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Koemel NA, Shah S, Senior AM, Severi G, Mancini FR, Gill TP, Simpson SJ, Raubenheimer D, Boutron-Ruault MC, Laouali N, Skilton MR. Macronutrient composition of plant-based diets and breast cancer risk: the E3N prospective cohort study. Eur J Nutr 2024:10.1007/s00394-024-03379-x. [PMID: 38635026 DOI: 10.1007/s00394-024-03379-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 03/15/2024] [Indexed: 04/19/2024]
Abstract
PURPOSE Recent evidence suggests that plant-based diets may reduce the risk of breast cancer (BC). However, the macronutrient composition of plant-based diets and its potential impact on BC risk has not been well explored. This analysis investigated the association of macronutrient composition with BC risk across a spectrum of plant-based diet indexes using a multidimensional approach. DESIGN This study followed 64,655 participants from the Etude Epidémiologique auprès de femmes de la Mutuelle Générale de l'Education Nationale (E3N) cohort from 1993 to 2014. Diets were evaluated using validated 208-item diet history questionnaires at baseline (1993) and follow-up (2005), to calculate adherence to the overall plant-based diet (PDI), healthful plant-based diet (hPDI), and unhealthful plant-based diet (uPDI). The association of macronutrient composition with BC risk was assessed via generalized additive time-dependent Cox models across different levels of these indexes. Response surfaces were generated to visualize compositional associations at the 25th, 50th, and 75th percentile of each index (low, moderate, and high). RESULTS A total of 3,932 incident BC cases were identified during the 21-year follow-up. There was a significant association between macronutrient composition and BC risk for hPDI, uPDI, and PDI (all P < 0.001). Akaike information criterion favored the hPDI model for characterizing the association between macronutrients and BC. BC risk was highest for individuals with a lower hPDI score who also consumed a diet containing lower protein (10%), lower carbohydrate (35%), and higher fat (55%). The lowest risk of BC was observed in those with higher hPDI scores with the lowest intake of protein (10%). At higher PDI and uPDI, diets containing higher protein (30%) and fat (45%) had the highest BC risk. CONCLUSION These results demonstrate a complex relationship between macronutrient composition, plant-based diet quality, and BC risk. Further research is needed to examine specific foods that may be driving these associations. REGISTRY The protocol is registered at clinicaltrials.gov as NCT03285230.
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Affiliation(s)
- Nicholas A Koemel
- Charles Perkins Centre, The University of Sydney, Sydney, Australia
- Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Sanam Shah
- Paris-Saclay University, UVSQ, Univ. Paris-Sud, CESP, Gustave Roussy, "Exposome and Heredity" team, Inserm, Villejuif, F-94805, France
| | - Alistair M Senior
- Charles Perkins Centre, The University of Sydney, Sydney, Australia
- School of Life and Environmental Sciences, The University of Sydney, Sydney, Australia
| | - Gianluca Severi
- Paris-Saclay University, UVSQ, Univ. Paris-Sud, CESP, Gustave Roussy, "Exposome and Heredity" team, Inserm, Villejuif, F-94805, France
- Department of Statistics, Computer Science, Applications "G. Parenti", University of Florence, Florence, Italy
| | - Francesca R Mancini
- Paris-Saclay University, UVSQ, Univ. Paris-Sud, CESP, Gustave Roussy, "Exposome and Heredity" team, Inserm, Villejuif, F-94805, France
| | - Timothy P Gill
- Charles Perkins Centre, The University of Sydney, Sydney, Australia
- Sydney Medical School, The University of Sydney, Sydney, Australia
- Susan Wakil School of Nursing and Midwifery, The University of Sydney, Sydney, Australia
| | - Stephen J Simpson
- Charles Perkins Centre, The University of Sydney, Sydney, Australia
- School of Life and Environmental Sciences, The University of Sydney, Sydney, Australia
| | - David Raubenheimer
- Charles Perkins Centre, The University of Sydney, Sydney, Australia
- School of Life and Environmental Sciences, The University of Sydney, Sydney, Australia
| | - Marie-Christine Boutron-Ruault
- Paris-Saclay University, UVSQ, Univ. Paris-Sud, CESP, Gustave Roussy, "Exposome and Heredity" team, Inserm, Villejuif, F-94805, France
| | - Nasser Laouali
- Paris-Saclay University, UVSQ, Univ. Paris-Sud, CESP, Gustave Roussy, "Exposome and Heredity" team, Inserm, Villejuif, F-94805, France.
- Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts, Amherst, MA, USA.
- Scripps Institution of Oceanography, University of California, San Diego, USA.
- Institute of Biological Sciences (ISSB), UM6P Faculty of Medical Sciences, Mohammed VI Polytechnic University, Ben Guerir, Morocco.
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Seck D, Shah S, Correia E, Marques C, Varraso R, Gaye B, Boutron-Ruault MC, Laouali N. High adherence to the French dietary guidelines decreases type 2 diabetes risk in females through pathways of obesity markers: Evidence from the E3N-EPIC prospective cohort study. Nutrition 2024; 124:112448. [PMID: 38677250 DOI: 10.1016/j.nut.2024.112448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 01/20/2024] [Accepted: 03/29/2024] [Indexed: 04/29/2024]
Abstract
OBJECTIVE Obesity and type 2 diabetes (T2D) have been associated with low adherence to the 2017 French food-based dietary guidelines, as assessed by the Programme National Nutrition Santé - guidelines score 2 (PNNS-GS2). Whether the association between T2D and PNNS-GS2 is direct or mediated by obesity has been little investigated. RESEARCH METHODS The study included 71,450 women from the E3N-EPIC cohort, mean age of 52.9 y (SD 6.7). The simplified PNNS-GS2 was derived via food history questionnaire. Multivariable Cox regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of T2D. Causal mediation analyses were used to decompose the total effect of sPNNS-GS2 on T2D into a direct effect and indirect effect mediated by body mass index (BMI) or the waist-hip ratio (WHR). RESULTS During a mean follow-up of 19 y, 3679 incident T2D cases were identified and validated. There was a linear association between adherence to sPNNS-GS2 and T2D (P-nonlinearity = 0.92). In the fully adjusted model, each 1-SD increase in the sPNNS-GS2 was associated with a lower T2D risk [HR (95% CI), 0.92 (0.89, 0.95)]. The overall associations were mainly explained by sPNNS-GS2-associated excess weight, with BMI and WHR mediating 52% and 58% of the associations, respectively. CONCLUSIONS Higher adherence to French food-based dietary guidelines was associated with a lower risk of T2D in women, and a significant portion of this effect could be attributed to excess weight measured by BMI or WHR. This finding helps better understand the mechanisms underlying the diet-T2D association.
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Affiliation(s)
- Daouda Seck
- Paris-Saclay University, UVSQ, Univ. Paris-Sud, Inserm, Gustave Roussy, "Exposome and Heredity" team, CESP, F-94805, Villejuif, France
| | - Sanam Shah
- Paris-Saclay University, UVSQ, Univ. Paris-Sud, Inserm, Gustave Roussy, "Exposome and Heredity" team, CESP, F-94805, Villejuif, France
| | - Emmanuelle Correia
- Paris-Saclay University, UVSQ, Univ. Paris-Sud, Inserm, Gustave Roussy, "Exposome and Heredity" team, CESP, F-94805, Villejuif, France
| | - Chloé Marques
- Paris-Saclay University, UVSQ, Univ. Paris-Sud, Inserm, Gustave Roussy, "Exposome and Heredity" team, CESP, F-94805, Villejuif, France
| | - Raphaëlle Varraso
- Paris-Saclay University, UVSQ, Univ. Paris-Sud, Inserm, Gustave Roussy, "Integrative Respiratory Epidemiology'' team, CESP, F-94805, Villejuif, France
| | - Bamba Gaye
- INSERM, U970, Paris Cardiovascular Research Center, Department of Epidemiology, Paris, France
| | - Marie-Christine Boutron-Ruault
- Paris-Saclay University, UVSQ, Univ. Paris-Sud, Inserm, Gustave Roussy, "Exposome and Heredity" team, CESP, F-94805, Villejuif, France
| | - Nasser Laouali
- Paris-Saclay University, UVSQ, Univ. Paris-Sud, Inserm, Gustave Roussy, "Exposome and Heredity" team, CESP, F-94805, Villejuif, France; Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts, Amherst, Massachusetts, USA; Scripps Institution of Oceanography, University of California, San Diego, California, USA; Institute of Biological Sciences (ISSB), UM6P Faculty of Medical Sciences, Mohammed VI Polytechnic University, Ben Guerir, Morocco.
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Matalenas LA, McLaughlin AC. Training flexible spatial-cognitive estimation strategies using augmented reality. ERGONOMICS 2024:1-19. [PMID: 38557313 DOI: 10.1080/00140139.2024.2332768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 03/14/2024] [Indexed: 04/04/2024]
Abstract
We investigated the potential for augmented reality (AR) as a training aid for spatial estimation skills. Though there are many tools to support spatial judgments, from measuring cups to rulers, not much is known about training spatial skills for retention and transfer. Display of AR was manipulated to train the spatial skill of portion estimation. In Experiment 1, an AR-aided strategy of creating smaller portions out of a larger example amount was compared to a no-AR control condition. This manipulation was based on previous non-AR experiments where amorphous foods were better estimated when divided into smaller portions. There was a significant benefit of estimating using a solid AR shape. In Experiment 2, cognitive anchoring was manipulated. Using meaningful AR anchors resulted in the best performance and most learning. We conclude that spatial estimation skills can be combined with mental strategies and trained via AR.
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Shah S, Mahamat-Saleh Y, Hajji-Louati M, Correia E, Oulhote Y, Boutron-Ruault MC, Laouali N. Palaeolithic diet score and risk of breast cancer among postmenopausal women overall and by hormone receptor and histologic subtypes. Eur J Clin Nutr 2023; 77:596-602. [PMID: 36726032 DOI: 10.1038/s41430-023-01267-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 01/18/2023] [Accepted: 01/18/2023] [Indexed: 02/03/2023]
Abstract
BACKGROUND The Palaeolithic diet (PD) has gained popularity globally. There is emerging evidence of its putative health benefits as short-term effects on chronic diseases have been reported. We evaluated the association between long-term adherence to the PD and breast cancer (BC) risk among postmenopausal women. METHODS 65,574 women from the Etude Epidémiologique auprès de femmes de la Mutuelle Générale de l'Education Nationale (E3N) cohort were followed from 1993 to 2014. Incident BC cases were identified and validated. The PD score was calculated using dietary intake self-reported at baseline (1993) and follow-up (2005) or baseline only if censored before follow-up. Multivariable Cox proportional hazards regression models were used to estimate BC hazard ratios (HR) and 95% confidence intervals (CI). RESULTS Over a mean follow-up of 20 years, 3968 incident BC cases occurred. An increase of 1 standard deviation in the PD score was associated with an 8% lower BC risk, fully-adjusted model: HR1-SD 0.92, 95% CI; 0.89, 0.95. Compared to women with low adherence to the PD, women with high adherence had a 17% lower BC risk, HRQ5 vs Q1 0.83, 95% CI; 0.75, 0.92, Ptrend < 0.01. When considering BC subtypes, we observed the same pattern of association (Pheterogeneity > 0.10 for all). CONCLUSIONS High adherence to a PD characterised by fruit, vegetables, nuts, fish, and lean meat and limited in dairy, grains, legumes, refined sugar, and alcohol was associated with a lower BC risk. The lack of heterogeneity according to BC subtypes could indicate the involvement of non-hormonal mechanisms. The protocol is registered at clinicaltrials.gov as NCT03285230. REGISTRY The protocol is registered at clinicaltrials.gov as NCT03285230.
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Affiliation(s)
- Sanam Shah
- Paris-Saclay University, UVSQ, Univ. Paris-Sud, Inserm, Gustave Roussy, "Exposome and Heredity" team, CESP, F-94805, Villejuif, France
| | - Yahya Mahamat-Saleh
- International Agency for Research on Cancer (IARC/WHO), 150 cours Albert Thomas, 69372, CEDEX 08, Lyon, France
| | - Mariem Hajji-Louati
- Paris-Saclay University, UVSQ, Univ. Paris-Sud, Inserm, Gustave Roussy, "Exposome and Heredity" team, CESP, F-94805, Villejuif, France
| | - Emmanuelle Correia
- Paris-Saclay University, UVSQ, Univ. Paris-Sud, Inserm, Gustave Roussy, "Exposome and Heredity" team, CESP, F-94805, Villejuif, France
| | - Youssef Oulhote
- Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts, Amherst, MA, USA
| | - Marie-Christine Boutron-Ruault
- Paris-Saclay University, UVSQ, Univ. Paris-Sud, Inserm, Gustave Roussy, "Exposome and Heredity" team, CESP, F-94805, Villejuif, France.
| | - Nasser Laouali
- Paris-Saclay University, UVSQ, Univ. Paris-Sud, Inserm, Gustave Roussy, "Exposome and Heredity" team, CESP, F-94805, Villejuif, France
- Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts, Amherst, MA, USA
- Scripps Institution of Oceanography, University of California, San Diego, CA, USA
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Hajji-Louati M, Gelot A, Frenoy P, Laouali N, Guénel P, Romana Mancini F. Dietary Inflammatory Index and risk of breast cancer: evidence from a prospective cohort of 67,879 women followed for 20 years in France. Eur J Nutr 2023:10.1007/s00394-023-03108-w. [PMID: 36869910 DOI: 10.1007/s00394-023-03108-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 01/31/2023] [Indexed: 03/05/2023]
Abstract
BACKGROUND Inflammation is implicated in breast cancer development, and diet is one of the modifiable risk factors involved in the regulation of chronic inflammation. Previous studies on the association between breast cancer risk and Dietary Inflammatory Indexes (DII) derived from food frequency questionnaires and data on inflammatory potential of dietary components have reported inconsistent results. OBJECTIVE To investigate the association between the DII and the risk of breast cancer using data from a large population-based cohort study. DESIGN A total of 67,879 women from the E3N cohort were followed from 1993 to 2014. A total of 5686 breast cancer cases were diagnosed during the follow-up. The food frequency questionnaire administered at baseline in 1993 was used to calculate an adapted DII. Cox proportional hazard models using age as the time scale were used to estimate hazard ratios (HR) and 95% confidence intervals (CI). Spline regression was used to determine any dose-response relationship. We also evaluated effect modification by menopausal status, body mass index, smoking status and alcohol consumption. RESULTS The median DII score of the study population was slightly pro-inflammatory (DII = + 0.39); ranged from - 4.68 in the lowest quintile to + 4.29 in the highest quintile. The HR increased linearly with the DII (HR per 1SD = 1.04 [95% CI: 1.01, 1.07]), and reached 1.13 [95% CI: 1.04, 1.23] in the 5th quintile group as compared to the first. A positive linear dose-response relationship was also observed when modeling DII with spline functions. Slightly higher HRs were observed in non-smokers (HR for 1-SD increase 1.06 [95% CI: 1.02, 1.10]; p trend = 0.001) and in low-alcohol consumers (≤ 1 glass/day) (HR for 1-SD increase 1.05 [95% CI: 1.01, 1.08]; p trend = 0.002). CONCLUSION Our results suggest a positive association between DII and breast cancer risk. Consequently, the promotion of anti-inflammatory diet may contribute to breast cancer prevention.
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Affiliation(s)
- Mariem Hajji-Louati
- Center for Research in Epidemiology and Population Health (CESP), Team Exposome and Heredity, U1018 Inserm, Institut Gustave Roussy, Espace Maurice Tubiana, University Paris-Saclay, 114 Rue Edouard Vaillant, 94805, Villejuif Cedex, France
| | - Amandine Gelot
- Center for Research in Epidemiology and Population Health (CESP), Team Exposome and Heredity, U1018 Inserm, Institut Gustave Roussy, Espace Maurice Tubiana, University Paris-Saclay, 114 Rue Edouard Vaillant, 94805, Villejuif Cedex, France
| | - Pauline Frenoy
- Center for Research in Epidemiology and Population Health (CESP), Team Exposome and Heredity, U1018 Inserm, Institut Gustave Roussy, Espace Maurice Tubiana, University Paris-Saclay, 114 Rue Edouard Vaillant, 94805, Villejuif Cedex, France
| | - Nasser Laouali
- Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts, Amherst, MA, USA
| | - Pascal Guénel
- Center for Research in Epidemiology and Population Health (CESP), Team Exposome and Heredity, U1018 Inserm, Institut Gustave Roussy, Espace Maurice Tubiana, University Paris-Saclay, 114 Rue Edouard Vaillant, 94805, Villejuif Cedex, France
| | - Francesca Romana Mancini
- Center for Research in Epidemiology and Population Health (CESP), Team Exposome and Heredity, U1018 Inserm, Institut Gustave Roussy, Espace Maurice Tubiana, University Paris-Saclay, 114 Rue Edouard Vaillant, 94805, Villejuif Cedex, France.
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Shah S, Mahamat-Saleh Y, Ait-Hadad W, Koemel NA, Varraso R, Boutron-Ruault MC, Laouali N. Long-term adherence to healthful and unhealthful plant-based diets and breast cancer risk overall and by hormone receptor and histologic subtypes among postmenopausal females. Am J Clin Nutr 2023; 117:467-476. [PMID: 36872016 PMCID: PMC10131618 DOI: 10.1016/j.ajcnut.2022.11.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 11/01/2022] [Accepted: 11/29/2022] [Indexed: 03/06/2023] Open
Abstract
BACKGROUND Epidemiological studies assessing the influence of vegetarian diets on breast cancer (BC) risk have produced inconsistent results. Few studies have assessed how the incremental decrease in animal foods and the quality of plant foods are linked with BC. OBJECTIVES Disentangle the influence of plant-based diet quality on BC risk between postmenopausal females. METHODS Total of 65,574 participants from the E3N (Etude Epidémiologique auprès de femmes de la Mutuelle Générale de l'Education Nationale) cohort were followed from 1993-2014. Incident BC cases were confirmed through pathological reports and classified into subtypes. Cumulative average scores for healthful (hPDI) and unhealthful (uPDI) plant-based diet indices were developed using self-reported dietary intakes at baseline (1993) and follow-up (2005) and divided into quintiles. Cox proportional hazards models were used to estimate adjusted HR and 95% CI. RESULTS During a mean follow-up of 21 y, 3968 incident postmenopausal BC cases were identified. There was a nonlinear association between adherence to hPDI and BC risk (Pnonlinear < 0.01). Compared to participants with low adherence to hPDI, those with high adherence had a lower BC risk [HRQ3 compared withQ1 (95% CI): 0.79 (0.71, 0.87) and HRQ4 compared with Q1 (95% CI): 0.78 (0.70, 0.86)]. In contrast, higher adherence to unhealthful was associated with a linear increase in BC risk [Pnonlinear = 0.18; HRQ5 compared with Q1 (95% CI): 1.20 (1.08, 1.33); Ptrend < 0.01]. Associations were similar according to BC subtypes (Pheterogeneity > 0.05 for all). CONCLUSIONS Long-term adherence to healthful plant foods with some intake of unhealthy plant and animal foods may reduce BC risk with an optimal risk reduction in the moderate intake range. Adherence to an unhealthful plant-based diet may increase BC risk. These results emphasize the importance of the quality of plant foods for cancer prevention. This trial was registered at clinicaltrials.gov (NCT03285230).
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Affiliation(s)
- Sanam Shah
- "Exposome and Heredity" Team, Paris-Saclay University, UVSQ, Univ. Paris-Sud, Inserm, Gustave Roussy, Villejuif, France
| | | | - Wassila Ait-Hadad
- "Integrative Respiratory Epidemiology" Team, Paris-Saclay University, UVSQ, Univ. Paris-Sud, Inserm, Gustave Roussy, Villejuif, France
| | - Nicholas A Koemel
- Charles Perkins Centre, The University of Sydney, Sydney, Australia; Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Raphaëlle Varraso
- "Integrative Respiratory Epidemiology" Team, Paris-Saclay University, UVSQ, Univ. Paris-Sud, Inserm, Gustave Roussy, Villejuif, France
| | - Marie-Christine Boutron-Ruault
- "Exposome and Heredity" Team, Paris-Saclay University, UVSQ, Univ. Paris-Sud, Inserm, Gustave Roussy, Villejuif, France.
| | - Nasser Laouali
- "Exposome and Heredity" Team, Paris-Saclay University, UVSQ, Univ. Paris-Sud, Inserm, Gustave Roussy, Villejuif, France; Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts, Amherst, MA, USA; Scripps Institution of Oceanography, University of California, San Diego, CA, USA
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Imagine this: Visualising a recent meal as bigger reduces subsequent snack intake. Appetite 2023; 181:106411. [PMID: 36463986 DOI: 10.1016/j.appet.2022.106411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 11/24/2022] [Accepted: 11/30/2022] [Indexed: 12/02/2022]
Abstract
Remembering a recent meal reduces subsequent intake of palatable snacks (i.e. the meal-recall effect), however, little is known about the factors which can potentiate this effect. The present experiment investigated whether a stronger meal-recall effect would be observed if recent consumption would be recalled in greater detail, than if it was recalled briefly. Moreover, it was investigated whether imagining a meal as bigger and more satiating than in reality could potentiate the meal-recall effect, and lead to lower intake. It was also explored whether mental visualisation tasks of a recent meal would affect the remembered portion size. Participants (N = 151) ate lunch at the laboratory, and then returned 3 h later to perform the imagination tasks and to participate in a bogus taste test (during which intake was covertly measured). Participants in the two main imagination task groups recalled the lunch meal and then either recalled the consumption episode in great detail or imagined the meal was larger and more filling than in reality. The results showed that imagining a recent meal as larger significantly reduced the quantity of biscuits eaten. However, contrary to the hypotheses, recalling a consumption episode in detail did not decrease snack intake. It was also shown that imagining a recent meal as larger than in reality did not lead participants to overestimate the true size of the meal. In fact, portion size estimations were significantly underestimated in that group. There were no significant estimation differences in any of the other groups. The results of this study suggest that the meal-recall effect can be an effective strategy to reduce food intake and may be amenable to strategic manipulation to enhance efficacy, but seems prone to disruption.
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Ait-hadad W, Bédard A, Delvert R, Orsi L, Chanoine S, Dumas O, Laouali N, Le Moual N, Leynaert B, Siroux V, Boutron-Ruault MC, Varraso R. Plant-Based Diets and the Incidence of Asthma Symptoms among Elderly Women, and the Mediating Role of Body Mass Index. Nutrients 2022; 15:nu15010052. [PMID: 36615710 PMCID: PMC9824479 DOI: 10.3390/nu15010052] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 12/13/2022] [Accepted: 12/16/2022] [Indexed: 12/25/2022] Open
Abstract
We aimed to test the hypothesis that adherence to a healthful plant-based diet (hPDI) is associated with a subsequent decrease in the incidence of asthma symptoms, with an opposite association with adherence to an unhealthful plant-based diet (uPDI). In addition, we evaluated a potential mediating role of body mass index (BMI) and the modifying effect of smoking. Among 5700 elderly women from the French Asthma-E3N study with dietary data in 1993 and 2005, we assessed the incidence of asthma symptoms in 2018 among women with no asthma symptoms in 2011. BMI was evaluated in 2008. Mediation analyses in the counterfactual framework were used to disentangle total, direct, and indirect effects mediated by BMI. We found that both healthful and unhealthful plant-based diets were associated with a lower incidence of asthma symptoms over time, mediated by BMI (OR (95%CI) for the indirect effect: 0.94 (0.89-1.00) for hPDI and 0.92 (0.70-1.00) for uPDI)). Associations with both healthful and unhealthful PDIs were mediated by changes in BMI by 33% and 89%, respectively. Plant-based diets (healthful and unhealthful) were associated with subsequently reduced incidences of asthma symptoms over time, partly or almost totally mediated by BMI according to their nutritional quality.
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Affiliation(s)
- Wassila Ait-hadad
- Université Paris-Saclay, UVSQ, Université Paris-Sud, Inserm, Équipe d’Épidémiologie Respiratoire Intégrative, CESP, 94805 Villejuif, France
| | - Annabelle Bédard
- Université Paris-Saclay, UVSQ, Université Paris-Sud, Inserm, Équipe d’Épidémiologie Respiratoire Intégrative, CESP, 94805 Villejuif, France
| | - Rosalie Delvert
- Université Paris-Saclay, UVSQ, Université Paris-Sud, Inserm, Équipe d’Épidémiologie Respiratoire Intégrative, CESP, 94805 Villejuif, France
| | - Laurent Orsi
- Université Paris-Saclay, UVSQ, Université Paris-Sud, Inserm, Équipe d’Épidémiologie Respiratoire Intégrative, CESP, 94805 Villejuif, France
| | - Sébastien Chanoine
- Team of Environmental Epidemiology Applied to the Development and Respiratory Health, Institute for Advanced Biosciences, Inserm U 1209, CNRS UMR 5309, Université Grenoble Alpes, 38000 Grenoble, France
| | - Orianne Dumas
- Université Paris-Saclay, UVSQ, Université Paris-Sud, Inserm, Équipe d’Épidémiologie Respiratoire Intégrative, CESP, 94805 Villejuif, France
| | - Nasser Laouali
- Université Paris-Saclay, UVSQ, Université Paris-Sud, Inserm, Gustave Roussy, Équipe “Exposome et Hérédité”, CESP, 94805 Villejuif, France
- Correspondence:
| | - Nicole Le Moual
- Université Paris-Saclay, UVSQ, Université Paris-Sud, Inserm, Équipe d’Épidémiologie Respiratoire Intégrative, CESP, 94805 Villejuif, France
| | - Bénédicte Leynaert
- Université Paris-Saclay, UVSQ, Université Paris-Sud, Inserm, Équipe d’Épidémiologie Respiratoire Intégrative, CESP, 94805 Villejuif, France
| | - Valérie Siroux
- Team of Environmental Epidemiology Applied to the Development and Respiratory Health, Institute for Advanced Biosciences, Inserm U 1209, CNRS UMR 5309, Université Grenoble Alpes, 38000 Grenoble, France
| | - Marie-Christine Boutron-Ruault
- Université Paris-Saclay, UVSQ, Université Paris-Sud, Inserm, Gustave Roussy, Équipe “Exposome et Hérédité”, CESP, 94805 Villejuif, France
| | - Raphaëlle Varraso
- Université Paris-Saclay, UVSQ, Université Paris-Sud, Inserm, Équipe d’Épidémiologie Respiratoire Intégrative, CESP, 94805 Villejuif, France
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Development of a Digital Photographic Food Atlas as a Portion Size Estimation Aid in Japan. Nutrients 2022; 14:nu14112218. [PMID: 35684017 PMCID: PMC9182677 DOI: 10.3390/nu14112218] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 05/18/2022] [Accepted: 05/23/2022] [Indexed: 11/22/2022] Open
Abstract
This study aimed to develop a digital photographic food atlas as a portion size estimation aid. Commonly consumed foods were identified from the 5512-day weighed dietary records of 644 Japanese adults. Portion sizes were determined based on the market research and distribution of food consumption in the dietary records. Each food item was classified into one of two photo types: a series of photographs showing gradually increasing portion sizes or guide photographs representing a range of portion sizes and food varieties in one photograph. Photographs of the food were taken at an angle of 42°, along with appropriate reference objects such as chopsticks. In total, 209 food and dish items were included in the food atlas. Series of photographs were taken for 105 items that are not usually served in predetermined amounts (e.g., rice and pasta), whereas guide photographs were taken for 104 items usually served in predetermined amounts (e.g., bananas and cookies). Moreover, photographs were taken for 12 kinds of household measurement items, such as cups and glasses. The food atlas could be a valuable tool for estimating the portion size in dietary surveys. Evaluating the validity of this food atlas for portion size estimation is warranted.
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10
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Ait-hadad W, Bédard A, Chanoine S, Dumas O, Laouali N, Le Moual N, Leynaert B, Macdonald C, Siroux V, Boutron-Ruault MC, Varraso R. Healthy diet associated with better asthma outcomes in elderly women of the French Asthma-E3N study. Eur J Nutr 2022; 61:2555-2569. [PMID: 35220443 PMCID: PMC9279211 DOI: 10.1007/s00394-022-02815-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 01/19/2022] [Indexed: 12/04/2022]
Abstract
Purpose The impact of a healthy diet on asthma prevention and management, particularly among elderly women, remains poorly understood. We investigated whether a healthy diet would be associated with fewer asthma symptoms, and, among women with asthma, with reduced uncontrolled asthma and metabolic-related multimorbidity. Methods We included 12,991 elderly women (mean age = 63 years) from the Asthma-E3N study, a nested case–control study within the French E3N cohort. Negative binomial regressions were used to analyse associations between a healthy diet [evaluated by the Alternate Healthy Eating Index-2010 (AHEI-2010)] and a validated asthma symptom score, and logistic regressions to analyse associations between the AHEI-2010 with the asthma control test and multimorbidity profiles previously identified by clustering methods on medications used. Results After adjustment for potential confounders, a linear inverse association was found between the AHEI-2010 score and the asthma symptom score [mean score ratio (95% CI) = 0.82 (0.75–0.90) for the highest versus lowest quintile; p for trend < 0.0001]. In addition, women in the highest versus lowest AHEI-2010 tertile were at a lower risk to belong to the “Predominantly metabolic multimorbidity-related medications profile” compared to the “Few multimorbidity-related medications" profile [OR 0.80 (0.63–1.00) for tertile 3; p for trend = 0.05; n = 3474]. Conclusion Our results show that a healthy dietary intake could play an important role in the prevention and management of asthma over the life course. Supplementary Information The online version contains supplementary material available at 10.1007/s00394-022-02815-0.
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11
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Mandracchia F, Tarro L, Llauradó E, Valls RM, Solà R. The “Healthy Meals” web app for the assessment of nutritional content and food allergens in restaurant meals: Development, evaluation and validation. Digit Health 2022; 8:20552076221081690. [PMID: 35251681 PMCID: PMC8891920 DOI: 10.1177/20552076221081690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 01/30/2022] [Indexed: 11/17/2022] Open
Abstract
Objective The development and the evaluation of the Healthy Meals web app designed for professionals from different disciplines related to food, aimed to assess the nutritional and food allergen content of restaurant meals, was described. Methods App evaluation concerned: (1) usability, scored on a 7-point scale by 6 restaurateurs and 10 nutritionists through the Computer System Usability Questionnaire; (2) quality, scored on a 5-point scale by 10 nutritionists through the Mobile App Rating Scale; (3) validation, by two nutritionists through differences in entered nutrient contents. Ratings reliability was assessed by the interclass correlation coefficient. Results Users agreed with the web app usability (mean 5.6/7 points, SD 0.9), with moderate reliability among ratings (interclass correlation coefficient = 0.57; 95% CI, 0.18 to 0.82). The web app showed good objective quality (mean 4.0/5 points, SD 0.4), with excellent reliability among nutritionists (interclass correlation coefficient = 0.91; 95% CI, 0.85 to 0.96). For web app validation, no significant differences were observed between the two nutritionists’ data, with excellent reliability (interclass correlation coefficient = 0.98; 95% CI, 0.97 to 0.99). App data entry was identified as a point to improve. Conclusions The Healthy Meals web app designed for professionals related to food, such as restaurateurs, demonstrated to be usable, of good quality and valid for dishes nutritional assessment and food allergen identification. Points to improve were identified, while app effectiveness should be tested in trials.
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Affiliation(s)
- Floriana Mandracchia
- Functional Nutrition, Oxidation, and Cardiovascular Diseases Group (NFOC-Salut), Healthy Environment Chair, Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, Spain
| | - Lucia Tarro
- Functional Nutrition, Oxidation, and Cardiovascular Diseases Group (NFOC-Salut), Healthy Environment Chair, Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, Spain
- Institut d’Investigació Sanitària Pere Virgili (IISPV), Spain
| | - Elisabet Llauradó
- Functional Nutrition, Oxidation, and Cardiovascular Diseases Group (NFOC-Salut), Healthy Environment Chair, Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, Spain
| | - Rosa M. Valls
- Functional Nutrition, Oxidation, and Cardiovascular Diseases Group (NFOC-Salut), Healthy Environment Chair, Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, Spain
| | - Rosa Solà
- Functional Nutrition, Oxidation, and Cardiovascular Diseases Group (NFOC-Salut), Healthy Environment Chair, Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, Spain
- Institut d’Investigació Sanitària Pere Virgili (IISPV), Spain
- Hospital Universitari Sant Joan de Reus, Spain
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12
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AMARAL YG, PENAFORTE FRDO, ARAÚJO LBD, JAPUR CC. Can hospitalized patients adequately estimate their own food intake? A cross-sectional pilot study. REV NUTR 2022. [DOI: 10.1590/1678-9865202235e210168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
ABSTRACT Objective To assess and identify factors linked to the accuracy of patients’ food intake estimations through a self-monitoring instrument filled in by the patient. Methods This cross-sectional study approached adult hospital patients subjected to regular or therapeutic diets. The actual food intake percentage was obtained by the ratio between the actual food intake and the amount of food served x 100. Patients had to complete a food chart including 9 circles representing plates of food in percentages (increasing scale of 12.5%) to represent their food intake at lunch and/or dinner. The Bland-Altman method assessed the agreement between the actual and the estimated values. The associations between variables (age, sex, hospitalization day, diet prescription, amount of food served and actual food intake percentage) and the accuracy of the food intake estimation (adequate ±10%, overestimated and underestimated) were evaluated through univariate multinomial logistic regression. Results Ninety-six patients were evaluated (51.0% male; 44.0±15.8 years of age). The Bland-Altman analysis showed good agreement between the actual and the estimated food intake. The actual food intake percentage was the only variable associated with the accuracy of the food intake estimation. Conclusion Most patients (~70%) adequately estimated their food intake using the 9-point food chart tested. Furthermore, the only factor linked to the accuracy of the food intake estimation was the actual food-intake percentage. These findings provide preliminary support for the usefulness of this instrument. However, it must be tested in a representative sample of hospitalized patients.
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13
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ALMASİ N, RAKICIOĞLU N. The Estimation of Standard Portion Sizes Using Food Photographic Booklet Among University Students in Turkey. CLINICAL AND EXPERIMENTAL HEALTH SCIENCES 2021. [DOI: 10.33808/clinexphealthsci.886274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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14
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The associations of the Palaeolithic diet alone and in combination with lifestyle factors with type 2 diabetes and hypertension risks in women in the E3N prospective cohort. Eur J Nutr 2021; 60:3935-3945. [PMID: 33909140 DOI: 10.1007/s00394-021-02565-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 04/16/2021] [Indexed: 12/12/2022]
Abstract
PURPOSE Patterns of change from the traditional Palaeolithic lifestyle to the modern lifestyle may partly explain the epidemic proportions of non-communicable diseases (NCDs). We investigated to what extent adherence to the Palaeolithic diet (PD) and the Palaeolithic-like lifestyle was associated with type 2 diabetes (T2D) and hypertension risks. METHODS A study of 70,991 women from the E3N (Etude Epidémiologique auprès de femmes de la Mutuelle Générale de l'Education Nationale) cohort, followed up for nearly 20 years. There were 3292 incident T2D and 12,504 incident hypertension cases that were validated. Dietary data were collected at baseline in 1993 via a food frequency questionnaire. The PD score and the Palaeolithic-like lifestyle score (PD, physical activity, smoking status, and body mass index [BMI]) were derived and considered in quintiles. Multivariable Cox regression models were employed to estimate hazard ratios (HR) and 95% confidence intervals (CI) for incident T2D and hypertension. RESULTS In the fully adjusted models, a 1-SD increase of the PD score was associated with 4% and 3% lower risks of T2D and hypertension, respectively. Those in the highest versus the lowest quintile of the score had HR (95% CI) of 0.88 (0.79, 0.98) and 0.91 (0.86, 0.96) for T2D and hypertension, respectively (P-trend < 0.0001). Associations were stronger for the Palaeolithic-like lifestyle score; in the fully adjusted model, a 1-SD increase of the score was associated with 19% and 6% lower risks of T2D and hypertension, respectively. Risks lowered successively with each increase in quintile; those in the highest versus the lowest quintile had HR (95% CI) of 0.58 (0.52, 0.65) and 0.85 (0.80, 0.90) for T2D and hypertension, respectively (P-trend < 0.0001). CONCLUSIONS Our data suggest that adhering to a PD based on fruit, vegetables, lean meats, fish, and nuts, and incorporating a Palaeolithic-like lifestyle could be promising options to prevent T2D and hypertension.
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15
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Amoutzopoulos B, Page P, Roberts C, Roe M, Cade J, Steer T, Baker R, Hawes T, Galloway C, Yu D, Almiron-Roig E. Portion size estimation in dietary assessment: a systematic review of existing tools, their strengths and limitations. Nutr Rev 2021; 78:885-900. [PMID: 31999347 DOI: 10.1093/nutrit/nuz107] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
CONTEXT Overestimation or underestimation of portion size leads to measurement error during dietary assessment. OBJECTIVE To identify portion size estimation elements (PSEEs) and evaluate their relative efficacy in relation to dietary assessment, and assess the quality of studies validating PSEEs. DATA SELECTION AND EXTRACTION Electronic databases, internet sites, and cross-references of published records were searched, generating 16 801 initial records, from which 334 records were reviewed and 542 PSEEs were identified, comprising 5% 1-dimensional tools (eg, food guides), 46% 2-dimensional tools (eg, photographic atlases), and 49% 3-dimensional tools (eg, household utensils). Out of 334 studies, 21 validated a PSEE (compared PSEE to actual food amounts) and 13 compared PSEEs with other PSEEs. CONCLUSION Quality assessment showed that only a few validation studies were of high quality. According to the findings of validation and comparison studies, food image-based PSEEs were more accurate than food models and household utensils. Key factors to consider when selecting a PSEE include efficiency of the PSEE and its applicability to targeted settings and populations.
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Affiliation(s)
- Birdem Amoutzopoulos
- MRC Elsie Widdowson Laboratory, Cambridge, UK.,NIHR BRC Diet, Anthropometry and Physical Activity Group, MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Polly Page
- MRC Elsie Widdowson Laboratory, Cambridge, UK.,NIHR BRC Diet, Anthropometry and Physical Activity Group, MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Caireen Roberts
- MRC Elsie Widdowson Laboratory, Cambridge, UK.,NIHR BRC Diet, Anthropometry and Physical Activity Group, MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Mark Roe
- EuroFIR AISBL, Brussels, Belgium
| | - Janet Cade
- Nutritional Epidemiology Group, University of Leeds, Leeds, UK
| | - Toni Steer
- MRC Elsie Widdowson Laboratory, Cambridge, UK.,NIHR BRC Diet, Anthropometry and Physical Activity Group, MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Ruby Baker
- MRC Elsie Widdowson Laboratory, Cambridge, UK
| | | | | | - Dove Yu
- MRC Elsie Widdowson Laboratory, Cambridge, UK
| | - Eva Almiron-Roig
- Centre for Nutrition Research, University of Navarra, Pamplona, Spain
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16
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Development and evaluation of image-series for portion size estimation in dietary assessment among adults. J Nutr Sci 2021; 10:e3. [PMID: 33889386 PMCID: PMC8057404 DOI: 10.1017/jns.2020.58] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 12/15/2020] [Indexed: 02/06/2023] Open
Abstract
Portion size images are advantageous in dietary assessment. The aim of the present study was to develop and validate new culturally specific image-series for portion size estimation to be used in a new Norwegian version of a British web-based dietary assessment tool (myfood24). Twenty-three image-series of different foods, each containing seven portion size images, were created and validated in a group of adults (n 41, 58 % female) aged 19–44 (median 23), out of which 63 % had higher (tertiary) education. The participants compared 46 portions of pre-weighed foods to the portion size images (1886 comparisons in total). Portion size estimations were either classified as correct, adjacent or misclassified. The weight discrepancy in percentage between the chosen and the correct portion size image was also calculated. Mann–Whitney U tests were used to explore if portion size estimation accuracy differed across sample characteristics, or if it depended on how the foods were presented. For thirty-eight of the forty-six presented food items, the participants selected the correct or adjacent portion size image 98 % on average. The remaining eight food items were on average misclassified by 27 % of the participants. Overall, a mean weight discrepancy of 2⋅5 % was observed between the chosen and the correct portion size images. Females estimated portion size more accurately than males (P = 0⋅019). No other significant differences in estimation accuracy were observed. In conclusion, the new image-series performed satisfactorily, except for the image-series depicting bread, caviar spread and marzipan cake, which will be altered. The present study demonstrates the importance of validating portion size estimation tools.
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17
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Lee Y, Kim MH, Shim JE, Park H. Evaluation of portion size estimation aids for the Korea National Health and Nutrition Examination Survey. Nutr Res Pract 2020; 14:667-678. [PMID: 33282127 PMCID: PMC7683201 DOI: 10.4162/nrp.2020.14.6.667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 08/23/2020] [Accepted: 09/28/2020] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND/OBJECTIVES This study aimed to improve portion size estimation aids (PSEAs) used in the nutrition survey of the Korea National Health and Nutrition Examination Survey (KNHANES) and validate the accuracy and precision of the newly developed aids. SUBJECTS/METHODS We conducted intensive interviews with survey experts in KNHANES and consulted with experts to collect opinions about improvement of PSEAs. Based on the results of the interviews, 5 types of PSEAs (rice bowl, earthen pots, mounds, measuring spoons, and thickness sticks) were newly developed using 3-dimensional (3D) modeling or modification of color or shape. Validation tests were conducted with 96 adults 20 years old or older. For the rice bowl and earthen pots, the participants were asked to select the more similar PSEA in size after being shown the real dishes. For the mounds, measuring spoons, and thickness sticks, the participants were presented with actual plates of food and asked to estimate the given portion sizes using the given PSEAs. RESULTS The improved 2-dimensional (2D) picture aid for the rice bowl reflecting the size distortion by angle of view using 3D modeling was perceived more closely to the actual size than the current 2D picture (P < 0.001). The change of the color of 2D pictures and 3D models, the change of shape of the measuring spoons, and the 3-dimensionalization of the 2D mounds had no significant improvement in the subjects' perception. CONCLUSIONS The currently used 2D PSEAs need to be fully redesigned using 3D modeling to improve subjects' perception. However, change of color or shape will not be necessary. For amorphous foods, it is suggested that more evaluation be performed before reaching a final conclusion in the use of PSEAs, or alternative ways to improve accuracy of estimation need to be explored.
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Affiliation(s)
- Youngmi Lee
- Department of Food and Nutrition, Myongji University, Yongin 17058, Korea
| | - Mi-Hyun Kim
- Division of Food Science, Kongju National University, Yesan 32439, Korea
| | - Jae Eun Shim
- Department of Food and Nutrition, Daejeon University, Daejeon 34520, Korea
| | - Haeryun Park
- Department of Food and Nutrition, Myongji University, Yongin 17058, Korea
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18
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Amadou A, Coudon T, Praud D, Salizzoni P, Leffondre K, Lévêque E, Boutron-Ruault MC, Danjou AMN, Morelli X, Le Cornet C, Perrier L, Couvidat F, Bessagnet B, Caudeville J, Faure E, Mancini FR, Gulliver J, Severi G, Fervers B. Chronic Low-Dose Exposure to Xenoestrogen Ambient Air Pollutants and Breast Cancer Risk: XENAIR Protocol for a Case-Control Study Nested Within the French E3N Cohort. JMIR Res Protoc 2020; 9:e15167. [PMID: 32930673 PMCID: PMC7525465 DOI: 10.2196/15167] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 01/14/2020] [Accepted: 01/22/2020] [Indexed: 12/24/2022] Open
Abstract
Background Breast cancer is the most frequent cancer in women in industrialized countries. Lifestyle and environmental factors, particularly endocrine-disrupting pollutants, have been suggested to play a role in breast cancer risk. Current epidemiological studies, although not fully consistent, suggest a positive association of breast cancer risk with exposure to several International Agency for Research on Cancer Group 1 air-pollutant carcinogens, such as particulate matter, polychlorinated biphenyls (PCB), dioxins, Benzo[a]pyrene (BaP), and cadmium. However, epidemiological studies remain scarce and inconsistent. It has been proposed that the menopausal status could modify the relationship between pollutants and breast cancer and that the association varies with hormone receptor status. Objective The XENAIR project will investigate the association of breast cancer risk (overall and by hormone receptor status) with chronic exposure to selected air pollutants, including particulate matter, nitrogen dioxide (NO2), ozone (O3), BaP, dioxins, PCB-153, and cadmium. Methods Our research is based on a case-control study nested within the French national E3N cohort of 5222 invasive breast cancer cases identified during follow-up from 1990 to 2011, and 5222 matched controls. A questionnaire was sent to all participants to collect their lifetime residential addresses and information on indoor pollution. We will assess these exposures using complementary models of land-use regression, atmospheric dispersion, and regional chemistry-transport (CHIMERE) models, via a Geographic Information System. Associations with breast cancer risk will be modeled using conditional logistic regression models. We will also study the impact of exposure on DNA methylation and interactions with genetic polymorphisms. Appropriate statistical methods, including Bayesian modeling, principal component analysis, and cluster analysis, will be used to assess the impact of multipollutant exposure. The fraction of breast cancer cases attributable to air pollution will be estimated. Results The XENAIR project will contribute to current knowledge on the health effects of air pollution and identify and understand environmental modifiable risk factors related to breast cancer risk. Conclusions The results will provide relevant evidence to governments and policy-makers to improve effective public health prevention strategies on air pollution. The XENAIR dataset can be used in future efforts to study the effects of exposure to air pollution associated with other chronic conditions. International Registered Report Identifier (IRRID) DERR1-10.2196/15167
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Affiliation(s)
- Amina Amadou
- Department of Prevention Cancer Environment, Centre Léon Bérard, Lyon, France.,Inserm UA 08 Radiations: Défense, Santé, Environnement, Lyon, France
| | - Thomas Coudon
- Department of Prevention Cancer Environment, Centre Léon Bérard, Lyon, France.,Ecole Centrale de Lyon, INSA, Université Claude Bernard Lyon 1, Ecully, France
| | - Delphine Praud
- Department of Prevention Cancer Environment, Centre Léon Bérard, Lyon, France.,Inserm UA 08 Radiations: Défense, Santé, Environnement, Lyon, France
| | - Pietro Salizzoni
- Ecole Centrale de Lyon, INSA, Université Claude Bernard Lyon 1, Ecully, France
| | - Karen Leffondre
- ISPED, Inserm U1219, Bordeaux Population Health Center, Université de Bordeaux, Bordeaux, France
| | - Emilie Lévêque
- ISPED, Inserm U1219, Bordeaux Population Health Center, Université de Bordeaux, Bordeaux, France
| | - Marie-Christine Boutron-Ruault
- Centre de Recherche en Epidémiologie et Santé des Populations (CESP, Inserm U1018), Faculté de Médecine, Université Paris-Saclay, Villejuif, France
| | - Aurélie M N Danjou
- Department of Prevention Cancer Environment, Centre Léon Bérard, Lyon, France
| | - Xavier Morelli
- Department of Prevention Cancer Environment, Centre Léon Bérard, Lyon, France
| | - Charlotte Le Cornet
- Department of Prevention Cancer Environment, Centre Léon Bérard, Lyon, France.,Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Lionel Perrier
- Univ Lyon, Centre Léon Bérard, GATE L-SE UMR 5824, Lyon, France
| | - Florian Couvidat
- National Institute for industrial Environment and Risks (INERIS), Verneuil-en-Halatte, France
| | - Bertrand Bessagnet
- National Institute for industrial Environment and Risks (INERIS), Verneuil-en-Halatte, France
| | - Julien Caudeville
- National Institute for industrial Environment and Risks (INERIS), Verneuil-en-Halatte, France
| | - Elodie Faure
- Department of Prevention Cancer Environment, Centre Léon Bérard, Lyon, France
| | - Francesca Romana Mancini
- Centre de Recherche en Epidémiologie et Santé des Populations (CESP, Inserm U1018), Faculté de Médecine, Université Paris-Saclay, Villejuif, France
| | - John Gulliver
- Centre for Environmental Health and Sustainability, School of Geography, Geology and the Environment, University of Leicester, Leicester, United Kingdom
| | - Gianluca Severi
- Centre de Recherche en Epidémiologie et Santé des Populations (CESP, Inserm U1018), Faculté de Médecine, Université Paris-Saclay, Villejuif, France
| | - Béatrice Fervers
- Department of Prevention Cancer Environment, Centre Léon Bérard, Lyon, France.,Inserm UA 08 Radiations: Défense, Santé, Environnement, Lyon, France
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19
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MacDonald CJ, Laouali N, Madika AL, Mancini FR, Boutron-Ruault MC. Dietary inflammatory index, risk of incident hypertension, and effect modification from BMI. Nutr J 2020; 19:62. [PMID: 32586324 PMCID: PMC7315510 DOI: 10.1186/s12937-020-00577-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 06/16/2020] [Indexed: 01/25/2023] Open
Abstract
Introduction Previous studies have identified a positive association between the inflammatory potential of the diet and hypertension. It is not known if BMI is an effect modifier for this association, nor if the association is dose-respondent. This study aimed to assess the association between the dietary inflammatory index (DII) and the risk of hypertension, and assess any effect modification from BMI. Methods Data from the E3N cohort study, a French prospective population-based study initiated in 1990 was used. From the women in the study, we included those who completed a detailed diet history questionnaire, and who did not have prevalent hypertension or cardiovascular disease at baseline, resulting in 46,652 women. The adapted DII was assessed with data from the dietary questionnaire. Hypertension cases were self-reported and verified through a drug-reimbursement database. Cox proportional hazard models were used to calculate hazard ratios. Spline regression was used to determine any dose-respondent relationship. Results During 884,267 person-years, 13,183 cases of incident hypertension were identified. The median DII in the population was slightly pro-inflammatory (DII = + 0.44). A highly pro-inflammatory diet (DII > 3.0) was associated with a slight increase in hypertension risk (HRQ1-Q5 = 1.07 [1.02, 1.13]). Evidence was observed for effect modification from BMI, with associations strongest amongst women in the 18.5–21.0 BMI range (HRQ1-Q5 = 1.17 [1.06, 1.29]). A weak dose-respondent relationship was observed. Conclusion Evidence for a weak association between DII and hypertension was observed. Associations were stronger amongst healthy-lean women.
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Affiliation(s)
- Conor-James MacDonald
- INSERM (Institut National de la Santé et de la Recherche Médicale) U1018, Center for Research in Epidemiology and Population Health (CESP), Institut Gustave Roussy, Villejuif, France.,Université Paris-Saclay, Université Paris-Sud, Villejuif, France
| | - Nasser Laouali
- INSERM (Institut National de la Santé et de la Recherche Médicale) U1018, Center for Research in Epidemiology and Population Health (CESP), Institut Gustave Roussy, Villejuif, France.,Université Paris-Saclay, Université Paris-Sud, Villejuif, France
| | - Anne-Laure Madika
- INSERM (Institut National de la Santé et de la Recherche Médicale) U1018, Center for Research in Epidemiology and Population Health (CESP), Institut Gustave Roussy, Villejuif, France.,Université Paris-Saclay, Université Paris-Sud, Villejuif, France.,Université de Lille, CHU Lille, EA 2694 - Santé publique : épidémiologie et qualité des soins, F-59000, Lille, France
| | - Francesca Romana Mancini
- INSERM (Institut National de la Santé et de la Recherche Médicale) U1018, Center for Research in Epidemiology and Population Health (CESP), Institut Gustave Roussy, Villejuif, France.,Université Paris-Saclay, Université Paris-Sud, Villejuif, France
| | - Marie-Christine Boutron-Ruault
- INSERM (Institut National de la Santé et de la Recherche Médicale) U1018, Center for Research in Epidemiology and Population Health (CESP), Institut Gustave Roussy, Villejuif, France. .,Université Paris-Saclay, Université Paris-Sud, Villejuif, France.
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20
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MacDonald CJ, Madika AL, Bonnet F, Fagherazzi G, Lajous M, Boutron-Ruault MC. Cholesterol and Egg Intakes, and Risk of Hypertension in a Large Prospective Cohort of French Women. Nutrients 2020; 12:nu12051350. [PMID: 32397298 PMCID: PMC7285051 DOI: 10.3390/nu12051350] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 05/01/2020] [Accepted: 05/04/2020] [Indexed: 11/29/2022] Open
Abstract
Purpose: The relationship between egg and cholesterol intakes, and cardiovascular disease is controversial. Meta-analyses indicate that egg consumption is associated with increased cardiovascular disease and mortality, but reduced incidence of hypertension, a major risk factor for cardiovascular disease. This study aims to investigate the associations between consumption of egg and cholesterol, and hypertension risk in a cohort of French women. Methods: We used data from the E3N cohort study, a French prospective population-based study initiated in 1990. From the women in the study, we included those who completed a detailed diet history questionnaire, and who did not have prevalent hypertension or cardiovascular disease at baseline, resulting in 46,424 women. Hypertension cases were self-reported. Egg and cholesterol intake was estimated from dietary history questionnaires. Cox proportional hazard models with time-updated exposures were used to calculate hazard ratios. Spline regression was used to determine any dose–respondent relationship. Results: During 885,321 person years, 13,161 cases of incident hypertension were identified. Higher cholesterol consumption was associated with an increased risk of hypertension: HRQ1–Q5 = 1.22 [1.14:1.30], with associations similar regarding egg consumption up to seven eggs per week: HR4–7 eggs = 1.14 [1.06:1.18]. Evidence for a non-linear relationship between hypertension and cholesterol intake was observed. Conclusions: Egg and cholesterol intakes were associated with a higher risk of hypertension in French women. These results merit further investigation in other populations.
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Affiliation(s)
- Conor-James MacDonald
- INSERM (Institut National de la Santé et de la Recherche Médicale) U1018, Center for Research in Epidemiology and Population Health (CESP), Institut Gustave Roussy, 94805 Villejuif, France; (C.-J.M.); (A.-L.M.); (F.B.); (G.F.)
- Université Paris-Saclay, Université Paris-Sud, 94805 Villejuif, France
| | - Anne-Laure Madika
- INSERM (Institut National de la Santé et de la Recherche Médicale) U1018, Center for Research in Epidemiology and Population Health (CESP), Institut Gustave Roussy, 94805 Villejuif, France; (C.-J.M.); (A.-L.M.); (F.B.); (G.F.)
- Université Paris-Saclay, Université Paris-Sud, 94805 Villejuif, France
- Université de Lille, CHU Lille, EA 2694-Santé publique: épidémiologie et qualité des soins, F-59000 Lille, France
| | - Fabrice Bonnet
- INSERM (Institut National de la Santé et de la Recherche Médicale) U1018, Center for Research in Epidemiology and Population Health (CESP), Institut Gustave Roussy, 94805 Villejuif, France; (C.-J.M.); (A.-L.M.); (F.B.); (G.F.)
- Université Paris-Saclay, Université Paris-Sud, 94805 Villejuif, France
- Faculty of Medicine, Université Rennes1, F-35043 Rennes, France
- Department of endocrinology diabetes and nutrition, CHU Rennes, F-35033 Rennes, France
| | - Guy Fagherazzi
- INSERM (Institut National de la Santé et de la Recherche Médicale) U1018, Center for Research in Epidemiology and Population Health (CESP), Institut Gustave Roussy, 94805 Villejuif, France; (C.-J.M.); (A.-L.M.); (F.B.); (G.F.)
- Université Paris-Saclay, Université Paris-Sud, 94805 Villejuif, France
- Department of Population Health, Luxembourg Institute of Health, L-1445 Strassen, Luxembourg
| | - Martin Lajous
- Center for Research on Population Health, INSP (Instituto Nacional de Salud Pública), Cuernavaca 62100, Mexico;
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Marie-Christine Boutron-Ruault
- INSERM (Institut National de la Santé et de la Recherche Médicale) U1018, Center for Research in Epidemiology and Population Health (CESP), Institut Gustave Roussy, 94805 Villejuif, France; (C.-J.M.); (A.-L.M.); (F.B.); (G.F.)
- Université Paris-Saclay, Université Paris-Sud, 94805 Villejuif, France
- Correspondence: ; Tel.: +33-1-42116466
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21
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A systematic review of recall errors associated with portion size estimation aids in children. Appetite 2020; 147:104522. [PMID: 31751634 DOI: 10.1016/j.appet.2019.104522] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 10/10/2019] [Accepted: 11/17/2019] [Indexed: 11/22/2022]
Abstract
To reduce errors in portion size estimation, a number of aids have been developed and tested. This systematic review synthesizes what is known about error associated with use of different portion size estimation aids (PSEAs) within self-reported dietary recall studies in children (aged ≤18 years). Eight electronic databases were searched using relevant keywords. From 8184 records identified and screened, 327 full texts were retrieved, with 10 records representing 9 studies meeting inclusion criteria. Studies using proxy reporting were excluded. Thirteen PSEAs were identified. To facilitate comparisons between different types of aids they were categorized into 'physical 2-dimensional (2D)', 'digital 2D' and '3-dimensional' PSEAs. Seven were physical 2D (e.g. food atlas), two were digital 2D (i.e. computer-based), and four were 3D (e.g. modelling clay, household items). Comparisons of PSEAs within studies found the smallest estimation errors for digital 2D and largest for 3D aids. Errors in relation to food type were varied, with portions of amorphous foods overestimated in multiple studies. No effects for recall interval time or sex were identified. One study reported a significant improvement in estimation error with increasing age. Across studies, large variations in study design and reporting of estimation error hindered the synthesis of evidence regarding the influence of different types of PSEAs on accuracy. While a definitive conclusion about the most accurate PSEA could not be drawn, a check-list to guide future PSEA development and testing has been proposed in the current review. This will assist comparability with future studies of PSEAs for children facilitate development of more accurate PSEAs in the future.
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22
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Delacour C, Chambe J, Lefebvre F, Bodot C, Bigerel E, Epifani L, Granda C, Haller DM, Maisonneuve H. Association between physical activity and Nocturnal Leg Cramps in patients over 60 years old: a case-control study. Sci Rep 2020; 10:2638. [PMID: 32060316 PMCID: PMC7021766 DOI: 10.1038/s41598-020-59312-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 01/24/2020] [Indexed: 11/09/2022] Open
Abstract
Nocturnal Legs Cramps are a frequent disorder, which have a negative impact on quality of life, particularly among patients over 60 years old. Lifestyle factors such as alcohol consumption have been shown to be associated with Nocturnal Leg Cramps. This study aimed to explore the association between nocturnal leg cramps and a sedentary lifestyle among elderly patients. A case-control study was conducted with a Bayesian approach for sensitivity analysis. Patients over 60 years old consulting their family doctor were recruited in the Alsace region, France. Cases were matched with controls free from cramps for age, sex, medical history and medications known to trigger cramps. The level of physical activity was assessed using the Dijon Physical Activity Score (DPAS). We performed univariate and multivariate analyses adjusting for alcohol consumption. 272 participants were matched into 136 pairs. 11% of all were sedentary persons. Adjusting for alcohol consumption, we observed an association between Nocturnal Leg Cramps and a sedentary lifestyle OR = 9.84 (95% credibility interval [1.74; 101.9]; posterior probability 99.68%). Our findings represent an additional argument to promote physical activity to patients over 60 years old. They also highlight the need to develop and evaluate physical activity interventions in the treatment of Nocturnal Legs Cramps.
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Affiliation(s)
- Chloé Delacour
- General Medicine Department, Faculty of Medicine, University of Strasbourg, Strasbourg, 67000, France.
| | - Juliette Chambe
- General Medicine Department, Faculty of Medicine, University of Strasbourg, Strasbourg, 67000, France
| | - François Lefebvre
- Public Health Department, Faculty of Medicine, University of Strasbourg, Strasbourg, 67000, France
| | - Claire Bodot
- General Medicine Department, Faculty of Medicine, University of Strasbourg, Strasbourg, 67000, France
| | - Elodie Bigerel
- General Medicine Department, Faculty of Medicine, University of Strasbourg, Strasbourg, 67000, France
| | - Laetitia Epifani
- General Medicine Department, Faculty of Medicine, University of Strasbourg, Strasbourg, 67000, France
| | - Céline Granda
- General Medicine Department, Faculty of Medicine, University of Strasbourg, Strasbourg, 67000, France
| | - Dagmar M Haller
- Primary Care Unit, Faculty of Medicine, University of Geneva, Geneva, 1211, Switzerland
| | - Hubert Maisonneuve
- General Medicine Department, Faculty of Medicine, University of Strasbourg, Strasbourg, 67000, France.,Primary Care Unit, Faculty of Medicine, University of Geneva, Geneva, 1211, Switzerland
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Villaverde P, Lajous M, MacDonald CJ, Fagherazzi G, Boutron-Ruault MC, Bonnet F. Dairy product consumption and hypertension risk in a prospective French cohort of women. Nutr J 2020; 19:12. [PMID: 32024524 PMCID: PMC7003316 DOI: 10.1186/s12937-020-0527-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 01/27/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Among potentially modifiable factors, dairy product consumption has been inconsistently associated with hypertension risk. The objective of this study was to investigate the relation between dairy product consumption and the risk of hypertension among middle-aged women. METHODS In a prospective cohort of 40,526 French women, there were 9340 new cases of hypertension after an average 12.2 years of follow up. Consumptions of milk, yogurt, and types of cheese were assessed at baseline using a validated dietary questionnaire. Hazard ratios (HRs) and 95% confidence intervals (95% CI) for hypertension were estimated with multivariate Cox models with age as the time scale. RESULTS The mean dairy consumption was 2.2 + 1.2 servings/day, as cottage cheese (0.2 + 0.2 servings/day), yogurt (0.6 + 0.5 servings/day), milk (0.4 + 0.7 servings/day), and cheese (1.1 + 0.8 servings/day). There was no association between risk of hypertension and total dairy consumption (multivariate HR for the fifth vs. first quintile HR5vs.1 = 0.97 [0.91; 1.04]). There was no association with any specific type of dairy, except for a positive association between processed cheese consumption and hypertension (multivariate HR4vs.1 = 1.12 [1.06; 1.18]; p trend = < 0.003). CONCLUSIONS In this large prospective cohort of French women, overall consumption of dairy products was not associated with the risk of hypertension. Results regarding processed cheese must be further confirmed.
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Affiliation(s)
- Paola Villaverde
- Center for Research on Population Health, INSP (Instituto Nacional de Salud Pública), Cuernavaca, Mexico.,Université Paris-Saclay, Villejuif, France.,Université Paris-Sud, Villejuif, France.,Center for Research in Epidemiology and Population Health (CESP), Institut Gustave Roussy, INSERM (Institut National de la Santé et de la Recherche Médicale) U1018, Villejuif, France
| | - Martin Lajous
- Center for Research on Population Health, INSP (Instituto Nacional de Salud Pública), Cuernavaca, Mexico.,Université Paris-Saclay, Villejuif, France.,Université Paris-Sud, Villejuif, France.,Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
| | - Conor-James MacDonald
- Université Paris-Saclay, Villejuif, France.,Université Paris-Sud, Villejuif, France.,Center for Research in Epidemiology and Population Health (CESP), Institut Gustave Roussy, INSERM (Institut National de la Santé et de la Recherche Médicale) U1018, Villejuif, France
| | - Guy Fagherazzi
- Université Paris-Saclay, Villejuif, France.,Université Paris-Sud, Villejuif, France.,Center for Research in Epidemiology and Population Health (CESP), Institut Gustave Roussy, INSERM (Institut National de la Santé et de la Recherche Médicale) U1018, Villejuif, France.,Department of Population Health, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Marie-Christine Boutron-Ruault
- Université Paris-Saclay, Villejuif, France. .,Université Paris-Sud, Villejuif, France. .,Center for Research in Epidemiology and Population Health (CESP), Institut Gustave Roussy, INSERM (Institut National de la Santé et de la Recherche Médicale) U1018, Villejuif, France.
| | - Fabrice Bonnet
- Université Paris-Saclay, Villejuif, France.,Université Paris-Sud, Villejuif, France.,Center for Research in Epidemiology and Population Health (CESP), Institut Gustave Roussy, INSERM (Institut National de la Santé et de la Recherche Médicale) U1018, Villejuif, France.,Groupe hospitalier Paris St-Joseph, Paris, France
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24
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Validation of a digitally displayed photographic food portion-size estimation aid among women in urban and rural Malawi. Public Health Nutr 2019; 22:3140-3150. [DOI: 10.1017/s1368980019002428] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjective:To validate digitally displayed photographic portion-size estimation aids (PSEA) against a weighed meal record and compare findings with an atlas of printed photographic PSEA and actual prepared-food PSEA in a low-income country.Design:Participants served themselves water and five prepared foods, which were weighed separately before the meal and again after the meal to measure any leftovers. Participants returned the following day and completed a meal recall. They estimated the quantities of foods consumed three times using the different PSEA in a randomized order.Setting:Two urban and two rural communities in southern Malawi.Participants:Women (n 300) aged 18–45 years, equally divided by urban/rural residence and years of education (≤4 years and ≥5 years).Results:Responses for digital and printed PSEA were highly correlated (>91 % agreement for all foods, Cohen’s κw = 0·78–0·93). Overall, at the individual level, digital and actual-food PSEA had a similar level of agreement with the weighed meal record. At the group level, the proportion of participants who estimated within 20 % of the weighed grams of food consumed ranged by type of food from 30 to 45 % for digital PSEA and 40–56 % for actual-food PSEA. Digital PSEA consistently underestimated grams and nutrients across foods, whereas actual-food PSEA provided a mix of under- and overestimates that balanced each other to produce accurate mean energy and nutrient intake estimates. Results did not differ by urban and rural location or participant education level.Conclusions:Digital PSEA require further testing in low-income settings to improve accuracy of estimations.
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25
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Villaverde P, Lajous M, MacDonald CJ, Fagherazzi G, Bonnet F, Boutron-Ruault MC. High dietary total antioxidant capacity is associated with a reduced risk of hypertension in French women. Nutr J 2019; 18:31. [PMID: 31186024 PMCID: PMC6560825 DOI: 10.1186/s12937-019-0456-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 05/27/2019] [Indexed: 02/07/2023] Open
Abstract
Background Although there is evidence for a reduced risk of hypertension associated with fruit and vegetable consumption, the relationship between the total antioxidant capacity of the diet (TAC) and the risk of hypertension has not been previously examined. We aimed to evaluate that association in the large E3N French prospective cohort of women. Methods Dietary TAC was estimated using total radical-trapping ability parameter (TRAP) assay food values; self-reported incident hypertension cases were validated. Cox regression models were adjusted for conventional risk factors, body mass index, physical activity, energy, sodium, magnesium, omega-3 fatty acids, and alcohol. Results After an average 12.7 years of follow up, there were 9350 incident cases of hypertension among 40,576 women. Dietary TAC was inversely associated with the risk of hypertension with a 15% lower risk of hypertension in those in the fifth vs. first quintile (HRQ5 0.85 [CI 95% 0.74; 0.95] p-trend 0.03) An inverse dose-effect relationship was observed for dietary TAC excluding coffee (HRQ5 0.85 [CI 95% 0.74; 0.95], p-trend 0.0008), while for dietary TAC from coffee, only the highest quintile was inversely associated with risk (HRQ5 0.86 [0.75, 0.97], p-trend 0.20). In a fully partitioned model with major dietary TAC contributors, TAC from fruit/vegetables, wine, and miscellaneous sources was inversely associated with risk, while associations with TAC from coffee, tea, and chocolate were not statistically significant. Conclusions In a large prospective cohort, the risk of incident hypertension in women was inversely associated with the antioxidant capacity of the diet, suggesting that promoting a diet naturally rich in antioxidants might help prevent the development of hypertension. Electronic supplementary material The online version of this article (10.1186/s12937-019-0456-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Paola Villaverde
- Center for Research on Population Health, INSP (Instituto Nacional de Salud Pública), Cuernavaca, México.,INSERM (Institut National de la Santé et de la Recherche Médicale) U1018, Center for Research in Epidemiology and Population Health (CESP), Institut Gustave Roussy, Villejuif, France.,Université Paris-Saclay, Université Paris-Sud, Villejuif, France
| | - Martin Lajous
- Center for Research on Population Health, INSP (Instituto Nacional de Salud Pública), Cuernavaca, México.,Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Conor-James MacDonald
- INSERM (Institut National de la Santé et de la Recherche Médicale) U1018, Center for Research in Epidemiology and Population Health (CESP), Institut Gustave Roussy, Villejuif, France.,Université Paris-Saclay, Université Paris-Sud, Villejuif, France
| | - Guy Fagherazzi
- INSERM (Institut National de la Santé et de la Recherche Médicale) U1018, Center for Research in Epidemiology and Population Health (CESP), Institut Gustave Roussy, Villejuif, France.,Université Paris-Saclay, Université Paris-Sud, Villejuif, France
| | - Fabrice Bonnet
- INSERM (Institut National de la Santé et de la Recherche Médicale) U1018, Center for Research in Epidemiology and Population Health (CESP), Institut Gustave Roussy, Villejuif, France.,Université Paris-Saclay, Université Paris-Sud, Villejuif, France.,Université Rennes1, F-35043, Rennes, France.,CHU Rennes, F-35033, Rennes, France
| | - Marie-Christine Boutron-Ruault
- INSERM (Institut National de la Santé et de la Recherche Médicale) U1018, Center for Research in Epidemiology and Population Health (CESP), Institut Gustave Roussy, Villejuif, France. .,Université Paris-Saclay, Université Paris-Sud, Villejuif, France.
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26
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Nichelle PG, Almeida CCB, Camey SA, Garmus LM, Elias VCM, Marchioni DM, da Silva DG, Ocke MC, Slimani N, Fisberg RM, Crispim SP. Subjects' Perception in Quantifying Printed and Digital Photos of Food Portions. Nutrients 2019; 11:E501. [PMID: 30818798 PMCID: PMC6471321 DOI: 10.3390/nu11030501] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 02/20/2019] [Accepted: 02/20/2019] [Indexed: 12/14/2022] Open
Abstract
Although digital photos have the potential to improve the precision of reported portions in dietary assessment, there are few studies investigating its accuracy in comparison to printed photos. The aim of this study was to evaluate the perception of adults in quantifying food portion sizes using printed and digital photos, displayed on computer-screens and tablets. In total, 1165 evaluations were performed for 60 photos of portion sizes in Brazil. Each participant (n = 58) attended two sessions in the study center, with an interval of at least one week. In each session, twelve food portions were prepared and randomly evaluated by each participant in its printed and digital forms. The mean error (difference between the estimated and true portions) was not significantly different between the printed photos (2.1 g ± 47.2) and the digital ones (-6.4 g ± 53.7). The agreement on using the printed and digital photos was 91% and 90%, respectively. Furthermore, the use of the tablet was more prone to underestimation when compared to printed and computer-screen photos (p < 0.001). Overall, participants did not present major difficulties in perceiving the portion sizes using the printed and digital photos, but the use of tablets led to less accurate results, indicating that this needs to be further evaluated.
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Affiliation(s)
- Pryscila G Nichelle
- Postgraduate Program in Food and Nutrition, Department of Nutrition, Federal University of Paraná (UFPR), Curitiba 80240-110, Brazil.
| | - Claudia C B Almeida
- Postgraduate Program in Food and Nutrition, Department of Nutrition, Federal University of Paraná (UFPR), Curitiba 80240-110, Brazil.
| | - Suzi A Camey
- Postgraduate Program in Epidemiology, Department of Statistics, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre 91509-900, Brazil.
| | - Lenine M Garmus
- Postgraduate Program in Food and Nutrition, Department of Nutrition, Federal University of Paraná (UFPR), Curitiba 80240-110, Brazil.
| | - Vanessa C M Elias
- Postgraduate Program in Food and Nutrition, Department of Nutrition, Federal University of Paraná (UFPR), Curitiba 80240-110, Brazil.
| | - Dirce M Marchioni
- Department of Nutrition, School of Public Health, University of São Paulo. Research Group of Epidemiological Studies and Innovation in Food and Health-GEIAS, São Paulo 01246-000, Brazil.
| | - Danielle G da Silva
- Postgraduate Program in Nutrition Science, Department of Nutrition, Federal University of Sergipe, São Cristóvão 49100-000, Brazil.
| | - Marga C Ocke
- National Institute for Public Health and the Environment, 3721 MA Bilthoven, The Netherlands.
| | - Nadia Slimani
- Nutrition and Metabolism Section, International Agency for Research on Cancer, 69372 Lyon, France.
| | - Regina M Fisberg
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo 01246-000, Brazil.
| | - Sandra P Crispim
- Postgraduate Program in Food and Nutrition, Department of Nutrition, Federal University of Paraná (UFPR), Curitiba 80240-110, Brazil.
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27
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Hooper A, McMahon A, Probst Y. The Role of Various Forms of Training on Improved Accuracy of Food-Portion Estimation Skills: A Systematic Review of the Literature. Adv Nutr 2019; 10:43-50. [PMID: 30629097 PMCID: PMC6370264 DOI: 10.1093/advances/nmy060] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 07/25/2018] [Indexed: 12/18/2022] Open
Abstract
This study describes the types of food-portion tools used and changes in accuracy for food-portion size estimation by adult populations after an intervention of food-portion education and training. This systematic review searched 7 scientific databases. Only internally comparable study designs were included. Studies were tabulated for nutrition- and non-nutrition-trained university students and the general population. Included studies were assessed for level of evidence and quality, including risk of bias. Thirteen studies were reviewed, with 8 targeting university students. Food type, length of training, number of tools, and the impact of repeated use on food-portion estimation were summarized. Estimation accuracy calculations across studies were not consistent, and training was found to improve portion-size estimation accuracy in the short term (4 wk). Computer-based training tools only identified for the general population were equally or less effective and shifted estimation from under- to overestimation. This review suggests that education with food-portion tools may be effective in improving estimation skills in university-recruited participants and the general population. Computerized tools for university students are required, likely combined with other tools for improved estimation accuracy. The use of food models or multiple tools is more effective until a tailored computerized solution is developed. Repeated training is needed to maintain skills over time. This systematic review was registered with PROSPERO at http://bit.ly/2mZK3u3 as CRD42016038110.
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Affiliation(s)
- Astrid Hooper
- Faculty of Science Medicine and Health, School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia
| | - Anne McMahon
- Faculty of Science Medicine and Health, School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia
| | - Yasmine Probst
- Faculty of Science Medicine and Health, School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia,Address correspondence to YP (e-mail: )
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28
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Rizk M, Guilloteau A, Mouillot T, Thiefin G, Bronowicki JP, Richou C, Doffoel M, Diab Assaf M, Hillon P, Cottet V. Dietary components modulate the risk of hepatocellular carcinoma in cirrhotic patients. Nutr Res 2018; 61:82-94. [PMID: 30683441 DOI: 10.1016/j.nutres.2018.10.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 09/07/2018] [Accepted: 10/05/2018] [Indexed: 02/07/2023]
Abstract
Eighty percent of hepatocellular carcinoma (HCC) cases occur after cirrhosis from various etiologies. The association between diet and cancer is well accepted, but the links with cirrhosis progression and HCC risk have been poorly investigated. However, we hypothesized that diet could be a modifiable preventive factor for HCC. Thus, the aim of our study was to explore the relationships between dietary factors and the risk of HCC in a population of cirrhotic patients. A total of 582 cirrhotic patients were studied: 401 without HCC (controls) and 181 with HCC (cases). These patients were recruited between 2008 and 2012 for the "CiRCE" case-control study conducted in six French university hospitals. Information about the consumption of 208 food items and 23 nutrients were collected through a diet history questionnaire. Unconditional multivariate logistic regressions were performed for each residual food group and nutrients in tertiles. HCC patients were more often men, diabetic and older than controls. After adjustment, a significant positive association was found between HCC risk and carbonated beverages (ORTertile3vsTertile1 = 2.44 [1.17-5.09] p-trend = 0.021), total cereals (ORT3vsT1 = 1.87 [1.09-3.22] p-trend = 0.035), processed meat (ORT3vsT1 = 1.97 [1.14-3.41] p-trend = 0.028) and sodium (ORT3vsT1 = 2.00 [1.14-3.53] p-trend = 0.043). Conversely, the consumption of fiber (ORT3vsT1 = 0.49 [0.28-0.86] p-trend = 0.012), vitamin E (ORT3vsT1 = 0.52 [0.30-0.89] p-trend = 0.017), vitamin B9 (folate and folic acid) (ORT3vsT1 = 0.56 [0.33-0.95] p-trend = 0.036), manganese (ORT3vsT1 = 0.56 [0.32-0.97] p-trend = 0.038) and potassium (ORT3vsT1 = 0.44 [0.25-0.76] p-trend = 0.004) were significantly lower in HCC patients compared with cirrhotic controls. Although these findings must be confirmed in prospective studies, using dietary patterns or biological parameters, they suggest that certain dietary components may modulate HCC risk in cirrhotic patients.
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Affiliation(s)
- Maud Rizk
- INSERM UMR 1231, University of Burgundy Franche-Comté, Dijon, France
| | - Adrien Guilloteau
- INSERM UMR 1231, University of Burgundy Franche-Comté, Dijon, France; Clinical Investigation Center 1432, University of Burgundy Franche-Comté, Dijon, France; Dijon University Hospital, Dijon, France
| | - Thomas Mouillot
- Dijon University Hospital, Dijon, France; Center for the Study of Taste and Eating Behavior, CNRS, INRA, University of Burgundy Franche-Comté, Dijon, France
| | - Gérard Thiefin
- Hepatology and Gastroenterology Department, University Hospital of Reims, Reims, France
| | - Jean-Pierre Bronowicki
- Hepatology Department, University Hospital of Nancy, Nancy, France; INSERM UMR 954, Nancy, France
| | - Carine Richou
- Hepatology Department, University Hospital of Besancon, Besancon, France
| | - Michel Doffoel
- Hepatology department, University Hospital of Strasbourg, Strasbourg, France
| | - Mona Diab Assaf
- Molecular Tumorigenesis and Anticancer Pharmacology, EDST, Lebanese University, Beirut, Lebanon
| | - Patrick Hillon
- INSERM UMR 1231, University of Burgundy Franche-Comté, Dijon, France; Dijon University Hospital, Dijon, France
| | - Vanessa Cottet
- INSERM UMR 1231, University of Burgundy Franche-Comté, Dijon, France; Clinical Investigation Center 1432, University of Burgundy Franche-Comté, Dijon, France; Dijon University Hospital, Dijon, France.
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Paulsen MM, Hagen MLL, Frøyen MH, Foss-Pedersen RJ, Bergsager D, Tangvik RJ, Andersen LF. A Dietary Assessment App for Hospitalized Patients at Nutritional Risk: Development and Evaluation of the MyFood App. JMIR Mhealth Uhealth 2018; 6:e175. [PMID: 30194059 PMCID: PMC6231855 DOI: 10.2196/mhealth.9953] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Revised: 05/03/2018] [Accepted: 05/08/2018] [Indexed: 01/04/2023] Open
Abstract
Background Disease-related malnutrition is a common challenge among hospitalized patients. There seems to be a lack of an effective system to follow-up nutritional monitoring and treatment of patients at nutritional risk after risk assessment. We identify a need for a more standardized system to prevent and treat disease-related malnutrition. Objective We aimed to develop a dietary assessment app for tablets for use in a hospital setting and to evaluate the app’s ability to measure individual intake of energy, protein, liquid, and food and beverage items among hospitalized patients for two days. We also aimed to measure patients’ experiences using the app. Methods We have developed the MyFood app, which consists of three modules: 1) collection of information about the patient, 2) dietary assessment function, and 3) evaluation of recorded intake compared to individual needs. We used observations from digital photography of the meals, combined with partial weighing of the meal components, as a reference method to evaluate the app’s dietary assessment system for two days. Differences in the intake estimations of energy, protein, liquid, and food and beverage items between MyFood and the photograph method were analyzed on both group and individual level. Results Thirty-two patients hospitalized at Oslo University Hospital were included in the study. The data collection period ran from March to May 2017. About half of the patients had ≥90% agreement between MyFood and the photograph method for energy, protein, and liquid intake on both recording days. Dinner was the meal with the lowest percent agreement between methods. MyFood overestimated patients’ intake of bread and cereals and underestimated fruit consumption. Agreement between methods increased from day 1 to day 2 for bread and cereals, spreads, egg, yogurt, soup, hot dishes, and desserts. Ninety percent of participants reported that MyFood was easy to use, and 97% found the app easy to navigate. Conclusions We developed the MyFood app as a tool to monitor dietary intake among hospitalized patients at nutritional risk. The recorded intake of energy, protein, and liquid using MyFood showed good agreement with the photograph method for the majority of participants. The app’s ability to estimate intake within food groups was good, except for bread and cereals which were overestimated and fruits which were underestimated. The app was well accepted among study participants and has the potential to be a dietary assessment tool for use among patients in clinical practice.
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Affiliation(s)
- Mari Mohn Paulsen
- National Advisory Unit on Disease-Related Malnutrition, Division of Cancer Medicine, Oslo University Hospital, Oslo, Norway.,Institute of Basic Medical Sciences, Department of Nutrition, University of Oslo, Oslo, Norway
| | | | - Marte Hesvik Frøyen
- The University Center for Information Technology, University of Oslo, Oslo, Norway
| | | | - Dagfinn Bergsager
- The University Center for Information Technology, University of Oslo, Oslo, Norway
| | - Randi Julie Tangvik
- National Advisory Unit on Disease-Related Malnutrition, Division of Cancer Medicine, Oslo University Hospital, Oslo, Norway.,Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Lene Frost Andersen
- National Advisory Unit on Disease-Related Malnutrition, Division of Cancer Medicine, Oslo University Hospital, Oslo, Norway.,Institute of Basic Medical Sciences, Department of Nutrition, University of Oslo, Oslo, Norway
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Affret A, El Fatouhi D, Dow C, Correia E, Boutron-Ruault MC, Fagherazzi G. Relative Validity and Reproducibility of a New 44-Item Diet and Food Frequency Questionnaire Among Adults: Online Assessment. J Med Internet Res 2018; 20:e227. [PMID: 29980502 PMCID: PMC6053608 DOI: 10.2196/jmir.9113] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 02/01/2018] [Accepted: 02/18/2018] [Indexed: 12/29/2022] Open
Abstract
Background Dietary questionnaires currently available which can assess the habitual diet are timely, costly, or not adapted well to the modern diet; thus, there is a need for a shorter food frequency e-Questionnaire (FFeQ) adapted to Western diets, in order to properly estimate energy and macronutrient intakes or rank individuals according to food and nutrient intakes. Objective The aim of this study was to evaluate the relative validity and reproducibility of a 30-minute and 44-item FFeQ in a sample of adults obtained from the general population. Methods A sample of French adults was recruited through social media and an advertising campaign. A total of 223 volunteers completed the FFeQ twice at one-year intervals and were included in the reproducibility study. During that interval, 92 participants completed three-to-six 24-hour recalls and were included in the validity study. Nutrient and dietary intakes were computed for all validity and reproducibility participants. The level of agreement between the two methods was evaluated for nutrient and food group intakes using classification into quintiles of daily intake, correlation coefficients and Bland-Altman plots. Results For relative validity, correlation coefficients ranged from 0.09 to 0.88 (unadjusted correlation coefficients, median: 0.48) and 0.02 to 0.68 (deattenuated and energy adjusted correlation coefficients, median: 0.50) for food group and nutrient intakes, respectively. The median proportion of subjects classified into the same or adjacent quintile was 73% and 66% for food and nutrient intakes, respectively. Bland-Altman plots showed good agreement across the range of intakes. Regarding reproducibility, intraclass correlation coefficients ranged from 0.33 to 0.72 (median: 0.60) and 0.55 to 0.73 (median: 0.64), for food and nutrient intakes, respectively. Conclusions The FFeQ showed acceptable validity and reproducibility in a sample of adults based on their food and nutrient intakes. The FFeQ is a promising and low-cost tool that can be used in large-scale online epidemiological studies or clinical routines and could be integrated into evidence-based smartphone apps for assessing diet components.
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Affiliation(s)
- Aurélie Affret
- Inserm U1018, Center for Research in Epidemiology and Population Health, Villejuif, France.,Université Paris-Sud, Orsay, France.,Université de Versailles-Saint-Quentin-en-Yvelines, Versailles, France
| | - Douae El Fatouhi
- Inserm U1018, Center for Research in Epidemiology and Population Health, Villejuif, France.,Université Paris-Sud, Orsay, France.,Université de Versailles-Saint-Quentin-en-Yvelines, Versailles, France
| | - Courtney Dow
- Inserm U1018, Center for Research in Epidemiology and Population Health, Villejuif, France.,Université Paris-Sud, Orsay, France.,Université de Versailles-Saint-Quentin-en-Yvelines, Versailles, France
| | - Emmanuelle Correia
- Inserm U1018, Center for Research in Epidemiology and Population Health, Villejuif, France.,Université Paris-Sud, Orsay, France.,Université de Versailles-Saint-Quentin-en-Yvelines, Versailles, France
| | - Marie-Christine Boutron-Ruault
- Inserm U1018, Center for Research in Epidemiology and Population Health, Villejuif, France.,Université Paris-Sud, Orsay, France.,Université de Versailles-Saint-Quentin-en-Yvelines, Versailles, France
| | - Guy Fagherazzi
- Inserm U1018, Center for Research in Epidemiology and Population Health, Villejuif, France.,Université Paris-Sud, Orsay, France.,Université de Versailles-Saint-Quentin-en-Yvelines, Versailles, France
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Soriano G, Goisser S, Guyonnet S, Vellas B, Andrieu S, Sourdet S. Misreporting of Energy Intake in Older People: Comparison of Two Dietary Assessment Methods. J Nutr Gerontol Geriatr 2018; 37:310-320. [PMID: 30280995 DOI: 10.1080/21551197.2018.1505578] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Revised: 05/07/2018] [Accepted: 07/24/2018] [Indexed: 06/08/2023]
Abstract
Accurate assessment of dietary intake is essential in clinical practice and research. While energy intake (EI) misreporting has been extensively studied in the general population, relatively little is known about misreporting among older people. This cross-sectional study used clinical data routinely collected in 127 participants, aged 70-96 years, from the Toulouse Frailty Clinic. EI was assessed by diet history interview and three-day food record. Misreporters were identified with the Goldberg cut-off method, using the Harris-Benedict equation to estimate total energy expenditure. The response rate was 66% for three-day food record and 93% for diet history interviews. EI from diet history interviews (1799 ± 416 kcal/day) was significantly higher than from food records (1400 ± 381 kcal/day; p < 0.001) and closest to total energy expenditure (1758 ± 437 kcal/day; (p > 0.05). Thirty percent of participants were identified as underreporters with three-day food records vs. 9% with diet history interviews. Overreporters were found with diet history interviews only (11% of participants). In older people, the diet history interview has the advantage of obtaining a higher response rate and a lower underreporting rate, compared to three-day food record. Nevertheless, with this method, overreporting was observed and interpreting results should be done with caution.
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Affiliation(s)
- Gaëlle Soriano
- a Gérontopôle , Centre Hospitalier Universitaire de Toulouse , Toulouse , France
- b Inserm UMR1027 , Université de Toulouse III Paul Sabatier , Toulouse , France
| | - S Goisser
- a Gérontopôle , Centre Hospitalier Universitaire de Toulouse , Toulouse , France
| | - S Guyonnet
- a Gérontopôle , Centre Hospitalier Universitaire de Toulouse , Toulouse , France
- b Inserm UMR1027 , Université de Toulouse III Paul Sabatier , Toulouse , France
| | - B Vellas
- a Gérontopôle , Centre Hospitalier Universitaire de Toulouse , Toulouse , France
- b Inserm UMR1027 , Université de Toulouse III Paul Sabatier , Toulouse , France
| | - S Andrieu
- b Inserm UMR1027 , Université de Toulouse III Paul Sabatier , Toulouse , France
| | - S Sourdet
- a Gérontopôle , Centre Hospitalier Universitaire de Toulouse , Toulouse , France
- b Inserm UMR1027 , Université de Toulouse III Paul Sabatier , Toulouse , France
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Ali HI, Platat C, El Mesmoudi N, El Sadig M, Tewfik I. Evaluation of a photographic food atlas as a tool for quantifying food portion size in the United Arab Emirates. PLoS One 2018; 13:e0196389. [PMID: 29698434 PMCID: PMC5919643 DOI: 10.1371/journal.pone.0196389] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Accepted: 04/12/2018] [Indexed: 11/18/2022] Open
Abstract
Although, United Arab Emirates (UAE) has one of the highest prevalence of overweight, obesity and type 2 diabetes in the world, however, validated dietary assessment aids to estimate food intake of individuals and populations in the UAE are currently lacking. We conducted two observational studies to evaluate the accuracy of a photographic food atlas which was developed as a tool for food portion size estimation in the UAE. The UAE Food Atlas presents eight portion sizes for each food. Study 1 involved portion size estimations of 13 food items consumed during the previous day. Study 2 involved portion size estimations of nine food items immediately after consumption. Differences between the food portion sizes estimated from the photographs and the weighed food portions (estimation error), as well as the percentage differences relative to the weighed food portion for each tested food item were calculated. Four of the evaluated food items were underestimated (by -8.9% to -18.4%), while nine were overestimated (by 9.5% to 90.9%) in Study 1. Moreover, there were significant differences between estimated and eaten food portions for eight food items (P<0.05). In Study 2, one food item was underestimated (-8.1%) while eight were overestimated (range 2.52% to 82.1%). Furthermore, there were significant differences between estimated and eaten food portions (P<0.05) for six food items. The limits of agreement between the estimated and consumed food portion size were wide indicating a large variability in food portion estimation errors. These reported findings highlight the need for further developments of the UAE Food Atlas to improve the accuracy of food portion size intake estimations in dietary assessments. Additionally, recalling food portions from the previous day did not seem to increase food portion estimation errors in this study.
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Affiliation(s)
- Habiba I. Ali
- Nutrition and Health Department, College of Food and Agriculture, United Arab Emirates University, Al Ain, United Arab Emirates
- * E-mail:
| | - Carine Platat
- Nutrition and Health Department, College of Food and Agriculture, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Najoua El Mesmoudi
- Nutrition and Health Department, College of Food and Agriculture, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Mohamed El Sadig
- Institute of Public Heath, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Ihab Tewfik
- Division of Food, Nutrition and Public Health, University of Westminster, London, United Kingdom
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, United States of America
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Abstract
Objective To validate a novel photographic portion guide as a tool to estimate consumption of
fish and shrimp. Application of such a validated tool can facilitate accurate individual
and community seafood intake assessments and provide meaningful data relative to health
benefits and hazard assessment, particularly in response to environmental contamination
and disasters. Design A photographic fish and shrimp portion guide presenting a stepped range of cooked
portion sizes was used by participants to estimate their typical portion sizes.
Participants selected their typical portion size from the photographic guide and also
from a selection of freshly cooked reference meals. Photographic portions selections
were compared with plated reference portions for each participant. Setting Academic sensory testing laboratory in the USA. Subjects Separate groups of adults (25–64 years) contributed to fish (n 54) and
shrimp (n 53) portion size comparison studies. Results In the fish study, there was no difference between photographic portion selections
(6·59 (sd 2·65) oz (186·8 (sd 75·1) g)) and reference plate selections
(7·04 (sd 2·63) oz (199·6 (sd 74·6) g); P=0·384).
Similarly in the shrimp study, there was no difference between photographic portion
selections (6·88 (sd 3·40) oz (195·0 (sd 96·4) g)) and reference plate
selections (6·06 (sd 2·65) oz (171·8 (sd 75·1) g);
P=0·159). Photographic portions predicted plated reference portions for
both fish and shrimp based on linear regression (P<0·001).
Bland–Altman plot analyses showed good agreement between the two methods, <1 oz
(<28·3 g) bias, in both fish and shrimp studies. Conclusions This validated photographic seafood portion guide provides a utilitarian tool for
accurately assessing fish and shrimp intake in a community setting.
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Evaluation of food photographs assessing the dietary intake of children up to 10 years old. Public Health Nutr 2017; 21:888-895. [PMID: 29199628 DOI: 10.1017/s1368980017003354] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Young children lack basic skills related to recognizing the types of foods they consume and dietary surveys often rely on parents' response. The present study aimed to evaluate how well parents of children aged from 3 months to 10 years perceive images of portions of foods commonly consumed by young children. DESIGN Pre-weighed, actual food portions (n 2314) were shown to the study participants who were asked to indicate the picture that corresponded to the food in view. Mean differences between picture numbers selected and shown were estimated and compared using unpaired t tests or Tukey-Cramer pairwise comparisons. SETTING Real-time testing of parents' perception of food images presenting portion sizes consumed by children up to 10 years old. SUBJECTS A convenience sample of 138 parents/caregivers of young children (69 % females). RESULTS Individuals selected the correct or adjacent image in about 97 % of the assessments. Images presenting amorphous solids (i.e. pies and pastries with a filling), liquid or semi-liquid dishes (i.e. soups, porridges, fruit and vegetable purées) were more prone to bias. There was no indication that personal characteristics (gender, age, educational background, age, number of offspring) were associated with differences in the way parents/caregivers perceived the food pictures. CONCLUSIONS Food pictures may not be appropriate to quantify the intake of liquid, semi-liquid or amorphous solid foods in surveys addressing young children and studies evaluating their performance as food portion anchors should ensure the inclusion of several and various amorphous foods in the assessment.
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Affret A, Wagner S, El Fatouhi D, Dow C, Correia E, Niravong M, Clavel-Chapelon F, De Chefdebien J, Fouque D, Stengel B, Boutron-Ruault MC, Fagherazzi G. Validity and reproducibility of a short food frequency questionnaire among patients with chronic kidney disease. BMC Nephrol 2017; 18:297. [PMID: 28915857 PMCID: PMC5599889 DOI: 10.1186/s12882-017-0695-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 08/22/2017] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND A balanced diet is essential to slowing the progression of chronic kidney disease (CKD) and managing the symptoms. Currently, no tool is available to easily and quickly assess energy and macronutrient intake in patients with non end-stage CKD. We aimed to develop and evaluate the validity and reproducibility of a new short 49-item food frequency questionnaire (SFFQ) adapted to patients with CKD. METHODS The CKD-REIN study is a prospective cohort that enrolled 3033 patients with moderate or advanced CKD from a national sample of nephrology clinics. A sub-sample of 201 patients completed the SFFQ twice, at a one-year interval and were included in the reproducibility study. During this interval, 127 patients also completed six 24-h recalls and were included in the validity study. Main nutrient and dietary intakes were computed. Validity was evaluated by calculating crude, energy-adjusted and de-attenuated correlation coefficients (CC) between FFQ and the mean of the 24-h recall results. Bland-Altman plots were performed and cross-classification into quintiles of consumption of each nutrient and food group was computed. Reproducibility between the two SFFQs was evaluated by intraclass CC (ICC). RESULTS Regarding validity, CC ranged from 0.05 to 0.79 (unadjusted CC, median: 0.40) and 0.10 to 0.59 (de-attenuated CC, median: 0.35) for food group and nutrient intakes, respectively. Five of the most important nutrients of interest in CKD, i.e. protein, calcium, phosphorus, potassium, and sodium had de-attenuated CC of 0.46, 0.43, 0.39, 0.32, and 0.12, respectively. The median of classification into the same or adjacent quintiles was 68% and 65% for food and nutrient intakes, respectively, and ranged from 63% to 69% for the five nutrients mentioned before. Bland-Altman plots showed good agreement across the range of intakes. ICC ranged from 0.18 to 0.66 (median: 0.46). CONCLUSIONS The CKD-REIN SFFQ showed acceptable validity and reproducibility in a sample of patients with CKD, notably for CKD nutrients of importance. It can now be used in large-scale epidemiological studies to easily assess the relations between diet and CKD outcomes as well as in clinical routine. It may also serve as a basis for the development of FFQs in international CKD cohort networks.
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Affiliation(s)
- Aurélie Affret
- Inserm U1018, Center for Research in Epidemiology and Population Health (CESP), Villejuif, France
- Univ Paris-Sud, Villejuif, France
- UVSQ, Villejuif, France
| | - Sandra Wagner
- Inserm U1018, Center for Research in Epidemiology and Population Health (CESP), Villejuif, France
- Univ Paris-Sud, Villejuif, France
- UVSQ, Villejuif, France
- FCRIN INI-CRCT, Lyon, France
| | - Douae El Fatouhi
- Inserm U1018, Center for Research in Epidemiology and Population Health (CESP), Villejuif, France
- Univ Paris-Sud, Villejuif, France
- UVSQ, Villejuif, France
| | - Courtney Dow
- Inserm U1018, Center for Research in Epidemiology and Population Health (CESP), Villejuif, France
- Univ Paris-Sud, Villejuif, France
- UVSQ, Villejuif, France
| | - Emmanuelle Correia
- Inserm U1018, Center for Research in Epidemiology and Population Health (CESP), Villejuif, France
- Univ Paris-Sud, Villejuif, France
- UVSQ, Villejuif, France
| | - Maryvonne Niravong
- Inserm U1018, Center for Research in Epidemiology and Population Health (CESP), Villejuif, France
- Univ Paris-Sud, Villejuif, France
- UVSQ, Villejuif, France
| | - Françoise Clavel-Chapelon
- Inserm U1018, Center for Research in Epidemiology and Population Health (CESP), Villejuif, France
- Univ Paris-Sud, Villejuif, France
- UVSQ, Villejuif, France
| | - Julie De Chefdebien
- Inserm U1018, Center for Research in Epidemiology and Population Health (CESP), Villejuif, France
- Univ Paris-Sud, Villejuif, France
- UVSQ, Villejuif, France
| | - Denis Fouque
- FCRIN INI-CRCT, Lyon, France
- Centre Hospitalier Lyon Sud, Lyon, F-69495 Pierre-Bénite, France
- CarMeN, Inserm UMRS 1060, Inserm, Univ Lyon-Sud, Lyon, 69921 Oullins, France
| | - Bénédicte Stengel
- Inserm U1018, Center for Research in Epidemiology and Population Health (CESP), Villejuif, France
- Univ Paris-Sud, Villejuif, France
- UVSQ, Villejuif, France
| | - Marie-Christine Boutron-Ruault
- Inserm U1018, Center for Research in Epidemiology and Population Health (CESP), Villejuif, France
- Univ Paris-Sud, Villejuif, France
- UVSQ, Villejuif, France
- Center for Research in Epidemiology and Population Health (CESP), INSERM (Institut National de la Santé et de la Recherche Médicale) U1018, Team 9, Health across generations, Gustave Roussy Institute, 114 rue Edouard Vaillant, 94805 Villejuif Cedex, France
| | - Guy Fagherazzi
- Inserm U1018, Center for Research in Epidemiology and Population Health (CESP), Villejuif, France
- Univ Paris-Sud, Villejuif, France
- UVSQ, Villejuif, France
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Bucher T, Weltert M, Rollo ME, Smith SP, Jia W, Collins CE, Sun M. The international food unit: a new measurement aid that can improve portion size estimation. Int J Behav Nutr Phys Act 2017; 14:124. [PMID: 28899402 PMCID: PMC5596841 DOI: 10.1186/s12966-017-0583-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 09/05/2017] [Indexed: 02/08/2023] Open
Abstract
Background Portion size education tools, aids and interventions can be effective in helping prevent weight gain. However consumers have difficulties in estimating food portion sizes and are confused by inconsistencies in measurement units and terminologies currently used. Visual cues are an important mediator of portion size estimation, but standardized measurement units are required. In the current study, we present a new food volume estimation tool and test the ability of young adults to accurately quantify food volumes. The International Food Unit™ (IFU™) is a 4x4x4 cm cube (64cm3), subdivided into eight 2 cm sub-cubes for estimating smaller food volumes. Compared with currently used measures such as cups and spoons, the IFU™ standardizes estimation of food volumes with metric measures. The IFU™ design is based on binary dimensional increments and the cubic shape facilitates portion size education and training, memory and recall, and computer processing which is binary in nature. Methods The performance of the IFU™ was tested in a randomized between-subject experiment (n = 128 adults, 66 men) that estimated volumes of 17 foods using four methods; the IFU™ cube, a deformable modelling clay cube, a household measuring cup or no aid (weight estimation). Estimation errors were compared between groups using Kruskall-Wallis tests and post-hoc comparisons. Results Estimation errors differed significantly between groups (H(3) = 28.48, p < .001). The volume estimations were most accurate in the group using the IFU™ cube (Mdn = 18.9%, IQR = 50.2) and least accurate using the measuring cup (Mdn = 87.7%, IQR = 56.1). The modelling clay cube led to a median error of 44.8% (IQR = 41.9). Compared with the measuring cup, the estimation errors using the IFU™ were significantly smaller for 12 food portions and similar for 5 food portions. Weight estimation was associated with a median error of 23.5% (IQR = 79.8). Conclusions The IFU™ improves volume estimation accuracy compared to other methods. The cubic shape was perceived as favourable, with subdivision and multiplication facilitating volume estimation. Further studies should investigate whether the IFU™ can facilitate portion size training and whether portion size education using the IFU™ is effective and sustainable without the aid. A 3-dimensional IFU™ could serve as a reference object for estimating food volume. Electronic supplementary material The online version of this article (10.1186/s12966-017-0583-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- T Bucher
- Department of Health Sciences and Technology, ETH Zurich, Universitätsrasse 16, 8092, Zurich, Switzerland. .,Priority Research Centre for Physical Activity and Nutrition, Faculty of Health and medicine, The University of Newcastle, Newcastle, Australia.
| | - M Weltert
- Department of Health Sciences and Technology, ETH Zurich, Universitätsrasse 16, 8092, Zurich, Switzerland.,Priority Research Centre for Physical Activity and Nutrition, Faculty of Health and medicine, The University of Newcastle, Newcastle, Australia
| | - M E Rollo
- Priority Research Centre for Physical Activity and Nutrition, Faculty of Health and medicine, The University of Newcastle, Newcastle, Australia
| | - S P Smith
- School of Electrical Engineering and Computing, The University of Newcastle, Newcastle, Australia
| | - W Jia
- Departments of Neurosurgery, University of Pittsburgh, Pittsburgh, USA
| | - C E Collins
- Priority Research Centre for Physical Activity and Nutrition, Faculty of Health and medicine, The University of Newcastle, Newcastle, Australia
| | - M Sun
- Departments of Neurosurgery, University of Pittsburgh, Pittsburgh, USA
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Biltoft-Jensen A, Holmgaard Nielsen T, Hess Ygil K, Christensen T, Fagt S. Accuracy of food photographs for quantifying food servings in a lunch meal setting among Danish children and adults. J Hum Nutr Diet 2017; 31:131-140. [PMID: 28656744 DOI: 10.1111/jhn.12490] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Visual aids, such as food photographs, are widely used in estimating food quantities in dietary surveys. The present study aimed to assess how accurately Danish adults and children can estimate food portion sizes using 37 series of photographs illustrating four to six different portion sizes under real-life conditions; determine whether adults were more accurate than children; and estimate the error caused by using portion size photographs to estimate weights of foods consumed in macronutrient calculation. METHODS Six hundred and twenty-two adults and 109 children were recruited in three workplace canteens and in two schools, respectively, to estimate their lunchtime portions based on photographs. Participants were instructed to keep the foods separated on their plate when taking lunch. Participants thereafter estimated their own portions by looking at the relevant series of photographs. The actual food portions were then weighed. RESULTS The proportion of correct estimations was 42% overall (range 19-77%). The mean difference (%) between estimated and actual weight was 17% (range 1-111%). Small portion size photographs were more often used correctly compared to larger portion photographs. Children had as many correct estimations as adults, although they overestimated portions more. Participants using fractions of (or more than) one photograph to estimate the portion of a food had significantly larger errors. When calculating the macronutrient content of a weekly menu using the estimated portion sizes, protein had the largest error (29%). CONCLUSIONS When used in a real-life situation, the portion size photographs validated in the present study showed a certain inaccuracy compared to the actual weights.
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Affiliation(s)
- A Biltoft-Jensen
- Division for Risk Assessment and Nutrition, The National Food Institute, Technical University of Denmark, Søborg, Denmark
| | - T Holmgaard Nielsen
- Division for Risk Assessment and Nutrition, The National Food Institute, Technical University of Denmark, Søborg, Denmark
| | - K Hess Ygil
- Division for Risk Assessment and Nutrition, The National Food Institute, Technical University of Denmark, Søborg, Denmark
| | - T Christensen
- Division for Risk Assessment and Nutrition, The National Food Institute, Technical University of Denmark, Søborg, Denmark
| | - S Fagt
- Division for Risk Assessment and Nutrition, The National Food Institute, Technical University of Denmark, Søborg, Denmark
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Rollo ME, Bucher T, Smith SP, Collins CE. ServAR: An augmented reality tool to guide the serving of food. Int J Behav Nutr Phys Act 2017; 14:65. [PMID: 28499433 PMCID: PMC5429537 DOI: 10.1186/s12966-017-0516-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 04/22/2017] [Indexed: 02/04/2023] Open
Abstract
Background Accurate estimation of food portion size is a difficult task. Visual cues are important mediators of portion size and therefore technology-based aids may assist consumers when serving and estimating food portions. The current study evaluated the usability and impact on estimation error of standard food servings of a novel augmented reality food serving aid, ServAR. Methods Participants were randomised into one of three groups: 1) no information/aid (control); 2) verbal information on standard serving sizes; or 3) ServAR, an aid which overlayed virtual food servings over a plate using a tablet computer. Participants were asked to estimate the standard serving sizes of nine foods (broccoli, carrots, cauliflower, green beans, kidney beans, potato, pasta, rice, and sweetcorn) using validated food replicas. Wilcoxon signed-rank tests compared median served weights of each food to reference standard serving size weights. Percentage error was used to compare the estimation of serving size accuracy between the three groups. All participants also performed a usability test using the ServAR tool to guide the serving of one randomly selected food. Results Ninety adults (78.9% female; a mean (95%CI) age 25.8 (24.9–26.7) years; BMI 24.2 (23.2–25.2) kg/m2) completed the study. The median servings were significantly different to the reference portions for five foods in the ServAR group, compared to eight foods in the information only group and seven foods for the control group. The cumulative proportion of total estimations per group within ±10%, ±25% and ±50% of the reference portion was greater for those using ServAR (30.7, 65.2 and 90.7%; respectively), compared to the information only group (19.6, 47.4 and 77.4%) and control group (10.0, 33.7 and 68.9%). Participants generally found the ServAR tool easy to use and agreed that it showed potential to support optimal portion size selection. However, some refinements to the ServAR tool are required to improve the user experience. Conclusions Use of the augmented reality tool improved accuracy and consistency of estimating standard serve sizes compared to the information only and control conditions. ServAR demonstrates potential as a practical tool to guide the serving of food. Further evaluation across a broad range of foods, portion sizes and settings is warranted.
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Affiliation(s)
- Megan E Rollo
- School of Health Sciences, Priority Research Centre for Physical Activity & Nutrition, ATC Building, University of Newcastle, Callaghan, NSW, 2308, Australia.
| | - Tamara Bucher
- School of Health Sciences, Priority Research Centre for Physical Activity & Nutrition, ATC Building, University of Newcastle, Callaghan, NSW, 2308, Australia.,Institute for Environmental Decisions, ETH Zurich, Zurich, Switzerland
| | - Shamus P Smith
- School of Electrical Engineering and Computing, University of Newcastle, Callaghan, Australia
| | - Clare E Collins
- School of Health Sciences, Priority Research Centre for Physical Activity & Nutrition, ATC Building, University of Newcastle, Callaghan, NSW, 2308, Australia
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Szenczi-Cseh J, Horváth Z, Ambrus Á. Validation of a food quantification picture book and portion sizes estimation applying perception and memory methods. Int J Food Sci Nutr 2017; 68:960-972. [PMID: 28366101 DOI: 10.1080/09637486.2017.1309521] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- J. Szenczi-Cseh
- National Food Chain Safety Office, Directorate for Food Safety Risk Assessment, Budapest, Hungary
| | - Zs. Horváth
- National Food Chain Safety Office, Directorate for Food Safety Risk Assessment, Budapest, Hungary
| | - Á. Ambrus
- National Food Chain Safety Office, Directorate for Food Safety Risk Assessment, Budapest, Hungary
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Foster E, Hawkins A, Barton KL, Stamp E, Matthews JNS, Adamson AJ. Development of food photographs for use with children aged 18 months to 16 years: Comparison against weighed food diaries - The Young Person's Food Atlas (UK). PLoS One 2017; 12:e0169084. [PMID: 28199319 PMCID: PMC5310878 DOI: 10.1371/journal.pone.0169084] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 12/12/2016] [Indexed: 11/24/2022] Open
Abstract
Traditional dietary assessment methods, used in the UK, such as weighed food diaries impose a large participant burden, often resulting in difficulty recruiting representative samples and underreporting of energy intakes. One approach to reducing the burden placed on the participant is to use portion size assessment tools to obtain an estimate of the amount of food consumed, removing the need to weigh all foods. An age range specific food atlas was developed for use in assessing children’s dietary intakes. The foods selected and portion sizes depicted were derived from intakes recorded during the UK National Diet and Nutrition Surveys of children aged 1.5 to 16 years. Estimates of food portion sizes using the food atlas were compared against 4-day weighed intakes along with in-school / nursery observations, by the research team. Interviews were conducted with parents the day after completion of the diary, and for children aged 4 to 16 years, also with the child. Mean estimates of portion size consumed were within 7% of the weight of food recorded in the weighed food diary. The limits of agreement were wide indicating high variability of estimates at the individual level but the precision increased with increasing age. For children 11 years and over, agreement with weighed food diaries, was as good as that of their parents in terms of total weight of food consumed and of intake of energy and key nutrients. The age appropriate food photographs offer an alternative to weighed intakes for dietary assessment with children.
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Affiliation(s)
- Emma Foster
- Human Nutrition Research Centre, Institute of Health and Society, Newcastle University, Newcastle, United Kingdom
- * E-mail:
| | - Adrian Hawkins
- Human Nutrition Research Centre, Institute of Health and Society, Newcastle University, Newcastle, United Kingdom
| | - Karen L. Barton
- Division of Food and Drink, School of Science, Engineering & Technology Abertay University, Dundee, United Kingdom
| | - Elaine Stamp
- Human Nutrition Research Centre, Institute of Health and Society, Newcastle University, Newcastle, United Kingdom
| | - John N. S. Matthews
- School of Mathematics and Statistics, Newcastle University, Newcastle, United Kingdom
| | - Ashley J. Adamson
- Human Nutrition Research Centre, Institute of Health and Society, Newcastle University, Newcastle, United Kingdom
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Kirkpatrick SI, Potischman N, Dodd KW, Douglass D, Zimmerman TP, Kahle LL, Thompson FE, George SM, Subar AF. The Use of Digital Images in 24-Hour Recalls May Lead to Less Misestimation of Portion Size Compared with Traditional Interviewer-Administered Recalls. J Nutr 2016; 146:2567-2573. [PMID: 27807039 DOI: 10.3945/jn.116.237271] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 07/16/2016] [Accepted: 09/23/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The Automated Self-Administered 24-hour (ASA24) dietary recall system enhances the feasibility of collecting high-quality intake data in population-based studies. OBJECTIVE The aim of this study was to assess the accuracy of portion size reporting in the ASA24 compared with interviewer-administered recalls. METHODS True intake for 3 meals was ascertained in 81 adults aged 20-70 y from the Washington, DC area. Participants were randomly assigned to complete an unannounced ASA24 or an interviewer-administered Automated Multiple-Pass Method (AMPM) recall the following day. An adapted Bland-Altman approach was used to assess agreement between true and reported portion sizes. Linear regression was used to assess log-scale differences between true and reported portion sizes by recall mode. The proportions of reported portion sizes within 10% and 25% of truth were estimated. Analyses were conducted for all foods and drinks and predetermined categories. RESULTS Mean differences between true and reported portion sizes were 3.7 g for the ASA24 and 11.8 g for the AMPM. According to the Bland-Altman-type plots, between 92% and 100% (depending on food or drink category and recall mode) of observations fell within the limits of agreement. After adjustment for multiple testing, the mean ratio of reported to true portion sizes was significantly >1 for the categories of all foods and drinks, all foods excluding liquids, amorphous or soft foods, and small pieces among AMPM respondents. Misestimation in the AMPM was significantly different from that in the ASA24 for all foods and drinks and for all foods excluding liquids. Small proportions of reported portions fell within 10% (16.2% for the ASA24 and 14.9% for the AMPM) and 25% (37.5% for the ASA24 and 33.2% for the AMPM) of truth. CONCLUSIONS The results raise the possibility that digital images tailored to different types and formats of foods may facilitate improved estimation of amounts eaten but highlight the need for continued work in this aspect of dietary assessment. This trial was registered at clinicaltrials.gov as NCT00978406.
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Affiliation(s)
- Sharon I Kirkpatrick
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada;
| | | | | | | | | | - Lisa L Kahle
- Information Management Services, Inc., Rockville, MD
| | - Frances E Thompson
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD
| | | | - Amy F Subar
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD
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Accuracy of hands v. household measures as portion size estimation aids. J Nutr Sci 2016; 5:e29. [PMID: 27547392 PMCID: PMC4976119 DOI: 10.1017/jns.2016.22] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 05/13/2016] [Accepted: 05/20/2016] [Indexed: 01/08/2023] Open
Abstract
Accurate estimation of food portion size is critical in dietary studies. Hands are potentially useful as portion size estimation aids; however, their accuracy has not been tested. The aim of the present study was to test the accuracy of a novel portion size estimation method using the width of the fingers as a 'ruler' to measure the dimensions of foods ('finger width method'), as well as fists and thumb or finger tips. These hand measures were also compared with household measures (cups and spoons). A total of sixty-seven participants (70 % female; age 32·7 (sd 13·7) years; BMI 23·2 (sd 3·5) kg/m(2)) attended a 1·5 h session in which they estimated the portion sizes of forty-two pre-weighed foods and liquids. Hand measurements were used in conjunction with geometric formulas to convert estimations to volumes. Volumes determined with hand and household methods were converted to estimated weights using density factors. Estimated weights were compared with true weights, and the percentage difference from the true weight was used to compare accuracy between the hand and household methods. Of geometrically shaped foods and liquids estimated with the finger width method, 80 % were within ±25 % of the true weight of the food, and 13 % were within ±10 %, in contrast to 29 % of those estimated with the household method being within ±25 % of the true weight of the food, and 8 % being within ±10 %. For foods that closely resemble a geometric shape, the finger width method provides a novel and acceptably accurate method of estimating portion size.
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Cadeau C, Fournier A, Mesrine S, Clavel-Chapelon F, Fagherazzi G, Boutron-Ruault MC. Vitamin C supplement intake and postmenopausal breast cancer risk: interaction with dietary vitamin C. Am J Clin Nutr 2016; 104:228-34. [PMID: 27194303 DOI: 10.3945/ajcn.115.126326] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 04/19/2016] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Experimental and epidemiologic studies have yielded conflicting results on the relation between vitamin C intake and breast cancer risk. OBJECTIVE We investigated the relation between vitamin C supplement intake and breast cancer risk while considering dietary vitamin C intake. DESIGN Between 1995 and 2008, 2482 invasive breast cancer cases occurred in 57,403 postmenopausal women from the Etude Epidémiologique auprès de femmes de la Mutuelle Générale de l'Education Nationale (E3N) prospective cohort during 581,085 person-years. We estimated vitamin C intake from foods with the use of a validated food-frequency questionnaire that was sent to subjects in 1993-1995 and vitamin C supplement use via questionnaires sent in 1995, 2000, 2002, and 2005. Multivariable HRs (95% CIs) for primary invasive breast cancer were estimated with the use of Cox regression models. All statistical tests were 2-sided. RESULTS Vitamin C supplement use (ever compared with never) was not associated with breast cancer risk overall; it was associated with higher breast cancer risk in women in the fourth quartile of vitamin C intake from foods (HR: 1.32; 95% CI: 1.04, 1.67) but not in other quartiles of dietary vitamin C intake (P-interaction = 0.03). CONCLUSIONS We observed that vitamin C supplement use was associated with increased postmenopausal breast cancer risk in women with high vitamin C intake from foods. Our data suggest a potential U- or J-shaped relation between total vitamin C intake and postmenopausal breast cancer risk that deserves further investigation.
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Affiliation(s)
- Claire Cadeau
- Center for Research in Epidemiology and Population Health (CESP), French Institute of Health and Medical Research (INSERM), University of Paris-Sud, University of Versailles Saint-Quentin-en-Yvelines, University of Paris-Saclay, Villejuif, France; and Gustave Roussy, Villejuif, France
| | - Agnès Fournier
- Center for Research in Epidemiology and Population Health (CESP), French Institute of Health and Medical Research (INSERM), University of Paris-Sud, University of Versailles Saint-Quentin-en-Yvelines, University of Paris-Saclay, Villejuif, France; and Gustave Roussy, Villejuif, France
| | - Sylvie Mesrine
- Center for Research in Epidemiology and Population Health (CESP), French Institute of Health and Medical Research (INSERM), University of Paris-Sud, University of Versailles Saint-Quentin-en-Yvelines, University of Paris-Saclay, Villejuif, France; and Gustave Roussy, Villejuif, France
| | - Françoise Clavel-Chapelon
- Center for Research in Epidemiology and Population Health (CESP), French Institute of Health and Medical Research (INSERM), University of Paris-Sud, University of Versailles Saint-Quentin-en-Yvelines, University of Paris-Saclay, Villejuif, France; and Gustave Roussy, Villejuif, France
| | - Guy Fagherazzi
- Center for Research in Epidemiology and Population Health (CESP), French Institute of Health and Medical Research (INSERM), University of Paris-Sud, University of Versailles Saint-Quentin-en-Yvelines, University of Paris-Saclay, Villejuif, France; and Gustave Roussy, Villejuif, France
| | - Marie-Christine Boutron-Ruault
- Center for Research in Epidemiology and Population Health (CESP), French Institute of Health and Medical Research (INSERM), University of Paris-Sud, University of Versailles Saint-Quentin-en-Yvelines, University of Paris-Saclay, Villejuif, France; and Gustave Roussy, Villejuif, France
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Seto E, Hua J, Wu L, Shia V, Eom S, Wang M, Li Y. Models of Individual Dietary Behavior Based on Smartphone Data: The Influence of Routine, Physical Activity, Emotion, and Food Environment. PLoS One 2016; 11:e0153085. [PMID: 27049852 PMCID: PMC4822823 DOI: 10.1371/journal.pone.0153085] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 03/23/2016] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Smartphone applications (apps) facilitate the collection of data on multiple aspects of behavior that are useful for characterizing baseline patterns and for monitoring progress in interventions aimed at promoting healthier lifestyles. Individual-based models can be used to examine whether behavior, such as diet, corresponds to certain typological patterns. The objectives of this paper are to demonstrate individual-based modeling methods relevant to a person's eating behavior, and the value of such approach compared to typical regression models. METHOD Using a mobile app, 2 weeks of physical activity and ecological momentary assessment (EMA) data, and 6 days of diet data were collected from 12 university students recruited from a university in Kunming, a rapidly developing city in southwest China. Phone GPS data were collected for the entire 2-week period, from which exposure to various food environments along each subject's activity space was determined. Physical activity was measured using phone accelerometry. Mobile phone EMA was used to assess self-reported emotion/feelings. The portion size of meals and food groups was determined from voice-annotated videos of meals. Individual-based regression models were used to characterize subjects as following one of 4 diet typologies: those with a routine portion sizes determined by time of day, those with portion sizes that balance physical activity (energy balance), those with portion sizes influenced by emotion, and those with portion sizes associated with food environments. RESULTS Ample compliance with the phone-based behavioral assessment was observed for all participants. Across all individuals, 868 consumed food items were recorded, with fruits, grains and dairy foods dominating the portion sizes. On average, 218 hours of accelerometry and 35 EMA responses were recorded for each participant. For some subjects, the routine model was able to explain up to 47% of the variation in portion sizes, and the energy balance model was able to explain over 88% of the variation in portion sizes. Across all our subjects, the food environment was an important predictor of eating patterns. Generally, grouping all subjects into a pooled model performed worse than modeling each individual separately. CONCLUSION A typological modeling approach was useful in understanding individual dietary behaviors in our cohort. This approach may be applicable to the study of other human behaviors, particularly those that collect repeated measures on individuals, and those involving smartphone-based behavioral measurement.
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Affiliation(s)
- Edmund Seto
- Environmental & Occupational Health Sciences, School of Public Health, University of Washington, Seattle, Washington, United States of America
| | - Jenna Hua
- Environmental Health Sciences, School of Public Health, University of California, Berkeley, California, United States of America
| | - Lemuel Wu
- Electrical Engineering and Computer Science, School of Engineering, University of California, Berkeley, California, United States of America
| | - Victor Shia
- Electrical Engineering and Computer Science, School of Engineering, University of California, Berkeley, California, United States of America
| | - Sue Eom
- Public Health Nutrition, School of Public Health, Seoul National University, Seoul, South Korea
| | - May Wang
- Community Health Sciences, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California, United States of America
| | - Yan Li
- Maternal and Child Health, School of Public Health, Kunming Medical University, Kunming, China
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Bastide N, Dartois L, Dyevre V, Dossus L, Fagherazzi G, Serafini M, Boutron-Ruault MC. Dietary antioxidant capacity and all-cause and cause-specific mortality in the E3N/EPIC cohort study. Eur J Nutr 2016; 56:1233-1243. [PMID: 26887577 DOI: 10.1007/s00394-016-1172-6] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 02/02/2016] [Indexed: 01/09/2023]
Abstract
PURPOSE The cellular oxidative stress (balance between pro-oxidant and antioxidant) may be a major risk factor for chronic diseases. Antioxidant capacity of human diet can be globally assessed through the dietary non-enzymatic antioxidant capacity (NEAC). Our aim was to investigate the relationship between the NEAC and all-cause and cause-specific mortality, and to test potential interactions with smoking status, a well-known pro-oxidant factor. METHODS Among the French women of the E3N prospective cohort study initiated in 1990, including 4619 deaths among 1,199,011 persons-years of follow-up. A validated dietary history questionnaire assessed usual food intake; NEAC intake was estimated using a food composition table from two different methods: ferric ion reducing antioxidant power (FRAP) and total radical-trapping antioxidant parameter (TRAP). Hazard ratio (HR) estimates and 95 % confidence intervals (CI) were derived from Cox proportional hazards regression models. RESULTS In multivariate analyses, FRAP dietary equivalent intake was inversely associated with mortality from all-causes (HR for the fourth vs. the first quartile: HR4 = 0.75, 95 % CI 0.67, 0.83, p trend < 0.0001), cancer, and cardiovascular diseases. Similar results were obtained with TRAP. There was an interaction between NEAC dietary equivalent intake and smoking status for all-cause and cardiovascular disease mortality, but not cancer mortality (respectively, for FRAP, p inter = 0.002; 0.013; 0.113, results were similar with TRAP), and the association was the strongest among current smokers. CONCLUSION This prospective cohort study highlights the importance of antioxidant consumption for mortality prevention, especially among current smokers.
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Affiliation(s)
- Nadia Bastide
- CESP, Team 9, UMR-S 1018: INSERM, Gustave Roussy, Université Paris-Sud, Espace Maurice Tubiana, 114 rue Edouard Vaillant, 94805, Villejuif Cedex, France
| | - Laureen Dartois
- CESP, Team 9, UMR-S 1018: INSERM, Gustave Roussy, Université Paris-Sud, Espace Maurice Tubiana, 114 rue Edouard Vaillant, 94805, Villejuif Cedex, France
| | - Valérie Dyevre
- CESP, Team 9, UMR-S 1018: INSERM, Gustave Roussy, Université Paris-Sud, Espace Maurice Tubiana, 114 rue Edouard Vaillant, 94805, Villejuif Cedex, France
| | - Laure Dossus
- CESP, Team 9, UMR-S 1018: INSERM, Gustave Roussy, Université Paris-Sud, Espace Maurice Tubiana, 114 rue Edouard Vaillant, 94805, Villejuif Cedex, France
| | - Guy Fagherazzi
- CESP, Team 9, UMR-S 1018: INSERM, Gustave Roussy, Université Paris-Sud, Espace Maurice Tubiana, 114 rue Edouard Vaillant, 94805, Villejuif Cedex, France
| | - Mauro Serafini
- Functional Foods and Metabolic Stress Prevention Laboratory, Center of Nutrition, Council for Agricultural Research and Economics, Center of Food and Nutrition, Rome, Italy
| | - Marie-Christine Boutron-Ruault
- CESP, Team 9, UMR-S 1018: INSERM, Gustave Roussy, Université Paris-Sud, Espace Maurice Tubiana, 114 rue Edouard Vaillant, 94805, Villejuif Cedex, France.
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Bastide N, Morois S, Cadeau C, Kangas S, Serafini M, Gusto G, Dossus L, Pierre FH, Clavel-Chapelon F, Boutron-Ruault MC. Heme Iron Intake, Dietary Antioxidant Capacity, and Risk of Colorectal Adenomas in a Large Cohort Study of French Women. Cancer Epidemiol Biomarkers Prev 2016; 25:640-7. [PMID: 26823477 DOI: 10.1158/1055-9965.epi-15-0724] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 01/09/2016] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Nitrosylated and non-nitrosylated heme iron from red processed and nonprocessed meat have been associated with increased colorectal carcinogenesis. Mechanisms include oxidative processes. It has been hypothesized that dietary antioxidants could counteract the effects of heme iron. We investigated the relationships between heme iron intake and the risk of colorectal adenomas, and a potential interaction with the dietary antioxidant capacity, in the E3N prospective cohort study. METHODS The study included 17,397 women, who underwent at least one colonoscopy. Among them, 1,409 were diagnosed with at least one first colorectal adenoma during the 103,253 person-years of follow-up. Dietary intake was measured by a semiquantitative food history questionnaire. HR estimates and 95% confidence intervals (CI) were obtained from Cox proportional hazards models, adjusted for potential confounders. RESULTS Heme iron intake was positively associated with colorectal and colon adenoma risks [HR for the fourth vs. first quartile: HR4 = 1.36 (1.13-1.65), Ptrend = 0.001 and HR4 = 1.49; 95% CI, 1.19-1.87; Ptrend = 0.0003, respectively]. Nonnitrosylated and nitrosylated heme iron intakes were, respectively, associated with advanced distal and proximal adenoma risks. There was a dose-effect relationship between the heme iron to total dietary antioxidant capacity ratio and colorectal adenoma risk. CONCLUSION In this prospective cohort study, the association between heme iron and colorectal adenoma risk was found to depend on site, nitrosylation or not, and the ratio with the NEAC. IMPACT These results emphasize the need for a global assessment of diet when considering nutritional prevention of colorectal carcinogenesis. Cancer Epidemiol Biomarkers Prev; 25(4); 640-7. ©2016 AACR.
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Affiliation(s)
- Nadia Bastide
- CESP, INSERM, Univ Paris-Sud, UVSQ, Université Paris-Saclay, Villejuif Cedex, F-94805, France. Gustave Roussy, F-94805, Villejuif Cedex, France
| | - Sophie Morois
- CESP, INSERM, Univ Paris-Sud, UVSQ, Université Paris-Saclay, Villejuif Cedex, F-94805, France. Gustave Roussy, F-94805, Villejuif Cedex, France
| | - Claire Cadeau
- CESP, INSERM, Univ Paris-Sud, UVSQ, Université Paris-Saclay, Villejuif Cedex, F-94805, France. Gustave Roussy, F-94805, Villejuif Cedex, France
| | - Suvi Kangas
- CESP, INSERM, Univ Paris-Sud, UVSQ, Université Paris-Saclay, Villejuif Cedex, F-94805, France. Gustave Roussy, F-94805, Villejuif Cedex, France
| | - Mauro Serafini
- Functional Food and Metabolic Stress Prevention Laboratory, CRA-NUT, Rome, Italy
| | - Gaëlle Gusto
- CESP, INSERM, Univ Paris-Sud, UVSQ, Université Paris-Saclay, Villejuif Cedex, F-94805, France. Gustave Roussy, F-94805, Villejuif Cedex, France
| | - Laure Dossus
- CESP, INSERM, Univ Paris-Sud, UVSQ, Université Paris-Saclay, Villejuif Cedex, F-94805, France. Gustave Roussy, F-94805, Villejuif Cedex, France
| | - Fabrice H Pierre
- TOXALIM, Team 9, INRA UMR 1331, ENVT, INP, UPS, Toulouse, France
| | - Françoise Clavel-Chapelon
- CESP, INSERM, Univ Paris-Sud, UVSQ, Université Paris-Saclay, Villejuif Cedex, F-94805, France. Gustave Roussy, F-94805, Villejuif Cedex, France
| | - Marie-Christine Boutron-Ruault
- CESP, INSERM, Univ Paris-Sud, UVSQ, Université Paris-Saclay, Villejuif Cedex, F-94805, France. Gustave Roussy, F-94805, Villejuif Cedex, France.
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Development and validation of two food portion photograph books to assess dietary intake among adults and children in Central Africa. Br J Nutr 2016; 115:895-902. [DOI: 10.1017/s0007114515005401] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
AbstractOwing to nutritional transition in Cameroon, one in two adults is overweight and one in five is obese, and 8·1 % of children are overweight and 2·1 % are obese. Given this phenomenon, dietary intake assessment is needed to establish appropriate preventive nutrition-sensitive strategies. Our aim was to develop and test the validity of two food portion photograph books (FPPB) to be used as visual aids for adults and children taking part in a 24-h dietary recall. To design FPPB, interviews and focus group discussions were undertaken with women to obtain consensus on the local categorisation of foods. For each cooked and weighed food, three photographs of the average small, medium and large serving portion sizes were taken, and four intermediary portion sizes were calculated. To validate the FPPB, a sample of adults (361) and children (224) were asked, at meal times, to self-serve a food portion prepared in the household and the portion sizes were weighed; 24 h after the measurement, the same subjects were shown the appropriate FPPB and were asked to indicate the food and the portion they consumed. In adults, of the 821 portions tested, 77 % were accurately estimated, whereas in children 74 % of the 556 portions tested were accurately estimated. For both groups, the small- and medium-sized portions were frequently selected and accurately estimated (>70 %). Our findings suggest that the adult and children’s FPPB can be used in Cameroon to estimate food portion sizes, and thus nutritional intake in the frame of the 24-h dietary recall.
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Marcinkevage J, Mayén AL, Zuleta C, DiGirolamo AM, Stein AD, Ramirez-Zea M. Relative Validity of Three Food Frequency Questionnaires for Assessing Dietary Intakes of Guatemalan Schoolchildren. PLoS One 2015; 10:e0139125. [PMID: 26465769 PMCID: PMC4605767 DOI: 10.1371/journal.pone.0139125] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 09/09/2015] [Indexed: 11/18/2022] Open
Abstract
Objective To determine the relative validity of three food frequency questionnaires (FFQs) compared with results from 24-hour dietary recalls for measuring dietary intakes in Guatemalan schoolchildren. Design A cross-sectional study of primary caregivers (mothers or grandmothers) of 6–11 year-old children. Caregivers completed one of three constructed FFQs to measure the child’s dietary consumption in the last week: FFQ1 did not incorporate portion sizes; FFQ2 provided portion sizes; and FFQ3 incorporated pictures of median portion sizes. During the same week, each caregiver also completed three 24-hour dietary recalls. Results from the FFQ were compared with corresponding results from the 24-hour dietary recalls. Setting Santa Catarina Pinula, peri-urban Guatemala City. Subjects Caregivers (n = 145) of 6–11 year-old children: 46 completed FFQ1, 49 completed FFQ2, and 50 completed FFQ3. Results The mean values for all nutrients obtained from the 24-hour dietary recall were lower than for those obtained from the FFQs, excluding folic acid in FFQ3, cholesterol and zinc in FFQ2, and cholesterol, folic acid, magnesium, potassium, sodium, and zinc in FFQ1. Energy-adjusted Pearson correlation coefficients ranged from 0.07 (protein) to 0.54 (cholesterol) for FFQ1 and from 0.05 to 0.74 for FFQ2 and FFQ3. Agreement by both methods (FFQ and 24-hour dietary recalls) of classifying children into the same or adjacent quartiles of energy-adjusted nutrient consumption ranged from 62.0% for cholesterol to 95.9% for vitamin B12 across all three FFQs. Conclusions Our FFQs had moderate to good relative validity in measuring energy and nutrient intakes for 6–11 year-old Guatemalan children. More evidence is needed to evaluate their reproducibility and applicability in similar populations.
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Affiliation(s)
- Jessica Marcinkevage
- Laney Graduate School, Graduate Division of Biological and Biomedical Sciences, Emory University, Atlanta, Georgia, United States of America
| | - Ana-Lucia Mayén
- INCAP Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama, Guatemala
| | - Clara Zuleta
- INCAP Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama, Guatemala
| | - Ann M DiGirolamo
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America; Andrew Young School of Policy Studies, Georgia State University, Atlanta, Georgia, United States of America
| | - Aryeh D Stein
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Manuel Ramirez-Zea
- INCAP Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama, Guatemala
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