Derivation and Validation of a Total Fruit and Vegetable Intake Prediction Model to Identify Targets for Biomarker Discovery Using the UK National Diet and Nutrition Survey.

BACKGROUND: Dietary assessments in research and clinical settings are largely reliant on self-reported questionnaires. It is acknowledged that these are subject to measurement error and biases and that objective approaches would be beneficial. Dietary biomarkers have been purported as a complementary approach to improve the accuracy of dietary assessments. Tentative biomarkers have been identified for many individual fruits and vegetables (FVs), but an objective total FV intake assessment tool has not been established. OBJECTIVES: To derive and validate a prediction model of total FV intake (TFVpred) to inform future biomarker studies. METHODS: Data from the National Diet and Nutrition Survey (NDNS) were used for this analysis. A modeling group (MG) consisting of participants aged >11 years from the NDNS years 5-6 was created (n = 1746). Intake data for 96 FVs were analyzed by stepwise regression to derive a model that satisfied 3 selection criteria: SEE ≤80, R2 >0.7, and ≤10 predictors. The TFVpred model was validated using comparative data from a validation group (VG) created from the NDNS years 7-8 (n = 1865). Pearson's correlation coefficients were assessed between observed and predicted values in the MG and VG. Bland-Altman plots were used to assess agreement between TFVpred estimates and total FV intake. RESULTS: A TFVpred model, comprised of tomatoes, apples, carrots, bananas, pears, strawberries, and onions, satisfied the selection criteria (R2 = 0.761; SEE = 78.81). Observed and predicted total FV intake values were positively correlated in the MG (r = 0.872; P < 0.001; R2 = 0.761) and the VG (r = 0.838; P < 0.001; R2 = 0.702). In the MG and VG, 95.0% and 94.9%, respectively, of TFVpred model residuals were within the limits of agreement. CONCLUSIONS: Intakes of a concise FV list can be used to predict total FV intakes in a UK population. The individual FVs included in the TFVpred model present targets for biomarker discovery aimed at objectively assessing total FV intake.

Type and density of independent takeaway outlets: a geographical mapping study in a low socioeconomic ward, Manchester.

OBJECTIVES: The socioeconomic disparity in childhood and early adult obesity prevalence has been well characterised. Takeaway outlets may cluster in lower socioeconomic areas and their proximity to schools is of concern. This study aimed to map takeaway food outlets, characterise takeaway types and their proximity to educational institutions within a low socioeconomic ward in Manchester. DESIGN: The Rusholme ward and a 2 km Euclidean buffer were included as the study area. Local authority Environmental Health data were used to map the takeaway outlets, using QGIS V.2.18.0 (OPENGIS.ch LLC, Einsiedeln, Switzerland). The types of takeaway outlets and major roads were included. Number of outlets within a 400 m Euclidean walking buffer of educational institutions were mapped. SETTING: Rusholme, Manchester, UK. RESULTS: Within the study area, 202 takeaway food outlets were identified and mapped as cluster points. Of these, 62.3% are located on major (A and B) roads, while the remaining outlets were located on minor roads. The majority (57.4%) of takeaway outlets sold similar items (fried chicken, burgers, pizzas, kebabs), with the remainder offering more diverse menus. Of the 53 schools, colleges and universities within the study area, 28 (52.8%) had 1-5 takeaway food outlets within 400 m, 9 (17.0%) had 6-10 outlets; 4 (7.5%) more than 11 outlets with 12 (22.6%) having zero outlets within 400 m. CONCLUSION: Within this low socioeconomic area, there was a high concentration of takeaway food outlets, predominantly along major roads and in easy walking distance of educational establishments with the majority offering similar foods. In addition, a high proportion of these outlets were in easy walking distance of educational establishments. Public health policy needs to consider the implications of current takeaway food outlets and not just the proliferation of these outlets with current planning laws.

Sociocultural aspects of takeaway food consumption in a low-socioeconomic ward in Manchester: a grounded theory study.

OBJECTIVES: Takeaway foods form a growing proportion of the UK diet. This consumption is linked with poor health outcomes due to their adverse nutritional profile. However, there is little research regarding the sociocultural context surrounding the consumption of takeaway meals. This research aimed to explore the sociocultural factors that influence the consumption of takeaway foods. DESIGN: The study employed constructivist grounded theory (GT) methodology. Data were collected using one-to-one semi-structured interviews from an inner-city area of Manchester (Rusholme). Data sorting and analysis was implemented using the GT constant comparative method. SETTING: Rusholme, Manchester, UK. PARTICIPANTS: Adult participants (aged 18 to 65 years) consuming takeaway meals at least once/month were recruited using social media and community settings. RESULTS: 13 participants were interviewed (female 69%, mean age=38 years). Three superordinate themes were derived from data: social factors, personal factors and resources. Social Factors included the influence of routines and traditions, influential others and a sense of community in the bonding and affirming of relationships. Personal Factors explored the subordinate themes of controlling damage and values relating to food choice. The third theme 'Resources' included time, availability, cost and quality. CONCLUSION: This study shows the sociocultural influences on food choice decisions are complex and may go beyond access and availability. Any policy change to limit takeaway consumption should acknowledge these vital processes in food choice to inform targeted effective approaches.

A qualitative analysis of the enforcement of the regulation of nutrition and health claims made for foods and its implications for health.

In common with local government organisations across the world, local authorities in the UK have responsibility for promoting health. A key part of this function is the frontline enforcement activities of officers responsible for compliance with health and nutrition claims. This study identifies attitudes, values and practices of enforcers: namely trading standards and environmental health officers, when faced with the problem of non-compliance with the Regulation. Semi-structured interviews with frontline enforcers from local authority regulatory services to investigate challenges with the enforcement of Regulation (EC) 1924/2006. Twenty participants were interviewed; sixteen were based in North West England and two in the North and two in the South of England. The participants were selected for their specialist knowledge and experience of enforcement of nutrition and health claims. Regulation (EC) No. 1924/2006 on nutrition and health claims presents particular challenges for enforcers seeking to apply an optimal strategy to flawed regulatory design. As with other regulations, when faced with non-compliance, enforcers, specifically trading standards and environmental health officers have a wide discretion to determine their response: ranging from the deterrent or accommodative styles of enforcement. The participants reported using advice rather than action and by doing so confronting their bifurcating identity of prosecutor and advisor. Enforcers used advice as a regulatory tool in enforcing the law relating to nutrition and health claims.

Public reaction to the UK government strategy on childhood obesity in England: A qualitative and quantitative summary of online reaction to media reports.

This work aimed to summarise public real-time reaction to the publication of the UK government childhood obesity strategy by applying a novel research design method. We used a netnographic technique to carry out thematic analysis of user-generated comments to online newspaper articles related to the strategy. We examined likes/dislikes associated with comments as a proxy of agreement of the wider community with identified themes. To examine media influence on the comments we carried out thematic analysis of online media headlines published about the strategy, and compared these themes with themes identified from comments. Three newspaper articles and 1704 associated comments were included. Three parent themes were identified: paternalism/libertarianism, lobbyist influence and, anecdotal solutions. The comments were largely negative (94%). Commenters were split as to individual responsibilities and the role of the government, some felt that lobbyist influence had won out over the nation's health and others offered non-evidence based solutions. The ten most liked and disliked comments reflected themes identified in our main analysis. There was parity between themes that emerged from comments and from headlines. This summary of public reaction to the obesity strategy publication may aid translation of public views and receptiveness into practice and inform subsequent government action and policy. Furthermore, the process applied herein may provide a means of informal public engagement.

Association of maternal diabetes/glycosuria and pre-pregnancy body mass index with offspring indicators of non-alcoholic fatty liver disease.

BACKGROUND: Little is known about early life determinants of non-alcoholic fatty liver disease (NAFLD). We examined associations of maternal pregnancy diabetes/glycosuria and pre-pregnancy body mass index (BMI) with offspring markers of NAFLD and liver pathology and examined mediation by birthweight and concurrent offspring adiposity. METHODS: We used data from a UK prospective pregnancy cohort. Offspring underwent abdominal ultrasonography (USS) at mean age 17.8 years. Outcomes included USS-assessed fatty liver, estimated liver volume and shear velocity, a variant of elastography (a marker of liver fibrosis) (N = 1 215) and blood-based markers of liver pathology [alanine amino transferase, aspartate amino transferase, gamma- glutamyltransferase and haptoglobin] (N = 2 359). RESULTS: 2.1 % (N = 25) of participants had USS-assessed fatty liver [maternal diabetes/glycosuria (N = 7) and no diabetes/glycosuria (N = 18)]. Maternal diabetes/glycosuria was associated with greater odds of offspring USS fatty liver in confounder adjusted models [adjusted odds ratio (aOR) 6.74 (95 % confidence interval (CI) 2.47, 18.40)] and higher shear velocity [adjusted ratio of geometric mean (aRGM):1.10 (95 % CI 1.05, 1.15)]. These associations were not mediated by offspring birthweight or concurrent adiposity. Maternal diabetes/glycosuria was not associated with liver volume or blood-based outcomes. Greater maternal pre-pregnancy BMI was associated with greater odds of offspring USS fatty liver [aOR 2.72 (95 % CI: 1.20, 6.15)], higher liver volume [aRGM 1.03 (95 % CI 1.00, 1.07)] and shear velocity [aRGM1.03 (95 % CI: 1.01, 1.06)] in confounder adjusted models. These associations were largely mediated by offspring adiposity. Maternal pre-pregnancy BMI was not consistently associated with blood-based outcomes. CONCLUSIONS: Results suggest that maternal pregnancy diabetes/glycosuria is associated with offspring NAFLD through mechanisms other than offspring's own adiposity.

The association of nonalcoholic fatty liver disease with central and peripheral blood pressure in adolescence: findings from a cross-sectional study.

OBJECTIVES: We aimed to determine the association of nonalcoholic fatty liver disease (NAFLD) with central and peripheral blood pressure (BP), in a general adolescent population and to examine whether associations are independent of adiposity. METHODS: Using cross-sectional data from a subsample (N = 1904) of a UK birth cohort, we assessed markers of NAFLD including ultrasound scan (USS) determined fatty liver, shear velocity (marker of liver fibrosis), alanine aminotransferase (ALT), aspartate aminotransferase (AST) and gamma-glutamyltransferase (GGT) at a mean age of 17.8 years. These were related to BP [central and peripheral SBP and DBP and mean arterial pressure (MAP)]. RESULTS: Fatty liver was positively associated with central and peripheral SBP, DBP and MAP in models adjusting for age, sex, social class, puberty and alcohol intake. These positive associations were attenuated to the null when fat mass was included. For example, in confounder-adjusted models, not including fat mass, mean central SBP was 3.74 mmHg [95% confidence interval (CI) 1.12 to 6.36] higher in adolescents with USS fatty liver than in those without; with additional adjustment for fat mass, the association attenuated to the null value (-0.37 mmHg; 95% CI -3.09 to 2.36). Similar patterns were found for associations of ALT and GGT with central and peripheral BP. There was no consistent evidence of associations of shear velocity or AST with BP measurements. Fatty liver was not consistently associated with central pulse pressure (PP), peripheral PP and Aix@75. CONCLUSION: NAFLD is not associated with higher central or peripheral BP in adolescents once confounding by adiposity is taken into account.

Cross-sectional association of dietary patterns with asthma and atopic sensitization in childhood - in a cohort study.

BACKGROUND: Many studies have investigated individual nutrients or foods as risk factors for allergic disease, but few have studied dietary patterns. We aimed to use principal component analysis (PCA) to determine dietary patterns in school age children and examine associations between these dietary patterns and wheeze, asthma and sensitization. METHODS: Participants in a population-based birth cohort attended review clinics at ages 8 and 11 yr. A validated questionnaire was interviewer-administered to collect information on parentally reported symptoms and doctor-diagnosed asthma. Atopic sensitization was ascertained by skin-prick tests. Current asthma was defined as doctor-diagnosed asthma and wheezing in the previous 12 months. A validated semi-quantitative food frequency questionnaire was completed at age 8 yr, and PCA was used to determine dietary patterns. RESULTS: Principal component analysis identified three dietary components, which based on their characteristics we termed as Traditional (mixed meat, fish, fruit and vegetables), Western (predominantly high fat content, processed foods) and Other (predominantly grains and nuts) dietary patterns. High adherence to the Western diet pattern was significantly associated with doctor-diagnosed asthma and current asthma at age 8 yr [aOR (95% CI): 2.19 (1.20-4.01), p = 0.01; 2.59 (1.15-5.81), p = 0.02; respectively]. A similar association was found for current asthma at age 11 yr [aOR (95% CI): 2.20 (1.07-4.51), p = 0.03]. There was no evidence of an association between dietary patterns and current wheeze and allergic sensitization at either age 8 or 11 yr. CONCLUSION: School age children adhering strongly to a Western diet, high in fat and processed foods, had a higher risk of current asthma and doctor-diagnosed asthma.

The association between irregular menstruations and acne with asthma and atopy phenotypes.

Earlier menarche and irregular periods, among other markers of sex-hormone levels, have been associated with a higher risk of asthma and allergic diseases. This has suggested an etiologic role of sex hormones in the development of these conditions. The authors investigated the association of age at menarche, irregular periods, duration of menstruation, and acne with reported medical history of asthma and/or atopy (hay fever and/or eczema/urticaria) in a historical cohort of students born before the rise in asthma prevalence in the United Kingdom and attending university in 1948-1968. Finding consistent associations in a cohort that has experienced different life-course exposures and has different confounding structure can help to identify causal associations. In the Glasgow Alumni Cohort, irregular periods were associated with atopic asthma (multinomial odds ratio (MOR) = 2.79, 95% confidence interval (CI): 1.33, 5.83) and atopy alone (MOR = 1.40, 95% CI: 1.06, 1.84) but not with nonatopic asthma (MOR = 1.02, 95% CI: 0.45, 2.30), compared with students reporting no asthma and no atopy. The authors found no association with acne, a marker of high testosterone levels, that they hypothesized could point to polycystic ovary syndrome underpinning these associations. In summary, the authors found evidence for a potentially etiologic role of irregular menstruations with some specific asthma phenotypes, namely, atopic asthma and atopy, but not with nonatopic asthma.

Associations between socioeconomic position and asthma: findings from a historical cohort.

Understanding the association between asthma and socioeconomic position (SEP) is key to identify preventable exposures to prevent inequalities and lessen overall disease burden. We aim to assess the variation in asthma across SEP groups in a historical cohort before the rise in asthma prevalence. Male students participating in a health survey at Glasgow University from 1948 to 1968 (n = 11,274) completed medical history of bronchitis, asthma, hay fever, eczema/urticaria, and reported father's occupation. A subsample responded to postal follow-up in adulthood (n = 4,101) that collected data on respiratory diseases, early life and adult SEP. Lower father's occupational class was associated with higher odds of asthma only (asthma without eczema/urticaria or hay fever) (trend adjusted multinomial odds ratio (aMOR) = 1.23, 95 % CI 1.03-1.47) but with lower odds of asthma with atopy (asthma with eczema/urticaria or hay fever) (trend aMOR = 0.66, 95 % CI 0.52-0.83) and atopy alone (trend aMOR = 0.84, 95 % CI 0.75-0.93). Household amenities (<3), in early life was associated with higher odds of adult-onset asthma (onset > 30 years) (OR = 1.48, 95 % CI 1.07-2.05) though this association attenuated after adjusting for age. Adult SEP (household crowding, occupation, income and car ownership) was not associated with adult-onset asthma. Lower father's occupational class in early life was associated with higher odds of asthma alone but lower odds of asthma with atopy in a cohort that preceded the 1960s rise in asthma prevalence. Different environmental exposures and/or disease awareness may explain this opposed socioeconomic patterning, but it is important to highlight that such patterning was already present before rises in the prevalence of asthma and atopy.

Estimated portion sizes in a school-aged population.

OBJECTIVE: To produce study-specific portion sizes for 11-year-old children in a population-based birth cohort and to compare these study-specific portion sizes with previously published children's portion sizes, to assess their relevance today. DESIGN: Two multiple-pass 24 h dietary recalls were taken. The Food Standard Agency's photographic food atlas was used to quantify intakes. Study-specific food portion sizes were calculated for each food group. Portion sizes were calculated for all children and separately for boys and girls. The nutrient intake from the 24 h dietary recalls was analysed using study-specific and published portion sizes for individual participants. Agreement was assessed using Pearson's correlation, intra-class correlation coefficients and the Bland-Altman method. SETTING: Birth cohort study, UK. SUBJECTS: Children (mean age 11.3 years, n 264) and parents/guardians. RESULTS: A total of 124 food portion sizes were calculated. Differences in portion weights between boys and girls were seen only for seven food items. There was a significant positive relationship (P < 0.001) between intakes of each nutrient as determined by the two sets of portion sizes. Correlation coefficients ranged from 0.77 (protein) to 0.98 (ß-carotene). The intra-class correlation coefficients showed good agreement between nutrient intakes determined by the study-specific and published portion sizes (P < 0.001). CONCLUSIONS: Nutrient intakes calculated using portion sizes from our population were similar to those calculated from portion size data collected in a national survey, despite being collected over a decade later. The present study adds to the small amount of evidence regarding portion sizes in UK children and shows agreement with previously published paediatric portion sizes.

Associations of gestational diabetes, existing diabetes, and glycosuria with offspring obesity and cardiometabolic outcomes.

OBJECTIVE: To assess associations of gestational diabetes, existing diabetes, and glycosuria with adiposity and cardiometabolic risk factors in offspring at adolescence. RESEARCH DESIGN AND METHODS: Multivariable regression analyses were conducted in a prospective pregnancy cohort (n = 2,563-4,198 for different outcomes). Obstetric data were abstracted from clinical records. Offspring outcomes were assessed at mean age 15.5 years. Compared with those lost to follow-up, participants included in the analysis were of higher socioeconomic position. Outcomes included BMI, waist circumference, fat mass determined by dual-energy X-ray absorptiometry scan, systolic and diastolic blood pressure (sBP and dBP, respectively), fasting glucose, insulin, lipids, and C-reactive protein (CRP). RESULTS: Maternal existing diabetes, gestational diabetes, and glycosuria were associated with higher offspring BMI and fat mass (z scores); however, this effect was attenuated in the confounder-adjusted model, and the CIs included the null value. Existing diabetes and gestational diabetes were associated with higher offspring fasting glucose levels (0.24 mmol/L [95% CI 0.03-0.45] and 0.20 mmol/L [0.02-0.39], respectively). Glycosuria was associated with higher fasting insulin (adjusted ratio of geometric means 1.12 [1.01-1.25]), but there were no clear associations of existing or gestational diabetes with offspring fasting insulin. There was little evidence of an association of maternal diabetes or glycosuria with offspring dBP, sBP, lipids, or CRP. CONCLUSIONS: Maternal pregnancy glycosuria, gestational diabetes, and existing diabetes show some associations with higher offspring fasting glucose and insulin assessed in adolescence but are not clearly associated with a wider range of cardiometabolic risk factors.