Dietary Patterns and Risk of Gallbladder Disease: A Hospital-based Case-Control Study in Adult Women

Gallbladder disease is one of the most prevalent gastrointestinal disorders that may result from a complex interaction of genetic and environmental factors. This study examined the association of dietary patterns with gallstone disease among Iranian women. This case-control study was conducted in general teaching hospitals in Tehran, Iran. Participants were 101 female cases and 204 female controls aged 40-65 years who were admitted for problems other than GBD. Dietary patterns were identified using principal components analysis based on food frequency questionnaire. Compared to the control group, cases were less educated, less physically active, and consumed more total energy (p<0.02). Having 653 livebirths increased the risk of gallstone by more than 5 times, followed by having rapid weight loss, being single, having familial history of gallstone, and consuming high total energy. Two distinct dietary patterns were identified in women (healthy and unhealthy). After adjustment for several confounding variables, healthy dietary pattern was associated with a decreased risk of gallstone disease (OR=0.14, 95% CI 0.048-0.4) while unhealthy dietary pattern was associated with an increased risk (OR=3.77, 95% CI 1.52-9.36). These findings confirm that dietary pattern approach provides potentially useful and relevant information on the relationship between diet and disease. Identifying risk factors will provide an opportunity for prevention of gallbladder disease in developing countries facing an increased risk of obesity

Validity of Energy Intake Reports in Relation to Dietary Patterns

The role of under- and overreporting of energy intake in determining the dietary patterns is yet unclear, especially in the Middle Eastern countries. This study identifies the prevalence of misreporting among Tehranian women aged 18-45 years and to compare the dietary intake patterns of plausible and all energy reporters. Dietary intakes and anthropometric data were collected. FitMate\u2122 metabolic analyzer and Goldberg equation were used in determining the under/overreporting of energy intake. Underreporters were more likely to be overweight and older compared to plausible reporters. Three dietary patterns emerged for all reporters, and two were identified for plausible reporters. Using only plausible reporters to determine dietary patterns was not similar to using all reporters. The proportion of underreporters was 59.3% in the mixture cluster, 30.4% in the unhealthy cluster, and 35.3% in the healthy cluster (p<0.05). Underreporting of energy intake is not uniformly distributed among dietary pattern clusters and tends to be less severe among subjects in the unhealthy cluster. Our data suggested that misreporting of energy intake might affect the dietary pattern analysis

Nutritional Quality and Price of Food Hampers Distributed by a Campus Food Bank: A Canadian Experience

Food insecurity is a mounting concern among Canadian post-secondary students. This study was conducted to evaluate the content of food hampers distributed by University of Alberta Campus Food Bank (CFB) and to assess the cost savings to students, using these hampers. Contents of hampers distributed among 1,857 students and their dependants since 2006 were evaluated against Canada\u2019s Food Guide (CFG) recommendations and Dietary Reference Intakes (DRI). Hampers were aimed at serving university students and one to five members of their households located in Edmonton, Western Canada. One thousand eight hundred fifty-seven clients in Alberta, Canada, were included in the study. Although all hampers provided adequate energy, their fat and animal protein contents were low. Compared to the CFG recommendations, the requirements of milk and alternatives and meat and alternatives were not sufficiently met for clients using 653-person hampers. None of food hampers (i.e. one- to five-person hampers) met the DRI recommendations for vitamin A and zinc. Clients of CFB received Canadian dollar (CN$) 14.88 to 64.3 worth of non-perishable food items in one- to five-person hampers respectively. Hampers provided from the CFB need improvement. Nutrients missing from the food hampers could be provided from fresh fruits, vegetables, dairy, and meat products; however, these foods are more expensive than processed food items. The CFB provides a significant amount of savings to its clients even without considering the additional perishable donations that are provided to clients. Interpretation of our data required the assumption that all clients were consuming all of their hampers, which may not always be the case. Clients that do not fully consume their hampers may benefit less from the food bank

Adherence to a priori dietary patterns in relation to obesity: results from two cycles of the Canadian National Nutrition Survey

Abstract Objective: To test whether adherence to the Mediterranean diet, the Dietary Approaches to Stop Hypertension (DASH) or a dietary pattern in-line with the 2015–2020 Dietary Guidelines for Americans (DGA) was associated with obesity. Design: 24-h dietary recall data from the Canadian Community Health Survey (CCHS)-Nutrition, 2004 and 2015 cycles, were analysed. Diet quality index scores were computed for the Mediterranean-Style Dietary Pattern Score (MSDPS), a DASH index and the 2015 Dietary Guidelines for Americans Adherence Index (DGAI). Higher scores indicated greater adherence. Association between scores and obesity was examined using logistic regression, adjusting for age, sex, physical activity, smoking status, sequence of dietary recall and alcohol and energy intake. Setting: Canada (excluding territories and the institutionalised population). Participants: Canadian adults (≥ 18 years), non-pregnant and non-breast-feeding; 11 748 from CCHS 2004 and 12 110 from CCHS 2015. The percentage of females in each sample was 50 %. Results: Mean MSDPS, DASH and DGAI scores were marginally but significantly higher in CCHS 2015 than in CCHS 2004. Those affected by obesity obtained lower scores for all indexes in CCHS 2004 (OR 10th v. 90th percentile for DASH: 2·23 (95 % CI 1·50, 3·32), DGAI: 3·01 (95 % CI 1·98, 4·57), MSDPS: 2·02 (95 % CI 1·14, 3·58)). Similar results were observed in CCHS 2015; however, results for MSDPS were not significant (OR 10th v. 90th percentile for DASH: 2·45 (95 % CI 1·72, 3·49), DGAI: 2·73 (95 % CI 1·85, 4·03); MSDPS: 1·30 (95 % CI 0·82, 2·06)). Conclusion: Following DASH or the 2015–2020 DGA was associated with a lower likelihood of obesity. Findings do not indicate causation, as the data are cross-sectional

Does Dietary Intake by Tehranian Adults Align with the 2005 Dietary Guidelines for Americans? Observations from the Tehran Lipid and Glucose Study

The aim of this study was to compare dietary intakes by Tehranian adults with recent dietary guidelines for the Americans. The study made a cross-sectional assessment of the dietary patterns of Tehranian adults using a validated food-frequency questionnaire. It included 2,510 subjects (1,121 men and 1,389 women) aged 19-70 years. They were the participants of the third follow-up survey of the Tehran Lipid and Glucose Study (2005-2008). The dietary patterns were assessed using the latest World Health Organization (WHO)'s nutritional goals and Dietary Guidelines for the Americans Adherence Index (DGAI) 2005. The mean [standard deviation (SD)] DGAI score for this population was 8.31 (1.9). Participants in the highest quartile category of DGAI were more likely to be female, older, non-smoking, and physically active than those in the lowest quartile category (p<0.001). Percentage of participants meeting the DGA recommendations waslow, especially for starchy vegetables (2.3%), orange vegetables (16.2%), lean meat (9.2%), grains (12.0%), and legumes (6.4%). Over-consumption of grains was observed in almost half of the participants while approximately 20% of the subjects over-consumed milk and meat groups. Intakes of most nutrients examined were significantly associated with the DGAI 2005 score (p<0.001), except for vitamin E, vitamin B12, and vitamin D. The least adherence with the WHO goals was observed with n-3 PUFAs, sodium, fruit, and vegetable intakes. The results revealed that the dietary patterns of most Tehranian adults did not comply with the 2005 DGA and nutritional goals of WHO/Food and Agriculture Organization

Comparison of Health Behaviour Mortality Hazards in Canada and the United States

Introduction National health surveys, available in over 100 countries, are the most common data used for health behaviour surveillance and are increasingly being linked to individual-level health outcomes. We propose that improved health behaviour hazard estimates can be obtained from pooled international population health surveys linked to outcome data. Objectives and Approach The objective of this study was to compare smoking, alcohol, diet and physical activity all-cause mortality hazards in Canada and the United States using individual-level, linked population health survey data and common model specifications. The Canadian Community Health Survey (CCHS) (2003-2007) and the United States National Health Interview Survey (NHIS) (2000, 2005) linked to individual-level mortality outcomes with follow up to December 31, 2011 were used. Variable definitions consistent across the CCHS and NHIS were developed and used to estimate country-specific mortality hazards with sex-specific Cox proportional hazard models, including health behaviours, sociodemographic indicators and proximal factors including disease history. Results A total of 296,407 respondents and 1,813,884 million person-years of follow-up from the CCHS and 62,226 respondents and 497,909 person-years from the NHIS were included. Hazards of smoking, alcohol consumption, diet and physical activity in Canada and the United States are of similar magnitude and direction, with similar dose response relationships. The largest health behaviour mortality hazards were associated with female heavy smokers in both Canada (HR: 3.36, 95% CI: 2.86, 3.95) and the United States (Female HR: 2.63, 95% CI: 2.11, 3.27), compared to non-smokers. Conclusion/Implications Health behaviour mortality hazards are comparable in Canada and the United States, supporting the use of hazards obtained from pooled analyses for population heath. These hazards can replace those obtained from independent epidemiology studies that are often incompletely adjusted, rarely population-based and often not generalizable to the population of interest

Comparison of mortality hazard ratios associated with health behaviours in Canada and the United States:a population-based linked health survey study

Background Modern health surveillance and planning requires an understanding of how preventable risk factors impact population health, and how these effects vary between populations. In this study, we compare how smoking, alcohol consumption, diet and physical activity are associated with all-cause mortality in Canada and the United States using comparable individual-level, linked population health survey data and identical model specifications. Methods The Canadian Community Health Survey (CCHS) (2003–2007) and the United States National Health Interview Survey (NHIS) (2000, 2005) linked to individual-level mortality outcomes with follow up to December 31, 2011 were used. Consistent variable definitions were used to estimate country-specific mortality hazard ratios with sex-specific Cox proportional hazard models, including smoking, alcohol, diet and physical activity, sociodemographic indicators and proximal factors including disease history. Results A total of 296,407 respondents and 1,813,884 million person-years of follow-up from the CCHS and 58,232 respondents and 497,909 person-years from the NHIS were included. Absolute mortality risk among those with a ‘healthy profile’ was higher in the United States compared to Canada, especially among women. Adjusted mortality hazard ratios associated with health behaviours were generally of similar magnitude and direction but often stronger in Canada. Conclusion Even when methodological and population differences are minimal, the association of health behaviours and mortality can vary across populations. It is therefore important to be cautious of between-study variation when aggregating relative effect estimates from differing populations, and when using external effect estimates for population health research and policy development

Evidence for a Paradigm Shift in Preventive Nutrition: Measuring the Role of Dietary Patterns in Chronic Disease Risk in Canada

National nutrition surveys are the cornerstones of nutritional surveillance for developing dietary guidelines and policies. Some recent studies have questioned the usefulness of nutrition surveys due to their methodological limitations. The overall goal of this thesis was to use the Canadian Community Health Survey (CCHS) 2.2 to address these limitations as the first step in population-based dietary pattern analysis, an essential component for development of evidence-based nutritional guidelines and policies. In the first study of this thesis, different methods for handling dietary misreporting were compared and “adjusting for misreporting bias” was identified as the most appropriate technique, which was used in all subsequent studies of this thesis. In the second study, we observed that closer adherence to the only Canadian a priori index, Health Canada’s Surveillance Tool Tier System (HCST) 2014, developed based on the Eating Well with Canada’s Food Guide 2007 (EWCFG) was associated with higher probability of meeting dietary reference intakes (DRI) for nutrients, even though it was not related to obesity risk. These findings were explained in the third study, where the strict focus of the EWCFG on single nutrients, rather than dietary patterns was identified as its main limitation. The first Canadian dietary pattern analyses using energy-based a priori (Study 4) and hybrid (Study 5) techniques were then conducted to address this limitation. Lack of adherence to the recommendations of 2015 Dietary Guidelines for Americans Adherence Index (DGAI), an a priori dietary quality index, and consumption of an energy-dense, high-fat and low-fiber dietary pattern derived from the weighted partial least squares, were associated with 2-3 times higher risk of obesity. Overall, studies in this thesis demonstrate that application of rigorous methodological techniques to survey data can enhance the usefulness of nutrition surveys for capturing the diet-disease relationships and for informing evidence-based national nutrition guidelines and policies.Ph.D.2018-11-30 00:00:0