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.     

Validation of a diet history questionnaire for use with Costa Rican adults

OBJECTIVE: To validate a diet history questionnaire (DHQ) using a weighed food record (WFR) as the standard method in the estimation of food consumption and nutrient intake in a group of adults. DESIGN: WFR: all foods consumed by subjects during 7 consecutive days were weighed and recorded by nutrition students. Two DHQ interviews were carried out on days 1 (first diet history questionnaire, DHQ1) and 28 (second diet history questionnaire, DHQ2). SETTING: Costa Rica. SUBJECTS: Sixty adults: 30 men and 30 women; 30 living in urban and 30 in rural areas. RESULTS: In comparison to the WFR, the DHQ1 gave statistically significant higher estimates of the mean intake of 19 nutrients for men and of three nutrients for women. The uncorrected correlation coefficients for nutrient intake according to both methods ranged from 0.40 to 0.83 for males and from 0.22 to 0.62 for females. Percentage of subjects classified in the same quartiles of nutrient intake according to each method ranged from 33.3% to 63.3% for males and from 23.3% to 53.3% for females. Misclassification in extreme quartiles ranged from 0% to 13.3% for both sexes. The mean food group consumption, according to the DHQ1, when compared with the WFR, gave statistically significant differences for three of the 18 food groups for men and for two groups in the case of women. The two applications of the DHQ gave similar results. CONCLUSION: Validation of a DHQ using a WFR as the standard method gave results that compare favourably with those reported by other authors. This study found important differences in the response of men and women to the DHQ: among men, the estimates of mean nutrient intake from DHQ1 were significantly greater than those of the WFR, while in the case of women, the mean nutrient intake estimates from both methods were not significantly different. There was a higher degree of correlation between the DHQ1 and the WFR mean nutrient intakes among men than among women. The DHQ showed good reproducibility.     

Validation of a semi-quantitative food-frequency questionnaire used among 2-year-old Norwegian children

OBJECTIVES: An adequate diet is of profound importance in infancy and early childhood. To ensure an optimal diet, knowledge about actual intake must be obtained. The aims of this study were to assess the validity of a semi-quantitative food-frequency questionnaire (SFFQ) applied in a large nation-wide survey among 2-year-old children and to examine the validity of the SFFQ in relation to different background parameters. DESIGN: The SFFQ was administered to the parents close to the child's second birthday, and one to two weeks later they started to weigh and record the child's diet for 7 days. SUBJECTS: One-hundred and eighty-seven families with a 2-year-old child completed both methods. RESULTS: There were no differences between the intakes of protein, saturated fatty acids, total carbohydrates and calcium estimated from the two methods. The average intake of all micronutrients, except for calcium, was overestimated by the SFFQ. Bland-Altman plots showed a systematic increase in difference between the two methods with increasing intake for most nutrients. Spearman correlation coefficients between methods for nutrient intakes ranged from 0.26 to 0.50, the median correlation was 0.38. The correlations increased when estimates were adjusted for energy intake, the median correlation being 0.52. Differences in observed validity were found according to the number of siblings.CONCLUSIONS: This study indicates that the SFFQ may be a valuable tool for measuring average intakes of energy, macronutrients and several food items among a 2-year-old population in Norway. The ability of the questionnaire to rank children according to intakes of nutrients and food items was rather low.     

Estimations of daily energy and nutrient availability based on nationally representative household budget survey data. The Data Food Networking (DAFNE) project

OBJECTIVE: To describe a cost-efficient method for estimating energy and nutrient availability using household budget survey (HBS) data. DESIGN: Four different approaches were tested and the results were compared with published nutrient intake data. The selected method was exemplarily applied in German and Greek data. SETTING: Germany, 1998; Greece, 1998/99. MATERIAL: Nationally representative HBSs. RESULTS: Comparisons showed that HBS-based estimates were generally close to intake data when results were presented as contributions to daily energy intake. Daily energy and protein availabilities were similar in Germany and Greece. Differences were observed in the availability of carbohydrates (German households reported a 5 percentage points higher contribution to daily energy availability) and lipids (Greek households recorded higher values for total fat, but lower values for saturated fat). Meat, added lipids and potatoes were important energy suppliers in Germany, whereas in Greece the first three energy suppliers were added lipids, cereals and meat. In both countries, meat, cereals, milk and cheese were important protein sources and cereals, potatoes, fruits and nuts contributed more than 60% of the daily carbohydrate availability. Added lipids were the major source of fat in the daily diet of both countries, but their contribution amounted to less than one-third in Germany and two-thirds in Greece. CONCLUSIONS: National HBS data can be used for monitoring and comparing nutrient availability among representative population samples of different countries. The ground is set for the development of a harmonised food composition table to be applied to HBS food data at international level.     

Reproducibility of a short semi-quantitative food group questionnaire and its performance in estimating nutrient intake compared with a 7-day diet diary in the Million Women Study

OBJECTIVES: To assess the short- and long-term reproducibility of a short food group questionnaire, and to compare its performance for estimating nutrient intakes in comparison with a 7-day diet diary. DESIGN: Participants for the reproducibility study completed the food group questionnaire at two time points, up to 2 years apart. Participants for the performance study completed both the food group questionnaire and a 7-day diet diary a few months apart. Reproducibility was assessed by kappa statistics and percentage change between the two questionnaires; performance was assessed by kappa statistics, rank correlations and percentages of participants classified into the same and opposite thirds of intake. SETTING: A random sample of participants in the Million Women Study, a population-based prospective study in the UK. SUBJECTS: In total, 12 221 women aged 50-64 years. RESULTS: In the reproducibility study, 75% of the food group items showed at least moderate agreement for all four time-point comparisons. Items showing fair agreement or worse tended to be those where few respondents reported eating them more than once a week, those consumed in small amounts and those relating to types of fat consumed. Compared with the diet diary, the food group questionnaire showed consistently reasonable performance for the nutrients carbohydrate, saturated fat, cholesterol, total sugars, alcohol, fibre, calcium, riboflavin, folate and vitamin C. CONCLUSIONS: The short food group questionnaire used in this study has been shown to be reproducible over time and to perform reasonably well for the assessment of a number of dietary nutrients.     

The influence of cereal and dairy consumption on the Irish diet: implications for developing food-based dietary guidelines

OBJECTIVES: To estimate the intakes of cereal and dairy products and their contribution to nutrient intakes in men and women from the Republic of Ireland with a view to formulating food-based dietary guidelines. DESIGN: The North/South Ireland Food Consumption Survey established a database of habitual food and drink consumption using a 7-day food diary. From this database all cereal and dairy products from recipes and identifiable sources were identified and a new database was generated from which analysis of the role of cereal and dairy products in the diet was carried out. RESULTS: Almost 100% of the population consumed cereal and dairy products over the course of the survey week. In general, men consumed significantly more cereal and dairy products than did women (P<0.05). Cereal products made an important contribution to the mean daily intakes of energy (26%), protein (21%), fat (13%), carbohydrate (41%), fibre (45%), iron (43%) and folate (27%). Dairy products also contributed largely to the mean daily intakes of energy (11%), protein (14%), fat (17%), calcium (48%), phosphorus (24%) and vitamin A (27%). Analysis of nutrient intakes across tertiles of cereal and dairy consumption showed that high consumers of wholemeal bread, breakfast cereals, reduced-fat milk and yoghurt had lower fat and higher carbohydrate, fibre and micronutrient intakes than low consumers of these foods. CONCLUSIONS: Findings from the present study could be used to develop effective health strategies to implement changes in cereal and dairy consumption that could alter fat, fibre and micronutrient intakes in the diet.     

A multilevel study of socio-economic inequalities in food choice behaviour and dietary intake among the Dutch population: the GLOBE study

OBJECTIVE: To examine the influence of individual- and area-level socio-economic characteristics on food choice behaviour and dietary intake. SETTING: The city of Eindhoven in the south-east Netherlands. DESIGN: A total of 1339 men and women aged 25-79 years were sampled from 85 areas (mean number of participants per area = 18.4, range 2-49). Information on socio-economic position (SEP) and diet was collected by structured face-to-face interviews (response rate 80.9%). Individual-level SEP was measured by education and household income, and area-level deprivation was measured using a composite index that included residents' education, occupation and employment status. Diet was measured on the basis of (1) a grocery food index that captured compliance with dietary guidelines, (2) breakfast consumption and (3) intakes of fruit, total fat and saturated fat. Multilevel analyses were performed to examine the independent effects of individual- and area-level socio-economic characteristics on the dietary outcome variables. RESULTS: After adjusting for individual-level SEP, few trends or significant effects of area deprivation were found for the dietary outcomes. Significant associations were found between individual-level SEP and food choice, breakfast consumption and fruit intake, with participants from disadvantaged backgrounds being less likely to report food behaviours or nutrient intakes consistent with dietary recommendations. CONCLUSIONS: The findings suggest that an individual's socio-economic characteristics play a more important role in shaping diet than the socio-economic characteristics of the area in which they live. In this Dutch study, no independent influence of area-level socio-economic characteristics on diet was detected, which contrasts with findings from the USA, the UK and Finland.     

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.     

The Medi-RIVAGE study (Mediterranean Diet, Cardiovascular Risks and Gene Polymorphisms): rationale, recruitment, design, dietary intervention and baseline characteristics of participants

OBJECTIVE: To report the rationale, recruitment, design, dietary intervention and baseline characteristics of participants in the Medi-RIVAGE study (Mediterranean Diet, Cardiovascular Risks and Gene Polymorphisms). DESIGN: A randomised, parallel trial comparing a new nutritional programme with a conventional programme. SETTING: Centre for Detection and Prevention of Arteriosclerosis, Timone University Hospital, Marseille, France, and collaborating teams. SUBJECTS: Two hundred and twelve male and female volunteers with at least one cardiovascular risk factor. INTERVENTION: A Mediterranean-type diet characterised mainly by the quality of fatty acids, amount of fish, vegetable foodstuffs and fibre was proposed and compared with a usually prescribed, low-fat/cholesterol diet. Body mass index, fasting lipids and lipoproteins, apolipoproteins, glucose, insulin and homocysteine were the main outcome measures. Gene polymorphisms of interest were determined. RESULTS: Characteristics of men in the two arms were comparable with regard to sociodemographic variables, and clinical and biological cardiovascular risk factors. There were few differences between the groups of women (cholesterol-related parameters, P<0.05). There was no difference between arms in allelic distribution of the gene polymorphisms studied. Saturated fat and protein intakes were high while carbohydrate and fibre intakes were low, but with no difference between arms. Overall, the nutritional markers were comparable in both arms with few exceptions. Correlations between nutritional intakes and plasma nutrient levels ranged from 0.19 (beta-carotene) to 0.47 (folate). CONCLUSIONS: The comparability of the two arms is notable and warrants a low risk of biases. Current diet departs from the traditional Mediterranean one. The assessment of nutritional intake is validated by correlations obtained between dietary intake and relevant biomarkers. This will be important to estimate participant compliance and to analyse intervention data.     

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.     

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.     

Analysis of the temporal intake of cereal and dairy products in Irish adults: implications for developing food-based dietary guidelines

OBJECTIVES: To analyse the temporal distribution of the intake of cereal and dairy products in the Republic of Ireland. DESIGN: The North/South Ireland Food Consumption Survey established a database of habitual food and drink consumption using a 7-day food diary. The database also recorded the time and day of food consumption. Mean intakes of cereal and dairy products were calculated for time of the day and day of the week. RESULTS: At the weekend, the percentage of consumers decreased for nearly all cereal and dairy products. White bread, total cereals, full-fat milk and total dairy intakes were significantly lower at the weekend (P<0.01) compared with weekdays. Intakes of cereal and dairy products over time of the day showed clear mealtime or snacking patterns when the number of consumers was controlled for. White bread, wholemeal bread, total cereals, full-fat milk, reduced-fat milk and total dairy intakes showed mealtime peaks for morning, afternoon and evening. When examined by tertile of intake, tertile of percentage energy from fat and tertile of fibre intake, intakes of cereal and dairy products over time of the day and day of the week were similar to trends described above, regardless of the tertile. CONCLUSIONS: Temporal analysis of the intakes of cereal and dairy products did not reveal any unusual trends in this population. However, the significant methodological issues raised in this paper will be of benefit to other aspects of research in this area.     

Predictors of misreporting in an elderly population: the 'Quality of life after 65' study

OBJECTIVES: To evaluate the prevalence and identify some predictors of misreporting in an elderly Belgian population and to assess the effect of underreporting on estimated intakes of macronutrients and foods. DESIGN: A 1-day food record was completed by 2083 adult men and women aged 65 years or more. Individuals whose energy intake was lower than 0.90 x BMR (basal metabolic rate) were defined as underreporters. Overreporting was defined as energy intake greater than 2 x BMR. RESULTS: Underreporting and overreporting occurred in 13.6% and 7.9% of food records, respectively. Results from logistic regression models indicated that gender and body mass index (BMI) were predictors of misreporting. Whereas women were more likely to underreport energy intake, the prevalence of overreporting was higher in men. Underreporting was more prevalent among obese people and overreporting more prevalent in normal-weight subjects. Smoking status and education level did not predict underreporting; however, overreporting was more likely to occur in more highly educated subjects. A cultural difference in reporting of nutrient intakes was also found, with the percentage of underreporters being higher among Walloons compared with Flemish. CONCLUSION: BMI seemed to be one of the most important factors in misreporting. This calls for special attention when dietary surveys are performed on obese or lean people.     

Dietary intake and body mass index in HIV-positive and HIV-negative drug abusers of Hispanic ethnicity

OBJECTIVE: Malnutrition in drug abusers has been attributed to poor diet. However, previous studies are conflicting. Many studies have not considered possible concurrent HIV disease. The purpose of this study was to determine the relationship between drug abuse and dietary intake in Hispanic Americans with and without HIV infection. DESIGN: Dietary intake was measured using 3-day food records and 24-hour dietary recalls in three groups: HIV-positive drug abusers, HIV-negative drug abusers and HIV-positive persons who do not use drugs ('non-drug abusers'). SETTING: The baseline data from a prospective cohort study of the role of drug abuse in HIV/AIDS weight loss and malnutrition conducted in Boston, Massachusetts, USA. SUBJECTS: The first 284 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. Reported energy, fat and fibre intakes did not differ between groups. All groups had median reported intakes of vitamin A, vitamin B6, vitamin B12, selenium and zinc that were in excess of the dietary reference values (DRI). Intakes of alpha-tocopherol were below the DRI, but did not differ from intakes of the general US population. However, increasing levels of drug abuse were associated with lower reported intakes of vitamin B6, vitamin B12, selenium and zinc. CONCLUSIONS: Overall, this study does not support the notion that dietary intake can explain the lower BMI of HIV-positive drug abusers. Further studies examining non-dietary determinants of nutritional status in drug abusers are warranted.     

A regional food-frequency questionnaire for the US Mississippi Delta

OBJECTIVE: To describe food sources of nutrient intake for white and African American adults in the Lower Mississippi Delta (LMD), and their use in the development of a regional food-frequency questionnaire (FFQ) based on an earlier version of the National Cancer Institute's Health Habits and History Questionnaire. DESIGN: We ranked food sources of energy, macronutrients, vitamins and minerals, and examined portion size distributions for 842 white and 857 African American residents aged 19 years and older, using 24-hour dietary intake recall data from a telephone survey of 36 LMD counties. These values were used to develop a regional FFQ, which was then field-tested with 100 subjects and revised to improve interpretability. SETTING: The LMD region of the USA. SUBJECTS: White and African American adult residents of the LMD. RESULTS: LMD African Americans obtained more of their energy and nutrient intakes from poultry, processed meat, salty snacks, fruit drinks, pork and cornbread; and less from milk, alcohol, legumes, salad dressing, butter/margarine and sweetened tea than did white residents. Regional foods not on nationally used FFQs included grits, turnip greens, okra, ham hocks, chitterlings, crawfish, catfish, cracklings, jambalaya, potato logs, chicken and dumplings, and sweet potato pie. Based on responses during field-testing, the questionnaire was also designed to add four portion sizes for each food item, presented as questions, rather than in grid format. CONCLUSIONS: Regional food use patterns differ from national patterns and furthermore differ between African American and white adults in the LMD. The resulting Delta NIRI FFQ for Adults should contribute to improved assessment of usual intake for use in studies of diet and health in this region.     

Development and simulated validation of a food-frequency questionnaire for the Colombian population

OBJECTIVE: To develop a food-frequency questionnaire (FFQ) useful for ranking of nutrient intakes. DESIGN: Subjects consuming their regular diet completed 7 days of weighed intake registry (7-WIR). Foods for the FFQ were selected by stepwise multiple regression. The FFQ was then completed for each subject using data on individual food consumption from the 7-WIR. The correlation and agreement between the extrapolated FFQ and the 7-WIR data were assessed using Spearman's rank correlation coefficients (rS) and Bland and Altman's limits of agreement (LOA). SETTING: Bucaramanga, Colombia. SUBJECTS: We studied 97 randomly selected 20-40-year-old subjects. RESULTS: Sixty foods were selected for the FFQ. The 7-WIR and the extrapolated FFQ intake estimates correlated well. rS was 0.58 for energy, 0.53 for carbohydrate, 0.50 for total fat, and 0.48 for protein. For micronutrients, rS varied from 0.46 (manganese) to 0.71 (vitamin B12). FFQ average intake estimates were 83%, 80%, 86.2% and 86.4% of 7-WIR estimates for energy, carbohydrate, total fat and protein, respectively. LOA for these nutrients ranged between 45% and 165%. FFQ micronutrient intakes were on average 96% (median) of those from the 7-WIR, and the median lower and upper LOA were 50% and 203%. However, there was no indication that the degree of agreement varied with the level of intake. CONCLUSIONS: According to our simulated validation, this FFQ may be useful to rank subjects by nutrient intake. Its validity against standard independent measurements and its applicability to other subsets of the Colombian population should be carefully considered.     

Effects of revision of Japanese food composition tables on estimation of nutrient intakes, with reference to age-dependent differences

OBJECTIVE: To identify effects of revision of the Japanese food composition tables from the fourth version to the fifth version on nutrient intake estimation. DESIGN: A database on 783 samples of 24-hour food duplicate portions was re-visited. Nutrients in the duplicate portions were estimated by use of the fourth and fifth versions of the Japanese food composition tables in parallel, together with supplemental use of other databases. The two sets of estimates were subjected to comparison. SETTING: The sample collection was conducted at 31 sites all over Japan. SUBJECTS: The sample donors were 783 women aged 20-78 years. RESULTS: Compared with the estimates by use of the fourth version of the tables, the estimates by the fifth version were substantially higher for intakes of energy, carbohydrate, dietary fibre, vitamin A and niacin, and lower for iron intake. The increase in carbohydrate intake estimates was more evident in older women than in young women, whereas the decrease in the intake estimation of iron and the increase in that of dietary fibre were more marked in young women than in older women. CONCLUSION: The recent revision of food composition tables in Japan induced substantial changes in the estimation of nutrient intakes, i.e. an increase in energy, carbohydrate, dietary fibre, vitamin A and niacin, and a decrease in iron. The extent of the changes varied depending on age.     

Mediterranean diet and cancer

OBJECTIVE: To analyse the role of various aspects of the Mediterranean diet in several common epithelial cancers, including digestive and selected non-digestive tract neoplasms. DESIGN: Systematic analysis of data from a series of case-control studies. SETTING: Northern Italy, between 1983 and 1998. SUBJECTS: Over 12,000 cases of 20 cancer sites and 10,000 controls. RESULTS: For most epithelial cancers, the risk decreased with increasing vegetable and fruit consumption, with relative risk (RR) between 0.3 and 0.7 for the highest versus the lowest tertile. For digestive tract cancers, population-attributable risks for low intake of vegetables and fruit ranged between 15 and 40%. A protective effect was observed also for breast, female genital tract, urinary tract and a few other epithelial neoplasms. A number of antioxidants and other micronutrients showed an inverse relationship with cancer risk, but the main components responsible for the favourable effect of a diet rich in vegetables and fruit remain undefined. Fish tended to be another favourable diet indicator. In contrast, subjects reporting frequent red meat intake showed RRs above unity for several common neoplasms. Intake of whole-grain foods was related to a reduced risk of several types of cancer, particularly of the upper digestive tract. This may be due to a favourable role of fibre, but the issue is still open to discussion. In contrast, refined grain intake and, consequently, glycaemic load and glycaemic index were associated with increased risk of different types of cancer including, among others, breast and colorectal. CONCLUSIONS: A low-risk diet for cancer in the Mediterranean would imply increasing the consumption of fruit and vegetables, as well as avoiding increasing the intakes of meat and refined carbohydrates. Further, olive oil and other unsaturated fats, which are also typical aspects of the Mediterranean diet, should be preferred to saturated ones.     

An examination of the influence of eating location on the diets of Irish children

OBJECTIVES: To examine the influence of eating location on the quality of the diets of Irish children and to compare intakes at home with intakes at other people's homes and intakes outside the home, and to compare intakes at various locations outside the home. DESIGN: Food intake was measured using a 7-day weighed diary in 594 children from the Republic of Ireland (aged 5-12 years). Details of where the food was prepared or obtained were also recorded. RESULTS: Eighty-nine per cent of all eating occasions occurred at home; < 6% occurred at both other people's homes and outside the home (takeaway, restaurant, shop, other). The percentage of food energy from fat was above the recommended 35% at other people's homes and outside the home, specifically at takeaways and restaurants. Fibre and micronutrient intakes (per 10 MJ) were significantly higher at home than at the other locations (P < 0.05). Within the 'out' locations, fibre and micronutrient intakes were generally higher at restaurants and lower at shops. High consumers of foods outside the home had a statistically significant, but relatively small decline in nutrient intakes compared with non- or low consumers. Chips and processed potatoes, meat products, savouries, sugars and confectionery, and savoury snacks made the greatest contribution to foods consumed outside the home. CONCLUSIONS: The main focus of nutrition policies to improve the diets of Irish children should be the home environment rather than the food service sector. However, guidelines could call for better food choices outside the home to improve nutrient intakes.     

Secular trends in the association of socio-economic position with self-reported dietary attributes and biomarkers in the US population: National Health and Nutrition Examination Survey (NHANES) 1971-1975 to NHANES 1999-2002

OBJECTIVE: Recent reports suggest persistence of health disparities related to socio-economic position (SEP). To understand if diet may be a contributor to these trends, we examined secular trends in the association of diet and indicators of SEP from 1971-1975 to 1999-2002. DESIGN: We used data from the National Health and Nutrition Examination Surveys (NHANES) I (1971-1975), II (1976-1980), III (1988-1994) and 1999-2002 to examine the independent associations of poverty income ratio (PIR) and education with diet and biomarkers of diet and disease in 25-74-year-olds (n = 36,600). We used logistic and linear regression methods to adjust for multiple covariates and survey design to examine these associations. RESULTS: A large PIR differential in the likelihood of reporting a fruit or all five food groups and vitamin C intake, and an education differential in likelihood of obesity and carbohydrate intake, was noted in 1971-1975 but narrowed in 1999-2002 (P < 0.007). The positive association of education with intake of a fruit, vegetable or all five food groups, vitamins A and C, calcium and potassium intake remained unchanged across surveys (P < 0.001). Similarly, the positive association of PIR with the amount of foods and intakes of energy and potassium remained unchanged over three decades (P < 0.001). The education and the PIR differential in energy density, and the PIR differential in the likelihood of obesity, persisted over the period of the four surveys (P < 0.001). CONCLUSIONS: Persistence of unfavourable dietary and biomarker profiles in Americans with low income and education suggests continued need for improvement in the quality of diets of these high-risk groups.