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Faessen JPM, Feskens EJM, Brouwer-Brolsma EM. Development and short evaluation of the Dutch healthy diet index for pregnant women; DHD-P. Front Nutr 2024; 11:1386888. [PMID: 38737511 PMCID: PMC11082309 DOI: 10.3389/fnut.2024.1386888] [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: 02/16/2024] [Accepted: 04/12/2024] [Indexed: 05/14/2024] Open
Abstract
Introduction Diet quality indices provide a quick indicator of overall diet and are commonly used in research and surveillance. We developed a Dutch Healthy Diet for pregnant women (DHD-P) index, comprising 22 components aligned with the 2021 Dutch food-based dietary guidelines for pregnant women. Our evaluation focused on assessing its performance and sensitivity to change. Methods The DHD-P index was quantified by using a validated Food Frequency Questionnaire (FFQ) and two 24-h recalls at 12 and 24 weeks gestation completed by 24-to-41 year old pregnant women participating in the GLIMP-II study. Strength and direction of associations were evaluated based on de-attenuated correlation coefficients between FFQ and 24-h recall data at 24 weeks gestation (n = 47). Sensitivity to change was evaluated by comparing DHD-P index data assessed by both FFQ and recalls at 12 and 24 weeks gestation using paired t-tests or Wilcoxon Signed Rank Test (n = 27). Results De-attenuated correlation coefficients between FFQ and 24-recall data showed a good correlation for the total DHD-P score (rho = 0.57) and moderate to good correlations for component scores. FFQ as well as recall data showed comparable dietary intake at 12 and 24 weeks, suggesting minimal changes during pregnancy. Correlations over time were moderate-to-good for scores based on FFQ and low to moderate for scores based on 24hRs, indicating better reproducibility of scores based on FFQ data. Conclusion Considering the moderate to good correlations, the DHD-P index appears to be an appropriate index to assess diet quality among pregnant women, and could serve as a foundation to provide dietary feedback toward healthier food choices. Studies including dietary data for all relevant food groups and nutrients are needed to substantiate our findings and further explore the DHD-P sensitivity to change.
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Affiliation(s)
- Janine P. M. Faessen
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, Netherlands
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Androutsos O, Tsiampalis T, Kouvari M, Manou M, Dimopoulou M, Georgiou A, Kosti RI, Charmandari E. Assessment of Diet Quality in Children and Adolescents with Overweight or Obesity in Greece. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1261. [PMID: 37508758 PMCID: PMC10378587 DOI: 10.3390/children10071261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 07/14/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023]
Abstract
The adoption of healthy nutritional habits constitutes one of the most important determinants of healthy growth and development in childhood. Few studies in Greece have examined children's diet quality using diet indices. The present study aimed to assess the diet quality of a large cohort of children and adolescents with overweight or obesity. Study participants (n = 1335), aged 2-18, were recruited through the Out-patient Clinic for the Prevention and Management of Overweight and Obesity in Childhood and Adolescence, Aghia Sophia Children's Hospital, Athens, Greece. Anthropometric, socio-demographic, and behavioral data were collected using standard methods and equipment. The Diet Quality Index (DQI), which includes four subcomponents (i.e., dietary diversity, dietary quality, dietary equilibrium, and meal index), was calculated to assess each subject's diet quality. According to the results of this study, children's total DQI score was 63.1%. It was observed that 66.7% of the children had at least moderate diet quality (total DQI ≥ 59.34%). Boys had higher values of the total DQI and certain components of the DQI (i.e., dietary equilibrium score and meal index) compared to girls. Three out of ten children with overweight/obesity had poor diet quality (i.e., DQI ≤ 59.33). Younger children (2-5 years old) were found to have the lowest values of dietary equilibrium compared to older children (6-9 and 12-18 years old). Moreover, boys had higher values of the total DQI score and of specific components of this index (i.e., dietary equilibrium and meal index) compared to girls. Children living in urban areas had higher values in the dietary quality score compared to those living in rural areas. Children with overweight had higher values of the dietary quality score and the total DQI score compared to children with obesity. The present study highlighted that children and adolescents with overweight or obesity have poor diet quality. Multilevel and higher intensity interventions should be designed specifically for this group to achieve tangible outcomes.
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Affiliation(s)
- Odysseas Androutsos
- Laboratory of Clinical Nutrition and Dietetics, Department of Nutrition and Dietetics, University of Thessaly, 42132 Trikala, Greece
| | - Thomas Tsiampalis
- Laboratory of Clinical Nutrition and Dietetics, Department of Nutrition and Dietetics, University of Thessaly, 42132 Trikala, Greece
| | - Matina Kouvari
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 17671 Athens, Greece
- Discipline of Nutrition and Dietetics, Faculty of Health, University of Canberra, Canberra, ACT 2601, Australia
- Functional Foods and Nutrition Research (FFNR) Laboratory, University of Canberra, Canberra, ACT 2617, Australia
| | - Maria Manou
- Division of Endocrinology, Metabolism, and Diabetes, First Department of Pediatrics, Medical School, National and Kapodistrian University of Athens, 'Aghia Sophia' Children's Hospital, 11527 Athens, Greece
| | - Maria Dimopoulou
- Laboratory of Clinical Nutrition and Dietetics, Department of Nutrition and Dietetics, University of Thessaly, 42132 Trikala, Greece
| | - Alexandra Georgiou
- Division of Endocrinology, Metabolism, and Diabetes, First Department of Pediatrics, Medical School, National and Kapodistrian University of Athens, 'Aghia Sophia' Children's Hospital, 11527 Athens, Greece
| | - Rena I Kosti
- Laboratory of Clinical Nutrition and Dietetics, Department of Nutrition and Dietetics, University of Thessaly, 42132 Trikala, Greece
| | - Evangelia Charmandari
- Division of Endocrinology, Metabolism, and Diabetes, First Department of Pediatrics, Medical School, National and Kapodistrian University of Athens, 'Aghia Sophia' Children's Hospital, 11527 Athens, Greece
- Division of Endocrinology and Metabolism, Center of Clinical, Experimental Surgery and Translational Research, Biomedical Research Foundation of the Academy of Athens, 11527 Athens, Greece
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Wang X, Xu Y, Tan B, Duan R, Shan S, Zeng L, Zou K, Zhao L, Xiong J, Zhang L, Rong S, Cheng G. Development of the Chinese preschooler dietary index: a tool to assess overall diet quality. BMC Public Health 2022; 22:2428. [PMID: 36572858 PMCID: PMC9791773 DOI: 10.1186/s12889-022-14672-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 11/18/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Diet quality in early childhood has a long-term impact on health outcomes. However, there are scarce dietary indexes for Chinese preschool children, and the existing indexes had limited validity and reliability. This study thus aimed to develop a dietary index for preschool children based on the Chinese Dietary Guideline and Chinese Dietary Reference Intakes and to assess their overall diet quality using the China Health and Nutrition Survey (CHNS). METHODS The Chinese Preschooler Dietary Index (CPDI) included 11 components, covering 9 food group components and two nutrient components. The total scores of CPDI ranged from 0 to 90, with a higher score indicating greater diet quality. This study assessed the diet quality of 1742 preschoolers aged two to five years old from CHNS using the CPDI. Dietary intake data were obtained using three-day 24-h diet recalls, and sociodemographic information was also collected. Cochran-Mantel-Haensel (CMH) test was used to explore the association between demographic and CPDI total scores. The principal component analysis, correlation analysis and Cronbach's alpha were used to evaluate the relative reliability and validity of the CPDI. Finally, a stepwise multiple regression analysis was performed to explore potential influencing factors of CPDI. RESULTS Among the 1742 CHNS preschool children, more than 70% resided in rural areas and 41.2% of the sample were raised in a low-income family. The mean CPDI score of the preschoolers was 38.8 ± 12.9. Higher diet scores were correlated with higher energy and nutrient intake. Children with higher age (β = 0.93, SE = 0.26, P = 0.0003), raised in a home with higher household income (β = 3.11, SE = 0.27, P < 0.0001) or living in urban areas (β = -4.44, SE = 0.66, P < 0.0001) were associated with higher CPDI scores. CONCLUSIONS The CPDI is useful in evaluating the diet quality of preschool children. Based on the CPDI, the diet quality of Chinese preschoolers needs to be improved, especially in rural areas.
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Affiliation(s)
- Xiaoyu Wang
- grid.461863.e0000 0004 1757 9397Laboratory of Molecular Translational Medicine, Center for Translational Medicine, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan 610041 People’s Republic of China
| | - Yujie Xu
- grid.461863.e0000 0004 1757 9397Laboratory of Molecular Translational Medicine, Center for Translational Medicine, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan 610041 People’s Republic of China
| | - Bingbing Tan
- grid.13291.380000 0001 0807 1581Department of Nutrition and Food Safety, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Ruonan Duan
- grid.461863.e0000 0004 1757 9397Laboratory of Molecular Translational Medicine, Center for Translational Medicine, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan 610041 People’s Republic of China ,grid.470966.aShanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China ,grid.412793.a0000 0004 1799 5032Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shufang Shan
- grid.461863.e0000 0004 1757 9397Laboratory of Molecular Translational Medicine, Center for Translational Medicine, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan 610041 People’s Republic of China
| | - Linan Zeng
- grid.13291.380000 0001 0807 1581Department of Pharmacy, Evidence-Based Pharmacy Center, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University), West China Second University Hospital, Sichuan University, Chengdu, China
| | - Kun Zou
- grid.13291.380000 0001 0807 1581Department of Pharmacy, Evidence-Based Pharmacy Center, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University), West China Second University Hospital, Sichuan University, Chengdu, China
| | - Li Zhao
- grid.13291.380000 0001 0807 1581Department of Health Policy and Management, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Jingyuan Xiong
- grid.13291.380000 0001 0807 1581Healthy Food Evaluation Research Center, West China School of Public Health and West China Fourth Hospital,, Sichuan University, Chengdu, China
| | - Lingli Zhang
- grid.13291.380000 0001 0807 1581Department of Pharmacy, Evidence-Based Pharmacy Center, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University), West China Second University Hospital, Sichuan University, Chengdu, China
| | - Shuang Rong
- grid.412787.f0000 0000 9868 173XDepartment of Nutrition Hygiene and Toxicology, Academic of Nutrition and Health, School of Public Health, Medical College, Wuhan University of Science and Technology, Wuhan, China
| | - Guo Cheng
- grid.461863.e0000 0004 1757 9397Laboratory of Molecular Translational Medicine, Center for Translational Medicine, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan 610041 People’s Republic of China
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Tarro S, Lahdenperä M, Junttila N, Lampimäki A, Lagström H. Parental Self-Efficacy and Child Diet Quality between Ages 2 and 5: The STEPS Study. Nutrients 2022; 14:nu14224891. [PMID: 36432577 PMCID: PMC9698359 DOI: 10.3390/nu14224891] [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: 10/14/2022] [Revised: 11/07/2022] [Accepted: 11/13/2022] [Indexed: 11/22/2022] Open
Abstract
Parental self-efficacy (PSE), a measure of the subjective competence in the parental role, has been linked with child well-being and health. Research on the influence of PSE on child eating habits is scarce, and the few studies have concentrated on certain food groups, such as vegetables or fruits, and have mostly included only maternal PSE. Thus, the aim of this study was to explore the associations between PSE (separately for mothers and fathers and as a total family-level score) and child diet quality in a cross-sectional and longitudinal study setting. PSE was measured at child ages of 1.5 and 5 years, and diet quality was measured at ages 2 and 5. Participants are from the Steps to Healthy Development (STEPS) Study (n = 270-883). We found that maternal PSE and family level PSE score were associated with child diet quality. Paternal PSE was not, but the dimension Routines was associated with child diet quality. PSE was similarly associated with child diet quality at both age points. Our results suggest that PSE is an important construct in the development of healthy dietary habits in children, and supporting parenting programs aimed at higher PSE could promote healthy diet quality in children.
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Affiliation(s)
- Saija Tarro
- Department of Public Health, University of Turku and Turku University Hospital, FI-20014 Turku, Finland
- Centre for Population Health Research, University of Turku and Turku University Hospital, FI-20014 Turku, Finland
- Correspondence:
| | | | - Niina Junttila
- Department of Teacher Education, University of Turku, FI-20014 Turku, Finland
- Department of Teacher Education, University of Jyväskylä, FI-40014 Jyväskylä, Finland
| | - Antti Lampimäki
- Department of Public Health, University of Turku and Turku University Hospital, FI-20014 Turku, Finland
| | - Hanna Lagström
- Department of Public Health, University of Turku and Turku University Hospital, FI-20014 Turku, Finland
- Centre for Population Health Research, University of Turku and Turku University Hospital, FI-20014 Turku, Finland
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Association between Diet Quality and Health Outcomes among Children in Rural Areas of Northwest China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137803. [PMID: 35805462 PMCID: PMC9265919 DOI: 10.3390/ijerph19137803] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 06/20/2022] [Accepted: 06/23/2022] [Indexed: 12/10/2022]
Abstract
This study aims to examine the relationship between diet quality and health outcomes among children in rural remote areas of China. We draw on a cross-sectional dataset of 1216 children from two counties in the Gansu Province in Northwest China. Child health outcomes were assessed with both anthropometric measurements and reports by primary caregivers of the children. Child diet quality was assessed with the diet quality score (DQS) using information from a food frequency questionnaire (FFQ). Our data show the prevalence of stunting and underweight among sample children were 12% and 11%, respectively; 27% of children were reported by their caregivers as unhealthy, and 60% of children had at least one of the seventeen selected non-communicable diseases (NCDs) over the past 14 days. Overall, 780 (72%) children have at least one of the four above-mentioned health problems. Results from logistic regression models show that a higher DQS was significantly associated with a lower likelihood of being stunted and a higher likelihood of being reported healthy after adjusting for confounders. These findings imply that improving child diet quality might be an option when designing interventions to improve child health.
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Diet quality in preschool children and associations with individual eating behavior and neighborhood socioeconomic disadvantage. The STEPS Study. Appetite 2022; 172:105950. [PMID: 35090977 DOI: 10.1016/j.appet.2022.105950] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 01/07/2022] [Accepted: 01/24/2022] [Indexed: 11/23/2022]
Abstract
A good quality diet in childhood is important for optimal growth as well as for long-term health. It is not well established how eating behaviors affect overall diet quality in childhood. Moreover, very few studies have considered the association of diet quality and a neighborhood socioeconomic disadvantage in childhood. Our aim was to investigate how diet quality is associated with eating behaviors and neighborhood disadvantage and their interaction in preschool age children in Finland. The participants were from the Steps to Healthy Development Study at age 2 y (n = 780) and 5 y (n = 653). Diet quality was measured with a short questionnaire on habitual food consumption and eating behavior was assessed with the child eating behavior questionnaire to indicate the child's eating style regarding food approach and food avoidance dimensions. Information on neighborhood socioeconomic disadvantage were obtained from the statistics Finland grid database. We found that diet quality was higher at 5 years compared to 2 years of age (p < 0.001). Food approach subscale, enjoyment of food, was positively associated with the diet quality (p < 0.001 for 2 and 5 y) while subscale desire to drink was negatively associated with the diet quality (p = 0.001 for 2 and 5 y). Food avoidance was negatively associated with the diet quality both at 2 and at 5 years of age (p < 0.001). A higher neighborhood disadvantage was negatively associated with the diet quality at the age of 2 years (p = 0.02), but not at the age of 5 years. Eating behavior had similar associations with diet quality both in affluent and deprived neighborhoods. Our results suggest that both the eating behavior and neighborhood disadvantage are, already in the early age, important factors when considering children's diet quality.
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Ding C, Fan J, Yuan F, Feng G, Gong W, Song C, Ma Y, Chen Z, Liu A. Association between Physical Activity, Sedentary Behaviors, Sleep, Diet, and Adiposity among Children and Adolescents in China. Obes Facts 2022; 15:26-35. [PMID: 34784593 PMCID: PMC8820170 DOI: 10.1159/000519268] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 08/25/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Physical activity (PA), sedentary behaviors (SB), sleep, and diet are related to adiposity among children and adolescents. However, there may be interactions between PA, SB, sleep, and diet, and these lifestyle behaviors may work together to affect body weight. The purpose of this study was to explore the impact of multiple lifestyle behaviors of PA, SB, sleep, and diet on childhood adiposity (body mass index z-score and overweight/obesity), and to investigate the effect of meeting multiple guidelines on adiposity among children and adolescents in China. METHODS Cross-sectional results were based on 28,048 children aged 6-17 years from the China National Nutrition and Health Surveillance in 2010-2012. Information about PA, SB, and sleep was measured through interview-administered questionnaire. Dietary intake was assessed with food frequency questionnaire. The associations between multiple lifestyle behaviors and BMI z-score and overweight/obese were examined. RESULTS The prevalence of overweight/obesity in the participants was 19.2%. The average time of moderate-to-vigorous PA (MVPA), leisure SB, and sleep was 76.7 ± 45.5 min, 2.9 ± 1.4 h, and 8.5 ± 1.1 h per day, respectively. The China Dietary Guidelines Index for Youth (CDGI-Y) score was 62.6 ± 11.0. Sleep duration and diet score were negative associated with BMI z-score (both p < 0.001). MVPA and SB time were positive associated with BMI z-score (p = 0.041, 0.004). Meeting the SB, sleep, and diet guidelines had a lower BMI z-score (all p < 0.01) and lower odds of overweight/obesity (all p < 0.05). There were significant interactions between PA and diet. Compared with meeting no guidelines, those who met multiple guidelines had a lower risk of overweight/obesity (all p < 0.01). The more guidelines the participants met, the lower odds of overweight/obesity (p for trend <0.001). CONCLUSIONS PA, SB, sleep, and diet are important behaviors associated with adiposity among children and adolescents. Attaining adequate amounts of appropriate multiple behaviors provided an additional benefit. It is important for children to meet recommended behavioral guidelines or recommendations. Interventions that aim to improve awareness of and compliance with these guidelines are needed in future.
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Affiliation(s)
- Caicui Ding
- Department of Nutrition and Health Education, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China,
| | - Jing Fan
- Department of Nutrition and Health Education, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Fan Yuan
- Department of Nutrition and Health Education, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Ganyu Feng
- Department of Nutrition and Health Education, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Weiyan Gong
- Department of Nutrition and Health Education, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Chao Song
- Department of Nutrition and Health Education, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yanning Ma
- Department of Nutrition and Health Education, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Zheng Chen
- Department of Nutrition and Health Education, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Ailing Liu
- Department of Nutrition and Health Education, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
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Buckland G, Northstone K, Emmett PM, Taylor CM. The inflammatory potential of the diet in childhood is associated with cardiometabolic risk in adolescence/young adulthood in the ALSPAC birth cohort. Eur J Nutr 2022; 61:3471-3486. [PMID: 35596006 PMCID: PMC9464173 DOI: 10.1007/s00394-022-02860-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 03/02/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE This study examined the association between a Dietary Inflammatory Score adapted for children (cDIS) and Cardiometabolic Risk (CMR) score in adolescence/early adulthood in the Avon Longitudinal Study of Parents and Children (ALSPAC). METHODS The cDIS was calculated at 7, 10 and 13 years using diet diary data. Anthropometric and biochemical data at 17 (N = 1937) and 24 (N = 1957) years were used to calculate CMR scores at each age [mean sex-specific z-scores from triacylglycerol, HDL-cholesterol, LDL-cholesterol, mean arterial blood pressure (MAP), homeostatic model assessment of insulin resistance (HOMA-IR) and fat-mass index (FMI)]. Multivariable linear regression models examined associations between cDIS at 7, 10 and 13 years and a continuous CMR z-score and individual CMR markers at 17 and 24 years. RESULTS In fully adjusted models, a higher cDIS (more pro-inflammatory diet) at 7 years was associated with an increase in CMR z-score at 17 years (β 0.19; 95% CI 0.03-0.35 for third versus first cDIS tertile) and at 24 years (β 0.28; 95% CI 0.11,0.44 for third versus first cDIS tertile). There was a weak association between a higher cDIS at 10 years and an increase in CMR z-score at 17 years (β 0.16; 95% CI - 0.003, 0.32 for third versus first cDIS tertile). No other clear associations were evident. FMI, MAP and HOMA-IR were the main CMR factors contributing to these associations. CONCLUSION A more pro-inflammatory diet during childhood was associated with a worse cardiometabolic profile in late adolescence/early adulthood. A childhood diet abundant in nutrients with anti-inflammatory properties could help reduce development of CMR factors.
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Affiliation(s)
- Genevieve Buckland
- Centre for Academic Child Health, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
| | - Kate Northstone
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Pauline M. Emmett
- Centre for Academic Child Health, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
| | - Caroline M. Taylor
- Centre for Academic Child Health, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
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Hernández-Ruiz Á, Díaz-Jereda LA, Madrigal C, Soto-Méndez MJ, Kuijsten A, Gil Á. Methodological Aspects of Diet Quality Indicators in Childhood: A Mapping Review. Adv Nutr 2021; 12:2435-2494. [PMID: 34192740 PMCID: PMC8634546 DOI: 10.1093/advances/nmab053] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 03/12/2021] [Accepted: 04/02/2021] [Indexed: 01/16/2023] Open
Abstract
Diet quality indicators (DQIns) are tools that aim to assess an individual's overall diet quality. Previous reviews focused mainly on health-related outcomes but did not provide detailed information about components, assessment variables, or important methodological issues for the development and application of DQIns in the pediatric age. The current mapping review aims to provide comprehensive guidance regarding DQIns developed through a priori methodology in children aged ≤14 y that have been applied worldwide. A mapping review was conducted, whereby 1665 original articles describing the development, modifications, and updates of DQIns, published up to June 26, 2020, in English and Spanish, were retrieved. A total of 139 articles were identified and classified into 13 subgroups. There were 10 overall DQIns: Healthy Eating Indexes (n = 25), Dietary Diversity Scores (n = 20), Diet Quality Indexes (n = 16), Food Variety Scores (n = 11), Healthy and Unhealthy Scores (n = 11), Feeding and Eating Indexes (n = 10), Diet Quality Scores (n = 5), Nutritional Adequacy and Micronutrients Indexes (n = 5), Dietary Guidelines Indexes (n = 5), and Other Healthy Diet Indexes (n = 13). Three additional subgroups of dietary and lifestyle indicators found were Mediterranean Diet Indexes (n = 10), Diet-Lifestyle Indexes (n = 5), and Breakfast Quality Indexes (n = 3). This compilation of DQIns will help researchers select the most appropriate tool for future epidemiological studies by considering a careful selection of information about the assessment components, scoring methods, and key methodological issues. The main limitations of this review are that, due to its nature, a risk-of-bias assessment was not performed and the article screening was completed in 2 databases (PubMed/MEDLINE and Scopus). More research is needed to identify health-related outcomes associated with DQIns in the pediatric population, using clearer and more standardized methodological criteria.
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Affiliation(s)
| | | | - Casandra Madrigal
- Iberoamerican Nutrition Foundation (FINUT), Granada, Spain
- Department of Nutrition and Food Science, Faculty of Pharmacy, University of Granada, Granada, Spain
| | | | - Anneleen Kuijsten
- Division of Human Nutrition and Health, Wageningen University, Wageningen, Netherlands
| | - Ángel Gil
- Iberoamerican Nutrition Foundation (FINUT), Granada, Spain
- Department of Biochemistry and Molecular Biology II, University of Granada, Granada, Spain
- Institute of Nutrition and Food Technology “José Mataix,” Biomedical Research Center, University of Granada, Granada, Spain
- Biosanitary Research Institute ibs.GRANADA, Granada University Hospital Complex, Granada, Spain
- CIBEROBN (Physiopathology of Obesity and Nutrition), Instituto de Salud Carlos III, Madrid, Spain
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Teixeira B, Afonso C, Rodrigues S, Oliveira A. Healthy and Sustainable Dietary Patterns in Children and Adolescents: A Systematic Review. Adv Nutr 2021; 13:1144-1185. [PMID: 34850824 PMCID: PMC9340991 DOI: 10.1093/advances/nmab148] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 10/18/2021] [Accepted: 11/24/2021] [Indexed: 01/02/2023] Open
Abstract
The need for adherence to a healthy and sustainable dietary pattern in the pediatric stage is discussed worldwide, being linked to a progressive incidence of noncommunicable diseases in adulthood. The aims of this systematic review were to summarize the healthy and/or sustainable dietary patterns, defined a priori, described in the literature for use during the pediatric stage; to evaluate the adherence to these dietary patterns; and identify the health-related benefits associated with adherence to these patterns. A literature search was carried out on Medline, Scopus, and Web of Science from 2010 up to 2021, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A total of 128 articles were included according to the following criteria: participants 2-17 y old, healthy and/or sustainable dietary patterns defined by an a priori methodology; articles written in English or Portuguese; and published since 2010. Fifty instruments with 14 adaptations that measure adherence to healthy and/or sustainable dietary patterns in children and adolescents were found. The Mediterranean Diet was the most studied dietary pattern. Adherence to healthy and/or sustainable dietary patterns has wide variations worldwide. Most of the instruments described have been little studied at pediatric ages, reducing the ability to extrapolate results. Higher adherence to these dietary patterns was associated with lower body fat, waist circumference, blood pressure, and metabolic risk. There is no consensus regarding the association with BMI. No studies have proofs of the sustainability characteristics of these instruments, it being necessary to produce a new sustainable instrument or test the association of the previous ones with, for example, the ecological footprint. Further validations of these instruments in each country and more prospective studies are needed to establish temporal relations with health-related outcomes. This systematic review was registered at www.crd.york.ac.uk/prospero/ as CRD42020221788.
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Affiliation(s)
| | - Cláudia Afonso
- Faculty of Nutrition and Food Sciences, University of Porto, Porto, Portugal,EPIUnit - Instituto de Saúde Pública, Universidade do Porto [Institute of Public Health, University of Porto], Porto, Portugal,Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), [Laboratory for Integrative and Translational Research in Population Health (ITR)], Porto, Portugal
| | - Sara Rodrigues
- Faculty of Nutrition and Food Sciences, University of Porto, Porto, Portugal,EPIUnit - Instituto de Saúde Pública, Universidade do Porto [Institute of Public Health, University of Porto], Porto, Portugal,Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), [Laboratory for Integrative and Translational Research in Population Health (ITR)], Porto, Portugal
| | - Andreia Oliveira
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto [Institute of Public Health, University of Porto], Porto, Portugal,Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), [Laboratory for Integrative and Translational Research in Population Health (ITR)], Porto, Portugal,Faculty of Medicine, University of Porto, Porto, Portugal
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Buckland G, Taylor CM, Emmett PM, Johnson L, Northstone K. Prospective association between a Mediterranean-style dietary score in childhood and cardiometabolic risk in young adults from the ALSPAC birth cohort. Eur J Nutr 2021; 61:737-752. [PMID: 34532761 PMCID: PMC8854247 DOI: 10.1007/s00394-021-02652-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 07/30/2021] [Indexed: 10/26/2022]
Abstract
PURPOSE To investigate the prospective association between a children's relative Mediterranean-style diet score (C-rMED) in childhood and a Cardiometabolic Risk (CMR) score in adolescence/young adulthood in the Avon Longitudinal Study of Parents and Children (ALSPAC). METHODS A C-rMED was calculated at 7, 10 and 13 years from diet diary data. Anthropometric and biochemical data at 17 (N = 1940) and 24 years (N = 1961) were used to calculate CMR scores (sum of sex-specific log-transformed z-scores from triacylglycerol, HDL cholesterol, LDL cholesterol, mean arterial blood pressure, homeostatic model assessment of insulin resistance (HOMA-IR) and fat mass index (FMI)). Adjusted logistic regression models examined associations between C-rMED (categorical and 2-unit increments) and a high CMR score (≥ 80th percentile) and individual CMR components (≥ 80th percentile). RESULTS A high C-rMED at 13 was associated with a 32% (OR 0.68 (95% CI: 0.49, 0.94)) decreased adjusted odds of having a high CMR score at 24 years, compared to participants with a low C-rMED. No associations were evident at other ages. Tracking of the C-rMED across the three ages showed a stronger negative association between C-rMED and CMR at 24 years when children had at least two high C-rMED scores from 7 to 13 years (adjusted OR: 0.49, 95% CI: 0.29, 0.85), compared to all low scores. FMI and HOMA-IR were the main CMR components contributing to this association. CONCLUSION Higher Mediterranean-style diet scores in early adolescence were associated with a better CMR profile in young adults (24 year olds). This underscores the importance of establishing healthy eating habits early in life for future cardiometabolic health.
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Affiliation(s)
- Genevieve Buckland
- Centre for Academic Child Health, Bristol Medical School, University of Bristol, Bristol, UK.
| | - Caroline M Taylor
- Centre for Academic Child Health, Bristol Medical School, University of Bristol, Bristol, UK
| | - Pauline M Emmett
- Centre for Academic Child Health, Bristol Medical School, University of Bristol, Bristol, UK
| | - Laura Johnson
- Centre for Exercise, Nutrition and Health Sciences, School of Policy Studies, University of Bristol, Bristol, UK
| | - Kate Northstone
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Cross-cultural measurement equivalence of the Healthy Eating Index adapted version for children aged 1-2 years. Br J Nutr 2021; 126:782-789. [PMID: 33234175 DOI: 10.1017/s0007114520004729] [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: 11/06/2022]
Abstract
The objectives of this study were to evaluate the cross-cultural measurement equivalence of the Healthy Eating Index (HEI) for children aged 1-2 years and to analyse the quality of nutrition of preterm infants. This was a cross-sectional study with 106 premature infants attended in two specialised outpatient clinics of university hospitals. The quality of the diet was analysed through an adapted HEI to meet the dietary recommendations of Brazilian children aged 1-2 years. Food consumption was measured by 24-h recalls. The reliability of the instrument was evaluated by internal consistency analysis and inter-observer reliability using Cronbach's α coefficient and κ with quadratic ponderation. The construct validity was evaluated by principal component analysis and by Spearman's correlation coefficient with total energy and consumption of some groups' food. The diet quality was considered adequate when the total HEI score was over 80 points. Cronbach's α was 0·54. Regarding inter-observer reliability, ten items showed strong agreement (κ > 0·8). The item scores had low correlations with energy consumed (r ≤ 0·30), and positive and moderate correlation of fruit (r 0·67), meat (r 0·60) and variety of diet (r 0·57) with total scores. When analysing the overall quality of the diet, most patients need improvement (median 78·7 points), which can be attributed to low total vegetable intake and the presence of ultraprocessed foods in the diet. The instrument showed auspicious psychometric properties, being promising to evaluate the quality of the diet in children aged 1-2 years.
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Bricarello LP, de Almeida Alves M, Retondario A, de Moura Souza A, de Vasconcelos FDAG. DASH diet (Dietary Approaches to Stop Hypertension) and overweight/obesity in adolescents: The ERICA study. Clin Nutr ESPEN 2021; 42:173-179. [PMID: 33745574 DOI: 10.1016/j.clnesp.2021.02.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 01/12/2021] [Accepted: 02/01/2021] [Indexed: 01/15/2023]
Abstract
BACKGROUND & AIMS Childhood and adolescent obesity is one of the most important issues in the global health of the population and has been increasing dramatically in recent decades. The aim of this study was to evaluate the association between overweight/obesity and the Dietary Approaches to Stop Hypertension (DASH) diet score in a representative sample of Brazilian adolescents. METHODS Data from the Study of Cardiovascular Risks in Adolescents (ERICA), a national school-based survey, were used. A total of 71,553 adolescents (12-17 years old), of both sexes, participated in the study; they had their anthropometric measurements taken and responded to a 24-h dietary recall. Eight food components of the DASH score were evaluated. 1) fruits (except fruit juices), 2) vegetables (except potatoes and beans), 3) pulses/nuts, 4) whole grains, 5) low-fat and diet/light dairy products, 6) sodium, 7) red and processed meats, and 8) sugary drinks and fruit juices. A higher score was indicative of greater accordance with the DASH diet, with a final score ranging from eight to 40 points. The association between overweight/obesity and the DASH score was assessed using Poisson regression models. RESULTS The highest prevalence of overweight/obesity was observed among boys aged 12-14 years (28.2%), white (27.7%), enrolled in private schools (32.4%) and among those who practiced ≥300 min physical activity/week (26.1%). The food groups most frequently consumed were sugary drinks, pulses and nuts, and red and processed meats. No association was found between overweight/obesity and the DASH diet score in Brazilian adolescents, in the adjusted analysis models. CONCLUSIONS Low consumption of foods considered protective and high consumption of health-risk foods, even among adolescents with greater accordance with the DASH diet, may have contributed to these findings. Public health measures are needed to prevent/reduce the prevalence of overweight/obesity in adolescence, as it is a risk for overweight/obesity in adulthood as well as other complications, leading to loss of quality of life for the individual and increased health spending.
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Affiliation(s)
| | | | | | - Amanda de Moura Souza
- Institute of Study in Public Health, Federal University of Rio de Janeiro, Ilha Do Fundão, Cidade Universitária, Rio de Janeiro, 21941-598, Brazil
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Indexes to assess feeding practices of children under 2 years old: a systematic review. Public Health Nutr 2021; 24:2033-2049. [PMID: 33504386 DOI: 10.1017/s1368980021000410] [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: 11/07/2022]
Abstract
OBJECTIVE To systematically review studies that used indexes to assess feeding practices of children under 2 years. DESIGN Seven databases were searched with no limit on language or publication date. SETTING The reviewed studies included thirteen Asian, ten Latin American, four European, four North American, three Oceanian and three African. PARTICIPANTS Children under 2 years. RESULTS We analysed thirty-six studies: twenty-two presenting original indexes and fourteen using adapted indexes. Among the original indexes, thirteen assess breast-feeding, fourteen food consumption, ten food groups, and ten other feeding practices. Original indexes were mainly adapted to fit the data available in the study, to update for current nutritional recommendations or to add components not present in the original indexes. Seven studies evaluated the associations between the indexes and nutrient intake or nutritional status. The main limitations cited by the authors were: flaws in the definition of the index components, criteria for cut-off points and weighting of the evaluated index components. CONCLUSIONS The assessment of feeding practices for young children and its comparison across countries remains a challenge, especially due to the lack of consensus on the construction of indexes and regional differences in dietary recommendations and practices. Lack of validation for some indexes also makes it difficult to choose the most appropriate index for a given objective. Adapting existing indexes is a viable option. We point out relevant recommendations that may contribute to future research. Validation and longitudinal studies in diverse populations are favourable to qualify the assessment of feeding practices in this group.
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Abstract
BACKGROUND Low-income racially and ethnically diverse children are at higher risk for obesity compared with their counterparts; yet, few studies have assessed their diet quality. OBJECTIVE The aim of the study was to evaluate the diet quality of a racially and ethnically diverse cohort of 2-year-olds using the Healthy Eating Index (HEI)-2010. METHODS We used 24-hour dietary recall data from caregivers of toddlers (24-34 months) at 4 pediatric resident clinics that participated in the Greenlight Study to calculate compliance with the Dietary Guidelines for Americans (DGA) using total HEI score (range 0-100) and 12 component scores. RESULTS Participants (n = 231) were mostly Hispanic (57%) or non-Hispanic black (27%) and from low-income families. Mean HEI-2010 score was 62.8 (standard deviation [SD] 10.5). Though not significant, Hispanics had the highest HEI score. Toddlers of caregivers without obesity, older than 35 years and born outside the United States had higher HEI scores. Most had high HEI component scores for dairy, fruit, and protein foods, but few achieved maximum scores, particularly for whole grains (13%), vegetables (10%), and fatty acid ratio (7%). CONCLUSIONS Despite scores reflective of DGA recommendations for fruit, dairy and protein foods, toddlers in this diverse sample had low quality diets as measured by the HEI, driven largely by low component scores for whole grains, vegetables, and ratio of unsaturated to saturated fatty acids.
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Shang X, Li Y, Xu H, Zhang Q, Liu A, Du S, Guo H, Ma G. Leading dietary determinants identified using machine learning techniques and a healthy diet score for changes in cardiometabolic risk factors in children: a longitudinal analysis. Nutr J 2020; 19:105. [PMID: 32950062 PMCID: PMC7502204 DOI: 10.1186/s12937-020-00611-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 08/24/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Identifying leading dietary determinants for cardiometabolic risk (CMR) factors is urgent for prioritizing interventions in children. We aimed to identify leading dietary determinants for the change in CMR and create a healthy diet score (HDS) to predict CMR in children. METHODS We included 5676 children aged 6-13 years in the final analysis with physical examinations, blood tests, and diets assessed at baseline and one year later. CMR score (CMRS) was computed by summing Z-scores of waist circumference, an average of systolic and diastolic blood pressure (SBP and DBP), fasting glucose, high-density lipoprotein cholesterol (HDL-C, multiplying by - 1), and triglycerides. Machine learning was used to identify leading dietary determinants for CMR and an HDS was then computed. RESULTS The nine leading predictors for CMRS were refined grains, seafood, fried foods, sugar-sweetened beverages, wheat, red meat other than pork, rice, fungi and algae, and roots and tubers with the contribution ranging from 3.9 to 19.6% of the total variance. Diets high in seafood, rice, and red meat other than pork but low in other six food groups were associated with a favorable change in CMRS. The HDS was computed based on these nine dietary factors. Children with HDS ≥8 had a higher decrease in CMRS (β (95% CI): - 1.02 (- 1.31, - 0.73)), BMI (- 0.08 (- 0.16, - 0.00)), SBP (- 0.46 (- 0.58, - 0.34)), DBP (- 0.46 (- 0.58, - 0.34)), mean arterial pressure (- 0.50 (- 0.62, - 0.38)), fasting glucose (- 0.22 (- 0.32, - 0.11)), insulin (- 0.52 (- 0.71, - 0.32)), and HOMA-IR (- 0.55 (- 0.73, - 0.36)) compared to those with HDS ≦3. Improved HDS during follow-up was associated with favorable changes in CMRS, BMI, percent body fat, SBP, DBP, mean arterial pressure, HDL-C, fasting glucose, insulin, and HOMA-IR. CONCLUSION Diets high in seafood, rice, and red meat other than pork and low in refined grains, fried foods, sugar-sweetened beverages, and wheat are leading healthy dietary factors for metabolic health in children. HDS is strongly predictive of CMR factors.
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Affiliation(s)
- Xianwen Shang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China.,School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, Australia.,Department of Medicine (Royal Melbourne Hospital), University of Melbourne, Melbourne, Australia
| | - Yanping Li
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Haiquan Xu
- Institute of food and nutrition development, Ministry of Agriculture and Rural Affairs, Beijing, China
| | - Qian Zhang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Ailing Liu
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | | | - Hongwei Guo
- School of Public Health, Fudan University, Shanghai, China
| | - Guansheng Ma
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, 38 Xue Yuan Road, Beijing, 100191, China.
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Wu H, Yuan YQ, Wang YC, Zhou XF, Liu SJ, Cai MQ, He GS, Li SG, Zang JJ, Chen B. The development of a Chinese Healthy Eating Index for School-age Children and its Application in children from China Health and Nutrition Survey. Int J Food Sci Nutr 2020; 72:280-291. [PMID: 32718190 DOI: 10.1080/09637486.2020.1796930] [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: 10/23/2022]
Abstract
This study aimed to develop a Chinese Healthy Eating Index for School-age Children (CHEI-SC), apply it in the 2011 China Health and Nutrition Survey (CHNS) to assess dietary quality, and compared it with our former developed index named CHEI. Data of 3-day 24-hour diet recalls and household food inventory survey from 1600 school-age children in CHNS-2011 were used to develop the CHEI-SC, using the methods of standard portion size, energy-density-based approach, and least restrictive approach. The CHEI-SC included 19 components with a total score (T-score) ranging from 0 to 100. The investigated children had a median score of 49.6. Children with a higher T-score were more likely to have higher social economic status (SES), higher level of urbanisation, fewer family size, and regularly attending school. The CHEI-SC was able to assess dietary quality of Chinese school-age children, was sensitive to demographics, and more comprehensive and accurate than the CHEI.
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Affiliation(s)
- Han Wu
- Key Laboratory of Public Health Safety of Ministry of Education, Collaborative Innovation Center of Social Risks Governance in Health, School of Public Health, Fudan University, Shanghai, China
| | - Ya-Qun Yuan
- Key Laboratory of Public Health Safety of Ministry of Education, Collaborative Innovation Center of Social Risks Governance in Health, School of Public Health, Fudan University, Shanghai, China
| | - Ying-Chuan Wang
- Key Laboratory of Public Health Safety of Ministry of Education, Collaborative Innovation Center of Social Risks Governance in Health, School of Public Health, Fudan University, Shanghai, China
| | - Xiao-Feng Zhou
- Key Laboratory of Public Health Safety of Ministry of Education, Collaborative Innovation Center of Social Risks Governance in Health, School of Public Health, Fudan University, Shanghai, China
| | - Shao-Jie Liu
- Key Laboratory of Public Health Safety of Ministry of Education, Collaborative Innovation Center of Social Risks Governance in Health, School of Public Health, Fudan University, Shanghai, China
| | - Mei-Qin Cai
- Department of Nutrition, School of Medicine Shanghai Jiao Tong University, Shanghai, China
| | - Geng-Sheng He
- Key Laboratory of Public Health Safety of Ministry of Education, Collaborative Innovation Center of Social Risks Governance in Health, School of Public Health, Fudan University, Shanghai, China
| | - Shu-Guang Li
- Key Laboratory of Public Health Safety of Ministry of Education, Collaborative Innovation Center of Social Risks Governance in Health, School of Public Health, Fudan University, Shanghai, China
| | - Jia-Jie Zang
- Department of Nutrition Hygiene, Division of Health Risk Factor Monitoring and Control, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Bo Chen
- Key Laboratory of Public Health Safety of Ministry of Education, Collaborative Innovation Center of Social Risks Governance in Health, School of Public Health, Fudan University, Shanghai, China
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Bérard S, Morel S, Teasdale E, Shivappa N, Hebert JR, Laverdière C, Sinnett D, Levy E, Marcil V. Diet Quality Is Associated with Cardiometabolic Outcomes in Survivors of Childhood Leukemia. Nutrients 2020; 12:nu12072137. [PMID: 32708379 PMCID: PMC7400871 DOI: 10.3390/nu12072137] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 07/14/2020] [Accepted: 07/15/2020] [Indexed: 12/12/2022] Open
Abstract
There is little information about how diet influences the health of childhood acute lymphoblastic leukemia (cALL) survivors. This study explores the associations between diet quality indices, cardiometabolic health indicators and inflammatory biomarkers among cALL survivors. Participants were part of the PETALE study (n = 241, median age: 21.7 years). Adherence to 6 dietary scores and caloric intake from ultra-processed foods were calculated. Multivariate logistirac regressions, Student t-tests and Mann-Whitney tests were performed. We found that 88% of adults and 46% of children adhered poorly to the Mediterranean diet, 36.9% had poor adherence to the World Health Organisation (WHO) recommendations and 76.3% had a diet to be improved according to the HEI-2015 score. On average, ultra-processed foods accounted for 51% of total energy intake. Low HDL-C was associated with a more inflammatory diet (E-DIITM score) and higher intake of ultra-processed foods. A greater E-DII score was associated with elevated insulin resistance (HOMA-IR), and consumption of ultra-processed foods was correlated with high triglycerides. Circulating levels of TNF-α, adiponectin and IL-6 were influenced by diet quality indices, while CRP and leptin were not. In conclusion, survivors of cALL have poor adherence to dietary recommendations, adversely affecting their cardiometabolic health.
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Affiliation(s)
- Sophie Bérard
- Research Centre, Sainte-Justine University Health Center, Department of Nutrition, Université de Montréal, Montreal, QC H3T 1C5, Canada; (S.B.); (S.M.); (E.T.); (E.L.)
- Institute of Nutrition and Functional Foods, Laval University, Quebec City, QC G1V 0A6, Canada
| | - Sophia Morel
- Research Centre, Sainte-Justine University Health Center, Department of Nutrition, Université de Montréal, Montreal, QC H3T 1C5, Canada; (S.B.); (S.M.); (E.T.); (E.L.)
- Institute of Nutrition and Functional Foods, Laval University, Quebec City, QC G1V 0A6, Canada
| | - Emma Teasdale
- Research Centre, Sainte-Justine University Health Center, Department of Nutrition, Université de Montréal, Montreal, QC H3T 1C5, Canada; (S.B.); (S.M.); (E.T.); (E.L.)
| | - Nitin Shivappa
- Cancer Prevention and Control Program, University of South Carolina, Columbia, SC 29208, USA; (N.S.); (J.R.H.)
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA
| | - James R. Hebert
- Cancer Prevention and Control Program, University of South Carolina, Columbia, SC 29208, USA; (N.S.); (J.R.H.)
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA
| | - Caroline Laverdière
- Research Centre, Sainte-Justine University Health Center, Department of Pediatrics, Université de Montréal, Montreal, QC H3T 1C5, Canada; (C.L.); (D.S.)
| | - Daniel Sinnett
- Research Centre, Sainte-Justine University Health Center, Department of Pediatrics, Université de Montréal, Montreal, QC H3T 1C5, Canada; (C.L.); (D.S.)
| | - Emile Levy
- Research Centre, Sainte-Justine University Health Center, Department of Nutrition, Université de Montréal, Montreal, QC H3T 1C5, Canada; (S.B.); (S.M.); (E.T.); (E.L.)
- 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; (S.B.); (S.M.); (E.T.); (E.L.)
- Institute of Nutrition and Functional Foods, Laval University, Quebec City, QC G1V 0A6, Canada
- Correspondence: ; Tel.: +1-514-345-4931 (ext. 3272)
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Trijsburg L, Talsma EF, de Vries JHM, Kennedy G, Kuijsten A, Brouwer ID. Diet quality indices for research in low- and middle-income countries: a systematic review. Nutr Rev 2019; 77:515-540. [PMID: 31127835 PMCID: PMC6609420 DOI: 10.1093/nutrit/nuz017] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
CONTEXT Dietary intake research has increasingly focused on improving diet quality in low- and middle-income countries (LMICs). Accompanying this is the need for sound metrics to assess diet quality. OBJECTIVE This systematic literature review aims to describe existing diet quality indices for general populations and highlights recommendations for developing such indices for food system research in LMICs. DATA SOURCES Three electronic databases were searched for papers published between January 2008 and December 2017. DATA EXTRACTION Articles published in English and describing the development of an index to measure overall diet quality, irrespective of whether they were for high-income countries or LMICs, were included. DATA ANALYSIS Eighty-one indices were identified, over two thirds were based on national dietary guidelines from high-income countries. Of the 3 key diet quality dimensions, "diversity" was included in all 18 indices developed for LMICs, "moderation" was captured by most, and "nutrient adequacy" was included 4 times. CONCLUSIONS Indices need to be developed that include all dimensions, include foods and/or food groups rather than nutrients, use an optimal range for individual components in the score, and express the intake of healthy and unhealthy components separately. Importantly, validation of the index should be part of its development.
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Affiliation(s)
- Laura Trijsburg
- Division of Human Nutrition, Wageningen University, Wageningen, the Netherlands
| | - Elise F Talsma
- Division of Human Nutrition, Wageningen University, Wageningen, the Netherlands
| | - Jeanne H M de Vries
- Division of Human Nutrition, Wageningen University, Wageningen, the Netherlands
| | | | - Anneleen Kuijsten
- Division of Human Nutrition, Wageningen University, Wageningen, the Netherlands
| | - Inge D Brouwer
- Division of Human Nutrition, Wageningen University, Wageningen, the Netherlands
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Night-time cardiac autonomic modulation as a function of sleep-wake stages is modified in otherwise healthy overweight adolescents. Sleep Med 2019; 64:30-36. [PMID: 31655323 DOI: 10.1016/j.sleep.2019.06.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 05/31/2019] [Accepted: 06/01/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Even though sympathetic dominance during the daytime period is well known, currently, scarce data exist on autonomic nervous system (ANS) regulation during sleep in pediatric obesity. We aimed to evaluate sleep cardiac ANS regulation in normal-weight (NW) and overweight and obese (OW) adolescents. PATIENTS/METHODS In this study, 60 healthy adolescents (15.7 ± 0.7 years) belonging to a birth cohort since infancy were classified based on body mass index percentiles criteria as: OW (N = 27) or NW (N = 33). Sleep was evaluated by polysomnography (PSG) during two consecutive in-lab overnight sessions. Non-rapid eye movement (non-REM) sleep stages (stages 1, 2, and slow-wave sleep [SWS]), rapid eye movement (REM) sleep, and wakefulness (Wake) were scored. R-waves were detected automatically in the electrocardiographic (ECG) signal. An all-night heart rate variability analysis was conducted in the ECG signal, with several time- and frequency-domain measures calculated for each sleep-wake stage. Sleep time was divided into thirds (T1, T2, T3). The analysis was performed using a mixed-effects linear regression model. RESULTS Sleep organization was comparable except for reduced REM sleep percentage in the OW group (p < 0.04). Shorter R-R intervals were found for all sleep stages in the OW group; time-domain measured standard deviation of all R-R intervals (RRSD) was lower during stage 2, SWS and REM sleep (all p < 0.05). The square root of the mean of the sum of the squares of differences between adjacent R-R intervals (RMSSD) was also lower only during wake after sleep onset (WASO) in T1 and T3 (p < 0.05). The OW group had increased very low- and low-frequency (LF) power during WASO (in T1 and T2), and LF power during stage 2 and REM sleep (in T2). During WASO in the OW group, high-frequency (HF) power was lower (in T1 and T2), and LF/HF ratio was higher (in T2, p < 0.007). CONCLUSIONS Several sleep-stage-dependent changes in cardiac autonomic regulation characterized the OW group. As sleep-related ANS balance was disturbed in the absence of concomitant metabolic alterations in this sample of otherwise healthy OW adolescents, their relevance for pediatric obesity should be further explored throughout development.
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Vadiveloo M, Tovar A, Østbye T, Benjamin-Neelon SE. Associations between timing and quality of solid food introduction with infant weight-for-length z-scores at 12 months: Findings from the Nurture cohort. Appetite 2019; 141:104299. [PMID: 31132424 DOI: 10.1016/j.appet.2019.05.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 04/24/2019] [Accepted: 05/23/2019] [Indexed: 12/28/2022]
Abstract
This study assesses associations of the timing and quality of solid foods introduced during infancy with weight-for-length (WFL) z-scores at 12 months within the Nurture cohort. Women from North Carolina self-reported sociodemographics, the timing and type of solid food introduction, and reasons for introducing solids; infant anthropometrics were measured every 3 months through 1 year (n = 666). Frequency (0-5x/day) infants consumed fruits and vegetables was used to compute a mean (4-12 months) healthy food score (HFS), and sweets, french fries, snacks, and ice cream was used to compute a mean unhealthy food score (UnHFS). Multivariable-adjusted generalized linear models were used to examine the relationship of early solid food introduction, HFS quartiles (Q), UnHFS quartiles, and interactions between these variables with WFL z-scores at 12 months (n = 449). Exploratory analyses evaluated WFL z-scores among 4 groups of infants with high/low HFS and high/low UnHFS. On average, mothers were 28 years with a pre-pregnancy BMI of 30.5 kg/m2; 65% were Non-Hispanic Black, and 59% had incomes <$20,000. Mean HFS and UnHFS were 2.4 (range 0-7.4 of 10) and 1.8 (range 0-9.9 of 20), respectively. Nearly 1/3 of mothers introduced solids early, but early introduction and the HFS were not associated with WFL z-scores. Infants in Q3 and Q4 of the UnHFS had higher WFL z-scores (0.75-0.79 ± 0.09) compared to infants in Q1 (0.42 ± 0.0.9), p < 0.05. Frequent unhealthy food intake was associated with higher WFL z-scores at 12-months, underscoring the importance of reducing unhealthy food intake in the first year.
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Affiliation(s)
- Maya Vadiveloo
- Department of Nutrition and Food Sciences, University of Rhode Island, 41 Lower College Rd, Kingston, RI, 02881, USA.
| | - Alison Tovar
- Department of Nutrition and Food Sciences, University of Rhode Island, 41 Lower College Rd, Kingston, RI, 02881, USA
| | - Truls Østbye
- Department of Community and Family Medicine, Duke University Medical Center, DUMC 2914, Durham, NC, 27710, USA
| | - Sara E Benjamin-Neelon
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD, 21205, USA
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Johnson BJ, Grieger JA, Wycherley TP, Golley RK. Theoretical Reductions in Discretionary Choices Intake via Moderation, Substitution, and Reformulation Dietary Strategies Show Improvements in Nutritional Profile: A Simulation Study in Australian 2- to 18-Year-Olds. J Acad Nutr Diet 2019; 119:782-798.e6. [DOI: 10.1016/j.jand.2018.10.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 10/03/2018] [Accepted: 10/16/2018] [Indexed: 11/25/2022]
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Ronca DB, Blume CA, Cureau FV, Camey SA, Leotti VB, Drehmer M, Schaan BD, de Carvalho KMB. Diet quality index for Brazilian adolescents: the ERICA study. Eur J Nutr 2019; 59:539-556. [PMID: 30963230 DOI: 10.1007/s00394-019-01923-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 02/03/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE This study aimed to assess the dietary patterns of adolescents using a food-based diet quality index and their compliance with a healthy dietary guideline METHODS: Participants included 71,553 Brazilian adolescents (12-17 years old) from the Study of Cardiovascular Risks in Adolescents (ERICA), a cross-sectional school-based multicenter study.. Dietary intake was measured by one 24-h recall. A second recall was collected in a random subsample (~ 10%) to correct within-person variability. The Diet Quality Index for Adolescents adapted for Brazilians (DQIA-BR) was used to measure the overall quality of the dietary intake. The National Cancer Institute method was applied to estimate usual dietary intake. The DQIA-BR and the distribution of its components (quality, diversity, and equilibrium) were analyzed according to sex, geographical area, and type of school RESULTS: The mean (SD) DQIA-BR scores were 14.8% (6.1%) for females and 19.0% (6.3%) for males. All analyzed strata revealed low scores of DQIA-BR and its components. The median usual intake was five to sevenfold below the recommendations for vegetables and fruits and approximately twofold below the recommendations for dairy. The highest DQIA-BR mean scores were found in the northern region [17.0% (6.4%), females; 20.7% (6.3%), males]. Adolescents in both types of schools had relatively similar median intakes of snacks (~ 85 g) and sugared drinks (~ 600 ml) CONCLUSIONS: The overall diet quality of Brazilian adolescents is inadequate based on evaluated parameters in all regions and socioeconomic backgrounds.
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Affiliation(s)
- Débora Barbosa Ronca
- Graduate Program in Human Nutrition, Universidade de Brasília, Brasília, Brazil.
| | - Carina Andriatta Blume
- Postgraduate Program in Medical Sciences: Endocrinology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Felipe Vogt Cureau
- Postgraduate Program in Medical Sciences: Endocrinology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Suzi Alves Camey
- Postgraduate Program in Epidemiology, Department of Statistics, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Vanessa Bielefeldt Leotti
- Postgraduate Program in Epidemiology, Department of Statistics, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Michele Drehmer
- Postgraduate Program in Epidemiology, Department of Nutrition and Food and Nutrition Research Center, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Beatriz D Schaan
- Postgraduate Program in Medical Sciences: Endocrinology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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Lovell AL, Milne T, Jiang Y, Chen RX, Grant CC, Wall CR. Evaluation of the Effect of a Growing up Milk Lite vs. Cow's Milk on Diet Quality and Dietary Intakes in Early Childhood: The Growing up Milk Lite (GUMLi) Randomised Controlled Trial. Nutrients 2019; 11:E203. [PMID: 30669521 PMCID: PMC6356321 DOI: 10.3390/nu11010203] [Citation(s) in RCA: 11] [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: 12/29/2018] [Revised: 01/12/2019] [Accepted: 01/15/2019] [Indexed: 12/19/2022] Open
Abstract
scores provide an alternative approach to measuring dietary quality. The Growing Up Milk-Lite (GUMLi) Trial was a multi-centre, double-blinded, randomised controlled trial of children randomised to receive a reduced protein GUM (GUMLi) or unfortified cow's milk (CM). In a secondary analysis of the GUMLi Trial, we used the Probability of Adequate Nutrient Intake (PANDiet) to determine the nutritional adequacy of the diets of participating children living in Auckland. The PANDiet was adapted to the New Zealand Nutrient Reference Values and data from four 24 h Recalls (24HR) collected at months 7, 8, 10, and 11 post-randomisation were used. Differences between randomised groups (GUMLi vs. CM) of the PANDiet and its components were made. Eighty-three Auckland participants were included in the study (GUMLi n = 41 vs. CM n = 42). Total PANDiet scores were significantly higher in the GUMLi group (p < 0.001), indicating better overall nutrient adequacy and diet quality. Dietary intakes of children in both groups met the recommendations for fat, total carbohydrates and most micronutrients; however, protein intakes exceeded recommendations. Consumption of GUMLi was associated with higher nutritional adequacy, with an increased likelihood of meeting nutrient requirements; however, the impact of the family diet and GUMLi on dietary diversity requires further evaluation.
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Affiliation(s)
- Amy L Lovell
- Discipline of Nutrition and Dietetics, Faculty of Medical and Health Sciences, University of Auckland, Auckland 1142, New Zealand.
| | - Tania Milne
- Faculty of Medical and Health Sciences, University of Auckland, Auckland 1142, New Zealand.
| | - Yannan Jiang
- Department of Statistics, Faculty of Science, University of Auckland, Auckland 1142, New Zealand.
| | - Rachel X Chen
- Department of Statistics, Faculty of Science, University of Auckland, Auckland 1142, New Zealand.
| | - Cameron C Grant
- Department of Paediatrics: Child and Youth Health, University of Auckland, Grafton 1023, New Zealand.
- Centre for Longitudinal Research He Ara ki Mua, University of Auckland, Auckland 1743, New Zealand.
- General Paediatrics, Starship Children's Hospital, Auckland District Health Board, Auckland, Auckland 1142, New Zealand.
| | - Clare R Wall
- Discipline of Nutrition and Dietetics, Faculty of Medical and Health Sciences, University of Auckland, Auckland 1142, New Zealand.
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Childhood dietary trajectories and adolescent cardiovascular phenotypes: Australian community-based longitudinal study. Public Health Nutr 2018; 21:2642-2653. [PMID: 29947308 DOI: 10.1017/s1368980018001398] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE With the intention to inform future public health initiatives, we aimed to determine the extent to which typical childhood dietary trajectories predict adolescent cardiovascular phenotypes. DESIGN Longitudinal study. Exposure was determined by a 4 d food diary repeated over eight waves (ages 4-15 years), coded by Australian Dietary Guidelines and summed into a continuous diet score (0-14). Outcomes were adolescent (Wave 8, age 15 years) blood pressure, resting heart rate, pulse wave velocity, carotid intima-media thickness, retinal arteriole-to-venule ratio. Latent class analysis identified 'typical' dietary trajectories from childhood to adolescence. Adjusted linear regression models assessed relationships between trajectories and cardiovascular outcomes, adjusted for a priori potential confounders. SETTING Community sample, Melbourne, Australia. SUBJECTS Children (n 188) followed from age 4 to 15 years. RESULTS Four dietary trajectories were identified: unhealthy (8 %); moderately unhealthy (25 %); moderately healthy (46 %); healthy (21 %). There was little evidence that vascular phenotypes associated with the trajectories. However, resting heart rate (beats/min) increased (β; 95 % CI) across the healthy (reference), moderately healthy (4·1; -0·6, 8·9; P=0·08), moderately unhealthy (4·5; -0·7, 9·7; P=0·09) and unhealthy (10·5; 2·9, 18·0; P=0·01) trajectories. CONCLUSIONS Decade-long dietary trajectories did not appear to influence macro- or microvascular structure or stiffness by mid-adolescence, but were associated with resting heart rate, suggesting an early-life window for prevention. Larger studies are needed to confirm these findings, the threshold of diet quality associated with these physiological changes and whether functional changes in heart rate are followed by phenotypic change.
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Measures of low food variety and poor dietary quality in a cross-sectional study of London school children. Eur J Clin Nutr 2018; 72:1497-1505. [PMID: 29391590 DOI: 10.1038/s41430-017-0070-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 07/21/2017] [Accepted: 10/10/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND/OBJECTIVES The use of simple screening tools to measure nutritional adequacy in a public health context in developed countries are currently lacking. We explore the relationship between food variety and nutrient intake of London school children using a simple tool with potential use for screening for inadequate diets. SUBJECTS/METHODS A cross-sectional survey was carried out in 2010. The survey included 2579 children aged 7-10 years in 52 primary schools in East London in the United Kingdom. The analysis included 2392 children (93% of the original sample). Food variety was assessed as the total number of listed foods recorded over 24 h using the validated Child and Diet Assessment Tool (CADET) comprising 115 listed foods divided into 16 food categories. Dietary quality was determined by the proportion of children meeting recommended intakes of individual micronutrients, namely, calcium, iron, zinc, folate, vitamin A and vitamin C. RESULTS The mean number of CADET-listed foods consumed daily by children was 17.1 (95% CI: 16.8, 17.5). Children who consumed fewer than 11 foods on the collection day had particularly low nutrient intakes. Children consuming three different vegetables and two different fruits on average consumed 19-20 listed foods. It was estimated between 4 and 20% of children did not meet the recommended levels for individual micronutrients during the period of data collection. CONCLUSIONS A simple method using food counts to assess daily food variety may help public health nutritionists identify groups of children at risk of inadequate diets.
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Kunaratnam K, Halaki M, Wen LM, Baur LA, Flood VM. Reliability and comparative validity of a Diet Quality Index for assessing dietary patterns of preschool-aged children in Sydney, Australia. Eur J Clin Nutr 2017; 72:464-468. [PMID: 29249825 DOI: 10.1038/s41430-017-0020-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Revised: 09/08/2017] [Accepted: 09/08/2017] [Indexed: 11/09/2022]
Abstract
BACKGROUND/OBJECTIVES To report on the reliability and validity of a Diet Quality Index (DQI) to assess preschoolers dietary patterns using a short food frequency questionnaire (sFFQ) and 3-day food records (3d-FR). SUBJECTS/METHODS Seventy-seven preschool carers/parents completed a telephone interview on preschoolers (2-5-year olds) dietary habits in metropolitan Sydney. Agreement in scores was assessed using intraclass correlation (ICC) and paired t-tests for repeated sFFQ-DQI scores and Bland-Altman methods and paired t-tests for sFFQ-DQI and 3d-FR-DQI scores. RESULTS Mean-total sFFQ-DQI ICC scores was high = 0.89, 95% CI (0.81, 0.93). There was weak agreement between sFFQ-DQI and 3d-FR-DQI scores (r = 0.36, p < 0.01). The 3d-FR-DQI scores were positively associated with carbohydrate, folate, ß-carotene, magnesium, calcium, protein, total fat and negatively associated with sugar, starch, niacin, vitamin C, phosphorus, polyunsaturated fat, and monounsaturated fat. CONCLUSIONS The sFFQ-DQI demonstrated good reliability but weak validity. Associations between nutrients and 3d-FR-DQI scores indicate promising usability and warrants further investigation. Further research is needed to establish its validity in accurately scoring children's diet quality using sFFQ compared to 3d-FR before the tool can be implemented for use in population settings.
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Affiliation(s)
- Kanita Kunaratnam
- Faculty of Health Sciences, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Mark Halaki
- Faculty of Health Sciences, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Li Ming Wen
- Health Promotion Service, Sydney Local Health District, Sydney, NSW, 2006, Australia.,School of Public Health, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Louise A Baur
- School of Public Health, The University of Sydney, Sydney, NSW, 2006, Australia.,Discipline of Pediatrics and Child Health, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Victoria M Flood
- Faculty of Health Sciences, The University of Sydney, Sydney, NSW, 2006, Australia. .,Westmead Hospital (Western Sydney Local Health District), Sydney, NSW, 2145, Australia.
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The Association between Parent Diet Quality and Child Dietary Patterns in Nine- to Eleven-Year-Old Children from Dunedin, New Zealand. Nutrients 2017; 9:nu9050483. [PMID: 28492490 PMCID: PMC5452213 DOI: 10.3390/nu9050483] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 04/26/2017] [Accepted: 05/04/2017] [Indexed: 12/20/2022] Open
Abstract
Previous research investigating the relationship between parents’ and children’s diets has focused on single foods or nutrients, and not on global diet, which may be more important for good health. The aim of the study was to investigate the relationship between parental diet quality and child dietary patterns. A cross-sectional survey was conducted in 17 primary schools in Dunedin, New Zealand. Information on food consumption and related factors in children and their primary caregiver/parent were collected. Principal component analysis (PCA) was used to investigate dietary patterns in children and diet quality index (DQI) scores were calculated in parents. Relationships between parental DQI and child dietary patterns were examined in 401 child-parent pairs using mixed regression models. PCA generated two patterns; ‘Fruit and Vegetables’ and ‘Snacks’. A one unit higher parental DQI score was associated with a 0.03SD (CI: 0.02, 0.04) lower child ‘Snacks’ score. There was no significant relationship between ‘Fruit and Vegetables’ score and parental diet quality. Higher parental diet quality was associated with a lower dietary pattern score in children that was characterised by a lower consumption frequency of confectionery, chocolate, cakes, biscuits and savoury snacks. These results highlight the importance of parental modelling, in terms of their dietary choices, on the diet of children.
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Rodrigues PRM, Luiz RR, Monteiro LS, Ferreira MG, Gonçalves-Silva RMV, Pereira RA. Adolescents' unhealthy eating habits are associated with meal skipping. Nutrition 2017; 42:114-120.e1. [PMID: 28596058 DOI: 10.1016/j.nut.2017.03.011] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 03/23/2017] [Accepted: 03/27/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Meal consumption and diet quality are important for healthy development during adolescence. The aim of this study was to determine the association between meal habits and diet quality in Brazilian adolescents. METHODS A school-based, cross-sectional study was conducted in 2008 with a probabilistic sample of adolescents ages 14 to 19 y (N = 1139) from high schools in central-western Brazil. Consumption of breakfast, morning snack, lunch, afternoon snack, and dinner was assessed to evaluate adolescents' meal profile. The Brazilian Healthy Eating Index-Revised (BHEI-R) was calculated to evaluate diet quality. The association between meal profile and BHEI-R (global estimates and components) was assessed using multivariate linear regression models. RESULTS Diet was characterized by unhealthy eating: a low consumption of fruits, vegetables, and milk/dairy, and a high consumption of fats and sodium. An unsatisfactory meal profile was observed in 14% of adolescents, whereas daily consumption of breakfast, lunch, and dinner was reported by 47%, 78%, and 52% of adolescents, respectively. Meal profile was positively associated with diet quality. Daily consumption of breakfast was associated with higher BHEI-R scores, lower sodium intake, and greater consumption of fruits and milk/dairy. Daily consumption of lunch was associated with greater consumption of vegetables and "meats, eggs, and legumes," whereas consumption of dinner was associated with an increased consumption of "whole fruits." CONCLUSION This study showed a parallelism between daily consumption of meals with healthier eating and greater adherence to traditional Brazilian food habits. Skipping meals was associated with a low-quality diet, especially concerning to the low consumption of fruits and vegetables and a high intake of sodium and calories from solid fats, added sugars, and alcoholic beverages. Therefore, the adoption of regular meal habits may help adolescents improve their diet quality.
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Affiliation(s)
| | - Ronir Raggio Luiz
- Instituto de Estudos em Saúde Coletiva, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Luana Silva Monteiro
- Faculdade de Nutrição - Universidade Federal do Rio de Janeiro/Campus Macaé Prof. Aloísio Teixeira, Rio de Janeiro, Brazil
| | | | | | - Rosangela Alves Pereira
- Departamento de Nutrição Social e Aplicada, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
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Iaccarino Idelson P, Scalfi L, Valerio G. Adherence to the Mediterranean Diet in children and adolescents: A systematic review. Nutr Metab Cardiovasc Dis 2017; 27:283-299. [PMID: 28254269 DOI: 10.1016/j.numecd.2017.01.002] [Citation(s) in RCA: 184] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 12/31/2016] [Accepted: 01/03/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIM A decreased adherence to the Mediterranean Diet (MD) may be related to a rise in chronic non-communicable diseases from childhood onward. The aim of this systematic review was to summarize the available literature regarding MD adherence in children and adolescents, and focusing, more specifically, on the association of MD adherence with demographic and anthropometric variables, body composition, lifestyle, and diet adequacy. METHODS AND RESULTS A search of scientific literature was carried out on PUBMED, SCOPUS, Clinical Trials Results, Google Scholar, and British Library Inside for studies published in the last 20 years. Fifty-eight papers were finally included according to the following criteria: MD adherence evaluated through a quantifying score or index, age 2-20 years, sample size >200 participants, observational or intervention studies regarding the general population. The KIDMED index was the most widely used scoring system. MD adherence widely varied within the Mediterranean countries for both children and adolescents, with also large differences among various European countries, while few data are available for non-Mediterranean countries. Most of the eligible studies showed that MD adherence was directly associated with physical activity (and possibly with diet adequacy) and inversely with sedentary behavior, while the results for gender, age, socioeconomic status and weight status were not consistent. CONCLUSIONS Further validation of MD indexes in terms of reproducibility and consistency with the MD is needed. At the same time, more prospective cohort and intervention studies may better elucidate the relationships of MD adherence with behavioral and health outcomes.
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Affiliation(s)
- P Iaccarino Idelson
- Department of Public Health, School of Medicine, Federico II University of Naples, Naples, Italy.
| | - L Scalfi
- Department of Public Health, School of Medicine, Federico II University of Naples, Naples, Italy
| | - G Valerio
- Department of Movement Sciences and Wellbeing, Parthenope University of Naples, Naples, Italy
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Dowda M, Taverno Ross SE, McIver KL, Dishman RK, Pate RR. Physical Activity and Changes in Adiposity in the Transition from Elementary to Middle School. Child Obes 2017; 13:53-62. [PMID: 27929670 PMCID: PMC5278816 DOI: 10.1089/chi.2016.0103] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES This study examined the longitudinal associations of objectively measured physical activity, sedentary behavior, and diet quality with two measures of adiposity and a measure of weight status. METHODS A total of 658 children from 21 elementary schools (45.1% boys; 40% white, 33% black, 9% Hispanic, and 18% other race/ethnicity) were assessed at least twice in fifth, sixth, and/or seventh grade. Fat mass index (FMI), percent body fat (PBF), and BMI were calculated from body weight, standing and seated heights, and bioelectrical impedance (BIA) measured each year. RESULTS At follow-up, both FMI and PBF decreased among boys and increased among girls, while BMI increased in both boys and girls. After controlling for race/ethnicity, parent education, and maturity offset at baseline, growth curve analyses showed that moderate-to-vigorous physical activity (MVPA) was significantly and negatively associated with FMI, PBF, and BMI for both boys and girls. After forming tertiles of fifth grade MVPA, least-square means for FMI, PBF, and BMI were examined by grade and gender. For both boys and girls, higher MVPA was associated with lower FMI, PBF, and BMI at all three grade levels. The relationships between sedentary behavior and diet quality and FMI, PBF, and BMI were not consistent for boys or girls. CONCLUSIONS As boys and girls transitioned from elementary to middle school, children who participated in higher levels of MVPA maintained more favorable levels of two indicators of adiposity and a measure of weight status. These findings support the need for interventions to help children meet current public health guidelines for physical activity.
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Affiliation(s)
- Marsha Dowda
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | | | - Kerry L. McIver
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | | | - Russell R. Pate
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC
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Hearst MO, Harnack LJ, Wang Q, Nanney MS. Dietary Quality of Diverse, Rural Adolescents Using the Healthy Eating Index - 2010. HEALTH BEHAVIOR AND POLICY REVIEW 2016; 3:519-527. [PMID: 30271808 PMCID: PMC6161826 DOI: 10.14485/hbpr.3.6.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE We report baseline dietary intake using the Healthy Eating Index (HEI) - 2010 in rural, diverse adolescents from Minnesota. METHODS In 2013-2014, 9th-10th graders who reported eating breakfast less than 3 or fewer times per week were recruited from 16 rural schools. Data included computer-based survey results, measured height and weight, and 24-hour dietary recalls. Schools provided student data on free/reduced meal status. The HEI-2010 was calculated from 24-hour dietary recalls. Regression models assessed demographic differences in HEI-2010. RESULTS The sample mean HEI-2010 score was 52 out of 100 (N = 732 adolescents). Boys (mean HEI-2010=50.1) were statistically significantly lower than girls (mean HEI-2010=53.4). There was no significant difference by free/reduced price lunch or white versus students of color. CONCLUSION Rural adolescent breakfast skippers report poor dietary intake quality.
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Affiliation(s)
- Mary O Hearst
- Henrietta Schmoll School of Health, St. Catherine University, Saint Paul, MN
| | - Lisa J Harnack
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN
| | - Qi Wang
- Clinical and Translational Science Institute, University of Minnesota, Minneapolis, MN
| | - Marilyn S Nanney
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN
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Eloranta AM, Schwab U, Venäläinen T, Kiiskinen S, Lakka HM, Laaksonen DE, Lakka TA, Lindi V. Dietary quality indices in relation to cardiometabolic risk among Finnish children aged 6-8 years - The PANIC study. Nutr Metab Cardiovasc Dis 2016; 26:833-841. [PMID: 27397511 DOI: 10.1016/j.numecd.2016.05.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 05/11/2016] [Accepted: 05/16/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND AIMS There are no studies on the relationships of dietary quality indices to the clustering of cardiometabolic risk factors in children. We therefore investigated the associations of four dietary quality indices with cardiometabolic risk score and cardiometabolic risk factors in Finnish children. METHODS AND RESULTS Subjects were a population sample of 204 boys and 198 girls aged 6-8 years. We assessed diet by 4-day food records and calculated Dietary Approaches to Stop Hypertension (DASH) Score, Baltic Sea Diet Score (BSDS), Mediterranean Diet Score (MDS), and Finnish Children Healthy Eating Index (FCHEI). We calculated the age- and sex-adjusted cardiometabolic risk score summing up Z-scores for waist circumference, mean of systolic and diastolic blood pressure and concentrations of fasting serum insulin and fasting plasma glucose, triglycerides and HDL cholesterol, the last multiplying by -1. Higher FCHEI was associated with lower cardiometabolic risk score among boys (standardised regression coefficient β = -0.14, P = 0.044) adjusted for age, physical activity, electronic media time and household income. Higher DASH Score was related to a lower serum insulin in boys (β = -0.15, P = 0.028). Higher DASH Score (β = -0.16, P = 0.023) and FCHEI (β = -0.17, P = 0.014) were related to lower triglyceride concentration in boys. Higher FCHEI was associated with lower triglyceride concentration in girls (β = -0.16, P = 0.033). Higher DASH Score (β = -0.19, P = 0.011) and BSDS (β = -0.23, P = 0.001) were associated with lower plasma HDL cholesterol concentration in girls. CONCLUSION Higher FCHEI was associated with lower cardiometabolic risk among boys, whereas DASH Score, BSDS or MDS were not associated with cardiometabolic risk in children.
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Affiliation(s)
- A M Eloranta
- Institute of Biomedicine, Physiology, University of Eastern Finland, Kuopio, Finland.
| | - U Schwab
- Institute of Public Health and Clinical Nutrition, Clinical Nutrition, School of Medicine, University of Eastern Finland, Kuopio, Finland; Institute of Clinical Medicine, Internal Medicine, Kuopio University Hospital, Kuopio, Finland
| | - T Venäläinen
- Institute of Biomedicine, Physiology, University of Eastern Finland, Kuopio, Finland; Institute of Public Health and Clinical Nutrition, Clinical Nutrition, School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - S Kiiskinen
- Institute of Biomedicine, Physiology, University of Eastern Finland, Kuopio, Finland
| | - H M Lakka
- Institute of Biomedicine, Physiology, University of Eastern Finland, Kuopio, Finland
| | - D E Laaksonen
- Institute of Biomedicine, Physiology, University of Eastern Finland, Kuopio, Finland; Institute of Clinical Medicine, Internal Medicine, Kuopio University Hospital, Kuopio, Finland
| | - T A Lakka
- Institute of Biomedicine, Physiology, University of Eastern Finland, Kuopio, Finland; Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, Kuopio, Finland; Kuopio Research Institute of Exercise Medicine, Kuopio, Finland
| | - V Lindi
- Institute of Biomedicine, Physiology, University of Eastern Finland, Kuopio, Finland
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Bernal J, Frongillo EA, Rivera JA. Food insecurity reported by children, but not by mothers, is associated with lower quality of diet and shifts in foods consumed. MATERNAL & CHILD NUTRITION 2016; 12:546-57. [PMID: 26260139 PMCID: PMC6860158 DOI: 10.1111/mcn.12206] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Household food security shows little indication of nutrient inadequacy among children, according to reports made by parents. We examined the associations of food insecurity as reported by children and mothers with children's consumption of energy, macronutrients such as vitamin A, calcium, iron and zinc, and selected foods, and whether these associations differed by child's gender. This cross-sectional study had non-probabilistic 128 Venezuelan mother-child pairs. We assessed food insecurity and management strategies in children using 10- and nine-item instruments, respectively. Mothers' report of food insecurity came from a previously validated 12-item instrument. Nutrient intake of children was assessed with a 67-item food frequency questionnaire. Comparisons were made using chi-square test for contingency tables and t-tests for trends (P < 0.05). Linear regression models were used for intakes of nutrients and selected foods. We tested for interactions with gender. Prevalence of child- and mother-reported food insecurity was 83.6 and 61.7%, respectively (P < 0.01). Greater food insecurity or management strategies reported by boys was associated with lower calcium, iron and zinc intake (P < 0.05), but reported intakes were low in girls who are even food secure. Rice and corn flour consumption was higher with higher food insecurity in children. Papaya and banana were less consumed by food-insecure children. We found shifts in 13 of 67 foods consumed, with less quality in those food insecure, as reported by children. Mother-reported food insecurity was associated only with rice intake of children. In contrast to mothers' reports, food insecurity reported by children was associated with children's lower quality of diet and shifts in foods consumed.
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Affiliation(s)
- Jennifer Bernal
- Biology and Biochemistry DepartmentLaboratory of Nutritional AssessmentUniversidad Simón BolívarCaracasVenezuela
| | - Edward A Frongillo
- Department of Health Promotion, Education, and BehaviorArnold School of Public HealthUniversity of South CarolinaColumbiaSouth CarolinaUSA
| | - Juan A Rivera
- Nutrition and Health Research CenterInstitute of Public HealthCuernavacaMéxico
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Anderson SE, Ramsden M, Kaye G. Diet qualities: healthy and unhealthy aspects of diet quality in preschool children. Am J Clin Nutr 2016; 103:1507-13. [PMID: 27099246 DOI: 10.3945/ajcn.115.128454] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 03/16/2016] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Diet quality indexes combine the healthy and unhealthy aspects of diet within a single construct, but few studies have evaluated their association. Emerging evidence suggests that predictors differ for the more and less healthy components of children's diets. OBJECTIVES Our objectives were to determine whether preschool-aged children's frequency of eating healthy foods was inversely related to their intake of unhealthy foods and to determine whether this differed by household income, maternal education, or child race-ethnicity. DESIGN We analyzed data from a representative sample of 8900 US children (mean age: 52.5 mo) who were born in 2001 and participated in the Early Childhood Longitudinal Study-Birth Cohort. Primary caregivers reported the frequency with which children consumed fruit, vegetables, milk, juice, sugar-sweetened beverages (SSBs), fast food, sweets, and salty snacks in the past week. Response options ranged from none to ≥4 times/d. We created healthy (fruit, vegetables, milk) and unhealthy (SSBs, fast food, sweets, salty snacks) diet scores. Healthy diet behaviors were defined as ≥2 daily servings of fruit, vegetables, and milk. RESULTS The prevalence of consuming fruit, vegetables, and milk ≥2 times/d (i.e., having 3 healthy diet behaviors) was 18.5%, and a similar proportion (17.6%) of children had none of these healthy behaviors. Contrary to our hypotheses, children with more healthy diet behaviors did not have lower unhealthy diet scores. The intake of healthy foods was not inversely associated with unhealthy foods overall or within any subgroup. Overall, the Spearman rank correlation between healthy and unhealthy diet scores was positive (r = 0.09). From the lowest to the highest strata of household income, these correlations were 0.12, 0.14, 0.14, 0.05, and 0.00, respectively. CONCLUSIONS No evidence was found in US preschool-aged children of an inverse association between eating healthy and unhealthy foods. The implications of combining healthy and unhealthy aspects of diet quality within an overall index should be considered by researchers.
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Affiliation(s)
| | | | - Gail Kaye
- Health Behavior and Health Promotion, The Ohio State University College of Public Health, Columbus, OH
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Rodrigues PRM, de Souza RAG, De Cnop ML, Monteiro LS, Coura CP, Brito AP, Pereira RA. Dietary quality varies according to data collection instrument: a comparison between a food frequency questionnaire and 24-hour recall. CAD SAUDE PUBLICA 2016; 32:e00047215. [PMID: 26910251 DOI: 10.1590/0102-311x00047215] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 08/27/2015] [Indexed: 11/22/2022] Open
Abstract
The objective of this study was to assess the agreement between the Brazilian Healthy Eating Index - Revised (BHEI-R), estimated by a food frequency questionnaire (FFQ) and multiple 24-hour recalls (24h-R). The Wilcoxon paired test, partial correlations (PC), intraclass correlation coefficient (ICC), and Bland-Altman method were used. The total BHEI-R scores and its components ("total fruits", "whole fruits", "total vegetables", "integral cereals", "saturated fat", "sodium", and "energy intake derived from solid fat, added sugar, and alcoholic beverages") were statistically different, with the ICC and PC indicating poor concordance and correlation. The mean concordance estimated for the total BHEI-R and its components varied from 68% for "integral cereals" to 147% for "whole fruits". The suitable concordance limits were violated for most of the components of the BHEI-R. Poor concordance was observed between the BHEI-R estimated by the FFQ and by multiple 24h-R, which indicated a strong reliability of the BHEI-R on the instrument used to collect information on food consumption.
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Affiliation(s)
| | | | - Mara Lima De Cnop
- Instituto de Nutrição Josué de Castro, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
| | - Luana Silva Monteiro
- Instituto de Nutrição Josué de Castro, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
| | - Camila Pinheiro Coura
- Instituto de Nutrição Josué de Castro, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
| | - Alessandra Page Brito
- Instituto de Nutrição Josué de Castro, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
| | - Rosangela Alves Pereira
- Instituto de Nutrição Josué de Castro, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
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Cheng G, Duan R, Kranz S, Libuda L, Zhang L. Development of a Dietary Index to Assess Overall Diet Quality for Chinese School-Aged Children: The Chinese Children Dietary Index. J Acad Nutr Diet 2016; 116:608-17. [PMID: 26825477 DOI: 10.1016/j.jand.2015.11.010] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 11/24/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND A composite measure of diet quality is preferable to an index of nutrients, food groups, or health-promoting behaviors in dietary assessment. However, to date, such a tool for Chinese children is lacking. OBJECTIVE Based on the current Chinese Dietary Guidelines and Dietary Reference Intakes, a dietary index for Chinese school-aged children, the Chinese Children Dietary Index was developed to assess overall diet quality among children in South China. DESIGN Dietary data were recorded using 24-hour recalls among 1,719 children aged 7 to 15 years between March and June 2013. Inactivity data and sociodemographic information were also collected. The Chinese Children Dietary Index included 16 components, which incorporated nutrients, foods/food groups, and health-promoting behaviors. The range of possible Chinese Children Dietary Index scores was 0 to 160, with a higher score indicating better diet quality. STATISTICAL ANALYSIS PERFORMED Pearson/Spearman correlation was used to assess relative validity using correlations between total Chinese Children Dietary Index score and age, body mass index (BMI; calculated as kg/m(2)), inactivity, whole-grain intake, frequency of fried-foods intake, nutrient adequacy ratios for energy intake and 12 nutrients not included in the Chinese Children Dietary Index, and the mean adequacy ratio. Finally, a stepwise multiple regression analysis was performed to indicate the factors correlated with Chinese Children Dietary Index. RESULTS Mean Chinese Children Dietary Index score of this sample was 88.1 points (range=34.2 to 137.8), the Chinese Children Dietary Index score of girls was higher than that of boys and decreased with higher age. Children with higher Chinese Children Dietary Index had lower body mass index and spent less time being inactive. Positive associations were observed between Chinese Children Dietary Index and the majority of nutrient adequacy ratios and the mean adequacy ratio. Age, paternal educational level, and family size were correlated with Chinese Children Dietary Index. CONCLUSIONS The Chinese Children Dietary Index successfully differentiated diets and, therefore, it can be used to rank-order overall diet quality among Chinese children. As the results showed, diet quality among Chinese children needs to be improved, especially in adolescents.
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Ntalla I, Yannakoulia M, Dedoussis GV. An Overweight Preventive Score associates with obesity and glycemic traits. Metabolism 2016; 65:81-8. [PMID: 26683799 DOI: 10.1016/j.metabol.2015.09.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Revised: 09/21/2015] [Accepted: 09/21/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE To develop a multidimensional, simple index which incorporates targeted dietary and lifestyle behaviors for the prevention and evaluation of treatment of childhood and adolescent obesity. METHODS A total of 1072 (53.8% females) healthy children and 857 (54.8% females) adolescents from GENDAI and TEENAGE studies respectively were included in the analysis. Both studies are cross-sectional, population-based studies. Dietary and lifestyle behaviors - either with negative or positive impact on obesity, based on the recommendations of Barlow and the Expert Committee - were assessed with use of two non-consecutive 24-h recalls and a dietary questionnaire. For each individual, cumulative exposures to 6 of these obesity-related behaviors, namely consumption of fruits and vegetables, breakfast and family meals, consumption of sugar sweetened beverages and fast-food meals, and screen time, were assessed through calculation of the Overweight Preventive Score. Obesity and glycemic control traits were also available for all individuals from both cohorts. RESULTS Overweight Preventive Score was significantly associated (P<0.05) with all obesity traits and with decreased likelihood of becoming overweight [OR (95% CI): 0.90 (0.84, 0.97), P=0.003] in all individuals after adjustment for potential confounders and exclusion of low-energy reporters. Associations were also significant in stratified analyses by sex (P<0.05). The score was also associated with glycemic control traits in all individuals independently of body mass index, but these associations remained significant (P<0.05) only in males and after adjustment for potential confounders and exclusion of low-energy reporters. CONCLUSIONS The proposed Overweight Preventive Score is a simple index and could be proven as a useful tool for the assessment of preventive and therapeutic interventions in child and adolescent overweight and insulin resistance.
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Affiliation(s)
- Ioanna Ntalla
- Harokopio University of Athens Department of Nutrition and Dietetics, Athens, Greece; University of Leicester Department of Health Sciences, Leicester, United Kingdom
| | - Mary Yannakoulia
- Harokopio University of Athens Department of Nutrition and Dietetics, Athens, Greece.
| | - George V Dedoussis
- Harokopio University of Athens Department of Nutrition and Dietetics, Athens, Greece
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Funtikova AN, Navarro E, Bawaked RA, Fíto M, Schröder H. Impact of diet on cardiometabolic health in children and adolescents. Nutr J 2015; 14:118. [PMID: 26574072 PMCID: PMC4647337 DOI: 10.1186/s12937-015-0107-z] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 11/05/2015] [Indexed: 01/10/2023] Open
Abstract
The manifestation of cardiovascular risk factors, such as hypertension, diabetes, and particularly obesity begins in children and adolescents, with deleterious effects for cardiometabolic health at adulthood. Although the impact of diet on cardiovascular risk factors has been studied extensively in adults, showing that their cardiometabolic health is strongly lifestyle-dependent, less is known about this impact in children and adolescents. In particular, little is known about the relationship between their dietary patterns, especially when derived a posteriori, and cardiovascular risk. An adverse association of cardiovascular health and increased intake of sodium, saturated fat, meat, fast food and soft drinks has been reported in this population. In contrast, vitamin D, fiber, mono-and poly-unsaturated fatty acids, dairy, fruits and vegetables were positively linked to cardiovascular health. The aim of this review was to summarize current epidemiological and experimental evidence on the impact of nutrients, foods, and dietary pattern on cardiometabolic health in children and adolescents. A comprehensive review of the literature available in English and related to diet and cardiometabolic health in this population was undertaken via the electronic databases PubMed, Cochrane Library, and Medline.
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Affiliation(s)
- Anna N Funtikova
- Cardiovascular Risk and Nutrition Research Group (CARIN), IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.,CIBER Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Barcelona, Spain.,Food and Nutrition PhD program, University of Barcelona, Barcelona, Spain
| | - Estanislau Navarro
- Molecular Oncology Laboratory, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
| | - Rowaedh Ahmed Bawaked
- Cardiovascular Risk and Nutrition Research Group (CARIN), IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.,Biomedicine PhD program, University of Pompeu Fabra, Barcelona, Spain
| | - Montserrat Fíto
- Cardiovascular Risk and Nutrition Research Group (CARIN), IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.,CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Instituto de Salud Carlos III, Barcelona, Spain
| | - Helmut Schröder
- Cardiovascular Risk and Nutrition Research Group (CARIN), IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain. .,CIBER Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Barcelona, Spain.
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Evaluation of a nutrient-based diet quality index in UK young children and investigation into the diet quality of consumers of formula and infant foods. Public Health Nutr 2015; 19:1785-94. [PMID: 26522249 DOI: 10.1017/s1368980015003134] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To adapt and evaluate a nutrient-based diet quality index (PANDiet) for UK young children and to determine the nutritional adequacy of their diets according to consumption of young child formula (YCF) and commercial infant foods (CIF). DESIGN Content and construct validity of the PANDiet were assessed by studying associations between the PANDiet and its components, energy intake, food intakes, and child and maternal characteristics. Four groups of children were defined according to their intake of YCF and CIF: (i) no consumption; (ii) consumption of YCF; (iii) consumption of CIF; and (iv) consumption of YCF and CIF. Child and maternal characteristics, PANDiet scores and food intakes of these four groups were compared. SETTING Secondary analysis of data from the UK Diet and Nutrition Survey of Infants and Young Children (DNSIYC, 2011). SUBJECTS Young children (n 1152) aged 12-18 months. RESULTS The PANDiet was adapted to the UK based on twenty-five nutrients. A lower PANDiet score was linked to lower intakes of YCF, CIF, vegetables and fruits. Determinants of having a lower score were being older, having siblings and having a younger mother with a lower educational level. Compared with children consuming neither YCF nor CIF, PANDiet scores were higher in children consuming CIF (+1·4), children consuming YCF (+7·2) and children consuming YCF and CIF (+7·8; all P<0·001). CONCLUSIONS The PANDiet is a valid indicator of the nutrient adequacy of the diet of UK young children. Consuming CIF was not found to be associated with lower nutritional adequacy whereas consuming YCF was associated with higher nutritional adequacy.
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Sharafi M, Peracchio H, Scarmo S, Huedo-Medina TB, Mayne ST, Cartmel B, Duffy VB. Preschool-Adapted Liking Survey (PALS): A Brief and Valid Method To Assess Dietary Quality of Preschoolers. Child Obes 2015; 11:530-40. [PMID: 26322657 DOI: 10.1089/chi.2015.0037] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Feasible, valid, and reliable tools are needed to assess dietary quality among preschoolers. We aimed to test construct-/criterion-related validity and reliability of a dietary quality index generated from a liking survey and novel dietary patterns for characterizing food hedonism and parental feeding practices. METHODS Participants included 416 economically disadvantaged, diverse preschoolers (41% overweight/obese) from educational centers and their parents. Parents completed liking and frequency surveys; the liking survey took half as long to complete. Preschoolers' skin carotenoid status (measured by Resonance Raman spectroscopy) and BMI percentile (measured weight/height) were assessed. The Healthy Eating Preference Index (HEPI) was constructed from weighted averages of liking scores for food groups and healthy variety score and Healthy Eating Index 2010 (HEI) from nutrient analysis of the frequency survey. RESULTS The HEPI was normally distributed and showed construct validity and adequate internal reliability. In hierarchical regression analyses, the HEPI explained carotenoid status and adiposity as alternative or value-added predictors to HEI, supporting criterion-related validity of HEPI. Parental reporting of children's liking of high-fat/sweet/salty foods in excess of pleasurable activities (food hedonism) predicted heavier preschoolers, as did discord between HEI and HEPI (potential parental pressure toward healthy eating). HEPI alone or with HEI explained variability in carotenoid status and adiposity in path models with adequate to good fits. CONCLUSIONS With simple collection and processing, the liking survey can generate a valid/reliable dietary quality index in child care settings to identify preschoolers at risk for lower nutritional status. Using liking and frequency-based screeners could improve understanding of parental feeding behaviors and precision of predicting nutritional status.
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Affiliation(s)
- Mastaneh Sharafi
- 1 Department of Allied Health Sciences, College of Agriculture, Health and Natural Resources, University of Connecticut , Storrs, CT
| | - Heather Peracchio
- 2 Department of Extension, College of Agriculture, Health and Natural Resources, University of Connecticut , Storrs, CT
| | - Stephanie Scarmo
- 3 Kids' Safe and Healthful Foods , Government Performance, The Pew Charitable Trusts, Washington, DC
| | - Tania B Huedo-Medina
- 1 Department of Allied Health Sciences, College of Agriculture, Health and Natural Resources, University of Connecticut , Storrs, CT
| | - Susan T Mayne
- 4 Chronic Disease Epidemiology, Yale School of Public Health , New Haven, CT
| | - Brenda Cartmel
- 4 Chronic Disease Epidemiology, Yale School of Public Health , New Haven, CT
| | - Valerie B Duffy
- 1 Department of Allied Health Sciences, College of Agriculture, Health and Natural Resources, University of Connecticut , Storrs, CT
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Perry CP, Keane E, Layte R, Fitzgerald AP, Perry IJ, Harrington JM. The use of a dietary quality score as a predictor of childhood overweight and obesity. BMC Public Health 2015; 15:581. [PMID: 26100985 PMCID: PMC4477494 DOI: 10.1186/s12889-015-1907-y] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 06/03/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The use of dietary quality scores/indices to describe diet quality in children has increased in the past decade. However, to date, few studies have focused on the use of these scores on disease outcomes such as childhood obesity and most are developed from detailed dietary assessments. Therefore, the aims of this study were: firstly to construct a diet quality score (DQS) from a brief dietary assessment tool; secondly to examine the association between diet quality and childhood overweight or obesity; thirdly we also aim to examine the associations between individual DQS components and childhood overweight or obesity. METHODS A secondary analysis of cross sectional data of a sample of 8,568 9-year-old children and their families as part of the Growing Up in Ireland (GUI) study. Subjects were drawn from a probability proportionate to size sampling of primary schools throughout Ireland over the school year 2007-2008. Height and weight were measured by trained researchers using standardised methods and BMI was classified using the International Obesity Taskforce cut-points. The DQS (un-weighted) was developed using a 20-item, parent reported, food frequency questionnaire of foods consumed over the past 24 h. Adjusted odds ratios for overweight and obesity were examined by DQS quintile, using the first quintile (highest diet quality) as the reference category. RESULTS The prevalence of normal weight, overweight and obese was 75, 19 and 6% respectively. DQS ranged from -5 to 25, higher scores indicated higher diet quality in the continuous score. In analyses adjusted for gender, parent's education, physical activity and T.V. viewing, child obesity but not overweight was significantly associated with poor diet quality: OR of 1.56 (95% CI 1.02 2.38) in the 5th compared to the 1st DQS quintile. Findings from individual food items were inconsistent. CONCLUSIONS The findings suggest that diet quality may be an important factor in childhood obesity. A simple DQS developed from a short dietary assessment tool is significantly associated with childhood obesity.
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Affiliation(s)
- Catherine P Perry
- Department of Epidemiology and Public Health, University College Cork, 4th Floor Western Gateway Building, Western Rd, Cork, Ireland.
| | - Eimear Keane
- Department of Epidemiology and Public Health, University College Cork, 4th Floor Western Gateway Building, Western Rd, Cork, Ireland.
| | - Richard Layte
- Economic and Social Research Institute (ESRI), Sir John Rogerson's Quay, Dublin 2, Ireland. .,Department of Sociology, Trinity College Dublin, 3 College Green Dublin 2, Dublin 2, Ireland.
| | - Anthony P Fitzgerald
- Department of Epidemiology and Public Health, University College Cork, 4th Floor Western Gateway Building, Western Rd, Cork, Ireland. .,School of Mathematical sciences 1st floor Western Gateway Building, Western Rd, Cork, Ireland.
| | - Ivan J Perry
- Department of Epidemiology and Public Health, University College Cork, 4th Floor Western Gateway Building, Western Rd, Cork, Ireland.
| | - Janas M Harrington
- Department of Epidemiology and Public Health, University College Cork, 4th Floor Western Gateway Building, Western Rd, Cork, Ireland.
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Okubo H, Crozier SR, Harvey NC, Godfrey KM, Inskip HM, Cooper C, Robinson SM. Diet quality across early childhood and adiposity at 6 years: the Southampton Women's Survey. Int J Obes (Lond) 2015; 39:1456-62. [PMID: 26121960 PMCID: PMC4597330 DOI: 10.1038/ijo.2015.97] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Revised: 05/14/2015] [Accepted: 05/17/2015] [Indexed: 11/09/2022]
Abstract
BACKGROUND Poor diet quality in early childhood is inconsistently linked to obesity risk. Understanding may be limited by the use of cross-sectional data and the use of body mass index (BMI) to define adiposity in childhood. OBJECTIVE The objective of this study is to examine the effects of continued exposure to diets of varying quality across early childhood in relation to adiposity at 6 years. METHODS One thousand and eighteen children from a prospective UK birth cohort were studied. Diet was assessed using food frequency questionnaires when the children were aged 6 and 12 months, and 3 and 6 years; diet quality was determined according to scores for a principal component analysis-defined dietary pattern at each age (characterized by frequent consumption of fruits, vegetables and fish). At each age, children were allocated a value of 0/1/2 according to third of the distribution (bottom/middle/top) their diet quality score was in; values were summed to calculate an overall diet quality index (DQI) for early childhood (range 0-8). Obesity outcomes considered at 6 years were dual-energy X-ray absorptiometry-assessed fat mass and BMI. RESULTS One hundred and seven (11%) children had a DQI=0, indicating a consistently low diet quality, 339 (33%) had a DQI=1-3, 378 (37%) had a DQI=4-6 and 194 (19%) had a DQI=7-8. There was a strong association between lower DQI and higher fat mass z-score at 6 years that was robust to adjustment for confounders (fat mass s.d. per 1-unit DQI increase: β=-0.05 (95% confidence interval (CI): -0.09, -0.01), P=0.01). In comparison with children who had the highest diet quality (DQI=7-8), this amounted to a difference in fat mass of 14% (95% CI: 2%, 28%) at 6 years for children with the poorest diets (DQI=0). In contrast, no independent associations were observed between DQI and BMI. CONCLUSIONS Continued exposure to diets of low quality across early childhood is linked to adiposity at the age of 6 years.
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Affiliation(s)
- H Okubo
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, UK.,Department of Health Promotion, National Institute of Public Health, Saitama, Japan
| | - S R Crozier
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, UK
| | - N C Harvey
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, UK.,National Institute of Health Research, Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton National Health Service Foundation Trust, Southampton, UK
| | - K M Godfrey
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, UK.,National Institute of Health Research, Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton National Health Service Foundation Trust, Southampton, UK
| | - H M Inskip
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, UK
| | - C Cooper
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, UK.,National Institute of Health Research, Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton National Health Service Foundation Trust, Southampton, UK.,National Institute for Health Research Musculoskeletal Biomedical Research Unit, Nuffield Orthopedic Centre, University of Oxford, Oxford, UK
| | - S M Robinson
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, UK.,National Institute of Health Research, Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton National Health Service Foundation Trust, Southampton, UK
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Abstract
OBJECTIVE We aimed to investigate the association between multiple measures of socio-economic position (SEP) and diet quality, using a diet quality index representing current national dietary guidelines, in the Australian adult population. DESIGN Cross-sectional study. Linear regression analyses were used to estimate the association between indicators of SEP (educational attainment, level of income and area-level disadvantage) and diet quality (measured using the Dietary Guideline Index (DGI)) in the total sample and stratified by sex and age (≤55 years and >55 years). SETTING A large randomly selected sample of the Australian adult population. SUBJECTS Australian adults (n 9296; aged ≥25 years) from the Australian Diabetes, Obesity and Lifestyle Study. RESULTS A higher level of educational attainment and income and a lower level of area-level disadvantage were significantly associated with a higher DGI score, across the gradient of SEP. The association between indicators of SEP and DGI score was consistently stronger among those aged ≤55 years compared with their older counterparts. The most disadvantaged group had a DGI score between 2 and 5 units lower (depending on the marker of SEP) compared with the group with the least disadvantage. CONCLUSIONS A higher level of SEP was consistently associated with a higher level of diet quality for all indicators of SEP examined. In order to reduce socio-economic inequalities in diet quality, healthy eating initiatives need to act across the gradient of socio-economic disadvantage with a proportionate focus on those with greater socio-economic disadvantage.
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Abstract
AbstractObjectiveTo holistically evaluate the extent of implementation of dietary guidelines in schools and present various monitoring systems.DesignThe study comprises three methods: (i) a cross-sectional survey (process evaluation); (ii) an indicator-based evaluation (menu quality); and (iii) a 5 d weighed food record of school lunches (output evaluation).SettingSlovenian primary schools.SubjectsA total 234 food-service managers from 488 schools completed a self-administrated questionnaire for process evaluation; 177 out of 194 randomly selected schools provided menus for menu quality evaluation; and 120 school lunches from twenty-four schools were measured and nutritionally analysed for output evaluation.ResultsThe survey among food-service managers revealed high levels of implementation at almost all process evaluation areas of the guidelines. An even more successful implementation of these guidelines was found in relation to organization cultural issues as compared with technical issues. Differences found in some process evaluation areas were related to location, size and socio-economic characteristics of schools. Evaluation of school menu quality demonstrated that score values followed a normal distribution. Higher (better) nutrition scores were found in larger-sized schools and corresponding municipalities with higher socio-economic status. School lunches did not meet minimum recommendations for energy, carbohydrates or dietary fibre intake, nor for six vitamins and three (macro, micro and trace) elements.ConclusionsThe implementation of the guidelines was achieved differently at distinct levels. The presented multilevel evaluation suggests that different success in implementation might be attributed to different characteristics of individual schools. System changes might also be needed to support and improve implementation of the guidelines.
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Voortman T, Kiefte-de Jong JC, Geelen A, Villamor E, Moll HA, de Jongste JC, Raat H, Hofman A, Jaddoe VWV, Franco OH, van den Hooven EH. The development of a diet quality score for preschool children and its validation and determinants in the Generation R Study. J Nutr 2015; 145:306-14. [PMID: 25644352 DOI: 10.3945/jn.114.199349] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Although many studies have examined health effects of infant feeding, studies on diet quality shortly after the weaning and lactation period are scarce. OBJECTIVES Our aims were to develop and evaluate a diet score that measures overall diet quality in preschool children and to examine the sociodemographic and lifestyle determinants of this score. METHODS On the basis of national and international dietary guidelines for young children, we developed a diet score containing 10 components: intake of vegetables; fruit; bread and cereals; rice, pasta, potatoes, and legumes; dairy; meat and eggs; fish; oils and fats; candy and snacks; and sugar-sweetened beverages. The total score ranged from 0 to 10 on a continuous scale and was standardized to an energy intake of 1200 kcal/d with the residual method. The score was evaluated in 3629 children participating in the Generation R Study, a population-based prospective cohort study. Food consumption was assessed with a food-frequency questionnaire (FFQ) at a median age of 13 mo. RESULTS The mean ± SD diet score was 4.1 ± 1.3. The food-based diet score was positively associated with intakes of many nutrients, including n-3 (ω-3) fatty acids [FAs; 0.25 SD increase (95% CI: 0.22, 0.27) per 1 point increase in the diet score], dietary fiber [0.32 (95% CI: 0.30, 0.34)], and calcium [0.13 (95% CI: 0.11, 0.16)], and was inversely associated with intakes of sugars [-0.28 (95% CI: -0.31, -0.26)] and saturated fat [-0.03 (95% CI: -0.05, -0.01)]. A higher diet score was associated with several health-conscious behaviors, such as maternal folic acid supplement use during pregnancy, no smoking during pregnancy, and children watching less television. CONCLUSION We developed a novel food-based diet score for preschool children that could be applied in future studies to compare diet quality in early childhood and to investigate associations between diet in early childhood and growth, health, and development.
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Affiliation(s)
- Trudy Voortman
- The Generation R Study Group and Departments of Epidemiology
| | | | - Anouk Geelen
- Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands; and
| | - Eduardo Villamor
- Department of Epidemiology, University of Michigan, Ann Arbor, MI
| | | | | | - Hein Raat
- Public Health, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | | | - Vincent W V Jaddoe
- The Generation R Study Group and Departments of Epidemiology Pediatrics, and
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Kyttälä P, Erkkola M, Lehtinen-Jacks S, Ovaskainen ML, Uusitalo L, Veijola R, Simell O, Knip M, Virtanen SM. Finnish Children Healthy Eating Index (FCHEI) and its associations with family and child characteristics in pre-school children. Public Health Nutr 2014; 17:2519-27. [PMID: 24152429 PMCID: PMC10284681 DOI: 10.1017/s1368980013002772] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Revised: 09/04/2013] [Accepted: 09/04/2013] [Indexed: 11/05/2022]
Abstract
OBJECTIVE The objective was to develop a Finnish Children Healthy Eating Index (FCHEI), to determine the relative validity of the index and to examine associations between the index and familial sociodemographic and lifestyle characteristics. DESIGN Cross-sectional samples of children participating in a population-based birth cohort study in Finland. SETTING Type I Diabetes Prediction and Prevention (DIPP) Study cohort. SUBJECTS Three-day food records from 1-year-old (n 455), 3-year-old (n 471) and 6-year-old (n 713) children were completed between 2003 and 2005. RESULTS Validity of the FCHEI was assessed by studying the associations between the FCHEI and nutrient intakes of the children. Among all age groups, intakes of SFA and sugars decreased across increasing quartiles of the FCHEI while intakes of PUFA, dietary fibre, vitamin D and vitamin E increased. Among 3- and 6-year-olds, being cared for at home was associated with the lowest FCHEI quartile (diet that deviates most from the recommendations). The lowest FCHEI quartile was also associated with residence in a semi-urban area among the 3-year-olds and low maternal education and smoking during pregnancy among the 6-year-olds. CONCLUSIONS The FCHEI serves as a valid indicator of the quality of Finnish children's diet. Public health programmes aimed at improving the dietary behaviours of pre-school aged children should aim to improve the quality of food served at home. Families with history of lower parental education, maternal smoking during pregnancy or non-urban place of residence may require special attention.
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Affiliation(s)
- Pipsa Kyttälä
- School of Health Sciences, FI-33014 University of Tampere, Tampere, Finland
- Unit of Nutrition, Department of Lifestyle and Participation, National Institute for Health and Welfare, Helsinki, Finland
| | - Maijaliisa Erkkola
- Division of Nutrition, Department of Food and Environmental Sciences, University of Helsinki, Helsinki, Finland
| | - Susanna Lehtinen-Jacks
- School of Health Sciences, FI-33014 University of Tampere, Tampere, Finland
- Unit of Nutrition, Department of Lifestyle and Participation, National Institute for Health and Welfare, Helsinki, Finland
- The Science Center of Pirkanmaa Hospital District, Tampere, Finland
| | - Marja-Leena Ovaskainen
- Unit of Nutrition, Department of Lifestyle and Participation, National Institute for Health and Welfare, Helsinki, Finland
| | - Liisa Uusitalo
- Unit of Nutrition, Department of Lifestyle and Participation, National Institute for Health and Welfare, Helsinki, Finland
| | - Riitta Veijola
- Department of Paediatrics, University of Oulu, Oulu, Finland
| | - Olli Simell
- Department of Paediatrics, University of Turku, Turku, Finland
| | - Mikael Knip
- Children's Hospital, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
- Research Center for Child Health, Tampere University Hospital, Tampere, Finland
| | - Suvi Mirjami Virtanen
- School of Health Sciences, FI-33014 University of Tampere, Tampere, Finland
- Unit of Nutrition, Department of Lifestyle and Participation, National Institute for Health and Welfare, Helsinki, Finland
- The Science Center of Pirkanmaa Hospital District, Tampere, Finland
- Research Center for Child Health, Tampere University Hospital, Tampere, Finland
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48
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Er V, Lane JA, Martin RM, Emmett P, Gilbert R, Avery KNL, Walsh E, Donovan JL, Neal DE, Hamdy FC, Jeffreys M. Adherence to dietary and lifestyle recommendations and prostate cancer risk in the prostate testing for cancer and treatment (ProtecT) trial. Cancer Epidemiol Biomarkers Prev 2014; 23:2066-77. [PMID: 25017249 PMCID: PMC4184865 DOI: 10.1158/1055-9965.epi-14-0322] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND The World Cancer Research Fund (WCRF) and the American Institute for Cancer Research (AICR) published eight recommendations for cancer prevention, but they are not targeted at prostate cancer prevention. We investigated whether adherence to the WCRF/AICR recommendations and a prostate cancer dietary index is associated with prostate cancer risk. METHODS We conducted a nested case-control study of 1,806 prostate-specific antigen (PSA)-detected prostate cancer cases and 12,005 controls in the ProtecT trial. We developed a prostate cancer dietary index by incorporating three dietary factors most strongly associated with prostate cancer. Scores were computed to quantify adherence to the WCRF/AICR recommendations and the prostate cancer dietary index separately. RESULTS The prostate cancer dietary index score was associated with decreased risk of prostate cancer [OR per 1 score increment: 0.91; 95% confidence interval (CI): 0.84-0.99; Ptrend = 0.04] but the WCRF/AICR index score was not (OR: 0.99; 95% CI: 0.94-1.05; Ptrend = 0.71). There was no heterogeneity in association by prostate cancer stage (P = 0.81) or grade (P = 0.61). Greater adherence to recommendations to increase plant foods (OR per 0.25 index score increment: 0.94; 95% CI: 0.89-0.99; Ptrend = 0.02) and tomato products (OR adherence vs. nonadherence: 0.82; 95% CI: 0.70-0.97; P = 0.02) was inversely associated with overall prostate cancer risk. CONCLUSIONS Adherence to the prostate cancer-specific dietary recommendations was associated with decreased risk of prostate cancer. High intake of plant foods and tomato products in particular may help protect against prostate cancer. IMPACT Meeting the WCRF/AICR recommendations alone is insufficient for prostate cancer prevention. Additional dietary recommendations should be developed.
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Affiliation(s)
- Vanessa Er
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom. National Institute for Health Research (NIHR) Bristol Nutrition Biomedical Research Unit, Bristol, United Kingdom.
| | - J Athene Lane
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom. National Institute for Health Research (NIHR) Bristol Nutrition Biomedical Research Unit, Bristol, United Kingdom
| | - Richard M Martin
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom. National Institute for Health Research (NIHR) Bristol Nutrition Biomedical Research Unit, Bristol, United Kingdom
| | - Pauline Emmett
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Rebecca Gilbert
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Kerry N L Avery
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Eleanor Walsh
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Jenny L Donovan
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - David E Neal
- University Department of Oncology, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Freddie C Hamdy
- Nuffield Department of Surgical Sciences, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
| | - Mona Jeffreys
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
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Dietary patterns and cardiovascular risk factors in adolescents and young adults: the Northern Ireland Young Hearts Project. Br J Nutr 2014; 112:1685-98. [DOI: 10.1017/s0007114514002682] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Dietary pattern (DP) analysis allows examination of the combined effects of nutrients and foods on the markers of CVD. Very few studies have examined these relationships during adolescence or young adulthood. Traditional CVD risk biomarkers were analysed in 12–15-year-olds (n487; Young Hearts (YH)1) and again in the same individuals at 20–25 years of age (n487; YH3). Based on 7 d diet histories, in the present study, DP analysis was performed usinga posterioriprincipal component analysis for the YH3 cohort and thea prioriMediterranean Diet Score (MDS) was calculated for both YH1 and YH3 cohorts. In thea posterioriDP analysis, YH3 participants adhering most closely to the ‘healthy’ DP were found to have lower pulse wave velocity (PWV) and homocysteine concentrations, the ‘sweet tooth’ DP were found to have increased LDL concentrations, systolic blood pressure, and diastolic blood pressure and decreased HDL concentrations, the ‘drinker/social’ DP were found to have lower LDL and homocysteine concentrations, but exhibited a trend towards a higher TAG concentration, and finally the ‘Western’ DP were found to have elevated homocysteine and HDL concentrations. In thea prioridietary score analysis, YH3 participants adhering most closely to the Mediterranean diet were found to exhibit a trend towards a lower PWV. MDS did not track between YH1 and YH3, and nor was there a longitudinal relationship between the change in the MDS and the change in CVD risk biomarkers. In conclusion, cross-sectional analysis revealed that some associations between DP and CVD risk biomarkers were already evident in the young adult population, namely the association between the healthy DP (and the MDS) and PWV; however, no longitudinal associations were observed between these relatively short time periods.
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50
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Burrows TL, Collins K, Watson J, Guest M, Boggess MM, Neve M, Rollo M, Duncanson K, Collins CE. Validity of the Australian Recommended Food Score as a diet quality index for Pre-schoolers. Nutr J 2014; 13:87. [PMID: 25178263 PMCID: PMC4162955 DOI: 10.1186/1475-2891-13-87] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Accepted: 08/29/2014] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Diet quality tools provide researchers with brief methods to assess the nutrient adequacy of usual dietary intake. This study describes the development and validation of a pediatric diet quality index, the Australian Recommended Food Scores for Pre-schoolers (ARFS-P), for use with children aged two to five years. METHODS The ARFS-P was derived from a 120-item food frequency questionnaire, with eight sub-scales, and was scored from zero to 73. Linear regressions were used to estimate the relationship between diet quality score and nutrient intakes, in 142 children (mean age 4 years) in rural localities in New South Wales, Australia. RESULTS Total ARFS-P and component scores were highly related to dietary intake of the majority of macronutrients and micronutrients including protein, β-carotene, vitamin C, vitamin A. Total ARFS-P was also positively related to total consumption of nutrient dense foods, such as fruits and vegetables, and negatively related to total consumption of discretionary choices, such as sugar sweetened drinks and packaged snacks. CONCLUSION ARFS-P is a valid measure that can be used to characterise nutrient intakes for children aged two to five years. Further research could assess the utility of the ARFS-P for monitoring of usual dietary intake over time or as part of clinical management.
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Affiliation(s)
- Tracy L Burrows
- />Nutrition and Dietetics, School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, >Callaghan, 2308 NSW Australia
- />Priority Research Centre in Physical Activity and Nutrition, Faculty of Health, The University of Newcastle, Callaghan, 2308 NSW Australia
| | - Kate Collins
- />Nutrition and Dietetics, School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, >Callaghan, 2308 NSW Australia
| | - Jane Watson
- />Nutrition and Dietetics, School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, >Callaghan, 2308 NSW Australia
- />Priority Research Centre in Physical Activity and Nutrition, Faculty of Health, The University of Newcastle, Callaghan, 2308 NSW Australia
| | - Maya Guest
- />Nutrition and Dietetics, School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, >Callaghan, 2308 NSW Australia
- />Environmental and Occupational Health and Safety, School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Callaghan, 2308 NSW Australia
| | - May M Boggess
- />Environmental and Occupational Health and Safety, School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Callaghan, 2308 NSW Australia
- />School of Mathematical and Statistical Sciences, Arizona State University, Tempe, 85281 AZ USA
| | - Melinda Neve
- />Nutrition and Dietetics, School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, >Callaghan, 2308 NSW Australia
- />Priority Research Centre in Physical Activity and Nutrition, Faculty of Health, The University of Newcastle, Callaghan, 2308 NSW Australia
| | - Megan Rollo
- />Nutrition and Dietetics, School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, >Callaghan, 2308 NSW Australia
- />Priority Research Centre in Physical Activity and Nutrition, Faculty of Health, The University of Newcastle, Callaghan, 2308 NSW Australia
| | - Kerith Duncanson
- />Nutrition and Dietetics, School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, >Callaghan, 2308 NSW Australia
- />Priority Research Centre in Physical Activity and Nutrition, Faculty of Health, The University of Newcastle, Callaghan, 2308 NSW Australia
- />Hunter New England Local Health District, Forster, 2428 NSW Australia
| | - Clare E Collins
- />Nutrition and Dietetics, School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, >Callaghan, 2308 NSW Australia
- />Priority Research Centre in Physical Activity and Nutrition, Faculty of Health, The University of Newcastle, Callaghan, 2308 NSW Australia
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