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 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.     

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.     

The impact of body mass index and Western advertising and media on eating style, body image and nutrition transition among Jordanian women

OBJECTIVES: To identify the impact of body mass index (BMI) and Western advertising and media on the stage of the nutrition transition among Jordanian women, and to evaluate their impact on eating styles and body image. DESIGN: A randomised cross-sectional survey that included a variety of culturally measured Likert-type scales and body size images. In addition, BMI was calculated based on measured height and weight. SETTING: In the homes of the participants. The data were collected by female interviewers who worked for the Jordan Department of Statistics. SUBJECTS: The sample was based on a random and representative selection of 800 mostly urban Jordanian women. A pre-test sample of 100 women was also used to validate the instruments. RESULTS: Women tended to agree that they ate based on emotional cues. They had high levels of disordered eating attitudes and behaviours and 42.1% were considered restrained eaters. However, these women also had higher than expected body esteem levels and desired a healthy body size. As expected, being obese was associated with a desire to lose weight, being a restrained and emotional eater, and having more disordered eating attitudes and behaviours. Similarly, Western advertising and media were associated with restrained and emotional eating, desired weight loss, and disordered eating attitudes and behaviours. CONCLUSIONS: There is a need to develop health education materials that explain the influence of obesity on health and the negative psychological and physical consequences of restrained and emotional eating, building on the current cultural preferences of healthy body size. Further implications and suggestions for future research are discussed.     

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.     

Alcohol intake in relation to body mass index and waist-to-hip ratio: the importance of type of alcoholic beverage

OBJECTIVE: Alcohol consumption may play a role in the development of obesity but the relationship between alcohol and weight is still unclear. The aim of our study was to assess the cross-sectional association of intakes of total alcohol and of specific alcoholic beverages (wine, beer and spirits) with waist-to-hip ratio (WHR) and body mass index (BMI) in a large sample of adults from all over France. DESIGN: Cross-sectional. SETTING: Participants were free-living healthy volunteers of the SU.VI.MAX study (an intervention study on the effects of antioxidant supplementation on chronic diseases). SUBJECTS: For 1481 women aged 35-60 years and 1210 men aged 45-60 years, intakes of total alcohol and specific alcoholic beverages were assessed by six 24-hour dietary records. BMI and WHR were measured during a clinical examination the year after. RESULTS: A J-shaped relationship was found between total alcohol consumption and WHR in both sexes and between total alcohol consumption and BMI in men only (P<0.05). The same relationships were observed with wine (P<0.05); men and women consuming less than 100 g day(-1) had a lower BMI (men only) and WHR than non-drinkers or those consuming more. Spirits consumption was positively associated with BMI (linear regression coefficient beta=0.21, 95% confidence interval (CI): 0.09-0.34 and beta=0.22, 95% CI: 0.06-0.39 for men and women, respectively) and WHR (beta=0.003, 95% CI: 0.001-0.005 and beta=0.003, 95%CI: 0.0002-0.006) in both sexes in a linear fashion. No relationship between beer consumption and BMI or WHR was found. CONCLUSION: If confirmed in longitudinal studies, our results indicate that consumption of alcoholic beverages may be a risk factor for obesity.     

Associations between salivary bacteria and reported sugar intake and their relationship with body mass index in women and their adolescent children

OBJECTIVE: To study associations between reported sugar intake and salivary bacteria (mutans streptococci, MS and lactobacilli, LB), and sugar intake in relation to body mass index (BMI), in women and adolescents. DESIGN: Cross-sectional study. Habitual dietary intake was reported in a questionnaire and whole saliva samples were collected and cultivated. SETTING: Stockholm, Sweden. SUBJECTS: Four hundred and fourteen mothers and their 16-year-old children (57% girls). RESULTS: Reported total sugar intake was significantly associated with LB in mothers (P = 0.001), but not in daughters and sons (P = 0.03 for mother-son interaction). When excluding lactose, the associations with LB and MS were significant in daughters (P = 0.032 and 0.005, respectively). High BMI and sugar intake from milk were independently associated with MS counts in mothers in a multiple regression model (R2 = 0.053). In daughters, sugar from beverages, candies/chocolates and fruits were all independently associated with MS counts (R2 = 0.074), whereas in sons, only mothers' MS counts were associated (R2 = 0.084). High BMI, low intake from cooked meals and high intake of candies/chocolates were all independently associated with LB in mothers (R2 = 0.076), while, except for candies/chocolates in daughters, no significant associations were found in children. BMI was significantly associated with bacteria counts in both mothers and children, whereas reported sugar intake was not. CONCLUSION: The associations between reported sugar intake and bacteria were generally weak. In mothers and daughters, some significant associations were found, but not in sons. Bacteria counts, but not reported sugar intake, were positively associated with BMI.     

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

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

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.     

Mediterranean diet in relation to body mass index and waist-to-hip ratio

OBJECTIVE: The Mediterranean diet is rich in fat and starch, and hence may be related to overweight. We therefore investigated the relationship between adherence to a Mediterranean diet and body mass index (BMI) and waist-to-hip ratio (WHR). DESIGN AND SETTING: Data were obtained from the control group of a network of case-control studies on cancer conducted in major teaching and general hospitals in four Italian areas between 1991 and 2002. An interviewer-administered validated 78-item food-frequency questionnaire was used to obtain information on the subjects' habitual diet. Information on socio-economic factors, lifestyle habits and anthropometric measures was also collected. A Mediterranean diet score (MDS) was derived on the basis of eight characteristics of the Mediterranean diet. SUBJECTS: Subjects were 6619 patients (3090 men, 3529 women) admitted to hospital for a wide spectrum of acute, non-neoplastic conditions, unrelated to known risk factors for cancer and long-term modifications of diet. RESULTS: In multiple linear regression models adjusted for age, study centre, education, tobacco smoking, occupational physical activity and total energy intake, the MDS was not related to BMI (beta = 0.05 for men and -0.04 for women) or WHR (beta = 0.000 and 0.001, respectively) in both sexes. CONCLUSIONS: Adherence to the major characteristics of the Mediterranean diet is unrelated to BMI and WHR, confirming previous data from Greece and Spain.     

Food insecurity, weight control practices and body mass index in adolescents

OBJECTIVE: We investigated whether experienced food insecurity was associated with weight control behaviour of adolescents. DESIGN: A national survey of 16-year-old students with the six-item food security scale, questions concerning intentions of trying to change weight, physical activity patterns, and measurement of height and weight. SETTING: Representative sample of 29 schools in Trinidad, West Indies. SUBJECTS: Data analysed for 1903 subjects including 1484 who were food-secure and 419 who were food-insecure. RESULTS: In the whole sample, food security status did not vary by body mass index (BMI) category. 'Trying to gain weight' and 'spending most free time in activities involving little physical effort' were each associated with lower BMI. 'Trying to gain weight' was more frequent in food-insecure subjects (135, 32%) than in food-secure subjects (369, 25%, P = 0.012). After adjustment for BMI, age, sex, ethnicity and socio-economic variables, the adjusted odds ratio (OR) of 'trying to gain weight' for food-insecure subjects was 1.39 (95% confidence interval (CI) 1.07-1.82, P = 0.014). Food-insecure subjects (197, 47%) were more likely than food-secure subjects (575, 39%) to report that most of their free time was spent doing things that involved little physical effort (P = 0.003). This association was not explained by adjustment for BMI, age, sex and ethnicity (OR = 1.41, 95% CI 1.13-1.76, P = 0.002) or additional socio-economic variables (OR = 1.27, 95% CI 1.02-1.57, P = 0.033). CONCLUSIONS: Adolescents who experience food insecurity are more likely to intend to gain weight but engage in less physical activity than food-secure subjects with the same BMI.     

Family average income and body mass index above the healthy weight range among urban and rural residents in regional Mainland China

OBJECTIVE: To explore the relationship between family average income (FAI; an index of socio-economic status) and body mass index (BMI; a widely used, inexpensive indicator of weight status) above the healthy weight range in a region of Mainland China. DESIGN: Population-based cross-sectional study, conducted between October 1999 and March 2000 on a sample of regular local residents aged 35 years or older who were selected by random cluster sampling. SETTING: Forty-five administrative villages selected from three urban districts and two rural counties of Nanjing municipality, Mainland China, with a regional population of 5.6 million. SUBJECTS: In total, 29,340 subjects participated; 67.7% from urban and 32.3% from rural areas; 49.8% male and 50.2% female. The response rate among eligible participants was 90.1%. RESULTS: The proportion of participants classified as overweight was 30.5%, while 7.8% were identified as obese. After adjusting for possible confounding variables (age, gender, area of residence, educational level, occupational and leisure-time physical activity, daily vegetable consumption and frequency of red meat intake), urban participants were more likely to be overweight or obese relative to their rural counterparts, more women than men were obese, and participants in the lowest FAI tertile were the least likely to be above the healthy weight range. CONCLUSIONS: The proportion of adults with BMI above the healthy weight range was positively related to having a higher socio-economic status (indexed by FAI) in a regional Chinese population.     

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.