The National Cancer Institute's Dietary Assessment Primer: A Resource for Diet Research

Glucose tolerance in Canadian and French cystic fibrosis adult patients

Cystic fibrosis (CF)-related diabetes is associated with increased mortality. We analysed the clinical and glycemic profiles of two cohorts of patients treated according to the same guidelines in France and Canada. To investigate incidence differences in phenotypic and glucose abnormalities and to explore the evolution over a 4-year follow-up period, two cohorts of 224 Canadian and 147 French adult CF patients (≥18 years) without treated CF-related diabetes (CFRD) were followed over a 4 year period. In each of these groups, we investigated the longitudinal relationship between glucose tolerance and pulmonary function. An annual 2-hour oral glucose tolerance test was performed: fasting blood glucose (G0) and 2-h blood glucose (G2) were measured. Patients were classified at inclusion according to their glucose tolerance status: Normal glucose tolerant, abnormal glucose tolerant or de novo CFRD. Age, sex ratio and proportion of F508del homozygous patients were not statistically different between both cohorts. Canadian patients had better pulmonary function (median %FEV1 (IQR): 71.0 (55.0–82.0) vs. 64.0 (40.0–78.0), p < 0.001) and greater body mass index (BMI; median BMI in kg/m²) (IQR) 21.1 (19.5–22.8) vs. 19.9 (18.4–21.4), p < 0.001). Glucose values: G0 (5.4 (5.0–5.9) vs. 4.8 (4.5–5.1) mmol/L, p < 0.001) and G2 (7.6 (5.8–9.7) vs. 6.5 (5.2–8.5) mmol/L, p = 0.001) were higher in the Canadian cohort translating into a higher incidence of de novo CFRD diagnosis (19.2 vs. 9.8%, p = 0.003). Decline in FEV1 over time was not different between patients according to glucose tolerance groups. Despite higher glucose levels and incidence of de novo CFRD, Canadian CF patients have a better lung function and a higher BMI than French patients. In spite of these differences between the cohorts, the decline in FEV1 in patients with abnormal glucose tolerance is similar between these groups.

Proceedings from the 2018 Association for Chemoreception Annual Meeting Symposium: Bariatric Surgery and Its Effects on Taste and Food Selection

This article provides a summary of the topics discussed at the symposium titled "Bariatric Surgery and Its Effects on Taste and Food Selection," which was held at the Fortieth Annual Meeting of the Association for Chemoreception Sciences. Bariatric surgery such as Roux-en-Y gastric bypass (RYGB) is currently one of the most effective treatments available for weight loss and Type 2 diabetes. For this reason, it is of great interest to clinicians as well as to basic scientists studying the controls of feeding and energy balance. Despite the commonly held view by clinicians that RYGB patients change their food preferences away from fats and sugars in favor of less energy dense alternatives such as vegetables, the empirical support for this claim is equivocal. It is currently thought that the taste and palatability of fats and sugars are affected by the surgery. Some key preclinical and clinical findings addressing these issues were evaluated in this symposium.

Child assessments of vegetable preferences and cooking self-efficacy show predictive validity with targeted diet quality measures

Background

Cooking interventions have the potential to improve child diet quality because cooking involvement is associated with positive changes in dietary behavior. Valid and reliable instruments that are low-cost and convenient to administer are needed to feasibly assess the impact of cooking interventions on dietary behavior. The purpose of the current research is to examine the validity of fruit and vegetable preferences, cooking attitudes and self-efficacy assessments to predict targeted Healthy Eating Index-2010 (HEI) scores among 4th-grade youth.

Methods

Child fruit and vegetable preferences, cooking attitudes, self-efficacy, age, sex and race/ethnicity were collected with the Fuel for Fun survey in classroom settings using a standardized administration protocol. Child dietary assessment data consisted of three 24-h dietary recalls collected by telephone over a 2–4 week period by trained interviewers using a standard protocol. Bootstrapped linear regressions examined the predictive validity of fruit and vegetable preference, cooking attitudes and cooking self-efficacy for the Total and 4 targeted HEI components: whole fruit, total vegetables, green vegetables and beans, and empty calories. Logistic regressions were used to confirm the relationships between Fuel for Fun survey items and HEI components. Sex and a categorical variable for race/ethnicity were included as a priori controls in each regression model.

Results

Vegetable preference predicted positive associations with HEI Total Score, Total Vegetables, and Green Vegetables and Beans (p < 0.05) Each additional 2 point increase in cooking self-efficacy was associated with a 1.33 point HEI Score increase, even after including BMI z-score as a control (b = 0.667, p = 0.003). Fruit preference and cooking attitudes did not significantly predict HEI total or component scores.

Conclusions

This study provides evidence that low-cost, validated measures of vegetable preferences and cooking self-efficacy predict diet quality in 4th grade children. These results also reinforce the relationship between cooking and healthful dietary behavior.

Dietary assessment toolkits: an overview

OBJECTIVE

A wide variety of methods are available to assess dietary intake, each one with different strengths and weaknesses. Researchers face multiple challenges when diet and nutrition need to be accurately assessed, particularly in the selection of the most appropriate dietary assessment method for their study. The goal of the current collaborative work is to present a collection of available resources for dietary assessment implementation.Design/Setting/ParticipantsAs a follow-up to the 9th International Conference on Diet and Physical Activity Methods held in 2015, developers of dietary assessment toolkits agreed to collaborate in the preparation of the present paper, which provides an overview of each toolkit. The toolkits presented include: the Diet, Anthropometry and Physical Activity Measurement Toolkit (DAPA; UK); the National Cancer Institute's (NCI) Dietary Assessment Primer (USA); the Nutritools website (UK); the Australasian Child and Adolescent Obesity Research Network (ACAORN) method selector (Australia); and the Danone Dietary Assessment Toolkit (DanoneDAT; France). An at-a-glance summary of features and comparison of the toolkits is provided.

RESULTS

The present review contains general background on dietary assessment, along with a summary of each of the included toolkits, a feature comparison table and direct links to each toolkit, all of which are freely available online.

CONCLUSIONS

This overview of dietary assessment toolkits provides comprehensive information to aid users in the selection and implementation of the most appropriate dietary assessment method, or combination of methods, with the goal of collecting the highest-quality dietary data possible.

Development and relative validation of a short food frequency questionnaire for assessing dietary intakes of non-alcoholic fatty liver disease patients

Purpose

This work aimed to design and validate a novel short food frequency questionnaire (SFFQ) to assess habitual intakes of food items related to non-alcoholic fatty liver disease (NAFLD) in a cohort of European patients.

Methods

A 48-item SFFQ was created, with questions from existing FFQs and expert knowledge, emphasizing foods and nutrients implicated in NAFLD pathogenesis. Consenting, fibroscan-diagnosed, NAFLD patients completed the SFFQ during a short interview and were asked to complete a 4-day diet diary (4DDD) at home for return by mail. Nutritional intakes were assessed utilizing the myfood24™ food composition dataset and estimated energy requirements (EER) were calculated using sex-, age- and weight-specific equations. Agreement between the dietary instruments was assessed by Spearman correlations and Bland Altman analysis.

Results

Fifty-five patients completed both the SFFQ and the 4DDD within 30 weeks; 42 (76%) were diagnosed with simple steatosis, whereas 13 (24%) had biopsy-proven steatohepatitis; the majority were overweight or obese, with a median (25th; 75th percentile) BMI of 33.2 kg/m² (29.3; 36.0). Reported energy intakes were well below EER with a median intake of 73% of requirements, suggesting widespread under-reporting. Significant correlations were observed between sugar (r = 0.408, P = 0.002), fat (r = 0.44, P = 0.001), fruits (r = 0.51, P = 0.0001) and vegetables (r = 0.40, P = 0.0024) measurements by the SFFQ and 4DDD. Bland Altman plots with regression analysis demonstrated broad comparability with the 4DDD for intakes of fat (bias − 13.8 g/day) and sugar (bias  + 12.9 g/day).

Conclusions

A novel SFFQ designed to be minimally burdensome to participants was effective at assessing dietary intakes in NAFLD patients.

Electronic supplementary material

The online version of this article (10.1007/s00394-019-01926-5) contains supplementary material, which is available to authorized users.

Best Practices for Dietary Supplement Assessment and Estimation of Total Usual Nutrient Intakes in Population-Level Research and Monitoring

The use of dietary supplements (DS) is pervasive and can provide substantial amounts of micronutrients to those who use them. Therefore when characterizing dietary intakes, describing the prevalence of inadequacy or excess, or assessing relations between nutrients and health outcomes, it is critical to incorporate DS intakes to improve exposure estimates. Unfortunately, little is known about the best methods to assess DS, and the structure of measurement error in DS reporting. Several characteristics of nutrients from DS are salient to understand when comparing to those in foods. First, DS can be consumed daily or episodically, in bolus form and can deliver discrete and often very high doses of nutrients that are not limited by energy intakes. These characteristics contribute to bimodal distributions and distributions severely skewed to the right. Labels on DS often provide nutrient forms that differ from those found in conventional foods, and underestimate analytically derived values. Finally, the bioavailability of many nutrient-containing DS is not known and it may not be the same as the nutrients in a food matrix. Current methods to estimate usual intakes are not designed specifically to handle DS. Two temporal procedures are described to refer to the order that nutrient intakes are combined relative to usual intake procedures, referred to as a "shrinking" the distribution to remove random error. The "shrink then add" approach is preferable to the "add then shrink" approach when users and nonusers are combined for most research questions. Stratifying by DS before usual intake methods is another defensible option. This review describes how to incorporate nutrient intakes from DS to usual intakes from foods, and describes the available methods and fit-for-purpose of different analytical strategies to address research questions where total usual intakes are of interest at the group level for use in nutrition research and to inform policy decisions. Clinical Trial Registry: NCT03400436.

Saturated Fat Intake Is Associated with Lung Function in Individuals with Airflow Obstruction: Results from NHANES 2007⁻2012

Nutritional status is a well-recognized prognostic indicator in chronic obstructive pulmonary disease (COPD); however, very little is known about the relationship between lung function and saturated fat intake. We used data from the cross-sectional National Health and Nutrition Examination Surveys (NHANES) to assess the relationship between saturated fatty acid (SFA) intake and lung function in the general US adult population. Adults in NHANES (2007⁻2012) with pre-bronchodilator spirometry measurements and dietary SFA intake were included. Primary outcomes were lung function including forced expiratory volume in one second (FEV₁)_, FEV₁, forced vital capacity (FVC), FEV₁/FVC ratio, percent predicted FEV₁ and percent predicted FVC. Multivariable regression models in the general population as well as those with spirometry-defined airflow obstruction were used to assess the relationship between lung function measurements and dietary SFA intake after adjustment for confounders. 11,180 eligible participants were included in this study. Univariate analysis revealed a statistically significant positive association between total SFA intake and lung function outcomes; however, these relationships were attenuated after adjustment for covariates. A secondary analysis of individuals with spirometry-defined airflow obstruction (FEV₁/FVC < 0.7) revealed that a lower intake of SFA was associated with reduced FEV₁ (β = -126.4, p = 0.04 for quartile 1 vs. quartile 4), FVC (β = -165.8. p = 0.01 for quartile 1 vs. quartile 4), and percent predicted FVC (β = -3.3. p = 0.04 for quartile 1 vs. quartile 4), after adjustment for relevant confounders. No associations were observed for the FEV₁/FVC ratio and percent predicted FEV₁. It is possible that characteristics such as food source and fatty acid chain length may influence associations between saturated fatty acid intake and health outcomes.

Differential reporting of fruit and vegetable intake among youth in a randomized controlled trial of a behavioral nutrition intervention

Background

Nutrition interventions typically rely on self-reported intake that may be susceptible to differential reporting bias due to exposure to the intervention. Such differences may result from increased social desirability, increased attention to eating or improved recall accuracy, and may bias estimates of the intervention effect. This study investigated differential reporting bias of fruit and vegetable intake in youth with type 1 diabetes participating in a randomized controlled trial targeting increased whole plant food intake.

Methods

Participants (treatment n = 66, control n = 70) completed 3-day food records at baseline, 6-,12-, and 18-months, from which fruit and vegetable intake (servings/day) was calculated. Serum carotenoids were assessed at these visits using a high-performance liquid chromatography-based assay. Linear regression estimated associations of fruit and vegetable intake with serum carotenoids by treatment assignment. Multiplicative interaction terms tested the interaction of treatment assignment with fruit and vegetable intake on serum carotenoids for each visit and within each group over time.

Results

The association of fruit and vegetable intake with serum carotenoids was significantly lower in the control versus intervention group at baseline (β = 0.22 Vs 0.46) and 6-month visits (β = 0.37 Vs 0.54), as evidenced by significant interaction effects. However, the association of fruit and vegetable intake with serum carotenoids did not significantly differ over time for either group.

Conclusions

While the stronger association of fruit and vegetable with carotenoids in the treatment arm suggests greater reporting accuracy, this difference was evident at baseline, and did not change significantly over time in either group. Thus, results indicate greater subject-specific bias in the control arm compared to the treatment, and lack of evidence for reactivity to the intervention by treatment assignment.

Clinical trial registry number and website

NCT00999375

Electronic supplementary material

The online version of this article (10.1186/s12966-019-0774-9) contains supplementary material, which is available to authorized users.

Socioeconomic Disadvantage across the Life Course Is Associated with Diet Quality in Young Adulthood

Socioeconomic position (SEP) is a key determinant of diet quality across the life course. Young adulthood is a unique period of transition where dietary inequities between groups with lower and higher SEP may widen. This study investigated associations between SEP in both childhood and young adulthood and diet quality in young adulthood. Data from 1949 Canadian young adults aged 18⁻30 who participated in the Canada Food Study were analyzed. Healthy Eating Index⁻2015 (HEI-2015) scores were calculated based on one 24-hour dietary recall. Childhood and young adult SEP were represented by self-report of participants' parent(s)' and their own highest educational level, respectively. Linear regression was used to examine associations between childhood and adult SEP and adult HEI-2015 score. Mediation analyses examined whether adult SEP mediated the relationship between childhood SEP and adult HEI-2015 score. Lower SEPs in childhood and adulthood were each associated with lower HEI-2015 scores in young adulthood. Adult SEP mediated up to 13.0% of the association between childhood SEP and adult HEI-2015 scores. Study findings provide support for key life course hypotheses and suggest latent, pathway, and cumulative effects of SEP across the early life course in shaping the socioeconomic patterning of diet quality in young adulthood.

A lifestyle intervention of weight loss via a low-carbohydrate diet plus walking to reduce metabolic disturbances caused by androgen deprivation therapy among prostate cancer patients: carbohydrate and prostate study 1 (CAPS1) randomized controlled trial

PURPOSE

The objective of this study was to test a low-carbohydrate diet (LCD) plus walking to reduce androgen deprivation therapy (ADT)-induced metabolic disturbances.

MATERIALS AND METHODS

This randomized multi-center trial of prostate cancer (PCa) patients initiating ADT was designed to compare an LCD (≤20g carbohydrate/day) plus walking (≥30 min for ≥5 days/week) intervention vs. control advised to maintain usual diet and exercise patterns. Primary outcome was change in insulin resistance by homeostatic model assessment at 6 months. To detect 20% reduction in insulin resistance, 100 men were required. The study was stopped early after randomizing 42 men due to slow accrual. Secondary outcomes included weight, body composition, lipids, and prostate-specific antigen (PSA). Changes from baseline were compared between arms using rank-sum tests.

RESULTS

At 6 months, LCD/walking reduced insulin resistance by 4% vs. 36% increase in control (p = 0.13). At 3 months, vs. control, LCD/walking arm significantly lost weight (7.8kg; p<0.001), improved insulin resistance (↑36%; p = 0.015), hemoglobin A1c (↓3.3%; p = 0.01), high-density lipoprotein (HDL) (↑13%; p = 0.004), and triglyceride (↓37%; p = 0.036). At 6 months, weight loss (10.6kg; p<0.001) and HDL (↑27%; p = 0.003) remained significant. LCD/walking preserved total body bone mineral count (p = 0.025), reduced fat mass (p = 0.002), lean mass (p = 0.036), and percent body fat (p = 0.004). There were no differences in PSA. Limitations include the effect of LCD, weight loss vs. walking instruction are indistinguishable, and small sample size.

CONCLUSIONS

In an underpowered study, LCD/walking did not improve insulin sensitivity at 6 months. Given most secondary outcomes were improved at 3 months with some remaining improved at 6 months and a secondary analysis showed that LCD/walking reduced insulin resistance over the study, supporting future larger studies of LCD/walking intervention to reduce ADT-induced disturbances.

Dietary Intake Reporting Accuracy of the Bridge2U Mobile Application Food Log Compared to Control Meal and Dietary Recall Methods

Mobile technology introduces opportunity for new methods of dietary assessment. The purpose of this study was to compare the reporting accuracy of a mobile food log application and 24 h recall method to a controlled meal among a convenience sample of adults (18 years of age or older). Participants were recruited from a community/university convenience sample. Participants consumed a pre-portioned control meal, completed mobile food log entry (mfood log), and participated in a dietary recall administered by a registered dietitian (24R). Height, weight, and application use survey data were collected. Sign test, Pearson’s correlation, and descriptive analyses were conducted to examine differences in total and macronutrient energy intake and describe survey responses. Bland Altman plots were examined for agreement between energy intake from control and 24R and mfood log. The 14 included in the analyses were 78.6% female, 85.7% overweight/obese, and 64.3% African American. Mean total energy, protein, and fat intakes reported via the mfood log were significantly (p < 0.05) lower compared to the control, by 268.31kcals, 20.37 g, and 19.51 g, respectively. Only 24R mean fat intake was significantly (p < 0.01) lower than the control, by 6.43 g. Significant associations (r = 0.57–0.60, p < 0.05) were observed between control and mfood log mean energy, carbohydrate, and protein intakes, as well as between control and 24R mean energy (r = 0.64, p = 0.01) and carbohydrate (r = 0.81, p < 0.001) intakes. Bland Altman plots showed wide limits of agreement, which were not statistically significant but may have practical limitations for individual dietary assessment. Responses indicated the ease of and likelihood of daily mfood log use. This study demonstrates that the Bridge2U mfood log is valid for the assessment of group level data, but data may vary too widely for individual assessment. Further investigation is warranted for nutrition intervention research.

Empirically derived dietary patterns through latent profile analysis among Brazilian children and adolescents from Southern Brazil, 2013-2015

The aims of this study were to identify dietary patterns (DPs) of children and adolescents participating in three cross-sectional surveys (2013-2015) and to test their associations with sociodemographic variables, physical activity (PAS), screen-based sedentary activity (SA), and weight status. One-day data were obtained from 5,364 schoolchildren (7-12 years) from public schools of Florianopolis (South of Brazil), using the validated questionnaire Web-CAAFE (Food Intake and Physical Activity of Schoolchildren). DPs were derived from the frequency of daily consumption of 32 foods/beverages by latent profile analysis. Multinomial logistic regression analysis was used to estimate the association of the DPs with sociodemographic variables, physical activity, screen activity and weight status. 'Traditional', 'Monotonous', and 'Mixed' DPs were identified. The percentages of children and adolescents within these profiles were 41.3, 36.3, and 22.4%, respectively. Children and adolescents in the highest tertiles of both PAS and daily frequency of SA had a higher probability to present a 'Mixed' DP compared to peers with less PAS and SA. Children and adolescents who reported having a school meal were significantly more likely to present the 'Traditional'DP, while boys who did not report having a school meal had a higher probability to present the 'Monotonous' DP. The DPs were not associated with the year of survey, age, family income, or weight status.

The Provision of Assistance Does Not Substantially Impact the Accuracy of 24-Hour Dietary Recalls Completed Using the Automated Self-Administered 24-H Dietary Assessment Tool among Women with Low Incomes

Background

Evidence is lacking informing the use of the Automated Self-Administered 24-h Dietary Assessment Tool (ASA24) with populations characterized by low income.

Objective

This study was conducted among women with low incomes to evaluate the accuracy of ASA24 recalls completed independently and with assistance.

Methods

Three hundred and two women, aged ≥18 y and with incomes below the Supplemental Nutrition Assistance Program thresholds, served themselves from a buffet; amounts taken as well as plate waste were unobtrusively weighed to enable calculation of true intake for 3 meals. The following day, women completed ASA24-2016 independently (n = 148) or with assistance from a trained paraprofessional in a small group (n = 154). Regression modeling examined differences by condition in agreement between true and reported foods; energy, nutrient, and food group intakes; and portion sizes.

Results

Participants who completed ASA24 independently and those who received assistance reported matches for 71.9% and 73.5% (P = 0.56) of items truly consumed, respectively. Exclusions (consumed but not reported) were highest for lunch (at which participants consumed approximately 2 times the number of distinct foods and beverages compared with breakfast and dinner). Commonly excluded foods were additions to main dishes (e.g., tomatoes in salad). On average, excluded foods contributed 43.6 g (46.2 kcal) and 40.1 g (43.2 kcal) among those in the independent and assisted conditions, respectively. Gaps between true and reported intake were different between conditions for folate and iron. Within conditions, significant gaps were observed for protein, vitamin D, and meat (both conditions); vitamin A, iron, and magnesium (independent); and folate, calcium, and vegetables (assisted). For foods and beverages for which matches were reported, no difference in the gap between true and reported portion sizes was observed by condition (P = 0.22).

Conclusions

ASA24 performed relatively well among women with low incomes; however, accuracy was somewhat lower than previously observed among adults with a range of incomes. The provision of assistance did not significantly impact accuracy.

Validity of Dietary Assessment Methods When Compared to the Method of Doubly Labeled Water: A Systematic Review in Adults

Accuracy in quantifying energy intake (EI) using common dietary assessment methods is crucial for interpreting the relationship between diet and chronic disease. The aim of this systematic review was to evaluate the validity of dietary assessment methods used to estimate the EI of adults in comparison to total energy expenditure (TEE) measured by doubly labeled water (DLW). Articles in English across nine electronic databases, published between 1973 and February 2019 were retrieved. Studies were included if participants were adults (≥18 years) and used the DLW technique to measure TEE compared to self-reported EI. A total of 59 studies were included, with a total of 6,298 free living adults and a mean of 107 participants per study. The majority of studies including 16 studies that included a technology based method reported significant (P < 0.05) under-reporting of EI when compared to TEE, with few over-reporting EI. Misreporting was more frequent among females compared to males within recall based dietary assessment methods. The degree of under-reporting was highly variable within studies using the same method, with 24 h recalls having less variation and degree of under-reporting compared to other methods.

Unaccompanied homeless youth have extremely poor diet quality and nutritional status

A lack of in-depth assessment of the nutritional status of homeless youth precludes interventions that achieve nutritional adequacy. We enrolled 118 unaccompanied homeless youth to obtain sociodemographic and health data along with dietary, anthropometric, biochemical, and clinical assessments. As a reference, homeless youth data were compared to a convenience sample of 145 college students. Obesity was prevalent among homeless youth than among college students (29% vs. 8% respectively (CI: 11.2, 29.9). Among homeless youth, 74% of females versus 41% of males were overweight/obese (CI: 14.9, 51.2). Homeless youth also had poor diet quality (44.37 (SD: 12.64)). Over 70% of homeless youth had inadequate intakes of vitamins A, C, D₃ and E, as well as calcium and magnesium. Our findings show increased weight, adiposity, and suboptimal intakes of essential nutrients among unaccompanied homeless youth. Further studies are needed to inform evidence-based nutrition interventions that will aid in improving their nutritional health.

A Comparison of a Pulse-Based Diet and the Therapeutic Lifestyle Changes Diet in Combination with Exercise and Health Counselling on the Cardio-Metabolic Risk Profile in Women with Polycystic Ovary Syndrome: A Randomized Controlled Trial

We compared the effects of a low-glycemic index pulse-based diet, containing lentils, beans, split peas, and chickpeas, to the Therapeutic Lifestyle Changes (TLC) diet on cardio-metabolic measures in women with polycystic ovary syndrome (PCOS). Ninety-five women (18⁻35 years) enrolled in a 16-week intervention; 30 women in the pulse-based and 31 in the TLC groups completed the study. Women participated in aerobic exercise training (minimum 5 days/week for 45 min/day) and were counselled (monthly) about PCOS and lifestyle modification. Women underwent longitudinal follow-up post-intervention. The pulse-based group had a greater reduction in total area under the curve for insulin response to a 75-g oral glucose tolerance test (mean change ± SD: -121.0 ± 229.9 vs. -27.4 ± 110.2 µIU/mL × min; p = 0.05); diastolic blood pressure (-3.6 ± 6.7 vs. -0.2 ± 6.7 mmHg, p = 0.05); triglyceride (-0.2 ± 0.6 vs. 0.0 ± 0.5 mmol/L, p = 0.04); low-density lipoprotein cholesterol (-0.2 ± 0.4 vs. -0.1 ± 0.4 mmol/L, p = 0.05); total cholesterol/high-density lipoprotein cholesterol (TC/HDL-C; -0.4 ± 0.4 vs. 0.1 ± 0.4, p < 0.001); and a greater increase in HDL-C (0.1 ± 0.2 vs. -0.1 ± 0.2 mmol/L, p < 0.01) than the TLC group. Decreased TC/HDL-C (p = 0.02) at six-month and increased HDL-C and decreased TC/HDL-C (p ≤ 0.02) at 12-month post-intervention were maintained in the pulse-based group. A pulse-based diet may be more effective than the TLC diet at improving cardio-metabolic disease risk factors in women with PCOS.

TRIAL REGISTRATION

CinicalTrials.gov identifier, NCT01288638.

Comparing Interviewer-Administered and Web-Based Food Frequency Questionnaires to Predict Energy Requirements in Adults

Traditional food frequency questionnaires (FFQs) are influenced by systematic error, but web-based FFQ (WEB-FFQs) may mitigate this source of error. The objective of this study was to compare the accuracy of interview-based and web-based FFQs to assess energy requirements (mERs). The mER was measured in a series of controlled feeding trials in which participants daily received all foods and caloric drinks to maintain stable body weight over 4 to 6 weeks. FFQs assessing dietary intakes and hence mean energy intake were either interviewer-administered by a registered dietitian (IA-FFQ, n = 127; control method) or self-administered using a web-based platform (WEB-FFQ, n = 200; test method), on a single occasion. Comparison between self-reported energy intake and mER revealed significant under-reporting with the IA-FFQ (-9.5%; 95% CI, -12.7 to -6.1) and with the WEB-FFQ (-11.0%; 95% CI, -15.4 to -6.4), but to a similar extent between FFQs (p = 0.62). However, a greater proportion of individuals were considered as accurate reporters of energy intake using the IA-FFQ compared with the WEB-FFQ (67.7% vs. 48.0%, respectively), while the prevalence of over-reporting was lower with the IA-FFQ than with the WEB-FFQ (6.3% vs. 17.5%, respectively). These results suggest less accurate prediction of true energy intake by a self-administered WEB-FFQ than with an IA-FFQ.

Applications of the Healthy Eating Index for Surveillance, Epidemiology, and Intervention Research: Considerations and Caveats

The Healthy Eating Index (HEI) is a measure of diet quality that can be used to examine alignment of dietary patterns with the Dietary Guidelines for Americans. The HEI is made up of multiple adequacy and moderation components, most of which are expressed relative to energy intake (ie, as densities) for the purpose of calculating scores. Due to these characteristics and the complexity of dietary intake data more broadly, calculating and using HEI scores can involve unique statistical considerations and, depending on the particular application, intensive computational methods. The objective of this article is to review potential applications of the HEI, including those relevant to surveillance, epidemiology, and intervention research, and to summarize available guidance for appropriate analysis and interpretation. Steps in calculating HEI scores are reviewed and statistical methods described. Consideration of salient issues in the calculation and interpretation of scores can help researchers avoid common pitfalls and reviewers ensure that articles reporting on the use of the HEI include sufficient details such that the work is comprehensible and replicable, with the overall goal of contributing to knowledge on dietary patterns and health among Americans.

Dietary Nitrate and Diet Quality: An Examination of Changing Dietary Intakes within a Representative Sample of Australian Women

Dietary nitrate is increasingly linked to a variety of beneficial health outcomes. Our purpose was to estimate dietary nitrate consumption and identify key dietary changes which have occurred over time within a representative sample of Australian women. Women from the 1946–1951 cohort of the Australian Longitudinal Study on Women’s Health with complete food frequency questionnaire data for both 2001 and 2013 were included for analysis. Dietary nitrate intakes were calculated using key published nitrate databases. Diet quality scores including the Australian Recommended Food Score, the Mediterranean Diet Score and the Nutrient Rich Foods Index were calculated along with food group serves as per the Australian Dietary Guidelines. Wilcoxon matched pairs tests were used to test for change in dietary intakes and Spearman’s correlations were used to examine associations. In our sample of 8161 Australian women, dietary nitrate intakes were on average 65–70 mg/day, and we detected a significant increase in dietary nitrate consumption over time (+6.57 mg/day). Vegetables were the primary source of dietary nitrate (81–83%), in particular lettuce (26%), spinach (14–20%), beetroot (10–11%), and celery (7–8%) contributed primarily to vegetable nitrate intakes. Further, increased dietary nitrate intakes were associated with improved diet quality scores (r = 0.3, p < 0.0001). Although there is emerging evidence indicating that higher habitual dietary nitrate intakes are associated with reduced morbidity and mortality, future work in this area should consider how dietary nitrate within the context of overall diet quality can facilitate health to ensure consistent public health messages are conveyed.

Simple and sensitive dilute-and-shoot analysis of carotenoids in human plasma

Carotenoids in human plasma are used as biomarkers of vegetable and fruit intake. Large sample volumes and intensive sample processing make measurement of these species cumbersome. We developed a dilute-and-shoot method for the quantitation of α-carotene, β-carotene, β-cryptoxanthin, lycopene and lutein/zeaxanthin using 10 μL of plasma. Plasma was injected into methanol containing internal standard and deproteinized by centrifugation. The carotenoids in the supernatant were separated using a YMC C-30 column and quantified by tandem mass spectrometry. The linearity for carotenoids ranged from sub-fmol to approximately 300 fmol on-column. Spike recovery experiments were used to correct for matrix effects. The method was validated using the human plasma standard NIST SRM 968e. Over 400 sample analyses were performed using the same guard and analytical columns. This method represents an improvement over current techniques because of the small sample size needed, ease of sample preparation, and improvement in the determination of carotenoid content.

A taxonomic signature of obesity in a large study of American adults

Animal models suggest that gut microbiota contribute to obesity; however, a consistent taxonomic signature of obesity has yet to be identified in humans. We examined whether a taxonomic signature of obesity is present across two independent study populations. We assessed gut microbiome from stool for 599 adults, by 16S rRNA gene sequencing. We compared gut microbiome diversity, overall composition, and individual taxon abundance for obese (BMI ≥ 30 kg/m2), overweight (25 ≤ BMI < 30), and healthy-weight participants (18.5 ≤ BMI < 25). We found that gut species richness was reduced (p = 0.04), and overall composition altered (p = 0.04), in obese (but not overweight) compared to healthy-weight participants. Obesity was characterized by increased abundance of class Bacilli and its families Streptococcaceae and Lactobacillaceae, and decreased abundance of several groups within class Clostridia, including Christensenellaceae, Clostridiaceae, and Dehalobacteriaceae (q < 0.05). These findings were consistent across two independent study populations. When random forest models were trained on one population and tested on the other as well as a previously published dataset, accuracy of obesity prediction was good (~70%). Our large study identified a strong and consistent taxonomic signature of obesity. Though our study is cross-sectional and causality cannot be determined, identification of microbes associated with obesity can potentially provide targets for obesity prevention and treatment.

Diet-Quality and Socio-Demographic Factors Associated with Non-Nutritive Sweetener Use in the Australian Population

Non-nutritive sweeteners (NNS) are used in the food supply to replace sugar and/or to reduce dietary energy intake. The aim of this research was to assess the consumption prevalence and food sources of NNS in the Australian population. Food group and nutrient intakes were assessed to compare diet quality of NNS consumers and non-consumers. Secondary analysis of the Australian National Nutrition and Physical Activity Survey, 2011/12 was conducted (n = 12,435) after identifying all NNS products consumed in the population. The proportion of participants that reported intake of NNS per day was 18.2% for adults (19+ years), and 8.5% for children (2–18 years), with the most common food sources being carbonated soft drinks, tabletop sweeteners, and yoghurt. Characteristics associated with NNS consumption in adults included being female, higher body mass index (BMI), self-reported diabetes status, and being on a weight-loss diet. For adults, NNS consumers had lower free sugar intake but energy intake did not differ from non-consumers. However, for children, no differences in free sugar or energy intake were observed between consumers and non-consumers. While these results support the use of NNS in reducing sugar intake, these data suggest compensatory increases in energy intake may occur.

Dietary approaches to treat MS-related fatigue: comparing the modified Paleolithic (Wahls Elimination) and low saturated fat (Swank) diets on perceived fatigue in persons with relapsing-remitting multiple sclerosis: study protocol for a randomized controlled trial

BACKGROUND

Fatigue is one of the most disabling symptoms of multiple sclerosis (MS) and contributes to diminishing quality of life. Although currently available interventions have had limited success in relieving MS-related fatigue, clinically significant reductions in perceived fatigue severity have been reported in a multimodal intervention pilot study that included a Paleolithic diet in addition to stress reduction, exercise, and electrical muscle stimulation. An optimal dietary approach to reducing MS-related fatigue has not been identified. To establish the specific effects of diet on MS symptoms, this study focuses on diet only instead of the previously tested multimodal intervention by comparing the effectiveness of two dietary patterns for the treatment of MS-related fatigue. The purpose of this study is to determine the impact of a modified Paleolithic and low saturated fat diet on perceived fatigue (primary outcome), cognitive and motor symptoms, and quality of life in persons with relapsing-remitting multiple sclerosis (RRMS).

METHODS/DESIGN

This 36-week randomized clinical trial consists of three 12-week periods during which assessments of perceived fatigue, quality of life, motor and cognitive function, physical activity and sleep, diet quality, and social support for eating will be collected. The three 12-week periods will consist of the following: 1.

OBSERVATION

Participants continue eating their usual diet. 2.

INTERVENTION

Participants will be randomized to a modified Paleolithic or low saturated fat diet for the intervention period. Participants will receive support from a registered dietitian (RD) through in-person coaching, telephone calls, and emails. 3.

FOLLOW-UP

Participants will continue the study diet for an additional 12 weeks with minimal RD support to assess the ability of the participants to sustain the study diet on their own.

DISCUSSION

Because fatigue is one of the most common and disabling symptoms of MS, effective management and reduction of MS-related fatigue has the potential to increase quality of life in this population. The results of this study will add to the evidence base for providing dietary recommendations to treat MS-related fatigue and other symptoms associated with this disease.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT02914964 . Registered on 24 August 2016.

Trends in linoleic acid intake in the United States adult population: NHANES 1999-2014

Linoleic acid (LA), the primary polyunsaturated fatty acid (PUFA) in the US diet, is an essential fatty acid. LA is available from a wide variety of foods, although it is primarily sourced from plant seed oils. Individual-level data on demography and food and nutrient intake were acquired from the NHANES waves 1999-2000, 2001-2002, 2003-2004, 2005-2006, 2007-2008, 2009-2010, 2011-2012, and 2013-2014. Mean daily intake of (LA) was estimated for each survey wave overall, and by age, gender, educational attainment, race/ethnicity, and income-to-poverty ratio. Linear temporal (1999-2014) trends in LA intake were estimated using univariate linear regression tests, with P < 0.05 and a two-tailed distribution. We found that US adults meet intake recommendation for LA and observed a trend of increasing intake of LA in the US overall and by sub-categories of age, sex, education, race/ethnicity, and income-to-poverty ratio.

Dietary Selenium Intake and Subclinical Hypothyroidism: A Cross-Sectional Analysis of the ELSA-Brasil Study

Selenium (Se) participates in several enzymatic reactions necessary for regulating the homeostasis of thyroid hormones. We aimed to analyze the association between dietary Se intake and subclinical hypothyroidism. Baseline data from the Longitudinal Study of Adult Health (Estudo Longitudinal de Saúde do Adulto-ELSA-Brasil) in Brazil were analyzed, with a final sample size of 14,283 employees of both sexes aged 35⁻74 years. Dietary data was collected using a previously validated food frequency questionnaire. Subclinical hypothyroidism was categorized as thyroid-stimulating hormone levels of >4.0 IU/mL and free prohormone thyroxine levels within normal limits, without administering drugs for thyroid disease. A multiple logistic regression model was used to assess the relationship between the presence of subclinical hypothyroidism and tertiles of Se consumption. The prevalence of subclinical hypothyroidism in the study sample was 5.4% (95% confidence interval [CI], 3.8⁻7.0%). Compared with the first tertile of Se intake, the second (odds ratio [OR], 0.79; 95% CI, 0.65⁻0.96%) and third (OR, 0.72; 95% CI, 0.58⁻0.90%) tertiles were inversely associated with subclinical hypothyroidism, however further research is needed to confirm the involvement of Se in subclinical hypothyroidism using more accurate methodologies of dietary assessment and nutritional status to evaluate this relationship.

Association of Coffee and Tea Intake with the Oral Microbiome: Results from a Large Cross-Sectional Study

Background: The oral microbiota play a central role in oral health, and possibly in carcinogenesis. Research suggests that coffee and tea consumption may have beneficial health effects. We examined the associations of these common beverages with the oral ecosystem in a large cross-sectional study.Methods: We assessed oral microbiota in mouthwash samples from 938 participants in two U.S. cohorts using 16S rRNA gene sequencing. Coffee and tea intake were assessed from food frequency questionnaires. We examined associations of coffee and tea intake with overall oral microbiota diversity and composition using linear regression and permutational MANOVA, respectively, and with taxon abundance using negative binomial generalized linear models; all models adjusted for age, sex, cohort, body mass index, smoking, ethanol intake, and energy intake.Results: Higher tea intake was associated with greater oral microbiota richness (P = 0.05) and diversity (P = 0.006), and shifts in overall community composition (P = 0.002); coffee was not associated with these microbiome parameters. Tea intake was associated with altered abundance of several oral taxa; these included Fusobacteriales, Clostridiales, and Shuttleworthia satelles (higher with increasing tea) and Bifidobacteriaceae, Bergeyella, Lactobacillales, and Kingella oralis (lower with increasing tea). Higher coffee intake was only associated with greater abundance of Granulicatella and Synergistetes.Conclusions: In the largest study to date of tea and coffee consumption in relation to the oral microbiota, the microbiota of tea drinkers differed in several ways from nondrinkers.Impact: Tea-driven changes to the oral microbiome may contribute to previously observed associations between tea and oral and systemic diseases, including cancers. Cancer Epidemiol Biomarkers Prev; 27(7); 814-21. ©2018 AACR.

Eating with others and meal location are differentially associated with nutrient intake by sex: The Diabetes Study of Northern California (DISTANCE)

Though eating with others is often a social behavior, relationships between social contexts of eating and nutrient intake have been underexplored. This study evaluates how social aspects of eating - frequencies of eating meals with others, meals prepared at home, and meals outside the home - are associated with nutrient intake. Because diet improvement can reduce complications of diabetes mellitus, we surveyed a multi-ethnic cohort of persons with type 2 diabetes (n = 770) about social aspects of diet (based on 24-hour recalls). Sex-stratified multiple regression analyses adjusted for confounders assessed the relationship between frequency of eating with others and nutrient intake (total energy, energy from fat, energy from carbohydrates, Healthy Eating Index/HEI, Dietary Approaches to Stop Hypertension/DASH score). Although there was slight variation in men's versus women's propensity to share meals, after adjustment for confounders, there was no consistently significant association between meals with others and the 5 nutrient intake measures for either men or women. The directions of association between categories of eating with others and diet quality (HEI and DASH scores) - albeit not significant - were different for men (positive) and women (mostly negative), which warrants further investigation. The next analyses estimated nutrient intake associated with meals prepared at home, and meals consumed outside the home. Analyses indicated that greater meal frequency at home was associated with significantly better scores on diet quality indices for men (but not women), while meal frequency outside the home was associated with poorer diet quality and energy intake for women (but not men). Better measurement of social dimensions of eating may inform ways to improve nutrition, especially for persons with diabetes for whom diet improvement can result in better disease outcomes.

Estimated 24-Hour Urinary Sodium and Potassium Excretion in US Adults

Importance

In 2010, the Institute of Medicine (now the National Academy of Medicine) recommended collecting 24-hour urine to estimate US sodium intake because previous studies indicated 90% of sodium consumed was excreted in urine.

Objective

To estimate mean population sodium intake and describe urinary potassium excretion among US adults.

Design, Setting, and Participants

In a nationally representative cross-sectional survey of the US noninstitutionalized population, 827 of 1103 (75%) randomly selected, nonpregnant participants aged 20 to 69 years in the examination component of the National Health and Nutrition Examination Survey (NHANES) collected at least one 24-hour urine specimen in 2014. The overall survey response rate for the 24-hour urine collection was approximately 50% (75% [24-hour urine component response rate] × 66% [examination component response rate]).

Exposures

24-hour collection of urine.

Main Outcomes and Measures

Mean 24-hour urinary sodium and potassium excretion. Weighted national estimates of demographic and health characteristics and mean electrolyte excretion accounting for the complex survey design, selection probabilities, and nonresponse.

Results

The study sample (n = 827) represented a population of whom 48.8% were men; 63.7% were non-Hispanic white, 15.8% Hispanic, 11.9% non-Hispanic black, and 5.6% non-Hispanic Asian; 43.5% had hypertension (according to 2017 hypertension guidelines); and 10.0% reported a diagnosis of diabetes. Overall mean 24-hour urinary sodium excretion was 3608 mg (95% CI, 3414-3803). The overall median was 3320 mg (interquartile range, 2308-4524). In secondary analyses by sex, mean sodium excretion was 4205 mg (95% CI, 3959-4452) in men (n = 421) and 3039 mg (95% CI, 2844-3234) in women (n = 406). By age group, mean sodium excretion was 3699 mg (95% CI, 3449-3949) in adults aged 20 to 44 years (n = 432) and 3507 mg (95% CI, 3266-3748) in adults aged 45 to 69 years (n = 395). Overall mean 24-hour urinary potassium excretion was 2155 mg (95% CI, 2030-2280); by sex, 2399 mg (95% CI, 2253-2545) in men and 1922 mg (95% CI, 1757-2086) in women; and by age, 1986 mg (95% CI, 1878-2094) in adults aged 20 to 44 years and 2343 mg (95% CI, 2151-2534) in adults aged 45 to 69 years.

Conclusions and Relevance

In cross-sectional data from a 2014 sample of US adults, estimated mean sodium intake was 3608 mg per day. The findings provide a benchmark for future studies.

2015 Health Survey of São Paulo with Focus in Nutrition: Rationale, Design, and Procedures

This paper describes the design, sampling methods, and data collection procedures, with particular focus on dietary data, used for the 2015 Health Survey of São Paulo (Inquérito de Saúde de São Paulo, 2015 ISA-Capital) with Focus in Nutrition Study (2015 ISA-Nutrition). The ISA is a household cross-sectional, population-based survey that uses complex, stratified, multistage sampling to create a representative sample of residents from urban São Paulo, Brazil. The 2015 ISA-Nutrition comprised a sub-sample of the 2015 ISA-Capital and intended to include 300 adolescents (aged 12 to 19 years), 300 adults (aged 20 to 59 years), and 300 older adults (aged ≥60 years). From February 2015 to February 2016, 1737 individuals answered the first 24-h dietary recall (24HR), and 901 individuals consented to have their blood sample collected, to undergo anthropometric and blood pressure assessment, and to answer the second 24HR. The 2015 ISA-Nutrition aims to evaluate lifestyle-related modifiable factors in São Paulo's residents, as well as their association with biochemical and genetic markers, and environmental aspects related to cardiometabolic risk factors. This paper concludes that 2015 ISA-Nutrition may provide valuable insights into the cardiometabolic risk factors in a big city in an upper middle-income country and contribute to the formulation of health and nutritional policies.

Utilizing selected social determinants and behaviors to predict obesity in military personnel

OBJECTIVE

Like the general population, the military is experiencing an increase in the number of obese personnel. This study aimed to identify predictors of obesity by assessing social determinants of health and behaviors in relation to Body Mass Index (BMI), and to use these variables to build a model to predict obesity in Active Duty Military Personnel (ADMP). Predicting obesity would allow early intervention of at risk personnel, potentially reducing the number of ADMP who are separated from the service for failing to meet weight standards.

DESIGN

A secondary data analysis of the 2011 Survey of Health-Related Behaviors of Active Duty Military Personnel was performed. The survey included 39,197 responders.

MEASURES

Descriptive statistics, bivariate analyses, and logistic regression analysis were conducted to examine the relationship between social determinants of health, behaviors in relation to Healthy People 2020 recommendations, and obesity. Moderator variables were used to determine what affects the direction and/or strength of the relationship between the independent variables (e.g., social determinants and behaviors) and the outcome variable of obesity.

RESULTS

At the bivariate level, these variables mirror existing research. However, logistic regression identified few statistically significant obesogenic lifestyle behaviors in relation to Healthy People 2020 recommendations and a weak interactive effect between the variables.

CONCLUSION

The low number of significant variables identified to predict obesity highlights the multifactorial nature of obesity making it difficult for weight-loss interventions to be effective if limited to one group or one specific behavior.

Dietary Energy Density in the Australian Adult Population from National Nutrition Surveys 1995 to 2012

BACKGROUND

It is hypothesized that the observed proliferation of energy-dense, nutrient-poor foods globally is an important contributing factor to the development of the obesity epidemic. However, evidence that the population's dietary energy density has increased is sparse. The World Cancer Research Fund recommends that dietary energy density be <1.25 kcal/g to prevent weight gain.

OBJECTIVE

The aim of this research was to determine whether the dietary energy density of the Australian population has changed between 1995 and 2012.

DESIGN

A secondary analysis of two cross-sectional Australian national nutrition surveys from 1995 and 2011/2012 was conducted.

PARTICIPANTS/SETTING

Participants of the surveys included adults aged 18 years and older (1995 n=10,986 and 2011/2012 n=9,435) completing 24-hour dietary recalls, including a second recall for a subset of the population (10.4% in 1995 and 64.6% in 2011/2012).

MAIN OUTCOME MEASURES

Outcome measures included the change in dietary energy density (calculated as energy/weight of food [kcal/g] for food only) between surveys.

STATISTICAL ANALYSIS

The National Cancer Institute method for "estimating ratios of two dietary components that are consumed nearly every day" was used to determine the usual distribution and the percentage of participants reporting energy density <1.25 kcal/g.

RESULTS

The mean (standard deviation) dietary energy density was 1.59 (0.26) kcal/g and 1.64 (0.32) kcal/g (P<0.0001) in 1995 and 2011/2012, respectively, with 13% and 5% (P<0.0001) of the population meeting dietary energy-density recommendations. For those aged 70 years and older, the percentage with energy density <1.25 kcal/g decreased from 22% to 6% (P<0.0001) for men and from 33% to 11% (P<0.0001) for women in 1995 and 2011/2012, respectively. Among those aged 18 to 29 years, 1% of men in both surveys (P=0.8) and 4% of women in 1995 and 2% in 2011/2012 (P=0.01) reported energy density <1.25 kcal/g.

CONCLUSIONS

Dietary energy density has increased between the two surveys and few people consumed low energy-dense diets in line with recommendations. The change was largely due to increased energy density of older adult's diets, while young adults had high dietary energy density at both time points. These data suggest efforts now focus on the evaluation of the role of modifying energy density of the diet to reduce the risk of weight gain in adults.

A Pilot Randomized Controlled Trial of a Technology-Based Approach for Preventing Excess Weight Gain during Pregnancy among Women with Overweight

OBJECTIVE

Overweight/obesity and excess weight gain during pregnancy are associated with adverse maternal and neonatal outcomes. Few interventions have been effective in limiting gestational weight gain among women with overweight or obesity. This pilot, randomized clinical trial compared treatment as usual (TAU) to a lifestyle modification program delivered via phone for the prevention of excess gestational weight gain in women who had overweight or obesity.

METHODS

Participants included 41 pregnant women with a body mass index (BMI) ≥ 25 kg/m2 (mean age = 28.7 ± 5.8 years; mean pre-gravid BMI = 31.2 ± 6.2 kg/m2; 54% black, 39% white). The intervention group (n = 20) received weekly telephone counseling sessions and used WiFi scales to monitor their weight from weeks 16 to 36 of pregnancy. We compared differences in weight and birth outcomes for the intervention vs. the TAU group (n = 21).

RESULTS

The intervention and TAU groups did not differ with respect to: gestational weight gain (15.5 ± 5.3 vs. 13.3 ± 6.8 kg, respectively); proportion gaining above the 2009 Institute of Medicine recommended weight range (83 vs. 70%); and weight gain from pre-pregnancy weight to 6 weeks postpartum (4.8 ± 4.6 vs. 3.0 ± 5.5 kg). Other birth and health outcomes also did not differ.

CONCLUSION

A telemedicine intervention designed to decrease logistical burden on participants was not more successful in reducing excessive weight gain during pregnancy as compared to TAU. Future studies should examine more intensive forms of remote treatment beginning earlier in pregnancy as well as interventions promoting a healthy weight prior to pregnancy.

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

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

Feasibility and Acceptability of Dietary Intake Assessment Via 24-Hour Recall and Food Frequency Questionnaire among Women with Low Socioeconomic Status

BACKGROUND

Comprehensive evaluation of dietary interventions depends on effective and efficient measurement to quantify behavior change. To date, little is known regarding which self-reported measure of dietary intake is most feasible and acceptable for use in evaluation of the effectiveness of diet intervention studies among underserved populations.

OBJECTIVE

This research focused on evaluating feasibility and acceptability of two self-report measures of diet.

DESIGN

Cross-sectional.

PARTICIPANTS/SETTING

Two interviewer-administered 24-hour recalls and a 110-item food frequency questionnaire (FFQ) were administered to both English- and Spanish-speaking participants (n=36) by native English- and Spanish-speaking research assistants. On completion of both dietary assessments, participants were interviewed regarding their preference of measure.

MAIN OUTCOME MEASURES

Feasibility for completion of the dietary assessment measures was determined for contacts and retention. Acceptability of the measures was determined through responses to open- and closed-ended questions.

RESULTS

During the 5-month trial, 36 participants were enrolled; 29 completed both intake measures, and 26 completed both measures and the interview. Participants were mainly Hispanic/Latina (72%), with a mean age of 37.0 (±7.6) years. Feasibility targets were met for contacts (1.9, 1.6, 1.8 contact attempts to complete each diet assessment measure with a target of ≤2) and for retention with 89% and 91% completing two 24-hour recalls and the FFQ, respectively. Participants indicated both diet assessment methods were generally acceptable; both positive and negative comments were received for use of the FFQ.

CONCLUSION

Dietary assessment with the use of 24-hour recalls or an FFQ can be feasible and acceptable among women with low socioeconomic status, although care should be taken to address cultural appropriateness in the selection of the measurement method.

Comparison of an interviewer-administered with an automated self-administered 24 h (ASA24) dietary recall in adolescents

OBJECTIVE

The current pilot study aimed to assess whether reporting quality would decline materially in adolescents completing weekly web-based Automated Self-Administered 24-Hour dietary recalls (ASA24-Kids-2014) and interviewer-administered 24 h dietary recalls for six weeks. We also aimed to assess method preference.

DESIGN

We conducted two studies. Study 1 (n 20) randomized participants to complete either one ASA24-Kids-2014 or one interviewer-administered recall weekly, for six weeks. Energy intake and number of foods reported were described for each method over time. Differences between recall methods for each measure were tested using mixed-effects regression. Study 2 (n 10) employed a randomized crossover design to describe method preference.

SETTING

Dietary intake was collected either by telephone (interviewer-administered dietary recalls) or via the Internet (ASA24-Kids-2014 dietary recalls).

SUBJECTS

Adolescents aged 12-17 years with no prior diet recording experience were enrolled.

RESULTS

In Study 1, mean (sd) total energy and number of foods reported decreased by 50 (222) kJ (12 (53) kcal) and 0·05 (0·31) items v. 38 (138) kJ (9 (33) kcal) and 0·17 (0·14) items per recall for participants randomized to the ASA24-Kids-2014 v. interviewer-administered recalls, respectively. There was no difference between groups for either measure (P > 0·57). In Study 2, eight of ten participants preferred the interviewer-administered recall over the ASA24-Kids-2014. Overall, seven of twenty participants experienced technical difficulties with the ASA24-Kids-2014.

CONCLUSIONS

No appreciable decay in reporting quality was seen for either method. However, participants reported a preference for the interviewer-administered recall. Our findings can help inform and support larger studies to further characterize the performance of the ASA24 in adolescents.

Novel Online or Mobile Methods to Assess Eating Patterns

Purpose of Review

Recent developments in technology-based dietary assessment allow real-time data collection of eating occasions, yet their application to assessing eating pattern constructs has not been evaluated. The purpose of this review was to examine existing electronic and mobile food diary methods in relation to their ability to assess eating patterns constructs (e.g. patterning, format and context of eating occasions).

Recent Findings

A systematic search of electronic databases identified 18 dietary assessment methods. Multiple methods with diverse technological capabilities have been developed, yet few studies report on their ability to assess all eating pattern constructs, particularly eating occasion context. Validity of the methods to assess overall dietary intake was found to be similar to traditional dietary assessment methods.

Summary

A diverse range of methods are available for examining the patterning and format/content, but not context, of eating occasions. Further consideration of eating pattern constructs is required when developing dietary assessment methods.

Discrepancy in socioeconomic status does not fully explain the variation in diet quality between consumers of different coffee types

PURPOSE

Habitual consumers of different coffee types may vary in socioeconomic status (SES), which is an important determinant of diet quality. Nonetheless, research on diet quality among coffee consumers was scarce. We aimed to compare the diet quality of coffee consumers with different preferences towards coffee type and additive usage.

METHODS

In this cross-sectional analysis, intake data of food, coffee, and additive usage from the adult respondents of the 2011-2012 Australian Health Survey were used. Participants were grouped according to the type of coffee (espresso and ground coffee, E&G; coffee made from coffee mixes and instant coffee, M&I; non-consumers, NC) and additives (milk, sugar, and intense sweetener) consumed. Adjusted food group intake was compared between consumption groups using general linear model.

RESULTS

E&G drinkers had better SES than M&I and NC. After adjusting for covariates, the mean dairy intake of E&G drinkers was 22.2% higher than M&I drinkers (p < 0.001) and 33.1% higher than NC (p < 0.001). Mean discretionary food intake of E&G drinkers was 12.1% lower than M&I (p = 0.003) and 12.3% lower than NC (p = 0.001). In terms of additive usage, non-users of coffee additive had the lowest dairy food intake and the highest discretionary food intake.

CONCLUSIONS

Coffee consumers' different preferences towards coffee type and additive usages reflected significant variations in their diet quality, even after adjustment of SES. Therefore, future epidemiological studies should consider separating coffee drinkers according to their habitual consumption of different types of coffee.

Relationship of the Reported Intakes of Fat and Fatty Acids to Body Weight in US Adults

Dietary fat composition may modulate energy expenditure and body weight. Little is known about the relationship between fatty acid intake and body weight at a population level. The purposes of this study were to compare intakes of energy, macronutrients, and individual fatty acids across BMI categories (1) for the US adult population and, (2) by sociodemographic groups. Reported dietary intake data from the National Health and Nutrition Examination Survey (NHANES) and What We Eat in America (WWEIA) surveys in the years 2005-2012 were analyzed. Overall, we found that the reported intake of carbohydrate, protein, total fat, total saturated fat (as well as long-chain saturated fatty acids 14:0-18:0), and monounsaturated fatty acids (MUFAs) were positively associated with BMI; while lauric acid (a medium-chain saturated fatty acid, 12:0) and total polyunsaturated fatty acids (PUFAs) (as well as all individual PUFAs) were not associated with BMI. Non-Hispanic black individuals demonstrated a negative association between BMI and energy intake and a positive association between total PUFAs, linoleic acid (LA), α-linolenic acid (ALA) and BMI. Individuals with less than a high school education showed a negative association between BMI and DHA. Mexican-Americans reported intakes with no association between BMI and energy, any macronutrient, or individual fatty acids. These findings support those of experimental studies demonstrating fatty acid-dependent associations between dietary fatty acid composition and body weight. Notably, we observed divergent results for some sociodemographic groups which warrant further investigation.

Self-Report Dietary Assessment Tools Used in Canadian Research: A Scoping Review

Choosing the most appropriate dietary assessment tool for a study can be a challenge. Through a scoping review, we characterized self-report tools used to assess diet in Canada to identify patterns in tool use and to inform strategies to strengthen nutrition research. The research databases Medline, PubMed, PsycINFO, and CINAHL were used to identify Canadian studies published from 2009 to 2014 that included a self-report assessment of dietary intake. The search elicited 2358 records that were screened to identify those that reported on self-report dietary intake among nonclinical, non-Aboriginal adult populations. A pool of 189 articles (reflecting 92 studies) was examined in-depth to assess the dietary assessment tools used. Food-frequency questionnaires (FFQs) and screeners were used in 64% of studies, whereas food records and 24-h recalls were used in 18% and 14% of studies, respectively. Three studies (3%) used a single question to assess diet, and for 3 studies the tool used was not clear. A variety of distinct FFQs and screeners, including those developed and/or adapted for use in Canada and those developed elsewhere, were used. Some tools were reported to have been evaluated previously in terms of validity or reliability, but details of psychometric testing were often lacking. Energy and fat were the most commonly studied, reported by 42% and 39% of studies, respectively. For ∼20% of studies, dietary data were used to assess dietary quality or patterns, whereas close to half assessed ≤5 dietary components. A variety of dietary assessment tools are used in Canadian research. Strategies to improve the application of current evidence on best practices in dietary assessment have the potential to support a stronger and more cohesive literature on diet and health. Such strategies could benefit from national and global collaboration.

The Comparative Reliability and Feasibility of the Past-Year Canadian Diet History Questionnaire II: Comparison of the Paper and Web Versions

Advances in technology-enabled dietary assessment include the advent of web-based food frequency questionnaires, which may reduce costs and researcher burden but may introduce new challenges related to internet connectivity and computer literacy. The purpose of this study was to evaluate the intra- and inter-version reliability, feasibility and acceptability of the paper and web Canadian Diet History Questionnaire II (CDHQ-II) in a sub-sample of 648 adults (aged 39–81 years) recruited from Alberta’s Tomorrow Project. Participants were randomly assigned to one of two groups: (1) paper, web, paper; or (2) web, paper, web over a six-week period. With few exceptions, no statistically significant differences in mean nutrient intake were found in the intra- and inter-version reliability analyses. The majority of participants indicated future willingness to complete the CDHQ-II online, and 59% indicated a preference for the web over the paper version. Findings indicate that, in this population of adults drawn from an existing cohort, the CDHQ-II may be administered in paper or web modalities (increasing flexibility for questionnaire delivery), and the nutrient estimates obtained with either version are comparable. We recommend that other studies explore the feasibility and reliability of different modes of administration of dietary assessment instruments prior to widespread implementation.

Development and Evaluation of e-CA, an Electronic Mobile-Based Food Record

Measures that capture diet as validly and reliably as possible are cornerstones of nutritional research, and mobile-based devices offer new opportunities to improve and simplify data collection. The balance between precision and acceptability of these data collection tools remains debated, and rigorous validations are warranted. Our objective was to develop and evaluate an electronic mobile-based food record for a research setting. We developed e-CA, which includes almost 900 foods and beverages classified in 14 categories and 60 subcategories. e-CA was evaluated using three different methods: (1) usability and acceptability through a logbook and qualitative interviews; (2) dietary intake accuracy through comparison with 2 unannounced 24-h phone recalls on overlapping days; and (3) reliability and process comparison with a paper-based food record in a laboratory setting with a randomized design. e-CA proved to be intuitive and practical and was perceived as modern, trendy, and fun. Comparisons of e-CA with 24-h telephone recalls or paper-based food records in a laboratory setting with two small convenient samples showed good agreement but highlighted the well-known difficulty of estimating portion sizes and a necessary learning time to use the app. e-CA is a functional tool that has the potential to facilitate food intake measurement for research by increasing the pleasure of using the food record tool and reducing the perceived burden for the participants. It also decreases the workload, costs and the risk of transcription errors for researchers.