Improvement of comparability of dietary intake assessment using currently available individual food consumption surveys

Comparison of Various Methods to Determine Added Sugars Intake to Assess the Association of Added Sugars Intake and Micronutrient Adequacy

Different methods for determining the effect of added sugars intake among children and adults on meeting recommended nutrient intakes were compared using 24 h dietary recall data from the National Health and Nutrition Examination Survey (NHANES) 2011-2014. Four methods were used to determine deciles of added sugars intake (as the percentage of total calories): 1 day intake, 2 day average intake, and individual usual intake (UI) determined with the National Cancer Institute (NCI) and the multivariate Markov Chain Monte Carlo methods. Percentages of the population below the Estimated Average Requirement (EAR) for calcium and vitamin D/above the Adequate Intake (AI) for potassium and dietary fiber for each decile of added sugars intake were assessed with the NCI method. Using regression analyses, added sugars intake deciles (by any method) in children were inversely associated (p < 0.001) with percentages below the EAR/above the AI of vitamin D, calcium, potassium, and fiber. In adults, added sugars intake deciles were inversely associated with meeting recommendations for vitamin D, potassium, and fiber. There were no significant between-method differences for regression coefficients for any nutrients investigated. Overall, these methods showed a similar association of added sugars intake with nutrient inadequacy/adequacy; therefore, method preference may depend more on practical reasons.

Deriving the Dietary Approaches to Stop Hypertension (DASH) Score in Women from Seven Pregnancy Cohorts from the European ALPHABET Consortium

The ALPHABET consortium aims to examine the interplays between maternal diet quality, epigenetics and offspring health in seven pregnancy/birth cohorts from five European countries. We aimed to use the Dietary Approaches to Stop Hypertension (DASH) score to assess diet quality, but different versions have been published. To derive a single DASH score allowing cross-country, cross-cohort and cross-period comparison and limiting data heterogeneity within the ALPHABET consortium, we harmonised food frequency questionnaire (FFQ) data collected before and during pregnancy in ≥26,500 women. Although FFQs differed strongly in length and content, we derived a consortium DASH score composed of eight food components by combining the prescriptive original DASH and the DASH described by Fung et al. Statistical issues tied to the nature of the FFQs led us to re-classify two food groups (grains and dairy products). Most DASH food components exhibited pronounced between-cohort variability, including non-full-fat dairy products (median intake ranging from 0.1 to 2.2 servings/day), sugar-sweetened beverages/sweets/added sugars (0.3-1.7 servings/day), fruits (1.1-3.1 servings/day), and vegetables (1.5-3.6 servings/day). We successfully developed a harmonized DASH score adapted to all cohorts being part of the ALPHABET consortium. This methodological work may benefit other research teams in adapting the DASH to their study's specificities.

Development of a harmonized food grouping system for between-country comparisons in the TEDDY Study

The Environmental Determinants of Diabetes in the Young (TEDDY) is an international study aiming to investigate associations between dietary and other environmental factors and the risk of developing islet autoimmunity and type 1 diabetes. Dietary intake was assessed using a 24-hour recall and repeated 3-day food records and analyzed using country-specific food composition databases (FCDBs) in Finland, Germany, Sweden, and the U.S. with respective in-house calculation programs. A food grouping harmonization process between four country-specific FCDBs was conducted to evaluate and achieve comparability on food group definitions and quantification of food consumption across the countries. Systematic review revealed that the majority of existing food groups of the TEDDY FCDBs were not comparable. Therefore, a completely new classification system of 15 mutually exclusive main food groups (e.g. vegetables) and 89 subgroups (e.g. root vegetables, leafy vegetables) was developed. Foods and beverages were categorized into basic foods (single ingredient) and composite dishes (multiple ingredients). Composite dishes were broken down to ingredients using food composition data available in the FCDBs or generic recipes created for the harmonization effort. The daily consumption of every food group across FCDBs was quantified consistently as either raw or prepared weight depending on the food group to achieve maximal comparability.

Comparison of two dietary assessment methods by food consumption: results of the German National Nutrition Survey II

PURPOSE

To further characterise the performance of the diet history method and the 24-h recalls method, both in an updated version, a comparison was conducted.

METHODS

The National Nutrition Survey II, representative for Germany, assessed food consumption with both methods. The comparison was conducted in a sample of 9,968 participants aged 14-80. Besides calculating mean differences, statistical agreement measurements encompass Spearman and intraclass correlation coefficients, ranking participants in quartiles and the Bland-Altman method.

RESULTS

Mean consumption of 12 out of 18 food groups was higher assessed with the diet history method. Three of these 12 food groups had a medium to large effect size (e.g., raw vegetables) and seven showed at least a small strength while there was basically no difference for coffee/tea or ice cream. Intraclass correlations were strong only for beverages (>0.50) and revealed the least correlation for vegetables (<0.20). Quartile classification of participants exhibited more than two-thirds being ranked in the same or adjacent quartile assessed by both methods. For every food group, Bland-Altman plots showed that the agreement of both methods weakened with increasing consumption.

CONCLUSIONS

The cognitive effort essential for the diet history method to remember consumption of the past 4 weeks may be a source of inaccurateness, especially for inhomogeneous food groups. Additionally, social desirability gains significance. There is no assessment method without errors and attention to specific food groups is a critical issue with every method. Altogether, the 24-h recalls method applied in the presented study, offers advantages approximating food consumption as compared to the diet history method.

A comparative analysis of dietary intakes during pregnancy in Europe: a planned pooled analysis of birth cohort studies

BACKGROUND

There is growing evidence that despite the absence of marked deficiencies, diet during pregnancy has important implications for maternal and child health in industrialized countries. At present, relatively little is known about prevailing patterns of intake across groups with diverse sociodemographic and lifestyle patterns in these settings.

OBJECTIVES

The aims of this study were to develop methods for the standardization of food group intake data and to describe the process of applying these methods to existing pregnancy cohort studies, which included >200,000 women across Europe.

DESIGN

The study developed a detailed standardization protocol to harmonize intakes of selected food groups, which included fruit, vegetables, meats, seafood, and dairy products. Standardization is necessary to facilitate valid comparisons of intake patterns and disparities across countries and will lead to the development of harmonized databases for possible future pooled analyses.

RESULTS

On the basis of comparisons with previously coordinated multicountry studies, preliminary data suggest that the standardization process yielded sufficiently comparable intake data, which indicate differences in food cultures across the countries that participated.

CONCLUSIONS

This project provides lessons on the feasibility of harmonizing dietary intake data from existing studies, which can be applied in future post hoc standardization efforts. The data yielded in this analysis will also provide useful information for the development of food and nutrition policies for pregnant women in Europe, including the identification of population subgroups in which dietary inadequacies during pregnancy may be widespread.

Performance of the quantitative food frequency questionnaire used in the Brazilian center of the prospective study Natural History of Human Papillomavirus Infection in Men: The HIM Study

The Natural History of Human Papillomavirus (HPV) Infection in Men: The HIM Study is a prospective multicenter cohort study that, among other factors, analyzes participants' diet. A parallel cross-sectional study was designed to evaluate the validity and reproducibility of the quantitative food frequency questionnaire (QFFQ) used in the Brazilian center from the HIM Study. For this, a convenience subsample of 98 men aged 18 to 70 years from the HIM Study in Brazil answered three 54-item QFFQ and three 24-hour recall interviews, with 6-month intervals between them (data collection January to September 2007). A Bland-Altman analysis indicated that the difference between instruments was dependent on the magnitude of the intake for energy and most nutrients included in the validity analysis, with the exception of carbohydrates, fiber, polyunsaturated fat, vitamin C, and vitamin E. The correlation between the QFFQ and the 24-hour recall for the deattenuated and energy-adjusted data ranged from 0.05 (total fat) to 0.57 (calcium). For the energy and nutrients consumption included in the validity analysis, 33.5% of participants on average were correctly classified into quartiles, and the average value of 0.26 for weighted kappa shows a reasonable agreement. The intraclass correlation coefficients for all nutrients were greater than 0.40 in the reproducibility analysis. The QFFQ demonstrated good reproducibility and acceptable validity. The results support the use of this instrument in the HIM Study.

Two non-consecutive 24 h recalls using EPIC-Soft software are sufficiently valid for comparing protein and potassium intake between five European centres – results from the European Food Consumption Validation (EFCOVAL) study

The use of two non-consecutive 24 h recalls using EPIC-Soft for standardised dietary monitoring in European countries has previously been proposed in the European Food Consumption Survey Method consortium. Whether this methodology is sufficiently valid to assess nutrient intake in a comparable way, among populations with different food patterns in Europe, is the subject of study in the European Food Consumption Validation consortium. The objective of the study was to compare the validity of usual protein and K intake estimated from two non-consecutive standardised 24 h recalls using EPIC-Soft between five selected centres in Europe. A total of 600 adults, aged 45–65 years, were recruited in Belgium, the Czech Republic, France, The Netherlands and Norway. From each participant, two 24 h recalls and two 24 h urines were collected. The mean and distribution of usual protein and K intake, as well as the ranking of intake, were compared with protein and K excretions within and between centres. Underestimation of protein (range 2–13 %) and K (range 4–17 %) intake was seen in all centres, except in the Czech Republic. We found a fair agreement between prevalences estimated based on the intake and excretion data at the lower end of the usual intake distribution ( < 10 % difference), but larger differences at other points. Protein and K intake was moderately correlated with excretion within the centres (ranges = 0·39–0·67 and 0·37–0·69, respectively). These were comparable across centres. In conclusion, two standardised 24 h recalls (EPIC-Soft) appear to be sufficiently valid for assessing and comparing the mean and distribution of protein and K intake across five centres in Europe as well as for ranking individuals.

Effects of dietary assessment methods on assessing risk of nutrient intake adequacy at the population level: from theory to practice

The present study evaluated how applying different dietary methods affects risk assessment of inadequate intakes at the population level. A pooled analysis was conducted using data from two Spanish regional representative surveys both applying similar methodology with a total sample of 2615 individuals aged 12-80. Diet was assessed in the entire sample applying data from one 24 h recall (24HR), a mean of two non-consecutive 24HR, both crude and adjusted for intraindividual variability, and a FFQ. Intakes of vitamins A, C, E, thiamin, riboflavin, niacin, vitamin B6, vitamin B12, Fe, Mg, P and Zn were compared to the average nutrient requirement (ANR or estimated average requirement) in the entire sample and also excluding under-reporters applying the ANR cut-point method (and the probability approach for Fe). Higher percentages of intakes below the ANR were seen for 1-24HR and the mean of 2-24HR, except for nutrients with the highest rates of inadequacy (vitamins A, E, folate and Mg). For these micronutrients, higher percentages of inadequacy were obtained by adjusted 24HR data and the lowest with FFQ. For the remaining nutrients, adjusted data gave the lowest inadequacy percentages. The best concordance was seen between 2-24HR and 1-24HR as well as for adjusted 24HR, with the least observed between FFQ and the other methods. Exclusion of under-reporters considerably reduced inadequacy in both daily methods and FFQ. Crude daily data gave higher estimates of inadequate intakes than adjusted data or FFQ. Reproducibility of daily methods was also reasonably good. Results may differ depending on the micronutrient thus impeding reaching conclusions/recommendations common for all micronutrients.

Role of naturally-occurring plant sterols on intestinal cholesterol absorption and plasmatic levels

Cardiovascular disease is a major health problem in developed countries although its incidence is relatively lower in Mediterranean countries which is partly ascribed to dietary habits. Epidemiologic evidence shows that elevated serum cholesterol, specifically low-density lipoprotein cholesterol (c-LDL), increases cardiovascular disease. Phytosterols are bioactive compounds, found in all vegetable foods, which inhibit intestinal cholesterol absorption and, therefore, have a serum cholesterol-lowering effect. Intestinal cholesterol absorption is a multistep process where plant sterols and stanols may act: a) attenuating the NPC1L1 gene expression, which may result in a lower cholesterol uptake from the lumen; b) lowering the cholesterol esterification rate by the ACAT2 (acyl-CoA cholesterol acyltransferase) and, consequently, the amount of cholesterol secreted via the chylomicrons and c) upregulating the expression of ABC-transporters ABCG5 and ABCG8 in intestinal cells, which may result in an increased excretion of cholesterol by the enterocyte back into the lumen. Many clinical trials proved that commercial products enriched with phytosterols reduce cholesterol levels. Likewise, recent studies show that phytosterols present in natural food matrices are also effective and could be an important component of cardioprotective dietary patterns such as the Mediterranean diet.

The Italian National Food Consumption Survey INRAN-SCAI 2005-06: main results in terms of food consumption

OBJECTIVE

The current paper aims to present the main results of the Italian National Food Consumption Survey INRAN-SCAI 2005-06.

DESIGN

A cross-sectional study was performed. Households were randomly selected after geographical stratification of the national territory. Food consumption was assessed on three consecutive days through individual estimated dietary records.

SETTING

Italy.

SUBJECTS

The final study sample comprised 3323 subjects (1501 males and 1822 females) aged 0.1 to 97.7 years belonging to 1329 households: fifty-two infants (0-2.9 years), 193 children (3-9.9 years), 247 teenagers (10-17.9 years), 2313 adults (18-64.9 years) and 518 elderly (65 years and above).

RESULTS

Participation rate was 33 %. The mean ratio of estimated energy intake to estimated BMR was 1.41 in adults. Indicators of mean and high individual consumption are presented for fifteen large categories and fifty-one subcategories of foods and beverages, in the total population and in consumers, by age and sex categories. The overall consumption of fruit and vegetables was 418 g/d. The consumption of red meat was approximately 700 g/week, expressed as raw weight. Some specific aspects of the Italian food consumption pattern were confirmed: a large contribution from bread, pasta and pizza to cereals, from olive oil to fats and from wine to alcoholic beverages.

CONCLUSIONS

The database obtained from the survey will be the key reference for Italian food consumption during the coming years and will be utilized for a variety of purposes including the assessment of nutrient intakes and risk analysis.

Analysis of meal patterns with the use of supervised data mining techniques--artificial neural networks and decision trees

BACKGROUND

At present, the analysis of dietary patterns is based on the intake of individual foods. This article demonstrates how a coding system at the meal level might be analyzed by using data mining techniques.

OBJECTIVE

The objective was to evaluate the usability of supervised data mining methods to predict an aspect of dietary quality based on dietary intake with a food-based coding system and a novel meal-based coding system.

DESIGN

Food consumption databases from the North-South Ireland Food Consumption Survey 1997-1999 were used. This was a randomized cross-sectional study of 7-d recorded food and nutrient intakes of a representative sample of 1379 Irish adults. Meal definitions were recorded by the respondent. A healthy eating index (HEI) score was developed. Artificial neural networks (ANNs) and decision trees were used to predict quintiles of the HEI based on combinations of foods consumed at breakfast and main meals.

RESULTS

This study applied both data mining techniques to the food and meal-based coding systems. The ANN had a slightly higher accuracy than did the decision tree in relation to its ability to predict HEI quintiles 1 and 5 based on the food coding system (78.7% compared with 76.9% and 71.9% compared with 70.1%, respectively). However, the decision tree had higher accuracies than did the ANN on the basis of the meal coding system (67.5% compared with 54.6% and 75.1% compared with 72.4%, respectively).

CONCLUSIONS

ANNs and decision trees were successfully used to predict an aspect of dietary quality. However, further exploration of the use of ANNs and decision trees in dietary pattern analysis is warranted.

The importance of harmonizing food composition data across Europe

OBJECTIVE

To examine the role of food composition data in Europe in four sectors, namely health, trade regulation and legislation, agriculture and the environment.

RESULTS

The need for further harmonization of data across Europe is clearly identified and evidenced from a number of previous successful European collaborations.

CONCLUSIONS

Data on the nutritional composition of foods are essential for a broad spectrum of activities, including public health nutrition, research, the food industry and government policy development and implementation. With the expansion of the European Union and the concomitant increase in cross border trade and cooperation harmonizing food composition data becomes a more important issue than ever. Harmonization is not solely a technical issue, but also involves creating durable and sustainable structures to maintain the viability of the data. These are some of the issues currently being addressed by the European Food Information Resource Network of Excellence.

Integration of probabilistic exposure assessment and probabilistic hazard characterization

A method is proposed for integrated probabilistic risk assessment where exposure assessment and hazard characterization are both included in a probabilistic way. The aim is to specify the probability that a random individual from a defined (sub)population will have an exposure high enough to cause a particular health effect of a predefined magnitude, the critical effect size (CES). The exposure level that results in exactly that CES in a particular person is that person's individual critical effect dose (ICED). Individuals in a population typically show variation, both in their individual exposure (IEXP) and in their ICED. Both the variation in IEXP and the variation in ICED are quantified in the form of probability distributions. Assuming independence between both distributions, they are combined (by Monte Carlo) into a distribution of the individual margin of exposure (IMoE). The proportion of the IMoE distribution below unity is the probability of critical exposure (PoCE) in the particular (sub)population. Uncertainties involved in the overall risk assessment (i.e., both regarding exposure and effect assessment) are quantified using Monte Carlo and bootstrap methods. This results in an uncertainty distribution for any statistic of interest, such as the probability of critical exposure (PoCE). The method is illustrated based on data for the case of dietary exposure to the organophosphate acephate. We present plots that concisely summarize the probabilistic results, retaining the distinction between variability and uncertainty. We show how the relative contributions from the various sources of uncertainty involved may be quantified.

Caracterização dos estudos de avaliação do consumo alimentar de pré-escolares

Os estudos dietéticos fornecem elementos elucidativos que contribuem para a compreensão da dinâmica e determinação dos diversos agravos nutricionais que atingem a população infantil. As investigações do consumo alimentar de crianças pequenas utilizam os mesmos métodos de inquéritos empregados nas demais faixas etárias, diferenciando-se pela necessidade de um respondente, geralmente um dos pais ou o cuidador da criança. O objetivo do trabalho foi identificar os principais métodos de avaliação do consumo alimentar utilizados nos inquéritos com pré-escolares, assim como os itens e formas de análise mais comumente empregados. Verificou-se que os estudos apresentaram baixa comparabilidade, em função, entre outros fatores, do uso de diferentes formas de análise e metas de ingestão. O recordatório de 24h foi o método mais utilizado, geralmente associado a um outro método de inquérito. Ainda são poucos os estudos que empregam as novas cotas dietéticas de referência para avaliação da adequação das dietas. No Brasil, assim como nos demais países em desenvolvimento, os estudos ainda priorizam as carências nutricionais. Apesar do aumento no número de estudos brasileiros nos últimos anos, as pesquisas existentes são de limitada comparabilidade, sendo essencial que se invista em uma estrutura (tabelas, softwares, seleção de indicadores) que possibilite um diagnóstico nutricional mais fidedigno e com potencial de comparação.

Analysis of multivariate extreme intakes of food chemicals

A recently published multivariate Extreme Value Theory (EVT) model is applied to the estimation of population risks associated with dietary intake of pesticides. The objective is to quantify the acute risk of pesticide intake above a threshold and relate it to the consumption of specific primary food products. As an example daily intakes of a pesticide from three foods are considered. The method models and extrapolates simultaneous intakes of pesticide, and estimates probability of exceeding unobserved large intakes. Multivariate analysis was helpful in identifying whether the avoidance of certain food combinations would reduce the likelihood of exceeding a threshold. We argue that the presented method can be an important contribution to exposure assessment studies.

Risk assessment of dietary exposure to pesticides using a Bayesian method

Risk assessment of pesticides can be a statistically difficult problem because pesticides occur only occasionally, but they may occur on multiple components in the diet. A Bayesian statistical model is presented which incorporates multivariate modelling of food consumption and modelling of pesticide measurements which are for a large part below a measurement threshold. It is shown that Bayesian modelling is feasible for a limited number of food components, and that in a data-rich situation the model compares well with an empirical Monte Carlo modelling.

Assessment of the safety of foods derived from genetically modified (GM) crops

This paper provides guidance on how to assess the safety of foods derived from genetically modified crops (GM crops); it summarises conclusions and recommendations of Working Group 1 of the ENTRANSFOOD project. The paper provides an approach for adapting the test strategy to the characteristics of the modified crop and the introduced trait, and assessing potential unintended effects from the genetic modification. The proposed approach to safety assessment starts with the comparison of the new GM crop with a traditional counterpart that is generally accepted as safe based on a history of human food use (the concept of substantial equivalence). This case-focused approach ensures that foods derived from GM crops that have passed this extensive test-regime are as safe and nutritious as currently consumed plant-derived foods. The approach is suitable for current and future GM crops with more complex modifications. First, the paper reviews test methods developed for the risk assessment of chemicals, including food additives and pesticides, discussing which of these methods are suitable for the assessment of recombinant proteins and whole foods. Second, the paper presents a systematic approach to combine test methods for the safety assessment of foods derived from a specific GM crop. Third, the paper provides an overview on developments in this area that may prove of use in the safety assessment of GM crops, and recommendations for research priorities. It is concluded that the combination of existing test methods provides a sound test-regime to assess the safety of GM crops. Advances in our understanding of molecular biology, biochemistry, and nutrition may in future allow further improvement of test methods that will over time render the safety assessment of foods even more effective and informative.