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Objective: Carbonated beverage consumption is associated with various adverse health conditions such as obesity, type 2 diabetes and CVD. Pakistan has a high burden of these health conditions. At the same time, the carbonated beverage industry is rapidly growing in Pakistan. In this context, we analyse the trends and socioeconomic factors associated with carbonated beverage consumption in Pakistan.Design: We use six waves of the cross-sectional household surveys from 2005-2006 to 2015-2016 to analyse carbonated beverage consumption. We examine the trends in carbonated beverage consumption-prevalence for different economic groups categorised by per capita household consumption quintiles. We estimate the expenditure elasticity of carbonated beverages for these groups using a two-stage budgeting system framework. We also construct concentration curves of carbonated beverage expenditure share to analyse the burden of expenditure across households of different economic status.Setting: Pakistan.Participants: Nationally representative sample of households in respective survey waves.Results: We find that the wealthier the household, the higher is the prevalence of carbonated beverage consumption, and the prevalence has increased for all household groups over time. From the expenditure elasticity analysis, we observe that carbonated beverages are becoming an essential part of food consumption particularly for wealthier households. And, lastly, poorer households are bearing a larger share of carbonated beverage expenditure in 2014-2016 than that in 2006-2008.Conclusion: Carbonated beverages are becoming an increasingly essential part of household food consumption in Pakistan. Concerns about added sugar intake can prompt consideration of public health approaches to reduce dietary causes of the disease burden in Pakistan. [ABSTRACT FROM AUTHOR]

Objective: To identify a high-sugar (HS) dietary pattern, a high-saturated-fat (HF) dietary pattern and a combined high-sugar and high-saturated-fat (HSHF) dietary pattern and to explore if these dietary patterns are associated with depressive symptoms.Design: We used data from the HELIUS (Healthy Life in an Urban Setting) study and included 4969 individuals aged 18-70 years. Diet was assessed using four ethnic-specific FFQ. Dietary patterns were derived using reduced rank regression with mono- and disaccharides, saturated fat and total fat as response variables. The nine-item Patient Health Questionnaire (PHQ-9) was used to assess depressive symptoms by using continuous scores and depressed mood (identified using the cut-off point: PHQ-9 sum score ≥10).Setting: The Netherlands.Results: Three dietary patterns were identified; an HSHF dietary pattern (including chocolates, red meat, added sugars, high-fat dairy products, fried foods, creamy sauces), an HS dietary pattern (including sugar-sweetened beverages, added sugars, fruit (juices)) and an HF dietary pattern (including high-fat dairy products, butter). When comparing extreme quartiles, consumption of an HSHF dietary pattern was associated with more depressive symptoms (Q1 v. Q4: β=0·18, 95 % CI 0·07, 0·30, P=0·001) and with higher odds of depressed mood (Q1 v. Q4: OR=2·36, 95 % CI 1·19, 4·66, P=0·014). No associations were found between consumption of the remaining dietary patterns and depressive symptoms.Conclusions: Higher consumption of an HSHF dietary pattern is associated with more depressive symptoms and with depressed mood. Our findings reinforce the idea that the focus should be on dietary patterns that are high in both sugar and saturated fat. [ABSTRACT FROM AUTHOR]

Objective: An absence of food literacy measurement tools makes it challenging for nutrition practitioners to assess the impact of food literacy on healthy diets and to evaluate the outcomes of food literacy interventions. The objective of the present scoping review was to identify the attributes of food literacy.Design: A scoping review of peer-reviewed and grey literature was conducted and attributes of food literacy identified. Subjects included in the search were high-risk groups. Eligible articles were limited to research from Canada, USA, the UK, Australia and New Zealand.Results: The search identified nineteen peer-reviewed and thirty grey literature sources. Fifteen identified food literacy attributes were organized into five categories. Food and Nutrition Knowledge informs decisions about intake and distinguishing between 'healthy' and 'unhealthy' foods. Food Skills focuses on techniques of food purchasing, preparation, handling and storage. Self-Efficacy and Confidence represent one's capacity to perform successfully in specific situations. Ecologic refers to beyond self and the interaction of macro- and microsystems with food decisions and behaviours. Food Decisions reflects the application of knowledge, information and skills to make food choices. These interdependent attributes are depicted in a proposed conceptual model.Conclusions: The lack of evaluated tools inhibits the ability to assess and monitor food literacy; tailor, target and evaluate programmes; identify gaps in programming; engage in advocacy; and allocate resources. The present scoping review provides the foundation for the development of a food literacy measurement tool to address these gaps. [ABSTRACT FROM AUTHOR]

Menu labelling is recommended as a policy intervention to reduce obesity and diet-related disease. The present commentary considers the many challenges the restaurant industry faces in providing nutrition information on its menus. Barriers include lack of nutrition expertise, time, cost, availability of nutrition information for exotic ingredients, ability to provide accurate nutrition information, libel risk, customer dissatisfaction, limited space on the menu, menu variations, loss of flexibility in changing the menu, staff training and resistance of employees to change current practice. Health promotion specialists and academics involved in fieldwork must help restaurateurs find solutions to these barriers for menu labelling interventions to be widely implemented and successful. Practical support for small independent restaurants such as free or subsidised nutrition analysis, nutrition training for staff and menu design may also be necessary to encourage voluntary participation. [ABSTRACT FROM AUTHOR]

ObjectiveThe aim of the present work was to determine what dietary assessment method can provide a valid and accurate estimate of nutrient intake by comparison with the gold standard.DesignA MEDLINE, EMBASE, ISI Web of Science, Cochrane and related references literature review was conducted on dietary assessment methods for adolescents reporting the validity and/or reproducibility values. A study quality assessment on the retrieved FFQ was carried out according to two different scoring systems, judging respectively the quality of FFQ nutrition information and of FFQ validation and calibration.SettingThe present review considered adolescents attending high schools and recruited in hospitals or at home.SubjectsThe target of the review was the healthy adolescent population in the age range 13–17 years.ResultsThirty-two eligible papers were included and analysed separately as ‘original articles’ (n 20) and ‘reviews’ (n 12). The majority (n 17) assessed the validation and reproducibility of FFQ. Almost all studies found the questionnaires to be valid and reproducible (r > 0·4), except for some food groups and nutrients. Different design and validation issues were highlighted, such as portion-size estimation, number of food items and statistics used.ConclusionsThe present review offers new insights in relation to the characteristics of assessment methods for dietary intake in adolescents. Further meta-analysis is required although the current review provides important indications on the development of a new FFQ, addressing the need for a valid, reproducible, user-friendly, cost-effective method of accurately assessing nutrient intakes in adolescents. [ABSTRACT FROM AUTHOR]

ObjectiveTo study the relationship between dietary intake and the development of type 2 diabetes among Chinese adults.DesignA prospective cohort study. Dietary assessment was carried out using a validated FFQ. Principal component analysis was used to identify dietary patterns. Dietary glycaemic load and variety of snacks were also calculated.SettingA hospital-based centre at the Queen Mary Hospital in Hong Kong SAR, China.SubjectsA total of 1010 Chinese adults aged 25–74 years who participated in a territory-wide dietary and cardiovascular risk factor prevalence survey in 1995–1996 were followed up for 9–14 years for the development of diabetes.ResultsA total of 690 (68·3 %) individuals completed follow-up during 2005–2008 and seventy-four cases of diabetes were identified over the follow-up period. Four dietary patterns were identified (‘more snacks and drinks’, ‘more vegetables, fruits and fish’, ‘more meat and milk products’ and ‘more refined grains’). After adjustment for age, sex, BMI, waist-to-hip ratio, smoking, alcohol intake, participation in exercise/sports and family history of diabetes, the more vegetables, fruits and fish pattern was associated with a 14 % lower risk (OR per 1 sd increase in score = 0·76; 95 % CI 0·58, 0·99), whereas the more meat and milk products pattern was associated with a 39 % greater risk of diabetes (OR per 1 sd increase in score = 1·39; 95 % CI 1·04, 1·84). Dietary glycaemic load, rice intake, snack intake and variety of snacks were not independently associated with diabetes.ConclusionsThe more vegetables, fruits and fish pattern was associated with reduced risk and the more meat and milk products pattern was associated with an increased risk of diabetes. [ABSTRACT FROM AUTHOR]

Objective: To investigate whether the socio-economic status (SES) of elderly eastern Mediterranean islanders is associated with their dietary habits, particularly with adherence to the traditional Mediterranean diet. Design: Cross-sectional. Setting: Adherence to the Mediterranean diet was measured by the MedDietScore (range: 0-55), whereas SES was estimated using education and financial status. Subjects: During 2005-2007, 300 men and women from Cyprus, 100 from Samothraki, 142 from Mitilini, 114 from Kefalonia, 131 from Crete, 150 from Lemnos, 150 from Corfu and 103 from Zakynthos (aged 65-100 years), free of known chronic diseases, participated in the survey. Results: Multiple linear regression analysis revealed that belonging to the highest SES was associated with a higher MedDietScore (P<0·01), after adjusting for potential sociodemographic, lifestyle, dietary and clinical confounders. A significant positive association was also found between MedDietScore and years of school (P=0·004), as well as financial status (P=0·001). Conclusions: Older Greek people of higher SES seem to follow a relatively healthier diet. Both education and income seem to play a role in this issue. Thus, public health policy makers should focus on people with low SES in order to improve their quality of diet and, consequently, their health status. [ABSTRACT FROM AUTHOR]

Objective: The estimation of dietary intake in population-based studies is often assessed by the FFQ. The objective of our study is to evaluate the validity of an FFQ used to assess dietary fatty acid intake among middle-aged Chinese adults in Southern China. Design: The method of triads was applied to obtain the validity coefficients (VC) of the FFQ for specific fatty acids. A subsample was randomly selected from an earlier cross-sectional study. The FFQ and 3 d dietary records were used for dietary assessment, and the fatty acid composition of erythrocyte membranes was determined as the biomarker. Results: The Spearman correlation coefficients between the FFQ and 3 d dietary records were moderate to good (r=0·28-0·66). The VC of the FFQ estimated by the method of triads were 0·72, 0·61, 0·65, 0·75 and 0·67 for MUFA, total n-6 fatty acids, α-linolenic acid, EPA and DHA, respectively. The VC could not be calculated for SFA, PUFA and total n-3 fatty acids because of negative correlations among the three measurements. But, the correlations between the FFQ and the dietary records were moderate for these fatty acids. Conclusions: Our FFQ applied in Southern Chinese adults was valid to estimate their dietary fatty acid intake and was thus suitable for use in a large cohort study. [ABSTRACT FROM AUTHOR]

Health and dietary monitoring has a long history in Finland. The aim of this review is to summarise the main sources of Finnish dietary information including food balance sheets, household budget survey data, questionnaires related to dietary behaviour and risk factors of main chronic diseases as well as dietary surveys. According to these sources, dietary behaviour and food choices have changed considerably during the last decades. For example, the total fat intake (E%) has decreased remarkably from nearly 40% in the late 1960s to close to 30% in 2007. Furthermore, the type of fat consumed has changed noticeably due to the increased popularity of oil used in cooking and the large variety of softer spreads available. There has also been a notable decrease in intake of salt, and a multiple increase in the consumption of fruits and vegetables since the 1970s. The future challenges of dietary monitoring include keeping the participation rates in dietary surveys at acceptable levels, controlling under/over-reporting of diet, developing a national monitoring system for children and adapting to international changes and requirements to harmonise dietary monitoring in Europe. [ABSTRACT FROM AUTHOR]

A cross-sectional survey, FINDIET 2007, was carried out in Finland. Food intake data was collected by a 48 h recall interview. Additional food intake data was collected by a repeated 3 d food diary, a barcode-based product diary, a food frequency questionnaire and by a supplementary questionnaire on rarely eaten foods. The purpose of the present paper is to describe the methodology of the national dietary survey and to discuss the particular implications for the applications of food consumption data in risk assessment. The food consumption data of the FINDIET 2007 survey can be used in food risk assessment, due thanks to flexible data processing of individual food consumption, and a risk assessment point of view was taken into account. However, international standardisation projects are needed in order to estimate comparable food intakes. [ABSTRACT FROM AUTHOR]

Objective: To estimate dietary cholesterol contribution to CHD risk among US females, relative to other dietary risk factors. Design: A risk apportionment model was applied to apportion CHD risk shares among the lifestyle and dietary risk factors. Setting: The model was implemented using relative risks from the Nurses' Health Study and data on CHD risk factors and consumption from the National Health and Nutrition Examination Survey 1999-2002. Subjects: US females aged 25 years or older. Results: On average, poor diet contributes 20% of the CHD risk relative to obesity, inactivity and smoking, of which trans fat intake contributes 2·9%, dietary cholesterol 1·5% and 16% is due to low consumption of nutrients, i.e. MUFA (1·5 %), PUFA (1·7 %), marine n-3 fatty acids (2·7 %), α-linolenic acid (1·1 %), dietary fibre (2·4 %), vitamin B6 (4·1 %), vitamin C (0·5%) and folate (1·8 %). Conclusions: Reducing trans fat and dietary cholesterol intakes could lead to CHD reduction, but greater risk reduction may be achieved by improving intakes of heart-healthy nutrients currently deficient in US females' diets. Total diet consideration is essential in any CHD risk reduction strategy. [ABSTRACT FROM AUTHOR]

AbstractBackgroundBecause most of the top determinants of the worldwide burden of disease are diet-related, the promotion of healthful diets is important for population health across the world. Furthermore, changes in eating habits may contribute to preservation of the environment.ObjectiveIn the present paper it is argued that the translation of health-promoting dietary recommendations into practical recommendations for healthful eating should be more tailored to regional circumstances. This will promote population health as well as help preserve cultural diversity in eating habits and contribute to more environmentally friendly eating. A regional Nordic diet, mimicking the Mediterranean diet to some extent, is presented as an example.ConclusionA theoretically health-enhancing Nordic diet is possible including six evidence-based ingredients: (i) native berries; (ii) cabbage; (iii) native fish and other seafood; (iv) wild (and pasture-fed) land-based animals; (v) rapeseed oil; and (vi) oat/barley/rye. [ABSTRACT FROM AUTHOR]

ObjectivesThe main purpose of this study was to evaluate the modification of knowledge, opinions and attitudes to healthy eating, weight perception and dieting practices and preventive habits over a 10-year trend in the Catalan population from 1992 to 2003.DesignTwo cross-sectional surveys were carried out in Catalonia, Spain, during 1992–93 and 2002–03.SubjectsIn all, 2361 individuals in the ENCAT 1992–93 nutritional survey and 2061 individuals in the ENCAT 2002–03 health survey. The subjects’ ages ranged from 10 to 75 years old.ResultsLettuce and carrots, fish and olive oil were chosen as the healthiest foods in the two Catalan Nutritional Surveys. Although some improvement was reported, a high percentage of the population still thought that bread (31%), potatoes (23%) or olive oil (19%) should be moderated to prevent high blood cholesterol, especially among the youngest individuals. The perception of being overweight increased among males and decreased among females. There was an increase in the percentage of the population following a diet (from 13% to 17%). An increase in the consumption of iodine-enriched salt (from 26% to 40%) was observed as well as of diet supplements, especially among females (from 6% to 13%). The prevalence of males with diabetes increased from 3.4% to 4.5% and the number of individuals with diabetes not following any treatment decreased.ConclusionThe Catalan population has improved their knowledge of healthy food and health-related attitudes. Nutrition policy should focus on young adults as a key age group for primary prevention of future nutrition-related chronic diseases. [ABSTRACT FROM PUBLISHER]

AbstractObjectiveTo compare two approaches to analysing energy- and nutrient-converted data from dietary validation (and relative validation) studies ? conventional analyses, in which the accuracy of reported items is not ascertained, and reporting-error-sensitive analyses, in which reported items are classified as matches (items actually eaten) or intrusions (items not actually eaten), and reported amounts are classified as corresponding or overreported.DesignSubjects were observed eating school breakfast and lunch, and interviewed that evening about that day's intake. For conventional analyses, reference and reported information were converted to energy and macronutrients; then t-tests, correlation coefficients and report rates (reported/reference) were calculated. For reporting error-sensitive analyses, reported items were classified as matches or intrusions, reported amounts were classified as corresponding or overreported, and correspondence rates (corresponding amount/reference amount) and inflation ratios (overreported amount/reference amount) were calculated.SubjectsSixty-nine fourth-grade children (35 girls) from 10 elementary schools in Georgia (USA).ResultsFor energy and each macronutrient, conventional analyses found that reported amounts were significantly less than reference amounts (every P?

AbstractObjectiveCohort study (the SUN project) to identify dietary determinants of hypertension, diabetes, obesity and coronary heart disease (CHD), among other conditions.DesignThe SUN project is a Mediterranean dynamic prospective follow-up (cohort) study assessing participants every 2 years. The recruitment started in 2000 and it is permanently open (this is a dynamic cohort). A preliminary case?control study of myocardial infarction was also conducted, selecting incident cases of myocardial infarction and matched hospital controls.SettingThe SUN study is conducted in Spain with university graduates, most of them being former students of the University of Navarra. The case?control study was conducted in three tertiary hospitals in the city of Pamplona (Spain).SubjectsThe case?control study included 171 cases and 171 controls. We have currently enrolled more than 17 500 participants in the SUN cohort. Approximately 7500 of them were enrolled less than 2 years ago, and have not received yet the invitation to complete the 2-year follow-up assessment. The follow-up rate for the first 10 000 participants approaches 90%.ResultsThe case?control study found inverse associations between olive oil (or adherence to a Mediterranean food pattern) and myocardial infarction. In the SUN cohort, after 28.5 months of follow-up a higher adherence to a Mediterranean food pattern rich in olive oil was associated with a reduced risk of hypertension, though the results were statistically significant only among men.ConclusionsThe SUN study and the accompanying case?control study support the benefits of a Mediterranean diet and olive oil against CHD and hypertension. [ABSTRACT FROM AUTHOR]