Comparison of a dietary record using reported portion size versus standard portion size for assessing nutrient intake

Improvement in dietary intake estimates through the combined use of different approaches

ABSTRACT Objective This study aimed to compare dietary intake estimates using two different methodological approaches: use of new portions obtained with the 24-Hour Diet Recall, which was applied in the current study population, and the application of calibration equations, which were estimated using the same 24h-recalls. Methods Calibration equations were estimated using linear regression. The medians and confidence intervals of energy and nutrient intakes were assessed using all the approaches. The U Mann Whitney test was applied to verify differences among dietary intakes obtained with the 24 Hour Recall and Food Frequency Questionnaire-based methods. The correlation between different measures was assessed with Spearman coefficient. Weighted Kappa was used to verify the capability of the Food Frequency Questionnaire -based methods to classify individuals in the same intake levels of the 24 Hour Recall. Results Nine of the eleven components that were analyzed using the Food Frequency Questionnaire with standard portions and calibrated had medians significantly different from those obtained using the 24 Hour Recall; only the measurements of vitamin E and energy were statistically equal. For the Food Frequency Questionnaire with 24 Hour Recall portions, only the medians of vitamin D and B12 did not significantly differ from the 24 Hour Recall medians. Finally, for the Food Frequency Questionnaire with 24 Hour Recall portions and calibrated, all components, except folate and iron, had medians statistically equal to those obtained using the 24 Hour Recall. Spearman correlation coefficients were higher for the Food Frequency Questionnaire with 24 Hour Recall portions calibrated for all the assessed components, and the values ranged from 0.27 (total fat) to 0.57 (iron). Higher Kappa correlation coefficients were found for the Food Frequency Questionnaire 24 Hour Recall portions calibrated. Conclusion Calibrated FFQ with portions estimated from the own target population obtained better estimates of dietary intake, with values considerably more similar to those obtained with the reference method.

Dietary Patterns and Long-Term Survival: A Retrospective Study of Healthy Primary Care Patients

BACKGROUND

Dietary patterns are related to mortality in selected populations with comorbidities. We studied whether dietary patterns are associated with long-term survival in a middle-aged, healthy population.

METHODS

In this observational cohort study at the Cooper Clinic preventive medicine center (Dallas, Tex), a volunteer sample of 11,376 men and women with no history of myocardial infarction or stroke completed a baseline dietary assessment between 1987 and 1999 and were observed for an average of 18 years. Proportional hazard regressions, including a tree-augmented model, were used to assess the association of the Dietary Approaches to Stop Hypertension (DASH) dietary pattern, Mediterranean dietary pattern, and individual dietary components with mortality. The primary outcome was all-cause mortality. The secondary outcome was cardiovascular mortality.

RESULTS

Mean baseline age was 47 years. Each quintile increase in the DASH diet score was associated with a 6% lower adjusted risk for all-cause mortality (P < .02). The Mediterranean diet was not independently associated with all-cause or cardiovascular mortality. Solid fats and added sugars were the most predictive of mortality. Individuals who consumed >34% of their daily calories as solid fats had the highest risk for all-cause mortality.

CONCLUSIONS

The DASH dietary pattern was associated with significantly lower all-cause mortality over approximately 2 decades of follow-up in a middle-aged, generally healthy population. Added solid fat and added sugar intake were the most predictive of all-cause mortality. These results suggest that promotion of a healthy dietary pattern should begin in middle age, before the development of comorbid risk factors.

Development of an online database of typical food portion sizes in Irish population groups

The Irish Food Portion Sizes Database (available at www.iuna.net) describes typical portion weights for an extensive range of foods and beverages for Irish children, adolescents and adults. The present paper describes the methodologies used to develop the database and some key characteristics of the portion weight data contained therein. The data are derived from three large, cross-sectional food consumption surveys carried out in Ireland over the last decade: the National Children's Food Survey (2003-2004), National Teens' Food Survey (2005-2006) and National Adult Nutrition Survey (2008-2010). Median, 25th and 75th percentile portion weights are described for a total of 545 items across the three survey groups, split by age group or sex as appropriate. The typical (median) portion weights reported for adolescents and adults are similar for many foods, while those reported for children are notably smaller. Adolescent and adult males generally consume larger portions than their female counterparts, though similar portion weights may be consumed where foods are packaged in unit amounts (for example, pots of yoghurt). The inclusion of energy under-reporters makes little difference to the estimation of typical portion weights in adults. The data have wide-ranging applications in dietary assessment and food labelling, and will serve as a useful reference against which to compare future portion size data from the Irish population. The present paper provides a useful context for researchers and others wishing to use the Irish Food Portion Sizes Database, and may guide researchers in other countries in establishing similar databases of their own.

Reliability and validity of a semi-quantitative FFQ for sodium intake in low-income and low-literacy Brazilian hypertensive subjects

Objective

To assess the reliability and validity of an FFQ to evaluate dietary patterns of Na consumption among low-income and low-literacy Brazilian hypertensive subjects.

Design

The initial FFQ was submitted to content analysis with the pre-test administered to fifteen subjects. Reliability was evaluated according to the reproducibility criterion, with interviewer administration of the FFQ twice within a 15 d interval. Validity was assessed against a 24 h recall (132 subjects), a 3 d diet record (121 subjects) and a biomarker (24 h urinary Na; 121 subjects). To test the correlation with the biomarker, discretionary salt was added to the FFQ Na values.

Setting

A large urban teaching hospital in south-eastern Brazil.

Subjects

The study was based on 132 randomly selected subjects (eighty-three women and forty-nine men) aged 18 to 85 years.

Results

Kappa coefficients ranged from 0·79 to 0·98, confirming the reproducibility of the FFQ. There was no correlation between urinary Na excretion, the FFQ and the 24 h recall for the general sample, although significant correlations had been observed when methods were summed up (24 h recall + discretionary salt + FFQ; 0·32, P = 0·01). The addition of discretionary salt significantly improved the biomarker-based FFQ validity, with correlation coefficients varying from 0·19 (general sample) to 0·31 (female sub-sample).

Conclusions

The developed FFQ demonstrated satisfactory evidence of validity and reliability and can be used as an important complementary tool for the evaluation of Na intake among Brazilian hypertensive subjects.

Changes in food advertisements during 'prime-time' television from 1991 to 2006 in the UK and Canada

Food advertisements on mainstream television have received less research attention than those on children's television. Little is known about how television food advertisements vary internationally or if there have been changes over recent years. We describe food-related television advertisements and the nutrient content of foods advertised during prime-time television in Ontario, Canada and the UK in 1991 and 2006. Information on what advertisements were broadcast were obtained from video recordings and audience research bureaux. Data on nutrient content of foods advertised were obtained from manufacturers and standard food tables. The proportion of advertisements that were food related decreased between 1991 and 2006 in both countries. The frequency of food-related advertisements was relatively constant in Canada but decreased between 1991 and 2006 in the UK. In 1991, advertisements for beverages and meals predominated in both countries. By 2006, food-related advertisements in Canada were dominated by meals and restaurants. In the UK advertisements for food stores and beverages predominated. The 'TV diet' in Canada in 1991 was relatively high in fat, high in alcohol and low in fibre, compared to current recommendations. By 2006, this had changed to high in fat and sodium and low in fibre. The 'TV diet' in the UK in 1991 was high in fat, sodium, sugar and alcohol and low in fibre compared to current recommendations. By 2006, the UK 'TV diet' was high in sodium, sugar and alcohol and low in fibre. Foods advertised on 'prime-time' television do not reflect a healthful diet.

Cardiorespiratory fitness, macronutrient intake, and the metabolic syndrome: the Aerobics Center Longitudinal Study

OBJECTIVE

This study examines the cross-sectional associations between cardiorespiratory fitness and the metabolic syndrome with adjustment for macronutrient intake from 3-day dietary records.

DESIGN

Cross-sectional study.

SUBJECTS/SETTING

Women and men who had a comprehensive medical examination, including a symptom-limited maximal treadmill exercise test, and completed 3-day dietary records at the Cooper Clinic, Dallas, TX.

MAIN OUTCOME MEASURES

Metabolic syndrome as defined by the National Cholesterol Education Program Adult Treatment Panel III criteria.

STATISTICAL ANALYSES PERFORMED

Analysis of variance was used to examine differences in continuous data. General linear analysis was used to examine linear trends. Mantel-Haenszel chi(2) analyses were used to examine differences in categorical data. Logistic regression was used to estimate odds ratios and 95% confidence intervals.

RESULTS

After adjusting for sex and age, cardiorespiratory fitness was inversely associated with the prevalence of metabolic syndrome (P<0.001). Adjustment for macronutrient intake and other potential confounding variables did not alter the association between cardiorespiratory fitness and prevalent metabolic syndrome.

CONCLUSIONS

Cardiorespiratory fitness is inversely associated with the prevalence of metabolic syndrome. Patients should be encouraged to increase their physical activity to decrease their risk for metabolic syndrome and coronary heart disease.

Pilot using World Wide Web to prevent diabetes in adolescents

This pilot study tested the effects of an interactive nutrition education Web site on fruit, vegetable, and fat consumption in minority adolescents genetically at risk for Type 2 diabetes. A one-group nonexperimental pretest, posttest focus group design was used. Twenty-one sixth-grade to eighth-grade junior high adolescents who were minorities volunteered to participate. Participants received 5 hours of Web-based nutrition education over 3 weeks. A significant difference in fat consumption was supported from the computerized dietary assessment. No difference was found in fruit or vegetable consumption. Comparative data indicated a rise in body mass index (BMI) percentile from 88.03 (1999) to 88.40 (2002; boys) and 88.25 (1999) to 91.2 (2002; girls). Focus group responses supported the satisfaction of adolescents in the study with the use of the Web-based intervention for nutrition education. Healthy eating interventions using Web-based nutrition education should be further investigated with adolescents.

Comparative Validation of a Bilingual Interactive Multimedia Dietary Assessment Tool

OBJECTIVE

To perform comparative validity testing for a bilingual interactive multimedia (IMM) dietary assessment tool that mimics a dietary recall against an interview-administered dietary recall.

DESIGN

This was a two-period crossover design study. First, participants were randomly assigned to complete an IMM recall or interview-administered 24-hour recall. The IMM recall generated a nutrient profile that included 20 dietary constituents. The interview-administered recall was analyzed using the Food Intake Analysis System (FIAS) and the Expanded Food and Nutrition Education Program (EFNEP) Evaluating/Reporting System. The effect of substituting standardized portion sizes for reported portion sizes was examined.

SUBJECTS/SETTING

Of 80 adult participants, 71 (91%) were female, 45 (56%) had 12th grade or less education, 65 (81%) had an annual income of dollar 15,000 or less, and 21 (26%) completed the IMM recall in Spanish.

STATISTICAL ANALYSES PERFORMED

Analysis of variance and unadjusted and energy-adjusted correlations were used.

RESULTS

No significant group differences were found for order of administration or demographic characteristics. There was only one significant (P=.025) method effect, whereby vitamin C intake was higher in the IMM recall than the FIAS. The unadjusted correlations between the IMM recalls and interview-administered recalls analyzed using both FIAS and EFNEP Evaluating/Reporting System were generally approximately 0.6. Energy-adjusted correlations were consistently lower. Substituting standardized portion sizes resulted in significant differences for six nutrients and caused all correlations to decrease.

CONCLUSIONS

The IMM dietary recall is a valid method for assessing dietary intake within the tested group. The results of comparative validity testing and positive reactions received from participants and nutrition educators indicate that diet assessment using IMM has tremendous potential.

Influence of individually estimated portion size on the assessment of nutritional risk in colorectal cancer in Portugal

We evaluated the influence of individually estimated portion sizes on the estimate of nutrient related risk of colorectal cancer, using data from a Portuguese hospital based case-control study on diet and colorectal cancer. A total of 100 patients with colorectal adenocarcinoma (aged 15-92 years) and 211 controls (aged 36-89 years) were included. Two data sets were created for nutrient analysis, the first one allowed estimates of food intake using data on portion size as collected with visual aids during the interview. The second estimate substituted respondents' estimate with a standard portion size, as used in the semi-quantitative (SQ) food frequency approach. The two analytic approaches yielded similar energy and nutrient intakes in cases and controls. The percent range of concordance is acceptable, in the same quartile varying from 44 to 82% (mean: 56%) and very good in the same or adjacent (+/-1) quartile (mean: 91%, range: 85-97%). The two estimates lead to a similar pattern of multivariate odd's ratio, however the SQ estimates resulted in more significant findings. We conclude that little extra information is gained by including individual portion size information when assessing diet-related risk of colorectal cancer.

Using technology to promote self-efficacy for healthy eating in adolescents

PURPOSE

To test the effects of a classroom and World Wide Web (WWW) educational intervention on self-efficacy (SE) for healthy eating (HE) and to examine the relationship of the theoretical concepts in a hypothesized model of eating behavior in adolescents.

DESIGN

A quasiexperimental pretest, posttest design was used in a random sample of students in two junior high schools.

METHODS

The intervention consisted of a combination of 5 hours of Web-based instruction and 10 hours of classroom curriculum, compared to nutrition education embedded in the standard school curriculum during a 1-month period. Participants completed six questionnaires. Data were analyzed using descriptive statistics, t tests, and Pearson's r correlation coefficient.

FINDINGS AND CONCLUSIONS

The intervention group had significantly higher scores for SE for fruits and vegetables, SE for lower fat, usual food choices, and dietary knowledge of fat compared to the control group. No difference was found between groups in food consumption. Self-efficacy was significantly associated with dietary knowledge of lower fat, usual food choices, and was inversely associated with lower-fat consumption in the hypothesized model of eating behavior. The intervention was tailored to the social and developmental preferences of adolescents and effectively increased SE for HE. The mediating role of SE in the hypothesized model of adolescent eating behavior warrants further investigation.

The Eating Behavior Patterns Questionnaire predicts dietary fat intake in African American women

OBJECTIVE

To develop a behavioral assessment of eating that would be predictive of fat intake in African American women.

DESIGN

Questionnaires were developed using a three-stage design, involving item generation, item refinement, and questionnaire validation.

SUBJECTS

Focus groups sessions were conducted with 40 African American women, initial questionnaire development employed 80 African American women, and questionnaire validation involved 310 African American women from diverse socioeconomic backgrounds. Statistical analyses Transcripts of focus groups were used to generate 113 behavioral questionnaire items. The initial questionnaire was administered along with a food frequency questionnaire, and the item pool was reduced to 51 items. Factor analysis was used to create subscales. Correlation (r) and multiple regression analysis (R) were used to evaluate construct validity.

RESULTS

Factor analysis revealed six subscales: low-fat eating, emotional eating, snacking on sweets, cultural/ethnic, haphazard planning, and meal skipping. The scales are significant predictors of micronutrient (R values from 0.22 to 0.47) and macronutrient intakes (R values from 0.33 to 0.58) assessed using a food frequency questionnaire and show construct validity in relationship to other measures of eating behavior (r values from 0.22 to 0.65).

APPLICATIONS

The Eating Behavior Patterns Questionnaire (EBPQ) may be a useful tool for clinical assessment, clinical and community nutrition intervention studies, and epidemiologic research with African American women.

Nutrient intake of physically fit and unfit men and women

OBJECTIVE

Participation in physical activity and following a diet low in fat, saturated fat, and cholesterol and high in fiber are important in the prevention and treatment of cardiovascular disease and other health problems. Despite the importance of both behaviors, little is known about the interactive role of diet and physical activity. The association between physical activity and diet has been studied, but data on the association between cardiorespiratory fitness (CRF), which is an objective measure of habitual physical activity, and diet are lacking in adults. This report examines nutrient intakes of men and women across low, moderate, and high fitness categories and compares the intakes to national dietary recommendations. It is the first step in examining the relationship between diet, CRF, and morbidity and mortality endpoints in the Aerobics Center Longitudinal Study (ACLS).

METHODS

Between 1987 and 1995, 7959 men and 2453 women participating in the ACLS provided 3-d diet records and completed a preventive medical examination. CRF was measured using a maximal exercise test, anthropometric and other clinical variables were measured following a standardized protocol, and lifestyle factors were assessed with a medical history questionnaire.

RESULTS

After adjusting for potential confounders, there was a significantly lower percent of energy from fat and saturated fat across low, moderate, and high CRF categories. With additional adjustment for total energy intake, there was a significantly higher dietary fiber intake and a significantly lower cholesterol intake across CRF categories. The percentage of men and women meeting national dietary recommendations was higher at higher CRF levels.

CONCLUSIONS

Men and women with higher fitness levels consumed diets that more closely approached national dietary recommendations than their lower fit peers.