Seven-day Food Diaries Research Articles

P0768 Ultra Processed Food in Inflammatory Bowel Disease – Friend or Foe? An examination into the contribution of UPFs to nutrient intake in an IBD remission cohort

Abstract Background Ultra-processed foods (UPFs) and their effect on the gut microbiome and their role in the pathogenesis and activity of inflammatory bowel disease (IBD) are attracting increasing interest. Dietary restrictions in Crohn’s Disease (CD) are common, whether self-imposed or result from adherence to advice from health professionals1. Increasing attention in UPFs may lead to further food restrictions and impact on nutrient intake. This study investigated the intake of UPFs of adults with CD during disease remission and explored their contribution to overall macro and micronutrient intake. Methods 195 CD outpatients in clinical remission (HBI <5 and faecal calprotectin <250µg) were recruited from a single UK IBD centre as part of the INTICO 2 observational study. Seven-day food diaries were electronically recorded (Nutritics® Libro) and used to determine dietary adequacy (number of nutrients <LRNI). UPF intake was determined using NOVA Scoring System2 to determine UPF (NOVA 4) intake by two registered dietitians. Product ingredient lists were examined to assign a NOVA score. Consensus on NOVA Scoring was achieved, and a data dictionary was prospectively updated to justify the assigned score. Results Mean Nova 4 score was 39.8 (SD 15.7) per 7 day food diary. Inadequacies of micronutrient intake were common and often multiple, with a mean of 6(SD 4) micronutrients below the LRNI per subject. UPFs contributed significantly to overall macro and micronutrient intake from food with 54% energy, 60% carbohydrates, 55% fat and 50% fibre intake derived from foods categorised as NOVA 4. There was no association between NOVA 4 intake and the degree of nutrient inadequacy as the number of nutrients below RNI in this cohort (Pearson’s Correlation P=0.629). Figure 1 and 2 describe the contribution of each NOVA group to micronutrients and fibre respectively. Conclusion In a CD remission cohort, UPF intake as captured by NOVA score was comparable with what was seen in other reports of healthy adults and other studies of patients with IBD. Eating more UPFs was not associated with a lower intake of micronutrients. Importantly, food categorised as NOVA-4 contributed to a significant proportion of energy, fibre, and micronutrient intake. NOVA scoring does not differentiate between UPFs high in fat, sugar, and salt and those that are not. Advice to "avoid UPFs" must be balanced against the potential consequences of reducing micronutrient intake, especially in those with low or marginal nutrient intakes. A targeted approach to reduce the intake of UPFs that provide little nutritional value is required to maintain nutrient intake. References 1)Holt D.Q., Strauss B.J. & Moore G.T. (2017) Patients with inflammatory bowel disease and their treating clinicians have different views regarding diet. J Hum Nutr Diet. 30, 66–72 doi: 10.1111/jhn.12400 2)SACN statement on processed foods and health. GOV.UK. https://www.gov.uk/government/publications/sacn-statement-on-processed-foods-and-healthOffice. SACN statement on processed foods and health - summary report. GOV.UK. Published July 11, 2023. https://www.gov.uk/government/publications/sacn-statement-on-processed-foods-and-health/sacn-statement-on-processed-foods-and-health-summary-report#results Figure 1: Micronutrient intake characterised by NOVA score Figure 2: Fibre intake characterised by NOVA Score

Influence of Dietary Heritage in a Restricted Geographic Area and Role of Food Additives on Risk of Recurrent Kidney Stone.

Dietary factors may be implicated in the formation of kidney stones and should be closely monitored. To achieve this aim, patients are routinely assessed by means of generic dietary recall, a tool widely used by authors in a range of extensive patient populations to record food intake; the findings obtained, however, may be skewed due to dietary variations and underestimation of the effect of food additives. Fifty Frequent Kidney Stone Formers (FKSFs, mean age: 54.3 ± 13.9 years) with normal kidney function, absence of comorbidities, and reliable compliance were selected from a total of 68 patients' resident in Sardinia, an Italian island where genetic admixtures have been relatively rare for generations. The study, conducted from 1 January 2020 to 31 December 2023, was aimed at assessing nutritional values based on the meticulous recording of food quantities, quality, and potential modifications related to food preparation. Patients were selected during an initial clinical check-up and all efforts made to ensure they were capable of reliably recording all food and drinks consumed. A seven-day food diary was provided in which food and drink intake and their impact on 24 h urine output was recorded. The following parameters were measured in both foods and urine output: citrates, oxalates, calcium, phosphorous, uric acid, proteins and nitrogen compounds, magnesium, sulfates, potassium, carbohydrates, free fatty acids. Study outcomes established the presence of hypocitraturia, hyperoxaluria, hypercalciuria, and moderately high levels of nitrogen compounds. Univariate analysis followed by multivariate analysis for further confirmation were performed and the following observations made. Citrate intake correlated with citraturia but did not promote oxaluria; calcium intake promoted onset of sulfaturia, azoturia, and ammoniuria, whilst magnesium correlated with magnesiuria but not with oxaluria, calciuria, phosphaturia, and azoturia; sulfate intake elicited onset of azoturia but not kaliuresis; potassium intake promoted oxaluria and protein intake resulted in onset of ammoniuria and azoturia. (A) The chemical composition of urine based on dietary intake is hard to predict without taking into account the presence of dietary and urinary interferents; (B) the geographic isolation of patients studied underlines the importance of epigenetics in maintaining a traditional dietary heritage. (C) Moreover, the widespread use of food additives should consistently be taken into account to ensure a correct diagnosis of FKSF and set up a valid treatment plan.

Novel associations between within-day energy balance (WDEB) and relative energy deficiency in sport (RED-S) in recreationally active women

Relative energy deficiency in sport (RED-S) is a syndrome whereby physiological process are downregulated to regain energy balance under conditions of low energy availability (LEA). There is a growing body of research investigating the diverse health and performance complications in relation to energy availability calculated over 24-h. However this may conceal energy deficient periods in the day, which could contribute to RED-S symptoms. There is a handful of research suggesting such periods of deficiency are associated with changes in body composition, and menstrual and endocrine dysfunction, however many RED-S symptoms are yet to be explored in this area. This study therefore aimed to explore within-day energy balance (WDEB) in relation to a variety of, yet to be investigated, RED-S consequences in recreationally active women. Following ethical approval from the Manchester Metropolitan University Ethics Committee, 16 women (age, 27 ± 6 years, stature, 1.67 ± 0.05 m, and mass, 63.5 ± 8.2 kg) engaging in 4-6-h per week moderate-vigorous physical activity were recruited via social media, word of mouth, and posters. Seven-day food and training diaries alongside accelerometery and heart rate were used to estimate 24-h energy availability and hourly WDEB. The largest within-day energy surplus and deficit, the number of hours spent in a surplus and deficit, and the maximum number of consecutive hours in each, were calculated daily and averaged across the 7-days. Quantitative ultrasound of bone, haematocrit, haemoglobin, total cholesterol, maximum voluntary contraction of the knee during flexion and extension, V̇O2peak and lactate profile were all assessed. Gastrointestinal health was assessed via questionnaire. Correlational analysis between WDEB variables and RED-S symptoms was done accounting for 24-h energy availability. Of all 16 participants, 87.5% did not have adequate energy availability (<45 kcal∙kgFFM∙day-1); 12.5% had low energy availability (<30 kcal∙kgFFM∙day-1), and 75% had subclinical energy availability (30-45 kcal∙kgFFM∙day-1), typically associated with weight loss. Gastrointestinal dysfunction was negatively correlated with within-day energy surpluses (r13 = −0.479, P = 0.035) and positively correlated with within-day energy deficit variables (r13 = 0.499 to 0.534, P ≤ 0.029). These correlations were maintained after also accounting for anxiety. Haemoglobin levels were negatively correlated with within-day energy deficit variables (r13 = −0.477 to −0.490, P ≤ 0.036). Radius and tibia, T- and Z-scores were positively correlated with energy surplus values (r13 = 0.593 & 0.681, P = 0.004 & 0.013, respectively). To conclude, this was the first study to show WDEB to be associated with gastrointestinal, haematological, and bone health, illustrating that WDEB in relation to RED-S warrants further research as it may have health and performance implications that are overlooked when assessing LEA alone.

P069 Ultra-processed food intake and dietary insufficiencies are common in adults with Crohn’s Disease in remission. The INTICO 2 Study

Abstract Background Adults with Crohn’s Disease (CD) may have dietary restrictions and micronutrient inadequacies. Consumption of ultra processed foods (UPF) has been associated with an increased need for IBD-related surgery and is a growing area of research. This study aimed to investigate the habitual diet of adults with CD during disease remission to understand the nutritional adequacy, diet diversity and diet quality. Methods 196 adult CD outpatients in remission (Harvey Bradshaw Index <5 and calprotectin <250µg) were recruited from a single UK IBD centre outpatients as part of the INTICO 2 observational study. Seven-day food diaries were electronically recorded using Nutritics® (Libro) software. UPF intake was determined using NOVA Score . Data cleaning was undertaken by a dietitian prior to analysis to identify input errors. NOVA Score1 criteria was utilised to determine UPF intake. Product ingredient lists were examined using supermarket websites and ‘Open food Facts’ by two research dietitians to assign a NOVA score. Consensus on NOVA Scoring was achieved, and a data dictionary was prospectively updated to justify the assigned score. Results 97% (189/195) of those who underwent food diary analysis had at least one micronutrient below the LNRI. The intake was below the LNRI for a mean of 6 (SD 4.2) micronutrients per subject. The number of subjects who failed to meet the LNRI from diet (with and without inclusion of usual supplements) is listed for each micronutrient in table 1. Of note, 93% (181/195) of subjects failed to meet the SACN recommended 30g of fibre per day (median intake 17.7g). 33% of dietary intake was classified as UPF (Nova 4) and 13% processed (NOVA 3). Conclusion Both micronutrient insufficiencies and UPF intake are common in a CD remission population and should be considered alongside one another in studies of dietary intake. UPF intake should be interpreted with caution as NOVA does not account for nutritional content. Blanket recommendations to avoid UPFs need to be carefully considered within this already nutritionally vulnerable population as avoidance of UPF products such as fortified cereals or oral nutritional supplements could lead to increased dietary inadequacies.

The Danish National Survey of Diet and Physical Activity (DANSDA) 1995-2011-2013: Study design, study participants, participation rate and underreporting.

This study describes the study design, study participants, participation rate and underreporting in the Danish National Surveys of Diet and Physical Activity (DANSDA) from 1995 to 2011-2013. DANSDA are government-funded surveys of food and nutrient intake, physical activity and lifestyle, undertaken to support nutritional policy, risk assessment and public health research. The surveys are cross-sectional based on primarily simple random samples (ages 1-80 years in 1995, 4-75 years in 2000-2013) drawn from the Danish Civil Registration System. Approximately 4800 individuals in 1995, 8200 in 2000-2002, 8400 in 2003-2008 and 7300 in 2011-2013 were invited to participate. Participants completed a seven-day food diary, a physical activity questionnaire (2000-2008), a step diary (2011-2013) and a face-to-face interview. Self-reported anthropometrics (1995-2013) were supplemented with device-based measures (2011-2013). Pedometers were included in 2011-2013. The number of participants included per survey round was 3100-4400. Participant rates decreased from 66% (1995) to 54% (2011-2013). Non-participation was primarily refusal. Ages 18-30 years, 61-75 years (2000-2013), 61-80 years (1995) and low educated and individuals living alone were underrepresented. Underreporting of energy intake among adults ranged from 14% (1995) to 26% (2008). The methods in DANSDA have been developed to include device-based measures on physical activity and anthropometrics. This has improved the applicability of the results of the survey. The participation rate has fallen, which has affected sample representativity, and underreporting has increased. Future DANSDA surveys should explore and consider new initiatives to counteract non-response and underreporting, with the aim of enhancing data representativeness and applicability.

Food Diary Completion Does Not Significantly Impact Glycemic Control in an Observational Single-Institution Pilot Study of Patients with Type 2 Diabetes Mellitus.

Hemoglobin A1c is frequently used to monitor glycemic control in patients with type 2 diabetes mellitus (T2DM). There is an association between dietary habits and hemoglobin A1c. Food diaries are often used to assist in dietary management and have been associated with modification of dietary habits. We aimed to investigate the impact of completing a seven-day food diary on hemoglobin A1c in subjects with T2DM. We hypothesized that patients who completed a food diary might independently modify their dietary habits, resulting in a clinically significant change in hemoglobin A1c. Forty-five subjects with T2DM who completed a seven-day food diary were included in this observational study. Subjects had a mean hemoglobin A1c at baseline of 7.56 ± 1.43 and a body mass index of 33.6 ± 7.6 kg/m². A majority were female (57.8%) and insulin-dependent (71.1%). The primary outcome of interest was a clinically significant change in hemoglobin A1c (≥0.5%). Outcomes were assessed before and within six months after the food diary completion. Chi-square, independent-sample t-tests, and logistic regression were used to analyze the data. Twelve patients demonstrated a clinically significant decrease in hemoglobin A1c; however, this was not statistically significant regardless of gender (p = 0.5), baseline body mass index (p = 0.5), insulin use (p = 0.3), or community needs index (p = 0.7). Although some patients had clinically significant improvements in their hemoglobin A1c, our findings suggest that the use of food diaries alone without goal-directed initiatives is insufficient to achieve differences in hemoglobin A1c in patients with T2DM and an average A1c within the range of 6%-8%.

Dietary Habits of Women with Gynecological Cancer before, during and after Treatment: A Long-Term Prospective Cohort Study

Background and aim Over 21,000 new cases of gynecological cancer are diagnosed annually in the United Kingdom. There is evidence of cancer patients altering their eating habits before and during treatment. Some women with gynecological cancer make conscious decisions to change their diet as self-management for their cancer symptoms and to adopt a healthier lifestyle. Little is known about the impact of treatment on dietary habits. This study aimed to identify and describe the dietary habits of women with gynecological cancer before, during and after treatment. Methods This was a longitudinal prospective cohort study using seven-day food diaries to collect dietary intake data before treatment and up to two years after gynecological cancer treatment. Nutritics© software was used for analysis of the diaries. A general linear mixed model was used for the statistical analysis, adjusted for multiple comparisons. Results 15 women with gynecological cancer participated; 69 food diaries were analyzed. There were no statistically significant changes in dietary habits or weight for this cohort during the two-year follow-up, except for caffeine intake which increased at 2 years (p < 0.05). Conclusions Despite the importance of maintaining a healthy dietary intake and weight after cancer treatment, participants' diets did not change.

Energy Availability in Male and Female Elite Wheelchair Athletes over Seven Consecutive Training Days.

Background: Low energy availability (LEA) is a major problem as athletes often restrict their energy intake. It has been shown that LEA occurs often in female and endurance athletes and in athletes from weight-sensitive or aesthetic sports. The purpose of this study was to investigate energy availability (EA) in elite wheelchair athletes. Methods: Fourteen elite wheelchair athletes (8 males; 6 females) participated. Data were collected using a weighed seven-day food and training diary to estimate energy intake and exercise energy expenditure. Resting energy expenditure and body composition were measured, whereas energy balance (EB) was calculated. Results: Measured over 7 days, EA was significantly different (36.1 ± 6.7 kcal kg−1 FFM day−1) in male compared to female (25.1 ± 7.1 kcal kg−1 FFM day−1) athletes (p < 0.001). From all analyzed days, LEA occurred in 73% of the days in female athletes and in 30% of the days in male athletes. EB was positive in male athletes (+169.1 ± 304.5 kcal) and negative (−288.9 ± 304.8 kcal) in female athletes. Conclusions: A higher prevalence of LEA was found in female compared to male athletes. A higher energy intake would be recommended to meet energy needs and to maximize training adaptation.

Meal timing and subjective sleep disturbances in older men.

Older adults often complain about sleep disturbances, such as difficulty falling asleep and difficulty maintaining sleep in the early morning hours. Here, we investigated whether meal timing is associated with sleep problems in a cohort of older Swedish men (n=998, mean age 71). Each participant filled out a seven-day food diary used to determine the daily eating time window, daily eating midpoint, and meal timing variability (i.e., the variance in daily eating midpoints over seven days). Questionnaires were used to assess difficulty initiating sleep and difficulty maintaining sleep. As indicated by logistic regression adjusted for potential confounders (e.g., BMI, diabetes status), no significant associations were found between the meal timing parameters and subjective sleep problems (P≥0.37). Similar results were obtained when restricting the analysis to adequate reporters of daily energy intake. Therefore, our findings suggest that meal timing variations do not contribute to subjective sleep problems in older men. Our results must be replicated in cohorts that also include women and other measures of sleep.

Association between dietary fiber intake and risk of incident aortic stenosis

Background and aimsAlthough aortic stenosis is the most common valvular heart disease requiring intervention in Europe, the role that diet plays in development of the disease is largely unknown. The pathophysiology of aortic stenosis is however similar to other cardiovascular diseases that fiber intake has been associated with. The aim of this study was consequently to investigate the association between dietary fiber intake as well as the main food sources of fiber, i.e. fruit and vegetables and whole grains, and risk of incident aortic stenosis. Methods and resultsThe Malmö Diet and Cancer Study is a Swedish prospective population-based cohort study with baseline data collection performed between year 1991–1996. Dietary habits were recorded through seven-day food diaries, 168-item diet questionnaires, and interviews, and data on incident aortic stenosis was collected through national registers. Among the 26,063 participants, 672 cases were ascertained during a mean follow-up period of 20 years. Cox regression was used to estimate the association between dietary intakes and incident aortic stenosis. No associations were found between incident aortic stenosis and intake of dietary fiber (HR for the highest vs lowest quintile: 0.93; 95% CI: 0.72–1.24), fruit and vegetables (HR: 0.98; 95% CI: 0.76–1.28), or whole grains (HR: 1.00; 95% CI: 0.79–1.26) in the main model. ConclusionThe findings of this study do not indicate that consumption of dietary fiber or fiber rich foods are associated with incident aortic stenosis.

0411 Association Between Healthy Dietary Patterns and Self-Reported Sleep Disturbances in Older Men

Abstract Introduction Ageing is often accompanied by an increased prevalence of sleep problems. Healthy lifestyle choices, including diet, are especially important to mitigate such impairments. To date, little is known about how dietary patterns may link to measures of sleep quality in older subjects. Therefore, we investigated in a Swedish older male population, whether adherence to the Mediterranean Diet (MD) or the Healthy Diet Indicator (HDI; based on recommendations from the World Health Organization) is linked to a decrease in sleep disturbances. Methods We studied 970 men (age: 71 ± 1yr) from the ULSAM dataset. Sleep initiation or maintenance problems were evaluated by self-reporting questionnaires. Dietary intake was recorded with a pre-coded seven-day food diary. To calculate the adherence scores, intake of dietary components was assessed. Traditional MD components included fat quality, vegetables, fruits, cereals, fish, meat, dairy, and alcohol. The HDI components included saturated-, polyunsaturated fatty acids, proteins, carbohydrates, sucrose, fiber, fruits and vegetables, cholesterol, and fish. Reasonable dietary reporting was calculated to identify possible under- or over-reporters. Results When adjusted for potential confounders, no associations between dietary scores and sleep parameters were found. In contrast, low consumption of dairy products —one of the dietary features of the MD —was associated with better subjective sleep initiation. This association was, however, not found in men with adequate reports of daily energy intake (~54% of the cohort). Conclusion Our findings do not suggest that older men can mitigate perceived sleep problems by adhering to the MD or HDI. Whether low consumption of dairy products can facilitate sleep initiation must be confirmed in future studies by utilizing objective measures of sleep, such as polysomnography. Finally, when investigating associations between dietary patterns and sleep, particular attention should be paid to the potential confounder of inadequate reporting of energy intake. Support This research was funded by Novo Nordisk Foundation (NNF14OC0009349), Swedish Brain Foundation, Swedish Research Council (2015-03100), Åke Wiberg Foundation (M17-0088), Fredrik and Ingrid Thuring Foundation (2017-00313) and the Swedish Medical Research Society.

Association between Healthy Dietary Patterns and Self-Reported Sleep Disturbances in Older Men: The ULSAM Study.

To date, little is known about how dietary patterns may link to measures of sleep quality in older subjects, who often suffer from sleep problems. Here, we investigated, in an older male population from Sweden (n = 970; aged 71 ± 1 year), whether adherence to the Healthy Diet Indicator (HDI; based on recommendations from the World Health Organization) or the Mediterranean Diet (MD) is linked to sleep disturbances. The diet scores were calculated using a seven-day food diary, and self-reported sleep initiation or maintenance problems were assessed by questionnaires. When adjusted for potential confounders, no associations between dietary scores and sleep parameters were found. In contrast, low consumption of milk and dairy products —one of the dietary features of the MD —was associated with better subjective sleep initiation. This association was, however, not found in men with adequate reports of daily energy intake (~54% of the cohort). To summarize, our findings do not suggest that older men can mitigate perceived difficulties to fall and stay asleep by adhering to either the HDI or MD. Whether low consumption of milk and dairy products can facilitate sleep initiation must be confirmed in future studies by utilizing objective measures of sleep such as polysomnography. Finally, when investigating associations between dietary patterns and sleep, particular attention should be paid to the potential confounder of inadequate reporting of energy intake.

Validation and reproducibility of an Australian caffeine food frequency questionnaire

The aim of this study was to measure validity and reproducibility of a caffeine food frequency questionnaire (C-FFQ) developed for the Australian population. The C-FFQ was designed to assess average daily caffeine consumption using four categories of food and beverages including; energy drinks; soft drinks/soda; coffee and tea and chocolate (food and drink). Participants completed a seven-day food diary immediately followed by the C-FFQ on two consecutive days. The questionnaire was first piloted in 20 adults, and then, a validity/reproducibility study was conducted (n = 90 adults). The C-FFQ showed moderate correlations (r = .60), fair agreement (mean difference 63 mg) and reasonable quintile rankings indicating fair to moderate agreement with the seven-day food diary. To test reproducibility, the C-FFQ was compared to itself and showed strong correlations (r = .90), good quintile rankings and strong kappa values (κ = 0.65), indicating strong reproducibility. The C-FFQ shows adequate validity and reproducibility and will aid researchers in Australia to quantify caffeine consumption.

Water Intake and Hydration Indices in Healthy European Adults: The European Hydration Research Study (EHRS).

Hydration status is linked with health, wellness, and performance. We evaluated hydration status, water intake, and urine output for seven consecutive days in healthy adults. Volunteers living in Spain, Germany, or Greece (n = 573, 39 ± 12 years (51.1% males), 25.0 ± 4.6 kg/m2 BMI) participated in an eight-day study protocol. Total water intake was estimated from seven-day food and drink diaries. Hydration status was measured in urine samples collected over 24 h for seven days and in blood samples collected in fasting state on the mornings of days 1 and 8. Total daily water intake was 2.75 ± 1.01 L, water from beverages 2.10 ± 0.91 L, water from foods 0.66 ± 0.29 L. Urine parameters were: 24 h volume 1.65 ± 0.70 L, 24 h osmolality 631 ± 221 mOsmol/kg Η2Ο, 24 h specific gravity 1.017 ± 0.005, 24 h excretion of sodium 166.9 ± 54.7 mEq, 24 h excretion of potassium 72.4 ± 24.6 mEq, color chart 4.2 ± 1.4. Predictors for urine osmolality were age, country, gender, and BMI. Blood indices were: haemoglobin concentration 14.7 ± 1.7 g/dL, hematocrit 43% ± 4% and serum osmolality 294 ± 9 mOsmol/kg Η2Ο. Daily water intake was higher in summer (2.8 ± 1.02 L) than in winter (2.6 ± 0.98 L) (p = 0.019). Water intake was associated negatively with urine specific gravity, urine color, and urine sodium and potassium concentrations (p < 0.01). Applying urine osmolality cut-offs, approximately 60% of participants were euhydrated and 20% hyperhydrated or dehydrated. Most participants were euhydrated, but a substantial number of people (40%) deviated from a normal hydration level.

Suboptimal dietary intake is associated with cardiometabolic risk factors in women with polycystic ovary syndrome

Aim Polycystic ovary syndrome (PCOS) is the most prevalent endocrine disorder in women and confers a substantial health burden. It is important to explore modifiable extrinsic factors that contribute to disease risk. The aim of the present study was to compare the dietary intake, physical activity and physiological characteristics of women with PCOS with those of controls to identify lifestyle behaviours associated with known cardiometabolic risk factors. Methods A seven-day food and activity diary was completed and anthropometric and biomarkers of type 2 diabetes mellitus and cardiovascular disease risk were measured in 38 women with PCOS, and 30 controls, matched for age and body mass index. Results Similar energy intakes and activity levels were observed between groups. Percentage energy intakes from total, saturated and monounsaturated fats were significantly higher (P = 0.008, P = 0.012 and P = 0.003, respectively) and % energy from carbohydrate was significantly lower (P < 0.001) in participants with PCOS compared with controls (P < 0.001). Insulin levels, two hours after a glucose challenge, were significantly higher in PCOS participants compared with controls (P = 0.029). Increased dietary glycaemic index appeared to be associated with a more negative biochemical profile in women with PCOS compared to controls, being significantly associated with an increased waist circumference and LDL-cholesterol and decreased HDL-cholesterol. Conclusions The present study has identified suboptimal dietary patterns in women with PCOS, and highlighted dietary factors associated with cardiometabolic risk factors that warrant monitoring in both lean and obese women with PCOS.

Inclusion of pork meat in the diets of young women reduces their intakes of energy-dense, nutrient-poor foods: results from a randomized controlled trial.

Adherence of young women to dietary recommendations has been examined predominantly by surveys. This study aimed to determine the quality of women’s diets relative to the Australian Guide to Healthy Eating (AGHE); and to evaluate dietary changes during an intervention trial with pork meat or an iron supplement. A 12-week randomized trial was conducted in young women who were assigned to one of three groups. They maintained three, seven-day food diaries while continuing their routine diet (CG); taking an iron supplement (SG); or incorporating into their diets 500 g/week of pork (PG). Participants (n = 58) provided dietary information on 1218 diary-days. The serves consumed from the vegetable, fruit and dairy groups were lower (p < 0.001), and from the meat and alternatives group greater (p < 0.001) than the recommended serves. PG consumed significantly fewer (p < 0.001) serves of “extra” foods, and ate fruit more frequently (p < 0.001) than CG and SG. The participants’ dietary self-assessment showed poor agreement with the AGHE description of “serve”. The inclusion of pork in the diets of young women is associated with the reduced consumption of energy-dense nutrient-poor “extra” foods and increased frequency of fruit intake. The effect may be explained by diverse factors such as increased food knowledge, cooking skills and the effect of pork on satiety.

Experimental manipulation of breakfast in normal and overweight/obese participants is associated with changes to nutrient and energy intake consumption patterns

The effect of breakfast and breakfast omission on daily food intake in normal and overweight participants was investigated. 37 participants were recruited for this experimental study and assigned to one of four groups on the basis of their body mass index (BMI) (normal weight BMI <25kg/m2 or overweight/obese BMI >25kg/m2) and breakfast habits (breakfast eater or breakfast omitter). All participants were requested to eat breakfast for an entire week, and then following a washout period, omit breakfast for an entire week, or vice versa. Seven-day food diaries reporting what was consumed and the timing of consumption were completed for each breakfast condition. Overall more energy was consumed during the breakfast than the no breakfast week. The present study revealed significant effects of timing on energy intakes; more energy was consumed during the afternoon in the no breakfast week compared to the breakfast week. Overweight participants consumed greater amounts of energy than normal weight participants in the early evening. Breakfast omitters consumed more than did breakfast eaters later in the evening. All groups consumed significantly less energy, carbohydrate and fibre in the no breakfast week; however, overweight participants increased their sugar intakes. Consumption of the micronutrients iron and folate was reduced in the no breakfast week. The findings highlight that the timing of food intake and habitual breakfast eating behaviour are important factors when investigating why breakfast consumption may be associated with BMI.

Caffeinated Coffee is Associated With a Reduction of Symptomatic Gallstones in Men. Data From a UK Prospective Cohort Study (EPIC-Norfolk) Using 7-Day Food Diaries

Introduction: Low iron intake reduces nitric oxide synthase (NOS) activity, which impairs gallbladder motility and bile flow. Low iron intake decreases activity of cholesterol 7-αhydroxlase, an enzyme which converts cholesterol to bile acids. Niacin increases plasma high density lipoprotein and lowers plasma triglycerides, both of which are associated with a lower incidence of gallstone disease. This study investigated dietary iron and niacin intake and the risk of developing symptomatic gallstones, for the first time using seven-day food diaries (7-DFDs), the most accurate feasible method of estimating food intake in large epidemiological studies. Methods: 25 639 participants (56% women), aged 40-74 yrs were recruited into the European Prospective Investigation into Cancer-Norfolk (EPIC-Norfolk) with 23 658 completing 7-DFDs at enrolment. The cohort was monitored for 14 years for new symptomatic gallstones, with diagnoses confirmed by review of the clinical notes. The 7-DFDs recorded one week's diet including food types, frequency of consumption, quantities and cooking methods. A representative sample of 3 970 and those with gallstone disease had their 7-DFDs coded by nutritionists using a computer program containing nutrient information on 11 000 food and 55 000 portion sizes. A cohort analysis used Cox regression to estimate sex specific hazard ratios (HR) for developing gallstones comparing fifths of dietary iron and niacin acid intake adjusted for age, body mass index, energy, alcohol and physical activity in men, and also parity and hormone replacement therapy use in women. Results: 177 women (mean age of diagnosis 66.5yrs SD=9.5yrs) and 90 men (64.2yrs SD= 9.2yrs) developed symptomatic gallstones. In women, increased dietary iron intake was associated with a decreased risk of symptomatic gallstones (highest vs lowest fifth, HR=0.36 95% CI=0.20-0.66; per fifth increase, HR=0.82 95% CI=0.72-0.94 p=0.003), although no effects were seen in men (per fifth increase, HR=0.97 95% CI=0.81-1.17). Increased dietary niacin intake was also associated with a decreased risk of disease in women (highest vs lowest fifth, HR=0.50 95% CI=0.30-0.83; per fifth increase, HR=0.86 95% CI=0.76-0.97 p=0.011), but no effects were found in men (per fifth increase, HR=0.96 95% CI=0.811.14). Conclusion: In women, gallstone disease may be prevented by increasing dietary iron and niacin intake, for which there are plausible biological mechanisms. No effects were found in men, although this could be due to a lack of power as only half the number of cases diagnosed and also that men are less likely to be iron deficient. These nutrients should be measured in future studies to confirm the association. Risk of developing symptomatic gallstones by fifths of dietary intake of iron and niacin in women and men.

Dietary Deficiencies of Iron and Niacin in the Aetiology of Symptomatic Gallstones – Data From a UK Prospective Cohort Study (EPIC-Norfolk) Using 7-Day Food Diaries

Introduction Low iron intake reduces nitric oxide synthase (NOS) activity, which impairs gallbladder motility and bile flow. Low iron intake decreases activity of cholesterol 7-α-hydroxlase, an enzyme which converts cholesterol to bile acids. Niacin increases plasma high density lipoprotein and lowers triglycerides, both of which are associated with lower rates of gallstone disease. This study investigated dietary iron and niacin intake and the risk of developing symptomatic gallstones, for the first time using seven-day food diaries (7-DFDs), the most accurate feasible method of estimating food intake in large studies. Methods 25,639 participants (56% women), aged 40–74 years were recruited into the European Prospective Investigation into Cancer-Norfolk (EPIC-Norfolk) with 23,658 completing 7-DFDs at enrolment. The cohort was monitored for 14 years for new symptomatic gallstones, with diagnoses confirmed by review of the clinical notes. The 7-DFDs recorded one week9s diet including food types, frequency of consumption, quantities and cooking methods. A representative sample of 3970 and those with gallstone disease had their 7-DFDs coded by nutritionists using a computer program containing nutrient information on 11,000 food and 55,000 portion sizes. A cohort analysis used Cox regression to estimate sex specific hazard ratios (HR) for developing gallstones for fifths of dietary iron and niacin acid intake, adjusted for age, body mass index, energy, alcohol and physical activity in men, and also parity and hormone replacement therapy use in women. Results 177 women (mean age of diagnosis 66.5 years SD = 9.5 years) and 90 men (64.2 years SD = 9.2 years) developed symptomatic gallstones. In women, increased dietary iron intake was associated with a decreased risk of symptomatic gallstones (highest vs lowest fifth HR = 0.36 95% CI = 0.20 to 0.66; per fifth increase HR = 0.82 95% CI = 0.72 to 0.94 p = 0.003), although no effects were seen in men (per fifth increase, HR = 0.97 95% CI = 0.81 to 1.17). Increased dietary niacin intake was also associated with a decreased risk of disease in women (highest vs lowest fifth, HR = 0.50 95% CI = 0.30 to 0.83; per fifth increase HR = 0.86 95% CI = 0.76 to 0.97 p = 0.011), but no effects were found in men (per fifth increase HR = 0.96 95% CI = 0.81 to 1.14). Conclusion In women, gallstone disease may be prevented by increasing dietary iron and niacin intake, for which there are plausible biological mechanisms. No effects were found in men, although this could be due to a lack of power as only half the number of cases diagnosed and also that men are less likely to be iron deficient. These nutrients should be measured in future studies to confirm the association.

Do Oleic Acid and N-3 Fatty Acids Prevent Pancreatic Cancer? Data From a UK Prospective Cohort Study Using 7-Day Food Diaries

Introduction There are plausible biological mechanisms for how both oleic acid and n-3 fatty acids may prevent the development of pancreatic cancer through their effects on cancer oncogenes, apoptosis and inflammatory processes. The aim of this study was to investigate the effect of these nutrients in a prospective cohort study, for the first time using seven-day food diaries (7-DFDs), the most accurate feasible method of estimating food intake in large scale epidemiological investigations. Methods 25 639 participants (56% women), aged 40–74 years were recruited into the European Prospective Investigation into Cancer-Norfolk (EPIC-Norfolk) with 23 658 completing 7-DFDs at enrolment. The cohort was monitored for 16 years, using hospital records and cancer registry data to identify participants who developed pancreatic cancer with all notes reviewed to confirm diagnosis. The 7-DFDs recorded one week9s diet including food types, frequency of consumption, quantities and cooking methods. A representative sample of 3970 as well as those with gallstone disease had their 7-DFDs coded by nutritionists using a computer program containing nutrient information on 11 000 food and 55 000 portion sizes. A cohort analysis used Cox regression to estimate sex specific hazard ratios (HR) for developing pancreatic cancer comparing fifths of: total dietary n-3 fatty acids, eicosapentaenoic acid (EPA), docosapentaenoic acid (DHA) and oleic acid intake, adjusted for the risk factors of age, gender, total energy intake, smoking and diabetes. Results A total of 88 participants with a mean age at diagnosis of 72.2 years (SD=9.0 years) (55.5% women) developed pancreatic cancer with 77% having advanced disease. The interval between recruitment and diagnosis was 7.9 years (SD=3.7 years). Increased oleic acid intake was associated with a decreased risk of developing pancreatic cancer (highest fifth (23.7–78.3 g/day) versus lowest fifth (2.5–13.2 g/day), HR=0.29 95% CI 0.09 to 0.91) with a significant trend across fifths (per fifth increase, HR=0.72 95% CI 0.55 to 0.96 p=0.023). The population attributable fraction for an intake of less than 23.7 g/day of oleic acid was 32.1%. No associations were found for total dietary n-3 fatty acids (highest vs lowest fifth, HR=0.55 95% CI 0.24 to 1.30) or dietary EPA and DHA intake. Conclusion An increased oleic acid intake may be involved in the aetiology of one-third of pancreatic cancer cases. No associations were found for n3 PUFA9s. The findings suggest oleic acid should be measured in future aetiological work of this aggressive cancer.