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Müllertz ALO, Stjernqvist NW, Outzen MH, Bloch P, Elsborg P, Ravn-Haren G. A cross-sectional study of the association between food literacy and dietary intake among Danish adolescents. Appetite 2024; 200:107526. [PMID: 38797236 DOI: 10.1016/j.appet.2024.107526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 05/16/2024] [Accepted: 05/24/2024] [Indexed: 05/29/2024]
Abstract
Food literacy is theorized to be associated with healthy dietary intake. However, empirical knowledge on the association between adolescents' food literacy and dietary intake is limited. The aim of this study was to investigate the association between food literacy and dietary intake among Danish schoolchildren aged 11-13 years. The study applied a cross-sectional design using baseline data from a cluster-based quasi-experimental controlled study in a sample (n = 377) of Danish school children. Mixed model analyses were performed to investigate the associations between overall food literacy as well as its five competencies ("to know", "to do", "to sense", "to care", and "to want") and dietary intake of vegetables, fruit, fish, meat, discretionary foods, and sugar-sweetened beverages. Positive associations were found between overall food literacy (E = 1.493, p = 0.002) as well as the competencies "to know" (E = 1.249, p = 0.027), "to do" (E = 1.236, p = 0.028), "to sense" (E = 1.183, p = 0.029), and "to care" (E = 1.249, p = 0.018) and intake of vegetables. The study also found a positive association between the competency "to want" and intake of fruit (E = 13.50, p = 0.037), "to care" and intake of fish (E = 2.050, p < 0.001), and a negative association between the competency "to want" and intake of meat (E = 0.748, p = 0.003) and sugar-sweetened beverages (E = 0.576, p = 0.0021). No associations were found between overall food literacy or any of its five competencies and intake of discretionary foods. These findings suggest that improving specific aspects of food literacy may have a potential to promote healthier dietary intake, though additional research is needed.
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Affiliation(s)
- Alberte Laura Oest Müllertz
- Center for Clinical Research and Prevention, Copenhagen University Hospital-Bispebjerg and Frederiksberg, The Capital Region of Denmark, DK-2000, Frederiksberg, Denmark.
| | - Nanna Wurr Stjernqvist
- Health Promotion Research, Steno Diabetes Center Copenhagen, Herlev Hospital, The Capital Region of Denmark, DK-2730, Herlev, Denmark
| | - Malene Høj Outzen
- National Food Institute, Technical University of Denmark, DK-2800, Kgs. Lyngby, Denmark
| | - Paul Bloch
- Health Promotion Research, Steno Diabetes Center Copenhagen, Herlev Hospital, The Capital Region of Denmark, DK-2730, Herlev, Denmark
| | - Peter Elsborg
- Center for Clinical Research and Prevention, Copenhagen University Hospital-Bispebjerg and Frederiksberg, The Capital Region of Denmark, DK-2000, Frederiksberg, Denmark
| | - Gitte Ravn-Haren
- National Food Institute, Technical University of Denmark, DK-2800, Kgs. Lyngby, Denmark
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Mehranfar S, Jalilpiran Y, Jafari A, Jayedi A, Shab-Bidar S, Speakman JR, Djafarian K. Validity of dietary assessment methods compared with doubly labeled water in children: A systematic review and meta-analysis. Obes Rev 2024:e13768. [PMID: 38783784 DOI: 10.1111/obr.13768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 04/20/2024] [Accepted: 04/20/2024] [Indexed: 05/25/2024]
Abstract
OBJECTIVES We aimed to validate dietary assessment methods against the gold standard, doubly labeled water (DLW), for estimating total energy intake (TEI). METHODS PubMed, Scopus, Web of Science, and Google Scholar databases were searched until May 2023. Inclusion criteria encompassed studies involving participants aged 1-18 years, employing dietary assessment methods like food records, dietary histories, food frequency questionnaire (FFQ), or 24-h recalls estimating TEI alongside DLW to measure total energy expenditure (TEE). Data were pooled using random-effects meta-analysis models. RESULTS Thirty-three studies were identified, with sample sizes ranging from 9 to 118 participants. Meta-analysis of 22 studies identified underestimation of TEI (mean difference [MD] = -262.9 kcal/day [95% CI: -380.0, -145.8]; I2 = 93.55%) for food records compared with TEE estimated by DLW. Other dietary assessment methods, including food recalls (n = 9) (MD = 54.2 kcal/day [95% CI: -19.8, 128.1]; I2 = 49.62%), FFQ (n = 7) (MD = 44.5 kcal/day [95% CI: -317.8, 406.8]; I2 = 94.94%), and diet history (n = 3) (MD = -130.8 kcal/day [95% CI: -455.8, 194.1]; I2 = 77.48%), showed no significant differences in TEI compared with DLW-estimated TEE. All studies were of high quality. CONCLUSION Food records may underestimate TEI, yet additional research is needed to identify the most accurate methods for assessing children's dietary intake.
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Affiliation(s)
- Sanaz Mehranfar
- Department of Community Nutrition, School of Nutritional Science and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Yahya Jalilpiran
- Students' Scientific Research Center (SSRC), Tehran University of Medical Sciences (TUMS), Tehran, Iran
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Alireza Jafari
- Department of Community Nutrition, School of Nutritional Science and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
- Physiology Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
| | - Ahmad Jayedi
- Department of Community Nutrition, School of Nutritional Science and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
- Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | - Sakineh Shab-Bidar
- Department of Community Nutrition, School of Nutritional Science and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - John R Speakman
- Institute of Biological and Environmental Sciences, University of Aberdeen, Aberdeen, UK
| | - Kurosh Djafarian
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
- Neuroscience Institute, Sports Medicine Research Center, Tehran University of Medical Sciences (TUMS), Tehran, Iran
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Moala Silatolu A, Santos JA, Palu A, Nand D, Deo A, Kama A, Lolohea S, Vakaloloma U, Seru L, Naivunivuni P, Kumar S, Tawakilai H, Vimatemate E, Sanif M, Misavu A, Prasad AU, Patay D, Woodward M, Rogers K, Reeve E, Bell C, Webster J, Waqa G, McKenzie BL. Salt and sugar intakes of adults in the central division of Fiji: findings from a nutrition survey in 2022. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2024; 46:101074. [PMID: 38726347 PMCID: PMC11079466 DOI: 10.1016/j.lanwpc.2024.101074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 12/12/2023] [Accepted: 04/11/2024] [Indexed: 05/12/2024]
Abstract
Background Excess salt and sugar consumption contribute to diseases, such as diabetes and hypertension. This study aimed to estimate salt and sugar intakes and main sources, in a population of adults in the Central Division of Fiji. Methods One adult per household was randomly selected to participate (n = 700). Sociodemographic characteristics; blood pressure, weight, and height; a 24-h diet recall; and spot-urine samples were collected, with 24-h urine samples from a sub-sample (n = 200). Sugar intake was estimated from the 24-h diet recalls and salt intake from the spot-urines. 24-hr diet recall was used to identify main sources of salt and sugar by food groups. Findings 534 adults (response rate 76%, 50% women, mean age 42 years) participated. Salt intake was 8.8 g/day (95% CI, 8.7-9.0), and free sugar intake was 74.1 g/day (67.5-80.7), 16.1% of total energy intake (15.0-17.1%). Main sources of salt were mixed cooked dishes (40.9% (38.2-43.5)), and bread and bakery products (28.7% (26.5-31.0)). Main sources of sugar were table sugars, honey, and related products (24.3% (21.7-26.8)), non-alcoholic beverages (21.4% (18.8-24.0)) and bread and bakery products (18.0% (16.2-19.9)). Interpretation Salt and sugar intakes exceeded World Health Organization recommendations in this sample of adults. Given dietary sources were foods high in salt and sugar, along with the addition to food or drinks, interventions focused on behavior along with environmental strategies to encourage healthier choices are needed. Funding NHMRC and GACD grant APP1169322.
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Affiliation(s)
- Anasaini Moala Silatolu
- Pacific Research Centre for the Prevention of Obesity and Non-communicable Diseases, College of Medicine Nursing and Heath Sciences, Fiji National University, Suva, Fiji
| | | | - Aliyah Palu
- The George Institute for Global Health, UNSW, Sydney, Australia
| | - Devina Nand
- The Wellness Team, Ministry of Health, Suva, Fiji
| | - Alvina Deo
- The Wellness Team, Ministry of Health, Suva, Fiji
| | - Ateca Kama
- The Wellness Team, Ministry of Health, Suva, Fiji
| | - Susana Lolohea
- Pacific Research Centre for the Prevention of Obesity and Non-communicable Diseases, College of Medicine Nursing and Heath Sciences, Fiji National University, Suva, Fiji
| | - Unise Vakaloloma
- Pacific Research Centre for the Prevention of Obesity and Non-communicable Diseases, College of Medicine Nursing and Heath Sciences, Fiji National University, Suva, Fiji
| | - Litiana Seru
- Pacific Research Centre for the Prevention of Obesity and Non-communicable Diseases, College of Medicine Nursing and Heath Sciences, Fiji National University, Suva, Fiji
| | - Penaia Naivunivuni
- Pacific Research Centre for the Prevention of Obesity and Non-communicable Diseases, College of Medicine Nursing and Heath Sciences, Fiji National University, Suva, Fiji
| | - Shajal Kumar
- Pacific Research Centre for the Prevention of Obesity and Non-communicable Diseases, College of Medicine Nursing and Heath Sciences, Fiji National University, Suva, Fiji
| | - Helen Tawakilai
- Pacific Research Centre for the Prevention of Obesity and Non-communicable Diseases, College of Medicine Nursing and Heath Sciences, Fiji National University, Suva, Fiji
| | - Emosi Vimatemate
- Pacific Research Centre for the Prevention of Obesity and Non-communicable Diseases, College of Medicine Nursing and Heath Sciences, Fiji National University, Suva, Fiji
| | - Mohammed Sanif
- Pacific Research Centre for the Prevention of Obesity and Non-communicable Diseases, College of Medicine Nursing and Heath Sciences, Fiji National University, Suva, Fiji
| | - Alena Misavu
- Pacific Research Centre for the Prevention of Obesity and Non-communicable Diseases, College of Medicine Nursing and Heath Sciences, Fiji National University, Suva, Fiji
| | | | - Dori Patay
- The George Institute for Global Health, UNSW, Sydney, Australia
| | - Mark Woodward
- The George Institute for Global Health, UNSW, Sydney, Australia
- The George Institute for Global Health, School of Public Health, Imperial College London, London, UK
| | - Kris Rogers
- The George Institute for Global Health, UNSW, Sydney, Australia
- Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Erica Reeve
- Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Colin Bell
- Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Jacqui Webster
- The George Institute for Global Health, UNSW, Sydney, Australia
| | - Gade Waqa
- Pacific Research Centre for the Prevention of Obesity and Non-communicable Diseases, College of Medicine Nursing and Heath Sciences, Fiji National University, Suva, Fiji
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Park SY, Eom J, Choi S, Kim J, Park EC. Association between watching eating broadcast "Mukbang and Cookbang" and body mass index status in South Korean adolescents stratified by gender. Nutr J 2024; 23:43. [PMID: 38637805 PMCID: PMC11027345 DOI: 10.1186/s12937-024-00946-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 04/01/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND It has been suggested that Mukbang and Cookbang, a type of eating broadcast originating from Korea and gaining popularity, may contribute to obesity. However, despite suggestions that Mukbang might contribute to obesity, studies investigating the impact of watching Mukbang on obesity is lacking. The goal of this study is to analyze the relationship between watching Mukbang and Cookbang and body mass index (BMI) status in Korean adolescents. All analyses were stratified by gender. METHODS This study utilized data from the 2022 Korea Youth Risk Behavior Web-based Surveys. The anonymous online survey was conducted with 56,213 students, and 51,850 students (92.2%) who participated in the survey were analyzed. Participants reported the frequency of watching Mukbang and Cookbang per week over the previous 12 months. BMI was categorized into four subgroups based on percentiles: underweight (< 5th percentile), normal (5th - 85th percentiles), overweight (85th - 95th percentiles), and obese (> 95th percentile). This study used multinomial logistic regression for analysis. RESULTS The likelihood of being obese was significantly higher in Mukbang-watching boys compared to those who never watched Mukbang and Cookbang (adjusted odds ratio [aOR]: 1.22, 95% confidence interval [CI]: 1.12-1.32). A dose-dependent association was found between the frequency of Mukbang and Cookbang watching and the likelihood of obesity among boys (p-for-trend < 0.0001). Subgroups that currently smoke, currently drink alcohol, frequently consume fast food, or drink sweetened beverages showed significantly higher odds of being obese in the "Ever" group than those in the "Never" group. CONCLUSION This study found a relationship between watching Mukbang and Cookbang and obesity in boys. Appropriate interventions should be considered for boys watching Mukbang and Cookbang.
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Affiliation(s)
- Sang-Yeon Park
- Premedical Courses, Yonsei University College of Medicine, Seoul, 03722, Republic of Korea
| | - Jeongha Eom
- Premedical Courses, Yonsei University College of Medicine, Seoul, 03722, Republic of Korea
| | - Sangyoun Choi
- Premedical Courses, Yonsei University College of Medicine, Seoul, 03722, Republic of Korea
| | - Jinhyun Kim
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea.
- Department of Psychiatry, Yonsei University College of Medicine, Seoul, Republic of Korea.
- Department of Preventive Medicine & Psychiatry, Institute of Health Services Research, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
| | - Eun-Cheol Park
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea.
- Department of Preventive Medicine & Institute of Health Services Research, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
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Jung S, Kim JY, Park S. Eating patterns in Korean adults, 1998-2018: increased energy contribution of ultra-processed foods in main meals and snacks. Eur J Nutr 2024; 63:279-289. [PMID: 37999737 PMCID: PMC10799128 DOI: 10.1007/s00394-023-03258-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 09/27/2023] [Indexed: 11/25/2023]
Abstract
PURPOSE Unfavorable changes in eating patterns over time may contribute to upward trends in chronic diseases, such as obesity. We examined 20-year trends in the percentage of energy from main meals and snacks and the food sources of each eating occasion among Korean adults. METHODS This study used nationally representative data from the 1st, 4th, and 7th Korea National Health and Nutrition Examination Surveys (1998, 2007-2009, and 2016-2018) among adults aged 20-69 years (n = 29,389). Each eating occasion (breakfast, lunch, dinner, and snacks) was defined by respondents during a 24-h dietary recall interview. To identify the food sources of each eating occasion, we used the NOVA system. The percentage of energy at each eating occasion and that from each NOVA group across survey cycles were estimated, and tests for linear trends were conducted using orthogonal polynomial contrasts in linear regression models. All analyses accounted for the complex survey design. RESULTS After adjusting for age and sex, the percentage of energy from breakfast decreased from 25.0% in 1998 to 16.7% in 2018 (difference, - 8.2%; standard error [SE], 0.3), whereas that from dinner and snacks increased from 31.1 to 33.8% (difference, + 2.7%; SE, 0.4) and from 14.0 to 19.0% (difference, + 5.0%; SE, 0.5), respectively (all P < 0.001). At all eating occasions, the percentage of energy from minimally processed foods declined (difference, - 18.6% for breakfast; - 13.1% for lunch; - 21.1% for dinner; - 20.7% for snacks), while that from ultra-processed foods increased (difference, + 17.0% for breakfast; + 11.3% for lunch; + 18.0% for dinner; + 30.7% for snacks). When stratified by age, the given trends were shown to a greater extent in younger adults (< 50 years old) than in older adults (≥ 50 years old). CONCLUSIONS The eating patterns of Korean adults changed from 1998 to 2018, with the greatest decrease in energy intake from breakfast and the greatest increase from snacking. At all eating occasions, the contribution of minimally processed foods declined, while that of ultra-processed foods increased, especially among younger adults.
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Affiliation(s)
- Sukyoung Jung
- Chungnam National University Hospital Biomedical Research Institute, Daejeon, South Korea
| | - Jee Young Kim
- National Food Safety Information Service, Seoul, South Korea.
| | - Sohyun Park
- Department of Food Science and Nutrition, Hallym University, Chuncheon, Gangwon, 24252, South Korea.
- The Korean Institute of Nutrition, Hallym University, Chuncheon, South Korea.
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Buso ME, Boshuizen HC, Naomi ND, Maho W, Diepeveen-de Bruin M, Balvers MG, de Vries JH, Harrold JA, Halford JC, Raben A, Feskens EJ, Brouwer-Brolsma EM. Relative validity of habitual sugar and low/no-calorie sweetener consumption assessed by food frequency questionnaire, multiple 24-h dietary recalls and urinary biomarkers: an observational study within the SWEET project. Am J Clin Nutr 2024; 119:546-559. [PMID: 38043866 DOI: 10.1016/j.ajcnut.2023.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 11/22/2023] [Accepted: 11/28/2023] [Indexed: 12/05/2023] Open
Abstract
BACKGROUND Studies investigating associations between sweeteners and health yield inconsistent results, possibly due to subjective self-report dietary assessment methods. OBJECTIVES We compared the performance of a food frequency questionnaire (FFQ), multiple 24-h dietary recalls (24hRs), and urinary biomarkers to estimate intake of sugars and low/no-calorie sweeteners (LNCSs). METHODS Participants (n = 848, age 54 ± 12 y) from a 2-y observational study completed 1 semiquantitative FFQ and ≥ 3 nonconsecutive 24hRs. Both methods assessed intake of sugars (mono- and disaccharides, sucrose, fructose, free and added sugars) and sweetened foods and beverages (sugary foods, fruit juice, and sugar or LNCS-containing beverages [sugar-sweetened beverages and low/no-calorie sweetened beverages (LNCSBs)]); 24hRs also included LNCS-containing foods and tabletop sweeteners (low/no-calorie sweetened foods [LNCSFs]). Urinary excretion of sugars (fructose+sucrose) and LNCSs (acesulfame K+sucralose+steviol glucuronide+cyclamate+saccharin) were simultaneously assessed using ultrapressure liquid chromatography coupled to tandem mass spectrometry in 288 participants with 3 annual 24-h urine samples. Methods were compared using, amongst others, validity coefficients (correlations corrected for measurement error). RESULTS Median (interquartile range) FFQ intakes ranged from 0 (0-7) g/d for LNCSBs to 94 (73-117) g/d for mono- and disaccharides. LNCSB use was reported by 32% of participants. Median LNCSB+LNCSF intake using 24hRs was 1 (0-50) g/d and reported by 58%. Total sugar excretions were detected in 100% of samples [56 (37-85) mg/d] and LNCSs in 99% of urine samples [3 (1-10) mg/d]. Comparing FFQ against 24hRs showed VCs ranging from 0.38 (fruit juice) to 0.74 (LNCSB). VCs for comparing FFQ with urinary excretions were 0.25 to 0.29 for sugars and 0.39 for LNCSBs; for 24hR they amounted to 0.31-0.38 for sugars, 0.37 for LNCSBs, and 0.45 for LNCSFs. CONCLUSIONS The validity of the FFQ against 24hRs for the assessment of sugars and LNCSBs ranged from moderate to good. Comparing self-reports and urine excretions showed moderate agreement but highlighted an important underestimation of LNCS exposure using self-reports.
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Affiliation(s)
- Marion Ec Buso
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, The Netherlands
| | - Hendriek C Boshuizen
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, The Netherlands
| | - Novita D Naomi
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, The Netherlands
| | - Walid Maho
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, The Netherlands
| | | | - Michiel Gj Balvers
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, The Netherlands
| | - Jeanne Hm de Vries
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, The Netherlands
| | - Joanne A Harrold
- Department of Psychology, University of Liverpool, United Kingdom
| | - Jason Cg Halford
- Department of Psychology, University of Liverpool, United Kingdom; School of Psychology, University of Leeds, United Kingdom
| | - Anne Raben
- Department of Nutrition, Exercise, and Sports, Faculty of Science, University of Copenhagen, Denmark; Clinical Research, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Edith Jm Feskens
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, The Netherlands
| | - Elske M Brouwer-Brolsma
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, The Netherlands.
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Smith S, Fisher A, Lally PJ, Croker HA, Roberts A, Conway RE, Beeken RJ. Perceiving a need for dietary change in adults living with and beyond cancer: A cross-sectional study. Cancer Med 2024; 13:e7073. [PMID: 38457197 PMCID: PMC10922024 DOI: 10.1002/cam4.7073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 02/08/2024] [Accepted: 02/20/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Many people living with and beyond cancer (LWBC) do not meet dietary recommendations. To implement a healthier diet, people LWBC must perceive a need to improve their diet. METHODS Participants included people diagnosed with breast, prostate or colorectal cancer in the UK. Two binary logistic regression models were conducted with perceived need for dietary change as the outcome (need to improve vs. no need). Predictor variables included demographic and clinical characteristics, receipt of dietary advice, and either body mass index (BMI) or adherence to seven relevant World Cancer Research Fund (WCRF) dietary recommendations. RESULTS The sample included 5835 responses. Only 31% perceived a need to improve their diet. Being younger (odds ratio [OR] 0.95, 95% confidence interval [CI] = 94-0.95), female (OR = 1.33, 95% CI = 1.15-1.53), not of white ethnicity (OR = 1.8, 95% CI = 1.48-2.27), not married/cohabiting (OR = 1.32, 95% CI = 1.16-1.52) and having received dietary advice (OR = 1.36, 95% CI = 1.43-1.86) was associated with an increased odds of perceiving a need to improve diet. This association was also seen for participants with two or more comorbidities (OR = 1.31, 95% CI = 1.09-1.57), those not meeting the recommendations for fruit and vegetables (OR = 0.47, 95% CI = 0.41-0.55), fat (OR = 0.67, 95% CI = 0.58-0.77), and sugar (OR = 0.86, 95% CI = 0.75-0.98) in the dietary components model and those who had a higher BMI (OR = 1.53, 95% CI = 1.32-1.77) in the BMI model. CONCLUSIONS Most of this sample of people LWBC did not perceive a need to improve their diet. More research is needed to understand the reasons for this and to target these reasons in dietary interventions.
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Affiliation(s)
- Susan Smith
- Department of Behavioural Science and Health, University College London, London, UK
| | - Abi Fisher
- Department of Behavioural Science and Health, University College London, London, UK
| | - Phillippa J Lally
- Department of Behavioural Science and Health, University College London, London, UK
- Department of Psychology, University of Surrey, Surrey, UK
| | - Helen A Croker
- Department of Behavioural Science and Health, University College London, London, UK
| | - Anna Roberts
- Department of Behavioural Science and Health, University College London, London, UK
| | - Rana E Conway
- Department of Behavioural Science and Health, University College London, London, UK
| | - Rebecca J Beeken
- Department of Behavioural Science and Health, University College London, London, UK
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
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Casey JL, Meijer JL, IglayReger HB, Ball SC, Han-Markey TL, Braun TM, Burant CF, Peterson KE. Comparing Self-Reported Dietary Intake to Provided Diet during a Randomized Controlled Feeding Intervention: A Pilot Study. DIETETICS (BASEL, SWITZERLAND) 2023; 2:334-343. [PMID: 38107624 PMCID: PMC10722558 DOI: 10.3390/dietetics2040024] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
Systematic and random errors based on self-reported diet may bias estimates of dietary intake. The objective of this pilot study was to describe errors in self-reported dietary intake by comparing 24 h dietary recalls to provided menu items in a controlled feeding study. This feeding study was a parallel randomized block design consisting of a standard diet (STD; 15% protein, 50% carbohydrate, 35% fat) followed by either a high-fat (HF; 15% protein, 25% carbohydrate, 60% fat) or a high-carbohydrate (HC; 15% protein, 75% carbohydrate, 10% fat) diet. During the intervention, participants reported dietary intake in 24 h recalls. Participants included 12 males (seven HC, five HF) and 12 females (six HC, six HF). The Nutrition Data System for Research was utilized to quantify energy, macronutrients, and serving size of food groups. Statistical analyses assessed differences in 24 h dietary recalls vs. provided menu items, considering intervention type (STD vs. HF vs. HC) (Student's t-test). Caloric intake was consistent between self-reported intake and provided meals. Participants in the HF diet underreported energy-adjusted dietary fat and participants in the HC diet underreported energy-adjusted dietary carbohydrates. Energy-adjusted protein intake was overreported in each dietary intervention, specifically overreporting beef and poultry. Classifying misreported dietary components can lead to strategies to mitigate self-report errors for accurate dietary assessment.
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Affiliation(s)
- James L. Casey
- Department of Nutritional Sciences, University of Michigan, Ann Arbor, MI 48109, USA
- Department of Molecular, Cellular, and Developmental Biology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Jennifer L. Meijer
- Department of Nutritional Sciences, University of Michigan, Ann Arbor, MI 48109, USA
- Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA
- Geisel School of Medicine, Dartmouth College, Hanover, NH 03755, USA
| | - Heidi B. IglayReger
- Division of Metabolism, Endocrinology, and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | - Sarah C. Ball
- Department of Nutritional Sciences, University of Michigan, Ann Arbor, MI 48109, USA
| | - Theresa L. Han-Markey
- Department of Nutritional Sciences, University of Michigan, Ann Arbor, MI 48109, USA
| | - Thomas M. Braun
- Department of Biostatistics, University of Michigan, Ann Arbor, MI 48109, USA
| | - Charles F. Burant
- Department of Nutritional Sciences, University of Michigan, Ann Arbor, MI 48109, USA
- Division of Metabolism, Endocrinology, and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | - Karen E. Peterson
- Department of Nutritional Sciences, University of Michigan, Ann Arbor, MI 48109, USA
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Presseller EK, Karbassi N, Gian C, Juarascio AS. Unequivocally large, but not enormous: An examination of the nutritional content of objective and subjective binge-eating episodes using ecological momentary assessment data. Int J Eat Disord 2023; 56:1991-1997. [PMID: 37345531 PMCID: PMC10592441 DOI: 10.1002/eat.24016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 06/08/2023] [Accepted: 06/09/2023] [Indexed: 06/23/2023]
Abstract
OBJECTIVE This study compared the macronutrient profiles of subjective binge-eating episodes (SBEs), objective binge-eating episodes (OBEs), and typical eating episodes. METHOD Twenty-one adults with binge eating completed ecological momentary assessment of all eating episodes for 2 weeks, including detailed monitoring of food types and portions. Binge-eating episodes (N = 237) were coded as OBEs (n = 76) or SBEs (n = 161). Calories and macronutrients were computed using manufacturer information and USDA Food and Nutrient Database for Dietary Studies. Multilevel regression models compared the eating episode types on caloric and macronutrient content. RESULTS OBEs contained an average of 121.5 (95.1) g fat, 363.7 (289.1) g carbohydrates, 65.2 (38.2) g protein, 20.9 (16.4) g fiber, and 2856.2 (1869.2) calories. SBEs contained 31.6 (30.5) g fat, 76.5 (54.0) g carbohydrates, 20.5 (21.6) g protein, 5.3 (5.9) g fiber, and 695.1 (505.9) calories. Although OBEs contained significantly more calories and grams of all macronutrients than SBEs (p < .001), the macronutrient proportions of OBEs and SBEs did not differ. The proportions of carbohydrates (p = .005) and protein (p < .001) in SBEs significantly differed from typical eating episodes. DISCUSSION Our findings offer preliminary evidence that OBEs and SBEs are more comparable in macronutrient profile than typical eating episodes. PUBLIC SIGNIFICANCE STATEMENT The present study compared the calories and grams of macronutrients in objectively large binge-eating episodes, subjectively large binge-eating episodes, and typical meals and snacks. Results suggest that objectively and subjectively large binge-eating episodes demonstrate similar profiles of macronutrients, which are different from the macronutrient profile of meals and snacks. These results may help the eating disorder field better study the impact of subjectively large binge-eating episodes.
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Affiliation(s)
- Emily K Presseller
- Department of Psychological and Brain Sciences, Drexel University, Philadelphia, Pennsylvania, USA
- Center for Weight, Eating, and Lifestyle Sciences, Drexel University, Philadelphia, Pennsylvania, USA
| | - Nikoo Karbassi
- Center for Weight, Eating, and Lifestyle Sciences, Drexel University, Philadelphia, Pennsylvania, USA
| | - Christina Gian
- Center for Weight, Eating, and Lifestyle Sciences, Drexel University, Philadelphia, Pennsylvania, USA
- Nutrition Sciences Department, Drexel University, Philadelphia, Pennsylvania, USA
| | - Adrienne S Juarascio
- Department of Psychological and Brain Sciences, Drexel University, Philadelphia, Pennsylvania, USA
- Center for Weight, Eating, and Lifestyle Sciences, Drexel University, Philadelphia, Pennsylvania, USA
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10
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Sullivan VK, Rebholz CM. Nutritional Epidemiology and Dietary Assessment for Patients With Kidney Disease: A Primer. Am J Kidney Dis 2023; 81:717-727. [PMID: 36610612 PMCID: PMC10200755 DOI: 10.1053/j.ajkd.2022.11.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 11/19/2022] [Indexed: 01/06/2023]
Abstract
Nutritional epidemiology seeks to understand nutritional determinants of disease in human populations using experimental and observational study designs. Though randomized controlled trials provide the strongest evidence of causality, the expense and difficulty of sustaining adherence to dietary interventions are substantial barriers to investigating dietary determinants of kidney disease. Therefore, nutritional epidemiology commonly employs observational study designs, particularly prospective cohort studies, to investigate long-term associations between dietary exposures and kidney disease. Due to the covarying nature and synergistic effects of dietary components, holistic characterizations of dietary exposures that simultaneously consider patterns of foods and nutrients regularly consumed are generally more relevant to disease etiology than single nutrients or foods. Dietary intakes have traditionally been self-reported and are subject to bias. Statistical methods including energy adjustment and regression calibration can reduce random and systematic measurement errors associated with self-reported diet. Novel approaches that assess diet more objectively are gaining popularity but have not yet fully replaced self-report and require refinement and validation in populations with chronic kidney disease. More accurate and frequent diet assessment in existing and future studies will yield evidence to better personalize dietary recommendations for the prevention and treatment of kidney disease.
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Affiliation(s)
- Valerie K Sullivan
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland; Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland
| | - Casey M Rebholz
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland; Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland; Division of Nephrology, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland.
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11
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Curtin EL, Johnson L, Salway R, Hinton EC. Snacking and anxiety during the coronavirus disease (COVID-19) pandemic: A prospective cohort study. Appetite 2023; 183:106491. [PMID: 36775067 PMCID: PMC9912813 DOI: 10.1016/j.appet.2023.106491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 02/03/2023] [Accepted: 02/09/2023] [Indexed: 02/12/2023]
Abstract
Anxiety and snacking increased during the initial coronavirus disease 2019 (COVID-19) lockdowns, but it remains unknown whether this change in snacking persisted and if it related to anxiety levels. We used prospective data to examine changes in snacking frequency from t1 (eased restrictions in England in May-June 2020) to t2 (national lockdown in December 2020-March 2021), the association of anxiety (assessed by the Generalised Anxiety Disorder-7 questionnaire at t1) with the snacking change, and the mediating and moderating effects of disinhibition and flexible restraint (assessed by the Three Factor Eating Questionnaire in 2016-17). Analyses including 2128 adults (mean age 28.4 y) residing in England from the Avon Longitudinal Study of Parents and Children showed that snacking frequency increased over time (mean change 1.23 (95% CI 0.81, 1.65) snacks/wk). Linear regressions of snacking adjusted for sociodemographic covariates showed that having clinical levels of generalised anxiety at t1, versus not, was associated with 1.22 (95% CI 0.07, 2.37) more snacks/wk at t2. Disinhibition partially mediated the association between Generalised Anxiety Disorder and snacking (βindirect = 0.15, 95% CI 0.01, 0.32), while there was no evidence that flexible restraint moderated the association (β = 0.05, 95% CI -0.57, 0.66). Our longitudinal findings highlight a detrimental anxiety-snacking association partly operating via disinhibition, suggesting future research could target mitigating anxiety and disinhibited eating behaviours to benefit diet-related outcomes following the pandemic.
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Affiliation(s)
- Esther L. Curtin
- Population Health Sciences, University of Bristol, BS8 2PS, UK,Corresponding author. Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Laura Johnson
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, BS8 1TZ, Bristol, UK; NatCen Social Research, 35 Northampton Square, London, EC1V 0AX, UK.
| | - Ruth Salway
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, BS8 1TZ, Bristol, UK.
| | - Elanor C. Hinton
- NIHR Bristol Biomedical Research Centre, Nutrition Theme, University of Bristol, BS2 8AE, Bristol, UK
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12
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Bulungu ALS, Palla L, Nambooze J, Priebe J, Forsythe L, Katic P, Varley G, Galinda BD, Sarah N, Wellard K, Ferguson EL. Automated wearable cameras for improving recall of diet and time use in Uganda: a cross-sectional feasibility study. Nutr J 2023; 22:7. [PMID: 36635676 PMCID: PMC9835269 DOI: 10.1186/s12937-022-00828-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 11/28/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Traditional recall approaches of data collection for assessing dietary intake and time use are prone to recall bias. Studies in high- and middle-income countries show that automated wearable cameras are a promising method for collecting objective health behavior data and may improve study participants' recall of foods consumed and daily activities performed. This study aimed to evaluate the feasibility of using automated wearable cameras in rural Eastern Ugandan to collect dietary and time use data. METHODS Mothers of young children (n = 211) wore an automated wearable camera on 2 non-consecutive days while continuing their usual activities. The day after wearing the camera, participants' dietary diversity and time use was assessed using an image-assisted recall. Their experiences of the method were assessed via a questionnaire. RESULTS Most study participants reported their experiences with the automated wearable camera and image-assisted recall to be good (36%) or very good (56%) and would participate in a similar study in the future (97%). None of the eight study withdrawals could be definitively attributed to the camera. Fifteen percent of data was lost due to device malfunction, and twelve percent of the images were "uncodable" due to insufficient lighting. Processing and analyzing the images were labor-intensive, time-consuming, and prone to human error. Half (53%) of participants had difficulty interpreting the images captured by the camera. CONCLUSIONS Using an automated wearable camera in rural Eastern Uganda was feasible, although improvements are needed to overcome the challenges common to rural, low-income country contexts and reduce the burdens posed on both participants and researchers. To improve the quality of data obtained, future automated wearable camera-based image assisted recall studies should use a structured data format to reduce image coding time; electronically code the data in the field, as an output of the image review process, to eliminate ex post facto data entry; and, ideally, use computer-assisted personal interviews software to ensure completion and reduce errors. In-depth formative work in partnership with key local stakeholders (e.g., researchers from low-income countries, representatives from government and/or other institutional review boards, and community representatives and local leaders) is also needed to identify practical approaches to ensuring that the ethical rights of automated wearable camera study participants in low-income countries are adequately protected.
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Affiliation(s)
- Andrea L. S. Bulungu
- grid.8991.90000 0004 0425 469XDepartment of Population Health, London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London, WC1E 7HT UK
| | - Luigi Palla
- grid.7841.aDepartment of Public Health and Infectious Diseases, University of Roma La Sapienza, 00185 Rome, Italy ,grid.8991.90000 0004 0425 469XDepartment of Medical Statistics, London School of Hygiene and Tropical Medicine, London, WC1E 7HT UK ,grid.444715.70000 0000 8673 4005School of Tropical Medicine and Global Health, University of Nagasaki, Nagasaki, 852-8102 Japan
| | - Joweria Nambooze
- grid.450043.6Africa Innovations Institute (AfrII), P.O Box 34981, Kampala, Uganda ,grid.442642.20000 0001 0179 6299Department of Nutritional Sciences and Dietetics, Kyambogo University, Kyambogo, P.O. Box 1, Kampala, Uganda
| | - Jan Priebe
- grid.36316.310000 0001 0806 5472Natural Resources Institute (NRI), University of Greenwich, Chatham Maritime, Kent, ME4 4TB UK
| | - Lora Forsythe
- grid.36316.310000 0001 0806 5472Natural Resources Institute (NRI), University of Greenwich, Chatham Maritime, Kent, ME4 4TB UK
| | - Pamela Katic
- grid.36316.310000 0001 0806 5472Natural Resources Institute (NRI), University of Greenwich, Chatham Maritime, Kent, ME4 4TB UK
| | - Gwen Varley
- grid.36316.310000 0001 0806 5472Natural Resources Institute (NRI), University of Greenwich, Chatham Maritime, Kent, ME4 4TB UK
| | - Bernice D. Galinda
- grid.8991.90000 0004 0425 469XDepartment of Population Health, London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London, WC1E 7HT UK
| | - Nakimuli Sarah
- grid.8991.90000 0004 0425 469XDepartment of Population Health, London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London, WC1E 7HT UK
| | - Kate Wellard
- grid.36316.310000 0001 0806 5472Natural Resources Institute (NRI), University of Greenwich, Chatham Maritime, Kent, ME4 4TB UK
| | - Elaine L. Ferguson
- grid.8991.90000 0004 0425 469XDepartment of Population Health, London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London, WC1E 7HT UK
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Whitton C, Ramos-García C, Kirkpatrick SI, Healy JD, Dhaliwal SS, Boushey CJ, Collins CE, Rollo ME, Kerr DA. A Systematic Review Examining Contributors to Misestimation of Food and Beverage Intake Based on Short-Term Self-Report Dietary Assessment Instruments Administered to Adults. Adv Nutr 2022; 13:2620-2665. [PMID: 36041186 PMCID: PMC9776649 DOI: 10.1093/advances/nmac085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 07/15/2022] [Accepted: 08/02/2022] [Indexed: 01/29/2023] Open
Abstract
Error in self-reported food and beverage intake affects the accuracy of dietary intake data. Systematically synthesizing available data on contributors to error within and between food groups has not been conducted but may help inform error mitigation strategies. In this review we aimed to systematically identify, quantify, and compare contributors to error in estimated intake of foods and beverages, based on short-term self-report dietary assessment instruments, such as 24-h dietary recalls and dietary records. Seven research databases were searched for studies including self-reported dietary assessment and a comparator measure of observed intake (e.g., direct observation or controlled feeding studies) in healthy adults up until December 2021. Two reviewers independently screened and extracted data from included studies, recording quantitative data on omissions, intrusions, misclassifications, and/or portion misestimations. Risk of bias was assessed using the QualSyst tool. A narrative synthesis focused on patterns of error within and between food groups. Of 2328 articles identified, 29 met inclusion criteria and were included, corresponding to 2964 participants across 15 countries. Most frequently reported contributors to error were omissions and portion size misestimations of food/beverage items. Although few consistent patterns were seen in omission of consumed items, beverages were omitted less frequently (0-32% of the time), whereas vegetables (2-85%) and condiments (1-80%) were omitted more frequently than other items. Both under- and overestimation of portion size was seen for most single food/beverage items within study samples and most food groups. Studies considered and reported error in different ways, impeding the interpretation of how error contributors interact to impact overall misestimation. We recommend that future studies report 1) all error contributors for each food/beverage item evaluated (i.e., omission, intrusion, misclassification, and portion misestimation), and 2) measures of variation of the error. The protocol of this review was registered in PROSPERO as CRD42020202752 (https://www.crd.york.ac.uk/prospero/).
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Affiliation(s)
- Clare Whitton
- Curtin School of Population Health, Curtin University, Perth, WA, Australia
- Curtin Health Innovation Research Institute, Curtin University, Perth, WA, Australia
| | - César Ramos-García
- Curtin School of Population Health, Curtin University, Perth, WA, Australia
- Division of Health Sciences, Tonalá University Center, University of Guadalajara, Guadalajara, Mexico
| | | | - Janelle D Healy
- Curtin School of Population Health, Curtin University, Perth, WA, Australia
- Curtin Health Innovation Research Institute, Curtin University, Perth, WA, Australia
| | - Satvinder S Dhaliwal
- Curtin Health Innovation Research Institute, Curtin University, Perth, WA, Australia
- Duke-NUS Medical School, National University of Singapore, Singapore
- Institute for Research in Molecular Medicine (INFORMM), Universiti Sains Malaysia, Pulau Pinang, Malaysia
- Singapore University of Social Sciences, Singapore
| | - Carol J Boushey
- Epidemiology Program, University of Hawaii Cancer Center, Honolulu, HI, USA
| | - Clare E Collins
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
- Food and Nutrition Research Program, Hunter Medical Research Institute, New Lambton, NSW, Australia
| | - Megan E Rollo
- Curtin School of Population Health, Curtin University, Perth, WA, Australia
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14
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Davison KM, Araujo Almeida V, Gondara L. Lower Energy-Adjusted Nutrient Intakes Occur Among Food Energy Under-Reporters With Poor Mental Health. Front Nutr 2022; 9:833354. [PMID: 36003837 PMCID: PMC9393501 DOI: 10.3389/fnut.2022.833354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 06/20/2022] [Indexed: 11/28/2022] Open
Abstract
Background Food energy under-reporting is differentially distributed among populations. Currently, little is known about how mental health state may affect energy-adjusted nutrient intakes among food energy under-reporters. Methods Stratified analysis of energy-adjusted nutrient intake by mental health (poor vs. good) and age/sex was conducted using data from Canadian Community Health Survey (CCHS) respondents (14–70 years; n = 8,233) who were deemed as under-reporters based on Goldberg's cutoffs. Results Most were experiencing good mental health (95.2%). Among those reporting poor mental health, significantly lower energy-adjusted nutrient intakes tended to be found for fiber, protein, vitamins A, B2, B3, B6, B9, B12, C, and D, and calcium, potassium, and zinc (probability measures (p) < 0.05). For women (51–70 years), all micronutrient intakes, except iron, were significantly lower among those reporting poor mental health (p < 0.05). For men (31–50 years), B vitamin and most mineral intakes, except sodium, were significantly lower among those reporting poor mental health (p < 0.05). Among women (31–50 years) who reported poor mental health, higher energy-adjusted intakes were reported for vitamin B9 and phosphorus (p < 0.05). Conclusions Among food energy under-reporters, poor mental health tends to lower the report of specific energy-adjusted nutrient intakes that include ones critical for mental health. Future research is needed to discern if these differences may be attributed to deviations in the accurate reports of food intakes, measurement errors, or mental health states.
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Affiliation(s)
- Karen M Davison
- Health Science, Kwantlen Polytechnic University, Richmond, BC, Canada
| | - Vanessa Araujo Almeida
- College of Tropical Agriculture & Human Resources, University of Hawai'i at Mānoa, Honolulu, HI, United States
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15
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Psychological distress and its association with intake of sugar-sweetened beverages, discretionary foods, and alcohol, in women during COVID-19, in Australia. Nutrition 2022; 103-104:111794. [PMID: 36055124 PMCID: PMC9427120 DOI: 10.1016/j.nut.2022.111794] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 05/24/2022] [Accepted: 07/01/2022] [Indexed: 11/22/2022]
Abstract
Objectives This study aimed to explore psychological distress, lifestyle, and demographic factors, as well as their relationship to discretionary choices in women of reproductive age during the coronavirus disease 2019 pandemic in Australia. Methods Reproductive-aged women (18–50 y) in Australia participated in a national online survey. Psychological distress score (using a validated 10-item Kessler Psychological Distress Scale questionnaire) was the primary exposure of interest, and key outcomes were frequencies of discretionary choices (sugar-sweetened beverages [SSBs], alcohol, and discretionary foods). Sociodemographic and physical activity data were also collected. Logistic regression was used to report adjusted odds ratio (aOR) and 95% confidence interval to predict SSBs (less than weekly; most days/daily), total discretionary foods (none/<2 times/d; ≥3 times/d), and alcohol use (never/less than monthly; most weeks/daily). Results A total of 1005 women were included in the study, of whom 40% had a high level of psychological distress. Women with high psychological distress (aOR: 1.96; 95% CI, 1.32–2.91) and those who gained weight during the pandemic (aOR: 1.71; 95% CI, 1.10–2.65) were more likely to consume discretionary foods ≥3 times/d. There was no association between psychological distress and SSB intake or alcohol; however, Australian, New Zealander, or Pacific Islander background (aOR: 1.68; 95% CI, 1.21–2.33) and more hours of sitting time (aOR: 1.88; 95% CI, 1.07–3.29) were associated with SSB consumption on most days/daily. Older age (aOR: 1.70; 95% CI, 1.00–2.89), higher household income (aOR: 1.44; 95% CI, 1.08–1.92), and moderate or high physical activity (aOR: 1.75; 95% CI, 1.10–2.80) were associated with alcohol intake on most weeks/daily. Conclusions Public health messaging to promote healthy eating should take into account the effect of psychological distress on health behavior. Messages aimed at maintaining a positive relationship between food intake and mental wellbeing, particularly among vulnerable groups, are warranted.
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Song X, Wang H, Su C, Wang Z, Zhang J, Ding G, Zhang B. Secular Trends in Time-of-Day of Energy Intake in a Chinese Cohort. Nutrients 2022; 14:2019. [PMID: 35631162 PMCID: PMC9146504 DOI: 10.3390/nu14102019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 05/02/2022] [Accepted: 05/10/2022] [Indexed: 11/16/2022] Open
Abstract
Few studies have described the status and change of time-of-day of energy intake on a population level. This study aims to investigate the secular trend in time-of-day of energy intake using a Chinese cohort, and to examine demographic disparities in trends. A total of 20,976 adults with at least two waves of dietary data in the China Health and Nutrition Survey (CHNS 1991-2018) were included. A multilevel linear mixed model was applied to the energy proportions of breakfast, lunch and dinner. A multilevel Tobit regression model was applied to the energy proportion of morning snack, afternoon snack and evening snack. Time-demographic interaction terms were tested to examine demographic disparities in the trends. From 1991 to 2018, the marginal mean of the energy proportion of breakfast experienced first a falling and then a rising trend, and the marginal mean of energy proportions of lunch and dinner both presented first a rising and then a falling trend. The marginal means of all snacks took on a rising trend. Significant time-demographic interactions were observed for energy proportion of each eating occasion. On average, female, older and rural people tended to have a higher energy proportion at breakfast and lower energy proportion at lunch and dinner. Female, younger and urban people tended to have higher snack energy proportions. The time-of-day of energy intake has first shifted towards later in the day and then towards a balanced meal pattern in this Chinese cohort. Demographic disparities were observed in both the secular trend and the mean level of energy proportions of eating occasions. The health implications of such meal patterns warrant further investigation.
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Affiliation(s)
- Xiaoyun Song
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China; (X.S.); (H.W.); (C.S.); (Z.W.); (J.Z.); (G.D.)
- National Health Commission Key Laboratory of Trace Element Nutrition, Beijing 100050, China
| | - Huijun Wang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China; (X.S.); (H.W.); (C.S.); (Z.W.); (J.Z.); (G.D.)
- National Health Commission Key Laboratory of Trace Element Nutrition, Beijing 100050, China
| | - Chang Su
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China; (X.S.); (H.W.); (C.S.); (Z.W.); (J.Z.); (G.D.)
- National Health Commission Key Laboratory of Trace Element Nutrition, Beijing 100050, China
| | - Zhihong Wang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China; (X.S.); (H.W.); (C.S.); (Z.W.); (J.Z.); (G.D.)
- National Health Commission Key Laboratory of Trace Element Nutrition, Beijing 100050, China
| | - Jiguo Zhang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China; (X.S.); (H.W.); (C.S.); (Z.W.); (J.Z.); (G.D.)
- National Health Commission Key Laboratory of Trace Element Nutrition, Beijing 100050, China
| | - Gangqiang Ding
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China; (X.S.); (H.W.); (C.S.); (Z.W.); (J.Z.); (G.D.)
- National Health Commission Key Laboratory of Trace Element Nutrition, Beijing 100050, China
| | - Bing Zhang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China; (X.S.); (H.W.); (C.S.); (Z.W.); (J.Z.); (G.D.)
- National Health Commission Key Laboratory of Trace Element Nutrition, Beijing 100050, China
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17
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Children's Community Nutrition Environment, Food and Drink Purchases and Consumption on Journeys between Home and School: A Wearable Camera Study. Nutrients 2022; 14:nu14101995. [PMID: 35631135 PMCID: PMC9146069 DOI: 10.3390/nu14101995] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/06/2022] [Accepted: 05/07/2022] [Indexed: 02/05/2023] Open
Abstract
Children's community nutrition environments are an important contributor to childhood obesity rates worldwide. This study aimed to measure the type of food outlets on children's journeys to or from school, children's food purchasing and consumption, and to determine differences by ethnicity and socioeconomic status. In this New Zealand study, we analysed photographic images of the journey to or from school from a sample of 147 children aged 11-13 years who wore an Autographer camera which recorded images every 7 s. A total of 444 journeys to or from school were included in the analysis. Camera images captured food outlets in 48% of journeys that had a component of active travel and 20% of journeys by vehicle. Children who used active travel modes had greater odds of exposure to unhealthy food outlets than children who used motorised modes; odds ratio 4.2 (95% CI 1.2-14.4). There were 82 instances of food purchases recorded, 84.1% of which were for discretionary foods. Of the 73 food and drink consumption occasions, 94.5% were for discretionary food or drink. Children on their journeys to or from school are frequently exposed to unhealthy food outlets. Policy interventions are recommended to limit the availability of unhealthy food outlets on school routes.
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Bulungu ALS, Palla L, Priebe J, Forsythe L, Katic P, Varley G, Galinda BD, Sarah N, Nambooze J, Wellard K, Ferguson EL. Validation of an Automated Wearable Camera-Based Image-Assisted Recall Method and the 24-h Recall Method for Assessing Women's Time Allocation in a Nutritionally Vulnerable Population: The Case of Rural Uganda. Nutrients 2022; 14:nu14091833. [PMID: 35565802 PMCID: PMC9101468 DOI: 10.3390/nu14091833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 04/24/2022] [Accepted: 04/26/2022] [Indexed: 11/16/2022] Open
Abstract
Accurate data are essential for investigating relationships between maternal time-use patterns and nutritional outcomes. The 24 h recall (24HR) has traditionally been used to collect time-use data, however, automated wearable cameras (AWCs) with an image-assisted recall (IAR) may reduce recall bias. This study aimed to evaluate their concurrent criterion validity for assessing women’s time use in rural Eastern Ugandan. Women’s (n = 211) time allocations estimated via the AWC-IAR and 24HR methods were compared with direct observation (criterion method) using the Bland–Altman limits of agreement (LOA) method of analysis and Cronbach’s coefficient alpha (time allocation) or Cohen’s κ (concurrent activities). Systematic bias varied from 1 min (domestic chores) to 226 min (caregiving) for 24HR and 1 min (own production) to 109 min (socializing) for AWC-IAR. The LOAs were within 2 h for employment, own production, and self-care for 24HR and AWC-IAR but exceeded 11 h (24HR) and 9 h (AWC-IAR) for caregiving and socializing. The LOAs were within four concurrent activities for 24HR (−1.1 to 3.7) and AWC-IAR (−3.2 to 3.2). Cronbach’s alpha for time allocation ranged from 0.1728 (socializing) to 0.8056 (own production) for 24HR and 0.2270 (socializing) to 0.7938 (own production) for AWC-IAR. For assessing women’s time allocations at the population level, the 24HR and AWC-IAR methods are accurate and reliable for employment, own production, and domestic chores but poor for caregiving and socializing. The results of this study suggest the need to revisit previously published research investigating the associations between women’s time allocations and nutrition outcomes.
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Affiliation(s)
- Andrea L. S. Bulungu
- Department of Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK; (B.D.G.); (N.S.); (E.L.F.)
- Correspondence: (A.L.S.B.); (L.P.)
| | - Luigi Palla
- Department of Public Health and Infectious Diseases, University of Roma La Sapienza, 00185 Rome, Italy
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
- School of Tropical Medicine and Global Health, University of Nagasaki, Nagasaki 852-8102, Japan
- Correspondence: (A.L.S.B.); (L.P.)
| | - Jan Priebe
- Natural Resources Institute (NRI), University of Greenwich, Chatham Maritime, Kent ME4 4TB, UK; (J.P.); (L.F.); (P.K.); (G.V.); (K.W.)
| | - Lora Forsythe
- Natural Resources Institute (NRI), University of Greenwich, Chatham Maritime, Kent ME4 4TB, UK; (J.P.); (L.F.); (P.K.); (G.V.); (K.W.)
| | - Pamela Katic
- Natural Resources Institute (NRI), University of Greenwich, Chatham Maritime, Kent ME4 4TB, UK; (J.P.); (L.F.); (P.K.); (G.V.); (K.W.)
| | - Gwen Varley
- Natural Resources Institute (NRI), University of Greenwich, Chatham Maritime, Kent ME4 4TB, UK; (J.P.); (L.F.); (P.K.); (G.V.); (K.W.)
| | - Bernice D. Galinda
- Department of Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK; (B.D.G.); (N.S.); (E.L.F.)
| | - Nakimuli Sarah
- Department of Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK; (B.D.G.); (N.S.); (E.L.F.)
| | - Joweria Nambooze
- Africa Innovations Institute (AfrII), Kampala P.O. Box 34981, Uganda;
- Department of Nutritional Sciences and Dietetics, Kyambogo University, Kyambogo, Kampala P.O. Box 1, Uganda
| | - Kate Wellard
- Natural Resources Institute (NRI), University of Greenwich, Chatham Maritime, Kent ME4 4TB, UK; (J.P.); (L.F.); (P.K.); (G.V.); (K.W.)
| | - Elaine L. Ferguson
- Department of Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK; (B.D.G.); (N.S.); (E.L.F.)
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Misreporting of dietary energy intake obtained by 24 h recalls in older adults: a comparison of five previous methods using doubly labeled water. Eur J Clin Nutr 2022; 76:535-543. [PMID: 34462557 DOI: 10.1038/s41430-021-00998-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 07/28/2021] [Accepted: 08/06/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND/OBJECTIVE To test five different methods to detect misreporting in comparison to doubly labeled water in a sample of older adults. SUBJECTS/METHODS A cross-sectional study with thirty-eight Brazilian community-dwelling older adults aged 60-84 years, who had their total energy expenditure measured by doubly labeled water (TEEDLW). Dietary data were collected by two 24 h recalls. Misreporting was compared with estimates obtained by the methods proposed by: Goldberg et al. [1, 2], Black [3], McCrory et al. [4], Huang et al [5], and Rennie et al [6]. Bland-Altman plots with 95% limits of agreement were constructed to assess the agreement between rEI and TEEDLW. Weighted kappa coefficients, sensitivity and specificity analyses, and area under the receiving operator characteristic curve (AUC) were used to test the performance of each method. RESULTS The prevalence of under-reporters (UR) and over-reporters (OR) obtained by the reference (DLW) were 57.9% (n = 22) and 5.3% (n = 2), respectively. Black [3] presented the worst agreement and McCrory et al. [4] the best one to accurately classify individuals in the three categories of energy reporting. McCrory et al. [4] had the best performance in the sensitivity and specificity analyses detecting UR and plausible reporters. CONCLUSIONS There was a high prevalence of misreporting, especially underreporting, in this sample of community-dwelling Brazilian older adults. The study showed a wide variation in the accuracy of predictive methods to handle misreporting, with none of the equations showing outstanding agreement with the reference. When DLW is not available, a valid method should be chosen to address energy intake reporting.
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Waterworth SP, Kerr CJ, McManus CJ, Costello R, Sandercock GRH. Obese individuals do not underreport dietary intake to a greater extent than nonobese individuals when data are allometrically‐scaled. Am J Hum Biol 2022; 34:e23743. [PMID: 35257435 PMCID: PMC9286371 DOI: 10.1002/ajhb.23743] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 02/21/2022] [Accepted: 02/27/2022] [Indexed: 01/25/2023] Open
Abstract
Objective The aim of this study was to assess the extent of misreporting in obese and nonobese adults on an absolute, ratio‐scaled, and allometrically‐scaled basis. Method Self‐reported daily energy intake (EI) was compared with total energy expenditure (TEE) in 221 adults (106 male, 115 female; age 53 ± 17 years, stature 1.68 ± 0.09 m, mass 79.8 ± 17.2 kg) who participated in a doubly‐labeled water (DLW) subsection of 2013–2015 National Diet and Nutrition Survey. Data were log transformed and expressed as absolute values, according to simple ratio‐standards (per kg body mass) and adjusted for body mass allometrically. Absolute and ratio‐scaled misreporting were examined using full‐factorial General Linear Models with repeated measures of the natural logarithms of TEE or EI as the within‐subjects factor. The natural logarithm of body mass was included as a covariate in the allometric method. The categorical variables of gender, age, obesity, and physical activity level (PAL) were the between‐factor variables. Results On an absolute‐basis, self‐reported EI (2759 ± 590 kcal·d−1) was significantly lower than TEE measured by DLW (2759 ± 590 kcal·d−1: F1,205 = 598.81, p < .001, ηp2 =0.75). We identified significantly greater underreporting in individuals with an obese BMI (F1,205 = 29.01, p <.001, ηp2 =0.12), in more active individuals (PAL > 1.75; F1,205 = 34.15, p <.001, ηp2 =0.14) and in younger individuals (≤55 years; F1,205 = 14.82, p < .001, ηp2 =0.07), which are all categories with higher energy needs. Ratio‐scaling data reduced the effect sizes. Allometric‐scaling removed the effect of body mass (F1,205 =0.02, p = 0.887, ηp2 =0.00). Conclusion In weight‐stable adults, obese individuals do not underreport dietary intake to a greater extent than nonobese individuals. These results contradict previous research demonstrating that obesity is associated with a greater degree of underreporting.
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Affiliation(s)
- Sally P. Waterworth
- School of Sport, Rehabilitation, and Exercise Sciences University of Essex Essex UK
| | - Catherine J. Kerr
- School of Sport, Rehabilitation, and Exercise Sciences University of Essex Essex UK
| | | | - Rianne Costello
- Oxford Brookes Centre for Nutrition and Health Oxford Brookes University Oxford UK
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Naja F, Ismail LC, Abbas N, Saleh S, Ali HI. Adherence to the Mediterranean diet and its association with environmental footprints among women of childbearing age in the United Arab Emirates. Eur J Nutr 2022; 61:2585-2599. [PMID: 35229167 DOI: 10.1007/s00394-022-02835-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 02/09/2022] [Indexed: 12/20/2022]
Abstract
PURPOSE To examine the association of adherence to the Mediterranean Diet (MD) with Environmental Footprints (EFPs) among women of childbearing age in the United Arab Emirates (UAE). METHODS Data belonging to a nationally representative sample of 482 women (19-50 years) were derived from a previous survey in the UAE. In face-to-face interviews, participants completed questionnaires addressing sociodemographic, physical activity, and dietary intake characteristics; the latter assessed using a multiple pass 24-h recall. The composite Mediterranean (c-MED) index was used to examine the adherence to the MD. Metrics for the EFPs (water use, energy use, and GHG emissions) were calculated using Life Cycle Analyses. Descriptive statistics and linear regressions were used in data analysis. RESULTS In the study sample, the distribution of the c-MED scores was skewed to the right, indicating a low adherence to the MD. The lowest contributions to the total c-MED score were observed for legumes (2.9%) and olive oil (1.8%). The EFPs associated with food consumption per 1000 kcal were: water use: 1256.89 ± 544.95 L/day; energy use: 18.01 ± 7.85 MJ/day, and GHG: 2.46 ± 1.46 kg CO2 eq/day. After adjustment for age, energy intake, and potential confounders, being adherent to the MD was associated with 540.57 [95% CI (- 726.6; - 354.54)] units decrease in water use and 0.94 units decrease in GHG emissions [95% CI (- 1.45; - 0.43)]. CONCLUSIONS The findings of this study revealed an inverse association between adherence to the MD and EFPs. As such, the MD may represent a promising dietary strategy to improve health outcomes and reduce the environmental impact. Public health programs addressing the low adherence to the MD among women of childbearing age in the UAE are warranted.
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Affiliation(s)
- Farah Naja
- Department of Clinical Nutrition and Dietetics, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
- Research Institute of Medical and Health Sciences (RIMHS), University of Sharjah, Sharjah, United Arab Emirates
- Department of Nutrition and Food Sciences, Faculty of Agriculture and Food Sciences, American University of Beirut, Beirut, Lebanon
| | - Leila Cheikh Ismail
- Department of Clinical Nutrition and Dietetics, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
- Research Institute of Medical and Health Sciences (RIMHS), University of Sharjah, Sharjah, United Arab Emirates
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
| | - Nada Abbas
- Department of Nutrition and Food Sciences, Faculty of Agriculture and Food Sciences, American University of Beirut, Beirut, Lebanon
| | - Sheima Saleh
- Department of Clinical Nutrition and Dietetics, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Habiba I Ali
- Department of Nutrition and Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates.
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22
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Gioia SC, Guirette M, Chen A, Tucker C, Gray BE, Vetter C, Garaulet M, Scheer FAJL, Saxena R, Dashti HS. How Accurately Can We Recall the Timing of Food Intake? A Comparison of Food Times from Recall-Based Survey Questions and Daily Food Records. Curr Dev Nutr 2022; 6:nzac002. [PMID: 35198846 PMCID: PMC8856939 DOI: 10.1093/cdn/nzac002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 12/07/2021] [Accepted: 01/06/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND There currently are no standard, low-cost, and validated methods to assess the timing of food intake. OBJECTIVES The aim of this study was to validate simple, recall-based questions that can characterize food timing in free-living populations. METHODS The concordance between recall-based survey questions and food times estimated from multiple daily food records was assessed in 249 generally healthy, free-living adults from the Shift Work, Heredity, Insulin, and Food Timing (SHIFT) Study. At baseline, participants were asked: "At what time do you first start and stop eating on weekdays/workdays and weekends/non-workdays?" and "At what time do you have your main meal on weekdays/workdays and weekends/non-workdays?" Participants were then asked to complete ≤14 d of food records noting the start time of each eating occasion. The timing of the first, last, and main (largest percentage calories) eating occasions were determined from food records. Wilcoxon matched pairs signed rank and Kendall's coefficient of concordance were used to compare differences and determine agreements between the methods for these food timing parameters, as well as for the midpoint between first and last eating occasion. RESULTS Eating occasions on work and free days showed significant agreements between the 2 methods, except for the main eating occasion on free days. Significant agreements were generally modest and ranged from 0.16 (workdays main eating occasion) to 0.45 (workdays first eating occasion). Generally, times based on recall were later than those estimated from food records, and the differences in estimated times were smaller on workdays compared with free days, and smaller for the first compared with the last eating occasion. Main eating occasions from food records often varied between lunch and dinner times, contributing to low concordance with recalled times. CONCLUSIONS Modest agreements were found between food times derived from simple, recall-based survey questions and food times estimated from multiple-day food records. Single administration of these questions can effectively characterize the overall timing of eating occasions within a population for chrononutrition research purposes.
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Affiliation(s)
- Siena C Gioia
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Mélanie Guirette
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Friedman School of Nutrition Science and Policy at Tufts, Tufts University, Boston, MA, USA
| | - Angela Chen
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Chandler Tucker
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Brianna E Gray
- Translational and Clinical Research Centers, Massachusetts General Hospital, Boston, MA, USA
| | - Céline Vetter
- Department of Integrative Physiology, University of Colorado, Boulder, CO, USA
- Broad Institute, Cambridge, MA, USA
| | - Marta Garaulet
- Department of Physiology, University of Murcia, Murcia, Spain
- IMIB-Arrixaca, Murcia, Spain
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA, USA
| | - Frank A J L Scheer
- Broad Institute, Cambridge, MA, USA
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA, USA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
| | - Richa Saxena
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Broad Institute, Cambridge, MA, USA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Hassan S Dashti
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Broad Institute, Cambridge, MA, USA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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Turck D, Bohn T, Castenmiller J, de Henauw S, Hirsch‐Ernst KI, Knutsen HK, Maciuk A, Mangelsdorf I, McArdle HJ, Naska A, Peláez C, Pentieva K, Siani A, Thies F, Tsabouri S, Adan R, Emmett P, Galli C, Kersting M, Moynihan P, Tappy L, Ciccolallo L, de Sesmaisons‐Lecarré A, Fabiani L, Horvath Z, Martino L, Muñoz Guajardo I, Valtueña Martínez S, Vinceti M. Tolerable upper intake level for dietary sugars. EFSA J 2022; 20:e07074. [PMID: 35251356 PMCID: PMC8884083 DOI: 10.2903/j.efsa.2022.7074] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Following a request from five European Nordic countries, the EFSA Panel on Nutrition, Novel Foods and Food Allergens (NDA) was tasked to provide scientific advice on a tolerable upper intake level (UL) or a safe level of intake for dietary (total/added/free) sugars based on available data on chronic metabolic diseases, pregnancy-related endpoints and dental caries. Specific sugar types (fructose) and sources of sugars were also addressed. The intake of dietary sugars is a well-established hazard in relation to dental caries in humans. Based on a systematic review of the literature, prospective cohort studies do not support a positive relationship between the intake of dietary sugars, in isocaloric exchange with other macronutrients, and any of the chronic metabolic diseases or pregnancy-related endpoints assessed. Based on randomised control trials on surrogate disease endpoints, there is evidence for a positive and causal relationship between the intake of added/free sugars and risk of some chronic metabolic diseases: The level of certainty is moderate for obesity and dyslipidaemia (> 50-75% probability), low for non-alcoholic fatty liver disease and type 2 diabetes (> 15-50% probability) and very low for hypertension (0-15% probability). Health effects of added vs. free sugars could not be compared. A level of sugars intake at which the risk of dental caries/chronic metabolic diseases is not increased could not be identified over the range of observed intakes, and thus, a UL or a safe level of intake could not be set. Based on available data and related uncertainties, the intake of added and free sugars should be as low as possible in the context of a nutritionally adequate diet. Decreasing the intake of added and free sugars would decrease the intake of total sugars to a similar extent. This opinion can assist EU Member States in setting national goals/recommendations.
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Lentjes MAH, Oude Griep LM, Mulligan AA, Montgomery S, Wareham NJ, Khaw KT. Face Validity of Observed Meal Patterns Reported with 7-Day Diet Diaries in a Large Population-Based Cohort Using Diurnal Variation in Concentration Biomarkers of Dietary Intake. Nutrients 2022; 14:238. [PMID: 35057419 PMCID: PMC8780432 DOI: 10.3390/nu14020238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 12/26/2021] [Accepted: 12/28/2021] [Indexed: 12/04/2022] Open
Abstract
In a cross-sectional analysis of a population-based cohort (United Kingdom, N = 21,318, 1993-1998), we studied how associations between meal patterns and non-fasting triglyceride and glucose concentrations were influenced by the hour of day at which the blood sample was collected to ascertain face validity of reported meal patterns, as well as the influence of reporting bias (assessed using formula of energy expenditure) on this association. Meal size (i.e., reported energy content), mealtime and meal frequency were reported using pre-structured 7-day diet diaries. In ANCOVA, sex-specific means of biomarker concentrations were calculated by hour of blood sample collection for quartiles of reported energy intake at breakfast, lunch and dinner (meal size). Significant interactions were observed between breakfast size, sampling time and triglyceride concentrations and between lunch size, sampling time and triglyceride, as well as glucose concentrations. Those skipping breakfast had the lowest triglyceride concentrations in the morning and those skipping lunch had the lowest triglyceride and glucose concentrations in the afternoon, especially among acceptable energy reporters. Eating and drinking occasion frequency was weakly associated with glucose concentrations in women and positively associated with triglyceride concentrations in both sexes; stronger associations were observed for larger vs. smaller meals and among acceptable energy reporters. Associations between meal patterns and concentration biomarkers can be observed when accounting for diurnal variation and underreporting. These findings support the use of 7-day diet diaries for studying associations between meal patterns and health.
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Affiliation(s)
- Marleen A. H. Lentjes
- Department of Public Health and Primary Care, University of Cambridge, Cambridge CB1 8RN, UK; (A.A.M.); (K.-T.K.)
- Clinical Epidemiology and Biostatistics/Nutrition Gut Brain Interactions Research Centre, School of Medical Sciences, Örebro University, 70182 Örebro, Sweden;
| | - Linda M. Oude Griep
- MRC Epidemiology Unit, Institute of Metabolic Sciences, University of Cambridge, Cambridge CB2 0QQ, UK; (L.M.O.G.); (N.J.W.)
- NIHR Biomedical Research Centre, Diet, Anthropometry and Physical Activity (DAPA) Group, MRC Epidemiology Unit, University of Cambridge, Cambridge CB2 0QQ, UK
| | - Angela A. Mulligan
- Department of Public Health and Primary Care, University of Cambridge, Cambridge CB1 8RN, UK; (A.A.M.); (K.-T.K.)
- NIHR Biomedical Research Centre, Diet, Anthropometry and Physical Activity (DAPA) Group, MRC Epidemiology Unit, University of Cambridge, Cambridge CB2 0QQ, UK
| | - Scott Montgomery
- Clinical Epidemiology and Biostatistics/Nutrition Gut Brain Interactions Research Centre, School of Medical Sciences, Örebro University, 70182 Örebro, Sweden;
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institute, 17177 Stockholm, Sweden
- Department of Epidemiology and Public Health, University College London, London WC1E 6BT, UK
| | - Nick J. Wareham
- MRC Epidemiology Unit, Institute of Metabolic Sciences, University of Cambridge, Cambridge CB2 0QQ, UK; (L.M.O.G.); (N.J.W.)
| | - Kay-Tee Khaw
- Department of Public Health and Primary Care, University of Cambridge, Cambridge CB1 8RN, UK; (A.A.M.); (K.-T.K.)
- School of Clinical Medicine/Clinical Gerontology, University of Cambridge, Cambridge CB1 8RN, UK
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Yasuda J, Murata K, Hasegawa T, Yamamura M, Maeo S, Takegaki J, Tottori N, Yokokawa T, Mori R, Arimitsu T, Nishikori S, Fujita S. Relation between protein intake and resistance training-induced muscle hypertrophy in middle-aged women: a pilot study. Nutrition 2022; 97:111607. [DOI: 10.1016/j.nut.2022.111607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 01/12/2022] [Accepted: 01/18/2022] [Indexed: 11/26/2022]
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Ricciuto L, Fulgoni VL, Gaine PC, Scott MO, DiFrancesco L. Trends in Added Sugars Intake and Sources Among US Children, Adolescents, and Teens Using NHANES 2001-2018. J Nutr 2021; 152:568-578. [PMID: 34850066 PMCID: PMC8826875 DOI: 10.1093/jn/nxab395] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 11/01/2021] [Accepted: 11/22/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Over the past 2 decades, there has been an increased emphasis on added sugars intake in the Dietary Guidelines for Americans (DGA), which has been accompanied by policies and interventions aimed at reducing intake, particularly among children, adolescents, and teens. OBJECTIVES The present study provides a comprehensive time-trends analysis of added sugars intakes and contributing sources in the diets of US children, adolescents, and teens (2-18 years) from 2001-2018, focusing on variations according to sociodemographic factors (age, sex, race and ethnicity, income), food assistance, and health-related factors (physical activity level, body weight status). METHODS Data from 9 consecutive 2-year cycles of the NHANES were combined and regression analyses were conducted to test for trends in added sugars intake and sources from 2001-2018 for the overall age group (2-18 years) and for 2 age subgroups (2-8 and 9-18 years). Trends were also examined on subsamples stratified by sex, race and ethnicity (Hispanic, non-Hispanic Asian, non-Hispanic Black, non-Hispanic White), income (household poverty income ratio), food assistance, physical activity level, and body weight status. RESULTS From 2001-2018, added sugars intakes decreased significantly (P < 0.01), from 15.6% to 12.6% kcal among children (2-8 years) and from 18.4% to 14.3% kcal among adolescents and teens (9-18 years), mainly due to significant declines in added sugars from sweetened beverages, which remained the top source. Declines in added sugars intakes were observed for all strata, albeit to varying degrees. CONCLUSIONS Declines in added sugars intakes were observed among children, adolescents, and teens from 2001-2018, regardless of sociodemographic factors, food assistance, physical activity level, or body weight status, but variations in the magnitudes of decline suggest persistent disparities related to race and ethnicity and to income. Despite these declines, intakes remain above the DGA recommendation; thus, continued monitoring is warranted.
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Affiliation(s)
- Laurie Ricciuto
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
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Proportions of Polyunsaturated Fatty Acids in Umbilical Cord Blood at Birth Are Related to Atopic Eczema Development in the First Year of Life. Nutrients 2021; 13:nu13113779. [PMID: 34836034 PMCID: PMC8624970 DOI: 10.3390/nu13113779] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 10/19/2021] [Accepted: 10/20/2021] [Indexed: 12/27/2022] Open
Abstract
Atopic eczema, the most common atopic disease in infants, may pave the way for sensitization and allergy later in childhood. Fatty acids have immune-regulating properties and may regulate skin permeability. Here we examine whether the proportions of fatty acids among the infant and maternal plasma phospholipids at birth were associated with maternal dietary intake during pregnancy and development of atopic eczema during the first year of age in the Nutritional impact on Immunological maturation during Childhood in relation to the Environment (NICE) birth cohort. Dietary data were collected with a semi-quantitative food frequency questionnaire, fatty acids were measured with GC-MS and atopic eczema was diagnosed by a pediatric allergologist at 12 months of age. We found that higher proportions of n-6 PUFAs (including arachidonic acid) but lower proportions of n-3 PUFAs (including DPA) in the infant’s phospholipids at birth were associated with an increased risk of atopic eczema at 12 months of age. The n-6 and n-3 PUFAs were related to maternal intake of meat and fish, respectively. Our results suggest that prenatal exposure to unsaturated fatty acids is associated with eczema development in the infant. Maternal diet during pregnancy may partly explain the fatty acid profiles in utero.
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A Systematic Review of Metabolomic Biomarkers for the Intake of Sugar-Sweetened and Low-Calorie Sweetened Beverages. Metabolites 2021; 11:metabo11080546. [PMID: 34436487 PMCID: PMC8401376 DOI: 10.3390/metabo11080546] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 08/13/2021] [Accepted: 08/14/2021] [Indexed: 11/16/2022] Open
Abstract
Intake of added sugars (AS) is challenging to assess compared with total dietary sugar because of the lack of reliable assessment methods. The reliance on self-reported dietary data in observational studies is often cited as biased, with evidence of AS intake in relation to health outcomes rated as low to moderate quality. Sugar-sweetened beverages (SSBs) are a major source of AS. A regular and high intake of SSBs is associated with an overall poor diet, weight gain, and cardiometabolic risks. An elevated intake of low-calorie sweetened beverages (LCSBs), often regarded as healthier alternatives to SSBs, is also increasingly associated with increased risk for metabolic dysfunction. In this review, we systematically collate evidence and provide perspectives on the use of metabolomics for the discovery of candidate biomarkers associated with the intake of SSBs and LCSBs. We searched the Medline, Embase, Scopus, and Web of Science databases until the end of December 2020. Seventeen articles fulfilled our inclusion criteria. We evaluated specificity and validity of the identified biomarkers following Guidelines for Biomarker of Food Intake Reviews (BFIRev). We report that the 13C:12C carbon isotope ratio (δ13C), particularly, the δ13C of alanine is the most robust, sensitive, and specific biomarker of SSBs intake. Acesulfame-K, saccharin, sucralose, cyclamate, and steviol glucuronide showed moderate validity for predicting the short-term intake of LCSBs. More evidence is required to evaluate the validity of other panels of metabolites associated with the intake of SSBs.
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Gauci S, Young LM, Arnoldy L, Lassemillante AC, Scholey A, Pipingas A. Dietary patterns in middle age: effects on concurrent neurocognition and risk of age-related cognitive decline. Nutr Rev 2021; 80:1129-1159. [PMID: 34392373 PMCID: PMC8990759 DOI: 10.1093/nutrit/nuab047] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Context Diet plays a critical role in cognitive integrity and decline in older adults. However, little is known about the relationship between diet and cognitive integrity in middle age. Objective To investigate the relationship between dietary patterns in healthy middle-aged adults and neurocognition both in middle age and later in life. Data Sources Using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, the following electronic databases were searched: Web of Science, Scopus, PubMed, and PsychInfo. Data Extraction Data from eligible articles was extracted by 2 reviewers. Data Analysis Articles included in the systematic review were synthesized (based on the synthesis without meta-analysis reporting guidelines) and assessed for quality (using the Joanna Briggs Institute checklist for randomized controlled trials, cohort studies, and cross-sectional studies) by 2 reviewers. Results Of 1558 studies identified, 34 met the eligibility criteria for inclusion. These comprised 9 cross-sectional studies, 23 longitudinal or prospective cohort studies, and 2 randomized controlled trials. Findings were mixed, with some studies reporting a significant positive relationship between adherence to various “healthy” dietary patterns and neurocognition, but others reporting no such relationship. Conclusion This systematic review demonstrated that adherence to the Mediterranean diet and other healthy dietary patterns in middle age can protect neurocognition later in life. Systematic Review Registration PROSPERO registration no. CRD42020153179.
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Affiliation(s)
- Sarah Gauci
- the Centre of Human Psychopharmacology, Swinburne University, Melbourne, Australia
- S. Gauci, Centre for Human Psychopharmacology, Mail H24, Swinburne University of Technology, PO Box 218, Hawthorn VIC 3122, Australia. E-mail:
| | - Lauren M Young
- the Centre of Human Psychopharmacology, Swinburne University, Melbourne, Australia
- IMPACT—the Institute for Mental and Physical Health and Clinical Translation, Food and Mood Centre, School of Medicine, Deakin University, Barwon Health, Geelong, Australia
| | - Lizanne Arnoldy
- the Centre of Human Psychopharmacology, Swinburne University, Melbourne, Australia
| | - Annie-Claude Lassemillante
- Department of Health and Medical Sciences and the Department of Health Professions, Swinburne University, Melbourne, Australia
| | - Andrew Scholey
- the Centre of Human Psychopharmacology, Swinburne University, Melbourne, Australia
- Nutrition Dietetics and Food, School of Clinical Sciences, Monash University, Melbourne, Australia
| | - Andrew Pipingas
- the Centre of Human Psychopharmacology, Swinburne University, Melbourne, Australia
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Chan V, Davies A, Wellard-Cole L, Lu S, Ng H, Tsoi L, Tiscia A, Signal L, Rangan A, Gemming L, Allman-Farinelli M. Using Wearable Cameras to Assess Foods and Beverages Omitted in 24 Hour Dietary Recalls and a Text Entry Food Record App. Nutrients 2021; 13:nu13061806. [PMID: 34073378 PMCID: PMC8228902 DOI: 10.3390/nu13061806] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 05/17/2021] [Accepted: 05/24/2021] [Indexed: 01/02/2023] Open
Abstract
Technology-enhanced methods of dietary assessment may still face common limitations of self-report. This study aimed to assess foods and beverages omitted when both a 24 h recall and a smartphone app were used to assess dietary intake compared with camera images. For three consecutive days, young adults (18–30 years) wore an Autographer camera that took point-of-view images every 30 seconds. Over the same period, participants reported their diet in the app and completed daily 24 h recalls. Camera images were reviewed for food and beverages, then matched to the items reported in the 24 h recall and app. ANOVA (with post hoc analysis using Tukey Honest Significant Difference) and paired t-test were conducted. Discretionary snacks were frequently omitted by both methods (p < 0.001). Water was omitted more frequently in the app than in the camera images (p < 0.001) and 24 h recall (p < 0.001). Dairy and alternatives (p = 0.001), sugar-based products (p = 0.007), savoury sauces and condiments (p < 0.001), fats and oils (p < 0.001) and alcohol (p = 0.002) were more frequently omitted in the app than in the 24 h recall. The use of traditional self-report methods of assessing diet remains problematic even with the addition of technology and finding new objective methods that are not intrusive and are of low burden to participants remains a challenge.
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Affiliation(s)
- Virginia Chan
- Charles Perkins Centre, Nutrition and Dietetics Group, School of Life and Environmental Science, The University of Sydney, Camperdown, NSW 2006, Australia; (A.D.); (L.W.-C.); (S.L.); (H.N.); (L.T.); (A.T.); (A.R.); (L.G.); (M.A.-F.)
- Correspondence:
| | - Alyse Davies
- Charles Perkins Centre, Nutrition and Dietetics Group, School of Life and Environmental Science, The University of Sydney, Camperdown, NSW 2006, Australia; (A.D.); (L.W.-C.); (S.L.); (H.N.); (L.T.); (A.T.); (A.R.); (L.G.); (M.A.-F.)
| | - Lyndal Wellard-Cole
- Charles Perkins Centre, Nutrition and Dietetics Group, School of Life and Environmental Science, The University of Sydney, Camperdown, NSW 2006, Australia; (A.D.); (L.W.-C.); (S.L.); (H.N.); (L.T.); (A.T.); (A.R.); (L.G.); (M.A.-F.)
- Cancer Prevention and Advocacy Division, Cancer Council NSW, Woolloomooloo, NSW 2011, Australia
| | - Silvia Lu
- Charles Perkins Centre, Nutrition and Dietetics Group, School of Life and Environmental Science, The University of Sydney, Camperdown, NSW 2006, Australia; (A.D.); (L.W.-C.); (S.L.); (H.N.); (L.T.); (A.T.); (A.R.); (L.G.); (M.A.-F.)
| | - Hoi Ng
- Charles Perkins Centre, Nutrition and Dietetics Group, School of Life and Environmental Science, The University of Sydney, Camperdown, NSW 2006, Australia; (A.D.); (L.W.-C.); (S.L.); (H.N.); (L.T.); (A.T.); (A.R.); (L.G.); (M.A.-F.)
| | - Lok Tsoi
- Charles Perkins Centre, Nutrition and Dietetics Group, School of Life and Environmental Science, The University of Sydney, Camperdown, NSW 2006, Australia; (A.D.); (L.W.-C.); (S.L.); (H.N.); (L.T.); (A.T.); (A.R.); (L.G.); (M.A.-F.)
| | - Anjali Tiscia
- Charles Perkins Centre, Nutrition and Dietetics Group, School of Life and Environmental Science, The University of Sydney, Camperdown, NSW 2006, Australia; (A.D.); (L.W.-C.); (S.L.); (H.N.); (L.T.); (A.T.); (A.R.); (L.G.); (M.A.-F.)
| | - Louise Signal
- Health Promotion & Policy Research Unit, Department of Public Health, University of Otago, 6242 Wellington, New Zealand;
| | - Anna Rangan
- Charles Perkins Centre, Nutrition and Dietetics Group, School of Life and Environmental Science, The University of Sydney, Camperdown, NSW 2006, Australia; (A.D.); (L.W.-C.); (S.L.); (H.N.); (L.T.); (A.T.); (A.R.); (L.G.); (M.A.-F.)
| | - Luke Gemming
- Charles Perkins Centre, Nutrition and Dietetics Group, School of Life and Environmental Science, The University of Sydney, Camperdown, NSW 2006, Australia; (A.D.); (L.W.-C.); (S.L.); (H.N.); (L.T.); (A.T.); (A.R.); (L.G.); (M.A.-F.)
| | - Margaret Allman-Farinelli
- Charles Perkins Centre, Nutrition and Dietetics Group, School of Life and Environmental Science, The University of Sydney, Camperdown, NSW 2006, Australia; (A.D.); (L.W.-C.); (S.L.); (H.N.); (L.T.); (A.T.); (A.R.); (L.G.); (M.A.-F.)
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McKenzie BL, Coyle DH, Santos JA, Burrows T, Rosewarne E, Peters SAE, Carcel C, Jaacks LM, Norton R, Collins CE, Woodward M, Webster J. Investigating sex differences in the accuracy of dietary assessment methods to measure energy intake in adults: a systematic review and meta-analysis. Am J Clin Nutr 2021; 113:1241-1255. [PMID: 33564834 PMCID: PMC8106762 DOI: 10.1093/ajcn/nqaa370] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 11/13/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND To inform the interpretation of dietary data in the context of sex differences in diet-disease relations, it is important to understand whether there are any sex differences in accuracy of dietary reporting. OBJECTIVE To quantify sex differences in self-reported total energy intake (TEI) compared with a reference measure of total energy expenditure (TEE). METHODS Six electronic databases were systematically searched for published original research articles between 1980 and April 2020. Studies were included if they were conducted in adult populations with measures for both females and males of self-reported TEI and TEE from doubly labeled water (DLW). Studies were screened and quality assessed independently by 2 authors. Random-effects meta-analyses were conducted to pool the mean differences between TEI and TEE for, and between, females and males, by method of dietary assessment. RESULTS From 1313 identified studies, 31 met the inclusion criteria. The studies collectively included information on 4518 individuals (54% females). Dietary assessment methods included 24-h recalls (n = 12, 2 with supplemental photos of food items consumed), estimated food records (EFRs; n = 11), FFQs (n = 10), weighed food records (WFRs, n = 5), and diet histories (n = 2). Meta-analyses identified underestimation of TEI by females and males, ranging from -1318 kJ/d (95% CI: -1967, -669) for FFQ to -2650 kJ/d (95% CI: -3492, -1807) for 24-h recalls for females, and from -1764 kJ/d (95% CI: -2285, -1242) for FFQ to -3438 kJ/d (95% CI: -5382, -1494) for WFR for males. There was no difference in the level of underestimation by sex, except when using EFR, for which males underestimated energy intake more than females (by 590 kJ/d, 95% CI: 35, 1,146). CONCLUSION Substantial underestimation of TEI across a range of dietary assessment methods was identified, similar by sex. These underestimations should be considered when assessing TEI and interpreting diet-disease relations.
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Affiliation(s)
- Briar L McKenzie
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Daisy H Coyle
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Joseph Alvin Santos
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Tracy Burrows
- School of Health Sciences, Faculty of Health and Medicine, and Priority Research Centre in Physical Activity and Nutrition, The University of Newcastle, Callaghan, NSW, Australia
| | - Emalie Rosewarne
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Sanne A E Peters
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
- The George Institute for Global Health, Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Cheryl Carcel
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Lindsay M Jaacks
- Global Academy of Agriculture and Food Security, The University of Edinburgh, Roslin, United Kingdom
| | - Robyn Norton
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
- The George Institute for Global Health, Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom
| | - Clare E Collins
- School of Health Sciences, Faculty of Health and Medicine, and Priority Research Centre in Physical Activity and Nutrition, The University of Newcastle, Callaghan, NSW, Australia
| | - Mark Woodward
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
- The George Institute for Global Health, Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - Jacqui Webster
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
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Aguilo A, Lozano L, Tauler P, Nafría M, Colom M, Martínez S. Nutritional Status and Implementation of a Nutritional Education Program in Young Female Artistic Gymnasts. Nutrients 2021; 13:nu13051399. [PMID: 33919356 PMCID: PMC8143314 DOI: 10.3390/nu13051399] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 04/16/2021] [Accepted: 04/19/2021] [Indexed: 12/31/2022] Open
Abstract
Adolescent high-performance gymnasts are considered to be at risk for low energy intake. The aim of the present study was to determine the effects of implementing a nutritional education program during the sports season on the nutritional status and nutrition knowledge of the female artistic gymnasts from the Technification Center of the Balearic Islands (n = 24; age, 14.1 ± 2.3 years). A quasi-experimental intervention design was applied, which consisted of implementing a nutritional education program of seven sessions given during eight months. Measurements of nutritional intake, nutrition knowledge, and anthropometric parameters, as well as hematological and biochemical blood parameters, were performed. Gymnasts reported low energy and carbohydrate intakes, with significant increases during the study (energy, 28.3 ± 1.4 vs. 32.8 ± 1.4 kcal kg−1, p = 0.015, carbohydrate 3.2 ± 0.2 vs. 3.9 ± 0.2 g kg−1, p = 0.004). The average values for parameters such as hemoglobin, ferritin, lipoprotein, and vitamin C and E levels in the plasma were within normal ranges. Low intakes of most of the food groups were observed during the study, with similar initial and final values. Nutrition knowledge did not change as a result of the study (28.0 ± 1.7 vs. 31.1 ± 1.3, p = 0.185). In conclusion, gymnasts reported low energy intakes. However, blood markers and most of the anthropometrical parameters measured were within normal ranges. The nutrition education program implemented did not produce significant improvements in the dietary habits or nutritional knowledge of gymnasts.
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Affiliation(s)
- Antoni Aguilo
- Research Group on Evidence, Lifestyles and Health, Department of Nursing and Physiotherapy, Research Institute of Health Sciences (IUNICS), University of the Balearic Islands, 07122 Palma, Spain; (A.A.); (L.L.); (M.N.); (M.C.); (S.M.)
- Health Research Institute of the Balearic Islands (IdISBa), 07120 Palma, Spain
| | - Leticia Lozano
- Research Group on Evidence, Lifestyles and Health, Department of Nursing and Physiotherapy, Research Institute of Health Sciences (IUNICS), University of the Balearic Islands, 07122 Palma, Spain; (A.A.); (L.L.); (M.N.); (M.C.); (S.M.)
| | - Pedro Tauler
- Health Research Institute of the Balearic Islands (IdISBa), 07120 Palma, Spain
- Research Group on Evidence, Lifestyles and Health, Department of Fundamental Biology and Health Sciences, Research Institute of Health Sciences (IUNICS), University of the Balearic Islands, 07122 Palma, Spain
- Correspondence: ; Tel.: +34-971-172858
| | - Mar Nafría
- Research Group on Evidence, Lifestyles and Health, Department of Nursing and Physiotherapy, Research Institute of Health Sciences (IUNICS), University of the Balearic Islands, 07122 Palma, Spain; (A.A.); (L.L.); (M.N.); (M.C.); (S.M.)
| | - Miquel Colom
- Research Group on Evidence, Lifestyles and Health, Department of Nursing and Physiotherapy, Research Institute of Health Sciences (IUNICS), University of the Balearic Islands, 07122 Palma, Spain; (A.A.); (L.L.); (M.N.); (M.C.); (S.M.)
| | - Sonia Martínez
- Research Group on Evidence, Lifestyles and Health, Department of Nursing and Physiotherapy, Research Institute of Health Sciences (IUNICS), University of the Balearic Islands, 07122 Palma, Spain; (A.A.); (L.L.); (M.N.); (M.C.); (S.M.)
- Health Research Institute of the Balearic Islands (IdISBa), 07120 Palma, Spain
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The Frequency and Context of Snacking among Children: An Objective Analysis Using Wearable Cameras. Nutrients 2020; 13:nu13010103. [PMID: 33396846 PMCID: PMC7824478 DOI: 10.3390/nu13010103] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 12/24/2020] [Accepted: 12/28/2020] [Indexed: 12/31/2022] Open
Abstract
Snacking is a common eating behaviour, but there is little objective data about children’s snacking. We aimed to determine the frequency and context of children’s snacking (n = 158; mean age = 12.6 years) by ethnicity, gender, socioeconomic deprivation and body mass index (BMI) children. Participants wore wearable cameras that passively captured images of their surroundings every seven seconds. Images (n = 739,162) were coded for snacking episodes, defined as eating occasions in between main meals. Contextual factors analysed included: snacking location, food source, timing, social contact and screen use. Rates of total, discretionary (not recommended for consumption) and healthful (recommended for consumption) snacking were calculated using negative binomial regression. On average, children consumed 8.2 (95%CI 7.4, 9.1) snacks per day, of which 5.2 (95%CI 4.6, 5.9) were discretionary foods/beverages. Children consumed more discretionary snacks than healthful snacks in each setting and at all times, including 15.0× more discretionary snacks in public spaces and 2.4× more discretionary snacks in schools. Most snacks (68.9%) were sourced from home. Girls consumed more total, discretionary and healthful snacks than boys, and Māori and Pacific consumed fewer healthful snacks than New Zealand (NZ) Europeans. Results show that children snack frequently, and that most snacking involves discretionary food items. Our findings suggest targeting home buying behaviour and environmental changes to support healthy snacking choices.
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Barman M, Rabe H, Hesselmar B, Johansen S, Sandberg AS, Wold AE. Cord Blood Levels of EPA, a Marker of Fish Intake, Correlate with Infants' T- and B-Lymphocyte Phenotypes and Risk for Allergic Disease. Nutrients 2020; 12:nu12103000. [PMID: 33007868 PMCID: PMC7601506 DOI: 10.3390/nu12103000] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 09/25/2020] [Accepted: 09/27/2020] [Indexed: 01/06/2023] Open
Abstract
Maternal fish intake during pregnancy has been associated with reduced allergy development in the offspring and here, we hypothesized that components of fish stimulate fetal immune maturation. The aim of this study was to investigate how maternal fish intake during pregnancy and levels of n-3 long-chain polyunsaturated fatty acids (LCPUFAs) in the infant’s cord serum correlated with different subsets of B- and T-cells in cord blood and B-cell activating factor (BAFF) in cord plasma, and with doctor-diagnosed allergy at 3 and 8 years of age in the FARMFLORA birth-cohort consisting of 65 families. Principal component analysis showed that infant allergies at 3 or 8 years of age were negatively associated with the proportions of n-3 LCPUFAs (eicosapentaenoic acid, docosapentaenoic acid, and docosahexaenoic acid) in infant cord serum, which, in turn correlated positively with maternal fish intake during pregnancy. Both maternal fish intake and cord serum n-3 LCPUFAs correlated negatively to CD5+ B cells and the FOXP3+CD25high of the CD4+ T cell subsets in cord blood, but not to BAFF in cord plasma. Our observational study suggests that fish might contain components that promote maturation of the infant’s immune system in a manner that protects against allergy development.
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Affiliation(s)
- Malin Barman
- Food and Nutrition Science, Department of Biology and Biological Engineering, Chalmers, University of Technology, 41296 Göteborg, Sweden;
| | - Hardis Rabe
- Institute of Biomedicine, Department of Infectious Diseases, University of Gothenburg, 40530 Göteborg, Sweden; (H.R.); (A.E.W.)
| | - Bill Hesselmar
- Department of Pediatrics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, 40530 Göteborg, Sweden;
| | | | - Ann-Sofie Sandberg
- Food and Nutrition Science, Department of Biology and Biological Engineering, Chalmers, University of Technology, 41296 Göteborg, Sweden;
- Correspondence:
| | - Agnes E. Wold
- Institute of Biomedicine, Department of Infectious Diseases, University of Gothenburg, 40530 Göteborg, Sweden; (H.R.); (A.E.W.)
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Self-reported food intake decreases over recording period in the National Diet and Nutrition Survey. Br J Nutr 2020; 124:586-590. [PMID: 32234082 DOI: 10.1017/s000711452000118x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
From 2008, the UK's National Diet and Nutrition Survey (NDNS) changed the method of dietary data collection from a 7-d weighed diary to a 4-d unweighed diary, partly to reduce participant burden. This study aimed to test whether self-reported energy intake changed significantly over the 4-d recording period of the NDNS rolling programme. Analyses used data from the NDNS years 1 (2008/2009) to 8 (2015/2016) inclusive, from participants aged 13 years and older. Dietary records from participants who reported unusual amounts of food and drink consumed on one or more days were excluded, leaving 6932 participants. Mean daily energy intake was 7107 kJ (1698 kcal), and there was a significant decrease of 164 kJ (39 kcal) between days 1 and 4 (P < 0·001). There was no significant interaction of sex or low-energy reporter status (estimated from the ratio of reported energy intake:BMR) with the change in reported energy intake. The decrease in reported energy intake on day 4 compared with day 1 was greater (P < 0·019) for adults with higher BMI (>30 kg/m2) than it was for leaner adults. Reported energy intake decreased over the 4-d recording period of the NDNS rolling programme suggesting that participants change their diet more, or report less completely, with successive days of recording their diet. The size of the effect was relatively minor, however.
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Energy misreporting is more prevalent for those of lower socio-economic status and is associated with lower reported intake of discretionary foods. Br J Nutr 2020; 125:1291-1298. [PMID: 32943124 DOI: 10.1017/s0007114520003621] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The role of socio-economic status (SES) on the misreporting of food and energy intakes is not well understood with disagreement in the literature. The aim of this study was to examine the associations between low energy reporting, dietary quality and SES in a representative sample of adults. Dietary data were collected using 2 d of 24-h recalls for 6114 adults aged 19 years and over, participating in the Australian National Nutrition and Physical Activity Survey 2011-2012. Low energy reporters (LER) and plausible reporters (PR) were identified. Discretionary food intake was used as a proxy indicator of diet quality. SES was determined using area-level SES and educational attainment. Regression analysis was applied to examine the effects of LER and SES on diet quality, adjusting for potential confounders. LER was more common in populations of lower SES than higher SES (area-level OR 1·46 (95 % CI 1·06, 2·00); education OR 1·64 (95 % CI 1·28, 2·09). LER and SES were independently associated with diet quality, with LER reporting lower percentage energy from discretionary foods compared with PR (27·4 v. 34·2, P < 0·001), and those of lower area-level SES and education reporting lower diet quality compared with those of higher SES (33·7 v. 31·2, P < 0·001; and 33·5 v. 29·6, P < 0·001, respectively). No interaction effect was found between LER and SES, indicating percentage energy in discretionary foods was not differentially misreported across the SES areas (0·3078) or education (P = 0·7078). In conclusion, LER and higher SES were associated with better diet quality.
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Validation of a life-logging wearable camera method and the 24-h diet recall method for assessing maternal and child dietary diversity. Br J Nutr 2020; 125:1299-1309. [PMID: 32912365 DOI: 10.1017/s0007114520003530] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Accurate and timely data are essential for identifying populations at risk for undernutrition due to poor-quality diets, for implementing appropriate interventions and for evaluating change. Life-logging wearable cameras (LLWC) have been used to prospectively capture food/beverage consumed by adults in high-income countries. This study aimed to evaluate the concurrent criterion validity, for assessing maternal and child dietary diversity scores (DDS), of a LLWC-based image-assisted recall (IAR) and 24-h recall (24HR). Direct observation was the criterion method. Food/beverage consumption of rural Eastern Ugandan mothers and their 12-23-month-old child (n 211) was assessed, for the same day for each method, and the IAR and 24HR DDS were compared with the weighed food record DDS using the Bland-Altman limits of agreement (LOA) method of analysis and Cohen's κ. The relative bias was low for the 24HR (-0·1801 for mothers; -0·1358 for children) and the IAR (0·1227 for mothers; 0·1104 for children), but the LOA were wide (-1·6615 to 1·3012 and -1·6883 to 1·4167 for mothers and children via 24HR, respectively; -2·1322 to 1·8868 and -1·7130 to 1·4921 for mothers and children via IAR, respectively). Cohen's κ, for DDS via 24HR and IAR, was 0·68 and 0·59, respectively, for mothers, and 0·60 and 0·59, respectively, for children. Both the 24HR and IAR provide an accurate estimate of median dietary diversity, for mothers and their young child, but non-differential measurement error would attenuate associations between DDS and outcomes, thereby under-estimating the true associations between DDS - where estimated via 24HR or IAR - and outcomes measured.
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Louie JCY. Objective Biomarkers for Total Added Sugar Intake - Are We on a Wild Goose Chase? Adv Nutr 2020; 11:1429-1436. [PMID: 32805008 PMCID: PMC7666891 DOI: 10.1093/advances/nmaa093] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 07/09/2020] [Indexed: 12/27/2022] Open
Abstract
Misreporting of added sugar intake has been the major criticism of studies linking high added sugar consumption to adverse health outcomes. Despite the advancement in dietary assessment methodologies, the bias introduced by self-reporting can never be completely eliminated. The search for an objective biomarker for total added sugar intake has therefore been a topic of interest. In this article, the reasons this search may be a wild goose chase will be outlined and discussed. The limitations and inability of the 2 candidate biomarkers, namely urinary sucrose and fructose and δ¹³C isotope, which are based on the 2 only possible ways (i.e., difference in metabolism and plant sources) to identify added sugar based on current knowledge in human physiology and food and nutritional sciences, are discussed in detail. Validation studies have shown that these 2 candidate biomarkers are unlikely to be suitable for use as a predictive or calibration biomarker for total added sugar intake. Unless advancement in our understanding in human physiology and food and nutritional sciences leads to new potential ways to distinguish between naturally occurring and added sugars, it is extremely unlikely that any accurate objective added sugar biomarker could be found. It may be time to stop the futile effort in searching for such a biomarker, and resources may be better spent on further improving and innovating dietary assessment methods to minimize the bias introduced by self-reporting.
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Yasuda J, Tomita T, Arimitsu T, Fujita S. Evenly Distributed Protein Intake over 3 Meals Augments Resistance Exercise-Induced Muscle Hypertrophy in Healthy Young Men. J Nutr 2020; 150:1845-1851. [PMID: 32321161 PMCID: PMC7330467 DOI: 10.1093/jn/nxaa101] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 11/14/2019] [Accepted: 03/23/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Although daily protein intake (PI) has been reported to be essential for regulating muscle mass, the distribution of daily PI in individuals is typically the lowest at breakfast and skewed toward dinner. Skewed protein intake patterns and inadequate PI at breakfast were reported to be negative factors for muscle maintenance. OBJECTIVES This study examined whether a protein-enriched meal at breakfast is more effective for muscle accretion compared with the typical skewed PI pattern. METHODS This 12-wk, parallel-group, randomized clinical trial included 26 men (means ± SEs; age: 20.8 ± 0.4 y; BMI: 21.8 ± 0.4 kg/m2). The "high breakfast" (HBR) group (n = 12) consumed a protein-enriched meal at breakfast providing a PI of 0.33 g/kg body weight (BW); their PI at lunch (0.46 g/kg BW) and dinner (0.48 g/kg BW) provided an adequate overall daily PI (1.30 g/kg BW/d). The "low breakfast" (LBR) group (n = 14) consumed 0.12 g protein/kg BW at breakfast; intakes at lunch (0.45 g/kg BW) and dinner (0.83 g/kg BW) yielded the same daily PI as in the HBR group. The participants performed supervised resistance training (RT) 3 times per week (75-80% 1-repetition maximum; 3 sets × 10 repetitions). DXA was used to measure the primary outcome variable, that is, total lean soft tissue mass (LTM). RESULTS The total LTM at baseline did not differ between the HBR (52.4 ± 1.3 kg) and LBR (53.4 ± 1.2 kg) groups. After the intervention, increases in total LTM were significant in both groups, with that in the HBR group (2.5 ± 0.3 kg) tending to be greater than that in the LBR group (1.8 ± 0.3 kg) (P = 0.06), with a large effect size (Cohen d = 0.795). CONCLUSIONS For RT-induced muscle hypertrophy in healthy young men, consuming a protein-enriched meal at breakfast and less protein at dinner while achieving an adequate overall PI is more effective than consuming more protein at dinner.This study was registered at University hospital Medical Information Network (UMIN) Clinical Trials Registry as UMIN000037583 (https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000042763).
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Affiliation(s)
- Jun Yasuda
- Faculty of Sport and Health Science, Ritsumeikan University, Nojihigashi, Kusatsu, Shiga, Japan
| | - Toshiki Tomita
- Faculty of Sport and Health Science, Ritsumeikan University, Nojihigashi, Kusatsu, Shiga, Japan
| | - Takuma Arimitsu
- Faculty of Sport and Health Science, Ritsumeikan University, Nojihigashi, Kusatsu, Shiga, Japan
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Dietary patterns associated with meeting the WHO free sugars intake guidelines. Public Health Nutr 2020; 23:1495-1506. [DOI: 10.1017/s1368980019004543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjective:Emerging evidence suggests that free sugars intake in many countries exceeds that recommended by the WHO. However, information regarding real-world dietary patterns associated with meeting the WHO free sugars guidelines is lacking. The current study aimed to determine dietary patterns associated with meeting the guidelines to inform effective free sugars reduction interventions in New Zealand (NZ) and similar high-income countries.Design:Dietary patterns were derived using principal component analysis on repeat 24-h NZ Adult Nutrition Survey dietary recall data. Associations between dietary patterns and the WHO guidelines (<5 and <10 % total energy intake) were determined using logistic regression analyses.Setting:New Zealand.Participants:NZ adults (n 4721) over 15 years old.Results:Eight dietary patterns were identified: ‘takeaway foods and alcohol’ was associated with meeting both WHO guidelines; ‘contemporary’ was associated with meeting the <10 % guideline (males only); ‘fast foods, sugar-sweetened beverages and dessert’, ‘traditional’ and ‘breakfast foods’ were negatively associated with meeting both guidelines; ‘sandwich’ and ‘snack foods’ were negatively associated with the <5 % guideline; and ‘saturated fats and sugar’ was negatively associated with the <10 % guideline.Conclusions:The majority of NZ dietary patterns were not consistent with WHO free sugars guidelines. It is possible to meet the WHO guidelines while consuming a healthier (‘contemporary’) or energy-dense, nutrient-poor (‘takeaway foods and alcohol’) diet. However, the majority of energy-dense patterns were not associated with meeting the guidelines. Future nutrition interventions would benefit from focusing on establishing healthier overall diets and reducing consumption and free sugars content of key foods.
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Ridoutt B, Anastasiou K, Baird D, Garcia JN, Hendrie G. Cropland Footprints of Australian Dietary Choices. Nutrients 2020; 12:E1212. [PMID: 32344857 PMCID: PMC7282022 DOI: 10.3390/nu12051212] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 04/23/2020] [Accepted: 04/23/2020] [Indexed: 12/22/2022] Open
Abstract
Food systems vitally depend on croplands, which are a scarce natural resource. Croplands are also heterogeneous, differing in productive capability and in environmental context. Some are in regions of high biodiversity conservation importance, others in regions vulnerable to food insecurity. In this study, life cycle assessment was used to quantify cropland scarcity footprints, cropland biodiversity footprints and cropland malnutrition footprints for 9341 individual Australian adult daily diets. Dietary cropland scarcity footprints averaged 7.1 m2yr-e person-1 day-1, exceeding a target of 6.1 m2yr-e person-1 day-1, consistent with the proposed global cropland planetary boundary of 15% of the ice-free land area. Discretionary foods, which are energy-dense and nutrient-poor foods high in saturated fat, added sugars and salt, and alcohol and are not essential to a healthy diet, made the largest contribution, followed by fresh meats and alternatives, breads and cereals, fruit, dairy and alternatives and vegetables. Around 45% of the variation in cropland footprint between individuals was explained by differences in total dietary energy intake. Diets characterised by higher diet quality and lower cropland scarcity footprint required only 4.2 m2yr-e person-1 day-1 and recommended diets based on the food choices of this subgroup required 5.9 m2yr-e person-1 day-1. Eating within the global cropland planetary boundary appears realistic if Australians greatly reduce their intake of discretionary foods and moderate their food choices within the "meat and alternatives" food group.
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Affiliation(s)
- Bradley Ridoutt
- Commonwealth Scientific and Industrial Research Organisation (CSIRO) Agriculture and Food, Clayton South, Victoria 3168, Australia
- Department of Agricultural Economics, University of the Free State, Bloemfontein 9300, South Africa
| | - Kim Anastasiou
- CSIRO Health and Biosecurity, Adelaide, South Australia 5000, Australia; (K.A.); (D.B.); (G.H.)
| | - Danielle Baird
- CSIRO Health and Biosecurity, Adelaide, South Australia 5000, Australia; (K.A.); (D.B.); (G.H.)
| | | | - Gilly Hendrie
- CSIRO Health and Biosecurity, Adelaide, South Australia 5000, Australia; (K.A.); (D.B.); (G.H.)
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Lancaster R, Radd‐Vagenas S, Fiatarone Singh M, Noble Y, Daniel K, Mavros Y, Sachdev PS, Lautenschlager N, Cox K, Brodaty H, O'Leary F, Flood VM. Electronic food records among middle‐aged and older people: A comparison of self‐reported and dietitian‐assisted information. Nutr Diet 2020; 78:145-153. [DOI: 10.1111/1747-0080.12606] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 11/11/2019] [Accepted: 12/08/2019] [Indexed: 12/22/2022]
Affiliation(s)
| | | | - Maria Fiatarone Singh
- The University of Sydney Sydney New South Wales Australia
- Hebrew Senior Life and Jean Mayer USDA Human Nutrition Research Center on Aging Tufts University Boston Massachusetts
| | - Yian Noble
- The University of Sydney Sydney New South Wales Australia
| | - Kenneth Daniel
- The University of Sydney Sydney New South Wales Australia
| | - Yorgi Mavros
- The University of Sydney Sydney New South Wales Australia
| | - Perminder S. Sachdev
- Centre for Healthy Brain Ageing, School of Psychiatry University of New South Wales Sydney New South Wales Australia
| | - Nicola Lautenschlager
- Department of Psychiatry University of Melbourne Melbourne Victoria Australia
- North Western Mental Health Melbourne Health Melbourne Victoria Australia
| | - Kay Cox
- Medical School University of Western Australia Perth Western Australia Australia
| | - Henry Brodaty
- Centre for Healthy Brain Ageing, School of Psychiatry University of New South Wales Sydney New South Wales Australia
| | - Fiona O'Leary
- The University of Sydney Sydney New South Wales Australia
| | - Victoria M. Flood
- The University of Sydney Sydney New South Wales Australia
- Western Sydney Local Health District Westmead Hospital Sydney New South Wales Australia
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Drew J, Cleghorn C, Macmillan A, Mizdrak A. Healthy and Climate-Friendly Eating Patterns in the New Zealand Context. ENVIRONMENTAL HEALTH PERSPECTIVES 2020; 128:17007. [PMID: 31967488 PMCID: PMC7015541 DOI: 10.1289/ehp5996] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
BACKGROUND The global food system is driving both the climate crisis and the growing burden of noncommunicable disease. International research has highlighted the climate and health co-benefit opportunity inherent in widespread uptake of plant-based diets. Nevertheless, uncertainty remains as to what constitutes healthy and climate-friendly eating patterns in specific world regions. OBJECTIVES Using New Zealand as a case study, this research investigates the extent to which potential contextual differences may affect the local applicability of international trends. It further examines the potential for demand-end avenues to support a transition toward a healthier, more climate-friendly food system in New Zealand. METHODS A New Zealand-specific life-cycle assessment (LCA) database was developed by modifying cradle to point-of-sale reference emissions estimates according to the New Zealand context. This food emissions database, together with a New Zealand-specific multistate life-table model, was then used to estimate climate, health, and health system cost impacts associated with shifting current consumption to align with dietary scenarios that conform to the New Zealand dietary guidelines (NZDGs). RESULTS Whole plant foods, including vegetables, fruits, legumes, and whole grains were substantially less climate-polluting (1.2-1.8 kgCO2e/kg) than animal-based foods, particularly red and processed meats (12-21 kgCO2e/kg). Shifting population-level consumption to align with the NZDGs would confer diet-related emissions savings of 4-42%, depending on the degree of dietary change and food waste minimization pursued. NZDG-abiding dietary scenarios, when modeled out over the lifetime of the current New Zealand population, would also confer large health gains (1.0-1.5 million quality-adjusted life-years) and health care system cost savings (NZ$14-20 billion). DISCUSSION Guideline-abiding dietary scenarios, particularly those that prioritize plant-based foods, have the potential to confer substantial climate and health gains. This research shows that major contextual differences specific to New Zealand's food system do not appear to cause notable deviation from global trends, reinforcing recent international research. https://doi.org/10.1289/EHP5996.
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Affiliation(s)
- Jonathan Drew
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Cristina Cleghorn
- Burden of Disease Epidemiology, Equity and Cost-Effectiveness Programme (BODE), Department of Public Health, University of Otago, Wellington, New Zealand
| | - Alexandra Macmillan
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Anja Mizdrak
- Burden of Disease Epidemiology, Equity and Cost-Effectiveness Programme (BODE), Department of Public Health, University of Otago, Wellington, New Zealand
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Fulton AS, Baldock KL, Coates AM, Williams MT, Howe PR, Haren MT, Garg ML, Hill AM. Polyunsaturated fatty acid intake and lung function in a regional Australian population: A cross-sectional study with a nested case-control analysis. JOURNAL OF NUTRITION & INTERMEDIARY METABOLISM 2019. [DOI: 10.1016/j.jnim.2019.100102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Loth KA, Tate A, Trofholz A, Orlet Fisher J, Neumark-Sztainer D, Berge JM. The Contribution of Snacking to Overall Diet Intake among an Ethnically and Racially Diverse Population of Boys and Girls. J Acad Nutr Diet 2019; 120:270-279. [PMID: 31780383 DOI: 10.1016/j.jand.2019.08.173] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 08/20/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Children in low-income and minority populations are at risk for poor dietary quality. At least one-third of the calories consumed by children are eaten between meals (ie, snacks). The contribution of snacking to diet quality among children is poorly understood. OBJECTIVE The current study examined associations between snacking and children's diet quality along with differences across ethnicity or race, sex, and weight status. DESIGN Cross-sectional data came from Phase I of the Family Matters Study, an observational study. PARTICIPANTS/SETTING This study included 150 families with children aged 5 to 7 years old from six ethnic or racial groups (n=25 from each: African American, Hispanic, Hmong, Native American, Somali, non-Hispanic white); data were collected in Minneapolis-Saint Paul, MN in 2017-2018. MAIN OUTCOME MEASURES Total daily energy (kilocalories), overall diet quality using the Healthy Eating Index (HEI-2010), and food group intakes (eg, fruit, vegetables, refined grains, sugar-sweetened beverages [SSB]) were assessed using three 24-hour dietary recalls. STATISTICAL ANALYSES PERFORMED Conditional fixed effects estimators (within-child variation) were used in regression analyses to characterize the relationship between daily snacking and dietary intake relative to dietary intake at all other daily meal occasions. Mean (±standard deviation) overall dietary intake including all meals and snacks was compared with mean (±standard deviation) intake of meals only. RESULTS Among boys, snacking was found to contribute positively to HEI-2010 scores (HEI-2010=57.6, HEI-2010 without snacks=55.0; effect size [ES]=0.28, P=0.03). Snacking was an important source of fruit (ES=0.71) and dairy (ES=0.53), but also contributed to children's consumption of refined grains (ES=0.68) and SSB (ES=0.31). Very few vegetables were consumed as snacks. Furthermore, snacks contributed more to the overall diet quality (HEI-2010) of Native American (ES=0.30) and Somali (ES=0.35) youth as compared with youth from other ethnic or racial backgrounds. CONCLUSIONS Findings suggest that snacks have the potential to improve diet quality in children. Future research should examine influences on children's food choices at snack times and barriers to serving more healthful foods as snacks that are faced by ethnically or racially diverse families.
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Ward AL, Galland BC, Haszard JJ, Meredith-Jones K, Morrison S, McIntosh DR, Jackson R, Beebe DW, Fangupo L, Richards R, Te Morenga L, Smith C, Elder DE, Taylor RW. The effect of mild sleep deprivation on diet and eating behaviour in children: protocol for the Daily Rest, Eating, and Activity Monitoring (DREAM) randomized cross-over trial. BMC Public Health 2019; 19:1347. [PMID: 31640636 PMCID: PMC6805447 DOI: 10.1186/s12889-019-7628-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Accepted: 09/13/2019] [Indexed: 03/15/2023] Open
Abstract
BACKGROUND Although insufficient sleep has emerged as a strong, independent risk factor for obesity in children, the mechanisms by which insufficient sleep leads to weight gain are uncertain. Observational research suggests that being tired influences what children eat more than how active they are, but only experimental research can determine causality. Few experimental studies have been undertaken to determine how reductions in sleep duration might affect indices of energy balance in children including food choice, appetite regulation, and sedentary time. The primary aim of this study is to objectively determine whether mild sleep deprivation increases energy intake in the absence of hunger. METHODS The Daily, Rest, Eating, and Activity Monitoring (DREAM) study is a randomized controlled trial investigating how mild sleep deprivation influences eating behaviour and activity patterns in children using a counterbalanced, cross-over design. One hundred and ten children aged 8-12 years, with normal reported sleep duration of 8-11 h per night will undergo 2 weeks of sleep manipulation; seven nights of sleep restriction by going to bed 1 hr later than usual, and seven nights of sleep extension going to bed 1 hr earlier than usual, separated by a washout week. During each experimental week, 24-h movement behaviours (sleep, physical activity, sedentary behaviour) will be measured via actigraphy; dietary intake and context of eating by multiple 24-h recalls and wearable camera images; and eating behaviours via objective and subjective methods. At the end of each experimental week a feeding experiment will determine energy intake from eating in the absence of hunger. Differences between sleep conditions will be determined to estimate the effects of reducing sleep duration by 1-2 h per night. DISCUSSION Determining how insufficient sleep predisposes children to weight gain should provide much-needed information for improving interventions for the effective prevention of obesity, thereby decreasing long-term morbidity and healthcare burden. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12618001671257 . Registered 10 October 2018.
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Affiliation(s)
- Aimee L. Ward
- Department of Medicine, University of Otago, Dunedin, New Zealand
| | - Barbara C. Galland
- Department of Women’s and Children’s Health, University of Otago, Dunedin, New Zealand
| | | | | | - Silke Morrison
- Department of Medicine, University of Otago, Dunedin, New Zealand
| | | | - Rosie Jackson
- Department of Medicine, University of Otago, Dunedin, New Zealand
| | - Dean W. Beebe
- Department of Pediatrics, University of Cincinnati College of Medicine, Division of Behavioral Medicine and Clinical Psychology Cincinnati Children’s Hospital Medical Center, Ohio, USA
| | - Louise Fangupo
- Department of Medicine, University of Otago, Dunedin, New Zealand
| | | | - Lisa Te Morenga
- School of Health, Victoria University of Wellington, Wellington, New Zealand
| | - Claire Smith
- Department of Women’s and Children’s Health, University of Otago, Dunedin, New Zealand
| | - Dawn E. Elder
- Department of Paediatrics and Child Health, University of Otago, Wellington, New Zealand
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Eating Style and the Frequency, Size and Timing of Eating Occasions: A cross-sectional analysis using 7-day weighed dietary records. Sci Rep 2019; 9:15133. [PMID: 31641145 PMCID: PMC6805948 DOI: 10.1038/s41598-019-51534-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Accepted: 09/09/2019] [Indexed: 01/18/2023] Open
Abstract
The tendencies to overeat in response to negative emotions (emotional eating) and environmental cues (external eating) have both been associated with BMI. However, it is unclear how they are expressed at the eating architecture level, for example, respecting frequency, timing and size of eating occasions, which could comprise 'downstream' specific behavioural intervention targets. In our analyses of the UK National Diet and Nutrition Survey 2000-2001, a 1-unit higher emotional eating score was associated with meals containing approximately 15 (3, 26) fewer kcals per occasion, consuming 1.4 (0.5, 2.3) more snacks per week and snacking over a 35- (16, 53) minute longer period a day. A 1-unit higher external eating score was associated with snacking over a 24- (1, 46) minute shorter period a day. Associations were independent of BMI and other potential confounders. The distinct pattern of eating architecture associated with emotional eating, suggests specific approaches to intervention, such as the number, timing and caloric content of snacks, could be considered further in experimental studies for their potential to prevent weight gain in people with a higher emotional eating tendency. Longitudinal studies and better measurement are also needed to strengthen causal inference in terms of the downstream effects of eating styles.
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Veatupu L, Puloka V, Smith M, McKerchar C, Signal L. Me'akai in Tonga: Exploring the Nature and Context of the Food Tongan Children Eat in Ha'apai Using Wearable Cameras. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16101681. [PMID: 31091717 PMCID: PMC6572351 DOI: 10.3390/ijerph16101681] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Revised: 05/05/2019] [Accepted: 05/07/2019] [Indexed: 11/21/2022]
Abstract
Unhealthy food consumption is a key driver of the global pandemic in non-communicable diseases (NCDs). The Government of Tonga has prioritised NCD prevention due to the very high rates of NCDs in the Kingdom. This research examines the nature and context of the me’akai (food) consumed by Tongan children in Ha’apai using wearable cameras. Thirty-six randomly selected 11-year-old children used wearable cameras to record their lives for three days, as part of the wider Kids’Cam Tonga project. Images were analysed to assess the participants’ food consumption according to a new data analysis protocol for Tonga. Core foods were defined as including breads and cereals, fresh fruit, vegetables, meat and alternatives, and staple vegetables. Non-core food types included confectionery, unhealthy snack foods, edible ices, and processed meat. Tongan researchers led the research in partnership with the Government of Tonga. Overall, children were observed to have consumed a mean of 4.5 (95% CI 3.3, 6.7) non-core and 2.3 (95% CI 1.8, 2.9) core foods per 10 h day, excluding mixed meals. Unhealthy snack foods, confectionary, and cookies, cakes, and desserts were the most commonly consumed non-core foods, and fresh fruit was the most frequently consumed core food. Snacking was the most frequent eating episode observed, with children snacking on non-core foods four times a day (95% confidence interval (CI) 2.5 to 6.2) compared to 1.8 (95% CI 1.3 to 2.6) core food snacks per day. Most commonly, children were observed eating at home, at school, and on the road while out walking. The most common sources of food were the home, other children, and the supermarket. On average, children consumed one purchased product per day, almost all (90%) of which were non-core. Children were also observed eating an average of just less than one mixed meal per day. Less than half (45.2%) of all mixed meals observed were traditional foods. This research illustrates the presence, and likely dominance, of energy-dense nutrient-poor (EDNP) foods in the diet of these Tongan children. It highlights a transition from a traditional diet and suggests that these children live in an obesogenic environment, one that promotes obesity as a normal response to an abnormal environment. The findings support efforts by the Government of Tonga for the implementation of a healthy School Food Policy, junk food taxes, and initiatives to ban the importation of EDNP foods. This study has relevance for other Pacific Island nations and all nations concerned with addressing obesity and other diet-related NCDs.
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Affiliation(s)
- Loma Veatupu
- Health Promotion & Policy Research Unit, University of Otago, Wellington 6242, New Zealand.
| | - Viliami Puloka
- Health Promotion & Policy Research Unit, University of Otago, Wellington 6242, New Zealand.
| | - Moira Smith
- Health Promotion & Policy Research Unit, University of Otago, Wellington 6242, New Zealand.
| | - Christina McKerchar
- Health Promotion & Policy Research Unit, University of Otago, Wellington 6242, New Zealand.
| | - Louise Signal
- Health Promotion & Policy Research Unit, University of Otago, Wellington 6242, New Zealand.
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Zhou Q, Wang D, Mhurchu CN, Gurrin C, Zhou J, Cheng Y, Wang H. The use of wearable cameras in assessing children's dietary intake and behaviours in China. Appetite 2019; 139:1-7. [PMID: 30946865 DOI: 10.1016/j.appet.2019.03.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 01/25/2019] [Accepted: 03/27/2019] [Indexed: 10/27/2022]
Abstract
The use of lifelogging device in dietary assessments can reduce misreporting and underreporting, which are common in the previous studies conventional methods. We performed the first study in Chinese children (primary school Grade 4) that applied the wearable cameras in assisting dietary recall. Children (n = 52) wore the wearable cameras (Narrative Clip 2) for seven consecutive days, during which they completed a 3-day 24-h dietary recall at home. Then children modified their dietary recalls at school by reviewing the photos taken by the wearable camera at school, with the assistance of the investigator, and generated the camera-assisted 24-h dietary recalls. Compared with camera-assisted dietary recalls, 8% (n = 160) and 1% (n = 11) of food items were underreported (i.e. not reported at all) and misreported (i.e. reported in an incorrect amount) by dietary recalls without camera-assistance, respectively. Dietary recalls without camera assistance underestimated daily energy intake by 149 ± 182 kcal/d (8%) in comparison to the camera-assisted dietary recalls. Foods consumed on the snacking occasions (40%) were more likely to be underreported than those consumed at main meals (P < 0.001). Beverages (37%), fruits (30%), snacks and desserts (16%) were foods most likely to be inaccurately reported. Children were satisfied with the wearable cameras, with a median score 5.0 (IQR: 5.0-5.0) for most features. Wearable cameras hold promise for improving accuracy of dietary intake assessment in children, providing rich objective information on dietary behaviours, and received high level of satisfaction and compliance of the users. Our results suggest that the accuracy of dietary recall among Chinse school-aged children could be improved by wearable camera, especially avoiding underreporting in the snacking occasions.
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Affiliation(s)
- Qianling Zhou
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, China
| | - Di Wang
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, China
| | - Cliona Ni Mhurchu
- National Institute for Health Innovation, University of Auckland, New Zealand
| | - Cathal Gurrin
- Insight Center for Data Analytics, Dublin City University, Ireland
| | - Jiang Zhou
- Insight Center for Data Analytics, Dublin City University, Ireland
| | - Yu Cheng
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, China
| | - Haijun Wang
- Department of Maternal and Child Health, School of Public Health, Peking University, Beijing, China.
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Association of Protein Intake in Three Meals with Muscle Mass in Healthy Young Subjects: A Cross-Sectional Study. Nutrients 2019; 11:nu11030612. [PMID: 30871197 PMCID: PMC6471574 DOI: 10.3390/nu11030612] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 03/03/2019] [Accepted: 03/08/2019] [Indexed: 12/25/2022] Open
Abstract
Protein intake of >0.24 g/kg of body weight (BW) at a single meal is necessary to maximize muscle protein synthesis in a young population. However, the association between the protein intake rate for three meals and muscle mass in the young population has not been evaluated. We hypothesized that a protein intake of >0.24 g/kg BW at all three meals is effective for maintaining muscle mass. Therefore, we cross-sectionally examined the association between protein intake at all three meals with muscle mass in 266 healthy young subjects (aged 21.4 ± 2.4 years). Subjects were divided into the AP group, which achieved protein intake >0.24 g/kg BW at all three meals; and the NP group, which did not. We calculated total fat-free mass (FFM) and appendicular fat-free mass (AppFFM) with dual-energy X-ray absorptiometry, and the percentage of total FFM (TotalFFM%) and appendicular FFM (AppFFM%) were calculated as the percentage of BW (%BW). We demonstrated that TotalFFM% (77.0 ± 0.5 vs. 75.2 ± 0.4%, p = 0.008) and AppFFM% (34.7 ± 0.3 vs. 34.1 ± 0.2%, p = 0.058) were higher in the AP than in the NP group. This finding suggests that achieving protein intake of >0.24 g/kg BW at all three meals is important for muscle mass maintenance in young populations.
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