Development of an on-line Irish food composition database for nutrients

Association of plant-based diet indexes with the metabolomic profile

Plant-based diets have gained attention for their potential benefits on both human health and environmental sustainability. The objective of this study was to investigate the association of plant-based dietary patterns with the endogenous metabolites of healthy individuals and identify metabolites that may act as mediators of the associations between dietary intake and modifiable disease risk factors. Adherence to plant-based dietary patterns was assessed for 170 healthy adults using plant-based diet indexes (PDI). Individuals with higher healthful PDI had lower BMI and fasting glucose and higher HDL-C, while those with higher unhealthful PDI had higher BMI, triacylglycerol and fasting glucose and lower HDL-C. Unhealthful PDI was associated with higher levels of several amino acids and biogenic amines previously associated with cardiometabolic diseases and an opposite pattern was observed for healthful PDI. Furthermore, healthful PDI was associated with higher levels of glycerophosphocholines containing very long-chain fatty acids. Glutamate, isoleucine, proline, tyrosine, α-aminoadipate and kynurenine had a statistically significant mediation effect on the associations between PDI scores and LDL-C, HDL-C and fasting glucose. These findings contribute to the growing evidence supporting the role of plant-based diets in promoting metabolic health and shed light on the potential mechanisms explaining their beneficial health effects.

Development of an Indian Food Composition Database

An open-access and comprehensive nutrient database is not available in India. Our objective was to develop an open-access Indian Nutrient Databank (INDB). The development of the INDB consisted of 2 stages: creating a database of the nutrient composition data of individual food items (n = 1095) and a database of commonly consumed recipes (n = 1014). The stage 1 database was primarily derived from the Indian Council of Medical Research-National Institute of Nutrition's Indian Food Composition Table (ICMR-NIN IFCT) from 2017, with gaps filled using the ICMR-NIN IFCT 2004 and nutrient databases from the United Kingdom and United States. The stage 2 database included information on the amounts of each ingredient used in each recipe, matched to a comparable item in the database from stage 1. This unique open-access resource can be used by researchers, the government, and the private and third sectors to derive nutrient intakes in India to better inform interventions and policies to address malnutrition.

A data-driven approach for prioritising microbial and chemical hazards associated with dairy products using open-source databases

This study presents a data-driven approach for classifying food safety alerts related to chemical and microbial contaminants in dairy products using the Rapid Alert System for Food and Feed (RASFF) and the World Health Organization (WHO)'s Global Environmental Monitoring System (GEMS) food contaminants databases. This research aimed to prioritise microbial and chemical hazards based on their presence and severity through exploratory data analysis and to classify the severity of chemical hazards using machine learning (ML) approaches. It identified Listeria monocytogenes, Escherichia coli, Salmonella, Pseudomonas spp., Staphylococcus spp., Bacillus cereus, Clostridium spp., and Cronobacter sakazakii as the microbial hazards of priority in dairy products. The study also prioritised the top ten chemical hazards based on their presence and severity. These hazards include nitrate, nitrite, ergocornine, 3-MCPD ester, lead, arsenic, ochratoxin A, cadmium, mercury, and aflatoxin (G1, B1, G2, B2, G5 and M1). Using ML techniques, the accuracy rate of classifying food safety alerts as either 'serious' or 'non-serious' was up to 98 %. Additionally, the study identified Reference dose (RfD), substance amount, notification type, product, and substance as the most important features affecting the ML models' performance. These ML models (decision trees, random forests, k-nearest neighbors, linear discriminant analysis, and support vector machines) were also validated on an external dataset of RASFF alerts related to chemical contaminants in dairy products. They achieved an accuracy of up to 95.1 %. The study's findings demonstrate the models' robustness and ability to classify food safety alerts related to chemical contaminants in dairy products, even on new data. These results can enhance the development of more effective machine-learning models for classifying food safety alerts related to chemical contaminants in dairy products, highlighting the importance of developing accurate and efficient classification models for timely intervention.

Poor Quality Diets Characterized by Low-Nutrient Density Foods Observed in One-Quarter of 2-Year-Olds in a High Resource Setting

BACKGROUND

Young children have high nutritional requirements relative to their body size, making healthy diets critical for normal growth and development.

OBJECTIVE

We aimed to integrate analysis of dietary patterns among 2-y-old children with indicators of dietary quality, micronutrient status, and body weight status.

METHODS

Data from the 2-y follow-up of the Cork BASELINE Birth Cohort included dietary assessment using a 2-d weighed food diary, vitamin D and iron status biomarkers, and anthropometry (n = 468). K-means cluster analysis identified predominant dietary patterns based on energy contributions and associations with nutrient intakes and status and body weight were investigated.

RESULTS

Four dietary patterns emerged: "Cows' milk" (unmodified cows' milk: 32% of total energy (TE)); "Traditional" (wholemeal breads, butter, fresh meat, fruit); "Low Nutrient Density (LND) foods" (confectionary, processed meat, convenience foods) and "Formula" (young child formula: 23%TE). The LND pattern was associated with excessive free sugar intake (14%TE) and salt intake (153% of daily limit). No differences in patterns of overweight were observed between the 4 groups; however, the LND group had 3-fold higher odds of being underweight [aOR (95% CI): 3.2 (1.2, 8.5)]. Children consuming >400ml/d of cows' milk or formula exhibited lower dietary variety, fewer family-type meals, and continued use of feeding bottles (75% and 81%, respectively, vs. 35-37% in the other groups).

CONCLUSIONS

Unhealthy eating habits are common among young children. Dietary guidance to support families to provide healthy diets needs to maintain currency with eating habits and focus on food choices for meals, snacks, and beverages.

Food Composition Databases (FCDBs): A Bibliometric Analysis

Food composition databases (FCDBs) are important tools that provide information on the nutritional content of foods. Previously, it was largely unclear what nutritional contents and which FCDBs were involved in highly cited papers. The bibliometric study aimed to identify the most productive authors, institutions, and journals. The chemicals/chemical compounds with high averaged citations and FCDBs used by highly cited papers were identified. In July 2023, the online database Web of Science Core Collection (WoSCC) was queried to identify papers related to FCDBs. A total of 803 papers were identified and analyzed. The first paper indexed in WoSCC was published in 1992 by Pennington, which described the usefulness of FCDB for researchers to identify core foods for their own studies. In that paper, the FCDB described was the USDA 1987-88 NFCS (the United States Department of Agriculture 1987-88 Nationwide Food Consumption Survey). The most productive author was Dr. Paul M. Finglas, the Head of the Food Databanks National Capability at the Quadram Institute (Norwich, UK) and the Managing Director of EuroFIR. His most cited paper among this dataset was about the development of an online Irish food composition database together with EuroFIR. The most productive institutions were the USDA and the World Health Organization (WHO) instead of universities. Flavonoid was the most recurring chemical class among the highly cited ones. The anti-oxidative properties and protective effects against heart disease and cancer of flavonoids might be some of the reasons for their popularity in research. Among the highly cited papers, the most heavily used FCDBs were the USDA database for the flavonoid content of selected foods, Fineli, the USDA National Nutrient Database for Standard Reference (USNDB), EuroFIR eBASIS-Bioactive Substances in Food Information Systems, and Phenol-Explorer. High-quality national and international FCDBs should be promoted and made more accessible to the research and public communities to promote better nutrition and public health on a global scale.

The Women's Health Initiative cancer survivorship clinic incorporating electronic patient-reported outcomes: a study protocol for the Linking You to Support and Advice (LYSA) randomized controlled trial

BACKGROUND

The improved survival rate for many cancers in high-income countries demands a coordinated multidisciplinary approach to survivorship care and service provision to ensure optimal patient outcomes and quality of life. This study assesses the feasibility of introducing a Women's Health Initiative cancer survivorship clinic in Ireland.

METHODS

The trial https://spcare.bmj.com/content/9/2/209.short comprises an intervention and control arm. Two hundred participants will be recruited. Key eligibility (1) women with early-stage hormone receptor-positive breast or gynecologic cancer (cervix or endometrial), within 12 months of completion of primary curative therapy, and (2) access to the Internet. The complex intervention comprises a nurse-led clinic targeting symptom management through a trigger alert system, utilizing electronic patient-reported outcome (ePRO) assessments at baseline, and 2, 4, 6, 8, 10, and 12 months. It also includes input from a dietitian monitoring diet and nutritional status. The control group will receive their usual care pathway standard of care and attend the cancer survivorship clinic and complete ePRO assessments at the start and end of the study. The primary endpoint (feasibility) includes the proportion of enrolled participants who complete baseline and follow-up ePRO surveys and partake in health professional consultations after ePRO data triggers. Secondary endpoints include changes in cancer-related symptom scores assessed by ePROs, health-related Quality of Life Questionnaire (QLQ) scores, Appraisal Self-Care Agency-R scores, and adjuvant endocrine therapy medication adherence. A process evaluation will capture the experiences of participation in the study, and the healthcare costs will be examined as part of the economic analysis. Ethical approval was granted in December 2020, with accrual commencing in March 2021.

DISCUSSION

This protocol describes the implementation of a parallel arm randomized controlled trial (RCT) which examines the feasibility of delivering a Cancer Survivorship Clinic. The ePRO is an innovative symptom monitoring system which detects the treatment-related effects and provides individualized support for cancer survivors. The findings will provide direction for the implementation of future survivorship care.

TRIAL REGISTRATION

ClinicalTrials.gov , NCT05035173 . Retrospectively registered on September 5, 2021.

Food neophobia and its relationship with dietary variety and quality in Irish adults: Findings from a national cross-sectional study

Food neophobia is characterised by a reluctance to eat novel or unfamiliar foods and has been linked to reduced dietary variety and quality. However, this link has been primarily studied in children. Therefore, we aimed to explore the relationship between food neophobia and dietary variety and quality in adults using a sub-sample of the National Adults Nutrition Survey collected between 2008 and 2010 (n = 1088). Food and nutrient intakes were assessed using a 4-day semi-weighed food diary. Food neophobia was measured using the Food Neophobia Scale (FNS). Dietary variety was assessed in three ways; Total Dietary Variety (TDV), Food-Group Variety (FGV) and Fruit and Vegetable Variety (FVV). Diet quality was assessed using the Mean Adequacy Ratio (MAR) and Nutrient-Rich Food Index (NRF9.3). A multivariate general linear model was used to assess the linear relationships between FNS score and all dietary measures, controlling for age, sex, education level, social class, location and BMI. Food neophobia was found to be inversely associated with TDV, FGV and FVV. In addition, food neophobia was negatively associated with vitamin C, magnesium and fruit and vegetable intakes and positively associated with percentage energy from free sugars. However, food neophobia was not significantly associated with all other nutrients, MAR and NRF9.3. While these results suggest food neophobia may not be a particularly important risk factor for poor nutrient status, adherence to certain dietary recommendations remains low within the Irish population and food neophobia may further inhibit the adaption of healthy and sustainable diets. Future research should seek to understand the implications of food neophobia on dietary behaviour change.

Respondent Characteristics and Dietary Intake Data Collected Using Web-Based and Traditional Nutrition Surveillance Approaches: Comparison and Usability Study

Background

There are many constraints to conducting national food consumption surveys for national nutrition surveillance, including cost, time, and participant burden. Validated web-based dietary assessment technologies offer a potential solution to many of these constraints.

Objective

This study aims to investigate the feasibility of using a previously validated, web-based, 24-hour recall dietary assessment tool (Foodbook24) for nutrition surveillance by comparing the demographic characteristics and the quality of dietary intake data collected from a web-based cohort of participants in Ireland to those collected from the most recent Irish National Adult Nutrition Survey (NANS).

Methods

Irish adult participants (aged ≥18 years) were recruited to use Foodbook24 (a web-based tool) between March and October 2016. Demographic and dietary intake (assessed by means of 2 nonconsecutive, self-administered, 24-hour recalls) data were collected using Foodbook24. Following the completion of the study, the dietary intake data collected from the web-based study were statistically weighted to represent the age-gender distribution of intakes reported in the NANS (2008-2010) to facilitate the controlled comparison of intake data. The demographic characteristics of the survey respondents were investigated using descriptive statistics. The controlled comparison of weighted mean daily nutrient intake data collected from the Foodbook24 web-based study (329 plausible reporters of a total of 545 reporters) and the mean daily nutrient intake data collected from the NANS (1051 plausible reporters from 1500 reporters) was completed using the Wilcoxon–Mann-Whitney U test in Creme Nutrition software.

Results

Differences between the demographic characteristics of the survey participants across the 2 surveys were observed. Notable differences included a lower proportion of adults aged ≥65 years and a higher proportion of females who participated in the web-based Foodbook24 study relative to the NANS study (P<.001). Similar ranges of mean daily intake for the majority of nutrients and food groups were observed (eg, energy [kilocalorie per day] and carbohydrate [gram per day]), although significant differences for some nutrients (eg, riboflavin [mg/10 MJ], P<.001 and vitamin B12 [µg/10 MJ], P<.001) and food groups were identified. A high proportion of participants (200/425, 47.1%) reported a willingness to continue using Foodbook24 for an additional 6 months.

Conclusions

These findings suggest that by using targeted recruitment strategies in the future to ensure the recruitment of a more representative sample, there is potential for web-based methodologies such as Foodbook24 to be used for nutrition surveillance efforts in Ireland.

Energy, Macronutrients, Dietary Fibre and Salt Intakes in Older Adults in Ireland: Key Sources and Compliance with Recommendations

The global population is rapidly ageing. Adequate nutritional status can play a key role in preventing or delaying the progression of age-related diseases. The aim of this study was to estimate the usual intake of energy, macronutrients, dietary fibre and salt in order to determine compliance with recommendations and to identify the sources of these nutrients in older adults (≥65 years) in Ireland. This study is based on data from the cohort of older adults aged ≥65 years (n = 226) in the Irish National Adult Nutrition Survey (NANS) (2008-2010) which estimated food and nutrient intakes in a representative sample of adults 18-90 years using a 4 day weighed food record. This study found that while intakes of macronutrients are generally sufficient in this population group, older adults in Ireland have high intakes of total fat, saturated fat, sugar and salt and low intakes of dietary fibre. Future strategies to address the nutritional issues identified in older adults could include the promotion of healthy food choices together with improvements of the food supply including reformulation (fat, sugar and salt) to support successful ageing of our population.

Pilot Randomized Controlled Trial of a Standard Versus a Modified Low-Phosphorus Diet in Hemodialysis Patients

INTRODUCTION

The standard low-phosphorus diet restricts pulses, nuts, and whole grains and other high phosphorus foods to control hyperphosphatemia. We conducted a randomized controlled trial to evaluate the effectiveness, safety, and tolerability of the modified diet, which introduced some pulses and nuts, increased the use of whole grains, increased focus on the avoidance of phosphate additives, and introduced the prescription of low-biological-value protein such as bread.

METHODS

We conducted a multicenter, pragmatic, parallel-arm, open-label, randomized controlled trial of modified versus standard diet in 74 adults on hemodialysis with hyperphosphatemia over 1 month. Biochemistry was assessed using monthly laboratory tests. Dietary intake was assessed using a 2-day record of weighed intake of food, and tolerability was assessed using a patient questionnaire.

RESULTS

There was no significant difference in the change in serum phosphate between the standard and modified diets. Although total dietary phosphorus intake was similar, phytate-bound phosphorus, found in pulses, nuts, and whole grains, was significantly higher in the modified diet (P < 0.001). Dietary fiber intake was also significantly higher (P < 0.003), as was the percentage of patients reporting an increase in bowel movements while following the modified diet (P = 0.008). There was no significant difference in the change in serum potassium or in reported protein intake between the 2 diets. Both diets were similarly well tolerated.

CONCLUSION

The modified low phosphorus diet was well tolerated and was associated with similar phosphate and potassium control but with a wider food choice and greater fiber intake than the standard diet.

Sugar-sweetened beverage consumption and association with weight status in Irish children: a cross-sectional study prior to the introduction of a government tax on sugar-sweetened beverages

OBJECTIVE

To provide baseline evidence of sugar-sweetened beverage (SSB) consumption in a sample of Irish children prior to the introduction of the SSB tax; to identify the energy contribution of SSB to daily energy intake; and to explore the association between SSB consumption and overweight/obesity.

DESIGN

Cross-sectional study.

SETTING

Primary schools in Cork, Ireland in 2012.

PARTICIPANTS

1075 boys and girls aged 8-11 years. SSB consumption was assessed from 3-d food diaries. BMI was used to define obesity (International Obesity Taskforce definitions). Plausible energy reporters (n 724, 68 % of total sample) were classified using Schofield equation.

RESULTS

Eighty-two per cent of children with plausible energy intake consumed SSB. Mean energy intake from SSB was 485 kJ (6 % of total kJ). Mean kilojoules from SSB increased with weight status from 443 kJ for normal-weight children to 648 kJ for children with overweight/obesity (5·8 and 7·6 % of total kJ, respectively). Mean SSB intake was significantly higher in children with overweight/obesity than normal-weight children (383 and 315 ml/d). In adjusted analyses, children consuming >200 ml/d had an 80 % increased odds of overweight/obesity compared to those consuming <200 ml/d (OR 1·8, 95 % CI 1·0, 3·5). Family socioeconomic status and lifestyle determinants, including frequency of takeaway consumption and TV viewing, were also significantly associated with SSB consumption.

CONCLUSIONS

SSB account for a substantial proportion of daily energy intake and are significantly associated with child overweight/obesity. This study provides baseline data from a sample of children from which the impact of the SSB tax can be benchmarked.

Sodium and Potassium Intakes and Their Ratio in Adults (18-90 y): Findings from the Irish National Adult Nutrition Survey

An individual's sodium to potassium intake ratio (Na:K) has been shown to be an important predictor of hypertension. The aim of this study was to estimate the mean 24 h urinary Na, K and Na:K of Irish adults and to identify the foods that determine Na:K in a nationally representative sample of Irish adults. This study was based on data from the Irish National Adult Nutrition Survey (2008-2010) (NANS), which collected spot urine samples and dietary data in a nationally representative sample of Irish adults aged 18+ years. The mean urinary molar Na:K of Irish men and women was 1.90 and 2.15, respectively, which exceed target molar ratios of ≤1.0 and ≤2.0. The mean estimated 24-h urinary excretion of Na was 4631 mg for men and 3525 mg for women, which exceed target maximum population intakes for all gender and age groups. The mean estimated 24-h urinary excretion of K was 3894 mg for men and 2686 mg for women, with intakes in women of all ages and older men (65+ years) below current recommendations. The key foods positively associated with a lower Na:K were fruits, vegetables, potatoes, breakfast cereals, milk, yogurt and fresh meat, while the foods negatively associated with a lower Na:K were breads, cured and processed meats and butters and fat spreads. Strategies to reduce sodium and increase potassium intakes are necessary to lower population Na:K, which may help to reduce the burden of hypertension-related diseases in the Irish population.

An observational analysis of meal patterns in overweight and obese pregnancy: exploring meal pattern behaviours and the association with maternal and fetal health measures

BACKGROUND

Nutrient intakes are known to be poorer among pregnant women with raised body mass index (BMI) than those with a healthy BMI. While meal patterns have the potential to influence obstetric, metabolic and anthropometric measures for mother and infant, limited data exists regarding meal patterns among pregnant women with raised BMI.

AIM

To identify categories of meal patterns among pregnant women with overweight and obesity and determine whether patterns change with advancing gestation. To determine if maternal meal patterns are associated with dietary intakes and pregnancy outcomes.

METHODS

Prospective, observational analysis of pregnant women (n = 143) (BMI 25-39.9 kg/m²). Meal pattern data were analysed from 3-day food diaries at 16 and 28 weeks' gestation. Outcomes include maternal blood glucose, insulin resistance, gestational diabetes, gestational weight gain and infant anthropometry.

RESULTS

Three meal pattern categories were identified: 'main meal dominant' (3 main eating occasions + 0-3 snacks), 'large meal dominant' (≤ 2 main eating occasions + < 2 snacks), and 'snack dominant' (3 main eating occasions + > 3 snacks and ≤ 2 main + ≥ 2 snacks). A main meal-dominant pattern prevailed at 16 weeks' (85.3%) and a snack-dominant pattern at 28 weeks' (68.5%). Dietary glycaemic index was lower among the main meal versus large meal-dominant pattern at 28 weeks (P = 0.018). Infant birth weight (kg) and macrosomia were highest among participants with a large meal-dominant pattern at 28 weeks (P = 0.030 and P = 0.008, respectively).

CONCLUSION

Women with raised BMI changed eating patterns as pregnancy progressed, moving from main meal-dominant to snack-dominant patterns. Large meal-dominant meal patterns in later pregnancy were associated with higher glycaemic index and greater prevalence of macrosomia.

Modelling the impact of mandatory folic acid fortification of bread or flour in Ireland on the risk of occurrence of NTD-affected pregnancies in women of childbearing age and on risk of masking vitamin B12 deficiency in older adults

PURPOSE

The rate of neural tube defects (NTDs) in Europe has remained similar since the 1990s despite folic acid supplement recommendations (400 µg/day) for women of childbearing age. Mandatory folic acid fortification of staple foods has proved effective for reducing the prevalence of NTDs in over 80 countries. This study estimated the impact of addition of folic acid to bread or flour in the Republic of Ireland on reducing the risk of occurrence of NTD-affected pregnancies and the possible risk of masking (undiagnosed) vitamin B₁₂ deficiency in older adults.

METHODS

Analyses were based on the Irish National Adult Nutrition Survey (2008-2010). Folic acid fortification was modelled using DaDiet© software. Estimates were made of the increase in average daily folic acid intake in women (18-50 years) and the risk of exceeding the tolerable upper intake level (UL) of 1000 µg for folic acid in adults over 50 years of age.

RESULTS

The fortification scenarios examined would reduce the risk of NTD-affected pregnancies by 8-32%, corresponding to an increase of 39-152 μg in the mean daily folic acid intake of WCBA. The risk of masking anaemia associated with vitamin B₁₂ deficiency in older adults would be negligible as the probability of exceeding the UL for folic acid, even by a small amount, is very low (≤ 0.2%).

CONCLUSIONS

These levels of addition of folic acid to bread or flour would effectively reduce the risk of NTDs while allowing safe consumption of folic acid at current levels from other fortified foods and supplements.

Nutritional composition of the food supply: a comparison of soft drinks and breakfast cereals between three European countries based on labels

BACKGROUND/OBJECTIVES

Monitoring of processed products at the brand level was implemented in Austria, France and Romania on the basis of the Oqali methodology during the Joint Action on Nutrition and Physical Activity (JANPA) to compare the nutritional quality of the food offering. The objective of this paper is to present the results obtained during this study.

SUBJECTS/METHODS

Collected data were those available on product packaging. In total, 2155 soft drinks and 943 breakfast cereals were classified in a standardised list of product families and analysed in a harmonised way. For each product family, mean values for sugar, fat, saturated fat, salt and dietary fibres were compared between countries. Common products across countries were also studied.

RESULTS

For all the studied nutrients, significant differences were observed between countries, with a higher sugar content for Romania in regular carbonated and non-carbonated beverages containing fruits, regular lemonades and regular tonics and bitters (together with Austria for tonics), for France in fruit beverages with more than 50% fruit, and for Austria in low-sugar beverages containing tea. For France, higher nutrient contents were also observed for sugar in chocolate-flavoured cereals, filled cereals and cornflakes, and other plain cereals (at a similar level as Romania for cornflakes), and for saturated fats in honey/caramel cereals and crunchy mueslis. These differences were explained by a different food offering in the three countries, but also by differences in nutrient contents for common products. This study also showed high variability of the nutrient content within a product family, suggesting a real potential for product reformulation.

CONCLUSIONS

National tools, at the branded products level, are essential to monitor the nutritional quality of the food offering, and to follow up on processed food reformulations.

A probabilistic intake model to estimate the impact of reformulation by the food industry among Irish consumers

This project quantified the impact that voluntary reformulation efforts of the food industry had on the Irish population's nutrient intake. Nutrient composition data on reformulated products were collected from 14 major food companies for two years, 2005 and 2012. Probabilistic intake assessments were performed using the Irish national food consumption surveys as dietary intake data. The nutrient data were weighted by market shares replacing existing food composition data for these products. The reformulation efforts assessed, significantly reduced mean energy intakes by up to 12 kcal/d (adults), 15 kcal/d (teens), 19 kcal/d (children) and 9 kcal/d (pre-schoolers). Mean daily fat intakes were reduced by up to 1.3 g/d, 1.3 g/d, 0.9 g/d and 0.6 g/d, saturated fat intakes by up to 1.7 g/d, 2.3 g/d, 1.8 g/d and 1 g/d, sugar intakes by up to 1 g/d, 2 g/d, 3.5 g/d and 1 g/d and sodium intakes by up to 0.6 g/d, 0.5 g/d, 0.2 g/d, 0.3 g/d for adults, teenagers, children and pre-school children, respectively. This model enables to assess the impact of industry reformulation amongst Irish consumers' nutrient intakes, using consumption, food composition and market share data.

Food Composition Databases: Considerations about Complex Food Matrices

Nowadays, many countries have their own national Food Composition Databases, whose continuous updating allows the inclusion of a large number of foods, reflecting the food habits of the population and the growing number of foods on the market in the best way possible. Therefore, particular attention should be directed to the study not only of individual foods or food components but also of the nutritional characteristics of dishes, meals and diets, as they are really consumed. Recently, a reviewed sensitivity in Europe towards the implementation of standardized procedures for generating reliable composition data for composite dishes has been carried out. Although direct chemical analysis is the most accurate method to determine food composition, the nutrient content of complex matrices and composite dishes is often calculated from the nutrient contents of the individual ingredients, considering the different thermal treatments and using some preparation factors. In this context, this paper aims to give an updated picture on Food Composition Databases; in particular, their application regarding complex matrices is examined together with the need to optimize their calculated nutritional values. Results obtained by this calculation should almost always be observed as approximations.

Estimating safe maximum levels of vitamins and minerals in fortified foods and food supplements

PURPOSE

To show how safe maximum levels (SML) of vitamins and minerals in fortified foods and supplements may be estimated in population subgroups.

METHODS

SML were estimated for adults and 7- to 10-year-old children for six nutrients (retinol, vitamins B6, D and E, folic acid, iron and calcium) using data on usual daily nutrient intakes from Irish national nutrition surveys.

RESULTS

SML of nutrients in supplements were lower for children than for adults, except for calcium and iron. Daily energy intake from fortified foods in high consumers (95th percentile) varied by nutrient from 138 to 342 kcal in adults and 40-309 kcal in children. SML (/100 kcal) of nutrients in fortified food were lower for children than adults for vitamins B6 and D, higher for vitamin E, with little difference for other nutrients. Including 25 % 'overage' for nutrients in fortified foods and supplements had little effect on SML. Nutritionally significant amounts of these nutrients can be added safely to supplements and fortified foods for these population subgroups. The estimated SML of nutrients in fortified foods and supplements may be considered safe for these population subgroups over the long term given the food composition and dietary patterns prevailing in the respective dietary surveys.

CONCLUSIONS

This risk assessment approach shows how nutrient intake data may be used to estimate, for population subgroups, the SML for vitamins and minerals in both fortified foods and supplements, separately, each taking into account the intake from other dietary sources.

Variation in iodine food composition data has a major impact on estimates of iodine intake in young children

BACKGROUND/OBJECTIVES

The reliability of an estimate of iodine intake is largely dependent on the quality of the food composition data. We aimed to assess the impact of variations in food composition data for iodine and season on the estimates of iodine intake in young children.

SUBJECTS/METHODS

Cross-sectional dietary intake study of Irish 2-year-olds participating in the Cork BASELINE Birth Cohort Study (n=468; 30% of the cohort at the 2-year follow-up) were used to assess the impact of variation in iodine food composition data on estimates of iodine intake, dietary adequacy and risk of exceeding the tolerable upper intake level (UL).

RESULTS

Mean (SD) iodine intakes calculated using UK (147 (71)) and Irish (177 (93)) food composition data were significantly different (P < 0.001) (mean difference (95% confidence interval) = 30 (26-33) µg/day) and largely adequate (7-14% below the estimated average requirement). Intakes at the 95th percentile were 138% and 173% of the UL using UK and Irish food composition data, respectively, of which milk accounted for 106% and 150% of the UL. This translated into 22% and 35% of toddlers exceeding the UL, using UK and Irish composition data, respectively. The mean (SD) daily intake of cow's milk among the 91% of consumers was 309 (208) ml. Intakes of cow's milk at the 75th and 95th percentiles were 452 and 706 ml, respectively. Using Irish composition data for iodine in cows' milk, a daily intake of 450 ml could result in a toddler exceeding the UL from milk alone.

CONCLUSIONS

Variability in food composition has a large impact on assessments of iodine intake, particularly among young children for whom milk contributes a large proportion of their daily nutrient intake. Although this is unlikely to result in long-term adverse effects, our study highlights the need for development of valid biomarkers of individual iodine status.

Development and evaluation of a concise food list for use in a web-based 24-h dietary recall tool

Foodbook24 is a self-administered web-based 24-h dietary recall tool developed to assess food and nutrient intakes of Irish adults. This paper describes the first step undertaken in developing Foodbook24 which was to limit participant burden by establishing a concise list of food items for inclusion in the tool. The aim of the present study was to evaluate whether using a concise food list (as opposed to an extensive list) with generic composition data would influence the estimates of nutrient intakes in a nationally representative sample of Irish adults. A 2319-item food list generated from the Irish National Adult Nutrition Survey (NANS) (2008-2010) (n 1500) was used as the basis for a shortened food list for integration into the tool. Foods similar in nutritional composition were recoded with a generic type food code to produce a concise list of 751 food codes. The concise food list was applied to the NANS food consumption dataset and intake estimates of thirty-five nutrients were compared with estimates derived using the original extensive list. Small differences in nutrient intakes (<6 %) with limited effect size (Cohen's d < 0·1) were observed between estimates from both food lists. The concise food list showed strong positive correlations (rs 0·9-1·0, n 1500, P < 0·001) and a high level of agreement with the extensive list (80-97 % of nutrient intakes classified into the same tertile; >90% of intakes similarly categorised according to dietary reference values). This indicates that a concise food list is suitable for use in a web-based 24-h dietary recall tool for Irish adults.

The Development, Validation, and User Evaluation of Foodbook24: A Web-Based Dietary Assessment Tool Developed for the Irish Adult Population

BACKGROUND

The application of technology in the area of dietary assessment has resulted in the development of an array of tools, which are often specifically designed for a particular country or region.

OBJECTIVE

The aim of this study was to describe the development, validation, and user evaluation of a Web-based dietary assessment tool "Foodbook24."

METHODS

Foodbook24 is a Web-based, dietary assessment tool consisting of a 24-hour dietary recall (24HDR) and food frequency questionnaire (FFQ) alongside supplementary questionnaires. Validity of the 24HDR component was assessed by 40 participants, who completed 3 nonconsecutive, self-administered 24HDR using Foodbook24 and a 4-day semi-weighed food diary at separate time points. Participants also provided fasted blood samples and 24-hour urine collections for the identification of biomarkers of nutrient and food group intake during each recording period. Statistical analyses on the nutrient and food group intake data derived from each method were performed in SPSS version 20.0 (SPSS Inc). Mean nutrient intakes (and standard deviations) recorded using each method of dietary assessment were calculated. Spearman and Pearson correlations, Wilcoxon Signed Rank and Paired t test were used to investigate the agreement and differences between the nutritional output from Foodbook24 (test method) and the 4-day semi-weighed food diary (reference method). Urinary and plasma biomarkers of nutrient intake were used as an objective validation of Foodbook24. To investigate the user acceptability of Foodbook24, participants from different studies involved with Foodbook24 were asked to complete an evaluation questionnaire.

RESULTS

For nutrient intake, correlations between the dietary assessment methods were acceptable to very good in strength and statistically significant (range r=.32 to .75). There were some significant differences between reported mean intakes of micronutrients recorded by both methods; however, with the exception of protein (P=.03), there were no significant differences in the reporting of energy or macronutrient intake. Of the 19 food groups investigated in this analysis, there were significant differences between 6 food groups reported by both methods. Spearman correlations for biomarkers of nutrient and food group intake and reported intake were similar for both methods. A total of 118 participants evaluated the acceptability of Foodbook24. The tool was well-received and the majority, 67.8% (80/118), opted for Foodbook24 as the preferred method for future dietary intake assessment when compared against a traditional interviewer led recall and semi-weighed food diary.

CONCLUSIONS

The results of this study demonstrate the validity and user acceptability of Foodbook24. The results also highlight the potential of Foodbook24, a Web-based dietary assessment method, and present a viable alternative to nutritional surveillance in Ireland.

Iron intakes and status of 2-year-old children in the Cork BASELINE Birth Cohort Study

Young children are at risk of iron deficiency and subsequent anaemia, resulting in long-term consequences for cognitive, motor and behavioural development. This study aimed to describe the iron intakes, status and determinants of status in 2-year-old children. Data were collected prospectively in the mother-child Cork BASELINE Birth Cohort Study from 15 weeks' gestation throughout early childhood. At the 24-month assessment, serum ferritin, haemoglobin and mean corpuscular volume were measured, and food/nutrient intake data were collected using a 2-day weighed food diary. Iron status was assessed in 729 children (median [IQR] age: 2.1 [2.1, 2.2] years) and 468 completed a food diary. From the food diary, mean (SD) iron intakes were 6.8 (2.6) mg/day and 30% had intakes < UK Estimated Average Requirement (5.3 mg/day). Using WHO definitions, iron deficiency was observed in 4.6% (n = 31) and iron deficiency anaemia in five children (1.0%). Following an iron series workup, five more children were diagnosed with iron deficiency anaemia. Twenty-one per cent had ferritin concentrations <15 µg/L. Inadequate iron intakes (OR [95% CI]: 1.94 [1.09, 3.48]) and unmodified cows' milk intakes ≥ 400 mL/day (1.95 [1.07, 3.56]) increased the risk of low iron status. Iron-fortified formula consumption was associated with decreased risk (0.21 [0.11, 0.41] P < 0.05). In this, the largest study in toddlers in Europe, a lower prevalence of low iron status was observed than in previous reports. Compliance with dietary recommendations to limit cows' milk intakes in young children and consumption of iron-fortified products appears to have contributed to improved iron status at two years.

Fruit and vegetable intakes, sources and contribution to total diet in very young children (1-4 years): the Irish National Pre-School Nutrition Survey

Although the importance of fruit and vegetable (F&V) intakes in the prevention of chronic diseases is well established, there are limited data on intakes in very young children. This study estimates F&V intakes and sources and the contribution to the total diet using data from the National Pre-School Nutrition Survey, a nationally representative sample (n 500) of Irish children aged 1-4 years. A 4-d weighed food record was used to collect food intake data. Of 1652 food codes consumed, 740 had a fruit/vegetable component. The percentage of edible fruits and/or vegetables in each food code was calculated. Intakes (g/d), sources (g/d) and the contribution of F&V to the weight of the total diet (%) were estimated, split by age. All children consumed F&V. Intakes of total fruits, in particular fruit juice, increased with age. The contribution to total fruit intake was discrete fruits (47-56 % range across age), 100 % fruit juice, smoothies and pureés (32-45 %) as well as fruits in composite dishes (7-13 %). Total vegetable intake comprised of discrete vegetables (48-62 % range across age) and vegetables in composite dishes (38-52 %). F&V contributed on average 20 % (15 % fruit; 5 % vegetables) to the weight of the total diet and was <10 % in sixty-one children (12 %). F&V contributed 50 % of vitamin C, 53 % of carotene, 34 % of dietary fibre and 42 % of non-milk sugar intakes from the total diet. F&V are important components of the diet of Irish pre-school children; however, some aspects of F&V intake patterns could be improved in this age group.

Diabetes-related nutrition knowledge and dietary intake among adults with type 2 diabetes

Nutrition knowledge and skills enable individuals with type 2 diabetes (T2DM) to make food choices that optimise metabolic self-management and quality of life. The present study examined the relationship between nutrition knowledge and skills, and nutrient intake in T2DM. A cross-sectional analysis of diabetes-related nutrition knowledge and nutrient intake was conducted in 124 T2DM individuals managed in usual care (64% male, age 57.4 (sd 5.6) years, BMI 32.5 (sd 5.8) kg/m2), using the Audit of Diabetes Knowledge (ADKnowl) questionnaire and a 4 d food diary. Data on sociodemographic characteristics, food label use and weight management were also collected. The average ADKnowl dietary subscale score was 59.2 (sd 16.4) %. Knowledge deficits relating to the impact of macronutrients/foods on blood glucose and lipids were identified. Lower diabetes-related nutrition knowledge was associated with lower intakes of sugar (10.8 (sd 4.7) v. 13.7 (sd 4.6) % for lower dietary knowledge score v. higher dietary knowledge score, P< 0.001), non-milk sugar (9.1 (sd 4.8) v. 12.1 (sd 4.7) % for lower dietary knowledge score v. higher dietary knowledge score, P< 0.001) and fruit/vegetables (230.8 (sd 175.1) v. 322.8 (sd 179.7) g for lower dietary knowledge score v. higher dietary knowledge score, P< 0.001), and higher dietary glycaemic index (GI) (61.4 (sd 4.5) v. 58.4 (sd 4.6) for lower dietary knowledge score v. higher dietary knowledge score, P< 0.002). The majority of the participants were dissatisfied with their weight. Sugar was the most frequently checked nutrient on food labels (59%), with only 12.1% checking foods for their energy content. Significant knowledge and skill deficits, associated with the impact of macronutrients/foods on metabolic parameters and food label use, were found. Lower diabetes-related nutrition knowledge was associated with lower sugar and fruit/vegetable intake and higher dietary GI. Dietary education, integrated throughout the lifespan of T2DM, may improve nutrition knowledge and skills and promote more balanced approaches to dietary self-management of T2DM.

Development and validation testing of a short nutrition questionnaire to identify dietary risk factors in preschoolers aged 12-36 months

Background

Although imbalances in dietary intakes can have short and longer term influences on the health of preschool children, few tools exist to quickly and easily identify nutritional risk in otherwise healthy young children.

Objectives

To develop and test the validity of a parent-administered questionnaire (NutricheQ) as a means of evaluating dietary risk in young children (12–36 months).

Design

Following a comprehensive development process and internal reliability assessment, the NutricheQ questionnaire was validated in a cohort of 371 Irish preschool children as part of the National Preschool Nutrition Survey. Dietary risk was rated on a scale ranging from 0 to 22 from 11 questions, with a higher score indicating higher risk.

Results

Children with higher NutricheQ scores had significantly (p<0.05) lower mean daily intakes of key nutrients such as iron, zinc, vitamin D, riboflavin, niacin, folate, phosphorous, potassium, carotene, retinol, and dietary fibre. They also had lower (p<0.05) intakes of vegetables, fish and fish dishes, meat and infant/toddler milks and higher intakes of processed foods and non-milk beverages, confectionery, sugars and savoury snack foods indicative of poorer dietary quality. Areas under the curve values of 84.7 and 75.6% were achieved for ‘medium’ and ‘high’ dietary risk when compared with expert risk ratings indicating good consistency between the two methods.

Conclusion

NutricheQ is a valid method of quickly assessing dietary quality in preschoolers and in identifying those at increased nutritional risk.

In Context

Analysis of data from national food and nutrition surveys typically identifies shortfalls in dietary intakes or quality of young children. This can relate to intakes of micronutrients such as iron or vitamin D as well as to the balance of macronutrients they consume (e.g. fat or sugar). Alongside this lie concerns regarding overweight and obesity and physical inactivity. This combination of risk factors has potential negative effects for both short and longer term health. Hence, screening tools, such as NutricheQ described here, offer an opportunity for early identification and subsequent appropriate timely intervention from 12 months of age. This paper describes the development and validation of NutricheQ, a short user-friendly questionnaire. Designed to be administered by parents or carers, it aims to help healthcare professionals identify children at risk based on known, evidence-based nutritional risk factors. It is hoped in the longer term that this tool can be adapted for use globally and improve child health through early identification, which can be followed up by targeted, cost-effective interventions.

Small Increments in Vitamin D Intake by Irish Adults over a Decade Show That Strategic Initiatives to Fortify the Food Supply Are Needed

BACKGROUND

Food fortification could be an effective method of increasing vitamin D intakes and preventing deficiency with minimal risk of excessive dosing.

OBJECTIVE

Secular trends in vitamin D intakes were examined over a 10-y period.

METHODS

We compared vitamin D intakes among 18- to 64-y-old adults from the base diet, fortified foods, and supplements in 2 nationally representative dietary surveys in 1999 and 2009 implemented using the same methodology.

RESULTS

There was a slight increase in the median (IQR) intake of vitamin D from 2.9 (3.2) to 3.5 (3.7) μg/d (mean ± SD, 4.3 ± 4.0 to 5.0 ± 6.4 μg). The median (IQR) intake from the base diet was 2.3 (1.6) μg/d in 1999 and 2.1 (1.8) μg/d in 2009. In vitamin D supplement users, median (IQR) intakes were 7.6 (6.7) and 8.7 (7.2) μg/d and the prevalence of inadequacy decreased from 67% to 57% in 2009. Although the consumption of vitamin D-containing supplements was similar in the 2 surveys (17% and 16%), the use of calcium-vitamin D supplements increased from 3% to 10% among women aged 50-64 y. The prevalence of fortified food consumption was also similar at 60%, and median (IQR) vitamin D intakes in consumers were 2.9 (2.2) and 3.7 (2.9) μg/d in 1999 and 2009, respectively. Mathematical modeling of food fortification using modified vitamin D composition data showed that there is potential to increase vitamin D intakes at the lower end of the distribution, without increasing the risk of exceeding the Tolerable Upper Intake Level.

CONCLUSIONS

We report small increases in vitamin D intakes among Irish adults over a decade of focus on vitamin D and in the context of a voluntary fortification policy. Strategic management of vitamin D in the food supply is required to yield measurable benefits.

Impact of voluntary food fortification practices in Ireland: trends in nutrient intakes in Irish adults between 1997-9 and 2008-10

Because of the discretionary nature of voluntary food fortification in the European Union, there is a need to monitor fortification practices and consumption of fortified foods in order to assess the efficacy and safety of such additions on an ongoing basis. The present study aimed to investigate the nutritional impact of changes in voluntary fortification practices in adults aged 18-64 years using dietary intake data from two nationally representative cross-sectional food consumption surveys, the North/South Ireland Food Consumption Survey (NSIFCS) (1997-9) and the National Adult Nutrition Survey (NANS) (2008-10). The supply of fortified foods increased between 1997-9 and 2008-10, resulting in a higher proportion of adults consuming fortified foods (from 67 to 82 ) and a greater contribution to mean daily energy intake (from 4.6 to 8.4%). The overall nutrient profile of fortified foods consumed remained favourable, i.e. higher in starch and dietary fibre and lower in fat and saturated fat, with polyunsaturated fat, sugars and Na in proportion to energy. Women, particularly those of childbearing age, remained the key beneficiaries of voluntary fortification practices in Ireland. Continued voluntary fortification of foods has increased protection against neural tube defect-affected pregnancy by folic acid and maintained the beneficial impact on the adequacy of Fe intake. Increased consumption of fortified foods did not contribute to an increased risk of intakes exceeding the tolerable upper intake level for any micronutrient. Recent increases in voluntary fortification of foods in Ireland have made a favourable nutritional impact on the diets of adults and have not contributed to an increased risk of adverse effects.

Dietary energy density: estimates, trends and dietary determinants for a nationally representative sample of the Irish population (aged 5–90 years)

Higher dietary energy density (DED) has been reported to be associated with weight gain, obesity and poorer dietary quality, yet nationally representative estimates that would allow tracking of secular trends and inter-country comparisons are limited. The aims of the present study were to calculate DED estimates for the Irish population and to identify dietary determinants of DED. Weighed/semi-weighed food records from three cross-sectional surveys (the National Children's Food Survey, the National Teens’ Food Survey and the National Adult Nutrition Survey) were collated to estimate habitual dietary intakes for a nationally representative sample of the Irish population, aged 5–90 years (n2535). DED estimates, calculated using the total diet method, the food only method and a novel method, including foods and solids in beverages, were 3·70 (sd1·09), 7·58 (sd1·72) and 8·40 (sd1·88) kJ/g, respectively. Determinants of DED did not vary by the calculation method used. Variation in the intakes of fruit, vegetables and sugar-sweetened beverages (SSB) across consumer groups contributed to the largest variance in DED estimates, followed by variation in the intakes of potatoes, fresh meat, bread, chips, ready-to-eat breakfast cereals, and confectionery. DED estimates were inversely associated with age group and consistently lower for females than for males. The inverse association of DED with age group was explained by higher intakes of vegetables, fruit, fish, potatoes, fresh meat and brown bread and lower intakes of SSB, chocolate confectionery, ready-to-eat breakfast cereals and savoury snacks in older age groups. Females consumed, on average, 1·5 times more fruit and vegetables combined when compared with males, largely explaining the sex differences in DED estimates. Current DED estimates for adults were similar to those calculated in a previous survey, carried out 10 years earlier. These estimates and determinants serve as a baseline for comparison for other works and public health campaigns.

Effect of vitamin E intake from food and supplement sources on plasma α- and γ-tocopherol concentrations in a healthy Irish adult population

Vitamin E is believed to play a preventive role in diseases associated with oxidative stress. The aims of the present study were to quantify vitamin E intake levels and plasma concentrations and to assess dietary vitamin E adequacy in Irish adults. Intake data from the National Adult Nutrition Survey were used; plasma samples were obtained from a representative cohort of survey participants. Plasma α- and γ-tocopherol concentrations were measured by HPLC. The main sources of vitamin E in the diet were ‘butter, spreadable fats and oils’ and ‘vegetables and vegetable dishes’. When vitamin E intake from supplements was taken into account, supplements were found to be the main contributor, making a contribution of 29·2 % to vitamin E intake in the total population. Supplement consumers had significantly higher plasma α-tocopherol concentrations and lower plasma γ-tocopherol concentrations when compared with non-consumers. Consumers of ‘vitamin E’ supplements had significantly higher vitamin E intake levels and plasma α-tocopherol concentrations compared with consumers of other types of supplements, such as multivitamin and fish oil. Comparison with the Institute of Medicine Estimated Average Requirement of 12 mg/d indicated that when vitamin E intake from food and supplement sources was taken into account, 100 % of the study participants achieved the recommended intake levels. When vitamin E intake from food sources was taken into account, only 68·4 % of the females were found to achieve the recommended intake levels compared with 99·2 % of the males. The results of the present study show that dietary vitamin E intake has a significant effect on plasma α- and γ-tocopherol concentrations. Furthermore, they show that the consumption of supplements is a major contributor to overall intake and has a significant effect on plasma vitamin E concentrations in the Irish population.