Does diet map with mortality? Ecological association of dietary patterns with chronic disease mortality and its spatial dependence in Switzerland

Relative Validity and Reproducibility of a Semi-Quantitative Web-Based Food Frequency Questionnaire for Swiss Adults

Background/Objectives: Food frequency questionnaires (FFQs) are widely used in large epidemiological studies to assess diet and elucidate its impacts on health. However, they must be validated in the target population before use. Methods: We assessed the relative validity, reproducibility, and usability of the Swiss eFFQ, a web-based, 83-item food frequency questionnaire, using a convenience sample of 177 adults (53.1% females, aged 18-75 years) from German- and French-speaking regions of Switzerland. The participants completed the Swiss eFFQ twice and kept a 4-day estimated food record (4-d FR). The dietary data were compared for energy, nutrient, and food group intakes by calculating mean group-level bias, performing the Wilcoxon signed-rank test, quartile cross-classification, weighted Cohen's kappa (Kw), and correlation coefficients. Results: The Swiss eFFQ was highly rated by the participants, with a completion time under 35 min, although it tended to underestimate nutrient and food intake compared to the 4-d FR. For 31 of 36 nutrients, fewer than 10% of the participants were classified in opposite quartiles. The median proportion of subjects classified in the same or adjacent quartile was 74.7% (median Kw: 0.25). The median crude and de-attenuated Spearman correlation coefficients were 0.37 and 0.42 for nutrients and 0.45 and 0.52 for food groups, respectively. The median Spearman and intraclass correlation coefficients for the reproducibility of the Swiss eFFQ were 0.70 and 0.69 for nutrients and 0.70 and 0.61 for food groups, respectively. Conclusions: The Swiss eFFQ was shown to be reproducible and user-friendly, with acceptable accuracy in categorizing study participants based on food intake, and offers several advantages for dietary assessment of Swiss adult populations.

Regional Dietary Pattern Associated with the Risk of Hypertensive Dyslipidemia Multimorbidity in Chinese Elderly: Results from China Nutrition and Health Surveillance in 2015-2017

Objectives: This study investigated regional dietary patterns and their association with hypertensive dyslipidemia multimorbidity among older Chinese adults. Methods: Data from 13,809 individuals (aged ≥ 65 years) were extracted from the 2015-2017 China Nutrition and Health Surveillance. Hypertensive dyslipidemia multimorbidity was defined as concurrent hypertension and dyslipidemia. Four dietary patterns were identified via exploratory factor analysis using 3-day 24 h dietary records. Results: Four dietary patterns were extracted: traditional southern, diverse, high oil and salt, and animal oil-other animal meat-coarse grain pattern. The national prevalence of hypertensive dyslipidemia multimorbidity was 31.9%, with significant regional variation (highest in North China: 36.4%; lowest in Central China: 27.9%; p < 0.0001). Regional dietary dominance included: the traditional southern pattern in South China (75.9%); the traditional southern (35.8%) and diversified (28.8%) patterns in East China; animal oil-other animal meat-coarse grain (38.4%) and traditional southern (37.9%) patterns in Southwest China; high oil and salt (36.8%) and traditional southern (25.9%) in Central China; diversified (47.7%) and high oil and salt (26.3%) patterns in North China; high oil and salt (44.9%) and diversified (37.9%) patterns in Northwest China; and the diversified (46.9%) pattern in Northeast China. In the highest scoring group of the animal oil-other animal meat-coarse grain pattern, the risk of hypertensive dyslipidemia multimorbidity was 1.179 times greater compared with the lowest scoring group (Q4 vs. Q1, OR = 1.179, 95% CI: 1.032-1.316, p < 0.001). Region-specific analyses highlighted: increased risks with the traditional southern pattern in South/East China (Q4 vs. Q1, OR = 2.080, 95% CI: 1.036-4.175, p < 0.001) and (Q4 vs. Q1, OR = 1.734, 95% CI: 1.052-2.859, p < 0.001); protective effects of the diversified pattern in Northwest China (Q4 vs. Q1, OR = 0.377, 95% CI: 0.173-0.824, p < 0.001); elevated risks with the high oil and salt pattern in Central/North China (Q4 vs. Q1, OR = 2.343, 95% CI: 1.107-4.955, p < 0.001) and (Q4 vs. Q1, OR = 1.837, 95% CI: 1.019-3.312, p < 0.001); and higher risks with the animal oil-other animal meat-coarse grain pattern in Southwest China (Q4 vs. Q1, OR = 2.009, 95% CI: 1.004-4.021, p < 0.001). Conclusions: In conclusion, dietary patterns among elderly Chinese are diversified and should be optimized based on local food resources to control hypertensive dyslipidemia multimorbidity.

Plasma Lipid Profile Among Perimenopausal Latvian Women in Relation to Dietary Habits

Background/Objectives: Hormonal changes throughout a woman's life cycle significantly affect serum lipid levels. Alterations in the serum lipid profile can increase the risk of cardiovascular diseases (CVDs). Additionally, nutrition and dietary habits are crucial for managing dyslipidemia. The current study evaluated the association between dietary habits and plasma lipid profiles among perimenopausal women in Latvia. Methods: The randomized clinical trial involved perimenopausal women (n = 61) aged 49 ± 3 years with moderately high low-density lipoprotein cholesterol (LDL-C) levels of 3.61 ± 0.30 mmol L-1. A series of questionnaires were completed, including a questionnaire on the subject's demographic, anthropometric, lifestyle, health, physical activity, and dietary factors, a 24 h food diary, a 72 h food diary, and a food-frequency questionnaire (FFQ). Blood testing was conducted for all participants, which included total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides (TG), alanine aminotransferase (ALAT), and glucose level analyses. Results: The consumption of refined sugar, honey, syrup, and jam demonstrated a strong positive association with higher levels of remnant cholesterol (β = 0.462, p ≤ 0.05) and non-high-density lipoprotein cholesterol (non-HDL-C) (β = 0.395, p ≤ 0.05). Similarly, the consumption of fruit juices is associated with increased LDL-C (β = 0.303, p ≤ 0.05) and non-HDL-C (β = 0.285, p ≤ 0.05). Conversely, higher meat and poultry consumption negatively correlates with TC levels (β = -0.290, p ≤ 0.05). Conclusions: This underscores the need for further examination to understand the impact of dietary habits on lipid profile.

Review of Diet Quality Indices that can be Applied to the Environmental Assessment of Foods and Diets

PURPOSE OF REVIEW

The aim was to identify indices of diet quality and health that could be applied to the environmental assessment of foods in order to provide metrics that collectively assess nutritional, health and environmental dimensions.

RECENT FINDINGS

The review identified five major groups of indices: nutrient-food quantity-based; guideline-based; diversity-based; nutrient quality-based; health-based. Nutrient-food quantity-based and guideline type indices were the most frequently used to evaluate diet quality. Scaled assessment using a nutritional functional unit is the most common integration of diet quality with the environmental analysis of foods. There are fewer indices that measure the heath impacts of foods, but epidemiological dietary risk factors seem a promising approach to integrate diet and health impacts into the environmental assessment of foods. Five groups of nutritional and health indices were identified that can be applied when performing an environmental assessment of foods. This review proposes different methodological insights when doing such assessments to ensure transparency and comparability of the results.

Development of a Multilingual Web-Based Food Frequency Questionnaire for Adults in Switzerland

Dietary assessment is a major challenge in epidemiological research and is associated with a high time and financial burden. Automated food frequency questionnaires (FFQs) have the potential to rapidly collect dietary intake data in large studies while reducing human error risk during data processing. We developed a semiquantitative, multilingual, electronic FFQ for real-time dietary intake assessment in the Swiss adult population, called "Swiss eFFQ". The iterative development process involved stages of content identification, construction, pretesting, translation, and adaptation of the FFQ. Using 24 h dietary recalls from 2085 participants aged 18-75 years from a nationally representative survey, we conducted a stepwise regression analysis to identify foods contributing to >90% of the variance in intakes of energy and six nutrients. All 118 foods identified in the overall cohort or in any of the Swiss linguistic regions were selected and standardized to define the comprehensive 83-item food list, covering >90% of the intake of key nutrients in the entire study population. Once validated, the Swiss eFFQ can be used to classify individuals based on their habitual diets. The methodology described in this paper enhances the transparency of the Swiss eFFQ and may help researchers to develop multilingual dietary assessment tools for other populations.

Association of dietary patterns and health outcomes by spatial regression analysis of nationally representative survey data from India

Background

Our aim was to study the regional differences in dietary patterns in India and their association with population-level nutrition-related health indicators such as the prevalence of anemia, overweight, undernutrition, and hyperglycemia.

Objectives

To identify and characterize the dietary patterns from publicly available nationally representative survey data on food consumption conducted by the National Sample Survey Office (NSSO) to study the regional differences in dietary patterns.

Methods

Dietary patterns were identified by factor analysis of per capita food consumption data from the household consumer expenditure survey (2011). Mean factor scores of dietary patterns were calculated for each district separately for urban and rural regions. Ecological association of factor scores with the district-level percentage prevalence of health indicators from the National Family Health Survey-4 (2015-2016) data was done by the Spatial Durbin Model of spatial regression analysis.

Results

Factor analyses revealed four dietary patterns which were similar in terms of the food items that characterized the factors for both rural and urban regions. Direct effects of dietary patterns by spatial regression analyses were observed with several health outcomes after adjusting for differences in socioeconomic development. Prevalence of anemia was positively associated with "Milk and wheat-rich diet" among men in the rural regions but negatively associated with other dietary patterns. Prevalence of overweight and high blood glucose was positively associated with "Rice and meat-rich diet" and "Coconut and seafood rich diet" in the rural regions. "Refined oil and tur dal-rich diet" was positively associated with the prevalence of overweight and hypertension in urban regions and negatively associated with underweight and anemia in men in rural and urban regions.

Conclusions

Spatial regression analyses revealed several important associations between dietary patterns and health outcomes, mostly in rural regions and some in urban regions. These results suggest the role of the major food items consumed in different regions and their impact on health outcomes in India and may have implications in tailoring dietary modifications accordingly.

Alcohol consumption: context and association with mortality in Switzerland

PURPOSE

Non-communicable diseases generate the largest number of avoidable deaths often caused by risk factors such as alcohol, smoking, and unhealthy diets. Our study investigates the association between amount and context of alcohol consumption and mortality from major non-communicable diseases in Switzerland.

METHODS

Generalized linear regression models were fitted on data of the cross-sectional population-based National Nutrition Survey menuCH (2014-2015, n = 2057). Mortality rates based on the Swiss mortality data (2015-2018) were modeled by the alcohol consumption group considering the amount and context (i.e., during or outside mealtime) of alcohol consumption and potential confounders. The models were checked for spatial autocorrelation using Moran's I statistic. Integrated nested Laplace approximation (INLA) models were fitted when evidence for missing spatial information was found.

RESULTS

Higher mortality rates were detected among drinkers compared to non-drinkers for all-cancer (rate ratio (RR) ranging from 1.01 to 1.07) and upper aero-digestive tract cancer (RR ranging from 1.15 to 1.20) mortality. Global Moran's I statistic revealed spatial autocorrelation at the Swiss district level for all-cancer mortality. An INLA model led to the identification of three districts with a significant decrease and four districts with a significant increase in all-cancer mortality.

CONCLUSION

Significant associations of alcohol consumption with all-cancer and upper aero-digestive tract cancer mortality were detected. Our study results indicate the need for further studies to improve the next alcohol-prevention scheme and to lower the number of avoidable deaths in Switzerland.

Is Following a Cancer-Protective Lifestyle Linked to Reduced Cancer Mortality Risk?

Objectives: This study investigates the association between a cancer protective lifestyle (defined based on the revised World Cancer Research Fund (WCRF) and the American Institute for Cancer Research (AICR) cancer prevention recommendations) and mortality in Switzerland. Methods: Based on the cross-sectional, population-based National Nutrition Survey, menuCH (n = 2057), adherence to the WCRF/AICR recommendations was assessed via a score. Quasipoisson regression models were fitted to examine the association of adherence to the WCRF/AICR recommendations with mortality at the Swiss district-level. Spatial autocorrelation was tested with global Moran's I. Integrated nested Laplace approximation models were fitted when significant spatial autocorrelation was detected. Results: Participants with higher cancer prevention scores had a significant decrease in all-cause (relative risk 0.95; 95% confidence interval 0.92, 0.99), all-cancer (0.93; 0.89, 0.97), upper aero-digestive tract cancer (0.87; 0.78, 0.97), and prostate cancer (0.81; 0.68, 0.94) mortality, compared to those with lower scores. Conclusion: The inverse association between adherence to the WCRF/AICR recommendations and mortality points out the potential of the lifestyle recommendations to decrease mortality and especially the burden of cancer in Switzerland.