Longitudinal associations of diurnal rest-activity rhythms with fatigue, insomnia, and health-related quality of life in survivors of colorectal cancer up to 5 years post-treatment.

BACKGROUND: There is a growing population of survivors of colorectal cancer (CRC). Fatigue and insomnia are common symptoms after CRC, negatively influencing health-related quality of life (HRQoL). Besides increasing physical activity and decreasing sedentary behavior, the timing and patterns of physical activity and rest over the 24-h day (i.e. diurnal rest-activity rhythms) could also play a role in alleviating these symptoms and improving HRQoL. We investigated longitudinal associations of the diurnal rest-activity rhythm (RAR) with fatigue, insomnia, and HRQoL in survivors of CRC. METHODS: In a prospective cohort study among survivors of stage I-III CRC, 5 repeated measurements were performed from 6 weeks up to 5 years post-treatment. Parameters of RAR, including mesor, amplitude, acrophase, circadian quotient, dichotomy index, and 24-h autocorrelation coefficient, were assessed by a custom MATLAB program using data from tri-axial accelerometers worn on the upper thigh for 7 consecutive days. Fatigue, insomnia, and HRQoL were measured by validated questionnaires. Confounder-adjusted linear mixed models were applied to analyze longitudinal associations of RAR with fatigue, insomnia, and HRQoL from 6 weeks until 5 years post-treatment. Additionally, intra-individual and inter-individual associations over time were separated. RESULTS: Data were available from 289 survivors of CRC. All RAR parameters except for 24-h autocorrelation increased from 6 weeks to 6 months post-treatment, after which they remained relatively stable. A higher mesor, amplitude, circadian quotient, dichotomy index, and 24-h autocorrelation were statistically significantly associated with less fatigue and better HRQoL over time. A higher amplitude and circadian quotient were associated with lower insomnia. Most of these associations appeared driven by both within-person changes over time and between-person differences in RAR parameters. No significant associations were observed for acrophase. CONCLUSIONS: In the first five years after CRC treatment, adhering to a generally more active (mesor) and consistent (24-h autocorrelation) RAR, with a pronounced peak activity (amplitude) and a marked difference between daytime and nighttime activity (dichotomy index) was found to be associated with lower fatigue, lower insomnia, and a better HRQoL. Future intervention studies are needed to investigate if restoring RAR among survivors of CRC could help to alleviate symptoms of fatigue and insomnia while enhancing their HRQoL. TRIAL REGISTRATION: EnCoRe study NL6904 ( https://www.onderzoekmetmensen.nl/ ).

Longitudinal associations of circadian eating patterns with sleep quality, fatigue and inflammation in colorectal cancer survivors up to 24 months post-treatment.

Fatigue and insomnia, potentially induced by inflammation, are distressing symptoms experienced by colorectal cancer (CRC) survivors. Emerging evidence suggests that besides the nutritional quality and quantity, also the timing, frequency and regularity of dietary intake (chrono-nutrition) could be important for alleviating these symptoms. We investigated longitudinal associations of circadian eating patterns with sleep quality, fatigue and inflammation in CRC survivors. In a prospective cohort of 459 stage I-III CRC survivors, four repeated measurements were performed between 6 weeks and 24 months post-treatment. Chrono-nutrition variables included meal energy contribution, frequency (a maximum of six meals could be reported each day), irregularity and time window (TW) of energetic intake, operationalised based on 7-d dietary records. Outcomes included sleep quality, fatigue and plasma concentrations of inflammatory markers. Longitudinal associations of chrono-nutrition variables with outcomes from 6 weeks until 24 months post-treatment were analysed by confounder-adjusted linear mixed models, including hybrid models to disentangle intra-individual changes from inter-individual differences over time. An hour longer TW of energetic intake between individuals was associated with less fatigue (ß: -6·1; 95 % CI (-8·8, -3·3)) and insomnia (ß: -4·8; 95 % CI (-7·4, -2·1)). A higher meal frequency of on average 0·6 meals/d between individuals was associated with less fatigue (ß: -3·7; 95 % CI (-6·6, -0·8)). An hour increase in TW of energetic intake within individuals was associated with less insomnia (ß: -3·0; 95 % CI (-5·2, -0·8)) and inflammation (ß: -0·1; 95 % CI (-0·1, 0·0)). Our results suggest that longer TWs of energetic intake and higher meal frequencies may be associated with less fatigue, insomnia and inflammation among CRC survivors. Future studies with larger contrasts in chrono-nutrition variables are needed to confirm these findings.

The Effect of Niacinamide Supplementation on Phosphate Concentrations in Dutch Dialysis Patients: A Randomized Crossover Trial.

OBJECTIVE: Hyperphosphatemia is a common complication in patients with kidney failure, despite the use of phosphate binders. Vitamin B3, either in the form of niacin or niacinamide (NAM), shows potential as "add-on" treatment to reduce serum phosphate concentrations in this population. NAM seems to lack many of the side effects that are observed with niacin. The aim of this study was to investigate whether NAM is an effective and acceptable treatment in reducing serum phosphate concentrations in patients with kidney failure. METHODS: DiaNia was a double-blind placebo-controlled randomized crossover trial, comparing NAM (250-500 mg/day) to placebo as "add-on" treatment to an individual treatment with approved phosphate binders for 12 weeks in patients receiving hemodialysis. The primary outcome was serum phosphate concentrations, and the secondary outcomes were platelet counts as well as drop-outs due to side effects. Data were analyzed using both per-protocol and intention-to-treat analyses. RESULTS: Mean age of the per-protocol population (n = 26) was 63.6 ± 17.2 years and 53.8% were men. NAM treatment significantly reduced serum phosphate with 0.59 mg/dL (p = .03). Linear mixed-effects models demonstrated superiority of 12 weeks NAM over 12 weeks placebo with a between-treatment difference of 0.77 mg/dL (95% CI 0.010, 1.43; P = .03). Similar results, although not significant, were found in the intention-to-treat population. We found no between-treatment differences in platelet counts and during the NAM treatment we observed 3 drop-outs due to side effects (8.6%). CONCLUSION: NAM is effective in reducing serum phosphate concentrations in patients with kidney failure receiving hemodialysis. In addition, NAM is well-tolerated and seems not to increase the risk of thrombocytopenia. Thus, NAM can be valuable as "add-on" treatment to combat hyperphosphatemia in patients with kidney failure. However, more research in larger populations is needed to confirm this.

Observational study on dietary changes of participants following a multicomponent lifestyle program (Reverse Diabetes2 Now).

BACKGROUND: Lifestyle intervention studies to treat type 2 diabetes (T2D) are on the rise. However, in-depth research is lacking into the dietary changes that participants make. METHODS: The present study aimed to observe the dietary intake of participants following the group program 'Reverse Diabetes2 Now' (RD2N) over 12 months. The web-based 24-h dietary recall-tool Compl-eat was used to collect dietary intake data. RESULTS: In total, 147 T2D patients were included in a cross-sectional study (n = 37 at baseline, n = 58 at 6 months, n = 52 at 12 months). A lower intake of total energy, carbohydrates and iodine was found for the groups at 6 and 12 months compared to the baseline group. The absolute consumption of total fat and saturated fat did not differ between the groups; only the percentage as total calorie consumption decreased. Consumption of vegetables and full-fat yoghurt was higher in groups at 6 and 12 months compared to the group at baseline. Consumption of bread, cakes and sweet biscuits, pasta/rice/tortillas, artificially sweetened soft drinks, and crisps were lower in the groups at 6 and 12 months compared to the group at baseline. Similar results were observed in a separate prospective study in 22 participants over 12 months following the same lifestyle-intervention. CONCLUSIONS: Overall, participants shifted their dietary intake somewhat towards a healthier dietary pattern with overall lower energy and carbohydrates and more vegetables. Moreover, participants largely maintained this healthier pattern over 12 months. There were some concerns regarding iodine intake. These promising results need to be confirmed in a fully-scaled study, as well in a comparison with controls.

Chrono-nutrition: From molecular and neuronal mechanisms to human epidemiology and timed feeding patterns.

The circadian timing system governs daily biological rhythms, synchronising physiology and behaviour to the temporal world. External time cues, including the light-dark cycle and timing of food intake, provide daily signals for entrainment of the central, master circadian clock in the hypothalamic suprachiasmatic nuclei (SCN), and of metabolic rhythms in peripheral tissues, respectively. Chrono-nutrition is an emerging field building on the relationship between temporal eating patterns, circadian rhythms, and metabolic health. Evidence from both animal and human research demonstrates adverse metabolic consequences of circadian disruption. Conversely, a growing body of evidence indicates that aligning food intake to periods of the day when circadian rhythms in metabolic processes are optimised for nutrition may be effective for improving metabolic health. Circadian rhythms in glucose and lipid homeostasis, insulin responsiveness and sensitivity, energy expenditure, and postprandial metabolism, may favour eating patterns characterised by earlier temporal distribution of energy. This review details the molecular basis for metabolic clocks, the regulation of feeding behaviour, and the evidence for meal timing as an entraining signal for the circadian system in animal models. The epidemiology of temporal eating patterns in humans is examined, together with evidence from human intervention studies investigating the metabolic effects of morning compared to evening energy intake, and emerging chrono-nutrition interventions such as time-restricted feeding. Chrono-nutrition may have therapeutic application for individuals with and at-risk of metabolic disease and convey health benefits within the general population.

Probiotics use for antibiotic-associated diarrhea: a pragmatic participatory evaluation in nursing homes.

BACKGROUND: Antibiotic-associated diarrhea (AAD) occurs in 2-25% of nursing home residents, which may lead to dehydration, malnutrition, severe complications and hospitalizations. Research shows that probiotics can be effective and safe in reducing AAD. However, probiotics are not routinely used in Dutch nursing homes. The objectives of this evaluation were to develop a procedure for the implementation of probiotics to prevent AAD in nursing homes, to evaluate effects on AAD occurrence, and to evaluate the implementation process of probiotics in daily care. METHODS: A pragmatic participatory evaluation (PPE) design was chosen, as it seemed a suitable approach for implementation of probiotics, as well as for evaluation of its effectiveness in daily nursing home practice. Probiotics administration was implemented in three nursing homes of the Rivas Zorggroep for residents with somatic and/or psychogeriatric conditions. Ninety-three residents provided data on 167 episodes of antibiotics use, of which 84 episodes that included supplementation with probiotics and 83 episodes with no probiotics supplementation. A multispecies probiotics was administered twice daily upon start of antibiotic treatment, up to 1 week after completing the antibiotics course. The occurrence of AAD was monitored and a process evaluation was conducted to assess facilitators and barriers of probiotics implementation. RESULTS: The number of episodes with AAD when using probiotics was significantly lower than when no probiotics was used (20% vs 36%; p = 0,022, Chi-square). No significant differences in the occurrence of AAD were found between the residents taking amoxicillin/clavulanic acid or ciprofloxacin. Reported facilitators for implementation were perceived benefits of probiotics and prescription by medical staff. Reported challenges were probiotics intake by residents and individual decision-making as to which resident would benefit from it. CONCLUSION: Successful implementation of probiotics demonstrated the prevention of AAD in nursing home residents. TRIAL REGISTRATION: ISRCTN 94786163, retrospectively registered on 3 February 2020.

Tree nut snack consumption is associated with better diet quality and CVD risk in the UK adult population: National Diet and Nutrition Survey (NDNS) 2008-2014.

OBJECTIVES: To examine associations of tree nut snack (TNS) consumption with diet quality and cardiovascular disease (CVD) risk in UK adults from National Diet and Nutrition Survey (NDNS) 2008-2014. DESIGN: Cross-sectional analysis using data from 4-d food diaries, blood samples and physical measurements for CVD risk markers. To estimate diet quality, modified Mediterranean Diet Score (MDS) and modified Healthy Diet Score (HDS) were applied. Associations of TNS consumption with diet quality and markers of CVD risk were investigated using survey-adjusted multivariable linear regression adjusted for sex, age, ethnicity, socio-economic and smoking status, region of residency and total energy and alcohol intake. SETTING: UK free-living population. SUBJECTS: 4738 adults (≥19 years). RESULTS: TNS consumers had higher modified MDS and HDS relative to non-consumers. TNS consumers also had lower BMI, WC, SBP and DBP and higher HDL compared to non-consumers, although a dose-related fully adjusted significant association between increasing nut intake (g per 4184 kJ/1000 kcal energy intake) and lower marker of CVD risk was only observed for SBP. TNS consumption was also associated with higher intake of total fat, mono-, n-3 and n-6 polyunsaturated fatty acids, fibre, vitamin A, thiamin, folate, vitamin C, vitamin E, potassium, magnesium, phosphorus, selenium and iron; and lower intake of saturated fatty acids, trans fatty acids, total carbohydrate, starch, free sugar, sodium and chloride. CONCLUSIONS: TNS consumers report better dietary quality and consumption was associated with lower CVD risk factors. Encouraging replacement of less healthy snacks with TNS should be encouraged as part of general dietary guidelines.

Fingerfoods: a feasibility study to enhance fruit and vegetable consumption in Dutch patients with dementia in a nursing home.

BACKGROUND: Eating problems are highly prevalent in older patients with dementia and as a consequence, these patients are at greater risk of becoming malnourished. Fingerfoods, snacks that can be picked with thumb and forefinger, could be used to counteract malnutrition in patients with dementia. The aim of this feasibility study was to evaluate whether providing fruit and vegetable rich fingerfoods in the form of recognizable and familiar snacks on top of the normal intake was feasible for both patients with dementia and caregivers as a means to increase patients' nutritional status. METHODS: Institutionalised patients with dementia (N = 15, 93% female, mean age = 85 years) were included in this feasibility study in the Netherlands. The residents received their regular diet supplemented with fingerfoods, comprising quiches and cakes rich in fruit or vegetables, for 6 weeks. Daily fingerfood consumption together with compensation behaviour at dinner of residents was administered with a checklist and food diaries at the start and end of the intervention as dose delivered. Furthermore, caregivers were asked to fill out a feedback form at the end of the intervention to measure fidelity and appreciation of the intervention. RESULTS: Patients consumed on average 1.4 pieces (70 g) of fingerfoods daily, containing 41 g of fruit and/or vegetables. Fruit and vegetable consumption increased during the provision of the fingerfoods and the residents seemed not to compensate this intake during the rest of the day. The intervention was generally positively received by the majority of caregivers, depending on the type of fingerfood and state of the resident. CONCLUSION: This feasibility study showed that providing recognizable fruit and vegetable rich fingerfoods to patients with dementia seems feasible for both patients and caregivers and could provide a pragmatic approach to enhance fruit and vegetable consumption and total food intake in institutionalized elderly. In an up-scaled study, effects of fingerfoods on nutritional status and quality of life should be investigated.

Portioning meat and vegetables in four different out of home settings: A win-win for guests, chefs and the planet.

Individuals increasingly consume their meals away from home. This article describes a series of studies that examined the effects of meals with reduced amounts of meat and increased amounts of vegetables on food consumption, waste and guest satisfaction in four real-life restaurant settings in the Netherlands: an a-la-carte restaurant, six company canteens, a self-service restaurant, and a buffet restaurant, including nearly 1500 participants in total. The four studies in these four different out of home settings consistently showed that adapting portion sizes of meat and vegetables was effective to reduce meat consumption and increase vegetable consumption, while maintaining high guest satisfaction. Guest satisfaction even increased when vegetables were presented and prepared in a more attractive and tasty way. Thus, adapting portion sizes of meat and vegetables provides a viable strategy to stimulate healthy and environmentally sustainable consumption patterns in out of home settings.

Dietary glycaemic index and cognitive function: prospective associations in adults of the 1946 British birth cohort.

OBJECTIVE: Evidence suggests that the rate of glucose release following consumption of carbohydrate-containing foods, defined as the glycaemic index (GI), is inversely associated with cognitive function. To date, most of the evidence stems from either single-meal studies or highly heterogeneous cohort studies. We aimed to study the prospective associations of diet GI at age 53 years with outcomes of verbal memory and letter search tests at age 69 years and rate of decline between 53 and 69 years. DESIGN: Longitudinal population-based birth cohort study. SETTING: MRC National Survey for Health and Development. PARTICIPANTS: Cohort members (n 1252). RESULTS: Using multivariable linear and logistic regression, adjusted for potential confounders, associations of higher-GI diet with lower verbal memory, lower letter search speed and lower number of hits in a letter search test were attenuated after adjustments for cognitive ability at age 15 years, educational attainment, further training and occupational social class. No association was observed between diet GI at 53 years and letter search accuracy or speed-accuracy trade-off at 69 years, or between diet GI at 53 years and rate of decline between 53 and 69 years in any cognitive measure. CONCLUSIONS: Diet GI does not appear to predict cognitive function or decline, which was mainly explained by childhood cognitive ability, education and occupational social class. Our findings confirm the need for further research on the association between diet and cognition from a life-course perspective.

Breakfast consumption and nutrient intakes in 4-18-year-olds: UK National Diet and Nutrition Survey Rolling Programme (2008-2012).

Although breakfast consumption is widely considered to be an important component of a healthy lifestyle, few UK studies have examined differences in nutrient intakes between breakfast consumers and breakfast skippers among children and adolescents. We investigated associations between breakfast skipping in 4-18-year-olds and their nutrient intakes using data from the UK's National Diet and Nutrition Survey Rolling Programme. Dietary data were derived from 4-d estimated food diaries of 802 children aged 4-10 years and 884 children aged 11-18 years (1686 in total). Daily nutrient intakes of children with different breakfast habits were compared by one-way ANCOVA adjusting for relevant covariates (sex, age, ethnicity, equivalised household income and BMI). Within-person analysis was carried out on children with an irregular breakfast habit (n 879) comparing nutrient intakes on breakfast days with those on non-breakfast days using repeated measures ANCOVA. We observed that the overall nutritional profile of the children in terms of fibre and micronutrient intake was superior in frequent breakfast consumers (micronutrients: folate, Ca, Fe and I (P<0·01)) and, for the 4-10 years age group, on breakfast days (micronutrients: folate, vitamin C, Ca and I (P<0·01)). Also, significantly higher proportions of breakfast-consuming children met their reference nutrient intakes of folate, vitamin C, Ca, Fe and I compared with breakfast skippers (χ 2 analysis, P<0·001). Our study adds to the body of data linking breakfast consumption with higher quality dietary intake in school-age children, supporting the promotion of breakfast as an important element of a healthy dietary pattern in children.

Main meal quality in Brazil and United Kingdom: Similarities and differences.

Consumption of fast food and ready-to-eat meals has been positively associated with obesity. In the UK, ready-made meals are more often consumed than in Brazil, a country in which nutrition transition is relatively low. This study aimed to compare the nutritional quality of the main meal consumed by adults in Brazil and UK. Food record data was obtained from representative samples from UK and Brazil databases. The Main Meal Quality Index (MMQI) was applied to estimate the quality of the main meal consumed in Brazil and UK. Differences in food groups consumed in the main meal in Brazil and UK were observed using classification decision tree. Meals with higher average energy content were lunch for Brazil, and dinner for the UK. On average, the Brazilian main meal had better nutritional quality (4.42 times higher), independently of sex, age, family income, nutritional status and energy consumed, with higher scores of fiber, carbohydrate, total fat, saturated fat and energy density. However, UK's main meal included more fruits and vegetables. Food preparations combined with rice and beans were classified as Brazilian main meal, while combinations with fast food items, as fried potatoes, sandwiches and sugary beverages, were classified as UK main meals. In Brazil, the main meal quality was lower among women and obese individuals, presenting significant positive association with age, and negative association with energy intake and family income; while in UK, only age was positively associated with MMQI. Although main meals in Brazil had higher nutritional quality compared to the UK, main meals consumed in both countries need nutritional improvement.

The influence of socio-demographic, psychological and knowledge-related variables alongside perceived cooking and food skills abilities in the prediction of diet quality in adults: a nationally representative cross-sectional study.

BACKGROUND: Interventions to increase cooking skills (CS) and food skills (FS) as a route to improving overall diet are popular within public health. This study tested a comprehensive model of diet quality by assessing the influence of socio-demographic, knowledge- and psychological-related variables alongside perceived CS and FS abilities. The correspondence of two measures of diet quality further validated the Eating Choices Index (ECI) for use in quantitative research. METHODS: A cross-sectional survey was conducted in a quota-controlled nationally representative sample of 1049 adults aged 20-60 years drawn from the Island of Ireland. Surveys were administered in participants' homes via computer-assisted personal interviewing (CAPI) assessing a range of socio-demographic, knowledge- and psychological-related variables alongside perceived CS and FS abilities. Regression models were used to model factors influencing diet quality. Correspondence between 2 measures of diet quality was assessed using chi-square and Pearson correlations. RESULTS: ECI score was significantly negatively correlated with DINE Fat intake (r = -0.24, p < 0.001), and ECI score was significantly positively correlated with DINE Fibre intake (r = 0.38, p < 0.001), demonstrating a high agreement. Findings indicated that males, younger respondents and those with no/few educational qualifications scored significantly lower on both CS and FS abilities. The relative influence of socio-demographic, knowledge, psychological variables and CS and FS abilities on dietary outcomes varied, with regression models explaining 10-20 % of diet quality variance. CS ability exerted the strongest relationship with saturated fat intake (ß = -0.296, p < 0.001) and was a significant predictor of fibre intake (ß = -0.113, p < 0.05), although not for healthy food choices (ECI) (ß = 0.04, p > 0.05). CONCLUSION: Greater CS and FS abilities may not lead directly to healthier dietary choices given the myriad of other factors implicated; however, CS appear to have differential influences on aspects of the diet, most notably in relation to lowering saturated fat intake. Findings suggest that CS and FS should not be singular targets of interventions designed to improve diet; but targeting specific sub-groups of the population e.g. males, younger adults, those with limited education might be more fruitful. A greater understanding of the interaction of factors influencing cooking and food practices within the home is needed.

The timing of the evening meal: how is this associated with weight status in UK children?

There is some evidence from studies in adults and limited evidence from studies in children that eating later in the day may increase the risk of overweight and obesity. In this cross-sectional study, we investigated associations between evening meal timing in children and their weight status and energy intake. Dietary data obtained from the UK's National Diet and Nutrition Survey Rolling Programme (2008-2012) for 768 children aged 4-10 years and 852 children aged 11-18 years were analysed. We tested for an association between evening meal timing (consuming the evening meal before or after 20.00 hours) and risk of overweight and/or obesity, adjusting for relevant confounding variables. We also explored whether evening meal timing was associated with overall nutrient intake. We found no association between evening meal timing and risk of obesity or risk of overweight and obesity combined in either the 4-10 years age group (obesity: OR 1·43; 95 % CI 0·49, 4·13; obesity and overweight combined: OR 1·33; 95 % CI 0·53, 3·33) or the 11-18 years age group (obesity: OR 0·50; 95 % CI 0·24, 1·02; obesity and overweight combined: OR 0·83; 95 % CI 0·50, 1·38), split by sex or as combined. No significant associations were found between evening meal timing and energy intake, and no clear patterns in variation of nutrient intakes with evening meal times were identified. In conclusion, we found no evidence that, for children aged 4-18 years in the UK, eating the evening meal after 20.00 hours was associated with excess weight or increased energy intake.

Irregularity of energy intake at meals: prospective associations with the metabolic syndrome in adults of the 1946 British birth cohort.

Irregularity in eating patterns could be a potential cardiometabolic risk factor. We aimed to study the associations of irregular intake of energy at meals in relation to cardiometabolic risk factors 10 and 17 years later. Variability of energy intake data - derived from 5-d estimated diet diaries of cohort members of the National Survey for Health and Development collected at ages 36 (n 1416), 43 (n 1505) and 53 years (n 1381) - was used as a measure for irregularity. Associations between meal irregularity scores with cardiometabolic risk factors measured 10 and 17 years later were investigated using linear mixed models and logistic regression models. The results showed that irregularity scores changed significantly over the years (P<0·05). At age 36 years, subjects with a more irregular intake of energy at lunch (OR 1·42; 95 % CI 1·05, 1·91) and between meals (OR 1·35; 95 % CI 1·01, 1·82) had an increased risk for the metabolic syndrome 17 years later; at lunch was also associated with an increased waist circumference (OR 1·58; 95 % 1·27, 1·96) and TAG levels (OR 1·33; 95 % CI 1·02, 1·72). At age 43 years, subjects with a more irregular intake at breakfast had an increased risk of the metabolic syndrome 10 years later (OR 1·53; 95 % CI 1·15, 2·04), as well as an increased BMI (OR 1·66; 95 % CI 1·31, 2·10), waist circumference (OR 1·53; 95 % CI 1·23, 1·90) and diastolic blood pressure (OR 1·42; 95 % CI 1·13, 1·78). In conclusion, subjects with a more irregular intake of energy, mostly at breakfast and lunch, appeared to have an increased cardiometabolic risk 10 and 17 years later.

The reliability of an adolescent dietary pattern identified using reduced-rank regression: comparison of a FFQ and 3 d food record.

Despite the increasing use of dietary patterns (DP) to study diet and health outcomes, relatively few studies have examined the reliability of DP using different dietary assessment methods. Reduced-rank regression (RRR) is an emerging statistical method that incorporates a priori information to characterise DP related to specific outcomes of interest. The aim of the present study was to compare DP identified using the RRR method in a FFQ with those in a 3 d food record (FR). Participants were 783 adolescents from the Western Australian Pregnancy (Raine) Cohort Study who completed both a FFQ and FR at 14 years of age. A similar 'energy-dense, high-fat and low-fibre' DP was identified in the FFQ and FR that was characterised by high intakes of processed meat and sugar-sweetened beverages, and low intakes of vegetables and fresh fruit. Nutrient profiles for this DP were consistent in the FFQ and FR. Pearson's correlation coefficient between participants' z-scores for the DP identified in the FFQ and FR was 0·35 for girls and 0·49 for boys (P< 0·05). The mean difference between DP z-scores derived from the FFQ and FR was -0·08 (95 % CI -0·21, 0·04) for girls and -0·05 (95 % CI -0·17, 0·07) for boys. The 95 % limits of agreement were -2·55 to 2·39 for girls and -2·52 to 2·41 for boys. These findings suggest that very similar DP may be identified and their z-scores show modest agreement when applying the RRR method to dietary intake data collected from adolescents using a FFQ or FR.

Development of the Eating Choices Index (ECI): a four-item index to measure healthiness of diet.

OBJECTIVE: Current indices of diet quality generally include intakes of specific foods or nutrients. We sought to develop an index that discriminates healthy and unhealthy eating choices for use in large surveys as a short questionnaire and as a measure in existing studies with adequate dietary data. DESIGN: The Eating Choices Index (ECI) score included four components: (i) consumption of breakfast, (ii) consumption of two portions of fruit per day, (iii) type of milk consumed and (iv) type of bread consumed, each providing a score from 1 to 5. In analysis of 5 d food records, the ECI score was examined in relation to macronutrients, fibre, vitamin C, Fe, Ca and folate using Pearson correlations. Variation with sex, BMI, socio-economic status, marital status, smoking status and physical activity were also investigated. SETTING: Medical Research Council National Survey of Health and Development. SUBJECTS: Individuals (n 2256) aged 43 years. RESULTS: The ECI score (mean 12·3 (sd 3·5)) was significantly positively associated with protein, carbohydrate, fibre, vitamin C, Fe, Ca and folate (r = 0·2-0·5; P < 0·001) and significantly negatively associated with fat intake (r = -0·2; P < 0·001); ECI scores were not correlated with total energy intake. Individuals with a lower ECI score were more likely to be men (P < 0·001), overweight or obese (P < 0·001), have lower socio-economic status (P < 0·001), smoke more (P < 0·001) and be less physically active (P < 0·001). CONCLUSIONS: ECI scores correlated with nutrient profiles consistent with a healthy diet. It provides a simple method to rank diet healthiness in large observational studies.

Dietary iron does not impact the quality of life of patients with quiescent ulcerative colitis: an observational study.

BACKGROUND: In animal models, excess luminal iron exacerbates colonic inflammation and cancer development. Moreover, in inflammatory bowel disease (IBD) patients with mild to moderate disease activity dietary fortificant iron intake is inversely related to quality of life. Here we sought to determine whether dietary iron intakes were also related to quality of life in IBD patients in remission. METHODS: Forty eight patients with ulcerative colitis (UC), 42 of which had quiescent disease during this observational study, and 53 healthy control subjects completed quality of life questionnaires and 7-day food diaries. For comparative analysis, 34/group were matched and the linear relationship between dietary iron intakes (total, haem, non-haem or fortificant) and EuroQol quality of life measures was investigated. For UC patients the linear relationship between dietary iron intakes and the scores from the disease specific inflammatory bowel disease questionnaire (IBDQ) was also considered. RESULTS: The intake of dietary iron, and its various sub-fractions, were not associated with quality of life (EuroQol) in patients with quiescent disease or in healthy control subjects. The picture was similar for the 42 quiescent UC patients when disease-specific IBDQ was used. However, the 6 patients who relapsed during the study again showed an inverse association between IBDQ and dietary iron intake (p = 0.03). CONCLUSIONS: Our data suggest that dietary iron does not impact on quality of life in quiescent UC patients but support that, once the disease is triggered, luminal iron may be a permissive factor for exacerbation of disease activity resulting in lower quality of life.

National Diet and Nutrition Survey: fat and fatty acid intake from the first year of the rolling programme and comparison with previous surveys.

High saturated fat intake is an established risk factor for several chronic diseases. The objective of the present study is to report dietary intakes and main food sources of fat and fatty acids (FA) from the first year of the National Diet and Nutrition Survey (NDNS) rolling programme in the UK. Dietary data were collected using 4 d estimated food diaries (n 896) and compared with dietary reference values (DRV) and previous NDNS results. Total fat provided 34-36 % food energy (FE) across all age groups, which was similar to previous surveys for adults. Men (19-64 years) and older girls (11-18 years) had mean intakes just above the DRV, while all other groups had mean total fat intakes of < 35 % FE. SFA intakes were lower compared with previous surveys, ranging from 13 to 15 % FE, but still above the DRV. Mean MUFA intakes were 12·5 % FE for adults and children aged 4-18 years and all were below the DRV. Mean n-3 PUFA intake represented 0·7-1·1 % FE. Compared with previous survey data, the direction of change for n-3 PUFA was upwards for all age groups, although the differences in absolute terms were very small. Trans-FA intakes were lower than in previous NDNS and were less than 2 g/d for all age groups, representing 0·8 % FE and lower than the DRV in all age groups. In conclusion, dietary intake of fat and FA is moving towards recommended levels for the UK population. However, there remains room for considerable further improvement.

Estimating the alcohol-breast cancer association: a comparison of diet diaries, FFQs and combined measurements.

The alcohol-breast cancer association has been established using alcohol intake measurements from Food Frequency Questionnaires (FFQ). For some nutrients diet diary measurements are more highly correlated with true intake compared with FFQ measurements, but it is unknown whether this is true for alcohol. A case-control study (656 breast cancer cases, 1905 matched controls) was sampled from four cohorts in the UK Dietary Cohort Consortium. Alcohol intake was measured prospectively using FFQs and 4- or 7-day diet diaries. Both relied on fixed portion sizes allocated to given beverage types, but those used to obtain FFQ measurements were lower. FFQ measurements were therefore on average lower and to enable fair comparison the FFQ was "calibrated" using diet diary portion sizes. Diet diaries gave more zero measurements, demonstrating the challenge of distinguishing never-from episodic-consumers using short term instruments. To use all information, two combined measurements were calculated. The first is an average of the two measurements with special treatment of zeros. The second is the expected true intake given both measurements, calculated using a measurement error model. After confounder adjustment the odds ratio (OR) per 10 g/day of alcohol intake was 1.05 (95 % CI 0.98, 1.13) using diet diaries, and 1.13 (1.02, 1.24) using FFQs. The calibrated FFQ measurement and combined measurements 1 and 2 gave ORs 1.10 (1.03, 1.18), 1.09 (1.01, 1.18), 1.09 (0.99,1.20), respectively. The association was modified by HRT use, being stronger among users versus non-users. In summary, using an alcohol measurement from a diet diary at one time point gave attenuated associations compared with FFQ.