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Controversy and Debate: Memory based Methods Paper 1: The Fatal Flaws of Food Frequency Questionnaires and other Memory-Based Dietary Assessment Methods
Abstract
There is an escalating debate over the value and validity of memory-based dietary assessment methods (M-BMs). Proponents argue that despite limitations, M-BMs such as food frequency questionnaires (FFQs), provide valid and valuable information about consumed foods and beverages, and therefore can be used to assess diet-disease relations and inform public policy. In fact, over the past 60 years thousands of research reports using these methods were published and used to populate the United States Department of Agriculture's National Evidence Library, inform public policy, and establish the Dietary Guidelines for Americans. Despite this impressive history, our position is that FFQs and other M-BMs are invalid and inadmissible for scientific research and cannot be employed in evidence-based policy making. Herein, we present the empirical evidence, and theoretic and philosophic perspectives that render M-BMs data both fatally flawed and pseudo-scientific. First, the use of M-BMs is founded upon two inter-related logical fallacies: a category error and reification. Second, human memory and recall are not valid instruments for scientific data collection. Third, in standard epidemiologic contexts, the measurement errors associated with self-reported data are non-falsifiable (i.e., pseudo-scientific) because there is no way to ascertain if the reported foods and beverages match the respondent's actual intake. Fourth, the assignment of nutrient and energy values to self-reported intake (i.e., the pseudo-quantification of qualitative/anecdotal data) is impermissible and violates the foundational tenets of measurement theory. Fifth, the proxy-estimates created via pseudo-quantification are physiologically implausible (i.e. meaningless numbers) and have little relation to actual nutrient and energy consumption. Finally, investigators engendered a fictional discourse on the health effects of dietary sugar, salt, fat and cholesterol when they failed to cite contrary evidence or address decades of research demonstrating the fatal measurement, analytic, and inferential flaws presented herein.
... There is very little doubt that food, diet, or nutrient intake plays a major role in the overall health status of individuals and populations in general (Buttriss et al., 2017;Johanningsmeier, Harris, & Klevorn, 2016;Margetts & Nelson, 1995). However, generating indisputable evidence of the role of specific nutrients, non-nutritive (antinutritional) food constituents, meals, diets, foods, food supplements, food groups or dietary habits or patterns in the etiology and/or pathogenesis of foodrelated health outcomes, has been a major challenging undertaking for nutritional epidemiologists Archer, Marlow, & Lavie, 2018;Satija, Yu, Willett, & Hu, 2015). ...
... Food or diet inarguably is a complex mixture of constituents made up of nutrients and the non-nutrititve components (Margetts & Nelson, 1995;Zhao & Singh, 2020 (Margetts & Nelson, 1995). Nonetheless, nutritional epidemiologists and nutritional scientists have successfully developed reasonably valid and reliable food or dietary intake assessment methods, albeit against the odds of harsh criticisms of their usefulness and credibility (Archer & Blair, 2015;Archer, Marlow et al., 2018;Archer, Pavela, & Lavie, 2015;Lachat et al., 2016;Margetts & Nelson, 1995;Naska et al., 2017;Subar et al., 2015). ...
... Given the influence of the dichotomy of philosophical perspectives on the relationships between food intake and health status of individuals and defined populations, other researchers have 43 suggested an integrated, multidisciplinary and/or interdisciplinary approach to addressing research questions in nutritional epidemiology, as criticisms against its methodological approaches are unrelenting Archer, Marlow et al., 2018;Boeing, 2013;Satija et al., 2015;Tapsell, Neale, Satija, & Hu, 2016). ...
... Epidemiological studies aiming to determine diet-disease relationships assess dietary intake using self-report methods, such as food diaries, 24-hour recalls, and FFQs (12)(13)(14). While necessary for obtaining data representative of habitual dietary intake, such methods are inherently subject to measurement error and biases and can be burdensome on participants (12,(15)(16)(17). A more succinct method of intake data collectionfor example, reporting a single food group of interestcould alleviate the burden on participants, while conversely reducing the utility of the data when the exploration of whole diet-disease associations is required. ...
... Self-report methods of dietary intake assessment, such as food diaries, 24-hour recalls, and FFQs, have been a longstanding topic of debate in nutritional research (17,38), while remaining the most prevalent techniques to assess diet-disease relationships (4,39). Critics state that the reliance on memory and the influence of researcher/social-approval biases can incur random and systematic measurement errors, such as the over-reporting of FV intake (12)(13)(14)17). ...
... Self-report methods of dietary intake assessment, such as food diaries, 24-hour recalls, and FFQs, have been a longstanding topic of debate in nutritional research (17,38), while remaining the most prevalent techniques to assess diet-disease relationships (4,39). Critics state that the reliance on memory and the influence of researcher/social-approval biases can incur random and systematic measurement errors, such as the over-reporting of FV intake (12)(13)(14)17). Furthermore, the accuracy of selfreported data may be influenced by the ability of individuals to quantify the size and contents of a FV serving, or by the sensitivity of the assessment method (40,41). ...
Background
Dietary assessments in research and clinical settings are largely reliant on self-reported questionnaires. It is acknowledged that these are subject to measurement error and biases and that objective approaches would be beneficial. Dietary biomarkers have been purported as a complementary approach to improve the accuracy of dietary assessments. Tentative biomarkers have been identified for many individual fruits and vegetables (FVs), but an objective total FV intake assessment tool has not been established.
Objectives
To derive and validate a prediction model of total FV intake (TFVpred) to inform future biomarker studies.
Methods
Data from the National Diet and Nutrition Survey (NDNS) were used for this analysis. A modeling group (MG) consisting of participants aged >11 years from the NDNS years 5–6 was created (n = 1746). Intake data for 96 FVs were analyzed by stepwise regression to derive a model that satisfied 3 selection criteria: SEE ≤80, R2 >0.7, and ≤10 predictors. The TFVpred model was validated using comparative data from a validation group (VG) created from the NDNS years 7–8 (n = 1865). Pearson's correlation coefficients were assessed between observed and predicted values in the MG and VG. Bland-Altman plots were used to assess agreement between TFVpred estimates and total FV intake.
Results
A TFVpred model, comprised of tomatoes, apples, carrots, bananas, pears, strawberries, and onions, satisfied the selection criteria (R2 = 0.761; SEE = 78.81). Observed and predicted total FV intake values were positively correlated in the MG (r = 0.872; P < 0.001; R2 = 0.761) and the VG (r = 0.838; P < 0.001; R2 = 0.702). In the MG and VG, 95.0% and 94.9%, respectively, of TFVpred model residuals were within the limits of agreement.
Conclusions
Intakes of a concise FV list can be used to predict total FV intakes in a UK population. The individual FVs included in the TFVpred model present targets for biomarker discovery aimed at objectively assessing total FV intake.
... Self-reported dietary intake as estimated by FFQs, are invalid measurements because FFQs have been shown to be pseudoscientific. The perception of usual intake and actual dietary intake are often assumed to be equivalent but are in fact very different due to social desirability bias (Archer et al., 2018;Hebert et al., 1995). Additionally, FFQs introduce recall bias (Archer et al., 2018). ...
... The perception of usual intake and actual dietary intake are often assumed to be equivalent but are in fact very different due to social desirability bias (Archer et al., 2018;Hebert et al., 1995). Additionally, FFQs introduce recall bias (Archer et al., 2018). Further, details on the quality assessment scores are provided in the fully extracted file which has been uploaded on OSF. ...
Background:
As the global population ages, there has been a growing incidence of neurodegenerative diseases such as Alzheimer's. More recently, studies exploring the relationship between dietary patterns and neuroimaging outcomes have received particular attention. This systematic literature review provides a structured overview of the association between dietary and nutrient patterns on neuroimaging outcomes and cognitive markers in middle-aged to older adults. A comprehensive literature search was conducted to find relevant articles published from 1999 to date using the following databases Ovid MEDLINE, Embase, PubMed, Scopus and Web of Science. The inclusion criteria for the articles comprised studies reporting on the association between dietary patterns and neuroimaging outcomes, which includes both specific pathological hallmarks of neurodegenerative diseases such as Aβ and tau and nonspecific markers such as structural MRI and glucose metabolism. The risk of bias was evaluated using the Quality Assessment tool from the National Heart, Lung, and Blood Institute of the National Institutes of Health. The results were then organized into a summary of results table, collated based on synthesis without meta-analysis. After conducting the search, 6050 records were extracted and screened for eligibility, with 107 eligible for full-text screening and 42 articles ultimately being included in this review. The results of the systematic review indicate that there is some evidence suggesting that healthy dietary and nutrient patterns were associated with neuroimaging measures, indicative of a protective influence on neurodegeneration and brain ageing. Conversely, unhealthy dietary and nutrient patterns showed evidence pointing to decreased brain volumes, poorer cognition and increased Aβ deposition. Future research should focus on sensitive neuroimaging acquisition and analysis methods, to study early neurodegenerative changes and identify critical periods for interventions and prevention.
Systematic review registration:
PROSPERO registration no, CRD42020194444).
... As TFA are not endogenously synthesized, blood levels of TFA are a biomarker for the balance of dietary TFA intake, distribution volume and catabolism independent of subjective memory-based assessment methods such as food frequency questionnaires [20]. They-like other blood fatty acid levels such as EPA and DHA levels [21]-reliably reflect cardiac and other tissue TFA levels over approximately the preceding 3 months [22,23]. ...
... Second, 53% of the patients included in Aldo-DHF were female, resulting in a representative gender distribution for the condition HFpEF, which is slightly more common in females [45]. Third, blood fatty acid levels are an objective biomarker of TFA status unbiased by recall-based dietary intake assessment methods (e.g., food frequency questionnaires) used in nutritional epidemiology which may not accurately reflect an individual's consumption of nutrients due to limitations such as measurement error, recall bias, selective reporting and incompleteness of food composition databases [22]. Our analysis is not without limitations. ...
Background
Industrially processed trans-fatty acids (IP-TFA) have been linked to altered lipoprotein metabolism, inflammation and increased NT-proBNP. In patients with heart failure with preserved ejection fraction (HFpEF), associations of TFA blood levels with patient characteristics are unknown.
Methods
This is a secondary analysis of the Aldo-DHF-RCT. From 422 patients, individual blood TFA were analyzed at baseline in n = 404 using the HS-Omega-3-Index ® methodology. Patient characteristics were: 67 ± 8 years, 53% female, NYHA II/III (87/13%), ejection fraction ≥ 50%, E / e ′ 7.1 ± 1.5; NT-proBNP 158 ng/L (IQR 82–298). A principal component analysis was conducted but not used for further analysis as cumulative variance for the first two PCs was low. Spearman’s correlation coefficients as well as linear regression analyses, using sex and age as covariates, were used to describe associations of whole blood TFA with metabolic phenotype, functional capacity, echocardiographic markers for LVDF and neurohumoral activation at baseline and after 12 months.
Results
Blood levels of the naturally occurring TFA C16:1n-7t were inversely associated with dyslipidemia, body mass index/truncal adiposity, surrogate markers for non-alcoholic fatty liver disease and inflammation at baseline/12 months. Conversely, IP-TFA C18:1n9t, C18:2n6tt and C18:2n6tc were positively associated with dyslipidemia and isomer C18:2n6ct with dysglycemia. C18:2n6tt and C18:2n6ct were inversely associated with submaximal aerobic capacity at baseline/12 months. No significant association was found between TFA and cardiac function.
Conclusions
In HFpEF patients, higher blood levels of IP-TFA, but not naturally occurring TFA, were associated with dyslipidemia, dysglycemia and lower functional capacity. Blood TFAs, in particular C16:1n-7t, warrant further investigation as prognostic markers in HFpEF.
Graphical abstract
Higher blood levels of industrially processed TFA, but not of the naturally occurring TFA C16:1n-7t, are associated with a higher risk cardiometabolic phenotype and prognostic of lower aerobic capacity in patients with HFpEF.
... They -like other blood fatty acid levels such as EPA and DHA levels [21] -reliably re ect cardiac and other tissue TFA levels over approximately the preceding three months. [22,23] We hypothesized that blood IP-TFA would directly correlate with cardiovascular risk factors, aerobic capacity and left ventricular diastolic function (LVDF), and neurohumoral activation in patients with HFpEF. ...
... food frequency questionnaires) used in nutritional epidemiology which may not accurately re ect an individual's consumption of nutrients due to limitations such as measurement error, recall bias, selective reporting, and incompleteness of food composition databases. [22] Our analysis is not without limitations. First, our analysis does not offer information on the prognostic impact of blood TFA levels in patients with HFpEF. ...
Background:
Industrially processed trans-fatty acids (IP-TFA) have been linked to altered lipoprotein metabolism, inflammation and increased NTproBNP. In patients with heart failure with preserved ejection fraction (HFpEF), associations of TFA blood levels with patient characteristics are unknown.
Methods:
This is a secondary analysis of the Aldo-DHF-RCT. From 422 patients, individual blood TFA were analyzed at baseline in n=404 using the HS-Omega-3-Index® methodology. Patient characteristics were; 67±8 years, 53% female, NYHA II/III (87/13%), ejection fraction ≥50%, E/e´ 7.1±1.5; NT-proBNP 158 ng/L (IQR 82-298). A principal component analysis was conducted but not used for further analysis as cumulative variance for the first two PCs was low. Spearman´s correlation coefficients as well as linear regression analyses, using sex and age as covariates, were used to describe associations of whole blood TFA with metabolic phenotype, functional capacity, echocardiographic markers for LVDF, and neurohumoral activation at baseline and after 12 months.
Results:
Blood levels of the naturally occurring TFA C16:1n-7t were inversely associated with dyslipidemia, body-mass-index/truncal adiposity, surrogate markers for non-alcoholic fatty liver disease and inflammation at baseline/12 months. Conversely, IP-TFA C18:1n9t, C18:2n6tt and C18:2n6tc were positively associated with dyslipidemia and isomer C18:2n6ct with dysglycemia. C18:2n6tt and C18:2n6ct were inversely associated with submaximal aerobic capacity at baseline/12 months. No significant association was found between TFA and cardiac function.
Conclusions:
In HFpEF patients, higher blood levels of IP-TFA, but not naturally occurring TFA, were associated with dyslipidemia, dysglycemia and lower functional capacity. Blood TFAs, in particular C16:1n-7t, warrant further investigation as prognostic markers in HFpEF.
... This latter focus was necessary for the following reasons. The use of self-reported (memory-based) dietary assessments (FFQ) induces nonquantifiable measurement error due to intentional and/or non-intentional misreporting and the invalidity of pseudo-quantification (assigning nutrient and caloric values to memories of consumed foods and beverages) (Archer, Lavie, and Hill 2018a;Archer, Marlow, and Lavie 2018b;Archer, Pavela, and Lavie 2015). This nonquantifiable error precludes examining meat consumption as a continuous variable. ...
... This distinction is necessary because self-reported (memory-based) dietary assessments (FFQ) should not be used for quantitative analyses because of their invalidity. Any study that attempts to use FFQs as continuous variables are invalid due to nonquantifiable measurement error (Archer, Lavie, and Hill 2018a;Archer, Marlow, and Lavie 2018b;Archer, Pavela, and Lavie 2015). ...
In this meta-analysis, we examined the quantitative relation between meat consumption or avoidance, depression, and anxiety. In June 2020, we searched five online databases for primary studies examining differences in depression and anxiety between meat abstainers and meat consumers that offered a clear (dichotomous) distinction between these groups. Twenty studies met the selection criteria representing 171,802 participants with 157,778 meat consumers and 13,259 meat abstainers. We calculated the magnitude of the effect between meat consumers and meat abstainers with bias correction (Hedges's g effect size) where higher and positive scores reflect better outcomes for meat consumers. Meat consumption was associated with lower depression (Hedges's g = 0.216, 95% CI [0.14 to 0.30], p < .001) and lower anxiety (g = 0.17, 95% CI [0.03 to 0.31], p = .02) compared to meat abstention. Compared to vegans, meat consumers experienced both lower depression (g = 0.26, 95% CI [0.01 to 0.51], p = .041) and anxiety (g = 0.15, 95% CI [-0.40 to 0.69], p = .598). Sex did not modify these relations. Study quality explained 58% and 76% of between-studies heterogeneity in depression and anxiety, respectively. The analysis also showed that the more rigorous the study, the more positive and consistent the relation between meat consumption and better mental health. The current body of evidence precludes causal and temporal inferences.
... Bycatch estimates derived from interviews may contain unknown errors. As the capture of most marine megafauna species is forbidden in Indonesia, the possible underreporting of bycatch and landings due to fear of arrest can limit the data accuracy (see also Lien et al., 1994) Fisher may also failed to accurately report catch and bycatch records (Daw et al., 2011;O'Donnell et al., 2012) despite their best intentions due to the natural flaws in human memories (Archer et al., 2018). ...
... Honest replies to questionnaires were also observed during similar studies by Pusineri and Quillard (2008) and Jamaan et al. (2008). Errors in bycatch numbers would be more likely to result from difficulties in remembering how many animals were caught annually, monthly or in total (see again Archer et al., 2018). Several respondents seemed to have trouble estimating bycatch rates and recall bias concerning the details of bycatch incidences might have a limiting effect on the study. ...
While bycatch, the unintentional catch of untargeted species, is one of the main threats to large marine species such as cetaceans, reef sharks and turtles, also known as megafauna, fishers can also be negatively impacted by bycatch. Understanding local fisheries profiles, fishers’ demography and their opinion is thus a necessary part of the strategy to mitigate marine megafauna bycatch in artisanal fisheries. Interviews with fishers were conducted in order to assess the magnitude of marine megafauna bycatch, the dependency of fishers on the fishery and the potential for implementation of bycatch mitigation measures in the artisanal fisheries in Gorontalo, northern Sulawesi (Indonesia). Quantitative and qualitative methods were used to analyse the data. Regression trees showed that cetacean and turtle bycatch were mainly influenced by the fishing location, while bycatch of reef sharks, whale sharks (Rhincodon typus) and mobulids was mainly influenced by the gear type. Cetaceans mostly escaped after being caught or were released. Reef sharks, which were often sold for their meat, were caught in the highest numbers followed by sea turtles. Interviewed fishers had large households, typically averaging more than five people, and mostly were dependent on the fishery, often with few other sources of income. Fishers were generally in favour of reducing bycatch as bycatch often posed a financial threat, due to lost catch and damaged gear. When implementing bycatch reduction measures, it is important to involve fishers in design and implementation of mitigation measures. As awareness on bycatch management and mitigation is growing in Indonesia, measures including recordings (official and self-reporting), capacity building on bycatch specimen handling and release and bycatch mitigation techniques (e.g. gear modifications) are some of the most important bycatch reduction strategies for the country.
... A number of studies (e.g., Armstrong et al., 2000;Baxter, Thompson, Litaker, Frye, & Guinn, 2002;Fries, Green, & Bowen, 1995) appear to support Wansink's claim and show that participants often underestimate how much food they consumed 24-hours prior. This proclivity to underestimate consumption has led some in the nutritional and medical communities to proclaim that self-reported dietary assessment techniques "offer an inadequate basis for scientific conclusions" (Archer, Marlow, & Lavie, 2018;Schoeller et al., 2013). It remains unclear however, if this underestimation bias in memory is unique to eating behavior, as it may be the case that similar behaviors are also misremembered. ...
... We sought to evaluate the strength and determinants of memory of eating. While some nutritional scientists (e.g., Archer et al., 2018;Schoeller et al., 2013;Wansink, 2006) claim memory of eating to be unreliably poor and inaccurate it remains unclear if memory of eating differs from memory of other similar behaviors. On the contrary, given the evolutionary significance of eating and the role that memory of eating has on moderating future food consumption, it may be the case that the act of eating is relatively well-remembered. ...
How well do we remember eating food? Some nutritional scientists have decried memory of eating as being highly unreliable (i.e. low in accuracy), but it is unclear if memory of eating is particularly worse than memory of other behaviors. In fact, evolutionary reasoning suggests the mammalian memory system might be biased towards enhanced memory of eating. We created a novel behavioral task to investigate the relative strength and determinants of memory of eating. In this task, participants were cued to eat a single item of food every time a tone was sounded and were later asked to recall how many items of food they consumed. In Experiment 1, we found that memory for the behavior of eating was more accurate than memory for similar but noneating behaviors. In Experiment 2, we ruled out a potential physiological mechanism (glucose ingestion) behind this effect. Last, in two pre-registered studies, we explored determinants of memory of eating. In Experiment 3, we found that the caloric density of the consumed food item potentiates its ability to be remembered and in Experiment 4 we found that a slow eating rate results in more accurate memory of eating than a fast eating rate. Understanding these and future factors that influence memory of eating might be useful in designing intervention strategies to enhance memory of eating, which has been shown to reduce future food consumption. Ultimately these four studies inform our understanding of how selective pressures shaped memory and lay the groundwork for further investigations into memory of eating.
... Within the context of an aging population, the shift in dietary profile of Western countries in the twenty-first century, characterized by an increase in processed foods, has led to an increased concern for the long term impact of poor nutrition on the brain (7)(8)(9). However, the legitimacy of this concern remains uncertain with the majority of evidence garnered from studies utilizing memory-based methods of dietary assessment (10). ...
... Nevertheless, it would be remiss to not consider the potential bias in the presented example. The screening tool used to classify "optimal" and "sub-optimal" relies on the participant recalling their own perception of their usual dietary intake and is not an objective measure of dietary intake (10). Moreover, the original validation paper awarded five additional points for dietary supplement use. ...
Many researchers have identified the issue of self-selection bias hindering the ability to detect nutrient effects in healthy populations. However, it appears that no effort has been made to mitigate this potential design flaw. By recruiting individuals on the basis of pre-trial dietary intake, the Memory and Attention Supplementation Trial aimed to capture a cohort of participants with a wide variety of dietary intake, thus increasing the likelihood of a diverse range of nutrient status. This perspective specifically examines the profile of these trial volunteers and in doing so, we present the first empirical evidence of self-selection bias when recruiting healthy volunteers for a randomized controlled trial of a nutrient-based supplement. These findings support the anecdotal proposal that traditional recruitment methods inherently attract trial volunteers who are vastly unrepresentative of the population and threatens the generalizability of this field of research. Alternative approaches to recruitment, including a-priori screening for baseline diet quality and nutrient status, are discussed as essential design recommendations to ensure accurate interpretation of nutrient effects within the context of baseline participant characteristics.
... This was done to facilitate comparisons to nutrient intakes in MRE participants during INT because self-report diet records commonly underestimate energy intakes, and micronutrient intakes are generally correlated with energy intakes. 17,18 Dietary intake in the MRE group during INT was assessed using ration-specific food logs completed at the time of consuming each meal, and through the collection and return of all trash and any uneaten food items. Ration-specific food logs were reviewed by RDs, and any inconsistencies between ration logs and collected trash were adjudicated with participants. ...
... Although still considered a research standard, and trained RDs reviewed and input dietary data into a recognized nutrition software, the method is known to have inaccuracies, and complete micronutrient information was not available for all foods. 17,18 These inaccuracies likely contributed to an underreport of usual nutrient intakes. Those inaccuracies likely also contributed to an underestimation of weight maintenance energy needs in the MRE group and, consequently, the slight mean weight loss in that group during INT. ...
Background
The US military Meal, Ready-to-Eat food ration is approved as a nutritionally adequate sole source of nutrition for ≤21 days. However, the ration continuously evolves, requiring periodic reassessment of its influence on nutritional status and health.
Objective
To determine the effects of consuming the US Armed Services Meal, Ready-to-Eat ration for 21 days, relative to usual diets, on nutrient intake, and indicators of nutritional status and cardiometabolic health.
Design
Parallel-arm, randomized, controlled trial, secondary analysis.
Participants
Sixty healthy, weight stable, free-living adults from the Natick, MA, area participated between June 2015 and March 2017.
Intervention
Participants were randomized to consume their usual diet for 31days (CON), or a strictly controlled Meal, Ready-to-Eat-only diet for 21 days followed by their usual diet for 10 days (MRE).
Main outcome measures
Nutrient intake (absolute and adjusted) throughout the study period, and indicators of nutrition status (vitamins B, D, folate, homocysteine, iron, magnesium, and zinc) and cardiometabolic health (glucose, insulin, and blood lipid levels) before (Day 0), during (Day 10 through Day 21), and after (Day 31) the intervention period.
Statistical analysis performed
Between-group differences over time were assessed using marginal models. Models for nutritional status and cardiometabolic health indicators were adjusted for age, initial body mass index, and baseline value of the dependent variable.
Results
Energy-adjusted fiber; polyunsaturated fatty acids; vitamins A, thiamin, riboflavin, B-6, C, D, and E; and magnesium and zinc intakes all increased in MRE during the intervention and were higher compared with CON (P<0.05), whereas relative protein intake decreased and was lower (P<0.05). Serum triglyceride concentrations averaged 19% (95% CI 0% to 41%) higher in MRE relative to CON during Days 10 to 31 (P=0.05). No statistically significant effects of diet on any other nutritional status or cardiometabolic health indicators were observed.
Conclusions
Findings demonstrate that a Meal, Ready-to-Eat ration diet can provide a more micronutrient-dense diet than usual dietary intake aiding in maintenance of nutritional status over 21 days.
... Diet is hard to measure Tools such as food frequency questionnaires or 24 h dietary recall instruments are commonly used to assess habitual dietary intakes. Despite efforts towards validating these tools and their ability to produce credible estimates of dietdisease associations, critics have called for them to be abandoned, considering them flawed because of their reliance on memory and cognition and issues of bias and measurement error [63,64]. Suggestions for suitable alternatives are sparse, however. ...
Nutrition therapy has been emphasised for decades for people with type 2 diabetes, and the vital importance of diet and nutrition is now also recognised for type 2 diabetes prevention. However, the complexity of diet and mixed messages on what is unhealthy, healthy or optimal have led to confusion among people with diabetes and their physicians as well as the general public. What should people eat for the prevention, management and remission of type 2 diabetes? Recently, progress has been made in research evidence that has advanced our understanding in several areas of past uncertainty. This article examines some of these issues, focusing on the role of diet in weight management and in the prevention and management of type 2 diabetes. It considers nutritional strategies including low-energy, low-fat and low-carbohydrate diets, discusses inter-relationships between nutrients, foods and dietary patterns, and examines aspects of quantity and quality together with new developments, challenges and future directions.
Graphical abstract
... Although a large number of potential confounders, such as cancer type, study design, and region of the study, were adjusted for in most studies, we cannot exclude that some other dietary biologically active components may partly or wholly affect the association. Second, recall bias associated with the assessment methods of chili pepper exposure should be considered because FFQ or frequency-reported questionnaires are subject to measurement errors, which can attenuate or overestimate the observed association (55). Additional limitations related to different cooking and processing methods for chili pepper. ...
Background
Stimulating food is emerging as an important modifiable factor in the development of gastrointestinal (GI) tract cancers, but the association between chili pepper consumption and the risk of GI cancers is unclear. We aimed to evaluate the direction and magnitude of the association between chili pepper consumption and the risk of GI cancers.
Methods
A literature search was performed in PubMed, Embase, and Web of Science databases from inception to 22 December 2021. Observational studies reporting the association between chili pepper consumption and the risk of gastric cancer (GC), esophageal cancer (EC), and/or colorectal cancer (CRC) in adults were eligible for inclusion. Data extraction and quality assessment were conducted independently by two reviewers for the included literature. Summary odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using a random-effects model. Subgroup analyses were also performed based on the cancer type, study design, region of the study, study quality, and adjustments.
Results
A total of 11,421 studies were screened, and 14 case-control studies were included involving 5009 GI cancers among 11,310 participants. The summary OR showed that high consumption of chili pepper was positively related to the risk of GI cancers (OR = 1.64; 95% CI: 1.00–2.70). A stronger positive relationship was observed between chili pepper consumption and EC risk (OR = 2.71; 95% CI: 1.54–4.75), but there was no statistically significant association between GC and CRC risk. In analyses stratified by geographical location, a positive association was found between chili pepper consumption and the risk of GI cancers in Asian studies (OR = 2.50; 95% CI: 1.23–5.08), African studies (OR = 1.62; 95% CI: 1.04–2.52), and North American studies (OR = 2.61; 95% CI: 1.34–5.08), but an inverse association was seen in South American studies (OR = 0.50; 95% CI: 0.29–0.87) and European studies (OR = 0.30; 95% CI: 0.15–0.61).
Conclusion
This meta-analysis suggests that chili pepper is a risk factor for certain GI cancers (e.g., EC). Geographical regions influence the risk of GI cancers, especially in Asian, African, and North American populations, which require more attention during dietary guidance.
Systematic review registration
[ https://www.crd.york.ac.uk/PROSPERO/ ], identifier [CRD42022320670].
... FFQs and other forms of memory-based dietary assessment methods are useful tools in epidemiological studies to understand subjects' dietary intake [49]. Even though the limitation of these assessment methods is acknowledged, SQFFQs remain until nowadays the most used dietary assessment method to study dietary patterns. ...
This study aims to evaluate the reproducibility and validity of a semi-quantitative food frequency questionnaire (SQFFQ) developed for vegetarians and omnivores in Harbin, China. Participants (36 vegetarians and 64 omnivores) administered SQFFQ at baseline (SQFFQ1) and six months later (SQFFQ2) to assess the reproducibility. The 24 h recalls (24 HRs) for three consecutive days were completed between the administrations of two SQFFQs to determine the validity. For reproducibility, Pearson correlation coefficients between SQFFQ1 and SQFFQ2 for vegetarians and omnivores were 0.45~0.88 and 0.44~0.84, respectively. For validity, unadjusted Pearson correlation coefficients were 0.46~0.83 with an average of 0.63 and 0.43~0.86 with an average of 0.61, respectively; energy-adjusted Pearson correlation coefficients were 0.43~0.82 with an average of 0.61 and 0.40~0.85 with an average of 0.59, respectively. Majority of the correlation coefficients for food groups and macronutrients decreased or remained unchanged after energy adjustment. Furthermore, all correlations were statistically significant (p < 0.05). Bland–Altman plots also showed reasonably acceptable agreement between the two methods. In conclusion, the SQFFQ developed in this study has reasonably acceptable reproducibility and validity.
... Advantages to FFQs include scalability, ease of administration, and opportunity for serial measurement. Disadvantages include concerns about reproducibility and systematic errors and biases associated with self-reported data, memory-based measurements, inability to verify or falsify data (161), or objective infant brain measurement (61), and data processing assumptions. ...
Multimodal brain magnetic resonance imaging (MRI) can provide biomarkers of early influences on neurodevelopment such as nutrition, environmental and genetic factors. As the exposure to early influences can be separated from neurodevelopmental outcomes by many months or years, MRI markers can serve as an important intermediate outcome in multivariate analyses of neurodevelopmental determinants. Key to the success of such work are recent advances in data science as well as the growth of relevant data resources. Multimodal MRI assessment of neurodevelopment can be supplemented with other biomarkers of neurodevelopment such as electroencephalograms, magnetoencephalogram, and non-imaging biomarkers. This review focuses on how maternal nutrition impacts infant brain development, with three purposes: (1) to summarize the current knowledge about how nutrition in stages of pregnancy and breastfeeding impact infant brain development; (2) to discuss multimodal MRI and other measures of early neurodevelopment; and (3) to discuss potential opportunities for data science and artificial intelligence to advance precision nutrition. We hope this review can facilitate the collaborative march toward precision nutrition during pregnancy and the first year of life.
... Previous meta-analyses did not consider the differences between prescribed and actual carbohydrate intakes, and only performed a sensitivity analysis restricting the analyses to participants with high adherence to the prescribed diets (8). Although self-reported dietary intakes are subject to measurement error, especially in trials wherein participants are not blinded (105,106), they can present more accurate information about the amounts of carbohydrate intake in the trials than can prescribed data (40). We converted g/d to % calorie, and thereby harmonized the data across trials. ...
Background
Carbohydrate restriction is effective for type 2 diabetes management.
Objectives
We aimed to evaluate the dose-dependent effect of carbohydrate restriction in patients with type 2 diabetes.
Methods
We systematically searched PubMed, Scopus, and Web of Science to May 2021 for randomized controlled trials evaluating the effect of a carbohydrate-restricted diet (≤45% total calories) in patients with type 2 diabetes. The primary outcome was glycated hemoglobin (HbA1c). Secondary outcomes included fasting plasma glucose (FPG); body weight; serum total, LDL, and HDL cholesterol; triglyceride (TG); and systolic blood pressure (SBP). We performed random-effects dose-response meta-analyses to estimate mean differences (MDs) for a 10% decrease in carbohydrate intake.
Results
Fifty trials with 4291 patients were identified. At 6 months, compared with a carbohydrate intake between 55%–65% and through a maximum reduction down to 10%, each 10% reduction in carbohydrate intake reduced HbA1c (MD, −0.20%; 95% CI, −0.27% to −0.13%), FPG (MD, −0.34 mmol/L; 95% CI, −0.56 to −0.12 mmol/L), and body weight (MD, −1.44 kg; 95% CI, −1.82 to −1.06 kg). There were also reductions in total cholesterol, LDL cholesterol, TG, and SBP. Levels of HbA1c, FPG, body weight, TG, and SBP decreased linearly with the decrease in carbohydrate intake from 65% to 10%. A U-shaped effect was seen for total cholesterol and LDL cholesterol, with the greatest reduction at 40%. At 12 months, a linear reduction was seen for HbA1c and TG. A U-shaped effect was seen for body weight, with the greatest reduction at 35%.
Conclusions
Carbohydrate restriction can exert a significant and important reduction on levels of cardiometabolic risk factors in patients with type 2 diabetes. Levels of most cardiometabolic outcomes decreased linearly with the decrease in carbohydrate intake. U-shaped effects were seen for total cholesterol and LDL cholesterol at 6 months and for body weight at 12 months.
... Although controversy exists in the literature relating to the accuracy and validity of self-reported dietary intake as estimated by Food Frequency Questionnaires, 24-h dietary interviews, and dietary records [46,47], the first limitation of our study is the lack of reports the athletes' dietary data. Further, we did not measured stool metabolites and therefore were unable to confirm the effects of any significant increase of intestinal SCFA producers at the end of the training period. ...
Background
Physical exercise has favorable effects on the structure of gut microbiota and metabolite production in sedentary subjects. However, little is known whether adjustments in an athletic program impact overall changes of gut microbiome in high-level athletes. We therefore characterized fecal microbiota and serum metabolites in response to a 7-week, high-intensity training program and consumption of probiotic Bryndza cheese.
Methods
Fecal and blood samples and training logs were collected from young competitive male ( n = 17) and female ( n = 7) swimmers. Fecal microbiota were categorized using specific primers targeting the V1–V3 region of 16S rDNA, and serum metabolites were characterized by NMR-spectroscopic analysis and by multivariate statistical analysis, Spearman rank correlations, and Random Forest models.
Results
We found higher α-diversity, represented by the Shannon index value (HITB-pre 5.9 [± 0.4]; HITB-post 6.4 [± 0.4], p = 0.007), (HIT-pre 5.5 [± 0.6]; HIT-post 5.9 [± 0.6], p = 0.015), after the end of the training program in both groups independently of Bryndza cheese consumption. However, Lactococcus spp . increased in both groups, with a higher effect in the Bryndza cheese consumers (HITB-pre 0.0021 [± 0.0055]; HITB-post 0.0268 [± 0.0542], p = 0.008), (HIT-pre 0.0014 [± 0.0036]; HIT-post 0.0068 [± 0.0095], p = 0.046). Concomitant with the increase of high-intensity exercise and the resulting increase of anaerobic metabolism proportion, pyruvate ( p [HITB] = 0.003; p [HIT] = 0.000) and lactate ( p [HITB] = 0.000; p [HIT] = 0.030) increased, whereas acetate ( p [HITB] = 0.000; p [HIT] = 0.002) and butyrate ( p [HITB] = 0.091; p [HIT] = 0.019) significantly decreased.
Conclusions
Together, these data demonstrate a significant effect of high-intensity training (HIT) on both gut microbiota composition and serum energy metabolites. Thus, the combination of intensive athletic training with the use of natural probiotics is beneficial because of the increase in the relative abundance of lactic acid bacteria.
... Limitations to this study include the attrition of the cohort at the 1-year visit (71% follow-up at 1-year). Further, a limitation of this work is that the dietary outcome is based on a self-reported food frequency questionnaire [54]. Sources of measurement error in such instruments have been well-documented. ...
Background:
Understanding the impact of maternal health behaviours and social conditions on childhood nutrition is important to inform strategies to promote health during childhood.
Objective:
To describe how maternal health sociodemographic factors (e.g., socioeconomic status, education), health behaviours (e.g., diet), and traditional health care use during pregnancy impact infant diet at age 1-year.
Methods:
Data were collected from the Indigenous Birth Cohort (ABC) study, a prospective birth cohort formed in partnership with an Indigenous community-based Birthing Centre in southwestern Ontario, Canada. 110 mother-infant dyads are included in the study and were enrolled between 2012 and 2017. Multiple linear regression analyses were performed to understand factors associated with infant diet scores at age 1-year, with a higher score indicating a diet with more healthy foods.
Results:
The mean age of women enrolled during pregnancy was 27.3 (5.9) years. Eighty percent of mothers had low or moderate social disadvantage, 47.3% completed more than high school education, and 70% were cared for by a midwife during their pregnancy. The pre-pregnancy body mass index (BMI) was <25 in 34.5% of women, 15.5% of mothers smoked during pregnancy, and 14.5% of mothers had gestational diabetes. Being cared for by an Indigenous midwife was associated with a 0.9-point higher infant diet score (p = 0.001) at age 1-year, and lower maternal social disadvantage was associated with a 0.17-point higher infant diet quality score (p = 0.04).
Conclusion:
This study highlights the positive impact of health care provision by Indigenous midwives and confirms that higher maternal social advantage has a positive impact on child nutrition.
... However, others have observed similar perceptions of fasting appetite [10], and three-day self-reported energy intake [11] following programs of HIIT compared with MICT, and a recent meta-analysis of the effect of interval training on energy intake revealed no significant differences in energy intake following varying interventions of HIIT or SIT and MICT [12]. Importantly, all but one of the 16 studies included in this analysis relied on self-report measures of food intake, such as food diaries or food frequency questionnaires, which may provide erroneous and/or biased results [13], particularly given that participants in many of the included studies were instructed to maintain their habitual food consumption. The heterogeneity of energy intake assessment, together with the varied interval training protocols studied, suggests that conclusions about the efficacy of interval training protocols to influence appetite and food choices may be premature. ...
An acute bout of sprint interval training (SIT) performed with psychological need-support incorporating autonomy, competence, and relatedness has been shown to attenuate energy intake at the post-exercise meal, but the long-term effects are not known. The aim of this trial was to investigate the effects of 12 weeks of SIT combined with need-support on post-exercise food consumption. Thirty-six physically inactive participants with overweight and obesity (BMI: 29.6 ± 3.8 kg·m−2; V˙O2peak 20.8 ± 4.1 mL·kg−1·min−1) completed three sessions per week of SIT (alternating cycling for 15 s at 170% V˙O2peak and 60 s at 32% V˙O2peak) with need-support or traditional moderate-intensity continuous training (MICT) without need-support (continuous cycling at 60% V˙O2peak). Assessments of appetite, appetite-related hormones, and ad libitum energy intake in response to acute exercise were conducted pre- and post-intervention. Fasting appetite and blood concentrations of active ghrelin, leptin, and insulin did not significantly differ between groups or following the training. Post-exercise energy intake from snacks decreased significantly from pre- (807 ± 550 kJ) to post- SIT (422 ± 468 kJ; p < 0.05) but remained unaltered following MICT. SIT with psychological need-support appears well-tolerated in a physically inactive population with overweight and offers an alternative to traditional exercise prescription where dietary intake is of concern.
... There has been some suggestion that obesity is the result of declining activity levels, but taking into account that heavier individuals require greater amounts of energy to sustain and move their bodyweight, the reduction in activity required to explain the rise in obesity is also too large to be plausible (Millward, 2013). This supports previous authors who question the validity of self-reported EI (Dhurandhar et al., 2015;Archer, Lavie and Hill, 2018;Archer, Marlow and Lavie, 2018). ...
Objective:
The aim of this study was to assess the extent of misreporting in obese and nonobese adults on an absolute, ratio-scaled, and allometrically-scaled basis.
Method:
Self-reported daily energy intake (EI) was compared with total energy expenditure (TEE) in 221 adults (106 male, 115 female; age 53 ± 17 years, stature 1.68 ± 0.09 m, mass 79.8 ± 17.2 kg) who participated in a doubly-labeled water (DLW) subsection of 2013-2015 National Diet and Nutrition Survey. Data were log transformed and expressed as absolute values, according to simple ratio-standards (per kg body mass) and adjusted for body mass allometrically. Absolute and ratio-scaled misreporting were examined using full-factorial General Linear Models with repeated measures of the natural logarithms of TEE or EI as the within-subjects factor. The natural logarithm of body mass was included as a covariate in the allometric method. The categorical variables of gender, age, obesity, and physical activity level (PAL) were the between-factor variables.
Results:
On an absolute-basis, self-reported EI (2759 ± 590 kcal·d-1 ) was significantly lower than TEE measured by DLW (2759 ± 590 kcal·d-1 : F1,205 = 598.81, p < .001, ηp 2 =0.75). We identified significantly greater underreporting in individuals with an obese BMI (F1,205 = 29.01, p <.001, ηp 2 =0.12), in more active individuals (PAL > 1.75; F1,205 = 34.15, p <.001, ηp 2 =0.14) and in younger individuals (≤55 years; F1,205 = 14.82, p < .001, ηp 2 =0.07), which are all categories with higher energy needs. Ratio-scaling data reduced the effect sizes. Allometric-scaling removed the effect of body mass (F1,205 =0.02, p = 0.887, ηp 2 =0.00).
Conclusion:
In weight-stable adults, obese individuals do not underreport dietary intake to a greater extent than nonobese individuals. These results contradict previous research demonstrating that obesity is associated with a greater degree of underreporting.
... As limitations, we assessed dietary intake using dietary surveys (FFQ), a method that possesses limitations [69]. However, we have used this instrument previously, and it has been validated in this population with the focus on dietary sources of fat and fatty acid intake [31,37,41]. ...
Obesity during pregnancy is a worrying public health problem worldwide. Maternal diet is critical for fatty acid (FA) placental transport and FA content in breast milk (BM). We evaluated FA composition in erythrocytes phospholipids (EP) and BM in pregnant women with (OBE, n = 30) and without (non-OBE, n = 31) obesity. Sixty-one healthy women were evaluated at their 20–24th gestational week and followed until 6th month of lactation. Diet was evaluated through a food frequency questionnaire. FA composition of EP and BM was assessed by gas-liquid chromatography. The OBE group showed lower diet quality, but total n-6 and n-3 polyunsaturated FA (PUFA), ALA, EPA, and DHA dietary intake was similar between groups. N-3 PUFA, ALA, DHA, and the n-6/n-3 PUFA ratio in EP were lower at the 6th lactation month in the OBE group. In BM, the arachidonic acid (AA) concentration was lower at the end of the lactation, and DHA content showed an earlier and constant decline in the OBE group compared to the non-OBE group. In conclusion, n-3 PUFA and AA and DHA levels were reduced in EP and BM in pregnant women with obesity. Strategies to increase n-3 PUFA are urgently needed during pregnancy and lactation, particularly in women with obesity.
... Studies were prone to inherent errors from portion size estimation, seasonal variations and recall bias due to score calculations being based on self-reported dietary intake (6,8, . Memory-based tools such as FFQ and 24-h recalls have been cited for misreporting dietary intake as they report on participants' perceived intake rather than the actual intake (52) . This was somewhat accounted for by studies via adjustments in their statistical models, such as excluding participants with an unreasonably high or low energy intake though they have been criticised for alteration of data (53) . ...
Diet quality indices (DQIs) are tools used to evaluate the overall diet quality against dietary guidelines or known healthy dietary patterns. This review aimed to evaluate DQIs and their validation processes to facilitate decision-making in the selection of appropriate DQIs for use in Australian contexts. A search of CINAHL, PubMed and Scopus electronic databases was conducted for studies published between January 2010 – May 2020, which validated a DQI, measuring >1 dimension of diet quality (adequacy, balance, moderation, variety) and was applicable to the Australian context. Data on constructs, scoring, weighting and validation methods (construct validity, criterion validity, reliability and reproducibility) were extracted and summarised. The quality of the validation process was evaluated using COSMIN Risk of Bias and Joanna Briggs Appraisal checklists. The review identified 27 indices measuring adherence to: national dietary guidelines (n=13), Mediterranean diet (n=8), and specific population recommendations and chronic disease risk (n=6). Extensiveness of the validation process varied widely across and within categories. Construct validity was the most strongly assessed measurement property, while evaluation of measurement error was frequently inadequate. DQIs should capture multiple dimensions of diet quality, possess a reliable scoring system, and demonstrate adequate evidence in their validation framework to support use in the intended context. Researchers need to understand the limitations of newly developed DQIs and interpret results in view of the validation evidence. Future research on DQIs is indicated to improve evaluation of measurement error, reproducibility and reliability.
... Future studies should incorporate measurement of peripheral concentrations of SCFAs in addition to fecal sampling (81). Third, fiber intake was based on food recalls, and it is well known that self-reporting assessment tools can be inherently biased (82). The use of self-reported measures (i.e., fiber intake) when analyzing results may have caused residual confounding. ...
Background
The gut microbiome has been associated with cardiorespiratory fitness.
Objective
To assess the effects of oligofructose (FOS)-enriched inulin supplementation on the gut microbiome and the peak oxygen uptake (V̇O2peak) response to high-intensity interval training (HIIT).
Methods
The study was a randomized controlled trial. Forty sedentary and apparently healthy adults (n = 31 females; age = 31.8±9.8 years, BMI = 25.9±4.3 kg·m−2) were randomly allocated to: i) six weeks of supervised HIIT (4×4 min bouts at 85–95% HRpeak, interspersed with 3 min of active recovery, 3·week−1) + 12 g·day−1 of FOS-enriched inulin (HIIT-I) or ii) six weeks of supervised HIIT (3·week−1, 4×4 min bouts) + 12 g·day−1 of maltodextrin/placebo (HIIT-P). Each participant completed an incremental treadmill test to assess V̇O2peak and ventilatory thresholds (VTs), provided a stool and blood sample, and completed a 24-hour diet recall and food frequency questionnaire before and after the intervention. Gut microbiome analyses were performed using metagenomic sequencing. Fecal short-chain fatty acids were measured by mass spectrometry.
Results
There were no differences in the mean change in V̇O2peak response between groups (P = 0.58). HIIT-I had a greater improvement in VTs than HIIT-P (VT1 - lactate accumulation: mean difference +4.3% and VT2 – lactate threshold: +4.2%, P<0.05). HIIT-I had a greater increase in the abundance of Bifidobacterium taxa (False Discovery Rate (FDR) <0.05) and several metabolic processes related to exercise capacity (FDR <0.05). Exploratory analysis of merged data found participants with a greater response to HIIT (V̇O2peak ≥3.5mL·kg−¹·min−¹) had a 2.2-fold greater mean abundance of gellan degradation pathways (FDR <0.05) and a greater, but not significant, abundance of B. Uniformis spp. (P<0.00023, FDR = 0.08).
Conclusions
FOS-enriched inulin supplementation did not potentiate HIIT-induced improvements in V̇O2peak, but led to gut microbiome changes possibly associated with greater ventilatory threshold improvements in healthy inactive adults. Gellan degradation pathways and B.uniformis spp. were associated with greater V̇O2peak responses to HIIT.
Clinical Trials Register
ACTRN12618000501246.
... 94 Dietary records and diaries can usually be considered more valid than recall-based methods, although all self-reported methods suffer from serious limitations. 47 48 95 96 The validity of food frequency questionnaires and other recall-based methods also depends on the results of validation studies. 48 A questionnaire may be sufficiently valid for some exposures and may not have been validated or may not be valid for other exposures and so review authors should look for results of validation studies specific to the exposure being investigated. ...
Background
An essential component of systematic reviews is the assessment of risk of bias. To date, there has been no investigation of how reviews of non-randomised studies of nutritional exposures (called ‘nutritional epidemiologic studies’) assess risk of bias.
Objective
To describe methods for the assessment of risk of bias in reviews of nutritional epidemiologic studies.
Methods
We searched MEDLINE, EMBASE and the Cochrane Database of Systematic Reviews (Jan 2018–Aug 2019) and sampled 150 systematic reviews of nutritional epidemiologic studies.
Results
Most reviews (n=131/150; 87.3%) attempted to assess risk of bias. Commonly used tools neglected to address all important sources of bias, such as selective reporting (n=25/28; 89.3%), and frequently included constructs unrelated to risk of bias, such as reporting (n=14/28; 50.0%). Most reviews (n=66/101; 65.3%) did not incorporate risk of bias in the synthesis. While more than half of reviews considered biases due to confounding and misclassification of the exposure in their interpretation of findings, other biases, such as selective reporting, were rarely considered (n=1/150; 0.7%).
Conclusion
Reviews of nutritional epidemiologic studies have important limitations in their assessment of risk of bias.
... However, the reliability of these questionnaires has been challenged (e.g. Archer et al., 2018) and it is pertinent to note that measures of dietary intake that rely on memory for what has been consumed may lead to issues of circularity when considering the impact of diet on memory, and particularly on memory for what has been consumed. Studies of "whole diets" or the frequency of particular foods (e.g., sugar-sweetened beverages or "junk food") in the diet have identified a number of consistent patterns (Kim and Kang, 2017;Muñoz-García et al., 2020;Wiles et al., 2009). ...
This paper reviews evidence demonstrating a bidirectional relationship between memory and eating in humans and rodents. In humans, amnesia is associated with impaired processing of hunger and satiety cues, disrupted memory of recent meals, and overconsumption. In healthy participants, meal-related memory limits subsequent ingestive behavior and obesity is associated with impaired memory and disturbances in the hippocampus. Evidence from rodents suggests that dorsal hippocampal neural activity contributes to the ability of meal-related memory to control future intake, that endocrine and neuropeptide systems act in the ventral hippocampus to provide cues regarding energy status and regulate learned aspects of eating, and that consumption of hypercaloric diets and obesity disrupt these processes. Collectively, this evidence indicates that diet-induced obesity may be caused and/or maintained, at least in part, by a vicious cycle wherein excess intake disrupts hippocampal functioning, which further increases intake. This perspective may advance our understanding of how the brain controls eating, the neural mechanisms that contribute to eating-related disorders, and identify how to treat diet-induced obesity.
... We were not able to confirm the associations between serum AGP and diet in multiple regression, which may indicate indirect relationships or may be associated with a limited number of studied patients. Data on dietary intake of nutrients were obtained via 24 h recall, which is prone to distortions [52,53]. However, in the studied group of patients we were not able to measure the concentration of each nutrient by means of adequate laboratory tests. ...
Management of end-stage renal disease (ESRD) patients requires monitoring each of the components of malnutrition–inflammation–atherosclerosis (MIA) syndrome. Restrictive diet can negatively affect nutritional status and inflammation. An acute-phase protein—α1-acid glycoprotein (AGP), has been associated with energy metabolism in animal and human studies. The aim of our study was to look for a relationship between serum AGP concentrations, laboratory parameters, and nutrient intake in ESRD patients. The study included 59 patients treated with maintenance hemodialysis. A 24 h recall assessed dietary intake during four non-consecutive days—two days in the post-summer period, and two post-winter. Selected laboratory tests were performed: complete blood count, serum iron, total iron biding capacity (TIBC) and unsaturated iron biding capacity (UIBC), vitamin D, AGP, C-reactive protein (CRP), albumin, prealbumin, and phosphate–calcium metabolism markers (intact parathyroid hormone, calcium, phosphate). Recorded dietary intake was highly deficient. A majority of patients did not meet recommended daily requirements for energy, protein, fiber, iron, magnesium, folate, and vitamin D. AGP correlated positively with CRP (R = 0.66), platelets (R = 0.29), and negatively with iron (R = −0.27) and TIBC (R = −0.30). AGP correlated negatively with the dietary intake of plant protein (R = −0.40), potassium (R = −0.27), copper (R = −0.30), vitamin B6 (R = −0.27), and folates (R = −0.27), p < 0.05. However, in multiple regression adjusted for confounders, only CRP was significantly associated with AGP. Our results indicate that in hemodialyzed patients, serum AGP is weakly associated with dietary intake of several nutrients, including plant protein.
... Bedacht werden muss allerdings, dass Beobachtungs-bzw. Kohortenstudien insbesondere in der Ernährungsmedizin sehr störanfällig sind (unzuverlässige subjektive Erhebungsmethoden, Confounding durch unzureichende Adjustierung von relevanten Lebensstilfaktoren, "selection bias" oder "residual confounding", "healthy user bias" etc.; [88][89][90][91] [75,77,94]. Zudem handelt es sich bei der FMHS nicht um eine RCT. ...
Zusammenfassung
Die „Fetthypothese der koronaren Herzkrankheit“, derzufolge „gesättigte Fettsäuren“ („saturated fatty acids“, SFA) die LDL(„low-density lipoprotein“)-Cholesterin-Konzentration (LDL-C) steigern und folglich das Risiko für kardiovaskuläre Erkrankungen erhöhen, prägte die Ernährungsempfehlungen der letzten 60 Jahre, zunächst in den USA und später auch in Europa. Über die Jahre mehrte sich Evidenz aus Epidemiologie und kontrollierten klinischen Studien, dass der Konsum von SFA per se nicht mit einem erhöhten kardiovaskulären Risiko einhergeht bzw. die Einschränkung des Konsums von SFA keine präventive Wirkung zeigt. Die Fokussierung auf den SFA-Gehalt negiert die biologisch heterogenen und zum Teil biologisch günstigen Wirkungen unterschiedlicher SFA. Zudem wird hierbei außer Acht gelassen, dass SFA in intakten Lebensmitteln in unterschiedliche komplexe Matrizes eingebunden sind, die aus Dutzenden Nährstoffen mit unterschiedlicher Struktur und Begleitstoffen bestehen und damit jeweils unterschiedliche biologische Antworten und metabolische Effekte auslösen. Entsprechend sind solche nährstoffbasierten Empfehlungen prinzipiell wenig zielführend und zudem schlecht umsetzbar. Hinzu kommt, dass LDL‑C kein geeigneter Marker ist, um den Effekt von Lebensstilintervention wie der Ernährung oder aber der körperlichen Aktivität auf das globale kardiovaskuläre Risiko zu beurteilen.
... These data should inform an ongoing debate within nutritional and medical communities regarding the validity of self-reported dietary assessment techniques. That there is a discrepancy between self-reported and actual eating, particularly among individuals with higher BMI, has long been a concern in nutritional research (Dao et al., 2019;Lichtman et al., 1992;Macdiarmid and Blundell, 1998;Schoeller et al., 2013) but some have recently argued that self-reported energy intakes are entirely inadequate measures that should not be used in scientific studies (Archer et al., 2018;Schoeller et al., 2013). If participants are so inaccurate in recalling how much food they consumed just minutes earlier (Seitz et al., 2021), relying on memory-based measures of dietary intake is likely to result in highly unreliable findings. ...
The study of memory is commonly associated with neuroscience, aging, education, and eyewitness testimony. Here we discuss how eating behavior is also heavily intertwined-and yet considerably understudied in its relation to memory processes. Both are influenced by similar neuroendocrine signals (e.g., leptin and ghrelin) and are dependent on hippocampal functions. While learning processes have long been implicated in influencing eating behavior, recent research has shown how memory of recent eating modulates future consumption. In humans, obesity is associated with impaired memory performance, and in rodents, dietary-induced obesity causes rapid decrements to memory. Lesions to the hippocampus disrupt memory but also induce obesity, highlighting a cyclic relationship between obesity and memory impairment. Enhancing memory of eating has been shown to reduce future eating and yet, little is known about what influences memory of eating or how memory of eating differs from memory for other behaviors. We discuss recent advancements in these areas and highlight fruitful research pursuits afforded by combining the study of memory with the study of eating behavior.
... One limitation of this study is that self-reported information, particularly in relation to aspects of health, introduces many challenges [75][76][77], and collecting data with FFQ's has generated much criticism [78]. However, the maternal FFQ utilized in this study has been extensively validated and was explicitly developed for the target population [34]. ...
Background
Attention Deficit Hyperactivity Disorder (ADHD) is a prevalent neurodevelopmental disorder. Effective long-term treatment options are limited, which warrants increased focus on potential modifiable risk factors. The aim of this study was to investigate associations between maternal diet quality during pregnancy and child diet quality and child ADHD symptoms and ADHD diagnosis.
Methods
This study is based on the Norwegian Mother, Father and Child Cohort Study (MoBa). We assessed maternal diet quality with the Prenatal Diet Quality Index (PDQI) and Ultra-Processed Food Index (UPFI) around mid-gestation, and child diet quality using the Diet Quality Index (CDQI) at 3 years. ADHD symptoms were assessed at child age 8 years using the Parent Rating Scale for Disruptive Behaviour Disorders. ADHD diagnoses were retrieved from the Norwegian Patient Registry.
Results
In total, 77,768 mother-child pairs were eligible for studying ADHD diagnoses and 37,787 for ADHD symptoms. Means (SD) for the PDQI, UPFI and CDQI were 83.1 (9.3), 31.8 (9.7) and 60.3 (10.6), respectively. Mean (SD) ADHD symptom score was 8.4 (7.1) and ADHD diagnosis prevalence was 2.9% (male to female ratio 2.6:1). For one SD increase in maternal diet index scores, we saw a change in mean (percent) ADHD symptom score of − 0.28 (− 3.3%) (CI: − 0.41, − 0.14 (− 4.8, − 1.6%)) for PDQI scores and 0.25 (+ 3.0%) (CI: 0.13, 0.38 (1.5, 4.5%)) for UPFI scores. A one SD increase in PDQI score was associated with a relative risk of ADHD diagnosis of 0.87 (CI: 0.79, 0.97). We found no reliable associations with either outcomes for the CDQI, and no reliable change in risk of ADHD diagnosis for the UPFI.
Conclusions
We provide evidence that overall maternal diet quality during pregnancy is associated with a small decrease in ADHD symptom score at 8 years and lower risk for ADHD diagnosis, with more robust findings for the latter outcome. Consumption of ultra-processed foods was only associated with increased ADHD symptom score of similar magnitude as for overall maternal diet quality, and we found no associations between child diet quality and either outcome. No causal inferences should be made based on these results, due to potential unmeasured confounding.
... Sugar-sweetened beverages (SSBs) have been associated with the risk of multiple chronic diseases (1)(2)(3)(4). Most of these associations are based on self-reported intakes, which are prone to error (5,6), especially for sugar-related intakes (7,8). Dietary estimates based on objective, unbiased dietary biomarkers may strengthen disease-risk models (9)(10)(11). ...
Background:
The carbon isotope ratios (CIRs) of individual amino acids (AAs) may provide more sensitive and specific biomarkers of sugar-sweetened beverages (SSBs) than total tissue CIR. Because CIRs turn over slowly, long-term controlled-feeding studies are needed in their evaluation.
Objective:
We assessed the responses of plasma and RBC CIRAA's to SSB and meat intake in a 12-wk inpatient feeding study.
Methods:
Thirty-two men (aged 46.2 ± 10.5 y) completed the feeding study at the National Institute of Diabetes and Digestive and Kidney Diseases in Phoenix, Arizona. The effects of SSB, meat, and fish intake on plasma and RBC CIRAA's were evaluated in a balanced factorial design with each dietary variable either present or absent in a common weight-maintaining, macronutrient-balanced diet. Fasting blood samples were collected biweekly from baseline. Dietary effects on the postfeeding CIR of 5 nonessential AAs (CIRNEAA's) and 4 essential AAs (CIREAA's) were analyzed using multivariable regression.
Results:
In plasma, 4 of 5 CIRNEAA's increased with SSB intake. Of these, the CIRAla was the most sensitive (β = 2.81, SE = 0.38) to SSB intake and was not affected by meat or fish intake. In RBCs, all 5 CIRNEAA's increased with SSBs but had smaller effect sizes than in plasma. All plasma CIREAA's increased with meat intake (but not SSB or fish intake), and the CIRLeu was the most sensitive (β = 1.26, SE = 0.23). CIRs of leucine and valine also increased with meat intake in RBCs. Estimates of turnover suggest that CIRAA's in plasma, but not RBCs, were in equilibrium with the diets by the end of the study.
Conclusions:
The results of this study in men support CIRNEAA's as potential biomarkers of SSB intake and suggest CIREAA's as potential biomarkers of meat intake in US diets. This trial was registered at clinicaltrials.gov/ct2/show/NCT01237093 as NCT01237093.
... This approach could shift studies of diet and health away from a reliance on FFQs as the dietary assessment tool of choice for large-scale population-based studies (3,5). Although FFQs can broadly stratify people as either high or low consumers of certain foods and nutrients (6), they fare less well at estimating exact intakes of many nutrients (7), and can produce biased estimates of true intake because participants rely on memory rather than recording information in real time (8), and their responses are subject to social desirability bias (9). Furthermore, most FFQs lack detailed information on food preparation methods while not reflecting variable rates of digestion and absorption of nutrients via the gastrointestinal tract, and biotransformation by the liver and gut microbiota (5). ...
Background:
Advances in metabolomics are anticipated to decipher associations between dietary exposures and health. Replication biomarker studies in different populations are critical to demonstrate generalizability.
Objectives:
To identify and validate robust serum metabolites associated with diet quality and specific foods in a multiethnic cohort of pregnant women.
Design:
In this cross-sectional analysis of 3 multiethnic Canadian birth cohorts, we collected semiquantitative FFQ and serum data from 900 women at the second trimester of pregnancy. We calculated a diet quality score (DQS), defined as daily servings of "healthy" minus "unhealthy" foods. Serum metabolomics was performed by multisegment injection-capillary electrophoresis-mass spectrometry, and specific serum metabolites associated with maternal DQSs were identified. We combined the results across all 3 cohorts using meta-analysis to classify robust dietary biomarkers (r > ± 0.1; P < 0.05).
Results:
Diet quality was higher in the South Asian birth cohort (mean DQS = 7.1) than the 2 white Caucasian birth cohorts (mean DQS <3.2). Sixty-six metabolites were detected with high frequency (>75%) and adequate precision (CV <30%), and 47 were common to all cohorts. Hippuric acid was positively associated with healthy diet score in all cohorts, and with the overall DQS only in the primarily white Caucasian cohorts. We observed robust correlations between: 1) proline betaine-citrus foods; 2) 3-methylhistidine-red meat, chicken, and eggs; 3) hippuric acid-fruits and vegetables; 4) trimethylamine N-oxide (TMAO)-seafood, meat, and eggs; and 5) tryptophan betaine-nuts/legumes.
Conclusions:
Specific serum metabolites reflect intake of citrus fruit/juice, vegetables, animal foods, and nuts/legumes in pregnant women independent of ethnicity, fasting status, and delays to storage across multiple collection centers. Robust biomarkers of overall diet quality varied by cohort. Proline betaine, 3-methylhistidine, hippuric acid, TMAO, and tryptophan betaine were robust dietary biomarkers for investigations of maternal nutrition in diverse populations.
... Правда, дискуссия по поводу ценности и достоверности самооценки питания с помощью опросников, отражающих частоту потребления пищевых продуктов, сохраняется. Тем не менее, сторонники утверждают, что, несмотря на ограничения метода, который основан на воспроизведении питания по памяти, он предоставляет достоверную и ценную информацию о потребляемых продуктах и напитках и, следовательно, может использоваться для оценки взаимосвязи между питанием и заболеваемостью [11]. ...
Introduction: Many countries develop approaches to understanding nutritional balance in order to estimate adequate intakes for each type of food and nutrient required to preserve health of individuals and the population as a whole. The objective of the study was to analyze changes in food preferences and diet-related diseases (conditions) in the population of the Russian Federation over a five-year period. Methods: A retrospective comparative analysis of data of questionnaire-based surveys of the population of the Russian Federation conducted in 2013 and 5 years later in 2018 by the Federal State Statistics Service in accordance with Decree No. 946 of the Russian Government of November 27, 2010 was conducted. Results: Both positive and negative changes were observed in the diet and health status of Russian people over the study period. The positive ones included an increase in the number of people consuming healthy foods on a daily basis and rejecting products with low biological value, especially in big cities, and a decrease in the number of people with diabetes or hyperglycemia. The observed negative changes included an increase in the proportion of people with excessive dietary fat intake, insufficient consumption of complex carbohydrates, and nutrition-related high blood cholesterol levels.
... That there is a discrepancy between self-reported and actual eating, particularly among individuals with higher BMI, has long been a concern in nutritional research (Dao et al., 2019;Lichtman et al., 1992;Macdiarmid & Blundell, 1998;Schoeller et al., 2013) but some have recently argued that self-reported energy intakes are entirely inadequate measures that should not be used in scientific studies (Archer, Marlow, & Lavie, 2018;Schoeller et al., 2013). Our findings appear to be in line with the latter position. ...
The study of memory is commonly associated with neuroscience, aging, education, and eyewitness testimony. Here we discuss how eating behavior is also heavily intertwined—and yet considerably understudied in its relation to memory processes. Both are influenced by similar neuroendocrine signals (e.g., leptin and ghrelin) and are dependent on hippocampal functions. While learning processes have long been implicated in influencing eating behavior, recent research has shed light on how memory of recent eating modulates future food consumption. In humans, overweight and obesity is associated with impaired memory performance, and studies in rodents (and to a lesser extent humans) show that dietary-induced obesity causes rapid decrements to memory. Lesions to the hippocampus not only disrupt memory, but also induce obesity, highlighting a cyclic relationship between obesity and memory impairment. Enhancing memory of eating has been shown to reduce future eating and yet, very little is known about what influences memory of eating or how memory of eating differs from memory for other behaviors. We discuss recent advancements in these areas and highlight fruitful research pursuits afforded by combining the study of memory with the study of eating behavior.
... However, hypertension assessment was suboptimal as subjects self-reported their BP and office BP was validated in a subset of only 127 subjects. Similarly, habitual dietary intake was assessed via food frequency questionnaire for the previous year, a method that has low accuracy due to recall bias [45]. ...
Consumption of ultra-processed food (UPF) replaces the intake of freshly prepared unprocessed/minimally processed food (MPF) and is positively associated with hypertension and cardiovascular disease (CVD). The objective of this observational study was to investigate the relation between (1) UPF and (2) MPF with peripheral and central blood pressure (BP), wave reflection, and arterial stiffness. Habitual dietary intake, ambulatory BP, augmentation index (AIx), and pulse wave velocity (PWV) were assessed in 40 normotensive young adults (15 M/25 W; 27 ± 1 y; body mass index 23.6 ± 0.5 kg/m 2). UPF consumption was positively associated with overall and daytime peripheral systolic BP (B = 0.25, 95% confidence interval (CI) 0.03, 0.46, p = 0.029; B = 0.32, 95% CI 0.09, 0.56, p = 0.008, respectively), daytime diastolic BP (B = 0.18, 95% CI 0.01, 0.36, p = 0.049) and daytime peripheral pulse pressure (PP; B = 0.22, 95% CI 0.03, 0.41, p = 0.027). MPF consumption was inversely associated with daytime peripheral PP (B = −0.27, 95% CI −0.47, −0.07, p = 0.011), overall and daytime central systolic BP (B = −0.27, 95% CI −0.51, −0.02, p = 0.035; B = −0.31, 95% CI −0.58, −0.04, p = 0.024, respectively), and nighttime central PP (B = −0.10, 95% CI −0.19, −0.01, p = 0.042). Both UPF and MPF were not associated with AIx nor PWV. These data suggest avoidance of UPF and consumption of more MPF may reduce CVD risk factors.
... In other words, physiology, not food and beverages, causes metabolic diseases. This fact explains why identical diets consumed by different individuals result in divergent nutritional, metabolic, and health effects, and why some individuals can consume massive quantities of sugar and other carbohydrates while maintaining metabolic health, whereas less fortunate individuals develop obesity and/or T2DM (Vrolix and Mensink 2010;Krogh-Madsen et al. 2014;Zeevi et al. 2015;Archer 2018c;Archer, Marlow, and Lavie 2018c;Archer et al. 2018e). ...
Sugar, tobacco, and alcohol have been demonized since the seventeenth century. Yet unlike tobacco and alcohol, there is indisputable scientific evidence that dietary sugars were essential for human evolution and are essential for human health and development. Therefore, the purpose of this analytic review and commentary is to demonstrate that anti-sugar rhetoric is divorced from established scientific facts and has led to politically expedient but ill-informed policies reminiscent of those enacted about alcohol a century ago in the United States. Herein, we present a large body of interdisciplinary research to illuminate several misconceptions, falsehoods, and facts about dietary sugars. We argue that anti-sugar policies and recommendations are not merely unscientific but are regressive and unjust because they harm the most vulnerable members of our society while providing no personal or public health benefits.
Zusammenfassung
Kritisch kranke Patienten leiden häufig unter einer komplexen und schwerwiegenden immunologischen Dysfunktion. Die Differenzierung und Funktion von Immunzellen werden maßgeblich durch metabolische Prozesse gesteuert. Neue immunonutritive Konzepte versuchen daher, die Immunfunktionen intensivmedizinischer Patienten über enterale und parenterale Ernährung positiv zu beeinflussen. Die vorliegende Übersichtsarbeit präsentiert kondensiert die verfügbare Evidenz zu den gängigen isolierten Supplementen (antioxidative Substanzen, Aminosäuren, essenzielle Fettsäuren) und die damit verbundenen Problematiken. Im zweiten Teil werden sich daraus ergebende neuartige und umfassendere Konzepte der Immunonutrition zur Beeinflussung des intestinalen Mikrobioms und zur Modulation der Makronährstoffkomposition vorgestellt. Die Immunonutrition des kritisch kranken Patienten hat enormes Potenzial und kann sich zukünftig zu einem wertvollen klinischen Tool zur Modulation des Immunmetabolismus intensivmedizinischer Patienten entwickeln.
Background and aims:
This study was designed to obtain daily weighed food intake of participants engaged in Alternate Day Feeding (ADF). Prior ADF studies have used self-reported food intake, a method that has received criticism for its limited accuracy.
Subjects and methods:
Forty-nine university students received academic credit for participating in the study. Following a 10-day baseline period, participants underwent ADF for the next 8 days. Restricted daily intake to ∼ 75% of baseline food intake levels was followed by ad libitum intake on alternate days. Food intake was weighed before and after each meal. Daily body weight was also tracked.
Intervention:
After the baseline period, participants underwent 8 days of ADF during which they consumed ∼ 75% of baseline energy intake by weight followed by ad libitum intake on alternate days. The trial concluded with 2 additional days of ad libitum feeding, for a total study duration of 10 days.
Results:
Daily food intake was constant during the baseline period (slope = -0.93 g/d, p = 0.56), and did not differ significantly (995 g ( 95% CI [752, 1198]) from the total consumed on ad libitum ADF days (951 g (95% CI [777, 1227]). Intake on ad libitum days did not show a trend to increase during the intervention. Body weight declined significantly during ADF.
Conclusions:
ADF produces significant weight loss because food intake does not increase on ad libitum feeding days to compensate for reduced intake on restricted energy days. Data are consistent with prior work that suggests humans do not fully compensate for imposed deficits in energy intake.
Background:
Interest and use of blended diets (BD) for young people who are tube fed has significantly increased in the last decade, driven primarily by the desires of motivated caregivers. This review identified, appraised, and synthesised the available evidence on the benefits and complications of BD versus commercial feeds.
Methods:
A systematic review following PRISMA guidance and registered with PROSPERO was conducted across PubMed, Embase, CINAHL, Scopus and Cochrane up to August 2022.
Inclusion criteria:
English language studies including (1) children, (2) original research (interventional and observational) and (3) examination of BD outcomes. Exclusion criteria were (1) unoriginal research or case reports, (2) focus on feeding management, preparations, or attitudes and (3) comparing commercial blends only. Data was synthesised using the narrative synthesis approach established by Popay et al, using the Mixed Methods Appraisal Tool.
Results:
806 database results were identified and 61 were sought for retrieval. Full text article review revealed 7 eligible, involving 267 participants (age range 9 months - 26 years). Studies reported differences in GI symptoms (n=222), medication use (n=119), growth (n=189), complications or adverse events (n=91). The results indicate towards positive outcomes, particularly in gastrointestinal symptom control with few reports of mild adverse events in the included studies.
Conclusion:
There is a paucity of data in this area and much heterogeneity in included studies, but the available literature points towards positive outcomes. This is an important and highly relevant topic and more primary research, ideally using standardised reporting, is required to answer the key questions. This article is protected by copyright. All rights reserved.
Background:
Exclusion diets for gastrointestinal symptom management have been hypothesized to be a risk factor for avoidant/restrictive food intake disorder (ARFID; a non-body image-based eating disorder). In a retrospective study of pediatric and adult neurogastroenterology patients, we aimed to (1) identify the prevalence and characteristics of an exclusion diet history and (2) evaluate if an exclusion diet history was concurrently associated with the presence of ARFID symptoms.
Methods:
We conducted a chart review of 539 consecutive referrals (ages 6-90, 69% female) to adult (n = 410; January-December 2016) and pediatric (n = 129; January 2016-December 2018) neurogastroenterology clinics. Masked coders (n = 4) retrospectively applied DSM-5 criteria for ARFID and a separate coder assessed documentation of exclusion diet history. We excluded patients with no documentation of diet in the chart (n = 35) or who were not orally fed (n = 9).
Results:
Of 495 patients included, 194 (39%) had an exclusion diet history, and 118 (24%) had symptoms of ARFID. Of reported diets, dairy-free was the most frequent (45%), followed by gluten-free (36%). Where documented, exclusion diets were self-initiated by patients/parents in 66% of cases, and recommended by gastroenterology providers in 30%. Exclusion diet history was significantly associated with the presence of ARFID symptoms (OR = 3.12[95% CI 1.92-5.14], p < 0.001).
Conclusions:
History of following an exclusion diet was common and was most often patient-initiated among pediatric and adult neurogastroenterology patients. As patients with self-reported exclusion diet history were over three times as likely to have ARFID symptoms, providers should be cognizant of this potential association when considering dietary interventions.
Dietary assessment, one of the four basic components of nutritional assessment, is required yet difficult to correctly measure in order to establish accurate links with health outcomes. The current systematic review was conducted to study the effectiveness and limitations of various types of dietary assessment tools as well as to pool qualitative evidence on comparing manual and digital versions of the same tool. Studies published between 2010-June 2021 comparing various types and/ or versions of dietary data collection tools by reporting at least one outcome variable (reliability, feasibility, validity and acceptability) were searched from Pubmed, advanced search in Google scholar, and Cochrane library. A total of 33 studies were considered eligible for final analyses. All studies showed a good agreement between the tested dietary assessment tool and the gold standard adopted (n=25). The studies conducted to find out feasibility and acceptability of digital versions of tools also showed positive results (n=9). Technological advancement in dietary assessment can offer promising outcomes in research as well as clinical settings.
Eating behavior problems are characteristic of children with autism spectrum disorders (ASD) with a highly restricted range of food choices, which may pose an associated risk of nutritional problems. Hence, detailed knowledge of the dietary patterns (DPs) and nutrient intakes of ASD patients is necessary to carry out intervention strategies if required. The present study aimed to determine the DPs and macro-and micronutrient intakes in a sample of Spanish preschool children with ASD compared to typically developing control children. Fifty-four children with ASD (two to six years of age) diagnosed with ASD according to the Diagnostic Manual-5 criteria), and a control group of 57 typically developing children of similar ages were recruited. A validated food frequency questionnaire was used, and the intake of energy and nutrients was estimated through three non-consecutive 24-h dietary registrations. DPs were assessed using principal component analysis and hierarchical clustering analysis. Children with ASD exhibited a DP characterized by high energy and fat intakes and a low intake of vegetables and fruits. Likewise, meat intake of any type, both lean and fatty, was associated with higher consumption of fish and dietary fat. Furthermore, the increased consumption of dairy products was associated with increased consumption of cereals and pasta. In addition, they had frequent consumption of manufactured products with poor nutritional quality, e.g., beverages, sweets, snacks and bakery products. The percentages of children with ASD complying with the adequacy of nutrient intakes were higher for energy, saturated fat, calcium, and vitamin C, and lower for iron, iodine, and vitamins of group B when compared with control children. In conclusion, this study emphasizes the need to assess the DPs and nutrient intakes of children with ASD to correct their alterations and discard some potential nutritional diseases.
Polyphenols, bitter and astringent compounds present in many healthy foods, induce varied sensory responses across individuals. These differences in liking and flavor intensity may be attributable, in part, to differences in saliva. In the current study, we tested the effect of repeated consumption of a bitter polyphenol (epigallocatechin gallate, EGCG) solution on perceived bitterness intensity and salivary protein composition. We hypothesized exposure to EGCG would cause an increase in concentrations of salivary proteins that inhibit bitterness of polyphenols. We also hypothesized that participants with higher habitual polyphenol, specifically the flavanols, intake would experience less bitterness from EGCG solutions than those with low habitual intake, and that the high flavanol consumers would be more resistant to salivary alterations. We also tested whether bovine milk casein, a food analog for salivary proteins that may suppress bitterness, would decrease bitterness intensity of the EGCG solution and mitigate effects of the intervention. Participants (N=37) in our crossover intervention adhered to two-week periods of daily bitter (EGCG) or control (water) solution consumption. Bitterness intensity ratings and citric acid-stimulated saliva were collected at baseline and after each exposure period. Results indicate that bitterness intensity of the EGCG solution decreased after polyphenol (bitter EGCG) exposure compared to control (water) exposure. Casein addition also decreased bitterness intensity of the EGCG solution. While there was not a significant overall main effect of baseline flavanol intake on solution bitterness, there was an interaction between intervention week and baseline flavanol intake. Surprisingly, the higher flavanol intake group rated EGCG solutions as more bitter than the low and medium intake groups. Of proteins relevant to taste perception, several cystatins changed in saliva in response to the intervention. Interestingly, most of these protein alterations occurred more robustly after the control (water) exposure rather than the bitter (EGCG) exposure, suggesting that additional factors not quantified in this work may influence salivary proteins. Thus, we confirm in this study that exposure to bitterness suppresses ratings of bitterness over time, but more work needs to establish the causal factors of how diet influences salivary proteins.
The prevalence of obesity and type 2 diabetes continues to rise in the pediatric and adult population. This increase in metabolic disease may be partially due to programming during sensitive periods of development. Metabolomics is a powerful tool to identify molecular biomarkers and mechanistic insights into adverse health outcomes. This dissertation describes the use of metabolomic profiling to define the metabolic environment in two human cohorts, during gestation and the pubertal transition, and relate them mechanistically to growth and metabolism outcomes. Lipidomic profiles performed on first trimester maternal plasma (M1), delivery maternal plasma (M3), and infant umbilical cord plasma (CB) in 106 mother-infant dyads showed selective transport of long-chain polyunsaturated fatty acids (PUFA) as well as lysophosphatidylcholine (LysoPC) and lysophosphatidylethanolamine (LysoPE) into CB. Using linear models, CB LysoPC and LysoPE groups were positively associated with birth weight, a commonly assessed indicator of gestational implications on fetal growth. M1 PUFA containing triglycerides and phospholipids appear to modulate the levels of the CB lysophospholipids related to BW. Furthermore, epigenome-wide DNA methylation was measured in CB leukocytes to determine how the maternal lipidome across gestation may influence fetal programming. M3 saturated LysoPCs and LysoPEs were associated with differential methylation in CpG islands within genes pertaining to cell proliferation and growth. These results highlight the influence of the maternal lipidome on the infant epigenome. A growing body of evidence suggests a relationship between the metabolome and metabolic health in adults, however, less is known in children and adolescents in the pubertal transition, who have changing hormonal patterns and accumulation of muscle and fat tissue. Using untargeted metabolomics, metabolites associated with BMI z-score include positive associations with diglycerides among girls and positive associations with branched chain and aromatic amino acids in boys. In contrast to that found in adults, medium-chain acylcarnitines were inversely associated with insulin resistance (IR), suggesting less imbalance in the delivery and oxidation of substrates in adolescents, perhaps due to the increased substrate utilization to fuel tissue and linear growth. Path analysis identified metabolites that underlie the relationship between energy-adjusted macronutrient intake with IR. Carbohydrate intake is positively associated with IR through decreases in intermediates of β-oxidation, while fat intake is positively associated with IR through increases in extra-mitochondrial fatty acid metabolism, the latter identified by accumulation of dicarboxylic fatty acids. Thus, biomarkers of IR and mitochondrial oxidative capacity may depend on the relative nutrient mix and an individual’s intrinsic mitochondrial metabolism. These studies demonstrate the ability to generate inferential hypotheses about metabolism by acquiring high dimensional metabolomics data. The suggested modulation of uptake of lysophospholipids into the developing fetus, potentially influencing birth weight, by PUFAs exposure in the first trimester could be tested in larger cohorts or experimentally by timed PUFA intake. Longitudinal follow-up is needed to identify if fetal programming, via the establishment of DNA methylation patterns at birth, influences risk of adult metabolic disease. During adolescence, our findings confirm and extend associations between the metabolome with obesity and IR, emphasizing sex-specific differences due to variations in muscle and fat tissue accumulation in puberty. These results suggest that adolescents prone to IR have an increase in selection of carbohydrates for fuel, exacerbated by elevated habitual carbohydrate consumption. Using controlled feeding studies, intrinsic differences in mitochondrial metabolism and the consequence of habitual macronutrient intake on IR could be directly tested.
Healthy Nordic diet has been beneficially associated with coronary heart disease (CHD) risk factors, but few studies have investigated risk of developing CHD. We investigated the associations of healthy Nordic diet with major CHD risk factors, carotid atherosclerosis, and incident CHD in middle-aged and older men from eastern Finland. A total of 1981 men aged 42-60 years and free of CHD at baseline in 1984-1989 were investigated. Diet was assessed with 4-d food recording and the healthy Nordic diet score was calculated based on the Baltic Sea Diet Score. Carotid atherosclerosis was assessed by ultrasonography of the common carotid artery intima-media thickness in 1053 men. Analysis of covariance and Cox proportional hazards regression analyses were used for analyses. Healthy Nordic diet score associated with lower serum C-reactive protein concentrations (multivariable-adjusted extreme-quartile difference 0.69 mg/L, 95% confidence interval 0.15-1.22 mg/L), but not with serum lipid concentrations, blood pressure, or carotid atherosclerosis. During the average follow-up of 21.6 years (SD 8.3 years), 407 men had a CHD event, of which 277 were fatal. The multivariable-adjusted hazard ratios (95% confidence interval) in the lowest vs. the highest quartile of the healthy Nordic diet score were 1.10 (0.85-1.45) for any CHD event ( P -trend 0.429) and 1.38 (0.95-2.00) ( P -trend 0.119) for fatal CHD event. We did not find evidence that adherence to a healthy Nordic diet would be associated with a lower risk of CHD or with carotid atherosclerosis or major CHD risk factors, except for an inverse association with serum C-reactive protein concentrations.
Purpose
The authors aimed to triangulate food intake data obtained by two qualitative methods (in-depth interviews and participant observations) and one quantitative method (food-frequency questionnaire (FFQ)). The purpose of this paper was to analyze the kind of data each method produced and how these different pieces of information are methodologically related to the characteristics and limitations of different methods used and theoretically connected to participants' identities and masculinities.
Design/methodology/approach
The analysis was based on data from an ethnographic study; whose participants were 35 men who self-identified as gay bears. The participants' food intake was investigated through participant observations, in-depth interviews and an FFQ.
Findings
The qualitative methods indicated an overconsumption of meat and beer and a rejection of fresh foods, especially fruits and vegetables, as diacritical signs of the bears' identity. The FFQ showed a major consumption of minimally processed food, with fruits and vegetables being eaten more than meat. The authors proposed that the participants have compartmentalized their many habitual intakes and assessed one of them, separately, according to the method used (what was being asked and the context of that moment). Additionally, the authors connected these two patterns of habitual intake to the participants' identities and masculinities, questioning the existence of a constant hegemonic masculinity among this group.
Originality/value
The triangulation of methods employed in the present study is seldom addressed in the literature. This approximation provided a rich discussion regarding the connections between eating, sexuality, gender and identity, through a novel methodological and theoretical lens.
Objective
To determine the efficacy and safety of low carbohydrate diets (LCDs) and very low carbohydrate diets (VLCDs) for people with type 2 diabetes.
Design
Systematic review and meta-analysis.
Data sources
Searches of CENTRAL, Medline, Embase, CINAHL, CAB, and grey literature sources from inception to 25 August 2020.
Study selection
Randomized clinical trials evaluating LCDs (<130 g/day or <26% of a 2000 kcal/day diet) and VLCDs (<10% calories from carbohydrates) for at least 12 weeks in adults with type 2 diabetes were eligible.
Data extraction
Primary outcomes were remission of diabetes (HbA 1c <6.5% or fasting glucose <7.0 mmol/L, with or without the use of diabetes medication), weight loss, HbA 1c , fasting glucose, and adverse events. Secondary outcomes included health related quality of life and biochemical laboratory data. All articles and outcomes were independently screened, extracted, and assessed for risk of bias and GRADE certainty of evidence at six and 12 month follow-up. Risk estimates and 95% confidence intervals were calculated using random effects meta-analysis. Outcomes were assessed according to a priori determined minimal important differences to determine clinical importance, and heterogeneity was investigated on the basis of risk of bias and seven a priori subgroups. Any subgroup effects with a statistically significant test of interaction were subjected to a five point credibility checklist.
Results
Searches identified 14 759 citations yielding 23 trials (1357 participants), and 40.6% of outcomes were judged to be at low risk of bias. At six months, compared with control diets, LCDs achieved higher rates of diabetes remission (defined as HbA 1c <6.5%) (76/133 (57%) v 41/131 (31%); risk difference 0.32, 95% confidence interval 0.17 to 0.47; 8 studies, n=264, I ² =58%). Conversely, smaller, non-significant effect sizes occurred when a remission definition of HbA 1c <6.5% without medication was used. Subgroup assessments determined as meeting credibility criteria indicated that remission with LCDs markedly decreased in studies that included patients using insulin. At 12 months, data on remission were sparse, ranging from a small effect to a trivial increased risk of diabetes. Large clinically important improvements were seen in weight loss, triglycerides, and insulin sensitivity at six months, which diminished at 12 months. On the basis of subgroup assessments deemed credible, VLCDs were less effective than less restrictive LCDs for weight loss at six months. However, this effect was explained by diet adherence. That is, among highly adherent patients on VLCDs, a clinically important reduction in weight was seen compared with studies with less adherent patients on VLCDs. Participants experienced no significant difference in quality of life at six months but did experience clinically important, but not statistically significant, worsening of quality of life and low density lipoprotein cholesterol at 12 months. Otherwise, no significant or clinically important between group differences were found in terms of adverse events or blood lipids at six and 12 months.
Conclusions
On the basis of moderate to low certainty evidence, patients adhering to an LCD for six months may experience remission of diabetes without adverse consequences. Limitations include continued debate around what constitutes remission of diabetes, as well as the efficacy, safety, and dietary satisfaction of longer term LCDs.
Systematic review registration
PROSPERO CRD42020161795.
Objectives
There is increasing evidence of the impact of ultra-processed foods on multiple metabolic and neurobiological pathways, including those involved in eating behaviors, both in animals and in humans. In this study we aimed to explore ultra-processed foods and their link with disordered eating in a clinical sample.
Methods
This was a single site, retrospective observational study in a specialist eating disorder service using self-report on the electronic health records. Patients with a Diagnostic and Statistical Manual of Mental Disorders (fifth edition) diagnosis of anorexia nervosa (AN), bulimia nervosa (BN), or binge eating disorder (BED) were randomly selected from the service database in Oxford from 2017 to 2019. The recently introduced NOVA classification was used to determine the degree of industrial food processing in each patient's diet. Frequencies of ultra-processed foods were analyzed for each diagnosis at each mealtime and during episodes of binging.
Results
A total of 70 female and 3 male patients were included in the study; 22 had AN, 25 BN, and 26 BED. Patients with AN reported consuming 55% NOVA-4 foods, as opposed to approximately 70% in BN and BED patients. Foods that were consumed in a binge pattern were 100% ultra-processed.
Conclusion
Further research into the metabolic and neurobiological effects of ultra-processed food intake on disordered eating, particularly on binging, is needed.
There has been increasing interest in vegan diets, but how this dietary pattern regulates tissue fatty acids (FA), especially in men, is unclear. Our aim was to evaluate the effect of a vegan diet on plasma, erythrocyte, and spermatozoa FA composition in young men. Two groups consisting of 67 young (18–25 years old) men were studied. One group following an omnivore diet but did not consume fish, shellfish or other marine foods (control, n = 33), and another group following a vegan diet (vegan, n = 34) for at least 12 months were compared. Dietary intake was assessed via a food frequency questionnaire and a 24‐h recall. FA composition was measured in plasma, erythrocyte phospholipids, and spermatozoa by gas–liquid chromatography. Compared to controls, the vegan group had higher reported intakes of carbohydrate, dietary fiber, vitamins (C, E, K, and folate), and minerals (copper, potassium) but lower intakes of cholesterol, trans FA, vitamins B6, D, and B12, and minerals (calcium, iron, and zinc). Vegan's reported a lower saturated FA and not arachidonic acid intake, both groups did not intake eicosapentaenoic acid and docosahexaenoic acid (DHA), but vegan's showed a higher alpha linolenic acid ALA intake. Vegans had higher plasma, erythrocyte phospholipid, and spermatozoa ALA, but lower levels of other n‐3 polyunsaturated fatty acid (PUFA), especially DHA. Vegans were characterized by higher ALA, but lower levels of other n‐3 PUFA, especially DHA in plasma, erythrocytes, and spermatozoids. The biological significance of these findings requires further study.
Adipose tissue inflammation is major factor in the development of insulin resistance (IR). Long-chain omega-3 polyunsaturated fatty acids (LCn-3PUFA) docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) are anti-inflammatory bioactive lipids, thus may protect against type 2 diabetes (T2D) development. Previous research has demonstrated a sex-dependent association between LCn-3PUFA and T2D, and evidence suggests LCn-3PUFA may improve IR in a sex-dependent manner. This double-blind, randomized, parallel-arm placebo-controlled study aimed to determine whether DHA-enriched fish oil (FO) supplementation improves IR. Sex-dependent effects were assessed by testing for an interaction between sex and treatment in the multiple regression models. Men and women with abdominal obesity (waist circumference: males, ≥102cm; females, ≥88cm) and without diabetes were recruited from the community. Participants (age: 50.9 ± 12.7 years, female: 63.7%, BMI: 32.4 ± 6.6 kg/m²) were randomly allocated to either 2g FO (860mg DHA + 120mg EPA) (intervention, n=38) or 2g corn oil (CO) /day (control, n=35) for 12 weeks in a double-blind randomised controlled trial. A fasting blood sample was collected at 0 and 12 weeks for assessment of IR, glucose and blood lipid profile. Sixty-eight participants completed the intervention. Compared with CO (n=32), FO (n=36) significantly reduced fasting insulin by -1.62 μIU/L (95%CI: -2.99, -0.26,) (p=0.021) and HOMA-IR by -0.40 units (95%CI: -0.78, -0.02, p=0.038). Higher insulin and HOMA-IR at baseline were associated with greater reductions in the FO group (p<0.001). There was no interaction between sex and treatment for the change in insulin (p-interactionsex*treatment=0.816) or HOMA-IR (p-interactionsex*treatment=0.825). DHA-enriched FO reduces IR in adults with abdominal obesity, however, sex-dependent differences were not evident in this study.
Objective
The current interest in mental imagery in fields such as sport and physical training, health, education, underscore the need for designing general measures of imagery vividness that include different sensorial modalities such as the Plymouth Sensory Imagery Questionnaire (Psi-Q; Andrade et al., 2014). The Psi-Q measures imagery vividness in seven sensorial modalities with a factorial structure of seven factors corresponding to the sensorial modalities, and has good internal consistency. The aim of the present study was to translate the Psi-Q into Spanish and to assess its psychometric properties.Methods
The questionnaire was back-translated, and administered to 394 fine arts undergraduates. Moreover, this test was compared to other questionnaires measuring different types de imagery.ResultsA confirmatory factor analysis found that the Psi-Q had seven factors (vision, sound, smell, taste, touch, bodily sensation, and emotional feeling) with results similar to the original test. Values suggested a better fit for the model of the short version. The internal consistency values were 0.93 for the long and 0.89 for the short test. The Psi-Q subscales correlated significantly (p < 0.01) with the total of the Betts’ QMI subscales, and the VVIQ, with the highest significance observed between the Psi-Q Touch and Betts’ QMI Cutaneous (r = −0.57), and between the Psi-Q Olfactory and Betts’ QMI Smell (r = −0.56). Owing to its novelty, the high correlation and significance (p < 0.01) between Psi-Q Vision and the OSIVQ Object (r = 0.36) is worth noting.Conclusion
The Spanish version of the Psi-Q was an adequate measure for evaluating different sensorial modalities of imagery vividness, and exhibited similar psychometric properties to those of the original version. The growing interest in mental imagery in different fields of application justifies the need for adapting the Psi-Q for the Spanish speaking population. This questionnaire is a valuable tool for the understanding of imagery as a psychological process, and as a variable influencing other processes.
Animal-source foods (ASF) have the potential to enhance the nutritional adequacy of cereal-based diets in low- and middle-income countries, through the provision of high-quality protein and bioavailable micronutrients. The development of guidelines for including ASF in local diets requires an understanding of the nutrient content of available resources. This article reviews food composition tables (FCT) used in sub-Saharan Africa, examining the spectrum of ASF reported and exploring data sources for each reference. Compositional data are shown to be derived from a small number of existing data sets from analyses conducted largely in high-income nations, often many decades previously. There are limitations in using such values, which represent the products of intensively raised animals of commercial breeds, as a reference in resource-poor settings where indigenous breed livestock are commonly reared in low-input production systems, on mineral-deficient soils and not receiving nutritionally balanced feed. The FCT examined also revealed a lack of data on the full spectrum of ASF, including offal and wild foods, which correspond to local food preferences and represent valuable dietary resources in food-deficient settings. Using poultry products as an example, comparisons are made between compositional data from three high-income nations, and potential implications of differences in the published values for micronutrients of public health significance, including Fe, folate and vitamin A, are discussed. It is important that those working on nutritional interventions and on developing dietary recommendations for resource-poor settings understand the limitations of current food composition data and that opportunities to improve existing resources are more actively explored and supported.
Background:
Poor lifestyle behaviors are leading causes of preventable diseases globally. Added sugars contribute to a diet that is energy dense but nutrient poor and increase risk of developing obesity, cardiovascular disease, hypertension, obesity-related cancers, and dental caries.
Methods and results:
For this American Heart Association scientific statement, the writing group reviewed and graded the current scientific evidence for studies examining the cardiovascular health effects of added sugars on children. The available literature was subdivided into 5 broad subareas: effects on blood pressure, lipids, insulin resistance and diabetes mellitus, nonalcoholic fatty liver disease, and obesity.
Conclusions:
Associations between added sugars and increased cardiovascular disease risk factors among US children are present at levels far below current consumption levels. Strong evidence supports the association of added sugars with increased cardiovascular disease risk in children through increased energy intake, increased adiposity, and dyslipidemia. The committee found that it is reasonable to recommend that children consume ≤25 g (100 cal or ≈6 teaspoons) of added sugars per day and to avoid added sugars for children <2 years of age. Although added sugars most likely can be safely consumed in low amounts as part of a healthy diet, few children achieve such levels, making this an important public health target.
Background:
Taxing sugar-sweetened beverages (SSBs) has been proposed as a strategy to combat child obesity. Yet it is unclear how a tax on SSBs might influence the overall quality of diet in preschool children. Thus, we use simulated price increases and the 2010 Healthy Eating Index (HEI-2010) to explore the relationship between SSB taxes and diet quality in preschool children.
Methods:
Price and purchase data from the 2009-2012 Nielsen Homescan Panel and a two-part marginal effects model were used to estimate relative changes in purchases with a 20% increase in the price of SSBs. Demand elasticities were applied to dietary intake data for children ages 2-5 years from the National Health and Nutrition Examination Survey (2009-2010 and 2011-2012) to estimate the impact of a 20% SSB tax on dietary intake and quality (HEI-2010).
Results:
A 20% increase in the price of SSBs was associated with lower total caloric intake (-28 kcal d(-1) , p < 0.01), caloric intake from juice drinks (-20 kcal d(-1) , p < 0.01), added sugars (-4.1 servings d(-1) , p = 0.03), refined grains (-0.63 servings d(-1) , p < 0.01) and total meat (-0.56 servings d(-1) , p < 0.01). Beneficial decreases in empty calories and refined grains were offset by unfavourable changes in fatty acid profile, total protein, vegetables and fruit, such that total HEI scores (0-100 range) were not meaningfully changed with a 20% increase in SSB price (difference: -0.85, p < 0.01).
Conclusions:
A 20% tax on SSBs could decrease caloric intake, and intakes of added sugars and SSBs, but may not improve diet quality as an isolated intervention among US preschool children.
Abbreviations:
CPG, consumer-packaged goods; D, day; FPI, Food Price Index; FPL, federal poverty level; G, grams; HEI, Healthy Eating Index; kcal, kilocalories; RTE, ready-to-eat; SSBs, sugar-sweetened beverages; Y, year.
This paper describes the Observing Protein and Energy Nutrition (OPEN) Study, conducted from September 1999 to March 2000. The purpose of the study was to assess dietary measurement error using two self-reported dietary instruments-the food frequency questionnaire (FFQ) and the 24-hour dietary recall (24HR)-and unbiased biomarkers of energy and protein intakes: doubly labeled water and urinary nitrogen. Participants were 484 men and women aged 40-69 years from Montgomery County, Maryland. Nine percent of men and 7% of women were defined as underreporters of both energy and protein intake on 24HRs; for FFQs, the comparable values were 35% for men and 23% for women. On average, men underreported energy intake compared with total energy expenditure by 12-14% on 24HRs and 31-36% on FFQs and underreported protein intake compared with a protein biomarker by 11-12% on 24HRs and 30-34% on FFQs. Women underreported energy intake on 24HRs by 16-20% and on FFQs by 34-38% and underreported protein intake by 11-15% on 24HRs and 27-32% on FFQs. There was little underreporting of the percentage of energy from protein for men or women. These findings have important implications for nutritional epidemiology and dietary surveillance.
NHANES is the cornerstone for national nutrition monitoring to inform nutrition and health policy. Nutritional assessment in NHANES is described with a focus on dietary data collection, analysis, and uses in nutrition monitoring. NHANES has been collecting thorough data on diet, nutritional status, and chronic disease in cross-sectional surveys with nationally representative samples since the early 1970s. Continuous data collection began in 1999 with public data release in 2-y cycles on ∼10,000 participants. In 2002, the Continuing Survey of Food Intakes by Individuals and the NHANES dietary component were merged, forming a consolidated dietary data collection known as What We Eat in America; since then, 24-h recalls have been collected on 2 d using the USDA's Automated Multiple-Pass Method. Detailed and targeted food-frequency questionnaires have been collected in some NHANES cycles. Dietary supplement use data have been collected (in detail since 2007) so that total nutrient intakes can be described for the population. The continuous NHANES can adapt its content to address emerging public health needs and reflect federal priorities. Changes in data collection methods are made after expert input and validation/crossover studies. NHANES dietary data are used to describe intake of foods, nutrients, food groups, and dietary patterns by the US population and large sociodemographic groups to plan and evaluate nutrition programs and policies. Usual dietary intake distributions can be estimated after adjusting for day-to-day variation. NHANES remains open and flexible to incorporate improvements while maintaining data quality and providing timely data to track the nation's nutrition and health status. In summary, NHANES collects dietary data in the context of its broad, multipurpose goals; the strengths and limitations of these data are also discussed in this review.
Recent reports have asserted that, because of energy underreporting, dietary self-report data suffer from measurement error so great that findings that rely on them are of no value. This commentary considers the amassed evidence that shows that self-report dietary intake data can successfully be used to inform dietary guidance and public health policy. Topics discussed include what is known and what can be done about the measurement error inherent in data collected by using self-report dietary assessment instruments and the extent and magnitude of underreporting energy vs. other nutrients and food groups. Also discussed is the overall impact of energy underreporting on dietary surveillance and nutritional epidemiology. In conclusion, 7 specific recommendations for collecting, analyzing, and interpreting self-report dietary data are provided: 1) continue to collect self-report dietary intake data because they contain valuable, rich, and critical information about foods and beverages consumed by populations that can be used to inform nutrition policy and assess diet-disease associations; 2) do not use self-reported energy intake as a measure of true energy intake; 3) do use self-reported energy intake for energy adjustment of other self-reported dietary constituents to improve risk estimation in studies of diet-health associations; 4) acknowledge the limitations of self-report dietary data and analyze and interpret them appropriately; 5) design studies and conduct analyses that allow adjustment for measurement error; 6) design new epidemiologic studies to collect dietary data from both short-term (recalls or food records) and long-term (food-frequency questionnaires) instruments on the entire study population to allow for maximizing the strengths of each instrument; and 7) continue to develop, evaluate, and further expand methods of dietary assessment, including dietary biomarkers and methods using new technologies.
Two experiments (modeled after J. Deese's 1959 study) revealed remarkable levels of false recall and false recognition in a list learning paradigm. In Experiment 1, subjects studied lists of 12 words (e.g., bed, rest, awake ); each list was composed of associates of 1 nonpresented word (e.g., sleep). On immediate free recall tests, the nonpresented associates were recalled 40% of the time and were later recognized with high confidence. In Experiment 2, a false recall rate of 55% was obtained with an expanded set of lists, and on a later recognition test, subjects produced false alarms to these items at a rate comparable to the hit rate. The act of recall enhanced later remembering of both studied and nonstudied material. The results reveal a powerful illusion of memory: People remember events that never happened.
The Scientific Report of the 2015 Dietary Guidelines Advisory Committee was primarily informed by memory-based dietary assessment methods (M-BMs) (eg, interviews and surveys). The reliance on M-BMs to inform dietary policy continues despite decades of unequivocal evidence that M-BM data bear little relation to actual energy and nutrient consumption. Data from M-BMs are defended as valid and valuable despite no empirical support and no examination of the foundational assumptions regarding the validity of human memory and retrospective recall in dietary assessment. We assert that uncritical faith in the validity and value of M-BMs has wasted substantial resources and constitutes the greatest impediment to scientific progress in obesity and nutrition research. Herein, we present evidence that M-BMs are fundamentally and fatally flawed owing to well-established scientific facts and analytic truths. First, the assumption that human memory can provide accurate or precise reproductions of past ingestive behavior is indisputably false. Second, M-BMs require participants to submit to protocols that mimic procedures known to induce false recall. Third, the subjective (ie, not publicly accessible) mental phenomena (ie, memories) from which M-BM data are derived cannot be independently observed, quantified, or falsified; as such, these data are pseudoscientific and inadmissible in scientific research. Fourth, the failure to objectively measure physical activity in analyses renders inferences regarding diet-health relationships equivocal. Given the overwhelming evidence in support of our position, we conclude that M-BM data cannot be used to inform national dietary guidelines and that the continued funding of M-BMs constitutes an unscientific and major misuse of research resources.
Copyright © 2015 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.
Limited data are available on the accuracy of 24-h dietary recalls used to monitor US sodium and potassium intakes.
We examined the difference in usual sodium and potassium intakes estimated from 24-h dietary recalls and urine collections.
We used data from a cross-sectional study in 402 participants aged 18-39 y (∼50% African American) in the Washington, DC, metropolitan area in 2011. We estimated means and percentiles of usual intakes of daily dietary sodium (dNa) and potassium (dK) and 24-h urine excretion of sodium (uNa) and potassium (uK). We examined Spearman's correlations and differences between estimates from dietary and urine measures. Multiple linear regressions were used to evaluate the factors associated with the difference between dietary and urine measures.
Mean differences between diet and urine estimates were higher in men [dNa - uNa (95% CI) = 936.8 (787.1, 1086.5) mg/d and dK - uK = 571.3 (448.3, 694.3) mg/d] than in women [dNa - uNa (95% CI) = 108.3 (11.1, 205.4) mg/d and dK - uK = 163.4 (85.3, 241.5 mg/d)]. Percentile distributions of diet and urine estimates for sodium and potassium differed for men. Spearman's correlations between measures were 0.16 for men and 0.25 for women for sodium and 0.39 for men and 0.29 for women for potassium. Urinary creatinine, total caloric intake, and percentages of nutrient intake from mixed dishes were independently and consistently associated with the differences between diet and urine estimates of sodium and potassium intake. For men, body mass index was also associated. Race was associated with differences in estimates of potassium intake.
Low correlations and differences between dietary and urinary sodium or potassium may be due to measurement error in one or both estimates. Future analyses using these methods to assess sodium and potassium intake in relation to health outcomes may consider stratifying by factors associated with the differences in estimates from these methods. This trial was registered at clinicaltrials.gov as NCT01631240.
© 2015 American Society for Nutrition.
Studies on the role of diet in the development of chronic diseases often rely on self-report surveys of dietary intake. Unfortunately, many validity studies have demonstrated that self-reported dietary intake is subject to systematic under-reporting, although the vast majority of such studies have been conducted in industrialised countries. The aim of the present study was to investigate whether or not systematic reporting error exists among the individuals of African ancestry (n 324) in five countries distributed across the Human Development Index (HDI) scale, a UN statistic devised to rank countries on non-income factors plus economic indicators. Using two 24 h dietary recalls to assess energy intake and the doubly labelled water method to assess total energy expenditure, we calculated the difference between these two values ((self-report - expenditure/expenditure) × 100) to identify under-reporting of habitual energy intake in selected communities in Ghana, South Africa, Seychelles, Jamaica and the USA. Under-reporting of habitual energy intake was observed in all the five countries. The South African cohort exhibited the highest mean under-reporting ( - 52·1 % of energy) compared with the cohorts of Ghana ( - 22·5 %), Jamaica ( - 17·9 %), Seychelles ( - 25·0 %) and the USA ( - 18·5 %). BMI was the most consistent predictor of under-reporting compared with other predictors. In conclusion, there is substantial under-reporting of dietary energy intake in populations across the whole range of the HDI, and this systematic reporting error increases according to the BMI of an individual.
The debate on the relative contributions of presumptive etiologic factors in the development of obesity is becoming increasingly speculative, insular, and partisan. As the global prevalence of obesity continues to rise, the sheer volume of unfounded conjecture threatens to obscure well-established evidence. We posit that the failure to distinguish between causal factors and mere statistical associations engendered the proliferation of misleading and demonstrably false research programs and failed public health initiatives. Nevertheless, scientific progress necessitates the elimination of unsupported speculation via critical examinations of contrary evidence. Thus, the purpose of this review is to present a concise survey of potentially falsifying evidence for the major presumptive etiologic factors inclusive of 'diet', 'genes', physical activity, and non-physiologic factors from the social sciences. Herein, we advance two 'Fundamental Questions of Obesity' that provide a conceptually clear but challenging constraint on conjecture. First, why would an individual (i.e., human or non-human animal) habitually consume more calories than s/he expends? And second, why would the excess calories be stored predominantly as 'fat' rather than as lean tissue? We posit that the conceptual constraint presented by these questions in concert with the parallel trends in body-mass, adiposity, and metabolic diseases in both human and non-human mammals offer a unique opportunity to refute the oversimplification, causal reductionism, and unrestrained speculation that impede progress. We conclude this review with an attempt at consilience and present two novel paradigms, the 'Metabolic Tipping Point' and the 'Maternal Resources Hypothesis', that offer interdisciplinary explanatory narratives on the etiology of obesity and metabolic diseases across mammalian species.
Sugars are foundational to biological life and played essential roles in human evolution and dietary patterns for most of recorded history. The simple sugar glucose is so central to human health that it is one of the World Health Organization's Essential Medicines. Given these facts, it defies both logic and a large body of scientific evidence to claim that sugars and other nutrients that played fundamental roles in the substantial improvements in life- and health-spans over the past century are now suddenly responsible for increments in the prevalence of obesity and chronic non-communicable diseases. Thus, the purpose of this review is to provide a rigorous, evidence-based challenge to 'diet-centrism' and the disease-mongering of dietary sugar. The term 'diet-centrism' describes the naïve tendency of both researchers and the public to attribute a wide-range of negative health outcomes exclusively to dietary factors while neglecting the essential and well-established role of individual differences in nutrient-metabolism. The explicit conflation of dietary intake with both nutritional status and health inherent in 'diet-centrism' contravenes the fact that the human body is a complex biologic system in which the effects of dietary factors are dependent on the current state of that system. Thus, macronutrients cannot have health or metabolic effects independent of the physiologic context of the consuming individual (e.g., physical activity level). Therefore, given the unscientific hyperbole surrounding dietary sugars, I take an adversarial position and present highly-replicated evidence from multiple domains to show that 'diet' is a necessary but trivial factor in metabolic health, and that anti-sugar rhetoric is simply diet-centric disease-mongering engendered by physiologic illiteracy. My position is that dietary sugars are not responsible for obesity or metabolic diseases and that the consumption of simple sugars and sugar-polymers (e.g., starches) up to 75% of total daily caloric intake is innocuous in healthy individuals.
Background: Underreporting of food intake is common in obese subjects.
Objective: One aim of this study was to assess to what extent underreporting by obese men is explained by underrecording (failure to record in a food diary everything that is consumed) or undereating. Another aim of the study was to find out whether there was an indication for selective underreporting.
Design: Subjects were 30 obese men with a mean (±SD) body mass index (in kg/m²) of 34 ± 4. Total food intake was measured over 1 wk. Energy expenditure (EE) was measured with the doubly labeled water method, and water loss was estimated with deuterium-labeled water. Energy balance was checked for by measuring body weight at the start and end of the food-recording week and 1 wk after the recording week.
Results: Mean energy intake and EE were 10.4 ± 2.5 and 16.7 ± 2.4 MJ/d, respectively; underreporting was 37 ± 16%. The mean body mass loss of 1.0 ± 1.3 kg over the recording week was significantly different (P < 0.05) from the change in body mass over the nonrecording week, and indicated 26% undereating. Water intake (reported + metabolic water) and water loss were significantly different from each other and indicated 12% underrecording. The reported percentage of energy from fat was a function of the level of underreporting: percentage of energy from fat = 46 – 0.2 × percentage of underreporting (r² = 0.28, P = 0.003).
Conclusions: Total underreporting by the obese men was explained by underrecording and undereating. The obese men selectively underreported fat intake.
Background:
A limited number of studies have evaluated self-reported dietary intakes against objective recovery biomarkers.
Objective:
The aim was to compare dietary intakes of multiple Automated Self-Administered 24-h recalls (ASA24s), 4-d food records (4DFRs), and food-frequency questionnaires (FFQs) against recovery biomarkers and to estimate the prevalence of under- and overreporting.
Design:
Over 12 mo, 530 men and 545 women, aged 50-74 y, were asked to complete 6 ASA24s (2011 version), 2 unweighed 4DFRs, 2 FFQs, two 24-h urine collections (biomarkers for protein, potassium, and sodium intakes), and 1 administration of doubly labeled water (biomarker for energy intake). Absolute and density-based energy-adjusted nutrient intakes were calculated. The prevalence of under- and overreporting of self-report against biomarkers was estimated.
Results:
Ninety-two percent of men and 87% of women completed ≥3 ASA24s (mean ASA24s completed: 5.4 and 5.1 for men and women, respectively). Absolute intakes of energy, protein, potassium, and sodium assessed by all self-reported instruments were systematically lower than those from recovery biomarkers, with underreporting greater for energy than for other nutrients. On average, compared with the energy biomarker, intake was underestimated by 15-17% on ASA24s, 18-21% on 4DFRs, and 29-34% on FFQs. Underreporting was more prevalent on FFQs than on ASA24s and 4DFRs and among obese individuals. Mean protein and sodium densities on ASA24s, 4DFRs, and FFQs were similar to biomarker values, but potassium density on FFQs was 26-40% higher, leading to a substantial increase in the prevalence of overreporting compared with absolute potassium intake.
Conclusions:
Although misreporting is present in all self-report dietary assessment tools, multiple ASA24s and a 4DFR provided the best estimates of absolute dietary intakes for these few nutrients and outperformed FFQs. Energy adjustment improved estimates from FFQs for protein and sodium but not for potassium. The ASA24, which now can be used to collect both recalls and records, is a feasible means to collect dietary data for nutrition research.
Which articles published in the JAMA Network of journals resonated with readers the most this year—and why? Those are the questions we set out to answer in our first-ever end-of-year roundup.
Calibrating dietary self-report instruments is recommended as a way to adjust for measurement error when estimating diet-disease associations. Because biomarkers available for calibration are limited, most investigators use self-reports (e.g., 24-hour recalls (24HRs)) as the reference instrument. We evaluated the performance of 24HRs as reference instruments for calibrating food frequency questionnaires (FFQs), using data from the Validation Studies Pooling Project, comprising 5 large validation studies using recovery biomarkers. Using 24HRs as reference instruments, we estimated attenuation factors, correlations with truth, and calibration equations for FFQ-reported intakes of energy and for protein, potassium, and sodium and their densities, and we compared them with values derived using biomarkers. Based on 24HRs, FFQ attenuation factors were substantially overestimated for energy and sodium intakes, less for protein and potassium, and minimally for nutrient densities. FFQ correlations with truth, based on 24HRs, were substantially overestimated for all dietary components. Calibration equations did not capture dependencies on body mass index. We also compared predicted bias in estimated relative risks adjusted using 24HRs as reference instruments with bias when making no adjustment. In disease models with energy and 1 or more nutrient intakes, predicted bias in estimated nutrient relative risks was reduced on average, but bias in the energy risk coefficient was unchanged.
Importance
In the United States, national associations of individual dietary factors with specific cardiometabolic diseases are not well established.
Objective
To estimate associations of intake of 10 specific dietary factors with mortality due to heart disease, stroke, and type 2 diabetes (cardiometabolic mortality) among US adults.
Design, Setting, and Participants
A comparative risk assessment model incorporated data and corresponding uncertainty on population demographics and dietary habits from National Health and Nutrition Examination Surveys (1999-2002: n = 8104; 2009-2012: n = 8516); estimated associations of diet and disease from meta-analyses of prospective studies and clinical trials with validity analyses to assess potential bias; and estimated disease-specific national mortality from the National Center for Health Statistics.
Exposures
Consumption of 10 foods/nutrients associated with cardiometabolic diseases: fruits, vegetables, nuts/seeds, whole grains, unprocessed red meats, processed meats, sugar-sweetened beverages (SSBs), polyunsaturated fats, seafood omega-3 fats, and sodium.
Main Outcomes and Measures
Estimated absolute and percentage mortality due to heart disease, stroke, and type 2 diabetes in 2012. Disease-specific and demographic-specific (age, sex, race, and education) mortality and trends between 2002 and 2012 were also evaluated.
Results
In 2012, 702 308 cardiometabolic deaths occurred in US adults, including 506 100 from heart disease (371 266 coronary heart disease, 35 019 hypertensive heart disease, and 99 815 other cardiovascular disease), 128 294 from stroke (16 125 ischemic, 32 591 hemorrhagic, and 79 578 other), and 67 914 from type 2 diabetes. Of these, an estimated 318 656 (95% uncertainty interval [UI], 306 064-329 755; 45.4%) cardiometabolic deaths per year were associated with suboptimal intakes—48.6% (95% UI, 46.2%-50.9%) of cardiometabolic deaths in men and 41.8% (95% UI, 39.3%-44.2%) in women; 64.2% (95% UI, 60.6%-67.9%) at younger ages (25-34 years) and 35.7% (95% UI, 33.1%-38.1%) at older ages (≥75 years); 53.1% (95% UI, 51.6%-54.8%) among blacks, 50.0% (95% UI, 48.2%-51.8%) among Hispanics, and 42.8% (95% UI, 40.9%-44.5%) among whites; and 46.8% (95% UI, 44.9%-48.7%) among lower-, 45.7% (95% UI, 44.2%-47.4%) among medium-, and 39.1% (95% UI, 37.2%-41.2%) among higher-educated individuals. The largest numbers of estimated diet-related cardiometabolic deaths were related to high sodium (66 508 deaths in 2012; 9.5% of all cardiometabolic deaths), low nuts/seeds (59 374; 8.5%), high processed meats (57 766; 8.2%), low seafood omega-3 fats (54 626; 7.8%), low vegetables (53 410; 7.6%), low fruits (52 547; 7.5%), and high SSBs (51 694; 7.4%). Between 2002 and 2012, population-adjusted US cardiometabolic deaths per year decreased by 26.5%. The greatest decline was associated with insufficient polyunsaturated fats (−20.8% relative change [95% UI, −18.5% to −22.8%]), nuts/seeds (−18.0% [95% UI, −14.6% to −21.0%]), and excess SSBs (−14.5% [95% UI, −12.0% to −16.9%]). The greatest increase was associated with unprocessed red meats (+14.4% [95% UI, 9.1%-19.5%]).
Conclusions and Relevance
Dietary factors were estimated to be associated with a substantial proportion of deaths from heart disease, stroke, and type 2 diabetes. These results should help identify priorities, guide public health planning, and inform strategies to alter dietary habits and improve health.