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Background: Health researchers may struggle to choose suitable validated dietary assessment tools (DATs) for their target population. The aim of this review was to identify and collate information on validated UK DATs and validation studies for inclusion on a website to support researchers to choose appropriate DATs.Design: A systematic review of reviews of DATs was undertaken. DATs validated in UK populations were extracted from the studies identified. A searchable website was designed to display these data. Additionally, mean differences and limits of agreement between test and comparison methods were summarized by a method, weighting by sample size.Results: Over 900 validation results covering 5 life stages, 18 nutrients, 6 dietary assessment methods, and 9 validation method types were extracted from 63 validated DATs which were identified from 68 reviews. These were incorporated into www.nutritools.org. Limits of agreement were determined for about half of validations. Thirty four DATs were FFQs. Only 17 DATs were validated against biomarkers, and only 19 DATs were validated in infant/children/adolescents.Conclusions: The interactive www.nutritools.org website holds extensive validation data identified from this review and can be used to guide researchers to critically compare and choose a suitable DAT for their research question, leading to improvement of nutritional epidemiology research.

BackgroundAge at natural menopause is a matter of concern for women of reproductive age as both an early or late menopause may have implications for health outcomes.MethodsStudy participants were women aged 40–65 years who had experienced a natural menopause from the UK Women’s Cohort Study between baseline and first follow-up. Natural menopause was defined as the permanent cessation of menstrual periods for at least 12 consecutive months. A food frequency questionnaire was used to estimate diet at baseline. Reproductive history of participants was also recorded. Regression modelling, adjusting for confounders, was used to assess associations between diet and age at natural menopause.ResultsDuring the 4-year follow-up period, 914 women experienced a natural menopause. A high intake of oily fish and fresh legumes were associated with delayed onset of natural menopause by 3.3 years per portion/day (99% CI 0.8 to 5.8) and 0.9 years per portion/day (99% CI 0.0 to 1.8), respectively. Refined pasta and rice was associated with earlier menopause (per portion/day: −1.5 years, 99% CI −2.8 to −0.2). A higher intake of vitamin B6 (per mg/day: 0.6 years, 99% CI 0.1 to 1.2) and zinc (per mg/day: 0.3 years, 99% CI −0.0 to 0.6) was also associated with later age at menopause. Stratification by age at baseline led to attenuated results.ConclusionOur results suggest that some food groups (oily fish, fresh legumes, refined pasta and rice) and specific nutrients are individually predictive of age at natural menopause.

ObjectivesExplore associations between maternal and neonatal outcomes and maternal age, with particular reference to adolescent women.DesignPopulation-based cohort study.SettingMaternity department of a large hospital in Northern England.ParticipantsPrimiparous women delivering a singleton at Bradford Royal Infirmary between March 2007 and December 2010 aged ≤19 years (n=640) or 20–34 years (n=3951). Subgroup analysis was performed using women aged ≤16 years (n=68). Women aged 20–34 years were used as the reference group.Primary outcome measuresMaternal and neonatal outcomes.ResultsThe odds of extremely low birth weight (Women in the adolescent group had lower odds of gestational diabetes (aOR 0.35, 95% CI 0.20 to 0.62), caesarean delivery (aOR 0.53, 95% CI 0.42 to 0.67 and instrumental delivery (aOR 0.53, 95% CI 0.41 to 0.67).ConclusionsThis study identifies important differences in maternal and neonatal outcomes between women by age group. These findings could help in identifying at-risk groups for additional support and tailored interventions to minimise the risk of adverse outcomes for these vulnerable groups. Further work is needed to identify the causal mechanisms linking age with outcomes in adolescent women where significant gaps in the literature exist.

Accurate diet measurement is challenging and strategies to support researchers in selecting the most appropriate dietary assessment tools (DATs) are required. DIET@NET (DIETary Assessment tools NETwork) partnership aimed to create an online resource that provides guidelines for selecting tools with access to validated DATs. The Nutritools website(1) (www.nutritools.org), was developed using 3 approaches. 1) Creation of Best Practice Guidelines(2), enabling researchers to choose the most appropriate DAT for their work. These were generated using the Delphi method which enabled integration of expert views. 2) Creating an interactive DAT e-library, with the DATs being identified through a systematic review of systematic reviews(3). Bubble charts and summary plots are used to compare DATs. 3) Development of a Food Questionnaire Creator (FQC), an online interface between food tables and the DATs which allows users to create their own food questionnaires. This work was overseen by the DIET@NET partnership. Other useful information includes links to food composition databases and a detailed glossary of terms. Results from the systematic review of reviews generated information for Nutritools. The website includes 127 international validated tools, of which 63 tools were validated in the UK (with 45 validated from year 2000 onwards). The majority (n = 34) of the validated tools were food frequency questionnaires, developed from 1981 to 2016. Numbers of foods included ranged from 8–692 items. Five of the 12 dietary recalls included were web-based. Tools were usually validated against another self-reported dietary assessment method, mainly weighed food diaries. More than 1500 papers with non-UK tools were identified, of these, data on 64 international tools and their validation studies were added to Nutritools. The FQC allows for food questionnaires to be created using data from the UK National Diet and Nutrition Survey (NDNS) Year 6 and the Composition of Foods Integrated Dataset. Results from the NDNS can be used to formulate food questions that capture a large proportion of the nutrients of interest and to inform portion sizes. In conclusion, Nutritools (www.nutritools.org), is an online platform that hosts international validated and interactive DATs. Researchers can use the interactive Best Practice Guidelines and features in the selection of the most appropriate DAT for their study, and the Food Questionnaire Creator to develop their own online food questionnaires. This project was funded by the Medical Research Council (MRC) (ref: MR/L02019X/1). 1. Warthon-Medina M, Hooson J, Hancock N, et al. (2017) The Lancet 390, pS94. 2. Cade JE, Warthon-Medina M, Albar S, et al. (2017) BMC Medicine 15(1), p202. 3. Hooson J, Hancock N, Greenwood DC, et al. (2016) Proc Nutr Soc 75(OCE3).

Studies have found that longer breastfeeding duration is associated with the risk of having ovarian cancer and other hormonal related cancers(1). However, the evidence is still inconsistent with a limited number of prospective studies providing evidence(2). Therefore, this analysis aimed to explore the association between breastfeeding duration and the risks of ovarian cancer in a large prospective cohort of middle-aged women, the UK Women’s Cohort Study (UKWCS). The UKWCS participants were recruited in 1995–1998 at the age of 35–69 years(3). Cancer incidence was obtained from the Office of National Statistics (ONS). A baseline questionnaire was used to estimate breastfeeding duration, ranging from >0 months to >6 months. Patients with prevalent cancers were excluded. The relationship between breast feeding duration and incidence of ovarian cancer was tested using survival analysis adjusting for age, children, socio-economic class, menopausal status, smoking status, body mass index, energy intake and age at menarche. The total number of incident ovarian cancer cases was 224 over 16 years follow up. Mean age at recruitment was 54 years. Breastfeeding duration for each child shows that ever breastfeeding was associated with 6 % risk reduction of ovarian cancer, after adjustment for confounders (HR: 0·94; 95 % CI: 0·90 to 0·99). Further analysis on breastfeeding duration per child shows that the risk reduces by 43 % among those who breastfed for more than 6 months per child (HR: 0·57; 95 % CI: 0·35 to 0·95). Additional analysis was done on cumulative breastfeeding duration across all children, with ovarian cancer risk, which shows a 2 % risk reduction for every 1 month of breastfeeding (HR: 0·98; 95 % CI: 0·97 to 1·00). In conclusion, ever breastfeeding per child was associated with 6 % risk reduction of ovarian cancer in a fully adjusted model and those who were breastfeeding for more than 6-month benefit more with a high-risk reduction of ovarian cancer by 43 %. This finding supports the World Health Organisation (WHO) recommendation for women to breastfeed for at least 6 months for each child. Future studies are warranted to determine if the duration of breastfeeding per child provides more meaningful data than cumulative breastfeeding duration. The average duration of breastfeeding per child might have more public health applicability than total duration and is a better reflection of lactation amenorrhea(1). 1. Luan NN, Wu QJ, Gong TT et al. (2013) Breastfeeding and ovarian cancer risk: a meta-analysis of epidemiologic studies.AmJ Clin Nutr 98, 1020–31. 2. Feng LP, Chen HL & Shen MY (2014) Breastfeeding and the risk of ovarian cancer: a meta-analysis. J Midwifery Womens Health 59, 428–37. 3. Cade JE, Burley VJ, Alwan NA et al. (2017) Cohort Profile: The UK Women’s Cohort Study (UKWCS). Int J Epidemiol 46, e11.

Regular nut consumption is associated with reduced risk factors for chronic disease; however, most population-based studies lack consideration of effect modification by dietary pattern. The UK Women’s Cohort Study (UKWCS) provides an ideal opportunity to examine relationships between nut consumption and chronic disease risk factors in a large sample with diverse dietary patterns. Nut and nutrient intake from 34,831 women was estimated using a food frequency questionnaire among self-identified omnivores, vegetarians and vegans. In this cross-sectional analysis, higher nut consumption was associated with lower body weight (difference between highest and lowest consumption categories from adjusted model: 6.1 kg; 95% CI: 4.7, 7.6) body mass index (BMI, 2.4 units difference; 95% CI: 1.9, 2.9), and waist circumference (2.6 cm difference; 95% CI: 1.4, 3.8) (all p for linear trend < 0.001). Higher nut consumption was also associated with reduced prevalence of high cholesterol and high blood pressure; having a history of heart attack, diabetes and gallstones; and markers of diet quality (all adjusted p for linear trend ≤ 0.011). Higher nut consumption appeared overall to be associated with greater benefits amongst omnivores compared to vegetarians and vegans. Findings support existing literature around beneficial effects of nut consumption and suggest that benefits may be larger among omnivores. Nut promotion strategies may have the highest population impact by specifically targeting this group.

The use of different analytical methods to measure the dietary fibre content of foods complicates the interpretation of epidemiological studies. The aim of this study was to determine the total (TDF) and insoluble (IDF) fibre content of 14 boiled and canned legumes commonly consumed in the UK using the Association of Official Analytical Chemists (AOAC) enzymatic gravimetric method. The fibre values obtained were compared to non-starch polysaccharide (NSP) values. The results showed that mean values for TDF (2.7–11.2 g/100 g) were higher than NSP (2.6–6.7 g/100 g), with a mean NSP:TDF ratio of 1:1.43. TDF was correlated with NSP (r = 0.6; p = 0.02). Canning significantly reduced TDF and IDF by an average of 30% and 26% compared to boiling respectively. However, IDF represented at least 60% of the TDF in both boiled and canned samples. In conclusion, fibre values are affected by the processing and analytical method used.

Handheld electronic devices could offer a convenient and scalable platform with which to deliver a weight loss intervention. This paper aims to summarise the evidence provided by randomised trials of such interventions. There is heterogeneity among trials in terms of the components of the intervention package, the theoretical framework, the comparison groups and the duration of follow-up. While in the short term (

To determine whether general dietary supplement use is associated with cancer risk in UK women and to estimate risks related to use at one and two recording points. Cox’s proportional hazard regression models were used to estimate cancer risks for 32 665 middle-aged women in the UK Women’s Cohort Study relating to any current supplement use recorded in a baseline questionnaire. During a median follow-up of 15 years, there were 3936 registered cancer incidences, including 1344 breast, 429 smoking-related and 362 colorectal cancers. Cancer risks for 12 948 of these women, who also completed questionnaires on average 4.4 years later, were estimated in relation to any supplement use at both time points (1527 cancers, including 561 breast, 131 smoking-related and 141 colorectal cancers). Adjustments were made for baseline confounders. Total smoking-related cancers were associated with baseline supplement use (hazard ratio (HR)=1.41, 95% confidence interval (CI): 1.10, 1.81) compared with non-use, but not associated with use at both recording points (HR=1.29; 95% CI: 0.78, 2.13) compared with use at neither. There was no evidence of the associations between total, colorectal or breast cancers and baseline supplement use, or use at both recording points. In sub-analyses, no significant associations with breast cancer were found for premenopausal or postmenopausal baseline users, or similarly for use at both points (HR=1.35, 95% CI: 0.91, 2.01; and HR=0.93, 95% CI: 0.68, 1.26, respectively). There was evidence that general supplement use was associated with increased smoking-related cancer risk, but there was no evidence of associations with total, colorectal and breast cancers.

OBJECTIVE Diets with high glycemic index (GI), with high glycemic load (GL), or high in all carbohydrates may predispose to higher blood glucose and insulin concentrations, glucose intolerance, and risk of type 2 diabetes. We aimed to conduct a systematic literature review and dose–response meta-analysis of evidence from prospective cohorts. RESEARCH DESIGN AND METHODS We searched the Cochrane Library, MEDLINE, MEDLINE in-process, Embase, CAB Abstracts, ISI Web of Science, and BIOSIS for prospective studies of GI, GL, and total carbohydrates in relation to risk of type 2 diabetes up to 17 July 2012. Data were extracted from 24 publications on 21 cohort studies. Studies using different exposure categories were combined on the same scale using linear and nonlinear dose–response trends. Summary relative risks (RRs) were estimated using random-effects meta-analysis. RESULTS The summary RR was 1.08 per 5 GI units (95% CI 1.02–1.15; P = 0.01), 1.03 per 20 GL units (95% CI 1.00–1.05; P = 0.02), and 0.97 per 50 g/day of carbohydrate (95% CI 0.90–1.06; P = 0.5). Dose–response trends were linear for GI and GL but more complex for total carbohydrate intake. Heterogeneity was high for all exposures (I2 >50%), partly accounted for by different covariate adjustment and length of follow-up. CONCLUSIONS Included studies were observational and should be interpreted cautiously. However, our findings are consistent with protective effects of low dietary GI and GL, quantifying the range of intakes associated with lower risk. Future research could focus on the type of sugars and other carbohydrates associated with greatest risk.

Dietary fibre has been associated with improvements in key risk factors for cardiovascular disease (CVD). Prior research has focussed more on CVD development in men and our aim was therefore to explore the association between dietary fibre intake and CVD mortality using data from the United Kingdom Women’s Cohort Study (UKWCS). Dietary fibre intake from 31,036 women was calculated both as non-starch polysaccharide (NSP) and using the Association of Official Analytical Chemist (AOAC) method from food-frequency questionnaires. Participants were free from history of CVD at baseline and mean age at recruitment was 51.8 years (standard deviation 9.2). Mortality records for participants were linked from national registry data and 258 fatal CVD cases [130 stroke, 128 coronary heart disease (CHD)] were observed over an average follow-up period of 14.3 years. Total dietary fibre (NSP/AOAC) and fibre from different food sources were not associated with fatal CHD, stroke or CVD risk in the full sample. For every 6 g/day increase in NSP, the hazard ratio (HR) was 0.91 (95 % confidence interval (CI) 0.76–1.08) or for every 11 g/day increase in fibre assessed as AOAC, the HR was 0.92 (95 % CI 0.80–1.05). Sensitivity analyses suggest a possible protective association for cereal sources of fibre on fatal stroke risk in overweight women, HR 0.80 (95 % CI 0.65–0.93) p < 0.01. In the UKWCS, a sample of health-conscious women, greater dietary fibre intake may confer no additional cardiovascular benefit, in terms of mortality, but may contribute to lower fatal stroke risk in some subgroups such as overweight women.

Research into the analysis, physical properties and health effects of dietary fibre has continued steadily over the last 40–50 years. From the knowledge gained, countries have developed guidelines for their populations on the optimal amount of fibre to be consumed each day. Food composition tables from many countries now contain values for the dietary fibre content of foods, and, from these, combined with dietary surveys, population intakes have been determined. The present review assessed the uniformity of the analytical methods used, health claims permitted, recommendations and intakes, particularly from national surveys across Europe and around the world. It also assessed current knowledge on health effects of dietary fibre and related the impact of different fibre types on health. The overall intent was to be able to provide more detailed guidance on the types of fibre which should be consumed for good health, rather than simply a total intake figure, the current situation. Analysis of data indicated a fair degree of uniformity in the definition of dietary fibre, the method used for analysis, the recommended amount to be consumed and a growing literature on effects on digestive health and disease risk. However, national dietary survey data showed that intakes do not reach recommendations and very few countries provide guidance on the types of fibre that are preferable to achieve recommended intakes. Research gaps were identified and ideas suggested to provide information for more detailed advice to the public about specific food sources that should be consumed to achieve health benefits.

Summary Obesity is a major public health issue and research is turning to information communication technologies as a means to deliver weight management interventions. A smartphone application (app) which allows the user to self monitor food intake and physical activity could be one such convenient and wide reaching approach. A smartphone app called ‘My Meal Mate’ (MMM) has been developed which uses behavioural strategies of goal setting, self monitoring and feedback to aid weight management. The development of the app has been informed by focus groups with potential system users and by benchmarking against popular diet tracking applications available to download. This paper describes the MMM app, discusses its development and outlines plans for further investigation.

STUDY QUESTION Are parity and the timing of menarche associated with premature and early natural menopause? SUMMARY ANSWER Early menarche (≤11 years) is a risk factor for both premature menopause (final menstrual period, FMP

Background Babies born to adolescent mothers have been shown to have poorer outcomes compared to those born to adults. Nutritional status may have an important role to play in improving the health of pregnant adolescents; however there is a lack of evidence regarding the adequacy of adolescent diets during pregnancy. This systematic review aims to examine what is known about the nutritional status of adolescent pregnant women. Methods A systematic search of the literature identified 21 studies which met the inclusion criteria for the review. Primary research papers using any methods were included where they were published in English between January 1995 and May 2015 and included measurements of nutrient intakes or biological markers of nutritional status in pregnant women aged 11–19 years. Individual study data was first summarised narratively before study means were pooled to give an estimate of nutritional status in the population. Results The results show that individual studies reported intakes of energy, fibre and a number of key micronutrients which were below recommended levels. Biological markers of iron and selenium status also showed cause for concern. Pooled analysis of individual means as a percentage of UK Dietary Reference Intakes showed intakes of vitamin D (34.8 % CI 0–83.1) to be significantly below recommendations (p = 0.05). Serum selenium levels were also found to be low (61.8 μg/L, CI 39–84). Conclusions This review has identified a number of areas where the nutritional status of pregnant adolescents is sub-optimal, which may have implications for the health of adolescent mothers and their babies. It was not however possible to examine the impact of supplement use or socio-demographic characteristics which limits the interpretation these results. Further work is needed to establish the characteristics of those most at risk within this population, how this differs from adult pregnant women and the role of supplementation in achieving adequate nutrition. Electronic supplementary material The online version of this article (doi:10.1186/s12884-016-1059-9) contains supplementary material, which is available to authorized users.

Background: High blood pressure is a strong risk factor for cardiovascular disease.Objective: The aim of this study was to determine the associations of dietary glycemic index (GI) and glycemic load (GL) with systolic blood pressure (SBP) and diastolic blood pressure (DBP) in healthy individuals.Design: A systematic review and meta-analysis of randomized controlled trials (RCTs) was carried out. Databases were searched for eligible RCTs in 2 phases. MEDLINE, Embase, CAB Abstracts, BIOSIS, ISI Web of Science, and the Cochrane Library were searched from January 1990 to December 2009. An updated search was undertaken with the use of MEDLINE and Embase from January 2010 to September 2016. Trials were included if they reported author-defined high- and low-GI or -GL diets and blood pressure, were of ≥6 wk duration, and comprised healthy participants without chronic conditions. Data were extracted and analyzed with the use of Stata statistical software. Pooled estimates and 95% CIs were calculated with the use of weighted mean differences and random-effects models.Results: Data were extracted from 14 trials comprising 1097 participants. Thirteen trials provided information on differences in GI between control and intervention arms. A median reduction in GI of 10 units reduced the overall pooled estimates for SBP and DBP by 1.1 mm Hg (95% CI: -0.3, 2.5 mm Hg; P = 0.11) and 1.3 mm Hg (95% CI: 0.2 mm Hg, 2.3; P = 0.02), respectively. Nine trials reported information on differences in GL between arms. A median reduction in GL of 28 units reduced the overall pooled estimates for SBP and DBP by 2.0 mm Hg (95% CI: 0.2, 3.8 mm Hg; P = 0.03) and 1.4 mm Hg (95% CI: 0.1, 2.6 mm Hg; P = 0.03), respectively.Conclusions: This review of healthy individuals indicated that a lower glycemic diet may lead to important reductions in blood pressure. However, many of the trials included in the analysis reported important sources of bias. This trial was registered at PROSPERO as CRD42016049026.

Udgivelsesdato: 2010-May-5 BACKGROUND: Results of epidemiological studies of dietary fiber and colorectal cancer risk have not been consistent, possibly because of attenuation of associations due to measurement error in dietary exposure ascertainment. METHODS: To examine the association between dietary fiber intake and colorectal cancer risk, we conducted a prospective case-control study nested within seven UK cohort studies, which included 579 case patients who developed incident colorectal cancer and 1996 matched control subjects. We used standardized dietary data obtained from 4- to 7-day food diaries that were completed by all participants to calculate the odds ratios for colorectal, colon, and rectal cancers with the use of conditional logistic regression models that adjusted for relevant covariates. We also calculated odds ratios for colorectal cancer by using dietary data obtained from food-frequency questionnaires that were completed by most participants. All statistical tests were two-sided. RESULTS: Intakes of absolute fiber and of fiber intake density, ascertained by food diaries, were statistically significantly inversely associated with the risks of colorectal and colon cancers in both age-adjusted models and multivariable models that adjusted for age; anthropomorphic and socioeconomic factors; and dietary intakes of folate, alcohol, and energy. For example, the multivariable-adjusted odds ratio of colorectal cancer for highest vs the lowest quintile of fiber intake density was 0.66 (95% confidence interval = 0.45 to 0.96). However, no statistically significant association was observed when the same analysis was conducted using dietary data obtained by food-frequency questionnaire (multivariable odds ratio = 0.88, 95% confidence interval = 0.57 to 1.36). CONCLUSIONS: Intake of dietary fiber is inversely associated with colorectal cancer risk. Methodological differences (ie, study design, dietary assessment instruments, definition of fiber) may account for the lack of convincing evidence for the inverse association between fiber intake and colorectal cancer risk in some previous studies.

Accurate dietary assessment is an essential foundation of research in nutritional epidemiology. Due to the weaknesses in current methodology, attention is turning to strategies that automate the dietary assessment process to improve accuracy and reduce the costs and burden to participants and researchers. ‘My Meal Mate’ (MMM) is a smartphone application designed to support weight loss. The present study aimed to validate the diet measures recorded on MMM against a reference measure of 24 h dietary recalls. A sample of fifty volunteers recorded their food and drink intake on MMM for 7 d. During this period, they were contacted twice at random to conduct 24 h telephone recalls. Daily totals for energy (kJ) and macronutrients recorded on MMM were compared against the corresponding day of recall usingttests for group means and Pearson's correlations. Bland–Altman analysis was used to assess the agreement between the methods. Energy (kJ) recorded on MMM correlated well with the recalls (day 1:r0·77 (95 % CI 0·62, 0·86), day 2:r0·85 (95 % CI 0·74, 0·91)) and had a small mean difference (day 1 (MMM − recall): − 68 kJ/d (95 % CI − 553, 418 kJ) ( − 16 kcal/d, 95 % CI − 127, 100 kcal); day 2 (MMM − recall): − 441 kJ/d (95 % CI − 854, − 29 kJ) ( − 105 kcal/d, 95 % CI − 204, − 7 kcal)). Bland–Altman analysis showed wide limits of agreement between the methods: − 3378 to 3243 kJ/d ( − 807 to 775 kcal/d) on day 1. At the individual level, the limits of agreement between MMM and the 24 h recall were wide; however, at the group level, MMM appears to have potential as a dietary assessment tool.

Questions remain about the shape of the dose-response relationship between body mass index (BMI) and pancreatic cancer risk, possible confounding by smoking, and differences by gender or geographic location. Whether abdominal obesity increases risk is unclear.We conducted a systematic review and meta-analysis of prospective studies of the association between BMI, abdominal fatness and pancreatic cancer risk and searched PubMed and several other databases up to January 2011. Summary relative risks (RRs) were calculated using a random-effects model.Twenty-three prospective studies of BMI and pancreatic cancer risk with 9504 cases were included. The summary RR for a 5-unit increment was 1.10 [95% confidence interval (CI) 1.07-1.14, I(2) = 19%] and results were similar when stratified by gender and geographic location. There was evidence of a non-linear association, P(non-linearity) = 0.005; however, among nonsmokers, there was increased risk even within the 'normal' BMI range. The summary RR for a 10-cm increase in waist circumference was 1.11 (95% CI 1.05-1.18, I(2) = 0%) and for a 0.1-unit increment in waist-to-hip ratio was 1.19 (95% CI 1.09-1.31, I(2) = 11%).Both general and abdominal fatness increases pancreatic cancer risk. Among nonsmokers, risk increases even among persons within the normal BMI range.

Background: Epidemiologic studies of dietary fat and breast cancer risk are inconsistent, and it has been suggested that a true relation may have been obscured by the imprecise measurement of fat intake. Objective: We examined associations of fat with breast cancer risk by using estimates of fat intake from food diaries and food-frequency questionnaires (FFQs) pooled from 4 prospective studies in the United Kingdom. Design: A total of 657 cases of breast cancer in premenopausal and postmenopausal women were matched on study, age, and recruitment date with 1911 control subjects. Nutrient intakes were estimated from food diaries and FFQs. Conditional logistic regression was used to estimate ORs for breast cancer associated with total, saturated, monounsaturated, and polyunsaturated fat intakes with adjustment for relevant covariates. Results: Neither the food diaries nor the FFQs showed any positive associations between fat intake and overall breast cancer risk. ORs (95% CIs) for the highest compared with lowest quintiles of percentage of energy from total fat were 0.90 (0.66, 1.23) for food diaries and 0.80 (0.59, 1.09) for FFQs. Conclusion: In this study, breast cancer risk was not associated with fat intake in middle-aged women in the United Kingdom, irrespective of whether diet was measured by food diaries or by FFQs.

OBJECTIVE:Explore associations between dietary patterns and maternal age. DESIGN:Population based cohort study. SETTING:Maternity department of a large hospital in northern England. SAMPLE:Women delivering a singleton at Bradford Royal Infirmary between March 2007 and December 2010 (N = 5,083). METHODS:Survey data including maternal dietary patterns derived from food frequency questionnaire data using principal component analysis (PCA) were compared by maternal age using one-way ANOVA and chi-squared as appropriate. MAIN OUTCOME MEASURES:Dietary pattern PCA scores, supplement use, familiarity and compliance with 5-a-day fruit and vegetable recommendations, consumption of cola, maternal BMI. RESULTS:Three distinct dietary patterns were derived from the data; snack and processed foods, meat and fish and grains and starches. Mean PCA score for snack and processed foods was higher among women aged ≤19 (0.6, CI 0.4 to 0.8) than women aged 20-34 (-0.02, CI -0.1 to 0.01) and those aged 35≥ (-0.3, CI -0.4 to -0.2). Women aged 35≥ had a significantly higher mean PCA score for the grains and starches dietary pattern (0.1, CI 0.03 to 0.3) compared to both the 20-34 years (-0.01, CI -0.05 to 0.02) and the ≤19 (-0.04, CI -0.2 to 0.1) groups. No differences were observed between groups in mean PCA scores for the meat and fish dietary pattern. Adolescent women also had higher intakes of sugar sweetened cola (0.9 cups per day, CI 0.7 to 1.1) and reported lower levels of fruit and vegetable and supplement intake. Women aged 35≥ had a higher mean BMI (28.0, CI 27.5 to 28.4) and higher prevalence of overweight (36.8%) and obesity (29.6%, p

Background:No studies to date have demonstrated a clear association with breast cancer risk and dietary exposure to acrylamide.Methods:A 217-item food frequency questionnaire was used to estimate dietary acrylamide intake in 33 731 women aged 35-69 years from the UK Women's Cohort Study followed up for a median of 11 years.Results:In all, 1084 incident breast cancers occurred during follow-up. There was no evidence of an overall association between acrylamide intake and breast cancer (hazard ratio=1.08 per 10 mug day(-1), 95% CI: 0.98-1.18, P(trend)=0.1). There was a suggestion of a possible weak positive association between dietary acrylamide intake and premenopausal breast cancer after adjustment for potential confounders (hazard ratio=1.2, 95% CI: 1.0-1.3, P(trend)=0.008). There was no suggestion of any association for postmenopausal breast cancer (hazard ratio=1.0, 95% CI: 0.9-1.1, P(trend)=0.99).Conclusions:There is no evidence of an association between dietary acrylamide intake and breast cancer. A weak association may exist with premenopausal breast cancer, but requires further investigation.British Journal of Cancer advance online publication, 19 October 2010; doi:10.1038/sj.bjc.6605956 www.bjcancer.com.

Introduction: Epidemiologic evidence for an association between colorectal cancer (CRC) risk and total dietary fat, saturated fat (SF), monounsaturated fat (MUFA) and polyunsaturated fat (PUFA) is inconsistent. Previous studies have used food frequency questionnaires (FFQ) to assess diet, but data from food diaries may be less prone to severe measurement error than data from FFQ. Methods: We conducted a case-control study nested within seven prospective UK cohort studies, comprising 579 cases of incident CRC and 1996 matched controls. Standardized dietary data from 4- to 7-day food diaries and from FFQ were used to estimate odds ratios for CRC risk associated with intake of fat and subtypes of fat using conditional logistic regression. We also calculated multivariate measurement error corrected odds ratios for CRC using repeated food diary measurements. Results: We observed no associations between intakes of total dietary fat or types of fat and CRC risk, irrespective of whether dietary data were obtained using food diaries or FFQ. Conclusion: Our results do not support the hypothesis that intakes of total dietary fat, SF, MUFA or PUFA are linked to risk of CRC. (C) 2010 Elsevier Ltd. All rights reserved.

Aliment Pharmacol Ther 2010; 32: 573–581 Summary Background The only therapy for coeliac disease (CD) is a long-term gluten-free diet (GFD). Little is known about the detailed composition of such a diet. Aim To clarify the nutritional composition of a GFD and to compare it with a non-GFD diet in representative non-CD populations. Methods A total of 139 consecutive patients with CD were invited to fill in a prospective validated 5-day food diary, of whom data from 93 were analysed. Results were compared with data from the National Diet and Nutrition Survey of Adults and the UK Women’s Cohort Study (UKWCS). Results Individuals consuming a strict GFD generally had similar intakes of energy and nutrients to those of comparison populations, but a higher proportion of carbohydrate intake was obtained from nonmilk extrinsic sugars and intakes of nonstarch polysaccharides were low. Compared with the UKWCS sample, female patients adhering to a GFD had lower intakes of magnesium, iron, zinc, manganese, selenium and folate. In male patients, intakes of magnesium and selenium were particularly low. Conclusions This study reinforces the need for clinicians to recognize that avoidance of gluten cannot be the sole focus of a gluten-free diet. Maintenance of adequate intakes of essential nutrients and in particular complex carbohydrates must also be the goal for patients.

Objectives There is increasing evidence to suggest an association between sleep and diet. The aim of the present study was to examine the association between sleep duration and fruit/vegetable (FV) intakes and their associated biomarkers in UK adults. Design Cross-sectional. Setting Data from The National Diet and Nutrition Survey. Participants 1612 adults aged 19–65 years were included, pregnant/breastfeeding women were excluded from the analyses. Outcome measures Sleep duration was assessed by self-report, and diet was assessed by 4-day food diaries, disaggregation of foods containing FV into their components was conducted to determine total FV intakes. Sleep duration was divided into: short (8 hours/day) sleep periods. Multiple regression adjusting for confounders was used for analyses where sleep duration was the exposure and FV intakes and their associated biomarkers were the outcomes. Restricted cubic spline models were developed to explore potential non-linear associations. Results In adjusted models, long sleepers (LS) consumed on average 28 (95% CI −50 to −6, p=0.01) g/day less of total FV compared to reference sleepers (RS), whereas short sleepers (SS) consumed 24 g/day less (95% CI −42 to –6, p=0.006) and had lower levels of FV biomarkers (total carotenoids, β-carotene and lycopene) compared to RS. Restricted cubic spline models showed that the association between sleep duration and FV intakes was non-linear (p

ObjectiveDespite the increasing dependence on systematic reviews to summarise the literature and to issue public health recommendations, the formal assessment of the reliability of conclusions emerging from systematic reviews has received little attention. The main goal of the present study was to evaluate whether two independent centres, in two continents, draw similar conclusions regarding the association of food, nutrition and physical activity and endometrial cancer, when provided with the same general instructions and with similar resources.DesignThe assessment of reproducibility concentrated on four main areas: (1) paper search and selection; (2) assignment of study design; (3) inclusion of ‘key’ papers; and (4) individual studies selected for meta-analysis and the summary risk estimate obtained.ResultsIn total 310 relevant papers were identified, 166 (54 %) were included by both centres. Of the remaining 144 papers, 72 (50 %) were retrieved in the searches of one centre and not the other (54 in centre A, 18 in centre B) and 72 were retrieved in both searches but regarded as relevant by only one of the centres (52 in centre A, 20 in centre B). Of papers included by both centres, 80 % were allocated the same study design. Agreement for inclusion of cohort-type and case–control studies was about 63 % compared with 50 % or less for ecological and case series studies. The agreement for inclusion of 138 ‘key’ papers was 87 %. Summary risk estimates from meta-analyses were similar.ConclusionsTransparency of process and explicit detailed procedures are necessary parts of a systematic review and crucial for the reader to interpret its findings.

Mycotoxins are common dietary contaminants in most regions of the world. The frequency of exposure to the various families of mycotoxins is often dependent on geographic location, national wealth and related agricultural and regulatory infrastructure, combined with diversity of diet and degree of food sufficiency. Deoxynivalenol (DON) is a Fusarium mycotoxin that frequently contaminates wheat, corn and barley in temperate regions. A number of acute poisoning incidences have been linked to DON-contaminated foods and chronic exposure to lower levels of DON has been predicted in many regions. DON is a potent animal toxin and exposure in humans may cause gastroenteritis, growth faltering and immune toxicity. An ability to conduct accurate exposure assessment at the individual level is required to fully understand the potential health consequences for humans. To date, such exposure biomarkers have been lacking for many important mycotoxins, including DON. To better assess exposure to DON at the individual level, we have developed a robust urinary assay, incorporating immunoaffinity column (IAC) enrichment and LC-MS detection. Further refinement of this urinary assay, by inclusion of (13)C-DON as an internal standard, was then undertaken and tested within the UK. DON was frequently observed in urine and was significantly associated with cereal intake. A dietary intervention study demonstrated that avoiding wheat in the diet markedly reduced urinary levels of DON. This biomarker requires further validation but our initial data suggest it may provide a useful tool in epidemiological investigations of the potential health consequences of this common environmental toxin.

Summary Background Reports of relationships between dietary fibre intake and breast cancer have been inconsistent. Previous cohort studies have been limited by a narrow range of intakes. Methods Women who developed invasive breast cancer, 350 post-menopausally and 257 pre-menopausally, during 240,959 person years of follow up in the UK Women’s Cohort Study (UKWCS) were studied. This cohort has 35,792 subjects with a wide range of exposure to dietary fibre with intakes of total fibre in the lowest quintile of 30g/day in the top quintile. Fibre and breast cancer relationships were explored using Cox regression modeling adjusted for measurement error. Effects of fibre, adjusting for confounders were examined for pre and post-menopausal women separately. Results In pre-menopausal, but not post-menopausal women a statistically significant inverse relationship was found between total fibre intake and risk of breast cancer (p for trend = 0.01). The top quintile of fibre intake was associated with a hazard ratio of 0.4850 (95 percent confidence interval (CI) 0.24, 0.9625, 1.00) compared to the lowest quintile. Pre-menopausally, fibre from cereals was inversely associated with risk of breast cancer (p for trend = 0.0503) and fibre from fruit had a borderline inverse relationship (p for trend = 0.09). A further model including dietary folate strengthened the significance of the inverse relationship between total fibre and pre-menopausal breast cancer. Conclusions These findings suggest that in pre-menopausal women, total fibre is protective against breast cancer; in particular fibre from cereals and possibly fruit.

BackgroundObesity is a major global public health issue due to its association with a number of serious chronic illnesses and its high economic burden to health care providers. Self-monitoring of diet has been consistently linked to weight loss. However, there is limited evidence about how frequently individuals need to monitor their diet for optimal weight loss. ObjectiveThe aim of this paper is to describe app usage frequency and pattern in the mobile phone arm of a previously conducted randomized controlled trial. The relationship between frequency and pattern of electronic dietary self-monitoring and weight loss is also investigated. MethodsA randomized pilot trial comparing three methods of self-monitoring (mobile phone app, paper diary, Web-based) was previously conducted. Trial duration was 6 months. The mobile phone app My Meal Mate features an electronic food diary and encourages users to self-monitor their dietary intake. All food consumption data were automatically uploaded with a time and date stamp. Post hoc regression analysis of app usage patterns was undertaken in the My Meal Mate group (n=43; female: 77%, 33/43; white: 100%, 43/43; age: mean 41, SD 9 years; body mass index: mean 34, SD 4 kg/m2) to explore the relationship between frequency and pattern of electronic dietary self-monitoring and weight loss. Baseline characteristics of participants were also investigated to identify any potential predictors of dietary self-monitoring. ResultsRegression analysis showed that those in the highest frequency-of-use category (recorded ≥129 days on the mobile phone app) had a −6.4 kg (95% CI −10.0 to −2.9) lower follow-up weight (adjusted for baseline weight) than those in the lowest frequency-of-use category (recorded ≤42 days; P

Background:This paper describes the development of the UK Women's Cohort Study and presents cohort baseline characteristics.Methods:In total, 35 372 women, aged 35–69 years at recruitment, were selected to ensure a wide range of dietary intakes. Diet was assessed by a 217-item food-frequency questionnaire (FFQ). Detailed lifestyle information was collected by postal questionnaire. Vegetarians, fish-eaters and meat-eaters were compared.Results:The cohort women are mainly white, well-educated, middle-class and married with children. They are health-conscious with only 11% current smokers and 58% taking dietary supplements. Twenty-eight per cent of subjects self-report as being vegetarian and 1% as vegan. However, only 18% are defined as 'vegetarian' from the FFQ. Fat provides 32% of energy; vitamin and mineral intakes are high, with a broad range of intakes. Meat-eaters are older, with a higher body mass index (BMI) and the lowest intakes of carbohydrate, fibre, vitamin C, folate, iron and calcium. Other fish-eaters are similar to vegetarians. Vegetarians have the lowest intakes of protein, fat and saturated fat. Oily fish-eaters have the lowest BMI; are the least likely to smoke or use full-fat milk; and are the most likely to use dietary supplements and consume the most fruit and vegetables. Oily fish-eaters have the highest total energy intake and vegetarians the lowest. Semi-skimmed milk, bread, potatoes, wine, bananas and muesli are important contributors to energy for all groups.Conclusion:A large cohort of middle-aged women has been created encompassing a wide range of different eating patterns, including diets currently of interest to research into protection against cancer and coronary heart disease. Participants will be followed up to study the effects of different food and nutrient intakes on long-term health outcomes.

Background/aims Fortified breakfast cereals (FBCs) are an important source of iron in the UK diet. In order to quantify their contribution to iron nutrition, food composition data for these products must be accurate. The very large amount of products available, together with inter-brand differences in iron content mean that discrepancies between the iron content of many FBCs and values in standard food composition databases (FCD) exist. The variation in reported iron contents of FBCs was examined and the impact of this variation on measurement of iron intake using standard food composition tables was investigated. Method Data on the reported iron content of 128 FBCs were collected. Completed food diaries from 291 participants of the UK Women's Cohort study were used in the analysis. Mean iron intake from a 4-day food diary was calculated using UK food tables’ values for FBCs. This was repeated using values reported by the manufacturer for each brand of cereal. The two sets of results were then compared. Results There is wide variation in iron content of breakfast cereals available in the United Kingdom. Use of FCD values instead of brand-specific values under- or overestimates an individual's iron intake by as much as 28 or 22% respectively. These results suggest that use of FCD values for breakfast cereals is potentially a source of substantial error in measurement of individuals’ iron intake. Conclusion Dietitians need to be aware of inter-brand differences in iron content and formulate advice accordingly. Failure to collect brand-specific data for the iron content of FBCs could lead to measurement error in measuring iron intake in dietary studies.

Objective: To determine the effect of different types of dietary fibre on systolic and diastolic blood pressure. Methods: A systematic review of the literature and a meta-analysis of randomised controlled trials using random effects models. Eligibility criteria for studies included randomised controlled trials of at least 6 weeks duration testing a fibre isolate or fibre rich diet against a control or placebo published between 1st January 1990 and 1st December 2013. Results: 28 trials met the inclusion criteria and reported fibre intake and systolic blood pressure (SBP) and/or diastolic blood pressure (DBP). 18 trials were included in a meta-analysis. Studies were categorised into one of twelve fibre-type categories. The pooled estimate for all fibre types were -0.9 mmHg (95% CI -2.5 to 0.6 mmHg), and -0.7 mmHg (95% CI -1.9 to 0.5 mmHg) for SBP and DBP respectively. Analyses of specific fibre types concluded that diets rich in beta-glucans reduce SBP by 2.9 mmHg (95% CI 0.9 to 4.9 mmHg) and DBP by 1.5 mmHg (95% CI 0.2 to 2.7 mmHg) for a median fibre difference of 13 g. Heterogeneity for individual fibre types was generally low. Conclusions: Higher consumption of beta-glucan fibre found in oats and barley is associated with lower systolic and diastolic blood pressure; however evidence for other types of fibre was not consistent. In many countries total dietary fibre consumption is considerably lower than recommended. Policies which increase oat and barley consumption and reduce cardiovascular disease, through lowering blood pressure, should be encouraged.

Sedentary behaviors (including sitting) may increase mortality risk independently of physical activity level. Little is known about how fidgeting behaviors might modify the association.Data were from the United Kingdom (UK) Women's Cohort Study. In 1999-2002, a total of 12,778 women (aged 37-78 years) provided data on average daily sitting time, overall fidgeting (irrespective of posture), and a range of relevant covariates including physical activity, diet, smoking status, and alcohol consumption. Participants were followed for mortality over a mean of 12 years. Proportional hazards Cox regression models estimated the relative risk of mortality in high (versus low) and medium (versus low) sitting time groups.Fidgeting modified the risk associated with sitting time (p=0.04 for interaction), leading us to separate groups for analysis. Adjusting for covariates, sitting for ≥7 hours/day (versus5 hours/day) was associated with 30% increased all-cause mortality risk (hazard ratio [HR]=1.30, 95% CI=1.02, 1.66) only among women in the low fidgeting group. Among women in the high fidgeting group, sitting for 5-6 hours/day (versus5 hours/day) was associated with decreased mortality risk (HR=0.63, 95% CI=0.43, 0.91), adjusting for a range of covariates. There was no increased mortality risk from longer sitting time in the middle and high fidgeting groups.Fidgeting may reduce the risk of all-cause mortality associated with excessive sitting time. More detailed and better-validated measures of fidgeting should be identified in other studies to replicate these findings and identity mechanisms, particularly measures that distinguish fidgeting in a seated from standing posture.

In observational studies, fruit intake is associated with a reduced risk of cardiovascular disease (CVD), though fruit type has been less frequently explored. The aim of the current study was to explore the association between total fruit and fruit subgroup intake according to polyphenol content and CVD mortality in the UK Women's Cohort Study. Total fruit intake (g/day) derived from a 217-item food frequency questionnaire was obtained from 30,458 women (aged 35-69 years) at baseline from 1995-1998. Fruit intakes were sub-categorised according to similarities in polyphenol profile from Phenol Explorer, including berries, citrus, drupes, pomes and tropical fruits. Mortality events were derived from the NHS Central Register. During the mean follow-up period of 16.7 years, 286 fatal CVD deaths [138 coronary heart disease (CHD), 148 stroke] were observed. Survival analysis was conducted using participants free from history of CVD at baseline. Total fruit intake was associated with lower risk of CVD and CHD mortality, with a 6-7 % reduction in risk for each 80 g/day portion consumed (99 % CI 0.89, 1.00 and 0.85, 1.01 respectively). Concerning particular fruit types, the direction of the associations tended to be inverse, but point estimates and tests for trend were not generally statistically significant. However, women in the highest intake group of grapes and citrus experienced a significant reduction in risk of CVD and stroke respectively compared with non-consumers [HR 0.56 (99 % CI 0.32, 0.98) and 0.34 (0.14, 0.82) respectively]. These findings support promoted guidelines encouraging fruit consumption for health in women, but do not provide strong evidence to suggest that fruit type is as important.

The intake of sugar-sweetened soft drinks has been reported to be associated with an increased risk of type 2 diabetes, but it is unclear whether this is because of the sugar content or related lifestyle factors, whether similar associations hold for artificially sweetened soft drinks, and how these associations are related to BMI. We aimed to conduct a systematic literature review and dose–response meta-analysis of evidence from prospective cohorts to explore these issues. We searched multiple sources for prospective studies on sugar-sweetened and artificially sweetened soft drinks in relation to the risk of type 2 diabetes. Data were extracted from eleven publications on nine cohorts. Consumption values were converted to ml/d, permitting the exploration of linear and non-linear dose–response trends. Summary relative risks (RR) were estimated using a random-effects meta-analysis. The summary RR for sugar-sweetened and artificially sweetened soft drinks were 1·20/330 ml per d (95 % CI 1·12, 1·29,PP= 0·02), respectively. The association with sugar-sweetened soft drinks was slightly lower in studies adjusting for BMI, consistent with BMI being involved in the causal pathway. There was no evidence of effect modification, though both these comparisons lacked power. Overall between-study heterogeneity was high. The included studies were observational, so their results should be interpreted cautiously, but findings indicate a positive association between sugar-sweetened soft drink intake and type 2 diabetes risk, attenuated by adjustment for BMI. The trend was less consistent for artificially sweetened soft drinks. This may indicate an alternative explanation, such as lifestyle factors or reverse causality. Future research should focus on the temporal nature of the association and whether BMI modifies or mediates the association.

BACKGROUND: Stroke risk is modifiable through many risk factors, one being healthy dietary habits. Fibre intake was associated with a reduced stroke risk in recent meta-analyses; however, data were contributed by relatively few studies, and few examined different stroke types. METHODS: A total of 27 373 disease-free women were followed up for 14.4 years. Diet was assessed with a 217-item food frequency questionnaire and stroke cases were identified using English Hospital Episode Statistics and mortality records. Survival analysis was applied to assess the risk of total, ischaemic or haemorrhagic stroke in relation to fibre intake. RESULTS: A total of 135 haemorrhagic and 184 ischaemic stroke cases were identified in addition to 138 cases where the stroke type was unknown or not recorded. Greater intake of total fibre, higher fibre density and greater soluble fibre, insoluble fibre and fibre from cereals were associated with a significantly lower risk for total stroke. For total stroke, the hazard ratio per 6 g/day total fibre intake was 0.89 (95% confidence intervals: 0.81–0.99). Different findings were observed for haemorrhagic and ischaemic stroke in healthy-weight or overweight women. Total fibre, insoluble fibre and cereal fibre were inversely associated with haemorrhagic stroke risk in overweight/obese participants, and in healthy-weight women greater cereal fibre was associated with a lower ischaemic stroke risk. In non-hypertensive women, higher fibre density was associated with lower ischaemic stroke risk. CONCLUSIONS: Greater total fibre and fibre from cereals are associated with a lower stroke risk, and associations were more consistent with ischaemic stroke. The different observations by stroke type, body mass index group or hypertensive status indicates potentially different mechanisms.