Public Health Nutrition

To explore the relationship between subjective mood, folate status and homocysteine in healthy individuals.

Subjective mood assessments were completed twice daily over the course of one week using the Positive and Negative Affect Scale (PANAS). The PANAS is a validated scale which considers mood state on two distinct continua, one reflecting positive mood and the other negative mood, each requiring response to 10 adjectives on a Likert scale. A blood sample was taken on one occasion at the start of the week during which subjective mood was assessed and analysed for red-blood-cell (RBC) folate, serum folate and plasma homocysteine concentrations.

Male volunteers aged 19–47 years (n = 58) were recruited from local industries.

High concentrations of RBC folate were associated with less variability (lower standard deviation) in negative mood (P = 0.023). Subjective mood, however, was not related to serum folate or homocysteine.

This study appears to be the first to uncover an association between long-term folate status and subjective mood (employing the PANAS) in healthy males. More research is needed to further explore the relationship between nutritional status and mood.

The effect of depression on dietary intake has not, to our knowledge, been examined in persons with HIV infection.

We conducted a longitudinal analysis of participants in the Nutrition for Healthy Living Study (NFHL). We measured changes in dietary macronutrient intake in participants who developed depression and, using multiple regression analysis, compared the changes with a control group of patients who did not become depressed.

Ninety patients developed depression during the observation period, and we compared these with 152 non-depressed controls. The two groups had similar age and body mass index (BMI) at baseline, but those who developed depression were more likely to be female, less educated and had lower incomes. After adjustment, compared with non-depressed participants, those who developed depression had significantly greater decreases in the following daily intakes: total energy (−341 kcal, P = 0.006), protein (−12.3 g, P = 0.02), total fat (−18.5 g, P = 0.008), carbohydrate (−36.8 g, P = 0.02), total fibre (−4.3 g, P = 0.001) and saturated fat (−6.7 g, P = 0.01). There were no significant differences in the daily intakes of simple sugars and long-chain n−3 fatty acids, or BMI.

Depression is associated with decreases in total daily energy intake and in six of the eight dietary components we measured. Clinicians should be aware that depression-associated nutritional deficiencies may complicate the care of persons with HIV.

To study dietary diversity and its relationship with socio-economic and nutritional characteristics of women in an urban Sahelian context.

A qualitative dietary recall was performed over a 24-h period. Dietary diversity scores (DDS = number of food groups consumed) were calculated from a list of nine food groups (DDS-9) or from a list of 22 food groups (DDS-22) which detailed both micronutrient- and energy-dense foods more extensively. Body mass index (BMI), mid upper-arm circumference and body fat percentage were used to assess the nutritional status of the women.

Five hundred and fifty-seven women randomly selected in two districts of Ouagadougou, the capital of Burkina Faso.

The mean DDS-9 and DDS-22 were 4.9 ± 1.0 and 6.5 ± 1.8 food groups, respectively. In the high tertile of DDS-22, more women consumed fatty and sweetened foods, fresh fish, non-fatty meat and vitamin-A-rich fruits and vegetables. The DDS-9 was not associated with the women’s socio-economic characteristics whereas the DDS-22 was higher when the women were younger, richer and had received at least a minimum education. Mean BMI of the women was 24.2 ± 4.9 kg m–2 and 37% of them were overweight or obese (BMI ≥ 25 kg m–2). Neither the DDS-9 nor the DDS-22 was associated with the women’s anthropometric status, even though there was a trend towards fewer overweight women in the lowest tertile of DDS-22.

In this urban area, the qualitative measurement of dietary diversity is not sufficient to identify women at risk of under- or overweight.

In view of the paucity of data on energy costs, the present study aimed to estimate these for typical daily activities performed by women in rural India.

A cross-sectional study covering 26 different activities was done by indirect calorimetry using the Oxylog™ instrument (Morgan).

Villages about 30–40 km from Pune city, Maharashtra, India.

Energy costs were measured on 22 rural Indian women aged 18–45 years.

Irrespective of whether an activity was domestic or farming, energy cost was lower when performed in sitting position (cleaning grains 5.24 kJ min−1, plucking leafy vegetables 5.76 kJ min−1) and increased considerably with the extent of muscular movement (carrying two water containers 14.77 kJ min−1, chopping firewood 14.5 kJ min−1), indicating the importance of the postural details of the activity. Physical activity ratio computed using the Food and Agriculture Organization/World Health Organization/United Nations University equation (PARw) was lower for all activities compared with that (PARm) based on measured basal metabolic rate, indicating the need for a population-specific equation. Furthermore, PARw identified more activities as belonging to the ‘very light’ category (nine out of 26 activities), in contrast to the perception of rural women which was supported with empirical evidence. Estimated daily energy expenditure of the women was 7.69 ± 0.63 MJ (1837 ± 150 kcal) and identified their daily activity pattern as ‘moderate’ based on PALw (1.65 ± 0.16) while PALm (2.04 ± 0.18) identified it as ‘heavy’.

Our results highlight the importance of qualitative descriptions of the various activities. The energy costs for several daily activities reported in this study could potentially be used for estimating daily energy expenditure of women from similar rural settings.

To measure the occurrence and correlates of hunger and to evaluate the association between hunger and three health indicators among undocumented Mexican immigrants.

Non-probability cross-sectional sample.

Neighbourhoods within New York City.

Four hundred and thirty-one undocumented Mexican immigrants living in the USA.

Hunger was indicated by approximately 28% of respondents. In a multivariate model, working as a day labourer was associated with hunger (odds ratio (OR) 3.33, 95% confidence interval (CI) 1.83–6.06) while receiving public assistance protected against hunger (OR 0.23, 95% CI 0.06–0.88). In multivariate models, respondents who reported experiencing hunger also reported poorer overall health (OR 1.69, 95% CI 0.95–3.02) and more days of poor mental (P = 0.045) and physical health (P < 0.0001). Greater amount of time lived in the USA was also associated with worse overall health (P = 0.054) and more days of poor mental and physical health (P < 0.01).

The present study shows that food insecurity and hunger may be problems among undocumented migrants living in the USA. Uncertain and unpredictable work schedules and limited access to public assistance may contribute to high levels of hunger, which in turn may also negatively affect mental and physical health. Increasing amount of time lived in the USA is also associated with poorer health indicators. Programmes that provide undocumented migrants with emergency access to resources may reduce food insecurity and lead to improved health outcomes among this vulnerable population.

To assess the ability of anthropometric measurements to identify young women at risk of developing diabetes, hypertension and heart disease in the future and to compare cut-off points for common anthropometric measures established with receiver-operating characteristic (ROC) curves with those reported in the literature.

Cross-sectional study.

Eight hundred and two young Mexican women living in semi-urban poverty.

The ability of anthropometric measures of fatness and fat distribution (body mass index (BMI), summed skinfold thickness (SST), waist circumference (WC), waist-to-hip ratio (WHR), conicity index (CI), abdominal volume index (AVI)) to predict risk of future disease (pre-diabetes: fasting blood glucose 100–126 mg dl−1; pre-hypertension: systolic blood pressure 120–139 mmHg and/or diastolic blood pressure 80–89 mmHg; hypertriglyceridaemia: triglycerides ≥150 mg dl−1; or a combination of risk factors) was assessed using ROC curve analysis.

Twenty-three of the 802 women who were interviewed had incomplete data and 50 (6.4%) were eliminated from the analysis due to hypertension and/or diabetes. Mean age of the remaining 729 women was 29.6 ± 5.4 years and mean BMI was 27.7 ± 4.5 kg m−2. There were no significant differences in the area under the ROC curve for BMI, WC, AVI or SST for any of the four outcomes. However, these indices performed significantly better than WHR and CI (P < 0.05). The BMI cut-off points that maximised sensitivity and specificity for the four outcomes were in the range of 27.7–28.4 kg m−2, and for WC were 89.3–91.2 cm. To detect 90% of the cases of any metabolic alteration, the necessary BMI cut-off was 26.1 kg m−2. Younger women (<25 years) were at greater risk than older women for a given BMI increment (P < 0.05).

We found that BMI and WC cut-off points commonly used for the identification of risk of existing disease were also appropriate in this population for the identification of risk in the future among women without diabetes or hypertension. The early identification of at-risk individuals, prior to the onset of disease, is fundamental particularly in the context of a country with scarce resources that is rapidly undergoing nutrition transition.

The purpose of this work was to identify dietary patterns in the past using cluster analysis of reported diet in childhood, and to assess predictors for dietary patterns in relation to ethnicity in the population in the Sámi core areas in Norway. The Sámis are an indigenous population living in the border areas of Norway, Sweden, Finland and Russia.

Population-based, cross-sectional study, using self-administered questionnaires. A food-frequency questionnaire covering selected food items eaten in childhood was used. The questionnaire also provided data on ethnicity.

This study was based on data collected from 7614 subjects participating in The Population Based Study of Health and Living Conditions in Areas with a Mixed Sámi and Norwegian Population (the SAMINOR study) who grew up in the SAMINOR geographical areas, i.e. areas with mixed Sámi and Norwegian populations in Norway.

Four dietary clusters were identified: a reindeer meat cluster; a cluster with high intakes of fish, traditional fish products and mutton, in addition to food sources from the local environment; a Westernised food cluster with high intakes of meat balls and sausages; and a cluster with a high intake of fish, but not any other foods in the questionnaire. The cluster distribution differed by ethnicity, but the effect of ethnicity on diet differed by coastal and inland residence.

Our study has shown that data gathered through the limited questionnaire could be used to group the study sample into different dietary clusters, which we believe will be useful for further research on relationships between diet in childhood and health in the Sámi core areas in Norway.

To identify and describe dietary patterns in a cohort of pregnant women and investigate whether the dietary patterns are associated with dietary intake and sociodemographic factors.

Mothers entering the Finnish Type 1 Diabetes Prediction and Prevention (DIPP) Nutrition Study in 1997–2002 were retrospectively asked to complete a food-frequency questionnaire concerning their diet during pregnancy. Principal components analysis was used to identify dietary patterns.

Finland.

Subjects were 3730 women with a newborn infant carrying increased genetic susceptibility to type 1 diabetes mellitus.

Seven factors were identified and named. Energy intake correlated positively with ‘Healthy’, ‘Fast food’, ‘Traditional bread’, ‘Traditional meat’ and ‘Coffee’ patterns and inversely with the ‘Alcohol and butter’ pattern. Intake of dietary fibre correlated positively with ‘Healthy’, ‘Traditional bread’ and ‘Low-fat foods’ patterns and inversely with the ‘Alcohol and butter’ pattern. The seven dietary patterns seemed to account for relatively large proportions of the variance in energy and nutrient intakes except for the intake of vitamin D, vitamin C, carotenoids and calcium. Maternal age and higher level of education were associated with higher scores on ‘Healthy’, ‘Low-fat foods’ and ‘Alcohol and butter’ patterns.

Principal components analysis produced seven dietary patterns which may be useful for further research concerning maternal diet and health outcomes among both mothers and their offspring.

We evaluated the performance of the food-frequency questionnaire (FFQ) administered to participants in the US NIH–AARP (National Institutes of Health–American Association of Retired Persons) Diet and Health Study, a cohort of 566 404 persons living in the USA and aged 50–71 years at baseline in 1995.

The 124-item FFQ was evaluated within a measurement error model using two non-consecutive 24-hour dietary recalls (24HRs) as the reference.

Participants were from six states (California, Florida, Pennsylvania, New Jersey, North Carolina and Louisiana) and two metropolitan areas (Atlanta, Georgia and Detroit, Michigan).

A subgroup of the cohort consisting of 2053 individuals.

For the 26 nutrient constituents examined, estimated correlations with true intake (not energy-adjusted) ranged from 0.22 to 0.67, and attenuation factors ranged from 0.15 to 0.49. When adjusted for reported energy intake, performance improved; estimated correlations with true intake ranged from 0.36 to 0.76, and attenuation factors ranged from 0.24 to 0.68. These results compare favourably with those from other large prospective studies. However, previous biomarker-based studies suggest that, due to correlation of errors in FFQs and self-report reference instruments such as the 24HR, the correlations and attenuation factors observed in most calibration studies, including ours, tend to overestimate FFQ performance.

The performance of the FFQ in the NIH–AARP Diet and Health Study, in conjunction with the study’s large sample size and wide range of dietary intake, is likely to allow detection of moderate (≥1.8) relative risks between many energy-adjusted nutrients and common cancers.

To compare intake estimates, validity and reliability of two summary questions to measure fish consumption with information from a detailed semi-quantitative food-frequency questionnaire (FFQ) on fish consumption.

Population-based, cross-sectional study. Participants completed an FFQ and provided blood samples for erythrocyte membrane eicosapentaenoic acid (EPA) analysis. Aggregate measures of consumption of fresh/frozen/canned fish (fresh fish) and smoked/salted/dried fish (preserved fish) were generated from the FFQ and were compared with responses to the summary questions regarding intakes of similar items. Both methods were tested for validity, using correlation and linear regression techniques with EPA, and retest reliability.

Perth metropolitan area, Western Australia.

One hundred and nine healthy volunteers of both sexes, aged 21–75 years.

The summary fresh fish measure underestimated frequency and grams per week given by the aggregate question by about 50%, while estimates from the summary preserved fish measure were approximately three times that of the aggregate measure. Multiple linear regression analysis suggested that the aggregates accounted for more of the variation in EPA levels, but the difference was minimal. Intra-class correlations confirmed that both methods were reliable.

Our study indicates that extensive questioning results in different absolute intakes of fish compared with brief questioning, but does not add any information if ranking individuals according to overall consumption of fish.

In light of the emerging obesity pandemic, front-of-pack calories labels may be an important tool to assist consumers in making informed healthier food choices. However, there is little prior research to guide key decisions on whether caloric content should be expressed in absolute terms or relative to recommended daily intake, whether it should be expressed in per serving or per 100 g and whether the information should be further brought alive for consumers in terms of what the extra calorie intake implies in relation to activity levels. The present study aimed at providing more insight into consumers’ appreciation of front-of-pack labelling of caloric content of food products and their specific preferences for alternative execution formats for such information in Europe.

For this purpose, eight executions of front-of-pack calorie flags were designed and their appeal and information value were extensively discussed with consumers through qualitative research in four different countries (Germany, The Netherlands, France and the UK).

The results show that calories are well-understood and that participants were generally positive about front-of-pack flags, particularly when flags are uniform across products. The most liked flags are the simpler flags depicting only the number of calories per serving or per 100 g, while more complex flags including references to daily needs or exercise and the flag including a phrase referring to balanced lifestyle were least preferred. Some relevant differences between countries were observed. Although participants seem to be familiar with the notion of calories, they do not seem to fully understand how to apply them.

From the results, managerial implications for the design and implementation of front-of-pack calorie labelling as well as important directions for future research are discussed.

The Mediterranean diet is rich in fat and starch, and hence may be related to overweight. We therefore investigated the relationship between adherence to a Mediterranean diet and body mass index (BMI) and waist-to-hip ratio (WHR).

Data were obtained from the control group of a network of case–control studies on cancer conducted in major teaching and general hospitals in four Italian areas between 1991 and 2002. An interviewer-administered validated 78-item food-frequency questionnaire was used to obtain information on the subjects’ habitual diet. Information on socio-economic factors, lifestyle habits and anthropometric measures was also collected. A Mediterranean diet score (MDS) was derived on the basis of eight characteristics of the Mediterranean diet.

Subjects were 6619 patients (3090 men, 3529 women) admitted to hospital for a wide spectrum of acute, non-neoplastic conditions, unrelated to known risk factors for cancer and long-term modifications of diet.

In multiple linear regression models adjusted for age, study centre, education, tobacco smoking, occupational physical activity and total energy intake, the MDS was not related to BMI (β = 0.05 for men and −0.04 for women) or WHR (β = 0.000 and 0.001, respectively) in both sexes.

Adherence to the major characteristics of the Mediterranean diet is unrelated to BMI and WHR, confirming previous data from Greece and Spain.