Linear measurement error models with restricted sampling

The relationship between nutrient consumption and chronic disease risk is the focus of a large number of epidemiological studies where food frequency questionnaires (FFQ) and food records are commonly used to assess dietary intake. However, these self-assessment tools are known to involve substantial random error for most nutrients, and probably important systematic error as well. Study subject selection in dietary intervention studies is sometimes conducted in two stages. At the first stage, FFQ-measured dietary intakes are observed and at the second stage another instrument, such as a 4-day food record, is administered only to participants who have fulfilled a prespecified criterion that is based on the baseline FFQ-measured dietary intake (e.g., only those reporting percent energy intake from fat above a prespecified quantity). Performing analysis without adjusting for this truncated sample design and for the measurement error in the nutrient consumption assessments will usually provide biased estimates for the population parameters. In this work we provide a general statistical analysis technique for such data with the classical additive measurement error that corrects for the two sources of bias. The proposed technique is based on multiple imputation for longitudinal data. Results of a simulation study along with a sensitivity analysis are presented, showing the performance of the proposed method under a simple linear regression model.     

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.     

Intake of dietary fats and colorectal cancer risk: Prospective findings from the UK Dietary Cohort Consortium

Introduction: Epidemiologic evidence for an association between colorectal cancer (CRC) risk and total dietary fat, saturated fat (SF), monounsaturated fat (MUFA) and polyunsaturated fat (PUFA) is inconsistent. Previous studies have used food frequency questionnaires (FFQ) to assess diet, but data from food diaries may be less prone to severe measurement error than data from FFQ. Methods: We conducted a case–control study nested within seven prospective UK cohort studies, comprising 579 cases of incident CRC and 1996 matched controls. Standardized dietary data from 4- to 7-day food diaries and from FFQ were used to estimate odds ratios for CRC risk associated with intake of fat and subtypes of fat using conditional logistic regression. We also calculated multivariate measurement error corrected odds ratios for CRC using repeated food diary measurements. Results: We observed no associations between intakes of total dietary fat or types of fat and CRC risk, irrespective of whether dietary data were obtained using food diaries or FFQ. Conclusion: Our results do not support the hypothesis that intakes of total dietary fat, SF, MUFA or PUFA are linked to risk of CRC.     

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.     

Binary regression in truncated samples, with application to comparing dietary instruments in a large prospective study

Summary .   We examine two issues of importance in nutritional epidemiology: the relationship between dietary fat intake and breast cancer, and the comparison of different dietary assessment instruments, in our case the food frequency questionnaire (FFQ) and the multiple-day food record (FR). The data we use come from women participants in the control group of the Dietary Modification component of the Women's Health Initiative (WHI) Clinical Trial. The difficulty with the analysis of this important data set is that it comes from a truncated sample, namely those women for whom fat intake as measured by the FFQ amounted to 32% or more of total calories. We describe methods that allow estimation of logistic regression parameters in such samples, and also allow comparison of different dietary instruments. Because likelihood approaches that specify the full multivariate distribution can be difficult to implement, we develop approximate methods for both our main problems that are simple to compute and have high efficiency. Application of these approximate methods to the WHI study reveals statistically significant fat and breast cancer relationships when a FR is the instrument used, and demonstrate a marginally significant advantage of the FR over the FFQ in the local power to detect such relationships.     

A zero‐augmented generalized gamma regression calibration to adjust for covariate measurement error: A case of an episodically consumed dietary intake

Measurement error in exposure variables is a serious impediment in epidemiological studies that relate exposures to health outcomes. In nutritional studies, interest could be in the association between long‐term dietary intake and disease occurrence. Long‐term intake is usually assessed with food frequency questionnaire (FFQ), which is prone to recall bias. Measurement error in FFQ‐reported intakes leads to bias in parameter estimate that quantifies the association. To adjust for bias in the association, a calibration study is required to obtain unbiased intake measurements using a short‐term instrument such as 24‐hour recall (24HR). The 24HR intakes are used as response in regression calibration to adjust for bias in the association. For foods not consumed daily, 24HR‐reported intakes are usually characterized by excess zeroes, right skewness, and heteroscedasticity posing serious challenge in regression calibration modeling. We proposed a zero‐augmented calibration model to adjust for measurement error in reported intake, while handling excess zeroes, skewness, and heteroscedasticity simultaneously without transforming 24HR intake values. We compared the proposed calibration method with the standard method and with methods that ignore measurement error by estimating long‐term intake with 24HR and FFQ‐reported intakes. The comparison was done in real and simulated datasets. With the 24HR, the mean increase in mercury level per ounce fish intake was about 0.4; with the FFQ intake, the increase was about 1.2. With both calibration methods, the mean increase was about 2.0. Similar trend was observed in the simulation study. In conclusion, the proposed calibration method performs at least as good as the standard method.     

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.     

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.     

Dietary intake of nickel and zinc by young children – Results from food duplicate portion measurements in comparison to data calculated from dietary records and available data on levels in food groups

The daily dietary intake of nickel (Ni) and zinc (Zn) by 42 young children, 21 boys and 21 girls, from 4 to 7 years of age, living in urban and rural areas of Germany and having different food consumption behaviour, was determined by the duplicate method with a 7-day sampling period. Dietary records were also kept by the children's parents for the 7-day sampling period. Individual reported food items were identified, assigned to food groups and, together with known Ni and Zn concentrations of foodstuffs, daily intake rates were calculated. The same method was used for calculations of the energy, fat, protein and carbohydrate intake rates.The levels in the food duplicates, determined by atomic absorption spectrometry, were in the range of 69–2000 μg Ni/kg_{dry weight} (geometric mean (GM): 348) and 7.1–43 mg Zn/kg_{dry weight} (GM: 17.5). Daily intake rates based on the 294 individual food duplicate analyses were 12–560 μg Ni/d (GM: 92.3) and 1.5–11 mg Zn/d (GM: 4.63). The results from the dietary records were 35–1050 μg Ni/d (GM: 123) and 1.7–15 mg Zn/d (GM: 5.35).The results of the daily intake rates from both methods showed a correlation with regard to Zn (r=0.56), but no correlation was found between either the Ni intake rates determined with both methods or between the Ni intake rates measured by the duplicate method and calculated intake rates from the dietary records of energy, fat, protein, carbohydrates or drinking water. In the case of nickel, the discrepancies between the methods lead one to suppose that the main factors influencing Ni intake by food are not directly caused by easily assessable food ingredients themselves. It is possible that other factors, such as contaminated drinking water or the transition of Ni from kettles or other household utensils made from stainless steel into the food, may be more relevant. In addition there are some foodstuffs with great variations in concentrations, often influenced by the growing area and environmental factors. Further, some food groups naturally high in Nickel like nuts, cocoa or teas might not have been kept sufficient within the records. In summary, the dietary record method gave sufficient results for Zn, but is insufficient for Ni.Based on the food duplicate analysis, children living in urban areas with consumption of food products from a family-owned garden or the surrounding area and/or products from domestic animals of the surrounding area had about one-third higher Ni levels in their food than children either living in an urban area or children consuming products exclusively from the supermarket. Only slight differences were found with regard to Zn.Compared to the recommendations of the German Society of Nutrition (DGE) (25–30 μg Ni/d and 5.0 mg Zn/d), the participants of the study had a clearly increased Ni and, in view of the geometric mean value, a nearly adequate Zn intake. Health risks are especially given with regard to the influence of nickel intake by food on dermatitis for nickel-sensitive individuals.     

Relative Validity of Three Food Frequency Questionnaires for Assessing Dietary Intakes of Guatemalan Schoolchildren

ObjectiveTo determine the relative validity of three food frequency questionnaires (FFQs) compared with results from 24-hour dietary recalls for measuring dietary intakes in Guatemalan schoolchildren.DesignA cross-sectional study of primary caregivers (mothers or grandmothers) of 6–11 year-old children. Caregivers completed one of three constructed FFQs to measure the child’s dietary consumption in the last week: FFQ1 did not incorporate portion sizes; FFQ2 provided portion sizes; and FFQ3 incorporated pictures of median portion sizes. During the same week, each caregiver also completed three 24-hour dietary recalls. Results from the FFQ were compared with corresponding results from the 24-hour dietary recalls.SettingSanta Catarina Pinula, peri-urban Guatemala City.SubjectsCaregivers (n = 145) of 6–11 year-old children: 46 completed FFQ1, 49 completed FFQ2, and 50 completed FFQ3.ResultsThe mean values for all nutrients obtained from the 24-hour dietary recall were lower than for those obtained from the FFQs, excluding folic acid in FFQ3, cholesterol and zinc in FFQ2, and cholesterol, folic acid, magnesium, potassium, sodium, and zinc in FFQ1. Energy-adjusted Pearson correlation coefficients ranged from 0.07 (protein) to 0.54 (cholesterol) for FFQ1 and from 0.05 to 0.74 for FFQ2 and FFQ3. Agreement by both methods (FFQ and 24-hour dietary recalls) of classifying children into the same or adjacent quartiles of energy-adjusted nutrient consumption ranged from 62.0% for cholesterol to 95.9% for vitamin B12 across all three FFQs.ConclusionsOur FFQs had moderate to good relative validity in measuring energy and nutrient intakes for 6–11 year-old Guatemalan children. More evidence is needed to evaluate their reproducibility and applicability in similar populations.     

Dietary Silicon Intake of Korean Young Adult Males and Its Relation to their Bone Status

Accumulated data suggests a positive effect of silicon on bone health; however, limited research exists on the silicon content of foods. To further the understanding of the relationship between dietary silicon intake and bone health, a food composition database of commonly consumed foods in Korea is required. For quantitative data on the intake levels of silicon, we analyzed the silicon content of 365 food items commonly consumed in Korea using inductively coupled plasma—atomic emission spectrometry following microwave-assisted digestion. To investigate the dietary silicon intake status and to examine the potential role of dietary silicon intake in the bone status of men, a total of 400 healthy Korean adult males aged 19–25 were observed for their diet intake and calcaneus bone density using the 24-h recall method and quantitative ultrasound, respectively. Clinical markers reflecting bone metabolism such as serum total alkaline phosphatase, N-mid osteocalcin, and type 1 collagen C-terminal telopeptide concentrations were also analyzed. Silicon intake of the subjects was estimated as 37.5 ± 22.2 mg/day. Major food sources of dietary silicon in the Korean male were cereal and cereal products (25.6 % of total silicon intake), vegetables (22.7 %), beverages and liquors (21.2 %), and milk and milk products (7.0 %). Silicon intake correlated positively with age, weight, energy intake, protein intake, calcium intake, and alcohol intake. After adjusted for age, weight, energy intake, protein intake, calcium intake, alcohol intake, smoking cigarettes, and regular exercise status, daily total silicon intake had no correlation with calcaneus bone density and the bone metabolism markers, but silicon intake from vegetables had a positive correlation with serum total alkaline phosphatase activity, a bone formation maker. These findings show the possible positive relationship between dietary silicon intake from vegetables and the bone formation of young adult males. Further investigation in a larger (Korean) population and correcting for additional nutritional confounders is required to confirm these findings.     

Modeling Data with Excess Zeros and Measurement Error: Application to Evaluating Relationships between Episodically Consumed Foods and Health Outcomes

Summary Dietary assessment of episodically consumed foods gives rise to nonnegative data that have excess zeros and measurement error. Tooze et al. (2006, Journal of the American Dietetic Association 106 , 1575–1587) describe a general statistical approach (National Cancer Institute method) for modeling such food intakes reported on two or more 24‐hour recalls (24HRs) and demonstrate its use to estimate the distribution of the food's usual intake in the general population. In this article, we propose an extension of this method to predict individual usual intake of such foods and to evaluate the relationships of usual intakes with health outcomes. Following the regression calibration approach for measurement error correction, individual usual intake is generally predicted as the conditional mean intake given 24HR‐reported intake and other covariates in the health model. One feature of the proposed method is that additional covariates potentially related to usual intake may be used to increase the precision of estimates of usual intake and of diet‐health outcome associations. Applying the method to data from the Eating at America's Table Study, we quantify the increased precision obtained from including reported frequency of intake on a food frequency questionnaire (FFQ) as a covariate in the calibration model. We then demonstrate the method in evaluating the linear relationship between log blood mercury levels and fish intake in women by using data from the National Health and Nutrition Examination Survey, and show increased precision when including the FFQ information. Finally, we present simulation results evaluating the performance of the proposed method in this context.     

Allowing for never and episodic consumers when correcting for error in food record measurements of dietary intake

Food records, including 24-hour recalls and diet diaries, are considered to provide generally superior measures of long-term dietary intake relative to questionnaire-based methods. Despite the expense of processing food records, they are increasingly used as the main dietary measurement in nutritional epidemiology, in particular in sub-studies nested within prospective cohorts. Food records are, however, subject to excess reports of zero intake. Measurement error is a serious problem in nutritional epidemiology because of the lack of gold standard measurements and results in biased estimated diet-disease associations. In this paper, a 3-part measurement error model, which we call the never and episodic consumers (NEC) model, is outlined for food records. It allows for both real zeros, due to never consumers, and excess zeros, due to episodic consumers (EC). Repeated measurements are required for some study participants to fit the model. Simulation studies are used to compare the results from using the proposed model to correct for measurement error with the results from 3 alternative approaches: a crude approach using the mean of repeated food record measurements as the exposure, a linear regression calibration (RC) approach, and an EC model which does not allow real zeros. The crude approach results in badly attenuated odds ratio estimates, except in the unlikely situation in which a large number of repeat measurements is available for all participants. Where repeat measurements are available for all participants, the 3 correction methods perform equally well. However, when only a subset of the study population has repeat measurements, the NEC model appears to provide the best method for correcting for measurement error, with the 2 alternative correction methods, in particular the linear RC approach, resulting in greater bias and loss of coverage. The NEC model is extended to include adjustment for measurements from food frequency questionnaires, enabling better estimation of the proportion of never consumers when the number of repeat measurements is small. The methods are applied to 7-day diary measurements of alcohol intake in the EPIC-Norfolk study.     

Factors determining dietary intakes of heterocyclic amines in cooked foods.

The identification of heterocyclic amines (HCAs) in cooked foods has focused attention on the potential health effects from their consumption in the diet. Recent studies have estimated daily dietary intakes of HCAs that vary 10-fold and implicated different cooked meats as the prime source of HCAs in the diet. These varied estimates can be attributed to the different dietary assessment methods used in these studies, as well as the different levels of HCAs ascribed to the most commonly consumed cooked meats. Epidemiological studies utilizing information on dietary practice and food intake have found higher risks for several cancers among individuals consuming the highest levels of HCAs. These studies have highlighted the importance of using information on cooking methods in addition to food intake to accurately estimate dietary exposure to HCAs.     

High Dietary Magnesium Intake Is Associated with Low Insulin Resistance in the Newfoundland Population

Background

Magnesium plays a role in glucose and insulin homeostasis and evidence suggests that magnesium intake is associated with insulin resistance (IR). However, data is inconsistent and most studies have not adequately controlled for critical confounding factors.

Objective

The study investigated the association between magnesium intake and IR in normal-weight (NW), overweight (OW) and obese (OB) along with pre- and post- menopausal women.

Design

A total of 2295 subjects (590 men and 1705 women) were recruited from the CODING study. Dietary magnesium intake was computed from the Willett Food Frequency Questionnaire (FFQ). Adiposity (NW, OW and OB) was classified by body fat percentage (%BF) measured by Dual-energy X-ray absorptiometry according to the Bray criteria. Multiple regression analyses were used to test adiposity-specific associations of dietary magnesium intake on insulin resistance adjusting for caloric intake, physical activity, medication use and menopausal status.

Results

Subjects with the highest intakes of dietary magnesium had the lowest levels of circulating insulin, HOMA-IR, and HOMA-ß and subjects with the lowest intake of dietary magnesium had the highest levels of these measures, suggesting a dose effect. Multiple regression analysis revealed a strong inverse association between dietary magnesium with IR. In addition, adiposity and menopausal status were found to be critical factors revealing that the association between dietary magnesium and IR was stronger in OW and OB along with Pre-menopausal women.

Conclusion

The results of this study indicate that higher dietary magnesium intake is strongly associated with the attenuation of insulin resistance and is more beneficial for overweight and obese individuals in the general population and pre-menopausal women. Moreover, the inverse correlation between insulin resistance and dietary magnesium intake is stronger when adjusting for %BF than BMI.     

Relationship of dietary intake of fish and non-fish selenium to serum lipids in Japanese rural coastal community.

Several studies have suggested that dietary selenium deficiency may be associated with an increased risk of coronary heart disease (CHD). In the present study, 55 men and 71 women were selected from participants in a health examination in a rural coastal community in Japan. The mean dietary selenium intake calculated from the simple food frequency questionnaire (SFFQ) was 127.5 micrograms/day. Fish was the major source of dietary selenium and it contributed to 68.7% of the daily total. HDL cholesterol was higher in the middle selenium intake group and in the high selenium intake group than in the low selenium intake group in all subjects and for males, and a significant difference was found between the middle selenium intake group and the low selenium intake group. The atherogenic index was significantly higher in the low selenium intake group than in the middle selenium intake group and in the high selenium intake group in males. GPx activity, total cholesterol and triacylglycerols did not show any significant differences among the three different selenium intake groups. Dietary intake of non-fish Se had a positive correlation with HDL cholesterol, and an inverse correlation with the atherogenic index in all subjects and for females. On the other hand, dietary intake of fish-Se had no relationship with any serum lipids. Non-fish Se is an important factor in selenium status for the prevention of CHD.     

Prevalence and Associated Factors of Subjective Halitosis in Korean Adolescents

This study was conducted to estimate the prevalence and associated factors of subjective halitosis in adolescents. In total, 359,263 participants were selected from the Korea Youth Risk Behavior Web-based Survey (KYRBWS) from 2009 through 2013. Demographic data including age, sex, obesity and residency; psychosocial factors such as subjective health, stress, and economic levels; and dietary factors such as alcohol consumption; smoking; and fruit, soda, fast food, instant noodle, confection, and vegetable consumption were analyzed for correlations with halitosis using simple and multiple logistic regression analyses with complex sampling. In total, 23.6% of the participants reported the presence of halitosis. The following subjectively assessed factors were related to halitosis: poor health status (adjusted odds ratio [AOR] = 2.56), overweight or obese (AOR = 1.37), stress (AOR = 2.56), and lower economic levels (AOR = 1.85). The high intake of fast food (AOR = 1.15), instant noodles (AOR = 1.17), and confections (AOR = 1.17) and the low intake of fruits (AOR = 1.22) and vegetables (AOR = 1.19) were also related to halitosis. The prevalence of subjective halitosis in the studied adolescents was 23.6%. Specific psychosocial factors and dietary intake were related to halitosis.     

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.     

Patterns in food intake correlate with body mass index

Quantifying eating behavior may give clues to both the physiological and behavioral mechanisms behind weight regulation. We analyzed year-long dietary records of 29 stable-weight subjects. The records showed wide daily variations of food intake. We computed the temporal autocorrelation and skewness of food intake mass, energy, carbohydrate, fat, and protein. We also computed the cross-correlation coefficient between intake mass and intake energy. The mass of the food intake exhibited long-term trends that were positively skewed, with wide variability among individuals. The average duration of the trends (P = 0.003) and the skewness (P = 0.006) of the food intake mass were significantly correlated with mean body mass index (BMI). We also found that the lower the correlation coefficient between the energy content and the mass of food intake, the higher the BMI. Our results imply that humans in neutral energy balance eating ad libitum exhibit a long-term positive bias in the food intake that operates partially through the mass of food eaten to defend against eating too little more vigorously than eating too much.