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OBJECTIVE: To develop and internally validate a Free Sugars Screener (FSS) for Australian children aged 2 and 5 years. DESIGN: Using data collected from a 99-item (2-year-olds) and 98-item (5-year-olds) Food Frequency Questionnaire in the Study of Mother's and Infant's Life Events affecting oral health (SMILE-FFQ), a regression-based prediction modelling approach was employed to identify a subset of items that accurately estimate total free sugars intake (FSI). The predictors were grams of free sugars (FSg) for individual items in the SMILE-FFQ and child's age and sex. The outcome variable was total FSI per person. To internally validate the SMILE-FSS items, the estimated FSg was converted to percent energy from free sugars (%EFS) for comparison to the WHO free sugars guideline categories (<5%, 5-<10%, ≥10%EFS) using cross-classification analysis. SETTING: Australia. PARTICIPANTS: 858 and 652 2- and 5-year-old children, respectively, with complete dietary (<5% missing) and sociodemographic data. RESULTS: 22- and 26-items were important in predicting FSI at 2 and 5 years, respectively. Items were similar between ages with more discretionary beverage items (e.g., sugar-sweetened beverages) at 5 years. %EFS was overestimated by 4.4% and 2.6%. Most children (75% and 82%) were categorised into the same WHO free sugars category with most (87% and 95%) correctly identified as having <10%EFS in line with the WHO recommendation. CONCLUSIONS: The SMILE-FSS has good internal validity and can be used in research and practice to estimate young Australian children's free sugars intake and compare to the WHO free sugars guidelines to identify those 'at risk'.

Background: Dietary change towards a diet low in greenhouse gas emissions (GHGEs) can reduce climate impact and improve individual-level health. However, there is a lack of understanding if diet interventions can achieve low-GHGE diets. Methods: A randomized controlled trial was conducted to assess the effects of an app-based intervention. The intervention was designed to improve dietary intake of people with Type 2 diabetes, and was delivered via an app over 12 weeks, with each week covering one diet-related topic. Dietary intake was assessed at baseline and 3-month follow up by a 95-item food frequency questionnaire and linked to GHGE values. A total of n = 93 participants (n = 46 and n = 47 for the intervention and control group, respectively) were included in the analysis. Changes to GHGEs within and between the groups were analysed with inferential statistics. Results: The majority (60%) of participants were male, with a mean age of 63.2 years and body mass index of 30 kg/m2. At baseline, diet-related GHGEs were 4.8 and 4.9 kg CO2-eq/day in the intervention and control group, respectively. At 3-month follow up the corresponding GHGEs were 4.7 and 4.9 kg CO2-eq/day. We found no statistically significant changes to diet-related GHGEs within or between groups, or within food categories, from baseline to 3-month follow up. Conclusion: No evidence was found for the effectiveness of the app-based intervention to generate changes to diet-related GHGEs in a population of people with Type 2 diabetes. However, future interventions that target reducing meat consumption specifically may have the potential to result in a reduction of individual-level diet-related GHGEs. Trial registration ClinicalTrials.gov, NCT03784612. Registered 24 December 2018. www.clinicaltrials.gov/ct2/show/NCT03784612.

Information on fortifiable food consumption is essential to design, monitor and evaluate fortification programmes, yet detailed methods like 24-h recalls (24HRs) that provide such data are rarely conducted. Simplified questionnaire-based methods exist but their validity compared with 24HRs has not been shown. We compared two simplified methods (i.e., a household food acquisition and purchase questionnaire [FAPQ] and a 7-day semiquantitative food frequency questionnaire [SQ-FFQ]) against 24HRs for estimating fortifiable food consumption. We assessed the consumption of fortifiable wheat flour and oil using a FAPQ and, for wheat flour only, a 7-day SQ-FFQ and compared the results against 24HRs. The participants included children 12-18 months (n = 123) and their mothers 18-49 years selected for a study assessing child vitamin A intake and status in Mandaluyong City, Philippines. For fortifiable wheat flour, the FAPQ estimated considerably lower mean intakes compared to 24HRs for children and mothers (2.2 vs. 14.1 g/day and 5.1 vs. 42.3 g/day, respectively), while the SQ-FFQ estimated slightly higher mean intakes (15.7 vs. 14.1 g/day and 51.5 vs. 42.3 g/day, respectively). For fortifiable oil, the FAPQ estimated considerably higher mean intakes compared to 24HRs for children and mothers (4.6 vs. 1.8 g/day and 12.5 vs. 6.1 g/day, respectively). The SQ-FFQ, but not the FAPQ, generated useful information on fortifiable food consumption that can inform fortification programme design and monitoring decisions in the absence of more detailed individual-level data. Potential adaptations to improve the FAPQ, such as additional questions on foods prepared away from home and usage patterns, merit further research.

BACKGROUND: Nutritional quality, and health and climate impacts are important considerations in the design of sustainable diets. OBJECTIVES: To investigate the association between diets varying in nutrient density and climate impact and MI and stroke HRs. METHODS: Dietary data of 41,194 women and 39,141 men (35-65 y) who participated in a Swedish population-based cohort study were employed. Nutrient density was calculated using the Sweden-adapted Nutrient Rich Foods 11.3 index. Dietary climate impact was calculated with data from life cycle assessments, including greenhouse gas emissions from primary production to industry gate. HRs and 95% CIs for MI and stroke were assessed with multivariable Cox proportional hazards regression, comparing a least-desirable diet scenario reference group (lower nutrient density, higher climate impact) with three diet groups that varied with respect to higher/lower nutrient density and higher/lower climate impact. RESULTS: Median follow-up time from the baseline study visit to MI or stroke diagnosis was 15.7 y for women and 12.8 y for men. The MI hazard was significantly higher for the men with diets of lower nutrient density and lower climate impact (HR: 1.19; 95% CI: 1.06, 1.33; P = 0.004), compared with the reference group. No significant association with MI was observed for any of the diet groups of women. No significant association with stroke was observed among any of the diet groups of women or men. CONCLUSIONS: The results among men suggest some adverse health effects for men when diet quality is not considered in the pursuit of more climate-sustainable diets. For women, no significant associations were detected. The mechanism underlying this association for men needs further investigation.

BACKGROUND: Nutritional quality, and health and climate impacts are important considerations in the design of sustainable diets. OBJECTIVES: To investigate the association between diets varying in nutrient density and climate impact and MI and stroke HRs. METHODS: Dietary data of 41,194 women and 39,141 men (35-65 y) who participated in a Swedish population-based cohort study were employed. Nutrient density was calculated using the Sweden-adapted Nutrient Rich Foods 11.3 index. Dietary climate impact was calculated with data from life cycle assessments, including greenhouse gas emissions from primary production to industry gate. HRs and 95% CIs for MI and stroke were assessed with multivariable Cox proportional hazards regression, comparing a least-desirable diet scenario reference group (lower nutrient density, higher climate impact) with three diet groups that varied with respect to higher/lower nutrient density and higher/lower climate impact. RESULTS: Median follow-up time from the baseline study visit to MI or stroke diagnosis was 15.7 y for women and 12.8 y for men. The MI hazard was significantly higher for the men with diets of lower nutrient density and lower climate impact (HR: 1.19; 95% CI: 1.06, 1.33; P = 0.004), compared with the reference group. No significant association with MI was observed for any of the diet groups of women. No significant association with stroke was observed among any of the diet groups of women or men. CONCLUSIONS: The results among men suggest some adverse health effects for men when diet quality is not considered in the pursuit of more climate-sustainable diets. For women, no significant associations were detected. The mechanism underlying this association for men needs further investigation.

BACKGROUND: Nutritional quality, and health and climate impacts are important considerations in the design of sustainable diets. OBJECTIVES: To investigate the association between diets varying in nutrient density and climate impact and MI and stroke HRs. METHODS: Dietary data of 41,194 women and 39,141 men (35-65 y) who participated in a Swedish population-based cohort study were employed. Nutrient density was calculated using the Sweden-adapted Nutrient Rich Foods 11.3 index. Dietary climate impact was calculated with data from life cycle assessments, including greenhouse gas emissions from primary production to industry gate. HRs and 95% CIs for MI and stroke were assessed with multivariable Cox proportional hazards regression, comparing a least-desirable diet scenario reference group (lower nutrient density, higher climate impact) with three diet groups that varied with respect to higher/lower nutrient density and higher/lower climate impact. RESULTS: Median follow-up time from the baseline study visit to MI or stroke diagnosis was 15.7 y for women and 12.8 y for men. The MI hazard was significantly higher for the men with diets of lower nutrient density and lower climate impact (HR: 1.19; 95% CI: 1.06, 1.33; P = 0.004), compared with the reference group. No significant association with MI was observed for any of the diet groups of women. No significant association with stroke was observed among any of the diet groups of women or men. CONCLUSIONS: The results among men suggest some adverse health effects for men when diet quality is not considered in the pursuit of more climate-sustainable diets. For women, no significant associations were detected. The mechanism underlying this association for men needs further investigation.

Background/Objectives Few studies have investigated the association between dietary flavonoid intake, including all major subclasses, and the long-term risk of ischemic heart disease (IHD). We examined whether dietary flavonoid intake associated with IHD incidence, assessing the possible modifying role of sex and smoking, in participants from the Danish Diet, Cancer, and Health study. Subjects/Methods In a cohort study design, 54,496 adults (46.8% male), aged 50-64 years, without a history of IHD, were followed for up to 23 years. Habitual dietary flavonoid intake was estimated from food frequency questionnaires using Phenol-Explorer. Incident cases of IHD were identified within Danish nationwide health registries. Restricted cubic splines in Cox proportional hazards models were used to examine associations between flavonoid intake and IHD risk. Results During follow-up, 5560 IHD events were recorded. No overall association was seen between total flavonoid intake, nor any subclass, and IHD, following adjustment for demographics, lifestyle, and dietary confounders. Stratified by sex and smoking status, higher intakes of specific subclasses associated with lower IHD risk among ever-smokers [Q5 vs. Q1 flavonols HR (95% CI): 0.90 (0.82, 0.99); flavanol oligo+polymers: 0.88 (0.80, 0.97)], but not among never-smokers, nor either sex specifically. Conclusions While we did not find clear evidence that higher habitual dietary flavonoid intake was associated with lower IHD risk, these results do not exclude the possibility that certain subclasses may have a protective role in prevention of IHD among population sub-groups; this was evident among smokers, who are at a higher risk of atherosclerosis.

he food frequency questionnaire (FFQ) is designed to capture an individual’s habitual dietary intake and is the most applied method in nutritional epidemiology. Our aim was to assess the relative validity and reproducibility of the FFQ used in the Diet, Cancer, and Health—Next Generations cohort (DCH-NG). We included 415 Danish women and men aged 18–67 years. Spearman’s correlations coefficients, Bland–Altman limits of agreement and cross-classification between dietary intakes estimated from the FFQ administered at baseline (FFQbaseline), and the mean of three 24-h dietary recalls (24-HDRs) and the FFQ administered after 12 months (FFQ12 months) were determined. Nutrient intakes were energy-adjusted by Nutrient Density and Residual methods. Correlation coefficients ranged from 0.18–0.58 for energy and energy-adjusted nutrient intakes, and the percentage of participants classified into the same quartile ranged from 28–47% between the FFQbaseline and the 24-HDRs. For the FFQ12 months compared with FFQbaseline, correlation coefficients ranged from 0.52–0.88 for intakes of energy, energy-adjusted nutrients, and food groups, and the proportion of participants classified into the same quartiles ranged from 43–69%. Overall, the FFQ provided a satisfactory ranking of individuals according to energy, nutrient, and food group intakes, making the FFQ suitable for use in epidemiological studies investigating diet in relation to disease outcomes. Keywords: food frequency questionnaire; 24-h dietary recall; web-based; relative validity; reproducibility; epidemiology; nutrition; diet; cancer, The food frequency questionnaire (FFQ) is designed to capture an individual’s habitual dietary intake and is the most applied method in nutritional epidemiology. Our aim was to assess the relative validity and reproducibility of the FFQ used in the Diet, Cancer, and Health—Next Generations cohort (DCH-NG). We included 415 Danish women and men aged 18–67 years. Spearman’s correlations coefficients, Bland–Altman limits of agreement and cross-classification between dietary intakes estimated from the FFQ administered at baseline (FFQbaseline), and the mean of three 24-h dietary recalls (24-HDRs) and the FFQ administered after 12 months (FFQ12 months) were determined. Nutrient intakes were energy-adjusted by Nutrient Density and Residual methods. Correlation coefficients ranged from 0.18–0.58 for energy and energy-adjusted nutrient intakes, and the percentage of participants classified into the same quartile ranged from 28–47% between the FFQbaseline and the 24-HDRs. For the FFQ12 months compared with FFQbaseline, correlation coefficients ranged from 0.52–0.88 for intakes of energy, energy-adjusted nutrients, and food groups, and the proportion of participants classified into the same quartiles ranged from 43–69%. Overall, the FFQ provided a satisfactory ranking of individuals according to energy, nutrient, and food group intakes, making the FFQ suitable for use in epidemiological studies investigating diet in relation to disease outcomes.

he food frequency questionnaire (FFQ) is designed to capture an individual’s habitual dietary intake and is the most applied method in nutritional epidemiology. Our aim was to assess the relative validity and reproducibility of the FFQ used in the Diet, Cancer, and Health—Next Generations cohort (DCH-NG). We included 415 Danish women and men aged 18–67 years. Spearman’s correlations coefficients, Bland–Altman limits of agreement and cross-classification between dietary intakes estimated from the FFQ administered at baseline (FFQbaseline), and the mean of three 24-h dietary recalls (24-HDRs) and the FFQ administered after 12 months (FFQ12 months) were determined. Nutrient intakes were energy-adjusted by Nutrient Density and Residual methods. Correlation coefficients ranged from 0.18–0.58 for energy and energy-adjusted nutrient intakes, and the percentage of participants classified into the same quartile ranged from 28–47% between the FFQbaseline and the 24-HDRs. For the FFQ12 months compared with FFQbaseline, correlation coefficients ranged from 0.52–0.88 for intakes of energy, energy-adjusted nutrients, and food groups, and the proportion of participants classified into the same quartiles ranged from 43–69%. Overall, the FFQ provided a satisfactory ranking of individuals according to energy, nutrient, and food group intakes, making the FFQ suitable for use in epidemiological studies investigating diet in relation to disease outcomes. Keywords: food frequency questionnaire; 24-h dietary recall; web-based; relative validity; reproducibility; epidemiology; nutrition; diet; cancer, The food frequency questionnaire (FFQ) is designed to capture an individual’s habitual dietary intake and is the most applied method in nutritional epidemiology. Our aim was to assess the relative validity and reproducibility of the FFQ used in the Diet, Cancer, and Health—Next Generations cohort (DCH-NG). We included 415 Danish women and men aged 18–67 years. Spearman’s correlations coefficients, Bland–Altman limits of agreement and cross-classification between dietary intakes estimated from the FFQ administered at baseline (FFQbaseline), and the mean of three 24-h dietary recalls (24-HDRs) and the FFQ administered after 12 months (FFQ12 months) were determined. Nutrient intakes were energy-adjusted by Nutrient Density and Residual methods. Correlation coefficients ranged from 0.18–0.58 for energy and energy-adjusted nutrient intakes, and the percentage of participants classified into the same quartile ranged from 28–47% between the FFQbaseline and the 24-HDRs. For the FFQ12 months compared with FFQbaseline, correlation coefficients ranged from 0.52–0.88 for intakes of energy, energy-adjusted nutrients, and food groups, and the proportion of participants classified into the same quartiles ranged from 43–69%. Overall, the FFQ provided a satisfactory ranking of individuals according to energy, nutrient, and food group intakes, making the FFQ suitable for use in epidemiological studies investigating diet in relation to disease outcomes.

BACKGROUND: Nutritional quality, and health and climate impacts are important considerations in the design of sustainable diets. OBJECTIVES: To investigate the association between diets varying in nutrient density and climate impact and MI and stroke HRs. METHODS: Dietary data of 41,194 women and 39,141 men (35-65 y) who participated in a Swedish population-based cohort study were employed. Nutrient density was calculated using the Sweden-adapted Nutrient Rich Foods 11.3 index. Dietary climate impact was calculated with data from life cycle assessments, including greenhouse gas emissions from primary production to industry gate. HRs and 95% CIs for MI and stroke were assessed with multivariable Cox proportional hazards regression, comparing a least-desirable diet scenario reference group (lower nutrient density, higher climate impact) with three diet groups that varied with respect to higher/lower nutrient density and higher/lower climate impact. RESULTS: Median follow-up time from the baseline study visit to MI or stroke diagnosis was 15.7 y for women and 12.8 y for men. The MI hazard was significantly higher for the men with diets of lower nutrient density and lower climate impact (HR: 1.19; 95% CI: 1.06, 1.33; P = 0.004), compared with the reference group. No significant association with MI was observed for any of the diet groups of women. No significant association with stroke was observed among any of the diet groups of women or men. CONCLUSIONS: The results among men suggest some adverse health effects for men when diet quality is not considered in the pursuit of more climate-sustainable diets. For women, no significant associations were detected. The mechanism underlying this association for men needs further investigation.

BACKGROUND: Nutritional quality, and health and climate impacts are important considerations in the design of sustainable diets. OBJECTIVES: To investigate the association between diets varying in nutrient density and climate impact and MI and stroke HRs. METHODS: Dietary data of 41,194 women and 39,141 men (35-65 y) who participated in a Swedish population-based cohort study were employed. Nutrient density was calculated using the Sweden-adapted Nutrient Rich Foods 11.3 index. Dietary climate impact was calculated with data from life cycle assessments, including greenhouse gas emissions from primary production to industry gate. HRs and 95% CIs for MI and stroke were assessed with multivariable Cox proportional hazards regression, comparing a least-desirable diet scenario reference group (lower nutrient density, higher climate impact) with three diet groups that varied with respect to higher/lower nutrient density and higher/lower climate impact. RESULTS: Median follow-up time from the baseline study visit to MI or stroke diagnosis was 15.7 y for women and 12.8 y for men. The MI hazard was significantly higher for the men with diets of lower nutrient density and lower climate impact (HR: 1.19; 95% CI: 1.06, 1.33; P = 0.004), compared with the reference group. No significant association with MI was observed for any of the diet groups of women. No significant association with stroke was observed among any of the diet groups of women or men. CONCLUSIONS: The results among men suggest some adverse health effects for men when diet quality is not considered in the pursuit of more climate-sustainable diets. For women, no significant associations were detected. The mechanism underlying this association for men needs further investigation.

Background/Objectives Few studies have investigated the association between dietary flavonoid intake, including all major subclasses, and the long-term risk of ischemic heart disease (IHD). We examined whether dietary flavonoid intake associated with IHD incidence, assessing the possible modifying role of sex and smoking, in participants from the Danish Diet, Cancer, and Health study. Subjects/Methods In a cohort study design, 54,496 adults (46.8% male), aged 50-64 years, without a history of IHD, were followed for up to 23 years. Habitual dietary flavonoid intake was estimated from food frequency questionnaires using Phenol-Explorer. Incident cases of IHD were identified within Danish nationwide health registries. Restricted cubic splines in Cox proportional hazards models were used to examine associations between flavonoid intake and IHD risk. Results During follow-up, 5560 IHD events were recorded. No overall association was seen between total flavonoid intake, nor any subclass, and IHD, following adjustment for demographics, lifestyle, and dietary confounders. Stratified by sex and smoking status, higher intakes of specific subclasses associated with lower IHD risk among ever-smokers [Q5 vs. Q1 flavonols HR (95% CI): 0.90 (0.82, 0.99); flavanol oligo+polymers: 0.88 (0.80, 0.97)], but not among never-smokers, nor either sex specifically. Conclusions While we did not find clear evidence that higher habitual dietary flavonoid intake was associated with lower IHD risk, these results do not exclude the possibility that certain subclasses may have a protective role in prevention of IHD among population sub-groups; this was evident among smokers, who are at a higher risk of atherosclerosis.

BackgroundIndividual diet components and specific dietary regimens have been shown to impact the gut microbiome.ObjectivesHere, we explored the contribution of long-term diet by searching for dietary patterns that would best associate with the gut microbiome in a population-based cohort.MethodsUsing a priori and a posteriori approaches, we constructed dietary patterns from an FFQ completed by 1800 adults in the American Gut Project. Dietary patterns were defined as groups of participants or combinations of food variables (factors) driven by criteria ranging from individual nutrients to overall diet. We associated these patterns with 16S ribosomal RNA-based gut microbiome data for a subset of 744 participants.ResultsCompared to individual features (e.g., fiber and protein), or to factors representing a reduced number of dietary features, 5 a posteriori dietary patterns based on food groups were best associated with gut microbiome beta diversity (P ≤ 0.0002). Two patterns followed Prudent-like diets-Plant-Based and Flexitarian-and exhibited the highest Healthy Eating Index 2010 (HEI-2010) scores. Two other patterns presented Western-like diets with a gradient in HEI-2010 scores. A fifth pattern consisted mostly of participants following an Exclusion diet (e.g., low carbohydrate). Notably, gut microbiome alpha diversity was significantly lower in the most Western pattern compared to the Flexitarian pattern (P ≤ 0.009), and the Exclusion diet pattern was associated with low relative abundance of Bifidobacterium (P ≤ 1.2 × 10-7), which was better explained by diet than health status.ConclusionsWe demonstrated that global-diet a posteriori patterns were more associated with gut microbiome variations than individual dietary features among adults in the United States. These results confirm that evaluating diet as a whole is important when studying the gut microbiome. It will also facilitate the design of more personalized dietary stra

Nutritional assessment is essential in the evaluation of individuals’ health status. this study seeks to develop and validate a food frequency questionnaire (FFQ) that can be used as a nutritional assessment tool in epidemiological studies. a stratified random sampling enrolled sixty-five participants from Baghdad university college of medicine. participants were asked to fill a four days food upon which the questionnaire was developed. the participants were asked to fill the questionnaire based on their food intake in the last year. the data was entered using a food application, and the data source for the food nutritional values was obtained from different food composition tables. the serving size was assessed based on the Canadian nutritional society guidelines. the validation and reliability of the questionnaire were evaluated by comparing food intake of the records and the questionnaires using paired mean difference and Pearson correlation coefficient. the energy was adjusted using the nutrient density method. the mean difference between the records and questionnaire was 151.3 kcal, 7.61, 10.45, 10.24 gram for energy, fat, carbohydrate, and protein, respectively. the correlation coefficient between the record and the questionnaire was 0.829, 0.583, 0.323, and 0.547 for energy, fat, carbohydrate, and protein, respectively. in conclusion, this is the first valid food frequency questionnaire that was shown to be valid and reliable in providing a nutritional assessment of dietary intake in Iraq. it requires more efforts to be considered as a national tool for dietary assessment.

Although dietary patterns are key to the management of childhood obesity, they are rarely assessed and thus poorly understood. This study examines preschoolers' dietary patterns and correlates 12 months after the start of obesity treatment (n = 99, mean age 5.2 years, 52% girls). A food frequency questionnaire (FFQ), the Child Eating Behavior Questionnaire (CEBQ), Child Feeding Questionnaire (CFQ) and Lifestyle Behavior Checklist (LBC) were answered by parents to assess children's food intake, eating behaviors, parental feeding practices, and obesity-related behaviors, respectively. Principal component analysis identified dietary patterns based on FFQ data. Through multiple linear regressions we examined correlations between a healthy (HD) and a less healthy (LHD) dietary pattern and mean scores of the CEBQ, CFQ, LBC scales as well as BMI z-scores. The reported intake of items in the LHD decreased after treatment while no differences were found for the HD. Children's eating behaviors, in particular food fussiness, showed consistent associations with diet (b = -0.39, 95% CI-0.63,-0.14 for HD and b = 0.41, 95% CI 0.15, 0.66 for LHD). Feeding practices and obesity-related behaviours were weakly associated with the dietary patterns (HD and Monitoring: b = 0.36, 95% CI 0.09, 0.62; LHD and Screen time b = 0.08, 95% CI 0.01, 0.15). Among the measured variables, eating behaviors had the largest impact on children's dietary patterns. The LHD was associated with a higher BMI z-score but no associations were found between changes in LHD intake and changes in BMI z-scores. Our findings suggest that decreasing food fussiness in children with obesity is key to positive dietary changes. Assessment of children's eating behaviors can help tailor dietary advice and provide support for families of children with obesity.

Although dietary patterns are key to the management of childhood obesity, they are rarely assessed and thus poorly understood. This study examines preschoolers' dietary patterns and correlates 12 months after the start of obesity treatment (n = 99, mean age 5.2 years, 52% girls). A food frequency questionnaire (FFQ), the Child Eating Behavior Questionnaire (CEBQ), Child Feeding Questionnaire (CFQ) and Lifestyle Behavior Checklist (LBC) were answered by parents to assess children's food intake, eating behaviors, parental feeding practices, and obesity-related behaviors, respectively. Principal component analysis identified dietary patterns based on FFQ data. Through multiple linear regressions we examined correlations between a healthy (HD) and a less healthy (LHD) dietary pattern and mean scores of the CEBQ, CFQ, LBC scales as well as BMI z-scores. The reported intake of items in the LHD decreased after treatment while no differences were found for the HD. Children's eating behaviors, in particular food fussiness, showed consistent associations with diet (b = -0.39, 95% CI-0.63,-0.14 for HD and b = 0.41, 95% CI 0.15, 0.66 for LHD). Feeding practices and obesity-related behaviours were weakly associated with the dietary patterns (HD and Monitoring: b = 0.36, 95% CI 0.09, 0.62; LHD and Screen time b = 0.08, 95% CI 0.01, 0.15). Among the measured variables, eating behaviors had the largest impact on children's dietary patterns. The LHD was associated with a higher BMI z-score but no associations were found between changes in LHD intake and changes in BMI z-scores. Our findings suggest that decreasing food fussiness in children with obesity is key to positive dietary changes. Assessment of children's eating behaviors can help tailor dietary advice and provide support for families of children with obesity.

Although dietary patterns are key to the management of childhood obesity, they are rarely assessed and thus poorly understood. This study examines preschoolers' dietary patterns and correlates 12 months after the start of obesity treatment (n = 99, mean age 5.2 years, 52% girls). A food frequency questionnaire (FFQ), the Child Eating Behavior Questionnaire (CEBQ), Child Feeding Questionnaire (CFQ) and Lifestyle Behavior Checklist (LBC) were answered by parents to assess children's food intake, eating behaviors, parental feeding practices, and obesity-related behaviors, respectively. Principal component analysis identified dietary patterns based on FFQ data. Through multiple linear regressions we examined correlations between a healthy (HD) and a less healthy (LHD) dietary pattern and mean scores of the CEBQ, CFQ, LBC scales as well as BMI z-scores. The reported intake of items in the LHD decreased after treatment while no differences were found for the HD. Children's eating behaviors, in particular food fussiness, showed consistent associations with diet (b = -0.39, 95% CI-0.63,-0.14 for HD and b = 0.41, 95% CI 0.15, 0.66 for LHD). Feeding practices and obesity-related behaviours were weakly associated with the dietary patterns (HD and Monitoring: b = 0.36, 95% CI 0.09, 0.62; LHD and Screen time b = 0.08, 95% CI 0.01, 0.15). Among the measured variables, eating behaviors had the largest impact on children's dietary patterns. The LHD was associated with a higher BMI z-score but no associations were found between changes in LHD intake and changes in BMI z-scores. Our findings suggest that decreasing food fussiness in children with obesity is key to positive dietary changes. Assessment of children's eating behaviors can help tailor dietary advice and provide support for families of children with obesity.

Although dietary patterns are key to the management of childhood obesity, they are rarely assessed and thus poorly understood. This study examines preschoolers' dietary patterns and correlates 12 months after the start of obesity treatment (n = 99, mean age 5.2 years, 52% girls). A food frequency questionnaire (FFQ), the Child Eating Behavior Questionnaire (CEBQ), Child Feeding Questionnaire (CFQ) and Lifestyle Behavior Checklist (LBC) were answered by parents to assess children's food intake, eating behaviors, parental feeding practices, and obesity-related behaviors, respectively. Principal component analysis identified dietary patterns based on FFQ data. Through multiple linear regressions we examined correlations between a healthy (HD) and a less healthy (LHD) dietary pattern and mean scores of the CEBQ, CFQ, LBC scales as well as BMI z-scores. The reported intake of items in the LHD decreased after treatment while no differences were found for the HD. Children's eating behaviors, in particular food fussiness, showed consistent associations with diet (b = -0.39, 95% CI-0.63,-0.14 for HD and b = 0.41, 95% CI 0.15, 0.66 for LHD). Feeding practices and obesity-related behaviours were weakly associated with the dietary patterns (HD and Monitoring: b = 0.36, 95% CI 0.09, 0.62; LHD and Screen time b = 0.08, 95% CI 0.01, 0.15). Among the measured variables, eating behaviors had the largest impact on children's dietary patterns. The LHD was associated with a higher BMI z-score but no associations were found between changes in LHD intake and changes in BMI z-scores. Our findings suggest that decreasing food fussiness in children with obesity is key to positive dietary changes. Assessment of children's eating behaviors can help tailor dietary advice and provide support for families of children with obesity.

BackgroundIndividual diet components and specific dietary regimens have been shown to impact the gut microbiome.ObjectivesHere, we explored the contribution of long-term diet by searching for dietary patterns that would best associate with the gut microbiome in a population-based cohort.MethodsUsing a priori and a posteriori approaches, we constructed dietary patterns from an FFQ completed by 1800 adults in the American Gut Project. Dietary patterns were defined as groups of participants or combinations of food variables (factors) driven by criteria ranging from individual nutrients to overall diet. We associated these patterns with 16S ribosomal RNA-based gut microbiome data for a subset of 744 participants.ResultsCompared to individual features (e.g., fiber and protein), or to factors representing a reduced number of dietary features, 5 a posteriori dietary patterns based on food groups were best associated with gut microbiome beta diversity (P ≤ 0.0002). Two patterns followed Prudent-like diets-Plant-Based and Flexitarian-and exhibited the highest Healthy Eating Index 2010 (HEI-2010) scores. Two other patterns presented Western-like diets with a gradient in HEI-2010 scores. A fifth pattern consisted mostly of participants following an Exclusion diet (e.g., low carbohydrate). Notably, gut microbiome alpha diversity was significantly lower in the most Western pattern compared to the Flexitarian pattern (P ≤ 0.009), and the Exclusion diet pattern was associated with low relative abundance of Bifidobacterium (P ≤ 1.2 × 10-7), which was better explained by diet than health status.ConclusionsWe demonstrated that global-diet a posteriori patterns were more associated with gut microbiome variations than individual dietary features among adults in the United States. These results confirm that evaluating diet as a whole is important when studying the gut microbiome. It will also facilitate the design of more personalized dietary stra

Nutritional assessment is essential in the evaluation of individuals’ health status. this study seeks to develop and validate a food frequency questionnaire (FFQ) that can be used as a nutritional assessment tool in epidemiological studies. a stratified random sampling enrolled sixty-five participants from Baghdad university college of medicine. participants were asked to fill a four days food upon which the questionnaire was developed. the participants were asked to fill the questionnaire based on their food intake in the last year. the data was entered using a food application, and the data source for the food nutritional values was obtained from different food composition tables. the serving size was assessed based on the Canadian nutritional society guidelines. the validation and reliability of the questionnaire were evaluated by comparing food intake of the records and the questionnaires using paired mean difference and Pearson correlation coefficient. the energy was adjusted using the nutrient density method. the mean difference between the records and questionnaire was 151.3 kcal, 7.61, 10.45, 10.24 gram for energy, fat, carbohydrate, and protein, respectively. the correlation coefficient between the record and the questionnaire was 0.829, 0.583, 0.323, and 0.547 for energy, fat, carbohydrate, and protein, respectively. in conclusion, this is the first valid food frequency questionnaire that was shown to be valid and reliable in providing a nutritional assessment of dietary intake in Iraq. it requires more efforts to be considered as a national tool for dietary assessment.

Objective: Food frequency questionnaires (FFQs) assess habitual dietary intake and are relatively inexpensive to process, but may take up to 60 minutes to complete. This article describes the validation of the Flower-FFQ, which consists of four short FFQs measuring the intake of energy and macronutrients or specific (micro)nutrients/foods that can be merged into one complete daily assessment using predefined algorithms. Design: Participants completed the Flower-FFQ and validated regular-FFQ (n=401). Urinary nitrogen (n=242) and potassium excretions (n=361) were measured. We evaluated: 1) group-level bias, 2) correlations, and 3) cross-classification. Setting: Observational study. Participants: Dutch adults, 54±11(mean±SD) years. Results: Flower-FFQ1, Flower-FFQ2, Flower-FFQ3, and Flower-FFQ4 were completed in ±24, 9, 8 and 9 minutes (±50 minutes total), respectively. The regular-FFQ was completed in ±43 minutes. Mean energy (flower vs. regular: 7953 vs. 8718 kJ/day) and macronutrient intakes (carbohydrates: 204 vs. 222 g/day; protein: 75 vs. 76 g/day; fat: 74 vs. 83 g/day; ethanol: 8 vs. 12 g/day) were comparatively similar. Spearman correlations between Flower-FFQ and regular-FFQ ranged from 0.60-0.80 for macronutrients and from 0.40-0.80 for micronutrients and foods. For all micronutrients and foods, ≥78% of the participants classified in the same/adjacent quartile. The flower-FFQ underestimated urinary nitrogen and potassium excretions by 24% and 18%; 75% and 73% of the participants ranked in the same/adjacent quartile. Conclusion: Completing the Flower-FFQ required 50 minutes with a maximum of 25 minutes per short FFQ. The Flower-FFQ has a moderate to good ranking ability for most nutrients and foods and performs sufficiently to study diet-disease associations.

Although dietary patterns are key to the management of childhood obesity, they are rarely assessed and thus poorly understood. This study examines preschoolers' dietary patterns and correlates 12 months after the start of obesity treatment (n = 99, mean age 5.2 years, 52% girls). A food frequency questionnaire (FFQ), the Child Eating Behavior Questionnaire (CEBQ), Child Feeding Questionnaire (CFQ) and Lifestyle Behavior Checklist (LBC) were answered by parents to assess children's food intake, eating behaviors, parental feeding practices, and obesity-related behaviors, respectively. Principal component analysis identified dietary patterns based on FFQ data. Through multiple linear regressions we examined correlations between a healthy (HD) and a less healthy (LHD) dietary pattern and mean scores of the CEBQ, CFQ, LBC scales as well as BMI z-scores. The reported intake of items in the LHD decreased after treatment while no differences were found for the HD. Children's eating behaviors, in particular food fussiness, showed consistent associations with diet (b = -0.39, 95% CI-0.63,-0.14 for HD and b = 0.41, 95% CI 0.15, 0.66 for LHD). Feeding practices and obesity-related behaviours were weakly associated with the dietary patterns (HD and Monitoring: b = 0.36, 95% CI 0.09, 0.62; LHD and Screen time b = 0.08, 95% CI 0.01, 0.15). Among the measured variables, eating behaviors had the largest impact on children's dietary patterns. The LHD was associated with a higher BMI z-score but no associations were found between changes in LHD intake and changes in BMI z-scores. Our findings suggest that decreasing food fussiness in children with obesity is key to positive dietary changes. Assessment of children's eating behaviors can help tailor dietary advice and provide support for families of children with obesity.

Intake of iron-rich foods was investigated in Senegalese adolescent girls. A cross-sectional survey was conducted among 136 girls aged 13 to 18, attending two colleges in Dakar. Data on the consumption of iron-rich foods over the previous week were collected through a food frequency questionnaire. Results show that 12% of the girls had consumed dishes made with iron-rich foods 3 times or less in the past seven days, 34%, 4 to 6 times, and 54%, 7 times and above. However, 83% of the girls had anntake of iron-rich foods below the 84 g per day recommended for animal protein sources by the EAT-Lancet Commission on Healthy Diets from Sustainable Food Systems. The diet of Senegalese adolescent girls seems conducive to iron deficiency. To define effective interventions to improve the situation, investigating underlying factors to the low consumption of iron-rich foods is warranted.

BackgroundDietary recommendations may underestimate the protein older adults need for optimal bone health. This study sought to determine associations of protein intake with bone mineral density (BMD) and fracture among community-dwelling White and Black older adults.MethodProtein as a percentage of total energy intake (TEI) was assessed with a Food Frequency Questionnaire in 2160 older adults (73.5 ± 2.8 years; 51.5% women; 35.8% Black) in the Health, Aging, and Body Composition prospective cohort. Hip, femoral neck, and whole body BMD was assessed by dual-energy x-ray absorptiometry at baseline and 4 years, and lumbar trabecular, cortical, and integral BMD was assessed by computed tomography at baseline and 5 years. Fragility fractures over 5 years were adjudicated from self-report data collected every 6 months. Associations with tertiles of protein intake were assessed using analysis of covariance for BMD and multivariate Cox regression for fracture, adjusting for confounders.ResultsParticipants in the upper protein tertile (≥15% TEI) had 1.8%-6.0% higher mean hip and lumbar spine BMD compared to the lower protein tertile (<13% TEI; p < .05). Protein intake did not affect change in BMD at any site over the follow-up period. Participants in the upper protein tertile had a reduced risk of clinical vertebral fracture over 5 years of follow-up (hazard ratio: 0.36 [95% confidence interval: 0.14, 0.97] vs lower protein tertile, p = .04).ConclusionsOlder adults with higher protein intake (≥15% TEI) had higher BMD at the hip, whole body, and lumbar spine, and a lower risk of vertebral fracture.

type:Text, Objective: Dietary patterns more closely resemble actual eating behaviours because multiple food groups, not a single food group or nutrient, are considered. The present study aimed to identify and assess changes of dietary patterns in Fukushima residents. Design: Dietary data were collected using a short-form FFQ in annual Fukushima Health Management Survey between 2011 and 2013 after the Great East Japan Earthquake. Year- and sex-specific dietary patterns were determined by the principal component analysis. Setting: Evacuation and nonevacuation zones in Fukushima, Japan. Participants: Eligible participants aged ≥16 years answered the FFQ (n 67 358 in 2011, n 48 377 in 2012 and n 40 742 in 2013). Results: Three identified dietary patterns were assessed similarly in men and women and among years: typical, juice and meat. In total participants, the Spearman's correlation coefficients between two survey years were 0·70-0·74 for the typical, 0·58-0·66 for the juice and 0·50-0·54 for the meat pattern scores. Adjusted for sociodemographic factors, evacuees had lower typical pattern scores, higher juice pattern scores and the same meat pattern scores compared with non-evacuees. The means of typical pattern scores in evacuees and it of juice pattern scores in non-evacuees continued declining over years. Similar profiles of dietary patterns and trends of pattern scores were observed in participants (n 22 805) who had provided three dietary assessments. Conclusions: Changes of dietary patterns have been observed between 2011 and 2013. Careful investigation of those with low intake of typical pattern foods and promotion of them, particularly in evacuees, are needed.

Purpose: The purpose of this study was to evaluate the reproducibility and validity of a short food frequency questionnaire (FFQ) for food group intake in Japan, the reproducibility and partial validity of which were previously confirmed for nutrients. Methods: A total of 288 middle-aged healthy volunteers from 11 different areas of Japan provided nonconsecutive 3-day weighed dietary records (DRs) at 3-month intervals over four seasons. We evaluated reproducibility based on the first (FFQ1) and second (FFQ2) questionnaires and their validity against the DRs by comparing the intake of 20 food groups. Spearman’s rank correlation coefficients (SRs) were calculated between energy-adjusted intake from the FFQs and that from the DRs. Results: The intake of 20 food groups estimated from the two FFQs was mostly equivalent. The median energy-adjusted SRs between the FFQ1 and FFQ2 were 0.61 (range 0.38–0.86) for men and 0.66 (0.45–0.84) for women. For validity, the median de-attenuated SRs between DRs and the FFQ1 were 0.51 (0.17–0.76) for men and 0.47 (0.23–0.77) for women. Compared with the DRs, the proportion of cross-classification into exact plus adjacent quintiles with the FFQ1 ranged from 58 to 86% in men and from 57 to 86% in women. According to the robust Z scores and the Bland–Altman plot graphs, the underestimation errors in the FFQ1 tended to be greater in individuals with high mean levels of consumption for meat for men and for other vegetables for both men and women. Conclusion: The FFQ demonstrated high reproducibility and reasonable validity for food group intake. This questionnaire is short and remains appropriate for identifying associations between diet and health/disease among adults in Japan.

Food frequency questionnaires (FFQ) are commonly used dietary assessment tools. The aim was to assess the relative validity of a 15-item FFQ, designed for the screening of poor dietary patterns with a validated diet history (DH). The study population was derived from the Gothenburg H70 Birth Cohort Studies. The DH registrations were harmonized in accordance with the FFQ frequencies. The agreement was assessed by Cohen’s kappa with corresponding confidence intervals (CI) for the frequency and categorical variables. Bland–Altman plots were used for the numeric variables. The study comprised data from 848 individuals (55.2% women). Overall, there was high agreement between the methods, with the exact and adjacent level of agreement over 80% for eight variables. The proportion attributed to the opposite frequency was fairly low for most of the frequency variables. Most of the kappa values were in fair or moderate agreement. The highest kappa values were calculated for the type of cooking fat (k = 0.68, CI = 0.63–0.72) and sandwich spread (k = 0.55, CI = 0.49–0.53), and the lowest for type of bread (0.13, CI = 0.07–0.20) and sweets (0.22 CI = 0.18–0.27). In conclusion, the FFQ showed overall good agreement compared with the DH. We, therefore, think it, with some improvements, could serve as a simple screening tool for poor dietary patterns., (This article belongs to the Special Issue Health Promotion in a Life Span Perspective)

Background: Accurately assessing dietary intake is crucial in understanding how diet affects a person’s health. In large cohorts, paper-based Dietary Assessment Tools (DAT) such as food recalls or food frequency questionnaires have emerged as valid tools with a low burden for participants. Objective: To validate a visually aided DAT for use in studies with Swiss adults against the gold standard of a weighed 7-day food record (7d-FR). Design: Fifty-one subjects (n=24 women, n=27 males) participated in the study and were recruited within two age groups (20- 40y and 50-70 y). Each subject filled out the visually aided DAT, then the 7dFR. The DAT was compared to the 7d-FR for total energy intake, macronutrients, sugar, water, and portions of fruits and vegetables. Pearson correlation and Bland-Altman analyses were used for statistical analyses. Results: Total correlations ranged from 0.288 (sugar, p<0.05) to 0.729 (water, p<0.01). The older age group showed higher correlations for total energy intake, protein, fats, carbohydrates, and sugar, but not for water (p<0.05). Correlations were moderate at r > 0.5, whereas only water and protein reached those values in the young group. Both groups overestimated total calories in kcal (+14.0%), grams of protein (+44.6%), and fats (+36.3%), and portions of fruits and vegetables (+16.0%) but strongly underestimated sugar intake (-50.9%). Conclusions: This DAT showed that all macronutrients and total energy intake were estimated more accurately by the older age group and therefore might be adequate to capture dietary habits in older Swiss adults.

Background: Probiotic supplements have shown the potential to reduce gastrointestinal (GI) distress symptoms; however, there is currently little research on dietary probiotic intake or the impact of probiotic food consumption on GI symptoms, particularly among athletes. Purpose: The purpose of this project was to: 1) develop and evaluate a tool for assessing intake of probiotic foods among collegiate athletes, 2) assess intake of probiotic and fermented foods among collegiate athletes at Virginia Tech, and 3) explore associations between intake of these items and GI symptoms in this study population. Methods: A literature review, review of 360 dietary recalls previously collected from collegiate athletes (n=120), and evaluation by five experts in sports nutrition and/or probiotic foods informed the development of a brief probiotic food frequency questionnaire (PRO-Q). The PRO-Q was then administered to participants (n=42), all of whom were members of Division I sports teams at Virginia Tech. Validity was assessed by comparing PRO-Q responses with probiotic intake determined using three 24-hour diet recalls (reference method). Participants also completed a questionnaire to evaluate type and severity of GI symptoms. Results: Overall intake of probiotic/fermented foods in this population was low (0.77 servings/day), with only 17% of participants reporting daily consumption. Based on Spearman’s Rho (r=0.766, p<0.001), Wilcoxon Signed-Rank test (p=0.168, indicating no difference between methods), and Bland-Altman analyses (95% agreement), PRO-Q responses were consistent with dietary recalls for average daily intake of probiotic/fermented foods. A total of 52% of participants reported experiencing regular GI distress symptoms. There was no association between PRO-Q responses and overall GI symptom score (r = 0.297, p = 0.056). Conclusion: These findings suggest that among collegiate athletes, probiotic/fermented food intake was generally low and GI distress symptoms were

Introduction: Helicobacter pylori (H. pylori) is a gram-negative bacterium that infects and colonizes the lining of the stomach. Approximately 50% of the global population has an active infection. Persistent infection is associated with the development of a variety of stomach pathologies, including non-cardia gastric cancer. Gastric cancer rates on the Navajo Nation are 4-times higher than that of non-Hispanic White populations living in the surrounding states. Certain dietary patterns have shown to be protective against gastric cancer and other gastrointestinal pathologies; specifically, diets high in green leafy vegetables and foods that are high in antioxidants, particularly citrus fruits. The goal of this research was to determine if there were associations between H. pylori infection and consumption of specific food groups, specifically green leafy vegetables, citrus fruits, traditional foods, and contemporary culturally specific food. Methods A cross-sectional study, Navajo Healthy Stomach Project, was conducted in Summer 2018 at three Navajo Nation chapters to study the prevalence of H. pylori in adults. The study included individual and household surveys and a 12-month food frequency questionnaire (FFQ) of 95 items. H. pylori infections were assessed using urea breath tests (UBT). Of the 101 participants, 94 completed both the UBT and the FFQ and are included in this current analysis. Food group consumption scores were created by averaging the reported usual consumption of specific food items for the following food categories: traditional Navajo foods, culturally specific foods, all fruits, citrus fruits, vegetables, and green leafy vegetables. Odds ratios (OR) and 95% confidence intervals (95% CI) were calculated using multiple logistic regression to determine associations between specific diet patterns and H. pylori infection with accounting for household clustering using STATA 16. Results The overall prevalence of H. pylori in this population was 64.9%. T

Food frequency questionnaires (FFQ) are commonly used dietary assessment tools. The aim was to assess the relative validity of a 15-item FFQ, designed for the screening of poor dietary patterns with a validated diet history (DH). The study population was derived from the Gothenburg H70 Birth Cohort Studies. The DH registrations were harmonized in accordance with the FFQ frequencies. The agreement was assessed by Cohen’s kappa with corresponding confidence intervals (CI) for the frequency and categorical variables. Bland–Altman plots were used for the numeric variables. The study comprised data from 848 individuals (55.2% women). Overall, there was high agreement between the methods, with the exact and adjacent level of agreement over 80% for eight variables. The proportion attributed to the opposite frequency was fairly low for most of the frequency variables. Most of the kappa values were in fair or moderate agreement. The highest kappa values were calculated for the type of cooking fat (k = 0.68, CI = 0.63–0.72) and sandwich spread (k = 0.55, CI = 0.49–0.53), and the lowest for type of bread (0.13, CI = 0.07–0.20) and sweets (0.22 CI = 0.18–0.27). In conclusion, the FFQ showed overall good agreement compared with the DH. We, therefore, think it, with some improvements, could serve as a simple screening tool for poor dietary patterns., (This article belongs to the Special Issue Health Promotion in a Life Span Perspective)

Food frequency questionnaires (FFQ) are commonly used dietary assessment tools. The aim was to assess the relative validity of a 15-item FFQ, designed for the screening of poor dietary patterns with a validated diet history (DH). The study population was derived from the Gothenburg H70 Birth Cohort Studies. The DH registrations were harmonized in accordance with the FFQ frequencies. The agreement was assessed by Cohen’s kappa with corresponding confidence intervals (CI) for the frequency and categorical variables. Bland–Altman plots were used for the numeric variables. The study comprised data from 848 individuals (55.2% women). Overall, there was high agreement between the methods, with the exact and adjacent level of agreement over 80% for eight variables. The proportion attributed to the opposite frequency was fairly low for most of the frequency variables. Most of the kappa values were in fair or moderate agreement. The highest kappa values were calculated for the type of cooking fat (k = 0.68, CI = 0.63–0.72) and sandwich spread (k = 0.55, CI = 0.49–0.53), and the lowest for type of bread (0.13, CI = 0.07–0.20) and sweets (0.22 CI = 0.18–0.27). In conclusion, the FFQ showed overall good agreement compared with the DH. We, therefore, think it, with some improvements, could serve as a simple screening tool for poor dietary patterns., (This article belongs to the Special Issue Health Promotion in a Life Span Perspective)

Food frequency questionnaires (FFQ) are commonly used dietary assessment tools. The aim was to assess the relative validity of a 15-item FFQ, designed for the screening of poor dietary patterns with a validated diet history (DH). The study population was derived from the Gothenburg H70 Birth Cohort Studies. The DH registrations were harmonized in accordance with the FFQ frequencies. The agreement was assessed by Cohen’s kappa with corresponding confidence intervals (CI) for the frequency and categorical variables. Bland–Altman plots were used for the numeric variables. The study comprised data from 848 individuals (55.2% women). Overall, there was high agreement between the methods, with the exact and adjacent level of agreement over 80% for eight variables. The proportion attributed to the opposite frequency was fairly low for most of the frequency variables. Most of the kappa values were in fair or moderate agreement. The highest kappa values were calculated for the type of cooking fat (k = 0.68, CI = 0.63–0.72) and sandwich spread (k = 0.55, CI = 0.49–0.53), and the lowest for type of bread (0.13, CI = 0.07–0.20) and sweets (0.22 CI = 0.18–0.27). In conclusion, the FFQ showed overall good agreement compared with the DH. We, therefore, think it, with some improvements, could serve as a simple screening tool for poor dietary patterns., (This article belongs to the Special Issue Health Promotion in a Life Span Perspective)

Food frequency questionnaires (FFQ) are commonly used dietary assessment tools. The aim was to assess the relative validity of a 15-item FFQ, designed for the screening of poor dietary patterns with a validated diet history (DH). The study population was derived from the Gothenburg H70 Birth Cohort Studies. The DH registrations were harmonized in accordance with the FFQ frequencies. The agreement was assessed by Cohen’s kappa with corresponding confidence intervals (CI) for the frequency and categorical variables. Bland–Altman plots were used for the numeric variables. The study comprised data from 848 individuals (55.2% women). Overall, there was high agreement between the methods, with the exact and adjacent level of agreement over 80% for eight variables. The proportion attributed to the opposite frequency was fairly low for most of the frequency variables. Most of the kappa values were in fair or moderate agreement. The highest kappa values were calculated for the type of cooking fat (k = 0.68, CI = 0.63–0.72) and sandwich spread (k = 0.55, CI = 0.49–0.53), and the lowest for type of bread (0.13, CI = 0.07–0.20) and sweets (0.22 CI = 0.18–0.27). In conclusion, the FFQ showed overall good agreement compared with the DH. We, therefore, think it, with some improvements, could serve as a simple screening tool for poor dietary patterns., (This article belongs to the Special Issue Health Promotion in a Life Span Perspective)

Background Dietary vitamin K (K-1 and K-2) may reduce atherosclerotic cardiovascular disease (ASCVD) risk via several mechanisms. However, studies linking vitamin K intake with incident ASCVD are limited. We aimed to determine the relationship between dietary vitamin K intake and ASCVD hospitalizations. Methods and Results In this prospective cohort study, participants from the Danish Diet, Cancer, and Health Study, with no prior ASCVD, completed a food-frequency questionnaire at baseline and were followed up for hospital admissions of ASCVD; ischemic heart disease, ischemic stroke, or peripheral artery disease. Intakes of vitamin K-1 and vitamin K-2 were estimated from the food-frequency questionnaire, and their relationship with ASCVD hospitalizations was determined using Cox proportional hazards models. Among 53 372 Danish citizens with a median (interquartile range) age of 56 (52-60) years, 8726 individuals were hospitalized for any ASCVD during 21 (17-22) years of follow-up. Compared with participants with the lowest vitamin K-1 intakes, participants with the highest intakes had a 21% lower risk of an ASCVD-related hospitalization (hazard ratio, 0.79; 95% CI: 0.74-0.84), after multivariable adjustments for relevant demographic covariates. Likewise for vitamin K-2, the risk of an ASCVD-related hospitalization for participants with the highest intakes was 14% lower than participants with the lowest vitamin K-2 intake (hazard ratio, 0.86; 95% CI, 0.81-0.91). Conclusions Risk of ASCVD was inversely associated with diets high in vitamin K-1 or K-2. The similar inverse associations with both vitamin K-1 and K-2, despite very different dietary sources, highlight the potential importance of vitamin K for ASCVD prevention.

The dietary intake of acrylamide (AA) is a health concern, and food is being monitored worldwide, but the extent of AA exposure from the diet is uncertain. The aim of this review was to provide an overview of estimated dietary intake. We performed a PubMed search identifying studies that used dietary questionnaires and recalls to estimate total dietary AA intake. A total of 101 studies were included, corresponding to 68 original study populations from 26 countries. Questionnaires were used in 57 studies, dietary recalls were used in 33 studies, and 11 studies used both methods. The estimated median AA intake ranged from 0.02 to 1.53 mu g/kg body weight/day between studies. Children were represented in 25 studies, and the body-weight-adjusted estimated AA intake was up to three times higher for children than adults. The majority of studies were from Europe (n = 65), Asia (n = 17), and the USA (n = 12). Studies from Asia generally estimated lower intakes than studies from Europe and the USA. Differences in methods undermine direct comparison across studies. The assessment of AA intake through dietary questionnaires and recalls has limitations. The integration of these methods with the analysis of validated biomarkers of exposure/internal dose would improve the accuracy of dietary AA intake exposure estimation. This overview shows that AA exposure is widespread and the large variation across and within populations shows a potential for reduced intake among those with the highest exposure.

Introduction: Modifiable lifestyle behaviors represent a central target for public health interventions. This study investigates the association between adherence to 4 modifiable lifestyle recommendations and all-cause, cancer, or cardiovascular disease mortality.Methods: Investigators used data from the Danish Diet, Cancer and Health cohort (1993-2013; N=54,276). Lifestyle recommendations included smoking (never smoking), diet (adherence to 6 national food-based dietary guidelines), alcohol consumption (= 30 minutes per day of moderate-to-vigorous leisure-time physical activity). Pseudo-values were used to estimate the adjusted risk differences and 95% CIs for all-cause, cancer, or cardiovascular disease mortality. Data were analyzed in 2019 -2020.Results: A total of 8,860 participants died during a median follow-up of 17.0 years. Adherence to all modifiable lifestyle recommendations was associated with an 18.46% (95% CI= -20.52%, -16.41%) lower absolute risk of all-cause mortality than no adherence. Never smokers had a 13.19% (95% CI= 13.95%, 12.44%) lower risk, those adhering to dietary guidelines (diet score >= 5) had a 7.52% (95% CI= -8.89%, -6.14%) lower risk, and those adhering to recommended levels of alcohol (2.11%, 95% CI= -2.75%, -1.48%) and physical activity (1.58%, 95% CI= -2.20%, -1.00%) had a lower risk than those who did not adhere. Stronger associations were observed in men than in women and in older than in middle-aged participants.Conclusions: Findings suggest that adherence to modifiable lifestyle recommendations is associated with a lower risk of mortality from all causes, cancer, and cardiovascular disease, underlining the importance of supporting adherence to national guidelines for lifestyle recommendations. (C) 2021 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Weight loss is one of the first line treatments for people with obstructive sleep apnea (OSA); however, people with OSA may have difficulties losing weight. Few studies have investigated the factors underlying these challenges in people with OSA. The aim of this study was to compare dietary intake, eating behavior and physical activity data in people with OSA and without OSA. Seventy-four patients referred to a sleep disorders clinic for suspected OSA underwent a standard clinical overnight polysomnography and completed questionnaires assessing dietary intake, physical activity and eating behavior prior to treatment. On the Three Factor Eating Questionnaire-R18 patients with OSA (n = 49, AHI 19.5 [13.0-55.4] events/h) had higher levels of uncontrolled eating (adjusted means, 19.7 (0.7) vs 16.1 (1.0): F (1, 69) = 7.103, p = 0.010 partial eta2 = 0.093), than those who did not have OSA (n = 25, AHI 3.3 [0.8-4.4] events/h) after adjusting for age, fat mass % and depression. There were no differences between groups in dietary intake measures or physical activity. These results suggest that people with OSA may need specific attention to eating behavior when undergoing weight loss interventions.Copyright © 2020, Japanese Society of Sleep Research.

OBJECTIVE: To examine associations between diet and risk of developing gastroesophageal reflux disease (GERD). DESIGN: Prospective cohort with a median follow-up of 15.8 years. Baseline diet was measured using a food frequency questionnaire. GERD was defined as self-reported current or history of daily heartburn or acid regurgitation beginning at least two years after baseline. Sex-specific logistic regressions were performed to estimate odds ratios for GERD associated with diet quality scores and intakes of nutrients, food groups, and individual foods and beverages. The effect of substituting saturated fat for monounsaturated or polyunsaturated fat on GERD risk was examined. SETTING: Melbourne, Australia. PARTICIPANTS: A cohort of 20,926 participants (62% women) aged 40-59 years at recruitment between 1990-1994. RESULT(S): For men, total fat intake was associated with increased risk of GERD (OR 1.05 per 5g/d; 95%CI 1.01-1.09; p=0.016), whereas total carbohydrate (OR 0.89 per 30g/d; 95%CI 0.82-0.98; p=0.010) and starch intakes (OR 0.84 per 30g/d; 95%CI 0.75-0.94; p=0.005) were associated with reduced risk. Nutrients were not associated with risk for women. For both sexes, substituting saturated fat for polyunsaturated or monounsaturated fat did not change risk. For both sexes, fish, chicken, cruciferous vegetables, and carbonated beverages were associated with increased risk, whereas total fruit and citrus were associated with reduced risk. No association was observed with diet quality scores. CONCLUSION(S): Diet is a possible risk factor for GERD, but food considered as triggers of GERD symptoms might not necessarily contribute to disease development. Potential differential associations for men and women warrant further investigation.

Weight loss is one of the first line treatments for people with obstructive sleep apnea (OSA); however, people with OSA may have difficulties losing weight. Few studies have investigated the factors underlying these challenges in people with OSA. The aim of this study was to compare dietary intake, eating behavior and physical activity data in people with OSA and without OSA. Seventy-four patients referred to a sleep disorders clinic for suspected OSA underwent a standard clinical overnight polysomnography and completed questionnaires assessing dietary intake, physical activity and eating behavior prior to treatment. On the Three Factor Eating Questionnaire-R18 patients with OSA (n = 49, AHI 19.5 [13.0-55.4] events/h) had higher levels of uncontrolled eating (adjusted means, 19.7 (0.7) vs 16.1 (1.0): F (1, 69) = 7.103, p = 0.010 partial eta2 = 0.093), than those who did not have OSA (n = 25, AHI 3.3 [0.8-4.4] events/h) after adjusting for age, fat mass % and depression. There were no differences between groups in dietary intake measures or physical activity. These results suggest that people with OSA may need specific attention to eating behavior when undergoing weight loss interventions.Copyright © 2020, Japanese Society of Sleep Research.

OBJECTIVE: To examine associations between diet and risk of developing gastroesophageal reflux disease (GERD). DESIGN: Prospective cohort with a median follow-up of 15.8 years. Baseline diet was measured using a food frequency questionnaire. GERD was defined as self-reported current or history of daily heartburn or acid regurgitation beginning at least two years after baseline. Sex-specific logistic regressions were performed to estimate odds ratios for GERD associated with diet quality scores and intakes of nutrients, food groups, and individual foods and beverages. The effect of substituting saturated fat for monounsaturated or polyunsaturated fat on GERD risk was examined. SETTING: Melbourne, Australia. PARTICIPANTS: A cohort of 20,926 participants (62% women) aged 40-59 years at recruitment between 1990-1994. RESULT(S): For men, total fat intake was associated with increased risk of GERD (OR 1.05 per 5g/d; 95%CI 1.01-1.09; p=0.016), whereas total carbohydrate (OR 0.89 per 30g/d; 95%CI 0.82-0.98; p=0.010) and starch intakes (OR 0.84 per 30g/d; 95%CI 0.75-0.94; p=0.005) were associated with reduced risk. Nutrients were not associated with risk for women. For both sexes, substituting saturated fat for polyunsaturated or monounsaturated fat did not change risk. For both sexes, fish, chicken, cruciferous vegetables, and carbonated beverages were associated with increased risk, whereas total fruit and citrus were associated with reduced risk. No association was observed with diet quality scores. CONCLUSION(S): Diet is a possible risk factor for GERD, but food considered as triggers of GERD symptoms might not necessarily contribute to disease development. Potential differential associations for men and women warrant further investigation.

Introduction: Helicobacter pylori (H. pylori) is a gram-negative bacterium that infects and colonizes the lining of the stomach. Approximately 50% of the global population has an active infection. Persistent infection is associated with the development of a variety of stomach pathologies, including non-cardia gastric cancer. Gastric cancer rates on the Navajo Nation are 4-times higher than that of non-Hispanic White populations living in the surrounding states. Certain dietary patterns have shown to be protective against gastric cancer and other gastrointestinal pathologies; specifically, diets high in green leafy vegetables and foods that are high in antioxidants, particularly citrus fruits. The goal of this research was to determine if there were associations between H. pylori infection and consumption of specific food groups, specifically green leafy vegetables, citrus fruits, traditional foods, and contemporary culturally specific food. Methods A cross-sectional study, Navajo Healthy Stomach Project, was conducted in Summer 2018 at three Navajo Nation chapters to study the prevalence of H. pylori in adults. The study included individual and household surveys and a 12-month food frequency questionnaire (FFQ) of 95 items. H. pylori infections were assessed using urea breath tests (UBT). Of the 101 participants, 94 completed both the UBT and the FFQ and are included in this current analysis. Food group consumption scores were created by averaging the reported usual consumption of specific food items for the following food categories: traditional Navajo foods, culturally specific foods, all fruits, citrus fruits, vegetables, and green leafy vegetables. Odds ratios (OR) and 95% confidence intervals (95% CI) were calculated using multiple logistic regression to determine associations between specific diet patterns and H. pylori infection with accounting for household clustering using STATA 16. Results The overall prevalence of H. pylori in this population was 64.9%. T

The dietary intake of acrylamide (AA) is a health concern, and food is being monitored worldwide, but the extent of AA exposure from the diet is uncertain. The aim of this review was to provide an overview of estimated dietary intake. We performed a PubMed search identifying studies that used dietary questionnaires and recalls to estimate total dietary AA intake. A total of 101 studies were included, corresponding to 68 original study populations from 26 countries. Questionnaires were used in 57 studies, dietary recalls were used in 33 studies, and 11 studies used both methods. The estimated median AA intake ranged from 0.02 to 1.53 mu g/kg body weight/day between studies. Children were represented in 25 studies, and the body-weight-adjusted estimated AA intake was up to three times higher for children than adults. The majority of studies were from Europe (n = 65), Asia (n = 17), and the USA (n = 12). Studies from Asia generally estimated lower intakes than studies from Europe and the USA. Differences in methods undermine direct comparison across studies. The assessment of AA intake through dietary questionnaires and recalls has limitations. The integration of these methods with the analysis of validated biomarkers of exposure/internal dose would improve the accuracy of dietary AA intake exposure estimation. This overview shows that AA exposure is widespread and the large variation across and within populations shows a potential for reduced intake among those with the highest exposure.

Background: Probiotic supplements have shown the potential to reduce gastrointestinal (GI) distress symptoms; however, there is currently little research on dietary probiotic intake or the impact of probiotic food consumption on GI symptoms, particularly among athletes. Purpose: The purpose of this project was to: 1) develop and evaluate a tool for assessing intake of probiotic foods among collegiate athletes, 2) assess intake of probiotic and fermented foods among collegiate athletes at Virginia Tech, and 3) explore associations between intake of these items and GI symptoms in this study population. Methods: A literature review, review of 360 dietary recalls previously collected from collegiate athletes (n=120), and evaluation by five experts in sports nutrition and/or probiotic foods informed the development of a brief probiotic food frequency questionnaire (PRO-Q). The PRO-Q was then administered to participants (n=42), all of whom were members of Division I sports teams at Virginia Tech. Validity was assessed by comparing PRO-Q responses with probiotic intake determined using three 24-hour diet recalls (reference method). Participants also completed a questionnaire to evaluate type and severity of GI symptoms. Results: Overall intake of probiotic/fermented foods in this population was low (0.77 servings/day), with only 17% of participants reporting daily consumption. Based on Spearman’s Rho (r=0.766, p<0.001), Wilcoxon Signed-Rank test (p=0.168, indicating no difference between methods), and Bland-Altman analyses (95% agreement), PRO-Q responses were consistent with dietary recalls for average daily intake of probiotic/fermented foods. A total of 52% of participants reported experiencing regular GI distress symptoms. There was no association between PRO-Q responses and overall GI symptom score (r = 0.297, p = 0.056). Conclusion: These findings suggest that among collegiate athletes, probiotic/fermented food intake was generally low and GI distress symptoms were

Background Dietary vitamin K (K-1 and K-2) may reduce atherosclerotic cardiovascular disease (ASCVD) risk via several mechanisms. However, studies linking vitamin K intake with incident ASCVD are limited. We aimed to determine the relationship between dietary vitamin K intake and ASCVD hospitalizations. Methods and Results In this prospective cohort study, participants from the Danish Diet, Cancer, and Health Study, with no prior ASCVD, completed a food-frequency questionnaire at baseline and were followed up for hospital admissions of ASCVD; ischemic heart disease, ischemic stroke, or peripheral artery disease. Intakes of vitamin K-1 and vitamin K-2 were estimated from the food-frequency questionnaire, and their relationship with ASCVD hospitalizations was determined using Cox proportional hazards models. Among 53 372 Danish citizens with a median (interquartile range) age of 56 (52-60) years, 8726 individuals were hospitalized for any ASCVD during 21 (17-22) years of follow-up. Compared with participants with the lowest vitamin K-1 intakes, participants with the highest intakes had a 21% lower risk of an ASCVD-related hospitalization (hazard ratio, 0.79; 95% CI: 0.74-0.84), after multivariable adjustments for relevant demographic covariates. Likewise for vitamin K-2, the risk of an ASCVD-related hospitalization for participants with the highest intakes was 14% lower than participants with the lowest vitamin K-2 intake (hazard ratio, 0.86; 95% CI, 0.81-0.91). Conclusions Risk of ASCVD was inversely associated with diets high in vitamin K-1 or K-2. The similar inverse associations with both vitamin K-1 and K-2, despite very different dietary sources, highlight the potential importance of vitamin K for ASCVD prevention.

Food frequency questionnaires (FFQ) are commonly used dietary assessment tools. The aim was to assess the relative validity of a 15-item FFQ, designed for the screening of poor dietary patterns with a validated diet history (DH). The study population was derived from the Gothenburg H70 Birth Cohort Studies. The DH registrations were harmonized in accordance with the FFQ frequencies. The agreement was assessed by Cohen’s kappa with corresponding confidence intervals (CI) for the frequency and categorical variables. Bland–Altman plots were used for the numeric variables. The study comprised data from 848 individuals (55.2% women). Overall, there was high agreement between the methods, with the exact and adjacent level of agreement over 80% for eight variables. The proportion attributed to the opposite frequency was fairly low for most of the frequency variables. Most of the kappa values were in fair or moderate agreement. The highest kappa values were calculated for the type of cooking fat (k = 0.68, CI = 0.63–0.72) and sandwich spread (k = 0.55, CI = 0.49–0.53), and the lowest for type of bread (0.13, CI = 0.07–0.20) and sweets (0.22 CI = 0.18–0.27). In conclusion, the FFQ showed overall good agreement compared with the DH. We, therefore, think it, with some improvements, could serve as a simple screening tool for poor dietary patterns., (This article belongs to the Special Issue Health Promotion in a Life Span Perspective)

BACKGROUND: Diets combining adequate nutritional quality and low climate impact are highly needed for human and planet health. OBJECTIVES: We aimed to 1) evaluate nutrient density indexes' ability to predict mortality, and 2) assess the effects of diets varying in nutrient density and climate impact on total mortality. METHODS: Dietary data from 49,124 women and 47,651 men aged 35-65 y in the population-based prospective study Västerbotten Intervention Programme (Sweden) were used. Greenhouse gas emissions (GHGEs) were estimated using data from life cycle assessments. Fifteen variants of nutrient density indexes were evaluated and the index that best predicted mortality was used to estimate participants' nutrient density. GHGEs and nutrient density were adjusted for energy intakes. Total mortality risk was estimated by Cox proportional hazards models for 4 groups of women and men, respectively, i.e., higher nutrient density, lower climate impact (HNutr/LClim); higher nutrient density, higher climate impact (HNutr/HClim); lower nutrient density, lower climate impact (LNutr/LClim); and lower nutrient density, higher climate impact (LNutr/HClim-reference group). RESULTS: NRF11.3, a Sweden-adapted variant of the Nutrient Rich Foods index, was identified to have the best ability to predict mortality in the study population. Median follow-up times for women and men were 16.0 and 14.7 y, respectively. For women a significantly lower mortality risk was found for HNutr/LClim (HR: 0.87; 95% CI: 0.79, 0.96; P = 0.008) and HNutr/HClim (HR: 0.87; 95% CI: 0.78, 0.97; P = 0.011) than for LNutr/HClim. Among men LNutr/LClim had a significantly higher mortality risk (HR: 1.10; 95% CI: 1.01, 1.21; P = 0.033) than LNutr/HClim. CONCLUSIONS: Diets beneficial for both health and climate are feasible and associated with lower mortality risk in women. Further studies are needed to understand how men may transition into diets that are more sustainable from a combined health and climate persp

BACKGROUND: Diets combining adequate nutritional quality and low climate impact are highly needed for human and planet health. OBJECTIVES: We aimed to 1) evaluate nutrient density indexes' ability to predict mortality, and 2) assess the effects of diets varying in nutrient density and climate impact on total mortality. METHODS: Dietary data from 49,124 women and 47,651 men aged 35-65 y in the population-based prospective study Västerbotten Intervention Programme (Sweden) were used. Greenhouse gas emissions (GHGEs) were estimated using data from life cycle assessments. Fifteen variants of nutrient density indexes were evaluated and the index that best predicted mortality was used to estimate participants' nutrient density. GHGEs and nutrient density were adjusted for energy intakes. Total mortality risk was estimated by Cox proportional hazards models for 4 groups of women and men, respectively, i.e., higher nutrient density, lower climate impact (HNutr/LClim); higher nutrient density, higher climate impact (HNutr/HClim); lower nutrient density, lower climate impact (LNutr/LClim); and lower nutrient density, higher climate impact (LNutr/HClim-reference group). RESULTS: NRF11.3, a Sweden-adapted variant of the Nutrient Rich Foods index, was identified to have the best ability to predict mortality in the study population. Median follow-up times for women and men were 16.0 and 14.7 y, respectively. For women a significantly lower mortality risk was found for HNutr/LClim (HR: 0.87; 95% CI: 0.79, 0.96; P = 0.008) and HNutr/HClim (HR: 0.87; 95% CI: 0.78, 0.97; P = 0.011) than for LNutr/HClim. Among men LNutr/LClim had a significantly higher mortality risk (HR: 1.10; 95% CI: 1.01, 1.21; P = 0.033) than LNutr/HClim. CONCLUSIONS: Diets beneficial for both health and climate are feasible and associated with lower mortality risk in women. Further studies are needed to understand how men may transition into diets that are more sustainable from a combined health and climate persp

Background: Accurately assessing dietary intake is crucial in understanding how diet affects a person’s health. In large cohorts, paper-based Dietary Assessment Tools (DAT) such as food recalls or food frequency questionnaires have emerged as valid tools with a low burden for participants. Objective: To validate a visually aided DAT for use in studies with Swiss adults against the gold standard of a weighed 7-day food record (7d-FR). Design: Fifty-one subjects (n=24 women, n=27 males) participated in the study and were recruited within two age groups (20- 40y and 50-70 y). Each subject filled out the visually aided DAT, then the 7dFR. The DAT was compared to the 7d-FR for total energy intake, macronutrients, sugar, water, and portions of fruits and vegetables. Pearson correlation and Bland-Altman analyses were used for statistical analyses. Results: Total correlations ranged from 0.288 (sugar, p<0.05) to 0.729 (water, p<0.01). The older age group showed higher correlations for total energy intake, protein, fats, carbohydrates, and sugar, but not for water (p<0.05). Correlations were moderate at r > 0.5, whereas only water and protein reached those values in the young group. Both groups overestimated total calories in kcal (+14.0%), grams of protein (+44.6%), and fats (+36.3%), and portions of fruits and vegetables (+16.0%) but strongly underestimated sugar intake (-50.9%). Conclusions: This DAT showed that all macronutrients and total energy intake were estimated more accurately by the older age group and therefore might be adequate to capture dietary habits in older Swiss adults.

BACKGROUND: Diets combining adequate nutritional quality and low climate impact are highly needed for human and planet health. OBJECTIVES: We aimed to 1) evaluate nutrient density indexes' ability to predict mortality, and 2) assess the effects of diets varying in nutrient density and climate impact on total mortality. METHODS: Dietary data from 49,124 women and 47,651 men aged 35-65 y in the population-based prospective study Västerbotten Intervention Programme (Sweden) were used. Greenhouse gas emissions (GHGEs) were estimated using data from life cycle assessments. Fifteen variants of nutrient density indexes were evaluated and the index that best predicted mortality was used to estimate participants' nutrient density. GHGEs and nutrient density were adjusted for energy intakes. Total mortality risk was estimated by Cox proportional hazards models for 4 groups of women and men, respectively, i.e., higher nutrient density, lower climate impact (HNutr/LClim); higher nutrient density, higher climate impact (HNutr/HClim); lower nutrient density, lower climate impact (LNutr/LClim); and lower nutrient density, higher climate impact (LNutr/HClim-reference group). RESULTS: NRF11.3, a Sweden-adapted variant of the Nutrient Rich Foods index, was identified to have the best ability to predict mortality in the study population. Median follow-up times for women and men were 16.0 and 14.7 y, respectively. For women a significantly lower mortality risk was found for HNutr/LClim (HR: 0.87; 95% CI: 0.79, 0.96; P = 0.008) and HNutr/HClim (HR: 0.87; 95% CI: 0.78, 0.97; P = 0.011) than for LNutr/HClim. Among men LNutr/LClim had a significantly higher mortality risk (HR: 1.10; 95% CI: 1.01, 1.21; P = 0.033) than LNutr/HClim. CONCLUSIONS: Diets beneficial for both health and climate are feasible and associated with lower mortality risk in women. Further studies are needed to understand how men may transition into diets that are more sustainable from a combined health and climate persp