3 results
Validation of the European Prospective Investigation into Cancer (EPIC) FFQ for use among adults in Lebanon
- Karim Khaled, Vanora Hundley, Maya Bassil, Mira Bazzi, Fotini Tsofliou
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- Journal:
- Public Health Nutrition / Volume 24 / Issue 13 / September 2021
- Published online by Cambridge University Press:
- 14 May 2021, pp. 4007-4016
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Objective:
To validate the European Prospective Investigation into Cancer (EPIC) FFQ in Lebanon.
Design:Validation of the EPIC FFQ was done against three 24-h recalls (24-HR). Unadjusted and energy-adjusted correlations, Bland–Altman plots and weighed kappa statistics were used to assess the agreement between the two methods.
Setting:Lebanon.
Participants:119 adults (staff and students) at a Lebanese University.
Results:Good unadjusted and energy-adjusted correlation coefficients were found between data from the two methods which ranged from –0·002 (vitamin A) to 0·337 (carbohydrates) and were all statistically significant except for vitamin D, vitamin E, vitamin A, Se and niacin. Slight/fair agreement was reported through weighed kappa estimates for unadjusted data ranging from –0·05 (vitamin C) to 0·248 (Mg) and for energy-adjusted data ranging from –0·034 (vitamin A) to 0·203 (P). Individuals were categorised into exact and adjacent quartiles with an average of 78 % for unadjusted data and 70 % for energy-adjusted data, indicating a very good agreement between the EPIC FFQ and the average of the 24-HR data. The visual inspection of the Bland–Altman plots revealed an overestimation of energy, carbohydrates, protein and fat intakes by the FFQ method.
Conclusion:Overall, when all tests were taken into consideration, the current study demonstrated an acceptable agreement of the EPIC FFQ with the 24-h dietary recall method and significantly good correlations between dietary intakes. Therefore, the EPIC FFQ can be considered a valid tool for assessing diet in epidemiological studies among Lebanese adults.
The association between a priori and a posterior dietary patterns with perceived stress in women of childbearing age
- Karim Khaled, Orouba Almilaji, Mareike Köppen, Vanora Hundley, Fotini Tsofliou
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- Journal:
- Proceedings of the Nutrition Society / Volume 79 / Issue OCE2 / 2020
- Published online by Cambridge University Press:
- 10 June 2020, E460
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More than half of women in developed countries are overweight or obese. Studies show that 20–25% of women in the UK enter pregnancy as obese. Healthy diet patterns such as the Mediterranean diet (MD) are linked with lower adiposity among women of childbearing age. However there is evidence that maternal diet in the UK is poor and stress increases the consumption of saturated-fat, sweets, and energy-dense foods. There is limited evidence on dietary patterns and stress among women of childbearing age, therefore this study aimed to investigate the association.
This was an anonymous online survey of female university students. The survey included: socio-demographic characteristics, physical activity, self-reported BMI and waist circumference. Dietary assessment was done via a validated 100-food item food frequency questionnaire and perceived stress via the Perceived Stress Scale (PSS). The dietary data were compared to the a priori defined Mediterranean Diet Score (MDS) and scored according to eight components (vegetables, legumes, fruit and nuts, cereals, fish, dairy products, meat and meat products, and the ratio of unsaturated to saturated fat). The scores ranged from 0 to 8 with MDS adherence groups being 0–3 low, 4–5 medium, and 6–8 high. Factor analysis was also applied on 11 food components (g/d) (the eight above plus eggs, potatoes, sweets and drinks) to reveal the latent major dietary patterns (DP) in the studied cohort.Negative binomial regression was used to examine the association between stress and the diet patterns, controlling for the socioeconomic factors, physical activity, marital status, BMI, and waist.
One hundred twenty-three students (mean age 27.7 (SD 7.3)) participated. Participants had medium (n = 49) or low MD adherence (n = 48), with fewer participants having high adherence (n = 26). Stress was not significantly associated with MD adherence, but was positively associated with sweets intake (p = 0.03). The scree plot of Factor analysis showed that the number of factors generated by the analysis is three.
Using minimum loading cut-off of 0.4, factor analysis revealed three latent diet patterns; the first (DP-1) contained: cereals, sweets and potatoes (comfort foods), DP-2 consisted: eggs, fish and meat (high protein) and DP-3 consisted of: vegetables, fruits, nuts, and legumes (vegan). Results showed a significant positive association between stress and DP-1 (p < 0.01). No association was found between other diet patterns and any other psychosocial and physical variables.
Future well designed randomised controlled trials are needed to investigate further the relationship between perceived stress and dietary patterns in women of childbearing age.
The association between perceived stress and diet quality in women of childbearing age: A systematic review
- Karim Khaled, Vanora Hundley, Fotini Tsofliou
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- Journal:
- Proceedings of the Nutrition Society / Volume 79 / Issue OCE2 / 2020
- Published online by Cambridge University Press:
- 10 June 2020, E599
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Poor diet quality is a major cause of maternal obesity and associated with adverse metabolic effects for mother and offspring. Psychological stress can increase intake of unhealthy dietary choices (e.g. highly palatable, energy dense diet), but no study has investigated the association between stress and diet quality in women of childbearing age.
This systematic review of the association between psychological stress and diet quality used the PEO (Population, Exposure, and Outcome) model.
Medline, CINAHL, Scopus, Cochrane Library, Web of Science, and Sciencedirect were searched (October 2018 - January 2019). From 139,552 hits, 471 papers were screened, but only 8 studies met our inclusion criteria: English language, stress (exposure) measured in combination with diet quality (outcome), healthy women (18–49 years of age (population). Data extraction was determined by the PEO. Quality assessment used CASP tool for Cohort studies.
The review included eight studies from USA (n = 6), Egypt (n = 1), and Iran (n = 1). The six cross-sectional and two longitudinal studies were published between 2011 and 2017 and had a total of 3,982 participants. Studies were heterogeneous in methods: three used food frequency questionnaires to assess dietary intake while the others used 24-hour dietary recalls. Diet quality was measured using different indices: Alternate Healthy Eating Index (n = 2), Healthy Eating Index (n = 2), Dietary Approach to Stop Hypertension (DASH) Diet Index (n = 2), Dietary Quality Index- Pregnancy (n = 2), and Dietary Guideline Adherence Index (n = 1). Only one study used three diet quality indices. No study explored dietary patterns using factor analysis and other statistical techniques. Most studies used the perceived stress scale to measure stress; however, there were differences regarding the use of this scale to form a continuous or categorical variable (with varying cut-off scores) perceived stress, whereas no study reported biological response to stress. Outcomes also varied in direction of association; no association (n = 4), negative association (n = 3), mixed results (n = 1).
This review is the first to systematically examine association between stress and diet quality in women of childbearing age; there was heterogeneity in measures of diet quality and study designs. Future studies that explore diet quality/patterns should include both diet indices and factor analysis and additionally measure biological markers of both dietary intake and stress.