Jennifer Isabel Macdiarmid

Dietary under-reporting : what people say about recording their food intake

No abstract

Dietary patterns of school-age children in Scotland: association with socio-economic indicators, physical activity and obesity

The Survey of Sugar Intake among Children in Scotland was carried out in May to September 2006. The present study aimed to identify dietary patterns in school-aged children from the survey and investigate associations with socio-economic factors, obesity and physical activity. Habitual diet was assessed using the Scottish Collaborative Group FFQ. Height and weight were measured by trained fieldworkers. A total of 1233 FFQ were available for analysis. Dietary patterns were identified by age (5-11 and 12-17 years) and sex using principal components analysis. Associations between factor scores and socio-economic status, education level of the main food provider, physical activity levels and BMI category (based on UK 1990 charts) were examined. Three dietary patterns were identified in each age and sex group. Healthier patterns loading highly for fruit and vegetables were significantly associated with higher socio-economic status and higher education levels of the main food provider whereas more unhealthy patterns (snacks and puddings) were associated with lower socio-economic status and lower education levels of the main food provider. There was no consistent association between dietary patterns and BMI group or time spent in physical activity. However, inactivity (screen time) was inversely associated with healthier patterns in all age and sex groups and positively associated with puddings and snacks in girls aged 5-11 years. Clear dietary patterns can be identified in school-age children in Scotland, which are consistently related to socio-economic factors and inactivity. This has implications for targeting health promotion at subgroups in terms of lifestyle changes required.

Meal and snacking patterns of school-aged children in Scotland

Background:Current lifestyles and the choice and availability of foods may influence the eating patterns of children. The aim of this study was to investigate the meal and snacking patterns of school-aged children in Scotland.Methods:A sub-sample of 156 children (5–17 years) from the national Survey of Sugar Intake among Children in Scotland completed a 4-day non-weighed diet diary. Meals and snacks were defined using a food-based classification system based on ‘core’ and ‘non-core’ foods. The first eating event containing a solid food item up to and including 0900 hours (1100 hours on weekend days) was defined as breakfast. Frequency of meal and snack consumption was compared between age, sex, body mass index (BMI) and socio-economic sub-groups, between term-time and school holidays and between weekdays and weekend days. Intakes of total fat, saturated fatty acids (SFA) and non-milk extrinsic sugars (NMES) on these days were also compared.Results:Children ate a median of 3.3 meals plus 2.0 snacks per day, which did not vary between age and BMI groups. In all, 83% of children ate breakfast on all 4 days. Boys ate more meals than girls but the number of snacks was similar. Children from lower socio-economic groups tended to eat more meals and fewer snacks. Snacks accounted for 21% of the total daily energy intake, 22% of total fat, 24% of SFA and 39% of NMES intake. Daily intake of energy, total fat, SFA and NMES did not differ between term-time and holidays or weekdays and weekend days.Conclusions:Children tended to follow a traditional pattern of three meals a day, which was consistent between age and BMI subgroups and between school term-time and holidays.

It was an education in portion size. Experience of eating a healthy diet and barriers to long term dietary change.

The aim of the study was to explore the expectations and experience of actually eating a healthy diet and using this experience to identify barriers to healthy eating and sustainable dietary change. Fifty participants (19-63 yrs) were provided with a healthy diet (i.e. complied with dietary recommendations) for three consecutive days. Afterwards a semi-structured interview was carried out to explore expectations, experience and barriers to healthy eating. Using a thematic analysis approach eight dominant themes emerged from the interviews. Four related to expectations and experience of healthy eating; realisation of what are appropriate portion sizes, an expectation to feel hungry, surprise that healthy diets comprised normal food, the desire for sweet snacks (e.g. chocolate). This demonstrated there are some misconception about healthy eating and distorted views of portion size. Four more themes emerged relating to barriers to healthy eating; competing priorities, social, peer and time pressure, importance of value for money, a lack of desire to cook. Poor knowledge of healthy eating or a lack of cooking skills were the least common barrier, suggesting that future interventions and policy to improve dietary intakes need to focus on social, cultural and economic issues rather than on lack of knowledge or skills.

Sugar intake and dental decay: results from a national survey of children in Scotland.

The aim of this analysis was to investigate the strength of the association between sugar intake and treatment for dental decay in children in Scotland, and the impact of tooth brushing frequency on this association. The Survey of Sugar Intake among Children in Scotland was carried out in 2006 in those aged 3-17 years. Diet was assessed using the Scottish Collaborative Group FFQ, and interviews were carried out by trained fieldworkers who asked about dental health. A total of 1700 interviews were carried out, and 1512 FFQ were returned. Of the children, 56% had received treatment for decay (fillings or teeth removed due to decay). Intake of non-milk extrinsic sugars (NMES), but not total sugar, increased the risk of having had treatment for decay: adjusted OR 1.84 (95% CI 1.28, 2.64) for the highest ( ≥ 20.0% food energy) v. lowest ( ≤ 14.8% food energy) tertile of NMES intake. This raised risk remained in children who reported brushing their teeth at least twice a day. Compared with children who reported brushing their teeth at least twice a day and were in the lowest tertile of NMES intake, children who reported brushing their teeth once a day or less and were in the highest tertile of NMES intake were over three times more likely to have received treatment for decay (adjusted OR 3.39, 95% CI 1.97, 5.82). In order to improve dental health in children in Scotland, dental health strategies must continue to stress the importance of both reduced NMES intake and good oral hygiene.

Hearing symptoms and audiometry in professional divers and offshore workers

AIMSnThe aims are to compare hearing loss between professional divers and offshore workers and to study whether hearing loss symptoms reflected physical disorder. A secondary objective was to study total threshold shift assessment as a method of detecting noise-induced hearing loss (NIHL).nnnMETHODSnParticipants (151 divers and 120 offshore workers) completed a questionnaire for symptoms and screening audiometry. Audiograms were assessed for total threshold shift at 1, 2, 3, 4 and 6 kHz and the prevalence of referral (within population 5th centile) or warning levels (within population 20th centile) of hearing loss. Audiograms were assessed for an NIHL pattern at four levels by two occupational physicians.nnnRESULTSnHearing loss symptoms were commoner in divers at all levels of hearing loss regardless of differences between groups on audiometry. Hearing loss in offshore workers was within the population age-adjusted norm. Thirteen per cent of divers were within the 5th percentile for threshold shift for the population norm in contrast to 4% of offshore workers and this was predominantly left sided (OR 3.16, 95% CI 1.13-8.93). This difference was lost after adjustment for history of regular exposure to explosion or gunfire. Divers were more likely to have a pattern of severe NIHL on the left (OR 4.61, 95% CI 1.39-15.39, P < 0.05). Approximately 50% of participants with severe NIHL did not have a referral level of hearing loss.nnnCONCLUSIONSnDivers suffer more NIHL than a control population. Current guidance on the assessment of total threshold shift for the detection of significant NIHL was inadequate in the sample studied.

Food frequency questionnaires vs diet diaries

Sir, We believe that Bingham and colleagues have overstated the case in favour of the use of diet diaries vs food frequency questionnaires, for a number of reasons. First, plasma or urinary concentrations of nutrients or their metabolites often reflect recent intake and are therefore more likely to agree with a diary collected around the same time than with a food frequency questionnaire which is designed to capture habitual intake over a much longer period. Second, the ability to detect an association between vitamin C and IHD is not a robust test of validity of any dietary assessment method since it is possible that there is no causal relationship between the two. Associations seen in case–control and cohort studies have not been reproduced in intervention trials such as the Heart Protection Study, which may reflect confounding by socio-economic factors in the observational studies. Third, diet diaries require more commitment from the participants and may therefore lead to greater bias towards more educated and motivated participants: in a recent survey of diet in children across Scotland, the proportion of completed food frequency questionnaires returned ranged from 71% in the least deprived quintile of the Scottish Index of Multiple Deprivation to 58% in the most deprived quintile while for 4-day non-weighed diet diaries, the corresponding figures were 56% and 31%. Fourth, the analysis of diet diaries requires a considerable amount of time from highly trained nutritionists, so in large studies the cost may be prohibitive. We estimate that the cost of collecting and analysing data using a food frequency questionnaire is less than one-fifth of that of a 4-day diet diary, so in studies with a fixed budget the gain in statistical power from increased sample size using a food frequency questionnaire could outweigh the loss from greater measurement error by this method. It is often not appreciated that food frequency questionnaires differ widely, not only in the ‘visible’ features of the food list and level of detail on portion size, but also in the ‘invisible’ assumptions made in the selection of foods for the calculation of nutrient intake. Validity can therefore vary markedly between questionnaires, study populations and nutrients of interest. The selection of the most suitable dietary assessment method for a particular survey is a challenging task: to suggest that diet diaries are always the best choice carries a risk of reducing not only the quantity but also the quality of research in this area.

Using food intake records to estimate compliance with the Eatwell Plate dietary guidelines

BACKGROUNDnThe UK Eatwell Plate is consumer based advice recommending the proportions of five food groups for a balanced diet: starchy foods, fruit and vegetables, dairy foods, nondairy sources of protein and foods and drinks high in fat or sugar. Many foods comprise ingredients from several food groups and consumers need to consider how these fit with the proportions of the Eatwell Plate. This involves disaggregating composite dishes into proportions of individual food components. The present study aimed to match the diets of adults in Scotland to the Eatwell Plate dietary recommendations and to describe the assumptions and methodological issues associated with estimating Eatwell Plate proportions from dietary records.nnnMETHODSnFoods from weighed intake records of 161 females and 151 males were assigned to a single Eatwell group based on the main ingredient for composite foods, and the overall Eatwell Plate proportions of each subjects diet were calculated. Food group proportions were then recalculated after disaggregating composite foods.nnnRESULTSnThe fruit and vegetables and starchy food groups consumed were significantly lower than recommended in the Eatwell Plate, whereas the proportions of the protein and foods high in fat or sugar were significantly higher. Failing to disaggregate composite foods gave an inaccurate estimate of the food group composition of the diet.nnnCONCLUSIONSnEstimating Eatwell Plate proportions from dietary records is not straightforward, and is reliant on methodological assumptions. These need to be standardised and disseminated to ensure consistent analysis.

Cognitive symptoms and welding fume exposure.

BACKGROUNDnPrevalence of moderate to severe cognitive symptoms is markedly higher in UK professional divers who have also worked as a welder (28%) than in either divers who have not welded (18%) or offshore workers who have worked neither as a diver nor as a welder (6%).nnnOBJECTIVESnTo determine whether cognitive symptoms are related to welding fume exposure or diving.nnnMETHODSnThree age-matched groups of male workers were studied using postal questionnaire: professional divers who had worked as a welder (PDW, n = 361), professional welders who had not dived (NDW, n = 352), and offshore oil field workers who had neither dived nor welded (NDNW, n =503). Health-related quality of life was assessed by the Short Form 12 questionnaire (SF12). Cognitive symptomatology was assessed using the Cognitive Failures Questionnaire (CFQ). A single variable for welding fume exposure (mg m(-3) days) was calculated, incorporating welding experience in different environments and using different welding techniques and respiratory protective equipment. The level of fume exposure during hyperbaric welding operations was measured during such work as ambient PM(10) (particles of 10 µm or less). Diving exposure was assessed as the number of dives performed plus the number of days spent working during saturation diving.nnnRESULTSnQuestionnaires were returned by 153 PDW, 108 NDW, and 252 NDNW. SF12 scores were the same in all groups and fell within normative values. Mean (95% CI) CFQ scores were higher in PDW [40.3 (37.7-42.9)] than in both NDW [34.6 (31.6-37.7)] and NDNW [32.1 (30.4-33.9)], but the scores in no groups fell outside the normative range. The mean PM(10) exposure during hyperbaric welding operations was 2.58 mg m(-3). The geometric mean mg m(-3) days (95% CI) for welding fume exposure in NDW [33 128 (24 625-44 567) n = 85] was higher than for that in PDW [10 904 (8103-14 673) n = 112]. For PDW the geometric mean (95% CI) diving exposure was 1491 [(1192-1866) n = 94] dives and days in saturation. In the general linear model regression analyses adjusted for age, alcohol consumption, and somatization, there was no signification association of CFQ score with either welding fume exposure (F = 0.072, P = 0.79, n = 152) or diving exposure (F = 0.042, P = 0.84, n = 74).nnnCONCLUSIONSnIn conclusion, cognitive sympomatology was not related to retrospectively assessed measures of welding fume exposure or diving experience. In addition, the levels of cognitive symptomatology, even in PDW, did not exceed normative values.

Psychological and physical correlates of musculoskeletal symptoms in male professional divers and offshore workers

BackgroundUnderwater divers are more likely to complain of musculoskeletal symptoms than a control population. Accordingly, we conducted a study to determine whether musculoskeletal symptoms reflected observable physical disorder, to ascertain the relationship between symptoms and measures of mood, memory and executive function and to assess any need for future screening.MethodsA 10% random sample of responders to a prior postal health questionnaire was examined (151 divers, 120 non-diving offshore workers). Participants underwent physical examination and a neuropsychological test battery for memory and executive function. Participants also completed the Hospital Anxiety and Depression Scale for anxiety (HADSa) and depression (HADSd), and questionnaires for physical health-related quality of life (SF36 PCS), mental health-related quality of life (SF36 MCS), memory (Cognitive Failures Questionnaire (CFQ), Prospective and Retrospective Memory Questionnaire (PRMQ)), executive function (dysexecutive syndrome questionnaire (DEX)), musculoskeletal symptoms (MSS) and general unrelated symptom reporting.ResultsOf participants with moderate/severe musculoskeletal symptoms, 52% had physical signs, and of participants with no symptoms, 73% had no physical signs. There was no difference in the prevalence of signs or symptoms between groups. Musculoskeletal symptoms were associated with lower SF36 PCS for both groups. In divers, musculoskeletal symptoms were associated with higher general unrelated symptom reporting and poorer scoring for HADSa, PRMQ, CFQ and DEX with scores remaining within the normative range. A positive physical examination was associated with general unrelated symptom reporting in divers. There were no differences in neuropsychological test scores attributable to either group or musculoskeletal symptoms.ConclusionsMusculoskeletal symptoms were associated with physical signs, but this was not a strong effect. Reporting of musculoskeletal symptoms by the divers studied was also associated with a tendency to report symptoms generally or somatisation, and caution should be exercised regarding their interpretation as an indication of physical disease or their use for health screening.