Illustration of the Importance of Adjustment for within- and between-Person Variability in Dietary Intake Surveys for Assessment of Population Risk of Micronutrient Deficiency/Excess Using an Example Data Set

Nutrition intervention decisions should be evidence based. Single 24-h recalls are often used for measuring dietary intake in large dietary studies. However, this method does not consider the day-to-day variation in populations’ diets. We illustrate the importance of adjustment of single 24-h recall data to remove within-person variation using the National Cancer Institute method to calculate usual intake when estimating risk of deficiency/excess. We used an example data set comprising a single 24-h recall in a total sample of 1326 1–<10-year-old children, and two additional recalls in a sub-sample of 11%, for these purposes. Results show that risk of deficiency was materially overestimated by the single unadjusted 24-h recall for vitamins B12, A, D, C and E, while risk of excess was overestimated for vitamin A and zinc, when compared to risks derived from usual intake. Food sources rich in particular micronutrients seemed to result in overestimation of deficiency risk when intra-individual variance is not removed. Our example illustrates that the application of the NCI method in dietary surveys would contribute to the formulation of more appropriate conclusions on risk of deficiency/excess in populations to advise public health nutrition initiatives when compared to those derived from a single unadjusted 24-h recall.     

Perceived Associations between Excessive Sugar Intake and Health Conditions

Excessive sugar intake represents an increased risk of developing non-communicable diseases (e.g., obesity, cardiometabolic diseases, and dental diseases). Still, it is unclear whether people are aware of these adverse health outcomes. The current study systematically examined the extent to which people associate health conditions with excessive sugar intake. Participants (N = 1010 Portuguese volunteers) freely reported all health conditions they associated with excessive sugar consumption and rated the strength of these associations for eight specific health conditions. All participants reported health conditions associated with excessive sugar intake, with the most frequent being risk factors for cardiometabolic diseases (e.g., diabetes), cardiovascular diseases, oral problems, oncological and mental health conditions. Moreover, participants considered diabetes, overweight/obesity, and oral problems as being the conditions most related to excessive sugar intake. Women, participants with children in the household, and experts in health/nutrition rated excessive sugar intake as being more strongly linked to some of the health conditions. The identification of the health conditions that people associate with excessive sugar consumption may inform policymakers, educators, and health professionals and support interventions targeting the general public or specific groups (e.g., overweight people) in raising awareness of potential adverse health outcomes and, ultimately, contribute to reducing sugar intake.     

Beverage Intake and Associated Nutrient Contribution for Aboriginal and Torres Strait Islander Australians: Secondary Analysis of a National Dietary Survey 2012–2013

Beverages contribute significantly to dietary intake. Research exploring the impact of beverage types on nutrient intake for Australian Aboriginal and Torres Strait Islander people is limited. A secondary analysis of the Australian Aboriginal and Torres Strait Islander Health Survey 2012–2013 (n = 4109) was undertaken. The daily intake, percentage of consumers, and contribution to total nutrient intake was estimated for 12 beverage categories. Beverage intake contributed to 17.4% of total energy, 27.0% of total calcium, 26.3% of total vitamin C, and 46.6% of total sugar intake. The most frequently consumed beverage categories for children (aged 2 to 18 years) were water, fruit juice/drinks, soft drinks, and cordial; and for adults, water, tea, coffee and soft drinks. The primary sources of beverages with added sugar were fruit juice/drinks (for children), tea (for people living remotely), coffee (for adults in metropolitan/regional areas) and soft drinks (for everyone). Actions to modify beverage intake to improve health should maintain the positive nutrient attributes of beverage intake. This analysis of a large-scale national dietary survey provides benchmarking of beverage intake to support program and policy development to modify intake where this is determined as a priority by the community.     

Dietary Habits of a Group of Children with Crohn’s Disease Compared to Healthy Subjects: Assessment of Risk of Nutritional Deficiencies through a Bromatological Analysis

Diet is a matter of interest in the pathogenesis and management of Crohn’s Disease (CD). Little is known about CD children’s dietary habits. Our aim was assessing the quality and the amount of nutrient intake in a group of CD pediatric patients. Data were compared with those of healthy subjects (HS). In total, 20 patients (13 males) and 48 HS (24 males) aged 4–18 years were provided with a food diary to fill out for one week. Winfood software performed the bromatological analysis, providing data about intakes of proteins and amino acids, fatty acids, carbohydrates, cholesterol, fibers, minerals, vitamins, and polyphenols. Estimates of the antioxidant activity of foods and of the dietetic protein load were also calculated. The diet of CD patients was poorer in fibers, polyphenols, vitamin A, beta-carotene, and fatty acids, and richer in animal proteins, vitamin B12, and niacin. PRAL was higher in CD patients’ diets, while ORAC was higher in HS. No significant differences were observed in carbohydrate and other macro- and micronutrient consumptions. CD dietary habits seem to reflect the so-called Western diet, possibly involved in CD pathogenesis. Furthermore, analysis of dietary habits allows for prevention of nutritional deficiencies and timely correction through education and supplementation.     

Farmers’ Market Nutrition Program Educational Events Are Broadly Accepted and May Increase Knowledge,Self-Efficacy and Behavioral Intentions

The Farmers’ Market Nutrition Program (FMNP) in the U.S. provides coupons for the purchase of fruit and vegetables (FV) to pregnant women and children enrolled in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC), and to income-eligible adults 60+ years of age. The New York State FMNP Education Event Guide was developed to support cooperative extension educators in providing information, food tastings, and cooking demonstrations at farmers’ markets (FM) to encourage consumption of FV. This paper describes implementation at seven FM in New York City, and shopping and eating behaviors in a cross-sectional survey of FM shoppers (n = 377). Three of nine lessons were implemented more than once, typically with food sampling (78.9%). FM shoppers were primarily women (81.5%), racially diverse (30.5% Black, 23.1% White), frequent shoppers (2.4 times/month), and had high FV consumption (2.24 cups fruit; 2.44 cups vegetables daily). Most FM shoppers participated in the FM education event (84%), and participants and non-participants had equivalent shopping and eating behaviors. More than 70% of FM education participants believed that the event positively impacted their knowledge, self-efficacy, and behavioral intentions. FMNP education events at FM were broadly accepted by FM shoppers of all characteristics, and may improve knowledge, self-efficacy, and behavioral intention.     

Nutrient Intakes among Brazilian Children Need Improvement and Show Differences by Region and Socioeconomic Level

Brazil is the most populous country in South America. Using 24 h dietary data, we compared the nutrient intakes of 4–13-year-olds to reference values and tested for regional and socioeconomic (SES) differences. A considerable proportion reported intakes below the Estimated Average Requirements (EAR) for vitamins E (78.1%, 96.5%), D (100% for both), and calcium (80.5%, 97.7%) for 4–8 and 9–13-year-olds, respectively. Few exceeded Adequate Intakes (AI) for potassium or fiber. Older children reported greater inadequacies and, while there was regional variability, patterns of inadequacy and excess tended to be similar. For vitamin C, the percent of children below EAR in the Northeast and Southeast was lower than in the South. Most children, regardless of SES, had energy intakes within the Acceptable Macronutrient Distribution Ranges (AMDRs) for carbohydrates and protein. Over a quarter reported total energy from fat less than the AMDR, and inversely associated with SES (low 50.9%, moderate 26.0%, and high 15.0%), but also exceeding the percentage of energy recommendation for saturated fat, increasing with SES (low 18.1%, moderate 38.9%, and high 48.8%). The contrast observed between the diets of young Brazilians and recommendations underscores the need for individual and regional environmental interventions to promote healthier dietary patterns.     

Association between Dietary Nitrate,Nitrite Intake,and Site-Specific Cancer Risk: A Systematic Review and Meta-Analysis

Background: People consume nitrates, nitrites, nitrosamines, and NOCs compounds primarily through processed food. Many studies have yielded inconclusive results regarding the association between cancer and dietary intakes of nitrates and nitrites. This study aimed to quantify these associations across the reported literature thus far. Methods: We performed a systematic review following PRISMA and MOOSE guidelines. A literature search was performed using Web of Science, Embase, PubMed, the Cochrane library, and google scholar up to January 2020. STATA version 12.0 was used to conduct meta-regression and a two-stage meta-analysis. Results: A total of 41 articles with 13 different cancer sites were used for analysis. Of these 13 cancer types/sites, meta-regression analysis showed that bladder and stomach cancer risk was greater, and that pancreatic cancer risk was lower with increasing nitrite intakes. Kidney and bladder cancer risk were both lower with increasing nitrate intakes. When comparing highest to lowest (reference) categories of intake, meta-analysis of studies showed that high nitrate intake was associated with an increased risk of thyroid cancer (OR = 1.40, 95% CI: 1.02, 1.77). When pooling all intake categories and comparing against the lowest (reference) category, higher nitrite intake was associated with an increased risk of glioma (OR = 1.12, 95% CI: 1.03, 1.22). No other associations between cancer risk and dietary intakes of nitrates or nitrites were observed. Conclusion: This study showed varied associations between site-specific cancer risks and dietary intakes of nitrate and nitrite. Glioma, bladder, and stomach cancer risks were higher and pancreatic cancer risk was lower with higher nitrite intakes, and thyroid cancer risk was higher and kidney cancer risk lower with higher nitrate intakes. These data suggest type- and site-specific effects of cancer risk, including protective effects, from dietary intakes of nitrate and nitrite.     

Validation of the MSM and NCI Method for Estimating the Usual Intake of Nutrients and Food According to Four Seasons of Seven Consecutive Daily 24 Hour Dietary Recalls in Chinese Adults

The Multiple Source Method (MSM) and the National Cancer Institute (NCI) method are used to estimate usual dietary intake from short-term dietary assessment instruments, such as 24 hour dietary recall (24-HRs). However, their performance has not been validated in the Chinese population via nutrition surveys. To validate the accuracy of the MSM and NCI method in estimating usual dietary intake in the Chinese population, 752 individuals from northern and southern China answered four seasons of seven consecutive 24-HRs (one for each season). The true usual dietary intake was considered as the average of the 28 collection days of dietary component intake. Using data sets with consecutive 3 collection days, the usual intakes of the selected dietary components were estimated by MSM, NCI and the within-person mean of three 24-HRs (3 day method). These estimates were compared with the true usual intake at the group and individual level. At the group level, the MSM and NCI method performed similarly, yielding estimates closer to the true usual intake than 3 day method. The percentage differences of the estimates for dietary components not consumed daily from the MSM and NCI method were larger than for the dietary components consumed daily. However, the larger percentage differences were observed in the tail of the usual intake distribution. In general, dietary components with larger variance ratios had greater percentage differences. At the individual level, for overall seasons and dietary components, the biases of individual usual intake did agree for MSM and NCI method, whereas NCI method estimates were closer to true intakes than for the MSM and 3 day method. Similar results were observed in the relative biases of dietary components consumed daily. As with the group level, there was less percentage difference in dietary components consumed daily. Both the MSM and NCI method can be used to estimate usual intake in Chinese populations and are closer to the true usual intake than the traditional mean method, at both group and individual levels.     

Liver is widely eaten by preschool children in the Northern Cape province of South Africa: Implications for routine vitamin A supplementation

Previous research has demonstrated a virtual absence of vitamin A deficiency and adequacy of vitamin A intake through consumption of liver in preschool children of a community in the Northern Cape province of South Africa where sheep farming is common, and liver, an exceptionally rich source of vitamin A, is frequently eaten. Only 60–75 g of liver per month is needed to meet the vitamin A requirement of preschool children. Because this may have implications for routine vitamin A supplementation, and because liver consumption for the rest of the province is unknown, the study aim was to establish the prevalence and frequency of liver intake in a provincial‐wide survey. An unquantified liver‐specific food frequency questionnaire, covering a period of 1 month, complemented by a 1‐year recall, was administered to mothers of 2‐ to 5‐year‐old children (n = 2,864) attending primary health care facilities in all five districts and 26 subdistricts. A total of 86% of children were reported to eat liver, which was eaten in all districts by at least 80% of children. The overall median frequency of liver intake was 1.0 [25th, 75th percentiles: 0.5, 3.0] times per month and ranged from 1.0 [0.3, 2.0] to 2.0 [1.0, 4.0] for the various districts. Based on a previously reported portion size of 66 g, these results suggest vitamin A dietary adequacy in all districts and possibly also vitamin A intake exceeding the Tolerable Upper Intake Level in some children. Routine vitamin A supplementation in this province may not be necessary and should be reconsidered.