Characterization of adults concerning the use of a hypothetical mHealth application addressing stress-overeating: an online survey.

BACKGROUND: About 40% of people respond to stress by consuming more unhealthy foods. This behavior is associated with increased energy intake and the risk of obesity. As mobile health (mHealth) applications (apps) have been shown to be an easy-to-use intervention tool, the characterization of potential app users is necessary to develop target group-specific apps and to increase adherence rates. METHODS: This cross-sectional online survey was conducted in the spring of 2021 in Germany. Sociodemographic data and data on personality (Big Five Inventory, BFI-10), stress-eating (Salzburg Stress Eating Scale, SSES), and technology behavior (Personal Innovativeness in the Domain of Information Technology, PIIT; Technology Acceptance Model 3, TAM 3) were collected. RESULTS: The analysis included 1228 participants (80.6% female, mean age: 31.4 ± 12.8 years, mean body mass index (BMI): 23.4 ± 4.3 kg/m2). Based on the TAM score, 33.3% (409/1228) of the participants had a high intention to use a hypothetical mHealth app to avoid stress-overeating. These persons are characterized by a higher BMI (24.02 ± 4.47 kg/m2, p < 0.001), by being stress-overeaters (217/409, 53.1%), by the personality trait "neuroticism" (p < 0.001), by having specific eating reasons (all p < 0.01), and by showing a higher willingness to adopt new technologies (p < 0.001). CONCLUSION: This study suggests that individuals who are prone to stress-overeating are highly interested in adopting an mHealth app as support. Participants with a high intention to use an mHealth app seem to have a general affinity towards new technology (PIIT) and appear to be more insecure with conflicting motives regarding their diet. TRIAL REGISTRATION: This survey was registered in the German Clinical Trials Register (Registration number: DRKS00023984).

Optimization of a Food List for Food Frequency Questionnaires Using Mixed Integer Linear Programming: A Proof of Concept Based on Data from the Second German National Nutrition Survey.

Food Frequency Questionnaires (FFQs) are important instruments to assess dietary intake in large epidemiological studies. To determine dietary intake correctly, food lists need to be adapted depending on the study aim and the target population. The present work compiles food lists for an FFQ with Mixed Integer Linear Programming (MILP) to minimize the number of foods in the food list. The optimized food lists were compared with the validated eNutri FFQ. The constraints of the MILP aimed to identify food items with a high nutrient coverage in a population and with a high interindividual variability. The optimization was based on data from the second German National Nutrition Survey. The resulting food lists were shorter than the one used in the validated eNutri FFQ.

Perspective: A Conceptual Framework for Adaptive Personalized Nutrition Advice Systems (APNASs).

Nearly all approaches to personalized nutrition (PN) use information such as the gene variants of individuals to deliver advice that is more beneficial than a generic "1-size-fits-all" recommendation. Despite great enthusiasm and the increased availability of commercial services, thus far, scientific studies have only revealed small to negligible effects on the efficacy and effectiveness of personalized dietary recommendations, even when using genetic or other individual information. In addition, from a public health perspective, scholars are critical of PN because it primarily targets socially privileged groups rather than the general population, thereby potentially widening health inequality. Therefore, in this perspective, we propose to extend current PN approaches by creating adaptive personalized nutrition advice systems (APNASs) that are tailored to the type and timing of personalized advice for individual needs, capacities, and receptivity in real-life food environments. These systems encompass a broadening of current PN goals (i.e., what should be achieved) to incorporate "individual goal preferences" beyond currently advocated biomedical targets (e.g., making sustainable food choices). Moreover, they cover the "personalization processes of behavior change" by providing in situ, "just-in-time" information in real-life environments (how and when to change), which accounts for individual capacities and constraints (e.g., economic resources). Finally, they are concerned with a "participatory dialog between individuals and experts" (e.g., actual or virtual dieticians, nutritionists, and advisors) when setting goals and deriving measures of adaption. Within this framework, emerging digital nutrition ecosystems enable continuous, real-time monitoring, advice, and support in food environments from exposure to consumption. We present this vision of a novel PN framework along with scenarios and arguments that describe its potential to efficiently address individual and population needs and target groups that would benefit most from its implementation.

The Assessment of a Personalized Nutrition Tool (eNutri) in Germany: Pilot Study on Usability Metrics and Users' Experiences.

BACKGROUND: To address the epidemic burden of diet-related diseases, adequate dietary intake assessments are needed to determine the actual nutrition intake of a population. In this context, the eNutri web app has been developed, providing online automated personalized dietary advice, based on nutritional information recorded via an integrated and validated food frequency questionnaire (FFQ). Originally developed for a British population and their dietary habits, the eNutri tool has specifically been adapted to the German population, taking into account national eating habits and dietary recommendations. OBJECTIVE: The primary aim of this study is to evaluate the system usability and users' experience and feedback on the eNutri app in a small-scale preliminary study. The secondary aim is to investigate the efficacy of personalized nutrition (PN) recommendations versus general dietary advice in altering eating habits. METHODS: The app was piloted for 4 weeks by 106 participants from across Germany divided into a PN group and a control group. The groups differed according to the degree of personalization of dietary recommendations obtained. RESULTS: An overall System Usability Scale (SUS) score of 78.4 (SD 12.2) was yielded, indicating an above average user experience. Mean completion time of the FFQ was 26.7 minutes (SD 10.6 minutes). Across subgroups (age, sex, device screen sizes) no differences in SUS or completion time were found, indicating an equal performance for all users independent of the assigned experimental group. Participants' feedback highlighted the need for more personalized dietary advice for controls, while personalized nutritional recommendations improved the awareness of healthy eating behavior. Further improvements to the eNutri app were suggested by the app users. CONCLUSIONS: In total, the eNutri app has proven to be a suitable instrument to capture the dietary habits of a German population sample. Regarding functionality, system usability, and handling, direct user feedback was quite positive. Nutritional advice given was rated ambivalent, pointing to several weaknesses in the eNutri app, minimizing the system's full potential. A higher level of personalization within nutritional advice subjectively improved the app's usability. The insights gained will be used as a basis to further develop and improve this digital diet assessment tool.

Stress eating: an online survey of eating behaviours, comfort foods, and healthy food substitutes in German adults.

BACKGROUND: In many people, stress is associated with changes in eating behaviour. Food products consumed during stress (comfort foods) are often unhealthy. It is rather unknown what comfort foods are consumed in Germany and what healthier food products are considered as alternatives to support stress-eaters in making healthier food choices. METHODS: This online survey was conducted in spring 2021 throughout Germany. Participants were digitally recruited by newsletters, homepages, social media, and mailing lists. The survey included a standardized questionnaire with items concerning e.g. sociodemography, stress, and nutrition. Comfort foods were pre-selected through literature search and food substitutes were defined and discussed by experts. Analyses examined comfort food consumption and substitute preferences dependent on sex, age, body mass index (BMI), and being a self-identified stress-eater. The statistical analysis was performed using R. RESULTS: Survey participants were mostly female (80.6%, 994/1234), had a mean age of 31.4 ± 12.8 years and a mean BMI of 23.4 ± 4.3 kg/m2. Participants stated, that the two favourite comfort foods were chocolate (consumed often/very often by 48.3%, 596/1234) and coffee (consumed often/very often by 45.9%, 566/1234). Regarding food substitutes, the most frequently named alternative food for chocolate and cookies was fresh fruits (for chocolate: 74.4%, 815/1096, for cookies: 62.6%, 565/902). Tea without added sugar (64.4%, 541/840) was the preferred substitute for coffee. Almost 50% of participants (48.1%, 594/1234) identified themselves as stress-eaters, of which 68.9% (408/592) stated to eat (very) often more than usual in subjective stress situations. CONCLUSIONS: The results from this work suggest that specific comfort foods and substitutes are preferred by the participants in stressful situations. This knowledge about food choices and substitutes should be investigated in further studies to improve eating behaviour in stressful situations. TRIAL REGISTRATION: The survey was registered in the German Register of Clinical Studies (Registration number: DRKS00023984 ).

Stress-induced hyperphagia: empirical characterization of stress-overeaters.

BACKGROUND: Stressful situations can have an impact on an individual's eating behavior. People vulnerable to the influence of stress tend to change the quantity and quality of their food intake. Variables such as sex and body mass index (BMI) seem to be related to this stress-eating behavior, but it is rather unclear what factors account to the parameters associated with stress-eating behavior. The aim of this survey was to identify further characteristics of adults in Germany related to stress-overeating, focusing on stress perception, coping, eating motives and comfort foods as well as personality types. METHODS: This online survey was performed throughout Germany and comprised a 38-item pre-tested questionnaire. Stress-induced overeating was classified based on the Salzburg Stress Eating Scale (SSES). Moreover, validated questionnaires were used to identify additional characteristics of stress eaters. Participants were recruited using a convenience sampling approach, and data were collected between January and April 2021. RESULTS: The overall sample consisted of 1222 participants (female 80.8%, aged 31.5±12.8). 42.1% of participants were identified as stress-overeaters. Among the remaining group, 78.9% stated to eat less, 21.1% to eat equally when stressed. Female participants had a higher mean SSES score compared to male participants. The BMI was positively correlated to SSES, r(1220)=0.28, p>0.005. 'Agreeableness' (BigFive) was found to be a negative predictor of stress-overeating. The most pronounced difference in eating motives (The Eating Motivation Survey, TEMS) was found for 'Affect Regulation' and 'Weight Control'. CONCLUSIONS: The results indicate that stress-overeating affects a large proportion of the surveyed population. BMI, personality and eating motives additionally characterize stress-overeaters and may contribute to develop new approaches to address unhealthy stress-related eating patterns.

Dietary Quality in Vegetarian and Omnivorous Female Students in Germany: A Retrospective Study.

Vegetarian diets have gained in popularity, especially among highly educated women, and are considered beneficial to health. Comparative studies assessing the diet of vegetarians against omnivores are rather limited and often provide ambivalent results. Therefore, this study examined the nutrient intake and nutritional quality of vegetarian and omnivorous diets in a group of 61 female students in Germany. Habitual dietary intake was evaluated using a validated graphical online food frequency questionnaire (FFQ). Differences in nutrient intakes were analyzed by Mann-Whitney-U-Tests. Odds Ratios (OR) were calculated for vegetarians exceeding dietary reference values (DRV) compared to omnivores. The overall nutritional quality was assessed using the Healthy-Eating-Index-2015 (HEI-2015). In omnivores, intakes of total energy from saturated fatty acids (SFA), monounsaturated fatty acids (MUFA), long-chain omega-3 polyunsaturated fatty acids (LC-n3-PUFA), cholesterol, sucrose, lactose, retinol, and cobalamin were significantly higher than in vegetarians. Significantly lower intakes were observed for fiber, magnesium, and beta-carotene. Significant OR were detected for total fat (OR = 0.29), SFA (OR = 0.04), beta-carotene (OR = 4.55), and cobalamin (OR = 0.32). HEI-2015 scores were higher for vegetarians than for omnivores (79 points versus 74 points) and significant differences were recorded for the HEI-2015 components dairy, seafood & plant proteins, fatty acids, added sugars, and saturated fatty acids.

Postprandial metabolic responses to ingestion of bovine glycomacropeptide compared to a whey protein isolate in prediabetic volunteers.

PURPOSE: Whey protein was shown to reduce blood glucose responses in humans and various other positive effects have been attributed to this protein. In contrast, studies using glycomacropeptide (GMP) as part of the whey fraction of bovine milk are rare. We, therefore, studied the postprandial responses to GMP administration in humans with impaired glucose tolerance compared to the effects of pure whey protein in a random design. METHODS: Fifteen prediabetic volunteers received on different occasions one of three test drinks containing 50 g of maltodextrin19 (MD19) alone or in combination with either 50 g GMP or 50 g whey protein isolate (WPI). Blood was collected over 4 h with analysis of blood glucose and hormones, gastric emptying rate as well as plasma amino- and fatty acids, ß-hydroxybutyrate and acylcarnitines. RESULTS: The WPI drink reduced the AUC of venous blood glucose compared to the MD19 drink in the prediabetic group by 11% (p = 0.0018) whereas GMP reduced the AUC by 18% (p < 0.0001), significantly different to the WPI drink (p = 0.0384). The reduction in blood glucose after the GMP drink was accompanied by a significantly lower AUC of insulin (- 34%) than for the WPI drink. Levels of C-peptide and of glucose insulinotropic polypeptide (GIP) were highly increased after the WPI drink over the MD19 control drink but remained in essence unaffected by the GMP. CONCLUSION: GMP reduced the glycemic response more potently than whey protein, whereas insulin output was less affected making GMP an interesting protein to control postprandial glucose responses.

Estimating Usual Intake in the 2nd Bavarian Food Consumption Survey: Comparison of the Results Derived by the National Cancer Institute Method and a Basic Individual Means Approach.

BACKGROUND: The valid estimation of the usual dietary intake remains a challenge till date. We applied the method suggested by the National Cancer Institute (NCI) to data from the 2nd Bavarian Food Consumption Survey (BVS II) and compared it to an individual means approach. METHODS: Within the cross-sectional BVS II, 1,050 Bavarian residents aged 13-80 years participated in a personal interview and completed three 24-h dietary recalls by telephone interview. For the 13 main food groups and 23 subgroups the usual intake was calculated by (1) an individual means approach and (2) by the NCI method. RESULTS: The distributions derived by the individual means approach are wider than those derived from the NCI approach. For a majority of food groups and subgroups, the proportion of participants who meet the dietary recommendations published by the German Nutrition Society is higher when the NCI approach is applied. The proportions of participants above or below recommended amounts differ greatly for "meat and meat products" and "cheese." CONCLUSION: The mean intake at the groups level can easily be derived from the individual means approach. Since only the NCI method accounts for intra-personal variation, this method provides more valid intake estimates at the individual level and should be applied when, for example, individual intakes are compared with dietary recommendations.

Determinants of postprandial plasma bile acid kinetics in human volunteers.

Bile acids (BA) are signaling molecules with a wide range of biological effects, also identified among the most responsive plasma metabolites in the postprandial state. We here describe this response to different dietary challenges and report on key determinants linked to its interindividual variability. Healthy men and women (n = 72, 62 ± 8 yr, mean ± SE) were enrolled into a 12-wk weight loss intervention. All subjects underwent an oral glucose tolerance test and a mixed-meal tolerance test before and after the intervention. BA were quantified in plasma by liquid chromatography-tandem mass spectrometry combined with whole genome exome sequencing and fecal microbiota profiling. Considering the average response of all 72 subjects, no effect of the successful weight loss intervention was found on plasma BA profiles. Fasting and postprandial BA profiles revealed high interindividual variability, and three main patterns in postprandial BA response were identified using multivariate analysis. Although the women enrolled were postmenopausal, effects of sex difference in BA response were evident. Exome data revealed the contribution of preselected genes to the observed interindividual variability. In particular, a variant in the SLCO1A2 gene, encoding the small intestinal BA transporter organic anion-transporting polypeptide-1A2 (OATP1A2), was associated with delayed postprandial BA increases. Fecal microbiota analysis did not reveal evidence for a significant influence of bacterial diversity and/or composition on plasma BA profiles. The analysis of plasma BA profiles in response to two different dietary challenges revealed a high interindividual variability, which was mainly determined by genetics and sex difference of host with minimal effects of the microbiota.NEW & NOTEWORTHY Considering the average response of all 72 subjects, no effect of the successful weight loss intervention was found on plasma bile acid (BA) profiles. Despite high interindividual variability, three main patterns in postprandial BA response were identified using multivariate analysis. A variant in the SLCO1A2 gene, encoding the small intestinal BA transporter organic anion-transporting polypeptide-1A2 (OATP1A2), was associated with delayed postprandial BA increases in response to both the oral glucose tolerance test and the mixed-meal tolerance test.

Predicting fatty acid profiles in blood based on food intake and the FADS1 rs174546 SNP.

SCOPE: A high intake of n-3 PUFA provides health benefits via changes in the n-6/n-3 ratio in blood. In addition to such dietary PUFAs, variants in the fatty acid desaturase 1 (FADS1) gene are also associated with altered PUFA profiles. METHODS AND RESULTS: We used mathematical modeling to predict levels of PUFA in whole blood, based on multiple hypothesis testing and bootstrapped LASSO selected food items, anthropometric and lifestyle factors, and the rs174546 genotypes in FADS1 from 1607 participants (Food4Me Study). The models were developed using data from the first reported time point (training set) and their predictive power was evaluated using data from the last reported time point (test set). Among other food items, fish, pizza, chicken, and cereals were identified as being associated with the PUFA profiles. Using these food items and the rs174546 genotypes as predictors, models explained 26-43% of the variability in PUFA concentrations in the training set and 22-33% in the test set. CONCLUSION: Selecting food items using multiple hypothesis testing is a valuable contribution to determine predictors, as our models' predictive power is higher compared to analogue studies. As unique feature, we additionally confirmed our models' power based on a test set.

Eating out is different from eating at home among individuals who occasionally eat out. A cross-sectional study among middle-aged adults from eleven European countries.

Eating out has been linked to the current obesity epidemic, but the evaluation of the extent to which out of home (OH) dietary intakes are different from those at home (AH) is limited. Data collected among 8849 men and 14,277 women aged 35-64 years from the general population of eleven European countries through 24-h dietary recalls or food diaries were analysed to: (1) compare food consumption OH to those AH; (2) describe the characteristics of substantial OH eaters, defined as those who consumed 25 % or more of their total daily energy intake at OH locations. Logistic regression models were fit to identify personal characteristics associated with eating out. In both sexes, beverages, sugar, desserts, sweet and savoury bakery products were consumed more OH than AH. In some countries, men reported higher intakes of fish OH than AH. Overall, substantial OH eating was more common among men, the younger and the more educated participants, but was weakly associated with total energy intake. The substantial OH eaters reported similar dietary intakes OH and AH. Individuals who were not identified as substantial OH eaters reported consuming proportionally higher quantities of sweet and savoury bakery products, soft drinks, juices and other non-alcoholic beverages OH than AH. The OH intakes were different from the AH ones, only among individuals who reported a relatively small contribution of OH eating to their daily intakes and this may partly explain the inconsistent findings relating eating out to the current obesity epidemic.

Metabolic responses of healthy or prediabetic adults to bovine whey protein and sodium caseinate do not differ.

BACKGROUND: Casein is considered a slowly digestible protein compared with whey protein, and this may cause differences in hormone responses and the kinetics of delivering amino acids into the circulation. OBJECTIVE: We investigated whether postprandial plasma hormone and metabolite responses were different when bovine casein or whey protein was co-administered with carbohydrates in healthy and prediabetic adults. METHODS: White healthy male adults (n = 15) and white, well-defined male and female prediabetic adults (n = 15) received test drinks randomly on 3 different occasions at least 2 d apart which contained 50 g of maltodextrin19 (MD19) alone or in combination with 50 g of whey protein isolate (WPI) or 50 g of sodium caseinate (SC). Blood samples were collected over a 240-min time period and were analyzed for hormone profiles and defined metabolites. RESULTS: No evidence was found that gastric emptying was different between the 2 protein drinks. Both proteins increased peak plasma insulin concentrations in prediabetic persons by 96% compared with MD19 (each, P < 0.05), which was accompanied by a reduction of peak venous blood glucose by 21% (each, P < 0.0001) without a difference between the 2 proteins. Peak plasma glucagon concentrations increased by 101% in both groups after the protein drinks (P < 0.05). The WPI drink also increased peak plasma glucose-dependent insulinotropic polypeptide concentrations in healthy volunteers by 56% (P < 0.01). Differences in plasma metabolite concentrations in volunteers could be attributed exclusively to the differences in the amino acid composition of the 2 proteins ingested. CONCLUSION: The WPI and the SC drinks similarly reduced postprandial glucose excursions when ingested with carbohydrates in healthy and prediabetic volunteers. Under our experimental conditions, however, no evidence was found that gastrointestinal processing of the 2 protein varieties differed substantially. This trial was registered at clinicaltrials.gov as DRKS00005682.

Effect of maternal obesity with and without gestational diabetes on offspring subcutaneous and preperitoneal adipose tissue development from birth up to year-1.

BACKGROUND: Maternal obesity and gestational diabetes mellitus (GDM) may independently influence offspring fat mass and metabolic disease susceptibility. In this pilot study, body composition and fat distribution in offspring from obese women with and without GDM and lean women were assessed within the 1st year of life, and maternal and newborn plasma factors were related to offspring adipose tissue distribution. METHODS: Serum and plasma samples from pregnant obese women with (n = 16) or without (n = 13) GDM and normoglycemic lean women (n = 15) at 3rd trimester and offspring cord plasma were used for analyzing lipid profiles, insulin and adipokine levels. At week-1 and 6, month-4 and year-1, offspring anthropometrics and skinfold thickness (SFT) were measured and abdominal subcutaneous (SCA) and preperitoneal adipose tissue (PPA) were determined by ultrasonography. RESULTS: Cord insulin was significantly increased in the GDM group, whereas levels of cord leptin, total and high molecular weight (HMW) adiponectin were similar between the groups. Neonates of the GDM group showed significantly higher SFT and fat mass until week-6 and significantly increased SCA at week-1 compared to the lean group that persisted as strong trend at week-6. Interestingly, PPA in neonates of the GDM group was significantly elevated at week-1 compared to both the lean and obese group. At month-4 and year-1, significant differences in adipose tissue growth between the groups were not observed. Multiple linear regression analyses revealed that cord insulin levels are independently related to neonatal PPA that showed significant relation to PPA development at year-1. Maternal fasted C-peptide and HMW adiponectin levels at 3rd trimester emerged to be determinants for PPA at week-1. CONCLUSION: Maternal pregravid obesity combined with GDM leads to newborn hyperinsulinemia and increased offspring fat mass until week-6, whereas pregravid obesity without GDM does not. This strongly suggests the pivotal role of GDM in the adverse offspring outcome. Maternal C-peptide and HMW adiponectin levels in pregnancy emerge to be predictive for elevated PPA in newborns and might be indicative for the obesity risk at later life. Altogether, the findings from our pilot study warrant evaluation in long-term studies. TRIAL REGISTRATION: German Clinical Trials Register DRKS00004370.

Mice lacking the intestinal peptide transporter display reduced energy intake and a subtle maldigestion/malabsorption that protects them from diet-induced obesity.

The intestinal transporter PEPT1 mediates the absorption of di- and tripeptides originating from breakdown of dietary proteins. Whereas mice lacking PEPT1 did not display any obvious changes in phenotype on a high-carbohydrate control diet (HCD), Pept1(-/-) mice fed a high-fat diet (HFD) showed a markedly reduced weight gain and reduced body fat stores. They were additionally protected from hyperglycemia and hyperinsulinemia. Energy balance studies revealed that Pept1(-/-) mice on HFD have a reduced caloric intake, no changes in energy expenditure, but increased energy content in feces. Cecal biomass in Pept1(-/-) mice was as well increased twofold on both diets, suggesting a limited capacity in digesting and/or absorbing the dietary constituents in the small intestine. GC-MS-based metabolite profiling of cecal contents revealed high levels and a broad spectrum of sugars in PEPT1-deficient mice on HCD, whereas animals fed HFD were characterized by high levels of free fatty acids and absence of sugars. In search of the origin of the impaired digestion/absorption, we observed that Pept1(-/-) mice lack the adaptation of the upper small intestinal mucosa to the trophic effects of the diet. Whereas wild-type mice on HFD adapt to diet with increased villus length and surface area, Pept1(-/-) mice failed to show this response. In search for the origin of this, we recorded markedly reduced systemic IL-6 levels in all Pept1(-/-) mice, suggesting that IL-6 could contribute to the lack of adaptation of the mucosal architecture to the diets.

Leptin plasma levels in the general population: influence of age, gender, body weight and medical history.

The polypeptide leptin exerts a multitude of regulatory functions. It has been implicated in the pathophysiology of inflammatory, metabolic and psychiatric disorders and has been found to be differentially expressed in men and women. Although a clear increase of leptin levels with age has been repeatedly observed in men, the association of leptin levels and age in women is an issue of scientific discussion. To investigate the association of age, gender, body mass index (BMI) and selected diseases with plasma levels of leptin in 551 adults randomly chosen from the Bavarian population, we assessed subjects' characteristics, lifestyle, and medical history including life time history of frequent diseases and performed blood sampling and standardized anthropometric measurements. Leptin plasma levels were measured using a Radioimmunoassay. Leptin levels were significantly higher in women as compared to men and this difference persisted even after controlling for differences in age or BMI. Leptin levels increased across the age groups in both men and women. Controlling for differences in BMI substantially attenuated the influence of age on leptin levels. In women, age was no longer significantly associated with leptin levels after controlling for BMI. With regard to medical history, hyperuricemia and gout were significantly associated with higher leptin levels, even after controlling for BMI, whereas subjects with high blood pressure or dyslipoproteinemia showed higher leptin levels only if the BMI was not considered as control variable. The BMI and its influence on the interrelations of gender, age and leptin should be considered when interpreting leptin levels.

A new FFQ designed to measure the intake of fatty acids and antioxidants in children.

OBJECTIVE: The present paper describes the systematic development of an FFQ to assess the intake of fatty acids and antioxidants in school-aged children. In addition, a validation study applying 24 h dietary recalls was performed. DESIGN: Using the variance-based Max_r method, a list of eighty-two foods was compiled from data obtained by 3 d weighed dietary records. The foods were used to design an FFQ, the comprehensibility of which was evaluated in a feasibility study. In addition, the FFQ was validated in a subset of 101 children from the German Infant Nutritional Intervention Study (GINI PLUS) against one 24 h dietary recall. RESULTS: The feasibility study attested a good acceptance of the FFQ. Mean intake of foods compared well between the FFQ and the 24 h dietary recall, although intake data generated from the FFQ tended to be higher. This difference became less apparent at the nutrient level, although the estimated average consumption of arachidonic acid and EPA using the FFQ still exceeded values recorded with the 24 h recall method by 45 % and 29 %, respectively. CONCLUSIONS: On the basis of the systematic selection process of the food list, the established practicability of the FFQ and the overall plausibility of the results, the use of this FFQ is justified in future epidemiological studies.

Food balance sheet and household budget survey dietary data and mortality patterns in Europe.

Worldwide dietary data for nutrition monitoring and surveillance are commonly derived from food balance sheets (FBS) and household budget surveys (HBS). We have compared food supply from FBS and food availability data from HBS among eighteen European countries and have estimated the extent to which they correlate, focusing on food groups which are comparably captured by FBS and HBS and for which there is epidemiological evidence that they can have a noticeable impact on population mortality. Spearman's correlation coefficient was +0.78 (P < 10- 3) for vegetables (including legumes),+0.76 (P < 10- 3) for fruits, +0.69 (P < 10- 3) for fish and seafood and +0.93 (P < 10- 3) for olive oil. With respect to meat and meat products, the coefficient was lower at +0.39 (P = 0.08). Moreover, we have examined whether the supply (FBS) or the availability (HBS) of food groups known or presumed to have beneficial effect on the occurrence of CHD and total cancer can predict overall, coronary and cancer mortality in ecological analyses. After controlling for purchasing power parity-adjusted gross domestic product and tobacco smoking we found that for vegetables, fruits, fish and seafood, as well as for olive oil, both the FBS and the HBS estimates were inversely associated with all three indicators of mortality, although the number of countries with complete information on all study variables hindered formal statistical documentation (P>0.05 in some instances). FBS and HBS have their own strengths and weaknesses, but they may complement each other in dietary assessments at the population level.

Determinants and correlates of serum undercarboxylated osteocalcin.

BACKGROUND/AIMS: To assess dietary and nondietary determinants of serum undercarboxylated osteocalcin (ucOC) as a measure of vitamin K status. METHODS: UcOC and total intact osteocalcin (iOC) concentrations were determined by specific ELISA tests in serum samples of 231 male and 320 female participants (18-81 years) of the representative, cross-sectional Bavarian Food Consumption Survey II. Determinants of ucOC were investigated by analysis of variance, Spearman's rank correlation coefficients and logistic regression models. RESULTS: Mean ucOC serum concentration was 2.46 ng/ml in men and 2.34 ng/ml in women. Corresponding means of the ratio of ucOC to iOC (ucOC/iOC) were 0.28 and 0.29. Concentrations of ucOC and iOC, as well as the ratio of ucOC/iOC, strongly depended on the participant's age. UcOC was influenced by smoking status, sports activity, and the season when blood was collected. Dietary intake of the dominant vitamin K sources, green leafy vegetables and dairy products, as well as the plasma concentration of the carotenoid lutein were inversely associated with serum ucOC values. CONCLUSIONS: In studies using serum ucOC as a measure of vitamin K supply, determinants, especially age, need to be taken into account.