Dietary patterns of men in ALSPAC: associations with socio-demographic and lifestyle characteristics, nutrient intake and comparison with women's dietary patterns

Associations between religious/spiritual beliefs and behaviours and dietary patterns: analysis of the parental generation in a prospective cohort study (ALSPAC) in Southwest England

OBJECTIVE

Religious/spiritual beliefs and behaviours (RSBB) have been associated with health outcomes, with diet a potential mediator of this relationship. We therefore explored whether RSBB were associated with differences in diet.

DESIGN

Dietary patterns and nutrient intakes were derived from food frequency questionnaire completed by pregnant women in 1991-1992 (mean age = 28·3 years, range = 15-46) and by the mothers and partners 4 years post-partum (mothers mean age = 32·3, range = 19-49; partners mean age = 34·5, range = 18-74). RSBB exposures measured in pregnancy included religious belief, affiliation and attendance. We first explored whether RSBBs were associated with dietary patterns in confounder-adjusted linear regression models. If associations were found, we examined whether RSBB were associated with nutrient intake (linear regression) and following nutrient intake guidelines (logistic regression).

SETTING

Prospective birth cohort study in Southwest England (Avon Longitudinal Study of Parents and Children; ALSPAC).

PARTICIPANTS

13 689 enrolled mothers and their associated partners.

RESULTS

In pregnant women, RSBB were associated with higher 'traditional' (i.e. 'meat and two veg') and lower 'vegetarian' dietary pattern scores. Religious attendance and non-Christian religious affiliation were associated with higher 'health-conscious' dietary pattern scores. Religious attendance was associated with increased micronutrient intake and following recommended micronutrient intake guidelines, with weaker effects for religious belief and affiliation. Comparable patterns were observed for mothers and partners 4 years post-partum, although associations between RSBB and nutrient intakes were weaker for partners.

CONCLUSIONS

RSBBs are associated with broad dietary patterns and nutrient intake in this cohort. If these reflect causal relationships, diet may potentially mediate the pathway between RSBB and health.

Trajectories of dietary patterns from pregnancy to 12 years post-pregnancy and associated maternal characteristics: evidence from the Avon Longitudinal Study of Parents and Children

PURPOSE

Dietary patterns (DPs) during pregnancy have been well researched. However, little is known about maternal diet after pregnancy. The aim of the study was to explore maternal DPs longitudinally, examine trajectories over 12 years after pregnancy and identify associated factors.

METHODS

Of 14,541 pregnant women enrolled in the Avon Longitudinal Study of Parents and Children (ALSPAC) complete dietary information was available for 5336 women. Principal components analysis (PCA) was used to derive DPs. DP scores at each time point were used to create DP trajectories using group-based trajectory modelling (GBTM). Multinomial logistic regression assessed the association with maternal factors.

RESULTS

A total of six distinct DPs were identified over time with different numbers of DPs at each time point. The "healthy" and "processed" DPs persisted over the 12-year post-pregnancy. Three trajectories of "healthy" and "processed" DPs were identified from GBTM. Half the women were on the moderately healthy DP trajectory with 37% on the lower trajectory and 9% on the higher healthy DP trajectory. 59% of women were on the lower processed DP trajectory with 38% on the moderate trajectory and 3.3% on the higher processed DP trajectory. Low educational attainment, low social class and smoking in pregnancy were independently associated with being on a less favourable DP trajectory over the 12 years.

CONCLUSION

Health professionals should provide support on smoking cessation along with healthy eating advice during ante-natal counselling. Continued support on eating healthily after pregnancy would be beneficial for mothers and families.

Examination of dietary intake of UK preschool children by varying carers: evidence from the 2008-2016 UK National Diet and Nutrition Survey

Early years caregivers can play a key role in young children's eating and the prevention of childhood obesity. The UK National Diet and Nutrition Survey (NDNS) is a large representative survey collecting detailed food and nutrition consumption data. Using these data, the aim of this study was to investigate the relationship between dietary intake of preschool children in the UK aged 2 to 4 years and accompanying adult/s. Nutrition consumption data from 1218 preschool children from years 1 to 8 of the 2008-2016 NDNS were accessed. Dietary data were captured using 3 or 4 day estimated food diaries. Regression analyses revealed significant differences in consumption when children were not accompanied by their parents. Compared with when children were with parents, children consumed significantly more energy dense meals (0·32 kJ/g, 95% CI 0·1-0·6 kJ/g), energy (62 kJ/g, (95% CI 27-97 kJ)) Na (19 mg, (95 % CI 6, 32)), added sugars (0·6 g, (95 % CI 0·1, 1·1)), vegetables (3 g, (95 % CI 1, 4)), total grams (12 g, (95 % CI 3, 21)) and saturated fat (0·2 g, (95 % CI 0·1, 0·4)) per eating occasion when accompanied by wider family. When children were accompanied by a formal childcare provider, they consumed significantly lower energy dense meals (-0·9 kJ/g, (95% CI -1·4 - -0·3 kJ/g)), less added sugars (-1·6 g, (95 % CI -2·4, -0·8)) and more fruit (12 g, (95 % CI 3, 21)) per eating occasion than when they were with their parents. The results demonstrate that non-parental caregivers might be an important target to promote healthy eating in young children. Further research is needed to establish which caregivers would benefit most.

Associations of Dietary-Lifestyle Patterns with Obesity and Metabolic Health: Two-Year Changes in MeDiSH® Study Cohort

This study aimed to evaluate changes in diet, adiposity, and metabolic outcomes after two years. In all, 358 Polish men aged 19-40 years old participated in the study. Data regarding dietary and lifestyle characteristics as well as family, socio-economic, and demographic status were collected using the food frequency questionnaire KomPAN^®. Dietary lifestyle patterns were previously derived from data for 358 men by principal component analysis (PCA). Changes over time were examined in 95 men who returned after two years by calculating relative differences (RD, %) in mean values and markers distribution. Diet quality was described with two predefined scores: pro-Healthy-Diet-Index (pHDI) and non-Healthy-Diet-Index (nHDI). After two years, changes were observed in diet quality and metabolic health markers. No significant changes were observed in family, socio-economic, and demographic status, as well as other lifestyle factors. In the "sandwiches and convenience foods" pattern, an nHDI decrease (RD = -25.3%) was associated with a fasting blood glucose decrease (RD = -6.1%). In the "protein food, fried-food and recreational physical activity" and the "healthy diet, activity at work, former smoking" patterns, pHDI decreases (RD = -13.6% and -14.6%, respectively,) were associated with an adiposity increase. In the "fast foods and stimulants" pattern, no changes in pHDI and nHDI were observed, while adiposity markers and systolic blood pressure worsened. Conclusion: in the two-year perspective, dietary improvement was associated with improved glycemic control, despite no changes in body weight, while worsening of the diet quality or maintenance of unhealthy dietary behaviours were associated with the deterioration of metabolic health.

Paternal Diet before Conception and Its Social Determinants in the Elfe Cohort

This study aimed to characterize paternal diet during the peri-conception period and its associated characteristics. These cross-sectional analyses were based on 998 fathers from the French nationwide ELFE birth cohort recruited in 2011. Fathers’ diet before mothers’ pregnancies was assessed by a 46-item food frequency questionnaire. Six exploratory dietary patterns were identified by principal component analysis: “Diverse diet”, “Balanced”, “Alcohol”, “Snacking”, “Bread and cheese”, and “Processed products”. Older age was related to higher scores for the “Balanced”, “Alcohol”, and “Snacking” patterns, and high education level with high scores on the “Balanced” pattern and low scores on the “Processed products” pattern. Unemployment and having a first child were related to high scores on the “Alcohol” pattern. Smoking was positively related to “Alcohol” and “Processed products” patterns. A restrictive diet was associated with high scores on the “Balanced” and “Processed products” patterns and low scores on “Alcohol”, “Snacking”, and “Bread and cheese” patterns. Maternal dietary patterns, identified in a previous analysis, were moderately and positively related to the similar patterns among fathers. These findings are important for screening fathers at risk of a suboptimal diet and for accounting for this factor in future studies to examine the specific influence of paternal diet on a child’s health and development.

Risk Factors for Overweight and Obesity within the Home Environment of Preschool Children in Sub-Saharan Africa: A Systematic Review

Sub-Saharan Africa (SSA) is experiencing an increasing prevalence of young children being overweight and obese. Many feeding and physical activity-related behaviours are established at home during preschool years, yet the precise factors that contribute to preschool overweight and obesity have not been fully elucidated. This review aims to identify factors in the home environment associated with overweight and or obesity in preschool children in SSA. Ovid MEDLINE, EMBASE, CINAHL, Scopus, Web of Science, Africa Journals Online (AJOL) and the African Index Medicus databases were systematically searched for qualitative and quantitative studies published between 2000 and 2021. Eleven studies (ten quantitative, one qualitative) met the inclusion criteria. Overall, the results highlight the paucity of studies exploring factors in the home environment associated with overweight and obesity in preschool children in Sub-Saharan Africa. The home food environment and maternal BMI appear to be important factors associated with overweight and obesity in preschool children; however, the information for all other factors explored remains unclear due to the lack of evidence. For successful obesity prevention and treatment interventions to be developed, more research in this area is required to understand how different aspects of the home environment contribute to overweight and obesity in preschool Sub-Saharan African children.

Deprivation Index and Lifestyle: Baseline Cross-Sectional Analysis of the PREDIMED-Plus Catalonia Study

This baseline cross-sectional analysis from data acquired in a sub-sample of the PREDIMED-Plus study participants aimed to evaluate the relation between the Composite Socioeconomic Index (CSI) and lifestyle (diet and physical activity). This study involved 1512 participants (759 (52.2%) women) between 55 and 80 years with overweight/obesity and metabolic syndrome assigned to 137 primary healthcare centers in Catalonia, Spain. CSI and lifestyle (diet and physical activity) were assessed. Multiple linear regression or multinomial regression were applied to the data. Cluster analysis was performed to identify dietary patterns. The multiple linear regression model showed that a high deprivation index was related to a higher consumption of refined cereals (11.98 g/d, p-value = 0.001) and potatoes (6.68 g/d, p-value = 0.001), and to a lower consumption of fruits (−17.52 g/d, p-value = 0.036), and coffee and tea (−8.03 g/d, p-value = 0.013). Two a posteriori dietary patterns were identified by cluster analysis and labeled as “healthy” and “unhealthy”. In addition, the multinomial regression model showed that a high deprivation index was related to an unhealthy dietary pattern and low physical activity (OR 1.42 [95% CI 1.06–1.89]; p-value < 0.05). In conclusion, a high deprivation index was related to an unhealthy lifestyle (diet and physical activity) in PREDIMED-Plus study participants.

Shifts towards healthy diets in the US can reduce environmental impacts but would be unaffordable for poorer minorities

Environmental implications of food choice are the focus of increasingly extensive research, but less is known about the impacts of dietary patterns of different socio-economic groups of a country, and the trade-offs between nutritional quality and environmental impacts of diet within those groups. We evaluate the impacts of US household dietary patterns on greenhouse gas emissions, blue water footprint, land use and energy consumption across supply chains using an environmentally extended input-output analysis. We compare the nutritional quality of these dietary patterns using healthy eating index scores across individuals' income and other socio-economic characteristics. Individuals with higher income or education levels are more likely to adopt healthier diets but are also responsible for larger environmental impacts of diet primarily due to a higher consumption of dairy and livestock products, seafood and items with lower energy density but higher nutrient density. Our optimization shows that a healthy diet with lower environmental impacts is achievable within current food budgets for almost 95% of people, and results in average decreases of 2% in food-related greenhouse gas emissions, 24% in land use and 4% in energy consumption, but a 28% increase in blue water consumption. However, such dietary patterns are unaffordable for 38% of Black and Hispanic individuals in the lowest income and education groups. Policies that affect income and food prices making nutritious food more affordable would be needed to achieve better nutrition and improved environmental outcomes simultaneously, particularly for more vulnerable socio-economic groups.

Prenatal Diet and Children's Trajectories of Anxiety and Depression Symptoms from 3 to 8 Years: The EDEN Mother-Child Cohort

BACKGROUND

Maternal diet quality during pregnancy has been linked to offspring's physical and mental health outcomes across the lifespan. However, few studies have examined its association with subsequent offspring's anxiety and depression issues.

OBJECTIVES

The objective of the study was to examine the relationship between maternal prenatal dietary patterns and offspring's anxiety and depression symptoms from 3 to 8 years.

METHODS

We used data from 1242 children enrolled in the French EDEN (Etude des déterminants pré- et postnatals précoces du développement et de la santé de l'enfant) birth cohort. Maternal third trimester dietary patterns-namely, "Healthy" (i.e., high intake in fruit, vegetables, fish, and whole-grain cereals) and "Western" (i.e., high intake in processed and snacking foods) patterns-were evaluated using a validated qualitative FFQ. Children's anxiety and depression symptoms (i.e., fears, worries, misery, nervousness, and somatic symptoms) were assessed by mothers using the Strengths and Difficulties Questionnaire at ages 3, 5, and 8 years, from which trajectories were derived using group-based trajectory modeling. We used logistic regressions to analyze the associations between maternal dietary patterns and children's anxiety and depression symptom trajectories.

RESULTS

We identified 2 trajectories of anxiety and depression symptoms from 3 to 8 years of age: low to moderate (n = 1058; reference group) and moderately high (n = 184). Maternal low adherence to the Healthy dietary pattern in the third trimester was significantly associated with moderately high children's anxiety and depression symptom trajectories from 3 to 8 years (OR, 1.87; 95% CI, 1.40-2.51), in crude and adjusted analyses. The maternal Western dietary pattern was not significantly associated with anxiety and depression symptom trajectories.

CONCLUSIONS

High maternal prenatal adherence to a Healthy dietary pattern was negatively related to anxiety and depression symptoms in children. As maternal diet is a key lifestyle factor, further research should investigate its association with subsequent offspring anxiety and depression symptoms in aiming to later inform prevention strategies focusing on pregnancy.

Dietary Approaches to Stop Hypertension (DASH) diet and associated socio-economic inequalities in the UK

The Dietary Approaches to Stop Hypertension (DASH) diet is an effective measure in the prevention and treatment of CVD. We evaluated recent trends in socio-economic differences in the DASH score in the UK population, using education, occupation and income as proxies of socio-economic position (SEP). We analysed data on 6416 subjects aged 18 years and older collected in the National Diet and Nutrition Survey (2008-2016). The DASH score was calculated using sex-specific quintiles of DASH items. Multiple linear regression and quantile regression models were used to evaluate the trend in DASH score according to SEP. The mean DASH score was 24 (sd 5). The estimated mean difference between people with no qualification and those having the highest level of education was -3·61 (95 % CI -4·00, -3·22) points. The mean difference between subjects engaged in routine occupations and those engaged in high managerial and professional occupations was -3·41 (95 % CI -3·89, -2·93) points and for those in the first fifth and last fifth of the household income distribution was -2·71 (95 % CI -3·15, -2·28) points. DASH score improved over time, and no significant differences in the trend were observed across SEP. The widest socio-economic differences emerged for consumption of fruit, vegetables, whole grains, nuts, seeds and legumes. Despite an overall increase in the DASH score, a persisting SEP gap was observed. This is an important limiting factor in reducing the high socio-economic inequality in CVD observed in the UK.

The relationship between lifestyle components and dietary patterns

We conducted a narrative review on the interaction between dietary patterns with demographic and lifestyle variables in relation to health status assessment. The food pattern has the advantage of taking into account the correlations that may exist between foods or groups of foods, but also between nutrients. It is an alternative and complementary approach in analysing the relationship between nutrition and the risk of chronic diseases. For the determination of dietary patterns one can use indices/scores that evaluate the conformity of the diet with the nutrition guidelines or the established patterns (a priori approach). The methods more commonly used are based on exploratory data (a posteriori): cluster analysis and factor analysis. Dietary patterns may vary according to sex, socio-economic status, ethnicity, culture and other factors, but more, they may vary depending on different associations between these factors. The dietary pattern exerts its effects on health in a synergistic way or even in conjunction with other lifestyle factors, and we can therefore refer to a 'pattern of lifestyle'.

Dietary-Lifestyle Patterns Associated with Adiposity and Metabolic Abnormalities in Adult Men under 40 Years Old: A Cross-Sectional Study (MeDiSH Project)

The aim of this study was to examine the associations of dietary-lifestyle patterns (DLPs) with adiposity and metabolic abnormalities in adult Polish men that were under 40. The cross-sectional study included 358 men that were 19–40-year-old. Dietary and lifestyle data were collected with multicomponent food frequency questionnaire (KomPAN^®). DPLs were derived with Principal Component Analysis (PCA) using 25 dietary and six lifestyle as the input variables. Adiposity was determined with the use of: overweight (body mass index 25–29.9 kg/m²), central obesity (waist-to-height ratio ≥ 0.5), general obesity (body fat ≥ 25%), excessive visceral fat tissue (≥ median), and increased skeletal muscle mass (≥ median). The metabolic abnormalities were characterised by elevated: fasting blood glucose (FBG ≥ 100 mg/dL), triglycerides (TG ≥ 150 mg/dL), total cholesterol (TC ≥ 200 mg/dL), or systolic or diastolic blood pressure (≥ 130 or ≥ 85 mmHg, respectively). Four PCA-driven DLPs were derived and labelled accordingly to the most characteristic dietary or lifestyle behaviours that were correlated with each pattern. Multivariate logistic regression revealed that higher adherence (upper vs. bottom tertile as referent) to “Protein food, fried-food, and recreational physical activity” pattern was associated with higher odds of overweight and increased skeletal muscle mass, and lower odds of: general obesity, excessive visceral fat tissue, and elevated TC. Higher adherence to “Healthy diet, active, past smokers” pattern was associated with higher odds of overweight and lower odds of: general obesity, excessive visceral fat tissue, and elevated FBG. Higher adherence to “Sandwiches and convenient diet” pattern was associated with higher odds of: central obesity, general obesity, excessive visceral fat tissue, elevated TC, elevated TG, occurrence at least two metabolic abnormalities, and lower odds of increased skeletal muscle mass. A higher adherence to “Fast foods and stimulants” pattern was associated with higher odds of central obesity, general obesity, excessive visceral fat tissue, and lower odds of increased skeletal muscle mass. The interrelations between diet and lifestyle behaviours were reflected in three out of four patterns. Healthy diet attempts combined with active lifestyle was associated with reduced risk of adiposity and metabolic abnormalities despite some unhealthy components, like former smoking or fried-food consumption. In contrary, patterns that were composed of undesirable dietary behaviours solely, as well as poor diet combined with stimulant use, were associated with higher adiposity and worse metabolic health, despite the relatively young age of the study participants. Accurate mapping of dietary-lifestyle behaviours can serve as a tool for formulating evidence-based recommendations.

Socioeconomic Status and the Prediction of Health Promoting Dietary Behaviours: A Systematic Review and Meta-Analysis Based on the Theory of Planned Behaviour

BACKGROUND

Dietary behaviours are strongly patterned by socioeconomic status (SES). However, the role of SES in the self-regulation of health promoting dietary behaviours is not fully understood. This systematic review with meta-analysis investigated whether four individual-level measures of SES (income, occupation, education, and ethnicity) moderate the relationships between Theory of Planned Behaviour (TPB) variables and different health promoting dietary behaviours in adults.

METHODS

A systematic literature search identified 106 studies from 77 articles providing information on TPB variables, SES, and health promoting dietary behaviours-choosing health promoting foods and restricting health compromising foods. Random-effects meta-analyses were conducted to generate pooled correlations corrected for sampling and measurement error, and meta-regression was used to test moderating effects of study-level SES.

RESULTS

All TPB variables were significantly and positively associated with both health promoting dietary behaviours, with intention having the strongest correlation with behaviour. However, none of the relationships between TPB variables and health promoting dietary behaviours were significantly moderated by study-level SES.

CONCLUSIONS

Results suggest robust associations between TPB predictors and healthy dietary behaviour that are not patterned by individual-level SES measures.

No independent associations between preconception paternal dietary patterns and embryonic growth; the Predict Study

BACKGROUND & AIM

Several studies show the importance of periconceptional maternal dietary patterns on human embryonic growth. Healthy paternal nutrition has been associated with better semen quality and fecundability, however, evidence on the impact on pregnancy outcome is limited. Therefore, the aim of this study was to investigate the association between preconception paternal dietary patterns and first trimester embryonic growth using the parameters longitudinal crown-rump length (CRL) and embryonic volume (EV).

METHODS

A total of 638 couples were enrolled in the Rotterdam Periconceptional Cohort and received longitudinal three dimensional transvaginal ultrasound scans from 7⁺⁰ up to 12⁺⁰ weeks of gestation. Virtual reality software was used to perform offline measurements of the embryonic CRL and EV. Food frequency questionnaires (FFQ) were used to estimate habitual food intake in couples. Principal component analysis (PCA) was performed to identify paternal and maternal dietary patterns. Linear mixed models adjusted for potential confounders were applied to analyze associations between paternal and maternal dietary patterns and embryonic growth parameters.

RESULTS

The paternal dietary patterns retrieved were identified as "Whole wheat grains and Vegetables", "Sauces and Snacks Refined Grains", "Fish and Legumes" and explained 27.5% of the total variance of the dietary intake. No significant additional effects, independent of maternal dietary patters and other maternal and paternal potential confounders, were shown of these paternal dietary patterns on embryonic growth in spontaneous or IVF/ICSI pregnancies.

CONCLUSION

No significant effects of paternal dietary patterns independent of maternal dietary patters and other parental potential confounders on embryonic growth parameters could be established in spontaneous or IVF/ICSI pregnancies. The biological importance of paternal nutrition on semen quality, however, supports the need of periconceptional tailored nutritional counselling of couples trying to conceive.

Dietary patterns of university students in the UK: a cross-sectional study

Background

University represents a key transition into adulthood for many adolescents but there are associated concerns about health and behaviours. One important aspect relates to diet and there is emerging evidence that university students may consume poor quality diets, with potential implications for body weight and long-term health. This research aimed to characterise dietary patterns of university students in the UK and their sociodemographic and lifestyle antecedents.

Methods

An online, cross-sectional survey was undertaken with a convenience sample of 1448 university students from five UK universities (King’s College London, Universities of St Andrews, Southampton and Sheffield, and Ulster University). The survey comprised a validated food frequency questionnaire alongside lifestyle and sociodemographic questions. Dietary patterns were generated from food frequency intake data using principal components analysis. Nutrient intakes were estimated to characterise the nutrient profile of each dietary pattern. Associations with sociodemographic variables were assessed through general linear modelling.

Results

Dietary analyses revealed four major dietary patterns: ‘vegetarian’; ‘snacking’; ‘health-conscious’; and ‘convenience, red meat & alcohol’. The ‘health-conscious’ pattern had the most favourable micronutrient profile. Students’ gender, age, year of study, geographical location and cooking ability were associated with differences in pattern behaviour. Female students favoured the ‘vegetarian’ pattern, whilst male students preferred the ‘convenience, red meat & alcohol’ pattern. Less healthful dietary patterns were positively associated with lifestyle risk factors such as smoking, low physical activity and take-away consumption. The health-conscious pattern had greatest nutrient density. The ‘convenience, red meat & alcohol’ pattern was associated with higher weekly food spending; this pattern was also identified most consistently across universities. Students reporting greater cooking ability tended towards the ‘vegetarian’ and ‘health-conscious’ patterns.

Conclusions

Food intake varied amongst university students. A substantial proportion of students followed health-promoting diets, which had good nutrient profiles obviating a need for dietary intervention. However, some students consumed poor diets, incurred greater food costs and practised unfavourable lifestyle behaviours, which may have long-term health effects. University policy to improve students’ diets should incorporate efforts to promote student engagement in cooking and food preparation, and increased availability of low cost healthier food items.

Electronic supplementary material

The online version of this article (10.1186/s12937-018-0398-y) contains supplementary material, which is available to authorized users.

Prenatal diet and children's trajectories of hyperactivity-inattention and conduct problems from 3 to 8 years: the EDEN mother-child cohort

BACKGROUND

Evidence shows that diet contributes substantially to lifelong physical and mental health. Although dietary exposure during gestation and early postnatal life is critical, human epidemiological data are limited regarding its link with children's subsequent externalizing issues. The aim of this study was to investigate the role of maternal diet during pregnancy in offspring's symptoms of hyperactivity-inattention and conduct problems from ages 3 to 8 years.

METHODS

We used data of 1,242 mother-child pairs from a French cohort followed up from pregnancy until the children were 8 years of age. Dietary patterns (DP) of the mother during pregnancy were assessed with food frequency questionnaires. Children's externalizing behavior was assessed with the Strength and Difficulties Questionnaire at ages 3, 5, and 8 years, from which trajectories of hyperactivity-inattention symptoms and conduct problems were derived. We conducted multivariable logistic models to study associations adjusted for a range of potential confounders.

RESULTS

Results showed significant relationships between maternal 'low Healthy diet' (adjusted Odds Ratio (aOR) = 1.61; IC 95%: 1.09-2.37) and 'high Western diet' (aOR = 1.67; IC 95%: 1.13-2.47) during pregnancy and children's trajectories of high symptoms of hyperactivity-inattention. The associations took into account relevant confounders such as DP of the children at age 2 years, maternal stress and depression, gestational diabetes, and socioeconomic variables.

CONCLUSIONS

Maternal diet during pregnancy was independently associated with children's hyperactivity-inattention symptoms but not with conduct problems. Early prevention addressing lifestyle should specifically target diet in pregnant women.

Empirically Derived Dietary Patterns in UK Adults Are Associated with Sociodemographic Characteristics, Lifestyle, and Diet Quality

The aim of this study was to examine empirical dietary patterns in UK adults and their association with sociodemographic characteristics, lifestyle factors, self-reported nutrient intake, nutrient biomarkers, and the Nutrient-based Diet Quality Score (NDQS) using National Diet and Nutrition Survey data 2008–2012 (n = 2083; mean age 49 years; 43.3% male). Four patterns explained 13.6% of the total variance: ‘Snacks, fast food, fizzy drinks’ (SFFFD), ‘Fruit, vegetables, oily fish’ (FVOF), ‘Meat, potatoes, beer’ (MPB), and ‘Sugary foods, dairy’ (SFD). ‘SFFFD’ was associated positively with: being male; smoking; body mass index (BMI); urinary sodium; intake of non-milk extrinsic sugars (NMES), fat and starch; and negatively with: age; plasma carotenoids; and NDQS. ‘FVOF’ was associated positively with: being non-white; age; income; socioeconomic classification (National Statistics Socio-economic Classifications; NSSEC); plasma carotenoids; intake of non-starch polysaccharides and polyunsaturated fatty acids. It was negatively associated with: being male, smoking, BMI, urinary sodium, intake of saturated fat; and NMES and NDQS. Whilst the patterns explained only 13.6% of the total variance, they were associated with self-reported nutrient intake, biomarkers of nutrient intake, sociodemographic and lifestyle variables, and the NDQS. These findings provide support for dietary patterns analyses as a means of exploring dietary intake in the UK population to inform public health nutrition policy and guidance.

Socio-demographic and lifestyle determinants of dietary patterns in French-speaking Switzerland, 2009-2012

Background

Food intake is a complex behaviour which can be assessed using dietary patterns. Our aim was to characterize dietary patterns and associated factors in French-speaking Switzerland.

Methods

Cross-sectional study conducted between 2009 and 2012 in the city of Lausanne, Switzerland, including 4372 participants (54% women, 57.3 ± 10.3 years). Food consumption was assessed using a validated food frequency questionnaire. Dietary patterns were assessed by principal components analysis.

Results

Three patterns were identified: “Meat & fries”; “Fruits & Vegetables” and “Fatty & sugary”. The “Meat & fries” pattern showed the strongest correlations with total and animal protein and cholesterol carbohydrates, dietary fibre and calcium. The “Fruits & Vegetables” pattern showed the strongest correlations with dietary fibre, carotene and vitamin D. The “Fatty & sugary” pattern showed the strongest correlations with total energy and saturated fat. On multivariate analysis, male gender, low educational level and sedentary status were positively associated with the “Meat & fries” and the “Fatty & sugary” patterns, and negatively associated with the “Fruits & Vegetables” pattern. Increasing age was inversely associated with the “Meat & fries” pattern; smoking status was inversely associated with the “Fruits & Vegetables” pattern. Being born in Portugal or Spain was positively associated with the “Meat & fries” and the “Fruits & Vegetables” patterns. Increasing body mass index was positively associated with the “Meat & fries” pattern and inversely associated with the “Fatty & sugary” pattern.

Conclusions

Three dietary patterns, one healthy and two unhealthy, were identified in the Swiss population. Several associated modifiable behaviours were identified; the information on socio- demographic determinants allows targeting of the most vulnerable groups in the context of public health interventions.

Electronic supplementary material

The online version of this article (10.1186/s12889-018-5045-1) contains supplementary material, which is available to authorized users.

Dietary patterns and depressive symptoms in a UK cohort of men and women: a longitudinal study

OBJECTIVE

There is evidence to suggest that individual components of dietary intake are associated with depressive symptoms. Studying the whole diet, through dietary patterns, has become popular as a way of overcoming intercorrelations between individual dietary components; however, there are conflicting results regarding associations between dietary patterns and depressive symptoms. We examined the associations between dietary patterns extracted using principal component analysis and depressive symptoms, taking account of potential temporal relationships.

DESIGN

Depressive symptoms in parents were assessed using the Edinburgh Postnatal Depression Scale (EPDS) when the study child was 3 and 5 years of age. Scores >12 were considered indicative of the presence of clinical depressive symptoms. Diet was assessed via FFQ when the study child was 4 years of age.

SETTING

Longitudinal population-based birth cohort.

SUBJECTS

Mothers and fathers taking part in the Avon Longitudinal Study of Parents and Children when their study child was 3-5 years old.

RESULTS

Unadjusted results suggested that increased scores on the 'processed' and 'vegetarian' patterns in women and the 'semi-vegetarian' pattern in men were associated with having EPDS scores ≥13. However, after adjustment for confounders all results were attenuated. This was the case for all those with available data and when considering a sub-sample who were 'disease free' at baseline.

CONCLUSIONS

We found no association between dietary patterns and depressive symptoms after taking account of potential confounding factors and the potential temporal relationship between them. This suggests that previous studies reporting positive associations may have suffered from reverse causality and/or residual confounding.

Dietary patterns: a literature review of the methodological characteristics of the main step of the multivariate analyzes

OBJECTIVE

To describe the solutions adopted in the multiple steps of the use of multivariate techniques to obtain a dietary pattern (DP) concerning: the objective of the studies, the selection of the method for measuring food intake, the criteria for grouping the foods, the number of food groups used, the number of DP obtained, and the nomenclature criteria.

METHODS

The articles were selected from MEDLINE and Lilacs scientific databases using the following keywords: "dietary patterns" versus "factor analysis"; "principal components analysis"; "cluster analysis" and "reduced regression rank." The initial search resulted in 1,752 articles. After inclusion and exclusion criteria, 189 publications were selected.

RESULTS

The following aspects were relevant among the studies: the prevalence of the principal component analysis (PCA); the prevalence of the use of 4 to 5 DPs in the studies of association with health outcomes; the use of 30 or more food groups from the food frequency questionnaire (FFQ); the prevalence of studies that associated DPs with health outcomes and socioeconomic factors; and the heterogeneity of criteria used throughout the analytical stages of the multivariate techniques.

CONCLUSION

The heterogeneity between the publications concentrates on the criteria for food grouping, the nomenclature, and the number of dietary patterns calculated, which varied depending on the number of food groups present in these analyses. To understand, apply, and explore in full, the multivariate techniques has become necessary in order to improve the reliability of the results and, consequently, to improve the relationships with health outcomes and socioeconomic factors.

Obesity Pathogenesis: An Endocrine Society Scientific Statement

Obesity is among the most common and costly chronic disorders worldwide. Estimates suggest that in the United States obesity affects one-third of adults, accounts for up to one-third of total mortality, is concentrated among lower income groups, and increasingly affects children as well as adults. A lack of effective options for long-term weight reduction magnifies the enormity of this problem; individuals who successfully complete behavioral and dietary weight-loss programs eventually regain most of the lost weight. We included evidence from basic science, clinical, and epidemiological literature to assess current knowledge regarding mechanisms underlying excess body-fat accumulation, the biological defense of excess fat mass, and the tendency for lost weight to be regained. A major area of emphasis is the science of energy homeostasis, the biological process that maintains weight stability by actively matching energy intake to energy expenditure over time. Growing evidence suggests that obesity is a disorder of the energy homeostasis system, rather than simply arising from the passive accumulation of excess weight. We need to elucidate the mechanisms underlying this "upward setting" or "resetting" of the defended level of body-fat mass, whether inherited or acquired. The ongoing study of how genetic, developmental, and environmental forces affect the energy homeostasis system will help us better understand these mechanisms and are therefore a major focus of this statement. The scientific goal is to elucidate obesity pathogenesis so as to better inform treatment, public policy, advocacy, and awareness of obesity in ways that ultimately diminish its public health and economic consequences.

Ethnic Differences in the Food Intake Patterns and Its Associated Factors of Adolescents in Kelantan, Malaysia

Objective: The aim of the study was to identify the ethnic differences in dietary patterns and its association with socio-economic, dietary and lifestyle practices among adolescents in Kelantan, Malaysia. Methods: A population-based study of 454 adolescents aged 12 to 19 years was included. A validated food frequency questionnaire was used to assess dietary patterns and three dietary patterns were identified based on the principal component analysis method. Results: Malay adolescents had significantly higher scores for the Western-based food pattern and local-based food pattern, whereas Chinese adolescents showed higher scores for the healthy-based food pattern. Multivariate analyses show that age and physical activity (PA) levels were positively associated with healthy-based food pattern in Malay (All, p < 0.001), whereas higher consumption of eating-out from home (EatOut) (p = 0.014) and fast food (p = 0.041) were negatively associated. High weekly breakfast skipping (p < 0.001) and EatOut (p = 0.003) were positively associated with a Western-based pattern, whereas age (p < 0.001) and household income (p = 0.005) were negatively associated. Higher frequency of daily snacking (p = 0.013) was positively associated with local-based food pattern. For Chinese adolescents, age (p < 0.001), PA levels (p < 0.001) and maternal education level (p = 0.035) showed positive associations with the healthy-based pattern, whereas high EatOut (p = 0.001) and fast food intakes (p = 0.001) were negatively associated. Higher weekly consumption of EatOut (p = 0.007), fast food (p = 0.023) and carbonated beverages (p = 0.023), and daily snacking practice (p = 0.004) were positively associated with higher Western-based food pattern, whereas age (p = 0.004) was inversely associated. Conclusion: This study showed that there were significant differences in dietary patterns and its association factors between Malay and Chinese adolescents. More importantly, these findings suggest that unhealthy dietary and lifestyle practices could increase the risk of adherence to unhealthy Western-based food pattern that is high in fat, sugar and salt contents, and, consequently, increase the risk of developing obesity and metabolic-related disorders during these critical years of growth.

Dietary patterns in the Avon Longitudinal Study of Parents and Children

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

Contribution of food prices and diet cost to socioeconomic disparities in diet quality and health: a systematic review and analysis

CONTEXT

It is well established in the literature that healthier diets cost more than unhealthy diets.

OBJECTIVE

The aim of this review was to examine the contribution of food prices and diet cost to socioeconomic inequalities in diet quality.

DATA SOURCES

A systematic literature search of the PubMed, Google Scholar, and Web of Science databases was performed.

STUDY SELECTION

Publications linking food prices, dietary quality, and socioeconomic status were selected.

DATA EXTRACTION

Where possible, review conclusions were illustrated using a French national database of commonly consumed foods and their mean retail prices.

DATA SYNTHESIS

Foods of lower nutritional value and lower-quality diets generally cost less per calorie and tended to be selected by groups of lower socioeconomic status. A number of nutrient-dense foods were available at low cost but were not always palatable or culturally acceptable to the low-income consumer. Acceptable healthier diets were uniformly associated with higher costs. Food budgets in poverty were insufficient to ensure optimum diets.

CONCLUSIONS

Socioeconomic disparities in diet quality may be explained by the higher cost of healthy diets. Identifying food patterns that are nutrient rich, affordable, and appealing should be a priority to fight social inequalities in nutrition and health.

Are Dietary Patterns of Mothers during Pregnancy Related to Children's Weight Status? Evidence from the Lifeways Cross- Generational Cohort Study

Children's diet patterns are likely to be influenced by their mothers' diet pattern. The primary objective of this study was to examine whether children's adiposity could be influenced by diet patterns of mothers during pregnancy. A secondary objective was to study the relative influence of fathers' and children's dietary patterns on childhood adiposity. The design was a prospective cross-generational cohort study initiated with 1,124 mothers recruited during pregnancy. Self-reported questionnaires included a food frequency instrument (FFQ) to assess parental intakes during the perinatal period. Child body mass index (BMI) was measured at 5 years and an age-appropriate FFQ was administered. Dietary patterns for each group were identified by principal components analysis. Pearson's correlation and logistic regression were used to test for associations. Dietary patterns were described for n = 1,042 mothers during pregnancy and n = 331 fathers during the perinatal period. Dietary patterns and BMI data were available for n = 443 children at age 5 years. The diet patterns identified for mothers correlated with the corresponding diet patterns for fathers. The children's "pasta & vegetable" pattern was positively correlated with "healthy patterns" in mothers (r = 0.195, p < 0.01) and fathers (r = 0.250, p < 0.01). The children's "junk" food pattern was correlated with the "processed" pattern in mothers (r = 0.245, p < 0.01) and fathers (r = 0.257, p < 0.01). In multivariate logistic regression analysis the upper tertiles of children's "cereal and juice" [Tertile 2 (T2): OR 0.44, 95% CI (0.22-0.90); T3: 0.41, (0.19-0.85)] and the middle tertile of the "pasta and veg" patterns [T3: 0.37, (0.18-0.75)] were negatively associated with overweight and obesity. The mothers' processed pattern during pregnancy was positively associated with offspring overweight and obesity [T2: 2.64, (1.28-5.45); T3: 2.03, (0.87-4.73)]. No significant associations were observed for the paternal diet patterns. This analysis shows that the influence of maternal diet pattern on child obesity is apparent early in the lifecourse.

Evaluation of dietary patterns among Norwegian postmenopausal women using plasma carotenoids as biomarkers

A number of studies have examined dietary patterns in various populations. However, to study to what extent such patterns capture meaningful differences in consumption of foods is of interest. In the present study, we identified important dietary patterns in Norwegian postmenopausal women (age 50-69 years, n 361), and evaluated these patterns by examining their associations with plasma carotenoids. Diet was assessed by a 253-item FFQ. These 253 food items were categorised into forty-six food groups, and dietary patterns were identified using principal component analysis. We used the partial correlation coefficient (r(adj)) and multiple linear regression analysis to examine the associations between the dietary patterns and the plasma carotenoids α-carotene, β-carotene, β-cryptoxanthin, lutein, lycopene and zeaxanthin. Overall, four dietary patterns were identified: the 'Western'; 'Vegetarian'; 'Continental'; 'High-protein'. The 'Western' dietary pattern scores were significantly inversely correlated with plasma lutein, zeaxanthin, lycopene and total carotenoids (-0·25 ≤ r(adj) ≤ -0·13). The 'Vegetarian' dietary pattern scores were significantly positively correlated with all the plasma carotenoids (0·15 ≤ r(adj) ≤ 0·24). The 'Continental' dietary pattern scores were significantly inversely correlated with plasma lutein and α-carotene (r(adj) = -0·13). No significant association between the 'High-protein' dietary pattern scores and the plasma carotenoids was found. In conclusion, the healthy dietary pattern, the 'Vegetarian' pattern, is associated with a more favourable profile of the plasma carotenoids than our unhealthy dietary patterns, the 'Western' and 'Continental' patterns.

Dietary advice for muscularity, leanness and weight control in Men's Health magazine: a content analysis

BACKGROUND

The dietary content of advice in men's lifestyle magazines has not been closely scrutinised.

METHODS

We carried out an analysis of such content in all 2009 issues (n = 11) of Men's Health (MH) focusing on muscularity, leanness and weight control.

RESULTS

Promotion of a mesomorphic body image underpinned advice to affect muscle building and control weight. Diet advice was underpinned by a strong pseudo-scientific discourse, with citation of expert sources widely used to legitimise the information. Frequently multiple dietary components were advocated within one article e.g. fat, omega-3 fatty acids, thiamine, zinc and high-glycaemic index foods. Furthermore advice would cover numerous nutritional effects, e.g. strengthening bones, reducing stress and boosting testosterone, with little contextualisation. The emphasis on attainment of a mesomorphic body image permitted promotion of slimming diets.Advice to increase calorie and protein intake to augment muscle mass was frequent (183 and 262 references, respectively). Such an anabolic diet was advised in various ways, including consumption of traditional protein foods (217 references) and sports foods (107 references), thereby replicating muscle magazines' support for nutritional supplements. Although advice to increase consumption of red meat was common (52 references), fish and non-flesh sources of protein (eggs, nuts & pulses, and soy products) together exceeded red meat in number of recommendations (206 references). Advice widely asserted micronutrients and phytochemicals from plant food (161 references) as being important in muscle building. This emphasis diverges from stereotypical gender-based food consumption patterns.Dietary advice for control of body weight largely replicated that of muscularity, with strong endorsement to consume fruits and vegetables (59 references), diets rich in nuts and pulses and fish (66 references), as well as specific micronutrients and phytochemicals (62 references). Notably there was emphasis on fat-burning, good fats and consumption of single foods, with relatively little mention of dietary restriction.

CONCLUSIONS

Despite the widespread use of scientific information to endorse dietary advice, the content, format and scientific basis of dietary content of MH leaves much to be desired. The dietary advice as provided may not be conducive to public health.

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

OBJECTIVES

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

DESIGN

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

PARTICIPANTS

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

OUTCOMES AND ANALYSIS

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

RESULTS

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

CONCLUSIONS

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

TRIAL REGISTRATION NUMBER

The Early ACTID trial number ISRCTN92162869.

The effect of an early childhood obesity intervention on father's obesity risk behaviors: the Melbourne InFANT Program

Background

To investigate the effect of an early childhood obesity prevention intervention, incorporating a parent modelling component, on fathers’ obesity risk-related behaviours.

Methods

Cluster randomized-controlled trial in the setting of pre-existing first-time parents groups organised by Maternal and Child Health Nurses in Victoria, Australia. Participants were 460 first-time fathers mean age = 34.2 (s.d.4.90) years. Dietary pattern scores of fathers were derived using principal component analysis, total physical activity and total television viewing time were assessed at baseline (infant aged three to four months) and after 15 months.

Results

No significant beneficial intervention effect was observed on fathers’ dietary pattern scores, total physical activity or total television viewing time.

Conclusion

Despite a strong focus on parent modelling (targeting parents own diet, physical activity and television viewing behaviours), and beneficial impact on mothers’ obesity risk behaviours, this intervention, with mothers as the point of contact, had no effect on fathers’ obesity risk-related behaviours. Based on the established links between children’s obesity risk-related behaviors and that of their fathers, a need exists for research testing the effectiveness of interventions with a stronger engagement of fathers.

Association between maternal education and diet of children at 9 months is partially explained by mothers' diet

Infants of mothers of low educational background display consistently poorer outcomes, including suboptimal weaning diets. Less is known about the different causal pathways that relate maternal education to infants' diet. The present study aimed to test the hypothesis that the relationship between maternal education and infants' diet is mediated by mothers' diet. The analyses included 421 mother-infant pairs from the Melbourne Infant Feeding Activity and Nutrition Trial (InFANT) Program. Dietary intakes were collected from mothers when infants were aged 3 months, using a validated food frequency questionnaire relating to the past year, and in infants aged 9 months using 3 × 24-h recalls. Principal component analysis was used to derive dietary pattern scores, based on frequencies of 55 food groups in mothers, and intakes of 23 food groups in infants. Associations were assessed with multivariable linear regression. We tested the product 'ab' to address the mediation hypothesis, where 'a' refers to the relationship between the predictor variable (education) and the mediator variable (mothers' diet), and 'b' refers to the association between the mediator variable and the outcome variable (infants' diet), controlling for the predictor variable. Maternal scores on the 'Fruit and vegetables' dietary pattern partially mediated the relationships between maternal education and two infant dietary patterns, namely 'Balanced weaning diet' [ab = 0.11; 95% confidence interval (CI): 0.04; 0.18] and 'Formula' (ab = -0.08; 95%CI: -0.15; -0.02). These findings suggest that targeting pregnant mothers of low education level with the aim of improving their own diet may also promote better weaning diets in their infants.

Cohort Profile: the Avon Longitudinal Study of Parents and Children: ALSPAC mothers cohort

Summary The Avon Longitudinal Study of Children and Parents (ALSPAC) was established to understand how genetic and environmental characteristics influence health and development in parents and children. All pregnant women resident in a defined area in the South West of England, with an expected date of delivery between 1st April 1991 and 31st December 1992, were eligible and 13761 women (contributing 13867 pregnancies) were recruited. These women have been followed over the last 19-22 years and have completed up to 20 questionnaires, have had detailed data abstracted from their medical records and have information on any cancer diagnoses and deaths through record linkage. A follow-up assessment was completed 17-18 years postnatal at which anthropometry, blood pressure, fat, lean and bone mass and carotid intima media thickness were assessed, and a fasting blood sample taken. The second follow-up clinic, which additionally measures cognitive function, physical capability, physical activity (with accelerometer) and wrist bone architecture, is underway and two further assessments with similar measurements will take place over the next 5 years. There is a detailed biobank that includes DNA, with genome-wide data available on >10000, stored serum and plasma taken repeatedly since pregnancy and other samples; a wide range of data on completed biospecimen assays are available. Details of how to access these data are provided in this cohort profile.

The associations between feeding difficulties and behaviours and dietary patterns at 2 years of age: the ALSPAC cohort

Little is known about the dietary patterns of toddlers. This period of life is important for forming good dietary habits later in life. Using dietary data collected via food frequency questionnaire (FFQ) at 2 years of age, we examined the dietary patterns of children from the Avon Longitudinal Study of Parents and Children (ALSPAC). Principal component analysis was performed for 9599 children and three patterns were extracted: 'family foods' associated with traditional British family foods such as meat, fish, puddings, potatoes and vegetables; 'sweet and easy' associated with foods high in sugar (sweets, chocolate, fizzy drinks, flavoured milks) and foods requiring little preparation (crisps, potatoes, baked beans, peas, soup); 'health conscious' associated with fruit, vegetables, eggs, nuts and juices. We found clear associations between dietary pattern scores and socio-demographic variables, with maternal education being the most important. Higher levels of education were associated with higher scores on both the 'family foods' and the 'health conscious' patterns, and decreased scores on the 'sweet and easy' pattern. Relationships were evident between dietary pattern scores and various feeding difficulties and behaviours. Notably, children who were introduced late to lumpy (chewy) solids (after 9 months) scored lower on both the 'family foods' and the 'health conscious' patterns. Further analyses are required to determine the temporal relationship between perceived feeding difficulties and behaviours, and it will be important to assess the contribution of the age of introduction to lumpy solids to these relationships.

Parents' dietary patterns are significantly correlated: findings from the Melbourne Infant Feeding Activity and Nutrition Trial Program

The objectives of the present study were to identify dietary patterns independently in first-time mothers and fathers, and to examine whether these patterns were correlated within families. Dietary intakes were collected at baseline in the Melbourne Infant Feeding Activity and Nutrition Trial Program using a validated FFQ in 454 pairs of first-time mothers and fathers. Education level was reported in associated questionnaires. Principal components analyses included frequencies of fifty-five food groups and were performed independently in mothers and fathers. Spearman's correlation coefficients were used to assess associations between dietary pattern scores. A total of four dietary patterns were identified in mothers and fathers. Of these, three dietary patterns had similar characteristics between these two populations, namely ‘Fruits and vegetables’, ‘High-energy snack and processed foods’, ‘High-fat foods’ in mothers; and ‘Fruits’, ‘High-energy snack and processed foods’, ‘High-fat foods’ in fathers. The following two additional patterns were identified: ‘Cereals and sweet foods’ in mothers and ‘Potatoes and vegetables’ in fathers. Patterns incorporating healthier food items were found to be positively associated with parent education. An inverse association with education was found for the ‘High-fat foods’ and ‘High-energy snack and processed foods’ dietary patterns. Qualitatively similar patterns between corresponding mothers and fathers were the most strongly correlated (ρ = 0·34–0·45, P < 0·001). There were some differences in dietary patterns between mothers and fathers, suggesting that it is worth deriving patterns separately when considering couples, and more generally between men and women. Exploring how these various patterns correlate within households provides important insights to guide the development and implementation of family-based interventions.

Does diet cost mediate the relation between socioeconomic position and diet quality?

BACKGROUND/OBJECTIVES

Socioeconomic disparities in diet quality are well established. This study tested the hypothesis that such disparities are mediated, in part, by diet cost.

SUBJECTS/METHODS

The Seattle Obesity Study (S.O.S) was a cross-sectional study based on a representative sample of 1266 adults of King County, WA, conducted in 2008-09. Demographic and socioeconomic variables were obtained through telephone survey. Income and education were used as indicators of socioeconomic position. Dietary intake data were obtained using a food frequency questionnaire (FFQ). Diet cost was calculated based on retail prices for FFQ component foods. Energy density (KJ/g) and mean adequacy ratio (MAR) were used as two indices of overall diet quality.

RESULTS

Higher income and education were each associated with lower energy density and higher MAR scores, adjusting for covariates. Higher income and education were also associated with higher energy adjusted diet cost. Higher quality diets were in turn associated with higher diet costs. All these associations were significant (P<0.0001). In formal mediation analyses, diet cost significantly mediated the pathway between income and diet quality measures, adjusting for covariates (P<0.05 each). Further, income-diet cost-diet quality pathway was found to be moderated by education level.

CONCLUSIONS

The social gradient in diet quality may be explained by diet cost. Strategies to improve diet quality among lower socioeconomic strata may need to take food prices and diet cost along with nutrition education into account.