An Italian Case Study for Assessing Nutrient Intake through Nutrition-Related Mobile Apps

National food consumption surveys are crucial for monitoring the nutritional status of individuals, defining nutrition policies, estimating dietary exposure, and assessing the environmental impact of the diet. The methods for conducting them are time and resource-consuming, so they are usually carried out after extended periods of time, which does not allow for timely monitoring of any changes in the population’s dietary patterns. This study aims to compare the results of nutrition-related mobile apps that are most popular in Italy, with data obtained with the dietary software Foodsoft 1.0, which was recently used in the Italian national dietary survey IV SCAI. The apps considered in this study were selected according to criteria, such as popularity (downloads > 10,000); Italian language; input characteristics (daily dietary recording ability); output features (calculation of energy and macronutrients associated with consumption), etc. 415 apps in Google Play and 226 in the iTunes Store were examined, then the following five apps were selected: YAZIO, Lifesum, Oreegano, Macro and Fitatu. Twenty 24-hour recalls were extracted from the IV SCAI database and inputted into the apps. Energy and macronutrient intake data were compared with Foodsoft 1.0 output. Good agreement was found between the selected apps and Foodsoft 1.0 (high correlation index), and no significant differences were found in the mean values of energy and macronutrients, except for fat intakes. In conclusion, the selected apps could be a suitable tool for assessing dietary intake.     

Development of food groupings to guide dietary advice for people with diabetes

Objective: To describe the development and characteristics of a food categorisation system and its application to guide advice for diabetes treatment. Design and methods: Foods commonly consumed by 16 adults with diabetes were grouped by macronutrient content and type of fat to form a set of reference food groups for dietary advice. Means for energy and macronutrients from individual food groups were then used to construct an overall intake pattern targeting 8000 kJ and relative amounts of carbohydrate, protein and fat (saturated fatty acids (SFA) < 10%E and (polyunsaturated fatty acids) PUFA ～ 10%E). Variation in energy and macronutrients contributed by all foods partitioned into each food group was assessed by the coefficient of variation of data on the whole diet. Results: To differentiate between sources of fat, 13 food groups emerged and 10 were deemed acceptable to nutritional guidelines for diabetes treatment. The food group pattern was judged adequate for the achievement of dietary recommendations with low‐potential variation in total energy (5%) and macronutrient proportions (protein 6%, fat 6%, carbohydrate 3%), but higher for fat types (SFA 22%, (monounsaturated fatty acids) MUFA 11%, PUFA 12%). Targeted proportions for fat types were achieved only when daily servings of PUFA‐rich, oils, nuts and oily fish or soy were included in an ideal intake pattern. Conclusions: In theory, a dietary pattern constructed from food group sources of macronutrients and individual fat types results in low‐potential variation from recommended nutrient targets and, therefore, is appropriate to guide advice for the treatment of diabetes.     

Energy intake and dietary macronutrient content in women with anorexia nervosa and volunteers

This study was designed to compare the dietary intakes of patients with anorexia nervosa and normal controls. Twenty-four patients hospitalized for treatment of anorexia nervosa were compared with 10 normal controls. Patients ate a self-selected diet and maintained their admission weight to within 1.0 kg during this period (19 +/- 3 days). Food chosen by each subject was weighed before and after meals, and intake was determined to be the difference. Intakes of food energy, protein, fat, and carbohydrate were calculated. Patients were closely monitored to ensure that no disposal of food occurred. Patients with anorexia nervosa had a mean daily energy intake of 1,017 +/- 54 kcal (mean +/- SEM), significantly lower than the mean energy intake for controls (1,651 +/- 108 kcal). Similarly, mean intakes of macronutrients (41 +/- 4 gm protein, 34 +/- 2 gm fat, and 136 +/- 9 gm carbohydrate) were significantly lower for patients than for controls (68.5 +/- gm protein, 65 +/- 6 gm fat, and 204 +/- 13 gm carbohydrate). However, when protein, fat, and carbohydrate were assessed as a percent of total calories, there were no significant differences between patients and controls. There were also no significant differences in calories consumed per kilogram body weight. Underweight patients with anorexia nervosa who maintain their weight on an unrestricted hospital diet have energy intake per kilogram body weight and dietary macronutrient content indistinguishable from those of normal women.     

Comparative Validity of Mostly Unprocessed and Minimally Processed Food Items Differs Among Popular Commercial Nutrition Apps Compared with a Research Food Database

BackgroundCommercial nutrition apps are increasingly used to evaluate diet. Evaluating the comparative validity of nutrient data from commercial nutrition app databases is important to determine the merits of using these apps for dietary assessment.ObjectiveNutrient data from four commercial nutrition apps were compared with a research-based food database, Nutrition Data System for Research (NDSR) (version 2017).DesignComparative validation study.Participants/settingAn investigator identified the 50 most frequently consumed foods (22% of total reported foods) from a weight-loss study in Chicago, IL, during 2017. Nutrient data were compared between four commercial databases with NDSR.Main outcome measuresComparative validity of energy, macronutrients, and other nutrient data (ie, total sugars, fiber, saturated fat, cholesterol, calcium, and sodium).Statistical analyses performedIntraclass correlation coefficients (ICCs) evaluated agreement between commercial databases with the NDSR for foods that were primarily un- and minimally processed and by the three most frequently consumed food groups. Bland-Altman plots determined degree of bias for calories between commercial databases and NDSR.ResultsThis study observed excellent agreement between NDSR and CalorieKing (ICC range = 0.90 to 1.00). Compared with NDSR, agreement for Lose It! and MyFitnessPal ranged from good to excellent (ICC range = 0.89 to 1.00), with the exception of fiber in MyFitnessPal (ICC = 0.67). Fitbit showed the widest variability with NDSR (ICC range = 0.52 to 0.98). When evaluating by food group, Fitbit had poor agreement for all food groups, with the lowest agreement observed for fiber within the vegetable group (ICC = 0.16). Bland-Altman plots confirmed ICC energy results but also found that MyFitnessPal had the poorest agreement to NDSR (mean 8.35 [SD 133.31] kcal) for all food items.ConclusionsDegree of agreement varied by commercial nutrition app. CalorieKing and Lose It! had mostly excellent agreement with NDSR for all investigated nutrients. Fitbit showed the widest variability in agreement with NDSR for most nutrients, which may reflect how well the app can accurately capture diet.     

Adjusting a nutrient database to improve calculation of percent calories from macronutrients

The sum of percent calories from protein, fat, carbohydrate, and alcohol did not always total 100% for dietary recalls or food records entered into the Nutrition Data System for Research (NDSR) 2007 and earlier versions of this software. This occurred because the calorie content of individual foods in the software's food and nutrient database were based on values calculated using either specific or general Atwater factors. Thus, daily total calorie intake estimates were based on calorie data derived from two different methods. In contrast, only general Atwater factors were applied when calculating the number of calories derived from each macronutrient in a daily diet. Two solutions to the macronutrient calculation problem just described were identified and evaluated. One approach was to create total daily calorie intake estimates based on general factors only. Using this approach, the same method to estimate energy is applied for both total calories and calories from each macronutrient calculation, thus ensuring that the sum of percent calories from each macronutrient totals 100%. The other solution was to incorporate energy factors specific to each core food into the NDSR nutrient database. Using these factors, calories contributed by each macronutrient are calculated for each food, and the calories/macronutrient summed for a daily total. The total calories/macronutrient divided by total calories per day × 100 provides the daily percent of calories from each energy macronutrient. The latter approach is preferable for a number of reasons. Most notably, we believe this approach will yield more accurate percent calories from macronutrient estimates, especially for diets rich in foods for which the general factors sub-optimally estimate energy composition. Thus, we opted to utilize this approach so that the sum of percent calories from macronutrients will total 100% for dietary recalls or food records entered into NDSR 2008 and subsequent versions of this software. The approaches to improving calculation of percent energy from individual macronutrients just described may be useful to others in maintaining databases that rely on energy composition information derived from varying methods.     

Macronutrient Intakes and Development of Type 2 Diabetes: A Systematic Review and Meta-Analysis of Cohort Studies

Objective: To synthesize the best available evidence on the association between macronutrient intake and type 2 diabetes risk.

Data Sources: MEDLINE, EMBASE, CINAHL, Cochrane Library, ProQuest, Mednar, and the JBI Library of Systematic Reviews were searched up to July 2012 to identify published and unpublished studies. The review was restricted to human participants only but was not restricted by date or by language.

Study Eligibility: Studies were included in the review if they were a cohort study examining the relationship between dietary macronutrient intake and type 2 diabetes risk, included healthy participants with no history of type 2 diabetes at the baseline assessment, and reported risk estimates (odds ratios, hazards ratios, or relative risks [RRs]) and corresponding 95% confidence intervals for type 2 diabetes risk by comparison of the highest with the lowest level of macronutrient consumption.

Methods: Data extraction and risk of bias assessments were performed in duplicate by 2 reviewers. Random-effects meta-analyses were performed to pool RR estimates from individual studies to assess the relationship between dietary macronutrient (carbohydrate, fat, protein, and macronutrient subtypes) intake and type 2 diabetes risk. Statistical heterogeneity was assessed using the I² statistic. Sensitivity analyses were performed to assess robustness of results, and publication bias was evaluated by the visual inspection of funnel plots and was formally assessed using Egger's test.

Results: Twenty-two relevant cohort studies were eligible for inclusion in this review. High intake of total dietary carbohydrate was associated with an increased type 2 diabetes risk (relative risk [RR] = 1.11, 95% confidence interval [CI]: 1.01 to 1.22, p = 0.035); however, this effect was not observed in an analysis stratified by gender. High vegetable fat intake was associated with a reduced type 2 diabetes risk in females (RR = 0.76, 95% CI: 0.68 to 0.85, p < 0.001). Other macronutrients were not significantly associated with type 2 diabetes risk.

Conclusions and Implications: The results of this systematic review and meta-analysis indicate that total carbohydrate is associated with an increased risk of type 2 diabetes; however, this effect was not observed in an analysis stratified by gender. High vegetable fat intake may decrease type 2 diabetes risk in females. There is a need for further well-designed prospective cohort studies to examine the potential association between macronutrient intake and type 2 diabetes risk.     

Adequacy of Parent-Packed Lunches and Preschooler's Consumption Compared to Dietary Reference Intake Recommendations

Background: U.S. preschool children consume inadequate amounts of key nutrients. Understanding the contents of lunches packed by parents and consumed by their children can help identify areas of opportunity for the development of healthy food preferences.

Objective: To evaluate the nutrient adequacy of lunches packed by parents and consumed by children attending early care and education (ECE) centers.

Methods: Baseline data from 607 parent–child dyads in the “Lunch Is in the Bag” cluster-randomized controlled trial in Central Texas were examined. Foods packed by parents and consumed by children in sack lunches were observed at 30 ECE centers on 2 nonconsecutive days. Mean levels of energy, macronutrients, vitamins, and minerals were estimated with covariate-adjusted multilevel regression models that accounted for center-level clustering and repeated within-child measures.

Results: Energy (kilocalories) was 602.48 for packed lunches compared to 374.40 for consumed lunches. In packed lunches, percentage of energy as macronutrients for protein (14.8%), carbohydrate (55.9%), and total fat (31.2%) were within the acceptable macronutrient distribution range (AMDR) for the children's ages. Sugar (28.9% of energy) was above the AMDR recommendation. Only a quarter of parents packed 33% or more of the child's dietary reference intake (DRI) for dietary fiber. Over half the parents packed 33% or more of the DRI for vitamin A and calcium, and less than one in 8 packed 33% of the DRI for potassium. Children consistently consumed between 60 and 80% of the nutrients that were packed.

Conclusions: Preschool children rely on parents to present them with healthy food choices, but lunches packed by parents for their preschool children do not consistently provide adequate nutrients. These data and the relationships between the dietary quality of packed and consumed lunches can be useful information to guide nutrition behavior change through targeted interventions.     

Macronutrient Intake as a Mediator with FTO to Increase Body Mass Index

Background: The fat mass and obesity-associated (FTO) single nucleotide polymorphisms (SNPs; rs1421085, rs17817449, rs9939609, rs8050136) and macronutrient intake (carbohydrate, protein, fat, total calories) are associated with body mass index (BMI). However, the mechanism for this relationship has not been fully elucidated.

Objective: This study examined whether macronutrient intake mediates the association between FTO SNPs and BMI.

Design: Baseline cross-sectional data from the Atherosclerosis Risk in Communities (ARIC) study of whites (n = 10,176) and African Americans (n = 3641) aged 45 to 64 years were analyzed.

Results: In linear regression models with BMI as the dependent variable, FTO SNPs were significantly associated with higher BMI after adjusting for covariates. The addition of energy-adjusted macronutrients attenuated the FTO effect estimates, indicating partial mediation. In whites, β ranged from 0.40 (95% confidence interval [CI], 0.20, 0.60) for rs17817449 heterozygous carriers to 0.93 (95% CI, 0.64, 122) for rs8050136 homozygous carriers; for African Americans rs17817449 homozygous carriers β was 0.65 (95% CI, 0.03, 1.27). In models with macronutrient intake as the dependent variable, all FTO SNPs were associated with higher protein intake for homozygous carriers after adjusting for BMI and other covariates. Among whites, β ranged from 1.44 (95% CI, 0.51, 2.37) for rs8050136 to 1.73 (95% CI, 0.85, 2.61) for rs17817449; among African American rs8050136 homozygous carriers β was 2.46 (95% CI, 0.77, 4.14). In mediation analysis, in whites only, FTO high-risk alleles were associated with higher BMI partly through their small effects on carbohydrate and protein intake.

Conclusions: These findings suggest that in adults, the relationship between FTO variants and BMI is not primarily through mediation of food intake.     

Association between enteral macronutrient delivery and inflammatory response in critically ill children

Background and aimsAn important goal of nutrition support in paediatric critical illness is minimising catabolism. While focussing on providing full energy requirements, macronutrient balance is often neglected. Studies suggest that there is interplay between nutrition and inflammation. We aimed to assess the amount of enteral macronutrients delivered compared to estimated requirements, and the association between delivered macronutrients and systemic inflammation in critically ill children.MethodWe prospectively evaluated energy and macronutrient intake in critically ill children who required at least 72 h of mechanical ventilation. Data on enteral energy and macronutrient intake was collected and expressed as a percentage of the estimated requirements. Circulating levels of inflammatory cytokines were measured by ELISA and association assessed with delivery of macronutrients from the previous 24 h.ResultsA total of 87 children (0–16 years) were included in this study. By day 3 the median (IQR) intake of energy, fat, carbohydrate (CHO) and protein were 75% (50–103), 85% (43–120), 63% (42–102) and 45% (23–65) respectively. We have also shown that delivery of enteral fat and protein was associated with elevation in the levels of tumour necrosis factor alpha (TNF-α) and interleukin-6 (IL-6).ConclusionThe inflammatory response in critically ill children is influenced by the amount of enteral fat and protein delivered. Our data suggests that within the feed delivered, fat is often higher than protein and CHO. It is crucial to take into account the proportion of macronutrients required and not only aim to achieve the energy goal.     

Low Comparability of Nutrition-Related Mobile Apps against the Polish Reference Method—A Validity Study

Nutrition-related mobile applications (apps) are commonly used to provide information about the user’s dietary intake, however, limited research has been carried out to assess to what extent their results agree with those from the reference method (RM). The main aim of this study was to evaluate the agreement of popular nutrition-related apps with the Polish RM (Dieta 6.0). The dietary data from two days of dietary records previously obtained from adults (60 males and 60 females) were compared with values calculated in five selected apps (FatSecret, YAZIO, Fitatu, MyFitnessPal, and Dine4Fit). The selection of apps was performed between January and February 2021 and based on developed criteria (e.g., availability in the Polish language, access to the food composition database, and the number of downloads). The data was entered by experienced clinical dietitians and checked by one more researcher. The mean age of study participants was 41.7 ± 14.8. We observed that all the apps tended to overestimate the energy intake, however, when considering the macronutrient intake, over- and underestimation were observed. According to our assumed criterion (±5% as perfect agreement, ±10% as sufficient agreement), none of the apps can be recommended as a replacement for the reference method both for scientific as well as clinical use. According to the Bland-Altman analysis, the smallest bias was observed in Dine4Fit in relation to energy, protein, and fat intake (respectively: −23 kcal; −0.7 g, 3 g), however, a wide range between the upper and lower limits of agreement were reported. According to the carbohydrate intake, the lowest bias was observed when FatSecret and Fitatu were used. These results indicate that the leading nutrition-related apps present a critical issue in the assessment of energy and macronutrient intake. Therefore, the implementation of validation studies for quality assessment is crucial to develop apps with satisfying quality.     

Season‐related variation in dietary recalls used in a paediatric population

Background: The effect of seasonality in estimating population mean nutrient intake using a single dietary recall has not been fully explored. The present study aimed to evaluate variation in energy and nutrient intake using a single 24‐h recall between two seasons (spring/summer and autumn/winter) in a sample of children and adolescents. Methods: A randomly selected subgroup (n = 623) of a representative sample of 3–18‐year‐old Greek children and adolescents was used in the present analysis. Information on participants’ socio‐demographic characteristics, body weight/height and dietary intake were collected through telephone interviews. Dietary assessment was based on two 24‐h recalls (the first during the spring/summer season and the second 6 months later, during autumn/winter season). Results: Reported daily energy intake in spring/summer was 344 ± 130 kJ (82 ± 31 kcal) higher compared to the one in autumn/winter after adjusting for potential confounders (P = 0.008). However, the contribution of the macronutrients to the total energy intake was not statistically different between the two periods and the same was also true for vitamin C and calcium. The results remained unchanged after excluding low energy reporters. Conclusions: The use of a second 24‐h recall in a different season of the year does not confer additional information with regard to a population assessment of macronutrient contribution to the total energy intake in paediatric samples; its use appears to be justified in the light of a more accurate assessment of energy intake.     

Dietary Intakes of Patients with Alcohol Use Disorder During a 4-Week Protocol on an Inpatient Treatment Unit Found to Meet Dietary Reference Intakes for Macronutrients,but Have Variability in Energy Balance and Adequacy of Micronutrient Intake

BackgroundDespite literature supporting the importance of diet during rehabilitation, minimal research quantifies dietary intake during treatment for alcohol use disorder (AUD).ObjectiveThe aim was to quantify dietary intake and energy balance of patients with AUD during inpatient treatment.DesignThis was a secondary analysis of data from a 4-week observational protocol. Participants self-selected food from a room service menu. Dietary intake was recorded by patients and reviewed by nutrition staff. To quantify nutrient and food group intake, data were coded into Nutrition Data Systems for Research software, versions 2016 and 2017. Daily average intake was calculated for all dietary variables.Participants/settingParticipants (n = 22) were adults seeking treatment for AUD at the National Institutes of Health Clinical Center (Bethesda, MD) between September 2016 and September 2017 and who were enrolled in a study examining the microbiome during AUD rehabilitation. Four participants discontinued protocol participation before study week 4 and were not included in analyses examining change over time.Main outcome measuresWeight change, daily energy, and macronutrient and select micronutrient intakes were the main outcome measures included.Statistical analyses performedMean differences in intake and weight were assessed using nonparametric tests.ResultsSixty-four percent of participants were male; mean ± SD age was 46.3 ± 13.0 years, mean ± SD body mass index (calculated as kg/m²) was 23.9 ± 2.5, and mean intake was 2,665 kcal/d (consisting of 45.9% carbohydrate, 34.9% fat, and 19.1% protein). Eighty percent or more of this sample met the Estimated Average Requirement for 10 of 16 micronutrients assessed. Male participants consumed more energy than estimated needs (P = .003) and gained a mean ± SD of 2.67 ± 1.84 kg (P = .006) when an outlier with weight loss and acute pancreatitis was removed from analysis. Female participants did not gain weight or consume more than estimated energy needs.ConclusionsOverall macronutrient intake was within recommended ranges, but intake of other dietary components and weight gain were variable, supporting the need for individualized nutrition care during AUD treatment.     

Detailed Dietary Assessment in Patients with Inoperable Tumors: Potential Deficits for Nutrition Care Plans

Advanced cancer often results in reduced dietary intake; however, data on actual intake at the time of diagnosis are limited. In the present study, a detailed dietary intake assessment was performed in patients with metastatic lung and upper gastrointestinal cancer, before initiation of systemic therapy. Basic demographics and performance status (PS) were recorded. Nutritional status was evaluated through anthropometry, Mini Nutritional Assessment (MNA), and 3 nonconsecutive 24-hour dietary recalls. Of the 84 patients enrolled, 61.4% were protein, energy, or protein–energy undernourished, regardless of body mass index (BMI) or MNA category. No differences in energy, macronutrients, and micronutrients intakes across BMI categories were recorded. Very low consumption of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), irrespective of energy intake, tumor site, BMI category, or PS was found. Suboptimal micronutrients intakes were recorded even in well-nourished and overweight/obese patients. Patients with adequate PS and better MNA score reported significantly higher intake of certain macro- and micronutrients (all P < 0.05). Most patients exhibited reduced dietary intake in terms of energy, macronutrient, and micronutrient. Very low EPA and DHA intake was recorded for the whole sample, whereas micronutrient suboptimal intakes were also prevalent in well-nourished or overweight patients. All the above should be taken into account during patients' nutritional care.     

Energy expenditure and dietary intake during high-volume and low-volume training periods among male endurance athletes

The primary purpose of this study was to examine dietary intake in endurance-trained athletes during a week of high-volume and a week of low-volume training while measuring exercise energy expenditure (EEE), resting metabolic rate (RMR), and nonexercise activity thermogenesis (NEAT). In addition, compliance with current American College of Sports Medicine/American Dietetic Association nutrition and performance recommendations for macronutrients was evaluated. Energy expenditure and dietary intake were measured in 15 male endurance athletes during 2 nonconsecutive weeks resembling a high-volume and a low-volume training period. Anthropometric measurements were taken and percentage body fat was determined at the beginning and end of each week of training. Total daily energy expenditure (TDEE) was calculated by summing RMR, NEAT, and EEE. Dietary intake was assessed with an online food-frequency questionnaire completed at the end of each week of data collection. Despite significant differences between TDEE and energy intake, no difference in body composition between the beginning and end of either week of training was observed, suggesting underreporting of caloric intake. Further, no changes in total caloric intake or macronutrient intake occurred even though TDEE increased significantly during the high-volume training. Reported carbohydrate intake (4.5?g·kg(-1)) and fiber intake (25?g·day(-1)) were below recommendations, whereas fat intake (1.3?g·kg(-1)) was slightly above recommendations. In summary, no short-term dietary adjustments occurred in response to differences in training regimen. Because these athletes were generally consuming a Western diet, they may have required some support to achieve desirable intakes for health and performance.     

Dietary Studies of Children: The Bogalusa Heart Study Experience

For more than 20 years the Bogalusa Heart Study has been collecting data on children's dietary intakes in a biracial community. The macronutrient contribution of children's diets is similar to that in diets of adolescents: 13% of energy from protein, 49% from carbohydrate, and 38% from fat. As children get older, mean intakes of vitamins and minerals per 1,000 kcal decrease. Ten-year-old children in 1987-1988 were 3 lb heavier than 10-year-olds in 1973-1974. Yet total energy intakes remained virtually the same from 1973 to 1988. The composition of macronutrients shifted over the 15-year period, with an increase in the percentage of energy from protein and carbohydrate and a decrease in the percentage of energy from total fat, particularly saturated fat. Dietary cholesterol intake also decreased as a result of a decrease in egg consumption. Although the diets of children changed positively from 1973 to 1988, more than 75% of children consumed more total fat, saturated fat, and cholesterol than the recommended amounts. School meals had a major impact on the diets of children. School breakfast and lunch, together, contributed approximately 50% of the day's total intake of energy, protein, cholesterol, carbohydrate, and sodium. About 40% of daily total fat intake came from school breakfast and lunch. The diets of children in the Bogalusa study are similar to those reported in national studies of children. What might be different, however, are the types of foods consumed and their contribution to intakes of specific nutrients. An understanding of the diet and nutrition habits of children is critical to the planning of intervention strategies that will assist us in meeting our dietary goals for Healthy People 2000. J Am Diet Assoc. 1995; 95:1127-1133.     

Target Fortification of Breast Milk: How Often Should Milk Analysis Be Done?

Target fortification (TFO) reduces natural macronutrient variation in breast milk (BM). Daily BM analysis for TFO increases neonatal intensive care unit work load by 10–15 min/patient/day and may not be feasible in all nurseries. The variation of macronutrient intake when BM analysis is done for various schedules was studied. In an observational study, we analyzed 21 subsequent samples of native 24-h BM batches, which had been prepared for 10 healthy infants (gestational age 26.1 ± 1.3 weeks, birth weight: 890 ± 210 g). Levels of protein and fat (validated near-infrared milk analyzer), as well as lactose (UPLC-MS/MS) generated the database for modelling TFO to meet recommendations of European Society for Paediatric Gastroenterology Hepatology and Nutrition. Intake of macronutrients and energy were calculated for different schedules of BM measurements for TFO (n = 1/week; n = 2/week; n = 3/week; n = 5/week; n = 7/week) and compared to native and fixed dose fortified BM. Day-to-day variation of macronutrients (protein 20%, carbohydrate 13%, fat 17%, energy 10%) decreased as the frequency of milk analysis increased and was almost zero for protein and carbohydrate with daily measurements. Measurements two/week led to mean macronutrient intake within a range of ±5% of targeted levels. A reduced schedule for macronutrient measurement may increase the practical use of TFO. To what extent the day-to-day variation affects growth while mean intake is stable needs to be studied.     

Long-Term Dietary Intake and Nutritional Deficiencies following Sleeve Gastrectomy or Roux-En-Y Gastric Bypass in a Mediterranean Population

BackgroundData on long-term dietary changes and nutritional deficiencies after sleeve gastrectomy (SG) in grade 3 obese patients are scarce.ObjectiveTo prospectively compare dietary changes and nutritional deficiencies in grade 3 obese patients 5 years after SG and Roux-en-y gastric bypass (GBP).Participants/settingThree hundred and fifty-five patients who had SG (n=61) or GBP (n=294) (May 2001-December 2006) at a Spanish university hospital.DesignLongitudinal, prospective, observational study.Primary outcomes/statistical analysesChanges in energy, macronutrient, and micronutrient intake, and weight loss were analyzed using mixed models for repeated measurements.ResultsAt the 5-year follow-up visit, the percentage of excess weight loss (P=0.420) and daily energy intake (P=0.826), as well as the proportion of energy from carbohydrates (P=0.303), protein (P=0.600), and fat (P=0.541) did not differ between surgical groups. Energy intake (P=0.004), baseline weight (P<0.001), and time period (P<0.001), but not the proportion of different macronutrients or the type of surgery, independently predicted the percentage excess weight loss over time. After SG or GBP, the mean daily dietary intake of calcium, magnesium, phosphorus, and iron was less than the current recommendations. Despite universal supplementation, the prevalence of nutritional deficiencies was comparable after SG or GBP, with 25-hydroxyvitamin D being the most commonly observed deficiency (SG, 93.3% to 100%; GBP, 90.9% to 85.7%, P=not significant). In an adjusted multivariate regression model, energy intake and lipid intake independently predicted plasma 25(OH)-vitamin D levels.ConclusionsData show that SG and GBP are associated with similar long-term weight loss with no differences in terms of dietary intake. Furthermore, data demonstrate that both types of surgeries carry comparable nutritional consequences.     

Conclusions about children's reporting accuracy for energy and macronutrients over multiple interviews depend on the analytic approach for comparing reported information to reference information

OBJECTIVE: Validation study data are used to illustrate that conclusions about children's reporting accuracy for energy and macronutrients over multiple interviews (ie, time) depend on the analytic approach for comparing reported and reference information-conventional, which disregards accuracy of reported items and amounts, or reporting-error-sensitive, which classifies reported items as matches (eaten) or intrusions (not eaten), and amounts as corresponding or overreported. SUBJECTS AND DESIGN: Children were observed eating school meals on 1 day (n=12), or 2 (n=13) or 3 (n=79) nonconsecutive days separated by >or=25 days, and interviewed in the morning after each observation day about intake the previous day. Reference (observed) and reported information were transformed to energy and macronutrients (ie, protein, carbohydrate, and fat), and compared. MAIN OUTCOME MEASURES: For energy and each macronutrient: report rates (reported/reference), correspondence rates (genuine accuracy measures), and inflation ratios (error measures). STATISTICAL ANALYSES: Mixed-model analyses. RESULTS: Using the conventional approach for analyzing energy and macronutrients, report rates did not vary systematically over interviews (all four P values >0.61). Using the reporting-error-sensitive approach for analyzing energy and macronutrients, correspondence rates increased over interviews (all four P values <0.04), indicating that reporting accuracy improved over time; inflation ratios decreased, although not significantly, over interviews, also suggesting that reporting accuracy improved over time. Correspondence rates were lower than report rates, indicating that reporting accuracy was worse than implied by conventional measures. CONCLUSIONS: When analyzed using the reporting-error-sensitive approach, children's dietary reporting accuracy for energy and macronutrients improved over time, but the conventional approach masked improvements and overestimated accuracy. The reporting-error-sensitive approach is recommended when analyzing data from validation studies of dietary reporting accuracy for energy and macronutrients.