Development and validation of a photographic atlas of food portions for accurate quantification of dietary intakes in China

High-salt-driven gut microbiota dysfunction aggravates prostatitis by promoting AHR/SGK1/FOXO1 axis-mediated Th17 cell differentiation

BACKGROUND

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a frequently encountered disorder characterized by voiding symptoms and pelvic or perineal pain. Proinflammatory T helper 17 (Th17) cells are essential for triggering the development of CP/CPPS. High-salt diet (HSD) consumption has been found to cause an accumulation of sodium chloride in peripheral organs, inducing autoimmune responses via the Th17 cell axis. It is currently unknown whether HSD affects the etiology and course of CP/CPPS.

METHODS

Patients diagnosed with CP/CPPS were evaluated with the National Institutes of Health Chronic Prostatitis Symptom Index scoring system, and the correlation between the symptoms of CP/CPPS with HSD was analyzed. The experimental autoimmune prostatitis (EAP) mouse was established and the mice were fed either a normal-salt diet (NSD) or HSD for 6 weeks to investigate the impact of HSD on CP/CPPS. Then, 16S ribosomal RNA sequencing and untargeted metabolomics were introduced to detect the differences in the gut microflora composition and metabolite profiles between NSD-fed and HSD-fed mice, followed by fecal microbiota transplantation, 5-hydroxyindole acetic acid (5-HIAA) supplementation, aryl hydrocarbon receptor (AHR) inhibition, and in vitro Th17 differentiation experiments, which were performed to explore the mechanisms underlying HSD-aggravated CP/CPPS. Finally, chromatin immunoprecipitation assay and quantitative polymerase chain reaction were conducted to validate whether AHR can serve as a transcription factor by interacting with the serum and glucocorticoid-regulated kinase 1 (Sgk1) promoter in CD4+ T cells.

RESULTS

Increased salt consumption had a positive correlation with symptom scores of CP/CPPS patients, which was validated by feeding EAP mice with HSD, and HSD worsened the prostate inflammation and tactile allodynia in EAP mice through promoting the differentiation of CD4+ T cells to Th17 cells. HSD exacerbated EAP by significantly reducing the relative abundance of beneficial gut microflora, such as Lactobacillaceae, and gut microbiota metabolite 5-HIAA, which is related to tryptophan metabolism. The prostate inflammation, tactile allodynia, and proportion of Th17 cells in mice that received fecal suspensions from the EAP + HSD group were significantly more severe or higher than those in mice that received fecal suspensions from the EAP + NSD group. However, 5-HIAA supplementation ameliorated the symptoms of EAP caused by HSD through inhibiting the differentiation of CD4+ T cells to Th17 cells, while AHR inhibition abrogated the protective effects of 5-HIAA supplementation on EAP mice fed a HSD through promoting the differentiation of CD4+ T cells to Th17 cells. Mechanistically, it has been revealed that the SGK1/forkhead box protein O1 (FOXO1) pathway was significantly activated during cytokine-induced Th17 cell differentiation, and AHR has been shown to inhibit SGK1 transcription by interacting with the Sgk1 promoter in CD4+ T cells to inhibit FOXO1 phosphorylation, consequently restoring the equilibrium of Th17 cell differentiation.

CONCLUSION

Our findings indicated that high salt intake represented a risk factor for the development of CP/CPPS as it promoted the differentiation of CD4+ T cells to Th17 cells through the 5-HIAA/AHR/SGK1/FOXO1 axis, which might be a potential therapeutic target for CP/CPPS.

Effects of a nurse-led individualized mHealth nutrition intervention for post-discharged gastric cancer patients following gastrectomy: A randomized controlled trial

OBJECTIVE

To evaluate the effects of a nurse-led individualized mHealth nutrition intervention on nutritional status, nutritional intake, cognitive beliefs related to nutritional behavior, weight loss, blood parameters, gastrointestinal symptoms, and quality of life in post-discharged gastric cancer patients following gastrectomy.

DESIGN

This was an assessor-blinded parallel-arm randomized controlled trial with a repeated-measures design.

SETTING(S)

The participants were recruited from inpatient gastric surgery units of two tertiary hospitals in Guangzhou, China.

PARTICIPANTS

A total of 108 patients with gastric cancer who underwent gastrectomy and were scheduled to be discharged to their homes were included.

METHOD

Participants were randomly allocated to either the intervention or the control group (n = 54 per group). The intervention group received the nurse-led individualized mHealth nutrition intervention in addition to the usual care, whereas the control group received only usual care. The intervention included face-to-face education before discharge, the use of an applet and phone consultations. Baseline data were collected on the day of discharge from the hospital (T0). The patients' nutritional status, cognitive beliefs related to nutritional behavior, nutritional intake, weight loss, blood parameters, gastrointestinal symptoms and quality of life were repeatedly measured at 4-week (T1) and 12-week (T2) after discharge.

RESULTS

Compared with the control group, the intervention group showed significant improvement in nutritional status (ꞵ₄ weeks = -1.08, 95 % CI -2.12 to 0.04, p = 0.042; ꞵ₁₂ weeks = -1.52, 95 % CI -2.57 to -0.47, p = 0.005). Improvements were also observed in energy and protein intake, weight loss, and cognitive beliefs related to nutritional behavior, including risk perception, outcome expectancy, self-efficacy, intention, and action plan (p < 0.05). However, no statistically significant differences were observed in coping plan, gastrointestinal symptoms, blood parameters, and quality of life (p > 0.05).

CONCLUSIONS

The nurse-led individualized mHealth nutrition intervention was effective for improving the cognitive beliefs related to nutritional behavior, energy and protein intake, and nutritional status, as well as reducing weight loss among post-discharged gastric cancer patients following gastrectomy.

REGISTRATION NUMBER

ChiCTR2200064808.

Mediterranean diet related to 3-year incidence of cognitive decline: results from a cohort study in Chinese rural elders

OBJECTIVE

This study aims to examine the effect of the Mediterranean diet (MeDi) on cognitive decline among the Chinese elderly with a 3-year follow-up.

METHODS

This study is divided into two waves: wave-1 January 2019 to June 2019 (n = 2313); wave-2 January 2022 to March 2022 (n = 1648). MeDi scores were calculated from the Mediterranean Diet Adherence Screener (MEDAS), with the scoring of low compliance (0-6 points) and high compliance (7-14 points). The Mini-Mental State Examination (MMSE) was used to assess cognitive function. An MMSE score dropping ≥ 2 points from baseline was defined as cognitive decline. The relationships between MeDi score and cognitive decline were analyzed by linear regression models or Binary logistic regression.

RESULTS

During the 3-year follow-up, 23.8% of patients exhibited cognitive decline. The study revealed a significant difference in MMSE score changes between low and high MeDi adherence groups (p < 0.001). MeDi score was negatively correlated with cognitive deterioration (β = -0.020, p = 0.026). MeDi score was only negatively associated with cognitive decline in the female subgroup aged ≥65 years (β = -0.034, p = 0.033). The food beans (OR = 0.65, 95%CI:0.51, 0.84), fish (OR = 0.72, 95%CI:0.54, 0.97), and cooked vegetables (OR = 0.68, 95%CI:0.53, 0.84) were protective factors for cognitive decline.

CONCLUSIONS

This study suggests that greater adherence to the MeDi is linked to a reduced risk of cognitive decline in elderly people. However, this is found only in women who are 65 years old or older. It also found long-term adherence to beans, fish, and vegetables are more effective in improving cognitive function.

Interaction between Dietary Magnesium Intake and Genetic Risk Score on the Risk of Gestational Diabetes

SCOPE

We aim to assess the interaction between genetic risk and magnesium (Mg) intake during pregnancy on the development of gestational diabetes mellitus (GDM).

METHODS AND RESULTS

Three thousand ninety-six pregnant women from Tongji Maternal and Child Health Cohort are involved in our study. One hundred twelve susceptibility genetic variants of diabetes are selected and genotyped through Asian Screening Array bead chip. Mg intake were assessed by a validated food frequency questionnaire conducted at gestational weeks 25.1 ± 2.7 before GDM diagnosis. The study identifies 22 variants associated with GDM. Weighted genetic risk score (GRS) based on these 22 SNPs is associated with higher occurrence of GDM. There is an interaction between GRS and Mg intake on GDM risk (p-interaction = 0.019). Pregnant women with high GRS (≥23.48) and insufficient Mg intake (<370.0 mg d-1) have a 1.74 (95% confidence interval [CI]: 1.02, 2.98) fold risk of GDM after adjusting for potential confounders. No such relationship exists among pregnant women with low GRS (<23.48) (adjusted relative risk [RR] = 1.18; 95% CI: 0.73, 1.92).

CONCLUSION

Genetic predisposition to GDM is modified by Mg intake. This suggests that clinical nutrition guidance may benefit from being tailored by screening women with high diabetic genetic risk.

Comprehensive global review and methodological framework for developing food atlases

Introduction

An atlas is a trustworthy resource created from precise data collection that serves as a guide for communities. A food atlas is a useful tool for analyzing dietary data. There is a growing need for a food atlas that is part of the nation's strategy to help the health sector with specific nutritional or dietary assessments of individual consumption and overall wellbeing. Although researchers previously attempted to create a food atlas on a national level, the process of data collection was not well defined.

Methods

This study provides an overview of global food atlases that can be used to develop a procedure manual to guide experts in creating a dependable food atlas.

Results

To date, 27 countries have developed food atlases for various reasons. After examining these countries' experiences, six important steps in the procedure manual that should be considered when developing a food atlas were identified: choosing the most consumed food, using traditional cooking utensils, determining portion sizes, capturing photographs of the food, validating the food atlas, and publishing the food atlas.

Discussion

This procedure manual can be used as a guide until a validation study is conducted.

A prospective observational study on maternal diet pre- and post-GDM diagnosis and pregnancy outcomes in individuals with/without GDM

AIMS

To investigate (1) the association between maternal dietary choices during the first and second trimesters and the diagnosis of gestational diabetes mellitus (GDM), (2) the association between a GDM diagnosis and dietary choices during pregnancy, and (3) the differences in pregnancy outcomes between individuals with and without GDM.

METHODS

A prospective cohort study. Pregnant individuals with singleton pregnancy aged 19 ∼ 44 years, without severe pregnancy complications were enrolled in the study. Dietary data were collected at three time points during routine antenatal appointments: 8 ∼ 12 weeks gestation(n = 993), 20 ∼ 24 weeks gestation(n = 732), and 32 ∼ 36 weeks gestation(n = 536). GDM diagnosis and pregnancy outcomes were collected during follow-up from the electronic medical record (EMR).

RESULTS

A total of 93 participants (12.9%) were diagnosed with GDM. Livestock and poultry meat intake during the second trimester were associated with an increased risk of developing GDM (aOR 1.371, 95%CI 1.070-1.756, P = 0.013), and a GDM diagnosis may lead to decreased intake of cereals and its products (P = 0.001), potatoes and its products (P < 0.001), and fruit (P = 0.002) and increased intake of fish, shrimp and shellfish (P = 0.001), eggs (P = 0.015), and milk and milk products (P = 0.011) in the third trimester. Individuals with GDM related to lower risk of excessive gestational weight gain (aOR 0.384, 95%CI 0.188-0.646, P = 0.001) but may increase the risk of fetal macrosomia (aOR 3.873, 95%CI 1.364-10.996, P = 0.011).

CONCLUSIONS

Understanding maternal dietary choices around GDM diagnosis is crucial for accurate nutritional assessment and effective education programs. While our findings suggest dietary changes may occur post-diagnosis, further research is needed to confirm these patterns and the potential benefits of early dietary counseling for individuals with GDM.

Design and validation of a photographic atlas of Peruvian foods to evaluate the food consumption of children from 6 to 12 months of age

OBJECTIVE

Design and validation a photographic atlas of Peruvian foods to evaluate the food consumption of children from 6 to 12 months of age.

METHODS

Quantitative, descriptive, and cross-sectional study. 12 food groups were established according to their nutrient content. The atlas is designed to be applied to mothers, fathers, or caregivers of children from 6 to 12 months of age. The methodology was divided into four stages: i) selection of the food list, regional recipe books from Peru were reviewed, then interviews with mothers of children in the age range were verified for the final selection of the food list; ii) preparation and weighing of food, utensils were used to establish home measurements and with the established weight the macro and micronutrients were calculated with tables of composition of Peruvian foods; iii) development of the photographic session, a professional photographer with previous experience in similar works was used; and iv) expert validation, with the participation of 5 nutritionists with experience in infant feeding.

RESULTS

The proposed atlas includes 57 foods with a total of 91 photographs. The content validity coefficient according to food category and in total obtained an assessment of 0.75 (Cohen's kappa coefficient), which gives it acceptable validity and agreement.

CONCLUSIONS

The photographic atlas of food portions for infant feeding in Peru is a practical, reliable, and culturally appropriate visual tool to help estimate the amount of food consumed by this population, which will facilitate the estimation of food intake.

Maternal Nutrition during Pregnancy and Offspring Brain Development: Insights from Neuroimaging

Maternal nutrition during pregnancy is known to be important for offspring growth and health and has also been increasingly recognized for shaping offspring brain development. On the other hand, recent advancements in brain imaging technology have provided unprecedented insights into fetal, neonatal, and pediatric brain morphometry and function. This review synthesizes the current literature regarding the impact of maternal nutrition on offspring brain development, with a specific focus on findings from neuroimaging studies. The diverse effects of maternal nutrients intake or status during pregnancy on neurodevelopmental outcomes in children are discussed. Neuroimaging evidence showed associations between maternal nutrition such as food categories, macronutrients, and micronutrients including vitamins and minerals during pregnancy and child brain imaging features measured using imaging techniques such as ultrasound, magnetic resonance imaging (MRI), electroencephalography (EEG), and magnetoencephalography (MEG). This review demonstrates the capability of neuroimaging in characterizing how maternal nutrition during pregnancy impacts structure and function of the developing brain that may further influence long-term neuropsychological, cognitive, and behavioral outcomes in children. It aims to inspire future research utilizing neuroimaging to deepen our understanding of the critical impacts of maternal nutrition during pregnancy on offspring brain development.

Investigation of Human Milk as a Biological System in a Multicenter Mother-Infant Cohort: Protocol Design and Cohort Profile of the Phoenix Study

Breastfeeding and human milk are the gold standard for infant feeding. Studying human milk with a systems biology approach in a large longitudinal cohort is needed to understand its complexity and health implications. The Phoenix study is a multicenter cohort study focusing on the interactions of maternal characteristics, human milk composition, infant feeding practices, and health outcomes of Chinese mothers and infants. A total of 779 mother-infant dyads were recruited from November 2021 to September 2022, and 769 mother-infant dyads were enrolled in the study. Scheduled home visits took place at 1, 4, 6, and 12 months postpartum, and 696 dyads (90.5% participants) completed the 12-month visit. At each visit, maternal and infant anthropometry was assessed. Questionnaires were administered to collect longitudinal information on maternal characteristics and lifestyle, infant feeding, and health. Digital diaries were used to record maternal dietary intake, infant feeding, and stool character. Human milk, maternal feces, infant feces, and infant saliva were collected. An external pharmaceutical-level quality assurance approach was implied to ensure the trial quality. Multi-omics techniques (including glycomics, lipidomics, proteomics, and microbiomics) and machine learning algorithms were integrated into the sample and data analysis. The protocol design of the Phoenix study provides a framework for prospective cohort studies of mother-infant dyads and will provide insights into the complex dynamics of human milk and its interplay with maternal and infant health outcomes in the Chinese population.

Design and Validation of MEDOC, a Tool to Assess the Combined Adherence to Mediterranean and Western Dietary Patterns

The Mediterranean diet (MD) and Western diet (WD) are poles apart as dietary patterns. Despite the availability of epidemiological tools to estimate the adherence to MD, to date, there is a lack of combined scores. We developed MEDOC, a food frequency questionnaire (FFQ) designed to calculate a combined adherence score for both diets and validated it on 213 subjects. The test-retest reliability revealed all frequency questions falling within the acceptable range of 0.5 to 0.7 (Pearson correlation coefficient) in younger (<30 years old) subjects, while 1 question out of 39 fell below the range in older (>30 years old) participants. The reproducibility for portion size was less satisfying, with, respectively, 38.2% and 70.5% of questions falling below 0.5 (Cohen's Kappa index) for younger and older subjects. The good correlation (R = 0.63, p < 0.0001 for subjects younger than 30 years and R = 0.54, p < 0.0001 for subjects older than 30 years, Pearson's correlation coefficient) between the MEDOC score and the MediDietScore (MDS) confirmed the validity of the MEDOC score in identifying patients who adhere to the MD. Harnessing the capabilities of this innovative tool, we aim to broaden the existing perspective to study complex dietary patterns in nutritional epidemiology studies.

Maternal Dietary Cholesterol and Egg Intake during Pregnancy and Large-for-Gestational-Age Infants: A Prospective Cohort Study

BACKGROUND

Cholesterol plays a vital role in fetal growth and development during pregnancy. There remains controversy over whether pregnant females should limit their cholesterol intake.

OBJECTIVES

The objective of this study was to investigate the association between maternal dietary cholesterol intake during pregnancy and infant birth weight in a Chinese prospective cohort study.

METHODS

A total of 4146 mother-child pairs were included based on the Jiangsu Birth Cohort study. Maternal dietary information was assessed with a semiquantitative food-frequency questionnaire. Birth weight z-scores and large-for-gestational-age (LGA) infants were converted by the INTERGROWTH-21st neonatal weight-for-gestational-age standard. Poisson regression and generalized estimating equations were employed to examine the relationships between LGA and maternal dietary cholesterol across the entire pregnancy and trimester-specific cholesterol intake, respectively.

RESULTS

The median intake of maternal total dietary cholesterol during the entire pregnancy was 671.06 mg/d, with eggs being the main source. Maternal total dietary cholesterol and egg-sourced cholesterol were associated with an increase in birth weight z-score, with per standard deviation increase in maternal total and egg-sourced dietary cholesterol being associated with an increase of 0.16 [95% confidence interval (CI): 0.07, 0.25] and 0.06 (95% CI: 0.03, 0.09) in birth weight z-score, respectively. Egg-derived cholesterol intake in the first and third trimesters was positively linked to LGA, with an adjusted relative risk of 1.11 (95% CI: 1.04, 1.18) and 1.09 (95% CI: 1.00, 1.18). Compared with mothers consuming ≤7 eggs/wk in the third trimester, the adjusted relative risk for having an LGA newborn was 1.37 (95% CI: 1.09, 1.72) for consuming 8-10 eggs/wk and 1.45 (95% CI: 1.12, 1.86) for consuming >10 eggs/wk (P-trend = 0.015).

CONCLUSIONS

Maternal total dietary cholesterol intake, as well as consuming over 7 eggs/wk during pregnancy, displayed significant positive relationships with the incidence of LGA, suggesting that mothers should avoid excessive cholesterol intake during pregnancy to prevent adverse birth outcomes.

Sensory sensitivity and intelligence are correlated with nutrient deficiency in children with autism spectrum disorder and intellectual disability

BACKGROUND/OBJECTIVES

Relationship between dietary intake and sensory sensitivity and intelligence in autism spectrum disorder (ASD) is not well described. This study aims to investigate nutrition status in children with ASD and ID and its association with sensory sensitivity and intelligence.

SUBJECTS/METHODS

84 students (34 ASD and 48 ID) in a special education school were recruited. Dietary intakes were evaluated with 3-day food dairy. Sensory sensitivity was measured using short sensory profile (SSP). Wechsler IQ test were performed.

RESULTS

Two out of twenty-four investigated nutrients had an adequate intake rate of over 50%. Four out of ten investigated vitamins had an inadequate intake rate of over 90% and another two over 80%. 75.6% of participants had inadequate energy intake. After adjusting for age, ASD participants had a higher intake of all surveyed nutrients but only the intake of vitamin E and folate were statistically different (p < 0.05) along with a smaller number of inadequate nutrients (p < 0.001). Taste/smell sensitivity, movement sensitivity, underresponsive/seeks sensation, and total sensory sensitivity symptoms severity were slightly higher in ASD group than in ID group (all p < 0.05). After adjusting for IQ and sensory sensitivity score, difference of number of inadequate nutrients between ASD and ID group were not statistically significant (p = 0.193).

CONCLUSIONS

Individuals with ASD had better dietary intake but worse sensory sensitivity compared to those with ID. Sensory sensitivity and intelligence are correlated with nutritional status in individuals with neurodevelopmental disorder.

The Validity and Feasibility of Utilizing the Photo-Assisted Dietary Intake Assessment among College Students and Elderly Individuals in China

Dietary assessments hold significant importance within the field of public health. However, the current methods employed for dietary assessments face certain limitations and challenges that necessitate improvement. The aim of our study was to develop a reliable and practical dietary assessment tool known as photo-assisted dietary intake assessment (PAD). In order to evaluate its validity, we conducted an analysis on a sample of 71 college students' dinners at a buffet in a canteen. We compared estimates of food weights obtained through the 24-h recall (24 HR) or PAD method with those obtained through the weighing method; we also evaluated the feasibility of PAD for recording dinner intakes among a sample of college students (n = 76) and elderly individuals (n = 121). In addition, we successfully identified the dietary factors that have a significant impact on the bias observed in weight estimation. The findings of the study indicated that the PAD method exhibited a higher level of consistency with the weighing method compared to the 24 HR method. The discrepancy in D% values between cereals (14.28% vs. 40.59%, P < 0.05), vegetables (17.67% vs. 44.44%, P < 0.05), and meats (14.29% vs. 33.33%, P < 0.05) was clearly apparent. Moreover, a significant proportion of the food mass value acquired through the PAD method fell within the limits of agreement (LOAs), in closer proximity to the central horizontal line. Furthermore, vegetables, cereals, eggs, and meats, for which the primary importance lies in accuracy, exhibited a considerably higher bias with the 24 HR method compared to the PAD method (P < 0.05), implying that the PAD method has the potential to mitigate the quality bias associated with these food items in the 24 HR method. Additionally, the PAD method was well received and easily implemented by the college students and elderly individuals. In conclusion, the PAD method demonstrates a considerable level of accuracy and feasibility as a dietary assessment method that can be effectively employed across diverse populations.

Water Intake and Hydration Status among Pregnant Women in the Second Trimester in China: A Three-Day Metabolic Trial

Adequate water intake and optimal hydration status during pregnancy are crucial for maternal and infant health. However, research on water intake by pregnant women in China is very limited. This study mainly aimed to observe the daily total water intake (TWI) of pregnant women and its different sources and to investigate the relationship between their water intake and hydration biomarkers. From October to November 2020, a convenience sample of pregnant women in the second trimester (n = 21) was recruited. Under conditions close to daily life, they undertook a 3-day metabolic trial. Each participant was provided with sufficient bottled water, and the weight of what they drank each time was measured. The intake of other beverages and foods was measured using a combination of weighing and duplicate portion method. Fasting venous blood and 24 h urine samples were collected and analyzed for the hydration biomarkers, including the serum/urine osmolality, urine pH, urine specific gravity, and the concentrations of major electrolytes in urine and serum. The results showed that the mean daily TWI was 3151 mL, of which water from beverages and foods accounted for 60.1% and 39.9%, respectively. The mean total fluid intake (TFI) was 1970 mL, with plain water being the primary contributor (68.7%, r = 0.896). Among the participants, 66.7% (n = 14, Group 1) met the TWI recommendation set by the Chinese Nutrition Society. Further analysis revealed that the TFI, water from beverages and foods, plain water, and milk and milk derivatives (MMDs) were significantly higher in Group 1 than those who did not reach the adequate intake value (Group 2) (p < 0.05). The results of hydration biomarkers showed that the mean 24 h urine volume in Group 1 was significantly higher than that in Group 2 (p < 0.05), while the 24 h urine osmolality, sodium, magnesium, phosphorus, chloride, and creatinine concentrations in Group 1 were significantly lower than those in Group 2 (p < 0.05). However, no significant differences were observed in serum biomarkers. Partial correlation analysis showed that TWI was moderately positively correlated with 24 h urine volume (r = 0.675) and negatively correlated with urine osmolality, sodium, potassium, magnesium, calcium, phosphorus, and chloride concentrations (r = from-0.505 to -0.769), but it was not significantly correlated with serum biomarkers. Therefore, under free-living conditions, increasing the daily intake of plain water and MMDs is beneficial for pregnant women to maintain optimal hydration. The hydration biomarkers in urine are more accurate indicators of water intake and exhibit greater sensitivity compared to serum biomarkers. These findings provide a scientific basis for establishing appropriate water intake and hydration status for pregnant women in China.

Effects of dynamic zero COVID-19 policy on anxiety status and lifestyle changes of pregnant women in rural South China: a survey-based analysis by propensity score matching method

Introduction

The coronavirus disease 2019 (COVID-19) pandemic triggered a global public health crisis and has brought an unprecedented impact on pregnant women. The problems faced by pregnant women in the rural areas of China during the epidemic are different from those in urban areas. Although the epidemic situation in China has gradually improved, studying the impact of the previous dynamic zero COVID-19 policy on the anxiety status and lifestyle of pregnant women in rural areas of China, is still necessary.

Methods

A cross-sectional survey of pregnant women in rural South China was conducted from September 2021 to June 2022.Using questionnaires, sociodemographic characteristics, anxiety status, physical activity, sleep quality, and dietary status of the population were collected. Using the propensity score matching method, the effect of the dynamic zero COVID-19 strategy on the anxiety status and lifestyle of pregnant women was analyzed.

Results

Among the pregnant women in the policy group (n = 136) and the control group (n = 680), 25.7 and 22.4% had anxiety disorders, 83.1 and 84.7% had low or medium levels of physical activity, and 28.7 and 29.1% had sleep disorders, respectively. However, no significant difference (p > 0.05) was observed between the two groups. Compared with control group, the intake of fruit in the policy group increased significantly (p = 0.019), whereas that of aquatic products and eggs decreased significantly (p = 0.027). Both groups exhibited an unreasonable dietary structure and poor compliance with the Chinese dietary guidelines for pregnant women (p > 0.05). The proportion of pregnant women in the policy group, whose intake of stable food (p = 0.002), soybean, and nuts (p = 0.004) was less than the recommended amount, was significantly higher than that in the control group.

Discussion

The dynamic zero COVID-19 strategy had little impact on the anxiety status, physical activity, and sleep disorders of pregnant women in the rural areas of South China. However, it affected their intake of certain food groups. Improving corresponding food supply and organized nutritional support should be addressed as a strategic approach to improve the health of pregnant women in rural South China during the pandemic.

Be aware of the sodium intake outside student canteens: development and validation of a sodium food frequency questionnaire in Chinese undergraduates

Background

Chinese college students used to eat in student canteens, making dietary consumption outside the cafeterias the main reason for the difference in sodium intake. This study aims to develop and validate a food frequency questionnaire (Sodium-FFQ) targeting dietary sodium intake outside the canteens among undergraduates in China.

Methods

This cross-sectional study included 124 and 81 college students from comprehensive universities in the development and validation stage. A 24 h dietary recall and a food frequency questionnaire were used to develop the Sodium-FFQ. Food items were selected according to the foods that contributed more to the total sodium intake. Test-retest correlation coefficients with an interval of 14 days were employed to evaluate reproducibility. Validity was assessed against a single 24 h urine collection and a 3-day dietary record using correlation coefficients, Bland-Altman analyses, and cross-classification analysis of Kappa coefficients.

Results

The Sodium-FFQ consists of 12 groups of foods with 48 items. The Spearman correlation coefficient of test-retest on sodium intake was 0.654 (p < 0.05), and that between the Sodium-FFQ, 3 × 24 h dietary record, and 24-h urinary sodium were 0.393 (p < 0.05) and 0.342 (p < 0.05), respectively. The Sodium-FFQ was correlated to 24 h urinary sodium-to-potassium ratio, with a Spearman coefficient of 0.370 (p < 0.05). The classification agreement of the Sodium-FFQ and 24 h urinary sodium was 68.4%, and the Kappa coefficient was 0.371 (p < 0.001).

Conclusion

The Sodium-FFQ developed in this study presented an acceptable reproducibility, validity, and classification agreement. It indicates that the Sodium-FFQ could be a potential tool for promoting sodium restriction in college students.

Effect of Circadian Distribution of Energy and Macronutrients on Gestational Weight Gain in Chinese Pregnant Women

Gestational weight gain (GWG) may be affected by the timing of dietary intake. Previous studies have reported contradictory findings, possibly due to inconsistent characterizations of meal timing. We conducted a birth cohort study in Tianjin to determine the effect of daily energy and macronutrient distribution in mid and late pregnancy on GWG. Dietary intake information in the second and third trimesters used three 24-h dietary recalls, and meal timing was defined in relation to sleep/wake timing. The adequacy of GWG was assessed using recommendations from the Institute of Medicine guidelines. Pregnant women who had a relatively high average energy and macronutrient distribution in the late afternoon-early evening time window exhibited a greater GWG rate and a greater total GWG than that in morning time window during the third trimester (β = 0.707; β = 0.316). Carbohydrate intake in the morning of the second and third trimesters (β = 0.005; β = 0.008) was positively associated with GWG rates. Morning carbohydrate intake in the second trimester was also positively associated with total GWG (β = 0.004). Fat intake in the morning of the third trimester (β = 0.051; β = 0.020) was positively associated with the GWG rates and total GWG. Excessive GWG of Chinese pregnant women was related closely to eating behavior focused on the late afternoon-early evening and carbohydrate and fat intake in the morning during the second and third trimesters.

Feasibility of an Individualized mHealth Nutrition (iNutrition) Intervention for Post-Discharged Gastric Cancer Patients Following Gastrectomy: A Randomized Controlled Pilot Trial

(1) Background: A major challenge for post-discharged gastric cancer patients following gastrectomy is the impact of the anatomy change on decreased oral intake, nutritional status, and, ultimately, quality of life. The purpose of this study is to examine the feasibility and preliminary effects of an individualized mHealth nutrition (iNutrition) intervention in post-discharged gastric cancer patients following gastrectomy. (2) Methods: A mixed-method feasibility study with a parallel randomized controlled design was conducted. Patients were randomly assigned to either the iNutrition intervention group (n = 12) or the control group (n = 12). Participants completed measures at baseline (T0), four (T1), and twelve weeks (T2) post-randomization. (3) Results: Recruitment (33%) and retention (87.5%) rates along with high adherence and acceptability supported the feasibility of the iNutrition intervention for post-discharged gastric cancer patients following gastrectomy, echoed by the qualitative findings. The iNutrition intervention significantly improved participants' nutritional behavior (p = 0.005), energy intake (p = 0.038), compliance with energy requirements (p = 0.006), and compliance with protein requirements (p = 0.008). (4) Conclusions: The iNutrition intervention is feasible and potentially benefits post-discharged gastric cancer patients following gastrectomy. A larger trial is required to establish the efficacy of this approach. Trial Registration: 19 October 2022 Chinese Clinical Trial Registry, ChiCTR2200064807.

Development and validation of a photographic food atlas of Middle Eastern Mediterranean diet: Toward improved understanding of traditional healthy and sustainable diets

Background

Middle Eastern Mediterranean diet (MEMD) is a traditional plant-based diet that is commonly consumed and increasingly popular, but not well studied in nutrition research. To facilitate the dietary assessment of MEMD, we developed and validated a photographic food atlas depicting a variety of foods and dishes consumed in the MEM region.

Methods

The photographic food atlas included 1,002 photos of 400 types of foods and traditional dishes photographed characterizing MEMD. Foods and dishes were prepared by a professional cook and were subsequently photographed as a series of photos depicting portion size options. In a validation study, 45 individuals aged 20-50 years were recruited to assess portion size estimation of 25 representative food-photo series for each item. The validity of portion size estimation was assessed by comparing actual and reported estimates using Pearson or Spearman correlation tests. Sizes of the differences between estimated portions and the actual served portion sizes were calculate as mean differences and standard deviations.

Results

In the validation study, there was a strong correlation (r > 0.7) between estimated portion size of actual foods for 7 food items, such as pita bread, milk, labneh, and tomatoes, a moderate correlation (< 0.5 | r | < 0.7) for 12 items, such as meat, chicken, and grapes, and weak correlation (r < 0.3) for 6 items, such as seeds. Underestimation of portion sizes was more commonly observed for food items quantified when using "grams" or "milliliters" as a unit of measurement. In contrast, when household measurements were used, the participants tended to overestimate the portion sizes of respective foods and dishes.

Conclusion

We developed and validated a photographic food atlas depicting a wide variety of foods and dishes typical for the MEMD. The application of the photographic food atlas may facilitate the accurate assessment of adherence to MEMD and support the understanding of its health and sustainability aspects. Further methodological work is warranted to extend the list of food items and to evaluate the validity of the food atlas among larger and more heterogeneous groups of participants.

Relationship between the Dietary Inflammatory Index Score and Cytokine Levels in Chinese Pregnant Women during the Second and Third Trimesters

The impact of dietary inflammatory potential on serum cytokine concentrations in second and third trimesters of Chinese pregnant women is not clear. A total of 175 pregnant women from the Tianjin Maternal and Child Health Education and Service Cohort (TMCHESC) were included. The dietary inflammatory index (DII) was calculated based on 24-h food records. Serum tumor necrosis factor-α (TNF-α), interleukin 1β (IL-1β), IL-6, IL-8, IL-10, C-reactive protein (CRP), and monocyte chemoattractant protein-1 (MCP-1) levels in the second and third trimesters were measured. The mean DII scores (mean ± SD) were -0.07 ± 1.65 and 0.06 ± 1.65 in the second and third trimesters, respectively. In the third trimester, IL-1β (p = 0.039) and MCP-1 (p = 0.035) levels decreased and then increased with increasing DII scores. IL-10 concentrations decreased in pregnant women whose DII scores increased between the second and third trimesters (p = 0.011). Thiamin and vitamin C were negatively correlated with MCP-1 (β = -0.879, and β = -0.003) and IL-6 (β = -0.602, and β = -0.002) levels in the third trimester. In conclusion, the DII score had a U-shaped association with cytokine levels during the third trimester. Changes in DII scores between the second and third trimesters of pregnancy were correlated with cytokine levels during the third trimester.

Dairy fortification as a good option for dietary nutrition status improvement of 676 preschool children in China: A simulation study based on a cross-sectional diet survey (2018-2019)

Background

Chinese children are deficient in several essential nutrients due to poor dietary choices. Dairy products are a source of many under-consumed nutrients, but preschool children in China consume dairy products significantly less than the recommended level.

Methods

From the cross-sectional dietary intake survey of infants and young children aged 0-6 years in China (2018-2019), preschool children (age: 3-6 years) (n = 676) were selected. The four-day dietary data (including 2 working days and 2 weekends) collected through an online diary with reference to the food atlas were used for analysis and simulation. In scenario 1, individual intake of liquid milk equivalents was substituted at a corresponding volume by soymilk, cow's milk, or formulated milk powder for preschool children (FMP-PSC). In scenario 2, the amount of cow's milk or FMP-PSC increased to ensure each child's dairy intake reached the recommended amount (350 g/day). In both scenarios, the simulated nutrient intakes and nutritional inadequacy or surplus were compared to the survey's actual baseline data.

Results

It was suggested suggested that replacing dairy foods with FMP-PSC at matching volume is better than replacing them with soymilk or cow's milk to increase the intake of DHA, calcium, iron, zinc, iodine, vitamin A, vitamin B₁, vitamin B₃, vitamin B₁₂, vitamin C and vitamin D. Moreover, our results suggested that adding FMP-PSC to bring each child's dairy intake to the recommended amount can bring the intakes of dietary fiber, DHA, calcium, iron, zinc, iodine, vitamin A, vitamin B₁, vitamin B₃, vitamin B₉, vitamin B₁₂, vitamin C and vitamin D more in line with the recommendations when compared with cow's milk.

Conclusion

Accurate nutrition information should be provided to the parents of preschool children so as to guide their scientific consumption of dairy products and the usage and addition of fortified dairy products can be encouraged as needed.

Associations of maternal dietary patterns during pregnancy and fetal intrauterine development

Dietary pattern is excellent in reflecting an individual's eating conditions. Longitudinal data on fetal growth can reflect the process of intrauterine growth. We aimed to evaluate the associations between maternal dietary patterns and intrauterine parameters in middle and late pregnancy. The present study was conducted within Jiangsu Birth Cohort (JBC) study. Dietary information was assessed with a food frequency questionnaire (FFQ) in the second and third trimester of gestation. B-ultrasound scans were performed to obtain fetal intrauterine parameters, including head circumference (HC), femur length (FL), abdominal circumference (AC), and estimated fetal weight (EFW). Exploratory factor analysis was used to extract dietary patterns. Multiple linear regression and linear mixed-effects model (LMM) were used to investigate the association between maternal dietary patterns and fetal growth. A total of 1,936 pregnant women were eligible for the study. We observed inverse associations of maternal "Vegetables and fish" and "Snack and less eggs" patterns during mid-pregnancy with fetal HC Z-score, respectively ("Vegetables and fish": β = -0.09, 95% CI -0.12, -0.06; "Snack and less eggs": β = -0.05, 95% CI -0.08, -0.02). On the contrary, "Animal internal organs, thallophyte and shellfish" pattern in the second trimester was associated with increased HC Z-scores (β = 0.04, 95% CI 0.02, 0.06). Consistently, score increase in "Vegetables and fish" pattern in the third trimester was inversely associated with the Z-scores of HC (β = -0.05, 95% CI -0.09, -0.02), while "Meat and less nuts" pattern was positively correlated with the Z-scores of HC (β = 0.04, 95% CI 0.02, 0.07). As compared to the fetus whose mothers at the lowest tertile of "Snack and less eggs" pattern in both trimesters, those whose mothers at the highest tertile demonstrated 1.08 fold (RR = 2.10, 95% CI 1.34-3.28) increased risk of small HC for gestational age (GA). No correlation was observed between maternal dietary patterns and other intrauterine parameters. Our results suggested the effects of maternal dietary patterns on fetal growth, particularly HC. These findings highlighted the adverse impact of unhealthy dietary pattern on fetal growth, might provide evidence for strategies to prevent intrauterine dysplasia and dietary guidelines during pregnancy.

Higher Intake of Fat, Vitamin E-(β+γ), Magnesium, Sodium, and Copper Increases the Susceptibility to Prostatitis-like Symptoms: Evidence from a Chinese Adult Cohort

Background: Prostatitis-like symptoms (PLS) lead to severe discomfort in males in their daily lives. Diet has been established as affecting PLS in our prior study, but the effect of nutrients, particularly for micronutrients remains largely unclear. Methods: This study enrolled 1284 participants from August 2020 to March 2021. The National Institute of Health−Chronic Prostatitis Symptom Index was used to assess PLS. The diet composition was evaluated by the Chinese Food Composition Tables. Results: Participants were separated into PLS (n = 216), control (n = 432), and noninflammatory-abnormal symptoms (NIANS) (n = 608) groups. We observed higher levels of carotene, vitamin C, vitamin E-(β+γ) and subclass, zinc, magnesium, selenium, potassium, sodium, iron and manganese in the PLS group than in the control group. After adjustment for the potential confounders, the elevated risk from IQR2 to IQR4 of fat (P for trend = 0.011), vitamin E-(β+γ) (P for trend = 0.003), magnesium (P for trend = 0.004), sodium (P for trend = 0.001) and copper (P for trend < 0.001) was identified. Conclusions: This is the first study to evaluate the nutrient distribution in PLS patients and reveal that the higher intake of fat, vitamin E-(β+γ), magnesium, sodium, and copper is associated with a risk of PLS.

Development of a Digital Photographic Food Atlas as a Portion Size Estimation Aid in Japan

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.

Association of Maternal Dietary Patterns during Gestation and Offspring Neurodevelopment

The health effects of diet are long term and persistent. Few cohort studies have investigated the influence of maternal dietary patterns during different gestational periods on offspring's health outcomes. This study investigated the associations between maternal dietary patterns in the mid- and late-gestation and infant's neurodevelopment at 1 year of age in the Jiangsu Birth Cohort (JBC) Study. A total of 1178 mother-child pairs were available for analysis. A semiquantitative food frequency questionnaire (FFQ) was used to investigate dietary intake at 22-26 and 30-34 gestational weeks (GWs). Neurodevelopment of children aged 1 year old was assessed using Bayley-Ⅲ Screening Test. Principal component analysis (PCA) and Poisson regression were used to extract dietary patterns and to investigate the association between dietary patterns and infant neurodevelopment. After adjusting for potential confounders, the maternal 'Aquatic products, Fresh vegetables and Homonemeae' pattern in the second trimester was associated with a lower risk of being non-competent in cognitive and gross motor development, respectively (cognition: aRR = 0.84; 95% CI 0.74-0.94; gross motor: aRR = 0.80; 95% CI 0.71-0.91), and the similar pattern, 'Aquatic products and Homonemeae', in the third trimester also showed significant association with decreased risk of failing age-appreciate cognitive and receptive communication development (cognition: aRR = 0.89; 95% CI 0.80-0.98; receptive communication: aRR = 0.91; 95% CI 0.84-0.99). Notably, adherence to the dietary pattern with relatively high aquatic and homonemeae products in both trimesters demonstrated remarkable protective effects on child neurodevelopment with the risk of being non-competent in cognitive and gross motor development decreasing by 59% (95% CI 0.21-0.79) and 63% (95% CI 0.18-0.77), respectively. Our findings suggested that adherence to the 'Aquatic products and Homonemeae' dietary pattern during pregnancy may have optimal effects on offspring's neurodevelopment.

Accuracy of estimates of serving size using digitally displayed food photographs among Japanese adults

We evaluated the accuracy of the estimated serving size using digital photographs in a newly developed food atlas. From 209 food items in the food atlas, we selected 14 items with various appearances for evaluation. At the study site, fifty-four participants aged 18-33 years were served fourteen foods in the amount they usually ate. After they left, each food item was weighed by a researcher. The following day, the participants estimated the quantity of each food they served based on food photographs using a web-based questionnaire. We compared the weights of the foods the participants served (true serving sizes) and those determined based on the photographs (estimated serving sizes). For ten of the fourteen food items, significant differences were observed between the estimated and true serving sizes, ranging from a 29⋅8 % underestimation (curry sauce) to a 34⋅0 % overestimation (margarine). On average, the relative difference was 8⋅8 %. Overall, 51⋅6 % of the participants were within ±25 % of the true serving size, 81⋅9 % were within ±50 % and 93⋅4 % were within ±75 %. Bland-Altman plots showed wide limits of agreement and increased variances with larger serving sizes for most food items. Overall, no association was found between estimation errors and participant characteristics. The food atlas has shown potential for assessment of portion size estimation. Further development, refinement and testing are needed to improve the usefulness of the digital food photographic atlas as a portion size estimation aid.

Evaluation of a Novel WeChat Applet for Image-Based Dietary Assessment among Pregnant Women in China

As an important part of antenatal care for pregnant women in China, dietary assessment plays a positive role in maternal and fetal health. Shortcomings in the associated methodologies require improvement. Our purpose was to develop a novel WeChat Applet for image-based dietary assessment (WAIDA) and evaluate its relative validity among pregnant women in China. Data on 251 lunch meals of pregnant women in their second trimester were analyzed. The differences in food weight, energy, and nutrient estimates by the dietary recall or WAIDA method with the weighing method were compared using paired t-tests. Pearson correlation coefficients were used to analyze the correlation between food weight, energy, and nutrient intake obtained from the recall or WAIDA method and those obtained from the weighing method. The Bland-Altman analysis was used to examine the agreement between the recall or WAIDA method and the weighing method for energy and nutrients. Compared with the weighing method, the variation range of food weight, energy and nutrients estimated by the WAIDA method was smaller and more stable than that estimated by the recall method. Compared with the recall method, the correlations suggested a better relationship between the energy and nutrient intakes from the weighing method and those estimated by the WAIDA method (0.752-0.970 vs. 0.480-0.887), which were similar to those of food weight (0.332-0.973 vs. -0.019-0.794). The Bland-Altman analysis showed that the mean differences of the energy and nutrients estimated from the recall method were further away from zero relative to the weighing method compared to the WAIDA method and with numerically wider 95% confidence intervals. The spans between the upper and lower 95% limit of agreement (LOAs) of the energy and nutrients obtained by the WAIDA method were narrower than those obtained by the recall method, and the majority of the data points obtained by the WAIDA method lay between the LOAs, closer to the middle horizontal line. Compared with the recall method, the WAIDA method is consistent with the weighing method, close to the real value of dietary data, and expected to be suitable for dietary assessment in antenatal care.

Association between dietary fatty acid patterns based on principal component analysis and fatty acid compositions of serum and breast milk in lactating mothers in Nanjing, China

This study aimed to comprehensively analyze dietary fatty acids (FAs) to evaluate their association with FA compositions of maternal serum and breast milk and assess their effects on mothers and infants. Overall, 121 healthy lactating Chinese mothers at 30-50 days of postpartum were enrolled and instructed to complete a Food Frequency Questionnaire, together with venous blood and breast milk sample collections. Dietary FA patterns were derived by principal component analysis with varimax rotation. Serum and breast milk FA compositions were detected using capillary gas chromatography and presented as relative concentrations (weight percentage of total FAs, %). Daily energy intake, absolute intake of most nutrients, and percentage of energy intake provided by these nutrients significantly varied among the different dietary FA patterns. There were significant differences in serum polyunsaturated fatty acid (PUFA) levels (P = 0.011); in monounsaturated fatty acid and PUFA proportions in breast milk with respect to four patterns (P = 0.002 and P = 0.026, respectively); and in n-6 PUFA, n-3 PUFA, linoleic acid, γ-linolenic acid, α-linolenic acid, and docosahexaenoic acid levels in breast milk (P = 0.027, P = 0.007, P = 0.048, P = 0.034, P = 0.020, and P = 0.002, respectively). Furthermore, maternal weight retention and length-for-age z scores, weight-for-age z scores and head circumference-for-age z scores of infants with respect to the four patterns exhibited significant differences (P = 0.038, P = 0.030, P = 0.034, and P<0.001, respectively). The results demonstrated the effect of dietary FA patterns on FA compositions of serum and breast milk, and patterns mainly characterized by LC-PUFA may have potentially beneficial effects on maternal postpartum recovery and infant growth.

Water Intake in Pregnant Women in China, 2018: The Report of a Survey

Background: Adequate water intake in pregnant women plays an important role in their health and in fetal growth and development. However, there is insufficient applicable data to guide and evaluate the water intake of pregnant women in China. Based on a nationwide sample of pregnant women, we mainly aimed to investigate the daily total water intake (TWI) and the contribution of different beverages and food sources to the TWI, to assess the percentage of participants who comply with the adequate intake (AI) value of water set by the Chinese Nutrition Society (CNS) and the European Food Safety Authority (EFSA) and to analyze the contribution of different water sources to the daily total energy intake (TEI). Methods: A multi-stage sampling method was used to recruit pregnant women from 11 provinces and two municipalities in China. A 4-day online diary with a food atlas was used to assess water and dietary intake. Finally, 653 pregnant women were included in the analysis. The Mann–Whitney U test and the independent-sample t-test were used to compare the differences between related variables in different age groups or different gestational periods, and partial correlation was used to explore the correlation between water and energy intake. Results: The median daily TWI of pregnant women was 2190 mL, of which water from beverages and foods accounted for 52.9% and 47.1%, respectively. Approximately 80.5% of the water from beverages was mainly from plain water (r = 0.973), while in the part of the water from foods, dishes (32.4%) were the main contributors (r = 0.663). Only 16.4% and 43.8% of the total population met the TWI recommendation set by the CNS and EFSA, respectively. Among these, the contribution of the water from beverages was higher than that of the water from food. For those whose TWI did not reach the recommended level, the contribution of the water from beverages was almost equal to that of food. The median daily TEI of pregnant women was 1589 kcal, of which beverages accounted for 9.7%. Milk and milk derivatives (71.3%) were the main contributors to energy from beverages, accounting for 71.3% (r = 0.444). Although sugar-sweetened drinks only accounted for 10.1% of the energy from beverages, they were highly correlated with energy from beverages (r = 0.836). Through grouping analysis, age and gestational period had no significant effect on the above main results. Conclusions: This was the beginning of a nationwide study on the TWI of pregnant women in China, and the results provide evidence of the need for interventions to improve water intake among pregnant women and the revision of reference values for AI of TWI in pregnant women in China.

Reproducibility and relative validity of a semi-quantitative food frequency questionnaire for the Chinese lactating mothers

Background

The dietary nutritional status of the lactating mothers is related to maternal health and has a significant impact on the growth and development of infants through the secretion of breast milk. The food frequency questionnaire (FFQ) is the most cost-effective dietary assessment method that can help obtain information on the usual dietary pattern of participants. Until now, the FFQs have been used for different populations in China, but there are few FFQs available for the lactating mothers. We aimed to develop a semi-quantitative, 156-item FFQ for the Chinese lactating mothers, and evaluate its reproducibility and relative validity.

Methods

A total of 112 lactating mothers completed two FFQs and one 3-d dietary record (3DR). The first FFQ (FFQ1) was conducted during postpartum at 60–65 days and the second FFQ (FFQ2) during subsequent follow-up at 5 weeks. The 3DR was completed with portion sizes assessed using photographs taken by the respondent before and after eating (instant photography) 1 week after FFQ1.

Results

For reproducibility, the Spearman’s correlation coefficients for food ranged from 0.34 to 0.68, and for nutrients from 0.25 to 0.61. Meanwhile, the intra-class correlation coefficients for food ranged from 0.48 to 0.87, and for nutrients from 0.27 to 0.70. For relative validity, the Spearman’s correlation coefficients for food ranged from 0.32 to 0.56, and for nutrients from 0.23 to 0.72. The energy-adjusted coefficients for food ranged from 0.26 to 0.55, and for nutrients from 0.22 to 0.47. Moreover, the de-attenuation coefficients for food ranged from 0.34 to 0.67, and for nutrients from 0.28 to 0.77. The Bland-Altman plots also showed reasonably acceptable agreement between the two methods.

Conclusions

This FFQ is a reasonably reproducible and a relative valid tool for assessing dietary intake of the Chinese lactating mothers.

Association between Chinese Dietary Guidelines Compliance Index for Pregnant Women and Risks of Pregnancy Complications in the Tongji Maternal and Child Health Cohort

BACKGROUND

Compliance with dietary guidelines among pregnant women can positively influence not only their own health but also the health of their babies. Measuring the compliance requires professional skills in nutrition and dietary counseling. In China, few simple and effective techniques assess dietary quality among pregnant women, especially in rural areas. We aimed to establish a new simple and effective assessment technique, the "Chinese Dietary Guidelines Compliance Index for Pregnant Women (CDGCI-PW)" and assess the association between maternal dietary compliance and risks of pregnancy complications.

METHODS

The CDGCI-PW consists of 13 main components which were based on the 2016 edition of the Chinese dietary guidelines for pregnant women. Each component was assigned a different score range, and the overall score ranged from 0 to 100 points. The Tongji Maternal and Child Health Cohort study (from September 2013 to May 2016) was a prospective cohort study designed to examine maternal dietary and lifestyle effects on the health of pregnant women and their offspring. The maternal diet during the second trimester was compared with the corresponding recommended intake of the Chinese balanced dietary pagoda for pregnant women to verify their compliance with dietary guidelines. The association between maternal dietary quality and risks of pregnancy complications was estimated by regression analysis. Receiver operating characteristic (ROC) curves were constructed to identify the optimal cut-off values of CDGCI-PW for gestational hypertension and gestational diabetes mellitus (GDM).

RESULTS

Among the 2708 pregnant women, 1489 were eventually followed up. The mean CDGCI-PW score was 74.1 (standard deviation (SD) 7.5) in the second trimester. The majority of foods showed the following trend: the higher the CDGCI-PW score, the higher the proportion of pregnant women who reported food intake within the recommended range. Moreover, a higher maternal CDGCI-PW score was significantly associated with lower risks of gestational hypertension [odds ratio (OR) (95% confidence interval [(CI): 0.30 (0.20, 0.37)] and GDM [OR (95% CI): 0.38 (0.31, 0.48)]. The optimal CDGCI-PW cut-off value for gestational hypertension was ≥68.5 (sensitivity 82%; specificity: 61%; area under the ROC curve, AUC = 0.743), and the optimal CDGCI-PW cut-off score for GDM was ≥75.5 (sensitivity 43%; specificity: 81%; area under the ROC curve, AUC = 0.714).

CONCLUSIONS

The CDGCI-PW is a simple and useful technique that assesses maternal diet quality during pregnancy, while adherence to the CDGCI-PW is associated with a lower risk of gestational hypertension and GDM.