Salt intake per dish in the Japanese diet: a clue to help establish dietary goals at home

The salt intake of Japanese at home remains high. To aid in salt reduction and encourage a balanced diet, we conducted a cross-sectional study using data from a previous clinical trial in community-dwelling individuals to evaluate major salt sources and relationships among the intake of different dishes in the Japanese diet at home. Dietary records and urinary salt excretion measurements were performed daily for 1 month in seventy-nine participants. The records were classified into six grain dish categories as staple dishes, seven side dish categories and a snack category. Regression analyses were used to estimate (1) salt intake per meal for each category of grain dish, (2) salt intake per dish from each dish category and its contribution to the total salt intake and (3) the influence of grain dish selection on the frequencies of other dishes. Salt intake per meal was approximately 3 g, regardless of grain dish selection. Fish and meat dishes showed the largest contribution to the total salt intake (35 %), followed by vegetable dishes (19 %). The intake of fish or meat and vegetables was promoted by plain rice and reduced by ramen noodles. The intake of dairy products was only promoted by bread, while that of fruits was not influenced by any grain dish category. These results suggest simple strategies to reduce salt intake while maintaining dietary balance, such as eating plain rice more often and using less salt to cook meat/fish and vegetable dishes.

Dietary patterns associated with obesity and overweight: When should misreporters be included in analysis?

OBJECTIVE

The aim of the study was to identify dietary patterns associated with overweight and obesity and to examine the effect of including and excluding misreporters on the analysis of these dietary patterns and on the associations between identified dietary patterns and anthropometric parameters.

METHODS

The study was carried out with adult participants in an observational case-control manner. The participants' diet was assessed using 3-d dietary records. To identify misreporters, the Goldberg and Black cutoff method was used. Dietary patterns were evaluated using factor analysis and dietary indices.

RESULTS

Among 410 participants, 100 were underreporters and 1 was an overreporter. The nutritional value of the diets and the relative intake of several groups of food products differed between those with normal and increased body weight. Excluding misreporters affected the differences between body weight groups in energy; dietary fiber; empty calories; cholesterol; sodium; magnesium; folate; vitamins C, PP, and A; groats; vegetables; coffee; and water intake. The Western diet (WD) factor correlated positively with the waist circumference and the amount of fat tissue, whereas the healthy diet (HD) factor correlated negatively with body weight, waist circumference, and the fat tissue amount. The coefficients of the correlation between the HD factor and the anthropometric parameters were stronger when misreporters were excluded, whereas those between the WD factor and the parameters did not change much after exclusion of misreporters.

CONCLUSIONS

There is a positive relationship between the WD pattern and obesity. The exclusion of misreporters from the data set may positively affect the association between the HD pattern and anthropometric parameters.

Validity and reliability of a food frequency questionnaire for assessing dietary intake among Shanghai residents

Background

Few localized food frequency questionnaires (FFQ) have been developed and used in Chinese nutrition surveys despite China’s large population and diverse dietary habits.

Method

We analyzed data collected in two waves (six months apart) of the Shanghai Diet and Health Study in 2012–2013, from 1623 Shanghai residents (798 men and 825 women) older than 18 years. The results of 3-day 24-h dietary recalls (HDR) plus condiment weighing were used to evaluate the validity and reliability of the SDHS FFQ.

Results

The median and first and third quartiles for energy intake (in kcal) derived from the FFQ1 and FFQ2 were 1566.5 (1310.1–1869.6) and 1561.9 (1280.2–1838.4), respectively, of which protein (in g) was 54.3 (42.5–65.8) and 52.9 (42.4–64.5), fat (in g) was 49.8 (37.2–64.7) and 47.9 (34.9–61.9), and carbohydrates (in g) was 227.3 (180.8–277.9) and 228.1 (182.2–275.2) in the reliability analysis. The median and first and third quartiles for energy-intake differences between the FFQ1 and the 3-day 24-HDR with condiment weighing was 59.3 (− 255.5–341.6), of which protein was − 5.2 (− 18.7–7.8) and fat was − 11.2 (− 30.8–5.3). The adjusted Spearman’s correlations were 0.33–0.77 for validity and 0.46–0.79 for reliability. The intra-class correlation coefficients exceeded 0.46 (validity) and 0.47 (reliability) for macronutrient intake. The consistency between the same and adjacent quartiles was approximately 80% for various nutrients.

Conclusion

The reliability and comparative validity of the SDHS FFQ is similar to FFQs that are used worldwide.

Electronic supplementary material

The online version of this article (10.1186/s12937-019-0454-2) contains supplementary material, which is available to authorized users.

Association of reported fish intake and supplementation status with the omega-3 index

BACKGROUND

An Omega-3 Index (O3I; EPA+DHA as a % of erythrocyte total fatty acids) in the desirable range (8%-12%) has been associated with improved heart and brain health.

OBJECTIVE

To determine the combination of fish intake and supplement use that is associated with an O3I of >8%.

DESIGN

Two cross-sectional studies comparing the O3I to EPA+DHA/fish intake.

PARTICIPANTS/SETTING

The first study included 28 individuals and assessed their fish and EPA+DHA intake using both a validated triple-pass 24-hr recall dietary survey and a single fish-intake question. The second study used de-identified data from 3,458 adults (84% from US) who self-tested their O3I and answered questions about their fish intake and supplement use.

STATISTICAL ANALYSES PERFORMED

Study 1, chi-squared, one-way ANOVA, and Pearson correlations were computed. In Study 2, multi-variable regression models were used to predict O3I levels from reported fish/supplement intakes.

RESULTS

The mean ± SD O3I was 4.87 ± 1.32%, and 5.99 ± 2.29% in the first and second studies, respectively. Both studies showed that for every increase in fish intake category the O3I increased by 0.50-0.65% (p < 0.0001). In the second study, about half of the population was taking omega-3 supplements, 32% reported no fish intake and 17% reported eating fish >2 times per week. Taking an EPA+DHA supplement increased the O3I by 2.2% (p < 0.0001). The odds of having an O3I of ≥8% were 44% in the highest intake group (≥3 servings/week and supplementation) and 2% in the lowest intake group (no fish intake or supplementation); and in those consuming 2 fish meals per week but not taking supplements (as per recommendations), 10%.

CONCLUSIONS

Current AHA recommendations are unlikely to produce a desirable O3I. Consuming at least 3 fish servings per week plus taking an EPA+DHA supplement markedly increases the likelihood of achieving this target level.

Collecting wrappers, labels, and packages to enhance accuracy of food records among children 2-8 years in the Pacific region: Children's Healthy Living Program (CHL)

The aim was to describe differences in dietary outcomes based on the provision of food wrappers, labels or packages (WLP) to complement data from dietary records (DR) among children from the US Affiliated Pacific. The WLP were intended to aid food coding. Since WLP can be associated with ultra-processed foods, one might expect differences in sodium, sugar, and other added ingredients to emerge. Dietary intakes of children (2-8 y) in Alaska, Hawai'i, Commonwealth of the Northern Mariana Islands, and Guam were collected using parent/caregiver completed 2-day DR. Parents were encouraged to collect WLP associated with the child's intake. Trained staff entered data from the DRs including the WLP when available using PacTrac3, a web application. Of the 1,868 DRs collected and entered at the time of this report, 498 (27%) included WLP. After adjusting for confounders (sex, age, location, education, food assistance), the DRs with WLP had significantly higher amounts of energy (kcal), total fat, saturated fat, added sugar, and sodium. These results suggest the inclusion of WLP enhanced the dietary intake data. The intake of energy, fat, added sugar and sodium derived from processed foods and foods consumed outside the home was better captured in children who had WLP.

Using item response theory to address vulnerabilities in FFQ

The limitations for self-reporting of dietary patterns are widely recognised as a major vulnerability of FFQ and the dietary screeners/scales derived from FFQ. Such instruments can yield inconsistent results to produce questionable interpretations. The present article discusses the value of psychometric approaches and standards in addressing these drawbacks for instruments used to estimate dietary habits and nutrient intake. We argue that a FFQ or screener that treats diet as a 'latent construct' can be optimised for both internal consistency and the value of the research results. Latent constructs, a foundation for item response theory (IRT)-based scales (e.g. Patient Reported Outcomes Measurement Information System) are typically introduced in the design stage of an instrument to elicit critical factors that cannot be observed or measured directly. We propose an iterative approach that uses such modelling to refine FFQ and similar instruments. To that end, we illustrate the benefits of psychometric modelling by using items and data from a sample of 12 370 Soldiers who completed the 2012 US Army Global Assessment Tool (GAT). We used factor analysis to build the scale incorporating five out of eleven survey items. An IRT-driven assessment of response category properties indicates likely problems in the ordering or wording of several response categories. Group comparisons, examined with differential item functioning (DIF), provided evidence of scale validity across each Army sub-population (sex, service component and officer status). Such an approach holds promise for future FFQ.

Comparison of weighed food record procedures for the reference methods in two validation studies of food frequency questionnaires

BACKGROUND

Although open-ended dietary assessment methods, such as weighed food records (WFRs), are generally considered to be comparable, differences between procedures may influence outcome when WFRs are conducted independently. In this paper, we assess the procedures of WFRs in two studies to describe their dietary assessment procedures and compare the subsequent outcomes.

METHODS

WFRs of 12 days (3 days for four seasons) were conducted as reference methods for intake data, in accordance with the study protocol, among a subsample of participants of two large cohort studies. We compared the WFR procedures descriptively. We also compared some dietary intake variables, such as the frequency of foods and dishes and contributing foods, to determine whether there were differences in the portion size distribution and intra- and inter-individual variation in nutrient intakes caused by the difference in procedures.

RESULTS

General procedures of the dietary records were conducted in accordance with the National Health and Nutrition Survey and were the same for both studies. Differences were seen in 1) selection of multiple days (non-consecutive days versus consecutive days); and 2) survey sheet recording method (individual versus family participation). However, the foods contributing to intake of energy and selected nutrients, the portion size distribution, and intra- and inter-individual variation in nutrient intakes were similar between the two studies.

CONCLUSION

Our comparison of WFR procedures in two independent studies revealed several differences. Notwithstanding these procedural differences, however, the subsequent outcomes were similar.

Lower birth weight is associated with alterations in dietary intake in adolescents independent of genetic factors: A twin study

BACKGROUND & AIMS

Lower birth weight is associated with an increased risk of cardiovascular and metabolic disease. These associations may, at least in part, be explained by alterations in dietary intake in later life. The aim of this study is to examine whether lower birth weight is associated with alterations in dietary intake in later life, and whether this association is due to intrauterine environmental or genetic factors.

METHODS

In this observational study birth weight and dietary intake were investigated in 78 dizygotic (DZ) and 94 monozygotic (MZ) adolescent same-sex twin subjects. Birth weight was obtained from the mothers. Dietary intake was assessed by two-day dietary records.

RESULTS

In the total group of twins, lower birth weight was associated with higher intake of saturated fat after adjustment for current weight (1.2 per cent of total energy intake (E%) per kg increase in birth weight, P < 0.01). Intra-pair analysis in all twin pairs demonstrated that twins with the lower birth weight had a 115 kcal higher total energy intake and a 0.7 E% higher saturated fat intake compared to their co-twins with the higher birth weight (P < 0.05). Intra-pair differences in birth weight were negatively associated with differences in energy intake and differences in intake of saturated fat after adjustment for differences in current weight (P = 0.07 and P < 0.05, respectively). Intra-pair differences in birth weight were positively associated with intra-pair differences in intake of dietary fibres (P < 0.05). These intra-pair differences and associations were similar for DZ and MZ twins (P for difference > 0.6).

CONCLUSIONS

Lower birth weight was related with higher intake of energy and saturated fat within twin pairs, and these associations were independent of zygosity, suggesting that the association between birth weight and alterations in dietary intake in later life is explained by intrauterine environmental rather than genetic factors.

Promising approaches of computer-supported dietary assessment and management-Current research status and available applications

PURPOSE

The aim of this review was to analyze computer-based tools for dietary management (including web-based and mobile devices) from both scientific and applied perspectives, presenting advantages and disadvantages as well as the state of validation.

METHODS

For this cross-sectional analysis, scientific results from 41 articles retrieved via a medline search as well as 29 applications from online markets were identified and analyzed.

RESULTS

Results show that many approaches computerize well-established existing nutritional concepts for dietary assessment, e.g., food frequency questionnaires (FFQ) or dietary recalls (DR). Both food records and barcode scanning are less prominent in research but are frequently offered by commercial applications. Integration with a personal health record (PHR) or a health care workflow is suggested in the literature but is rarely found in mobile applications.

CONCLUSIONS

It is expected that employing food records for dietary assessment in research settings will be increasingly used when simpler interfaces, e.g., barcode scanning techniques, and comprehensive food databases are applied, which can also support user adherence to dietary interventions and follow-up phases of nutritional studies.

[Effects of individualized nutritional education programs on the level of nutrient intake and nutritional status of colorectal cancer patients undergoing palliative chemotherapy]

PURPOSE

The purpose of this study was to examine the effects of an individualized nutritional education programs on nutrient intake and nutritional status of patients with colorectal cancer who are undergoing palliative chemotherapy.

METHODS

Forty patients with colorectal cancer (19 experimental and 21 control patients) were recruited from a chemotherapy ward at S University Hospital in Seoul, Korea. The experimental group received two individualized nutritional counseling sessions and two telephone counseling sessions over 6 weeks. The control group received nutritional counseling after completion of data collection. Nutritional education included general guidelines for food intake while receiving chemotherapy, dietary guidelines for patients with colorectal cancer, daily meal schedules to overcome cancer, and dietary guideline for each chemotherapy side effect. Data were analyzed using χ²-test and t-test with the SPSS program 17.0.

RESULTS

Two group comparison revealed that the experimental group had significantly improved calorie (p=.038) and total protein intake (p=.001), and serum albumin percentage change (p=.040). Body weight did not increase but remained the same as the baseline in both groups.

CONCLUSION

Study results indicate that this individualized nutritional education programs are effective in enhancing nutrient intake and nutritional status of patients with colorectal cancer who are undergoing palliative chemotherapy.