Adjusting for energy intake in dietary pattern investigations using principal components analysis

OBJECTIVE: The effect of energy adjustment on variables entered into principal component analysis (PCA) to derive dietary patterns has received little attention. DESIGN AND METHODS: As part of regular self-completion questionnaires, used in the Avon Longitudinal Study of Parents and Children, pregnant women were asked to record the frequency of consumption of a variety of food items. A total of 12 053 women completed the questionnaire. Individual dietary types were identified using PCA, before and after adjusting the food variables for energy intake. Associations with estimated nutrient intakes and with birthweight were examined for the two solutions and when energy adjustment was performed at a later stage of the analysis. RESULTS: Slight differences were seen in terms of the components extracted and the factor loadings obtained. The associations with nutrient intakes showed that there was a general reduction in the size of the correlation coefficients for the energy-adjusted components compared to the unadjusted components. There did not appear to be any difference in the size of the effects of the dietary pattern scores on birthweight, whether energy was adjusted for before entry into the PCA or after. CONCLUSIONS: In this sample, it is not necessary to adjust for energy intake before entry into a PCA analysis to determine dietary patterns when using food frequency questionnaire data. Effects of energy intake can be determined at a later stage in the analytical process.This study determines the effect of adjusting for energy on dietary patterns resulting from PCA and the subsequent effect on future outcomes.     

Evaluation of the Nutrient Guide as a dietary assessment tool

The purpose of this study was to evaluate the validity of the Nutrient Guide as a quantitative estimate of dietary adequacy. Using 24-hour dietary recalls of 300 men, food group and overall diet scores based on the Nutrient Guide were compared with nutrient adequacy ratios for eight nutrients and a mean adequacy ratio derived from nutrient analysis. Caloric, fat, and sodium intakes estimated using Nutrient Guide ratings were also compared with nutrient Nutrient Guide ratings were also compared with nutrient analysis estimates. Correlations between food group scores and nutrient adequacy ratios were all positive and significant. Regression analyses revealed a strong linear relationship between caloric, fat, and sodium intakes estimated by the two methods and a curvilinear relationship between mean adequacy ratio and total diet score. These results suggest that the Nutrient Guide can be used to provide a reasonable estimate of adequacy for the nutrients upon which the guide is currently based. Food group and total diet scores in either the upper or lower ends of the score ranges seemed to be better predictors of individual nutrient or overall dietary adequacy than did mid-range scores, which slightly underestimated dietary adequacy of the selected nutrients.     

Dietary Patterns of Infants and Toddlers Are Associated with Nutrient Intakes

Dietary patterns are a useful summary measure of diet. Few studies have examined the nutrient profiles underpinning the dietary patterns of young children. The study aim is to determine whether dietary patterns at 6 and 15 months of age are associated with nutrient intakes at 8 and 18 months, respectively. Participants were children from the Avon Longitudinal Study of Parents and Children who had complete dietary pattern and nutrient intake data (n = 725 at 6–8 months, n = 535 at 15–18 months). The association between tertiles of dietary pattern scores and nutrient intake was examined using a non-parametric test for trend. Scores on the home-made traditional pattern (6–8 months) were positively associated with median energy intake. Each dietary pattern had different associations with energy-adjusted intakes of macro- and micro-nutrients. At both times, the discretionary pattern was positively and the ready-prepared baby foods pattern was negatively associated with sodium intake. At 6–8 months, calcium and iron intakes decreased across scores on the home-made traditional and breastfeeding patterns, but increased across the ready-prepared baby food patterns. These findings highlight that dietary patterns in infants and toddlers vary in their underlying energy and nutrient composition.     

Nutrient intake and food consumption among pregnant women from an agricultural region of Morocco

This study aimed to assess dietary intake and nutrient adequacy in pregnant women selected from an agricultural region of Morocco. On a sample of 172 pregnant women from rural and urban area, data on socio-demographic characteristics and dietary habits by a quantified food frequency were collected using questionnaires. Mean daily intakes of energy and nutrients were estimated and compared to reference nutrient intakes (RNI). The results show that the mean daily intakes of energy (3110.9 kcal in urban; 2707.5 kcal in rural) and some nutrients were adequate. However, iron, folate, zinc and calcium intakes were inadequate for the majority of women and more markedly in rural area. Education level appeared to affect nutrient intakes while no differences were registered across pregnancy stages or according to household size. The study suggests that an education program should be conducted to improve dietary intakes in order to prevent risks for pregnancy outcome in this population.     

Nutrient intake and food consumption among pregnant women from an agricultural region of Morocco

This study aimed to assess dietary intake and nutrient adequacy in pregnant women selected from an agricultural region of Morocco. On a sample of 172 pregnant women from rural and urban area, data on socio-demographic characteristics and dietary habits by a quantified food frequency were collected using questionnaires. Mean daily intakes of energy and nutrients were estimated and compared to reference nutrient intakes (RNI).

The results show that the mean daily intakes of energy (3110.9?kcal in urban; 2707.5?kcal in rural) and some nutrients were adequate. However, iron, folate, zinc and calcium intakes were inadequate for the majority of women and more markedly in rural area. Education level appeared to affect nutrient intakes while no differences were registered across pregnancy stages or according to household size. The study suggests that an education program should be conducted to improve dietary intakes in order to prevent risks for pregnancy outcome in this population.     

Variability of food intakes. An analysis of a 12-day data series using persistence measures

Data from the US Department of Agriculture's Exploratory Study of Longitudinal Measures of Individual Food Intake, conducted in 1982, were used to evaluate individual intakes for day-to-day patterns and to relate these patterns to the reliability of estimated daily energy and nutrient intake means. Generalized least squares estimators incorporating a simple persistence hypothesis showed the importance of including day-to-day patterns in estimating mean daily intake levels. The simple persistence hypothesis was that day-to-day intakes follow a first-order autoregressive process. Results on the accuracy of mean intake estimates and sample size suggested that for the dietary components examined, greatest gains in accuracy of estimated mean daily intake were generally obtained with the first six days of intake data. This conclusion was, however, highly conditioned by the inclusion of the persistence hypothesis in the calculations. It was concluded that additional investigations exploring alternative and perhaps more physiologically justified persistence hypotheses for food intakes would improve the use of sample data in estimating mean daily intakes of diet components.     

Food and nutrient intakes and their associations with lower BMI in middle-aged US adults: the International Study of Macro-/Micronutrients and Blood Pressure (INTERMAP)

BACKGROUND: Clinical trial data show that reduction in total energy intake enhances weight loss regardless of the macronutrient composition of the diet. Few studies have documented dietary patterns or nutrient intakes that favor leanness [BMI (in kg/m(2)) ≤25] in free-living populations. OBJECTIVE: This investigation examined associations of usual energy, food, and nutrient intakes with BMI among US participants of the International Study of Macro-/Micronutrients and Blood Pressure (INTERMAP). DESIGN: The INTERMAP is an international cross-sectional study of dietary factors and blood pressure in men and women (ages 40-59 y) that includes 8 US population samples. The present study included data from 1794 Americans who were not consuming a special diet and who provided four 24-h dietary recalls and 2 timed 24-h urine collections. Multivariable linear regression with the residual method was used to adjust for energy intake; sex-specific associations were assessed for dietary intakes and urinary excretions with BMI adjusted for potential confounders including physical activity. RESULTS: Lower energy intake was associated with lower BMI in both sexes. Univariately, higher intakes of fresh fruit, pasta, and rice and lower intakes of meat were associated with lower BMI; these associations were attenuated in multivariable analyses. Lower urinary sodium and intakes of total and animal protein, dietary cholesterol, saturated fats, and heme iron and higher urinary potassium and intakes of carbohydrates, dietary fiber, and magnesium were associated with lower BMI in both sexes. CONCLUSION: The consumption of foods higher in nutrient-dense carbohydrate and lower in animal protein and saturated fat is associated with lower total energy intakes, more favorable micronutrient intakes, and lower BMI.     

A Comparison of Dietary Patterns and Factors Influencing Food Choice among Ethnic Groups Living in One Locality: A Systematic Review

Globally, the number of minority ethnic groups in high-income countries is increasing. However, despite this demographic change, most national food consumption surveys are not representative of ethnically diverse populations. In consequence, many ethnic minorities’ dietary intakes are underreported, meaning that accurate analysis of food intake and nutrient status among these groups is not possible. This systematic review aims to address these gaps and understand differences in dietary intakes and influencers of dietary habits of ethnic groups worldwide. A systematic search was conducted through three databases (Pubmed, Web of Science and Scopus) and manual searches, generating n = 56,647 results. A final search of these databases was completed on 13 September 2021, resulting in a total of 49 studies being included in this review. Overall, food group intakes—particularly fruit, vegetable and fish intake—and diet quality scores were seen to differ between ethnicities. Overall Black/African American groups were reported to be among the poorest consumers of fruit and vegetables, whilst Asian groups achieved high diet quality scores due to higher fish intakes and lower fat intakes compared to other groups. Limited data investigated how nutrient intakes, dietary and meal patterns compared between groups, meaning that not all aspects of dietary intake could be compared. Socioeconomic status and food availability appeared to be associated with food choice of ethnic groups, however, confounding factors should be considered more closely. Future work should focus on comparing nutrient intakes and meal patterns between ethnicities and investigate potential targeted interventions which may support adherence to food-based dietary guidelines by all ethnic groups.     

Diet diversity and nutrient intake

Variety is espoused as a key to dietary adequacy, yet data from new shortcut dietary measures suggest that intakes of relatively few foods can accurately classify individuals according to nutrient intake. This study examines diet diversity, caloric intake, and nutrient density values as contributors to the level of selected nutrients in the diets of 1,747 white men and 1,898 white women, 18 to 34 years old, completing the 24-hour recall in NHANES II. Nutrient intake was directly related to both number of foods eaten and total calories consumed, as well as to nutrient density values. For fat, saturated fat, and potassium, higher caloric consumption alone may account for substantial differences in nutrient intakes between the lowest and highest quartiles. For cholesterol, calcium, and vitamin A, differences in dietary density were more important in explaining nutrient intake differences. Both caloric intake and nutrient density influence sodium intake from food sources. For some nutrients, an overall measure of diversity may be useful for estimating intakes. For others, nutrient-specific diversity indexes would likely be needed. Knowledge of specific foods in diets with high levels of nutrients could aid the construction of food frequency instruments.     

Food and nutrient intakes of a population sample of 7-year-old children in the south-west of England in 1999/2000 - what difference does gender make?

OBJECTIVES: To describe the diet of schoolchildren aged 7 years, and identify gender differences in food and nutrient intakes. SUBJECTS: A cohort of children resident in the south-west of England in 1999/2000. METHODS: Diet was assessed using three 1-day unweighed food diaries. Nutrient intakes were compared with dietary reference values for this age group, and with children aged 7-10 years in the British National Diet and Nutrition Survey. Food and nutrient intakes were contrasted between boys and girls. RESULTS: Median nutrient intakes exceeded the reference nutrient intake (RNI) for most nutrients. Median intakes of iron and zinc were below the RNI. Median sodium intake was greater than the maximum set by the Scientific Advisory Committee on Nutrition. The mean energy intake for boys and girls, respectively, were 7.3 and 6.8 MJ, this is below the estimated average requirement. The percentage of energy from fat was 35.3% for boys and 36.1% for girls. Boys had higher iron intakes than girls, even after adjustment for energy intake. There were differences in the types of foods eaten between boys and girls; girls ate more fruit and vegetables (P = 0.001) and boys ate more breakfast cereals (P = 0.016). CONCLUSIONS: The dietary intakes of these 7-year-old children were adequate for most nutrients. However, a reduction in the sodium content of the diet would be advantageous. Fruit and vegetable consumption should be encouraged particularly among boys.     

Food choices of vegetarians and nonvegetarians during pregnancy and lactation

Data on food choices and nutrient intake were obtained from 60 lactating women, including 29 vegetarians. The most common changes in consumption patterns during pregnancy were increased intake of high-protein foods, especially milk products, and decreased intake of coffee, tea, and alcohol. The changes were partially based on food cravings and/or aversions. In addition to high-protein foods, some of the women craved fruits and sweets. Items most commonly eliciting aversive reactions were vegetables, strong-smelling and strong-tasting combination dishes, and greasy foods. Aversions to coffee, tea, and alcohol were almost as frequent as those to greasy foods. Nutrient intake during lactation was measured using 24-hour recalls and 2-day diet records that also considered dietary supplements. A total of 332 intake records were evaluated relative to the RDAs for lactating women. Mean energy intake was 2,200 kcal (88% of the recommendation), and mean protein intake was 86 gm (134% of the RDA). Mean nutrient intakes from diet alone ranged from 89% of the RDA for iron to 154% for vitamin A; mean intakes from diet plus supplements ranged from 133% of the RDA for calcium to 581% of the RDA for thiamin. Dietary supplementation provided a substantial part of the intake of some nutrients; for most women, however, the RDAs were met by diet alone.     

Scores on the dietary guideline index for children and adolescents are associated with nutrient intake and socio-economic position but not adiposity

Diet quality indices reflect overall dietary patterns better than single nutrients or food groups. The study aims were to develop a measure of adherence with dietary guidelines applicable to child and adolescent populations in Australia and determine the association between index scores and food and nutrient intake, socio-demographic characteristics, and measures of adiposity. Data were analyzed from 4- to 16-y-old participants of the 2007 Australian Children's Nutrition and Physical Activity Survey (n = 3416). The Dietary Guideline Index for Children and Adolescents (DGI-CA) comprises 11 components: 5 core food groups, wholegrain bread, reduced-fat dairy foods, extra foods (nutrient poor and high in fat, salt, and added sugar), healthy fats/oils, water, and diet variety (possible score of 100). The index criteria were age specific. The mean DGI-CA score was low (53.6 ± 0.4), similar between boys and girls, and differed by age; the youngest children scored higher than the oldest children (P < 0.0001). Higher DGI-CA scores were associated with lower energy intake, energy density, total and saturated fat, and sugar intake; higher protein, carbohydrate, fiber, calcium, iron, vitamin C, vitamin A, folate, phosphorous, magnesium, zinc, and iodine intakes; and a higher polyunsaturated:saturated fat ratio (P < 0.0001). DGI-CA scores were associated with socio-economic characteristics and measures of family circumstance. Weak positive associations were observed between DGI-CA score and BMI or waist circumference Z-scores in the 4- to 10-y and 12- to 16-y age groups only. This index is the first validated index in Australia and one of the few international indices to describe the diet quality of children and adolescents.     

Relationship of self-concept to nutrient intake and eating patterns in young women

The relationships between attitudes toward oneself (self-concept) and nutrition-related behavior were examined for 153 single women aged 18 to 35 years. Nutrition-related behaviors were assessed with 3-day food records that were analyzed for nutrient composition and eating patterns (Basic Four Food Group scores, number of meals per day, and percent of energy from meals and snacks). Attitudes toward self, knowledge and attitudes about nutrition, and general health practices were assessed with a written questionnaire that incorporated several existing scales. Because of potential overlap among the three self-concept scales, as well as nutrition-attitude and health-practice items, responses were factor analyzed, yielding 14 factors. These factors were then compared with nutrient intake and eating patterns. Scores for the seemingly desirable factors of the "Super Person" or "Do Your Own Thing" were negatively correlated with intake of several nutrients; scores on the self-perception of a "Traditional" orientation to life were positively related to calcium intake and meal patterns. The "Nutrition Is Important" and "Nutrition Knowledge" factors were also positively related to desirable eating patterns and nutrient intakes. We conclude that several self-concept variables, as well as nutrition attitudes and knowledge, can potentially influence nutrient intakes and eating patterns in young women.     

Socio-demographic inequalities in the diets of mid-aged Australian women

OBJECTIVES: This study reports on the distributions of food and nutrient intakes by socio-demographic factors for a large population sample of mid-aged Australian women participating in the Australian Longitudinal Study on Women's Health. DESIGN: This cross-sectional population-based study used the Cancer Council of Victoria food frequency questionnaires to derive estimates of food and nutrient intakes. SETTING: Nationwide community-based survey. SUBJECTS: A total of 10561 women aged 50-55 y, at the time of the survey in 2001. RESULTS: Analysis showed favourable patterns of food intake, with frequent consumption of many foods that are promoted as components of a healthy diet (eg, fresh fruit, leafy green and other vegetables, bread, cereals, milk and meat). Intakes of both foods and nutrients varied significantly across socio-demographic groups, with unmarried women, and women in 'labouring' occupations (eg, cleaner, factory worker, kitchenhand) having poorer nutrient intake. CONCLUSIONS: Although many mid-aged women in this sample had generally healthful diets, women in certain socio-demographic groups (particularly unmarried women and those in labouring occupations) had nutrient intakes of concern. As well as helping to address the dearth of current data on dietary intakes in the Australian population, the results highlight the need for continued targeted public health strategies aimed at improving diet of women from the various socio-economic backgrounds.     

Inadequate nutrient intakes are common and are associated with low diet variety in rural, community-dwelling elderly

Poor dietary habits and inadequate nutrient intakes are of concern in the elderly. The nutritional characteristics of those who survive to become the oldest are not well defined. Our goal was to describe dietary habits, nutrient intakes and nutritional risk of community-dwelling, rural Iowans, 79 y of age and older. Subjects were interviewed (n = 420) using a standardized format on one occasion in their homes and instructed to complete 3-d diet records (n = 261) after the in-home interview. Standardized interviews assessed demographic information, cognitive function and dietary habits (Nutrition Screening Initiative Checklist). Adequate nutrient intake was defined as consumption of the nutrient's estimated average requirement, 67% adequate intake or 67% recommended dietary allowance. Mean age was 85.2 y, 57% lived alone and 58% were widowed. Subjects completing 3-d diet records were younger, more cognitively intact and less likely to be at nutritional risk than subjects not completing diet records. The percentage of subjects with inadequate intakes of selected nutrients was 75% for folate, 83% for vitamin D and 63% for calcium. Eighty percent of subjects reported inadequate intakes of four or more nutrients. Diet variety was positively associated with the number of nutrients consumed at adequate intakes (r = 0.498), total energy (r = 0.522) and dietary fiber (r = 0.421). Our results suggest that rural, community-dwelling old have inadequate intakes of several nutrients. Recommendations to increase diet variety and consume a nutrient supplement may be necessary for elderly people to achieve adequate nutrient intakes.     

Food and nutrient intakes of a population sample of 7-year-old children in the south-west of England in 1999/2000 – what difference does gender make?

Objectives To describe the diet of schoolchildren aged 7 years, and identify gender differences in food and nutrient intakes. Subjects A cohort of children resident in the south-west of England in 1999/2000. Methods Diet was assessed using three 1-day unweighed food diaries. Nutrient intakes were compared with dietary reference values for this age group, and with children aged 7–10 years in the British National Diet and Nutrition Survey. Food and nutrient intakes were contrasted between boys and girls. Results Median nutrient intakes exceeded the reference nutrient intake (RNI) for most nutrients. Median intakes of iron and zinc were below the RNI. Median sodium intake was greater than the maximum set by the Scientific Advisory Committee on Nutrition. The mean energy intake for boys and girls, respectively, were 7.3 and 6.8 MJ, this is below the estimated average requirement. The percentage of energy from fat was 35.3% for boys and 36.1% for girls. Boys had higher iron intakes than girls, even after adjustment for energy intake. There were differences in the types of foods eaten between boys and girls; girls ate more fruit and vegetables (P = 0.001) and boys ate more breakfast cereals (P = 0.016). Conclusions The dietary intakes of these 7-year-old children were adequate for most nutrients. However, a reduction in the sodium content of the diet would be advantageous. Fruit and vegetable consumption should be encouraged particularly among boys.     

Gluten-free diet survey: are Americans with coeliac disease consuming recommended amounts of fibre,iron, calcium and grain foods?

OBJECTIVE: This survey was conducted to assess nutrient intakes and food consumption patterns of adults with coeliac disease who adhere to a strict gluten-free diet. DESIGN: Three-day estimated self-reported food records were used to assess daily intakes of calories, percent daily calories from carbohydrates, dietary fibre, iron, calcium and grain food servings. SUBJECTS: Volunteers for this survey were recruited through notices placed in coeliac disease support group newsletters, as well as a national magazine for persons with coeliac disease. Forty-seven volunteers met all criteria for participation and returned useable food records. RESULTS: Group mean daily intake of nutrients by gender: Males (n = 8): 2882 calories; 55% carbohydrate; 24.3 g dietary fibre; 14.7 mg iron; 1288.8 mg calcium; 6.6 grain food servings. Females (n = 39): 1900 calories; 52% carbohydrate; 20.2 g dietary fibre; 11.0 mg iron; 884.7 mg calcium; 4.6 grain food servings. Recommended amounts of fibre, iron and calcium were consumed by 46, 44 and 31% of women and 88, 100 and 63% of men, respectively. CONCLUSIONS: Nutrition therapy for coeliac disease has centred around food allowed/not allowed on a gluten-free diet. Emphasis also should be placed on the nutritional quality of the gluten-free diet, particularly as it concerns the iron, calcium and fibre consumption of women. The use of the estimated food record as the dietary survey method may have resulted in the under-reporting of energy intake. Due to the small sample size and possible bias of survey participants, the findings of this survey may not be representative of the larger coeliac community.     

Diet quality among Yup'ik Eskimos living in rural communities is low: the Center for Alaska Native Health Research Pilot Study

OBJECTIVE: The objectives of this pilot study were to describe the nutrient intake of Yup'ik Eskimos in comparison with national intake, identify dietary sources of key nutrients, and assess the utility of the Healthy Eating Index (HEI) to measure diet quality of Yup'ik Eskimos living in rural Alaskan Native communities. PARTICIPANTS AND DESIGN: A single 24-hour recall was collected from 48 male and 44 female Yup'ik Eskimos (aged 14 to 81 years), who resided in three villages in the Yukon Kuskokwim River Delta, AK, during September 2003. MAIN OUTCOME MEASURES: HEI scores, nutrient intake, and traditional food intake. STATISTICAL ANALYSES PERFORMED: Spearman correlations for associations between variables. RESULTS: Youth scored higher than elders despite similar nutrient intakes. Overall diet quality was generally low; 63% of all participants' diets were classified as poor. Although the HEI serves to identify areas of concern with respect to diet quality, it is limited in its ability to detect the positive value of traditional foods. CONCLUSIONS: Traditional foods and healthful market foods, including rich sources of fiber and calcium, should be encouraged. Although traditional foods were important sources of energy and nutrients, market foods composed the preponderance of the diet, emphasizing the importance of appropriately modifying a diet quality index based on a Western framework, such as the HEI.     

Inadequate nutrient intakes among homebound elderly and their correlation with individual characteristics and health-related factors

BACKGROUND: The prevalence of inadequate nutrient intakes among the homebound elderly and their correlation with individual characteristics and health-related factors remain poorly understood. OBJECTIVE: We assessed the extent of inadequate dietary intakes of key nutrients among the homebound elderly by using the newly released dietary reference intakes and examined the associations of individual characteristics and health-related factors with low nutrient intakes. DESIGN: This was a cross-sectional examination of data collected during the baseline assessment of a prospective study of nutrition and function among a randomly recruited sample of cognitively eligible recipients of home-delivered meals who completed a home visit and three 24-h dietary recalls (n = 345). Nutrient analysis was performed with the NUTRITION DATA SYSTEM software, and associations were identified through multiple regression models. RESULTS: In multiple regression models, lower intakes of specific nutrients were associated with subjects who were women, who were black, who reported a low income and limited education, and who did not usually eat breakfast. On the basis of the estimated average requirement standard for nutrient inadequacy, the intake of >/= 6 nutrients was inadequate in 27% of subjects, of 3-5 nutrients in 40% of subjects, and of 1-2 nutrients in 29% of subjects. On the basis of the adequate intake standard, a less than adequate intake of calcium was reported by 96% of subjects and of vitamin D by 99% of subjects. CONCLUSIONS: The findings suggest that home-delivered meals programs should target specific subgroups of participants with interventions, such as a breakfast meal or more-nutrient-dense meals, tailored to increase nutrient intakes and reduce the prevalence of nutrient inadequacy.