Self-Report Dietary Assessment Tools Used in Canadian Research: A Scoping Review

The future backbone of nutritional science: integrating public health priorities with system-oriented precision nutrition

Adopting policies that promote health for the entire biosphere (One Health) requires human societies to transition towards a more sustainable food supply as well as to deepen the understanding of the metabolic and health effects of evolving food habits. At the same time, life sciences are experiencing rapid and groundbreaking technological developments, in particular in laboratory analytics and biocomputing, placing nutrition research in an unprecedented position to produce knowledge that can be translated into practice in line with One Health policies. In this dynamic context, nutrition research needs to be strategically organised to respond to these societal expectations. One key element of this strategy is to integrate precision nutrition into epidemiological research. This position article therefore reviews the recent developments in nutrition research and proposes how they could be integrated into cohort studies, with a focus on the Swiss research landscape specifically.

Risk of Social Isolation as a Contributing Factor to Diet Quality in Community-Dwelling Older Persons Living in the Australian Capital Territory-A Pilot Study

OBJECTIVES

Social isolation is recognised as a risk factor in the inflammatory process. This study explored the association between social isolation and the Dietary Inflammatory Index (DII) in community-dwelling older persons.

METHODS

This cross-sectional pilot study recruited 107 community-dwelling people aged over 55 years living in the Australian Capital Territory. Participants completed an extensive food frequency questionnaire and provided anthropometric and sociodemographic data. Social isolation was evaluated using the Lubben Social Network Scale (LSNS). Diet quality was assessed using DII.

RESULTS

Average age was 70.1 (±8.61) years and 62.8% were female. The average DII score was -1.10 (±1.21), indicating an anti-inflammatory diet. Higher LSNS was associated with lower DII (b (95% CI) = -0.041 (-0.066, -0.17); p < 0.01) and was positively influenced by the number of people in household (b (95% CI) = 5.731 (2.336, 9.127); p = 0.001).

CONCLUSION

Increased risk of social isolation was associated with an increased tendency towards a more inflammatory diet. Reducing social isolation may decrease the inflammatory component of dietary intake for older persons living independently in the community.

The relative validity of a semiquantitative food frequency questionnaire among pregnant women in the United Arab Emirates: The Mutaba'ah study

Background: Food frequency questionnaire (FFQ) is the most frequently used dietary assessment method in estimating dietary intakes in epidemiological studies. Aim: This study aimed to assess the relative validity of a semiquantitative FFQ in evaluating dietary intake among pregnant women in the United Arab Emirates. Methods: Within the Mutaba'ah study, a subsample of 111 pregnant women completed a semiquantitative FFQ and a single 24-hour dietary recall (24-HDR) regarded as the reference method. Absolute and energy-adjusted nutrient and food intakes between the FFQ and 24-HDR were compared using the Wilcoxon signed ranks test, correlations, Bland-Altman analysis, cross-classification, and weighted kappa analysis. Results: There were no significant differences in reported absolute intakes between the FFQ and 24-HDR for carbohydrates, whole grains, white meat, beta-carotene, vitamin K, sodium, and selenium. Spearman's correlation coefficients between the FFQ and 24-HDR ranged from 0.09 (trans fatty acids) to 0.5 (potassium) for absolute intakes. Correlation decreased after energy adjustment. Bland-Altman analysis showed that the FFQ overestimated intakes compared with 24-HDR and that the limits of agreement were wide. The average percentage of pregnant women classified into the same or adjacent quartile of intake by both methods was 73%. Weighted kappa values ranged from -0.02 (white meat) to 0.33 (magnesium). Conclusion: Our findings showed that the semi-quantitative FFQ is a useful tool in ranking pregnant women from the Emirati population according to their dietary intake. However, the validity of some estimated intakes was poor; hence, certain intakes should be interpreted with caution.

Nutritional Assessment in Patients with Chronic Diseases: Tools, Challenges, and Future Directions

Chronic diseases, such as cardiovascular diseases, diabetes, cancer, and chronic respiratory diseases, are leading causes of morbidity and mortality worldwide [...].

Validation and reliability for the updated REAP-S dietary screener, (Rapid Eating Assessment of Participants, Short Version, v.2)

BACKGROUND

The American Heart Association (AHA) chose the REAP-S dietary screener in 2020 as one of three US dietary screeners recommended for integrating dietary assessment into clinical care. The REAP-S v.2 is an updated version that is aligned with the 2020-2025 US Dietary Guidelines and is easily incorporated into electronic medical records and taught to medical students.

METHODS

The University of New England, Institutional Review Board, approved the study protocol. We evaluated the reliability and validity of the REAP-S v.2 scale by having first-year medical students (n = 167) complete both the REAP-S v.2 and a three-day food record and then analyzing their data with the following statistical techniques: Internal consistency was measured using Cronbach's alpha. Construct validity was assessed with exploratory factor analysis. Criterion validity was evaluated using analysis of variance (ANOVA) that explored the associations between REAP-S v.2 scale item responses and selected nutrient estimates from the food record analyses. The hierarchical cluster analysis classified healthy and unhealthy diet grouping under each subscale. Further using these groupings, cut points for "good" and "bad" diets for each of the three main REAP-S v.2 subscales (Food Sufficiency/Food Insufficiency; Healthy Eating Pattern and Low Nutrient Density Foods) were calculated using receiver operating characteristics (ROC) analysis. Students analyzed their three-day food intake records using an online USDA application called SuperTracker.

RESULTS

The Cronbach's alpha measuring internal consistency was acceptable for the overall scale at 0.71. The exploratory factor analysis extracted three factors that roughly paralleled the three main subscales, suggesting construct validity. Most selected food record-derived nutrient values were significantly associated with scale items confirming criterion validity. The score cut points suggest that dietary counseling might be needed at ≤ 8, ≤ 10, and ≤ 16 for the above subscales.

CONCLUSION

The REAP-S v.2 is intended for clinicians to use as a brief dietary screener with their patients. Tested in a population of first-year medical students, the REAP-S v.2 brief dietary screener showed acceptable internal consistency, criterion, and construct validity. It is easily scored and incorporated into the electronic medical record.

Physical activity-induced alterations of the gut microbiota are BMI dependent

Physical inactivity is one of the leading causes of chronic metabolic disease including obesity. Increasing physical activity (PA) has been shown to improve cardiometabolic and musculoskeletal health and to be associated with a distinct gut microbiota composition in trained athletes. However, the impact of PA on the gut microbiota is inconclusive for individuals performing PA in their day-to-day life. This study examined the role of PA and hand-grip strength on gut microbiome composition in middle-aged adults (40-65 years, n = 350) with normal (18.5-24.9 kg/m2 ) and overweight (25-29.9 kg/m2 ) body mass index (BMI). PA was recorded using the International Physical Activity Questionnaire, and hand-grip strength was measured using a dynamometer. Serum samples were assessed for lipidomics while DNA was extracted from fecal samples for microbiome analysis. Overweight participants showed a higher concentration of triacylglycerols, and lower concentrations of cholesteryl esters, sphingomyelin, and lyso-phosphotidylcholine lipids (p < .05) compared with those with normal BMI. Additionally, overweight participants had a lower abundance of the Oscillibacter genus (p < .05). The impact of PA duration on the gut microbiome was BMI dependent. In normal but not overweight participants, high PA duration showed greater relative abundance of commensal taxa such as Actinobacteria and Proteobacteria phyla, as well as Collinsella and Prevotella genera (p < .05). Furthermore, in males with normal BMI, a stronger grip strength was associated with a higher relative abundance of Faecalibacterium and F. prausnitzii (p < .05) compared with lower grip strength. Taken together, data suggest that BMI plays a significant role in modeling PA-induced changes in gut microbiota.

Yarning about Diet: The Applicability of Dietary Assessment Methods in Aboriginal and Torres Strait Islander Australians-A Scoping Review

Conventional dietary assessment methods are based predominately on Western models which lack Aboriginal and Torres Strait Islander knowledges, methodologies, and social and cultural contextualisation. This review considered dietary assessment methods used with Aboriginal and Torres Strait Islander populations and assessed their applicability. Four electronic databases and grey literature were searched with no time limit applied to the results. Screening, data extraction and quality appraisal were undertaken independently by two reviewers. Out of 22 studies, 20 were conducted in rural/remote settings, one in an urban setting, and one at the national population level. The most frequently used and applicable dietary assessment method involved store data. Weighed food records and food frequency questionnaires had low applicability. Modifications of conventional methods were commonly used to adapt to Indigenous practices, but few studies incorporated Indigenous research methodologies such as yarning. This highlights an opportunity for further investigation to validate the accuracy of methods that incorporate qualitative yarning-based approaches, or other Indigenous research methodologies, into quantitative data collection. The importance of developing validated dietary assessment methods that are appropriate for this population cannot be understated considering the high susceptibility to nutrition-related health conditions such as malnutrition, overweight or obesity, diabetes, and cardiovascular disease.

Reproducibility and validity of the Toronto-modified Harvard food frequency questionnaire in a multi-ethnic sample of young adults

BACKGROUND/OBJECTIVES

To assess the reproducibility and validity of a Toronto-modified Harvard food frequency questionnaire (FFQ) among a multi-ethnic sample of young adults.

SUBJECTS/METHODS

A total of 150 participants recruited from the Toronto Nutrigenomics and Health Study cohort who had existing dietary intakes assessed by FFQ (FFQ1) and reassessment one year later (FFQ2). Of these, 100 participants also completed a three-day food record to evaluate the validity of the FFQ for 38 nutrients (energy, 14 macronutrients, 22 micronutrients, and 1 bioactive). Analyses were also stratified between the two major ethnic groups (Caucasian and East Asian).

RESULTS

Among the full sample, mean intakes of most nutrients (27/38) did not differ significantly between estimates derived from FFQ2 compared to the three-day food record. Energy, sex, and ethnicity adjusted deattenuated Pearson correlation coefficients ranged from 0.20 to 0.92 (mean r = 0.52 ± 0.15), and 34/38 validity coefficients were r ≥ 0.32. Gross misclassification of intakes between FFQ2 and the three-day food record was low (<6%), but energy, polyunsaturated fatty acids (PUFA), and sodium were underestimated by FFQ2. Mean intakes between FFQ1 and FFQ2 did not differ significantly for any nutrient. Between the two major ethnic groups, mean validity coefficients were similar, but varied for individual nutrients with saturated fat, PUFA, and omega 3 being among the most discrepant.

CONCLUSIONS

Compared to a three-day food record, the Toronto-modified Harvard FFQ is a reproducible and valid tool to estimate dietary intake among a multi-ethnic sample of young adults. However, incorporation of protocols to improve the assessment of culturally diverse diets should be considered.

Comparison of dietary intake measured by a web-based FFQ and repeated 24-hour dietary recalls: the Hordaland Health Study

All dietary assessment methods inevitably introduce measurement errors, which should ideally be considered during data analysis and interpretation. Methodological studies should be conducted to address how well a given assessment method captures dietary intake and to highlight the extent and direction of the measurement error. Within a subgroup of the Hordaland Health Study (HUSK3), we examined the relative validity of a web-based food frequency questionnaire (WebFFQ) by comparing its estimates of mean daily intake of nutrients and foods with estimated mean daily intakes from repeated administrations of 24-hour dietary recall interviews (24-HDRs). Men and women born between 1950 and 1951 were recruited from HUSK3. The participants (n = 67) completed a WebFFQ and three non-consecutive 24-HDRs over the course of a year. Relative validity was assessed using Spearman's rank correlation, crosstab analysis and Bland-Altman plots. Linear regression models were used to compute the calibration coefficients. The estimated correlation coefficients were acceptable or strong for all nutrients and foods except iodine (r_s = 0⋅19). The highest correlation coefficient was found for juice (r_s = 0⋅71), whereas the lowest correlation coefficient was found for iodine (r_s = 0⋅19). Cross-classification by quartiles categorised more than 72 % of the participants into the same or adjacent quartiles using the two methods. Few data points fell outside the limits of agreement in the Bland-Altman plots. Calibration coefficients ranged from 0⋅10 (wholegrain) to 0⋅81 (alcohol). Our findings suggest that the WebFFQ has reasonable ranking abilities for all the included nutrients and foods, except for iodine.

Methods for the dietary assessment of adult kidney stone formers: a scoping review

BACKGROUND

Kidney stones are a frequent and potentially severe condition, affecting 5-10% of the European population. Causes are multifactorial, diet in particular plays a major role in the formation and management of kidney stones. The aim of this scoping review is to assess the methods used to study the diet of adult kidney stone formers.

METHODS

We conducted a systematic search in Medline Ovid SP, Embase, Cinahl, Cochrane (CENTRAL), Web of Sciences databases on June 10th, 2020. Self-report methods (such as food frequency questionnaires or 24-h dietary recalls), objective nutritional biomarkers and controlled diets were considered. We analyzed the selected publications based on the origin of participants, study design and dietary assessment methods used.

RESULTS

We screened 871 publications and included 162 of them. Most studies included participants from North America and Europe and were observational. Short and cost-effective tools such as food frequency questionnaires and other questionnaires were the most frequently used. Moreover, food diary was a frequently selected method to study the diet of kidney stone formers. New technologies (e.g. online questionnaires, phone applications, connected tools) were rarely used.

CONCLUSION

Accurate reporting of the methods used in nutritional studies is of key importance to interpret results and build evidence. Assessing long-term dietary intake is still a challenge for nutritional epidemiology. A combination of self-report methods with objective dietary biomarkers and new technologies probably represents the best way forward.

Exploring the Intersection Between Diet and Self-Identity: A Cross-Sectional Study With Australian Adults

OBJECTIVE

Diet-related self-identity, which includes components such as individuals' overall dietary pattern and food choice motivations, is a strong predictor of health behaviors. This study sought to assess the variation in dietary patterns reported by a sample of Australian adults and their associations with diet quality.

DESIGN

Cross-sectional survey.

PARTICIPANTS

Australian adults (n = 2,010) VARIABLES MEASURED: The main outcome measure was diet quality relative to the Australian Dietary Guidelines, measured by the Healthy Diet Score survey. Other outcomes captured included dietary patterns (eg, unrestricted, vegetarian, flexitarian, or ketogenic diets), diet-related self-identity constructs (centrality, prosocial motivation, personal motivation, and strictness), and sociodemographic characteristics (eg, age, sex, and education level).

ANALYSIS

Data were analyzed descriptively, and ordinary least squares regression was performed to identify significant predictors of diet quality.

RESULTS

Eighteen unique dietary patterns were reported. These were classified into 3 categories on the basis of the degree of restriction of core food groups. Diets based on restriction of animal protein were associated with the highest diet quality, including the highest consumption of fruits, vegetables, and whole grains, whereas restriction of other foods was associated with the poorest diet quality. Unrestricted diets reported the highest consumption of discretionary food (high in saturated fat, salt, or added sugar). Finally, the regression analysis found that diet quality was significantly predicted by dietary pattern and diet-related self-identity constructs (F[8, 1974] = 54.952; P < 0.0001; adjusted R² = 0.179).

CONCLUSIONS AND IMPLICATIONS

Dietary pattern and diet-related self-identity constructs are key determinants of diet quality. This has implications for future interventions, including that programs and messages could be tailored to ensure they align with the target population's self-identity and overall dietary patterns.

Development of a Portfolio Diet Score and Its Concurrent and Predictive Validity Assessed by a Food Frequency Questionnaire

The Portfolio Diet, a plant-based portfolio of cholesterol-lowering foods, has been shown to reduce low-density lipoprotein cholesterol (LDL-C), and other cardiovascular risk factors, in randomized controlled trials (RCTs). It is not known if these beneficial effects translate to a lower incidence OF cardiovascular disease (CVD). To support examinations between Portfolio Diet adherence and disease, a Portfolio Diet score (PDS) was developed and its predictive and concurrent validity was assessed within the Toronto Healthy Diet Study, a six-month RCT in overweight adults. Predictive validity was assessed using change in the PDS measured by food frequency questionnaire (FFQ) and concomitant change in LDL-C from baseline to six months using multiple linear regression, adjusted for potential confounders (n = 652). Concurrent validity was assessed in a subset of participants (n = 50) who completed the FFQ and a 7-day diet record (7DDR) at baseline. The PDS determined from each diet assessment method was used to derive correlation coefficients and Bland–Altman plots to assess the between-method agreement. The change in PDS was inversely associated with change in LDL-C (β coefficients: −0.01 mmol/L (95% confidence intervals (CIs): −0.02, −0.002; p = 0.02). The correlation between the PDS from the FFQ and 7DDR was 0.69 (95% CIs: 0.48, 0.85). The Bland–Altman plot showed reasonable agreement between the score from the FFQ and 7DDR. These findings indicate predictive validity of the PDS with lower LDL-C, and reasonable concurrent validity of the PDS as assessed by an FFQ against a 7DDR.

Use of the Healthy Eating Index in Intervention Studies for Cardiometabolic Risk Conditions: A Systematic Review

Researchers and counselors need diet-assessment tools that characterize diet at baseline and over time in diet counseling and coaching interventions. Among possible tools, the Healthy Eating Index (HEI) is of interest in cardiometabolic treatment as it has undergone significant validation and development. The objective of this study was to systematically review relevant intervention studies using the HEI and its adaptations to examine whether diet interventions improve diet quality as measured by the HEI and the magnitude of change in included diet-quality scores following dietary intervention. Two databases [Cumulative Index to Nursing and Allied Health Literature (CINAHL) and PubMed] were searched for articles published from January 1995 to December 2019. The review included intervention studies in adults presenting with overweight/obesity and obesity-related chronic disease (metabolic syndrome, diabetes, prediabetes, hypertension, dyslipidemia) who received education or counseling, and the HEI was evaluated from baseline to follow-up (US or Canadian version) or Alternate HEI. Study quality was assessed using Cochrane risk of bias for randomized controlled trials (RCTs) or Cochrane Risk of Bias for Nonrandomized interventions (ROBINS-I). A total of 25 studies were included: 15 RCTs, 3 quasi-experimental studies, and 7 pre-post studies. Eight different versions of the HEI were used. Results demonstrated that diet quality assessed by HEI and its adaptations improved to a clinically relevant degree, especially in studies where multiple food behaviors/food-behavior goals were the focus and where an intensive, long-term intervention was compared with a no-treatment control group. There was wide variation in magnitude of change in included diet-quality indicators. Use of the HEI and its adaptations and other diet-quality tools is promising for better characterization of diet-counseling interventions and results when multiple food behaviors are a focus. Additional development is encouraged.

Development and Pilot Testing of a Nutrition Attitudes and Knowledge Questionnaire to Measure Changes of Child Nutrition Knowledge related to the Canada's Food Guide

Foodbot Factory is a serious game developed to teach children about the 2019 Canada's Food Guide (CFG) healthy eating principles. Because no measurement tools existed to assess changes in children's knowledge of the CFG, the Nutrition Attitudes and Knowledge (NAK) questionnaire was developed for this purpose. The NAK is based on the 2019 CFG nutrition content and aligned with the Foodbot Factory modules (Drinks, Whole Grain foods, Vegetables and Fruit, Protein foods). Seven experts assessed face and content validity of the draft NAK questionnaire. Three sections were deemed valid, while the remaining two required minor revisions. The NAK was pilot tested for changes in nutrition attitudes and knowledge among children 9-10 years-old (n=23), who answered the NAK questionnaire before and after using Foodbot Factory. Significant increases were found in overall nutrition knowledge, and knowledge of Whole Grain foods, Vegetables and Fruit and Protein foods. Knowledge of Drinks and nutrition attitudes remained unchanged. The NAK showed a moderate reliability when tested among a group of children (n=23). While the NAK questionnaire is a promising tool for assessing changes nutrition knowledge related to the 2019 CFG guidelines in children, further research is required to test construct validity of this instrument. Novelty bullets: • The Nutrition Attitudes and Knowledge (NAK) questionnaire was developed by educators and dietitians. • The NAK underwent face and content validity assessments and was pilot tested among children. • The NAK questionnaire is a potential tool to detect changes in children's knowledge of the 2019 Canada's Food Guide.

Dietary assessment methodology and reporting in Pacific Island research: a scoping review protocol

OBJECTIVE

This scoping review aims to identify and describe the methods used to collect and analyze dietary intake data in residents of Pacific Island countries.

INTRODUCTION

Dietary assessment explores associations between dietary factors and health outcomes. In regions, including the Pacific Islands, where diet-related, non-communicable diseases are increasing, this is a growing area of research. As this information is used to inform food and nutrition policies and practice, accurate collection, analysis, and interpretation of dietary assessment data relies on robust methods. A greater understanding of how nutrition studies are designed can strengthen the evidence on nutrition and health in Pacific Island settings and inform future research approaches.

INCLUSION CRITERIA

The scoping review will consider studies published in peer-reviewed journals, including quantitative and qualitative study designs and gray literature, including government reports, research and technical reports, theses and dissertations that measure and/or assess dietary intake in resident populations of the Pacific Island member countries of the Secretariat of the Pacific Community: American Samoa, Commonwealth of the Northern Mariana Islands, the Cook Islands, the Federated States of Micronesia, French Polynesia, Guam, the Independent State of Papua New Guinea, the Independent State of Samoa, the Kingdom of Tonga, New Caledonia, Niue, Pitcairn Islands, the Republic of Fiji, the Republic of Kiribati, the Republic of the Marshall Islands, the Republic of Nauru, the Republic of Palau, the Republic of Vanuatu, Solomon Islands, Tokelau, Tuvalu, and Wallis and Futuna.

METHODS

There will be no time limit and searches will be conducted in PubMed, CINAHL, CABI, Scopus, Cochrane Library, and Web of Science. Results will be limited to English-language articles. Data will be extracted independently by two reviewers into a charting table. Results will be presented graphically and with tables accompanied by a narrative summary.

A systematic review of dietary acids and habits on dental erosion in adolescents

BACKGROUND

Dental erosion is the dissolution of dental hard tissues caused by acids of a non-bacterial origin. Dietary acids are considered the predominant and most controllable factor.

AIM

To synthesise the literature on the effects of dietary acids and habits on dental erosion in the permanent dentition of 10- to 19-year-old adolescents.

MATERIALS AND METHODS

An electronic literature search was undertaken in Cochrane, MEDLINE, CINAHL, Dentistry & Oral Sciences Source via EBSCOhost, and Embase with no restriction on the date of publication.

RESULTS

The initial search identified 449 articles, and 338 remained after removal of duplicates. Seventy-seven articles remained after screening of titles and abstracts, and 52 were eligible for the full-text review. A considerable variety of beverages, food, and dietary habits were reported as risk factors for dental erosion. The most consistent findings implicated the erosive potential of carbonated beverages and the consumption of acidic drinks at bedtime.

CONCLUSIONS

Although results were not consistent between cohort and cross-sectional studies, this review suggests certain dietary risk factors may contribute to dental erosion in adolescents. There is a need for more high-quality cohort studies to establish more conclusive evidence on the role of dietary acids and habits on dental erosion.

Assessment of nationally representative dietary studies in the Gulf Cooperation Council: a scoping review

Background

Obesity is at a record high in Gulf Cooperation Council (GCC) countries and is expected to continue increasing. Diet is a major contributor to this disease, but there is inadequate nationally representative dietary research from these countries. The aim was to quantify the number dietary studies using food frequency questionnaires (FFQs) that have been conducted in individual GCC countries and to assess the quality of eligible studies.

Methodology

Four databases (PubMed, Web of Science, MEDLINE, and DOAJ) were searched for keywords; records were screened for eligible studies and data were abstracted on study characteristics (publication year, geographical locations, sample size, units of measurement, number of foods examined, number of Arab foods and key findings). Quality was assessed using an adapted Newcastle-Ottawa Quality Assessment Scale for cross-sectional studies.

Results

Only seven studies were eligible from four of six GCC countries (Saudi Arabia, Bahrain, Kuwait and Qatar). All eligible studies used FFQs, but only 29% used a validated questionnaire, one being in Arabic, and none of the studies used any additional tools to measure diet. Fifty-seven percent of studies made an effort to include local foods. The majority of studies (71%) either measured frequency or quantity of food consumed, but only 29% attempted to account for both frequency and quantity.

Conclusions

The quality of studies varied and major weaknesses of FFQ validity and adaptability have been highlighted. More dietary investigations are needed using validated FFQs that have been adapted to the local GCC diets. Using reference tools will allow for better dietary estimations.

Validity and Usability of a Smartphone Image-Based Dietary Assessment App Compared to 3-Day Food Diaries in Assessing Dietary Intake Among Canadian Adults: Randomized Controlled Trial

Background

Accurate dietary assessment is needed in studies that include analysis of nutritional intake. Image-based dietary assessment apps have gained in popularity for assessing diet, which may ease researcher and participant burden compared to traditional pen-to-paper methods. However, few studies report the validity of these apps for use in research. Keenoa is a smartphone image-based dietary assessment app that recognizes and identifies food items using artificial intelligence and permits real-time editing of food journals.

Objective

This study aimed to assess the relative validity of an image-based dietary assessment app — Keenoa — against a 3-day food diary (3DFD) and to test its usability in a sample of healthy Canadian adults.

Methods

We recruited 102 participants to complete two 3-day food records. For 2 weeks, on 2 non-consecutive days and 1 weekend day, in random order, participants completed a traditional pen-to-paper 3DFD and the Keenoa app. At the end of the study, participants completed the System Usability Scale. The nutrient analyses of the 3DFD and Keenoa data before (Keenoa-participant) and after they were reviewed by dietitians (Keenoa-dietitian) were analyzed using analysis of variance. Multiple tests, including the Pearson coefficient, cross-classification, kappa score, % difference, paired t test, and Bland-Altman test, were performed to analyze the validity of Keenoa (Keenoa-dietitian).

Results

The study was completed by 72 subjects. Most variables were significantly different between Keenoa-participant and Keenoa-dietitian (P<.05) except for energy, protein, carbohydrates, fiber, vitamin B1, vitamin B12, vitamin C, vitamin D, and potassium. Significant differences in total energy, protein, carbohydrates, % fat, saturated fatty acids, iron, and potassium were found between the 3DFD and Keenoa-dietitian data (P<.05). The Pearson correlation coefficients between the Keenoa-dietitian and 3DFD ranged from .04 to .51. Differences between the mean intakes assessed by the 3DFD and Keenoa-dietitian were within 10% except for vitamin D (misclassification rate=33.8%). The majority of nutrients were within an acceptable range of agreement in the Bland-Altman analysis; no agreements were seen for total energy, protein, carbohydrates, fat (%), saturated fatty acids, iron, potassium, and sodium (P<.05). According to the System Usability Scale, 34.2% of the participants preferred using Keenoa, while 9.6% preferred the 3DFD.

Conclusions

The Keenoa app provides acceptable relative validity for some nutrients compared to the 3DFD. However, the average intake of some nutrients, including energy, protein, carbohydrates, % fat, saturated fatty acids, and iron, differed from the average obtained using the 3DFD. These findings highlight the importance of verifying data entries of participants before proceeding with nutrient analysis. Overall, Keenoa showed better validity at the group level than the individual level, suggesting it can be used when focusing on the dietary intake of the general population. Further research is recommended with larger sample sizes and objective dietary assessment approaches.

Perceived stress and diet quality in women of reproductive age: a systematic review and meta-analysis

BACKGROUND

Poor diet quality is associated with obesity-related morbidity and mortality. Psychological stress can increase unhealthy dietary choices, but evidence pertinent to women of reproductive age remains unclear. This paper systematically reviewed the literature to determine the association between psychological stress and diet quality in women of reproductive age.

METHODS

Medline, CINAHL, Scopus, Cochrane Library, Web of Science, and Sciencedirect were searched. Data extraction was determined by the PEO. Inclusion criteria consisted of: English language, stress (exposure) measured in combination with diet quality (outcome), healthy women of reproductive age (18-49 years old (population)). Observational studies, due to the nature of the PEO, were included. Quality assessment used the Risk of Bias in Non-randomised Studies from the Cochrane Handbook of Systematic Reviews of Interventions. Meta-analysis was conducted using random-effect model to estimate the Fisher's z transformed correlation between stress and diet quality with 95% confidence interval (CI).

RESULTS

From 139,552 hits, 471 papers were screened; 24 studies met the inclusion criteria and were conducted in different countries: 8 studies on diet quality and 16 on food intake and frequency of consumption. Studies of diet quality consisted of six cross-sectional and two longitudinal designs with a total of 3982 participants. Diet quality was measured with diverse indices; Alternate Healthy Eating Index (n = 2), Healthy Eating Index (n = 2), Dietary Approach to Stop Hypertension (DASH) Diet Index (n = 2), Dietary Quality Index- Pregnancy (n = 2), and Dietary Guideline Adherence Index (n = 1). Most studies used Cohen's perceived stress scale and no study measured biological stress response. After sensitivity analysis, only 5 studies (3471 participants) were included in the meta-analysis. Meta-analysis revealed a significant negative association between stress and diet quality with substantial heterogeneity between studies (r = - 0.35, 95% CI [- 0.56; - 0.15], p value < 0.001, Cochran Q test P < 0.0001, I2 = 93%). The 16 studies of food intake and frequency of consumption were very heterogeneous in the outcome measure and were not included in the meta-analysis. These studies showed that stress was significantly associated with unhealthy dietary patterns (high in fat, sweets, salt, and fast food and low in fruits, vegetables, fish, and unsaturated fats).

CONCLUSION

Future studies that explore diet quality/patterns should include both diet indices and factor analysis and measure biological markers of stress and dietary patterns simultaneously.

Development, validation and utilisation of dish-based dietary assessment tools: a scoping review

Objective:

To summarise the existing evidence of development, validation and current status of utilisation of dish-based dietary assessment tools.

Design:

Scoping review.

Setting:

Systematic search using PubMed and Web of Science.

Results:

We identified twelve tools from seventy-four eligible publications. They were developed for Koreans (n 4), Bangladeshis (n 2), Iranians (n 1), Indians/Malays/Chinese (n 1), Japanese (n 3) and Chinese Americans (n 1). Most tools (10/12) were composed of a dish-based FFQ. Although the development process of a dish list varied among the tools, six studies classified mixed dishes based on the similarity of their characteristics such as food ingredients and cooking methods. Tools were validated against self-reported dietary information (n 9) and concentration biomarkers (n 1). In the eight studies assessing the differences between the tool and a reference, the mean (or median) intake of energy significantly differed in five studies, and 26–83 % of nutrients significantly differed in eight studies. Correlation coefficients for energy ranged from 0·15 to 0·87 across the thirteen studies, and the median correlation coefficients for nutrients ranged from 0·12 to 0·77. Dish-based dietary assessment tools were used in fifty-nine studies mainly to assess diet–disease relationships in target populations.

Conclusions:

Dish-based dietary assessment tools have exclusively been developed and used for Asian-origin populations. Further validation studies, particularly biomarker-based studies, are needed to assess the applicability of tools.

Major Depressive Disorder and Food Hypersensitivity: A Case Report

INTRODUCTION

Major depressive disorder (MDD) is a common chronic mental health condition and not all patients respond to pharmacotherapy. Increasing evidence suggests that dietary choices play a role in the pathogenesis of mental illness and serve as modifiable factors with utility in the treatment of these disorders. Although many mechanisms are being explored, one area of study is the role of food hypersensitivity reactions in mental health conditions.

CASE PRESENTATION

This article reports on a 34-year-old female patient with MDD whose symptoms improved in response to a dietary intervention involving the elimination of common food allergens. Reintroduction of the foods on several occasions was associated with a worsening of mood symptoms. Serum IgG testing reported results consistent with the reintroduction challenge.

DISCUSSION AND CONCLUSIONS

Hypothesized mechanisms underlying the potential relationship between food hypersensitivity and MDD are presented. Further research in this area is warranted.

A question of food intake: The impact of living arrangement and meal factors on total daily caloric intake

There has been dramatic weight gain among college students during their collegiate years. A food diary can give much insight of a college student's life. The purpose of this study is to analyze the food intake of college-aged students taking in factors such as the size of meal, the foods being eaten, the location of the meal, and if the meal was eaten with others. The results of this study suggest that being male, eating breakfast, and eating more snacks relative to the number meals increases daily caloric intake. On the other hand, being female and eating more meals at home will result in a lower daily caloric intake.

Nutrient intake and dietary quality changes within a personalized lifestyle intervention program for metabolic syndrome in primary care

A team-based 12-month lifestyle program for the treatment of metabolic syndrome (MetS) (involving physicians, registered dietitians (RDs), and kinesiologists) was previously shown to reverse MetS in 19% of patients (95% confidence interval, 14% to 24%). This work evaluates changes in nutrient intake and diet quality over 12 months (n = 205). Individualized diet counselling was provided by 14 RDs at 3 centres. Two 24-h recalls, the Canadian Healthy Eating Index (HEI-C), and the Mediterranean Diet Score (MDS) were completed at each time point. Total energy intake decreased by 145 ± 586 kcal (mean ± SD) over 3 months with an additional 76 ± 452 kcal decrease over 3–12 months. HEI-C improved from 58 ± 15 to 69 ± 12 at 3 months and was maintained at 12 months. Similarly, MDS (n = 144) improved from 4.8 ± 1.2 to 6.2 ± 1.9 at 3 months and was maintained at 12 months. Changes were specific to certain food groups, with increased intake of fruits, vegetables, and nuts and decreased intake of “other foods” and “commercial baked goods” being the most prominent changes. There was limited change in intake of olive oil, fish, and legumes. Exploratory analysis suggested that poorer diet quality at baseline was associated with greater dietary changes as assessed by HEI-C.

Novelty Multiple dietary assessment tools provided rich information on food intake changes in an intervention for metabolic syndrome. Improvements in diet were achieved by 3 months and maintained to 12 months. The results provide a basis for further dietary change implementation studies in the Canadian context.

Practical Guidance for Interventions in Adults with Metabolic Syndrome: Diet and Exercise vs. Changes in Body Composition

(1) Objective: to establish practical guidance for the design of future clinical trials in MS (metabolic syndrome) patients aged 18 and older, based on a systematic review of randomized clinical trials connecting diet, physical exercise and changes in body composition. (2) Method: this systematic review of randomized clinical trials (RCT) is based on the guidelines recommended by PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses). Criteria of selection: ≥18 years of age; patients diagnosed with MS; intervention programs including diet, physical exercise and/or modifications in the style of life as treatment, as well as the magnitude of changes in body composition (BC); randomized clinical trial published between 2004 and 2018. (3) Results: the multidisciplinary interventions describe major changes in BC, and the recurring pattern in these clinical trials is an energy reduction and control in the percentage of intake of macronutrients along with the performance of regularly structured exercise; the most analyzed parameter was waist circumference (88.9% of the trials), followed by body weight (85.2%), BMI (77.8%) and body fat (55.6%). (4) Conclusions: The analysis of the information here reported sheds light for the design of future clinical trials in adults with MS. The best anthropometric parameters and units of measurement to monitor the interventions are related to dietary and physical exercise interventions. A list of practical advice that is easy to implement in daily practice in consultation is here proposed in order to guarantee the best results in changes of body composition.

Development and validation of a Brief Diet Quality Assessment Tool in the French-speaking adults from Quebec

Background

The objective of this study was to develop and validate a short, self-administered questionnaire to assess diet quality in clinical settings, using the Alternative Healthy Eating Index (AHEI) as reference.

Methods

A total of 1040 men and women (aged 44.6 ± 14.4 y) completed a validated web-based food frequency questionnaire (webFFQ) and had their height and weight measured (development sample). Participants were categorized arbitrarily according to diet quality (high: AHEI score ≥ 65/110, low: AHEI score < 65/110) based on dietary intake data from the webFFQ. The Brief Diet Quality Assessment Tool was developed using a classification and regression tree (CART) approach and individual answers to the webFFQ among participants considered to have a plausible energy intake (ratio of reported energy intake to basal metabolic rate ≥ 1.2 and < 2.4; n = 1040). A second sample of 3344 older adults (aged 66.5 ± 6.4 y) was used to test the external validity of the Brief Diet Quality Assessment Tool (external validation sample).

Results

The decision tree included sequences of 3 to 6 binary questions, yielding 21 different pathways classifying diet quality as being high or low. In the development sample, the area under the receiver operating characteristic (ROC) curve of the predictive model was 0.92, with sensitivity, specificity and agreement values of 89.5, 83.9 and 87.2%. Compared with individuals having a low-quality diet according to the Brief Diet Quality Assessment Tool (mean AHEI 56.7 ± 11.4), individuals classified as having a high-quality diet (mean AHEI 71.3 ± 11.0) were significantly older, and had lower BMI, percent body fat and waist circumference, and had lower blood pressure, triglycerides, cholesterol/HDL ratio and fasting insulin as well as higher HDL-cholesterol concentrations (all P < 0.05). Similar results were observed in the external validation sample, although overall performance of the Brief Diet Quality Assessment Tool was slightly lower than in the development sample, with an area under the ROC curve of 0.79 and sensitivity, specificity and agreement values of 73.0, 69.0 and 71.3%, respectively.

Conclusion

The CART approach yielded a simple and rapid Brief Diet Quality Assessment Tool that identifies individuals at risk of having a low-quality diet. Further studies are needed to test the performance of this tool in primary care settings.

Electronic supplementary material

The online version of this article (10.1186/s12966-019-0821-6) contains supplementary material, which is available to authorized users.

Are French Canadians able to accurately self-rate the quality of their diet? Insights from the PREDISE study

The main objective of this study was to compare self-rated diet quality with a more comprehensive score of diet quality and to assess the ability of self-rated diet quality to predict adherence to healthy eating guidelines. This study also aimed to evaluate the influence of individual characteristics on the association between self-rated diet quality and the overall diet quality score. As part of the PRédicteurs Individuels, Sociaux et Environnementaux (PREDISE) study, 1045 participants (51% women) from the Province of Québec, Canada, self-rated their diet quality (“In general, would you say that your dietary habits are excellent, very good, good, fair, or poor?”). Three Web-based 24-h food recalls were completed, generating data for the calculation of the Canadian Healthy Eating Index (C-HEI) score, an overall diet quality indicator. Participants rated their diet quality as excellent (2.4%), very good (22.7%), good (49.5%), fair (20.3%), or poor (5.1%). C-HEI scores differed significantly between diet ratings, in the expected direction (p < 0.0001). Self-rated diet quality predicted adherence to healthy eating guidelines (i.e., C-HEI > 68) with a sensitivity of 44.5% and a specificity of 81.5% (C-statistic = 0.63). Sex significantly modified the association between self-rated diet quality and C-HEI score (p interaction = 0.0131); women had higher C-HEI scores than did men in the “good” and “fair” ratings. Self-rated diet quality can be useful in obtaining an overview of the diet quality of a population, but the results of this study suggest that such data should be used with caution given their poor ability to predict adherence to healthy eating guidelines. Individual characteristics may influence one’s ability to appropriately self-evaluate diet quality.

Comparing Interviewer-Administered and Web-Based Food Frequency Questionnaires to Predict Energy Requirements in Adults

Traditional food frequency questionnaires (FFQs) are influenced by systematic error, but web-based FFQ (WEB-FFQs) may mitigate this source of error. The objective of this study was to compare the accuracy of interview-based and web-based FFQs to assess energy requirements (mERs). The mER was measured in a series of controlled feeding trials in which participants daily received all foods and caloric drinks to maintain stable body weight over 4 to 6 weeks. FFQs assessing dietary intakes and hence mean energy intake were either interviewer-administered by a registered dietitian (IA-FFQ, n = 127; control method) or self-administered using a web-based platform (WEB-FFQ, n = 200; test method), on a single occasion. Comparison between self-reported energy intake and mER revealed significant under-reporting with the IA-FFQ (-9.5%; 95% CI, -12.7 to -6.1) and with the WEB-FFQ (-11.0%; 95% CI, -15.4 to -6.4), but to a similar extent between FFQs (p = 0.62). However, a greater proportion of individuals were considered as accurate reporters of energy intake using the IA-FFQ compared with the WEB-FFQ (67.7% vs. 48.0%, respectively), while the prevalence of over-reporting was lower with the IA-FFQ than with the WEB-FFQ (6.3% vs. 17.5%, respectively). These results suggest less accurate prediction of true energy intake by a self-administered WEB-FFQ than with an IA-FFQ.

Assessing the relative validity of a new, web-based, self-administered 24 h dietary recall in a French-Canadian population

OBJECTIVE

To assess the relative validity of a new, web-based, self-administered 24 h dietary recall, the R24W, for assessment of energy and nutrient intakes among French Canadians.

DESIGN

Each participant completed a 3d food record (FR) and the R24W on three occasions over a 4-week period. Intakes of energy and of twenty-four selected nutrients assessed by both methods were compared.

SETTING

Québec City metropolitan area.

SUBJECTS

Fifty-seven women and fifty men (mean (sd) age: 47·2 (13·3) years).

RESULTS

Equivalent proportions of under-reporters were found with the R24W (15·0%) and the FR (23·4%). Mean (sd) energy intake from the R24W was 7·2% higher than that from the FR (10 857 (3184) kJ/d (2595 (761) kcal/d) v. 10 075 (2971) kJ/d (2408 (710) kcal/d); P<0·01). Significant differences in mean nutrient intakes between the R24W and the FR ranged from -54·8% (i.e. lower value with R24W) for niacin to +40·0% (i.e. higher value with R24W) for alcohol. Sex- and energy-adjusted deattenuated correlations between the two methods were significant for all nutrients except Zn (range: 0·35-0·72; P<0·01). Cross-classification demonstrated that 40·0% of participants were classified in the same quartile with both methods, while 40·0% were classified in the adjacent quartile and only 3·6% were grossly misclassified (1st v. 4th quartile). Analysis of Bland-Altman plots revealed proportional bias between the two assessment methods for 8/24 nutrients.

CONCLUSIONS

These data suggest that the R24W presents an acceptable relative validity as compared with the FR for estimating usual dietary intakes in a cohort of French Canadians.

Adjustment Factors Can Improve Estimates of Food Group Intake Assessed Using a Short Dietary Assessment Instrument

BACKGROUND

Methods to address misreporting associated with short dietary assessment instruments are needed.

OBJECTIVE

Our objective was to develop and evaluate the direct and indirect validity of adjustment factors applied to a short dietary assessment instrument to improve estimates of usual consumption of core and discretionary food and beverage intake.

DESIGN

Validation of the Short Food Survey relative to 24-hour recalls was performed. The Short Food Survey requires individuals to report their usual intake of fruit, vegetables, grains, meat, dairy, and discretionary choices in multiples of standard servings. Adjustment factors were developed based on a ratio (usual portion size estimated from national data to standard serving size). The estimates of food group intakes (unadjusted and adjusted) were compared to 24-hour recalls.

PARTICIPANTS/SETTING

Three population samples were used in this study. The direct validation used data from 61 Australian adults (collected 2013-2014). The indirect validation compared data from the 2011-2013 Australian National Nutrition and Physical Activity Survey (n=9,435) to a sample of 145,975 who completed the Short Food Survey in a format that is freely available online (2015-2016).

MAIN OUTCOME MEASURES

Food group intake (in servings) was measured.

STATISTICAL ANALYSES PERFORMED

Descriptive and inferential statistical analyses were conducted.

RESULTS

Direct validation showed the adjustment factors improved the survey-derived estimates of intake for all food groups except grain foods. For grains, the mean difference went from -0.6 servings to +1.2 to 1.5 servings. The absolute difference in food group intake between the adjusted Short Food Survey and recalls remained statistically significant for fruit, meat, dairy, and grains, but was not different for vegetables and discretionary foods. The indirect validation showed that the adjusted estimates of intake from the online Short Food Survey were closer to the population estimates reported by 24-hour recall for all food groups except meat.

CONCLUSIONS

Adjustment factors can improve estimates of food group intake assessed using a short dietary assessment instrument for some but not all food groups.

Utilizing selected social determinants and behaviors to predict obesity in military personnel

OBJECTIVE

Like the general population, the military is experiencing an increase in the number of obese personnel. This study aimed to identify predictors of obesity by assessing social determinants of health and behaviors in relation to Body Mass Index (BMI), and to use these variables to build a model to predict obesity in Active Duty Military Personnel (ADMP). Predicting obesity would allow early intervention of at risk personnel, potentially reducing the number of ADMP who are separated from the service for failing to meet weight standards.

DESIGN

A secondary data analysis of the 2011 Survey of Health-Related Behaviors of Active Duty Military Personnel was performed. The survey included 39,197 responders.

MEASURES

Descriptive statistics, bivariate analyses, and logistic regression analysis were conducted to examine the relationship between social determinants of health, behaviors in relation to Healthy People 2020 recommendations, and obesity. Moderator variables were used to determine what affects the direction and/or strength of the relationship between the independent variables (e.g., social determinants and behaviors) and the outcome variable of obesity.

RESULTS

At the bivariate level, these variables mirror existing research. However, logistic regression identified few statistically significant obesogenic lifestyle behaviors in relation to Healthy People 2020 recommendations and a weak interactive effect between the variables.

CONCLUSION

The low number of significant variables identified to predict obesity highlights the multifactorial nature of obesity making it difficult for weight-loss interventions to be effective if limited to one group or one specific behavior.