Adherence to the EAT-Lancet Diet and Risk of Stroke and Stroke Subtypes: A Cohort Study.

BACKGROUND AND PURPOSE: We investigated the association between adherence to the EAT-Lancet diet, a sustainable and mostly plant-based diet, and risk of stroke and subtypes of stroke in a Danish population. For comparison, we also investigated the Alternate Healthy Eating Index-2010 (AHEI). METHODS: We used the Danish Diet, Cancer and Health cohort (n=55 016) including adults aged 50 to 64 years at baseline (1993-1997). A food frequency questionnaire was used to assess dietary intake and group participants according to adherence to the diets. Stroke cases were identified using a national registry and subsequently validated by review of medical records (n=2253). Cox proportional hazards models were used to estimate hazard ratios and 95% CIs for associations with the EAT-Lancet diet or the AHEI and risk of stroke and stroke subtypes. RESULTS: Adherence to the EAT-Lancet diet was associated with a lower risk of stroke, although not statistically significant (highest versus lowest adherence: hazard ratio, 0.91 [95% CI, 0.76-1.09]). A lower risk was observed for AHEI (0.75 [95% CI, 0.64-0.87]). For stroke subtypes, we found that adherence to the EAT-Lancet diet was associated with a lower risk of subarachnoid hemorrhage (0.30 [95% CI, 0.12-0.73]), and the AHEI was associated with a lower risk of ischemic stroke (0.76 [95% CI, 0.64-0.90]) and intracerebral hemorrhage (0.58 [95% CI, 0.36-0.93]). CONCLUSIONS: Adherence to the EAT-Lancet diet in midlife was associated with a lower risk of subarachnoid stroke, and the AHEI was associated with a lower risk of total stroke, mainly ischemic stroke and intracerebral hemorrhage.

Estimation of Sodium and Potassium Intake: Current Limitations and Future Perspectives.

Globally, average dietary sodium intake is double the recommended amount, whereas potassium is often consumed in suboptimal amounts. High sodium diets are associated with increased cardiovascular and renal disease risk, while potassium may have protective properties. Consequently, patients at risk of cardiovascular and renal disease are urged to follow these recommendations, but dietary adherence is often low due to high sodium and low potassium content in processed foods. Adequate monitoring of intake is essential to guide dietary advice in clinical practice and can be used to investigate the relationship between intake and health outcomes. Daily sodium and potassium intake is often estimated with 24-h sodium and potassium excretion, but long-term balance studies demonstrate that this method lacks accuracy on an individual level. Dietary assessment tools and spot urine collections also exhibit poor performance when estimating individual sodium and potassium intake. Collection of multiple consecutive 24-h urines increases accuracy, but also patient burden. In this narrative review, we discuss current approaches to estimating dietary sodium and potassium intake. Additionally, we explore alternative methods that may improve test accuracy without increasing burden.

Innovative approaches to estimate individual usual dietary intake in large-scale epidemiological studies.

Valid estimation of usual dietary intake in epidemiological studies is a topic of present interest. The aim of the present paper is to review recent literature on innovative approaches focussing on: (1) the requirements to assess usual intake and (2) the application in large-scale settings. Recently, a number of technology-based self-administered tools have been developed, including short-term instruments such as web-based 24-h recalls, mobile food records or simple closed-ended questionnaires that assess the food intake of the previous 24 h. Due to their advantages in terms of feasibility and cost-effectiveness these tools may be superior to conventional assessment methods in large-scale settings. New statistical methods have been developed to combine dietary information from repeated 24-h dietary recalls and FFQ. Conceptually, these statistical methods presume that the usual food intake of a subject equals the probability of consuming a food on a given day, multiplied by the average amount of intake of that food on a typical consumption day. Repeated 24-h recalls from the same individual provide information on consumption probability and amount. In addition, the FFQ can add information on intake frequency of rarely consumed foods. It has been suggested that this combined approach may provide high-quality dietary information. A promising direction for estimation of usual intake in large-scale settings is the integration of both statistical methods and new technologies. Studies are warranted to assess the validity of estimated usual intake in comparison with biomarkers.

Measuring diet in the 21st century: use of new technologies.

The advent of the internet and smartphone technology has allowed dietary assessment to reach the 21st century! The variety of foods available on the supermarket shelf is now greater than ever before. New approaches to measuring diet may help to reduce measurement error and advance our understanding of nutritional determinants of disease. This advance provides the potential to capture detailed dietary data on large numbers of individuals without the need for costly and time-consuming manual nutrition coding. This aim of the present paper is to review the need for new technologies to measure diet with an overview of tools available. The three main areas will be addressed: (1) development of web-based tools to measure diet; (2) use of smartphone apps to self-monitor diet; (3) improving the quality of dietary assessment through development of an online library of tools. A practical example of the development of a web-based tool to assess diet myfood24 (www.myfood24.org) will be given exploring its potential, limitations and challenges. The development of a new food composition database using back-of-pack information will be described. Smartphone apps used to measure diet with a focus on obesity will be reviewed. Many apps are unreliable in terms of tracking, and most are not evaluated. Accurate and consistent measurement of diet is needed for public health and epidemiology. The choice of the most appropriate dietary assessment method tends to rely on experience. The DIET@NET partnership has developed best practice guidelines for selection of dietary assessment tools, which aim to improve the quality, consistency and comparability of dietary data. These developments provide us with a step-change in our ability to reliably characterise food and nutrient intake in population studies. The need for high-quality, validated systems will be important to fully realise the benefits of new technologies.

Resultados de una encuesta nacional sobre la hipolactasia: ¿cómo se diagnostica y se maneja esta entidad en nuestro medio? / Results of a nation-wide survey on hypolactasia - How is this condition diagnosed and managed in our setting?

No disponible

[Effects of age, period, and cohort on the trends in obesity rate and energy intake ratio from fat in Japanese adults].

OBJECTIVES: In the present study, we aimed to clarify the specific effects of age, period, and cohort on trends in obesity rate and energy intake ratio from fat in Japanese adults using a Bayesian age-period-cohort (APC) analysis and to evaluate the relationship between changes in obesity rate and energy intake ratio from fat. METHODS: We obtained data regarding obesity rate and calorie intake of fat, animal fat, carbohydrate, protein, animal protein, and total energy intake of Japanese adults from the National Nutrition Survey. The data were tabulated for five 10-year age groups (from 20-29 years to 60-69 years) and 17 annual demographic profiles (from 1995 to 2011), with regard to the energy intake ratio. These standard cohort tables were analyzed using a Bayesian APC model. RESULTS: With regard to obesity rate, the effect of age was the greatest and increased rapidly in the age group of 30-39 years for both genders. Moreover, the period effect consistently increased in men, but had very little variation in women. The cohort effect indicated a reverse of the decreasing trend in the cohorts born after 1962-1971 in men and indicated a reverse of the increasing trend in the cohorts born after 1965-1974 in women. With regard to the energy intake ratio from fat, the trends for the three effects differed from those for obesity rate for both genders. The age effect generally decreased with increasing age. Furthermore, for both genders, the period effect gradually decreased after 1998 and markedly decreased in 2001, remained constant or slightly increased until 2008, and increased thereafter. However, the cohort effect was the greatest among the three, and although a decreasing trend was observed in the cohorts born after 1976-1985 in women, the energy intake from fat increased in the younger cohorts in both genders. The overall effect on energy intake ratio from animal fat had a slope similar to that of the energy intake ratio from fat. CONCLUSION: Each effect affected obesity and energy intake ratio from fat in a different manner, suggesting that factors other than energy intake ratio from fat, such as energy expenditure, contributed to the changes in obesity rate. However, obesity risk markedly increased in the age group of 30-39 years, and younger generations had a higher energy intake ratio from fat. These results suggest that dietary guidelines, particularly the optimal intake of animal products, is needed for younger generations to prevent the development of obesity in adulthood.

Trends in blood mercury concentrations and fish consumption among U.S. women of reproductive age, NHANES, 1999-2010.

BACKGROUND: Consumption of finfish and shellfish is the primary exposure pathway of methylmercury (MeHg) in the US. MeHg exposure in utero is associated with neurodevelopmental and motor function deficits. Regulations and fish advisories may contribute to decreased exposure to mercury over time. OBJECTIVES: Combine fish tissue mercury (FTHg) concentrations and 1999-2010 NHANES blood mercury concentrations and fish consumption data to investigate trends in blood mercury concentrations, fish consumption, and mercury intake in women of reproductive age. METHODS: Blood MeHg was calculated from the blood total and inorganic concentrations. Dietary datasets were combined to estimate 30-day fish consumption, then combined with FTHg concentrations to estimate mercury intake and mercury concentration in the fish consumed. Non-linear and logistic regression analyses were used to evaluate trends over time. RESULTS: Regression analysis found NHANES 1999-2000 to have higher blood MeHg concentrations than the mean of the later releases (p<0.0001) and a positive quadratic trend since 2000 (p=0.004). No trend was observed in fish consumption amount or mercury intake. A decreasing trend was found in the ratio of mercury intake to fish consumed (p=0.04). CONCLUSIONS: The analyses found blood MeHg concentrations in NHANES 1999-2000 to be significantly higher than the mean of the later releases. There was no trend in fish consumption amount across the study period. The analysis found a decreasing trend in the ratio of mercury intake to fish consumed, consistent with women shifting their consumption to fish with lower mercury concentrations.

Worldwide trends in dietary sugars intake.

Estimating trends in dietary intake data is integral to informing national nutrition policy and monitoring progress towards dietary guidelines. Dietary intake of sugars is a controversial public health issue and guidance in relation to recommended intakes is particularly inconsistent. Published data relating to trends in sugars intake are relatively sparse. The purpose of the present review was to collate and review data from national nutrition surveys to examine changes and trends in dietary sugars intake. Only thirteen countries (all in the developed world) appear to report estimates of sugars intake from national nutrition surveys at more than one point in time. Definitions of dietary sugars that were used include 'total sugars', 'non-milk extrinsic sugars', 'added sugars', sucrose' and 'mono- and disaccharides'. This variability in terminology across countries meant that comparisons were limited to within countries. Hence trends in dietary sugars intake were examined by country for the whole population (where data permitted), and for specific or combined age and sex subpopulations. Findings indicate that in the majority of population comparisons, estimated dietary sugars intake is either stable or decreasing in both absolute (g/d) and relative (% energy) terms. An increase in sugars intake was observed in few countries and only in specific subpopulations. In conclusion, the findings from the present review suggest that, in the main, dietary sugars intake are decreasing or stable. A consistent approach to estimation of dietary sugars intake from national nutrition surveys is required if more valid estimates of changes in dietary sugars intakes are required in the future.

Results of Fortification Rapid Assessment Tool (FRAT) surveys in sub-Saharan Africa and suggestions for future modifications of the survey instrument.

BACKGROUND: Food fortification has been increasingly recognized as a promising approach to prevent micronutrient deficiencies. The Fortification Rapid Assessment Tool (FRAT) was developed to assist public health program managers to acquire the information needed to implement an effective mass food fortification program. Multiple countries have conducted FRAT surveys, but information on results and experiences with the FRAT tool has been available only at the national level. OBJECTIVE: To summarize the findings of the FRAT surveys previously conducted in sub-Saharan Africa. METHODS: Surveys from 12 sub-Saharan African countries (Burkina Faso, Cameroon, Congo, Guinea, Malawi, Mali, Mauritania, Mozambique, Niger, Rwanda, Senegal, Uganda) were identified. Information on consumption patterns for wheat flour, vegetable oil, sugar, and bouillon cubes was reviewed and summarized. RESULTS: Most surveys found that a moderate to high proportion of women reported consuming wheat flour (48% to 93%), vegetable oil (44% to 98%), sugar (55% to 99%), and bouillon cubes (79% to 99%) in the past 7 days, although consumption was more common and more frequent in urban areas than in rural areas. Similarly, the reported amounts consumed during the previous 24 hours were generally higher in urban settings. CONCLUSIONS: The FRAT instrument has been successfully used in multiple countries, and the results obtained have helped in planning national food fortification programs. However, the recommended sampling scheme may need to be reconsidered, and the guidelines should be revised to clarify important aspects of fieldworker training, implementation, data analysis and interpretation, and reporting of the results.

Custo da alimentação e densidade energética da dieta no Brasil, 2008-2009 / Cost and energy density of diet in Brazil, 2008-2009

Este estudo tem por objetivo avaliar a relação entre o custo da alimentação e a densidade energética da dieta consumida nos domicílios brasileiros. Utilizaram-se dados da Pesquisa de Orçamentos Familiares (POF-2008/2009) para identificação dos alimentos com consumo mais relevante e seus preços. Tais alimentos foram agrupados, resultando em uma cesta de 67 produtos. Empregou-se a programação linear para composição de cestas isoenergéticas, minimizando o afastamento da dieta média encontrada nos domicílios. Foram impostos limites para quantidade de inclusão dos itens e contribuição energética dos grupos de alimentos; e uma redução no custo médio da dieta foi aplicada a intervalos de R$0,15 até o menor custo possível. Identificou-se associação inversa entre densidade energética e preço da dieta (p < 0,05), e, no menor custo possível, obteve-se o valor máximo de densidade energética. Verificou-se que restrições no custo da alimentação resultaram na seleção de dietas com maior densidade energética, indicando que o custo da alimentação pode conduzir à adoção de dietas inadequadas no Brasil.

This study aimed to evaluate the relationship between the cost and energy density of diet consumed in Brazilian households. Data from the Brazilian Household Budget Survey (POF 2008/2009) were used to identify the main foods and their prices. Similar items were grouped, resulting in a basket of 67 products. Linear programming was applied for the composition of isoenergetic baskets, minimizing the deviation from the average household diet. Restrictions were imposed on the inclusion of items and the energy contribution of the various food groups. A reduction in average cost of diet was applied at intervals of R$0.15 to the lowest possible cost. We identified an inverse association between energy density and cost of diet (p < 0.05), and at the lowest possible cost we obtained the maximum value of energy density. Restrictions on the diet's cost resulted in the selection of diets with higher energy density, indicating that cost of diet may lead to the adoption of inadequate diets in Brazil.

[The past, present and future of food consumption databases]. / Az élelmiszer-fogyasztási adatbázisok múltja, jelene és jövoje.

Results of the food consumption surveys are utilized in many areas, such as for example risk assessment, cognition of consumer trends, health education and planning of prevention projects. Standardization of national consumption data for international comparison is an important task. The intention work began in the 1970s. Because of the widespread utilization of food consumption data, many international projects have been done with the aim of their harmonization. The present study shows data collection methods for groups of the food consumption data, their utilization, furthermore, the stations of the international harmonization works in details. The authors underline that for the application of the food consumption data on the international level, it is crucial to harmonize the surveys' parameters (e.g. time of data collection, method, number of participants, number of the analysed days and the age groups). For this purpose the efforts of the EU menu project, started in 2012, are promising.

Automation of Food Questionnaires in Medical Studies: a state-of-the-art review and future prospects.

Applications for automating the most commonly used dietary surveys in nutritional research, Food Frequency Questionnaires (FFQs) and 24 h Dietary Recalls (24HDRs), are reviewed in this paper. A comprehensive search of electronic databases was carried out and findings were classified by a group of experts in nutrition and computer science into: (i) Computerized Questionnaires and Web-based Questionnaires; (ii) FFQs and 24HDRs and combinations of both; and (iii) interviewer-administered or self-administered questionnaires. A discussion on the classification made and the works reported is included. Finally, works that apply innovative technologies are outlined and the future trends for automating questionnaires in nutrition are identified.

Índice de alimentación saludable en mujeres adolescentes de Morelos, México / The healthy eating index in female adolescents from Morelos, Mexico

Fundamentos: Son escasos los instrumentos para la valoración de la calidad de la dieta en poblaciones. Uno es The Healthy Eating Index (HEI), creado en Estados Unidos en 1995; el objetivo del presente trabajo fue conocer la calidad de la alimentación de mujeres adolescentes de la zona oriente del estado de Morelos, México, adecuando este índice a la población mexicana. Métodos: Se realizó un estudio transversal. Se aplicaron encuestas alimentarias con Recordatorio de 24 horas de un día a 514 adolescentes, para calcular el consumo de alimentos de acuerdo al Sistema Mexicano de Alimentos Equivalentes y se comparó con la recomendación para la edad, las metas nutricionales y la variedad de la dieta. Resultados: La edad promedio del grupo fue de 13,8 años (DE 1,2). El Índice de Masa Corporal promedio de las participantes fue de 20,3 kg/m2 (DE 3,2). Sólo el 1% de esta población tiene una alimentación de buena calidad, según la recomendación establecida para la edad usando el HEI. Conclusiones: Fue posible evaluar la calidad de la dieta de las adolescentes del estudio modificando el HEI, a población mexicana. El 98,8% de la población de estudio tuvo una alimentación poco saludable, o necesita realizar modificaciones en ella (AU)

Background: The instruments for the assessment of the quality of the diet in populations are scarce. One is The Healthy Eating Index (HEI) created in the United States in 1995. The aim of the present work was to assess the quality of the diet of adolescent women in the eastern area of the Morelos state , Mexico, adapting this index to the Mexican population. Methods: We conducted a cross-sectional study. Applied food consumption surveys with a 24-hour dietary recalls to 514 adolescents, in order to calculate the consumption of food according to the Mexican System of Food Equivalents and compared this with the age recommendations, the nutritional goals and the variety of the diet. Results: The average age of the group was 13.8 years (1.2). The Body Mass Index average of the participants was 20.3 kg/m2 (3.2). Only 1% of the population has a diet of good quality, according to the recommendation for the age using the HEI. Conclusions: It was possible to evaluate the quality of the diet of the adolescents in the study by modifying the HEI, according to the Mexican population. 98.8% of the population studied had an unhealthy diet, or they need to make modifications to it (AU)

[Cost and energy density of diet in Brazil, 2008-2009]. / Custo da alimentação e densidade energética da dieta no Brasil, 2008-2009.

This study aimed to evaluate the relationship between the cost and energy density of diet consumed in Brazilian households. Data from the Brazilian Household Budget Survey (POF 2008/2009) were used to identify the main foods and their prices. Similar items were grouped, resulting in a basket of 67 products. Linear programming was applied for the composition of isoenergetic baskets, minimizing the deviation from the average household diet. Restrictions were imposed on the inclusion of items and the energy contribution of the various food groups. A reduction in average cost of diet was applied at intervals of R$0.15 to the lowest possible cost. We identified an inverse association between energy density and cost of diet (p < 0.05), and at the lowest possible cost we obtained the maximum value of energy density. Restrictions on the diet's cost resulted in the selection of diets with higher energy density, indicating that cost of diet may lead to the adoption of inadequate diets in Brazil.