Association Between the Risk of Multiple Sclerosis and Dietary Proinflammatory/Anti-Inflammatory Food Intake and Dietary Diversity: A Case-Control Study.

A diet rich in proinflammatory components and inflammation are suggested to be significant risk factors for multiple sclerosis (MS). This study aimed to investigate the association between the risk of MS and the inflammatory potential of an individual's diet and dietary diversity through pro-inflammatory/anti-inflammatory food intake score (PAIFIS) and dietary diversity score (DDS). In a hospital-based case-control study, 397 participants, including 197 patients with MS and 200 healthy participants aged over 18 years, were evaluated. The history of smoking, dietary intake, and anthropometric characteristics, including body mass index, waist circumference, total body fat, and fat-free mass were assessed. A validated 160-item semiquantitative food frequency questionnaire was used to calculate the PAIFIS and DDS scores. The mean age of the participants was 32.45 ± 8.66 years, and most were females (274, 79.4%). The PAIFIS score was significantly higher among MS patients than healthy participants (p = 0.001). Between PAIFIS and DDS, only PAFIS was significantly related to MS risk (odds ratio, 1.002; 95% confidence interval, 1.001-1.004; p = 0.001). PAIFIS, as an index of dietary inflammation, can predict MS. Further studies are needed to document these findings.

A validation study comparing energy and nutrient intake between a web-based food frequency questionnaire and a 4-d dietary record.

OBJECTIVE: Reliable assessments of dietary intake is crucial when examining associations between dietary factors and different outcomes. Today, web-based instead of paper-based food frequency questionnaires (FFQs) are common. A web-based FFQ implies a different experience (including design differences, the possibility only to show relevant questions, and automatic checks for completeness) and may capture dietary intake differently. The aim of this study was to validate a well-used paper-based FFQ transferred to a web-based version against a 4-d dietary record. METHODS: Baseline data from a dietary intervention study comprising women and men with type 2 diabetes were used. Diet was assessed with the web-based FFQ and a 4-d dietary record. Energy intake and energy-adjusted nutrient intakes were assessed and compared using Spearman's rank correlation and Bland-Altman analysis. The analysis included 101 participants. RESULTS: The average energy intake with the FFQ was 2068 kcal, 157 kcal higher than the average from the dietary record. Significant deattenuated correlations were found for intake of energy (r = 0.37; 95% confidence interval [CI],0.19-0.53), carbohydrates (r = 0.85; 95% CI, 0.78-0.89), protein (r = 0.53; 95% CI, 0.38-0.66) and fat (r = 0.59; 95% CI, 0.44-0.70). Significant deattenuated correlations (ranging r = 0.26-0.73) were found for intake of alcohol, whole grain, fiber, saturated fat, monounsaturated fat, polyunsaturated fat, cholesterol, vitamins A, B12, C, D, and E, folate, iron, potassium, magnesium, and calcium. Bland-Altman analyses showed no clear trends but wide limits of agreement. CONCLUSION: Overall, the web-based FFQ performed well and is similar to the paper-based version. It can be a useful tool for dietary assessments.

Dietary intake of pregnant women with non-alcoholic fatty liver disease: A case-control study.

BACKGROUND AND AIMS: Findings on the role of diet in non-alcoholic fatty liver disease (NAFLD) pathogenesis are inconsistent. There are few studies on the dietary habits of pregnant women with NAFLD. Our primary aim was to compare the dietary intakes of pregnant women with and without NAFLD. METHODS: This case-control study recruited 60 women (26-34 weeks' gestation) with recently diagnosed gestational diabetes (GDM) before any treatment was implemented. At recruitment, all participants underwent B-mode hepatic ultrasound. We included 30 women with sonographic NAFLD (cases) and 30 women without NAFLD (controls) matched for age, skin color, and pre-pregnancy body mass index. We assessed participants' dietary intakes in the last six months using a validated food frequency questionnaire. Mann-Whitney´s test was used to compare differences in median macro and micronutrient intakes between cases and controls. RESULTS: Total median daily energy (1965.1 × 1949.2 calories) and lipid (25.1% × 28.3%) intakes were similar in women with and without NAFLD and fell within recommended ranges. Participants with NAFLD reported significantly higher median daily intakes of carbohydrates (59.4% × 53.1% p = 0.003), and significantly lower protein (15.6% × 17.0% p = 0.005), fiber (10.7 × 13.3 g/day p = 0.010), and vitamin C (151.8 × 192.6 mg/day p = 0.008) intakes than those without NAFLD. CONCLUSIONS: Pregnant women with NAFLD ingest more carbohydrates and less protein, fiber, and vitamin C than those without NAFLD. Our findings contribute to understanding the role of diet in the development of NAFLD in pregnant women.

The relationship of sperm DNA integrity with serum vitamin levels (folate and cobalamin) and food consumption in infertile men.

OBJECTIVE: The aim of this study was to investigate the relationships of serum folate (vitamin B9), cobalamin (vitamin B12) levels and diet with semen parameters (semen standard parameters [SSP] and DNA fragmentation index [DFI]) in infertile men. METHODS: Sperm samples were assessed for SSP and DFI (using the sperm chromatin dispersion test). Serum vitamin concentrations were measured with an immuno-electrochemiluminescence assay, and men completed a semi-quantitative food frequency questionnaire (FFQ). RESULTS: Serum folate levels were positively correlated with sperm progressive motility and DFI. A comparison of SSP between two groups of patients according to serum folate concentration (B9 <4.840 ng/mL and B9 ≥4.840 ng/mL) showed significantly higher sperm concentration and sperm progressive motility in the latter group. However, there was no difference between these groups regarding DFI. Interestingly, serum folate levels were significantly higher in patients with a high DFI (using the cut-offs of 30% or 18%). FFQ data showed that the consumption of fruits and egg yolk correlated positively with sperm concentration and sperm motility, respectively. CONCLUSION: Serum folate levels showed significant associations with sperm concentration and sperm progressive motility. However, the positive association of serum folate with DFI raises the need for careful prescription of folate supplements.

Food Intake Visual Scale-A practical tool for assessing the dietary intake of hospitalized patients with decompensated cirrhosis.

BACKGROUND: The aim of this study was whether the Food Intake Visual Scale (FIVS) can be used in clinical practice to measure food intake in patients with decompensated cirrhosis. METHODS: A cross-sectional study was performed with patients with cirrhosis between April 2017 and July 2019. The food intake was assessed through the 1-day diet record (DR) and according to FIVS, which consists of pictures of four plates of food at different levels of consumption: "about all," "half," "a quarter," or "nothing." The analysis of variance test with Bonferroni multiple comparison analysis was used to compare the mean energy intake through the DR according to the FIVS categories. RESULTS: This study included 94 patients with a mean age of 60.29 ± 9.33 years. Patients with lower food intake according to the FIVS categories also had lower mean energy and macronutrient intake according to the DR: patients eating "about all" (n = 49, 52.1%) consumed a mean of 1526.58 ± 428.27 kcal/day, patients eating "half" (n = 16, 17%) consumed a mean of 1282.08 ± 302.83 kcal/day, patients eating "a quarter" (n = 25, 26.6%) consumed a mean of 978.96 ± 468.81 kcal/day, and patients eating "nothing" (n = 4, 4.3%) consumed a mean of 353.59 ± 113.16 kcal/day (P < .001). CONCLUSION: The results of this study demonstrate that FIVS can be implemented in clinical practice to measure food intake in patients with decompensated cirrhosis as a substitute for the DR because it is a noninvasive, low-cost, quick, reliable, and easy bedside method for obtaining data.

Evaluation of food intake through residual analysis in 90 Basque school canteens / Evaluación de la ingesta de alimentos a través del análisis residual en 90 comedores escolares vascos

Objective: To measure the consumption of 25 food items (Comstock scale), to test whether school management type (public schools vs. private with subsidy schools) and food origin (on-site preparation vs. catering) affected food consumption and to quantify variability associated with territory, school and individual. Method: This cross-sectional study involved 14,717 schoolchildren of ages 2-16, recruited in 90 schools of the Basque Autonomous Community (Spain). Waste (non-consumed food) of 25 analysed food items was visually estimated by trained school monitors, via the Comstock categorical scale thus adapted: 1 = 0%; 2 = 25%; 3 = 50%, 4 = 75% and 5 = 100%. To analyse the data, mixed modelling was applied. Results: Vegetables, fish and fruits were the less-accepted food types. While school management did not affect food intake, on-site food preparation had better acceptance for legumes with vegetables, oily and lean fish, meat and pre-cooked meals. The largest source of variability in food intake not accounted for by school management and food preparation was the individual subject, while school and territory had moderate and almost no effects, respectively. Conclusions: Acceptance of the 25 evaluated foods is adequate, albeit can be improved. We believe that promoting on-site food preparation should improve the acceptance of legumes with vegetables, oily/lean fish, meat and pre-cooked meals. We recommend that future interventions oriented to improve intake should focus on individual subjects. (AU)

Objetivo: Medir el consumo de 25 alimentos (escala Comstock), comprobar si el tipo de gestión escolar (pública o concertada) y el origen de los alimentos (in situ o transportados) afecta al consumo, y cuantificar la variabilidad asociada con el territorio, la escuela y los individuos. Método: Estudio transversal con 14.717 escolares de 2-16 años reclutados en 90 escuelas del País Vasco. La estimación de residuos (alimento no consumido) de 25 grupos de alimentos la realizó visualmente personal escolar entrenado, mediante la escala categórica de Comstock así adaptada: 1 = 0%, 2 = 25%, 3 = 50%, 4 = 75% y 5 = 100%. Para analizar los datos se aplicó un modelo estadístico de efectos mixtos. Resultados: Verduras, pescado y frutas fueron los alimentos menos consumidos. Aunque el tipo de gestión escolar no afectó a la ingesta alimentaria, se determinó que la cocina in situ logró una mejor aceptación de legumbres con verduras, pescado azul y blanco, carne y precocinados. La mayor fuente adicional de variabilidad en la ingesta alimentaria fue el sujeto individual, mientras que la escuela y el territorio tuvieron efectos moderados y casi nulos, respectivamente. Conclusiones: La aceptación de los 25 alimentos evaluados es adecuada, aunque mejorable. Creemos que la promoción de cocinas in situ mejoraría la aceptación de legumbres con verduras, pescado azul y blanco, carne y platos precocinados. Recomendamos que las futuras intervenciones para mejorar la ingesta se dirijan al sujeto individual. (AU)

Personal Devices to Monitor Physical Activity and Nutritional Intake After Colorectal Cancer Surgery: Feasibility Study.

BACKGROUND: The use of self-monitoring devices is promising for improving perioperative physical activity and nutritional intake. OBJECTIVE: This study aimed to assess the feasibility, usability, and acceptability of a physical activity tracker and digital food record in persons scheduled for colorectal cancer (CRC) surgery. METHODS: This observational cohort study was conducted at a large training hospital between November 2019 and November 2020. The study population consisted of persons with CRC between 18- and 75 years of age who were able to use a smartphone or tablet and scheduled for elective surgery with curative intent. Excluded were persons not proficient in Dutch or following a protein-restricted diet. Participants used an activity tracker (Fitbit Charge 3) from 4 weeks before until 6 weeks after surgery. In the week before surgery (preoperative) and the fifth week after surgery (postoperative), participants also used a food record for 1 week. They shared their experience regarding usability (system usability scale, range 0-100) and acceptability (net promoter score, range -100 to +100). RESULTS: In total, 28 persons were included (n=16, 57% male, mean age 61, SD 8 years), and 27 shared their experiences. Scores regarding the activity tracker were as follows: preoperative median system usability score, 85 (IQR 73-90); net promoter score, +65; postoperative median system usability score, 78 (IQR 68-85); net promotor score, +67. The net promoter scores regarding the food record were +37 (preoperative) and-7 (postoperative). CONCLUSIONS: The perioperative use of a physical activity tracker is considered feasible, usable, and acceptable by persons with CRC in this study. Preoperatively, the use of a digital food record was acceptable, and postoperatively, the acceptability decreased.

Evaluation of food intake through residual analysis in 90 Basque school canteens.

OBJECTIVE: To measure the consumption of 25 food items (Comstock scale), to test whether school management type (public schools vs. private with subsidy schools) and food origin (on-site preparation vs. catering) affected food consumption and to quantify variability associated with territory, school and individual. METHOD: This cross-sectional study involved 14,717 schoolchildren of ages 2-16, recruited in 90 schools of the Basque Autonomous Community (Spain). Waste (non-consumed food) of 25 analysed food items was visually estimated by trained school monitors, via the Comstock categorical scale thus adapted: 1=0%; 2=25%; 3=50%, 4=75% and 5=100%. To analyse the data, mixed modelling was applied. RESULTS: Vegetables, fish and fruits were the less-accepted food types. While school management did not affect food intake, on-site food preparation had better acceptance for legumes with vegetables, oily and lean fish, meat and pre-cooked meals. The largest source of variability in food intake not accounted for by school management and food preparation was the individual subject, while school and territory had moderate and almost no effects, respectively. CONCLUSIONS: Acceptance of the 25 evaluated foods is adequate, albeit can be improved. We believe that promoting on-site food preparation should improve the acceptance of legumes with vegetables, oily/lean fish, meat and pre-cooked meals. We recommend that future interventions oriented to improve intake should focus on individual subjects.

Digital Solutions to Diagnose and Manage Postbariatric Hypoglycemia.

Postbariatric hypoglycemia (PBH) is an increasingly recognized late metabolic complication of bariatric surgery, characterized by low blood glucose levels 1-3 h after a meal, particularly if the meal contains rapid-acting carbohydrates. PBH can often be effectively managed through appropriate nutritional measures, which remain the cornerstone treatment today. However, their implementation in daily life continues to challenge both patients and health care providers. Emerging digital technologies may allow for more informed and improved decision-making through better access to relevant data to manage glucose levels in PBH. Examples include applications for automated food analysis from meal images, digital receipts of purchased food items or integrated platforms allowing the connection of continuously measured glucose with food and other health-related data. The resulting multi-dimensional data can be processed with artificial intelligence systems to develop prediction algorithms and decision support systems with the aim of improving glucose control, safety, and quality of life of PBH patients. Digital innovations, however, face trade-offs between user burden vs. amount and quality of data. Further challenges to their development are regulatory non-compliance regarding data ownership of the platforms acquiring the required data, as well as user privacy concerns and compliance with regulatory requirements. Through navigating these trade-offs, digital solutions could significantly contribute to improving the management of PBH.

Dietary Risk Factors for Pediatric Kidney Stones: A Case-Control Study.

PURPOSE: Data are scarce regarding dietary risk factors for pediatric nephrolithiasis. Our objective was to perform a case-control study (nonmatched) of the association of dietary nutrients with pediatric urolithiasis. MATERIALS AND METHODS: We obtained dietary information from pediatric urolithiasis patients (from stone clinic in 2013-2016) and healthy controls (well-child visit at primary care in 2011-2012). Survey results were converted to standard nutrient intakes. Children younger than 5 years of age and those with extreme calorie intake values (<500 or >5,000 kcal/day) were excluded. The association of individual nutrients with urolithiasis was assessed by bivariate analysis results and machine-learning methods. A multivariable logistic regression model was fitted using urolithiasis as the outcome. RESULTS: We included 285 patients (57 stones/228 controls). Mean±SD age was 8.9±3.6 years (range 5-20). Of the patients 47% were male. After adjusting for age, sex, body mass index (obese/overweight/normal), calorie intake and oxalate, urolithiasis was associated with higher dietary sodium (OR=2.43 [95% CI=1.40-4.84] per quintile increase, p=0.004), calcium (OR=1.73 [95% CI=1.07-3.00] per quintile increase, p=0.034) and beta carotene (OR=2.01 [95% CI=1.06-4.18] per quintile increase, p=0.042), and lower potassium (OR=0.31 [95% CI=0.13-0.63] per quintile increase, p=0.003). Sensitivity analysis was performed by removing oxalate from the model and limiting the sample to patients aged 5-13 years, with similar results. CONCLUSIONS: In our cohort, higher dietary intake of calcium, sodium and beta carotene, and lower potassium intake were associated with pediatric urolithiasis. This is the first study using a detailed dietary survey to identify dietary risk factors for pediatric urolithiasis. Further research is warranted to delineate the mechanisms and to generate a lower risk diet profile for pediatric urolithiasis.

Effect of a Multicomponent mHealth Intervention on the Composition of Diet in a Population with Overweight and Obesity-Randomized Clinical Trial EVIDENT 3.

A balanced diet can help in the prevention of chronic diseases. The aim of this study was to evaluate the effect of an mHealth intervention on the distribution of macronutrients and the intake of food groups. A total of 650 participants were included in this multi-center, clinical, randomized, controlled trial (Evident 3 study). All participants were given brief advice about diet and exercise. The intervention group received, in addition, an app (Evident 3) for the self-recording of their diet and an activity tracker wristband for 3 months. Follow-up visits were performed at 3 and 12 months to collect the diet composition using the Food Frequency Questionnaire. There were decreases in the intake of total calories, fat, protein and carbohydrates in both groups throughout the study, without significant differences between them. The intervention group reduced the intake of cholesterol (-30.8; 95% CI -59.9, -1.7) and full-fat dairies (-23.3; 95% CI -42.8, -3.8) and increased the intake of wholemeal bread (3.3; 95% CI -6.7, 13.3) and whole-grain cereals (3.4; 95% CI -6.8, 13.7) with respect to the control group. No differences were found in the rest of the nutritional parameters. The brief advice is useful to promote a healthier diet, and the app can be a support tool to obtain changes in relevant foods, such as integral foods, and the intake of cholesterol. Trial registration: ClinicalTrials.gov with identifier NCT03175614.

Evolution of beverage portion sizes consumed in Brazil between 2008 and 2018.

Objective: To describe the evolution of beverage portion sizes consumed in Brazil between 2008 and 2018. Methods: Data from the dietary surveys of 2008-2009 and 2017-2018 Brazilian Household Budget Surveys, conducted with 34,003 and 46,164 individuals, respectively, were used to analyze the portion size of beverages. Food consumption data were used to group beverages according to nutritional characteristics, type and size of portions into eight groups: high-calorie soft drinks, fruit refreshments, alcoholic beverages, coffee/tea, fruit juices, milk and milk substitutes and ultra-processed milk-based beverages. The two-day food record and recall were considered to analyze the consumed portions. Comparisons between the surveys were done using Chi-Square tests and linear regression models. Results: Between 2008 and 2018, the average portion consumed showed a significant increase for the group of alcoholic beverages (+29%), flavored juices (+11%), caloric soft drinks (+8%), milk and milk substitutes (+6%) and fruit juices (+5%); and reduction for the coffee/tea group (-11%). Analyzes by age group showed that among individuals between 20 and 40 years of age, the soft drinks and alcoholic beverage groups showed the greatest increase in portion size, +12 and +44%, respectively. Conclusion: The beverage portion sizes consumed in Brazil between 2008 and 2018 increased for the group of alcoholic beverages, flavored juices, caloric soft drinks, milk and milk substitutes, and fruit juices.

Evaluation of paper-based and web-based food frequency questionnaires for 7-year-old children in Singapore.

Advances in technology enabled the development of a web-based, pictorial FFQ to collect parent-report dietary intakes of 7-year-old children in the Growing Up in Singapore Towards healthy Outcomes study. This study aimed to compare intakes estimated from a paper-FFQ and a web-FFQ and examine the relative validity of both FFQ against 3-d diet records (3DDR). Ninety-two mothers reported food intakes of their 7-year-old child on a paper-FFQ, a web-FFQ and a 3DDR. A usability questionnaire collected participants' feedback on the web-FFQ. Correlations and agreement in energy, nutrients and food groups intakes between the dietary assessments were evaluated using Pearson's correlation, Lin's concordance, Bland-Altman plots, Cohen's κ and tertile classification. The paper- and web-FFQ had good correlations (≥ 0·50) and acceptable-good agreement (Lin's concordance ≥ 0·30; Cohen's κ ≥ 0·41; ≥ 50 % correct and ≤ 10 % misclassification into same or extreme tertiles). Compared with 3DDR, both FFQ showed poor agreement (< 0·30) in assessing absolute intakes except micronutrients (web-FFQ had acceptable-good agreement), but showed acceptable-good ability to classify children into tertiles (κ ≥ 0·21; ≥ 40 % and ≤ 15 % correct or misclassification). Bland-Altman plots suggest good agreement between web-FFQ and 3DDR in assessing micronutrients and several food groups. The web-FFQ was well-received, and majority (81 %) preferred the web-FFQ over the paper-FFQ. The newly developed web-FFQ produced intake estimates comparable to the paper-FFQ, has acceptable-good agreement with 3DDR in assessing absolute micronutrients intakes and has acceptable-good ability to classify children according to categories of intakes. The positive acceptance of the web-FFQ makes it a feasible tool for future dietary data collection.

Evaluation of the Diet Tracking Smartphone Application Keenoa™: A Qualitative Analysis.

Keenoa™ is a novel Canadian diet application (app) currently used by Canadian dietitians to collect diet-related data from clients. The goal of this study was to evaluate Keenoa™ based on user feedback and compare it to a conventional pen and paper method. One hundred and two participants were recruited and randomly assigned to record their diets using this application for 3 nonconsecutive days. Following this, participants were invited to complete an online "exit" survey. Seventy-two subjects responded, with 50 completing an open-ended question asking for general feedback about the app. Data were reviewed and 3 main themes emerged: strengths, challenges, and future recommendations. Strengths associated with the app consisted of picture recognition software, the additional commentary feature, and the overall pleasant data collection process. Challenges that were identified included inconsistencies with the barcode scanning features, the limited food database, time to enter food details, and software issues. Future recommendations included using a larger food database, pairing dietary intake with physical activity monitoring, and having accessible nutritional data. Despite these limitations, participants preferred using mobile apps to record diet compared with traditional written food diaries.

Evolution of food intake estimates in Brazil: the 2008-2009 and 2017-2018 National Dietary Surveys / Evolução das estimativas da quantidade dos alimentos consumidos no Brasil: Inquérito Nacional de Alimentação 2008-2009 e 2017-2018

ABSTRACT Objective To present changes in the estimated amount of food intake in Brazil between the 2008-2009 and 2017-2018 National Dietary Surveys. Methods Food intake data from the 2008-2009 and 2017-2018 surveys were used to highlight the differences in the frequencies of foods mentioned, the number of the measurement units mentioned, and the frequency of measurements that were incompatible with the reported food and were exchanged by the most mentioned measurement (standard measurement), as well as to describe the updates performed in the database between edits. Results The elaboration of the 2017-2018 referenced measurement table was based on the 2008-2009 table, which was revised and updated. In the 2008-2009 survey, 9980 household measurements were mentioned for 1970 types of food and preparations, while in 2017-2018 there were 11050 and 2534, respectively. While in 2008-2009, 2.8% of citations were replaced by the standard measurement, in 2017-2018, only 0.7% of food items needed to be replaced. Conclusion The procedures used to estimate the amount of food intake between the surveys allowed updating the table of household measurements and minimizing errors in the estimate of this amount, with a reduction in measurement units that were inconsistent or incompatible with the aforementioned foods.

RESUMO Objetivo Apresentar a evolução na estimativa da quantidade dos alimentos consumidos no Brasil entre os Inquéritos Nacionais de Alimentação de 2008-2009 e de 2017-2018. Métodos Foram utilizados dados de consumo alimentar de 2008-2009 e de 2017-2018 para evidenciar as diferenças nas frequências de citações, nos números de unidades de medidas citadas e na frequência de medidas incompatíveis com o alimento que foram substituídas pela medida citada com maior frequência (medida padrão), bem como descrever as atualizações realizadas no banco de dados entre as edições. Resultados A construção da tabela de medidas referidas de 2017-2018 foi baseada na tabela de 2008-2009, a qual foi revisada e atualizada. No inquérito de 2008-2009 foram citadas 9980 medidas caseiras para 1970 alimentos e preparações, enquanto em 2017-2018 foram 11050 para 2534, respectivamente. Enquanto em 2008-2009 2,8% das citaçoes foram substituídas pela medida padrao, em 2017-2018, somente 0,7% dos alimentos precisaram ser substituídos. Conclusão Os procedimentos utilizados na estimativa de quantidade de alimentos consumidos entre os inquéritos permitiram atualizar a tabela de medidas caseiras e minimizar erros na estimativa dessa quantidade, com redução de unidades de medidas incoerentes ou incompatíveis com os alimentos citados.

A short education session increases the accuracy of estimated food records in young Korean women during a controlled-feeding study.

BACKGROUND/OBJECTIVES: Despite the widespread use of dietary assessment tools, the validity of food records has not been evaluated in Koreans. We assessed the accuracy of estimated food records and the effect of a short education session in young Korean women. SUBJECTS/METHODS: Thirty women (aged 18-23 yrs) each completed 3 food records during a controlled-feeding study. One educational session was provided on day 2 of the study. Food records were analyzed for the accuracy of food items and portion size estimation according to food group (grains; meat, fish, eggs, and beans; vegetables; fruit; dairy; and oils and sugars) and type of dish (rice, kimchi, soup, side dishes, spreads, beverages, and snacks). Reported food items were categorized as exact, close, or far matches, exclusions, or intrusions. Portion sizes were evaluated as accurate, similar, or inaccurate estimates, or missing. The means of days 2 and 3 were used to assess post-education results. Paired t-tests were performed to assess the effects of the education session. RESULTS: The mean percentages of exact matches, close matches, far matches, and exclusions on day 1 were 80.9%, 10.9%, 2.0%, and 6.2%, respectively, and mean intrusions observed were 0.1. The education session slightly increased the accuracy of recorded food items. The percentages of accurate, similar, and inaccurate estimates, and missing portion sizes were 11.7%, 19.8%, 12.2%, and 56.3%, respectively, at baseline. The percentage of missing portion size estimates decreased to 14.0% after the education session, resulting in an increase in the percentages of all other estimates. An increase was observed in the accuracy of reported portion sizes of vegetables, rice, and kimchi. CONCLUSIONS: In young Korean women, estimated food records are highly accurate for food items but not for portion size estimates without prior education. A short education session can improve the accuracy of portion size estimation. TRIAL REGISTRATION: Clinical Research Information Service Identifier: KCT0003307.

Is there a relationship between diet quality and bone health in elderly women? A cross-sectional study.

OBJECTIVE: To evaluate whether there is a relationship between diet quality and bone health in a group of elderly Brazilian women. METHODS: A cross-sectional study was performed with 105 elderly women. Participants were evaluated regarding diet quality (good, needing improvement, and poor) and its relationship with bone mineral density (BMD), bone-specific alkaline phosphatase (BSAP), and C-telopeptide (CTX). RESULTS: Fifty eight participants (55.2%) presented a poor-quality diet and 47 (44.8%) required dietary improvements, while no subjects presented a good quality diet. The group requiring dietary improvements had lower CTX [0.35 (0.05;1.09) vs. 0.52 (0.10;1.45); p = 0.03)] and BSAP (38.7 ± 12.9 U/L vs. 46.10 ± 15.2 U/L; p < 0.01) levels than the poor-quality diet group. Groups did not differ in terms of BMD. CONCLUSION: In this group of elderly Brazilian women, there was a relationship between diet quality and bone health, where worse diet quality was associated with higher levels of bone remodelling markers.

Abbreviated Dietary Self-monitoring for Type 2 Diabetes Management: Mixed Methods Feasibility Study.

BACKGROUND: Type 2 diabetes mellitus (T2D) can be managed through diet and lifestyle changes. The American Diabetes Association acknowledges that knowing what and when to eat is the most challenging aspect of diabetes management. Although current recommendations for self-monitoring of diet and glucose levels aim to improve glycemic stability among people with T2D, tracking all intake is burdensome and unsustainable. Thus, dietary self-monitoring approaches that are equally effective but are less burdensome should be explored. OBJECTIVE: This study aims to examine the feasibility of an abbreviated dietary self-monitoring approach in patients with T2D, in which only carbohydrate-containing foods are recorded in a diet tracker. METHODS: We used a mixed methods approach to quantitatively and qualitatively assess general and diet-related diabetes knowledge and the acceptability of reporting only carbohydrate-containing foods in 30 men and women with T2D. RESULTS: The mean Diabetes Knowledge Test score was 83.9% (SD 14.2%). Only 20% (6/30) of participants correctly categorized 5 commonly consumed carbohydrate-containing foods and 5 noncarbohydrate-containing foods. The mean perceived difficulty of reporting only carbohydrate-containing foods was 5.3 on a 10-point scale. Approximately half of the participants (16/30, 53%) preferred to record all foods. A lack of knowledge about carbohydrate-containing foods was the primary cited barrier to acceptability (12/30, 40%). CONCLUSIONS: Abbreviated dietary self-monitoring in which only carbohydrate-containing foods are reported is likely not feasible because of limited carbohydrate-specific knowledge and a preference of most participants to report all foods. Other approaches to reduce the burden of dietary self-monitoring for people with T2D that do not rely on food-specific knowledge could be more feasible.

Variedad en la calidad de la dieta en adultos españoles y mexicanos / Diet quality variety in Spanish and Mexican adults

La pérdida de patrones de alimentación tradicionales a favor de otros más occidentales redunda en un descenso de calidad de la dieta alrededor del mundo. Muchos aspectos determinan la calidad dietética, aunque en general pueden resumirse en una dieta moderada, variada, equilibrada y adecuada para cada individuo. Estos aspectos son evaluados por el Diet Quality Index-International (DQI-I). Objetivo: Comparar la calidad de la dieta de población mexicana y española mediante un índice de calidad internacional de la dieta, determinando que factores son en mayor medida responsables de la pérdida de calidad. Material y métodos: Estudio observacional transversal sobre una muestra representativa de sujetos adultos residentes en Querétaro (México) y de sujetos de la misma franja de edad procedentes de la Región de Murcia, en la cuenca mediterránea española. Se recogieron datos sociodemográficos, antropométricos, de frecuencia de consumo de alimentos y de ingesta con 3 recuerdos de 24 horas y se valoró el DQI-I en la población. Resultados: Se encontraron diferencias para el gasto energético y el DQI-I en todos sus aspectos con valores de calidad superiores para la población mexicana. La variedad fue la dimensión más castigada para todos los sujetos, presentando los mexicanos mejores cifras de consumo de vegetales pero peores para las fuentes proteicas. Conclusiones: La muestra mexicana mejoró las cifras de calidad de la española, tal vez por una mayor influencia de conocimientos en nutrición. El 86% de la población podría mejorar sus puntajes de calidad en el DQI-I ajustando sus frecuencias de consumo de alimentos(AU)

The loss of traditional eating patterns in favour of more Western ones results in a decline in dietary quality around the world. Many aspects determine dietary quality, but in general they can be summarised as a moderate, varied, balanced diet suitable for each individual. These aspects are assessed by the Diet Quality Index-International (DQI-I). Objective: To compare the quality of the diet of the Mexican and Spanish populations using an international diet quality index, determining which factors are most responsible for the loss of quality. Material and methods: Cross-sectional observational study on a representative sample of adult subjects living in Querétaro (Mexico) and subjects of the same age group from the Region of Murcia, in the Spanish Mediterranean basin. Sociodemographic, anthropometric, food frequency consumption and intake data were collected with 3 24-hour recall and the DQI-I was assessed in the population. Results: Differences were found for energy expenditure and DQI-I in all aspects with higher quality values for the Mexican population. Variety was the most punished dimension for all subjects, with Mexicans presenting better figures for vegetable intake but worse for protein sources. Conclusions: The Mexican sample improved the quality figures of the Spanish sample, perhaps due to a greater influence of nutritional knowledge. Eighty-six percent of the population could improve their DQI-I quality scores by adjusting their food consumption frequencies(AU)

The food diary as a pedagogical strategy in undergraduate nursing nutrition education: A student evaluation.

BACKGROUND: Few studies have evaluated educational nutrition activities in undergraduate nursing, and none have published how the established food assessment method, the food diary, can be used as a pedagogical method in this context. OBJECTIVE: To describe undergraduate nursing students' learning outcomes of basic nutrition and important elements for their learning after conducting a one-day food record with a subsequent seminar (henceforth: "the food diary method"). DESIGN: Cross-sectional. SETTING: Undergraduate nursing program in Sweden. PARTICIPANTS: 161 students. METHODS: Participants conducted a one-day food record by documenting their food intake and calculating the nutritional values. After completion, students participated in a seminar, and an evaluative questionnaire was distributed at the end. The questionnaires contained both numerical and free-text questions. RESULTS: Of 162 students attending the seminar, all but one completed the questionnaire (response rate: 99%). The highest rated learning outcome, on the 5-point Likert scale, was an increased understanding for the nutritional recommendations (Median, M = 5). The highest rated educational aspects were that they compared their records with the nutritional recommendations (M = 5), and the calculations of nutritional values of their records (M = 5). Participants also indicated that they gained information that would be useful for them as practicing nurses (M = 5). CONCLUSIONS: Overall, the food diary method appeared to be a feasible method in educating and engaging undergraduate nursing students in the field of basic nutrition. These findings support results from previous studies in this area, such that educational nutrition activities that utilize active, experiential, and social learning strategies were appreciated by the students.