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Factors which may limit the value of dietary diversity and its association with nutritional outcomes in preschool children in high burden districts of India

Background and Objectives: Dietary diversity plays a critical role in infants as they need energy and nutrient dense foods for both physical and mental development. This study examines whether three dietary diversity indices validate against Nutrient Adequacy Ratio (NAR) and Mean Adequacy Ratio (MAR) and studies the relationship of dietary diversity with nutritional status of preschool children, in two districts of India: Wardha district in Maharashtra state and Koraput district in Odisha state. Methods and Study Design: Dietary diversity was calculated using: individual food scores calculated using 24 hour diet recall (FS_(24hr)) data; household dietary diversity using Berry's index (DDI) and food scores calculated using food frequency data (FS_(FFQ)). Nutritional status was assessed by anthropometric indices. Results: It was observed that 42.7% of 1 to 5 years children were underweight, 38% stunted and 27.6% wasted across both locations. The dietary diversity was found to be relatively better in Wardha when compared with Koraput with mean diversity of FS_(24hr) 7, DDI 90 and FS_(FFQ) 63 in both locations. Preschool children in both locations consumed a cereal based diet. Apart from protein in both locations and energy in Koraput, the NAR of all nutrients consumed was ＜70% of requirement. MAR showed lower consumption of nutrients than the recommended levels (50% adequacy). NAR and MAR correlate with FS_(24hr) indicating that dietary diversity calculated using 24 hour diet recall ensures nutrient adequacy but showed association only with Height-for-Age scores. Conclusion: Dietary diversity calculated using three methods did not show any correlation with nutritional status of 1 to 5 years children.

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Breakfast consumption among Malaysian primary and secondary school children and relationship with body weight status - Findings from the MyBreakfast Study

Background and Objectives: This study aimed to determine the relationship between breakfast consumption and body weight status among primary and secondary school children in Malaysia. Methods and Study Design: This nationwide cross-sectional study involved 5,332 primary school children aged 6 to 12 years and 3,000 secondary school children aged 13 to 17 years. Height and weight were measured and BMI-for-age was determined. Socio-demographic backgrounds, breakfast habits and physical activity levels were assessed using questionnaires. Breakfast frequency was defined as follows: breakfast skippers (ate breakfast 0-2 days/week), irregular breakfast eaters (ate breakfast 3-4 days/week) and regular breakfast eaters (ate breakfast ≥5 days/week). Results: The overall prevalence of breakfast skippers and irregular breakfast eaters was 11.7% and 12.7% respectively. Breakfast skipping was related to age, sex, ethnicity, income and physical activity level. Among primary school boys and secondary school girls, the proportion of overweight/obesity was higher among breakfast skippers (boys: 43.9%, girls: 30.5%) than regular breakfast eaters (boys: 31.2%, girls: 22.7%). Among primary school children, only boys who skipped breakfast had a higher mean BMI-for-age z-score than regular breakfast eaters. Among secondary school boys and girls, BMI-for-age z-score was higher among breakfast skippers than regular breakfast eaters. Compared to regular breakfast eaters, primary school boys who skipped breakfast were 1.71 times (95% CI=1.26-2.32, p=0.001) more likely to be overweight/obese, while the risk was lower in primary school girls (OR=1.36, 95% CI=1.02-1.81, p=0.039) and secondary school girls (OR=1.38, 95% CI=1.01-1.90, p=0.044). Conclusion: Regular breakfast consumption was associated with a healthier body weight status and is a dietary behaviour which should be encouraged.

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Intake ratio and major food sources of n-3 and n-6 fatty acids in Korea: a study based on the sixth Korea national health and nutrition examination survey (2013-2014)

Background and Objectives: In addition to the intake ratio of omega 6 (n-6) to omega 3 (n-3) fatty acids, their intake amount has an effect on health. This study evaluated the n-6:n-3 intake ratio as well as the food sources and association of these fatty acids with demographic characteristics based on sixth Korea National Health and Nutrition Examination Survey data. Methods and Study Design: This study included 13,937 participants from the survey. The weighted mean intake and major food groups of n-3 and n-6 fatty acids were determined. The 10 chief food sources of n-3 and n-6 fatty acid were expressed as percent contribution to total intake. Results: α- Linolenic acid constituted approximately 80% of total n-3 intake, followed by docosahexaenoic acid (10.5%) and eicosapentaenoic acid (6.1%). Linoleic acid constituted 97% of total n-6 intake. After adjustment for cofactors (age, sex, and energy intake), education level (p＜0.01), alcohol consumption frequency (p＜0.05) and monthly income (p＜0.01) were significant variables determining n-3 and n-6 FA intake by Korean people. The average n- 6:n-3 intake ratio was 7.49:1. The major source of α-linolenic acid and linoleic acid was soybean oil, whereas that of docosahexaenoic acid and eicosapentaenoic acid was mackerel. Pork (70.0%) and egg (38.7%) were the major food sources of arachidonic acid and dihomo-γ-linolenic acid, respectively. Conclusion: Monthly income, alcohol consumption frequency, and education level significantly affected n-3 FA intake. The dietary n-6: n-3 intake ratio in Korea is 7.49:1; however, eicosapentaenoic acid and docosahexaenoic acid intake remains inadequate (0.27 g/day).

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Prevalence and characteristics of misreporting of energy intake in Japanese adults: the 2012 National Health and Nutrition Survey

Background and Objectives: Information on a whole array of characteristics associated with dietary misreporting in a representative sample in each country is still limited. Using data from the 2012 National Health and Nutrition Survey, Japan, we investigated the prevalence and characteristics of under- and over-reporting of energy intake among 19,986 Japanese adults aged ≥20 years. Methods and Study Design: Each individual's energy intake was calculated based on a 1-day semi-weighed dietary record. Under-, plausible, and over-reporters were identified based on the 95% confidence limits 1) for agreement between the ratio of energy intake to basal metabolic rate and a physical activity level for sedentary lifestyle (1.55), and 2) of the expected ratio of energy intake to estimated energy requirement of 1.0, assuming 'low active' level of physical activity. Results: Almost all subjects (≥92.8%) were classified as plausible reporters by any of the methods applied, with very low percentages of under- and over-reporters (≤6.3% and ≤2.0%, respectively). Under-reporting was associated with younger age, overweight and obesity (compared with normal weight), current smoking (compared with never smoking), no alcohol drinking (compared with drinking everyday), and household consisting of a single person (compared with that consisting of two persons). Over-reporting was associated with gender (female), normal weight (compared with overweight), and household consisting of a single person. Conclusions: Overall mean energy intake obtained in this sample of Japanese adults appears to be plausible, but caution should be exercised when assessing the plausibility of energy intake in some subgroups.

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Dietary patterns, dietary lead exposure and hypertension in the older Chinese population

Background and Objectives: With rapid population ageing and an increasing rate of hypertension in China, this study aims to examine the association between dietary patterns, dietary lead and hypertension among older Chinese population. Methods and Study Design: We analysed the 2009 China Health and Nutrition Survey data (2,634 individuals with dietary and hypertension measurement data, aged ≥60 years). Dietary data were obtained using 24 hour-recall over three consecutive days. Dietary lead intake is based on a published systematic review of food lead concentration and dietary lead exposure in China. Factor analysis was used to identify dietary patterns. Poisson regression and multinomial logistic regression models were used to explore the association between dietary patterns and hypertension. Results: The prevalence of hypertension was 47.0% in men and 48.9% in women. Traditional dietary pattern (high intake of rice, pork and vegetables) was significantly inversely associated with known hypertension. In the fully adjusted model, compared with the lowest quartile of traditional dietary pattern, the highest quartile had a lower risk of known hypertension, with Relative Risk Ratio=0.69 (95% CI: 0.50; 0.95). However, associations between modern dietary pattern and hypertension differed by urbanization; an inverse, positive and null association was seen in low, medium and high urbanization. Additionally, dietary lead showed a significant positive association with hypertension and known hypertension. Conclusions: Policies that facilitate and promote healthy diets, and the availability of healthy foods particularly at the regional and local levels, are important for the prevention of hypertension.

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Assessing self-reported green tea and coffee consumption by food frequency questionnaire and food record and their association with polyphenol biomarkers in Japanese women

Background and Objectives: Despite the demonstrated protective effects of green tea and coffee intake against several chronic diseases, finding between studies have not been consistent. One potential reason of this discrepancy is the imprecision in the measurement of tea or coffee consumption using food frequency questionnaire (FFQ) and food record (FR) in epidemiological studies. Methods and Study Design: In a sample of 57 healthy Japanese women, intake of green tea and coffee was estimated by a validated FFQ and a 3-day FR, while their plasma and urine concentrations of polyphenol biomarkers were measured by HPLC. The polyphenols assessed included (-)-epigallocatechin gallate (EGCG), (-)-epicatechin gallate (ECG), (-)-epigallocatechin (EGC) and (-)- epicatechin (EC), caffeic acid (CA) and chlorogenic acid (CGA). Results: Green tea consumption estimated by FFQ and FR showed moderate association, while strong association was detected for coffee consumption. Urinary green tea polyphenol concentrations were moderately-strongly associated with FR-estimated intake, while the associations were weak with FFQ. Similarly, coffee polyphenols in urine were moderately associated with FR-estimated coffee intake, whereas FFQ showed poor correlation. The associations between urinary and plasma polyphenols ranged from moderate to high. Conclusions: The results indicated that firstly, the FFQ tends to overestimate green tea intake. Secondly, the urinary polyphenols are preferred over plasma polyphenols as a potential surrogate marker of the short-term green tea and coffee intake, while their use as an indicator of long-term consumption is not reliable.

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Role of behavioural feedback in nutrition education for enhancing nutrition knowledge and improving nutritional behaviour among adolescents

Background and Objectives: The integration of nutrition knowledge into nutritional behaviour can help children to develop a healthy lifestyle that may be carried forward into adulthood. E-learning enables students to take ownership of recording their dietary intake and modify their diets by making their own decisions regarding food choices and portion sizes through reflective feedback. This study investigated the role of behavioural feedback in nutrition education in modifying students' nutrition knowledge and behaviour. Methods and Study Design: Ninety-five secondary students studying from Secondary 1 to Secondary 3 were recruited from five schools. Moreover, 50 and 45 students were randomly assigned to experimental and control groups, respectively. Nutrition education delivered through e-learning (NeL) was adopted to record students' diets. Online reports with behavioural feedback were provided for the experimental group but not for the control group. NeL sessions lasted for 12 weeks. The energy and nutrient profiles of the students were recorded as pre-post measurements. Pre-post nutrition knowledge was assessed using a self-administered questionnaire at the baseline and after intervention. Results: The experimental group had significantly higher scores in the 'dietary recommendation' and 'food choices' domains of the questionnaire and demonstrated significant dietary improvement in the intake of all studied macronutrients and micronutrients. Conclusions: Nutrition education conducted with behavioural feedback can effectively improve adolescents' nutrition knowledge and nutritional behaviour.

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Nutritional quality and patterns of lunch menus at child care centers in South Korea and Japan

Background and Objectives: This study aimed to investigate the nutritional quality and patterns of lunch menus provided by child care centers in South Korea and Japan. Methods and Study Design: The weekly lunch menus from Monday to Saturday that child care centers provided in November 2014 in South Korea and Japan were analyzed. For Korea, a total of 72 meals provided by 12 centers in Seoul were analyzed by referring to the homepage of the Center for Children's Foodservice Management, which serviced menus for child care centers. For Japan, a total of 30 meals provided by 5 child care centers in Tokyo were analyzed. Nutrient content and pattern in lunch menus were evaluated. Results: The lunch menus in Korea and Japan provided 359.5 kcal (25.7% of the estimated energy requirement) and 376.3 kcal (29.5% of the estimated energy requirement), respectively. 'Rice + Soup + Main dish + Side dish I + Side dish II' were provided in 66.7% of meals in Korea, while various patterns with rice and soup as their bases were provided in Japan. Conclusions: The lunch menus of child care centers in Korea and Japan provide similar amounts of energy, protein, carbohydrate, vitamin A, calcium, and other nutrients. However, there were significant differences in the lunch menu patterns in Korea and Japan. This study provides information about the nutritional content and pattern of lunch menus at child care centers in Asian countries with rice as a staple food.

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Taste perception and diet in people of Chinese ancestry

Background and Objectives: Taste perception plays a key role in consumer acceptance and food choice, which has an important impact on human health. Our aim was to examine the relationship between taste intensities and preferences of sweet (sucrose), salty (sodium chloride and potassium chloride), sour (citric acid), and bitter (quinine and phenylthiocarbamide) in relation to dietary intake and dietary patterns in people of Chinese ancestry. Methods and Study Design: This cross-sectional study included 100 adult Singaporean Chinese (50 women). A validated taste methodology was used with taste solutions provided by Monell Chemical Senses Center. Dietary intake and patterns were assessed by dietary recalls. Results: There was little relationship between taste intensity and tastant preference in regard to background dietary intake or pattern. Tastant differentiation was reliable, but there was some confusion in regard to the rating of saltiness as sourness. Conclusions: There was a salty-sour confusion among Singaporean Chinese unlike the bitter-sour confusion reported for Caucasians. Most sodium came from sauces and was added during food preparation. In programs to address sodium: potassium ratio excess among Chinese prone to hypertension and stroke, sour as well as salty taste may need to be considered.

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Ambient temperature-related exaggerated post-prandial insulin response in a young athlete: a case report and implications for climate change

The objective is to present the case of a 21-yr-old athlete observed with non-physiological immediate postprandial insulin response (1162 pmol/l; normal glucose excursion: 6.6 mmol/l), in a warm environment. No suspicion or evidence of any underlying pathology was found in this well-trained Afro-Caribbean male runner. He never reported any hypoglycemic episode. When performing the same protocol performed in a cooler environment (21.0°C vs 30.3°C), only physiological responses were observed. We conclude that 1) youth, leanness and regular exercise training are not absolutely protective against glucose metabolism impairment in apparently healthy subjects; 2) ambient temperature should be regarded as a potential source of glucose metabolism impairment.