Reproducibility and Relative Validity of a Food Frequency Questionnaire Developed for Adults in Taizhou,China

Objective

To evaluate the reproducibility and validity of a food frequency questionnaire (FFQ) developed to investigate the relationship between dietary factors and diseases in the adult Chinese population in East China.

Methods

A total of 78 males and 129 females aged 30–75 years completed four inconsecutive 24-hour dietary recalls (24-HRs, served as a reference method) and two FFQs (FFQ1 and FFQ2) over a nine-month interval. The reproducibility of the FFQ was estimated with correlation coefficients, cross-classification, and weighted kappa statistic. The validity was assessed by comparing the data obtained from FFQ and 24-HRs.

Results

The median nutrient intakes assessed with FFQs were higher than the average of four 24-HRs. For the food groups, Spearman, Pearson, and intraclass correlation coefficients between FFQ1 and FFQ2 ranged from 0.23 to 0.61, 0.27 to 0.64, and 0.26 to 0.65, respectively. For total energy and nutrient intakes, the corresponding coefficients ranged from 0.25 to 0.61, 0.28 to 0.64, and 0.28 to 0.62, respectively. The correlations between FFQ1 and FFQ2 for most nutrients decreased after adjustment with total energy intake. More than 70% of the subjects were classified into the same and adjacent categories by both FFQs. For food groups, the crude, energy-adjusted, and de-attenuated Spearman correlation coefficients between FFQ2 and the 24-HRs ranged from 0.17 to 0.59, 0.10 to 0.57, and 0.11 to 0.64, respectively. For total energy and nutrient intakes, the corresponding coefficients ranged from 0.20 to 0.58, 0.08 to 0.54, and 0.09 to 0.56, respectively. More than 67% of the subjects were classified into the same and adjacent categories by both instruments. Both weighted kappa statistic and Bland-Altman Plots showed reasonably acceptable agreement between the FFQ2 and 24-HRs.

Conclusion

The FFQ developed for adults in the Taizhou area is reasonably reliable and valid for assessment of most food and nutrient intakes.     

Reproducibility and relative validity of a food frequency questionnaire developed for female adolescents in Suihua, North China

Background

This study aims to evaluate the reproducibility and validity of a food frequency questionnaire (FFQ) developed for female adolescents in the Suihua area of North China. The FFQ was evaluated against the average of 24-hour dietary recalls (24-HRs).

Methodology/Principal Findings

A total of 168 female adolescents aged 12 to 18 completed nine three consecutive 24-HRs (one three consecutive 24 HRs per month) and two FFQs over nine months. The reproducibility of the FFQ was estimated using intraclass correlation coefficients (ICCs), and its relative validity was assessed by comparing it with the 24-HRs. The mean values of the 24-HRs were lower than those of the FFQs, except for protein (in FFQ1) and iron (in FFQ2). The ICCs for all nutrients and food groups in FFQ1 and FFQ2 were moderately correlated (0.4–0.8). However, all the ICCs decreased after adjusting for energy. The weighted κ statistic showed moderate agreement (0.40–0.6) for all nutrients and food groups, except for niacin and calcium, which showed poor agreement (0.35). The relative validity results indicate that the crude Spearman''s correlation coefficients of FFQ1 and the 24-HRs ranged from 0.41 (for Vitamin C) to 0.65 (for fruit). The coefficients of each nutrient and food group in FFQ2 and the 24-HRs were higher than those in FFQ1 and the 24-HRs, indicating good correlation. Although all energy-adjusted Spearman''s correlation coefficients were lower than the crude coefficients, de-attenuation to correct for intra-individual variability improved the correlation coefficients. The weighted κ coefficients of nutrients and food groups ranged from 0.32 for beans to 0.52 for riboflavin in FFQ1 and the 24-HRs, and 0.32 for Vitamin C to 0.54 for riboflavin in FFQ2 and the 24-HRs.

Conclusion

The FFQ developed for female adolescents in the Suihua area is a reliable and valid instrument for ranking individuals within this study.     

Added Sugar,Macro- and Micronutrient Intakes and Anthropometry of Children in a Developing World Context

Objective

The objective of this study was to determine the relationship between added sugar and dietary diversity, micronutrient intakes and anthropometric status in a nationally representative study of children, 1–8.9 years of age in South Africa.

Methods

Secondary analysis of a national survey of children (weighted n = 2,200; non weighted n = 2818) was undertaken. Validated 24-hour recalls of children were collected from mothers/caregivers and stratified into quartiles of percentage energy from added sugar (% EAS). A dietary diversity score (DDS) using 9 food groups, a food variety score (FVS) of individual food items, and a mean adequacy ratio (MAR) based on 11 micronutrients were calculated. The prevalence of stunting and overweight/obesity was also determined.

Results

Added sugar intake varied from 7.5–10.3% of energy intake for rural and urban areas, respectively. Mean added sugar intake ranged from 1.0% of energy intake in Quartile 1 (1–3 years) (Q1) to 19.3% in Q4 (4–8 years). Main sources of added sugar were white sugar (60.1%), cool drinks (squash type) (10.4%) and carbonated cool drinks (6.0%). Added sugar intake, correlated positively with most micronutrient intakes, DDS, FVS, and MAR. Significant negative partial correlations, adjusted for energy intake, were found between added sugar intake and intakes of protein, fibre, thiamin, pantothenic acid, biotin, vitamin E, calcium (1–3 years), phosphorus, iron (4–8 years), magnesium and zinc. The prevalence of overweight/obesity was higher in children aged 4–8 years in Q4 of %EAS than in other quartiles [mean (95%CI) % prevalence overweight 23.0 (16.2–29.8)% in Q4 compared to 13.0 (8.7–17.3)% in Q1, p = 0.0063].

Conclusion

Although DDS, FVS, MAR and micronutrient intakes were positively correlated with added sugar intakes, overall negative associations between micronutrients and added sugar intakes, adjusted for dietary energy, indicate micronutrient dilution. Overweight/obesity was increased with higher added sugar intakes in the 4–8 year old children.     

Energy Intake and Physical Activity in Pima Indians: Comparison with Energy Expenditure Measured by Doubly-Labeled Water

To test the validity of survey techniques for measuring diet and activity patterns of Pima Indians, sequential 24-hour recalls, a food frequency ques tionnaire (FFQ), and an activity questionnaire were compared to free-living energy expenditure. Total energy expenditure (TEE) measured by doubly labeled water was 13.27 ± 2.95 MJ/d for the 12 males (mean±SD: 35 ± 14 yr; 97 ± 35 kg; 32 + 9% body fat) and 11.67 ± 1.85 MJ/d for the 9 females (31 ± 13 yr; 106 ± 32 kg; 49 ± 6% body fat). Energy intake assessed by 24-hour recall was 13.59 ± 7.81 MJ/d for men and 9.29 ± 2.77 MJ/d for women, compared to 12.84 ± 2.85 and 9.40 ± 2.61 MJ/d for men and women, respectively, by FFQ. Both dietary methods indicated significant underreporting by women when compared to TEE. Energy intake assessed by FFQ was significantly correlated with TEE (r=0.48, p=0.03). This was true with 24-hour recall energy intake only when data from two extremely large alcohol consumers were eliminated (r=0.64, p=0.03, N=19). Although a low level of activity was apparent, the activity questionnaire produced significant correlations with measurements of energy expenditure and therefore represents an important tool for examining the relationship between physical activity and diseases.     

Vitamin D Intake,Month the Mammogram Was Taken and Mammographic Density in Norwegian Women Aged 50–69

BackgroundThe role of vitamin D in breast cancer etiology is unclear. There is some, but inconsistent, evidence that vitamin D is associated with both breast cancer risk and mammographic density (MD). We evaluated the associations of MD with month the mammogram was taken, and with vitamin D intake, in a population of women from Norway—a country with limited sunlight exposure for a large part of the year.Methods3114 women aged 50–69, who participated in the Norwegian Breast Cancer Screening Program (NBCSP) in 2004 or 2006/07, completed risk factor and food frequency (FFQ) questionnaires. Dietary and total (dietary plus supplements) vitamin D, calcium and energy intakes were estimated by the FFQ. Month when the mammogram was taken was recorded on the mammogram. Percent MD was assessed using a computer assisted method (Madena, University of Southern California) after digitization of the films. Linear regression models were used to investigate percent MD associations with month the mammogram was taken, and vitamin D and calcium intakes, adjusting for age, body mass index (BMI), study year, estrogen and progestin therapy (EPT), education, parity, calcium intakes and energy intakes.ResultsThere was no statistical significant association between the month the mammogram was taken and percent MD. Overall, there was no association between percent MD and quartiles of total or dietary vitamin D intakes, or of calcium intake. However, analysis restricted to women aged <55 years revealed a suggestive inverse association between total vitamin D intake and percent MD (p for trend = 0.03).ConclusionOverall, we found no strong evidence that month the mammogram was taken was associated with percent MD. We found no inverse association between vitamin D intake and percent MD overall, but observed a suggestive inverse association between dietary vitamin D and MD for women less than 55 years old.     

Taxed and untaxed beverage intake by South African young adults after a national sugar-sweetened beverage tax: A before-and-after study

BackgroundIn an effort to prevent and reduce the prevalence rate of people with obesity and diabetes, South Africa implemented a sugar-content-based tax called the Health Promotion Levy in April 2018, one of the first sugar-sweetened beverage (SSB) taxes to be based on each gram of sugar (beyond 4 g/100 ml). This before-and-after study estimated changes in taxed and untaxed beverage intake 1 year after the tax, examining separately, to our knowledge for the first time, the role of reformulation distinct from behavioral changes in SSB intake.Methods and findingsWe collected single-day 24-hour dietary recalls from repeat cross-sectional surveys of adults aged 18–39 years in Langa, South Africa. Participants were recruited in February–March 2018 (pre-tax, n = 2,459) and February–March 2019 (post-tax, n = 2,489) using door-to-door sampling. We developed time-specific food composition tables (FCTs) for South African beverages before and after the tax, linked with the diet recalls. By linking pre-tax FCTs only to dietary intake data collected in the pre-tax and post-tax periods, we calculated changes in beverage intake due to behavioral change, assuming no reformulation. Next, we repeated the analysis using an updated FCT in the post-tax period to capture the marginal effect of reformulation. We estimated beverage intake using a 2-part model that takes into consideration the biases in using ordinary least squares or other continuous variable approaches with many individuals with zero intake. First, a probit model was used to estimate the probability of consuming the specific beverage category. Then, conditional on a positive outcome, a generalized linear model with a log-link was used to estimate the continuous amount of beverage consumed. Among taxed beverages, sugar intake decreased significantly (p < 0.0001) from 28.8 g/capita/day (95% CI 27.3–30.4) pre-tax to 19.8 (95% CI 18.5–21.1) post-tax. Energy intake decreased (p < 0.0001) from 121 kcal/capita/day (95% CI 114–127) pre-tax to 82 (95% CI 76–87) post-tax. Volume intake decreased (p < 0.0001) from 315 ml/capita/day (95% CI 297–332) pre-tax to 198 (95% CI 185–211) post-tax. Among untaxed beverages, sugar intake increased (p < 0.0001) by 5.3 g/capita/day (95% CI 3.7 to 6.9), and energy intake increased (p < 0.0001) by 29 kcal/capita/day (95% CI 19 to 39). Among total beverages, sugar intake decreased significantly (p = 0.004) by 3.7 (95% CI −6.2 to −1.2) g/capita/day. Behavioral change accounted for reductions of 24% in energy, 22% in sugar, and 23% in volume, while reformulation accounted for additional reductions of 8% in energy, 9% in sugar, and 14% in volume from taxed beverages. The key limitations of this study are an inability to make causal claims due to repeat cross-sectional data collection, and that the magnitude of reduction in taxed beverage intake may not be generalizable to higher income populations.ConclusionsUsing a large sample of a high-consuming, low-income population, we found large reductions in taxed beverage intake, separating the components of behavioral change from reformulation. This reduction was partially compensated by an increase in sugar and energy from untaxed beverages. Because policies such as taxes can incentivize reformulation, our use of an up-to-date FCT that reflects a rapidly changing food supply is novel and important for evaluating policy effects on intake.

Rina Swart and co-authors use real world data to demonstrate that sugar-sweetened beverage tax was associated with reduced sugary drink intake in a low-income population within a middle-income country.     

Relationships between Dietary Fat,Body Fat,and Serum Lipid Profile in Prepubertal Children

KU, CHING YI, BARBARA A. GOWER, TIM R. NAGY, MICHAEL I. GORAN. Relationships between dietary fat, body fat, and serum lipid profile in prepubertal children. Obes Res. 1998;6:400–407. Objective : The purpose of the study was to test the hypothesis that dietary fat components were associated with the serum lipid profile independent of ethnicity, body fat, and fat distribution in prepubertal children. Research Methods and Procedures : Sixty-six children (45 African American and 21 Caucasian), aged from 4 to 10 years, were recruited into the study. Dietary total fat, saturated fat, monounsaturated fat, and polyunsaturated fat were estimated by averaging two 24-hour diet recalls. Fasting serum triacylglycerol, total cholesterol, and high-density lipoprotein cholesterol were analyzed, and low-density lipoprotein cholesterol (LDL-C) was calculated by the method of Friedewald. Body composition and fat distribution were measured by dual energy X-ray absorptiometry and computed tomography. Results : Children in both ethnic groups tended to overreport their dietary intake relative to total energy expenditure by 18%. African American children consumed more energy from total fat (35.3% vs. 31.5%, p<0.05), saturated fat (13.7% vs 12.2%, p<0.05), protein (16.4% vs. 13.2%, p = 0.02), and less from carbohydrate (48% vs. 57.1%, p<0.01) than Caucasian children. There was no significant correlation between dietary fat and either serum lipids or body fat indices after adjusting for nonfat energy intake and total lean tissue mass. Total body fat (r = 0.32), subcutaneous abdominal adipose tissue (r = 0.39), and intraabdominal adipose tissue (r = 0.42) were positively related to serum triacylglycerol; these associations remained significant in a multiple linear regression model in which body fat indices were adjusted for ethnicity, total lean tissue, dietary total fat, and nonfat intake. Discussion : Our results do not support a link between dietary fat and serum lipids; instead, our data suggest that body fat may play a more important role than dietary fat in the course of cardiovascular disease development in prepubertal children.     

Dietary Adequacies among South African Adults in Rural KwaZulu-Natal

Background

Food quality, determined by micronutrient content, is a stronger determinant of nutritional status than food quantity. Health concerns resulting from the co-existence of over-nutrition and under-nutrition in low income populations in South Africa have been fully recognized in the last two decades. This study aimed to further investigate dietary adequacy amongst adults in rural KwaZulu-Natal, by determining daily energy and nutrient intakes, and identifying the degree of satisfaction of dietary requirements.

Methods

Cross-sectional study assessing dietary adequacy from 24-hour dietary recalls of randomly selected 136 adults in Empangeni, KwaZulu-Natal, South Africa.

Results

Results are presented for men (n = 52) and women (n = 84) 19–50 and >50 years old. Mean energy intake was greatest in women >50 years (2852 kcal/day) and exceeded Dietary Reference Intake’s for both men and women, regardless of age. Mean daily energy intake from carbohydrates was 69% for men and 67% for women, above the Dietary Reference Intake range of 45–65%. Sodium was also consumed in excess, and the Dietary Reference Intakes of vitamins A, B12, C, D, and E, calcium, zinc and pantothenic acid were not met by the majority of the population.

Conclusion

Despite mandatory fortification of staple South African foods, micronutrient inadequacies are evident among adults in rural South African communities. Given the excess caloric intake and the rising prevalence of obesity and other non-communicable diseases in South Africa, a focus on diet quality may be a more effective approach to influence micronutrient status than a focus on diet quantity.     

Dietary Pattern and Its Association with the Prevalence of Obesity and Related Cardiometabolic Risk Factors among Chinese Children

Background

The association of dietary pattern with chronic diseases has been investigated widely in western countries. However, information is quite limited among children in China. Our study is aimed to identify the dietary patterns of Chinese children and examine their association with obesity and related cardiometabolic risk factors.

Methods

A total of 5267 children were selected using multistage random sampling from 30 primary schools of 5 provincial capital cities in China. Dietary intake was derived from 24 hour dietary recall for three consecutive days. Anthropometric measurements, glucose and lipid profiles were obtained. Factor analysis combined with cluster analysis was used for identifying major dietary patterns. The associations of dietary patterns with obesity and related cardiometabolic risk factors were examined by logistic regression analysis.

Results

Three mutually exclusive dietary patterns were identified, which were labeled as the healthy dietary pattern, the transitive dietary pattern, and the Western dietary pattern. Compared with children of the healthy dietary pattern, the multiple-adjusted odds ratios (95% confidence interval (CI)) of obesity were 1.11 (0.89–1.38) for children with the transitive dietary pattern and 1.80 (1.15–2.81) for children with the Western dietary pattern, which was 1.31 (95%CI 1.09–1.56) and 1.71 (95%CI: 1.13–2.56), respectively, for abdominal obesity. The Western dietary pattern was associated with significantly higher concentrations of low-density lipoprotein cholesterol (P<.001), triglycerides (P<.001), systolic blood pressure (P = 0.0435) and fasting glucose (P = 0.0082) and a lower concentration of high-density lipoprotein cholesterol (P = 0.0023), as compared with the healthy dietary pattern.

Conclusions

The Western dietary pattern characterized by red meat, eggs, refined grain and products, was positively associated with odds of obesity, the levels of plasma glucose, low-density lipoprotein cholesterol and triglycerides, and was inversely associated with the level of high-density lipoprotein cholesterol.     

The Growth Attainment,Hematological, Iron Status and Inflammatory Profile of Guatemalan Juvenile End-Stage Renal Disease Patients

BackgroundStunting, anemia and inflammation are frequently observed in children with end-stage renal disease (ESRD).ObjectivesTo assess anthropometric, hematological and inflammatory data and to study their potential interrelationship in Guatemalan juveniles undergoing hemodialysis (HD) and peritoneal dialysis (PD).Methods54 juveniles 7–20 years of age were recruited in FUNDANIER, Guatemala City: 27 on HD and 27 PD. Hemoglobin, serum iron, transferrin, serum transferrin receptor (sTfR), serum ferritin, transferrin saturation and iron-binding capacity, white blood cell count (WBC), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), as well as IL-6, IL-1 and TNF-α, weight and height were determined by standard methods. Hepcidin–25 (Hep-25) was assessed by weak cation exchange time-of-flight mass-spectrometry.Results92% and 55% of HD and PD children, respectively, were stunted and 95% and 85% were anemic. Among iron status biomarkers, serum ferritin was massively increased and significantly higher in the HD group compared to the PD group. Hep-25 was also greatly elevated in both groups. 41% of HD patients showed increments in three or more inflammatory biomarkers, while it was 2 or less in all PD subjects.ConclusionsThe degree of stunting, the prevalence and severity of anemia in Guatemalan juvenile ESRD far exceed the national statistics for this low-income Central American country. Ferritin and Hep-25 concentrations were elevated, with the latter to an extraordinary magnitude. Additional biomarkers of inflammation not directly related to iron status were elevated as well. The role of both disease- and environment-related factors in combination best explains the magnitude of the biomarker abnormalities.     

The Impact of Macronutrients on Retinal Microvasculature among Singapore Pregnant Women during the Mid-Late Gestation

BackgroundImbalanced macronutrient intakes can induce impairment of endothelial and vascular function, and further lead to metabolic and cardiovascular disease. However, little is known about the influence of such diets on endothelial and vascular dysfunction in pregnant women, even though high-fat diet is a known risk for pregnancy complications such as gestational diabetes and pre-eclampsia.ObjectiveWe aimed to assess the association between maternal macronutrient intakes (protein, fat and carbohydrates), dietary quality and retinal microvascular changes in a multi-ethnic Asian mother-offspring cohort.MethodsPregnant women (n = 614) with singleton pregnancies were recruited during their first trimester from June 2009 to Sep 2010. Maternal diet quality and macronutrient intakes, expressed as a percentage of total energy during pregnancy, were ascertained using 24 hr recalls and 3 d food diaries at 26–28 weeks gestation. Retinal examination was completed at the same clinic visit. Dietary quality was assessed and scored using the Health Eating Index in Asian Pregnant women (HEI-AP), while macronutrients intakes ware expressed as percentages of total energy and further log transformed for analysis. Associations were examined cross-sectionally by substitution models with the use of multiple linear regression.ResultsIn adjusted model, each 20 points decrease in HEI-AP score was associated with a significant increase of 1.70 μm (p<0.05) in retinal venular calibre. Each 0.1 log increase in percentage of total fat intake was associated with a significant increment of 1.84 μm (p<0.05) in retinal venular caliber. Additionally, each 0.1 log increase in percentage of mono-unsaturated fat intake was associated with an increment of 1.84 μm (p<0.01) in retinal venular caliber.ConclusionsIn this cross-sectional study, we found that women with higher fat and lower protein intakes, and lower diet quality tended to have wider retinal venular caliber, which is suggestive of suboptimal microvasculature.     

Development of a culturally sensitive food frequency questionnaire for use in the Southern Community Cohort Study.

A food frequency questionnaire (FFQ) was developed to assess long-term habitual dietary intake in a cohort of approximately 100,000 40 to 79 year-old men and women living in the Southeastern US. Using the NHANES-III database for the southem region for specific race and sex subgroups, a list of 262 food categories was developed, coded and reduced to 102 food items that could discriminate between racial groups and account for large portions of cancer-relevant nutrients. The developed FFQ was tested in a pilot study in three southeastern states involving 239 African Americans and Whites, aged 56.9 +/- 12.2 years. The frequencies of consumption and portion sizes of the 102 foods were determined and intakes of various nutrients were estimated and compared with the NHANES-III data. African Americans reported higher total energy intakes and higher consumption of macronutrients and several micronutrients, compared to Whites. Estimated nutrient indices were higher among pilot study than among NHANES-III participants, although adjustment for total energy essentially eliminated the differences. Analysis of the frequency distribution of individual foods shows that the questionnaire includes commonly eaten foods that can discriminate between African Americans and Whites. The FFQ is currently being calibrated within the cohort study population.     

Validation of overweight children's fruit and vegetable intake using plasma carotenoids

Assessing dietary intake in children is difficult and limited validated tools exist. Plasma carotenoids are nutritional biomarkers of fruit and vegetable intake and therefore suitable to validate reported dietary intakes. The aim of this study was to examine the comparative validity of a food frequency questionnaire (FFQ), completed by parents reporting child fruit and vegetable intake compared to plasma carotenoid concentrations. A sample of children aged 5-12 years (n = 93) from a range of weight categories were assessed. Dietary intake was measured using a 137-item semi-quantitative FFQ. Plasma carotenoids were measured using reverse phase high-performance liquid chromatography. Pearson correlation coefficients between reported dietary intake of carotenoids and plasma carotenoid concentrations were strongest after adjustment for BMI (beta-carotene (r = 0.56, P < 0.05), alpha-carotene (r = 0.51, P < 0.001), cryptoxanthin (r = 0.32, P < 0.001)). Significantly lower levels (P < 0.05) of all plasma carotenoids, except lutein, were found among overweight and obese children when compared to healthy weight children. Parental report of children's carotenoid intakes, using a FFQ can be used to provide a relative validation of fruit and vegetable intake. The lower plasma carotenoid concentrations found in overweight and obese children requires further investigation.     

A High Dietary Glycemic Index Increases Total Mortality in a Mediterranean Population at High Cardiovascular Risk

Objective

Different types of carbohydrates have diverse glycemic response, thus glycemic index (GI) and glycemic load (GL) are used to assess this variation. The impact of dietary GI and GL in all-cause mortality is unknown. The objective of this study was to estimate the association between dietary GI and GL and risk of all-cause mortality in the PREDIMED study.

Material and Methods

The PREDIMED study is a randomized nutritional intervention trial for primary cardiovascular prevention based on community-dwelling men and women at high risk of cardiovascular disease. Dietary information was collected at baseline and yearly using a validated 137-item food frequency questionnaire (FFQ). We assigned GI values of each item by a 5-step methodology, using the International Tables of GI and GL Values. Deaths were ascertained through contact with families and general practitioners, review of medical records and consultation of the National Death Index. Cox regression models were used to estimate multivariable-adjusted hazard ratios (HR) and their 95% CI for mortality, according to quartiles of energy-adjusted dietary GI/GL. To assess repeated measures of exposure, we updated GI and GL intakes from the yearly FFQs and used Cox models with time-dependent exposures.

Results

We followed 3,583 non-diabetic subjects (4.7 years of follow-up, 123 deaths). As compared to participants in the lowest quartile of baseline dietary GI, those in the highest quartile showed an increased risk of all-cause mortality [HR = 2.15 (95% CI: 1.15–4.04); P for trend  = 0.012]. In the repeated-measures analyses using as exposure the yearly updated information on GI, we observed a similar association. Dietary GL was associated with all-cause mortality only when subjects were younger than 75 years.

Conclusions

High dietary GI was positively associated with all-cause mortality in elderly population at high cardiovascular risk.     

Development of a Quantitative Food Frequency Questionnaire for Use among the Yup'ik People of Western Alaska

Alaska Native populations are experiencing a nutrition transition and a resulting decrease in diet quality. The present study aimed to develop a quantitative food frequency questionnaire to assess the diet of the Yup''ik people of Western Alaska. A cross-sectional survey was conducted using 24-hour recalls and the information collected served as a basis for developing a quantitative food frequency questionnaire. A total of 177 males and females, aged 13-88, in six western Alaska communities, completed up to three 24-hour recalls as part of the Alaska Native Dietary and Subsistence Food Assessment Project. The frequency of the foods reported in the 24-hour recalls was tabulated and used to create a draft quantitative food frequency questionnaire, which was pilot tested and finalized with input from community members. Store-bought foods high in fat and sugar were reported more frequently than traditional foods. Seven of the top 26 foods most frequently reported were traditional foods. A 150-item quantitative food frequency questionnaire was developed that included 14 breads and crackers; 3 cereals; 11 dairy products; 69 meats, poultry and fish; 13 fruit; 22 vegetables; 9 desserts and snacks; and 9 beverages. The quantitative food frequency questionnaire contains 39 traditional food items. This quantitative food frequency questionnaire can be used to assess the unique diet of the Alaska Native people of Western Alaska. This tool will allow for monitoring of dietary changes over time as well as the identification of foods and nutrients that could be promoted in a nutrition intervention program intended to reduce chronic disease.     

Models of Individual Dietary Behavior Based on Smartphone Data: The Influence of Routine,Physical Activity,Emotion, and Food Environment

IntroductionSmartphone applications (apps) facilitate the collection of data on multiple aspects of behavior that are useful for characterizing baseline patterns and for monitoring progress in interventions aimed at promoting healthier lifestyles. Individual-based models can be used to examine whether behavior, such as diet, corresponds to certain typological patterns. The objectives of this paper are to demonstrate individual-based modeling methods relevant to a person’s eating behavior, and the value of such approach compared to typical regression models.MethodUsing a mobile app, 2 weeks of physical activity and ecological momentary assessment (EMA) data, and 6 days of diet data were collected from 12 university students recruited from a university in Kunming, a rapidly developing city in southwest China. Phone GPS data were collected for the entire 2-week period, from which exposure to various food environments along each subject’s activity space was determined. Physical activity was measured using phone accelerometry. Mobile phone EMA was used to assess self-reported emotion/feelings. The portion size of meals and food groups was determined from voice-annotated videos of meals. Individual-based regression models were used to characterize subjects as following one of 4 diet typologies: those with a routine portion sizes determined by time of day, those with portion sizes that balance physical activity (energy balance), those with portion sizes influenced by emotion, and those with portion sizes associated with food environments.ResultsAmple compliance with the phone-based behavioral assessment was observed for all participants. Across all individuals, 868 consumed food items were recorded, with fruits, grains and dairy foods dominating the portion sizes. On average, 218 hours of accelerometry and 35 EMA responses were recorded for each participant. For some subjects, the routine model was able to explain up to 47% of the variation in portion sizes, and the energy balance model was able to explain over 88% of the variation in portion sizes. Across all our subjects, the food environment was an important predictor of eating patterns. Generally, grouping all subjects into a pooled model performed worse than modeling each individual separately.ConclusionA typological modeling approach was useful in understanding individual dietary behaviors in our cohort. This approach may be applicable to the study of other human behaviors, particularly those that collect repeated measures on individuals, and those involving smartphone-based behavioral measurement.     

Weighted normality-based estimator in correcting correlation coefficient estimation between incomplete nutrient measurements

Consider the problem of estimating the correlation between two nutrient measurements, such as the percent energy from fat obtained from a food frequency questionnaire (FFQ) and that from repeated food records or 24-hour recalls. Under a classical additive model for repeated food records, it is known that there is an attenuation effect on the correlation estimation if the sample average of repeated food records for each subject is used to estimate the underlying long-term average. This paper considers the case in which the selection probability of a subject for participation in the calibration study, in which repeated food records are measured, depends on the corresponding FFQ value, and the repeated longitudinal measurement errors have an autoregressive structure. This paper investigates a normality-based estimator and compares it with a simple method of moments. Both methods are consistent if the first two moments of nutrient measurements exist. Furthermore, joint estimating equations are applied to estimate the correlation coefficient and related nuisance parameters simultaneously. This approach provides a simple sandwich formula for the covariance estimation of the estimator. Finite sample performance is examined via a simulation study, and the proposed weighted normality-based estimator performs well under various distributional assumptions. The methods are applied to real data from a dietary assessment study.     

Regular Breakfast Consumption and Type 2 Diabetes Risk Markers in 9- to 10-Year-Old Children in the Child Heart and Health Study in England (CHASE): A Cross-Sectional Analysis

Background

Regular breakfast consumption may protect against type 2 diabetes risk in adults but little is known about its influence on type 2 diabetes risk markers in children. We investigated the associations between breakfast consumption (frequency and content) and risk markers for type 2 diabetes (particularly insulin resistance and glycaemia) and cardiovascular disease in children.

Methods and Findings

We conducted a cross-sectional study of 4,116 UK primary school children aged 9–10 years. Participants provided information on breakfast frequency, had measurements of body composition, and gave fasting blood samples for measurements of blood lipids, insulin, glucose, and glycated haemoglobin (HbA1c). A subgroup of 2,004 children also completed a 24-hour dietary recall. Among 4,116 children studied, 3,056 (74%) ate breakfast daily, 450 (11%) most days, 372 (9%) some days, and 238 (6%) not usually. Graded associations between breakfast frequency and risk markers were observed; children who reported not usually having breakfast had higher fasting insulin (percent difference 26.4%, 95% CI 16.6%–37.0%), insulin resistance (percent difference 26.7%, 95% CI 17.0%–37.2%), HbA1c (percent difference 1.2%, 95% CI 0.4%–2.0%), glucose (percent difference 1.0%, 95% CI 0.0%–2.0%), and urate (percent difference 6%, 95% CI 3%–10%) than those who reported having breakfast daily; these differences were little affected by adjustment for adiposity, socioeconomic status, and physical activity levels. When the higher levels of triglyceride, systolic blood pressure, and C-reactive protein for those who usually did not eat breakfast relative to those who ate breakfast daily were adjusted for adiposity, the differences were no longer significant. Children eating a high fibre cereal breakfast had lower insulin resistance than those eating other breakfast types (p for heterogeneity <0.01). Differences in nutrient intakes between breakfast frequency groups did not account for the differences in type 2 diabetes markers.

Conclusions

Children who ate breakfast daily, particularly a high fibre cereal breakfast, had a more favourable type 2 diabetes risk profile. Trials are needed to quantify the protective effect of breakfast on emerging type 2 diabetes risk. Please see later in the article for the Editors'' Summary     

Do More Active Children Sleep More? A Repeated Cross-Sectional Analysis Using Accelerometry

Aim

To determine whether levels of daytime physical activity are associated with sleep duration and night waking in children assessed using accelerometry, and if these associations change over time.

Methods

24-hour accelerometry data were obtained from 234 children at 3, 5 and 7 years of age for at least 5 days at each time. Sleep duration was estimated using the Sadeh algorithm. Time spent in sedentary, light and moderate-vigorous (MVPA) activity was established using published cut-points. Appropriate statistical techniques were utilised to account for the closed nature of the data (24-hour periods).

Results

Time spent asleep was related more to sedentary or light activity and not to MVPA. The most active (95^th percentile) children spent 55–84 fewer minutes asleep and 16–19 more minutes awake at night compared to the least active (5^th percentile) children. Children with later bedtimes slept less at night (30–40 minutes) and undertook more sedentary (10–15 minutes) but also more light (18–23 minutes) activity during the day. However, no differences in MVPA were apparent according to bedtime. Children slept slightly less on weekend nights (11 minutes) compared with week-nights, but only at 3 years of age. Most relationships were broadly similar at 3, 5 and 7 years of age.

Conclusion

Children who are more physically active during the day have shorter total sleep time and are more awake at night than less active children. The protective effect of sleep on obesity does not appear to be mediated by increased physical activity.     

Biological Status and Dietary Intakes of Iron,Zinc and Vitamin A among Women and Preschool Children in Rural Burkina Faso

Background

Food-based approaches such as biofortification are meant to sustainably address micronutrient deficiencies in poor settings. Knowing more about micronutrient intakes and deficiencies is a prerequisite to designing and evaluating interventions.

Objective

The objectives of the study were to assess biological status and dietary intakes of iron, zinc and vitamin A among women and children aged 36–59 months in rural Burkina Faso and to study relationships between intake and status to better inform future food-based interventions.

Design

A cross-sectional survey was carried out in two rural provinces of Burkina Faso on a random cluster sample of 480 mother-child pairs. Dietary data was obtained by 24-hour recalls repeated on a random sub-selection of 37.5% of subjects to allow calculation of nutrient’s probability of adequacy (PA). Biomarkers were measured on a sub-sample of 180 mother-child pairs. Blood samples were analyzed for hemoglobin, serum ferritin, soluble transferrin receptors (sTfR), C-reactive protein, alpha-1-glycoprotein, serum zinc concentration (SZnC) and retinol. For each micronutrient the relationship between biomarker and dietary intake was investigated by multiple linear regression models accounting for inflammatory biomarkers.

Results

Mean PA for iron, zinc and vitamin A was 0.49, 0.87 and 0.21 among women and 0.61, 0.95 and 0.33 among children, respectively. Prevalence of anemia, corrected low serum ferritin and high sTfR was 37.6%, 4.0% and 77.5% among women and 72.1%, 1.5% and 87.6% among children, respectively. Prevalence of low SZnC and corrected low serum retinol was 39.4% and 12.0% among women and 63.7% and 24.8% among children, respectively. There was a tendency for a positive relationship between vitamin A intakes and serum retinol among women (β = 0.0003, P = 0.06). Otherwise, no link was found between micronutrients biomarkers and intakes.

Conclusion

Our study depicted different images of micronutrient deficiencies when based on dietary intakes or biomarkers results, thus highlighting the need for more suitable biomarkers and more precise measures of absorbable micronutrient intakes at the individual level. It thus points to challenges in the design and evaluation of future biofortification or other food-based interventions in rural areas of Burkina Faso.