Reliability and validity of a food-frequency questionnaire for Chinese postmenopausal women

Association between Dietary Inflammatory Index and Bone Mineral Density Changes among Pregnant Women: A Prospective Study in China

OBJECTIVES

This study aims to examine the relationship between dietary inflammatory index (DII) and bone mineral density (BMD) changes among Chinese pregnant women, offering valuable insights for dietary guidance during pregnancy.

METHODS

289 pregnant women were enrolled in this cohort. Serum inflammatory factors and ultrasonic BMD were measured at the first, second, and the third trimesters. DII scores were calculated based on a semi-quantitative food frequency questionnaire (FFQ) and divided into tertiles. We compared the differences in inflammatory factors in serum across the tertiles of DII and changes in BMD at the second and third trimesters across the tertiles.

RESULTS

The participants with higher DII scores had higher total energy intakes than those with lower DII scores. The serum level of interleukin-6 (IL-6) was significantly different across the tertiles of the DII. Women who had lower DII scores had higher T-scores and Z-scores in the BMD assessment. In the test of trends, after adjusting potential covariates, including educational level, physical activity, body mass index, and calcium, vitamin D, or multivitamin supplements, DII values were determined to be positively related to the maternal BMD lost.

CONCLUSIONS

DII was positively associated with serum IL-6. Meanwhile, higher DII scores were associated with more bone mass loss in pregnant women. We recommend adhering to a lower-DII diet to preserve BMD during pregnancy.

The association between alcohol drinking and glycemic management among people with type 2 diabetes in China

INTRODUCTION

To investigate the association between alcohol drinking and glycemic management among adult patients with type 2 diabetes in regional China.

MATERIALS AND METHODS

In this cross-sectional survey conducted in Nanjing Municipality of China in 2018, adult type 2 diabetes patients were randomly selected from urban and rural communities. The outcome variable was the glycemic management status. The explanatory measure was alcohol drinking. Mixed-effects regression models were employed to estimate odds ratios (ORs) and 95% confidence interval (95% CI) for examining the associations of alcohol drinking with glycemic management among type 2 diabetes patients.

RESULTS

Among the overall 5,663 participants, the glycemic management rate was 39.8% (95% CI = 38.5, 41.1), with 41.2% (95% CI = 39.7, 42.7), 43.9% (95% CI = 38.9, 48.8), and 34.1% (95% CI = 31.5, 36.7) for non-drinkers, mild/moderate drinkers, and heavy drinkers, respectively. After adjustment for potential confounders and community-level clustering effect, heavy and mild/moderate alcohol drinkers were at 0.76 (95% CI = 0.66, 0.89) and 1.04 (95% CI = 0.87, 1.28) times odds to have glycemia under control than non-drinkers among the overall participants. Furthermore, when stratified separately by gender and use of anti-diabetes agents, the scenario within men, either regular or irregular users of anti-diabetes agents was the same as that for overall participants, while the association between alcohol drinking and glycemic management became non-significant among women.

CONCLUSIONS

Heavy alcohol drinking might have a negative effect on glycemic management among patients with type 2 diabetes irrespective of the use of anti-diabetes agents in regional China. This study has important public health implications regarding precision intervention on patients' glycemia control for type 2 diabetes management.

Food frequency questionnaire for foods high in sodium: Validation with the triads method

This study aimed to validate a food frequency questionnaire for foods high in sodium (FFQ-FHS) in a population aged ≥18 years and to test its reproducibility. This cross-sectional study included 50 individuals (≥18 years) of both sexes. In addition to the FFQ-FHS, four 24-h dietary recalls (24hRs) were conducted and a socioeconomic and lifestyle questionnaire was administered. Two 24-h urinary excretions were collected for sodium analysis, and anthropometry was performed. For validation, the triad method was applied using the validity coefficient (ρ). For reproducibility, the intraclass correlation coefficient (ICC), 95% confidence interval, kappa coefficient, and Bland-Altman plots were used to check for agreement. The Kolmogorov-Smirnov test was used to verify the data distribution. The validity coefficients for daily energy-adjusted sodium intake were high for the 24hR (ρRAI = 0.85) and weak for the FFQ-FHS (FFQAI = 0.26) and biomarker (ρBAI = 0.20). The ICC values were 0.68 for unadjusted sodium and 0.54 for energy-adjusted sodium intake. The weighed Kappa scores were 0.49 (p<0.01) and 0.260 (p = 0.02) for unadjusted and adjusted sodium intake, respectively. Although the FFQ-FHS is reproducible, it is not valid for the assessment of sodium intake and cannot be the sole instrument used for this purpose.

Validity of the food frequency questionnaire for adults in nutritional epidemiological studies: A systematic review and meta-analysis

As the most widely used tool for assessing dietary intake, the validity of food frequency questionnaires (FFQs) should be evaluated before application. A comprehensive search of the PubMed and Web of Science databases was conducted for publications from January 2000 to April 1, 2020. Pooled estimates were calculated for correlation coefficients and mean differences for energy and 61 nutrients between FFQs and standard methods. The literature search identified 130 articles that included 21,494 participants. Subgroup analyses according to the number of administrations of the reference method, sample size, administration methods, FFQ items, reference periods, quality of the studies, gender, and regions were also performed. We conducted a meta-analysis by summarizing the available evidence to comprehensively assess the validity of FFQs stratified by the reference method type (24-hour recall (24HRs) and food records (FRs). We also performed subgroup analyses to examine the impact on the final summary estimates. After a meta-analysis of the FFQs' validity correlation coefficients of the included studies, this study showed that the range (median) of the validity coefficients of the 24HRs as reference methods was 0.220-0.770 (0.416), and for the FRs, it was 0.173-0.735 (0.373), which indicated that FFQs were suitable to assess the overall dietary intake in nutritional epidemiological studies. The results of the subgroup analysis showed that the number of administrations of the reference method, administration mode, number of items, reference periods, sample size, and gender mainly affected the validity correlation of FFQs.Supplemental data for this article is available online at https://doi.org/10.1080/10408398.2021.1966737 .

Reproducibility and relative validity of a semi-quantitative food frequency questionnaire for the Chinese lactating mothers

Background

The dietary nutritional status of the lactating mothers is related to maternal health and has a significant impact on the growth and development of infants through the secretion of breast milk. The food frequency questionnaire (FFQ) is the most cost-effective dietary assessment method that can help obtain information on the usual dietary pattern of participants. Until now, the FFQs have been used for different populations in China, but there are few FFQs available for the lactating mothers. We aimed to develop a semi-quantitative, 156-item FFQ for the Chinese lactating mothers, and evaluate its reproducibility and relative validity.

Methods

A total of 112 lactating mothers completed two FFQs and one 3-d dietary record (3DR). The first FFQ (FFQ1) was conducted during postpartum at 60–65 days and the second FFQ (FFQ2) during subsequent follow-up at 5 weeks. The 3DR was completed with portion sizes assessed using photographs taken by the respondent before and after eating (instant photography) 1 week after FFQ1.

Results

For reproducibility, the Spearman’s correlation coefficients for food ranged from 0.34 to 0.68, and for nutrients from 0.25 to 0.61. Meanwhile, the intra-class correlation coefficients for food ranged from 0.48 to 0.87, and for nutrients from 0.27 to 0.70. For relative validity, the Spearman’s correlation coefficients for food ranged from 0.32 to 0.56, and for nutrients from 0.23 to 0.72. The energy-adjusted coefficients for food ranged from 0.26 to 0.55, and for nutrients from 0.22 to 0.47. Moreover, the de-attenuation coefficients for food ranged from 0.34 to 0.67, and for nutrients from 0.28 to 0.77. The Bland-Altman plots also showed reasonably acceptable agreement between the two methods.

Conclusions

This FFQ is a reasonably reproducible and a relative valid tool for assessing dietary intake of the Chinese lactating mothers.

A meta-analysis of the reproducibility of food frequency questionnaires in nutritional epidemiological studies

BACKGROUND

Reproducibility of FFQs measures the consistency of the same subject at different time points. We performed a meta-analysis to explore the reproducibility of FFQs and factors related to reproducibility of FFQs.

METHODS AND FINDINGS

A systematic literature review was performed before July 2020 using PubMed and Web of Science databases. Pooled intraclass and Spearman correlation coefficients (95% confidence interval) were calculated to assess the reproducibility of FFQs. Subgroup analyses based on characteristics of study populations, FFQs, or study design were performed to investigate factors related to the reproducibility of FFQs. A total of 123 studies comprising 20,542 participants were eligible for the meta-analysis. The pooled crude intraclass correlation coefficients ranged from 0.499 to 0.803 and 0.499 to 0.723 for macronutrients and micronutrients, respectively. Energy-adjusted intraclass correlation coefficients ranged from 0.420 to 0.803 and 0.507 to 0.712 for macronutrients and micronutrients, respectively. The pooled crude and energy-adjusted Spearman correlation coefficients ranged from 0.548 to 0.851 and 0.441 to 0.793, respectively, for macronutrients; and from 0.573 to 0.828 and 0.510 to 0.744, respectively, for micronutrients. FFQs with more food items, 12 months as dietary recall interval (compared to less than 12 months), and a shorter time period between repeated FFQs resulted in superior FFQ reproducibility.

CONCLUSIONS

In conclusion, FFQs with correlation coefficients greater than 0.5 for most nutrients may be considered a reliable tool to measure dietary intake. To develop FFQs with higher reproducibility, the number of food items and dietary recall interval should be taken into consideration.

Dietary nutrient intake related to higher grade cervical intraepithelial neoplasia risk: a Chinese population-based study

Background

Dietary nutrient intake plays a significant role in carcinogenesis. Few studies have investigated the association between dietary nutrient intake and cervical intraepithelial neoplasia (CIN) risk in China.

Methods

Data on 2304 women from an ongoing cohort comprising 40,000 women from China in 2014 were included. Study randomly selected 218 out of 2304 people as subjects during 2019. All participants were surveyed through in-person interviews, physical examinations, and laboratory tests. Clinical data were obtained from physical examinations and laboratory tests. Dietary intakes were assessed using a semiquantitative food frequency questionnaire. Nutrition intakes from 26 food sources were calculated using a comprehensive validated database. Descriptive statistics were used to describe the frequency and proportion, and mean and standard deviation of the demographic characteristics. Characteristics were examined for significant differences, and Pearson chi-square tests were used for categoric variables. Logistic regression was used to obtain odds ratios (ORs) and confidence intervals (CIs) for CIN risk in each nutrient intake quartile relative to that in the highest quartile.

Results

The food frequency questionnaire exhibited acceptable reproducibility and reasonable validity in assessing nutrient intakes among these women. After adjusting for multiple confounders, several dietary nutrients showed significant associations with CIN2+ risk. Low dietary folate intake was associated with the risk of CIN2+ (first versus fourth quartile: OR = 1.55, 95% CI 1.03–2.33). Similar results were also observed for vitamin B6 (OR = 1.63, 95% CI 1.08–2.46), vitamin C (OR = 1.59, 95% CI 1.05–2.42), niacin (OR = 1.65, 95% CI 1.08–2.51), and vitamin K (second versus fourth quartile: OR = 1.60, 95% CI 1.05–2.44).

Conclusions

Low folate; vitamin B6, C, and K; and niacin intakes were associated with CIN2+ risk. Nutrients may influence the development of higher grade CIN and cervical cancer.

Trial registration The study was registered in the Chinese Clinical Trial Register (ChiCTR-ROC-15006479) (https://www.chictr.org.cn).

Adjusting DBI-2016 to dietary balance index for Chinese maternal women and assessing the association between maternal dietary quality and postpartum weight retention: A longitudinal study

Diet is believed to play a major role in maternal recovery, postpartum weight retention (PPWR) is one of the challenges for Chinese women. However, the association between puerperal women’s diet and PPWR remained unclear and complicated in China. The study assessed the dietary quality of puerperal women using adjusted Chinese Dietary Balance Index-16 (DBI-16) and explored its associations with PPWR. Participants were enrolled in the Mother-Infant Cohort Study of China. Dietary intake and demographic characteristics were obtained by a semi-quantitative food frequency questionnaire and a self-designed questionnaire at 0–3 months postpartum. PPWR was calculated by the weight difference at 0-3months and 6-8months postpartum minus pre-pregnancy weight. Dietary quality was assessed using adjusted DBI-16. 316 puerperal women were enrolled. According to adjusted DBI-16, 84.8% of participants had an insufficient dietary intake (vegetables 84.8%, fruits 91.8%, dairy 87.3%, soybean 61.4% and aquatic foods 79.4%, respectively), 67.1% had an excessive intake (cereals 60%, meat 57.3% and eggs 64.9%, respectively), 98.4% had an imbalanced diet consumption. PPWR at 0–3, and 6–8 months were 6.0 (±5.1) kg and 5.2 (±7.7) kg, and the percentage of PPWR (≥5kg) were 63.0% and 52.8% respectively. Multivariable linear regression showed the intake of fish and shrimp at 0–3 months postpartum was negatively associated with PPWR at 6–8 months (β = -0.114, SE = 0.279, p < 0.05). The diet quality of Chinese puerperal women was unreasonable and imbalanced. Fish intake tended to be a favorable factor for postpartum weight loss.

Association between dietary inflammatory index and bone density in lactating women at 6 months postpartum: a longitudinal study

BACKGROUND

Chronic inflammation contributes to the risk of osteoporosis and fracture. Dietary Inflammatory Index (DII), a novel method appraising the inflammatory potential of diet, has been utilized to examine the association between diet and bone health among postmenopausal women or the elderly. However, its relationship with bone density (BD) in lactating women has not been studied.

METHODS

The prospective study was conducted to assess the possible association between DII and maternal BD during lactation. We enrolled 150 lactating women in the cohort. Participants were measured ultrasonic BD as baseline values at 1 month postpartum. After five-month follow up, the participants' BD were measured again. DII scores were calculated from semi-quantitative food frequency questionnaires (FFQ) and divided into tertiles. We compared the differences in the changes of BD at 6 months postpartum without or with adjustment for potential covariates across the tertiles.

RESULTS

The women in Q1 of DII scores had less bone mass loss than those in Q2 and Q3 without adjustment for any covariates (p < 0.01); after adjusting demographic characteristics such as BMI (kg/m2) at 6 months postpartum, educational level, metabolic equivalent (MET), daily energy intake (kcal/d), we found that participants in the highest tertile of DII scores had much more bone loss than those in the lowest tertile (p = 0.038). However, in the test for trend, no significant association between DII and the changes of maternal BD at 6 months postpartum was observed.

CONCLUSIONS

Chinese lactating women with higher DII scores have more bone mass loss; however significant differences and trends are attenuated and/or disappear depending on covariates and confounders that are taken into account in statistical analysis. The further study should be conducted in larger population to explore whether the significant association between DII and BD exists in Chinese lactating women.

Validation of a Quantitative Food Frequency Questionnaire for a Japanese Population in Hawaii

Objective: To measure the validity of a quantitative food frequency questionnaire (QFFQ). Design: A cross-sectional validation study of the QFFQ against a four-day food record (4DR) using Spearman correlation, cross-classification, kappa statistics, and Bland-Altman plotting. Setting: The Gastroenterology Department of Kaiser Permanente Hawaii. Subjects: 76 healthy Japanese American men and women, aged 40-75 years. Results: Somewhat stronger average correlations were observed between the QFFQ and the 4DR for macronutrients compared to micronutrients (Spearman rho of 0.47 vs. 0.35). Moderate correlations between the two tools were observed for macronutrients (including saturated fatty acids and dietary fibre), iron, β-carotene, vitamin C, and ethanol (rho: 0.38-0.58). Overall, stronger correlations were found among men than women between the two tools (mean rho 0.41 vs. 0.26). In a cross classification analysis, for more than 75% of the observations, a complete to relative agreement between the two methods was observed for fat, α-carotene, folate, vitamin D, and ethanol. Sex difference in agreement was minimal in cross-classification (overall extreme misclassification of 9.80% for men and 12.40% for women). Bland-Altman plots showed over-estimations of dietary fibre and α-carotene intake and an under-estimation of cholesterol intake by the QFFQ at high levels of consumption. However, the QFFQ estimation for fat, dietary fibre, folate, cholesterol, α-carotene, vitamins D and C, and ethanol intake was less than 7% different compared to the 4DR. Conclusions: The QFFQ has an adequate validity for fat, folate, vitamin D, and ethanol and can correctly categorize participants for intakes of cholesterol, dietary fibre, α-carotene, and zinc.

Re-look at socioeconomic inequalities in stroke prevalence among urban Chinese: is the inflexion approaching?

Background

The present association between socioeconomic status (SES) and stroke is positive in developing communities, but it is negative in developed countries where a positive SES-stroke relationship was recorded several decades ago. We hypothesized that the SES-stroke relationship in developing societies mirrors the trajectory of the Western countries at some stage of economic development. This study aimed to examine whether this inflexion is approaching in China.

Methods

This study comprises of two cross-sectional surveys conducted in the same urban areas of Nanjing, China in 2000 (S2000) and 2011 (S2011) using the same selection criteria (i.e., aged≥35 years) and sampling approach. Physician-diagnosed stroke was the outcome event, while family average income (FAI) was the explanatory variable and tertiled in our anlaysis. Mixed-effects models were used to examine the FAI-stroke association.

Results

Overall, 19,861 (response rate = 90.1%) and 7824 (response rate = 82.8%) participants participated in the S2000 and S2011, respectively. The prevalence of stroke increased by 2.5-folds (95%CI = 2.2, 2.9) from 2000 (2.1%, 95%CI = 1.9%, 2.3%) to 2011 (5.1%, 95%CI = 4.6%, 5.6%) (p < 0.01). Compared with the lower FAI category, the positive association between stroke prevalence and the higher FAI group decreased from 1.99 (95%CI = 1.55, 2.56) in 2000 to 1.49 (95%CI = 1.09, 2.03) in 2011 after control for potential confounders. A similar pattern was also observed for the middle FAI group (1.60, 95% CI = 1.23, 2.08 in 2000 vs. 1.37, 95%CI = 1.01, 1.88 in 2011).

Conclusions

This study revealed that socioeconomic inequalities in stroke were diminishing in regional China during the recent 11-year period, although the SES-stroke association was still positive. Tailored intervention against stroke should currently target on SES-vulnerable people.

Joint associations of dietary pattern and television viewing with CVD risk factors among urban men and women in China: a cross-sectional study

The purpose of this study was to investigate the joint associations of dietary pattern and television viewing with risk factors of CVD among urban adults in China. A community-based cross-sectional study was conducted among urban adults in Nanjing, China. Five dietary patterns were identified based on a FFQ. Television time was obtained from a standard questionnaire and further classified into two categories (≤7, >7 h/week). Multiple logistic regression was used to calculate the OR and 95 % CI for the separate and joint associations of dietary patterns and television viewing with CVD risk factors. Compared with other dietary patterns, participants who followed the healthy traditional pattern had a lower likelihood of abdominal obesity (AO) (OR 0·52; 95 % CI 0·41, 0·67). Participants watching television no more than 7 h/week presented a 19 and 21 % lower likelihood for hypertension (HT) and elevated total cholesterol (ETC) than those with television time >7 h/week. Individuals who had less television time and a healthy dietary pattern had a lower OR for the presence of AO (OR 0·48; 95 % CI 0·36, 0·65), HT (OR 0·71; 95 % CI 0·66, 0·77), ETC (OR 0·72; 95 % CI 0·57, 0·91) and elevated TAG (OR 0·76; 95 % CI 0·61, 0·95), compared with those who followed other dietary patterns and television time >7 h/week. In conclusion, both healthy traditional pattern and less television time are jointly associated with reduced levels of CVD risk factors. It has important public health implications regarding the precision prevention of CVD at population level.

Robotic Total Knee Arthroplasty with a Cruciate-Retaining Implant: A 10-Year Follow-up Study

Background

This study compared clinical and radiological results between robotic total knee arthroplasty (TKA) and conventional TKA with a cruciate-retaining implant at 10-year follow-up. The hypothesis was that robotic TKA would allow for more accurate leg alignment and component placement, and thus enhance clinical and radiological results and long-term survival rates.

Methods

A total of 113 primary TKAs performed using a cruciate-retaining implant in 102 patients from 2004 to 2007 were reviewed retrospectively. Of the 113 TKAs, 71 were robotic TKAs and 42 were conventional TKAs. Clinical outcomes (visual analogue scale pain score, Hospital for Special Surgery score, Western Ontario and McMaster University score, range of motion, and complications), radiological outcomes, and long-term survival rates were evaluated at a mean follow-up of 10 years.

Results

Clinical outcomes and long-term survival rates were similar between the two groups. Regarding the radiological outcomes, the robotic TKA group had significantly fewer postoperative leg alignment outliers (femoral coronal inclination, tibial coronal inclination, femoral sagittal inclination, tibial sagittal inclination, and mechanical axis) and fewer radiolucent lines than the conventional TKA group.

Conclusions

Both robotic and conventional TKAs resulted in good clinical outcomes and postoperative leg alignments. Robotic TKA appeared to reduce the incidence of leg alignment outliers and radiolucent lines compared to conventional TKA.

Effectiveness of a Randomized Controlled Lifestyle Intervention to Prevent Obesity among Chinese Primary School Students: CLICK-Obesity Study

Background

Childhood obesity has been increasing rapidly worldwide. There is limited evidence for effective lifestyle interventions to prevent childhood obesity worldwide, especially in developing countries like China. The objective of this study was to assess the effectiveness of a school-based multi-component lifestyle childhood obesity prevention program (the CLICK-Obesity study) in Mainland China.

Methods

A cluster randomized controlled trial was developed among grade 4 students from 8 urban primary schools (638 students in intervention, 544 as control) in Nanjing City, China. Students were randomly allocated to the control or intervention group at school-level. A one-year multi-component intervention program (classroom curriculum, school environment support, family involvement and fun programs/events) together with routine health education was provided to the intervention group, while the control group received routine health education only. The main outcome variables assessed were changes in body mass index, obesity occurrence, obesity-related lifestyle behaviors and knowledge.

Results

Overall, 1108 (93.7%) of the 1182 enrolled students completed the intervention study. The intervention group had a larger marginal reduction than did the control group in overall mean BMI value (-0.32±1.36 vs. -0.29±1.40, p = 0.09), although this was not significant. Compared with the control group, the intervention group was more likely to decrease their BMI (OR = 1.44, 95%CI = 1.10, 1.87) by 0.5 kg/m² or above, increase the frequency of jogging/running (OR = 1.55, 95%CI = 1.18, 2.02), decrease the frequency of TV/computer use (OR = 1.41, 95%CI = 1.09, 1.84) and of red meat consumption (OR = 1.50, 95%CI = 1.15, 1.95), change commuting mode to/from school from sedentary to active mode (OR = 2.24, 95%CI = 1.47, 3.40), and be aware of the harm of selected obesity risk factors.

Conclusions

The school-based lifestyle intervention program was practical and effective in improving health behaviors and obesity-related knowledge for children in China. This study provides important policy implications on school-based intervention programs for modifications of obesity-related lifestyles.

Trial Registration

Chinese Clinical Trial Registry ChiCTR-ERC-11001819

Reproducibility and Validity of a Food Frequency Questionnaire for Assessing Dietary Consumption via the Dietary Pattern Method in a Chinese Rural Population

Objective

This study was conducted to assess the reproducibility and validity of a food frequency questionnaire (FFQ) that was developed to assess the overall dietary consumption via dietary pattern method in a rural population in southwest China.

Methods

A total of 179 participants aged between 40 and 70 years old were included in this study. Participants administered FFQ at baseline (FFQ1) and one year later (FFQ2) to assess the reproducibility. Six 3-day 24-hour recalls (24HRs) were completed between the administrations of two FFQs to determine the validity. Dietary patterns from three separate dietary sources were derived by using principle component factor analysis. Comparisons between dietary pattern scores were made by using Pearson or intraclass correlation coefficient, cross-classification analysis, weighted kappa (κ) statistic and Bland-Altman analysis. The de-attenuated method was adopted to correct the monthly and seasonally variation and the partial correlation analysis was used correct the influence by total energy intake.

Results

Two major dietary factors, labeled as prudent pattern and processed food pattern, were identified. The prudent pattern was characterized by higher factor loadings of wheat, rice, fresh vegetables, bean products, nuts, red meat, white meat and fresh eggs; and the processed food pattern was characterized by higher factor loadings of pickled vegetables, preserved vegetables and salted meat. Between Two FFQs, intraclass correlation coefficients were 0.57 for prudent pattern and 0.55 for processed food pattern, partial Pearson correlation coefficients were 0.51 for the prudent pattern and 0.56 for the processed food pattern; weighted κ statistic ranged from 0.45 (for the prudent pattern) to 0.56 (for the processed food pattern). Between FFQs and 24HRs, de-attenuated correlation coefficients ranged from 0.54 to 0.78 for the prudent pattern and from 0.55 to 0.61 for the processed food pattern; partial Pearson correlation coefficients ranged from 0.41 to 0.56 for the prudent pattern and from 0.42 to 0.44 for the processed food pattern; weighted κ statistic ranged from 0.42 to 0.46 for prudent pattern and from 0.43 to 0.60 for processed food pattern. The Bland-Altman plots and limits of agreement indicated that the deviation/divergence was not obvious for both of the patterns between FFQ1 and FFQ2 and between FFQs and 24HRs.

Conclusion

The study suggests that the FFQ is reasonably reproducible and valid to assess the overall dietary consumption via dietary pattern methods in the Chinese rural population.

Dietary patterns and the incidence of hyperglyacemia in China

OBJECTIVE

Epidemiological studies have examined associations between dietary patterns and the risk of type 2 diabetes. However, information on dietary patterns and the risk of type 2 diabetes in Chinese populations is scarce. The aim of the present study was to identify dietary patterns and examine their association with incident hyperglycaemia in Nanjing, China.

DESIGN

A community-based prospective cohort study. Dietary assessment was carried out using a validated eighty-seven-item FFQ. Dietary patterns were identified by exploratory factor analysis. Participants were categorized into tertiles of dietary factor score for each dietary pattern. The relationship between dietary patterns and hyperglycaemia risk was analysed using multivariable linear and Cox regression.

SETTING

Seven communities from two urban districts in Nanjing, China.

SUBJECTS

A total of 2900 of Chinese local residents aged 30 years or above, free of hyperglycaemia and other serious diseases, who participated in the baseline survey from June to September 2007 were followed up 3 years later from June to September 2010 for the development of hyperglycaemia. Fasting blood samples were collected at both baseline and 3-year follow-up surveys. Hyperglycaemia was defined as fasting plasma glucose concentration of ≥6·1 mmol/l or already taking oral hyperglycaemia agents for treatment of type 2 diabetes.

RESULTS

Five major dietary patterns were identified: (i) the 'condiments' pattern; (ii) the 'animal and plant protein' pattern; (iii) the 'healthy traditional' pattern; (iv) the 'fruits, eggs and juice' pattern; and (v) the 'alcohol, milk and tea' pattern. A total of 2093 (72·2 %) individuals completed the follow-up survey and the 3-year cumulative incidence of hyperglycaemia was 7·5 % (158/2093). A 1-unit increase in the score for the 'healthy traditional' pattern was associated with a decrease of 0·054 mmol/l in fasting plasma glucose (P=0·017), while a 1-unit increase in the 'fruits, eggs and juice' pattern score was associated with an increase of 0·050 mmol/l in fasting plasma glucose (P=0·023) by multivariable linear regression. For men, tertile 3 of the 'fruits, eggs and juice' pattern was associated with an 88 % greater risk (hazard ratio=1·88; 95 % CI 1·04, 3·54) of hyperglycaemia than tertile 1 of this pattern. Being in tertile 3 of the 'alcohol, milk and tea' pattern was associated with a 35 % greater risk (hazard ratio=1·35; 95 % CI 1·04, 2·16) relative to tertile 1 in women, while for the ''healthy traditional' pattern tertile 3 was associated with a 41 % lower risk (hazard ratio=0·59; 95 % CI 0·35, 0·99) compared with tertile 1. The 'condiments' and the 'animal and plant protein' patterns were not independently associated with hyperglycaemia.

CONCLUSIONS

Our findings suggest that modifying dietary patterns could reduce hyperglycaemia incidence in the mainland Chinese adult population.

Development, validation, and use of a semi-quantitative food frequency questionnaire for assessing protein intake in Papua New Guinean Highlanders

OBJECTIVES

The aim of this article was to develop a semi-quantitative food frequency questionnaire (FFQ) and evaluate its validity to estimate habitual protein intake, and investigate current dietary protein intakes of Papua New Guinea (PNG) Highlanders.

METHODS

A 32-item FFQ was developed and tested among 135 healthy male and female volunteers. The FFQ-estimated daily total and animal protein intakes were compared with biomarkers and 3-day Weighed Food Records (WFR) by correlation analyses, Bland-Altman plot analyses and joint classification analyses.

RESULTS

The FFQ-estimated total protein intake significantly correlated with urinary nitrogen in the first morning void after adjusting urinary creatinine concentration (r = 0.28, P < 0.01) and the FFQ-estimated animal protein intake significantly correlated with the hair δ(15) N (Spearman's r = 0.34, P < 0.001). The limits of agreement were ±2.39 Z-score residuals for total protein intake and ±2.19 Z-score for animal protein intake, and intra-individual differences increased as protein intake increased. The classification into the same and adjacent quartiles was 66.0% for total protein intake and 73.6% for animal protein intake. Median daily total and animal protein intake estimates from the FFQ and the 3-day WFR showed a good agreement with differences of 0.2 and 4.9 g, respectively. None of the studied communities in the PNG Highlands met the biologically required protein intake; although the community closer to an urban center showed higher protein intake than the more remote communities.

CONCLUSIONS

The newly developed 32-item FFQ for PNG Highlanders is applicable for evaluation of protein intake at the individual level. Am. J. Hum. Biol. 27:349-357, 2015. © 2014 Wiley Periodicals, Inc.

A school-based comprehensive lifestyle intervention among Chinese kids against Obesity (CLICK-Obesity) in Nanjing City, China: the baseline data

BACKGROUND

urgent development of effective interventions to prevent rapidly rising childhood obesity in China is needed.

METHODS

Between May 2010 and December 2013, a cluster randomized controlled trial was conducted among 4th graders in eight urban primary schools randomly assigned to intervention or control groups in Nanjing, China. A multi-component intervention program was implemented within the treatment group, while students in the control group followed their usual health education curriculum without additional intervention.

RESULTS

At baseline, 638 and 544 students were enrolled in the intervention and control group, respectively. The prevalence of excess body weight was 26.8%, with 27.4% in the intervention group and 26.1% in the control group (p=0.61). The mean (SD) BMI and WC was 18.7 (3.0) and 63.0 (9.2) for participants in intervention schools, and 18.5 (2.9) and 63.6 (8.7) for students in control group, separately (p=0.24 and 0.41, respectively). Compared to those who were not aware of what lifestyle/behavior factors were unhealthy, students who were aware of the unhealthy lifestyle/ behavior factors consumed fewer fried snacks (0.46±0.76 serves/week vs 0.65±0.91 serves/week; p<0.01), soft drinks (160±194 ml/week vs 199±227 ml/week; p<0.01), but larger amount of meat (502±429 g/week vs 449±344 g/week; p=0.03), and reported less screen time (214±232 minutes/week vs 252±264 minutes/week; p<0.01). Moreover, there was no difference within physical activity time between these two groups (257±341 minutes/week vs 218±324 minutes/week; p=0.13).

CONCLUSIONS

Main characteristics of participants were balanced at baseline within intervention and control schools, but a gap existed between healthy lifestyle knowledge and actual healthy behavior in students.

TRIAL REGISTRATION NUMBER

ChiCTR-ERC-11001819.

Joint associations of physical activity and hypertension with the development of type 2 diabetes among urban men and women in Mainland China

BACKGROUND

Physical activity (PA) and hypertension (HTN) are important influences on the development of type 2 diabetes (T2D). However, the joint impact of PA and HTN on T2D development is unknown.

METHODS

Two community-based prospective cohort studies, with the same protocols, instruments and questionnaires, were conducted among adults in urban areas of Nanjing, China, during 2004-2007 and 2007-2010. T2D was defined using World Health Organization criteria based on physicians' diagnosis and fasting blood glucose concentration. PA level (sufficient/insufficient) and blood pressure status (hypertensive/normotensive) were assessed at baseline and the third year of follow-up. We pooled and analyzed data from these two studies.

RESULTS

Among 4550 participants aged 35 years or older, the three-year cumulative incidence of T2D was 5.1%. After adjusting for potential confounders, participants with sufficient PA were less likely to develop T2D than those with insufficient PA (OR = 0.43, 95%CI = 0.27, 0.68) and those who were normotensive were less likely to develop T2D than those who were hypertensive (OR = 0.39, 95%CI = 0.29, 0.51). Compared to participants with insufficient PA and who were hypertensive, those with sufficient PA and hypertension were at lower risk of developing T2D (OR = 0.36, 95%CI = 0.19, 0.69), as were those with insufficient PA who were normotensive (OR = 0.37, 95%CI = 0.28, 0.50) and those with sufficient PA who were normotensive (OR = 0.19, 95%CI = 0.10, 0.37).

CONCLUSIONS

Insufficient PA was found to be associated with the development of T2D among adults with and without hypertension. These findings support a role for promoting higher physical activity levels to lower T2D risk in both hypertensive and non-hypertensive individuals.

Repeatability and relative validity of a quantitative food-frequency questionnaire among French adults

BACKGROUND

A 50-item self-administered food frequency questionnaire (FFQ) was developed for French adults, to assess the intake of energy, 10 macronutrients, 11 vitamins, and 11 minerals, and to be used in the context of a medical consultation.

OBJECTIVE

To assess the repeatability and relative validity of this FFQ compared to a 7-day diet record (7-DR).

DESIGN

A total of 54 and 100 French adults were included in the repeatability and validation studies, respectively. Repeatability was assessed using two FFQs, the second carried out 3 weeks after the first. In the validation study, subjects first completed the FFQ, then the 7-DR the following week. Energy and nutrient intakes were compared using Pearson correlation. The degree of misclassification by the FFQ, compared to the 7-DR, was calculated by a contingency table of quintiles. Bland-Altman plots assessed the correlation between FFQ and 7-DR across the intake range.

RESULTS

Repeatability for intake, explored by Pearson correlation, was 0.62-0.90 (median: 0.81). Relative validity, as determined by Pearson correlation for the nutrient intake derived from the FFQ and 7-DR, was 0.36-0.80 (0.64). The FFQ tended to report higher fiber and micronutrient intake than 7-DR. Misclassification into opposite quintiles ranged 0-6% (1%), whereas classification into same or adjacent quintiles ranged 59-83% (74%). Bland-Altman plots showed good agreement for most nutrients across the range of intake.

CONCLUSION

This new FFQ showed a high repeatability and good relative validity, and thanks to its short length, should be a useful tool for rapidly evaluating the nutrient intake of French adults.

A school-based comprehensive lifestyle intervention among chinese kids against obesity (CLICK-Obesity): rationale, design and methodology of a randomized controlled trial in Nanjing city, China

BACKGROUND

The prevalence of childhood obesity among adolescents has been rapidly rising in Mainland China in recent decades, especially in urban and rich areas. There is an urgent need to develop effective interventions to prevent childhood obesity. Limited data regarding adolescent overweight prevention in China are available. Thus, we developed a school-based intervention with the aim of reducing excess body weight in children. This report described the study design.

METHODS/DESIGN

We designed a cluster randomized controlled trial in 8 randomly selected urban primary schools between May 2010 and December 2013. Each school was randomly assigned to either the intervention or control group (four schools in each group). Participants were the 4th graders in each participating school. The multi-component program was implemented within the intervention group, while students in the control group followed their usual health and physical education curriculum with no additional intervention program. The intervention consisted of four components: a) classroom curriculum, (including physical education and healthy diet education), b) school environment support, c) family involvement, and d) fun programs/events. The primary study outcome was body composition, and secondary outcomes were behaviour and behavioural determinants.

DISCUSSION

The intervention was designed with due consideration of Chinese cultural and familial tradition, social convention, and current primary education and exam system in Mainland China. We did our best to gain good support from educational authorities, school administrators, teachers and parents, and to integrate intervention components into schools' regular academic programs. The results of and lesson learned from this study will help guide future school-based childhood obesity prevention programs in Mainland China.

TRIAL REGISTRATION

REGISTRATION NUMBER

ChiCTR-ERC-11001819.

Reliability and relative validity of a quantitative food-frequency questionnaire for use among adults in Italian population

Our objective was to assess the reliability and relative validity of a food frequency questionnaire (FFQ) among adult people. In a cross-sectional study carried out in northern Italy, 112 adults were recruited. A total of 189 food and drink items were selected according to those typically consumed by Italians. FFQ reliability was assessed by two repeated administrations at 6 weeks. The FFQ was validated using four 24-h recalls repeated in the same period of time. For the validation study, classification into quartiles from the two methods and Bland-Altman plot were also performed. The reliability study showed a good correlation between the two methods. Bland-Altman plots showed that the two methods are very likely to agree for individual energy and macronutrient intakes. The reliability and relative validity of this FFQ was good, supporting its use in assessing dietary intakes of Italians in nutritional surveillance programs and in epidemiological dietary surveys.

Diet, activity, and other lifestyle risk factors for forearm fracture in postmenopausal women in China: a case-control study

OBJECTIVE

Forearm fractures are a major cause of disability in postmenopausal women, but the risk factors have not been previously studied in China and the results from Western studies may not be applicable to the Chinese population. The aim of this study was to determine whether calcium intake, activity level, lifestyle, and other factors are associated with risk of forearm fracture among Chinese postmenopausal women.

DESIGN

In this case-control study, the authors used a structured questionnaire to assess potential risk factors in 209 postmenopausal women 50 to 70 years old with new forearm fractures identified in eight hospitals in Chengdu and in age and location of residence-matched control subjects randomly selected from the community.

RESULTS

Adjusted odds ratios (95% CIs) were as follows: each quintile increase in current energy intake 0.46 (0.36, 0.60); fifth quintile energy-adjusted current calcium intake versus lowest quintile, 0.17 (0.06, 0.47); eating bean products when 30 to 49 years old, 0.15 (0.05, 0.47); eating meat, 0.13 (0.02, 0.74) and eating pork ribs, 0.37 (0.17, 0.83) when 16 to 29 years old; greater past activity, 0.78 (0.68, 0.89) and present activity, 0.84 (0.74-0.96); greater height (per centimeter), 1.12 (1.06, 1.20); each year irregular menses before menopause, 1.25 (1.04, 1.49); each floor of residence, 1.71 (1.38, 2.12); and prior fracture in first- or second-degree relatives, 2.74 (1.08, 6.92).

CONCLUSION

Some risk factors for forearm fractures were similar to those described in white women, whereas others were specific to this ethnic setting, and would need to be considered in future preventive programs.

New evidence on variations of human body burden of methylmercury from fish consumption

Epidemiologic studies commonly use mercury (Hg) level in hair as a valid proxy to estimate human exposure to methylmercury (MeHg) through fish consumption. This study presents the results yielded by a complete data set on fish consumption habits, Hg levels in edible fish resources, and corresponding Hg accumulation in hair, gathered in three distinct communities of eastern Canada. For one of these communities, the average hair Hg concentration was 14 times less than the expected value based on calculated daily oral exposure and current knowledge of MeHg metabolism. This finding could be explained by differences in specific genetic characteristics and/or interactive effects of other dietary components.