Intake Occasions Research Articles

Temporal Dietary Patterns Are Associated with Body Mass Index, Waist Circumference and Obesity

Abstract Objectives The integration of time with dietary patterns throughout a day, or temporal dietary patterns (TDP), have been linked with dietary quality but links to health outcomes are unknown. TDP were created with the objective to examine their association with health status indicators including body mass index (BMI), waist circumference (WC), fasting plasma glucose, hemoglobin A1c, triglyceride, high-density lipoprotein cholesterol, total cholesterol, blood pressure, and chronic diseases obesity, diabetes, and metabolic syndrome in US adults 20–65 years. Methods The first-day 24-hour dietary recall from 1627 non-pregnant US adult participants of the cross-sectional National Health and Nutrition Examination Survey 2003–2006 was used to determine energy intake (kcal), time of intake (min), and sequence of intake occasions throughout the 24-hour day. Modified dynamic time warping coupled with kernel k-means algorithm, clustered participants into four groups representing distinct TDP. Multivariate regression models determined associations between TDP clusters and all outcomes, controlling for potential confounders, energy misreporting, and adjusting for multiple comparisons and the complex survey design (P < 0.05/6). Results The cluster representing a TDP with proportionally equivalent average energy at three main eating occasions from 8:00 to 23:00 with peaks reaching 175 kcal at 9:00, 13:00, and 19:00, had statistically significant and clinically meaningful lower BMI (P < 0.0001), WC (P < 0.0001) and 75% lower odds of obesity compared to three other clusters representing distinct patterns of much higher average peak energy intake of 500 kcal at 13:00 (odds ratio (OR): 4.4; 95% confidence interval (CI)): 2.5, 7.9), 530 kcal at 18:00 (OR: 5.3; 95% CI: 2.8, 10.1), and 550 kcal at 20:00 (OR: 6.7; 95%CI: 3.9, 11.6). Conclusions A positive association of the TDP of moderate energy intake throughout the day with healthy weight outcomes supports previous findings of higher dietary quality among those with a similar TDP and provides unique evidence that incorporating time with other aspects of a dietary pattern are linked to health. Funding Sources Research reported in this publication was supported by the National Cancer Institute of the National Institutes of Health and Purdue University.

Assessment of alcohol intake: Retrospective measures versus a smartphone application

IntroductionResearch investigating problem drinking often relies on retrospective measures to assess alcohol consumption behaviour. Limitations associated with such instruments can, however, distort actual consumption levels and patterns. We developed the smartphone application (app), CNLab-A, to assess alcohol intake behaviour in real-time. MethodsHealthy individuals (N=671, M age 23.12) completed demographic questions plus the Alcohol Use Questionnaire and a 21-day Timeline Followback before using CNLab-A for 21days. The app asked participants to record alcohol consumption details in real time. We compared data reported via retrospective measures with that captured using CNLab-A. ResultsOn average, participants submitted data on 20.27days using CNLab-A. Compared to Timeline Followback, a significantly greater percentage of drinking days (24.79% vs. 26.44%) and significantly higher total intake (20.30 vs. 24.26 standard drinks) was recorded via the app. CNLab-A captured a substantially greater number of high intake occasions at all levels from 8 or more drinks than Timeline Followback. Additionally, relative to the Alcohol Use Questionnaire, a significantly faster rate of consumption was recorded via the app. ConclusionsCNLab-A provided more nuanced information regarding quantity and pattern of alcohol intake than the retrospective measures. In particular, it revealed higher levels of drinking than retrospective reporting. This will have implications for how particular at-risk alcohol consumption patterns are identified in future and might enable a more sophisticated exploration of the causes and consequences of drinking behaviour.

The Influence of Sweet Taste Perception on Dietary Intake in Relation to Dental Caries and BMI in Saudi Arabian Schoolchildren.

Objectives The aim of the study was to evaluate the influence of sweet taste perception on dietary habits in Saudi schoolchildren. In addition, the relationship between dietary habits and both caries and BMI was studied. Methods A cross-sectional observational study comprising 225 schoolchildren aged 13–15 years from Jeddah, Saudi Arabia, was conducted. The consumption frequency of certain food items was analysed from a beverage and snack questionnaire and a three-day estimated dietary record was obtained. The sweet taste perception level was determined as sweet taste threshold (TT) and sweet taste preference (TP). Children were grouped into low, medium, and high, according to their sweet taste perception level. ICDAS and DMFS indices were used for caries registration and anthropometric measurements using BMI were collected. Results Sweet taste perception was found to be negatively correlated to the number of main meals and positively correlated to both snack and sweet intake occasions. Statistically significant differences were found between the TT and TP groups with regard to the number of main meals and sweet intake (p ≤ 0.01). No significant correlation between the dietary variables and caries or BMI was found. Conclusions The dietary habits and sweet intake were found to be influenced by the sweet taste perception level, while the relation between the dietary habits and the caries and BMI was found insignificant.

Associations between Restrained Eating and the Size and Frequency of Overall Intake, Meal, Snack and Drink Occasions in the UK Adult National Diet and Nutrition Survey.

Obesity is a global public health priority. Restrained eating is related to obesity and total energy intake but associations with the eating patterns are unclear. We examined the associations of restrained eating with the size and frequency of intake occasions among 1213 British adult (19–64 y) participants in a cross-sectional analysis of the UK National Diet and Nutrition Survey 2000. The Dutch Eating Behaviour Questionnaire assessed restrained eating. Overall intake occasions were all energy consumed in a 60 min period. A food-based classification separated intake occasions into meals, snacks, or drinks from seven-day weighed food diaries. Average daily frequency and size (kcal) of overall intake, meal, snack and drink occasions were calculated and associations with restrained eating were modelled using multiple linear regression including under-reporting of energy intake, age, gender, BMI, emotional eating, external eating and physical activity as covariates. Restrained eating was very weakly positively correlated with overall intake (r = 0.08, p<0.05) and meal frequency (r = 0.10, p<0.05) but not snack or drink frequency (r = 0.02 and -0.02 respectively). Adjusted regressions showed a one-point change in restrained eating was associated with 0.07 (95% CI 0.03, 0.11) more meal occasions/day and 0.13 (95% CI 0.01, 0.25) extra overall intake occasions/day. Overall intake occasion size was weakly negatively correlated with restrained eating regardless of type (r = -0.16 to -0.20, all p<0.0001). Adjusted regressions showed each one-point increase in restrained eating was associated with lower-energy meals (-15 kcal 95% CI -5.9, -24.2) and drinks (-4 kcal 95%CI -0.1, -8), but not snacks or overall intake occasions. Among a national sample of UK adults, greater restrained eating was associated with smaller and slightly more frequent eating, suggesting that restrained eaters restrict their energy intake by reducing meal/drink size rather than skipping snacks.

Meal patterns across ten European countries - results from the European Prospective Investigation into Cancer and Nutrition (EPIC) calibration study.

To characterize meal patterns across ten European countries participating in the European Prospective Investigation into Cancer and Nutrition (EPIC) calibration study. Cross-sectional study utilizing dietary data collected through a standardized 24 h diet recall during 1995-2000. Eleven predefined intake occasions across a 24 h period were assessed during the interview. In the present descriptive report, meal patterns were analysed in terms of daily number of intake occasions, the proportion reporting each intake occasion and the energy contributions from each intake occasion. Twenty-seven centres across ten European countries. Women (64 %) and men (36 %) aged 35-74 years (n 36 020). Pronounced differences in meal patterns emerged both across centres within the same country and across different countries, with a trend for fewer intake occasions per day in Mediterranean countries compared with central and northern Europe. Differences were also found for daily energy intake provided by lunch, with 38-43 % for women and 41-45 % for men within Mediterranean countries compared with 16-27 % for women and 20-26 % for men in central and northern European countries. Likewise, a south-north gradient was found for daily energy intake from snacks, with 13-20 % (women) and 10-17 % (men) in Mediterranean countries compared with 24-34 % (women) and 23-35 % (men) in central/northern Europe. We found distinct differences in meal patterns with marked diversity for intake frequency and lunch and snack consumption between Mediterranean and central/northern European countries. Monitoring of meal patterns across various cultures and populations could provide critical context to the research efforts to characterize relationships between dietary intake and health.

Temporal Dietary Patterns Derived among the Adult Participants of the National Health and Nutrition Examination Survey 1999-2004 Are Associated with Diet Quality

BackgroundTemporal dietary patterns, the distribution of energy or nutrient intakes observed over a period of time, is an emerging area of dietary patterns research that incorporates time of dietary intake with frequency and amount of intake to determine population clusters that may have similar characteristics or outcomes related to diet quality. ObjectiveWe examined whether differences in diet quality were present between clusters of individuals with similar daily temporal dietary patterns. DesignThe first-day 24-hour dietary recall data from the cross-sectional National Health and Nutrition Examination Survey, 1999-2004, were used to determine proportional energy intake, time of intake, frequency of intake occasions, and mean diet quality. Participants/settingData from 9,326 US adults aged 20 to 65 years were included. Statistical analyses performedThe mean diet quality, classified by the Healthy Eating Index-2005, of participant clusters with similar temporal dietary patterns derived on the basis of individual proportional energy intake, time of intake, and frequency of intake, were inferentially compared using multiple linear regression that controlled for potential confounders and other covariates (P<0.05/6). ResultsDiet quality differences were present between US population clusters exhibiting similar daily temporal dietary patterns (P<0.001 with one exception, which was P=0.08). Participant characteristics of race/ethnicity, age, household poverty-income ratio, and body mass index were associated with the temporal dietary patterns. The cluster representing the temporal dietary pattern with proportionally equivalent energy consumed during three evenly spaced eating occasions had a significantly greater mean total Healthy Eating Index-2005 score compared with the other temporal dietary pattern clusters. ConclusionsTemporal dietary patterns are associated with differences in US adult daily diet quality, demonstrating that elements beyond food and nutrient intake, such as time, can be incorporated with dietary patterns to determine links to diet quality that enhance knowledge of the complicated interplay of time and dietary patterns.

Temporal dietary patterns derived from Spectral clustering and factor analysis are associated with diet quality using NHANES 1999‐2004.

ObjectiveThe study evaluated the relationship of temporal dietary patterns derived from a novel application of spectral clustering and factor analysis, to dietary quality among adult participants from the National Health and Nutrition Examination Survey (NHANES, 1999‐2004).MethodsNHANES adult participants (20‐65y) with a complete day‐one 24‐hour dietary recall were clustered based on proportional energy intake, time of eating, and number of eating occasions, using algorithms of spectral clustering analysis and factor analysis. The association between clusters and mean dietary quality, as indicated by the 2005 Healthy Eating Index (HEI), was evaluated using multiple linear regression and controlled for potential confounders.ResultsMean dietary quality among the four clusters representing distinct temporal dietary patterns was significantly different (P&lt;0.0001). The cluster representing a pattern with proportionally equivalent energy intake consumed at three evenly spaced intake occasions throughout the daytime had the highest HEI score (50.1±0.3, mean±SEM).ImplicationKnowledge of the temporal aspect of dietary patterns may enhance understanding of the relationship of diet to health within the context of daily patterns.FundingPurdue University

Living Gut Health Improvement through Time-Managing Nutrient Assimilation: An Evolutionary Probiotic

This article describes an innovative postmodern strategy to optimize function and health of the living gut in human by time-managing of nutrient assimilation. Inspired by the probiotic nature, at certain times of the circadian phase, microbial metabolism especially in hindgut can be improved. Discovering such occasions of food intake can serve the symbiotic microbial fermentation of the gut while improving gut integrity and overall health.

Association of dental caries with socioeconomic status in relation to different water fluoridation levels.

The aim of this study was to assess the prevalence of dental caries in 11-year-old children, related to water fluoridation and family affluence scale (FAS), as an indicator of socioeconomic status (SES) in Korea. A total of eight areas were selected for study: four areas with fluoridated piped water (WF areas) and four areas with nonfluoridated piped water (non-WF areas). Non-WF areas had a similar economic level and population size compared with the WF areas. A total of 1446 elementary school students, 11years of age, were included. They were examined, and questionnaires completed by their parents were analyzed. In the questionnaire, information about gender, FAS as an indicator of SES, occasions of daily cariogenic snack intake, occasions of daily cariogenic beverage intake, drinking of piped water, cooking with piped water, and usage of oral hygiene supplemental measures were surveyed. The bivariate association between the characteristics of the subjects and the number of decayed, filled, and missing permanent teeth (DMFT score) was analyzed through an independent samples t-test. The difference in the mean DMFT score between different FAS groups was analyzed by DMFT ratio, after adjusting for gender, oral health behaviors, and usage of piped water variables. The DMFT ratio was calculated from a Poisson regression model, because the DMFT score was not normally distributed. There was no significant association between FAS and the mean DMFT score in both areas, by bivariate analysis. After adjusting for each group of confounders, a significant association (95% CI: 1.032-1.513) was found between the FAS and mean DMFT scores in non-WF areas; however, no significant difference was observed in the WF areas (95% CI: 0.766-1.382). This study supported that water fluoridation could not only lead to a lower prevalence of dental caries, but also help to reduce the effect of SES inequalities on oral health.

Eating frequency, energy intake and body weight during a successful weight loss trial in overweight and obese postpartum women

To examine associations among eating frequency, energy intake and body weight at baseline, as well as associations among change in eating frequency and change in energy intake and weight during a 12-week successful weight loss intervention in overweight and obese postpartum women. Sixty-one Swedish women with pre-pregnancy body mass index of 25-35 kg/m(2) completed a 4-day diet record at 10-14 weeks postpartum (baseline) and 12 weeks later (post-intervention), which were used to calculate energy intake and eating frequency, that is, the mean number of intake occasions per day. The women had a mean eating frequency of 5.9 ± 1.2 intake occasions at baseline. A positive association was found between eating frequency and energy intake at baseline (β: 307 ± 46 kcal, P<0.001), whereas no significant association between eating frequency and weight was observed (β: 2.3 ± 1.2 kg, P=0.063). During the intervention period, reduced eating frequency was positively associated with energy intake reduction (β: 169 ± 69 kcal, P=0.017) whereas no significant association was found with weight loss (β: 0.9 ± 0.7 kg, P=0.179). Women receiving dietary intervention reduced their eating frequency more during the intervention period than did women not receiving dietary intervention (-1.0 ± 0.7 vs -0.5 ± 1.1, P=0.001). A positive association was found between eating frequency and energy intake at baseline and between reduced eating frequency and reduced energy intake during a 12-week weight loss intervention in overweight and obese postpartum women. Intervention studies on eating frequency are warranted to elucidate its effect on energy intake and weight among postpartum women.

청소년들의 식생활습관 및 구강보건행동과 치아우식증의 관련성

Objectives : This study aimed to explore the influence of food intake and oral health behaviors on dental caries in juveniles. Methods : A total of 2,129 juveniles completed a questionnaire survey to identify the presence of permanent teeth caries, behaviors relevant to oral health and food intake based on the fourth National Health and Nutrition Survey. Results : Multiple logistic regression analysis showed that higher occasions of intake of carbonated drinks significantly cased dental caries in the meanwhile oral health behavior and the number of toothbrushing was in reverse proportion to dntal caries. The risk of dental caries was higher in the group of lower frequency of toothbrushing and intake of carbonated drink. Conclusions : Carbonated drinks intake and the number of toothbrushing is closely related to dental caries. So it is very important to develop oral health education program in order to improve eating habits and toothbrushing habits in juveniles.

Characterizing Systemic Exposure of Inhaled Drugs: Application to the Long-Acting β2-Agonist PF-00610355

PF-00610355 is an orally inhaled long-acting β2-adrenoreceptor agonist that is being developed for the once-daily treatment of chronic obstructive pulmonary disease (COPD). The pharmacological effect is exerted in the lungs. However, systemic exposure of PF-00610355 is expected to be responsible for certain drug-related adverse effects. This analysis characterizes PF-00610355 using an integrated analysis of systemic exposure, across trials and patient populations. A total of 6,107 samples of PF-00610355 plasma concentration, collected in 264 subjects from eight studies in healthy volunteers, asthma, and COPD patients, were analyzed using non-linear mixed-effects models. Model-based mean (95 % CI) exposure profiles for a range of PF-00610355 doses in COPD patients were simulated. PF-00610355 exposure profiles were described by a three-compartment disposition model with first-order absorption through a transit compartment. Patient status, inhalation device, and demographic factors were found to influence systemic drug exposure. Relative fine particle dose had a minor effect, whereas no effect of baseline lung function on the systemic exposure was found. An implicit method to address pharmacokinetic variability between occasions of drug intake yielded similar results as the established explicit method, yet in a much more efficient way. The estimated systemic pre-dose and maximum PF-00610355 plasma concentration was 23 and 38 % in COPD patients compared to healthy volunteers, respectively. The analysis illustrated the value of an integrated pharmacokinetic analysis to address specific challenges in the clinical development of long-/ultra-long-acting β2-agonists and inhaled compounds in general, both in relation to selecting a safe starting dose in patients, but also in understanding exposure and systemic safety information across different patient populations and different inhalation devices/formulations.

Validation of personal digital photography to assess dietary quality among people with intellectual disabilities

Dietary assessment is a challenge in general, and specifically in individuals with intellectual disabilities (ID). This study aimed to evaluate personal digital photography as a method of assessing different aspects of dietary quality in this target group. Eighteen adults with ID were recruited from community residences and activity centres in Stockholm County. Participants were instructed to photograph all foods and beverages consumed during 1 day, while observed. Photographs were coded by two raters. Observations and photographs of meal frequency, intake occasions of four specific food and beverage items, meal quality and dietary diversity were compared. Evaluation of inter-rater reliability and validity of the method was performed by intra-class correlation analysis. With reminders from staff, 85% of all observed eating or drinking occasions were photographed. The inter-rater reliability was excellent for all assessed variables (ICC ≥ 0.88), except for meal quality where ICC was 0.66. The correlations between items assessed in photos and observations were strong to almost perfect with ICC values ranging from 0.71 to 0.92 and all were statistically significant. Personal digital photography appears to be a feasible, reliable and valid method for assessing dietary quality in people with mild to moderate ID, who have daily staff support.

Near-Death States Reported in a Sample of 50 Misusers

Increase in recreational ketamine use may be a cause for concern. We aimed here at assessing, in a sample of ketamine misusers, concordance between the typical near-death experience (NDE) features and the on-drug psychoactive effects the subjects experienced. In 2003–2005, a sample of previous ketamine misusers recollecting a ketamine-related NDE were recruited through snowballing and screened with the means of the Greyson NDE Scale; 125 participants made an initial contact with the researcher and 50 reported a minimum score of seven at the “Greyson NDE Scale”. Interviewees were in the range 21–66 years old; 27 participants (54%) were educated at BA level, 18 (36%) had an MSc, and 5 (10%) a PhD. Eight (16%) interviewees had a definite religious background. An average lifetime ketamine intake of 140 occasions was reported by the interviewees, who typically presented with a polydrug, including cannabis and MDMA/ecstasy, misuse history. In 45 (90%) cases, the NDE occurred during the first few occasions of intake. Most frequent features of reported NDE states included: altered perception of time (90%), strong sense of detaching from own physical body (88%), and a sense of peace/joy (76% of subjects). Although results here described were elicited from a self-selected, nonrandomized, limited size sample of misusers, we suggest that recreational ketamine intake may be associated with occurrence of near-death related states.

Are Eating Occasions and Their Energy Content Related to Child Overweight and Socioeconomic Status?

The objectives of this study were: (i) to assess the relationships between childhood overweight (OW) and four eating behaviors: daily eating frequency, and the relative contribution of breakfast, main meals (lunch and dinner), and snacks to total daily energy intake (EI); (ii) to explore whether these eating behaviors are involved in the negative association between socioeconomic status (SES) and OW. A representative sample of French children aged 3-11 years (n = 748) was taken from the 1998-1999 cross-sectional French INCA1 (Enquête Individuelle et Nationale sur les Consommations Alimentaires) food consumption survey. Food intake was reported in a 7-day food record, and SES, physical activity, sedentary behavior (SED), weight, and height were reported by answering face-to-face questionnaires. After adjusting for EI, physical activity, and SED, OW was positively associated with the contribution of the main meals to EI (P = 0.03), not significantly associated with the contribution of breakfast to EI, and inversely correlated to the number of eating episodes (P = 0.009) and to the contribution of snacking episodes to EI (P = 0.007). Our data suggest that a combination of more frequent intake occasions and lower contribution of the main meals to total daily EI is associated with a smaller risk of OW in children. However, eating frequency was the only eating behavior that played a slight mediation role (contributing approximately 8%) in the inverse relationship between SES and OW.

Snacking frequency in relation to energy intake and food choices in obese men and women compared to a reference population

To investigate snacking frequency in relation to energy intake and food choices, taking physical activity into account, in obese vs reference men and women. Cross-sectional, descriptive study. In total, 4259 obese, middle-aged subjects (1891 men and 2368 women) from the baseline examination of the XENDOS study and 1092 subjects (505 men and 587 women) from the SOS reference study were included. A meal pattern questionnaire describing habitual intake occasions (main meals, light meals/breakfast, snacks, drink-only), a dietary questionnaire describing habitual energy and macronutrient intake and a questionnaire assessing physical activity at work and during leisure time were used. The obese group consumed snacks more frequently compared to the reference group (P<0.001) and women more frequently than men (P<0.001). Energy intake increased with increasing snacking frequency, irrespective of physical activity. Statistically significant differences in trends were found for cakes/cookies, candies/chocolate and desserts for the relation between energy intake and snacking frequency, where energy intake increased more by snacking frequency in obese subjects than in reference subjects. Obese subjects were more frequent snackers than reference subjects and women were more frequent snackers than men. Snacks were positively related to energy intake, irrespective of physical activity. Sweet, fatty food groups were associated with snacking and contributed considerably to energy intake. Snacking needs to be considered in obesity treatment, prevention and general dietary recommendations.

The effect of low and moderate fat intakes on the postprandial lipaemic and hormonal responses in healthy volunteers

Present literature indicates that whereas an acute fat intake of 5 g does not elicit a postprandial triacylglycerolaemic response, 20 g of fat does. Since 67% of fat intake occasions involve fat doses of less than 20 g, the present study examined the effect of a relatively low-fat (LF) meal (0.2 g/kg body weight; mean 14 g) on postprandial triacylglycerol (TAG) metabolism, compared with a high-fat (HF) meal (0.6 g/kg body weight; mean 43 g), a fat dose which is more typical of laboratory studies. Plasma- and chylomicron-TAG concentrations increased significantly (P < or = 0.001) following both meals, and the increase was significantly (P < or = 0.02) greater after the HF meal. The postprandial areas under the curves and maximal postprandial TAG concentrations for plasma- and chylomicron-TAG were significantly higher following the HF meal (P < or = 0.05). Postprandial plasma insulin and gastric inhibitory polypeptide concentrations increased significantly (P < or = 0.001) after each meal, but there was no difference between the two meals. These data show that modest amounts of fat in a meal will elicit a measurable postprandial TAG response. Since postprandial lipaemia affects the composition and concentration of the TAG- and cholesterol-rich lipoproteins, controlling dietary TAG supply may influence the metabolic fate of these lipoproteins.

What Other Regimens Are Under Investigation to Treat Helicobacter pylori Infection?

The most common infection in the world, Helicobacter pylori infection, is very specific, and present experience in treating infectious diseases is not applicable in general for this infection. Animal models (e.g., mouse and ferret) are thus far inadequate as reliable screening models. Old-fashioned trial-and-error treatment of infected humans is still the screening model and the gold standard in the evaluation of regimens aimed at eradication of H. pylori. A variety of studies on treatment of H. pylori infection have been performed with varying results. This pooled analysis of the following therapeutic combinations: proton pump inhibitor (PPI) plus two antibiotics or antimicrobials, quadruple therapies, and nonantibiotic regimens is an attempt to make a fair comparison of tested therapeutic strategies aimed at eradicating H. pylori. Data from treatment groups including specified drug combinations are pooled, regardless of dose or duration. Search methods are: MEDLINE 1984-1996, Digestive Disease Week 1988-1996, United European Gastroenterology Week 1992-1996, European Helicobacter pylori Study Group 1988-1996, Asia Pacific Congress 1996, H. pylori International Workshop Hong Kong 1996, and miscellaneous. Eradication rates (efficacy) are presented as intention-to-treat data (i.e., worst-case analysis). Separate subanalyses with regard to study quality, dose, and duration are performed for some groups. A general cost-efficacy analysis is performed based on pooled efficacy data. Convenience data are presented as total number of tablets, total number of intake occasions, and duration of therapy. Drugs evaluated in the analysis are bismuthdicitrate, tetracycline, amoxicillin, nitroimidazoles, macrolides, H2-receptor antagonists, PPIs, sucralfate, and sofalcone. The most effective and convenient drug combinations are the PPI-based triple therapies. No significant difference was observed between the three PPIs. The cure rate did not improve after addition of bismuth. Cost-effectiveness is closely associated with efficacy.

O-4-58 - Statistical contribution to prognostic factors in spontaneous intracerebral hematomas. Of v-cramer coefficient and discriminative analysis

The most common infection in the world, Helicobacter pylori infection, is very specific, and present experience in treating infectious diseases is not applicable in general for this infection. Animal models (e.g., mouse and ferret) are thus far inadequate as reliable screening models. Oldfashioned trial-and-error treatment of infected humans is still the screening model and the gold standard in the evaluation of regimens aimed at eradication of H. pylori. A variety of studies on treatment of H. pylori infection have been performed with varying results. This pooled analysis of the following therapeutic combinations: proton pump inhibitor (PPI) plus two antibiotics or antimicrobials, quadruple therapies, and nonantibiotic regimens is an attempt to make a fair comparison of tested therapeutic strategies aimed at eradicating H. pylori. Data from treatment groups including specified drug combinations are pooled, regardless of dose or duration. Search methods are: MEDLINE 1984-1996, Digestive Disease Week 1988-1996, United European Gastroenterolgy Week 1992-1996, European Helicobacter pylori Study Group 1988-1996, Asia Pacific Congress 1996, H. pylori International Workshop Hong Kong 1996, and miscellaneous. Eradication rates (efficacy) are presented as intention-to-treat data (i.e., worstcase analysis). Separate subanalyses with regard to study quality, dose, and duration are performed for some groups. A general cost-efficacy analysis is performed based on pooled efficacy data. Convenience data are presented as total number of tablets, total number of intake occasions, and duration of therapy. Drugs evaluated in the analysis are bismuthdicitrate, tetracycline, amoxicillin, nitroimidazoles, macrolides, H2-receptor antagonists, PPIs, sucralfate, and sofalcone. The most effective and convenient drug combinations are the PPI-based triple therapies. No significant difference was observed between the three PPIs. The cure rate did not improve after addition of bismuth. Cost-effectiveness is closely associated with efficacy.

Relative validity and reproducibility of a diet history questionnaire in Spain. I. Foods. EPIC Group of Spain. European Prospective Investigation into Cancer and Nutrition.

A pilot study was carried out to evaluate the relative validity and reproducibility of a dietary history questionnaire (DH) designed to be used in Spain as part of a prospective European research project on diet and cancer. A total of 91 volunteers (46 men and 45 women) aged 35-60 years, and of various occupational categories, participated in the study. The DH was structured according to occasions of intake and was administered twice by interview, with a year's interval. Twelve 24-hour diet recalls, administered monthly between the two administrations of the DH, were used as a reference method. Natural units, geometric figures and a set of photographs were used to quantity portion size. Of a total of 17 food groups, the Pearson correlation coefficients between the daily intake of food groups, based on the mean of 12 24-hour diet recalls, and the second DH showed values between 0.65 and 0.90 in 14 groups (potatoes, vegetables, fruits, cheese, other dairy products, bread, other cereals, meat and poultry, fish and shellfish, butter, margarine and oils, sugar and sweets, other desserts, alcohol and coffee and tea) in males and in 11 groups (potatoes, other vegetables, fruits, cheese, other dairy products, bread, meat and poultry, fish and shellfish, sugar and sweets, alcohol and coffee and tea) in females. In comparison with the mean of 12 24-hour diet recalls the DH questionnaire over-estimated (in both sexes) the intake of vegetables, cereals, butter, margarine and oils and underestimated the intake of sugar and sweets, and other desserts. The DH method is more expensive and more difficult to apply than other instruments but it provides good information on the habitual food intake of the individual.