Compliance to the Norwegian Food-Based Dietary Guidelines among patients with colorectal cancer -Validation of a compliance questionnaire

Background: This master thesis is a subproject within the Norwegian Foods Study (NFS), which is a diet and lifestyle intervention in colorectal cancer (CRC) survivors. Within the study there was a need for a specific and effective tool for repeated, self-administered assessment of compliance to the Norwegian Food-Based Dietary Guidelines (NFBDG). Therefore, a new questionnaire designed to measure compliance to the NFBDG was developed. The compliance questionnaire is a short food frequency questionnaire that assesses food intake and physical activity the preceding week. Aims: The aim of this master thesis was to validate the compliance questionnaire to the NFBDG among patients with colorectal cancer (CRC). In addition, we examined to which extent the patients complied to the NFBDG after surgery. Study design and Methods: A subgroup (n=17) of newly diagnosed CRC patients from the main NFS population was recruited from Ullevål University Hospital. At the baseline of NFS intervention (i.e. 2-3 months post surgery), the participants were asked to fill out the compliance questionnaire and to use two validation tools; SenseWear Armband (n=13) and 7-days weighted food records (n=15). Results: Significant correlations for intake estimates were found between the compliance questionnaire and the food records for the following variables: fruits and berries including juice, nuts, total red meat, total non-processed meat, alcoholic beverages, juice, beverages with added sugar, foods added sugar and vitamin D (Spearman’s correlation coefficient rho 0.51 - 0.88 (p ≤ 0.05)). There were no significant differences in the absolute intake for any of these categories. On an individual level, the percentage of the participants who achieving full compliance to the guidelines varied from 20 % for total vegetables, fruits and berries to 80 % for intake of fatty fish. On group level, median intake showed 100 % compliance to the guidelines for nuts, total fish, fatty fish, total red meat and juice, and the median compliance to physical activity was 40 % as measured from the Armband. Conclusion: The compliance questionnaire provides good estimates of intake for fruits and berries including juice, nuts, total red meat, total non-processed meat, alcoholic beverages, juice, beverages with added sugar, foods added sugar and vitamin D. In the CRC the highest compliance to the NFBDG was found for intake of fish, red meat, nuts and juice. Moreover the compliance was lowest for intake of fruits and berries, vegetables and alcoholic beverages

Use of bioelectrical impedance analysis to monitor changes in fat-free mass during recovery from colorectal cancer– a validation study

Background & aims Although previous research show high correlation between fat-free mass (FFM) measured by bioelectrical impedance analysis (BIA) and dual-energy X-ray absorptiometry (DXA), the validity of BIA to track longitudinal changes in FFM is uncertain. Thus, the aim of this study was to validate the ability of BIA to assess changes in FFM during 6 months of recovery from non-metastatic colorectal cancer (CRC). Methods A total of 136 women and men (50–80 years) with stage I-III CRC and a wide range of baseline FFM (35.7–73.5 kg) were included in the study. Body composition was measured at study baseline within 2–9 months of surgery and again 6 months later. Whole-body BIA FFM estimates (FFMBIA) were calculated using three different equations (manufacturer's, Schols' and Gray's) before comparison to FFM estimates obtained by DXA (FFMDXA). Results Correlation between changes in FFMBIA and FFMDXA was intermediate regardless of equation (r ≈ 0.6). The difference in change of FFMBIA was significant compared to FFMDXA, using all three equations and BIA overestimated both loss and gain. However, BIA showed 100% sensitivity and about 90% specificity to identify individuals with ≥5% loss in FFM, using all three equations. Sensitivity of FFMBIA to detect a smaller loss of FFM (60–76%) or a gain in FFM of ≥5% (33–62%) was poor. Conclusion In a well-nourished population of non-metastatic CRC patients, a single-frequency whole-body BIA device yielded imprecise data on changes in FFM, regardless of equation. BIA is thus not a valid option for quantifying changes in FFM in individuals. However, BIA could be used to identify patients with loss in FFM ≥5% in this population. The validity of BIA to monitor changes in FFM warrants further investigation before implementation in clinical praxis

Use of bioelectrical impedance analysis to monitor changes in fat-free mass during recovery from colorectal cancer– a validation study

Background & aims Although previous research show high correlation between fat-free mass (FFM) measured by bioelectrical impedance analysis (BIA) and dual-energy X-ray absorptiometry (DXA), the validity of BIA to track longitudinal changes in FFM is uncertain. Thus, the aim of this study was to validate the ability of BIA to assess changes in FFM during 6 months of recovery from non-metastatic colorectal cancer (CRC). Methods A total of 136 women and men (50–80 years) with stage I-III CRC and a wide range of baseline FFM (35.7–73.5 kg) were included in the study. Body composition was measured at study baseline within 2–9 months of surgery and again 6 months later. Whole-body BIA FFM estimates (FFMBIA) were calculated using three different equations (manufacturer's, Schols' and Gray's) before comparison to FFM estimates obtained by DXA (FFMDXA). Results Correlation between changes in FFMBIA and FFMDXA was intermediate regardless of equation (r ≈ 0.6). The difference in change of FFMBIA was significant compared to FFMDXA, using all three equations and BIA overestimated both loss and gain. However, BIA showed 100% sensitivity and about 90% specificity to identify individuals with ≥5% loss in FFM, using all three equations. Sensitivity of FFMBIA to detect a smaller loss of FFM (60–76%) or a gain in FFM of ≥5% (33–62%) was poor. Conclusion In a well-nourished population of non-metastatic CRC patients, a single-frequency whole-body BIA device yielded imprecise data on changes in FFM, regardless of equation. BIA is thus not a valid option for quantifying changes in FFM in individuals. However, BIA could be used to identify patients with loss in FFM ≥5% in this population. The validity of BIA to monitor changes in FFM warrants further investigation before implementation in clinical praxis

Relative validity of a short food frequency questionnaire assessing adherence to the Norwegian dietary guidelines among colorectal cancer patients

Background: The Norwegian food-based dietary guidelines (FBDG) aim at reducing the risk of developing chronic diseases and promote overall health. We studied the effect of the Norwegian FBDG in colorectal cancer (CRC) patients. There is a need for a time-efficient dietary assessment tool measuring adherence to these guidelines in patients treated for dietary dependent cancer, such as CRC patients. Objective: To evaluate a new short food frequency questionnaire (NORDIET-FFQ), developed to estimate adherence to the Norwegian FBDG among CRC patients. Design: Eighty-one CRC patients from both study groups in the Norwegian Dietary Guidelines and Colorectal Cancer Survival study, an ongoing dietary intervention, completed both the short 63-item NORDIET-FFQ and a 7-day weighed food record. Results: The NORDIET-FFQ was on group level able to estimate intakes of fruits, vegetables, unsalted nuts, fish, fatty fish, high fat dairy products, unprocessed meat, processed meat, red meat, water, sugar-rich beverages, alcoholic drinks, and sugar- and fat-rich foods. Ranking of individuals according to intake was good (r = 0.31–0.74) for fruits and vegetables, fruits, unsalted nuts, whole grain products, sugar-rich cereals, fish, fatty fish, dairy products, red meat, water, sugar-rich beverages, alcoholic beverages, and sugar- and fat-rich foods. The NORDIET-FFQ was able to identify the individuals who did not fulfil the recommendations of fruits, vegetables, unsalted nuts, whole grains, low-fat dairy products, processed meat, water, alcoholic beverages, and sugar- and fat-rich foods (sensitivity: 67–93%). Conclusions: The NORDIET-FFQ showed good ability in to estimate intakes of plant-based foods, fish, dairy products, meat, and energy-dense foods; adequate ranking of individuals according to intake of most recommendations except for unprocessed meat, processed meat, and vegetables; and importantly a good ability to identify those patients in need of dietary counselling for foods that are known to modulate the risk of CRC. Trial registration: National Institutes of Health ClinicalTrials.gov; Identifier: NCT01570010

Exchanging a few commercial, regularly consumed food items with improved fat quality reduces total cholesterol and LDL-cholesterol: A double-blind, randomised controlled trial

The healthy Nordic diet has been previously shown to have health bene fi cial effects among subjects at risk of CVD. However, the extent of food changes needed to achieve these effects is less explored. The aim of the present study was to investigate the effects of exchanging a few commercially available, regularly consumed key food items (e.g. spread on bread, fat for cooking, cheese, bread and cereals) with improved fat quality on total cholesterol, LDL-cholesterol and in fl ammatory markers in a double-blind randomised, controlled trial. In total, 115 moderately hypercholesterolaemic, non-statin-treated adults (25 – 70 years) were randomly assigned to an experimental diet group (Ex-diet group) or control diet group (C-diet group) for 8 weeks with commercially available food items with different fatty acid composition (replacing SFA with mostly n -6 PUFA). In the Ex-diet group, serum total cholesterol ( P < 0 · 001) and LDL-cholesterol ( P < 0 · 001) were reduced after 8 weeks, compared with the C-diet group. The difference in change between the two groups at the end of the study was − 9 and − 11 % in total cholesterol and LDL-cholesterol, respectively. No difference in change in plasma levels of in fl ammatory markers (high-sensitive C-reactive protein, IL-6, soluble TNF receptor 1 and interferon- γ ) was observed between the groups. In conclusion, exchanging a few regularly consumed food items with improved fat quality reduces total cholesterol, with no negative effect on levels of inflammatory markers. This shows that an exchange of a few commercially available food items was easy and manageable and led to clinically relevant cholesterol reduction, potentially affecting future CVD risk