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Peer reviewed: True, Funder: Public Health England and the UK Food Standards Agency, The UK National Diet and Nutrition Survey rolling programme (NDNS RP) commenced in 2008 and moved in 2019 from a traditional paper food diary to a web-based 24 h recall, Intake24. This paper describes the approach to update and downsize the underlying UK Nutrient Databank (NDB) for efficient data management and integration into Intake24. Consumption data from the first 10 years (2008/2009 to 2017/2018) of NDNS RP informed decisions on whether foods from the extensive UK NDB were to be retained, excluded, revised or added to for creation of a rationalised NDB. Overall, 5933 food codes in the extensive NDB were reduced to 2481 food codes in the rationalised NDB. Impact on assessment of nutrient intakes was evaluated by re-coding NDNS 2017 data using the rationalised NDB. Small differences were observed between estimated intakes (Cohen's d ≤ 0.1) for all nutrients and there was a good level of agreement (Cohen's κ ≥ 0.6) between the extensive and rationalised NDBs. The evaluation provides confidence in dietary intake estimates for ongoing nutritional surveillance in the UK and strengthens the evidence of a good agreement between concise food databases and large food databases incorporated into web-based 24 h recalls for estimating nutrient intakes at the population level.

Additional file 1: Text S1. Dietary assessment and creation of the MedDiet scores. Table S1. Components and scoring of the MEDAS and MEDAS Continuous Mediterranean diet scores. Table S2. Components and scoring of the PYRAMID Mediterranean diet adherence score. Table S3. ICD-9 and ICD-10 codes for dementia diagnosis. Figure S1. Participant flowchart. Table S4. Risk of incident dementia according to Mediterranean diet adherence, with analyses restricted to individuals with a minimum of 2 dietary reports. Table S5. Risk of incident dementia according to Mediterranean diet adherence excluding participants with extreme energy intakes. Table S6. Influence of each component of the MEDAS and MEDAS Continuous scores on dementia risk. Table S7. Influence of each component of the PYRAMID score on dementia risk. Table S8. Risk of incident dementia according to Mediterranean diet adherence, excluding participants with less than 2 years and 5 years of follow up. Table S9. Sensitivity analyses adjusting for potential effect mediators (BMI, Depression and stroke). Table S10. Association between MedDiet adherence and risk of dementia in analyses stratified by polygenic risk score tertiles. Table S11. Associations between MedDiet adherence and dementia incidence in APOE ε4 non-carriers and carriers. Table S12. Associations between MedDiet adherence and dementia incidence in analyses where missing data were imputed. Table S13. Risk of incident dementia according to Mediterranean diet adherence restricted to fatal and non-fatal dementia cases. Table S14. Risk of incident dementia according to Mediterranean diet adherence for individuals with higher and lower education levels.

In a cross-sectional analysis of a population-based cohort (United Kingdom, N = 21,318, 1993-1998), we studied how associations between meal patterns and non-fasting triglyceride and glucose concentrations were influenced by the hour of day at which the blood sample was collected to ascertain face validity of reported meal patterns, as well as the influence of reporting bias (assessed using formula of energy expenditure) on this association. Meal size (i.e., reported energy content), mealtime and meal frequency were reported using pre-structured 7-day diet diaries. In ANCOVA, sex-specific means of biomarker concentrations were calculated by hour of blood sample collection for quartiles of reported energy intake at breakfast, lunch and dinner (meal size). Significant interactions were observed between breakfast size, sampling time and triglyceride concentrations and between lunch size, sampling time and triglyceride, as well as glucose concentrations. Those skipping breakfast had the lowest triglyceride concentrations in the morning and those skipping lunch had the lowest triglyceride and glucose concentrations in the afternoon, especially among acceptable energy reporters. Eating and drinking occasion frequency was weakly associated with glucose concentrations in women and positively associated with triglyceride concentrations in both sexes; stronger associations were observed for larger vs. smaller meals and among acceptable energy reporters. Associations between meal patterns and concentration biomarkers can be observed when accounting for diurnal variation and underreporting. These findings support the use of 7-day diet diaries for studying associations between meal patterns and health.

The aim of the present study was to describe the energy, nutrient and crude v. disaggregated food intake measured using 7 d diet diaries (7dDD) for the full baseline Norfolk cohort recruited for the European Prospective Investigation into Cancer (EPIC-Norfolk) study, with emphasis on methodological issues. The first data collection took place between 1993 and 1998 in Norfolk, East Anglia (UK). Of the 30,445 men and women, aged 40-79 years, registered with a general practitioner invited to participate in the study, 25,639 came for a health examination and were asked to complete a 7dDD. Data from diaries with data recorded for at least 1 d were obtained for 99% members of the cohort; 10,354 (89·8%) of the men and 12,779 (91·5%) of the women completed the diet diaries for all 7 d. Mean energy intake (EI) was 9·44 (SD 2·22) MJ/d and 7·15 (SD 1·66) MJ/d, respectively. EI remained approximately stable across the days, but there was apparent under-reporting among the participants, especially among those with BMI >25 kg/m². Micronutrient density was higher among women than among men. In conclusion, under-reporting is an issue, but not more so than that found in national surveys. How foods were grouped (crude or disaggregated) made a difference to the estimates obtained, and comparison of intakes showed wide limits of agreement. The choice of variables influences estimates obtained from the food group data; while this may not alter the ranking of individuals within studies, this issue may be relevant when comparing absolute food intakes between studies.

OBJECTIVES: To describe the research methods for the development of a new open source, cross-platform tool which processes data from the European Prospective Investigation into Cancer and Nutrition Norfolk Food Frequency Questionnaire (EPIC-Norfolk FFQ). A further aim was to compare nutrient and food group values derived from the current tool (FETA, FFQ EPIC Tool for Analysis) with the previously validated but less accessible tool, CAFÉ (Compositional Analyses from Frequency Estimates). The effect of text matching on intake data was also investigated. DESIGN: Cross-sectional analysis of a prospective cohort study-EPIC-Norfolk. SETTING: East England population (city of Norwich and its surrounding small towns and rural areas). PARTICIPANTS: Complete FFQ data from 11 250 men and 13 602 women (mean age 59 years; range 40-79 years). OUTCOME MEASURES: Nutrient and food group intakes derived from FETA and CAFÉ analyses of EPIC-Norfolk FFQ data. RESULTS: Nutrient outputs from FETA and CAFÉ were similar; mean (SD) energy intake from FETA was 9222 kJ (2633) in men, 8113 kJ (2296) in women, compared with CAFÉ intakes of 9175 kJ (2630) in men, 8091 kJ (2298) in women. The majority of differences resulted in one or less quintile change (98.7%). Only mean daily fruit and vegetable food group intakes were higher in women than in men (278 vs 212 and 284 vs 255 g, respectively). Quintile changes were evident for all nutrients, with the exception of alcohol, when text matching was not executed; however, only the cereals food group was affected. CONCLUSIONS: FETA produces similar nutrient and food group values to the previously validated CAFÉ but has the advantages of being open source, cross-platform and complete with a data-entry form directly compatible with the software. The tool will facilitate research using the EPIC-Norfolk FFQ, and can be customised for different study populations.

Objectives: Assess the association between marine omega-3 polyunsaturated fatty acid (n 3 PUFA) intake from supplements, mainly cod liver oil, and coronary heart disease (CHD) mortality. Design: Prospective cohort study, with three exposure measurements over 22 y. Setting: Norfolk-based European Prospective Investigation into Cancer (EPIC-Norfolk, UK). Participants: 22,035 men and women from the general population, 39-79 y at recruitment. Exposure: Supplement use was assessed in three questionnaires (1993-1998; 2002-2004; 2004-2011). Participants were grouped into non-supplement users (NSU), n 3 PUFA supplement users (SU+n3) and non n 3 PUFA supplement users (SU n3). Cox regression adjusted for time-point specific variables: age, smoking, prevalent illnesses, BMI, alcohol consumption, physical activity and season and baseline assessments of sex, social class, education and dietary intake (7-day diet diary). Primary and secondary outcome measures: During a median of 19 y follow-up, 1562 CHD deaths were registered for 22,035 included participants. Results: Baseline supplement use was not associated with CHD mortality, but baseline food and supplement intake of n 3 PUFA was inversely associated with CHD mortality after adjustment for fish consumption. Using time-varying covariate analysis, significant associations were observed for SU+n3 (HR: 0.74, 95%CI: 0.66, 0.84), but not for SU n3 vs. NSU. In further analyses, the association for SU+n3 persisted in those who did not take other supplements (HR: 0.83, 95%CI: 0.71, 0.96) and those who did (HR: 0.74, 95%CI: 0.60, 0.91). Those who became SU+n3 over time or were consistent SU+n3 vs. consistent NSU had a lower hazard of CHD mortality; no association with CHD was observed in those who stopped using n 3 PUFA-containing supplements. Conclusions: Recent use of n 3 PUFA supplements was associated with a lower hazard of CHD mortality in this general population with low fish consumption. Residual confounding cannot be excluded, but the findings observed may be explained by postulated biological mechanisms and the results were specific to SU+n3.

Additional file 1. Supplementary information. Baseline characteristics of EPIC-Norfolk men and women who attended 1HE, and those who attended both 1HE and 2HE, before and after exclusion criteria were applied. Cox multivariable-adjusted HRs after 16â years of follow-up for CVD mortality in 5469 men.

Studies have reported a higher mortality risk associated with weight loss, particularly in middle-aged and older adults, although some of these studies did find that gaining weight was also associated with an increased mortality risk. We examined changes in weight in relation to mortality in a prospective population-based cohort study of men and women, resident in Norfolk, UK. Participants were assessed at baseline (1993-1997) and at a second examination (1998-2000), as part of the European Prospective Investigation into Cancer and Nutrition (EPIC-Norfolk) study, and followed up to 2015 for mortality. Participants with a self-reported history of cancer or cardiovascular disease, body mass index < 18.5 kg/m2 or missing data on adjustment variables, at either time-point were excluded, leaving 12,580 participants, aged 39-78 in 1993-1997, eligible for analyses. Cox proportional hazards models were used to determine Hazard Ratios (HRs) for all-cause (2603 deaths), cardiovascular (749 deaths), cancer (981 deaths), respiratory (226 deaths) and other causes of mortality (647 deaths) by categories of weight change. After multivariate adjustment, the HRs (95% CIs) for all-cause mortality for men and women who lost more than 5 kg were 1.85 (1.48-2.31) and 1.64 (1.31-2.05) respectively. Higher hazards were also found for specific causes of mortality and weight loss > 5 kg. Similar associations were observed after excluding deaths in the first 5 years of follow-up. Results for weight gain were inconclusive. We conclude that objectively measured weight loss, but not weight gain, was associated with subsequent higher mortality risk in this population-based study of middle-aged and elderly men and women. However, undiagnosed, pre-existing disease and the inability to account for weight cycling need to be remembered when interpreting these results. Unravelling the causal pathways underlying this association will require more detailed studies, including that of changes in body composition.