Agreement between an Image-Based Dietary Assessment Method and a Written Food Diary among Adolescents with Type 1 Diabetes.

Valid and useful dietary assessment methods for adolescents with type 1 diabetes (T1D) are needed. In this study, we compared an image-based method with a written food diary for dietary intake estimation among adolescents with T1D and evaluated the adolescents' experiences of the methods. Adolescents with T1D aged 13 to 18 years (n = 13) photographed their meals (n = 264) with a mobile phone camera and simultaneously kept a written food diary for four consecutive days. The participants filled out electronic background and feedback questionnaires. The agreement between the methods was evaluated using intraclass correlation coefficients (ICCs) and Bland-Altman plot analyses. The agreement between the methods was moderate to excellent for the energy intake (ICC = 0.91, 95% confidence interval (CI): 0.66 to 0.97, p < 0.001) and good to excellent for total carbohydrate intake (ICC = 0.95, 95% CI: 0.84 to 0.99, p < 0.001). The adolescents considered photographing easier and faster than keeping a food diary. In conclusion, the image-based method appeared comparable to the food diary for dietary intake estimation among adolescents with T1D. The photographing of meals may become a useful dietary assessment tool for adolescents with T1D, but must be further developed and validated.

Trends in Beverage Consumption and Related Demographic Factors and Obesity among Korean Children and Adolescents.

It is well known that reducing consumption of sugar is a global public health priority. Beverages were the primary source of total sugar intake from processed foods. However, there are few studies investigating the trend of beverage consumption among children and adolescents in Korea. We examined the overall trend in beverage consumption among 11,996 participants aged 10-18 years who were enrolled in the Korea National Health and Nutrition Examination Survey (KNHANES) (1998-2018). Further, we examined the effect of beverage types on beverage consumption-related demographic factors and obesity among 6121 participants using the recent 24 h dietary recall data (2010-2018) that captured the consumption of fruit and vegetable juices, soft drinks, milk and milk-based products and alcoholic beverages. Demographic characteristics, including sex, age, body mass index, household income level and residential area, were considered. Consumers' overall beverage intake and the percentage of energy derived from fruit and vegetable juices and soft drinks steadily increased from 1998 to 2016-2018 (p-trend < 0.0001); in contrast, dairy product consumption declined since 2010-2012. The main sources of beverage-based calories were fruit and vegetable juices (107.5 kcal/day), soft drinks (145.2 kcal/day), dairy products (181.8 kcal/day) and alcoholic beverages (103.5 kcal/day). Also, Korean adolescents aged 16-18 years consumed more soft drinks, fewer dairy products and higher alcoholic drinks than other age groups; particularly, boys consumed more energy from beverages (p < 0.0001). The odds ratios of obesity prevalence tended to be higher for soft drink consumption than for other beverages but this was not significant. The consumption of fruit and vegetable juices and milk and milk products showed a marginal association with a reduced risk of obesity prevalence. Since beverage consumption has increased steadily among Korean children and adolescents, appropriate interventions are needed. In the future, data from a larger sample of Korean children and adolescents are necessary to identify significant differences and longitudinal studies are necessary to examine the causalities.

An Assessment of Three Carbohydrate Metrics of Nutritional Quality for Packaged Foods and Beverages in Australia and Southeast Asia.

Carbohydrate quality is an aetiological factor of diet-related disease. Indices of carbohydrate quality featuring various ratios of carbohydrates-to-dietary fibre-to-sugar have been associated with improved product and/or diet quality in westernised countries. Carbohydrate intake is especially high in Asia Pacific. Thus, this study evaluated the ability of such carbohydrate metrics to discriminate the nutritional quality of carbohydrate-rich packaged foods and beverages in Australia, Malaysia, Singapore, Thailand and the Philippines, with an additional focus on beverages. This evaluation was conducted by comparing product nutritional composition and assessing products against three national nutrient profiling models. Results showed that Australia had the highest proportion of products meeting all metrics, compared to the Southeast Asian countries. Beverages had a low adherence to all metrics compared to solid foods. Across the five countries, both processed food and beverages meeting the metrics generally contained higher dietary fibre, protein, and certain vitamins and minerals whilst having lower energy, total sugars, free sugars, trans fat and cholesterol content compared to products not meeting the metrics. The metrics were also aligned with national nutrient profiling models to identify nutritious products. In conclusion, these metrics allowed us to discriminate product nutritional quality in the countries assessed and are applicable to beverages.

Dietary Fibre for the Prevention of Cardiovascular Disease.

Cardiovascular disease (CVD) remains the major cause of mortality worldwide. The importance of diet in optimising cardiovascular health has been illustrated in various studies. The role of dietary fibre in CVD prevention remains debatable. Dietary fibre helps to reduce total cardiovascular risk by engendering better cholesterol level and blood pressure, for example. The observed benefits, particularly for CVD mortality, seem to correlate with the level of dietary fibre intake in a dose-response fashion. Total aversion to foods with carbohydrates could potentially restrict the sources of dietary fibre that are available, particularly whole grain products which are recommended in the Mediterranean diet and the Eat-Lancet report on healthy diets. Further high-quality nutrition research is required to discern the absolute benefits of dietary fibre for CVD prevention. This may have implications for total healthcare expenditure, by means of public health and prevention policy that would serve to reduce the global burden of CVD.

Assessment of the glycemic index of groats available on the Polish food market

Background: Glycemic index (GI) and glycemic load (GL) are often used to assess diet quality in relation to the risk of diabetes, cardiovascular diseases and cancer development. Taking into account differences in nutritional value of food products in different countries it is often suggested to used national databases to assess dietary intake in different populations. Objective: To assess the glycemic index and glycemic load of the selected groats available on the Polish food market. Material and methods: GI of the following groats available on the Polish food market was assessed: couscous, buckwheat (roasted) groats, millet groats, spelt groats, barley (hulled) groats and bulgur groats. The GI was assessed as the incremental area under the blood glucose response curve of a 50g carbohydrate portion of a test food expressed as a percent of the response to the same amount of carbohydrate from a standard food taken by the same subject. GL was calculated for the 100 g of the cooked product. Results: The lowest GI was found for buckwheat (34.7±8.2%) and barley (31.3±13.4%) groats. The GL for these groats was 8.1±1.9 and 8.0±3.4, respectively. The GI for millet, spelt and bulgur groats amounted to 56.2±20.6%, 69.8±35.0%, 64.5±36.8%, respectively, while for couscous amounted to 99.0± 36.0%. The highest GL was observed for couscous (24.7±9.0). Conclusions: The groats tested in this study can be classified as follows: barley and buckwheat as a low GI food, millet and bulgur as a medium GI food, spelt and couscous as a high GI food. Buckwheat and barley groats should be chosen the most often among these products, while the intake of couscous should be limited especially by people with diabetes.

The concentration of heavy metals in noodle samples from Iran's market: probabilistic health risk assessment.

In the current study, the concentration of heavy metals including lead (Pb), chromium (Cr), cadmium (Cd), and aluminum (Al) in commonly instant noodles consumed in Iran (either imported from other countries or produced in Iran) was investigated by acid digestion method followed by an inductively coupled plasma optical emission spectrometry system (ICP-OES). Also, the associated non-carcinogenic risk due to ingestion of heavy metals for adults and children was estimated by calculating percentile 95% target hazard quotient (THQ) in the Monte Carlo simulation (MCS) method. The average concentrations of Pb, Cr, Cd, and Al in Iranian instant noodle samples were measured as 1.21 ± 0.81, 0.08 ± 0.10, 0.03 ± 0.06, and 9.15 ± 4.82 (mg/kg) and in imported instant noodle samples were 1.00 ± 0.61, 0.07 ± 0.07, 0.04 ± 0.03, and 15.90 ± 0.93 (mg/kg), respectively. A significant difference (p value < 0.05) in the mean concentration of Pb, Cr, Cd, and Al of Iranian instant noodle and imported instant noodle samples was observed. Also, the concentration of Pb, Cr, Cd, and Al in all brands of instant noodle (0.025 mg/kg, 0.050 mg/kg, 0.003 mg/kg, and 0.237 mg/kg, respectively) surpassed the WHO-permitted limits for Pb, Cr, Cd, and Al. Percentile 95% of THQ of Pb, Cr, Cd, and Al for the adult consumers was calculated as 0.012, 0.000007, 0.010, and 1.789; while in the case of children, percentile 95% of THQ of Pb, Cr, Cd, and Al was defined as 0.044, 0.00023, 0.035, and 6.167, respectively. Health risk assessment indicated that both adults and children are at considerable non-carcinogenic health risk for Al (THQ > 1). Therefore, approaching the required strategies in order to reduce the concentration of heavy metals particularly Al in the instant noodle is recommended.

Nutritional Composition Assessment of 3000 Individualized Parenteral Nutrition Bags in a Tertiary Referral Hospital: Current Prescribing Patterns.

Individualized parenteral nutrition is the most specialized type of nutritional support in the hospital setting. The composition and prescribing patterns for parenteral nutrition have evolved due to new emerging scientific evidence. In the last few years, there has been a tendency to increase the nitrogen and lipid content and decrease the carbohydrate content. To assess the prescribing pattern in a tertiary referral hospital in Spain, the nutritional composition of individualized parenteral nutrition was evaluated retrospectively from January to December of 2016. A total of 3029 parenteral nutrition units were analysed, corresponding to 257 hospitalized adult patients. Medical specialists in General Surgery and Haematology were the most common petitioners. The three most frequently prescribed parenteral nutrition formulae contained 13.4 (28.8%), 15.7 (19.54%) and 17.9 (17.79%) g of nitrogen. The quantity of carbohydrates and lipids showed a mean non-protein calories-to-nitrogen ratio of approximately 78:1 and a carbohydrate-to-lipid ratio that was near 50:50 in most cases. These results suggest a trend towards the administration of parenteral nutrition with a high content of nitrogen and smaller proportion of the non-protein components.

Total and Free Sugar Content of Pre-Packaged Foods and Non-Alcoholic Beverages in Slovenia.

Scientific evidence of the association between free sugar consumption and several adverse health effects has led many public health institutions to take measures to limit the intake of added or free sugar. Monitoring the efficiency of such policies and the amount of free sugar consumed requires precise knowledge of free sugar content in different food products. To meet this need, our cross-sectional study aimed at assessing free sugar content for 10,674 pre-packaged food items available from major Slovenian food stores during data collection in 2015. Together, 52.6% of all analyzed products contained free sugar, which accounted for an average of 57.5% of the total sugar content. Food categories with the highest median free sugar content were: honey and syrups (78.0 g/100 g), jellies (62.9 g/100 g), chocolate and sweets (44.6 g/100 g), jam and spreads (35.9 g/100 g), and cereal bars (23.8 g/100 g). Using year-round sales data provided by the retailers, the data showed that chocolate, sweets, and soft drinks alone accounted for more than 50% of all free sugar sold on the Slovenian market. The results of this study can be used to prepare more targeted interventions and efficient dietary recommendations.

Composition of legume soaking water and emulsifying properties in gluten-free bread.

Soaking of legumes results in the loss of macronutrients, micronutrients and phytochemicals. Fibre, protein and phytochemicals found in legumes exert emulsifying activity that may improve the structure and texture of gluten-free bread. The legume soaking water of haricot beans, garbanzo chickpeas, whole green lentils, split yellow peas and yellow soybeans were tested in this study for functional properties and use as food ingredients. Composition, physicochemical properties and effect on the quality of gluten-free bread were determined for each legume soaking water. Haricot beans and split yellow peas released the highest amount of solids in the legume soaking water: 1.89 and 2.38 g/100 g, respectively. Insoluble fibre was the main constituent of haricot beans legume soaking water, while water-soluble carbohydrates and protein were the major fraction of split yellow peas. High quantities of phenolics (∼400 µg/g) and saponins (∼3 mg/g) were found in the legume soaking water of haricot beans, whole green lentils and split yellow peas. High emulsifying activity (46 and 50%) was found for the legume soaking water of garbanzo chickpeas and split yellow peas, probably due to their protein content and high ratio of water-soluble carbohydrates to dry matter. Such activity resulted in softer texture of the gluten-free bread. A homogeneous structure of crumb pores was found for split yellow peas, opposing that of whole green lentils. A balance between the contents of yeast nutrients and antinutrients was the likely basis of the different appearances.

Development of a New Branded UK Food Composition Database for an Online Dietary Assessment Tool.

The current UK food composition tables are limited, containing ~3300 mostly generic food and drink items. To reflect the wide range of food products available to British consumers and to potentially improve accuracy of dietary assessment, a large UK specific electronic food composition database (FCDB) has been developed. A mapping exercise has been conducted that matched micronutrient data from generic food codes to "Back of Pack" data from branded food products using a semi-automated process. After cleaning and processing, version 1.0 of the new FCDB contains 40,274 generic and branded items with associated 120 macronutrient and micronutrient data and 5669 items with portion images. Over 50% of food and drink items were individually mapped to within 10% agreement with the generic food item for energy. Several quality checking procedures were applied after mapping including; identifying foods above and below the expected range for a particular nutrient within that food group and cross-checking the mapping of items such as concentrated and raw/dried products. The new electronic FCDB has substantially increased the size of the current, publically available, UK food tables. The FCDB has been incorporated into myfood24, a new fully automated online dietary assessment tool and, a smartphone application for weight loss.

A Review of Nutritional Tracking Mobile Applications for Diabetes Patient Use.

Diabetes, a prevalent disease in the United States, is greatly impacted by lifestyle choices, notably nutrition. The goal of this research was to determine which of the nutritional tracking applications (apps) available for Apple (Cupertino, CA) iOS, Android® (Google, Mountain View, CA), and Windows (Microsoft, Redmond, WA) platforms should be a first recommendation to diabetes patients searching for a smartphone app to aid in dietary logging and, for some apps, other varying lifestyle and health data. This project did so by identifying the smartphone apps available on the iTunes® (Apple), Google Play, and Microsoft stores that have nutritional tracking capabilities and are of potential benefit to a patient with diabetes based on certain criteria. Each of the individual apps was then evaluated to determine which would be of most benefit to a diabetes patient. The apps were assessed based on several parameters, such as their food databases, logging options, additional tracking options, interoperability with other devices and apps, and diabetes-specific resources. This information was then compiled and evaluated to determine which apps would be of most benefit for diabetes patients. This research provides valuable information for both patients and healthcare providers because the results of this study can be used as a reference for practitioners wishing to make app recommendations for diabetes patients who are implementing lifestyle change as an aspect of therapy.

Where people shop is not associated with the nutrient quality of packaged foods for any racial-ethnic group in the United States.

BACKGROUND: In the literature, it has been suggested that there are race-ethnic disparities in what Americans eat. In addition, some studies have shown that residents of African American and low-income neighborhoods have less access to grocery stores and supermarkets, which tend to stock healthier foods. However, it is unclear whether differences in food shopping patterns contribute to the poorer nutrient profile of food purchases made by racial-ethnic minorities. OBJECTIVES: We examined whether the mix of food stores where people shop (i.e., food-shopping patterns) was associated with the nutrient profile of packaged food purchases (PFPs) and the types of foods and beverages purchased, and we determined whether these associations differ across racial-ethnic groups. DESIGN: We used PFPs by US households (Nielsen National Consumer Panel) from 2007 to 2012 and implemented a cluster analysis to categorize households according to their food-shopping patterns. Longitudinal random-effects linear regression models were used to examine the association between food shopping patterns and the nutrient qualities and types of packaged foods and beverages purchased by race-ethnicity in US households. RESULTS: Shopping primarily at grocery chains was not associated with a better nutrient profile of household PFPs or the food and beverages that households purchased than was shopping primarily at mass merchandisers (value-oriented stores that sell merchandise lines in multiple departments) or at a combination of large and small stores. These results were consistent across racial-ethnic groups. Regardless of where households shopped, non-Hispanic African American households purchased foods with higher energy, total sugar, and sodium densities than did non-Hispanic white and Hispanic households. CONCLUSION: Policy initiatives that focus on increasing physical access to stores or helping stores sell healthier products to encourage healthier purchases may be ineffective because other factors may be more important determinants of food and beverage purchases than where people shop or what is available in the store.

Dietary Intake at 9 Years and Subsequent Body Mass Index in Adolescent Boys and Girls: A Study of Monozygotic Twin Pairs.

There is a lack of evidence pointing to specific dietary elements related to weight gain and obesity prevention in childhood and adulthood. Dietary intake and obesity are both inherited and culturally transmitted, but most prospective studies on the association between diet and weight status do not take genetics into consideration. The objective of this study was to document the association between dietary intake at 9 years and subsequent Body Mass Index (BMI) in adolescent monozygotic boy and girl twin pairs. This research used data from 152 twin pairs. Dietary data were collected from two 24-hour-recall interviews with a parent and the child aged 9 years. Height and weight were obtained when the twins were aged 9, 12, 13, and 14 years. Intrapair variability analysis was performed to identify dietary elements related to BMI changes in subsequent years. BMI-discordant monozygotic twin pairs were also identified to analyze the dietary constituents that may have generated the discordance. After eliminating potential confounding genetic factors, pre-adolescent boys who ate fewer grain products and fruit and consumed more high-fat meat and milk had higher BMIs during adolescence; pre-adolescent girls who consumed more grain products and high-fat meat and milk had higher BMIs during adolescence. Energy intake (EI) at 9 years was not related to BMI in subsequent years. Our study suggests that messages and interventions directed at obesity prevention could take advantage of sex-specific designs and' eventually' genetic information.

Validity and reliability of a food frequency questionnaire to estimate dietary intake among Lebanese children.

BACKGROUND: Nutritional status during childhood is critical given its effect on growth and development as well as its association with disease risk later in life. The Middle East and North Africa (MENA) region is experiencing alarming rates of childhood malnutrition, both over- and under-nutrition. Hence, there is a need for valid tools to assess dietary intake for children in this region. To date, there are no validated dietary assessment tools for children in any country of the MENA region. The main objective of this study was to examine the validity and reliability of a Food Frequency Questionnaire (FFQ) for the assessment of dietary intake among Lebanese children. METHODS: Children, aged 5 to 10 years (n = 111), were recruited from public and private schools of Beirut, Lebanon. Mothers (proxies to report their children's dietary intake) completed two FFQs, four weeks apart. Four 24-hour recalls (24-HRs) were collected weekly during the duration of the study. Spearman correlations and Bland-Altman plots were used to assess validity. Linear regression models were used to derive calibration factors for boys and girls. Reproducibility statistics included Intraclass Correlation Coefficient (ICC) and percent agreement. RESULTS: Correlation coefficients between dietary intake estimates derived from FFQ and 24-HRs were significant at p < 0.001 with the highest correlation observed for energy (0.54) and the lowest for monounsaturated fatty acids (0.26). The majority of data points in the Bland-Altman plots lied between the limits of agreement, closer to the middle horizontal line. After applying the calibration factors for boys and girls, the mean energy and nutrient intakes estimated by the FFQ were similar to those obtained by the mean 24-HRs. As for reproducibility, ICC ranged between 0.31 for trans-fatty acids and 0.73 for calcium intakes. Over 80 % of study participants were classified in the same or adjacent quartile of energy and nutrients intake. CONCLUSIONS: Findings of this study showed that the developed FFQ is reliable and is also valid, when used with calibration factors. This FFQ is a useful tool in dietary assessment and evaluation of diet-disease relationship in this age group.

The placemat protocol: Measuring preschoolers' healthy-meal schemas with pretend meals.

Nutrition instruction can lead to more healthful food choices among children, but little is known about preschoolers' healthy-meal schemas because there are few developmentally appropriate measures. This study validated the Placemat Protocol, a novel measure of preschooler healthy-meal schemas using realistic food models to assemble pretend meals. Preschoolers (N = 247, mean age 4 years 8 months) created 2 meals (preferred and healthy), completed measures of verbal nutrition knowledge and vocabulary, and were weighed and measured for BMI. Parents reported healthy eating guidance, child dietary intake, and family demographics. Children used an average of 5.1 energy-dense (ED) and 3.4 nutrient-dense (ND) foods for their preferred meal, but reversed the ratio to 3.1 ED and 5.1 ND foods for their healthy meal. Healthy meals contained fewer estimated kcal, less fat, less sugar, and more fiber than preferred meals. Meal differences held for younger children, children with lower verbal nutrition knowledge and vocabulary, and child subgroups at higher risk for obesity. Placemat Protocol data correlated with parent healthy eating guidance and child obesogenic dietary intake as expected. The Placemat Protocol shows promise for assessing developing healthy-meal schemas before children can fully articulate their knowledge on verbal measures.

Neutralising antibodies for Mayaro virus in Pantanal, Brazil

The Pantanal hosts diverse wildlife species and therefore is a hotspot for arbovirus studies in South America. A serosurvey for Mayaro virus (MAYV), eastern (EEEV), western (WEEV) and Venezuelan (VEEV) equine encephalitis viruses was conducted with 237 sheep, 87 free-ranging caimans and 748 equids, including 37 collected from a ranch where a neurologic disorder outbreak had been recently reported. Sera were tested for specific viral antibodies using plaque-reduction neutralisation test. From a total of 748 equids, of which 264 were immunised with vaccine composed of EEEV and WEEV and 484 had no history of immunisation, 10 (1.3%) were seropositive for MAYV and two (0.3%) for VEEV using criteria of a ≥ 4-fold antibody titre difference. Among the 484 equids without history of immunisation, 48 (9.9%) were seropositive for EEEV and four (0.8%) for WEEV using the same criteria. Among the sheep, five were sero- positive for equine encephalitis alphaviruses, with one (0.4%) for EEEV, one (0.4%) for WEEV and three (1.3%) for VEEV. Regarding free-ranging caimans, one (1.1%) and three (3.4%), respectively, had low titres for neutralising antibodies to VEEV and undetermined alphaviruses. The neurological disorder outbreak could not be linked to the alphaviruses tested. Our findings represent strong evidence that MAYV and all equine encephalitis alphaviruses circulated in the Pantanal.

Considerations in developing lipid-based nutrient supplements for prevention of undernutrition: experience from the International Lipid-Based Nutrient Supplements (iLiNS) Project.

The International Lipid-Based Nutrient Supplements (iLiNS) Project began in 2009 with the goal of contributing to the evidence base regarding the potential of lipid-based nutrient supplements (LNS) to prevent undernutrition in vulnerable populations. The first project objective was the development of acceptable LNS products for infants 6-24 months and for pregnant and lactating women, for use in studies in three countries (Burkina Faso, Ghana and Malawi). This paper shares the rationale for a series of decisions in supplement formulation and design, including those related to ration size, ingredients, nutrient content, safety and quality, and packaging. Most iLiNS supplements have a daily ration size of 20 g and are intended for home fortification of local diets. For infants, this ration size is designed to avoid displacement of breast milk and to allow for dietary diversity including any locally available and accessible nutrient-dense foods. Selection of ingredients depends on acceptability of flavour, micronutrient, anti-nutrient and essential fatty acid contents. The nutrient content of LNS designed to prevent undernutrition reflects the likelihood that in many resource-poor settings, diets of the most nutritionally vulnerable individuals (infants, young children, and pregnant and lactating women) are likely to be deficient in multiple micronutrients and, possibly, in essential fatty acids. During ingredient procurement and LNS production, safety and quality control procedures are required to prevent contamination with toxins or pathogens and to ensure that the product remains stable and palatable over time. Packaging design decisions must include consideration of product protection, stability, convenience and portion control.

Chickpeas­composition, nutritional value, health benefits, application to bread and snacks: a review.

Chickpea is grain legumes grown mainly in areas with temperate and semiarid climate. It is characterized by a high content of protein, fat, vitamins, fiber, and a lower content of carbohydrates than flour of wheat. Chickpeas may contain antinutritional compounds that can impair utilization of the nutrients by people. Heat treatment is an effective method to increase the amount of protein available for intestinal digestibility. Adding chickpeas to a foodstuff can increase their nutritional value and reduce the acrylamide content. Acrylamide is an antinutritional substance present in foods, such as bread, snacks, and chips. Chickpea flour and protein may be new way to a reduce the content of acrylamide in products of this type. The addition of chickpea flour affects the sensory and textural properties.