Editorial Board Members' Collection Series: Epidemiologic and Public Health Assessment from a Global Perspective

Chronic low-grade inflammation may be associated with the development of chronic non-communicable diseases in young populations, often lasting to adulthood. Studies show that the diet is related to chronic inflammation. The Pro-inflammatory/Anti-inflammatory Food Intake Score (PAIFIS) is an indicator that measures the inflammatory potential of the diet, with the help of validated tools that assess food consumption. The validation of tools that assess inflammatory dietary patterns in young populations to produce valid and reliable results is essential to guide disease prevention strategies for adulthood. Methods: This study aimed to estimate the Pro-inflammatory/Anti-inflammatory Food Intake Score (PAIFIS) in children and adolescents in South America and to test its reliability and validity using a food frequency questionnaire (FFQ) and an inflammatory biomarker. This work consists of a validation study in a sample of children and adolescents conducted in South America (SAYCARE Study). The habitual consumption of food contributing to calculating the PAIFIS was obtained through an FFQ and 24 h Dietary Recall (24HDR). Reliability was tested using the FFQ (FFQ1 × FFQ2), using Spearman’s correlation coefficient to estimate the agreement between measurements. The validity of the PAIFIS was tested using 24HDR and the inflammatory biomarker C-reactive protein (CRP) using Spearman’s correlation and multilevel linear regression. Results: For children and adolescents, pro- and anti-inflammatory food groups showed Spearman’s correlation coefficients ranging from 0.31 to 0.66, convergent validity ranging from 0.09 to 0.40, and criterion validity for a reliability range from −0.03 to 0.18. The PAIFIS showed Spearman’s correlation coefficients for reliability ranging from 0.61 to 0.69, convergent validity from 0.16 to 0.23, and criterion validity from −0.03 to 0.24. Conclusion: The PAIFIS showed acceptable reliability, weak convergent validity, and weak criterion validity in children and adolescents. Full article

Introduction: Due to the restrictions imposed to control the COVID-19 pandemic, there has been an increase in studies based on online surveys. However, there are important concerns about the validity and generalizability of results from online surveys. Thus, we aimed to test the reliability and validity of the online version of the International Physical Activity Questionnaire short form (IPAQ-SF) among college students from low-income regions. Methods: This was a methodological feasibility study with a random stratified sample from a college located in the state of Maranhão in the city of Imperatriz (Brazil). The sample consisted of 195 college students (at least 17 years of age) to evaluate the validity and 117 students to evaluate the reliability. All data were collected in a self-reported online format (via Google Forms) twice, with an interval of 2 weeks. We used Spearman’s correlation analysis for the reliability study. Additionally, we applied exploratory and confirmatory factor analysis to evaluate the structural validity. Results: The questionnaire showed acceptable (rho > 0.30) and significant (p < 0.05) reliability, except for the question about the duration of sitting time on a weekend day. When assessing the construct validity (exploratory analysis), we identified a single factor that explained 88.8% of the variance. The 1-factor model showed acceptable model fit (SRMR = 0.039; CFI = 0.96; TLI = 0.90) in confirmatory analysis. Conclusions: The online version of the IPAQ-SF has acceptable reliability among college students from low-income regions and maintains the structure of the construct regarding to physical activity. Full article

Causal reductions in cardiovascular disease (CVD) with the Mediterranean diet (MedDiet) are supported by randomized trials, but the ability of nonrandomized studies to provide causal inferences in nutritional epidemiology is questioned. The “Seguimiento Universidad de Navarra” (SUN) project, conducted during 1999–2019 with 18,419 participants, was used to try to refute non-causal explanations for the inverse association found between adherence to the MedDiet and reduced CVD risk. A framework of different analytical strategies is proposed: alternative definitions of the exposure, exploration of residual confounding, resampling methods, depiction of absolute risks across the follow-up period, trial emulation, and negative controls. Additionally, we calculated the rate advancement period (RAP). We found that one standard deviation increase in the most frequently used MedDiet score was associated with a 29% relative reduction in CVD risk (95% Confidence Interval [CI] 14–41%), which is almost identical to that found in 2 randomized trials. The RAP of CVD would be postponed by an average of 7.9 years (95% CI: 1.6 to 14.2 years) by switching from low (MDS = 0 to2) to high (MDS = 7 to 9) adherence to the MedDiet in the fully adjusted model. Sensitivity analyses, graphical representations of absolute risks, trial emulation, and negative controls also supported causality. In conclusion, a framework of analytical approaches supported the causal effect of the MedDiet on CVD prevention using observational data. Similar methodology could be applied for causal inferences regarding other hypotheses. Full article