Improving the nutritional status of food-insecure women: first, let them eat what they like

OBJECTIVE: To determine the extent to which identified nutrient inadequacies in the dietary intakes of a sample of food-insecure women could be ameliorated by increasing their access to the 'healthy' foods they typically eat. DESIGN: Merged datasets of 226 food-insecure women who provided at least three 24-hour dietary intake recalls over the course of a month. Dietary modelling, with energy adjustment for severe food insecurity, explored the effect of adding a serving of the woman's own, and the group's typically chosen, nutrient-rich foods on the estimated prevalence of nutrient inadequacy. SETTING AND SUBJECTS: One study included participants residing in 22 diverse community clusters from the Atlantic Provinces of Canada, and the second study included food bank attendees in Toronto, Ontario, Canada. Of the 226 participants, 78% lived alone with their children. RESULTS: While nutritional vulnerability remained after modelling, adding a single serving of either typically chosen 'healthy' foods from women's own diets or healthy food choices normative to the population reduced the prevalence of inadequacy by at least half for most nutrients. Correction for energy deficits resulting from severe food insecurity contributed a mean additional 20% improvement in nutrient intakes. CONCLUSIONS: Food-insecure women would sustain substantive nutritional gains if they had greater access to their personal healthy food preferences and if the dietary compromises associated with severe food insecurity were abated. Increased resources to access such choices should be a priority.     

Validating a nutrient profile model

OBJECTIVE: To assess the validity of nutrient profiling Model WXYfm - developed for the purpose of regulating the promotion of 'less healthy' foods to children. The model ranks foods according to their healthiness and categorises foods into 'healthier' and 'less healthy' foods. DESIGN: Convergent and discriminant validity was tested by comparing the way Model WXYfm categorises foods with the way the UK's national food guide - the Balance of Good Health (BGH) - categorises foods. Construct validity was assessed by testing a hypothesis relating the constructs of 'healthiness' of foods (as measured by Model WXYfm) and the 'healthiness' of diets (measured using the Diet Quality Index) and assessing whether this hypothesis was confirmed or refuted by using data on the dietary patterns of subjects (n = 1117) of the National Diet and Nutrition Survey of adults carried out in Great Britain in 2000-01. RESULTS: Model WXYfm showed good convergent and discriminant validity: the level of agreement between the way the model categorises foods and the way the BGH categorises foods was good (kappa = 0.69). Model WXYfm also showed good construct validity: the energy intake from 'less healthy' foods amongst subjects with the least healthy diets was nearly twice the energy intake from 'less healthy' foods amongst the subjects with the healthiest diets. CONCLUSIONS: Model WXYfm demonstrated good validity in categorising foods in a way that is related to the healthiness of diets both recommended and achieved. The methods for assessing the validity of a nutrient profile model used in this paper have not, to our knowledge, been used before.     

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.     

Issues in assessing the validity of nutrient data obtained from a food-frequency questionnaire: folate and vitamin B12 examples

OBJECTIVE: To compare methods used to assess the validity of nutrient intake data obtained from a food-frequency questionnaire (FFQ), using folate and vitamin B12 as nutrient examples. DESIGN: Cross-sectional sample from a population cohort. SETTING: Two postcode areas west of Sydney, Australia. SUBJECTS: In total, 2895 people aged 49 years and older provided dietary data using a semi-quantitative FFQ (79% of 3654 subjects examined). The validity of the FFQ was assessed against three 4-day weighed food records (WFRs) completed by 78 people (mean age 70 years). RESULTS: Folate and vitamin B12 validity data were assessed using different methods. The Spearman ranked correlations (energy-adjusted) were 0.66 for folate and 0.38 for vitamin B12. Using the Bland-Altman method, following loge transformation, no linear trend existed between the differences and means for folate and vitamin B12. Large differences existed between the FFQ and WFR in individual cases, particularly for vitamin B12. Finally, data were divided into quintile categories for the test and reference method: 79% classified folate within one quintile, 65% classified vitamin B12 within one quintile; there was no gross misclassification for folate and only 3% misclassification for vitamin B12. CONCLUSIONS: Different methods of analysis provided different information about the validity of the FFQ. Correlation coefficients should not be used alone to assess the validity of nutrient data, but should be used in conjunction with Bland-Altman analyses. Depending on the use of the data, additional assessment of classification categories is recommended. This worked example demonstrates that absolute intakes of folate and vitamin B12 should be used with caution.     

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.     

Validity of carbohydrate, glycaemic index and glycaemic load data obtained using a semi-quantitative food-frequency questionnaire

OBJECTIVE: To assess the ability of a food-frequency questionnaire (FFQ) to rank Australians according to their intake of total carbohydrate, sugar, starch, fibre, glycaemic index (GI) and glycaemic load (GL). DESIGN: Cross-sectional sample from a population cohort. SETTING: Two postcode areas west of Sydney, Australia. SUBJECTS: From 1992 to 1994, a total of 2868 older Australians provided dietary data using a 145-item Willett-derived FFQ. A representative sub-sample of 78 subjects completed three 4-day weighed food records (WFRs). Pearson and Spearman correlations, Bland-Altman plots and weighted kappa values were calculated. RESULTS: Compared with the WFR, the FFQ provided higher mean estimates of all nutrients except starch and GI. All Pearson and/or Spearman correlations were greater than 0.5, except for GL. For GI, sugar, starch and fibre, the regression lines from the Bland-Altman analysis indicated a non-significant linear trend (P = 0.07, P = 0.36, P = 0.28 and P = 0.10, respectively). For GL and total carbohydrate, however, there was a significant linear trend (P = 0.006 and P < 0.0001, respectively), indicating that as the GL and carbohydrate intake of individuals increased, so did the magnitude of the error between the FFQ and WFR. Weighted kappa values all indicated moderate to good agreement, with the exception of GL which was only fair. The proportions of subjects correctly classified within one quintile for all of the nutrients were over 50% and gross misclassification was low (<10%). CONCLUSION: This FFQ was able to rank individuals according to their intakes of total carbohydrate, sugar, starch, fibre and GI, but not as well for GL.     

Separate estimates of portion size were not essential for energy and nutrient estimation: results from the Southern Community Cohort food-frequency questionnaire pilot study

OBJECTIVE: A food-frequency questionnaire (FFQ) was developed to assess habitual dietary intake in the Southern Community Cohort Study (SCCS), a prospective epidemiological study to analyse disparities in cancer and other chronic diseases between African-Americans and Whites. DESIGN: Frequency and portion size estimates were obtained for each of 104 foods. Daily intakes of 13 food groups, energy and 18 nutrients were computed. Each participant's rank and quintile classification of nutrient intakes was determined with and without the use of the subject's reported portion size. SUBJECTS: The sample was obtained from the SCCS pilot study conducted in Tennessee, Mississippi and Florida, and consisted of 209 adults, 54% African-American, with a mean (standard deviation) age of 57.1 (12.5) years. RESULTS: Correlations between the ranks from the two methods of estimation were high, ranging from 0.66 to 0.94 for food groups and 0.81 to 0.94 for nutrients. Pearson correlations were similarly high for food groups and nutrients. Concordance in exact quintile rank across the nutrient indices ranged from 52 to 70%, rising to 90-99% for concordance within adjacent quintiles. CONCLUSIONS: To reduce the respondents' burden and to increase data completeness, the assignment of a uniform portion size when scoring the SCCS FFQ was considered acceptable.     

How well do Australian women comply with dietary guidelines?

OBJECTIVE: To investigate the proportion of middle-aged Australian women meeting national dietary recommendations and its variation according to selected sociodemographic and behavioural characteristics. DESIGN: This cross-sectional population-based study used a food-frequency questionnaire to investigate dietary patterns and compliance with 13 commonly promoted dietary guidelines among a cohort of middle-aged women participating in the Australian Longitudinal Study on Women's Health. SETTING: Nation-wide community-based survey. SUBJECTS: A total of 10,561 women aged 50-55 years at the time of the survey in 2001. RESULTS: Only about one-third of women complied with more than half of the guidelines, and only two women in the entire sample met all 13 guidelines examined. While guidelines for meat/fish/poultry/eggs/nuts/legumes and 'extra' foods (e.g. ice cream, chocolate, cakes, potatoes, pizza, hamburgers and wine) were met well, large percentages of women (68-88%) did not meet guidelines relating to the consumption of breads, cereal-based foods and dairy products, and intakes of total and saturated fat and iron. Women working in lower socio-economic status occupations, and women living alone or with people other than a partner and/or children, were at significantly increased risk of not meeting guidelines. CONCLUSIONS: The present results indicate that a large proportion of middle-aged Australian women are not meeting dietary guidelines. Without substantial changes in their diets, and help in making these changes, current national guidelines appear unachievable for many women.     

Traditional food diversity predicts dietary quality for the Awajún in the Peruvian Amazon

OBJECTIVE: Our goal was to assess the potential for evaluating strengths of the Awajún traditional food system using dietary assessment, a traditional food diversity score and ranking of local foods. DESIGN: The method was used for dietary data obtained from mothers and children in the Awajún culture of the Peruvian Amazon where >90% of the dietary energy is derived from local, traditional food. Traditional food diversity scores were calculated from repeat 24-hour recalls. Group mean intakes of energy, fat, protein, iron, vitamin A and vitamin C from each food item were used to rank foods by nutrient contribution. SETTING: The study took place in six remote communities along the lower Cenepa River in the Amazonas District of Peru, South America. SUBJECTS: Dietary data were collected from 49 Awajún mothers and 34 children aged 3-6 years, representative of the six communities. RESULTS: Higher traditional food diversity was associated with greater protein, fibre, vitamin and mineral intakes when controlling for energy (partial correlations = 0.37 to 0.64). Unique sources for iron, total vitamin A and vitamin C were found in the Awajún traditional food system. CONCLUSIONS: A traditional food diversity score was a useful tool for predicting nutrient adequacy for the Awajún. Promotion of the Awajún traditional food system should focus on dietary diversity and unique nutrient-dense local foods.     

Tracking of energy and nutrient intakes from adolescence to young adulthood: the experiences of the Young Hearts Project, Northern Ireland

OBJECTIVE: To assess tracking of energy and nutrient intakes between adolescence and young adulthood. DESIGN: Longitudinal study of a random sample of adolescents (aged 15 years at baseline). The extent of tracking of dietary intakes (assessed by diet history) was investigated using weighted kappa statistics (kappa). SETTING: Northern Ireland population survey. SUBJECTS: Adolescents who participated in the Young Hearts Project, Northern Ireland at age 15 years, and subsequently at young adulthood aged between 20 and 25 years (n=245 males, n=231 females). RESULTS: Despite overall increases in height and weight (both P<0.001), increases in body mass index in males (P<0.001) and body fatness in females (P<0.001), median reported intakes of energy (kJ kg(-1) day(-1)), carbohydrate (g day(-1)) and fat (g day(-1)) decreased (all P<0.001) over time. Expressed as nutrient densities (per MJ), diets at young adulthood were overall richer in thiamin, vitamin B6, total folate (all P<0.001), vitamin C (P<0.01) and vitamin D (P<0.05). Whereas the nutrient density of the males' diets decreased over time for calcium (P<0.05) and vitamin A (P<0.001), iron and riboflavin densities increased in the females' diet (P<0.001). Tracking of energy (MJ day(-1)) and nutrient intakes (expressed per MJ day(-1)) at the individual level was only poor to fair (all kappa<0.25), indicating substantial drift of subjects between the low, medium and high classes of intake with increasing age. CONCLUSIONS: These data suggest that individual dietary patterns exhibited at 15 years of age are unlikely to be predictive of dietary intakes at young adulthood.     

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.     

What do babies eat? Evaluation of a food frequency questionnaire to assess the diets of infants aged 6 months

OBJECTIVE: To evaluate the relative validity of a food frequency questionnaire (FFQ) for assessing nutrient intakes in 6-month-old infants. DESIGN AND SETTING: The FFQ was developed to assess the diets of infants born to women in the Southampton Women's Survey (SWS), a population-based survey of young women and their offspring. The energy and nutrient intakes obtained from an interviewer-administered FFQ were compared with those obtained from a 4-day weighed diary. SUBJECTS AND METHODS: A sub-sample of 50 infants aged 6 months from the SWS had their diets assessed by both methods. The FFQ recorded the frequencies and amounts of milks, baby foods, regular foods and drinks consumed by the infants over the previous seven days. The diaries recorded the weights of all foods and drinks consumed by the infants on four separate days within 15 days following FFQ completion. RESULTS: Spearman rank correlation coefficients for intakes of energy, macronutrients and 18 micronutrients, determined by the two methods, ranged from r = 0.39 to 0.86; adjustment for energy intake tended to increase the correlation coefficients, range r(a) = 0.55 to 0.89. Bland-Altman statistics showed that mean differences between methods were in the range of -12.5% to +12.5% except for vitamin B12 (-18.9%). CONCLUSION: Although there were differences in absolute energy and nutrient intakes between methods, Spearman rank correlation coefficients indicated reasonable agreement in the ranking of intakes. The interviewer-administered FFQ is a useful tool for assessing energy and nutrient intakes of healthy infants aged about 6 months.     

The role of breakfast in nutrient intake of urban schoolchildren

OBJECTIVES: To ascertain the breakfast habits of 10-15-year-old schoolchildren and to assess the quality of this meal as well as its relationship to the food consumption pattern for the full day. DESIGN: Cross-sectional survey. SUBJECTS AND SETTING: Eight hundred and two schoolchildren, boys and girls, aged 10-15 years, belonging to different urban schools located in Secunderabad, Andhra Pradesh, India. METHOD: The breakfast eating patterns of the children were studied and their impact on growth was assessed, using dietary recalls and anthropometric measurements. RESULTS: Only 42.8% of the children ate breakfast regularly. Over half of the children skipped breakfast, ranging from daily to once in two weeks. The energy and protein composition of breakfasts eaten by the children indicated that those who did not skip breakfast met one-quarter to one-third of their total daily energy and protein requirements. Mean nutrient intakes calculated from 24-hour recalls revealed that the children's diets were inadequate compared with the recommended values for energy and protein. The inadequate energy intake was reflected in a high incidence of malnutrition in both boys and girls; 40.3% of the boys and 32.1% of the girls studied were found to be underweight. Protein intake was also inadequate among boys and girls, although a higher percentage of children met their protein requirements. CONCLUSIONS: Over half of the schoolchildren studied skipped breakfast frequently, the main reason being getting up late. Children who consumed breakfast had higher daily intakes of energy and protein than children who skipped breakfast. These data confirm the importance of breakfast to overall dietary quality and adequacy in school-aged children.     

Changes in consumption of sugars by English adolescents over 20 years

OBJECTIVE: Dietary surveys of 11- to 12-year-old Northumbrian children in 1980 and 1990 revealed that consumption of non-milk extrinsic sugars (NMES) was 16-17% of energy intake. This study reports dietary sugars consumption in 2000 and compares it with data collected in 1980 and 1990, using identical methods. DESIGN: A repeat cross-sectional dietary survey of children aged 1-12 years attending the same schools as in the 1980 and 1990 surveys. SETTING: Seven middle schools in south Northumberland. SUBJECTS: All children aged 11-12 years old attending the seven schools. METHOD: Food consumption was recorded using two 3-day diet diaries. Food composition tables were used to calculate energy and nutrient intakes. NMES, and milk and intrinsic sugars were calculated using previously described methods. RESULTS: The numbers of children completing the surveys in 1980, 1990 and 2000 were 405, 379 and 424, respectively; approximately 60-70% of eligible children. Total sugars provided 22% of energy consistently over the three surveys. NMES consumption in 2000 provided 16% of energy compared with 16% in 1980 and 17% in 1990. Sources of NMES changed over the three surveys. NMES from soft drinks doubled from 15 to 31 g day(-1), and from breakfast cereals increased from 2 to 7 g day(-1) over the 20 years. Confectionery and soft drinks provided 61% of NMES. Over 20 years, the proportion of energy from fat decreased by 5% and from starch increased by 4%, creating a welcome tilt in the fat-starch see-saw, without an adverse effect on sugars intake. CONCLUSIONS: Consumption of NMES in 2000 was substantially higher than recommended, and there has been little change over 20 years. Continued and coordinated efforts are required at a national, community and individual level to reduce the intake of NMES.     

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.     

Potential renal acid load in the diet of children and adolescents: impact of food groups, age and time trends

OBJECTIVE: The impact of acid-base balance on health is widely accepted. Here, we describe the potential renal acid load (PRAL) in the diet of healthy German children and adolescents. DESIGN: The Dortmund Nutritional and Anthropometric Longitudinally Designed (DONALD) Study is an ongoing longitudinal (open cohort) study (start 1985) collecting detailed data on diet, growth, development and metabolism in infants, children and adolescents. SETTING: Research Institute of Child Nutrition, Dortmund. SUBJECTS: Seven hundred and twenty children and adolescents (351 boys and 369 girls), aged 3-18 years, provided 4187 yearly collected 3-day dietary records between 1995 and 2005. RESULTS: Mean daily PRAL was positive in all age/sex groups (6-21 mEq day-1), and significantly higher in boys than in girls after the age of 8 years, even when calculated as mEq MJ-1. Fruits, vegetables and potatoes had a negative impact on PRAL; cheese, dairy products, cereals/bread and meat/fish/eggs had a positive impact. In a mixed linear model, PRAL, expressed as mEq day-1 and mEq MJ-1, remained stable during the study period, since time trends of PRAL-relevant food groups countervail each other. PRAL intake (mEq MJ-1) was significantly positively associated (P < 0.0001) with fat intake (% of energy intake, %E), but negatively with carbohydrate intake (%E; P < 0.0001). CONCLUSIONS: The analysis of dietary habits in our sample of German children and adolescents showed a moderate excess of acidity. Especially older boys should be encouraged to eat more potatoes and vegetables as good sources of dietary alkalinity. The PRAL concept is compatible with current concepts for a healthy diet.     

Dietary intake and a food-frequency instrument to evaluate a nutrition intervention for the Apache in Arizona

OBJECTIVE: To demonstrate how dietary data collected from 24-hour dietary recalls were incorporated into the development of a quantitative food-frequency questionnaire (QFFQ) for the Apache in Arizona. DESIGN: A cross-sectional study was first conducted using 24-hour dietary recalls to identify foods for inclusion on a QFFQ that would be used to evaluate a nutrition intervention. SETTING: The White Mountain and San Carlos Apache reservations in East-central Arizona. SUBJECTS: The 24-hour dietary recalls were collected from a random sample of 53 adults (34 women and 19 men). RESULTS: A QFFQ was developed that included all foods reported by two or more respondents, plus traditional and seasonal foods. Portion size was assessed using familiar household units and culturally appropriate food models. The final instrument contains 155 foods. Frequency of consumption is assessed using eight categories ranking from 'never or less than once a month' to '2 or more times a day'. Nutrient intakes and the five major food sources of energy, fat and sugar are presented. CONCLUSION: The QFFQ developed is complete and up-to-date for assessing usual food and nutrient intake for the Apache in Arizona. The instrument will be used to evaluate a food store-based nutrition intervention to reduce risk of chronic diseases.     

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.     

Age-related variations in flavonoid intake and sources in the Australian population

OBJECTIVE: To estimate flavonoid intake in the Australian population. DESIGN: Flavonoid consumption was estimated from 24-hour recall data and apparent consumption data using US Department of Agriculture flavonoid composition data. SUBJECTS: The National Nutrition Survey 1995 assessed dietary intake (24-hour recall) in a representative sample (n=13,858) of the Australian population aged 2 years and over. RESULTS: Analysis of the 24-hour recall data indicated an average adult intake (>18 years) of 454 mg day(-1) (92% being flavan-3-ols). Apple was the highest quercetin source until age 16-18 years, after which onion became an increasingly important prominent source. Variations in hesperetin consumption reflected orange intake. Apple, apricot and grapes were the major sources of epicatechin and catechin for children, but subsided as wine consumption increased in adulthood. Wine was the main source of malvidin. Naringenin intake remained static as a percentage of total flavonoid intake until age 19-24 years, corresponding to orange intake, and then increased with age from 19-24 years, corresponding to grapefruit intake. Apparent dietary flavonoid consumption was 351 mg person(-1) day(-1), of which 75% were flavan-3-ols. Black tea was the major flavonoid source (predominantly flavan-3-ols) representing 70% of total intake. Hesperetin and naringenin were the next most highly consumed flavonoids, reflecting orange intake. Both 24-hour recall and apparent consumption data indicated that apigenin intake was markedly higher in Australia than reported in either the USA or Denmark, presumably due to differences in consumption data for leaf and stalk vegetables and parsley. CONCLUSIONS: Tea was the major dietary flavonoid source in Australia. Flavonoid consumption profiles and flavonoid sources varied according to age. More consistent methodologies, survey tools validated for specific flavonoid intakes and enhanced local flavonoid content data for foods would facilitate better international comparisons of flavonoid intake.     

The development of self-efficacy and outcome expectation measures regarding glycaemic load and the nutritional management of type 2 diabetes

OBJECTIVE: Traditionally, carbohydrate has been the largest contributor to energy intake among people with diabetes, yet different carbohydrate foods produce different glycaemic responses. Glycaemic load represents the total glycaemic effect of the diet and influences glycaemic control. Adequate self-efficacy and outcome expectations are needed to change carbohydrate intake and to evaluate relevant interventions. The purpose of this research was to develop and test instruments regarding self-efficacy and outcome expectations for the adoption of a lower glycaemic load diet. DESIGN: Participants completed each instrument at their convenience and mailed the instruments to the investigators. SETTING/SUBJECTS: A community sample of individuals 21-75 years of age with type 2 diabetes for >or= 1 year (n = 108) was recruited. RESULTS: Principal components analysis revealed three factors on the self-efficacy questionnaire: glycaemic index, negative food selection and self-regulation efficacy which accounted for 62% of the variance in these items. The outcome expectations instrument yielded three factors: barriers to dietary change and glycaemic control, and family support expectations which accounted for 48% of the variance. Coefficient alpha for each construct was >0.70 and coefficient H for each construct was >or= 0.80. CONCLUSIONS: The two instruments developed for this study can provide important insights about the self-efficacy and outcome expectations regarding the quantity and quality of carbohydrate consumed and self-monitoring performed for diabetes management. Future research is needed to evaluate the relationship among these constructs, dietary intake and glycaemic control.