The Effect of Meal Glycemic Index and Meal Frequency on Glycemic Control and Variability in Female Nurses Working Night Shifts: A Two-Arm Randomized Cross-Over Trial.

BACKGROUND: Night shift workers are exposed to circadian disruption, which contributes to impaired glucose tolerance. Although fasting during the night shift improves glucose homeostasis, adhering to this dietary strategy may be challenging. OBJECTIVES: This study evaluated the effect of fasting compared with the consumption of meals with different combinations of glycemic index (GI, low or high) and frequency (1 or 3 times) during the night shift on continuous glucose monitoring metrics. METHODS: A 2-arm randomized cross-over trial was conducted on female nurses working night shifts. In each of those arms, the participants were either provided with no meal (fasted), low GI, or high-GI meal during the night shift with a meal frequency according to which arm they were randomly allocated to, either 1-MEAL or 3-MEAL. Outcome variables were glycemic control and variability (GC and GV) metrics during the night shift (21:30-7:00), in the morning after the night shift (07:00-13:00), and in the 24 h period (18:00-18:00). RESULTS: Compared to no meal, the consumption of 1 high-GI meal increased all GV metrics not only during the night shifts but also in the morning, for instance, as observed in the coefficient of variation (ß = 0.03 mmol/L; 95% CI: 0.01, 0.05), and GV percentage (ß = 4.13; 95% CI: 2.07, 6.18). The consumption of 1 or 3 low GI meals did not raise GC or GV metrics except for continuous overall net glycemic action during the night shifts after consuming 3 low GI meals. When controlling for GI, night shift meal frequency did not affect any metrics in any timeframe. CONCLUSIONS: High meal GI but not higher meal frequency during the night shift increased GC and GV in female night shift workers. Results for 1 low-GI meal during the night shift were not different from a glucose profile after no meal. This trial was registered at trialsearch.who.int as NL8715.

The Effect of Meal Frequency and Glycemic Index During the Night Shift on Alertness, Hunger, and Gastrointestinal Complaints in Female Health Care Workers-A Two-Armed Randomized Crossover Trial.

BACKGROUND: Nutrition strategies for night-shift workers could optimize alertness and minimize hunger and reduce gastrointestinal complaints, enhancing safety and well-being. OBJECTIVES: This study aimed to investigate the effects of 1 or 3 small meals, with either low or high glycemic index (GI), compared with no meal, on alertness, hunger, and gastrointestinal complaints during the night shift. METHODS: Fifty-one female health care workers, aged 18 to 61 Y, participated in a 2-armed randomized crossover design. In 1 study arm, participants received 1 yogurt meal during the night shift, AND in the other, they received 3. Each study arm involved 3 intervention periods during night shifts, with participants consuming yogurt with low GI (1LGI or 3LGI) OR high GI (1HGI or 3HGI) carbohydrates, or no meal (0NGI). Objective alertness was assessed using a validated brief psychomotor vigilance task (PVT-B), subjective alertness with the Samn-Perelli scale, and hunger and gastrointestinal complaints through questionnaires. RESULTS: Participants in the 1LGI (ß: -4.6; 95% CI: 0.0, 9.3) and 3LGI (ß: -3.4; 95% CI: 0.0, 6.8) conditions had fewer lapses during the PVT-B than those in the 3HGI condition. No differences were found between meal conditions for median and reciprocal reaction time or subjective alertness. All 4 conditions reported less hunger (ß: from -0.6 to -1.2) compared with no meal. The 3LGI condition resulted in more rumbling intestines than the 3HGI (ß: 1.1; 95% CI: 0.4, 1.7) and 0NGI (ß: 0.74; 95% CI: 0.11, 1.37) conditions. CONCLUSIONS: Our study suggests that consuming 3 small low GI meals during the night shift helps maintain alertness and reduces lapses compared with 3 high GI meals. It also minimizes hunger but may cause mild gastrointestinal complaints. This trial was registered at International Clinical Trial Registry (https://trialsearch.who.int/Trial2.aspx?TrialID%3dNL-OMON25574).

Developing feasible healthy diets for Ethiopian women of reproductive age: a linear goal programming approach.

OBJECTIVE: To develop a healthy diet for Ethiopian women closely resembling their current diet and taking fasting periods into account while tracking the cost difference. DESIGN: Linear goal programming models were built for three scenarios (non-fasting, continuous fasting and intermittent fasting). Each model minimised a function of deviations from nutrient reference values for eleven nutrients (protein, Ca, Fe, Zn, folate, and the vitamins A, B1, B2, B3, B6, and B12). The energy intake in optimised diets could only deviate 5 % from the current diet. SETTINGS: Five regions are included in the urban and rural areas of Ethiopia. PARTICIPANTS: Two non-consecutive 24-h dietary recalls (24HDR) were collected from 494 Ethiopian women of reproductive age from November to December 2019. RESULTS: Women's mean energy intake was well above 2000 kcal across all socio-demographic subgroups. Compared to the current diet, the estimated intake of several food groups was considerably higher in the optimised modelled diets, that is, milk and dairy foods (396 v. 30 g/d), nuts and seeds (20 v. 1 g/d) and fruits (200 v. 7 g/d). Except for Ca and vitamin B12 intake in the continuous fasting diet, the proposed diets provide an adequate intake of the targeted micronutrients. The proposed diets had a maximum cost of 120 Ethiopian birrs ($3·5) per d, twice the current diet's cost. CONCLUSION: The modelled diets may be feasible for women of reproductive age as they are close to their current diets and fulfil their energy and nutrient demands. However, the costs may be a barrier to implementation.

Relative validity of a short screener to assess diet quality in patients with severe obesity before and after bariatric surgery.

OBJECTIVE: To determine the relative validity and reproducibility of the Eetscore FFQ, a short screener for assessing diet quality, in patients with (severe) obesity before and after bariatric surgery (BS). DESIGN: The Eetscore FFQ was evaluated against 3-d food records (3d-FR) before (T0) and 6 months after BS (T6) by comparing index scores of the Dutch Healthy Diet index 2015 (DHD2015-index). Relative validity was assessed using paired t tests, Kendall's tau-b correlation coefficients (τb), cross-classification by tertiles, weighted kappa values (k w ) and Bland-Altman plots. Reproducibility of the Eetscore FFQ was assessed using intraclass correlation coefficients (ICC). SETTING: Regional hospital, the Netherlands. PARTICIPANTS: Hundred and forty participants with obesity who were scheduled for BS. RESULTS: At T0, mean total DHD2015-index score derived from the Eetscore FFQ was 10·2 points higher than the food record-derived score (P < 0·001) and showed an acceptable correlation (τb = 0·42, 95 % CI: 0·27, 0·55). There was a fair agreement with a correct classification of 50 % (k w = 0·37, 95 % CI: 0·25, 0·49). Correlation coefficients of the individual DHD components varied from 0·01-0·54. Similar results were observed at T6 (τb = 0·31, 95 % CI: 0·12, 0·48, correct classification of 43·7 %; k w = 0·25, 95 % CI: 0·11, 0·40). Reproducibility of the Eetscore FFQ was good (ICC = 0·78, 95 % CI: 0·69, 0·84). CONCLUSION: The Eetscore FFQ showed to be acceptably correlated with the DHD2015-index derived from 3d-FR, but absolute agreement was poor. Considering the need for dietary assessment methods that reduce the burden for patients, practitioners and researchers, the Eetscore FFQ can be used for ranking according to diet quality and for monitoring changes over time.

Development and external validation of the 'Flower-FFQ': a FFQ designed for the Lifelines Cohort Study.

OBJECTIVE: FFQ assess habitual dietary intake and are relatively inexpensive to process, but may take up to 60 min to complete. This article describes the validation of the Flower-FFQ, which consists of four short FFQ measuring the intake of energy and macronutrients or specific (micro)nutrients/foods that can be merged into one complete daily assessment using predefined algorithms. DESIGN: Participants completed the Flower-FFQ and validated regular-FFQ (n 401). Urinary N (n 242) and K excretions (n 361) were measured. We evaluated: (1) group-level bias, (2) correlations and (3) cross-classification. SETTING: Observational study. PARTICIPANTS: Dutch adults, 54 ± 11 (mean ± SD) years. RESULTS: Flower-FFQ1, Flower-FFQ2, Flower-FFQ3 and Flower-FFQ4 were completed in ±24, 9, 8 and 9 min (±50 min total), respectively. The regular-FFQ was completed in ±43 min. Mean energy (flower v. regular: 7953 v. 8718 kJ/d) and macronutrient intakes (carbohydrates: 204 v. 222 g/d; protein: 75 v. 76 g/d; fat: 74 v. 83 g/d; ethanol: 8 v. 12 g/d) were comparatively similar. Spearman correlations between Flower-FFQ and regular-FFQ ranged from 0·60 to 0·80 for macronutrients and from 0·40 to 0·80 for micronutrients and foods. For all micronutrients and foods, ≥ 78 % of the participants classified in the same/adjacent quartile. The Flower-FFQ underestimated urinary N and K excretions by 24 and 18 %; 75 and 73 % of the participants ranked in the same/adjacent quartile. CONCLUSION: Completing the Flower-FFQ required 50 min with a maximum of 25 min per short FFQ. The Flower-FFQ has a moderate to good ranking ability for most nutrients and foods and performs sufficiently to study diet-disease associations.

How full is your glass? Portion sizes of wine, fortified wine and straight spirits at home in the Netherlands.

OBJECTIVE: Alcohol consumption may be wrongly estimated because of inaccurate information on actual portion sizes. We compared portion sizes of wine, fortified wine and straight spirits poured at home with the Dutch standard drink sizes. DESIGN: Participants measured portion sizes of wine, fortified wine and straight spirits at home up to a maximum of three times and reported these via an online survey. Average portion sizes (in millilitres) were compared with the Dutch standard drink sizes. Portion sizes were compared between subgroups of gender, age, BMI and level of education, and for different glass types. SETTING: Wageningen and surroundings, the Netherlands.ParticipantsAdults (N 201) living in the Netherlands and consuming wine and/or straight spirits at home at least once per week. RESULTS: Participants poured on average 129·4 ml white wine and 131·7 ml red wine, which is significantly more than the standard of 100 ml. For fortified wine, the average poured amount was 94·0 ml, significantly more than the standard of 50 ml; also for straight spirits the poured amount was significantly more than the standard (47·0 v. 35 ml). CONCLUSIONS: Participants' portion sizes of wine, fortified wine and straight spirits poured at home were on average larger than the Dutch standard drink sizes. This suggests that at-home alcohol consumption in the Netherlands is underestimated.

Implementation of a multicomponent telemonitoring intervention to improve nutritional status of community-dwelling older adults: a process evaluation.

OBJECTIVE: The present study aimed to conduct a process evaluation of a multicomponent nutritional telemonitoring intervention implemented among Dutch community-dwelling older adults. DESIGN: A mixed-methods approach was employed, guided by the process evaluation framework of the Medical Research Council and the Unified Theory of Acceptance and Use of Technology. The process indicators reach, dose, fidelity and acceptability were measured at several time points within the 6-month intervention among participants and/or nurses. SETTING: The intervention was implemented in the context of two care organisations in the Netherlands. SUBJECTS: In total, ninety-seven participants (average age 78 years) participated in the intervention and eight nurses were involved in implementation. RESULTS: About 80 % of participants completed the intervention. Dropouts were significantly older, had worse cognitive and physical functioning, and were more care-dependent. The intervention was largely implemented as intended and received well by participants (satisfaction score 4·1, scale 1-5), but less well by nurses (satisfaction score 3·5, scale 1-5). Participants adhered better to weight telemonitoring than to telemonitoring by means of questionnaires, for which half the participants needed help. Intention to use the intervention was predicted by performance expectancy (ß=0·40; 95 % CI 0·13, 0·67) and social influence (ß=0·17; 95 % CI 0·00, 0·34). No association between process indicators and intervention outcomes was found. CONCLUSIONS: This process evaluation showed that nutritional telemonitoring among older adults is feasible and accepted by older adults, but nurses' satisfaction should be improved. The study provided relevant insights for future development and implementation of eHealth interventions among older adults.

Validating fatty acid intake as estimated by an FFQ: how does the 24 h recall perform as reference method compared with the duplicate portion?

OBJECTIVE: To compare the performance of the commonly used 24 h recall (24hR) with the more distinct duplicate portion (DP) as reference method for validation of fatty acid intake estimated with an FFQ. DESIGN: Intakes of SFA, MUFA, n-3 fatty acids and linoleic acid (LA) were estimated by chemical analysis of two DP and by on average five 24hR and two FFQ. Plasma n-3 fatty acids and LA were used to objectively compare ranking of individuals based on DP and 24hR. Multivariate measurement error models were used to estimate validity coefficients and attenuation factors for the FFQ with the DP and 24hR as reference methods. SETTING: Wageningen, the Netherlands. SUBJECTS: Ninety-two men and 106 women (aged 20-70 years). RESULTS: Validity coefficients for the fatty acid estimates by the FFQ tended to be lower when using the DP as reference method compared with the 24hR. Attenuation factors for the FFQ tended to be slightly higher based on the DP than those based on the 24hR as reference method. Furthermore, when using plasma fatty acids as reference, the DP showed comparable to slightly better ranking of participants according to their intake of n-3 fatty acids (0·33) and n-3:LA (0·34) than the 24hR (0·22 and 0·24, respectively). CONCLUSIONS: The 24hR gives only slightly different results compared with the distinctive but less feasible DP, therefore use of the 24hR seems appropriate as the reference method for FFQ validation of fatty acid intake.

A national FFQ for the Netherlands (the FFQ-NL1.0): development and compatibility with existing Dutch FFQs.

OBJECTIVE: In the Netherlands, various FFQs have been administered in large cohort studies, which hampers comparison and pooling of dietary data. The present study aimed to describe the development of a standardized Dutch FFQ, FFQ-NL1.0, and assess its compatibility with existing Dutch FFQs. DESIGN: Dutch FFQTOOLTM was used to develop the FFQ-NL1.0 by selecting food items with the largest contributions to total intake and explained variance in intake of energy and thirty-nine nutrients in adults aged 25-69 years from the Dutch National Food Consumption Survey (DNFCS) 2007-2010. Compatibility with the Maastricht-FFQ, Wageningen-FFQ and EPICNL-FFQ was assessed by comparing the number of food items, the covered energy and nutrient intake, and the covered variance in intake. RESULTS: FFQ-NL1.0 comprised 160 food items, v. 253, 183 and 154 food items for the Maastricht-FFQ, Wageningen-FFQ and EPICNL-FFQ, respectively. FFQ-NL1.0 covered ≥85 % of energy and all nutrients reported in the DNFCS. Covered variance in intake ranged from 57 to 99 % for energy and macronutrients, and from 45 to 93 % for micronutrients. Differences between FFQ-NL1.0 and the other FFQs in covered nutrient intake and covered variance in intake were <5 % for energy and all macronutrients. For micronutrients, differences between FFQ-NL and other FFQs in covered level of intake were <15 %, but differences in covered variance were much larger, the maximum difference being 36 %. CONCLUSIONS: The FFQ-NL1.0 was compatible with other FFQs regarding energy and macronutrient intake. However, compatibility for covered variance of intake was limited for some of the micronutrients. If implemented in existing cohorts, it is advised to administer the old and the new FFQ in combination to derive calibration factors.

BMI was found to be a consistent determinant related to misreporting of energy, protein and potassium intake using self-report and duplicate portion methods.

OBJECTIVE: As misreporting, mostly under-reporting, of dietary intake is a generally known problem in nutritional research, we aimed to analyse the association between selected determinants and the extent of misreporting by the duplicate portion method (DP), 24 h recall (24hR) and FFQ by linear regression analysis using the biomarker values as unbiased estimates. DESIGN: For each individual, two DP, two 24hR, two FFQ and two 24 h urinary biomarkers were collected within 1·5 years. Also, for sixty-nine individuals one or two doubly labelled water measurements were obtained. The associations of basic determinants (BMI, gender, age and level of education) with misreporting of energy, protein and K intake of the DP, 24hR and FFQ were evaluated using linear regression analysis. Additionally, associations between other determinants, such as physical activity and smoking habits, and misreporting were investigated. SETTING: The Netherlands. SUBJECTS: One hundred and ninety-seven individuals aged 20-70 years. RESULTS: Higher BMI was associated with under-reporting of dietary intake assessed by the different dietary assessment methods for energy, protein and K, except for K by DP. Men tended to under-report protein by the DP, FFQ and 24hR, and persons of older age under-reported K but only by the 24hR and FFQ. When adjusted for the basic determinants, the other determinants did not show a consistent association with misreporting of energy or nutrients and by the different dietary assessment methods. CONCLUSIONS: As BMI was the only consistent determinant of misreporting, we conclude that BMI should always be taken into account when assessing and correcting dietary intake.

Optimising the selection of food items for FFQs using Mixed Integer Linear Programming.

OBJECTIVE: To support the selection of food items for FFQs in such a way that the amount of information on all relevant nutrients is maximised while the food list is as short as possible. DESIGN: Selection of the most informative food items to be included in FFQs was modelled as a Mixed Integer Linear Programming (MILP) model. The methodology was demonstrated for an FFQ with interest in energy, total protein, total fat, saturated fat, monounsaturated fat, polyunsaturated fat, total carbohydrates, mono- and disaccharides, dietary fibre and potassium. RESULTS: The food lists generated by the MILP model have good performance in terms of length, coverage and R 2 (explained variance) of all nutrients. MILP-generated food lists were 32-40 % shorter than a benchmark food list, whereas their quality in terms of R 2 was similar to that of the benchmark. CONCLUSIONS: The results suggest that the MILP model makes the selection process faster, more standardised and transparent, and is especially helpful in coping with multiple nutrients. The complexity of the method does not increase with increasing number of nutrients. The generated food lists appear either shorter or provide more information than a food list generated without the MILP model.

Associations between Variability in Between- and Within-Day Dietary Intake with Adiposity and Glucose Homeostasis in Adults: A Systematic Review.

This systematic review aims to comprehensively evaluate the literature regarding the impact of variations in dietary intake, both between- and within-day, on adiposity and glucose metabolism. We included observational and experimental articles obtained from PubMed, Scopus, Cochrane Library, and gray literature until 9 October, 2023, evaluating the impact of between- or within-day variations in meal, energy, or macronutrient intake on these outcomes. Our focus was on adults aged ≥18 y, spanning both healthy individuals and those with type 2 diabetes mellitus (T2DM). Given the diverse range of exposures, treatments, and outcomes among the selected articles, we chose a qualitative synthesis approach to effectively analyze the data. Eighty articles from 43 observational and 37 experimental studies were included, involving 89,178 participants. Patterns of dietary intake variation were identified and systematically organized into distinct categories based on similarities. Between-day variations in dietary intake consisted of between-day variations in both the quantity consumed and meal timing. Meanwhile, within-day variations encompassed factors such as eating window, meal omission, within-day meal timing, within-day variation in dietary intake quantity, and temporal distribution. Despite mixed results, time-restricted eating was generally associated with lower adiposity. However, limited control for total daily energy intake (TDEI) suggests that the contribution of lower energy intake cannot be conclusively excluded. Conversely, the adverse effect of meal omission on glucose parameters was consistently supported by randomized trials. Interestingly, the results showed that consuming a substantial portion of TDEI in the morning may increase the likelihood of observing improvements in adiposity. Furthermore, inconsistencies in outcomes across articles examining the effects in healthy compared with T2DM populations, or in energy-sufficient compared with deficient individuals, indicate potential condition-specific effects. These findings support the need for further investigation into the effects of between- and within-day variations in dietary intake to better understand their impact on adiposity and glucose homeostasis. This review was registered in PROSPERO as CRD42020214307.

Relative validity of habitual sugar and low/no-calorie sweetener consumption assessed by food frequency questionnaire, multiple 24-h dietary recalls and urinary biomarkers: an observational study within the SWEET project.

BACKGROUND: Studies investigating associations between sweeteners and health yield inconsistent results, possibly due to subjective self-report dietary assessment methods. OBJECTIVES: We compared the performance of a food frequency questionnaire (FFQ), multiple 24-h dietary recalls (24hRs), and urinary biomarkers to estimate intake of sugars and low/no-calorie sweeteners (LNCSs). METHODS: Participants (n = 848, age 54 ± 12 y) from a 2-y observational study completed 1 semiquantitative FFQ and ≥ 3 nonconsecutive 24hRs. Both methods assessed intake of sugars (mono- and disaccharides, sucrose, fructose, free and added sugars) and sweetened foods and beverages (sugary foods, fruit juice, and sugar or LNCS-containing beverages [sugar-sweetened beverages and low/no-calorie sweetened beverages (LNCSBs)]); 24hRs also included LNCS-containing foods and tabletop sweeteners (low/no-calorie sweetened foods [LNCSFs]). Urinary excretion of sugars (fructose+sucrose) and LNCSs (acesulfame K+sucralose+steviol glucuronide+cyclamate+saccharin) were simultaneously assessed using ultrapressure liquid chromatography coupled to tandem mass spectrometry in 288 participants with 3 annual 24-h urine samples. Methods were compared using, amongst others, validity coefficients (correlations corrected for measurement error). RESULTS: Median (interquartile range) FFQ intakes ranged from 0 (0-7) g/d for LNCSBs to 94 (73-117) g/d for mono- and disaccharides. LNCSB use was reported by 32% of participants. Median LNCSB+LNCSF intake using 24hRs was 1 (0-50) g/d and reported by 58%. Total sugar excretions were detected in 100% of samples [56 (37-85) mg/d] and LNCSs in 99% of urine samples [3 (1-10) mg/d]. Comparing FFQ against 24hRs showed VCs ranging from 0.38 (fruit juice) to 0.74 (LNCSB). VCs for comparing FFQ with urinary excretions were 0.25 to 0.29 for sugars and 0.39 for LNCSBs; for 24hR they amounted to 0.31-0.38 for sugars, 0.37 for LNCSBs, and 0.45 for LNCSFs. CONCLUSIONS: The validity of the FFQ against 24hRs for the assessment of sugars and LNCSBs ranged from moderate to good. Comparing self-reports and urine excretions showed moderate agreement but highlighted an important underestimation of LNCS exposure using self-reports.

Dietary Recommendations for Ethiopians on the Basis of Priority Diet-Related Diseases and Causes of Death in Ethiopia: An Umbrella Review.

Food-based dietary guidelines (FBDG) need to be evidence-based. As part of the development of Ethiopian FBDG, we conducted an umbrella review to develop dietary recommendations. Protein-energy malnutrition (PEM), deficiencies of vitamin A, zinc, calcium, or folate, cardiovascular diseases (CVD), and type 2 diabetes mellitus (T2DM) were selected as a priority. Systematic reviews were eligible if they investigated the impact of foods, food groups, diet, or dietary patterns on priority diseases. After a search, 1513 articles were identified in PubMed, Scopus, and Google Scholar published from January 2014 to December 2021. The results showed that 19 out of 164 systematic reviews reported the impact of diet on PEM or micronutrient deficiencies. Daily 30-90 g whole-grain consumption reduces risk of CVD and T2DM. Pulses improve protein status, and consuming 50-150 g/d is associated with a reduced incidence of CVD and T2DM. Nuts are a good source of minerals, and consuming 15-35 g/d improves antioxidant status and is inversely associated with CVD risk. A daily intake of 200-300 mL of milk and dairy foods is a good source of calcium and contributes to bone mineral density. Limiting processed meat intake to <50 g/d reduces CVD risk. Fruits and vegetables are good sources of vitamins A and C. CVD and T2DM risks are reduced by consuming 200-300 g of vegetables plus fruits daily. Daily sugar consumption should be below 10% of total energy to lower risk of obesity, CVD, and T2DM. Plant-based fat has favorable nutrient profiles and modest saturated fat content. The association of saturated fatty acids with CVD and T2DM is inconclusive, but intake should be limited because of the low-density lipoprotein cholesterol-raising effect. Plant-based diets lower risk of CVD and T2DM but reduce micronutrient bioavailability. The review concludes with 9 key dietary recommendations proposed to be implemented in the Ethiopian FBDG. This review was registered at PROSPERO (CRD42019125490).

Optimizing Low-Socioeconomic Status Pregnant Women's Dietary Intake in the Netherlands: Protocol for a Mixed-Methods Study.

BACKGROUND: Although the importance of maternal nutrition is evident, adherence to dietary guidelines is limited in pregnant women, especially in those with a low socioeconomic status. Promotion of a healthy diet in midwifery practice is promising, as prenatal diet affects both maternal and child health, pregnant women are open to dietary changes during this critical transition, and midwives are their first and most important source of information. Unfortunately, nutrition communication by Dutch midwives is limited. OBJECTIVE: The objective of this study is to optimize the dietary intake of low-socioeconomic status pregnant women by contributing to the further development and adjustment of a tool or toolbox to support midwives in providing nutrition communication. METHODS: This interdisciplinary, mixed-methods study includes 2 phases, in which quantitative and qualitative research are complementary. In phase 1, we will conduct a literature study and interviews to gain insight into midwives' knowledge, needs, and practice. We will obtain data on the dietary intake of low-socioeconomic status pregnant women and factors influencing this intake from another literature study, an interviewer-administered meal-based food frequency questionnaire, and qualitative interviews with pregnant women. We will identify the availability of suitable tools to improve pregnant women's dietary intake from the literature, interviews, focus groups, and expert meetings. In phase 2, we shall adapt an existing tool or develop a new tool(box), depending on the results of phase 1, and implement it in 5 midwifery practices. Ultimately, a process evaluation will provide insight into barriers and facilitating factors playing a role in the implementation of the tool(box). RESULTS: The main outcome of this study will be a tool(box) to optimize the dietary intake of Dutch pregnant women. We anticipate that the developed or adjusted tool(s) will be available in February 2020. After we implement the tool(s) and evaluate the implementation process, the final results should be available by February 2021. CONCLUSIONS: This study is scientifically and socially relevant, as we will study low-socioeconomic status pregnant women's contextual dietary intake in-depth from an ecological perspective on health. The results obtained will lead to recommendations for multidisciplinary strategies to promote a healthy maternal dietary intake in low-socioeconomic status populations. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/14796.

Nutritional Assessment in Inflammatory Bowel Disease (IBD)-Development of the Groningen IBD Nutritional Questionnaires (GINQ).

Diet plays a key role in the complex etiology and treatment of inflammatory bowel disease (IBD). Most existing nutritional assessment tools neglect intake of important foods consumed or omitted specifically by IBD patients or incorporate non-Western dietary habits, making the development of appropriate dietary guidelines for (Western) IBD patients difficult. Hence, we developed a food frequency questionnaire (FFQ), the Groningen IBD Nutritional Questionnaires (GINQ-FFQ); suitable to assess dietary intake in IBD patients. To develop the GINQ-FFQ, multiple steps were taken, including: identification of IBD specific foods, a literature search, and evaluation of current dietary assessment methods. Expert views were collected and in collaboration with Wageningen University, division of Human Nutrition and Health, this semi-quantitative FFQ was developed using standard methods to obtain a valid questionnaire. Next, the GINQ-FFQ was digitized into a secure web-based environment which also embeds additional nutritional and IBD related questions. The GINQ-FFQ is an online self-administered FFQ evaluating dietary intake, taking the previous month as a reference period. It consists of 121 questions on 218 food items. This paper describes the design process of the GINQ-FFQ which assesses dietary intake especially (but not exclusively) in IBD patients. Validation of the GINQ-FFQ is needed and planned in the near future.

The Maastricht FFQ: Development and validation of a comprehensive food frequency questionnaire for the Maastricht study.

OBJECTIVE: The aim of this study was to develop and validate a comprehensive food frequency questionnaire (FFQ) for The Maastricht Study, a population-based prospective cohort study in Maastricht, The Netherlands. METHODS: Item selection for the FFQ was based on explained variation and contribution to intake of energy and 24 nutrients. For validation, the FFQ was completed by 135 participants (25-70 y of age) of the Nutrition Questionnaires plus study. Per person, on average 2.8 (range 1-5) telephone-based 24-h dietary recalls (24HRs), two 24-h urinary samples, and one blood sample were available. Validity of 54 nutrients and 22 food groups was assessed by ranking agreement, correlation coefficients, attenuation factors, and ultimately deattenuated correlation coefficients (validity coefficients). RESULTS: Median correlation coefficients for energy and macronutrients, micronutrients, and food groups were 0.45, 0.36, and 0.38, respectively. Median deattenuated correlation coefficients were 0.53 for energy and macronutrients, 0.45 for micronutrients, and 0.64 for food groups, being >0.50 for 18 of 22 macronutrients, 16 of 30 micronutrients and >0.50 for 17 of 22 food groups. The FFQ underestimated protein and potassium intake compared with 24-h urinary nitrogen and potassium excretion by -18% and -2%, respectively. Correlation coefficients ranged from 0.50 and 0.55 for (fatty) fish intake and plasma eicosapentaenoic acid and docosahexaenoic acid, and from 0.26 to 0.42 between fruit and vegetable intake and plasma carotenoids. CONCLUSION: Overall, the validity of the 253-item Maastricht FFQ was satisfactory. The comprehensiveness of this FFQ make it well suited for use in The Maastricht Study and similar populations.