The influence of age and body mass index on relative accuracy of energy intake among Japanese adults

OBJECTIVE: To examine relationships between the ratio of energy intake to basal metabolic rate (EI/BMR) and age and body mass index (BMI) among Japanese adults. DESIGN: Energy intake was assessed by 4-day semi-weighed diet records in each of four seasons (16 days in total). The EI/BMR ratio was calculated from reported energy intake and estimated basal metabolic rate as an indicator of reporting accuracy. SETTING: Residents in three areas in Japan, namely Osaka (urban), Nagano (rural inland) and Tottori (rural coastal). SUBJECTS: One hundred and eighty-three healthy Japanese men and women aged > or =30 years. RESULTS: The oldest age group (> or =60 years) had higher EI/BMR values than the youngest age group (30-39 years) in both sexes (1.74 vs. 1.37 for men; 1.65 vs. 1.43 for women). In multiple regression analyses, age correlated positively (partial correlation coefficient, beta = 0.012, P < 0.001 for men; beta = 0.011, P < 0.001 for women) and BMI correlated negatively (beta = -0.031, P < 0.001 for men; beta = -0.025, P < 0.01 for women) with EI/BMR. CONCLUSION: Age and BMI may influence the relative accuracy of energy intake among Japanese adults.     

Underreporting of energy intake among Japanese women aged 18-20 years and its association with reported nutrient and food group intakes

OBJECTIVES: To evaluate the ratio of energy intake to basal metabolic rate (EI/BMR) among young female Japanese adults, and to compare the lifestyle and dietary characteristics between relatively low and high reporters. DESIGN: Dietary intakes were assessed over a 1-month period with a validated, self-administered, diet history questionnaire, and lifestyle variables were assessed by a second questionnaire designed for this survey. The ratio of EI/BMR was calculated from reported energy intake and estimated basal metabolic rate. SUBJECTS: In total, 1889 female Japanese university students aged 18-20 years who were enrolled in dietetics courses. RESULTS: Ninety-five per cent of the subjects were classified into a non-obese group (body mass index (BMI) <25 kg m(-2); mean+/-standard deviation (SD): 20.8+/-2.6 kg m(-2)). EI/BMR was 1.43+/-0.40 (mean+/-SD). Sixty-eight per cent of the subjects showed an EI/BMR level below the possibly balanced value of 1.56, 37% showed EI/BMR below the minimum survival value of 1.27 and 2% of the subjects showed EI/BMR exceeding the maximum value for a sustainable lifestyle of 2.4. BMI, body weight and BMR decreased significantly with the increase in EI/BMR (P<0.001). The percentage of energy from carbohydrate was significantly higher, whereas those from fat and protein were significantly lower, among the lower EI/BMR groups. As for food groups, a significantly declining trend from the lowest to the highest EI/BMR groups was observed for cereals. CONCLUSION: Underreporting, rather than overreporting, of energy intake was predominant in this relatively lean Japanese female population. BMI was the most important factor affecting the reporting accuracy of energy intake.     

Underreporting of energy intake from a self-administered food-frequency questionnaire completed by adults in Montreal

BACKGROUND: Energy intake determined from self-reported dietary assessment methods may be underreported. Therefore, it is important that such methods be validated against another with known validity for energy intake or energy expenditure. METHODS: We investigated potential underestimation of energy intake obtained from our semi-quantitative food-frequency questionnaire (FFQ) administered between 2000 and 2001 in the metropolitan area of Montreal, Canada. The study population included 246 adults aged 18 to 82 years. The ratio of energy intake to estimated basal metabolic rate (EI/BMR) was used to assess underreporting and physical activity was determined from self-administered questions. Comparison of the EI/BMR ratio with the Goldberg statistical cut-off allowed us to detect individuals who were low energy reporters (LERs). LERs and non-LERs were compared to determine if they differed on sociodemographic, anthropometric and lifestyle variables. RESULTS: The EI/BMR ratio was 1.26 for men and 1.32 for women. LERs represented 43% of the sample of individuals. Male LERs accounted for 54% compared with 35% among females. Underreporting of energy intake was highest in men and individuals who were older, heavier, with higher body mass index and lower education level. A higher proportion of male LERs perceived their financial situation as adequate while a greater proportion of female LERs considered themselves poor. CONCLUSION: Our data suggest that underreporting of energy intake from the FFQ was considerable and may bias dietary interpretation. As this was uneven across the sample, it is crucial to recognise the characteristics of LERs in order to increase the validity of reported energy intake.     

Validity of a food-frequency questionnaire for elderly men in southeast China

OBJECTIVE: To investigate the internal validity of a food-frequency questionnaire (FFQ) developed for a case-control study of prostate cancer in southeast China. DESIGN: A comprehensive questionnaire comprising a quantitative FFQ and a short food habit questionnaire (SFHQ) was developed and modified from previous cancer and nutritional studies. The Goldberg formula (ratio of energy intake (EI) to basal metabolic rate (BMR), EI/BMR) was used to assess the validity of the FFQ by making comparisons with physical activity levels. Physical activity levels were measured by the estimated total metabolic equivalents (MET) and the ratio of energy expenditure (EE) to BMR (EE/BMR). Correlation analyses were undertaken to compare the SFHQ variables with those of the quantitative FFQ. SETTING: Hangzhou, Zhejiang Province, China. SUBJECTS: A total of 404 men over 45 years old with or without prostate cancer were recruited from eight hospitals. RESULTS: The partial correlation coefficients, controlling for age and family history of prostate cancer, were moderate to high (P<0.05) for preserved foods intake, fat consumption and tea drinking variables between the SFHQ and the quantitative FFQ. The average EI/BMR was 1.72, with 76% of subjects exceeding the Goldberg cut-off value of 1.35. Apart from weight, BMI, EE/BMR and MET, there were no significant differences in characteristics between low (<1.35) and normal EI/BMR groups. CONCLUSIONS: The FFQ is demonstrated to be a valid instrument to measure energy and food intake for elderly men in southeast China.     

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.     

Concurrent comparison of energy intake and expenditure among adults in Butajira District, Ethiopia

OBJECTIVE: To estimate and compare dietary energy intake (DEI) and total energy expenditure (TEE) among adults, using questionnaires. DESIGN: Comparative, cross-sectional study. SETTING: Community-based, at the demographic surveillance site (DSS) in Butajira District of Ethiopia. SUBJECTS: A total of 619 adults, 18-64 years of age, were randomly selected from among the urban and rural population of Butajira using the DSS sampling frame. Habitual dietary intake and physical activity were assessed using questionnaires. BMR was estimated using a regression equation, and TEE was calculated from BMR and the metabolic energy equivalent task (MET) and duration of reported activities. Physical activity level (PAL) was calculated as TEE/BMR, while food intake level (FIL) was calculated as DEI/BMR. The mean DEI:TEE ratio was used to evaluate reported DEI at the population level, while individual misreporters were identified by applying the Goldberg cut-off points at three levels of PAL. RESULTS: Based on the Goldberg method, 57% of the study participants were identified as acceptable reporters of DEI, among whom mean TEE was 8.21 (95% CI 8.01, 8.42) MJ (1963 (95% CI 1914, 2012) kcal), mean DEI was 8.13 (95% CI 7.93, 8.34) MJ (1944 (95% CI 1895, 1993) kcal) and mean DEI:TEE was 1.01 (95% CI 0.99, 1.04). CONCLUSION: The dietary history and physical activity questionnaires provide comparable estimates of mean energy intake and expenditure at a population level. Acceptable reporters have to be identified in order to obtain better estimates. Questionnaire-based estimates of energy intake should not be interpreted without an inherent system of comparison or validation.     

Sources of variation in nutrient intakes among men in Shanghai, China

BACKGROUND AND OBJECTIVE: Random errors, from any source, will attenuate epidemiological risk estimates. Before we launched the Shanghai Men's Health Study (SMHS), a large population-based cohort study investigating the diet-cancer association among Chinese men, a dietary calibration study was conducted among 96 men aged 40-75 years (mean age 56.5 years), with biweekly 24-hour dietary recalls (24HDRs) implemented over a 1-year period. Data from this study were analysed to evaluate the nature and magnitude of variances for intake of 26 nutrients among SMHS participants, to compare variance ratios of 26 nutrients among Chinese men and women and individuals in other studies, and to estimate the number of 24HDRs required for future dietary calibration studies in similar populations. DESIGN: Ninety-six healthy, free-living men in Shanghai were administered biweekly 24HDR interviews 24 times over a 1-year period. To assess between-individual and within-individual contributions to variance, a mixed effects model was fitted and ratios of within-individual to between-individual (sigma(w)(2)/sigma(b)(2)) dietary intake variances were computed. SETTING: Shanghai, China. RESULTS: In agreement with reports from studies conducted in the USA and many other countries, we found that within-individual variances were usually larger than between-individual variances in dietary intake for all nutrients. The sum of all other variation (e.g. weekday and weekend, seasonal, interviewer) accounted for less than 5% of total variation. Ratios of within- to between-individual variances (for log-transformed data) ranged from 1.25 for carbohydrate intake to near 8 for delta-tocopherol intake. CONCLUSIONS: The results of this study suggest that among middle-aged and elderly Chinese men in Shanghai, within- and between-individual variation account for more than 95% of the total variation for 26 nutrients. Further dietary validation studies in the same population could be adequately carried out with only 12 days of dietary recalls, if 100 participants were enrolled.     

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.     

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.     

Dietary and non-dietary determinants of central adiposity among Tehrani women

OBJECTIVE: To determine the correlates of central adiposity. DESIGN: Population-based cross-sectional study. SUBJECTS: A total of 926 women (aged 40-60 years) from all districts of Tehran. METHODS: Demographic data were collected and anthropometric indices were measured according to standard protocols. Dietary intakes were assessed by means of a semi-quantitative food-frequency questionnaire. The suggested cut-off point for waist-to-hip ratio (WHR>or=0.84) for Tehrani people, adjusted for their age group, was used to determine central adiposity. Logistic regression analysis was used to determine the correlates of WHR, which were adjusted for age, taking medications and body mass index (BMI). The components of dietary intake were determined by factor analysis. Pearson correlation was used to determine the association between the dietary components and WHR. Analysis of covariance was employed to compare the mean values of WHR in different lifestyle groups, with adjustment for BMI and age. RESULTS: Mean WHR was 0.82 +/- 0.06. The possibility of being centrally obese was higher in women with light physical activity (odds ratio: 2.11; 95% confidence interval: 1.40-2.53), depressed women (1.36; 1.02-1.93), smokers (1.21; 1.02-1.56) and unemployed women (1.41; 1.13-1.72). Marriage (1.31; 1.10-1.82), menopause (1.22; 1.02-1.61), low vitamin C intake (2.31; 1.25-4.25) and low calcium intake (1.30; 1.07-3.78) were associated with central fat accumulation. Dairy consumption was inversely correlated with central fat accumulation (r = -0.2, P < 0.05). CONCLUSION: Central adiposity is associated with poor lifestyle factors including low physical activity, depression, smoking, low intake of vitamin C, low intake of calcium and dairy products and high fat consumption. Thus lifestyle modifications should be encouraged to achieve a healthier body shape.     

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.     

Lipid, protein and carbohydrate intake in relation to body mass index: an Italian study

OBJECTIVE: To analyse the association between macronutrient intake and body mass index (BMI). DESIGN: A series of hospital-based case-control studies. SETTINGS: Selected teaching and general hospitals in several Italian regions. SUBJECTS: A total of 6619 subjects from the comparison groups of the case-control studies were included in the analysis. METHODS: We obtained data from a validated 78-item food-frequency questionnaire submitted between 1991 and 2002. For various macronutrients, the partial regression coefficient (variation of BMI (kg m(-2)) per 100 kcal increment of energy intake) was derived from multiple linear regression models, after allowance for age, study centre, education, smoking habits, number of eating episodes and mutual adjustment for macronutrients. RESULTS: BMI was directly associated with protein intake among women only (beta = 0.68) and with unsaturated fats in both genders (for monounsaturated fats beta = 0.27 for men and 0.26 for women; for polyunsaturated fats beta = 0.27 for men and 0.54 for women), and inversely related to carbohydrates (beta = -0.05 for men and -0.21 for women) and number of eating episodes in both genders (beta = -0.42 for men and -0.61 for women) and to saturated fats among women only (beta = -0.57). CONCLUSIONS: These results confirm and provide convincing evidence that, after allowance for selected covariates including total energy intake, a protein-rich diet is not inversely related to BMI, and a carbohydrate-rich diet is not directly related to BMI.     

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 development of a quantitative food-frequency questionnaire for a lifestyle intervention to reduce the risk of chronic diseases in Canadian First Nations in north-western Ontario

OBJECTIVES: To characterise the diet of First Nations in north-western Ontario, highlight foods for a lifestyle intervention and develop a quantitative food-frequency questionnaire (QFFQ). DESIGN: Cross-sectional survey using single 24 h dietary recalls. SETTING: Eight remote and semi-remote First Nations reserves in north-western Ontario. SUBJECTS: 129 First Nations (Oji-Cree and Ojibway) men and women aged between 18 and 80 years. RESULTS: The greatest contributors to energy were breads, pasta dishes and chips (contributing over 20 % to total energy intake). 'Added fats' such as butter and margarine added to breads and vegetables made up the single largest source of total fat intake (8.4 %). The largest contributors to sugar were sugar itself, soda and other sweetened beverages (contributing over 45 % combined). The mean number of servings consumed of fruits, vegetables and dairy products were much lower than recommended. The mean daily meat intake was more than twice that recommended. A 119-item QFFQ was developed including seven bread items, five soups or stews, 24 meat- or fish-based dishes, eight rice or pasta dishes, nine fruits and 14 vegetables. Frequency of consumption was assessed by eight categories ranging from 'Never or less than one time in one month' to 'two or more times a day'. CONCLUSION:We were able to highlight foods for intervention to improve dietary intake based on the major sources of energy, fat and sugar and the low consumption of fruit and vegetable items. The QFFQ is being used to evaluate a diet and lifestyle intervention in First Nations in north-western Ontario.     

Seven distinct dietary patterns identified among pregnant Finnish women--associations with nutrient intake and sociodemographic factors

OBJECTIVES: To identify and describe dietary patterns in a cohort of pregnant women and investigate whether the dietary patterns are associated with dietary intake and sociodemographic factors. DESIGN: Mothers entering the Finnish Type 1 Diabetes Prediction and Prevention (DIPP) Nutrition Study in 1997-2002 were retrospectively asked to complete a food-frequency questionnaire concerning their diet during pregnancy. Principal components analysis was used to identify dietary patterns. SETTING: Finland. SUBJECTS: Subjects were 3730 women with a newborn infant carrying increased genetic susceptibility to type 1 diabetes mellitus. RESULTS: Seven factors were identified and named. Energy intake correlated positively with 'Healthy', 'Fast food', 'Traditional bread', 'Traditional meat' and 'Coffee' patterns and inversely with the 'Alcohol and butter' pattern. Intake of dietary fibre correlated positively with 'Healthy', 'Traditional bread' and 'Low-fat foods' patterns and inversely with the 'Alcohol and butter' pattern. The seven dietary patterns seemed to account for relatively large proportions of the variance in energy and nutrient intakes except for the intake of vitamin D, vitamin C, carotenoids and calcium. Maternal age and higher level of education were associated with higher scores on 'Healthy', 'Low-fat foods' and 'Alcohol and butter' patterns. CONCLUSION: Principal components analysis produced seven dietary patterns which may be useful for further research concerning maternal diet and health outcomes among both mothers and their offspring.     

Demographic factors associated with the diet quality of older US men: baseline data from the Osteoporotic Fractures in Men (MrOS) study

OBJECTIVE: Throughout the world, the proportion of the male population aged 65 years and older is increasing. Yet, we have limited information regarding diet quality and predictors of diet quality in this segment of the population. The objectives of the current analyses are to describe the diet quality of a cohort of men >65 years of age, and identify lifestyle factors associated with poor diet quality. METHODS: We present a cross-sectional analysis of the diet quality of 5928 men, aged 65-100 years, who are participants in the Osteoporotic Fractures in Men (MrOS) cohort study. Dietary intake was determined using a modified Block 98 food-frequency questionnaire. Diet quality was calculated using the previously validated Diet Quality Index-Revised (DQI-R). Univariate and multivariate modelling was used to estimate the variance in diet quality predicted by a number of sociodemographic factors, including age, race/ethnicity, body mass index (BMI), marital status, education, smoking status, physical activity, self-perceived health and nutritional supplement use. RESULTS: Overall, we found that in this geographically diverse group of older men, diet quality was low, with a mean modified DQI-R for the entire study population of 62.5 (standard deviation 13.1) out of an ideal of 100. Further, younger age, very low total calorie intake (< or = 1187 kcal day- 1), higher BMI, residence in a North or Southeast community, being of African-American or Hispanic race, being less educated, not using dietary supplements and smoking were each significant independent predictors of a poorer diet. CONCLUSION: These data may prove useful in both understanding the dietary intake of older US men as it relates to published dietary guidelines, and for targeting future dietary intervention programmes.     

Dietary and socio-economic factors associated with overweight and obesity in a southern French population

OBJECTIVE: To investigate the socio-economic and dietary factors associated with overweight and obesity, respectively, in southern France. DESIGN: Cross-sectional analysis of socio-economic, lifestyle and nutritional characteristics of a representative population sample. A questionnaire elicited information on anthropometric measurements, socio-economic factors, physical activity, tobacco use, and alcohol and food intakes. Non-parametric tests, multiple linear regression models and correspondence factorial analysis (CFA) were used to estimate the association of the various factors with overweight and obesity. SETTING: French Southwest and Mediterranean areas. SUBJECTS: In total, 1169 subjects (578 women and 552 men), aged 30-77 years, were recruited at random. RESULTS: Overweight and obesity were associated with age and education in both genders, reproductive factors in women and tobacco use in men. A few dietary factors were identified (high energy intake and low intake of carbohydrates), but all these variables explained little of the variation (18.5% in women and 14.6% in men). The CFA further investigated the association of lifestyle and nutritional factors, giving more weight to nutritional behaviour for overweight men and women. Factors for obesity differed from those for overweight by being different in men and women, possibly related to psychological behaviour, and there were fewer of them, suggesting an insufficient coverage by the usual questionnaires. CONCLUSIONS: Overweight and obesity appear as two different entities. Energy imbalance induced by various lifestyle factors plays a major role in the development of overweight, whereas obesity represents a more complex entity where psychological and genetic factors that are difficult to assess may be more important. General nutritional guidelines appear more adapted to the prevention of overweight than to that of obesity, and individual counselling to the prevention of obesity.     

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.     

Calcium, diet and fracture risk: a prospective study of 1898 incident fractures among 34 696 British women and men

OBJECTIVE: The risk factors for fractures are incompletely understood. An outstanding question concerns the optimal amount of dietary calcium needed to minimise the risk of fracture. DESIGN: We examined the associations of dietary calcium and other nutrients with self-reported fracture risk in a prospective cohort study. Nutrient intakes were estimated using a semi-quantitative food-frequency questionnaire administered at recruitment. SETTING: The UK. Participants: A total of 26 749 women and 7947 men aged 20-89 years. RESULTS: Over an average of 5.2 years of follow-up, 1555 women and 343 men reported one or more fractures, 72% of these resulting from a fall. Among women, fracture risk was higher at lower calcium intakes, with a relative risk of 1.75 (95% confidence interval (CI) 1.33-2.29) among women with a calcium intake of < 525 mg day- 1 compared with women with a calcium intake of at least 1200 mg day- 1 (test for linear trend, P < 0.001). The association of dietary calcium with fracture risk was stronger among women aged under 50 years at recruitment than among women aged 50 and above. Dietary calcium intake was not associated with fracture risk in men. Fracture risk was not related to the dietary intake of any other nutrient examined. CONCLUSION: In this population, women with a low dietary calcium intake had an increased risk of bone fracture, and this association was more marked among younger women than among older women.     

Longitudinal changes in dietary intake in Scottish women around the menopause: changes in dietary pattern result in minor changes in nutrient intake

Objective: To examine dietary change that has occurred over 5 to 6 years.Subjects: A cohort of Scottish women (n=898) with a mean age of 47.5 years (range 45-54 years) at baseline.Design: Dietary intake was assessed by validated food-frequency questionnaire (FFQ) and analysed using the UK Composition of Foods database.Results: Since the first dietary assessment, mean daily energy intake had decreased from 8.2+/-2.3 to 7.9+/-2.2 MJ. The degree of low energy reporting (defined as ratio of energy intake to basal metabolic rate <1.1) had increased from 18.7% at baseline to 25.6% at follow-up. Low energy reporters were significantly heavier than 'normal' energy reporters (mean weight at follow-up, 68.9+/-12.6 vs. 66.8+/-11.3 kg) and could be deliberately restricting intake rather than underreporting. Overall there were decreases in intakes of red meat, processed meat and cheese, but increases in poultry and non-oily fish consumption. Consumption of bread, biscuits and cakes had gone down and there was an increase in cereal and rice/pasta consumption. Intake of potatoes had decreased whereas fruit intake had increased. There were small but statistically significant differences in intakes for most nutrients (<8% change). Nutrient intakes at both visits were similar across menopausal status and usage groups of hormone replacement therapy. Modifications to the computer version of the McCance and Widdowson nutrient database, which differed from the published version, were noted. These changes altered the original baseline values for our study.Conclusions: The menopause per se is not a period of marked change in nutrient intake. Caution is advised when using computer databases of food compositions for longitudinal studies.