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Objective: This study investigated associations between types and food sources of protein with overweight/obesity and underweight in Ethiopia.Design: We conducted a cross-sectional dietary survey using a non-quantitative FFQ. Linear regression models were used to assess associations between percentage energy intake from total, animal and plant protein and BMI. Logistic regression models were used to examine the associations of percentage energy intake from total, animal and plant protein and specific protein food sources with underweight and overweight/obesity.Setting: Addis Ababa, Ethiopia.Participants: 1624 Ethiopian adults (992 women and 632 men) aged 18-49 years in selected households sampled using multi-stage random sampling from five sub-cities of Addis Ababa.Results: Of the surveyed adults, 31 % were overweight or obese. The majority of energy intake was from carbohydrate with only 3 % from animal protein. In multivariable-adjusted linear models, BMI was not associated with percentage energy from total, plant or animal protein. Total and animal protein intake were both associated with lower odds of overweight/obesity (OR per 1 % energy increment of total protein 0·92; 95 % CI: 0·86, 0·99; P = 0·02; OR per 1 % energy increment of animal protein 0·89; 95 % CI: 0·82, 0·96; P = 0·004) when substituted for carbohydrate and adjusted for socio-demographic covariates.Conclusion: Increasing proportion of energy intake from total protein or animal protein in place of carbohydrate could be a strategy to address overweight and obesity in Addis Ababa; longitudinal studies are needed to further examine this potential association. [ABSTRACT FROM AUTHOR]

Objective: About one-third of under-five Filipino children are stunted, with significant socio-economic inequality. This study aims to quantify factors that explain the large gap in stunting between poor and non-poor Filipino children.Design: Using the 2015 Philippine National Nutrition Survey, we conducted a linear probability model to examine the determinants of child stunting and then an Oaxaca-Blinder decomposition to explain the factors contributing to the gap in stunting between poor and non-poor children.Setting: Philippines.Participants: 1881 children aged 6-23 months participated in this study.Results: The overall stunting prevalence was 38·5 % with a significant gap between poor and non-poor (45·0 % v. 32·0 %). Maternal height, education and maternal nutrition status account for 26 %, 18 % and 17 % of stunting inequality, respectively. These are followed by quality of prenatal care (12 %), dietary diversity (12 %) and iron supplementation in children (5 %).Conclusions: Maternal factors account for more than 50 % of the gap in child stunting in the Philippines. This signifies the critical role of maternal biological and socio-economic circumstances in improving the linear growth of children. [ABSTRACT FROM AUTHOR]

Objective: Limiting SFA intake may minimise the risk of CHD. However, such reduction often leads to increased intake of carbohydrates. We aimed to evaluate associations and the interplay of carbohydrate and SFA intake on CHD risk.Design: Prospective cohort study.Setting: We followed participants in the Hordaland Health Study, Norway from 1997-1999 through 2009. Information on carbohydrate and SFA intake was obtained from a FFQ and analysed as continuous and categorical (quartiles) variables. Multivariable Cox regression estimated hazard ratios (HR) and 95 % CI. Theoretical substitution analyses modelled the substitution of carbohydrates with other nutrients. CHD was defined as fatal or non-fatal CHD (ICD9 codes 410-414 and ICD10 codes I20-I25).Participants: 2995 men and women, aged 46-49 years.Results: Adjusting for age, sex, energy intake, physical activity and smoking, SFA was associated with lower risk (HRQ4 v. Q1 0·44, 95 % CI 0·26, 0·76, Ptrend = 0·002). For carbohydrates, the opposite pattern was observed (HRQ4 v. Q1 2·10, 95 % CI 1·22, 3·63, Ptrend = 0·003). SFA from cheese was associated with lower CHD risk (HRQ4 v. Q1 0·44, 95 % CI 0·24, 0·83, Ptrend = 0·006), while there were no associations between SFA from other food items and CHD. A 5 E% substitution of carbohydrates with total fat, but not SFA, was associated with lower CHD risk (HR 0·75, 95 % CI 0·62, 0·90).Conclusions: Higher intake of predominantly high glycaemic carbohydrates and lower intake of SFA, specifically lower intake from cheese, were associated with higher CHD risk. Substituting carbohydrates with total fat, but not SFA, was associated with significantly lower risk of CHD. [ABSTRACT FROM AUTHOR]

Objective: The Democratic Republic of the Congo (DRC) has one of the highest levels of child undernutrition globally; however, little information exists on the underlying socio-economic inequalities resulting in undernutrition. This study aims to examine the differences in the nutritional statuses of children across different wealth quintiles and explores the association between malnutrition in children and related factors.Design: We utilised the 2018 Multiple Indicator Cluster Survey data. We estimated the prevalence of malnutrition across all twenty-six provinces. The study used the WHO 2006 child growth standards to measure stunting, underweight and wasting. We employed a mixed-effect linear model to analyse the association between nutritional status and healthcare accessibility, domestic sanitation, and socio-demographic factors.Setting: Twenty-six provinces in the DRC.Participants: 21 477 children under 5 years of age and 21 828 women of childbearing age in the DRC.Results: The national prevalence of underweight, stunting and wasting was found to be 23·33 %, 42·05 % and 5·66 %, respectively. Household wealth and mother's education level were significantly positively associated with the nutritional statuses of children. Among households in the lowest wealth quintile, residence in urban areas was a protective factor against undernutrition.Conclusion: The findings of this study indicate considerable socio-economic inequalities in the nutritional statuses of children under 5 years of age in the DRC, highlighting the need for nutrition promotion as part of maternal and child healthcare. Interventions and policies should include improving nutrition education for less-educated mothers, in particular, in the central provinces of the DRC. [ABSTRACT FROM AUTHOR]

Objective: The US Dietary Guidelines for Americans recommends increased consumption of the dairy group to three daily servings for ages 9+ years to help achieve adequate intakes of prominent shortfall nutrients. Identifying affordable, consumer-acceptable foods to replace dairy's shortfall nutrients is important especially for people who avoid dairy.Design: Linear programming identified food combinations to replace dairy's protein and shortfall nutrients. We examined cost, energy and dietary implications of replacing dairy with food combinations optimised for lowest cost, fewest kJ or the smallest amount of food by weight.Setting: National Health and Nutrition Examination Survey (2011-2014).Participants: Nationally representative sample of US population; 2 years and older (n 15 830).Results: Phase 1 (only dairy foods excluded): when optimised for lowest cost or fewest kJ, all non-dairy food replacements required large amounts (2·5-10 cups) of bottled/tap water. Phase 2 (dairy and unreasonable non-dairy foods excluded (e.g. baby foods; tap/bottled water): when intake of non-dairy foods was constrained to <90th percentile of current intake, the lowest cost food combination replacements for dairy cost 0·5 times more and provide 5·7 times more energy; the lowest energy food combinations cost 5·9 times more, provide 2·5 times more energy and require twice the amount of food by weight; and food combinations providing the smallest amount of food by weight cost 3·5 times more and provide five times more energy than dairy.Conclusions: Identifying affordable, consumer-acceptable foods that can replace dairy's shortfall nutrients at both current and recommended dairy intakes remains a challenge. [ABSTRACT FROM AUTHOR]

Objective: To assess the relationship between exposure to social media food messages and self-reported adolescent eating outcomes (including food intake, perceived norms and food literacy).Design: A cross-sectional survey was used to assess reported exposure to core and non-core food messages (including marketing messages) on social media, as well as reported food intake, perceived norms, food literacy, attitudes, self-regulation, among others.Setting: 18 secondary schools across Flanders, Belgium.Participants: 1002 adolescents 11-19 years of age.Results: Self-reported exposure to food marketing and overall food messages on social media was positively associated with eating attitudes, behaviours, perceived norms and food literacy among adolescents. Interestingly, the relationship between food exposure and intake was shaped differently depending on food type; descriptive norms mediated the positive relationship between non-core food social media exposure and non-core food intake (e.g. indirect effect estimate on self-reported sweets consumption is 0·005, se 0·002, P < 0·01), while food literacy mediated the positive relationship between core food social media exposure and core food intake (e.g. indirect effect estimate on self-reported vegetable consumption is 0·01, se 0·003, P < 0·000).Conclusions: This study highlights the significance of social media in relation to adolescent eating. There is an opportunity for health professionals to use social media in the promotion of core food among adolescents. We call for relevant policy actions to regulate the marketing of non-core food to adolescents on social media. [ABSTRACT FROM AUTHOR]

Objective: To examine how socio-demographic characteristics and diet quality vary with consumption of ultra-processed foods (UPF) in a cross-sectional nationally representative survey of Australian adults.Design: Using a 24-h recall, this cross-sectional analysis of dietary and socio-demographic data classified food items using the NOVA system, estimated the percentage of total energy contributed by UPFs and assessed diet quality using the Dietary Guideline Index (DGI-2013 total and components). Linear regression models examined associations between socio-demographic characteristics and diet quality with percentage of energy from UPF.Setting: Australian Health Survey 2011-2013.Participants: Australian adults aged ≥ 19 years (n 8209).Results: Consumption of UPF was higher among younger adults (aged 19-30 years), adults born in Australia, those experiencing greatest area-level disadvantage, lower levels of education and the second lowest household income quintile. No significant association was found for sex or rurality. A higher percentage of energy from UPF was inversely associated with diet quality and with lower DGI scores related to the variety of nutritious foods, fruits, vegetables, total cereals, meat and poultry, fish, eggs, nuts and seeds, legumes/beans, water and limits on discretionary foods, saturated fat and added sugar.Conclusions: This research adds to the evidence on dietary inequalities across Australia and how UPF are detrimental to diet quality. The findings can be used to inform interventions to reduce UPF consumption and improve diet quality. [ABSTRACT FROM AUTHOR]

Objective: To investigate the association between plant-based diets (PBD) and overweight/obesity compared to regular meat eaters in older women.Design: Cross-sectional analysis.Setting: 1946-1951 birth cohort of the Australian Longitudinal Study on Women's Health (ALSWH). PBD were categorised as vegan, lacto-ovo vegetarian, pesco-vegetarian, semi-vegetarian and regular meat eaters. Outcomes included body weight (BW), BMI and waist circumference (WC).Participants: Women who completed Survey 7 (n 9102) with complete FFQ data.Results: Compared to regular meat eaters, BW, BMI and WC were significantly lower in pesco-vegetarians (-10·2 kg (95 % CI -5·1, -15·2); -3·8 kg/m2 (95 % CI -2·0, -5·6); -8·4 cm (95 % CI -3·9, -12·9)) and BW and BMI lower in lacto-ovo vegetarians (-7·4 kg (95 % CI -1·2, -13·6); -2·9 kg/m2 (95 % CI -0·6, -5·1)). In regular meat eaters, individuals consuming meat daily or multiple times/d had significantly higher BW, BMI and WC compared to those consuming meat >2 times/week but 1 but ≤2 times/week (6·8 kg (95 % CI 1·8, 11·8); 2·1 kg/m2 (95 % CI 0·3, 4·0) and 6·0 cm (95 % CI 1·7, 10·4)). This association was dose-dependent such that for every increase in category of weekly meat intake (i.e. >1 time/week but ≤2 times/week; >2 times/week but less than daily, and daily or multiple times/d), an associated 2·6 kg (95 % CI 1·8, 3·4) increase in BW, 0·9 kg/m2 (95 % CI 0·6, 1·2) increase in BMI and 2·3 cm (95 % CI 1·6, 3·0) increase in WC was reported.Conclusions: BW, BMI and WC are lower in women following PBD and positively associated with increasing meat consumption. Results were robust to adjustment for confounders including physical activity levels, smoking status, habitual alcohol intake, use of supplements, and hormone replacement therapy. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to assess the validity of MEDFICTS (Meats, Eggs, Dairy, Fried foods, fat In baked goods, Convenience foods, fats added at the Table, Snacks) questionnaire in Turkish population.Design: MEDFICTS questionnaire is a brief dietary assessment tool developed as part of the National Cholesterol Education Program Adult Treatment Panel guidelines, and it measures the adherence to Step 1 and Step 2 diets that are recommended for the prevention and treatment of CVD. MEDFICTS questionnaire was administered with 3-d food record to compare overall dietary fat intake.Setting: This study was conducted at the Hacettepe University (Ankara, Turkey) in 2017.Participants: Subjects were university students, recruited from several departments of Hacettepe University by trained dietitians. A total of 442 adults (249 females and 194 males) between the ages of 18 and 31 years participated in the study. Students with CVD were excluded.Results: Total fat intake ratio was higher than the recommended level for both males and females (39·4 % and 39·9 %, respectively). Mean MEDCISTS score was 66·3 ± 27·24 points. Total energy, total fat, SFA and cholesterol intakes from 3-d food records within the different MEDFICTS diet groups significantly differed (P < 0·001 for all). Receiver operating characteristics curve analysis demonstrated that a cut-off point of 60 showed 80 % sensitivity and 65 % specificity.Conclusions: Our data indicate that the MEDFICTS questionnaire is moderately accurate; however, sensitivity analysis did not demonstrate the recommended 40 points as an optimal cut-off point for Turkish population. [ABSTRACT FROM AUTHOR]

Objective: To develop and evaluate a stand-alone Elementary School-aged Children's Index of Diet Quality (ES-CIDQ).Design: In this cross-sectional study, children filled in a food frequency questionnaire (FFQ) with twenty-nine multiple-item questions on the consumption of foods, portion sizes and eating frequency and a 5-d food diary. Nutrient intakes were calculated with nutrient analysis software. FFQ questions best reflecting a health-promoting diet with reference to dietary recommendations were identified by correlations, logistic regression modelling and receiver-operating characteristics curve analysis.Setting: Southwest and Eastern Finland.Participants: Healthy elementary school-aged volunteers [n 266, mean (sd) age 9·7 (1·7) years] were recruited between March 2017 and February 2018.Results: A set of questions was identified from the FFQ that best depicted the children's diet quality as defined in the dietary recommendations. These fifteen questions were scored and formulated into a stand-alone index as a continuous index score (range 0-16·5 points) and a two-category score: good and poor diet quality. The cut-off score of six points for a good diet quality had a sensitivity of 0·60 and a specificity of 0·78. Children with a good diet quality (49·8 % of the children) had higher intakes of protein, dietary fibre, and several vitamins and minerals, and lower intakes of sucrose, total fat, SFA and cholesterol compared to children with a poor diet quality.Conclusions: The developed short stand-alone index depicted diet quality as defined in the dietary recommendations. Thus, ES-CIDQ may be used for assessing diet quality in Finnish elementary school-aged children in school health care and nutrition research. [ABSTRACT FROM AUTHOR]

Objective: The current study evaluated the associations between different forms and sources of Fe and breast cancer risk in Southern Chinese women.Design: Case-control study. We collected data on the consumption of Fe from different forms and food sources by using a validated FFQ. Multivariable logistic regression and restricted cubic spline (RCS) analysis was used to reveal potential associations between Fe intake and breast cancer risk.Setting: A case-control study of women at three major hospitals in Guangzhou, China.Participants: From June 2007 to March 2019, 1591 breast cancer cases and 1622 age-matched controls were recruited.Results: In quartile analyses, Fe from plants and Fe from white meat intake were inversely associated with breast cancer risk, with OR of 0·65 (95 % CI 0·47, 0·89, Ptrend = 0·006) and 0·76 (95 % CI 0·61, 0·96, Ptrend = 0·014), respectively, comparing the highest with the lowest quartile. No associations were observed between total dietary Fe, heme or non-heme Fe, Fe from meat or red meat and breast cancer risk. RCS analysis demonstrated J-shaped associations between total dietary Fe, non-heme Fe and breast cancer, and reverse L-shaped associations between heme Fe, Fe from meat and Fe from red meat and breast cancer.Conclusion: Fe from plants and white meat were inversely associated with breast cancer risk. Significant non-linear J-shaped associations were found between total dietary Fe, non-heme Fe and breast cancer risk, and reverse L-shaped associations were found between heme Fe, Fe from meat or red meat and breast cancer risk. [ABSTRACT FROM AUTHOR]

Objective: To examine associations between diet and risk of developing gastro-oesophageal reflux disease (GERD).Design: Prospective cohort with a median follow-up of 15·8 years. Baseline diet was measured using a FFQ. GERD was defined as self-reported current or history of daily heartburn or acid regurgitation beginning at least 2 years after baseline. Sex-specific logistic regressions were performed to estimate OR 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 and 1994.Results: For men, total fat intake was associated with increased risk of GERD (OR 1·05 per 5 g/d; 95 % CI 1·01, 1·09; P = 0·016), whereas total carbohydrate (OR 0·89 per 30 g/d; 95 % CI 0·82, 0·98; P = 0·010) and starch intakes (OR 0·84 per 30 g/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.Conclusions: 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. [ABSTRACT FROM AUTHOR]

Objective: Increasing evidence links unhealthy food environments with diet quality and overweight/obesity. Recent evidence has demonstrated that relative food environment measures outperform absolute measures. Few studies have examined the interplay between these two measures. We examined the separate and combined effects of the absolute and relative densities of unhealthy food outlets within 1600 m buffers around elementary schools on children's diet- and weight-related outcomes.Design: This is a cross-sectional study of 812 children from thirty-nine schools. The Youth Healthy Eating Index (Y-HEI) and daily vegetables and fruit servings were derived from the Harvard Food Frequency Questionnaire for Children and Youth. Measured heights and weights determined BMI Z-scores. Food outlets were ranked as healthy, somewhat healthy and unhealthy according to provincial paediatric nutrition guidelines. Multilevel mixed-effects regression models were used to assess the effect of absolute (number) and relative (proportion) densities of unhealthy food outlets within 1600 m around schools on diet quality and weight status.Setting: Two urban centres in the province of Alberta, Canada.Participants: Grade 5 students (10-11 years).Results: For children attending schools with a higher absolute number (36+) of unhealthy food outlets within 1600 m, every 10 % increase in the proportion of unhealthy food outlets was associated with 4·1 lower Y-HEI score and 0·9 fewer daily vegetables and fruit.Conclusions: Children exposed to a higher relative density of unhealthy food outlets around a school had lower diet quality, specifically in areas where the absolute density of unhealthy food outlets was also high. [ABSTRACT FROM AUTHOR]

Objective: To explore the relationship between dietary patterns and physical fitness among older Chinese (≥60 years) individuals.Design: Cross-sectional survey. Dietary data were collected by a simplified semi-quantitative FFQ. The 30-s Chair Stand test (30sCST), 30-s Arm Curl test (30sACT), 8-foot Time Up-and-Go test (8fTUAGT) and 6-min Walking test (6mWT) were used to assess physical fitness. Dietary patterns were obtained by factor analysis. The association between dietary patterns and physical fitness was explored by multiple logistic regression.Setting: Six communities (villages) of three districts in Liaocheng City (Shandong Province, China).Participants: A total of 596 residents were recruited from April to May 2017.Results: Among 556 residents who were finally enrolled, 196 were men (35 %) and 360 were women (65 %). Three dietary patterns were identified: 'Western', 'Vegetarian' and 'Modern'. The 30sACT revealed that men in the fourth quartile of the Western pattern were less likely to be classified in the 'high-level' group, but men in the fourth quartile of the Vegetarian pattern were classified in the high-level group. The 6mWT revealed that men in the fourth quartile of the Modern pattern were classified in the high-level group. These associations were independent of confounding factors.Conclusions: Adherence to the Vegetarian pattern and Modern pattern may be protective factors for maintaining good physical fitness in older Chinese individuals. The Western pattern may lead to poor physical fitness in this population. [ABSTRACT FROM AUTHOR]

Objective: To investigate the relationship between functional dentition (FD) and changes in dietary patterns (DP) in older adults.Design: This was a 12-month prospective study, with dental examinations at baseline and questionnaires at baseline and follow-up. Dentition was classified as FD (containing ≥10 occlusal contacts), non-FD with dentures and non-FD without dentures. A 154-item FFQ assessed dietary intake in the previous month. Food items (servings/d) were combined into twenty-two food groups based on their similar nutrient profile, culinary use and previous studies in Thailand. DP were identified through factor analysis of baseline intake and applied scores were used to estimate changes in DP scores. The association between baseline FD (exposure) and change in each DP score (outcome) was tested in linear regression models adjusting for baseline socio-demographic factors, behaviours, chronic conditions, medications, total energy intake and DP score.Setting: Phetchaburi, Thailand.Participants: Totally, 788 community dwellers aged ≥ 60 years.Results: In total, 651 participants were retained after 12 months (82·6 % retention rate), of whom 14·1 % had FD. Having an FD was positively associated with larger increases in vegetable intake. Three DP were identified. Participants with FD had larger increases in healthy (0·13; 95 % CI: -0·13, 0·39) and carbohydrate-rich diets intake (0·12; 95 % CI: -0·17, 0·40) as well as larger reductions in meat-rich diet intake (-0·12; 95 % CI: -0·45, 0·21) than those with neither FD nor dentures. However, these differences were not significant.Conclusion: There was little support for an association between baseline FD and changes in DP. [ABSTRACT FROM AUTHOR]

Objective: Few studies have validated FFQ estimates of dietary glycaemic index (GI) and load (GL). We investigated how well our estimates of overall GI and GL from FFQs correlate with estimates from repeated 24 h recall data to validate overall GI and GL in the Adventist Health Study-2 (AHS-2).Design: The AHS-2 is a prospective population-based cohort of 95 873 Seventh-day Adventist adult church members enrolled from 2002 to 2007 to investigate diet, cancer and mortality.Setting: A 204-item FFQ was used to assess race- and gender-specific validity of GI and GL and 24 h recall data, from the calibration sub-study, were used as the reference.Participants: The 734 calibration study participants were randomly selected by church and included approximately equal numbers of blacks and whites but were otherwise similar to the whole cohort with respect to gender, age, education and vegetarian status.Results: The deattenuated correlation coefficients for overall GI ranged from 0·19 (95 % CI -0·06, 0·53) in black men to 0·46 (95 % CI 0·40, 0·60) in black women, with both non-black men and women falling between those values (0·45 (95 % CI 0·35, 0·65) and 0·38 (95 % CI 0·27, 0·57), respectively). GL correlations were somewhat higher for all study participants. When looking at the entire cohort, the deattenuated validity correlation value for overall GI was (r 0·38, 95 % CI 0·36, 0·47) and GL was (r 0·39, 95 % CI 0·34, 0·49).Conclusions: Our findings support the cautious use of our FFQ in epidemiological studies when assessing associations of overall GI and GL with disease risk. However, observed differences by race should be considered when interpreting results. [ABSTRACT FROM AUTHOR]