Abstract
BackgroundAccurate assessment of fruit and vegetable intake (FVI) is essential for public health nutrition research and surveillance. Blood carotenoid concentrations are robust biomarkers of FVI, but collecting blood samples typically is not feasible in population-based studies. Understanding how well non-invasive measures compare to blood estimates is important for advancing surveillance and evaluation. The objective of this study was to examine the associations between serum carotenoids and four non-invasive measures of FVI in overweight and obese women.MethodsThis study utilized baseline data from 157 overweight or obese women (95.5% white, mean age 58.56 years ± 9.49 years) enrolled in the Strong Hearts, Healthy Communities randomized trial, including two direct measures of carotenoids and three self-reported measures of FVI. Participants completed a fasting blood draw, dermal carotenoid scans using resonance Raman spectroscopy (RRS), a two-item FVI screener modeled after the American Heart Association’s Life’s Simple 7 “My Life Check” tool (modified AHA tool), the National Cancer Institute’s All-Day Fruit and Vegetable Screener (FVS), multiple 24-h dietary recalls, physical measurements, and demographic and health behavior questions. We analyzed blood for total carotenoids and derived total FVI estimates from self-report tools. We used multivariate linear regression models to examine associations between each non-invasive tool and serum carotenoids under four scenarios analogous to different research contexts in which varying breadths of participant data are available. We also calculated adjusted Pearson’s correlations between serum carotenoids, dermal carotenoids, and the self-reported measures.ResultsDermal carotenoids were strongly correlated with serum carotenoids (0.71, P < 0.00067) and associated with serum carotenoids in all regression models (0.42–0.43, P < 0.002). None of the self-reported FVI measures were significantly associated with serum or dermal carotenoids in adjusted regression models or correlation analyses.ConclusionsCompared to self-reported FVI, we found dermal carotenoids measured by RRS to be a superior method to approximate serum carotenoids among overweight and obese women. More research is needed to investigate these assessment methods in diverse populations.Trial registrationClinicalTrials.gov Identifier: NCT02499731, registered July 16, 2015.
Highlights
Accurate assessment of fruit and vegetable intake (FVI) is essential for public health nutrition research and surveillance
Dermal carotenoids and FVI estimated by the modified American Heart Association (AHA) tool were significantly associated with serum carotenoids (Table 2)
In this study, we found that dermal carotenoid levels measured by Raman spectroscopy (RRS) were strongly associated with serum carotenoids; whereas, self-reported FVI measured by the two-item modified AHA tool, the validated National Cancer Institute (NCI) Fruit and Vegetable Screener (FVS), and multiple 24-h recalls using the Automated Self-Administered 24Hour (ASA24) were not associated with serum carotenoids
Summary
Accurate assessment of fruit and vegetable intake (FVI) is essential for public health nutrition research and surveillance. Blood carotenoid concentrations are robust biomarkers of FVI, but collecting blood samples typically is not feasible in population-based studies. Understanding how well non-invasive measures compare to blood estimates is important for advancing surveillance and evaluation. Dietary patterns high in fruit and vegetable intake (FVI) are associated with lower risks for multiple chronic, non-communicable diseases, cardiovascular disease and some cancers [1], and all-cause mortality [2]. Blood carotenoids are less suitable for studies focused on usual FVI, as they are influenced by recent dietary intake, with an estimated carotene halflife of less than 2 weeks [9]. Welldocumented weaknesses of self-reported dietary intake include recall or response bias for reasons related to memory, knowledge, and perceived social desirability; failure to capture seasonal variation in diet; the possibility that participants may alter eating behaviors in anticipation of reporting; and within-person random error due to day-to-day variation in food and drinks consumed [10,11,12]
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