Retrospectively Estimating Energy Intake and Misreporting From a Qualitative Food Frequency Questionnaire: An Example Using Australian Cohort and National Survey Data

Investigating the relationship between anthropometric profiles, dietary oxygen radical absorption capacity and healthy eating index with acne in adolescents

OBJECTIVE

Acne is one of the most common skin diseases, especially among teenagers. Many factors were blamed for creating acne including nutrition. The purpose of this study was to evaluate the relationship between body mass index, oxygen radical absorption capacity (ORAC), and healthy eating index (HEI), and acne among adolescents. This case-control study was conducted on 57 students with acne and 57 students without acne. Demographic information, food frequency and anthropometric indices were collected. The amount of ORAC was determined by USDA data. The HEI was calculated using HEI-2015 for 9 components. The data were analyzed using SPSS software.

RESULTS

In this study cross-sectional study, the average weight in the group with and without acne was 62.27 ± 11.50 vs. 59.26 ± 14.33, and there was no significant difference between weight and acne (P = 0.219). Chromium intake in people without acne was significantly higher (P < 0.022). The macronutrient and micronutrient intakes were insignificantly higher in the healthy group. Food group intake was not significantly different between the healthy and sick groups. There was no significant difference in the ORAC (P = 0.814), and the HEI between the two groups with acne and healthy people (P = 0.616). No correlation was found between HEI, and ORAC with acne as well. The findings of this study showed that anthropometric indices, HEI and ORAC had no significant relationship with acne. To have tangible conclusion, further large-scale cohort study is highly recommended.

Developing an effective and simple digital screening tool to identify inadequate calcium intake in pregnant women: A prediction model in the Rotterdam periconception cohort

OBJECTIVES

An inadequate intake of calcium in pregnancy is associated with higher risks of maternal hypertensive pregnancy disorders, premature birth and intrauterine growth restriction. An evidence based and clinically applicable tool to efficiently estimate the adequacy of calcium intake in pregnant women currently does not exist. The aim of this study is to develop an effective and simple digital screening tool for calcium intake in pregnancy.

STUDY DESIGN

We extracted all data from the Rotterdam Periconceptional cohort (PREDICT study) conducted at the Erasmus MC, University Medical Centre in Rotterdam, the Netherlands, between November 2014 and December 2020. Data was extracted from food frequency questionnaires. The estimated average requirement of 750 m/day was defined as the lower limit for an adequate calcium intake. We created a prediction model, using multivariable binary logistic regression with backward stepwise selection, predicting the probability of adequate calcium intake. We developed a simple screening tool based on the prediction model.

RESULTS

694 participants are included, of which 201 (29 %) had an adequate calcium intake. Total daily or weekly intakes of cheese, milk, and yogurt or curd were selected as predictors for the prediction model. The model had excellent discrimination (AUC 0.858), a good fit (Brier score 0.136, HL statistic p = 0.499) and satisfactory calibration. The test accuracy measures were: sensitivity 80.9 %, specificity 77.1 %, PPV 89.7 %, NPV 62.2 %. A colour coded digital screening tool was developed for use in clinical practice.

CONCLUSIONS

This evidence-based and simple screening tool is a reliable and efficient instrument to predict inadequate calcium intakes in pregnancy, which can easily be incorporated in daily clinical practice and existing pregnancy coaching platforms.

Validity and reproducibility of a food frequency questionnaire to determine dietary intakes among Lebanese athletes

BACKGROUND AND OBJECTIVE

Nutrition is a basic need for athletes; thus, adequate dietary intake is crucial for maintaining overall health, facilitating training adaptations and boosting athletic performance. Accurate dietary assessment tools are required to minimize the challenges faced by athletes. This study verifies the validity and reproducibility of a 157 item semi-quantitative food frequency questionnaire (FFQ) among Lebanese athletes. This is the only Arabic questionnaire in Lebanon that estimates food consumption for athletes which can also be used in Arabic speaking countries. There has been no previous validated food frequency questionnaire that estimated food consumption for athletes in Lebanon.

METHODS

A total of 194 athletes were included in the study to assess the validity of the food frequency questionnaire against four days dietary recalls by comparing the total nutrient intake values from the food frequency questionnaire with the mean values of four 24-hour dietary recalls using Spearman correlation coefficient and Bland Altman plots. In order to measure the reproducibility, the intra class correlation coefficients were calculated by repeating the same food frequency questionnaire after one month.

RESULTS

The intra-class correlation coefficient between the two-food frequency questionnaires ranged from average (0.739 for carbohydrates) to good (0.870 for energy (Kcal)), to excellent (0.919 for proteins) concerning macronutrients and ranged from average (0.688 for vitamin D), to excellent (0.952 for vitamin B12), indicating an acceptable reproducibility. Spearman's correlation coefficients of dietary intake estimate from the food frequency questionnaire and the four dietary recalls varied between 0.304 for sodium, 0.469 for magnesium to 0.953 for caloric intake (kcal). Bland-Altman plots illustrated a percentage of agreement ranging between 94.3% for fats to 96.4% for proteins.

CONCLUSION

This food frequency questionnaire has a reliable validity and reproducibility to evaluate dietary assessments and is an appropriate tool for future interventions to ensure the adoption of adequate eating strategies by athletes.

Modelling the replacement of red and processed meat with plant-based alternatives and the estimated effect on insulin sensitivity in a cohort of Australian adults

Dietary guidelines are increasingly promoting mostly plant-based diets, limits on red meat consumption, and plant-based sources of protein for health and environmental reasons. It is unclear how the resulting food substitutions associate with insulin resistance, a risk factor for type 2 diabetes. We modelled the replacement of red and processed meat with plant-based alternatives and the estimated effect on insulin sensitivity. We included 783 participants (55 % female) from the Childhood Determinants of Adult Health study, a population-based cohort of Australians. In adulthood, diet was assessed at three time points using FFQ: 2004–2006, 2009–2011 and 2017–2019. We calculated the average daily intake of each food group in standard serves. Insulin sensitivity was estimated from fasting glucose and insulin concentrations in 2017–2019 (aged 39–49 years) using homoeostasis model assessment. Replacing red meat with a combination of plant-based alternatives was associated with higher insulin sensitivity (β = 10·5 percentage points, 95 % CI (4·1, 17·4)). Adjustment for waist circumference attenuated this association by 61·7 %. Replacing red meat with either legumes, nuts/seeds or wholegrains was likewise associated with higher insulin sensitivity. Point estimates were similar but less precise when replacing processed meat with plant-based alternatives. Our modelling suggests that regularly replacing red meat, and possibly processed meat, with plant-based alternatives may associate with higher insulin sensitivity. Further, abdominal adiposity may be an important mediator in this relationship. Our findings support advice to prioritise plant-based sources of protein at the expense of red meat consumption.

Understanding the Interplay of Dietary Intake and Eating Behavior in Type 2 Diabetes

Diet and eating behavior both play a crucial role in the prevention and management of type 2 diabetes mellitus (T2DM). The main objective of this study was to investigate the relationship between dietary intake and eating behavior in a population of patients with T2DM. A cross-sectional study was performed using 416 patients with T2DM and their dietary intake and eating behavior were assessed with validated questionnaires. Women scored significantly higher than men for emotional and restrained eating (p < 0.001). Correlation analyses showed that emotional eaters consumed significantly more calories (r = 0.120, p = 0.014) and fat (r = 0.101, p = 0.039), as well as non-alcoholic beverages for women (r = 0.193, p = 0.003) and alcohol for men (r = 0.154, p = 0.038). Also, individuals who ate based on external cues consumed significantly more calories (r = 0.188, p < 0.001) and fat (r = 0.139, p = 0.005). These results demonstrate that eating behavior influences dietary intake. Understanding this relationship could optimize diabetes management and allow for more individualized nutritional guidance.

Energy and macronutrient intakes in Jordan: a population study

Jordan has never conducted a nutrition survey to determine nutrient and energy intakes. The current study aimed to describe the energy and macronutrient consumed by the Jordanian population. A cross-sectional food consumption study was conducted, including a sample of Jordanians using two non-consecutive 24-h dietary recalls (24-h DR) between October 2021 and March 2022. A total of 2145 males and females aged 8 to 85 years old living in households were studied. The average of two 24-h DRs for each individual was converted into energy and nutrient intakes. After measuring weight, height, and waist circumference, the body mass index (BMI) and waist-to-height ratio (WHtR) were calculated. The percentage of under-reporters was higher in women than men (58.2% vs. 45.9%). Adults and older adult women had the highest prevalence of obesity (29.6%), while adults and older adult men had the highest prevalence of overweight (41.4%). There is a significant increase in energy intake in children, boys, and all adults, compared to the recommended calories. The mean energy percentage (E %) of total fat was 38%, exceeding the upper limit of the Acceptable Macronutrient Distribution Range (AMDR). At the same time, the mean daily dietary fiber intake fell below the recommended levels (ranging from 13.5 g in children to 19.5 g in older adults). The study population consumes more fat and less fiber than the recommended levels. Actions must be taken across all age groups to correct the deviation of energy and macronutrient intakes from the recommended dietary allowances.

A healthful plant-based eating pattern is longitudinally associated with higher insulin sensitivity in Australian adults

BACKGROUND

A healthful plant-based eating pattern is associated with lower type 2 diabetes risk; however, the association with its preceding state, compromised insulin sensitivity, is less well-established, particularly in younger populations with repeated measures of diet over time.

OBJECTIVE

We aimed to examine the longitudinal relationship between a healthful plant-based eating pattern and insulin sensitivity in young to middle-aged adults.

METHODS

We included 667 participants from the Childhood Determinants of Adult Health (CDAH) study, a population-based cohort in Australia. Healthful plant-based diet index (hPDI) scores were derived from food frequency questionnaire data. Plant foods considered 'healthful' were scored positively (e.g., whole grains, fruit, vegetables), with all remaining foods scored reversely (e.g., refined grains, soft drinks, meat). Updated homeostatic model assessment (HOMA2) estimated insulin sensitivity from fasting insulin and glucose concentrations. We used linear mixed-effects regression to analyse data from two time points: CDAH-1 (2004-06, aged 26-36 years) and CDAH-3 (2017-19, aged 36-49 years). hPDI scores were modelled as between- and within-person effects (i.e., a participant's overall mean and their deviation from said mean at each time point, respectively).

RESULTS

The median follow-up duration was 13 years. In our primary analysis, each 10-unit difference in hPDI score was associated with higher log-HOMA2 insulin sensitivity [95% confidence interval], with between-person (β = 0.11 [0.05, 0.17], P < .001) and within-person effects (β = 0.10 [0.04, 0.16], P = .001). The within-person effect persisted despite accounting for compliance with dietary guidelines. Adjustment for waist circumference attenuated the between-person effect by 70% (P = .26) and the within-person effect by 40% (P = .04).

CONCLUSIONS

In young to middle-aged Australian adults, a healthful plant-based eating pattern (determined using hPDI scores) was longitudinally associated with higher insulin sensitivity, and therefore, potentially lower type 2 diabetes risk later in life.

Associations between childhood to adulthood socio-economic mobility and adult diet quality

The impact of change in socio-economic status (SES) from childhood to adulthood (SES mobility) on adult diet is not well understood. This study examined associations between three SES mobility variables (area disadvantage, education, occupation) and adult diet quality. 1482 Australian participants reported childhood area-level SES in 1985 (aged 10-15 years) and retrospectively reported highest parental education and main occupation (until participant age 12) and own area-level SES, education, occupation and dietary intake in 2004-2006 (aged 26-36 years). A Dietary Guidelines Index (DGI) was calculated from food frequency and habit questionnaires. A higher score (range 0-100) indicated better diet quality. Sex-stratified linear regression models adjusted for confounders. Area-level SES mobility was not associated with diet quality. Compared with stable high (university) education, stable low (school only) was associated with lower DGI scores (males: β = -5·5, 95 % CI: -8·9, -2·1; females: β = -6·3, 95 % CI: -9·3, -3·4), as was downward educational mobility (participant's education lower than their parents) (males: β = -5·3, 95 % CI: -8·5, -2·0; females: β = -4·5, 95 % CI: -7·2, -1·7) and stable intermediate (vocational) education among males (β = -3·9, 95 % CI: -7·0, -0·7). Compared with stable high (professional/managerial) occupation, stable low (manual/out of workforce) males (β = -4·9, 95 % CI: -7·6, -2·2), and participants with downward occupation mobility (males: β = -3·2, 95 % CI: -5·3, -1·1; females: β = -2·8, 95 % CI: -4·8, -0·8) had lower DGI scores. In this cohort, intergenerational low education and occupation, and downward educational and occupational mobility, were associated with poor adult diet quality.

Development of an online food frequency questionnaire and estimation of misreporting of energy intake during the COVID-19 pandemic among young adults in Peru

Background

The Young Lives longitudinal study switched to remote data collection methods including the adaptation of dietary intake assessment to online modes due to the physical contact restrictions imposed by the COVID-19 pandemic. This study aimed to describe the adaptation process and validation of an online quantitative food frequency questionnaire (FFQ) for Peruvian young adults.

Methods

A previously validated face-to-face FFQ for the adult Peruvian population was adapted to be administered through an online self-administered questionnaire using a multi-stage process. Questionnaire development was informed by experts' opinions and pilot surveys. FFQ validity was assessed by estimating misreporting of energy intake (EI) using the McCrory method, and the FFQ reliability with Cronbach alpha. Logistic regressions were used to examine associations of misreporting with sociodemographic, body mass index (BMI), and physical activity covariates.

Results

The FFQ was completed by 426 Peruvian young adults from urban and rural areas, among whom 31% were classified as misreporters, with most of them (16.2%) overreporting daily EI. Men had a lower risk of under-reporting and a higher risk of over-reporting (OR = 0.28 and 1.89). Participants without a higher education degree had a lower risk of under-reporting and a higher risk of over-reporting (OR = 2.18 and 0.36, respectively). No major difference in misreporting was found across age groups, areas, studying as the main activity, being physically active or sedentary, or BMI. Results showed good internal reliability for the overall FFQ (Cronbach alpha = 0.82).

Conclusion

Misreporting of EI was mostly explained by education level and sex across participants. Other sociodemographic characteristics, physical activity, sedentary behavior, and BMI did not explain the differences in EI misreporting. The adapted online FFQ proved to be reliable and valid for assessing dietary intakes among Peruvian young adults during the COVID pandemic. Further studies should aim at using and validating innovative dietary intake data collection methods, such as those described, for informing public health policies targeting malnutrition in different contexts after the COVID-19 pandemic.