Duration of WIC Participation and Early Feeding Practices Are Associated With Meeting the Added Sugars Recommendation at Age 3 Years.

OBJECTIVE: To examine whether duration of participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and early feeding practices are associated with the likelihood of meeting the Dietary Guidelines for Americans (DGA) recommendation for added sugars (AS) at age 3 years. METHODS: Using data from the WIC Infant and Toddler Feeding Practices Study-2 (WIC ITFPS-2), logistic regression assessed associations between WIC participation patterns, early feeding practices, and whether 3-year-olds met the AS recommendation. RESULTS: Children introduced to sugar-sweetened beverages (SSBs) in their first year were about half (adjusted odds ratio, 0.65; P < 0.01) as likely to meet the recommendation as those not exposed in their first 2 years. First-year-only WIC participation (adjusted odds ratio, 0.61; P < 0.04) also increased the risk of excessive consumption compared with children who participated in their third year. CONCLUSIONS AND IMPLICATIONS: Duration of WIC participation is inversely associated with young children's AS intakes. Public health efforts to reduce WIC attrition and enhance education efforts focused on delaying sugar-sweetened beverage introduction are supported.

The Accuracy of Portion Size Reporting on Self-Administered Online 24-Hour Dietary Recalls Among Women With Low Incomes.

BACKGROUND: Accurately estimating portion sizes remains a challenge in dietary assessment. Digital images used in online 24-hour dietary recalls may be conducive to accuracy. OBJECTIVE: The current analyses were conducted to examine the accuracy of portion size estimation by women with low incomes who completed 24-hour dietary recalls using the online Automated Self-Administered 24-hour Dietary Assessment Tool (ASA24) in the Food and Eating Assessment Study II. DESIGN: True dietary intake was observed for 3 meals on 1 day through a controlled feeding study conducted from May through July 2016. The following day, participants completed an unannounced 24-hour dietary recall using ASA24, independently or with assistance in a small-group setting. PARTICIPANTS/SETTING: Participants included 302 women aged 18 to 82 years living in the Washington, DC, area who met the income thresholds for the Supplemental Nutrition Assistance Program. MAIN OUTCOME MEASURES: The accuracy of portion size estimation was assessed by comparing the weight truly consumed (observed) and the weight reported for predetermined categories of foods and beverages. STATISTICAL ANALYSES PERFORMED: The differences between observed and reported portions were examined and linear regression tested differences by recall condition. Analyses were conducted by condition and repeated with stratification by racial/ethnic identity, education, and body mass index. RESULTS: On average across foods and beverages, reported portion sizes were 7.4 g (95% CI, 4.3-10.5) and 6.4 g (95% CI, 2.8-10.0) higher than observed portion sizes in the independent and assisted conditions, respectively. Portion sizes were overestimated for small pieces and shaped foods in both conditions, as well as for amorphous/soft foods in the assisted condition and underestimated for single-unit foods in both conditions. Misestimation was fairly consistent by participants' race/ethnicity, education, and body mass index, to varying magnitudes. CONCLUSIONS: Women with low incomes overestimated the amounts of foods and beverages consumed across several categories using online 24-hour dietary recalls with digital images to support portion size estimation. Assistance with ASA24 had little impact on accuracy.

Shifts in Sources of Food but Stable Nutritional Outcomes among Children in the Early Months of the COVID-19 Pandemic.

Early in the COVID-19 pandemic, the U.S. Department of Agriculture (USDA), State governments, and school districts took unprecedented steps to mitigate the pandemic's impact on students' nutrition. To examine the effect of emergency responses on 6-year-old children's nutritional outcomes, this study analyzed longitudinal data from a national study of children's feeding practices, the Special Supplemental Nutrition Program for Women, Infants, and Children-Infant and Toddler Feeding Practices Study-2 (WIC ITFPS-2). Findings include no differences in food insecurity prevalence; however, there were shifts in sources of food, with children in the post-COVID-emergency-declaration (post-ED) group consuming more dietary energy from stores and community food programs and less from restaurants and schools than children in the pre-COVID-emergency-declaration (pre-ED) group (p < 0.01 for all comparisons). Examination of within-person mean differences in 2015 Healthy Eating Index scores and nutrient intakes between ages 5 and 6 years revealed few statistically significant differences between the two groups: children in the post-ED group consumed slightly fewer vegetables (p = 0.02) and less sodium (p = 0.01) than their pre-ED peers. Findings suggest emergency efforts to maintain children's nutrition were largely successful in the early months of the pandemic. Research is needed to understand the mechanisms by which emergency efforts contributed to these findings.

Healthy Eating Index-2015 Scores Among Adults Based on Observed vs Recalled Dietary Intake.

BACKGROUND: The construct and predictive validity of the Healthy Eating Index (HEI) have been demonstrated, but how error in reported dietary intake may affect scores is unclear. OBJECTIVE: These analyses examined concordance between HEI-2015 scores based on observed vs reported intake among adults. DESIGN: Data were from two feeding studies (Food and Eating Assessment STudy, or FEAST, I and II) in which true intake was observed for three meals on 1 day. The following day, participants completed an unannounced 24-hour dietary recall. PARTICIPANTS/SETTING: FEAST I (2012) included 81 men and women, aged 20 to 70 years, living in the Washington, DC, area. FEAST II (2016) included 302 women, aged 18 years or older, with low household incomes and living in the Washington, DC, area. In FEAST I, recalls were completed independently using the Automated Self-Administered 24-hour Dietary Assessment Tool (ASA24-2011) or interviewer-administered using the Automated Multiple-Pass Method. In FEAST II, recalls were completed using ASA24-2016, independently or in a small group setting with assistance. MAIN OUTCOME MEASURES: HEI-2015 scores were calculated using the population ratio method. STATISTICAL ANALYSES PERFORMED: T-tests determined whether differences between scores based on observed and reported intake were different from zero. FEAST I data were stratified by sex, and in FEAST II, analyses were repeated by education and body mass index (BMI). RESULTS: Differences in total HEI-2015 scores between observed and reported intake ranged from -1.3 to 5.8 points among those completing ASA24 independently in both studies, compared with -2.5 points in the small group setting. For interviewer-administered recalls, the differences were -1.1 for men and 2.3 for women. In FEAST II, total HEI-2015 scores derived from observed intake were lower than scores derived from reported intake among those who had completed high school or less (-3.2, SE 1.1, P<0.01) and those with BMI ≥ 30 (-2.8, SE 1.1, P = 0.01). CONCLUSIONS: HEI-2015 scores based on 24-hour dietary recall data are generally well estimated.

Dietary consumption of advanced glycation end products and pancreatic cancer in the prospective NIH-AARP Diet and Health Study.

BACKGROUND: Advanced glycation end products (AGEs) are a heterogeneous group of compounds present in uncooked foods as well as in foods cooked at high temperatures. AGEs have been associated with insulin resistance, oxidative stress, and chronic inflammation in patients with diabetes. Dietary AGEs are an important contributor to the AGE pool in the body. N(ϵ)-(carboxymethyl)lysine (CML) AGE is one of the major biologically and chemically well-characterized AGE markers. The consumption of red meat, which is CML-AGE rich, has been positively associated with pancreatic cancer in men. OBJECTIVES: With the use of a published food CML-AGE database, we estimated the consumption of CML AGE in the prospective NIH-AARP Diet and Health Study and evaluated the association between CML-AGE consumption and pancreatic cancer and the mediating effect of CML AGE on the association between red meat consumption and pancreatic cancer. DESIGN: Multivariate Cox proportional hazard regression models were used to estimate HRs and 95% CIs for pancreatic cancer. RESULTS: During an average of 10.5 y of follow-up, we identified 2193 pancreatic cancer cases (1407 men and 786 women) from 528,251 subjects. With the comparison of subjects in the fifth and the first quintiles of CML-AGE consumption, we observed increased pancreatic cancer risk in men (HR: 1.43; 95% CI: 1.06, 1.93, P-trend = 0.003) but not women (HR: 1.14; 95% CI: 0.76, 1.72, P-trend = 0.42). Men in the highest quintile of red meat consumption had higher risk of pancreatic cancer (HR: 1.35; 95% CI: 1.07, 1.70), which attenuated after adjustment for CML-AGE consumption (HR: 1.20; 95% CI: 0.95, 1.53). CONCLUSION: Dietary CML-AGE consumption was associated with modestly increased risk of pancreatic cancer in men and may partially explain the positive association between red meat and pancreatic cancer.

Simulated adaptations to an adult dietary self-report tool to accommodate children: impact on nutrient estimates.

OBJECTIVE: To simulate the effect of child-friendly (CF) adaptations of the National Cancer Institute's Automated Self-Administered 24-Hour Dietary Recall (ASA24) on estimates of nutrient intake. METHOD: One hundred twenty children, 8-13 years old, entered their previous day's intake using the ASA24 and completed an interviewer-administered recall using the Nutrition Data System for Research (NDSR). Based on a hypothesis that proposed adaptations to the ASA24 will not significantly affect mean nutrient estimates, ASA24 data were manipulated postadministration to simulate a CF version in which 2 categories of data collection were removed: (1) foods not likely to be consumed by children (45%) based on previous analyses of national dietary data and (2) food detail questions (probes) to which children are unlikely to know the answers (46%), based on our experience. RESULTS: Mean estimates of select nutrients between the beta version of ASA24 and the simulated CF recall showed no significant differences, indicating that the food and probe elimination did not significantly affect results. However, a comparison of total sugar and vitamin C assessments between the original ASA24, the CF version, and NDSR showed that the daily nutrient totals for both nutrients were significantly higher in the self-administered methods (both ASA24 and CF version) than in NDSR (interviewer-administered), which warrants a review of different methods for obtaining information about foods that are sources of these nutrients. CONCLUSION: The simulation of CF adaptations showed that it is feasible to implement, thereby reducing CF response burden without significantly affecting the results.

Assessment of the accuracy of portion size reports using computer-based food photographs aids in the development of an automated self-administered 24-hour recall.

OBJECTIVE: To assess the accuracy of portion-size estimates and participant preferences using various presentations of digital images. DESIGN: Two observational feeding studies were conducted. In both, each participant selected and consumed foods for breakfast and lunch, buffet style, serving themselves portions of nine foods representing five forms (eg, amorphous, pieces). Serving containers were weighed unobtrusively before and after selection as was plate waste. The next day, participants used a computer software program to select photographs representing portion sizes of foods consumed the previous day. Preference information was also collected. In Study 1 (n=29), participants were presented with four different types of images (aerial photographs, angled photographs, images of mounds, and household measures) and two types of screen presentations (simultaneous images vs an empty plate that filled with images of food portions when clicked). In Study 2 (n=20), images were presented in two ways that varied by size (large vs small) and number (4 vs 8). SUBJECTS/SETTING: Convenience sample of volunteers of varying background in an office setting. STATISTICAL ANALYSES PERFORMED: Repeated-measures analysis of variance of absolute differences between actual and reported portions sizes by presentation methods. RESULTS: Accuracy results were largely not statistically significant, indicating that no one image type was most accurate. Accuracy results indicated the use of eight vs four images was more accurate. Strong participant preferences supported presenting simultaneous vs sequential images. CONCLUSIONS: These findings support the use of aerial photographs in the automated self-administered 24-hour recall. For some food forms, images of mounds or household measures are as accurate as images of food and, therefore, are a cost-effective alternative to photographs of foods.

Challenges in converting an interviewer-administered food probe database to self-administration in the National Cancer Institute Automated Self-administered 24-Hour Recall (ASA24).

The National Cancer Institute (NCI) is developing an automated, self-administered 24-hour dietary recall (ASA24) application to collect and code dietary intake data. The goal of the ASA24 development is to create a web-based dietary interview based on the US Department of Agriculture (USDA) Automated Multiple Pass Method (AMPM) instrument currently used in the National Health and Nutrition Examination Survey (NHANES). The ASA24 food list, detail probes, and portion probes were drawn from the AMPM instrument; portion-size pictures from Baylor College of Medicine's Food Intake Recording Software System (FIRSSt) were added; and the food code/portion code assignments were linked to the USDA Food and Nutrient Database for Dietary Studies (FNDDS). The requirements that the interview be self-administered and fully auto-coded presented several challenges as the AMPM probes and responses were linked with the FNDDS food codes and portion pictures. This linking was accomplished through a "food pathway," or the sequence of steps that leads from a respondent's initial food selection, through the AMPM probes and portion pictures, to the point at which a food code and gram weight portion size are assigned. The ASA24 interview database that accomplishes this contains more than 1,100 food probes and more than 2 million food pathways and will include about 10,000 pictures of individual foods depicting up to 8 portion sizes per food. The ASA24 will make the administration of multiple days of recalls in large-scale studies economical and feasible.

Adaptation and evaluation of the National Cancer Institute's Diet History Questionnaire and nutrient database for Canadian populations.

BACKGROUND AND OBJECTIVE: Despite assumed similarities in Canadian and US dietary habits, some differences in food availability and nutrient fortification exist. Food-frequency questionnaires designed for the USA may therefore not provide the most accurate estimates of dietary intake in Canadian populations. Hence, we undertook to evaluate and modify the National Cancer Institute's Diet History Questionnaire (DHQ) and nutrient database. METHODS: Of the foods queried on the DHQ, those most likely to differ in nutrient composition were identified. Where possible these foods were matched to comparable foods in the Canadian Nutrient File. Nutrient values were examined and modified to reflect the Canadian content of minerals (calcium, iron, zinc) and vitamins (A, C, D, thiamin, riboflavin, niacin, B6, folate and B12). DHQs completed by 13 181 Alberta Cohort Study participants aged 35-69 years were analysed to estimate nutrient intakes using the original US and modified versions of the DHQ databases. Misclassification of intake for meeting the Dietary Reference Intake (DRI) was determined following analysis with the US nutrient database. RESULTS: Twenty-five per cent of 2411 foods deemed most likely to differ in nutrient profile were subsequently modified for folate, 11% for vitamin D, 10% for calcium and riboflavin, and between 7 and 10% for the remaining nutrients of interest. Misclassification with respect to meeting the DRI varied but was highest for folate (7%) and vitamin A (7%) among men, and for vitamin D (7%) among women over 50 years of age. CONCLUSION: Errors in nutrient intake estimates owing to differences in food fortification between the USA and Canada can be reduced in Canadian populations by using nutrient databases that reflect Canadian fortification practices.

Methodology for adding glycemic load values to the National Cancer Institute Diet History Questionnaire database.

BACKGROUND: A growing interest exists in using glycemic index and glycemic load as potentially important exposures in investigations of risk for a variety of chronic diseases. OBJECTIVE: We added values for glycemic index and glycemic load to the nutrient database of a commonly used dietary assessment instrument, the Diet History Questionnaire (DHQ). DESIGN: The nutrient database for the DHQ is based on 4,200 individual foods reported by adults in the 1994-1996 US Department of Agriculture Continuing Survey of Food Intakes by Individuals (CSFII). This list was condensed into 225 nutritionally similar groupings of individual foods. Using published glycemic index values we assigned glycemic index values to each of the individual CSFII foods in these food groups. In cases where CSFII foods did not correspond tightly to foods with published glycemic index values, we used decision criteria to assign glycemic index values. We then calculated sex- and serving size-specific glycemic load for each of the 225 food groups using the weighted mean method. Quality assessments were made to help evaluate the success of this method for assigning glycemic load values. RESULTS: Seventy-one percent of the top carbohydrate-contributing food groups had in excess of 90% of the CSFII mentions linked directly to a published glycemic index value (ie, no imputation was required), and 100% of these food groups had at least 50% of total mentions linked directly. CONCLUSIONS: Using this method, it is now possible to use DHQ responses to assess the associations between reported glycemic load and glycemic index and risk of many chronic diseases in epidemiologic studies.