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PubMed1996

The dietary intake of a group of vegetarian children aged 7-11 years compared with matched omnivores.

There is a lack of information concerning the diet of vegetarian children. The present study compared the dietary intake of fifty vegetarian children, aged 7-11 years, with fifty matched omnivores. Three 3 d food records were completed by each child at intervals of 6 months. The day after completing the record each child was interviewed to clarify food items and assess portion sizes. Food records were analysed using Microdiet (University of Salford). Finger-prick cholesterol and haemoglobin measurements were taken from a subsample of the group. Only one child's family was a member of the Vegetarian Society and almost one-third of vegetarian children had omnivorous parents (seventeen of fifty subjects). The energy intake (MJ) of the vegetarians was significantly lower than that of the omnivores, 7.6 (SD 1.05) and 8.0 (SD 1.36) respectively; there were no significant differences in Fe or fat intakes. For the vegetarians polyunsaturated:saturated fat ratio (P:S 0.7 (SD 0.04)) and NSP intake (13.8 (SD 0.7) g/d) were significantly higher than those of the omnivores (P:S 0.5 (SD 0.02), NSP 10.3 (SD 0.4) g/d). There was no significant difference in cholesterol measurements (mmol/l) between the two groups: vegetarian 3.5 (SD 0.12), omnivores 3.7 (SD 0.15). The haemoglobin level (g/l) of the vegetarians (11.8 (SD 0.2)) was significantly below that of the omnivores (12.4 (SD 0.2)); 47.5% of the vegetarian children fell below the third percentile of the Dallman reference curves (Dallman & Siimes, 1979). The intake of the vegetarians more closely resembled current recommendations (Department of Health, 1991), although they need to be as aware as omnivores of the need to reduce fat intake. The haemoglobin levels of vegetarian children suggest that they need dietary advice to ensure optimal absorption of Fe.

Child↗
PubMed2001

Analysis of energy density of food in relation to energy intake regulation in human subjects.

The relationship between energy density (ED) of food and drink consumption ad libitum and energy intake (EI) was analysed. EI was taken as average daily EI over the long term, and as EI during a single meal. Moreover, the distribution of EI over three ED categories was analysed. Average daily EI was related to ED of the food and drinks when ED was strongly influenced by specific macronutrients. When ED was strongly influenced by the weight of water, it was not related to EI. During a meal subjects monitored mainly weight, and to a lesser extent, the energy content of the food ingested. Therefore, covertly manipulated ED of a meal affected EI directly. The impact of ED on EI was modulated by dietary behaviours such as restraint. Overt manipulation of ED for 6 months showed that EI was adjusted to a decreased but not to an increased ED in dietary-unrestrained subjects, and that EI was adjusted to an increased but not to a decreased ED in dietary-restrained subjects. Knowledge of ED was shown to lead to an inverse relationship between portion sizes and ED during a meal. Average daily EI consisted of a distribution of EI over the three different categories of ED, so that obese women ate more of foods with a high ED and less of foods with a low ED compared with normal weight women (and nutritional guidelines). In conclusion, ED affected daily EI by means of macronutrient specific effects. EI from a meal with an unknown ED can become inversely related to EI through learning or conditioning. Therefore, the effect of ED on EI during a single meal observation cannot be extrapolated directly to the 24 h effect on EI. With regard to the treatment of obesity, a conscious decreased consumption of foods high in ED and an increase in consumption of low-ED food is necessary to decrease and subsequently maintain body weight, particularly in subjects with a sedentary lifestyle.

Adult↗
PubMed2004

Standardised coding of diet records: experiences from INTERMAP UK.

Coding diet records is a basic element of most dietary surveys, yet it often receives little attention even though errors in coding can lead to flawed study results. In the INTERnational study of MAcro- and micronutrients and blood Pressure (INTERMAP study), efforts were made to minimise errors in coding the 18, 720 diet records. Staff were centrally trained and certified before being able to process study data and ongoing quality control checks were performed. This involved the senior (site) nutritionist re-coding randomly selected diet records. To facilitate standardisation of coding in the UK, a code book was designed; it included information about coding brand items, density and portion size information, and default codes to be assigned when limited information was available for food items. It was found that trainees, despite previous experience in coding elsewhere, made coding errors that resulted in errors in estimates of daily energy and nutrient intakes. As training proceeded, the number of errors decreased. Compilation of the code book was labour-intensive, as information from food manufacturers and retailers had to be collected. Strategies are required to avoid repetition of this effort by other research groups. While the methods used in INTERMAP to reduce coding errors were time consuming, the experiences suggest that such errors are important and that they can be reduced.

Diet↗
PubMed2006

Sources of saturated fatty acids in Belgian adolescents' diet: implications for the development of food-based dietary guidelines.

The objectives of the present study are to describe the dietary sources of total fat and of saturated fatty acids (SFA) and to formulate food-based dietary guidelines for SFA in Belgian adolescents. A random sample of 13-18-year-old adolescents was drawn from secondary schools in the region of Ghent. A 7 d estimated food record method was used to quantify nutrient and food intake. The average daily SFA intake is 4 % above the recommended 10 % of the total energy contribution. The most important contributors of SFA on food group level were 'fats, oils and savoury sauces', 'meat and meat products', 'sugar, confectionery, sweet fillings and sauces', 'cheese', 'milk and milk products' and 'bread, rusk and breakfast rolls'. On food subgroup level 'fresh meat', 'high-fat margarine' and 'high-fat cheese' had the highest contribution to SFA intake in all adolescents. Adolescents with a low SFA intake (lowest tertile) were compared with adolescents with a high intake (highest tertile). In the lowest tertile the intake of total fat and MUFA was significantly lower than in the highest tertile, while the intake of total carbohydrates, mono- and disaccharides and complex carbohydrates was significantly higher. Overall, the high-fat cheese intake is significantly lower in the lowest tertile, while the fruit intake is higher. The present analysis shows that the nutritional profile of Belgian adolescents could be potentially improved by decreasing the portion sizes of fresh meat (in boys), high-fat margarine, high-fat cheese and reducing intake of commercially prepared baked goods and processed foods, including fast foods.

Adolescent↗
PubMed2001

Under-reporting in dietary surveys--implications for development of food-based dietary guidelines.

OBJECTIVE: To illustrate issues related to under-reporting in dietary surveys relevant for development of food-based dietary guidelines. SETTING: Food and nutrient intakes in two national dietary surveys are analysed in relation to under-reporting using the concept of cut-off values for the ratio between energy intake and basal metabolic rate as well as biochemical markers of nutritional status. RESULTS: Subjects with an implausibly low EI/BMR ratio had dietary patterns more close to recommended levels, e.g. lower fat intake and higher fibre intake, than those with acceptable energy intakes. Intakes of micronutrients were lower. This was due to both general and selective under-reporting of foods. Under-reporting was due to less frequent consumption, larger proportion of non-consumers and smaller portion sizes. Low EI/BMR ratios did not influence the characterisation of protein and micronutrient intake of low and high consumers of fruit and vegetable intake. CONCLUSIONS: Under-reporting can influence the usefulness of dietary data as a tool for developing food-based dietary guidelines, and the extent of under-reporting should be assessed using appropriate methods.

Basal Metabolism↗
PubMed2001

DINER (Data Into Nutrients for Epidemiological Research) - a new data-entry program for nutritional analysis in the EPIC-Norfolk cohort and the 7-day diary method.

BACKGROUND AND OBJECTIVE: A new data-entry system (DINER - Data Into Nutrients for Epidemiological Research) for food record methods has been devised for the European Prospective Investigation into Cancer (EPIC) cohort study of 25,000 men and women in Norfolk. DINER has been developed to address the problems of efficiency and consistency of data entry, comparability of data, maximising information and future flexibility in large long-term population studies of diet and disease that use record methods to assess dietary intakes. DINER captures more detail than traditional systems and enables provision of new variables for specific food types or groups. The system has been designed to be fully flexible and easy to update. Analysis of consistency of data entry was tested in a group of 3525 participants entered by 25 coders. RESULTS: A food list of 9000 food items and values for 24,000 portion sizes have been incorporated into the database, using information from the 5979 diaries coded since 1995. Analysis of consistency of entry indicated that this has largely been achieved. The effect of coders in a multivariate regression model was significant only if the three coders involved in early use of the program were included (P < 0.013). CONCLUSIONS: The development of DINER has facilitated the use of more accurate record methods in large-scale epidemiological studies of diet and disease. Furthermore, the retention of original information as an extensive food list allows greater flexibility in later analyses of data of multiple dietary hypotheses.

Cohort Studies↗
PubMed2001

Vitamins in Spanish food patterns: the eVe Study.

OBJECTIVE: To describe vitamin intakes in Spanish food patterns, identify groups at risk for inadequacy and determine conditioning factors that may influence this situation. DESIGN: Pooled-analysis of eight cross-sectional regional nutrition surveys. SUBJECTS: Ten thousand two hundred and eight free-living subjects (4728 men, 5480 women) aged 25-60 years. Respondents of population nutritional surveys carried out in eight Spanish regions (Alicante, Andalucia, Balearic Islands, Canary Islands, Catalunya, Galicia, Madrid and Basque Country) from 1990 to 1998. The samples were pooled together and weighted to build a national random sample. METHODS: Dietary assessment by means of repeated 24-hour recall using photograph models to estimate portion size. Adjusted data for intra-individual variation were used to estimate the prevalence of inadequate intake. A Diet Quality Score (DQS) was computed considering the risk for inadequate intake for folate, vitamin C, vitamin A and vitamin E. DQS scores vary between 0 (good) and 4 (very poor). Influence of lifestyle (smoking, alcohol consumption and physical activity) was considered as well. RESULTS: Inadequate intakes (<2/3 Recommended Dietary Intake) were estimated in more than 10% of the sample for riboflavin (in men), folate (in women), vitamin C, vitamin A, vitamin D and vitamin E. More than 35% of the sample had diets classified as poor quality or very poor quality. Factors identified to have an influence on a poor-quality diet were old age, low education level and low socio-economical level. A sedentary lifestyle, smoking, usual consumption of alcohol and being overweight were conditioning factors for a poor-quality diet as well. CONCLUSION: Results from The eVe Study suggest that a high proportion of the Spanish population has inadequate intakes for at least one nutrient and nearly 50% should adjust their usual food pattern towards a more nutrient-dense, healthier diet.

Adult↗
PubMed2002

Validation of the second version of a quantitative food-frequency questionnaire for use in Western Mali.

OBJECTIVE: To assess the relative validity of the second version of a quantitative food-frequency questionnaire (QFFQ), designed to measure the habitual food and nutrient intake in one season in rural populations in Western Mali, West Africa. DESIGN: The dietary intake during the previous week was assessed with the 164-item QFFQ administered by interview. This was compared with the intake from a 2-day weighed record (WR) with weighed recipes. SETTING: The village of Ouassala in the Kayes region, Western Mali. SUBJECTS: Thirty-four women and 36 men aged 15-45 years, from 29 households. RESULTS: The QFFQ gave a lower intake of lunch and dinner and a higher intake of snacks than the WR. The discrepancies were larger for women than for men. The median proportion of subjects classified in the same quartile of intake was 29% for food groups and 36% for energy and nutrients. For classification into extreme opposite quartiles, the median proportion was 6% for food groups and 7% for energy and nutrients. Spearman's rank correlation for energy and nutrients ranged from 0.16 (% energy from protein) to 0.62 (retinol equivalents). CONCLUSIONS: The second version of the QFFQ tends to underestimate total food weight. The methods used for estimating food portion size should therefore be applied with caution. The changes made from the first version had little effect. The ability to rank subjects according to dietary intake is similar with both versions. The improved layout of the new QFFQ makes it a more user-friendly tool for comparing dietary intake between population groups and for measuring changes over time.

Adolescent↗
PubMed2003

Adaptation of international nutrition databases and data-entry system tools to a specific population.

OBJECTIVE: To develop a nutritional dietary intake database based on available reliable international nutritional databases adapted to the local needs of a specific population. DESIGN: The Negev Nutritional Study (NNS) is a survey of a random sample of the Negev population regarding their dietary intake using 24-hour dietary recalls. A nutritional database for the Israeli population was developed based on adaptation and modification of the US Department of Agriculture's database. A data-entry system was developed based on the logic of the US Food Information Analysis System. The system was designed as bilingual (English and Hebrew). Local foods and recipes were collected during the NNS, which included 1465 24-hour diet interviews. RESULTS: During the course of the NNS, 383 basic Israeli recipes were constructed. In total 1362 Israeli products were added to the database, and each was given a code, specific gravity and portion size. Most of the added products were cereals and grains and dairy products. The added recipes were collected from the interviewees in the NNS and from the most popular cookbooks. CONCLUSIONS: This paper describes the process undertaken to develop an Israeli food composition database as well as the data-entry system. This knowledge may aid other research groups in developing a computerised, nation-specific nutritional database and data-entry system adapted to their own specific local needs.

Databases, Factual↗
PubMed2005

Dietary strategies for the prevention of obesity.

The rising tide of obesity has led to a resurgence of interest in dietary strategies to prevent excess weight gain. Data from controlled intervention studies is sparse, but nonetheless evidence from other diverse sources has identified a number of specific dietary factors and aspects of eating behaviour that either promote or protect against obesity. The present paper reviews the evidence in relation to energy density, the macronutrient composition of the diet, including the nature of carbohydrate foods and sugar-rich drinks, portion size and snacking habits. It concludes that there is now sufficient evidence to develop clear dietary guidelines to prevent weight gain that are largely consistent with those for the prevention of CVD and cancer. However, coordinated action across multiple stakeholders is also required if these guidelines are to be translated into sustained changes in eating habits.

Animals↗
PubMed1985

Indicator foods for vitamin A assessment.

Epidemiological interview studies examining the association between vitamin A and cancer at various sites have been hampered by restricted time available for interview; consequently, studies have included varying lists of food items or broad food groups, thus making comparability of results difficult. To identify a standardized list of indicator foods that adequately assess total vitamin A intake, we examined the 24-hour dietary recall of 13,201 adults who participated in the First National Health and Nutrition Examination Survey (NHANES I) from 1971 to 1974. Food items reportedly consumed were ranked by contribution to overall (aggregated) intake in various subpopulations by an index of vitamin A contribution, which reflected the frequency of consumption, portion size, and vitamin A concentration (IUs/100 g). A comparison of these ranks identified certain food items that had a relative contribution to vitamin A intake which varied by sex/race group, season of interview, age, or region of the country; income level had little effect on the food rankings. The top-ranking 50 foods were sufficient to correctly classify 80%-90% of the individuals into low-, moderate-, and high-consumer categories. The major contributing foods for any subpopulation examined included both retinol (e.g., dairy products, liver) and carotenoid sources of vitamin A (e.g., certain fruits and vegetables) in addition to items (e.g., mixed tomato and cheese dishes) not included in earlier questionnaire studies. Recommendations are made for future questionnaires designed to assess vitamin A.

Adolescent↗
PubMed2005

Evaluation of vitamin B12 status in Egypt IV: food consumption patterns among lactating mothers and their impact on the intake of the vitamin.

The adequacy of vitamin B12 intake was assessed among 62 lactating mothers in the 2-32 weeks of lactation by an interactive 24-h recall and an open-ended food frequency questionnaire. Double portions of the foods consumed were sampled and assayed microbiologically for its vitamin B12 content. Based on the food item and its respective vitamin B12 content, combined with the usual portion size in grams and the frequency of consumption, a rapid calculator of approximate dietary vitamin B12 intake was developed. The estimated vitamin B12 intake averaged 4.17+/-0.74 microg/d. Only 25.8% of the lactating mothers had adequate vitamin B12 intake (>2.5 microg vitamin B12 daily). Three quarter of the studied population were consuming vitamin B12<2.5 microg/d. Out of those, 50% had estimated daily intake <2.0 microg/d. This percentage prevalence confirms the additional burden on the lactating mothers to satisfy the daily vitamin B12 requirement for its breast-fed baby.

Diet↗
PubMed2001

Eating patterns, dietary quality and obesity.

Obesity among children has reached epidemic proportions. Today, an estimated one in four children in the United States is overweight. while 11% arc obese. Children who are overweight tend to remain so up to 20 years of age; in general, they have a 1.5- to twofold higher risk for becoming overweight as adults. The prevalence of overweight has increased approximately twofold in the 20-year period from 1974 to 1994, with the largest increases observed among 19- to 24-year-olds. The annual increases in weight and obesity that occurred from 1983 to 1994 were 50% higher than those from 1973 to 1982. Overweight youth are 2.4 times as likely to have a high serum total cholesterol level, and 43.5 times as likely to have three cardiovascular risk factors. Although the total energy intake of children has remained the same, and the macronutrient density of the diet has changed, the percentage of energy from fat has decreased, while that from carbohydrates and protein has increased. Children have been consuming lower amounts of fats/oils, vegetables/soups, breads/grains, mixed meats, desserts, candy, and eggs. and increasing amounts of fruits/fruit juices, beverages. poultry, snacks, condiments, and cheese. Changes in specific eating patterns may explain the increase in adiposity among children; e.g., increases have occurred in the number of meals eaten at restaurants, food availability, portion sizes, snacking and meal-skipping. Successful prevention and treatment of obesity in childhood could reduce the adult incidence of cardiovascular disease. Because substantial weight loss is difficult to maintain, the prevention of obesity by promoting healthier lifestyles should be one of our highest priorities in the new millennium.

Adolescent↗
PubMed2001

Perceptions of infant cereals and dietary intakes of children aged 4-24 months in a rural South African community.

The objectives of this study were to determine (1) mothers' perceptions on infant cereals, and (2) dietary intakes of children aged 4-24 months in a rural South African community. All mothers/caregivers of preschool children who attended community-based growth monitoring posts during January-March 2000 were interviewed. The setting was a low socioeconomic rural African community (Ndunakazi), approximately 60 km northwest of the coastal city of Durban in KwaZulu-Natal, South Africa. Mothers/caretakers (n = 119) of children aged 5 years and under were interviewed to determine perceptions on infant cereals, and to collect retrospective data on complementary feeding practices. Dietary intakes of children aged 4-24 months (n = 50) were determined by 24 h recall. Retrospective data for the 119 children represented in the survey showed that (1) an infant cereal was given as first solid food to 50% of the children; (2) 81% of children had received an infant cereal at some stage, usually at an early age; (3) half of the children had not received any infant cereal after the age of 6 months; (4) the duration for the use of infant cereals was short (on average 3 months); and (5) feeding of an infant cereal was stopped for more than half of the children because the child did not want to eat it any more (disliked it). Most mothers had a positive attitude towards the use of infant cereals, recognizing the health benefits. The cost of the products is high compared to the amount of money spent to feed the household. For children aged 4-24 months of age, the quantities of infant cereal used was inadequate (approximately a quarter of the recommended portion size) and total dietary intakes were below 67% of the recommended levels for calcium, iron, zinc, niacin, vitamin B6 and vitamin B12. It was found that the concept of infant cereals is well accepted and the health benefits thereof are recognized in this rural community. Although these products are available in the area, intakes of children aged 4-24 months were below recommended levels for most of the micronutrients. The availability of culturally acceptable fortified products which are affordable for people in the lower socioeconomic sector is needed.

Attitude to Health↗
PubMed1991

Dose-dependent inhibitory effect of phenolic compounds in foods on nonheme-iron absorption in men.

Nonheme-iron absorption from a typical Southeast Asian meal was studied to examine the effect of a common vegetable, Yod Kratin, which contains a considerable amount of iron-binding phenolic groups. Yod Kratin (leaves of the lead tree) is a very popular vegetable in Thailand. It is consumed at least once a week year round, sometimes every day, together with the main meal. With a common portion size of the vegetable (20 g), iron absorption was reduced by almost 90%. As little as 5 g inhibited iron absorption by 75%. Addition of ascorbic acid partly counteracted inhibition. Adding 100 mg ascorbic acid reduced inhibition of iron absorption from 5 g Yod Kratin by half and the inhibition from 10 g Yod Kratin by a quarter. The study illustrates the marked effect of iron-binding phenolic compounds on iron nutrition and, thus, the importance of acquiring knowledge of the content of such compounds in different foods.

Absorption↗
PubMed1994

Use of a multicultural food-frequency questionnaire with pregnant and lactating women.

In a multicultural society the difficulty experienced by pregnancy care teams in asking subjects to remember what they have eaten and then adjusting the food recall for lapses in detail related to portion size, product names, food combinations, and ethnic uniqueness poses a handicap for collecting food-recall data. The purpose of this study was to design and administer a food-frequency questionnaire (FFQ) to clarify the 24-h dietary recall of pregnant and lactating women of Caribbean and African descendants. Focus groups convened in eight states around the United States determined ethnic food nomenclature, methods of preparation and cooking, types of and additions to food, and cultural differences in quantifying food servings. The FFQ assessed weekly intake patterns of six categories of foods and described the frequency of consumption of 82 food items. Correlation analysis and paired t tests compared agreement indicators (0.80) and differences on the reporting.

Adult↗
PubMed1997

Dietary assessment using a picture-sort approach.

Food-frequency questionnaires are usually administered as a list of foods to be checked off by the respondent or interviewer. Techniques in which participants sort into categories cards on which names or pictures of foods are printed can also be used to assess food intake. Food-frequency scores were obtained from a five-category picture sort administered to 4643 men and women aged > or = 65 y in the Cardiovascular Health Study (CHS). This one-step (qualitative) assessment yielded significant associations in expected directions between frequency scores and sex, age, race or ethnicity, body mass index, and use of a special diet. In the two-step (semiquantitative) version of this instrument, an interviewer documented specific frequencies and portion-size information for the foods in each sorting category. A substudy of the two-step version with 96 CHS participants indicated relative validity similar to that of conventionally administered food-frequency questionnaires. The one-step version may be broadly applicable to situations in which general food-pattern data can be informative and cost and time limitations are great. When it is feasible, the two-step picture sort may offer certain methodologic advantages because respondents have a chance to change their responses and the format may simplify the cognitive-response task. Sorting or picture-sort procedures deserve systematic attention in research on dietary assessment methods.

Aged↗
PubMed1998

Soy intake and risk of breast cancer in Asians and Asian Americans.

Evidence from case-control studies suggests, although not entirely consistently, that soy intake may protect against breast cancer. The designs and findings of studies conducted in Asian women living in Japan, Singapore, China, and the United States are reviewed. Because of the considerably higher intake of soy by native Asians than by Asian Americans living in California and Hawaii, these studies investigated different segments of the dose-response relation between soy intake and breast cancer risk. Data are not sufficient to determine the amount or frequency of soy intake effective in protecting against breast cancer. Of concern is that soy intake may be homogeneously high in Asia, making it difficult to identify differences in breast cancer risk between high and moderate daily consumers. In studies conducted in Asian Americans, it is difficult to be certain that soy intake is not a marker of other factors related to Western lifestyle that are causally associated with risk of breast cancer. Additional studies assessing the role of soy and breast cancer are needed. These studies should assess intake of all food sources of soy, considering portion size as well as other dietary and nondietary factors that may confound the soy-breast cancer association. A better understanding of the mechanisms whereby soy intake may influence the risk of breast cancer is also needed. Dietary intervention studies with soy will provide information on the acute effects of soy on endogenous hormone concentrations. Cross-sectional and longitudinal studies are necessary to investigate the longer-term relations between hormone concentrations and soy intake in women.

Asian↗