Fourth-Grade Children's Dietary Recall Accuracy Is Influenced by Retention Interval (Target Period and Interview Time)

Background

For a 24-hour dietary recall, two possible target periods are the prior 24 hours (24 hours immediately preceding the interview time) and previous day (midnight to midnight of the day before the interview), and three possible interview times are morning, afternoon, and evening. Target period and interview time determine the retention interval (elapsed time between to-be-reported meals and the interview), which, along with intervening meals, can influence reporting accuracy.

Objective

The effects of target period and interview time on children's accuracy for reporting school meals during 24-hour dietary recalls were investigated.

Design and subjects/setting

During the 2004-2005, 2005-2006, and 2006-2007 school years in Columbia, SC, each of 374 randomly selected fourth-grade children (96% African American) was observed eating two consecutive school meals (breakfast and lunch) and interviewed to obtain a 24-hour dietary recall using one of six conditions defined by crossing two target periods with three interview times. Each condition had 62 or 64 children (half boys).

Main outcome measures

Accuracy for reporting school meals was quantified by calculating rates for omissions (food items observed eaten but unreported) and intrusions (food items reported eaten but unobserved); a measure of total inaccuracy combined errors for reporting food items and amounts.

Statistical analyses performed

For each accuracy measure, analysis of variance was conducted with target period, interview time, their interaction, sex, interviewer, and school year in the model.

Results

There was a target-period effect and a target-period by interview-time interaction on omission rates, intrusion rates, and total inaccuracy (six P values <0.004). For prior-24-hour recalls compared to previous-day recalls, and for prior-24-hour recalls in the afternoon and evening compared to previous-day recalls in the afternoon and evening, omission rates were better by one third, intrusion rates were better by one half, and total inaccuracy was better by one third.

Conclusions

To enhance children's dietary recall accuracy, target periods and interview times that minimize the retention interval should be chosen.     

Cluster Analysis Defines Distinct Dietary Patterns for African-American Men and Women

Background

African Americans have a higher prevalence of diet-related chronic diseases than the general US population. Recent evidence suggests that examining dietary patterns rather than specific nutrients may better allow public health professionals to translate national dietary goals into practical dietary recommendations that are culturally relevant and sex-specific.

Objective

To examine and characterize the dietary patterns of African-American men and women using cluster analysis.

Design

Participants older than the age of 18 years were recruited from a variety of locations and completed a self-administered questionnaire.

Subjects/setting

Seven-hundred sixty-three African-American men and women in North Central Florida.

Statistical analyses performed

Cluster analysis was done with the VARCLUS procedure and Ward's clustering approach in the Statistical Analysis System program. The pseudo-t² statistic was then used to identify the optimal numbers of clusters of men and women with distinctive food-consumption patterns.

Results

Cluster analyses identified six clusters of men with 13 distinctive dietary patterns and six clusters of women with 15 distinctive dietary patterns. Pairwise comparisons of group means indicated notable differences in intakes between clusters of women in all but two food clusters. Pairwise comparisons of group means indicated notable differences in intakes between clusters of men in all but two food clusters.

Conclusions

The study illustrated that cluster analysis can be used to identify groups of African Americans with unique patterns of food consumption. They also suggest that a single “typical” eating pattern does not exist for African Americans and that dietary pattern vary by sex.     

Dietary diversity and adequacy of women caregivers in a peri-urban informal settlement in South Africa

Objective

Simple measures reflecting dietary quality are preferred for assessment of dietary intakes in low-income communities, e.g. dietary diversity that reflects a healthy, varied, nutritious diet, associated with nutrient adequacy. A strong association between household income and food access suggests dietary diversity assessment as one of the indicators of household food security. The aim of this study was to assess the food security situation of black women in an informal settlement by exploring their food access capabilities through dietary diversity measures and the coping strategies they employ to cope with poverty and hunger.

Methods

A randomly selected sample of black women living in an informal settlement completed a pretested socio-demographic questionnaire (socio-economic circumstances) and validated questionnaires (1-wk quantified food frequency questionnaire: diversity measures; 24-h recall: nutrient intake; Cornell Hunger Scale: coping strategies). Food variety scores and food group diversity scores were calculated from frequency analyses for all foods and food groups. Nutrient adequacy ratios for various nutrients and the mean adequacy ratio for their diet were calculated. Relationships between dietary diversity and nutritional adequacy were investigated with Pearson correlations. Food variety score cut points were tested for sensitivity and specificity against nutritional adequacy.

Results

Intakes were deficient for all nutrients except carbohydrates. Individual mean ± SD nutrient adequacy ratios ranging between 0.15 ± 0.18 and 0.95 ± 0.19 confirmed the poor dietary quality. Zero to 40 individual foods were consumed, but the mean ± SD food variety score was only 3.17 ± 1.21, indicating low food diversity, as did the low dietary diversity score (2.82 ± 0.99) using 0 to 6 food groups.

Conclusions

Limited food access and food variety in poor households resulted in inadequate nutrient intakes (low nutrient adequacy ratios), confirmed by poor dietary diversity (food variety score and food group diversity score). Dietary diversity assessment can successfully replace traditional dietary assessment tools in poverty-stricken or low-income communities where quick assessments are often required to assess the greatest need.     

Effect of a continuous regimen of contraceptive combination of ethinylestradiol and drospirenone on lipid, carbohydrate and coagulation profiles

Background

The objective of this study was to evaluate the effects of a contraceptive pill containing ethinylestradiol (30 mcg) and drospirenone (3 mg) in a continuous regimen on lipid, carbohydrate and coagulation parameters.

Study Design

This open, prospective, randomized study included 78 participants (mean age 27.8 years) who were randomized into two groups to use the pill continuously for 168 days or for six 28-day cycles with a 7-day hormone-free interval between cycles. Markers of lipid, carbohydrate and coagulation profiles were measured prior to initiation and after the 6 months of pill use.

Results

No statistically significant differences were found between the two contraceptive regimens with respect to carbohydrate or lipid profiles or in the parameters related to coagulation.

Conclusions

The contraceptive combination of ethinylestradiol and drospirenone used in a continuous regimen was associated with metabolic alterations similar to those found during the traditional cyclic regimen of oral contraceptive use.     

Development and Validation of a Comprehensive Semi-Quantitative Food Frequency Questionnaire that Includes FODMAP Intake and Glycemic Index

Background

Fermentable, short chain carbohydrates (FODMAPs) have been identified as triggers for functional gastrointestinal symptoms. In addition, excess FODMAP consumption has been implicated in the onset of Crohn's disease, and animal studies suggest that a low glycemic index diet can impair absorption of fructose, a major dietary FODMAP. Such hypotheses cannot be tested without the ability to quantify FODMAP ingestion with a validated dietary assessment tool.

Objective

To assess the validity and reproducibility of a 297-item comprehensive, semi-quantitative food frequency questionnaire (FFQ) in estimating intake of macro- and micronutrients, FODMAPs, and glycemic index/load.

Subjects/setting

One hundred healthy participants were recruited to complete the FFQ on two occasions, plus four 1-week food diaries kept during a 12-month period. Participants exhibiting major dietary change during the study period or low energy reporting on the FFQ were excluded.

Main outcome measures

Validation and reproducibility of the semi-quantitative FFQ by comparison with the mean of four 1-week food diaries.

Statistical analyses performed

Validation was assessed using Wilcoxon signed rank test, Spearman's correlation, Bland-Altman, and weighted κ statistics. Reproducibility was examined using Shrout-Fleiss intraclass correlation coefficient.

Results

Seventy-two participants fulfilled inclusion and exclusion criteria. Demographics of the participants were comparable with 2006 Australian Census data. Consistent with other reported FFQs, the FFQ overestimated nutrient intake by a mean 140% (range=95% to 249%). However, based on the other analyses performed, it demonstrated validity for intake of sugars, fiber, alcohol, glycemic index, glucose, FODMAPs, calcium, folate, phosphate, potassium, iron, and magnesium; moderate validation for energy, total fat, saturated fat, carbohydrates, sodium, thiamin, sucrose, and retinol; poor validation for protein, mono/polyunsaturated fat, starch, glycemic load, niacin, and zinc. Riboflavin intake was not validated. Intraclass correlation coefficients for reproducibility ranged from 0.352 to 0.928.

Conclusions

The FFQ was validated for assessment of a wide range of nutrients, including the new class of carbohydrates, FODMAPs, and glycemic index. This provides a useful tool for dietary research, particularly in the area of gastroenterological disorders.     

Reproducibility and relative validity of a semi-quantitative food frequency questionnaire designed for assessing the intake of dioxin-like contaminants

Objective

The aim of this study was to assess the reproducibility and relative validity of a food frequency questionnaire (FFQ) designed to estimate the intake of dioxin-like contaminants.

Method

In total, 180 adults (50-65 years) completed the FFQ twice and 157 of them kept four times a 2-day estimated dietary record (EDR) spread over a year.

Results

Spearman rank correlation coefficients varied between 0.58 and 0.67 for reproducibility, versus between 0.28 and 0.46 for validity for the different food groups under study. Exact agreement within quartiles was between 34% and 39%, only between 3% and 9% was grossly misclassified. The weighed kappa statistics indicated fair agreement between the two methods (0.29 for the total diet). The correction factors used had a relevant influence on the absolute estimated intake.

Conclusion

The FFQ presented here is a valuable tool for ranking individuals in the study population on the basis of estimated intake of dioxin-like contaminants. However, absolute intakes should be estimated without correction factors and interpreted with caution.     

Nibbling: frequency and relationship to BMI, pattern of eating, and shape, weight, and eating concerns among university women

Objective

Nibbling has been defined by the Eating Disorder Examination (EDE 16.0) as eating in an unplanned and repetitious manner between meals and snacks without an accompanying sense of loss of control. We investigated the nature and frequency of nibbling in young women.

Method

Fifty-eight university women aged 19-41 years with an average BMI of 22.8 (4.8) were administered the EDE-interview.

Results

Only 9% of women reported no nibbling during the preceding 28 days, 14% nibbled on 1-5 days; 40% on 6-12 days; 21% on 13-15 days and 17% nibbled on 16-28 days. Nibbling was not significantly related to BMI, frequency of meals, binge eating, dietary restraint, or shape, eating, or weight concerns. Significant inverse relationships were found between nibbling and food avoidance (−.27, p = .03) and sensitivity to weight gain (−.26; p = .04).

Discussion

Nibbling occurred frequently among young women but did not appear to have significant consequences for BMI, the overall pattern or eating, shape or weight concerns, or for any measured pathological eating behaviors.     

Contribution of dietary supplements to nutrient adequacy among children in Hawaii

Objectives

To quantify the use of dietary supplements over a 24-hour and 1-month time frame, to determine the contribution of dietary supplements to the prevalence of dietary nutrient adequacy in the population, and to identify factors associated with supplement use, including characteristics of caregivers.

Design

Cross-sectional study.

Subjects/setting

Children aged 8 to 11 years from four primarily Native Hawaiian and Pacific Islander communities on Oahu (n=115) and the island of Hawaii (n=70).

Methods

A 24-hour food recall and a dietary supplement record were collected and analyzed for each child. Demographic and supplement use data were collected for each caregiver.

Statistical analyses

Significant differences between supplement users and nonusers were determined by χ² analysis. Prevalence of dietary nutrient adequacy with and without intake from dietary supplements was calculated using PC-Side software (version 1.02, 2001, Department of Statistics and Center for Agricultural and Rural Development, Iowa State University, Ames).

Results

Use of any dietary supplement by children in the previous day and month was 26% (n=48) and 40% (n=74), respectively. Prevalence of dietary nutrient adequacy from foods alone ranged from 33% to 100%, and increased to 59% to 100% when the nutrient contribution from dietary supplements was included. The largest increases in nutrient adequacy were for vitamins A, E, and C. Use of dietary supplements was most strongly associated with use of dietary supplements by caregivers, as well as with younger age of child, and greater years of caregiver education.

Conclusions

Dietary supplements are being used by a large percentage of these children in Hawaii and use is associated with use by their caregivers. The nutrient contribution from dietary supplements increased the prevalence of nutrient adequacy for several nutrients.     

Validity and Calibration of Food Frequency Questionnaires Used with African-American Adults in the Jackson Heart Study

Objective

To examine the relative validity of two food frequency questionnaires (FFQs) developed for use in investigating diet and disease relationships within the adult African-American population in the southern United States.

Design

Cross-sectional analyses of dietary nutrient intake data, comparing four 24-hour dietary recalls with an FFQ developed by the Lower Mississippi Delta Nutrition Intervention Research Initiative, and its shorter version adapted for use in the Jackson Heart Study.

Subjects

A representative subset of participants (n=499, aged 35 to 81 years) from the baseline Jackson Heart Study cohort (N=5,302) was selected for this study. Data collection took place between winter 2000 and spring 2004.

Statistical analyses

Pearson's correlation coefficients (energy adjusted and de-attenuated) for 26 nutrients estimates from each of the FFQs, comparing them with the mean of four 24-hour dietary recalls. The ability of the FFQs to rank individuals based on nutrient intakes was compared to that of the mean of four 24-hour dietary recalls and attenuation coefficients were also calculated.

Results

Median nutrient intake estimates tended to be higher on the long and lower on the short FFQ compared to the median for the mean of four 24-hour dietary recalls. Energy adjusted and deattenuated correlations of FFQ intake estimates with recalls ranged from 0.20 for sodium to 0.70 for carbohydrate for the short FFQ and from 0.23 for polyunsaturated fat to 0.75 for dietary fiber and magnesium for the long. Attenuation coefficients for men on average were 0.42 for the short and 0.49 for the long FFQ. For women, these were 0.31 for the short and 0.42 for the long FFQ.

Conclusions

Both FFQs appear to be reasonably valid for assessment of dietary intake of adult African Americans in the South. The Lower Mississippi Delta Nutrition Intervention Research Initiative FFQ exhibited higher intake estimates and stronger correlations with recalls than the Jackson Heart Study FFQ for most nutrients analyzed, more so for women than men.     

The efficacy and safety of a low-dose, 91-day, extended-regimen oral contraceptive with continuous ethinyl estradiol

Background

This clinical trial was conducted to demonstrate the efficacy and safety of a 91-day extended-regimen, low-dose combination oral contraceptive (OC) consisting of 84 days of ethinyl estradiol (EE) 20 mcg/levonorgestrel (LNG) 100 mcg, followed by 7 days of 10 mcg EE in place of placebo.

Study Design

A multicenter open-label, single-treatment, Phase 3 study evaluated women aged 18 through 40 years over a treatment period of up to 1 year (four 91-day extended cycles). All subjects completed daily paper diaries to monitor compliance, bleeding and additional forms of contraception used during the course of the study.

Results

A total of 1249 subjects completed the study. The Pearl Index was 2.74 (95% confidence interval, 1.92-3.78), based on 36 pregnancies that occurred after the onset of treatment and within 14 days after the last combination tablet in women aged 18-35 years. Among compliant-use subjects 18-35 years old, the Pearl Index was 1.73 based on 22 on-treatment pregnancies. The life table pregnancy rate for subjects 18-35 years of age was 2.39%. Cycle control and adverse events reported with this regimen were similar to those reported with other low-dose OCs.

Conclusions

This study demonstrated effective prevention of pregnancy with a 20-mcg EE, 91-day extended-regimen OC. In addition, the regimen was well tolerated and incidence of adverse events were consistent with what has been reported with other low-dose OCs.     

Dietary pattern change and acculturation of Chinese Americans in Pennsylvania

Objective

To obtain information about dietary pattern change of Chinese Americans in Pennsylvania and its relationship with demographic characteristics and acculturation indicators.

Design

A cross-sectional self-administered survey.

Subjects

A convenience sample of 399 Chinese Americans.

Statistical analyses performed

t Tests, analysis of variance with Tukey post-hoc tests, Spearman rank correlation, and χ² test.

Results

After immigration, Chinese Americans increased consumption frequency of all seven food groups (grains, vegetables, fruits, meat/meat alternatives, dairy products, fats/sweets, and beverages) and Western foods while consumption frequency of traditional Chinese foods decreased. Dietary variety also increased after immigration. Higher education and higher income levels were associated with a larger increase in consumption frequency of grains, vegetables, and fruits. Persons who resided in the United States for a longer period of time shared a greater increase in their consumption frequencies of vegetables, fats/sweets, and beverages. Persons with better English proficiency had a greater increase in their consumption frequency of grains, fruits, meat/meat alternatives, and fats/sweets.

Conclusions

This study can help nutrition educators design appropriate educational programs for first-generation Chinese Americans that can facilitate the adoption of more healthful dietary practices. Nutrition educators should consider the dietary changes of Chinese-American participants, such as skipping breakfast and increased consumption frequency of fats, sweets, and soft drinks, which were observed in this study. For example, acculturated first-generation Chinese Americans should be encouraged to decrease fats, sweets, and soft-drink consumption. Less-acculturated persons should be encouraged to maintain their healthful dietary pattern and increase consumption of vegetables and fruits.     

The Association between Food Patterns and the Metabolic Syndrome Using Principal Components Analysis: The ATTICA Study

Background

Dietary habits have been associated with the prevalence of the metabolic syndrome.

Objective

The associations between foods or food patterns and the characteristics of the metabolic syndrome were evaluated.

Design

Cross-sectional survey.

Subjects

During 2001 to 2002, 1,514 men (aged 18 to 87 years) and 1,528 women (aged 18 to 89 years) without any clinical evidence of cardiovascular disease were randomly enrolled, from the Attica region in Greece.

Main outcome measures

Dietary habits were evaluated using a semiquantitative, food frequency questionnaire. Characteristics of the metabolic syndrome (ie, blood pressure, waist circumference, glucose, triglycerides, and high-density lipoprotein cholesterol) were also measured.

Statistical analysis

Principal components analysis was applied to extract dietary patterns from 22 foods or food groups. Multivariate regression analysis evaluated the associations between the extracted dietary patterns and characteristics of the metabolic syndrome.

Results

Six components were derived explaining 56% of the total variation in intake. Component 1 was characterized by the consumption of cereals, fish, legumes, vegetables, and fruits (explained variation 19.7%); component 2 was characterized by the intake of potatoes and meat (explained variation 11.7%), component 6 was characterized by alcohol intake (explained variation 4.8%), whereas the other components were mainly characterized by consumption of dairy and sweets. After adjusting for various confounders, component 1 was inversely associated with waist circumference, systolic blood pressure, triglycerides, positively associated with high-density lipoprotein cholesterol levels, and inversely with the likelihood of the metabolic syndrome (odds ratio [OR] 0.87, 95% confidence interval [CI] 0.79 to 0.97), whereas components 2 and 6 were positively correlated with the previous indexes, and the likelihood of having the metabolic syndrome (OR 1.13, 95% CI 1.05 to 1.21 and OR 1.26, 95% CI 1.21 to 1.33).

Conclusions

A dietary pattern that includes cereals, fish, legumes, vegetables, and fruits was independently associated with reduced levels of clinical and biological markers linked to the metabolic syndrome, whereas meat and alcohol intake showed the opposite results.     

Rice Consumption in the United States: Recent Evidence from Food Consumption Surveys

Background

Little is known about rice consumption, related food intake patterns, and the nutritional contribution that rice provides in the diets of Americans.

Objective

To provide information about rice consumption in the United States and the diets of rice consumers.

Design

Data come from the Continuing Survey of Food Intakes by Individuals (1994-1996) and the National Health and Nutrition Examination Survey (2001-2002). Respondents report 24-hour recall dietary intakes. The amount of rice available in foods is estimated using the Food Commodity Intake Database. Consumers are classified based on the amount of rice they consume in foods.

Subjects

The analysis includes information from adult individuals: 9,318 from the Continuing Survey of Food Intakes by Individuals and 4,744 from National Health and Nutrition Examination Survey.

Statistics

Weighted percentages and mean values show the food and nutrient intake amounts. Logistic regression analysis is used to examine relationships among economic, social, and demographic factors that affect rice consumption.

Results

Rice is consumed by a significant portion of the US adult population. Compared with others who did not consume rice, rice consumers consumed a smaller share of energy per day from fat and saturated fat; more iron and potassium; and more dietary fiber, meat, vegetables, and grains. Race/ethnicity and education are determinants of the probability of consuming rice, and more so than low-income status.

Conclusions

Rice consumers choose a diet that includes more vegetables, a smaller share of energy from fat and saturated fat, more dietary fiber and more iron than those who do not consume rice; the differences have remained relatively stable over the last decade. Accounting for race/ethnicity and income levels is important for better understanding of factors that affect food choices and for effective design of dietary interventions.     

Protein dietary reference intakes may be inadequate for vegetarians if low amounts of animal protein are consumed

Objective

The health benefits of vegetarian diets are well-recognized; however, long-term adherence to these diets may be associated with nutrient inadequacies, particularly vitamins B12 and D, calcium, iron, zinc, and protein. The dietary reference intakes (DRIs) expert panels recommended adjustments to the iron, zinc, and calcium DRIs for vegetarians to account for decreased bioavailability, but no adjustments were considered necessary for the protein DRI under the assumption that vegetarians consume about 50% of protein from animal (dairy/egg) sources. This study examined dietary protein sources in a convenience sample of 21 young adult vegetarian women who completed food logs on 4 consecutive days (3 weekdays and 1 weekend day).

Methods

The daily contribution percentages of protein consumed from cereals, legumes, nuts/seeds, fruits/vegetables, and dairy/egg were computed, and the protein digestibility corrected amino acid score of the daily diets was calculated.

Results

The calculated total dietary protein digestibility score for participants was 82 ± 1%, which differed significantly (P < 0.001) from the DRI reference score, 88%, and the 4-d average protein digestibility corrected amino acid score for the sample was 80 ± 2%, which also differed significantly (P < 0.001) from the DRI reference value, 100%. The analyses indicated that animal protein accounted for only 21% of dietary protein.

Conclusion

This research suggests that the protein DRI for vegetarians consuming less than the expected amounts of animal protein (45% to 50% of total protein) may need to be adjusted from 0.8 to about 1.0 g/kg to account for decreased protein bioavailability.     

Intrauterine device insertion during the postpartum period: a systematic review

Background

Insertion of an intrauterine device (IUD) at different times or by different routes during the postpartum period may increase the risk of complications.

Methods

We searched Medline, Lilacs and Cochrane Collaboration databases for articles in any language, between database inception until December 2008, which compared outcomes of postpartum IUD insertion time intervals. Search terms included postpartum, puerperium, postcesarean delivery, cesarean section, IUD(s), IUCD(s), intrauterine device(s) and insertion.

Results

From 297 articles, we identified 15 for inclusion in this review: all studies examined the outcomes from copper IUD insertions within the postpartum time period compared to other time intervals or compared routes (vaginal or via hysterotomy) of postpartum insertion. No studies of levonorgestrel IUDs were identified.Immediate IUD insertion (within 10 min of placental delivery) was safe when compared with later postpartum time periods and interval insertion. Immediate postpartum IUD insertion demonstrated lower expulsion rates when compared with delayed postpartum insertion but with higher rates than interval insertion. Immediate insertion following cesarean delivery demonstrated lower expulsion rates than immediate insertion following vaginal delivery.

Conclusion

Poor to fair quality evidence from 15 articles demonstrated no increase in risk of complications among women who had an IUD inserted during the postpartum period; however, some increase in expulsion rates occurred with delayed postpartum insertion when compared to immediate insertion and with immediate insertion when compared to interval insertion. Postplacental placements during cesarean delivery are associated with lower expulsion rates than postplacental vaginal insertions, without increasing rates of postoperative complications.     

The ω-3 and ω-6 fats in meals: a proposal for a simple new label

Objective

The ω-3 and ω-6 polyunsaturated fatty acids (PUFAs) are separate essential dietary fatty acids that play a key role in many physiologic processes in higher animals. The content of these PUFAs is relatively well described for many individual food components. Our goal in this study was to analyze the PUFA content of whole meals and produce a simple measurement to estimate the intake of these fatty acids.

Methods

The fatty acid profile and macronutrient composition were determined for a range of fast food, cuisine (restaurant-prepared), and home-prepared whole meals commonly consumed by Australians.

Results

Across the different meals there was significant variation in protein (4-fold), fat (13-fold), and carbohydrate (23-fold) contents. With regard to the fatty acid profile, saturated and monounsaturated fatty acids made up approximately 80% of total fatty acids for most meals. The ω-6 PUFAs were substantially more abundant than ω-3 PUFAs for most meals. The balance of dietary ω-3 and ω-6 PUFAs is an important determinant of their metabolic effects within the body, and accordingly we calculated the percentage of the total PUFA comprised of ω-3 PUFAs and referred to this as the PUFA Balance. This parameter showed the greatest variation among the different meals (>45-fold).

Conclusion

The relative proportions of ω-3 and ω-6 PUFAs vary greatly across meals. PUFA Balance is a useful tool that will allow individuals to more easily monitor and balance their intake of ω-3 and ω-6 fats.     

Evaluation of Dietary Assessment Tools Used to Assess the Diet of Adults Participating in the Communities Advancing the Studies of Tribal Nations Across the Lifespan Cohort

Background

Accurate assessment of dietary intake is essential for researchers and public health practitioners to make advancements in public health. This is especially important in Native Americans who display disease prevalence rates that are dramatically higher than the general US population.

Objective

To evaluate three dietary assessment tools: dietary records, a food frequency questionnaire (FFQ), and a shellfish assessment survey among Native American adults from the Communities Advancing the Studies of Tribal Nations Across the Lifespan (CoASTAL) cohort.

Design

The CoASTAL cohort was composed of randomly selected individuals from three tribal registries of Pacific Northwest Tribal Nations. This cross-sectional study used data from the baseline of CoASTAL and was restricted to the non-pregnant adults (aged 18 years or older) who completed the shellfish assessment survey (n=500), an FFQ (n=518), dietary records (n=444), weight measures (n=493), and height measures (n=496). Paired t tests, Pearson correlation coefficients, and percent agreement were used to evaluate the dietary records and the FFQ with and without accounting for plausibility of reported energy intake (rEI). Sensitivity and specificity as well as Spearman correlation coefficients were used to evaluate the shellfish assessment survey and the FFQ compared to dietary records.

Results

Statistically significant correlations between the FFQ and dietary records for selected nutrients were not the same by sex. Accounting for plausibility of rEI for the dietary records and the FFQ improved the strength of the correlations for percent energy from protein, energy from carbohydrate, and calcium for both men and women. In addition, the association between rEI (dietary records and FFQ) and weight became significant when the sample was limited to plausible rEI. The shellfish assessment survey was found to similarly assess shellfish consumption in comparison to the FFQ.

Conclusions

These results support the benefit of multiple measures of diet, including regional and culturally specific surveys, especially among Native Americans. Accounting for plausibility of rEI may ensure more accurate estimations of dietary intakes.     

Adolescent and Young Adult Vegetarianism: Better Dietary Intake and Weight Outcomes but Increased Risk of Disordered Eating Behaviors

Objective

Examine characteristics of current and former adolescent and young adult vegetarians and investigate the relationships between vegetarianism, weight, dietary intake, and weight-control behaviors.

Design

Cross-sectional analysis using data from a population-based study in Minnesota (Project EAT-II: Eating Among Teens).

Setting

Participants completed a mailed survey and food frequency questionnaire in 2004.

Participants

Males and females (n=2,516), ages 15-23 years.

Main outcome measures

Weight status, dietary intake (fruit, vegetables, fat, calories), unhealthful weight-control behaviors.

Analysis

Multiple regression models controlling for socioeconomic status and sex were used to test for significant differences between current, former, and never vegetarians within the younger and older cohort.

Results

Participants were identified as current (4.3%), former (10.8%), and never (84.9%) vegetarians. Current vegetarians in the younger and older cohorts had healthier dietary intakes than nonvegetarians with regard to fruits, vegetables, and fat. Among young adults, current vegetarians were less likely than never vegetarians to be overweight or obese. Adolescent and young adult current vegetarians were more likely to report binge eating with loss of control when compared to nonvegetarians. Among adolescents, former vegetarians were more likely than never vegetarians to engage in extreme unhealthful weight-control behaviors. Among young adults, former vegetarians were more likely than current and never vegetarians to engage in extreme unhealthful weight-control behaviors.

Conclusions and implications

Adolescent and young adult vegetarians may experience the health benefits associated with increased fruit and vegetable intake and young adults may experience the added benefit of decreased risk for overweight and obesity. However, current vegetarians may be at increased risk for binge eating with loss of control, while former vegetarians may be at increased risk for extreme unhealthful weight-control behaviors. It would be beneficial for clinicians to inquire about current and former vegetarian status when assessing risk for disordered eating behaviors.