Multiple 24-hour Dietary Recalls Research Articles

Associations of ultra-processed food intake with maternal weight change and cardiometabolic health and infant growth

BackgroundExcessive intake of ultra-processed foods, formulated from substances extracted from foods or derived from food constituents, may be a modifiable behavioral risk factor for adverse maternal and infant health outcomes. Prior work has predominately examined health correlates of maternal ultra-processed food intake in populations with substantially lower ultra-processed food intake compared to the US population. This longitudinal study investigated relations of ultra-processed food intake with maternal weight change and cardiometabolic health and infant growth in a US cohort.MethodsMothers in the Pregnancy Eating Attributes Study were enrolled at ≤12 weeks gestation and completed multiple 24-Hour Dietary Recalls within six visit windows through one-year postpartum (458 mothers enrolled, 321 retained at one-year postpartum). The NOVA (not an acronym) system categorized food and underlying ingredient codes based on processing level. Maternal anthropometrics were measured throughout pregnancy and postpartum, and infant anthropometrics were measured at birth and ages 2 months, 6 months, and 1 year. Maternal cardiometabolic markers were analyzed from blood samples obtained during the second and third trimesters.ResultsHolding covariates and total energy intake constant, a 1-SD greater percent energy intake from ultra-processed foods during pregnancy was associated with 31% higher odds of excessive gestational weight gain (p = .045, 95% CI [1.01, 1.70]), 0.68±0.29 mg/L higher c-reactive protein during pregnancy (p = .021, 95% CI [0.10, 1.26]), 6.7±3.4% greater gestational weight gain retained (p = .049, 95% CI [0.03, 13.30]), and 1.09±0.36 kg greater postpartum weight retention (p = .003, 95% CI [0.38, 1.80]). No other significant associations emerged.ConclusionsUltra-processed food intake during pregnancy may be a modifiable behavioral risk factor for adverse maternal weight outcomes and inflammation. Randomized controlled trials are needed to test whether targeting ultra-processed food intake during pregnancy may support optimal maternal health.Trial registrationClinicaltrials.gov. Registration ID – NCT02217462. Date of registration – August 13, 2014.

Dietary Protein Source Matters for Changes in Inflammation Measured by Urinary C-Reactive Protein in Rural Polish Women.

Multiple macronutrients have been shown to affect systemic inflammation, a well-known predictor of chronic disease. Less often, varying sources of these macronutrients are examined. Different subsistence environments lead to varying access to protein sources which, combined with physical activity patterns, may lead to different relationships than among more typically studied sedentary, industrialized populations. This study hypothesizes an association between dietary protein intake and urinary C-Reactive Protein (CRP) concentration in women from a rural, agrarian Polish community. We assessed protein intake and their sources for 80 nonsmoking, premenopausal Polish women who were not pregnant, nursing, or on hormonal birth control during the study or within the previous six months. Each participant completed multiple 24-hour dietary recalls during one menstrual cycle. Participants collected morning void urinary samples daily over one menstrual cycle for urinary CRP analysis. We analyzed relationships between plant and animal protein intake and CRP over the menstrual cycle by multiple linear regression. Plant protein in cereal foods was significantly positively associated with cycle-average urinary CRP concentrations (p<0.05) after controlling for body fat percent, total energy intake, and dietary fiber. Foods containing animal protein were not significantly associated with CRP. Contents of this population's main plant and animal protein sources differ from those of more commonly studied industrialized populations. Within the context of a population's typical diet, more emphasis may need to be placed on particular source of protein consumed, beyond plant versus animal, in order to understand relationships with CRP.

“Breakfast like a king, lunch like a prince, and dinner like a pauper”: how do European children and adolescents eat?

AbstractChrono-nutrition is an emerging field of research that focuses on the interplay between nutrition, circadian rhythms and metabolism. Most nutritional guidelines recommend regular and frequent meals for children and adolescents throughout the day. However, preliminary research, mostly in animals suggests that eating at the “wrong” time of the day and longer eating windows (and concomitant shorter fasting periods) may relate to metabolic health. This study aimed to identify meal-timing patterns of European children and adolescents in eight European countries.We examined 1225 children and adolescents (mean age: 11.8 years, 50% boys, and 26% overweight/obese) from Belgium, Cyprus, Estonia, Germany, Hungary, Italy, Spain and Sweden enrolled in the European I.Family study (2013/2014). Information on energy intake and meal-timing patterns was derived from multiple web-based 24-hour dietary recalls (proxy-assisted for children &lt; 12 years). We used the National Cancer Institute (NCI) method to estimate individual usual intakes. Subsequently, we applied the k-means algorithm to identify clusters for meal-timing patterns. Five variables were selected for the cluster analysis: 1) Duration between first and last meal of the day (eating window in hours), 2) Proportion of daily energy intake before 11am, 3) Proportion of daily energy intake after 5pm, 4) Number of meals per day, and 5) Pre-sleep fasting time.Three clusters, labelled “late and time-restricted”, “late and long” and “early and frequent” meal-timing patterns were identified. Similar clusters were derived when excluding energy misreporters according to Goldberg cut-offs. Children in the “early and frequent” pattern were younger, had a lower body mass index (BMI) z-score, and a longer sleep duration than children in the other two meal-timing patterns. A higher proportion of plausible energy reporters were classified into the “early and frequent” pattern than into the other two patterns. The proportion of children from Italy, Cyprus and Spain was highest in the “late and long” pattern, while the proportion of children from Belgium, Sweden, Germany and Hungary was highest in the “early and frequent” patterns, and the proportion of children from Estonia was highest in the “late and time-restricted” pattern.In conclusion, this study identified three different meal-timing patterns in children that varied by age, BMI z-score, country, misreporting status, and sleep duration. Investigations on the associations between meal timing patterns and metabolic health in this study sample are currently ongoing.

NUTRITIONAL INTAKE AND STATUS AND PHYSICAL FUNCTION OF OLDER ETHNIC MINORITIES: A LONGITUDINAL STUDY

There are limited longitudinal data regarding nutritional intake and status, and physical function in community-dwelling ethnically diverse older adults. This study explored these variables and their relationship at baseline (n=100) and after 8-months (n=81) among community-dwelling ethnically diverse older adults (≥60 years) in Birmingham, United Kingdom. Multiple pass 24-hour dietary recalls and the Mini Nutritional Assessment-Short Form assessed nutritional intake and status, respectively. The Short Physical Performance Battery(SPPB) and handgrip strength measured physical function. Linear and multinomial regression analyses were used to predict the relationship between nutritional intake, status and physical function. Mean(SD) age was 70(8.1) years (60% male), with 62% of the sample being obese. Significant decreases in intakes of vitamin B6(0.88-0.77mg/day, p=0.014); vitamin B1(0.73-0.63mg/day, p=0.029); iron(6.16-5.85mg/d, p=0.045); folate(113.23-106.66µg/d, p=0.043); and magnesium(154.54-144.59mg/d, p=0.031) occurred over time. At both timepoints, across sexes, daily intakes of all micronutrients except vitamin B12, phosphorus and manganese were below the Recommended Nutrient Intakes. There were significant declines in SPPB scores(Z=-4.01, p<0.001) and nutritional status(Z=-2.37,p=0.018) over time. At baseline, younger age, better nutritional status, and higher vitamin D and fibre intakes were associated with higher SPPB scores. At follow-up, higher baseline SPPB scores (OR=0.54 95% CI:0.35, 0.81) were associated with reduced decline in nutritional status. The observed declines in nutritional status and physical function, and the inadequate nutrient intakes in the absence of weight loss within eight months pose serious challenges to healthy ageing. There is an urgent need to re-evaluate and tailor appropriate dietary advice for this population to support them to age healthily.

Abstract P289: Effects of Dietary App-Supported Tele-Counseling on Sodium Intake, Diet Quality, and Blood Pressure in Patients With Diabetes and Kidney Disease

Background: Despite the importance of healthy diet for cardiovascular (CVD) health, the vast majority of patients with chronic kidney disease (CKD) do not receive dietitian counseling or make dietary modifications. Evidence for using dietary apps and tele-counseling to improve CVD risk factors is limited. Methods: We examined the effects of dietary app-supported tele-counseling on sodium intake and diet quality in 44 patients with type 2 diabetes and stage 1-3a CKD. Patients recorded and shared dietary data via MyFitnessPal with registered dietitians, who used motivational interviewing to provide telephone counseling weekly for 8 weeks. Outcomes included 24-hour urine sodium (2 collections per timepoint), Healthy Eating Index (HEI) 2015 score (multiple 24-hour dietary recalls per timepoint), 24-hour systolic blood pressure (SBP), and 24-hour urine albumin excretion. We report interim results for patients who completed 8-week and 6-month data collection; final outcome data at 12 months will be completed in November 2018. Results: Out of 44 consented patients (mean age 60.3 ± 11.9 y, 43% female, 93% white, 20% &lt;$25,000 annual income, 84% hypertension), 32 (73%) completed 8-week follow-up and 29 (66%) completed 6-month follow-up. While 78% owned a smartphone, 52% entered dietary data using a computer. Among patients who completed 6-month follow-up, sodium excretion did not significantly decrease from baseline to 8 weeks (-345 mg/d, 95% CI: -865, 175) or 6 months: (-182 mg/d, CI: -460, 97) (Table) . However, HEI-2015 score improved by 3.19 (CI: 0.51-5.87) at 8 weeks and 7.21 (CI: 3.07, 11.3) at 6 months; 24-hour SBP improved by -3.7 (CI: -7.4, 0.1) at 8 weeks and by -4.9 (CI: -8.8, -0.9) at 6 months. Conclusions: An app-supported tele-counseling program with a registered dietitian appears to be a feasible strategy to improve dietary quality and blood pressure, even in patients with diabetes and early CKD. Sodium is ubiquitous in the food supply and hard to change at the individual level. Studies to demonstrate efficacy are needed.

A Raw Food Based Quantitative Food Frequency Questionnaire to Assess Long-Term Dietary-Intake among Urban Adults of South India: Relative Validity and Reproducibility

Food Frequency Questionnaire (FFQ) is a commonly used tool for the measurement of food intake of a large population. However, FFQ could be influenced by the cultures, seasons and food habits. Thus FFQ should be validated against a known or standard tool like a multiple 24-hour dietary recalls (24h) and also needs to be tested for its reproducibility. Hence, in this study, the reproducibility of a Raw food based quantitative FFQ (RFFQ) was assessed and validated against the standard multiple 24h method. A community-based longitudinal study was conducted among 106 urban adult subjects in Hyderabad Metropolitan city of South India. The reproducibility of RFFQ was assessed at two reference periods of a year and seasonal variation was investigated across three seasons. Further, RFFQ was validated against 24h across three seasons of the year. The median and Inter Quartile Range (IQR) of food and nutrient intakes have shown that the RFFQ was comparable to 24h of four months duration and also between baseline and final RFFQs. No significant seasonal difference in food and nutrient intake was observed by the RFFQs (p&amp;gt;0.05). Bland-Altman analysis showed an agreement between the RFFQ and 24h indicating relative validity of the RFFQ in the study population. The reproducibility of the RFFQs was found to be good as observed by Intra class Correlation Coefficients (ICC). The RFFQ of one year duration is thus a valid tool to elicit long-term habitual dietary intake pattern of urban adult subjects in South India. As the RFFQ used in this study is raw food based it could be adopted to other parts of the country.

Feasibility of skin carotenoids as a biomarker of vegetable intake among Mexican-Origin children in a community setting: A cross-sectional pilot study

Background and purpose: Studies in adults and children have demonstrated a strong correlation of skin carotenoids with fruit and vegetable (F/V) intake. There are few studies testing the usefulness of this methodology in a community setting. This study aimed to determine the feasibility of resonance Raman spectroscopy (RRS) skin carotenoid intensity scores in young children to assess F/V intake.Methods: A cross-sectional study design was used to capture the RRS skin carotenoid intensity scores using the Pharmanex BioPhotonic Scanner. The RRS skin carotenoid intensity score ranges from 0 to 70,000+ with increasing scores indicating a higher carotenoid concentration. Children’s dietary intake of F/V was assessed within one-month period using a 26-item food frequency questionnaire (FFQ) and multiple pass 24-hour dietary recalls (24HDRs) administered to the parent of the child. Participants were 51 Mexican-origin children (ages 3-8 years) living in two rural California school districts during July-August 2014. RRS skin carotenoid intensity scores; frequency of fruit and vegetable intake from FFQ; daily servings of fruit and vegetables and carotenoid intake from 24HDR. Spearman correlation was used to determine the correlation between RRS skin carotenoid intensity scores and average 24HDR F/V intake and FFQ F/V intake.Results: The results of the study demonstrate a significant positive correlation between skin carotenoid levels and parent-reported 24HDR vegetable consumption (r = .41, p = .003) but not with 24HDR fruit, FFQ fruit, or FFQ vegetable consumption.Conclusion: The use of skin carotenoid measurements may be more indicative of short-term vegetable consumption than overall fruit and vegetable or fruit-only consumption in this population of Mexican-origin children.

Validation of the Dietary Screening Tool in a Middle‐Aged Appalachian Population

The Dietary Screening Tool (DST) was developed and validated to assess nutritional risk in older adults. The purpose of this study was to assess its use in a middle‐aged sample of adults (45–64 years) in Appalachia (n=87) and evaluate its validity with multiple 24‐hour dietary recalls and selected biomarkers. Adults identified by the DST as at nutrition risk (&lt;60 of 100 points) were significantly more likely to have had lower overall diet quality as assessed by the Healthy Eating Index (64 vs 50, p&lt;0.001) when compared to those not at risk or potential risk. Dietary intakes of vitamin A, vitamin C, vitamin B2, vitamin B6, niacin, vitamin K and potassium were also lower among those considered at risk, despite having significantly higher energy intakes (1653 ± 106 vs 2032 ± 76 kcal/day, p=0.004). The diets of those at risk were higher in added sugars (33 g vs 23 g, P=0.005) and lower in dietary fiber (10 g vs 12 g, p&lt;0.001) than those not at risk. The at risk group had significantly lower serum levels of 13‐cis‐β carotene (40 vs 60 nmol/L, p&lt;0.02), trans‐ β‐carotene (395 vs 711 nmol/L, p&lt;0.001), β‐Cryptoxanthin (137 vs 198 nmol/L, p&lt;0.01), cis‐Lutein (90 vs 137 nmol/L, p&lt;0.02), and trans‐lutein (292 vs 424 nmol/L, p=0.01). The DST was able to identify middle‐aged adults at nutritional risk.Support or Funding InformationUSDA Northeast Regional Project NE1439, WVU Health Disparities Mountains of Excellence Flash Funding and the WVU ADVANCE Sponsorship Program.

Delta Healthy Sprouts: Participants' Diet and Food Environment at Baseline

Local food environments influence the nutrition and health of area residents. This baseline analysis focuses on the food environments of women who participated in the Delta Healthy Sprouts project, a randomized, controlled, comparative trial designed to test the efficacy of two Maternal, Infant, and Early Childhood Home Visiting programs on weight status and health behaviors of mothers and their infants residing in the rural Mississippi Delta. Participants resided in Washington, Bolivar, or Humphreys County and were visited in their homes thus precise geographical location data was available.At baseline, participants were in the early second trimester of pregnancy. The majority were African American (96.3%), single (92.7%), received Medicaid (91.5%), enrolled in SNAP (75.6%), enrolled in WIC (84.1%), and owned or had access to a car (90.2%). Two‐thirds of the participants were classified as overweight or obese based on self‐reported pre‐pregnancy body weight and measured height.Over an 18 month period, dietary data was gathered from participants using multiple pass 24‐hour dietary recalls via the Nutrition Data System for Research software. Diet quality was calculated from this data using Healthy Eating Index‐2010 which measures adherence to the 2010 Dietary Guidelines for Americans. The Healthy Eating Index‐2010 total score ranges from 0 to 100 points. At baseline, the participants' mean Healthy Eating Index score was 43.1 with a range of 21.5 to 72.0.Participants also completed surveys asking about food practices, including the name and address of the store where most of the household food was purchased. All grocery and convenience stores in the towns where more than two participants lived were enumerated and evaluated for availability of healthy options, price, and quality using the Nutrition Environment Measures Survey for grocery stores (NEMS‐S) and convenience stores (NEMS‐CS). The 12 measured grocery stores had a mean score of 30.6 with a range of 23 to 41 (57 possible points). The 84 measured convenience stores had a mean score of 8.1 with a range from 2 to 14 (58 possible points).Focusing on the store where most of the household food was purchased, all but two participants reported grocery shopping at a store in their county. In Washington County, all residents of the largest town (n=42) reported shopping in town. For the two smaller towns in Washington County, about half (46.1%) reported commuting to the largest neighboring town for food shopping. In Bolivar County, all but one resident (n=16) reported shopping in in the largest town, regardless of town residency.Results suggest that grocery stores rated adequately for provision of healthy items while convenience store ratings were insufficient. Additionally rural participants reported grocery shopping in larger towns rather than stores closer to their residence. Future research will investigate the impact of food environments on nutrition intake and overall health.Support or Funding InformationSupported by the USDA Agricultural Research Service with in kind support from the Delta Health Alliance.

Delta Healthy Sprouts: Participants' Postnatal Diet Quality and Food Habits

The early postpartum period is a critical time for many women because excessive gestational weight gain and postnatal weight retention put them at risk for short and long term obesity. Given that poor diet quality and poor dietary choices can negatively affect the health of women and that of their offspring, the nutrition of postpartum women deserves considerable attention. The Delta Healthy Sprouts Project is a randomized, controlled, comparative trial designed to test the effectiveness of two maternal, infant, and early childhood home visiting curricula on weight status, dietary intake, and other health behaviors of mothers and their infants residing in the rural Mississippi Delta. The objective of this study was to compare the longitudinal diet quality and food habits of participants enrolled in the two treatment arms of this project.The Parents as Teachers (PAT) control arm followed the nationally recognized, evidence based, Parents as Teachers® curriculum. The Parents as Teachers Enhanced (PATE) experimental arm built upon the PAT curriculum by adding culturally tailored, maternal weight management and early childhood obesity prevention components. Following 6 months of intervention in the gestational period, women were followed for an additional 12 months of intervention in the postnatal period. Dietary data was gathered from participants using multiple pass 24‐hour dietary recalls via the Nutrition Data System for Research software. Diet quality was calculated from this data using the Healthy Eating Index‐2010 which measures adherence to the 2010 Dietary Guidelines for Americans. The Healthy Eating Index‐2010 total score ranges from 0 to 100 points. Participants also completed surveys addressing socio‐demographic characteristics and food practices.Postnatal retention rates were 83% (25/30) and 88% (21/24) for the PAT and PATE arms. The majority of both PAT and PATE participants were African American (97% and 96%), single (87% and 92%), receiving government food assistance (93% and 83%), young (mean age = 24 and 23 years), and obese (mean body mass index = 30 and 32 kg/m2). Mean total HEI‐2010 scores for postnatal months 1, 4, 6, 8 and 12 were 37, 37, 40, 39, and 36 in the PAT arm. Corresponding mean scores were 42, 42, 40, 46, and 38 in the PATE arm. Mean scores in the PATE arm were significantly higher across time as compared to the PAT arm. Significant effects for time and the interaction between treatment and time were not apparent. Of the 575 PAT and 462 PATE participant meal occasions, 8% and 7% occurred in a delicatessen, restaurant, cafeteria, or fast food establishment. Additionally, 77% (23/30) of PAT and 83% (20/24) of PATE participants reported eating breakfast regularly (i.e., for every dietary recall).Results suggest that neither treatment was effective at improving the diet quality of this cohort of rural, Southern, primarily African American women in the postnatal period. Future research will investigate the impact of the food environment (e.g., type and proximity of food outlets to participants' homes) on participants' nutrition.Support or Funding InformationSupported by the USDA Agricultural Research Service with in kind support from the Delta Health Alliance.

Infant Adiposity is Independently Associated with a Maternal High Fat Diet but not Related to Niacin Intake: The Healthy Start Study.

Objectives Over-nutrition during pregnancy resulting from maternal obesity or an unhealthy diet can lead to excess infant adiposity at birth. Specific dietary macro- and micronutrients have been shown to increase fat cell development in both in-vitro and in-vivo models and may therefore link maternal diet to increased infant adiposity. We hypothesized that high maternal dietary niacin intake during pregnancy, especially in combination with a high-fat diet (HFD) would increase infant adiposity. Methods We included 1040 participants from a pre-birth cohort of mother-infant pairs. Maternal diet was assessed using multiple 24-hour dietary recalls. HFD was defined as ≥30% of calories from fat and ≥12% of fat calories from saturated fat. Neonatal body composition (% fat mass [%FM], fat mass [FM], fat-free mass [FFM]) was measured by PEAPOD. We used multivariate regression to assess the joint effect of maternal dietary niacin and maternal HFD on neonatal body composition. Results Dietary niacin was not associated with neonatal body composition, and maternal HFD did not modify this finding. However, maternal HFD was independently associated with %FM (β = 0.8 [0.1, 1.4]%, p < 0.01] and FM (β = 32.4 [6.7, 58.0] g, p < 0.01).Conclusions for Practice Our results suggest that a HFD during pregnancy may increase infant adiposity, therefore supporting the need for improved diet counseling of pregnant women at both the clinical and community levels.

Application of a New Statistical Model for Measurement Error to the Evaluation of Dietary Self-report Instruments.

Most statistical methods that adjust analyses for dietary measurement error treat an individual's usual intake as a fixed quantity. However, usual intake, if defined as average intake over a few months, varies over time. We describe a model that accounts for such variation and for the proximity of biomarker measurements to self-reports within the framework of a meta-analysis, and apply it to the analysis of data on energy, protein, potassium, and sodium from a set of five large validation studies of dietary self-report instruments using recovery biomarkers as reference instruments. We show that this time-varying usual intake model fits the data better than the fixed usual intake assumption. Using this model, we estimated attenuation factors and correlations with true longer-term usual intake for single and multiple 24-hour dietary recalls (24HRs) and food frequency questionnaires (FFQs) and compared them with those obtained under the "fixed" method. Compared with the fixed method, the estimates using the time-varying model showed slightly larger values of the attenuation factor and correlation coefficient for FFQs and smaller values for 24HRs. In some cases, the difference between the fixed method estimate and the new estimate for multiple 24HRs was substantial. With the new method, while four 24HRs had higher estimated correlations with truth than a single FFQ for absolute intakes of protein, potassium, and sodium, for densities the correlations were approximately equal. Accounting for the time element in dietary validation is potentially important, and points toward the need for longer-term validation studies.

Abstract A18: Personalized prevention of colorectal cancer trial

Abstract Background: High calcium or high magnesium consumption has been linked to reduced risks of colorectal adenoma and cancer. However, results are not consistent. In the Tennessee Colorectal Polyp Study (TCPS), the Calcium Polyp Prevention Study (a large-scale randomized trial), we found that high intake of supplemental calcium or total calcium was related to a reduced risk of colorectal adenoma or adenoma recurrence only among those with calcium/magnesium intake ratio below 2.8 or 2.6. This effect modification by the calcium/magnesium ratio cannot solely be attributed to the dietary intake in calcium or magnesium. Furthermore, we found in the TCPS that calcium/magnesium intake ratio significantly interacted with Thr1482Ile polymorphism (rs8042919, GàA) in the TRPM7 gene, in relation to both adenomas and hyperplastic polyps. The TRPM7 gene is involved in magnesium and calcium re(absorption) and homeostasis. Compared to those with the GG genotype, we found that people who carry A allele(s) were at 60% and 85% increased risks of adenoma and hyperplastic polyp, respectively, if they also consumed diets with calcium/magnesium intake ratio &amp;gt;2.8; and the corresponding risks increased by 345% and 1500% among those with the AA genotype. The risk was not increased among those who carried the A allele(s) if they consumed diets low in calcium/magnesium ratio (&amp;lt;2.8). Objectives: 1) Test the hypothesis whether reducing the calcium/magnesium through magnesium supplementation affects biomarkers related to colorectal carcinogenesis in rectal tissues; and 2) Test whether the effect differs by TRPM7 genotype. Methods: Personalized Prevention of Colorectal Cancer Trial (PPCCT, R01CA149633) is an ongoing double-blind, randomized trial of 12 week personalized magnesium supplementation. 288 participants with high calcium/magnesium intake ratio and at high risk of colorectal cancer are being recruited. The uniqueness of the trial includes 1) only target participants with a high calcium/magnesium ratio through nutritional screening using multiple 24-hour dietary recalls; 2) personalized doses are based on and used to reduce the current calcium/magnesium intake ratios; and finally, 3) the participants are also randomized by the TRPM7 genotype. Results: As of July 20, 2014, we have enrolled at least 170 participants. We have conducted immunohistochemical assays to measure expressions of carcinogenesis biomarkers, including apoptosis, cell proliferation, COX2 and TRPM7, in normal rectal tissues collected at baseline and the end of the intervention for 40 participants who first completed the trial. We are also assaying lipid profile and other novel biomarkers, including DNA methylation, and microbial markers. We have obtained some very promising preliminary findings. We will report updated findings in the presentation. Conclusions: The results from our study may ultimately help to develop personalized strategies to prevent colorectal cancer. Citation Format: Xiangzhu Zhu Zhu, Chang Yu, Martha J. Shrubsole, Xinqing Deng, Eugene Shubin, Jennifer M. Engle, Wei Zheng, Harvey J. Murff, Douglas L. Seidner, Reid M. Ness, Qi Dai. Personalized prevention of colorectal cancer trial. [abstract]. In: Proceedings of the Thirteenth Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2014 Sep 27-Oct 1; New Orleans, LA. Philadelphia (PA): AACR; Can Prev Res 2015;8(10 Suppl): Abstract nr A18.

Abstract 2132: Personalized prevention of colorectal rectal trial (PPCCT)

Abstract We previously reported from the Tennessee Colorectal Polyp Study that high total intakes of calcium or magnesium may only be related to a reduced risk of colorectal adenoma or hyperplastic polyp when the calcium/magnesium intake ratio was below 2.8. Furthermore, we found that calcium/magnesium intake ratio significantly interacted with the common Thr1482Ile polymorphism (rs8042919, GA) in the TRPM7 gene, in relation to both adenomas and hyperplastic polyps. The TRPM7 gene is involved in magnesium and calcium re(absorption) and homeostasis. Compared to those with the GG genotype, we found that people who carry A allele(s) were at 60% and 85% increased risks of adenoma and hyperplastic polyp, respectively, if they also consumed diets with calcium/magnesium intake ratio &amp;gt;2.8; and the corresponding risks increased by 345% and 1500% among those with the AA genotype. The risk was not increased among those who carried the A allele(s) if they consumed diets low in calcium/magnesium ratio (&amp;lt;2.8). In a recent report from the Calcium Polyp Prevention Study, a large-scale randomized clinical trial of calcium supplementation, it was found that calcium treatment only significantly reduced colorectal adenoma recurrence risk when the baseline dietary calcium/magnesium intake ratio was under 2.6 and this effect modification by the calcium/magnesium ratio cannot solely be attributed to the baseline dietary intake in calcium or magnesium. It is possible for those with a high calcium/magnesium ratio, reducing the calcium/magnesium intake ratio may be helpful. We are funded by NCI (R01CA149633) to conduct a personalized intervention trial clinical trial among 240 colorectal polyp patients with a high calcium/magnesium intake ratio. We are testing 1) if reducing the calcium/magnesium through magnesium supplementation affects biomarkers related to colorectal carcinogenesis in rectal tissues; and 2) if the effects differ by TRPM7 genotype. As of November 16, 2013, we have enrolled at least 160 participants and we plan to complete the trial by the end of January, 2015. Thus the uniqueness of the trial includes 1) only target colorectal polyp patients with a high calcium/magnesium ratio through nutritional screening using multiple 24-hour dietary recalls; 2) personalized doses are based on and used to reduce the current calcium/magnesium intake ratios; and finally, 3) the participants are also randomized by the TRPM7 genotype. We have conducted immunohistochemical assays to measure expressions of carcinogenesis biomarkers, including apoptosis, cell proliferation, COX2 and TRPM7, in normal rectal tissues collected at baseline and the end of the intervention for 40 participants who first completed the trial. We have also measured lipid profile and blood pressure. We have obtained very promising preliminary findings. We will report updated findings in the presentation. The results from our study may ultimately help to develop personalized strategies to prevent the colorectal cancer. Citation Format: Qi Dai, Martha J. Shrubsole, Xinqing Deng, Xiangzhu Zhu, Eugene Shubin, Tiffany McCray, Wei Zheng, Harvey Murff, Douglas Seidner, Reid M. Ness, Chang Yu. Personalized prevention of colorectal rectal trial (PPCCT). [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 2132. doi:10.1158/1538-7445.AM2014-2132

Fried food intake estimated by the multiple source method is associated with gestational weight gain

This present study aimed to test the association between fried food intake estimated by a semiquantitative food frequency questionnaire (FFQ), multiple 24-hour dietary recalls (24hRs), and the application of the multiple source method (MSM) in relation to gestational weight gain at the second and third trimesters and weight gain ratio (observed weight gain/expected weight gain). We hypothesized that distinct relationships with weight gain would be found given the measurement errors of self-reported dietary approaches. A prospective study was conducted with 88 adult pregnant women. Fried food intake during pregnancy was assessed using a validated 85-item FFQ, two to six 24hRs per woman, and the MSM with and without frequency of food intake as covariate. Linear regression models were used to evaluate the relationship between fried food estimated by the methods and weight gain. For every 100-g increment of fried food intake, the β (95% confidence interval) for weight gain was β 1.87 (0.34, 3.40) and β 2.00 0.55, 3.45) for estimates using MSM with and without the frequency of intake as covariate, respectively, after multiple adjustments. We found that fried food intake estimated by the FFQ and 24hRs β 0.40 (−0.68, 1.48) and β 0.49 (−0.53, 1.52), respectively, was unrelated to weight gain. In relation to weight gain ratio, a positive association was found for estimates using the MSM with [β 0.29 (0.03, 0.54)] and without the frequency of intake as covariate [β 0.31 (0.07, 0.55)]; and no associations were found for estimates by the FFQ or 24hRs. The data showed that fried food intake estimated the MSM, but not by the FFQ and 24hRs, is associated with excessive weight gain during pregnancy.

Intensively managed young children with type 1 diabetes consume high-fat, low-fiber diets similar to age-matched controls

Despite significant emphasis on nutrition, older children with diabetes demonstrate poor dietary quality. We tested the hypothesis that dietary quality in young children with type 1 diabetes (T1D) would be better than age-matched children in the US population. Dietary data from children with T1D (n = 67) aged 2 to 12 years attending a pediatric diabetes clinic were compared with a nationally representative, age-matched sample from the National Health and Nutrition Examination Survey (NHANES; n = 1691). Multiple 24-hour dietary recalls were used. Recommended intakes were based on national guidelines, and dietary quality was assessed using the Healthy Eating Index-2005. More children with T1D were overweight or obese compared with children participating in NHANES (42% vs 30%, P = .04). Greater proportions of children with T1D met daily recommendations for vegetables (22% vs 13%, P = .03), whole grains (12% vs 5%, P = .005), and dairy (55% vs 36%, P = .001) compared with NHANES children, whereas similar proportions met daily fruit recommendations (40% vs 33%, P = .2). Less than one-third of all children limited total fat to recommended levels; children with T1D consumed more saturated fat than did NHANES children (14% vs 12% total energy intake, P = .0009). Fiber intakes were very low in both groups. Compared with NHANES children, children with T1D had higher Healthy Eating Index-2005 scores (59.6 vs 49.7, P = .0006) primarily because of lower intakes of added sugars. The nutritional intake of young children with T1D remains suboptimal in the contemporary era of diabetes management. Despite focused nutrition management, young children with T1D consume high-fat, low-fiber diets comparable with youth in the general population.

Macronutrient and sociodemographic determinants of gestational weight gain among HIV-negative women in Tanzania.

The effect of dietary macronutrient composition on the rate of gestational weight gain among women in sub-Saharan Africa is unclear. To examine the effect of macronutrient intake on the rate of gestational weight gain among HIV-negative women in Tanzania. The weights of 8,428 women were measured monthly from 12 weeks of gestation to term. Prenatal dietary intake was estimated as the cumulative average of multiple 24-hour dietary recalls. The association between energy intake and percentage of energy from carbohydrate, protein, and total fat and rate of weight gain (grams per month) was estimated from generalized estimating equation models. Macronutrient effects were adjusted for total energy using the nutrient density model and maternal age, maternal height, maternal mid-upper-arm circumference, parity, marital status, maternal occupation, maternal education, household wealth, season, and treatment regimen assignment. Body mass index (BMI) was considered as a confounder and a potential modifier of the effect of macronutrient intake on gestational weight gain. A 6 g/month increase in rate of weight gain was associated with every 100-kcal increment in daily total energy intake (95% CI, 1 to 12; p = .03). Analyses substituting 5% of energy from fat by protein showed that weight gain would decrease by 72 g/month (95% CI, 6 to 140; p = .03); substituting 5% of energy from carbohydrate by protein decreased gain by 70 g/month (95% CI, 15 to 124; p = .01). Baseline BMI did not modify these associations. Further research on the effects of macronutrient composition on gestational weight gain is needed to inform the design of supplementation programs for women in developing countries.

Validation of different instruments for caffeine measurement among premenopausal women in the BioCycle study.

Effects of caffeine on women's health are inconclusive, in part because of inadequate exposure assessment. In this study we determined 1) validity of a food frequency questionnaire compared with multiple 24-hour dietary recalls (24HDRs) for measuring monthly caffeine and caffeinated beverage intakes; and 2) validity of the 24HDR compared with the prior day's diary record for measuring daily caffeinated coffee intake. BioCycle Study (2005-2007) participants, women (n = 259) aged 18-44 years from western New York State, were followed for 2 menstrual cycles. Participants completed a food frequency questionnaire at the end of each cycle, four 24HDRs per cycle, and daily diaries. Caffeine intakes reported for the food frequency questionnaires were greater than those reported for the 24HDRs (mean = 114.1 vs. 92.6mg/day, P = 0.01) but showed high correlation (r = 0.73, P < 0.001) and moderate agreement (К = 0.51, 95% confidence interval: 0.43, 0.57). Women reported less caffeinated coffee intake in their 24HDRs compared with their corresponding diary days (mean = 0.51 vs. 0.80 cups/day, P < 0.001) (1 cup = 237 mL). Although caffeine and coffee exposures were highly correlated, absolute intakes differed significantly between measurement tools. These results highlight the importance of considering potential misclassification of caffeine exposure.

Sodium Intake and Blood Pressure Among US Children and Adolescents

To assess the association between usual dietary sodium intake and blood pressure among US children and adolescents, overall and by weight status. Children and adolescents aged 8 to 18 years (n = 6235) who participated in NHANES 2003-2008 comprised the sample. Subjects' usual sodium intake was estimated by using multiple 24-hour dietary recalls. Linear or logistic regression was used to examine association between sodium intake and blood pressure or risk for pre-high blood pressure and high blood pressure (pre-HBP/HPB). Study subjects consumed an average of 3387 mg/day of sodium, and 37% were overweight/obese. Each 1000 mg per day sodium intake was associated with an increased SD score of 0.097 (95% confidence interval [CI] 0.006-0.188, ∼1.0 mm Hg) in systolic blood pressure (SBP) among all subjects and 0.141 (95% CI: -0.010 to 0.298, ∼1.5 mm Hg) increase among overweight/obese subjects. Mean adjusted SBP increased progressively with sodium intake quartile, from 106.2 mm Hg (95% CI: 105.1-107.3) to 108.8 mm Hg (95% CI: 107.5-110.1) overall (P = .010) and from 109.0 mm Hg (95% CI: 107.2-110.8) to 112.8 mm Hg (95% CI: 110.7-114.9; P = .037) among those overweight/obese. Adjusted odds ratios comparing risk for pre-HBP/HPB among subjects in the highest versus lowest sodium intake quartile were 2.0 (95% CI: 0.95-4.1, P = .062) overall and 3.5 (95% CI: 1.3-9.2, P = .013) among those overweight/obese. Sodium intake and weight status appeared to have synergistic effects on risk for pre-HBP/HPB (relative excess risk for interaction = 0.29 (95% CI: 0.01-0.90, P < .05). Sodium intake is positively associated with SBP and risk for pre-HBP/HPB among US children and adolescents, and this association may be stronger among those who are overweight/obese.

Evaluation of Three Short Dietary Instruments to Assess Fruit and Vegetable Intake: The National Cancer Institute's Food Attitudes and Behaviors Survey

BackgroundFruit and vegetable (F/V) intake assessment tools that are valid, reliable, brief, and easy to administer and code are vital to the field of public health nutrition. ObjectiveTo evaluate three short F/V intake screeners (ie, a 2-item serving tool, a 2-item cup tool, and a 16-item F/V intake screener) among adults using multiple 24-hour dietary recalls (24-hour recalls) as the reference instrument and evaluate test–retest reliability of the screeners across a 2- to 3-week time period. DesignValidity and reliability study. Participants/settingTwo hundred forty-four adults for the validity study and 335 adults for test–retest reliability. Statistical analyses performedMedian values for F/V intakes were calculated for the screeners and 24-hour recalls. The Wilcoxon signed rank test was used to compare screeners with the 24-hour recalls. Deattenuated Pearson correlations were reported for validity and intraclass correlation coefficient used for reliability. ResultsThe estimated median daily servings/cups of F/V for the 2-item serving screener was lower, for the 2-item cup screener was equivalent for men but higher for women, and for the 16-item F/V intake screener were about the same when compared with 24-hour recall values. The deattenuated correlations comparing the 24-hour recalls with the screeners were positive but weak for the 2-item serving screener, and were positive and moderate in strength for the 2-item cup and 16-item F/V intake screeners. The test–retest intraclass correlation coefficients were all positive and fairly strong for all of the screeners. ConclusionsAlthough dietary screeners offer a more cost-effective, less burdensome way to obtain gross estimates to rank individuals with regard to F/V intake, these methods are not recommended for assessing precise intake levels.