Abstracts of Articles on Nutrition and Bone Loss

Objective: To identify if particular foods or food groups may be associated with obesity in children and adolescents and to determine if consuming food away from home (FAFH) has an effect on the nutritional quality of their diets.

Design: One-year cross-sectional study.

Setting/Subjects: The obese subjects (n = 91) were on the waiting list for a hospital-based weight control treatment program. The non-obese subjects (n = 90) were recruited from community advertisements.

Measures of Outcome: Information on food intake was obtained using the dietary history method by a Registered Dietitian. Body fat was determined by bioelectrical impedance analysis.

Results: Obese children and adolescents consumed significantly more servings of meat and alternatives, grain products, FAFH, sugar-sweetened drinks and potato chips which contributed to a higher calorie, fat and sugar intake compared to non-obese children and adolescents. Sugar-sweetened drinks were only significantly greater in boys. The consumption of meat servings, sugar-sweetened drinks and FAFH was positively correlated with percent body fat. The frequency of food consumed outside of the Canada’s Food Guide To Healthy Eating was not different between the two groups.

Conclusions: Obese children and adolescents need to limit their access to food consumed away from home and sugar-sweetened drinks as there is a relationship between these foods and body fatness.     

Dietary Sodium Intake and Its Relation to Human Health: A Summary of the Evidence

Objectives: Relating food diversity, quality, and intake is one of the key aspects in understanding household food security. This paper aimed at marying food intake and quality, both being measurement for food security.

Methods: A household food consumption survey (n = 200) exploring food diversity, quality of foods, and their relation to food intake in Embo, a poor farming community in rural KwaZulu-Natal was carried out in November 2004 (period of insufficiency) and repeated in March 2005 (period of plenty). Household food intake strata were developed using matrices obtained from the Household Food Intake Index and nutritional adequacy ratios. Food quality was measured using food count and later using 5 food groups, namely, starches, vegetables and fruits,animal sourced foods, fats, and legumes.

Results: Single food count showed dietary diversity to be significantly different across households with different food intake during the period of plenty (P ≤ 0.000). During the period of plenty, vegetable and fruits contributed significantly different proportions of energy (P ≤ 0.000), protein (P ≤ 0.006), iron (P ≤ 0.020), and vitamin E (P ≤ 0.006) to household food intake strata. Intake of vitamin A was more elastic as its intake variation from legumes, fats, and animal sourced foods was (P ≤ 0.000), from starches (P ≤ 0.008) and from vegetable and fruits (P ≤ 0.064) during the second round. Starches are the most important food group to the community, whereas fats and animal sourced food groups are less important.

Conclusions: The current study has been able to include food quality in food security studies. Seasonality accounts for variation in food quality. The South African food-based dietary guidelines are relevant to the Embo community.     

Report

Household food procurement strategies, preservation methods and intake frequency of contemporary and traditional foods were examined in the Eastern Cherokee township of Snowbird. In addition to purchasing food, 98.6 percent of households obtained food using traditional acquisition strategies such as gardening and gathering wild foods. Home food preservation was practiced in 97.2 percent of homes. Most common preservation methods were canning, freezing and drying. Estimates of food intake frequency indicate a variety of foods were eaten in Snowbird homes. Types of foods consumed were similar to those for the general United States population. However, native Cherokee foods were part of this group's diet.     

Development and validation of a food frequency questionnaire to estimate the intake of genistein in Malaysia

Abstract

Objective: To develop and validate a food frequency questionnaire (FFQ) to estimate the genistein intake in a Malaysian population of pregnant women. Method: A single 24-h dietary recall was obtained from 40 male and female volunteers. A FFQ of commonly consumed genistein-rich foods was developed from these recalls, and a database of the genistein content of foods found in Malaysia was set up. The FFQ was validated against 7-d food diary (FD) kept by 46 pregnant women and against non-fasting serum samples obtained from 64 pregnant women. Reproducibility was assessed by comparing the responses on two FFQs administered approximately 1 month apart. Results: The Pearson correlation coefficient between FFQ1 and FD was 0.724 and that between FFQ2 and FD was 0.807. Classification into the same or adjacent quintiles was 78% for FFQ1 versus FD and 88% for FFQ2 versus FD. A significant dose -- response relation was found between FFQ-estimated genistein intake and serum levels. Conclusion: The FFQ developed is a reliable, valid tool for categorising people by level of genistein intake.     

The nutrient and food intakes of 16–17 year old female dieters in the UK

A group of female teenage dieters was isolated from a larger national dietary survey of teenagers at 16–17 years of age. The dieting group included girls who both claimed to be dieting and who had energy intakes which were considered appropriate for weight loss, based on calculated reported energy intake to estimated basal metabolic rate cut-off points. The nutrient intakes and food choices of dieters (n= 204) were compared with a similar sample of non-dieters (n= 226) from the same cohort group. The mean reported energy intake of the dieters was 1604 kcals/day compared to 2460 kcals/day amongst non-dieters. The intakes of all the macronutrients in g/day were considerably lower amongst dieters, allowing for differences in region and social class, but when expressed as a percentage of energy intake, dieters had significantly lower intakes of fat and higher intakes of protein and intrinsic sugars, milk sugars and starch. No differences were seen in the percentage of energy provided by non-milk extrinsic sugars between the two groups. The intake of all micronutrients was substantially lower amongst dieters, allowing for regional and social class differences, and more than twice as many dieters as non-dieters failed to achieve the reference nutrient intake (RNI) for retinol equivalents, thiamin, riboflavin, folates, vitamin B12, vitamin B₆, zinc, copper and selenium. Reported food intake data for the two groups suggest that dieters consumed smaller quantities of most foods, although intakes of items associated with dieting such as low calorie soft drinks, low fat spread, skimmed milk, cottage cheese, yoghurt, salad vegetables, fruit and fruit juice were consumed in equal or greater amounts by dieters. Teenage dieters should be encouraged to include more nutrient-dense foods in their diets such as fortified breakfast cereals and low fat dairy products in order to obtain sufficient micronutrients from a lower calorie intake.     

Determinants and nutritional implications associated with low-fat food consumption

Objectives: the objective was to study determinants and nutritional implications associated with low-fat food consumption. Methods: a cross-sectional design was used, 5,000 military men were contacted and 1,852 participated. Using mailed questionnaires, the low-fat food consumption frequency was recorded and stratified in number of portions a day. The following low-fat food items were included: mayonnaise, yoghurt, milk, cheese, cottage cheese and meat. Results: the two most daily consumed low-fat foods were meat and yoghurt by, respectively, 21.7% and 17.3% of the participants. Only 3.5% consumed a daily portion of low-fat cheese, and 7.4% consumed one or more daily portions of low-fat milk. After adjustment, Body Mass Index (BMI), physical activity and non-smoking were associated with an increasing consumption of low-fat foods. Consumption of low-fat foods was associated with a decreased daily total and saturated fat intake, from respectively, 37.9 and 14.7 energy-percent for low consumption to 30.5 and 11.6 energy-percent for high consumption. This decrease was compensated by an increased intake in carbohydrates and sugar, respectively, 42.5 and 16.7 energy-percent to 46.5 and 22.6 energy-percent. Conclusions: age, BMI, physical activity and non-smoking were associated with an increasing consumption of low-fat foods. The fact that low-fat foods consumers had a higher intake of carbohydrates and proteins question the efficacy of these items in energy reducing programs.     

Assessing the SAIN,LIM nutrient profile of foods sold by fast food restaurants in Tunisia: Exploring ways for improvement

ObjectivesNon-communicable diseases have increased in Tunisia after the epidemiological transition. That is why the national strategy to prevent and control obesity was elaborated and implemented. Improving the quality of foods is one axis of this strategy. The purpose of this paper was to estimate and evaluate the nutritional profiles of Tunisian foods sold by fast food restaurants, and explore ways for improvement.Material and methodsNutritional quality of 35 average recipes or items was assessed by 70 recipes of dishes sold by fast food restaurants. The SAIN,LIM French scoring system was used. Foods were classified into the four SAIN,LIM classes, i.e. from the healthiest (class 1) to the least healthy (class 4). The recipes were then reformulated and improved by deleting or reducing some unfavorable ingredients like salt.ResultsBefore reformulation, the items were spread over the 4 SAIN,LIM classes (class 1: 42.9%; class 2: 8.6%; class 3: 20.0% and class 4: 28.6%). After reformulation, the items were spread over class 1 (85.7%) and class 3 (14.3%), showing clear improvement of their nutritional quality.ConclusionIn Tunisia, an important percentage of foods sold by fast food restaurant have a good nutrient profile (43%). After reformulation, most items were in the healthiest class. This study is the first to show that it is possible to improve the nutritional quality of foods sold by fast food restaurants, and that the SAIN,LIM system can help to that end.     

Nutritional composition of dishes commonly consumed by Japanese Brazilians in São Paulo,Brazil

Abstract

Primary objective To calculate the nutritional composition of commonly consumed Brazilian foods and beverages to analyze dietary intake data obtained with a quantitative food frequency questionnaire in a colorectal adenoma case–control study in Japanese Brazilians.

Methods and procedures Weighed recipes were collected in São Paulo, Brazil and analyzed using NutriBase Clinical Nutrition Manager.

Main outcomes and results A total of 387 recipes for 76 dishes commonly consumed by Japanese Brazilians were collected: 30 composite main course dishes, 26 composite vegetable dishes, 19 snack foods and desserts, and one beverage. The nutritional composition (energy and 32 macronutrients and micronutrients) was calculated per 100 g for each dish.

Conclusions We provided, for the first time, complete and up-to-date calculated nutritional composition data for commonly consumed Brazilian food items, which are essential to assess the current dietary intake among Japanese Brazilians.     

Healthy Eating Index-2015 Scores Vary by Types of Food Outlets in the United States

Diet quality in the United States is improving over time but remains poor. Food outlets influence diet quality and represent the environments in which individuals make choices about food purchases and intake. The objective of this study was to use the Healthy Eating Index-2015 (HEI-2015) to evaluate the quality of foods consumed from the four major outlets where food is obtained—stores, full-service restaurants, quick-services restaurants, and schools—and to assess changes over time. This cross-sectional study used 24 h dietary recall data from eight cycles (2003–2004 to 2017–2018) of the National Health and Nutrition Examination Survey (NHANES). Linear trend estimation was used to test for changes in HEI scores over time, and balanced repeated replicate weighted linear regression was used to test for differences in total and component scores between types of food outlets. Overall, Americans are not consuming a mix of foods from any major category of food outlet that aligns with dietary guidelines. The total score for schools (65/100 points) and stores (62/100 points) was significantly higher than full-service (51/100 points) and quick-service (39/100 points) restaurants (p < 0.0001). HEI scores significantly improved over time for schools (p < 0.001), including an increase in whole grains from less than 1 point in 2003–2004 to 7 out of 10 points in 2017–2018. In 2017–2018, schools received the maximum score for total fruits, whole fruits, and dairy. Continued research on strategies for improving the quality of foods consumed from restaurants and stores is warranted.     

Type 1 Diabetes Mellitus and Components in Drinking Water and Diet: A Population-Based,Case-Control Study in Prince Edward Island,Canada

Objective: To determine the relationship between the risk of type 1 diabetes (T1D) and daily intake of drinking water and dietary components, including nitrate, nitrite, and nitrosamines, during the year prior to diagnosis.

Methods: Controls (n = 105) were matched by age at diagnosis and sex to T1D cases (n = 57) newly diagnosed during 2001–2004. Food consumption was assessed using a food frequency questionnaire. Locally available samples of foods were tested for nitrate, nitrite, and nitrosamine concentrations. Water consumption was determined through an additional questionnaire, and water samples were taken from homes and tested for routine chemical components, including nitrate.

Results: After controlling for age, age, sex, and daily energy intake, nitrate intake from food sources showed a non‐significant positive trend (odds ratios and 95% confidence intervals for quartiles = 1.00, 1.63 (0.58, 4.63), 1.71 (0.54, 5.40), 3.02 (0.78, 11.74); p for trend = 0.13). Nitrite and nitrosamine intake were not related to T1D risk (p for trend = 0.77 and 0.81, respectively). When food and water components were combined, zinc and calcium intakes were marginally and inversely related to T1D risk (p for trend = 0.07 and 0.06, respectively). After further model adjustment of possible confounders and significant risk factors, an increased intake of caffeine marginally increased the risk of T1D (p = 0.07).

Conclusion: Dietary components from both food and water sources may influence the risk of developing T1D in young persons.     

Frequency of Sweet and Salty Snack Food Consumption Is Associated with Higher Intakes of Overconsumed Nutrients and Weight-For-Length z Scores During Infancy and Toddlerhood

BackgroundCurrent dietary guidelines recommend avoiding foods and beverages with added sugars and higher sodium before age 2 years.ObjectiveThe aim was to describe daily snack food intake (frequency and total energy) and the associations with overconsumed nutrients (added sugars, sodium, and saturated fats) and child weight-for-length z scores.DesignA cross-sectional, secondary analysis of baseline data from an ongoing longitudinal intervention was conducted.Participants and settingA sample of 141 caregivers with infants (aged 9 to 11 months) and toddlers (aged 12 to 15 months) was recruited in Buffalo, NY, between 2017 and 2019.Main outcome measuresThree 24-hour dietary recalls were used to categorize 'sweet and salty snack foods' or 'commercial baby snack foods' based on the US Department of Agriculture What We Eat in America food group classifications and estimate nutrient intakes. Child recumbent length and weight were measured by trained researchers.Statistical analysisDaily frequency (times/day), energy (kcal/day), and overconsumed nutrients from snack food intake were calculated. Multivariable regression models examined associations between the frequency of and energy from snack food intake with overconsumed nutrients and child weight-for-length z scores.ResultsInfants consumed snack foods on average 1.2 times/day contributing 5.6% of total daily energy, 19.6% of added sugars, and 6.8% of sodium. Toddlers consumed snack foods on average 1.4 times/day contributing 8.9% of total daily energy, 40.0% of added sugars, and 7.2% of sodium. In adjusted models including all children, greater frequency of sweet and salty snack food intake, but not commercial baby snack foods, was associated with higher weight-for-length z scores.ConclusionsSnack foods are frequently consumed by infants and toddlers and contribute to the intake of overconsumed nutrients such as added sugars and sodium. Given the current guidelines to avoid added sugars and higher sodium before age 2 years, additional recommendations related to nutrient-dense snack intake may be beneficial.     

The Major Source of Antioxidants Intake From Typical Diet Among Rural Farmers in North-eastern Japan in the 1990s

BackgroundPrevious Japanese studies have led to the erroneous conclusion of antioxidant capacity (AOC) intakes of the overall Japanese diet due to limitations in the number and types of food measured, especially in rice and seafood intake. The aims of the study were to construct an AOC database of foods representative of the typical Japanese diet and to clarify the high contributors to AOC intake from the overall diet of the Japanese population.MethodsCommonly consumed foods were estimated using 3-day dietary records (DRs) over the four seasons among 55 men and 58 women in Japan. To generate an AOC database suitable for the typical Japanese diet, hydrophilic (H-)/lipophilic (L-) oxygen radical absorbance capacity (ORAC) values of foods in each food group were measured via validated methods using the food intake rankings. Subsequently, we estimated the AOC intake and the AOC characteristics of a typical Japanese diet.ResultsOf 989 food items consumed by the participants, 189 food items were measured, which covered 78.8% of the total food intake. The most commonly consumed types of antioxidant-containing food were tea, soybean products, coffee, and rice according to H-ORAC, and soybean products, fish and shellfish, vegetables, and algae according to L-ORAC.ConclusionsThe characteristics of high AOC intake in rice and seafood more appropriately reflected the Japanese-style diet. Further studies are expected to clarify the association between food-derived AOC and its role in preventing or ameliorating lifestyle-related diseases.Key words: antioxidant capacity, dietary records, Japanese, oxygen radical absorbance capacity (ORAC) method, overall diet     

Vital Signs: Sodium Intake Among U.S. School-Aged Children — 2009–2010

Background

A national health objective is to reduce average U.S. sodium intake to 2,300 mg daily to help prevent high blood pressure, a major cause of heart disease and stroke. Identifying common contributors to sodium intake among children can help reduction efforts.

Methods

Average sodium intake, sodium consumed per calorie, and proportions of sodium from food categories, place obtained, and eating occasion were estimated among 2,266 school-aged (6–18 years) participants in What We Eat in America, the dietary intake component of the National Health and Nutrition Examination Survey, 2009–2010.

Results

U.S. school-aged children consumed an estimated 3,279 mg of sodium daily with the highest total intake (3,672 mg/d) and intake per 1,000 kcal (1,681 mg) among high school–aged children. Forty-three percent of sodium came from 10 food categories: pizza, bread and rolls, cold cuts/cured meats, savory snacks, sandwiches, cheese, chicken patties/nuggets/tenders, pasta mixed dishes, Mexican mixed dishes, and soups. Sixty-five percent of sodium intake came from store foods, 13% from fast food/pizza restaurants, 5% from other restaurants, and 9% from school cafeteria foods. Among children aged 14–18 years, 16% of total sodium intake came from fast food/pizza restaurants versus 11% among those aged 6–10 years or 11–13 years (p<0.05). Among children who consumed a school meal on the day assessed, 26% of sodium intake came from school cafeteria foods. Thirty-nine percent of sodium was consumed at dinner, followed by lunch (29%), snacks (16%), and breakfast (15%).

Implications for Public Health Practice

Sodium intake among school-aged children is much higher than recommended. Multiple food categories, venues, meals, and snacks contribute to sodium intake among school-aged children supporting the importance of populationwide strategies to reduce sodium intake. New national nutrition standards are projected to reduce the sodium content of school meals by approximately 25%–50% by 2022. Based on this analysis, if there is no replacement from other sources, sodium intake among U.S. school-aged children will be reduced by an average of about 75–150 mg per day and about 220–440 mg on days children consume school meals.     

The association of maternal food intake and infants' and toddlers' food intake

Background Young children's first experiences with food may influence development of food preferences and lifelong eating habits. However, little is known about what factors are associated with the development of eating behaviours in infants and toddlers. Studies with older children and adolescents suggest that parental food intake is associated with children's food intake. The purpose of the present paper is to determine whether this association starts even earlier during infancy and toddlerhood. Methods A convenience sample of n= 98 primarily African American mothers of children 6–18 months old completed questionnaires, including questions on their own and their young child's food intake. Mothers completed questions while waiting to be seen by their child's primary care provider. Results Per maternal report, children consumed fruit 2.45 (1.79) times, vegetables 1.63 (1.51) times and snack foods 2.22 (2.49) times each day. Infants' and toddlers' fruit (r= 0.54, P < 0.001), vegetable (r= 0.42, P < 0.001) and snack food (r= 0.37, P < 0.001) intake were significantly associated with maternal intake of each of these foods, respectively. These significant associations remained even after controlling for additional study variables. Conclusion Even at very young ages, maternal food intake is an important correlate of children's food intake. Taken together with findings documenting significant snack food consumption in this age group, findings suggest that development of prevention and intervention programmes to enhance healthy eating behaviours need to start very early, perhaps just prior to children being introduced to complementary foods.     

Dietary intake among adults in Trinidad and Tobago and development of a quantitative food frequency questionnaire to highlight nutritional needs for lifestyle interventions

Primary objective To create a food list and develop a draft quantitative food frequency questionnaire (QFFQ) for Trinidad and Tobago.

Methods and procedures A mixed sampling method was used to obtain a representative sample and trained interviewers administered 24-h dietary recalls. Portion sizes were assessed and the most frequently reported foods were tabulated.

Main outcomes and results Results are from 155 men and 169 women aged 21–64 years. The most frequently reported food items were: full-cream milk (64%), rice (61%), and sweetened fruit drinks (50%). Carbonated drinks were consumed by 28%. The most frequently consumed fruits were banana (23%) and citrus (22%); < 20% consumed a vegetable food item. The final QFFQ contains 146 items: 19 breads/cakes/cereals; seven rice/pastas/noodles; 12 dairy; 26 meats/poultry/fish/soy products; 15 fruits; 34 vegetables; six legumes; 11 other; 12 drinks; four alcoholic drinks.

Conclusions A list of commonly consumed foods in Trinidad and Tobago was obtained and a draft QFFQ was prepared.     

Acute Effects of a Spinach Extract Rich in Thylakoids on Satiety: A Randomized Controlled Crossover Trial

Objective: By retarding fat digestion, thylakoids, the internal photosynthetic membrane system of green plants, promote the release of satiety hormones. This study examined the effect of consuming a single dose of concentrated extract of thylakoids from spinach on satiety, food intake, lipids, and glucose compared to a placebo.

Design: Sixty overweight and obese individuals enrolled in a double-blind randomized crossover study consumed the spinach extract or placebo in random order at least a week apart. Blood was drawn for assessments of lipids and glucose before a standard breakfast meal, followed 4 hours later by a 5 g dose of the extract and a standard lunch. Visual analog scales were administered before lunch and at intervals until an ad libitum pizza dinner served 4 hours later. Two hours after lunch a second blood draw was conducted. Mixed models were used to analyze response changes.

Results: Compared to placebo, consuming the spinach extract reduced hunger (p < 0.01) and longing for food over 2 hours (p < 0.01) and increased postprandial plasma glucose concentrations (p < 0.01). There were no differences in plasma lipids and energy intake at dinner, but males showed a trend toward decreased energy intake (p = 0.08).

Conclusions: At this dose, the spinach extract containing thylakoids increases satiety over a 2-hour period compared to a placebo. Thylakoid consumption may influence gender-specific food cravings.     

Eating Down in Pregnancy: Exploring Food-Related Beliefs and Practices of Pregnancy in Rural Nepal

Adequate nutrition during pregnancy, vital for the health of the mother and the newborn, may be influenced by pregnancy-related food beliefs. This study explores food-related beliefs and practices specifically related to reducing food intake in pregnancy in a rural community in Nepal by combining ethnographic and quantitative data collected from pregnant Nepali women.

A large proportion (60%) of women reported reducing rice intake during pregnancy but the reduction was related to food aversions and being unwell (66%), rather than the desire to have smaller babies or other cultural beliefs (18%). Only 10–20% reported reducing intakes of other nutrient-rich foods during pregnancy. Such foods were generally consumed in inadequate amounts due to seasonal variation or because of their high cost. In a multivariate analysis, maternal characteristics that were associated with decreasing food intake during pregnancy included literacy, poor appetite, socio-economic status, and presence of night blindness, caused by vitamin A deficiency.

We conclude that eating down to prevent difficult deliveries may not be very common in rural Nepal but women may reduce food intake for reasons of aversion to food, lack of appetite, or feeling unwell. A decline in the consumption of foods rich in protein and micronutrients was not evident; such foods appear to be chronically low in the diets of poor women in this setting.     

Associations between ultraprocessed food consumption and total water intake in the US population

BackgroundLongitudinal studies have shown significant dose–response associations between dietary share of ultraprocessed foods and the incidence of several noncommunicable diseases and all-cause mortality. Several attributes of ultraprocessed foods are potential mechanisms for their link with health outcomes, including their typically unbalanced nutrient profile, high glycemic loads, high energy intake rate, and the presence of food additives, neoformed substances, and substances released by synthetic packaging materials. However, no studies have assessed the plausibility of reduced water intake as an additional association of diets rich in ultraprocessed foods.ObjectiveTo assess the association between ultraprocessed food consumption and total water intake.DesignThis cross-sectional secondary analysis used data from the National Health and Nutrition Examination Survey, cycles 2011 to 2016, in the United States.Participants/settingsThis study included 24,505 participants aged ≥1 year who completed the first 24-hour dietary recall interview.Main outcomes measuresThe main outcome evaluated was the mean of total water intake.Statistical analysisCrude and adjusted linear regressions were applied to investigate the association between quintiles of the dietary share of ultraprocessed foods and the total water intake.ResultsA significant linear reduction in the daily mean total water intake was observed across ultraprocessed food quintiles, amounting to 706 mL between the lower and the upper quintiles. Important increases across quintiles were observed for the intake of sugar-sweetened and artificially sweetened drinks, whereas important reductions occurred for unsweetened drinks, plain water, and water present in solid foods and dishes.ConclusionsReduced total water intake and an imbalance between sources of water that favors energy-dense and nutrient-poor sources were associated with increased consumption of ultraprocessed food, suggesting that decreased total water consumption might be a negative outcome of diets rich in ultraprocessed foods. This relationship should be further investigated in longitudinal or clinical trials.     

A comparative study of dietary intake among urban Japanese and Chinese aged 50∼79

This study examined the difference in dietary intake between middle-aged and elderly Japanese and Chinese. Volunteers aged 50–79 living in two cities in both Japan and China were recruited in local community service centers and were asked to complete a 3-day diet recording. The final results were based on 356 subjects (166 Chinese and 190 Japanese). In men, the Japanese subjects significantly consumed more energy, with a large proportion of the energy coming from carbohydrates, dietary fiber, vitamin A, vitamin B₂, vitamin C and they consumed less iron, and a lower proportion of energy from protein and fat than in the Chinese subjects. In women, the Japanese subjects had significantly higher intakes of energy, the proportion of energy from carbohydrates, dietary fiber, calcium, vitamin A, vitamin B₁, vitamin B₂, vitamin C and they consumed less iron, with the proportion of energy from protein and from fat in comparison with the Chinese women. Fat intake provided more than 29% of the total dietary energy in Chinese subjects. Daily intake of food items was significantly greater in the Japanese participants, both men and women (18.54 ±2.85, 20.11 ± 2.40, respectively), than in the Chinese subjects (14.11 ± 3.62, 15.51 ± 4.15, respectively) (p<0.01 by Mann WhitneyU-test). The present study suggests that the middleaged and elderly Chinese subjects should increase their variety of foods consumed while decreasing their consumption of high-fat foods. For the Japanese subjects, the higher intake of total calories among the woman should also be noted.     

Dietary Patterns and Their Relationship With the Perceptions of Healthy Eating in European Adolescents: The HELENA Study

Abstract

Objective: The aim of this study was to identify dietary patterns (DPs) in European adolescents and to examine the association between perceptions of healthy eating and the obtained DPs.

Method: A multinational cross-sectional study was carried out in adolescents aged 12.5 to 17.5?years and 2,027 (44.9% males) were considered for analysis. A self-reported questionnaire with information on food choices and preferences, including perceptions of healthy eating, and two 24-hour dietary recalls were used. Principal component analysis was used to obtain sex-specific DPs, and linear analyses of covariance were used to compare DPs according to perceptions of healthy eating.

Results: Three and four DPs for boys and girls were obtained. In boys and girls, there were significant associations between some perceptions about healthy food and the Breakfast-DP (p?<?0.05). In boys, Breakfast-DP and Healthy Beverage-DP were associated with the perception of the own diet as healthy (p?<?0.05). Healthy Beverage-DP was associated with those disliking fruits and vegetables (p?<?0.05). Girls considering the own diet as healthy were associated with Mediterranean-DP, Breakfast-DP, and Unhealthy Beverage and Meat-DP (p?<?0.05). The perception of snacking as a necessary part of a healthy diet was associated with Breakfast-DP in both genders (p?<?0.05).

Conclusions: In European adolescents, perceptions of healthy eating were mainly associated with a DP characterized by foods consumed at breakfast. Future studies should further explore these findings in order to implement health promotion programs to improve healthy eating habits in adolescents.