Showing papers in "Journal of Human Nutrition and Dietetics in 2006"

The impact of a gluten‐free diet on adults with coeliac disease: results of a national survey

Abstract: Objective We sought to evaluate the impact of the gluten-free diet on the 5,240 members of the Canadian Celiac Association (CCA). Data are presented on 2,681 adults (‡16 years) with biopsy-proven celiac disease (CD). Methods A mail-out survey was used. Quality of life was evaluated using the ‘SF12’, and celiac-specific questions. Results Mean age was 56 years, mean age at diagnosis was 45 years, and 75% were female. The ‘SF12’ summary scores were similar to normative Canadian data, but were significantly lower for females and newly diagnosed patients. Respondents reported: following a gluten-free (GF) diet (90%), improvement on the diet (83%), and difficulties following the diet (44%), which included: determining if foods were GF (85%), finding GF foods in stores (83%), avoiding restaurants (79%), and avoiding travel (38%). Most common reactions to consumed gluten (among 73%) included pain, diarrhea, bloating, fatigue, nausea, and headache. Excellent information on CD and its treatment was provided by the CCA (64%), gastroenterologists (28%), dietitians (26%) and family doctor (12%). Conclusions Quality of life in those with CD could be increased with early diagnosis, increased availability of gluten-free foods, improved food labelling, and better dietary instruction. Education of physicians and dietitians about CD and its treatment is essential.

Frequency of under‐ and overfeeding in mechanically ventilated ICU patients: causes and possible consequences

Abstract: Introduction In critically ill patients enteral nutrition (EN) is frequently associated with underfeeding and intolerance, whilst parenteral nutrition (PN) has been associated with a greater risk of infectious complications and overfeeding Materials and methods The adequacy of nutritional support provided to critically ill patients was prospectively recorded and compared with estimated requirements The incidence of, and practices contributing to, under- ( 110% of energy requirements) were identified Results Overall patients received approximately 81% and 76% of prescribed energy and protein intakes respectively Underfeeding occurred on 503% of days Reasons for patients failing to achieve adequate intakes included, fasting for airway management procedures (21%) and gastrointestinal intolerance (14%) Overfeeding, although less common (186% of days), was more likely to occur in patients with a tracheostomy requiring prolonged mechanical ventilation (>16 days) The combination of oral and nasogastric feeding or use of nutrient-dense feeds were most frequently associated with overfeeding Discussion The overall adequacy of nutritional intakes in the present study was similar to those reported elsewhere However, the incidence of overfeeding was greater than anticipated and occurred in patients already experiencing delayed weaning from mechanical ventilation

Growth during the first 6 months of life in infants using formula enriched with Lactobacillus rhamnosus GG: double‐blind, randomized trial

Abstract: Background Probiotic bacteria have beneficial effects on the immune system and gastrointestinal tract, but the impacts of their long-term consumption on health and growth in early infancy are not well documented. The aim of this study was to evaluate the influence of Lactobacillus rhamnosus GG (LGG)-enriched formula on growth and faecal microflora during the first 6 months of life in normal healthy infants. Materials and methods One hundred and twenty healthy infants (up to 2 months) received LGG-supplemented formula or regular formula in a double-blind, randomized manner until the age of 6 months. Weight, length and head circumference were measured monthly and transformed into standard deviation scores (SDS). Faecal samples were obtained from a random sample of infants (n = 25) at entry and at the end of the study. Results One hundred and five infants (51 in the LGG group) completed the study. Children receiving LGG-supplemented formula grew better: their changes in their length and weight SDS (ΔSDS) at the end of the study were significantly higher than those receiving regular formula (0.44 ± 0.37 versus 0.07 ± 0.06, P < 0.01 and 0.44 ± 0.19 versus 0.07 ± 0.06, P < 0.005, respectively). The LGG group had a significant, higher defecation frequency 9.1 ± 2.6 versus 8.0 ± 2.8 (P < 0.05). More frequent colonization with lactobacilli was found in the LGG group, 91% versus 76% (P < 0.05) at the end of the study. Conclusions Infants fed with LGG-enriched formula grew better than those fed with regular formula. Further studies are necessary to clarify the mechanism of LGG in infant growth.

Eating together is important: using a dining room in an acute elderly medical ward increases energy intake.

Abstract: Aim To investigate the effect of eating in a supervised dining room, on nutritional intake and weight, for elderly patients on an acute medicine for the elderly ward. Method Patients on the intervention ward were encouraged to attend a dining room every lunchtime by a trained nursing assistant as part of the rehabilitation process. The patients on the control ward ate only by their bedside. Food intake and weight data were collected over the study period on each patient. Results Forty-eight patients participated in the study. At the lunchtime meal studied the dining room group had higher intakes of energy compared with the controls [489 kcal (95% CI: 438–554) versus 360 kcal (95% CI: 289–448), P < 0.013]. There was no difference in protein intake between the groups [18.9 g (95% CI: 16.6–21.2) versus 17.7 g (95% CI: 13.2–22.2), P = 0.63]. No significant difference in weight gain between the two groups was seen (P = 0.6). However, there was a trend towards weight gain in the dining room group. Conclusion Food intake can be improved by using a supervised dining room, and this will potentially lead to weight gain and corresponding improvements in nutritional status and rehabilitation.

Dietetic guidelines on food and nutrition in the secondary prevention of cardiovascular disease : evidence from systematic reviews of randomized controlled trials (second update, January 2006)

Abstract: Aim To update dietetic guidelines based on systematic review evidence on dietary advice to prevent further events in people with existing cardiovascular disease (CVD) (secondary prevention). Methods The Cochrane Library, MEDLINE and EMBASE were comprehensively searched to January 2005 for systematic reviews on aspects of diet and heart health. Reviews were included if they searched systematically for randomized controlled trials relating to diet and secondary prevention of CVD. Each review was critically appraised by at least two members of the UK Heart Health and Thoracic Dietitians Group. The quality and results of each review were discussed and summarized at a group meeting. Results Evidence-based strategies that reduce cardiovascular events in those with CVD include reduction in saturated fat and substitution with unsaturated fats. Individuals who have suffered a myocardial infarction may also benefit from adopting a Mediterranean type diet and increasing intake of omega 3 fats, but it is not clear whether they are beneficial for all patients with CVD. There is no systematic review evidence to support the use of antioxidant vitamins supplements, low glycaemic index diets, or homocysteine lowering therapies in this group. Conclusion There remains good evidence that reducing saturated fat reduces morbidity in patients with CVD. This advice is consistent for most manifestations of CVD, with the addition of Mediterranean dietary advice and increased omega 3 fats for those who have had a myocardial infarction.

Underestimation and overestimation of personal weight status: associations with socio‐demographic characteristics and weight maintenance intentions

Abstract: Objective Unwarranted underestimation and overestimation of personal weight status may prevent weight maintenance behaviour. The present study reports on correlates of under- and overestimation of personal weight status and the association with weight maintenance intentions and self-reported action. Design Comparison of three cross-sectional surveys, representing different population groups. Subjects Survey 1: 1694 adolescents 13–19 years of age; survey 2: 979 nonobese adults 25–35 years of age; survey 3: 617 adults 21–62 years of age. Measurements Self-administered written questionnaires (surveys 1 and 3) and telephone-administered questionnaires (survey 2); self-reported BMI, self-rated weight status, intentions and self-reported actions to avoid weight gain or to lose weight, sex, age, education and ethnic background. Respondents were classified as people who are realistic about personal body weight status or people who under- and overestimate their body weight status, based on BMI and self-rated weight status. Results Most respondents in the three survey populations were realistic about their weight status. Overestimation of weight status was consistently more likely among women, whereas underestimation was more likely among men, older respondents and respondents from ethnic minorities. Self-rated weight status was a stronger correlate of intentions and self-report actions to avoid weight gain than weight status based on Body Mass Index. Conclusions Relevant proportions of the study populations underestimated or overestimated their bodyweight status. Overestimation of personal weight status may lead to unwarranted weight maintenance actions, whereas underestimation may result in lack of motivation to avoid further weight gain.

Hospital food service: a comparative analysis of systems and introducing the ‘Steamplicity’ concept

Abstract: Background Patient meals are an integral part of treatment hence the provision and consumption of a balanced diet, essential to aid recovery. A number of food service systems are used to provide meals and the Steamplicity concept has recently been introduced. This seeks, through the application of a static, extended choice menu, revised patient ordering procedures, new cooking processes and individual patient food heated/cooked at ward level, to address some of the current hospital food service concerns. The aim of this small-scale study, therefore, was to compare a cook-chill food service operation against Steamplicity. Specifically, the goals were to measure food intake and wastage at ward level; ‘stakeholders’ (i.e. patients, staff, etc.) satisfaction with both systems; and patients’ acceptability of the food provided. Method The study used both quantitative (self-completed patient questionnaires, n = 52) and qualitative methods (semi-structured interviews, n = 16) with appropriate stakeholders including medical and food service staff, patients and their visitors. Results Patients preferred the Steamplicity system overall and in particular in terms of food choice, ordering, delivery and food quality. Wastage was considerably less with the Steamplicity system, although care must be taken to ensure that poor operating procedures do not negate this advantage. When the total weight of food consumed in the ward at each meal is divided by the number of main courses served, at lunch, the mean intake with the cook-chill system was 202 g whilst that for the Steamplicity system was 282 g and for the evening meal, 226 g compared with 310 g. Conclusions The results of this small study suggest that Steamplicity is more acceptable to patients and encourages the consumption of larger portions. Further evaluation of the Steamplicity system is warranted. The purpose of this study was to directly compare selected aspects (food wastage at ward level; satisfaction with systems and food provided) of a traditional cook-chill food service operation against ‘Steamplicity’. Results indicate that patients preferred the ‘Steamplicty’ system in all areas: food choice, ordering, delivery, food quality and overall. Wastage was considerably less with the ‘Steamplicity’ system; although care must be taken to ensure that poor operating procedures do not negate this advantage. When the total weight of food consumed in the ward at each meal is divided by the number of main courses served, results show that at lunch, mean intake with the cook-chill system was 202g whilst that for the ‘Steamplicity’ system was 282g and for the evening meal, 226g compared with 310g.

The impact of percutaneous endoscopic gastrostomy feeding upon daily life in adults

Abstract: Background: The provision of home enteral tube feeding in adults has increased in the UK This study explored how percutaneous endoscopic gastrostomy (PEG) feeding impacts on daily lives of adult patients, from the patients’ and carers’ perspectives Methods: A semi-structured interview approach was developed to obtain participants’ views of the impact of living with a PEG A cross-sectional qualitative purposive sampling design was employed Thirty-four semi-structured interviews were conducted (15 adult patients and 19 carers) and data were analysed descriptively and thematically Results: Difficulties arising from PEG feeding included vomiting, diarrhoea, infection of the PEG site and leakage The key issues that emerged included relief of pressure to consume an oral diet, disturbed sleep, restricted ability to go out, restricted choice of clothing, difficulties finding a place to feed, missing being able to eat and drink, social occasions, negative attitudes of others towards feeding and the burden placed on family members Conclusions: The key themes that emerged from participants were diverse and highlight a need for increased social support for both patients and their carers, planned on an individual basis

Differences in weaning practice, food and nutrient intake between breast- and formula-fed 4-month-old infants in England

Abstract: Background Breastfed infants may grow more slowly in the second half of infancy than formula-fed infants, differences in weaning practice may contribute. Methods Dietary intakes of 4-month-old infants have been investigated cross-sectionally. Diet was assessed using a structured 1-day un-weighed dietary record in 852 white singletons (72% of those invited) from a random sub-sample of infants taking part in Avon Longitudinal Study of Parents and Children. Nutrient intakes of formula-fed infants were compared by sex and with UK reference values. Estimated mean energy and nutrient intakes, mean bodyweight and daily quantities of food consumed were compared by weaning practice. Results In formula-fed infants mean energy intakes and intakes of most nutrients were adequate. There were significant differences in intakes of most nutrients by weaning practice; however, mean energy intake and body weight of breastfed infants was similar to formula-fed infants. Infants given formula milk were less likely to consume vegetables and fruit, and more likely to consume commercial infant drinks, compared with infants who were breastfed. In breastfed infants breast milk intake was lower if solids were given (905 g versus 818 g; P = 0.01); however, nutrient intake was not compromised. In formula-fed infants milk intake was not different in those having solids compared to those having milk only (810 g versus 795 g; P = 0.649). Conclusions Differences in weaning practice and patterns of food consumption were seen between breast- and formula-fed infants, these may contribute to later growth differences.

Acculturation and education level in relation to quality of the diet: a study of Surinamese South Asian and Afro-Caribbean residents of the Netherlands

Abstract: BACKGROUND: To consider the changes in overall diet quality following migration we examined the associations of acculturation variables and education level with diet in Surinamese South Asian and Surinamese Afro-Caribbean origin on the one hand, and ethnic Dutch residents of the Netherlands on the other. Surinam is a former Dutch colony in South America. METHODS: We randomly selected men and women aged 35-60 years: ethnic Dutch, n = 552; South Asian, n = 306; Afro-Caribbean, n = 660. Intakes of fruit, vegetables, red meat, fish, vegetable oils, breakfast and salt were measured using a short questionnaire that formed the basis for a 'diet quality indicator' score. Highest education was measured and acculturation of the Surinamese groups was assessed by age at migration, number of resident years and a scale measure of social contacts with ethnic Dutch. RESULTS: Compared with ethnic Dutch, both Surinamese groups scored higher on overall diet quality (P < or = 0.001) but some aspects of diet (breakfast and salt use) were less prudent. Education was positively associated with diet quality in ethnic Dutch (P < or = 0.01), but not consistently so in Surinamese. Associations with social contact with ethnic Dutch varied for different quality aspects of the diet. Residence duration (mean = 22 years) and age at migration (mean = 21 years) were not associated with diet. CONCLUSIONS: A greater degree of acculturation does not necessarily lead to a less healthful diet in migrants. In addition, the association of education level with diet may differ for migrant groups. The diet of migrants differ from host populations, suggesting that migrant groups should be considered in the development of nutrition health promotion activities

The effect of socioeconomic status on dietary intake, physical activity and Body Mass Index in Austrian pregnant women.

Abstract: Objectives To examine the associations of socioeconomic status (SES) with dietary intake and health related factors in pregnant women. Subjects A total of 261 pregnant women attending maternity clinics in Austria. Methods Descriptive cross-sectional survey using a self-administered questionnaire in combination with an interview to assess dietary intake (24-hour-recall). Results In the linear regression models, women with a higher level of education showed a higher intake of dietary fibre (P = 0.015), folate (P = 0.048), beta-carotene (P = 0.008), and calcium (P = 0.003), whereas the intake of total fat (P = 0.039) was lower. The mean reported prepregnancy Body Mass Index (BMI) of lower educated women (23.6 kg m−2) was significantly higher (p for trend = 0.018) than that of women with medium or high levels of education (21.7 and 21.6 kg m−2, respectively). The manual occupation group was more than four times less likely to engage in structured physical activity compared with the nonmanual occupation group (adjusted odds ratio for manual group = 0.23, 95% CI: 0.08; 0.87). Conclusions Education is a strong and independent predictor of nutrient intake and BMI in pregnant women. The use of occupation and household income in addition to education improves the description of socioeconomic inequalities in diet and health related factors.

Parent and child reports of fruit and vegetable intakes and related family environmental factors show low levels of agreement.

Abstract: OBJECTIVE: The purpose of the present study was to determine the level of agreement between child and parent reports of 9- to 10-year-old children's consumption of fruit and vegetables and potential family-environmental determinants. METHODS: Schoolchildren and their parents completed parallel questionnaires at baseline and at follow-up (1 year later) about usual fruit and vegetable consumption of the child, potential determinants and general demographics. Matched child-parent couples were included in the analyses (baseline = 380; follow-up = 307). To assess the level of agreement between child and parent reports at both points in time, dependent-sample t-test, correlation coefficients, weighted Cohen's kappa coefficients and Bland-Altman plots including limits of agreement were used. RESULTS: Both at baseline and at follow-up, the mean intake of fruit and vegetable reported by the children were significantly higher than reported by their parents, but differences were smaller at follow-up. Correlation coefficients between child and parent reports (0.28-0.43) and weighted Cohen's kappa coefficients (0.25-0.28) were weak to moderate. Limits of agreement were wide. CONCLUSION: The agreement between parent and child reports is weak to moderate and may depend on the age of the child. Fourth graders may overestimate their own intake of fruit and vegetables.

Processes underlying young women's decisions to eat fruits and vegetables

Abstract: Objective To relate the use of identified processes that college women use to eat enough fruits and enough vegetables to their stages of readiness to change and their fruit and vegetable (F/V) intakes. Method A cross-sectional assessment of college women 18–24 years of age (n = 236) was conducted to assess stage of readiness to eat F/V. Use of seven processes, earlier confirmed in a separate sample of college students the same age (health concerns, self-reevaluation, social liberation, health commitment/action, interpersonal control, external reinforcement and helping relationships) was compared with stage of change for F/V and 3 days of dietary intakes. Results In these young college women, use of self-reevaluation, a cognitive process for change, peaked in the preparation stage for both F/V. Use of health commitment/action, a post-action process including counter-conditioning, peaked in those in action/maintenance for F/V. Weight concerns related to the counter-conditioning processes women used to eat more fruit. Conclusion Health practitioners should focus on weight management, appearance and health benefits of eating fruits and vegetables for this demographic group.

Vulnerable patients with a fractured neck of femur: nutritional status and support in hospital.

Abstract: Background and aim Malnutrition has serious consequences for recovery and increases the risk of complications in hospital patients. Fractured neck of femur (NOF) patients may be particularly at risk because of their old age and frail state of health. We conducted an observational study to evaluate the nutritional state and the nutritional support, which was provided to this group during their stay in hospital. Methods Twenty-five consecutive people admitted to an orthopaedic ward with a fractured NOF at Charing Cross Hospital, London were recruited. Anthropometric measures, biochemical indices, 3 days dietary intake and dietetic referral rates were collected. Results Patients had a significantly lower body mass index (BMI) compared with the mean BMI for sex and age in an elderly UK population (21.97 ± 1.06 versus 26.73 ± 0.03 kg m−2; P < 0.005). They took just 58.6% of their energy requirements in hospital (4219 ± 319 versus 7199 ± 202 kJ mean−1 daily intake over 3 days in week 2). Using the hospitals own nutritional risk assessment tool 56% of patients were found to be at risk of malnutrition on admission, which increased to 68% after 2–3 weeks. Of these 64% were referred to a dietitian and were given nutritional supplements. Nutritional assessment revealed that their nutritional status worsened during stay. Conclusions This group of patients with fractured NOF is likely to be malnourished on admission and to show a rapid deterioration in its nutrition status during admission. Energy needs were not met in up to 50% of patients. These results reinforce the need to screen, supplement and monitor fractured NOF patients.

Prepregnancy body mass index and dietary intake in the first trimester of pregnancy

Abstract: Objectives: Adequate maternal nutrition is of paramount importance in pregnancy, particularly in the first trimester when fetal development is crucial. It has been reported that heavier women are most likely to fear weight gain associated with pregnancy. Few studies have, however, investigated associations between prepregnancy body mass index (BMI) and nutrient intakes in the first trimester of gestation using detailed, prospective methodologies. The aim of this study was to investigate possible associations between prepregnancy BMI and nutrient intakes in the first trimester of gestation. Design: Seventy-two Caucasian, primiparous nonsmokers of mean age 33.1 years (SD 4.6) were recruited from three London teaching hospitals and they completed a background information questionnaire and a 4- to 7-day weighed inventory food diary during the first trimester of pregnancy. Prepregnancy anthropometric data were extracted from General Practitioner records. Results: Prepregnancy BMI was inversely associated with dietary energy (P = 0.04), Southgate and Englyst fibre (P < 0.01), and iron and folate (P < 0.01). After excluding under-reporters [individual energy intake:basal metabolic rate (estimated) ratio < 1.2], prepregnancy BMI was inversely associated with folate intake (P =0.04). Dietary intakes of Englyst fibre (P = 0.03) were statistically significantly lower than average dietary recommendations in this group. Conclusions: This study identified that women with a high prepregnancy BMI are more likely to under-report nutrient intakes. The finding that folate intake was significantly lower in heavier women accurately reporting dietary intake is of particular concern.

A systematic review of multivitamin and multimineral supplementation for infection

Abstract: Background Infections are major causes of morbidity and mortality worldwide. Micronutrients have important functions in the body's immune system. This systematic review examined the evidence from randomized controlled trials (RCTs) on whether multivitamin and multimineral supplementation is effective in reducing infection. Methods Electronic databases searched: Cochrane Controlled Trials Register, EMBASE, MEDLINE, BIOSIS, CAB abstracts. Hand searching of nutrition journals and reference lists was carried out. RCTs and quasi-randomized trials of supplementation of adults with at least two vitamins or minerals or a combination were selected. Study results were combined in meta-analysis plots where appropriate. Results Twenty studies were included in the review. Small numbers were available for each meta-analysis. Results are presented here without the Chandra group studies. No significant difference was found in the number of episodes of infection in older people (≥65 years) between those supplemented and those not supplemented; (WMD) 0.06 [95% confidence interval (CI) −0.04, 0.16], P = 0.25. In other adults groups, there were significantly less episodes of infection in those supplemented; (WMD) −1.20 (95% CI −2.08, −0.32), P = 0.008. There was no significant difference between those older people supplemented and those not supplemented in the number with at least one infection; relative risk (RR) 0.98 (95% CI 0.86, 1.11), P = 0.77. Similarly, there was no significant difference in the numbers in other adult groups who had at least one episode of infection between those supplemented and those taking placebo; (RR) 0.81 (95% CI 0.65, 1.00), P = 0.06. Subgroup analyses suggested that supplemented people aged 65 years or over may benefit more if they are undernourished and supplemented for over 6 months, WMD −0.67 infections (95% CI −1.24, −0.10), P = 0.02. Conclusion Further large trials are needed, particularly in undernourished older people. Trials of supplementation periods of over 6 months are recommended.

Validation and reproducibility of a semi-quantitative Food Frequency Questionnaire for use in elderly Swiss women.

Abstract: Objective The principal aim of this study was to develop a Swiss Food Frequency Questionnaire (FFQ) for the elderly population for use in a study to investigate the influence of nutritional factors on bone health. The secondary aim was to assess its validity and both short-term and long-term reproducibility. Design A 4-day weighed record (4 d WR) was applied to 51 randomly selected women of a mean age of 80.3 years. Subsequently, a detailed FFQ was developed, cross-validated against a further 44 4-d WR, and the short- (1 month, n = 15) and long-term (12 months, n = 14) reproducibility examined. Setting French speaking part of Switzerland. Subjects The subjects were randomly selected women recruited from the Swiss Evaluation of the Methods of Measurement of Osteoporotic Fracture cohort study. Results Mean energy intakes by 4-d WR and FFQ showed no significant difference [1564.9 kcal (SD 351.1); 1641.3 kcal (SD 523.2) respectively]. Mean crude nutrient intakes were also similar (with nonsignifcant P-values examining the differences in intake) and ranged from 0.13 (potassium) to 0.48 (magnesium). Similar results were found in the reproducibility studies. Conclusion These findings provide evidence that this FFQ adequately estimates nutrient intakes and can be used to rank individuals within distributions of intake in specific populations.

Media use as a reason for meal skipping and fast eating in secondary school children.

Abstract: Objective This study examined self-reported meal skipping and eating faster than usual with the goal of watching television or playing computer games. Method Respondents reported their media use and indicated how often they skipped a meal to watch a favourite television programme or to play a computer game, and how often they ate faster than usual in order to watch television or play a computer game. Subjects Respondents were 2546 adolescents of 13 (first year of secondary school) and 16 years (fourth year of secondary school) of age. Results About one respondent in 10 skipped at least one meal every week for either television viewing or computer game playing. Weekly meal skipping for television viewing occurs more regularly in boys and first-year students, but particularly in teenagers who view 5 h or more daily (15% of the sample). The category of teenagers who play computer games four times a week or more (25.3% of the sample) is at increased risk of meal skipping; those who play more than four times a week are 10 times more likely weekly to skip a meal. A quarter of the adolescents eat faster at least once a week to be able to watch television or play a computer game. Regardless of gender and school year, teenagers’ risk of eating faster progressively increases with their use of the media. Those who watch 4 h or more daily are about seven times more likely to skip a meal for television and those who play computer games at least four times a week are nine times more likely weekly to skip a meal. Conclusions Unhealthy eating habits can be a side effect of heavy or excessive media use. Teenagers’ use of television or game computers during nonworking or out-of-school hours partly displaces the amount of time that needs to be spent at meals. Practitioners and educators may try to encourage or restore a pattern of healthful meal consumption habits by reducing the amount of media use, and by supporting parental rule-making regarding children's eating habits and media use.

Energy and nutrient intake of Swiss women aged 75-87 years.

Abstract: Objective Reliable data about the nutrient intake of elderly noninstitutionalized women in Switzerland is lacking. The aim of this study was to assess the energy and nutrient intake in this specific population. Subjects The 401 subjects were randomly selected women of mean age of 80.4 years (range 75–87) recruited from the Swiss SEMOF (Swiss Evaluation of the Methods of Measurement of Osteoporotic Fracture Risk) cohort study. A validated food frequency questionnaire (FFQ) was submitted to the 401 subjects to assess dietary intake. Results The FFQ showed a mean daily energy intake of 1544 kcal (±447.7). Protein intake was 65.2 g (±19.9), that is 1.03 g kg−1 body weight per day. The mean daily intake for energy, fat, carbohydrate, calcium, magnesium, vitamin C, D and E were below the RNI. However, protein, phosphorus, potassium, iron and vitamin B6 were above the RNI. Conclusion The mean nutrient intake of these free living Swiss elderly women was low compared with standards. Energy dense foods rich in carbohydrate, magnesium, calcium, vitamin D and E as well as regular sunshine exposure is recommended in order to optimise dietary intake.

Mis)interpretation of body weight in adult women and men

Abstract: Introduction This study examined what methods people use to determine and interpret their body weight, and what factors are associated with either an underestimation of overweight or an overestimation of a healthy body weight. Method The study used self-reported data on weight and height. Data were collected by means of questionnaires (n = 722). Results In comparison with unaware overweight individuals, aware overweight respondents had a significantly lower score on comparing their body to that of others and on listening to remarks from others as methods to determine and interpret their body weight. The same was true for respondents with a correct perception of their healthy body weight compared with respondents who overestimated their healthy body weight. Respondents with a correct perception also had a significantly lower score on using the need to change to a different clothing size to determine body weight. Underestimation of overweight was significantly associated with body mass index (BMI), intense physical activity, knowledge of a healthy weight range and body comparison; overestimation of healthy body weight was significantly associated with gender, BMI, weight loss history and media influences. Discussion The study had a cross-sectional design, and therefore no causal relations could be determined. Despite this, the study provided more insight into the way people estimate and judge their body weight.

One year follow-up of overweight and obese hypertensive adults following intensive lifestyle therapy.

Abstract: Objective To examine the long-term effect on weight maintenance and dietary habits of participants in a clinical trial for weight loss. Setting Community-based residents living in Maryland. Participants Forty-four hypertensive, overweight adults who participated in a randomized clinical trial of weight loss. Participants were randomized to an intensive ‘lifestyle’ intervention or a ‘monitoring’ group. Main outcome measures Weight, self-reported current intake of fat and fruit/fibre and self-reported barriers to maintain weight loss were assessed 1 year after the completion of the Diet, Exercise and Weight-loss Intervention Trial (DEW-IT) trial. Analysis t-tests were used to compare groups for differences in continuous variables and chi-square tests were used to compare groups for categorical variables. Results Fourty-two of the 44 DEW-IT subjects participated in the follow-up study. Overall, 55% (12/19) of the lifestyle intervention group remained at or below their baseline weight at 1 year, compared with 48% (11/23) of the monitoring group (P = 0.32). However, during that year, 95% (18/19) of the lifestyle intervention group and 52% (12/23) of the monitoring group gained weight from the end of the study. Both groups reported similar intake of fruits/vegetables (servings day−1), dietary fibre (g day−1) and fat (g day−1). Conclusions and implications The majority of participants who lost weight during the trial regained weight during the course of 1 year. A successful intensive 2-month programme of lifestyle modification (DEW-IT) was ineffective for long-term maintenance of weight loss.

The determination of phenylalanine content of foods suitable for phenylketonuria

Abstract: Background A low phenylalanine diet for people with phenylketonuria (PKU) is very restrictive. Natural foods allowed are based chiefly on fruits and vegetables but there is limited analysis on the phenylalanine content of newer and exotic fruit and vegetables. The assumption that 1 g protein yields 50 mg phenylalanine does not apply to fruits and vegetables. Methods The National Society for Phenylketonuria Medical Advisory Panel commissioned the phenylalanine analysis of 172 foods, which emphasis on fruit and vegetables. The foods were purchased from retail outlets and analysed by LGC Limited (67 foods) and the LFI (105 foods). Results There was a strong correlation between this phenylalanine and UK analyses published in 1980, but previous analysis included only a limited range of fruits and vegetables (r = 0.8746; P < 0.0001). There was also correlation between phenylalanine and UK protein analyses (r = 0.7976; P < 0.0001). Conclusion This new phenylalanine data have enabled a wider range of fruits and vegetables to be safely incorporated into the diet of people with PKU.

Unidentified under-nutrition: dietary intake and anthropometric indices in a residential care home population.

Abstract: Background Research investigating the nutritional status of older people in residential care homes is scant. Objective To determine the anthropometric measures and dietary intakes of older people in this setting as a basis for future intervention studies. Methods Dietary intake was assessed using 3-day-weighed food records, nutritional status was evaluated using anthropometric measurements (knee height to predict standing height, and body weight). Catering provision was assessed using a computer-based menu assessment tool (CORA). Results Mean body mass index (BMI) for the 34 participants was 22.2 kg m2 (range 14.5–34.4). Six participants (17.6%) had a BMI ≤18.5 kg m2 with a further seven identified as having a BMI >18.5 but <20 kg m2. Only two subjects with BMI <18.5 kg m2 were prescribed oral supplements. In both men and women, recorded mean energy intakes were below current estimated average requirements by 24% and 22% respectively. Conclusion Despite adequate food provision, under-nutrition was prevalent and, in the majority of cases, unidentified and untreated. A larger study is warranted to investigate whether improved nutritional intake is achievable through dietary modification. These data indicate that a sample size of around 60, with 90% power and at the 5% significance level, is required to detect a difference of 1674 kJ between groups of residents in an intervention study following a cluster randomized design.

Reliability and validity of a maternal food frequency questionnaire designed to estimate consumption of common food allergens

Abstract: Background Maternal food intake during pregnancy may influence the development of food hypersensitivity (FHS) in the child. A food frequency questionnaire estimating the frequency with which some of the mains food allergens are consumed was designed and validated. Materials and methods Pregnant women were recruited at the ante-natal clinic of St. Mary's Hospital, Isle of Wight, UK. A food frequency questionnaire was developed and validated by comparing responses to information recorded in 7 days food diaries. The reliability of the food frequency questionnaire was evaluated by asking women to complete the questionnaire on two separate occasions at 30 and 36 weeks gestation. Results Fifty-seven women completed the validity study and 91 women completed the reliability study. For both validity and reliability, questions with dichotomous response categories showed the highest level of agreement. Frequency of intake of foods commonly ‘hidden’ in foods produced the lowest validity and reliability scores. In the validity study responses to the food frequency questionnaire identically matched information recorded in the food diaries 80% of the time, on average. In the reliability study, responses were identical on both questionnaires 85% of the time on average. Conclusion In this study a food frequency questionnaire estimating the frequency with which some of the main food allergens are consumed during pregnancy was designed and validated. This food frequency questionnaire could be used in future studies to assess the role of maternal food intake in the development of FHS in the infant.

Diet, blood lipid profile and physical activity patterns in primary school children from a semi-rural area of Greece.

Abstract: BACKGROUND Risk factors for heart disease are becoming increasingly prevalent among young populations. The aim of this study was to assess the cardiovascular risk profile of young adolescents living in a semi-rural area of mainland Greece, Volos. MATERIALS AND METHODS A total of 198 children (106 females and 92 males) aged 11.6 +/- 0.4 years were randomly recruited. RESULTS Mean body mass index was 20.4 +/- 3.5 kg m(-2), while 30.3% of children were overweight and 6.7% were obese; no differences were observed between boys and girls. Mean plasma cholesterol (4.93 +/- 0.75 mmol L(-1)), low-density lipoprotein-cholesterol (3.29 +/- 0.64 mmol L(-1)) and triglyceride (0.97 +/- 0.31 mmol L(-1)) concentrations were above age-specific recommended values. On the other hand, mean high-density lipoprotein-cholesterol was acceptable for 92.3% of the children. Self-reported daily energy intake (8.37 +/- 3.06 MJ) was adequate for age, but intake of fat was high (42.0 +/- 9.2% of energy) and that of carbohydrate was relatively low (44.5 +/- 10.0% of energy). Saturated fat consumption was elevated (15.6 +/- 4.3% of energy), while polyunsaturated fat intake fell short (4.8 +/- 1.6% of energy). The study participants spent 9.60 +/- 6.44 h week(-1) on moderate to vigorous physical activities, while they devoted 16.60 +/- 8.81 h week(-1) to sedentary activities. Boys spent significantly more time than girls on both physical (P < 0.001) and sedentary (P = 0.001) activities. No major gender differences were observed in anthropometric, dietary and plasma lipid parameters. CONCLUSION The findings from the present study support the worrisome trends that have been documented in Greek youngsters elsewhere, and predict an unfavourable cardiovascular risk profile for the Greek population in the foreseeable future.

Dietary habits of the Somali population in Liverpool, with respect to foods containing calcium and vitamin D: a cause for concern?

Abstract: Background A large percentage of Liverpool Somalis have vitamin D deficiency and low calcium excretion. The dietary habits of Liverpool Somalis were investigated with respect to food items containing calcium and vitamin D. Methods A questionnaire, administered by a Somali field worker, assessed the intake of food of 60 adult (45 females and 15 males; mean age 42 years) and 10 child (seven females and three males; mean age 10 years) Somali volunteers. Questions concerned personal details, health (bone and muscle problems) and dietary habits including the frequency of consumption of food items containing substantial amounts of calcium and vitamin D. Results Most subjects reported bone and muscle pain. Eating habits reflected traditional customs. Foods containing substantial amounts of calcium and vitamin D were consumed infrequently. Milk was only consumed in tea. Those self-reporting bone pain consumed eggs, cheese and beans rarely. Conclusion The food choices of these individuals with regard to bone health is a cause for concern and indicates a likelihood of low calcium and vitamin D intake.

An audit of diabetes control, dietary management and quality of life in adults with type 1 diabetes mellitus, and a comparison with nondiabetic subjects.

Abstract: Objectives The study's objective was to audit current diet and disease management in a community-based sample of people with type 1 diabetes. Methods The study involved adults with type 1 diabetes and control subjects. Reported amounts of dietary intake were collected. Indices of diabetes control were determined by standard methods. Quality of life of both groups was assessed with appropriate measures. Results were compared between two groups. Results Mean HbA1c concentration was 8.5% (SD 2.21%) for women with diabetes and 8.6% (SD 1.91%) for men. There was no significant difference between the diabetic and control subjects in self-reported energy intake and macronutrient intake, with the exception that the contribution of saturated fatty acid to energy intake was higher in male controls than in male diabetics. There was no association between dietary intakes and glycemic control in diabetic subjects. Anthropometric measurements, blood pressure and plasma lipids in patients were within normal range and not significantly different from the controls. Plasma fibrinogen concentration was higher in patients. Diabetic subjects did not have a diminished quality of life. Conclusions Dietary management in these patients was generally focused on controlling carbohydrate intake. Most had suboptimal diabetes control.

The effect of advice to walk 2000 extra steps daily on food intake

Abstract: Background: It is currently unclear how physical activity and diet interact within the ranges of activity seen in the general population. This study aimed to establish whether a small, acute, increase in physical activity would lead to compensatory change in energy intake and nutrient balance, and to provide power analysis data for future research in this field. Method: Twelve participants were studied over 7 days of habitual activity and 2 weeks after instruction to increase physical activity by 2000 steps per day. Physical activity was assessed using a diary, the 'activPAL' activity monitor and a pedometer. Dietary analyses from prospective food diaries were compared between the first and third weeks. Results: Participants increased step-counts (+2600 steps per day, P = 0.008) and estimated energy expenditure (+300-1000 kJ day(-1), P = 0.002) but did not significantly change their energy intake, dietary composition or number of meals per day. From reverse power analysis 38 participants would be needed to exclude a change in energy intake of 400 kJ day(-1) with 90% power at P < 0.05; 400 kJ day(-1) would compensate for a 2000 steps per day increase in physical activity. Conclusion: These results did not demonstrate any compensatory increase in food consumption when physical activity was increased by walking an average of 2600 additional steps per day. Power analysis indicates that a larger study (n = 38) will be necessary to exclude such an effect with confidence.