An evaluation of the sensitivity and specificity of energy expenditure measured by heart rate and the Goldberg cut-off for energy intake: basal metabolic rate for identifying mis-reporting of energy intake by adults and children: a retrospective analysis

The association between FTO genotype with macronutrients and calorie intake in overweight adults

Background

Dietary macronutrients may indirectly affect body weight through their interactions with the fat mass and obesity associated (FTO) gene. This study aimed to investigate the association between FTO gene rs9939609 polymorphism with macronutrients intake in overweight adults.

Methods

This study was carried out on 196 overweight adults of Shiraz, Iran. Dietary intake was assessed using a validated 168-item semi-quantitative food frequency questionnaire (FFQ). The FTO gene was genotyped for rs9939609 polymorphism. The association between dietary macronutrients and the FTO genotype were assessed using linear regression after adjustments for sex, age, physical activity, and the serum levels of triglycerides, fasting blood sugar (FBS), and low density lipoprotein (LDL).

Results

The higher intake of carbohydrates (P < 0.001), fat (P = 0.009), and calorie (P = 0.001) were significantly associated with rs9939609 AA genotype (P = 0.001). Carriers of the AA genotype of rs9939609 had significantly higher calorie, fat, and carbohydrate intake than the carriers of the TT genotype after adjusting for age and sex (P = 0.019, P = 0.010 and P = 0.001, respectively). Further adjustments for physical activity, TG, LDL, and FBS did not change these results.

Conclusion

The amounts of dietary calorie, carbohydrate, and fat intake were associated with FTO genotype. Further studies are warranted to confirm these associations and to identify the underlying mechanisms.

Total energy expenditure and body composition of children with developmental disabilities

BACKGROUND

Obesity prevalence is increased in children with developmental disabilities, specifically in children with spina bifida and Down syndrome. Energy expenditure, a critical aspect of weight management, has been extensively studied in the typically developing population, but not adequately studied in children with developmental disabilities.

OBJECTIVE

Determine energy expenditure, fat-free mass and body fat percentile and the impact of these findings on recommended caloric intake in children with spina bifida and Down syndrome.

METHODS/MEASURES

This pilot study included 36 children, 18 with spina bifida, 9 with Down syndrome and 9 typically developing children. Half of the children with spina bifida were non-ambulatory. Doubly labeled water was used to measure energy expenditure and body composition. Descriptive statistics described the sample and MANOVA and ANOVA methods were used to evaluate differences between groups.

RESULTS

Energy expenditure was significantly less for children with spina bifida who primarily used a wheelchair (p = .001) and children with Down syndrome (p = .041) when compared to children without a disability when adjusted for fat-free mass. However, no significant difference was detected in children with spina bifida who ambulated without assistance (p = .072).

CONCLUSIONS

Children with spina bifida and Down syndrome have a significantly decreased energy expenditure which directly impacts recommended caloric intake. No significant difference was detected for children with spina bifida who ambulated, although the small sample size of this pilot study may have limited these findings. Validating these results in a larger study is integral to supporting successful weight management of these children.

Dietary glycaemic index and glycaemic load among Australian adults - results from the 2011-2012 Australian Health Survey

This study aimed to determine the major food groups contributing to dietary glycaemic load (GL). Plausible food intake data collected using a multiple-pass 24 hour recall from a weighted sample of 6326 adult respondents (52% male) of the 2011-2012 Australian Health Survey dataset (AHS) were analysed. The GI of foods was estimated based on a previously published step-wise method. Descriptive statistics were calculated for dietary glycaemic index (GI), GL and contribution to GL by major food groups, stratified by age and sex. Trends across age groups were assessed using linear regression. Pearson's χ² was used to test for differences between age groups for categorical demographics variables. The mean (SD) dietary GI and GL was 54 (7) and 135 (59) respectively and the top 3 contributors to dietary GL were breads (14.4%), cereal-based dishes (10.3%) and breakfast cereals (ready to eat) (6.6%). There were small but significant differences in the GL contribution pattern between the sexes. The findings indicate that the average dietary GI of Australian adults is similar to that of other population groups, with a large proportion of starchy and energy-dense nutrient-poor foods that contribute to a high GL.

Identification of dietary patterns associated with obesity in a nationally representative survey of Canadian adults: application of a priori, hybrid, and simplified dietary pattern techniques

Background: Analyzing the effects of dietary patterns is an important approach for examining the complex role of nutrition in the etiology of obesity and chronic diseases.Objectives: The objectives of this study were to characterize the dietary patterns of Canadians with the use of a priori, hybrid, and simplified dietary pattern techniques, and to compare the associations of these patterns with obesity risk in individuals with and without chronic diseases (unhealthy and healthy obesity).Design: Dietary recalls from 11,748 participants (≥18 y of age) in the cross-sectional, nationally representative Canadian Community Health Survey 2.2 were used. A priori dietary pattern was characterized with the use of the previously validated 2015 Dietary Guidelines for Americans Adherence Index (DGAI). Weighted partial least squares (hybrid method) was used to derive an energy-dense (ED), high-fat (HF), low-fiber density (LFD) dietary pattern with the use of 38 food groups. The associations of derived dietary patterns with disease outcomes were then tested with the use of multinomial logistic regression.Results: An ED, HF, and LFD dietary pattern had high positive loadings for fast foods, carbonated drinks, and refined grains, and high negative loadings for whole fruits and vegetables (≥|0.17|). Food groups with a high loading were summed to form a simplified dietary pattern score. Moving from the first (healthiest) to the fourth (least healthy) quartiles of the ED, HF, and LFD pattern and the simplified dietary pattern scores was associated with increasingly elevated ORs for unhealthy obesity, with individuals in quartile 4 having an OR of 2.57 (95% CI: 1.75, 3.76) and 2.73 (95% CI: 1.88, 3.98), respectively (P-trend < 0.0001). Individuals who adhered the most to the 2015 DGAI recommendations (quartile 4) had a 53% lower OR of unhealthy obesity (P-trend < 0.0001). The associations of dietary patterns with healthy obesity and unhealthy nonobesity were weaker, albeit significant.Conclusions: Consuming an ED, HF, and LFD dietary pattern and lack of adherence to the recommendations of the 2015 DGAI were associated with a significantly higher risk of obesity with and without accompanying chronic diseases.

Using reduced rank regression methods to identify dietary patterns associated with obesity: a cross-country study among European and Australian adolescents

This study aims to examine repeatability of reduced rank regression (RRR) methods in calculating dietary patterns (DP) and cross-sectional associations with overweight (OW)/obesity across European and Australian samples of adolescents. Data from two cross-sectional surveys in Europe (2006/2007 Healthy Lifestyle in Europe by Nutrition in Adolescence study, including 1954 adolescents, 12-17 years) and Australia (2007 National Children's Nutrition and Physical Activity Survey, including 1498 adolescents, 12-16 years) were used. Dietary intake was measured using two non-consecutive, 24-h recalls. RRR was used to identify DP using dietary energy density, fibre density and percentage of energy intake from fat as the intermediate variables. Associations between DP scores and body mass/fat were examined using multivariable linear and logistic regression as appropriate, stratified by sex. The first DP extracted (labelled 'energy dense, high fat, low fibre') explained 47 and 31 % of the response variation in Australian and European adolescents, respectively. It was similar for European and Australian adolescents and characterised by higher consumption of biscuits/cakes, chocolate/confectionery, crisps/savoury snacks, sugar-sweetened beverages, and lower consumption of yogurt, high-fibre bread, vegetables and fresh fruit. DP scores were inversely associated with BMI z-scores in Australian adolescent boys and borderline inverse in European adolescent boys (so as with %BF). Similarly, a lower likelihood for OW in boys was observed with higher DP scores in both surveys. No such relationships were observed in adolescent girls. In conclusion, the DP identified in this cross-country study was comparable for European and Australian adolescents, demonstrating robustness of the RRR method in calculating DP among populations. However, longitudinal designs are more relevant when studying diet-obesity associations, to prevent reverse causality.

Vitamin D Status and Bone Mineral Density is Influenced by Vitamin D Supplementation and Vitamin K1 Intake in Adults with Diabetes and Chronic Kidney Disease

PURPOSE

Patients with diabetes (DM) and chronic kidney disease (CKD) are at increased risk for suboptimal bone health. The study objective was to investigate the relationships between vitamin D (vitD), vitamin K1 (vitK₁), and calcium intake with bone mineral density (BMD) and vitamin D status in an ambulatory population with DM and CKD.

METHODS

Adults (age 18-80 years; n = 62) with DM and CKD (stages 1-4) were recruited from the Northern Alberta Renal Program. Primary outcome variables included vitD, vitK₁, and calcium intake; serum 25(OH)D, 1,25(OH)₂D; and BMD as measured by dual X-ray absorptiometry. Statistical significance was determined at P < 0.05.

RESULTS

Participants met the estimated average requirement or adequate intake for vitD, vitK₁, and calcium intake in 73% (n = 45), 66% (n = 39), and 52% (n = 31), respectively, with a combined intake of micronutrient supplementation and diet. Participants had serum 25(OH)D concentrations ≥75 nmol/L (n = 41), normal BMDs (n = 48), and 66% (n = 41/62) were taking vitD supplements (>1000 IU/D). BMD was positively influenced by serum 25(OH)D. However, serum 25(OH) ≥100 nmol/L was associated with lower BMD (absolute and T-scores) for whole-body and spine (P ≤ 0.05). VitK₁ intake (≥200 μg/day) was associated with higher whole-body and femoral-neck BMDs (absoluteand T-scores; P ≤ 0.05).

CONCLUSION

VitD status and BMD in adults with DM and CKD was influenced by vitD supplementation and vitK₁ intake.

Dietary fat intake modifies the influence of the FTO rs9939609 polymorphism on adiposity in adolescents: The HELENA cross-sectional study

BACKGROUND AND AIMS

The fat mass and obesity associated gene (FTO) has been associated with obesity and dietary intake. The aims were: (i) To assess whether energy and macronutrient intakes were different across the FTOrs9939609 genotypes in adolescents, and (ii) to explore whether dietary fat intake modified the association of the rs9939609 polymorphism with adiposity.

METHODS AND RESULTS

The FTOrs9939609 polymorphism was genotyped in 652 adolescents (53% females, 14.8 ± 1.2 years, TT = 246, TA = 296, AA = 110). Energy and macronutrient intake were assessed by two non-consecutive 24 h-recalls. Weight, height, waist circumference and skinfold thicknesses were measured and body fat percent was calculated. Energy and macronutrient intake were similar across the FTOrs9939609 genotypes (P > 0.2). There were significant interactions between the FTO polymorphism and fat intake on adiposity estimates (P < 0.05). In adolescents whose fat intake was below 30% (N = 203), the A allele of rs9939609 was not associated with adiposity indices. In contrast, in adolescents whose fat intake was between 30% and 35% of energy (N = 190), the rs9939609 polymorphism was associated with a 1.9% higher body fat per risk allele (95%CI: 0.39, 3.33; P < 0.05), and in those whose fat intake was higher than 35% (N = 259), it was associated with a 2.8% higher body fat per risk allele (95%CI: 1.27, 4.43; P < 0.001).

CONCLUSIONS

These findings support the concept that the deleterious effect of the FTOrs9939609 polymorphism on adiposity is exacerbated in adolescents consuming high fat diets. In contrast, the consumption of low fat diets (<30% of energy) may attenuate the genetic predisposition to obesity in risk allele carriers.

The independent prospective associations of activity intensity and dietary energy density with adiposity in young adolescents

There is limited evidence on the prospective association of time spent in activity intensity (sedentary (SED), moderate (MPA) or vigorous (VPA) physical activity) and dietary intake with adiposity indicators in young people. This study aimed to assess associations between (1) baseline objectively measured activity intensity, dietary energy density (DED) and 4-year change in adiposity and (2) 4-year change in activity intensity/DED and adiposity at follow-up. We conducted cohort analyses including 367 participants (10 years at baseline, 14 years at follow-up) with valid data for objectively measured activity (Actigraph), DED (4-d food diary), anthropometry (waist circumference (WC), %body fat (%BF), fat mass index (FMI), weight status) and covariates. Linear and logistic regression models were fit, including adjustment for DED and moderate-to-vigorous physical activity. Results showed that baseline DED was associated with change in WC (β for 1kJ/g difference: 0·71; 95% CI 0·26, 1·17), particularly in boys (1·26; 95% CI 0·41, 2·16 v. girls: 0·26; 95% CI −0·34, 0·87), but not with %BF, FMI or weight status. In contrast, baseline SED, MPA or VPA were not associated with any of the outcomes. Change in DED was negatively associated with FMI (β for 1kJ/g increase: −0·86; 95% CI −1·59, −0·12) and %BF (−0·86; 95% CI −1·25, −0·11) but not WC (−0·27; 95% CI −1·02, 0·48). Change in SED, MPA and VPA did not predict adiposity at follow-up. In conclusion, activity intensity was not prospectively associated with adiposity, whereas the directions of associations with DED were inconsistent. To inform public health efforts, future studies should continue to analyse longitudinal data to further understand the independent role of different energy-balance behaviours in changes in adiposity in early adolescence.

Evaluation of different methods to handle misreporting in obesity research: evidence from the Canadian national nutrition survey

The association of dietary exposures with health outcomes may be attenuated or reversed as a result of energy intake (EI) misreporting. This study evaluated several methods for dealing with implausible recalls when analysing the association between dietary factors and obesity. We examined data from 16,187 Canadians aged ≥12 years in the nationally representative Canadian Community Health Survey 2.2. Under- and over-reporting were defined as the ratio of EI:estimated energy requirement <0·7 and >1·42, respectively. Multinomial logistic regression-generalised logit model was conducted to test the utility of different methods for handling misreporting, including (a) adjusting for variables related to misreporting, (b) excluding misreported recalls, (c) adjusting for reporting groups (under-, plausible and over-reporters), (d) adjusting for propensity score and (e) stratifying the analyses by reporting groups. In the basic model, EI showed a negative association with overweight (OR 0·988; 95% CI 0·979, 0·998) and obesity (OR 0·989; 95% CI 0·977, 0·999). Similarly, the association between total energy density and overweight (OR 0·670; 95% CI 0·487, 0·923) and obesity (OR 0·709; 95% CI 0·495, 1·016) was inverse. Among all methods of handling misreporting, adjusting for the reporting status revealed the most satisfactory results, where a positive association between EI and overweight (OR 1·037; 95% CI 1·019, 1·055) and obesity (OR 1·109; 95% CI 1·082, 1·137) was observed (P<0·0001), as well as direct positive associations between energy density and percentage energy from solid fats and added sugars with obesity (P<0·05). The results of this study can help advance knowledge about the relationship between dietary variables and obesity and demonstrate to researchers and nutrition policy makers the importance of adjusting for recall plausibility in obesity research, which is highly relevant in light of global obesity epidemic.

Effect of energy under-reporting on secular trends of dietary patterns in a mediterranean population

BACKGROUND

Diet is an important factor in the prevention of chronic diseases. Analysis of secular trends of dietary patterns can be biased by energy under-reporting. Therefore, the objective of the present study was to analyse the impact of energy under-reporting on dietary patterns and secular trends in dietary patterns defined by cluster analysis.

DESIGN AND METHODS

Two cross-sectional population-based surveys were conducted in Spain, in 2000 and 2005, with 3058 and 6352 participants, respectively, aged 25 to 74 years. Validated questionnaire was used to collect dietary data. Cluster analysis was run separately for all participants, plausible energy reporters (PER), and energy under-reporters (EUR) to define dietary patterns.

RESULTS

Three clusters, "healthy", "mixed" and "western", were identified for both surveys. The "mixed" cluster was the predominant cluster in both surveys. Excluding EUR reduced the proportion of the "mixed" cluster up to 6.40% in the 2000 survey; this caused secular trend increase in the prevalence of the "mixed" pattern. Cross-classification analysis of all participants and PER' data showed substantial agreement in cluster assignments: 68.7% in 2000 and 84.4% in 2005. Excluding EUR did not cause meaningful (≥ 15%) changes in the "healthy" pattern. It provoked changes in consumption of some food groups in the "mixed" and "western" patterns: mainly decreases of unhealthy foods within the 2000 and increases of unhealthy foods within the 2005 surveys. Secular trend effects of EUR were similar to those within the 2005 survey. Excluding EUR reversed the direction of secular trends in consumption of several food groups in PER in the "mixed" and "western" patterns.

CONCLUSIONS

EUR affected distribution of participants between dietary patterns within and between surveys, secular trends in food group consumption and amount of food consumed in all, but not in the "healthy" pattern. Our findings emphasize threats from energy under-reporting in dietary data analysis.

The ANIBES Study on Energy Balance in Spain: design, protocol and methodology

Energy Balance (EB) is an important topic to understand how an imbalance in its main determinants (energy intake and consumption) may lead to inappropriate weight gain, considered to be "dynamic" and not "static". There are no studies to evaluate EB in Spain, and new technologies reveal themselves as key tools to solve common problems to precisely quantify energy consumption and expenditure at population level. The overall purpose of the ANIBES ("Anthropometry, Intake and Energy Balance") Study was to carry out an accurate updating of food and beverage intake, dietary habits/behaviour and anthropometric data of the Spanish population (9-75 years, n=2009), as well as the energy expenditure and physical activity patterns. Anthropometry measurements (weight, height, body mass index, waist circumference, % body fat, % body water) were obtained; diet was evaluated throughout a three-day dietary record (tablet device) accompanied by a 24 h-dietary recall; physical activity was quantified by questionnaire and accelerometers were also employed. Finally, information about perception and understanding of several issues related to EB was also obtained. The ANIBES study will contribute to provide valuable useful data to inform food policy planning, food based dietary guidelines development and other health oriented actions in Spain.

Modifying influence of dietary sugar in the relationship between cortisol and visceral adipose tissue in minority youth

OBJECTIVE

Cortisol has been associated with preferential visceral adipose tissue (VAT) deposition; however, findings in humans are mixed, which may be clarified when diet is considered.

DESIGN AND METHODS

Participants included 165 African-American and Latino, overweight adolescents (BMI% 97.2±3.2%, ages 13-18, 67% Latino, 66% female). Body composition was determined by dual energy X-ray absorptiometry, abdominal fat depots [VAT, subcutaneous (SAT)] by multiple-slice MRI, time-controlled serum sample to measure cortisol, and 2-day multi-pass 24-hour dietary recall. Linear regression analysis examined the cross-sectional relationship between cortisol, and the interaction of diet and cortisol on adiposity measures. Sex, race, age, and total body fat were a priori covariates.

RESULTS

There was a significant interaction between cortisol and sugar (total and added) in the prediction of VAT (P(interaction)  ≤ 0.05). Amongst participants with high total or added-sugar intake, cortisol was significantly associated with VAT (ß = 0.031 P < 0.001; ß = 0.026 P < 0.001), with no relationship in low consumers of total or added-sugar.

CONCLUSION

Dietary sugar may play an important role in modifying the relationship between cortisol and VAT, such that cortisol is significantly associated with elevated VAT under conditions of high sugar intake.

The effect of a low fructose and low glycemic index/load (FRAGILE) dietary intervention on indices of liver function, cardiometabolic risk factors, and body composition in children and adolescents with nonalcoholic fatty liver disease (NAFLD)

BACKGROUND

Nonalcoholic fatty liver disease (NAFLD) is a common liver disease in obese children. Diets high in added fructose (high fructose corn syrup; HFCS) and glycemic index (GI)/glycemic load (GL) are associated with increased risk of NAFLD. Lifestyle modification is the main treatment, but no guidelines regarding specific dietary interventions for childhood NAFLD exist. We hypothesized that reductions in dietary fructose (total, free, and HFCS)/GI/GL over 6 months would result in improvements in body composition and markers of liver dysfunction and cardiometabolic risk in childhood NAFLD.

METHODS

Children and adolescents with NAFLD (n = 12) and healthy controls (n = 14) 7-18 years were studied at baseline and 3 and 6 months post-dietary intervention. Plasma markers of liver dysfunction (ALT, AST, γGT), cardiometabolic risk (TG, total cholesterol, LDL-HDL cholesterol, Apo-B100, Apo-B48, Apo-CIII, insulin, homeostasis model of assessment of insulin resistance [HOMA-IR]), inflammation (TNF-α, IL-6, IL-10), anthropometric, and blood pressure (BP) were studied using validated methodologies.

RESULTS

Significant reductions in systolic BP (SBP), percentage body fat (BF), and plasma concentrations of ALT (P = .04), Apo-B100 (P < .001), and HOMA-IR were observed in children with NAFLD at 3 and 6 months (P < .05). Dietary reductions in total/free fructose/HFCS and GL were related to reductions in SBP (P = .01), ALT (P = .004), HOMA-IR (P = .03), and percentage BF in children with NAFLD. Reductions in dietary GI were associated with reduced plasma Apo-B100 (P = .02) in both groups. With the exception of Apo-B100, no changes in laboratory variables were observed in the control group.

CONCLUSION

Modest reductions in fructose (total/free, HFCS) and GI/GL intake result in improvements of plasma markers of liver dysfunction and cardiometabolic risk in childhood NAFLD.

Gluten intake in 6-36-month-old Danish infants and children based on a national survey

Coeliac disease (CD) affects about 1 % of the general population. Information concerning gluten intake in the general population is scarce. In particular, variation in gluten intake during the complementary feeding period may be an independent risk factor in CD pathogenesis. We determined the intake of gluten from wheat, barley, rye and oats in a cross-sectional National Danish Survey of Dietary Habits among Infants and Young Children (2006-2007). The study population comprised a random sample of 1743 children aged 6-36 months, recruited from the National Danish Civil Registry. The protein contents from wheat, rye, barley and oats were found in the National Danish Food Composition Table, and multiplied with the amounts in the recipes. The amounts of gluten were calculated as the amount of cereal protein × 0·80 for wheat and oats, ×0·65 for rye and ×0·50 for barley. Dietary intake was recorded daily for seven consecutive days in pre-coded food records supplemented with open-answer possibilities. Gluten intake increased with age (P < 0·0001). Oats were introduced first, rapidly outpaced by wheat, the intake of which continued to increase with age, whereas oats started to decrease at 12 months. Boys had a higher intake of energy (P ≤ 0·0001) and all types of gluten, except for barley (P ≤ 0·87). In 8-10-month-old (P < 0·0001) and 10-12-month-old (P = 0·007), but not in 6-8-month-old infants (P = 0·331), non-breast-fed infants had higher total gluten intake than partially breast-fed infants. In conclusion, this study presents representative population-based data on gluten intake in Danish infants and young children.

Diet–obesity associations in children: approaches to counteract attenuation caused by misreporting

Objective

Measurement errors in dietary data lead to attenuated estimates of associations between dietary exposures and health outcomes. The present study aimed to compare and evaluate different approaches of handling implausible reports by exemplary analysis of the association between dietary intakes (total energy, soft drinks, fruits/vegetables) and overweight/obesity in children.

Design

Cross-sectional multicentre study.

Setting

Kindergartens/schools from eight European countries participating in the IDEFICS Study.

Subjects

Children (n 5357) aged 2–9 years who provided one 24 h dietary recall and complete covariate information.

Results

The 24 h recalls were classified into three reporting groups according to adapted Goldberg cut-offs: under-report, plausible report or over-report. In the basic logistic multilevel model (adjusted for age and sex, including study centre as random effect), the dietary exposures showed no significant association with overweight/obesity (energy intake: OR=0·996 (95 % CI 0·983, 1·010); soft drinks: OR = 0·999 (95 % CI 0·986, 1·013)) and revealed even a positive association for fruits/vegetables (OR = 1·009 (95 % CI 1·001, 1·018)). When adding the reporting group (dummy variables) and a propensity score for misreporting as adjustment terms, associations became significant for energy intake as well as soft drinks (energy: OR = 1·074 (95 % CI 1·053, 1·096); soft drinks: OR = 1·015 (95 % CI 1·000, 1·031)) and the association between fruits/vegetables and overweight/obesity pointed to the reverse direction compared with the basic model (OR = 0·993 (95 % CI 0·984, 1·002)).

Conclusions

Associations between dietary exposures and health outcomes are strongly affected or even masked by measurement errors. In the present analysis consideration of the reporting group and inclusion of a propensity score for misreporting turned out to be useful tools to counteract attenuation of effect estimates.

Comparison of estimated energy intake from 2×24-hour recalls and a seven-day food record with objective measurements of energy expenditure in children

Objective

The objective of the present study was to evaluate energy intake (EI) estimated from two non-consecutive 24-hour recalls (24-HDRs) and a pre-coded seven-day food record (7-dFR) against objective measurements of energy expenditure (EE) in children.

Design

A total of 67 7–8 year-olds and 64 12–13 year-olds completed the 2×24-HDRs, the 7-dFR, and wore ActiReg^® (PreMed AS, Oslo, Norway), a combined position and motion recording instrument, during the same seven days as the 7-dFR was filled in.

Results

In the 7–8 year-olds, EI from the 2×24-HDRs (EI_2×24-HDR) was overestimated with 3% compared to EE (not significantly different), while EI from the 7-dFR (EI_7-dFR) was underestimated with 7% compared to EE (P=0.001). In the 12–13 year-olds, the corresponding figures was underestimation by 10% with the 2×24-HDRs (P<0.001) and by 20% with the 7-dFR (P<0.001). For both age groups combined, the 95% limits of agreement were −4·38 and 3.52 MJ/d for the 2×24-HDRs, and −5.90 and 2.94 MJ/d for the 7-dFR. Pearson correlation coefficients between EI and EE were 0.51 for EI_2×24-HDR and 0.29 for EI_7-dFR, respectively. The proportion classified in the same or adjacent quartiles was 76% for EI_2×24-HDR and 73% for EI_7-dFR in the 7–8 year-olds, and 83% for EI_2×24-HDR and 70% for EI_7-dFR in the 12–13 year-olds.

Conclusion

Misreporting of EI seemed modest with both the 2×24-HDRs and the 7-dFR in the 7–8 year-olds when compared to EE measured with ActiReg^®. Under-reporting appeared to be more evident in the 12–13 year-olds, especially with the 7-dFR. Compared to measurements of EE, the 2×24-HDRs seemed to perform slightly better than the 7-dFR in terms of ranking of individuals according to EI.

A cross-sectional study of overweight in pediatric survivors of acute lymphoblastic leukemia (ALL)

BACKGROUND

Survivors of childhood acute lymphoblastic leukemia (ALL) are at risk for overweight, predisposing them to long-term morbidity. We examined the relationship between body mass index (BMI) and demographic and lifestyle factors in a cohort of ALL survivors.

PROCEDURE

We enrolled consecutive ALL survivors who attended the institutional AfterCare Clinic over a 1-year period. BMI (kg/m(2) ) at diagnosis, end-therapy, and current time were calculated. Survivors were classified as overweight/obese (overweight group; BMI for age ≥ 85th percentile) or normal/underweight (normal weight group; BMI for age <85th percentile). We assessed the relationship between current BMI and self-reported current caloric intake, physical activity, and sedentary behavior.

RESULTS

102/157 (65%) eligible survivors consented to enrollment. Median age was 14.3 years (range 8.4-18.6) and time from end of treatment 7 years (2.5-15.6). The proportion of overweight survivors was 21%, 45%, and 35% at diagnosis, end-therapy, and current time, respectively. The overweight group reported less calories (Δ324 kcal, P = 0.018), fat (Δ14.5 g, P = 0.02), and carbohydrates (Δ39 g, P = 0.02) than the normal weight group. These differences disappeared after excluding patients classified as under-reporting their calorie intake according to the Goldberg cut-off method. There were no differences in sedentary behavior or activity between groups.

CONCLUSIONS

Many children with ALL gain weight during therapy and fail to return to normal weight after treatment concludes. Subsequent diet, physical activity, and sedentary behavior do not appear to differ between overweight and normal weight survivors. Clinicians should focus on ways to minimize weight gain during therapy rather than waiting for treatment to conclude.

The accuracy of the Goldberg method for classifying misreporters of energy intake on a food frequency questionnaire and 24-h recalls: comparison with doubly labeled water

BACKGROUND/OBJECTIVES

Adults often misreport dietary intake; the magnitude varies by the methods used to assess diet and classify participants. The objective was to quantify the accuracy of the Goldberg method for categorizing misreporters on a food frequency questionnaire (FFQ) and two 24-h recalls (24HRs).

SUBJECTS/METHODS

We compared the Goldberg method, which uses an equation to predict total energy expenditure (TEE), with a criterion method that uses doubly labeled water (DLW), in a study of 451 men and women. Underreporting was classified using recommended cut points and calculated values. Sensitivity and specificity, positive predictive value (PPV) and negative predictive value and the area under the receiver operating characteristic curve (AUC) were calculated. Predictive models of underreporting were contrasted for the Goldberg and DLW methods.

RESULTS

AUCs were 0.974 and 0.972 on the FFQ, and 0.961 and 0.938 on the 24HR for men and women, respectively. The sensitivity of the Goldberg method was higher for the FFQ (92%) than the 24HR (50%); specificity was higher for the 24HR (99%) than the FFQ (88%); PPV was high for the 24HR (92%) and FFQ (88%). Simulation studies indicate attenuation in odds ratio estimates and reduction of power in predictive models.

CONCLUSIONS

Although use of the Goldberg method may lead to bias and reduction in power in predictive models of underreporting, the method has high predictive value for both the FFQ and the 24HR. Thus, in the absence of objective measures of TEE or physical activity, the Goldberg method is a reasonable approach to characterize underreporting.

Dietary intake and nutritional status in a Scandinavian adult cystic fibrosis-population compared with recommendations

BACKGROUND

Malnutrition is a well-known complication in cystic fibrosis (CF). There is good evidence that maintaining a normal body-weight correlates well with improved survival in CF. Energy intake in excess of 120% of the estimated average requirement (EAR) has been advised since 1980s.

OBJECTIVES

To investigate the nutritional intake and status in the adult Scandinavian CF-population.

SUBJECTS/METHODS

A cross-sectional multi-centre study was used to investigate the nutritional status of 456 adult CF-patients (2003 2006). Height and weight were measured and body mass index (BMI) and z-scores were calculated. Pulmonary function was examined by dynamic spirometry. A 7-day pre-coded food record (FR) obtained energy and nutrient intake data in 180 patients.

RESULTS

The mean energy intake was 114 (SD 30.0)% of EAR and thus significantly lower than the target of 120% EAR (p< 0.001) for patients with pancreatic insufficiency (PI) (n=136). Mean BMI was 22.0 (SD 2.9), the prevalence of BMI <18 was 13% and the prevalence of BMI ≥25 was 15% (n=136). Mean BMI was 20.8 (SD 2.4) in PI-patients with FEV(1) <70% and 23.2% (SD 3.0), in PI-patients with FEV(1) ≥70%, mean difference 2.4, (95% CI: 1.5, 3.3) (p<0.001), but there was no difference in energy intake. BMI ≥18.5 and a reported energy intake <120% were revealed in 54% of the PI-patients.

CONCLUSIONS

The energy intake did not reach the recommended 120% EAR, but the prevalence of underweight was lower than reported in other studies. The recommendation may exceed the requirement for a number of CF-patients. The nutritional status must still be closely monitored and nutritional advice and intervention should be individualised and adjusted to actual needs.

Dietary intakes assessed by 24-h recalls in peri-urban African adolescents: validity of energy intake compared with estimated energy expenditure

BACKGROUND/OBJECTIVE

The objective of this study is to determine the relative validity of reported energy intake (EI) derived from multiple 24-h recalls against estimated energy expenditure (EE(est)). Basal metabolic rate (BMR) equations and physical activity factors were incorporated to calculate EE(est).

SUBJECTS/METHODS

This analysis was nested in the multidisciplinary PhysicaL Activity in the Young study with a prospective study design. Peri-urban black South African adolescents were investigated in a subsample of 131 learners (87 girls and 44 boys) from the parent study sample of 369 (211 girls and 158 boys) who had all measurements taken. Pearson correlation coefficients and Bland-Altman plots were calculated to identify the most accurate published equations to estimate BMR (P<0.05 statistically significant). EE(est) was estimated using BMR equations and estimated physical activity factors derived from Previous Day Physical Activity Recall questionnaires. After calculation of EE(est), the relative validity of reported energy intake (EI(rep)) derived from multiple 24-h recalls was tested for three data subsets using Pearson correlation coefficients. Goldberg's formula identified cut points (CPs) for under and over reporting of EI.

RESULTS

Pearson correlation coefficients between calculated BMRs ranged from 0.97 to 0.99. Bland-Altman analyses showed acceptable agreement (two equations for each gender). One equation for each gender was used to calculate EE(est). Pearson correlation coefficients between EI(rep) and EE(est) for three data sets were weak, indicating poor agreement. CPs for physical activity groups showed under reporting in 87% boys and 95% girls.

CONCLUSION

The 24-h recalls measured at five measurements over 2 years offered poor validity between EI(rep) and EE(est).

The control of food intake of free-living humans: putting the pieces back together

The control of food intake has been studied using reductionism; by separately investigating environmental, physiological, and genetic variables. The general model of intake regulation attempts to reassemble the pieces into an organized whole. It postulates that intake is influenced by sets of both physiological factors which have negative feedback loops to intake and environmental factors which do not. Data and behavioral genetic analysis on a number of environmental, psychological, dietary, and social variables demonstrate that they have large impacts on the intake of free-living humans in their everyday environments and their magnitude and impact on intake are influenced by heredity. Recent evidence of built environment influences on activity and intake further indicate the profound influence of environmental circumstances on both intake and expenditure. A computer simulation of the general model of intake regulation demonstrates that the model predicts different maintained levels of intake and body weight depending upon the external environment and that change in the environment can produce new sustained levels. It is suggested that eating is influenced by a myriad of physiological and non-physiological factors and that total intake results from the integral of their influences. It is concluded that recombining the components broken down in the reductionistic process results in a functional whole that can well describe human behavior in natural environments. The paper represents an invited review by a symposium, award winner or keynote speaker at the Society for the Study of Ingestive Behavior [SSIB] Annual Meeting in Portland, July 2009.

Trends in energy and sugar intakes and body mass index between 1983 and 1997 among children in Great Britain

BACKGROUND

It has been suggested that rising obesity among children is partly attributable to sugary foods and soft drinks driving an increase in energy intake (EI). Yet historical data on sugar intake are sparse. The present study calculated total sugar intake de novo among 3296 children aged 10-11 and 14-15 years in 1983 and compared EI, macronutrients and sugar sources with data from 459 children of same age in the 1997 National Diet and Nutrition Survey.

METHODS

Secondary analysis of 7-day weighed diet records and anthropometric data from two British surveys. Compositional data on sugars applied to individual food codes to calculate sugar intake and sources for 1983. Trends examined before/after adjustment for low/high energy reporting (LHER) defined as EI : basal metabolic rate <1.16 or >2.65.

RESULTS

Mean EI (kJ day(-1)) was 7% lower in 1997 than in 1983, mainly as a result of lower fat intake. After excluding LHER, mean EI was 3% lower in 1997. Mean body mass index (BMI) increased by 0.7-1 kg m(-2) (2-3 kg). Total sugar intake averaged 115 g day(-1) in 1983 and 113 g day(-1) in 1997 (122 versus 127 g day(-1) excluding LHER, P = 0.08). Excluding LHER, fat energy was lower in 1997 (35.4% versus 37.8%) and sugars slightly higher (23.6% versus 22.3%). Sugar sources showed a marked shift away from table sugar with smaller falls in milk, biscuits and cakes, counterbalanced by an significant increase in sugar from soft drinks and, to a lesser extent, fruit juice and breakfast cereals.

CONCLUSIONS

Although the study design precludes drawing causal inferences regarding nutrient intake and obesity, a higher prevalence of under-reporting and lower levels of physical activity in 1997 could explain the paradox of lower reported EI and rising BMI.

The tracking of dietary intakes of children and adolescents in Sweden over six years: the European Youth Heart Study

BACKGROUND

The stability of dietary habits through various life-stages is not well understood. A better understanding of the tracking of diet over time could have implications for health promotion as well as for the planning of nutritional epidemiology studies. We examined the stability of dietary intakes of children and adolescents over six years.

METHODS

As part of the European Youth Heart Study, in 1998-9, a 24-h dietary recall was performed on over one thousand 9- and 15-year-olds in Sweden. In 2004-5, 40% returned to the follow-up study. These 452 subjects (273 15- and 179 21-year-olds) were assigned to age- and gender-specific tertiles of intakes of food groups, energy, selected nutrients and energy density (low, mid and high) at each time point. The agreement between the classification of subjects into tertiles at both time points was examined using Cohen's weighted kappa and other stability coefficients. We included a dropout analysis and considered the effect that energy mis-reporting might have on our results.

RESULTS

Fair tracking was seen between childhood and adolescence for the milk, fil and yoghurt food group (kappa = 0.30), and between adolescence and young adulthood for fruit (kappa = 0.24). Slight tracking was observed for most other food groups and fair to slight tracking for all nutrients studied. Only membership of the high milk, fil and yoghurt tertile could be predicted from membership at baseline, in children. Excluding potential energy mis-reporters did not affect the results.

CONCLUSIONS

Despite the long time between data collections, and the method of dietary data collection used, evidence for slight tracking was observed for most food groups and nutrients over these six years.

Anthropometric, metabolic, dietary and psychosocial profiles of underreporters of energy intake: a doubly labeled water study among overweight/obese postmenopausal women--a Montreal Ottawa New Emerging Team study

BACKGROUND/OBJECTIVES

To analyze the anthropometric, metabolic, psychosocial and dietary profiles of underreporters, identified by the doubly labeled water technique, in a well-characterized population of overweight and obese postmenopausal women.

SUBJECTS/METHODS

The study population consisted of 87 overweight and obese sedentary postmenopausal women (age: 57.7+/-4.8 years, body mass index: 32.4+/-4.6 kg/m(2)). Subjects were identified as underreporters based on the energy intake to energy expenditure ratio of <0.80. We measured (1) body composition (by dual-energy X-ray absorptiometry), (2) visceral fat (by computed tomography), (3) blood profile, (4) resting blood pressure, (5) peak oxygen consumption (VO(2 peak)), (6) total energy expenditure, (7) muscle strength and (8) psychosocial and dietary profiles.

RESULTS

Out of 87 subjects, 50 (57.5%) were identified as underreporting subjects in our cohort. Underreporters showed higher levels of body mass index, fat mass, visceral fat, hsC-reactive protein, perceived stress and percentage of energy from protein, as well as lower levels of VO(2 peak), dietary intake of calcium, fiber, iron, vitamin B-1 and 6, as well as servings of fruit and vegetables. Logistic regression analysis showed that fat mass, odd ratio 1.068 (95% confidence interval 1.009-1.130) and perceived stress, odd ratio 1.084 (95% confidence interval 1.011-1.162) were independent characteristics of underreporters.

CONCLUSIONS

Results from this study show significant differences in anthropometric, metabolic, psychosocial and dietary profiles between underreporters and non-underreporters in our cohort of overweight and obese postmenopausal women.

Lifestyle factors and colorectal cancer risk (2): a systematic review and meta-analysis of associations with leisure-time physical activity

OBJECTIVE

Increased physical activity may decrease the risk of colorectal cancer. As a prerequisite to the determination of lifestyle attributable risks, we performed a systematic review and meta-analysis of prospective observational studies to quantify gender-specific risk associated with increased leisure-time physical activity (LT-PA).

METHOD

We searched MEDLINE and EMBASE (to December 2007), and other sources, selecting reports based on strict inclusion criteria. We used random-effects meta-analyses to estimate summary risk ratios (RR) and 95% confidence intervals (95% CI) for uppermost vs lowermost categories of physical activity. To investigate dose-response, we explored risks ratios as a function of cumulative percentiles of physical activity distribution.

RESULTS

Fifteen datasets from 14 articles, including 7873 incident cases, were identified. For colon cancer, there were inverse associations with LT-PA for men (RR: 0.80; 95% CI: 0.67-0.96) and women (0.86; 0.76-0.98). LT-PA did not influence risk of rectal cancer. The dose-response analysis was consistent with linear pattern reductions in risk of colon cancer in both genders. There was evidence of moderate between-study heterogeneity but summary estimates were broadly consistent across potential confounding factors.

CONCLUSION

Increased LT-PA is associated with a modest reduction in colon but not rectal cancer risk; a risk reduction, which previously may have been overstated. LT-PA only interventions in public health cancer prevention strategies are unlikely to impact substantially on colorectal cancer incidences.

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

In order to assess nutritional adequacy, valid estimates of nutrient intake are required. One of the main errors in dietary assessment is misreporting. The objective was to review the extent, nature and determinants of misreporting in dietary assessment, how this affects reported intakes of micronutrients and how this is identified and measured, and to identify the best ways of dealing with misreporting when interpreting results. A systematic literature search was conducted for studies of misreporting of dietary intake in adults by 24 hour recalls or by estimated or weighed food records, published up to March 2008. Thirty-seven relevant studies were identified. Possible causes of misreporting were identified. Methods most used to identify misreporting were the Goldberg cut-off (46 % studies) and the doubly labelled water technique (24 % studies). The magnitude of misreporting of energy intake was similar in all three dietary assessment methods. The percentage of under-reporters was about 30 % and energy intake was underestimated by approximately 15 %. Seven papers presented usable data for micronutrient intake. Absolute intakes of Fe, Ca and vitamin C (the three micronutrients addressed in all papers) were on average 30 % lower in low-energy reporters (LER) than that in non-LER and, although results were not consistent, there was a tendency for micronutrient density to be higher in LER. Excluding underreporters or using energy adjustment methods for micronutrient intakes is discussed. Residual method of energy adjustment seems to be a good tool for practice to decrease an influence of misreporting when interpreting results of studies based on food records and 24 hour recalls.

Commercial weight loss diets meet nutrient requirements in free living adults over 8 weeks: a randomised controlled weight loss trial

Objective

To investigate the effect of commercial weight loss programmes on macronutrient composition and micronutrient adequacy over a 2 month period.

Design

Adults were randomly allocated to follow the Slim Fast Plan, Weight Watchers Pure Points Programme, Dr Atkins' New Diet Revolution, or Rosemary Conley's "Eat Yourself Slim" Diet & Fitness Plan.

Setting

A multi-centre randomised controlled trial.

Subjects

293 adults, mean age 40.3 years and a mean BMI 31.7 (range 27–38) were allocated to follow one of the four diets or control group. Subjects completed a 7-day food and activity diary at baseline (prior to randomisation) and after 2 months. Diet records were analysed for nutrient composition using WinDiets (research version).

Results

A significant shift in the macronutrient composition of the diet with concurrent alteration of the micronutrient profile was apparent with all diets. There was no evidence to suggest micronutrient deficiency in subjects on any of the dietary regimens. However, those sub-groups with higher needs for specific micronutrients, such as folate, iron or calcium may benefit from tailored dietary advice.

Conclusion

The diets tested all resulted in considerable macronutrient change and resulted in an energy deficit indicating dietary compliance. Health professionals and those working in community and public health should be reassured of the nutritional adequacy of the diets tested.

Trial Registration Number

NCT00327821

Prevalence and determinants of physical activity and lifestyle in relation to obesity among schoolchildren in Israel

OBJECTIVE

To describe the relationships between physical activity, lifestyle determinants and obesity in adolescent Israeli schoolchildren.Design and settingCross-sectional survey.

SUBJECTS

The MABAT Youth Survey was a nationally representative, school-based study of youth in grades 7 to 12 (ages 11-19 years).

METHODS

Self-administered questionnaires assessed health behaviours and anthropometric indices were measured. Logistic regression analysis was used to examine the associations between obesity, physical activity, socio-economic status and other lifestyle habits. One-way ANOVA was used to determine mean physical activity levels (MET values) by BMI categories.

RESULTS

The prevalence of overweight was 13-15 % and of obesity 4-9 % depending on gender and ethnicity, and was higher among the non-Jewish sectors. Thirty-six per cent and 57 % of Jewish girls and boys, and 40 % and 58 % of non-Jewish girls and boys, respectively, were optimally active. Boys from low socio-economic schools and those who slept for less than 6 h at night were less active. Girls from middle school were found to be 53 % more optimally physically active among Jews, and 89 % more among non-Jews, compared with girls from high school (P = 0.001); girls with less educated parents were also less physically active. No clear relationship was found between the level of obesity and physical activity.

CONCLUSIONS

Physical inactivity was strongly related to gender, age, social status, sleeping habits, hookah smoking, and parental educational status. Education and intervention programmes should focus on these risk factors.

Fiber intake, not dietary energy density, is associated with subsequent change in BMI z-score among sub-groups of children

OBJECTIVE

Results from short-term studies demonstrate that energy density influences energy intake, but in children and adolescents the long-term effects of energy density and obesity development are sparse. We examined the longitudinal relationship between dietary energy density, fiber intake, and body weight change over 3 years among Danish children.

METHODS

Multiple regression analyses were performed using anthropometric and dietary data of 398 boys and girls (8-10 years) who were enrolled in 1997/1998 and followed up in 2000/2001. Validated 24-hour recall interviews were conducted in order to collect dietary energy intake. Overweight was defined as 1.05 SD, equivalent to the 85th percentile, of age- and sex-specific BMI z-score reference values.

RESULTS

An inverse association between fiber intake and subsequent excess weight gain was observed among the normal weight boys. In overweight boys, there was a direct association with excess weight gain. A high energy intake was associated with a higher weight gain among overweight than among normal-weight boys. No significant association between dietary energy density and subsequent excess weight change was seen. The prevalence of overweight increased from 27.1 to 29.9%. Mean Deltaz-score was +0.1 and +0.4 for boys and girls, respectively.

CONCLUSION

Dietary energy density was not associated with 3-year weight gain in boys and girls. Only energy and fiber intakes were related to weight gain, but in different ways for subgroups of normal-weight and overweight boys.

General and visceral adiposity in black and white adolescents and their relation with reported physical activity and diet

BACKGROUND

Excess body fat accumulation may begin in youth and is linked with increased risk of cardiovascular disease. Examination of physical activity (PA) and diet behaviours predictive of adiposity may help target efforts to reduce chronic disease risk.

OBJECTIVE

We hypothesized that energy intake (EI) from fat, vigorous PA (VPA), and their interaction would predict body fat percentage (%BF) and visceral adipose tissue (VAT) in youth and that sedentary behaviours and intake of dairy, fruit, vegetable and whole grain foods would be related to adiposity.

DESIGN

A cross-sectional, observational study of reported PA and diet behaviours and objective adiposity measures.

SUBJECTS

Six-hundred sixty-one healthy black and white adolescents aged 14-18 years.

MEASUREMENTS

Diet by 24-h recalls using Nutrition Data Systems for Research (Minneapolis, MN, USA), VPA by previous day physical activity recalls (PAR), and %BF with dual-energy X-ray absorptiometry. VAT by magnetic resonance imaging for 434 subjects.

RESULTS

Reported EI and VPA were positively correlated with each other and were negative predictors of %BF. Time spent watching television or movies and %EI from protein were positive predictors of %BF. Adjusted for EI, none of the independent variables predictive of %BF retained their significance. %BF and VAT were highly correlated (r=0.73, P<0.0001). EI was the sole and negative predictor of VAT.

CONCLUSIONS

Higher energy 'throughput', not energy restriction, characterize leaner youths. Youths should be advised to engage in VPA so that they can eat sufficient calories to obtain the nutrients required for optimal health while remaining lean.

Issues in dietary intake assessment of children and adolescents

Studies of food habits and dietary intakes face a number of unique respondent and observer considerations at different stages from early childhood to late adolescence. Despite this, intakes have often been reported as if valid, and the interpretation of links between intake and health has been based, often erroneously, on the assumption of validity. However, validation studies of energy intake data have led to the widespread recognition that much of the dietary data on children and adolescents is prone to reporting error, mostly through under-reporting. Reporting error is influenced by body weight status and does not occur systematically across different age groups or different dietary survey techniques. It appears that the available methods for assessing the dietary intakes of children are, at best, able to provide unbiased estimates of energy intake only at the group level, while the food intake data of most adolescents are particularly prone to reporting error at both the group and the individual level. Moreover, evidence for the existence of subject-specific responding in dietary assessments challenges the assumption that repeated measurements of dietary intake will eventually obtain valid data. Only limited progress has been made in understanding the variables associated with misreporting in these age groups, the associated biases in estimating nutrient intakes and the most appropriate way to interpret unrepresentative dietary data. Until these issues are better understood, researchers should exercise considerable caution when evaluating all such data.

Relative validation of a pre-coded food diary among children, under-reporting varies with reporting day and time of the day

OBJECTIVE

The aim of this study was to validate intake of energy, macro- and micronutrients assessed from pre-coded food diaries (PFDs) by using weighed records (WRs) as the reference method among a group of Norwegian 9-year-olds. We also examined how under-reporters (UR) differed from acceptable reporters (AR) according to the energy intake during the 4-day recording period and energy intake distribution during the day.

SUBJECTS AND DESIGN

One hundred 9-year-olds, 45 girls and 55 boys, were recruited to complete a 4-day record with a PFD followed 3 days later with a 4-day WR.

RESULTS

There were no differences between energy and nutrient intake from the two recording methods among boys, but girls reported significantly higher intakes with PFD compared with WR. The median Spearman correlation coefficient between PFD and WR for energy and nutrients was 0.43 for girls and 0.49 for boys. Twelve participants were classified as UR with the PDF method. Energy percentages from macronutrients were not significantly different between UR and AR with the PFD method. UR had significantly lower energy intake in the last two recording days and from 1000 to 2200 hours during the day compared to AR.

CONCLUSIONS

The PFD method is promising as a tool for assessing food intake in large surveys among children. The present study indicates that the PFD gives more valid data for boys than girls according to the group intake and ranking of nutrient intake when WR is the reference method. However, UR seemed to develop a study fatigue during the day and during the recording period. Increased awareness about the tendency of study fatigue can lead to more specific instructions on how participants can handle the problem.

Varying levels of food energy self-reporting are associated with between-group, but not within-subject, differences in food intake

Energy intakes reported in diet diaries are frequently significantly below the energy requirements for a weight-stable individual. To investigate the impact of low energy reporting on between-group comparisons and within-subject analyses of eating behavior, we examined the baseline 7-d food-intake diaries submitted by 365 male and 564 female free-living normal adult humans. Participants were separated into 5 different groups, based upon their levels of energy reporting relative to their predicted basal metabolic rate: EI:BMR(est) = 0-0.99, 1.0-1.199, 1.2-1.399, 1.3-1.599, and > or =1.6. Between-group analysis revealed significant inverse relations among reporting level and body weight, BMI, cognitive restraint, positive relations with intake, meal size, and meal frequency. On the other hand, within-subject analyses suggested that, regardless of the level of energy reporting, equivalent relations are found among the amounts eaten in meals and the presence of other people, palatability, hunger, satiety, dietary energy density, contents of the stomach, time since the last meal, and time of day and correlations between daily intake and intake on subsequent days. The results suggest that comparing the intakes reported in diet diaries by different groups may be confounded by group differences in reporting levels. In contrast, the results clearly support the conclusion that diet diary data are suitable for assessing the relations between variables assessed within subjects irrespective of the level of reporting of energy intake.

Attainment of precision in implementation of 24 h dietary recalls: INTERMAP UK

Collection of complete and accurate dietary intake data is necessary to investigate the association of nutrient intakes with disease outcomes. A standardised multiple-pass 24 h dietary recall method was used in the International Collaborative Study of Macro- and Micronutrients and Blood Pressure (INTERMAP) to obtain maximally objective data. Dietary interviewers were intensively trained and recalls taped, with consent, for randomly selected evaluations by the local site nutritionist (SN) and/or country nutritionists (CN) using a twelve-criterion checklist marked on a four-point scale (1, retrain, to 4, excellent). In the Belfast centre, seven dietary interviewers collected 932 24 h recalls from 40-59-year-old men and women. Total scores from the 134 evaluated recalls ranged from thirty-four to the maximum forty-eight points. All twelve aspects of the interviews were completed satisfactorily on average whether scored by the SN (n 53, range: probing 3.25 to privacy of interview 3.98) or CN (n 19, range: probing 3.26 to pace of interview and general manner of interviewer 3.95); the CN gave significantly lower scores than the SN for recalls evaluated by both nutritionists (n 31, Wilcoxon signed rank test, P=0.001). Five evaluations of three recalls identified areas requiring retraining or work to improve performance. Reporting accuracy was estimated using BMR; energy intake estimates less than 1.2 x BMR identifying under-reporting. Mean ratios in all age, sex and body-mass groups were above this cut-off point; overall, 26.1 % were below. Experiences from the INTERMAP Belfast centre indicate that difficulties in collection of dietary information can be anticipated and contained by the systematic use of methods to prevent, detect and correct errors.