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Landberg R, Karra P, Hoobler R, Loftfield E, Huybrechts I, Rattner JI, Noerman S, Claeys L, Neveu V, Vidkjaer NH, Savolainen O, Playdon MC, Scalbert A. Dietary biomarkers-an update on their validity and applicability in epidemiological studies. Nutr Rev 2024; 82:1260-1280. [PMID: 37791499 PMCID: PMC11317775 DOI: 10.1093/nutrit/nuad119] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023] Open
Abstract
The aim of this literature review was to identify and provide a summary update on the validity and applicability of the most promising dietary biomarkers reflecting the intake of important foods in the Western diet for application in epidemiological studies. Many dietary biomarker candidates, reflecting intake of common foods and their specific constituents, have been discovered from intervention and observational studies in humans, but few have been validated. The literature search was targeted for biomarker candidates previously reported to reflect intakes of specific food groups or components that are of major importance in health and disease. Their validity was evaluated according to 8 predefined validation criteria and adapted to epidemiological studies; we summarized the findings and listed the most promising food intake biomarkers based on the evaluation. Biomarker candidates for alcohol, cereals, coffee, dairy, fats and oils, fruits, legumes, meat, seafood, sugar, tea, and vegetables were identified. Top candidates for all categories are specific to certain foods, have defined parent compounds, and their concentrations are unaffected by nonfood determinants. The correlations of candidate dietary biomarkers with habitual food intake were moderate to strong and their reproducibility over time ranged from low to high. For many biomarker candidates, critical information regarding dose response, correlation with habitual food intake, and reproducibility over time is yet unknown. The nutritional epidemiology field will benefit from the development of novel methods to combine single biomarkers to generate biomarker panels in combination with self-reported data. The most promising dietary biomarker candidates that reflect commonly consumed foods and food components for application in epidemiological studies were identified, and research required for their full validation was summarized.
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Affiliation(s)
- Rikard Landberg
- Division of Food and Nutrition Science, Department of Life Sciences, Chalmers University of Technology, Gothenburg, Sweden
| | - Prasoona Karra
- Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, UT, USA
- Cancer Control and Population Sciences Program, Huntsman Cancer Institute, University of Utah Salt Lake City, UT, USA
| | - Rachel Hoobler
- Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, UT, USA
- Cancer Control and Population Sciences Program, Huntsman Cancer Institute, University of Utah Salt Lake City, UT, USA
| | - Erikka Loftfield
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Inge Huybrechts
- International Agency for Research on Cancer, Nutrition and Metabolism Branch, Lyon, France
| | - Jodi I Rattner
- International Agency for Research on Cancer, Nutrition and Metabolism Branch, Lyon, France
| | - Stefania Noerman
- Division of Food and Nutrition Science, Department of Life Sciences, Chalmers University of Technology, Gothenburg, Sweden
| | - Liesel Claeys
- International Agency for Research on Cancer, Molecular Mechanisms and Biomarkers Group, Lyon, France
| | - Vanessa Neveu
- International Agency for Research on Cancer, Nutrition and Metabolism Branch, Lyon, France
| | - Nanna Hjort Vidkjaer
- Division of Food and Nutrition Science, Department of Life Sciences, Chalmers University of Technology, Gothenburg, Sweden
| | - Otto Savolainen
- Division of Food and Nutrition Science, Department of Life Sciences, Chalmers University of Technology, Gothenburg, Sweden
| | - Mary C Playdon
- Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, UT, USA
- Cancer Control and Population Sciences Program, Huntsman Cancer Institute, University of Utah Salt Lake City, UT, USA
| | - Augustin Scalbert
- International Agency for Research on Cancer, Nutrition and Metabolism Branch, Lyon, France
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Sam CHY, Skeaff S, Skidmore PML. A comprehensive FFQ developed for use in New Zealand adults: reliability and validity for nutrient intakes. Public Health Nutr 2014; 17:287-96. [PMID: 23199788 PMCID: PMC10282265 DOI: 10.1017/s1368980012005058] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Revised: 09/18/2012] [Accepted: 09/21/2012] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To evaluate the reliability and relative validity of a semi-quantitative FFQ for assessing the habitual intake of multiple nutrients in New Zealand (NZ) adults over the past 12 months. DESIGN A 154-item FFQ was developed. After initial pre-testing, reliability was assessed using intra-class correlations. Relative validity was assessed by comparing nutrient intakes derived from the FFQ v. those from an 8 d diet record (8dWDR) collected over 12 months and selected blood biomarkers, using Spearman correlations. Supplementary cross-classification and Bland-Altman analyses were performed to assess validity of the FFQ v. the 8dWDR. SETTING Dunedin, NZ. SUBJECTS One hundred and thirty-two males and females aged 30-59 years who completed all FFQ and 8dWDR and provided a blood sample. RESULTS Reliability coefficients ranged from 0·47 for Ca to 0·83 for alcohol, with most values falling between 0·60 and 0·80. The highest validity coefficients for energy-adjusted data were observed for alcohol (0·74), cholesterol (0·65) and β-carotene (0·58), and the lowest for Zn (0·24) and Ca (0·28). For all energy-adjusted nutrients mean percentage correct classification was 77·9% and gross misclassification was 4·5%. Results of Bland-Altman analyses showed wide limits of agreement for all micronutrients but high agreement was observed for most macronutrients (99% for protein, 103% for total fat). When compared with biomarkers, energy-adjusted coefficients were 0·34 for β-carotene and 0·33 for vitamin C. CONCLUSIONS The FFQ provides highly repeatable measurements and good validity in ranking individuals' intake, suggesting that it will be a useful tool to assess nutrient intake of NZ adults in future research.
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Affiliation(s)
- Cecilia HY Sam
- Department of Human Nutrition, University of Otago, PO Box 56, Dunedin, New Zealand
| | - Sheila Skeaff
- Department of Human Nutrition, University of Otago, PO Box 56, Dunedin, New Zealand
| | - Paula ML Skidmore
- Department of Human Nutrition, University of Otago, PO Box 56, Dunedin, New Zealand
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Dietary assessment methods for micronutrient intake: a systematic review on vitamins. Br J Nutr 2012; 102 Suppl 1:S10-37. [PMID: 20100364 DOI: 10.1017/s0007114509993126] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The EURRECA Network of Excellence is working towards the development of aligned micronutrient recommendations across Europe. The purpose of the present study was to define how to identify dietary intake validation studies in adults pertaining to vitamins. After establishing a search strategy, we conducted a MEDLINE and EMBASE literature review. A scoring system was developed to rate the quality of each validation study according to sample size, statistical methods, data collection procedure, seasonality and vitamin supplement use. This produced a quality index with possible scores obtained ranging from 0.5 to 7. Five thousand four-hundred and seventy-six papers were identified. The numbers meeting the inclusion criteria were: for vitamin A, 76; vitamin C, 108; vitamin D, 21; vitamin E, 75; folic acid, 47; vitamin B12, 19; vitamin B6, 21; thiamine, 49; riboflavin, 49; and niacin, 32. The most frequently used method to ascertain dietary intake was the Food Frequency Questionnaire (FFQ), whereas dietary records (DR) and 24-h recalls were the most used reference methods. The correlation coefficients (CC) between vitamin intakes estimated by FFQ and the reference method were weighted according to the study's quality index and ranged from 0.41 to 0.53 when the reference method was the DR and from 0.43 to 0.67 when the reference was 24-h recalls. A minority of studies (n 33) used biomarkers for validation and in these the CC ranged from 0.26 to 0.38. The FFQ is an acceptable method of assessing vitamin intake. The present review provides new insights regarding the characteristics that assessment methods for dietary intake should fulfil.
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Cade JE, Burley VJ, Warm DL, Thompson RL, Margetts BM. Food-frequency questionnaires: a review of their design, validation and utilisation. Nutr Res Rev 2009; 17:5-22. [PMID: 19079912 DOI: 10.1079/nrr200370] [Citation(s) in RCA: 333] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
A review of the literature concerning the design, utilisation and validation of food-frequency questionnaires (FFQ) has been carried out using a semi-systematic approach to obtaining, reviewing and extracting data from articles. Databases were searched from 1980 to 1999. The present review identified 227 validation (from 1980 to September 1999) and 164 utilisation (for 1998 only) studies. A number of design issues have been evaluated through the present review. These include: the need to consider how portion sizes have been described, self-defined giving higher mean correlations; how an FFQ was administered, interviewer-administered giving higher mean correlations for some nutrients; how many items to include on an FFQ, those with the largest number of items having higher correlations. Validation techniques were described. Most validation studies involved comparing an FFQ against another dietary assessment method; only 19 % compared an FFQ to a biomarker. Measurement differences were most commonly assessed by correlation coefficients as opposed to other more appropriate methods. Mean correlation coefficients were highest for Ca and fat, and lowest for vitamin A and vegetables. The utilisation studies showed that FFQ were most commonly used in cross-sectional surveys, with ninety-three of the FFQ being designed to be disease-specific. The present review results were presented to a group of experts and a consensus arrived at concerning the development, validation and use of FFQ. Recommendations derived from the consensus arising from the literature review are presented as an appendix to the present paper.
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Affiliation(s)
- J E Cade
- Nutritional Epidemiology Group, University of Leeds, Leeds LS2 9JT, UK.
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Männistö S, Smith-Warner SA, Spiegelman D, Albanes D, Anderson K, van den Brandt PA, Cerhan JR, Colditz G, Feskanich D, Freudenheim JL, Giovannucci E, Goldbohm RA, Graham S, Miller AB, Rohan TE, Virtamo J, Willett WC, Hunter DJ. Dietary carotenoids and risk of lung cancer in a pooled analysis of seven cohort studies. Cancer Epidemiol Biomarkers Prev 2004; 13:40-8. [PMID: 14744731 DOI: 10.1158/1055-9965.epi-038-3] [Citation(s) in RCA: 116] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Intervention trials with supplemental beta-carotene have observed either no effect or a harmful effect on lung cancer risk. Because food composition databases for specific carotenoids have only become available recently, epidemiological evidence relating usual dietary levels of these carotenoids with lung cancer risk is limited. We analyzed the association between lung cancer risk and intakes of specific carotenoids using the primary data from seven cohort studies in North America and Europe. Carotenoid intakes were estimated from dietary questionnaires administered at baseline in each study. We calculated study-specific multivariate relative risks (RRs) and combined these using a random-effects model. The multivariate models included smoking history and other potential risk factors. During follow-up of up to 7-16 years across studies, 3,155 incident lung cancer cases were diagnosed among 399,765 participants. beta-Carotene intake was not associated with lung cancer risk (pooled multivariate RR = 0.98; 95% confidence interval, 0.87-1.11; highest versus lowest quintile). The RRs for alpha-carotene, lutein/zeaxanthin, and lycopene were also close to unity. beta-Cryptoxanthin intake was inversely associated with lung cancer risk (RR = 0.76; 95% confidence interval, 0.67-0.86; highest versus lowest quintile). These results did not change after adjustment for intakes of vitamin C (with or without supplements), folate (with or without supplements), and other carotenoids and multivitamin use. The associations generally were similar among never, past, or current smokers and by histological type. Although smoking is the strongest risk factor for lung cancer, greater intake of foods high in beta-cryptoxanthin, such as citrus fruit, may modestly lower the risk.
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Affiliation(s)
- Satu Männistö
- Harvard School of Public Health, Department of Nutrition, Boston, Massachusetts, USA
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Abstract
Many studies have examined the impact of single nutrients on neural tube defect (NTD) risk, particularly folate. The impact of dietary patterns or nutrients in combination has received much less attention. This study examines the association of diet quality with NTD risk, using food frequency data from a population-based case-control study of NTDs (n=454 cases and 462 controls). The diet quality score was based on low (<10th percentile among controls) versus high (>90th percentile) values for intakes of iron, vitamins B(6) and A, calcium, folate, and percentage of kilocalories from fat and from sweets (range=0-14). Women with a low score (i.e., <4, or <10th percentile) had an elevated risk of an NTD-affected pregnancy (odds ratio 1.6, 95% CI 1.0-2.6). Stratified analyses suggested that the effect may be restricted to certain groups of women who may be at greater nutritional risk (i.e., women who did not take vitamin supplements or regularly consume breakfast cereals before pregnancy).
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Affiliation(s)
- Suzan L Carmichael
- March of Dimes Birth Defects Foundation/California Birth Defects Monitoring Program, Oakland 94606, USA.
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Marshall JR. Methodologic and statistical considerations regarding use of biomarkers of nutritional exposure in epidemiology. J Nutr 2003; 133 Suppl 3:881S-887S. [PMID: 12612174 DOI: 10.1093/jn/133.3.881s] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
In nutritional epidemiology, accurate quantification of nutritional exposure is critical. Even moderate flaws in measurement can lead to sizeable distortions in estimations of the effects of exposure. In many situations, this will lead to inaccurate direct estimation of exposure effects. In others, it will make it difficult to control for the confounding effects of nutritional exposure. Biomarkers offer important opportunities to advance research in nutritional epidemiology; their objectivity and potentially greater accuracy give them the potential to substantially lessen distortions that might result from imperfect measurements. Clearly, the accuracy of biomarkers as indicators of nutritional exposure is critical to their value. It is likely that establishing the accuracy of biomarkers will require some reference to self-reports, even if those reports are not as accurate as the biomarkers they are used to test. The goal of this paper is to describe aspects of accuracy-reproducibility, reliability and validity-as they apply to biomarkers in nutritional epidemiology.
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Fowke JH, Hebert JR, Fahey JW. Urinary excretion of dithiocarbamates and self-reported Cruciferous vegetable intake: application of the 'method of triads' to a food-specific biomarker. Public Health Nutr 2002; 5:791-9. [PMID: 12570887 DOI: 10.1079/phn2002345] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Greater intake of Cruciferous vegetables (e.g. broccoli) may prevent cancer at several sites. Urinary excretion of isothiocyanate conjugates (dithiocarbamates, DTC) provides a specific biomarker of Cruciferous vegetable consumption suitable for epidemiological investigations. However, no gold-standard referent is available for evaluating urinary DTC levels as an estimator of Cruciferous vegetable consumption. We compared urinary DTC levels to intake as measured by two self-reported dietary assessment techniques. DESIGN Cruciferous vegetable consumption was measured before and after a behavioural dietary intervention using multiple 24-hour recalls (24HR), a food-counting questionnaire (VFQ) and urinary DTC excretion levels. Analysis included a structural equation approach (Method of Triads) combining these three assessment techniques to estimate the relationship between DTC level and the study population's 'true' Cruciferous vegetable intake. SETTING The intervention curriculum assisted participants in consuming about 2 servings per day for a 6-week period. Participants attended four classes emphasising problem-solving skills, dietary counselling and vegetable preparation skills. There were no dietary restrictions. SUBJECTS Thirty-three healthy, free-living, post-menopausal women. RESULTS Although few participants reported Cruciferae consumption prior to the intervention, 30 participants reported Cruciferae consumption after the intervention (Post-intervention). Urinary DTC levels were correlated with estimated intake derived from either the 24HR (r = 0.57; 95% confidence interval (95% CI) 0.28, 0.76) or VFQ (r =0.49; 95% CI 0.17, 0.71). The validity coefficient (Method of Triads) between urinary DTC excretion and an index of true Cruciferous intake was stronger than the Pearson correlation (r(v) = 0.65; 95% CI 0.35, 0.90), and comparable to estimates derived from the 24HR (r(v) = 0.82; 95% CI 0.65, 1.00) or VFQ (r(v) = 0.76; 95% CI 0.47, 0.92) method. These associations were not affected by adjustment for body mass index, energy intake, or social approval or desirability response sets. CONCLUSIONS Food-frequency questionnaires (FFQ) suitable for large epidemiological studies may not be designed to measure all Cruciferae, and cannot capture exposure to phytochemicals derived from those vegetables. Urinary DTC measurement was significantly correlated with Cruciferae intake derived from two dietary assessment approaches, and urinary DTC levels could supplement traditional FFQ data by providing an index of recent Cruciferous vegetable intake not susceptible to reporting biases.
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Affiliation(s)
- Jay H Fowke
- Vanderbilt-Ingram Cancer Center, Vanderbilt Center for Health Services Research, Nashville, TN 37232-8300, USA.
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Cade J, Thompson R, Burley V, Warm D. Development, validation and utilisation of food-frequency questionnaires - a review. Public Health Nutr 2002; 5:567-87. [PMID: 12186666 DOI: 10.1079/phn2001318] [Citation(s) in RCA: 903] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The purpose of this review is to provide guidance on the development, validation and use of food-frequency questionnaires (FFQs) for different study designs. It does not include any recommendations about the most appropriate method for dietary assessment (e.g. food-frequency questionnaire versus weighed record). METHODS A comprehensive search of electronic databases was carried out for publications from 1980 to 1999. Findings from the review were then commented upon and added to by a group of international experts. RESULTS Recommendations have been developed to aid in the design, validation and use of FFQs. Specific details of each of these areas are discussed in the text. CONCLUSIONS FFQs are being used in a variety of ways and different study designs. There is no gold standard for directly assessing the validity of FFQs. Nevertheless, the outcome of this review should help those wishing to develop or adapt an FFQ to validate it for its intended use.
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Affiliation(s)
- Janet Cade
- Nutrition Epidemiology Group, Division of Public Health, Nuffield Institute for Health, 71-75 Clarendon Road, University of Leeds, UK.
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Mahabir S, Coit D, Liebes L, Brady MS, Lewis JJ, Roush G, Nestle M, Fry D, Berwick M. Randomized, placebo-controlled trial of dietary supplementation of alpha-tocopherol on mutagen sensitivity levels in melanoma patients: a pilot trial. Melanoma Res 2002; 12:83-90. [PMID: 11828262 DOI: 10.1097/00008390-200202000-00012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We evaluated the effects of vitamin E (dl-alpha-tocopherol) on mutagen sensitivity levels in a randomized placebo-controlled pilot trial. In brief, a dietary supplement of 1000 mg/day vitamin E or a placebo was randomly administered for 3 months to melanoma outpatients clinically free of the disease. Plasma vitamin E and mutagen sensitivity levels were measured at baseline and at the end of the trial after 3 months. At baseline, we found no significant differences in plasma vitamin E and mutagen sensitivity levels between the two groups. We also measured dietary intake at baseline and found dietary vitamin E to be a poor predictor of plasma levels of vitamin E. After 3 months of supplementation, we found that plasma levels of alpha-tocopherol increased significantly (P = 0.0005) in the vitamin E compared to the placebo group. We also found a non-significant, but consistent decrease in plasma gamma-tocopherol concentrations in the vitamin E supplemented compared to the placebo group. We did not find any significant difference between the vitamin E and placebo groups in mutagen sensitivity levels either at baseline or after 3 months of supplementation. We conclude that short term vitamin E supplementation, although it causes increased blood levels of alpha-tocopherol, does not provide protection against bleomycin-induced chromosome damage.
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Affiliation(s)
- S Mahabir
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA
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Abstract
Several hundred carotenoid research studies have been published since 1996, when two major intervention trials showed a lack of protective effect of beta-carotene supplements against lung cancer. Recent epidemiologic studies continue to show an association between high dietary intake of beta-carotene and lower risk of lung cancer. New research is attempting to clarify the apparently contradictory results of intervention and epidemiologic studies. Promising areas of investigation include characterizing biologic activities of carotenoids and gaining further insight into whether they may serve primarily as markers for a healthy lifestyle or diet.
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Affiliation(s)
- D A Cooper
- Department of Regulatory and Clinical Development, Food and Beverage Products, Procter & Gamble Company, Cincinnati, OH 45224-1703, USA
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