The American Cancer Society Cancer Prevention Study-3 FFQ Has Reasonable Validity and Reproducibility for Food Groups and a Diet Quality Score

Overnight Fasting and Body Weight: Emulated Target Trial Using Cancer Prevention Study-3 Data

Background/Objectives: Intermittent fasting has gained attention in managing weight, yet its long-term effects remain unclear. We examined the impact of overnight, before-sleep, and after-sleep fasting on body weight over two years using data from the Cancer Prevention Study-3 Diet Assessment Substudy. Methods: We emulated three target trials in 457 adults without diabetes or cancer. Participants were assigned to fasting strategies of <12 vs. ≥12 h overnight, <4 vs. ≥4 h before sleep, and <1 vs. ≥1 h after sleep at baseline (2016). Mean body weight 2 years post baseline was estimated using marginal structural models with stabilized inverse probability weights, adjusting for pre-baseline covariates. Results: After two years (median [IQR]: 2.0 [1.8-2.0] years), the estimated mean body weight was 79.4 kg (≥12 h overnight) vs. 78.9 kg (<12 h overnight) (mean difference: 0.4 kg; 95% CI: -4.1 to 4.7); 79.4 kg (≥4 h before sleep) vs. 77.5 kg (<4 h before sleep) (mean difference: 1.9 kg; 95% CI: -0.4 to 4.1); and 79.8 kg (≥1 h after sleep) vs. 78.9 kg (<1 h after sleep) (mean difference: 0.9 kg; 95% CI: -4.3 to 4.4). Among men, overnight fasting ≥ 12 h showed a higher weight (100.9 kg vs. 83.9 kg, mean difference: 17.0 kg; 95% CI: 10.8, 23.1), whereas, among women, it was estimated weight was lower (74.3 kg vs. 77.1 kg, mean difference: -2.8 kg; 95% CI: -6.8, 1.2). Conclusions: Overall, overnight fasting alone may not substantially influence body weight, but sex-specific differences suggest a need for further investigation.

Association of Low-Calorie Sweeteners with Selected Circulating Biomarkers of Intestinal Permeability in the Cancer Prevention Study-3 Diet Assessment Substudy

BACKGROUND

Low-calorie sweeteners (LCSs) are popular sugar substitutes and have been shown to alter the gut microbiota, which raises concerns about potential impacts on intestinal permeability.

OBJECTIVES

This study aimed to examine cross-sectional associations between LCS consumption and circulating biomarkers of intestinal permeability.

METHODS

We analyzed data from 572 United States adults participating in the Cancer Prevention Study-3 Diet Assessment Substudy who provided ≤2 fasting blood samples, collected 6 mo apart, to measure biomarkers of intestinal permeability including antibodies to flagellin (anti-flagellin), lipopolysaccharide (anti-LPS), and total antibodies; and ≤6 24-h dietary recalls, collected over the course of 12 mo, to estimate average intake of LCS including aspartame, sucralose, acesulfame-potassium, and saccharin. Multivariable linear regression, adjusted for sociodemographic characteristics, lifestyle factors, and medical history, was used to examine associations between LCS consumption and levels of intestinal permeability biomarkers by comparing mean differences in biomarkers among lower (>0 to ≤50th percentile) (n = 158) and higher (>50th percentile) LCS consumers (n = 157) than nonconsumers. A linear trend across nonconsumers and the 2 consumption categories was evaluated using a continuous variable based on the median LCS intake (median = 0, 11.3, and 124.2 mg/d for non-, lower, and higher consumers, respectively).

RESULTS

Among the 572 study participants, the mean age was 52.5 y, 63.3% were female, 60.7% were on-Hispanic White, and 55.1% reported consuming LCS-containing products. Greater LCS consumption was not associated with anti-flagellin, anti-LPS, or total antibodies. Additionally, no associations between specific types of LCS and intestinal permeability biomarkers were observed.

CONCLUSIONS

The results of our study did not demonstrate an association between LCS consumption and intestinal permeability biomarkers. Further research with larger sample sizes and randomized controlled trials is needed to confirm our findings.

Cross-sectional associations between consumption of non-nutritive sweeteners and diet quality among United States adults in the Cancer Prevention Study-3

BACKGROUND

Non-nutritive sweeteners (NNS) are used to replace added sugar, yet whether NNS consumers have better or worse diet quality compared to nonconsumers is unclear.

OBJECTIVE

To investigate cross-sectional associations between NNS consumption and diet quality.

METHODS

Data from participants in the American Cancer Society (ACS) Cancer Prevention Study-3 cohort were used for this analysis. NNS intake was estimated using self-reported consumption of NNS-containing beverages, packets, and yogurt from a validated food frequency questionnaire. Participants were categorized into nonconsumers, <1 serving, 1 to <2 servings and ≥2 servings per day. Diet quality was assessed using the ACS diet score (2020) and Healthy Eating Index (HEI-2015). Analysis of variance was used to compare diet quality scores across NNS consumption groups, and multivariable linear regression was used to examine associations between NNS consumption and diet quality. Multivariable logistic regression was used to evaluate the odds of low diet quality across NNS consumption groups.

RESULTS

Data from 163,679 participants [median age 53 y (IQR 45-60), 78.9% females, mean NNS intake 1.0 ± 1.5 servings/d, mean HEI-2015 score 75.4 ± 10.2] were included. NNS consumers had lower diet quality for ACS diet score (6.8 ± 0.03 among nonconsumers compared with 6.5 ± 0.03, 6.3 ± 0.03, and 6.1± 0.03 for consumers of <1 serving, 1 to <2 servings, and ≥2 servings of NNS per day, respectively, P-trend < 0.0001) and HEI-2015 (76.3 ± 0.1 among nonconsumers compared with 76.7 ± 0.1, 75.6 ± 0.2, and 72.7± 0.2 for consumers of <1 serving, 1 to <2 servings, and ≥2 servings of NNS per day, respectively, P-trend < 0.0001). Odds of low diet quality were higher among NNS consumers and were higher with higher NNS consumption (3%, 17%, and 43% higher odds of low diet quality among those who consumed <1 serving, 1 to <2 servings and ≥2 servings of NNS per day).

CONCLUSIONS

NNS consumers have lower diet quality in a large cohort of adults in the United States.

Reproducibility and Validity of Plant-Based Dietary Indices in the Cancer Prevention Study-3 Diet Assessment Substudy

BACKGROUND

The Overall Plant-based Diet Index (PDI), the Healthful Plant-based Diet Index (hPDI), and the Unhealthful Plant-based Diet Index (uPDI) are relatively new tools for characterizing the quality of plant-based dietary patterns in epidemiologic studies. Reproducibility and validity of these indices have not been assessed across populations.

OBJECTIVE

The objective of this study was to evaluate the reproducibility and validity of PDI, hPDI, and uPDI in a racially and ethnically diverse population.

METHODS

Participants (n = 433 women, n = 244 men, n = 417 non-Hispanic White, n = 159 non-Hispanic Black, and n = 101 Hispanic) from the 2015-2016 Cancer Prevention Study 3 Dietary Assessment Substudy (CPS-3 DAS) completed the CPS-3 Food Frequency Questionnaire (FFQ) on 2 occasions (FFQ1 and FFQ2) and ≤6 24-h dietary recalls (24HRs) over 1 y. Plant-based diet scores were calculated using energy-adjusted food group intakes from each FFQ and mean 24HRs. Pearson correlations were used to evaluate reproducibility of each score between FFQs. Validity of the scores derived from FFQ2 was assessed relative to the mean of the 24HRs and blood and urine biomarkers.

RESULTS

Pearson correlations for reproducibility between FFQs for men and women were 0.64 and 0.66 for PDI, 0.85 and 0.80 for hPDI, and 0.84 and 0.78 for uPDI. Pearson correlations for validity between FFQ2 and the mean 24HRs for PDI, hPDI, and uPDI for men were 0.54, 0.68, and 0.60, respectively, and for women were 0.49, 0.0.62, and 0.62, respectively. Biomarkers of most carotenoids, total protein, sodium, and potassium showed correlations ≥0.20 with certain plant-based diet scores. Reproducibility and validity were moderate to good in all racial/ethnic subgroups and were highest in non-Hispanic White adults.

CONCLUSIONS

There was good reproducibility and moderate to good validity of PDI within the CPS-3 FFQ. Future work should continue to validate these indices across populations with varied diets and dietary measurement tools.

Relative validity of three diet quality scores derived from the Brief-type Self-administered Diet History Questionnaire and Meal-based Diet History Questionnaire in Japanese adults

No study has validated questionnaires for assessing easily calculable diet quality scores in Japan. The Brief-type self-administered Diet History Questionnaire (BDHQ) is widely used to assess dietary intake in Japan, while the Meal-based Diet History Questionnaire (MDHQ) assesses dietary intake for each meal (breakfast, lunch, dinner and snacks) and overall dietary intake. This study examined the relative validity of the BDHQ and MDHQ for assessing three diet quality scores in Japanese adults. A total of 111 women and 111 men aged 30-76 years completed the web MDHQ and BDHQ, followed by 4-non-consective-day weighed dietary records. The diet quality scores examined included the Diet Quality Score for Japanese (DQSJ), Dietary Approaches to Stop Hypertension (DASH) score and Alternate Mediterranean Diet (AMED) score. The means of the three scores for overall diet from the BDHQ were not significantly different from those from the dietary records in both sexes, whereas those from the MDHQ were higher than those from the dietary records, except for the DASH and AMED in women. Pearson's correlation coefficients between both questionnaires and dietary records were 0·57-0·63 for DQSJ, 0·49-0·57 for DASH and 0·31-0·49 for AMED across both sexes and both questionnaires. For each meal, Pearson's correlation coefficients between the MDHQ and dietary records ranged from 0·01 (DASH for snacks in women) to 0·55 (DQSJ for breakfast in men), with a median of 0·35. This study showed that the ability of the BDHQ and MDHQ to rank individuals was good for DQSJ and DASH and acceptable for AMED.

Length of Overnight Fasting and 6-year Weight Change in the Cancer Prevention Study-3

BACKGROUND

Longer overnight fasting (ONF) is a potential strategy for weight control. Although promising, the evidence from large population-based studies is limited.

OBJECTIVES

To examine the association of self-reported ONF duration with 3- and 6-y weight change in the American Cancer Society's Cancer Prevention Study-3 prospective cohort.

METHODS

United States adult Cancer Prevention Study-3 participants completed a 24-h validated meal and snack timing and frequency grid (weekday and weekend) in 2015, from which weighted ONF hours were calculated. Participants reported body weight in 2015, 2018, and 2021. Three- and 6-y weight change (kg, and % body weight) were assessed.

RESULTS

Among 104,420 mostly female (78.5%) participants aged 52.7 ± 9.5 (standard deviation) y followed for 6 y, a 1-h increase in ONF length was associated with a small but statistically significant reduction in weight gain over 3- and 6-y periods [multivariable-adjusted mean difference in % body weight = -0.02, 95% confidence interval (CI): -0.05, -0.00, P = 0.03 and -0.04, 95% CI: -0.07, -0.01, P < 0.01, respectively]. The mean difference of 6-y % reduction in weight gain was slightly greater among individuals with overweight (-0.05, 95% CI: -0.10, 0.00, P = 0.05) and obesity (-0.06, 95% CI: -0.12, 0.01, P = 0.08) compared with those with healthy body mass index (-0.03, 95% CI:-0.07, 0.01, P = 0.13) or underweight (0.16, 95% CI: -0.04, 0.36, P = 0.13, Pinteraction < 0.0001). Stronger associations were observed among those ≤55 y than 56+ (P < 0.001), and those with higher waist circumference (Pinteraction < 0.0001) but not by sex or earlier/later fasting period.

CONCLUSIONS

Longer ONF was associated with slightly lower body weight in adult males and females over 6 y that was stronger among those with overweight or obesity, higher waist circumference, and those aged ≤55 y. The magnitude of weight change, although in the hypothesized direction, suggests that prolonged ONF may have modest impact on weight control over time.

What to Eat for Cancer Prevention: The Total Dietary Pattern as a Combination Treatment for Prevention

ABSTRACT

Over the past 2 decades, the search for dietary factors for developing cancer prevention guidelines has led to a significant expansion in the study of dietary patterns and their relation to cancer. Dietary patterns, which consider the types, amounts, variety, and combination of consumed foods, may encompass additive, synergistic, or interactive effects on human health, compared with individual nutrients or foods. In this review, we discuss the history and methodologies of dietary pattern research, describe common dietary indices used in cancer research, and summarize the existing evidence on dietary patterns and cancer risk. Current evidence supports the beneficial role of dietary patterns that are rich in vegetables, legumes, whole fruit, and whole grains and limited in added sugars, refined grains, processed foods, and red and processed meat in preventing various cancers, including breast, colorectal, and prostate cancers. Additionally, emerging evidence suggests that dietary patterns based on biological mechanisms, such as hyperinsulinemic diet and inflammatory diet, hold promise and may be priority areas for future research.

Development and Evaluation of the Reliability of a Semi-Quantitative Food Frequency Questionnaire to Assess the Intake in the Serbian Population

Assessing dietary habits with validated questionnaires is crucial for achieving reliable results in health research. The aim of this study was the development and validation of a semi-quantitative food frequency questionnaire (FFQ) in an 18-30-year-old Serbian population. A total of 93 participants completed the FFQ and three 24 h dietary recalls (24 hR). Pearson and intraclass correlations between FFQ and 24 hR intakes were assessed and were de-attenuated and energy-adjusted. Bland-Altman plots were generated, and quintiles of energy, water, fiber, and macronutrient intake were analyzed with contingency tables. Adjustments for sex differences were included. The validity of the FFQ varied, with significant correlations for energy, carbohydrates, cholesterol, and vitamin B12, vitamin C and vitamin D. Misclassification rates were generally low. Bland-Altman plots indicated good agreement between methods. It can be concluded that the validated FFQ is a promising tool for dietary assessment in the Serbian population. Results for several nutrients align closely with previous studies. The new FFQ is a useful tool for dietary assessment in the Serbian population.

Validation of a digital food frequency questionnaire for the Northern Sweden Diet Database

BACKGROUND

Dietary habits strongly influence health, with poor diets contributing to numerous deaths annually. Addressing this requires improved dietary habits and consistent monitoring thereof. In northern Sweden, a validated food frequency questionnaire (FFQ) has been used for decades, but trends show that its ability to accurately measure intake has diminished. With changing eating habits and food supply, updating the FFQ was crucial, leading to the development of FFQ2020. This study assessed FFQ2020's relative validity using 24-hour recalls and evaluated its reproducibility.

METHODS

Participants were recruited from one of the northern-Sweden population-based health screenings and by advertising. Food intake was registered in an electronic food frequency questionnaire (FFQ2020) (test instrument) and reference data were obtained by six repeated electronic 24-hour dietary recalls (24HDR). Intakes of single foods were aggregated into food groups and healthy diet index scores, and daily energy and nutrient intakes were estimated. Results from the two methods were described and tested in univariate analyses and correlation tests, Bland Altman plots, cross-classification validity, and intra-class correlation analyses.

RESULTS

Totally, 628 adults were invited to participate in the study. Of these, 320 joined, and 244 completed at least four 24HDRs. The median intakes in food groups, as well as the mean index scores and estimated nutrient intakes, were largely similar between the FFQ2020 and 24HDR recordings. The correlation coefficients between the two assessments ranged from 0.253 to 0.693 for food groups, 0.520 to 0.614 for diet indices, and 0.340 to 0.629 for energy and nutrients. Intra-class correlation coefficients indicated at least good reproducibility for intakes of food groups, diet index scores, and nutrients. Generally, Bland-Altman plots did not reveal any gross systematic disagreement between the two methods for any of the assessments. However, there were single observations located outside the upper or lower 95% confidence interval (CI) limits for the difference between FFQ2020 and the 24HDR recordings.

CONCLUSION

In concert, the results suggest that the relative validity and reproducibility of FFQ2020 are acceptable for trend analyses and group comparisons in large-scale studies but also that extended reference periods would improve the precision of less frequently consumed foods.

Validity and Reproducibility of a Semiquantitative Food Frequency Questionnaire for Measuring Intakes of Foods and Food Groups

We evaluated the validity and reproducibility of a semiquantitative food frequency questionnaire (FFQ) for measuring intakes of 149 foods and 25 food groups among 736 participants of the Women's Lifestyle Validation Study (WLVS, 2010-2012) and 649 participants of the Men's Lifestyle Validation Study (MLVS, 2011-2013). Validity of the FFQ compared with two 7-day dietary records measured 6 months apart and the reproducibility between 2 FFQs administered 1 year apart (FFQ1 and FFQ2) were assessed using Spearman correlations and intraclass correlation coefficients. The average 1-year reproducibility of FFQ-measured foods was 0.64 in both the WLVS and MLVS. Reproducibility of the food groups (mean = 0.71 among women and 0.72 among men) was generally higher than that for individual foods. Among women, the average validity correlation for individual foods was 0.59 when comparing FFQ2 with the 7-day dietary records. Among men, the corresponding average validity correlation was 0.61. Compared with individual foods, food groups had slightly higher validity correlations in both women (range, 0.45-0.92; mean = 0.61) and men (range, 0.46-0.88; mean = 0.65). This study reaffirms that the FFQ performs well in measuring most foods and food groups and provides data to adjust for measurement errors in epidemiologic studies of foods and food groups.

Evaluation of a Novel Ambient Light Survey Question in the Cancer Prevention Study-3

Nighttime light exposure may increase cancer risk by disrupting the circadian system. However, there is no well-established survey method for measuring ambient light. In the Cancer Prevention Study-3, 732 men and women answered a light survey based on seven environments. The light environment in the past year was assessed twice, one year apart, and four one-week diaries were collected between the annual surveys. A total of 170 participants wore a meter to measure photopic illuminance and circadian stimulus (CS). Illuminance and CS values were estimated for lighting environments from measured values and evaluated with a cross validation approach. The kappas for self-reported light environment comparing the two annual surveys were 0.61 on workdays and 0.49 on non-workdays. Kappas comparing the annual survey to weekly diaries were 0.71 and 0.57 for work and non-workdays, respectively. Agreement was highest for reporting of darkness (95.3%), non-residential light (86.5%), and household light (75.6%) on workdays. Measured illuminance and CS identified three peaks of light (darkness, indoor lighting, and outdoor daytime light). Estimated illuminance and CS were correlated with the measured values overall (r = 0.77 and r = 0.67, respectively) but were less correlated within each light environment (r = 0.23-0.43). The survey has good validity to assess ambient light for studies of human health.

Development and Validation of a Food Frequency Questionnaire for Evaluating the Nutritional Status of Patients with Cancer

Patients with cancer need to maintain proper nutritional status to overcome cancer, alleviate the side effects of chemotherapy, and prevent a recurrence. As such, it is necessary to manage nutritional status. This study aimed to develop a dish-based semi-quantitative food frequency questionnaire (FFQ) to evaluate the nutritional status of patients with cancer and assess the validity of the FFQ. A total of 109 dish items were selected through contribution and variability analyses using the 2016-2018 Korea National Health and Nutrition Examination Survey data. The FFQ was validated against the average 3-day dietary records of 100 patients with cancer. Pearson correlation coefficients and quartile agreements between FFQ and 3-day dietary records were calculated for intake of energy, macronutrients, and micronutrients. Age and energy-adjusted Pearson correlation coefficients ranged from 0.20 (iron) to 0.54 (potassium). The percentage of participants who were classified into the same or adjacent quartile between the FFQ and the 3-day dietary record ranged from 68% (protein) to 81% (energy, dietary fiber). The results suggest that the FFQ is an appropriate tool for assessing nutritional status in Korean cancer patients.

Change in Diet Quality and Meal Sources during the COVID-19 Pandemic in a Diverse Subset of Men and Women in the Cancer Prevention Study-3

The COVID-19 pandemic resulted in restrictive measures that caused disruptions in behaviors that may have long-term consequences on diet, health, and chronic disease risk. The aim of this study was to assess longitudinal changes in diet quality from before to during the pandemic among 2335 adult participants (816 males and 1519 females; aged 36-78) of the Cancer Prevention Study-3 cohort. We compared dietary screeners conducted in 2018 and 2020 and calculated a diet quality score, which assigned higher points for recommended foods. Overall diet quality slightly improved among all participants from before to during the pandemic, particularly among males (+0.45 points, p < 0.001), White participants (+0.24 points, p < 0.001), and participants reporting weight loss (+0.66 points, p < 0.001 for 2.25 -< 4.5 kg loss; +1.04 points, p < 0.001 for ≥4.5 kg loss); change in diet quality did not differ by other sociodemographic factors. Reported consumption of most food groups decreased, especially whole grains (-0.17 servings/day, p < 0.001) and vegetables (-0.21 servings/day, p < 0.001), primarily among females, Black participants, and participants who gained ≥2.25 kg. The frequency of meals from outside the home decreased, especially in full-service restaurants (-0.47 times/week, p < 0.001) and for ready-to-eat meals (-0.37 times/week, p < 0.001). Declines in whole grain and vegetable consumption raise concerns for weight gain in these populations and increased risk of poor metabolic health and chronic disease.

Consistent and changing consumption of fast-food and full-service meals and 3-year weight change in a large population cohort study

BACKGROUND

An average American consumes 3 meals weekly from fast-food or full-service restaurants, which contain more calories, fat, sodium, and cholesterol than meals prepared at home.

OBJECTIVES

This study examined whether consistent and changing fast-food or full-service consumption was associated with weight change over a 3-y period.

METHODS

Among 98,589 US adults from the American Cancer Society's Cancer Prevention Study-3, self-reported weight and fast-food and full-service consumption from 2015 and 2018 were examined using a multivariable-adjusted linear regression analysis to assess the association of consistent and changing consumption on 3-y weight change.

RESULTS

Individuals who made no changes to their fast-food or full-service intake over the study period gained weight regardless of consumption frequency, although low consumers gained less weight than high consumers (low fast-food: β = -1.08; 95% CI: -1.22, -0.93; low full-service: β = -0.35; 95% CI: -0.50, -0.21; P < 0.001). Decreased fast-food intake during the study period (e.g., from high [>1 meal/wk] to low [≤0.5 meal/wk], high to medium [>0.5 to ≤1 meal/wk], or medium to low) and decreased full-service intake from high (≥1 meal/wk) to low (<1 meal/mo) were significantly associated with weight loss (high-low: β = -2.77; 95% CI: -3.23, -2.31; high-medium: β = -1.53; 95% CI: -1.72, -1.33; medium-low: β = -0.85; 95% CI: -1.06, -0.63; high-low full-service: β = -0.92; 95% CI: -1.36, -0.49; P < 0.001). Decreased consumption of both fast-food and full-service restaurant meals was associated with greater weight loss than decreasing fast-food alone (both: β = -1.65; 95% CI: -1.82, -1.37; fast-food only: β = -0.95; 95% CI: -1.12, -0.79; P < 0.001).

CONCLUSIONS

Decreased consumption of fast-food and full-service meals over 3 y, particularly among high consumers at baseline, was associated with weight loss and may be an effective approach to weight loss. Moreover, decreasing both fast-food and full-service meal consumption was associated with a greater weight loss than decreasing only fast-food meal consumption.

Self-Reported Eating-Occasion Frequency and Timing are Reproducible and Relatively Valid in the American Cancer Society Cancer Prevention Study-3 Diet Assessment Substudy

BACKGROUND

Accurate assessment of eating-occasion behaviors, such as timing, frequency, and consumption intervals, is important for evaluating associations with obesity and other chronic diseases.

OBJECTIVES

The main objective of this study was to assess the relative validity of a 24-hour grid approach to assess eating-occasion timing and frequency in comparison to data derived from repeated 24-hour dietary recalls (DRs). A second objective was to assess the 1-year test-retest reproducibility of the 24-hour grid.

METHODS

Between 2015 and 2016, 626 participants in the Cancer Prevention Study-3 (CPS-3) Diet Assessment Substudy (mean age, 52 years; age range, 31-70 years; 64% female; 64% non-Hispanic white, 22% non-Hispanic black, 14% Hispanic) completed 2 grids and up to 6 unannounced, telephone, interviewer-administered DRs over 1 year. Spearman correlations (ρ; 95% CIs) were calculated to assess reproducibility between the repeated eating-occasion grid-derived variables (e.g., numbers of snacks and meals per day, timing of eating occasions) and to assess relative validity by comparing the meal grid and DR-derived summary data separately for weekdays and weekend days.

RESULTS

Reproducibility correlations for eating-occasion variables derived from the eating-occasion grids completed 1 year apart were ≥0.5 for the majority of variables analyzed for both weekdays and weekend days, including numbers of snacks and meals per day and timing of the first and last eating occasions of the day. Relative validity was highest among weekday variables and was ≥0.5 for the majority of variables, with correlations ranging from ρ values of 0.32 (number of meals per day) to 0.68 (hour of the first eating occasion).

CONCLUSIONS

These findings suggest the eating-occasion grid used in CPS-3 has good reproducibility over 1 year and yields estimates comparable to those from a more detailed method of assessment of eating timing and frequency.

Association of Socioeconomic and Geographic Factors With Diet Quality in US Adults

IMPORTANCE

Poor diet quality is a key factor associated with obesity and chronic disease. Understanding associations of socioeconomic and geographic factors with diet quality can inform public health and policy efforts for advancing health equity.

OBJECTIVE

To identify socioeconomic and geographic factors associated with diet quality in a large US cohort study.

DESIGN, SETTING, AND PARTICIPANTS

This cross-sectional study included adult men and women who enrolled in the Cancer Prevention Study-3 at American Cancer Society community events in 35 US states, the District of Columbia, and Puerto Rico between 2006 and 2013. Participants completed a validated food frequency questionnaire between 2015 and 2017. Data were analyzed from February to November 2021.

EXPOSURES

The main exposures included self-reported race and ethnicity, education, and household income. Geocoded addresses were used to classify urbanization level using Rural-Urban Commuting Area codes; US Department of Agriculture's Food Access Research Atlas database classified residence in food desert.

MAIN OUTCOMES AND MEASURES

Poor diet quality was defined as lowest quartile of dietary concordance with the 2020 American Cancer Society recommendations for cancer prevention score, based on sex-specific intake categories of vegetables and legumes, whole fruits, whole grains, red and processed meat, highly processed foods and refined grains, and sugar-sweetened beverages.

RESULTS

Among 155 331 adults, 123 115 were women (79.3%), and the mean (SD) age was 52 (9.7) years), and there were 1408 American Indian or Alaskan Native individuals (0.9%); 2721 Asian, Native Hawaiian, or Pacific Islander individuals (1.8%); 3829 Black individuals (2.5%); 7967 Hispanic individuals (5.1%); and 138 166 White individuals (88.9%). All key exposures assessed were statistically significantly and independently associated with poor diet quality. Compared with White participants, Black participants had a 16% (95% CI, 8%-25%) higher risk of poor diet quality, while Hispanic/Latino had 16% (95% CI, 12%-21%) lower risk and Asian, Native Hawaiian, and Pacific Islander participants had 33% (95% CI, 26%-40%) lower risk of poor diet quality. After controlling for other characteristics, rural residence was associated with a 61% (95% CI, 48%-75%) higher risk of poor diet quality, and living in a food desert was associated with a 17% (95% CI, 12%-22%) higher risk. Associations of income with diet quality and education with diet quality varied by race and ethnicity (income: P for interaction = .01; education: P for interaction < .001). All diet score components were associated with disparities observed.

CONCLUSIONS AND RELEVANCE

This cross-sectional study found that multiple individual-level socioeconomic and geographic variables were independently associated with poor diet quality among a large, racially and ethnically and geographically diverse US cohort. These findings could help to identify groups at highest risk of outcomes associated with poor diet to inform future approaches for advancing health equity.

Reproducibility and validity of diet quality scores derived from food-frequency questionnaires

BACKGROUND

Diet quality scores (DQSs) are frequently used to study diet-disease relations but the validity of these scores derived from FFQs has rarely been evaluated.

OBJECTIVES

To evaluate the validity and reproducibility of 6 commonly used DQSs derived from the FFQ, including the Alternate Healthy Eating Index-2010, Dietary Approaches to Stop Hypertension Trial score, alternative Mediterranean diet score, and 3 plant-based diet indices (overall, healthful, and unhealthful).

METHODS

This analysis included 1394 participants from the Men's Lifestyle Validation Study (N = 652) and the Women's Lifestyle Validation Study (N = 742). Participants completed a 152-item FFQ at the beginning of the study and 1 y later, as well as completed 2 weighed 7-d dietary records (7DDRs) and donated 2 blood samples 6 mo apart between FFQ assessments. The reproducibility of the FFQs was evaluated by rank intraclass correlation coefficients (ICCs). The validity was assessed by comparing FFQ-derived DQSs with those from the average of two 7DDRs using Spearman rank correlation coefficients deattenuated for random measurement error in the 7DDRs (rs). Furthermore, we calculated the correlations between DQSs and plasma biomarkers of diet, including fatty acids, folate, carotenoids, retinol, and α- and γ-tocopherol.

RESULTS

Six FFQ-derived DQSs demonstrated moderate to high reproducibility (energy-adjusted ICCs: 0.61-0.84) and validity (energy-adjusted, deattenuated rs = 0.56-0.80) in both men and women. We consistently observed expected correlations between FFQ-derived DQSs with plasma fatty acids, including long-chain n-3 (ω-3) and trans fatty acids, most carotenoids, and γ-tocopherol (rs > 0.2).

CONCLUSIONS

Our study demonstrates the validity of the FFQ to evaluate overall diet quality using 6 commonly used DQSs. In addition, these DQSs have qualitatively demonstrated biological relevance, as indicated by their correlations with circulating biomarkers.

Dietary Data in the Malmö Offspring Study-Reproducibility, Method Comparison and Validation against Objective Biomarkers

Irregular dietary intakes impairs estimations from food records. Biomarkers and method combinations can be used to improve estimates. Our aim was to examine reproducibility from two assessment methods, compare them, and validate intakes against objective biomarkers. We used the Malmö Offspring Study (55% women, 18–71 y) with data from a 4-day food record (4DFR) and a short food frequency questionnaire (SFFQ) to compare (1) repeated intakes (n = 180), (2) intakes from 4DFR and SFFQ (n = 1601), and (3) intakes of fatty fish, fruits and vegetables, and citrus with plasma biomarkers (n = 1433) (3-carboxy-4-methyl-5-propyl-2-furanpropanoic acid [CMPF], β-carotene and proline betaine). We also combined 4DFR and SFFQ estimates using principal component analysis (PCA). Moderate correlations were seen between repeated intakes (4DFR median ρ = 0.41, SFFQ median ρ = 0.59) although lower for specific 4DFR-items, especially fatty/lean fish (ρ ≤ 0.08). Between-method correlations (median ρ = 0.33) were higher for intakes of overall food groups compared to specific foods. PCA scores for citrus (proline betaine ρ = 0.53) and fruits and vegetables (β-carotene: ρ = 0.39) showed the highest biomarker correlations, whereas fatty fish intake from the SFFQ per se showed the highest correlation with CMPF (ρ = 0.46). To conclude, the reproducibility of SFFQ data was superior to 4DFR data regarding irregularly consumed foods. Method combination could slightly improve fruit and vegetable estimates, whereas SFFQ data gave most valid fatty fish intake.

Identification and Reproducibility of Urinary Metabolomic Biomarkers of Habitual Food Intake in a Cross-Sectional Analysis of the Cancer Prevention Study-3 Diet Assessment Sub-Study

Previous cross-sectional metabolomics studies have identified many potential dietary biomarkers, mostly in blood. Few studies examined urine samples although urine is preferred for dietary biomarker discovery. Furthermore, little is known regarding the reproducibility of urinary metabolomic biomarkers over time. We aimed to identify urinary metabolomic biomarkers of diet and assess their reproducibility over time. We conducted a metabolomics analysis among 648 racially/ethnically diverse men and women in the Diet Assessment Sub-study of the Cancer Prevention Study-3 cohort to examine the correlation between >100 food groups/items [101 by a food frequency questionnaire (FFQ), and 105 by repeated 24 h diet recalls (24HRs)] and 1391 metabolites measured in 24 h urine sample replicates, six months apart. Diet-metabolite associations were examined by Pearson's partial correlation analysis. Biomarkers were evaluated for prediction accuracy assessed using area under the curve (AUC) calculated from the receiver operating characteristic curve and for reproducibility assessed using intraclass correlation coefficients (ICCs). A total of 1708 diet-metabolite associations were identified after Bonferroni correction for multiple comparisons and restricting correlation coefficients to >0.2 or <-0.2 (1570 associations using the FFQ and 933 using 24HRs), 513 unique metabolites correlated with 79 food groups/items. The median ICCs of the 513 putative biomarkers was 0.53 (interquartile range 0.42-0.62). In this study, with comprehensive dietary data and repeated 24 h urinary metabolic profiles, we identified a large number of diet-metabolite correlations and replicated many found in previous studies. Our findings revealed the promise of urine samples for dietary biomarker discovery in a large cohort study and provide important information on biomarker reproducibility, which could facilitate their utilization in future clinical and epidemiological studies.

A Simple Liking Survey Captures Behaviors Associated with Weight Loss in a Worksite Program among Women at Risk of Type 2 Diabetes

In a secondary analysis, we assessed the ability of dietary and physical activity surveys to explain variability in weight loss within a worksite-adapted Diabetes Prevention Program. The program involved 58 overweight/obese female employees (average age = 46 ± 11 years SD; average body mass index = 34.7 ± 7.0 kg/m² SD) of four long-term care facilities who survey-reported liking and frequency of dietary and physical activity behaviors. Data were analyzed using a latent variable approach, analysis of covariance, and nested regression analysis to predict percent weight change from baseline to intervention end at week 16 (average loss = 3.0%; range—6% gain to 17% loss), and follow-up at week 28 (average loss = 2.0%; range—8% gain to 16% loss). Using baseline responses, restrained eaters (reporting liking but low intakes of high fat/sweets) achieved greater weight loss at 28 weeks than those reporting high liking/high intake (average loss = 3.5 ± 0.9% versus 1.0 ± 0.8% S.E., respectively). Examining the dietary surveys separately, only improvements in liking for a healthy diet were associated significantly with weight loss (predicting 44% of total variance, p < 0.001). By contrasting liking versus intake changes, women reporting concurrent healthier diet liking and healthier intake lost the most weight (average loss = 5.4 ± 1.1% S.E.); those reporting eating healthier but not healthier diet liking (possible misreporting) gained weight (average gain = 0.3 ± 1.4% S.E.). Change in liking and frequency of physical activity were highly correlated but neither predicted weight loss independently. These pilot data support surveying dietary likes/dislikes as a useful measure to capture dietary behaviors associated with weight loss in worksite-based programs. Comparing dietary likes and intake may identify behaviors consistent (appropriate dietary restraint) or inconsistent (misreporting) with weight loss success.

The Cancer Prevention Study-3 FFQ Is a Reliable and Valid Measure of Nutrient Intakes among Racial/Ethnic Subgroups, Compared with 24-Hour Recalls and Biomarkers

BACKGROUND

Valid assessment of dietary intake in diverse populations is important for studies of chronic disease risk in the United States.

OBJECTIVES

We evaluated the reproducibility and validity of a food frequency questionnaire (FFQ) modified for the American Cancer Society's Cancer Prevention Study-3 (CPS-3) prospective cohort, among a racially/ethnically diverse subgroup.

METHODS

The Diet Assessment Substudy included 677 CPS-3 participants (64% women; 61% non-Hispanic white, 24% non-Hispanic black, 15% Hispanic), aged 31-70 y, who completed 2 FFQs 1 y apart (FFQ1, FFQ2), 4-6 telephone-administered 24-h dietary recalls (24HRs), and 2 fasting blood samples and 24-h urine collections ∼6 mo apart in the interim. Spearman rank correlation coefficients (ρ) were used to evaluate FFQ reproducibility and validity compared with 24HRs for 67 nutrient exposures. For 18 of these nutrients, we used the method of triads to calculate validity coefficients (VCs, ρ) from pairwise correlations of FFQ2, 24HRs, and biomarkers. Analyses were stratified by sex, race/ethnicity, education, and BMI.

RESULTS

Mean (range) FFQ reproducibility correlations were ρ = 0.65 (0.50-0.91) for men and ρ = 0.63 (0.37-0.89) for women; mean (range) energy-adjusted, deattenuated correlations of FFQ2 with 24HRs were ρ = 0.60 (0.33-0.84) for men and ρ = 0.55 (0.21-0.79) for women. FFQ2 VCs (ρ) among men ranged from 0.42 for β-cryptoxanthin to 0.91 for omega-3 (n-3) fatty acids and, among women, from 0.41 for sodium to 0.79 for total vitamin D. Mean FFQ reproducibility and validity were highest among whites (ρ = 0.68, ρ = 0.58, respectively) and slightly lower among blacks (ρ = 0.57, ρ = 0.49, respectively) and Hispanics (ρ = 0.59, 0.55, respectively). FFQ reproducibility and validity were slightly lower among those with less than a 4-y college degree, and those with a BMI ≥30 kg/m2.

CONCLUSIONS

Reproducibility and validity of the CPS-3 FFQ were comparable with similar studies for most nutrients, among all subgroups. These findings support future dietary analyses in the contemporary CPS-3 cohort and other similar cohorts.

Identification and Reproducibility of Plasma Metabolomic Biomarkers of Habitual Food Intake in a US Diet Validation Study

Previous metabolomic studies have identified putative blood biomarkers of dietary intake. These biomarkers need to be replicated in other populations and tested for reproducibility over time for the potential use in future epidemiological studies. We conducted a metabolomics analysis among 671 racially/ethnically diverse men and women included in a diet validation study to examine the correlation between >100 food groups/items (101 by a food frequency questionnaire (FFQ), 105 by 24-h diet recalls (24HRs)) with 1141 metabolites measured in fasting plasma sample replicates, six months apart. Diet–metabolite associations were examined by Pearson’s partial correlation analysis. Biomarker reproducibility was assessed using intraclass correlation coefficients (ICCs). A total of 677 diet–metabolite associations were identified after Bonferroni adjustment for multiple comparisons and restricting absolute correlation coefficients to greater than 0.2 (601 associations using the FFQ and 395 using 24HRs). The median ICCs of the 238 putative biomarkers was 0.56 (interquartile range 0.46–0.68). In this study, with repeated FFQs, 24HRs and plasma metabolic profiles, we identified several potentially novel food biomarkers and replicated others found in our previous study. Our findings contribute to the growing literature on food-based biomarkers and provide important information on biomarker reproducibility which could facilitate their utilization in future nutritional epidemiological studies.

Modeling the risk factors for dyslipidemia and blood lipid indices: Ravansar cohort study

BACKGROUND

Lipid disorder is one of the most important risk factors for chronic diseases. Identifying the factors affecting the development of lipid disorders helps reduce chronic diseases, especially Chronic Heart Disease (CHD). The aim of this study was to model the risk factors for dyslipidemia and blood lipid indices.

METHODS

This study was conducted based on the data collected in the initial phase of Ravansar cohort study (2014-16). At the beginning, all the 453 available variables were examined in 33 stages of sensitivity analysis by perceptron Artificial Neural Network (ANN) data mining model. In each stage, the variables that were more important in the diagnosis of dyslipidemia were identified. The relationship among the variables was investigated using stepwise regression. The data obtained were analyzed in SPSS software version 25, at 0.05 level of significance.

RESULTS

Forty percent of the subjects were diagnosed with lipid disorder. ANN identified 12 predictor variables for dyslipidemia related to nutrition and physical status. Alkaline phosphatase, Fat Free Mass (FFM) index, and Hemoglobin (HGB) had a significant relationship with all the seven blood lipid markers. The Waist Hip Ratio was the most effective variable that showed a stronger correlation with cholesterol and Low-Density Lipid (LDL). The FFM index had the greatest effect on triglyceride, High-Density Lipid (HDL), cholesterol/HDL, triglyceride/HDL, and LDL/HDL. The greatest coefficients of determination pertained to the triglyceride/HDL (0.203) and cholesterol/HDL (0.188) model with nine variables and the LDL/HDL (0.180) model with eight variables.

CONCLUSION

According to the results, alkaline phosphatase, FFM index, and HGB were three common predictor variables for all the blood lipid markers. Specialists should focus on controlling these factors in order to gain greater control over blood lipid markers.