Usefulness of a short food frequency questionnaire for screening of low intake of fruit and vegetable and for intake of fat.

In Mexico, the 2012 National Health and Nutrition Survey estimated that 65.6% of the schoolchildren aged 5-11 years has inadequate intake of fruits and vegetables. This study was conducted to validate and determine the reproducibility of a short Food Frequency Questionnaire (FFQ) designed to measure changes in fruit and vegetable intake in schoolchildren from Northwest Mexico. To the development of the FFQ, a total of 249 Dietary Recalls (24HR) were collected from 189 schoolchildren. To evaluate validity and reproducibility, two non-consecutive 24HR (as reference method) and two FFQ were collected from 124 schoolchildren. They were randomly divided into two groups: intervention (62) used for reproducibility and control (62) to evaluate validity. The intervention group received a program that promotes consumption of fruits and vegetables for a period of 6 months. Spearman correlations, Wilcoxon test and Bland-Altman plots were used to assess validity. Reproducibility statistics included Spearman correlations, Percent agreement and Weighted Kappa (κw) test and Bland-Altman plot. For validity, the mean intake estimated did not differ significantly for vegetable and the combined vegetable and fruit but it was different in fruit intake. There was a moderate correlation between FFQ1 and the 24HR to estimate the consumption of fruit or vegetable (r = 0.38, r = 0.48) and improves for fruit and vegetables combined (r = 0.69) and the bland and altman plot, showed a homogeneous dispersion of points around the line of the differences for the consumption of fruit and vegetable. For FFQ reproducibility the spearman coefficient values ranged from 0.47 for fruit intake to 0.73 for vegetable and fruit combined intake. Cross-classification between the two methods showed that > 30% of subjects were classified correctly and the κw ranged between 0.425 for fruit to 0.605 for vegetable and fruit, indicating from moderate to substantial level of agreement. The results on validation and reproducibility indicate that the two methods (FFQ and 24HR) give similar results. Food frequency questionnaire has validity and reproducibility to evaluate intake of fruit and vegetable in schoolchildren from northwest Mexico, and can be used to evaluate changes in fruit and vegetable intake on intervention programs, specially aimed to increase the consumption of such food.

Does Lowering Fat Intake in Children's Diets Result in Increasing Fruit and Vegetable Intake?: Data from the Child and Adolescent Trial for Cardiovascular Health (CATCH)

The relationship between Fruit and vegetable intake and frailty: Data from NHANES 2007–2018

Introduction: While saturated fat (SFA) intake has long been considered as an important risk factor for cardiovascular disease (CVD), some evidence in recent years has called these findings into question. There is limited evidence examining the separate effects of SFAs from different food sources on cardiovascular risk. Objective: The goal of this study was to determine whether higher (vs. lower) intakes of SFA from dairy and non-dairy sources were associated with risk of incident cardiovascular disease. Methods: Data from 1991 adults, ages 30 and older, who were free of CVD at the time of baseline dietary assessment in the prospective Framingham Offspring Study were included in these analyses. Dairy and non-dairy SFA was assessed using 3-day diet records at exams 3 and 5; intakes were adjusted for body weight using the residual method. Subjects were followed from exam 5 to exam 9 for CVD events (median follow-up 16.9 years). Cox proportional hazards models were used to adjust for confounding by sex, age, BMI, physical activity, smoking (pack-years), non-dairy SFA (in dairy SFA models, and vice versa for non-dairy models), and time dependent occurrence of hypertension or use of lipid-lowering medications. Results: Subjects were classified into 3 categories of sex-specific intake of dairy SFA (<9, 9-<13, and ≥13 g/day for men; <6, 6-<9, ≥9 g/day for women) and non-dairy SFA (<15, 15-<18 and ≥18 g/day for men; <12, 12-<15, and ≥15 g/day for women). Women with moderate (vs. low) and high (vs. low) dairy SFA intakes had 56% (95% CI: 0.27-0.71) and 20% (95% CI: 0.56-1.14) lower CVD risks, respectively, while women consuming high (vs. low) non-dairy SFA had 22% (CI: 0.52-1.16) lower risks. Neither dairy-based SFA nor non-dairy SFA intake was associated with CVD occurrence in men. To determine whether the combined effects of SFA from dairy and non-dairy sources were associated with CVD risk, we cross-classified SFA intakes from the two sources (i.e., high/low dairy SFA intake: <9 vs. ≥9 g/day for men, <6 vs ≥6 g/day for women; high/low non-dairy SFA intake: <15 vs. ≥15 g/day for both men & women). Overall, subjects with higher intakes of dairy SFA combined with lower intakes of non-dairy SFA had the lowest risks of CVD (HR:0.73; 95% CI: 0.54-0.98). These effects were stronger in women (HR:0.60; 95% CI: 0.41-0.88), and non-statistically significant in men (HR: 0.88; 95% CI: 0.54-1.43). Women with higher combined intakes of SFA from both dairy and non-dairy sources still had 44% lower risks of CVD. However, higher intakes of SFA from non-dairy sources alone was not associated with CVD risk in either men or women. Conclusions: Saturated fats derived from dairy sources were associated with a reduced risk of incident CVD in women. For both men and women, those who had higher intakes of dairy-derived SFA combined with lower intakes of non-dairy SFA tended to have lower risks of CVD than those with lower intakes of SFA from both sources.

BackgroundFrequency of eating breakfast, lunch and evening meal as a determinant of fruit and vegetable intake among young people is little studied. We investigated whether irregular meal consumption was associated with fruit and vegetable intake among adolescents. We used separate analyses, and special emphasis was on the potentially modifying effect of sex and age.MethodsData were from the Danish contribution to the international collaborative Health Behavior in School-Aged Children Study (HBSC) in 2002. We used a questionnaire-based, cross-sectional design to study schoolchildren aged 11, 13 and 15 years (n = 3913) selected from a random sample of schools in Denmark. Fruit intake and vegetable intake were measured by a food frequency questionnaire and analyses were conducted using multivariate logistic regression.ResultsOverall, statistically significant associations were found between irregular breakfast, lunch and evening meal consumption and low frequency of fruit intake and vegetable intake (breakfast: fruit OR = 1.42, vegetables OR = 1.48; lunch: fruit OR = 1.68, vegetables OR = 1.83; evening meal: vegetables OR = 1.70). No association was found for irregular evening meal consumption and low frequency of fruit intake. Analyses stratified by sex showed that the associations between irregular breakfast consumption and both fruit and vegetable intake remained statistically significant only among girls. When analyses were stratified by both sex and age, different patterns appeared. Overall, skipping meals seemed to be a less serious risk factor for low frequency of fruit and vegetable intake among younger participants compared with those who were older. This was especially evident for skipping breakfast. The same tendency was also seen for skipping lunch and evening meal, although the age pattern varied between boys and girls and between fruit and vegetable intake.ConclusionOur results showed that irregular breakfast, lunch and evening meal consumption among adolescents was associated with a low frequency of fruit and vegetable intake and that sex and age may play a modifying role. The different associations observed in different age and sex groups indicate the importance of analysing fruit and vegetable intake and meal types separately. The results highlight the importance of promoting regular meal consumption when trying to increase the intake of fruit and vegetables among adolescents.

BackgroundEating patterns in Western industrialized countries are characterized by a high energy intake and an overconsumption of (saturated) fat, cholesterol, sugar and salt. Many chronic diseases are associated with unhealthy eating patterns. On the other hand, a healthy diet (low saturated fat intake and high fruit and vegetable intake) has been found important in the prevention of health problems, such as cancer and cardio-vascular disease (CVD). The worksite seems an ideal intervention setting to influence dietary behavior. The purpose of this study is to present the effects of a worksite environmental intervention on fruit, vegetable and fat intake and determinants of behavior.MethodsA controlled trial that included two different governmental companies (n = 515): one intervention and one control company. Outcome measurements (short-fat list and fruit and vegetable questionnaire) took place at baseline and 3 and 12 months after baseline. The relatively modest environmental intervention consisted of product information to facilitate healthier food choices (i.e., the caloric (kcal) value of foods in groups of products was translated into the number of minutes to perform a certain (occupational) activity to burn these calories).ResultsSignificant changes in psychosocial determinants of dietary behavior were found; subjects at the intervention worksite perceived more social support from their colleagues in eating less fat. But also counter intuitive effects were found: at 12 months the attitude and self-efficacy towards eating less fat became less positive in the intervention group. No effects were found on self-reported fat, fruit and vegetable intake.ConclusionThis environmental intervention was modestly effective in changing behavioral determinant towards eating less fat (social support, self-efficacy and attitude), but ineffective in positively changing actual fat, fruit and vegetable intake of office workers.

Variation in food and nutrient intakes among older men: Age, and other socio-demographic factors

Computerized Portion-Size Estimation Compared to Multiple 24-Hour Dietary Recalls for Measurement of Fat, Fruit, and Vegetable Intake in Overweight Adults

Eating Pattern Analyses: The Whole Is More than the Sum of Its Parts

Changes in dietary intake after diagnosis of breast cancer

This thesis describes the studies on body composition and dietary intakes of the three major ethnic groups residing in Singapore, and how these are related to cardiovascular risk factors in these groups.Body composition : Body fat percentage was measured using a four-compartment model described by Baumgartner. When the relationship between body mass index (BMI) and body fat percentage was studied, it was discovered that Singaporeans have higher percentage of body fat compared to Caucasians with the same BMI and that the BMI cut-off value for obesity in Chinese and Malays is around 27 kg/m 2 , while that for Indians is around 26 kg/m 2 . At levels of BMI and waist-to-hip ratio which are much lower than the WHO recommended cut-off limits for obesity and abdominal fatness respectively, both the absolute and relative risks of developing cardiovascular risk factors are markedly elevated for all three ethnic groups. Both the excessive fat accumulation and increased risks at low levels of BMI signal a need to re-examine cut-off values for obesity among Chinese, Malays and Indians.Diet : Dietary intakes of energy, total fat, saturated fat, polyunsaturated fat, monounsaturated fat and cholesterol were measured using a food frequency questionnaire specially validated for this purpose. In addition, intakes of fruits, vegetables and grain-based foods were also measured using the same questionnaire. Singaporeans generally have a low intake of fruits, vegetables and whole grain products. The intake of total fat is just within the upper recommended limit while that for saturated fat is higher than the recommended level. On a group level, it is found that high intakes of fat, saturated fat and low intakes of polyunsaturated fat and vegetables affect serum cholesterol levels adversely. However, on an individual level, due to the rather homogenous intake patterns among the three groups, this cross sectional study was unable to demonstrate that dietary intakes could explain the differences in serum cholesterol levels among ethnic groups.In summary, the thesis shows that in the light of increased body fat percentage and cardiovascular risks at low BMI, there is a need to re-examine the WHO's cut-off values for the three major ethnic groups in Singapore. Longitudinal studies are also needed for better insight into the effect of dietary intakes and other lifestyle risk factors on cardiovascular risk factors and mortality.

EPIC is a prospective multi-center study coordinated by the International Agency for Research on Cancer (IARC) operating under the WHO which commenced in 1993 with the collecting of data and blood samples at twenty-three centers in ten European countries (Germany, Denmark, Spain, France, Greece, the Netherlands, Italy, Norway, the United Kingdom and Sweden). In Spain, this study was conducted in five geographic areas (Asturias, Granada, Guipuzcoa, Murcia and Navarre). This study included a total of 519,978 individuals (366,521 of whom were females), blood samples for laboratory analysis being available for a total of 385,719 of these individuals. To date, a total of 24,195 incident cancer cases have been identified. The results of the food intake comparison among the twenty-three European centers were published in 2002, in a European Nutrition journal supplement. The initial EPIC results concerning the relationship between diet and cancer show the intake of fiber, fruits and vegetables to have an effect on protect against colon and rectal cancer, the intake of fruits to have an effect on protect against lung cancer and the intake of fruits and vegetables on the upper digestive tract, whilst a high intake of fruits and vegetables has been shown to have no effect on prostate cancer. Using a seven-day diary for evaluating saturated fat intake, a high intake of saturated fats has been shown to increase the risk of breast cancer.

Fruit and vegetable intake is inversely associated with cancer risk in many epidemiological studies. Accurate assessment of consumption of these foods is difficult, and biomarkers of intake would overcome several drawbacks of currently used dietary assessment methods. Therefore, we investigated the relation between plasma carotenoids and usual vegetable and fruit intake. Plasma carotenoid concentrations were measured and vegetable, fruit and juice consumption was assessed by a food frequency questionnaire (FFQ) in a random sample of 591 Dutch men and women aged 20-59 y from the MORGEN-project, one of the contributions to the European Prospective Investigation into Cancer and Nutrition (EPIC)-study. In this sample of the general Dutch population, in both genders, relative to the other carotenoids, plasma beta-cryptoxanthin was the best indicator for fruit intake, and for the sum of vegetable, fruit and juice intake, while lutein concentrations best reflected intake of vegetables, although quartiles of intake were not consistently separated. Since levels of lycopene were not associated with any of the main food groups examined, associations with total carotenoids improved when excluding lycopene, and monotonously increasing plasma levels were seen for intakes of vegetables, of fruits, and of the sum of vegetables, fruits and juices. Several vegetable types and orange/grapefruit juice were associated with plasma levels of one of the carotenoids. Plasma carotenoids were only crude indicators of vegetable and fruit intake as assessed by a FFQ; beta-cryptoxanthin for fruit intake and lutein for vegetable intake. None of the plasma carotenoids could distinguish all four quartiles of vegetables, fruit and/or juice intake.

BackgroundMulti-factorial intervention studies have been found to be successful in the initiation of lifestyle changes. However, little is known about the longer-term maintenance of health behavior improvements. The purpose of this study was to investigate whether improvements in physical activity and dietary habits achieved in a population-based multi-factorial lifestyle intervention of five years duration were maintained five years after intervention activities have ended.MethodsThe study was a population-based randomized controlled trial, Inter99 (1999–2006), Copenhagen, Denmark. Over five years, all participants in the intervention group (n = 6,091) received individual lifestyle counseling; participants at high risk of ischemic heart disease – according to pre-specified criteria – were also offered group-based counseling. The control group (n = 3,324) was followed by questionnaires. Both groups were followed one, three, five, and ten years after baseline. Changes in physical activity and dietary habits (intake of vegetables, fruit, fish, and saturated fat) during and after the intervention were investigated using random-coefficient models.ResultsFive years after the intervention, women in the intervention group reported greater improvements in the intake of fruit (MΔ = 90.2 g/week, p = 0.041) and less intake of saturated fat (OR = 0.30, 95% CI: 0.17–0.54) than the control group. Men in the intervention group reported greater improvements in physical activity (MΔ = 19.6 min/week, p = 0.003) and less intake of saturated fat (OR = 0.31, 95% CI: 0.17–0.56) than the control group. Improvements in the intake of vegetables and fish achieved during the intervention were not maintained in the longer-term.ConclusionsScreening and lifestyle counseling had sustained effects on physical activity and dietary habits five years after its discontinuation. The patterns of long-term changes in lifestyle differed across behaviors and between men and women.Trial registrationClinicalTrials.gov (NCT00289237)

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