Multiple-pass 24-hour Dietary Recalls Research Articles

Micronutrient intake and associated factors among school adolescent girls in Meshenti Town, Bahir Dar City Administration, Northwest Ethiopia, 2020.

Adolescent girls have a greater nutrient demand and their poor dietary intake is associated with micronutrient deficiencies and poor maternal outcomes. Having information on micronutrient intake inadequacy in adolescent girls is critical for promoting healthy behavior and breaking the cycle of intergenerational malnutrition. Thus, this study assessed overall micronutrient intake inadequacy and associated factors among school adolescent girls in Meshenti town of Bahir Dar City Administration, North West Ethiopia. A school-based cross-sectional study was conducted among 401 adolescent girls from February 7 to 23, 2020. A Simple random sampling technique was used to select study participants. A multiple-pass 24-hour dietary recall with portion size estimation method and recommended dietary allowance cut-off point were used to assess micronutrient intake inadequacy. Overall micronutrient intake inadequacy was measured using the mean adequacy ratio. Nutrient databases were developed by ESHA FOOD PROCESSOR version 8.1 software. Data were entered into Epi-data version 3.1 and exported to SPSS version 23 for analysis. Multivariable logistic regression was performed to identify determinants of overall micronutrient intake inadequacy and an adjusted odds ratio at a p-value of less than 0.05 was used to see the strength of statistical association. The prevalence of overall micronutrient intake inadequacy was 44.4% (95% CI: 39.7%-49.6%). Early adolescent age (AOR: 2.75, 95% CI: 1.71-4.42), food-insecure household (1.74, 95%CI: 1.087-2.784), low dietary diversity score (AOR = 2.83, 95% CI: 1.35-5.92), and high peer pressure on eating and body concern (AOR = 1.853, 95% CI: 1.201-2.857) were significantly associated factors with overall micronutrient intake inadequacy. Findings of this study revealed that micronutrient intake inadequacy among adolescent girls was a high public health problem in the study area. Therefore, attention should be given to adolescent girls of the study area, especially the ones in the early adolescent age. Interventions should also focus on nutrition-sensitive activities to address food insecurity, a less diversified diet, and the negative impact of peer influence.

989 IS DIET QUALITY AS IMPORTANT AS DIET QUANTITY IN THE OLDER ADULT? MICRONUTRIENT DEFICIENCY, FRAILTY AND SARCOPENIA

Abstract Introduction Dietary research in older adults has focused on energy content, macronutrient composition and diet quantity. Dietary antioxidants can theoretically ameliorate oxidative stress, which is widely implicated in age-related degeneration. Additional vital micronutrients are magnesium, being a co-factor for antioxidant enzyme function, and potassium, given its role in nerve and muscle function, and fluid balance. This study sought to investigate diet quality, specifically micronutrient content, and independent nutritional risk factors for frailty and sarcopenia. Method Secondary analysis of NUTRICOM 2015–2018 study participants (NIHR 19045)—exploring the impact of malnutrition on community-dwelling older adults—was conducted. Dietary intake was assessed using multiple-pass 24-hour dietary recall, nutrition risk status (NRS) using Guy’s and St Thomas’ NRS Tool, frailty using the 7-point Clinical Frailty Scale (CFS) and sarcopenia using EWGSOP2 handgrip strength cut-offs. Mann–Whitney U-Test assessed differences in dietary intake between malnutrition risk groups. Multivariable regression models, adjusting for age, gender, deprivation and comorbidities, established nutritional correlates of frailty and sarcopenia. Results 142 participants; mean age 77.4(SD 8.4) years, 83(59%) female, mean BMI 26.05(SD 5.35). 79%–91% of older adults showed dietary deficiency in zinc, selenium, copper, magnesium and potassium. CFS increase was independently associated with NRS, and deficiency of potassium, copper and cumulative micronutrients, by 1.52, 1.19, 0.82 and 0.28 respectively (p < 0.05). Individuals with dietary zinc deficiency were 3.25 times more likely to have sarcopenia than individuals with sufficient zinc intake (95%CI: 1.04–10.16, p = 0.042). Conclusion Routine nutrition risk screening (accounting for macronutrient intake) finds only about 5% of older adults to be at-risk of malnutrition, whilst assessment of dietary intake in this study suggests dietary micronutrient deficiency is very common and is associated with increased frailty. 24-hour recall only provides a snapshot of dietary intake; further studies should be conducted using method that measure habitual dietary intake e.g. 7-day dietary diary.

Relationship between tooth loss, nutritional status and consumption of macro and micronutrients in elderly people from southern Brazil

Maintaining a functional natural dentition plays an important role in keeping a satisfactory nutritional status. The aim of this study was to evaluate the relationship between oral health conditions determined by the presence of edentulism and the number of missing teeth, nutritional status and consumption of nutrients by the elderly. This cross-sectional study comprised 494 independent elderly of both genders, over 60 years of age, registered at the Brazilian public health service in Londrina, southern Brazil. The data collection included: oral examinations; anthropometric measurements by calculating the Body Mass Index (BMI); analysis of food consumption based on a multiple pass 24-hour dietary recall and a food intake frequency questionnaire; and structured interviews to obtain sociodemographic information. Multiple linear regression, the Fisher’s Exact test, chi-square and Mann‑Whitney tests, were applied at a 5% significance level. The prevalence of edentulism was 47.3%; this predominated in females, age group from 65 to 74 years, low education level and low/medium economic classification. A larger number of underweight and fewer number of overweight elderly were recorded among the edentulous versus dentate participants (< 0.0001). Significantly lower consumption of several nutrients, as well as fruit, was recorded among the edentulous group. In particular, carbohydrates, vitamins (B1, B9 and C), and the majority of the minerals studied were associated with a larger number of missing teeth. In conclusion, tooth loss was associated with the food consumption pattern of some macro- and micronutrients and the nutritional status of the Brazilian elderly.

Balanced carbohydrate ratios are associated with improved diet quality in Australia: A nationally representative cross-sectional study.

BackgroundCarbohydrate quality influences major health outcomes; however, the best criteria to assess carbohydrate quality remain unknown.ObjectiveThe objectives were to: i) evaluate whether a diet that meets a carbohydrate ratio (simple, modified or dual ratio) is associated with higher nutrient intakes and diet quality, and ii) model the impact of substituting carbohydrate foods that meet the proposed ratios in place of foods that do not, on nutrient intakes.DesignA secondary analysis of cross-sectional data from the 2011–12 Australian National Nutrition and Physical Activity Survey.Participants/SettingNational data from participants aged 2 years and older (n = 12,153).Main outcome measuresRatios were defined as (i) simple ratio, 10:1 (10g carbohydrate:≥1g dietary fiber); (ii) modified ratio, 10:1:2 (10g carbohydrate:≥1g dietary fiber:≤2g free sugars); and (iii) dual ratio, 10:1 & 1:2 (10g carbohydrate:≥1g dietary fiber & ≤2g free sugars per 1g dietary fiber). Ratios were compared to nutrient intakes obtained via automated multiple-pass 24-hour dietary recall and diet quality calculated using the Australian Healthy Eating Index.Statistical analyses performedSubstitution dietary modelling was performed. Data were analyzed using paired and independent sample t-tests.ResultsRatio adherence was highest for simple (50.2% adults; 28.6% children), followed by dual (40.6% adults; 21.7% children), then modified (32.7% adults; 18.6% children) ratios. Participants who met any ratio reported higher nutrient intake and diet quality compared to those who failed to meet the respective ratio (P < .001 for all), with the greatest nutrient intakes found for those who met modified or dual ratios. Dietary modelling improved nutrient intakes for all ratios, with the greatest improvement found for the dual ratio.ConclusionsAll carbohydrate ratios were associated with higher diet quality, with a free sugars constraint in the dual ratio providing the greatest improvements.

Dietary Consumption Among Youth with Antipsychotic-Induced Weight Gain and Changes Following Healthy Lifestyle Education.

Background: Youth treated with antipsychotic medications are high risk for weight gain, increased lipids/glucose, and development of metabolic syndrome. Little is known about the dietary intake/nutritional adequacy in this vulnerable population, and effect on weight gain. This secondary data analysis describes the baseline intake and changes in diet after receiving healthy lifestyle education/counseling over 6 months, in a sample of youth with antipsychotic-induced weight gain. Methods: The U.S. Department of Agriculture (USDA) Automated Multiple-Pass Method 24-hour dietary recall was administered to 117 youth at baseline, 3 months, and 6 months. Parent/child received personalized healthy lifestyle education sessions over 6 months. Baseline intake was compared with the USDA Recommended Daily Allowance using independent samples t-tests. Individual dietary covariates were examined for change over 6 months using longitudinal linear mixed modeling. Influence of each on body mass index (BMI) z-score change was tested in a pooled group analysis and then compared by treatment group. Results: Pooled analysis revealed baseline consumption high in carbohydrates, fat, protein, sugar, and refined grains, while low in fruit/vegetables, whole grains, fiber, and water. Change over 6 months demonstrated a statistically significant decrease in daily calories (p = 0.002), carbohydrates (p = 0.003), fat (p = 0.012), protein (p = 0.025), sugar (p = 0.008), refined grains (p = 0.008), total dairy (p = 0.049), and cheese (p = 0.027). Small increases in fruits/vegetables were not statistically significant, although the Healthy Eating Index subscores for total vegetables (p = 0.013) and dark green/orange vegetables (p = 0.034) were. No dietary covariates were predictors of change in BMI z-score. Nondietary predictors were parent weight/BMI and treatment group, with the metformin and switch groups experiencing significant decreases in BMI z-score. Conclusions: Further pediatric studies are necessary to assess the effects of antipsychotic medications on dietary intake, and test efficacy of healthy lifestyle interventions on change in nutrition. The relationship of nutrition to cardiometabolic health in this population must be further investigated. Clinical Trial Registration number: NCT02877823.

Influence Of Social Networks On Nutrition And Physical Function Of Ethnic Older Minorities Over Time

BACKGROUND: Social networks (SN) are consistently shown to influence health outcomes in later life. However, relatively little is known about SN of ethnic older minorities, and how they impact on health outcomes over time. PURPOSE: To explore SN and their impact on nutritional intake and status, and physical function in ethnic older minorities (≥60 years) living in Birmingham, United Kingdom. METHODS: SN were assessed using the Wenger Practitioner Assessment of Network Types (PANT). Multiple-pass 24-hour dietary recalls and the Mini Nutritional Assessment-Short Form assessed nutritional intake and status, respectively. Short Physical Performance Battery (SPPB) and handgrip strength measured physical function. Correlation and regression analyses examined relationships between SN, physical function, nutrient intake and nutritional status. The influences of SN were captured through semi-structured interviews at baseline (N=92) and follow-up (N=81). Interviews were transcribed verbatim and analysed using directed content analysis. RESULTS: Of the 100 participants measured at baseline, 81 were followed up 8-months later. Mean age =70.9±8.1 years (62% male) comprising African/Caribbean (65%), South Asian (28%), and other ethnicities (7%). Five SN were identified and grouped into two broad categories: integrated SN (locally integrated (44%) and wider community (8%)); and non-integrated SN (family dependent (25%), locally self-contained (17%), and private restricted (6%)). At follow-up, SN declined in 19% and improved in 11%. There was an overall decrease in physical function (F(1))=9.73, P=0.03) and nutritional status (F(1))=6.04, P=0.016) over time. Participants in integrated SN compared with non-integrated SN at baseline were less likely to experience a decline in physical function at follow-up (OR: 0.17; 95% CI:0.04-0.63). Qualitative results indicate that participants with declines in SN perceived this as causing poorer physical function and eating behaviours. CONCLUSION: Changes in SN occurred over a relatively brief period in this sample, with integrated SN associated with better physical function, nutritional intake and status. These findings can inform interventions and community outreach programmes designed to enhance SN and the health status of this population.

INDDEX24: An Innovative Global Dietary Assessment Platform to Scale Up the Availability, Access, and Use of Dietary Data

Abstract Objectives Regular collection and use of dietary data, particularly in low- and middle-income countries (LMICs), is hindered by the lack of available and accessible dietary data research infrastructure (e.g., accessible food composition tables (FCT), portion conversions, and standard recipes; electronic dietary assessment tools). INDDEX24 is a global dietary assessment platform that addresses these bottlenecks. Methods Priority technical specification were drafted and reviewed by experts with extensive dietary assessment experience in LMICs. Specifications included use of the multiple pass 24-hour dietary recall method, offline data collection capability, contextual adaptability, and an interviewer-administered format. Existing dietary assessment platforms were evaluated against the technical specifications via a structured literature review and key informant interviews. An initial version of INDDEX24 was developed and tested through feasibility studies in Vietnam and Burkina Faso. Feedback from potential users of the platform was gathered during webinars. The platform was subsequently revised, and its relative validity, time, and cost compared to use of paper-based 24-hour dietary recalls were then evaluated in Vietnam and Burkina Faso. Results INDDEX24 is comprised of a mobile application (app) that is linked with a web app. The web app is used by researchers to manage the dietary data inputs for their survey context (i.e., FCT data, recipes, food descriptors, and portion conversions). Users can search the web app for dietary data inputs and integrate them into their workspace or upload their own inputs. The INDDEX24 mobile app is a 24-hour dietary recall app that has been built using CommCare mobile platform technology. Users can adapt mobile app questionnaire text to their survey language and context, add survey modules, conduct data monitoring, and basic food matching. To maximize the time and cost saving benefits of the platform, a concerted effort will be needed to populate the web app with dietary data inputs from LMICs. Conclusions The extensive consultative process and evidence driven design has produced a high-quality platform that balances flexibility of adaptation to a range of contexts with quality control and standardization. Funding Sources Bill and Melinda Gates Foundation.

A Single-Goal Fiber Intervention Does Not Compromise Nutritional Intake During Pregnancy

Abstract Objectives This study evaluated the effects of a single-goal (SG) vs. multiple goal (MG) intervention on food group and nutrient intake during pregnancy. Methods Two separate pilot studies randomized women to an intervention (SG or MG) or usual care (UC; n = 19 combined) aiming to prevent excessive gestational weight gain. Each group met weekly with a registered dietitian. In the MG study (n = 21), women were counseled on healthy eating and exercise. In the SG study (n = 16), weekly lessons focused only on increasing fiber intake (≥30 g/day); mention of all other nutrients including calories was intentionally omitted. In both studies, multiple-pass 24-hour dietary recalls were collected at baseline and end of study and analyzed with Nutrient Data System for Research (NDS-R). Diet quality was calculated using the Alternative Healthy Eating Index for Pregnancy (AHEI-P). ANOVA determined between group differences for micronutrient intake and food group servings. Paired t-tests determined within group differences in diet quality. Nutrients from dietary supplements were not included in analyses. Results All analyses reported are for data from the end of the studies. For nutrients of concern during pregnancy, when compared to the MG group, the SG group had greater calcium intake (P = 0.04). No between group difference was found for folate, iron, choline, or DHA. For food groups, when compared to the MG group, the SG group had greater fruit and whole grain intake (P &amp;lt; 0.05). No between group difference was found for protein, vegetables, nuts and legumes, or sugar-sweetened beverages (P &amp;gt; 0.05). No differences were found between SG and UC or MG and UC for any nutrients or food groups. AHEI-P score increased in the SG group during the study (P = 0.01), but not in the MG or UC groups (P &amp;gt; 0.05). Conclusions An intervention focused solely on increasing fiber intake did not cause decreased intake in other foods groups or nutrients. Only the SG group increased diet quality throughout the study. These data suggest focusing on fiber only did not create unintended negative dietary consequences and may be an effective simple message intervention for diet improvement. Larger studies are needed to further explore these results. Funding Sources This study was supported by a NIH Clinical and Translational Science Award and the Kansas City Area Life Sciences Institute.

The Use of Tablet-Based Multiple-Pass 24-Hour Dietary Recall Application (MP24Diet) to Collect Dietary Intake of Children under Two Years Old in the Prospective Cohort Study in Indonesia.

Dietary intake data are crucial for developing or evaluating nutrition interventions to improve the nutritional status of populations. The collection of accurate and reliable dietary data in developing countries, however, remains challenging. The emergence of new technologies, which facilitate electronic data capture, might address some of these challenges. This paper aims to describe an application developed to collect a multiple-pass 24-h dietary recall, using electronic data capture, and compare the results to those estimated using a paper-based method. In this study, a tablet-based application was developed, in the CommCare platform, to evaluate the effectiveness, for improving dietary adequacy, of a package of behavior change interventions to reduce stunting and anemia among 6–23-month-old children in East Java, Indonesia (Baduta project). Dietary intakes of energy and nutrients were estimated using electronic data capture in the cohort study of the Baduta project (n = 680). We compared these results with those estimated using paper-based data capture in the project’s end-line cross-sectional study (n = 2740). We found a higher percentage of children classified as acceptable energy reporters (reported energy intake within the 95% CI of Total Energy Expenditure) with the electronic data capture compared with paper-based data capture (i.e., 60.8%, 72.4% and 80.7% for 6–8-, 9–11- and 12–23-month-old children, respectively, vs. 40.9%, 56.9%, and 54.3%, respectively). The estimated mean energy and nutrient intakes were not significantly different between these dietary data capture methods. These results suggest dietary data collection, using a tablet-based application, is feasible and can improve the quality of dietary data collected in developing countries.

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.

Validation of the Oxford WebQ Online 24-Hour Dietary Questionnaire Using Biomarkers.

The Oxford WebQ is an online 24-hour dietary questionnaire that is appropriate for repeated administration in large-scale prospective studies, including the UK Biobank study and the Million Women Study. We compared the performance of the Oxford WebQ and a traditional interviewer-administered multiple-pass 24-hour dietary recall against biomarkers for protein, potassium, and total sugar intake and total energy expenditure estimated by accelerometry. We recruited 160 participants in London, United Kingdom, between 2014 and 2016 and measured their biomarker levels at 3 nonconsecutive time points. The measurement error model simultaneously compared all 3 methods. Attenuation factors for protein, potassium, total sugar, and total energy intakes estimated as the mean of 2 applications of the Oxford WebQ were 0.37, 0.42, 0.45, and 0.31, respectively, with performance improving incrementally for the mean of more measures. Correlation between the mean value from 2 Oxford WebQs and estimated true intakes, reflecting attenuation when intake is categorized or ranked, was 0.47, 0.39, 0.40, and 0.38, respectively, also improving with repeated administration. These correlations were similar to those of the more administratively burdensome interviewer-based recall. Using objective biomarkers as the standard, the Oxford WebQ performs well across key nutrients in comparison with more administratively burdensome interviewer-based 24-hour recalls. Attenuation improves when the average value is taken over repeated administrations, reducing measurement error bias in assessment of diet-disease associations.

Tablet Based Multiple-pass Dietary Recall Application to Collect Dietary Intake of Under-two Children in the Prospective Cohort Study in Indonesia (P16-054-19)

ObjectivesThe purpose of the paper is to describe the process of developing electronic data collection which can accommodate the principle of multiple-pass 24-hour dietary recall (24HR) in cohort study. MethodsThe study was part of Baduta project which evaluated the effectiveness of integrated nutrition-sensitive and nutrition-specific intervention to reduce stunting and anemia among undertwo-year-old children and mothers in East Java, Indonesia. CommCare platform was used for electronic data collection. Among 680 cohort children, dietary data were collected using electronic data collection while paper-based 24HR was conducted among 2000 undertwo-year-old children in cross-sectional survey. ResultsApproximately 76%, 86% and 90% for 6–8mo, 9–11mo and 12–23mo were classified as acceptable energy reporters (within 95% CI of Energy Intake to Total Energy Expenditure (EI: TEE) ratio. These proportions were lower for the paper-based interview ie 45%, 57% and 61%, respectively. The energy and nutrient intakes were comparable between paper-based and tablet-based dietary data. ConclusionsWe have shown that dietary data collection using tablet-based application was feasible and reliable in longitudinal cohort study. This will open up opportunity for integrating electronic-based dietary data collection in nation-wide survey and follow-up study in developing countries. Funding SourcesGlobal Alliance for Improved Nutrition. Supporting Tables, Images and/or Graphs▪▪▪

Antioxidant intake in relation to serum C-reactive protein in mid-life and older African Americans

ABSTRACT Objective: African Americans (AAs) experience greater prevalence of cardiovascular disease (CVD) compared to other ethnic/racial groups. Low-grade chronic inflammation (often quantified by serum C-reactive protein CRP) is a well-documented risk factor for CVD. A healthy diet is plentiful in antioxidant nutrients and is associated with a lower inflammatory status and CVD risk. Our objective was to examine the relationship between dietary intake of antioxidants (carotenoids, vitamins A, C, E, and selenium) and serum CRP concentrations in mid-life and older AAs, while controlling for confounders. Methods: Data were from the baseline phase of a longitudinal church-based intervention study to reduce CVD risk in AAs. Anthropometrics were measured in a standard manner. Fasting serum samples were analyzed with ELISA for CRP. Multiple-pass 24-hour dietary recalls were used to assess intake; self-reported questionnaires were used to collect demographics. Statistical analyses were performed using SPSS Statistics 21 with the level of significance set at p < 0.05. Results: A total of n = 73 participants (n = 51 females) were included in the analyses. The females and males, respectively were 58.9 ± 10.3 and 59.4 ± 9.7 years old, with BMI of 34.6 ± 8.3 and 35.6 ± 9.3 kg/m2 (Mean ± SD). The mean serum CRP was above 0.6 mg/dL, although slightly lower in males. Males consumed more energy (kcal) and met RDA for selenium, whereas females met RDA for vitamin C. Both groups met RDA for vitamin A. All other dietary variables fell below the RDA or had no RDA established. Results from the binary logistic regression did not show significant association between dietary antioxidants and serum CRP in males or females. However, among females, for every unit increase in BMI, there was a 15% increase in serum CRP (OR = 1.15, p = 0.04). Conclusions: Our study does not support the inverse relationship between antioxidants intake and CRP, but does support the evidence for obesity-induced inflammation and suggests the association can be applied to AA women.

The Heat Is On: A Mixed-Method Examination of Eating Behavior and Executive Functions Among Low Income Minority Girls During Summertime

Despite evidence that youth gain weight disproportionately over the summer months, few studies examine contributing obesogenic behaviors. Utilizing a mixed-methods approach, this study examined associations between summertime dietary intake patterns and executive function among 79 low-income urban minority early adolescent girls (ages 9-13 years). Participants were interviewed via the multiple-pass 24-hour dietary recall method and completed individually administered executive function tasks. A subsample of 14 parents completed interviews to gather qualitative information about summertime eating patterns. Results suggested that participants consumed 25% to 35% more daily calories than recommended, and inhibition difficulties were associated with higher calorie and sugar-sweetened soft drink intake. In addition, over one third of participants were classified as nighttime eaters, and these participants had more difficulty with inhibition, even when accounting for sleep influences, and consumed more soft drinks than daytime eaters. Qualitative interviews consistently indicated that summertime changes food consumption as well as the timing and structure of the meals.

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.

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.

The use of a wearable camera to capture and categorise the environmental and social context of self-identified eating episodes

Research investigating the influence of the environmental and social factors on eating behaviours in free-living settings is limited. This study investigates the utility of using wearable camera images to assess the context of eating episodes. Adult participants (N = 40) wore a SenseCam wearable camera for 4 days (including 1 familiarisation day) over a 15-day period in free-living conditions, and had their diet assessed using three image-assisted multiple-pass 24-hour dietary recalls. The images of participants' eating episodes were analysed and annotated according to their environmental and social contexts; including eating location, external environment (indoor/outdoor), physical position, social interaction, and viewing media screens. Data for 107 days were used, with a total of 742 eating episodes considered for annotation. Twenty nine per cent (214/742) of the episodes could not be categorised due to absent images (12%, n = 85), dark/blurry images (8%, n = 58), camera not worn (7%, n = 54) and for mixed reasons (2%, n = 17). Most eating episodes were at home (59%) and indoors (91%). Meals at food retailers were 24.8 minutes longer (95% CI: 13.4 to 36.2) and were higher in energy (mean difference = 1196 kJ 95% CI: 242, 2149) than at home. Most episodes were seated at tables (27%) or sofas (26%), but eating standing (19%) or at desks (18%) were common. Social interaction was evident for 45% of episodes and media screens were viewed during 55% of episodes. Meals at home watching television were 3.1 minutes longer (95% CI: −0.6 to 6.7) and higher in energy intake than when no screen was viewed (543 kJ 95% CI: −32 to 1120). The environmental and social context that surrounds eating and dietary behaviours can be assessed using wearable camera images.

Folate status and intake of tribal Indian adolescents aged 10 to 17 years.

Adequate folate intake and levels are advisable throughout life but are of particular importance during adolescence, a period of rapid growth. However, folate insufficiency in economically deprived Indian adolescents is understudied. This cross-sectional study examined the prevalence of folate deficiency and adequacy of folate intake of 224 tribal Indian adolescents (10 to 17 years of age). The secondary aim was to study the association between anemia status and folate status. Radioimmunoassay, multiple-pass 24-hour dietary recall, and HemoCue were used to measure red blood cell (RBC) folate, folate intake, and anemia status, respectively. The geometric mean (95% CI) RBC folate concentration (nmol/L) was 360.2 (329.7 to 393.6), and the mean ± SD folate intake (μg/day) and hemoglobin level (g/L) were 159.9 ± 44.7 and 125.4 ± 13.0, respectively. Almost half of boys and girls aged 10 to 12 and 13 to 15 years and 66.7% of girls aged 16 to 17 years were deficient in RBCfolate (< 340 nmol/L). The mean ± SD folate intake (μg/day) of girls (139.4 ± 34.5) was lower than that of boys (173.8 ± 45.5) (p < .001). With respect to adequacy of folate intake, a greater proportion of girls in the age group of 13-15 years (78.5% vs 38.6%, p < 0.001) and 16-17 years (100.0% vs 76.9%, p = 0.04) had intakes below their Recommended Dietary Allowance (RDA). No association was observed between folate intake and RBC folate deficiency or between anemia status and RBC folate deficiency. Folate insufficiency was widespread in tribal Indian adolescents. There is an urgent need to develop culturally sensitive strategies for improvement.

Validation of a food frequency questionnaire specific for salt intake in Saudi Arabian adults using urinary biomarker and repeated multiple pass 24-hour dietary recall

Validation of a food frequency questionnaire specific for salt intake in Saudi Arabian adults using urinary biomarker and repeated multiple pass 24-hour dietary recall