Development, reproducibility and validity of the food frequency questionnaire in the Poland arm of the Prospective Urban and Rural Epidemiological (PURE) study

Relationship between the number of lost teeth and the occurrence of depressive symptoms in middle-aged adults: a cross-sectional study

BACKGROUND

Many recent studies suggest the existence of a relationship between oral health and the occurrence of depressive symptoms. The aim of this study was to assess the relationship between the number of lost teeth and the occurrence of depressive symptoms in middle-aged adults.

METHODS

An analysis was performed on the data obtained from the PONS project (POlish-Norwegian Study), conducted in the Świętokrzyskie Province in Poland in 2010-2011. The research material included the cross-sectional data of 11,901 individuals aged 40-64 years (7967 women). Depressive symptoms, used as outcome variables, were assessed with a questionnaire. The participants provided the responses to questions concerning the occurrence of eight symptoms over the last 12 months. The answers were scored as 1 point or 0 points. The participants were divided into three tercile groups based on their total scores: no or mild (0-2 points), moderate (3-5 points), and severe depressive symptoms (6-8 points). The self-reported number of lost teeth was analysed according to the following categories: 0-4, 5-8, 9-27, and a complete lack of natural teeth. Multivariable logistic regression analysis for depressive symptoms was used in relation to the number of lost teeth. The following covariates were included in the adjusted model: age, sex, place of residence, education, marital status, BMI, diabetes status, stressful life events in the last year, use of antidepressants, smoking, and sugar and sweet consumption.

RESULTS

The likelihood of both moderate (OR = 1.189; 95%CI: 1.028-1.376; p < .020) and severe (OR = 1.846; 95%CI: 1.488-2.290; p < .001) depressive symptoms showed the strongest relationship with a total lack of natural teeth. A loss of more than 8 natural teeth was also significantly associated (OR = 1.315; 95%CI: 1.075-1.609; p < .008) with the occurrence of severe depressive symptoms.

CONCLUSIONS

The loss of natural teeth was positively related to the occurrence of depressive symptoms in middle-aged adults. Thus, there is an urgent need to intensify stomatological prophylaxis, education and treatment for middle-aged individuals.

Optimization of a Food List for Food Frequency Questionnaires Using Mixed Integer Linear Programming: A Proof of Concept Based on Data from the Second German National Nutrition Survey

Food Frequency Questionnaires (FFQs) are important instruments to assess dietary intake in large epidemiological studies. To determine dietary intake correctly, food lists need to be adapted depending on the study aim and the target population. The present work compiles food lists for an FFQ with Mixed Integer Linear Programming (MILP) to minimize the number of foods in the food list. The optimized food lists were compared with the validated eNutri FFQ. The constraints of the MILP aimed to identify food items with a high nutrient coverage in a population and with a high interindividual variability. The optimization was based on data from the second German National Nutrition Survey. The resulting food lists were shorter than the one used in the validated eNutri FFQ.

Dietary Patterns and the Prevalence of Noncommunicable Diseases in the PURE Poland Study Participants

The aim of the study was to analyze the association between dietary patterns (DP) identified in the group of Lower Silesia (Poland) inhabitants and the prevalence of selected noncommunicable diseases, such as total cardiovascular diseases (CVD), hypertension, diabetes, impaired fasting glucose (IFG), visceral obesity, and excessive body weight. This study involved 2023 subjects aged 35-70 years, from Wroclaw and surrounding villages. The assessment of food intake in the study group was assessed using the standardized Food Frequency Questionnaire. Dietary patterns were identified using the principal components analysis (PCA) with varimax rotation. Three dietary patterns were identified in the study group: unhealthy, healthy, and traditional. The prevalence of hypertension, diabetes, IFG, and visceral obesity decreased across the quartiles of healthy DP. Prevalence of IFG increased across the quartiles of unhealthy DP, but the prevalence of hypertension decreased. When the diet was more adherent to the traditional DP the prevalence of CVD, diabetes, IFG, visceral obesity, obesity, and being overweight was higher. DP abundant in fruits, vegetables, seeds, nuts, raisins, and unrefined grains, named "healthy dietary pattern", had a beneficial association with lower prevalence of selected noncommunicable diseases. DP abundant in meat products, but poor in fruits and vegetables were positively associated with higher prevalence of total CVD, diabetes, IFG, excessive body weight, and visceral obesity.

Comparison of Intake of Food Groups Based on Dietary Inflammatory Index (DII) and Cardiovascular Risk Factors in the Middle-Age Population of Lower Silesia: Results of the PURE Poland Study

Chronic inflammation is involved in the pathogenesis of many non-infectious diseases, including cardiovascular diseases (CVD), a leading cause of death in Europe. The aim of the study was to assess the inflammatory potential of the diets of participants enrolled in the Polish arm of the Prospective Urban and Rural Epidemiological (PURE) study, evaluate the association between the dietary inflammatory index (DII) score with the dietary content, and to determine the correlation of DII score with selected anthropometric parameters and biochemical risk factors for CVD. Diets were assessed with the Food Frequency Questionnaire (FFQ). Among participants with pro-inflammatory diets, we reported higher mean values of triglycerides (TG), fasting glucose (FG), atherogenic index of plasma (AIP), and the Castelli's risk index (CRI) in the group of men and women, and higher waist circumference (WC) and waist-to-hip ratio (WHR) in the group of women. Pro-inflammatory diets were associated with higher intake of refined grains, sweets, juices, red meat, high-fat cheese and cream, alcohol, fats except for vegetable oils, potatoes, sugar and honey, French fries, fried fish, and processed/high-fat poultry. Moreover, study participants with pro-inflammatory diets consumed more milk, low-fat dairy, and eggs associated with unhealthy dietary habits, but this should not be considered as an independent CVD risk factor. Anthropometric and biochemical outcomes were more favorable among study participants who consumed more vegetables, fruits, nuts, seeds, raisins, pulses, low-fat poultry, and tea. However, association of beverage consumption with dietary inflammatory potential requires further study.

A High-Quality Diet, as Measured by the DASH Score, Is Associated with a Lower Risk of Metabolic Syndrome and Visceral Obesity

The current study was designed to examine the relationship between diet quality, as measured by the Dietary Approaches to Stop Hypertension (DASH) score, and the prevalence of metabolic syndrome (MetS) and its components. The study was cross-sectional in design and enrolled 535 people, including 215 with MetS and 320 without MetS. Using a validated food frequency questionnaire, the DASH diet quality score was counted. The mean age of the MetS group and control subjects was 58.48 ± 14.65 and 58.33 ± 9.26 years, respectively. The study showed that the MetS group had a significantly lower mean total DASH score than the control group (23.13 ± 5.44 vs. 24.62 ± 5.07, p = 0.0023). In addition, it was found that an increase in the total DASH score was associated with a lower risk of MetS (odds ratio [OR] = 0.95, 95% confidence interval [CI] = 0.91-0.99, p = 0.009). In the correlation analysis of the total population, a better-quality diet (higher DASH score) was positively correlated with high-density lipoprotein cholesterol (HDL-c), and negatively correlated with triglyceride (TG) concentration and waist circumference. It was also found that an increase in the total DASH score was associated with a lower risk of abdominal obesity (OR = 0.93, 95% CI = 0.88-0.99, p = 0.017). The results from the analyzed data highlight the potential benefits of following a healthy diet such as DASH.

Dietary Inflammatory Index (DII)® and Metabolic Syndrome in the Selected Population of Polish Adults: Results of the PURE Poland Sub-Study

The aim of the study was to assess the relationship between the inflammatory potential of the diets of residents of Lower Silesia, based on the Dietary Inflammatory Index (DII), with the incidence of metabolic syndrome (MetS) and its components. Diets were characterized according to DII terciles. The study group consisted of 1570 individuals enrolled in the Polish arm of the Prospective Urban and Rural Epidemiological (PURE) study. Participants’ diets in DII T1 (most anti-inflammatory diet) had the highest intake of vegetables (except for potatoes), fruits, nuts and seeds, low-calorie beverages, tea, and coffee (all p < 0.001). On the other hand, participants’ diets in DII T3 (most pro-inflammatory diet) contained a lot of whole-fat products, refined cereals, fats (except for vegetable oils), fruit juices, red meat, processed meat/meat products, sugar-sweetened beverages, sweets, sugar, and honey (all p < 0.001). Overall, we did not find an increased prevalence of MetS and its individual components in DII tercile 3 (T3) compared to DII tercile 1 (T1), except for an increased prevalence of abnormal TG in DII T3 compared to T1 (OR 1.34; 95% CI = 1.01 to 1.78) in the crude model. In the adjusted model, a lower prevalence of abnormal fasting glucose (FG) was found in DII T2 compared to DII T1 (OR 0.71; 95% CI = 00.54 to 0.94). Results of this study are informative and provide an important basis for further research on the quality of diet and nutrition.

Association of Household Utility of Cleaner Fuel With Lower Hypertension Prevalence and Blood Pressure in Chinese Adults

Objectives: To investigate whether lower hypertension prevalence or blood pressure was associated with cleaner household fuel usage for cooking and heating among Chinese adults. Methods: We enrolled 44,862 Chinese adults at the baseline of the prospective urban and rural epidemiology (PURE) study in China during 2005-2009, as a subset of the PURE-global China site. Multilevel logistic regression and generalized linear mixed models were conducted to estimate the adjusted odds ratio (AOR) and regression coefficient for hypertension and blood pressure respectively, while subgroup analysis by ambient PM2.5 concentration and location was also examined. Results: Compared with the least clean household solid fuel group, gas (AOR = 0.91, 95% CI: 0.83, 0.99) or electricity (AOR = 0.72, 95% CI: 0.60, 0.87) was associated with significantly lower levels of hypertension prevalence and blood pressure, and a similar pattern of the association was consistently observed among participants with high ambient PM2.5 exposure and those living in urban areas. Conclusion: Household utility of cleaner fuel type was associated with lower hypertension prevalence and blood pressure in Chinese adults. Our study urges the utilization of cleaner household energy to mitigate the burden of hypertension.

Reproducibility of the German and Slovakian Versions of the Dietary Habits and Nutrition Beliefs Questionnaire (KomPAN)

PURPOSE

The aim of this study was to assess the reproducibility and reliability of the KomPAN questionnaire among two groups of university students from Germany and Slovakia.

METHODS

A total of 422 individuals (mean age 21.4 years, SD 4.0), including 197 from Slovakia (men 26.2%) and 225 from Germany (men 22.3%), were tested using the self-administered (SA-Q) version of the KomPAN questionnaire and then retested two weeks later. A cross-classification analysis, kappa coefficients, Cronbach's ɑ coefficients, and a test-retest result comparison were conducted separately for each group of students to assess the reproducibility and reliability of the questionnaire.

RESULTS

The cross-classification values were higher than 46.2% among the German students and higher than 55.8% among the Slovakian students. The kappa coefficients ranged from 0.21 to 0.90 in the German students and from 0.38 to 0.94 in the Slovakian students. Cronbach's ɑ ranged from 0.58 to 0.78.

CONCLUSION

The questionnaire displayed a moderate to very good reproducibility, which was slightly higher in the Slovakian group than in the German group. Therefore, the questionnaire can be recommended for further analysis and comparison of the dietary habits among Germans and Slovakians on a larger scale.

Metabolic Syndrome Is Associated with Low Diet Quality Assessed by the Healthy Eating Index-2015 (HEI-2015) and Low Concentrations of High-Density Lipoprotein Cholesterol

Presenting diet quality of patients with metabolic syndrome (MetS), using a holistic approach is more useful than investigating dietary individual components, but there is still a small amount of research in this area. The aim of this study assessed the diet quality, as measured by the HEI-2015, of MetS patients compared to healthy individuals. The study and control group consisted of 215 patients with MetS and 320 people without MetS, respectively. A nutritional analysis using a semi-quantitative food frequency questionnaire was used to evaluate the nutritional habits in the study and control group. Total HEI-2015 scores were significantly lower in MetS subjects than in those in the control group (65.04 ± 9.71 vs. 66.75 ± 8.88) and the quality of women’s diets was better than the quality of men’s diet (66.83 ± 8.99 vs. 64.75 ± 9.57). We also observed that low HDL-c concentration increased the risk of MetS in the general population the most. Across the population, there was a weak positive correlation between HDL-c concentrations and total HEI-2015 scores and a weak negative correlation between mean waist circumference values and total HEI-2015 scores. HDL-c concentrations may be a key factor in the prevention of MetS and appropriate therapeutic management to increase HDL-c levels may be of key importance in patients diagnosed with MetS.

Lifestyle elements and risk of metabolic syndrome in adults

Background

The aim of the study was to investigate which elements of lifestyle are associated with metabolic health in adults, defined as the absence of components of metabolic syndrome (MetS) based on the International Diabetes Federation criteria.

Methods

Data from 10,277 individuals aged 40–65 years constituted the material of this study. Univariate and multivariate analyses with backward stepwise selection were carried out to identify the factors associated with the absence of metabolic disorders.

Results

No family history of cardiovascular disease increased the odds of being metabolically healthy 1.5-2-fold. Furthermore, the following factors were associated with higher odds of being metabolically healthy in men: abstinence from alcohol (healthy individuals vs. those with ≥3 [OR = 5.49 (2.23–13.52); p<0.001], ≥2 [OR = 4.52 (1.87–10.91); p = 0.001], and ≥1 components of MetS [OR = 3.04 (1.41–6.56); p = 0.005]), moderate alcohol use (healthy individuals vs. those with ≥3 [OR = 3.36 (1.54–7.32); p = 0.002], ≥2 [OR = 3.28 (1.52–7.10); p = 0.002], and ≥1 components of MetS [OR = 3.93 (1.64–9.42); p = 0.002]), moderate-to-vigorous physical activity (MVPA) >2 hours/day and sitting time of 3–6 hours/day. Drinking >2 cups of coffee per day (healthy vs. those with ≥3 [OR = 2.00 (1.47–2.71)], ≥2 [OR = 1.84 (1.38–2.45)], and ≥1 components of MetS [OR = 1.72 (1.30–2.28); all p<0.001]), limiting animal fats to <2 servings/day, MVPA >2 hours/day, and 7–8 hours of sleep per day were associated with higher odds of being metabolically healthy in women.

Conclusions

A healthy lifestyle increased the odds of being metabolically healthy. Some lifestyle modifications may appear effective in prevention of not only MetS, but also single metabolic risk factors.

The 72-Item Semi-Quantitative Food Frequency Questionnaire (72-Item SQ-FFQ) for Polish Young Adults: Reproducibility and Relative Validity

The food frequency questionnaires (FFQs) are the most common tools used in dietary research. Each newly developed, modified, or adapted FFQ should be validated in the target population. The aim of this study was to assess the reproducibility and relative validity of the 72-item semi-quantitative food frequency questionnaire (72-item SQ-FFQ) for Polish adults. The 72-item SQ-FFQ was developed based on a non-quantitative FFQ covering 62 food items (62-item FFQ-6®). The study was conducted among 186 university students aged 19–26 years (47.8% of females). The FFQ was administered on two occasions (FFQcrude and FFQretest) to assess the test–retest reproducibility, and the FFQcrude was compared with the estimated food record (FRcrude) to evaluate the relative validity of the FFQ in assessing the intake of energy, 38 nutrients, and alcohol. The energy intake obtained with both methods was standardized to 2000 kcal/day (FFQstand, FRstand). The dietary intake obtained with FFQcrude was adjusted using linear regression analysis (FFQreg). The reproducibility and relative validity of the FFQ were assessed by comparing the mean values of energy and nutrient intake and using Spearman’s correlation coefficient, the cross-classification analysis, and the Bland–Altman method. Spearman’s correlation coefficient between both administrations of the FFQ ranged from 0.631 to 0.878 (the intraclass correlation coefficient: 0.583–0.935), for FFQcrude and FRcrude ranged from −0.025 to 0.390, for FFQstand and FRstand ranged from 0.021 to 0.546, and for FFQreg and FRcrude ranged from 0.028 to 0.391. The percentage of respondents classified into the same or adjacent quartiles of nutrient intake obtained from two administrations of the FFQ ranged from 84.9% to 97.8%, for FFQcrude and FRcrude ranged from 61.3% to 76.9%, for FFQstand and FRstand ranged from 63.4% to 83.9%, and for FFQreg and FRcrude ranged from 60.2% to 76.9%. In conclusion, our findings showed good reproducibility and acceptable relative validity of the 72-item SQ-FFQ. This tool can be recommended for assessing dietary intake among Polish young adults. However, the intake of certain nutrients should be interpreted with caution.

Estimation of Vitamin K Content and Its Sources in the Diet of the Polish Participants of the PURE Study

The aim of the study was to estimate the content of K1, K2 (MK-n) as well as total K vitamins and their sources in the diets of 1985 PURE Poland study participants based on the FFQ questionnaire. Due to the pleiotropic effect of K vitamins, it is important to know their food sources depending on different eating habits. Total vitamin K in the diets amounted to 331.1 ± 151.5 µg/d and 358.6 ± 181.0 µg/d for men and women, respectively. Dietary patterns (DPs) were identified in the study group, and the relationship between them and vitamin K intake was assessed. The proportion of dominant products as sources of vitamin K in the fourth quartile of each of the three identified DPs did not change significantly compared to the proportion of these products as sources of vitamin K in all subjects. In the fourth quartile of individual DPs, vitamin K1 came mainly from vegetables (56.5-76.8%); K2 mainly from processed meat and high-fat cheese and cream (70.1-77.6%); and total K mainly from vegetables and processed meat (57.6-67.8%). Intakes of K vitamins were high and similar in terms of predominant vitamin K provider products, in groups of subjects whose diets were most consistent with the particular DP. In the absence of global findings on the most appropriate dietary content of MK-n vitamins other than phylloquinone, the estimated high content of these vitamins in the diets of the subjects compared with other nations suggests that their level in diets was satisfactory. Future studies should aim to determine the need for MK-n vitamins in terms of fulfilling all their functions in the body.

Development, validity and reproducibility of a dish-based semi-quantitative food frequency questionnaire in Iran

BACKGROUND: The food frequency questionnaire (FFQ) is the method of choice for dietary assessment in epidemiological studies. FFQs focusing on mixed-dishes and simple food items are useful where mixed-dishes are an essential part of food consumption. OBJECTIVE: Regarding the fact that the nature of the Iranian diet is mixed-dish, the present study aimed to design and assess the validity and reproducibility of a dish-based semi-quantitative FFQ in the Iranian adult population. METHODS: A list of 302 food items was collected from four geographical areas around Iran. The validation study was conducted on 97 healthy adults. The FFQ was introduced at the beginning of the study and 10 months after; two three-day food records were collected during the study. Also, biomarkers including 24-hour urinary potassium and nitrogen, serum retinol, and alpha-tocopherol were measured. RESULTS: A 142-food-item FFQ was concluded. The correlation coefficient between the second FFQ and the second three-day food record ranged from 0.225 to 0.323 for macronutrients and 0.128 to 0.476 for micronutrients. The percentile agreements (same or adjacent quartile) between the two methods were more than 60% for all nutrients. The intraclass correlation coefficient between FFQs (except for vitamin E) ranged from 0.363 to 0.578. The correlation coefficient between the second FFQ and the second biomarker assessment was 0.241 for protein.

Reproducibility and Validity of a Food Frequency Questionnaire (FFQ) Developed for Middle-Aged and Older Adults in Semarang, Indonesia

We assessed the reproducibility and validity of a food frequency questionnaire (FFQ) among middle-aged and older adults in Semarang, Indonesia. A total of 259 subjects aged 40-80 years completed two FFQs (nine-month apart) and nine 24 h dietary recalls (24HDRs, as a reference method). The reproducibility of the FFQ was analyzed using correlation coefficient, intra-class correlation coefficient (ICC), weighted kappa statistics and misclassification analysis. The validity was estimated by comparing the data acquired from FFQ1 and 24HDRs. The crude Pearson's correlation coefficients and ICC for total energy and nutrients between FFQ1 and FFQ2 ranged from 0.50 to 0.81 and 0.44 to 0.78, respectively. Energy adjustment decreased the correlation coefficients for most nutrients. The crude, energy-adjusted and de-attenuated correlation coefficients for FFQ1 and 24HDRs ranged from 0.41 to 0.70, 0.31 to 0.89 and 0.54 to 0.82, respectively. The agreement rates for the same or adjacent quartile classifications were 81.1-94.6% for two FFQs and 80.7-89.6% for FFQ1 and 24HDRs. The weighted kappa values were 0.21 to 0.42 for two FFQs and 0.20 to 0.34 for FFQ1 and 24HDRs. A positive mean difference was found in the Bland-Altman analyses for energy and macronutrients. The FFQ could be acceptable for nutritional epidemiology study among Indonesians.

Characteristic of FINDRISC Score and Association with Diabetes Development in 6-Year Follow-Up in PURE Poland Cohort Study

Purpose

The aim of the study was to assess if FINDRISC score was associated with diabetes development after 6 years of observation.

Methods

Polish cohort is a part of global PURE study. Hereby analysis presents data from baseline (2007–2010) and 6-year follow-up (2013–2016) and was conducted on 1090 participants (702 women) from urban and rural areas in Lower Silesia region (Poland) without diabetes at the baseline and with complete data throughout course of the study.

Results

At the baseline, women had significantly higher FINDRISC score than men (10.43 vs 8.91; p=0.000) and participants from rural areas had higher score than from urban areas (10.97 vs 9.33; p=0.000). At the baseline, 25.87% of the participants had low risk of diabetes according to FINDRISC score, 38.90% had slightly elevated risk, 16.79% moderate risk, 16.42% high risk and 2.02% very high risk. Participants, who were healthy at baseline, but developed diabetes after 6 years of observation had significantly higher FINDRISC, than those who did not (13.39 vs 9.36; p=0.000). In 6-year follow-up, diabetes was diagnosed in 2.8% of participants, who were ascertained to “low risk” according to FINDRISC score in baseline; in 9.9% of participants of “slightly elevated risk”, 17.5% of participants of “moderate risk”, 26.8% in participants of “high risk” and 50.0% of participants of “very high risk”.

Conclusions

Results of PURE Poland cohort study indicates that higher FINDRISC score at the baseline was associated with higher risk of diabetes development during 6 years of observation.

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 .

Breastfeeding history and the risk of overweight and obesity in middle-aged women

BACKGROUND

The increased metabolic activity required to sustain breastfeeding and its associated milk production helps to reduce maternal fat stores accumulated during pregnancy. This study aims to assess the association between breastfeeding duration and fatness indices in middle-aged women.

METHODS

The analysis was carried out in a group of 7500 parous 55.5 ± 5.3 year old women included body mass index, body fat percentage, and waist-to-height ratio. The likelihood of excessive weight or obesity in relation to total breastfeeding time using multivariate logistic regression analyses.

RESULTS

An analysis of adjusted odds ratios did not show significant associations between breastfeeding duration and the risk of excessive weight and obesity in premenopausal women. After menopause, women who gave birth to 2 children and breastfed 1-6 and > 12 months had a lower risk of abdominal obesity (OR 0.70; 95% CI 0.50-0.99; p = 0.042; and OR 0.68; 95% CI 0.47-0.98; p = 0.039). Women who gave birth to 3 or more children and breastfed for 1-6 months, also showed a lower risk of overweight (OR 0.52; 95% CI 0.27-0.99; p = 0.047), compared to those ones that have never breastfed. There was no relationship found between the duration of lactation and the risk of excessive body fat.

CONCLUSION

Breastfeeding may have some beneficial, long-term effect on the risk of excessive weight and abdominal obesity in women.

Omega-3 fatty acids reduce cardiometabolic risk in first-episode schizophrenia patients treated with antipsychotics: Findings from the OFFER randomized controlled study

Metabolic syndrome (MetS) increases the risk of premature mortality observed in schizophrenia (SCZ). N-3 polyunsaturated fatty acid (PUFA) deficiency has been reported in different stages of schizophrenia. N-3 PUFA supplementation was found to be beneficial in both chronic SCZ and MetS. No intervention studies based on n-3 PUFA as add-on therapy to antipsychotics have examined the changes in MetS risk in first-episode schizophrenia.

AIM

This randomized placebo-controlled trial assesses the effect of a 26-week intervention composed of either 2.2 g/day of n-3 PUFA or olive oil placebo on the frequency of MetS and the changes in its constituents as a secondary outcome measure.

METHODS

Seventy-one adult inpatients diagnosed with first-episode schizophrenia were randomly assigned to study groups. The active intervention used a 3:2 mixture of eicosapentaenoic (EPA) and docosahexaenoic (DHA) acids. Metabolic syndrome components were monitored throughout the study.

RESULTS

A significant reduction in the frequency of MetS was observed in the EPA + DHA group (p = 0.0408); as well as some specific MetS components: e.g., a decrease in fasting blood glucose (p = 0.045). The beneficial effects of EPA + DHA were even more pronounced in patients treated mainly with olanzapine, e.g. significant reductions of total cholesterol (p = 0.037) and blood glucose levels (p = 0.034). Significant positive correlations were found between the general psychopathology subscale of PANSS (primary outcome) and triglyceride level changes.

CONCLUSION

N-3 PUFA supplementation in early SCZ may constitute a safe and affordable intervention that can reduce the risk of MetS and its lethal complications.

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.

Associations of household solid fuel for heating and cooking with hypertension in Chinese adults

OBJECTIVE

The association between indoor air pollution resulting from household solid fuel use for heating and cooking with hypertension or blood pressure (BP) remains less clear. This study aims to rectify these knowledge gaps in a large Chinese population.

METHODS

During 2005-2009, 44 007 individuals aged 35-70 years with complete information on household solid fuel use for cooking and heating were recruited from 279 urban and rural communities of 12 centers. Solid fuel referred to charcoal, coal, wood, agriculture crop, animal dung or shrub. Annual concentration of ambient atmospheric particulate matter that have a diameter of less than 2.5 μm for all communities was collected. Generalized linear mixed models using community as the random effect were performed to estimate the association with hypertension prevalence or BP after considering ambient atmospheric particulate matter that have a diameter of less than 2.5 μm and a comprehensive set of potential confounding factors at the individual and household level.

RESULTS

A total of 47.6 and 61.2% of participants used household solid fuel for heating and cooking, respectively. Solid fuel use for heating was not associated with an increase in hypertension prevalence (adjusted odds ratio = 1.08, 95% confident interval: 0.98, 1.20) or elevated SBP (0.62 mmHg, 95% confident interval: -0.24, 1.48). No association was found between solid fuel for cooking and hypertension or BP, and no additional risk was observed among participants who had both exposures to solid fuel for heating and cooking compared with those used for heating only.

CONCLUSION

The current large Chinese study revealed a statistically insignificant increase in the association between solid fuel use for heating and hypertension prevalence or BP. As this cross-sectional study has its inherent limitation on causality, findings from this study would have to be confirmed by prospective cohort studies.

Frequency of legume consumption related to sociodemographic factors, health status and health-related variables among surveyed adults from Poland

OBJECTIVE

The aims of the study were: (i) to estimate the frequency of legume consumption in a study sample from Poland; (ii) to assess relationships between frequency of legume consumption and sociodemographic factors, health status and health-related variables and (iii) to describe the sociodemographic and health-related profiles of 'frequent', 'rare' and 'never legume consumers'.

DESIGN

A cross-sectional study with a self-administered questionnaire was conducted. χ2 test compared the distribution of sociodemographic, health status and health-related variables in accordance with frequency of legume consumption. Multiple correspondence analysis (MCA) revealed the sociodemographic and health-related profiles of 'frequent', 'rare' and 'never legume consumers'.

SETTING

Adult individuals from Poland.

PARTICIPANTS

The present study included 1135 adults aged 18-80 years.

RESULTS

Only 22·8 % of all participants declared frequent legume consumption. The prevalence of 'rare' and 'never consumers' was 72·1 and 5·1 %, respectively. The MCA highlighted strong correspondence of sociodemographic factors, health status and health-related variables with the frequency of legume consumption.

CONCLUSIONS

Low frequency of legume consumption in a study sample of adults from Poland was strongly associated with male sex, low educational level, physical work, living in villages and small cities, and living with more than one co-resident; low legume consumption was also associated with sedentary lifestyle, no disease prevalence and no dietary supplementation.

Mortality and cardiovascular and respiratory morbidity in individuals with impaired FEV1 (PURE): an international, community-based cohort study

BACKGROUND

The associations between the extent of forced expiratory volume in 1 s (FEV₁) impairment and mortality, incident cardiovascular disease, and respiratory hospitalisations are unclear, and how these associations might vary across populations is unknown.

METHODS

In this international, community-based cohort study, we prospectively enrolled adults aged 35-70 years who had no intention of moving residences for 4 years from rural and urban communities across 17 countries. A portable spirometer was used to assess FEV₁. FEV₁ values were standardised within countries for height, age, and sex, and expressed as a percentage of the country-specific predicted FEV₁ value (FEV₁%). FEV₁% was categorised as no impairment (FEV₁% ≥0 SD from country-specific mean), mild impairment (FEV₁% <0 SD to -1 SD), moderate impairment (FEV₁% <-1 SD to -2 SDs), and severe impairment (FEV₁% <-2 SDs [ie, clinically abnormal range]). Follow-up was done every 3 years to collect information on mortality, cardiovascular disease outcomes (including myocardial infarction, stroke, sudden death, or congestive heart failure), and respiratory hospitalisations (from chronic obstructive pulmonary disease, asthma, pneumonia, tuberculosis, or other pulmonary conditions). Fully adjusted hazard ratios (HRs) were calculated by multilevel Cox regression.

FINDINGS

Among 126 359 adults with acceptable spirometry data available, during a median 7·8 years (IQR 5·6-9·5) of follow-up, 5488 (4·3%) deaths, 5734 (4·5%) cardiovascular disease events, and 1948 (1·5%) respiratory hospitalisation events occurred. Relative to the no impairment group, mild to severe FEV₁% impairments were associated with graded increases in mortality (HR 1·27 [95% CI 1·18-1·36] for mild, 1·74 [1·60-1·90] for moderate, and 2·54 [2·26-2·86] for severe impairment), cardiovascular disease (1·18 [1·10-1·26], 1·39 [1·28-1·51], 2·02 [1·75-2·32]), and respiratory hospitalisation (1·39 [1·24-1·56], 2·02 [1·75-2·32], 2·97 [2·45-3·60]), and this pattern persisted in subgroup analyses considering country income level and various baseline risk factors. Population-attributable risk for mortality (adjusted for age, sex, and country income) from mildly to moderately reduced FEV₁% (24·7% [22·2-27·2]) was larger than that from severely reduced FEV₁% (3·7% [2·1-5·2]) and from tobacco use (19·7% [17·2-22·3]), previous cardiovascular disease (5·5% [4·5-6·5]), and hypertension (17·1% [14·6-19·6]). Population-attributable risk for cardiovascular disease from mildly to moderately reduced FEV₁ was 17·3% (14·8-19·7), second only to the contribution of hypertension (30·1% [27·6-32·5]).

INTERPRETATION

FEV₁ is an independent and generalisable predictor of mortality, cardiovascular disease, and respiratory hospitalisation, even across the clinically normal range (mild to moderate impairment).

FUNDING

Population Health Research Institute, the Canadian Institutes of Health Research, Heart and Stroke Foundation of Ontario, Ontario Ministry of Health and Long-Term Care, AstraZeneca, Sanofi-Aventis, Boehringer Ingelheim, Servier, and GlaxoSmithKline, Novartis, and King Pharma. Additional funders are listed in the appendix.

Association between egg consumption and elevated fasting glucose prevalence in relation to dietary patterns in selected group of Polish adults

Background

The safety of high egg intake in view of its impact on glucose metabolism remains inconclusive. The aim of the study was to assess the relationship between egg intake, dietary patterns and elevated fasting glucose (FG) level in a selected group of Polish adults.

Methods

The study group consisted of 1630 adults who participated in the Polish arm of the Prospective Urban Rural Epidemiological Study. Dietary intake, including egg intake, was assessed based on the data from the Additional file 2 Food Frequency Questionnaire previously validated for the population of Lower Silesia. DPs were derived using principal component analysis. FG levels ≥100 mg/dl were considered elevated. Subjects who used antidiabetic drugs were included in the group with elevated FG levels.

Results

Egg consumption increased in higher quartiles of “Western” and “traditional” DPs in both men and women (p < 0.0001). In a crude model each 10 g of eggs consumed per day was associated with 7% increased risk (OR 1.07; 95% CI: 1.01–1.15) of elevated glucose level in the overall group and 10% increased risk (OR 1.10; 95% CI: 1.01–1.21) of elevated glucose level in the group of men. Men who consumed at least five eggs per week had higher risk for elevated FG level compared to men who consumed at most one egg per week (OR 1.79; 95% CI 1.13–2.84), but this relationship became insignificant when the data were adjusted for DPs. In the group of women no association between egg intake and elevated FG level was observed.

Conclusions

Higher egg intake may be associated with the overall unhealthy dietary habits, which is why the number of eggs consumed daily should not be considered an independent risk factor for elevated fasting glucose level.

Predictive Values of Anthropometric Measurements for Cardiometabolic Risk Factors and Cardiovascular Diseases Among 44 048 Chinese

Background The predictive value of adiposity indices and the newly developed index for cardiometabolic risk factors and cardiovascular diseases (CVDs) remains unclear in the Chinese population. This study aimed to compare the predictive value of A Body Shape Index with other 5 conventional obesity-related anthropometric indices (body mass index, waist circumference, hip circumference, waist-to-hip ratio, waist-to-height ratio) in Chinese population. Methods and Results A total of 44 048 participants in the study were derived from the baseline data of the PURE-China (Prospective Urban and Rural Epidemiology) study in China. All participants' anthropometric parameters, CVDs, and risk factors (dyslipidemia, abnormal blood pressure, and hyperglycemia) were collected by standard procedures. Multivariable logistic regression models and receiver operator characteristic curve analysis were used to evaluate the predictive values of obesity-related anthropometric indices to the cardiometabolic risk factors and CVDs. A positive association was observed between each anthropometric index and cardiometabolic risk factors and CVDs in all models (P<0.001). Compared with other anthropometric indices (body mass index, waist circumference, hip circumference, waist-to-hip ratio, and A Body Shape Index), waist-to-height ratio had significantly higher areas under the curve (AUCs) for predicting dyslipidemia (AUCs: 0.646, sensitivity: 65%, specificity: 44%), hyperglycemia (AUCs: 0.595, sensitivity: 60%, specificity: 45%), and CVDs (AUCs: 0.619, sensitivity: 59%, specificity: 41%). Waist circumference showed the best prediction for abnormal blood pressure (AUCs: 0.671, sensitivity: 66%, specificity: 40%) compared with other anthropometric indices. However, the new body shape index did not show a better prediction to either cardiometabolic risk factors or CVDs than that of any other traditional obesity-related indices. Conclusions Waist-to-height ratio appeared to be the best indicator for dyslipidemia, hyperglycemia, and CVDs, while waist circumference had a better prediction for abnormal blood pressure.

Association between dietary patterns and metabolic syndrome in the selected population of Polish adults-results of the PURE Poland Study

BACKGROUND

Dietary pattern (DP) analysis is a statistical method used to evaluate the comprehensive effect of the diet on health. The aim of the study was to assess the relationship between DPs derived in selected population of Lower Silesia and the prevalence of metabolic syndrome (MS) and its components.

METHODS

Study group consisted of 1634 individuals enrolled in the Prospective Urban and Rural Epidemiological Study Poland. Dietary intake was estimated using the data from the Food Frequency Questionnaire. DPs were identified using principal component analysis. MS prevalence was evaluated based on the criteria accepted by International Diabetes Federation, American Heart Association and National Heart, Lung and Blood Institute in 2009.

RESULTS

Three DPs were identified. The percentage of individuals with MS was lower in the upper quartile (Q) of the 'fruit & vegetables' DP in comparison with Q1 (40.4 vs. 48.9%). Inverse relationship was observed for 'Western' (Q4 vs. Q1: 50.7 vs. 40.8%) and 'traditional' DPs (51.0 vs. 38.3%). After adjusting for potential confounders, in Q4 of 'traditional' DP higher risk for central obesity was observed compared to Q1 (OR 1.52; 95% CI: 1.10-2.12). Individuals in Q3 of 'fruit & vegetables' DP had lower risk for raised blood pressure in comparison with the bottom Q (OR 0.54; 95% CI: 0.36-0.82).

CONCLUSIONS

DP analysis allows to evaluate the synergistic effect of the diet on the MS prevalence. 'Fruit & vegetables' DP, in contrast to 'Western' and 'traditional' DPs, was negatively associated with the prevalence of MS and its components in the study group.

Validation of the Romanian Version of a Self-Administered Food Frequency Questionnaire

Background and aims: The present study aimed to assess the relative validity of the Romanian version of a food frequency questionnaire (FFQ) in evaluating habitual dietary intake.

Material and methods: We used an FFQ that comprised questions on 90 beverage and food items from Nurses Health Questionnaire. The linguistic interchangeability between translation and original questions of the FFQ was assessed in 50 bilingual adults. Also, the FFQ was validated against the 24-h recall diary in 85 participants from ORO study enrolled in Cluj County.

Results: The Spearman correlation coefficients between the Romanian and English versions of the FFQ ranged between 0.614 and 1.000, with the majority having values >0.900 (p <0.05 for all). Caloric and nutrient intake estimated from FFQ was significantly correlated with that derived from 24-h dietary recall (correlation coefficients 0.243 to 0.339; p-values <0.05). >70% of the participants were classified in the same or adjacent quartiles of energy and nutrient consumption showing a good agreement between FFQ and 24-h dietary recall. Tested FFQ questionnaire had a good internal consistency with Cronbach’s alpha coefficients of 0.931 and 0.949, respectively.

Conclusion: Tested FFQ had an acceptable relative validity and can be used to estimate caloric and macronutrient intake.

The Consumption of Alcoholic Beverages and the Prevalence of Cardiovascular Diseases in Men and Women: A Cross-Sectional Study

Associations between alcohol consumption and the prevalence of cardiovascular diseases have been the subject of several studies for a long time; however, the presence and nature of any associations still remain unclear. The aim of the study was to analyze the associations between the consumption of alcoholic beverages and the prevalence of cardiovascular diseases in men and women. The data of 12,285 individuals aged 37-66 were used in the analysis. Multiple logistic regression models were utilized to estimate odds ratios and confidence intervals. The multivariable models included several potential confounders including age, education, marital status, body mass index (BMI), physical activity, smoking, coffee consumption, and statin use. The analyses were performed separately for men and women. In the model adjusted for confounders, the consumption from 0.1 to 10.0 g of alcohol/day was related to a lower risk of coronary disease and stroke (p < 0.05), and the consumption from 0.1 to 15.0 g/day was related to a lower risk of hypertension in women (p < 0.05). In men, in the adjusted model, there were no associations between alcohol consumption and the occurrence of hypertension or stroke. The risk of circulatory failure was significantly lower in the group in which participants drank more than 20.0 g of alcohol/day (p < 0.05) compared to nondrinkers. The risk of coronary disease was lower in drinkers at every level of alcohol consumption (p < 0.05) compared to nondrinkers. Alcohol consumption was related to a lower prevalence of cardiovascular diseases (CVD), both in men and women.

An increase in plasma brain derived neurotrophic factor levels is related to n-3 polyunsaturated fatty acid efficacy in first episode schizophrenia: secondary outcome analysis of the OFFER randomized clinical trial

RATIONALE

N-3 polyunsaturated fatty acids (n-3 PUFA) influence multiple biochemical mechanisms postulated in the pathogenesis of schizophrenia that may influence BDNF synthesis.

OBJECTIVES

A randomized placebo-controlled study was designed to compare the efficacy of a 26-week intervention composed of either 2.2 g/day of n-3 PUFA or olive oil placebo, with regard to symptom severity in first-episode schizophrenia patients. The secondary outcome measure of the study was to describe the association between n-3 PUFA clinical effect and changes in peripheral BDNF levels.

METHODS

Seventy-one patients aged 16-35 were enrolled in the study and randomly assigned to the following study arms: 36 to the EPA + DHA group and 35 to the placebo group. Plasma BDNF levels were assessed three times, at baseline and at weeks 8 and 26 of the intervention. BDNF levels were determined in plasma samples using Quantikine Human BDNF ELISA kit. Plasma BDNF level changes were further correlated with changes in the severity of symptoms in different clinical domains.

RESULTS

A significantly greater increase in plasma BDNF levels was observed in the intervention compared to the placebo group (Cohen's d = 1.54). Changes of BDNF levels inversely correlated with change in depressive symptoms assessed using the Calgary Depression Rating Scale in Schizophrenia (Pearson's r = - 0.195; p = 0.018).

CONCLUSIONS

The efficacy of a six-month intervention with n-3 PUFA observed in first-episode schizophrenia may be related to an increase in BDNF levels, which may be triggered by the activation of intracellular signaling pathways including transcription factors such as cAMP-reactive element binding protein.

Reproducibility of a Questionnaire for Dietary Habits, Lifestyle and Nutrition Knowledge Assessment (KomPAN) in Polish Adolescents and Adults

The aim of the study was to evaluate the reproducibility of the Dietary Habits and Nutrition Beliefs Questionnaire (KomPAN) in Polish adolescents and adults, including the assessment of indexes developed based on the questionnaire. In total, the study involved 954 subjects aged 15–65 (53.9% females). Interviews using the interviewer-administered questionnaire (IA-Q) in healthy subjects (n 299) and the self-administered questionnaire (SA-Q) in healthy subjects (n 517) and outpatients (n 138) were conducted and repeated after two weeks. Considering the consumption frequency of 33 food items, the cross-classification (test-retest) agreement of classification into the same category obtained for IA-Q in healthy subjects ranged from 72.2% (fruit juices) to 91.6% (energy drinks); the kappa statistic was >0.60 for all food items. For SA-Q conducted in healthy subjects the cross-classification agreement ranged from 63.8% (vegetable oils, margarines, mixes of butter and margarines) to 84.7% (lard); the kappa statistic was >0.50 for all food items. For SA-Q in outpatients, the cross-classification agreement ranged from 42.0% (both fruit juices and white rice, white pasta, fine-ground groats) to 92.0% (energy drinks); the kappa statistic was ≥0.40 for 20/33 food items. The kappa statistic for lifestyle items ranged 0.42–0.96, and for the nutrition knowledge level it ranged 0.46–0.73. The questionnaire showed moderate to very good reproducibility and can be recommended to assess dietary habits, lifestyle and nutrition knowledge of healthy adolescents and adults and those suffering from chronic diseases, after validation and/or calibration study is carried out. The reproducibility of the interviewer-administered questionnaire was better than its self-administered version. The reproducibility of the self-administered questionnaire was better in healthy subjects than in outpatients.

Relationship Between Sitting Time, Physical Activity, and Metabolic Syndrome Among Adults Depending on Body Mass Index (BMI)

Background

The aim of this study was to assess the possible relationship between sitting time and physical activity and the risk of occurrence of metabolic syndrome and its components. Analyses were conducted in the whole sample, and with stratification according to BMI. We have formulated a hypothesis that individuals with different BMIs have different responses to metabolic health modifiers such as physical activity and sitting time.

Material/Methods

Altogether, the data from 10 367 participants from urban and rural areas, aged 37–66 years were used in the study (7479 of whom were overweight or obese). The definition of metabolic syndrome devised by the IDF Joint Interim Statement criteria using an ethnic-specific cut-off point for waist circumference as the central obesity criterion was used.

Results

In all analyzed BMI groups, longer sitting time was only associated with abdominal obesity (all p for trend <0.05). In participants declaring low physical activity levels, the risk of metabolic syndrome and abnormal triglycerides concentration was higher compared to those declaring high physical activity, regardless of BMI (all p for trend <0.05). In the group with overweight or obesity, low physical activity was associated with a higher risk of abdominal obesity (p for trend <0.05), increased glucose concentration (p for trend <0.05), and elevated blood pressure (p for trend <0.05). In participants with a normal BMI, these associations did not occur.

Conclusions

Our data suggest that physical activity helps preventive metabolic syndrome and its abnormal components, especially in participants who are overweight or obese.

A systematic review of methods to assess intake of saturated fat (SF) among healthy European adults and children: a DEDIPAC (Determinants of Diet and Physical Activity) study

BACKGROUND

Dietary fat is an essential macronutrient. However, saturated fact has been associated with negative health outcomes including cardiovascular disease. Shifting consumption from saturated fat to unsaturated fats and limiting the level of saturated fat in the diet has been recommended. Currently, there is no standard method to measure saturated fat intake in etiologic studies. Therefore, it is difficult to obtain a reliable picture of saturated fat intake in Europe. To inform the development of the DEDIPAC (DEterminants of DIet and Physical Activity) toolbox of methods, we aimed to identify the assessment methods and specific instruments which have been used to assess saturated fat intake among children or adults in pan-European studies.

METHODS

Three electronic databases were searched for English language studies of any design which assessed intake of saturated fat. Reference lists were hand-searched. Studies were included if they were conducted in two or more European countries, and involved healthy, free-living children and adults.

RESULTS

The review identified 20 pan-European studies which assessed saturated fat intake. Food Frequency Questionnaires (n = 8) and diet records (n = 7) were most common, followed by 24-h recalls (n = 5). Methods differed in portion size estimation and the composition data which was used to calculate nutrient intake. Of the instruments used in more than two European countries, five Food Frequency Questionnaires had been specifically tested for validity to assess saturated fat intake; four among adults (Food4me, PURE, IMMIDIET, Health, Alcohol and Psychosocial factors in Eastern Europe (HAPIEE)) and one among children (used by Piqueras et al.).

CONCLUSIONS

A standardised approach to portion size estimation and a common source of food composition data are required to measure saturated fat intake across Europe effectively. Only five instruments had been used in more than two European countries and specifically tested for validity to assess saturated fat intake. These instruments may be most appropriate to evaluate intake of saturated fat in future pan-European studies. However, only two instruments had been tested for validity in more than one European country. Future work is needed to assess the validity of the identified instruments across European countries.

Telomerase level increase is related to n-3 polyunsaturated fatty acid efficacy in first episode schizophrenia: Secondary outcome analysis of the OFFER randomized clinical trial

Schizophrenia is associated with shortening of the lifespan mainly due to cardiovascular events, cancer and chronic obstructive pulmonary disease. Both telomere attrition and decrease of telomerase levels were observed in schizophrenia. Polyunsaturated fatty acids (PUFA) influence multiple biochemical mechanisms which are postulated to accelerate telomere shortening and limit the longevity of patients with schizophrenia. Intervention studies based on add-on therapy with n-3 polyunsaturated fatty acids (n-3 PUFA) in patients with schizophrenia did not assess the changes in telomerase levels. A randomized placebo-controlled trial named OFFER was designed to compare the efficacy of a 26-week intervention composed of either 2.2g/day of n-3 PUFA or olive oil placebo with regard to symptom severity in first-episode schizophrenia patients. The secondary outcome measure of the study was to describe the association between the clinical effect of n-3 PUFA and changes in telomerase levels. Seventy-one patients aged 16-35 were enrolled in the study and randomly assigned to the study arms. The Positive and Negative Syndrome Scale (PANSS) was used to assess the change in symptom severity. Telomerase levels of peripheral blood mononuclear cells (PBMC) were assessed at three points: at baseline and at weeks 8 and 26 of the intervention. A significantly greater increase in PBMC telomerase levels in the intervention group compared to placebo was observed (p<0.001). Changes in telomerase levels significantly and inversely correlated with improvement in depressive symptoms and severity of the illness. The efficacy of a six-month intervention with n-3 PUFA observed in first-episode schizophrenia may be related to an increase in telomerase levels.

The cholesterol-lowering effect of statins is potentiated by whole grains intake. The Polish Norwegian Study (PONS)

BACKGROUND

Hypercholesterolemia treatment guidelines emphasize an adequate whole grains (WG) intake, alone or complementary to pharmacological treatment. We conducted this study to compare the prevalence of adequate WG intake and levels of blood lipids according to the statin/WG intake status.

METHODS

This cross-sectional analysis of a community-based study included 12,754 men and women, age 45-64. Statin use over past 30days was recorded by trained nurses. Food intake over past 12months was assessed by a validated food-frequency questionnaire. Adequate WG intake was defined as ≥3oz-equivalents/day, representing ≥3WGservings/day.

RESULTS

The prevalence of an adequate WG intake was marginally superior in statin users (26.79%) than non-users (21.51%). This superiority was attenuated after multiple covariates adjustment (PR 1.12, 95%CI 1.02-1.22). Statin users with an adequate WG intake had lower multivariable-adjusted mean blood total cholesterol (185.14mg/dL vs. 190.14mg/dL) and LDL cholesterol (103.30mg/dL vs. 108.19mg/dL) than those with an inadequate WG intake. Statin users with an adequate WG intake had lower odds (OR, 95% CI) of having TC≥240mg/dL (OR 0.67, 95% CI 0.46-0.98) and lower odds of having LDL≥100mg/dL (OR 0.72, 95% CI 0.58-0.89), compared to statin users with inadequate WG intake. A subgroup analysis restricted to those with prevalent CVD yielded similar results.

CONCLUSIONS

In this community based sample of middle-aged adults, only one in four statin users had adequate whole grain intake. Statin users with adequate WG intake had statistically and clinically significant lower levels of blood total- and LDL-cholesterol.

Dietary Patterns in Relation to Metabolic Syndrome among Adults in Poland: A Cross-Sectional Study

In several populations the associations between diet and the risk of metabolic syndrome have not been fully examined yet. The aim of the study is to identify the main dietary patterns among Polish adults and the evaluation of the relationships of these patterns with metabolic syndrome and its components. The study was conducted on a group of 7997 participants, aged between 37 and 66 years old. Dietary patterns were identified by factor analysis. Metabolic syndrome was defined according to the International Diabetes Federation. Three dietary patterns were identified and designated as: "Healthy", "Westernized" and "Traditional-carbohydrate". In the adjusted model, a higher score in the "Westernized" pattern aligns with a higher risk of abnormal glucose concentration (p_trend = 0.000), but with a lower risk of abnormal High-Density Lipoprotein Cholesterol HDL-cholesterol concentration (p_trend = 0.024). Higher scores in the "Traditional-carbohydrate" pattern were connected with the risk of abdominal obesity (p_trend = 0.001) and increased triglycerides concentration (p_trend = 0.050). Our results suggest that adherence to the "Traditional-carbohydrate" dietary pattern, characterized by higher intakes of refined grains, potatoes, sugar and sweets is associated with a higher risk of abdominal obesity and triglyceridemia. A "Westernized" dietary pattern on the other hand, is related to hyperglycemia. The study results can be used for community-based health promotion and intervention programs to prevent or better manage chronic diseases.

Associations of fats and carbohydrate intake with cardiovascular disease and mortality in 18 countries from five continents (PURE): a prospective cohort study

BACKGROUND

The relationship between macronutrients and cardiovascular disease and mortality is controversial. Most available data are from European and North American populations where nutrition excess is more likely, so their applicability to other populations is unclear.

METHODS

The Prospective Urban Rural Epidemiology (PURE) study is a large, epidemiological cohort study of individuals aged 35-70 years (enrolled between Jan 1, 2003, and March 31, 2013) in 18 countries with a median follow-up of 7·4 years (IQR 5·3-9·3). Dietary intake of 135 335 individuals was recorded using validated food frequency questionnaires. The primary outcomes were total mortality and major cardiovascular events (fatal cardiovascular disease, non-fatal myocardial infarction, stroke, and heart failure). Secondary outcomes were all myocardial infarctions, stroke, cardiovascular disease mortality, and non-cardiovascular disease mortality. Participants were categorised into quintiles of nutrient intake (carbohydrate, fats, and protein) based on percentage of energy provided by nutrients. We assessed the associations between consumption of carbohydrate, total fat, and each type of fat with cardiovascular disease and total mortality. We calculated hazard ratios (HRs) using a multivariable Cox frailty model with random intercepts to account for centre clustering.

FINDINGS

During follow-up, we documented 5796 deaths and 4784 major cardiovascular disease events. Higher carbohydrate intake was associated with an increased risk of total mortality (highest [quintile 5] vs lowest quintile [quintile 1] category, HR 1·28 [95% CI 1·12-1·46], p_trend=0·0001) but not with the risk of cardiovascular disease or cardiovascular disease mortality. Intake of total fat and each type of fat was associated with lower risk of total mortality (quintile 5 vs quintile 1, total fat: HR 0·77 [95% CI 0·67-0·87], p_trend<0·0001; saturated fat, HR 0·86 [0·76-0·99], p_trend=0·0088; monounsaturated fat: HR 0·81 [0·71-0·92], p_trend<0·0001; and polyunsaturated fat: HR 0·80 [0·71-0·89], p_trend<0·0001). Higher saturated fat intake was associated with lower risk of stroke (quintile 5 vs quintile 1, HR 0·79 [95% CI 0·64-0·98], p_trend=0·0498). Total fat and saturated and unsaturated fats were not significantly associated with risk of myocardial infarction or cardiovascular disease mortality.

INTERPRETATION

High carbohydrate intake was associated with higher risk of total mortality, whereas total fat and individual types of fat were related to lower total mortality. Total fat and types of fat were not associated with cardiovascular disease, myocardial infarction, or cardiovascular disease mortality, whereas saturated fat had an inverse association with stroke. Global dietary guidelines should be reconsidered in light of these findings.

FUNDING

Full funding sources listed at the end of the paper (see Acknowledgments).

Fruit, vegetable, and legume intake, and cardiovascular disease and deaths in 18 countries (PURE): a prospective cohort study

BACKGROUND

The association between intake of fruits, vegetables, and legumes with cardiovascular disease and deaths has been investigated extensively in Europe, the USA, Japan, and China, but little or no data are available from the Middle East, South America, Africa, or south Asia.

METHODS

We did a prospective cohort study (Prospective Urban Rural Epidemiology [PURE] in 135 335 individuals aged 35 to 70 years without cardiovascular disease from 613 communities in 18 low-income, middle-income, and high-income countries in seven geographical regions: North America and Europe, South America, the Middle East, south Asia, China, southeast Asia, and Africa. We documented their diet using country-specific food frequency questionnaires at baseline. Standardised questionnaires were used to collect information about demographic factors, socioeconomic status (education, income, and employment), lifestyle (smoking, physical activity, and alcohol intake), health history and medication use, and family history of cardiovascular disease. The follow-up period varied based on the date when recruitment began at each site or country. The main clinical outcomes were major cardiovascular disease (defined as death from cardiovascular causes and non-fatal myocardial infarction, stroke, and heart failure), fatal and non-fatal myocardial infarction, fatal and non-fatal strokes, cardiovascular mortality, non-cardiovascular mortality, and total mortality. Cox frailty models with random effects were used to assess associations between fruit, vegetable, and legume consumption with risk of cardiovascular disease events and mortality.

FINDINGS

Participants were enrolled into the study between Jan 1, 2003, and March 31, 2013. For the current analysis, we included all unrefuted outcome events in the PURE study database through March 31, 2017. Overall, combined mean fruit, vegetable and legume intake was 3·91 (SD 2·77) servings per day. During a median 7·4 years (5·5-9·3) of follow-up, 4784 major cardiovascular disease events, 1649 cardiovascular deaths, and 5796 total deaths were documented. Higher total fruit, vegetable, and legume intake was inversely associated with major cardiovascular disease, myocardial infarction, cardiovascular mortality, non-cardiovascular mortality, and total mortality in the models adjusted for age, sex, and centre (random effect). The estimates were substantially attenuated in the multivariable adjusted models for major cardiovascular disease (hazard ratio [HR] 0·90, 95% CI 0·74-1·10, p_trend=0·1301), myocardial infarction (0·99, 0·74-1·31; p_trend=0·2033), stroke (0·92, 0·67-1·25; p_trend=0·7092), cardiovascular mortality (0·73, 0·53-1·02; p_trend=0·0568), non-cardiovascular mortality (0·84, 0·68-1·04; p_trend =0·0038), and total mortality (0·81, 0·68-0·96; p_trend<0·0001). The HR for total mortality was lowest for three to four servings per day (0·78, 95% CI 0·69-0·88) compared with the reference group, with no further apparent decrease in HR with higher consumption. When examined separately, fruit intake was associated with lower risk of cardiovascular, non-cardiovascular, and total mortality, while legume intake was inversely associated with non-cardiovascular death and total mortality (in fully adjusted models). For vegetables, raw vegetable intake was strongly associated with a lower risk of total mortality, whereas cooked vegetable intake showed a modest benefit against mortality.

INTERPRETATION

Higher fruit, vegetable, and legume consumption was associated with a lower risk of non-cardiovascular, and total mortality. Benefits appear to be maximum for both non-cardiovascular mortality and total mortality at three to four servings per day (equivalent to 375-500 g/day).

FUNDING

Full funding sources listed at the end of the paper (see Acknowledgments).

Oxidative stress reduction related to the efficacy of n-3 polyunsaturated fatty acids in first episode schizophrenia: Secondary outcome analysis of the OFFER randomized trial

Intervention studies of n-3 polyunsaturated fatty acids (n-3 PUFA) as add-on therapy in patients with schizophrenia have not examined changes in oxidative stress. A randomized placebo-controlled trial of a 26-week intervention composed of 2.2g/day of n-3 PUFA was found to reduce symptom severity in first-episode schizophrenia patients. The present study is an extension of our previous report, whose secondary aim was to assess the association between the clinical effect of n-3 PUFA and changes in oxidative stress indices. Seventy-one patients aged 16-35 were enrolled in the study and randomly assigned to the study arms. Total plasma antioxidant capacity and 8-epi-isoprostane F_2α content were assessed at baseline and at weeks 8 and 26 of the study as secondary outcome measures. Significant changes in oxidative stress indices favouring the intervention group were observed: decreases in 8-isoprostane F_2α (p<0.001) and increases in total plasma antioxidant capacity (p<0.001). Significant correlations between changes in clinical scores relevant to symptom severity and changes in oxidative indices were observed. The results of the present study hence suggest that the efficacy of a six-month intervention with n-3 PUFA observed in first-episode schizophrenia may be related to improvement in oxidative stress indices.

Development of a FFQ for breast cancer survivors in Korea

Diet may play an important role in breast cancer recurrence or survival, and therefore assessment of long-term diet among breast cancer survivors is important in breast cancer survivorship research. Given that the diet of breast cancer survivors may differ from that of the general population, the use of a FFQ specific to this group may be needed. The objective of this study was to develop a FFQ for breast cancer survivors, the most commonly used tool to measure long-term dietary patterns in nutritional epidemiological studies. We collected information on the foods and amounts of foods consumed using 3-d dietary records from a total of 192 women who had been diagnosed with stage I–III breast cancers and had undergone breast cancer surgery at least 6 months before the baseline study. A total of 1254 foods and dishes consumed were re-grouped by the similarity of the main ingredients and/or serving units, and several dishes commonly consumed among the Korean population were added. After we performed contribution analyses and variability analyses to detect between-person variation for selected nutrients, we listed a total of 123 foods and dishes for the FFQ specific to breast cancer survivors. Our breast cancer survivor-specific FFQ can be used to estimate long-term dietary intake and to examine its association with breast cancer prognosis in epidemiological studies of breast cancer in Korea.

Coffee consumption and the occurrence and intensity of metabolic syndrome: a cross-sectional study

The objective of the study was to investigate associations between coffee consumption and the occurrence of metabolic syndrome (MetS) and its components in individuals with a normal BMI, as well in those who are overweight and obese. The analysis was based on the data of 10,367 participants. The studies included a questionnaire interview, anthropometric measurements, blood pressure measurements and analyses of collected fasting-blood samples. In the overweight and obese participants, lower coffee consumption, compared with higher consumption was correlated with a significantly higher risk of abdominal obesity, hypertension, an abnormal glucose concentration, HDL cholesterol, triglycerides and MetS (p < .05). In the participants with a normal BMI, lower coffee consumption was related to the abdominal obesity, HDL cholesterol and MetS (p < .05). Individuals with a normal BMI may react slightly differently to nutritional factors modifying metabolism such as coffee, compared with those with excessive body mass.

Availability, affordability, and consumption of fruits and vegetables in 18 countries across income levels: findings from the Prospective Urban Rural Epidemiology (PURE) study

BACKGROUND

Several international guidelines recommend the consumption of two servings of fruits and three servings of vegetables per day, but their intake is thought to be low worldwide. We aimed to determine the extent to which such low intake is related to availability and affordability.

METHODS

We assessed fruit and vegetable consumption using data from country-specific, validated semi-quantitative food frequency questionnaires in the Prospective Urban Rural Epidemiology (PURE) study, which enrolled participants from communities in 18 countries between Jan 1, 2003, and Dec 31, 2013. We documented household income data from participants in these communities; we also recorded the diversity and non-sale prices of fruits and vegetables from grocery stores and market places between Jan 1, 2009, and Dec 31, 2013. We determined the cost of fruits and vegetables relative to income per household member. Linear random effects models, adjusting for the clustering of households within communities, were used to assess mean fruit and vegetable intake by their relative cost.

FINDINGS

Of 143 305 participants who reported plausible energy intake in the food frequency questionnaire, mean fruit and vegetable intake was 3·76 servings (95% CI 3·66-3·86) per day. Mean daily consumption was 2·14 servings (1·93-2·36) in low-income countries (LICs), 3·17 servings (2·99-3·35) in lower-middle-income countries (LMICs), 4·31 servings (4·09-4·53) in upper-middle-income countries (UMICs), and 5·42 servings (5·13-5·71) in high-income countries (HICs). In 130 402 participants who had household income data available, the cost of two servings of fruits and three servings of vegetables per day per individual accounted for 51·97% (95% CI 46·06-57·88) of household income in LICs, 18·10% (14·53-21·68) in LMICs, 15·87% (11·51-20·23) in UMICs, and 1·85% (-3·90 to 7·59) in HICs (ptrend=0·0001). In all regions, a higher percentage of income to meet the guidelines was required in rural areas than in urban areas (p<0·0001 for each pairwise comparison). Fruit and vegetable consumption among individuals decreased as the relative cost increased (ptrend=0·00040).

INTERPRETATION

The consumption of fruit and vegetables is low worldwide, particularly in LICs, and this is associated with low affordability. Policies worldwide should enhance the availability and affordability of fruits and vegetables.

FUNDING

Population Health Research Institute, the Canadian Institutes of Health Research, Heart and Stroke Foundation of Ontario, AstraZeneca (Canada), Sanofi-Aventis (France and Canada), Boehringer Ingelheim (Germany and Canada), Servier, GlaxoSmithKline, Novartis, King Pharma, and national or local organisations in participating countries.

Cardiac Rehabilitation Delivery Model for Low-Resource Settings: An International Council of Cardiovascular Prevention and Rehabilitation Consensus Statement

Cardiovascular disease (CVD) is a global epidemic, which is largely preventable. Cardiac rehabilitation (CR) is demonstrated to be efficacious and cost-effective for secondary prevention in high-income countries. Given its affordability, CR should be more broadly implemented in middle-income countries as well. Hence, the International Council of Cardiovascular Prevention and Rehabilitation (ICCPR) convened a writing panel to recommend strategies to deliver all core CR components in low-resource settings, namely: (1) initial assessment, (2) lifestyle risk factor management (i.e., diet, tobacco, mental health), (3) medical risk factor management (lipids, blood pressure), (4) education for self-management; (5) return to work; and (6) outcome evaluation. Approaches to delivering these components in alternative, arguably lower-cost settings, such as the home, community and primary care, are provided. Recommendations on delivering each of these components where the most-responsible CR provider is a non-physician, such as an allied healthcare professional or community health care worker, are also provided.

Factors Associated with Adiposity, Lipid Profile Disorders and the Metabolic Syndrome Occurrence in Premenopausal and Postmenopausal Women

The aim of the study was the assessment of the dependencies between a woman’s menopausal status and adiposity, lipid profile and metabolic syndrome occurrence, as well as finding out whether the correlations between the socio-demographic profile and lifestyle elements and adiposity, lipid profile and the risk of MetS are the same before and after menopause. A cross-sectional study was carried out on 3636 women, aged between 40–59, which involved a questionnaire interview, anthropometric measurements and fasting blood samples, on the basis of which the concentration of triglycerides, cholesterol and glucose was estimated. Before menopause, a greater adiposity (BMIβ = 0.08; %BFβ = 0.07; WCβ = 0.06) was characteristic for women living in a stable relationship than for single women. Women who smoked in the past were characterized by a higher BMI (β = 0.09) and WC (β = 0.06) in comparison with women who have never smoked, while after menopause a greater adiposity (%BFβ = 0.12) and a worse lipid profile (TCβ = 0.08; LDLβ = 0.07; HDLβ = -0.05; TGβ = 0.14) were present in women currently smoking, in comparison to women who have never smoked. After menopause, in women who had two or more children, a greater adiposity (BMIβ = 0.07 and 0.09; %BFβ = 0.05 and 0.07) and a higher risk of MetS (OR = 1.22, 95%CI: 1.03–1.44) was observed compared to nulliparous women, than before menopause. In women with a higher level of education, the risk of MetS after menopause was significantly lower compared with women with a lower level of education (OR = 0.74, 95%CI: 0.61–0.90). Physical activity after menopause had a higher influence on the decrease in the women’s adiposity (BMIβ = -0.11 v. -0.06; %BFβ = -0.11 v. -0.06; WCβ = -0.14 v. -0.08), than before menopause. In women not undergoing hormone replacement therapy, some of the socio-demographic factors and lifestyle elements affected adiposity, lipid profile and the risk of MetS differently before and after menopause, which requires verification through long-term research.

A randomized controlled study of the efficacy of six-month supplementation with concentrated fish oil rich in omega-3 polyunsaturated fatty acids in first episode schizophrenia

Short-term clinical trials of omega-3 polyunsaturated fatty acids (n-3 PUFA) as add-on therapy in patients with schizophrenia revealed mixed results. The majority of these studies used an 8- to 12-week intervention based on ethyl-eicosapentaenoic acid. A randomized placebo-controlled trial was designed to compare the efficacy of 26-week intervention, composed of either 2.2 g/day of n-3 PUFA, or olive oil placebo, with regard to symptom severity in first-episode schizophrenia patients. Seventy-one patients (aged 16-35) were enrolled in the study and randomly assigned to the study arms. The primary outcome measure of the clinical evaluation was schizophrenia symptom severity change measured by the Positive and Negative Syndrome Scale (PANSS). Mixed models repeated measures analysis revealed significant differences between the study arms regarding total PANSS score change favouring n-3 PUFA (p = 0.016; effect size (ES) = 0.29). A fifty-percent improvement in symptom severity was achieved significantly more frequently in the n-3 PUFA group than in the placebo group (69.4 vs 40.0%; p = 0.017). N-3 PUFA intervention was also associated with an improvement in general psychopathology, measured by means of PANSS (p = 0.009; ES = 0.32), depressive symptoms (p = 0.006; ES = 0.34), the level of functioning (p = 0.01; ES = 0.31) and clinical global impression (p = 0.046; ES = 0.29). The findings suggest that 6-month intervention with n-3 PUFA may be a valuable add-on therapy able to decrease the intensity of symptoms and improve the level of functioning in first-episode schizophrenia patients.

Prognostic value of grip strength: findings from the Prospective Urban Rural Epidemiology (PURE) study

BACKGROUND

Reduced muscular strength, as measured by grip strength, has been associated with an increased risk of all-cause and cardiovascular mortality. Grip strength is appealing as a simple, quick, and inexpensive means of stratifying an individual's risk of cardiovascular death. However, the prognostic value of grip strength with respect to the number and range of populations and confounders is unknown. The aim of this study was to assess the independent prognostic importance of grip strength measurement in socioculturally and economically diverse countries.

METHODS

The Prospective Urban-Rural Epidemiology (PURE) study is a large, longitudinal population study done in 17 countries of varying incomes and sociocultural settings. We enrolled an unbiased sample of households, which were eligible if at least one household member was aged 35-70 years and if household members intended to stay at that address for another 4 years. Participants were assessed for grip strength, measured using a Jamar dynamometer. During a median follow-up of 4.0 years (IQR 2.9-5.1), we assessed all-cause mortality, cardiovascular mortality, non-cardiovascular mortality, myocardial infarction, stroke, diabetes, cancer, pneumonia, hospital admission for pneumonia or chronic obstructive pulmonary disease (COPD), hospital admission for any respiratory disease (including COPD, asthma, tuberculosis, and pneumonia), injury due to fall, and fracture. Study outcomes were adjudicated using source documents by a local investigator, and a subset were adjudicated centrally.

FINDINGS

Between January, 2003, and December, 2009, a total of 142,861 participants were enrolled in the PURE study, of whom 139,691 with known vital status were included in the analysis. During a median follow-up of 4.0 years (IQR 2.9-5.1), 3379 (2%) of 139,691 participants died. After adjustment, the association between grip strength and each outcome, with the exceptions of cancer and hospital admission due to respiratory illness, was similar across country-income strata. Grip strength was inversely associated with all-cause mortality (hazard ratio per 5 kg reduction in grip strength 1.16, 95% CI 1.13-1.20; p<0.0001), cardiovascular mortality (1.17, 1.11-1.24; p<0.0001), non-cardiovascular mortality (1.17, 1.12-1.21; p<0.0001), myocardial infarction (1.07, 1.02-1.11; p=0.002), and stroke (1.09, 1.05-1.15; p<0.0001). Grip strength was a stronger predictor of all-cause and cardiovascular mortality than systolic blood pressure. We found no significant association between grip strength and incident diabetes, risk of hospital admission for pneumonia or COPD, injury from fall, or fracture. In high-income countries, the risk of cancer and grip strength were positively associated (0.916, 0.880-0.953; p<0.0001), but this association was not found in middle-income and low-income countries.

INTERPRETATION

This study suggests that measurement of grip strength is a simple, inexpensive risk-stratifying method for all-cause death, cardiovascular death, and cardiovascular disease. Further research is needed to identify determinants of muscular strength and to test whether improvement in strength reduces mortality and cardiovascular disease.

FUNDING

Full funding sources listed at end of paper (see Acknowledgments).

Association between dietary patterns and metabolic syndrome in individuals with normal weight: a cross-sectional study

Background

The results of several papers have confirmed the existence of correlations between an unhealthy diet and the presence of metabolic syndrome. However, relationships between eating habits and metabolic obesity with normal weight have not yet been sufficiently studied. The aim of the study is to determine which dietary patterns are present in individuals with a normal BMI and to find out whether those patterns were connected with the risk of metabolic syndrome and its features.

Methods

A cross-sectional study was carried out in a group of 2479 subjects with a normal weight (BMI = 18.5–24.9 kg/m²), aged between 37–66. The study included the evaluation of eating habits, anthropometric measurements, blood pressure tests and the analysis of the collected fasting-blood samples, on the basis of which cholesterol, triglycerides and glucose levels were determined. Dietary patterns were determined by means of factor analysis.

Results

In the group of individuals with a normal BMI, four dietary patterns were distinguished: “healthy”, “fat, meat and alcohol”, “prudent” and “coca cola, hard cheese and French fries”. After controlling for potential confounders, subjects in the highest tertile of prudent dietary pattern scores had a lower odds ratio for the metabolic obesity normal weight) (odds ratio: 0.69; 95 % CI: 0.53-0.89; p < 0.01) and low HDL cholesterol (odds ratio: 0.77; 95 % CI: 0.59-0.99; p < 0.05), in comparison to those from the lowest tertile, whereas the individuals in the second tertile had a higher odds ratio for the increased blood glucose concentration than those in the lowest tertile (odds ratio: 0.74; 95 % CI: 0.57-0.96; p < 0.05).

Conclusion

A dietary pattern characterized by a high consumption of fish and whole grains, and a low consumption of refined grains, sugar, sweets and cold cured meat, is connected with lower risk of metabolic obesity normal weight as well as with the lower risk of low HDL cholesterol concentration and increased glucose concentration.

Comparison of a full food-frequency questionnaire with the three-day unweighted food records in young Polish adult women: implications for dietary assessment

The food frequency questionnaire (FFQ) and the food record (FR) are among the most common methods used in dietary research. It is important to know that is it possible to use both methods simultaneously in dietary assessment and prepare a single, comprehensive interpretation. The aim of this study was to compare the energy and nutritional value of diets, determined by the FFQ and by the three-day food records of young women. The study involved 84 female students aged 21-26 years (mean of 22.2 ± 0.8 years). Completing the FFQ was preceded by obtaining unweighted food records covering three consecutive days. Energy and nutritional value of diets was assessed for both methods (FFQ-crude, FR-crude). Data obtained for FFQ-crude were adjusted with beta-coefficient equaling 0.5915 (FFQ-adjusted) and regression analysis (FFQ-regressive). The FFQ-adjusted was calculated as FR-crude/FFQ-crude ratio of mean daily energy intake. FFQ-regressive was calculated for energy and each nutrient separately using regression equation, including FFQ-crude and FR-crude as covariates. For FR-crude and FFQ-crude the energy value of diets was standardized to 2000 kcal (FR-standardized, FFQ-standardized). Methods of statistical comparison included a dependent samples t-test, a chi-square test, and the Bland-Altman method. The mean energy intake in FFQ-crude was significantly higher than FR-crude (2740.5 kcal vs. 1621.0 kcal, respectively). For FR-standardized and FFQ-standardized, significance differences were found in the mean intake of 18 out of 31 nutrients, for FR-crude and FFQ-adjusted in 13 out of 31 nutrients and FR-crude and FFQ-regressive in 11 out of 31 nutrients. The Bland-Altman method showed an overestimation of energy and nutrient intake by FFQ-crude in comparison to FR-crude, e.g., total protein was overestimated by 34.7 g/day (95% Confidence Interval, CI: -29.6, 99.0 g/day) and fat by 48.6 g/day (95% CI: -36.4, 133.6 g/day). After regressive transformation of FFQ, the absolute difference between FFQ-regressive and FR-crude equaled 0.0 g/day and 95% CI were much better (e.g., for total protein 95% CI: -32.7, 32.7 g/day, for fat 95% CI: -49.6, 49.6 g/day). In conclusion, differences in nutritional value of diets resulted from overestimating energy intake by the FFQ in comparison to the three-day unweighted food records. Adjustment of energy and nutrient intake applied for the FFQ using various methods, particularly regression equations, significantly improved the agreement between results obtained by both methods and dietary assessment. To obtain the most accurate results in future studies using this FFQ, energy and nutrient intake should be adjusted by the regression equations presented in this paper.

Validation of a semi-quantitative Food Frequency Questionnaire for Argentinean adults

BACKGROUND

The Food Frequency Questionnaire (FFQ) is the most commonly used method for ranking individuals based on long term food intake in large epidemiological studies. The validation of an FFQ for specific populations is essential as food consumption is culture dependent. The aim of this study was to develop a Semi-quantitative Food Frequency Questionnaire (SFFQ) and evaluate its validity and reproducibility in estimating nutrient intake in urban and rural areas of Argentina.

METHODS/PRINCIPAL FINDINGS

Overall, 256 participants in the Argentinean arm of the ongoing Prospective Urban and Rural Epidemiological study (PURE) were enrolled for development and validation of the SFFQ. One hundred individuals participated in the SFFQ development. The other 156 individuals completed the SFFQs on two occasions, four 24-hour Dietary Recalls (24DRs) in urban, and three 24DRs in rural areas during a one-year period. Correlation coefficients (r) and de-attenuated correlation coefficients between 24DRs and SFFQ were calculated for macro and micro-nutrients. The level of agreement between the two methods was evaluated using classification into same and extreme quartiles and the Bland-Altman method. The reproducibility of the SFFQ was assessed by Pearson correlation coefficients and Intra-class Correlation Coefficients (ICC). The SFFQ consists of 96 food items. In both urban and rural settings de-attenuated correlations exceeded 0.4 for most of the nutrients. The classification into the same and adjacent quartiles was more than 70% for urban and 60% for rural settings. The Pearson correlation between two SFFQs varied from 0.30-0.56 and 0.32-0.60 in urban and rural settings, respectively.

CONCLUSION

Our results showed that this SFFQ had moderate relative validity and reproducibility for macro and micronutrients in relation to the comparison method and can be used to rank individuals based on habitual nutrient intake.