Effect of Manual Data Cleaning on Nutrient Intakes Using the Automated Self-Administered 24-Hour Dietary Assessment Tool (ASA24).

BACKGROUND: Automated dietary assessment tools such as ASA24® are useful for collecting 24-hour recall data in large-scale studies. Modifications made during manual data cleaning may affect nutrient intakes. OBJECTIVES: We evaluated the effects of modifications made during manual data cleaning on nutrient intakes of interest: energy, carbohydrate, total fat, protein, and fiber. METHODS: Differences in mean intake before and after data cleaning modifications for all recalls and average intakes per subject were analyzed by paired t-tests. The Chi-squared test was used to determine whether unsupervised recalls had more open-ended text responses that required modification than supervised recalls. We characterized food types of text response modifications. Correlations between predictive energy requirements, measured total energy expenditure (TEE), and mean energy intake from raw and modified data were examined. RESULTS: After excluding 11 recalls with invalidating technical errors, 1499 valid recalls completed by 393 subjects were included in this analysis. We found significant differences before and after modifications for energy, carbohydrate, total fat, and protein intakes for all recalls (P < 0.05). Limiting to modified recalls, there were significant differences for all nutrients of interest, including fiber (P < 0.02). There was not a significantly greater proportion of text responses requiring modification for home compared with supervised recalls (P = 0.271). Predicted energy requirements correlated highly with TEE. There was no significant difference in correlation of mean energy intake with TEE for modified compared with raw data. Mean intake for individual subjects was significantly different for energy, protein, and fat intakes following cleaning modifications (P < 0.001). CONCLUSIONS: Manual modifications can change mean nutrient intakes for an entire cohort and individuals. However, modifications did not significantly affect the correlation of energy intake with predictive requirements and measured expenditure. Investigators can consider their research question and nutrients of interest when deciding to make cleaning modifications.

Comprehensive Nutrient Gap Assessment (CONGA): A method for identifying the public health significance of nutrient gaps.

Identifying dietary nutrient gaps and interpreting their public health significance are essential for improving poor diets and reducing malnutrition. Evidence indicative of the burden of nutrient deficiencies and inadequate nutrient intake or availability exists in many countries yet is often misinterpreted or underused in decision-making. Clear guidance is lacking on how to synthesize and interpret the relevant evidence, which comes in many forms. To fill this methodological gap, an approach called Comprehensive Nutrient Gap Assessment was created to enable use of existing evidence to assess the public health significance of nutrient gaps and identify evidence gaps. Comprehensive Nutrient Gap Assessment requires ≥ 2 experts in nutritional assessment but does not require primary data collection or secondary quantitative data analysis. It can be implemented relatively quickly with low costs, for specific countries and subnational regions, and updated on the basis of new data with minimal effort. The findings from a Comprehensive Nutrient Gap Assessment are easily interpretable by nontechnical decision makers yet include clear justification for technical audiences.

Micronutrient gaps during the complementary feeding period in 6 countries in Eastern and Southern Africa: a Comprehensive Nutrient Gap Assessment.

Insufficient quantity and inadequate quality of foods in early life are key causes of all forms of malnutrition. Identification of nutrient and dietary gaps in the diets of infants and young children is essential to inform policies and programs designed to improve child diets. A Comprehensive Nutrient Gap Assessment was used to assess the public health significance of nutrient gaps during the complementary feeding period and to identify evidence gaps in 6 countries in Eastern and Southern Africa. Important gaps were identified in iron, vitamin A, zinc, and calcium and, to a lesser extent, vitamin B12 and folate. The best whole-food sources of these micronutrients available in part or all of the countries studied include beef liver, chicken liver, small dried fish, beef, and eggs. Investment is needed in many countries to collect data on micronutrient biomarkers and dietary intake. Strategic actions to improve child diets will require engagement and intervention across relevant systems to accelerate progress on improving the diets of infants and young children.

Micronutrient gaps during the complementary feeding period in South Asia: A Comprehensive Nutrient Gap Assessment.

Micronutrient malnutrition is a key driver of morbidity and mortality for millions of children in South Asia. Understanding the specific micronutrients lacking in the diet during the complementary feeding period is essential for addressing undernutrition caused by inadequate diets. A Comprehensive Nutrient Gap Assessment was used to synthesize diverse evidence and estimate the public health significance of complementary-feeding micronutrient gaps and identify evidence gaps in 8 countries in South Asia. There were important gaps across the region in iron, zinc, vitamin A, folate, vitamin B12, and, to a lesser extent, calcium and vitamin C. The most nutrient-dense, whole-food sources of these micronutrients include liver, small fish, eggs, ruminant meat, and dark leafy greens. Investment is needed in some countries to collect data on micronutrient biomarkers and dietary intakes. A food systems approach is essential for improving child diets and reducing malnutrition, which affects millions of children, their futures, and society at large across South Asia and beyond.

Nutrition Label Use and Its Association With Dietary Quality Among Latinos: The Roles of Poverty and Acculturation.

OBJECTIVE: To investigate how acculturation and poverty are independently and jointly associated with the use of the Nutrition Facts panel (nutrition label) and to examine the extent to which nutrition label use moderates the association of poverty and acculturation on dietary quality among Latinos. DESIGN: Cross-sectional analysis of the 2007/2008 and 2009/2010 waves of the National Health and Nutrition Examination Survey. PARTICIPANTS: A total of 3,696 adults (aged >19 years) self-identified as Latino/Hispanic with food label use data from the most recent Consumer Behavior Phone Follow-Up Modules. MAIN OUTCOME MEASURE(S): Nutrition label use and dietary quality. ANALYSIS: Logistic regression. RESULTS: Acculturation moderated the association of income on the likelihood of using nutrition labels, such that lower-income English-speaking Latinos were half as likely as higher-income English-speakers to use nutrition labels (P = .01, odds ratio [OR] = 0.44, 95% confidence interval [CI], 0.24-0.81); however, Spanish speakers were equally likely to use nutrition labels across income levels (P = .99; OR = 1.00; 95% CI, 0.77-1.31). Nutrition label use moderated the association of acculturation on diet. Among English-speaking Latinos, those who read nutrition labels had less than half the risk for poor diet (P =.001; OR = 0.43; 95% CI, 0.26-0.69); however, label use was not significantly associated with the diet quality of Spanish speakers (P = .07; OR = 0.82; 95% CI, 0.67-1.02). Nutrition label use decreased the risk for poor dietary quality regardless of poverty status. CONCLUSIONS AND IMPLICATIONS: Overall, results demonstrated a positive association between the use of the Nutrition Facts panel for Latinos and dietary quality. An important nutrition education strategy among bicultural Latinos at risk for a poor diet as a result of acculturation may include label reading comprehension. This approach may also address the low rates of label use. The study provides evidence of segmented assimilation in which low-income, bicultural Latinos follow an underclass pattern of acculturation demonstrated by a lower likelihood of reading nutrition labels and higher-income, bicultural Latinos follow the more successful selective pattern.

Dietary gap assessment: an approach for evaluating whether a country's food supply can support healthy diets at the population level.

OBJECTIVE: Dietary diversity, and in particular consumption of nutrient-rich foods including fruits, vegetables, nuts, beans and animal-source foods, is linked to greater nutrient adequacy. We developed a 'dietary gap assessment' to evaluate the degree to which a nation's food supply could support healthy diets at the population level. Design/Setting In the absence of global food-based dietary guidelines, we selected the Dietary Approaches to Stop Hypertension (DASH) diet as an example because there is evidence it prevents diet-related chronic disease and supports adequate micronutrient intakes. We used the DASH guidelines to shape a hypothetical 'healthy' diet for the test country of Cameroon. Food availability was estimated using FAO Food Balance Sheet data on country-level food supply. For each of the seven food groups in the 'healthy' diet, we calculated the difference between the estimated national supply (in kcal, edible portion only) and the target amounts. RESULTS: In Cameroon, dairy and other animal-source foods were not adequately available to meet healthy diet recommendations: the deficit was -365 kcal (-1527 kJ)/capita per d for dairy products and -185 kcal (-774 kJ)/capita per d for meat, poultry, fish and eggs. Adequacy of fruits and vegetables depended on food group categorization. When tubers and plantains were categorized as vegetables and fruits, respectively, supply nearly met recommendations. Categorizing tubers and plantains as starchy staples resulted in pronounced supply shortfalls: -109 kcal (-457 kJ)/capita per d for fruits and -94 kcal (-393 kJ)/capita per d for vegetables. CONCLUSIONS: The dietary gap assessment illustrates an approach for better understanding how food supply patterns need to change to achieve healthier dietary patterns.

Perceived stress, unhealthy eating behaviors, and severe obesity in low-income women.

BACKGROUND: Stress has been associated with poor eating behaviors and diet quality, as well as high body mass index (BMI). Low-income women may be particularly vulnerable to stress and severe obesity. Yet it is unknown how stress increases the risk of severe obesity through disordered eating behaviors and poor diet quality or through mechanisms independent of diet. METHODS: We examined cross-sectional data from women (n = 101) with a child enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children in Cumberland County, North Carolina (spring 2012). We collected measured heights and weights to calculate BMI. Using structural equation modeling, we differentiated pathways from stress to weight status: (1) indirectly through eating behaviors (cognitive restraint, emotional eating, and uncontrolled eating) and diet quality, which we examined with the Healthy Eating Index 2010 and 24-h dietary recalls, and (2) directly through possible unmeasured risk factors independent of diet. The analysis controlled for race/ethnicity, income, age, whether the dietary recall day was typical, and whether the respondent completed one or two 24-h dietary recalls. RESULTS: Perceived stress was positively associated with uncontrolled eating (ß = 0.38, p < 0.001) and emotional eating (ß = 0.50, p < 0.001). However, higher stress was not associated with weight status through eating behaviors and diet quality. Independent of eating behaviors and diet quality, stress was positively associated with severe obesity (ß = 0.26, p = 0.007). CONCLUSIONS: Improving stress coping strategies for low-income women may improve eating behaviors and reduce severe obesity.

Very low adequacy of micronutrient intakes by young children and women in rural Bangladesh is primarily explained by low food intake and limited diversity.

Documentation of micronutrient intake inadequacies among developing country populations is important for planning interventions to control micronutrient deficiencies. The objective of this study was to quantify micronutrient intakes by young children and their primary female caregivers in rural Bangladesh. We measured 24-h dietary intakes on 2 nonconsecutive days in a representative sample of 480 children (ages 24-48 mo) and women in 2 subdistricts of northern Bangladesh by using 12-h weighed food records and subsequent 12-h recall in homes. We calculated the probability of adequacy (PA) of usual intakes of 11 micronutrients and an overall mean PA, and evaluated dietary diversity by counting the total number of 9 food groups consumed. The overall adequacy of micronutrient intakes was compared to dietary diversity scores using correlation and multivariate regression analyses. The overall mean prevalence of adequacy of micronutrient intakes for children was 43% and for women was 26%. For children, the prevalence of adequate intakes for each of the 11 micronutrients ranged from a mean of 0 for calcium to 95% for vitamin B-6 and was <50% for iron, calcium, riboflavin, folate, and vitamin B-12. For women, mean or median adequacy was <50% for all nutrients except vitamin B-6 and niacin and was <1% for calcium, vitamin A, riboflavin, folate, and vitamin B-12. The mean PA (MPA) was correlated with energy intake and dietary diversity, and multivariate models including these variables explained 71-76% of the variance in MPA. The degree of micronutrient inadequacy among young children and women in rural Bangladesh is alarming and is primarily explained by diets low in energy and little diversity of foods.

A novel approach to selecting and weighting nutrients for nutrient profiling of foods and diets.

BACKGROUND: Nutrient profiling of foods is the science of ranking or classifying foods based on their nutrient composition. Most profiling systems use similar weighting factors across nutrients due to lack of scientific evidence to assign levels of importance to nutrients. OBJECTIVE: Our aim was to use a statistical approach to determine the nutrients that best explain variation in Healthy Eating Index (HEI) scores and to obtain ß-coefficients for the nutrients for use as weighting factors for a nutrient-profiling algorithm. DESIGN: We used a cross-sectional analysis of nutrient intakes and HEI scores. PARTICIPANTS: Our subjects included 16,587 individuals from the National Health and Nutrition Examination Survey 2005-2008 who were 2 years of age or older and not pregnant. MAIN OUTCOME MEASURE: Our main outcome measure was variation (R(2)) in HEI scores. STATISTICAL ANALYSES: Linear regression analyses were conducted with HEI scores as the dependent variable and all possible combinations of 16 nutrients of interest as independent variables, with covariates age, sex, and ethnicity. The analyses identified the best 1-nutrient variable model (with the highest R(2)), the best 2-nutrient variable model, and up to the best 16-nutrient variable model. RESULTS: The model with 8 nutrients explained 65% of the variance in HEI scores, similar to the models with 9 to 16 nutrients, but substantially higher than previous algorithms reported in the literature. The model contained five nutrients with positive ß-coefficients (ie, protein, fiber, calcium, unsaturated fat, and vitamin C) and three nutrients with negative coefficients (ie, saturated fat, sodium, and added sugar). ß-coefficients from the model were used as weighting factors to create an algorithm that generated a weighted nutrient density score representing the overall nutritional quality of a food. CONCLUSIONS: The weighted nutrient density score can be easily calculated and is useful for describing the overall nutrient quality of both foods and diets.

Overweight is more prevalent than stunting and is associated with socioeconomic status, maternal obesity, and a snacking dietary pattern in school children from Bogota, Colombia.

The objectives of this study were to estimate the prevalence of overweight in school-aged children from Bogotá, Colombia and to examine its associations with sociodemographic characteristics, dietary patterns, and indicators of physical activity. We measured height and weight in 3075 children between 5 and 12 y of age who attended public primary schools in 2006 and we obtained information on maternal sociodemographic and anthropometric characteristics. The survey was representative of children from low and middle socioeconomic backgrounds. The prevalences of child overweight (including obesity) and obesity according to the International Obesity Task Force criteria were 11.1 and 1.8%, respectively. The prevalence of stunting was 9.8%. In multivariate analysis, child overweight was positively associated with indicators of higher socioeconomic status (SES), including low maternal parity and ownership of household assets. The prevalence of overweight was 3.6 times greater in children whose mothers were obese compared with children whose mothers had an adequate BMI (adjusted prevalence ratio = 3.61; 95% CI = 2.64, 4.93). Child overweight was positively associated with adherence to a "snacking" dietary pattern (P-trend = 0.06) and to frequent intake of hamburgers or hot dogs (adjusted prevalence ratio for at least once per week vs. never = 1.93; 95% CI = 1.03, 3.62), independent of total energy intake and other potential confounders. Time spent viewing television or playing outside the household were not significantly related to the prevalence of child overweight. In conclusion, child overweight in Bogotá is more common than stunting and is associated with higher SES, maternal obesity, and a snacking dietary pattern.