Multiple-pass 24-hour Recall Research Articles

Consumption of ultraprocessed food is associated with higher blood pressure among 6-year-old children from southern Brazil

Ultraprocessed foods (UPF) consumption plays a critical role in the development of chronic diseases, but evidence of their effect on children's health is limited. We hypothesized that the consumption of UPF can influence blood pressure levels in 6-year-old children. This study is a secondary analysis of a randomized field trial in Brazil that is registered at clinicaltrial.gov (NCT00635453). Dietary intake was obtained using 2 multiple-pass 24-hour recalls when 305 children were 3 and 6 years old. We classified foods according to the NOVA system and determined the percentage of total energy intake derived from ultraprocessed foods. We collected anthropometric measures from and evaluated systolic and diastolic blood pressures of 6-year-old children. Linear regression analysis was used to assess the association between UPF consumption and blood pressure levels. UPF represented 40.3% (interquartile range, 34.1-48.5) of the total energy intake at 3 years and 45.2% (interquartile range, 41.5-53.2) at 6 years. The adjusted linear regression analyses showed that systolic blood pressure was associated with UPF consumption at 6 years (P = .05), birth weight (P = .02), waist circumference (P < .01), and physical activity (P = .04), whereas diastolic blood pressure was associated with UPF consumption at 3 and 6 years (P = .01 and P < .01, respectively), birth weight (P = .05), and waist circumference (P < .01). Our data suggest that UPF consumption played a role in increasing 6-year-old children's blood pressure. These results reinforce the importance of effective strategies to prevent the excessive consumption of UPF in childhood.

Development of a mobile application to assess Brazilian schoolchildren's diet: CADE - food consumption at home and at school.

The development of technologies for children's dietary assessment shows important potential for reducing the occurrence of inherent errors in traditional methods. The present study aimed to describe the development of a mobile app for the dietary assessment of Brazilian schoolchildren. The mobile app assesses schoolchildren's diet with self-report by their parents or guardians in the home environment, through multiple-pass 24-hour recall coupled with a food propensity questionnaire; and by an adult in the school environment, through a food record. The tool presents a database of food items usually consumed by Brazilian schoolchildren, including modes of preparation, probing foods and types of food quantification such as digital photos of household measurements and food portions. The CADE app (food consumption at home and at school) contains 2125 food items, 9 options for preparation methods and 18 options for probing items. There are 75 options for household measurements, also including 26 digital photos of four types of household measurements and 440 photos of portion sizes of 90 foods from the Brazilian Manual of Child Food Portion Quantification. Some innovative features include an interface to take photos of the child's meals and report seconds and leftover food consumption, besides the possibility of receiving notifications on the mobile device to remember to report the diet. The CADE app can assist the standardisation and automation of dietary data collection from schoolchildren, support food and nutrition data in childhood and promote research in nutritional epidemiology while reducing data collection costs.

Associations of Low-Inflammatory Dietary Patterns With Psychological Health and Wellbeing During Weight Loss in Military Family Dependents

ObjectivesEmerging evidence suggests that anti-inflammatory dietary patterns may improve depression, stress, and quality of life. Similar benefits are observed during weight loss interventions; however, the effect of combining these dietary patterns with weight loss is not clear. We evaluated the association between dietary inflammation and measures of psychological health in female military dependents with overweight and obesity during a behavioral weight loss intervention. MethodsParticipants (n = 120) received a 6-month intervention recommending dietary patterns with an anti-inflammatory profile. An energy-adjusted dietary inflammatory index (DII) score was calculated from 28 food components collected using 3 interviewer-administered multiple-pass 24-hour recalls at each study time point. A negative score indicates a lower-inflammatory dietary pattern, and a positive score indicates a pro-inflammatory pattern. Self-reported symptoms of depression, stress, general health, vitality, and psychological quality of life were measured by validated questionnaires. Multivariable linear mixed models were used to assess the association between 6-month changes in DII and each outcome and were adjusted for age, ethnicity, military rank of spouse, body weight, and physical activity. ResultsOn average, females were 42.2 ± 11.8 years old with a body mass index of 34.9 ± 6.4 kg/m2. The average DII score was 0.07 (range: –4.3, 3.0) at baseline. Six-month improvements in DII scores (i.e., for a 1-unit reduction) were associated with fewer self-reported symptoms of depression (β: –0.87; 95% confidence interval: –1.43, –0.31; P = 0.003) and stress (–0.85; –1.44, –0.26; P = 0.005), as well as higher general health (0.57; 0.23, 0.91; P = 0.001), vitality (0.45; 0.12, 0.77; P = 0.008), and psychological quality of life (0.33; 0.11, 0.55; P = 0.004). No significant associations between weight loss or physical activity and any outcome were observed in these models that included the DII. ConclusionsAnti-inflammatory dietary patterns are associated with beneficial effects on a range of psychological health and wellbeing measures independent of weight loss. Funding SourcesJean Mayer USDA Human Nutrition Research Center on Aging Doctoral Scholarship; Department of Defense (DoD) grant W81XWH-14–2-0005 (SBR). Author views do not reflect official DoD or Army policy.

Molar ratios of dietary phytate to minerals and iron status of female residential students in University of Dhaka, Bangladesh.

Female undergraduate students may undergo many health implications due to the transition from secondary to undergraduate level. The study was aimed to assess molar ratios of phytate to minerals (calcium, zinc, and iron) in the diets, and to measure the iron status of resident female students at Dhaka University. In total, 180 female students between 18-26 years of age from 3 dormitories of Dhaka University were selected for the study. Dietary intake information was collected over three consecutive days. Multiple-Pass 24-hour recall. Blood hemoglobin and serum ferritin levels were analyzed for sub-sample (20 participants from each dormitory). The mean dietary intake of phytate, calcium, zinc, and iron were estimated at 347.11, 181.04, 6.59, and 7.14 mg/day, and hemoglobin and serum ferritin at 11.34 g/dl, and 18.48 ng/ml, respectively. The respective molar ratios of phytate: calcium, phytate: zinc, phytate: iron and phytate × calcium: zinc were 0.13, 5.27, 4.20, and 21.26 in the diet of the respondents. The prevalence of anemia, iron deficiency and iron deficiency anemia among the respondents was found to be 51.7%, 48.4%, and 28.3%, respectively. Linear regression analysis showed that only zinc intake had positive association with hemoglobin, while iron and zinc intake had a significant positive, and phytate:iron molar ratio had a significant negative association with serum ferritin concentration (p < 0.05). After adjusting all significant determinants of serum ferritin, no predictors have found significant. Larger and more specific research is needed to clearly understand the mechanism behind anemia and iron deficiency among female residential students.

Patterns of Dietary Iron Intake, Iron Status, and Predictors of Haemoglobin Levels among Early Adolescents in a Rural Ghanaian District.

Introduction Early adolescents are vulnerable to anaemia due to lean body mass and menarche. The study assessed patterns of dietary iron intake, iron status, and predictors of anaemia among early adolescents. Method One hundred and thirty-seven early adolescents were randomly selected in a rural district in Ghana. Multiple-pass 24-hour recall, iron food frequency questionnaire consisting of 27 food items, and semistructured questionnaire were administered. Variables include sociodemographics, dietary factors, and laboratory investigation including haemoglobin, ferritin, and C-reactive protein examination. Statistical Package for the Social Sciences (SPSS) software was used to calculate odds ratio and perform Mann–Whitney U test, chi-square (X2) test, exploratory factor analysis, and partial correlation (r) tests. Results Participants had mean age of 11.5 years. Three iron dietary patterns explaining 28.7% of the total variance were identified: iron dietary pattern 1 (11%) composed of iron-rich, iron-enhancing, and iron-inhibiting foods; iron dietary pattern 2 (9.9%) comprised of iron-rich, iron-enhancing, and non-iron-inhibiting foods; and iron dietary pattern 3 (7.1%) consisting of stinging nettle, iron-inhibiting foods, non-iron-enhancing foods, non-cocoyam leaves, and non-turkey berries. Meal skipping (X2 = 5.7, p < 0.05), times of eating a day (X2 = 12.6, p < 0.05), and guardian educational status (X2 = 6.7, p < 0.05) significantly affected dietary iron intake. Anaemia was associated with meal skipping (β = 0.367, p > 0.05), snacking (β = 0.484, p > 0.05), and junior high school (JHS) education (β = 0.544, p > 0.05). Partial correlation showed statistically significant relationship between iron dietary pattern 1 and dietary iron (r = −0.234, p < 0.01), iron dietary pattern 2 and dietary iron (r = -0.198, p < 0.05), iron dietary pattern 2 and vitamin C (r = -0.201, p < 0.05), and haemoglobin and ferritin (r = −0.178, p < 0.05). Conclusion Meal skipping, guardian educational status, and number of times of eating a day were significantly associated with dietary iron intake. Meal skipping, snacking, and adolescents with JHS education were positively associated with anaemia.

Self-Identified Vegetarian Pregnant Women in India Have Better Diets Than Self-Identified Non-Vegetarian Women Because of the Intersections of Caste and Economic Status

Abstract Objectives Poor dietary intake during pregnancy remains a significant public health concern affecting the health of the mother and fetus. This study examines the adequacy of energy, macronutrient and micronutrient intakes among vegetarian and non-vegetarian pregnant women. Methods We analyzed dietary data from 627 pregnant women enrolled at baseline from an Alive &amp;Thrive maternal nutrition program in Uttar Pradesh, India. Dietary intake was assessed using a multiple-pass 24-hour diet recall. We compared differences between vegetarian and non-vegetarian women in dietary diversity (calculated using the minimum dietary diversity for women guidelines), probability of adequacy, and mean probability of adequacy (MPA) for 11 micronutrients. Results Women who identified themselves as vegetarians (∼47%) were more likely to have higher education and socioeconomic status, and belong to upper caste groups than non-vegetarians. Average dietary diversity score was 4 out of 10 food groups for both groups. Vegetarian women were more likely to meet the MDD-W cutoff of five or more food groups compared to non-vegetarian women (39.2% compared to 32.4% respectively) (P &amp;lt; 0.05). Average MPA for vegetarians was 20% (SD:15.3) compared to 17% (SD:13.7) for non-vegetarian group (P = 0.02). In both groups, median intake of 9 out of 11 micronutrients was below the Estimated Average Requirement (EAR). Only zinc and thiamin had a median intake slightly above EAR. Starchy staple foods accounted for 62.4% of total energy for vegetarians and 69.1% for non-vegetarians. Dairy foods were an important source of fat, calcium, and vitamin B12 for both groups. Among non-vegetarian women, consumption of animal source foods was low (&amp;lt;8%). Conclusions Vegetarian women were more likely to have probability of nutrient adequacy and diet diversity during pregnancy than non-vegetarian women, but these differences are likely confounded by socio-economic and caste status. Since diets are poor for both groups, a range of policies and interventions that address the food environment, nutrition counseling during pregnancy, behavior change, and supplementation are needed in order to achieve adequate nutrient intake for pregnant women in this population. Funding Sources Bill and Melinda Gates Foundation, through Alive &amp; Thrive, managed by FHI 360.

Skipping Breakfast Is Associated with Diet Quality and the Distribution of Food Intake Throughout the Day: NHANES 2005–20016

Abstract Objectives Distribution of carbohydrate intakes (carb choices) throughout the day are an important aspect to diabetes management and reducing blood glucose spikes. Skipping breakfast represents a behavior of concern, providing an extension of the overnight fast and may result in elevated sugar levels later in the day. Therefore, the purpose of this study was to evaluate dietary intake differences, including carbohydrates, based on consuming breakfast or not, and by diabetes status. Methods Adults over 30 years from NHANES 2005–2016 were classified into nondiabetes (HbA1c &amp;lt;5.7%, n = 14,701), prediabetes (HbA1c 5.7–6.4%, n = 5855) and diabetes (HbA1c (≥6.5%, n = 2881). Dietary intakes were assessed using a multiple pass 24-hour recall to estimate intakes from the foods and beverages reported as consumed on the day prior to the NHANES visit. Breakfast was self-defined by participants. Total population-based means (95% CI) of nutrient intakes, MyPlate equivalents, and Healthy Eating Index 2015 scores from the day of intake were calculated across levels of glycemic control and skipping breakfast status. Results Across all groups, adults who reported breakfast consumption had a significantly better overall diet quality, while total intakes of whole grains and fiber were significantly lower in those who skipped breakfast. Intakes of added sugars were not significantly different between those who skipped versus consumed breakfast. Conclusions The absence of breakfast on the day of intake was related to differential intakes of several nutrients related to healthy eating and glycemic management, resulting in a poorer overall diet quality. Healthcare professionals could evaluate meal skipping patterns and its impact on overall nutrient intakes, and the distribution of food intake throughout the day, in people with diabetes, to help improve disease management. Funding Sources Abbott Nutrition.

Progressive 24-Hour Recall: Usability Study of Short Retention Intervals in Web-Based Dietary Assessment Surveys

BackgroundUnder-reporting because of the limitations of human memory is one of the key challenges in dietary assessment surveys that use the multiple-pass 24-hour recall. Research indicates that shortening a retention interval (ie, the time between the eating event and recall) reduces the burden on memory and may increase the accuracy of the assessment.ObjectiveThis study aimed to explore the accuracy and acceptability of Web-based dietary assessment surveys based on a progressive recall, where a respondent is asked to record multiple recalls throughout a 24-hour period using the multiple-pass protocol and portion size estimation methods of the 24-hour recall.MethodsThe experiment was conducted with a dietary assessment system, Intake24, that typically implements the multiple-pass 24-hour recall method where respondents record all meals they had for the previous day on a single occasion. We modified the system to allow respondents to add multiple recalls throughout the day using the multiple-pass protocol and portion size estimation methods of the 24-hour recall (progressive recall). We conducted a dietary assessment survey with 33 participants, where they were asked to record dietary intake using both 24-hour and progressive recall methods for weekdays only. We compared mean retention intervals (ie, the time between eating event and recall) for the 2 methods. To examine accuracy, we compared mean energy estimates and the mean number of reported foods. Of these participants, 23 were interviewed to examine the acceptability of the progressive recall.ResultsRetention intervals were found to be, on average, 15.2 hours (SD 7.8) shorter during progressive recalls than those during 24-hour recalls. We found that the mean number of foods reported for evening meals for progressive recalls (5.2 foods) was significantly higher (P=.001) than that for 24-hour recalls (4.2 foods). The number of foods and the amount of energy reported for other meals remained similar across the 2 methods. In interviews, 65% (15/23) of participants said that the 24-hour recall is more convenient in terms of fitting in with their daily lifestyles, and 65% (15/23) of respondents indicated that they remembered meal content and portion sizes better with the progressive recall.ConclusionsThe analysis of interviews and data from our study indicate that progressive recalls provide minor improvements to the accuracy of dietary assessment in Intake24. Additional work is needed to improve the acceptability of progressive recalls in this system.

Vitamin D, muscle strength and physical function in UK South Asian older women

AbstractA positive association has been reported between vitamin D status, muscle strength and physical function in older Caucasian women. However, little is known about this relationship in UK South Asian older women. This cross-sectional study aimed to explore the association between vitamin D status, muscle strength and physical function in UK South Asian (Pakistani and Indian) older women.One hundred and twenty community-dwelling women were recruited via visiting community centres, mosques, Indian temples (Gurdwara) and by word of mouth (between January to May 2018). Inclusion criteria were: community-dwelling, South Asian women, age 60 years and above, able to communicate effectively and able to give written or verbal consent. A general interview (demographic, anthropometric, self-reported exhaustion, health history, supplementation use/duration/dose), handgrip strength (kg), short physical performance battery (single chair stand, repeated chair stands, balance, timed up-and-go test), and blood 25 hydroxyvitamin D (25(OH)D, nmol/l) concentration were performed. Dietary intake and self-reported physical activity was also assessed using multiple-pass 24-hour diet recall method and International Physical Activity Questionnaire (IPAQ) short form respectively.Overall, 47% of participants had insufficient blood 25(OH)D concentration (&lt; 50nmol/L) and 53% had sufficient blood 25(OH)D (≥ 50nmol/L) using the IOM classification. As expected 86% of current vitamin D supplement users had adequate vitamin D status and only 14% of women who reported current vitamin D supplement use had insufficient vitamin D status. Amongst supplement non-users 68% had insufficient vitamin D status and only 32% had adequate levels. An inverse correlation (Spearman's analysis) was found between vitamin D status and single chair stand test (sec) (r = -0.25, p = 0.006); repeated chair stand test (sec) (r = -0.29, p = 0.002) and timed up-and-go test (sec) (r = -0.20, p = 0.02). No correlation was observed between vitamin D status and handgrip strength (r = 0.09, p = 0.30).The prevalence of vitamin D insufficiency is high in post-menopausal South Asian women not taking vitamin D supplements. Significant association was observed between vitamin D status and some aspects of muscle strength and physical function. We are now conducting a randomized control trial to investigate whether vitamin D supplementation may restore muscle strength and function in this population.

The associations between genetics, salt taste perception and salt intake in young adults

AbstractHypertension is a major cause of cardiovascular disease and overall mortality. High dietary salt intake is one of the key risk factors for hypertension and in 2017, it was one of the three leading dietary risk factors for death and disability adjusted life years globally. Despite the efforts to change this behaviour, salt consumption still exceeds the recommendations. One of the main determinants of food intake, and potentially salt, is taste. Taste perception may be genetically determined, however research exploring the associations between genetics, salt taste perception and salt intake is scarce. This may be of special importance in younger adult populations where increased preference for salt is suggested. Therefore, the aim of this study was to explore the associations between genetics, salt taste perception (taste threshold and preference) and salt intake in young adults.This study was approved by the St Mary's University Ethics Sub-Committee. Forty-two participants (18–35 years, 67% female and 33% male) completed the study. Salt taste thresholds were identified using the British Standards Institution sensory analysis method (BS ISO 3972:2011) and preference for salty taste by asking participants how salty they usually prefer to eat their food using a Likert scale. Salt intake, expressed as mg sodium/1000 kcal, was measured using a five-step multiple pass 24-hour recall for one day of the week and one weekend day. Participants were genotyped for two genetic variants in the SCNN1B and TRPV1 genes, which code for ion channels expressed in taste cells. Multiple regression analysis was performed including SCNN1B and TRPV1 variants, salt taste threshold and preference as predictor variables and sodium intake (mg/1000 kcal) as the dependent variable. Statistical significance was set at p &lt; 0.05.Participants were normal weight (Body Mass Index 23.8 ± 3.7 kg/m2), predominantly Caucasian with salt intake 7.5 ± 2.7 g per day, reflecting current intakes in the UK. Regression model including genetics, thresholds and preference for salty taste explained 54% of the variance (p = 0.028). In this model, TRPV1 variant rs8065080 [β = 422, confidence interval (50, 794), p = 0.030] and salt preference [β = 618, confidence interval (258, 978), p = 0.004] were indicated as predictors of sodium intake. These findings suggest that genetics and preference for salty taste may be drivers of salt intake in younger populations. If replicated, this information may in the future be used in designing more personalised approaches in changing this behaviour.

Seasonal Changes in Soccer Players' Body Composition and Dietary Intake Practices.

Devlin, BL, Kingsley, M, Leveritt, MD, and Belski, R. Seasonal changes in soccer players' body composition and dietary intake practices. J Strength Cond Res 31(12): 3319-3326, 2017-The aims of this study were 2-fold: to determine seasonal changes in dietary intake and body composition in elite soccer players and to evaluate the influence of self-determined individual body composition goals on dietary intake and body composition. This longitudinal, observational study assessed body composition (total mass, fat-free soft tissue mass, and fat mass) using dual-energy x-ray absorptiometry and dietary intake (energy and macronutrients) via multiple-pass 24-hour recalls, at 4 time points over a competitive season in elite soccer players from one professional club in the Australian A-League competition. Self-reported body composition goals were also recorded. Eighteen elite male soccer players took part (25 ± 5 years, 180.5 ± 7.4 cm, 75.6 ± 6.5 kg). Majority (≥67%) reported the goal to maintain weight. Fat-free soft tissue mass increased from the start of preseason (55,278 ± 5,475 g) to the start of competitive season (56,784 ± 5,168 g; p < 0.001), and these gains were maintained until the end of the season. Fat mass decreased over the preseason period (10,072 ± 2,493 g to 8,712 ± 1,432 g; p < 0.001), but increased during the latter part of the competitive season. Dietary intake practices on training days were consistent over time and low compared with sport nutrition recommendations. The self-reported body composition goals did not strongly influence dietary intake practices or changes in body composition. This study has demonstrated that body composition changes over the course of a soccer season are subtle in elite soccer players despite relatively low self-reported intake of energy and carbohydrate.

Skin Carotenoids: A Biomarker of Fruit and Vegetable Intake in Children

BackgroundStudies of adult subjects have found a strong correlation between serum carotenoids and skin carotenoids measured by resonance Raman spectroscopy (RRS). No published studies have examined correlations between skin and serum carotenoids among children. ObjectivesWe aimed to validate skin RRS methodology against serum carotenoid measurements by high-performance liquid chromatography and to determine whether RRS can be used as a valid biomarker of fruit and vegetable (F/V) intake among children. DesignIn our cross-sectional study, participants were 45 healthy children aged 5 to 17 years who provided three blood samples used to assess serum carotenoid concentrations and three RRS skin measurements of the palm within a 4-week period. Dietary intake of F/V was assessed three times within 4 weeks using a 27-item food frequency questionnaire (FFQ) and an automated multiple-pass 24-hour daily recall. Estimates of intake from three FFQs, completed at least 7 days apart, were averaged. Estimates of intake from 24-hour daily recalls were collected on 2 weekdays and 1 weekend day and averaged. ResultsLevels of skin and serum carotenoids were highly correlated (R2=0.62; P<0.001). A linear regression model, controlling for child's weight and scanner unit, predicted that for every unit increase of total F/V from FFQ and total F/V as assessed by 24-hour daily recall, RRS intensity was predicted to increase by 3,798 (P=0.001) and 3,504 (P=0.001), respectively. Similar results were observed for reported high-carotenoid vegetable intake. Total carotenoid and beta carotene levels from 24-hour daily recalls correlated to total serum carotenoids levels (P<0.01 and P<0.05, respectively). Total carotenoid, alpha carotene, and beta carotene levels from the 24-hour daily recalls correlated to RRS (P<0.01). ConclusionsSkin carotenoids measured by RRS were strongly correlated with serum carotenoid levels and were positively associated with estimates of intake from FFQ and an automated multiple-pass 24-hour daily recall among children aged 5 to 17 years. Skin carotenoids may be used as valid biomarker of F/V intake among children.

Photo assisted 24‐hour dietary recalls in adults with intellectual and developmental disabilities

OBJECTIVEDietary assessment of adults with intellectual and developmental disabilities (IDD) is challenging due to their limited cognitive abilities. The objective of this study was to determine if photo‐assisted 24‐hour dietary recalls improve the assessment of energy and macronutrient intake in adults with IDD.METHODSParticipants used a tablet computer to take photos of all food and beverages consumed before a standard dietary recall. After a standard multiple‐pass 24‐hour diet recall was conducted the photos were reviewed with the participant and differences were recorded. The standard recall and the photo‐assisted recall were entered separately into Nutrition Data System for Research (NDSR) and compared using mixed modeling.RESULTS30 eating occasions were entered from 10 participants (50% female; mean age 31.0 ± 12.3 years). Participants captured photos for 62% ± 28% of all recorded eating occasions. The photo‐assisted recalls reported greater energy intake per eating occasion than the standard recalls (543.9 ± 227.7 kcals vs. 352.5 ± 277.7 kcals, p=0.005) and a greater intake of fat (0=0.021) protein (p=0.012) and carbohydrates (p=0.006).CONCLUSIONPhoto‐assisted 24‐ hour recalls provided a significant increase in total calories and macronutrient content compared to a standard 24‐hour recall and may improve the dietary assessment of adults with IDD.Grant Funding Source: NIH: DK083539

Dietary Intake Assessment in Adults and its Association with Weight Status and Dental Caries

This cross-sectional study was designed to determine the relationship between dietary intake with body composition and dental caries experience among adults at the dental clinic in Universiti Kebangsaan Malaysia (UKM). The dietary compositions of the participants were estimated by using a multiple-pass 24hour recall method. A sugar checklist was used to determine the most popular sugary food/beverages categories consumed. Anthropometric measurements (height and weight measurements) were taken. Dental caries experience was charted clinically and was reported using the Decayed/Missing/Filled Teeth Index (DMFT). Participant’s consumption for cereal groups, meat groups, fruits and vegetables group met the recommendation of the Malaysian food pyramid. Male participants consumed significantly higher energy, carbohydrate, fat and sugar than female participants. The total daily added sugar intake among the cariesfree group was significantly lower than that in the group with caries. There was no significant difference in energy intake, protein intake, fat intake and total sugar intake between BMI classes; however the carbohydrate intake was significantly different. A significant correlation was found between carbohydrate consumption and BMI. There was also a significant correlation between BMI and DMFT score. The most popular sugary food/beverages category among participants was sugar and sweeteners added to beverages followed by biscuits and pastry. The least popular choice was breakfast cereal. The results indicated that adults with caries consumed significantly higher amounts of added sugar in their daily diet. The study shows that sugar remains an undeniable risk for dental caries and highlights that sugary foods and beverages remains a favorite of participants.

Adequacy of Oral Intake in Critically Ill Patients 1 Week after Extubation

Hospital malnutrition is associated with increased morbidity and mortality, particularly among patients admitted to intensive care units (ICUs). The purpose of this observational study (August to November 2007) was to examine the adequacy of oral intake and to identify predictors of oral intake after ICU patients were removed from invasive mechanical ventilation. Patients aged ≥18 years who required mechanical ventilation for at least 24 hours, advanced to an oral diet postextubation, and did not require supplemental enteral or parenteral nutrition were included. The first 7 days of oral intake after extubation were assessed via modified multiple-pass 24-hour recall and the numbers of days on therapeutic diets and reasons for decreased intake were collected. Oral intake <75% of daily requirements was considered inadequate. Descriptive statistics, χ 2, Student t tests, and logistic regression analyses were conducted. Of the 64 patients who met eligibility criteria, 50 were included. Of these 50 patients, 54% were women and intubated for 5.2 days, with a mean age of 59.1 years, body mass index of 28.7, and Acute Physiology and Chronic Health Evaluation II score of 21.9. Subjective Global Assessment determined 44% were malnourished upon admission to the ICU. The average daily energy and protein intake failed to exceed 50% of daily requirements on all 7 days for the entire population. The majority of patients who consumed <75% of daily requirements were prescribed a therapeutic diet and/or identified “no appetite” and nausea/vomiting as the barriers to eating. Although more research is needed, these data call into question the use of restrictive oral diets and suggest that alternative medical nutrition therapies are needed to optimize nutrient intake in this unique patient population.

Correlates of Dietary Energy Sources with Cardiovascular Disease Risk Markers in Mexican School-Age Children

Dietary and lifestyle changes in Mexico have been linked to an increase in chronic diseases such as obesity and cardiovascular disease. Important dietary changes such as an increase in the consumption of energy-dense foods (high in oils, animal or processed fats, and sugars) have been recently reported. The objective of this study was to identify how key dietary energy sources correlated with other indexes of cardiovascular disease in a Mexican school-age population. From 2004 to 2006, a convenience sample (n=228) of 9- to 13-year-olds, 48.2% girls and 51.8% boys, from three public urban schools were included. Anthropometric, blood pressure, and dietary assessment (two multiple pass 24-hour recalls) were done. More than half of children did not meet the fruit and vegetable recommended intake. High-fat dairy foods (14% of total energy intake), refined carbohydrates (13.5%), red/processed meat (8.5%), added sugars/desserts (7%), corn tortilla (6.5%), and soft drinks/sweetened beverages (5%) were the highest dietary energy sources consumed. In a subgroup of children (n=185), a fasting blood sample was collected for biochemical analysis. A positive association was observed between glucose and diastolic blood pressure with the intake of soft drinks/sweetened beverages, insulin concentrations and the intake of white bread, and triglyceride concentrations with the intake of added fats. Unhealthful dietary energy sources are frequently consumed by these children. Culturally competent nutrition counseling should be offered to Mexican-American children and their families with a significant risk of cardiovascular disease. Efforts should be made to design and implement nutrition education and health promotion strategies in schools.

Correlations suggest low magnesium may lead to higher rates of type 2 diabetes in Indigenous Australians

Diabetes accounts for a significant part of the morbidity and mortality experienced by Australian Aboriginal and Torres Strait Islander populations. Research over the past two decades has provided evidence of a clinical correlation between diabetes and low magnesium intake. Hypomagnesaemia is the most common electrolyte abnormality in diabetic outpatients and may be linked to the development of both macrovascular and microvascular diabetic complications. A diabetes risk reduction of 33%-34% has been found among those with diets highest in magnesium. This study examines the case for magnesium as a potential contributor to diabetes in Australia, especially among Aboriginal and Torres Strait Islander peoples. Specifically explored are associations between diabetes and the magnesium content of drinking water and diet, as well as climatic and socioeconomic factors that may impact on magnesium status including temperature, rainfall, education, employment and income. Queensland age-standardized death rates due to diabetes were correlated with the magnesium content of drinking water, maximum average temperature, rainfall, unemployment rate, proportion of population with post-school qualification, weekly income, and the percentage population identified as Indigenous. Multiple-pass 24-hour recalls from a convenience sample of 100 Indigenous patients at a regional centre were also analyzed to estimate dietary magnesium intake. The Indigenous nutrient intake was then compared with the Australian National Nutrition Survey estimates. Diabetes related mortality was significantly correlated to the percentage of the population identified as Indigenous (r = 0.675), to water magnesium levels (r = -.414), and to average maximum daily temperature (r = 0.579). The average daily magnesium intake in an Indigenous cohort from a regional centre was 248 mg (men: 267 mg +/- 17; women: 245 mg +/- 6 mg), significantly less than intakes observed in the 1995 National Nutrition Survey (p<.001). Although not representative of all Indigenous people, this study identified low dietary magnesium intake among an Indigenous cohort from a regional centre. We also found a significant correlation between the magnesium content of municipal water supplies and age-standardized deaths due to diabetes. We hypothesise that low magnesium dietary intake, compounded by inadequate magnesium replenishment in drinking water, may increase the risk of hypomagnesaemia in the Indigenous population of Queensland. The associations identified in this study support the hypothesis that magnesium may be a potential contributor to diabetes in Australia, especially among Indigenous people, and confirm the need for further research.

A comparison of four dietary assessment methods in materially deprived households in England

Low-income households in the UK concentrate factors associated with poor record-keeping such as lower literacy, numeracy and English language skills. The present study aimed to (1) compare the validity and acceptability of three dietary survey methods against appropriate reference measures and (2) identify a method which was both valid and acceptable in low-income households. Cross-sectional design comparing three 4-day dietary survey methods (multiple-pass 24-hour recall, food checklist and semi-weighed method) against a 4-day weighed inventory and other reference measures within subjects. London, UK, 2001. Low-income households were selected using a doorstep screening questionnaire in 18 of the 60 most deprived neighbourhoods in London. Results are based on 384 respondents (159 males, 225 females) aged 2-90 years in 240 households. Respondents were mainly White (48%), Black or Black British (31%) or Asian or Asian British (9%). The dietary survey method preferred by interviewers was the 24-hour recall. Most respondents preferred the food checklist. Compared with the weighed inventory, repeat 24-hour recalls and the food checklist yielded higher estimates of energy and nutrient intakes. The semi-weighed method was least liked and yielded the lowest estimates of intake. Based partly on evidence presented here and partly on evidence to be presented in later publications, four multiple-pass 24-hour recalls were recommended as the most appropriate method for a national study of diet and nutrition in low-income households in the UK.

Does Chronic Exercise Influence Energy Intake and Macronutrient Composition?

It is a common belief that moderate aerobic exercise leads to changes in energy intake and the composition of the diet, specifically causing an increase in carbohydrate intake at the expense of fat intake. PURPOSE: To determine the effects of a supervised, long-term program of exercise on macronutrient intake of previously sedentary, overweight and moderately obese men and women. METHODS: Participants (N=74) were recruited from university and surrounding communities and were randomized to exercise or control. Moderate intensity exercise was performed for 45 minutes per day, 5 days per week, under supervision. Diet intake was ad libitum and was measured for energy and macronutrient composition at baseline and five other occasions across the 16-month study by weigh and measure techniques. Each measurement consisted of a 2-week period of direct measurement in the university cafeteria. Food consumption outside the cafeteria during the 2-week periods (i.e. snacks) was measured by multiple pass 24-hour recall procedures. RESULTS: There were no significant differences for men or women between exercisers and controls from baseline to 16-months for fat, carbohydrate or protein expressed as grams or percentage of total energy intake or for energy intake expressed as kilojoules/kg body weight or kilojoules/kg fat free mass. CONCLUSION: Sixteen months of moderate intensity exercise is not likely to measurably change the energy intake or macronutrient content of an ad libitum diet to increase carbohydrate and decrease fat intake without dietary advice.

Lifestyle correlates of trait anxiety

Chronic stress, both physiological and psychological, may lead to dysregulation of the hypothalamic-pituitary axis and be associated with adverse health consequences such as visceral adiposity and cardiovascular disease. We hypothesized that psychological stress may be associated with maladjusted eating behaviors and other lifestyle factors. We examined stress as an individual’s general tendency toward anxiety, or “trait anxiety,” as measured by the STAI questionnaire (Spielberger, 1983) in a convenience sample of 19 healthy, non-smoking adults (35.74±10.3 y; BMI 26.4±4.4 kg/m2) participating in a study on diet and obesity. Physical activity level (PAL, from 7-day physical activity recall), dietary intake (3 multiple pass 24-hour recalls), eating behavior (Eating Inventory), and percent body fat (BOD POD) were also assessed. Trait anxiety was associated positively with emotional eating (r=0.57), disinhibited eating (r=0.54), and alcohol intake (r=0.48), and negatively correlated with PAL (r= −0.54) (all p≤ 0.05). Emotional and disinhibited eating were positively associated with BMI, waist circumference, and percent body fat (r=0.58–0.75, p≤ 0.05). We also found significant negative associations of disinhibited eating and emotional eating with sleep duration (r= −0.56 and −0.45, respectively; p≤ 0.05). Additionally, sleep duration was negatively associated with waist circumference (r= −0.60, p≤ 0.05) and marginally associated with BMI (r= −0.40, p=0.09). These findings suggest that a more anxious personality may be associated with lifestyle behaviors that elevate risk for obesity and chronic disease. [Supported in part by: 5T32 AT00815-03]