Relative validity of FFQ to assess food items, energy, macronutrient and micronutrient intake in children and adolescents: a systematic review with meta-analysis

Cross-sectional associations between Mediterranean diet and body composition in preschool children. CORAL study

BACKGROUND

Overweight and obesity in children are rising globally, and the Mediterranean diet may help reduce obesity and related diseases.

OBJECTIVE

To assess the association between adherence to the Mediterranean diet and body composition in Spanish preschool children.

METHODS

This study included 1218 children aged 3-6 years from the CORALS cohort. Mediterranean diet adherence was evaluated using the validated MED4CHILD and COME-Kids F&B-FQ questionnaires. Body composition measurements included weight, height, waist circumference, BMI, Fat Mass (FM), Fat-Free Mass Index (FFMI), and Waist-to-Height ratio (WtHR). Multivariate regression and ANCOVA were used to examine associations, adjusting for factors like age, physical activity, and energy intake. We also performed a Cohen's d analysis to assess effect size.

RESULTS

Adherence to the Mediterranean diet was associated with more favourable body composition in children. Specifically, both the MED4CHILD score and the COME-Kids-derived score showed significant associations with BMI, FFMI, and Waist-to-Height ratio, showing differences by sex. Children who adhered to the Mediterranean diet exhibited lower BMI and higher fat-free mass, and a more favourable waist-to-height ratio. Additionally, although some measures showed weaker associations, all analyses highlighted a trend towards improved body composition with higher adherence. Cohen's d analysis showed small to moderate effect sizes.

CONCLUSION

Adherence to the Mediterranean diet was significantly linked to favorable body composition indices in Spanish children, highlighting the importance of promoting healthy dietary patterns to prevent overweight and obesity.

Dietary intakes of flavonoids in relation to cognitive function among middle-aged and older adults: results from the Chinese Square Dance Cohort

Objective: The study aims to explore the association between intake of dietary flavonoids and global cognition, domain-specific cognition and mild cognitive impairment (MCI) in middle-aged and older adults in China. Design: A cross-sectional study. Methods: This study used baseline data collected during 2021-2023 from the Chinese Square Dance Cohort. Dietary information was collected using a semi-quantitative food frequency questionnaire, and flavonoid intakes were calculated. Cognitive function was evaluated using a battery of neuropsychological tests, and global cognition was assessed using the composite z-score. Participants with MCI were diagnosed by Petersen's criteria. The relationship between flavonoid intake and cognitive score was determined using multiple linear regression and presented as β values with 95%CIs. The association of flavonoid intake with MCI was evaluated using logistic regression models and presented as odds ratios (ORs) with 95%CIs. Results: Among 3990 middle-aged and older participants, the median (P25-P75) age was 63 (59-67) years, and 85.05% were females. After adjusting for various covariates, compared to the lowest quartile (Q1), the highest intakes (Q4) of total flavonoids, anthocyanidins and flavan-3-ols, flavanones, flavones, flavonols, procyanidins, and isoflavones were associated with higher composite z-scores, with β values (95%CIs) of 0.12 (0.06, 0.17), 0.15 (0.10, 0.21), 0.09 (0.04, 0.15), 0.11 (0.06, 0.17), 0.08 (0.02, 0.13), 0.09 (0.03, 0.14), and 0.09 (0.04, 0.15), respectively. In addition, higher dietary intakes of anthocyanidins and isoflavones were associated with lower odds of MCI, where the corresponding ORs (95%CIs) for Q4 were 0.69 (0.51, 0.94) and 0.72 (0.54, 0.97), respectively. Conclusion: Higher flavonoid intakes were related to better cognitive function. These findings suggest a beneficial effect of flavonoid intake on the cognitive aging process.

Associations of behavioral, motivational, and socioeconomic factors with BMI among children and adolescents

BACKGROUND

Higher weight represents a significant health concern in youth and may be influenced by socioeconomic and behavioral factors. We investigated the relationship between BMI and parental education, nutritional health, eating culture, organized and non-organized physical activity (PA), motives for PA (weight loss/maintenance, enjoyment), and screen-time in children and adolescents.

METHODS

677 2- to 11-year-olds (young-age-group) and 464 12- to 20-year-olds (old-age-group) from Leipzig, a city in Germany, participated. We applied multivariate linear regression analyses to assess associations.

RESULTS

BMI-SDS was negatively associated with parental education (young-age-group: b = -0.25, p < 0.001, old-age-group: b = -0.27, p = 0.02), non-organized PA (young-age-group: b = -0.23, p = 0.029), and PA enjoyment (young-age-group: b = -0.05, p = 0.01, old-age-group: b = -0.05, p = 0.038), but negatively with media use during dinner (old-age-group: b = 0.53, p < 0.001), PA for weight loss/maintenance (young-age-group: b = 0.15, p < 0.001, old-age-group: b = 0.12, p < 0.001), and screen-time (young-age-group: b = 0.11, p = 0.009, old-age-group: b = 0.09, p = 0.001). Significant interactions with age, sex and parental education were observed.

CONCLUSION

A lower BMI in children is associated with high parental education, screen-free eating, higher participation in non-organized PA and lower screen-time. While measures of motivation were limited and thus findings should be interpreted with caution, intrinsic motivation for PA is associated with lower BMI whereas extrinsic motivation for PA is associated with higher BMI.

IMPACT

In a German cohort of children and adolescents, lower BMI is associated with high parental education, less screen time, more participation in non-organized physical activity and less media use during dinner. Intrinsic and extrinsic motives for physical activity are directly linked to the weight status of children and adolescents. These associations are particularly strong in families with low/medium formal education.

Bidirectional causality between micronutrients and mental illness: Mendelian randomization studies

BACKGROUND

Previous observational clinical research has suggested a link between micronutrients and psychiatric conditions. However, the causal relationship between these nutrients and mental health disorders remains uncertain. This study endeavors to fill this knowledge gap by employing a Mendelian randomization (MR) analysis on pooled data from genome-wide association studies (GWAS), aiming to explore the potential causal associations between 20 prevalent micronutrients and 7 common psychiatric disorders.

METHODS

A collection of single nucleotide polymorphisms (SNPs) associated with 20 micronutrients and seven common psychiatric disorders and extracted from a dataset comprising 7,368,835 individuals. MR analysis, including inverse variance weighting (IVW), Mendelian randomization-egger, weighted median, and sensitivity analysis, was used to evaluate the reliability of the study results. A significance threshold of p < 0.05 was used to identify evidence of potential associations.

RESULTS

Our forward MR analysis found some commonalities between certain micronutrients and psychiatric disorders. Notably, Vitamin D level is related to the risk of reducing depression and emotional disorders. Carotene levels were associated with an elevated risk of depression, mood disorders, bipolar disorder (BIPO), and post-traumatic stress disorder (PTSD). Additionally, multivitamins ± minerals and retinol were associated with a decreased risk of BIPO, while folate and selenium levels were associated with decreased risks of dementia and schizophrenia, respectively. The study found a significant association between elevated copper levels and an increased likelihood of Bipolar Disorder (BD), while magnesium levels were observed to be positively correlated with a heightened risk of depression. Our sensitivity study confirmed the results of the IVW MR primary analysis.

CONCLUSION

Our study suggests that carotene, copper, and magnesium are important risk factors for depression, mood disorders, PTSD, phobia, BIPO, and dementia. Elevated levels of these micronutrients are related to an increased likelihood of these disorders.

Validity of a Short Food Frequency Questionnaire for Toddlers of NELA Birth Cohort Study

BACKGROUND/OBJECTIVES

Our aim was to evaluate the reproducibility and validity of a semi-quantitative food frequency questionnaire (FFQ) for the assessment of usual nutrient and food intakes in children of 18 months old.

METHODS

We included 103 toddlers aged 18 months from the Nutrition in Early Life and Asthma (NELA) birth cohort study. A 47-item FFQ was administered twice to parents with a 3-month interval. During that period, we also performed three non-consecutive 24 h dietary recalls (24hDRs) and oral mucosa samples for determining the fatty acid profile (glycerophospholipids). We estimated correlation coefficients of reproducibility for nutrient and food group intakes by comparing both FFQs and validity coefficients by comparing nutrient intakes between the second FFQ and the average of the three 24hDRs. We also explored biochemical validity by comparing the intake of fish from the FFQ with the percentage of fatty acids in oral mucosa cells.

RESULTS

The average of correlation coefficients for FFQ reproducibility was r = 0.48 for energy-adjusted nutrient intakes (ranging from r = 0.28 for Na to r = 0.62 for Mg and Zn) and r = 0.35 for the intake of energy-adjusted food groups. The average correlation coefficient for FFQ validity on nutrient intakes was r = 0.48, ranging from r = 0.16 for α-carotene to r = 0.75 for vitamin E. We also found a positive correlation between total omega-3 fatty acids and docosahexaenoic acid percentages in oral mucosa cells and the intake of total and white fish, r = 0.31 and r = 0.34, respectively.

CONCLUSIONS

This study shows that our short FFQ demonstrated moderate reproducibility (mean r = 0.48) and validity (mean r = 0.48) for dietary assessment of most nutrients and foods in 18-month-old children in Spain. This FFQ provides an efficient and minimally invasive method for evaluating toddler dietary intake, particularly in Mediterranean contexts.

Validity and Reproducibility of a Spanish EPIC Food Frequency Questionnaire in Children and Adolescents

BACKGROUND

Dietary habits are crucial for preventing many diseases, particularly in children and adolescents. Accurate assessment of dietary intake is essential for understanding the relationship between diet and health in these age groups.

OBJECTIVE

This study aimed to evaluate the reproducibility and validity of a Spanish version of the European Prospective Investigation into Cancer and Nutrition (EPIC) Food Frequency Questionnaire (FFQ) in 150 Spanish children and adolescents aged 10 to 17 using the average of 9 days of 24-h dietary recall (24H-DR) as a reference.

METHODS

Intraclass correlation coefficients (ICCs) were calculated to asses reproducibility and Spearman/Pearson correlation coefficients were calculated to assess validity and reproducibility.

RESULTS

The average ICCs were 0.41 for crude nutrients, 0.31 for food groups, 0.31 for energy-adjusted nutrients, and 0.4 for energy-adjusted food groups. Spearman/Pearson correlation coefficients averaged 0.39 and 0.41 for crude and energy-adjusted nutrients, respectively, and 0.51 and 0.47 for corresponding food groups. Regarding validity, the average correlation coefficient for crude, energy-adjusted, and de-attenuated nutrients was 0.32, 0.50, and 0.50, respectively. The highest crude coefficient was 0.50 for vitamin C and fiber, while the highest energy-adjusted coefficient was 0.76 for protein and carbohydrates. The highest de-attenuated coefficient was 0.72 for vitamin B6.

CONCLUSIONS

Overall, these results suggest that the EPIC FFQ is a valid and reliable instrument for assessing dietary intake in Spanish children and adolescents.

Eating Behaviours and Dietary Intake in Children and Adolescents: A Systematic Review

PURPOSE OF REVIEW

This systematic review aimed to examine existing evidence related to associations between eating behaviours and dietary intake in children and adolescents, with a focus on the Children Eating Behaviour Questionnaire (CEBQ) and the Dutch Eating Behaviour Questionnaire (DEBQ) as assessment tools.

RECENT FINDING

We conducted a systematic review following PRISMA guidelines. We included observational and interventional studies published in English, Spanish, or Portuguese, that evaluated the association between eating behaviours and food and beverage intake. Thirteen studies from nine countries met the inclusion criteria, with sample sizes ranging from 62 to 4,914 individuals aged 2 to 16 years-old. Ten studies used the CEBQ, and three used the DEBQ. Our retrieved studies showed that children and adolescents engaging in food approach behaviours tend to consume foods rich in sugar and fats. However, we observed a higher consumption of fruits and vegetables. On the other hand, children and adolescents with lower engagement to food avoidant behaviours, generally exhibited a lower overall food consumption, except for snacks, which they consumed at a higher rate. This systematic review suggests that eating behaviours play an important role in shaping dietary intake. Nevertheless, due to the heterogeneity related to eating behaviours and diet intake, it highlights the need for further research to understand these complex relationships to develop effective interventions for promoting healthy eating habits in children and adolescents.

Development and Evaluation of the Reliability of a Semi-Quantitative Food Frequency Questionnaire to Assess the Intake in the Serbian Population

Assessing dietary habits with validated questionnaires is crucial for achieving reliable results in health research. The aim of this study was the development and validation of a semi-quantitative food frequency questionnaire (FFQ) in an 18-30-year-old Serbian population. A total of 93 participants completed the FFQ and three 24 h dietary recalls (24 hR). Pearson and intraclass correlations between FFQ and 24 hR intakes were assessed and were de-attenuated and energy-adjusted. Bland-Altman plots were generated, and quintiles of energy, water, fiber, and macronutrient intake were analyzed with contingency tables. Adjustments for sex differences were included. The validity of the FFQ varied, with significant correlations for energy, carbohydrates, cholesterol, and vitamin B12, vitamin C and vitamin D. Misclassification rates were generally low. Bland-Altman plots indicated good agreement between methods. It can be concluded that the validated FFQ is a promising tool for dietary assessment in the Serbian population. Results for several nutrients align closely with previous studies. The new FFQ is a useful tool for dietary assessment in the Serbian population.

Dietary patterns and insomnia symptoms: A systematic review and meta-analysis

We aimed to systematically review and synthesize the available evidence regarding the link between dietary patterns and insomnia symptoms among the general population using observational studies. We reviewed 16,455 references, of which 37 studies met inclusion criteria with a total sample size of 591,223. There was a significant association of the Mediterranean diet (OR: 0.86; 95 % CI, 0.79, 0.93; P < 0.001; I2 = 32.68 %), a high-quality diet (OR: 0.66; 95 % CI, 0.48, 0.90; P = 0.010; I2 = 84.62 %), and an empirically-derived healthy dietary pattern (OR: 0.91; 95 % CI, 0.85, 0.98; P = 0.010; I2 = 57.14 %) with a decreased risk of insomnia symptoms. Moreover, the dietary glycemic index (OR: 1.16; 95 % CI, 1.08, 1.25; P < 0.001; I2 = 0.0 %), the dietary glycemic load (OR: 1.10; 95 % CI, 1.01, 1.20; P = 0.032; I2 = 74.36 %), and an empirically-derived unhealthy dietary pattern (OR: 1.20; 95 % CI, 1.01, 1.42; P = 0.040; I2 = 68.38 %) were linked with a higher risk of insomnia symptoms. Most individual studies were of good quality (NOS) but provided very low certainty of evidence (GRADE). Consistent data reveals that following healthy diets is associated with decreased insomnia symptoms prevalence, while adherence to an unhealthy pattern is associated with an increased prevalence of insomnia symptoms.

A scoping review of dietary assessment questionnaires potentially suitable for assessing habitual dietary intake in the National Health and Nutrition Survey, Japan

This scoping review aimed to identify questionnaire-based dietary assessment methods for use in the National Health and Nutrition Survey (NHNS) in Japan. The search was conducted in three databases (PubMed, Web of Science, and Ichushi) to identify questionnaire such as food frequency questionnaire and dietary history questionnaire validated against dietary recalls or food records for the intakes of both food groups and nutrients among Japanese adults. Study quality was assessed based on previously developed criteria. We extracted the questionnaire characteristics and the design and results of the validation studies. We identified 11 questionnaires, with the number of food items ranging from 40 to 196, from 32 articles of good quality. In the validation studies, participants were aged 30-76 years and 90% of the articles used ≥3 d dietary records as reference. The number of nutrients and food groups with a group-level intake difference within 20% against the reference method ranged from 1 to 30 and 1 to 11, respectively. The range of mean correlation coefficients between questionnaire and reference methods were 0.35-0.57 for nutrients and 0.28-0.52 for food groups. When selecting a survey instrument in the NHNS from the 11 existing questionnaires identified in this study, it is important to select one with high group-level comparison and correlation coefficient values on the intended assessment items after scrutinizing the design and results of the validation study. This review may serve as a reference for future studies that explore dietary assessment tools used for assessing dietary intake in specific representative populations.

The buffet challenge: a behavioral assessment of eating behavior in adolescents with an eating disorder

OBJECTIVE

Eating disorders are characterized by disturbances in nutritional intake and abnormal mealtime behaviors. Laboratory eating paradigms offer a unique opportunity to accurately measure dietary intake and eating behaviors, however, these studies have predominantly occurred in adults. This paper describes the development and preliminary psychometric examination of the Buffet Challenge, a laboratory-based meal task for youths with an eating disorder.

METHOD

We recruited and assessed 56 participants as part of a randomized controlled trial of Family-Based Treatment for adolescents with anorexia nervosa. Adolescents completed the Buffet Challenge at baseline, midway through treatment (~ week 16 of a 6 months course), and end of treatment. Participants and their parents also reported eating disorder symptomatology and treatment related variables of interest were recorded.

RESULTS

All adolescents were willing to complete the Buffet Challenge at all time points, although one refused to give up their cellphone, and there were no significant adverse events recorded. Preliminary results are presented.

CONCLUSIONS

Our initial pilot of this task in adolescents with anorexia nervosa demonstrates its acceptability, although investigation of our hypotheses was hindered by significant missing data due to COVID-related research shutdowns. Future studies should replicate procedures in a larger sample to ensure analyses are adequately powered.

Characteristics of Global Data on Adolescent's Dietary Intake: A Systematic Scoping Review

Data on adolescents' dietary intake are essential to improve their diets and nutrition. However, the availability of (high-quality) data on adolescents' dietary intake is scarce with great global differences. We conducted a systematic scoping review to investigate the availability, characteristics, and gaps in global adolescent dietary data, following the Preferred Reporting Items for Systematic Reviews and Meta Analyses-Extension for Scoping Reviews checklist and guidelines (registered under PROSPERO no. 171170 https://www.crd.york.ac.uk/PROSPERO/). We included peer-reviewed and grey literature articles (2010 onwards) on the dietary intake of male and female adolescents (10-24 y). Studies from all countries and languages and including any information related to types of food consumed, diet composition, dietary diversity, or meal patterns were considered. We excluded studies with insufficient methodological information, unclear description of population, samples sizes <25, school-based data sets containing <6 schools, and studies that focused on pregnant or unhealthy study populations. Data, including year(s) of data collection, age, gender, sample size, dietary assessment methods, number of food items/groups, study design, location, and representativeness, were extracted. A total of 52,889 titles were identified and 722 articles, describing 1,322 data sets, were retained for analysis. Nationally representative, detailed dietary data for adolescents aged 10-24 y are still lacking, particularly in sub-Saharan Africa, South Asia, and low-income countries. Data quality and representativeness remain limited, highlighting the need for data disaggregation by age, gender, locality, comprehensive dietary information, and broader geographic coverage. A notable amount of data was available through grey literature, especially in data-scarce countries. The study underscores the importance of addressing adolescent nutrition, emphasizing the urgent need for more robust, accessible, and representative data on adolescents' dietary intake to support effective nutritional efforts.

Reproducibility and relative validity of a semi-quantitative food and beverage frequency questionnaire for Spanish children aged 3 to 11 years: the COME-Kids F&B-FQ

A reliable food and beverage frequency questionnaire (F&B-FQ) to measure dietary intakes for children across Spain is currently unavailable. Thus, we designed and assessed the reproducibility and relative validity of a new F&B-FQ in 210 Spanish children aged 3-11 years. COME-Kids F&B-FQ contained 125 items to assess the usual diet intake in the past year among children. To explore the reproducibility, caregivers answered COME-Kids F&B-FQ twice over a 15-day period (± 1 week). To evaluate the relative validity, estimates from a third COME-Kids F&B-FQ administered at 1 year of follow-up were compared with the mean estimates from 3-day dietary records (3d-DR) collected at baseline, 6 months, and after 1 year of follow-up. Reproducibility and relative validity of the COME-Kids F&B-FQ in estimating food groups and nutrients were assessed using Pearson (r) and intra-class (ICC) correlation coefficients. We used the kappa index to evaluate the agreement in repeat administrations or with the 3d-DR. We used Bland-Altman plots to identify bias across levels of intake. A total of 195 children (105 boys, 90 girls) completed the study. The reproducibility of data estimated from COME-Kids F&B-FQ was substantial with mean r and ICC being 0.65 and 0.64 for food groups and 0.63 and 0.62 for nutrients, respectively. Validation assessments comparing the FFQ and 3d-DRs showed r = 0.36 and ICC = 0.30 for food groups and r = 0.29 and ICC = 0.24 for nutrients. The mean agreement for food group reproducibility and relative validity was 86% and 65%, respectively. These estimates were 85% for reproducibility and 64% for relative validity in the case of nutrients. For reproducibility and relative validity, the overall mean kappa index was 63% and 37% for all food groups and 52% and 27% for nutrients, respectively. Bland-Altman plots showed no specific bias relating to the level of intake of nutrients and several food groups.

CONCLUSION

COME-Kids F&B-FQ showed substantial reproducibility and acceptable relative validity to assess food and beverage intake in Spanish children aged 3 to 11 years. Most children were correctly classified in relation to the intake of food groups and nutrients, and misclassification was unlikely with reference to 3d-DR.

WHAT IS KNOWN

• The estimation of dietary intake in children is complex, especially in large cohorts. • The food frequency questionnaire is a well-recognized and the most frequently used method for assessing food consumption.

WHAT IS NEW

• A new food and beverage frequency questionnaire including a beverage section and novel plant-based food items has been validated in Spanish children aged 3-11 years.

Proposition of an Energy Intake Estimating Scale through Item Response Theory

BACKGROUND

Traditional methods for assessing individual energy consumption often involve lengthy and intricate procedures. This study aims to introduce an Energy Consumption Estimation Scale, utilizing Item Response Theory (IRT) for adolescents aged 18-19 years.

METHODS

This psychometric investigation applies IRT to 93 items extracted from a validated food frequency questionnaire. The study encompasses a representative sample of 2515 adolescents from the São Luís birth cohort in Brazil. The latent trait, energy intake, is derived using IRT and subsequently validated through hierarchical multiple linear regression modeling. Significance was established at p < 0.05.

RESULTS

A Samejima's model was successfully fitted (CFI and TLI > 0.9 and RMSEA < 0.08), effectively capturing variations across all energy consumption levels. Factors associated with the latent trait demonstrate consistent behavioral patterns. Adolescents with higher energy intake exhibited increased consumption of dairy products, artificially sweetened beverages, and seasonal fruits and vegetables.

CONCLUSIONS

The proposed Energy Consumption Estimation Scale demonstrates a reliable measurement of energy intake and serves as a practical and concise alternative for assessing energy consumption among adolescents. These findings suggest the potential for adapting similar models for different age groups and incorporating diverse food items based on the obtained results.

Association of Plasma Zinc and Copper with Body Composition, Lipids and Inflammation in a Cross-Sectional General Population Sample from Germany

We aimed to relate circulating plasma zinc and copper to a broad spectrum of adiposity-related traits in a cross-sectional Northern German study (n = 841, 42% female, age: 61 ± 12 years). Zinc and copper were measured by inductively coupled plasma-mass spectrometry. Subcutaneous (SAT) and visceral (VAT) adipose tissue and liver fat were derived from 534 and 538 participants, respectively, via magnet resonance imaging. Associations were assessed using multivariable-adjusted linear regression analysis. An increase per one standard deviation (SD) in zinc was associated with direct linear increases in body mass index (BMI) (1.17%; 95% confidence interval (95%CI) 0.15-2.20%), waist circumference (0.85%; 95%CI 0.04-1.67%) and waist-to-hip ratio (0.64%; 95%CI 0.18-1.09%). A 1-SD increment in copper was directly associated with BMI (1.64%; 0.41-2.88%) and waist circumference (1.22%; 95%CI 0.25-2.20%) but not waist-to-hip ratio. Independent of fat intake, zinc displayed associations with VAT (5.73%; 95%CI 2.04-9.56%) and with liver fat (3.84%; 95%CI 1.49-6.25%), the latter association being also independent of BMI. Copper was directly associated with SAT (4.64%; 95%CI 0.31-9.15%) before accounting for BMI, but showed no association with VAT or liver fat. Observed associations suggest a possible relevance of zinc and copper to adiposity. Particularly zinc displayed associations with traits of abdominal adiposity and liver fat.

Food frequency questionnaires developed and validated for pregnant women: Systematic review

OBJECTIVES

Assessing food intake of pregnant women is extremely important, because maternal dietary patterns can influence fetal development as well as have either positive or negative effects on both the mother and fetus. Thus, the aim of the present study was to carry out a systematic review of the literature on food frequency questionnaires developed and validated for pregnant women, in order to assess their methodological quality and validation process.

METHODS

A systematic review of studies focused on validating food frequency questionnaires for pregnant women was carried out in the PubMed, Embase, Scopus, LILACS, and OpenGrey databases. The selected studies were assessed based on their correlation coefficient in validation and reproducibility analyses, whereas their methodological quality was assessed based on the scoring system proposed by the EURopean micronutrient RECommendations Aligned Network of Excellence.

RESULTS

In total, 10 965 articles were identified in these databases; among them, 14 studies, with sample sizes ranging from 46 to 221 participants, and with participants (pregnant women) at a mean age of 28.68 ± 4.34 y, were selected. Most of the included studies used the 24-h food recall as the method for developing the food list (n = 6), with composition ranging from 46 to 255 items. With respect to the methodological assessment of the selected articles, half of the assessed tools were classified as having excellent methodological quality; their validation and reproducibility correlation coefficients were classified as moderate and high (r ≥ 0.40).

CONCLUSIONS

Food frequency questionnaires developed for pregnant women appear to be reliable tools to assess food intake by this group. Overall, they had good methodological quality and adequate correlation coefficients compared with reference methods.

Mineral Composition and Consumer Acceptability of Amaranthus Leaf Powder Supplemented Ujeqe for Improved Nutrition Security

Malnutrition, especially micronutrient deficiency, is a widespread health challenge that predominantly affects young children, young ladies who are within the productive age, refugees, and older adults who reside in rural communities and informal settlements in underdeveloped and developing countries. Malnutrition is caused by consuming either too little or too much of one or more food nutrients. Additionally, monotonous dietary lifestyle, especially the over-reliance on staple foods, is identified among the top factors limiting many individuals' intake of essential nutrients. Thus, enriching starchy and cereal-based staple foods including Ujeqe (steamed bread) with fruits and especially leafy vegetables is being suggested as a strategic medium for essential nutrient delivery to malnourished populations and especially the Ujeqe regular consumers. Amaranthus, called pigweed, has been rediscovered as a nutrient-dense multipurpose plant. The seed has been explored as a nutrient-enhancer in staple foods; however, the leaves are underutilized, especially in Ujeqe. This study aims to enhance the mineral content of Ujeqe. An integrated research approach was used where Amaranthus dubius was self-processed into leaf powder. Amaranthus leaf powder (ALP), and the ALP-supplemented wheat flour Ujeqe prototypes 0%, 2%, 4%, and 6% were investigated for their mineral composition. Sensory evaluations of enriched Ujeqe were conducted using 60 panelists on a five-point hedonic scale. Findings show that the moisture contents of the raw materials and the supplemented prototypes were low, indicating a good shelf life of the food ingredient before being used for Ujeqe development. Carbohydrates of raw materials ranged from 41.6-74.3%, fat ranged from 1.58-4.47%, ash ranged from 2.37-17.97%, and protein ranged from 11.96-31.56%. Additionally, fat, protein, and ash content had significant differences at (p < 0.05). The moisture content of enhanced Ujeqe was equally low, connoting keeping quality of the sample. The increase concentration of ALP led to an enriched Ujeqe especially in the ash and protein content. Similarly, calcium, copper, potassium, phosphorus, manganese, and iron content were significantly influenced at (p < 0.05); 2% ALP-supplemented Ujeqe was the most acceptable prototype as the control sample, 6% was the least preferred prototype. Although ALP dubius can enrich staple foods including (Ujeqe), this study declared that higher addition of ALP dubius leads to low consumer acceptability rate of the Ujeqe, which is not statistically significant. Amaranthus is an economical source of fiber, which was not investigated in the study. Therefore, further studies can explore the fiber content of the ALP-supplemented Ujeqe.

Association between Antibiotic Exposure and Type 2 Diabetes Mellitus in Middle-Aged and Older Adults

BACKGROUND

Although previous studies have shown an association between clinically used antibiotics and type 2 diabetes, the relationship between antibiotic exposure from food and drinking water and type 2 diabetes in middle-aged and older adults is unclear.

OBJECTIVE

This study was aimed at exploring the relationship between antibiotic exposures from different sources and type 2 diabetes in middle-aged and older people, through urinary antibiotic biomonitoring.

METHODS

A total of 525 adults who were 45-75 years of age were recruited from Xinjiang in 2019. The total urinary concentrations of 18 antibiotics in five classes (tetracyclines, fluoroquinolones, macrolides, sulfonamides and chloramphenicol) commonly used in daily life were measured via isotope dilution ultraperformance liquid chromatography coupled with high-resolution quadrupole time-of-flight mass spectrometry. The antibiotics included four human antibiotics, four veterinary antibiotics and ten preferred veterinary antibiotics. The hazard quotient (HQ) of each antibiotic and the hazard index (HI) based on the mode of antibiotic use and effect endpoint classification were also calculated. Type 2 diabetes was defined on the basis of international levels.

RESULTS

The overall detection rate of the 18 antibiotics in middle-aged and older adults was 51.0%. The concentration, daily exposure dose, HQ, and HI were relatively high in participants with type 2 diabetes. After model adjustment for covariates, participants with HI > 1 for microbial effects (OR = 3.442, 95%CI: 1.423-8.327), HI > 1 for preferred veterinary antibiotic use (OR = 3.348, 95%CI: 1.386-8.083), HQ > 1 for norfloxacin (OR = 10.511, 96%CI: 1.571-70.344) and HQ > 1 for ciprofloxacin (OR = 6.565, 95%CI: 1.676-25.715) had a higher risk of developing type 2 diabetes mellitus.

CONCLUSIONS

Certain antibiotic exposures, mainly those from sources associated with food and drinking water, generate health risks and are associated with type 2 diabetes in middle-aged and older adults. Because of this study's cross-sectional design, additional prospective studies and experimental studies are needed to validate these findings.

Walnut consumption and health outcomes with public health relevance-a systematic review of cohort studies and randomized controlled trials published from 2017 to present

CONTEXT

Considering the accumulation of recent studies investigating the health effects of walnut consumption, both including and beyond cardiovascular health effects, a systematic review of this literature to investigate the strength of the evidence is warranted.

OBJECTIVE

To investigate associations between walnut consumption and outcomes with public health relevance (specifically all-cause mortality, type 2 diabetes, CVD, metabolic syndrome, obesity, cancer, neurological and mental health, musculoskeletal, gastrointestinal, and maternal disorders) and the effect on associated disease risk markers, reported in studies published from 2017 to present.

DATA SOURCES

MEDLINE, FSTA, CENTRAL, and Scopus were searched from 1 January 2017 to 5 May 2021.

DATA EXTRACTION

Human studies (cohort studies and RCTs) ≥3 weeks in duration comparing consumption of walnuts (whole, pieces, or 100% butter) to a control and measuring associations with relevant public health outcomes and disease risk markers were assessed. Key study characteristics were extracted independently by 2 investigators using a standardized table. The quality of the studies was assessed using the Cochrane Risk-of-Bias tool 2.0 and the Newcastle-Ottawa Scale.

DATA ANALYSIS

Only 1 RCT was considered to be at low risk of bias for any of its outcomes. The cohort studies were considered to be of moderate or high quality. The results were synthesized using vote counting, based on the direction of effect. Thirty-three articles, 23 describing RCTs (walnut dose ∼10-99 g/day, 1,948 subjects) and 10 describing cohort studies (∼675,928 subjects), were included. Vote counting could be performed for the blood lipids, cardiovascular function, inflammation- and hemostatic-related factors, markers of glucose metabolism, and body weight and composition outcome groupings. The results are presented in effect direction plots. With respect to blood lipids, results from 8/8 RCTs favoured walnuts, in accordance with associations with a reduced risk of CVD suggested by cohort studies; results from 6/6 RCTs favoured control with respect to body weight and composition, although most of these effects were small. This was contrary to cohort study results suggesting small benefits of walnut consumption on body weight. There was no overall consistent direction of effect for cardiovascular function, markers of glucose metabolism, or inflammation- and hemostatic-related factors.

CONCLUSIONS

Evidence published since 2017 is consistent with previous research suggesting that walnut consumption improves lipid profiles and is associated with reduced CVD risk. Evidence is accumulating in other areas, such as cognitive health, although more research is needed to draw firm conclusions.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CRD4202122.

Evaluation of paper-based and web-based food frequency questionnaires for 7-year-old children in Singapore

Advances in technology enabled the development of a web-based, pictorial FFQ to collect parent-report dietary intakes of 7-year-old children in the Growing Up in Singapore Towards healthy Outcomes study. This study aimed to compare intakes estimated from a paper-FFQ and a web-FFQ and examine the relative validity of both FFQ against 3-d diet records (3DDR). Ninety-two mothers reported food intakes of their 7-year-old child on a paper-FFQ, a web-FFQ and a 3DDR. A usability questionnaire collected participants' feedback on the web-FFQ. Correlations and agreement in energy, nutrients and food groups intakes between the dietary assessments were evaluated using Pearson's correlation, Lin's concordance, Bland-Altman plots, Cohen's κ and tertile classification. The paper- and web-FFQ had good correlations (≥ 0·50) and acceptable-good agreement (Lin's concordance ≥ 0·30; Cohen's κ ≥ 0·41; ≥ 50 % correct and ≤ 10 % misclassification into same or extreme tertiles). Compared with 3DDR, both FFQ showed poor agreement (< 0·30) in assessing absolute intakes except micronutrients (web-FFQ had acceptable-good agreement), but showed acceptable-good ability to classify children into tertiles (κ ≥ 0·21; ≥ 40 % and ≤ 15 % correct or misclassification). Bland-Altman plots suggest good agreement between web-FFQ and 3DDR in assessing micronutrients and several food groups. The web-FFQ was well-received, and majority (81 %) preferred the web-FFQ over the paper-FFQ. The newly developed web-FFQ produced intake estimates comparable to the paper-FFQ, has acceptable-good agreement with 3DDR in assessing absolute micronutrients intakes and has acceptable-good ability to classify children according to categories of intakes. The positive acceptance of the web-FFQ makes it a feasible tool for future dietary data collection.

Validating Accuracy of an Internet-Based Application against USDA Computerized Nutrition Data System for Research on Essential Nutrients among Social-Ethnic Diets for the E-Health Era

Internet-based applications (apps) are rapidly developing in the e-Health era to assess the dietary intake of essential macro-and micro-nutrients for precision nutrition. We, therefore, validated the accuracy of an internet-based app against the Nutrition Data System for Research (NDSR), assessing these essential nutrients among various social-ethnic diet types. The agreement between the two measures using intraclass correlation coefficients was good (0.85) for total calories, but moderate for caloric ranges outside of <1000 (0.75) and >2000 (0.57); and good (>0.75) for most macro- (average: 0.85) and micro-nutrients (average: 0.83) except cobalamin (0.73) and calcium (0.51). The app underestimated nutrients that are associated with protein and fat (protein: −5.82%, fat: −12.78%, vitamin B12: −13.59%, methionine: −8.76%, zinc: −12.49%), while overestimated nutrients that are associated with carbohydrate (fiber: 6.7%, B9: 9.06%). Using artificial intelligence analytics, we confirmed the factors that could contribute to the differences between the two measures for various essential nutrients, and they included caloric ranges; the differences between the two measures for carbohydrates, protein, and fat; and diet types. For total calories, as an example, the source factors that contributed to the differences between the two measures included caloric range (<1000 versus others), fat, and protein; for cobalamin: protein, American, and Japanese diets; and for folate: caloric range (<1000 versus others), carbohydrate, and Italian diet. In the e-Health era, the internet-based app has the capacity to enhance precision nutrition. By identifying and integrating the effects of potential contributing factors in the algorithm of output readings, the accuracy of new app measures could be improved.

Validating Accuracy of a Mobile Application against Food Frequency Questionnaire on Key Nutrients with Modern Diets for mHealth Era

In preparation for personalized nutrition, an accurate assessment of dietary intakes on key essential nutrients using smartphones can help promote health and reduce health risks across vulnerable populations. We, therefore, validated the accuracy of a mobile application (app) against Food Frequency Questionnaire (FFQ) using artificial intelligence (AI) machine-learning-based analytics, assessing key macro- and micro-nutrients across various modern diets. We first used Bland and Altman analysis to identify and visualize the differences between the two measures. We then applied AI-based analytics to enhance prediction accuracy, including generalized regression to identify factors that contributed to the differences between the two measures. The mobile app underestimated most macro- and micro-nutrients compared to FFQ (ranges: -5% for total calories, -19% for cobalamin, -33% for vitamin E). The average correlations between the two measures were 0.87 for macro-nutrients and 0.84 for micro-nutrients. Factors that contributed to the differences between the two measures using total calories as an example, included caloric range (1000-2000 versus others), carbohydrate, and protein; for cobalamin, included caloric range, protein, and Chinese diet. Future studies are needed to validate actual intakes and reporting of various diets, and to examine the accuracy of mobile App. Thus, a mobile app can be used to support personalized nutrition in the mHealth era, considering adjustments with sources that could contribute to the inaccurate estimates of nutrients.

Associations between the Mediterranean Diet Pattern and Weight Status and Cognitive Development in Preschool Children

Cognitive dysfunctions are a global health concern. Early-life diet and weight status may contribute to children’s cognitive development. For this reason, we explored the associations between habitual food consumption, body mass index (BMI) and cognitive outcomes in 54 preschool children belonging to the Pisa birth Cohort (PISAC). We estimated groups of foods, nutrients and calorie intakes through a food frequency questionnaire (FFQ) and Italian national databases. Then, we adopted the Mediterranean diet (MD) score to assess relative MD adherence. Cognition was examined using the Griffiths Mental Development Scales-Extended Revised (GMDS-ER). We found that higher, compared to low and moderate, adherence to MD was associated with higher performance scores. Furthermore, white meat consumption was positively related to BMI, and BMI (age–gender specific, z-scores) categories were negatively related to practical reasoning scores. All associations were independent of maternal IQ estimates, parents’ socioeconomic status, exclusive/non-exclusive breastfeeding, actual age at cognitive assessment and gender. In conclusion, in preschool children, very high adherence to MD seemed protective, whereas BMI (reinforced by the intake of white meat) was negatively associated with cognition.

Biochemical Validation of a Self-Administered Food Frequency Questionnaire to Assess Diet Using Carotenoids and Vitamins E and D in Male Adolescents in Spain

Reliable tools to evaluate diet are needed, particularly in life periods such as adolescence in which a rapid rate of growth and development occurs. We assessed the biochemical validity of a self-administered food frequency questionnaire (FFQ) in a sample of Spanish male adolescents using carotenoids and vitamin E and D data. We analyzed data from 122 male adolescents aged 15–17 years of the INMA-Granada birth cohort study. Adolescents answered a 104-item FFQ and provided a non-fasting blood sample. Mean daily nutrient intakes and serum concentration were estimated for main carotenoids (lutein-zeaxanthin, β-cryptoxanthin, lycopene, α-carotene and β-carotene), vitamins E and D and also for fruit and vegetable intake. Pearson correlation coefficients (r) and the percentage of agreement (same or adjacent quintiles) between serum vitamin concentrations and energy-adjusted intakes were estimated. Statistically significant correlation coefficients were observed for the total carotenoids (r = 0.40) and specific carotenoids, with the highest correlation observed for lutein–zeaxanthin (r = 0.42) and the lowest for β-carotene (0.23). The correlation coefficient between fruit and vegetable intake and serum carotenoids was 0.29 (higher for vegetable intake, r = 0.33 than for fruit intake, r = 0.19). Low correlations were observed for vitamin E and D. The average percentage of agreement for carotenoids was 55.8%, and lower for vitamin E and D (50% and 41%, respectively). The FFQ may be an acceptable tool for dietary assessment among male adolescents in Spain.

Potential of Erythrocyte Membrane Lipid Profile as a Novel Inflammatory Biomarker to Distinguish Metabolically Healthy Obesity in Children

Metabolically healthy obesity (MHO) has been described as BMI ≥ 30 kg/m², without metabolic disorders traditionally associated with obesity. Beyond this definition, a standardized criterion, for adults and children, has not been established yet to explain the absence of those metabolic disorders. In this context, biomarkers of inflammation have been proposed as suitable candidates to describe MHO. The use of mature red blood cell fatty acid (RBC FA) profile is here proposed since its membrane lipidome includes biomarkers of pro- and anti-inflammatory conditions with a strict relationship with metabolic and nutritional status. An observational study was carried out in 194 children (76 children with obesity and 118 children with normal weight) between 6 and 16 years old. RBC FAs were analyzed by gas chromatography-flame ionization detector (GC-FID). An unsupervised hierarchical clustering method was conducted on children with obesity, based on the RBC FA profile, to isolate the MHO cluster. The MHO cluster showed FA levels similar to children with normal weight, characterized by lower values of arachidonic acid, (total ω-6 FA, ω6/ω3 FA ratios and higher values for EPA, DHA, and total ω-3 FA) (for all of them p ≤ 0.01) compared to the rest of the children with obesity (obese cluster). The MHO cluster also presented lipid indexes for higher desaturase enzymatic activity and lower SFA/MUFA ratio compared to the obese cluster. These differences are relevant for the follow-up of patients, also in view of personalized protocols providing tailored nutritional recommendations for the essential fatty acid intakes.

Fatty Acid Profile of Mature Red Blood Cell Membranes and Dietary Intake as a New Approach to Characterize Children with Overweight and Obesity

Obesity is a chronic metabolic disease of high complexity and of multifactorial origin. Understanding the effects of nutrition on childhood obesity metabolism remains a challenge. The aim of this study was to determine the fatty acid (FA) profile of red blood cell (RBC) membranes as a comprehensive biomarker of children’s obesity metabolism, together with the evaluation of their dietary intake. An observational study was carried out on 209 children (107 healthy controls, 41 who were overweight and 61 with obesity) between 6 and 16 years of age. Mature RBC membrane phospholipids were analyzed for FA composition by gas chromatography-mass spectrometry (GC-MS). Dietary habits were evaluated using validated food frequency questionnaires (FFQ) and the Mediterranean Diet Quality Index for children (KIDMED) test. Compared to children with normal weight, children with obesity showed an inflammatory profile in mature RBC FAs, evidenced by higher levels of ω-6 polyunsaturated FAs (mainly arachidonic acid, p < 0.001). Children who were overweight or obese presented lower levels of monounsaturated FA (MUFA) compared to children with normal weight (p = 0.001 and p = 0.03, respectively), resulting in an increased saturated fatty acid (SFA)/MUFA ratio. A lower intake of nuts was observed for children with obesity. A comprehensive membrane lipidomic profile approach in children with obesity will contribute to a better understanding of the metabolic differences present in these individuals.