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Objective: The purpose of this study is to determine if healthier neighbourhood food environments are associated with healthier diet quality., Design: This was a cross-sectional study using linear regression models to analyse data from the Maastricht Study. Diet quality was assessed using data collected with a FFQ to calculate the Dutch Healthy Diet (DHD). A buffer zone encompassing a 1000 m radius was created around each participant home address. The Food Environment Healthiness Index (FEHI) was calculated using a Kernel density analysis within the buffers of available food outlets. The association between the FEHI and the DHD score was analysed and adjusted for socio-economic variables., Setting: The region of Maastricht including the surrounding food retailers in the Netherlands., Participants: 7367 subjects aged 40-75 years in the south of the Netherlands., Results: No relationship was identified between either the FEHI (B = 0·62; 95 % CI = -2·54, 3·78) or individual food outlets, such as fast food (B = -0·07; 95 % CI = -0·20, 0·07) and diet quality. Similar null findings using the FEHI were identified at the 500 m (B = 0·95; 95 % CI = -0·85, 2·75) and 1500 m (B = 1·57; 95 % CI = -3·30, 6·44) buffer. There was also no association between the food environment and individual items of the DHD including fruits, vegetables and sugar-sweetened beverages., Conclusion: The food environment in the Maastricht area appeared marginally unhealthy, but the differences in the food environment were not related to the quality of food that participants reported as intake.

Background: Dicarbonyls are highly reactive compounds and major precursors of advanced glycation end products (AGEs). Both dicarbonyls and AGEs are associated with development of age-related diseases. Dicarbonyls are formed endogenously but also during food processing. To what extent dicarbonyls from the diet contribute to circulating dicarbonyls and AGEs in tissues is unknown., Objectives: To examine cross-sectional associations of dietary dicarbonyl intake with plasma dicarbonyl concentrations and skin AGEs., Methods: In 2566 individuals of the population-based Maastricht Study (age: 60 ± 8 y, 50% males, 26% with type 2 diabetes), we estimated habitual intake of the dicarbonyls methylglyoxal (MGO), glyoxal (GO), and 3-deoxyglucosone (3-DG) by combining FFQs with our dietary dicarbonyl database of MGO, GO, and 3-DG concentrations in > 200 commonly consumed food products. Fasting plasma concentrations of MGO, GO, and 3-DG were measured by ultra-performance liquid chromatography-tandem mass spectrometry. Skin AGEs were measured as skin autofluorescence (SAF), using the AGE Reader. Associations of dietary dicarbonyl intake with their respective plasma concentrations and SAF (all standardized) were examined using linear regression models, adjusted for age, sex, potential confounders related to cardiometabolic risk factors, and lifestyle., Results: Median intake of MGO, GO, and 3-DG was 3.6, 3.5, and 17 mg/d, respectively. Coffee was the main dietary source of MGO, whereas this was bread for GO and 3-DG. In the fully adjusted models, dietary MGO was associated with plasma MGO (β: 0.08; 95% CI: 0.02, 0.13) and SAF (β: 0.12; 95% CI: 0.07, 0.17). Dietary GO was associated with plasma GO (β: 0.10; 95% CI: 0.04, 0.16) but not with SAF. 3-DG was not significantly associated with either plasma 3-DG or SAF., Conclusions: Higher habitual intake of dietary MGO and GO, but not 3-DG, was associated with higher corresponding plasma concentrations. Higher intake of MGO was also associated with higher SAF. These results suggest dietary absorption of MGO and GO. Biological implications of dietary absorption of MGO and GO need to be determined. The study has been approved by the institutional medical ethical committee (NL31329.068.10) and the Minister of Health, Welfare and Sports of the Netherlands (Permit 131088-105234-PG)., (© The Author(s) 2021. Published by Oxford University Press on behalf of the American Society for Nutrition.)

Our aim was to assess the association between a priori defined dietary patterns and incident depressive symptoms. We used data from The Maastricht Study, a population-based cohort study ( n = 2646, mean (SD) age 59.9 (8.0) years, 49.5% women; 15,188 person-years of follow-up). Level of adherence to the Dutch Healthy Diet (DHD), Mediterranean Diet, and Dietary Approaches To Stop Hypertension (DASH) were derived from a validated Food Frequency Questionnaire. Depressive symptoms were assessed at baseline and annually over seven-year-follow-up (using the 9-item Patient Health Questionnaire). We used Cox proportional hazards regression analyses to assess the association between dietary patterns and depressive symptoms. One standard deviation (SD) higher adherence in the DHD and DASH was associated with a lower hazard ratio (HR) of depressive symptoms with HRs (95%CI) of 0.78 (0.69-0.89) and 0.87 (0.77-0.98), respectively, after adjustment for sociodemographic and cardiovascular risk factors. After further adjustment for lifestyle factors, the HR per one SD higher DHD was 0.83 (0.73-0.96), whereas adherence to Mediterranean and DASH diets was not associated with incident depressive symptoms. Higher adherence to the DHD lowered risk of incident depressive symptoms. Adherence to healthy diet could be an effective non-pharmacological preventive measure to reduce the incidence of depression.

Purpose: Observational studies showed inverse associations between milk consumption and knee osteoarthritis (knee OA). There is lack of information on the role of specific dairy product categories. We explored the association between dairy consumption and the presence of knee osteoarthritis in 3010 individuals aged 40-75 years participating in The Maastricht Study., Methods: The presence of knee OA was defined according to a slightly modified version of the American College of Rheumatology (ACR) clinical classification criteria. Data on dairy consumption were appraised by a 253-item FFQ covering 47 dairy products with categorization on fat content, fermentation or dairy type. Multivariable logistic regression analyses were performed to estimate odd ratios (ORs) and 95% confidence intervals (95%CI), while correcting for relevant factors., Results: 427 (14%) participants were classified as having knee OA. Significant inverse associations were observed between the presence of knee OA and intake of full-fat dairy and Dutch, primarily semi-hard, cheese, with OR for the highest compared to the lowest tertile of intake of 0.68 (95%CI 0.50-0.92) for full-fat dairy, and 0.75 (95%CI 0.56-0.99) for Dutch cheese. No significant associations were found for other dairy product categories., Conclusion: In this Dutch population, higher intake of full-fat dairy and Dutch cheese, but not milk, was cross-sectionally associated with the lower presence of knee OA. Prospective studies need to assess the relationship between dairy consumption, and in particular semi-hard cheeses, with incident knee OA.

Objective: The aim of this study was to develop and validate a comprehensive food frequency questionnaire (FFQ) for The Maastricht Study, a population-based prospective cohort study in Maastricht, The Netherlands., Methods: Item selection for the FFQ was based on explained variation and contribution to intake of energy and 24 nutrients. For validation, the FFQ was completed by 135 participants (25-70 y of age) of the Nutrition Questionnaires plus study. Per person, on average 2.8 (range 1-5) telephone-based 24-h dietary recalls (24HRs), two 24-h urinary samples, and one blood sample were available. Validity of 54 nutrients and 22 food groups was assessed by ranking agreement, correlation coefficients, attenuation factors, and ultimately deattenuated correlation coefficients (validity coefficients)., Results: Median correlation coefficients for energy and macronutrients, micronutrients, and food groups were 0.45, 0.36, and 0.38, respectively. Median deattenuated correlation coefficients were 0.53 for energy and macronutrients, 0.45 for micronutrients, and 0.64 for food groups, being >0.50 for 18 of 22 macronutrients, 16 of 30 micronutrients and >0.50 for 17 of 22 food groups. The FFQ underestimated protein and potassium intake compared with 24-h urinary nitrogen and potassium excretion by -18% and -2%, respectively. Correlation coefficients ranged from 0.50 and 0.55 for (fatty) fish intake and plasma eicosapentaenoic acid and docosahexaenoic acid, and from 0.26 to 0.42 between fruit and vegetable intake and plasma carotenoids., Conclusion: Overall, the validity of the 253-item Maastricht FFQ was satisfactory. The comprehensiveness of this FFQ make it well suited for use in The Maastricht Study and similar populations., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Objective: In the Netherlands, various FFQs have been administered in large cohort studies, which hampers comparison and pooling of dietary data. The present study aimed to describe the development of a standardized Dutch FFQ, FFQ-NL1.0, and assess its compatibility with existing Dutch FFQs., Design: Dutch FFQTOOLTM was used to develop the FFQ-NL1.0 by selecting food items with the largest contributions to total intake and explained variance in intake of energy and thirty-nine nutrients in adults aged 25-69 years from the Dutch National Food Consumption Survey (DNFCS) 2007-2010. Compatibility with the Maastricht-FFQ, Wageningen-FFQ and EPICNL-FFQ was assessed by comparing the number of food items, the covered energy and nutrient intake, and the covered variance in intake., Results: FFQ-NL1.0 comprised 160 food items, v. 253, 183 and 154 food items for the Maastricht-FFQ, Wageningen-FFQ and EPICNL-FFQ, respectively. FFQ-NL1.0 covered ≥85 % of energy and all nutrients reported in the DNFCS. Covered variance in intake ranged from 57 to 99 % for energy and macronutrients, and from 45 to 93 % for micronutrients. Differences between FFQ-NL1.0 and the other FFQs in covered nutrient intake and covered variance in intake were <5 % for energy and all macronutrients. For micronutrients, differences between FFQ-NL and other FFQs in covered level of intake were <15 %, but differences in covered variance were much larger, the maximum difference being 36 %., Conclusions: The FFQ-NL1.0 was compatible with other FFQs regarding energy and macronutrient intake. However, compatibility for covered variance of intake was limited for some of the micronutrients. If implemented in existing cohorts, it is advised to administer the old and the new FFQ in combination to derive calibration factors.

Background/objectives: The few prospective studies that examined lung, female breast and prostate cancer risk in vegetarians have yielded mixed results, whereas none have studied the effects of low meat diets. Moreover, little is known about the explanatory role of (non-) dietary factors associated with these diets., Subjects/methods: The Netherlands Cohort Study-Meat Investigation Cohort (NLCS-MIC)- is an analytical cohort of 11 082 individuals including 1133 self-reported vegetarians (aged 55-69 years at baseline). At baseline (1986), subjects completed a questionnaire on dietary habits and other risk factors for cancer and were classified into vegetarians (n=691), pescetarians (n=389), 1 day per week (n=1388), 2-5 days per week (n=2965) and 6-7 days per week meat consumers (n=5649)., Results: After 20.3 years of follow-up, 279 lung, 312 postmenopausal breast and 399 prostate cancer cases (including 136 advanced) were available for analyses. After adjustment for confounding variables, we found no statistically significant association between meat consumption groups and the risk of lung cancer. As well, no significant associations were observed for postmenopausal breast and overall prostate cancer. After adjustment for confounders, individuals consuming meat 1 day per week were at a 75% increased risk of advanced prostate cancer compared with 6-7 days per week meat consumers (95%CI 1.03-2.97)., Conclusions: Vegetarians, pescetarians and 1 day per week meat consumers did not have a reduced risk of lung, postmenopausal breast and overall prostate cancer compared with individuals consuming meat on a daily basis after taking confounders into account.

Observational studies suggest an inverse association between total dairy product intake and diabetes risk. However, there is a lack of information on the relationship of specific dairy products with impaired glucose metabolism (IGM) and type 2 diabetes mellitus (T2DM). Individuals aged 40-75 years were recruited for the Maastricht Study. All the participants filled out a 253-food item FFQ, covering fifty specific dairy items that captured differences between full-fat, semi-skimmed and skimmed products, as well as fermented and non-fermented products. Glucose metabolism status was assessed by an oral glucose tolerance test, and participants were informed on their glucose metabolism status after returning the FFQ. Data of 2391 individuals were available to estimate OR (95 % CI) for IGM (n 470) and newly diagnosed (ND) T2DM (n 125), with adjustment for age, sex, BMI, physical activity, smoking status, education, energy intake and intakes of vegetables, fruits, meat and fish. For IGM, fully adjusted analyses revealed inverse associations, with OR comparing the highest with the lowest tertile of intake of 0·73 (95 % CI 0·55, 0·96) for skimmed products and 0·74 (95 % CI 0·54, 0·99) for fermented products. These dairy products were not associated with ND T2DM. In contrast, full-fat products were positively associated with ND T2DM (OR 2·01; 95 % CI 1·16, 3·47), whereas total dairy product intake was inversely associated with ND T2DM (OR 0·50; 95 % CI 0·26, 0·93). In conclusion, individuals with a high consumption of skimmed and fermented products had lower odds of having IGM, and individuals with a high consumption of total dairy products had lower odds of having ND T2DM. High intake of full-fat products was not related to IGM but was positively related to ND T2DM.

Research on parenting practices has focused on individual behaviors while largely failing to consider the context of their use, i.e., general parenting. We examined the extent to which food parenting practices predict children's dietary behavior (classified as unhealthy: snacking, sugar-sweetened beverage; and healthy: water and fruit intake). Furthermore, we tested the moderating role of general parenting on this relationship. Within the KOALA Birth Cohort Study, in the Netherlands, questionnaire data were collected at 6 and 8 years (N = 1654). Correlations were computed to assess the association between food parenting practices and general parenting (i.e., nurturance, behavioral control, structure, coercive control, and overprotection). Linear regression models were fitted to assess whether food parenting practices predict dietary behavior. Instrumental and emotional feeding, and pressure to eat were found to have associations with undesirable child dietary behavior (increased unhealthy intake/decreased healthy intake), whereas associations were in the desirable direction for covert control, encouragement and restriction. Moderation analyses were performed by evaluating interactions with general parenting. The associations of encouragement and covert control with desirable child dietary behaviors were found to be stronger for children who were reared in a positive parenting context. Future research should assess the influence of contextual parenting factors moderating the relationships between food parenting and child dietary behavior as the basis for the development of more effective family-based interventions., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

The amino acid arginine is a well-known growth hormone (GH) stimulator and GH is an important modulator of linear growth. The aim of the present study was to investigate the effect of dietary arginine on growth velocity in children between 7 and 13 years of age. Data from the Copenhagen School Child Intervention Study during 2001-2 (baseline), and at 3-year and 7-year follow-up, were used. Arginine intake was estimated via a 7 d precoded food diary at baseline and 3-year follow-up. Data were analysed in a multilevel structure in which children were embedded within schools. Random intercept and slopes were defined to estimate the association between arginine intake and growth velocity, including the following covariates: sex; age; baseline height; energy intake; puberty stage at 7-year follow-up and intervention/control group. The association between arginine intake and growth velocity was significant for the third and fourth quintile of arginine intake (2.5-2.8 and 2.8-3.2 g/d, respectively) compared with the first quintile ( < 2.2 g/d) (P for trend = 0.04). Protein intake (excluding arginine) was significantly associated with growth velocity; however, the association was weaker than the association between arginine intake and growth velocity (P for trend = 0.14). The results of the present study suggest a dose-dependent physiological role of habitual protein intake, and specifically arginine intake, on linear growth in normally growing children. However, since the study was designed in healthy children, we cannot firmly conclude whether arginine supplementation represents a relevant clinical strategy. Further research is needed to investigate whether dietary arginine may represent a nutritional strategy potentially advantageous for the prevention and treatment of short stature.

Background: Insights into the effects of energy balance-related parenting practices on children's diet and activity behavior at an early age is warranted to determine which practices should be recommended and to whom. The purpose of this study was to examine child and parent background correlates of energy balance-related parenting practices at age 5, as well as the associations of these practices with children's diet, activity behavior, and body mass index (BMI) development., Methods: Questionnaire data originated from the KOALA Birth Cohort Study for ages 5 (N = 2026) and 7 (N = 1819). Linear regression analyses were used to examine the association of child and parent background characteristics with parenting practices (i.e., diet- and activity-related restriction, monitoring and stimulation), and to examine the associations between these parenting practices and children's diet (in terms of energy intake, dietary fiber intake, and added sugar intake) and activity behavior (i.e., physical activity and sedentary time) at age 5, as well as BMI development from age 5 to age 7. Moderation analyses were used to examine whether the associations between the parenting practices and child behavior depended on child characteristics., Results: Several child and parent background characteristics were associated with the parenting practices. Dietary monitoring, stimulation of healthy intake and stimulation of physical activity were associated with desirable energy balance-related behaviors (i.e., dietary intake and/or activity behavior) and desirable BMI development, whereas restriction of sedentary time showed associations with undesirable behaviors and BMI development. Child eating style and weight status, but not child gender or activity style, moderated the associations between parenting practices and behavior. Dietary restriction and monitoring showed weaker, or even undesirable associations for children with a deviant eating style, whereas these practices showed associations with desirable behavior for normal eaters. By contrast, stimulation to eat healthy worked particularly well for children with a deviant eating style or a high BMI., Conclusion: Although most energy balance-related parenting practices were associated with desirable behaviors, some practices showed associations with undesirable child behavior and weight outcomes. Only parental stimulation showed desirable associations with regard to both diet and activity behavior. The interaction between parenting and child characteristics in the association with behavior calls for parenting that is tailored to the individual child.

Objective: To validate an integrated food-frequency questionnaire (FFQ) developed to assess habitual food intake of Flemish and Italian-native subjects in Belgium as part of the European Collaborative Dietary Habit Profile in European Communities With Different Risk of Myocardial Infarction: the Impact of Migration as a Model of Gene/Environment Interaction (IMMIDIET Project)., Methods: The semiquantitative FFQ contained 322 items on food and food preparation. FFQs filled by a sample (n = 70) of the Flemish-Flemish and Flemish-Italian IMMIDIET subpopulations were randomly selected. Five 24-h recalls, administered over a period of 1 y by the same sample, served for validation. Energy and macronutrients were calculated using the Dutch NEVO and the Belgian NUBEL food composition tables. Intakes of energy and macronutrients estimated by the FFQ and repeated 24-h recall, respectively, were compared by means of correlation coefficients, classification into quartiles, and Bland-Altman plotting., Results: The FFQ overestimated intake of energy and most macronutrients by 40-70%. This overestimation largely disappeared when values were expressed as energy percentage. Correlations ranked from 0.40 to 0.60 for energy and most macronutrients (median 0.53); correlations were lower (null to 0.41) for fat and higher (up to 0.90) for alcohol. Classification in quartiles of intake showed good agreement: 83% were classified in the same or adjacent quartile of energy, and 66-90% for macronutrients. Correlations and classification of macronutrient intake into quartiles remained similar when macronutrients were expressed as energy percentage. Stratification according to ethnic subgroup, age, body mass index, or social status showed no differences., Conclusion: The IMMIDIET FFQ is a valuable tool for studies of the role of energy and macronutrients in disease etiology or outcome, but less suitable for estimating absolute intake levels., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Objective: We aimed to investigate the effect of dietary intake of micronutrients that are metabolized and excreted via the urinary tract on bladder cancer risk., Methods: A semi-quantitative 322 item food frequency questionnaire (FFQ) was used to collect dietary data from 200 bladder cancer cases and 386 control subjects participating in the Belgian case-control study on bladder cancer risk. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using unconditional logistic regression adjusting for age, sex, smoking characteristics, occupational exposures, and energy intake., Results: We observed a positive association between calcium intake and bladder cancer (OR: 1.77; 95% CI: 1.00-3.15; p-trend = 0.049) and increased odds, although not statistically significant, for highest tertile of phosphorus intake (OR: 1.82; 95% CI: 0.95-3.49; p-trend = 0.06). We identified possible modification of the effects of both calcium and phosphorus by level of magnesium intake. Increased odds of bladder cancer were also observed for participants with highest intake of phosphorus and lowest intake of vitamin D (OR: 4.25; 95% CI: 1.44-12.55) and among older participants with the highest intakes of calcium (OR: 1.90; 95% CI: 1.08-3.36) and phosphorus (OR: 2.02; 95% CI: 1.05-3.92)., Conclusion: The positive associations we observed between bladder cancer and intake of calcium and phosphorus require confirmation by other studies. The balances between inter-related micronutrients also warrant further examination.

The authors automated the selection of foods in a computer system that compiles and processes tailored FFQ. For the selection of food items, several methods are available. The aim of the present study was to compare food lists made by MOM2, which identifies food items with highest between-person variance in intake of the nutrients of interest without taking other items into account, with food lists made by forward regression. The name MOM2 refers to the variance, which is the second moment of the nutrient intake distribution. Food items were selected for the nutrients of interest from 2 d of recorded intake in 3524 adults aged 25-65 years. Food lists by 80 % MOM2 were compared to those by 80 % explained variance for regression on differences between the number and type of food items, and were evaluated on (1) the percentage of explained variance and (2) percentage contribution to population intake computed for the selected items on the food list. MOM2 selected the same food items for Ca, a few more for fat and vitamin C, and a few less for carbohydrates and dietary fibre than forward regression. Food lists by MOM2 based on 80 % of variance in intake covered 75-87 % of explained variance for different nutrients by regression and contributed 53-75 % to total population intake. Concluding, for developing food lists of FFQ, it appears sufficient to select food items based on the contribution to variance in nutrient intake without taking covariance into account.

Background: Previous research has shown that children in child-care do not comply with dietary intake recommendations (i.e. either exceeding or not meeting recommendations), which may be attributable to specific features of the child-care environment. The present study explored the relationship between the social and physical child-care (day-care) environment and dietary intake of 2- and 3-year-olds in Dutch child-care centres., Methods: The dietary intake of 135 children, aged 2 and 3 years, who were in child-care was assessed by observing randomly selected children at three meals (morning snack, lunch and afternoon snack) to determine dietary intake (i.e. saturated fat, dietary fibre and energy intake). The environment was observed using the Environment and Policy Assessment and Observation checklist, a structured instrument assessing the physical and social environment., Results: Children consumed a mean of 486 kJ (116 kcal) during the morning snack, 2043 kJ (488 kcal) during lunch and 708 kJ (169 kcal) during the afternoon snack. There were some gender and age differences in dietary intake. Several environmental factors (e.g. serving style and staff's model dietary behaviour) were significantly associated with the children's dietary intake., Conclusions: Overall, energy intake was in the upper range of recommended intake for children in child-care. The associations of several environmental factors with dietary intake stress the importance of the child-care environment for children's dietary behaviour. Intervening in this setting could possibly contribute to the comprehensive prevention of childhood obesity.

Objective: To examine clustering of energy balance-related behaviors (EBRBs) in young children. This is crucial because lifestyle habits are formed at an early age and track in later life. This study is the first to examine EBRB clustering in children as young as 2 years., Study Design: Cross-sectional data originated from the Child, Parent and Health: Lifestyle and Genetic Constitution (KOALA) Birth Cohort Study. Parents of 2578 2-year-old children completed a questionnaire. Correlation analyses, principal component analyses, and linear regression analyses were performed to examine clustering of EBRBs., Results: We found modest but consistent correlations in EBRBs. Two clusters emerged: a "sedentary-snacking cluster" and a "fiber cluster." Television viewing clustered with computer use and unhealthy dietary behaviors. Children who frequently consumed vegetables also consumed fruit and brown bread more often and white bread less often. Lower maternal education and maternal obesity were associated with high scores on the sedentary-snacking cluster, whereas higher educational level was associated with high fiber cluster scores., Conclusions: Obesity-prone behavioral clusters are already visible in 2-year-old children and are related to maternal characteristics. The findings suggest that obesity prevention should apply an integrated approach to physical activity and dietary intake in early childhood.

Background: Dietary flavonoids are suggested to have antiobesity effects. Prospective evidence of an association between flavonoids and body mass index (BMI) is lacking in general populations., Objective: We assessed this association between 3 flavonoid subgroups and BMI over a 14-y period in 4280 men and women aged 55-69 y at baseline from the Netherlands Cohort Study., Design: Dietary intake was estimated at baseline (1986) by a validated food-frequency questionnaire. BMI was ascertained through self-reported height (in 1986) and weight (in 1986, 1992, and 2000). Analyses were based on sex-specific quintiles for the total intake of 6 catechins and of 3 flavonols/flavones. Linear mixed effect modeling was used to assess longitudinal associations in 3 adjusted models: age only, lifestyle (age, energy intake, physical activity, smoking status, alcohol intake, type 2 diabetes, and coffee consumption), and lifestyle and diet (vegetables, fruit, fiber, grains, sugar, dessert, and dieting habits)., Results: After adjustment for age and confounders, the BMI (kg/m(2)) of women with the lowest intake of total flavonols/flavones and total catechins increased by 0.95 and 0.77, respectively, after 14 y. Women with the highest intake of total flavonols/flavones and total catechins experienced a significantly lower increase in BMI of 0.40 and 0.31, respectively (between group difference: P < 0.05). This difference remained after additional adjustment for dietary determinants and after stratification of median baseline BMI. In men, no significant differences in BMI change were observed over the quintiles of flavonoid intake after 14 y., Conclusion: Our results suggest that flavonoid intake may contribute to maintaining body weight in the general female population.

The objective of this study was to show or to exclude an effect of dietary supplement on rising prostate-specific antigen (PSA) levels. We have studied the effect of a dietary supplement (verum, administered for 6 weeks) containing plant estrogens, antioxidants, including carotenoids, selenium and other putative prostate cancer inhibiting substances in a randomized placebo-controlled double-blind crossover study in 37 hormonally untreated men with prostate cancer and increasing PSA levels. Outcome measures were changes in the rates of change of serum concentrations of total and free PSA and changes in male sex hormone levels. Male sex hormone levels were significantly lower during the verum phase (DHT: -0.11 nmol/L, p = 0.005; testosterone: -1 nmol/L, p = 0.02). Total PSA doubling time was unaffected. Free PSA, which increased during the placebo phase (average doubling time of 68 weeks), decreased during the verum period (average half-life of 13 weeks; p = 0.02). In those men in whom the free androgen index decreased (21 out of 32), a significant decrease in the slopes of both total and free PSA was observed (p = 0.04). Overall total PSA doubling times did not increase significantly during verum. However, the study demonstrates that this dietary intervention reduces DHT and testosterone levels and increases free PSA doubling time (and total PSA doubling time in a relevant subgroup). If future studies confirm that these observations translate into a slowing of disease progression, a dietary intervention may become an attractive option for prostate cancer treatment and prevention., ((c) 2004 Wiley-Liss, Inc.)

We reviewed 37 prospective cohort and four intervention studies on potential dietary risk factors for prostate cancer, published between 1966 and September 2003. Some studies were limited by small size, crude measurement of dietary exposure and limited control for confounders. Intervention and prospective cohort studies support a protective role against prostate cancer for selenium, and possibly for vitamin E, pulses and tomatoes/lycopene. Overall consumption of meat, eggs, vegetables, fruit, coffee, tea, carotenoids and vitamins A, C and D was not consistently related to prostate cancer risk. Intervention studies also indicate that supplementation with beta-carotene does not lower prostate cancer risk, except possibly in men with low beta-carotene status at baseline. For specific types of meat, alcoholic drinks, dairy products, fat and anthropometric measures, most cohort studies suggest either an increased risk or no relation with prostate cancer. For calcium, two cohort studies suggest an increased risk at very high calcium intakes (>2000 mg/day). In conclusion, prospective studies are consistent with a protective role for selenium, and possibly vitamin E, pulses and tomatoes/lycopene, in the aetiology of prostate cancer. Studies are inconclusive on the role of meat, dairy products, fat, vegetables, fruits, alcohol and anthropometric measures, whereas a very high calcium intake appears to be positively associated with prostate cancer risk.

Our meta-analysis was aimed at providing a systematic review of the literature regarding the effect of energy restriction on spontaneous mammary tumors in mice and at providing a more precise pooled (summary) estimate of the risk of mammary tumors. A sensitivity analysis was conducted to obtain insight in potential heterogeneity between the animal studies. A literature search was conducted with the following terms to identify relevant articles: animal studies, mammary tumors, fat restricted, dietary carbohydrates, energy restriction and calorie restriction. A criteria list for the assessment of quality items (i.e., study characteristics) in animal experiments was developed that was intended to quantitatively assess potential factors that underlie heterogeneous results of different animal experiments. Incidence figures were used to calculate the risk difference. The pooled risk difference was calculated by random effects meta regression analysis. Fourteen animal experiments were included in this meta-analysis. Publication bias could not be identified. The pooled risk difference for the 14 studies was -0.55 with a narrow 95% confidence interval (-0.69; -0.41), implying that the energy-restricted animal groups developed 55% less mammary tumors than the control groups. No heterogeneity could be detected between the studies based on study characteristics that included the age of mice at the start of intervention, duration of intervention, allocation of the mice, use of ad libitum control group, fertility of the mice and the type of energy-providing nutrient (fat, carbohydrate or protein). This meta-analysis confirms that energy restriction in itself consistently protects against the development of mammary tumor in mice, irrespective of the type of restricted nutrient or other study characteristics., (Copyright 2003 Wiley-Liss, Inc.)

To correct for overreporting of fruit and vegetable (FV) consumption in a food-frequency questionnaire, summary questions about consumption of main FV groups are often used to calculate correction factors. This study compared the ability to rank people according to their FV intake of those summary questions and the sum of questions on individual FV items within categories, and of corrected or uncorrected estimates of specific sorts of FV. Healthy middle-age women (n = 161) completed a food-frequency questionnaire about FV consumption during the previous month and gave a single fasting blood sample. Correction factors were calculated as the reported frequency on a summary question divided by the summed frequencies of all items in a category. Plasma carotenoids and vitamin C served as biomarkers of FV consumption. Significant correlations between FV consumption and biomarkers were observed (e.g., Spearman's correlation coefficient r with total carotenoids/vitamin C: 0.32/0.34 for vegetables, 0.30/0.25 for fruits). Summary estimates of cooked, raw and total vegetable consumption correlated higher with biomarkers than sum estimates. For fruits no differences in correlations between sum and summary estimates were observed. Applying a correction factor on the consumption of carrots and total cabbage resulted in lower correlations with relevant biomarkers. For broccoli/cauliflower, Brussels sprouts and citrus fruits, correlations with biomarkers did not change after correction. We conclude that summary questions may suffice to rank individuals according to their intake of main FV categories, and that correction for overreporting of individual FV items is probably not advisable when ranking individuals according to intake of these items.

The effect of increasing dietary folate on folate status during pregnancy is controversial. The aim of this study was to compare folate intake and folate status during pregnancy of women with high long-term vegetable intake and those eating an average Western diet. In a prospective study that included 109 participants, pregnant women adhering to a predominant vegetarian diet with high vegetable intake for 8 +/- 0.5 y with subgroups of ovo-lacto vegetarians (n = 27) and low meat eaters (n = 43) and women eating an average Western diet (control group, n = 39) were compared with regard to dietary intake and plasma and red blood cell (RBC) folate concentrations during wk 9-12, 20-22 and 36-38 of gestation. Plasma and RBC folate concentrations were highest in ovo-lacto vegetarians, followed by low meat eaters and lowest in the controls. Ovo-lacto vegetarians and low meat eaters showed a lower risk for folate deficiency, with RBC folate concentrations of <320 nmol/L resulting in odds ratios of 0.10 (95% confidence interval, 0.01-0.56) and 0.52 (95% confidence interval, 0.20-1.34), respectively. In ovo-lacto vegetarians, the RBC folate concentration was positively related to the intake of vitamin B-12 (r = 0.51, P: < 0.0001). The results of the study suggest that long-term high vegetable intake favorably affects plasma folate as well as RBC folate concentrations throughout pregnancy and reduces the risk of folate deficiency if an adequate vitamin B-12 supply is ensured.

Food is the major source for polychlorinated biphenyl (PCB) and dioxin accumulation in the human body. Therefore, investigating food habits from early ages until reproductive age (25 years) is important in order to assess exposure risk for the next generation. The objective of this study was to assess the PCB/dioxin exposure and the relative contribution of different foods to total exposure during preschool age. Particularly, the importance of lactational PCB/dioxin exposure vs. dietary exposure until adulthood was investigated. A cohort of 207 children was studied from birth until preschool age. Based on 3 planar PCBs and 17 2,3,7,8-substituted dibenzo-para-dioxins (PCDDs) and dibenzofurans (PCDFs) measured in breast milk, a model was developed to calculate the cumulative toxic equivalent (TEQ) intake during breast-feeding (0-1 year). In 3. 5-year-old children, daily dietary intake of planar PCB-TEQ and dioxin-TEQ was measured with a validated food questionnaire. Cumulative TEQ intake from 1 to 5 years was estimated using the PCB- and dioxin-TEQ intake measured with the food questionnaire. Cumulative TEQ intake from 6 to 25 years was estimated using national food consumption and contamination data of PCB- and dioxin-TEQ intake. In toddlers, dairy products contributed 43% to PCB-TEQ and 50% to dioxin-TEQ intake. Meat and meat products contributed 14% and 19%, respectively, and processed foods 23% and 15%, respectively. Breast-feeding for 6 months contributed to the cumulative PCB/dioxin TEQ intake until 25 years of age, 12% in boys and 14% in girls. The daily TEQ intake per kilogram body weight is 50 times higher in breast-fed infants and three times higher in toddlers than in adults. Long-term dietary exposure to PCBs and dioxins in men and women is partly due to breast-feeding (12 and 14%, respectively). After weaning, dairy products, processed foods, and meat are major contributors of PCB and dioxin accumulation until reproductive age. Instead of discouraging breast-feeding, maternal transfer of PCBs and dioxins to the next generation must be avoided by enforcement of strict regulations for PCB and dioxin discharge and by reducing consumption of animal products and processed foods in all ages.

Children who are fed alternative and especially macrobiotic diets have been reported to be smaller and weigh less than their peers fed omnivorous diets. To answer the questions: at what age does growth in children on macrobiotic diets slow down, and is there any return to standards later in childhood, a cross-sectional anthropometric study was performed in the Dutch macrobiotic child population aged 0-8 years (n = 243). Addresses were obtained from macrobiotic organizations and from families already participating in the study. Food habits were checked by a structured food frequency questionnaire. Anthropometric measurements included weight, height, mid-upper arm circumference and triceps and subscapular skinfolds. For each sex, age curves were constructed in comparison to standards. For selected age intervals, standard deviation scores (SDS) were tested for differences from the reference after accounting for confounding variables in a multiple regression model. Reported birth weight was 150 g lower than the Dutch reference; birth weight was positively associated with the consumption frequency of dairy products and fish. During the first 6-8 months of life, SDS were not different from the standard except for arm circumference and skinfolds. From 6-8 months onwards, growth stagnation occurred in both sexes, but was most marked in girls. A minimum level of 1 to 1.5 SD below the P50 of the reference was reached by the age of 18 months. Between 2 and 4 years a partial return towards the P50 occurred for arm circumference and, in boys only, for weight and skinfolds, but not for height. SDS of weight, height and arm circumference were higher in children from families with regular consumption of dairy products than in children from families avoiding dairy products.

A mixed-longitudinal study was carried out in the 1985 Dutch birth cohort of macrobiotic infants aged 4-18 months (n = 53) and 57 omnivorous control infants matched for month of birth, sex, parity, educational level of the father and the residential area. Study methods included regular anthropometric measurements and a psychomotor testing. Reported birth weight was 180 g lower in the macrobiotic group than in the control group and was positively associated with maternal weight increase during pregnancy. Between 4 and 18 months of age, mean values for all anthropometric parameters were considerably lower in the macrobiotic infants. From birth to 4 months, weight gain was less in macrobiotic infants, and from 6 months the rate of growth in weight and length decreased further, reaching its lowest value between 8 and 14 months of age. A similar pattern was also observed for other anthropometric parameters. Between 8 and 14 months, arm circumference showed an absolute decrease. During this period, increase in arm muscle mass in the macrobiotic group was only half of that in the control group. From 14 months of age, growth stabilized parallel to the 10th percentile of the Dutch references. Gross motor and language development were also slower in the macrobiotic infants. The paediatrician observed major wasting of skin and muscles in 30 per cent of them. The growth rate for weight and arm circumference was independently associated with the energy intake and the protein content of the macrobiotic diet. Growth in length was positively associated with protein content of the diet, but not with energy intake.

Information on food intake during weaning was collected as part of a mixed-longitudinal study on the nutritional status and growth of the 1985 Dutch birth cohort of infants on macrobiotic diets (n = 53) and a matched control group on omnivorous diets (m = 57). Weighed food records over 3d, including breast-milk, were obtained on 49 macrobiotic and 57 control infants at 2-monthly intervals between the ages of 6 and 16 months. Intake of energy and nutrients was calculated using the Dutch food composition table which was supplemented by our own analyses of 50 macrobiotic foods. Ninety-six per cent of the macrobiotic infants and 74 per cent of the control infants had been breast-fed, but breast-feeding continued longer in the macrobiotic group (13.6 vs 6.6 months, P less than 0.001). In the macrobiotic group, complementary feeding started at 4.8 months with water-based cereal porridges, followed later by vegetables, sesame seeds and pulses. Fruits were rarely given and products of animal origin were avoided. For all age groups combined, the intake of energy, protein, fat, calcium, riboflavin and vitamin B12 was significantly lower in the macrobiotic infants, whereas their intake of polysaccharides, fibre, iron and thiamin was higher than that of the control infants. The macrobiotic weaning diet tended to be bulky with a low energy density (2.4 kJ/g, controls: 3.4 kJ/g, P less than 0.05) and a high fibre content. Protein intake of the macrobiotic infants was only 80 per cent of the Dutch recommended daily intakes at the age of 6-8 months, and at 8 months, 69 per cent of this was derived from plant sources. Calcium intake was 280 mg/d; correction for calcium derived from hard tap-water raised the calcium intake to 308 mg in the macrobiotic age group of 14 months. The evidence of biochemical deficiencies of iron, riboflavin, vitamin B12, vitamin D and calcium is discussed. It is suggested that the macrobiotic diet should be supplemented with fat, fatty fish and dairy products.