Recent research has shown an inverse relationship between bone marrow adipose tissue (BMAT) and bone mineral density (BMD). There is a lack of evidence at the macro-imaging level to establish whether increased BMAT is a cause or effect of bone loss. This cross-sectional study compared the BMAT and BMD relationship between a younger adult group at or approaching peak bone mass (PBM) (age 18.0-39.9 yrs) and an older group with potential bone loss (PoBL) (age 40.0-88 yrs).
Pelvic BMAT was evaluated in 560 healthy men and women with T1-weighted whole body magnetic resonance imaging. BMD was measured using whole body dual-energy x-ray absorptiometry.
An inverse correlation was observed between pelvic BMAT and pelvic, total, and spine BMD in the younger PBM group (r=-0.419 to -0.461, P<0.001) and in the older PoBL group (r=-0.405 to -0.500, P<0.001). After adjusting for age, sex, ethnicity, menopausal status, total body fat, skeletal muscle, subcutaneous and visceral adipose tissue, neither subject group (younger PBM vs. older PoBL) nor its interaction with pelvic BMAT significantly contributed to the regression models with BMD as dependent variable and pelvic BMAT as independent variable (P=0.434 to 0.928).
Our findings indicate that an inverse relationship between pelvic BMAT and BMD is present both in younger subjects who have not yet experienced bone loss and also in older subjects. These results provide support at the macro-imaging level for the hypothesis that low BMD may be a result of preferential differentiation of mesenchymal stem cells from osteoblasts to adipocytes.
body composition; bone marrow adipose tissue; bone mineral density; dual-energy X-ray absorptiometry; magnetic resonance imaging; aging
Soy consumption may protect against breast cancer through modification of estrogen metabolism.
We examined the effect of soy foods on urinary estrogens and the 2-hydroxy (OH)/16α-OH estrone (E1) ratio in 2 dietary interventions with premenopausal women.
BEAN1 was a 2-year randomized trial and BEAN2 a 13-month randomized crossover study. In both interventions, study participants consumed a high-soy diet with 2 soy food servings/day and a low-soy diet with <3 servings of soy/week. Urine samples were collected at baseline and at the end of the diet periods, analyzed for 9 estrogen metabolites by liquid chromatography mass spectrometry, and adjusted for creatinine levels. For BEAN1, 2 samples for 188 participants and for BEAN2, 3 samples for 79 women were analyzed. We applied mixed-effects regression models with log-transformed values of estrogen metabolites and soy intake as the exposure variable.
In BEAN1, no effect of the high-soy diet on individual estrogen metabolites or hydroxylation pathways was observed. The median 2-OH/16α-OH E1 ratio decreased non-significantly in the intervention group from 6.2 to 5.2 as compared to 6.8 and 7.2 in the control group (p=0.63). In BEAN2, only 4-OHE1 was significantly lower after the high-soy diet. Interaction terms of the high-soy diet with equol producer status, ethnicity, and weight status revealed no significant effect modification.
Contrary to our hypothesis and some previous reports, the results from 2 well controlled dietary interventions do not support an effect of a high-soy diet on a panel of urinary estrogen metabolites and the 2-OH/16α-OHE1 ratio.
Soy foods; estrogen metabolites; isoflavones; breast cancer risk; dietary intervention; premenopausal women
Deficiencies in antioxidants contribute to immune dysregulation and viral replication.
To evaluate the correlation of selenium (Se) and zinc (Zn) levels on the treatment outcomes in HIV-infected children.
HIV-infected Thai children 1–12 years old, CD4 15–24%, without severe HIV symptoms were included. Se and Zn levels were measured by graphite furnace atomic absorption spectrometry at baseline and 48 weeks. Deficiency cut-offs were Se<0.1 μmol/L and Zn<9.9 μmol/L. Serum ferritin and C-reactive protein (CRP) were performed every 24 weeks. No micronutrient supplement was prescribed.
141 children (38.3% male) with a median (IQR) age of 7.3 (4.2–9.0) years, were enrolled. Median baseline CD4% was 20%, HIV-RNA was 4.6 log10copies/mL. At baseline, median (IQR) Se and Zn levels were 0.9 (0.7–1.0) μmol/L and 5.9 (4.8–6.9) μmol/L, respectively. None had Se deficiency while all had Zn deficiency.
Over 48 weeks, 97 initiated antiretroviral therapy (ART) and 81% achieved HIV-RNA <50 copies/mL with 11% median CD4 gain. The mean change of Se was 0.06 μmol/L (p = 0.003) and Zn was 0.42 μmol/L (p=0.003), respectively. By multivariate analysis in children who received ART, predictors for greater increase of CD4% from baseline were lower baseline CD4% (p<0.01) and higher baseline Zn level (p=0.02). The predictors for greater decrease of HIV-RNA from baseline were higher baseline HIV-RNA and higher ferritin (both p<0.01). No association of CRP to the changes from baseline of CD4% or HIV-RNA was found.
In HIV-infected Thai children without severe immune deficiency who commenced ART, no correlation between selenium and ART treatment outcomes were found. Higher pre-ART Zn levels were associated with significant increases in CD4 percent at 48 weeks.
HIV-infected children; selenium; zinc; CD4%; HIV-RNA; disease progression
As vitamin D deficiency is considered to be more common in regions with little solar ultraviolet light in winter, the aim of the present study was to investigate predictors of vitamin D status by season within a large sample of male smokers from Finland, a country where there is negligible solar ultraviolet light in winter.
Vitamin D (measured by 25-hydroxyvitamin D (25(OH)D) nmol/L) and other serum constituents were assayed and measured anthropometry, and self-reported dietary intake and physical activity (PA) were obtained and analysed by step-wise multiple linear and logistic regression in 2,271 middle-aged Finnish male smokers.
Twenty-seven % of the population in winter and 17% in summer had serum 25(OH)D levels < 25 nmol/L, respectively. In summer, in multiple logistic regression analyses with adjustment for confounding and other predictors, high dietary vitamin D (OR=3.6; 95% CI= 1.5–8.5), some leisure time PA (OR=2.0; 95% CI=1.3–3.1) and having a body mass index (BMI) ≥ 21 kg/m2 compared to < 21 kg/m2 (OR=2.6; 95% CI=1.3–5.0) were associated with 25(OH)D ≥ 25 nmol/L. In winter, additional modifiable factors were occupational PA (OR=1.6; 95% CI=1.1–2.5), and high fish (OR=3.1; 95% CI=1.7–6.2) or poultry consumption (OR=1.7; 95%CI=1.1–2.7). Predictors from linear regression analyses of continuous levels of 25(OH)D were similar to the logistic regression analyses of 25(OH)D < 25 nmol/L.
In this Finnish sample more vitamin D intake, PA and having a BMI ≥ 21 may play important modifiable roles in maintaining an adequate vitamin D status.
Vitamin D (25(OH) D) Status; Predictors of Vitamin D Deficiency; Vitamin D Intake; Fish intake; Physical Activity; BMI
There is convincing evidence that a high dietary fiber intake may lower the risk of coronary heart disease. However, the role of fiber in the prevention of stroke is unclear. We examined the associations of dietary fiber and fiber-rich food intake with risk of stroke within the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study.
Between 1985 and 1988, 26 556 Finnish male smokers aged 50–69 years who had no history of stroke completed a dietary questionnaire. During a mean follow-up of 13.6 years, 2702 cerebral infarctions, 383 intracerebral hemorrhages, and 196 subarachnoid hemorrhages were ascertained.
After adjustment for cardiovascular risk factors and folate and magnesium intakes, there was no significant association between intake of total fiber, water-soluble fiber, water-insoluble fiber, or fiber derived from fruit or cereal sources and risk of any stroke subtype. Vegetable fiber intake as well as consumption of fruit, vegetables, and cereals were inversely associated with risk of cerebral infarction; the multivariate relative risks (RR) for the highest quintile of intake compared with the lowest were 0.86 (95% confidence interval (CI): 0.76–0.99) for vegetable fiber, 0.82 (95% CI: 0.73–0.93) for fruit, 0.75 (95% CI: 0.66–0.85) for vegetables, and 0.87 (95% CI: 0.74–1.03) for cereals. Vegetable consumption was inversely associated with risk of subarachnoid hemorrhage (RR for highest versus lowest quintile: 0.62; 95% CI: 0.40–0.98) and cereal consumption was inversely associated with risk of intracerebral hemorrhage (RR: 0.64; 95% CI: 0.41–1.01).
These findings suggest a beneficial effect of consumption of fruits, vegetables, and cereals on stroke risk.
cereals; dietary fiber; fruits; prospective studies; stroke; vegetables
To examine associations between food patterns, constructed with cluster analysis, and colorectal cancer incidence within the National Institutes of Health (NIH)–AARP Diet and Health Study.
A prospective cohort, aged 50–71 years at baseline in 1995–96, followed until the end of 2000.
Subjects and Method
Food patterns were constructed, separately in men (n=293 576) and women (n=198 730), with 181 food variables (daily intake frequency per 1 000 kilocalories) from a food frequency questionnaire. Four large clusters were identified in men and three in women. Cox proportional hazards regression examined associations between patterns and cancer incidence.
In men, a Vegetable and Fruit Pattern was associated with reduced colorectal cancer incidence (multivariate HR: 0.85 95%CI: 0.76, 0.94), when compared to less salutary food choices. Both the Vegetable and Fruit pattern and a Fat-Reduced Foods pattern were associated with reduced rectal cancer incidence in men. In women, a similar Vegetable and Fruit pattern was associated with colorectal cancer protection (age-adjusted HR: 0.82 95%CI: 0.70, 0.95), but the association was not statistically significant in multivariate analysis.
These results, together with findings from previous studies support the hypothesis that micronutrient dense, low-fat, high-fiber food patterns protect against colorectal cancer.
food patterns; cluster analysis; colorectal cancer; prospective cohort
Moderate, long-term weight loss results in loss of bone mass in overweight or obese premenopausal women. However, whether these changes persist during weight maintenance or regain remains to be determined.
Overweight or obese (BMI: 25.8–42.5 kg/m2) women (n=40) with at least two risk factors for the metabolic syndrome participated in this 12-mo study that examined the effects of prescribed weight loss and regain, with or without exercise, on bone turnover and on bone mineral density (BMD) in a subset of participants (n=24). During the first 6 mo, participants lost ~10% of their initial body weight via energy restriction and supervised aerobic exercise. Following weight loss, participants were randomly assigned to either an exercise or a no-exercise treatment for the regain (+50% of weight lost) phase. A one-way (time) repeated measures ANOVA tested the effects of weight loss on BMD and bone turnover, and a two-way RM ANOVA (time, exercise) was used to examine the effects of exercise during weight regain.
Hip (p=0.007) and lumbar spine (p=0.05) BMD decreased with weight loss, and remained reduced after weight regain with or without exercise. Likewise, the weight-loss-associated increases in osteocalcin (p<0.001) and C-terminal peptide of type I collagen (p<0.001) persisted following weight regain, independent of exercise.
the results of the present study, which is the first to examine changes in bone mass and turnover during carefully controlled weight regain, suggest that weight-loss-induced perturbations in bone mass and turnover persist after partial weight regain, regardless of whether regular, weight-bearing aerobic exercise was continued.
weight loss; weight regain; bone mineral density; bone turnover
Adults often misreport dietary intake; the magnitude varies by the methods used to assess diet and classify participants. The objective was to quantify the accuracy of the Goldberg method for categorizing misreporters on a food frequency questionnaire (FFQ) and two 24-hour recalls (24HR).
We compared the Goldberg method, which uses an equation to predict total energy expenditure (TEE), to a criterion method that uses doubly labeled water (DLW), in a study of 451 men and women. Underreporting was classified using recommended cutpoints and calculated values. Sensitivity and specificity, positive and negative predictive value (PPV and NPV), and the area under the receiver operating characteristic curve (AUC) were calculated. Predictive models of underreporting were contrasted for the Goldberg and DLW methods.
AUC were 0.974 and 0.972 on the FFQ, and 0.961 and 0.938 on the 24HR for men and women, respectively. The sensitivity of the Goldberg method was higher for the FFQ (92%) than the 24HR (50%); specificity was higher for the 24HR (99%) than the FFQ (88%); PPV was high for the 24HR (92%) and FFQ (88%). Simulation studies indicate attenuation in odds ratio estimates and reduction of power in predictive models.
Although use of the Goldberg method may lead to bias and reduction in power in predictive models of underreporting, the method has high predictive value for both the FFQ and the 24HR. Thus, in the absence of objective measures of TEE or physical activity, the Goldberg method is a reasonable approach to characterizing underreporting.
Diet; Diet Surveys; Energy Intake; Statistical Bias; Questionnaires/standards; Research Design
Advanced glycation end products (AGEs) are implicated in the pathogenesis of atherosclerosis, diabetes, and kidney disease. The objective was to describe dietary intake, the dominant source of exposure to AGEs, with carboxymethyl-lysine (CML), a major AGE, in serum and urine, respectively.
Serum and urinary CML were measured in 261 adults, aged 21–69 years, and compared with diet as assessed by six separate 24-hour dietary recalls.
Median (25th, 75th percentile) serum and urinary CML concentrations were 686 (598, 803 μg/L) and 1023 (812, 1238) μg/gm creatinine. There was no correlation between serum and urinary CML (r = −0.02, P = 0.78). Serum CML was positively correlated with intake of soy, fruit juice, cold breakfast cereal, non-fat milk, whole grains, fruit, non-starchy vegetables, and legumes, and negatively correlated with intake of red meat. Intake of fast food was not significantly correlated with serum CML. Urinary CML was positively correlated with intake of starchy vegetables, whole grains, sweets, nuts/seeds, and chicken, and negatively correlated with intake of fast foods. Intake of AGE-rich foods such as fried chicken, French fries, bacon/sausage, and crispy snacks were not significantly correlated with serum or urinary CML, except for a significant negative correlation between fried chicken and serum CML.
These findings suggest that the high consumption of foods considered high in CML is not a major determinant of either serum or urinary CML. Further work is needed to understand the relationship of AGEs in blood and urine with the metabolism of dietary AGEs.
advanced glycation end products; carboxymethyl-lysine; diet; 24-hour dietary recall; food
Fasting leptin and ghrelin levels were measured in 36 insulin-sensitive (IS) and 28 insulin-resistant (IR) men who consumed a legume-enriched low-glycemic index (LG) diet or healthy American (HA) diet in a randomly ordered cross-over feeding study consisting of two 4-week periods. Weight remained stable over the entire study. Fasting plasma leptin was significantly reduced from pre-study levels by both the LG (18.8%, P<0.001) and HA (16.1%, P<0.001) diets, whereas fasting ghrelin did not change. By subgroup analysis according to prestudy insulin status, leptin was reduced in IR subjects after both the LG (17.1%, P<0.01) and the HA (33.3%, P<0.001) diets, whereas IS subjects responded only after the LG diet (23.1%, P<0.01). Thus, a legume-rich LG index diet may be a beneficial strategy for reducing circulating leptin concentrations, even under conditions of weight maintenance.
ghrelin; insulin resistance; legume-enriched diet; leptin
To investigate whether a ‘junk food’ diet at 81 months of age is associated with the development of behavioural problems over the following 16 months.
The study used data from the Avon Longitudinal Study of Parents and Children (ALSPAC) and 12,942 children were included. The main outcome measure was behavioural problems, measured using the Strengths and Difficulties Questionnaire (SDQ). SDQ scores were available at 81 and 97 months of age. Child-based dietary data were collected at 81 months by food frequency questionnaire; from this a ‘junk food’ score was derived, and mean weekly non-milk extrinsic sugar (NMES) intake estimated. Statistical analyses examined the associations between dietary exposures at 81 months and SDQ outcomes at 97 months. Children with SDQ scores suggesting behavioural problems at baseline were excluded in order to identify new cases. Adjustments were made for potential confounders such as socioeconomic status.
Unadjusted analyses suggested associations between the ‘junk food’ score at 81 months and both total difficulties and pro-social behaviour at 97 months. However, adjustment for baseline SDQ scores attenuated these associations, with confidence intervals including the null for both total difficulties [OR(95% CI):1.05(0.92,1.21);P=0.45] and pro-social behaviour [1.13(1.00,1.26);P=0.04]. Adjustment for other potential confounders further attenuated the effects. Adjustment for confounders similarly attenuated modest associations between NMES intake and behavioural problems.
There was no evidence to support an association between a ‘junk food’ diet at 81 months of age and behavioural problems 16 months later.
ALSPAC; child behaviour; diet
To assess the traditional postpartum practices, mother and child nutritional status and associated factors.
A cross-sectional study in 41 randomly selected villages on the outskirts of Vientiane capital city, Lao PDR (Laos). 300 pairs of infants (<6 months of age) and their mothers were enrolled. Information was collected about pregnancy, delivery and traditional practices through a standardized questionnaire. Dietary intake and food frequency were estimated using the 24 h recall method, calibrated bowls and FAO food composition tables. Mothers’ and infants’ anthropometry was assessed and multivariate analysis performed.
Contrasting with a high antenatal care attendance (91%) and delivery under health professional supervision (72%), a high prevalence of traditional practices was found, including exposure to hot beds of embers (97%), use of traditional herb tea as the only beverage (95%) and restricted diets (90%). Twenty-five mothers (8.3%) were underweight. Mothers had insufficient intake of calories (55.6%), lipids (67.4%), iron (92.0%), vitamins A (99.3%) and C (45%), thiamin (96.6%) and calcium (96.6%). Chewed glutinous rice was given to infants as an early (mean 34.6, 95% CI:29.3–39.8 days) complementary food by 53.7% of mothers, and was associated with stunting in 10% children (OR = 1.35, 95% CI:1.04–1.75).
The high prevalence of traditional postpartum restricted diets and practices, and inadequate maternal nutritional intake in urban Laos, suggest that antenatal care may be an important opportunity to improve postpartum diets.
food taboo; Lao PDR; mother; beliefs; children; infant
Numerous studies reported beneficial effects of marine n-3 fatty acids (n-3 FAs) on cardiovascular disease (CVD) and its risk factors. However, the association of marine n-3 FAs with plasma fibrinogen, a risk factor for CVD, remains uncertain.
In a population-based, cross-sectional study of 795 men aged 40-49 without CVD (262 whites in Allegheny County, Pennsylvania, US, 302 Japanese in Kusatsu, Japan, and 229 Japanese Americans in Honolulu, Hawaii, US), we examined the association of marine n-3 FAs with plasma fibrinogen. Serum FAs were measured by capillary gas-liquid chromatography. Marine n-3 FAs were defined as the sum of docosahexaenoic, eicosapentaenoic, and docosapentaenoic acids. Plasma fibrinogen was measured by an automated clot-rate assay. Multiple linear regression analyses were performed to assess the association.
White, Japanese, and Japanese American men had mean marine n-3 FAs levels of 3.47%, 8.78%, and 4.46%, respectively. Japanese men had a significant inverse association of marine n-3 FAs with fibrinogen (standardized regression coefficient of -0.11, p=0.049), after adjusting for age, body-mass index, and current smoking. The significant inverse association remained after further adjusting for diabetes, C-reactive protein, triglycerides and other variables. White or Japanese American men did not show a significant association.
We observed the significant inverse association of marine n-3 FAs with fibrinogen in Japanese, but not in whites or Japanese Americans. The observation suggests that marine n-3 FAs at very high levels, as seen in the Japanese, may decrease plasma fibrinogen levels.
fibrinogen; marine n-3 fatty acids; epidemiology; Japanese
Strategies to achieve healthier diets for children are likely to benefit from an understanding of the determinants. We examined environmental and individual predictors of children’s intake of ‘core’ foods (fruit, vegetables) and ‘non-core’ foods (snacks, sweetened beverages). Predictors included parental intake, home availability, parental feeding styles (Encouragement and Monitoring), and children’s food preferences. Based on research with older children, we expected intake of both food types to be associated with maternal intake, core foods to be more associated with children’s preferences, and non-core food intake more with the home environment.
Primary caregivers (n=434) of children (2-5 years) from preschools and Children’s Centres in London, UK, completed a self-report survey in 2008.
Multiple regression analyses indicated children’s fruit intake was associated with maternal fruit intake (B=.29; p=0.000), children’s liking for fruit (B=.81; p=0.000) and a Monitoring style of parental feeding (B=.13; p=0.021). Children’s vegetable intake was similarly associated with maternal intake (B=.39; p=0.000), children’s liking for vegetables (B=.77; p=0.000), Encouragement (B=.19; p=0.021) and Monitoring (B=.11; p=0.029). Non-core snack intake was associated with maternal intake (B=.25; p=0.029), Monitoring (B=−.16; p=0.010), home availability (B=.10; p=0.022) and television viewing (B=.28; p=0.012). Non-core drink intake was associated with maternal intake (B=.32; p=0.000) and television viewing (B=.20; p=0.019).
Results indicate commonalities and differences in the predictors of core and non-core food intake; with only maternal intake important across all types. Effective interventions to improve young children’s diets may need to call on different strategies for different foods.
Core food; non-core food; children; diet
The results of short-term studies in humans suggest that, compared with glucose, acute consumption of fructose leads to increased postprandial energy expenditure and carbohydrate oxidation and decreased postprandial fat oxidation. The objective of this study was to determine the potential effects of increased fructose consumption compared to isocaloric glucose consumption on substrate utilization and energy expenditure following sustained consumption and under energy-balanced conditions.
As part of a parallel arm study, overweight/obese male and female subjects, 40–72 y, consumed glucose- or fructose-sweetened beverages providing 25% of energy requirements for 10 weeks. Energy expenditure and substrate utilization were assessed using indirect calorimetry at baseline and during the 10th week of intervention.
Consumption of fructose, but not glucose, led to significant decreases of net postprandial fat oxidation and significant increases of net postprandial carbohydrate oxidation (P < 0.0001 for both). Resting energy expenditure decreased significantly from baseline values in subjects consuming fructose (P = 0.031) but not in those consuming glucose.
Increased consumption of fructose for 10 weeks leads to marked changes of postprandial substrate utilization including a significant reduction of net fat oxidation. In addition, we report that resting energy expenditure is reduced compared to baseline values in subjects consuming fructose-sweetened beverages for 10 weeks.
fructose; fat oxidation; carbohydrate oxidation; energy expenditure; metabolic rate; humans
Background and Objective
Our objective was to describe the fluid and energy consumption of beverages in a large sample of European adolescents
We used data from 2,741 European adolescents residing in 8 countries participating in the Healthy Lifestyle in Europe by Nutrition in Adolescence Cross Sectional Study (HELENA-CSS). We averaged two 24-hour recalls, collected using the HELENA-dietary assessment tool. By gender and age subgroup (12.5–14.9 y and 15–17.5 y), we examined per capita and per consumer fluid (milliliters [mL]) and energy (kilojoules [kJ]) intake from beverages and percent consuming ten different beverage groups.
Mean beverage consumption was 1611 ml/d in boys and 1316 ml/d in girls. Energy intake from beverages was about 1966 kJ/d and 1289 kJ/d in European boys and girls respectively, with sugar-sweetened beverages (carbonated and non-carbonated beverages, including soft drinks, fruit drinks and powders/concentrates) contributing to daily energy intake more than other groups of beverages. Boys and older adolescents consumed the most amount of per capita total energy from beverages. Among all age and gender subgroups sugar-sweetened beverages, sweetened milk (including chocolate milk and flavored yogurt drinks all with added sugar), low-fat milk, and fruit juice provided the highest amount of per capita energy. Water was consumed by the largest percent of adolescents followed by sugar-sweetened beverages, fruit juice, and sweetened milk. Among consumers, water provided the greatest fluid intake and sweetened milk accounted for the largest amount of energy intake followed by sugar-sweetened beverages. Patterns of energy intake from each beverage varied between countries.
European adolescents consume an average of 1455 ml/d of beverages, with the largest proportion of consumers and the largest fluid amount coming from water. Beverages provide 1609 kJ/d, of which 30.4%, 20.7%, and 18.1% comes from sugar-sweetened beverages, sweetened milk, and fruit juice respectively.
adolescents; Europe; sugar-sweetened beverages; sweetened milk; fruit juice
There is variability in the association between dietary intake and health outcomes across different countries, especially among the elderly. We used the gold standard dietary assessment method, a weighed food record, to examine the association between dietary pattern and mortality in a representative sample of community dwelling participants from Great Britain aged 65 years and older.
Dietary intake was recorded at baseline in 1017 elderly participants (520 men, 497 women, mean age 76.3±7.4 years). Exploratory factor analysis was performed to examine dietary patterns and participants were followed up over an average of 9.2 years for mortality.
The factor analysis revealed four interpretable principal components accounting for approximately 9.8% of the total variance, with similar patterns across sex. A ‘Mediterranean-style’ dietary pattern explained the greatest proportion of the variance (3.7%), followed by ‘health-aware’ (2.2%), ‘traditional’ (2.0%) and ‘sweet and fat’ (1.9%) factors. There were a total of 683 deaths through follow-up. After adjustment for potential confounders, only the Mediterranean-style dietary pattern remained associated with mortality (highest vs lowest tertile; hazard ratio=0.82, 95% CI, 0.68–1.00). The benefits of the Mediterranean-style diet were only observed among women (hazard ratio=0.71, 95% CI 0.52–0.96) although in men the traditional diet was a risk factor for mortality (hazard ratio=1.30, 95% CI 1.00–1.71).
Using a gold standard approach, our results confirm previous evidence that dietary patterns are important in longevity among the elderly.
ageing; dietary pattern; longevity; nutritional epidemiology
Several studies have linked dietary patterns to insulin sensitivity and systemic inflammation, which affect risk of multiple chronic diseases. The purpose of this study was to investigate the dietary patterns of a cohort of older adults, and examine relationships of dietary patterns with markers of insulin sensitivity and systemic inflammation.
The Health, Aging and Body Composition (Health ABC) Study is a prospective cohort study of 3075 older adults. In Health ABC, multiple indicators of glucose metabolism and systemic inflammation were assessed. Food intake was estimated with a modified Block food frequency questionnaire (FFQ). In this study, dietary patterns of 1751 participants with complete data were derived by cluster analysis.
Six clusters were identified, including a ‘Healthy foods’ cluster, characterized by higher intake of lowfat dairy products, fruit, whole grains, poultry, fish and vegetables. In the main analysis, the ‘Healthy foods’ cluster had significantly lower fasting insulin and HOMA-IR than the ‘Breakfast cereal’ and ‘High-fat dairy products’ clusters, and lower fasting glucose than the ‘High-fat dairy products’ cluster (P ≤ 0.05). No differences were found in 2-hour glucose. With respect to inflammation, the ‘Healthy foods’ cluster had lower IL-6 than the ‘Sweets and desserts’ and ‘High-fat dairy products’ clusters, and no differences were seen in CRP or TNF-α.
A dietary pattern high in lowfat dairy products, fruit, whole grains, poultry, fish and vegetables may be associated with greater insulin sensitivity and lower systemic inflammation in older adults.
diet; dietary patterns; insulin sensitivity; inflammation; older adults
Dietary assessment in children is difficult, suggesting a need to develop more objective biomarkers of intake. Resonance Raman spectroscopy (RRS) is a non-invasive, validated method of measuring carotenoid status in skin as a biomarker of fruit/vegetable intake. The purpose of this study was to examine the feasibility of using RRS in preschool children, to describe inter-individual variability in skin carotenoid status and to identify factors associated with the biomarker in this population.
We conducted a cross-sectional study of 381 economically disadvantaged preschoolers in urban centers in Connecticut (USA). In all, 85.5% were black non-Hispanic or Hispanic/Latino, and 14.1% were obese and 16.9% were overweight by age- and sex-specific body mass index (BMI) percentiles. Children had their skin carotenoid status assessed by RRS in the palm of the hand. Fruit/vegetable consumption was assessed by a brief parent/guardian-completed food frequency screener and a liking survey.
We observed inter-individual variation in RRS values that was nearly normally distributed. In multiple regression analysis, higher carotenoid status, measured by RRS, was positively associated with fruit/vegetable consumption (P =0.02) and fruit/vegetable preference (P<0.01). Lower carotenoid status was observed among younger children, those participating in the US Supplemental Nutrition Assistance Program, and those with greater adiposity (P<0.05 for all).
We observed wide variability in skin carotenoid status in a population of young children, as assessed by RRS. Parent-reported fruit/vegetable intake and several demographic factors were significantly associated with RRS-measured skin carotenoid status. We recommend further development of this biomarker in children, including evaluating response to controlled interventions.
carotenoids; biomarker; children; resonance Raman spectroscopy
Vitamin C intake has been inversely associated with breast cancer risk in case-control studies, but not in meta-analyses of cohort studies using Food Frequency Questionnaires, which can over-report fruit and vegetable intake, the main source of vitamin C. This is the first study to investigate associations between vitamin C intake and breast cancer risk using food diaries.
Estimated dietary vitamin C intake was derived from four to seven day food diaries pooled from five prospective studies in the UK Dietary Cohort Consortium. This nested case-control study of 707 incident breast cancer cases and 2144 matched controls examined breast cancer risk in relation to dietary vitamin C intake using conditional logistic regression adjusting for relevant covariates. Additionally, total vitamin C intake from supplements and diet was analysed in three cohorts.
No evidence of associations were observed between breast cancer risk and vitamin C intake analysed for dietary vitamin C intake (OR = 0.98 per 60mg/d, 95%CI: 0.88 to 1.09, Ptrend = 0.7), dietary vitamin C density (OR = 0.97 per 60mg/d, 95% CI: 0.87 to 1.07, Ptrend = 0.5) or total vitamin C intake (OR = 1.01 per 60mg/d, 95%CI: 0.99 to 1.03, Ptrend = 0.3). Additionally, there was no significant association for post-menopausal women (OR = 1.02 per 60mg/d, 95%CI: 0.99 to 1.05, Ptrend = 0.3).
This pooled analysis of individual UK women found no evidence of significant associations between breast cancer incidence and dietary or total vitamin C intake derived uniquely from detailed diary recordings.
Breast cancer; Vitamin C; cohort studies; food diaries
Few equations for calculating body fat percentage (BF%) from field methods have been developed in South Asian children.
To assess agreement between BF% derived from primary reference methods and that from skinfold equations and bio-impedance analysis (BIA) in Indian children.
We measured BF% in two groups of Indian children. In Pune, 570 rural children aged 6-8 years underwent dual-energy X-ray absorptiometry (DXA) scans. In Mysore 18O was administered to 59 urban children aged 7-9 years. We conducted BIA at 50kHz and anthropometry including subscapular and triceps skinfold thicknesses. We used the published equations of Wickramasinghe, Shaikh, Slaughter and Dezenburg to calculate BF% from anthropometric data and the manufacturer’s equation for BIA measurements. We assessed agreement with values derived from DXA and DLW using Bland Altman analysis.
Children were light and thin compared to international standards. There was poor agreement between the reference BF% values and those from all equations. Assumptions for Bland Altman analysis were not met for Wickramasinghe, Shaikh and Slaughter equations. The Dezenberg equations under-predicted BF% for most children (mean difference in Pune −13.4, LOA −22.7, −4.0 and in Mysore −7.9, LOA −13.7 and −2.2). The mean bias for the BIA equation in Pune was +5.0% and in Mysore +1.95% and the LOA were wide; −5.0, 15.0 and −7.8, 11.7 respectively.
Currently available skinfold equations do not accurately predict BF% in Indian children. We recommend development of BIA equations in this population using a 4-compartment model.
body composition; India; children; bio-impedance; skinfold
Given the importance of nutrition therapy in diabetes management, we hypothesized that food intake differs between individuals with and without diabetes. We investigated this hypothesis in two large prospective studies including different countries and ethnic groups.
Study populations were the EPIC (European Prospective Investigation into Cancer and Nutrition)-Study and the Multiethnic Cohort Study (MEC). Dietary intake was assessed via food frequency questionnaires, and calibrated using 24h-recall information for the EPIC-Study. Only confirmed self-reports of diabetes at cohort entry were included: 6192 diabetes patients in EPIC and 13 776 in the MEC. For the cross-sectional comparison of food intake and lifestyle variables at baseline, individuals with and without diabetes were matched 1:1 on sex, age in five year categories, BMI in 2.5 kg/m2 categories, and country.
Higher intake of softdrinks (by 13 and 44% in the EPIC and MEC), and lower consumption of sweets, juice, wine, and beer (>10% difference) were observed in participants with diabetes compared to those without. Consumption of vegetables, fish and meat was slightly higher in individuals with diabetes in both studies, but the differences were less than 10%. Findings were more consistent across different ethnic groups than countries, but generally showed largely similar patterns.
Although diabetes patients are expected to undergo nutritional education, we found only small differences in dietary behavior in comparison to cohort members without diabetes. These findings suggest that emphasis on education is needed to improve the current behaviors in order to assist in the prevention of complications.
Diabetes; food intake; medical nutrition therapy; secondary prevention; behavior
The accuracy of dietary recalls might be enhanced by providing participants with photo images of foods they consumed during the test period.
We examined the feasibility of a system (Image-Diet Day) that is a user-initiated camera-equipped mobile phone that is programmed to automatically capture and transmit images to a secure website in conjunction with computer-assisted, multi-pass, 24-hour dietary recalls in 14 participants during 2007. Participants used the device during eating periods on each of the three independent days. Image processing filters successfully eliminated underexposed, over-exposed, and blurry images. Captured images were accessed by participants using the ImageViewer software while completing the 24-hour dietary recall on the following day.
None of the participants reported difficulty using the ImageViewer. Images were deemed “helpful” or “sort of helpful” by 93% of participants. A majority (79%) of users reported having no technical problems, but 71% rated the burden of wearing the device as somewhat to very difficult, owing to issues such as limited battery life, self-consciousness about wearing the device in public, and concerns about the camera’s field of view.
Overall, these findings suggest that automated imaging is a promising technology to facilitate dietary recall. The challenge of managing the thousands of images generated can be met. Smaller devices with a broader field of view may aid in overcoming user’s self-consciousness with using or wearing the device
dietary assessment; automated imaging; 24-hour recalls; food frequency questionnaire; camera phones; web-based assessment; wireless technology
Milk Thistle contains silybin, which is a potential iron chelator. We aimed to determine whether silybin reduced iron absorption in patients with hereditary haemochromatosis. In this crossover study, on three separate occasions, 10 patients who were homozygous for the C282Y mutation in the HFE gene (and fully treated) consumed a vegetarian meal containing 13.9mg iron with: 200ml water; 200ml water and 140mg silybin (Legalon® Forte); or 200ml tea. Blood was drawn once before, then 0.5, 1, 2, 3 and 4h after the meal. Consumption of silybin with a meal resulted in a reduction in the postprandial increase in serum iron (AUC ±SE) compared with water (silybin 1726.6 ± 346.8 v water 2988.8 ± 167; P<0.05) and tea (silybin 1726.6 ± 346.8 v tea 2099.3 ± 223.3; P<0.05). In conclusion, silybin has the potential to reduce iron absorption, and this deserves further investigation as silybin could be an adjunct in the treatment of haemochromatosis.
Hereditary Haemochromatosis; iron absorption; milk thistle; silybin
The UAE has undergone remarkable economic and social transformations over the past few decades. We present findings on the prevalence of overweight and obesity, dietary and activity patterns among Emiratis in 2009/10, and explore associated urbanization and wealth factors.
A cross-sectional study was conducted in 628 randomly-selected households in all seven emirates. Sociodemographics, 24-hour dietary recalls, physical activity and anthropometric data were collected from adult females (≥19y), adolescents (11-18y) and children (6-10y) in each family via in-person interviews using validated questionnaires.
In 2009/10, 65% of adult women, 28% of male adolescents and 40% of female adolescents, 25% of male children and 41% of female children were overweight or obese. 43% of girls and 38% of boys (6-10y) consumed more calories than their estimated energy requirements. Snacking represents a major source of Emirati caloric intake (>20%) of total calories. In addition, caloric beverages account for 8-14% of total calories. Meanwhile, physical activity levels are low, especially among females Emiratis and those living in urban areas.
These trends represent the potential risk for severe cardio-metabolic problems in the UAE. The significant gender differentials among children and adolescents are driven by diet and activity differences. More attention should be paid to educate the public on nutrition (e.g., limit the consumption of sugared sodas, fruit drinks and whole milk, promote water and low-fat/skim milk consumption instead) and encourage physical activity from a young age, especially among females. Built environments and social support for improved lifestyle choices by individuals are needed.
Nutrition transition; obesity; diet; activity; UAE