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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

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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.

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... 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). ...
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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.
... 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. ...
Article
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. ...
Article
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.
... Recently, the memory-based dietary assessment methods utilized in epidemiological research related to food group consumption and major events of disease have been challenged due to the varied precision and accuracy of self-reported data [36][37][38]. Archer et al. [11,36,38] empirically refuted memory-based dietary assessment methods (M-BM), such as food records, food frequency questionnaires (FFQs), and 24HR, arguing that the errors associated with M-BM-data are unquantifiable, as they are prone to omissions, false memories, intentional misreporting (i.e., lying), and gross misestimations. ...
... Recently, the memory-based dietary assessment methods utilized in epidemiological research related to food group consumption and major events of disease have been challenged due to the varied precision and accuracy of self-reported data [36][37][38]. Archer et al. [11,36,38] empirically refuted memory-based dietary assessment methods (M-BM), such as food records, food frequency questionnaires (FFQs), and 24HR, arguing that the errors associated with M-BM-data are unquantifiable, as they are prone to omissions, false memories, intentional misreporting (i.e., lying), and gross misestimations. In particular, FFQs are prone to measurement error [39]. ...
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Diet is one of the key modifiable behaviors that can help to control and prevent non-communicable chronic diseases. Therefore, it is important to evaluate the overall diet composition of the population through non-invasive and independent indexes or scores as diet quality indexes (DQIs). The primary aim of the present work was to estimate the adequacy of the intake of critical nutrients in the Spanish “Anthropometry, Intake, and Energy Balance Study” (ANIBES) (n = 2285; 9–75 years), considering, as a reference, the European Food Scientific Authority (EFSA) values for nutrients for the European Union. We also assessed the quality of the diet for adults and older adults using four internationally accepted DQIs, namely the Healthy Diet Indicator (HDI), the Mediterranean Diet Score (MDS), the Mediterranean Diet Score-modified (MDS-mod), and the Mediterranean-Diet Quality Index (MED-DQI), as well as the ANIBES-DQI, stratified by education and income. The ANIBES-DQI was based on compliance with EFSA and Food and Agriculture Organization recommendations for a selected group of nutrients (i.e., total fat, saturated fatty acids (SFAs), simple sugars, fiber, calcium, vitamin C, and vitamin A), with a total range of 0–7. Misreporting was assessed according to the EFSA protocol, which allowed us to assess the DQIs for both the general population and plausible reporters. The majority of the Spanish population had high intakes of SFAs and sugars and low intakes of fiber, folate, and vitamins A and C. In addition, about half of the population had low DQI scores and exhibited low adherence to the Mediterranean diet pattern. Overall, older adults (>65–75 years) showed better DQIs than adults (18–64 years), without major differences between men and women. Moreover, primary education and low income were associated with low MDS and ANIBES-DQI scores. For the ANIBES-DQI, the percentage of the population with low scores was higher in the whole population (69.5%) compared with the plausible energy reporters (49.0%), whereas for medium and high scores the percentages were higher in plausible reporters (41.2% vs. 26.2% and 9.8% vs. 4.3%, respectively). In conclusion, the present study adds support to marked changes in the Mediterranean pattern in Spain, and low education and income levels seem to be associated with a low-quality diet. Additionally, the misreported evaluation in the ANIBES population suggests that this analysis should be routinely included in nutrition surveys to give more precise and accurate data related to nutrient intake and diet quality.
... 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). ...
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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.
... 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. ...
Article
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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.
... In epidemiologic and clinical nutrition, dietary assessment typically relies on researcher-facilitated or autonomous participant recall using methods such as 24-hour recall, food frequency questionnaires, and food diary inventories. These memory-based assessment methods have demonstrated poor validity because of human under-or overestimation of intake and intentional or unintentional alteration of intake patterns [23]. Each traditional assessment method is a reflection of the individual's perceived intake rather than an accurate measure of true intake. ...
... Establishing reliable adherence or compliance protocols is a widespread goal in measuring the dietary intake of human subjects [23]. Continuous glucose monitors were used to measure the participants' adherence to food intake recording protocols. ...
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Background Wearable and mobile sensor technologies can be useful tools in precision nutrition research and practice, but few are reliable for obtaining accurate and precise measurements of diet and nutrition. Objective This study aimed to assess the ability of wearable technology to monitor the nutritional intake of adult participants. This paper describes the development of a reference method to validate the wristband’s estimation of daily nutritional intake of 25 free-living study participants and to evaluate the accuracy (kcal/day) and practical utility of the technology. Methods Participants were asked to use a nutrition tracking wristband and an accompanying mobile app consistently for two 14-day test periods. A reference method was developed to validate the estimation of daily nutritional intake of participants by the wristband. The research team collaborated with a university dining facility to prepare and serve calibrated study meals and record the energy and macronutrient intake of each participant. A continuous glucose monitoring system was used to measure adherence with dietary reporting protocols, but these findings are not reported. Bland-Altman tests were used to compare the reference and test method outputs (kcal/day). Results A total of 304 input cases were collected of daily dietary intake of participants (kcal/day) measured by both reference and test methods. The Bland-Altman analysis had a mean bias of −105 kcal/day (SD 660), with 95% limits of agreement between −1400 and 1189. The regression equation of the plot was Y=−0.3401X+1963, which was significant (P<.001), indicating a tendency for the wristband to overestimate for lower calorie intake and underestimate for higher intake. Researchers observed transient signal loss from the sensor technology of the wristband to be a major source of error in computing dietary intake among participants. Conclusions This study documents high variability in the accuracy and utility of a wristband sensor to track nutritional intake, highlighting the need for reliable, effective measurement tools to facilitate accurate, precision-based technologies for personal dietary guidance and intervention.
... 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. ...
Article
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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.
... 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]. ...
Article
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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.
... First, the included prospective cohort studies were observational in nature, and so one cannot discount the possibility of measured and unmeasured residual confounding. In addition, the validity of self-reported dietary consumption is limited, [63][64][65] as it is argued that it represents only a collection of memories of perception of dietary intake, leading to its possible implausibility due to misestimations. [66][67][68] Estimates of sugar dose in our paper are based upon self-reported dietary recall and should be inferred in light of this limitation. ...
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Objective: To determine the association of total and added fructose-containing sugars on cardiovascular (CVD) incidence and mortality. Methods: MEDLINE, EMBASE and Cochrane Library were searched from January 1, 1980, to July 31, 2018. Prospective cohort studies assessing the association of reported intakes of total, sucrose, fructose and added sugars with CVD incidence and mortality in individuals free from disease at baseline were included. Risk estimates were pooled using the inverse variance method, and dose-response analysis was modeled. Results: Eligibility criteria were met by 24 prospective cohort comparisons (624,128 unique individuals; 11,856 CVD incidence cases and 12,224 CVD mortality cases). Total sugars, sucrose, and fructose were not associated with CVD incidence. Total sugars (risk ratio, 1.09 [95% confidence interval, 1.02 to 1.17]) and fructose (1.08 [1.01 to 1.15]) showed a harmful association for CVD mortality, there was no association for added sugars and a beneficial association for sucrose (0.94 [0.89 to 0.99]). Dose-response analyses showed a beneficial linear dose-response gradient for sucrose and nonlinear dose-response thresholds for harm for total sugars (133 grams, 26% energy), fructose (58 grams, 11% energy) and added sugars (65 grams, 13% energy) in relation to CVD mortality (P<.05). The certainty of the evidence using GRADE was very low for CVD incidence and low for CVD mortality for all sugar types. Conclusion: Current evidence supports a threshold of harm for intakes of total sugars, added sugars, and fructose at higher exposures and lack of harm for sucrose independent of food form for CVD mortality. Further research of different food sources of sugars is needed to define better the relationship between sugars and CVD.
... 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]. ...
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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.
... 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. ...
Preprint
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.
... While this review considers the potential effect of food timing on obesity and weight control, most of the studies are association studies and cannot address causality. Moreover, one limitation is that dietary data from observational (e.g., longitudinal) studies are based on memory-based methods, that may fail in the assessments [74]. Further, randomized cross-over intervention studies giving a fixed diet and changing the timing of food intake should be performed to address causality. ...
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(1) Background: Eating is fundamental to survival. Animals choose when to eat depending on food availability. The timing of eating can synchronize different organs and tissues that are related to food digestion, absorption, or metabolism, such as the stomach, gut, liver, pancreas, or adipose tissue. Studies performed in experimental animal models suggest that food intake is a major external synchronizer of peripheral clocks. Therefore, the timing of eating may be decisive in fat accumulation and mobilization and affect the effectiveness of weight loss treatments. (2) Results: We will review multiple studies about the timing of the three main meals of the day, breakfast, lunch and dinner, and its potential impact on metabolism, glucose tolerance, and obesity-related factors. We will also delve into several mechanisms that may be implicated in the obesogenic effect of eating late. Conclusion: Unusual eating time can produce a disruption in the circadian system that might lead to unhealthy consequences.
... 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). ...
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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.
... 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. ...
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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.
... 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). ...
Article
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.
... Because of the online delivery of the current study, observational assessment of food intake was no possible. Apart from visual analogue scales, food frequency questionnaires and food recall questionnaires are commonly used, but, as with visual analogue scales, the subjective nature of the measurement means that accuracy is sacrificed for the sake of convenience, when compared with observational measurement (Archer, Marlow, & Lavie, 2018;Hackett, 2011). ...
Article
Objective: The current research evaluated whether Go/No-go training for highly palatable (HP) food affected attention bias for HP food (an automatic/implicit outcome) and intention to eat unhealthy food (a controlled/explicit outcome). Method: A sample of Australian adults representative for age, gender and Body Mass Index (BMI) (N = 561, Mage = 46.31 years, SD = 16.75, 52.3% women, MBMI = 27.11, SD = 6.34) completed self-report measures of dietary psychological constructs and food image modified Stroop tasks as measures of pre- and post-test attention bias for HP food. After random assignment of participants to two conditions, a Go/No-go intervention was used to train HP food targeted inhibitory control in the experimental group, or general inhibitory control in the control group. All research tasks were delivered online. Results: The experimental, HP food inhibitory control training group reported intention to eat less unhealthy food than the control group, F(1, 637) = 4.81, R2 = .09, p = .029. Counter to expectations, the experimental group exhibited a heightened attention bias to HP food images after the training, F(1, 637) = 9.48, R2 = .39, p = .002. Conclusion: Go/No-go training for food may improve both top-down and bottom-up inhibitory control, using both automatic and controlled processes. Further, it may not be effective in lowering attention bias for HP food, but may be effective in lowering unhealthy food intake despite raising attention bias for HP food. Further research that tests these effects using varied reaction time tasks is needed to confirm these results and to explore possible alternative explanations.
... 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). ...
Article
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.
... incompatible with survival). 8,9 Therefore, this review focuses on evidence from randomized controlled trials (RCTs) on surrogate markers for cardiometabolic health and clinical endpoints. The resulting conceptual Food-versus nutrient-based recommendations. ...
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Despite major efforts to reduce atherosclerotic cardiovascular disease (ASCVD) burden with conventional risk factor control, significant residual risk remains. Recent evidence on non-traditional determinants of cardiometabolic health has advanced our understanding of lifestyle–disease interactions. Chronic exposure to environmental stressors like poor diet quality, sedentarism, ambient air pollution and noise, sleep deprivation and psychosocial stress affect numerous traditional and non-traditional intermediary pathways related to ASCVD. These include body composition, cardiorespiratory fitness, muscle strength and functionality and the intestinal microbiome, which are increasingly recognized as major determinants of cardiovascular health. Evidence points to partially overlapping mechanisms, including effects on inflammatory and nutrient sensing pathways, endocrine signalling, autonomic function and autophagy. Of particular relevance is the potential of low-risk lifestyle factors to impact on plaque vulnerability through altered adipose tissue and skeletal muscle phenotype and secretome. Collectively, low-risk lifestyle factors cause a set of phenotypic adaptations shifting tissue cross-talk from a proinflammatory milieu conducive for high-risk atherosclerosis to an anti-atherogenic milieu. The ketone body ß-hydroxybutyrate, through inhibition of the NLRP-3 inflammasome, is likely to be an intermediary for many of these observed benefits. Adhering to low-risk lifestyle factors adds to the prognostic value of optimal risk factor management, and benefit occurs even when the impact on conventional risk markers is discouragingly minimal or not present. The aims of this review are (a) to discuss novel lifestyle risk factors and their underlying biochemical principles and (b) to provide new perspectives on potentially more feasible recommendations to improve long-term adherence to low-risk lifestyle factors.
... Although we minimized confounding by using the most adjusted analyses from each study in our meta-analyses, residual confounding remains a plausible explanation for all associations. Finally, eligible studies used recall-based methods for dietary measurement that are prone to measurement error, which can result in either an underestimate or an overestimate of observed associations (41,42). ...
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Background: Studying dietary patterns may provide insights into the potential effects of red and processed meat on health outcomes. Purpose: To evaluate the effect of dietary patterns, including different amounts of red or processed meat, on all-cause mortality, cardiometabolic outcomes, and cancer incidence and mortality. Data Sources: Systematic search of MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, CINAHL, Web of Science, and ProQuest Dissertations & Theses Global from inception to April 2019 with no restrictions on year or language. Study Selection: Teams of 2 reviewers independently screened search results and included prospective cohort studies with 1000 or more participants that reported on the association between dietary patterns and health outcomes. Data Extraction: Two reviewers independently extracted data, assessed risk of bias, and evaluated the certainty of evidence using GRADE (Grading of Recommendations Assessment, Development and Evaluation) criteria. Data Synthesis: Eligible studies that followed patients for 2 to 34 years revealed low- to very-low-certainty evidence that dietary patterns lower in red and processed meat intake result in very small or possibly small decreases in all-cause mortality, cancer mortality and incidence, cardiovascular mortality, nonfatal coronary heart disease, fatal and nonfatal myocardial infarction, and type 2 diabetes. For all-cause, cancer, and cardiovascular mortality and incidence of some types of cancer, the total sample included more than 400 000 patients; for other outcomes, total samples included 4000 to more than 300 000 patients. Limitation: Observational studies are prone to residual confounding, and these studies provide low- or very-low-certainty evidence according to the GRADE criteria. Conclusion: Low- or very-low-certainty evidence suggests that dietary patterns with less red and processed meat intake may result in very small reductions in adverse cardiometabolic and cancer outcomes.
... 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) . ...
Article
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.
... 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. ...
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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. ...
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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. ...
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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. ...
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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). ...
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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]. ...
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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.
... 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. ...
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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.
... We used routinely collected data, rather than the standard food frequency questionnaires. However, food frequency questionnaires have been heavily criticized, due to recall and reporting bias (Archer, Marlow, & Lavie, 2018). For example, the UK NDNS survey (Rauber et al., 2018) reported daily intake of only 1764.7 Kcal, which was inconsistent with the obesity epidemic, and therefore indicates significant underreporting, To improve the reliability and accuracy of self reports, in our study, we only attempted to code the type of foods and not the amounts consumed, and we did not attempt to estimate the overall calorie intake. ...
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Abstract OBJECTIVE There is increasing evidence of the impact of ultra-processed foods on multiple metabolic and neurobiological pathways, including those involved in eating behaviours, both in animals and in humans. In this pilot 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 DSM-5 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 analysed for each diagnosis, at each mealtime and during episodes of bingeing. RESULTS 71 female and 3 male patients were included in the study. 22 had AN, 25 BN and 26 had BED. Patients with AN reported consuming 55% NOVA-4 foods, as opposed to approximately 70% in BN and BED. Binge foods were 100% ultra-processed. DISCUSSION Further research into the metabolic and neurobiological effects of reducing ultra-processed food intake on bingeing behaviour is needed. Key words: Anorexia nervosa, bulimia nervosa, binge eating disorder, ultra-processed food, metabolic and neurobiological effect.
... 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). ...
Article
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. ...
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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.
... (Ioannidis, 2018) Schoenfeld and Ioannidis (2013) found that, among 50 common ingredients used in a cookbook, 40 had been associated with cancer risk or benefit based on observational studies. As a first point of concern, the input data obtained from food frequency questionnaires should be interpreted prudently as they can be problematic for a variety of reasons (Schatzkin et al., 2003;Archer et al., 2018;Feinman, 2018). Social desirability bias in food reporting is just one example, as reported consumption can be affected by the perceived health status of certain foods. ...
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Mainstream dietary recommendations now commonly advise people to minimize the intake of red meat for health and environmental reasons. Most recently, a major report issued by the EAT-Lancet Commission recommended a planetary reference diet mostly based on plants and with no or very low (14 g/d) consumption of red meat. We argue that claims about the health dangers of red meat are not only improbable in the light of our evolutionary history, they are far from being supported by robust scientific evidence. OPEN ACCESS here: https://www.tandfonline.com/doi/full/10.1080/10408398.2019.1657063?
... 3 There is unprecedented attention globally to interventions such as product labeling and taxation to support healthy eating and reduce disease risk among populations, 4-6 with a concomitant need to monitor intake. Although commonly used dietary assessment methods have been subject to criticism based on their reliance on selfreport, 7,8 there is more interest than ever in measuring what people eat and drink. 9 This speaks to the need for robust efforts to understand whether a given method or measure is well suited to a given purpose and context. ...
Article
Careful consideration of the validity and reliability of methods intended to assess dietary intake is central to the robustness of nutrition research. A dietary assessment method with high validity is capable of providing useful measurement for a given purpose and context. More specifically, a method with high validity is well grounded in theory; its performance is consistent with that theory; and it is precise, dependable, and accurate within specified performance standards. Assessing the extent to which dietary assessment methods possess these characteristics can be difficult due to the complexity of dietary intake, as well as difficulties capturing true intake. We identified challenges and best practices related to the validation of self-report dietary assessment methods. The term validation is used to encompass various dimensions that must be assessed and considered to determine whether a given method is suitable for a specific purpose. Evidence on the varied concepts of validity and reliability should be interpreted in combination to inform judgments about the suitability of a method for a specified purpose. Self-report methods are the focus because they are used in most studies seeking to measure dietary intake. Biomarkers are important reference measures to validate self-report methods and are also discussed. A checklist is proposed to contribute to strengthening the literature on the validation of dietary assessment methods and ultimately, the nutrition literature more broadly.
... 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. ...
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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.
... In addition, studies varied in their choice of adjustment variables. All included studies measured diet via recallbased methods, primarily food-frequency questionnaires, which are subject to measurement error that can both attenuate and overestimate observed associations (41,42). Although food-frequency questionnaires may provide reliable information on relative intake, substantial error regarding absolute intake may compromise dose-response meta-analyses that rely on these estimates (41). ...
Article
This article has been corrected. The original version (PDF) is appended to this article as a Supplement. Background: Dietary guidelines generally recommend limiting intake of red and processed meat. However, the quality of evidence implicating red and processed meat in adverse health outcomes remains unclear. Purpose: To evaluate the association between red and processed meat consumption and all-cause mortality, cardiometabolic outcomes, quality of life, and satisfaction with diet among adults. Data sources: EMBASE (Elsevier), Cochrane Central Register of Controlled Trials (Wiley), Web of Science (Clarivate Analytics), CINAHL (EBSCO), and ProQuest from inception until July 2018 and MEDLINE from inception until April 2019, without language restrictions, as well as bibliographies of relevant articles. Study selection: Cohort studies with at least 1000 participants that reported an association between unprocessed red or processed meat intake and outcomes of interest. Data extraction: Teams of 2 reviewers independently extracted data and assessed risk of bias. One investigator assessed certainty of evidence, and the senior investigator confirmed the assessments. Data synthesis: Of 61 articles reporting on 55 cohorts with more than 4 million participants, none addressed quality of life or satisfaction with diet. Low-certainty evidence was found that a reduction in unprocessed red meat intake of 3 servings per week is associated with a very small reduction in risk for cardiovascular mortality, stroke, myocardial infarction (MI), and type 2 diabetes. Likewise, low-certainty evidence was found that a reduction in processed meat intake of 3 servings per week is associated with a very small decrease in risk for all-cause mortality, cardiovascular mortality, stroke, MI, and type 2 diabetes. Limitation: Inadequate adjustment for known confounders, residual confounding due to observational design, and recall bias associated with dietary measurement. Conclusion: The magnitude of association between red and processed meat consumption and all-cause mortality and adverse cardiometabolic outcomes is very small, and the evidence is of low certainty. Primary funding source: None. (PROSPERO: CRD42017074074).
... 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. ...
Article
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.
... As such, the oversampling of groups that are highly invested in their dietary regimes for health, religious, or ideologic concerns (e.g., animals rights) will lead to biased recruitment and extremely unreliable data. In fact, research on cognitive dissonance and social desirability suggests that the greater the motivation for adhering to one's dietary or lifestyle pattern (or self-conception), the larger the potential error induced via the use of self-reports (Archer, Marlow, and Lavie 2018c;Festinger 1962). Future studies should employ objective data collection protocols when over-sampling groups that may be prone to intentional and/or non-intentional misreporting. ...
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Objective: To examine the relation between the consumption or avoidance of meat and psychological health and well-being. Methods: A systematic search of online databases (PubMed, PsycINFO, CINAHL Plus, Medline, and Cochrane Library) was conducted for primary research examining psychological health in meat-consumers and meat-abstainers. Inclusion criteria were the provision of a clear distinction between meat-consumers and meat-abstainers, and data on factors related to psychological health. Studies examining meat consumption as a continuous or multi-level variable were excluded. Summary data were compiled, and qualitative analyses of methodologic rigor were conducted. The main outcome was the disparity in the prevalence of depression, anxiety, and related conditions in meat-consumers versus meat-abstainers. Secondary outcomes included mood and self-harm behaviors. Results: Eighteen studies met the inclusion/exclusion criteria; representing 160,257 participants (85,843 females and 73,232 males) with 149,559 meat-consumers and 8584 meat-abstainers (11 to 96 years) from multiple geographic regions. Analysis of methodologic rigor revealed that the studies ranged from low to severe risk of bias with high to very low confidence in results. Eleven of the 18 studies demonstrated that meat-abstention was associated with poorer psychological health, four studies were equivocal, and three showed that meat-abstainers had better outcomes. The most rigorous studies demonstrated that the prevalence or risk of depression and/or anxiety were significantly greater in participants who avoided meat consumption. Conclusion: Studies examining the relation between the consumption or avoidance of meat and psychological health varied substantially in methodologic rigor, validity of interpretation, and confidence in results. The majority of studies, and especially the higher quality studies, showed that those who avoided meat consumption had significantly higher rates or risk of depression, anxiety, and/or self-harm behaviors. There was mixed evidence for temporal relations, but study designs and a lack of rigor precluded inferences of causal relations. Our study does not support meat avoidance as a strategy to benefit psychological health.
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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.
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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.
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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.
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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.
Article
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.
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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.
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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.
Thesis
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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.