Overview of methods used to evaluate the adequacy of nutrient intakes for individuals and populations

Prevalence and Correlates of Stunting among Children Aged 6-23 Months from Poor Households in Rwanda

Stunted linear growth continues to be a public health problem that overwhelms the entire world and, particularly, developing countries. Despite several interventions designed and implemented to reduce stunting, the rate of 33.1% is still high for the proposed target of 19% in 2024. This study investigated the prevalence and associated factors of stunting among children aged 6-23 months from poor households in Rwanda. A cross-sectional study was conducted among 817 mother-child dyads (two individuals from one home) living in low-income families in five districts with a high prevalence of stunting. Descriptive statistics were used to determine the prevalence of stunting. In addition, we used bivariate analysis and a multivariate logistic regression model to measure the strength of the association between childhood stunting and exposure variables. The prevalence of stunting was 34.1%. Children from households without a vegetable garden (AOR = 2.165, p-value < 0.01), children aged 19-23 months (AOR = 4.410, p-value = 0.01), and children aged 13-18 months (AOR = 2.788, p-value = 0.08) showed increased likelihood of stunting. On the other hand, children whose mothers were not exposed to physical violence (AOR = 0.145, p-value < 0.001), those whose fathers were working (AOR = 0.036, p-value = 0.001), those whose parents were both working (AOR = 0.208, p-value = 0.029), and children whose mothers demonstrated good hand washing practice (AOR = 0.181, p-value < 0.001) were less likely to be stunted. Our findings underscore the importance of integrating the promotion of handwashing practices, owning vegetable gardens, and intimate partner violence prevention in the interventions to fight child stunting.

Micronutrient intake inadequacy and its associated factors among lactating women in Bahir Dar city, Northwest Ethiopia, 2021

Background

Inadequate intake of micronutrients in lactating women was prevalent worldwide. In particular, to our knowledge, there has been little report concerning Ethiopian lactating women regarding their micronutrient intake. Our objective was to assess micronutrient intake inadequacy and its associated factors among lactating women in Bahir Dar city, Northwest Ethiopia, 2021.

Methods

Community-based cross-sectional study was conducted from February 15 to March 05, 2021. Four hundred thirteen respondents were selected through systematic random sampling. Data were collected by interviewer-administered semi-structured questionnaire and a single multiphasic 24 hours dietary recall was used to assess dietary assessment. Data entry and analysis were carried out using EpiData and SPSS respectively. The ESHA food processor, Ethiopian food composition table, and world food composition table have used the calculation of nutrient values of the selected micronutrient. The nutrient intakes were assessed by Nutrient Adequacy Ratio (NAR) and Mean Adequacy Ratio (MAR). Multivariable binary logistic regression analysis was done to identify the factors of overall micronutrient intake inadequacy.

Result

The overall prevalence of micronutrient intake inadequacy across 12 nutrients was 39.9% [95% CI (34.9, 45.0)]. The inadequate intake of vitamin A was 98.2%. Similarly, the inadequate intake of B vitamins ranges from 13.4% to 68.5%. The insufficient intakes of calcium, iron, and zinc were 70.9%, 0%, and 4.7%, respectively. Around 36 and 91.6% of the respondents had inadequate intake of selenium and sodium, respectively. On multivariable logistic regression analysis; Being divorced was 2.7 times more likely to have overall micronutrient intake inadequacy than being married [AOR = 2.71, 95% CI (1.01, 7.33)]. The odds of overall micronutrient intake inadequacy were 2.6 higher in merchants than in housewives [AOR = 2.63, 95% CI (1.40, 4.93)]. Lactating women who had poor nutritional knowledge were 2.7 times more likely to have overall micronutrient intake inadequacy than those who had good nutritional knowledge [AOR = 2.71, 95% CI (1.47, 4.99)].

Conclusion and recommendation

Overall, the micronutrient intake in lactating women was lower than the recommended levels. Therefore; educating lactating women about appropriate dietary intake is essential.

Positive Association Between Nutrient Adequacy and Waist Circumference: Results of a Cross-Sectional Study

Metabolic syndrome (MetS) is a multifactorial disease with its exact causes not completely clear. Micronutrients such as vitamin A, vitamin D, zinc, and magnesium have been associated with MetS components. Our objective was to investigate the association of nutrient adequacy (NA) with MetS components. The present cross-sectional study consisted of 850 adults between 18-59 years from Tehran, Iran. Dietary intake, socio-demographic data, medical history, and anthropometric indices were collected by trained personnel. NA was calculated as the mean intake ratio to the recommended amount of 16 micronutrients. MetS were defined by the consensus of National Cholesterol Education Program-Adult Treatment Panel III criteria. The association between NA and MetS was examined using linear regression analyses after controlling potential confounders. More participants in the highest quartile were obese in terms of general obesity (p = 0004) and abdominal obesity (p = 0.003) compared with subjects in the least quartile. A significant positive correlation was found between waist circumference (WC) and NA even after controlling for all potential confounders (p < 0.001). NA was positively associated with WC among adults living in Tehran.

Aquatic foods to nourish nations

Despite contributing to healthy diets for billions of people, aquatic foods are often undervalued as a nutritional solution because their diversity is often reduced to the protein and energy value of a single food type ('seafood' or 'fish')1-4. Here we create a cohesive model that unites terrestrial foods with nearly 3,000 taxa of aquatic foods to understand the future impact of aquatic foods on human nutrition. We project two plausible futures to 2030: a baseline scenario with moderate growth in aquatic animal-source food (AASF) production, and a high-production scenario with a 15-million-tonne increased supply of AASFs over the business-as-usual scenario in 2030, driven largely by investment and innovation in aquaculture production. By comparing changes in AASF consumption between the scenarios, we elucidate geographic and demographic vulnerabilities and estimate health impacts from diet-related causes. Globally, we find that a high-production scenario will decrease AASF prices by 26% and increase their consumption, thereby reducing the consumption of red and processed meats that can lead to diet-related non-communicable diseases5,6 while also preventing approximately 166 million cases of inadequate micronutrient intake. This finding provides a broad evidentiary basis for policy makers and development stakeholders to capitalize on the potential of aquatic foods to reduce food and nutrition insecurity and tackle malnutrition in all its forms.

Nutritional Inadequacy: Unraveling the Methodological Challenges for the Application of the Probability Approach or the EAR Cut-Point Method-A Pregnancy Perspective

The aim of this study was to unravel the methodological challenges when exploring nutritional inadequacy, involving 608 healthy pregnant women. The usual intake of twenty-one nutrients was recorded by employing a validated FFQ. Simulated datasets of usual intake were generated, with randomly imposed uncertainty. The comparison between the usual intake and the EAR was accomplished with the probability approach and the EAR cut-point method. Point estimates were accompanied by bootstrap confidence intervals. Bootstrap intervals applied on the risk of inadequacy for raw and simulated data tended in most cases to overlap. A detailed statistical analysis, aiming to predict the level of inadequacy, as well as the application of the EAR cut-point method, along with bootstrap intervals, could effectively be used to assess nutrient inadequacy. However, the final decision for the method used depends on the distribution of nutrient-intake under evaluation. Irrespective of the applied methodology, moderate to high levels of inadequacy, calculated from FFQ were identified for certain nutrients (e.g., vitamins C, B6, magnesium, vitamin A), while the highest were recorded for folate and iron. Considering that micronutrient-poor, obesogenic diets are becoming more common, the underlying rationale may help towards unraveling the complexity characterizing nutritional inadequacies, especially in vulnerable populations.

Strengthening Nutrition Interventions in Antenatal Care Services Affects Dietary Intake, Micronutrient Intake, Gestational Weight Gain, and Breastfeeding in Uttar Pradesh, India: Results of a Cluster-Randomized Program Evaluation

BACKGROUND

Maternal nutrition interventions are inadequately integrated into antenatal care (ANC). Alive & Thrive aimed to strengthen delivery of micronutrient supplements and intensify interpersonal counseling and community mobilization through government ANC services.

OBJECTIVES

We compared nutrition-intensified ANC (I-ANC) with standard ANC (S-ANC) on coverage of nutrition interventions and maternal nutrition practices.

METHODS

We used a cluster-randomized design with cross-sectional baseline (2017) and endline (2019) surveys (n ∼660 pregnant and 1800 recently delivered women per survey) and a repeated-measures longitudinal study in 2018-2019 (n = 400). We derived difference-in-difference effect estimates (DIDs) for diet diversity, consumption of micronutrient supplements, weight monitoring, and early breastfeeding practices.

RESULTS

Despite substantial secular improvements in service coverage from India's national nutrition program, women in the I-ANC arm received more home visits [DID: 7-14 percentage points (pp)] and counseling on core nutrition messages (DID: 10-23 pp) than in the S-ANC arm. One-third of women got ≥3 home visits and one-fourth received ≥4 ANC check-ups in the I-ANC arm. Improvements were greater in the I-ANC arm than in the S-ANC arm for any receipt and consumption of iron-folic acid (DID: 7.5 pp and 9.5 pp, respectively) and calcium supplements (DID: 14.1 pp and 11.5 pp, respectively). Exclusive breastfeeding improved (DID: 7.5 pp) but early initiation of breastfeeding did not. Maternal food group consumption (∼4 food groups) and probability of adequacy of micronutrients (∼20%) remained low in both arms. Repeated-measures longitudinal analyses showed similar results, with additional impact on consumption of vitamin A-rich foods (10 pp, 11 g/d), other vegetables and fruits (22-29 g/d), and gestational weight gain (0.4 kg).

CONCLUSIONS

Intensifying nutrition in government ANC services improved maternal nutrition practices even with strong secular trends in service coverage. Dietary diversity, supplement consumption, and breastfeeding practices remained suboptimal. Achieving greater behavior changes will require strengthening the delivery and use of maternal nutrition services integrated into ANC services in the health system. This trial was registered at clinicaltrials.gov as NCT03378141.

Preconception Evaluation Before In Vitro Fertilization

Importance

Infertility poses a substantial public health problem for women of reproductive age, in the United States and globally. Infertility can be overcome with a variety of emerging assisted reproductive technologies (ARTs). In vitro fertilization (IVF) currently represents the most commonly utilized method of ART and is typically associated with the highest clinical pregnancy rate and live birth rate compared with other infertility treatment options. However, proper preconception evaluation and counseling is paramount for optimizing IVF and pregnancy outcomes.

Objective

This article aims to outline current guidelines and recommendations for comprehensive preconception evaluation before initiation of IVF.

Evidence Acquisition

Articles were obtained from PubMed, ACOG committee opinions 781 and 762, and relevant textbook chapters.

Results

A variety of recommendations and best practices exist for optimally managing patients seeking IVF. Special attention must be paid to the workup of certain patient populations, such as those with age older than 35 years, uterine abnormalities, comorbidities (especially hypertension, diabetes, and thrombophilias), and obesity. In addition, many lifestyle factors must be addressed before IVF initiation, such as smoking, illicit drug use, and inadequate nutrition. Preconception counseling and expectation management is key to optimizing pregnancy outcome.

Conclusion and Relevance

A myriad of patient and environmental factors impact the potential success rates of IVF in treating infertility. Providers must be equipped to provide data-driven, patient-centered counseling before initiation of IVF.

Assessing Dietary Diversity in Pregnant Women: Relative Validity of the List-Based and Open Recall Methods

BACKGROUND

The Minimum Dietary Diversity for Women (MMD-W) was validated as a proxy of micronutrient adequacy for nonpregnant women, with proposed data collection being either a list-based or a qualitative open recall method. Few studies have compared the performance of these 2 methods.

OBJECTIVES

We compared performance in predicting micronutrient adequacy of food group indicators (FGIs) measured by the list-based and the quantitative open recall methods using varying quantity cut-offs. We also examined the agreement between list-based and open recall FGIs.

METHODS

Data were collected in Bangladesh (n = 600 pregnant women) and India (n = 655). The performance of different indicators to predict micronutrient adequacy was compared using receiver operating characteristic (ROC) analysis. Correlations between list-based and open recall FGIs were calculated using Spearman's rank test; agreement was assessed by the intraclass correlation coefficient (ICC) and kappa statistics. Food groups that were most often misreported by the list-based method were identified.

RESULTS

There were no statistically significant differences in ROC curves between list-based and open recall FGIs in either country. In Bangladesh, correlations between list-based and open recall FGIs varied between 0.6 and 0.8; ICC values were 0.43-0.75; kappa values were 0.51-0.53 when using a cut-off of any quantity or 15 g for open recall, but were lower (k = 0.24) with the cut-off of 1 portion. In India, these values were lower: ∼0.4 for correlation, 0.32-0.37 for ICCs, and 0.17-0.22 for kappas. Food groups most susceptible to misreporting using the list-based method were beans/peas in Bangladesh and other vegetables in India.

CONCLUSIONS

Our study provides initial support for the use of list-based questionnaires in assessing food group diversity or prevalence of MDD-W in pregnant women. Additional and context-specific work may be required to understand the potential of simple methodologies to assess consumption of specific food groups. This trial was registered at clinicaltrials.gov as NCT02745249 (Bangladesh) and NCT03378141 (India).

Nutrient Intake Is Insufficient among Senegalese Urban School Children and Adolescents: Results from Two 24 h Recalls in State Primary Schools in Dakar

Due to rapid urbanization and high food prices and in the absence of nutrition programs, school children from urban areas in West Africa often have insufficient and inadequate diet leading to nutrient deficiencies that affect their health and schooling performance. Acute malnutrition and micronutrient deficiencies are prevalent in children from primary state schools of Dakar (Senegal). The objectives of the present study were to assess the overall diet of these children, to report insufficient/excessive energy and nutrient intakes and to investigate association between insufficient nutrient intake and micronutrient deficiencies. Children attending urban state primary schools in the Dakar area were selected through a two-stage random cluster sampling (30 schools × 20 children). Dietary intake data were obtained from two 24 h recalls and blood samples were collected from 545 children (aged 5-17 years, 45% < 10 years, 53% girls) and adjusted for intra-individual variability to estimate nutrient usual intakes. Energy intake was insufficient and unbalanced with insufficient contribution of protein and excessive contribution of fat to global energy intake in one third of the children. Proportions of children with insufficient intake were: 100% for calcium, 100% for folic acid, 79% for vitamin A, 69% for zinc, 53% for vitamin C and 46% for iron. Insufficient iron and protein intake were risk factors for iron deficiency (odds ratio, OR 1.5, 2.2). Insufficient zinc intake and energy intake from protein were risk factors for zinc deficiency (OR 1.8, 3.0, 1.7, 2.9). Insufficient iron and vitamin C intake, and insufficient energy intake from protein were risk factors for marginal vitamin A status (OR 1.8, 1.8, 3.3). To address nutritional deficiencies associated with a diet deficient in energy, protein and micronutrients, nutrition education or school feeding programs are needed in urban primary schools of Senegal.

Strengthening the Reporting of Observational Studies in Epidemiology - nutritional epidemiology (STROBE-nut): An extension of the STROBE statement

Concerns have been raised about the quality of reporting in nutritional epidemiology. Research reporting guidelines such as the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement can improve quality of reporting in observational studies. Herein, we propose recommendations for reporting nutritional epidemiology and dietary assessment research by extending the STROBE statement into Strengthening the Reporting of Observational Studies in Epidemiology - Nutritional Epidemiology (STROBE-nut). Recommendations for the reporting of nutritional epidemiology and dietary assessment research were developed following a systematic and consultative process, co-ordinated by a multidisciplinary group of 21 experts. Consensus on reporting guidelines was reached through a three-round Delphi consultation process with 53 external experts. In total, 24 recommendations for nutritional epidemiology were added to the STROBE checklist. When used appropriately, reporting guidelines for nutritional epidemiology can contribute to improve reporting of observational studies with a focus on diet and health.

Strengthening the Reporting of Observational Studies in Epidemiology-Nutritional Epidemiology (STROBE-nut): An Extension of the STROBE Statement

BACKGROUND

Concerns have been raised about the quality of reporting in nutritional epidemiology. Research reporting guidelines such as the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement can improve quality of reporting in observational studies. Herein, we propose recommendations for reporting nutritional epidemiology and dietary assessment research by extending the STROBE statement into Strengthening the Reporting of Observational Studies in Epidemiology-Nutritional Epidemiology (STROBE-nut).

METHODS AND FINDINGS

Recommendations for the reporting of nutritional epidemiology and dietary assessment research were developed following a systematic and consultative process, coordinated by a multidisciplinary group of 21 experts. Consensus on reporting guidelines was reached through a three-round Delphi consultation process with 53 external experts. In total, 24 recommendations for nutritional epidemiology were added to the STROBE checklist.

CONCLUSION

When used appropriately, reporting guidelines for nutritional epidemiology can contribute to improve reporting of observational studies with a focus on diet and health.

May Underdiagnosed Nutrition Imbalances Be Responsible for a Portion of So-Called Unexplained Infertility? From Diagnosis to Potential Treatment Options

The aim of the study was to investigate whether women affected by unexplained infertility may have undiagnosed dietary imbalances which negatively affect fertility. Secondarily, we investigated whether varying degrees of nutritional abnormalities may benefit from different periconceptional dietary supplementations, evaluating the most effective intervention in improving pregnancy rate after in vitro fertilization (IVF). We conducted a survey on 2 cohorts of patients (group A: unexplained infertility and group B: healthy first trimester spontaneous pregnancies) with the scope of investigating and comparing their dietary status discriminating women without dietary abnormalities (cohort 1) from those with abnormalities exclusively in micronutrient intake (cohort 2) or combined abnormalities in both micronutrient and macronutrient intake and associated obesity (cohort 3). All women included in group A were offered the opportunity to receive a prescription for one of the 3 designated daily dietary supplementation schemes (subgroups A1, A2, and A3) which were to be implemented in the 3 months immediately prior to beginning IVF treatment. When compared with fertile women, patients having unexplained infertility showed significant abnormalities in dietary habits. These differences ranged from a minimal imbalance in micronutrient intake (potentially avoidable with dietary supplementation) to severe combined macronutrient and micronutrient imbalance frequently associated with obesity (partially amendable by inositol supplementation and frequently requiring long-term dietary reeducation before establishment of fertility). Nutritional investigation and treatment may explain and resolve a portion of cases of unexplained infertility, improving the outcome of IVF treatment and, with minimal imbalances, likely restore spontaneous fertility.

EURRECA-Framework for Aligning Micronutrient Recommendations

There is currently no standard approach for deriving micronutrient recommendations, and large variations exist across Europe, causing confusion among consumers, food producers, and policy makers. More aligned information could influence dietary behaviors and potentially lead to a healthier population. Funded by the European Commission, EURRECA (EURopean micronutrient RECommendations Aligned) has developed methods and applications to guide Nutrient Recommendation Setting Bodies through the process of setting micronutrient reference values. The EURRECA approach is crystallized into its framework that outlines a standard process for deriving and using dietary reference values for micronutrients in a transparent, systematic, and scientific way. The 9 activities of the framework can be clustered into four stages (i) defining the problem, (ii) monitoring and evaluating, (iii) deriving dietary reference values, and (iv) using dietary reference values in policy making. The EURRECA framework should not be interpreted as a prescriptive description of a linear process, but as a structured guide for checking that all issues essential for deriving requirements have at least been considered.

The Mediterranean diet and nutritional adequacy: a review

The Mediterranean dietary pattern, through a healthy profile of fat intake, low proportion of carbohydrate, low glycemic index, high content of dietary fiber, antioxidant compounds, and anti-inflammatory effects, reduces the risk of certain pathologies, such as cancer or Cardiovascular Disease (CVD). Nutritional adequacy is the comparison between the nutrient requirement and the intake of a certain individual or population. In population groups, the prevalence of nutrient inadequacy can be assessed by the probability approach or using the Estimated Average Requirement (EAR) cut-point method. However, dietary patterns can also be used as they have moderate to good validity to assess adequate intakes of some nutrients. The objective of this study was to review the available evidence on the Nutritional Adequacy of the Mediterranean Diet. The inclusion of foods typical of the Mediterranean diet and greater adherence to this healthy pattern was related to a better nutrient profile, both in children and adults, with a lower prevalence of individuals showing inadequate intakes of micronutrients. Therefore, the Mediterranean diet could be used in public health nutrition policies in order to prevent micronutrient deficiencies in the most vulnerable population groups.

Food and nutrient intake of Irish community-dwelling elderly subjects: who is at nutritional risk?

OBJECTIVES

To assess the dietary intakes of Irish community-dwelling elderly individuals, participating in the ELDERMET project.

DESIGN

Cross-sectional study.

SETTING

Cork city and county region of southern Ireland.

PARTICIPANTS

Two hundred and eight (94 males, 114 females) community-dwelling subjects aged 64-93 yrs.

MEASUREMENTS

Dietary intake was assessed using a validated semi-quantitative food frequency questionnaire (FFQ). Anthropometric data were recorded. Nutritional status was assessed using the Mini Nutritional Assessment (MNA).

RESULTS

A high rate of overweight/obesity was observed in this population group. Consumption of energy-dense, low-nutrient foods was excessive among this population group. Older elderly subjects (≥75 yrs) consumed significantly (P<0.01) more desserts/sweets than younger elderly (64-74 yrs). Intakes of dietary fat and saturated fat were high while dairy food consumption was inadequate in both males and females. Elderly females typically had a more nutrient-dense diet than males. A considerable proportion of subjects, particularly males, had inadequate intakes of calcium, magnesium, vitamin D, folate, zinc and vitamin C.

CONCLUSION

The data indicate that the diet of Irish community-dwelling elderly individuals is sub-optimal with respect to nutrient intake, and excessive in terms of fat intake, with implications for the health status of this population group. Reductions in dietary fat and increased low fat dairy food intakes are recommended for the prevention of diet-related disease in older persons. In addition, strategies to improve a number of sub-optimal micronutrient intakes need to be developed and implemented, particularly among elderly males.

Mapping low intake of micronutrients across Europe

Achieving an understanding of the extent of micronutrient adequacy across Europe is a major challenge. The main objective of the present study was to collect and evaluate the prevalence of low micronutrient intakes of different European countries by comparing recent nationally representative dietary survey data from Belgium, Denmark, France, Germany, The Netherlands, Poland, Spain and the United Kingdom. Dietary intake information was evaluated for intakes of Ca, Cu, I, Fe, Mg, K, Se, Zn and the vitamins A, B₁, B₂, B₆, B₁₂, C, D, E and folate. The mean and 5th percentile of the intake distributions were estimated for these countries, for a number of defined sex and age groups. The percentages of those with intakes below the lower reference nutrient intake and the estimated average requirement were calculated. Reference intakes were derived from the UK and Nordic Nutrition Recommendations. The impact of dietary supplement intake as well as inclusion of apparently low energy reporters on the estimates was evaluated. Except for vitamin D, the present study suggests that the current intakes of vitamins from foods lead to low risk of low intakes in all age and sex groups. For current minerals, the study suggests that the risk of low intakes is likely to appear more often in specific age groups. In spite of the limitations of the data, the present study provides valuable new information about micronutrient intakes across Europe and the likelihood of inadequacy country by country.

A systematic review on micronutrient intake adequacy in adult minority populations residing in Europe: the need for action

This systematic review evaluated micronutrient intake inadequacy of ten micronutrients for adult ethnic minority populations residing in Europe. Pubmed was searched for studies, related references were checked and experts consulted. Ten studies were identified and six were included in the final analysis representing Albanian, Roma, Sub-Saharan African, South Asian and African-Caribbean minority groups. The Estimated Average Requirement cut point was applied to estimate inadequate intake. With the exception of a sub-Saharan African study, of seven micronutrients analysed, inadequate intakes were markedly elevated (>50 % of the population in most cases) in both genders for folate, vitamin B(12), calcium and iron (the latter in females only). A pressing need exists for intake adequacy studies with sound methodologies addressing ethnic minority groups in Europe. These populations constitute a vulnerable population for inadequate intakes and results substantiate the need for further investigation, interventions and policy measures to reduce their nutritional risk.

Is the food frequency questionnaire suitable to assess micronutrient intake adequacy for infants, children and adolescents?

The objective of this study was to review how accurately micronutrient intakes in infants, children, and adolescents were assessed with validated food frequency questionnaires (FFQs) to which study quality criteria had been applied. The methodology and the analysis presented were based on several research activities carried out within the European Micronutrient Recommendation Aligned Network of Excellence. The analysis was limited to vitamin D, vitamin C, vitamin B₁₂, folate, selenium, iron, zinc, iodine, calcium, and copper. A search strategy was defined in MEDLINE and EMBASE literature for studies validating FFQs that estimated intakes of micronutrients being evaluated. Identification of at least three validation studies per micronutrient was required to be included in the analysis. A total score for each nutrient was calculated from the mean of the correlation coefficients weighted by the quality of the study, which included a quality score that was based on sample size, statistics used, data collection procedure, consideration of seasonality and supplement use, an adjustment/weighting of the correlation coefficient according to the quality score, and a rating of the adjusted/weighted correlation. When the mean weighted correlation coefficient was equal to or higher than 0.5, micronutrient intake was considered as adequately estimated. Sufficient validation studies were identified for vitamin C, vitamin D, vitamin B₁₂, iron, zinc, and calcium for infants and pre-school children, and vitamin C, calcium, and iron for older children and adolescents. Results showed that the FFQ was a good instrument for estimating intake of vitamin C, vitamin D, calcium, zinc and iron in infants and pre-school children, and for estimating calcium and vitamin C in children and adolescents.

The preconception diet is associated with the chance of ongoing pregnancy in women undergoing IVF/ICSI treatment

BACKGROUND

Subfertility and poor nutrition are increasing problems in Western countries. Moreover, nutrition affects fertility in both women and men. In this study, we investigate the association between adherence to general dietary recommendations in couples undergoing IVF/ICSI treatment and the chance of ongoing pregnancy.

METHODS

Between October 2007 and October 2010, couples planning pregnancy visiting the outpatient clinic of the Department of Obstetrics and Gynaecology of the Erasmus Medical Centre in Rotterdam, the Netherlands were offered preconception counselling. Self-administered questionnaires on general characteristics and diet were completed and checked during the visit. Six questions, based on dietary recommendations of the Netherlands Nutrition Centre, covered the intake of six main food groups (fruits, vegetables, meat, fish, whole wheat products and fats). Using the questionnaire results, we calculated the Preconception Dietary Risk score (PDR), providing an estimate of nutritional habits. Dietary quality increases with an increasing PDR score. We define ongoing pregnancy as an intrauterine pregnancy with positive heart action confirmed by ultrasound. For this analysis we selected all couples (n=199) who underwent a first IVF/ICSI treatment within 6 months after preconception counselling. We applied adjusted logistic regression analysis on the outcomes of interest using SPSS.

RESULTS

After adjustment for age of the woman, smoking of the woman, PDR of the partner, BMI of the couple and treatment indication we show an association between the PDR of the woman and the chance of ongoing pregnancy after IVF/ICSI treatment (odds ratio 1.65, confidence interval: 1.08-2.52; P=0.02]. Thus, a one-point increase in the PDR score associates with a 65% increased chance of ongoing pregnancy.

CONCLUSIONS

Our results show that increasing adherence to Dutch dietary recommendations in women undergoing IVF/ICSI treatment increases the chance of ongoing pregnancy. These data warrant further confirmation in couples achieving a spontaneous pregnancy and in randomized controlled trials.

Projected prevalence of inadequate nutrient intakes in Europe

BACKGROUND

The purpose of this study was to analyze the prevalence of nutrient intake inadequacy in Europe, applying the Nordic Nutritional Recommendations in the context of the EURRECA Network of Excellence.

METHODS

Nutrient data was obtained from the European Nutrition and Health Report II. Those nutritional surveys using a validated food frequency questionnaire or diet history and a food diary/ register with at least 7 days of registers or with an adjustment for intraindividual variability were included. The nutrients analyzed were: vitamin C, vitamin D, vitamin B(12), folic acid, calcium, iron, zinc, selenium, copper, and iodine. The estimated average requirement cut point was applied to estimate inadequacy. The Nordic and Institute of Medicine nutrient recommendations were used as references.

RESULTS

The mean prevalence of inadequacy was below 11% for zinc, iron, and vitamin B(12) (only in the elderly), and it was 11-20% for copper in adults and the elderly and for vitamin B(12) in adults and vitamin C in the elderly. The prevalence was above 20% for vitamin D, folic acid, calcium, selenium, and iodine in adults and the elderly and for vitamin C in adults.

CONCLUSIONS

Vitamin C, vitamin D, folic acid, calcium, selenium, and iodine were the nutrients showing a higher prevalence of inadequate intakes in Europe.

Explaining the variability in recommended intakes of folate, vitamin B12, iron and zinc for adults and elderly people

Objective

To signal key issues for harmonising approaches for establishing micronutrient recommendations by explaining observed variation in recommended intakes of folate, vitamin B12, Fe and Zn for adults and elderly people.

Design

We explored differences in recommended intakes of folate, vitamin B12, Fe and Zn for adults between nine reports on micronutrient recommendations. Approaches used for setting recommendations were compared as well as eminence-based decisions regarding the selection of health indicators indicating adequacy of intakes and the consulted evidence base.

Results

In nearly all reports, recommendations were based on the average nutrient requirement. Variation in recommended folate intakes (200–400 μg/d) was related to differences in the consulted evidence base, whereas variation in vitamin B12recommendations (1·4–3·0 μg/d) was due to the selection of different CV (10–20 %) and health indicators (maintenance of haematological status or basal losses). Variation in recommended Fe intakes (men 8–10 mg/d, premenopausal women 14·8–19·6 mg/d, postmenopausal women 7·5–10·0 mg/d) was explained by different assumed reference weights and bioavailability factors (10–18 %). Variation in Zn recommendations (men 7–14 mg/d, women 4·9–9·0 mg/d) was also explained by different bioavailability factors (24–48 %) as well as differences in the consulted evidence base.

Conclusions

For the harmonisation of approaches for setting recommended intakes of folate, vitamin B12, Fe and Zn across European countries, standardised methods are needed to (i) select health indicators and define adequate biomarker concentrations, (ii) make assumptions about inter-individual variation in requirements, (iii) derive bioavailability factors and (iv) collate, select, interpret and integrate evidence on requirements.

Uso do método Grade of Membership na identificação de perfis de consumo e comportamento alimentar de adolescentes do Rio de Janeiro, Brasil

Com objetivo de identificar perfis de consumo e de comportamentos alimentares e descrever suas prevalências, aplicou-se o método Grade of Membership em dados de um inquérito sobre fatores de risco à saúde de adolescentes do ensino fundamental da cidade do Rio de Janeiro, Brasil (N = 1.632). Foram gerados quatro perfis: perfil "A" (12,1%), caracterizado pelo consumo frequente de todos os alimentos marcadores de dieta saudável, menos frequente dos alimentos não saudáveis e pela presença de comportamentos alimentares saudáveis; perfil "B" (45,8%), marcado pelo hábito de realizar o desjejum e três refeições/dia, consumo menos frequente de legumes e frutas e de cinco dos marcadores de alimentação não saudável; perfil "C" (22,8%), ausência de comportamentos alimentares saudáveis e pelo consumo menos frequente de legumes, frutas, leite, embutidos, biscoitos e refrigerantes; e perfil "D", caracterizado pelo consumo frequente de todos os alimentos não saudáveis e menos frequente de legumes e frutas. Os resultados apontam para a necessidade de promoção da alimentação saudável nesta população.

Food group diversity indicators derived from qualitative list-based questionnaire misreported some foods compared to same indicators derived from quantitative 24-hour recall in urban Burkina Faso

To be useful proxies of micronutrient intake at the population level in resource-limited societies, dietary diversity indicators should be simple and easy to collect in large surveys and their accuracy needs to be assessed. The present study aimed at comparing food group diversity indicators (FGI) derived from simple qualitative list-based questionnaires (qFGI) to the same indicators derived from quantitative 24-h recalls (QFGI). Both methods were administered separately on each of 3 recall days to women in 2 districts of Ouagadougou, Burkina Faso. Data were available for a total of 526 women x recalls. This study was performed within the framework of the Women's Dietary Diversity Project, which sought to analyze the relationships between various QFGI and the mean probability of adequacy (MPA) of women's diets across 11 micronutrients. The comparison between paired qFGI and QFGI scores was made both in terms of accuracy of the reporting by the list-based questionnaire, taking the QFGI as the gold standard, and in terms of performance of indicators in predicting an MPA > 60%. Examination of paired QFGI-qFGI differences revealed that the more disaggregated the FGI, the higher were the mean differences in scores. Food groups most frequently misreported often corresponded to foods put in small quantities in sauces. Overreporting by list-based questionnaires was observed for indicators applying a 15-g minimum quantity of consumption for a group to count in the score and this may result in weaker performance in predicting the MPA. These results highlight trade-offs between accuracy and simplicity when operationalizing FGI through qualitative questionnaires.

Integrated electronic platforms for weight loss

What can be done to build effective weight loss solutions for the 1.5 billion people with obesity? It is self-evident that no one good solution exists for people who are overweight or obese, otherwise it would have been applied across the people who need it worldwide. There is, therefore, an urgent need for approaches that will afford weight loss; what is more, such approaches need to be scalable. For that reason, it is attractive to consider electronic platforms as an avenue for scalable weight loss solutions. Such platforms often do not require substantial investments but rather the integration of pre-existing off-the-shelf components. In this article we explore the concepts and design challenges for electronic platforms that precipitate weight loss.

How does the quality of surveys for nutrient intake adequacy assessment compare across Europe? A scoring system to rate the quality of data in such surveys

Research was conducted within the EURopean micronutrient RECommendations Aligned (EURRECA) Network of Excellence, to find the best practice in assessing nutrient intakes. Objectives include: to search for and use data on individual nutrient intake adequacy (NIA) assessment collected in twenty-eight European countries and the four European Free Trade Association countries; to design and test innovative tools for data quality analysis. The information was obtained using the method described by Blanquer et al. in the present issue. The best-practice criteria were devised to select the most appropriate survey in each country. Then a survey quality scoring system was developed in consultation with experts and tested on these surveys. Weights were allocated according to a variable priority order agreed by consultation. The thirty-two countries yielded twenty-four national surveys (eight countries excluded). Data collection techniques: eleven countries/surveys used personal interviews only; six used combinations of techniques. Dietary assessment methods: two used repeated 24 h recalls only; eleven used combinations. NIA assessment methods: two used probabilistic approach and sd/Z-scores only; eleven used comparison with estimated average requirements/RDA only. Countries were ranked according to the survey quality scoring, but careful interpretation is needed because of incomplete data from some surveys; bearing this in mind, the information quality is high in 37.5 % countries, medium in 50.0 % and low in 12.5 %. Although there is room for improvement and caution should be taken when drawing conclusions and recommendations from these results, the lessons learned and tools developed at this first attempt form the basis for future work within the EURRECA framework for aligning European micronutrient recommendations.

Effects of dietary assessment methods on assessing risk of nutrient intake adequacy at the population level: from theory to practice

The present study evaluated how applying different dietary methods affects risk assessment of inadequate intakes at the population level. A pooled analysis was conducted using data from two Spanish regional representative surveys both applying similar methodology with a total sample of 2615 individuals aged 12-80. Diet was assessed in the entire sample applying data from one 24 h recall (24HR), a mean of two non-consecutive 24HR, both crude and adjusted for intraindividual variability, and a FFQ. Intakes of vitamins A, C, E, thiamin, riboflavin, niacin, vitamin B6, vitamin B12, Fe, Mg, P and Zn were compared to the average nutrient requirement (ANR or estimated average requirement) in the entire sample and also excluding under-reporters applying the ANR cut-point method (and the probability approach for Fe). Higher percentages of intakes below the ANR were seen for 1-24HR and the mean of 2-24HR, except for nutrients with the highest rates of inadequacy (vitamins A, E, folate and Mg). For these micronutrients, higher percentages of inadequacy were obtained by adjusted 24HR data and the lowest with FFQ. For the remaining nutrients, adjusted data gave the lowest inadequacy percentages. The best concordance was seen between 2-24HR and 1-24HR as well as for adjusted 24HR, with the least observed between FFQ and the other methods. Exclusion of under-reporters considerably reduced inadequacy in both daily methods and FFQ. Crude daily data gave higher estimates of inadequate intakes than adjusted data or FFQ. Reproducibility of daily methods was also reasonably good. Results may differ depending on the micronutrient thus impeding reaching conclusions/recommendations common for all micronutrients.