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Apostolopoulou A, Tranidou A, Chroni V, Tsakiridis I, Tsekitsidi E, Kalaitzopoulou I, Magriplis E, Bakaloudi D, Chrysoula L, Pazaras N, Dagklis T, Chourdakis M. Preconceptional micronutrient adequacy among women in Greece: a prospective epidemiological study. J Matern Fetal Neonatal Med 2024; 37:2343613. [PMID: 38637273 DOI: 10.1080/14767058.2024.2343613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 02/29/2024] [Indexed: 04/20/2024]
Abstract
INTRODUCTION The importance of micronutrient intake during the preconceptional and early pregnancy period for both maternal and fetal outcomes is well-known, however, relevant data are not available for Greek pregnant women. The aim of the present study is to delineate the nutritional status preceding conception among a representative cohort of Greek pregnant women. METHODS This was a prospective study of pregnant women from routine care, recruited at 11+0-13+6 gestational weeks, between December 2020 and October 2022, at the 3rd Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Greece. Eligible participants for the study included healthy pregnant women aged 20 years or older, possessing a proficient understanding of the Greek language, and not engaged in specific nutritional programs. A validated Food Frequency Questionnaire was applied to gather information regarding nutritional habits in the last 6 months prior to conception. The consumption of nutrients was compared to the reference intake levels suggested by the European Food Safety Authority. Further analyses between different participants' subgroups were performed. RESULTS Overall, 1100 pregnant women (mean age: 32.4 ± 4.9 years) were enrolled. Almost all examined micronutrients' intake was significantly different from dietary reference values. Furthermore, nutrient adequacy ratio was below 60% in 6 out of 22 micronutrients examined, and Mean Adequacy Ratio was 93%. However, Mean Adequacy Ratio is characterized by extreme variance between the examined values. Iodine, folic acid, potassium, and vitamin D intake levels were significantly lower than the recommended intake levels (p < .001 for all), while vitamin K and niacin (p < .001 for both) were consumed in great extent. Sodium median intake, without calculating extra salt addition also exceeded the reference value levels (p = .03). Notably, magnesium intake exceeded the upper safety limits in 12.4% of the sample. CONCLUSION Potential inadequacies in important micronutrients for uneventful pregnancy outcomes have been revealed.. Special attention is needed for magnesium to balance possible toxicity with evident benefits.
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Affiliation(s)
- Aikaterini Apostolopoulou
- Laboratory of Hygiene, Social and Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Antigoni Tranidou
- Laboratory of Hygiene, Social and Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Violeta Chroni
- Laboratory of Hygiene, Social and Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Tsakiridis
- 3rd Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eirini Tsekitsidi
- Laboratory of Hygiene, Social and Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioustini Kalaitzopoulou
- Laboratory of Hygiene, Social and Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Emmanuella Magriplis
- Department of Food Science and Human Nutrition, Agricultural University of Athens, Athens, Greece
| | - Dimitra Bakaloudi
- Laboratory of Hygiene, Social and Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Lydia Chrysoula
- Laboratory of Hygiene, Social and Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikolaos Pazaras
- Laboratory of Hygiene, Social and Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Themistoklis Dagklis
- 3rd Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Michail Chourdakis
- Laboratory of Hygiene, Social and Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Assaad M, Ajjour S, Rahme M, Al-Shaar L, Sakr M, Ghattas H, El-Hajj Fuleihan G, Jabbour J. Development and validity of the 'Modified Mediterranean Prime Screen' to assess dietary intake among women of reproductive age in Lebanon. Br J Nutr 2024:1-9. [PMID: 38818715 DOI: 10.1017/s0007114524000977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
The Mediterranean Region registers an increasing prevalence of obesity. The region lacks a diet screener to assess obesogenic nutrients. This study aimed to evaluate the reproducibility and validity of the Modified Mediterranean Prime Screen (MMPS) in estimating obesogenic nutrients' intake among women of reproductive age, as compared with a culturally validated Food Frequency Questionnaire (FFQ), in Lebanon. We developed the MMPS consisting of thirty-two food/beverage items specific to the Lebanese Mediterranean culture. The MMPS and FFQ were administered in two visits (2 weeks-6 months apart), face to face and via telephone during the coronavirus disease 2019 pandemic. The reproducibility and validity of the MMPS were assessed using intraclass correlation coefficients (ICC) and Pearson's correlations, respectively. The study included 143 women, aged 31·5 (sd 4·6) years, BMI 24·2 (sd 4·0) kg/m2, 87 % with university education and 91 % food secure. The reproducibility of the MMPS was moderate for energy and all assessed nutrients except for SFA (ICC = 0·428). The agreement of the MMPS with the reference FFQ was adequate for energy and obesogenic nutrients. Yet, the Pearson correlations for energy-adjusted nutrient intake were low for trans-fatty acids (0·294) and PUFA (0·377). The MMPS can be a time-efficient tool for dietary assessment of energy and many obesogenic nutrients. Future studies should validate the MMPS across the lifespan and re-evaluate it after updating the fatty acid profiles in the culturally specific food composition tables.
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Affiliation(s)
- Mariam Assaad
- Calcium Metabolism and Osteoporosis Program, World Health Organization Collaborating Center for Metabolic Bone Disorders, American University of Beirut, Beirut, 1107 2020, Lebanon
| | - Sara Ajjour
- Calcium Metabolism and Osteoporosis Program, World Health Organization Collaborating Center for Metabolic Bone Disorders, American University of Beirut, Beirut, 1107 2020, Lebanon
| | - Maya Rahme
- Calcium Metabolism and Osteoporosis Program, World Health Organization Collaborating Center for Metabolic Bone Disorders, American University of Beirut, Beirut, 1107 2020, Lebanon
| | - Laila Al-Shaar
- Department of Public Health Sciences, Penn State University, University Park, USA
| | - May Sakr
- Department of Clinical Nutrition, American University of Beirut Medical Center, Beirut, 1107 2020, Lebanon
| | - Hala Ghattas
- Health Promotion, Education, and Behavior Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Ghada El-Hajj Fuleihan
- Calcium Metabolism and Osteoporosis Program, World Health Organization Collaborating Center for Metabolic Bone Disorders, American University of Beirut, Beirut, 1107 2020, Lebanon
| | - Jana Jabbour
- Nutrition Program, Department of Natural Sciences, Lebanese American University, Beirut, Lebanon
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Tranidou A, Magriplis E, Apostolopoulou A, Tsakiridis I, Chroni V, Tsekitsidi E, Kalaitzopoulou I, Pazaras N, Chourdakis M, Dagklis T. Impact of Maternal Micronutrient Intake on Gestational Diabetes Risk: Results from Greece's BORN2020 Prospective Cohort Study. Nutrients 2024; 16:1375. [PMID: 38732620 PMCID: PMC11085310 DOI: 10.3390/nu16091375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Revised: 04/28/2024] [Accepted: 04/29/2024] [Indexed: 05/13/2024] Open
Abstract
Understanding how maternal micronutrient intake and dietary habits impact gestational diabetes mellitus (GDM) is crucial. Data from 797 pregnant women were prospectively analyzed to assess GDM status with the oral glucose tolerance test (OGTT). Nutritional intake was evaluated using a validated food frequency questionnaire (FFQ) across two periods: Period A, covering 6 months before pregnancy, and Period B, from pregnancy onset to mid-gestation (24 weeks). Micronutrient intakes were compared against the European Food Safety Authority (EFSA) dietary reference values (DRVs) and were used to estimate the mean adequacy ratio (MAR) to assess dietary adequacy. GDM was diagnosed in 14.7% (n = 117) of women with the characteristics of a higher mean maternal age (MA) and pre-pregnancy body mass index (BMI). Out of the 13 vitamins assessed, biotin, folate, niacin, and pantothenic acid were found significantly higher in the GDM group, as did iron, magnesium, manganese, phosphorus, and zinc from the 10 minerals. The results were influenced by the timing of the assessment. Importantly, MAR was higher during pregnancy and was found to increase the risk of GDM by 1% (95%CI: 1, 1.02). A sensitivity analysis revealed that reducing MAR significantly raised the GDM risk by 68% (95%CI: 1.02, 2.79). No association was revealed between adherence to the Mediterranean diet (MD) and GDM risk. These findings highlight areas for further investigation into whether dietary modifications involving these specific micronutrients could effectively influence GDM outcomes.
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Affiliation(s)
- Antigoni Tranidou
- 3rd Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece; (A.T.); (I.T.)
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece; (A.A.); (V.C.); (E.T.); (I.K.); (N.P.)
| | - Emmanuella Magriplis
- Department of Food Science and Human Nutrition, Agricultural University of Athens, Iera Odos 75, 118 55 Athens, Greece;
| | - Aikaterini Apostolopoulou
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece; (A.A.); (V.C.); (E.T.); (I.K.); (N.P.)
| | - Ioannis Tsakiridis
- 3rd Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece; (A.T.); (I.T.)
| | - Violeta Chroni
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece; (A.A.); (V.C.); (E.T.); (I.K.); (N.P.)
| | - Eirini Tsekitsidi
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece; (A.A.); (V.C.); (E.T.); (I.K.); (N.P.)
| | - Ioustini Kalaitzopoulou
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece; (A.A.); (V.C.); (E.T.); (I.K.); (N.P.)
| | - Nikolaos Pazaras
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece; (A.A.); (V.C.); (E.T.); (I.K.); (N.P.)
| | - Michail Chourdakis
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece; (A.A.); (V.C.); (E.T.); (I.K.); (N.P.)
| | - Themistoklis Dagklis
- 3rd Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece; (A.T.); (I.T.)
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Khammarnia M, Ansari-Moghaddam A, Kakhki FG, Clark CCT, Barahouei FB. Maternal macronutrient and energy intake during pregnancy: a systematic review and meta-analysis. BMC Public Health 2024; 24:478. [PMID: 38360655 PMCID: PMC10870573 DOI: 10.1186/s12889-024-17862-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 01/23/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Nutritional status during pregnancy can have a significant impact on infant and maternal health outcomes. To maintain maternal homeostasis and support fetal growth, adequate macronutrient and energy intake during pregnancy is essential. Therefore, this study sought to systematically review and meta-analyze macronutrient and energy intakes during pregnancy. METHODS A systematic review and meta-analysis was carried out based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The required data were collected from four databases including: Web of Sciences, ProQuest, Scopus, and PubMed, from 1 January 1980 to 30 May 2023, by using a combination of search terms (dietary pattern" OR "diet quality" OR "food habits" OR "nutrition surveys" OR "diet surveys" OR "food-frequency questionnaire" OR "diet record" OR "dietary recall") AND ( "pregnancy" OR "reproduction" OR "maternal health" OR "neonatal outcomes") among interventional and observational studies. Excel and STATA version 11 were used for data analysis. RESULTS Among 7081 published articles, 54 studies were included in the review. Most of the 33 (61%) studies were cohort studies and a total of 135,566 pregnant women were included. The overall average of energy, carbohydrate, fat, and protein intake was 2036.10 kcal/day, 262.17 gr/day, 74.17 gr/day, and 78.21 gr/day, respectively. Also, energy intake during pregnancy was higher in American (2228.31 kcal/day, CI95%: 2135.06-2325.63) and Eastern Mediterranean regions (2226.70 kcal/day, CI95%: 2077.23-2386.92) than other regions (P < 0.001). Energy intake was higher in the third trimester than others (2115.64 kcal/day, CI95%: 1974.15-2267.27). Furthermore, based on the findings, there was a significant difference between energy intake in different World Health Organization (WHO) regions (P < 0.05). CONCLUSIONS According to the results of meta-analysis, the average total energy was below than average total energy required during pregnancy. More efforts are needed to encourage women to adopt healthy eating habits during pregnancy to support healthy fetal and infant development.
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Affiliation(s)
- Mohammad Khammarnia
- Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
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Apostolopoulou A, Tranidou A, Chroni V, Tsakiridis I, Magriplis E, Dagklis T, Chourdakis M. Association of Maternal Diet with Infant Birthweight in Women with Gestational Diabetes Mellitus. Nutrients 2023; 15:4545. [PMID: 37960200 PMCID: PMC10648020 DOI: 10.3390/nu15214545] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 10/21/2023] [Accepted: 10/23/2023] [Indexed: 11/15/2023] Open
Abstract
OBJECTIVE This study aimed to explore the potential impact of pre-pregnancy and early pregnancy maternal nutrition on the incidence of small-for-gestational-age neonates (SGA) in women with gestational diabetes mellitus (GDM). METHODS A prospective cohort study was conducted between 2020 and 2022 at the 3rd Department of Obstetrics and Gynaecology (School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece). Pregnant women from routine care were surveyed about their dietary habits during two distinct periods: six months prior to pregnancy (period A) and from the onset of pregnancy until the oral glucose tolerance test at 24-28 gestational weeks (period B). The intake of various micronutrients and macronutrients was quantified from the questionnaire responses. Logistic regression models, adjusted for potential confounders including age, pre-pregnancy body mass index (BMI), smoking status, physical activity and parity, were used to evaluate the association between nutrient intake and small-for-gestational-age neonate incidence. RESULTS In total, 850 women were screened and of these, 90 (11%) were diagnosed with gestational diabetes mellitus and were included in the study. There were significant associations between the intake of specific nutrients and the occurrence of small-for-gestational-age neonates; higher fat intake compared to non-small for gestationa age during period B (aOR: 1.1, p = 0.005) was associated with an increased risk for small-for-gestational-age neonates, while lower intake of carbohydrates (g) (aOR: 0.95, p = 0.005), fiber intake (aOR: 0.79, p = 0.045), magnesium (aOR: 0.96, p = 0.019), and copper (aOR:0.01, p = 0.018) intake during period B were significantly associated with a decreased risk for small-for-gestational-age neonates. CONCLUSIONS The findings of this study highlight the potential role of maternal nutrition in modulating the risk of small for gestational age neonatesamong women with gestational diabetes mellitus. The results advocate for further research on the assessment and modification of both pre-pregnancy and early pregnancy nutrition for women, especially those at higher risk of gestational diabetes mellitus, to reduce the risk of gestational diabetes mellitus.
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Affiliation(s)
- Aikaterini Apostolopoulou
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece; (A.A.); (A.T.); (V.C.); (M.C.)
| | - Antigoni Tranidou
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece; (A.A.); (A.T.); (V.C.); (M.C.)
| | - Violeta Chroni
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece; (A.A.); (A.T.); (V.C.); (M.C.)
| | - Ioannis Tsakiridis
- 3rd Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece;
| | - Emmanuella Magriplis
- Department of Food Science and Human Nutrition, Agricultural University of Athens, Iera odos 75, 118 55 Athens, Greece;
| | - Themistoklis Dagklis
- 3rd Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece;
| | - Michail Chourdakis
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece; (A.A.); (A.T.); (V.C.); (M.C.)
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Kyrkou C, Fotakis C, Dimitropoulou A, Tsakoumaki F, Zoumpoulakis P, Menexes G, Biliaderis CG, Athanasiadis AP, Michaelidou AM. Maternal Dietary Protein Patterns and Neonatal Anthropometrics: A Prospective Study with Insights from NMR Metabolomics in Amniotic Fluid. Metabolites 2023; 13:977. [PMID: 37755257 PMCID: PMC10535439 DOI: 10.3390/metabo13090977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 08/17/2023] [Accepted: 08/21/2023] [Indexed: 09/28/2023] Open
Abstract
This study aimed to characterize dietary protein patterns (DPPs) in a sample pool of 298 well-nourished pregnant women and explore potential associations between DPPs and neonatal anthropometrics. Maternal dietary data were collected using a validated food frequency questionnaire. Neonatal anthropometrics were abstracted from health booklets. A hierarchical cluster analysis identified three DPPs: "Dairy-focused", "Med-fusion", and "Traditional-inspired". The "Dairy-focused" DPP exhibited the highest protein intake (p < 0.001), predominantly animal protein (p < 0.001), while the "Traditional-inspired" DPP presented higher plant protein (p < 0.001) and fiber intakes (p < 0.001), and, therefore, a reduced carbohydrate-to-fiber quotient (p < 0.001). The "Med-fusion" DPP had the lowest protein-to-fat ratio (p < 0.001). Infants of women following the "Dairy-focused" DPP had the highest birth height centiles (p = 0.007) and the lowest ponderal index (p = 0.003). The NMR-metabolomics approach was implemented on a subset of women that provided amniotic fluid (AF) specimens (n = 62) to elucidate distinct metabolic signatures associated with DPPs. PCA and OPLS-DA models verified the adherence to three DPPs, revealing that the levels of several amino acids (AAs) were the highest in "Dairy-focused", reflecting its protein-rich nature. The "Traditional-inspired" DPP showed decreased AAs and glucose levels. This knowledge may contribute to optimizing maternal dietary recommendations. Further research is needed to validate these findings and better understand the relationships between maternal diet, AF metabolic signature, and neonatal anthropometrics.
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Affiliation(s)
- Charikleia Kyrkou
- Department of Food Science and Technology, School of Agriculture, Faculty of Agriculture, Forestry and Natural Environment, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece; (C.K.); (A.D.); (F.T.); (C.G.B.)
| | - Charalambos Fotakis
- Institute of Chemical Biology, National Hellenic Research Foundation, 116 35 Athens, Greece; (C.F.); (P.Z.)
| | - Aristea Dimitropoulou
- Department of Food Science and Technology, School of Agriculture, Faculty of Agriculture, Forestry and Natural Environment, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece; (C.K.); (A.D.); (F.T.); (C.G.B.)
| | - Foteini Tsakoumaki
- Department of Food Science and Technology, School of Agriculture, Faculty of Agriculture, Forestry and Natural Environment, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece; (C.K.); (A.D.); (F.T.); (C.G.B.)
| | - Panagiotis Zoumpoulakis
- Institute of Chemical Biology, National Hellenic Research Foundation, 116 35 Athens, Greece; (C.F.); (P.Z.)
- Department of Food Science and Technology, University of West Attica, Ag. Spyridonos, 122 43 Egaleo, Greece
| | - Georgios Menexes
- Department of Field Crops and Ecology, School of Agriculture, Faculty of Agriculture, Forestry and Natural Environment, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece;
| | - Costas G. Biliaderis
- Department of Food Science and Technology, School of Agriculture, Faculty of Agriculture, Forestry and Natural Environment, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece; (C.K.); (A.D.); (F.T.); (C.G.B.)
| | - Apostolos P. Athanasiadis
- 3rd Department of Obstetrics and Gynecology, School of Medicine, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece;
| | - Alexandra-Maria Michaelidou
- Department of Food Science and Technology, School of Agriculture, Faculty of Agriculture, Forestry and Natural Environment, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece; (C.K.); (A.D.); (F.T.); (C.G.B.)
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Tranidou A, Dagklis T, Magriplis E, Apostolopoulou A, Tsakiridis I, Chroni V, Tsekitsidi E, Kalaitzopoulou I, Pazaras N, Chourdakis M. Pre-Pregnancy Adherence to Mediterranean Diet and Risk of Gestational Diabetes Mellitus: A Prospective Cohort Study in Greece. Nutrients 2023; 15:nu15040848. [PMID: 36839206 PMCID: PMC9967881 DOI: 10.3390/nu15040848] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 01/30/2023] [Accepted: 02/03/2023] [Indexed: 02/10/2023] Open
Abstract
Gestational Diabetes Mellitus (GDM) is a growing epidemic affecting pregnant women and their offspring. This study aimed to identify the relationship between adherence to a Mediterranean diet (MD) before conception and the risk of GDM in a contemporary Greek pregnant cohort. A prospective cohort of pregnant women was recruited at the routine first trimester visit. Nutritional intake was evaluated using a population specific validated food frequency questionnaire (FFQ). Pre-pregnancy adherence to MD was derived using two different scoring systems, the Mediterranean diet index score (MDS), and a modified version. Adjusted odds ratios (aOR) were computed using multiple logistic regression models for each score derived. Of 743 participating women, 112 (15.1%) developed GDM. The MDS index showed that scoring 5-9 points (high adherence) was associated with a lower GDM incidence (aOR: 0.57 95% CI (0.32, 0.90), p = 0.02), while the modified MDS index showed no significant association for any level of adherence. Pre-pregnancy consumption of "meat and derivatives" and "fatty meat and processed meat" was associated with a higher risk of GDM, with both scoring systems (p = 0.008, p = 0.004, respectively). A higher adherence to a MD pre-pregnancy, especially with less meat consumption, may have a protective effect on the occurrence of GDM.
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Affiliation(s)
- Antigoni Tranidou
- 3rd Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece
| | - Themistoklis Dagklis
- 3rd Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece
- Correspondence:
| | - Emmanuella Magriplis
- Department of Food Science and Human Nutrition, Agricultural University of Athens, 11855 Athens, Greece
| | - Aikaterini Apostolopoulou
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Ioannis Tsakiridis
- 3rd Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece
| | - Violeta Chroni
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Eirini Tsekitsidi
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Ioustini Kalaitzopoulou
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Nikolaos Pazaras
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Michail Chourdakis
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
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Philippou E, Demetriou CA, Loucaides G, Solomonidou N, Critselis E, Polykarpou M, Sioulis S, Hadjisavvas A, Kyriacou K. Relative validity and reproducibility of the CyFFQ semiquantitative food frequency questionnaire for assessing dietary intake in Cypriot adults. J Hum Nutr Diet 2023; 36:139-153. [PMID: 35567380 PMCID: PMC10084044 DOI: 10.1111/jhn.13032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 05/09/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND Assessment of dietary intake is fundamental for evaluating the interrelationships between diet and disease. The present study aimed to develop and validate the semiquantitative Cypriot food frequency questionnaire (CyFFQ). METHODS A 171-item paper-and-pencil semiquantitative interview-administered FFQ was developed, including local foods and culturally specific meals commonly consumed among Cypriot adults. FFQ reproducibility was assessed by comparing the energy-adjusted daily macro- and micronutrients intake at baseline (FFQ1) and 1 year later (FFQ2) using a Wilcoxon matched pairs signed rank test and intraclass correlation coefficients (ICCs) in a random sample of Cypriot adults. FFQ relative validity was evaluated by comparing the intake as estimated by FFQ2 with that obtained from the average of three 24-h recalls taken over the year between FFQ1 and FFQ2. Associations between nutrient intakes estimated using FFQ2 and the 24-h recalls were assessed using Spearman rank correlation and Bland-Altman plots were used to assess agreement between the FFQ and the 24-h recalls. RESULTS Among eligible participants, 68 (78%) completed the study (44.1% males, aged 30.5-47.5 years). The energy-adjusted intakes of macro- and micronutrients did not significantly differ between the two FFQs, excluding magnesium. The FFQ2 and the averaged 24-h recalls were significantly correlated for most macro- and micronutrients. The median (interquartile) ICC for all macro- and micronutrients was 0.46 (0.38-0.52) (p < 0.05). Agreement was satisfactory (>30%) for most micro- and macronutrients. Bland-Altman plots also confirmed good agreement between the two methods. CONCLUSIONS The CyFFQ is a valid and reliable tool for assessing dietary consumption in Cypriot adults.
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Affiliation(s)
- Elena Philippou
- Department of Life and Health Sciences, University of Nicosia, Nicosia, Cyprus.,Department of Nutritional Sciences, King's College London, London, UK
| | - Christiana A Demetriou
- Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus
| | - George Loucaides
- Department of Life and Health Sciences, University of Nicosia, Nicosia, Cyprus
| | | | - Elena Critselis
- Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus
| | - Maria Polykarpou
- Department of Life and Health Sciences, University of Nicosia, Nicosia, Cyprus
| | - Spyros Sioulis
- Department of Life and Health Sciences, University of Nicosia, Nicosia, Cyprus
| | - Andreas Hadjisavvas
- The Cyprus School of Molecular Medicine, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
| | - Kyriacos Kyriacou
- The Cyprus School of Molecular Medicine, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
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9
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Bezerra AR, Tenório MCDS, Souza BGD, Wanderley TM, Bueno NB, Oliveira ACMD. Food frequency questionnaires developed and validated for pregnant women: Systematic review. Nutrition 2023; 110:111979. [PMID: 36965239 DOI: 10.1016/j.nut.2023.111979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 01/05/2023] [Accepted: 01/19/2023] [Indexed: 01/27/2023]
Abstract
OBJECTIVES Assessing food intake by pregnant women is extremely important, because maternal dietary patterns can influence fetal development as well as have either a positive or negative effects on both the mother and fetus. Thus, the aim of the present study was to carry out a systematic review of the literature on food frequency questionnaires developed and validated for pregnant women, in order to assess their methodological quality and validation process. METHODS A systematic review of studies focused on validating food frequency questionnaires for pregnant women was carried out in the PubMed, Embase, Scopus, LILACS, and OpenGrey databases. The selected studies were assessed based on their correlation coefficient in validation and reproducibility analyses, whereas their methodological quality was assessed based on the scoring system proposed by the EURopean micronutrient RECommendations Aligned Network of Excellence. RESULTS In total, 10 965 articles were identified in these databases; among them, 14 studies, with sample sizes ranging from 46 to 221 participants, and with participants (pregnant women) at a mean age of 28.68 ± 4.34 y, were selected. Most of the included studies used the 24-h food recall as the method for developing the food list (n = 6), with composition ranging from 46 to 255 items. With respect to the methodological assessment of the selected articles, half of the assessed tools were classified as having excellent methodological quality; their validation and reproducibility correlation coefficients were classified as moderate and high (r ≥ 0.40). CONCLUSIONS Food frequency questionnaires developed for pregnant women appear to be reliable tools to assess food intake by this group. Overall, they had good methodological quality and adequate correlation coefficients compared with reference methods.
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Cieśla E, Suliga E, Kadučáková H, Michel S, Ižová M, Simočková V, Martin T, Braun A, Kozieł D, Głuszek S. Reproducibility of the German and Slovakian Versions of the Dietary Habits and Nutrition Beliefs Questionnaire (KomPAN). Nutrients 2022; 14:nu14224893. [PMID: 36432579 PMCID: PMC9696161 DOI: 10.3390/nu14224893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/11/2022] [Accepted: 11/16/2022] [Indexed: 11/22/2022] Open
Abstract
PURPOSE The aim of this study was to assess the reproducibility and reliability of the KomPAN questionnaire among two groups of university students from Germany and Slovakia. METHODS A total of 422 individuals (mean age 21.4 years, SD 4.0), including 197 from Slovakia (men 26.2%) and 225 from Germany (men 22.3%), were tested using the self-administered (SA-Q) version of the KomPAN questionnaire and then retested two weeks later. A cross-classification analysis, kappa coefficients, Cronbach's ɑ coefficients, and a test-retest result comparison were conducted separately for each group of students to assess the reproducibility and reliability of the questionnaire. RESULTS The cross-classification values were higher than 46.2% among the German students and higher than 55.8% among the Slovakian students. The kappa coefficients ranged from 0.21 to 0.90 in the German students and from 0.38 to 0.94 in the Slovakian students. Cronbach's ɑ ranged from 0.58 to 0.78. CONCLUSION The questionnaire displayed a moderate to very good reproducibility, which was slightly higher in the Slovakian group than in the German group. Therefore, the questionnaire can be recommended for further analysis and comparison of the dietary habits among Germans and Slovakians on a larger scale.
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Affiliation(s)
- Elżbieta Cieśla
- Institute of Health Sciences, Medical College, Jan Kochanowski University, 25-369 Kielce, Poland
- Correspondence:
| | - Edyta Suliga
- Institute of Health Sciences, Medical College, Jan Kochanowski University, 25-369 Kielce, Poland
| | - Helena Kadučáková
- Department of Nursing, Faculty of Health, Catholic University in Ružomberok, 03401 Ružomberok, Slovakia
| | - Sven Michel
- Institute for Health, Faculty of Social Work, Health and Music, Brandenburg University of Technology Cottbus-Senftenberg, 03048 Cottbus, Germany
| | - Marcela Ižová
- Institute for Health, Faculty of Social Work, Health and Music, Brandenburg University of Technology Cottbus-Senftenberg, 03048 Cottbus, Germany
| | - Viera Simočková
- Department of Nursing, Faculty of Health, Catholic University in Ružomberok, 03401 Ružomberok, Slovakia
| | - Titus Martin
- Institute for Health, Faculty of Social Work, Health and Music, Brandenburg University of Technology Cottbus-Senftenberg, 03048 Cottbus, Germany
| | - Alexander Braun
- Institute for Health, Faculty of Social Work, Health and Music, Brandenburg University of Technology Cottbus-Senftenberg, 03048 Cottbus, Germany
| | - Dorota Kozieł
- Institute of Medical Sciences, Medical College, Jan Kochanowski University, 25-369 Kielce, Poland
| | - Stanisław Głuszek
- Institute of Medical Sciences, Medical College, Jan Kochanowski University, 25-369 Kielce, Poland
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11
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Chen TL, Cheng SF, Gau ML, Lin LL. Processed Dietary Patterns during Pregnancy Are Associated with Low Birth Weight at Term among Women of Advanced and Non-Advanced Age. Nutrients 2022; 14:nu14163429. [PMID: 36014935 PMCID: PMC9416086 DOI: 10.3390/nu14163429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/13/2022] [Accepted: 08/18/2022] [Indexed: 11/16/2022] Open
Abstract
Inappropriate dietary intake during pregnancy is a key factor in low birth weight (LBW). This study compares LBW between healthy and processed dietary patterns by focusing on women of advanced maternal age. A cross-sectional survey was conducted with 327 postpartum women in Taiwan. The participants were assigned to two groups according to their age (≥35 years, n = 151; and 20−34 years, n = 176). An online questionnaire asked women how often they consumed 27 food items during their pregnancy. The prevalence of LBW was higher in the processed dietary pattern (79.3%) than in the healthy pattern (13.78%, p < 0.001). LBW was positively correlated with advanced maternal age (≥35 ages), low pre-pregnancy weight (BMI less than 18.5 kg/m2), insufficient gestational weight gain (GWG), and processed dietary patterns. Older mothers were 5.8 times more likely to have infants with LBW (odds ratio = 5.8; 95% confidence interval 2.0−16.6). A processed dietary pattern was 9.4 times more likely to result in LBW. Insufficient GWG was significantly positively associated with LBW (OR = 4.0; 95%CI 1.4−11.6). Maternal diet during pregnancy is an important modifiable factor for LBW. Prenatal advice should emphasize optimal nutrition, especially in older and underweight women.
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Affiliation(s)
- Tzu-Ling Chen
- Department of Nurse-Midwifery and Women Health, National Taipei University of Nursing and Health Sciences, Taipei 11221, Taiwan
| | - Su-Fen Cheng
- Department of Allied Health Education and Digital Learning, National Taipei University of Nursing and Health Sciences, Taipei 11221, Taiwan
| | - Meei-Ling Gau
- Department of Nurse-Midwifery and Women Health, National Taipei University of Nursing and Health Sciences, Taipei 11221, Taiwan
- Correspondence: ; Tel.: +886-2-28227101 (ext. 3260)
| | - Li-Li Lin
- Obstetrics and Gynecology ward, MacKay Memorial Hospital, New Taipei City 251031, Taiwan
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Framework of Methodology to Assess the Link between A Posteriori Dietary Patterns and Nutritional Adequacy: Application to Pregnancy. Metabolites 2022; 12:metabo12050395. [PMID: 35629899 PMCID: PMC9148035 DOI: 10.3390/metabo12050395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 04/21/2022] [Accepted: 04/26/2022] [Indexed: 02/07/2023] Open
Abstract
This study aimed to explore the nutritional profile of 608 women during the second trimester of pregnancy, in terms of nutrient patterns, dietary quality and nutritional adequacy. Dietary data were collected using a validated Mediterranean-oriented, culture-specific FFQ. Principal component analysis was performed on 18 energy-adjusted nutrients. Two main nutrient patterns, “plant-origin” (PLO) and “animal-origin” (ANO), were extracted. Six homogenous clusters (C) relative to nutrient patterns were obtained and analyzed through a multidimensional methodological approach. C1, C5 and C6 scored positively on PLO, while C1, C2 and C3 scored positively on ANO. When dietary quality was mapped on food choices and dietary indexes, C6 unveiled a group with a distinct image resembling the Mediterranean-type diet (MedDiet Score = 33.8). Although C1–C5 shared common dietary characteristics, their diet quality differed as reflected in the HEI-2010 (C1:79.7; C2:73.3; C3:70.9; C4:63.2; C5:76.6). The appraisal of nutritional adequacy mirrored a “nutritional-quality gradient”. A total of 50% of participants in C6 had almost 100% adequate magnesium intake, while 50% of participants in C4 had a probability of adequacy of ≤10%. Our methodological framework is efficient for assessing the link between a posteriori dietary patterns and nutritional adequacy during pregnancy. Given that macro- and micronutrient distributions may induce metabolic modifications of potential relevance to offspring’s health, public health strategies should be implemented.
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Cecati M, Vignini A, Borroni F, Pugnaloni S, Alia S, Sabbatinelli J, Nicolai G, Taus M, Santarelli A, Fabri M, Mazzanti L, Emanuelli M. TAS1R3 and TAS2R38 Polymorphisms Affect Sweet Taste Perception: An Observational Study on Healthy and Obese Subjects. Nutrients 2022; 14:nu14091711. [PMID: 35565677 PMCID: PMC9101038 DOI: 10.3390/nu14091711] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 04/16/2022] [Accepted: 04/18/2022] [Indexed: 11/16/2022] Open
Abstract
Background: The inter-individual differences in taste perception find a possible rationale in genetic variations. We verified whether the presence of four different single nucleotide polymorphisms (SNPs) in genes encoding for bitter (TAS2R38; 145G > C; 785T > C) and sweet (TAS1R3; −1572C > T; −1266C > T) taste receptors influenced the recognition of the basic tastes. Furthermore, we tested if the allelic distribution of such SNPs varied according to BMI and whether the associations between SNPs and taste recognition were influenced by the presence of overweight/obesity. Methods: DNA of 85 overweight/obese patients and 57 normal weight volunteers was used to investigate the SNPs. For the taste test, filter paper strips were applied. Each of the basic tastes (sweet, sour, salty, bitter) plus pure rapeseed oil, and water were tested. Results: Individuals carrying the AV/AV diplotype of the TAS2R38 gene (A49P G/G and V262 T/T) were less sensitive to sweet taste recognition. These alterations remained significant after adjustment for gender and BMI. Moreover, a significant decrease in overall taste recognition associated with BMI and age was found. There was no significant difference in allelic distribution for the investigated polymorphisms between normal and overweight/obese patients. Conclusions: Our findings suggest that overall taste recognition depends on age and BMI. In the total population, the inter-individual ability to identify the sweet taste at different concentrations was related to the presence of at least one genetic variant for the bitter receptor gene but not to the BMI.
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Affiliation(s)
- Monia Cecati
- Department of Clinical Sciences, Università Politecnica delle Marche, 60126 Ancona, Italy; (M.C.); (S.P.); (S.A.); (J.S.); (A.S.); (L.M.); (M.E.)
| | - Arianna Vignini
- Department of Clinical Sciences, Università Politecnica delle Marche, 60126 Ancona, Italy; (M.C.); (S.P.); (S.A.); (J.S.); (A.S.); (L.M.); (M.E.)
- Research Center of Health Education and Health Promotion, Università Politecnica delle Marche, 60126 Ancona, Italy
- Correspondence: ; Tel.: +39-071-2206058
| | - Francesca Borroni
- Department of Clinical Sciences, School of Specialization in Clinical Nutrition, Università Politecnica delle Marche, 60126 Ancona, Italy;
| | - Sofia Pugnaloni
- Department of Clinical Sciences, Università Politecnica delle Marche, 60126 Ancona, Italy; (M.C.); (S.P.); (S.A.); (J.S.); (A.S.); (L.M.); (M.E.)
| | - Sonila Alia
- Department of Clinical Sciences, Università Politecnica delle Marche, 60126 Ancona, Italy; (M.C.); (S.P.); (S.A.); (J.S.); (A.S.); (L.M.); (M.E.)
| | - Jacopo Sabbatinelli
- Department of Clinical Sciences, Università Politecnica delle Marche, 60126 Ancona, Italy; (M.C.); (S.P.); (S.A.); (J.S.); (A.S.); (L.M.); (M.E.)
| | - Giulia Nicolai
- Dietology and Clinical Nutrition, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona, 60126 Ancona, Italy; (G.N.); (M.T.)
| | - Marina Taus
- Dietology and Clinical Nutrition, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona, 60126 Ancona, Italy; (G.N.); (M.T.)
| | - Andrea Santarelli
- Department of Clinical Sciences, Università Politecnica delle Marche, 60126 Ancona, Italy; (M.C.); (S.P.); (S.A.); (J.S.); (A.S.); (L.M.); (M.E.)
| | - Mara Fabri
- Department of Life and Environmental Sciences, Università Politecnica delle Marche, 60131 Ancona, Italy;
| | - Laura Mazzanti
- Department of Clinical Sciences, Università Politecnica delle Marche, 60126 Ancona, Italy; (M.C.); (S.P.); (S.A.); (J.S.); (A.S.); (L.M.); (M.E.)
- Fondazione Salesi, Ospedale G. Salesi, 60123 Ancona, Italy
| | - Monica Emanuelli
- Department of Clinical Sciences, Università Politecnica delle Marche, 60126 Ancona, Italy; (M.C.); (S.P.); (S.A.); (J.S.); (A.S.); (L.M.); (M.E.)
- New York-Marche Structural Biology Center (NY-MaSBiC), Università Politecnica delle Marche, 60131 Ancona, Italy
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14
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Vassilopoulou E, Feketea G, Konstantinou GN, Zekakos Xypolias D, Valianatou M, Petrodimopoulou M, Vourga V, Tasios I, Papadopoulos NG. Food Protein-Induced Allergic Proctocolitis: The Effect of Maternal Diet During Pregnancy and Breastfeeding in a Mediterranean Population. Front Nutr 2022; 9:843437. [PMID: 35433785 PMCID: PMC9005850 DOI: 10.3389/fnut.2022.843437] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Accepted: 02/11/2022] [Indexed: 12/21/2022] Open
Abstract
Background The aim of the current investigation was to explore the association of food protein-induced allergic proctocolitis (FPIAP) with the maternal diet during pregnancy and breastfeeding in Greek infants. Methods A multicenter retrospective case-control study was conducted in 6 regions in Greece, with 96 mothers of infants with and 141 mothers of infants without a history of FPIAP. Maternal dietary habits during pregnancy and breastfeeding were evaluated with the following validated questionnaires: (a) The Mediterranean Diet Score and (b) The Mediterranean Oriented Culture-Specific Semi-Quantitative Food Frequency Questionnaire. Results FPIAP was associated with cow's milk (83.6%), egg (7.3%), wheat (6.4%), and beef (6.4%) in the maternal diet. Adherence to Mediterranean Diet was similar among the mothers. Mothers of FPIAP infants consumed more vegetables. Elastic net prediction models showed that, in this Mediterranean population, increased consumption during pregnancy and lactation of common allergens, whole grain products, homemade food, fish and shellfish, and fruits was associated with a decreased risk of FPIAP. Conversely, a high intake of vegetables, sugar and total fat, and non-stick/grilled cooking, were associated with increased risk of FPIAP, as was a high intake of salt and white flour during lactation only. Conclusions Components of a maternal Mediterranean Diet may protect against FPIAP when traditional cooking methods are adopted and fish, fruit, and whole wheat products are consumed frequently during pregnancy and breastfeeding.
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Affiliation(s)
- Emilia Vassilopoulou
- Department of Nutritional Sciences and Dietetics, International Hellenic University, Thessaloniki, Greece
| | - Gavriela Feketea
- PhD School, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
- Department of Pediatrics, Pediatric Allergy Outpatient Clinic, Hospital Unit of Amaliada, General Hospital of Ilia, Amaliada, Greece
- *Correspondence: Gavriela Feketea
| | - George N. Konstantinou
- Department of Allergy and Clinical Immunology, 424 General Military Training Hospital, Thessaloniki, Greece
| | - Dimitris Zekakos Xypolias
- Department of Nutritional Sciences and Dietetics, International Hellenic University, Thessaloniki, Greece
| | - Mina Valianatou
- Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Petrodimopoulou
- Department of Nutritional Sciences and Dietetics, International Hellenic University, Thessaloniki, Greece
| | - Vasiliki Vourga
- Department of Nutritional Sciences and Dietetics, International Hellenic University, Thessaloniki, Greece
| | - Ioannis Tasios
- Department of Nutritional Sciences and Dietetics, International Hellenic University, Thessaloniki, Greece
| | - Nikolaos G. Papadopoulos
- Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece
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15
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Validating Accuracy of a Mobile Application against Food Frequency Questionnaire on Key Nutrients with Modern Diets for mHealth Era. Nutrients 2022; 14:nu14030537. [PMID: 35276892 PMCID: PMC8839756 DOI: 10.3390/nu14030537] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 01/21/2022] [Accepted: 01/24/2022] [Indexed: 02/06/2023] Open
Abstract
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.
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Tsakoumaki F, Kyrkou C, Athanasiadis AP, Menexes G, Michaelidou AM. Nutritional Inadequacy: Unraveling the Methodological Challenges for the Application of the Probability Approach or the EAR Cut-Point Method-A Pregnancy Perspective. Nutrients 2021; 13:3473. [PMID: 34684473 PMCID: PMC8538604 DOI: 10.3390/nu13103473] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 09/20/2021] [Accepted: 09/28/2021] [Indexed: 12/17/2022] Open
Abstract
The aim of this study was to unravel the methodological challenges when exploring nutritional inadequacy, involving 608 healthy pregnant women. The usual intake of twenty-one nutrients was recorded by employing a validated FFQ. Simulated datasets of usual intake were generated, with randomly imposed uncertainty. The comparison between the usual intake and the EAR was accomplished with the probability approach and the EAR cut-point method. Point estimates were accompanied by bootstrap confidence intervals. Bootstrap intervals applied on the risk of inadequacy for raw and simulated data tended in most cases to overlap. A detailed statistical analysis, aiming to predict the level of inadequacy, as well as the application of the EAR cut-point method, along with bootstrap intervals, could effectively be used to assess nutrient inadequacy. However, the final decision for the method used depends on the distribution of nutrient-intake under evaluation. Irrespective of the applied methodology, moderate to high levels of inadequacy, calculated from FFQ were identified for certain nutrients (e.g., vitamins C, B6, magnesium, vitamin A), while the highest were recorded for folate and iron. Considering that micronutrient-poor, obesogenic diets are becoming more common, the underlying rationale may help towards unraveling the complexity characterizing nutritional inadequacies, especially in vulnerable populations.
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Affiliation(s)
- Foteini Tsakoumaki
- Department of Food Science and Technology, School of Agriculture, Faculty of Agriculture, Forestry and Natural Environment, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece; (F.T.); (C.K.)
| | - Charikleia Kyrkou
- Department of Food Science and Technology, School of Agriculture, Faculty of Agriculture, Forestry and Natural Environment, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece; (F.T.); (C.K.)
| | - Apostolos P. Athanasiadis
- 3rd Department of Obstetrics and Gynecology, School of Medicine, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece;
| | - Georgios Menexes
- Department of Field Crops and Ecology, School of Agriculture, Faculty of Agriculture, Forestry and Natural Environment, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece;
| | - Alexandra-Maria Michaelidou
- Department of Food Science and Technology, School of Agriculture, Faculty of Agriculture, Forestry and Natural Environment, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece; (F.T.); (C.K.)
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Apostolopoulou A, Magriplis E, Tsekitsidi E, Oikonomidou AC, Papaefstathiou E, Tsakiridis I, Dagklis T, Chourdakis M. Development and validation of a short culture-specific food frequency questionnaire for Greek pregnant women and their adherence to the Mediterranean diet. Nutrition 2021; 90:111357. [PMID: 34218120 DOI: 10.1016/j.nut.2021.111357] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 05/09/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The aim of this study was to develop and evaluate the validity of a short, culture-specific, semiquantitative food frequency questionnaire (FFQ) for Greek dietary habits and among a population of pregnant women, and to assess the adherence of reported nutritional habits to the Mediterranean diet. METHODS The validity of the FFQ was assessed by comparing FFQ-derived nutrient intakes against the average of two 24-h dietary recalls of 70 pregnant women. We used appropriate statistical methods to examine the nutrient correlation and level of agreement between the two figures (Pearson or Spearman correlation and Bland-Altman test, respectively). Calculation of the Mediterranean Diet Score was performed to evaluate participants' adherence to the Mediterranean diet. RESULTS Statistically significant positive correlations, of medium strength, were observed for almost all macronutrient groups (ρs ranging from 0.326 to 0.538). Dietary fiber intake was the only nutrient where a weak correlation was identified (ρ = -0.106; P > 0.05). Mean intakes, derived from the FFQ, agreed with results from the 24-h recalls based on Bland-Altman analysis, with the agreement ranging between 94.3% and 98.6% for the macronutrient groups under examination. The calculation of the Mediterranean Diet Score revealed that Greek pregnant women's habits are in accordance with the principles of the Mediterranean diet. CONCLUSIONS The developed FFQ is a valid tool that could provide reliable nutrient intake assessment in studies monitoring dietary habits of pregnant women, a group where nutritional monitoring is essential but to date remains limited.
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Affiliation(s)
- Aikaterini Apostolopoulou
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Emmanuella Magriplis
- Department of Food Science and Human Nutrition, Agricultural University of Athens, Athens, Greece
| | - Eirini Tsekitsidi
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Artemis Christina Oikonomidou
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Efstathios Papaefstathiou
- Second Urology Department, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Tsakiridis
- Third Department of Obstetrics and Gynaecology, Department of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Themistoklis Dagklis
- Third Department of Obstetrics and Gynaecology, Department of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Michail Chourdakis
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece.
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El Sayed Ahmad R, Baroudi M, Shatila H, Nasreddine L, Chokor FAZ, Chehab RF, Forman MR, Naja F. Validity and Reproducibility of a Culture-Specific Food Frequency Questionnaire in Lebanon. Nutrients 2020; 12:E3316. [PMID: 33137973 PMCID: PMC7692843 DOI: 10.3390/nu12113316] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 10/23/2020] [Accepted: 10/24/2020] [Indexed: 12/19/2022] Open
Abstract
This study aims to assess the validity and reproducibility of a culture-specific semi-quantitative food frequency questionnaire (FFQ) for Lebanese adults. The 94-item FFQ captures intake of traditional Mediterranean dishes and Western food, reflective of current Lebanese nutrition transition. Among 107 participants (18-65 years), the FFQ was administered at baseline (FFQ-1) and one year thereafter (FFQ-2); 2-3 24-h recalls (24-HRs)/season were collected for a total of 8-12 over four seasons. A subset (n = 67) provided a fasting blood sample in the fall. Spearman-correlation coefficients, Bland-Altman plots, joint-classification and (ICC) were calculated. Mean intakes from FFQ-2 were higher than from the total 24-HRs. Correlations for diet from FFQ-2 and 24-HRs ranged from 0.17 for α-carotene to 0.65 for energy. Joint classification in the same/adjacent quartile ranged from 74.8% to 95%. FFQ-2-plasma carotenoid correlations ranged from 0.18 for lutein/zeaxanthin to 0.59 for β-carotene. Intra-class correlations for FFQ-1 and FFQ-2 ranged from 0.36 for β-cryptoxanthin to 0.85 for energy. 24-HRs carotenoid intake varied by season; combining season-specific 24-HRs proximal to biospecimen collection to the FFQ-2 improved diet-biochemical correlations. By applying dietary data from two tools with biomarkers taking into consideration seasonal variation, we report a valid, reproducible Lebanese FFQ for use in diet-disease research.
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Affiliation(s)
- Raeda El Sayed Ahmad
- Department of Nutrition and Food Sciences, Faculty of Agriculture and Food Sciences, American University of Beirut, P.O. Box 11-0236, Riad El Solh, Beirut 11072020, Lebanon; (R.E.S.A.); (M.B.); (H.S.); (L.N.); (F.A.Z.C.)
| | - Mariam Baroudi
- Department of Nutrition and Food Sciences, Faculty of Agriculture and Food Sciences, American University of Beirut, P.O. Box 11-0236, Riad El Solh, Beirut 11072020, Lebanon; (R.E.S.A.); (M.B.); (H.S.); (L.N.); (F.A.Z.C.)
| | - Hibeh Shatila
- Department of Nutrition and Food Sciences, Faculty of Agriculture and Food Sciences, American University of Beirut, P.O. Box 11-0236, Riad El Solh, Beirut 11072020, Lebanon; (R.E.S.A.); (M.B.); (H.S.); (L.N.); (F.A.Z.C.)
| | - Lara Nasreddine
- Department of Nutrition and Food Sciences, Faculty of Agriculture and Food Sciences, American University of Beirut, P.O. Box 11-0236, Riad El Solh, Beirut 11072020, Lebanon; (R.E.S.A.); (M.B.); (H.S.); (L.N.); (F.A.Z.C.)
| | - Fatima Al Zahraa Chokor
- Department of Nutrition and Food Sciences, Faculty of Agriculture and Food Sciences, American University of Beirut, P.O. Box 11-0236, Riad El Solh, Beirut 11072020, Lebanon; (R.E.S.A.); (M.B.); (H.S.); (L.N.); (F.A.Z.C.)
| | - Rana F. Chehab
- Department of Nutrition Science, Purdue University, West Lafayette, IN 47907, USA;
| | - Michele R. Forman
- Nutrition Sciences, College of Health and Human Sciences, Purdue University, West Lafayette, IN 47907, USA
| | - Farah Naja
- Department of Nutrition and Food Sciences, Faculty of Agriculture and Food Sciences, American University of Beirut, P.O. Box 11-0236, Riad El Solh, Beirut 11072020, Lebanon; (R.E.S.A.); (M.B.); (H.S.); (L.N.); (F.A.Z.C.)
- Department of Clinical Nutrition and Dietetics, College of Health Sciences, Research Institute of Medical & Health Sciences (RIMHS), University of Sharjah, Sharjah 27272, UAE
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A culture-sensitive semi-quantitative FFQ for use among the adult population in Nairobi, Kenya: development, validity and reproducibility. Public Health Nutr 2020; 24:834-844. [PMID: 32705973 DOI: 10.1017/s136898002000169x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To develop a semi-quantitative FFQ and to evaluate its validity and reproducibility for the assessment of total dietary intake of Kenyan urban adult population, given its non-existence in Kenya. DESIGN The current study adopted a cross-sectional design. A culture-sensitive semi-quantitative FFQ was developed and its validity was tested relative to three non-consecutive 24-h recalls (24hR). Reproducibility was tested by the test-retest method, with a 3-week interval. Spearman's correlation coefficients and intra-class correlation coefficients were calculated for several macro- and micronutrients. Cross-classification into quartiles and Bland and Altman plots were analysed. SETTING Nairobi county (Dagoreti South and Starehe constituencies). PARTICIPANTS A convenient sample was recruited in three different clusters in Nairobi. RESULTS A culture-sensitive 123-food-item semi-quantitative FFQ showed higher nutrient intakes compared with the 24hR (total energy median 12543·632 v. 8501·888 kJ, P < 0·001). Energy-adjusted and deattenuated Spearman's correlations for macronutrients ranged between 0·21 (total fat) and 0·47 (protein). The agreement in the same quartile varied from 28 % (protein) to 41 % (carbohydrates). Including adjacent quartiles, the range increased: 76 % (protein and fat) to 81 % (carbohydrates). The extreme disagreement was low. The first FFQ application resulted in higher mean values for all nutrients compared with the second FFQ (total energy median 12459·952 v. 10485·104 kJ, P < 0·001). Energy-adjusted correlations for macronutrients ranged from 0·28 (carbohydrates) to 0·61 (protein). Intra-class correlation coefficients for macronutrients were moderate, between 0·6 and 0·7. CONCLUSIONS The developed semi-quantitative FFQ was shown to be a valid and reproducible tool for ranking urban adult Kenyans according to their dietary intake.
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Harmouche-Karaki M, Mahfouz M, Obeyd J, Salameh P, Mahfouz Y, Helou K. Development and validation of a quantitative food frequency questionnaire to assess dietary intake among Lebanese adults. Nutr J 2020; 19:65. [PMID: 32631430 PMCID: PMC7339409 DOI: 10.1186/s12937-020-00581-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 06/24/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The food frequency questionnaire (FFQ) is the most frequently used method to assess dietary intake in epidemiological studies evaluating diet-disease association. The objective of this study was to validate a FFQ for use among Lebanese adults by evaluating various facets of validity and reproducibility. METHODS The quantitative 164-items FFQ was validated against the average of six 24-h dietary recalls (DRs) in a sample of 238 Lebanese adults. Reproducibility of the FFQ was assessed by administering it twice within 1 month' time interval. RESULTS Positive statistically significant Pearson correlations were observed in most macro and micronutrients between the FFQ and the six 24-h DRs, ranging from 0.16 to 0.65, with two thirds of the correlation coefficients exceeding 0.3. Energy, gender, and age-adjusted statistically significant Pearson correlation coefficients ranged from 0.14 to 0.64, with two thirds of the coefficients exceeding 0.2. Intakes from the FFQ were mostly higher than those of the 24-h DRs. Mean percent difference between nutrient intakes from both dietary methods decreased remarkably after using energy-adjusted mean intakes. Values were acceptable to good for all macronutrients and several micronutrients. Cross-classification analysis revealed that around 64.3 to 83.9% of participants were classified into the same and adjacent quartile whereas grossly misclassified proportions ranged from 3.7 to 12.2%. Weighted kappa values ranged from 0.02 to 0.36 with most of them exceeding 0.2. In indirect validity analysis, key nutrient mean intakes estimated from the six 24-h DRs were significantly positively associated with tertiles of food groups derived from the FFQ. Bland Altman plots showed that the majority of data points fell within the limits of agreement (LOA) for all nutrients. As for reproducibility analysis, ICC values were all statistically significant ranging from 0.645 to 0.959 and Bland Altman plots confirmed these results. CONCLUSIONS Based on various aspects of validity and reproducibility, and an extensive range of statistical tests, the present FFQ developed for a Lebanese community is an acceptable tool for dietary assessment and is useful for evaluating diet-disease associations in future studies.
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Affiliation(s)
- Mireille Harmouche-Karaki
- Department of Nutrition, Faculty of Pharmacy, Saint Joseph University of Beirut, Lebanon B.P. 11-5076 – Riad el Solh, Beirut, 1107 2180 Lebanon
| | - Maya Mahfouz
- Department of Nutrition, Faculty of Pharmacy, Saint Joseph University of Beirut, Lebanon B.P. 11-5076 – Riad el Solh, Beirut, 1107 2180 Lebanon
| | - Jawaher Obeyd
- Department of Nutrition, Faculty of Pharmacy, Saint Joseph University of Beirut, Lebanon B.P. 11-5076 – Riad el Solh, Beirut, 1107 2180 Lebanon
| | - Pascale Salameh
- Clinical and Epidemiological Research Laboratory, Faculty of Pharmacy, Lebanese University, Hadath, Lebanon
| | - Yara Mahfouz
- Department of Nutrition, Faculty of Pharmacy, Saint Joseph University of Beirut, Lebanon B.P. 11-5076 – Riad el Solh, Beirut, 1107 2180 Lebanon
| | - Khalil Helou
- Department of Nutrition, Faculty of Pharmacy, Saint Joseph University of Beirut, Lebanon B.P. 11-5076 – Riad el Solh, Beirut, 1107 2180 Lebanon
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21
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The Cardio-Med survey tool: development and pilot validation of a FFQ in a multicultural cardiology cohort. Public Health Nutr 2020; 23:2303-2313. [PMID: 32517840 DOI: 10.1017/s1368980020000737] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE (i) Describe the development of a multipurpose Cardio-Med survey tool (CMST) comprising a semi-quantitative FFQ designed to measure dietary intake in multicultural patients with or at high risk of CVD and (ii) report pilot evaluation of test-retest reliability and validity of the FFQ in measuring energy and nutrient intakes. DESIGN The CMST was developed to identify CVD risk factors and assess diet quality over 1 year using an FFQ. Design of the ninety-three-item FFQ involved developing food portion photographs, and a list of foods appropriate for the Australian multicultural population allowing the capture of adherence to a Mediterranean diet pattern. The FFQ was administered twice, 2 weeks apart to assess test-retest reliability, whilst validity was assessed by comparison of the FFQ with a 3-d food record (3DFR). SETTING The Northern Hospital and St Vincent's Hospital, Melbourne, Australia. PARTICIPANTS Thirty-eight participants aged 34-81 years with CVD or at high risk. RESULTS Test-retest reliability of the FFQ was good: intraclass correlation coefficient (ICC) ranged from 0·52 (Na) to 0·88 (alcohol) (mean 0·79), with energy and 70 % of measured nutrients being above 0·75. Validity was moderate: ICC ranged from 0·08 (Na) to 0·94 (alcohol) (mean 0·59), with energy and 85 % of measured nutrients being above 0·5. Bland-Altman plots demonstrated good levels of agreement between the FFQ and 3DFR for carbohydrates, protein, alcohol, vitamin D and Na. CONCLUSIONS The CMST FFQ demonstrated good test-retest reliability and moderate validity for measuring dietary energy and nutrients in a multicultural Australian cardiology population.
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22
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HD-FFQ to Detect Nutrient Deficiencies and Toxicities for a Multiethnic Asian Dialysis Population. Nutrients 2020. [PMCID: PMC7352606 DOI: 10.3390/nu12061585] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
A rapid and reliable tool appropriate to quantifying macronutrient and micronutrient intakes in diets consumed by Malaysian hemodialysis (HD) patients is lacking. We aimed to develop and validate a novel HD-food frequency questionnaire (HD-FFQ) to assess habitual nutritional intakes of HD patients with diverse ethnic backgrounds. This study was conducted in three phases. In Phase I, a HD-FFQ comprising 118 food items was developed using 3-day diet recalls (3DDR) from 388 HD patients. Phase II was the face and content validation using the Scale-Content Validity Index (S-CVI). After successfully developing the FFQ, Phase III tested relative validation against a reference method, the 3DDR. Results from Phase III showed that the mean difference for absolute intakes of nutrients assessed by HD-FFQ and 3DDR were significant (p < 0.05). However, there was a significant correlation between the HD-FFQ and reference method ranging from 0.35–0.47 (p < 0.05). Cross-quartile classification showed that <10% of patients were grossly misclassified. In conclusion, the HD-FFQ has an acceptable relative validity in assessing and ranking the dietary intake of the HD patients in Malaysia.
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23
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Zanini B, Simonetto A, Bertolotti P, Marullo M, Marconi S, Becchetti C, Gilioli G, Valerio A, Donato F, Ricci C, Castellano M. A new self-administered semi-quantitative food frequency questionnaire to estimate nutrient intake among Italian adults: development design and validation process. Nutr Res 2020; 80:18-27. [PMID: 32673962 DOI: 10.1016/j.nutres.2020.05.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 05/04/2020] [Accepted: 05/13/2020] [Indexed: 01/21/2023]
Abstract
Food Frequency Questionnaires (FFQs) are valuable research tools in nutritional epidemiology. This study aimed to develop and validate a new semi-quantitative FFQ, specifically designed for the Italian population and best fitted for self-administration. During the development process, we adapted to Italian needs the validated FFQ proposed by the Fred Hutchinson Cancer Research Center, revising food items, food frequency scale, portion sizes, and time frame. To assess the validity of the proposed FFQ, we compared the estimated daily intake using FFQ with the mean of 3-day food diaries and one 24-hour recall (considered as reference method). The validation process was conducted among a cohort of 51 healthy subjects enrolled in a clinical trial. Four statistical tests were applied on 23 estimated nutrient intakes. Spearman's coefficients ranged from 0.223 (sodium) to 0.748 (alcohol) and were good (≥0.50) and acceptable (0.20-0.49) for 7 and 16 nutrients, respectively. Cross classification showed a good agreement (≥50% in the same tertile or ≤10% in the opposite tertile) for 7 nutrients. The weighted Cohen's kappa values indicated an acceptable outcome (0.20-0.60) for 13 nutrients. Bland Altman plots did not show heteroscedasticity in the error terms, despite the presence of a bias. Our study provided a new Italian semi-quantitative FFQ for self-administration with an acceptable validation level. Its definitive release requires additional refinements and efforts.
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Affiliation(s)
- Barbara Zanini
- Department of Clinical and Experimental Sciences, University of Brescia, Viale Europa 11, Brescia, Italy.
| | - Anna Simonetto
- AgroFood Lab, Department of Molecular and Translational Medicine; University of Brescia, Viale Europa 11, Brescia, Italy.
| | - Paola Bertolotti
- AgroFood Lab, Department of Molecular and Translational Medicine; University of Brescia, Viale Europa 11, Brescia, Italy.
| | - Monica Marullo
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Viale Europa 11, Brescia, Italy.
| | - Silvia Marconi
- AgroFood Lab, Department of Molecular and Translational Medicine; University of Brescia, Viale Europa 11, Brescia, Italy.
| | - Chiara Becchetti
- Department of Clinical and Experimental Sciences, University of Brescia, Viale Europa 11, Brescia, Italy.
| | - Gianni Gilioli
- AgroFood Lab, Department of Molecular and Translational Medicine; University of Brescia, Viale Europa 11, Brescia, Italy.
| | - Alessandra Valerio
- AgroFood Lab, Department of Molecular and Translational Medicine; University of Brescia, Viale Europa 11, Brescia, Italy.
| | - Francesco Donato
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Viale Europa 11, Brescia, Italy.
| | - Chiara Ricci
- Department of Clinical and Experimental Sciences, University of Brescia, Viale Europa 11, Brescia, Italy; Department of Medicine, ASST Spedali Civili of Brescia, Piazzale Spedali Civili 1, Brescia, Italy.
| | - Maurizio Castellano
- Department of Clinical and Experimental Sciences, University of Brescia, Viale Europa 11, Brescia, Italy; Department of Medicine, ASST Spedali Civili of Brescia, Piazzale Spedali Civili 1, Brescia, Italy.
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24
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Kowalkowska J, Wadolowska L, Czarnocinska J, Czlapka-Matyasik M, Galinski G, Jezewska-Zychowicz M, Bronkowska M, Dlugosz A, Loboda D, Wyka J. Reproducibility of a Questionnaire for Dietary Habits, Lifestyle and Nutrition Knowledge Assessment (KomPAN) in Polish Adolescents and Adults. Nutrients 2018; 10:nu10121845. [PMID: 30513711 PMCID: PMC6315932 DOI: 10.3390/nu10121845] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 11/17/2018] [Accepted: 11/21/2018] [Indexed: 12/15/2022] Open
Abstract
The aim of the study was to evaluate the reproducibility of the Dietary Habits and Nutrition Beliefs Questionnaire (KomPAN) in Polish adolescents and adults, including the assessment of indexes developed based on the questionnaire. In total, the study involved 954 subjects aged 15–65 (53.9% females). Interviews using the interviewer-administered questionnaire (IA-Q) in healthy subjects (n 299) and the self-administered questionnaire (SA-Q) in healthy subjects (n 517) and outpatients (n 138) were conducted and repeated after two weeks. Considering the consumption frequency of 33 food items, the cross-classification (test-retest) agreement of classification into the same category obtained for IA-Q in healthy subjects ranged from 72.2% (fruit juices) to 91.6% (energy drinks); the kappa statistic was >0.60 for all food items. For SA-Q conducted in healthy subjects the cross-classification agreement ranged from 63.8% (vegetable oils, margarines, mixes of butter and margarines) to 84.7% (lard); the kappa statistic was >0.50 for all food items. For SA-Q in outpatients, the cross-classification agreement ranged from 42.0% (both fruit juices and white rice, white pasta, fine-ground groats) to 92.0% (energy drinks); the kappa statistic was ≥0.40 for 20/33 food items. The kappa statistic for lifestyle items ranged 0.42–0.96, and for the nutrition knowledge level it ranged 0.46–0.73. The questionnaire showed moderate to very good reproducibility and can be recommended to assess dietary habits, lifestyle and nutrition knowledge of healthy adolescents and adults and those suffering from chronic diseases, after validation and/or calibration study is carried out. The reproducibility of the interviewer-administered questionnaire was better than its self-administered version. The reproducibility of the self-administered questionnaire was better in healthy subjects than in outpatients.
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Affiliation(s)
- Joanna Kowalkowska
- Department of Human Nutrition, University of Warmia and Mazury in Olsztyn, Słoneczna 45F, 10-718 Olsztyn, Poland.
| | - Lidia Wadolowska
- Department of Human Nutrition, University of Warmia and Mazury in Olsztyn, Słoneczna 45F, 10-718 Olsztyn, Poland.
- Behavioral Conditions of Nutrition Team, Committee of Human Nutrition Science, Polish Academy of Sciences, 00-901 Warsaw, Poland.
| | - Jolanta Czarnocinska
- Behavioral Conditions of Nutrition Team, Committee of Human Nutrition Science, Polish Academy of Sciences, 00-901 Warsaw, Poland.
- Institute of Human Nutrition and Dietetics, Poznan University of Life Sciences, Wojska Polskiego 28, 60-637 Poznan, Poland.
| | - Magdalena Czlapka-Matyasik
- Institute of Human Nutrition and Dietetics, Poznan University of Life Sciences, Wojska Polskiego 28, 60-637 Poznan, Poland.
| | - Grzegorz Galinski
- Institute of Human Nutrition and Dietetics, Poznan University of Life Sciences, Wojska Polskiego 28, 60-637 Poznan, Poland.
| | - Marzena Jezewska-Zychowicz
- Behavioral Conditions of Nutrition Team, Committee of Human Nutrition Science, Polish Academy of Sciences, 00-901 Warsaw, Poland.
- Department of Organization and Consumption Economics, Warsaw University of Life Sciences-SGGW, Nowoursynowska 159 C, 02-776 Warsaw, Poland.
| | - Monika Bronkowska
- Department of Human Nutrition, Wrocław University of Environmental and Life Sciences, Chełmońskiego 37, 51-630 Wroclaw, Poland.
| | - Anna Dlugosz
- Faculty of Chemical Technology and Engineering, University of Technology and Life Sciences in Bydgoszcz, Seminaryjna 3, 85-326 Bydgoszcz, Poland.
| | - Dorota Loboda
- Institute of Health, University of Economy in Bydgoszcz, Garbary 2, 85-229 Bydgoszcz, Poland.
| | - Joanna Wyka
- Department of Human Nutrition, Wrocław University of Environmental and Life Sciences, Chełmońskiego 37, 51-630 Wroclaw, Poland.
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25
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Gnagnarella P, Dragà D, Misotti AM, Sieri S, Spaggiari L, Cassano E, Baldini F, Soldati L, Maisonneuve P. Validation of a short questionnaire to record adherence to the Mediterranean diet: An Italian experience. Nutr Metab Cardiovasc Dis 2018; 28:1140-1147. [PMID: 30077491 DOI: 10.1016/j.numecd.2018.06.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 06/11/2018] [Accepted: 06/11/2018] [Indexed: 01/23/2023]
Abstract
BACKGROUND AND AIMS A greater adherence to the Mediterranean diet has been associated with a reduced risk of major chronic diseases and cancer. The aim of the study was to assess the validity of a new short self-administered 15-item questionnaire (QueMD) to measure adherence to the Mediterranean diet in Italy. METHODS AND RESULTS Four-hundred and eighty three participants to cancer-screening programmes at the European Institute of Oncology, Milan (Italy) were invited to join this study. Those interested compiled the QueMD and a validated Food Frequency Questionnaire (FFQ) reporting their usual food consumption during the previous six months. We derived the alternate Mediterranean score (aMED) from both questionnaires with values ranging from 0 (minimal adherence) to 9 (maximal adherence). Complete dietary data were available for 343 individuals (participation rates 71.0%). Spearman correlation coefficient between the responses to the 15 questions of the QueMD and corresponding food intake derived from the FFQ ranged from 0.15 to 0.84. A moderate correlation was found between the aMED scores calculated from the QueMD and the FFQ (intraclass correlation coefficient 0.50; 95% CI, 0.42-0.58), while agreement between the two instruments was only poor to fair for 7 of the 9 single items composing the aMED score, with values ranging from 53.0% for wholegrain products to 79.5% for fruits. CONCLUSION This new self-administered 15-item questionnaire could be a useful tool to assess adherence to the Mediterranean diet in the Italian population.
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Affiliation(s)
- P Gnagnarella
- Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy.
| | - D Dragà
- Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy
| | - A M Misotti
- UOSD Dietologia e Nutrizione Clinica, ASST Melegnano e Martesana, Italy
| | - S Sieri
- Department of Research, Epidemiology and Prevention Unit, Fondazione IRCSS Istituto Nazionale dei Tumori, Milan, Italy
| | - L Spaggiari
- Department of Thoracic Surgery, European Institute of Oncology, Milan, Italy; Department of Oncology and Emato-Oncology, University of Milan, Milan, Italy
| | - E Cassano
- Breast Imaging Division, European Institute of Oncology, Milan, Italy
| | - F Baldini
- Division of Melanoma, Sarcoma and Rare Cancer, European Institute of Oncology, Milan, Italy
| | - L Soldati
- Department of Health Sciences, University of Milan, Milan, Italy
| | - P Maisonneuve
- Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy
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26
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Morel S, Portolese O, Chertouk Y, Leahy J, Bertout L, Laverdière C, Krajinovic M, Sinnett D, Levy E, Marcil V. Development and relative validation of a food frequency questionnaire for French-Canadian adolescent and young adult survivors of acute lymphoblastic leukemia. Nutr J 2018; 17:45. [PMID: 29679986 PMCID: PMC5911374 DOI: 10.1186/s12937-018-0355-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 04/10/2018] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Survivors of childhood acute lymphoblastic leukemia (cALL) experience cardiometabolic and bone complications after treatments. This study aimed at developing and validating an interview-administrated food frequency questionnaire (FFQ) that will serve to estimate the impact of nutrition in the development of long-term sequalea of French-Canadian cALL survivors. METHODS The FFQ was developed to assess habitual diet, Mediterranean diet score, nutrients promoting bone health and antioxidants. It was validated using a 3-day food record (3-DFR) in 80 cALL survivors (50% male) aged between 11.4 and 40.1 years (median of 18.0 years). Reproducibility was evaluated by comparing FFQs from visit 1 and 2 in 29 cALL survivors. RESULTS When compared to 3-DFR, the mean values for macro- and micronutrient intake were overestimated by our FFQ with the exception of lipid-related nutrients. Correlations between nutrient intakes derived from the FFQs and the 3-DFRs showed moderate to very good correlations (0.46-0.74). Intraclass correlation coefficients assessing FFQ reproducibility ranged from 0.62 to 0.92, indicating moderate to good reliability. Furthermore, classification into quartiles showed more than 75% of macro- and micronutrients derived from FFQs 1 and 2 classified into the same or adjacent quartile. CONCLUSIONS Overall, our results support the reproducibility and accuracy of the developed FFQ to appropriately classify individuals according to their dietary intake. This validated tool will be valuable for future studies analyzing the impact of nutrition on cardiometabolic and bone complications in French-speaking populations.
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Affiliation(s)
- Sophia Morel
- Research Centre, Sainte-Justine University Health Center, Department of Nutrition, Université de Montréal, Montreal, QC H3T 1C5 Canada
- Institute of Nutrition and Functional Foods, Laval University, Quebec City, QC G1V 0A6 Canada
| | - Olivia Portolese
- Research Centre, Sainte-Justine University Health Center, Department of Nutrition, Université de Montréal, Montreal, QC H3T 1C5 Canada
| | - Yasmine Chertouk
- Research Centre, Sainte-Justine University Health Center, Department of Nutrition, Université de Montréal, Montreal, QC H3T 1C5 Canada
| | - Jade Leahy
- Research Centre, Sainte-Justine University Health Center, Department of Nutrition, Université de Montréal, Montreal, QC H3T 1C5 Canada
| | - Laurence Bertout
- Research Centre, Sainte-Justine University Health Center, Department of Pediatrics, Université de Montréal, Montreal, QC H3T 1C5 Canada
| | - Caroline Laverdière
- Research Centre, Sainte-Justine University Health Center, Department of Pediatrics, Université de Montréal, Montreal, QC H3T 1C5 Canada
| | - Maja Krajinovic
- Research Centre, Sainte-Justine University Health Center, Department of Pediatrics, Université de Montréal, Montreal, QC H3T 1C5 Canada
| | - Daniel Sinnett
- Research Centre, Sainte-Justine University Health Center, Department of Pediatrics, Université de Montréal, Montreal, QC H3T 1C5 Canada
| | - Emile Levy
- Research Centre, Sainte-Justine University Health Center, Department of Nutrition, Université de Montréal, Montreal, QC H3T 1C5 Canada
- Institute of Nutrition and Functional Foods, Laval University, Quebec City, QC G1V 0A6 Canada
| | - Valérie Marcil
- Research Centre, Sainte-Justine University Health Center, Department of Nutrition, Université de Montréal, Montreal, QC H3T 1C5 Canada
- Institute of Nutrition and Functional Foods, Laval University, Quebec City, QC G1V 0A6 Canada
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Fotiou M, Fotakis C, Tsakoumaki F, Athanasiadou E, Kyrkou C, Dimitropoulou A, Tsiaka T, Chatziioannou AC, Sarafidis K, Menexes G, Theodoridis G, Biliaderis CG, Zoumpoulakis P, Athanasiadis AP, Michaelidou AM. 1H NMR-based metabolomics reveals the effect of maternal habitual dietary patterns on human amniotic fluid profile. Sci Rep 2018; 8:4076. [PMID: 29511239 PMCID: PMC5840288 DOI: 10.1038/s41598-018-22230-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 02/13/2018] [Indexed: 12/25/2022] Open
Abstract
Maternal diet may influence offspring’s health, even within well-nourished populations. Amniotic fluid (AF) provides a rational compartment for studies on fetal metabolism. Evidence in animal models indicates that maternal diet affects AF metabolic profile; however, data from human studies are scarce. Therefore, we have explored whether AF content may be influenced by maternal diet, using a validated food-frequency questionnaire and implementing NMR-based metabolomics. Sixty-five AF specimens, from women undergoing second-trimester amniocentesis for prenatal diagnosis, were analysed. Complementary, maternal serum and urine samples were profiled. Hierarchical cluster analysis identified 2 dietary patterns, cluster 1 (C1, n = 33) and cluster 2 (C2, n = 32). C1 was characterized by significantly higher percentages of energy derived from refined cereals, yellow cheese, red meat, poultry, and “ready-to-eat” foods, while C2 by higher (P < 0.05) whole cereals, vegetables, fruits, legumes, and nuts. 1H NMR spectra allowed the identification of metabolites associated with these dietary patterns; glucose, alanine, tyrosine, valine, citrate, cis-acotinate, and formate were the key discriminatory metabolites elevated in C1 AF specimens. This is the first evidence to suggest that the composition of AF is influenced by maternal habitual dietary patterns. Our results highlight the need to broaden the knowledge on the importance of maternal nutrition during pregnancy.
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Affiliation(s)
- Maria Fotiou
- Department of Food Science and Technology, School of Agriculture, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Charalambos Fotakis
- Institute of Biology, Medicinal Chemistry and Biotechnology, National Hellenic Research Foundation, Athens, Greece
| | - Foteini Tsakoumaki
- Department of Food Science and Technology, School of Agriculture, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Elpiniki Athanasiadou
- 1st Department of Obstetrics and Gynecology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Charikleia Kyrkou
- Department of Food Science and Technology, School of Agriculture, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Aristea Dimitropoulou
- Department of Food Science and Technology, School of Agriculture, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Thalia Tsiaka
- Institute of Biology, Medicinal Chemistry and Biotechnology, National Hellenic Research Foundation, Athens, Greece
| | | | - Kosmas Sarafidis
- 1st Department of Neonatology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - George Menexes
- Department of Field Crops and Ecology, School of Agriculture, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Costas G Biliaderis
- Department of Food Science and Technology, School of Agriculture, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Panagiotis Zoumpoulakis
- Institute of Biology, Medicinal Chemistry and Biotechnology, National Hellenic Research Foundation, Athens, Greece.
| | - Apostolos P Athanasiadis
- 3rd Department of Obstetrics and Gynecology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - Alexandra-Maria Michaelidou
- Department of Food Science and Technology, School of Agriculture, Aristotle University of Thessaloniki, Thessaloniki, Greece.
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28
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Adherence to the "Mediterranean Diet" in Spain and Its Relationship with Cardiovascular Risk (DIMERICA Study). Nutrients 2016; 8:nu8110680. [PMID: 27801819 PMCID: PMC5133068 DOI: 10.3390/nu8110680] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 09/16/2016] [Accepted: 10/20/2016] [Indexed: 02/07/2023] Open
Abstract
Background: Nutritional studies focus on traditional cultural models and lifestyles in different countries. The aim of this study was to examine the adherence to the Mediterranean diet, life habits, and risk factors associated with cardiovascular diseases among people living in different geographical regions in Spain. Methods: A descriptive cross-sectional study was conducted in each region. The sampling scheme consisted of a random three-stage stratified sampling program according to geographic region, age, and gender. A total of 1732 subjects were asked to complete a questionnaire designed to assess their nutrient intake, dietary habits, and exercise. A diet score that assesses the adherence of participants to the Mediterranean diet (range 0–10) was also applied. Results: Southeastern Spain had the lowest score for adherence to the Mediterranean diet because of the low consumption of fish and plant products. A lower adherence score to the Mediterranean diet was strongly associated with the prevalence of hypertension (p = 0.018). Conclusions: A low level of adherence to the Mediterranean diet is accompanied by a high prevalence of hypertension and, therefore, a raised cardiovascular risk in the country. The adherence score could help identify individuals at greater cardiovascular risk.
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