Frequentist and Bayesian approaches for food allergen risk assessment: risk outcome and uncertainty comparisons.

Peer-reviewed probabilistic methods already predict the probability of an allergic reaction resulting from an accidental exposure to food allergens, however, the methods calculate it in different ways. The available methods utilize the same three major input parameters in the risk model: the risk is estimated from the amount of food consumed, the concentration of allergen in the contaminated product and the distribution of thresholds among allergic persons. However, consensus is lacking about the optimal method to estimate the risk of allergic reaction and the associated uncertainty. This study aims to compare estimation of the risk of allergic reaction and associated uncertainty using different methods and suggest improvements. Four cases were developed based on the previous publications and the risk estimations were compared. The risk estimation was found to agree within 0.5% with the different simulation cases. Finally, an uncertainty analysis method is also presented in order to evaluate the uncertainty propagation from the input parameters to the risk.

Food groups for allergen risk assessment: Combining food consumption data from different countries in Europe.

To prevent allergic reactions, food producers have to be able to make a knowledge based decision on whether to label their products with precautionary labelling. As many manufactured food products are sold in different countries across Europe, the allergen risk assessment should be estimated at the European levels. As currently, there are no pan-European food data suitable for food allergy risk assessment. The aim of this paper is to investigate if consumption data, at a meal level, from National Food Consumption Surveys, can be combined to form a common Food Consumption database. In this first attempt we developed a procedure to investigate, if national food consumption data can be combined and grouped using data from Netherlands, France and Denmark. The homogeneity of consumption patterns and the relevance of difference in risk of allergic reaction were compared, using a fixed framework of allergen concentration levels and threshold distribution. Thus, the relevance of using common consumption data across countries was verified. The food groups formed were subsequently evaluated and adjusted based on practical considerations. It resulted in designing 61 food groups that can be used for allergen risk assessment. The summary statistics and descriptive names for each food group are included.

Determinants of meal satisfaction in a workplace environment.

Workplace lunches are recurrent meal occasions that can contribute to the general well-being of employees. The objective of our research was to study which factors influence consumers' satisfaction with these meals by exploring the relative role of food-related, personal, situational factors. Using a longitudinal approach, we monitored a total of 71 participants compiled and experienced 519 meals from their workplace canteen buffet during a three-month period; in addition the composed lunches were photographed. Before and after the lunch choice period respondents filled in a questionnaire on several meal-related variables. A mixed modelling approach was used to analyse the data. Meal satisfaction was directly associated with a positive ambience and a positive evaluation of both the quality of the food eaten and the buffet assortment, whereas the meal's energy content did not contribute to meal satisfaction. Additionally, meal satisfaction was associated with a more positive mood, lower hunger level as well as feeling less busy and stressed after lunch. The buffet assortment, a more positive mood before lunch and mindful eating contributed to the perceived food quality, but not associated with the hunger level before lunch. Time available, mindful eating and eating with close colleagues were positively associated with perceived ambience. The results indicate that consumers' satisfaction with workplace meals can be increased by putting emphasis on the quality of food served, but equally important is the ambience in the lunch situation. Most of the ambience factors were related to available time and mental resources of the participants and the possibility to share the meal with close colleagues. These are factors that can be facilitated by the service provider, but not directly influenced.

Comparison of estimated energy intake using Web-based Dietary Assessment Software with accelerometer-determined energy expenditure in children.

BACKGROUND: The OPUS (Optimal well-being, development and health for Danish children through a healthy New Nordic Diet) project carried out a school meal study to assess the impact of a New Nordic Diet (NND). The random controlled trial involved 834 children aged 8-11 in nine local authority schools in Denmark. Dietary assessment was carried out using a program known as WebDASC (Web-based Dietary Assessment Software for Children) to collect data from the children. OBJECTIVE: To compare the energy intake (EI) of schoolchildren aged 8-11 estimated using the WebDASC system against the total energy expenditure (TEE) as derived from accelerometers worn by the children during the same period. A second objective was to evaluate the WebDASC's usability. DESIGN: Eighty-one schoolchildren took part in what was the pilot study for the OPUS project, and they recorded their total diet using WebDASC and wore an accelerometer for two periods of seven consecutive days: at baseline, when they ate their usual packed lunches and at intervention when they were served the NND. EI was estimated using WebDASC, and TEE was calculated from accelerometer-derived activity energy expenditure, basal metabolic rate, and diet-induced thermogenesis. WebDASC's usability was assessed using a questionnaire. Parents could help their children record their diet and answer the questionnaire. RESULTS: Evaluated against TEE as derived from the accelerometers worn at the same time, the WebDASC performed just as well as other traditional methods of collecting dietary data and proved both effective and acceptable with children aged 8-11, even with perhaps less familiar foods of the NND. CONCLUSIONS: WebDASC is a useful method that provided a reasonably accurate measure of EI at group level when compared to TEE derived from accelerometer-determined physical activity in children. WebDASC will benefit future research in this area.

Evaluation of Web-based Dietary Assessment Software for Children: comparing reported fruit, juice and vegetable intakes with plasma carotenoid concentration and school lunch observations.

Web-based Dietary Assessment Software for Children (WebDASC) was developed to estimate dietary intake in a school meal intervention study among 8- to 11-year-old Danish children. The present study validates self-reported fruit, juice and vegetable (FJV) intakes in 8- to 11-year-old children by comparing intake with plasma carotenoid concentration, and by comparing the reported FJV intake to actually eaten FJV, as observed by a photographic method. A total of eighty-one children, assisted by parents, reported their diet for seven consecutive days. For the same five schooldays as they reported their diet, the children's school lunch was photographed and weighed before and after eating. In the week after the diet reporting, fasting blood samples were taken. Self-reported intake of FJV and estimated intake of carotenoids were compared with plasma carotenoid concentration. Accuracy of self-reported food and FJV consumption at school lunch was measured in terms of matches, intrusion, omission and faults, when compared with images and weights of lunch intake. Self-reported intake of FJV was significantly correlated with the total carotenoid concentration (0·58) (P< 0·01). Fruit and juice consumption showed higher correlations than vegetables with plasma carotenoid concentration (0·38 and 0·42 v. 0·33) (P< 0·01). A total of 82 % of the participants fell into the same or adjacent quartiles when cross-classified by FJV intake and carotenoids biomarkers. WebDASC attained 82 % reporting matches overall and a higher percentage match for reporting fruits compared with beverages. The present study indicated that WebDASC can be used to rank 8- to 11-year-old Danish children according to their intake of FJV overall and at school meals.

Comparison of estimated energy intake from 2×24-hour recalls and a seven-day food record with objective measurements of energy expenditure in children.

OBJECTIVE: The objective of the present study was to evaluate energy intake (EI) estimated from two non-consecutive 24-hour recalls (24-HDRs) and a pre-coded seven-day food record (7-dFR) against objective measurements of energy expenditure (EE) in children. DESIGN: A total of 67 7-8 year-olds and 64 12-13 year-olds completed the 2×24-HDRs, the 7-dFR, and wore ActiReg(®) (PreMed AS, Oslo, Norway), a combined position and motion recording instrument, during the same seven days as the 7-dFR was filled in. RESULTS: In the 7-8 year-olds, EI from the 2×24-HDRs (EI(2×24-HDR)) was overestimated with 3% compared to EE (not significantly different), while EI from the 7-dFR (EI(7-dFR)) was underestimated with 7% compared to EE (P=0.001). In the 12-13 year-olds, the corresponding figures was underestimation by 10% with the 2×24-HDRs (P<0.001) and by 20% with the 7-dFR (P<0.001). For both age groups combined, the 95% limits of agreement were -4·38 and 3.52 MJ/d for the 2×24-HDRs, and -5.90 and 2.94 MJ/d for the 7-dFR. Pearson correlation coefficients between EI and EE were 0.51 for EI(2×24-HDR) and 0.29 for EI(7-dFR), respectively. The proportion classified in the same or adjacent quartiles was 76% for EI(2×24-HDR) and 73% for EI(7-dFR) in the 7-8 year-olds, and 83% for EI(2×24-HDR) and 70% for EI(7-dFR) in the 12-13 year-olds. CONCLUSION: Misreporting of EI seemed modest with both the 2×24-HDRs and the 7-dFR in the 7-8 year-olds when compared to EE measured with ActiReg(®). Under-reporting appeared to be more evident in the 12-13 year-olds, especially with the 7-dFR. Compared to measurements of EE, the 2×24-HDRs seemed to perform slightly better than the 7-dFR in terms of ranking of individuals according to EI.

Effective population management practices in diabetes care - an observational study.

BACKGROUND: Ensuring that evidence based medicine reaches patients with diabetes in the US and internationally is challenging. The chronic care model includes evidence based management practices which support evidence based care. However, despite numerous studies, it is unclear which practices are most effective. Few studies assess the effect of simultaneous practices implemented to varying degrees. The present study evaluates the effect of fifteen practices applied concurrently and takes variation in implementation levels into account while assessing the impact of diabetes care management practices on glycemic and lipid monitoring. METHODS: Fifteen management practices were identified. Implementation levels of the practices in 41 medical centres caring for 553,556 adults with diabetes were assessed from structured interviews with key informants. Stepwise logistic regression models with management practices as explanatory variables and glycemic and lipid monitoring as outcome variables were used to identify the diabetes care practices most associated with high performance. RESULTS: Of the 15 practices studied, only provider alerts were significantly associated with higher glycemic and lipid monitoring rates. The odds ratio for glycemic monitoring was 4.07 (p < 0.00001); the odds ratio for lipid monitoring was 1.63 (p < 0.006). Weaker associations were found between action plans and glycemic monitoring (odds ratio = 1.44; p < 0.03) and between guideline distribution and training and lipid monitoring (odds ratio = 1.46; p < 0.03). The covariates of gender, age, cardiac disease and depression significantly affected monitoring rates. CONCLUSIONS: Of fifteen diabetes care management practices, our data indicate that high performance is most associated with provider alerts and more weakly associated with action plans and with guideline distribution and training. Lack of convergence in the literature on effective care management practices suggests that factors contributing to high performance may be highly context-dependent or that the factors involved may be too numerous or their implementation too nuanced to be reliably identified in observational studies.