Special Issue "Dietary Assessment in Nutritional Epidemiology: Public Health Implications for Promoting Lifelong Health"

A special issue of Nutrients (ISSN 2072-6643).

Deadline for manuscript submissions: closed (30 September 2019).

Special Issue Editors

Prof. Dr. Antonella Agodi
Website
Guest Editor
Department of Medical and Surgical Sciences and Advanced Technologies “G.F. Ingrassia”, University of Catania, Italy. Via S. Sofia, 87, 95123 Catania, Italy
Interests: public health; epidemiology and prevention; nutritional epidemiology; molecular epidemiology; epigenetics; public health; genomics; healthcare-associated infections
Dr. Martina Barchitta
Website
Guest Editor
Department of Medical and Surgical Sciences and Advanced Technologies “G.F. Ingrassia”, University of Catania, Italy. Via S. Sofia, 87, 95123 Catania, Italy
Interests: Nutritional epidemiology; Molecular epidemiology; Public health; Mediterranean diet; Nutrigenetics; Nutrigenomics; Nutriepigenomics
Special Issues and Collections in MDPI journals

Special Issue Information

Dear Colleagues,

Nutritional epidemiology research has great public health importance for surveillance purposes and to validate, evaluate and promote novel, evidence-based prevention strategies. The choice of the most appropriate methods for dietary assessment depends on the aims of the study, the type of data required, available resources and the population of interest. Although traditional methods are usually simpler and less expensive, the use of alternative methods, such as biomarkers or clinical indicators, might be useful for overcoming potential bias and to take into account individual variability in response to diet. In recent years, technological development has also offered solutions to address limitations of traditional dietary assessment methods for nutritional data collection and analysis.

This Special Issue of Nutrients, entitled "Dietary assessment in nutritional epidemiology: public health implications for promoting lifelong health", welcomes the submission of original research, narrative reviews, systematic reviews and meta-analyses that highlight the importance of nutritional epidemiology in the context of public health research.

Potential topics may include, but are not limited, to the development and validation of novel technologies, methods and biomarkers for dietary assessment and evaluating the associations between dietary patterns, diet quality and health outcomes.

Prof. Dr. Antonella Agodi
Dr. Martina Barchitta
Guest Editors

Manuscript Submission Information

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Keywords

  • Nutritional epidemiology
  • Dietary assessment methods and analyses
  • Public health
  • Biomarkers

Published Papers (19 papers)

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Open AccessArticle
The Use of Tablet-Based Multiple-Pass 24-Hour Dietary Recall Application (MP24Diet) to Collect Dietary Intake of Children under Two Years Old in the Prospective Cohort Study in Indonesia
Nutrients 2019, 11(12), 2889; https://doi.org/10.3390/nu11122889 - 27 Nov 2019
Abstract
Dietary intake data are crucial for developing or evaluating nutrition interventions to improve the nutritional status of populations. The collection of accurate and reliable dietary data in developing countries, however, remains challenging. The emergence of new technologies, which facilitate electronic data capture, might [...] Read more.
Dietary intake data are crucial for developing or evaluating nutrition interventions to improve the nutritional status of populations. The collection of accurate and reliable dietary data in developing countries, however, remains challenging. The emergence of new technologies, which facilitate electronic data capture, might address some of these challenges. This paper aims to describe an application developed to collect a multiple-pass 24-h dietary recall, using electronic data capture, and compare the results to those estimated using a paper-based method. In this study, a tablet-based application was developed, in the CommCare platform, to evaluate the effectiveness, for improving dietary adequacy, of a package of behavior change interventions to reduce stunting and anemia among 6–23-month-old children in East Java, Indonesia (Baduta project). Dietary intakes of energy and nutrients were estimated using electronic data capture in the cohort study of the Baduta project (n = 680). We compared these results with those estimated using paper-based data capture in the project’s end-line cross-sectional study (n = 2740). We found a higher percentage of children classified as acceptable energy reporters (reported energy intake within the 95% CI of Total Energy Expenditure) with the electronic data capture compared with paper-based data capture (i.e., 60.8%, 72.4% and 80.7% for 6–8-, 9–11- and 12–23-month-old children, respectively, vs. 40.9%, 56.9%, and 54.3%, respectively). The estimated mean energy and nutrient intakes were not significantly different between these dietary data capture methods. These results suggest dietary data collection, using a tablet-based application, is feasible and can improve the quality of dietary data collected in developing countries. Full article
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Open AccessArticle
Strategies to Address Misestimation of Energy Intake Based on Self-Report Dietary Consumption in Examining Associations Between Dietary Patterns and Cancer Risk
Nutrients 2019, 11(11), 2614; https://doi.org/10.3390/nu11112614 - 01 Nov 2019
Abstract
The objective of this study was to determine the influence of strategies of handling misestimation of energy intake (EI) on observed associations between dietary patterns and cancer risk. Data from Alberta’s Tomorrow Project participants (n = 9,847 men and 16,241 women) were [...] Read more.
The objective of this study was to determine the influence of strategies of handling misestimation of energy intake (EI) on observed associations between dietary patterns and cancer risk. Data from Alberta’s Tomorrow Project participants (n = 9,847 men and 16,241 women) were linked to the Alberta Cancer Registry. The revised-Goldberg method was used to characterize EI misestimation. Four strategies assessed the influence of EI misestimation: Retaining individuals with EI misestimation in the cluster analysis (Inclusion), excluding before (ExBefore) or after cluster analysis (ExAfter), or reassigning into ExBefore clusters using the nearest neighbor method (InclusionNN). Misestimation of EI affected approximately 50% of participants. Cluster analysis identified three patterns: Healthy, Meats/Pizza and Sweets/Dairy. Cox proportional hazard regression models assessed associations between the risk of cancer and dietary patterns. Among men, no significant associations (based on an often-used threshold of p < 0.05) between dietary patterns and cancer risk were observed. In women, significant associations were observed between the Sweets/Dairy and Meats/Pizza patterns and all cancer risk in the ExBefore (HR (95% CI): 1.28 (1.04–1.58)) and InclusionNN (HR (95% CI): 1.14 (1.00–1.30)), respectively. Thus, strategies to address misestimation of EI can influence associations between dietary patterns and disease outcomes. Identifying optimal approaches for addressing EI misestimation, for example, by leveraging biomarker-based studies could improve our ability to characterize diet-disease associations. Full article
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Open AccessArticle
Intake of Processed Meat and Association with Sociodemographic and Lifestyle Factors in a Representative Sample of the Swiss Population
Nutrients 2019, 11(11), 2556; https://doi.org/10.3390/nu11112556 - 23 Oct 2019
Cited by 1
Abstract
Processed meat (PM) intake is associated with health risks, but data are lacking in Switzerland. Using national representative data from a recent menuCH Survey, we first aimed to quantify intake of PM and its subtypes, and second to investigate associations with sociodemographic and [...] Read more.
Processed meat (PM) intake is associated with health risks, but data are lacking in Switzerland. Using national representative data from a recent menuCH Survey, we first aimed to quantify intake of PM and its subtypes, and second to investigate associations with sociodemographic and lifestyle factors by multivariable regression analysis. PM was consumed by 72% of the population, and mean daily intake was 42.7 g/day (standard error of the mean (SEM) 1.2 g/day), ranging considerably across PM subtypes: highest intake of sausages 18.1 g/day (SEM 0.7 g/day) and lowest of bacon 2.0 g/day (SEM 0.2 g/day). PM intake by women was 4.7 g/1000 kcal lower than men (95% confidence interval (CI): −6.7; −2.7) and 2.9 g/1000 kcal lower in the French- language region compared with the German region (95% CI: 2.4; 8.7). Among sociodemographic and lifestyle factors examined, BMI (obese vs. normal: 5.5 g/1000 kcal, 95% CI: 2.4; 8.7) and current smoking (vs. never smoked: 3.1 g/kcal, 95% CI: 0.6; 5.6) were independently associated with PM intake. The results are a first description of PM intake, separate from other meat types, and which identified associations with two unhealthy lifestyle factors in Switzerland. Such data will contribute to better nutritional recommendations and guidance for public health interventions. Full article
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Open AccessArticle
Reproducibility and Relative Validity of the Healthy Eating Index-2015 and Nutrient-Rich Food Index 9.3 Estimated by Comprehensive and Brief Diet History Questionnaires in Japanese Adults
Nutrients 2019, 11(10), 2540; https://doi.org/10.3390/nu11102540 - 21 Oct 2019
Cited by 2
Abstract
We examined the reproducibility and relative validity of two measures of overall diet quality, the Healthy Eating Index-2015 (HEI-2015) and Nutrient-Rich Food Index 9.3 (NRF9.3), as estimated by well-established self-administered dietary assessment questionnaires for the Japanese, namely the comprehensive diet history questionnaire (DHQ) [...] Read more.
We examined the reproducibility and relative validity of two measures of overall diet quality, the Healthy Eating Index-2015 (HEI-2015) and Nutrient-Rich Food Index 9.3 (NRF9.3), as estimated by well-established self-administered dietary assessment questionnaires for the Japanese, namely the comprehensive diet history questionnaire (DHQ) and the brief diet history questionnaire (BDHQ). Diet was assessed separately by two DHQs and two BDHQs at a 1-year interval and by 16-day weighed dietary records (DRs) in 121 women and 121 men aged 31–81 years. HEI-2015 and NRF9.3 were calculated from each method. The reproducibility correlation for the two questionnaires (intraclass correlation) ranged from 0.53 (HEI-2015 from BDHQ in men) to 0.77 (NRF9.3 from BDHQ in women). The validity correlation between the first questionnaires and DR (Pearson correlation) ranged from 0.37 (NRF9.3 from BDHQ in men) to 0.61 (NRF9.3 from DHQ and BDHQ in women). Bland–Altman plots showed poor agreement between the DHQ or BDHQ and DR, as well as the presence of weak proportional bias. Overall, these data indicate reasonable reproducibility and ranking ability of the DHQ and BDHQ for assessing the HEI-2015 and NRF9.3 and support their usefulness in future epidemiological research on the overall effects of Japanese diets on various health outcomes. Full article
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Open AccessArticle
Reliability of Repeated Measures of Nutrient Intake by Diet Records in Residents in the Western Region of Japan
Nutrients 2019, 11(10), 2515; https://doi.org/10.3390/nu11102515 - 18 Oct 2019
Cited by 1
Abstract
Objective: We aimed to assess the day-to-day variation in twelve one-day diet records over one year from 131 residents of urban and rural areas in the western region of Japan. Methods: Between 2014 and 2015, the participants provided repeated one-day diet records once [...] Read more.
Objective: We aimed to assess the day-to-day variation in twelve one-day diet records over one year from 131 residents of urban and rural areas in the western region of Japan. Methods: Between 2014 and 2015, the participants provided repeated one-day diet records once a month. We estimated the intraclass correlation coefficient (ICCs) for intakes for energy and 39 crude and energy-adjusted nutrients using linear mixed models. Results: Among the unadjusted nutrients, ICCs ranged from 0.05 (95 percent confidence interval = 0.03–0.09) for vitamin A retinol equivalent (RE) to 0.55 (95% CI = 0.48–0.62) for potassium. After energy adjustment, the ICCs were 0.02 (95 percent confidence interval = 0.03–0.09) for vitamin A (RE) and 0.52 (95 percent confidence interval = 0.45–0.59) for potassium. Intakes of energy-adjusted macronutrients tended to have moderate degrees of day-to-day coefficients of variation (CVw, range = 0.13–0.23, mean = 0.18), while the coefficients of variation for intakes of micronutrients varied dramatically (CVw, range = 0.17–2.59, mean = 0.54). Conclusion: There were large day-to-day variations in nutrient intake assessed by diet records among urban and rural residents in the western region of Japan. This study provided information on the reproducibility of crude and energy-adjusted nutrients that may be useful for other dietary studies in Japanese populations. Full article
Open AccessArticle
Metabolic Trajectories Following Contrasting Prudent and Western Diets from Food Provisions: Identifying Robust Biomarkers of Short-Term Changes in Habitual Diet
Nutrients 2019, 11(10), 2407; https://doi.org/10.3390/nu11102407 - 09 Oct 2019
Cited by 9
Abstract
A large body of evidence has linked unhealthy eating patterns with an alarming increase in obesity and chronic disease worldwide. However, existing methods of assessing dietary intake in nutritional epidemiology rely on food frequency questionnaires or dietary records that are prone to bias [...] Read more.
A large body of evidence has linked unhealthy eating patterns with an alarming increase in obesity and chronic disease worldwide. However, existing methods of assessing dietary intake in nutritional epidemiology rely on food frequency questionnaires or dietary records that are prone to bias and selective reporting. Herein, metabolic phenotyping was performed on 42 healthy participants from the Diet and Gene Intervention (DIGEST) pilot study, a parallel two-arm randomized clinical trial that provided complete diets to all participants. Matching single-spot urine and fasting plasma specimens were collected at baseline, and then following two weeks of either a Prudent or Western diet with a weight-maintaining menu plan designed by a dietician. Targeted and nontargeted metabolite profiling was conducted using three complementary analytical platforms, where 80 plasma metabolites and 84 creatinine-normalized urinary metabolites were reliably measured (CV < 30%) in the majority of participants (>75%) after implementing a rigorous data workflow for metabolite authentication with stringent quality control. We classified a panel of metabolites with distinctive trajectories following two weeks of food provisions when using complementary univariate and multivariate statistical models. Unknown metabolites associated with contrasting dietary patterns were identified with high-resolution MS/MS, as well as co-elution after spiking with authentic standards if available. Overall, 3-methylhistidine and proline betaine concentrations increased in both plasma and urine samples after participants were assigned a Prudent diet (q < 0.05) with a corresponding decrease in the Western diet group. Similarly, creatinine-normalized urinary imidazole propionate, hydroxypipecolic acid, dihydroxybenzoic acid, and enterolactone glucuronide, as well as plasma ketoleucine and ketovaline increased with a Prudent diet (p < 0.05) after adjustments for age, sex, and BMI. In contrast, plasma myristic acid, linoelaidic acid, linoleic acid, α-linoleic acid, pentadecanoic acid, alanine, proline, carnitine, and deoxycarnitine, as well as urinary acesulfame K increased among participants following a Western diet. Most metabolites were also correlated (r > ± 0.30, p < 0.05) to changes in the average intake of specific nutrients from self-reported diet records reflecting good adherence to assigned food provisions. Our study revealed robust biomarkers sensitive to short-term changes in habitual diet, which is needed for accurate monitoring of healthy eating patterns in free-living populations, and evidence-based public health policies for chronic disease prevention. Full article
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Open AccessArticle
Validation of a Food Frequency Questionnaire to Assess Intake of n-3 Polyunsaturated Fatty Acids in Switzerland
Nutrients 2019, 11(8), 1863; https://doi.org/10.3390/nu11081863 - 10 Aug 2019
Cited by 1
Abstract
Population-based data suggest that high intake of omega-3 (n-3) polyunsaturated fatty acids (PUFA) may be beneficial in a variety of health conditions. It is likely that mainly those patients with preexisting n-3 deficiency are those that benefit most from n-3 fatty acid [...] Read more.
Population-based data suggest that high intake of omega-3 (n-3) polyunsaturated fatty acids (PUFA) may be beneficial in a variety of health conditions. It is likely that mainly those patients with preexisting n-3 deficiency are those that benefit most from n-3 fatty acid supplementation. Therefore, for targeted interventions, a fast and reliable screening tool for n-3 PUFA intake is necessary. Thus, the aim of this project was to adapt and validate a food frequency questionnaire (FFQ) for n-3 PUFA intake in Switzerland while using as references the following: (1) 7-day food records (FR), and (2) n-3 fatty acid composition of red blood cells (RBC). We recruited 46 healthy adults for the first part of the study and 152 for the second. We used the dietary software EBISpro for the analysis of n-3 PUFA intake. RBC fatty acid composition was determined by gas chromatography mass spectrometry (GC-MS). Using correlation analysis, we found a moderate significant association between FFQ and FR for α-linolenic acid (ALA), eicosapentanoic acid (EPA), docosahexanoic acid (DHA), and total n-3 fatty acids (all r between 0.523 and 0.586, all p < 0.001). Bland Altman analysis further showed good agreement between the two methods and no proportional bias. Correlations between FFQ and RBC fatty acid composition were also moderate for EPA and DHA (r = 0.430 and r = 0.605, p < 0.001), but weaker for ALA and total n-3 (r = 0.314 and r = 0.211, p < 0.01). The efficacy of the FFQ to classify individuals into the same or adjacent quartile of RBC PUFA content ranged between 70% and 87% for the different fatty acids. In conclusion, we showed that the Swiss n-3 PUFA FFQ is a valid tool to assess dietary n-3 PUFA intake, especially DHA and EPA, to determine population groups at risk for low intake. Full article
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Open AccessArticle
Dietary Patterns are Associated with Leukocyte LINE-1 Methylation in Women: A Cross-Sectional Study in Southern Italy
Nutrients 2019, 11(8), 1843; https://doi.org/10.3390/nu11081843 - 09 Aug 2019
Cited by 9
Abstract
Bioactive food compounds have different effects on global DNA methylation, an epigenetic mechanism associated with chromosomal stability and genome function. Since the diet is characterized by a mixture of foods, we aimed to identify dietary patterns in women, and to evaluate their association [...] Read more.
Bioactive food compounds have different effects on global DNA methylation, an epigenetic mechanism associated with chromosomal stability and genome function. Since the diet is characterized by a mixture of foods, we aimed to identify dietary patterns in women, and to evaluate their association with long interspersed nuclear elements (LINE-1) methylation, a surrogate marker of global DNA methylation. We conducted an observational cross-sectional study of 349 women from Southern Italy, with no history of severe diseases. Dietary patterns were derived by food frequency questionnaire and principal component analysis. LINE-1 methylation of leukocyte DNA was assessed by pyrosequencing. We observed that intake of wholemeal bread, cereals, fish, fruit, raw and cooked vegetables, legumes, soup, potatoes, fries, rice, and pizza positively correlated with LINE-1 methylation levels. By contrast, vegetable oil negatively correlated with LINE-1 methylation levels. Next, we demonstrated that adherence to a prudent dietary pattern—characterized by high intake of potatoes, cooked and raw vegetables, legumes, soup and fish—was positively associated with LINE-1 methylation. In particular, women in the 3rd tertile exhibited higher LINE-1 methylation level than those in the 1st tertile (median = 66.7 %5mC; IQR = 4.67 %5mC vs. median = 63.1 %5mC; IQR = 12.3 %5mC; p < 0.001). Linear regression confirmed that women in the 3rd tertile had higher LINE-1 methylation than those in the 1st tertile (β = 0.022; SE = 0.003; p < 0.001), after adjusting for age, educational level, employment status, smoking status, use of folic acid supplement, total energy intake and body mass index. By contrast, no differences in LINE-1 methylation across tertiles of adherence to the Western dietary pattern were evident. Interestingly, women who exclusively adhered to the prudent dietary pattern had a higher average LINE-1 methylation level than those who exclusively or preferably adhered to the Western dietary pattern (β = 0.030; SE = 0.004; p < 0.001; β = 0.023; SE = 0.004; p < 0.001; respectively), or those with no preference for a specific dietary pattern (β = 0.013; SE = 0.004; p = 0.002). Our study suggested a remarkable link between diet and DNA methylation; however, further mechanistic studies should be encouraged to understand the causal relationship between dietary intake and DNA methylation. Full article
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Open AccessArticle
The Validity of Children’s Fruit and Vegetable Intake Using Plasma Vitamins A, C, and E: The SAYCARE Study
Nutrients 2019, 11(8), 1815; https://doi.org/10.3390/nu11081815 - 06 Aug 2019
Cited by 1
Abstract
Despite that fruits and vegetables are key elements for health promotion, there are limited studies validating their intake in children. We aimed to validate the SAYCARE (South American Youth/Child Cardiovascular and Environmental) Study Food Frequency Questionnaire (FFQ) and the combination of the FFQ [...] Read more.
Despite that fruits and vegetables are key elements for health promotion, there are limited studies validating their intake in children. We aimed to validate the SAYCARE (South American Youth/Child Cardiovascular and Environmental) Study Food Frequency Questionnaire (FFQ) and the combination of the FFQ frequency of intake with the 24 h-dietary-recall (24 h-DR) (mean of 3 days), for children’s fruit and vegetable intake. The reference methods were plasma dosages of β-carotene, retinol, ascorbic acid, and α-tocopherol, which were collected in the school environment. It is a validity study in a subsample of 45 children aged 6–10 years participating in the SAYCARE Study, from São Paulo (Brazil). The FFQ was answered by the parents/guardians over the previous 3 months; the 24 h-DR was answered three times (two weekdays by nutritionists, one weekend day by parents/guardians). The mean fruit and vegetable intake (combined with frequency of intake) was calculated using the multiple source method (MSM). Multiple linear regression showed pooled correlation coefficients of 0.29 to 0.35 for the reported fruit and vegetable intake estimated by the FFQ and the MSM, respectively. The SAYCARE FFQ is an accurate and useful tool for ranking fruit and vegetable intake in children between 6–10 years from the SAYCARE Study. Full article
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Open AccessArticle
Identification of Dietary Patterns Associated with Incidence of Hyperglycemia in Middle-Aged and Older Korean Adults
Nutrients 2019, 11(8), 1801; https://doi.org/10.3390/nu11081801 - 04 Aug 2019
Cited by 3
Abstract
Little is known about the association between dietary patterns and hyperglycemia incidence among Korean adults. Hence, we aimed to prospectively investigate the major dietary patterns associated with hyperglycemia among middle-aged and older Korean adults. In total, 55,457 adults (18,292 men and 37,165 women) [...] Read more.
Little is known about the association between dietary patterns and hyperglycemia incidence among Korean adults. Hence, we aimed to prospectively investigate the major dietary patterns associated with hyperglycemia among middle-aged and older Korean adults. In total, 55,457 adults (18,292 men and 37,165 women) aged 40 to 79 years, who were previously enrolled in the Health Examinee Study of the Korean Genome and Epidemiology Study and had no history of type 2 diabetes mellitus (T2DM) or cancer at baseline, were included. Dietary patterns were identified by a factor analysis based on dietary data, which were assessed at baseline using a validated food-frequency questionnaire. Participants were classified as having hyperglycemia if fasting blood glucose levels were ≥126 mg/dL or physician diagnosed T2DM during follow-up. Multivariable Cox proportional hazard models were used to examine the associations between each dietary pattern and future hyperglycemia risk after adjusting for potential confounders. After a mean follow-up of 4.9 years, 2574 new cases of hyperglycemia were identified. Using a factor analysis, four distinct dietary patterns were identified: “prudent;” “fatty fish, meat, and flour-based food;” “coffee and sweets;” and “whole grain (men)” or “white rice (women).” The “prudent” pattern was inversely associated with hyperglycemia risk only in women (hazard ratio [HR], 0.75; 95% confidence interval [CI], 0.63–0.89; p for trend = 0.0003). Conversely, women in the highest quintile of the “fatty fish, meat, and flour-based food” pattern showed an increased risk of hyperglycemia (HR, 1.22; 95% CI, 1.03–1.44; p for trend = 0.0210) compared with those in the lowest quintile. The “coffee and sweets” and “white rice” patterns were not associated with hyperglycemia risk in women. The dietary patterns observed in men had no associations with hyperglycemia incidence. Our findings suggest that a diet rich in vegetables, mushrooms, seaweeds, fruits, and soy products and low in fatty fish and high-fat meat may potentially play a protective role in T2DM development with sex differences in middle-aged and older Korean adults. Full article
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Open AccessArticle
Phenotyping Women Based on Dietary Macronutrients, Physical Activity, and Body Weight Using Machine Learning Tools
Nutrients 2019, 11(7), 1681; https://doi.org/10.3390/nu11071681 - 22 Jul 2019
Cited by 1
Abstract
Nutritional phenotyping can help achieve personalized nutrition, and machine learning tools may offer novel means to achieve phenotyping. The primary aim of this study was to use energy balance components, namely input (dietary energy intake and macronutrient composition) and output (physical activity) to [...] Read more.
Nutritional phenotyping can help achieve personalized nutrition, and machine learning tools may offer novel means to achieve phenotyping. The primary aim of this study was to use energy balance components, namely input (dietary energy intake and macronutrient composition) and output (physical activity) to predict energy stores (body weight) as a way to evaluate their ability to identify potential phenotypes based on these parameters. From the Women’s Health Initiative Observational Study (WHI OS), carbohydrates, proteins, fats, fibers, sugars, and physical activity variables, namely energy expended from mild, moderate, and vigorous intensity activity, were used to predict current body weight (both as body weight in kilograms and as a body mass index (BMI) category). Several machine learning tools were used for this prediction. Finally, cluster analysis was used to identify putative phenotypes. For the numerical predictions, the support vector machine (SVM), neural network, and k-nearest neighbor (kNN) algorithms performed modestly, with mean approximate errors (MAEs) of 6.70 kg, 6.98 kg, and 6.90 kg, respectively. For categorical prediction, SVM performed the best (54.5% accuracy), followed closely by the bagged tree ensemble and kNN algorithms. K-means cluster analysis improved prediction using numerical data, identified 10 clusters suggestive of phenotypes, with a minimum MAE of ~1.1 kg. A classifier was used to phenotype subjects into the identified clusters, with MAEs <5 kg for 15% of the test set (n = ~2000). This study highlights the challenges, limitations, and successes in using machine learning tools on self-reported data to identify determinants of energy balance. Full article
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Open AccessArticle
Considering Gender Differences in Portion Sizes to Improve the Accuracy of Nutrient Intakes from A Food Frequency Questionnaire
Nutrients 2019, 11(7), 1449; https://doi.org/10.3390/nu11071449 - 26 Jun 2019
Cited by 2
Abstract
The aim of this study was to examine whether using gender specific-portion size (GS-PS) improves the accuracy of nutrient intake assessment by a quantitative food frequency questionnaire (QFFQ). For GS-PS quantification, a gram amount was assigned to each PS category for each food [...] Read more.
The aim of this study was to examine whether using gender specific-portion size (GS-PS) improves the accuracy of nutrient intake assessment by a quantitative food frequency questionnaire (QFFQ). For GS-PS quantification, a gram amount was assigned to each PS category for each food item for men and women separately using data from three 24 h dietary recalls (24HDRs) in a calibration study of the Multiethnic Cohort (men = 1141, women = 1150). Nutrient intakes were calculated from the QFFQ using the original-PS and the GS-PS, and were compared with 24HDRs. When intakes of energy and 15 nutrients were compared, absolute intakes calculated using the GS-PS were closer to intake levels of 24HDRs in both men and women. Using GS-PS did not affect intakes expressed as nutrient density or correlations between 24HDRs and the QFFQ. The current findings indicate that considering gender in PS determination can increase the accuracy of intake assessment by QFFQ for absolute nutrient intakes, but not for nutrient densities. Full article
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Open AccessArticle
Procedure to Estimate Added and Free Sugars in Food Items from the Swedish Food Composition Database Used in the National Dietary Survey Riksmaten Adolescents 2016–17
Nutrients 2019, 11(6), 1342; https://doi.org/10.3390/nu11061342 - 14 Jun 2019
Cited by 2
Abstract
A high intake of added and free sugars is associated with poor diet quality, caries, and potentially has a role in non-communicable diseases. As a result, dietary guidelines advice limitation. However, there is no standardized method for estimation of added and free sugars [...] Read more.
A high intake of added and free sugars is associated with poor diet quality, caries, and potentially has a role in non-communicable diseases. As a result, dietary guidelines advice limitation. However, there is no standardized method for estimation of added and free sugars in food items and consequently intake is difficult to measure. This study aimed to refine a procedure for sugars estimation and apply it to a Swedish dietary survey on adolescents (Riksmaten Adolescents 2016–17). A national sample of 3099 adolescents in school year 5, 8 and 11 participated (55% girls). Individual dietary intake data from two non-consecutive days was collected retrospectively and used for analysis. A ten-step systematic procedure for estimation of sugars in a Swedish context has been developed by combining two earlier methods, one for estimation of added sugars and one for free sugars. Sugars estimates were made for all food items comprising the survey database. Mainly objective decisions were necessary to make the estimates (92% and 93% for the sugars respectively); meaning that the procedure was largely transparent. In relation to Nordic Nutrition Recommendations, 45% of the participants had an intake that adhered to the guidelines. However, the majority of intakes was close to the recommendation. Further research on how specific food sources contribute to added and free sugars is necessary to facilitate further guidance on sugars and how to reach recommended target levels in Sweden. Full article
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Open AccessArticle
Maternal Dietary Patterns Are Associated with Pre-Pregnancy Body Mass Index and Gestational Weight Gain: Results from the “Mamma & Bambino” Cohort
Nutrients 2019, 11(6), 1308; https://doi.org/10.3390/nu11061308 - 10 Jun 2019
Cited by 10
Abstract
The present study investigated the association of maternal dietary patterns with pre-pregnancy body mass index (BMI) and total gestational weight gain (GWG), using data of 232 women from the “Mamma & Bambino” cohort. Dietary patterns were derived by a food frequency questionnaire and [...] Read more.
The present study investigated the association of maternal dietary patterns with pre-pregnancy body mass index (BMI) and total gestational weight gain (GWG), using data of 232 women from the “Mamma & Bambino” cohort. Dietary patterns were derived by a food frequency questionnaire and principal component analysis. Self-reported pre-pregnancy BMI and GWG were calculated according to the World Health Organization and Institute of Medicine guidelines, respectively. The adherence to the “Western” dietary pattern—characterized by high intake of red meat, fries, dipping sauces, salty snacks and alcoholic drinks—was associated with increased GWG (β = 1.217; standard error [SE] = 0.487; p = 0.013), especially among obese women (β = 7.363; SE = 1.808; p = 0.005). In contrast, the adherence to the “prudent” dietary pattern—characterized by high intake of boiled potatoes, cooked vegetables, legumes, pizza and soup—was associated with reduced pre-pregnancy BMI (β = −0.631; SE = 0.318; p-trend = 0.038). Interestingly, the adherence to this pattern was positively associated with GWG among underweight (β = 4.127; SE = 1.722; p = 0.048), and negatively among overweight and obese individuals (β = −4.209; SE = 1.635; p = 0.016 and β = −7.356; SE = 2.304; p = 0.031, respectively). Our findings point out that the promotion of a healthy diet might represent a potential preventive strategy against inadequate weight gain, even during the periconceptional period. Full article
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Open AccessArticle
Childhood Dietary Intake in Italy: The Epidemiological “MY FOOD DIARY” Survey
Nutrients 2019, 11(5), 1129; https://doi.org/10.3390/nu11051129 - 21 May 2019
Cited by 6
Abstract
Promoting a healthy lifestyle during the first years of life is a key strategy for controlling obesity risk in later life; having good-quality epidemiological data on eating habits of infants and toddlers can improve awareness and possibly the education given by pediatricians to [...] Read more.
Promoting a healthy lifestyle during the first years of life is a key strategy for controlling obesity risk in later life; having good-quality epidemiological data on eating habits of infants and toddlers can improve awareness and possibly the education given by pediatricians to parents and children. With this aim, we performed a survey about the dietary pattern of Italian children in early childhood. We described the intake of energy, macronutrients and fiber, minerals, and vitamins of 443 Italian children (range 6.4–131 months), through a three-day food record filled out by their parents and assessed by family pediatricians. The results were compared with the Italian Dietary Reference Values. The median protein intake, in g/kg per body weight, exceeded the average requirement in all age groups, and in the 12–36 month period, the intake as % of energy was outside the reference range (>15%). The majority of the children consumed quantities of simple carbohydrates (consisting of both natural sugars and free or added sugars, 82.3% of the children in the study) and saturated fats (69% of the children in the study) above the limits of the Italian Dietary Reference Values, with low intake of fiber and polyunsaturated fats. Median mineral intake, in our study, was different depending on age, while vitamin D intake was very low in all age groups. This is one of the few studies reporting on the nutrient intake of Italian children with reference to nutrition recommendations in order to identify the principal nutritional errors. The present results underline the need for healthcare policies starting from the first years of life in order to ameliorate nutrient intake during childhood, possibly impacting long-term health outcomes. Full article
Open AccessArticle
Red and Processed Meat and Mortality in a Low Meat Intake Population
Nutrients 2019, 11(3), 622; https://doi.org/10.3390/nu11030622 - 14 Mar 2019
Cited by 9
Abstract
Associations of low-to-moderate consumption of red and processed meat with mortality would add to the evidence of possible adverse effects of these common foods. This study aims to investigate the association of red and processed meat intake with mortality. The Adventist Health Study-2 [...] Read more.
Associations of low-to-moderate consumption of red and processed meat with mortality would add to the evidence of possible adverse effects of these common foods. This study aims to investigate the association of red and processed meat intake with mortality. The Adventist Health Study-2 (AHS-2) is a prospective cohort study of ~96,000 Seventh-day Adventist men and women recruited in the US and Canada between 2002 and 2007. The final analytic sample after exclusions was 72,149. Cox proportional hazards regression was used and hazard ratios (HR) and confidence intervals (CI) were obtained. Diet was assessed by a validated quantitative food frequency questionnaire (FFQ), calibrated using six 24-h dietary recalls. Mortality outcome data were obtained from the National Death Index. During a mean follow-up of 11.8 years, there were 7961 total deaths, of which 2598 were Cardiovascular diseases (CVD) deaths and 1873 were cancer deaths. Unprocessed red meat was associated with risk of all-cause mortality (HR: 1.18; 95% CI: 1.07–1.31) and CVD mortality (HR: 1.26; 95% CI: 1.05–1.50). Processed meat alone was not significantly associated with risk of mortality. The combined intake of red and processed meat was associated with all-cause mortality (HR: 1.23; 95% CI: 1.11–1.36) and CVD mortality (HR: 1.34; 95% CI: 1.12–1.60). These findings suggest moderately higher risks of all-cause and CVD mortality associated with red and processed meat in a low meat intake population. Full article
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Open AccessArticle
Subjects’ Perception in Quantifying Printed and Digital Photos of Food Portions
Nutrients 2019, 11(3), 501; https://doi.org/10.3390/nu11030501 - 27 Feb 2019
Cited by 2
Abstract
Although digital photos have the potential to improve the precision of reported portions in dietary assessment, there are few studies investigating its accuracy in comparison to printed photos. The aim of this study was to evaluate the perception of adults in quantifying food [...] Read more.
Although digital photos have the potential to improve the precision of reported portions in dietary assessment, there are few studies investigating its accuracy in comparison to printed photos. The aim of this study was to evaluate the perception of adults in quantifying food portion sizes using printed and digital photos, displayed on computer-screens and tablets. In total, 1165 evaluations were performed for 60 photos of portion sizes in Brazil. Each participant (n = 58) attended two sessions in the study center, with an interval of at least one week. In each session, twelve food portions were prepared and randomly evaluated by each participant in its printed and digital forms. The mean error (difference between the estimated and true portions) was not significantly different between the printed photos (2.1 g ± 47.2) and the digital ones (−6.4 g ± 53.7). The agreement on using the printed and digital photos was 91% and 90%, respectively. Furthermore, the use of the tablet was more prone to underestimation when compared to printed and computer-screen photos (p < 0.001). Overall, participants did not present major difficulties in perceiving the portion sizes using the printed and digital photos, but the use of tablets led to less accurate results, indicating that this needs to be further evaluated. Full article
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Open AccessFeature PaperArticle
Protein Intake Estimated from Brief-Type Self-Administered Diet History Questionnaire and Urinary Urea Nitrogen Level in Adolescents
Nutrients 2019, 11(2), 319; https://doi.org/10.3390/nu11020319 - 01 Feb 2019
Cited by 1
Abstract
Our aim was to assess the validity of the brief-type self-administered diet history questionnaire (BDHQ15y) to estimate the protein intake in 248 Japanese secondary school students (mean age = 14.2 years), using urinary biomarkers as references. Participants provided three samples of overnight urine [...] Read more.
Our aim was to assess the validity of the brief-type self-administered diet history questionnaire (BDHQ15y) to estimate the protein intake in 248 Japanese secondary school students (mean age = 14.2 years), using urinary biomarkers as references. Participants provided three samples of overnight urine for measurement of urea nitrogen and creatinine levels, underwent anthropometric measurements, and answered the questionnaires. Additionally, 58 students provided 24-h urine specimens. A significant correlation was observed between excretion of urea nitrogen in overnight and 24-h urine specimens (ρ = 0.527; p < 0.001), with biases ≤5.8%. The mean daily protein intake estimated from urinary biomarkers was 76.4 ± 20.4 g/d in males and 65.4 ± 16.9 g/d in females, and the mean protein intake estimated from the BDHQ15y (PRTbdhq) was 89.3 ± 33.7 g/d in males and 79.6 ± 24.6 g/d in females. Crude and energy-adjusted coefficients of correlation between PRTbdhq and protein intake estimated from urinary biomarkers were 0.205 (p = 0.001; 0.247 for males and 0.124 for females), and 0.204 (p = 0.001; 0.302 for males and 0.109 for females), respectively. The BDHQ15y is a low-cost tool to assess protein intake of a large population, instead of a weakness of overestimation. Full article
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Review

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Open AccessReview
A Systematic Review of Ecological Momentary Assessment of Diet: Implications and Perspectives for Nutritional Epidemiology
Nutrients 2019, 11(11), 2696; https://doi.org/10.3390/nu11112696 - 07 Nov 2019
Cited by 4
Abstract
The ecological momentary assessment (EMA) of eating behaviors represents an innovative, detailed and valid approach to capture the complexity of food intake and to overcome limitations of traditional dietary assessment methods. Moreover, EMA studies might generate a large variety of data (e.g., dietary, [...] Read more.
The ecological momentary assessment (EMA) of eating behaviors represents an innovative, detailed and valid approach to capture the complexity of food intake and to overcome limitations of traditional dietary assessment methods. Moreover, EMA studies might generate a large variety of data (e.g., dietary, behavioral, physical, sociopsychological, and contextual information), thereby enabling to examine concurrent exposures and events. Due to the increasing number of studies in this field of research, here we systematically reviewed EMA methods for the assessment of dietary intake in epidemiological studies, and discussed implications and perspectives for future research. Our study summarized several protocols and platforms that may be applied to assess diet in terms of eating frequency, choices, and habits. Nearly 38% of studies used an event-contingent strategy by asking participants to report foods and beverages consumed in real-time at each eating occasion. Instead, approximately 55% of studies used a signal-contingent prompting approach that notified the participants to record their dietary consumption. The remaining studies used a combination of event- and signal-contingent protocols to compare their accuracy or to improve the assessment of dietary data. Although both approaches might improve the accuracy and ecological validity of dietary assessment—also reducing the burden for participants—some limitations should nevertheless be considered. Despite these limitations, our systematic review pointed out that EMA can be applied in various fields of nutritional epidemiology, from the identification of determinants of dietary habits in healthy people to the management of patients with eating or metabolic disorders. However, more efforts should be encouraged to improve the validity and the reliability of EMA and to provide further technological innovations for public health research and interventions. Full article
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