, 6-, and 12- months follow-up. The primary outcomes were physical activity and sedentary time assessed by accelerometers and servings of fruit, vegetables and junk food assessed by 3-day food records.

Results

During the intensive 8-week intervention sedentary time decreased by −5.1 min/day/month (95% CI: −11.0, 0.8) which was significantly greater than the rate of change during the waitlist period (p = .014). Moderate physical activity increased by 1.8 min/day/month (95% CI: −0.04, 3.6) during the intervention period, which was significantly greater than the rate of change during the waitlist period (p = .041). Fruit consumption increased during the intervention period (monthly incidence rate ratio (IRR) 1.3, 95% CI: 1.10, 1.56) and junk food consumption decreased (monthly IRR 0.8, 95% CI: 0.74, 0.94) and these changes were different to those seen during the waitlist period (p = .004 and p = .020 respectively).

Conclusions

Participating in CAFAP appeared to have a positive influence on the physical activity, sedentary and healthy eating behaviours of overweight and obese adolescents and many of these changes were maintained for one year following the intensive intervention.

Trial Registration

Australia and New Zealand Clinical Trials Registry ACTRN12611001187932

Energy requirements of adult dogs: a meta-analysis

A meta-analysis was conducted to determine the maintenance energy requirements of adult dogs. Suitable publications were first identified, and then used to generate relationships amongst energy requirements, husbandry, activity level, methodology, sex, neuter status, dog size, and age in healthy adult dogs. Allometric equations for maintenance energy requirements were determined using log-log linear regression. So that the resulting equations could readily be compared with equations reported by the National Research Council, maintenance energy requirements in the current study were determined in kcal/kg(0.75) body weight (BW). Ultimately, the data of 70 treatment groups from 29 publications were used, and mean (± standard deviation) maintenance energy requirements were 142.8±55.3 kcal·kgBW(-0.75)·day(-1). The corresponding allometric equation was 81.5 kcal·kgBW(-0.9)·day(-1) (adjusted R2 = 0.64; 70 treatment groups). Type of husbandry had a significant effect on maintenance energy requirements (P<0.001): requirements were greatest in racing dogs, followed by working dogs and hunting dogs, whilst the energy requirements of pet dogs and kennel dogs were least. Maintenance energy requirements were less in neutered compared with sexually intact dogs (P<0.001), but there was no effect of sex. Further, reported activity level tended to effect the maintenance energy requirement of the dog (P = 0.09). This review suggests that estimating maintenance energy requirements based on BW alone may not be accurate, but that predictions that factor in husbandry, neuter status and, possibly, activity level might be superior. Additionally, more information on the nutrient requirements of older dogs, and those at the extremes of body size (i.e. giant and toy breeds) is needed.

Handheld Electronic Technology for Weight Loss in Overweight/Obese Adults

Handheld electronic devices could offer a convenient and scalable platform with which to deliver a weight loss intervention. This paper aims to summarise the evidence provided by randomised trials of such interventions. There is heterogeneity among trials in terms of the components of the intervention package, the theoretical framework, the comparison groups and the duration of follow-up. While in the short term (<6 months) trials have shown some promising findings, two trials (one of a text message intervention and one of a PDA device for dietary self-monitoring) do not indicate clinically significant weight loss in the longer term (1-2 years). Topical issues are discussed including the importance of further research into dietary self-monitoring, the logistics of trialling smartphone applications and considerations of health literacy. There is currently no definitive randomised controlled trial of a smartphone app for weight loss in adults and further research into this approach is warranted.

Obscurity on obesity

Much research is underway on the links between diet and obesity. So too are long-running disputes among nutritionists on core questions about the relationship. This editorial reviews the state-of-play on four issues: what makes people fat, how to lose weight, how much do we eat, and what policies to adopt towards obesity. The practical consequence is that, at present, frontline health professionals will not find in nutrition science agreed, actionable solutions to assist overweight patients. But research and debate continues actively.

Misreporting of dietary intake affects estimated nutrient intakes in low-income Spanish-speaking women

Misreporting of dietary intake affects the validity of data collected and conclusions drawn in studies exploring diet and health outcomes. One consequence of misreporting is biological implausibility. Little is known regarding how accounting for biological implausibility of reported intake affects nutrient intake estimates in Hispanics, a rapidly growing demographic in the United States. Our study explores the effect of accounting for plausibility on nutrient intake estimates in a sample of Mexican-American women in northern California in 2008. Nutrient intakes are compared with Dietary Reference Intake recommendations, and intakes of Mexican-American women in a national survey are presented as a reference. Eighty-two women provided three 24-hour recalls. Reported energy intakes were classified as biologically plausible or implausible using the reported energy intakes to total energy expenditure cutoff of <0.76 or >1.24, with low-active physical activity levels used to estimate total energy expenditure. Differences in the means of nutrient intakes between implausible (n=36) and plausible (n=46) reporters of energy intake were examined by bivariate linear regression. Estimated energy, protein, cholesterol, dietary fiber, and vitamin E intakes were significantly higher in plausible reporters than implausible. There was a significant difference between the proportions of plausible vs implausible reporters meeting recommendations for several nutrients, with a larger proportion of plausible reporters meeting recommendations. Further research related to misreporting in Hispanic populations is warranted to explore the causes and effects of misreporting in studies measuring dietary intake, as well as actions to be taken to prevent or account for this issue.

Fast-food consumers in Singapore: demographic profile, diet quality and weight status

OBJECTIVE

To determine the demographic profile of fast-food consumers among adult Singapore residents and ascertain whether fast-food consumption frequency is associated with diet quality and weight status.

DESIGN

A nationally representative cross-sectional survey including an FFQ and anthropometric measures. Participants were grouped based on their fast-food consumption frequency as non-consumer, occasional consumer or regular consumer, with regular defined as at least once per week.

SETTING

Individuals living in the community in Singapore.

SUBJECTS

Singapore residents (n 1627) aged 18-69 years of Chinese, Malay and Indian ethnicity.

RESULTS

Proportions of regular fast-food consumers were higher in younger age groups, higher income groups and middle education level groups. Mean daily energy intake was positively associated with fast-food consumption frequency (non-consumers 9636 kJ (2303 kcal); occasional consumers 11 159 kJ (2667 kcal); regular consumers 13 100 kJ (3131 kcal); P for trend < 0·001). Fast-food consumers were more likely to exceed the RDA for energy, fat and saturated fat, and less likely to meet wholegrain and fruit recommendations. Both regular consumers (OR = 1·24; 95 % CI 1·03, 1·51) and occasional consumers (OR = 1·52; 95 % CI 1·32, 1·77) were more likely to have a waist:hip ratio indicating abdominal obesity. Occasional consumers were more likely to have a BMI ≥ 23·0 kg/m2 (OR = 1·19; 95 % CI 1·04, 1·37), whereas regular consumers were less likely (OR = 0·76; 95 % CI 0·64, 0·91) to have an 'at-risk' BMI.

CONCLUSIONS

Fast-food consumption is most prevalent in young adults, high income and middle education level groups. Frequent fast-food consumption in Singapore is associated with unfavourable dietary and nutrient profiles and abdominal obesity.

Shifts in the recent distribution of energy intake among U.S. children aged 2-18 years reflect potential abatement of earlier declining trends

Recent national surveys suggest that child obesity in the United States may have reached a plateau, but corresponding trends in energy intake have not been examined in depth. This article evaluates medium-term trends in children's reported energy intake by using 4 waves of national dietary surveillance from 2003-2004 to 2009-2010. The analysis uses up to 2 24-h dietary recalls, incorporating methods that address challenges in estimating usual intake, accounting for intraindividual variance and covariates such as the presence of atypical consumption days. Quantile regression was used to assess disparities in intake among sociodemographic subgroups at extremes of the distribution as well as at the median, and the potential influence of misreporting was evaluated. Results indicated that after an initial decline in intakes across all age groups through 2007-2008, there were significant increases of ∼90 kcal/d at the median among adolescents in 2009-2010, whereas intakes in younger children remained steady. Among adolescent boys, the recent increase was larger at the 90th percentile than at the median. Intake trends did not vary by race/ethnic group, among whom intakes were similar at the upper end of the distribution. Misreporting did not influence trends over time, but intakes were lower in younger children and higher in older children after excluding misreporters. Overall, findings suggest that declines in children's energy intake from 2003-2004 through 2007-2008 were consistent with the obesity plateau observed in most age and gender subgroups through 2009-2010. However, there is evidence of increased intakes among adolescents in 2009-2010, which may threaten the earlier abatement in overweight in this older age group.

Sugars consumption in a low-income sample of British young people and adults

OBJECTIVE

To report the consumption of non-milk extrinsic sugars (NMES) among a low-income UK sample, compare it with nationally representative estimates and examine the association between socioeconomic position and NMES consumption among low income adults.Design Secondary analysis of the Low Income Diet and Nutrition Survey (LIDNS) data.

SETTING AND SUBJECTS

Two thousand, seven hundred and ninety-six adults and 415 young people from 2,477 households.Main outcome measures Mean NMES intakes (grams) and their percentage contribution to food energy, from dietary data collected via a 24-hour recall 'multiple pass' method.

RESULTS

The low income sample consumed more NMES than the general population sample. The percentage of food energy from NMES exceeded the 11% target, especially among adolescents (17.2% in males, 16.3% in females). After adjusting for age, men who finished full-time education aged 16 years consumed significantly more sugar (p = 0.028), whereas those who finished aged 18 consumed significantly less sugar (p = 0.023) than the reference group (finished aged 15). No significant associations were found between NMES and socioeconomic variables in women.

CONCLUSION

Compared to the general population, the nutritional disadvantage of the most deprived segments of society relates primarily to excessive NMES consumption. In men, higher educational level appears to play a protective role against high sugar intakes.

Relationship between 24 h urinary potassium and diet quality in the adult Spanish population

Objective

To study the relationship between diet quality and 24 h urinary K excretion.

Design

K was measured in 24 h urine samples, while diet was studied using a 24 h recall method over two consecutive days. Diet quality was determined using the Healthy Eating Index (HEI). The body weight, height and body composition of all participants were recorded, and the BMI of each calculated.

Setting

Representative members of the adult Spanish population from the FANPE Study (‘Fuentes Alimentarias de Nutrientes en Población Española’; Dietary Sources of Nutrients in the Spanish Population).

Subjects

The final sample size was 329 participants aged 18–60 years.

Results

Participants with a 24 h urinary K excretion ≥93 mmol/d (group AP = adequate potassium) had greater self-reported K intakes, consumed more fruit and vegetables, had a more varied diet and had better HEI scores than those with a 24 h urinary K excretion <93 mmol/d (group IP = inadequate potassium). A significant positive correlation was seen between 24 h urinary K and dietary variety and the number of servings of fruits, vegetables and dairy products consumed, and between each of these and the HEI after correcting for age, sex, BMI, coefficient of activity, energy intake and the under-reporting of energy intake. AP participants were less likely to have an inadequate diet (HEI score <50) than IP participants (OR =0·439; 95 % CI 0·201, 0·961;P=0·039).

Conclusions

Diet quality, measured by the HEI, is correlated with 24 h urinary K excretion in Spanish adults.

Dietary mineral supplies in Africa

Dietary micronutrient deficiencies (MNDs) are widespread, yet their prevalence can be difficult to assess. Here, we estimate MND risks due to inadequate intakes for seven minerals in Africa using food supply and composition data, and consider the potential of food-based and agricultural interventions. Food Balance Sheets (FBSs) for 46 countries were integrated with food composition data to estimate per capita supply of calcium (Ca), copper (Cu), iron (Fe), iodine (I), magnesium (Mg), selenium (Se) and zinc (Zn), and also phytate. Deficiency risks were quantified using an estimated average requirement (EAR) 'cut-point' approach. Deficiency risks are highest for Ca (54% of the population), followed by Zn (40%), Se (28%) and I (19%, after accounting for iodized salt consumption). The risk of Cu (1%) and Mg (<1%) deficiency are low. Deficiency risks are generally lower in the north and west of Africa. Multiple MND risks are high in many countries. The population-weighted mean phytate supply is 2770 mg capita(-1) day(-1). Deficiency risks for Fe are lower than expected (5%). However, 'cut-point' approaches for Fe are sensitive to assumptions regarding requirements; e.g. estimates of Fe deficiency risks are 43% under very low bioavailability scenarios consistent with high-phytate, low-animal protein diets. Fertilization and breeding strategies could greatly reduce certain MNDs. For example, meeting HarvestPlus breeding targets for Zn would reduce dietary Zn deficiency risk by 90% based on supply data. Dietary diversification or direct fortification is likely to be needed to address Ca deficiency risks.

Effect of glutamine supplementation on cardiovascular risk factors in patients with type 2 diabetes

OBJECTIVE

The aim of this study was to assess clinical relevance of long-term oral glutamine supplementation on lipid profile and inflammatory and metabolic factors in patients with diabetes.

METHOD

Sixty-six patients with type 2 diabetes between the ages of 18 and 65 y were randomized to receive glutamine 30 g/d (10 g powder, three times a day) or placebo, in a double-blind, placebo-controlled trial during a 6-wk treatment period. Fifty-three patients completed the trial. Independent samples t test and analysis of covariance were used.

RESULTS

After a 6-wk treatment period, a significant difference was observed between the two groups in body fat mass (P = 0.01) and percentage of body fat (P = 0.008). Moreover, a significant reduction in waist circumference (P < 0.001) and a tendency for an increase in fat-free mass (P = 0.03), with no change in body weight and body mass index (BMI) was found. Enhancement in body fat-free mass was mainly attributed to trunk (P = 0.03). There was a downward trend in systolic blood pressure (P = 0.005) but not diastolic. Fasting blood glucose (mmol/L) concentration significantly decreased after the 6-wk intervention (P = 0.04). Mean hemoglobin A1c was significantly different between the groups at week 6 (P = 0.04). No significant difference was detected for fasting insulin, homeostasis model assessment for insulin resistance and quantitative insulin sensitivity index between groups (P > 0.05). No significant difference was observed between groups in total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol and triglyceride. No treatment effect on C-reactive protein was found (P = 0.44).

CONCLUSION

We demonstrated that the 6-wk supplementation with 30 g/d glutamine markedly improved some cardiovascular risk factors, as well as body composition, in patients with type 2 diabetes. Future glutamine dose-response studies are warranted in these areas.

Dietary changes and associations with metabolic improvements in adults with type 2 diabetes during a patient-centred dietary intervention: an exploratory analysis

OBJECTIVES

Describe dietary intake of participants enrolled in a non-prescriptive dietary intervention and dietary changes at 6 months and explore whether these changes had a role in observed improvements in glycated haemoglobin (HbA1c), weight, lipids and blood pressure.

DESIGN

Secondary analysis of data from the Early ACTivity in Diabetes randomised controlled trial.

PARTICIPANTS

262 patients with newly diagnosed type 2 diabetes randomised to the dietary intervention.

OUTCOMES AND ANALYSIS

Changes in energy intake, macronutrients, fibre and alcohol and in weight, waist circumference, lipids, HbA1c and blood pressure at baseline and 6 months. Multivariate models were used to examine associations between dietary changes and metabolic variables.

RESULTS

Men reported reducing mean energy intake from 1903±462 kcal to 1685 kcal±439 kcal (p<0.001), increasing carbohydrate intake from 42.4±6.6% to 43.8±6.6% (p=0.002) and reducing median alcohol intake from 13 (0-27) g to 5 (0-18) g (p<0.001). Women reported reducing mean energy intake from 1582±379 kcal to 1459±326 kcal (p<0.001) with no change to macronutrient distribution and alcohol. Fibre intake was maintained. In men (n=148), weak and clinically insignificant associations were found between increased carbohydrates and reduction in HbA1c (β=-0.003 (-0.006, -0.001); p=0.009), increased fibre and reduction in total cholesterol (β=-0.023 (-0.044, -0.002); p=0.033), decreased total fat and reduction in low-density lipoprotein (LDL)-cholesterol (β=0.024 (0.006, 0.001); p=0.011), and decreased alcohol and reduction in diastolic blood pressure (β=0.276 (0.055, 0.497); p=0.015). In women (n=75), associations were found between a decrease in transfats and reductions in waist circumference (β=-0.029 (0.006, 0.052); p=0.015), total cholesterol (β=0.399 (0.028, 0.770); p=0.036) and LDL cholesterol (β=0.365 (0.042, 0.668); p=0.028).

CONCLUSIONS

Clinically important metabolic improvements observed in a patient-centred dietary intervention were not explained by changes in macronutrients. However, a non-prescriptive approach may promote a reduction in total energy intake while maintaining fibre consumption.

TRIAL REGISTRATION NUMBER

The Early ACTID trial number ISRCTN92162869.

Development of a food-exchange model to replace saturated fat with MUFAs and n-6 PUFAs in adults at moderate cardiovascular risk

The recommendation to reduce saturated fatty acid (SFA) consumption to ≤10% of total energy (%TE) is a key public health target aimed at lowering cardiovascular disease (CVD) risk. Replacement of SFA with unsaturated fats may provide greater benefit than replacement with carbohydrates, yet the optimal type of fat is unclear. The aim of the DIVAS (Dietary Intervention and Vascular Function) study was to develop a flexible food-exchange model to investigate the effects of substituting SFAs with monounsaturated fatty acids (MUFAs) or n-6 (ω-6) polyunsaturated fatty acids (PUFAs) on CVD risk factors. In this parallel study, UK adults aged 21-60 y with moderate CVD risk (50% greater than the population mean) were identified using a risk assessment tool (n = 195; 56% females). Three 16-wk isoenergetic diets of specific fatty acid (FA) composition (%TE SFA:%TE MUFA:%TE n-6 PUFA) were designed using spreads, oils, dairy products, and snacks as follows: 1) SFA-rich diet (17:11:4; n = 65); 2) MUFA-rich diet (9:19:4; n = 64); and 3) n-6 PUFA-rich diet (9:13:10; n = 66). Each diet provided 36%TE total fat. Dietary targets were broadly met for all intervention groups, reaching 17.6 ± 0.4%TE SFA, 18.5 ± 0.3%TE MUFA, and 10.4 ± 0.3%TE n-6 PUFA in the respective diets, with significant overall diet effects for the changes in SFAs, MUFAs, and n-6 PUFAs between groups (P < 0.001). There were no differences in the changes of total fat, protein, carbohydrate, and alcohol intake or anthropometric measures between groups. Plasma phospholipid FA composition showed changes from baseline in the proportions of total SFAs, MUFAs, and n-6 PUFAs for each diet group, with the changes in SFAs and MUFAs differing between the groups (P < 0.001). In conclusion, successful implementation of the food-exchange model broadly achieved the dietary target intakes for the exchange of SFAs with MUFAs or n-6 PUFAs with minimal disruption to the overall diet in a free-living population. This trial was registered at clinicaltrials.gov as NCT01478958.

Measuring the difference between actual and reported food intakes in the context of energy balance under laboratory conditions

To date, no study has directly and simultaneously measured the discrepancy between what people actually eat and what they report eating under observation in the context of energy balance (EB). The present study aimed to objectively measure the ‘extent’ and ‘nature’ of misreporting of dietary intakes under conditions in which EB and feeding behaviour were continuously monitored. For this purpose, a total of fifty-nine adults were recruited for 12 d, involving two 3 d overt phases and two 3 d covert phases of food intake measurement in a randomised cross-over design. Subjects had ad libitum access to a variety of familiar foods. Food intake was covertly measured using a feeding behaviour suite to establish actual energy and nutrient intakes. During the overt phases, subjects were instructed to self-report food intake using widely accepted methods. Misreporting comprised two separate and synchronous phenomena. Subjects decreased energy intake (EI) when asked to record their food intake (observation effect). The effect was significant in women ( − 8 %, P< 0·001) but not in men ( − 3 %, P< 0·277). The reported EI was 5 to 21 % lower (reporting effect) than the actual intake, depending on the reporting method used. Semi-quantitative techniques gave larger discrepancies. These discrepancies were identical in men and women and non-macronutrient specific. The ‘observation’ and ‘reporting’ effects combined to constitute total misreporting, which ranged from 10 to 25 %, depending on the intake measurement assessed. When studied in a laboratory environment and EB was closely monitored, subjects under-reported their food intake and decreased the actual intake when they were aware that their intake was being monitored.

Methodological Issues in Cohort Studies That Relate Sodium Intake to Cardiovascular Disease Outcomes

Background—

The results of cohort studies relating sodium (Na) intake to blood pressure–related cardiovascular disease (CVD) are inconsistent. To understand whether methodological issues account for the inconsistency, we reviewed the quality of these studies.

Methods and Results—

We reviewed cohort studies that examined the association between Na and CVD. We then identified methodological issues with greatest potential to alter the direction of association (reverse causality, systematic error in Na assessment), some potential to alter the direction of association (residual confounding, inadequate follow-up), and the potential to yield false null results (random error in Na assessment, insufficient power). We included 26 studies with 31 independent analyses. Of these, 13 found direct associations between Na and CVD, 8 found inverse associations, 2 found J-shaped associations, and 8 found null associations only. On average there were 3 to 4 methodological issues per study. Issues with greater potential to alter the direction of association were present in all but 1 of the 26 studies (systematic error, 22; reverse causality, 16). Issues with lesser potential to alter the direction of association were present in 18 studies, whereas those with potential to yield false null results were present in 23.

Conclusions—

Methodological issues may account for the inconsistent findings in currently available observational studies relating Na to CVD. Until well-designed cohort studies in the general population are available, it remains appropriate to base Na guidelines on the robust body of evidence linking Na with elevated blood pressure and the few existing general population trials of the effects of Na reduction on CVD.

Dietary fat and fatty acid profile are associated with indices of skeletal muscle mass in women aged 18-79 years

Age-related loss of skeletal muscle mass results in a reduction in metabolically active tissue and has been related to the onset of obesity and sarcopenia. Although the causes of muscle loss are poorly understood, dietary fat has been postulated to have a role in determining protein turnover through an influence on both inflammation and insulin resistance. This study was designed to investigate the cross-sectional relation between dietary fat intake, as dietary percentage of fat energy (PFE) and fatty acid profile, with indices of skeletal muscle mass in the population setting. Body composition [fat-free mass (FFM; in kg)] and the fat-free mass index (FFMI; kg FFM/m(2)) was measured by using dual-energy X-ray absorptiometry in 2689 women aged 18-79 y from the TwinsUK Study and calculated according to quintile of dietary fat (by food-frequency questionnaire) after multivariate adjustment. Positive associations were found between the polyunsaturated-to-saturated fatty acid (SFA) ratio and indices of FFM, and inverse associations were found with PFE, SFAs, monounsaturated fatty acids (MUFAs), and trans fatty acids (TFAs) (all as % of energy). Extreme quintile dietary differences for PFE were -0.6 kg for FFM and -0.28 kg/m(2) for FFMI; for SFAs, MUFAs, and TFAs, these were -0.5 to -0.8 kg for FFM and -0.26 to -0.38 kg/m(2) for FFMI. These associations were of a similar magnitude to the expected decline in muscle mass that occurs over 10 y. To our knowledge, this is the first population-based study to demonstrate an association between a comprehensive range of dietary fat intake and FFM. These findings indicate that a dietary fat profile already associated with cardiovascular disease protection may also be beneficial for conservation of skeletal muscle mass.

Tracking a dietary pattern associated with increased adiposity in childhood and adolescence

OBJECTIVE

Understanding dietary tracking may help to inform interventions to improve dietary intakes and health outcomes. This study investigated how a dietary pattern (DP) associated with increased adiposity in childhood tracked from 7 to 13 years of age, in the Avon Longitudinal Study of Parents and Children (ALSPAC).

DESIGN AND METHODS

Three-day food diaries were collected at 7, 10 and 13 years. Reduced rank regression was used to score respondents for an energy-dense, high fat, low fiber DP at each age. Tracking coefficients were estimated for the DP and its key foods using data from 7,027 children.

RESULTS

The DP tracking coefficient was 0.48 (95% CI: 0.44-0.52) for boys and 0.38 (95% CI: 0.35-0.41) for girls. Of 10 key food groups, fruit, vegetables, high fiber bread, high fiber breakfast cereals and full fat milk intakes exhibited the strongest tracking, particularly among low consumers. Lower maternal education and greater prepregnancy maternal BMI predicted higher DP z scores and lower fruit and vegetable intakes.

CONCLUSIONS

A dietary pattern associated with increased adiposity tracks moderately from 7 to 13 years of age in this large UK cohort. Specific groups of families may require additional support to foster lifelong healthy dietary habits in their children.

Dietary fat and fatty acid profile are associated with indices of skeletal muscle mass in women aged 18-79 years

Age-related loss of skeletal muscle mass results in a reduction in metabolically active tissue and has been related to the onset of obesity and sarcopenia. Although the causes of muscle loss are poorly understood, dietary fat has been postulated to have a role in determining protein turnover through an influence on both inflammation and insulin resistance. This study was designed to investigate the cross-sectional relation between dietary fat intake, as dietary percentage of fat energy (PFE) and fatty acid profile, with indices of skeletal muscle mass in the population setting. Body composition [fat-free mass (FFM; in kg)] and the fat-free mass index (FFMI; kg FFM/m(2)) was measured by using dual-energy X-ray absorptiometry in 2689 women aged 18-79 y from the TwinsUK Study and calculated according to quintile of dietary fat (by food-frequency questionnaire) after multivariate adjustment. Positive associations were found between the polyunsaturated-to-saturated fatty acid (SFA) ratio and indices of FFM, and inverse associations were found with PFE, SFAs, monounsaturated fatty acids (MUFAs), and trans fatty acids (TFAs) (all as % of energy). Extreme quintile dietary differences for PFE were -0.6 kg for FFM and -0.28 kg/m(2) for FFMI; for SFAs, MUFAs, and TFAs, these were -0.5 to -0.8 kg for FFM and -0.26 to -0.38 kg/m(2) for FFMI. These associations were of a similar magnitude to the expected decline in muscle mass that occurs over 10 y. To our knowledge, this is the first population-based study to demonstrate an association between a comprehensive range of dietary fat intake and FFM. These findings indicate that a dietary fat profile already associated with cardiovascular disease protection may also be beneficial for conservation of skeletal muscle mass.

Comparison of estimated energy intake using Web-based Dietary Assessment Software with accelerometer-determined energy expenditure in children

BACKGROUND

The OPUS (Optimal well-being, development and health for Danish children through a healthy New Nordic Diet) project carried out a school meal study to assess the impact of a New Nordic Diet (NND). The random controlled trial involved 834 children aged 8-11 in nine local authority schools in Denmark. Dietary assessment was carried out using a program known as WebDASC (Web-based Dietary Assessment Software for Children) to collect data from the children.

OBJECTIVE

To compare the energy intake (EI) of schoolchildren aged 8-11 estimated using the WebDASC system against the total energy expenditure (TEE) as derived from accelerometers worn by the children during the same period. A second objective was to evaluate the WebDASC's usability.

DESIGN

Eighty-one schoolchildren took part in what was the pilot study for the OPUS project, and they recorded their total diet using WebDASC and wore an accelerometer for two periods of seven consecutive days: at baseline, when they ate their usual packed lunches and at intervention when they were served the NND. EI was estimated using WebDASC, and TEE was calculated from accelerometer-derived activity energy expenditure, basal metabolic rate, and diet-induced thermogenesis. WebDASC's usability was assessed using a questionnaire. Parents could help their children record their diet and answer the questionnaire.

RESULTS

Evaluated against TEE as derived from the accelerometers worn at the same time, the WebDASC performed just as well as other traditional methods of collecting dietary data and proved both effective and acceptable with children aged 8-11, even with perhaps less familiar foods of the NND.

CONCLUSIONS

WebDASC is a useful method that provided a reasonably accurate measure of EI at group level when compared to TEE derived from accelerometer-determined physical activity in children. WebDASC will benefit future research in this area.

Characteristics of energy intake under-reporting in French adults

Energy intake under-reporting (UR) is a concern in nutritional epidemiological studies, as it may distort the relationships between dietary habits and health. Although UR is known to be associated with certain characteristics, few studies have investigated them in France. Therefore, the goal of the present study was to assess the prevalence and characteristics of UR in French adults. UR was defined according to Goldberg's classification. A sample of 1567 adults was drawn from the nationally representative French dietary survey (Individuelle Nationale des Consommations Alimentaires 2 2006-7). Food intake (7 d record), dietary habits, socio-economic status, region of residence, sedentary behaviour and weight perception variables were assessed. Multivariate logistic regression was used to investigate the associations between UR and a number of covariates. The overall prevalence of UR was 22.5%, similar in men and women. In both sexes, UR was positively associated with overweight and protein intake and inversely associated with age. In women, UR was associated with eating lunch in the office, poor perception of diet quality and sedentary behaviour and was inversely associated with educational level, residence in the Paris region, cereal product intake and eating lunch in a friend's or family member's home. In men, UR was positively associated with a history of slimming and inversely associated with dairy product intake and eating lunch at a staff canteen. In conclusion, UR is prevalent in French adults and is associated with several different characteristics. It is important to take account of UR when investigating diet-disease associations in adults.

Can adherence to dietary guidelines address excess caloric intake? An empirical assessment for the UK

The facilitation of healthier dietary choices by consumers is a key element of government strategies to combat the rising incidence of obesity in developed and developing countries. Public health campaigns to promote healthier eating often target compliance with recommended dietary guidelines for consumption of individual nutrients such as fats and added sugars. This paper examines the association between improved compliance with dietary guidelines for individual nutrients and excess calorie intake, the most proximate determinant of obesity risk. We apply quantile regressions and counterfactual decompositions to cross-sectional data from the National Diet and Nutrition Survey (2000-01) to assess how excess calorie consumption patterns in the UK are likely to change with improved compliance with dietary guidelines. We find that the effects of compliance vary significantly across different quantiles of calorie consumption. Our results show that compliance with dietary guidelines for individual nutrients, even if successfully achieved, is likely to be associated with only modest shifts in excess calorie consumption patterns. Consequently, public health campaigns that target compliance with dietary guidelines for specific nutrients in isolation are unlikely to have a significant effect on the obesity risk faced by the population.

Childhood dietary patterns and later obesity: a review of the evidence

A range of individual nutrients and foods have been suggested to increase obesity risk in childhood, but the evidence is inconsistent. Dietary patterns that summarise the whole diet may, however, be more informative. The aim of the present paper was to systematically review the current evidence pertaining to overall dietary patterns in childhood and later obesity risk. Studies eligible for review identified childhood dietary patterns using an empirical method, i.e. principal components analysis, factor analysis or reduced rank regression, and reported their prospective associations with an obesity-related outcome. Literature searches identified 166 studies and of these, seven met the eligibility criteria. Despite differences between studies, a common dietary pattern was identified in all seven studies that was high in energy-dense, high-fat and low-fibre foods. The quality of studies varied, however; the four studies reporting positive associations between this type of dietary pattern and later obesity risk were of consistently higher quality than those reporting null associations. The balance of evidence from this systematic review indicates that dietary patterns that are high in energy-dense, high-fat and low-fibre foods predispose young people to later overweight and obesity. It also highlights that examining multiple dietary factors within a dietary pattern may better explain obesity risk than individual nutrients or foods. However, more prospective studies are needed and dietary pattern research requires greater rigour and focus, to further clarify the role of dietary factors in the aetiology of obesity and inform future interventions.

Nutrition care for patients with weight regain after bariatric surgery

Achieving optimal weight outcomes for patients with obesity is important to the management of their chronic disease. All interventions present risks for weight regain. Bariatric surgery is the most efficacious treatment, producing greater weight losses that are sustained over more time compared to lifestyle interventions. However, approximately 20-30% of patients do not achieve successful weight outcomes, and patients may experience a regain of 20-25% of their lost weight. This paper reviews several factors that influence weight regain after bariatric surgery, including type of surgery, food tolerance, energy requirements, drivers to eat, errors in estimating intake, adherence, food and beverage choices, and patient knowledge. A comprehensive multidisciplinary approach can provide the best care for patients with weight regain. Nutrition care by a registered dietitian is recommended for all bariatric surgery patients. Nutrition diagnoses and interventions are discussed. Regular monitoring of weight status and early intervention may help prevent significant weight regain.

The evolution of policy and actions to tackle obesity in England

Tackling obesity has been a policy priority in England for more than 20 years. Two formal government strategies on obesity in 2008 and 2011 drew together a range of actions and developed new initiatives to fill perceived gaps. Today, a wide range of policies are in place, including support for breastfeeding and healthy weaning practices, nutritional standards in schools, restrictions on marketing foods high in fat, sugar and salt to children, schemes to boost participation in sport, active travel plans, and weight management services. Data from annual surveys show that the rate of increase in obesity has attenuated in recent years, but has not yet been reversed. This paper considers the actions taken and what is known about the impact of individual policies and the overarching strategy to tackle obesity in England.

The monetary value of diets consumed by British adults: an exploration into sociodemographic differences in individual-level diet costs

OBJECTIVE

To describe the diet costs of adults in the National Diet and Nutrition Study (NDNS) and explore patterns in costs according to sociodemographic indicators.

DESIGN

Cross-sectional diet diary information was matched to a database of food prices to assign a cost to each food or non-alcoholic beverage consumed. Daily diet costs were calculated, as well as costs per 10 MJ to improve comparability across differing energy requirements. Costs were compared between categories of sociodemographic variables and health behaviours. Multivariable regression assessed the effects of each variable on diet costs after adjustment.

SETTING

The NDNS is a rolling dietary survey, recruiting a representative UK sample each year. The study features data from 2008-2010.

SUBJECTS

Adults aged 19 years or over were included. The sample consisted of 1014 participants.

RESULTS

The geometric mean daily diet cost was £2·89 (95 % CI £2·81, £2·96). Energy intake and daily diet cost were strongly associated. The mean energy-adjusted cost was £4·09 (95 % CI £4·01, £4·18) per 10 MJ. Energy-adjusted costs differed significantly between many subgroups, including by sex and household income. Multivariable regression found significant effects of sex, qualifications and occupation (costs per 10 MJ only), as well as equivalized household income, BMI and fruit and vegetable consumption on diet costs.

CONCLUSIONS

This is the first time that monetary costs have been applied to the diets of NDNS adults. The findings suggest that certain subgroups in the UK - for example those on lower incomes - consume diets of lower monetary value. Observed differences were mostly in the directions anticipated.