Lidia Wadolowska

Comparison of a Full Food-Frequency Questionnaire with the Three-Day Unweighted Food Records in Young Polish Adult Women: Implications for Dietary Assessment

The food frequency questionnaire (FFQ) and the food record (FR) are among the most common methods used in dietary research. It is important to know that is it possible to use both methods simultaneously in dietary assessment and prepare a single, comprehensive interpretation. The aim of this study was to compare the energy and nutritional value of diets, determined by the FFQ and by the three-day food records of young women. The study involved 84 female students aged 21–26 years (mean of 22.2 ± 0.8 years). Completing the FFQ was preceded by obtaining unweighted food records covering three consecutive days. Energy and nutritional value of diets was assessed for both methods (FFQ-crude, FR-crude). Data obtained for FFQ-crude were adjusted with beta-coefficient equaling 0.5915 (FFQ-adjusted) and regression analysis (FFQ-regressive). The FFQ-adjusted was calculated as FR-crude/FFQ-crude ratio of mean daily energy intake. FFQ-regressive was calculated for energy and each nutrient separately using regression equation, including FFQ-crude and FR-crude as covariates. For FR-crude and FFQ-crude the energy value of diets was standardized to 2000 kcal (FR-standardized, FFQ-standardized). Methods of statistical comparison included a dependent samples t-test, a chi-square test, and the Bland-Altman method. The mean energy intake in FFQ-crude was significantly higher than FR-crude (2740.5 kcal vs. 1621.0 kcal, respectively). For FR-standardized and FFQ-standardized, significance differences were found in the mean intake of 18 out of 31 nutrients, for FR-crude and FFQ-adjusted in 13 out of 31 nutrients and FR-crude and FFQ-regressive in 11 out of 31 nutrients. The Bland-Altman method showed an overestimation of energy and nutrient intake by FFQ-crude in comparison to FR-crude, e.g., total protein was overestimated by 34.7 g/day (95% Confidence Interval, CI: −29.6, 99.0 g/day) and fat by 48.6 g/day (95% CI: −36.4, 133.6 g/day). After regressive transformation of FFQ, the absolute difference between FFQ-regressive and FR-crude equaled 0.0 g/day and 95% CI were much better (e.g., for total protein 95% CI: −32.7, 32.7 g/day, for fat 95% CI: −49.6, 49.6 g/day). In conclusion, differences in nutritional value of diets resulted from overestimating energy intake by the FFQ in comparison to the three-day unweighted food records. Adjustment of energy and nutrient intake applied for the FFQ using various methods, particularly regression equations, significantly improved the agreement between results obtained by both methods and dietary assessment. To obtain the most accurate results in future studies using this FFQ, energy and nutrient intake should be adjusted by the regression equations presented in this paper.

Dairy Products, Dietary Calcium and Bone Health: Possibility of Prevention of Osteoporosis in Women: The Polish Experience

The objective of the study was to analyze the consumption of dairy products and dietary calcium by women in the context of bone mineral density and to assess opportunities to prevent osteoporosis in a dietary manner. The study was carried out with 712 Polish women. In 170 women aged 32 to 59 bone mineral density (BMD) was measured. The data on the consumption of dairy products and dietary calcium and some other osteoporosis risk factors was collected from 712 women. The average calcium intake from a diet was 507 mg/day. Only 2% of the women met Polish calcium intake recommendations. During adulthood, dairy product consumption or dietary calcium intake did not differ significantly between women with low BMD (below −1 SD) and women with regular BMD (≥−1 SD) (47.4 vs. 44.3 servings/week and 459 vs. 510 mg/day, respectively, p > 0.05). The odds ratios adjusted for age, menstruation and BMI in women with upper BMD tercile in comparison to the reference group (bottom tercile) was 2.73 (95% CI: 1.14, 6.55; p < 0.05) for the daily consumption of dairy products during the pre-school period and 2.40 (95% CI: 1.01, 5.70; p < 0.05) for the daily consumption of dairy products during the school period. Two clusters of women were established. In the S1 cluster, low BMD (below −1 SD) was associated with older age (≥50 years), lack of menstrual cycle. In the S2 cluster, regular BMD (≥−1 SD) was related to younger aged women (<50 years), presence of menstrual cycle, consumption of higher level of dairy products (≥28 servings/week) during adulthood and daily intake of dairy products during childhood and adolescence. The results indicate that good bone health to the large extent depended upon the combined impact of dietary factors and some non-modifiable risk factors of osteoporosis such as age and the presence of menstruation. Consumption of dairy products in childhood and adolescence may improve bone mineral density and reduce the risk of osteoporosis in adult women.

Vegetarian diet alters the assessment of exocrine pancreatic function with the use of fecal tests.

Vegetarian diets are becoming increasingly popular, yet the assessment of pancreatic function tests in vegetarians is sparse. Chronic pancreatitis and exocrine pancreatic insufficiency are more common than previously thought. Therefore, a means of accurately measuring pancreatic function in vegetarian subjects is needed. Direct pancreatic function tests, such as the secretincholecystokinin-test (SCT), have the highest sensitivity and specificity. However, they have some major disadvantages, including invasiveness and availability, which make them unsuited for routine use (1). Among the indirect tests, the measurement of fecal enzyme concentrations/activities is the easiest. Fecal elastase-1 is probably the most sensitive and specific of the indirect tests (2). However, there are no data regarding the specificity of these tests in vegetarians. In the current study we investigated the impact of vegetarian diet on the specificity of fecal tests of pancreatic function.

Comparing dietary patterns derived by two methods and their associations with obesity in Polish girls aged 13-21 years: the cross-sectional GEBaHealth study

Aims: To compare dietary patterns (DPs) derived by two methods and their assessment as a factor of obesity in girls aged 13–21 years. Methods: Data from a cross-sectional study conducted among the representative sample of Polish females (n = 1,107) aged 13–21 years were used. Subjects were randomly selected. Dietary information was collected using three short-validated food frequency questionnaires (FFQs) regarding fibre intake, fat intake and overall food intake variety. DPs were identified by two methods: a priori approach (a priori DPs) and cluster analysis (data-driven DPs). The association between obesity and DPs and three single dietary characteristics was examined using multiple logistic regression analysis. Results: Four data-driven DPs were obtained: ‘Low-fat-Low-fibre-Low-varied’ (21.2%), ‘Low-fibre’ (29.1%), ‘Low-fat’ (25.0%) and ‘High-fat-Varied’ (24.7%). Three a priori DPs were pre-defined: ‘Non-healthy’ (16.6%), ‘Neither-pro-healthy-nor-non-healthy’ (79.1%) and ‘Pro-healthy’ (4.3%). Girls with ‘Low-fibre’ DP were less likely to have central obesity (adjusted odds ratio (OR) = 0.36; 95% confidence interval (CI): 0.17, 0.75) than girls with ‘Low-fat-Low-fibre-Low-varied’ DP (reference group, OR = 1.00). No significant associations were found between a priori DPs and overweight including obesity or central obesity. The majority of girls with ‘Non-healthy’ DP were also classified as ‘Low-fibre’ DP in the total sample, in girls with overweight including obesity and in girls with central obesity (81.7%, 80.6% and 87.3%, respectively), while most girls with ‘Pro-healthy’ DP were classified as ‘Low-fat’ DP (67.8%, 87.6% and 52.1%, respectively). Conclusion: We found that the a priori approach as well as cluster analysis can be used to derive opposite health-oriented DPs in Polish females. Both methods have provided disappointing outcomes in explaining the association between obesity and DPs. The cluster analysis, in comparison with the a priori approach, was more useful for finding any relationship between DPs and central obesity. Our study highlighted the importance of method used to derive DPs in exploring associations between diet and obesity.

Self-Reported Dietary Restrictions and Dietary Patterns in Polish Girls: A Short Research Report (GEBaHealth Study)

Dietary restraint is a commonly reported practice observed among young females. The practice remains controversial and can be interpreted as a beneficial self-regulating behavior or the opposite, an eating disorder that may have a detrimental effect on health. The aim of this short report was to investigate if dietary restrictions are associated with dietary patterns in a representative sample of Polish girls. Analyses were carried out on data from the Girls’ Eating Behavior and Health (GEBaHealth) study. The sample included 1107 girls, ranging in age from 13 to 21 years old. Restrictions regarding food quantities and selected food groups were assessed using a standardized interview. Dietary patterns were identified with Principal Component Analysis (PCA), based on dietary data collected with Food Frequency Questionnaires (FFQs). Logistic regression analysis was used to study the associations between self-reported restrictions and each dietary pattern. In the total sample, 30.5% of girls reported following some food restrictions. The most common restrictions regarded consumption of sugar and/or sweets (23.7%), high-fat foods (22.4%), and fats (21.3%). Girls who declared following any restrictions, restrictions in food quantity and restrictions in the consumption of sugar and/or sweets, high-fat foods, fats, cereals and/or bread and/or potatoes were more likely to adhere to the “fruit and vegetables” (considered pro-healthy) dietary pattern (adjusted odds ratios (ORs): 1.55, 95% CI: 1.14–2.12; 1.61, 95% CI: 1.17–2.21; 1.81, 95% CI: 1.30–2.52; 1.46, 95% CI: 1.04–2.06; 1.96, 95% CI: 1.38–2.80 and 3.25, 95% CI: 1.97–5.37, respectively), and less likely to adhere to the “fast foods and sweets” (unhealthy) and “traditional Polish” (rather unhealthy) patterns, compared to girls who declared no restrictions. Declared restrictions in the consumption of foods high in sugar, fat, and starch were observed in girls in the “fruit and vegetables” pattern and were uncommon in girls with unhealthy dietary patterns. Although cautious interpretation is needed when considering restrictions in the overall quantity of food consumed, the results indicate that dietary restrictions of sugar, high-fat foods, fats, and starch may be considered predictors of both pro-healthy and unhealthy dietary patterns in the population of Polish girls.

Dairy-Related Dietary Patterns, Dietary Calcium, Body Weight and Composition: A Study of Obesity in Polish Mothers and Daughters, the MODAF Project

The role of the family environment in regards to dairy products and dietary calcium in the context of obesity is not fully understood. The aim of the study was to investigate the association among dairy-related dietary patterns (DDPs), dietary calcium, body weight and composition in mothers and daughters. Data were collected through a cross-sectional survey within the MODAF Project. A total sample of 712 pairs of mothers (<60 years) and daughters (12–21 years) was studied. This study included 691 pairs. A semi-quantitative food frequency questionnaire (ADOS-Ca) was used to collect dietary data. Waist circumference (WC), body fat, waist-to-height ratio (WHtR) and body mass index (BMI) were determined. Previously derived DDPs were used—three in mothers and three in daughters. In mothers, two of the DDPs were characterized by higher consumption of various dairy products with suboptimal calcium content (means: 703 or 796 mg/day) which decreased the chance of: z-WC > 1 standard deviation (SD), WC > 80 cm, body fat > 32%, WHtR > 0.5, BMI = 25–29.9 kg/m2 or BMI ≥ 30 kg/m2 by 44–67% when compared to low-dairy low-calcium DDP (288 mg/day). In mothers per 100 mg/day of dietary calcium, the chance of z-WC > 1SD, WC > 80 cm, z-WHtR > 1SD, WHtR > 0.5 cm, BMI = 25 to 29.9 kg/m2 or BMI ≥ 30 kg/m2 decreased by 5–9%. In correspondence analysis, a clear association was found between mothers’ and daughters’ low-dairy low-calcium DDPs and upper categories of z-WC (>1 SDs). This study reinforces evidence of the similarity between mothers and daughters in dairy-related dietary patterns and provides a new insight on the adverse relation between low-dairy low-calcium dietary patterns and obesity. It was found that diets containing various dairy products with suboptimal dietary calcium content may be recommended in obesity prevention.

Associations of Mediterranean Diet and a Posteriori Derived Dietary Patterns with Breast and Lung Cancer Risk: A Case-Control Study

Lung cancer in men and breast cancer in women are the most commonly diagnosed cancers in Poland and worldwide. Results of studies involving dietary patterns (DPs) and breast or lung cancer risk in European countries outside the Mediterranean Sea region are limited and inconclusive. This study aimed to develop a ‘Polish-adapted Mediterranean Diet’ (‘Polish-aMED’) score, and then study the associations between the ‘Polish-aMED’ score and a posteriori-derived dietary patterns with breast or lung cancer risk in adult Poles. This pooled analysis of two case-control studies involved 560 subjects (280 men, 280 women) aged 40–75 years from Northeastern Poland. Diagnoses of breast cancer in 140 women and lung cancer in 140 men were found. The food frequency consumption of 21 selected food groups was collected using a 62-item Food Frequency Questionnaire (FFQ)-6. The ‘Polish-adapted Mediterranean Diet’ score which included eight items—vegetables, fruit, whole grain, fish, legumes, nuts and seeds—as well as the ratio of vegetable oils to animal fat and red and processed meat was developed (range: 0–8 points). Three DPs were identified in a Principal Component Analysis: ‘Prudent’, ‘Non-healthy’, ‘Dressings and sweetened-low-fat dairy’. In a multiple logistic regression analysis, two models were created: crude, and adjusted for age, sex, type of cancer, Body Mass Index (BMI), socioeconomic status (SES) index, overall physical activity, smoking status and alcohol abuse. The risk of breast or lung cancer was lower in the average (3–5 points) and high (6–8 points) levels of the ‘Polish-aMED’ score compared to the low (0–2 points) level by 51% (odds ratio (OR): 0.49; 95% confidence interval (Cl): 0.30–0.80; p < 0.01; adjusted) and 63% (OR: 0.37; 95% Cl: 0.21–0.64; p < 0.001; adjusted), respectively. In the middle and upper tertiles compared to the bottom tertile of the ‘Prudent’ DP, the risk of cancer was lower by 38–43% (crude) but was not significant after adjustment for confounders. In the upper compared to the bottom tertile of the ‘Non-healthy’ DP, the risk of cancer was higher by 65% (OR: 1.65; 95% Cl: 1.05–2.59; p < 0.05; adjusted). In conclusion, the Polish adaptation of the Mediterranean diet could be considered for adults living in non-Mediterranean countries for the prevention of the breast or lung cancers. Future studies should explore the role of a traditional Mediterranean diet fitted to local dietary patterns of non-Mediterranean Europeans in cancer prevention.

Fibre-Related Dietary Patterns: Socioeconomic Barriers to Adequate Fibre Intake in Polish Adolescents. A Short Report

There is no complete explanation for the association between socioeconomic status (SES), fibre, and whole diet described by dietary patterns. The aim of this short report was to increase the understanding of adolescent dietary patterns related to fibre in their social context. A cross-sectional study was conducted involving 1176 adolescents aged 13–18 years from central and north-eastern Poland. The overall SES was composed of five single factors: place of residence, self-declared economic situation of family, self-declared economic situation of household, paternal and maternal education. The consumption frequency of nine dietary fibre sources was collected using Block’s questionnaire and was expressed in points. Fibre dietary patterns (DPs) were drawn by cluster analysis and odds ratios (ORs) adjusted for age, sex, and BMI were calculated. Three fibre-related DPs were identified: “High-fibre” (mean frequency of total fibre intake 22.7 points; range: 0–36), “Average-fibre” (17.7 points), “Low-fibre” (14.6 points). The “High-fibre” DP was characterized by a relatively higher frequency consumption of white bread, fruit, fruit or vegetable juices, potatoes, green salad and prepared vegetables, and a moderate frequency consumption of high-fibre or bran cereals and wholegrain bread compared to the “Low-fibre” DP. The “Average-fibre” DP was characterized by a relatively higher frequency consumption of wholegrain bread and high-fibre or bran cereals and a moderate frequency consumption of fruit, fruit or vegetable juices, green salad and prepared vegetables compared to the “Low-fibre” DP. Less likely to adhere to the “High-fibre” DP were adolescents with low SES (OR: 0.55, 95% CI: 0.39–0.77) or average SES (0.58, 95% CI: 0.41–0.81) in comparison with high SES (reference) as a result of elementary or secondary paternal or maternal education, rural residence, and lower household economic situation. Similar associations were found for the “Average-fibre” DP. Low and average socioeconomic status resulting from lower parents’ education, rural residence, and lower economic situation were inversely associated with achieving a relatively high fibre intake in Polish adolescents. Consuming single high-fibre foods was not sufficient to achieve a high-fibre diet in Polish adolescents. These data suggest that the consumption of a wide variety of dietary fibre sources—both relatively high-fibre and low-fibre foods—may help Polish adolescents in achieving a relatively high-fibre diet.

Perceived Health and Nutrition Concerns as Predictors of Dietary Patterns among Polish Females Aged 13–21 Years (GEBaHealth Project)

Health-related concerns can often be factors influencing health-related behaviours. It remains unclear whether a high level of concerns is associated with pro-healthy or unhealthy dietary behaviours and whether any associations between nutrition-related concerns and dietary behaviours exist in a population of girls and young women. The aim of the study was to investigate the associations between perceived health and nutrition concerns and dietary patterns in a representative sample of Polish young females. Data was collected in 2012 through a cross-sectional quantitative survey within the GEBaHealth (Girls Eating Behaviours and Health) project in a group of 1107 Polish girls aged 13–21 years old. Dietary patterns were identified by Principal Component Analysis (PCA) based on dietary data collected with Food Frequency Questionnaires (FFQs). Nutrition and health concerns were assessed separately by two indices: Health Concern Index (HCI) and Nutrition Concern Index (NCI); both based on the Health Concern Scale (HCS). The associations between perceived health and nutrition concerns and each dietary pattern were investigated using logistic regression analysis. Displaying a higher level of health concerns increased the chances of adherence to the upper tertile of ‘Fruit & vegetables’ pattern (adjusted odds ratio [adj. ORs]: 1.46, 95% Confidence Interval [95% CI]: 1.02–2.10). Displaying a lower level of health concerns increased the chances of the adherence to the upper tertiles of ‘Traditional Polish’, ‘Dairy & fats’, ‘Fruit and vegetables’ and ‘Fast food & sweets’ patterns (adj. ORs: 1.87, 95% CI: 1.31–2.67; 1.66, 95% CI: 1.18–2.34; 1.57, 95% CI: 1.11–2.22; 1.52, 95% CI: 1.08–2.13; respectively). No significant associations were found between levels of nutrition concerns and dietary patterns in the adjusted model. We found associations between self-perceived health concerns and dietary patterns in our study sample, suggesting health concerns can be an important predictor of dietary behaviours in girls and young women. To increase the effectiveness of healthy eating, an emphasis should be laid on health, reinforced with awareness of nutrition, when advising on food-related decisions.

Health- and Taste-Related Attitudes Associated with Dietary Patterns in a Representative Sample of Polish Girls and Young Women: A Cross-Sectional Study (GEBaHealth Project)

Attitudes can be predictors of certain health-related behaviours. The attitudes of young females towards health and taste have not been yet fully examined and their associations with dietary behaviours remain unclear. The aim of the study was to investigate if attitudes are associated with dietary patterns in a representative sample of Polish girls. The study population consisted of 1107 girls, aged 13–21 and living in Poland. Attitudes were assessed using the Health and Taste Attitudes Scale (HTAS) and categorised as negative, neutral or positive. Dietary data was obtained using a Food Frequency Questionnaire. Dietary patterns (DPs), derived previously with a Principal Component Analysis (PCA), were ‘Traditional Polish’, ‘Fruit and vegetables’, ‘Fast food and sweets’ and ‘Dairy and fats’. The associations between attitudes and DPs were assessed using Spearman’s correlation coefficients and logistic regression. The reference group were girls with neutral attitudes. Odds ratios (ORs) were adjusted for age, socioeconomic status (SES), and body mass index (BMI). The correlations between attitudes and DPs ranged from −0.28 for attitudes towards health and ‘Fast food and sweets’ and ‘Traditional Polish’ DPs to 0.33 for attitudes towards health and the ‘Fruit and vegetables’ DP (p < 0.05). In the logistic regression analysis, the strongest associations within health-related HTAS subscales were observed between negative attitudes towards natural products and the ‘Fast food and sweets’ DP (OR: 10.93; 95% CI: 3.32–36.01) and between positive attitudes towards health and the ‘Fruit and vegetables’ DP (OR: 5.10; 3.11–8.37). The strongest associations within taste-related HTAS subscales were observed between positive attitudes towards craving for sweet foods and the ‘Traditional Polish’ DP (OR: 1.93; 1.43–2.61) and between positive attitudes towards using food as a reward and the ‘Dairy and fats’ DP (OR: 2.08; 1.22–3.55) as well as the ‘Fast food and sweets’ DP (OR: 2.07; 1.14–3.74). Positive attitudes towards health were associated with a pro-healthy dietary pattern characterised by the consumption of fruit and vegetables, while negative attitudes towards natural products as well as a strong craving for sweets and using food as a reward were associated with less healthy dietary patterns. To improve the dietary habits of girls and young women, positive attitudes towards health should be strengthened and supported by emphasizing the sensory values of pro-healthy foods.