A Method to Estimate the Efficacy vs. Effectiveness in Meta-Analysis of Clinical Trials with Different Adherence Scenarios: A Monte Carlo Simulation Study in Nutrition.

Randomized clinical trials (RCTs) evaluating the effectiveness of interventions to promote fruit and vegetable (FV) consumption usually report intention-to-treat (ITT) analysis as the main outcome. These analyses compare the randomly assigned groups and accept that some individuals may not follow the recommendations received in their group. The ITT analysis is useful to quantify the global effect of promoting the consumption of FV in a population (effectiveness) but, if non-adherence is significant in the RCT, they cannot estimate the specific effect in the individuals that increased their FV consumption (efficacy). To calculate the efficacy of FV consumption, a per protocol analysis (PP) would have to be carried out, in which groups of individuals are compared according to their actual adherence to FV consumption, regardless of the group to which they were assigned; unfortunately, many RCTs do not report the PP analysis. The objective of this article is to apply a new method to estimate the efficacy of Meta-analysis (MA) PP which include RCTs of effectiveness by ITT, without estimates of adherence. The method is based on generating Monte Carlo simulations of percentages of adherence in each allocation group from prior distributions informed by expert knowledge. We illustrate the method reanalyzing a Cochrane Systematic Review (SR) of RCTs on increased FV consumption reported with ITT, simulating 1000 times the estimation of a PP meta-analyses, and obtaining means and ranges of the potential PP effects. In some cases, the range of estimated PP effects was clearly more favourable than the effect calculated with the original ITT assumption, and therefore this corrected analysis must be considered when estimating the true effect of the consumption of a certain food.

Assessment of the contribution of industrially processed foods to salt and iodine intake in Thailand.

Iodization of food grade salt has been mandated in Thailand since 1994. Currently, processed food consumption is increasing, triggered by higher income, urbanization, and lifestyle changes, which affects the source of salt and potentially iodized salt among the population. However, adequate information about the use of iodized salt in processed foods in Thailand is still lacking. Therefore, this study aimed to assess iodine intake through salt-containing processed foods and condiments which were identified using national survey data. Potential iodine intake from iodized salt in food products was modelled using consumption data and product salt content from food labelling and laboratory analysis. Fish sauce, soy sauce and seasoning sauces (salty condiments) have alternative regulation allowing for direct iodization of the final product, therefore modelling was conducted including and excluding these products. Daily salt intake from household salt and food industry salt (including salty condiments) was estimated to be 2.4 g for children 0-5 years of age, 4.6 g for children 6-12 years of age, and 11.5 g for adults. The use of iodized salt in processed foods (excluding salty condiments) met approximately 100% of the estimated average requirement (EAR) for iodine for non-pregnant adults and for children 6 to 12 years of age, and 50% of the EAR for iodine for children aged 0 to 5 years of age. In all cases, iodine intake from processed food consumption was greater than from estimated household iodized salt consumption. Findings suggest that iodized salt from processed foods is an important source of iodine intake, especially in adults. The use of iodized salt by the food industry should be enforced along with population monitoring to ensure sustainability of optimal iodine intake. Currently, the addition of iodine into fish sauce, soy sauce and seasoning sauces has an important role in achieving and sustaining optimal iodine intake.

[Validation, reproducibility, and reliability of food photographic record for food intake assessment]. / Validación, reproducibilidad y confiabIlidad del registro dietético fotográfico para la valoración de la ingesta alimentaria.

INTRODUCTION: Introduction: food intake records are a useful resource for diet assessment, as well as for self-evaluation, self-control, and self-motivation to change an eating behavior. New technologies based on mobile phones permit a different way of recording food intake. Objective: to validate and assess food photographic record (FPR) as a useful instrument in professional practice for assessing food intake. Methodology: forty nutrition professionals participated. In a first stage, food variables obtained through FPR were analyzed and correlated with data from the frequency of food consumption questionnaire (FFQ) and a 24-hour recall (24HR). In a second stage, FPR was applied again to evaluate temporal stability (FPR 1 versus FPR 2). Wilcoxon's test and Spearman's correlation test were applied. Results: a moderate and significant positive association was found for total caloric intake (TCI) and total fat between FPR and 24HR (r = 0.68, p = 0.0008, and r = 0.52, p = 0.01, respectively). In addition, a positive and moderate association was found for TCI, proteins and fats between FPR 1 and FPR 2 (r = 0.61, p = 0.0004; r = 0.60, p = 0.0005; r = 0.64, p = 0.0002, respectively). Conclusion: FPR is a valid method for professional practice to estimate dietary intake, with greater consistency with 24HR data than FFQ, and presents temporal stability for TCI, protein and fat recordings. In addition, FPR may facilitate the adoption of positive eating habits such as more conscious intakes, among other benefits.

INTRODUCCIÓN: Introducción: registrar la ingesta alimentaria permite valorar la dieta y facilita el proceso de autoevaluación, autocontrol y motivación al cambio del comportamiento alimentario. Las nuevas tecnologías y el uso de los teléfonos móviles permiten otra forma de registrar la ingesta. Objetivo: validar y valorar el registro dietético fotográfico (RDF) como instrumento de utilidad en la práctica profesional. Metodología: participaron 40 licenciados en Nutrición. En una primera etapa, se analizaron y correlacionaron las variables alimentarias obtenidas a través de los instrumentos RDF frente a un cuestionario de frecuencia de consumo alimentario (CFCA) y un recordatorio de 24 horas (R24hs). En una segunda etapa se aplicó nuevamente el RDF y se valoró su estabilidad temporal en los registros obtenidos (RDF 1 y RDF 2). Se aplicaron el test de Wilcoxon y el test de correlación de Spearman. Resultados: se encontró una asociación positiva moderada y estadísticamente significativa para el VET y las grasas totales entre el RDF y el R24hs (r = 0,68, p = 0,0008 y r = 0,52, p = 0,01, respectivamente). Además, se observó una asociación positiva de intensidad moderada y estadísticamente significativa para el VET, las proteínas y las grasas entre el RDF 1 y el RDF 2 (r = 0,61, p = 0,0004; r = 0,60, p = 0,0005; r = 0,64, p = 0,0002, respectivamente). Conclusión: el RDF es un método válido en la práctica profesional para la estimación de la ingesta alimentaria, en mayor consonancia con los datos obtenidos con el R24hs, y presenta estabilidad temporal para los registros de VET, proteínas y grasas. Además, colabora en la adquisición de hábitos alimentarios positivos como son las ingestas más conscientes, entre otros beneficios.

Performance and Feasibility of Recalls Completed Using the Automated Self-Administered 24-Hour Dietary Assessment Tool in Relation to Other Self-Report Tools and Biomarkers in the Interactive Diet and Activity Tracking in AARP (IDATA) Study.

BACKGROUND: Automated Self-Administered 24-Hour Dietary Assessment Tool (ASA24) is a self-administered web-based tool designed to collect detailed dietary data at low cost in observational studies. OBJECTIVE: The objectives of this study were to describe, overall and by demographic groups, the performance and feasibility of ASA24-2011 recalls and compare Healthy Eating Index-2015 (HEI-2015) total and component scores to 4-day food records (4DFRs) and food frequency questionnaires (FFQs). DESIGN: Over 12 months, participants completed up to 6 ASA24 recalls, 2 web-based FFQs, and 2 unweighed paper-and-pencil 4DFRs. Up to 3 attempts were made to obtain each ASA24 recall. Participants were administered doubly-labeled water to provide a measure of total energy expenditure and collected two 24-hour urine samples to assess concentrations of nitrogen, sodium, and potassium. PARTICIPANTS/SETTING: From January through September 2012, 1,110 adult members of AARP, 50 to 74 years of age, were recruited from the Pittsburgh, PA, area to participate in the Interactive Diet and Activity Tracking in AARP (IDATA) study. After excluding 33 participants who had not completed any dietary assessments, 531 men and 546 women remained. MAIN OUTCOME MEASURES: Response rates, nutrient intakes compared to recovery biomarkers across each ASA24 administration day, and HEI-2015 total and component scores were measured. STATISTICAL ANALYSES PERFORMED: Means, medians, standard deviations, interquartile ranges, and HEI-2015 total and component scores computed using a multivariate measurement error model are presented. RESULTS: Ninety-one percent of men and 86% of women completed 3 ASA24 recalls. Approximately three-quarters completed 5 or more, higher than the completion rates for 2 4DFRs and 2 FFQs. Approximately, three-quarters of men and 70% of women completed ASA24 on the first attempt; 1 in 5 completed it on the second. Completion rates varied slightly by age and body mass index. Median time to complete ASA24-2011 (current version: ASA24-2020) declined with subsequent recalls from 55 to 41 minutes in men and from 58 to 42 minutes in women and was lowest in those younger than 60 years. Mean nutrient intakes were similar across recalls. For each recording day, energy intakes estimated by ASA24 were lower than energy expenditure. Reported intakes for protein, potassium, and sodium were closer to recovery biomarkers for women, but not for men. Geometric means of reported intakes of these nutrients did not systematically vary across ASA24 administrations, but differences between reported intakes and biomarkers differed by nutrient. Of 100 possible points, HEI-2015 total scores were nearly identical for 4DFRs and ASA24 recalls and higher for FFQs (men: 61, 60, and 68; women: 64, 64, and 72, respectively). CONCLUSIONS: ASA24, a freely available dietary assessment tool for use in large-scale nutrition research, was found to be highly feasible. Similar to previously reported data for nutrient intakes, HEI-2015 total and component scores for ASA24 recalls were comparable to those for 4DFRs, but not FFQs. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT03268577 (http://www.clinicaltrials.gov).

Celiac Dietary Adherence Test and Standardized Dietician Evaluation in Assessment of Adherence to a Gluten-Free Diet in Patients with Celiac Disease.

Adherence to a gluten-free diet (GFD) is currently the mainstay of treatment strategy for celiac disease (CD). The aim of our study was measuring a GFD adherence in CD patients using two newly validated methods of dietary assessment-Standardized Dietician Evaluation (SDE) and the Celiac Dietary Adherence Test (CDAT). Ninety-two adults with CD were evaluated by a registered dietitian with extensive experience with the use of SDE and CDAT. Duodenal biopsy was performed and blood was drawn for serum anti-endomysial, anti-deamidated gliadin peptide and anti-tissue transglutaminase antibodies in forty four of those patients. The results of CDAT and SDE were very convergent, but SDE scores better correlated with serologic and histologic findings. As many as 24-52% of study participants did not adhere well enough to a GFD. Insufficient adherence to a GFD in CD patients is still a significant problem. The knowledge about gluten content in food ingredients and additives is very low among adults with CD. SDE is the most accurate method in assessing compliance with a GFD and is especially helpful in determining hidden sources of gluten. The CDAT may be a fast tool for screening for a GFD adherence in CD patients.

Development and reliability of questionnaires for the assessment of diet and physical activity behaviors in a multi-country sample in Europe the Feel4Diabetes Study.

BACKGROUND: Assessment of diet and physical activity and their determinants still remains a demanding task, especially when the objective is to evaluate the efficacy of lifestyle interventions. In the context of the Feel4Diabetes study (a European community based intervention study in families with school aged children and at high risk of developing diabetes), we aimed to develop questionnaires for the assessment of food-frequency and eating behaviors, and physical activity and sedentary behaviors in both parents and school-aged children and a questionnaire for overall family's energy balance-related behaviors. METHODS: Questionnaires were developed to be used in 6 countries under standardized harmonization procedures and included questions regarding not only food intake and physical activity, but also questions of their determinants. A reliability study was conducted in 191 pairs of parents and their children (N = 191). Parents completed the questionnaires on two occasions, within a 1-2 week interval. Reliability was tested by the intra-class correlation coefficients (ICC) of test-retest. RESULTS: Most of the questions in all questionnaires had excellent reliability, assessed as an ICC of > 0.810. Mean ICCs for food-frequency and eating behaviors questionnaires were 0.838 and 0.787, and for physical activity and sedentary behaviors questionnaires were 0.734 and 0.793, in adults and children respectively. Mean ICC for overall family's energy balance-related behaviors and their determinants was 0.659. CONCLUSION: The developed questionnaires showed acceptable reliability and may be valuable tools in the assessment of children's and parents' behaviors related to diet, physical activity, sedentary behavior and overall energy balance in school- and community-based interventions.

Dietary patterns of Brazilian farmers and their relation with sociodemographic, labor, and lifestyle conditions.

BACKGROUND: The eating habits have changed in the last few decades, but few studies prioritize the food consumption of farmers and the rural population. Therefore, the objective of this study was explore the sociodemographic, occupational and lifestyle factors to the high adherence these dietary patterns. METHODS: This is a cross-sectional epidemiological study of 740 farmers (51.5%, n = 381 males; 48.5%, n = 359 females) from a municipality in Southeastern Brazil. Food intake data were obtained by applying multipass 24-h recall and dietary intake was presented in dietary patterns determined by Principal Component Analysis with varimax orthogonal rotation. RESULTS: Three dietary patterns were identified. The first pattern, "local traditional", was associated with sociodemographic and labor variables, being considered typical of the region's farmer as white race/color (p = 0.003), not extra-physical activity (p = 0.014) and cultivating 5 or more crops (p = 0.005). The permanence of a "traditional Brazilian" pattern and the occurrence of an "industrialized" pattern were also observed. Farmers working in non-conventional agriculture were 54% less adhere to "traditional Brazilian" pattern (OR 0.46, 95% CI 0.25-0.86, p = 0.014). Individuals aged 50 and over years were 82% less likely (OR 0.18, 95% CI 0.10-0.30) to adhere to "industrialized" pattern. Still, individuals of lower socioeconomic class were 52% less likely to adhere to this pattern (OR 0.48, 95% CI 0.24-0.96). Farmers who spent R$ 200 or more per capita to buy food were more than twice as likely to adhere to this food pattern (OR 2.22, 95% CI 1.32-3.73), and who had the habit of frequently eating out were 1.62 as likely adhere to "industrialized" pattern (95% CI 1.11-2.36). CONCLUSIONS: The findings indicate changes in dietary patterns in rural areas of the country, maintaining a traditional Brazilian pattern, as well as a local and an industrialized pattern. This last pattern demonstrates that the contemporary rural population also opts for a diet with ultra-processed products, being associated with the characteristic habits of a more urbanized rural region.

Food availability and food insecurity in households in the state of Tocantins, Northern Brazil / Disponibilidade de alimentos e insegurança alimentar de domicílios do Estado do Tocantins, Região Norte do Brasil

ABSTRACT Objective To assess the relationship between food availability, food insecurity and socioeconomic and demographic characteristics of households in the urban area of the state of Tocantins. Methods Population-based, cross-sectional study conducted in 594 households in the urban area of 22 municipalities in the state of Tocantins. A survey was carried out in the households, to collect socioeconomic and data, and assess food insecurity using the Brazilian Food Insecurity Scale. Further a food availability questionnaire was applied by the interviewer with the head of the family, who reported on the food and drinks available at home in the last 30 days. The description of the food available in the households resulted in a total of 142 food items that were grouped according to the NOVA classification of foods. demographic Results It was found that 63.3% of households were in a situation of food insecurity. The median caloric availability found was 2,771.4kcal/per capita/day, with the largest caloric contribution coming from fresh and minimally processed foods, regardless of the degree of food insecurity. Food availability was affected by socioeconomic vulnerability and the situation of food insecurity in the families.

RESUMO Objetivo Avaliar a relação entre a disponibilidade alimentar, a situação de insegurança alimentar e características socioeconômicas e demográficas de domicílios da zona urbana do Estado do Tocantins. Métodos Estudo de base populacional, do tipo transversal, realizado em 594 domicílios da área urbana de 22 municípios do Estado do Tocantins. A coleta de dados foi realizada nos domicílios, com levantamento de dados socioeconômicos e demográficos, avaliação da insegurança alimentar por meio da Escala Brasileira de Insegurança Alimentar e avaliação da disponibilidade dos alimentos a partir de um questionário de disponibilidade alimentar aplicado pelo entrevistador ao chefe da família, que informou sobre os alimentos e bebidas disponíveis no domicílio nos últimos 30 dias. A descrição dos alimentos disponíveis nos domicílios resultou em um total de 142 itens alimentares que foram agrupados de acordo com a classificação NOVA de alimentos. Resultados Constatou-se que 63,3% dos domicílios encontravam-se em situação de insegurança alimentar. A disponibilidade calórica mediana encontrada foi de 2.771,4kcal/per capita/dia, sendo a maior contribuição calórica advinda de alimentos in natura e minimamente processados, independente do grau de insegurança alimentar. Conclusão A disponibilidade alimentar foi afetada pela vulnerabilidade socioeconômica e pela situação de insegurança alimentar das famílias.

High prevalence of inadequate dietary fiber consumption and associated factors in older adults: a population-based study. / Elevada prevalência de inadequação do consumo de fibras alimentares em idosos e fatores associados: um estudo de base populacional.

INTRODUCTION: Several factors can lead to changes in dietary practices of the older adults; which contributes with nutritional recommendations not being met. OBJECTIVES: To estimate the prevalence of inadequate dietary fiber consumption and to identify associated factors. METHODOLOGY: Population-based, cross-sectional study that used data from a health survey in the municipality of Campinas, SP, Brazil, held in 2008/2009, in which 1,509 individuals aged 60 or older were assessed. Food consumption was estimated through a 24-hour recall, and the prevalence of inadequacy was calculated according to the Institute of Medicine's cut-off point for total fiber (30 g/day for men and 21 g/day for women). Associated factors were identified using the hierarchical Poisson regression model to estimate the prevalence, adjusted for block distal (sociodemographic) and proximal variables (health and lifestyle indicators). RESULTS: Inadequate consumption was observed in 90.1% of the population, and after adjustments in the final model, this rate remained significantly higher among males (RP = 1.06), seniors with a partner (RP = 1.05), lower income (RP = 0.95), physically inactive (RP = 1.05) and those who would not like to change body weight (RP = 1.05). CONCLUSION: Considering that inadequacy of dietary fiber was very high, the whole 60-year-old or older population must be targeted for nutritional intervention in order to ensure adequate intake of this nutrient.

INTRODUÇÃO: Vários fatores podem gerar mudanças nas práticas alimentares dos idosos, contribuindo para que as recomendações nutricionais não sejam atendidas. OBJETIVO: Estimar a prevalência de inadequação do consumo de fibras alimentares e seus fatores associados. METODOLOGIA: Estudo transversal de base populacional que utilizou dados do Inquérito de Saúde no Município de Campinas, realizado em 2008/2009, no qual foram analisados 1.509 indivíduos ≥ 60 anos. O consumo alimentar foi estimado por meio do recordatório de 24 horas, e foi calculada a prevalência de inadequação de acordo com o ponto de corte para fibras totais do Institute of Medicine de 30 g/dia para homens e 21 g/dia para mulheres. Os fatores associados foram identificados utilizando modelo hierárquico de regressão de Poisson para estimativa das razões de prevalência, ajustados por variáveis de bloco distal (sociodemográficos) e bloco proximal (condições de saúde e indicadores de estilo de vida). RESULTADOS: A inadequação do consumo de fibras alimentares foi observada em 90,1% da população, significantemente maior no sexo masculino (RP = 1,06), em idosos com parceiro (RP = 1,05), de menor renda (RP = 0,95), inativos fisicamente (RP = 1,05) e naqueles que não gostariam de mudar o peso corporal (RP = 1,05). CONCLUSÃO: Considerando que a inadequação de fibras alimentares foi muito elevada, toda a população de 60 anos ou mais deve ser alvo de intervenção nutricional para garantir o aporte adequado desse nutriente.

Sex differences in sociodemographic and lifestyle factors associated with diet quality in a multiethnic population.

OBJECTIVES: The purpose of this study was to examine associations of sociodemographic and lifestyle factors with diet quality in a multiethnic population. METHODS: The analysis included 160 353 African American, Native Hawaiian, Japanese American, Latino, and non-Hispanic white participants aged 45 to 75 y who entered the Multiethnic Cohort study by completing a comprehensive questionnaire in 1993 to 1996 and did not report cancer or heart disease. Diet quality was assessed using four diet quality indexes (DQIs): the Healthy Eating Index 2010, the Alternative Healthy Eating Index 2010, the alternate Mediterranean Diet, and the Dietary Approaches to Stop Hypertension. RESULTS: For three DQIs, the Healthy Eating Index 2010, Alternative Healthy Eating Index 2010, and Dietary Approaches to Stop Hypertension, mean scores were significantly higher in women than men, whereas the mean score of the alternate Mediterranean Diet was significantly higher in men than women. In both men and women, older age, higher education, being physically active, and multivitamin use were associated with scores above the median of DQIs, whereas overweight/obesity, current smoking, and heavy alcohol consumption (≥2 drinks/d) were associated with scores less than the median of DQIs. Race/ethnicity had inconsistent associations according to the DQIs. Being widowed, being a previous smoker, and having a low body mass index (<20 kg/m2) were associated with scores less than the median of DQIs in men but not in women. CONCLUSIONS: Diet quality was associated with sociodemographic and lifestyle characteristics in men and women. The associations with several factors, such as marital status, body mass index, and smoking status, differed by sex. These findings may help to identify at-risk populations for nutritional screening and to develop nutritional intervention strategies and educational materials.

Socioeconomic disparity in the diet quality of pregnant women in Northwest China.

BACKGROUND AND OBJECTIVES: Few studies have described the socioeconomic disparity of dietary quality in Northwest China. The present study aimed to evaluate the diet quality of pregnant women in Shaanxi province of Northwest China by using the Diet Balance Index for Pregnancy (DBI-P) and explored the relationships with socioeconomic status (SES). METHODS AND STUDY DESIGN: A cross-sectional analysis of data from 7,630 women who were pregnant during 2012-2013 was performed. Dietary intake during the whole pregnancy was assessed by FFQ within 12 months (median, 3 months; 10th-90th percentile, 0-7 months) after delivery. Diet quality evaluated by the DBI-P was related to socioeconomic factors. RESULTS: Most women had insufficient consumption of vegetables (72.27%), dairy (89.58%), meat (82.07%), fish and shrimp (92.23%), eggs (62.54%), and dietary variety (97.92%). 67.76% of women had excessive intake of grains, and 87.77% and 69.79% of participants had surplus consumption of edible oil and salt respectively. Women with higher education, occupation and household wealth index (HWI) consumed more vegetables, fruit, dairy, soybean and nuts, meat, fish and shrimp, eggs, edible oil, alcohol and dietary variety but less grains and salt. After adjusting for confounders, education, occupation and HWI were negatively associated with the level of inadequate dietary intake. Conversely, individuals with medium HWI had higher level of excessive dietary intake compared to low HWI groups. CONCLUSIONS: The diet quality of pregnant women in Northwest China was associated with SES. Socioeconomic disparities in diet quality should be considered when planning nutrition interventions for pregnant women.

Reproducibility and relative validity of a food frequency questionnaire to assess dietary intake of adults living in a Mediterranean country.

OBJECTIVE: Food frequency questionnaires (FFQs) must be validated among the population of interest due to the specificities in dietary habits, culture and food in each country of the Mediterranean region. The objective of this study was to determine the relative validity and reproducibility of a 157 item semi-quantitative FFQ among Lebanese adult population. MATERIAL AND METHODS: Dietary intake was assessed through dietary recalls, a FFQ with food items, and traditional recipes from the Mediterranean cuisine. Validity of the FFQ was measured by comparing the intake of calories, macro and micronutrients to the mean values derived from three dietary recalls (DR). Reproducibility of the FFQ was evaluated after repeating the same FFQ among the participant after a four-month period. RESULTS: 114 healthy adults aged between 18 and 60 years of which 52.6% are men participated in this study. 53 of these adults participated in the reproducibility study. Intra class correlation coefficient (ICC) between the two FFQ measurements ranged from 0.822 for sodium to 0.998 for energy indicating excellent reproducibility. The FFQ showed slightly higher intakes than the dietary recalls for most of the nutrients and foods reaching 2.1% for nutrients (polyunsaturated fatty acids) and 18% for food groups (olive oil). Correlation coefficients ranged between 0.783 (sodium) and 0.996 (carbs) for nutrients and between 0.906 (fish) and 1 (fruits and nuts) for food groups, with a significant p value (p = 0.038 for folate). Cross-classification of nutrients into quartiles showed that more than 81% of the participants were classified in the same quartile. Misclassifications were low for most nutrients with one to three persons misclassified at the extreme quartiles. CONCLUSION: The FFQ used in this research contained western and Mediterranean type of dishes and foods. Statistical analysis showed good reproducibility and validity of the tested tool in a heterogeneous sample of adults living in a Mediterranean country. It is a useful tool for future investigations and strategies promoting the comeback of this traditional diet.

Single-Meal Nutrient Assessment by a Self-Administered, Electronic Exit Survey Compared with a Multipass Dietary Interview in University Undergraduates in an All-You-Care-to-Eat Campus Dining Hall.

BACKGROUND: Assessing nutritional intake in all-you-care-to-eat dining facilities poses unique challenges. New methods that streamline accurate data collection would facilitate better nutrition intervention research in this dining hall environment, which is common on university campuses. OBJECTIVE: To compare nutrient and food group intake data of university undergraduate students from a single visit to an all-you-care-to-eat campus dining hall, collected by two methods: multiple-pass dietary recall interview and self-administered, electronic survey. PARTICIPANTS/SETTING: Undergraduate students (n=42) ages 18 and older were recruited as they exited the dining hall during lunch service hours during 1 week. DESIGN: Using a cross-sectional design, participants completed two dietary assessment methods in random order: an electronic tablet-based exit survey listing the available menu items at that service with drop-down menus to report portion size consumed and a multiple-pass structured dietary interview by a single, trained interviewer. STATISTICAL ANALYSES PERFORMED: Agreement of nutrients and food groups between the two methods was assessed by Pearson and Spearman correlations and paired t tests. Significance was set at P<0.05. RESULTS: Respondents were primarily underclassmen and women who lived on campus, with 16 of 42 students identifying as white. Students reported an average of 1.1 additional food items via the diet interview method compared with the survey. Average kilocalorie intake by the interview and survey methods was 837±561 and 860±586, respectively. Mean intake of all measured nutrients and all food groups except total and lean protein was not significantly different across the two methods. Spearman correlations between method results ranged across nutrients from r=0.541 to r=0.998 and across food groups from r=0.507 to r=0.948; all were significant at P<0.001. However, mean differences between methods exhibited notable variation. CONCLUSIONS: The electronic survey method performs similar to a multiple-pass dietary interview in assessing mean nutrient intake of ethnically diverse university undergraduates in a single eating occasion at an all-you-care-to-eat dining hall, but the survey may not be as efficient at capturing the total number of food items consumed.

Household coverage of vitamin A fortification of edible oil in Bangladesh.

Mandatory fortification of edible oil (soybean and palm) with vitamin A was decreed in Bangladesh in 2013. Yet, there is a dearth of data on the availability and consumption of vitamin A fortifiable oil at household level across population sub-groups. To fill this gap, our study used a nationally representative survey in Bangladesh to assess the purchase of fortifiable edible oil among households and project potential vitamin A intake across population sub-groups. Data is presented by strata, age range and poverty-the factors that potentially influence oil coverage. Across 1,512 households, purchase of commercially produced fortifiable edible oil was high (87.5%). Urban households were more likely to purchase fortifiable oil (94.0%) than households in rural low performing (79.7%) and rural other strata (88.1%) (p value: 0.01). Households in poverty were less likely to purchase fortifiable oil (82.1%) than households not in poverty (91.4%) (p <0.001). Projected estimates suggested that vitamin A fortified edible oil would at least partially meet daily vitamin A estimated average requirement (EAR) for the majority of the population. However, certain population sub-groups may still have vitamin A intake below the EAR and alternative strategies may be applied to address the vitamin A needs of these vulnerable sub-groups. This study concludes that a high percentage of Bangladeshi population across different sub-groups have access to fortifiable edible oil and further provides evidence to support mandatory edible oil fortification with vitamin A in Bangladesh.

Estimated dietary sodium intake in peritoneal dialysis patients using food frequency questionnaires and total urinary and peritoneal sodium losses and assessment of extracellular volumes.

BACKGROUND: Peritoneal dialysis (PD) patients are advised to restrict sodium intake. For best use of resources, rapid screening tools are required for dietary assessments to allow for targeting of patients. We wished to evaluate the usefulness of food frequency questionnaires (FFQ) for estimating dietary sodium. METHODS: Sodium intake was estimated using the Derby Salt Questionnaire (DSQ), and Royal Free Sodium Questionnaire (RFSQ). Body composition was determined by bioimpedance. RESULTS: 90 peritoneal dialysis patients, 52 men (57.8%), mean age 62 ± 15.8 years, were asked to complete the DSQ and RFSQ questionnaires. 88 completed one or more questionnaire, with 87 completing the DSQ and 86 the RFSQ. The median estimated dietary sodium intake 104 (72-145) mmol/day (2.39 (1.64-3.34) g sodium/day) DSQ, and 92 (60-114) mmol/day (2.11 (1.38-2.62) g sodium/day) RFSQ. Younger patients, aged ≤52 years had greater dietary sodium intake compared to those ≥76 years (RFSQ 105.4 (73-129) vs 96 (71-116) mmol/day), p < 0.05. Extracellular water to total body water (ECW/TBW) was greater in those with higher DSQ estimated dietary sodium intake (0.40 ± 0.01 vs 0.39 ± 0.01, p < 0.05). A multivariable model showed that increased dietary sodium intake was independently associated with increased SMM (DSQ odds ratio (OR) 1.17 (95% confidence limits 1.05-1.32, RFSQ OR 1.15 (1.04-1.27, p < 0.05) and raised ECW/TBW (DSQ OR 1.88 (1.22-2.92) p = 0.004, and ECW/height (RFSQ OR 1.42 (1.02-1.98) p = 0.04. CONCLUSIONS: Both questionnaires were acceptable to patients, and the majority were found to be consuming more dietary sodium than recommended. Dietary sodium estimation was associated with SMM and increased ECW.

Consumo alimentar segundo o grau de processamento e características sociodemográficas: Estudo Pró-Saúde / Food consumption according to degree of processing and sociodemographic characteristics: Estudo Pró-Saúde, Brazil

RESUMO: Objetivo: Investigar o consumo alimentar segundo o grau de processamento e associações com características sociodemográficas. Métodos: Estudo transversal de subamostra do Estudo Pró-Saúde, com 520 funcionários públicos de campi universitários, Rio de Janeiro, 2012-13. Questionário de frequência alimentar foi utilizado para classificar o consumo alimentar: 1) in natura, minimamente processados, preparações culinárias à base desses alimentos; 2) alimentos processados; 3) alimentos ultraprocessados. Determinou-se a contribuição energética relativa de cada grupo, e foi utilizado modelo de regressão seemingly unrelated equations regression (SUR) para estimar associações com as características sociodemográficas. Resultados: O grupo de alimentos in natura (1) contribuiu com 59% do consumo energético e foi diretamente associado à idade [45-49 anos (β = 1,8 intervalo de confiança de 95% - IC95% -1,2; 4,8); 50-54 (β = 1,5 IC95% -1,5; 4,5); 55-59 (β = 2,9 IC95% -0,4; 6,3) e ≥ 60 (β = 4,6 IC95% 1,1; 8,2)], comparado à idade ≤ 44. Em contraste, ultraprocessados contribuíram com 27% e foram inversamente associados à idade [45-49 (β = -1,7 IC95% -4,3; 0,9); 50-54 (β = -1,8 IC95% -4,3; 0,9); 55-59 (β = -4,9 IC95% -8,0; -2,0); ≥ 60 (β = -4,5 IC95% -7,6; -1,5)]. Sexo, renda e escolaridade não foram associados ao consumo alimentar. Conclusão: Adultos mais jovens apresentaram maior consumo de ultraprocessados, indicando a necessidade de intervenções principalmente nessa faixa etária. A ausência de associação com demais características sociodemográficas pode ser por conta da influência de fatores contextuais.

ABSTRACT: Objective: To investigate the food consumption according to the degree of processing and associations with sociodemographic characteristics. Methods: A cross-sectional study of the Estudo Pró-Saúde (Pro-Health Study), with 520 civil servants of university campuses, Rio de Janeiro, 2012-13. A food frequency questionnaire was used to classify food consumption: 1) in natura, minimally processed, food preparations based on these foods; 2) processed foods; 3) ultra-processed foods. The relative energy contribution of each group was determined, and a seemingly unrelated equations regression (SUR) regression model was used to estimate associations with sociodemographic characteristics. Results: The in natura food group (1) contributed with 59% of the energy consumption and was directly associated with age [45-49 years (β = 1.8 confidence interval of 95% - 95%CI -1.2; 4.8); 50-54 (β = 1.5 95%CI -1.5; 4.5); 55-59 (β = 2.9 95%CI -0.4; 6.3) and ≥ 60 (β = 4.6 95%CI 1.1; 8.2)], compared to age ≤ 44. In contrast, the group of ultra-processed foods contributed 27% and were inversely associated with age [45-49 (β = -1.7 95%CI -4.3; 0.9); 50-54 (β = -1.8 95%CI -4.3; 0.9); 55-59 (β = -4.9 95%CI -8.0; -2.0); ≥ 60 (β = -4.5 95%CI -7.6; -1.5)]. Gender, income and schooling were not associated with food consumption. Conclusion: Younger adults had higher consumption of ultra-processed foods, indicating the need for interventions mainly in this age group. The absence of association with other sociodemographic characteristics may be due to the influence of contextual factors.

Elevada prevalência de inadequação do consumo de fibras alimentares em idosos e fatores associados: um estudo de base populacional / High prevalence of inadequate dietary fiber consumption and associated factors in older adults: a population-based study

RESUMO: Introdução: Vários fatores podem gerar mudanças nas práticas alimentares dos idosos, contribuindo para que as recomendações nutricionais não sejam atendidas. Objetivo: Estimar a prevalência de inadequação do consumo de fibras alimentares e seus fatores associados. Metodologia: Estudo transversal de base populacional que utilizou dados do Inquérito de Saúde no Município de Campinas, realizado em 2008/2009, no qual foram analisados 1.509 indivíduos ≥ 60 anos. O consumo alimentar foi estimado por meio do recordatório de 24 horas, e foi calculada a prevalência de inadequação de acordo com o ponto de corte para fibras totais do Institute of Medicine de 30 g/dia para homens e 21 g/dia para mulheres. Os fatores associados foram identificados utilizando modelo hierárquico de regressão de Poisson para estimativa das razões de prevalência, ajustados por variáveis de bloco distal (sociodemográficos) e bloco proximal (condições de saúde e indicadores de estilo de vida). Resultados: A inadequação do consumo de fibras alimentares foi observada em 90,1% da população, significantemente maior no sexo masculino (RP = 1,06), em idosos com parceiro (RP = 1,05), de menor renda (RP = 0,95), inativos fisicamente (RP = 1,05) e naqueles que não gostariam de mudar o peso corporal (RP = 1,05). Conclusão: Considerando que a inadequação de fibras alimentares foi muito elevada, toda a população de 60 anos ou mais deve ser alvo de intervenção nutricional para garantir o aporte adequado desse nutriente.

ABSTRACT: Introduction: Several factors can lead to changes in dietary practices of the older adults; which contributes with nutritional recommendations not being met. Objectives: To estimate the prevalence of inadequate dietary fiber consumption and to identify associated factors. Methodology: Population-based, cross-sectional study that used data from a health survey in the municipality of Campinas, SP, Brazil, held in 2008/2009, in which 1,509 individuals aged 60 or older were assessed. Food consumption was estimated through a 24-hour recall, and the prevalence of inadequacy was calculated according to the Institute of Medicine's cut-off point for total fiber (30 g/day for men and 21 g/day for women). Associated factors were identified using the hierarchical Poisson regression model to estimate the prevalence, adjusted for block distal (sociodemographic) and proximal variables (health and lifestyle indicators). Results: Inadequate consumption was observed in 90.1% of the population, and after adjustments in the final model, this rate remained significantly higher among males (RP = 1.06), seniors with a partner (RP = 1.05), lower income (RP = 0.95), physically inactive (RP = 1.05) and those who would not like to change body weight (RP = 1.05). Conclusion: Considering that inadequacy of dietary fiber was very high, the whole 60-year-old or older population must be targeted for nutritional intervention in order to ensure adequate intake of this nutrient.

Dietary patterns, sociodemographic and behavioral characteristics among Brazilian adolescents. / Padrões alimentares, características sociodemográficas e comportamentais entre adolescentes brasileiros.

INTRODUCTION: Inadequate dietary patterns in childhood and adolescence are a major risk factor for the early onset of obesity and other chronic diseases. OBJECTIVES: To identify and to analyze dietary patterns among Brazilian adolescents. METHODS: Data from the Brazilian National School Health Survey (PeNSE) of 2015 were used (n = 10,926 adolescents). The identification and analyses of dietary patterns were calculated using principal component analysis and linear regression, respectively. RESULTS: Two dietary patterns were identified. The first one was characterized by the presence of markers of unhealthy eating, and the second one by markers of healthy eating. The adherence to the unhealthy pattern was positively associated with female adolescents, which mothers had completed, at least, the elementary school, residents in developed regions and urban areas, as well as those students who usually chose to skip breakfast, to not have meals with their parents/guardians, and who usually had meals while watching TV/studying, and at fast food restaurants. DISCUSSION: Analyses of the consumption of isolated food groups, which do not consider the diet in all its complexity, have been insufficient in explaining the main outcomes of the public health nutrition area. CONCLUSION: Our findings contributed to the identification of the most vulnerable population groups to unhealthy dietary patterns and to the understanding of the coexistence of different food habit determinants among adolescents.

INTRODUçÃO: Padrões inadequados de alimentação na infância e na adolescência são um dos principais fatores de risco para o aparecimento precoce da obesidade e de outras doenças crônicas. OBJETIVOS: Identificar e analisar os padrões alimentares entre os adolescentes brasileiros. MÉTODOS: Foram utilizados dados da Pesquisa Nacional de Saúde do Escolar de 2015 (n = 10.926 adolescentes). A identificação e a análise dos padrões alimentares foram realizadas por meio da análise de componentes principais e pela regressão linear, respectivamente. RESULTADOS: Dois padrões foram identificados: o primeiro, caracterizado por marcadores de uma alimentação não saudável; e o segundo, por marcadores de uma alimentação saudável. A adesão ao padrão não saudável esteve positivamente associada aos adolescentes do sexo feminino, que possuem mães com, ao menos, ensino fundamental completo, que residem em regiões mais desenvolvidas e em área urbana, bem como entre aqueles que possuem o hábito de não tomar café da manhã, não realizar as refeições com os pais/responsáveis, se alimentar enquanto estuda ou assiste TV e frequentar restaurantes fast-food. DISCUSSÃO: Análises do consumo de grupos alimentares isolados, que não consideram a dieta em toda a sua complexidade, têm se mostrado insuficientes na explicação dos principais desfechos da área de nutrição em saúde pública. CONCLUSÃO: Os achados contribuíram para a identificação de grupos populacionais mais vulneráveis ao padrão alimentar não saudável e para a compreensão da coexistência de diferentes determinantes ao hábito alimentar entre os adolescentes.

Prevalence of consumption and nutritional content of breakfast meal among adolescents from the Brazilian National Dietary Survey / Prevalência de consumo e teor nutricional da refeição do café da manhã entre adolescentes da Pesquisa Nacional de Consumo Alimentar

Abstract Objective: To estimate the prevalence of breakfast consumption and describe the foods and nutrients consumed at this meal and throughout the day by Brazilian adolescents. Method: A total of 7276 adolescents aged 10-19 years were evaluated in the Brazilian National Dietary Survey 2008-9, a population-based cross-sectional study. Individuals' information was collected at home. Dietary data were obtained by two food records. Breakfast was defined as the first eating occasion of the day that occurred between 6 and 9:59 am. Differences between breakfast consumers, occasional consumers, and skippers were tested through Pearson's chi-squared test or F-test of regression analysis. Results: Breakfast was consumed by 93% of adolescents and it was associated with age, income, geographic region and household area. The most frequently consumed foods at breakfast were white bread, coffee, butter/margarine, refined cookies and crackers, and whole milk. The mean daily intakes of total energy, sugar, and calcium were higher among occasional consumers and skippers. Breakfast consumers had higher intake of vitamins B12, C, and D. Breakfast contributed more to total intake of calcium, phosphorus, thiamin, riboflavin, and vitamins A, B6, and D (17-32%), trans fat and sodium (about 30%) and less to folate, vitamin C, iron, zinc, and fiber (8-12%) and energy intake (16%). Conclusions: Although the prevalence of breakfast consumption among Brazilian adolescents was high, the overall nutritional quality of this meal is suboptimal, highlighting the need to support adolescents and their families to make more nutrient-dense food choices.

Resumo Objetivo: Estimar a prevalência de consumo de café da manhã e descrever os alimentos e nutrientes consumidos nessa refeição e durante todo o dia por adolescentes brasileiros. Método: Foram avaliados 7.276 adolescentes entre 10-19 anos no Inquérito Nacional de Alimentação 2008-2009, um estudo transversal de base populacional. As informações dos indivíduos foram coletadas nos domicílios. Os dados alimentares foram obtidos por dois registros alimentares. O café da manhã foi definido como a primeira refeição do dia entre 6h e 9h59. As diferenças entre os consumidores de café da manhã, consumidores ocasionais e aqueles que não tomam café da manhã foram testadas por meio do teste de qui-quadrado ou teste F para análise de regressão. Resultados: O café da manhã foi consumido por 93% dos adolescentes e seu consumo foi associado à idade, renda, região geográfica e área residencial. Os alimentos mais frequentemente consumidos foram pão branco, café, manteiga/margarina, biscoitos e bolachas refinados e leite integral. A ingestão média diária de energia total, açúcar e cálcio foi maior entre os consumidores ocasionais e aqueles que não tomam café da manhã. Aqueles que tomam café da manhã apresentam maior ingestão de vitaminas B12, C e D. O café da manhã contribuiu mais para a ingestão total de cálcio, fósforo, tiamina, riboflavina e vitaminas A, B6 e D (17%-32%), gordura trans e sódio (cerca de 30%) e menos para a ingestão de ácido fólico, vitamina C, ferro, zinco e fibras (8%-12%) e energia (16%). Conclusões: Apesar de a prevalência de consumo de café da manhã entre os adolescentes brasileiros ter sido alta, a qualidade nutricional dessa refeição está abaixo do ideal, destaca a necessidade de apoio aos adolescentes e suas famílias para possibilitar a escolha de alimentos mais densos em nutrientes.