Harvard Food Frequency Questionnaire Research Articles

Ultra-Processed Food, Disease Activity, and Inflammation in Ulcerative Colitis: The Manitoba Living With IBD Study.

The purpose of this study was to investigate the relationship between ultra-processed food (UPF) consumption and (i) symptomatic disease and (ii) intestinal inflammation among adults with inflammatory bowel disease (IBD). We identified participants (Crohn's disease [CD] and ulcerative colitis [UC]) from the Manitoba Living with IBD study. Active disease was defined using the IBD Symptom Inventory (score >14 for CD; >13 for UC); fecal calprotectin was measured for intestinal inflammation (>250 μg/g). Diet data were collected using the Harvard Food Frequency Questionnaire. UPF consumption was determined by the NOVA classification system. Percentage of energy consumption from UPFs was calculated and divided into 3 tertiles (T1 = low; T3 = high). Multiple linear regression analysis was used for active disease and inflammation predicted by UPF consumption. Among 135 participants (65% with CD), mean number of episodes of active disease (14.2 vs 6.21) and active inflammation (1.6 vs 0.6) was significantly higher among participants with UC in T3 compared with T1 of UPF consumption ( P < 0.05). When adjusting for age, sex, disease type, and duration, number of episodes of active disease was lower in T1 compared with T3 (β = -7.11, P = 0.02); similarly, number of episodes of intestinal inflammation was lower in T1 (β = -0.95, P = 0.03). No significant differences were observed among participants with CD. UPF consumption may be a predictor of active symptomatic disease and inflammation among participants with UC. Reducing UPF consumption is a dietary strategy that can be suggested for minimizing symptoms and inflammation among people living with IBD.

Construct Validation of the Dietary Inflammatory Index (DII) among Young College-Aged Women.

The Dietary Inflammatory Index (DII) is designed to assess the inflammatory potential of the diet. While previous research has utilized DII among college-aged women, no study to date has validated it in this population. We conducted a construct validation of DII among 393 healthy women aged 18-31 years against a robust panel of 14 inflammatory biomarkers, including CRP, IL-1β, IL-4, IL-6, IL-10, and TNF-α, which were used in the development of DII. Three linear regression models were constructed: (1) an age-adjusted model, (2) the most parsimonious model based on likelihood ratio tests, and (3) a fully adjusted model for age, race, body mass index, waist circumference, physical activity, smoking status, and nonsteroidal anti-inflammatory drug use. DII was derived from the Harvard food frequency questionnaire and categorized into quartiles. Consistent with our hypothesis, DII was negatively and significantly associated with back-transformed IL-10 levels, confirming that a more pro-inflammatory diet was associated with lower levels of an anti-inflammatory cytokine (Model 3: Q4 vs. Q1 β = 0.62; 95% CI: 0.42, 0.93; p-trend = 0.04). While validated in other populations, DII may not be a suitable tool for assessing the inflammatory potential of the diet among college-aged women.

Associations Between Dietary Vitamin C, Serum Ascorbic Acid, and GSTT1 Genotype and Premenstrual Symptoms

Objective Premenstrual symptoms are a cyclically occurring combination of adverse psychological and somatic symptoms that impact the quality of life for most females of childbearing age. Growing evidence suggests that diet may attenuate premenstrual symptoms; however, the relationship between vitamin C and premenstrual symptoms remains unclear. The aim of the research was to determine the association between different measures of vitamin C status and premenstrual symptoms. Method Females (n = 555) aged 20 to 29 years from the Toronto Nutrigenomics and Health Study completed a General Health and Lifestyle Questionnaire, capturing 15 premenstrual symptoms. Dietary intake was measured using a 196-item Toronto-modified Harvard food frequency questionnaire. Serum ascorbic acid concentrations were measured, and participants were categorized into deficient (<11 µmol/L), suboptimal (11–28 µmol/L), and adequate (>28 µmol/L) ascorbic acid levels. DNA was genotyped for the GSTT1 (Ins/Del) polymorphism. Using logistic regression, odds of experiencing premenstrual symptoms were compared between vitamin C intake levels above and below the recommended daily allowance (75 mg/d) between ascorbic acid levels and between GSTT1 genotypes. Results Increased vitamin C intake was associated with premenstrual appetite changes (OR, 1.65; 95% CI, 1.01–2.68). Compared to deficient ascorbic acid levels, suboptimal levels were associated with premenstrual appetite changes (OR, 2.59; 95% CI, 1.02–6.58) and bloating/swelling (OR, 3.00; 95% CI, 1.09–8.22). Adequate serum ascorbic acid levels were not associated with premenstrual appetite changes (OR, 1.69; 95% CI, 0.73–3.94) or bloating/swelling (OR, 1.92; 95% CI, 0.79–4.67). Those with the GSTT1 functional variant (Ins*Ins) had an increased risk of premenstrual bloating/swelling (OR, 1.96; 95% CI, 1.10–3.48); however, the interaction between vitamin C intake and GSTT1 was not significant for any premenstrual symptoms. Conclusions Our findings suggest that indicators of higher vitamin C status are associated with increased premenstrual appetite changes and bloating/swelling. The observed associations with GSTT1 genotype suggest that these observations are not likely due to reverse causation.

Reproducibility and validity of the Toronto-modified Harvard food frequency questionnaire in a multi-ethnic sample of young adults.

To assess the reproducibility and validity of a Toronto-modified Harvard food frequency questionnaire (FFQ) among a multi-ethnic sample of young adults. A total of 150 participants recruited from the Toronto Nutrigenomics and Health Study cohort who had existing dietary intakes assessed by FFQ (FFQ1) and reassessment one year later (FFQ2). Of these, 100 participants also completed a three-day food record to evaluate the validity of the FFQ for 38 nutrients (energy, 14 macronutrients, 22 micronutrients, and 1 bioactive). Analyses were also stratified between the two major ethnic groups (Caucasian and East Asian). Among the full sample, mean intakes of most nutrients (27/38) did not differ significantly between estimates derived from FFQ2 compared to the three-day food record. Energy, sex, and ethnicity adjusted deattenuated Pearson correlation coefficients ranged from 0.20 to 0.92 (mean r = 0.52 ± 0.15), and 34/38 validity coefficients were r ≥ 0.32. Gross misclassification of intakes between FFQ2 and the three-day food record was low (<6%), but energy, polyunsaturated fatty acids (PUFA), and sodium were underestimated by FFQ2. Mean intakes between FFQ1 and FFQ2 did not differ significantly for any nutrient. Between the two major ethnic groups, mean validity coefficients were similar, but varied for individual nutrients with saturated fat, PUFA, and omega 3 being among the most discrepant. Compared to a three-day food record, the Toronto-modified Harvard FFQ is a reproducible and valid tool to estimate dietary intake among a multi-ethnic sample of young adults. However, incorporation of protocols to improve the assessment of culturally diverse diets should be considered.

Macronutrient and Micronutrient Intake in Adolescents With Non-alcoholic Fatty Liver Disease: The Association With Disease Severity.

While dietary changes are recommended to treat pediatric non-alcoholic fatty liver disease (NAFLD), the role of specific nutrients in disease progression is unclear. The objective of this study is to (1) assess the macronutrient and micronutrient intake in adolescents with liver biopsy proven NAFLD [with and without non-alcoholic steatohepatitis (NASH)] and lean controls; (2) determine nutritional predictors of disease severity amongst these groups. Adolescents with biopsy-proven NAFLD and lean controls completed the Harvard Food Frequency Questionnaire. Twenty-eight NAFLD and 15 lean controls were studied. NAFLD with (n = 20) and without NASH (n = 8) had similar total calorie, protein, fat, and carbohydrate intake. Subjects with NASH had higher total sugar (122.3 ± 48.3 vs 83.1 ± 38.8 g), glucose (24.3 ± 9.3 vs 15.2 ± 7.5 g), sucrose (42.3 ± 16.9 vs 28.8 ± 11.7 g), and fructose (29.4 ± 12.5 vs 18.1 ± 8.0 g) intake than those with NAFLD but without NASH ( P < 0.05). Both NAFLD groups had similar micronutrient intake. Alanine aminotransferase (ALT) correlated with total caloric intake ( ρ = 0.4; P = 0.04). Total carbohydrate calories correlated with a higher NAS summary score ( ρ = 0.38; P = 0.04) and lobular inflammation ( ρ = 0.50; P = 0.007). Percent calories from added sugar and glucose correlated with worsening NAS summary score ( ρ = 0.44, P = 0.02; ρ = 0.48, P = 0.009) and lobular inflammation ( ρ = 0.51, P = 0.006; ρ = 0.53, P = 0.004). Percent calories from fructose correlated with lobular inflammation ( ρ = 0.56; P = 0.002). Total daily calories, protein, fat, carbohydrate, and micronutrient intake were similar between NAFLD and lean controls. NASH patients consume similar total calories, protein, and fat as those without NASH, but have significantly higher sugar intake. NAFLD and lean children, however, have similar macro/micronutrient intake. Histologic disease severity correlates with total carbohydrate and added sugar intake, supporting a role for simple sugar intake in NAFLD progression.

Intake of Flavonoids and Odds of Frailty Onset in Adults in the Framingham Offspring Cohort

Polyphenols (antioxidants derived from plant-foods) could play a role in inhibition of oxidative stress and frailty reduction, yet data on the polyphenol subclass of dietary flavonoids is limited. This study sought to determine the association between dietary flavonoids and frailty onset in middle-aged and older adults. This prospective cohort study included non-frail individuals from the Framingham Offspring Cohort (FOC) with total flavonoid intake (mg/day; defined as sum flavonols, flavan-3-ols, flavonones, flavones, and anthocyanins via Harvard Food Frequency Questionnaire), frailty (via Fried phenotype), and covariate information measured at baseline (1998-2001). Follow-up frailty was evaluated in 2011-2014. Logistic regression estimated odds ratio (OR) and 95% confidence intervals (95% CI) adjusting for relevant confounders. Participants (n=1,701; 55.5% female) had a mean age of 58.4 years (SD ± 8.3). Mean flavonoid intake was 309 mg/d (SD ± 266). After 12.4 years (SD ± 0.8), 224 (13.2%) individuals exhibited frailty. In age and sex adjusted models, every 50 mg/day of higher total flavonoid intake was associated with 3% reduced odds of frailty [OR (95%CI): 0.97 (0.94-1.00), p-value: 0.05). Further adjustment for smoking, energy and protein intake, and disease indicators did not appreciably change the association, and associations became non-significant (p-value=0.12). Thus, there was no association between flavonoid intake and odds of frailty onset in adults in the FOC. This could be due to participants' higher intake of flavonoids compared to average intake of ~200 mg/d in Americans.

The complex relationship between diet, symptoms, and intestinal inflammation in persons with inflammatory bowel disease: The Manitoba Living With IBD Study.

We aimed to examine whether an association exists between diet quality, based on the Prospective Urban Rural Epidemiology (PURE) Healthy Diet Score (HDS), and active inflammatory bowel disease (IBD). Participants were drawn from the Manitoba Living With IBD Study cohort. The Harvard Food Frequency Questionnaire (FFQ) was used to calculate the HDS at two time points: baseline and 1-year follow-up. Using generalized estimating equations (GEE) logistic regression, we assessed the association between the HDS and (1) the IBD Symptom Inventory (IBDSI); (2) intestinal inflammation, measured by fecal calprotectin (FCAL); and (3) self-reported IBD flares. There were 294 completed FFQs among 153 people. Of these, 100% had completed data about an IBD flare, 98% had FCAL measurements, and 96% had completed IBDSI scores. On a HDS scoring method of 0-8, the odds of FCAL >250 mcg/g were lower for participants with a HDS of 4 vs 0-3 (adjusted odds ratio [OR], 0.38; 95% CI, 0.19-0.77). When applying a second HDS scoring method (8-40), the odds of having an IBD flare were 3.6 times greater with a HDS between 21 and 24 compared with an HDS ≤20 (adjusted OR, 3.63; 95% CI, 1.03-12.78). We found that active inflammation was less likely among those with a moderate HDS , whereas symptomatic IBD flares were more likely. People may choose to consume a moderate amount of healthy foods such as fruits and vegetables, even knowing that those foods may cause a symptomatic flare.

Mediterranean Diet and Lifestyle Index Development for Older Adults

ObjectivesThe Mediterranean diet is associated with many health benefits, yet it is typically only the food pattern that is assessed without consideration for lifestyle attributes that accompany a Mediterranean way of life. The Mediterranean diet pyramid includes lifestyle activities at the base of the pyramid such as regular physical activity (PA), adequate rest, conviviality, biodiversity and seasonality, traditional local and eco-friendly products, and culinary activities. The purpose of this study was to design and pilot test a Mediterranean diet and lifestyle index for older adults in the U.S.MethodsThe Harvard Food Frequency Questionnaire was used to determine the alternative Mediterranean Diet Score (aMed). The short version of the Minnesota Leisure Time PA questionnaire and additional Mediterranean diet-related dietary habit and lifestyle questions were piloted in 75 older adults attending senior centers.ResultsParticipants were primarily women (80.6%) and Caucasian (68%) with an average age of 71.89+/−7.60 years. A 27-item index including the aMed food groups, dietary habits, PA, culinary activities, purchasing of local and seasonal foods, and adequate rest resulted in a reliable score (α = 0.75). Individual index factors correlated with the overall Mediterranean diet and lifestyle score.ConclusionsWhile this Mediterranean diet and lifestyle index resulted in good internal consistency; assessment of conviviality, especially for older adults in the time of Covid-19, need be re-evaluated as a lifestyle measure that can impact dietary intake and overall health.Funding SourcesEastern Michigan University Faculty Research Fellowship Award.

An An Exploratory Study Examining Mediterranean Diet Perceptions, Eating Practices, and Food Choice of Emerging Adults from Cyprus and the United States

Background. The Mediterranean Diet (MD) is a food pattern that offers numerous potential health benefits. Mediterranean countries, including Cyprus, are experiencing a decline in adherence to the traditional MD while other non-Mediterranean countries, such as the United States (U.S.), are providing recommendations to increase adherence to the MD.&#x0D; Objective. The aim of this research was to explore the foods, eating practices, and perception of the MD in emerging adults (18-25 years of age) from a Mediterranean (Cyprus) and non-Mediterranean (U.S.) country to better understand emerging adult adherence and behaviors related to a MD pattern.&#x0D; Design. An exploratory descriptive study was designed to include focus group interviews to understand perceptions and eating practices as well as dietary assessment using the Mediterranean Diet Score Survey and Harvard Food Frequency Questionnaire for calculation of the alternate Mediterranean Diet Score to determine MD adherence among emerging adults in Mediterranean and non-Mediterranean regions.&#x0D; Participants/Setting. Twenty-four emerging adults from Cyprus and the U.S. participated. &#x0D; Analysis. Descriptive approaches for analysis of qualitative and quantitative data were used. A qualitative content analysis was used for focus group interview data that included both inductive and deductive processes. Descriptive statistics were used to describe participant demographic and dietary characteristics. &#x0D; Results. Themes that emerged from the focus group interviews included perceptions of MD foods, health benefits of a MD, lifestyle cooking and eating practices, and influences on food choice in Cyprus and the U.S. While perception of MD foods and eating practices differed, MD adherence scores and participant identification of health benefits did not differ. Likewise, there were similar influences on food choice among emerging adults from both populations.&#x0D; Conclusion. These findings suggest that emerging adults may acknowledge health benefits of a MD but can benefit from emphasis on food preparation and other behaviors to promote MD food pattern adherence in both Mediterranean and non-Mediterranean countries.

Unhealthy food options in the school environment are associated with diet quality and body weights of elementary school children in Canada.

Increasing evidence links unhealthy food environments with diet quality and overweight/obesity. Recent evidence has demonstrated that relative food environment measures outperform absolute measures. Few studies have examined the interplay between these two measures. We examined the separate and combined effects of the absolute and relative densities of unhealthy food outlets within 1600 m buffers around elementary schools on children's diet- and weight-related outcomes. This is a cross-sectional study of 812 children from thirty-nine schools. The Youth Healthy Eating Index (Y-HEI) and daily vegetables and fruit servings were derived from the Harvard Food Frequency Questionnaire for Children and Youth. Measured heights and weights determined BMI Z-scores. Food outlets were ranked as healthy, somewhat healthy and unhealthy according to provincial paediatric nutrition guidelines. Multilevel mixed-effects regression models were used to assess the effect of absolute (number) and relative (proportion) densities of unhealthy food outlets within 1600 m around schools on diet quality and weight status. Two urban centres in the province of Alberta, Canada. Grade 5 students (10-11 years). For children attending schools with a higher absolute number (36+) of unhealthy food outlets within 1600 m, every 10 % increase in the proportion of unhealthy food outlets was associated with 4·1 lower Y-HEI score and 0·9 fewer daily vegetables and fruit. Children exposed to a higher relative density of unhealthy food outlets around a school had lower diet quality, specifically in areas where the absolute density of unhealthy food outlets was also high.

Association Between Change in Inflammatory Aspects of Diet and Change in IBD-related Inflammation and Symptoms Over 1 Year: The Manitoba Living With IBD Study.

We aimed to investigate (1) the stability of inflammatory aspects of diet over 1 year among persons with inflammatory bowel disease (IBD) and (2) the impact of change in diet on changes in inflammation and IBD symptoms over 1 year. Participants were recruited to the Manitoba Living with IBD Study and completed the Harvard Food Frequency Questionnaire (FFQ). The Dietary Inflammatory Index (DII) and the Empirical Dietary Inflammatory Index (EDII) were used to calculate the inflammatory potential of the diet. Inflammation was measured by fecal calprotectin (≥250 µg/g). Symptoms were measured by the IBD Symptom Inventory (IBDSI). All measures were obtained at baseline and 1 year. Dietary Inflammatory Index and Empirical Dietary Inflammatory Index scores >0 and <0 reflect pro- and anti-inflammatory diet, respectively. Variance components analyses were used to describe diet stability. Associations between changes in diet and changes in active inflammation and symptoms were assessed using ordinal logistic regression and multilevel linear regression modeling. One hundred thirty-five participants (66% CD) were included. Approximately one third of the variance in EDII (36%) and DII (33%) scores was explained by changes in diet over time. Each unit increase in the change in EDII (baseline to follow-up) was associated with a greater odds of FCAL, indicating active inflammation (>250 µg/g; odds ratio, 3.1; 95% confidence interval [CI], 1.02-9.93; P = 0.04) and with a rise in IBDSI of 6.7 (95% CI, 1.0-12.4; P = 0.022; theoretical IBDSI range, 0-81). There was no association between changes in DII and changes in FCAL or IBDSI. The EDII, but not the DII, may have utility to identify the inflammatory potential of diet. This inflammatory potential can contribute to inflammation and/or disease symptoms in persons with IBD.

Lifestyle Behavior and Mental Health in Early Adolescence.

Mental illnesses affect >15% of Canadian adolescents. New preventive strategies are critically needed. We examined the associations of meeting established recommendations for diet, physical activity, sleep, and sedentary behavior in childhood with mental illness in adolescence. Population-based prospective study (n = 3436) linking 2011 health behavior survey data of 10- to 11-year-olds with administrative health data from 2011 to 2014. Lifestyle behaviors were measured with the Harvard Food Frequency Questionnaire and self- and parental-proxy reports, expressed as meeting recommendations for vegetables and fruit, grain products, milk and alternatives, meat and alternatives, added sugar, saturated fat, sleep, screen time, and physical activity. Mental illness was defined by physician-diagnosed internalizing, externalizing, and other psychiatric conditions. Negative binomial regression was used to determine the independent and cumulative associations of meeting lifestyle recommendations with physician visits for mental illnesses. Of all participants, 12%, 67%, and 21% met 1 to 3, 4 to 6, and 7 to 9 recommendations, respectively, and 15% had a mental illness diagnosis during follow-up. Compared with meeting 1 to 3 recommendations, meeting 7 to 9 recommendations was associated with 56% (95% confidence interval: 38%-69%) fewer physician visits for mental illness during follow-up. Every additional recommendation met was associated with 15% fewer physician visits for mental illnesses (95% confidence interval: 9%-21%). Mental illness in adolescence is associated with compliance to lifestyle recommendations in childhood, with stronger associations seen when more recommendations are met. Emphasizing lifestyle recommendations in pediatric practice may reduce the future burden of mental illness.

Moderate Renal Impairment and Toxic Metabolites Produced by the Intestinal Microbiome: Dietary Implications

Toxic metabolites produced by the intestinal microbiome from animal proteins, carnitine (mainly from red meat), or phosphatidylcholine (mainly from egg yolk), have important adverse effects on cardiovascular disease. These are renally eliminated and may be termed gut-derived uremic toxins (GDUT). We hypothesized that even moderate renal impairment and intake of nutrient precursors would raise plasma levels of GDUT. A cohort study. Academic medical center. Patients attending stroke prevention clinics at a university medical center were recruited. Nutrient intake was assessed by the 131-item Harvard Food Frequency Questionnaire; estimated glomerular filtration rate (eGFR) was caculated using the Chronic Kidney Disease-Epidemiology (EPI) equations. Plasma levels of trimethylamine n-oxide, p-cresyl sulfate, hippuric acid, p-cresyl glucuronide, pheny acetyl glutamine, and phenyl sulfate were measured by ultra-performance liquid chromatography coupled to quadrupole time-of-flight mass spectrometry. Among 316 patients recruited, the mean (standard deviation [SD]) age was 66.74 (10.42) years; 59.7% were men. Mean eGFR was 76.03±20.01; 57 (18%) had eGFR<60mL/min/1.73m2. Plasma levels of all GDUT were significantly higher even with moderate reduction of eGFR. Nutrient intake affected plasma levels of some GDUT; the effects differed by eGFR above and below 60mL/min/1.73m2. Plasma levels were obtained fasting, so we probably underestimated the effect of nutrient intake. Even moderate impairment of renal function was associated with higher plasma levels of GDUT. This has dietary implications for patients at risk of atherosclerosis, particularly in those with impaired renal function (including the elderly): they should limit intake of animal protein, red meat, and egg yolk. It also points the way to novel approaches to vascular prevention, including more intensive dialysis, renal transplantation, and modification of the intestinal microbiome with probiotics or fecal transplantation.

Mediterranean Diet Score: Associations with Metabolic Products of the Intestinal Microbiome, Carotid Plaque Burden, and Renal Function.

Metabolic products of the intestinal microbiome such as trimethylamine N-oxide (TMAO) that accumulate in renal failure (gut-derived uremic toxins, GDUTs) affect atherosclerosis and increase cardiovascular risk. We hypothesized that patients on a Mediterranean diet and those consuming lower amounts of dietary precursors would have lower levels of GDUTs. Patients attending vascular prevention clinics completed a Harvard Food Frequency Questionnaire (FFQ) and had plasma levels of TMAO, p-cresylsulfate, hippuric acid, indoxyl sulfate, p-cresyl glucuronide, phenyl acetyl glutamine, and phenyl sulfate measured by ultra-performance liquid chromatography coupled to quadrupole time-of-flight mass spectrometry. Carotid plaque burden was measured by ultrasound; CKD-Epi equations were used to estimate the glomerular filtration rate. In total, 276 patients completed the study. Even moderate renal function significantly increased plasma GDUTs, which were significantly associated with higher carotid plaque burden. There was no significant difference in plasma levels of any GDUT associated with a Mediterranean diet score or with intake of dietary precursors. In omnivorous patients with vascular disease, the intake of dietary precursors of intestinal metabolites or adherence to a Mediterranean diet did not change plasma GDUT. Approaches other than diet, such as probiotics and repopulation of the intestinal microbiome, may be required to mitigate the adverse effects of GDUTs.

Improved Diet Quality Associates With Reduction in Liver Fat, Particularly in Individuals With High Genetic Risk Scores for Nonalcoholic Fatty Liver Disease

Dietary modification has been recommended for treatment of nonalcoholic fatty liver disease (NAFLD), although it is not clear whether improving diet quality can prevent its development. We performed a prospective study to examine the association between diet quality change and change in liver fat. We also examined the association between genetic risk score and liver fat change in individuals with different levels of diet quality change. Our study included 1521 participants who attended the seventh and eighth examinations (1998-2001 and 2005-2008) of the second-generation cohort or attended the first and second examinations (2002-2005 and 2008-2011) of the third-generation cohort in the Framingham Heart Study. The self-administered semiquantitative 126-item Harvard food frequency questionnaire was used to determine dietary intake in the year leading up to an examination. We assessed levels of liver fat using liver-phantom ratio (LPR) on computed tomography images from 2002 through 2005 and again from 2008 through 2011. LPR values are inversely related to liver fat: increased LPR indicates decreased liver fat. We examined associations of changes in 2 diet scores, the Mediterranean-style diet score (MDS) and Alternative Healthy Eating Index (AHEI), with changes in liver fat and new-onset fatty liver. We evaluated interactions between diet score change and a weighted genetic risk score for NAFLD, determined based on multiple single-nucleotide polymorphisms identified in genome-wide association studies of NAFLD. The primary outcome was change in LPR between baseline and follow-up measurement. For each 1 standard deviation increase in MDS, the LPR increased (meaning liver fat decreased) by 0.57 (95% confidence interval [CI] 0.27-0.86; P<.001) and the odds for incident fatty liver decreased by 26% (95% CI 10%-39%; P= .002). For each 1 standard deviation increase in AHEI, LPR increased by 0.56 (95% CI 0.29-0.84; P<.001) and the odds for incident fatty liver decreased by 21% (95% CI 5%-35%; P= .02). Increased diet scores were also associated with reduced odds of developing more-advanced fatty liver. Higher genetic risk scores were associated with increased liver fat accumulation in participants who had decreased MDS (P < .001) or AHEI scores (P= .001), but not in those with stable or improved diet scores (P for gene-diet interaction <.001). In an analysis of participants in the Framingham Heart Study, increasing diet quality, determined based on MDS and AHEI scores, is associated with less liver fat accumulation and reduced risk for new-onset fatty liver. An improved diet is particularly important for individuals with a high genetic risk for NAFLD.

Abstract P222: Consumption of Sugar-Sweetened Beverages, but Not 100% Fruit Juice, is Associated With Fasting High-density Lipoprotein and Triglyceride Concentrations in U.S. Adults

Introduction: Dyslipidemia, characterized by high triglyceride (TG) and low HDL concentrations, is a risk factor for cardiovascular disease (CVD). Decreasing dietary sugar consumption is one dietary modification that may influence dyslipidemia risk to reduce the risk for CVD. Two major sources of dietary sugar in the US are sugar-sweetened beverages (SSB) and 100% fruit juices, and both can contribute to excess caloric intake. Based on current observational data, there is limited evidence linking these dietary exposures to lipid levels in population-based studies. Hypothesis: We hypothesize that SSB and 100% fruit juices may differentially associate with TG and HDL concentrations in adults due to differences in both beverage consumption patterns and nutrient content. Methods: We conducted a cross-sectional analysis of data from the Framingham Heart Study (1998-2005; n=6,802). Fasting plasma TG and HDL concentrations were measured using standard assays. Consumption of SSB (sodas and fruit drinks; 1 serving = 12 oz.) and 100% fruit juice (1 serving = 8 oz.) was estimated using the Harvard-Food Frequency Questionnaire. Participants were grouped by category of intake. Using mixed-effect linear regression models accounting for family structure, we examined the associations between SSB intake and 100% fruit juice intake with TG and HDL concentrations, adjusting for potential confounding factors related to demographics, lifestyle, and diet. Results: After multivariate adjustment for potential confounding factors, SSB intake was positively associated with TG concentrations [ &amp;#946; ± SE: 0.12 ± 0.03 [ln] mg/dl comparing the highest category of intake (median = 8.5 servings/week) with the lowest category (median = 0 servings/day); p for trend &lt; 0.0001] and inversely associated with HDL concentrations ( &amp;#946; ± SE: -2.90 ± 0.69 mg/dl comparing the highest category of intake with the lowest category; p for trend &lt; 0.0001). Fruit juice intake was not significantly associated with TG concentrations [ &amp;#946; ± SE: 0.04 ± 0.02 [ln] mg/dl comparing highest category of intake (median = 11 servings/week) with the lowest category (median = 0 servings/day); p for trend = 0.15] or HDL concentrations ( &amp;#946; ± SE: -0.18 ± 0.60 mg/dl comparing the highest category of intake with the lowest category; p for trend = 0.73). Conclusions: Higher intakes of SSB are significantly associated with lower HDL and higher TG concentrations, which supports dietary recommendations to limit SSB intake. Fruit juice consumption patterns, up to 1.5 servings/day, were not significantly associated with TG and HDL concentrations in this study.

Factors Predicting Paediatric Obesity Among Primary School Children in Kuantan

Objective: This study was aimed to investigate the association of parental obesity, food habits, and physical activity levels with body mass index status and sociodemographic factors among children in Kuantan, Pahang. Method: A cross-sectional study was conducted on 300 pupils in three primary schools in Kuantan. The three schools were representative of the three major ethnicities in Malaysia, Malays, Chinese, and Indians, and the children were aged 8 to 11 years. Self-developed questionnaires were used to record sociodemographic details and anthropometric measures of both parents and children, and physical activity and food habits were measured using a Children Physical Activity Questionnaire (C-PAQ) and the Harvard Food Frequency Questionnaire (HFFQ), respectively. Data was analysed using IBM SPSS 20.0, with a binary logistic regression model then used to represent the interactions among different factors in terms of predicting childhood obesity. Results: Binary logistic regression analysis shows that parental anthropometric measures, children’s ages, levels of physical activity, and food habits are signif-icant predictors for paediatric obesity. There is also a significant association between parents’ anthropo-metric measurements and childhood obesity. Significant correlation was found between fast food con-sumption, fruit and vegetable consumption, and physical activity and body mass index in children (p˂0.05). Conclusion: The study provides evidence that parental obesity, fast food consumption, fruit and vegetables intakes, and physical activity levels have significant associations with children's body mass indices.

Dietary Nutrient Intake, Ethnicity, and Epigenetic Silencing of Lung Cancer Genes Detected in Sputum in New Mexican Smokers.

Lung cancer gene methylation detected in sputum assesses field cancerization and predicts lung cancer incidence. Hispanic smokers have higher lung cancer susceptibility compared with non-Hispanic whites (NHW). We aimed to identify novel dietary nutrients affecting lung cancer gene methylation and determine the degree of ethnic disparity in methylation explained by diet. Dietary intakes of 139 nutrients were assessed using a validated Harvard food frequency questionnaire in 327 Hispanics and 1,502 NHWs from the Lovelace Smokers Cohort. Promoter methylation of 12 lung cancer genes was assessed in sputum DNA. A global association was identified between dietary intake and gene methylation (Ppermutation = 0.003). Seventeen nutrient measurements were identified with magnitude of association with methylation greater than that seen for folate. A stepwise approach identified B12, manganese, sodium, and saturated fat as the minimally correlated set of nutrients whose optimal intakes could reduce the methylation by 36% (Ppermutation < 0.001). Six protective nutrients included vitamin D, B12, manganese, magnesium, niacin, and folate. Approximately 42% of ethnic disparity in methylation was explained by insufficient intake of protective nutrients in Hispanics compared with NHWs. Functional validation of protective nutrients showed an enhanced DNA repair capacity toward double-strand DNA breaks, a mechanistic biomarker strongly linked to acquisition of lung cancer gene methylation in smokers. Dietary intake is a major modifiable factor for preventing promoter methylation of lung cancer genes in smokers' lungs. Complex dietary supplements could be developed on the basis of these protective nutrients for lung cancer chemoprevention in smokers. Hispanic smokers may benefit the most from this complex for reducing their lung cancer susceptibility. Cancer Prev Res; 11(2); 93-102. ©2017 AACR.

Abstract WP404: Intestinal Microbiome and Carotid Atherosclerosis

Background: It is increasingly recognized that metabolic products of the intestinal microbiome may have important effects on cardiovascular disease. Methods: We studied dietary intake of precursors and plasma levels of toxic metabolic products of the intestinal microbiome in patients at extremes of carotid plaque burden, defined by residual scores (Res) in multiple regression with coronary risk factors: Protected (Res &lt;-2, n = 83), Explained (Res -2 to 2 n = 82) and Unexplained atherosclerosis (Res &gt;2 n = 62). Diet was assessed by a Harvard Food Frequency Questionnaire, and metabolites were measured by ultra-performance liquid chromatography (UPLC) coupled to mass spectrometry (MS). Microbiota were studied by DNA extraction from stool samples; bacteria in each sample were identified and quantitated based upon amplification and sequencing of 16S rRNA variable regions. Results: There were no significant differences in Mediterranean diet score, renal function, intake of protein, total choline, carnitine, phenylalanine or tyrosine or the fecal microbiota amongst the groups. However, plasma levels of trimethylamine n-oxide (TMAO), indoxylsulfate, p-cresylsulfate, and phenylacetylglutamine were significantly lower in Protected patients and higher in Unexplained patients (Table 1). Serum creatinine and 3-carboxy-4-methyl-5-propyl-2-furanpropionic acid ( a marker of renal function) were not different among the groups. In this small sample we did not detect differences in the fecal microbiota. Discussion: Despite no difference in dietary precursors, renal function or the fecal microbiota, patients protected from atherosclerosis had lower levels and those with unexplained atherosclerosis had higher levels of toxic metabolites of the intestinal microbiome. This suggests their intestinal microbiota are responding differently to dietary intake of precursors from those of patients with explained atherosclerosis. Conclusion: This finding raises the potential for manipulation of the intestinal microbiota function through probiotic or prebiotic intake, or replacement of intestinal bacteria, to reduce the risk of carotid atherosclerosis and stroke.

Influence of physical activity, sedentary behavior, and diet quality in childhood on the incidence of internalizing and externalizing disorders during adolescence: a population-based cohort study

PurposeStudies among youth suggest that physical inactivity, sedentary behaviors, and poor diet quality are associated with poor mental health. Few population-based studies have investigated these relationships longitudinally. We examined the association between physical activity, sedentary behaviors, and diet quality in childhood and the incidence of internalizing and externalizing disorders throughout adolescence. MethodsWe linked health behavior survey data from 2003 among 10- to 11-year-old children across Nova Scotia, Canada, with administrative health care data from 2003 to 2011. Students' diet quality was assessed using the Harvard Food Frequency Questionnaire. Physical activity and sedentary behaviors were self-reported, and internalizing and externalizing disorders were diagnosed by a physician. We applied Cox regression to examine the associations of the health behaviors with the incidence of internalizing and externalizing disorders between 2003 and 2011. ResultsOf the 4861 participating students, 23.7% and 9.4% had a diagnosis of internalizing and externalizing disorders, respectively. The incidences of internalizing and externalizing disorders were higher among students who were less physically active and spent more time using computers and video games. ConclusionsThese findings suggest that promoting an active lifestyle in childhood may contribute to the prevention of both internalizing and externalizing disorders during adolescence.