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

Dietary advanced glycation end products, body composition, and anthropometric measures: A cross-sectional analysis in women with excess body weight

BACKGROUND AND AIMS

To assess the association between dietary advanced glycation end products (dAGEs) versus body composition and anthropometric variables.

METHODS AND RESULTS

Body composition (dual-energy X-ray absorptiometry), anthropometry, and habitual food intake were cross-sectionally evaluated in women with excess body weight and body fat. Mean dAGEs content was estimated using a database containing the Nԑ-(carboxymethyl)lysine (CML) content of 549 foods, which was adjusted by mean energy intake, and categorized into low, medium, and high dAGEs, by the 10th and 50th percentiles of the sample. Associations were tested by linear regression adjusted for age, education, marital status, and physical activity level. Eighty participants had mean ± standard deviation dAGEs 7.85 ± 2.65 AGEs kU/kcal. Compared with high dAGEs, women with low dAGEs ingested more carbohydrate (62% vs. 50% of calories, p < 0.001) and fiber (≈25 g vs. ≈18 g, p = 0.027) and less protein (13% vs. 17% of calories, p = 0.006) and fat (26% vs. 33% of calories, p = 0.011). Women with low dAGEs had waist/hip ratio 0.05 higher than those with high dAGEs (R2 = 0.256, p = 0.005). Low dAGEs relative to medium (p = 0.009) and high (p = 0.002) dAGEs was associated with a ≈5% gynoid fat reduction (R2 = 0.164).

CONCLUSION

Low dAGEs was associated with a higher waist/hip ratio and lower percentage of gynoid fat in women with excess body weight and excess body fat.

REGISTRATION NUMBER

RBR-7z358j.

Considerations for a protein-focused screening instrument in clinical nutrition assessment

Physiological stress during injury and surgery negatively impacts protein balance and muscle mass maintenance. Adequate perioperative protein intake may attenuate muscle atrophy to maintain and facilitate functional recovery, particularly in older adults; yet, screening tools routinely used in clinical settings do not specifically assess protein intake when assessing nutrition risk. Although assessing malnutrition is a priority, suboptimal protein intake in non-malnourished patients should also be identified given protein's critical role in muscle health. This opinion paper highlights the potential for using a clinically appropriate protein-focused screener for rapid and efficient characterization of protein intake.

The Mediterranean Diet Scale (MDS): Translation and validation of the Arabic version

OBJECTIVES

The self-administered version of the Mediterranean Diet Scale (MDS) has been developed to test the inherent characteristics of this dietary pattern in a quick and simple way, due to the need of this assessment in the clinical and research setting. This study aimed to translate and psychometrically validate the self-administered MDS in Arabic (CRBS-A).

METHODS

The original (English) version was originally translated to Arabic, followed by back-translation. Next, 10 healthcare providers, followed by 10 cardiovascular disease (CVD) patients rated the face and content validity (CV) of materials, providing input to improve cross-cultural applicability. Then, 200 patients from Saudi Arabia completed the questionnaire, of which factor structure, internal consistency, criterion and construct validity were assessed.

RESULTS

Content and face validity was supported based on experts and patients' reviews (ranges: CV scores 0.9-1.0/1.0 and clarity 3.5 to 4.5/5). Minor edits were made. Subsequent factor analysis revealed 4 factors consistent with the original version of the instrument, all internally consistent. Total CRBS-A α was 0.74. Criterion validity was confirmed by the significantly higher scores in patients who participated in CR. Construct validity was also established by significant associations between MDS scores and monthly family income, having the diagnosis of acute coronary syndrome or with a history of valve repair or replacement, being obese or having dyslipidemia.

CONCLUSIONS

Overall, these results confirm the validity and reliability of the MDS in Arabic-speaking patients.

Development and validation of a comprehensive food frequency questionnaire that assesses the dietary intake related with dental health in children: A pilot study

BACKGROUND AND AIMS

This study aimed to develop a validated and reliable food frequency questionnaire (FFQ) that assess dietary intake related with dental health in children.

METHODS

Children, two-to-nine-years old, who consulted to a paediatric dental clinic for any reason, were recruited to complete the FFQ and 24-h recall, inquired oral hygiene habits, performed oral examinations, recorded dmft(s)/DMFT(S) index, and taken anthropometric measurements. The statistical methods used for validation were Wilcoxon signed rank test, Spearman ranked correlations, weighted kappa statistic and Bland-Altman graphs were drawn. Besides, intraclass and spearman correlation coefficients calculated for the reliability.

RESULTS

A total of 120 children participated in to the first stage of the study while 70 participants completed the 4-month period. The Spearman correlation coefficient and weighted kappa values confirmed that the FFQ had moderate validation against the food records for lactose, calcium and phosphorus. Dietary fat, fibre, lactose, calcium, potassium, fluoride, magnesium, phosphorus and zinc intakes were negatively and statistically significantly correlated with DMFT and DMFS according to both FFQ and 24-h (p < 0.05, for each). Furthermore, a positive correlation between DMFT/S and dietary carbohydrate, starch, polysaccharide and sucrose intakes was obtained.

CONCLUSIONS

These results provide the preliminary evidence for the moderated reliability and validity of the FFQ; the higher DMFT and DMFS scores might be linked to lower dietary intakes of fat, fibre, lactose, calcium, potassium, fluorine, magnesium, phosphorus and zinc; and probably higher dietary intakes of carbohydrate, starch, polysaccharide and sucrose in children.

Associations between Serum Saturated Fatty Acids Content and Mortality in Dialysis Patients

Background: Cardiovascular mortality in dialysis population remains very high. Saturated fatty acids (SFA) contribute to atherosclerosis and to cardiovascular risk. Aim: The aim of this study was to evaluate the relationship between mortality in dialysis patients and the serum SFA content. Methods: Survival of 54 patients on dialysis was assessed. A total of 21 SFA from patients’ sera were measured by gas chromatography-mass spectrometry (GC-MS). Diet was assessed by food frequency questionnaire FFQ-6. The SFA content is presented as fatty acid proportion (%). Results: During the observation time (median 66 months) 22 patients died. There was a significant relationship between elevated SFA (above SFA mean) and mortality (log-rank 3.13; p = 0.0017). Moreover, patients who ingested foods rich in SFA, according to FFQ-6, had a higher mortality risk (log-rank 2.24; p = 0.03). The hazard ratio for mortality associated with increased SFA content equalled 4.47 (1.63−12.26). Addition of age and inflammation (hsCRP > 5 mg/L) into the Cox model did not modify this relationship. However, SFA content turned out to be significantly higher in patients with diabetes mellitus and cardiovascular disease, as compared to patients free from these co-morbidities. Their addition to the model attenuated the relationship between SFA and mortality, making it statistically insignificant. Conclusion: The serum content of SFA turned out to be a strong predictor of mortality in dialysis patients. However, given the significant associations between SFA, DM, and CVD, interventional studies with controlled SFA intake are needed to evaluate the causal links between SFA, co-morbidities and survival.

Validating Accuracy of an Internet-Based Application against USDA Computerized Nutrition Data System for Research on Essential Nutrients among Social-Ethnic Diets for the E-Health Era

Internet-based applications (apps) are rapidly developing in the e-Health era to assess the dietary intake of essential macro-and micro-nutrients for precision nutrition. We, therefore, validated the accuracy of an internet-based app against the Nutrition Data System for Research (NDSR), assessing these essential nutrients among various social-ethnic diet types. The agreement between the two measures using intraclass correlation coefficients was good (0.85) for total calories, but moderate for caloric ranges outside of <1000 (0.75) and >2000 (0.57); and good (>0.75) for most macro- (average: 0.85) and micro-nutrients (average: 0.83) except cobalamin (0.73) and calcium (0.51). The app underestimated nutrients that are associated with protein and fat (protein: −5.82%, fat: −12.78%, vitamin B12: −13.59%, methionine: −8.76%, zinc: −12.49%), while overestimated nutrients that are associated with carbohydrate (fiber: 6.7%, B9: 9.06%). Using artificial intelligence analytics, we confirmed the factors that could contribute to the differences between the two measures for various essential nutrients, and they included caloric ranges; the differences between the two measures for carbohydrates, protein, and fat; and diet types. For total calories, as an example, the source factors that contributed to the differences between the two measures included caloric range (<1000 versus others), fat, and protein; for cobalamin: protein, American, and Japanese diets; and for folate: caloric range (<1000 versus others), carbohydrate, and Italian diet. In the e-Health era, the internet-based app has the capacity to enhance precision nutrition. By identifying and integrating the effects of potential contributing factors in the algorithm of output readings, the accuracy of new app measures could be improved.

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.

Relationship between Habitual Intake of Vitamins and New-Onset Prediabetes/Diabetes after Acute Pancreatitis

Vitamins have many established roles in human health. However, the role of habitual dietary intake of vitamins in glucose homeostasis in individuals after acute pancreatitis (AP) is yet to be elucidated. The aim was to investigate the associations between habitual intake of fat- and water-soluble vitamins/vitamers and markers of glucose metabolism (fasting plasma glucose (FPG), homeostasis model assessment insulin resistance (HOMA-IR) index, and homeostasis model assessment β-cell function (HOMA-β)) in individuals after AP. A total of 106 participants after AP were included in this cross-sectional study and were grouped based on glycaemic status: new-onset prediabetes/diabetes after AP (NODAP), pre-existing prediabetes/type 2 diabetes (T2DM), and normoglycaemia after AP (NAP). Habitual intake of seven fat-soluble vitamins/vitamers and seven water-soluble vitamins were determined by the EPIC-Norfolk food frequency questionnaire. Multiple linear regression analyses were conducted using five statistical models built to adjust for covariates (age, sex, daily energy intake, visceral/subcutaneous fat volume ratio, smoking status, daily alcohol intake, aetiology of AP, number of AP episodes, cholecystectomy, and use of antidiabetic medications). In the NODAP group, three fat-soluble vitamins/vitamers (α-carotene, β-carotene, and total carotene) were significantly associated with HOMA-β. One water-soluble vitamin (vitamin B3) was also significantly associated with HOMA-β in the NODAP group. None of the studied vitamins were significantly associated with FPG or HOMA-IR in the NODAP group. Prospective longitudinal studies and randomised controlled trials are now warranted to investigate if the observed associations between vitamin/vitamer intake and NODAP are causal and to unveil the specific mechanisms underlying their involvement with NODAP.

Validation and reproducibility of a semi-qualitative food frequency questionnaire for assessment of sodium intake in Iranian population

Background

Few semi-quantitative food frequency questionnaires (SFFQ)s has yet been developed to assess sodium intake in Middle East region. This study was performed to validate a SFFQ for assessment of sodium consumption and food groups΄ contribution to sodium intake.

Methods

This study was performed on 219 healthy participants including 113 adults aged ≥19 years and 106 children aged 6–18 years in Isfahan, Iran. They were administered two SFFQ at the beginning and after 1 year to evaluate the reproducibility. The validity of SFFQ for assessment of sodium intake was compared with 24-h urine sodium and twelve 24-h dietary recalls which were completed monthly during a year as two standard methods.

Results

Correlation coefficient between the contribution of food groups to sodium intake based on SFFQ and 24-h dietary recalls varied from 0.04 for legumes (P = 0.667) to 0.47 for added salt (P < 0.001). There was a significant correlation between the estimated total sodium intake based on SFFQ and both standard methods (P < 0.01). Intraclass correlation coefficient (95% CI) between first and second SFFQ had a diverse range from 0.10 (-0.05, 0.17) for fats and oils to 0.49 (0.28, 0.69) for bread. According to the Bland-Altman plots, we observed an acceptable level of agreement between the two methods for sodium intake.

Conclusions

The SFFQ was a relatively valid and reproducible method for estimating sodium intake. Combination of this SFFQ with a valid prediction of 24-h urinary sodium excretion can be useful in achieving more accurate results.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12937-021-00749-7.

Validating Accuracy of a Mobile Application against Food Frequency Questionnaire on Key Nutrients with Modern Diets for mHealth Era

In preparation for personalized nutrition, an accurate assessment of dietary intakes on key essential nutrients using smartphones can help promote health and reduce health risks across vulnerable populations. We, therefore, validated the accuracy of a mobile application (app) against Food Frequency Questionnaire (FFQ) using artificial intelligence (AI) machine-learning-based analytics, assessing key macro- and micro-nutrients across various modern diets. We first used Bland and Altman analysis to identify and visualize the differences between the two measures. We then applied AI-based analytics to enhance prediction accuracy, including generalized regression to identify factors that contributed to the differences between the two measures. The mobile app underestimated most macro- and micro-nutrients compared to FFQ (ranges: -5% for total calories, -19% for cobalamin, -33% for vitamin E). The average correlations between the two measures were 0.87 for macro-nutrients and 0.84 for micro-nutrients. Factors that contributed to the differences between the two measures using total calories as an example, included caloric range (1000-2000 versus others), carbohydrate, and protein; for cobalamin, included caloric range, protein, and Chinese diet. Future studies are needed to validate actual intakes and reporting of various diets, and to examine the accuracy of mobile App. Thus, a mobile app can be used to support personalized nutrition in the mHealth era, considering adjustments with sources that could contribute to the inaccurate estimates of nutrients.

Associations of Habitual Mineral Intake with New-Onset Prediabetes/Diabetes after Acute Pancreatitis

Associations between habitual dietary intake of minerals and glucose metabolism have been extensively studied in relation to metabolic disorders. However, similar research has yet to be conducted in individuals after acute pancreatitis (AP). The main aim was to investigate the associations between habitual intake of 13 minerals and glycaemic status: new-onset prediabetes/diabetes after AP (NODAP), pre-existing prediabetes/type 2 diabetes (T2DM), and normoglycaemia after AP (NAP). Associations between the dietary intake of minerals and markers of glucose metabolism (glycated haemoglobin and fasting plasma glucose) were also studied. The EPIC-Norfolk food frequency questionnaire was used in a cross-sectional fashion to determine the habitual intake of 13 dietary minerals. ANCOVA as well as multiple linear regression analyses were conducted and five statistical models were built to adjust for covariates. The study included 106 individuals after AP. In the NODAP group, intake of 4 minerals was significantly less when compared with the NAP group: iron (B = -0.076, p = 0.013), nitrogen (B = -0.066, p = 0.003), phosphorous (B = -0.046, p = 0.006), and zinc (B = -0.078, p = 0.001). Glycated haemoglobin was significantly associated with iodine intake (B = 17.763, p = 0.032) and manganese intake (B = -17.147, p = 0.003) in the NODAP group. Fasting plasma glucose was significantly associated with manganese intake (B = -2.436, p = 0.027) in the NODAP group. Habitual intake of minerals differs between individuals with NODAP, T2DM, and NAP. Prospective longitudinal studies and randomised controlled trials are now warranted to further investigate the associations between mineral intake and NODAP.

Are Nutritional Patterns among Polish Hashimoto Thyroiditis Patients Differentiated Internally and Related to Ailments and Other Diseases?

There is not any diet recommended for Hashimoto's disease, despite that those patients are often undernourished. Because of the high heterogeneity of Hashimoto's patients, insight into dietary patterns might shed some light on the patient-tailored dietary approach, thus improving their treatment and helping to identify patients with the highest probability of particular nutritional deficiencies. The aim of this study was to identify Hashimoto's patients' dietary patterns and their characterization based on both socio-demographic variables and dietary self-assessment. We collected data online from patients with Hashimoto's disease. The questionnaire formula used in the study was developed based on a validated food frequency questionnaire KomPAN®. K-means pattern analyses were used to characterize patients into patterns based on the frequency of particular types of foods consumption and socio-demographic factors. Four patterns were identified. We labeled them as 'Convenient', 'Non-meat', 'Pro-healthy', and 'Carnivores' with participants proportions at approximately one-fourth per each pattern. The patients were mainly of the female gender (94.08%), with a female: male ratio of 15.9. Hashimoto's patients differed in their food product choices, food choice motives, dieting experience, nutritional knowledge, smoking habits, food allergies and intolerances, and lipid disorders, and thus represent different eating patterns. However, these patterns were not determined by comorbidities or the majority of ailments.

Correlation between the Macronutrient Content of Dental Calculus and the FFQ-Based Nutritional Intake of Obese and Normal-Weight Individuals

The growing epidemic of chronic diseases afflicting both developed and developing countries is related to diet and lifestyle. The current dietary assessment still has many constraints, particularly related to the objectivity of data gathering. Dental calculus, which is usually considered as medical waste in dental treatment, turns out to be a provider of abundant oral information. The objective of this study is to obtain the correlation between the macronutrient content of dental calculus and nutritional intake based on FFQ. This research is an analytic observational study with a case-control study design. Samples consisting of 35 obese individuals and 21 normal-weight individuals were taken using purposive sampling. The nutritional intake data were obtained using FFQ. The macronutrient content of dental calculus was checked using a colorimetric assay. The comparison between obese individuals and normal-weight individuals was tested using the Mann–Whitney test and T-test. The correlation between the macronutrient content of dental calculus and nutritional intake based on FFQ was measured using Spearman's rank-order correlation. The results showed there was a correlation between the macronutrient content of dental calculus and macronutrient intake based on FFQ. However, strong correlation was found only between fat intake with the total lipid content of dental calculus with rs = 0.521 and between carbohydrate intake with the total carbohydrate content of dental calculus with rs = 0.519. It was concluded that carbohydrate, protein, and lipid intake can be assessed using dental calculus. Dental calculus can be an alternative source of noninvasive, inexpensive, and specific dietary biomarkers.

Dietary and Physical Activity Habits in Adolescent Girls with Polycystic Ovary Syndrome (PCOS)-HAstudy

The role of inappropriate lifestyle in the etiology of polycystic ovary syndrome (PCOS) and its metabolic and reproductive complications has attracted much attention in recent years; however, most studies involve adult patients. Thus, the study aimed to compare dietary patterns, physical activity, metabolic, anthropometric and inflammatory markers of 14-18-year-old girls with and without PCOS (n = 61 and n = 35, respectively) as well as to assess correlations between concentrations of metabolic and inflammatory markers and macronutrient intake and to identify the independent predictors of PCOS, related to diet and physical activity (PA). Compared to the control group, PCOS girls consumed significantly more total fat (p = 0.0005), including both saturated (SFA) (p = 0.03), monounsaturated (MUFA) (p = 0.0003) and polyunsaturated fatty acids (PUFA) (p = 0.01). A significantly higher percentage of PCOS patients consumed high and medium glycemic index (GI) foods (p = 0.03) and represented a low level of PA, both during school and in leisure time (41.67 vs. 6.06%; p = 0.0001 and 32.79 vs. 5.71%; p = 0.003, respectively). The PCOS group had also significantly higher waist circumference (WC), C-reactive protein (CRP) (p = 0.01), LDL cholesterol (p = 0.01), fasting insulin (p = 0.002) and HOMA-IR (p = 0.006) levels. There was an inverse correlation between fiber intake and fasting insulin, (p = 0.0002, r = -0.37), HOMA-IR (p = 0.0004, r = -0.35), WC (p = 0.029; r = -0.222) and a positive relationship between high and medium GI diet and insulin concentration (p = 0.003; r = 0.3). An increase of 10 g/day in total fat intake per day increases the probability of PCOS by 1.4 times. If the SFA or MUFA intakes increase by 10 g, the probability of PCOS increase 1.7-fold and 2.5-fold, respectively. The consumption of foods with a medium GI raises the probability of PCOS by more than 3 times, after adjusting for age. The odds ratio decreased for the moderate and high PA at school/work and in leisure time. Further research in girls with PCOS is needed to test whether low GI and dietary fatty acid reduction combined with increased PA is effective in the nonpharmacological treatment and prevention of PCOS complications. ClinicalTrial.gov Identifier: NCT04738409.

Intra-pancreatic fat deposition as a modifier of the relationship between habitual dietary fat intake and insulin resistance

BACKGROUND

Insulin resistance is a well-known derangement after an attack of pancreatitis but the role of dietary fat intake and intra-pancreatic fat deposition (IPFD) in it is unknown. We aimed to investigate the relationship of dietary fat intake with markers of insulin resistance in individuals after acute pancreatitis, taking into account IPFD.

METHODS

This was a cross-sectional study. The EPIC-Norfolk food frequency questionnaire was used to determine the habitual intake of saturated, monounsaturated, polyunsaturated fatty acids. The studied markers of insulin resistance were fasting insulin, HOMA-IR, and METS-IR. 3 T magnetic resonance imaging was used to quantify IPFD. Linear regression analysis, with adjustment for possible confounders, was performed.

RESULTS

A total of 111 individuals after acute pancreatitis (33 low IPFD, 40 moderate IPFD, and 38 high IPFD) were included. In the high IPFD group, intake of monounsaturated fatty acids was inversely associated with both fasting insulin, and HOMA-IR, and METS-IR in the unadjusted (β = -65.405, p < 0.001; β = -15.762, p < 0.001; β = -0.760, p = 0.041, respectively) and fully adjusted models (β = -155.620, p < 0.001; β = -34.656, p < 0.001, β = -2.008, p = 0.018, respectively). Intake of polyunsaturated or saturated fatty acids did not have a consistently significant pattern of associations with the three markers of insulin resistance. None of the above associations was significant in the low IPFD and moderate IPFD groups.

CONCLUSIONS

Habitual dietary fat intake is associated with insulin resistance only in individuals after an attack of pancreatitis who have high IPFD. These indviduals may benefit from a calorically balanced diet that is rich in monounsaturated fatty acids.

Combined analysis of gut microbiota, diet and PNPLA3 polymorphism in biopsy-proven non-alcoholic fatty liver disease

BACKGROUND AND AIMS

Non-alcoholic fatty liver disease (NAFLD) is a global health burden. Risk factors for disease severity include older age, increased body mass index (BMI), diabetes, genetic variants, dietary factors and gut microbiota alterations. However, the interdependence of these factors and their individual impact on disease severity remain unknown.

METHODS

In this cross-sectional study, we performed 16S gene sequencing using fecal samples, collected dietary intake, PNPLA3 gene variants and clinical and liver histology parameters in a well-described cohort of 180 NAFLD patients. Principal component analyses were used for dimensionality reduction of dietary and microbiota data. Simple and multiple stepwise ordinal regression analyses were performed.

RESULTS

Complete data were available for 57 NAFLD patients. In the simple regression analysis, features associated with the metabolic syndrome had the highest importance regarding liver disease severity. In the multiple regression analysis, BMI was the most important factor associated with the fibrosis stage (OR per kg/m² : 1.23, 95% CI 1.10-1.37, P < .001). The PNPLA3 risk allele had the strongest association with the histological grade of steatosis (OR 5.32, 95% CI 1.56-18.11, P = .007), followed by specific dietary patterns. Low abundances of Faecalibacterium, Bacteroides and Prevotella and high abundances of Gemmiger were associated with the degree of inflammation, ballooning and stages of fibrosis, even after taking other cofactors into account.

CONCLUSIONS

BMI had the strongest association with histological fibrosis, but PNPLA3 gene variants, gut bacterial features and dietary factors were all associated with different histology features, which underscore the multifactorial pathogenesis of NAFLD.

Food Neophobia among Adults: Differences in Dietary Patterns, Food Choice Motives, and Food Labels Reading in Poles

Food neophobia (FN) is associated with reduced quality of diet in adults; thus, the understanding of the relationship between FN and food consumption in more depth appears to be a key issue. The aim of the study was to assess the relationship between food neophobia, dietary patterns, food choice motives, and food label reading in the group of adults. Data were collected using the computer-assisted personal interviewing technique (CAPI). A cross-sectional quantitative survey was carried out in November-December 2017 in a sample of 1017 Polish adults. The questionnaire used in the study included the Food Neophobia Scale (FNS), the Beliefs and Eating Habits Questionnaire (KomPAN), and questions regarding food choice motives, reading food labels, and sociodemographic characteristics. The food neophobics were older, had a lower level of education, and had higher BMI compared to others. Compared to others, among the food neophobics, there were more people who often consumed vegetables, fruit, meat, and meat products and who rarely consumed functional and convenience food, sweets, and sweetened beverages. When choosing food, more food neophobics chose healthy and tasteless food products, while more food neophilics chose unhealthy and tasty products. More food neophobics declared not reading price and shelf-life information on food labels compared to the other two groups. Although food neophobia may make adaptation to dietary recommendations difficult, health-promoting features of the diet were observed within the food neophobics. Actions focusing on food choice motives may help even more to limit the effects of food neophobia in adults. Further research is recommended to confirm the observed relationships under different sociocultural conditions.

Dietary Fibre Intake in Type 2 and New-Onset Prediabetes/Diabetes after Acute Pancreatitis: A Nested Cross-Sectional Study

The association between intake of dietary fibre and glucose metabolism has been extensively investigated in numerous metabolic disorders. However, little is known about this association in individuals after an attack of acute pancreatitis (AP). The aim was to investigate the associations between intake of dietary fibre and markers of glucose metabolism in individuals with new-onset prediabetes or diabetes after acute pancreatitis (NODAP), pre-exiting type 2 prediabetes or diabetes, and normoglycaemia after acute pancreatitis. This cross-sectional study was nested within the parent prospective longitudinal cohort study. The studied markers of glucose metabolism were fasting plasma glucose and glycated haemoglobin. Habitual intake of dietary fibre was determined using the EPIC-Norfolk food frequency questionnaire. Multivariable linear regression analyses were conducted. The study included a total of 108 individuals after AP. In the NODAP group, increased intakes of total fibre (β = −0.154, p = 0.006), insoluble fibre (β = −0.133, p = 0.01), and soluble fibre (β = −0.13, p = 0.02) were significantly associated with a reduction in fasting plasma glucose. Increased intakes of vegetables (β = −0.069, p = 0.004) and nuts (β = −0.039, p = 0.038) were significantly associated with a reduction in fasting plasma glucose. Increased intake of nuts (β = −0.054, p = 0.001) was also significantly associated with a reduction in glycated haemoglobin. None of the above associations were significant in the other study groups. Habitual intake of dietary fibre was inversely associated with fasting plasma glucose in individuals with NODAP. Individuals after an attack of AP may benefit from increasing their intake of dietary fibre (specifically, vegetables and nuts) with a view to preventing NODAP.

An optimal glycemic load range is better for reducing obesity and diabetes risk among middle-aged and elderly adults

Background

Due to the lack of evidence, advice pertaining to glycemic load (GL) can be misleading. Does the excessive restriction of GL, mostly through an extreme reduction in carbohydrate intake, result in a relatively high intake of fat and protein and result in overweight and obesity? This study was performed to initially explore the optimal GL range.

Methods

A cross-sectional study involving 2029 participants aged 40 years or older in Guangzhou, China was conducted. Participants were divided into four groups according to cluster analysis. Dietary data were assessed using a previously validated 3-day food record.

Results

Instead of participants with the highest [cluster 1, median (interquartile ranges) GL was 112(107–119)/1000 kcal] and the lowest GL intake [cluster 4, 90(82–96)/1000 kcal], those with moderate GL intakes [clusters 2 and 3, 93(85–102) and 93(85–99)/1000 kcal, respectively] had a lower prevalence of overweight, obesity and diabetes. In addition, clusters 2 and 3 were more consistent with the macronutrient intake reference with adequate micronutrient intake. Therefore, the optimal GL range was determined to be (85–100)/1000 kcal, rather than “lower is better”.

Conclusions

Reducing the GL intake to prevent diabetes deserves more attention in the context of a balanced diet. An appropriate GL may be better than excessive restriction.

Dietary carbohydrate intake and insulin traits in individuals after acute pancreatitis: Effect modification by intra-pancreatic fat deposition

OBJECTIVES

Current knowledge of the link between dietary carbohydrate intake and insulin regulation in individuals after an attack of pancreatitis is limited. We aimed to investigate the associations between dietary carbohydrate intake and insulin traits in post-pancreatitis versus healthy individuals, taking into account intrapancreatic fat deposition (IPFD).

METHODS

All participants underwent magnetic resonance imaging (using the same protocol and 3T scanner) to quantify IPFD. Dietary carbohydrate intake was assessed using a validated 131-item food frequency questionnaire. Insulin, HOMA-IR, HOMA-β were determined in the fasted state. Linear regression and effect modification analyses were conducted in unadjusted and adjusted models (accounting for age, sex, body mass index, daily energy intake, use of anti-diabetic medications, and recurrence of acute pancreatitis).

RESULTS

The study included 111 post-pancreatitis individuals (categorized into low IPFD (n = 33), moderate IPFD (n = 40), high IPFD (n = 38)) and 47 healthy controls. In the high IPFD group, starch intake was negatively associated with fasting insulin and HOMA-β in both the unadjusted (p < 0.001 both) and fully adjusted models (p < 0.001 both); and with HOMA-IR in the fully adjusted model (p < 0.001) only. Total sugar intake was positively associated with fasting insulin (p = 0.015) and HOMA-β (p = 0.007) in the fully adjusted model but not associated with HOMA-IR. None of the above associations was statistically significant in the low IPFD, moderate IPFD, and healthy controls groups. The studied associations were more pronounced in the high IPFD group but not in the moderate IPFD or low IPFD groups (when compared with the healthy controls group).

CONCLUSIONS

Dietary carbohydrate intake is differentially associated with insulin traits in individuals after an attack of pancreatitis and the associations are modified by IPFD. These findings will be helpful for the development of dietary guidelines specifically for individuals after an attack of pancreatitis.

Assessing Overall Diet Quality: Development and Evaluation of the Performance of a Short Self-Administrated Questionnaire SCASA

Several tools assessing diet quality have been developed over the last decades, but their use in public health and clinical practice is limited because they necessitate detailed quantitative assessment of food intake. Our goal was to develop and validate a score (Score d’Alimentation Saine, SCASA) based on a short self-administrated online questionnaire to assess overall diet quality. SCASA targets the adult population in French-speaking Switzerland, but it was designed in a way enabling its adaptation for other regions. The choice of the items involved experts and lay volunteers. Construct validation and inter-method reliability were assessed by screening meal plans and by comparing the self-rated scores with food-record derived scores (kappa and Bland–Altman). SCASA (17 components) discriminated adequately balanced from imbalanced meal plans (93–95% and 44–46% of maximal score). Agreement between self-assessed and food record-based scores ranged between >90% (3 items), 80–89% (3 items), 70–79% (4 items), and <70% (5 items). The Bland–Altman plot showed a mean difference of −1.60 (95% CI −2.36 to −0.84), indicating a slight overestimation of the self-assessed diet quality compared to the food record. SCASA offers a reliable way to assess overall diet quality without requiring burdensome data collection or nutrient calculations.

Perceived Nutrition and Health Concerns: Do They Protect against Unhealthy Dietary Patterns in Polish Adults?

The aim of the study was to explore the associations between perceived health and nutrition concerns, sociodemographic characteristics and unhealthy dietary patterns in a representative group of Polish adults. The data were collected in 2017 through a cross-sectional quantitative survey under the National Health Program 2016-2020. Logistic regression models were used to analyze the data. It was found that higher health concerns decreased the chances of adhering to upper tertiles of "Fast food & alcohol" and "Refined food & sweetened beverages" dietary patterns (DPs), thus displaying less frequent consumption of such foods. No relationship was found between health concerns and adhering to the "Fat food" and "Butter" DPs. Nutrition concerns increased the likelihood of frequent consumption of foods from "Fast food & alcohol" DP. Women were less likely to adhere to unhealthy eating patterns than men, while older people were less likely to often consume fast food, alcohol, or refined food and sweetened beverages. Findings of this study showed that concerns about health or nutrition were differently associated with dietary patterns and consumption of unhealthy foods. These relationships should be considered when developing interventions to address health-related lifestyle changes. However, further research is needed to identify cause-effect relationships between these variables.

Dietary Patterns and Determinants of Pregnant and Lactating Women From Marginalized Communities in India: A Community-Based Cross-Sectional Study

Objective: Dietary pattern analysis has emerged as a balanced and realistic approach that reflects how the food is consumed in real life. However, previous studies have overlooked the two important phases in women's life, pregnancy, and lactation. We aimed to explore dietary patterns and their determinants among pregnant and lactating women from marginalized families in rural areas and urban slums of India. Methods: It was a community-based cross-sectional study conducted across four districts of India, one from each region (North, West, East, and South). We used a structured questionnaire to collect data on socio-demographic characteristics and access to nutrition services. The dietary data were collected using a qualitative food frequency questionnaire having 204 food items, which were clubbed into 16 major food groups. The principal component analysis method was employed to identify dietary patterns (prefixed at 4). We used multinomial logistic regression to explore associations of socio-demographic and access to nutrition services' variables with identified dietary patterns. Results: The data of 476 pregnant and 446 lactating women were assessed. Four patterns explained for 54% of the variation in their food intake. The patterns identified were low-mixed vegetarian (19%), non-vegetarian (15%), high-mixed vegetarian (11%), and calorie-rich (9%). The low-mixed diet was rich in rice, roots and tubers, green leafy vegetables, and other vegetables. The non-vegetarian diet was characterized by high loadings for nuts or seeds, chicken, meat or fish, eggs, beverages (milk-based), and snacks. The high-mixed vegetarian diet was rich in cereals other than rice and wheat, pulses, and fruits. The calorie-rich diet had high factor loadings for wheat, butter and oil, sweets, and milk and milk products. Hindus and women who lived in rural areas had higher odds of consuming a low-mixed vegetarian diet and lower odds of a high-mixed vegetarian diet. Working women and those who received nutrition advice during pregnancy or lactation had 2-3 times higher odds of consuming a high-mixed vegetarian diet. Conclusions: A high prevalence of a low-mixed vegetarian diet among women can have adverse pregnancy and birth outcomes. Healthy dietary patterns during pregnancy and lactation are required to meet the increased micro- and macronutrient requirements for improved maternal and child health.

Association between Habitual Dietary Iron Intake and Glucose Metabolism in Individuals after Acute Pancreatitis

Dietary intake of iron is known to be associated with impaired glucose metabolism. However, its involvement in derangements of glucose metabolism after acute pancreatitis (AP) is not completely understood. The aim was to investigate the association between dietary iron intake and markers of glucose metabolism in individuals after an attack of AP. Fasting blood samples were collected to analyse markers of glucose metabolism (fasting plasma glucose (FPG) and haemoglobin A1c (HbA1c)). The EPIC-Norfolk food frequency questionnaire was used to determine the habitual intake of dietary iron (total, haem, and non-haem). Multivariable linear regression analyses were conducted and six statistical models were built to adjust for covariates. A total of 109 individuals after AP were studied in a cross-sectional fashion. Total iron (β (95% confidence interval) = -0.19 (-0.35, -0.05); p = 0.01 in the most adjusted model) and non-haem iron (β (95% confidence interval) = -0.19 (-0.33, -0.04); p = 0.03 in the most adjusted model) were significantly associated with FPG, consistently in all adjusted model. Total iron and non-haem iron did not have consistent significant associations with HbA1c. Dietary haem iron intake was not associated with either FPG or HbA1c. Habitual intake of dietary iron is inversely associated with FPG in individuals after an attack of AP and may be involved in the pathogenesis of new-onset diabetes after pancreatitis. Prospective longitudinal studies are now warranted to unveil the specific mechanism underlying the involvement of dietary iron.

Cassava consumption and the occurrence of cyanide in cassava in Vietnam, Indonesia and Philippines

OBJECTIVE

To make a tentative assessment of the consumption of cassava in three countries in South-east Asia and the cyanogenic potential (CNp) of the crop as a possible food safety issue.

DESIGN

We used data from the Ministry of Health in Vietnam and Statistics Authorities in Indonesia and Philippines (mean household consumption per province) to assess cassava consumption. Conversions of units were needed to facilitate the comparison of cassava consumption between countries. The most up-to-date data available regarding both cassava consumption and the CNp of cassava grown in the respective countries were assessed.

SETTINGS

Vietnam, Indonesia and Philippines.

PARTICIPANTS

Respondents from provinces in Vietnam (nineteen), Indonesia (thirty-three) and Philippines (eighty-one) were asked to complete a recall questionnaire detailing either the previous 24-h' or the 7-d' cassava consumption.

RESULTS

Among the three countries, available data indicated that the highest median cassava-consumption figures percapita were from Indonesia and the Philippines (9·01 and 7·28 g/capita per d, respectively), with Vietnam having the least (1·14 g/capita per d). Published information regarding the CNp of cassava in the three countries was limited.

CONCLUSIONS

While the findings of the present study are somewhat limited by a lack of available information regarding both the extent of cassava consumption and the CNp of cassava consumed in the three countries, it appears likely that cyanogen intake arising from cassava consumption among the three countries exceeds the FAO/WHO Provisional Maximum Tolerable Daily Intake, although any risk to public health appears limited to a minority of provinces in each country.

Increasing Comparability and Utility of Gut Microbiome Studies in Parkinson's Disease: A Systematic Review

Gut microbiota have been studied in relation to the pathophysiology of Parkinson's disease (PD) due to the early gastrointestinal symptomatology and presence of alpha-synuclein pathology in the enteric nervous system, hypothesized to ascend via the vagal nerve to the central nervous system. Accordingly, sixteen human case-control studies have published gut microbiome composition changes in PD and reported over 100 differentially abundant taxa covering all taxonomic levels from phylum to genus or species, depending on methodology. While certain findings were replicated across several studies, various contradictory findings were reported. Here, differences in methodologies and the presence of possible confounders in the study populations are assessed for their potential to confound the results of gut microbiome studies in PD. Gut microbiome studies in PD exhibited considerable variability with respect to the study population, sample transport conditions, laboratory protocols and sequencing, bioinformatics pipelines, and biostatistical methods. To move from the current heterogeneous dataset towards clinically relevant biomarkers and the identification of putative therapeutic targets, recommendations are derived from the limitations of the available studies to increase the future comparability of microbiome studies in PD. In addition, integration of currently available data on the gut microbiome in PD is proposed to identify robust gut microbiome profiles in PD. Furthermore, expansion of the current dataset with atypical parkinsonism cohorts, prodromal and treatment-naïve de novo PD subjects, measurements of fecal microbial concentrations and multi-omics assessments are required to provide clinically relevant biomarkers and reveal therapeutic targets within the gut microbiome of PD.

Validation of a Food Propensity Questionnaire for the Hellenic National Nutrition and Health Survey (HNNHS) and Results on This Population's Adherence to Key Food-Group Nutritional Guidelines

Background: Food propensity questionnaires (FPQs) are means of dietary assessment in nutritional epidemiology, which provide valuable information for long term intakes and food group consumption. These tools, however, may be subjected to misreporting and need to be validated against standard quantitative methods. Aim: The aim of this study was to examine the validity of the qualitative FPQ developed to assess the dietary habits of the general population in Greece during the Hellenic National Nutrition and Health Survey (HNNHS) and to assess the population’s intake of specific food groups in relation to guidelines. Methods: Validation analysis was based on 3796 [1543 men (42.82%) and 2253 women (57.18%)] participants of the HNNHS in relation to two interviewer-administered 24 h recalls (24 hR). Participants were asked to report the frequency of their dietary intake, using the FPQ provided. Correlations and significance between methods were assessed via Spearman correlation and a Two-sample Wilcoxon rank-sum (Mann-Whitney) test, respectively. Agreement between the FPQ and the 24 hR was performed using the Bland–Altman test and differences between the FPQ’s shown intakes and the recommended intakes by the Dietary Guidelines for Greek Adults were calculated. Results: Medium to weak correlations, but statistically significant (p < 0.05), were observed for most food groups between 24 hR and the FPQ; medium for fruits, dairy products, drinks, and spirits (ranging from ρ = 0.371 to ρ = 0.461; highest for drinks and spirits) and weak for vegetables, meat, fish, eggs, starch foods, sweets, nuts, fats and oils, and fast food (ρ = 0.111 to ρ = 0.290; lowest for starch foods). A non-significant correlation was found for legumes (ρ = 0.070). The mean intake agreement (Bland–Altman analysis) between the FPQ and the 24 hR was 96.08% and ranged from 94.43 to 99.34% for the 14 food groups under examination. When food group intakes were compared to guidelines, results showed that the population’s dietary intake was below the guidelines for fruits, vegetables, whole grains, fish, and legumes. On the other hand, it was above the guidelines for most of the “unhealthy” food groups, in particular, fast food, sweets, drinks and spirits, red meat, and sweets. Conclusions: The specific FPQ provides valid information on major food groups and can be used to examine long term dietary patterns in nutritional studies. Ιn addition, dietary intakes of Greek adults are problematic and initiatives at the public health level are necessary.

Dietary Glycemic Index and Glycemic Load Are Not Associated with the Metabolic Syndrome in Lebanese Healthy Adults: A Cross-Sectional Study

High dietary glycemic index (GI) and glycemic load (GL) were suggested to increase the risk of metabolic syndrome (MetS). This study aims to estimate dietary GI and GL in a sample of healthy Lebanese adults and examine their association with MetS and its individual abnormalities. The study uses data from a community-based survey of 501 Lebanese urban adults. Dietary intake was assessed using a food frequency questionnaire. Biochemical, anthropometric, and blood pressure measurements were obtained. Subjects with previous diagnosis of chronic disease, metabolic abnormalities, or with incomplete data or implausible energy intakes were excluded, yielding a sample of 283. Participants were grouped into quartiles of GI and GL. Multivariate logistic regression analyses were performed. Average dietary GI and GL were estimated at 59.9 ± 8 and 209.7 ± 100.3. Participants belonging to the highest GI quartile were at increased risk of having MetS (odds ratio (OR) = 2.251, 95% CI:1.120–4.525) but this association lost significance with further adjustments. Those belonging to the second quartile of GI had significantly lower odds of having hyperglycemia (OR: 0.380, 95% CI:0.174–0.833). No associations were detected between GL and MetS. The study contributes to the body of evidence discussing the relationship between GI, GL, and MetS, in a nutrition transition context.

High Protein Intake Is Associated With Histological Disease Activity in Patients With NAFLD

Overconsumption of carbohydrates and lipids are well known to cause nonalcoholic fatty liver disease (NAFLD), while the role of nutritional protein intake is less clear. In Western diet, meat and other animal products are the main protein source, with varying concentrations of specific amino acids. Whether the amount or composition of protein intake is associated with a higher risk for disease severity has not yet been examined. In this study, we investigated associations of dietary components with histological disease activity by analyzing detailed 14-day food records in a cohort of 61 patients with biopsy-proven NAFLD. Furthermore, we used 16S ribosomal RNA gene sequencing to detect associations with different abundances of the gut microbiota with dietary patterns. Patients with definite nonalcoholic steatohepatitis (NAFLD activity score of 5-8 on liver biopsy) had a significantly higher daily relative intake of protein compared with patients with a NAFLD activity score of 0-4 (18.0% vs. 15.8% of daily protein-based calories, P = 0.018). After adjustment for several potentially confounding factors, a higher protein intake (≥17.3% of daily protein-based calories) remained associated with definite nonalcoholic steatohepatitis, with an odds ratio of 5.09 (95% confidence interval 1.22-21.25, P = 0.026). This association was driven primarily by serine, glycine, arginine, proline, phenylalanine, and methionine. A higher protein intake correlated with a lower Bacteroides abundance and an altered abundance of several other bacterial taxa. Conclusion: A high protein intake was independently associated with more active and severe histological disease activity in patients with NAFLD. Further studies are needed to investigate the potential harmful role of dietary amino acids on NAFLD, with special attention to meat as their major source.

Development and validation of the semi-quantitative brief food frequency questionnaire to assess the magnesium intake in young women

AIM

The aim of the study was to develop and validate the semi-quantitative brief food frequency questionnaire to assess the magnesium intake (Mg-FFQ).

METHODS

The developed questionnaire consists of 39 questions and it was validated in a group of 75 women aged 20-30. The validity was assessed with reference to the 3-day dietary record and the reproducibility was assessed for a period of 6 weeks.

RESULTS

The Bland-Altman index for the assessment of validity was 6.7% and for reproducibility-8.0%, while the kappa statistic indicated a slight and substantial agreement, respectively. The high reproducibility was confirmed by a high share of respondents correctly classified into tertiles (73.3%) and correctly classified into categories of adequate/inadequate intake (85.3%).

CONCLUSION

For the developed and validated Mg-FFQ, a high reproducibility, accompanied by a satisfactory validity, was confirmed, so it may be used to assess the magnesium intake in the epidemiological studies in young Polish women aged 20-30.

Validation and reproducibility of a new iodine specific food frequency questionnaire for assessing iodine intake in Norwegian pregnant women

BACKGROUND

Iodized salt is not mandatory in Norway, and the permitted level of iodine in table salt is low (5 μg/g). Thus, milk and dairy products, fish and eggs are the main dietary sources of iodine in Norway. Mild-to-moderate iodine deficiency in pregnant women has been described in several European countries, including Norway. There are few validated tools available to assess iodine intake in an efficient manner. The aim of the current study was to assess the validity and reproducibility of a new iodine-specific food frequency questionnaire (I-FFQ) in Norwegian pregnant women.

METHODS

An I-FFQ consisting of a total of 60 food items and the use of supplements was developed to assess iodine intake and was administrated to 137 pregnant women at gestational week 18-19. Reference methods were a structured 6-days iodine specific food diary, urinary iodine concentration (UIC) (pooled sample of spot UIC from six consecutive days), and thyroid function tests. Correlation analyses, Cohen's weighted kappa, Bland-Altman plots, and linear regression analyses were used to assess validity. Reproducibility of the I-FFQ was assessed in a subgroup (n = 47) at gestational week 35-36.

RESULTS

There was a strong correlation between estimated iodine intake from the I-FFQ and food diary (r = 0.62, P < 0.001) and an acceptable correlation between the I-FFQ and UIC (r = 0.21, P = 0.018). There was no significant association between the I-FFQ and thyroid function tests. The I-FFQ estimated higher iodine intake compared to the food diary with a mean absolute difference 33 μg/day. The limits of agreement from the Bland-Altman plots were large, however few participants fell outside the limits of agreement (5.2-6.5%). There was no difference between the estimated iodine intake from the I-FFQ assessed at gestational week 18-19, and gestational week 35-36 (P = 0.866), and there was a strong correlation between the two time points (r = 0.63, P < 0.001).

CONCLUSION

In summary, this study suggests that the I-FFQ can be used as a valid tool to estimate and rank iodine intake among Norwegian pregnant women. We further suggest that this I-FFQ may also be valid in other populations with similarly dietary patterns and where salt is not iodized.

TRIAL REGISTRATION

The study is registered in ClinicalTrials.gov (NCT02610959).

Diet-Related Factors, Physical Activity, and Weight Status in Polish Adults

Obesity is a serious problem for both the individual and society due to its health and economic consequences. Therefore, there is a need to focus on factors which explain this phenomenon and may be useful in preventing future occurrence. The aim of this study was to determine the lifestyle factors coexisting with increased body mass index (BMI ≥ 25 kg/m²) in Polish adults, including factors related to diet (dietary patterns-DPs; dietary restrictions; number of meals; frequency of snacking, eating out, and ordering home delivery meals), physical activity, and sociodemographic characteristics. A cross-sectional quantitative survey was carried out in 2016 amongst 972 Polish adults under the Life Style Study (LSS). To determine the factorscoexisting with BMI ≥ 25 kg/m², the logistic regression model was developed. Women were less likely to be overweight or obese compared to men. The likelihood of BMI ≥ 25 kg/m² increased with age by 4% in each subsequent year of life. Frequent consumption of fruits and vegetables, adhering to restrictions in quantity of food consumed and at least moderate physical activity during leisure time decreased the likelihood of BMI ≥ 25 kg/m². More frequent consumption of meat and eating five or more meals a day increased the likelihood of BMI ≥ 25 kg/m². Diet-related factors explained the developed model better than factors related to physical activity, however, age and gender were the factors most strongly correlated with BMI ≥ 25 kg/m². Therefore, development of strategies to prevent and reduce overweight and obesity should focus on the demographic characteristics of the population, and then on teaching behaviors conducive for reducing the amount of food consumed, especially meat. However, physical activity in leisure time should also be included in the prevention of obesity.

Reproducibility of A Non-Quantitative Food Frequency Questionnaire (62-Item FFQ-6) and PCA-Driven Dietary Pattern Identification in 13-21-Year-Old Females

The aim of this study was to evaluate the test-retest reproducibility of a non-quantitative food frequency questionnaire (acronym: 62-item FFQ-6) and the possibility of identifying dietary patterns (DPs) in 13-21-year-old females. The study involved 97 females within three age groups: 13-15, 16-18, and 19-21 years, including 31, 38, and 28 subjects, respectively. The questionnaire was completed twice with a two-week interval (test and retest). For the total sample, using a principal component analysis (PCA), two similar PCA-driven DPs (DP1 and DP2) were identified separately from test data and retest data, considering two sets of input variables. 60-item-DP1 and 60-item-DP2 were identified after excluding two items-vegetables and fruits in general-due to including single items of various kinds of vegetables and fruits. After an aggregation of some items of the questionnaire, 25-item-DP1 and 25-item-DP2 were identified. The kappa statistic (test vs. retest) in the total sample averaged at 0.52 (0.32-0.72 for food items), while within age groups, it averaged at 0.41, 0.53, and 0.65, respectively. The percentage of subjects classified into the same food frequency category (test vs. retest) in the total sample averaged at 68% (51%-89% for food items), while within age groups, it averaged at 60%, 68%, and 77%, respectively. The Spearman correlations between dietary pattern scores (test vs. retest) in the total sample were: 0.84 (within age groups 0.83, 0.81, and 0.78, respectively) for 60-item-DP1, 0.68 (within age groups 0.24, 0.79, and 0.76, respectively) for 60-item-DP2, 0.76 (within age groups 0.56, 0.82, and 0.89, respectively) for 25-item-DP1, and 0.48 (within age groups 0.40, 0.57, and 0.53, respectively) for 25-item-DP2 (p < 0.05 for all). In conclusion, the test-retest reproducibility of the 62-item FFQ-6 was good or very good for most food items, with a tendency to be higher in older age groups of females under study. Due to the acceptable-to-good reproducibility of dietary pattern identification, the use of a 62-item FFQ-6 to describe the overall diet of young Polish females can be recommended.

Dietary acid load and cardiometabolic risk factors: a systematic review and meta-analysis of observational studies

OBJECTIVE

Dietary acid load (DAL) might contribute to change the levels of cardiometabolic risk factors; however, the results are conflicting. The present review was conducted to determine the relationship between DAL and cardiometabolic risk factors.

DESIGN

Systematic review and meta-analysis.

SETTING

A systematic search was conducted in electronic databases including ISI Web of Science, PubMed/MEDLINE, Scopus and Google Scholar for observational studies which assessed cardiometabolic risk factors across DAL. Outcomes were lipid profile, glycaemic factors and anthropometric indices. Effect sizes were derived using a fixed- or random-effect model (DerSimonian-Laird). Also, subgroup analysis was performed to find the probable source of heterogeneity. Egger's test was performed for finding any publication bias.

RESULTS

Thirty-one studies were included in the current review with overall sample size of 92 478. There was a significant relationship between systolic blood pressure (SBP; weighted mean difference (WMD) = 1·74 (95 % CI 0·25, 3·24) mmHg; P = 0·022; I2 = 95·3 %), diastolic blood pressure (DBP; WMD = 0·75 (95 % CI 0·07, 1·42) mmHg; P = 0·030; I2 = 80·8 %) and DAL in cross-sectional studies. Serum lipids, glycaemic parameters including fasting blood sugar, glycated Hb, serum insulin, homeostatic model assessment of insulin resistance and waist circumference had no significant relationship with DAL. No publication bias was found. BMI was not associated with DAL in both cross-sectional and cohort studies.

CONCLUSIONS

Higher DAL is associated with increased SBP and DBP. More studies are needed to find any relationship of DAL with lipid profile and glycaemic factors.

Alterations of Fatty Acid Profile May Contribute to Dyslipidemia in Chronic Kidney Disease by Influencing Hepatocyte Metabolism

Chronic kidney disease (CKD) is associated with atherogenic dyslipidemia. Our aim was firstly to investigate patterns of fatty acids (FA) composition through various stages of CKD, and secondly, to evaluate the effect of CKD-specific FA disturbances on the expression of genes related to lipid metabolism at a cellular level. Serum FA composition was analyzed in 191 patients with consecutive severity stages of CKD, and 30 healthy controls free from CKD. Next, HepG2 human hepatic cells were treated with major representatives of various FA groups, as well as with FA extracted from a mix of serums of controls and of CKD stage 5 patients. Across worsening stages of CKD severity, there was an increasing monounsaturated FA (MUFA) content. It was associated with a concomitant decrease in n-3 and n-6 polyunsaturated FA. The incubation of hepatocytes with FA from CKD patients (compared to that of healthy subjects), resulted in significantly higher mRNA levels of genes involved in FA synthesis (fatty acid synthase (FASN) increased 13.7 ± 3.5 times, stearoyl-CoA desaturase 1 (SCD1) increased 4.26 ± 0.36 times), and very low density lipoprotein (VLDL) formation (apolipoprotein B (ApoB) increased 7.35 ± 1.5 times, microsomal triacylglycerol transfer protein (MTTP) increased 2.74 ± 0.43 times). In conclusion, there were progressive alterations in serum FA composition of patients with CKD. These alterations may partly contribute to CKD hypertriglyceridemia by influencing hepatocyte expression of genes of lipid synthesis and release.

Rotating night shift work and nutrition of nurses and midwives

Previous research points to some inappropriate nutritional habits among nurses working night shifts. However, the knowledge of specific nutritional components of their diet has been limited. In the present study, we aimed to investigate the association between rotating night shifts of nurses and midwives and their usual dietary intake of energy and nutrients. A cross-sectional study was conducted among 522 Polish nurses and midwives: 251 working rotating night shifts (i.e. working night shift followed by a day off on a subsequent day) and 271 day workers. Polish adaptation of the Food Frequency Questionnaire, regarding 151 food items, was used to assess the usual dietary energy and nutrient intake. Data on occupational history and potential confounders were collected via face-to-face interviews. Body weight, height, waist and hip circumference were measured. Linear regression models: univariate (crude) and multivariate (adjusted) were run, with the nutrient intake as dependent variables, night work characteristics, and important confounders. Among nurses and midwives working rotating night shifts, a significantly higher adjusted mean intake was found for the total energy (2005 kcal vs 1850 kcal) and total fatty acids (77.9 g vs 70.4 g) when compared to day workers, as well as for cholesterol (277 mg vs 258 mg), carbohydrates (266 g vs 244 g) and sucrose (55.8 g vs 48.6 g). Night shift work duration was inversely related to the consumption of calcium, phosphorus, vitamin A, vitamin C and % energy from proteins. The higher energy consumption may contribute to increase risk of overweight and obesity among nurses working night shifts.

The Relationship of the Atlantic Diet with Cardiovascular Risk Factors and Markers of Arterial Stiffness in Adults without Cardiovascular Disease

Background: Studying the adherence of the population to the Atlantic Diet (AD) could be simplified by an easy and quickly applied dietary index. The aim of this study is to analyse the relationship of an index measuring compliance with recommendations regarding the Atlantic diet and physical activity with cardiovascular disease risk factors, cardiovascular risk factors, obesity indexes and arterial stiffness markers.

METHODS

We included 791 individuals from the EVIDENT study (lifestyles and arterial ageing), (52.3 ± 12 years, 61.7% women) without cardiovascular disease. Compliance with recommendations on AD was collected through the responses to a food frequency questionnaire, while physical activity was measured by accelerometer. The number of recommendations being met was estimated using a global scale between 0 and 14 points (a higher score representing greater adherence). Blood pressure, plasma lipid and glucose values and obesity rates were measured. Cardiovascular risk was estimated with the Framingham equation.

RESULTS

In the overall sample, 184 individuals (23.3%) scored between 0⁻3 on the 14-point index we created, 308 (38.9%) between 4 and 5 points, and 299 (37.8%) 6 or more points. The results of multivariate analysis yield a common tendency in which the group with an adherence score of at least 6 points shows lower figures for total cholesterol (p = 0.007) and triglycerides (p = 0.002). Similarly, overall cardiovascular risk in this group is the lowest (p < 0.001), as is pulse wave velocity (p = 0.050) and the mean values of the obesity indexes studied (p < 0.05 in all cases).

CONCLUSION

The rate of compliance with the Atlantic diet and physical activity shows that greater adherence to these recommendations is linked to lower cardiovascular risk, lower total cholesterol and triglycerides, lower rates of obesity and lower pulse wave velocity values.

EVIDENT Smartphone App, a New Method for the Dietary Record: Comparison With a Food Frequency Questionnaire

BACKGROUND

More alternatives are needed for recording people's normal diet in different populations, especially adults or the elderly, as part of the investigation into the effects of nutrition on health.

OBJECTIVE

The aim of this study was to compare the estimated values of energy intake, macro- and micronutrient, and alcohol consumption gathered using the EVIDENT II smartphone app against the data estimated with a food frequency questionnaire (FFQ) in an adult population aged 18 to 70 years.

METHODS

We included 362 individuals (mean age 52 years, SD 12; 214/362, 59.1% women) who were part of the EVIDENT II study. The participants registered their food intake using the EVIDENT app during a period of 3 months and through an FFQ. Both methods estimate the average nutritional composition, including energy intake, macro- and micronutrients, and alcohol. Through the app, the values of the first week of food recording, the first month, and the entire 3-month period were estimated. The FFQ gathers data regarding the food intake of the year before the moment of interview.

RESULTS

The intraclass correlation for the estimation of energy intake with the FFQ and the app shows significant results, with the highest values returned when analyzing the app's data for the full 3-month period (.304, 95% CI 0.144-0.434; P<.001). For this period, the correlation coefficient for energy intake is .233 (P<.001). The highest value corresponds to alcohol consumption and the lowest to the intake of polyunsaturated fatty acids (r=.676 and r=.155; P<.001), respectively. The estimation of daily intake of energy, macronutrients, and alcohol presents higher values in the FFQ compared with the EVIDENT app data. Considering the values recorded during the 3-month period, the FFQ for energy intake estimation (Kcal) was higher than that of the app (a difference of 408.7, 95% CI 322.7-494.8; P<.001). The same is true for the other macronutrients, with the exception g/day of saturated fatty acids (.4, 95% CI -1.2 to 2.0; P=.62).

CONCLUSIONS

The EVIDENT app is significantly correlated to FFQ in the estimation of energy intake, macro- and micronutrients, and alcohol consumption. This correlation increases with longer app recording periods. The EVIDENT app can be a good alternative for recording food intake in the context of longitudinal or intervention studies.

TRIAL REGISTRATION

ClinicalTrials.gov NCT02016014; http://clinicaltrials.gov/ct2/show/NCT02016014 (Archived by WebCite at http://www.webcitation.org/760i8EL8Q).

Development and validation of a quantitative choline food frequency questionnaire for use with drinking and non-drinking pregnant women in Cape Town, South Africa

Background

Although animal and human studies have demonstrated interactions between dietary choline and fetal alcohol spectrum disorders, dietary choline deficiency in pregnancy is common in the US and worldwide. We sought to develop and validate a quantitative food frequency questionnaire (QFFQ) to estimate usual daily choline intake in pregnant mothers.

Methods

A panel of nutrition experts developed a Choline-QFFQ food item list, including sources with high choline content and the most commonly consumed choline-containing foods in the target population. A data base for choline content of each item was compiled. For reliability and validity testing in a prospective longitudinal cohort, 123 heavy drinking Cape Coloured pregnant women and 83 abstaining/light-drinking controls were recruited at their first antenatal clinic visit. At 3 prenatal study visits, each gravida was interviewed about alcohol, smoking, and drug use, and administered a 24-hour recall interview and the Choline-QFFQ.

Results

Across all visits and assessments, > 78% of heavy drinkers and controls reported choline intake below the Dietary Reference Intakes adequate intake level (450 mg/day). Women reported a decrease in choline intake over time on the QFFQ. Reliability of the QFFQ across visits was good-to-acceptable for 2 of 4 group-level tests and 4 of 5 individual-level tests for both drinkers and controls. When compared with 24-hr recall data, validity of the QFFQ was good-to-acceptable for 3 of 4 individual-level tests and 3 of 5 group-level tests. For controls, validity was good-to-acceptable for all 4 individual-level tests and all 5 group-level tests.

Conclusions

To our knowledge, this is the first quantitative choline food frequency screening questionnaire to be developed and validated for use with both heavy and non-drinking pregnant women and the first to be used in the Cape Coloured community in South Africa. Given the high prevalence of inadequate choline intake and the growing evidence that maternal choline supplementation can mitigate some of the adverse effects of prenatal alcohol exposure, this tool may be useful for both research and future clinical outreach programs.

Consumption of ultra-processed food and obesity: cross sectional results from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) cohort (2008-2010)

OBJECTIVE

To verify if the intake of ultra-processed foods is associated with higher BMI and waist circumference (WC) among participants of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) cohort.

DESIGN

Cross-sectional analysis of the ELSA-Brasil baseline (2008-2010). Dietary information obtained through an FFQ was classified according to characteristics of food processing (NOVA) and used to estimate the percentage energy contribution from ultra-processed foods (i.e. industrial formulations, elaborated from food processing, synthetic constituents and food additives) to individuals' total energy intake. BMI and WC and their respective cut-off points served as response variables. Associations were estimated through linear and multinomial logistic regression models, after adjusting for confounders and total energy intake.

SETTING

Six Brazilian capital cities, 2008-2010.

SUBJECTS

Active and retired civil servants, aged 35-64 years, from universities and research organizations (n 8977).

RESULTS

Ultra-processed foods accounted for 22·7 % of total energy intake. After adjustments, individuals in the fourth quartile of percentage energy contribution from ultra-processed foods presented (β; 95 % CI) a higher BMI (0·80; CI 0·53, 1·07 kg/m2) and WC (1·71; 1·02, 2·40 cm), and higher chances (OR; 95 % CI) of being overweight (1·31; 1·13, 1·51), obese (1·41; 1·18, 1·69) and having significantly increased WC (1·41; 1·20, 1·66), compared with those in the first quartile. All associations suggest a dose-response gradient.

CONCLUSIONS

Results indicate the existence of associations between greater energy contribution from ultra-processed foods and higher BMI and WC, which are independent of total energy intake. These findings corroborate public policies designed to reduce the intake of this type of food.

Evaluation of a short food frequency questionnaire for dietary intake assessment among children

BACKGROUND/OBJECTIVES

The objective of this study was to evaluate the performance of a short food frequency questionnaire (FFQ) to assess dietary intake at 4 and 7 years of age, against 3d food diaries (FD) and serum biomarkers, using two methods to convert the FFQ to daily intake in grams and nutrients (standard and z-score method).

SUBJECTS/METHODS

The present analysis comprises data from 2482 4-year-old children and 3511 7-year-old children, from the birth cohort Generation XXI (Porto, Portugal). To estimate daily consumption from the FFQ, the frequency response was multiplied by a standard mean portion (standard method) or adjusted with data from the FD (z-score method). The dietary intake obtained from the FFQ was compared with the FD and serum biomarkers, using Intra-Class Correlation Coefficients (ICC), de-attenuated Pearson's correlation coefficients and Bland Altman analysis.

RESULTS

In general, the mean daily food intake estimated by the z-score method had a higher agreement with the FD, than the standard method. The highest ICC was obtained for "vegetable soup" (ICC = 0.536), using the z-score method, compared to an ICC of 0.373 using the standard method. Significant correlation coefficients were observed for all nutrients; the average of correlation coefficients was 0.39 at 4 years and 0.42 at 7 years of age. For the majority of nutrients, the correlation between mean and mean difference was lower using the z-score method, in comparison with the standard method.

CONCLUSIONS

The results suggest that the FFQ is a reasonably good instrument to estimate dietary intake in children. Moreover, adjusting the FFQ portion size, by using a z-score method, seems to increase the accuracy of dietary data in children.

Child Temperament, Maternal Feeding Practices, and Parenting Styles and Their Influence on Obesogenic Behaviors in Hispanic Preschool Children

Although obesogenic behaviors (physical activity and/or sedentary behavior and dietary intake) are known predictors of childhood weight status, little is known about mother and child behaviors contributing to obesogenic behaviors and obesity in Hispanic preschool children, whose obesity rate is higher than in non-Hispanic Whites and non-Hispanic Blacks. The purpose of this cross-sectional, descriptive study was to examine relationships among child temperament, maternal behaviors (feeding practices and parenting style), child obesogenic behaviors, and child weight status in 100 Hispanic preschool children. Results showed that higher scores on the negative affectivity dimension of child temperament were associated with higher scores on the dimension of permissive parenting, and permissive parenting was associated with less time spent in sedentary behaviors (B = -3.53, confidence interval [-7.52, -0.90]). Findings can guide school nurses in developing interventions that consider child temperament and parenting style to promote nonobesogenic behavior in Hispanic preschoolers.

Differences in omega-3 and omega-6 polyunsaturated fatty acid consumption in people at ultra-high risk of psychosis, first-episode schizophrenia, and in healthy controls

AIM

Supplementation with omega-3 PUFA showed efficacy in reducing the risk of transition into psychosis in UHR individuals. It is uncertain whether dietary patterns can be partly responsible for n-3 deficiencies observed in susceptible participants before the diagnosis of schizophrenia. The study was designed to assess differences in omega-3 and omega-6 PUFA consumption in healthy controls (HC), UHR participants and FES patients as well as to verify the hypothesis that dietary changes in PUFA consumption are present before active psychosis develops, that is, in UHR individuals.

METHODS

Dietary habits during the previous year were assessed in 34 patients at UHR of psychosis, 33 patients diagnosed with FES and 33 HC participants using a validated Food-Frequency Questionnaire and the Polish Food Composition Tables.

RESULTS

Significant differences in omega-3 and omega-6 PUFA intake were observed between study groups. UHR and FES groups reported significantly higher consumption of omega-6 PUFA in comparison with HC. FES patients also reported a higher consumption of alpha-linolenic acid (omega-3) in comparison with HC. No significant differences were seen in consumption of long-chain marine PUFA.

CONCLUSIONS

Differences in omega-6 and omega-3 PUFA consumption exist before development of psychotic symptoms, fulfilling the criteria of schizophrenia.

Validity and Reproducibility of a Food Frequency Questionnaire for Dietary Factors Related to Colorectal Cancer

Dietary factors play a major role in the development of colorectal cancer. This study evaluated the reproducibility and validity of a 109-food item Food Frequency Questionnaire (FFQ) to measure the consumption of foods and nutrients related to the development of colorectal cancer in a population aged ≥50 years in Flanders, Belgium. A semi-quantitative FFQ was administered two times in a period of two weeks to evaluate reproducibility (FFQ1 and FFQ2). The validity of the FFQ was assessed by comparing FFQ1 against the 3-day diary method (3 DD). A total of 162 respondents (mean age 57.5 years) provided data for the FFQ, of whom 156 also participated in the validity assessment. Mean differences in the intake of foods and nutrients between FFQ1 and FFQ2 were, overall, small and statistically insignificant. However, a higher estimation was observed by FFQ1 as compared to the 3-DD method for the majority of food groups and nutrient intake in the validity assessment. A systematic mean difference (g/day) was observed for eight food groups in the Bland-Altman agreement test; the largest was for fruit intake. Regarding the nutrients, a systematic mean difference was observed in calcium, fat, and vitamin D intake. Overall, the reproducibility of the FFQ was good, and its validity could be satisfactory for estimating absolute food and nutrient intakes and ranking individuals according to high and low intake categories.

Validity and Reproducibility of the Iodine Dietary Intake Questionnaire Assessment Conducted for Young Polish Women

The aim of this study was to analyse a designed brief iodine dietary intake questionnaire based on a food frequency assessment (IOdine Dietary INtake Evaluation-Food Frequency Questionnaire—IODINE-FFQ), including the assessment of validity and reproducibility in a group of 90 Polish women aged 20–35 years. Participants collected 3-day dietary records and filled in the IODINE-FFQ twice (FFQ1—directly after the dietary record and FFQ2—6 weeks later). The analysis included an assessment of validity (comparison with the results of the 3-day dietary record) and of reproducibility (comparison of the results obtained twice—FFQ1 and FFQ2). In the analysis of validity, a Bland-Altman index of 5.5% and 4.4% was recorded, respectively for FFQ1 and FFQ2. In the analysis of reproducibility it was 6.7%, but the share of individuals correctly classified into tertiles was over 70% (weighted κ of 0.675). It was stated, that assessment of IODINE-FFQ revealed a satisfactory level of validity and reproducibility in the analysis of Bland-Alman plot. The IODINE-FFQ may be indicated as a tool for the assessment of iodine intake in the young women in Poland, however further studies should be considered in order to obtain the practical tool for public health specialists. Due to the lack of validated iodine-specific food frequency questionnaires for countries of Eastern Europe, the IODINE-FFQ may be adjusted for courtiers other than Poland including iodine-fortified products.