Biochemical validation of a self-administered semi-quantitative food-frequency questionnaire

Associations between Maternal Dietary Patterns, Biomarkers and Delivery Outcomes in Healthy Singleton Pregnancies: Multicenter Italian GIFt Study

Background: Maternal nutrition represents a critical risk factor for adverse health outcomes in both mother and offspring. We aimed to investigate associations between maternal nutritional habits, biomarker status, and pregnancy outcome among Italian healthy normal-weight pregnancies. Methods: Multicenter prospective cohort study recruiting Italian healthy normal-weight women with singleton spontaneous pregnancies at 20 ± 2 weeks (T1) in Milan and Naples. All patients underwent nutritional evaluations by our collecting a 7-day weighed dietary record at 25 ± 1 weeks (T2) and a Food Frequency Questionnaire at 29 ± 2 weeks (T3). Maternal venous blood samples were collected at T3 to assess nutritional, inflammatory and oxidative biomarker concentrations (RBCs folate, vitamin D, hepcidin, total antioxidant capacity). Pregnancy outcomes were collected at delivery (T4). General linear models adjusted for confounding factors were estimated to investigate associations between maternal dietary pattern adherence, nutrient intakes, biomarker concentrations and delivery outcomes. Results: 219 healthy normal-weight pregnant women were enrolled. Vitamin D and RBCs folate concentrations, as well as micronutrient intakes, were consistently below the recommended range. In a multi-adjusted model, maternal adherence to the most prevalent ‘high meat, animal fats, grains’ dietary pattern was positively associated with hepcidin concentrations and negatively associated with gestational age at delivery in pregnancies carrying female fetuses. Hepcidin plasma levels were further negatively associated to placental weight, whereas vitamin D concentrations were positively associated to neonatal weight. Conclusions: A high adherence to an unbalanced ‘high meat, animal fats, grains’ pattern was detected among Italian normal-weight low-risk pregnancies, further associated with maternal pro-inflammatory status and gestational age at delivery. This evidence underlines the need for a dedicated nutritional counseling even among low-risk pregnancies.

"HEALTH-FOR": a pilot study to assess eating habits during pregnancy among Arab and Chinese immigrants living in Italy

A 1-year pilot cross-sectional study was performed to assess eating behaviours and lifestyle among Chinese and Arab pregnant immigrants to Italy. A number of 95 Chinese and 83 Arab women were interviewed. Two ethnic-specific food frequency questionnaires were designed to reflect the habitual diet of women belonging to these ethnic groups. Food items frequency of consumption was discussed using healthy eating guidelines. In both populations, women met healthy eating guidelines, except for salt intake, which was double than recommended; meat, sweet products and sugar-sweetened beverages were consumed more frequently than recommended, while olive oil and yogurt were eaten less frequently. Chinese women did not reach the recommendations for dairy products and fatty fish and exceeded those for red and processed meat, whereas Arab women exceeded the recommendations for cheese. Our findings suggest that the Italian food environment did not significantly affect Chinese and Arab pregnant immigrants' diet.

Exploring Associations between Interindividual Differences in Taste Perception, Oral Microbiota Composition, and Reported Food Intake

The role of taste perception, its relationship with oral microbiota composition, and their putative link with eating habits and food intake were the focus of the present study. A sample of 59 reportedly healthy adults (27 male, 32 female; age: 23.3 ± 2.6 years) were recruited for the study and taste thresholds for basic tastes, food intake, and oral microbiota composition were evaluated. Differences in taste perception were associated with different habitual food consumption (i.e., frequency) and actual intake. Subjects who were orally hyposensitive to salty taste reported consuming more bakery and salty baked products, saturated-fat-rich products, and soft drinks than hypersensitive subjects. Subjects hyposensitive to sweet taste reported consuming more frequently sweets and desserts than the hypersensitive group. Moreover, subjects hypersensitive to bitter taste showed higher total energy and carbohydrate intakes compared to those who perceived the solution as less bitter. Some bacterial taxa on tongue dorsum were associated with gustatory functions and with vegetable-rich (e.g., Prevotella) or protein/fat-rich diets (e.g., Clostridia). Future studies will be pivotal to confirm the hypothesis and the potential exploitation of oral microbiome as biomarker of long-term consumption of healthy or unhealthy diets.

Relationship between Mediterranean diet and asymptomatic peripheral arterial disease in a population of pre-menopausal women

BACKGROUND AND AIMS

The Mediterranean Diet (MedD) is considered a very healthy diet useful in the prevention of cardiovascular disease. The present study aims to evaluate adherence to MedD in unselected premenopausal women and its relation with ankle-brachial index (ABI), an index of preclinical atherosclerosis.

METHODS AND RESULTS

A group of 425 patients (age range 45-54 years) was investigated. They were enrolled only if they were asymptomatic for cardiovascular disease. Nutritional parameters were assessed by a self-administered food frequency validated questionnaire (116 items) completed by an interviewer administered 24 h diet recall. They all underwent ABI measurement. The mean MedD Score was 32.2 ± 6.1 (Q1-Q3 range 26-37) comparing with data from Italian population (46 ± 8.3) was significantly lower. Intake of food categories sources of antioxidants was higher in patients with a greater adherence to Med D and was mainly related to fruit and vegetables. Patients were categorized in quartile according to MedD Score and we evaluate the distribution of ABI index within quartile. 31.4% of women in Q1 (lower adherence to MedD) had an ABI lower than 0.9 compared to 18.3% of women in Q4 (higher adherence to MedD): p < 0.01. Obesity was more frequent in Q1 compared to Q4 and in women with lower ABI.

CONCLUSIONS

Women with a low MedD Score were more obese and showed instrumental sign of preclinical peripheral atherosclerosis. MedD rich in antioxidants from fruit, vegetables and nuts influenced the development of atherosclerosis and was associated with a lower incidence of asymptomatic atherosclerosis.

Dietary Phosphorus Intake and the Kidney

Although phosphorus is an essential nutrient required for multiple physiological functions, recent research raises concerns that high phosphorus intake could have detrimental effects on health. Phosphorus is abundant in the food supply of developed countries, occurring naturally in protein-rich foods and as an additive in processed foods. High phosphorus intake can cause vascular and renal calcification, renal tubular injury, and premature death in multiple animal models. Small studies in human suggest that high phosphorus intake may result in positive phosphorus balance and correlate with renal calcification and albuminuria. Although serum phosphorus is strongly associated with cardiovascular disease, progression of kidney disease, and death, limited data exist linking high phosphorus intake directly to adverse clinical outcomes. Further prospective studies are needed to determine whether phosphorus intake is a modifiable risk factor for kidney disease.

A single serving of blueberry (V. corymbosum) modulates peripheral arterial dysfunction induced by acute cigarette smoking in young volunteers: a randomized-controlled trial

Cigarette smoking causes oxidative stress, hypertension and endothelial dysfunction. Polyphenol-rich foods may prevent these conditions. We investigated the effect of a single serving of fresh-frozen blueberry intake on peripheral arterial function and arterial stiffness in young smokers. Sixteen male smokers were recruited for a 3-armed randomized-controlled study with the following experimental conditions: smoking treatment (one cigarette); blueberry treatment (300 g of blueberry) + smoking; control treatment (300 mL of water with sugar) + smoking. Each treatment was separated by one week of wash-out period. The blood pressure, heart rate, peripheral arterial function (reactive hyperemia and Framingham reactive hyperemia), and arterial stiffness (digital augmentation index, digital augmentation index normalized for a heart rate of 75 bpm) were measured before and 20 min after smoking with Endo-PAT2000. Smoking impaired the blood pressure, heart rate and peripheral arterial function, but did not affect the arterial stiffness. Blueberry consumption counteracted the impairment of the reactive hyperemia index induced by smoking (-4.4 ± 0.8% blueberry treatment vs. -22.0 ± 1.1% smoking treatment, p < 0.01) and Framingham reactive hyperemia (+28.3 ± 19.2% blueberry treatment vs. -42.8 ± 20.0% smoking treatment, p < 0.0001), and the increase of systolic blood pressure (+8.4 ± 0.02% blueberry treatment vs. +13.1 ± 0.02% smoking treatment, mmHg, p < 0.05) after cigarette smoking. No effect was observed for arterial stiffness and other vital signs. In conclusion, data obtained suggest a protective role of blueberry on reactive hyperemia, Framingham reactive hyperemia, and systolic blood pressure in subjects exposed to smoke of one cigarette. Future studies are necessary to elucidate the mechanisms involved.

A comprehensive FFQ developed for use in New Zealand adults: reliability and validity for nutrient intakes

OBJECTIVE

To evaluate the reliability and relative validity of a semi-quantitative FFQ for assessing the habitual intake of multiple nutrients in New Zealand (NZ) adults over the past 12 months.

DESIGN

A 154-item FFQ was developed. After initial pre-testing, reliability was assessed using intra-class correlations. Relative validity was assessed by comparing nutrient intakes derived from the FFQ v. those from an 8 d diet record (8dWDR) collected over 12 months and selected blood biomarkers, using Spearman correlations. Supplementary cross-classification and Bland-Altman analyses were performed to assess validity of the FFQ v. the 8dWDR.

SETTING

Dunedin, NZ.

SUBJECTS

One hundred and thirty-two males and females aged 30-59 years who completed all FFQ and 8dWDR and provided a blood sample.

RESULTS

Reliability coefficients ranged from 0·47 for Ca to 0·83 for alcohol, with most values falling between 0·60 and 0·80. The highest validity coefficients for energy-adjusted data were observed for alcohol (0·74), cholesterol (0·65) and β-carotene (0·58), and the lowest for Zn (0·24) and Ca (0·28). For all energy-adjusted nutrients mean percentage correct classification was 77·9% and gross misclassification was 4·5%. Results of Bland-Altman analyses showed wide limits of agreement for all micronutrients but high agreement was observed for most macronutrients (99% for protein, 103% for total fat). When compared with biomarkers, energy-adjusted coefficients were 0·34 for β-carotene and 0·33 for vitamin C.

CONCLUSIONS

The FFQ provides highly repeatable measurements and good validity in ranking individuals' intake, suggesting that it will be a useful tool to assess nutrient intake of NZ adults in future research.

Modulation of plasma antioxidant levels, glutathione S-transferase activity and DNA damage in smokers following a single portion of broccoli: a pilot study

BACKGROUND

Broccoli is a rich source of bioactive compounds (i.e. glucosinolates, carotenoids, vitamin C and folate) that may exert an antioxidant effect and reduce oxidative damage. The objective of this pilot study was to investigate the effect of broccoli consumption on carotenoids, vitamin C and folate absorption, glutathione S-transferase (GST) activity, and oxidatively induced DNA damage in male smokers.

METHODS

Ten healthy subjects consumed a single portion of steamed broccoli (250 g) with cooked pasta. Blood was drawn at baseline and at 3, 6 and 24 h from consumption.

RESULTS

Broccoli significantly (P ≤ 0.01) increased plasma level of vitamin C and folate (+35% and 70%, respectively) at 3 h, and β-carotene (+8%) at 6 h. A modulation of GST activity occurred in plasma 6 h after broccoli consumption. A significant (P ≤ 0.01) reduction of the levels of H₂O₂-induced DNA damage (-18%) was observed in blood mononuclear cells 24 h after broccoli intake in GSTM1 positive, but not in GSTM1 null subjects.

CONCLUSION

One portion of broccoli increased plasma antioxidant levels, modulated plasma GST activity and improved cell resistance against H₂O₂-induced DNA damage in healthy smokers. These results support the importance of consuming fruit and vegetable regularly.

Selected micronutrient intake and status in men with differing meat intakes, vegetarians and vegans

Dietary factors play a critical role in human health. The aim of this cross-sectional study was to examine micronutrient intake and status of subjects who were habitual meat eaters eating different quantities of meat with those who were habitual vegetarians or vegans. One hundred and thirty-nine healthy male subjects (vegan, n = 18; ovolacto-vegetarian, n = 46; moderate meat-eater, n = 65; and high meat-eater, n = 18) aged 20-55 years were recruited in metropolitan Melbourne. Each volunteer completed a semiquantitative Food Frequency Questionnaire (FFQ) and gave a fasting venous blood sample. Dietary sodium/potassium ratio was significantly lower and vitamin C, fibre and iron intakes were higher in vegetarians than in meat-eaters. High meat-eaters had a significantly higher calcium, retinol and zinc intake than did the other three dietary groups; moderate meateaters had the lowest mean intake of fibre, vitamin C and β-carotene. Vegans had a significantly higher β-carotene intake than did the other groups. Serum ferritin and vitamin B12 levels, and haemoglobin concentration were significantly lower in vegetarians than in meat-eaters. Vegans had a significantly higher serum folate concentration than did ovolacto-vegetarian and moderate meat-eater groups. There was no significant difference in serum α-tocopherol concentration. There are differences between the four diet groups that have potential to affect the subjects' health and susceptibility to chronic diseases including cardiovascular disease and cancer. Based on the present data, high meat-eaters may particularly benefit from altering their dietary pattern to reduce their sodium and saturated fat intake, and moderate meat-eaters from increasing their fibre and antioxidant consumption. Vegetarians, especially vegans, may need to increase their vitamin B12 and zinc intakes.

Adherence to Mediterranean diet and intake of antioxidants influence spontaneous conversion of atrial fibrillation

BACKGROUND AND AIM

The Mediterranean diet (MedD) has long been associated with lower incidence of cardiovascular disease. Little information is available on association between MedD, vitamins intake and arrhythmias. We sought to investigate the relationship between adherence to MedD, antioxidants intake and spontaneous conversion of atrial fibrillation (AF).

METHODS AND RESULTS

A group of 800 subjects was included in a case-control study; 400 of them had a first detected episode of AF. Nutritional parameters were assessed by a self-administered food frequency validated questionnaire and completed by an interviewer-administered 7 days diet recall. Adherence to MedD was evaluated using the Mediterranean Score and intake of antioxidants from food was calculated. Adherence to the Med Diet was lower in patients that developed AF compared to control (mean Med Score: 22.3 ± 3.1 vs 27.9 ± 5.6; p < 0.001). The median value was 23.5 (Q1-Q3 range 23-30) in patients with AF and 27.4 (Q1-Q3 range 26-33). The estimated intake of total antioxidants was lower in patients with AF (13.5 ± 8.3 vs 18.2 ± 9.4 mmol/d; p < 0.001). Patients in the highest quartile of Mediterranean Score had higher probability of spontaneous conversion of atrial fibrillation (OR1.9; 95%CI 1.58-2.81). High levels of antioxidants intake were also associated with an increasing probability of spontaneous conversion of arrhythmia (O.R. 1.8; 95%CI 1.56-2.99; P < 0.01).

CONCLUSIONS

Patients with atrial fibrillation had lower adherence to MedD and lower antioxidant intake compared to control population. Moreover patients with arrhythmia showing a higher Med Score had more probability of a spontaneous conversion of atrial fibrillation.

A single portion of blueberry (Vaccinium corymbosum L) improves protection against DNA damage but not vascular function in healthy male volunteers

It has been suggested that anthocyanin-rich foods may exert antioxidant effects and improve vascular function as demonstrated mainly in vitro and in the animal model. Blueberries are rich sources of anthocyanins and we hypothesized that their intake could improve cell protection against oxidative stress and affect endothelial function in humans. The aim of the study was to investigate the effect of one portion (300 g) of blueberries on selected markers of oxidative stress and antioxidant protection (endogenous and oxidatively induced DNA damage) and of vascular function (changes in peripheral arterial tone and plasma nitric oxide levels) in male subjects. In a randomized cross-over design, separated by a wash out period ten young volunteers received one portion of blueberries ground by blender or one portion of a control jelly. Before and after consumption (at 1, 2, and 24 hours), blood samples were collected and used to evaluate anthocyanin absorption (through mass spectrometry), endogenous and H(2)O(2)-induced DNA damage in blood mononuclear cells (through the comet assay), and plasma nitric oxide concentrations (through a fluorometric assay). Peripheral arterial function was assessed by means of Endo-PAT 2000. Blueberries significantly reduced (P < .01) H(2)O(2)-induced DNA damage (-18%) 1 hour after blueberry consumption compared to control. No significant differences were observed for endogenous DNA damage, peripheral arterial function and nitric oxide levels after blueberry intake. In conclusion, one portion of blueberries seems sufficient to improve cell antioxidant defense against DNA damage, but further studies are necessary to understand their role on vascular function.

Dietary phosphorus is associated with greater left ventricular mass

Dietary phosphorus consumption has risen steadily in the United States. Oral phosphorus loading alters key regulatory hormones and impairs vascular endothelial function which may lead to an increase in left ventricular mass (LVM). We investigated the association of dietary phosphorus with LVM in 4,494 participants from the Multi-Ethnic Study of Atherosclerosis, a community-based study of individuals free of known cardiovascular disease. The intake of dietary phosphorus was estimated using a 120-item food frequency questionnaire and the LVM was measured using magnetic resonance imaging. Regression models were used to determine associations of estimated dietary phosphorus with LVM and left ventricular hypertrophy (LVH). Mean estimated dietary phosphorus intake was 1,167 mg/day in men and 1,017 mg/day in women. After adjustment for demographics, dietary sodium, total calories, lifestyle factors, comorbidities, and established LVH risk factors, each quintile increase in the estimated dietary phosphate intake was associated with an estimated 1.1 gram greater LVM. The highest gender-specific dietary phosphorus quintile was associated with an estimated 6.1 gram greater LVM compared to the lowest quintile. Higher dietary phosphorus intake was associated with greater odds of LVH among women, but not men. These associations require confirmation in other studies.

Assessing dietary intake: Who, what and why of under-reporting

Under-reporting of food intake is one of the fundamental obstacles preventing the collection of accurate habitual dietary intake data. The prevalence of under-reporting in large nutritional surveys ranges from 18 to 54% of the whole sample, but can be as high as 70% in particular subgroups. This wide variation between studies is partly due to different criteria used to identify under-reporters and also to non-uniformity of under-reporting across populations. The most consistent differences found are between men and women and between groups differing in body mass index. Women are more likely to under-report than men, and under-reporting is more common among overweight and obese individuals. Other associated characteristics, for which there is less consistent evidence, include age, smoking habits, level of education, social class, physical activity and dietary restraint. Determining whether under-reporting is specific to macronutrients or food is problematic, as most methods identify only low energy intakes. Studies that have attempted to measure under-reporting specific to macronutrients express nutrients as percentage of energy and have tended to find carbohydrate under-reported and protein over-reported. However, care must be taken when interpreting these results, especially when data are expressed as percentages. A logical conclusion is that food items with a negative health image (e.g. cakes, sweets, confectionery) are more likely to be under-reported, whereas those with a positive health image are more likely to be over-reported (e.g. fruits and vegetables). This also suggests that dietary fat is likely to be under-reported. However, it is necessary to distinguish between under-reporting and genuine under-eating for the duration of data collection. The key to understanding this problem, but one that has been widely neglected, concerns the processes that cause people to under-report their food intakes. The little work that has been done has simply confirmed the complexity of this issue. The importance of obtaining accurate estimates of habitual dietary intakes so as to assess health correlates of food consumption can be contrasted with the poor quality of data collected. This phenomenon should be considered a priority research area. Moreover, misreporting is not simply a nutritionist's problem, but requires a multidisciplinary approach (including psychology, sociology and physiology) to advance the understanding of under-reporting in dietary intake studies.

Dietary assessment methods for micronutrient intake: a systematic review on vitamins

The EURRECA Network of Excellence is working towards the development of aligned micronutrient recommendations across Europe. The purpose of the present study was to define how to identify dietary intake validation studies in adults pertaining to vitamins. After establishing a search strategy, we conducted a MEDLINE and EMBASE literature review. A scoring system was developed to rate the quality of each validation study according to sample size, statistical methods, data collection procedure, seasonality and vitamin supplement use. This produced a quality index with possible scores obtained ranging from 0.5 to 7. Five thousand four-hundred and seventy-six papers were identified. The numbers meeting the inclusion criteria were: for vitamin A, 76; vitamin C, 108; vitamin D, 21; vitamin E, 75; folic acid, 47; vitamin B12, 19; vitamin B6, 21; thiamine, 49; riboflavin, 49; and niacin, 32. The most frequently used method to ascertain dietary intake was the Food Frequency Questionnaire (FFQ), whereas dietary records (DR) and 24-h recalls were the most used reference methods. The correlation coefficients (CC) between vitamin intakes estimated by FFQ and the reference method were weighted according to the study's quality index and ranged from 0.41 to 0.53 when the reference method was the DR and from 0.43 to 0.67 when the reference was 24-h recalls. A minority of studies (n 33) used biomarkers for validation and in these the CC ranged from 0.26 to 0.38. The FFQ is an acceptable method of assessing vitamin intake. The present review provides new insights regarding the characteristics that assessment methods for dietary intake should fulfil.

Blanching improves anthocyanin absorption from highbush blueberry ( Vaccinium corymbosum L.) purée in healthy human volunteers: a pilot study

Blueberries ( Vaccinium corymbosum L.) are rich sources of phenolics and anthocyanins (ACNs). We investigated the absorption of ACNs after consumption of one portion (300 g) of minimally processed blueberry purée (P) obtained from blanched (BL) or unblanched (NB) berries. A repeated-measures, crossover design study was conducted on healthy human volunteers. Blood was drawn between baseline and 24 h after BL-P or NB-P consumption, while urine were collected from the day before the experiment up to 48 h. Total plasma ACN content was not significantly different, while phenolics content was higher in BL-P with respect to NB-P. The maximum ACN absorption in plasma was observed after 1.5 h from the intake of the purées and was significantly higher (p ≤ 0.05) after the intake of BL-P. Both products increased the excretion of hippuric acid in urine. In conclusion, blanching had no significant effect on total ACN content and enhanced their absorption from minimally processed purées.

Six-week consumption of a wild blueberry powder drink increases bifidobacteria in the human gut

Wild blueberries are a rich source of polyphenols and other compounds that are highly metabolized by the intestinal microbiota and may, at the same time, affect the intestinal environment itself. A repeated-measure, crossover dietary intervention on human volunteers was designed to study the effect of six week consumption of a wild blueberry ( Vaccinium angustifolium ) drink, versus a placebo drink, in modulating the intestinal microbiota. Relative to total eubacteria, Bifidobacterium spp. significantly increased following blueberry treatment (P ≤ 0.05), while Lactobacillus acidophilus increased after both treatments (P ≤ 0.05). No significant differences were observed for Bacteroides spp., Prevotella spp., Enterococcus spp., and Clostridium coccoides . Bifidobacteria, which have been largely proposed to be of benefit for the host, appeared to be selectively favored suggesting an important role for the polyphenols and fiber present in wild blueberries. Results obtained suggest that regular consumption of a wild blueberry drink can positively modulate the composition of the intestinal microbiota.

Influence of coffee and caffeine consumption on atrial fibrillation in hypertensive patients

BACKGROUND AND AIMS

Coffee and caffeine are widely consumed in Western countries. Little information is available on the influence of coffee and caffeine consumption on atrial fibrillation (AF) in hypertensive patients. We sought to investigate the relationship between coffee consumption and atrial fibrillation with regard to spontaneous conversion of arrhythmia.

METHODS AND RESULTS

A group of 600 patients presenting with a first known episode of AF was investigated, and we identified 247 hypertensive patients. The prevalence of nutritional parameters was assessed with a food frequency questionnaire. Coffee and caffeine intake were specifically estimated. Left ventricular hypertrophy was evaluated by electrocardiogram (ECG) and echocardiogram. Coffee consumption was higher in normotensive patients. High coffee consumers were more frequent in normotensive patients compared with hypertensive patients. On the other hand, the intake of caffeine was similar in hypertensive and normotensive patients, owing to a higher intake in hypertensive patients from sources other than coffee. Within normotensive patients, we report that non-habitual and low coffee consumers showed the highest probability of spontaneous conversion (OR 1.93 95%CI 0.88-3.23; p=0.001), whereas, within hypertensive patients, moderate but not high coffee consumers had the lowest probability of spontaneous conversion (OR 1.13 95%CI 0.67-1.99; p=0.05).

CONCLUSION

Coffee and caffeine consumption influence spontaneous conversion of atrial fibrillation. Normotensive non-habitual coffee consumers are more likely to convert arrhythmia within 48h from the onset of symptoms. Hypertensive patients showed a U-shaped relationship between coffee consumption and spontaneous conversion of AF, moderate coffee consumers were less likely to show spontaneous conversion of arrhythmia. Patients with left ventricular hypertrophy showed a reduced rate of spontaneous conversion of arrhythmia.

Proline betaine and its biotransformation products in fasting urine samples are potential biomarkers of habitual citrus fruit consumption

The lack of robust measures of dietary exposure hinders a quantitative understanding of causal relationships between diet and health. Non-targeted metabolite fingerprinting was used to explore the relationships between citrus exposure in free-living human subjects, estimated by a FFQ, and the chemical content of urine. Volunteers (study 1, n 12; study 2, n 11) were classified into high-, medium- and low-frequency citrus consumption groups. Overnight and spot fasting urine samples were obtained after exposure to a standardised citrus-free evening meal. The urine samples were analysed by flow injection electrospray-ionisation MS followed by supervised multivariate data classification analysis to discover discriminatory features associated with the level of citrus exposure. Good separation of high and low citrus consumption classes was achieved. Deeper exploration of high-ranked explanatory mass signals revealed several correlated signals derived from proline betaine. Targeted analysis of the relative levels of proline betaine in both fasting and overnight urine samples demonstrated good correlation with FFQ exposure data. Acute exposure of volunteers to orange juice resulted in the appearance of proline betaine and several biotransformed products in postprandial urine samples. Biomarker validation showed sensitivities of 80·8-92·2 % and specificities of 74·2-94·1 % (false discovery rate-adjusted P values < 0·05) for elevated proline betaine in participants who reported high citrus consumption. Proline betaine biotransformation products displayed weaker quantitative relationships with habitual citrus exposure. Targeted screening for the presence of biotransformation products of hesperidin and narirutin, known to be abundant in oranges, revealed that they were relatively poor indicators of citrus exposure.

Food-frequency questionnaires: a review of their design, validation and utilisation

A review of the literature concerning the design, utilisation and validation of food-frequency questionnaires (FFQ) has been carried out using a semi-systematic approach to obtaining, reviewing and extracting data from articles. Databases were searched from 1980 to 1999. The present review identified 227 validation (from 1980 to September 1999) and 164 utilisation (for 1998 only) studies. A number of design issues have been evaluated through the present review. These include: the need to consider how portion sizes have been described, self-defined giving higher mean correlations; how an FFQ was administered, interviewer-administered giving higher mean correlations for some nutrients; how many items to include on an FFQ, those with the largest number of items having higher correlations. Validation techniques were described. Most validation studies involved comparing an FFQ against another dietary assessment method; only 19 % compared an FFQ to a biomarker. Measurement differences were most commonly assessed by correlation coefficients as opposed to other more appropriate methods. Mean correlation coefficients were highest for Ca and fat, and lowest for vitamin A and vegetables. The utilisation studies showed that FFQ were most commonly used in cross-sectional surveys, with ninety-three of the FFQ being designed to be disease-specific. The present review results were presented to a group of experts and a consensus arrived at concerning the development, validation and use of FFQ. Recommendations derived from the consensus arising from the literature review are presented as an appendix to the present paper.

The role of diet in the metabolism of daidzein by human faecal microbiota sampled from Italian volunteers

The intestinal microbial transformation of daidzein into equol is subject to a wide inter-individual variability. The aim of this study was to investigate in vitro this transformation and to evaluate possible correlations between individual diet and equol production. The transformation of daidzein was investigated in anaerobic batch cultures inoculated with mixed fecal bacteria from 90 volunteers. The daidzein metabolism was monitored by liquid chromatography-mass spectrometry, and a chiral column was used to distinguish equol and dihydrodaidzein enantiomers. The obtained results show that daidzein was unchanged ( approximately 27%) or degraded to equol ( approximately 28%), O-desmethylangolensin ( approximately 12%) or dihydrodaidzein ( approximately 31%). Furthermore, some subjects ( approximately 2%) are able to produce both equol and O-desmethylangolensin. Bacteria represent sub-dominant populations (10(5)-10(9) cell/g wet faeces) in "slow" equol producers, while higher counts of equol-producing microorganisms (10(10)-10(11) cell/g wet faeces) were found in "quick" equol producers. The in vitro test to evaluate equol-producing status is quick and not invasive, and the obtained results are comparable with those reported in vivo. Indeed, the only enantiomer present in the batch cultures containing equol was the S-form. No significant correlations between equol production, BMI, age and sex were found. It seems that the equol-producer group consumed less fibre, vegetables and cereals, and more lipids from animal sources.

Maternal and fetal fatty acid profile in normal and intrauterine growth restriction pregnancies with and without preeclampsia

The aim of this study was to evaluate maternal and fetal lipid profile in intrauterine growth restriction (IUGR) pregnancies with and without preeclampsia (PE). Thirteen normal pregnancies studied during the third trimester (control M) and 29 at elective cesarean section (control CS) were compared with 18 pregnancies complicated by IUGR (IUGR only) and with seven pregnancies complicated by both IUGR and PE (IUGR-PE). Total plasma fatty acids, triglycerides, cholesterol, and nonesterified fatty acids (NEFA) were determined in maternal and fetal plasma. Nutritional intake was analyzed. IUGR only mothers had lower percentage of linoleic acid (LA) and higher arachidonic acid (AA) than controls, partly explained by higher AA dietary intake. Higher levels of NEFA were observed both in IUGR only and in IUGR-PE mothers whereas triglyceride levels were increased in IUGR-PE mothers only. In IUGR-PE fetuses, LA and AA were significantly decreased, whereas triglyceride and NEFA concentrations were significantly increased compared with normal fetuses. In conclusion, IUGR only is associated with altered fatty acids profile not completely accounted by dietary changes. We hypothesize that the differences observed in IUGR with PE for triglycerides and other lipids could be related to a difference in maternal phenotype.

Is plasma vitamin C an appropriate biomarker of vitamin C intake? A systematic review and meta-analysis

Background

As the primary source of dietary vitamin C is fruit and to some extent vegetables, the plasma level of vitamin C has been considered a good surrogate or predictor of vitamin C intake by fruit and vegetable consumption. The purpose of this systematic review was to investigate the relationship between dietary vitamin C intakes measured by different dietary methods and plasma levels of vitamin C.

Method

We searched the literature up to May 2006 through the OVID interface: MEDLINE (from 1960) and EMBASE (from 1988). We also reviewed the reference lists in the articles, reviews, and textbooks retrieved. A total of 26 studies were selected and their results were combined using meta-analytic techniques with random-effect model approach.

Results

The overall result of this study showed a positive correlation coefficient between Food Frequency Questionnaire (FFQ) and biomarker (r = 0.35 for "both" genders, 0.39 for females, and 0.46 for males). Also the correlation between Dietary Recalls (DR)/diary and biomarker was 0.46 for "both" genders, 0.44 for females, and 0.36 for males. An overall correlation of 0.39 was found when using the weight record method. Adjusting for energy intake improved the observed correlation for FFQ from 0.31 to 0.41. In addition, we compared the correlation for smokers and non-smokers for both genders (FFQ: for non-smoker r = 0.45, adjusted for smoking r = 0.33).

Conclusion

Our findings show that FFQ and DR/diary have a moderate relationship with plasma vitamin C. The correlation may be affected/influenced by the presence of external factors such as vitamin bioavailability, absorption condition, stress and food processing and storage time, or by error in reporting vitamin C intake.

Urinary potassium is as reliable as urinary nitrogen for use as a recovery biomarker in dietary studies of free living individuals

Twenty-four-hour urinary nitrogen (UN) is commonly used to validate dietary assessment methods. Potassium is more widespread in food than nitrogen, but the role of 24-h urinary potassium (UK) as a biomarker has been less studied and characterized. To investigate the performance of UK as a recovery biomarker compared with UN in subjects consuming their normal diet, 7 males and 6 females consumed known amounts of food based on their habitual varying diet (assessed beforehand from 4 consecutive 7-d food diaries) for 30 d in a metabolic suite. All daily urine samples and dietary duplicates were collected, and N and K were measured. Stool K was determined in 5-d pooled samples. Thirty-day mean analyzed K intake was 121.3 +/- 25.1 (mean +/- SD) mmol/d. Overall, 77 +/- 6.7% of K in the diet was excreted in urine and 18 +/- 5% in stool. Dietary K was correlated with UK (r = 0.89; P < 0.001). UN was 77.7 +/- 6.6% of N intake and was correlated with N in the diet (r = 0.87; P < 0.001). When 16 d of intake and 8 d of urine-collection measurements were randomly selected from the 30-d measurements, correlations were significant for both K (r = 0.86; P < 0.001) and N (r = 0.92; P < 0.001). The high correlations between UK and K in the diet show that UK is a reliable recovery biomarker for use in studies of dietary measurement error. Factors for use of urinary N as a recovery biomarker are also confirmed.

Effect of a tomato-based drink on markers of inflammation, immunomodulation, and oxidative stress

Regular consumption of tomato and its products is being consistently associated with lower risk of several types of cancer and, to a lesser extent, coronary heart disease. Among the many tomato components credited with healthful properties, carotenoids and particularly lycopene are being actively investigated. Given the recognized role of immune/inflammatory processes in atherogenesis, the effects of a tomato-based drink (Lyc-o-Mato), which was previously shown to afford DNA protection from oxidative stress, on the modulation of immune and inflammatory markers (by enzyme immunoessay), on basal lymphocyte DNA damage (by comet assay), and on F2-isoprostane excretion (by LC-MS/MS), were investigated in 26 healthy young volunteers. In a placebo-controlled, double-blind, crossover study, Lyc-o-Mato (5.7 mg of lycopene, 3.7 mg of phytoene, 2.7 mg of phytofluene, 1 mg of beta-carotene, and 1.8 mg of alpha-tocopherol) or a placebo drink (same taste and flavor, but devoid of active compounds) were given for 26 days, separated by a wash-out period. During the study subjects maintained their habitual, hence unrestricted, diet. TNF-alpha production by whole blood was 34.4% lower after 26 days of drink consumption, whereas the other parameters were not significantly modified by the treatment. In turn, modest effects of the regular intake of a tomato drink, providing small amounts of carotenoids, were found on the production of inflammatory mediators, such as TNF-alpha, in young healthy volunteers. Future intervention trials in subjects with low carotenoid status and/or compromised immune system will resolve the issue of whether carotenoids modulate immune parameters in humans.

Validation of a food-frequency questionnaire assessment of carotenoid and vitamin E intake using weighed food records and plasma biomarkers: The method of triads model

BACKGROUND

Reliability or validity studies are important for the evaluation of measurement error in dietary assessment methods. An approach to validation known as the method of triads uses triangulation techniques to calculate the validity coefficient of a food-frequency questionnaire (FFQ).

OBJECTIVE

To assess the validity of an FFQ estimates of carotenoid and vitamin E intake against serum biomarker measurements and weighed food records (WFRs), by applying the method of triads.

DESIGN

The study population was a sub-sample of adult participants in a randomised controlled trial of beta-carotene and sunscreen in the prevention of skin cancer. Dietary intake was assessed by a self-administered FFQ and a WFR. Nonfasting blood samples were collected and plasma analysed for five carotenoids (alpha-carotene, beta-carotene, beta-cryptoxanthin, lutein, lycopene) and vitamin E. Correlation coefficients were calculated between each of the dietary methods and the validity coefficient was calculated using the method of triads. The 95% confidence intervals for the validity coefficients were estimated using bootstrap sampling.

RESULTS

The validity coefficients of the FFQ were highest for alpha-carotene (0.85) and lycopene (0.62), followed by beta-carotene (0.55) and total carotenoids (0.55), while the lowest validity coefficient was for lutein (0.19). The method of triads could not be used for beta-cryptoxanthin and vitamin E, as one of the three underlying correlations was negative.

CONCLUSIONS

Results were similar to other studies of validity using biomarkers and the method of triads. For many dietary factors, the upper limit of the validity coefficients was less than 0.5 and therefore only strong relationships between dietary exposure and disease will be detected.

New perspectives on vitamin E: gamma-tocopherol and carboxyelthylhydroxychroman metabolites in biology and medicine

Vitamin E (alpha-tocopherol or alphaT) has long been recognized as a classic free radical scavenging antioxidant whose deficiency impairs mammalian fertility. In actuality, alpha-tocopherol is one member of a class of phytochemicals that are distinguished by varying methylation of a chroman head group. Early studies conducted between 1922 and 1950 indicated that alpha-tocopherol was specific among the tocopherols in allowing fertility of laboratory animals. The unique vitamin action of alphaT, combined with its prevalence in the human body and the similar efficiency of tocopherols as chain-breaking antioxidants, led biologists to almost completely discount the "minor" tocopherols as topics for basic and clinical research. Recent discoveries have forced a serious reconsideration of this conventional wisdom. New and unexpected biological activities have been reported for the desmethyl tocopherols, such as gamma-tocopherol, and for specific tocopherol metabolites, most notably the carboxyethyl-hydroxychroman (CEHC) products. The activities of these other tocopherols do not map directly to their chemical antioxidant behavior but rather reflect anti-inflammatory, antineoplastic, and natriuretic functions possibly mediated through specific binding interactions. Moreover, a nascent body of epidemiological data suggests that gamma-tocopherol is a better negative risk factor for certain types of cancer and myocardial infarction than is a alpha-tocopherol. The potential public health implications are immense, given the extreme popularity of alphaT supplementation which can unintentionally deplete the body of gamma-tocopherol. These findings may or may not signal a major paradigm shift in free radical biology and medicine. The data argue for thorough experimental and epidemiological reappraisal of desmethyl tocopherols, especially within the contexts of cardiovascular disease and cancer biology.

Dietary potential renal acid load and renal net acid excretion in healthy, free-living children and adolescents

BACKGROUND

There is increasing evidence that acid-base status has a significant effect on high-intensity physical performance, urolithiasis, and calcium metabolism. Experimental studies in adults showed that renal net acid excretion (NAE) can be reliably estimated from the composition of diets.

OBJECTIVE

We investigated whether a reasonable estimation of NAE is also possible from the dietary records of free-living children and adolescents.

DESIGN

Healthy children (aged 8 y; n = 165) and adolescents (aged 16-18 y; n = 73) each collected a 24-h urine sample and completed a weighed diet record on the same day. Urinary NAE was analyzed (NAE(an)) and estimated (NAE(es)). Potential renal acid load (PRAL), the diet-based component of NAE(es), corrects for intestinal absorption of ingested minerals and sulfur-containing protein. A urinary excretion rate of organic acids (OAs) proportional to body surface area was assumed for the complete estimate (NAE(es) = PRAL + OA(es)).

RESULTS

Significant (P < 0.001) correlations between NAE(es) and NAE(an) were seen in the children (r = 0.43) and the adolescents (r = 0.51). A simplified estimate based on only 4 components of dietary PRAL (protein, phosphorus, potassium, and magnesium) yielded almost identical associations. Mean simplified NAE(es) (32.6 +/- 13.9 and 58.4 +/- 22.0 mEq/d in the children and the adolescents, respectively) agreed reasonably with NAE(an) (32.4 +/- 15.5 and 52.8 +/- 24.3 mEq/d, respectively).

CONCLUSIONS

Predicting NAE from dietary intakes, food tables, and anthropometric data is also applicable during growth and yields appropriate estimates even when self-selected diets are consumed. The PRAL estimate based on only 4 nutrients may allow relatively simple assessment of the acidity of foods and diets.

Urine nitrogen as a biomarker for the validation of dietary protein intake

When validated for completeness, 24-h urine nitrogen obtained from repeated 24-h urine collections has provided useful insights into the validity of dietary assessments, underreporting behaviors and the structure of measurement errors that are associated with different methods. This is particularly so when nitrogen is combined with another marker in 24-h urine samples, potassium. Although the collection of 24-h urine is a tedious procedure, the method is readily accessible and comparatively inexpensive. Other markers of dietary intake and intermediate risk markers may also be measured in the 24-h urine that is obtained.

Can the EPIC food-frequency questionnaire be used in adolescent populations?

OBJECTIVE

To assess the validity of the food-frequency questionnaire used in the European Prospective Investigation of Cancer (EPIC FFQ) for estimating nutrient intake in an adolescent population.

DESIGN

Sixty-seven schoolchildren (mean age: 12.3 +/- 0.3 years) were recruited to complete a 7-day weighed dietary record (7-day WDR), the EPIC FFQ and supply one 24-hour urine collection.

SETTING

Harris Academy in Dundee (UK).

RESULTS

Fifty subjects completed both dietary assessment methods. Thirteen of these were classified as underreporters with energy intake/basal metabolic rate < 1.14. The EPIC FFQ showed higher estimates than the 7-day WDR for all nutrients. The median Spearman correlation coefficient for the nutrients examined was found to be 0.31 and increased to 0.48 after adjustment for total energy. The limits of agreement were as far apart as 13.4 MJ, 120 g, 270 g, 120 g and 1170 mg for energy, fat, sugar, protein and calcium, respectively. Correlations between urine and 7-day WDR dietary nitrogen and potassium were found to be statistically significant with r = 0.45 (P < 0.05) and r = 0.78 (P < 0.001) respectively. The median proportion of subjects that appeared in the same and opposite third of intake was found to be 45.9% and 10.8%, respectively.

CONCLUSIONS

The EPIC FFQ seems adequate to correctly classify low, medium and high consumers and might therefore be used to identify adolescent population groups at risk or for differences between populations. However, agreement between the EPIC FFQ and the 7-day WDR was very poor on both a group and an individual basis, and demonstrates that the EPIC FFQ is not an appropriate method for estimating absolute intakes in this age group.

Use of biological markers to validate self-reported dietary intake in a random sample of the European Prospective Investigation into Cancer United Kingdom Norfolk cohort

BACKGROUND

The validity of dietary assessment methods should be established before diet-disease associations are reported.

OBJECTIVE

Our objective was to validate a 7-d food diary and a food-frequency questionnaire (FFQ) against independent biomarkers of intake in urine (nitrogen, potassium, and sodium) and blood (plasma ascorbic acid).

DESIGN

A total of 146 healthy middle-aged men and women were recruited from the European Prospective Investigation into Cancer UK Norfolk cohort, a free-living cohort of approximately 25000 persons. Over a 9-mo period, urinary nitrogen, potassium, and sodium were estimated from 2-6 complete 24-h urine collections in 134 subjects and plasma ascorbic acid was estimated from 2-3 fasting blood samples in 118 subjects. Subjects completed 2 FFQs and two 7-d food diaries.

RESULTS

In men and women combined, correlations between 24-h urinary nitrogen excretion and dietary intake from the 7-d food diary were high (r = 0.57-0.67) compared with those for the FFQ (r = 0.21-0.29). Similarly, correlations between urinary potassium and dietary potassium were higher for the 7-d food diary (r = 0.51-0.55) than for the FFQ (r = 0.32-0.34). There was no overall difference in correlations between plasma ascorbic acid and dietary vitamin C between the 7-d food diary (r = 0.40-0.52) and the FFQ (r = 0.44-0.45).

CONCLUSIONS

These data indicate that, despite increased subject burden, the 7-d food diary provided a better estimate of nitrogen and potassium intakes than did the FFQ in this study population. However, with respect to plasma ascorbic acid, both the FFQ and 7-d food diary provided a similar ranking of subjects according to vitamin C intake.

Assessing the effect of fatty acids on prostate carcinogenesis in humans: does self-reported dietary intake rank prostatic exposure correctly?

BACKGROUND

Dietary fatty acids may influence prostate carcinogenesis. Although the standard for assessing dietary effects in humans is the semiquantitative food-frequency questionnaire, the extent to which self-reported intake correctly ranks prostatic exposure is unknown.

OBJECTIVE

The objective was to examine the correlation between reported intakes of different fatty acids and their concentrations in prostate tissue.

DESIGN

This was a cross-sectional study of 52 men undergoing surgical resection of the prostate gland. Usual dietary intake of saturated, total unsaturated, oleic, and linoleic fatty acids over the previous year was estimated with use of a 122-item version of the Health Habits and History Questionnaire. Concentrations in prostate tissue were measured directly by use of gas chromatography in healthy tissue collected at the time of surgery and were expressed as a percentage of total fatty acids. Correlations with 4 measures of dietary intake [g/d, g/d adjusted for total daily energy intake, % of total fat (as g/d), and % of total energy] were evaluated by Spearman's rank-order correlation coefficients.

RESULTS

Linoleic acid concentrations in prostate tissue were significantly correlated with dietary intake expressed as g/d adjusted for total energy [r = 0.29 (95% CI: 0.03, 0.49), P = 0.04], % of total fat [r = 0.36 (0.14, 0.550), P = 0.008], and % of total energy [r = 0.28 (0.04, 0.49), P = 0.042], but not as g/d. Although mean concentrations of saturated, total unsaturated, and oleic fatty acids in prostate tissue resembled mean intakes for the group, prostatic concentrations did not correlate with individual intakes.

CONCLUSION

Self-reported intake of fatty acids is a satisfactory marker of prostatic exposure at the group level, but, with the exception of linoleic acid, does not correctly rank individuals with respect to intensity of exposure.

A combination of statistical methods for the analysis of the relative validation data of the quantitative food frequency questionnaire used in the THUSA study. Transition, Health and Urbanisation in South Africa

OBJECTIVE

To apply structural equation modelling (SEM) and estimation of variance components to the relative validation data obtained from the quantitative food frequency questionnaire (QFFQ) used in the Transition, Health and Urbanisation in South Africa (THUSA) study.

DESIGN

A cross-sectional study.

SETTING

A community-based field study in an African population conducted during 1996.

SUBJECTS

Residents of the North West Province, South Africa, aged between 15 and 65 years.

METHODS

Relative validity of the QFFQ was tested against 7-day weighed food records, 24-hour urinary nitrogen (UN) excretion and estimated basal metabolic rate (BMR). SEM and estimation of variance components were applied to the log-transformed energy, protein, fat, calcium, iron, vitamin A and vitamin C intakes. UN excretion was used as a biomarker in the application of the SEM to protein and estimated BMR to energy intakes.

RESULTS

Constant bias (alphaQ) derived by the SEM varied from 0.85 (vitamin C) to 5.8 (energy). There was significant proportional bias for all nutrients except vitamin C. Validation coefficients (ro(Q,T) varied from 0.3 (fat, calcium, iron) to 0.7 (vitamin C). The inclusion of estimated BMR in the SEM for energy increased ro(Q, T) from 0.38 to 0.42. The estimation of variance components gave slightly lower correlations for the relationship between intakes from the QFFQ and the unknown true intake.

CONCLUSIONS

Robust statistical methods were successfully applied in a relative validation study for a QFFQ in an African population. Estimated BMR as a biomarker for energy intake produced more meaningful results than UN excretion as a biomarker for protein intake.

Validation of a self-administered food-frequency questionnaire administered in the European Prospective Investigation into Cancer and Nutrition (EPIC) Study: comparison of energy, protein, and macronutrient intakes estimated with the doubly labeled water, urinary nitrogen, and repeated 24-h dietary recall methods

BACKGROUND

The validation of dietary assessment instruments is critical in the evaluation of diet as a chronic disease risk factor.

OBJECTIVE

The objective was to assess the validity of a self-administered food-frequency questionnaire by comparison with dietary recall, urinary nitrogen excretion, and total energy expenditure data.

DESIGN

Over a 1-y period, data from twelve 24-h dietary recalls, a food-frequency questionnaire, and four 24-h urine samples were obtained from 134 study participants of the European Prospective Investigation into Cancer and Nutrition (EPIC) Study in Potsdam, Germany. In a substudy of 28 participants, total energy expenditure from doubly labeled water measurements was assessed.

RESULTS

Energy-adjusted, deattenuated correlation coefficients between the questionnaire and the recalls ranged from 0.54 for dietary fiber to 0.86 for alcohol. Cross-classification of quintiles of nutrient intakes from the questionnaire and recalls indicated severe misclassification to be <4%. Reported protein intake correlated with estimated protein excretion (r = 0.46). Energy intake and total energy expenditure were also significantly correlated (r = 0.48); however, all but one subject underreported their energy intake. The magnitude of underreporting varied considerably, by 22% on average, and increased slightly with increasing energy intake. A similar pattern of underreporting was observed when energy intakes from the 24-h dietary recalls were compared with total energy expenditure.

CONCLUSIONS

These data indicate an acceptable relative validity of the food-frequency questionnaire in this study population. Compared with measurements of total energy expenditure and protein excretion, however, only moderate agreement with both the food-frequency questionnaire and the 24-h dietary recalls was observed.