Examining the relative validity of an adult food frequency questionnaire in children and adolescents

Pre-Diagnosis Diet Predicts Response to Exclusive Enteral Nutrition and Correlates with Microbiome in Pediatric Crohn Disease

Exclusive enteral nutrition (EEN) is effective in inducing remission in pediatric Crohn disease (CD). EEN alters the intestinal microbiome, but precise mechanisms are unknown. We hypothesized that pre-diagnosis diet establishes a baseline gut microbiome, which then mediates response to EEN. We analyzed prospectively recorded food frequency questionnaires (FFQs) for pre-diagnosis dietary patterns. Fecal microbiota were sequenced (16SrRNA) at baseline and through an 18-month follow-up period. Dietary patterns, Mediterranean diet adherence, and stool microbiota were associated with EEN treatment outcomes, disease flare, need for anti-tumor necrosis factor (TNF)-α therapy, and long-term clinical outcomes. Ninety-eight patients were included. Baseline disease severity and microbiota were associated with diet. Four dietary patterns were identified by FFQs; a "mature diet" high in fruits, vegetables, and fish was linked to increased baseline microbial diversity, which was associated with fewer disease flares (p < 0.05) and a trend towards a delayed need for anti-TNF therapy (p = 0.086). Baseline stool microbial taxa were increased (Blautia and Faecalibacterium) or decreased (Ruminococcus gnavus group) with the mature diet compared to other diets. Surprisingly, a "pre-packaged" dietary pattern (rich in processed foods) was associated with delayed flares in males (p < 0.05). Long-term pre-diagnosis diet was associated with outcomes of EEN therapy in pediatric CD; diet-microbiota and microbiota-outcome associations may mediate this relationship.

Dietary adherence to the Mediterranean diet pattern in a randomized clinical trial of patients with quiescent ulcerative colitis

Background

The Mediterranean diet pattern (MDP) is believed to improve health and promote balanced inflammation and metabolism. While unknown, compelling evidence suggests that MDP could benefit patients with inflammatory bowel disease (IBD). We aimed to evaluate the level of diet adherence, diet quality, and nutritional adequacy of the MDP in patients with Ulcerative Colitis (UC).

Methods

Adult participants (n = 32) with quiescent UC were randomized to follow a MDP (n = 18) or Canadian Habitual Diet (CHD) (n = 14) for 12 weeks. The MDP participants received tailored nutrition education from a Registered Dietitian. Demographic, clinical data, medical history, and quality of life were assessed with the Short Inflammatory Bowel Disease Questionnaire (SIBDQ), dietary adherence with the Mediterranean Diet Serving Score (MDSS), diet quality via the Healthy Eating Index-2015 (HEI-2015), and dietary intake (ASA-24) were completed at baseline and week 12.

Results

Participants' diets were analyzed (MDP n = 15, CHD n = 13). The MDP (n = 10, 67%) achieved a high level of adherence (MDSS score between 16 and 24) vs. CHD (n = 3), (p = 0.030). HEI-2015 significantly increased from baseline to week 12 (p = 0.007) in the MDP and was significantly higher at week 12 compared to the CHD (p = 0.0001). The SIBDQ (bowel domain) showed reductions in the passage of large amounts of gas (p = 0.01) and improvements in tenesmus (p = 0.03) in the MDP. Despite enhanced diet quality and adherence in the MDP, females had inadequate intakes of calcium, iron, vitamin D, vitamin E, and choline and males had inadequate intakes of fiber, vitamin D, vitamin E, and choline. No adverse events were reported.

Conclusion

With nutrition education, high adherence to the MDP was achieved without an increase in bowel symptoms. Following the MDP led to a higher diet quality; however, nutritional inadequacies were identified. Tailored dietary education focusing on nutrients of concern when following the MDP is recommended to ensure nutritional adequacy.

Clinical trial registration

[www.ClinicalTrials.gov], identifier [NCT03053713].

Mediterranean-Like Dietary Pattern Associations With Gut Microbiome Composition and Subclinical Gastrointestinal Inflammation

BACKGROUND & AIMS

Case-control studies have shown that patients with Crohn's disease (CD) have a microbial composition different from healthy individuals. Although the causes of CD are unknown, epidemiologic studies suggest that diet is an important contributor to CD risk, potentially via modulation of bacterial composition and gut inflammation. We hypothesized that long-term dietary clusters (DCs) are associated with gut microbiome compositions and gut inflammation. Our objectives were to identify dietary patterns and assess whether they are associated with alterations in specific gut microbial compositions and subclinical levels of gut inflammation in a cohort of healthy first-degree relatives (FDRs) of patients with CD.

METHODS

As part of the Genetic, Environmental, Microbial (GEM) Project, we recruited a cohort of 2289 healthy FDRs of patients with CD. Individuals provided stool samples and answered a validated food frequency questionnaire reflecting their habitual diet during the year before sample collection. Unsupervised analysis identified 3 dietary and 3 microbial composition clusters.

RESULTS

DC3, resembling the Mediterranean diet, was strongly associated with a defined microbial composition, with an increased abundance of fiber-degrading bacteria, such as Ruminococcus, as well as taxa such as Faecalibacterium. The DC3 diet was also significantly associated with lower levels of subclinical gut inflammation, defined by fecal calprotectin, compared with other dietary patterns. No significant associations were found between individual food items and fecal calprotectin, suggesting that long-term dietary patterns rather than individual food items contribute to subclinical gut inflammation. Additionally, mediation analysis demonstrated that DC3 had a direct effect on subclinical inflammation that was partially mediated by the microbiota.

CONCLUSIONS

Overall, these results indicated that Mediterranean-like dietary patterns are associated with microbiome and lower intestinal inflammation. This study will help guide future dietary strategies that affect microbial composition and host gut inflammation to prevent diseases.

Development and Validation of a Food Frequency Questionnaire for Population of Adolescents in Croatia

Research background

Food frequency questionnaire (FFQ) is an important method for the estimation of dietary intake in epidemiologic studies. The aim of the study is to develop a FFQ and evaluate its relative validity for adolescents 12 to 18 years old.

Experimental approach

FFQ was developed from a previously validated youth/adolescent diet questionnaire (YAQ) by modifying it in order to include Croatian national foods. The final version of the FFQ (FFQ-m) comprised 87 food items. The reference method was a set of two 3-day food records (3DFR) administered twice during the 3 non-consecutive days, one month apart. The FFQ-m was administered approximately on the last day of the second applied dietary food record. Adolescents were recruited from randomly selected elementary and high schools in urban and rural areas of Croatia. FFQ-m was validated on a sample of 84 adolescents (70.2% female). Nutritional intake from FFQ-m and 3DFR were analysed for each participant. Spearman correlation coefficients (r) and Bland-Altman method were used to assess the validity of the FFQ-m compared to 3DFR. Anthropometric parameters were assessed in 78 adolescents.

Results and conclusions

The mean nutrient intake estimated by the FFQ-m was higher than that of the 3DFR. The average correlation coefficient for energy and nutrients in our validation study was 0.40. On average, 76.5% of adolescents were classified in the same or adjacent quartile of the nutrient intake. Bland-Altman analysis showed good agreement with all macronutrients and some micronutrients (sodium, phosphorus, potassium, calcium, magnesium and iron). A simple self-administered questionnaire completed by adolescents is a valid tool for measuring energy and nutrient intake among adolescent population.

Novelty and scientific contribution

This is the first FFQ developed and validated for population of adolescents in Croatia. It will contribute to further research of nutritional intake in the population of adolescents, especially those from the region.

Effectiveness of Mediterranean Diet's Adherence in children with Inflammatory Bowel Diseases

BACKGROUND

Nutritional support is very important in the treatment of Paediatric Inflammatory Bowel Disease (IBD). The role of the Mediterranean Diet (MD) has been understudied in children with IBD. The aims of this study were to assess the dietary intakes of IBD children in comparison with healthy controls (HCs), their adherence to MD; and the relationship between inflammation and dietary behaviors.

METHODS

Paediatric IBD patients in clinical remission and HCs were enrolled. The nutritional status and adherence to the Mediterranean Diet was evaluated through a 3-day food diary and the Mediterranean Diet Quality Index for Children and Adolescents (KIDMED).

RESULTS

The analysis of food diaries showed a significantly higher kilocalorie intake in IBD patients compared to HCs (p = 0.012), an increase in carbohydrates (p = 0.015) and in protein intake (p = 0.024). Both IBD and HCs have an intermediate adherence to MD. The comparison between Crohn's disease (CD) and Ulcerative colitis (UC) patients showed significant difference in protein intake in CD patients (p = 0.047), as well as for vitamin D (p = 0.044) and iron intake (p = 0.023). Interestingly; in IBD patients we found a significant association between adherence to MD and a low level of fecal calprotectin (p = 0.027).

CONCLUSION

Children with IBD in remission have a sub-optimal food intake compared to HCs. MD seems to correlate to decreased intestinal inflammation.

Evaluating the association of free sugars intake and glycemic load on cardiometabolic outcomes: A prospective analysis throughout adolescence into early adulthood

PURPOSE

To prospectively evaluate the relation of free sugars intake and glycemic load with adiposity and insulin resistance, from adolescence into early adulthood.

METHODS

Data from the population-based cohort EPITeen (Porto, Portugal) at 13 and 21 years old was used (n = 1034). At both ages, dietary assessment was obtained by food frequency questionnaires (FFQ). Added sugar of each food item was estimated based on a systematic methodology described by Louie et al. Free sugars (FS) were defined according to World Health Organization. To each food item of the FFQ, a calculated mean value of FS and glycemic index was assigned. Dietary glycemic load (GL) was determined for each participant. Sex- and age-specific body mass index z-score (BMIz) and waist-to-weight ratio (WWr) were used as measures of adiposity, and the homeostasis model assessment (HOMA-IR) as a measure of insulin resistance. A cross-lagged path analysis was performed to examine causal relationships between FS intake or dietary GL with BMIz, WWr or HOMA-IR.

RESULTS

No significant association was found between intake of FS and dietary GL at 13 years with BMIz, WWr or HOMA-IR at 21. A significant inverse association was found between BMIz at 13 and FS (β = -0.595,95%CI -0.830, -0.359) and dietary GL (β = -0.687,95%CI -0.937,-0.437) at 21 years. Intake of FS, dietary GL, as well as BMIz, WWr and HOMA-IR tracked from 13 to 21 years.

CONCLUSION

No significant association was found between consumption of FS and GL at 13 years with cardiometabolic features at 21 years. Dietary intake and cardiometabolic outcomes tracked from adolescence into early adulthood.

Adherence to Southern European Atlantic Diet and physical fitness on the atherogenic index of plasma in adolescents

We sought (i) to evaluate the associations of cardiorespiratory fitness (CRF), muscular fitness (MF) and Southern European Atlantic Diet (SEADiet) with atherogenic index of plasma (AIP) and (ii) to investigate de combined association of MF, CRF and SEADiet on AIP in adolescents. A cross-sectional school-based study was conducted on 493 adolescents (285 girls and 208 boys) aged 15-18 years, from the Portuguese Azorean Archipelago. CRF was measured by shuttle run test and MF by curl up and push up tests. Adherence to SEADiet was assessed with a semi-quantitative food frequency questionnaire (FFQ). The AIP was estimated as log (TG/HDL-C). Measures of pubertal stage and socioeconomic status were assessed. Linear regression showed a significant inverse association between MF (standardized β = -0.165; p < 0.001), CRF (standardized β = -0.081; p < 0.030) and SEADiet (standardized β = -0.081; p < 0.045) with AIP, after adjustments for age, sex, pubertal stage and parental education. Furthermore, participants classified with an optimal as well as those with low adherence to a SEADiet but with LowMF/LowCRF had on average the highest AIP (F(7.482) = 3.270; p = 0.002). Moreover, optimal SEADiet with HighMF/HighCRF group showed the lowest AIP when compared with those with low adherence to a SEADiet with HighMF/HighCRF group (p = 0.03). AIP is inversely associated with MF, CRF and SEADiet. The low MF combined with a low CRF levels seems to overcome the potential healthy effect of having an optimal adherence to the SEADiet on AIP. However, an optimal adherence to SEADiet seems to improve the AIP in those adolescents with high fitness levels.

Nutritional Assessment in Inflammatory Bowel Disease (IBD)-Development of the Groningen IBD Nutritional Questionnaires (GINQ)

Diet plays a key role in the complex etiology and treatment of inflammatory bowel disease (IBD). Most existing nutritional assessment tools neglect intake of important foods consumed or omitted specifically by IBD patients or incorporate non-Western dietary habits, making the development of appropriate dietary guidelines for (Western) IBD patients difficult. Hence, we developed a food frequency questionnaire (FFQ), the Groningen IBD Nutritional Questionnaires (GINQ-FFQ); suitable to assess dietary intake in IBD patients. To develop the GINQ-FFQ, multiple steps were taken, including: identification of IBD specific foods, a literature search, and evaluation of current dietary assessment methods. Expert views were collected and in collaboration with Wageningen University, division of Human Nutrition and Health, this semi-quantitative FFQ was developed using standard methods to obtain a valid questionnaire. Next, the GINQ-FFQ was digitized into a secure web-based environment which also embeds additional nutritional and IBD related questions. The GINQ-FFQ is an online self-administered FFQ evaluating dietary intake, taking the previous month as a reference period. It consists of 121 questions on 218 food items. This paper describes the design process of the GINQ-FFQ which assesses dietary intake especially (but not exclusively) in IBD patients. Validation of the GINQ-FFQ is needed and planned in the near future.

The long-term impact of very preterm birth on adult bone mineral density

Introduction

Preterm infants are at increased risk of osteopenia of prematurity due to insufficient bone mineral accretion. Data on long term effects of prematurity on bone health are conflicting. This study aimed to compare bone mineral density (BMD) in young adults born very preterm and full-term controls and to examine factors associated with long-term bone health.

Methods

This observational cross-sectional study enrolled 101 young adults (18–29 years) born <29 weeks of gestation and 95 sex- and age-matched full-term controls. Participants underwent dual-energy X-ray absorptiometry to measure areal BMD and body composition. Generalized estimated equations were used to compare groups adjusting for height Z-score, lean body mass and fat mass.

Results

Adults born preterm were shorter and lighter than full-term controls. Areal BMD was reduced at the lumbar spine, the femoral neck and whole body in the preterm versus full-term group, but after adjustment, areal BMD Z-score was only significantly lower at the femoral neck by −0.3 unit (95% confidence interval −0.6 to −0.0). Low BMD (Z-score ≤ −1 standard deviation) at any site was observed in 53% of adults born preterm versus 28% of full-term controls, but this was not statistically significantly different. We did not identify any neonatal factors associated with lower BMD within the preterm group.

Conclusions

Very preterm birth is associated with lower areal BMD at the femoral neck in young adulthood, even after accounting for body size. Whether this will translate into higher risk of osteoporotic fractures later in life remains unknown.

Food intake and high-sensitivity C-reactive protein levels in adolescents

BACKGROUND AND AIMS

Diet comprises factors with anti and pro-inflammatory potential that can contribute to modulate obesity-induced inflammation. We aimed to assess the association between food intake and high-sensitivity C-reactive protein (hsCRP) levels in adolescents.

METHODS AND RESULTS

A cross-sectional analysis of 991 adolescents aged 13 years old was conducted as part of the EPITeen cohort, Porto, Portugal. Food intake was assessed by a food frequency questionnaire and thirteen food groups were defined. Anthropometric assessment was performed and serum hsCRP was measured in a fasting blood sample. hsCRP concentrations above the 75th percentile were considered high. Logistic regression was fitted to estimate the association between the intake frequency of the food groups and hsCRP, stratified by BMI and adjusted for sex, parental education and total energy intake. Median (25-75th percentiles) hsCRP concentrations increased with increasing values of BMI [normal weight: 0.20 (0.10-0.50); overweight: 0.40 (0.20-0.80); obese: 1.10 (0.40-2.15) mg/l, p < 0.001]. After adjustment for sex, parental education and total energy intake, no statistically significant associations were found amongst normal weight and overweight participants. However, among obese individuals, having as reference the first frequency category (<1 per day), a higher frequency of vegetables/legumes intake showed a decreased odds of high hsCRP levels (OR: 0.10, 95%CI 0.03-0.38, 1-3 per day; and OR: 0.14, 95%CI 0.04-0.52, >3 per day).

CONCLUSION

Among participants with obesity-induced higher hsCRP levels, a higher frequency of vegetable/legume intake was inversely related to hsCRP.

Nutrition in Pediatric Inflammatory Bowel Disease: A Position Paper on Behalf of the Porto Inflammatory Bowel Disease Group of the European Society of Pediatric Gastroenterology, Hepatology and Nutrition

BACKGROUND AND AIMS

A growing body of evidence supports the need for detailed attention to nutrition and diet in children with inflammatory bowel disease (IBD). We aimed to define the steps in instituting dietary or nutritional management in light of the current evidence and to offer a useful and practical guide to physicians and dieticians involved in the care of pediatric IBD patients.

METHODS

A group of 20 experts in pediatric IBD participated in an iterative consensus process including 2 face-to-face meetings, following an open call to Nutrition Committee of the European Society of Pediatric Gastroenterology, Hepatology and Nutrition Porto, IBD Interest, and Nutrition Committee. A list of 41 predefined questions was addressed by working subgroups based on a systematic review of the literature.

RESULTS

A total of 53 formal recommendations and 47 practice points were endorsed with a consensus rate of at least 80% on the following topics: nutritional assessment; macronutrients needs; trace elements, minerals, and vitamins; nutrition as a primary therapy of pediatric IBD; probiotics and prebiotics; specific dietary restrictions; and dietary compounds and the risk of IBD.

CONCLUSIONS

This position paper represents a useful guide to help the clinicians in the management of nutrition issues in children with IBD.

Development and Validation of a Food Frequency Questionnaire to Estimate Intake among Children and Adolescents in Urban Peru

Tools to assess intake among children in Latin America are limited. We developed and assessed the reproducibility and validity of a semi-quantitative food frequency questionnaire (FFQ) administered to children, adolescents, and their caregivers in Lima, Peru. We conducted 24-h diet recalls (DRs) and focus groups to develop a locally-tailored FFQ prototype for children aged 0-14 years. To validate the FFQ, we administered two FFQs and three DRs to children and/or their caregivers (N = 120) over six months. We examined FFQ reproducibility by quartile agreement and Pearson correlation coefficients, and validity by quartile agreement and correlation with DRs. For reproducibility, quartile agreement ranged from 60-77% with correlations highest for vitamins A and C (0.31). Age-adjusted correlations for the mean DR and the second-administered FFQ were highest in the 0-7 age group, in which the majority of caregivers completed the FFQ on behalf of the child (total fat; 0.67) and in the 8-14 age group, in which both the child and caregiver completed the FFQ together (calcium, niacin; 0.54); correlations were <0.10 for most nutrients in the 8-14 age group in which the caregiver completed the FFQ on the child's behalf. The FFQ was reproducible and the first developed and validated to assess various nutrients in children and adolescents in Peru.

Validation of a food frequency questionnaire designed for adolescents in Salvador, Bahia, Brazil

Objective: This study assessed the validity of a Food Frequency Questionnaire used to assess food intake in adolescents in Salvador, Bahia, Brazil. Methods: Seventy adolescents enrolled in public schools aged 11 to 17 years participated in this study. The dietary intake of the adolescents was assessed using the Food Frequency Questionnaire and the mean value of three-day food record, used as the reference method. The mean (and standard deviation) energy and nutrient intakes estimated from the Food Frequency Questionnaire and food records were calculated. The paired Student's t test was used to determine differences between the data. Results: Pearson's correlation coefficient and Kappa statistics were used to measure the strength of the association between the two instruments. There was variation in the crude unadjusted (r=0.61-0.73) and deattenuated (r=0.33-0.99) Pearson correlation coefficients. After adjusting for energy, the crude and deattenuated coefficients ranged from r=0.53-0.81 and r=0.27-0.99, respectively. The intake of energy and most nutrients were found to be adequate, except for fiber (r=0.27) and calcium (r=0.33), which showed a weak correlation. Kappa statistics showed good correlation between all values varying from r=0.47 to 0.73. Conclusion: It is considered that an average r value greater than 0.40 indicates a good correlation, the results obtained indicate the good ability of the Food Frequency Questionnaire to assess individuals according to their usual intake of most nutrients.

Design, Implementation, and Evaluation of the Adolescents and Surveillance System for the Obesity Prevention Project

The Adolescents Surveillance System for Obesity prevention (ASSO) Project aimed at developing standardized and web-based tools for collecting data on adolescents' obesity and its potential determinants. This has been implemented and piloted in the local area of Palermo city, Italy. The aim of the present study is to provide an overview of the Project's design, implementation, and evaluation, highlighting all the aspects for a potential scale-up of the surveillance system on the whole national territory and abroad, as a sustainable and effective source of data.The overall structure and management, the ASSO-toolkit, the ASSO-NutFit software, and all developed and used procedures for recruiting, training, and data collecting/analyzing are addressed. An interim evaluation has been performed through a feasibility study; a final Project evaluation has been performed reporting the Strengths, Weaknesses, Opportunities, and Threats (SWOT) and the attributes that a surveillance system should have.This article provides a detailed overview of the Project and highlights that ASSO can be considered a valid, logical, coherent, efficient, and sustainable surveillance system that is consistent with countries' needs and priorities.The system developed by the ASSO Project provides high-quality data and complies with several characteristics typical of a suitable surveillance system. It has a potential of being adopted within the National Health Service and other countries' Health Services for monitoring adolescents' obesity and its determinants, such as food intakes, behaviors, physical activity, and fitness profiles.

A meta-analysis of the validity of FFQ targeted to adolescents

Objective

The present work is aimed at meta-analysing validity studies of FFQ for adolescents, to investigate their overall accuracy and variables that can affect it negatively.

Design

A meta-analysis of sixteen original articles was performed within the ASSO Project (Adolescents and Surveillance System in the Obesity prevention).

Setting

The articles assessed the validity of FFQ for adolescents, compared with food records or 24 h recalls, with regard to energy and nutrient intakes.

Subjects

Pearson’s or Spearman’s correlation coefficients, means/standard deviations, kappa agreement, percentiles and mean differences/limits of agreement (Bland–Altman method) were extracted. Pooled estimates were calculated and heterogeneity tested for correlation coefficients and means/standard deviations. A subgroup analysis assessed variables influencing FFQ accuracy.

Results

An overall fair/high correlation between FFQ and reference method was found; a good agreement, measured through the intake mean comparison for all nutrients except sugar, carotene and K, was observed. Kappa values showed fair/moderate agreement; an overall good ability to rank adolescents according to energy and nutrient intakes was evidenced by data of percentiles; absolute validity was not confirmed by mean differences/limits of agreement. Interviewer administration mode, consumption interval of the previous year/6 months and high number of food items are major contributors to heterogeneity and thus can reduce FFQ accuracy.

Conclusions

The meta-analysis shows that FFQ are accurate tools for collecting data and could be used for ranking adolescents in terms of energy and nutrient intakes. It suggests how the design and the validation of a new FFQ should be addressed.

Comparative validity of the ASSO-Food Frequency Questionnaire for the web-based assessment of food and nutrients intake in adolescents

BACKGROUND

A new web-based food frequency questionnaire (the ASSO-FFQ) was developed within the ASSO Project funded by the Italian Ministry of Health.

OBJECTIVE

The aim of the present study is to assess the validity of the ASSO-FFQ at food groups, energy, and nutrients level.

DESIGN AND SUBJECTS

The validation study compared the ASSO-FFQ against a weighted food record (WFR) measuring foods, beverages and supplements intake, compiled during the week following the ASSO-FFQ administration. Ninety-two subjects aged 14-17, recruited from secondary schools in Palermo (Italy), completed the ASSO-FFQ and WFR. The intake of 24 food groups, energy, and 52 nutrients were taken as main outcomes. Tests for paired observations, Spearman and Pearson's correlation coefficients (cc), kappa statistics and classification in quintiles, Bland-Altman plots and multiple regressions, on untransformed and transformed data were used for the statistical analysis.

RESULTS

High cc (≥0.40) were found for soft drinks, milk, tea/coffee, vegetables, and lactose; fair energy-adjusted cc (0.25-0.40) for water, alcoholic drinks, breakfast cereals, fishery products, savory food, fruit juice, eggs, and 19 nutrients. The subjects classified in the same or adjacent quintile for food groups ranged from 40% (alcoholic drinks) to 100% (dried fruit); for energy and nutrients from 43% (phosphorus, thiamin, niacin) to 77% (lactose). Mean differences were not significant for water, soft drinks, meat, sweets, animal fats, milk and white bread, and vitamin B12 and folate. Limits of Agreement were broad for all food groups and nutrients. School, gender, alcohol consumption and between meals mainly affected most food groups' intake differences. Gender stratification showed females had increased Pearson's cc for energy and 28 nutrients, such as almost all fats, carbohydrates, vitamins and minerals.

CONCLUSIONS

The ASSO-FFQ could be applied in epidemiological studies for the assessment of dietary consumption in adolescents to adequately rank food, energy and nutrient intakes at a group level.

Relative validity and reproducibility of a brief-type self-administered diet history questionnaire for Japanese children aged 3-6 years: application of a questionnaire established for adults in preschool children

Background

Dietary intake assessment and subsequent dietary education or intervention in young children is important in decreasing prevalence of various noncontagious diseases in adulthood. Validation of diet assessment questionnaires for preschool children has just started in Japan. In this study, we rearranged the brief-type self-administered diet history questionnaire (BDHQ), a convenient diet assessment questionnaire that is widely used in a range of situations for adults, for use in children aged 3–6 years (BDHQ3y) and then validated the BDHQ3y in Japanese children.

Methods

The guardians of 61 children aged 3–4 years completed the BDHQ3y twice at an interval of 1 month, along with a 3-nonconsecutive-day diet record (DR) between the two administrations of the BDHQ3y. Dietary intakes for energy and 42 selected nutrients were estimated using both the DR and the BDHQ3y. Mean intakes estimated by the two methods were compared, and correlation coefficients were calculated. Reproducibility of the BDHQ3y estimates was investigated using intra-class correlation coefficients (ICCs).

Results

No significant differences in mean intakes estimated by the DR and the BDHQ3y were observed for one- to two-thirds of energy and examined nutrients. The median of Pearson correlation coefficients between intakes energy-adjusted by the residual method was 0.31 (interquartile range, 0.24 to 0.38). The median ICC was 0.72 (interquartile range, 0.63 to 0.76) for the crude nutrient intakes.

Conclusions

Although the BDHQ3y might be a good candidate for dietary intake assessment in Japanese preschool children, its validity is currently moderate to low. Shortcomings should be overcome by obtaining and utilizing more information about children’s dietary habits.

Relative validity and reliability of an FFQ in youth with type 1 diabetes

OBJECTIVE

To evaluate the relative validity and reliability of the SEARCH FFQ that was modified from the Block Kids Questionnaire.

DESIGN

Study participants completed the eighty-five-item FFQ twice plus three 24 h dietary recalls within one month. We estimated correlations between frequencies obtained from participants with the true usual intake for food groups and nutrients, using a two-part model for episodically consumed foods and measurement error adjustment.

SETTING

The multi-centre SEARCH for Diabetes in Youth Nutrition Ancillary Study.

SUBJECTS

A subgroup of 172 participants aged 10-24 years with type 1 diabetes.

RESULTS

The mean correlations, adjusted for measurement error, of food groups and nutrients between the FFQ and true usual intake were 0·41 and 0·38, respectively, with 57 % of food groups and 70 % of nutrients exhibiting correlations >0·35. Correlations were high for low-fat dairy (0·80), sugar-sweetened beverages (0·54), cholesterol (0·59) and saturated fat (0·51), while correlations were poor for high-fibre bread and cereal (0·16) and folate (0·11). Reliability of FFQ intake based on two FFQ administrations was also reasonable, with 54 % of Pearson correlation coefficients ≥0·5. Reliability was high for low-fat dairy (0·7), vegetables (0·6), carbohydrates, fibre, folate and vitamin C (all 0·5), but less than desirable for low-fat poultry and high-fibre bread, cereal, rice and pasta (0·2-0·3).

CONCLUSIONS

While there is some room for improvement, our findings suggest that the SEARCH FFQ performs quite well for the assessment of many nutrients and food groups in a sample of youth with type 1 diabetes.

Validation and reproducibility of dietary assessment methods in adolescents: a systematic literature review

OBJECTIVE

The aim of the present work was to determine what dietary assessment method can provide a valid and accurate estimate of nutrient intake by comparison with the gold standard.

DESIGN

A MEDLINE, EMBASE, ISI Web of Science, Cochrane and related references literature review was conducted on dietary assessment methods for adolescents reporting the validity and/or reproducibility values. A study quality assessment on the retrieved FFQ was carried out according to two different scoring systems, judging respectively the quality of FFQ nutrition information and of FFQ validation and calibration.

SETTING

The present review considered adolescents attending high schools and recruited in hospitals or at home.

SUBJECTS

The target of the review was the healthy adolescent population in the age range 13-17 years.

RESULTS

Thirty-two eligible papers were included and analysed separately as 'original articles' (n 20) and 'reviews' (n 12). The majority (n 17) assessed the validation and reproducibility of FFQ. Almost all studies found the questionnaires to be valid and reproducible (r > 0·4), except for some food groups and nutrients. Different design and validation issues were highlighted, such as portion-size estimation, number of food items and statistics used.

CONCLUSIONS

The present review offers new insights in relation to the characteristics of assessment methods for dietary intake in adolescents. Further meta-analysis is required although the current review provides important indications on the development of a new FFQ, addressing the need for a valid, reproducible, user-friendly, cost-effective method of accurately assessing nutrient intakes in adolescents.

Dietary patterns among 13-y-old Portuguese adolescents

OBJECTIVE

The aim of this study was to identify dietary patterns in 13-y-old adolescents and to evaluate their association with socioeconomic and behavioral factors.

METHODS

Data from 1489 adolescents born in 1990 and enrolled in schools of Porto, Portugal, in 2003-2004 (EPITeen study) were analyzed, after excluding those without information on the food frequency questionnaire and the outliers. The questionnaire items were grouped into 14 food groups and dietary patterns were identified by cluster analysis (k-means). Their association with participants' characteristics was computed using multinomial logistic regression.

RESULTS

Four dietary patterns were identified. The pattern healthier (16.1%) was characterized by the highest consumption of seafood, soup, vegetables/legumes, fruit, and added fats. The dairy products pattern (29.7%) showed the highest consumption of dairies. The pattern fast food and sweets (14.2%) presented the highest intake of fast food, sweets and pastry, soft drinks and coffee or tea. The lower intake pattern (40%) was characterized by a lower consumption of the majority of food groups. A higher odds of belonging to the fast food and sweets pattern, compared with the lower intake pattern was found among adolescents spending more time watching TV on the weekends (>360 min: odds ratio [OR], 2.09; 95% confidence interval [CI], 1.23-3.57) and among those consuming four to seven fried meals per week (OR, 3.96; 95% CI, 2.27-6.90). Adolescents with highly educated parents were less likely to belong to the fast food and sweets group.

CONCLUSION

Unhealthier behaviors and lower socioeconomic position were the main factors associated with the unhealthier dietary pattern (fast food and sweets). This information should be considered in the development of health-promotion interventions.

Evaluating a Fruit and Vegetable Program: In Eastern Ontario Schools

Purpose: Effectiveness was evaluated for a fruit and vegetable program developed to encourage Canadian elementary school children to eat the recommended number of daily servings. Also examined was whether the program modified children’s personal factors, perceived social environment, and perceived physical environment.

Methods: A prospective, quasi-experimental trial was conducted to compare the eight schools receiving the intervention curriculum (Freggie Friday schools [FFS]) with six control schools (CS). A food frequency questionnaire was used to measure differences in fruit and vegetable consumption. Personal factors, perceived social environment, and perceived physical environment supporting fruit and vegetable consumption were assessed with an adapted version of the validated Pro Children study questionnaire.

Results: Of the 942 children who completed the baseline assessment, 807 also completed the follow-up questionnaire (FFS, 450; CS, 357). A mixed-effects regression model indicated no significant intervention effects on fruit or vegetable consumption, snack food consumption, or knowledge or attitudes related to fruit and vegetable consumption.

Conclusions: The results suggest that an intervention based on a single visit from an external group, followed by teacher-led programming, may be an ineffective method of eliciting dietary behaviour change in this population. Future programs may need to implement multicomponent intervention designs.

Sleep duration and adiposity during adolescence

BACKGROUND AND OBJECTIVE

The association between sleep and obesity has been described in different age groups. However, there are not sufficient data to clarify the inconsistent results reported in adolescents. Our objective was to study the associations between sleep duration and adiposity at 13 and at 17 years of age, with both cross-sectional and longitudinal approaches.

METHODS

We evaluated, as part of an urban population-based cohort (EPITeen), 1171 adolescents at both 13 and 17 years of age. Sleep duration was estimated by self-reported bedtimes and wake-up times. Age- and gender-specific BMI z scores were calculated based on Centers for Disease Control and Prevention references. Body fat percentage (BF%) was assessed by bioelectrical impedance. Regression coefficients (β) and respective 95% confidence intervals (CIs) were used to estimate the association between sleep and BMI z scores and BF%. Additionally, a cross-lagged analysis was performed to investigate the causal relations.

RESULTS

In the cross-sectional analysis, at 13 years, sleep duration was inversely associated with BMI z score only in boys (β = -0.155, 95% CI: -0.267 to -0.043); at 17 years, a positive association was found among girls but was only significant for BF% (β = 0.510, 95% CI: 0.061-0.958). In the longitudinal approach, sleep duration at age 13 was inversely associated with BMI z score (β = -0.123, 95% CI: -0.233 to -0.012) and BF% (β = -0.731, 95% CI: -1.380 to -0.081) at 17 years only in boys. These significant associations disappeared after adjustment for adiposity at 13 years. These results were corroborated by those from cross-lagged analysis.

CONCLUSIONS

Our results showed an effect of sleep duration in adiposity at younger ages of adolescence and suggested gender differences in this association.