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

Metabolic signatures associated with Western and Prudent dietary patterns in women

BACKGROUND

The Western dietary pattern (WD) is positively associated with risk of coronary artery disease (CAD) and cancer, whereas the Prudent dietary pattern (PD) may be protective. Foods may influence metabolite concentrations as well as oxidative stress and lipid dysregulation, biological mechanisms associated with CAD and cancer.

OBJECTIVE

The aim was to assess the association of 2 derived dietary pattern scores with serum metabolites and identify metabolic pathways associated with the metabolites.

METHODS

We evaluated the cross-sectional association between each dietary pattern (WD, PD) and metabolites in 2199 Women's Health Initiative (WHI) participants. With FFQ and factor analysis, we determined 2 dietary patterns consistent with WD and PD. Metabolites were measured with LC-tandem MS. Metabolite discovery among 904 WHI Observational Study (WHI-OS) participants was replicated among 1295 WHI Hormone Therapy Trial (WHI-HT) participants. We analyzed each of 495 metabolites with each dietary score (WD, PD) in linear regression models.

RESULTS

The PD included higher vegetables and fruit intake compared with the WD with higher saturated fat and meat intake. Independent of energy intake, BMI, physical activity, and other confounding variables, 45 overlapping metabolites were identified (WHI-OS) and replicated (WHI-HT) with an opposite direction of associations for the WD compared with the PD [false discovery rate (FDR) P < 0.05]. In metabolite set enrichment analyses, phosphatidylethanolamine (PE) plasmalogens were positively enriched for association with WD [normalized enrichment score (NES) = 2.01, P = 0.001, FDR P = 0.005], and cholesteryl esters (NES = -1.77, P = 0.005, FDR P = 0.02), and phosphatidylcholines (NES = -1.72, P = 0.01, P = 0.03) were negatively enriched for WD. PE plasmalogens were positively correlated with saturated fat and red meat. Phosphatidylcholines and cholesteryl esters were positively correlated with fatty fish.

CONCLUSIONS

Distinct metabolite signatures associated with Western and Prudent dietary patterns highlight the positive association of mitochondrial oxidative stress and lipid dysregulation with a WD and the inverse association with a PD.

What Healthcare Professionals Think of "Nutrition & Diet" Apps: An International Survey

Accurate dietary assessment is crucial for both the prevention and treatment of nutrition-related diseases. Since mobile-based dietary assessment solutions are promising, we sought to examine the acceptability of "Nutrition and Diet" (ND) apps by Healthcare Professionals (HCP), explore their preferences on apps' features and identify predictors of acceptance. A 23 question survey was developed by an interdisciplinary team and pilot-tested. The survey was completed by 1001 HCP from 73 countries and 6 continents. The HCP (dietitians: 833, doctors: 75, nurses: 62, other: 31/females: 847, males: 150, neither: 4) had a mean age (SD) of 34.4 (10.2) years and mean job experience in years (SD): 7.7 (8.2). There were 45.5% who have recommended ND apps to their clients/patients. Of those who have not yet recommended an app, 22.5% do not know of their existence. Important criteria for selecting an app were ease of use (87.1%), apps being free of charge (72.6%) and validated (69%). Significant barriers were the use of inaccurate food composition database (52%), lack of local food composition database support (48.2%) and tech-savviness (43.3%). Although the adoption of smartphones is growing and mobile health research is advancing, there is room for improvement in the recommendation of ND apps by HCP.

Assessment of Dietary Intake and Nutritional Status in CrossFit-Trained Individuals: A Descriptive Study

CrossFit is a discipline with high training and nutritional requirements. To date, there is only scarce data evaluating nutrition among CrossFit training and they mostly focus on selected nutritional interventions. Therefore, the purpose of this descriptive study was the assessment of dietary intake and nutritional status in a selected group of CrossFit-trained participants. The study consisted of 62 CrossFit athletes (31 men and 31 women, aged 31.0 ± 5.2 and 30.0 ± 4.3 years, respectively). Body composition was analyzed by electrical bioimpedance. Dietary intake was assessed using a standardized 3-day food record. Body fat percentage for females and males was 20.3 ± 4.3% and 13.7 ± 3.3% respectively. The energy intake in the diet was lower (~1700 kcal in women and ~2300 kcal in men) than the recommended demand. Moreover, low consumption of carbohydrates was stated, as well as an inadequate intake of folate, vitamin E (in women), and minerals, such as Fe and Ca (in women). The energy, carbohydrate, iron, and calcium intake in the CrossFit participants' diet was too low in comparison to recommendations. It seems justified to educate athletes and coaches about nutritional habits, and individual energy and nutrients requirements.

Whole-Fat or Reduced-Fat Dairy Product Intake, Adiposity, and Cardiometabolic Health in Children: A Systematic Review

Dietary guidelines commonly recommend that children aged >2 y consume reduced-fat dairy products rather than regular- or whole-fat dairy. In adults, most studies have not found the consumption of whole-fat dairy products to be associated with increased cardiometabolic or adiposity risk. Associations in children could differ due to growth and development. We systematically reviewed the literature in indexed, peer-reviewed journals to summarize pediatric studies (children aged from 2 to 18 y) assessing associations between whole- and reduced-fat dairy intake and measures of adiposity as well as biomarkers of cardiometabolic disease risk, including the serum lipid profile, blood pressure, low-grade chronic inflammation, oxidative stress, and measures of glucose homeostasis. For the purposes of this review, a "whole-fat" dairy product was defined as a product with the natural fat content, whereas a "reduced-fat" dairy product was defined as a product with some or all of the fat removed (including "low-fat" and "skim" versions). A total of 29 journal articles met our criteria for inclusion. The majority were conducted in the United States and were prospective or cross-sectional observational studies, with only 1 randomized controlled trial. Studies were consistent in reporting that whole-fat dairy products were not associated with increased measures of weight gain or adiposity. Most evidence indicated that consumption of whole-fat dairy was not associated with increased cardiometabolic risk, although a change from whole-fat to reduced-fat dairy improved outcomes for some risk factors in 1 study. Taken as a whole, the limited literature in this field is not consistent with dietary guidelines recommending that children consume preferably reduced-fat dairy products. High-quality randomized controlled trials in children that directly compare the effects of whole-fat compared with reduced-fat dairy intake on measures of adiposity or biomarkers of cardiometabolic disease risk are needed to provide better quality evidence in this area.

Nutriome-metabolome relationships provide insights into dietary intake and metabolism

Dietary assessment traditionally relies on self-reported data which are often inaccurate and may result in erroneous diet-disease risk associations. We illustrate how urinary metabolic phenotyping can be used as alternative approach for obtaining information on dietary patterns. We used two multi-pass 24-hr dietary recalls, obtained on two occasions on average three weeks apart, paired with two 24-hr urine collections from 1,848 U.S. individuals; 67 nutrients influenced the urinary metabotype measured with ¹H-NMR spectroscopy characterized by 46 structurally identified metabolites. We investigated the stability of each metabolite over time and showed that the urinary metabolic profile is more stable within individuals than reported dietary patterns. The 46 metabolites accurately predicted healthy and unhealthy dietary patterns in a free-living U.S. cohort and replicated in an independent U.K. cohort. We mapped these metabolites into a host-microbial metabolic network to identify key pathways and functions. These data can be used in future studies to evaluate how this set of diet-derived, stable, measurable bioanalytical markers are associated with disease risk. This knowledge may give new insights into biological pathways that characterize the shift from a healthy to unhealthy metabolic phenotype and hence give entry points for prevention and intervention strategies.

Diet Quality and Associations with Food Security among Women Eligible for Indiana Supplemental Nutrition Assistance Program-Education

BACKGROUND

The diet quality among adults receiving nutrition education lessons through Supplemental Nutrition Assistance Program-Education (SNAP-Ed) is currently unknown.

OBJECTIVES

The objectives of this study were to characterize the diet quality of Indiana SNAP-Ed-eligible women; estimate their mean usual intake of fruits, vegetables, dairy, and whole grains compared to Dietary Guidelines for Americans (DGA) recommendations; and determine if these dietary outcomes differed by food security status.

METHODS

SNAP-Ed paraprofessionals recruited participants from August 2015 to May 2016 for this secondary analysis of cross-sectional data collected as the baseline assessment for a randomized controlled trial. Participants were SNAP-Ed-eligible women aged ≥18 y interested in nutrition education lessons. Dietary outcomes were assessed by one or two 24-h dietary recalls. The Healthy Eating Index (HEI)-2010 was used to characterize diet quality. Mean usual intake of food groups was estimated using the National Cancer Institute Method. Food security status was classified using the US Household Food Security Survey Module. Data were analyzed in October 2019.

RESULTS

Mean ± SEM HEI-2010 total score was 42 ± 0.9 for the study sample. Mean ± SE usual intake of servings of fruits (0.61 ± 0.08 cups [144.32 ± 18.93 mL]), vegetables [1.4 ± 0.10 cups (331.2 ± 23.66 mL)], dairy [1.5 ± 0.11 cups (354.88 ± 26.02 mL)], and whole grains [0.48 ± 0.06 ounces (13.61 ± 1.70 g)] did not differ by food security subgroup. Mean HEI-2010 total score was significantly higher by 4.8 ± 2.0 points for the food-secure than for the food-insecure subgroup (P = 0.01). Mean HEI-2010 component scores were 1.1 ± 0.5 points higher for whole grain (P = 0.01) and 1.0 ± 0.5 points higher for dairy (P = 0.05) in the food-secure than in the food-insecure subgroup. The proportions of the study sample not meeting the DGA recommendations for food group intake were ≥85% for both food-secure and -insecure subgroups.

CONCLUSIONS

Indiana SNAP-Ed-eligible women reported poor diet quality, highlighting their need for nutrition interventions aiming to improve food security and diet as per DGA recommendations in low-income populations.

Eveningness in Energy Intake among Adolescents with Implication on Anthropometric Indicators of Nutritional Status: The CRO-PALS Longitudinal Study

Shifting of energy intake towards a later time in the day is associated with an increased risk of obesity in adults. However, there is a lack of data for adolescents. The aim of this study was to investigate adolescents eveningness in energy intake (EV) and its association with anthropometric indicators of nutritional status. This investigation was based on results from the Croatian physical activity in adolescence longitudinal study (CRO-PALS). The cohort included 607 adolescents (50.25% females and 49.75% males) who were assessed at the age of 15/16 and 18/19. A single multi-pass 24-h recall was used as a dietary assessment method, while anthropometric indicators of nutritional status included body mass index (BMI), waist to hip ratio (WHR) and the sum of four skinfolds. The School Health Action, Planning and Evaluation System (SHAPES) questionnaire was used to assess active daily energy expenditure and sedentary behaviors. EV was significantly higher at 18/19 years compared to 15/16 years in whole population (p < 0.01), among male adolescents (p < 0.01), but not among female adolescents (p > 0.05). Although a significant correlation between EV and WHR was found in females at the age of 15/16 (p < 0.01), the results of this study suggest that EV has no or a minor effect on anthropometric indicators of nutritional status in adolescence.

RETRACTED ARTICLE: Dietary metabotype modelling predicts individual responses to dietary interventions

Habitual consumption of poor quality diets is linked directly to risk factors for many non-communicable diseases. This has resulted in the vast majority of countries and the World Health Organization developing policies for healthy eating to reduce the prevalence of non-communicable diseases in the population. However, there is mounting evidence of variability in individual metabolic responses to any dietary intervention. We have developed a method for applying a pipeline for understanding interindividual differences in response to diet, based on coupling data from highly controlled dietary studies with deep metabolic phenotyping. In this feasibility study, we create an individual Dietary Metabotype Score (DMS) that embodies interindividual variability in dietary response and captures consequent dynamic changes in concentrations of urinary metabolites. We find an inverse relationship between the DMS and blood glucose concentration. There is also a relationship between the DMS and urinary metabolic energy loss. Furthermore, we use a metabolic entropy approach to visualize individual and collective responses to dietary interventions. Potentially, the DMS offers a method to target and to enhance dietary response at the individual level, thereby reducing the burden of non-communicable diseases at the population level.

"Everyone can take photos." Feasibility and relative validity of phone photography-based assessment of children's diets - a mixed methods study

Background

Dietary assessment methods that are user-friendly, simple, yet valid are of interest to both researchers and participants, particularly for use in disadvantaged settings, where language barriers and low levels of education are often present. We tested if parents taking photos of what children ate, using mobile phones, would be a feasible, acceptable method that could still provide information with adequate relative validity.

Methods

We used a mixed-methods design, with parents of 21 5- to 7-year-olds from disadvantaged areas in Sweden. Parents reported all dietary intake, during non-school hours, on three days (two weekdays) using a photo method (PM). The PM consisted of simple instructions and a fiduciary card, but no training, equipment or software. Text messages could be sent if necessary. As a reference method, parents completed three 24-h recalls (24HRs) with an interviewer each following day. The next week, parents completed a 9-item semi-FFQ regarding the preceding week. The outcomes were intakes (in dl) of 9 food groups, categorised as fruits and vegetables, energy-dense sweet/salty foods, and sweet drinks. Agreement with the reference 24HRs was assessed using correlations, median differences and Bland-Altman plots. Parents completed an open-ended questionnaire on barriers and facilitators. Data collectors provided complementary information. Qualitative data was analysed using qualitative manifest analysis.

Results

Nineteen parents (90%) provided complete data. The majority (n = 13) spoke Swedish as a second language, few (n = 4) were proficient. Compared to 24HRs, intakes measured by PM correlated well for all categories (Spearman’s rho = 0.609–0.845). However, intakes were underreported, significantly so for fruits and vegetables; Bland-Altman plots indicated that the underestimation was fairly constant across intake levels. When the FFQ was compared to the 24HRs, parameters of agreement were generally inferior than for the PM. Parents found the PM a positive experience, primarily facilitated by its simplicity and familiarity. Barriers, mainly related to time and logistics, can inform further methodological refinements.

Conclusions

The PM was an acceptable and feasible way to measure children’s diet outside of school hours in this population of parents from disadvantaged areas. While the absolute validity should be evaluated further, this relatively simple method has potential for assessing intakes of well-defined foods at group level.

Enhancing employee wellness: Translating an effective community behavioral weight-loss treatment to the worksite

BACKGROUND

As rates of obesity continue to rise in the USA, there is a need for effective treatments for excess adiposity. Behavioral weight-loss interventions can produce clinically meaningful weight reduction through life-style modifications. However, few studies have evaluated the effectiveness of high-intensity behavioral weight-loss interventions at worksites.

AIM

The present research investigated the effectiveness of a previously validated behavioral weight-loss intervention in a Hawai'i worksite.

METHODS

Thirty-six participants were recruited from the employee population of a local employer. Participants received six months of group behavioral weight-loss treatment from trained providers. Anthropomorphic, physiological, psychological, and behavioral assessments were collected pre and post treatment. Select physiological and behavioral assessments were collected every four sessions.

RESULTS

Sixty-one percent of participants adhered to treatment, and 78% of participants completed treatment. From pre to post treatment, results found that participants achieved clinically significant improvements in weight, body mass index (BMI), and waist circumference, with accompanying physiological, psychological, and behavioral improvements (F(12, 2)=101.379, p=0.010, partial η²=0.998). Analyses revealed that participants also achieved significant changes in weight, BMI, and waist circumference across time points, as well as improvements in specific eating habits.

CONCLUSIONS

The present study demonstrated the efficacy of a worksite behavioral weight-loss program. The present intervention produced clinically significant weight losses for a large proportion of participants, accompanied by significant improvements in physiological, behavioral, and psychological outcomes. This research is promising for the ongoing implementation of behavioral weight-loss approaches.

Dietary intake from complementary feeding is associated with intestinal barrier function and environmental enteropathy in Brazilian children from the MAL-ED cohort study

A child's diet contains nutrients and other substances that influence intestinal health. The present study aimed to evaluate the relations between complementary feeding, intestinal barrier function and environmental enteropathy (EE) in infants. Data from 233 children were obtained from the Brazilian site of the Etiology, Risk Factors, and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development Project cohort study. Habitual dietary intake from complementary feeding was estimated using seven 24-h dietary recalls, from 9 to 15 months of age. Intestinal barrier function was assessed using the lactulose-mannitol test (L-M), and EE was determined as a composite measure using faecal biomarkers concentrations - α-1-antitrypsin, myeloperoxidase (MPO) and neopterin (NEO) at 15 months of age. The nutrient adequacies explored the associations between dietary intake and the intestinal biomarkers. Children showed adequate nutrient intakes (with the exception of fibre), impaired intestinal barrier function and intestinal inflammation. There was a negative correlation between energy adequacy and L-M (ρ = -0·19, P < 0·05) and between folate adequacy and NEO concentrations (ρ = -0·21, P < 0·01). In addition, there was a positive correlation between thiamine adequacy and MPO concentration (ρ = 0·22, P < 0·01) and between Ca adequacy and NEO concentration (ρ = 0·23; P < 0·01). Multiple linear regression models showed that energy intakes were inversely associated with intestinal barrier function (β = -0·19, P = 0·02), and fibre intake was inversely associated with the EE scores (β = -0·20, P = 0·04). Findings suggest that dietary intake from complementary feeding is associated with decreased intestinal barrier function and EE in children.

Dietary patterns and cardiovascular disease in Australian adults: Findings from the 2011-12 Australian Health Survey

BACKGROUND AND AIMS

Great discrepancies exist in results from studies examining the association between dietary patterns and cardiovascular disease (CVD) in different populations. The aim of this study is to examine the relationship between the Australian Dietary Guidelines (ADG) 2013, Mediterranean-DASH diet Intervention for Neurodegenerative Delay (MIND), Paleolithic and Okinawan dietary patterns and CVD respectively.

METHODS AND RESULTS

In this cross-sectional secondary analysis of the 2011-12 Australian Health Survey, adults who self-reported physician-diagnosed CVD, completed two multiple-pass 24 h recalls and had no missing data on all confounders were analysed (weighted n = 5376; 295 CVD cases). Dietary intake was transformed to represent usual intake by the multiple source method. The score of Healthy Eating Index for Australian Adults (HEIFA-2013) was adopted for ADG 2013, while the scores of MIND, Paleolithic and Okinawan dietary patterns were constructed by separating the intake of each predefined food and nutrient into quintiles. The associations between the dietary patterns (as tertiles of scores) and CVD were examined using binary logistic regression adjusted for significant cardiovascular risk factors. Higher adherence to the Okinawan diet pattern was significantly associated with a reduced prevalence of ischemic heart disease (IHD) (OR per unit increase in dietary pattern score: 0.94, 95%CI: 0.90-0.98). Comparing its extreme tertiles, the OR was 0.49 (95%CI: 0.29-0.82; p_trend < 0.01). The associations between HEIFA-2013, MIND and Paleolithic diet patterns and CVD were insignificant.

CONCLUSION

The findings suggested an inverse association between adherence to Okinawan dietary pattern and prevalence of IHD in Australian adults.

Inequalities in education and national income are associated with poorer diet: Pooled analysis of individual participant data across 12 European countries

Background

Malnutrition linked to noncommunicable diseases presents major health problems across Europe. The World Health Organisation encourages countries to conduct national dietary surveys to obtain data to inform public health policies designed to prevent noncommunicable diseases.

Methods

Data on 27334 participants aged 19-64y were harmonised and pooled across national dietary survey datasets from 12 countries across the WHO European Region. Weighted mean nutrient intakes were age-standardised using the Eurostat 2013 European Standard Population. Associations between country-level Gross Domestic Product (GDP) and key nutrients and nutrient densities were investigated using linear regression. The potential mitigating influence of participant-level educational status was explored.

Findings

Higher GDP was positively associated with total sugar intake (5·0% energy for each 10% increase in GDP, 95% CI 0·6, 9·3). Scandinavian countries had the highest vitamin D intakes. Participants with higher educational status had better nutritional intakes, particularly within lower GDP countries. A 10% higher GDP was associated with lower total fat intakes (-0·2% energy, 95% CI -0·3, -0·1) and higher daily total folate intakes (14μg, 95% CI 12, 16) in higher educated individuals.

Interpretation

Lower income countries and lower education groups had poorer diet, particularly for micronutrients. We demonstrate for the first time that higher educational status appeared to have a mitigating effect on poorer diet in lower income countries. It illustrates the feasibility and value of harmonising national dietary survey data to inform European policy regarding access to healthy diets, particularly in disadvantaged groups. It specifically highlights the need for strong policies supporting nutritional intakes, prioritising lower education groups and lower income countries.

Dietary Intervention in Pregnant Women with Gestational Diabetes; Protocol for the DiGest Randomised Controlled Trial

Gestational diabetes mellitus (GDM) annually affects 35,000 pregnancies in the United Kingdom, causing suboptimal health outcomes to the mother and child. Obesity and excessive gestational weight gain are risk factors for GDM. The Institute of Medicine recommends weight targets for women that are overweight and obese, however, there are no clear guidelines for women with GDM. Observational data suggest that modest weight loss (0.6-2 kg) after 28 weeks may reduce risk of caesarean section, large-for-gestational-age (LGA), and maternal postnatal glycaemia. This protocol for a multicentre randomised double-blind controlled trial aims to identify if a fully controlled reduced energy diet in GDM pregnancy improves infant birthweight and reduces maternal weight gain (primary outcomes). A total of 500 women with GDM (National Institute of Health and Care Excellence (NICE) 2015 criteria) and body mass index (BMI) ≥25 kg/m2 will be randomised to receive a standard (2000 kcal/day) or reduced energy (1200 kcal/day) diet box containing all meals and snacks from 28 weeks to delivery. Women and caregivers will be blinded to the allocations. Food diaries, continuous glucose monitoring, and anthropometry will measure dietary compliance, glucose levels, and weight changes. Women will receive standard antenatal GDM management (insulin/metformin) according to NICE guidelines. The secondary endpoints include caesarean section rates, LGA, and maternal postnatal glucose concentrations.

Micronutrient intakes and their food sources among Greek children and adolescents

OBJECTIVE

To assess the usual dietary intake of twenty micronutrients and to identify their food sources in a representative sample of Greek children and adolescents.

DESIGN

Cross-sectional data from the Hellenic National Nutrition and Health Survey (HNNHS). Vitamin and mineral intakes were estimated from two 24 h dietary recalls by sex and age groups. Estimates were calculated using the National Research Council method and the statistical software package Stata13 to account for within- and between-person variations. The prevalence of nutrients' inadequacy among sample was estimated using the estimated average requirement (EAR) cut-point method. The contribution of food groups to nutrient intake was estimated to identify micronutrients food sources.

SETTING

Greece.

PARTICIPANTS

Children and adolescents aged 1-19 years (n 577) who provided sufficient and plausible 24-h recalls.

RESULTS

A substantial percentage of children and adolescents had insufficient intakes of numerous micronutrients. Usual intake of vitamins D, K and potassium was inadequate in practically all individuals. Vitamin A, folate, Ca and Mg were also insufficient to a considerable percentage, especially in girls aged 14-18 years. Pantothenic acid was highlighted as nutrient of interest since only one out of ten boys 9-13 years and girls 14-19 years had intake above the EAR. Data demonstrated that food groups highly ranked in energy contribution were not necessarily important sources of micronutrients.

CONCLUSIONS

Results suggest that micronutrient density of Greek children and adolescents' diet should be improved. These findings might be used by public health policy-makers to help young people optimise their food choices in Greece.

The validity of technology-based dietary assessment methods in childhood and adolescence: a systematic review

Technology-based dietary assessment has promising benefits on improving accuracy and reducing cost of dietary data collection. The validity of technology-based tools in children/adolescents was examined. A systematic literature search was performed to identify studies published till September 2019. In total, 26 studies with 29 validation-related estimations were selected; 13 web-based 24-hdietary recalls (image assisted; n = 12, drop-down food list; n = 13), 4 mobile applications and 3 web-based dietary records (image based; n = 2 and image assisted; n = 1, drop-down food list; n = 3) and 6 web-based food frequency questionnaires (FFQs) (image assisted; n = 3). Fourteen studies were addressed to adolescents, ten studies to children (principally 9-11 years old) and two studies to mixed study samples. Validation was mostly performed through 24-h dietary recalls and dietary records while in some cases objective methods were used. Image-assisted 24-h dietary recalls presented good level of agreement with paper-based methods, yet principally in adolescents. Mobile-application dietary records with image-based facilities and drop-down food lists were found to accurately record dietary intake even when compared with objective methods. FFQs, mainly examined in adolescents, had good level of agreement with the "gold standard" dietary records method. The validity of technology-based methods could be supported yet various technical/methodological issues need better clarification.

A systematic review of recall errors associated with portion size estimation aids in children

To reduce errors in portion size estimation, a number of aids have been developed and tested. This systematic review synthesizes what is known about error associated with use of different portion size estimation aids (PSEAs) within self-reported dietary recall studies in children (aged ≤18 years). Eight electronic databases were searched using relevant keywords. From 8184 records identified and screened, 327 full texts were retrieved, with 10 records representing 9 studies meeting inclusion criteria. Studies using proxy reporting were excluded. Thirteen PSEAs were identified. To facilitate comparisons between different types of aids they were categorized into 'physical 2-dimensional (2D)', 'digital 2D' and '3-dimensional' PSEAs. Seven were physical 2D (e.g. food atlas), two were digital 2D (i.e. computer-based), and four were 3D (e.g. modelling clay, household items). Comparisons of PSEAs within studies found the smallest estimation errors for digital 2D and largest for 3D aids. Errors in relation to food type were varied, with portions of amorphous foods overestimated in multiple studies. No effects for recall interval time or sex were identified. One study reported a significant improvement in estimation error with increasing age. Across studies, large variations in study design and reporting of estimation error hindered the synthesis of evidence regarding the influence of different types of PSEAs on accuracy. While a definitive conclusion about the most accurate PSEA could not be drawn, a check-list to guide future PSEA development and testing has been proposed in the current review. This will assist comparability with future studies of PSEAs for children facilitate development of more accurate PSEAs in the future.

Associations of fat and carbohydrate intake with cardiovascular disease and mortality: prospective cohort study of UK Biobank participants

OBJECTIVE

To investigate the association of macronutrient intake with all cause mortality and cardiovascular disease (CVD), and the implications for dietary advice.

DESIGN

Prospective population based study.

SETTING

UK Biobank.

PARTICIPANTS

195 658 of the 502 536 participants in UK Biobank completed at least one dietary questionnaire and were included in the analyses. Diet was assessed using Oxford WebQ, a web based 24 hour recall questionnaire, and nutrient intakes were estimated using standard methodology. Cox proportional models with penalised cubic splines were used to study non-linear associations.

MAIN OUTCOME MEASURES

All cause mortality and incidence of CVD.

RESULTS

4780 (2.4%) participants died over a mean 10.6 (range 9.4-13.9) years of follow-up, and 948 (0.5%) and 9776 (5.0%) experienced fatal and non-fatal CVD events, respectively, over a mean 9.7 (range 8.5-13.0) years of follow-up. Non-linear associations were found for many macronutrients. Carbohydrate intake showed a non-linear association with mortality; no association at 20-50% of total energy intake but a positive association at 50-70% of energy intake (3.14 v 2.75 per 1000 person years, average hazard ratio 1.14, 95% confidence interval 1.03 to 1.28 (60-70% v 50% of energy)). A similar pattern was observed for sugar but not for starch or fibre. A higher intake of monounsaturated fat (2.94 v 3.50 per 1000 person years, average hazard ratio 0.58, 0.51 to 0.66 (20-25% v 5% of energy)) and lower intake of polyunsaturated fat (2.66 v 3.04 per 1000 person years, 0.78, 0.75 to 0.81 (5-7% v 12% of energy)) and saturated fat (2.66 v 3.59 per 1000 person years, 0.67, 0.62 to 0.73 (5-10% v 20% of energy)) were associated with a lower risk of mortality. A dietary risk matrix was developed to illustrate how dietary advice can be given based on current intake.

CONCLUSION

Many associations between macronutrient intake and health outcomes are non-linear. Thus dietary advice could be tailored to current intake. Dietary guidelines on macronutrients (eg, carbohydrate) should also take account of differential associations of its components (eg, sugar and starch).

Stricter Adherence to Dietary Approaches to Stop Hypertension (DASH) and its Association with Lower Blood Pressure, Visceral Fat, and Waist Circumference in University Students

How diet affects blood pressure (BP) in young adults has not been studied in sufficient depth. For this purpose, we analyzed adherence to the Dietary Approaches to Stop Hypertension (DASH) dietary pattern and BP in Spanish university students. The sample population of our cross-sectional study consisted of 244 subjects (18-31 years old), who were in good health. Measurements were taken of their systolic and diastolic BP. A food frequency questionnaire and 72 h food record were used to assess their dietary intake in the previous year. The resulting DASH score was based on foodstuffs that were emphasized or minimized in the DASH diet. Analysis of covariance adjusted for potential confounding factors showed that the mean values for systolic BP, visceral fat rating, and waist circumference (WC) of the subjects in the upper third of the DASH score were significantly lower than those of the subjects in the lower third (for systolic BP: mean difference -4.36 mmHg, p = 0.004; for visceral fat rating: mean difference -0.4, p = 0.024; for waist circumference: mean difference -3.2, p = 0.019). Stricter adherence to the DASH dietary pattern led to a lower BP, visceral fat rating, and WC values in these university students. Nevertheless, further prospective studies are needed to confirm these results.

Differences in Diet Quality and Snack Intakes Among Non-Hispanic White and Mexican American Adolescents from Different Acculturation Groups

Mexican American adolescents have an increased risk for obesity compared to non-Hispanic whites (NHWs), especially as their degree of acculturation increases. Snack intakes can impact diet quality and may affect obesity risk, yet little is known about differences in snack intakes among NHW and Mexican American adolescents from different acculturation groups. This study compared diet quality and snack intakes among NHW and Mexican American adolescents from different acculturation groups. This study used cross-sectional data from 3636 Mexican American and NHW adolescents in the 2005-2014 National Health and Nutrition Examination Survey. Acculturation was defined based on generational status and language use. Outcomes were Healthy Eating Index-2015 (HEI-2015) score, daily energy intake from snacks, snack frequency, energy value of snacks, and percent contribution of snacks to total daily energy. Analysis of covariance was used to compare outcomes across groups, after adjustment for sex and income. In the full sample, mean HEI-2015 score was 45 ± 0.4. Non-Hispanic white adolescents had modestly poorer diet quality compared to US-born adolescents with a foreign-born parent and Mexican-born adolescents (P < 0.001). Mean daily snack intake was 583 ± 16 kcal. Items in the Snacks and Sweets and Beverages categories contributed more than half of the energy provided by snacks. Non-Hispanic white adolescents had a greater total snack intake compared to all language use at home groups, except equal Spanish and English use. Improving the types of foods consumed as snacks has the potential to partially mitigate differences in snack intakes and diet quality among non-Hispanic white and Mexican American adolescents.

Oral Microbiota Profile Associates with Sugar Intake and Taste Preference Genes

Oral microbiota ecology is influenced by environmental and host conditions, but few studies have evaluated associations between untargeted measures of the entire oral microbiome and potentially relevant environmental and host factors. This study aimed to identify salivary microbiota cluster groups using hierarchical cluster analyses (Wards method) based on 16S rRNA gene amplicon sequencing, and identify lifestyle and host factors which were associated with these groups. Group members (n = 175) were distinctly separated by microbiota profiles and differed in reported sucrose intake and allelic variation in the taste-preference-associated genes TAS1R1 (rs731024) and GNAT3 (rs2074673). Groups with higher sucrose intake were either characterized by a wide panel of species or phylotypes with fewer aciduric species, or by a narrower profile that included documented aciduric- and caries-associated species. The inferred functional profiles of the latter type were dominated by metabolic pathways associated with the carbohydrate metabolism with enrichment of glycosidase functions. In conclusion, this study supported in vivo associations between sugar intake and oral microbiota ecology, but it also found evidence for a variable microbiota response to sugar, highlighting the importance of modifying host factors and microbes beyond the commonly targeted acidogenic and acid-tolerant species. The results should be confirmed under controlled settings with comprehensive phenotypic and genotypic data.

Quantitative Dietary Fingerprinting (QDF)-A Novel Tool for Comprehensive Dietary Assessment Based on Urinary Nutrimetabolomics

Accurate dietary assessment is a challenge in nutritional research, needing powerful and robust tools for reliable measurement of food intake biomarkers. In this work, we have developed a novel quantitative dietary fingerprinting (QDF) approach, which enables for the first time the simultaneous quantitation of about 350 urinary food-derived metabolites, including (poly)phenolic aglycones, phase II metabolites, and microbial-transformed compounds, as well as other compounds (e.g., glucosinolates, amino acid derivatives, methylxanthines, alkaloids, and markers of alcohol and tobacco consumption). This method was fully validated for 220 metabolites, yielding good linearity, high sensitivity and precision, accurate recovery rates, and negligible matrix effects. Furthermore, 127 additional phase II metabolites were also included in this method after identification in urines collected from acute dietary interventions with various foods. Thus, this metabolomic approach represents one-step further toward precision nutrition and the objective of improving the accurateness and comprehensiveness in the assessment of dietary patterns and lifestyles.

Are Households in Kiribati Nutrition Secure? A Case Study of South Tarawa and Butaritari

BACKGROUND AND OBJECTIVES

This study assessed the nutritional status among householders in urban South Tarawa and rural Butaritari in Kiribati.

METHODS AND STUDY DESIGN

In this cross-sectional study, we assessed energy and nutrient intakes, food variety scores, and dietary diversity scores of men and women from 468 households randomly selected in South Tarawa (n = 161) and Butaritari (n = 307) using a 24-hour dietary recall. Nutrient adequacy ratios and mean adequacy ratios of selected nutrients were also determined from 3-day weighed food records collected among participants living in a further 28 households from South Tarawa (n = 29) and Butaritari (n = 44).

RESULTS

Based on the 24-hour dietary recall, the average energy intake for men and women was 2536 kcals and 2068 kcals, respectively. Carbohydrate (CHO), fat, and protein intakes for men and women were 332.5 g, 76.5 g, and 130.4 g and 291.7 g, 55.1 g, and 103.5 g, respectively. The mean and standard deviation of household Food Variety Score and Dietary Diversity Score was 3.90 ± 1.25 and 5.44 ± 1.92, respectively. Intakes of vitamin A, calcium, and iron, and zinc were notably deficient in both locations, with the urban participants having lower intakes of vitamin B-1, vitamin B-2, magnesium, and potassium than their rural counterparts. Mean sodium intakes exceeded recommendations for all age groups in South Tarawa except children aged 4 to 6 years.

CONCLUSIONS

Food consumption patterns of the households in South Tarawa and Butaritari reflected high consumption of nontraditional diets and refined foods, which manifested in inadequate micronutrient intake estimates and low dietary diversity: strong risk factors for noncommunicable diseases such as obesity and diabetes.

Specificity, Dose Dependency, and Kinetics of Markers of Chicken and Beef Intake Using Targeted Quantitative LC-MS/MS: A Human Intervention Trial

SCOPE

Common methods for food intake assessment are error-prone. Estimating food intake via metabolite biomarkers in blood/urine is challenged by inter-individual variation. Here, meat intake markers based on criteria defined within the FoodBAll consortium, including dose dependency, specificity, kinetics, and their ability to predict meat dose, are evaluated.

METHODS AND RESULTS

In two randomized human interventions, meat at different doses are consumed. Plasma concentrations of 100 analytes, including previously proposed meat intake markers, are determined at different time points up to 24 h after meat ingestion using targeted liquid chromatography-tandem mass spectrometry. Plasma concentrations of π-methylhistidine (π-M-His) correlated best with the chicken meat amount consumed even after 24 h (R² = 0.96). Both, anserine and π-M-His show first-order elimination kinetics, irrespective of meat dose (t_1/2 is 1.4 and 5.9 h, respectively). Surprisingly, π-M-His best predicted the amount of beef consumed, albeit at lower concentrations. Furthermore, trimethylamine-N-oxide (TMAO) increases only after beef, while dimethylglycine only after chicken consumption. The lack of baseline concentrations for π-M-His and anserine is likely the strength of these compounds to predict meat dose.

CONCLUSION

Quantitative assessment of meat intake within 24 h is most accurate with π-M-His, whereas TMAO and dimethylglycine best discriminate between chicken and beef.

Nutrition Knowledge is Correlated with a Better Dietary Intake in Adolescent Soccer Players: A Cross-Sectional Study

Nutrition education is one of the factors that may help to promote behavior change and therefore may improve the dietary habits of adolescent soccer players. However, information about the relationship between nutrition knowledge (NK) and the dietary behavior of these athletes is scarce. The purpose of this study was to evaluate the eating habits of adolescent soccer players and analyse the correlations among dietary intake and NK. Seventy-three Brazilian adolescent soccer players (aged 14–19 years), from four professional clubs, underwent anthropometric evaluation and completed 3-day food records. Misreporting of energy intake was evaluated and the dietary intake data were energy-adjusted and compared with recommendations for athletes and dietary reference intakes. The athletes also answered a questionnaire about barriers for healthy eating and a nutrition knowledge test divided into three sections: Basic Nutrition Knowledge (BNK), Sports Nutrition Knowledge (SNK), and Food Pyramid Nutrition Knowledge (FPNK). The participants showed a low NK (54.6%) and an inadequate intake of fruits, vegetables, dairy, carbohydrates, and micronutrients. A positive correlation was found between the ingestion of phosphorus and FPNK as well as among calcium and both SNK and Total NK (p < 0.05). Sodium intake was negatively correlated with all categories of the NK test (p < 0.05). The adolescents reported that the principal barriers for adopting a healthy diet were the lack of willpower and a busy lifestyle. In this context, nutrition education is recommended and should also provide practicable healthy eating goals according to athletes´ lifestyle as well as target motivational barriers to increase adherence.

System Identification Approaches For Energy Intake Estimation: Enhancing Interventions For Managing Gestational Weight Gain

Excessive maternal weight gain during pregnancy represents a major public health concern that calls for novel and effective gestational weight management interventions. In Healthy Mom Zone (HMZ), an on-going intervention study, energy intake underreporting has been found to be an important consideration that interferes with accurate weight control assessment, and the effective use of energy balance models in an intervention setting. In this paper, a series of estimation approaches that address measurement noise and measurement losses are developed to better understand the extent of energy intake underreporting. These include back-calculating energy intake from an energy balance model developed for gestational weight gain prediction, a Kalman filtering-based approach to recursively estimate energy intake from intermittent measurements in real-time, and an approach based on semi-physical identification principles which features the capability of adjusting future self-reported energy intake by parameterizing the extent of underreporting. The three approaches are illustrated by evaluating with participant data obtained through the HMZ intervention study, with the results demonstrating the potential of these methods to promote the success of weight control. The pros and cons of the presented approaches are discussed to generate insights for users in future applications.

Counting Bites With Bits: Expert Workshop Addressing Calorie and Macronutrient Intake Monitoring

BACKGROUND

Conventional diet assessment approaches such as the 24-hour self-reported recall are burdensome, suffer from recall bias, and are inaccurate in estimating energy intake. Wearable sensor technology, coupled with advanced algorithms, is increasingly showing promise in its ability to capture behaviors that provide useful information for estimating calorie and macronutrient intake.

OBJECTIVE

This paper aimed to summarize current technological approaches to monitoring energy intake on the basis of expert opinion from a workshop panel and to make recommendations to advance technology and algorithms to improve estimation of energy expenditure.

METHODS

A 1-day invitational workshop sponsored by the National Science Foundation was held at Northwestern University. A total of 30 participants, including population health researchers, engineers, and intervention developers, from 6 universities and the National Institutes of Health participated in a panel discussing the state of evidence with regard to monitoring calorie intake and eating behaviors.

RESULTS

Calorie monitoring using technological approaches can be characterized into 3 domains: (1) image-based sensing (eg, wearable and smartphone-based cameras combined with machine learning algorithms); (2) eating action unit (EAU) sensors (eg, to measure feeding gesture and chewing rate); and (3) biochemical measures (eg, serum and plasma metabolite concentrations). We discussed how each domain functions, provided examples of promising solutions, and highlighted potential challenges and opportunities in each domain. Image-based sensor research requires improved ground truth (context and known information about the foods), accurate food image segmentation and recognition algorithms, and reliable methods of estimating portion size. EAU-based domain research is limited by the understanding of when their systems (device and inference algorithm) succeed and fail, need for privacy-protecting methods of capturing ground truth, and uncertainty in food categorization. Although an exciting novel technology, the challenges of biochemical sensing range from a lack of adaptability to environmental effects (eg, temperature change) and mechanical impact, instability of wearable sensor performance over time, and single-use design.

CONCLUSIONS

Conventional approaches to calorie monitoring rely predominantly on self-reports. These approaches can gain contextual information from image-based and EAU-based domains that can map automatically captured food images to a food database and detect proxies that correlate with food volume and caloric intake. Although the continued development of advanced machine learning techniques will advance the accuracy of such wearables, biochemical sensing provides an electrochemical analysis of sweat using soft bioelectronics on human skin, enabling noninvasive measures of chemical compounds that provide insight into the digestive and endocrine systems. Future computing-based researchers should focus on reducing the burden of wearable sensors, aligning data across multiple devices, automating methods of data annotation, increasing rigor in studying system acceptability, increasing battery lifetime, and rigorously testing validity of the measure. Such research requires moving promising technological solutions from the controlled laboratory setting to the field.

An Exploration of Milk Product Health Beliefs and Dietary Calcium Intake in Young Adults

Purpose: Milk products (fluid milk, cheese, yogurt) typically provide a rich source of calcium and other nutrients, yet consumption is declining in Canada. This study examined milk product health beliefs among young adults and the association between these beliefs and dietary calcium intake. Methods: Seventy-nine participants (25 ± 4 y; 40 males) completed a milk product health belief questionnaire to determine a milk product health belief score (MPHBS) and a 3-day food record to assess dietary intake. Results: Despite generally positive views, young adults were uncertain about milk products in relation to health, weight management, and ethical concerns. Females would be more likely than males to increase milk product intake if they were confident that milk products are ethically produced. There was no significant association between MPHBS and dietary calcium intake. Energy-adjusted dietary calcium intake was positively associated with intakes of vitamin A (r = 0.3, P < 0.05), riboflavin (r = 0.5, P < 0.01), vitamin B₁₂ (r = 0.5, P = < 0.01), vitamin D (r = 0.4, P < 0.01), phosphorus (r = 0.4, P < 0.01), zinc (r = 0.3, P < 0.01), and with milk and alternatives servings (r = 0.8, P < 0.01). Conclusion: Nutrition education efforts focused on increasing calcium-rich food consumption will help consumers to be better informed when making dietary choices.

The association between dietary energy intake and the risk of mortality in maintenance haemodialysis patients: a multi-centre prospective cohort study

Maintenance haemodialysis (MHD) is the use of a machine to filter wastes, salts and fluid from blood for at least 3 months to prolong the life of patients with advanced kidney failure. Although low dietary energy intake (DEI) has been observed in MHD patients, few studies have related DEI to the risk of mortality. To explore this relationship, a study included 1039 MHD patients from eight centres was conducted. DEI was assessed by three 24-h diet recalls and was normalised to ideal body weight (IBW). All-cause mortality and CVD mortality were the primary and secondary outcomes, respectively. During a median follow-up of 28 months, a U-shaped relationship was observed between DEI and all-cause or CVD mortality. The risk of all-cause mortality decreased significantly with the increase of DEI in participants with DEI <167·4 kJ/kg IBW per d (hazard ratio (HR) 0·98; 95 % CI 0·96, 1·00) and increased significantly with the increase of DEI in those with DEI ≥167·4 kJ/kg IBW per d (HR 1·12; 95 % CI 1·04, 1·20). Similarly, the risk of CVD mortality decreased with the increase of DEI in participants with DEI <152·7 kJ/kg IBW per d (HR 0·96; 95 % CI 0·93, 0·99) and increased with the increase of DEI in participants with DEI ≥152·7 kJ/kg IBW per d (HR 1·11; 95 % CI 1·04, 1·18). In summary, there was a U-shaped association between DEI and all-cause or CVD mortality, with a turning point at about 167·4 and 152·7 kJ/kg IBW per d, respectively, in MHD patients.

The Analysis of Food Intake in Patients with Cirrhosis Waiting for Liver Transplantation: A Neglected Step in the Nutritional Assessment

Patients with cirrhosis waiting for liver transplantation (LT) frequently present a nutritional disorder, which represents an independent predictor of morbidity and mortality before and after transplantation. Thus, a proper assessment of the food intake by using different methods, such as food records, food frequency questionnaires, and 24 h recall, should be deemed an important step of the nutritional management of these patients. The available published studies indicate that the daily food intake is inadequate in the majority of waitlisted patients. These findings were confirmed by our experience, showing that the daily intake of total calories, proteins and carbohydrates was inadequate in approximately 85–95% of patients, while that of lipids and simple carbohydrates was inadequate in almost 50% of them. These data highlight the need to implement an effective educational program provided by certified nutritionists or dieticians, who should work in close collaboration with the hepatologist to provide a nutritional intervention tailored to the individual patient requirements.

Dietary Energy Density is Associated with Body Mass Index and Fat Mass in Early Adulthood

A cross-sectional study was conducted to investigate the association between body composition parameters as well as body mass index (BMI), and dietary energy density in a population of 538 young adults. Fat mass, fat mass percent, fat-free mass, and visceral fat were measured using a body composition analyzer. Daily energy intake was assessed using a 72-hr diet recall, and dietary energy density was calculated. Significant differences in dietary energy density among underweight, normal-weight and overweight/obesity young adults were identified (M = 1.42, SD = 0.26 vs. M = 1.52, SD = 0.46 vs. M = 1.66, SD = 0.53, p = .002). Dietary energy density was associated with BMI (β = .961; CI 95% = 0.335, 1.586; p = .0030), fat mass percent (β = 1.921; CI 95% = 0.707, 3.135; p = .002), and fat mass (β = 2.146; CI 95% = 0.827, 3.466; p = .001). Dietary energy density might be considered as an important aspect in the obesity nutritional education programs in young people.

Dietary patterns associated with obesity and overweight: When should misreporters be included in analysis?

OBJECTIVE

The aim of the study was to identify dietary patterns associated with overweight and obesity and to examine the effect of including and excluding misreporters on the analysis of these dietary patterns and on the associations between identified dietary patterns and anthropometric parameters.

METHODS

The study was carried out with adult participants in an observational case-control manner. The participants' diet was assessed using 3-d dietary records. To identify misreporters, the Goldberg and Black cutoff method was used. Dietary patterns were evaluated using factor analysis and dietary indices.

RESULTS

Among 410 participants, 100 were underreporters and 1 was an overreporter. The nutritional value of the diets and the relative intake of several groups of food products differed between those with normal and increased body weight. Excluding misreporters affected the differences between body weight groups in energy; dietary fiber; empty calories; cholesterol; sodium; magnesium; folate; vitamins C, PP, and A; groats; vegetables; coffee; and water intake. The Western diet (WD) factor correlated positively with the waist circumference and the amount of fat tissue, whereas the healthy diet (HD) factor correlated negatively with body weight, waist circumference, and the fat tissue amount. The coefficients of the correlation between the HD factor and the anthropometric parameters were stronger when misreporters were excluded, whereas those between the WD factor and the parameters did not change much after exclusion of misreporters.

CONCLUSIONS

There is a positive relationship between the WD pattern and obesity. The exclusion of misreporters from the data set may positively affect the association between the HD pattern and anthropometric parameters.

Characterizing energy intake misreporting and its effects on intake estimations, in the Portuguese adult population

OBJECTIVE

The aim of the current study was to evaluate energy intake misreporting prevalence, its associated factors and its effects on nutrient intake, in the Portuguese population aged from 18 to 84 years.

DESIGN

Cross-sectional study.

SETTING

Portugal.

SUBJECTS

Adults participants from the National Food, Nutrition and Physical Activity Survey, IAN-AF, 2015-2016, who provided two complete 24 h dietary recall and complete covariate information.

RESULTS

Under, plausible and over-reporters were identified according to the Goldberg method. Total misreporting prevalence was 29·9 %, being 28·5 % of under-reporting and 1·4 % of over-reporting. The current study found higher odds of being classified as an under-reporter especially in participants with higher BMI and in those who self-reported health perception status as non-favourable. Energy intake estimation increases by 853.5 kJ/d (204 kcal/d) when misreporters are excluded, and the same tendency is observed for macro and micronutrients. It is worth mentioning that the prevalence of inadequacy for protein intake decreases by about 5 % when considering plausible reporters.

CONCLUSIONS

The exclusion of misreporters has a small impact on the crude energy and nutrient estimates as well as on assessing the contribution of nutrients to total energy intake. However, a moderate impact was observed in the estimation of nutrient inadequacy prevalence.

Reliability and validity of an FFQ for South American children and adolescents from the SAYCARE study

Objective:

The purpose of this study was to analyse the reliability and validity of a semi-quantitative FFQ to assess food group consumption in South American children and adolescents.

Design:

The SAYCARE (South American Youth/Child cARdiovascular and Environmental) study is an observational, multicentre, feasibility study performed in a sample of 3- to 18-year-old children and adolescents attending private and public schools from six South American countries. Participants answered the FFQ twice with a two-week interval and three 24-h dietary recalls. Intraclass and Spearman’s correlations, weighted Cohen’s kappa (κw), percentage of agreement and energy-adjusted Pearson’s correlation coefficients were calculated.

Setting:

Seven cities in South America (Buenos Aires, Lima, Medelin, Montevideo, Santiago, Sao Paulo and Teresina).

Subjects:

A sample of 200 children and 244 adolescents for reliability analyses and 252 children and 244 adolescents for validity analyses were included.

Results:

Depending on the food group, for children and adolescents, reliability analyses resulted in Spearman’s coefficients from 0·47 to 0·73, intraclass correlation coefficients from 0·66 to 0·99, κw coefficients from 0·35 to 0·63, and percentage of agreement between 72·75 and 83·52 %. In the same way, validity analyses resulted in Spearman’s coefficients from 0·17 to 0·37, energy-adjusted Pearson’s coefficients from 0·17 to 0·61, κw coefficients from 0·09 to 0·24, and percentages of agreement between 45·79 and 67·06 %.

Conclusion:

The SAYCARE FFQ achieved reasonable reliability and slight-moderate validity for almost all food groups intakes. Accordingly, it can be used for the purpose of ranking the intake of individuals within a population.

Dietary Inflammatory Index Score and Cardiovascular Disease Risk Markers in Women with Systemic Lupus Erythematosus

BACKGROUND

Patients with systemic lupus erythematosus (SLE), a chronic inflammatory autoimmune disease, have an increased risk of developing cardiovascular diseases. Environmental factors like diet and nutrition are known to play a key role in modulating inflammation and the prognosis of cardiovascular diseases.

OBJECTIVE

To investigate the relationship between Dietary Inflammatory Index score and cardiovascular disease risk markers in a population of women with SLE.

DESIGN

A cross-sectional study was conducted in women with SLE recruited from 2016 through 2017.

PARTICIPANTS/SETTINGS

Clinically stable women with SLE were enrolled from three public hospitals in the Andalusian region of Spain. Participants with chronic renal failure, active infections, recent trauma, pregnancy, and/or other autoimmune diseases were excluded.

MAIN OUTCOME MEASURES

A 24-hour diet recall was used to estimate Dietary Inflammatory Index score and physical activity was assessed through the International Physical Activity Questionnaires. Cardiovascular disease risk markers included blood lipid profile (total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and triglyceride levels), high-sensitivity C-reactive protein levels, and homocysteine levels, along with diagnosis of obesity, diabetes mellitus, hypertension, dyslipidemia, and ankle-brachial index measurement.

STATISTICAL ANALYSIS

Comparisons of cardiovascular disease risk markers across Dietary Inflammatory Index score tertiles were analyzed through a one-way analysis of variance and linear regressions adjusting for age, physical activity level, and medical treatment.

RESULTS

A total of 105 women (aged 45.4±12.8 years) were included. Linear regression analysis revealed that Dietary Inflammatory Index score was significantly associated with total cholesterol levels (β=.26, 95% CI 1.66 to 14.28; P=0.014) after adjusting for age, physical activity, and the use of medical treatment. No significant associations were observed between Dietary Inflammatory Index score and the other cardiovascular markers considered.

CONCLUSIONS

Higher inflammatory potential of the diet was positively associated with higher total cholesterol levels in women with SLE. These findings suggest that the inflammatory potential of a person's diet may play a role in lipid profiles in this population. Future intervention studies are needed to build on these results and explore the effect of anti-inflammatory diets on health outcomes in individuals with SLE.

Investigating Physical and Nutritional Changes During Prolonged Intermittent Fasting in Hemodialysis Patients: A Prospective Cohort Study

OBJECTIVE

Studies investigating the health effects of prolonged intermittent fasting during Ramadan among Muslim patients on hemodialysis (HD) are limited and reported heterogeneous findings. This study aimed to evaluate the effects of intermittent fasting during Ramadan on nutritional and functional status of patients on maintenance HD.

DESIGN AND METHODS

This was a 12-week, multicenter, prospective observational study. The study setting included three HD centers. Adult Muslim patients, who were undergoing HD session thrice weekly and planned to fast during Ramadan, were screened for eligibility and recruited. Nutritional and functional status assessments were carried out 2 weeks before (V₀), at the fourth week of Ramadan (V₁), and 4 weeks after Ramadan (V₂). Nutritional status parameters included anthropometry (body mass index, interdialytic weight gain, waist circumference), body composition (mid-arm circumference, triceps skinfold, body fat percentage), blood biochemistry (albumin, renal profile, lipid profile, and inflammatory markers), blood pressure, dietary intake, and handgrip strength. Changes in nutritional and functional status parameters across study timepoints were analyzed using repeated-measures analysis of variance.

RESULTS

A total of 87 patients completed the study, with 68 patients (78.2%) reporting fasting ≥20 days. Ramadan fasting led to significant reductions (all P < .05) in body mass index, interdialytic weight gain, waist circumference, mid-arm circumference, fat tissue mass, and body fat percentage, but these were not accompanied by any significant change in lean tissue mass (P > .05). Significant improvement was observed in serum phosphate levels, but serum albumin, urea, and creatinine were also reduced significantly during Ramadan (P < .05). There were no significant changes in lipid profile and inflammatory markers. Interestingly, energy and protein intakes remain unchanged during Ramadan. Handgrip strength improved significantly during Ramadan and further improved after Ramadan.

CONCLUSION

Intermittent Ramadan fasting leads to temporary changes in nutritional status parameters and poses nondetrimental nutritional risk for patients on maintenance HD.

Nutritional Risk Screening and Assessment

Malnutrition is an independent risk factor that negatively influences patients’ clinical outcomes, quality of life, body function, and autonomy. Early identification of patients at risk of malnutrition or who are malnourished is crucial in order to start a timely and adequate nutritional support. Nutritional risk screening, a simple and rapid first-line tool to detect patients at risk of malnutrition, should be performed systematically in patients at hospital admission. Patients with nutritional risk should subsequently undergo a more detailed nutritional assessment to identify and quantify specific nutritional problems. Such an assessment includes subjective and objective parameters such as medical history, current and past dietary intake (including energy and protein balance), physical examination and anthropometric measurements, functional and mental assessment, quality of life, medications, and laboratory values. Nutritional care plans should be developed in a multidisciplinary approach, and implemented to maintain and improve patients’ nutritional condition. Standardized nutritional management including systematic risk screening and assessment may also contribute to reduced healthcare costs. Adequate and timely implementation of nutritional support has been linked with favorable outcomes such as a decrease in length of hospital stay, reduced mortality, and reductions in the rate of severe complications, as well as improvements in quality of life and functional status. The aim of this review article is to provide a comprehensive overview of nutritional screening and assessment methods that can contribute to an effective and well-structured nutritional management (process cascade) of hospitalized patients.

A randomized controlled trial for overweight and obesity in preschoolers: the More and Less Europe study - an intervention within the STOP project

Background

Childhood overweight and obesity is a serious public health issue with an increase being observed in preschool-aged children. Treating childhood obesity is difficult and few countries use standardized treatments. Therefore, there is a need to find effective approaches that are feasible for both health care providers and families. Thus, the overall aim of this study is to assess the acceptance and effectiveness of a parent support program (the More and Less, ML) for the management of overweight and obesity followed by a mobile health (mHealth) program (the MINISTOP application) in a socially diverse population of families.

Methods/design

A two-arm, parallel design randomized controlled trial in 300 2-to 6-year-old children with overweight and obesity from Romania, Spain and Sweden (n = 100 from each). Following baseline assessments children are randomized into the intervention or control group in a 1:1 ratio. The intervention, the ML program, consists of 10-weekly group sessions which focus on evidence-based parenting practices, followed by the previously validated MINISTOP application for 6-months to support healthy eating and physical activity behaviors. The primary outcome is change in body mass index (BMI) z-score after 9-months and secondary outcomes include: waist circumference, eating behavior (Child Eating Behavior Questionnaire), parenting behavior (Comprehensive Feeding Practices Questionnaire), physical activity (ActiGraph wGT3x-BT), dietary patterns (based on metabolic markers from urine and 24 h dietary recalls), epigenetic and gut hormones (fasting blood samples), and the overall acceptance of the overweight and obesity management in young children (semi-structured interviews). Outcomes are measured at baseline and after: 10-weeks (only BMI z-score, waist circumference), 9-months (all outcomes), 15- and 21-months (all outcomes except physical activity, dietary patterns, epigenetics and gut hormones) post-baseline.

Discussion

This study will evaluate a parent support program for weight management in young children in three European countries. To boost the effect of the ML program the families will be supported by an app for 6-months. If the program is found to be effective, it has the potential to be implemented into routine care to reduce overweight and obesity in young children and the app could prove to be a viable option for sustained effects of the care provided.

Trial registration

ClinicalTrials.gov NCT03800823; 11 Jan 2019.

The Contribution of Diet Quality to Socioeconomic Inequalities in Obesity: A Population-based Study of Swiss Adults

Socioeconomically disadvantaged people are disproportionally more likely to develop obesity and obesity-related diseases. However, it remains unclear to what extent diet quality contributes to socioeconomic inequalities in obesity. We aimed to assess the role of diet quality in the association between socioeconomic status (SES) and obesity. Data originated from the national nutrition survey, a cross-sectional sample of the adult Swiss population (N = 1860). We used education and income as proxies for SES; calculated the Alternate Healthy Eating Index (AHEI) as a measure of diet quality; and used body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), and waist-to-height ratio (WHtR) as obesity markers. We applied counterfactual mediation modelling to generate odds ratios, 95% confidence intervals, and the proportion mediated by diet quality. Individuals with less than a tertiary education were two to three times more likely to be obese, regardless of the marker (OR (95% CI): 3.36 (2.01, 5.66) using BMI; 2.44 (1.58, 3.75) using WC; 2.48 (1.63, 3.78) using WHR; and 2.04 (1.43, 2.96) using WHtR). The proportion of the association between educational level and obesity that was mediated by diet quality was 22.1% using BMI, 26.6% using WC, 31.4% using WHtR, and 35.8% using WHR. Similar findings were observed for income. Our findings suggest that diet quality substantially contributes to socioeconomic inequalities in obesity while it does not fully explain them. Focusing efforts on improving the diet quality of disadvantaged groups could help reduce social inequalities in obesity.

Developing a Food Exposure and Urine Sampling Strategy for Dietary Exposure Biomarker Validation in Free-Living Individuals

SCOPE

Dietary choices modulate the risk of chronic diseases and improving diet is a central component of public health strategies. Food-derived metabolites present in urine could provide objective biomarkers of dietary exposure. To assist biomarker validation, this work aims to develop a food intervention strategy mimicking a typical annual diet over a short period of time and assesses urine sampling protocols potentially suitable for future deployment of biomarker technology in free-living populations.

METHODS AND RESULTS

Six different menu plans comprehensively represent a typical UK annual diet that is split into two dietary experimental periods. Free-living adult participants (n = 15 and n = 36, respectively) are provided with all their food, as a series of menu plans, over a period of three consecutive days. Multiple spot urine samples are collected and stored at home.

CONCLUSION

A successful food exposure strategy is established following a conventional UK eating pattern, which is suitable for biomarker validation in free-living individuals. The urine sampling procedure is acceptable for volunteers and delivered samples suitable for biomarker quantification. The study design provides scope for validation of existing biomarker candidates and potentially for discovery of new biomarker leads, and should help inform the future deployment of biomarker technology for habitual dietary exposure measurement.

Prevalence and characteristics of energy intake under-reporting among Australian adults in 1995 and 2011 to 2012

AIM

Misreporting of energy intake is a common source of measurement error found in dietary surveys, resulting in biased estimates and a reduction in statistical power. The present study aims to refine the conventional cut-off methods and to examine the extent to which Australian adults misreport their energy intake, and the characteristics of under-reporters between two time points.

METHODS

A revised Goldberg cut-off approach was used to identify those who reported implausible intake amounts in a secondary analysis of two large cross-sectional surveys. Identified low energy reporters were then used as the outcome variable in Poisson regressions to examine association with sex, age, body mass index (BMI), weight perceptions, education, relative household income, geographic remoteness and relative socioeconomic disadvantage.

RESULTS

The prevalence of under-reporting increased from 32% in 1995 to 41% in 2012, most of which can be attributed to an increase in men. Under-reporting has a positive association with BMI and relative socioeconomic disadvantage, but an inverse association with age, education, relative household income and residence in inner regional areas.

CONCLUSIONS

Under-reporting of energy intake is high in Australian adults, and appears have worsened over time in men, which could be partly explained by the upward trend in obesity. The use of conventional Goldberg method to identify under-reporters can greatly underestimate the prevalence of under-reporting, future studies should consider selecting a lower critical value to improve accuracy.

Assessment of Dietary Under-Reporting in Italian College Team Sport Athletes

BACKGROUND

Nutrition is an important factor for sports performance and the assessment of dietary intakes in athletes can correct unhealthy eating habits. However, dietary assessment may be biased due to misreporting. The aim of our study was to investigate the occurrence of misreporting in a sample of collegiate team sport athletes.

METHODS

A total of 50 athletes participated. Each athlete filled in food records for seven days. Reported energy intake (EI) was considered in relation to the predicted basal metabolic rate (BMR) and expressed as the ratio EI/ BMR. All participants with EI/BMRestd ≤1.23 were classified as "low energy reporters" (LER), and those with an EI/BMRestd ratio >1.23 were classified as "adequate energy reporters" (AER).

RESULTS

According to cut-off values for under-reporting, 28 out of 50 athletes (56%) were classified as LER. The LER (16 M/12 F) had significantly higher BMI (23.17 ± 3.46 kg/m2 compared to 21.41 ± 1.91 kg/m2; p = 0.038) than the AER. The EI/kg fat free mass (FFM) was significantly lower in LER than the AER (33.34 ± 6.56 kcal/FFM compared to 48.51 ± 8.59 kcal/FFM, p < 0.0001). Nutrient intake was also significantly different between the two groups.

CONCLUSIONS

Our results suggest that under-reporting of energy intake by collegiate team sport athletes may occur frequently and needs to be taken into consideration in the interpretation of nutrient intake.

Project Spraoi: a two-year longitudinal study on the effectiveness of a school-based nutrition and physical activity intervention on dietary intake, nutritional knowledge and markers of health of Irish schoolchildren

OBJECTIVE

To assess the effectiveness of a nutrition and physical activity (PA) intervention on dietary intake (DI), nutritional knowledge (NK), blood pressure (BP), anthropometric measures and cardiorespiratory fitness (CRF) of schoolchildren.

DESIGN

Longitudinal study. DI, NK, BMI, waist-to-height ratio (WHtR), BP and CRF were all measured/calculated prior to (October 2014) and at the end of (June 2016) intervention delivery.

SETTING

Two primary schools (one intervention and one control), Cork, Ireland.

PARTICIPANTS

Six-year-olds (n 49; mean age = 6·09 (sd 0·33) years) and 10-year-olds (n 52; mean age = 9·90 (sd 0·37) years).

RESULTS

There was a large and a moderate statistically significant difference between the change in systolic (P = 0·005, effect size (ES) = 0·165) and diastolic BP (P = 0·023, ES = 0·116), respectively, for 10-year-olds in the intervention and control groups. There was also a large statistically significant difference between the change in WHtR (P = 0·0005, ES = 0·386) and a moderate statistically significant difference between the change in NK (P = 0·027, ES = 0·107) for 10-year-olds in the intervention and control groups. There was a large statistically significant difference between the change in percentage of energy from protein in 10-year-old females (P = 0·021, ES = 0·276) in the intervention and control groups.

CONCLUSIONS

Project Spraoi is Ireland's first ever school-based intervention that has been evaluated and proven effective in improving DI, NK, WHtR and BP in older primary-school children in one intervention school.

Assessment of Dietary Intake and Eating Attitudes in Recreational and Competitive Adolescent Rock Climbers: A Pilot Study

The dietary intake and eating attitudes of adolescent climbers has not previously been studied. To fill this knowledge gap, we administered three surveys to 22 rock climbers (13 males, 9 females, age 14.2 ± 1.9 years): climbing ability, three-day dietary recall, and Eating Attitude Test-26 (EAT-26). The majority (82%) of climbers did not meet their target energy intake (target = 2,471 ± 493 kcal·day⁻¹; actual = 1,963 ± 581 kcal·day⁻¹) (p = 0.003) and 86% of climbers consumed below their target carbohydrate intake (target = 283 ± 67 g·day⁻¹; actual intake = 226 ± 72 g·day⁻¹) (p = 0.009). Average dietary protein intake was 95 ± 51 g·day⁻¹, with the majority of climbers meeting their target intake of 88 ± 21 g (p = 0.580). Seventy-three percent of climbers consumed below their target dietary fat intake (target = 90 ± 21 g·day⁻¹; actual = 69 ± 20 g·day⁻¹) (p = 0.001). Average EAT-26 scores were 5.3 ± 4.1, indicating minimal risk of disordered eating attitudes/behaviors. There were no significant differences in boulderers vs. top rope climbers for energy/macronutrient intake, BMI, and EAT-26 score. There were no associations between energy intake and EAT-26 score (R² = 0.245, p = 0.271) or climbing ability and EAT-26 score (R² = p = 0.217). These data suggest that, with the exception of dietary protein intake, adolescent climbers fail to meet target dietary intakes, and exhibit minimal risk of disordered eating.