Search

Objective:This study examined Na intake and identified the major food sources of Na in healthy Chinese adults aged ≥50 years in Hong Kong.Design:Participants who completed a baseline assessment of a randomised controlled trial assessing the effectiveness of exercise and nutrition supplementation on improving physical and cognitive functions were included. A single 24-h urine sample and a 3-d diet record were used to measure urinary Na excretion and dietary intake, respectively. The compliances to the WHO (Setting:Community facilities.Participants:Totally, 114 healthy Chinese adults (mean age 60·6 years, 55 % women).Results:The mean urinary Na excretion over 24-h was 2876·6 ± 1249·4 mg/d (7·3 ± 3·2 g salt/d). Overall, 22·8 % of participants met the WHO recommendation and 34·2 % met the Chinese Nutrition Society recommendation for salt intake. The major food sources of dietary Na intake were condiments (42·4 %), cereals and their products (16·8 %) and soups (13·5 %). Higher intakes of seafood and nuts were associated with lower urinary Na excretion.Conclusions:Public health strategies should target healthy Chinese adults in Hong Kong to modify the current patterns of Na intake. Targeting condiments, cereals and their products and soups will be an important strategy to reduce their Na intake.

Objective:The aim of the current study is to assess the validity and reproducibility of a FFQ focused on pregnant women living in Northeastern Brazil.Design:Three 24-hour-dietary recalls (24 hR) and two FFQ were applied at 15-d intervals between research stages in order to confirm the validity and reproducibility of the FFQ. Validity assessment was based on Pearson’s correlation coefficient (PCC) or Spearman’s correlation coefficient (SCC) between FFQ and the mean of three 24 hR (the 24 hR was used as reference standard), whereas reproducibility assessment was based on the intraclass correlation coefficient (ICC) among FFQ, and P < 0·05 was set as significance level.Setting:Public health network of a capital city in Northeastern Brazil.Participants:Overall, 100 pregnant women were included in the study.Results:The PCC or SCC adopted in the validity analysis recorded the recommended values (from 0·4 and 0·7) for energy (0·44; P < 0·001), carbohydrate (0·40; P < 0·001), vitamins B2 (0·40; P < 0·001), B5 (0·40; P < 0·001), E (0·47; P < 0·001), B12 (0·48; P < 0·001), phosphorus (0·92; P < 0·001), Mg (0·81; P < 0·001), Se (0·70; P < 0·001), cholesterol (0·64; P < 0·001), saturated (0·76; P < 0·001), polyunsaturated (0·73; P < 0·001) and monounsaturated fats (0·87; P < 0·001) and fibres (0·77; P < 0·001). Mg (0·72; P < 0·001), Fe (0·65; P < 0·001), lipid (0·56; P < 0·001) and energy (0·55; P < 0·001) presented ICC within the recommended reproducibility values.Conclusions:The FFQ developed in the current study is a useful tool to assess the usual food intake of pregnant women.

Objective:The present study aimed to estimate the consumption of Na and K and to assess salt-related knowledge, attitude and behaviour among adults in Addis Ababa, Ethiopia.Design:A community-based cross-sectional study was conducted. Estimates of Na and K intake were made using repeated multiple-pass 24-h dietary recall as well as using random urine. The usual intake of Na and K from the 24-h dietary recall was determined using the National Cancer Institute methodology. Estimated 24-h Na and K excretion was calculated using International Cooperative Study on Salt, Other Factors, and Blood Pressure and Tanaka formula.Settings:Addis Ababa, the capital city of Ethiopia.Participants:Individuals aged 20 years and above residing in the city.Result:The mean Na and K intake estimated using the diet recall data was 3·0 (0·9) g/d and 1·9 (0·6) g/d, respectively. Based on the urine analysis, the estimated mean Na and K intakes were 3·3 (0·7) g/d and 1·9 (0·4) g/d, respectively. Moreover, the analysis showed that the mean Na:K ratio was 2·5 (1·4). The daily intake of K was below the recommended amount for all study participants. More than 98 % and 90 % of participants had an excess intake of Na and Na:K ratio, respectively.Conclusion:We found a high prevalence of inadequate K intake as well as excess intake of Na resulting in an increased prevalence of excess Na:K ratio. Thus, interventions targeting to decrease Na intake and to increase K intake are needed.

Objective:To estimate the total energy and micronutrient intakes of children 9–24 months of age and evaluate the probability of adequacy (PA) of the diet in seven MAL-ED sites.Design:Cohort study. Food intake was registered monthly using 24-h recalls beginning at 9 months. We estimated PA for thirteen nutrients and overall mean PA (MPA) by site and 3-month periods considering estimated breast milk intake.Setting:Seven sites in Asia, Africa and Latin America.Participants:1669 children followed from birth to 24 months of age.Results:Median estimated %energy from breast milk ranged from 4 to 70 % at 9–12 months, and declined to 0–39 % at 21–24 months. Iron bioavailability was low for all sites, but many diets were of moderate bioavailability for zinc. PA was optimal for most nutrients in Brazil and South Africa, except for iron and vitamin E (both), calcium and zinc (South Africa). PA for zinc increased only for children consuming a diet with moderate bioavailability. MPA increased 12–24 months as the quantity of complementary foods increased; however, PA for vitamin A remained low in Bangladesh and Tanzania. PA for vitamins D and E and iron was low for most sites and age groups.Conclusions:MPA increased from 12 to 24 months as children consumed higher quantities of food, while nutrient density remained constant for most nutrients. Ways to increase the consumption of foods containing vitamins D, E and A, and calcium are needed, as are ways to increase the bioavailability of iron and zinc.

Objective: The aim of the current study was to evaluate the accuracy of the new software eAT24 used to assess dietary intake in the National Food, Nutrition and Physical Activity Survey (IAN-AF) against urinary biomarkers: N (nitrogen), K (potassium) and Na (sodium). Design: We conducted a cross-sectional study. Two non-consecutive 24-h dietary recalls (24-HDR) were applied, and a 24-h urine sample was collected. We examined differences between estimates from dietary and urine measures, Pearson correlation coefficients were calculated and the Bland-Altman plots were drawn. Multiple linear regression was used to evaluate the factors associated with the difference between estimates. Setting: Sub-sample from the Portuguese IAN-AF sampling frame. Participants: Ninety-five adults (men and women) aged 18-84 years. Results: The estimated intake calculated using the dietary recall data was lower than that estimated from urinary excretion for the three biomarkers studied (protein 94·3 v. 100·4 g/d, K 3212 v. 3416 mg/d and Na 3489 v. 4003 mg/d). Considering 2 d of recall, the deattenuated correlation coefficients were 0·33, 0·64 and 0·26 for protein, K and Na, respectively. For protein, differences between dietary and urinary estimates varied according to BMI (β = -1·96, P = 0·017). The energy intake and 24-h urine volume were significantly associated with the difference between estimates for protein (β = 0·03, P < 0·001 and β = -0·02, P = 0·002, respectively), K (β = 0·71, P < 0·001 and β = -0·42, P = 0·040, respectively) and Na (β = 1·55, P < 0·001 and β = -0·81, P = 0·011, respectively). Conclusions: The new software eAT24 performed well in estimating protein and K intakes, but lesser so in estimating Na intake, using two non-consecutive 24-HDR. The IAN-AF 2015–2016 was developed by a consortium: Carla Lopes, Andreia Oliveira, Milton Severo, Faculty of Medicine, University of Porto; Duarte Torres, Sara Rodrigues, Faculty of Nutrition and Food Sciences, University of Porto; Elisabete Ramos, Sofia Vilela, EPIUnit, Institute of Public Health, University of Porto; Sofia Guiomar, Luísa Oliveira, National Health Institute Doutor Ricardo Jorge; Violeta Alarcão, Paulo Nicola, Institute of Preventive Medicine and Public Health, Faculty of Medicine, University of Lisbon; Jorge Mota, CIAFEL, Faculty of Sports, University of Porto; Pedro Teixeira, Faculty of Human Kinetics, CIPER, University of Lisbon; Simão Soares, SilicoLife, Lda, Portugal; Lene Frost Andersen, Faculty of Medicine, University of Oslo. The current study had institutional support from the General Directorate of Health, the Regional Health Administration Departments, the Central Administration of the Health System and from the European Food Safety Authority (CFT/EFSA/DCM/2012/01-C03). The researchers acknowledge all these institutions and persons involved in all phases of the survey, as well as participants. Financial support: The current study has received funding from the EEA Grants Program, Public Health Initiatives (PT06 – 000088SI3). The EEA Grant Program had no role in the design, analysis or writing of the current article.

Objective:To examine whether skipping breakfast or lunch increased the next meal’s energy content and changed total daily energy content and the quality of food intake measured by the 2010 Healthy Eating Index (HEI-2010).Design:Means were compared across intake days and meal patterns. Multivariate individual fixed-effects model was used to account for individual food intake and diet quality preferences.Setting:National Health and Nutrition Examination Survey, 2007–2016.Participants:Adults aged 18 years or older who reported 2 d (24-h periods) of dietary intake and were not pregnant or lactating (n 23 488).Results:Adults consumed 193 more kJ at lunch after skipping breakfast and 783 more kJ at dinner after skipping breakfast and lunch. Skipping at least one meal reduced total daily intake between 1053 (breakfast) and 1464 (dinner) kJ and reduced the daily HEI score. Skipping breakfast or skipping lunch reduced the HEI component scores for fruit, whole grains, dairy and empty energy; skipping lunch reduced the component scores for fruit, vegetables, whole grain, dairy, seafood and plant protein, and empty energy. Skipping dinner reduced component scores for vegetables, greens and beans, dairy, protein food, seafood and plant proteins, and empty energy. Skipping one or more meals increased component scores for total vegetables (breakfast), whole grains (dinner), Na (lunch or dinner) and refined grains (breakfast, lunch or dinner).Conclusions:Skipping meals (particularly dinner) reduces daily energy intake, but the reduction in daily diet quality (particularly when skipping breakfast) may impact health negatively over time.

Objective:To identify differences in dietary quality, dietary greenhouse gas (GHG) emissions and food consumption over 20 years in a Dutch cohort.Design:Participants (n 8932) filled out an FFQ in 1993–1997 and in 2015. The Dutch Healthy Diet index 2015 (DHD15-index) score, GHG emissions and consumption of food groups (g/4184 kJ (1000 kcal)) were compared between the time points with paired t tests.Setting:The Netherlands.Participants:European Prospective Investigation into Cancer and Nutrition – Netherlands (EPIC-NL) cohort, aged 18–65 years at baseline.Results:Total energy intake decreased by –678 (95 % CI –4908, 3377) kJ/d (–162 (95 % CI –1173, 807) kcal/d) for men and –372 (95 % CI –3820, 3130) kJ/d (–89 (95 % CI –913, 748) kcal/d) for women. DHD15-index scores increased by 11 % (from 64·8 to 71·9 points) and 13 % (from 65·2 to 73·6 points) in men and women, respectively (P 2-eq/4184 kJ (1000 kcal), P 2-eq/4184 kJ (1000 kcal), P = 0·3930) due to the increased consumption of (shell)fish, nuts/seeds/nut paste, poultry and higher GHG-intensive red meats such as beef.Conclusions:This Dutch cohort analyses showed more healthy diets without mitigated GHG emissions over a 20-year period, at similar energy intakes. Higher consumption of (shell)fish and poultry was not yet at the expense of red and processed meat. Lower consumption of animal-based foods is needed to achieve healthier as well as environmentally friendly diets.

ObjectiveTo investigate trends in total fat and fatty acid intakes and chronic health conditions among Korean adults over nine years between 2007 and 2015.DesignCross-sectional, observational study using a stratified, multistage probability sampling design at a national level. Intakes of total fat and fatty acids were estimated from 24 h dietary recalls by sex and age groups. Trends of total fat and fatty acid intakes were determined by multiple linear regression after adjusting for covariates. Trends in age-standardized prevalence of obesity, hypercholesterolaemia and hypertriacylglycerolaemia were examined by sex.SettingKorea.ParticipantsPopulation data of 47749 healthy adults (aged ≥19 years) derived from the Korea National Health and Nutrition Examination Survey between 2007 and 2015.ResultsOver the survey period, daily intakes of energy and total, saturated, monounsaturated, polyunsaturated, n-3 and n-6 fats (grams and percentage of energy (%E)) increased steadily. In all sex and age groups, significant increases were seen in SFA intake from 9·9 g (4·7 %E) to 12·0 g (5·3 %E) and in MUFA intake from 9·9 g (4·6 %E) to 13·3 g (5·8 %E). The prevalence of hypercholesterolaemia increased from 10·7 to 17·9 % over the same period.ConclusionsIn Korean adults, total fat, SFA and other fatty acids have been increasing along with the prevalence of hypercholesterolaemia. This information can help set adequate macronutrient and fatty acid distribution ranges in developing population-specific preventive strategies against diet-related illness.

ObjectiveTo compare the contributions of UVB exposure and diet to total vitamin D among Asians living in Kuala Lumpur (KL) and Aberdeen (AB).DesignLongitudinal study.SettingUVB exposure (using polysulfone film badges) and skin colour and dietary vitamin D intake (by web-based questionnaire) were measured at each season in AB and during south-west (SWM) and north-east monsoons (NEM) in KL.SubjectsOne hundred and fifteen Asians in KL and eighty-five Asians in AB aged 20–50 years.ResultsMedian summer UVB exposure of Asians in AB (0·25 SED/d) was higher than UVB exposure for the KL participants (SWM=0·20 SED/d, P=0·02; NEM= 0·14 SED/d, PPP=0·04; NEM=5·35 µg/d (214 IU/d), PP=0·78).ConclusionsUVB exposure among Asians in their home country is low. For Asians residing at the northerly latitude of Scotland, acquiring vitamin D needs from UVB exposure alone (except in summer) may be challenging due to low ambient UVB in AB (available only from April to October).

Objective For dietary assessment, mobile devices with a camera can be used as an alternative to hand-written paper records. The Nutritional Tracking Information Smartphone (Nutris-Phone) study aimed to examine relative validity and feasibility of a photo-based dietary record in everyday life. Design Parallel to the photo-based technique, a weighed record was performed. Participant satisfaction was assessed by questionnaire. A trained nutrition scientist evaluated portion sizes and nutrient content was calculated (DGExpert). Spearman correlation and Bland–Altman analyses were applied. Setting Healthy, non-pregnant volunteers (≥18 years) without intent to lose weight recruited at Ulm University, Germany. Subjects Sixty-six participants (36 % males, median age 22·0 (interquartile range 20·0–25·0) years) took pictures of foods and beverages consumed with a commercially available mobile phone. Results Significant correlation between the photo-based and weighed record was observed: energy (r=0·991), carbohydrate (r=0·980), fat (r=0·972), protein (r=0·988), fibre (r=0·941). Bland–Altman analyses indicated comparable means and acceptable 95 % limits of agreement (energy: −345·2 to 302·9 kJ (−82·5 to 72·4 kcal); carbohydrate: −15·2 to 13·1 g; fat: −6·4 to 6·4 g; protein: −5·9 to 5·6 g; fibre: −2·7 to 2·5 g). However, with increasing intake level, underestimation by the digital method was present (except for fat, all P Conclusions Compared with a weighed record, the photo-based dietary record seems to be valid, feasible and user-friendly to estimate energy, macronutrient and fibre intakes, although a systematic bias with increasing levels of intake should be kept in mind.

ObjectiveConcerns have been raised about the potential health impact of ultra-processed foods (UPF) in the diet. Our objective was to investigate the contribution of UPF in the diet in a large French population and its association with sociodemographic factors and dietary patterns.DesignCross-sectional analysis of dietary data from 74 470 participants in the web-based NutriNet-Santé cohort. UPF were identified in repeated 24 h records and the proportion (in weight) of UPF in the total diet (UPFp) was computed for each participant. Associations of sociodemographic characteristics and UPFp in quartiles were assessed using multivariate multinomial logistic regression. Food group consumption and nutrient intakes across quartiles of UPFp were estimated using linear regression adjusted for sociodemographic factors and energy intake.SettingFrance.ResultsUPF contributed 18·4 % of the foods consumed in weight and 35·9 % of total energy intake. Higher UPFp consumption was independently associated with male gender, younger age, lower education, smoking, and overweight and obesity (all PPPConclusionsUPF represent an important part of the diet in adults from the French general population and are associated with unbalanced nutritional intakes.

Objective:Ready-to-eat (RTE) cereal is an important source of nutrients in the American diet. Recent regulatory changes to labelling requirements may impact the fortification of RTE cereal. We used an evidence-based approach to optimize the fortification of RTE cereal considering current dietary patterns and nutrition policy.Design:A US modelling study of cross-sectional data from the National Health and Nutrition Examination Survey (NHANES) 2013–2014. The percentage of the population below the Estimated Average Requirement (EAR) and above the Upper Tolerable Intake Level (UL) was modelled under three scenarios: baseline, zero fortification and optimized fortification.Setting:USA.Participants:Toddlers aged 1–3 years, n 559; children aged 4–12 years, n 1540; adolescents aged 13–18 years, n 992; and adults aged ≥19 years, n 576.Results:Comparing current with optimized fortification, nutrient/100 g RTE cereal decreased for vitamin A, thiamin, riboflavin, niacin, vitamin B6, folic acid, vitamin B12, Ca and Fe (by 2–82 %). The amount of vitamins C and D increased (by 13 and 50 %, respectively). Among RTE cereal eaters, these changes resulted in modest increases in the percentage of the population aged ≥1 year below the EAR (+0·5 to +11·5 percentage points). Decreases were observed in the percentage of the population above the UL.Conclusions:Fortification of RTE cereal can be optimized to provide key nutrients and minimize the percentage of the population below the EAR and above the UL. Dietary intake modelling is useful to ensure that RTE cereal continues to help the population meet their nutrient needs.

ObjectiveTo determine the effects of increasing plant-based foods v. dairy foods on energy and nutrients of concern in adolescent females via diet modelling exercises.DesignData from the National Health and Nutrition Examination Survey (NHANES) were used to compare nutrient intakes from usual diet with those from three dietary scenarios that increased current intakes by 100 % of the following: (i) plant-based foods; (ii) protein-rich plant-based foods; and (iii) milk, cheese and yoghurt. The first two scenarios had commensurate reductions in animal products.SettingWhat We Eat in America, NHANES 2007–2010.SubjectsFemale adolescents (n 1594) aged 9–18 years.ResultsWhen currently consumed plant-based foods were increased by 100 %, there were increases in dietary fibre, added sugar, vitamin E, Fe and folate intakes. These increases were accompanied by decreases in total fat, saturated fat, Zn, vitamin D, Ca and protein intakes. Protein-rich plant foods are consumed in very low quantities in this population such that doubling their intake resulted in no real nutritional impact. When dairy products were increased by 100 % there were increases in intakes of vitamin D, Mg, Zn, Ca, K, energy, saturated fat and protein.ConclusionsNon-specific recommendations to increase plant foods can lead to unintended nutritional consequences. For adolescent girls, meeting the dietary recommendation of three daily servings of dairy improved the intake of the identified nutrients of concern while simultaneously providing adequate nutrients essential for proper growth and bone health critical during the adolescent phase.

ObjectiveTo determine if 7 d physical activity (PA) predicts energy intake over the same days and if PA on a given day predicts energy intake on the same day, the next day or subsequent days.DesignA 7 d prospective investigation. PA was measured using accelerometers worn for seven consecutive days. During the same week, total energy intake (including alcohol) was assessed using weighed food records.SettingTwenty cities in the USA.SubjectsThree hundred middle-aged women.ResultsAfter controlling for the covariates, energy intake was 36 (se8) kJ higher for each additional 100000 activity counts (F=19·0,Pn75) had a mean energy intake of 8364 (sd1235) kJ/d (1998 (sd295) kcal/d), those with Moderate PA (n150) consumed 8523 (sd1264) kJ/d (2036 (sd302) kcal/d) and those with High PA (n75) consumed 9079 (sd1473) kJ/d (2169 (sd352) kcal/d;F=6·4,P=0·0019), a 5023 kJ/d (1200 kcal/d) difference between the High and Low PA groups. PA on a given day was predictive of energy consumption on the same day on four of the seven monitored days, and was predictive of energy intake the next day, with five of six associations significant. PA was not consistently predictive of energy intake on days beyond the next day.ConclusionsOver 7 d, PA and energy consumption tend to be positively related. Considered day to day, increased PA is weakly associated with increased energy intake the following day and, to a lesser extent, the same day. Therefore, managing weight by increasing PA may not result in the energy deficit expected.

ObjectiveTo identify dietary patterns in the current Japanese diet and evaluate the associations between these patterns and Na and K intakes.DesignDietary patterns were extracted by factor analysis from the intakes of food groups assessed with a validated self-administrated diet history questionnaire. Na and K intakes and urinary Na:K were assessed by repeated 24 h urine collection.SubjectsHealthy Japanese adults aged 20–69 years (353 men and 349 women).SettingTwenty study areas in twenty-three prefectures in Japan.ResultFour dietary patterns were identified in each sex. After adjustment for several confounding factors, the ‘Fish and vegetable’ pattern was associated with higher urinary Na excretion, but the association was not significant (P=0·37 in men and P=0·06 in women). This pattern was also associated with higher K excretion in both sexes. The ‘Noodle’ pattern tended to be associated with higher urinary Na excretion (P=0·17 in men and P=0·04 in women) and higher Na:K (P=0·02 in men). The ‘Meat, vegetable and oil’ (in men)/‘Meat and oil’ (in women) and ‘Bread and confectioneries’ patterns were not associated with urinary Na excretion (in men) or were negatively associated (in women).ConclusionsContrary to the case in Western countries, the ‘Fish and vegetable’ and ‘Noodle’ patterns contributed to higher Na intake in Japan. Target foods for salt reduction should be set based on careful consideration of the relationships between dietary patterns and Na and K intakes in the target population.

ObjectiveTo assess salt intake and its dietary sources using biochemical and self-report methods and to characterize salt intake according to sociodemographic and disease-related variables in a sample of the Brazilian population.DesignPopulation-based cross-sectional survey.SettingSalt intake was assessed by biochemical (24 h urinary Na excretion) and self-report methods (sodium FFQ, 24 h dietary recall, seasoned-salt questionnaire, discretionary-salt questionnaire and total reported salt intake).ParticipantsAdults and older people (n 517) aged 20–80 years, living in Artur Nogueira, São Paulo, Brazil.ResultsMean salt intake based on 24 h urinary Na excretion and total reported salt intake was 10·5 and 11·0 g/d, respectively; both measures were significantly correlated. Discretionary salt and seasoned salt were the most important sources of salt intake (68·2 %). Men in the study consumed more salt than women as estimated by 24 h urinary Na excretion (11·7 v. 9·6 g salt/d; PConclusionsSalt intake in this population was well above the recommended amount. The main source of salt intake came from salt added during cooking. Salt intake varied according to sex and waist circumference.

ObjectiveTo simulate impact of Ca supplementation on estimated total Ca intakes among women in a population with low dietary Ca intakes, using WHO recommendations: 1·5–2·0 g elemental Ca/d during pregnancy to prevent pre-eclampsia.DesignSingle cross-sectional 24 h dietary recall data were adjusted using IMAPP software to simulate proportions of women who would meet or exceed the Estimated Average Requirement (EAR) and Tolerable Upper Intake Level (UL) assuming full or partial adherence to WHO guidelines.SettingNationally and regionally representative data, Ethiopia’s ‘lean’ season 2011.SubjectsWomen 15–45 years (n 7908, of whom 492 pregnant).ResultsNational mean usual Ca intake was 501 (sd 244) mg/d. Approximately 89, 91 and 96 % of all women, pregnant women and 15–18 years, respectively, had dietary Ca intakes below the EAR. Simulating 100 % adherence to 1·0, 1·5 and 2·0 g/d estimated nearly all women (>99 %) would meet the EAR, regardless of dosage. Nationally, supplementation with 1·5 and 2·0 g/d would result in intake exceeding the UL in 3·7 and 43·2 % of women, respectively, while at 1·0 g/d those exceeding the UL would be ConclusionsMost Ethiopian women consume insufficient Ca, increasing risk of pre-eclampsia. Providing Ca supplements of 1·5–2·0 g/d could result in high proportions of women exceeding the UL, while universal consumption of 1·0 g/d would meet requirements with minimal risk of excess. Appropriately tested screening tools could identify and reduce risk to high Ca consumers. Research on minimum effective Ca supplementation to prevent pre-eclampsia is also needed to determine whether lower doses could be recommended.

ObjectiveWe sought to assess the universal salt iodization (USI) strategy in Armenia by characterizing dietary iodine intake from naturally occurring iodine, salt-derived iodine in processed foods and salt-derived iodine in household-prepared foods.DesignUsing a cross-sectional cluster survey model, we collected urine samples which were analysed for iodine and sodium concentrations (UIC and UNaC) and household salt samples which were analysed for iodine concentration (SI). SI and UNaC data were used as explanatory variables in multiple linear regression analyses with UIC as dependent variable, and the regression parameters were used to estimate the iodine intake sources attributable to native iodine and iodine from salt in processed foods and household salt.SettingArmenia is naturally iodine deficient; in 2004, the government mandated a USI strategy.SubjectsWe recruited school-age children (SAC), pregnant women (PW) and non-pregnant women of reproductive age (WRA).ResultsFrom thirteen sites covering all provinces, sufficient urine and table salt samples were obtained from 312 SAC, 311 PW and 332 WRA. Findings revealed significant differences between groups: contribution of native iodine ranged from 81% in PW to 46% in SAC, while household salt-derived iodine contributed from 19% in SAC to 1% in PW.ConclusionsDifferences between groups may reflect differences in diet. In all groups, household and processed food salt constituted a significant part of total iodine intake, highlighting the success and importance of USI in ensuring iodine sufficiency. There appears to be leeway to reduce salt intake without adversely affecting the iodine status of the population in Armenia.

ObjectiveTo evaluate the nutritional quality, particularly the fat and salt contents, of meals offered to children (kids’ meals) at chain restaurants in Japan.DesignA web-based content analysis was conducted to evaluate the type of restaurant, type of meal, incentives, health claims and nutrition data of kids’ meals. The nutritional appropriateness of kids’ meals was assessed with the Standard for the School Lunch Program, which regulates energy (≤2218 kJ), protein (20–30 g), fat (≤30 % of energy (E%)) and salt (SettingRestaurant websites providing nutritional data of kids’ meals in Japan.SubjectsA total of 438 kids’ meals offered by forty-two chain restaurant brands from across twenty food-service companies.ResultsOverall, 58·9, 40·6 and 34·5 % of the kids’ meals were determined to be appropriate regarding their energy (≤2218 kJ), fat (≤30 E%) and salt content (β=−6·2; 95 % CI −11·0, −1·4) and an increase in the salt content (β=0·7; 95 % CI 0·06, 1·3).ConclusionsThe characteristics of the restaurant-served kids’ meals in Japan were high fat E% and high salt content from different cultural contexts of the Western and the Japanese diet.

ObjectivePortion sizes and bowl sizes may be related to food intake and perceived fullness. The objective of the present study was to investigate the effects of portion size and bowl size and possible interactions between these variables on food intake and fullness in a sample of Japanese men.DesignParticipants ate four different experimental meals across four weeks and completed questionnaires about their fullness using a visual analogue scale administered before and after meals. The four meal patterns included consistent portions of several foods commonly eaten together in typical Japanese meals, along with 150 g of rice served in a small rice bowl (diameter of 11·5 cm), 150 g of rice served in a large rice bowl (diameter of 13·5 cm), 250 g of rice served in a small rice bowl or 250 g of rice served in a large rice bowl.SettingTokyo.SubjectTwenty-one adult men participated in the study.ResultsPortion size had a significant main effect on rice intake (F(1,20)=83, PF(1,20)=8·0, P=0·010), but no significant effects of bowl size on the outcome variables were found. The interactions between portion size and bowl size on intake and fullness were not significant.ConclusionsThe sample of Japanese men showed an influence of portion size on food intake. Further research is needed to clarify the combined effects of bowl size and portion size on intake and fullness.

ObjectiveNutrient and food standards exist for school lunches in English primary schools although packed lunches brought from home are not regulated. The aim of the present study was to determine nutritional and dietary differences by lunch type.DesignA cross-sectional survey was carried out in 2007 assessing diet using the Child and Diet Evaluation Tool (CADET), a validated 24 h estimated food diary. The data were analysed to determine nutritional and dietary intakes over the whole day by school meal type: school meals and packed lunches.SettingFifty-four primary schools across England.SubjectsChildren (n 2709) aged 6–8 years.ResultsChildren having a packed lunch consumed on average 11·0 g more total sugars (95 % CI 6·6, 15·3 g) and 101 mg more Na (95 % CI 29, 173 mg) over the whole day. Conversely, children having a school meal consumed, on average, 4·0 g more protein (95 % CI 2·3, 5·7 g), 0·9 g more fibre (NSP; 95 % CI 0·5, 1·3 g) and 0·4 mg more Zn (95 % CI 0·1, 0·6 mg). There was no difference in daily energy intake by lunch type. Children having a packed lunch were more likely to consume snacks and sweetened drinks; while children having a school meal were more likely to consume different types of vegetables and drink water over the whole day.ConclusionsCompared with children having a school meal, children taking a packed lunch to school consumed a lower-quality diet over the whole day, including higher levels of sugar and Na and fewer vegetables. These findings support the introduction of policies that increase school meal uptake.

ObjectiveThe main objectives were to assess the adequacy of the micronutrient intakes of lactating women in a peri-urban area in Nepal and to describe the relationships between micronutrient intake adequacy, dietary diversity and sociodemographic variables.DesignA cross-sectional survey was performed during 2008–2009. We used 24 h dietary recall to assess dietary intake on three non-consecutive days and calculated the probability of adequacy (PA) of the usual intake of eleven micronutrients and the overall mean probability of adequacy (MPA). A mean dietary diversity score (MDDS) was calculated of eight food groups averaged over 3 d. Multiple linear regression was used to identify the determinants of the MPA.SettingBhaktapur municipality, Nepal.SubjectsLactating women (n 500), 17–44 years old, randomly selected.ResultsThe mean usual energy intake was 8464 (sd 1305) kJ/d (2023 (sd 312) kcal/d), while the percentage of energy from protein, fat and carbohydrates was 11 %, 13 % and 76 %, respectively. The mean usual micronutrient intakes were below the estimated average requirements for all micronutrients, with the exception of vitamin C and Zn. The MPA across eleven micronutrients was 0·19 (sd 0·16). The diet was found to be monotonous (MDDS was 3·9 (sd 1·0)) and rice contributed to about 60 % of the energy intake. The multiple regression analyses showed that MPA was positively associated with energy intake, dietary diversity, women’s educational level and socio-economic status, and was higher in the winter.ConclusionsThe low micronutrient intakes are probably explained by low dietary diversity and a low intake of micronutrient-rich foods.

ObjectiveThe study objective was to determine the relative validity and reproducibility of a modified FFQ for ranking the nutrient intakes of New Zealand toddlers aged 12–24 months.DesignCross-sectional study.SettingDunedin, New Zealand.SubjectsOne hundred and fifty-two participants completed a ninety-five-item FFQ twice, and five days of weighed diet recording (WDR), over one month. Validity and reproducibility were assessed for crude data and for data that were weighted for total fruit and vegetable intake (FV-adjusted).ResultsDe-attenuated correlations between FV-adjusted FFQ data and WDR data ranged from 0·45 (Zn) to 0·77 (Ca). The percentage classified to the correct WDR quartile by the FV-adjusted FFQ data ranged from 34·6 % (total fat, Zn) to 50·3 % (Fe). Average gross misclassification was 3 %. Bland–Altman statistics showed crude data had a range of 128–178 % agreement with the WDR and mean FV-adjusted intakes had 112–160 % agreement. FV-adjusted intra-class correlations, assessing reproducibility, ranged from 0·65 (vitamin C) to 0·75 (Ca).ConclusionsThe Eating Assessment in Toddlers (EAT) FFQ showed acceptable to good relative validity, and good reproducibility, for ranking participants’ nutrient intake and is able to identify toddlers at extremes of the nutrient intake distribution. It will be a useful tool for investigating toddlers’ nutrient intakes in studies that require a method of dietary assessment with low respondent burden.

ObjectiveTo explore the association between diet and socio-economic position for 2007–2009 and investigate trends in socio-economic inequalities in the Scottish diet between 2001 and 2009.DesignUK food purchase data (collected annually from 2001 to 2009) were used to estimate household-level consumption data. Population mean food consumption, nutrient intakes and energy density were estimated by quintiles of an area-based index of multiple deprivation. Food and nutrient intakes estimated were those targeted for change in Scotland and others indicative of diet quality. The slope and relative indices of inequality were used to assess trends in inequalities in consumption over time.SettingScotland.SubjectsScottish households (n 5020).ResultsDaily consumption of fruit and vegetables (200 g, 348 g), brown/wholemeal bread (17 g, 26·5 g), breakfast cereals (16 g, 27 g) and oil-rich (21 g, 40 g) and white fish (77 g, 112 g) were lowest, and that of total bread highest (105 g, 91·5 g) in the most deprived compared with the least deprived households, respectively, for the period 2007–2009. With regard to nutrients, there was no association between deprivation and the percentage of food energy from total fat and saturated fat; however, non-milk extrinsic sugar intakes (15·5 %, 14·3 %) and energy density (741 kJ/100 g, 701 kJ/100 g) were significantly higher in the most deprived households. The slope and relative indices of inequality showed that inequalities in intakes between 2001 and 2009 have changed very little.ConclusionsThere was no evidence to suggest that the difference in targeted food and nutrient intakes between the least and most deprived has decreased compared with previous years.

ObjectiveThe present study aimed to examine the effectiveness of two different implementation forms of the EU School Fruit and Vegetable Scheme (SFVS).DesignA quasi-experimental design was applied including a thrice as well as a twice weekly intervention group. Repeated 24 h dietary recalls were used to measure children’s fruit and vegetable (F&V) intake. Effects were analysed on days with and without F&V deliveries using hierarchical linear regression models.SettingTwelve primary schools in North Rhine-Westphalia, Germany.SubjectsThird and fourth graders (n 664).ResultsAverage daily F&V intake at pre-intervention was 0·84 frequencies in the thrice weekly intervention group, 0·90 frequencies in the twice weekly intervention group and 1·25 frequencies in the control group. Providing children thrice weekly with F&V increased children’s F&V intake on average by 0·96 (PPPPPPConclusionsThe SFVS with thrice or twice weekly deliveries of F&V led to a significant increase in children’s F&V intake on days with and without deliveries. The latter might provide an indication of positive long-term effects of the scheme. The scheme shows equal efficiency for almost all subgroups.

ObjectiveEpidemiological studies suggest that green leafy vegetables, which are high in dietary nitrate, are protective against CVD such as stroke. High blood pressure (BP) is a major risk factor for stroke and inorganic nitrate has been shown to reduce BP. The objective of the present study was to test the hypothesis that diets containing high-nitrate (HN) vegetables would increase plasma nitrate and nitrite concentrations and reduce BP in healthy women.DesignA randomized, crossover trial, where participants received HN vegetables (HN diet) or avoided HN vegetables (Control diet) for 1 week. Before and after each intervention, resting BP and plasma nitrate and nitrite concentrations were measured.SettingUniversity of Exeter, UK.SubjectsNineteen healthy women (mean age 20 (sd2) years; mean BMI 22·5 (sd3·8) kg/m2).ResultsThe HN diet significantly increased plasma nitrate concentration (before HN diet: mean 24·4 (sd5·6) µmol/l; after HN diet: mean 61·0 (sd44·1) µmol/l,Psd91) nmol/l; after HN diet: mean 185 (sd34) nmol/l,Psd9) mmHg; after HN diet: mean 103 (sd6) mmHg,Psd8) mmHg; after Control diet: mean 106 (sd8) mmHg).ConclusionsConsumption of HN vegetables significantly increased plasma nitrate and nitrite concentrations and reduced BP in normotensive women.

ObjectiveTo examine dietary Na and K intake at eating occasions in Australian adults and identify the contribution of major food sources to Na and K at different eating occasions.DesignSecondary analysis of 24 h recall diet data from the Australian Health Survey (2011–2013).SettingNationally representative survey in Australia.SubjectsMale and female Australians aged 18–84 years (n7818).ResultsDinner contributed the greatest proportion to total daily Na intake (33 %) and K intake (35 %). Na density was highest at lunch (380 mg/MJ) and K density highest at between-meal time eating occasions (401 mg/MJ). Between-meal time eating occasions provided 20 % of daily Na intake and 26 % of daily K intake. The major food group sources of Na were different at meal times (breads and mixed dishes) compared with between-meal times (cakes, muffins, scones, cake-type desserts). The top food group sources of K at meal times were potatoes and unprocessed meat products and dishes.ConclusionsFoods which contributed to Na and K intake differed according to eating occasion. Major food sources of Na were bread and processed foods. Major food sources of K were potatoes and meat products and dishes. Public health messages that emphasise meal-based advice and diet patterns high in vegetables, fruits and unprocessed foods may also aid reduction in dietary Na intake and increase in dietary K intake.

ObjectiveWestern studies have suggested cultural differences in food and nutrient intake patterns associated with dietary glycaemic index (GI) and glycaemic load (GL). Here, we conducted a cross-sectional study to examine the GI and GL of Japanese diets in relation to food and nutrient intakes.DesignDietary intake was assessed using a validated, self-administered, diet history questionnaire.SettingA total of thirty-five of forty-seven prefectures in Japan.SubjectsYoung (age 18 years), middle-aged (mean age 48 years) and older (mean age 74 years) Japanese women (n 3961, 3800 and 2202, respectively).ResultsIrrespective of age, a positive association with dietary GI was seen for white rice only, which contributed most (37–42 %) to the variation in dietary GI. Conversely, all other food groups (such as fruit and vegetable juice, dairy products, noodles and fruit) were negative predictors of dietary GI. For dietary GL, 95–96 % of variation was explained by carbohydrate-rich food groups, all of which were positive predictors of GL. After adjustment for potential confounding factors, only carbohydrate intake was positively associated with dietary GI and GL, irrespective of age. Conversely, dietary GI and GL were inversely associated with intakes of all other nutrients examined (including SFA and Na).ConclusionsA low-GI and -GL diet, which was characterized principally by a low intake of white rice, was associated with both favourable (higher intakes of dietary fibre and key vitamins and minerals) and unfavourable (higher intakes of SFA and Na) aspects of dietary intake patterns in three generations of Japanese women.

ObjectiveTo quantify the association of dietary quality with prospective changes in adiposity.DesignChildren participating in the QUALITY (QUebec Adipose and Lifestyle InvesTigation in Youth) study underwent examination at baseline and at 2-year follow-up. Dietary quality was assessed by the Diet Quality Index–International (DQII) using three non-consecutive 24 h diet recalls at baseline. The DQII has four main categories: dietary adequacy, variety, moderation and overall balance. Fat mass index (FMI; [fat mass (kg)]/[height (m)]2), central FMI (CFMI; [trunk fat mass (kg)]/[height (m)]2), percentage body fat (%BF; [total fat mass (kg)]/[total mass (kg)]) and percentage central BF (%CBF; [trunk fat mass (kg)]/[total mass (kg)]) were assessed through dual-energy X-ray absorptiometry.SettingChildren were selected from schools in the greater Montreal, Sherbrooke and Quebec City metropolitan areas between 2005 and 2008, Quebec, Canada.SubjectsA total of 546 children aged 8–10 years, including 244 girls and 302 boys.ResultsRegression analysis adjusting for age, sex, energy intake, physical activity and Tanner stage revealed that every 10-unit improvement in overall DQII score was associated with lower gain in CFMI (β=−0·08; 95 % CI −0·17, −0·003) and %BF (β=−0·55; 95 % CI −1·08, −0·02). Each unit improvement in dietary adequacy score was associated with lower gain in FMI (β=−0·05; 95 % CI −0·08, −0·008), CFMI (β=−0·03; 95 % CI −0·05, −0·007), %BF (β=−0·15; 95 % CI −0·28, −0·03) and %CBF (β=−0·09; 95 % CI −0·15, −0·02).ConclusionsPromotion of dietary quality and adequacy may reduce weight gain in childhood and prevent chronic diseases later in life.

ObjectiveTo characterize energy and macronutrient intakes in Brazil and to describe the top food items contributing to energy and macronutrient intakes.DesignTwo non-consecutive 24 h dietary records were collected and energy and macronutrient data were adjusted for usual intake distribution. Descriptive statistics and ANOVA with the Bonferroni post hoc test were analysed using SAS version 9·1. Means and standard deviations were estimated for sex, age and income strata.SettingNationwide cross-sectional survey, 2008–2009.SubjectsNationally representative sample of individuals ≥10 years old (n32 749), excluding pregnant and lactating women (n 1254).ResultsThe average energy intake was 7958 kJ/d (1902 kcal/d) and mean energy density was 6·82 kJ/g (1·63 kcal/g). Added sugar represented 13 % of total energy intake and animal protein represented 10 %. The mean contribution of total fat to energy intake was 27 %, while the mean saturated fat contribution was 9 %. Compared with the lowest quartile of income, individuals in the highest income quartile had greater mean intakes of energy, added sugar, alcohol, animal protein, total fat, saturated fat, monounsaturated fat and trans fat. Rice, beans, beef, bread and coffee were among the top five foods contributing most to the intakes of energy, carbohydrates, protein, fat and fibre.ConclusionsIn general, Brazilians’ dietary intake is compatible with a high risk of obesity and non-communicable chronic diseases, being characterized by high intakes of added sugar and saturated fat. Income may be a major determinant of diet nutritional characteristics.