Development and validation of a food frequency questionnaire for assessing nutrient intake during childhood in Jordan / Desarrollo y validación de un cuestionario de frecuencia alimentaria para evaluar la ingesta de nutrientes durante la infancia en Jordania

INTRODUCTION: assessing the relationship between childhood diseases and nutrient intake is a crucial issue that requires valid and reliable dietary assessment tools in this period of physical and physiological development. OBJECTIVE: the present study aimed to develop and validate a food frequency questionnaire (FFQ) to assess nutrient intake in Jordanian children. METHODS: in this validation study, nutrient intake as obtained from a culturally sensitive quantitative FFQ was compared to nutrient intake as assessed by four 24-hour dietary recalls (24-HRs) between September 2017 and May 2018. One hundred and thirty-six children aged 6-18 years were enrolled from selected schools in Amman, Jordan. Children or their caregivers were asked to complete the FFQ during an initial face-to-face interview. Four 24-HRs were collected weekly over one month. Of these children, 50 also took part in the reproducibility phase, which involved a repeat completion of the FFQ within 1 month. RESULTS: the intraclass correlation coefficients between the two FFQs ranged from 0.5 for trans-fats to 0.96 for calcium. Correlation coefficients between dietary intake estimates derived from the FFQ and 24-HRs were significant at p < 0.05. The highest correlation was detected for energy (0.8) while the lowest was identified for trans-fatty acids (0.04). For all nutrients, over 60 % of participants were classified into the same or adjacent quartile of crude and adjusted intake. Bland-Altman plots showed a satisfactory agreement between the two methods for energy and proteins. CONCLUSION: the FFQ showed a good reproducibility and a reasonable relative validity for most nutrients

INTRODUCCIÓN: evaluar la relación entre las enfermedades infantiles y la ingesta de nutrientes es un tema crucial que requiere herramientas de evaluación dietética válidas y confiables en este período de desarrollo físico y fisiológico. OBJETIVO: el presente estudio tuvo como objetivo desarrollar y validar un cuestionario de frecuencia de alimentos (FFQ) para evaluar la ingesta de nutrientes de los niños jordanos. MÉTODOS: en este estudio de validación, la ingesta de nutrientes de un FFQ cuantitativo culturalmente sensible se comparó con la ingesta de nutrientes de cuatro recordatorios dietéticos de 24 horas (24-HR) entre septiembre de 2017 y mayo de 2018. Se reclutaron ciento treinta y seis niños y adolescentes de 6 a 18 años en escuelas seleccionadas de Amán, Jordania. Se pidió a los niños o sus cuidadores que completaran el FFQ en una entrevista inicial presencial. Se recogieron cuatro 24-HR semanalmente durante un mes. De estos niños, 50 también participaron en la fase de reproducibilidad, que involucró la repetición del FFQ en un plazo de 1 mes. RESULTADOS: los coeficientes de correlación intraclase entre los dos FFQ oscilaron entre 0,5 para las grasas trans y 0,96 para el calcio. Los coeficientes de correlación entre las estimaciones de la ingesta alimentaria derivadas del FFQ y los 24-HR fueron significativas, con un valor p < 0,05. La correlación más alta se detectó para la energía (0,8) mientras que la más baja fue para los ácidos grasos trans (0,04). Para todos los nutrientes, más del 60 % de los participantes se clasificaron en el mismo cuartil o el adyacente de ingesta cruda y ajustada. Las gráficas de Bland-Altman mostraron un acuerdo satisfactorio entre los dos métodos en términos de energía y proteínas. CONCLUSIÓN: el FFQ mostró una buena reproducibilidad y una validez relativa razonable para la mayoría de los nutrientes

Food Group Intake of Pregnant Jordanian Women Based on the Three Pregnancy Trimesters.

Inadequate diets have adverse effects on maternal, fetal, and, possibly, childhood health. This cross-sectional study aimed to examine daily food group intake of pregnant Jordanian women during the three pregnancy trimesters and to compare these to the recommended servings of the five food groups reported by The United States Department of Agriculture and My Plate Plan. A total of 283 pregnant Jordanian women were recruited during their antenatal visits. Data were obtained by interviewer-administered structured questionnaires. Our results showed that 1.1% of participants consumed the recommended number of servings for all five food groups during pregnancy and 10.2% did not consume the minimum number of servings of the five food groups. Nearly half of the participants in the first trimester met the recommended daily servings for three food groups but only approximately two-third of participants met the minimum recommended daily servings for one or two food groups in the second and third trimesters. Consumption of grains and sweets was significantly higher in the third trimester compared with the first and second trimesters. Overall, the majority of pregnant Jordanian women in this study did not consume the recommended number of servings for all five food groups during pregnancy.

Adequacy of Nutrients Intake among Jordanian Pregnant Women in Comparison to Dietary Reference Intakes.

OBJECTIVE: Maternal nutrition is considered an important pillar in the pregnancy outcomes for both mother and infant. A mother's malnutrition and inadequate nutrient intake is associated with many undesirable pregnancy outcomes. Hence, assessing the nutritional status of the mother in the early stages of the pregnancy and preventing any inadequacy can preclude many health problems for both mother and infant. Therefore, this study aimed to assess the adequacy of nutrient intakes among Jordanian pregnant women as compared to their corresponding dietary reference intakes (DRIs). METHODS: This cross-sectional study was conducted at a major University Hospital in Jordan. Three hundred pregnant women were invited to participate in the study and 286 agreed to participate. Fifty pregnant women were enrolled at week 9, then 96 pregnant women were at week 20 and 137 pregnant women were at week 30 of pregnancy. The participants completed the interview-based demographic questionnaire, pregnancy physical activity questionnaire, and quantitative food frequency questionnaire (FFQ). RESULTS: The mean energy intake was 2768.9 ± 767.8 kcal/day and it was significantly higher in the 3rd trimester (p < 0.05). Women in the 3rd trimester consumed significantly more protein, carbohydrates, and sugar than women in the 1st and 2nd trimesters (p < 0.05). The pregnant women in the 3rd trimester consumed more sodium than women in the 1st and 2nd trimesters (p < 0.05). The vitamin K intake was significantly (p = 0.045) lower in the 2nd trimester than the 1st and 3rd trimesters. The calcium intake was significantly higher in the 3rd trimester than the 1st and 2nd trimesters (p = 0.021). The total micronutrient (vitamins B1, B2, B3, B6, B12, and D, calcium, and iron) intakes derived from dietary supplements and food sources throughout the 3 trimesters was significantly higher in the 3rd trimester than the 1st and 2nd trimesters (p < 0.05). The vitamin D, calcium, and iron intakes had the most significant increases between the 1st and 3rd trimesters (p < 0.001), while folic acid intake was significantly higher in the 1st trimester than the 2nd and 3rd trimester (p < 0.001). Most women exceeded the tolerable upper intake level (UL) for sodium in all trimesters, while 82% of women exceeded the UL of folic acid in the 1st trimester and from the supplement, not the diet. CONCLUSION: While the intake of some nutrients from food alone remains below the DRIs in the diets of pregnant women, the intake of other nutrients is above the UL. Raising the awareness of pregnant women about their diet and how a supplement intake can reduce the risk of inadequate intake for many micronutrients and improve their pregnancy outcomes is of great importance.

Dietary and exercise interventions and glycemic control and maternal and newborn outcomes in women diagnosed with gestational diabetes: Systematic review.

Gestational diabetes mellitus (GDM) is one of the most common complication of pregnancy and can lead to significant perinatal mortalities as well as long term risk of comorbidities for both mother and her offspring. This systematic review aimed to explore whether combined diet and exercise interventions are associated with improved glycemic control and/or improved maternal and newborn outcomes in women with GDM when compared to dietary interventions. A search on combined diet and exercise interventions during pregnancy in women with GDM was performed in 3 electronic databases: PubMed (NCBI), ScienceDierct, and the Cochrane Library. Evaluated outcomes were fasting blood glucose levels, postprandial blood glucose levels, glycated hemoglobin percentages, total weight gain during pregnancy, proportion of caesarean delivery, proportion of patients needing insulin, neonatal birth weight, proportion of macrosomia, neonatal hypoglycemia, and preterm birth. This systematic review identified eight randomized, controlled trials involving 592 pregnant women and 350 infants. The risk of bias of the included trials ranged from high to low. The combined diet and exercise interventions reduced fasting and postprandial blood glucose levels when compared to dietary interventions. No significant differences were reported in the selected trials regarding total weight gain during pregnancy, cesarean section, neonatal birth weight, macrosomia, neonatal hypoglycemia, and preterm birth between diet plus exercise and diet groups. The combination of diet and exercise interventions help to control postprandial blood glucose concentration in women diagnosed with GDM, but did not change either maternal or newborn outcomes. REGISTRATION: PROSPERO CRD42018109896.

Subcutaneous and visceral fat volumes measured by MRI and their relationships with nutrient intakes among adults.

BACKGROUND AND OBJECTIVES: Types and amounts of nutrients may influence the volume of subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT). This study targeted to investigate the relationship between SAT and VAT volumes and macro- and micronutrients intake among adults. METHODS AND STUDY DESIGN: Data were collected via a private face-to-face interview, in which diet history was obtained using validated quantitative food frequency questionnaire. The different fat volumes were assessed using magnetic resonance imaging (MRI) scanning. RESULTS: Participants with the lowest VAT volume had the highest intake of saturated fats, monounsaturated fatty acids and omega-3 and omega-6 fatty acids (p<0.05). VAT volume was significantly associated with the highest level of total energy and energy from carbohydrate consumption among participants while significantly associated with the lowest energy intake from fat among participants (p=0.013). There was a significant relationship with the highest consumption of total carbohydrate, soluble fiber, and insoluble fiber and VAT volume (p<0.05). Participants in the highest VAT volume had significantly the highest intake of vitamin A, ß- carotene, and copper. CONCLUSIONS: This study underscores the importance of quantifying depot-specific body fat and highlights the unique responsiveness of various fat depots to dietary intake.

Dietary inflammatory index and odds of coronary artery disease in a case-control study from Jordan.

OBJECTIVE: The aim of this study was to examine the association between inflammatory potential diet as determined by dietary inflammatory index (DII) scores and coronary artery disease (CAD) in a population-based, case-control study of middle-aged Jordanian adults. METHODS: In the present study, 388 patients who were referred for elective coronary angiography at Prince Hamza Hospital, Amman, were enrolled. Of these, 198 were confirmed CAD cases and 190 were CAD-free control participants. DII scores were computed from dietary intake assessed by a food frequency questionnaire. Logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: CAD cases had significantly higher DII scores, higher body mass index (BMI), higher prevalence of diabetes, lower educational attainment, and lower physical activity than the CAD-free controls. A statistically significant higher risk for CAD was observed in those with DII scores in the highest tertile than in those in the lowest (ORtertile3vs1, 2.10; 95% CI, 1.18-3.66), after adjusting for cardiovascular risk factors. A positive association was found between higher DII and CAD risk when DII score was used as a continuous variable (ORcontinuous, 1.13 per unit increase in DII corresponding to ∼11% of its range in the current study; 95% CI, 1.00-1.32). CONCLUSIONS: The present findings, obtained in this ordanian population, add to the growing literature indicating that a proinflammatory diet is associated with higher risk for developing CAD.

Relative Validity and Reproducibility of a Food Frequency Questionnaire to Assess Food Group Intake in Pregnant Jordanian Women.

BACKGROUND: Research on the relationship between maternal diet and pregnancy outcomes requires valid dietary assessment tools in pregnancy. OBJECTIVE: This study aimed to develop and examine the relative validity and reproducibility of a quantitative food frequency questionnaire (FFQ) to estimate food group intake in a sample of pregnant Jordanian women. DESIGN: In this validation study, food group intake from a culturally sensitive quantitative FFQ was compared with food group intake from three 24-hour dietary recalls. PARTICIPANTS AND SETTING: The validation study was conducted from 2015 to 2017 at the maternity clinics in Jordan University Hospital among 131 healthy singleton pregnant Jordanian women. Of these women, 30 also took part in the reproducibility phase, which involved repeated completion of the FFQ in a time frame of 1 month. Pregnant women who had gestational diabetes, preeclampsia, and chronic diseases were excluded. MAIN OUTCOME MEASURES: Relative validity and reproducibility of a 117-item quantitative FFQ used to estimate usual food intake over a period of 1 month. STATISTICAL ANALYSES PERFORMED: Intraclass correlation coefficients and weighted κ statistics were calculated to test the reproducibility between the two administrations of the FFQ. Pearson correlations were estimated to validate the FFQ against 24-hour dietary recalls. Cross-classification and Bland-Altman plots were used to examine the agreement between the two dietary assessment methods. RESULTS: The intraclass correlation coefficients between the two FFQs ranged from 0.24 for legumes to 0.93 for processed meats. A moderate level of agreement was observed between two FFQs. De-attenuated and energy-adjusted correlations ranged from 0.08 for sweets and sugar to 0.93 for sugary drinks. On average, 50.9% and 45.2% of participants were classified by the FFQ and the 24-hour dietary recalls into the same quartile based on their crude and energy-adjusted food group intake, respectively. Bland-Altman plots showed satisfactory agreement between two methods for most food groups. CONCLUSIONS: The FFQ showed moderate reproducibility and good relative validity for most food groups.

Relationship of serum leptin with some biochemical, anthropometric parameters and abdominal fat volumes as measured by magnetic resonance imaging.

AIMS: To measure the level of leptin in volunteers and correlate it with several anthropometric, biochemical variables and abdominal fat volumes. METHODS: The level of leptin was investigated in 167 disease-free volunteers. Serum levels of IL-6, adiponectin, and resistin, blood lipid profile (cholesterol, low-density lipoprotein (LDL), high-density lipoprotein (HDL), and triglyceride (TG) were determined. Waist circumference (WC) was measured using tape and magnetic resonance imaging (MRI) images. RESULTS: All measured anthropometric (BMI, WC measured by tape and MRI) and biochemical variables (adiponectin, resistin, cholesterol, HDL, LDL and TG); and abdominal fats showed a significant (p<0.05) difference between participants with abnormal serum leptin levels and those with normal leptin levels. A higher percentage of participants with abnormal serum leptin were obese males while participants with normal leptin levels were either overweight or normal weight females. A significant (p <0.05) positive correlation was detected between serum leptin concentration and WC, BMI, subcutaneous fat, visceral fat, total abdominal fat, and resistin. A moderate association was found between serum leptin concentration and the inflammatory cytokine IL-6. CONCLUSION: Abnormal serum leptin, was detected in obese male individuals which may be considered as an important indicator for the development of cardiovascular diseases and type 2 diabetes.

Fast foods perception among adolescents by gender and weight status.

BACKGROUND: Fast food restaurants have become widespread in both developed and developing countries due to nutritional and economic transitions. The frequency of fast food intake is relatively high among adolescents; however, fast food consumption is positively associated with total energy intake and obesity in adolescents. OBJECTIVE: This study aimed to examine the perception of Jordanian adolescents towards fast foods relative to gender and obesity. METHODS: A cross-sectional survey was conducted on 400 boys and 395 girls, aged 15-18 years. The adolescents completed a validated questionnaire to measure the perception of adolescents towards fast foods during the year 2013-2014. Weight and height were measured. Numbers who were non-overweight, overweight, and obese were calculated for each age and sex using the International Obesity Task Force (IOTF) standard. RESULTS: The majority of participants perceived foods which are eaten as sandwiches as fast foods. A significant difference between boy and girl adolescents was reported regarding perception of French fries ( p < 0.012), fried chicken ( p < 0.001), fattayer ( p < 0.001), foul (boiled broad beans) sandwich ( p < 0.001), falafel sandwich ( p < 0.044) and fried eggs sandwich ( p < 0.001) as fast foods. Girls were significantly more enthusiastic than boys to consider cuscusi plate ( p < 0.001), rice dishes ( p < 0.002), Chinese foods ( p < 0.001), Indian foods ( p < 0.010), Mexican foods ( p < 0.011), and Italian foods ( p < 0.004) as non-fast foods. The difference between obese and non-obese regarding the perception of fast foods was only significant among boy participants. Western or non-Arab foods, food prepared fast and eaten fast in self-service outlets, and food rich in calories were significantly perceived as fast food by Jordanian adolescents ( p < 0.05). CONCLUSIONS: The perception of foods as fast foods or non-fast foods was significantly different between both genders as well as in obese and non-obese male Jordanian adolescents.