Food Composition at Present: New Challenges

Cross-continental national nutrition surveys: a narrative review

Many countries use national nutrition surveys (NNSs) to assess their population's health and nutrition needs. However, NNS aims, approaches, tools, and measurements vary among countries. To date, there has been no review evaluating the NNSs and their practices worldwide to help conduct future NSSs. Therefore, this narrative review was conducted to 1) explore and tabulate current NNSs in five continents (Asia, Europe, Africa, North America, and Australia) and 2) help lay the foundation for establishing clear guidelines for future NNSs. The NNSs were identified using two approaches. First, an electronic database search was conducted with key terms in PubMed database. Second, a general web-based search on the survey webpages of governmental organizations was conducted using the same key terms to identify eligible surveys. The review included general adult population (≥ 18 years) with a cross-sectional design, excluding NNSs related to household-only surveys, specific age groups, or insufficient sample sizes. A total of 41 NNSs were identified in 37 countries across four continents: Asia (n = 15), Europe (n = 21), North America (n = 3), and Australia (n = 2). Broad differences between the surveys were identified, including survey purposes and designs, definitions of geographic areas and target groups, and dietary assessments. Currently, there are 26 ongoing NNSs, while 15 have ended. Among the ongoing NNSs, the cycles of the surveys were either at regular intervals (n = 8) or irregular intervals (n = 8). Of the 41 surveys, 24-h dietary recalls were used in 27 surveys, while only 6 surveys used diet diaries and 8 surveys relied on FFQs. Some surveys (n = 17) utilized multiple tools to assess dietary intake. Most of the surveys that assessed biochemical status (n = 12) focused on blood glucose, haemoglobin A1c (HbA1c), and lipid status, whereas some surveys (n = 6) tested for vitamin and mineral status in blood and/or urine samples. The review identified key characteristics, time frames, sampling methods, and dietary and physical assessment methods obtained from different surveys worldwide. The information organized in this review will be important for researchers, policymakers, and public health programme developers in developing and improving NNS.

Development of a Database of LanguaLTM and FoodEx2 Codes of 50 Ready-to-Eat Products

Ready-to-eat (RTE) and ready-to-heat (RTH) dishes are food items that help save time, physical energy, and mental effort in all food-related activities. Convenience of use, variability of supply, and adaptability to different consumption occasions have led to an increase of acceptance among consumers through the years. Specialized databases can help in this context, where food composition databases can provide information and data to create sustainable nutritional models by reducing the now growing number of chronic diseases. This paper aims at developing a database of LanguaLTM and FoodEx2 codes of 50 food preparations and ready-to-eat dishes designed for consumption outside the home. LanguaLTM, as well as FoodEx2, are classification and description systems for indexing, in the sense of a systematic description, of foods based on a hierarchical model (parent-child relationship), thus facilitating the international exchange of data on food composition, consumption, assessing chronic and/or acute exposure to a certain agent, and not least the assessment of nutrient intake. The database, here presented, consists of the codes of fifty ready-to-eat products present on the market in Italy, obtained by using the two mostly commonly used and widely recognized coding systems: LanguaLTM and FoodEx2. This database represents a tool and a guideline for other compilers and users to apply coding systems to ready-to-eat products. Moreover, it can be represented a resource for several applications, such as nutritional cards, nutritional facts, food labels, or booklet and brochures for promotion of food products, to be used at health and food nutrition interface, useful for consumers, dieticians, and food producers.

B Vitamins, Glucoronolactone and the Immune System: Bioavailability, Doses and Efficiency

The present review deals with two main ingredients of energy/power drinks: B vitamins and glucuronolactone and their possible effect on the immune system. There is a strong relationship between the recommended daily dose of selected B vitamins and a functional immune system. Regarding specific B vitamins: (1) Riboflavin is necessary for the optimization of reactive oxygen species (ROS) in the fight against bacterial infections caused by Staphylococcus aureus and Listeria monocytogenes. (2) Niacin administered within normal doses to obese rats can change the phenotype of skeletal fibers, and thereby affect muscle metabolism. This metabolic phenotype induced by niacin treatment is also confirmed by stimulation of the expression of genes involved in the metabolism of free fatty acids (FFAs) and oxidative phosphorylation at this level. (3) Vitamin B5 effects depend primarily on the dose, thus large doses can cause diarrhea or functional disorders of the digestive tract whereas normal levels are effective in wound healing, liver detoxification, and joint health support. (4) High vitamin B6 concentrations (>2000 mg per day) have been shown to exert a significant negative impact on the dorsal root ganglia. Whereas, at doses of approximately 70 ng/mL, sensory symptoms were reported in 80% of cases. (5) Chronic increases in vitamin B12 have been associated with the increased incidence of solid cancers. Additionally, glucuronolactone, whose effects are not well known, represents a controversial compound. (6) Supplementing with D-glucarates, such as glucuronolactone, may help the body's natural defense system function better to inhibit different tumor promoters and carcinogens and their consequences. Cumulatively, the present review aims to evaluate the relationship between the selected B vitamins group, glucuronolactone, and the immune system and their associations to bioavailability, doses, and efficiency.

Food composition databases in the era of Big Data: Vegetable oils as a case study

Understanding the population's dietary patterns and their impacts on health requires many different sources of information. The development of reliable food composition databases is a key step in this pursuit. With them, nutrition and health care professionals can provide better public health advice and guide society toward achieving a better and healthier life. Unfortunately, these databases are full of caveats. Focusing on the specific case of vegetable oils, we analyzed the possible obsolescence of the information and the differences or inconsistencies among databases. We show that in many cases, the information is limited, incompletely documented, old or unreliable. More importantly, despite the many efforts carried out in the last decades, there is still much work to be done. As such, institutions should develop long-standing programs that can ensure the quality of the information on what we eat in the long term. In the face of climate change and complex societal challenges in an interconnected world, the full diversity of the food system needs to be recognized and more efforts should be put toward achieving a data-driven food system.

Alignment of Nutri-Score with Mediterranean Diet Pyramid: A Food Level Analysis

The Mediterranean diet (MD) has been incorporated as a healthy diet pattern in food-based dietary guidelines of countries all over Europe and the world. Testing the alignment of Nutri-Score with the MD Pyramid is a key step in ensuring that future food-level policies will not be conflicting with existing dietary guidelines. All foods available (n = 4002) in the HelTH database, were classified as eligible or not for inclusion in the MD and they were ranked in their respective tier in the food pyramid following two pyramid schemes, the 1995 traditional and 2020 sustainable MD pyramids. For all foods, Nutri-Score was calculated both as the continuous FSAm-NPS score and its categorical outcome-Nutri-Score grades-and their distribution across the MD pyramid tiers was used as a measure of alignment between the MD and the Nutri-Score algorithm. Only 25% of all foods were eligible under the traditional MD, while the sustainable MD covered ~58% of all foods. For both pyramids, Nutri-Score was successful in clearly separating the foods at the top and the bottom of the pyramids (Nutri-Score Mode "D" or "E" for the top tiers and "A" for the bottom tiers), thus suggesting a good alignment between the two. Good discriminatory capacity was also seen within each tier.

Food Composition Data and Tools Online and Their Use in Research and Policy: EuroFIR AISBL Contribution in 2022

Food, nutrition, and health are linked, and detailed knowledge of nutrient compositions and bioactive characteristics is needed to understand these relationships. Additionally, increasingly these data are required by database systems and applications. This communication aims to describe the contribution to databases and nutrition fields as well as the activities of EuroFIR AISBL; this member-based, non-profit association was founded to ensure sustained advocacy for food information in Europe and facilitate improved data quality, storage, and access as well as encouraging wider exploitation of food composition data for both research and commercial purposes. In addition to the description of its role and main objectives, a snapshot of EuroFIR AISBL's activities over the years is also given using a quantitative research literature analysis approach. The focus of this communication is to provide descriptions and updates of EuroFIR's online tools, i.e., FoodEXplorer, eBASIS, and PlantLIBRA, by highlighting the main uses and applications. Integrating food-related infrastructures and databases, following standardized and harmonized approaches, and considering interoperability and metrological principles are significant challenges. Ongoing activities and future plans of EuroFIR AISBL are highlighted, including, for instance, work within the Food Nutrition Security Cloud (FNS-Cloud) to make food, nutrition, and (food) security data more findable, accessible, interoperable, and ultimately reusable.

Profiling consumers with an environmentally sustainable and healthy diet: The case of Spanish households

Our diet has substantial implications not only for our health but also for the environment. However, the two dimensions are not comparable, even though consumers often associate them with their purchasing choices. Promoting more sustainable diets requires a better knowledge of household profiles considering the healthy and organically sustainable character of the food purchased. Previous studies have approached the analysis of consumer profiles separately, differentiating both dimensions without clear conclusion regarding the variables that make up these profiles. In this study, we looked for household profiles by cross-referencing the organic nature of the products consumed (environmental sustainability) with their degree of processing (healthfulness) in Spain. The results show that the most sustainable products are consumed in tiny municipalities (less than 2,000 inhabitants). In contrast, less sustainable products are consumed in high-income, single-family households or households with small children. The person responsible for the purchase is working or between 39 and 45 years old. In conclusion, our study shows that socio-demographic variables are statistically significant in identifying household profiles with sustainable diets.

Integrated Spreadsheets for Nutritional Analysis of Population Diet Surveys

It can be challenging to calculate nutrient intakes in population diet surveys because existing nutritional analysis software is generally oriented toward analyzing intakes of individuals and may not allow users to input or easily modify the food composition data used in the analysis. These are drawbacks that are more problematic in low- and middle-income country settings. While there are numerous software-assisted dietary assessment platforms that conduct onboard nutritional analysis and are appropriate for use in large surveys, they are often similarly limited, and further restrict users to specific assessment modalities. This paper presents a multifunctional system of integrated spreadsheets for nutritional analysis of population diet surveys (ISNAPDS) that provides a solution for situations in which data have been collected but cannot be adequately analyzed with existing software. The protocol involves supplying the system with fully customizable data on food composition, food group classifications, and food intake (food intake in g/day may be entered directly or calculated based on user-supplied intake frequencies and either standard or variable serving sizes). Following data entry, the user modifies a set of simple pre-populated formulas to match them to the structure of the input data and the system applies these formulas to calculate nutrient and food group intakes, and the contributions of food groups to nutrient intakes for all members of the survey population. The flexibility of the ISNAPDS system allows it to accommodate the global diversity of foods consumed and analyze quantitative, semiquantitative, and nonquantitative food consumption data collected using prospective and retrospective assessment methods employing different reference periods and portion size estimation methods. To date, the system has been applied in published and ongoing analyses of 24 h recall, diet record, food frequency, and disaggregated household consumption data from population surveys in China, Ethiopia, India, Mongolia, Thailand, and a multi-country analysis of 10 sub-Saharan African countries.

Performance and discriminatory capacity of Nutri-Score in branded foods in Greece

Background

The harmonization of front-of-pack nutritional declaration is in the heart of food and nutrition policy discussions in Europe. The Nutri-Score system has been proposed by many countries as a potential candidate but its suitability for use across Europe is still under consideration. The current study aimed to evaluate the performance and discriminatory capacity of Nutri-Score in Greece and to test its alignment with the national food-based dietary guidelines.

Materials and methods

Data on the energy, saturated fat, total sugars, sodium, protein, and fiber content per 100°g or ml were extracted for all foods available (n = 4,002) in the Greek branded food composition database HelTH. Each food content in fruits, vegetables, pulses, nuts and oils was manually estimated from the ingredients list. The Nutri-Score algorithm was used both as a continuous (FSAm-NPS Score) and a categorical variable [Grades (A)–(E)].

Results

The average FSAm-NPS Score in Greece was 8.52 ± 9.4. More than half of the solid foods (53.8%) were graded from (A) to (C), while most beverages (59.2%) were graded (E). More than 50% of food categories were populated with foods in all Nutri-Score grades, indicative of a good discriminatory capacity. The system scores favorably vegetables, pulses, and low-fat dairy products and unfavourablly sweets and processed meats showing in this way good alignment with the national guidelines. Eggs and seafood scored preferably compared to meat products. Animal fats received less favorable scores and so did cereal products that were highly processed.

Discussion

Nutri-Score showed good capacity to inform consumers toward better food choices in line with the national guidelines. It showed a potential to guide consumers and manufacturers toward less energy dense and more nutrient dense options and highlighted areas of improvement in the food supply.

National Food Intake Assessment: Technologies to Advance Traditional Methods

National dietary surveillance produces dietary intake data used for various purposes including development and evaluation of national policies in food and nutrition. Since 2000, What We Eat in America, the dietary component of the National Health and Nutrition Examination Survey, has collected dietary data and reported on the dietary intake of the US population. Continual innovations are required to improve methods of data collection, quality, and relevance. This review article evaluates the strengths and limitations of current and newer methods in national dietary data collection, underscoring the use of technology and emerging technology applications. We offer four objectives for national dietary surveillance that serve as guiding principles in the evaluation. Moving forward, national dietary surveillance must take advantage of new technologies for their potential in enhanced efficiency and objectivity in data operations while continuing to collect accurate dietary information that is standardized, validated, and publicly transparent.

The Expansion of the Hellenic Food Thesaurus; Allergens Labelling and Allergens-Free Claims on Greek Branded Food Products

Branded food composition databases (BFCDs) are valuable information tools that meet multiple user needs. Recently, recognising allergies and intolerances as an emerging concern for various stakeholders, BFCDs evolve to embed information on allergens. This study aims to expand the Greek BFCD, HelTH, to include allergen information for its 4002 products. A new file was added to the structure of HelTH, and data were curated to record label information. In 68.4% of products, at least one allergen was present in the ingredient list and in 38.9% at least one allergen in a precautionary statement. Milk (38.8%), gluten (32.7%), and soybeans (17.4%) were most commonly declared in the ingredient list; nuts (18.3%), eggs (13.1%), and milk (12.2%) were most commonly declared in precautionary statements. Allergen-free claims were present in 5.3% of the products and referred mostly on gluten and milk. In general, no statistically significant differences were identified between the nutritional composition of allergen-free claimed products and their equivalents. This study delivers an expanded BFCD that provides organised and detailed allergen information; new insights on the presence of food allergens in branded foods and issues of concern regarding allergen declaration that need to be addressed in order to improve label information.

A Need for a Paradigm Shift in Healthy Nutrition Research

Research in the field of sustainable and healthy nutrition is calling for the application of the latest advances in seemingly unrelated domains such as complex systems and network sciences on the one hand and big data and artificial intelligence on the other. This is because the confluence of these fields, whose methodologies have experienced explosive growth in the last few years, promises to solve some of the more challenging problems in sustainable and healthy nutrition, i.e., integrating food and behavioral-based dietary guidelines. Focusing here primarily on nutrition and health, we discuss what kind of methodological shift is needed to open current disciplinary borders to the methods, languages, and knowledge of the digital era and a system thinking approach. Specifically, we advocate for the adoption of interdisciplinary, complex-systems-based research to tackle the huge challenge of dealing with an evolving interdependent system in which there are multiple scales-from the metabolome to the population level-, heterogeneous and-more often than not- incomplete data, and population changes subject to many behavioral and environmental pressures. To illustrate the importance of this methodological innovation we focus on the consumption aspects of nutrition rather than production, but we recognize the importance of system-wide studies that involve both these components of nutrition. We round off the paper by outlining some specific research directions that would make it possible to find new correlations and, possibly, causal relationships across scales and to answer pressing questions in the area of sustainable and healthy nutrition.

A review of harmonization methods for studying dietary patterns

Data harmonization is the process by which each of the variables from different research studies are standardized to similar units resulting in comparable datasets. These data may be integrated for more powerful and accurate examination and prediction of outcomes for use in the intelligent and smart electronic health software programs and systems. Prospective harmonization is performed when researchers create guidelines for gathering and managing the data before data collection begins. In contrast, retrospective harmonization is performed by pooling previously collected data from various studies using expert domain knowledge to identify and translate variables. In nutritional epidemiology, dietary data harmonization is often necessary to construct the nutrient and food databases necessary to answer complex research questions and develop effective public health policy. In this paper, we review methods for effective data harmonization, including developing a harmonization plan, which common standards already exist for harmonization, and defining variables needed to harmonize datasets. Currently, several large-scale studies maintain harmonized nutrient databases, especially in Europe, and steps have been proposed to inform the retrospective harmonization process. As an example, data harmonization methods are applied to several U.S longitudinal diet datasets. Based on our review, considerations for future dietary data harmonization include user agreements for sharing private data among participating studies, defining variables and data dictionaries that accurately map variables among studies, and the use of secure data storage servers to maintain privacy. These considerations establish necessary components of harmonized data for smart health applications which can promote healthier eating and provide greater insights into the effect of dietary patterns on health.

Verifying the Use of Food Labeling Data for Compiling Branded Food Databases: A Case Study of Sugars in Beverages

Branded food composition databases are an important tool for research, education, healthcare, and policy making, amongst others. Such databases are typically compiled using food labeling data without chemical analyses of specific products. This study aimed to verify whether the labeled sugar content in sugar-sweetened beverages (SSBs) corresponds to the actual sugar content in these products, thus enabling food monitoring studies to be conducted. A secondary objective was to determine the specific types of sugars in these SSBs. A case study was conducted using market share-driven sampling of these beverages from the Slovenian food supply. On the basis of nationwide yearly sales data, 51 best-selling products were sampled in 2020 and analyzed using high-performance liquid chromatography. This sales-driven approach to sampling has been shown to be very useful for conducting food monitoring studies. With the careful selection of a small proportion of available products, we finished with a manageable sample size, reflecting the composition of a majority (69%) of the national market share volume. The analyzed total sugar content was compared with labeled data, within the context of the European Union's regulatory labeling tolerances. In all samples, the sugar content was within the tolerance levels. The most common (N = 41) deviation was within ±10% of the labeled sugar content. In the subcategories, the differences between the analyzed and labeled median sugar contents were not statistically significant. Sucrose was most commonly (N = 36; 71%) used for sweetening, suggesting that the proportion of fructose in most SSBs was around 50%. A higher fructose content was only observed in beverages with fructose–glucose syrup or a higher content of fruit juice. The study results show that the labeled sugar content information in SSBs is reliable and can be used to compile branded food databases and monitor the nutritional quality of foods in the food supply.

Labelling Assessment of Greek "Quality Label" Prepacked Cheeses as the Basis for a Branded Food Composition Database

A labelling assessment study of Greek prepacked “quality label” cheeses was conducted with a view to provide an overview of the whole category. In total, 158 prepacked products belonging to 19 “quality label” cheeses were identified in the Greek market. Among them, Feta had the highest share followed by Kasseri, Graviera Kritis, Kefalograviera and Ladotyri Mitilinis with 81, 16, 15, 11 and 9 products found in the market, respectively. For the rest of the 14 cheeses, the share was limited, ranging from 1 to 4. All labelling indications, nutritional information, claims and other labelling data were recorded and analysed in relation to their compliance against European food law requirements. The results of the analysis showed that for only 6 of the 19 cheeses, all products fully complied with EU labelling legislation. Among the 14 mandatory labelling requirements, the lowest overall compliance was observed for allergens declaration (65%). The analysis of the nutritional data showed a remarkable variability between cheeses and products. Differences in the nutritional characteristics were more pronounced among soft, semi-hard, hard and whey cheese. The above data were entered into an archival database. Application of global harmonisation and standardisation guidelines and tools lead to the initialisation of a branded food composition database (BFCD), conceptualising a specialised database for “quality label” foods.

Branded Foods Databases as a Tool to Support Nutrition Research and Monitoring of the Food Supply: Insights From the Slovenian Composition and Labeling Information System

Branded foods databases are becoming very valuable not only in nutrition research but also for clinical practice, policymakers, businesses, and general population. In contrast to generic foods, branded foods are marked by rapid changes in the food supply because of reformulations, the introduction of new foods, and the removal of existing ones from the market. Also, different branded foods are available in different countries. This not only complicates the compilation of branded foods datasets but also causes such datasets to become out of date quickly. In this review, we present different approaches to the compilation of branded foods datasets, describe the history and progress of building and updating such datasets in Slovenia, and present data to support nutrition research and monitoring of the food supply. Manufacturers are key sources of information for the compilation of branded foods databases, most commonly through food labels. In Slovenia, the branded food dataset is compiled using standard food monitoring studies conducted at all major retailers. Cross-sectional studies are conducted every few years, in which the food labels of all available branded foods are photographed. Studies are conducted using the Composition and Labeling Information System (CLAS) infrastructure, composed of a smartphone application for data collection and online data extraction and management tool. We reviewed various uses of branded foods datasets. Datasets can be used to assess the nutritional composition of food in the food supply (i.e., salt, sugar content), the use of specific ingredients, for example, food additives, for nutrient profiling, and assessment of marketing techniques on food labels. Such datasets are also valuable for other studies, for example, assessing nutrient intakes in dietary surveys. Additional approaches are also being tested to keep datasets updated between food monitoring studies. A promising approach is the exploitation of crowdsourcing through the mobile application VešKajJeš, which was launched in Slovenia to support consumers in making healthier dietary choices.

The “Healthy Meals” web app for the assessment of nutritional content and food allergens in restaurant meals: Development, evaluation and validation

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.

Development of an Unified Food Composition Database for the European Project "Stance4Health"

The European Commission funded project Stance4Health (S4H) aims to develop a complete personalised nutrition service. In order to succeed, sources of information on nutritional composition and other characteristics of foods need to be as comprehensive as possible. Food composition tables or databases (FCT/FCDB) are the most commonly used tools for this purpose. The aim of this study is to describe the harmonisation efforts carried out to obtain the Stance4Health FCDB. A total of 10 FCT/FCDB were selected from different countries and organizations. Data were classified using FoodEx2 and INFOODS tagnames to harmonise the information. Hazard analysis and critical control points analysis was applied as the quality control method. Data were processed by spreadsheets and MySQL. S4H’s FCDB is composed of 880 elements, including nutrients and bioactive compounds. A total of 2648 unified foods were used to complete the missing values of the national FCDB used. Recipes and dishes were estimated following EuroFIR standards via linked tables. S4H’s FCDB will be part of the smartphone app developed in the framework of the Stance4Health European project, which will be used in different personalized nutrition intervention studies. S4H FCDB has great perspectives, being one of the most complete in terms of number of harmonized foods, nutrients and bioactive compounds included.

Raw versus cooked food matching: Nutrient intake using the 2015/16 Kenya Integrated Household Budget Survey

•

Dietary energy assessment does not require matching foods in cooked form.

•

Macronutrient dietary assessment does not require matching foods in cooked form.

•

Vitamin and mineral dietary assessment requires matching foods in cooked form.

In many countries, statistics from household consumption and expenditure surveys are increasingly being used to inform policies and programs. In household surveys, foods are typically reported as they are acquired (the majority are raw). However, the micronutrient content of some foods diminishes during processing and cooking. Using food consumption data from the 2015/16 Kenya Integrated Household Budget Survey, this study analyzes whether mean consumption estimates of dietary energy, macronutrients, and eight micronutrients are equivalent (applying a two-side paired equivalence test) when matching foods: (1) considering the nutrient content in raw foods (as reported in the survey), and (2) considering the nutrient content in foods as typically consumed, thus applying yield and retention factors as needed. Both food matching approaches rendered statistically equivalent mean consumption estimates, at national and county levels, for dietary energy, protein, fats, available carbohydrates, total fiber, calcium and zinc. Non-equivalent means were found for iron, vitamins A, B1, B2, B12, and C. The higher differences between the means were, in percentage change, for vitamin C (47 %), B1 (34 %) and B12 (26 %).

An Italian Case Study for Assessing Nutrient Intake through Nutrition-Related Mobile Apps

National food consumption surveys are crucial for monitoring the nutritional status of individuals, defining nutrition policies, estimating dietary exposure, and assessing the environmental impact of the diet. The methods for conducting them are time and resource-consuming, so they are usually carried out after extended periods of time, which does not allow for timely monitoring of any changes in the population’s dietary patterns. This study aims to compare the results of nutrition-related mobile apps that are most popular in Italy, with data obtained with the dietary software Foodsoft 1.0, which was recently used in the Italian national dietary survey IV SCAI. The apps considered in this study were selected according to criteria, such as popularity (downloads > 10,000); Italian language; input characteristics (daily dietary recording ability); output features (calculation of energy and macronutrients associated with consumption), etc. 415 apps in Google Play and 226 in the iTunes Store were examined, then the following five apps were selected: YAZIO, Lifesum, Oreegano, Macro and Fitatu. Twenty 24-hour recalls were extracted from the IV SCAI database and inputted into the apps. Energy and macronutrient intake data were compared with Foodsoft 1.0 output. Good agreement was found between the selected apps and Foodsoft 1.0 (high correlation index), and no significant differences were found in the mean values of energy and macronutrients, except for fat intakes. In conclusion, the selected apps could be a suitable tool for assessing dietary intake.

Investigating the performance of 24-h urinary sucrose and fructose as a biomarker of total sugars intake in US participants - a controlled feeding study

BACKGROUND

Developing approaches for the objective assessment of sugars intake in population research is crucial for generating reliable disease risk estimates, and evidence-based dietary guidelines. Twenty-four-hour urinary sucrose and fructose (24uSF) was developed as a predictive biomarker of total sugars intake based on 3 UK feeding studies, yet its performance as a biomarker of total sugars among US participants is unknown.

OBJECTIVES

To investigate the performance of 24uSF as a biomarker of sugars intake among US participants, and to characterize its use.

METHODS

Ninety-eight participants, aged 18-70 y, consumed their usual diet under controlled conditions of a feeding study for 15 d, and collected 8 nonconsecutive 24-h urines measured for sucrose and fructose.

RESULTS

A linear mixed model regressing log 24uSF biomarker on log total sugars intake along with other covariates explained 56% of the biomarker variance. Total sugars intake was the strongest predictor in the model (Marginal R2 = 0.52; P <0.0001), followed by sex (P = 0.0002) and log age (P = 0.002). The equation was then inverted to solve for total sugars intake, thus generating a calibrated biomarker equation. Calibration of the biomarker produced mean biomarker-based log total sugars of 4.79 (SD = 0.59), which was similar to the observed log 15-d mean total sugars intake of 4.69 (0.35). The correlation between calibrated biomarker and usual total sugars intake was 0.59 for the calibrated biomarker based on a single biomarker measurement, and 0.76 based on 4 biomarker repeats spaced far apart.

CONCLUSIONS

In this controlled feeding study, total sugars intake was the main determinant of 24uSF confirming its utility as a biomarker of total sugars in this population. Next steps will include validation of stability assumptions of the biomarker calibration equation proposed here, which will allow its use as an instrument for dietary validation and measurement error correction in diet-disease association studies.

Current Knowledge and Challenges on the Development of a Dietary Glucosinolate Database in the United States

Glucosinolates (GSLs) are a group of cancer chemopreventive sulfur-containing compounds found primarily in Brassica vegetables. The goals of this study were to summarize the current knowledge and discuss the challenges of developing a dietary GSL database for US foods. A systematic literature search was conducted for the period 1980-2020. Thirty articles were found to meet all inclusion and exclusion criteria; 27 GSLs were reported in 16 different vegetables. GSLs identified and quantified ranged from 3 for winter cress to 16 for cabbage. In general, the experimental designs of these 30 studies did not fully consider the factors related to the data quality. Enormous variations of GSLs are observed between different vegetables and in the same vegetables. In conclusion, the studies on GSLs in commonly consumed vegetables are still limited, and some data may be outdated. Currently available data are not sufficient to develop a valid GSL database in the United States.

From bench to worktop: Rapid evaluation of nutritional parameters in liquid foodstuffs by IR spectroscopy

We evaluated the use of attenuated total reflectance infrared spectroscopy for simultaneous in situ quantification of the nutritional composition of liquid food stuffs in the industrial kitchen context. Different methodologies were compared, including dry and wet acquisition along with instrument parameters and measurement times of 4 and 60 s. The most effective technique was 1-minute measurement, with prediction errors of 2.6, 0.7, 1.0, 2.2, 0.8, 2.4 g/100 mL and 150 Kcal, for carbohydrates, proteins, fat, sugars, saturated fat, water and energy values, respectively.The 4-second method resulted in larger errors but was more applicable for inline measurements. Dry measurements successfully predicted the fractions of proteins, fat, carbohydrates, and sugars, relative to total solids. An app was created to facilitate implementation in a kitchen environment. Compared with other techniques recommended by the FAO, the approach offered a simple alternative for simultaneous prediction of nutritional parameters in an industrial kitchen set-up.

Scenario Analysis of a Municipality’s Food Purchase to Simultaneously Improve Nutritional Quality and Lower Carbon Emission for Child-Care Centers

Public procurement has been highlighted as an important strategic tool to drive sustainable development. The present study aimed at providing direction for decreasing greenhouse gas emissions (GHGE) by 25% for the food purchased by child-care centers in the City of Copenhagen while simultaneously providing nutritionally adequate, affordable and tasty menus. Baseline data were provided by compiling food purchase data with datasets matching each food item to a proxy food item and further with databases containing nutrient and GHGE information. For each food item, the edible amount was estimated in order to evaluate nutritional content and GHGE per 10 MJ. Two scenarios were modeled, i.e., a plant-rich diet and a lacto-ovo vegetarian diet directed at children two to five years old based on current purchase practice. Finally, the diets were translated into guidelines for menu planning. Amounts of pulses, nuts and seeds, as well as dark green vegetables and plant-based fats, were increased substantially in the two scenarios, while animal fat was decreased and the amount of meat was either reduced or eliminated in the plant-rich and lacto-ovo vegetarian diets, respectively. These kinds of changes in public food procurement have the power to significantly affect the transition toward a more healthy and sustainable food system.

European Database of Carotenoid Levels in Foods. Factors Affecting Carotenoid Content

Many studies indicate that diets including carotenoid-rich foods have positive effects on human health. Some of these compounds are precursors of the essential nutrient vitamin A. The present work is aimed at implementing a database of carotenoid contents of foods available in the European market. Factors affecting carotenoid content were also discussed. Analytical data available in peer-reviewed scientific literature from 1990 to 2018 and obtained by HPLC/UHPLC were considered. The database includes foods classified according to the FoodEx2 system and will benefit compilers, nutritionists and other professionals in areas related to food and human health. The results show the importance of food characterization to ensure its intercomparability, as large variations in carotenoid levels are observed between species and among varieties/cultivars/landraces. This highlights the significance of integrating nutritional criteria into agricultural choices and of promoting biodiversity. The uncertainty quantification associated with the measurements of the carotenoid content was very rarely evaluated in the literature consulted. According to the EuroFIR data quality evaluation system for food composition tables, the total data quality index mean was 24 in 35, reflecting efforts by researchers in the analytical methods, and less resources in the sampling plan documentation.

A New Food Composition Database of Lactose-Free Products Commercialized in Spain: Differences in Nutritional Composition as Compared to Traditional Products

We developed a new database to evaluate the nutritional composition of lactose-free products from Spain. The database includes dairy products and other products, all of which show the "lactose-free" declaration on their label, accounting for 327 products in total. Of these, 123 are dairy products, 16 are non-dairy products which include a dairy ingredient (5%) and 188 items (57% of the sample) are non-dairy products that do not contain any dairy ingredient. The main subgroups are yogurt (25%), milk (24%), and cheese (17%). Nineteen percent of the compiled products included nutritional claims on their labels. Most lactose-free products did not contain either added sugars or low- or no-calorie sweeteners (58%), while 34% included added sugars and only 6%, sweeteners or a combination of both (2%). We found that 19.5%, mainly within the milk subgroup, were fortified with vitamins A, D, E, K, B₉, and B₁₂, P, and Ca. There were no significant differences in the nutritional composition between lactose-free products and traditional products. According to the NOVA classification, 55% of compiled lactose-free products were ultra-processed, and 20% processed. The array of lactose-free products marketed in Spain proves that there are enough, both in quantity and quality, to satisfy the dairy needs of lactose intolerants.

The landscape of nutri-informatics: a review of current resources and challenges for integrative nutrition research

Informatics has become an essential component of research in the past few decades, capitalizing on the efficiency and power of computation to improve the knowledge gained from increasing quantities and types of data. While other fields of research such as genomics are well represented in informatics resources, nutrition remains underrepresented. Nutrition is one of the most integral components of human life, and it impacts individuals far beyond just nutrient provisions. For example, nutrition plays a role in cultural practices, interpersonal relationships and body image. Despite this, integrated computational investigations have been limited due to challenges within nutrition informatics (nutri-informatics) and nutrition data. The purpose of this review is to describe the landscape of nutri-informatics resources available for use in computational nutrition research and clinical utilization. In particular, we will focus on the application of biomedical ontologies and their potential to improve the standardization and interoperability of nutrition terminologies and relationships between nutrition and other biomedical disciplines such as disease and phenomics. Additionally, we will highlight challenges currently faced by the nutri-informatics community including experimental design, data aggregation and the roles scientific journals and primary nutrition researchers play in facilitating data reuse and successful computational research. Finally, we will conclude with a call to action to create and follow community standards regarding standardization of language, documentation specifications and requirements for data reuse. With the continued movement toward community standards of this kind, the entire nutrition research community can transition toward greater usage of Findability, Accessibility, Interoperability and Reusability principles and in turn more transparent science.

Development of the Hellenic Food Thesaurus (HelTH), a branded food composition database: Aims, design and preliminary findings

The Hellenic Food Thesaurus (HelTH) is the first systematic attempt to create a Greek Branded Food Composition Database. Data on the nutritional composition of foods for up to 45 nutrients, on-pack claims (health, nutrition, social, environmental), quality indicators, and prices were recorded for more than 4,000 foods as they appear on the photographs of their packages available on retailers' websites. A group of trained researchers carried out data collection and classification using LanguaL. HelTH highlights the variability in nutritional compositions of packaged foods in Greece and the need for better labelling of key nutrients such as trans fatty acids. According to a preliminary analysis of on-pack communications (n = 2008 products), health claims are used rarely (4.1% of products analyzed) with greater prevalence of nutrition (~32%) and natural claims (~24%). HelTH is a key infrastructure for the implementation of food and nutrition policies, new product development, and nutrition and consumer research.

Feasibility of a Digital Health Intervention to Improve Diet Quality Among Women With High Blood Pressure: Randomized Controlled Feasibility Trial

BACKGROUND

Over 100 million individuals have high blood pressure, and more than half of them are women. The Dietary Approaches to Stop Hypertension (DASH) dietary pattern is a proven lifestyle approach to lower blood pressure, yet population-level adherence is poor. Innovative strategies that promote DASH are needed.

OBJECTIVE

This paper aims to improve adherence to the DASH diet among women with hypertension or prehypertension.

METHODS

We conducted a 3-month randomized controlled feasibility trial comparing app-based diet tracking (active comparator) to app-based diet tracking plus feedback on DASH adherence via text message (intervention). The intervention platform extracted nutrient data from the app, compared it to DASH recommendations, and sent tailored feedback text messages. Outcomes included the number of days participants tracked their diet, changes in their DASH adherence score, and blood pressure.

RESULTS

The women (N=59) had a mean age of 49.9 (SD 11.9) years and were primarily non-Hispanic White (41/59, 69%) and college educated (49/59, 83%). The mean baseline DASH score was 2.3 (SD 1.3). At 3 months, the intervention and active comparator participants had similar mean days tracked per week (4.2, SD 2.1 days vs 4.6, SD 2.7 days; P=.54) and mean changes in their DASH score (0.8, 95% CI 0.2-1.5 vs 0.8, 95% CI 0.4-1.2; P=.75). Intervention participants had lower systolic (mean difference: -2.8 mmHg, 95% CI -1.8 to 7.4; P=.23) and diastolic (mean difference: -3.6 mmHg, 95% CI -0.2 to 7.3; P=.07) blood pressure compared with active comparator participants. Most intervention participants (23/29, 79%) said they would recommend the DASH Cloud intervention to a friend or family member. However, only 34% (10/59) indicated that the feedback text messages helped them reach their diet goals.

CONCLUSIONS

A digital health intervention to improve DASH adherence is feasible and produces moderately high engagement among women with elevated blood pressure. The intervention did not enhance DASH adherence over diet tracking alone but resulted in greater reductions in blood pressure. Larger studies are needed to determine how digital health interventions can improve population-level adherence to DASH.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03215472; https://clinicaltrials.gov/ct2/show/study/NCT03215472.

Leveraging the Food System in the Eastern Mediterranean Region for Better Health and Nutrition: A Case Study from Oman

The adoption of a food system approach is vital for the Eastern Mediterranean Region (EMR) in achieving the 2030 Agenda. The objective of this paper is to present a case-study from Oman, where a roadmap of context-specific entry points within the food system was proposed, with the overarching aim of fostering healthier diets in the population. A four-staged process was adopted: (1) selection of potential target food groups; (2) assessment of self-sufficiency and sustainability considerations related to the target foods; (3) characterization of challenges, opportunities and potential interventions related to the target food groups and (4) identification of specific entry points within the three elements of the food system (food supply chain; food environment; and consumer behavior). Data collection was based on a review of pertinent literature as well as a participatory approach involving policy makers and stakeholders. Findings showed that fruit, vegetables, fish and foods that are high in fat, sugar and salt are priority targets for intervention. Specific entry points within the food system were identified and a realistic roadmap of activities was outlined. Findings and recommendations presented in this paper may facilitate policy convergence efforts in Oman and serve as a case-study for other EMR countries.

Updated Food Composition Database for Cereal-Based Gluten Free Products in Spain: Is Reformulation Moving on?

We developed a comprehensive composition database of 629 cereal-based gluten free (GF) products available in Spain. Information on ingredients and nutritional composition was retrieved from food package labels. GF products were primarily composed of rice and/or corn flour, and 90% of them included added rice starch. The most common added fat was sunflower oil (present in one third of the products), followed by palm fat, olive oil, and cocoa. Only 24.5% of the products had the nutrition claim “no added sugar”. Fifty-six percent of the GF products had sucrose in their formulation. Xanthan gum was the most frequently employed fiber, appearing in 34.2% of the GF products, followed by other commonly used such as hydroxypropyl methylcellulose (23.1%), guar gum (19.7%), and vegetable gums (19.6%). Macronutrient analysis revealed that 25.4% of the products could be labeled as a source of fiber. Many of the considered GF food products showed very high contents of energy (33.5%), fats (28.5%), saturated fatty acids (30.0%), sugars (21.6%), and salt (28.3%). There is a timid reformulation in fat composition and salt reduction, but a lesser usage of alternative flours and pseudocereals.

Current Developments in Digital Quantitative Volume Estimation for the Optimisation of Dietary Assessment

Obesity is a global health problem with wide-reaching economic and social implications. Nutrition surveillance systems are essential to understanding and addressing poor dietary practices. However, diets are incredibly diverse across populations and an accurate diagnosis of individualized nutritional issues is challenging. Current tools used in dietary assessment are cumbersome for users, and are only able to provide approximations of dietary information. Given the need for technological innovation, this paper reviews various novel digital methods for food volume estimation and explores the potential for adopting such technology in the Southeast Asian context. We discuss the current approaches to dietary assessment, as well as the potential opportunities that digital health can offer to the field. Recent advances in optics, computer vision and deep learning show promise in advancing the field of quantitative dietary assessment. The ease of access to the internet and the availability of smartphones with integrated cameras have expanded the toolsets available, and there is potential for automated food volume estimation to be developed and integrated as part of a digital dietary assessment tool. Such a tool may enable public health institutions to be able to gather an effective nutritional insight and combat the rising rates of obesity in the region.