Can adverse effects of dietary fat intake be overestimated as a consequence of dietary fat underreporting?

OBJECTIVE: To describe the consequences of systematic reporting bias by the obese for diet-disease relationships. DESIGN: The present report used 24-hour urinary nitrogen and estimates of 24-hour energy expenditure to assess error in diet reporting, and examined the consequence of accounting for this error for associations between dietary fat intake and serum low-density lipoprotein (LDL)-cholesterol. SETTING: Sub-study to the Danish MONICA (Monitoring Trends and Determinants in Cardiovascular Disease) project, carried out in 1987-1988. SUBJECTS: A random sub-sample of the adult Danish male population (n = 152). RESULTS: Correcting dietary fat for underreporting error weakened, rather than strengthened, the association between dietary fat intake and LDL-cholesterol by reducing the slope of the regression from beta = 3.4, P = 0.02 to beta = 2.7, P = 0.04. CONCLUSION: This example illustrates that systematic underreporting of dietary fat by high-risk groups such as the obese may produce an overestimated association. These results imply that previous epidemiological studies showing a positive association between percentage of energy from fat and other health outcomes, e.g. cancer and heart disease, may have overestimated the negative effects of a high-fat diet. If we were able to correctly assess dietary fat intake in general populations, recommendations for fat intake may be more liberal than the 30% suggested today. Improved assessment of fat intake in epidemiological studies is necessary for future development of evidence-based recommendations for diet and health .     

Acrylamide: a dietary carcinogen formed in vivo?

Acrylamide, a chemical formed during heating of human foods, reacts with N-terminal valine in hemoglobin (Hb) and forms stable reaction products (adducts). These adducts to N-terminal valine in Hb have been used to estimate daily intake of acrylamide. Daily intake of acrylamide estimated from Hb adduct levels was higher than daily intake estimated from dietary questionnaires, possibly indicating other sources of exposures. Therefore, in this study the possible endogenous formation of acrylamide was investigated by treating mice with FeSO 4, 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine-hydrochloric acid (MPTP), or methamphetamine (METH). Acrylamide Hb adducts were determined, and a significant increase ( p < 0.05) in acrylamide Hb adduct levels was observed 24 h following treatment with FeSO 4 and 72 h following treatment with MPTP or METH. The results of this study show that acrylamide Hb adduct levels are increased in mice treated with compounds known to induce free radicals, thus suggesting the endogenous production of acrylamide.     

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.     

Tea or coffee? A case study on evidence for dietary advice

The present paper explores the level of evidence required to justify giving dietary advice to the public. There are important practical differences between the development of public health nutrition guidelines and guidelines for clinical practice. While the gold standard for evidence for clinical practice guidelines is a meta-analysis of a number of randomised controlled trials, this is often unrealistic and sometimes unethical for the evaluation of public health nutrition interventions. Hence, epidemiological studies make up the bulk of evidence for nutrition guidelines. Tea and coffee are an interesting case study in relation to this issue. They are two of the most commonly consumed beverages worldwide, yet there is little dietary advice on their use. The evidence for a relationship between coffee or tea consumption and several diseases is discussed. The available studies, predominantly epidemiological, together with animal and in vitro studies, indicate that coffee and tea are both safe beverages. However, tea is the healthier option because it has a possible role in the prevention of several cancers and CVD. While the evidence for such relationships is not strong, the public will continue to drink both tea and coffee, and will continue to ask nutritionists to make recommendations. It is therefore argued that advice should be given on the best available data, as waiting for complete data to become available could have severe consequences for public health.     

The nutritional status of asymptomatic HIV-infected Africans: directions for dietary intervention?

OBJECTIVE: To compare the relationships between food (nutrient) intakes and biochemical markers of nutritional status of asymptomatic HIV-infected with HIV-uninfected subjects, to gain more information on the appropriate diet for HIV-infected persons at an early stage of infection. DESIGN: Cross-sectional population-based survey. SETTING: North West Province, South Africa. SUBJECTS: Two hundred and sixteen asymptomatic HIV-infected and 1550 HIV-uninfected men and women volunteers aged 15 years and older, recruited as 'apparently healthy' subjects from 37 randomly selected sites. OUTCOME MEASURES: Food and nutrient intakes, measured with a validated food-frequency questionnaire, and nutritional status indicated by anthropometric and biochemical variables, measured by a standardised methodology. RESULTS: The prevalence of HIV infection in the study population was 11.9%. The anthropometric indices and nutrient intakes of HIV-infected and uninfected subjects did not differ significantly, indicating that these 216 HIV-infected subjects were at an early stage of infection. Of the biochemical nutritional status variables, high-density lipoprotein cholesterol and total cholesterol, haemoglobin, albumin and triglycerides were significantly lower in infected subjects. They also had higher globulin and liver enzyme levels than uninfected subjects. In infected subjects, serum albumin correlated significantly with serum lipids, serum vitamin A, serum vitamin E, serum iron, total iron-binding capacity and haemoglobin. The significant positive correlations of the liver enzymes with serum lipids, albumin, vitamin A and iron, observed in HIV-uninfected subjects, disappeared in the infected subjects. Polyunsaturated fat intake showed significant positive correlations with the increased liver enzymes in infected subjects. A principal components analysis indicated that, in infected subjects, increased liver enzymes correlated with higher consumption of maize meal and lower consumption of meat and vegetables. CONCLUSIONS AND RECOMMENDATIONS: This survey indicated that asymptomatic HIV-infected subjects who followed a diet rich in animal foods had smaller decreases in serum albumin, haemoglobin and lipid variables, and smaller increases in liver enzymes, than those who consumed a diet based on staple foods. This suggests that animal foods are associated with improved nutritional status in HIV-infected persons. These results should be confirmed with intervention studies before dietary recommendations for asymptomatic HIV-infected individuals can be made.     

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.     

24-hour national dietary survey data: how do we interpret them most effectively?

OBJECTIVE: To illustrate the effect of common mistakes when using 24-hour national dietary survey data to estimate the prevalence of inadequate nutrient intakes. DESIGN: Raw data on nutrient intake from the Australian 1995 National Nutrition Survey were adjusted for within-person variance using standard techniques and corrected for underreporting using the criteria of Goldberg et al. The distributions for six nutrients were compared with current dietary reference values from the UK, USA and Australia. SETTING: A national sample of the Australian population with a 61.4% response rate. RESULTS: Adjusting for within-person variance reduced the range of nutrient intakes to 66-80% of the raw data range and the proportion with intakes below the estimated average requirement (EAR) by up to 20%. Excluding underreporters further reduced the proportion below the EAR by up to 10%. Using the dietary reference values from different countries also resulted in some markedly different estimates. For example, the prevalence of low folate intakes ranged from < 1 to 92% for adult women depending on the reference used. Except for vitamin A and protein, the prevalence of low intakes was invariably higher for women than for men. CONCLUSIONS: Estimates of the prevalence of low nutrient intakes based on raw 24-hour survey data are invariably misleading. However, even after adjustment for within-person variance and underreporting, estimates of the prevalence of low nutrient intakes may still be misleading unless interpreted in the light of the reference criteria used and supported by relevant biochemical and physiological measures of nutritional status.     

α-Mangostin, a dietary xanthone, induces autophagic cell death by activating the AMP-activated protein kinase pathway in glioblastoma cells

This study is the first to investigate the anticancer effects of α-mangostin in human glioblastoma cells. α-Mangostin decreases cell viability by inducing autophagic cell death but not apoptosis. Pretreatment of cells with the autophagy inhibitors 3-methyladenine (3-MA) and bafilomycin or knockdown beclin-1, resulted in the suppression of α-mangostin-mediated cell death. We also found that liver kinase B1 (LKB1)/AMP-activated protein kinase (AMPK) signaling is a critical mediator of α-mangostin-induced inhibition of cell growth. Activation of AMPK induces α-mangostin-mediated phosphorylation of raptor, which subsequently associates with 14-3-3γ and results in the loss of mTORC1 activity. The phosphorylation of both downstream targets of mTORC1, p70 ribosomal protein S6 kinase (p70S6 kinase) and 4E-BP1, is also diminished by activation of AMPK. Furthermore, the inhibition of AMPK expression with shRNAs or an inhibitor of AMPK reduced α-mangostin-induced autophagy and raptor phosphorylation, supporting the theory that activation of AMPK is beneficial to autophagy. A further investigation revealed that α-mangostin also induced autophagic cell death in transplanted glioblastoma in nude mice. Together, these results suggest a critical role for AMPK activation in the α-mangostin-induced autophagy of human glioblastoma cells.     

Are dietary diversity scores related to the socio-economic and anthropometric status of women living in an urban area in Burkina Faso?

OBJECTIVES: To study dietary diversity and its relationship with socio-economic and nutritional characteristics of women in an urban Sahelian context. DESIGN: A qualitative dietary recall was performed over a 24-h period. Dietary diversity scores (DDS = number of food groups consumed) were calculated from a list of nine food groups (DDS-9) or from a list of 22 food groups (DDS-22) which detailed both micronutrient- and energy-dense foods more extensively. Body mass index (BMI), mid upper-arm circumference and body fat percentage were used to assess the nutritional status of the women. SETTING AND SUBJECTS: Five hundred and fifty-seven women randomly selected in two districts of Ouagadougou, the capital of Burkina Faso. RESULTS: The mean DDS-9 and DDS-22 were 4.9 +/- 1.0 and 6.5 +/- 1.8 food groups, respectively. In the high tertile of DDS-22, more women consumed fatty and sweetened foods, fresh fish, non-fatty meat and vitamin-A-rich fruits and vegetables. The DDS-9 was not associated with the women's socio-economic characteristics whereas the DDS-22 was higher when the women were younger, richer and had received at least a minimum education. Mean BMI of the women was 24.2 +/- 4.9 kg m-2 and 37% of them were overweight or obese (BMI > or = 25 kg m-2). Neither the DDS-9 nor the DDS-22 was associated with the women's anthropometric status, even though there was a trend towards fewer overweight women in the lowest tertile of DDS-22. CONCLUSION: In this urban area, the qualitative measurement of dietary diversity is not sufficient to identify women at risk of under- or overweight.     

Secular and socio-economic trends in compliance with dietary targets in the north Glasgow MONICA population surveys 1986-1995: did social gradients widen?

OBJECTIVE: To compare trends in the consumption of key foods over 10 years in the most deprived and least deprived quarters in north Glasgow, Scotland as defined by the Carstairs deprivation index for their postcode of domicile. DESIGN: Four random, cross-sectional, age- and gender-stratified population surveys carried out in 1986, 1989, 1992 and 1995. After assigning a deprivation score, food-frequency questionnaires from 2883 men and 3127 women were examined for compliance with dietary targets, examining trends by gender and within the most and least deprived quarters of the population. SETTING: North Glasgow, Scotland. SUBJECTS: Over 600 men and 600 women (aged 25-64 years) in each of the four survey years who completed a lifestyle questionnaire including a food frequency section. RESULTS: Increasing trends in the reported consumption of fruit and vegetables and oil-rich fish were observed over the 10-year period. However, the trend to increased fruit and vegetable consumption in the most deprived groups was not significant, and in 1995 only 8% of men and 12% of women in this group claimed consumption of these foods 4 or more times a day. In general, a higher percentage of those in the least deprived group met the targets for the key foods. CONCLUSIONS: Trends to increasing consumption of fruit and vegetables and fish were in the right direction, but the targets for consumption of certain key foods were met by a minority of the population. The progress towards the target for fruit and vegetables showed widening social gradients with time.     

A systematic review of associations between environmental factors, energy and fat intakes among adults: is there evidence for environments that encourage obesogenic dietary intakes?

OBJECTIVE: To review the literature examining associations between environmental factors, energy and fat intakes among adults, and to identify issues for future research. METHODS: Literature searches of studies published between 1980 and 2004 were conducted in major databases (i.e. PubMed, Human Nutrition, Web of Science, PsychInfo, Sociofile). Additional articles were located by citation tracking. RESULTS: Twenty-one articles met the inclusion criteria. No study provided a clear conceptualisation of how environmental factors may influence these dietary intakes. Availability, social, cultural and material aspects of the environment were relatively understudied compared with other factors such as seasonal/day of the week variation and work-related factors. Few studies examined the specific environmental factors implicated in the obesity epidemic, and there was little study replication. All studies were observational and cross-sectional. CONCLUSIONS: It is too premature to conclude whether or not environmental factors play a role in obesogenic and unhealthy dietary intakes. More studies need to examine associations with those environmental factors thought to contribute to obesogenic environments. There needs to be more development in theories that conceptualise the relationship between environmental factors and dietary intakes.