Sources of vegetables, fruits and vitamins A, C and E among five ethnic groups: results from a multiethnic cohort study

A Review of Foods of Plant Origin as Sources of Vitamins with Proven Activity in Oxidative Stress Prevention according to EFSA Scientific Evidence

Beyond their nutritional benefits, vitamins could decrease the risk of chronic diseases due to their potent antioxidant capacity. The present work is aimed at reviewing the state of the art regarding (1) the vitamins involved in oxidative stress prevention in accordance with the requirements established by the European Food Safety Authority (EFSA) and (2) the foods of plant origin that are sources of those vitamins and have potential benefits against oxidative stress in humans. According to the European regulations based on EFSA scientific evidence, riboflavin, vitamin C, and vitamin E are those vitamins subjected to the approved health claim "contribute to the protection of cells from oxidative stress". Scientific studies conducted in humans with some natural food sources of riboflavin (almonds, wheat germ, mushrooms, oat bran), vitamin C (guava, kale, black currant, Brussels sprouts, broccoli, orange), and vitamin E (hazelnuts, almonds, peanuts, pistachio nuts, extra virgin olive oil, dates, rye) have been performed and published in the literature. However, no food of plant origin has obtained a favorable EFSA opinion to substantiate the approval of health claims related to its potential properties related to oxidative stress prevention. Further studies (concretely, well-controlled human intervention studies) must be carried out in accordance with EFSA requirements to provide the highest level of scientific evidence that could demonstrate the potential relationship between foods of plant origin and antioxidant capacity. This review could be useful for the scientific community to study the application of health claims referring to the antioxidant capacity potentially exerted by foods of plant origin.

An Examination of Culturally Relevant Health Messages in African-American Churches

This quantitative study examined the presence of culturally relevant health messages for African-Americans based on a preexisting dataset from 21 African-American churches in South Carolina (USA). Content analysis served as the primary methodological approach to code printed media messages based on their cultural relevance among African-Americans (Cohen's kappa = .74). Within the dataset (n = 2166), 477 (22%) items were identified as culturally relevant. A low prevalence of culturally relevant messages was found across the three message topics, two media types, and one media source. Due to the limited presence of culturally relevant messages, researchers should collaborate with African-American churches to design health promotion messages.

Associations Between Dietary Vitamin C, Serum Ascorbic Acid, and GSTT1 Genotype and Premenstrual Symptoms

OBJECTIVE

Premenstrual symptoms are a cyclically occurring combination of adverse psychological and somatic symptoms that impact the quality of life for most females of childbearing age. Growing evidence suggests that diet may attenuate premenstrual symptoms; however, the relationship between vitamin C and premenstrual symptoms remains unclear. The aim of the research was to determine the association between different measures of vitamin C status and premenstrual symptoms.

METHOD

Females (n = 555) aged 20 to 29 years from the Toronto Nutrigenomics and Health Study completed a General Health and Lifestyle Questionnaire, capturing 15 premenstrual symptoms. Dietary intake was measured using a 196-item Toronto-modified Harvard food frequency questionnaire. Serum ascorbic acid concentrations were measured, and participants were categorized into deficient (<11 µmol/L), suboptimal (11-28 µmol/L), and adequate (>28 µmol/L) ascorbic acid levels. DNA was genotyped for the GSTT1 (Ins/Del) polymorphism. Using logistic regression, odds of experiencing premenstrual symptoms were compared between vitamin C intake levels above and below the recommended daily allowance (75 mg/d) between ascorbic acid levels and between GSTT1 genotypes.

RESULTS

Increased vitamin C intake was associated with premenstrual appetite changes (OR, 1.65; 95% CI, 1.01-2.68). Compared to deficient ascorbic acid levels, suboptimal levels were associated with premenstrual appetite changes (OR, 2.59; 95% CI, 1.02-6.58) and bloating/swelling (OR, 3.00; 95% CI, 1.09-8.22). Adequate serum ascorbic acid levels were not associated with premenstrual appetite changes (OR, 1.69; 95% CI, 0.73-3.94) or bloating/swelling (OR, 1.92; 95% CI, 0.79-4.67). Those with the GSTT1 functional variant (Ins*Ins) had an increased risk of premenstrual bloating/swelling (OR, 1.96; 95% CI, 1.10-3.48); however, the interaction between vitamin C intake and GSTT1 was not significant for any premenstrual symptoms.

CONCLUSIONS

Our findings suggest that indicators of higher vitamin C status are associated with increased premenstrual appetite changes and bloating/swelling. The observed associations with GSTT1 genotype suggest that these observations are not likely due to reverse causation.

Clinical interventions to increase vegetable intake in children

PURPOSE OF REVIEW

Eating behaviors and dietary patterns begin in early childhood and persist into adolescence and adulthood, affecting lifelong acute and chronic disease risk. Vegetables provide a high density of necessary vitamins, minerals, and fiber. Dietary intake data show that children of all ages consume below the recommended range for vegetables. Pediatric providers are optimally positioned to promote vegetable intake in childhood. This review seeks to summarize lessons learned from behavioral interventions useful in the pediatric primary care setting to improve vegetable intake.

RECENT FINDINGS

Ten published studies tested behavioral interventions in primary care to increase child vegetable intake. Strategies tested include teaching healthy eating behaviors and role modeling to parents of infants, and motivational interviewing paired with frequent office visits and reminders for families of older children and adolescents. Some strategies suggested positive change, despite study quality being limited by underpowered samples, heterogeneity of outcome measures, and statistical analytic approach.

SUMMARY

Increased vegetable intake was achieved in infants through parental role-modeling when providers emphasized healthy dietary choices in parents. Older children increased their vegetable intake with motivational interviewing and frequent reminders from providers. Despite the high prevalence of inadequate vegetable intake among children, at present, there is only a modest body of literature to help guide pediatric providers in implementing practice-based interventions to improve vegetable intake in childhood, highlighting a need for high-quality research in this area.

Sociocultural influences on dietary behavior and meal timing among Native Hawaiian and Pacific Islander women at risk of endometrial cancer: a qualitative investigation

PURPOSE

Determine sociocultural influences on dietary behavior, body image, weight loss, and perceptions of the cultural appropriateness of a meal-timing intervention design and menu among Native Hawaiian and Pacific Islander (NHPI) women at risk of endometrial cancer.

METHODS

Six 90-min videoconference focus groups among NHPI women (n = 35) recruited by a community champion in Utah. Eligible women were aged ≥ 18 years at risk of endometrial cancer (i.e., BMI ≥ 25 kg/m², history of non-insulin-dependent diabetes or complex atypical endometrial hyperplasia) had a working cell phone capable of downloading a phone app, could use their cell phone during the day, and were not night-shift workers. Twelve semi-structured questions were posed during the focus groups. Using inductive qualitative methods based on Hatch's 9-step approach, de-identified transcript data were analyzed.

RESULTS

Overarching themes included economic factors, cultural influences, meal choice and timing, and perceptions of health. Subthemes included affordability, waste avoidance, inundated schedules, and cultural influences. Perceptions of body size and weight loss were influenced by family, community, and social media, whose messages could be conflicting. Important intervention components included satisfying, convenient pre-made meals, while barriers included the need to cook for family members.

CONCLUSIONS

Dietary interventions targeting metabolic health among NHPI women should consider the multitude of sociocultural and economic factors that influence food choices and meal timing in this population, including affordability, hectic schedules, and immigrant adjustment. Promoting the link between physical and mental well-being as opposed to weight loss is a key approach to reaching this population.

Association Between Dietary Intakes and Plaque Vulnerability Measured by Optical Coherence Tomography in Patients With Coronary Heart Disease: A Mediation Analysis of Inflammatory Factors

Although studies have proven that diet has a critical role in preventing or delaying atherosclerosis and is far simpler to adjust and adhere to than other risk factors, the underlying mechanisms behind this effect remain not well comprehended. The purpose of this investigation was to determine the impact of inflammatory factors on the connection between dietary ingestion and coronary plaque fragility as measured via optical coherence tomography (OCT) in patients with coronary heart disease (CHD). This research eventually comprised 194 participants with CHD who met the inclusion and exclusion criteria. Semi-quantitative food frequency questionnaire (SQFFQ) was utilized to investigate dietary consumption status, serum levels of inflammatory biomarkers were analyzed using enzyme-linked immunosorbent assay, and OCT was employed to identify the plaque susceptibility of causative lesions in the body. Following correction for statistically meaningful possible confounders in univariate analysis, quartiles of soy and nuts, fruits and vitamin C were negatively associated with coronary plaque vulnerability. Conversely, the upper quartile group of sodium intake had 2.98 times the risk of developing vulnerable plaques compared with the most minimal quartile group. Meanwhile, we observed an inverse dose–response connection between vitamin C consumption and inflammatory biomarkers as well as plaque vulnerability. More importantly, tumor necrosis factor- α (TNF-α) and interleukin-6 (IL-6) were significant mediators of the connection between vitamin C and plaque vulnerability, suggesting that vitamin C may inhibit the atherosclerotic inflammatory process by decreasing the expression of IL-6 and TNF-α, thereby reducing the risk of vulnerable plaques. These new findings provide crucial clues to identify anti-inflammatory dietary components as effective therapeutic approaches in the management of CHD, while also providing some insights into their mechanisms of action.

A Comparison of Dietary Patterns and Factors Influencing Food Choice among Ethnic Groups Living in One Locality: A Systematic Review

Globally, the number of minority ethnic groups in high-income countries is increasing. However, despite this demographic change, most national food consumption surveys are not representative of ethnically diverse populations. In consequence, many ethnic minorities' dietary intakes are underreported, meaning that accurate analysis of food intake and nutrient status among these groups is not possible. This systematic review aims to address these gaps and understand differences in dietary intakes and influencers of dietary habits of ethnic groups worldwide. A systematic search was conducted through three databases (Pubmed, Web of Science and Scopus) and manual searches, generating n = 56,647 results. A final search of these databases was completed on 13 September 2021, resulting in a total of 49 studies being included in this review. Overall, food group intakes-particularly fruit, vegetable and fish intake-and diet quality scores were seen to differ between ethnicities. Overall Black/African American groups were reported to be among the poorest consumers of fruit and vegetables, whilst Asian groups achieved high diet quality scores due to higher fish intakes and lower fat intakes compared to other groups. Limited data investigated how nutrient intakes, dietary and meal patterns compared between groups, meaning that not all aspects of dietary intake could be compared. Socioeconomic status and food availability appeared to be associated with food choice of ethnic groups, however, confounding factors should be considered more closely. Future work should focus on comparing nutrient intakes and meal patterns between ethnicities and investigate potential targeted interventions which may support adherence to food-based dietary guidelines by all ethnic groups.

Plasma Carotenoids and Premenstrual Symptoms in a Multi-Ethnic Population of Young Women

Premenstrual symptoms are experienced by most women of reproductive age, but effective therapies are limited. Carotenoids may have an attenuating effect on premenstrual symptoms; however, studies to date are equivocal. The objective of the present study was to examine the association between plasma concentrations of seven carotenoids and premenstrual symptom severity in 553 women from the Toronto Nutrigenomics and Health study. Participants provided information on fifteen common premenstrual symptoms and severities. Each participant completed a General Health and Lifestyle Questionnaire and provided a fasting blood sample from which plasma carotenoid concentrations were measured. Multinomial logistic regressions were used to determine associations between plasma carotenoid concentrations and premenstrual symptom severity. Beta-cryptoxanthin was associated with moderate/severe increased appetite for women in the highest compared to the lowest tertile (OR: 2.33; 95% CI: 1.39, 3.89). This association remained significant after adjusting for multiple comparisons. There were no observed associations between other plasma carotenoids and any premenstrual symptoms. In summary, higher concentrations of beta-cryptoxanthin were associated with an increased appetite as a premenstrual symptom, but no associations were observed for any other carotenoid and for any other symptom.

Effectiveness of Expanded Food and Nutrition Education Program in Changing Nutrition-Related Outcomes Among Adults With Low Income: A Systematic Review

OBJECTIVE

To review the effect of the Expanded Food and Nutrition Education Program (EFNEP) in changing nutrition-related outcomes.

METHODS

Relevant research conducted before December 2020 was identified using PubMed, Web of Science, Google Scholar, and the EFNEP Research Database. The methodological quality of each eligible study was assessed.

RESULTS

Of the 406 studies found, 30 were eligible; 26 studies were on EFNEP, and 4 included both EFNEP and Supplemental Nutrition Assistance Program Nutrition Education (SNAP-Ed). The sample sizes ranged from 35 to 122,961. Outcome measures included consumption of food groups, nutrients, other nutrition-related behaviors, and food security. At least 1 immediate behavior change (P < 0.05) was reported in each study, but long-term maintenance of behavior change was not evident.

DISCUSSION

This review found a consistent, immediate improvement in nutrition behaviors after program participation but poor retention over time. Overall, variation in programming and outcome measures, incomplete reporting, and generally low study quality by modern standards precluded strong conclusions.

IMPLICATIONS FOR RESEARCH AND PRACTICE

This review identified the need for control groups, improved reporting of program protocols, theory-based curriculum, and measurement of long-term outcomes.

Contamination of fresh produce sold on the Italian market with Cyclospora cayetanensis and Echinococcus multilocularis

To investigate the presence of Cyclospora cayetanensis, Toxoplasma gondii and Echinococcus spp. in fresh produce sold in Italy, 324 locally produced 'ready-to-eat' (RTE) mixed-salad packages belonging to three brands and 324 berries packages (blueberries and blackberries imported from Peru and Mexico, respectively, and raspberries grown in Italy) were purchased at retail. Nine individual packages from each of the six types of fresh produce were collected monthly for one year, and with the same produce pooled, this resulted in a total of 72 pools for the whole year. Using microscopy (FLOTAC), a Cyclospora-like oocyst was detected in a blueberry sample and a taeniid egg was detected in a RTE-salad sample. Molecular tools confirmed these to be C. cayetanensis and Echinococcus multilocularis, respectively. Toxoplasma gondii was not detected in any of the samples. This study shows for the first time in Europe that imported berries on the Italian market may be contaminated with C. cayetanensis and RTE salads grown in Italy with E. multilocularis. The results indicate a new epidemiological scenario and highlight that current management of fresh produce, locally produced or imported, does not ensure products are free from parasite contamination.

Global Vegetable Intake and Supply Compared to Recommendations: A Systematic Review

Low vegetable intake is associated with higher incidence of noncommunicable diseases. Data on global vegetable intake excluding legumes and potatoes is currently lacking. A systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted to assess vegetable consumption and supply in adult populations and to compare these data to the existing recommendations (≥240 g/day according to World Health Organization). For vegetable intake data online, websites of government institutions and health authorities, European Food Safety Authority (EFSA) Comprehensive European Food Consumption Database, STEPwise approach to surveillance (STEPS) and Pubmed/Medline databases were searched from March 2018 to June 2019. Vegetable supply data was extracted from Food Balance Sheets, Food and Agriculture Organization Corporate Statistical Database (FAOSTAT), 2013. Vegetable intake was expressed as means and 95% confidence intervals. Data were summarized for each region by calculating weighted means. Vegetable intake and supply data were available for 162 and 136 countries, respectively. Weighted mean vegetable intake was 186 g/day (56-349 g/day). Weighted mean vegetable supply was 431 g/day (71-882 g/day). For 88% of the countries vegetable intake was below the recommendations. Public health campaigns are required to encourage vegetable consumption worldwide. In the 61% of the countries where vegetable supply is currently insufficient to meet the recommendations, innovative food system approaches to improve yields and decrease post-harvest losses are imperative.

Is carrot consumption associated with a decreased risk of lung cancer? A meta-analysis of observational studies

Findings of epidemiological studies regarding the association between carrot consumption and lung cancer risk remain inconsistent. The present study aimed to summarise the current epidemiological evidence concerning carrot intake and lung cancer risk with a meta-analysis. We conducted a meta-analysis of case-control and prospective cohort studies, and searched PubMed and Embase databases from their inception to April 2018 without restriction by language. We also reviewed reference lists from included articles. Prospective cohort or case-control studies reporting OR or relative risk with the corresponding 95 % CI of the risk lung cancer for the highest compared with the lowest category of carrot intake. A total of eighteen eligible studies (seventeen case-control studies and one prospective cohort study) were included, involving 202 969 individuals and 5517 patients with lung cancer. The pooled OR of eighteen studies for lung cancer was 0·58 (95 % CI 0·45, 0·74) by comparing the highest category with the lowest category of carrot consumption. Based on subgroup analyses for the types of lung cancer, we pooled that squamous cell carcinoma (OR 0·52, 95 % CI 0·19, 1·45), small-cell carcinoma (OR 0·43, 95 % CI 0·12, 1·59), adenocarcinoma (OR 0·34, 95 % CI 0·15, 0·79), large-cell carcinoma (OR 0·40, 95 % CI 0·10, 1·57), squamous and small-cell carcinoma (OR 0·85, 95 % CI 0·45, 1·62), adenocarcinoma and large-cell carcinoma (OR 0·20, 95 % CI 0·02, 1·70) and mixed types (OR 0·61, 95 % CI 0·46, 0·81). Exclusion of any single study did not materially alter the pooled OR. Integrated epidemiological evidence from observational studies supported the hypothesis that carrot consumption may decrease the risk of lung cancer, especially for adenocarcinoma.

Serum carotenoid concentrations and their association with ethnic differences in type 2 diabetes within the Healthy Life in an Urban Setting (HELIUS) study

OBJECTIVE

Studies have reported an inverse association between a diet rich in fruits and vegetables and type 2 diabetes (T2D), but data on high-risk ethnic minority groups is limited. We investigated whether serum carotenoids, as biomarkers for fruit and vegetable intake, mediate ethnic differences in the prevalence of T2D.

DESIGN

Age-adjusted serum carotenoid concentrations were compared using ANCOVA. A cross-sectional analysis was performed using Cox regression to estimate prevalence ratios (PR) and their 95 % CI of the association between serum carotenoid concentrations and T2D. To study whether serum carotenoids potentially mediate the differences in the prevalence of T2D across ethnic groups, we compared PR of the model including known risk factors and the model additionally adjusted for serum carotenoid concentrations using the Dutch group as reference.

SETTING

A study among six ethnic groups living in Amsterdam, the Netherlands.

PARTICIPANTS

Data on 204 Dutch, 203 South Asian Surinamese, 204 African Surinamese, 203 Turkish and 200 Moroccan-origin participants from the Healthy Life in an Urban Setting (HELIUS) study were used.

RESULTS

Serum carotenoid concentrations differed across ethnic groups. After adjusting for confounders, the serum concentrations of total carotenoids (PR 0·67, 95 % CI 0·54, 0·84), α-carotene (PR 0·57, 95 % CI 0·42, 0·77), β-carotene (PR 0·45, 95 % CI 0·32, 0·63) and β-cryptoxanthin (PR 0·73, 95 % CI 0·58, 0·92) were inversely associated with T2D. Despite the associations, serum carotenoids did not mediate the ethnic differences in the prevalence of T2D.

CONCLUSIONS

The limited contribution of serum carotenoids to ethnic differences in T2D suggests that a focus on increasing fruit and vegetable intake alone will not likely eliminate ethnic differences in T2D prevalence.

Relationship Between Health Behaviors and Obesity in a Sample of Hawai'i's 4 Most Populous Ethnicities

Proactive health behavior change and maintenance are essential for preventing obesity and other lifestyle diseases. Few studies have examined the relationship between eating behavior and physical condition among multiethnic samples. In this study, ethnic differences were examined to obtain basic data on health education for improvement of obesity in Hawai'i. The intake of fruits and vegetables and exercise habits in each of the transtheoretical model stages of change were evaluated in the 4 most populous ethnic groups in Hawai'i in terms of how the participants' health behaviors were associated with obesity. The participants comprised 2795 white, Native Hawaiian, Filipino, and Japanese adults (age range, 18-55 years). There are 4 main findings of this study. First, there were differences in fruit and vegetable intake and exercise habits in each transtheoretical model stage among the ethnic groups. Second, there were differences in attitudes regarding nutrition and healthy food intake and self-efficacy regarding exercise in each ethnic group. Third, items that have the potential to improve obesity in the theory of planned behavior differed, particularly among men, in the 4 ethnic groups. Finally, a low percentage of participants recognized that the recommended number of servings of fruits and vegetables was 5 or more. Education for men may be particularly important. The findings indicate that modified health education approaches may be needed in accordance with the ethnicity of the population.

An Additional Asset for the FLOTAC Technique: Detection of Gastrointestinal Parasites in Vegetables

INTRODUCTION

Gastrointestinal parasites are considered amongst the most important threats to veterinary and human health worldwide. The transmission of these parasitic diseases usually involves the accidental ingestion of oocysts, cysts, eggs, and larvae, whose detection is generally achieved by classical coproparasitological methods, based on sedimentation and/or flotation techniques. These procedures might be inefficient or display a low sensitivity when performed on food matrices. This study aimed to assess the value of the FLOTAC technique for the detection of different parasitic stages of gastrointestinal parasites of domestic animals in fresh lettuce.

MATERIAL AND METHODS

Samples (n = 100) were purchased from public markets located in the metropolitan region of Recife (Brazil).

RESULTS

A total of 79% scored positive for eggs and/or cysts of gastrointestinal parasites. Protozoa and nematodes were detected in 32% (32/100) and 64% (64/100) of samples, respectively, with cysts of the genus Entamoeba (32%) and eggs of nematodes of the order Strongylida (30%) being the most frequently diagnosed.

CONCLUSIONS

The findings herein reported demonstrate that the FLOTAC technique can be successfully applied for recovering food-borne parasites of medical and veterinary concern in food matrices.

Quantity, Quality, and Timing of Carbohydrate Intake and Blood Pressure

PURPOSE OF REVIEW

This review discusses recent evidence on the association of dietary carbohydrates (quantity, quality, and timing of intake) with hypertension (HTN) risk and out-of-clinic blood pressure (BP) measures.

RECENT FINDINGS

Studies on carbohydrate quantity are inconclusive, but low carbohydrate diets may be associated with lower BP. Plant-based carbohydrate-containing foods such as fruits, vegetables, and whole grains may lower HTN risk and 24-h BP. Excessive sugar intakes from sugar-sweetened beverages are associated with higher BP levels and HTN risk, with evidence of a dose-response relationship. Preliminary data suggest that timing of carbohydrate intake may influence HTN risk and 24-h BP. The role of carbohydrate nutrition in HTN's etiology warrants further investigation. Additional studies are needed to investigate the influence of dietary carbohydrates on HTN risk and the circadian pattern of BP, evaluate potential sex and racial/ethnic differences in these associations, and elucidate underlying mechanisms.

Dietary Intake of Anti-Oxidant Vitamins A, C, and E Is Inversely Associated with Adverse Cardiovascular Outcomes in Chinese-A 22-Years Population-Based Prospective Study

Background: Conflicting and population-dependent findings have been reported from epidemiological studies on the associations of dietary intake of anti-oxidant vitamins with cardiovascular events. We investigated the prospective relationship between dietary intake of anti-oxidant vitamins and incident adverse cardiovascular outcomes amongst Hong Kong Chinese. Methods: In this prospective population-based study, baseline dietary intake of anti-oxidant vitamins (A, C, and E) were assessed using a food frequency questionnaire in 875 Chinese participants from the Hong Kong Cardiovascular Risk Factor Prevalence Study (CRISPS) in 1995–1996. The adjusted hazard ratio (HR) of incident adverse cardiovascular outcomes, defined as the first recorded diagnosis of cardiovascular deaths, non-fatal myocardial infarction or non-fatal stroke, and coronary or other arterial revascularizations, was calculated per unit intake of each vitamin using multivariable Cox regression. Results: Over a median follow-up of 22 years, 85 participants (9.7%) developed adverse cardiovascular outcomes. Dietary intakes of vitamin A, C, and E were independently and inversely associated with incident adverse cardiovascular outcomes (HR 0.68, 95%CI 0.53–0.88, p = 0.003 for vitamin A; HR 0.66, 95%CI 0.52–0.85, p = 0.001 for vitamin C; and HR 0.57, 95%CI 0.38–0.86, p = 0.017 for vitamin E) after adjustments for conventional cardiovascular risk factors at baseline. Conclusions: Dietary intakes of anti-oxidant vitamins A, C, and E reduced the risk of adverse cardiovascular outcomes in Hong Kong Chinese.

Food Sources and Potential Determinants of Dietary Vitamin C Intake in Chinese Adults: A Cross-Sectional Study

Vitamin C is essential for human health. It is important to estimate the dietary vitamin C intake in the Chinese population to examine the effects of the nutritional transition occurred in recent decades. The present study aimed to estimate the dietary vitamin C intake in Chinese adults by using cross-sectional data from the 2015 China Nutritional Transition Cohort Study and selecting those aged 18–65 years with complete records of sociodemographic characteristics and dietary measurements (n = 11,357). Wilcoxon rank-sum test, Kruskal-Wallis analysis, Chi-squared test, and multiple logistic regression were employed to analyze the daily dietary vitamin C intake on the basis of three-day 24 h dietary recalls and food sources in relation to demographic factors, to evaluate vitamin C intake status using the estimated average requirement cut-off point, and to explore underlying influencing factors. The mean (SD (standard deviation)) and median (interquartile range) levels of the dietary vitamin C intake in adults were 78.1 (54.6) and 65.4 (61.4) mg/day, respectively. Light vegetables, dark vegetables, fruits, and tubers were the top four food sources, contributing a combined 97.3% of total daily dietary vitamin C intake in the study population. The prevalence of risk of insufficient dietary vitamin C intake was 65.1%. Both the distribution of vitamin C intake and the prevalence of risk of insufficient dietary vitamin C intake differed by several demographic factors. Educational level, residence area, geographic location, vegetable consumption, and total energy intake were independent determinants of the risk of insufficient dietary vitamin C intake. In conclusion, dietary vitamin C intake is inadequate in Chinese adult population, and an increase in vitamin C intake should be recommended especially to the population at risk for vitamin C insufficiency.

Consumption of a High Quantity and a Wide Variety of Vegetables Are Predicted by Different Food Choice Motives in Older Adults from France, Italy and the UK

BACKGROUND

Consumption of a high quantity and wide variety of vegetables is currently recommended for health. Dietary variety can be low, however, particularly for older adults. This study investigated the affective factors associated with the quantity and variety of vegetables consumed by older adults in France, Italy and the UK.

METHODS

Adults aged 65 years plus completed questionnaires on self-reported vegetable intake (quantity and variety), liking for vegetables, attitudes towards intake, and demographic variables.

RESULTS

In 497 older adults (France, n = 187, Italy, n = 152, UK, n = 158), higher quantities of vegetables consumed were associated with a higher age, affluence score and liking for vegetables, and a lower importance in consumption of familiarity (smallest β = 0.11, p = 0.03). Greater variety was associated with a higher liking and importance of health benefits, and a lower importance of familiarity (smallest β = -0.11, p < 0.01). Higher quantity and variety combined (quantity × variety) was associated with a higher age, liking and importance of health benefits, and a lower importance of familiarity (smallest β = 0.14, p = 0.02). Country-specific effects were also found (smallest β = 0.20, p < 0.01).

CONCLUSIONS

These findings demonstrate a role for liking and a lower concern for eating familiar foods in vegetable consumption, and a particular role for concern for health benefits in the consumption of a greater variety of vegetables.

A priori-defined diet quality indices, biomarkers and risk for type 2 diabetes in five ethnic groups: the Multiethnic Cohort

Dietary indices have been related to risk for type 2 diabetes (T2D) predominantly in white populations. The present study evaluated this association in the ethnically diverse Multiethnic Cohort and examined four diet quality indices in relation to T2D risk, homoeostatic model assessment-estimated insulin resistance (HOMA-IR) and biomarkers of dyslipidaemia, inflammation and adipokines. The T2D analysis included 166 550 white, African American, Native Hawaiian, Japanese American and Latino participants (9200 incident T2D cases). Dietary intake was assessed at baseline using a quantitative FFQ and T2D status was based on three self-reports and confirmed by administrative data. Biomarkers were assessed about 10 years later in a biomarker subcohort (n 10 060). Sex- and ethnicity-specific hazard ratios were calculated for the Healthy Eating Index-2010 (HEI-2010), the alternative HEI-2010 (AHEI-2010), the alternate Mediterranean diet score (aMED) and the Dietary Approaches to Stop Hypertension (DASH). Multivariable-adjusted means of biomarkers were compared across dietary index tertiles in the biomarker subcohort. The AHEI-2010, aMED (in men only) and DASH scores were related to a 10-20 % lower T2D risk, with the strongest associations in whites and the direction of the relationships mostly consistent across ethnic groups. Higher scores on the four indices were related to lower HOMA-IR, TAG and C-reactive protein concentrations, not related to leptin, and the DASH score was directly associated with adiponectin. The AHEI-2010 and DASH were directly related to HDL-cholesterol in women. Potential underlying biological mechanisms linking diet quality and T2D risk are an improved lipid profile and reduced systemic inflammation and, with regards to DASH alone, an improved adiponectin profile.

Genetics of serum carotenoid concentrations and their correlation with obesity-related traits in Mexican American children

Background: Dietary intake of phytonutrients present in fruits and vegetables, such as carotenoids, is associated with a lower risk of obesity and related traits, but the impact of genetic variation on these associations is poorly understood, especially in children.Objective: We estimated common genetic influences on serum carotenoid concentrations and obesity-related traits in Mexican American (MA) children.Design: Obesity-related data were obtained from 670 nondiabetic MA children, aged 6-17 y. Serum α- and β-carotenoid concentrations were measured in ∼570 (α-carotene in 565 and β-carotene in 572) of these children with the use of an ultraperformance liquid chromatography-photodiode array. We determined heritabilities for both carotenoids and examined their genetic relation with 10 obesity-related traits [body mass index (BMI), waist circumference (WC), high-density lipoprotein (HDL) cholesterol, triglycerides, fat mass (FM), systolic and diastolic blood pressure, fasting insulin and glucose, and homeostasis model assessment of insulin resistance] by using family data and a variance components approach. For these analyses, carotenoid values were inverse normalized, and all traits were adjusted for significant covariate effects of age and sex.Results: Carotenoid concentrations were highly heritable and significant [α-carotene: heritability (h²) = 0.81, P = 6.7 × 10^-11; β-carotene: h² = 0.90, P = 3.5 × 10^-15]. After adjusting for multiple comparisons, we found significant (P ≤ 0.05) negative phenotypic correlations between carotenoid concentrations and the following traits: BMI, WC, FM, and triglycerides (range: α-carotene = -0.19 to -0.12; β-carotene = -0.24 to -0.13) and positive correlations with HDL cholesterol (α-carotene = 0.17; β-carotene = 0.24). However, when the phenotypic correlations were partitioned into genetic and environmental correlations, we found marginally significant (P = 0.051) genetic correlations only between β-carotene and BMI (-0.27), WC (-0.30), and HDL cholesterol (0.31) after accounting for multiple comparisons. None of the environmental correlations were significant.Conclusions: The findings from this study suggest that the serum carotenoid concentrations were under strong additive genetic influences based on variance components analyses, and that the common genetic factors may influence β-carotene and obesity and lipid traits in MA children.

Nutrition and Diet as It Relates to Health and Well-Being of Native Hawaiian Kūpuna (Elders): A Systematic Literature Review

PURPOSE

The key to improving the health and well-being of Native Hawaiians is to understand the historical events that have caused change to their diet and nutrition, and identify the connection between food, life, and the land. The purpose of this article is to (a) present a review of the literature addressing nutrition and diet as it relates to health and well-being of Native Hawaiian kūpuna (elders) and (b) identify limitations and gaps to promote future research.

DESIGN

This systematic literature review focused on 29 studies.

FINDINGS

Native Hawaiians have the highest body mass index levels, highest daily energy (kilocalorie) intake, and lowest multivitamin use. They have the highest prevalence of diabetes and hypertension compared with Whites. Traditional Hawaiian diet programs and family support were beneficial to improving health and well-being.

CONCLUSION

Future research of traditional Hawaiian diet programs and revitalization of the culture may lead to improving the health and well-being of Native Hawaiians.

Increasing vegetable intakes: rationale and systematic review of published interventions

Purpose

While the health benefits of a high fruit and vegetable consumption are well known and considerable work has attempted to improve intakes, increasing evidence also recognises a distinction between fruit and vegetables, both in their impacts on health and in consumption patterns. Increasing work suggests health benefits from a high consumption specifically of vegetables, yet intakes remain low, and barriers to increasing intakes are prevalent making intervention difficult. A systematic review was undertaken to identify from the published literature all studies reporting an intervention to increase intakes of vegetables as a distinct food group.

Methods

Databases—PubMed, PsychInfo and Medline—were searched over all years of records until April 2015 using pre-specified terms.

Results

Our searches identified 77 studies, detailing 140 interventions, of which 133 (81 %) interventions were conducted in children. Interventions aimed to use or change hedonic factors, such as taste, liking and familiarity (n = 72), use or change environmental factors (n = 39), use or change cognitive factors (n = 19), or a combination of strategies (n = 10). Increased vegetable acceptance, selection and/or consumption were reported to some degree in 116 (83 %) interventions, but the majority of effects seem small and inconsistent.

Conclusions

Greater percent success is currently found from environmental, educational and multi-component interventions, but publication bias is likely, and long-term effects and cost-effectiveness are rarely considered. A focus on long-term benefits and sustained behaviour change is required. Certain population groups are also noticeably absent from the current list of tried interventions.

Comparable Dietary Patterns Describe Dietary Behavior across Ethnic Groups in the Netherlands, but Different Elements in the Diet Are Associated with Glycated Hemoglobin and Fasting Glucose Concentrations

BACKGROUND

Ethnic minority populations in Western societies suffer from a disproportionate burden of type 2 diabetes (T2D). Insight into the role of dietary patterns in T2D may assist public health nutrition efforts in addressing these health disparities.

OBJECTIVE

We explored the association between dietary patterns and biomarkers of T2D in 5 ethnic groups living in Amsterdam, Netherlands.

METHODS

A total of 3776 men and women aged 18-70 y of Dutch, South Asian Surinamese, African-Surinamese, Turkish, and Moroccan origin from the HELIUS (HEalthy LIfe in an Urban Setting) study were included. Diet was assessed by using a food-frequency questionnaire, and dietary patterns were derived separately per ethnic group. First, food group-based dietary patterns were derived by using principal components analysis and the association with glycated hemoglobin (HbA1c) and plasma fasting glucose was assessed by using multivariable linear regression. Second, biomarker-driven dietary patterns based on HbA1c and fasting glucose concentrations were derived by applying reduced rank regression.

RESULTS

Two comparable food group-based dietary patterns were identified in each ethnic group: a "meat and snack" pattern and a "vegetable" pattern. The meat-and-snack pattern derived within the Dutch origin population was significantly associated with HbA1c (β = 0.09; 95% CI: 0.00, 0.19) and fasting glucose (β = 0.18; 95% CI: 0.09, 0.26) concentrations. A biomarker-derived pattern characterized by red and processed meat was observed among Dutch-origin participants; however, among ethnic minority groups, this pattern was characterized by other foods including ethnicity-specific foods (e.g., roti, couscous).

CONCLUSIONS

Although similar food group dietary patterns were derived within 5 ethnic groups, the association of the meat-and-snack pattern with fasting glucose concentrations differed by ethnicity. Taken together with the finding of ethnic differences in biomarker-driven dietary patterns, our results imply that addressing T2D risk in multiethnic populations requires ethnicity-specific approaches.