Emily Fitt

DINO (Diet In Nutrients Out) – an integrated dietary assessment system

OBJECTIVE The current paper describes Diet In Nutrients Out (DINO), an integrated dietary assessment system incorporating dietary data entry and nutritional analysis within one platform for use in dietary assessment in small-scale intervention studies to national surveys. DESIGN DINO contains >6000 food items, mostly aggregated composites of branded foods, across thirty-one main food groups divided into 151 subsidiary groups for detailed reporting requirements, with fifty-three core nutrient fields. SETTING MRC Human Nutrition Research (HNR), Cambridge, UK and MRC Keneba, Gambia. SUBJECTS DINO is used across dietary assessment projects at HNR and MRC Keneba. RESULTS DINO contains macro- and micronutrients as well as additional variables of current research and policy interest, such as caffeine, whole grains, vitamin K and added sugars. Disaggregated data are available for fruit, vegetables, meat, fish and cheese in composite foods, enabling greater accuracy when reporting food consumption or assessing adherence to dietary recommendations. Portion sizes are categorised in metric and imperial weights, with standardised portion sizes for each age group. Regular reviews are undertaken for portion sizes and food composition to ensure contemporary relevance. A training programme and a checking schedule are adhered to for quality assurance purposes, covering users and data. Eating context questions are integrated to record where and with whom the respondent is eating, allowing examination between these factors and the foods consumed. CONCLUSIONS An up-to-date quality-assured system for dietary assessment is crucial for nutritional surveillance and research, but needs to have the flexibility to be tailored to address specific research questions.

Disaggregating composite food codes in the UK National Diet and Nutrition Survey food composition databank

Objective:To disaggregate composite food codes used in the UK National Diet and Nutrition Survey (NDNS) into their individual food components in order to provide a more complete estimate of intake at the individual food level.Methods:A total of 3216 composite food codes from the NDNS food composition databank were subject to disaggregation. The main food components used were meat, fish, fruit, vegetables and cheese, which were further divided into 26 subcategories.Results:It was shown that previous determination of meat containing composite food codes provided an overestimate of meat intake and underestimate of additional components such as fruit and vegetables.Conclusions:By incorporating disaggregated data into NDNS, variations will be seen in consumption of some main food groups, but these variations may be also attributable to trends in consumption.

Assessing caffeine intake in the United Kingdom diet.

Caffeine occurs naturally in the leaves and seeds of many plants and is artificially added to some beverages. Consumption of caffeine has been linked to both positive and adverse health outcomes. We incorporated estimates of caffeine content (mg/100g or ml) of foods and drinks, taken from the published literature, to provide a preliminary estimate of caffeine intake for the UK population, based on data collected in the National Diet and Nutrition Survey 2008-10. Among consumers mean total caffeine intakes of adult men 19+ y were significantly greater than intakes by boys 4-10y and 11-18y (p<0.05), with the same age-related differences seen for females. 4.1% of men 19+ y and 3.8% of women 19+ y had caffeine intakes in excess of 300mg/d. The addition of caffeine to UK food composition databases will allow more detailed study of the health effects of caffeine consumption.

Assessing eating context and fruit and vegetable consumption in children: new methods using food diaries in the UK National Diet and Nutrition Survey Rolling Programme

BackgroundEating context is the immediate environment of each eating occasion (EO). There is limited knowledge on the effects of the eating context on food consumption in children, due to the difficulty in measuring the multiple eating contexts children experience throughout the day. This study applied ecological momentary assessment using food diaries to explore the relationships between eating context and fruit and vegetable consumption in UK children.MethodsUsing 4 d unweighed food diaries, data were collected for 642 children aged 1.5-10y in two years of the UK National Diet and Nutrition Survey (2008–2010). Participants recorded all foods and drinks consumed at each EO, where and with whom the food was consumed, whether the TV was on and if eaten at a table. Mixed logistic regression and mixed multinomial logistic regression were used to calculate associations between eating contexts and fruit and vegetables (FV) consumed by quartiles.ResultsOf 16,840 EOs, 73% took place at home and 31% with parents only. Frequency of eating alone and with friends increased with age. Compared to eating at home, children aged 1.5-3y were more likely to consume fruit at care outside home (>10-50g OR:2.39; >50-100g OR:2.12); children aged 4-6y were more likely to consume fruit (>50-100g OR:3.53; >100g OR:1.88) and vegetables at school (>30-60g OR:3.56). Compared to eating with parents only, children aged 1.5-3y were more likely to consume fruit with friends (>10-50g OR:2.69; >50-100g OR:3.49), and with carer and other children/others (>10-50g OR:2.25); children aged 4-6y were more likely to consume fruit (>50-100g OR:1.96) and vegetables with friends (>30-60g OR:3.56). Children of all ages were more likely to eat vegetables when the TV was off than on and at a table than not at table.ConclusionsThe use of food diaries to capture multiple eating contexts and detailed fruit and vegetable consumption data was demonstrated at a population level. Higher odds of FV consumption were seen from structured settings such as school and care outside home than at home, as well as when eating at a table and the TV off. This study highlights eating contexts where provision of fruit and vegetables could be improved, especially at home. Future research should take eating context into consideration when planning interventions to target children’s food consumption and eating behaviour.

Innovations in national nutrition surveys

The aim of this paper is to describe innovations taking place in national nutrition surveys in the UK and the challenges of undertaking innovations in such settings. National nutrition surveys must be representative of the overall population in characteristics such as socio-economic circumstances, age, sex and region. High response rates are critical. Dietary assessment innovations must therefore be suitable for all types of individuals, from the very young to the very old, for variable literacy and/or technical skills, different ethnic backgrounds and life circumstances, such as multiple carers and frequent travel. At the same time, national surveys need details on foods consumed. Current advances in dietary assessment use either technological innovations or simplified methods; neither lend themselves to national surveys. The National Diet and Nutrition Survey (NDNS) rolling programme, and the Diet and Nutrition Survey of Infants and Young Children (DNSIYC), currently use the 4-d estimated diary, a compromise for detail and respondent burden. Collection of food packaging enables identification of specific products. Providing space for location of eating, others eating, the television being on and eating at a table, adds to eating context information. Disaggregation of mixed dishes enables determination of true intakes of meat and fruit and vegetables. Measurement of nutritional status requires blood sampling and processing in DNSIYC clinics throughout the country and mobile units were used to optimise response. Hence, innovations in national surveys can and are being made but must take into account the paramount concerns of detail and response rate.

Variability in the reported energy, total fat and saturated fat contents in fast-food products across ten countries.

OBJECTIVE Fast foods are often energy dense and offered in large serving sizes. Observational data have linked the consumption of fast foods to an increased risk of obesity and related diseases. DESIGN We surveyed the reported energy, total fat and saturated fat contents, and serving sizes, of fast-food items from five major chains across ten countries, comparing product categories as well as specific food items available in most countries. SETTING MRC Human Nutrition Research, Cambridge, UK. SUBJECTS Data for 2961 food and drink products were collected, with most from Canada (n 550) and fewest from the United Arab Emirates (n 106). RESULTS There was considerable variability in energy and fat contents of fast foods across countries, reflecting both the portfolio of products and serving size variability. Differences in total energy between countries were particularly noted for chicken dishes (649-1197 kJ/100 g) and sandwiches (552-1050 kJ/100g). When comparing the same product between countries variations were consistently observed in total energy and fat contents (g/100 g); for example, extreme variation in McDonalds Chicken McNuggets with 12 g total fat/100 g in Germany compared with 21·1 g/100 g in New Zealand. CONCLUSIONS These cross-country variations highlight the possibility for further product reformulation in many countries to reduce nutrients of concern and improve the nutritional profiles of fast-food products around the world. Standardisation of serving sizes towards the lower end of the range would also help to reduce the risk of overconsumption.

Patterns of sociodemographic and food practice characteristics in relation to fruit and vegetable consumption in children: results from the UK National Diet and Nutrition Survey Rolling Programme (2008-2010)

OBJECTIVE Few studies have considered the combined effects of home-related determinants on children’s diet. The present study investigated independent associations between sociodemographic and food practice (SFP) characteristics and fruit and vegetable consumption in U.K. children and the combined effects of SFP on consumption using pattern analysis. DESIGN Diet was assessed using 4 d food diaries, SFP were collected using computer-assisted personal interview. Linear regressions were used to test associations; principal component analysis was used to identify patterns of SFP characteristics. Regression of fruit (g/d) and vegetables (g/d) v. component scores of each pattern were performed. SETTING U.K. National Diet and Nutrition Survey Rolling Programme (2008–2010). SUBJECTS Children aged 1.5–10 years (n 642). RESULTS Significant associations were found between fruit and vegetable consumption and household socio-economic status. Pattern 1, which was positively correlated with household structure characteristics, was associated with increased fruit consumption (P < 0.001). Pattern 2, characterised by positive correlations for socio-economic status, fruit availability and organic food purchase, and negatively correlated with household size and the number of children per household, was associated with higher fruit and vegetable consumption (both P < 0.001). Pattern 3, characterised by high frequency of eating out and eating takeaway, was associated with a lower consumption of both fruit (P < 0.012) and vegetables (P < 0.023). CONCLUSIONS Patterns of SFP determinants may be more informative than individual characteristics in relation to dietary outcomes. Results have public health implications on the healthfulness of meals eaten out of home and in takeaways, as well as the need to reduce diet inequality in larger households with lower socio-economic status.

Dietary iron does not impact the quality of life of patients with quiescent ulcerative colitis: an observational study

BackgroundIn animal models, excess luminal iron exacerbates colonic inflammation and cancer development. Moreover, in inflammatory bowel disease (IBD) patients with mild to moderate disease activity dietary fortificant iron intake is inversely related to quality of life. Here we sought to determine whether dietary iron intakes were also related to quality of life in IBD patients in remission.MethodsForty eight patients with ulcerative colitis (UC), 42 of which had quiescent disease during this observational study, and 53 healthy control subjects completed quality of life questionnaires and 7-day food diaries. For comparative analysis, 34/group were matched and the linear relationship between dietary iron intakes (total, haem, non-haem or fortificant) and EuroQol quality of life measures was investigated. For UC patients the linear relationship between dietary iron intakes and the scores from the disease specific inflammatory bowel disease questionnaire (IBDQ) was also considered.ResultsThe intake of dietary iron, and its various sub-fractions, were not associated with quality of life (EuroQol) in patients with quiescent disease or in healthy control subjects. The picture was similar for the 42 quiescent UC patients when disease-specific IBDQ was used. However, the 6 patients who relapsed during the study again showed an inverse association between IBDQ and dietary iron intake (p = 0.03).ConclusionsOur data suggest that dietary iron does not impact on quality of life in quiescent UC patients but support that, once the disease is triggered, luminal iron may be a permissive factor for exacerbation of disease activity resulting in lower quality of life.

Assessing the home eating context and fruit and vegetable consumption in children: new methods from the UK National Diet and Nutrition Survey (2008-2010)

There is currently limited knowledge on the associations between eating context in relation to food consumption in children at the population level. The eating context describes the location, the people eating with and other environment influences such as television at an eating occasion. Children spend the majority of their eating occasions at home, and by studying the eating context within home will allow us to determine the contextual factors that drive positive eating behaviours in children. The aim of this study is to present a methodology to quantify the home eating contexts and to identify associations with fruit and vegetable consumption in UK children. The National Diet and Nutrition Survey (NDNS) Rolling Programme has introduced a new feature in the 4 day food diaries, which asked participants to record four elements of their eating context, including where and with whom the meal was consumed, whether the TV was on and if eaten at a table, as well as detailed dietary information for each eating occasion. Data was collected for 642 children aged 1.5–10 y in the first two years of NDNS (2008–2010). Eating occasions that took place within home were included in the analyses (n = 12020); total fruit and vegetable consumption was disaggregated and calculated for each eating occasion. Mixed-effects logistic regression and multilevel multinomial logistic regression were used. All models were adjusted for age, sex, time of meal, weekend/ weekday variation. Children were less likely to consume vegetables in the kitchen (OR = 0.55), living room (OR = 0.17) and other areas within home (OR = 0.11) than compared to eating in the dining room. The likelihood of consuming >60 g vegetables were around 50% lower in the living room (p<0.001) than the dining room. They were approximately two times more likely to consume >50–100 g of fruit in the kitchen, living room and other areas than the dining room (all p<0.001). Compared to eating with parents only, children were more likely to eat vegetables with parents and siblings (OR = 1.22) and with adult relatives and friends (OR = 1.58); least likely when alone or with others (OR = 0.33). Children were more likely to eat vegetables when the TV was off (OR = 1.75); and they had higher odds of consuming >100 g of vegetable (OR = 1.54) but lower odds of eating >100 g of fruit (OR = 0.69) when TV was off. Children were 90% less likely to eat vegetable when not eating at table (p<0.001). However, they were more likely to consume >50 g of fruit when not eating at the table (all p<0.01). For the first time we quantitatively studied the home eating context in relation to fruit and vegetable consumption in a nationally representative sample of children using food diaries. Our results suggest that eating in the dining room at the table and with the TV off may be beneficial to children’s vegetable consumption. This serves as a good guidance for parents and carers to provide a positive eating context for their children. The eating context assessment method can be a simple addition to current dietary assessment tools to enable further understanding of eating behaviours and consumption of different food groups.