ShoeCase: A data set of mock crime scene footwear impressions

This project's main objective is to create an open-source database containing a sizeable number of high-quality images of shoe impressions. The Center for Statistics and Applications in Forensic Evidence (CSAFE) team collected images that represented those found at crime scenes and constructed a database that is publicly available to forensic science and research communities. The database includes images obtained from mixed impression types: full blood impression, partial blood impression, and dust impression. The impressions are made on different flooring (vinyl and tile), and captured via various lift techniques: gel lifts and handiprints (exemplar prints with high definition using graphite powder and clear sticky vinyl, backed by a white sheet), and saved in multiple digital file types (TIF, XMP, CR3, and JPG). Our data were collected to ensure reproducibility, using simple but well-described protocols and easily accessible materials. The complete dataset includes 936 unique shoeprint images saved in 3,275 digital files. Data were collected by trained volunteers making shoe impressions on flooring with the two mediums: spatter blood and graphite powder. To make an impression, volunteers wearing a shoe stepped into the material and then walked on the flooring. A separate "lighter" step was taken to create a partial print for the blood prints. The blood prints were brought to the photography station, where researchers labeled and photographed them. Graphite prints were covered with a gel lifter before being moved to the photography room. There, the researchers removed the lift, labeled, and then photographed them. Our data will be of significant use to researchers, examiners, and anyone who could benefit from using a large dataset like this. Footwear datasets are often difficult to find, especially ones that resemble crime scenes, so our data can help fill that gap.

Hierarchical Bayesian non-response models for error rates in forensic black-box studies

Forensic science plays a critical role in the United States criminal legal system. Historically, however, most feature-based fields of forensic science, including firearms examination and latent print analysis, have not been shown to be scientifically valid. Recently, black-box studies have been proposed as a means of assessing whether these feature-based disciplines are valid, at least in terms of accuracy, reproducibility and repeatability. In these studies, forensic examiners frequently either do not respond to every test item or select an answer equivalent to 'don't know'. Current black-box studies do not account for these high levels of missingness in statistical analyses. Unfortunately, the authors of black-box studies typically do not share the data necessary to meaningfully adjust estimates for the high proportion of missing responses. Borrowing from work in the context of small area estimation, we propose the use of hierarchical Bayesian models that do not require auxiliary data to adjust for non-response. Using these models, we offer the first formal exploration of the impact that missingness is playing in error rate estimations reported in black-box studies. We show that error rates currently reported as low as 0.4% could actually be at least 8.4% in models accounting for non-response where inconclusive decisions are counted as correct, and over 28% when inconclusives are counted as missing responses. These proposed models are not the answer to the missingness problem in black-box studies. But with the release of auxiliary information, they can be the foundation for new methodologies to adjust for missingness in error rate estimations. This article is part of the theme issue 'Bayesian inference: challenges, perspectives, and prospects'.

Productos procesados y ultraprocesados y su relación con la calidad de la dieta en niños

Objetivo.

Estimar el efecto que representa en la calidad de la dieta de la primera infancia uruguaya —niños de 2 a 4 años— el consumo de productos que contienen cantidades excesivas de nutrientes críticos asociados a las enfermedades no transmisibles (ENT) (azúcares libres, grasas totales, grasas saturadas y sodio), según el modelo de perfil de nutrientes de la Organización Panamericana de la Salud (OPS).

Métodos.

Se utilizó un recordatorio de ingesta de alimentos durante 24 horas en una muestra representativa de 401 participantes de la Encuesta de Nutrición, Desarrollo Infantil y Salud del año 2018. Se usó la clasificación de alimentos propuesta por el sistema NOVA para categorizarlos según su naturaleza y los procesos industriales a los que son sometidos. A partir de esto se lo analizó con base en el modelo de perfil de nutrientes de la OPS, lo cual permitió identificar los productos con contenido excesivo de estos nutrientes.

Resultados.

El 50 % de los niños consumieron tres o más productos con exceso de alguno de los nutrientes vinculados con las ENT. Aproximadamente 9 de cada 10 niños consumen productos con exceso de al menos uno de los nutrientes críticos estudiados.

Conclusión.

Las dietas que no contienen productos ultraprocesados y procesados con exceso de azúcares libres, grasas totales, grasas saturadas y sodio fueron la mejor opción para los niños de 2 a 4 años. La ingesta de productos con exceso de nutrientes críticos según la OPS (y cada gramo adicional consumido de tales productos) empeora la calidad de la dieta de manera significativa, e impide que se cumpla con las recomendaciones de la Organización Mundial de la Salud.

Assessing adult physical activity and compliance with 2008 CDC guidelines using a Bayesian two-part measurement error model

While there is wide agreement that physical activity is an important component of a healthy lifestyle, it is unclear how many people adhere to public health recommendations on physical activity. The Physical Activity Guidelines (PAG), published by the CDC, provides guidelines to American adults, but it is difficult to assess compliance with these guidelines. The PAG further complicates adherence assessment by recommending activity to occur in at least 10 min bouts. To better understand the measurement capabilities of various instruments to quantify activity, and to propose an approach to evaluate activity relative to the PAG, researchers at Iowa State University administered the Physical Activity Measurement Survey (PAMS) to over 1000 participants in four different Iowa counties. In this paper, we develop a two-part Bayesian measurement error model and apply it to the PAMS data in order to assess compliance with the PAG in the Iowa adult population. The model accurately accounts for the 10 min bout requirement put forth in the PAG. The measurement error model corrects biased estimates and accounts for day-to-day variation in activity. The model is also applied to the nationally representative National Health and Nutrition Examination Survey.

The relationship between moderate to vigorous physical activity and metabolic syndrome: a Bayesian measurement error approach

Metabolic Syndrome (MetS) is a serious condition that can be an early warning sign of heart disease and Type 2 diabetes. MetS is characterized by having elevated levels of blood pressure, cholesterol, waist circumference, and fasting glucose. There are many articles in the literature exploring the relationship between physical activity and MetS, but most do not consider the measurement error in the physical activity measurements nor the correlations among the MetS risk factors. Furthermore, previous work has generally treated MetS as binary, rather than directly modeling the risk factors on their measured, continuous space. Using data from the National Health and Nutrition Examination Survey (NHANES), we explore the relationship between minutes of moderate to vigorous physical activity (MVPA) and MetS risk factors. We construct a measurement error model for the accelerometry data, and then model its relationship between MetS risk factors with nonlinear seemingly unrelated regressions, incorporating dependence among MetS risk factors. The novel features of this model give the medical research community a new way to understand relationships between MVPA and MetS. The results of this approach present the field with a different modeling perspective than previously taken and suggest future avenues of scientific discovery.

Estimation of Intake of Critical Nutrients Associated with Noncommunicable Diseases According to the PAHO/WHO Criteria in the Diet of School-Age Children in Montevideo, Uruguay

Purpose: To estimate the effect of the consumption of products with an excessive amount of critical nutrients associated with NCDs, according to the PAHO Nutrient Profile Model on the quality of the diet of Uruguayan school-age children (4 to 12 years). Methods: A 24 h recall of food intake was conducted in a representative sample of 332 participants in the evaluation of the School Feeding Program in 2018 in public schools in Montevideo, Uruguay. Food and preparations were categorized according to the NOVA food classification, according to the nature, extent, and purposes of the industrial processes they undergo. Later, they were analyzed according to the Pan American Health Organization Nutrient Profile Model (PAHO NPM) to identify processed and ultra-processed products with an excessive content of critical nutrients. Results: Only 0.52% of children consumed exclusively natural foods, or culinary ingredients. Twenty-five per cent of children consumed ≥4 products categorized with an excessive content of free sugars, total fat, or saturated fat according to the PAHO NPM; in the case of excessive sodium, this was 40%. In general, children who included products with excessive free sugars, sodium, or saturated fat in their diet exceeded the limits established by the World Health Organization, and, as a result, their diet is of poorer nutritional quality compared to children who did not consume such products. Conclusion: Diets free of ultra-processed and processed products with excess free sugars, total fats, saturated fats, and sodium increased the chances of school-age children in Montevideo of meeting WHO nutrient intake recommendations. Meanwhile, intake of each additional gram of products with excessive critical nutrients according to PAHO NPM, significantly worsens diets, preventing children from meeting WHO recommendations.

The effect of image descriptors on the performance of classifiers of footwear outsole image pairs

Shoe prints are commonly found at the scene of a crime and can sometimes help link a suspect to the scene. Because prints tend to be partially observed or smudgy, comparing crime scene prints with reference images from a putative shoe can be challenging. Footwear examiners rely on guidelines such as those published by SWGTREAD [1] to visually assess the similarity between two or more footwear impressions, one reason being that reliable, quantitative methods have yet to be validated for use in real cases. To help in the development of such methods, we created a study dataset of images of outsole impressions that shared class characteristics and degree of wear and that were subject to a specific type of degradation. We also propose a method to quantify the similarity between two outsole images that extends the capabilities of MC-COMP [2]. The proposed method is composed of three steps; (1) extracting image descriptors, (2) aligning images using the maximum clique, (3) calculating similarity values using two different classifiers; (a) degree of overlap between the two images, and (b) a score produced by a random forest. To explore the performance of the algorithm we propose, we compared degraded, crime scene-like images to high-quality reference images produced by the same or by different shoes. Even though comparisons involved matches or very close non-matches, and one of the images was blurry, the algorithm shows good source classification performance.

Knot selection in sparse Gaussian processes with a variational objective function

Sparse, knot-based Gaussian processes have enjoyed considerable success as scalable approximations of full Gaussian processes. Certain sparse models can be derived through specific variational approximations to the true posterior, and knots can be selected to minimize the Kullback-Leibler divergence between the approximate and true posterior. While this has been a successful approach, simultaneous optimization of knots can be slow due to the number of parameters being optimized. Furthermore, there have been few proposed methods for selecting the number of knots, and no experimental results exist in the literature. We propose using a one-at-a-time knot selection algorithm based on Bayesian optimization to select the number and locations of knots. We showcase the competitive performance of this method relative to optimization of knots simultaneously on three benchmark datasets, but at a fraction of the computational cost.

A database of two-dimensional images of footwear outsole impressions

Footwear outsole images were obtained from 150 pairs of used shoes. The motivation for constructing the database was to enable a statistical analysis of two-dimensional (2D) images of shoe outsoles, to understand within shoe (between replicate images of the same shoe) and between shoe variability, and to develop methods for the evaluation of forensic pattern evidence of shoeprints. Since we scanned the outsole of the used shoes, the images capture not only the outsole pattern design but also the marks that arise from wear and tear and that may help identify the shoe that made the impression. Each shoe in a pair was scanned five times, so that replicate images can be used to estimate within-shoe variability. In total, there are 1500 2D images in the database. The EverOS footwear scanner was used to capture the outsole of each shoe. The scanner detects the weight distribution of the person wearing the shoe when he or she steps on the scanning surface. It images the portions of the outsole that make contact with the scanning surface. The database is a useful resource for forensic scientists or for anybody else with an interest in image comparison. The database we describe, was constructed by researchers in the Center for Statistics and Applications in Forensic Evidence (CSAFE) at Iowa State University.

An algorithm to compare two-dimensional footwear outsole images using maximum cliques and speeded-up robust feature

Footwear examiners are tasked with comparing an outsole impression (Q) left at a crime scene with an impression (K) from a database or from the suspect's shoe. We propose a method for comparing two shoe outsole impressions that relies on robust features (speeded-up robust feature; SURF) on each impression and aligns them using a maximum clique (MC). After alignment, an algorithm we denote MC-COMP is used to extract additional features that are then combined into a univariate similarity score using a random forest (RF). We use a database of shoe outsole impressions that includes images from two models of athletic shoes that were purchased new and then worn by study participants for about 6 months. The shoes share class characteristics such as outsole pattern and size, and thus the comparison is challenging. We find that the RF implemented on SURF outperforms other methods recently proposed in the literature in terms of classification precision. In more realistic scenarios where crime scene impressions may be degraded and smudged, the algorithm we propose-denoted MC-COMP-SURF-shows the best classification performance by detecting unique features better than other methods. The algorithm can be implemented with the R-package shoeprintr.

A database of handwriting samples for applications in forensic statistics

Handwriting samples were collected from 90 adults for the purpose of developing statistical approaches to the evaluation of handwriting as forensic evidence. Each participant completed three data collection sessions, each at least three weeks apart. At each session, a survey was completed and three writing prompts were each transcribed three times. In total, the repository includes 2430 handwriting sample images as well as demographic and session specific information for all 90 participants. The writing samples were scanned and instructional header text was cropped out to obtain the raw writing data as image files. Survey data are provided in table format. Reliable methods for data management were incorporated through systematic document generation, QR code text embedding, and the development of an application to facilitate data entry and automated file naming and handling. The data presented in this article were collected by researchers at the Center for Statistics and Applications in Forensic Evidence (CSAFE) at Iowa State University.

Food sources, energy and nutrient intakes of adults: 2013 Philippines National Nutrition Survey

BACKGROUND

Comprehensive assessment of dietary intakes of foods and nutrients in Filipino adults are lacking. This study evaluated energy and nutrient intakes and food sources of key nutrients consumed by Filipino adults.

METHODS

The participants were from the 2013 National Nutrition Survey wherein food intake of young adults aged 19-49 years (n = 12,896) and older adults aged 50 years and above (n = 7853) were collected using 24-h recalls. Usual nutrient intakes were estimated using PC-SIDE program. The Philippines Dietary Reference Intakes were used to calculate proportions of inadequate intake using Estimated Average Requirement (EAR) and Acceptable Macronutrient Distribution Ranges (AMDR). Energy adequacy was evaluated using the Institute of Medicine (IOM) equation for Estimated Energy Requirements (EER).

RESULTS

The nutrient intakes with the highest prevalence of inadequacy (> 50%) were: iron (97-99%), vitamin C (96-98%), calcium (95-98%), riboflavin (86-91%), folate (89-90%), thiamine (73-89%), energy (67-70%), total fat (55-67%), and vitamin A (54-56%). Refined rice, pork and breads contributed most to daily intakes of energy, protein, carbohydrates, thiamine, riboflavin, and iron. Low intake of vegetables, fruits and dairy was common in both age groups.

CONCLUSIONS

This study demonstrated that intakes of many nutrients were markedly inadequate among adults in the Philippines, due to the rice-dominant dietary pattern with few nutrient-dense foods. These results can be used to support the development of specific interventions to improve the shortfalls in nutrient intakes.

Higher dietary magnesium intake is associated with lower body mass index, waist circumference and serum glucose in Mexican adults

BACKGROUND

Obesity and diabetes mellitus (DM) are public health concerns in Mexico of top-level priority due to their high prevalence and their growth rate in recent decades. The accumulation of adipose tissue leads to an unbalanced release of pro-oxidant factors, which causes cellular damage and favors the development of comorbidities. Recent evidence suggests that oxidative stress also promotes the accumulation of adipose tissue and the development of insulin resistance. The objective of this study is to evaluate the association between usual intake of antioxidant nutrients, specifically vitamins A, C, E and magnesium with body mass index (BMI), waist circumference (WC) and serum glucose concentrations in a representative sample of Mexican adults.

METHODOLOGY

We analyzed data on diet, BMI, WC and serum glucose from the Mexican National Health and Nutrition Survey 2012. Analysis included 20- to 65-year-old adults without a known diagnosis of DM (n = 1573). Dietary information was obtained using the five-step multiple-pass method developed by the United States Department of Agriculture and adapted to the Mexican context. Nutrient usual intake distributions were estimated using the Iowa State University method, through the "Software for Intake Distribution Estimation" (PC-Side) v.1.02. Associations were analyzed using multivariate regression models.

RESULTS

Higher dietary magnesium intake was associated with lower markers of adiposity, so that an increase in 10 mg per 1000 kcal/day of magnesium was associated with an average decrease in BMI of 0.72% (95% CI: -1.36, - 0.08) and 0.49 cm (95% CI: -0.92, - 0.07) of WC. Additionally, in women with normal glucose concentrations, an increase in magnesium intake was associated with an average decrease in serum glucose by 0.59% (95% CI: -1.08, - 0.09).

CONCLUSION

The results suggest that magnesium intake is associated with lower BMI, WC and serum glucose in Mexican population. However, more studies are required to elucidate the nature of this association.

Nutrient Intakes and Food Sources of Filipino Infants, Toddlers and Young Children are Inadequate: Findings from the National Nutrition Survey 2013

Comprehensive assessment of nutrient intakes and food sources of nutrients in Filipino children under 5 years old are lacking. We studied energy and nutrient intakes and food sources in 4218 children aged 6⁻59.9 months using two 24-h dietary recalls. Usual energy and nutrient intakes were estimated using the PC-SIDE program. Reported foods and beverages were assigned to one of 85 food groups. Percentage contribution of each food group to nutrient intake was calculated. The results showed that the intake of total fat as a percentage of energy and of most micronutrients were highly inadequate. The prevalence of inadequate nutrient intakes, defined as the percent of children with intakes less than the estimated average requirements (EAR) ranged from 60⁻90% for iron, calcium, vitamin C, and zinc and ranged from 30⁻50% for others such as vitamin A, thiamine, riboflavin, niacin, vitamin B6, and phosphorus. The diets of these children were composed of limited foods, namely a large amount of refined rice and other low-nutrient-dense foods (cookies and sugar), while vegetables, fruits, meats, and eggs made little contribution to daily energy or nutrients. These findings provide direction to health professionals developing food-based recommendations and strategies to tackle the shortfalls in the diet of this population.

Modeling energy balance while correcting for measurement error via free knot splines

Measurements of energy balance components (energy intake, energy expenditure, changes in energy stores) are often plagued with measurement error. Doubly-labeled water can measure energy intake (EI) with negligible error, but is expensive and cumbersome. An alternative approach that is gaining popularity is to use the energy balance principle, by measuring energy expenditure (EE) and change in energy stores (ES) and then back-calculate EI. Gold standard methods for EE and ES exist and are known to give accurate measurements, albeit at a high cost. We propose a joint statistical model to assess the measurement error in cheaper, non-intrusive measures of EE and ES. We let the unknown true EE and ES for individuals be latent variables, and model them using a bivariate distribution. We try both a bivariate Normal as well as a Dirichlet Process Mixture Model, and compare the results via simulation. Our approach, is the first to account for the dependencies that exist in individuals' daily EE and ES. We employ semiparametric regression with free knot splines for measurements with error, and linear components for error free covariates. We adopt a Bayesian approach to estimation and inference and use Reversible Jump Markov Chain Monte Carlo to generate draws from the posterior distribution. Based on the semiparameteric regression, we develop a calibration equation that adjusts a cheaper, less reliable estimate, closer to the true value. Along with this calibrated value, our method also gives credible intervals to assess uncertainty. A simulation study shows our calibration helps produce a more accurate estimate. Our approach compares favorably in terms of prediction to other commonly used models.

Smokers report lower intake of key nutrients than nonsmokers, yet both fall short of meeting recommended intakes

Smoking is a major risk factor in the development of preventable disease which may be due to a poorer diet and the reduced nutrient intake of smokers. Our objective was to compare and evaluate the reported intake of current smokers with that of nonsmokers among participants of a study evaluating stress and smoking. We hypothesized (1) that overall energy and nutrient intake would be reduced in smokers compared with nonsmokers and (2) that smokers would have increased noncompliance with Dietary Reference Intakes (DRIs). Men and women (smokers n=138, nonsmokers n=46) completed a 3-day diet record at baseline. Mean energy and nutrient intakes were stratified by smoking status and compared with DRI levels. The mean body mass index was 28.3±0.5kg/m2 for smokers and 27.2±1.0kg/m2 for nonsmokers. Compared with nonsmokers, the smokers reported lower intakes of energy, total polyunsaturated fatty acids, linolenic acid, docosahexaenoic acid, total sugars, calcium, iron, magnesium, phosphorus, potassium, vitamin C, riboflavin, niacin, pantothenic acid, vitamin B6, folate, vitamin A, and vitamin E. Smokers reported reduced compliance with the DRIs for iron, phosphorus, vitamin C, riboflavin, and folate compared with nonsmokers. Unlike other evaluations of smokers vs nonsmokers, we observed no difference in body weight between groups. Smokers and nonsmokers alike reported dietary intakes lower than the DRIs for many nutrients. However, the reported nutrient intake of the smokers was substantially lower than nonsmokers for key nutrients, and they were more likely to not comply with the DRIs for essential nutrients, placing them at increased risk of chronic disease.

Nutrient Intake Is Insufficient among Senegalese Urban School Children and Adolescents: Results from Two 24 h Recalls in State Primary Schools in Dakar

Due to rapid urbanization and high food prices and in the absence of nutrition programs, school children from urban areas in West Africa often have insufficient and inadequate diet leading to nutrient deficiencies that affect their health and schooling performance. Acute malnutrition and micronutrient deficiencies are prevalent in children from primary state schools of Dakar (Senegal). The objectives of the present study were to assess the overall diet of these children, to report insufficient/excessive energy and nutrient intakes and to investigate association between insufficient nutrient intake and micronutrient deficiencies. Children attending urban state primary schools in the Dakar area were selected through a two-stage random cluster sampling (30 schools × 20 children). Dietary intake data were obtained from two 24 h recalls and blood samples were collected from 545 children (aged 5–17 years, 45% < 10 years, 53% girls) and adjusted for intra-individual variability to estimate nutrient usual intakes. Energy intake was insufficient and unbalanced with insufficient contribution of protein and excessive contribution of fat to global energy intake in one third of the children. Proportions of children with insufficient intake were: 100% for calcium, 100% for folic acid, 79% for vitamin A, 69% for zinc, 53% for vitamin C and 46% for iron. Insufficient iron and protein intake were risk factors for iron deficiency (odds ratio, OR 1.5, 2.2). Insufficient zinc intake and energy intake from protein were risk factors for zinc deficiency (OR 1.8, 3.0, 1.7, 2.9). Insufficient iron and vitamin C intake, and insufficient energy intake from protein were risk factors for marginal vitamin A status (OR 1.8, 1.8, 3.3). To address nutritional deficiencies associated with a diet deficient in energy, protein and micronutrients, nutrition education or school feeding programs are needed in urban primary schools of Senegal.

Biofortified β-carotene rice improves vitamin A intake and reduces the prevalence of inadequacy among women and young children in a simulated analysis in Bangladesh, Indonesia, and the Philippines

BACKGROUND

Vitamin A deficiency continues to be a major public health problem affecting developing countries where people eat mostly rice as a staple food. In Asia, rice provides up to 80% of the total daily energy intake.

OBJECTIVE

We used existing data sets from Bangladesh, Indonesia, and the Philippines, where dietary intakes have been quantified at the individual level to 1) determine the rice and vitamin A intake in nonpregnant, nonlactating women of reproductive age and in nonbreastfed children 1-3 y old and 2) simulate the amount of change that could be achieved in the prevalence of inadequate intake of vitamin A if rice biofortified with β-carotene were consumed instead of the rice consumed at present.

DESIGN

We considered a range of 4-20 parts per million (ppm) of β-carotene content and 10-70% substitution levels for the biofortified rice. Software was used to estimate usual rice and vitamin A intake for the simulation analyses.

RESULTS

In an analysis by country, the substitution of biofortified rice for white rice in the optimistic scenario (20 ppm and 70% substitution) decreased the prevalence of vitamin A inadequacy from baseline 78% in women and 71% in children in Bangladesh. In Indonesia and the Philippines, the prevalence of inadequacy fell by 55-60% in women and dropped by nearly 30% in children from baseline.

CONCLUSIONS

The results of the simulation analysis were striking in that even low substitution levels and modest increases in the β-carotene of rice produced a meaningful decrease in the prevalence of inadequate intake of vitamin A. Increasing the substitution levels had a greater impact than increasing the β-carotene content by >12 ppm.

Usual Vitamin Intakes by Mexican Populations

BACKGROUND

In the past several years, the consumption of high-energy, nutrient-poor foods has increased globally. Dietary intake data collected by the National Health and Nutrition Survey (ENSANUT) 2012 provide information to assess the quality of the Mexican diet and to guide food and nutrition policy.

OBJECTIVE

The aim was to describe the usual intake and the prevalence of inadequate intakes of vitamins for the overall Mexican population and by subgroups defined by sex, age, region, urban or rural areas, and socioeconomic status (SES).

METHODS

ENSANUT 2012 is a cross-sectional probabilistic survey representative of the Mexican population. Dietary information was collected by using the 24-h recall automated multiple-pass method (n = 10,096) with a repeated measurement on a subsample (n = 889) to permit adjustment for intraindividual variability with the use of the Iowa State University method. Mean usual intakes and the prevalence of inadequate intakes of thiamin, riboflavin, niacin, folate, and vitamins A, D, E, C, B-6, and B-12 were calculated for children aged 1-4 y (CH1-4y), children aged 5-11 y (CH5-11y), adolescents aged 12-19 y, and adults aged ≥20 y.

RESULTS

In all of the age groups, prevalences of inadequate intakes of vitamins D and E were the highest (77-99% of adults and adolescents and 53-95% of CH5-11y and CH1-4y) and those of folate and vitamin A were intermediate (47-70% of adults and adolescents, 15-23% of CH5-11y and 8-13% of CH1-4y), whereas those of thiamin, riboflavin, niacin, and vitamins B-6, B-12, and C were the lowest (0-37% of adults, 1-27% of adolescents, and 0-2.4% of CH5-11y and CH1-4y). With few exceptions, the highest prevalences of inadequate intakes for vitamins were observed in the poorest populations (rural South region and the lowest tertile of SES).

CONCLUSIONS

The intake of vitamins among Mexicans is inadequate overall. Information collected by ENSANUT can help target food assistance programs and develop strategies to prevent vitamin deficiencies.

Characteristics of U.S. Adults with Usual Daily Folic Acid Intake above the Tolerable Upper Intake Level: National Health and Nutrition Examination Survey, 2003-2010

The Food and Drug Administration mandated that by 1998, all enriched cereal grain products (ECGP) be fortified with folic acid in order to prevent the occurrence of neural tube defects. The Institute of Medicine established the tolerable upper intake level (UL) for folic acid (1000 µg/day for adults) in 1998. We characterized U.S. adults with usual daily folic acid intake exceeding the UL. Using NHANES 2003–2010 data, we estimated the percentage of 18,321 non-pregnant adults with usual daily folic acid intake exceeding the UL, and among them, we calculated the weighted percentage by sex, age, race/ethnicity, sources of folic acid intake, supplement use and median usual daily folic acid intakes. Overall, 2.7% (standard error 0.6%) of participants had usual daily intake exceeding the UL for folic acid; 62.2% were women; 86.3% were non-Hispanic whites; and 98.5% took supplements containing folic acid. When stratified by sex and age groups among those with usual daily folic acid intake exceeding the UL, 20.8% were women aged 19–39 years. Those with usual daily intake exceeding the folic acid UL were more likely to be female, non-Hispanic white, supplement users or to have at least one chronic medical condition compared to those not exceeding the folic acid UL. Among those with usual daily folic acid intake exceeding the UL who also took supplements, 86.6% took on average >400 µg of folic acid/day from supplements. Everyone with usual daily folic acid intake exceeding the UL consumed folic acid from multiple sources. No one in our study population had usual daily folic acid intake exceeding the UL through consumption of mandatorily-fortified enriched cereal grain products alone. Voluntary consumption of supplements containing folic acid is the main factor associated with usual daily intake exceeding the folic acid UL.

Validity of 24-h physical activity recall: physical activity measurement survey

PURPOSE

The primary purpose of this study was to evaluate the validity of an interviewer-administered, 24-h physical activity recall (PAR) compared with that of the SenseWear Armband (SWA) for estimation of energy expenditure (EE) and moderate-to-vigorous physical activity (MVPA) in a representative sample of adults. A secondary goal was to compare measurement errors for various demographic subgroups (gender, age, and weight status).

METHODS

A sample of 1347 adults (20-71 yr, 786 females) wore an SWA for a single day and then completed a PAR, recalling the previous day's physical activity. The participants each performed two trials on two randomly selected days across a 2-yr time span. The EE and MVPA values for each participant were averaged across the 2 d. Group-level and individual-level agreement were evaluated using 95% equivalence testing and mean absolute percent error, respectively. Results were further examined for subgroups by gender, age, and body mass index.

RESULTS

The PAR yielded equivalent estimates of EE (compared with those in the SWA) for almost all demographic subgroups, but none of the comparisons for MVPA were equivalent. Smaller mean absolute percent error values were observed for EE (ranges from 10.3% to 15.0%) than those for MVPA (ranges from 68.6% to 269.5%) across all comparisons. The PAR yielded underestimates of MVPA for younger, less obese people but overestimates for older, more obese people.

CONCLUSIONS

For EE measurement, the PAR demonstrated good agreement relative to the SWA. However, the use of PAR may result in biased estimates of MVPA both at the group and individual level in adults.

Selecting desirable micronutrient fortificants for plant-based complementary foods for infants and young children in low-income countries

The World Health Organization (WHO) recommends that both breast-fed and non-breast-fed children are fed micronutrient fortified complementary foods designed to meet their high nutrient requirements from aged 6 to 23 months of age. This paper summarises the steps recommended by WHO/FAO to identify the country-specific micronutrient shortfalls in complementary diets and establish desirable levels of bioavailable fortificants for centrally processed plant-based complementary foods for infant and young child feeding. The goal of the WHO/FAO guidelines is to achieve a desirably low prevalence of inadequate micronutrient intakes in the target group whilst simultaneously ensuring minimal risk of excessive intakes.

Fortification: new findings and implications

This article reviews the current landscape regarding food fortification in the United States; the content is based on a workshop sponsored by the North American Branch of the International Life Sciences Institute. Fortification of the food supply with vitamins and minerals is a public health strategy to enhance nutrient intakes of the population without increasing caloric intake. Many individuals in the United States would not achieve recommended micronutrient intakes without fortification of the food supply. The achievement and maintenance of a desirable level of nutritional quality in the nation's food supply is, thus, an important public health objective. While the addition of nutrients to foods can help maintain and improve the overall nutritional quality of diets, indiscriminate fortification of foods could result in overfortification or underfortification in the food supply and nutrient imbalances in the diets of individuals. Any changes in food fortification policy for micronutrients must be considered within the context of the impact they will have on all segments of the population and of food technology and safety applications and their limitations. This article discusses and evaluates the value of fortification, the success of current fortification efforts, and the future role of fortification in preventing or reversing nutrient inadequacies.

Trends in the prevalence of excess dietary sodium intake - United States, 2003-2010

Excess sodium intake can lead to hypertension, the primary risk factor for cardiovascular disease, which is the leading cause of U.S. deaths. Monitoring the prevalence of excess sodium intake is essential to provide the evidence for public health interventions and to track reductions in sodium intake, yet few reports exist. Reducing population sodium intake is a national priority, and monitoring the amount of sodium consumed adjusted for energy intake (sodium density or sodium in milligrams divided by calories) has been recommended because a higher sodium intake is generally accompanied by a higher calorie intake from food. To describe the most recent estimates and trends in excess sodium intake, CDC analyzed 2003-2010 data from the National Health and Nutrition Examination Survey (NHANES) of 34,916 participants aged ≥1 year. During 2007-2010, the prevalence of excess sodium intake, defined as intake above the Institute of Medicine tolerable upper intake levels (1,500 mg/day at ages 1-3 years; 1,900 mg at 4-8 years; 2,200 mg at 9-13 years; and 2,300 mg at ≥14 years) (3), ranged by age group from 79.1% to 95.4%. Small declines in the prevalence of excess sodium intake occurred during 2003-2010 in children aged 1-13 years, but not in adolescents or adults. Mean sodium intake declined slightly among persons aged ≥1 year, whereas sodium density did not. Despite slight declines in some groups, the majority of the U.S. population aged ≥1 year consumes excess sodium.

Modeling a methylmalonic acid-derived change point for serum vitamin B-12 for adults in NHANES

BACKGROUND

No consensus exists about which cutoff point should be applied for serum vitamin B-12 (SB-12) concentrations to define vitamin B-12 status in population-based research.

OBJECTIVE

The study's aim was to identify whether a change point exists at which the relation between plasma methylmalonic acid (MMA) and SB-12 changes slope to differentiate between inadequate and adequate vitamin B-12 status by using various statistical models.

DESIGN

We used data on adults (≥19 y; n = 12,683) from NHANES 1999-2004-a nationally representative, cross-sectional survey. We evaluated 6 piece-wise polynomial and exponential decay models that used different control levels for known covariates.

RESULTS

The MMA-defined change point for SB-12 varied depending on the statistical model used. A linear-splines model was determined to best fit the data, as determined by the approximate permutation test; 3 slopes relating SB-12 and MMA and resulting in 2 change points and 3 subgroups were shown. The first group (SB-12 <126 pmol/L) was small and had the highest MMA concentration (median: 281 nmol/L; 95% CI: 245, 366 nmol/L; n = 157, 1.2%); many in this group could be considered at high risk of severe deficiency because combined abnormalities of MMA and homocysteine were very frequent and the concentrations themselves were significantly higher. The highest SB-12 group (SB-12 >287 pmol/L; n = 8569, 67.6%) likely had adequate vitamin B-12 status (median MMA: 120 nmol/L; 95% CI: 119, 125 nmol/L). The vitamin B-12 status of the sizable intermediate group (n = 3957, 33%) was difficult to interpret.

CONCLUSIONS

The 3 distinct slopes for the relation between SB-12 and MMA challenges the conventional use of one cutoff point for classifying vitamin B-12 status. In epidemiologic research, the use of one cutoff point would fail to separate the small, severely deficient group from the intermediate group that has neither normal nor clearly deficient vitamin B-12 concentrations (ie, unknown vitamin B-12 status). This intermediate group requires further characterization.

A complete diet-based algorithm for predicting nonheme iron absorption in adults

Many algorithms have been developed in the past few decades to estimate nonheme iron absorption from the diet based on single meal absorption studies. Yet single meal studies exaggerate the effect of diet and other factors on absorption. Here, we propose a new algorithm based on complete diets for estimating nonheme iron absorption. We used data from 4 complete diet studies each with 12-14 participants for a total of 53 individuals (19 men and 34 women) aged 19-38 y. In each study, each participant was observed during three 1-wk periods during which they consumed different diets. The diets were typical, high, or low in meat, tea, calcium, or vitamin C. The total sample size was 159 (53 × 3) observations. We used multiple linear regression to quantify the effect of different factors on iron absorption. Serum ferritin was the most important factor in explaining differences in nonheme iron absorption, whereas the effect of dietary factors was small. When our algorithm was validated with single meal and complete diet data, the respective R(2) values were 0.57 (P < 0.001) and 0.84 (P < 0.0001). The results also suggest that between-person variations explain a large proportion of the differences in nonheme iron absorption. The algorithm based on complete diets we propose is useful for predicting nonheme iron absorption from the diets of different populations.

The effect of soy protein beverages on serum cell adhesion molecule concentrations in prehypertensive/stage 1 hypertensive individuals

OBJECTIVE

Prehypertensive and hypertensive individuals are at increased risk of atherosclerotic cardiovascular disease (CVD), in part because hypertension contributes to endothelial dysfunction and increased cell adhesion molecule expression. Soy protein and isoflavones may favorably alter CVD risk factors, and hence the aim of this study was to determine whether intake of cow's milk compared with soy beverage prepared from whole soy bean (WSB) or soy protein isolate (SPI) would lower soluble cell adhesion molecule concentrations as a means of decreasing CVD risk.

METHODS

We enrolled healthy prehypertensive/stage 1 hypertensive men (n = 60; 18-63 years) and premenopausal women (n = 8; 20-48 years). Participants were randomized to 1 of 3 groups for 8 weeks: cow's milk (600 mL/d), SPI beverage (840 mL/d; 30.1 mg total isoflavones/d), or WSB beverage (840 mL/d; 91.4 mg total isoflavones/d). We measured soluble vascular cell adhesion molecule-1 (VCAM-1), intercellular cell adhesion molecule-1 (ICAM-1), and endothelial-leukocyte adhesion molecule-1 (E-selectin) concentrations at baseline and week 8.

RESULTS

Soluble CAM concentrations were not altered by treatment and did not differ between prehypertensive and hypertensive participants. However, analysis of variance indicated a treatment × gender interaction (gender effect) for ICAM-1 (p = 0.0037) but not for E-selectin (p = 0.067) or VCAM-1 (p = 0.16). Men had higher concentrations of ICAM-1 and E-selectin, respectively, at baseline (p = 0.0071, p = 0.049) and week 8 (p = 0.0054, p = 0.038) than women did.

CONCLUSION

Neither intake of cow's milk nor soy beverage for 8 weeks altered soluble CAM concentrations in prehypertensive/stage 1 hypertensive individuals, suggesting that neither type of beverage diminished atherosclerotic CVD risk in mildly hypertensive individuals by way of improving circulating CAM concentrations.

Introduction of β-carotene-rich orange sweet potato in rural Uganda resulted in increased vitamin A intakes among children and women and improved vitamin A status among children

Vitamin A deficiency (VAD) persists in Uganda and the consumption of β-carotene-rich orange sweet potato (OSP) may help to alleviate it. Two large-scale, 2-y intervention programs were implemented among Ugandan farmer households to promote the production and consumption of OSP. The programs differed in their inputs during year 2, with one being more intensive (IP) and the other being reduced (RP). A randomized, controlled effectiveness study compared the impact of the IP and RP with a control on OSP and vitamin A intakes among children aged 6-35 mo (n = 265) and 3-5 y (n = 578), and women (n = 573), and IP compared with control on vitamin A status of 3- to 5-y-old children (n = 891) and women (n = 939) with serum retinol <1.05 μmol/L at baseline. The net OSP intake increased in both the IP and RP groups (P < 0.01), accounting for 44-60% of vitamin A intake at follow-up. The prevalence of inadequate vitamin A intake was reduced in the IP and RP groups compared with controls among children 6-35 mo of age (>30 percentage points) and women (>25 percentage points) (P < 0.01), with no differences between the IP and RP groups of children (P = 0.75) or women (P = 0.17). There was a 9.5 percentage point reduction in prevalence of serum retinol <1.05 μmol/L for children with complete data on confounding factors (n = 396; P < 0.05). At follow-up, vitamin A intake from OSP was positively associated with vitamin A status (P < 0.05). Introduction of OSP to Ugandan farming households increased vitamin A intakes among children and women and was associated with improved vitamin A status among children.

Should Household Consumption and Expenditures Surveys (HCES) be Used for Nutritional Assessment and Planning?

Background

Household Consumption and Expenditures Surveys (HCES) are routinely conducted in several countries on nationally representative samples, often on a regular basis. The HCES have been considered as a potential alternative to more expensive surveys of individuals' food intakes for use in nutritional assessment and in planning programs such as food fortification. HCES gather information on household food availability (purchased, produced, or received as gifts) and use over a given period of time, often the past week or month.

Objective

To discuss the potential usefulness of HCES consumption data for nutritional assessment and planning for populations of households and individuals within the households.

Conclusions

There are several limitations to the HCES, most notably the difficulty of estimating the intrahousehold allocation of foods and therefore of quantifying the actual food intake of individual household members. Another concern is the lack of information on the variability of consumption over time, making it difficult to estimate the distribution of usual consumption, and thus the prevalence of nutrient inadequacies or excesses. Other potential limitations might be addressed by improvements to the HCES questionnaires, such as including information on foods that are available but not consumed and those that are consumed outside the home. Research is needed to better understand both the strengths and the weaknesses of the HCES data when used to assess and plan intakes at the household and individual levels

Local wellness policy strength and perceived implementation of school nutrition standards across three states

BACKGROUND

Congress sought to address escalating rates of childhood obesity by mandating local wellness policies (LWP) (Child Nutrition and WIC Reauthorization Act of 2004). Previous research has examined LWP content and quality; however, data relative to LWP implementation is limited, and none has examined the relationship between LWP quality and implementation. The purpose of this study was to examine the influence of LWP strength on perceived implementation of LWP components.

METHODS

Data collected from school districts in California, Iowa, and Pennsylvania included district LWPs and online surveys at the district (n = 23) and school levels (n = 76). LWPs were scored using a standardized coding tool. Binary and multinomial regression models were used to examine the predictive ability of covariates and independent factors on perceived implementation of reimbursable school meals and nutrition guidelines for competitive foods sold and offered.

RESULTS

Overall LWP strength score did not predict perceived implementation of reimbursable school meals or nutrition guidelines for competitive foods. LWP component strength scores for reimbursable meals and nutrition guidelines did not consistently predict perceived implementation of those components. State and urban-centric locale did predict perceived implementation of some LWP components, particularly nutrition guidelines for competitive foods sold and offered. State was a particularly influential factor in the implementation of LWPs in this study, likely due to differences in state policies and laws.

CONCLUSIONS

Overall LWP, reimbursable school meals, and nutrition guidelines for competitive foods strength scores do not predict perceived implementation of reimbursable school meals and nutrition guidelines for competitive foods.

Summary of an NIH workshop to identify research needs to improve the monitoring of iodine status in the United States and to inform the DRI

The Office of Dietary Supplements (ODS) at the NIH sponsored a workshop on May 12-13, 2011, to bring together representatives from various NIH institutes and centers as a first step in developing an NIH iodine research initiative. The workshop also provided an opportunity to identify research needs that would inform the dietary reference intakes for iodine, which were last revised in 2001. Iodine is required throughout the life cycle, but pregnant women and infants are the populations most at risk of deficiency, because iodine is required for normal brain development and growth. The CDC monitors iodine status of the population on a regular basis, but the status of the most vulnerable populations remains uncertain. The NIH funds very little investigator-initiated research relevant to iodine and human nutrition, but the ODS has worked for several years with a number of other U.S. government agencies to develop many of the resources needed to conduct iodine research of high quality (e.g., validated analytical methods and reference materials for multiple types of samples). Iodine experts, scientists from several U.S. government agencies, and NIH representatives met for 2 d to identify iodine research needs appropriate to the NIH mission.

[Association between hematopoietic nutrient intake and the origin of nutritional anemia in women of childbearing age in Colombia]

OBJECTIVES

Compare the nutritional origin of anemia by sociodemographic variables and analyze its association with deficient hematopoietic nutrient intake.

METHODS

The database of Colombia's 2005 National Survey of Nutritional Status was used. The data were obtained through complex representative sampling of the population and processed using SPSS v.15. Anemic women of childbearing age were selected and divided into two groups according to serum ferritin levels. Their customary hematopoietic nutrient intake and risk of deficiency were determined. The proportions of anemia types were compared by sociodemographic variables using the F-distribution, the Rao-Scott second order correction (P < 0.05). The association between the origin of the anemia and classification of the nutrient was analyzed using the odds ratio (OR).

RESULTS

SAMPLE

595 women. Non-hypoferric anemia (67.2%) predominated, with no statistical difference by sociodemographic variable, except in the Pacific region (hypoferric anemia, 52.1%). The prevalence of deficiency in the customary intake of hematopoietic nutrients was high. There was no significant association between the deficit in consumption and the origin of the anemia.

CONCLUSIONS

Non-hypoferric anemia was most common, with no difference by sociodemographic indicators except in the Pacific region. All the women were at high risk of deficiency in their customary hematopoietic nutrient intake, but a statistically significant association between the deficiency and the origin of the nutritional anemia was not observed. Programs to improve nutrient intake and a continued search for causes of nutritional anemia other than iron deficiency are justified.

A measurement error approach to assess the association between dietary diversity, nutrient intake, and mean probability of adequacy

Collection of dietary intake information requires time-consuming and expensive methods, making it inaccessible to many resource-poor countries. Quantifying the association between simple measures of usual dietary diversity and usual nutrient intake/adequacy would allow inferences to be made about the adequacy of micronutrient intake at the population level for a fraction of the cost. In this study, we used secondary data from a dietary intake study carried out in Bangladesh to assess the association between 3 food group diversity indicators (FGI) and calcium intake; and the association between these same 3 FGI and a composite measure of nutrient adequacy, mean probability of adequacy (MPA). By implementing Fuller's error-in-the-equation measurement error model (EEM) and simple linear regression (SLR) models, we assessed these associations while accounting for the error in the observed quantities. Significant associations were detected between usual FGI and usual calcium intakes, when the more complex EEM was used. The SLR model detected significant associations between FGI and MPA as well as for variations of these measures, including the best linear unbiased predictor. Through simulation, we support the use of the EEM. In contrast to the EEM, the SLR model does not account for the possible correlation between the measurement errors in the response and predictor. The EEM performs best when the model variables are not complex functions of other variables observed with error (e.g. MPA). When observation days are limited and poor estimates of the within-person variances are obtained, the SLR model tends to be more appropriate.

Simple food group diversity indicators predict micronutrient adequacy of women's diets in 5 diverse, resource-poor settings

Women of reproductive age living in resource-poor settings are at high risk of inadequate micronutrient intakes when diets lack diversity and are dominated by staple foods. Yet comparative information on diet quality is scarce and quantitative data on nutrient intakes is expensive and difficult to gather. We assessed the potential of simple indicators of dietary diversity, such as could be generated from large household surveys, to serve as proxy indicators of micronutrient adequacy for population-level assessment. We used 5 existing data sets (from Burkina Faso, Mali, Mozambique, Bangladesh, and the Philippines) with repeat 24-h recalls to construct 8 candidate food group diversity indicators (FGI) and to calculate the mean probability of adequacy (MPA) for 11 micronutrients. FGI varied in food group disaggregation and in minimum consumption required for a food group to count. There were large gaps between intakes and requirements across a range of micronutrients in each site. All 8 FGI were correlated with MPA in all sites; regression analysis confirmed that associations remained when controlling for energy intake. Assessment of dichotomous indicators through receiver-operating characteristic analysis showed moderate predictive strength for the best choice indicators, which varied by site. Simple FGI hold promise as proxy indicators of micronutrient adequacy.

Simple food group diversity indicators predict micronutrient adequacy of women's diets in 5 diverse, resource-poor settings

Women of reproductive age living in resource-poor settings are at high risk of inadequate micronutrient intakes when diets lack diversity and are dominated by staple foods. Yet comparative information on diet quality is scarce and quantitative data on nutrient intakes is expensive and difficult to gather. We assessed the potential of simple indicators of dietary diversity, such as could be generated from large household surveys, to serve as proxy indicators of micronutrient adequacy for population-level assessment. We used 5 existing data sets (from Burkina Faso, Mali, Mozambique, Bangladesh, and the Philippines) with repeat 24-h recalls to construct 8 candidate food group diversity indicators (FGI) and to calculate the mean probability of adequacy (MPA) for 11 micronutrients. FGI varied in food group disaggregation and in minimum consumption required for a food group to count. There were large gaps between intakes and requirements across a range of micronutrients in each site. All 8 FGI were correlated with MPA in all sites; regression analysis confirmed that associations remained when controlling for energy intake. Assessment of dichotomous indicators through receiver-operating characteristic analysis showed moderate predictive strength for the best choice indicators, which varied by site. Simple FGI hold promise as proxy indicators of micronutrient adequacy.

Folic acid source, usual intake, and folate and vitamin B-12 status in US adults: National Health and Nutrition Examination Survey (NHANES) 2003-2006

BACKGROUND

US adults have access to multiple sources of folic acid. The contribution of these sources to usual intakes above the tolerable upper intake level (UL) (1000 microg/d) and to folate and vitamin B-12 status is unknown.

OBJECTIVE

The objective was to estimate usual folic acid intake above the UL and adjusted serum and red blood cell folate, vitamin B-12, methylmalonic acid, and homocysteine concentrations among US adults by 3 major folic acid intake sources-enriched cereal-grain products (ECGP), ready-to-eat cereals (RTE), and supplements (SUP)-categorized into 4 mutually exclusive consumption groups.

DESIGN

We used data from the National Health and Nutrition Examination Survey (NHANES) 2003-2006 (n = 8258).

RESULTS

Overall, 2.7% (95% CI: 1.9%, 3.5%) of adults consumed more than the UL of folic acid. The proportions of those who consumed folic acid from ECGP only, ECGP+RTE, ECGP+SUP, and ECGP+RTE+SUP were 42%, 18%, 25%, and 15%, respectively. Of 60% of adults who did not consume supplements containing folic acid (ECGP only and ECGP+RTE), 0% had intakes that exceeded the UL. Of 34% and 6% of adults who consumed supplements with an average of < or = 400 and >400 microg folic acid/d, <1% and 47.8% (95% CI: 39.6%, 56.0%), respectively, had intakes that exceeded the UL. Consumption of RTE and/or supplements with folic acid was associated with higher folate and vitamin B-12 and lower homocysteine concentrations, and consumption of supplements with vitamin B-12 was associated with lower methylmalonic acid concentrations (P < 0.001).

CONCLUSION

At current fortification levels, US adults who do not consume supplements or who consume an average of < or =400 microg folic acid/d from supplements are unlikely to exceed the UL in intake for folic acid.