Development and validation of a photographic food atlas of Middle Eastern Mediterranean diet: Toward improved understanding of traditional healthy and sustainable diets

Development and validation of food frequency questionnaire screener software for sodium intake among palestinian population

BACKGROUND

High sodium intake has been linked to negative health effects, including cardiovascular and renal diseases. Traditional dietary sodium assessment methods are time-consuming and subjected to errors. Using technology may increase the efficiency and accuracy of dietary assessment. The objective of this study is to develop and validate a food frequency questionnaire (FFQ) screener using software to assess sodium intake among the Palestinian population.

METHODOLOGY

The study was conducted in four phases. In Phase 1, Palestinian foods were categorized and subcategorized according to their mode of consumption, sodium content, and food groups. The sodium content values were calculated from Palestinian food composition database. Content validity was done in Phase 2, while in Phase 3, a pilot study was conducted to determine test-retest reliability. In Phase 4, the criterion validity of the screener was assessed by comparing the results of sodium intake from the FFQ screener with the results from a 24-hour urinary sodium test and a 3-day diet recall. Correlations between the sodium intake values from the three methods were analyzed using Pearson correlation tests, and the difference was assessed using the Bland-Altman test.

RESULTS

The developed FFQ screener sodium screener included 41 food items categorized into nine groups, with photo-based portion size estimation and frequency of consumption. The reliability test showed a Pearson correlation coefficient of 0.7, p < 0.01 using test and retest. For criterion validity, the correlation coefficient between dietary sodium intake using the FFQ screener software and the 24-hour urine sodium test was (0.6, p < 0.000). The correlation coefficient between dietary sodium intake using the FFQ screener software and dietary sodium intake using a 3-day recall was (0.3, p < 0.000). Sodium intake was significantly correlated with preferences for low-sodium food and previous salt reduction, p < 0.05.

CONCLUSIONS

Using the FFQ screener software was a valid and reliable method for assessing dietary sodium intake. Using the photo-based method to estimate portion size improved precision and accuracy in diet assessment.

Validity and Reproducibility of a Semiquantitative Food Frequency Questionnaire and Food Picture Book in Nigeria

Background

Increasing noncommunicable diseases in Nigeria are partly related to dietary factors. However, the lack of validated nutrition assessment tools hinders the conduct of nutritional epidemiology research in this population.

Objectives

To develop a Food Frequency Questionnaire (FFQ) and Food Picture Book (FPB) for Nigerian adults, and to assess its reproducibility and validity compared with 24-h dietary recalls (24DRs) during different seasons in the year.

Methods

We compiled 202 foods for the FFQ through focus groups and consultations with local dietitians. We created an FPB with standardized food portion images to enhance the accuracy of reports of dietary intakes. We administered the FFQs to 205 purposively selected adults in Ibadan, Nigeria at ∼6 monthly intervals between November 2018 and October 2020. We evaluated the FFQ's reproducibility and validity compared with 24DR across the dry and rainy seasons by examining the consumption of common food and mixed dishes. We computed the Spearman's correlation coefficients (SCC), intraclass correlation coefficients (ICC), and Wilcoxon signed-rank tests, and generated Bland and Altman plots.

Results

Overall, we studied 110 women (53.7%) and 95 men (46.3%) with a mean age of 45.0 ± 13.4 y (mean ± SD). The reproducibility tests showed a mean ± SD SCC of 0.39 ± 0.14 and mean ± SD ICC of 0.32 ± 0.12. Higher mean ± SD SCC values were noted for cereal products (0.43 ± 0.09), starchy roots and tubers (0.45 ± 0.17), and soups (0.44 ± 0.20). Conversely, lower mean ± SD SCC values were observed for milk products (0.29 ± 0.02), solid fats (0.29 ± 0.26), and fish (0.22 ± 0.19). Regarding validity tests, the overall mean ± SD SCC was 0.27 ± 0.16 and mean ± SD ICC was 0.26 ± 0.16. We observed seasonal variations in intakes of fruits, cassava flour-based products, and nuts, although most foods did not show significant differences in intakes between seasons.

Conclusions

Our FFQ and FPB demonstrated moderate correlations and seasonal variations in intakes of certain foods, emphasizing the need to account for seasonality in dietary intakes in nutritional studies in Nigeria and similar countries.

Acne Vulgaris and adherence to the mediterranean diet among university students: a case‒control study

BACKGROUND

Western diets, characterized by a high glycemic index and dairy content, can be risk factors for acne vulgaris. A few studies have suggested that adherence to non-Western diets, such as the Mediterranean diet (MD), may be protective against acne. This study aimed to explore the relationships between adherence to the MD and acne diagnosis and severity.

METHODS

This was a matched case‒control study carried out among university students studying health sciences to explore the relationship between adhering to the MD and an acne diagnosis. Convenience sampling was utilized for the initial recruitment of eligible participants, who were then 1:1 individually matched for age, gender, and body mass index (BMI). Adherence to the MD was assessed using the Mediterranean Diet Adherence Screener (MEDAS) tool, and acne severity was assessed using the Global Acne Grading System (GAGS). The data were analyzed using descriptive statistics, bivariate analysis, and conditional logistic regression, which included two models based on clinical data and the backward elimination technique.

RESULTS

A final sample of 121 cases was individually matched to 121 controls. Each group consisted of 28.9% males and 71.1% females, with most having a BMI within the healthy range (71.9%). Both the case (80.2%) and control groups (77.7%) demonstrated a predominant pattern of low adherence to the MD. At the bivariate level, family history significantly differed between the case and control groups (OR = 2.01, CI = 1.17-3.44), while adherence to the MD (OR = 0.86, CI = 0.46-1.60) did not reach statistical significance. According to the regression analysis, family history remained significant in the backward elimination model (aOR = 1.94, CI = 1.14-3.34), while it disappeared in the full model (aOR = 1.95, CI = 1.14-3.34). Neither model revealed a significant association between acne and the other variables. Among the participants in the case group, neither adherence to the MD nor adherence to its components was significantly associated with acne severity, except for vegetables (p = 0.022).

CONCLUSIONS

Adherence to the MD was not correlated with acne diagnosis or clinical severity. More research on the association between acne and adherence to the MD is needed, as earlier studies are few, were conducted in specific settings, and used variable methodologies. To improve the validity and reliability of the research methodology, the development of detailed and culturally adapted MD definitions and practical guides is recommended.