Data from the EPIC-Norfolk cohort

Contribution of cod liver oil-related nutrients (vitamins A, D, E and eicosapentaenoic acid and docosahexaenoic acid) to daily nutrient intake and their associations with plasma concentrations in the EPIC-Norfolk cohort

Lentjes et al., JHND Early View

Background

Total nutrient intake (TNI) is intake from food and supplements. This provides an assessment of nutrient adequacy and the prevalence of excessive intake, as well as the response with respect to biomarkers. Cod liver oil (CLO) is the most frequently consumed supplement in the UK, containing nutrients that might have varying influences on health. We calculated TNI for vitamins A, D and E, as well as eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), and assessed associations with the respective blood concentrations.

Methods

Seven-day diet diaries and blood samples were taken from two subsets of the European Prospective Investigation into Cancer (EPIC-Norfolk) cohort (age range 39–79 years; n = 1400 for vitamin D; n = 6656 for remaining nutrients). TNI was calculated for the subgroups: nonsupplement users, those consuming the nutrient in supplement form and those consuming a supplement without this nutrient.

Results

CLO-related nutrients were supplemented by 15%–33%, which approximately doubled median intakes. Almost everyone in the supplement + vitamin A group reached the estimated average requirement; however, guideline levels were likely to be exceeded. Partial correlations between intake of vitamins A and D and biomarkers were low and modestly strengthened by the inclusion of supplement sources (correlation = 0.01–0.13). Correlations between biomarker and TNI of vitamin E and EPA+DHA were in the range 0.40–0.46; however, vitamin E exceeding food intake resulted in attenuated coefficients. Linear associations between food or TNI EPA+DHA and plasma were weak but consistent across subgroups.

Conclusions

CLO-related nutrients contribute substantially to nutrient intake, with a risk of over-consumption. Apart from EPA+DHA, biomarker data suggest that CLO-related nutrients in supplements are not linearly associated with vitamin status.

Marriage reduces prospects for successful weight loss

Factors predictive of drop-out and weight loss success in weight management of obese patients

Ortner Hadžiabdić et al., JHND Early View.

Background

The prevention and treatment of overweight and obese individuals on a population-wide basis is challenging because patients have difficulties with adhering to weight loss programmes. The present study aimed to evaluate patients’ adherence to the weight reduction programme by identifying factors predictive of both drop-out rate and weight loss success.

Methods

One-hundred and twenty-four obese patients participated in a 12-month weight reduction programme, involving group therapy during an intensive 5-day educational intervention, followed by five, 2-h follow-up visits. The primary outcome measures included drop-out rate and percentage weight loss. Sociodemographic and clinical characteristics, as well as type of diet, were explored as potential predictive factors. Type of diet was assigned based on randomisation. Regression analyses were conducted to identify predictive variables of drop-out and weight loss success.

Results

In total, 33.1% of all recruited participants were deemed successful because they reduced the initial weight by more than 5% after the 12-month intervention. The overall attrition rate was 32.3%. In a multiple regression model, initial weight loss and marital status were the strongest predictors of weight loss success after 1-year period (r2 = 0.481, P < 0.001). In a separate analysis, subjects more likely to drop-out were those with a lower educational level [odds ratio (OR) = 3.26, 95% confidence interval (CI) = 1.22–8.70, P = 0.018] and a higher level of obesity (OR = 0.974, 95% CI = 0.95–0.99, P = 0.010).

Conclusions

The present study demonstrates that initial weight loss at 1 month made the strongest unique contribution to the prediction of percentage weight loss after 12 months, whereas being married was a negative predictor. Those with a lower educational level and a higher level of obesity were more likely to drop-out.

Calling all student dietitians

Originally posted on JHND NOTES:

Calling all student dietitians

Student dietitians all over the world!

For those who are 1st years, then welcome to the start of you career in dietetics. For are in 2nd, 3rd or 4th years then we hope your studies and placements have gone well.

Evidence-based practice is essential to being a successful student and a successful dietitian. Therefore keeping up to date with newly published research, systematic reviews and clinical guidelines is essential.

The Journal of Human Nutrition and Dietetics is the official journal of the British Dietetic Association and is an international peer-reviewed journal publishing papers in applied nutrition and dietetics. A new issue is published every 2 months and we encourage you to read this journal regularly.

The journal can be accessed here:

http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1365-277X

You can register to receive an email alerting you when a new issue is published every two months, details are here:

http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1365-277X/homepage/transition_to_online_only_from_2013.htm

In addition, the editor regularly published…

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Estimating fatty acid intake using a food frequency questionnaire

Validation of fatty acid intakes estimated by a food frequency questionnaire using erythrocyte fatty acid profiling in the Montreal Heart Institute Biobank

Turcot et al., JHND Early View

Background

To improve the prevention, treatment and risk prediction of cardiovascular diseases, genetic markers and gene–diet interactions are currently being investigated. The Montreal Heart Institute (MHI) Biobank is suitable for such studies because of its large sample size (currently, = 17 000), the availability of biospecimens, and the collection of data on dietary intakes of saturated (SFAs) and n-3 and n-6 polyunsaturated (PUFAs) fatty acids estimated from a 14-item food frequency questionnaire (FFQ). We tested the validity of the FFQ by correlating dietary intakes of these fatty acids with their red blood cell (RBC) content in MHI Biobank participants.

Methods

Seventy-five men and 75 women were selected from the Biobank. We successfully obtained RBC fatty acids for 142 subjects using gas chromatography coupled to mass spectrometry. Spearman correlation coefficients were used to test whether SFA scores and daily intakes (g day−1) of n-3 and n-6 PUFAs correlate with their RBC content.

Results

Based on covariate-adjusted analyses, intakes of n-3 PUFAs from vegetable sources were significantly correlated with RBC α-linolenic acid levels (ρ = 0.23, = 0.007), whereas n-3 PUFA intakes from marine sources correlated significantly with RBC eicosapentaenoic acid (ρ = 0.29, = 0.0008) and docosahexaenoic acid (ρ = 0.41, = 9.2 × 10–7) levels. Intakes of n-6 PUFAs from vegetable sources correlated with RBC linoleic acid (ρ = 0.18, = 0.04). SFA scores were not correlated with RBC total SFAs.

Conclusions

The MHI Biobank 14-item FFQ can appropriately estimate daily intakes of n-3 PUFAs from vegetable and marine sources, as well as vegetable n-6 PUFAs, which enables the possibility of using these data in future studies.

Infant feeding schemes in Scotland

‘I didn’t know why you had to wait’: an evaluation of NHS infant-feeding workshops amongst women living in areas of high deprivation

Andrews et al., JHND Early View

Background

Inappropriate maternal and infant-feeding practices are known to have a major impact on morbidity in infancy, childhood and later life. Ring-fenced funding over 3 years from the Scottish Government to the National Health Service (NHS) in Scotland has allowed the development of a range of nutrition interventions for women of childbearing age and infants living in areas of deprivation to help address these issues. The present study aimed to determine mothers’ knowledge of appropriate infant-feeding practices, opinions about feeding advice and any changes in practice following attendance at workshops.

Methods

Fifteen semi-structured interviews with women who participated in NHS infant-feeding workshops. Verbatim transcripts were analysed using framework analysis.

Results

Participants appreciated the opportunity to enhance their knowledge and there was evidence of a reasonable understanding and awareness of appropriate infant-feeding behaviours following workshop attendance. However, the findings highlight the challenge of multiple sources of advice and identify persistent uncertainties about feeding practice. Reported feeding behaviour following workshops was encouraging (e.g. delayed weaning, increased use of -prepared fruits and vegetables), although there was also evidence of resistance to change. The legacy of the workshop in terms of reported confidence in infant feeding was also apparent.

Conclusions

The workshops appears to aid current knowledge and practice about infant feeding but further work is needed to examine the long term impact of these interventions on maternal and infant dietary behaviours.

September/October issue out soon

Issue 5 for 2014 will be published very shortly. Keep a look out for it on our website, where you can sign up for automatic Table of Contents alerts. Accompanying the issue is my latest Editors Pick. The September Pick is:

Impact of polyunsaturated vegetable oils on adiponectin levels, glycaemia and blood lipids in individuals with type 2 diabetes: a randomised, double-blind intervention study

Mullner et al. 2014.

Background

Low adiponectin levels are discussed as risk factor for cardiovascular events. This is of special importance in individuals with type 2 diabetes (T2DM) because they are at higher risk for cardiovascular diseases. The present study aimed to investigate the effect of two plant oils rich in polyunsaturated fatty acids (PUFA), with different content of omega-3 fatty acids, on adiponectin levels, glucose and lipid metabolism in T2DM individuals treated either with insulin or oral anti-diabetics (OAD).

Methods

Ninety-two subjects with T2DM [34 treated with insulin (T2DM-Ins) and 58 treated with OAD (T2DM-OAD)] participated in this randomised, double-blind, parallel intervention study. Individuals received either 9 g of nut oil (n-3:n-6 ratio: 1.3 : 6.1) or mixed oil (n-3:n-6 ratio: 0.6 : 5.7) per day for 10 weeks. The fatty acid profile, tocopherol, adiponectin levels and parameters regarding glucose and lipid metabolism were assessed at baseline, during and after the intervention.

Results

Compliance was confirmed by significant increases in γ-tocopherol and PUFA in both oil groups. An increase in adiponectin levels in T2DM-Ins participants (+6.84% in nut oil and +4.47% in mixed oil group after 10 weeks compared to baseline) was observed, albeit not significantly different from T2DM-OAD individuals (= 0.051). Lipid and glucose metabolism were not affected by the intervention.

Conclusions

The present study provides evidence that a small and easy change in dietary behaviour towards better fat quality moderately increases adiponectin levels in T2DM-Ins subjects, independently of the administered plant oil.

Use of neutropenic diets

Investigating the use of the neutropenic diet: a survey of UK dietitians

 

Carr and Hallday, JHND Early View

 

Background

Patients with chemotherapy-induced neutropenia are at increased risk of infection. Historically, dietary restrictions commonly referred to as ‘clean’, ‘low bacteria’, ‘low-microbial’ or ‘neutropenic’ diets have been prescribed to reduce the risk of foodborne infection. Although research does not support their effectiveness, they continue to be used in clinical practice. The present study aimed to investigate the use of dietary restrictions in patients with cancer in the UK by surveying registered dietitians (RDs).

Methods

An online questionnaire was distributed to 573 RDs via local and specialist interest groups of the British Dietetic Association.

Results

One hundred and ten questionnaires were returned. Of these, 67.8% of RDs prescribed dietary restrictions to patients, with ‘neutropenic diet’ being the most commonly used term. Specialist oncology or haematology RDs were more likely to use the diet than nonspecialist RDs (P < 0.005). The variety of foods restricted varied greatly and was often contradicting. Unpasteurised dairy products and raw or lightly cooked meat or fish were most commonly restricted. Less than half (43.6%) of RDs had a policy in place for the use of neutropenic diets, with specialist oncology and haematology RDs more likely to report this (P < 0.005).

Conclusions

Neutropenic dietary advice provided by dietitians in the UK varies greatly. Further high-quality research is required to create an evidence base from which national clinical guidelines can be formed.

Dairy products and obesity

Dairy product consumption, dietary nutrient and energy density and associations with obesity in Australian adolescents

O’Sullivan et al JHND Early View

Background

Dairy intake is likely to influence dietary energy density (ED) and nutrient density (ND), which are factors representing aspects of dietary quality. Although evidence suggests dairy intake is unlikely to contribute to obesity, intake tends to decrease over adolescence, potentially as a result of concerns around weight gain. We examined associations between dairy intake, ED and ND, and investigated relationships with obesity in adolescents.

Methods

The present study comprised a cross-sectional study of 1613 14-year-olds in the Western Australian Pregnancy Cohort (Raine) Study. Adolescents completed a 212-item food frequency questionnaire. Nutrient Rich Food index 9.3 (NRF9.3) was used to estimate ND. Age-specific body mass index (BMI) and waist–height cut-offs were used to categorise obesity risk.

Results

Mean (SD) dairy intake was: 2.62 (1.51) servings daily; ED was 4.53 (0.83) (food and beverage) and 6.28 (1.33) (food only); ND was 373 (109). Dairy intake was inversely associated with ED and positively associated with ND. The odds of being overweight (as assessed by BMI) increased by 1.24 (95% confidence interval = 1.09–1.42) with each 100-point increase in ND, after adjustment for potential confounders and energy intake. ED measures and dairy intake were inversely associated with obesity after adjustment for confounders; associations became nonsignificant after energy adjustment.

Conclusions

The NRF9.3 was originally designed to assess foods, not diets. Further research in other cohorts to determine whether similar findings exist, or investigations into alternate measures of dietary ND, may prove useful. Our findings may be the result of factors such as an excess consumption of refined but fortified foods. Although higher dairy intakes were associated with higher ND, intakes were not associated with higher obesity risk.

 

Measuring body composition by bioimpedance

Impact of eating and drinking on body composition measurements by bioelectrical impedance

Androutsos et al., JHND Early View

 

Background

Bioelectrical impedance analysis would be a more practical tool to measure body composition in clinical settings, dietetic practice and epidemiological studies if patients/subjects did not have to fast before measurements. The present study assessed whether the ingestion of food or drink had any biologically significant effect on bioimpedance measurements and body composition by the foot-to-foot method.

Methods

Fifty-five healthy adults [30 males and 25 females; mean (SD) age 27.7 (7.1) years; mean (SD)body mass index 24 (3.8) kg m−2] were randomly assigned to a 2-day food trial (high-fat meal or high-carbohydrate meal) or a 2-day drink trial (water or high electrolyte drink). Body composition measurements were carried out in the fasting state, immediately after meal consumption and every 30 min for 2 h by the foot-to-foot single frequency bioimpedance technique.

Results

Bioimpedance increased significantly after the ingestion of food and fluid, although the changes were small. The electrolyte drink, high-fat and high-carbohydrate meals significantly increased the percentage body fat and fat mass. In all cases, the median percentage changes from baseline were approximately 1% in body fat percentage units.

Conclusions

Although there were statistically significant changes in body composition estimates after food or drink consumption, these were small and within the imprecision of the impedance technique, and so are unlikely to be of clinical significance. The present study suggests that impedance measures of body fatness in clinical settings do not require strict adherence to fasting, and this should increase the opportunities for clinical application.

 

 

What do overweight adolescents eat?

Overweight adolescents eat what? And when? Analysis of consumption patterns to guide dietary message development for intervention

Smith et al., JHND Early View

Background

Little is known about overweight adolescent dietary consumption patterns, with challenges to collecting meaningful data making it difficult to develop targeted obesity interventions. The present study aimed to examine the timing and consumption of fruit, vegetables and junk food by time of the day and day of the week.

Methods

Overweight adolescents (n = 61), aged 12–16 years, completed 3-day food records. Negative binomial and binary logistic regression using generalised estimating equations were used to compare the amount and likelihood of the consumption of each food group between time periods.

Results

Overweight adolescent girls were more likely to eat fruit on weekdays than weekends [odds ratio (OR) = 5.0. P < 0.001], as were boys (OR = 2.5, P = 0.034). Adolescents consumed more fruit at school than other meals [girls: incident rate ratio (IRR) = 7.5, P < 0.001; boys: IRR = 4.0, P = 0.050]. Weekday dinner was the meal where girls were most likely to consume vegetables (OR = 3.0, P = 0.009) and when boys consumed the most vegetables (IRR = 30.9, P = 0.006). Fast food consumption was most likely for girls at dinner on the weekend (OR = 9.6, P = 0.042), whereas fast food intake for boys increased overall on the weekend (IRR = 3.6, P = 0.001). Intake of ‘other junk’ (e.g. crisps) peaked during school hours for girls (IRR = 7.2, P < 0.001) and sugar-sweetened beverage consumption increased for boys on the weekend (IRR = 3.3, P = 0.001). Overall, trends in fruit intake showed opposing times for high and low consumption compared to vegetable intake.

Conclusions

These results represent the next step in using time of day and day of week consumption patterns to develop targeted, evidence-based dietary messages for interventions in overweight adolescents.