Jane Watson

Measuring dietary intake in children and adolescents in the context of overweight and obesity.

Dietary intake throughout childhood is a key determinant of growth and development and has an important role in both the prevention and treatment of childhood overweight and obesity. Although dietary intake assessment is fraught with challenges and limitations, reporting intake remains an important research outcome if dietary recommendations to promote healthy weight are to be refined. The aims of this paper are to review current dietary intake assessment methodologies for children, to identify their biases and provide guidance on how these can be addressed to improve reporting of dietary intakes of overweight children in the literature and to identify future research priorities. Knowledge of the methodological aspects of studies examining dietary intake a priori in the context of obesity will assist researchers in improving the quality of dietary data collected and reported and facilitate publication of both dietary intake and nutrition outcomes in the context of body weight. This will help to develop a strong evidence base against which to evaluate the effectiveness of nutrition interventions for both the prevention and treatment of pediatric obesity.

Assessing dietary intake in children and adolescents: Considerations and recommendations for obesity research

Abstract Dietary intake and food habits are important contributors to the obesity epidemic. They are highly modifiable components of energy balance and are usually targeted in both obesity prevention and treatment programs. However, measurement of total diet creates challenges and can convey a large burden in terms of cost, technical expertise, impact on respondents and time. It is not surprising therefore that comprehensive reports of dietary intake in children are uncommon and, when reported, have limitations. The aim of this paper is to guide researchers and practitioners in selecting the most appropriate dietary assessment method for situations involving children and adolescents. This paper presents a summary of the issues to consider when choosing a method, a description of some of the more commonly used dietary assessment methods for young people and a series of case-studies to illustrate the range of circumstances faced when measuring dietary intake. We recommend that researchers consider the specific components of dietary intake addressed in their research and practice, and whether diet should be reported comprehensively or as targeted components. Other considerations include age, cognitive ability, weight status, physical activity level, respondent burden, and reliability and validity in the context of program goals and research questions. A checklist for selecting the appropriate dietary methodology is provided. This guide aims to facilitate the reporting of dietary intake and food habits in the context of obesity using valid and reliable measures, thus contributing to the evidence-base for nutrition policies and programs relating to obesity.

Reproducibility and comparative validity of a food frequency questionnaire for Australian adults

BACKGROUND Food frequency questionnaires (FFQ) are used in epidemiological studies to investigate the relationship between diet and disease. There is a need for a valid and reliable adult FFQ with a contemporary food list in Australia. AIMS To evaluate the reproducibility and comparative validity of the Australian Eating Survey (AES) FFQ in adults compared to weighed food records (WFRs). METHODS Two rounds of AES and three-day WFRs were conducted in 97 adults (31 males, median age and BMI for males of 44.9 years, 26.2 kg/m(2), females 41.3 years, 24.0 kg/m(2). Reproducibility was assessed over six months using Wilcoxon signed-rank tests and comparative validity was assessed by intraclass correlation coefficients (ICC) estimated by fitting a mixed effects model for each nutrient to account for age, sex and BMI to allow estimation of between and within person variance. RESULTS Reproducibility was found to be good for both WFR and FFQ since there were no significant differences between round 1 and 2 administrations. For comparative validity, FFQ ICCs were at least as large as those for WFR. The ICC of the WFR-FFQ difference for total energy intake was 0.6 (95% CI 0.43, 0.77) and the median ICC for all nutrients was 0.47, with all ICCs between 0.15 (%E from saturated fat) and 0.7 (g/day sugars). CONCLUSIONS Compared to WFR the AES FFQ is suitable for reliably estimating the dietary intakes of Australian adults across a wide range of nutrients.

The development and evaluation of the Australian child and adolescent recommended food score: A cross-sectional study

BackgroundDiet quality tools have been developed to assess the adequacy of dietary patterns for predicting future morbidity and mortality. This study describes the development and evaluation of a brief food-based diet quality index for use with children at the individual or population level. The Australian Child and Adolescent Recommended Food Score (ACARFS) was developed to reflect adherence to the Dietary Guidelines for Children and Adolescents in Australia and modelled on the approach of the US Recommended Food Score.MethodsThe ACARFS has eight sub-scales and is scored from zero to 73. The diet quality score was evaluated by assessing correlation (Spearman’s correlations) and agreement (weighted κ statistics) between ACARFS scores and nutrient intakes, derived from a food frequency questionnaire in 691 children (mean age 11.0, SD 1.1) in New South Wales, Australia. Nutrient intakes for ACARFS quartiles were compared with the relevant Australian nutrient reference values.ResultsACARFS showed slight to substantial agreement (κ 0.13-0.64) with nutrient intakes, with statistically significant moderate to strong positive correlations with all vitamins, minerals and energy intake (r = 0.42-0.70). ACARFS was not related to BMI.Participants who scored less than the median ACARFS were more likely to have sub-optimal intakes of fibre, folic acid and calcium.ConclusionACARFS demonstrated sufficient accuracy for use in future studies evaluating diet quality. Future research on its utility in targeting improvements in the nutritional quality of usual eating habits of children and adolescents is warranted.

The Comparative Validity and Reproducibility of a Diet Quality Index for Adults: The Australian Recommended Food Score

Adult diet quality indices are shown to predict nutritional adequacy of dietary intake as well as all-cause morbidity and mortality. This study describes the reproducibility and validity of a food-based diet quality index, the Australian Recommended Food Score (ARFS). ARFS was developed to reflect alignment with the Australian Dietary Guidelines and is modelled on the US Recommended Food Score. Dietary intakes of 96 adult participants (31 male, 65 female) age 30 to 75 years were assessed in two rounds, five months apart. Diet was assessed using a 120-question semi-quantitative food frequency questionnaire (FFQ). The ARFS diet quality index was derived using a subset of 70 items from the full FFQ. Reproducibility of the ARFS between round one and round two was confirmed by the overall intraclass correlation coefficient of 0.87 (95% CI 0.83, 0.90), which compared favourably to that for the FFQ at 0.85 (95% CI 0.80, 0.89). ARFS was correlated with FFQ nutrient intakes, particularly fiber, vitamin A, beta-carotene and vitamin C (0.53, 95% CI 0.37–0.67), and with mineral intakes, particularly calcium, magnesium and potassium (0.32, 95% CI 0.23–0.40). ARFS is a suitable brief tool to evaluate diet quality in adults and reliably estimates a range of nutrient intakes.

Changes to dietary intake during a 12-week commercial web-based weight loss program: a randomized controlled trial

Background/objectives:The primary aim of this secondary analysis was to compare changes in dietary intake among participants randomized to two versions of a 12-week commercial web-based weight loss program (basic or enhanced) with a waiting-list control. An additional investigation compared changes in dietary intake of successful participants (weight loss ⩾5%) with those not successful.Subjects/methods:Dietary intake was assessed at baseline and 12 weeks using a validated 120-item semiquantitative food frequency questionnaire. Adults (n=268, 60% female participants, body mass index 32.1±3.9) classified as plausible reporters of energy intake were included in the analyses. Analysis of covariance with baseline observations carried forward for drop-outs (n=38) was used.Results:The basic and enhanced groups significantly increased their percentage of energy contribution from fruits and reduced energy-dense, nutrient-poor foods compared with controls (P<0.001). Successful participants (n=49) reported superior improvements in dietary intake including greater reductions in the mean daily energy intake (P<0.001), the percentage of energy from energy-dense, nutrient-poor foods (−12.0% E vs −4.3% E, P<0.001) and greater increases in the energy contribution from fruits (P<0.001), vegetables (P=0.003) and breads/cereals (P=0.02).Conclusions:Use of a commercial web-based weight loss program facilitated some improvements in the dietary intake. The enhanced web-based tools appeared not to have generated greater improvements in reported dietary intake, compared with the basic or control groups. Those who achieved a weight loss of ⩾5% improved their dietary intake in line with the program recommendations and dietary guidelines. Further research to determine web-based components that may improve success and the reasons why programs are successful for some participants is required.

Trends in Food and Beverage Portion Sizes in Australian Children; a Time-Series Analysis Comparing 2007 and 2011–2012 National Data

In 2011–2012 approximately 26% of Australian children aged between 5–17 years were reported to be overweight or obese. Furthermore, the increase in prevalence of overweight and obesity among US children parallels reported increases in energy intake and portion sizes of common foods, leading to the recognition that availability of larger portion sizes contributes to the rise in overweight and obesity prevalence. Thus, the aim of this time-series analysis was to investigate whether selected food portion sizes in Australian children aged 2–16 years changed between 2007 and 2011–2012. Portion size data from 24-h recalls collected in Australian nutrition surveys were compared between 2007 and 2011–2012. Portion sizes changed significantly in 23% of items with increases in 15% and decreases in 8%. Changes in portion sizes varied by age, sex, and food group. Changes occurred for many meat-based items, energy-dense, nutrient-poor food items, breads, cereals, and some fruits and vegetables. Vegetable and fruit portion sizes were below the respective serving sizes of 75 g and 150 g in the Australian Guide to Healthy Eating, while portion sizes of some energy-dense, nutrient-poor foods have increased. These findings suggest approaches to increasing consumption of nutrient-dense core foods and reducing energy-dense, nutrient-poor food items in children are warranted.

Determining priorities for research in ageing: A community survey

Objectives:  This paper reports the culmination of a local process of priority setting for ageing research.

Dietary patterns of adolescent girls attending schools in low-income communities highlight low consumption of core foods

Aim Overweight and obesity prevalence is high among adolescent girls of low socioeconomic position and this increases their risk of cardiovascular disease and metabolic disorders in adulthood. The aim of this present study was to describe the dietary patterns of adolescent girls in terms of the relative contribution of core food groups to overall diet and by weight status category. Methods Year 8 female students were recruited from schools in low-income communities. Weight status (i.e. underweight, healthy weight, overweight, obese) was determined using age- and sex-adjusted body mass index (BMI; z score). Dietary intakes were assessed using a validated semi-quantitative food frequency questionnaire. Individual foods were collated into core food group or energy-dense, nutrient-poor categories in line with the Australian Guide to Healthy Eating (AGHE) and the percentage contribution to total energy intake calculated. Results Participants (n = 332) were (mean ± SD) 13.7 ± 0.4 years old with BMI z score 0.63 ± 1.22. Few girls met AGHE core food group recommendations for daily serves; meat and substitutes 69.3%, vegetables 28.6%, fruit 23.8%, dairy 15.7% and breads/cereals 5.7%. Total percentage energy derived from energy-dense, nutrient-poor foods was 46.6% (37.2–54.6%) (median (interquartile range)), with takeaways 9.8% (7.0–13.6%), confectionery 7.0% (4.1–10.9%) and packaged snacks 6.8% (4.0–10.7%), with no significant differences by weight status. Conclusions Core food intakes are poor with excessive consumption of energy-dense, nutrient-poor foods in these adolescent girls. Nutrition education programs targeting this population are needed to address this imbalance. Strategies could include substitution of unhealthy snacks for core food items and greater inclusion of core foods within main meals.