Beverage Intake Assessment Questionnaire: Relative Validity and Repeatability in a Spanish Population with Metabolic Syndrome from the PREDIMED-PLUS Study

Long-term association between water intake and kidney function in a population at high cardiovascular risk

OBJECTIVES

The evidence on water intake in the prevention of kidney function decline is scarce at population level in well-being individuals at high cardiovascular risk. Therefore, we aimed to longitudinally evaluate the associations between total water intake and subtypes and kidney function, through estimated-Glomerular Filtration Rate (eGFR).

METHODS

Three-year prospective analysis conducted in 1986 older adults (aged 55-75 year) with overweight/obesity and metabolic syndrome from the PREDIMED-Plus study. Water intake was assessed using validated beverage and food frequency questionnaires. Serum creatinine-based eGFR (SCr-based eGFR; ml/min/1.73 m2) was estimated using the CKD-EPI equation at baseline, one-year and 3-years of follow-up. Mixed-effects linear regression models were fitted to evaluate the associations between baseline total water intake and subtypes, and SCr-based eGFR over 3-years of follow-up.

RESULTS

Participants in the highest baseline tertile of total water intake, plain water and water from all fluids showed a lower decrease in SCr-based eGFR after 3-years of follow-up, compared to those in the lowest tertile. Participants with the highest tap water consumption showed a lower SCr-based eGFR decline after 1-year and 3-years of follow-up, in comparerd to participants in the lowest intake category (T3 vs. T1: β: 1.4 ml/min/1.73 m2; 95%CI: 0.5-2.3, β: 1.0; 95%CI: 0.1-2.0, respectively).

CONCLUSIONS

Plain water rather than other water sources, and especially tap water, was associated with lower kidney function decline assessed through eGFR over 3-years of follow-up, in older individuals at high cardiovascular risk.

TRIAL REGISTRATION

ISRCTN89898870. Retrospectively registered on 24 July 2014.

Development and Evaluation of the Reliability of a Semi-Quantitative Food Frequency Questionnaire to Assess the Intake in the Serbian Population

Assessing dietary habits with validated questionnaires is crucial for achieving reliable results in health research. The aim of this study was the development and validation of a semi-quantitative food frequency questionnaire (FFQ) in an 18-30-year-old Serbian population. A total of 93 participants completed the FFQ and three 24 h dietary recalls (24 hR). Pearson and intraclass correlations between FFQ and 24 hR intakes were assessed and were de-attenuated and energy-adjusted. Bland-Altman plots were generated, and quintiles of energy, water, fiber, and macronutrient intake were analyzed with contingency tables. Adjustments for sex differences were included. The validity of the FFQ varied, with significant correlations for energy, carbohydrates, cholesterol, and vitamin B12, vitamin C and vitamin D. Misclassification rates were generally low. Bland-Altman plots indicated good agreement between methods. It can be concluded that the validated FFQ is a promising tool for dietary assessment in the Serbian population. Results for several nutrients align closely with previous studies. The new FFQ is a useful tool for dietary assessment in the Serbian population.

Influence of daily life and health profile in subtle cognitive decline of women residing in Spanish religious communities: DeCo religious orders study

Background

Prior to the onset of dementia, individuals commonly undergo a phase marked by subtle cognitive changes, known as subtle cognitive decline. Recognizing these early cognitive alterations is crucial, as they can serve as indicators of an impending decline in cognitive function, warranting timely intervention and support.

Objectives

To determine the incidence of subtle cognitive decline in a population of Spanish women and establish the relationship with possible protective and/or risk factors such as cognitive reserve, cardiovascular risk factors, medication consumption and psychosocial factors.

Design and participants

This is a cross-sectional observational study with women from the general population and a more homogeneous population composed of nuns from the Valencian region (Spain).

Measurements

A validated questionnaire was used including lifestyle variables, chronic illnesses, level of education and pharmacological treatments. Three validated subtle cognitive decline screening tests with varying levels of sensitivity and specificity were used: Memory Impairment Screening, Pfeiffer's Short Portable Mental State Questionnaire, and Semantic Verbal Fluency.

Results

Our results suggest that nuns may have a significantly reduced risk of cognitive decline compared to the general population (20.67% in nuns vs. 36.63% in the general population). This lower risk for subtle cognitive decline in nuns may be partly attributed to their higher cognitive reserve and long-time engagement in intellectually stimulating activities. Additionally, nuns tend to adopt healthy lifestyles, they are not isolated because they live in community and obtained lower scores for risk factors such as depression, anticholinergic burden, and benzodiazepine consumption.

Conclusion

A healthy lifestyle combined with intellectually stimulating activities is related with preserved cognitive function.

Associations between muscular strength and mental health in cognitively normal older adults: a cross-sectional study from the AGUEDA trial

Objective

To examine the associations between muscular strength and mental health.

Design

We used baseline data of 91 cognitively healthy older adults (71.69 ± 3.91 years old, 57 % women) participating in the AGUEDA randomized controlled trial.

Methods

Muscular strength was assessed using both objective (i.e., handgrip strength, biceps curl, squats, and isokinetic test) and perceived (i.e., International Fitness Scale) indicators. Psychological ill-being indicators: anxiety, depression, stress, and loneliness; and psychological well-being indicators: satisfaction with life, self-esteem, and emotional well-being) were assessed using a set of valid and reliable self-reported questionnaires. Linear regression analyses were performed adjusting for sex, age, years of education, body mass index , alcohol, diet, and smoking (model 1), and additionally by cardiorespiratory fitness (model 2).

Results

Elbow extension was positively associated with stress in model 1 (β = 0.252, 95 % Confidence Interval [95 % CI] = 0.007 to 0.497, p = 0.044), and even after further adjustment for cardiorespiratory fitness (β = 0.282, 95 % CI = 0.032 to 0.532, p = 0.028). Perceived strength was negatively associated with depressive symptoms in model 1 (β = -0.271, 95 % CI = -0.491 to -0.049, p = 0.017) and model 2 reported associations tending towards significant (β = -0.220, 95 % CI = -0.445 to 0.005, p = 0.055). Handgrip strength was positively associated with self-esteem in model 1 (β = 0.558, 95 % CI = 0.168 to 0.949, p = 0.006) and model 2 (β = 0.546, 95 % CI = 0.135 to 0.956, p = 0.010). No further associations were found among other muscular strength and mental health variables.

Conclusion

Handgrip had a moderate association with self-esteem and there was a small association between perceived strength with depressive symptoms and elbow extension with stress. No other associations were observed between muscular strength and mental health outcomes in cognitively normal older adults.

Dietary intake of Perfluorooctanesulfonic acid (PFOS) and glucose homeostasis parameters in a non-diabetic senior population

BACKGROUND

Endocrine disruptors (EDs) have emerged as potential contributors to the development of type-2 diabetes. Perfluorooctane sulfonate (PFOS), is one of these EDs linked with chronic diseases and gathered attention due to its widespread in food.

OBJECTIVE

To assess at baseline and after 1-year of follow-up associations between estimated dietary intake (DI) of PFOS, and glucose homeostasis parameters and body-mass-index (BMI) in a senior population of 4600 non-diabetic participants from the PREDIMED-plus study.

METHODS

Multivariable linear regression models were conducted to assess associations between baseline PFOS-DI at lower bound (LB) and upper bound (UB) established by the EFSA, glucose homeostasis parameters and BMI.

RESULTS

Compared to those in the lowest tertile, participants in the highest tertile of baseline PFOS-DI in LB and UB showed higher levels of HbA1c [β-coefficient(CI)] [0.01 %(0.002 to 0.026), and [0.06 mg/dL(0.026 to 0.087), both p-trend ≤ 0.001], and fasting plasma glucose in the LB PFOS-DI [1.05 mg/dL(0.050 to 2.046),p-trend = 0.022]. Prospectively, a positive association between LB of PFOS-DI and BMI [0.06 kg/m2(0.014 to 0.106) per 1-SD increment of energy-adjusted PFOS-DI was shown. Participants in the top tertile showed an increase in HOMA-IR [0.06(0.016 to 0.097), p-trend = 0.005] compared to participants in the reference tertile after 1-year of follow-up.

DISCUSSION

This is the first study to explore the association between DI of PFOS and glucose homeostasis. In this study, a high baseline DI of PFOS was associated with a higher levels of fasting plasma glucose and HbA1c and with an increase in HOMA-IR and BMI after 1-year of follow-up.

Association between Beverage Consumption and Environmental Sustainability in an Adult Population with Metabolic Syndrome

Beverages are an important part of the diet, but their environmental impact has been scarcely assessed. The aim of this study was to assess how changes in beverage consumption over a one-year period can impact the environmental sustainability of the diet. This is a one-year longitudinal study of 55-75-year-old participants with metabolic syndrome (n = 1122) within the frame of the PREDIMED-Plus study. Food and beverage intake were assessed using a validated food frequency questionnaire and a validated beverage-specific questionnaire. The Agribalyse® 3.0.1 database was used to calculate environmental impact parameters such as greenhouse gas emission, energy, water, and land use. A sustainability beverage score was created by considering the evaluated environmental markers. A higher beverage sustainability score was obtained when decreasing the consumption of bottled water, natural and packed fruit juice, milk, and drinkable dairy, soups and broths, sorbets and jellies, soft drinks, tea without sugar, beer (with and without alcohol), and wine, as well as when increasing the consumption of tap water and coffee with milk and without sugar. Beverage consumption should be considered when assessing the environmental impact of a diet. Trial registration: ISRCTN, ISRCTN89898870. Registered 5 September 2013.

The A-to-Z factors associated with cognitive impairment. Results of the DeCo study

Introduction

Cognitive impairment (CI) is known to be mediated by several risk and protective factors, many of which are potentially modifiable. Therefore, it is important to have up-to-date studies that address a standard assessment of psychosocial, clinical and lifestyle variables.

Materials and methods

We conducted a cross-sectional observational study, with a 24-month timeframe, to estimate the relationship between risk and protective factors associated with dementia, according to the A-to-Z Dementia Knowledge. Participants were considered at CI risk if they tested positive for at least one of three validated CI screening tests: The Memory Impairment Screening, Short Portable Mental State Questionnaire, and Semantic Verbal Fluency. The A-to-Z data Collection included Mediterranean Diet Adherence Screener and Geriatric Depression Scale.

Results

The estimated prevalence of CI was 22.6% in a sample of 709 patients with an average of 69.3±10.3 years. The risk factors gradually associated with cognitive decline were hypertension, loneliness, and depression. In contrast, the protective factors gradually associated with less cognitive decline were internet use, reading, and intellectually stimulating jobs. Finally, living alone, having diabetes, taking benzodiazepines, and sleeping more than 9 h were statistically significant associated with CI, whereas to do memory training or a family history of dementia was characteristic of patients without CI.

Conclusion

A joint assessment of the influence of psychosocial, clinical, and lifestyle-related factors is needed to develop dementia prevention strategies.

Online Arabic Beverage Frequency Questionnaire (ABFQ): evaluation of validity and reliability

BACKGROUND

Obesity and chronic diseases are significant public health issues in the Middle East and North Africa region. A robust body of evidence demonstrated the association between beverage consumption, obesity, and chronic diseases. Therefore, the assessment of beverage consumption is gaining more interest in health policy development, food industry partnerships, research expansion and community involvement. Although beverage-consumption assessment tools have been developed for various populations, none were developed for the Arabic population. In this study, we developed and validated an online Arabic Beverage Frequency Questionnaire (ABFQ) to assess the total beverage intake among Arabic speaking population.

METHODS

A cross-sectional validation study was conducted among healthy adults aged between 18 and 55 years. Participants (n = 49) completed a 24-item ABFQ on two occasions and provided one 24-h urine sample. For validity, total beverage consumption (ABFQ1) was assessed against a 24-h urine sample using an osmolality test and correlation analysis. Reliability was assessed by comparing the participants' consumption in total and for every 24 individual items from ABFQ1 with the total and individual items in ABFQ2 using correlation and paired sample t-test.

RESULTS

The average daily consumption of beverages was 1504 ml/day, while the average urine osmolality/kg was 614. The validity assessment between ABFQ and urine osmolality indicates a negative correlation. However, the correlation was week and not statistically significant (r_s = -0.2, p = 0.12). In reliability test, correlation analysis was positive and acceptable in all beverage categories (r_s = 0.4 - 0.9; all p < 0.05) except flavored milk (r_s = 0.2; p < 0.181) and sweetened coffee (r_s = 0.3; p < 0.022). Furthermore, no significant differences were found between the means of total consumption in both ABFQ1 and ABFQ2.

CONCLUSIONS

The finding of this study suggest that the ABFQ is a reliable reproducible tool for assessing beverage consumption among Arabic-speaking consumers. However, the survey could not be validated using 24-h urine osmolality only and other methods such as multi dietary records may use in future re-assessment.

Water intake, hydration status and 2-year changes in cognitive performance: a prospective cohort study

BACKGROUND

Water intake and hydration status have been suggested to impact cognition; however, longitudinal evidence is limited and often inconsistent. This study aimed to longitudinally assess the association between hydration status and water intake based on current recommendations, with changes in cognition in an older Spanish population at high cardiovascular disease risk.

METHODS

A prospective analysis was conducted of a cohort of 1957 adults (aged 55-75) with overweight/obesity (BMI between ≥ 27 and < 40 kg/m²) and metabolic syndrome from the PREDIMED-Plus study. Participants had completed bloodwork and validated, semiquantitative beverage and food frequency questionnaires at baseline, as well as an extensive neuropsychological battery of 8 validated tests at baseline and 2 years of follow-up. Hydration status was determined by serum osmolarity calculation and categorized as < 295 mmol/L (hydrated), 295-299.9 mmol/L (impending dehydration), and ≥ 300 mmol/L (dehydrated). Water intake was assessed as total drinking water intake and total water intake from food and beverages and according to EFSA recommendations. Global cognitive function was determined as a composite z-score summarizing individual participant results from all neuropsychological tests. Multivariable linear regression models were fitted to assess the associations between baseline hydration status and fluid intake, continuously and categorically, with 2-year changes in cognitive performance.

RESULTS

The mean baseline daily total water intake was 2871 ± 676 mL/day (2889 ± 677 mL/day in men; 2854 ± 674 mL/day in women), and 80.2% of participants met the ESFA reference values for an adequate intake. Serum osmolarity (mean 298 ± 24 mmol/L, range 263 to 347 mmol/L) indicated that 56% of participants were physiologically dehydrated. Lower physiological hydration status (i.e., greater serum osmolarity) was associated with a greater decline in global cognitive function z-score over a 2-year period (β: - 0.010; 95% CI - 0.017 to - 0.004, p-value = 0.002). No significant associations were observed between water intake from beverages and/or foods with 2-year changes in global cognitive function.

CONCLUSIONS

Reduced physiological hydration status was associated with greater reductions in global cognitive function over a 2-year period in older adults with metabolic syndrome and overweight or obesity. Future research assessing the impact of hydration on cognitive performance over a longer duration is needed.

TRIAL REGISTRATION

International Standard Randomized Controlled Trial Registry, ISRCTN89898870. Retrospectively registered on 24 July 2014.

A systematic review of measurement methods used to estimate fluid and beverage intake in free-living, working-age adults

BACKGROUND

Beverage intake in employees is important to quantify due to the potential of dehydration to increase the risk of errors and reduced work performance. This systematic review aimed to (1) characterise existing fluid intake measurement tools used in the workplace setting or among free-living, healthy adults of working age and (2) report the current validation status of available assessment tools for use in a UK setting.

METHODS

Three electronic databases were searched for publications measuring beverage intake using a defined tool or method. Additional studies were identified by hand from trial registers, grey literature and reference lists. Eligibility was determined using predefined inclusion/exclusion criteria. Study quality was assessed using a modified Strengthening the Reporting of Observational Studies in Epidemiology framework. Narrative synthesis was performed.

RESULTS

The review identified 105 studies. The most frequently reported beverage assessment methods were total diet diaries/records (n = 22), fluid specific diaries/records (n = 18), food and fluid frequency questionnaires (n = 17), beverage-specific frequency questionnaires (n = 23) and diet recalls (n = 11). General dietary measurement tools (measuring beverages as part of total diet) were used in 60 studies, and 45 studies used a beverage-specific tool. This review identified 18 distinct dietary assessment tools, of which 6 were fluid/beverage specific. Twelve tools published relative validity for a beverage-related variable and seven tools for total daily fluid intake (from whole diet or from beverages only).

CONCLUSIONS

Several fluid intake assessment tools were identified; however, few have been fully evaluated for total beverage intake, and none in a UK working population.

Addressing Psychosocial Factors in Cognitive Impairment Screening from a Holistic Perspective: The DeCo-Booklet Methodology Design and Pilot Study

Cognitive impairment (CI), an intermediate phase between the decline in physiological cognition and dementia, is known to be mediated by a variety of risk and protective factors, with age being the most influential of these. The multifactorial nature of CI and the worldwide phenomenon of an aging population makes decoupling old age from disease through the concept of healthy aging (HA) a matter of major interest. Focusing on psychosocial variables and psychological constructs, here we designed and piloted a data collection booklet (DeCo-B) to assess CI and HA from a holistic perspective. The DeCo-B comprises six sections: sociodemographic factors, CI, meaning in life, psychosocial factors, health problems, and lifestyle. The estimated prevalence of CI and HA in our cohort were 24.4% and 6.6%, respectively. Spearman correlations mainly identified pairwise associations between the meaning in life domains and psychosocial variables. Moreover, age, marital status, purpose in life, resilience, chronic pain, cognitive reserve, and obstructive sleep apnea were significantly associated with an increased risk of CI. Our results showed that DeCo-B is a suitable tool for researching how modifiable risk and protective factors influence cognitive status. The complex interrelationships between variables should be further investigated and, for practical reasons, the questionnaire should be optimized in future work.

Fluid Intake and Hydration Status Among North Carolina Farmworkers: A Mixed Methods Study

BACKGROUND

Agricultural workers are disproportionately at risk for heat-related morbidity and mortality. The purpose of this study was to explore how sociocultural and occupational factors, and environmental heat stress influenced fluid intake and hydration status among Latino farmworkers working in eastern North Carolina.

METHODS

A community-informed, mixed methods research study was conducted in partnership with staff at a federally qualified health center. In summer 2020, we recruited Latino farmworkers at migrant camps. Twenty-eight male, migrant farmworkers participated in focus group discussions and 30 completed surveys and provided urine specimens. Wet bulb globe temperatures were measured in fields where workers labored. Content analysis and parametric analyses were performed. Data integration was completed using a meta-matrix.

RESULTS

Prior to work, 46.7% of farmworkers' urine specific gravity measurements indicated dehydration, which increased to 100% after work. The farmworkers spent between 2 and 7.5 hours of their day working in conditions above the recommended limits for workplace heat exposure. Farmworkers described exposure to extreme heat and inconsistent occupational policy compliance. Farmworkers expressed the opportunity to drink water but accessibility and poor water quality limited hydration. The integrated data supported congruent findings of extreme heat, few work breaks, and substandard housing.

CONCLUSION/APPLICATION TO PRACTICE

Farmworkers are dehydrated at work, placing them at higher risk for heat-related illness (HRI). By engaging with agricultural stakeholders, occupational health nurses can combine efforts and advocate for effective health and safety work policies to reduce HRIs and deaths among farmworkers. Legislation stipulating cooling and hydration practices would support safer work environments.

Baseline drinking water consumption and changes in body weight and waist circumference at 2-years of follow-up in a senior Mediterranean population

BACKGROUND & AIMS

The association between drinking water consumption and adiposity has been poorly explored. Therefore, we aimed to analyse the associations between the frequency of drinking water consumption and body weight and waist circumference changes in an elderly Mediterranean cohort.

METHODS

A total of 1832 elderly participants (aged 55-75 years) with metabolic syndrome from the PREDIMED-Plus study with baseline data on drinking water and other beverages assessed by a validated 32-item Spanish fluid-intake questionnaire and with data on body weight (BW) and waist circumference (WC) at 1-year and 2-year were included in these prospective analyses. Multivariable linear regression models were fitted to assess the β-coefficients and 95% confidence interval (CI) for BW and WC changes in terms of categories of baseline drinking water consumption (tap water and bottled water). The theoretical effect on BW and WC of replacing several beverages with drinking water was assessed using mathematical models.

RESULTS

The baseline frequency of drinking water consumption was inversely associated with 1-year and 2-year changes in BW. β-coefficients (95%CI) across categories of water consumption (<2.5, 2.5 to <5, 5 to < 7.5, ≥7.5 servings/d) expressed in % of weight changes at 2 years of follow-up were 0.0, -0.80 (-1.48, -0.12), -1.36 (-2.18, -0.54), and -1.97 (-3.09, -0.86), respectively. Individuals in the two highest categories of drinking water consumption (5 to < 7, and ≥7.5 servings/d) also showed a higher decrease in WC (expressed as % of change) after 2 years of follow-up: -1.11 (-1.96, -0.25) and -1.45 (-2.66, -0.24) compared to the reference intake (<2.5 servings/day), after adjustment for potential confounding factors. The theoretical replacement of soups, beers, spirits, hot beverages, dairy beverages, and other beverages group with drinking water was associated with greater reductions in BW at one- and two-years of follow-up.

CONCLUSIONS

Drinking water consumption was inversely associated with 2-year adiposity changes in an elderly Mediterranean cohort at high cardiovascular risk. Our results also suggest that the consumption of drinking water instead of energy-containing beverages is associated with lower weight gain.

THE TRIAL REGISTRATION

ISRCTN89898870.

Update of the BEVQ-15, a beverage intake questionnaire for habitual beverage intake for adults: determining comparative validity and reproducibility

INTRODUCTION

The BEVQ-15 is a beverage intake questionnaire that estimates the habitual average daily intake of 15 beverage categories (kcal and fl oz), as well as total sugar-sweetened beverages (SSB) and total beverages. However, subsequent to its initial validation in 2010, it has not been updated. The present study aimed to assess the convergent validity and reproducibility of the updated form of the BEVQ-15 to better reflect current beverage consumption trends.

METHODS

The study population included adults (n = 50) aged ≥18 years, recruited from a local university community. Participation consisted of three laboratory visits within a 4-week period in which the updated BEVQ-15 was administered during the first and last visit and four 24-h dietary recalls were collected. BEVQ-15 modifications included removing limits of 60 fl oz per beverage, adding a nut milk category, and providing creamer and sweetener preferences for coffee/tea categories. Convergent validity was assessed by comparing reported beverage intake between the BEVQ-15 and dietary recalls. Reproducibility was assessed by comparing both BEVQ-15 administrations. Analyses included descriptive statistics, Wilcoxon signed rank tests, Bland-Altman plots and Spearman's correlations.

RESULTS

For validity, Bland-Altman plot agreement between the BEVQ-15 and recalls was in the range 92-96% for total SSB and total beverage intake. For reproducibility, all beverage categories, total SSB, and total beverage intake were significantly correlated between the two BEVQ-15 administrations (r = 0.41-0.85; P ≤ 0.01).

CONCLUSIONS

This updated version of the BEVQ-15 demonstrated moderate convergent validity and reproducibility for total beverage consumption among well-educated southwest Virginia adults.

Fluid and total water intake in a senior mediterranean population at high cardiovascular risk: demographic and lifestyle determinants in the PREDIMED-Plus study

PURPOSE

We aimed to evaluate associations between compliance with recommendations for total water intake (TWI) and total water intake from fluids (TWIF), and some socio-demographic and lifestyle factors of a senior Mediterranean population at high cardiovascular risk.

METHODS

Cross-sectional analysis with data of 1902 participants from the PREDIMED-Plus study. A validated 32-item Spanish fluid-intake questionnaire was used to assess beverage consumption and water intake. Multivariable logistic regression models were used to assess the odds ratio (OR) and the 95% confidence interval (CI) for complying with European Food Safety Agency recommendations for TWI and TWIF according to various socio-demographic and lifestyle factors, and for the joint associations of Mediterranean diet (MedDiet) adherence and moderate-vigorous physical activity (MVPA).

RESULTS

The mean total volume of fluid intake in the population studied was 1934 ± 617 mL/day. Water was the most frequently consumed beverage. Significant differences between sex were only observed in alcoholic and hot beverage consumption. Compliance with TWIF was associated with being women (OR 3.02; 2.40, 3.80), high adherence to MedDiet (OR 1.07; 1.02, 1.12), and participants who were more engaged in physical activity (PA) (OR 1.07; 1.02, 1.13). Age was inversely associated (OR 0.96; 0.94, 0.98). Similar results for TWI recommendations compliance were observed in relation to being women (OR 5.34; 3.85, 7.42), adherence to MedDiet (OR 1.16; 1.02, 1.31) and PA (OR 1.07; 1.00, 1.15). The joint association of PA and MedDiet, showed that participants with higher adherence to MedDiet and meeting WHO recommendations for MVPA complied better with the TWI recommendations (OR 1.66; 1.19, 2.32).

CONCLUSIONS

High compliance with recommendations for TWI was associated with being a woman, and a healthy lifestyle characterized by high adherence to the MedDiet and PA.

Development and relative validity of a self-administered semi-quantitative drinks frequency questionnaire, validated in a population of university students

AIM

Drinks can contribute to energy as well as micro- and macro-nutrient intake. Drink-specific, validated, quick and easy to administer questionnaires are needed to monitor secular trends in beverage consumption for different populations. The aim of the present cross-sectional study was to develop and validate a drink-specific questionnaire for the Greek population.

METHODS

A 41-item semi-quantitative drinks frequency questionnaire (DFQ) was developed and validated against 7-day weighed food records, among young Greek adults. Wilcoxon ranks tests, Kendall tau-b correlations and Bland-Altman plot were used to compare the two methods. Fifty-nine Greek University students (28 males, 31 females) completed both methods.

RESULTS

No difference was observed in total drinks intake between the two methods. The Bland-Altman plot showed that the two methods are likely to agree concerning the total drinks intake. Wilcoxon's rank test showed no significant differences between the two methods, except for the 'whiskey/vodka/gin' intake (P < 0.001). 'Good' agreement (tau-b > 0.61) was observed for most DFQ items, including low-fat and chocolate milk, hot chocolate, Greek/espresso coffee, commercial tea, packaged fruit juices, wine, alcohol-free beer, light cola-type drinks and water (tap/bottled/sparkling). 'Low' agreement (<0.30) was noted for filtered/instant/iced coffee, freshly squeezed orange juice and some alcoholic drinks (beer/whiskey/vodka/gin).

CONCLUSIONS

The DFQ appears to be an overall valid means of estimating the habitual intake of drinks in large-scale epidemiological surveys. The study supports the use of DFQ for assessing drinks consumption patterns and secular trends.

Relative Validity of a Beverage Frequency Questionnaire Used to Assess Fluid Intake in the Autosomal Dominant Polycystic Kidney Disease Population

Maintaining hydration sufficient to reduce levels of arginine vasopressin has been hypothesised to slow kidney cyst growth in autosomal dominant polycystic kidney disease (ADPKD). The semi-quantitative beverage frequency questionnaire (BFQ) was designed to measure usual fluid intake over the past month. The aim of this study was to assess the validity and reliability of the BFQ compared with the 24-h urine biomarkers. Participants with ADPKD (18–67 years; estimated glomerular filtration rate (eGFR) ≥ 30 mL/min1.73 m²) completed the BFQ. Serum creatinine, eGFR, 24-h urine volume, and osmolality were measured. Pearson correlation coefficients, paired t test, and Bland–Altman plots were used to evaluate agreement between the methods. A subset repeated the BFQ to assess reliability. A total of 121 participants (54% male, 43 ± 11 years; mean ± SD) completed the BFQ and at least one 24-h urine collection. The correlation between the BFQ and the 24-h urine volume was moderate (r = 0.580) and weaker with the 24-h urine osmolality (r = −0.276). The Bland–Altman plots revealed good agreement between the BFQ and the 24-h urine volume with no obvious bias; however, the limits of agreement were wide (−1517–1943 mL). The BFQ1 and BFQ2 were strongly correlated (r = 0.799, p < 0.001) and were not significantly different (p = 0.598). The BFQ is a valid and reliable tool to assess the usual fluid intake of the ADPKD population.

Is the default of 2 liters for daily per-capita water consumption appropriate? A nationwide survey reveals water intake in Japan

Two liters per day is generally applied as the default drinking water intake rate for risk assessments, although evidence supporting this value is insufficient. This study aimed to reveal actual water intakes from tap water and other types of drinks, and to explore the relationships between these intakes. For this purpose, we conducted a nationwide Internet questionnaire survey. Tap water intake negatively correlated with bottled water and soft drink intakes, suggesting a mutually complementary relationship. We propose an index, potential Tap Water Intake (pTWI), calculated by adding soft drinks and bottled water to tap water intake. Mean per-capita tap water intake across the entire Japanese population was estimated at 1.28 L/d, whereas mean pTWI was estimated at 1.65 L/d. Two liters per day corresponds to the 88th percentile of tap water intake and to the 76th percentile of pTWI, and covers the intake of the majority of the population in Japan. This rate should continue being used as the default in the Japanese population, but the rate to cover the tap water intake of almost the entire population would be higher: it was >2.5 L/d.

Challenges in the assessment of total fluid intake in children and adolescents: a discussion paper

Purpose

In recent years, evidence has emerged about the importance of healthy fluid intake in children for physical and mental performance and health, and in the prevention of obesity. Accurate data on water intake are needed to inform researchers and policymakers and for setting dietary reference values. However, to date, there are few published data on fluid or water intakes in children. This is due partly to the fact that drinking water is not always reported in dietary surveys. The aim of this paper is to review the current status of the literature and highlight the challenges of assessing total fluid intake in children and adolescents.

Results

From the dietary assessment literature it is apparent that children present unique challenges to assessing intake due to ongoing cognitive capacity development, limited literacy skills, difficulties in estimating portion sizes and multiple caregivers during any 1 day making it difficult to track intakes. As such, many issues should be considered when assessing total fluid intakes in children or adolescents. Various methods to assess fluid intakes exist, each with its own strengths and weaknesses; the ultimate choice of method depends on the research question and resources available. Based on the literature review, it is apparent that if the research focus is to assess only fluid intake, a fluid-specific method, such as a diary or record, appears to be a feasible approach to provide an accurate estimate of intakes.

Fluid intake patterns of children and adolescents: results of six Liq.In7 national cross-sectional surveys

PURPOSE

This study aimed to identify and characterize patterns of fluid intake in children and adolescents from six countries: Argentina, Brazil, China, Indonesia, Mexico and Uruguay.

METHODS

Data on fluid intake volume and type amongst children (4-9 years; N = 1400) and adolescents (10-17 years; N = 1781) were collected using the validated 7-day fluid-specific record (Liq.In7 record). To identify relatively distinct clusters of subjects based on eight fluid types (water, milk and its derivatives, hot beverages, sugar-sweetened beverages (SSB), 100% fruit juices, artificial/non-nutritive sweetened beverages, alcoholic beverages, other beverages), a cluster analysis (partitioning around k-medoids algorithm) was used. Clusters were then characterized according to their socio-demographics and lifestyle indicators.

RESULTS

The six interpretable clusters identified were: low drinkers-SSB (n 523), low drinkers-water and milk (n 615), medium mixed drinkers (n 914), high drinkers-SSB (n 513), high drinkers-water (n 352) and very high drinkers-water (n 264). Country of residence was the dominant characteristic, followed by socioeconomic level, in all six patterns.

CONCLUSIONS

This analysis showed that consumption of water and SSB were the primary drivers of the clusters. In addition to country, socio-demographic and lifestyle factors played a role in determining the characteristics of each cluster. This information highlights the need to target interventions in particular populations aimed at changing fluid intake behavior and improving health in children and adolescents.

Validation Testing Demonstrates Efficacy of a 7-Day Fluid Record to Estimate Daily Water Intake in Adult Men and Women When Compared with Total Body Water Turnover Measurement

Background: Mean daily water intake from fluids (WATER-FL) has proven to be difficult to measure because of a range of nonvalidated data collection techniques. Few questionnaires have been validated to estimate WATER-FL against self-reported diaries or urinary hydration markers, which may limit their objectivity.Objectives: The goals of this investigation were 1) to assess the validity of a 7-d fluid record (7dFLR) to measure WATER-FL (WATER-FL-7dFLR) through comparison with WATER-FL as calculated by measuring deuterium oxide (D₂O) disappearance (WATER-FL-D₂O), and 2) to evaluate the reliability of the 7dFLR in measuring WATER-FL.Methods: Participants [n = 96; 51% female; mean ± SD age: 41 ± 14 y; mean ± SD body mass index (in kg/m²): 26.2 ± 5.1] completed body water turnover analysis over 3 consecutive weeks. They completed the 7dFLR and food diaries during weeks 2 and 4 of the observation. The records were entered into nutritional software to determine the water content of all foods and fluids consumed. WATER-FL-D₂O was calculated from water turnover (via the D₂O dilution method), minus water from food and metabolic water. The agreement between the 2 methods of determining WATER-FL were compared according to a Bland-Altman plot at week 2. The test-retest reliability of 7dFLR between weeks 2 and 4 was assessed via intraclass correlation (ICC).Results: The mean ± SD difference between WATER-FL-7dFLR and WATER-FL-D₂O was -131 ± 845 mL/d. In addition, no bias was observed (F_[1,94] = 0.484; R² = 0.006; P = 0.488). When comparing WATER-FL-7dFLR from weeks 2 and 4, no significant difference (mean ± SD difference: 71 ± 75 mL/d; t_[79] = 0.954; P = 0.343) and an ICC of 0.85 (95% CI: 0.77, 0.90) was observed.Conclusions: The main findings of this study were that the use of the 7dFLR is an effective and reliable method to estimate WATER-FL in adults. This style of questionnaire may be extremely helpful for collecting water intake data for large-scale epidemiologic studies.