The effect of drug abuse on body mass index in Hispanics with and without HIV infection

OBJECTIVE: There is a widely held view that the lower weight of drug abusers is attributable to diet. However, many studies on the dietary intake of drug abusers have failed to find energy insufficiency, while non-dietary factors have rarely been examined. The purpose of this study was to examine non-dietary factors that could affect the weight of drug abusers with and without HIV infection. DESIGN: Participants were recruited into one of three groups: HIV-positive drug abusers (n=85), HIV-negative drug abusers (n=102) and HIV-positive persons who do not use drugs ('non-drug abusers', n=98). Non-dietary factors influencing weight included infection with HIV and/or hepatitis, malabsorption, resting energy expenditure and physical activity. SETTING: The baseline data from a prospective cohort study of the role of drug abuse in HIV/AIDS weight loss conducted in Boston, USA. SUBJECTS: The first 286 participants to enroll in the study. RESULTS: HIV-positive drug abusers had a body mass index (BMI) that was significantly lower than that of HIV-positive non-drug abusers. The differences in weight were principally differences in fat. In the men, cocaine abuse, either alone or mixed with opiates, was associated with lower BMI, while strict opiate abuse was not. Infection with HIV or hepatitis, intestinal malabsorption, resting energy expenditure and physical activity, as measured in this study, did not explain the observed differences in weight and BMI. CONCLUSIONS: Drug abuse, and especially cocaine abuse, was associated with lower weight in men. However, infection with HIV and/or hepatitis, malabsorption and resting energy expenditure do not explain these findings.     

Unique patterns of dietary adequacy in three cultures of Canadian Arctic indigenous peoples

BACKGROUND: Information is needed on dietary adequacy of Arctic indigenous populations in Canada. Extensive work has been completed on composition of Arctic food and food use, and dietary reference intakes are available. OBJECTIVE: To complete the first comprehensive dietary adequacy assessment of three populations of adult Arctic indigenous people. SETTING AND SUBJECTS: Dietary assessment interviews were conducted with randomly selected indigenous adults during two seasons in 44 representative communities of Yukon First Nations (n = 797), Dene/Métis, (n = 1007) and Inuit (n = 1525). METHODS: Twenty-four-hour recalls were used to derive adjusted distributions of usual nutrient intakes in four age/gender groups for assessment of dietary adequacy for carbohydrate, dietary fibre, protein, n-3 fatty acids, n-6 fatty acids, calcium, copper, iron, magnesium, manganese, phosphorus, selenium, zinc, vitamin A, riboflavin, folate, vitamin B6, vitamin C, vitamin D and vitamin E. RESULTS: Nutrients with high prevalence of adequacy for most age/gender groups in all three cultures were protein, carbohydrate, n-3 fatty acids, iron, copper, zinc, manganese, selenium, riboflavin and vitamin B6; some individuals exceeded the upper intake level for iron, zinc, selenium, vitamin A and vitamin D. Estimated average requirement nutrients of concern for adequacy were magnesium, folate, vitamin A, vitamin C and vitamin E; however, a few age/gender groups were exceptions. Prevalence of inadequacy for AI nutrients which may be undesirably high were fibre, n-6 fatty acids and calcium. Vitamin D was more adequate in Inuit women and men than for Yukon First Nations or Dene/Métis. CONCLUSIONS: Unique patterns of dietary adequacy exist among Arctic indigenous peoples. Local wildlife food sources and market food sources should be maximised for their nutrient contributions to Arctic diets.     

National fortification of staple foods can make a significant contribution to micronutrient intake of South African adults

BACKGROUND: A national survey found that micronutrient deficiencies are prevalent in South African children, particularly calcium, iron, zinc, riboflavin, niacin, vitamin B6, folate, vitamin A, E and C. Mandatory fortification of maize meal and wheat flour were introduced in 2003 to combat some of the deficiencies found in children. To date however, there has not been a national survey on dietary intake in adults. OBJECTIVES: The main objectives of this study were to evaluate the micronutrient intake of the diet consumed by the average adult South African by means of secondary data analyses and secondly to evaluate the effects of fortification on selected nutrient intakes. STUDY DESIGN: Secondary data analysis was carried out with numerous dietary surveys on adults to create a database that included sampling (and weighting) according to ethnic/urban-rural residence in line with the population census, of which 79% were black Africans and the majority resided in rural areas. The effect of fortification was evaluated by substituting fortified foods in the diet for the unfortified products. SUBJECTS: The combined database used in this study comprised 3229 adults. RESULTS: Mean calcium, iron, folate and vitamin B6 intakes were very low particularly in women. Mean intakes of most micronutrients were lower in rural areas. Fortification of maize meal and wheat flour (bread) raised mean levels of thiamine, riboflavin, niacin, vitamin B6 and folate above the recommended nutrient intakes (RNIs). In women, despite fortification, mean iron intakes remained below the RNIs, as did calcium since it was not in the fortification mix. CONCLUSION: The average dietary intake of adults was of poor nutrient density, particularly in rural areas. Fortification of maize meal and wheat flour (bread) considerably improved mean vitamin B6, thiamine, riboflavin, niacin, folate and iron intakes as well as the overall mean adequacy ratio of the diet.     

Adaptation and evaluation of the National Cancer Institute's Diet History Questionnaire and nutrient database for Canadian populations

BACKGROUND AND OBJECTIVE: Despite assumed similarities in Canadian and US dietary habits, some differences in food availability and nutrient fortification exist. Food-frequency questionnaires designed for the USA may therefore not provide the most accurate estimates of dietary intake in Canadian populations. Hence, we undertook to evaluate and modify the National Cancer Institute's Diet History Questionnaire (DHQ) and nutrient database. METHODS: Of the foods queried on the DHQ, those most likely to differ in nutrient composition were identified. Where possible these foods were matched to comparable foods in the Canadian Nutrient File. Nutrient values were examined and modified to reflect the Canadian content of minerals (calcium, iron, zinc) and vitamins (A, C, D, thiamin, riboflavin, niacin, B6, folate and B12). DHQs completed by 13 181 Alberta Cohort Study participants aged 35-69 years were analysed to estimate nutrient intakes using the original US and modified versions of the DHQ databases. Misclassification of intake for meeting the Dietary Reference Intake (DRI) was determined following analysis with the US nutrient database. RESULTS: Twenty-five per cent of 2411 foods deemed most likely to differ in nutrient profile were subsequently modified for folate, 11% for vitamin D, 10% for calcium and riboflavin, and between 7 and 10% for the remaining nutrients of interest. Misclassification with respect to meeting the DRI varied but was highest for folate (7%) and vitamin A (7%) among men, and for vitamin D (7%) among women over 50 years of age. CONCLUSIOn: Errors in nutrient intake estimates owing to differences in food fortification between the USA and Canada can be reduced in Canadian populations by using nutrient databases that reflect Canadian fortification practices.     

Dietary patterns in middle-aged Irish men and women defined by cluster analysis

OBJECTIVES: To identify and characterise dietary patterns in a middle-aged Irish population sample and study associations between these patterns, sociodemographic and anthropometric variables and major risk factors for cardiovascular disease. DESIGN: A cross-sectional study. SUBJECTS AND METHODS: A group of 1473 men and women were sampled from 17 general practice lists in the South of Ireland. A total of 1018 attended for screening, with a response rate of 69%. Participants completed a detailed health and lifestyle questionnaire and provided a fasting blood sample for glucose, lipids and homocysteine. Dietary intake was assessed using a standard food-frequency questionnaire adapted for use in the Irish population. The food-frequency questionnaire was a modification of that used in the UK arm of the European Prospective Investigation into Cancer study, which was based on that used in the US Nurses' Health Study. Dietary patterns were assessed primarily by K-means cluster analysis, following initial principal components analysis to identify the seeds. RESULTS: Three dietary patterns were identified. These clusters corresponded to a traditional Irish diet, a prudent diet and a diet characterised by high consumption of alcoholic drinks and convenience foods. Cluster 1 (Traditional Diet) had the highest intakes of saturated fat (SFA), monounsaturated fat (MUFA) and percentage of total energy from fat, and the lowest polyunsaturated fat (PUFA) intake and ratio of polyunsaturated to saturated fat (P:S). Cluster 2 (Prudent Diet) was characterised by significantly higher intakes of fibre, PUFA, P:S ratio and antioxidant vitamins (vitamins C and E), and lower intakes of total fat, MUFA, SFA and cholesterol. Cluster 3 (Alcohol & Convenience Foods) had the highest intakes of alcohol, protein, cholesterol, vitamin B(12), vitamin B(6), folate, iron, phosphorus, selenium and zinc, and the lowest intakes of PUFA, vitamin A and antioxidant vitamins (vitamins C and E). There were significant differences between clusters in gender distribution, smoking status, physical activity, body mass index, waist circumference and serum homocysteine concentrations. CONCLUSION: In this general population sample, cluster analysis methods yielded two major dietary patterns: prudent and traditional. The prudent dietary pattern is associated with other health-seeking behaviours. Study of dietary patterns will help elucidate links between diet and disease and contribute to the development of healthy eating guidelines for health promotion.     

The impact of high non-starch polysaccharide intake on serum micronutrient concentrations in a cohort of women

OBJECTIVE: Many public health campaigns encourage increased fibre consumption, but short-term studies suggest that various components of dietary fibre inhibit the absorption of certain micronutrients including carotenoids. These do not take into account long-term adaptation to nutrient intake levels. We aimed to investigate the effect of non-starch polysaccharide (NSP) fibre on plasma micronutrient concentrations in a large free-living population consuming their usual diet. DESIGN: Prospective cohort study. Semi-weighed 4-day food diaries were analysed for micronutrient and NSP fibre intakes. Blood samples were taken and analysed for carotenoids, vitamin A, vitamin E, thiamine, riboflavin, vitamin B6, vitamin B12, folic acid, vitamin C and trace metals. SETTING: Participants in a large national cohort study who lived within 30 miles of Leeds. SUBJECTS: Two hundred and eighty-three middle-aged women. RESULTS: The association between NSP intake and plasma nutrient concentrations was assessed taking into account nutrient intakes and other dietary and lifestyle factors. Higher levels of NSP were not associated with lower plasma concentrations of the micronutrients measured, even allowing for the higher nutrient levels generally found in high-fibre foods. CONCLUSIONS: Amongst middle-aged women we have shown that current guidelines for increasing the population's NSP consumption can be safely applied. Such guidelines are unlikely to reduce serum micronutrient concentrations, although other, more vulnerable population groups may benefit from further investigation.     

Efficacy of a community-based dietary intervention to enhance micronutrient adequacy of high-phytate maize-based diets of rural Malawian children

OBJECTIVE: To evaluate the efficacy of a community-based dietary intervention to reduce risk of micronutrient inadequacies in high-phytate maize-based Malawian diets. DESIGN: Quasi-experimental post-test design with a non-equivalent control group. SETTING: Four villages in Mangochi District, Southern Malawi. PARTICIPANTS: Households with children aged 3-7 years in two intervention (n = 200) and two control (n = 81) villages participated in a 6-month intervention employing dietary diversification, changes in food selection patterns, and modifications to food processing to reduce the phytate content of maize-based diets. Baseline comparability between the groups was confirmed via assessment of sociodemographic characteristics, anthropometry, knowledge and practices, morbidity, haemoglobin and hair zinc. After 12 months, knowledge and practices and dietary intakes were assessed by interactive 24-hour recalls, one during the food plenty and a second during the food shortage season. Nutrient adequacy for the two groups was compared via dietary quality indicators and predicted prevalence of inadequate intakes using the probability approach. RESULTS: Intervention children had diets that were significantly more diverse and of a higher quality than those of controls. Median daily intakes of protein, calcium, zinc (total and available), haem iron, vitamin B12 and animal foods (grams; % of total energy) were higher (P < 0.05) whereas phytate intakes, phytate/zinc and phytate/iron molar ratios were lower (P < 0.01) in the intervention group; some spread of knowledge and practices to controls occurred. CONCLUSIONS: Our community-based dietary strategies reduced the predicted prevalence of inadequate intakes of protein, calcium, zinc and vitamin B12, but not iron, in children from Malawian households with very limited resources.     

Complementary foods consumed by 6-12-month-old rural infants in South Africa are inadequate in micronutrients

OBJECTIVE: To determine the nutrient composition of complementary foods consumed by 6-12-month-old South African infants. DESIGN: Nutrient intake was determined for infants who were recruited to participate in a randomised controlled trial using a single 24-hour dietary recall. SETTING/SUBJECTS: Infants aged 6-12 months (n=475) residing in The Valley of a Thousand Hills, a rural area in KwaZulu-Natal, South Africa. RESULTS: Energy and protein intakes from complementary foods were adequate. Infants who consumed infant products (commercially available fortified infant cereals/ready-to-eat canned baby foods/formula milk powder) had significantly higher intakes of calcium, iron, zinc, vitamin A, thiamine, riboflavin, niacin, vitamin B6, vitamin B12 and vitamin C than infants who did not consume any infant products. For infants who consumed infant cereals (n=142), these cereals provided 51% of total iron intake. Infant cereals provided more than 25% of total intake for magnesium, thiamine, niacin and vitamin B12. For infants consuming ready-to-eat canned baby foods (n=77), these products contributed less than 15% of total intake for all the micronutrients. The nutrient density of the complementary diet was less than half the desired density for calcium, iron and zinc. Animal products were consumed by 17% of infants, 26% consumed dairy products and 18% consumed vitamin-A-rich fruit and vegetables during the 24-hour recall period. CONCLUSION: The nutrient composition of complementary foods among rural South African infants was inadequate, especially for iron, zinc and calcium. Strategies should be developed to improve the nutritional quality of their diets.     

Declines in dietary macronutrient intake in persons with HIV infection who develop depression

BACKGROUND: The effect of depression on dietary intake has not, to our knowledge, been examined in persons with HIV infection. METHODS: We conducted a longitudinal analysis of participants in the Nutrition for Healthy Living Study (NFHL). We measured changes in dietary macronutrient intake in participants who developed depression and, using multiple regression analysis, compared the changes with a control group of patients who did not become depressed. RESULTS: Ninety patients developed depression during the observation period, and we compared these with 152 non-depressed controls. The two groups had similar age and body mass index (BMI) at baseline, but those who developed depression were more likely to be female, less educated and had lower incomes. After adjustment, compared with non-depressed participants, those who developed depression had significantly greater decreases in the following daily intakes: total energy (-341 kcal, P = 0.006), protein (-12.3 g, P = 0.02), total fat (-18.5 g, P = 0.008), carbohydrate (-36.8 g, P = 0.02), total fibre (-4.3 g, P = 0.001) and saturated fat (-6.7 g, P = 0.01). There were no significant differences in the daily intakes of simple sugars and long-chain n-3 fatty acids, or BMI. CONCLUSION: Depression is associated with decreases in total daily energy intake and in six of the eight dietary components we measured. Clinicians should be aware that depression-associated nutritional deficiencies may complicate the care of persons with HIV.     

Dietary intake of vitamin B6 and concentration of vitamin B6 in blood samples of German vegans

OBJECTIVE: The study aimed to evaluate the dietary vitamin B6 intake and determine the vitamin B6 concentration in blood samples of German vegans. DESIGN AND SETTING: Cross-sectional study with 33 examination sites all over Germany.Subjects Ninety-three vegans (50 females) with a mean (+/- standard deviation (SD)) age of 43.7 +/- 15.7 years who took no vitamin supplements. METHODS: Dietary intake was assed using a semi-quantitative food-frequency questionnaire. Erythrocyte aspartate aminotransferase activity coefficient (EAST-AC) was calculated as the ratio of stimulated (pyridoxal 5'-phosphate added) to unstimulated activity in blood samples that were provided after an overnight fast. RESULTS: Mean +/- SD vitamin B6 intake was 2.83 +/- 0.98 mg day(-1) and mean +/- SD protein intake was 56.6 +/- 21.7 g day(-1). Of the participants 4% showed vitamin B6 intakes lower than daily recommended intakes for Germany, 16% showed EAST-AC > 1.85, and a further 58% showed EAST-AC of 1.5-1-85. Moderate vegans were affected to a lesser extent than strict vegans. None of the established confounders was a significant predictor of EAST-AC. In logistic regression analyses the contribution of nutriments and cereals to pyridoxine intake was the only predictor of EAST-AC classified as < or = 1.85 and > 1.85, respectively. CONCLUSIONS: In spite of the high total intake of vitamin B6, an adequate concentration in blood samples could not be realised for a majority of the participants. Due to the health implications of a marginal pyridoxine status, vegans should be encouraged to include foods with a high bioavailability of pyridoxine, such as beans, lentils and bananas, in the daily diet.     

Anaemia and vitamin A status among adolescent schoolboys in Dhaka City, Bangladesh

OBJECTIVES: To investigate the prevalence of anaemia and subclinical vitamin A deficiency among adolescent schoolboys in Dhaka City, Bangladesh, and to identify factors related to anaemia and vitamin A status.DESIGN: A cross-sectional study.SETTING: Government high schools in Dhaka City, Bangladesh.SUBJECTS AND METHODS: A total of 381 boys, aged 11-16 years, from 10 schools in Dhaka City participated in the study. Socio-economic, anthropometric and dietary data were collected. Haemoglobin and serum retinol (vitamin A) concentrations were determined.RESULTS: Seven per cent of the boys were anaemic and 22% had serum vitamin A levels below the adequate level of 1.05 micromol l(-1), with only 1.5% having subclinical vitamin A deficiency (<0.70 micromol l(-1)). Food frequency data revealed poor dietary habits. Multiple regression analysis showed that age, body mass index (BMI), parents' occupation, serum vitamin A level and frequency of intakes of meat and fruit were significantly independently related to haemoglobin level. The overall F-ratio (13.1) was highly significant (P<0.000) and the adjusted R(2) was 0.192. For serum vitamin A, BMI, father's education, per capita expenditure on food, haemoglobin concentration and frequency of intake of vitamin A-rich fruit were found to be significantly independently related. The overall F-ratio (14.5) was highly significant (P<0.000) and the adjusted R(2) was 0.186.CONCLUSION: The data show that adolescent schoolboys in Dhaka City have anaemia and inadequate vitamin A status, although the extent of the problems is lower than in other population groups in the country. Sociodemographic and dietary factors appear to have important relationships with anaemia and vitamin A status of these boys.     

Monetary costs of dietary energy reported by young Japanese women: association with food and nutrient intake and body mass index

OBJECTIVE: Little is known about the relationship of monetary diet costs to dietary intake and obesity, particularly in non-Western populations. This study examined monetary cost of dietary energy in relation to diet quality and body mass index (BMI) among young Japanese women. DESIGN: Dietary intake was assessed by a validated, self-administered, diet history questionnaire. Diet costs were estimated using retail food prices. Monetary cost of dietary energy (Japanese yen 1000 kcal-1) was then calculated. BMI was computed from self-reported body weight and height. SUBJECTS: A total of 3931 female Japanese dietetic students aged 18-20 years. RESULTS: Monetary cost of dietary energy was positively associated with intakes of fruits, vegetables, fish and shellfish, and pulses; however, higher monetary cost of dietary energy was also associated with higher consumption of fat and oil, meat and energy-containing beverages, and lower consumption of cereals (rice, bread and noodles) (all P for trend <0.01). At the nutrient level, monetary cost of dietary energy was positively associated with intakes of dietary fibre and key vitamins and minerals, but also associated positively with intakes of fat, saturated fatty acids, cholesterol and sodium, and negatively with carbohydrate intake (all P for trend <0.0001). After adjustment for possible confounders, monetary cost of dietary energy was quite weakly but significantly negatively associated with BMI (P for trend = 0.0197). CONCLUSIONS: Increasing monetary cost of dietary energy was associated with both favourable and unfavourable dietary intake patterns and a quite small decrease in BMI in young Japanese women.     

Intake and food sources of nitrites and N-nitrosodimethylamine in Spain

OBJECTIVE: To conduct a comprehensive assessment of dietary intakes of nitrites and N-nitrosodimethylamine (NDMA). SUBJECTS AND SETTING: A study was conducted within the Spanish cohort of the European Prospective Investigation in Cancer and Nutrition (EPIC) to assess the intake and food sources of these compounds in Spanish adults. The study included 41,446 health volunteers, aged 29-69 years, from Northern and Southern regions. Usual food intake was estimated by in-person interviews using a computerised dietary questionnaire. RESULTS: The estimated geometric mean was 0.994 mg day(-1) for nitrites and 0.114 microg day(-1) for NDMA. For both compounds a positive trend in consumption with increasing energy intake was observed. Dietary NDMA was related to age and sex after energy adjustment, while nitrite consumption increased with higher intakes of vitamin C (P < 0.001). The food groups that contributed most to intakes were meat products, cereals, vegetables and fruits for nitrites, and processed meat, beer, cheese and broiled fish for NDMA. Current and past smokers, who had high levels of NDMA from tobacco exposure, were also identified as the highest consumers of dietary NDMA. Furthermore, smokers had low intakes of vitamin C (an inhibitor of endogenous nitrosation). CONCLUSIONS: Intake levels of NDMA and nitrites in a Mediterranean cohort are currently relatively lower than those previously reported, although processed meat, beer and cured cheese still are the most important contributors to NDMA intake.     

The UK Women's Cohort Study: comparison of vegetarians, fish-eaters and meat-eaters

BACKGROUND: This paper describes the development of the UK Women's Cohort Study and presents cohort baseline characteristics. METHODS: In total, 35,372 women, aged 35-69 years at recruitment, were selected to ensure a wide range of dietary intakes. Diet was assessed by a 217-item food-frequency questionnaire (FFQ). Detailed lifestyle information was collected by postal questionnaire. Vegetarians, fish-eaters and meat-eaters were compared. RESULTS: The cohort women are mainly white, well-educated, middle-class and married with children. They are health-conscious with only 11% current smokers and 58% taking dietary supplements. Twenty-eight per cent of subjects self-report as being vegetarian and 1% as vegan. However, only 18% are defined as 'vegetarian' from the FFQ. Fat provides 32% of energy; vitamin and mineral intakes are high, with a broad range of intakes. Meat-eaters are older, with a higher body mass index (BMI) and the lowest intakes of carbohydrate, fibre, vitamin C, folate, iron and calcium. Other fish-eaters are similar to vegetarians. Vegetarians have the lowest intakes of protein, fat and saturated fat. Oily fish-eaters have the lowest BMI; are the least likely to smoke or use full-fat milk; and are the most likely to use dietary supplements and consume the most fruit and vegetables. Oily fish-eaters have the highest total energy intake and vegetarians the lowest. Semi-skimmed milk, bread, potatoes, wine, bananas and muesli are important contributors to energy for all groups. CONCLUSION: A large cohort of middle-aged women has been created encompassing a wide range of different eating patterns, including diets currently of interest to research into protection against cancer and coronary heart disease. Participants will be followed up to study the effects of different food and nutrient intakes on long-term health outcomes.     

Impact of disaggregation of composite foods on estimates of intakes of meat and meat products in Irish adults

OBJECTIVE: To evaluate the impact of the disaggregation of composite foods on intake estimates of meat and individual meat categories and on the contribution of meat to nutrient intakes in Irish adults. DESIGN: Data were analysed from the North/South Ireland Food Consumption Survey, which used a 7-day food diary to estimate food intake. Of 742 food codes that contained meat, 320 were codes for meat consumed as an individual portion and 422 were composite foods and were disaggregated to estimate the meat content. SUBJECTS: A nationally representative sample of 475 men and 483 women (not pregnant or lactating) from the Republic of Ireland aged 18-64 years. RESULTS: The mean intake of meat was 134 g day(-1) in consumers (98.5%) and men (168 g day(-1)) consumed significantly more (P<0.001) than women (102 g day(-1)). Mean intakes of meat were higher in subjects with manual skilled occupations (P<0.01) and lower in those with third-level educational qualifications (P<0.05). Without disaggregating meat from composite foods, meat intake was overestimated by 43% (57 g day(-1)) and varied widely by meat category. Meat disaggregated from composite foods contributed 25% of meat intake. The contribution meat made to nutrient intakes ranged from 29% for protein, vitamin B12, zinc and niacin to 20% for vitamin D, 16% for vitamin B6, 15% for thiamine and 14% for iron. CONCLUSIONS: Failure to disaggregate meat from composite foods substantially overestimates meat intake, with a large variation between meat categories. This has important implications for estimates of meat intakes in nutritional epidemiological studies and for food safety purposes.     

Dietary intake of heterocyclic amines in relation to socio-economic, lifestyle and other dietary factors: estimates in a Swedish population

OBJECTIVES: To estimate the dietary intakes of heterocyclic amines (HCAs), to examine the intakes in relation to socio-economics, lifestyle and other dietary factors and to compare the classification of subjects by intake of HCA versus intake of meat and fish. DESIGN: Cross-sectional analysis within the Malm? Diet and Cancer (MDC) cohort. Data were obtained from a modified diet history, a structured questionnaire on socio-economics and lifestyle, anthropometric measurements and chemical analysis of HCAs. HCA intake was cross-classified against meat and fish intake. The likelihood of being a high consumer of HCAs was estimated by logistic regression analysis. Dietary intakes were examined across quintiles of HCA intake using analysis of variance. SETTING: Baseline examinations conducted in 1991-1994 in Malm?, Sweden. SUBJECTS: A sub-sample of 8599 women and 6575 men of the MDC cohort. RESULTS: The mean daily HCA intake was 583 ng for women and 821 ng for men. Subjects were ranked differently with respect to HCA intake compared with intake of fried and baked meat and fish (kappa = 0.13). High HCA intake was significantly associated with lower age, overweight, sedentary lifestyle and smoking. Intakes of dietary fibre, fruits and fermented milk products were negatively associated with HCA intake, while intakes of selenium, vegetables, potatoes, alcohol (among men) and non-milk-based margarines (among women) were positively associated with HCA intake. CONCLUSIONS: The estimated daily HCA intake of 690 ng is similar to values obtained elsewhere. The present study suggests that lifestyle factors (e.g. smoking, physical activity, fruit and vegetable intakes, and types of milk products and margarines) may confound associations between HCA intake and disease. The poor correlation between HCA intake and intakes of fried meat and fish facilitates an isolation of the health effects of HCAs.     

Dietary intake and different types of physical activity: full-day energy expenditure, occupational and leisure-time

OBJECTIVE: To describe the relationship between dietary intake and different levels and types of physical activity (PA). DESIGN: Cross-sectional evaluation of the EPIPorto study. Energy expenditure (metabolic energy equivalent tasks) and dietary intake during the past year were assessed using a PA questionnaire and a semi-quantitative food-frequency questionnaire, respectively. SETTING: Representative sample of adults in Porto, Portugal. SUBJECTS: Data were analysed for 2404 Portuguese Caucasian adults, aged between 18 and 92 years. RESULTS: For total PA, males who were active had significantly higher mean intake of energy (10.76 (2570.7) vs. 9.78 (2336.9) MJ/d (kcal/d), P < 0.001) and lower level of protein consumption (16.9 vs. 17.6 % of energy, P < 0.001) compared with sedentary males. In males, the association between total PA and energy intake remained after adjustment for age, education and body mass index. Similar results were observed when occupational activity was analysed. Concerning the energy expended in leisure time, in both genders, after adjustment for the previously described variables, a significant positive association was found between PA and intake of vitamin C (g/d): beta = 0.12, 99 % confidence interval (CI) 0.02, 0.21 for females and beta = 0.13, 99 % CI 0.03, 0.22 for males. Leisure-time activity in females was also positively associated with intakes of fibre, vitamin E, folate, calcium and magnesium, and negatively associated with saturated fat. CONCLUSIONS: Higher levels of PA in leisure time were associated with higher intakes of micronutrients and lower intakes of saturated fat, particularly in females. For total and occupational PA, similar nutrient intake was observed between active and sedentary individuals.     

Saturated fat in the diet of Spanish children: relationship with anthropometric, alimentary, nutritional and lipid profiles

OBJECTIVE: To compare the anthropometric, alimentary, nutritional and lipid profiles and global diet quality of Spanish children according to saturated fat intake. DESIGN: This was a cross-sectional study. Food data were collected using a food-frequency questionnaire. SUBJECTS AND METHODS: The sample included 1112 children of both sexes, aged between 6 and 7 years, selected by means of random cluster sampling in schools. The plasma lipid profile included measurements of low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides, apolipoprotein A1 (apoA1) and apolipoprotein B (apoB). Global diet quality was evaluated by the Dietary Variety Index (DVI) and the Healthy Eating Index (HEI). RESULTS: Energy intake, DVI and HEI of children from the lower quartile of saturated fat intake (LL) were higher (P<001) than in the remaining children (UL). However, there were no significant differences in average height or weight between groups. The UL children had lower intakes of meat, fish, vegetables, fruits and olive oil and a higher intake of dairy products (P<0.001). The intakes of fibre, vitamins C, D, B6, E and folic acid were higher in the LL children, who had lower intakes of vitamin A and calcium. The ratios LDL-C/HDL-C and apoB/apoA1 were lower (P=0.04) in the LL children (1.87 and 0.52, respectively) than in the UL children (2.02 and 0.54, respectively). CONCLUSIONS: The growth rate of children does not seem to be affected by the level of saturated fat intake. Furthermore, at the levels of intake observed in this study, diets with less saturated fat are associated with better alimentary, nutritional and plasma lipid profiles.     

Whole-grain intake as a marker of healthy body weight and adiposity

OBJECTIVE: To review evidence relating to the consumption of whole grains and healthy body weight (BW). DESIGN: Systematic review and analysis of observational studies reporting whole-grain consumption and measures of BW and adiposity, including the effect on macronutrient intakes and lifestyle factors. SETTING: Medline and other databases were searched for the period 1990 to 2006 to produce a full reference list; observational studies were retained for further analysis if they included an appropriate control group and reported whole-grain intake and body mass index (BMI) or a measure of adiposity. SUBJECTS: Fifteen trials were identified which included data from 119 829 male and female subjects aged 13 years and over. RESULTS: The combined and weighted mean difference in BMI from 15 studies representing 20 treatment groups (n = 119 829) using a random-effects model was 0.630 kg/m2 lower when high versus low whole-grain intake was compared, P < 0.0001 (95 % confidence interval (CI) 0.460, 0.800 kg/m2). In high consumers, adiposity assessed as waist circumference was reduced by 2.7 (95 % CI 0.2, 5.2) cm, P = 0.03 (six data sets, n = 4178) or as waist:hip ratio by 0.023 (95 % CI 0.016, 0.030), P < 0.0001 (four data sets, n = 20 147). Higher intake of whole grains led to increased dietary fibre intake (9 g, P < 0.01), while total and saturated fat intakes decreased by 11 g and 3.9 g, respectively. CONCLUSION: A higher intake of whole grains (about three servings per day) was associated with lower BMI and central adiposity. In addition, people who consume more whole grains are likely to have a healthier lifestyle as fewer of them smoke, they exercise more frequently and they tend to have lower fat and higher fibre intakes.     

Validation of a food-frequency questionnaire for use in pregnancy

OBJECTIVES: As a part of an ongoing project to develop a nutritional screening tool, we evaluated the performance of a semi-quantitative food-frequency questionnaire (FFQ) in terms of validity in a Sheffield Caucasian pregnant population using two different statistical approaches--the correlation coefficient and the limits of agreement (LOA). The FFQ was designed specifically for pregnant women and previously used in a large-scale study. DESIGN: A validation study. SETTING: A community-based field study of a general population of pregnant women booked for their first antenatal appointment at the Jessop Wing, Royal Hallamshire Hospital, Sheffield, UK. SUBJECTS: One hundred and twenty-three women of different socio-economic status, aged between 17 and 43 years, provided complete dietary data. RESULTS: The validity of the FFQ was tested against a series of two 24-hour recalls. As expected, the intakes of all examined nutrients, except for iodine, carotene, vitamin E, biotin, vitamin C and alcohol, were higher when determined by the FFQ than when determined by 24-hour recall. Pearson's correlation coefficient between the two methods ranged from 0.19 (added sugar, zinc) to 0.47 (Englyst fibre). The LOA were broader for some of the nutrients, e.g. protein, Southgate fibre and alcohol, and an increasing lack of agreement between the two methods was identified with higher dietary intakes. CONCLUSIONS: The FFQ gave useful estimates of the nutrient intakes of Caucasian pregnant women and appears to be a valid tool for categorising pregnant women according to dietary intake. The FFQ performed well for most nutrients and had acceptable agreement with the 24-hour recall.