Showing papers in "Public Health Nutrition in 2014"

Designing and developing a literature-derived, population-based dietary inflammatory index

Abstract: Objective To design and develop a literature-derived, population-based dietary inflammatory index (DII) to compare diverse populations on the inflammatory potential of their diets. Design Peer-reviewed primary research articles published through December 2010 on the effect of diet on inflammation were screened for possible inclusion in the DII scoring algorithm. Qualifying articles were scored according to whether each dietary parameter increased (+1), decreased (−1) or had no (0) effect on six inflammatory biomarkers: IL-1β, IL-4, IL-6, IL-10, TNF-α and C-reactive protein. Setting The Dietary Inflammatory Index Development Study was conducted in the Cancer Prevention and Control Program of the University of South Carolina in Columbia, SC, USA from 2011 to 2012. Results A total of ≈6500 articles published through December 2010 on the effect of dietary parameters on the six inflammatory markers were screened for inclusion in the DII scoring algorithm. Eleven food consumption data sets from countries around the world were identified that allowed individuals’ intakes to be expressed relative to the range of intakes of the forty-five food parameters observed across these diverse populations. Qualifying articles (n 1943) were read and scored based on the forty-five pro- and anti-inflammatory food parameters identified in the search. When fit to this composite global database, the DII score of the maximally pro-inflammatory diet was +7·98, the maximally anti-inflammatory DII score was −8·87 and the median was +0·23. Conclusions The DII reflects both a robust literature base and standardization of individual intakes to global referent values. The success of this first-of-a-kind attempt at relating intakes of inflammation-modulating foods relative to global norms sets the stage for use of the DII in a wide variety of epidemiological and clinical studies.

Mediterranean diet and health status: an updated meta-analysis and a proposal for a literature-based adherence score.

Abstract: Objective To update previous meta-analyses of cohort studies that investigated the association between the Mediterranean diet and health status and to utilize data coming from all of the cohort studies for proposing a literature-based adherence score to the Mediterranean diet. Design We conducted a comprehensive literature search through all electronic databases up to June 2013. Setting Cohort prospective studies investigating adherence to the Mediterranean diet and health outcomes. Cut-off values of food groups used to compute the adherence score were obtained. Subjects The updated search was performed in an overall population of 4 172 412 subjects, with eighteen recent studies that were not present in the previous meta-analyses. Results A 2-point increase in adherence score to the Mediterranean diet was reported to determine an 8 % reduction of overall mortality (relative risk = 0·92; 95 % CI 0·91, 0·93), a 10 % reduced risk of CVD (relative risk = 0·90; 95 % CI 0·87, 0·92) and a 4 % reduction of neoplastic disease (relative risk = 0·96; 95 % CI 0·95, 0·97). We utilized data coming from all cohort studies available in the literature for proposing a literature-based adherence score. Such a score ranges from 0 (minimal adherence) to 18 (maximal adherence) points and includes three different categories of consumption for each food group composing the Mediterranean diet. Conclusions The Mediterranean diet was found to be a healthy dietary pattern in terms of morbidity and mortality. By using data from the cohort studies we proposed a literature-based adherence score that can represent an easy tool for the estimation of adherence to the Mediterranean diet also at the individual level.

A population-based dietary inflammatory index predicts levels of C-reactive protein in the Seasonal Variation of Blood Cholesterol Study (SEASONS)

Abstract: Objective: To perform construct validation of the population-based Dietary Inflammatory Index (DII) using dietary data from two different dietary assessments and serum high-sensitivity C-reactive protein (hs-CRP) as the construct validator. Design: Using data derived from (i) three 24h dietary recalls (24HR) at baseline and at the end of each subsequent quarter (i.e. up to fifteen over a year) and (ii) a 7 d dietary recall (7DDR) measured at baseline and then quarterly, regression analyses were conducted to test the effect of the DII score on serum hs-CRP as dichotomous (#3mg/l, .3mg/l), while controlling for important potential confounders. Setting: Existing data from the Seasonal Variation of Blood Cholesterol Study (SEASONS), a longitudinal observational study of healthy participants recruited in Worcester, MA, USA and participants were followed for 1 year. Subjects: Participants who had at least one hs-CRP measurement over her/his 1-year participation (n 495 for 24HR, n 559 for 7DDR). Results: Higher DII scores were associated with values of hs-CRP .3mg/l (OR 51?08; 95% CI 1?01, 1?16, P 50?035 for the 24HR; and OR 51?10; 95% CI 1?02, 1?19, P 50?015 for the 7DDR). Conclusions: The population-based DII was associated with interval changes in hs-CRP using both the 24HR and 7DDR. The success of this first-of-a-kind attempt at relating individuals’ intakes of inflammation-modulating foods using this refined DII, and the finding that there is virtually no drop-off in predictive capability using a structured questionnaire in comparison to the 24HR standard, sets the stage for use of the DII in a wide variety of other epidemiological and clinical studies.

Eating for the better: a social marketing review (2000-2012)

Abstract: Objective The present study sought to identify both the ingredients for success and the potential impediments to social marketing effectiveness for healthy eating behaviour, focusing on studies conducted over the last 10 years. Design A comprehensive literature review was undertaken examining seventeen databases to identify studies reporting the use of social marketing to address healthy eating. Thirty-four empirical studies were analysed to examine the effectiveness of social marketing interventions to improve healthy eating behaviour using Andreasen's (2002) social marketing benchmark criteria. Statistical analysis was undertaken to quantitatively evaluate whether effectiveness varied between study categories (subsets). Setting Healthy eating empirical studies published from 2000 onwards. Subjects Empirical studies that self-identified as social marketing. Results Sixteen social marketing studies (subset 1) were identified in the review. These were systematic studies which sought to change behaviour through tailored solutions (e.g. use of marketing tools beyond communication was clearly evident) that delivered value to the target audience. For these sixteen studies, the mean number of criteria identified was five. Six studies met all six criteria. Positive change to healthy eating behaviour was found in fourteen of sixteen studies. The sixteen studies that met the definition of social marketing used significantly more of Andreasen's (2002) criteria and were more effective in achieving behavioural change than the eighteen studies in subset 2. Conclusions Social marketing is an involved process and it is important that studies identifying as social marketing adopt social marketing benchmark criteria. Social marketing when employed to its full extent offers the potential to change healthy eating.

Obesity prevalence in Mexico: impact on health and economic burden.

Abstract: Objective Along with other countries having high and low-to-middle income, Mexico has experienced a substantial change in obesity rates. This rapid growth in obesity prevalence has led to high rates of obesity-related diseases and associated health-care costs. Design Micro-simulation is used to project future BMI trends. Additionally thirteen BMI-related diseases and health-care costs are estimated. The results are simulated for three hypothetical scenarios: no BMI reduction and BMI reductions of 1 % and 5 % across the population. Setting Mexican Health and Nutrition Surveys 1999 and 2000, and Mexican National Health and Nutrition Survey 2006. Subjects Mexican adults. Results In 2010, 32 % of men and 26 % of women were normal weight. By 2050, the proportion of normal weight will decrease to 12 % and 9 % for males and females respectively, and more people will be obese than overweight. It is projected that by 2050 there will be 12 million cumulative incidence cases of diabetes and 8 million cumulative incidence cases of heart disease alone. For the thirteen diseases considered, costs of $US 85 million in 2050. Conclusions Obesity rates are leading to a large health and economic burden. The projected numbers are high and Mexico should implement strong action to tackle obesity. Results presented here will be very helpful in planning and implementing policy interventions.

Relationships between intuitive eating and health indicators: Literature review

Abstract: Objective: To review the peer-reviewed literature on relationships between intuitive eating and health indicators and suggest areas of inquiry for future research. We define the fundamental principles of intuitive eating as: (i) eating when hungry; (ii) stopping eating when no longer hungry/full; and (iii) no restrictions on types of food eaten unless for medical reasons. Design: We include articles cited by PubMed, PsycInfo and Science Direct published in peer-reviewed journals or theses that include ‘intuitive eating’ or related concepts in the title or abstract and that test relationships between intuitive eating and physical or mental health indicators. Results: We found twenty-six articles that met our criteria: seventeen cross-sectional survey studies and nine clinical studies, eight of which were randomised controlled trials. The cross-sectional surveys indicate that intuitive eating is negatively associated with BMI, positively associated with various psychological health indicators, and possibly positively associated with improved dietary intake and/or eating behaviours, but not associated with higher levels of physical activity. From the clinical studies, we conclude that the implementation of intuitive eating results in weight maintenance but perhaps not weight loss, improved psychological health, possibly improved physical health indicators other than BMI (e.g. blood pressure; cholesterol levels) and dietary intake and/or eating behaviours, but probably not higher levels of physical activity. Conclusions: Research on intuitive eating has increased in recent years. Extant research demonstrates substantial and consistent associations between intuitive eating and both lower BMI and better psychological health. Additional research can add to the breadth and depth of these findings. The article concludes with several suggestions for future research.

Nutritional contribution of street foods to the diet of people in developing countries: a systematic review

Abstract: Human Sciences Research Council, Medical Research Council, Cape Peninsula University of Technology and the National Research Foundation

A new understanding of the relationship between sugars, dental caries and fluoride use: implications for limits on sugars consumption

Abstract: ObjectiveTo examine the quantitative relationship between sugar intake and the progressive development of dental caries.DesignA critical in-depth review of international studies was conducted. Methods included reassessing relevant studies from the most recent systematic review on the relationship between levels of sugars and dental caries. Reanalysis of dose–response relationships between dietary sugars and caries incidence in teeth with different levels of caries susceptibility in children was done using data from Japanese studies conducted by Takeuchi and co-workers.SettingGlobal, with emphasis on marked differences in both national sugar intake and fluoride use and preferably where one factor such as sugar intake changed progressively without changes in other factors over a decade or more.SubjectsChildren aged 6 years or more and adults.ResultsCaries occurred in both resistant and susceptible teeth of children when sugar intakes were only 2–3 % of energy intake, provided that the teeth had been exposed to sugars for >3 years. Despite increased enamel resistance after tooth eruption, there was a progressive linear increase in caries throughout life, explaining the higher rates of caries in adults than in children. Fluoride affects progression of caries development but there still is a pandemic prevalence of caries in populations worldwide.ConclusionsPrevious analyses based on children have misled public health analyses on sugars. The recommendation that sugar intakes should be ≤10 % of energy intake is no longer acceptable. The much greater adult burden of dental caries highlights the need for very low sugar intakes throughout life, e.g. 2–3 % of energy intake, whether or not fluoride intake is optimum.

Food choice, plate waste and nutrient intake of elementary- and middle-school students participating in the US National School Lunch Program.

Abstract: Objective To (i) evaluate food choices and consumption patterns of elementary- and middle-school students who participate in the National School Lunch Program (NSLP) and (ii) compare students’ average nutrient intake from lunch with NSLP standards. Design Plate waste from elementary- and middle-school students’ lunch trays was measured in autumn 2010 using a previously validated digital photography method. Percentage waste was estimated to the nearest 10 % for the entree, canned fruit, fresh fruit, vegetable, grain and milk. Univariate ANOVA determined differences in percentage waste between schools, grades and genders. Daily nutrient intake was calculated using the district's menu analysis and percentage waste. Setting Elementary and middle schools in northern Colorado (USA). Subjects Students, grades 1–8. Results Plate waste was estimated from 899 lunch trays; 535 elementary- and 364 middle-school students. Only 45 % of elementary- and 34 % middle-school students selected a vegetable. Elementary-school students wasted more than a third of grain, fruit and vegetable menu items. Middle-school students left nearly 50 % of fresh fruit, 37 % of canned fruit and nearly a third of vegetables unconsumed. Less than half of the students met the national meal standards for vitamins A and C, or Fe. Conclusions Few students’ lunch consumption met previous or new, strengthened NSLP lunch standards. Due to the relatively low intake of vegetables, intakes of vitamins A and C were of particular concern. Effective behavioural interventions, combined with marketing, communications and behavioural economics, will likely be necessary to encourage increased vegetable intake to meet the new meal standards.

The influence of gender, age, education and household size on meal preparation and food shopping responsibilities.

Abstract: Objective To examine the extent to which the gendered division of labor persists within households in the US in regard to meal planning/preparation and food shopping activities.

What's for dinner? Types of food served at family dinner differ across parent and family characteristics

Abstract: Family meals are important for the health and well-being of adolescents. Past research examining family meal frequency has found that more frequent family meals are associated with positive outcomes in youth, including better dietary intake,(1–14) lower prevalence of overweight/obesity,(6, 14–17) fewer disordered eating behaviors,(8, 18–30) and higher levels psychological well-being.(31, 32) This body of research has stimulated interest in family meals among health professionals and the public and has led to questions on what family meals look like, particularly with regard to the types of foods being served. Learning more about what is served at family meals, and parent and family factors that are correlated with healthier meals, can help in guiding interventions to improve the home food environment. Knowledge about how the types of foods served at family meals differ by socio-demographic characteristics can help in guiding decisions regarding who is in greatest need of intervention. Learning more about how psychosocial factors, such as parent work-life stress, parent depressive symptoms, and family functioning (e.g., communication, problem-solving, connectedness) are correlated with foods served at family meals may help to elucidate the types of factors that need to be taken into account in developing interventions.(17, 33) Finally, knowledge about how meal-specific variables such as attitudes toward family meals, food purchasing barriers, and meal planning and preparation practices are associated with the types of foods served at family meals, can help guide specific intervention messages.(1, 17) The present study builds upon the extant body of literature on family meals, which has primarily focused on frequency of family meals, by addressing the research questions: What types of foods are served at family dinners? How are parent and family sociodemographic characteristics, psychosocial well-being, and meal-specific variables associated with the type of food served at family dinners? We focused on family dinners, rather than on other meals, in that breakfast is likely to include different types of foods,(34) and lunch seems less likely to be eaten on a regular basis as a family meal given school schedules. Factors hypothesized to be associated with healthier family dinners include higher levels of income and education, not working full time, higher levels of psychosocial well-being, more positive attitudes regarding family meals, fewer food purchasing barriers, enjoyment of cooking, and greater involvement in meal planning and food preparation.(1, 17, 33)

Sugar consumption and global prevalence of obesity and hypertension: an ecological analysis

Abstract: Objective The nutrition transition model provides an integrated approach to analyse global changes in food consumption and lifestyle patterns. Whether variability in food availability for consumption, lifestyle and sociodemographic factors is associated with the worldwide prevalence distribution of overweight, obesity and hypertension is unclear. Design Ecological analysis. Setting Country-specific prevalence estimates of overweight, obesity and hypertension were obtained. Prevalence estimates were then matched to year- and country-specific food and energy availability for consumption of cereals, sugar, sweeteners and honey, vegetable oils, fruits, starchy roots, pulses, total vegetables, alcoholic beverages, total meat, animal fat, eggs, milk, and fish and seafood. The per capita Gross Domestic Product (GDP), urbanization rates and prevalence of physical inactivity for each country were also obtained. Subjects The overweight, obesity and hypertension databases included information from 128, 123 and seventy-nine countries, respectively. Results Consumption of sugar and animal products were directly associated with GDP and urbanization rates. In a multivariate regression model, physical inactivity (B = 0·01, se = 0·005, P = 0·003), cereal consumption (B = −0·02, se = 0·006, P < 0·001) and sugar consumption (B = 0·03, se = 0·01, P = 0·03) were significant predictors of obesity prevalence. Midpoint age (B = 0·21, se = 0·10, P = 0·02), prevalence of overweight (B = 0·18, se = 0·08, P = 0·02) and consumption of cereals (B = −0·22, se = 0·10, P = 0·02) were significant predictors of hypertension. Women appeared to have a significant obesity excess compared with men. Conclusions High sugar consumption and sedentary lifestyle are associated with increased obesity prevalence. The non-linear association of sugar consumption with prevalence of obesity suggests that effective strategies to reduce its consumption may have differential effects in countries at different stages of the nutrition transition.

Growth faltering and recovery in children aged 1-8 years in four low- and middle-income countries: Young Lives.

Abstract: This study is based on research funded by the Bill & Melinda Gates Foundation (Global Health Grant OPP1032713), the Eunice Shriver Kennedy National Institute of Child Health and Development (Grant R01 HD070993) and Grand Challenges Canada (Grant 0072–03 )

The impact of restaurant consumption among US adults: effects on energy and nutrient intakes.

Abstract: Objective To examine the effect of fast-food and full-service restaurant consumption on adults’ energy intake and dietary indicators. Design Individual-level fixed-effects regression model estimation based on two different days of dietary intake data was used. Setting Parallel to the rising obesity epidemic in the USA, there has been a marked upward trend in total energy intake derived from food away from home. Subjects The full sample included 12 528 respondents aged 20–64 years who completed 24 h dietary recall interviews for both day 1 and day 2 in the National Health and Nutrition Examination Survey (NHANES) 2003–2004, 2005–2006, 2007–2008 and 2009–2010. Results Fast-food and full-service restaurant consumption, respectively, was associated with an increase in daily total energy intake of 813·75 kJ (194·49 kcal) and 858·04 kJ (205·21 kcal) and with higher intakes of saturated fat (3·48 g and 2·52 g) and Na (296·38 mg and 451·06 mg). Individual characteristics moderated the impacts of restaurant food consumption with adverse impacts on net energy intake being larger for black adults compared with their white and Hispanic counterparts and greater for middle-income v . high-income adults. Conclusions Adults’ fast-food and full-service restaurant consumption was associated with higher daily total energy intake and poorer dietary indicators.

Islamic fasting and weight loss: a systematic review and meta-analysis

Abstract: Objective Studies on the effects of Ramadan fasting on weight changes have been contradictory. We brought together all published data to comprehensively examine the effects in a systematic review and meta-analysis. Design Relevant studies were obtained through searches of PubMed and CINAHL and by independent screening of reference lists and citations without any time restriction. All searches were completed between October and November 2011. Setting Changes in body weight during and after Ramadan were extracted from thirty-five English-language studies and were meta-analysed. Most of the studies were conducted in West Asia (n 19); the remainder were conducted in Africa (n 7), East Asia (n 3) and North America/Europe (n 4). Subjects Healthy adults. Results Fasting during Ramadan resulted in significant weight loss (-1·24 kg; 95% CI -1·60, -0·88 kg). However, most of the weight lost was regained within a few weeks and only a slight decrease in body weight was observed in the following weeks after Ramadan compared with that at the beginning of Ramadan. Weight loss at the end of Ramadan was significant in both genders (-1·51 kg for men and -0·92 kg for women); but again the weight loss lasted no longer than 2 weeks after Ramadan. Weight loss during Ramadan was greater among Asian populations compared with Africans and Europeans. Conclusions Weight changes during Ramadan were relatively small and mostly reversed after Ramadan, gradually returning to pre-Ramadan status. Ramadan provides an opportunity to lose weight, but structured and consistent lifestyle modifications are necessary to achieve lasting weight loss.

Associations of parental feeding styles with child snacking behaviour and weight in the context of general parenting.

Abstract: Objective To examine cross-sectional and longitudinal (one-year follow-up) associations of parental feeding styles with child snacking behaviour and weight in the context of general parenting, taking into account the multidimensionality of the controlling feeding style. Design Linear regression analyses were performed. Parents completed a questionnaire to measure five feeding style dimensions (Instrumental Feeding, Emotional Feeding, Encouragement, Overt Control and Covert Control) and children's fruit, energy-dense snack and sugar-sweetened beverage (SSB) intakes. Children's height and weight were measured to calculate their BMI Z-scores. Moderation by parenting style was tested by adding interaction terms to the regression analyses. Setting Observational study in the Netherlands. Subjects Parent-child dyads (n 1275) participating in the INPACT (IVO Nutrition and Physical Activity Child cohorT) study; children were (on average) 9 years of age. Results Instrumental Feeding and Emotional Feeding were negatively related to child fruit intake one year later and positively to (changes in) child energy-dense snack intake. Encouragement was negatively related to child energy-dense snacking and SSB intake one year later. Overt Control was cross-sectionally and prospectively related to (changes in) child energy-dense snacking and SSB intake in a negative direction. Covert Control showed similar associations with child energy-dense snacking and SSB intake as Overt Control. Although Covert Control was also positively related to child fruit intake and (changes in) child BMI Z-score, bootstrapping analyses revealed only a differential effect of Overt Control and Covert Control on child BMI Z-score one year later, with Covert Control displaying a stronger, positive association. Moderation analyses showed that some significant associations between parental feeding styles and outcome measures were dependent on the degree of psychological control and behavioural control. Conclusions Instrumental Feeding and Emotional Feeding may have a detrimental impact on children's snacking behaviour, while Encouragement, Overt Control and Covert Control may lead to less energy-dense snacking and less SSB intake. Overt Control and Covert Control have differential effects on child BMI Z-score one year later, which supports the idea that they should be treated as separate constructs. Prospective studies with a longer follow-up may elucidate the causal pathways between the various feeding styles and children's snacking behaviour and weight, as well as the moderating influences of psychological and behavioural control.

Socio-economic determinants of micronutrient intake and status in Europe: a systematic review.

Abstract: OBJECTIVE: To provide the evidence base for targeted nutrition policies to reduce the risk of micronutrient/diet-related diseases among disadvantaged populations in Europe, by focusing on: folate, vitamin B12, Fe, Zn and iodine for intake and status; and vitamin C, vitamin D, Ca, Se and Cu for intake. DESIGN: MEDLINE and Embase databases were searched to collect original studies that: (i) were published from 1990 to 2011; (ii) involved >100 subjects; (iii) had assessed dietary intake at the individual level; and/or (iv) included best practice biomarkers reflecting micronutrient status. We estimated relative differences in mean micronutrient intake and/or status between the lowest and highest socio-economic groups to: (i) evaluate variation in intake and status between socio-economic groups; and (ii) report on data availability. SETTING: Europe. SUBJECTS: Children, adults and elderly. RESULTS: Data from eighteen publications originating primarily from Western Europe showed that there is a positive association between indicators of socio-economic status and micronutrient intake and/or status. The largest differences were observed for intake of vitamin C in eleven out of twelve studies (5-47 %) and for vitamin D in total of four studies (4-31 %). CONCLUSIONS: The positive association observed between micronutrient intake and socio-economic status should complement existing evidence on socio-economic inequalities in diet-related diseases among disadvantaged populations in Europe. These findings could provide clues for further research and have implications for public health policy aimed at improving the intake of micronutrients and diet-related diseases

Towards healthy and sustainable food consumption: an Australian case study.

Abstract: This research received support from the Climate and Health Cluster which is funded by the CSIRO (Commonwealth Scientific and Industrial Research Organization) Flagship Collaboration Fund.

Alarming predictions for obesity and non-communicable diseases in the Middle East.

Abstract: Objective The present study aimed to model obesity trends and future obesity-related disease for nine countries in the Middle East; in addition, to explore how hypothetical reductions in population obesity levels could ameliorate anticipated disease burdens. Design A regression analysis of cross-sectional data v. BMI showed age- and sex-specific BMI trends, which fed into a micro simulation with a million Monte Carlo trials for each country. We also examined two alternative scenarios where population BMI was reduced by 1 % and 5 %. Setting Statistical modelling of obesity trends was carried out in nine Middle East countries (Bahrain, Egypt, Iran, Jordan, Kuwait, Lebanon, Oman, Saudi Arabia and Turkey). Subjects BMI data along with disease incidence, mortality and survival data from national and sub-national data sets were used for the modelling process. Results High rates of overweight and obesity increased in both men and women in most countries. The burden of incident type 2 diabetes, CHD and stroke would be moderated with even small reductions in obesity levels. Conclusions Obesity is a growing problem in the Middle East which requires government action on the primary prevention of obesity. The present results are important for policy makers to know the effectiveness of obesity interventions on future disease burden.

Very low food security in the USA is linked with exposure to violence.

Abstract: OBJECTIVE: To investigate characteristics of exposure to violence in relation to food security status among female-headed households. DESIGN: Ongoing mixed-method participatory action study. Questions addressed food insecurity, public assistance, and maternal and child health. Grounded theory analysis of qualitative themes related to violence was performed. These themes were then categorized by food security status. SETTING: Homes of low-income families in Philadelphia, PA, USA. SUBJECTS: Forty-four mothers of children under 3 years of age participating in public assistance programmes. RESULTS: Forty women described exposure to violence ranging from fear of violence to personal experiences with rape. Exposure to violence affected mental health, ability to continue school and obtain work with living wages, and subsequently the ability to afford food. Exposure to violence during childhood and being a perpetrator of violence were both linked to very low food security status and depressive symptoms. Ten of seventeen (59 %) participants reporting very low food security described life-changing violence, compared with three of fifteen (20 %) participants reporting low food security and four of twelve (33 %) reporting food security. Examples of violent experiences among the very low food secure group included exposure to child abuse, neglect and rape that suggest exposure to violence is an important factor in the experience of very low food security. CONCLUSIONS: Descriptions of childhood trauma and life-changing violence are linked with severe food security. Policy makers and clinicians should incorporate violence prevention efforts when addressing hunger. Language: en

Mediterranean diet adherence rates in Sicily, southern Italy

Abstract: Objective: To assess adherence to the Mediterranean diet and nutrient intakes in a population of Sicily, southern Italy and to evaluate possible determinants, particularly socio-cultural and lifestyle factors. Design: Cross-sectional. Setting: Urban and rural areas of eastern Sicily. Subjects: Between May 2009 and December 2010, 3090 adults were randomly recruited through the collaboration of fourteen general practitioners. Adherence to the Mediterranean diet was measured by the MedDietScore. Nutrient intakes were assessed through the 24 h recall of the previous day’s dietary intake. Results: Rural participants were barely more adherent to the Mediterranean diet than their urban counterparts (mean scores were 27?8 and 27?2, respectively, P 5 0?037). The MedDietScore was correlated with intakes of MUFA, fibre and vitamin C, as well as with consumption of non-refined cereals, vegetables, fruit, meat, dairy products, alcohol and nuts. Regression analysis revealed that older and more educated people were more likely to be in the highest tertile of MedDietScore (OR 5 1.90; 95 % CI 1?39, 2?59 and OR 5 1?29; 95 % CI 1?05, 1?58, respectively). A significant difference in quantity (moderate) and quality (red wine and beer) of alcohol was found according to adherence to the Mediterranean diet. Finally, more active participants were 1?5 times more likely to form part of the high-adherence group. Conclusions: A slow but concrete moving away from traditional patterns has been observed in younger people and low educated people. Public health interventions should focus on these target populations in order to improve the quality of their diet.

The relationship of perceptions of tap water safety with intake of sugar-sweetened beverages and plain water among US adults

Abstract: Objective: Research is limited on whether mistrust of tap water discourages plain water intake and leads to a greater intake of sugar-sweetened beverages (SSB). The objective of the present study was to examine demographic differences in perceptions of tap water safety and determine if these perceptions are associated with intake of SSB and plain water. Design: The study examined perceptions of tap water safety and their cross-sectional association with intake of SSB and plain water. Racial/ethnic differences in the associations of tap water perceptions with SSB and plain water intake were also examined. Setting: Nationally weighted data from the 2010 HealthStyles Survey (n 4184). Subjects: US adults aged $18 years. Results: Overall, 13?0% of participants disagreed that their local tap water was safe to drink and 26?4% of participants agreed that bottled water was safer than tap water. Both mistrust of tap water safety and favouring bottled water differed by region, age, race/ethnicity, income and education. The associations of tap water mistrust with intake of SSB and plain water were modified by race/ethnicity (P ,0?05). Non-white racial/ethnic groups who disagreed that their local tap water was safe to drink were more likely to report low intake of plain water. The odds of consuming $1 SSB/d among Hispanics who mistrusted their local tap water was twice that of Hispanics who did not (OR 52?0; 95% CI 1?2, 3?3). Conclusions: Public health efforts to promote healthy beverages should recognize the potential impact of tap water perceptions on water and SSB intake among minority populations.

Development of a New Nordic Diet score and its association with gestational weight gain and fetal growth – a study performed in the Norwegian Mother and Child Cohort Study (MoBa)

Abstract: Objective To construct a diet score for assessing degree of adherence to a healthy and environmentally friendly New Nordic Diet (NND) and to investigate its association with adequacy of gestational weight gain and fetal growth in a large prospective birth cohort. Design Main exposure was NND adherence, categorized as low, medium or high adherence. Main outcomes were adequacy of gestational weight gain, described as inadequate, optimal or excessive according to the 2009 Institute of Medicine guidelines, and fetal growth, categorized as being small, appropriate or large for gestational age. Associations of NND adherence with gestational weight gain and fetal growth were estimated with multinomial logistic regression in crude and adjusted models. Setting Norway. Subjects Women ( n 66 597) from the Norwegian Mother and Child Cohort Study (MoBa). Results Higher NND adherence implied higher energy and nutrient intakes, higher nutrient density and a healthier macronutrient distribution. Normal-weight women with high as compared with low NND adherence had lower adjusted odds of excessive gestational weight gain (OR=0·93; 95 % CI 0·87, 0·99; P =0·024). High as compared with low NND adherence was associated with reduced odds of the infant being born small for gestational age (OR=0·92; 95 % CI 0·86, 0·99; P =0·025) and with higher odds of the baby being born large for gestational age (OR=1·07; 95 % CI 1·00, 1·15; P =0·048). Conclusions The NND score captures diet quality. Adherence to a regional diet including a large representation of fruits and vegetables, whole grains, potatoes, fish, game, milk and drinking water during pregnancy may facilitate optimal gestational weight gain in normal-weight women and improve fetal growth in general.

Prevalence and patterns of cooking dinner at home in the USA: National Health and Nutrition Examination Survey (NHANES) 2007-2008

Abstract: Objective: To measure the prevalence of cooking dinner at home in the USA and test whether home dinner preparation habits are associated with socio-economic status, race/ethnicity, country of birth and family structure. Design: Cross-sectional analysis. The primary outcome, self-reported frequency of cooking dinner at home, was divided into three categories: 0–1 dinners cooked per week (‘never’), 2–5 (‘sometimes’) and 6–7 (‘always’). We used bivariable and multivariable regression analyses to test for associations between frequency of cooking dinner at home and factors of interest. Setting: The 2007–2008 National Health and Nutrition Examination Survey (NHANES). Subjects: The sample consisted of 10 149 participants. Results: Americans reported cooking an average of five dinners per week; 8 % never, 43 % sometimes and 49 % always cooked dinner at home. Lower household wealth and educational attainment were associated with a higher likelihood of either always or never cooking dinner at home, whereas wealthier, more educated households were more likely to sometimes cook dinner at home (P , 0?05). Black households cooked the fewest dinners at home (mean 5 4?4, 95 % CI 4?2, 4?6). Households with foreign-born reference persons cooked more dinners at home (mean 5 5?8, 95 % CI 5?7, 6?0) than households with US-born reference persons (mean 5 4?9, 95 % CI 4?7, 5?1). Households with dependants cooked more dinners at home (mean 5 5?2, 95 % CI 5?1, 5?4) than households without dependants (mean 5 4?6, 95 % CI 4?3, 5?0). Conclusions: Home dinner preparation habits varied substantially with socioeconomic status and race/ethnicity, associations that likely will have implications for designing and appropriately tailoring interventions to improve home food preparation practices and promote healthy eating.

Fast-food menu offerings vary in dietary quality, but are consistently poor

Abstract: Objective To evaluate five popular fast-food chains’ menus in relation to dietary guidance. Design Menus posted on chains’ websites were coded using the Food and Nutrient Database for Dietary Studies and MyPyramid Equivalents Database to enable Healthy Eating Index-2005 (HEI-2005) scores to be assigned. Dollar or value and kids’ menus and sets of items promoted as healthy or nutritious were also assessed. Setting Five popular fast-food chains in the USA. Subjects Not applicable. Results Full menus scored lower than 50 out of 100 possible points on the HEI-2005. Scores for Total Fruit, Whole Grains and Sodium were particularly dismal. Compared with full menus, scores on dollar or value menus were 3 points higher on average, whereas kids’ menus scored 10 points higher on average. Three chains marketed subsets of items as healthy or nutritious; these scored 17 points higher on average compared with the full menus. No menu or subset of menu items received a score higher than 72 out of 100 points. Conclusions The poor quality of fast-food menus is a concern in light of increasing away-from-home eating, aggressive marketing to children and minorities, and the tendency for fast-food restaurants to be located in low-income and minority areas. The addition of fruits, vegetables and legumes; replacement of refined with whole grains; and reformulation of offerings high in sodium, solid fats and added sugars are potential strategies to improve fast-food offerings. The HEI may be a useful metric for ongoing monitoring of fast-food menus.

Accuracy of food portion size estimation from digital pictures acquired by a chest-worn camera

Abstract: Self-reporting (e.g. electronic or paper-and-pencil food diary, 24h dietary recall, FFQ) is the most common method of dietary assessment(1–5). Although this approach is used widely in large cohort studies, its accuracy is limited by its dependence on the willingness of the participant to report and his/her ability to estimate accurately the amount of food consumed(6–8). To improve assessment accuracy, various portion size measurement aids are employed, including pictures (two dimensions) or realistic models (three dimensions) of objects of known sizes (e.g. a life-size picture of a tennis ball or a real tennis ball)(9–12). With the help of portion size measurement aids, an individual’s ability to estimate portion size can be improved significantly, especially after training(13–16). However, the ability of portion size measurement aids to improve accuracy varies with food models, training methods, food type and study population(13–25). For example, Lanerolle and co-workers developed models specifically for Asian foods (e.g. rice, noodles)(21,22). Yuhas et al. compared estimation accuracies among solid foods, liquids and amorphous foods using portion size measurement aids. They concluded that errors were smallest in solid foods and largest in amorphous foods(23). Foster et al. showed the importance of using age-appropriate food photographs for studies in children(24,25). Regardless of these findings, the accuracy of dietary assessment methods still highly depends on the individual’s ability to estimate portion size accurately. Recently a picture-based method for dietary analysis has been reported that uses camera-enabled mobile phones or tablet computers to record pictures of consumed foods and beverages. Pictures are acquired by the participant before and after meal and snack consumption. Food volume is then estimated from the pictures, and converted to energy and nutrient values using a nutritional database(5,26–31). Compared with the method of employing portion size measurement aids, the picture-based method provides more objective estimation of portion size. However, it requires the willingness of the participant to take pictures at each eating event. Hence, the food intake record may be incomplete if the participant forgets or ignores picture taking, especially when a meal involves multiple courses of foods and when picture taking disrupts his/her normal social interaction during eating. To resolve this issue, we developed a wearable device (‘eButton’) that automatically takes pictures at a pre-set rate without interrupting the participant’s eating behaviour. eButton is convenient to use, since the wearer only needs to turn it on and off. However, an important question is whether eButton pictures (which are two-dimensional) can provide accurate food volume (i.e. three-dimensional (3D)) estimates. In the present study we therefore compared food volumes estimated from eButton pictures with actual volumes measured using a seed displacement method(32,33). A few picture-based studies have attempted to analyse volume measurement error, but the food samples used in these studies were limited to those with standard volumes or volumes that could easily be measured by water displacement (e.g. solid fruits)(31,34). In this experiment, we studied real foods prepared or purchased by study participants and consumed at lunch break in the lab (see Fig. 1). The volume of each food item was first measured using the seed displacement method (see ‘Experimental methods’ section and online supplementary material) and then calculated using a software program from eButton images acquired during lunch. Different from water displacement, seed displacement involves no liquids and thus permits volume measurements of a wide variety of foods. For example, an airtight waterproof enclosure is required for measuring hamburgers with water displacement; yet controlling the amount of sealed air appropriately is more difficult. To validate further the accuracy of our software for volume estimation, we recruited three human raters to estimate the volume of each food sample by observing the same eButton-acquired pictures. Fig. 1 (colour online) (a) eButton Prototype; (b) a person wearing an eButton during eating

Relative validity of the Children's Eating Habits Questionnaire-food frequency section among young European children: the IDEFICS Study.

Abstract: Objective: To compare, specifically by age group, proxy-reported food group estimates obtained from the food frequency section of the Children's Eating Habits questionnaire (CEHQ-FFQ) against the e ...

Diet quality in young adults and its association with food-related behaviours.

Abstract: Objective To determine the diet quality of a group of young adults and explore its associations with two food-related behaviours (involvement in meal preparation and consumption of commercially prepared meals). Design Cross-sectional study of young adults. Sample characteristics, food-related behaviours and dietary intake were assessed using a self-administered questionnaire including an FFQ. Diet quality was measured using the fifteen-item Dietary Guideline Index (DGI) designed to assess adherence to Australian dietary guidelines. One-way ANOVA, t tests and multiple linear regression analyses were used to explore the relationships between DGI scores, sample characteristics and food-related behaviours. Setting University students enrolled in an undergraduate nutrition class, Melbourne, Australia. Subjects Students (n 309) aged 18–36 years. Results The DGI score was normally distributed, with a mean score of 93·4 (sd 17·1) points (range 51·9–127·4 points), out of a possible score of 150 points. In multivariate analyses adjusted for age, sex, nationality, BMI and maternal education, cooking meals for oneself was positively associated with DGI score (β = 0·15; 95 % CI 1·15, 10·03; P = 0·01); frequency of takeaway and frequency of convenience meal consumption were inversely associated with DGI score (β = −0·21; 95 % CI −9·96, −2·32; P = 0·002 and β = −0·16; 95 % CI −7·40, −0·97; P < 0·01, respectively). Conclusions Cooking meals for oneself was linked to higher diet quality among young adults, while consumption of commercially prepared meals was associated with poorer diet quality. Maintaining education programmes that promote cooking skills within young adults has the potential to improve DGI scores.

The Baltic Sea Diet Score: a tool for assessing healthy eating in Nordic countries

Abstract: Finnish Heart Association, Helsinki, FinlandSubmitted 16 November 2012: Final revision received 23 July 2013: Accepted 28 July 2013: First published online 4 September 2013AbstractObjective: The health-related effects of the Nordic diet remain mostly unidentified.We created a Baltic Sea Diet Score (BSDS) for epidemiological research to indi-cate adherence to a healthy Nordic diet. We examined associations between thescore and nutrient intakes that are considered important in promoting publichealth. We also examined the performance of the BSDS under two different cut-offstrategies.Design: The cross-sectional study included two phases of the National FINRISK2007 Study. Diet was assessed using a validated FFQ. Food and nutrient intakeswere calculated using in-house software. Nine components were selected for thescore. Each component was scored according to both sex-specific consumptionquartiles (BSDS-Q) and medians (BSDS-M), and summed to give the final scorevalues.Setting: A large representative sample of the Finnish population.Subjects: Men (n 2217) and women (n 2493) aged 25 to 74 years.Results: In the age- and energy-adjusted model, adherence to the diet wasassociated with a higher intake of carbohydrates (E%), and lower intakes of SFA(E%) and alcohol (E%, where E% is percentage of total energy intake; P,0?01).Furthermore, the intakes of fibre, Fe, vitamins A, C and D, and folate were higheramong participants who adhered to the diet (P,0?05). After further adjustments,the results remained significant ( P,0?05) and did not differ remarkably betweenBSDS-Q and BSDS-M.Conclusions: The BSDS can be used as a measure of a healthy Nordic diet to assessdiet–health relationships in public health surveys in Nordic countries.KeywordsBaltic Sea dietDiet scoreDiet qualityDietary intakeNordic countriesNutrition is an important part of health policies due toits critical role in chronic disease prevention