Sugar-sweetened beverages, low/no-calorie beverages, fruit juices intake and risks of metabolic syndrome in adults: The SWEET project.

BACKGROUND AND AIMS: Metabolic syndrome (MetS) is an important determinant of cardiometabolic disease development, with excessive sugar intake as one of the key modifiable risk factors. However, evidence on the association between sugar-sweetened beverages (SSB), their replacement by low/no caloric beverages (LNCB), and MetS development is still limited. METHODS AND RESULTS: Data from participants' of Lifelines (n = 58 220), NQPlus (n = 1094) and Feel4Diabetes (n = 342) were prospectively analysed. Dose-response associations were investigated using restricted cubic spline analyses (Lifelines). Cox proportional hazard regression analysis with robust variance was used to quantify associations between intakes of SSB, fruit juices (FJ) and LNCB and MetS incidence; data were pooled using random-effects models. Associations were adjusted for demographic, lifestyle and other dietary factors. In Lifelines, NQPlus, and Feel4Diabetes, 3853 (7 %), 47 (4 %), and 39 (11 %) participants developed MetS, respectively. Pooled analyses showed that each additional serving of SSB was associated with a 6 % higher risk of MetS (95%CI 1.02-1.10). A J-shaped association was observed for FJ and MetS, with a significant inverse association at moderate intake levels (IPR 0.89, 95 % CI 0.82-0.96). LNCB intake was not associated with MetS (IPR 1.59, 95%CI 0.74-2.43), but findings across studies were inconsistent (I2 94 %, p-value <0.01). Replacing SSB with FJ or LNCB did not show any associations with MetS incidence. CONCLUSION: SSB intake was adversely associated with MetS incidence. A J-shaped association was observed between FJ and MetS. For LNCB, results were inconsistent across studies and therefore findings must be interpreted cautiously.

"Miffy eats the rainbow!" - A colorful modeling- and reward-based intervention to increase willingness to taste fruit and vegetables in 3-7-year-old children.

Diets rich in fruit and vegetables (F&Vs) improve cognitive functioning and reduce the risk of non-communicable diseases in children. Nevertheless, 59% of Dutch children do not meet recommended intake levels. Given the importance of color in children's food choices, the concept of "eat the rainbow" presents a promising approach. This project aimed to evaluate the effects of a modeling- and reward-based intervention to stimulate the consumption of colorful foods to increase willingness to taste different F&Vs among children aged 3-7 years. 164 children from Dutch elementary schools participated in a nested cluster randomized multi-arm parallel design study. During two morning school breaks, children were invited to choose from ten F&Vs in five different colors. Their willingness to taste and ad libitum intake were recorded. The first session served as a baseline with no intervention, while the second session involved either the Miffy intervention (modeling- and reward-based), a reward-only intervention (reward-based), or a control session. In the Miffy intervention, children listened to a story about Miffy eating the rainbow before tasting F&Vs and they received colored stickers (e.g., red sticker for tomatoes, green sticker for celery) upon tasting them. In the reward-only intervention, children received a sticker upon tasting a food. The Miffy group showed a higher probability (P(tasted) = 0.39) of tasting a food product compared to the control group (P(tasted) = 0.29; OR = 0.63, p = .04). No significant differences were observed between the Miffy and reward-only groups or between the reward-only and control groups. Both interventions did not significantly impact intake or liking of the foods. The Miffy-themed intervention demonstrates potential to enhance children's willingness to taste F&Vs, primarily due to the use of non-food incentives.

Association between diet quality and all-cause mortality in a large Dutch cohort.

Food-based dietary guidelines are helpful for governments and health agencies to encourage healthy eating at the population level. In order to assess adherence to such guidelines, index scores have been developed, the version in the Netherlands being the Dutch Healthy Diet-index (2015) (DHD2015-index), which reflect adherence to the 2015 Dutch dietary guidelines. Because a higher diet quality, i.e. a higher adherence to the dietary guidelines, is associated with better health outcomes, a higher DHD2015-index score would also mean better outcomes on measures of health, such as all-cause mortality. The present study aimed to elucidate this by investigating the association between DHD2015-index score and mortality in the Dutch population using data from 97 999 participants in the Lifelines cohort study. For the analyses, Cox Proportional Hazards regression was used, whilst accounting for age, sex, physiological measurements, exercise, and biochemical and lifestyle variables. There was a strong negative association between DHD2015-index score and mortality. Hazard ratios for DHD2015-index scores below 60 were approximately 1.2x larger than the mean. Every 10 unit increase in DHD2015-index scores between 60 and 90 led to a 0.1 reduction in hazard ratio, and every 10 unit increase between 90 and the highest DHD2015-index scores led to a reduction in hazard ratios of 0.05. The hazard ratio for the lowest quartile of DHD2015-index scores was 1.14 (95% CI = 1.04-1.26), whereas that for the highest quartile was 0.88 (95% CI = 0.84-0.92). Our results show a clear inverse relationship between DHD2015-index score and all-cause mortality.

Rule-based systems to automatically count bites from meal videos.

Eating behavior is a key factor for nutritional intake and plays a significant role in the development of eating disorders and obesity. The standard methods to detect eating behavior events (i.e., bites and chews) from video recordings rely on manual annotation, which lacks objective assessment and standardization. Yet, video recordings of eating episodes provide a non-invasive and scalable source for automation. Here, we present a rule-based system to count bites automatically from video recordings with 468 3D facial key points. We tested the performance against manual annotation in 164 videos from 15 participants. The system can count bites with 79% accuracy when annotation is available, and 71.4% when annotation is unavailable. The system showed consistent performance across varying food textures. Eating behavior researchers can use this automated and objective system to replace manual bite count annotation, provided the system's error is acceptable for the purpose of their study. Utilizing our approach enables real-time bite counting, thereby promoting interventions for healthy eating behaviors. Future studies in this area should explore rule-based systems and machine learning methods with 3D facial key points to extend the automated analysis to other eating events while providing accuracy, interpretability, generalizability, and low computational requirements.

Diet quality and associations with motivation and ability to consume a healthy diet among adolescents from urban low-income households in Bangladesh.

In low- and middle-income countries, particularly in urban areas, adolescent diets consist mainly of energy-dense and nutrient-poor foods, putting them at risk of malnutrition and non-communicable diseases (NCD). In Bangladesh, little is known about the diet quality of adolescents, their food choices and the drivers of such choices. This study assessed motivations and ability to consume a healthy diet among adolescent girls and boys from low-income urban families and how these drivers were associated with dietary diversity and diet quality. A cross-sectional survey was conducted among 299 adolescents (15-19 years) from low-income households in Dhaka city during September-October 2020. The Diet Quality Questionnaire was used to collect non-quantitative food intake in the previous day or night to calculate diet quality indicators of food group diversity score, % of adolescents achieving minimum dietary diversity, NCD-Protect and NCD-Risk and the Global Dietary Recommendations score. Motivation was measured by 11 food choice motives. Ability was measured by belief in own ability to engage in healthy eating behaviors (self-efficacy). Adolescent diets showed a mean food group diversity of 4.9 out of 10, with 60% of adolescents achieving minimum dietary diversity, but lacked health-promoting foods (average of 2.7 out of 9 food groups) yet included few foods to avoid and limit (1.6 out of 9). Adolescents valued food choice motive 'safety' the most, followed by 'health', 'taste', 'price', 'convenience' and 'local or seasonal'. A higher motivation to consume 'local or seasonal' and a lower motivation driven by 'price', and a higher perceived self-efficacy were associated with better diet quality. Future interventions should address self-efficacy, concerns about food price and increase local and seasonal foods availability in the urban poor food environment of Dhaka to improve overall diet quality.

Development and short evaluation of the Dutch healthy diet index for pregnant women; DHD-P.

Introduction: Diet quality indices provide a quick indicator of overall diet and are commonly used in research and surveillance. We developed a Dutch Healthy Diet for pregnant women (DHD-P) index, comprising 22 components aligned with the 2021 Dutch food-based dietary guidelines for pregnant women. Our evaluation focused on assessing its performance and sensitivity to change. Methods: The DHD-P index was quantified by using a validated Food Frequency Questionnaire (FFQ) and two 24-h recalls at 12 and 24 weeks gestation completed by 24-to-41 year old pregnant women participating in the GLIMP-II study. Strength and direction of associations were evaluated based on de-attenuated correlation coefficients between FFQ and 24-h recall data at 24 weeks gestation (n = 47). Sensitivity to change was evaluated by comparing DHD-P index data assessed by both FFQ and recalls at 12 and 24 weeks gestation using paired t-tests or Wilcoxon Signed Rank Test (n = 27). Results: De-attenuated correlation coefficients between FFQ and 24-recall data showed a good correlation for the total DHD-P score (rho = 0.57) and moderate to good correlations for component scores. FFQ as well as recall data showed comparable dietary intake at 12 and 24 weeks, suggesting minimal changes during pregnancy. Correlations over time were moderate-to-good for scores based on FFQ and low to moderate for scores based on 24hRs, indicating better reproducibility of scores based on FFQ data. Conclusion: Considering the moderate to good correlations, the DHD-P index appears to be an appropriate index to assess diet quality among pregnant women, and could serve as a foundation to provide dietary feedback toward healthier food choices. Studies including dietary data for all relevant food groups and nutrients are needed to substantiate our findings and further explore the DHD-P sensitivity to change.

Immunometabolic Signatures of Circulating Monocytes in Humans With Obesity and Insulin Resistance.

Obesity is associated with chronic inflammation and metabolic complications, including insulin resistance (IR). Immune cells drive inflammation through the rewiring of intracellular metabolism. However, the impact of obesity-related IR on the metabolism and functionality of circulating immune cells, like monocytes, remains poorly understood. To increase insight into the interindividual variation of immunometabolic signatures among individuals and their role in the development of IR, we assessed systemic and tissue-specific IR and circulating immune markers, and we characterized metabolic signatures and cytokine secretion of circulating monocytes from 194 individuals with a BMI ≥25 kg/m2. Monocyte metabolic signatures were defined using extracellular acidification rates (ECARs) to estimate glycolysis and oxygen consumption rates (OCRs) for oxidative metabolism. Although monocyte metabolic signatures and function based on cytokine secretion varied greatly among study participants, they were strongly associated with each other. The ECAR-to-OCR ratio, representing the balance between glycolysis and oxidative metabolism, was negatively associated with fasting insulin levels, systemic IR, and liver-specific IR. These results indicate that monocytes from individuals with IR were relatively more dependent on oxidative metabolism, whereas monocytes from more insulin-sensitive individuals were more dependent on glycolysis. Additionally, circulating CXCL11 was negatively associated with the degree of systemic IR and positively with the ECAR-to-OCR ratio in monocytes, suggesting that individuals with high IR and a monocyte metabolic dependence on oxidative metabolism also have lower levels of circulating CXCL11. Our findings suggest that monocyte metabolism is related to obesity-associated IR progression and deepen insights into the interplay between innate immune cell metabolism and IR development in humans.

Body composition and body fat distribution in tissue-specific insulin resistance and in response to a 12-week isocaloric dietary macronutrient intervention.

BACKGROUND: Body composition and body fat distribution are important predictors of cardiometabolic diseases. The etiology of cardiometabolic diseases is heterogenous, and partly driven by inter-individual differences in tissue-specific insulin sensitivity. OBJECTIVES: To investigate (1) the associations between body composition and whole-body, liver and muscle insulin sensitivity, and (2) changes in body composition and insulin sensitivity and their relationship after a 12-week isocaloric diet high in mono-unsaturated fatty acids (HMUFA) or a low-fat, high-protein, high-fiber (LFHP) diet. METHODS: This subcohort analysis of the PERSON study includes 93 individuals (53% women, BMI 25-40 kg/m2, 40-75 years) who participated in this randomized intervention study. At baseline and after 12 weeks of following the LFHP, or HMUFA diet, we performed a 7-point oral glucose tolerance test to assess whole-body, liver, and muscle insulin sensitivity, and whole-body magnetic resonance imaging to determine body composition and body fat distribution. Both diets are within the guidelines of healthy nutrition. RESULTS: At baseline, liver fat content was associated with worse liver insulin sensitivity (ß [95%CI]; 0.12 [0.01; 0.22]). Only in women, thigh muscle fat content was inversely related to muscle insulin sensitivity (-0.27 [-0.48; -0.05]). Visceral adipose tissue (VAT) was inversely associated with whole-body, liver, and muscle insulin sensitivity. Both diets decreased VAT, abdominal subcutaneous adipose tissue (aSAT), and liver fat, but not whole-body and tissue-specific insulin sensitivity with no differences between diets. Waist circumference, however, decreased more following the LFHP diet as compared to the HMUFA diet (-3.0 vs. -0.5 cm, respectively). After the LFHP but not HMUFA diet, improvements in body composition were positively associated with improvements in whole-body and liver insulin sensitivity. CONCLUSIONS: Liver and muscle insulin sensitivity are distinctly associated with liver and muscle fat accumulation. Although both LFHP and HMUFA diets improved in body fat, VAT, aSAT, and liver fat, only LFHP-induced improvements in body composition are associated with improved insulin sensitivity. TRIAL REGISTRATION: NCT03708419 (clinicaltrials.gov).

Procedure to identify fortified foods in the Dutch branded food database.

Introduction: Information on fortified foods is needed for multiple purposes, including food consumption research and dietary advice. Branded food databases are a valuable source of food label data. European labeling legislation prescribes that food fortification should be indicated in the ingredient list, and nutrient values should be declared under certain conditions. This creates the potential to identify fortified foods in branded food databases, though it is not straightforward and labor-intensive. The aim of our study was to develop an automated approach to identify fortified foods in the Dutch branded food database called LEDA. Methods: An automated procedure, based on a stepwise approach conforming with European labeling legislation, using a list of rules and search terms, was developed to identify fortified foods. Fortification with calcium, folic acid, vitamin B12, and zinc was studied as an example. The results of a random stratified sample with fortified and not-fortified foods were validated by two experts. Results: The automated approach resulted in identifying 1,817 foods fortified with one or more of the selected nutrients in the LEDA dataset (0.94%). The proportions of fortified foods per nutrient were below 0.7%. The classification of fortified/non-fortified foods matched manual validation by experts for the majority of the foods in the sample, i.e., sensitivity and specificity indicating the probability of correctly identifying fortified and non-fortified foods was high (>94.0%). Conclusion: The automated approach is capable of easily and quickly identifying fortified foods in the Dutch branded food database with high accuracy, although some improvements to the automated procedure could be made. In addition, the completeness, correctness, and consistency of the LEDA database can be improved. To fully benefit from this automated approach, it needs to be expanded to cover all micronutrients that may be added to foods.

Hepatic insulin resistance and muscle insulin resistance are characterized by distinct postprandial plasma metabolite profiles: a cross-sectional study.

BACKGROUND: Tissue-specific insulin resistance (IR) predominantly in muscle (muscle IR) or liver (liver IR) has previously been linked to distinct fasting metabolite profiles, but postprandial metabolite profiles have not been investigated in tissue-specific IR yet. Given the importance of postprandial metabolic impairments in the pathophysiology of cardiometabolic diseases, we compared postprandial plasma metabolite profiles in response to a high-fat mixed meal between individuals with predominant muscle IR or liver IR. METHODS: This cross-sectional study included data from 214 women and men with BMI 25-40 kg/m2, aged 40-75 years, and with predominant muscle IR or liver IR. Tissue-specific IR was assessed using the muscle insulin sensitivity index (MISI) and hepatic insulin resistance index (HIRI), which were calculated from the glucose and insulin responses during a 7-point oral glucose tolerance test. Plasma samples were collected before (T = 0) and after (T = 30, 60, 120, 240 min) consumption of a high-fat mixed meal and 247 metabolite measures, including lipoproteins, cholesterol, triacylglycerol (TAG), ketone bodies, and amino acids, were quantified using nuclear magnetic resonance spectroscopy. Differences in postprandial plasma metabolite iAUCs between muscle and liver IR were tested using ANCOVA with adjustment for age, sex, center, BMI, and waist-to-hip ratio. P-values were adjusted for a false discovery rate (FDR) of 0.05 using the Benjamini-Hochberg method. RESULTS: Sixty-eight postprandial metabolite iAUCs were significantly different between liver and muscle IR. Liver IR was characterized by greater plasma iAUCs of large VLDL (p = 0.004), very large VLDL (p = 0.002), and medium-sized LDL particles (p = 0.026), and by greater iAUCs of TAG in small VLDL (p = 0.025), large VLDL (p = 0.003), very large VLDL (p = 0.002), all LDL subclasses (all p < 0.05), and small HDL particles (p = 0.011), compared to muscle IR. In liver IR, the postprandial plasma fatty acid (FA) profile consisted of a higher percentage of saturated FA (p = 0.013), and a lower percentage of polyunsaturated FA (p = 0.008), compared to muscle IR. CONCLUSION: People with muscle IR or liver IR have distinct postprandial plasma metabolite profiles, with more unfavorable postprandial metabolite responses in those with liver IR compared to muscle IR.

Growth and micronutrient status parameters of Nigerian preterm infants consuming preterm formula or breastmilk.

BACKGROUND: Moderate-to-late preterm infants (32-34 weeks GA) have increased risk of neonatal morbidities compared to term infants, however dedicated nutritional guidelines are lacking. METHODS: Moderate-to-late preterm infants received a preterm formula (n = 17) or breastmilk (n = 24) from age 2-10 weeks in a non-randomized, open-label observational study. Anthropometric measurements were assessed bi-weekly. Blood concentrations of hemoglobin, ferritin, serum retinol, and 25-hydroxy-vitamin D (25OHD) were analyzed at age 2 and 10 weeks. RESULT: Average growth per day was 14.7 g/kg BW/day in formula-fed and 12.8 g/kg BW/day in breastmilk-fed infants but not different from each other. Length and head circumference in both groups were in line with the median reference values of the Fenton growth chart. At 10 weeks of age, hemoglobin tended to be higher in the formula-fed group (10.2 g/dL vs. 9.6 g/dL, p = 0.053). 25OHD increased in formula- and breastmilk-fed infants from 73.8 to 180.9 nmol/L and from 70.7 to 97.6 nmol/L, respectively. Serum retinol only increased in the formula-fed group (0.63 to 1.02 µmol/L, p < 0.001). CONCLUSION: Breastfeeding resulted in adequate growth in moderate-late preterm infants but was limiting in some micronutrients. The preterm formula provided adequate micronutrients, but weight gain velocity was higher than the Fenton reference value. IMPACT STATEMENT: Unfortified breastmilk resulted in adequate growth in weight, length and head circumference in Nigerian moderate to late preterm infants during an study period of 8 weeks, but status of vitamin D, vitamin A and iron needs to be monitored. The high-energy formula, developed for very preterm infants, resulted in higher growth in body weight in moderate to late preterm infants than the median of the Fenton preterm growth chart. This study supports the necessity of dedicated nutritional guidelines, and regular monitoring of growth and nutritional status of moderate to late preterm infants.

Dietary taste patterns and diet quality of female nurses around the night shift.

PURPOSE: Night shift workers are at risk of making poor food choices: e.g. sleep deprivation may lead to higher food intake with innate preferred tastes, such as sweet, savoury and fatty foods. Therefore, better insight in dietary taste patterns of night shift workers may improve the understanding of their food choices. METHODS: This observational study assessed dietary taste patterns of 120 female night shift working nurses and compared them to 307 women of a reference population. Dietary intake, assessed with 24-h dietary recalls, was combined with a taste intensity database, including taste profiles of 557 foods. The contribution to the daily intake of 6 taste clusters was assessed: fat, neutral, sweet/fat, sweet/sour, salt/umami/fat and bitter. RESULTS: During night shifts, nurses consumed a significantly higher energy percentage (en%) of 'neutral' (5.9 en%), 'sweet/sour' (8.1 en%) and 'sweet/fat' (6.5 en%) tasting foods and a lower en% of 'fat' (- 17.1 en%) and 'bitter' (- 2.1 en%) tasting foods than outside the night shift. They consumed a larger en% from foods with a 'sweet/sour' (1.9 en%) taste and a lower en% from foods with a 'bitter' (- 2.1 en%) taste than the reference population, irrespective of age, BMI and smoking status. A higher en% and gram% of 'fat' tasting foods and a higher gram% 'fat/salt/umami' tasting foods were associated with lower diet quality. CONCLUSION: Our results only partly support our hypothesis that nurses would select foods with more innate taste preferences. In addition, fat and savoury tasting foods were negatively associated with their diet quality.

Ten2Twenty-Ghana: a randomised controlled trial on the efficacy of multiple micronutrient-fortified biscuits on the micronutrient status of adolescent girls.

Adolescent girls are an important target group for micronutrient interventions particularly in Sub-Saharan Africa where adolescent pregnancy and micronutrient deficiencies are common. When consumed in sufficient amounts and at levels appropriate for the population, fortified foods may be a useful strategy for this group, but little is known about their effectiveness and timing (regarding menarche), particularly in resource-poor environments. We evaluated the effect of consuming multiple micronutrient-fortified biscuits (MMB), sold in the Ghanaian market, 5 d/week for 26 weeks compared with unfortified biscuits (UB) on the micronutrient status of female adolescents. We also explored to what extent the intervention effect varied before or after menarche. Ten2Twenty-Ghana was a 26-week double-blind, randomised controlled trial among adolescent girls aged 10-17 years (n 621) in the Mion District, Ghana. Biomarkers of micronutrient status included concentrations of Hb, plasma ferritin (PF), soluble transferrin receptor (TfR) and retinol-binding protein (RBP), including body-iron stores. Intention-to-treat analysis was supplemented by protocol-specific analysis. We found no effect of the intervention on PF, TfR and RBP. MMB consumption did not affect anaemia and micronutrient deficiencies at the population level. MMB consumption increased the prevalence of vitamin A deficiency by 6·2 % (95 % CI (0·7, 11·6)) among pre-menarche girls when adjusted for baseline micronutrient status, age and height-for-age Z-score, but it decreased the prevalence of deficient/low vitamin A status by -9·6 % (95 % CI (-18·9, -0·3)) among post-menarche girls. Consuming MMB available in the market did not increase iron status in our study, but reduced the prevalence of deficient/low vitamin A status in post-menarcheal girls.

Comparison of test performance of two commonly used multiplex assays to measure micronutrient and inflammatory markers in serum: results from a survey among pregnant women in South Africa.

The combined sandwich-ELISA (s-ELISA; VitMin Lab, Germany) and the Quansys Q-Plex™ Human Micronutrient Array (7-Plex) are multiplex serum assays that are used to assess population micronutrient status in low-income countries. We aimed to compare the agreement of five analytes, α-1-acid glycoprotein (AGP), C-reactive protein (CRP), ferritin, retinol-binding protein 4 (RBP4) and soluble transferrin receptor (sTfR) as measured by the 7-Plex and the s-ELISA. Serum samples were collected between March 2016 and December 2017. Pregnant women (n 249) were recruited at primary healthcare clinics in Johannesburg, and serum samples were collected between March 2016 and December 2017. Agreement between continuous measurements was assessed by Bland-Altman plots and concordance measures. Agreement in classifications of deficiency or inflammation was assessed by Cohen's kappa. Strong correlations (r > 0·80) were observed between the 7-Plex and s-ELISA for CRP and ferritin. Except for CRP, the 7-Plex assay gave consistently higher measurements than the s-ELISA. With the exception of CRP (Lin's ρ = 0·92), there was poor agreement between the two assays, with Lin's ρ < 0·90. Discrepancies of test results difference between methods increased as the serum concentrations rose. Cohen's kappa for all the five analytes was < 0·81 and ranged from slight agreement (vitamin A deficiency) to substantial (inflammation and Fe deficiency) agreement. The 7-Plex 1.0 is a research and or surveillance tool with potential for use in low-resource laboratories but cannot be used interchangeably with the s-ELISA. Further optimising and validation is required to establish its interchangeability with other validated methods.

Assessment of the Dutch Healthy Diet index 2015 in the Lifelines cohort study at baseline.

BACKGROUND: Dietary indices are useful measures to investigate associations between dietary intake and disease development. The Dutch Healthy Diet index 2015 (DHD2015-index), a measure of diet quality, assesses adherence to the 2015 Dutch dietary guidelines. We assessed the DHD2015-index in the Lifelines cohort study, and compared calculations from basic and detailed dietary intake data. This article replaces the retracted article that was published on 16 May 2022 [1]. METHODS: Dietary intake was assessed with a specially developed Food Frequency Questionnaire (FFQ) called Flower-FFQ, which consists of one main questionnaire (heart-FFQ), which asks for intakes of major food groups, and three complementary questionnaires (petal-FFQs), which ask for detailed information on food types within major food groups of the heart-FFQ. The DHD2015-index was assessed using data from the total Flower-FFQ (for 56,982 participants), and using data from the heart-FFQ only (for 129,030 participants). Agreement between the two indices was assessed with correlation and cross-classification. RESULTS: The median (25th-75th percentile) DHD2015-index score was 75 (65-85) for men and 81 (70-91) for women based on the Flower-FFQ, and 68 (58-77) for men and 73 (63-82) for women based on the heart-FFQ. The Kendall's tau-b correlation coefficient between the two scores was 0.67 for men and 0.66 for women. Cross-classification into quartiles of the DHD2015-index showed that 59-60% of participants were classified in the same quartile, 36-37% in the adjacent, and 4% in the non-adjacent. CONCLUSION: Dietary data from the Flower-FFQ provide the most optimal information to assess the DHD2015-index. However, the DHD2015-index from the heart-FFQ showed good agreement with the index from the Flower-FFQ of ranking participants according to diet quality, and can be used when the DHD2015 index from the Flower-FFQ is not available.

Macronutrient intake and alertness during night shifts - the time interval matters.

Background: Working night shifts is associated with higher safety risks due to shift work-related fatigue. Nutrition, especially certain (macro) nutrient compositions, has been suggested to reduce fatigue, however, results of studies are contradictory. This could be explained by differences in the time interval investigated between the consumption of a meal and measurement of cognitive performance. Therefore, this observational study investigated the association between macronutrient intake and objective alertness at different time intervals during the night shift in nurses. Methods: 128 nurses, aged 20-61 years, completed an alertness test (Psychomotor Vigilance Task) during the night shift and a 24-h dietary recall after the night shift. This was repeated three times, always on the first night shift in a night shift series. The associations between macronutrient intake 0 to 1, 1 to 2, and 2 to 3 h before the PVT with alertness during the night shift were analyzed through Linear Mixed Models. The basic model was adjusted for age and gender and the adjusted model additionally for BMI, start time of PVT and energy and caffeine intake during the relevant time interval. Results: Protein intake was not associated with objective alertness levels, while fat and carbohydrates intake had opposite associations with objective alertness levels over similar time intervals. Fat intake up to 1 h prior to the PVT was borderline associated with a longer median reaction time (RT) (ß = 9.00 ms/10 g fat, 95% CI: -0.21, 18.20), while a higher carbohydrate intake up to 1 h prior to the PVT was borderline associated with shorter median RTs (ß = -3.89, 95% CI: -7.85, 0.06). A higher fat intake 2 to 3 h prior to the PVT was associated with less lapses (log transformed ß = -0.16; 95% CI: -0.31, -0.02), while a higher carbohydrate intake 2 to 3 h prior to the PVT was associated with more lapses (ß = 0.06, 95% CI: 0.01, 0.12). Conclusion: Our results contribute to understanding the association between macronutrient intake, as part of a mixed meal, and alertness levels. Conflicting results from previous studies may probably be due to time differences between macronutrient intake and alertness testing.

#sleepingbaby on Instagram: Nonadherence of images to safe sleeping advice and implications for prevention of Sudden Unexpected Death in Infancy.

OBJECTIVES: Safe sleep of infants is important to reduce the risk of Sudden Unexpected Death in Infancy (SUDI). The depiction of infant care behavior which is inconsistent with the safe sleep recommendations on social media has an impact on parental infant care thoughts, norms and behaviors. This study aims to determine the adherence of Instagram images to the Dutch safe sleeping advice. DESIGN: A systematic social media analysis on Instagram was performed using 22 hashtags and 9 accounts of Dutch companies or platforms related to infants. Images of sleeping infants were analyzed on consistency with the criteria: supine sleeping position, own cot or crib, sleep sack, and an empty bed. RESULTS: Based on 514 collected images, 5.9% was consistent with sleep sack use, 16.8% with an empty bed, 30.7% with an own cot or crib, and 67.5% with the supine sleeping position. For 311 images (60.5%), all four criteria could be rated, as for the others, at least one criterion was not clearly depicted. Only 6 of these images (1.9%) were consistent with all four criteria. CONCLUSIONS: Although Instagram images are probably not representative of regular infant care behavior, the exposure to these images that are mostly inconsistent with the safe sleep advice can contribute to the formation of norms, and therefore influence parental care behavior. Accurate communication of the safe sleep recommendations through social media is needed, and opportunities are described for preventive health professionals to engage more in this communication with their public.