Consumption of sweet beverages and type 2 diabetes incidence in European adults: results from EPIC-InterAct.

AIMS/HYPOTHESIS: Consumption of sugar-sweetened beverages has been shown, largely in American populations, to increase type 2 diabetes incidence. We aimed to evaluate the association of consumption of sweet beverages (juices and nectars, sugar-sweetened soft drinks and artificially sweetened soft drinks) with type 2 diabetes incidence in European adults. METHODS: We established a case-cohort study including 12,403 incident type 2 diabetes cases and a stratified subcohort of 16,154 participants selected from eight European cohorts participating in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. After exclusions, the final sample size included 11,684 incident cases and a subcohort of 15,374 participants. Cox proportional hazards regression models (modified for the case-cohort design) and random-effects meta-analyses were used to estimate the association between sweet beverage consumption (obtained from validated dietary questionnaires) and type 2 diabetes incidence. RESULTS: In adjusted models, one 336 g (12 oz) daily increment in sugar-sweetened and artificially sweetened soft drink consumption was associated with HRs for type 2 diabetes of 1.22 (95% CI 1.09, 1.38) and 1.52 (95% CI 1.26, 1.83), respectively. After further adjustment for energy intake and BMI, the association of sugar-sweetened soft drinks with type 2 diabetes persisted (HR 1.18, 95% CI 1.06, 1.32), but the association of artificially sweetened soft drinks became statistically not significant (HR 1.11, 95% CI 0.95, 1.31). Juice and nectar consumption was not associated with type 2 diabetes incidence. CONCLUSIONS/INTERPRETATION: This study corroborates the association between increased incidence of type 2 diabetes and high consumption of sugar-sweetened soft drinks in European adults.

Evaluation of food and nutrient intake assessment using concentration biomarkers in European adolescents from the Healthy Lifestyle in Europe by Nutrition in Adolescence study.

Accurate food and nutrient intake assessment is essential for investigating diet-disease relationships. In the present study, food and nutrient intake assessment among European adolescents using 24 h recalls (mean of two recalls) and a FFQ (separately and the combination of both) were evaluated using concentration biomarkers. Biomarkers included were vitamin C, ß-carotene, DHA+EPA, vitamin B12 (cobalamin and holo-transcobalamin) and folate (erythrocyte folate and plasma folate). For the evaluation of the food intake assessment 390 adolescents were included, while 697 were included for the nutrient intake assessment evaluation. Spearman rank and Pearson correlations, and validity coefficients, which are correlations between intake estimated and habitual true intake, were calculated. Correlations were higher between frequency of food consumption (from the FFQ) and concentration biomarkers than between mean food intake (from the recalls) and concentration biomarkers, especially for DHA+EPA (r 0·35 v. r 0·27). Most correlations were higher among girls than boys. For boys, the highest validity coefficients were found for frequency of fruit consumption (0·88) and for DHA+EPA biomarker (0·71). In girls, the highest validity coefficients were found for fruit consumption frequency (0·76), vegetable consumption frequency (0·74), mean fruit intake (0·90) and DHA+EPA biomarker (0·69). After exclusion of underreporters, correlations slightly improved. Correlations between usual food intakes, adjusted for food consumption frequency, and concentration biomarkers were higher than correlations between mean food intakes and concentration biomarkers. In conclusion, two non-consecutive 24 h recalls in combination with a FFQ seem to be appropriate to rank subjects according to their usual food intake.

Review and evaluation of innovative technologies for measuring diet in nutritional epidemiology.

INTRODUCTION: The use of innovative technologies is deemed to improve dietary assessment in various research settings. However, their relative merits in nutritional epidemiological studies, which require accurate quantitative estimates of the usual intake at individual level, still need to be evaluated. OBJECTIVE: To report on the inventory of available innovative technologies for dietary assessment and to critically evaluate their strengths and weaknesses as compared with the conventional methodologies (i.e. Food Frequency Questionnaires, food records, 24-hour dietary recalls) used in epidemiological studies. METHODS: A list of currently available technologies was identified from English-language journals, using PubMed and Web of Science. The search criteria were principally based on the date of publication (between 1995 and 2011) and pre-defined search keywords. RESULTS: Six main groups of innovative technologies were identified ('Personal Digital Assistant-', 'Mobile-phone-', 'Interactive computer-', 'Web-', 'Camera- and tape-recorder-' and 'Scan- and sensor-based' technologies). Compared with the conventional food records, Personal Digital Assistant and mobile phone devices seem to improve the recording through the possibility for 'real-time' recording at eating events, but their validity to estimate individual dietary intakes was low to moderate. In 24-hour dietary recalls, there is still limited knowledge regarding the accuracy of fully automated approaches; and methodological problems, such as the inaccuracy in self-reported portion sizes might be more critical than in interview-based applications. In contrast, measurement errors in innovative web-based and in conventional paper-based Food Frequency Questionnaires are most likely similar, suggesting that the underlying methodology is unchanged by the technology. CONCLUSIONS: Most of the new technologies in dietary assessment were seen to have overlapping methodological features with the conventional methods predominantly used for nutritional epidemiology. Their main potential to enhance dietary assessment is through more cost- and time-effective, less laborious ways of data collection and higher subject acceptance, though their integration in epidemiological studies would need additional considerations, such as the study objectives, the target population and the financial resources available. However, even in innovative technologies, the inherent individual bias related to self-reported dietary intake will not be resolved. More research is therefore crucial to investigate the validity of innovative dietary assessment technologies.

Inventory of experiences from national/regional dietary monitoring surveys using EPIC-Soft.

BACKGROUND/OBJECTIVES: The EPIC-Soft 24-h recall (the software developed to conduct 24-h dietary recalls (24-HDRs) in the European Prospective Investigation into Cancer and Nutrition (EPIC) Study) has been used in several regional/national dietary monitoring surveys. The main objective of the study was to present and discuss design, settings, logistics, data management and quality controls of dietary monitoring surveys that used EPIC-Soft for the collection of food consumption data. SUBJECTS/METHODS: Within European Food Consumption Validation (EFCOVAL), a questionnaire including questions on current/past EPIC-Soft experiences and requirements for the future was developed and sent to all institutes that used EPIC-Soft in their food consumption survey(s) (five surveys in four different countries). RESULTS: EPIC-Soft was used in the national food consumption survey in Belgium (≥ 15-97 years), Germany (14-80 years), the Netherlands (19-30 years and 2-6 years) and Spain (regional only; 4-18 years). Participation rates in these surveys were 46% (Belgium), 42% (Germany), 42% (Dutch survey in adults), 79% (Dutch survey in children) and 77% (Basque survey). Two 24-HDRs were collected by conducting face-to-face interviews in Belgium and Spain, and through telephone interviews in Germany and the Netherlands. Except the Netherlands (19-30 years), where the study was conducted only in autumn, in all other countries the study was conducted throughout the four seasons, including all days of the week. Interviews were conducted by dietitians, except in Germany and Spain. Mean EPIC-Soft interview time was 20-34 min. The dropout rate between the first and second interviews was low (<7.5%) in all surveys. CONCLUSION: EPIC-Soft has been used in different study settings and populations for nutritional exposure assessments. To guarantee the comparability of data across countries, recommendations for the design of future pan-European dietary monitoring surveys using EPIC-Soft should be drawn.

Respondents' evaluation of the 24-h dietary recall method (EPIC-Soft) in the EFCOVAL Project.

BACKGROUND: To improve participation rate, accuracy and respondents' compliance, it is important to know the respondents' viewpoint. OBJECTIVE: To evaluate respondents' preferences and perception about the EPIC-Soft (the software developed to conduct 24-h dietary recalls (24-HDRs) in the European Prospective Investigation into Cancer and Nutrition (EPIC) Study) 24-HDR interviews and to compare these preferences and perception between population groups (for example, between genders). DESIGN: Data were collected in Belgium, Czech Republic, France, the Netherlands and Norway in 2007. Two 24-HDRs (face-to-face and telephone administered) were conducted using EPIC-Soft. An evaluation questionnaire on different study aspects was completed by the respondents. SETTING: Data were collected in the European Food Consumption Validation Study. SUBJECTS: A convenience sample of 600 apparently healthy men and women, 45-65 years old and including all educational levels, were recruited (120 subjects per country). Differences among population groups were compared by means of the χ (2)-test. RESULTS: A total of 585 respondents completed the evaluation questionnaire. In all, 88% experienced problems only to a low degree when answering face-to-face and telephone-administered 24-HDR using EPIC-Soft. A total of 15% would have preferred help of another person during the face-to-face interview in the study center (mainly men: P < 0.001). Significantly, more subjects in the Netherlands and in Norway preferred two telephone (instead of face-to-face) interviews compared with the other countries (P<0.001). CONCLUSION: Most subjects only experienced problems to a low degree during the EPIC-Soft interviews. Differences in preferences and capabilities to answer the EPIC-Soft interviews were identified between population groups (for example, gender differences). Therefore, the methods and the design to be used in a survey should be adapted according to the study population, so as to optimize response rate and compliance.

Biomarker-based evaluation of two 24-h recalls for comparing usual fish, fruit and vegetable intakes across European centers in the EFCOVAL Study.

BACKGROUND/OBJECTIVES: A standardized methodology is important to enable consistent monitoring of dietary intake across European countries. For this reason, we evaluated the comparability of the assessment of usual food intake collected with two non-consecutive computerized 24-h dietary recalls (24-HDRs) and a food propensity questionnaire (FPQ) among five European centers. SUBJECTS/METHODS: Two 24-HDRs using EPIC-Soft (the software developed to conduct 24-HDRs in the European Prospective Investigation into Cancer and Nutrition (EPIC) Study) were performed to determine fish, fruit and vegetable (FV) consumed by 600 adults in Belgium (BE), the Czech Republic (CZ), France (FR), the Netherlands (NL) and Norway (NO) in a validation study. An FPQ was used to identify non-consumers. Information from the 24-HDRs and FPQ were used to estimate individual usual food intake by the Multiple Source Method (MSM). Blood samples were drawn to determine fatty acids in phospholipids and serum carotenoids as biomarkers of fish, and FV intake, respectively. RESULTS: The pooled correlation between usual fish intake and eicosapentaenoic acid plus docosahexaenoic acid in phospholipids was 0.19 in men and 0.31 in women (P for heterogeneity >0.50) and center-specific correlations ranged between 0.08 (CZ) and 0.28 (BE and NO) in men, and between 0.19 (BE) and 0.55 (FR) in women. For usual FV intake, the pooled correlation with serum carotenoids was 0.31 in men and 0.40 in women (P for heterogeneity >0.10); the center-specific correlations varied between 0.07 (NO) and 0.52 (FR) in men, and between 0.25 (NL) and 0.45 (NO) in women. CONCLUSION: Two standardized 24-HDRs using EPIC-Soft and an FPQ appeared to be appropriate to rank individuals according to their fish and FV intake in a comparable way among five European centers.

Dietary exposure to flavouring substances: from screening methods to detailed assessments using food consumption data collected with EPIC-Soft software.

This study aimed to compare different methods of assessing dietary exposure to flavourings in the context of a stepwise approach. The dietary exposure to four flavourings--raspberry ketone, glycyrrhizinic acid, coumarin, and caffeine--was determined. When dietary exposure exceeded the safety limits, the need for more detailed assessment using less aggregated data was judged necessary. First, screening methods--maximized survey-derived daily intake (MSDI), single-portion exposure technique (SPET), and modified theoretical added maximum daily intake (mTAMDI)--were applied. Next, individual food consumption data were used for creating models with different levels of detail to identify the foods: a model based on food groups and models based on food items. These were collected from 121 Dutch adults using a standardized 2 x 24-h dietary recall (EPIC-Soft) in the European Food Consumption Validation (EFCOVAL) study. Three food item models were developed: without improvements of the flavouring descriptor built in the software; with improvements; and with use of non-specified flavour descriptors. Based on the results of at least one of the three screening methods, refined assessment was necessary for raspberry ketone, glycyrrhizinic acid, and caffeine. When applying the food group model, the need for refinement was indicated for the four flavourings. When applying the food item models, only glycyrrhizinic acid and caffeine presented dietary exposure above the safety limits. In the raspberry ketone case, dietary exposure increased when improvements in food description were considered. The use of non-specified flavour descriptors hardly changed the results. The collection of detailed food consumption data at the individual level is useful in the dietary exposure assessment of these flavourings.

The influence of education in the validation process of a food frequency questionnaire for adults in Viçosa, Minas Gerais, Brazil.

OBJECTIVE: To evaluate the educational influence in the relative validation of a semiquantitative food frequency questionnaire (FFQs) for adults in the city of Viçosa, Brazil. DESIGN AND SUBJECTS: Four 24-h dietary recalls (reference method) were applied to a sample of 94 adults of both genders, at intervals of 1 month. At the end of the study, an FFQs consisting of 58 food items was also applied. Then, the individuals were divided into two main groups according to their educational level (lower and higher). The dietary data were calculated by the Diet Pro 4.0 software and analyzed according to differences of means or medians and Pearson's correlation coefficients. These coefficients were adjusted by the energy and corrected by the within-person variance for each educational group, considering the extreme quartiles of the data distribution. RESULTS: The intake of energy and nutrients, based on the 24 h dietary recalls, was inferior for the lower educational group (P < 0.05). For the FFQs, just the protein and calcium intakes were statistically different, suggesting interference of the education variable in this assessment. Over estimations in the FFQs were identified in the analyses of means and medians for vitamin C and retinol intakes in the lower education group and for retinol in the higher education one. However, when evaluated by correlation coefficients non-adjusted and adjusted, they were well correlated. On the other hand, lipid (r = 0.34) and calcium (r = 0.13) coefficients of the group with less instruction showed beneath the desirable values, suggesting weak consistence of the estimates provided by the FFQs for these nutrients. Correlation means of r = 0.65 and 0.54 were found for the higher and lower educational groups, respectively. CONCLUSIONS: The results indicate that FFQs showed acceptable performance on evaluating the habitual food consumption for most of the nutrients in the studied population. A tendency for better quantifications in the groups with higher education was observed, inferring its influence in the assessment of the dietary intake.