Dietary Flavonoid Intakes in France Are Linked to Brewed Tea Consumption and to Socioeconomic Status: Analyses of the Third French Individual and National Food Consumption (INCA3) Survey for Children and Adults

Flavonoids from green and black tea may benefit cardiovascular health. Brewed tea consumption and flavonoid intake in France have not been previously explored. This study assessed the dietary intake of flavonoids among French children and adults, using 3 days' dietary recall for 3896 persons aged >4 y in the Third French Individual and National Food Consumption Survey (INCA3). Foods consumed by INCA 3 participants were manually matched with the flavonoid content of foods from the French PhenolExplorer database and the US Department of Agriculture expanded flavonoid database (2018 version). The six subclasses of flavonoids were flavan-3-ols, flavanones, anthocyanidins, flavonols, flavones, and isoflavones. Flavonoid intake was stratified by age subgroups (children and adults separately) and examined using socio-demographics and tea consumption patterns. Mean flavonoid intake was 210 mg/d. Flavonoids in the French diet were predominantly flavan-3-ols (147 mg/d), of which tea is the main source. The effects of age, education, income, and socio-professional category (SPC) on flavonoid intake were all significant (p < 0.0001). Brewed tea consumers were 31.88% of French adults and 3.79% of children. Brewed tea consumption and flavonoid intake were highly correlated. The highest brewed tea and flavonoid intakes were found among individuals with the highest SPC and education levels. Flavonoid intake in France was associated with brewed tea consumption and with higher education and income.

Environmental impact and nutritional quality of adult diet in France based on fruit and vegetable intakes

PURPOSE

To describe the nutritional quality and environmental impact of self-selected diets of adults in France in relation to their fruit and vegetable (FV) intakes.

METHODS

Estimates of food and nutrient intakes were taken from the national INCA3 Survey on food intakes carried out in France in 2014-2015. The population (n = 2121 adults) was split into five quintiles of FV intakes, in g/d (Q1 representing the lowest intake, and Q5 the highest). The nutritional quality of diets was assessed through 4 indicators: mean adequacy ratio (MAR), solid energy density, mean excess ratio (MER) and Programme National Nutrition Santé guideline score 2 (PNNS-GS2). The environmental impacts were measured with environmental footprint (EF) scores and 4 additional indicators: climate change, ozone depletion, fine particulate matter and water use. Indicators were compared between quintiles. Analysis was conducted on diets adjusted to 2000 kcal.

RESULTS

MAR and PNNS-GS2 increased with increased FV quintiles, while solid energy density decreased. Fibre, potassium, vitamin B9 and vitamin C densities increased with increasing FV intakes. Climate change, ozone depletion and fine particulate matter impacts of diets decreased with increasing quintiles of FV consumption. Conversely, water use impact increased.

CONCLUSION

Higher intake of FV is associated with higher nutritional quality of diets and lower environmental impact, except for water use. Given the benefits of fruit and vegetables for human health and the environment, their negative impact on water use could be improved by working on the agricultural upstream, rather than by changing individuals' food choices and reducing their consumption.

A three-component Breakfast Quality Score (BQS) to evaluate the nutrient density of breakfast meals

Background

Nutrient profiling methods can be applied to individual foods or to composite meals. This article introduces a new method to assess the nutrient density of breakfast meals.

Objective

This study aimed to develop a new breakfast quality score (BQS), based on the nutrient standards previously published by the International Breakfast Research Initiative (IBRI) consortium.

Methods

BQS was composed of three sub-scores derived from the weighted arithmetic mean of corresponding nutrient adequacy: an eLIMf sub-score (energy, saturated fat, free sugars, and sodium), a PF (protein and fiber) sub-score, and a VMn1 - 14 micronutrient sub-score, where n varied from 0 to 14. The effects of assigning different weights to the eLIMf, PF, and VMn were explored in four alternative models. The micronutrients were calcium, iron, potassium, magnesium, zinc, vitamin A, thiamin, riboflavin, niacin, vitamin B5, vitamin B6, vitamin B12, vitamin C, and vitamin D. Micronutrient permutations were used to develop alternate VMn1 - 14 sub-scores. The breakfast database used in this study came from all breakfasts declared as consumed by adults (>18 years old) in the French dietary survey INCA3. All models were tested with respect to the Nutrient Rich Food Index (NRF9.3). BQS sensitivity was tested using three prototype French breakfasts, for which improvements were made.

Results

The correlations of the models with NRF9.3 improved when the VMn>3 sub-score (n > 3) was included alongside the PF and eLIMf sub-scores. The model with (PF+VMn) and eLIMf each accounting for 50% of the total score showed the highest correlations with NRF9.3 and was the preferred final score (i.e., BQS). BQS was sensitive to the changing quality of three prototype breakfasts defined as tartine, sandwich, and cereal.

Conclusion

The proposed BQS was shown to valuably rank the nutritional density of breakfast meals against a set of nutrient recommendations. It includes nutrients to limit along with protein, fiber, and a variable number of micronutrients to encourage. The flexible VMn sub-score allows for the evaluation of breakfast quality even when nutrient composition data are limited.

Fresh Pork as Protein Source in the USDA Thrifty Food Plan 2021: A Modeling Analysis of Lowest-Cost Healthy Diets

The USDA Thrifty Food Plan (TFP) is an estimate of a lowest-cost healthy diet that meets dietary guidelines while respecting existing eating habits. In the US, the TFP provides the basis for federal food assistance. Included in the TFP are protein foods from both animal and plant sources. The present goal was to explore the place of fresh pork among protein foods in the revised TFP 2021. Our analyses used the same databases and the same quadratic programming (QP) methods as had been used by the USDA to develop the TFP 2021. Dietary intakes came from the National Health and Nutrition Examination Survey (NHANES 2015-16); nutrient composition data came from the Food and Nutrient Database for Dietary Studies (FNDDS 2015-16), and national food prices came from the 2021 TFP report. Amounts and prices were for foods as consumed. Our QP Model 1 used USDA modeling categories to replicate the TFP 2021. The non-poultry meat category was then separated into pork and beef. Model 2 examined whether the TFP 2021 algorithm would select pork or beef. Model 3 sought the lowest cost healthy diet, the same as the TFP 2021. Model 4 replaced beef and poultry with pork; whereas Model 5 replaced pork and poultry with beef. Weekly costs were calculated for a family of four and eight age-gender groups. All models met the nutrient requirements. The market basket cost for a family of four in Model 1 was USD 189.88, compared to the purchase price of USD 192.84 in the TFP 2021. In Model 2, fresh pork was selected preferentially over beef. The lowest-cost healthy food plan in Model 3 increased fresh pork to 3.4 lbs/week. Replacing beef and poultry with pork in Model 4 led to a modest decrease in the weekly cost. Replacing pork and poultry with beef in Model 5 led to a major increase in the weekly cost. We conclude, based on TFP-analogous modeling, that fresh pork is the preferred meat source, providing high-quality protein at a low cost. QP methods, as used in the TFP 2021, are a valuable tool for designing food plans that are affordable, acceptable, and nutrient-rich.

NMR-based metabolomic analysis of the physiological role of the electron-bifurcating FeFe-hydrogenase Hnd in Solidesulfovibrio fructosivorans under pyruvate fermentation

Solidesulfovibrio fructosivorans (formely Desulfovibrio fructosovorans), an anaerobic sulfate-reducing bacterium, possesses six gene clusters encoding six hydrogenases catalyzing the reversible oxidation of hydrogen gas (H₂) into protons and electrons. One of these, named Hnd, was demonstrated to be an electron-bifurcating hydrogenase Hnd (Kpebe et al., 2018). It couples the exergonic reduction of NAD⁺ to the endergonic reduction of a ferredoxin with electrons derived from H₂ and whose function has been recently shown to be involved in ethanol production under pyruvate fermentation (Payne 2022). To understand further the physiological role of Hnd in S. fructosivorans, we compared the mutant deleted of part of the hnd gene with the wild-type strain grown on pyruvate without sulfate using NMR-based metabolomics. Our results confirm that Hnd is profoundly involved in ethanol metabolism, but also indirectly intervenes in global carbon metabolism and additional metabolic processes such as the biosynthesis of branched-chain amino acids. We also highlight the metabolic reprogramming induced by the deletion of hndD that leads to the upregulation of several NADP-dependent pathways.

Study protocol for a pragmatic cluster randomized controlled trial to improve dietary diversity and physical fitness among older people who live at home (the "ALAPAGE study")

BACKGROUND

Diet and physical activity are key components of healthy aging. Current interventions that promote healthy eating and physical activity among the elderly have limitations and evidence of French interventions' effectiveness is lacking. We aim to assess (i) the effectiveness of a combined diet/physical activity intervention (the "ALAPAGE" program) on older peoples' eating behaviors, physical activity and fitness levels, quality of life, and feelings of loneliness; (ii) the intervention's process and (iii) its cost effectiveness.

METHODS

We performed a pragmatic cluster randomized controlled trial with two parallel arms (2:1 ratio) among people ≥60 years old who live at home in southeastern France. A cluster consists of 10 people participating in a "workshop" (i.e., a collective intervention conducted at a local organization). We aim to include 45 workshops randomized into two groups: the intervention group (including 30 workshops) in the ALAPAGE program; and the waiting-list control group (including 15 workshops). Participants (expected total sample size: 450) will be recruited through both local organizations' usual practices and an innovative active recruitment strategy that targets hard-to-reach people. We developed the ALAPAGE program based on existing workshops, combining a participatory and a theory-based approach. It includes a 7-week period with weekly collective sessions supported by a dietician and/or an adapted physical activity professional, followed by a 12-week period of post-session activities without professional supervision. Primary outcomes are dietary diversity (calculated using two 24-hour diet recalls and one Food Frequency Questionnaire) and lower-limb muscle strength (assessed by the 30-second chair stand test from the Senior Fitness Test battery). Secondary outcomes include consumption frequencies of main food groups and water/hot drinks, other physical fitness measures, overall level of physical activity, quality of life, and feelings of loneliness. Outcomes are assessed before the intervention, at 6 weeks and 3 months later. The process evaluation assesses the fidelity, dose, and reach of the intervention as its causal mechanisms (quantitative and qualitative data).

DISCUSSION

This study aims to improve healthy aging while limiting social inequalities. We developed and evaluated the ALAPAGE program in partnership with major healthy aging organizations, providing a unique opportunity to expand its reach.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT05140330 , December 1, 2021.

PROTOCOL VERSION

Version 3.0 (November 5, 2021).

Multiple Metrics of Carbohydrate Quality Place Starchy Vegetables Alongside Non-starchy Vegetables, Legumes, and Whole Fruit

Background

Starchy vegetables, including white potatoes, are often categorized as “lower-quality” carbohydrate foods, along with refined grains, 100% fruit juices, sweetened beverages, and sugars, snacks and sweets. Among “higher-quality” carbohydrates are whole grains, non-starchy vegetables, legumes, and whole fruits.

Objective

To apply multiple nutrient profiling (NP) models of carbohydrate quality to foods containing &gt;40% carbohydrate by dry weight in the USDA Food and Nutrient Database for Dietary Studies (FNDDS 2017-18).

Methods

Carbohydrate foods in the FNDDS (n = 2423) were screened using four recent Carbohydrate Quality Indices (CQI) and a new Carbohydrate Food Quality Score (CFQS-4). Cereal products containing &gt;25% whole grains by dry weight were classified as whole grain foods.

Results

Based on percent items meeting the criteria for 4 CQI scores, legumes, non-starchy and starchy vegetables, whole fruit, and whole grain foods qualified as “high quality” carbohydrate foods. Distribution of mean CFQS-4 values showed that starchy vegetables, including white potatoes placed closer to non-starchy vegetables and fruit than to candy and soda.

Conclusion

Published a priori determinations of carbohydrate quality do not always correspond to published carbohydrate quality metrics. Based on CQI metrics, specifically designed to assess carbohydrate quality, starchy vegetables, including white potatoes, merit a category reassignment and a more prominent place in dietary guidance.

A New Carbohydrate Food Quality Scoring System to Reflect Dietary Guidelines: An Expert Panel Report

Existing metrics of carbohydrate food quality have been based, for the most part, on favorable fiber- and free sugar-to-carbohydrate ratios. In these metrics, higher nutritional quality carbohydrate foods are defined as those with >10% fiber and <10% free sugar per 100 g carbohydrate. Although fiber- and sugar-based metrics may help to differentiate the nutritional quality of various types of grain products, they may not aptly capture the nutritional quality of other healthy carbohydrate foods, including beans, legumes, vegetables, and fruits. Carbohydrate food quality metrics need to be applicable across these diverse food groups. This report introduces a new carbohydrate food scoring system known as a Carbohydrate Food Quality Score (CFQS), which supplements the fiber and free sugar components of previous metrics with additional dietary components of public health concern (e.g., sodium, potassium, and whole grains) as identified by the Dietary Guidelines for Americans. Two CFQS models are developed and tested in this study: one that includes four dietary components (CFQS-4: fiber, free sugars, sodium, potassium) and one that considers five dietary components (CFQS-5: fiber, free sugars, sodium, potassium, and whole grains). These models are applied to 2596 carbohydrate foods in the Food and Nutrient Database for Dietary Studies (FNDDS) 2017−2018. Consistent with past studies, the new carbohydrate food scoring system places large percentages of beans, vegetables, and fruits among the top scoring carbohydrate foods. The whole grain component, which only applies to grain foods (N = 1561), identifies ready-to-eat cereals, oatmeal, other cooked cereals, and selected whole grain breads and crackers as higher-quality carbohydrate foods. The new carbohydrate food scoring system shows a high correlation with the Nutrient Rich Food (NRF9.3) index and the Nutri-Score. Metrics of carbohydrate food quality that incorporate whole grains, potassium, and sodium, in addition to sugar and fiber, are strategically aligned with multiple 2020−2025 dietary recommendations and may therefore help with the implementation of present and future dietary guidelines.

Pulses Twice a Week in Replacement of Meat Modestly Increases Diet Sustainability

The French food-based dietary guidelines recommend eating pulses at least twice a week and to reduce meat consumption. This study assessed the impact on the sustainability characteristics (nutrition, cost, environment) of individual diets of meeting the pulse guideline. Dietary data of 2028 adults from the Esteban survey were completed with the nutritional content (considering bioavailability on iron, zinc and protein), price and environmental impacts of foods. When the pulse guideline (i.e., 57 g/day) was not met, two substitution scenarios raised the quantity of pulses to the recommended level, in replacement of an equivalent portion of (i) starches or (ii) meat. Only 9.6% of the participants reached the pulse guideline. Diet sustainability characteristics improved with the meat scenario (nutritional indicators improved; diet cost, greenhouse gas emissions and acidification decreased), while several indicators deteriorated with the starches scenario. Zinc available for absorption slightly decreased in both scenarios while iron available for absorption decreased in the meat scenario only. Increasing pulse consumption to two portions/week could modestly improve the sustainability of diets when pulses replace meat but not starches. Cultural acceptability of that substitution still needs to be proven, and iron and zinc status of individuals at risk of deficiency should be monitored.

Opposing Consumption Trends for Sugar-Sweetened Beverages and Plain Drinking Water: Analyses of NHANES 2011-16 Data

Background: Choosing water in place of sugar-sweetened beverages (SSB) can reduce added sugars while maintaining adequate hydration. The present goal was to examine 2011–16 time trends in SSB vs. water consumption across US population subgroups.

Methods: Dietary intake data for 22,716 persons aged >4 years came from two 24-h dietary recalls in successive cycles of the National Health and Examination Survey (NHANES 2011–16). Water intakes (in mL/d) from plain water (tap and bottled) and from beverages (SSB and not-SSB) were the principal outcome variables. Intakes were analyzed by age group, income to poverty ratio (IPR), and race/ethnicity. Time trends by demographics were also examined.

Results: SSB and water intakes followed distinct social gradients. Most SSB was consumed by Non-Hispanic Black and lower-income groups. Most tap water was consumed by Non-Hispanic White and higher-income groups. During 2011–16, water from SSB declined from 322 to 262 mL/d (p < 0.005), whereas plain water increased (1,011–1,144 mL/d) (p < 0.05). Groups aged <30 years reduced SSB consumption (p < 0.0001) but it was groups aged >30 years that increased drinking water (p < 0.001). Non-Hispanic White groups reduced SSB and increased tap water consumption. Non-Hispanic Black and lower income groups reduced SSB and increased bottled water, not tap.

Conclusion: The opposing time trends in SSB and water consumption were not uniform across age groups or sociodemographic strata. Only the non-Hispanic White population reduced SSB and showed a corresponding increase in tap water. Lower-income and minority groups consumed relatively little plain drinking water from the tap.

Flavonoid Intakes in the US Diet Are Linked to Higher Socioeconomic Status and to Tea Consumption: Analyses of NHANES 2011-16 Data

BACKGROUND

Many of the health benefits of tea have been attributed to its flavonoid content. Tea consumption in US adults varies by socioeconomic status (SES).

OBJECTIVES

The present objective was to explore intakes of total flavonoids and flavonoid subclasses by participant sociodemographics and by patterns of tea consumption.

METHODS

The present analyses were based on 2 d of dietary recalls for 17,506 persons aged >9 y in the 2011-2016 NHANES. The What We Eat in America nutrient composition database was merged with the USDA Expanded Flavonoid database, which included total flavonoids and flavan-3-ols (including catechins), flavanones, flavonols, anthocyanidins, flavones, and isoflavones. Flavonoid intakes were compared by sex, age, race/ethnicity, education, and income-to-poverty ratio (IPR) in univariate analyses. Flavonoid intakes of children and adults were also compared by tea consumption status. Time trends in flavonoid intakes were also examined.

RESULTS

Mean total flavonoid intake was 219 mg/d, of which flavan-3-ols provided 174 mg/d, or 79%. The highest total flavonoid intakes were found in adults aged 51-70 y (293 mg/d), non-Hispanic whites (251 mg/d) and in groups with college education (251 mg/d) and higher income (IPR >3.5: 249 mg/d) (P < 0.001 for all). The socioeconomic gradient was significant for anthocyanidins, flavonols, and flavones (P < 0.001 for all) but not for flavan-3-ols, and persisted across 3 cycles of NHANES. Adult tea consumers had higher intakes of total flavonoids (610 mg/d compared with 141 mg/d) and flavan-3-ols (542 mg/d compared with 97.8 mg/d) than did nonconsumers (P < 0.001). Time trend analyses showed that both tea consumption and flavonoid intakes were unchanged from 2011 to 2016.

CONCLUSIONS

Flavonoid intakes in children and adults in the NHANES 2011-16 sample were associated with higher SES and were largely determined by tea consumption. Studies of diet and disease risk need to take sociodemographic gradients and eating and drinking habits into account.

Consumption of 100% Orange Juice in Relation to Flavonoid Intakes and Diet Quality Among US Children and Adults: Analyses of NHANES 2013-16 Data

This study explored consumption patterns of 100% orange juice by socio-demographics among US children and adults. Dietary intakes data for 15,983 persons aged >2 y came from the nationally representative National Health and Nutrition Examination Survey (NHANES 2013-2016). The What We Eat in America nutrient composition database was merged with the USDA Expanded Flavonoid Database to assess flavonoid intakes. Diet quality measures were the Healthy Eating Index (HEI-2015) and Nutrient Rich Food (NRF9.3) Index. Orange juice consumption accounted for a mean of 14 kcal/d and varied with age, incomes, and race/ethnicity. Orange juice consumption was associated with higher intakes of bioactive flavonoids, lower added sugars, and higher-quality diets overall. Diets of consumers were higher in vitamin C, potassium, calcium, vitamin D (adults), flavanones, and total flavonoids (children) as compared to non-consumers. Consumers had significantly higher HEI-2015 and NRF9.3 scores and lower body mass index values (adults). However, only 15.9% of the NHANES sample consumed any orange juice at all; of these 11.8% had <1 serving/day and only 3.4% had 1 serving/day or more.

Who is Replacing Sugar-Sweetened Beverages with Plain Water? Analyses of NHANES 2011–16 Data

Objectives

In the United States, replacing sugar-sweetened beverages (SSB) with plain drinking water is recommended via by numerous public health agencies and non-governmental organizations. While declines in SSB consumption in the US are well-documented, it is not clear if consumers are replacing SSBs with other beverages, namely plain drinking water.

Methods

Beverage consumption data for 7453 children (4–18y) and 15,263 adults (≥19y) came from two 24 h dietary recalls in three most recent cycles of the National Health and Nutrition Examination Survey (NHANES 2011–2016). Consumption trends for water intakes (in mL/d) from SSBs and from drinking water were analyzed by gender, age group, family income, and race/ethnicity.

Results

Mean water intakes from SSBs declined from 322 mL/d to 262 mL/d (p-trend = 0.002) on average, whereas plain drinking water increased from 1011 mL/d to 1144 mL/d (p-trend = 0.0108). Statistically significant reductions in SSBs were observed only among men (-18%), younger participants (-26% in 4–8, -22% in 9–13, -33% in 14–19 and -30% in 20–30), those with lower incomes (family income-to-poverty ratio &lt; 2.0), non-Hispanic whites and non-Hispanic black participants (p-trend &lt; 0.05 for each). Within these population sub-groups, only non-Hispanic white participants, those with a family income to poverty ratio of 1–1.99, but not &lt; 1.0, and children aged &lt; 14y had a corresponding increase in plain water consumption. When examining types of water, non-Hispanic white participants replaced SSBs with tap water as opposed to bottled water, and the lower income group replaced SSBs with bottled water, as opposed to tap water.

Conclusions

The expected replacement of SSBs with plain drinking water was not uniformly observed across socio-demographic group. Only non-Hispanic Whites and lower income groups replaced SSB with water, whereas teenagers (14–19y) and non-Hispanic black participants did not. Understanding how and if specific population sub-groups are replacing a declining food/beverage category with another category has important population health implications.

Funding Sources

Analyses of publicly available federal NHANES databases were sponsored by PepsiCo Inc. and conducted by MS-Nutrition. The views expressed in this abstract are those of the authors and do not necessarily reflect the position or policy of PepsiCo, Inc.

Are Young US Adults Meeting the National Academy of Medicine Recommendations for Adequate Water Intakes? Analyses of NHANES 2011–16 Data

Objectives

Young US adults consume inadequate amounts of recommended food groups, including fruit, vegetables, and whole grains but little is known about their fluid consumption. The present study aimed to evaluate if this population is meeting the recommendations for adequate fluid intake issued by National Academy of Medicine (NAM).

Methods

Beverage consumption data for 2160 adults aged 18–24y came from two 24 h dietary recalls in the three most recent cycles of the United States National Health and Nutrition Examination Survey (NHANES 2011–16). Water intakes (in mL/d) from drinking water, other beverages and moisture from foods were analyzed in relation to the current NAM Adequate Intake (AI) thresholds (3700 mL/d for males and 2700 mL/d for females). The proportion of young adults adhering to the AIs for total water intake was assessed using the National Cancer Institute method for estimating usual intake distributions. Additional analyses examined adherence by gender, income-to-poverty ratio and race/ethnicity.

Results

Mean water intakes were 2713 mL/d (3003 mL/d for men and 2382 mL/d for women). Of total water, 1191 mL/d (44%) came from drinking water, tap and bottled; 947 mL/d (35%) from non-water beverages; and 575 mL/d (21%) from foods. Only 35.3% of young adults met the AI recommendations. Female young adults were significantly more likely to meet the recommendations than males (37.8% vs. 29.6%; P = 0.04). Compared to the other race/ethnicity groups, non-Hispanic white young adults were most likely to meet recommendations (41.5%). Compared to non-Hispanic white young adults, non-Hispanic black young adults were least likely (18.7%, P &lt; 0.001) to meet recommendations. Mexican-American (29.3%) and other Hispanic young adults (32.3%, P &lt; 0.05 for each) were also less likely to meet recommendations when compared to non-Hispanic white young adults. No significant effects by family income were observed.

Conclusions

Less than half of all young adults and only 18.7% of non-Hispanic Black young adults met the AI recommendations for water. Understanding the reasons for the high proportion of young adults failing to meet recommendations should be the subject of future research. Given the impact of habitual fluid intake on health outcomes, adequate hydration among young adults remains a cause for concern.

Funding Sources

Data analyses were sponsored by PepsiCo Inc.

Trends in tap and bottled water consumption among children and adults in the United States: analyses of NHANES 2011-16 data

BACKGROUND

Dietary Guidelines for Americans 2015-20 recommend choosing water in place of sugar-sweetened beverages (SSB). This study examined water consumption patterns and trends among children and adults in the US.

METHODS

Dietary intake data for 7453 children (4-18y) and 15,263 adults (>19y) came from two 24 h dietary recalls in three cycles of the National Health and Nutrition Examination Survey (NHANES 2011-2016). Water was categorized as tap or bottled (plain). Other beverages were assigned to 15 categories. Water and other beverage intakes (in mL/d) were analyzed by sociodemographic variables and sourcing location. Consumption time trends from 2011 to 2016 were also examined. Total water intakes from water, other beverages and moisture from foods (mL/d) were compared to Dietary Reference Intakes (DRI) for water.

RESULTS

Total dietary water (2718 mL/d) came from water (1066 mL/d), other beverages (1036 mL/d) and from food moisture (618 mL/d). Whereas total water intakes remained stable, a significant decline in SSB from 2011 to 2016 was fully offset by an increase in the consumption of plain water. The main sources of water were tap at home (288 mL/d), tap away from home (301 mL/d), and bottled water from stores (339 mL/d). Water and other beverage consumption patterns varied with age, incomes and race/ethnicity. Higher tap water consumption was associated with higher incomes, but bottled water was not. Non-Hispanic whites consumed most tap water (781 mL/d) whereas Mexican Americans consumed most bottled water (605 mL/d). Only about 40% of the NHANES sample on average followed US recommendations for adequate water intakes.

CONCLUSION

The present results suggest that while total water intakes among children and adults have stayed constant, drinking water, tap and bottled, has been replacing SSB in the US diet.

The Timing of Water and Beverage Consumption During the Day Among Children and Adults in the United States: Analyses of NHANES 2011-2016 Data

Dietary Guidelines for Americans 2015–20 recommend replacing sugar sweetened beverages (SSBs) with plain water in order to promote adequate hydration while reducing added sugar intake. This study explored how water intakes from water, beverages, and foods are distributed across the day. The dietary intake data for 7453 children (4–18 y) and 15,263 adults (>19 y) came from the National Health and Nutrition Examination Survey (NHANES 2011–2016). Water was categorized as tap or bottled. Beverages were assigned to 15 categories. Water intakes (in mL/d) from water, beverages, and food moisture showed significant differences by age group, meal occasion, and time of day. Plain water was consumed in the morning, mostly in the course of a morning snack and between 06:00 and 12:00. Milk and juices were consumed at breakfast whereas SSBs were mostly consumed at lunch, dinner, and in the afternoon. Children consumed milk and juices, mostly in the morning. Adults consumed coffee and tea in the morning, SSBs in the afternoon, and alcohol in the evening. Relatively little drinking water was consumed with lunch or after 21:00. Dietary strategies to replace caloric beverages with plain water need to build on existing drinking habits by age group and meal type.

Tea Consumption Patterns in Relation to Diet Quality among Children and Adults in the United States: Analyses of NHANES 2011-2016 Data

Flavonoid-rich tea offers an alternative to sugar-sweetened beverages. The present analyses, based on 2 24-hour dietary recalls for 17,506 persons aged ≥9 years old in the 2011–2016 National Health and Nutrition Examination Survey database (NHANES 2011–2016), explored tea consumption patterns in relation to demographics, diet quality, cardiovascular disease (CVD) biomarkers (lipids and blood pressure), and body weight. Beverage categories were unsweetened tea, other tea (herbal and presweetened tea), coffee, milk, 100% juice, water and other high-calorie (HC) and low-calorie (LC) beverages. Tea consumption (18.5% of the sample) was highest among older adults (51–70 years old), non-Hispanic Asians and Whites, and those with college education and higher incomes. The effects of age, gender, education, income, and race/ethnicity were all significant (p < 0.001 for all). Adult tea consumers had diets with more protein, fiber, potassium, iron, and magnesium, and less added sugars and alcohol. Their diets contained fewer HC beverages and coffee but had more total and citrus fruit, more total dark green and orange vegetables, and more seafood, eggs, soy and milk. Tea consumers had higher Healthy Eating Index (HEI-2015) and higher Nutrient-Rich Foods (NRF9.3) nutrient density scores. Few children drank tea and no differences in diet quality between consumers and non-consumers were observed. Adult tea consumers had slightly higher high-density lipoprotein (HDL) cholesterol and lower body mass index (BMI) values. Tea consumption was associated with higher socioeconomic status and better diets.

Consumption Patterns of Milk and 100% Juice in Relation to Diet Quality and Body Weight Among United States Children: Analyses of NHANES 2011-16 Data

Background: The American Academy of Pediatrics (AAP) has recommended placing limits on the consumption of milk and 100% juice by children. Methods: Consumption data for 9,069 children aged 2-19 years came from three cycles of the nationally representative National Health and Nutrition Examination Survey (NHANES 2011-2016). Beverages were classified into 100% juices, milk (whole, reduced fat, and skim), caloric sugar sweetened beverages (SSB), low calorie beverages (LCB), and drinking water. The Healthy Eating Index 2015 and Nutrient Rich Food Index NRF9.3 were two measures of diet quality. Analyses examined consumption patterns for milk and 100% juice in relation to diet quality, AAP recommendations, and BMI z-scores across time and for different age groups. Results: Intakes of milk and 100% juice declined sharply with age, whereas SSB and water increased. Top quartiles of HEI 2015 and NRF9.3 diet quality scores were associated with higher intakes of water, milk, and 100% juice and with lower intakes of SSB. Lower-income groups drank less skim milk and water and more whole milk and SSB. Only 30% of the children consumed any 100% juice. There was no association between the consumption of milk or 100% juice and BMI z-scores for any age group. Conclusions: Top quartiles of diet quality were associated with more milk, 100% juice, and water, and less SSB. Higher quality diets were associated with lower compliance with the AAP 100% juice recommendations. Compliance with the AAP 100% juice recommendations was not associated with lower body weights. Attempts to limit the consumption of milk and 100% juice by children might have the unintended consequence of increasing consumption of SSB and may have limited value for obesity prevention.

Planning dietary improvements without additional costs for low-income individuals in Brazil: linear programming optimization as a tool for public policy in nutrition and health

BACKGROUND

Meeting nutrient intake recommendations may demand substantial modifications in dietary patterns, and may increase diet cost. Incentives for modifying one's dietary intake that disregard prices are unlikely to be effective in the general population, especially among low-income strata, due to the high percentage of income committed to food purchases. The aim of this study is to evaluate how much the nutrient content can be increased through a modeled diet, without any cost increase, for low-income Brazilian households.

METHODS

Low-income households were selected from the Household Budget Survey (24,688 households) and National Dietary Survey (6,032 households, 16,962 individuals), from where we obtained food prices and consumption data. Food quantities were modeled using linear programming to find diets that meet nutritional recommendations in two sets of models: cost-constrained (the cost should not be higher than the observed diet cost) and cost-free. Minimum and maximum amounts of each food in the modelled diets were allowed at three levels of food acceptability: rigorous (least deviance from the current observed diets), moderate, and flexible (higher deviance from the current observed diets).

RESULTS

We found no feasible solution that would accommodate all the nutritional targets. The most frequent limiting nutrients were calcium; vitamins D, E, and A; zinc; fiber; sodium; and saturated and trans-fats. However, increases in nutrient contents were observed, especially for fiber, calcium, copper, magnesium, vitamin A, vitamin C, and vitamin E. In general, the best achievement was obtained with cost-free models. Fruits and beans increased in all models; large increase in whole cereals was observed only in the flexible models; large increase in vegetables was observed only in the cost-free models; and fish increased only in the cost-free models. Reductions were observed for rice, red and processed meats, sugar-sweetened beverages, and sweets. The mean observed cost was US$2.16 per person/day. The mean cost in the cost-free models was US$2.90 (moderate), US$2.70 (rigorous), and US$2.60 (flexible).

CONCLUSION

The complete nutritional adequacy is unattainable, although feasible changes would substantially improve diet quality by improving nutrient content without additional costs.

Designing Optimal Breakfast for the United States Using Linear Programming and the NHANES 2011-2014 Database: A Study from the International Breakfast Research Initiative (IBRI)

The quality of dietary patterns can be optimized using a mathematical technique known as linear programming (LP). LP methods have rarely been applied to individual meals. The present LP models optimized the breakfast meal for those participants in the nationally representative National Health and Nutrition Examination Survey 2011-2014 who ate breakfast (n = 11,565). The Nutrient Rich Food Index (NRF9.3) was a measure of diet quality. Breakfasts in the bottom tertile of NRF9.3 scores (T1) were LP-modeled to meet nutrient requirements without deviating too much from current eating habits. Separate LP models were run for children and for adults. The LP-modeled breakfasts resembled the existing ones in the top tertile of NRF9.3 scores (T3), but were more nutrient-rich. Favoring fruit, cereals, and dairy, the LP-modeled breakfasts had less meat, added sugars and fats, but more whole fruit and 100% juices, more whole grains, and more milk and yogurt. LP modeling methods can build on existing dietary patterns to construct food-based dietary guidelines and identify individual meals and/or snacks that need improvement.

A Food Group Based Approach to Satisfy Nutrient Recommendations in Toddlers (12-24 Months) Using Dietary Modelling (P11-091-19)

Objectives

The aim of this study was to optimize the quantity of daily intake of food groups to meet energy, nutrient needs, and to assess differences in diets using fortified versus unfortified foods to provide nutrient adequacy in the second year of life.

Methods

Mathematical modeling was applied to the Feeding Infants and Toddlers Study 2016 (observed diet) data set to develop optimized theoretical toddler (12 – 24 months old) diets. The model was constrained to meet median energy requirements and appropriate nutrient reference values and minimize the deviation from the average observed diet. Only the complementary food component of the diet was modelled. Using the Nutrition Data System for Research (NDSR, version 2015: University of Minnesota, Minneapolis, MN), the current US fortification of grains and dairy were accounted for and the analysis was repeated without fortification.

Results

The mathematically modeled diets revealed a lower quantity of food (613 to 732 g/day less) and energy (449.3 kcal/per day) were needed to meet nutrient recommendations, compared to the observed diet. The modelled diets contained less meat and fish and less starches and grains, compared to the observed diet. However, the modelled diets contained greater quantities of vegetables and fruit than the observed diet. Additional fruit and vegetables were required when the modelled diet was unfortified rather than when it was fortified. However, the fortified diet allowed for greater variety, and inclusion of other dairy (yogurt and cheese), and starches and grains compared with the unfortified diet. In terms of nutrient adequacy, the modelled fortifed diet met all recommendations, whereas the unfortified diet met all but vitamin D.

Conclusions

Our results indicate that with the exception of Vitamin D, nutrient needs of young toddler age children can be satisfied with lower and more appropriate energy intake than currently observed. These findings can assist with dietary recommendations based on a food group approach, for meal planning, or for the development of food based dietary guidelines.

Funding Sources

Nestlé Nutrition, Vevey, Switzerland.

How to Evaluate the Free Sugars’ Content of a Food Product in Europe? Developing and Testing the Reproducibility of a New Method (FS02-08-19)

Objectives

Lowering dietary intakes of free sugars is currently promoted by several authorities worldwide. However, the free sugars’ content of food is today not readily available on food packaging or food composition tables. The aim of this work was to develop and test the reproducibility of a new methodology to evaluate the free sugars’ content of packaged foods sold in the European market.

Methods

The new methodology is an 8-step algorithm, consisting of a series of sequential questions based on the information available on packaging. This includes nutrition declaration and list of ingredients, both of which are mandatory on any pre-packaged food sold in the European Union. This method has been tested by eight trained nutritionists on a selection of 37 packaged food products, twice with a 6-week interval. Inter-and intra-individual variability in the estimated free sugar values were studied by linear regression, analysis of variance and principal component analysis.

Results

Correlation coefficients between users and sessions for estimated free sugar contents of the 37 selected products were highly significant and above 0.965. When available, the free sugar values provided by the manufacturer, considered to be the true values, were always lower than the estimates generated with the algorithm, in line with the prerequisite of maximizing the free sugars’ content in case of uncertainties. In terms of amounts of free sugars, the algorithm performed better than the World Health Organization's method (i.e., provided a value closer to the true value) in 50% of cases; performance was equal in 20% and worse in 30% of cases. Variation coefficients were not dependent on the mean value of estimated free sugars or on the session, but were higher for mixed dishes and composite products (0.942 and 0.193 on average for pooled sessions, respectively) than for other food categories (below 0.09 on average). Finally, there was a user effect, which may come from selecting different steps in the algorithm, a situation that may be limited by improving instructions or training to users.

Conclusions

With optimization, this new method shows potential to inform about free sugars’ content of individual food products, even those closely related, and could be used for monitoring at the product level.

Funding Sources

No funding has been received from external sources for this study.

Optimizing Complementary Diets to Provide Nutrient Adequacy for Infants 6 to 12 Months Old: A Dietary Modelling Study (P11-090-19)

Objectives

The purpose of this study was to determine the optimal composition of complementary diets for infants 6 to 12 months old (m.o), in terms of daily intake of food groups to ensure nutrient adequacy. A secondary goal was to determine differences in these optimized diets with fortified versus unfortified foods.

Methods

Dietary modelling using linear programming was applied to the Feeding Infants and Toddlers Study 2016 data set to develop theoretical diets that satisfy nutrient requirements, while meeting median energy needs, for 6 to 8 m.o. and 9 to 12 m.o. breast-fed, formula-fed, and mixed-fed infants. The food data set was adjusted to ensure, among other criteria, developmental appropriateness and safety. Using the Nutrition Data System for Research (NDSR, version 2015: University of Minnesota, Minneapolis, MN), the current US fortification for grains was included, and analyses were then performed without fortification.

Results

Among modelled diets for 6 to 8 m.o., a greater amount of total food, particularly vegetables, was required to achieve nutrient adequacy in the absence of fortification. The quantity of vegetables ranged from 54 g/day (3.5% of total energy (E)) in the formula based fortified diet up to 206 g/day (15% of E) in the breast milk unfortified diet. The modelling showed that inclusion of starches and grains was negligible in the unfortified diets, being primarily replaced by vegetables and pulses. For 9 to 12 m.o., daily intake of vegetables were particularly high at 222 g/day (12% of E), in the breast-fed, unfortified group. Pulses, nuts and seeds were featured in the unfortified diets at a level of 61 g/day (10% of E) in both the breast milk diet and the mixed diet.

In terms of nutrient adequacy, all requirements were met apart from iron in the breast fed unfortified diet for 6 to 8 m.o.. Meeting Vitamin D was unachievable in all but the formula based diets for 6 to 8 m.o.

Conclusions

Fortification or supplementation is required to provide adequate iron to breast-fed infants, particularly in the early months of complementary feeding, and vitamin D to most infants. The diet optimization, which could be the basis for food based dietary guidelines, showed that complementary diets should be adapted according to the milk source in the infant diet.

Funding Sources

Nestlé Nutrition, Vevey, Switzerland.

Modeled industry-wide food and beverage reformulations reduce the gap between current and nutritionally adequate dietary intakes among French adults

PURPOSE

The objective was to assess the capacity of food reformulations to reduce the required dietary changes to reach overall nutritional adequacy in the French adult population.

METHODS

Reformulation standards, defined using the Nestlé Nutritional Profiling System (NNPS), were applied to the French food composition database (CIQUAL-2013), classifying foods into "PASS" or "FAIL". Baseline nutritional intakes were estimated for 1838 adults of the INCA2 French national survey according to three scenarios based on: (1) the original food composition database (CURRENT), (2) a "reformulated" database in which the nutrient composition of FAIL products was adjusted to the NNPS standards (REFORMULATION), and (3) a "substituted" database in FAIL products were replaced by the most nutritionally similar PASS products from the same NNPS-category (SUBSTITUTION). For each scenario, starting from each baseline diet, a new optimized diet was modeled to fulfill a complete set of nutrient recommendations while remaining closest to the respective baseline diet. To quantify the dietary changes needed to reach nutritional adequacy in the optimized diets, the total dietary deviation (TDD) was calculated as the sum in quantities (grams) of the absolute difference between observed and optimized amount of repertoire foods (i.e., foods already consumed) plus the amount of non-repertoire foods (i.e., new foods added).

RESULTS

TDD was significantly lower in the REFORMULATION and the SUBSTITUTION scenarios compared to CURRENT (1269 g/day, 1191 g/day and 1494 g/day, respectively). This was explained by smaller shifts among repertoire foods and less additions of non-repertoire foods.

CONCLUSIONS

Nutritional reformulation of the food supply may reduce the dietary changes required to achieve nutritionally adequate diets, but would not suffice to reach the complete set of nutrient recommendations.

The Presence of Pulses within a Meal can Alter Fat-Soluble Vitamin Bioavailability

SCOPE

It is widely advised to increase pulse consumption. However, pulses are rich in molecules displaying lipid-lowering properties, including fibers, phytates, saponins, and tannins. The effects of pulses on fat-soluble vitamin bioavailability were thus explored.

METHODS

Vitamin A (β-carotene and retinyl palmitate), vitamin E (α-tocopherol), vitamin D (cholecalciferol), and vitamin K (phylloquinone) bioaccessibility was evaluated by assessing micellarization after in vitro digestion of meals containing either potatoes (control), household-cooked, or canned pulses. The obtained mixed micelles were delivered to Caco-2 cells to evaluate vitamin uptake. The impact of fibers, phytates, saponins, and tannins on both phylloquinone (used as a model vitamin) bioaccessibility and uptake were then specifically assessed.

RESULTS

The presence of pulses significantly decreased both vitamin bioaccessibility (up to -65% for β-carotene, -69% for retinyl-palmitate, -45% for cholecalciferol, -53% for α-tocopherol and -67% for phylloquinone) and uptake (-40% for retinyl-palmitate, -67% for cholecalciferol, -50% for α-tocopherol and -57% for phylloquinone). Effects on bioaccessibility, but not on uptake, are dependent on pulse cooking method. Phylloquinone bioaccessibility is specifically impacted by saponins, tannins, and fibers while its uptake is impacted by saponins, fibers, and phytates.

CONCLUSION

Pulses can alter fat-soluble micronutrient bioavailability. Pulses should thus be cooked appropriately and consumed within micronutrient-rich meals.

Mathematical Optimization to Explore Tomorrow's Sustainable Diets: A Narrative Review

A sustainable diet is, by definition, nutritionally adequate, economically affordable, culturally acceptable, and environmentally respectful. Designing such a diet has to integrate different dimensions of diet sustainability that may not be compatible with each other. Among multicriteria assessment methods, diet optimization is a whole-diet approach that simultaneously combines several metrics for dimensions of diet sustainability. This narrative review based on 67 published studies shows how mathematical diet optimization can help with understanding the relations between the different dimensions of diet sustainability and how it can be properly used to identify sustainable diets. Diet optimization aims to find the optimal combination of foods for a population, a subpopulation, or an individual that fulfills a set of constraints while minimizing or maximizing an objective function. In the studies reviewed, diet optimization was used to examine the links between dimensions of diet sustainability, identify the minimum cost or environmental impact of a nutritionally adequate diet, or identify food combinations able to combine ≥2 sustainability dimensions. If some constraints prove difficult to fulfill, this signals an incompatibility between nutrient recommendations, over-monotonous food-consumption patterns, an inadequate supply of nutrient-rich foods, or an incompatibility with other dimensions. If diet optimization proves successful, it can serve to design nutritionally adequate, culturally acceptable, economically affordable, and environmentally friendly diets. Diet optimization results can help define dietary recommendations, tackle food security issues, and promote sustainable dietary patterns. This review emphasizes the importance of carefully choosing the model parameters (variables, objective function, constraints) and input data and the need for appropriate expertise to correctly interpret and communicate the results. Future research should make improvements in the choice of metrics used to assess each aspect of a sustainable diet, especially the cultural dimension, to improve the practicability of the results.

Beverage consumption patterns among 4-19 y old children in 2009-14 NHANES show that the milk and 100% juice pattern is associated with better diets

BACKGROUND

Patterns of beverage consumption among children and adolescents can be indicative of food choices and total diet quality.

METHODS

Analyses of beverage consumption patterns among 8119 children aged 4-19 y were based on the first 24-h recall of the National Health and Nutrition Examination Survey (2009-14 NHANES). Four pre-defined beverage patterns were: 1) milk pattern; 2) 100% juice pattern; 3) milk and 100% juice pattern; and 4) other caloric beverages. Food- and nutrient-based diet quality measures included the Healthy Eating Index 2010.

RESULTS

Most children drank other caloric beverages, as opposed to milk (17.8%), 100% juice (5.6%), or milk and 100% juice (13.5%). Drinkers of milk and 100% juice had diets that did not differ from each other in total calories, total and added sugars, fiber, or vitamin E. Milk drinkers consumed more dairy and had higher intakes of calcium, potassium, vitamin A and vitamin D as compared to all other patterns. Juice drinkers consumed more total fruit, same amounts of whole fruit, and had higher intakes of vitamin C as compared to the other consumption patterns. Drinkers of both milk and 100% juice had the highest HEI 2010 scores of all the consumption patterns.

CONCLUSIONS

Beverage consumption patterns built around milk and/or 100% juice were relatively uncommon. Promoting the drinking of milk and 100% juice, in preference to other caloric beverages, may be an effective strategy to improve children's diet quality. Restricting milk and 100% juice consumption may encourage the selection of other caloric beverages.

Structural Validation of a French Food Frequency Questionnaire of 94 Items

Background

Food frequency questionnaires (FFQs) are used to estimate the usual food and nutrient intakes over a period of time. Such estimates can suffer from measurement errors, either due to bias induced by respondent’s answers or to errors induced by the structure of the questionnaire (e.g., using a limited number of food items and an aggregated food database with average portion sizes). The “structural validation” presented in this study aims to isolate and quantify the impact of the inherent structure of a FFQ on the estimation of food and nutrient intakes, independently of respondent’s perception of the questionnaire.

Methods

A semi-quantitative FFQ (n = 94 items, including 50 items with questions on portion sizes) and an associated aggregated food composition database (named the item-composition database) were developed, based on the self-reported weekly dietary records of 1918 adults (18–79 years-old) in the French Individual and National Dietary Survey 2 (INCA2), and the French CIQUAL 2013 food-composition database of all the foods (n = 1342 foods) declared as consumed in the population. Reference intakes of foods (“REF_FOOD”) and nutrients (“REF_NUT”) were calculated for each adult using the food-composition database and the amounts of foods self-reported in his/her dietary record. Then, answers to the FFQ were simulated for each adult based on his/her self-reported dietary record. “FFQ_FOOD” and “FFQ_NUT” intakes were estimated using the simulated answers and the item-composition database. Measurement errors (in %), spearman correlations and cross-classification were used to compare “REF_FOOD” with “FFQ_FOOD” and “REF_NUT” with “FFQ_NUT”.

Results

Compared to “REF_NUT,” “FFQ_NUT” total quantity and total energy intake were underestimated on average by 198 g/day and 666 kJ/day, respectively. “FFQ_FOOD” intakes were well estimated for starches, underestimated for most of the subgroups, and overestimated for some subgroups, in particular vegetables. Underestimation were mainly due to the use of portion sizes, leading to an underestimation of most of nutrients, except free sugars which were overestimated.

Conclusion

The “structural validation” by simulating answers to a FFQ based on a reference dietary survey is innovative and pragmatic and allows quantifying the error induced by the simplification of the method of collection.

Co-construction and Evaluation of a Prevention Program for Improving the Nutritional Quality of Food Purchases at No Additional Cost in a Socioeconomically Disadvantaged Population

Background: Food prices influence food choices. Purchasing foods with higher nutritional quality for their price may help improve the diet quality of socioeconomically disadvantaged individuals. Objective: This study aimed to describe the co-construction and evaluation of the Opticourses prevention program, which promotes healthy eating among participants in socioeconomically deprived situations by improving the nutritional quality of their household food purchases with no additional cost. Methods: Individuals were recruited in poor districts of Marseille, France. The intervention and evaluation tools and protocols were co-constructed with 96 individuals. Then, 93 adults willing to participate in a standardized intervention comprising 5 participative workshops on diet and budget were enrolled. Impact on food purchases was estimated with experimental economics: 2-d experimental food purchase intents were observed at baseline and endline for workshop participants (WPs, n = 35) and controls (n = 23), with the use of monetary incentives to limit social-desirability bias. Changes in food and nutrient content and energy cost (expressed in €/2000 kcal) of experimental purchases were assessed. Results: The co-constructed participative workshops included playful activities around food purchase practices and the nutritional quality, taste, and price of foods. Experimental purchases contained a large amount of energy at baseline for both WPs and controls (5114 and 4523 kcal ⋅ d-1 ⋅ person-1, respectively). For WPs only, the mean energy content decreased between baseline and endline (-1729 kcal ⋅ d-1 ⋅ person-1; P < 0.01; medium effect size: Cohen's d = 0.5), and the percentage of energy from free sugars and from foods high in fat, sugar, and salt also decreased (both P < 0.05 and medium effect sizes), whereas energy cost remained unchanged. No significant changes between baseline and endline were observed for the controls. Conclusions: After the intervention, the energy content of participants' experimental purchases was closer to their needs, suggesting that the workshops helped them plan and rationalize their food purchases better. The nutritional quality of the experimental purchases increased but energy cost did not, showing that the co-constructed Opticourses prevention program can favorably change food purchasing behaviors of socioeconomically disadvantaged individuals with no additional cost. This trial was registered at clinicaltrials.gov as NCT02383875.

Dietary changes needed to reach nutritional adequacy without increasing diet cost according to income: An analysis among French adults

OBJECTIVE

To explore the dietary changes needed to achieve nutritional adequacy across income levels at constant energy and diet cost.

MATERIALS AND METHODS

Individual diet modelling was used to design iso-caloric, nutritionally adequate optimised diets for each observed diet in a sample of adult normo-reporters aged ≥20 years (n = 1,719) from the Individual and National Dietary Survey (INCA2), 2006-2007. Diet cost was estimated from mean national food prices (2006-2007). A first set of free-cost models explored the impact of optimisation on the variation of diet cost. A second set of iso-cost models explored the dietary changes induced by the optimisation with cost set equal to the observed one. Analyses of dietary changes were conducted by income quintiles, adjusting for energy intake, sociodemographic and socioeconomic variables, and smoking status.

RESULTS

The cost of observed diets increased with increasing income quintiles. In free-cost models, the optimisation increased diet cost on average (+0.22 ± 1.03 euros/d) and within each income quintile, with no significant difference between quintiles, but with systematic increases for observed costs lower than 3.85 euros/d. In iso-cost models, it was possible to design nutritionally adequate diets whatever the initial observed cost. On average, the optimisation at iso-cost increased fruits and vegetables (+171 g/day), starchy foods (+121 g/d), water and beverages (+91 g/d), and dairy products (+20 g/d), and decreased the other food groups (e.g. mixed dishes and salted snacks), leading to increased total diet weight (+300 g/d). Those changes were mostly similar across income quintiles, but lower-income individuals needed to introduce significantly more fruit and vegetables than higher-income ones.

CONCLUSIONS

In France, the dietary changes needed to reach nutritional adequacy without increasing cost are similar regardless of income, but may be more difficult to implement when the budget for food is lower than 3.85 euros/d.

Individual Diet Modeling Shows How to Balance the Diet of French Adults with or without Excessive Free Sugar Intakes

Dietary changes needed to achieve nutritional adequacy for 33 nutrients were determined for 1719 adults from a representative French national dietary survey. For each individual, an iso-energy nutritionally adequate diet was generated using diet modeling, staying as close as possible to the observed diet. The French food composition table was completed with free sugar (FS) content. Results were analyzed separately for individuals with FS intakes in their observed diets ≤10% or >10% of their energy intake (named below FS-ACCEPTABLE and FS-EXCESS, respectively). The FS-EXCESS group represented 41% of the total population (average energy intake of 14.2% from FS). Compared with FS-ACCEPTABLE individuals, FS-EXCESS individuals had diets of lower nutritional quality and consumed more energy (2192 vs. 2123 kcal/day), particularly during snacking occasions (258 vs. 131 kcal/day) (all p-values < 0.01). In order to meet nutritional targets, for both FS-ACCEPTABLE and FS-EXCESS individuals, the main dietary changes in optimized diets were significant increases in fresh fruits, starchy foods, water, hot beverages and plain yogurts; and significant decreases in mixed dishes/sandwiches, meat/eggs/fish and cheese. For FS-EXCESS individuals only, the optimization process significantly increased vegetables and significantly decreased sugar-sweetened beverages, sweet products and fruit juices. The diets of French adults with excessive intakes of FS are of lower nutritional quality, but can be optimized via specific dietary changes.

A review of total & added sugar intakes and dietary sources in Europe

Public health policies, including in Europe, are considering measures and recommendations to limit the intake of added or free sugars. For such policies to be efficient and monitored, a precise knowledge of the current situation regarding sugar intake in Europe is needed. This review summarizes published or re-analyzed data from 11 representative surveys in Belgium, France, Denmark, Hungary, Ireland, Italy, Norway, The Netherlands, Spain and the UK. Relative intakes were higher in children than in adults: total sugars ranged between 15 and 21% of energy intake in adults and between 16 and 26% in children. Added sugars (or non-milk extrinsic sugars (NMES), in the UK) contributed 7 to 11% of total energy intake in adults and represented a higher proportion of children's energy intake (11 to 17%). Educational level did not significantly affect intakes of total or added sugars in France and the Netherlands. Sweet products (e.g. confectionery, chocolates, cakes and biscuits, sugar, and jam) were major contributors to total sugars intake in all countries, genders and age groups, followed by fruits, beverages and dairy products. Fruits contributed more and beverages contributed less to adults' total sugars intakes than to children's. Added sugars were provided mostly by sweet products (36 to 61% in adults and 40 to 50% in children), followed by beverages (12 to 31% in adults and 20 to 34% in children, fruit juices excluded), then by dairy products (4 to 15% in adults and 6 to 18% in children). Caution is needed, however, as survey methodologies differ on important items such as dietary data collection, food composition tables or estimation of added sugars. Cross-country comparisons are thus not meaningful and overall information might thus not be robust enough to provide a solid basis for implementation of policy measures. Data nevertheless confirm that intakes of total and added sugars are high in the European countries considered, especially in children, and point to sweet products and beverages as the major contributors to added sugar intakes.

A methodology to compile food metrics related to diet sustainability into a single food database: Application to the French case

The holistic approach required to assess diet sustainability is hindered by lack of comprehensive databases compiling relevant food metrics. Those metrics are generally scattered in different data sources with various levels of aggregation hampering their matching. The objective was to develop a general methodology to compile food metrics describing diet sustainability dimensions into a single database and to apply it to the French context. Each step of the methodology is detailed: indicators and food metrics identification and selection, food list definition, food matching and values assignment. For the French case, nutrient and contaminant content, bioavailability factors, distribution of dietary intakes, portion sizes, food prices, greenhouse gas emission, acidification and marine eutrophication estimates were allocated to 212 commonly consumed generic foods. This generic database compiling 279 metrics will allow the simultaneous evaluation of the four dimensions of diet sustainability, namely health, economic, social and environmental, dimensions.

Drinking Water Intake Is Associated with Higher Diet Quality among French Adults

This study aimed to examine the association between drinking water intake and diet quality, and to analyse the adherence of French men and women to the European Food Safety Authority 2010 Adequate Intake (EFSA AI). A representative sample of French adults (≥18) from the Individual and National Survey on Food Consumption (INCA2) was classified, by sex, into small, medium, and large drinking water consumers. Diet quality was assessed with several nutritional indices (mean adequacy ratio (MAR), mean excess ratio (MER), probability of adequate intakes (PANDiet), and solid energy density (SED)). Of the total sample, 72% of men and 46% of women were below the EFSA AI. This percentage of non-adherence decreased from the small to the large drinking water consumers (from 95% to 34% in men and from 81% to 9% in women). For both sexes, drinking water intake was associated with higher diet quality (greater MAR and PANDiet). This association remained significant independently of socio-economic status for women only. Low drinking water consumers did not compensate with other sources (beverages and food moisture) and a high drinking water intake was not a guarantee for reaching the EFSA AI, meaning that increasing consumption of water should be encouraged in France.

Quantitative and qualitative analysis of breakfast nutritional composition in French schoolchildren aged 9-11 years

BACKGROUND

The present study aimed to analyse the nutritional quality of childrens' breakfasts using data collected during a cross-sectional observational study on the prevalence of urinary osmolality in 529 French children aged 9-11 years.

METHODS

Total nutrient intake, mean adequacy ratio (MAR), energy density and solid energy density were calculated from breakfast food and fluid nutritional composition. To identify the main qualitative breakfast patterns, each breakfast item was categorised into 15 solid and liquid food categories and a principal component analysis followed by a cluster analysis was performed.

RESULTS

Only 9.8% included skipped breakfast. Breakfast provided, on average, 22.9% of the recommended daily energy intake and 24.7% of the mean adequacy ratio of 23 key nutrients. Four breakfast patterns were identified: 'Sweets breakfast' (40.0% of children), 'Traditional French breakfast' (27.2%), 'Ready-to-eat cereal (RTEC) + milk' (18.1%) and 'Dairy and juice breakfast' (9.5%). Nutritionally, the 'RTEC + milk' pattern was the most advantageous. Flavoured milk was the most frequently consumed food (50.5%) and the major component of the 'Traditional French breakfast'.

CONCLUSIONS

Although breakfast provided a substantial contribution to a range of nutrients, opportunity for improvement, particularly to less nutrient breakfast patterns, should not be overlooked.

How low can dietary greenhouse gas emissions be reduced without impairing nutritional adequacy, affordability and acceptability of the diet? A modelling study to guide sustainable food choices

OBJECTIVE

To assess the compatibility between reduction of diet-related greenhouse gas emissions (GHGE) and nutritional adequacy, acceptability and affordability dimensions of diet sustainability.

DESIGN

Dietary intake, nutritional composition, GHGE and prices were combined for 402 foods selected among those most consumed by participants of the Individual National Study on Food Consumption. Linear programming was used to model diets with stepwise GHGE reductions, minimized departure from observed diet and three scenarios of nutritional constraints: none (FREE), on macronutrients (MACRO) and for all nutrient recommendations (ADEQ). Nutritional quality was assessed using the mean adequacy ratio (MAR) and solid energy density (SED).

SETTING

France.

SUBJECTS

Adults (n 1899).

RESULTS

In FREE and MACRO scenarios, imposing up to 30 % GHGE reduction did not affect the MAR, SED and food group pattern of the observed diet, but required substitutions within food groups; higher GHGE reductions decreased diet cost, but also nutritional quality, even with constraints on macronutrients. Imposing all nutritional recommendations (ADEQ) increased the fruits and vegetables quantity, reduced SED and slightly increased diet cost without additional modifications induced by the GHGE constraint up to 30 % reduction; higher GHGE reductions decreased diet cost but required non-trivial dietary shifts from the observed diet. Not all the nutritional recommendations could be met for GHGE reductions ≥70 %.

CONCLUSIONS

Moderate GHGE reductions (≤30 %) were compatible with nutritional adequacy and affordability without adding major food group shifts to those induced by nutritional recommendations. Higher GHGE reductions either impaired nutritional quality, even when macronutrient recommendations were imposed, or required non-trivial dietary shifts compromising acceptability to reach nutritional adequacy.

In-store marketing of inexpensive foods with good nutritional quality in disadvantaged neighborhoods: increased awareness, understanding, and purchasing

BACKGROUND

Consumers often do not understand nutrition labels or do not perceive their usefulness. In addition, price can be a barrier to healthy food choices, especially for socio-economically disadvantaged individuals.

METHOD

A 6-month intervention combined shelf labeling and marketing strategies (signage, prime placement, taste testing) to draw attention to inexpensive foods with good nutritional quality in two stores located in a disadvantaged neighborhood in Marseille (France). The inexpensive foods with good nutritional quality were identified based on their nutrient profile and their price. Their contribution to customers' spending on food was assessed in the two intervention stores and in two control stores during the intervention, as well as in the year preceding the intervention (n = 6625). Exit survey (n = 259) and in-depth survey (n = 116) were used to assess customers' awareness of and perceived usefulness of the program, knowledge of nutrition, understanding of the labeling system, as well as placement-, taste- and preparation-related attractiveness of promoted products. Matched purchasing data were used to assess the contribution of promoted products to total food spending for each customer who participated in the in-depth survey.

RESULTS

The contribution of inexpensive foods with good nutritional quality to customers' total food spending increased between 2013 and 2014 for both the control stores and the intervention stores. This increase was significantly higher in the intervention stores than in the control stores for fruits and vegetables (p = 0.001) and for starches (p = 0.011). The exit survey revealed that 31 % of customers had seen the intervention materials; this percentage increased significantly at the end of the intervention (p < 0.001). The in-depth survey showed that customers who had seen the intervention materials scored significantly higher on quizzes assessing nutrition knowledge (p < 0.001) and understanding of the labeling system (p = 0.024).

CONCLUSION

A social marketing intervention aimed at increasing the visibility and attractiveness of inexpensive foods with good nutritional quality may improve food purchasing behaviors in disadvantaged neighborhoods.

Metabolomics reveals dose effects of low-dose chronic exposure to uranium in rats: identification of candidate biomarkers in urine samples

INTRODUCTION

Data are sparse about the potential health risks of chronic low-dose contamination of humans by uranium (natural or anthropogenic) in drinking water. Previous studies report some molecular imbalances but no clinical signs due to uranium intake.

OBJECTIVES

In a proof-of-principle study, we reported that metabolomics is an appropriate method for addressing this chronic low-dose exposure in a rat model (uranium dose: 40 mg L^-1; duration: 9 months, n = 10). In the present study, our aim was to investigate the dose-effect pattern and identify additional potential biomarkers in urine samples.

METHODS

Compared to our previous protocol, we doubled the number of rats per group (n = 20), added additional sampling time points (3 and 6 months) and included several lower doses of natural uranium (doses used: 40, 1.5, 0.15 and 0.015 mg L^-1). LC-MS metabolomics was performed on urine samples and statistical analyses were made with SIMCA-P+ and R packages.

RESULTS

The data confirmed our previous results and showed that discrimination was both dose and time related. Uranium exposure was revealed in rats contaminated for 9 months at a dose as low as 0.15 mg L^-1. Eleven features, including the confidently identified N1-methylnicotinamide, N1-methyl-2-pyridone-5-carboxamide and 4-hydroxyphenylacetylglycine, discriminated control from contaminated rats with a specificity and a sensitivity ranging from 83 to 96 %, when combined into a composite score.

CONCLUSION

These findings show promise for the elucidation of underlying radiotoxicologic mechanisms and the design of a diagnostic test to assess exposure in urine, in a dose range experimentally estimated to be above a threshold between 0.015 and 0.15 mg L^-1.

Primary care weight loss maintenance with behavioral nutrition: An observational study

OBJECTIVE

To evaluate the rate of weight loss maintenance, defined as a 10% loss of initial weight maintained beyond 1 year, among patients with BMI > 25 kg/m(2) who had been managed by primary care physicians practicing behavioral nutrition (moderately high-protein diet, carbohydrate restriction, and behavioral therapy).

METHODS

Restrospective analysis of anthropometric characteristics, weight loss, and its determinants was conducted in 14,256 patients.

RESULTS

26.7% of subjects met the success criterion (successful maintenance group; SM), 25.7% did not maintain their weight loss (unsuccessful maintenance group; UM), and 47.6% did not lose 10% of their initial weight (failure group; F). At inclusion, patients in the SM group had a greater BMI and fat mass percentage (40.5% in SM, 38.5% in UM, and 37.0% in F). These patients lost more weight (-14.1% vs. -4.59%) and fat mass (-24.7% vs. -8.21%) than patients in the UM group, and contribution of adiposity to their weight loss was 75.1%. Follow-up of patients in the SM group was characterized by a greater frequency of consultations.

CONCLUSIONS

Management by primary care providers with behavioral nutrition facilitates weight loss maintenance in patients with overweight and obesity. The determinants of success are frequency of consultations, initial BMI, and initial weight loss.

The feasibility of meeting the WHO guidelines for sodium and potassium: a cross-national comparison study

OBJECTIVE

To determine joint compliance with the WHO sodium-potassium goals in four different countries, using data from nationally representative dietary surveys.

SETTING

Compared to national and international recommendations and guidelines, the world's population consumes too much sodium and inadequate amounts of potassium. The WHO recommends consuming less than 2000 mg sodium (86 mmol) and at least 3510 mg potassium (90 mmol) per person per day.

PARTICIPANTS

Dietary surveillance data were obtained from the National Health and Nutrition Examination Survey (NHANES 2007-2010) for the USA; the Encuesta Nacional de Salud y Nutrición 2012 for Mexico; the Individual and National Study on Food Consumption (INCA2) for France; and the National Diet and Nutrition Survey (NDNS) for the UK.

PRIMARY OUTCOME MEASURES

We estimated the proportion of adults meeting the joint WHO sodium-potassium goals in the USA, the UK, France and Mexico.

RESULTS

The upper bounds of joint compliance with the WHO sodium-potassium goals were estimated at 0.3% in the USA, 0.15% in Mexico, 0.5% in France and 0.1% in the UK.

CONCLUSIONS

Given prevailing food consumption patterns and the current food supply, implementing WHO guidelines will be an enormous challenge for global public health.

Can we trust untargeted metabolomics? Results of the metabo-ring initiative, a large-scale, multi-instrument inter-laboratory study

The metabo-ring initiative brought together five nuclear magnetic resonance instruments (NMR) and 11 different mass spectrometers with the objective of assessing the reliability of untargeted metabolomics approaches in obtaining comparable metabolomics profiles. This was estimated by measuring the proportion of common spectral information extracted from the different LCMS and NMR platforms. Biological samples obtained from 2 different conditions were analysed by the partners using their own in-house protocols. Test #1 examined urine samples from adult volunteers either spiked or not spiked with 32 metabolite standards. Test #2 involved a low biological contrast situation comparing the plasma of rats fed a diet either supplemented or not with vitamin D. The spectral information from each instrument was assembled into separate statistical blocks. Correlations between blocks (e.g., instruments) were examined (RV coefficients) along with the structure of the common spectral information (common components and specific weights analysis). In addition, in Test #1, an outlier individual was blindly introduced, and its identification by the various platforms was evaluated. Despite large differences in the number of spectral features produced after post-processing and the heterogeneity of the analytical conditions and the data treatment, the spectral information both within (NMR and LCMS) and across methods (NMR vs. LCMS) was highly convergent (from 64 to 91 % on average). No effect of the LCMS instrumentation (TOF, QTOF, LTQ-Orbitrap) was noted. The outlier individual was best detected and characterised by LCMS instruments. In conclusion, untargeted metabolomics analyses report consistent information within and across instruments of various technologies, even without prior standardisation.