Measuring diet in the 21st century: use of new technologies

The advent of the internet and smartphone technology has allowed dietary assessment to reach the 21st century! The variety of foods available on the supermarket shelf is now greater than ever before. New approaches to measuring diet may help to reduce measurement error and advance our understanding of nutritional determinants of disease. This advance provides the potential to capture detailed dietary data on large numbers of individuals without the need for costly and time-consuming manual nutrition coding. This aim of the present paper is to review the need for new technologies to measure diet with an overview of tools available. The three main areas will be addressed: (1) development of web-based tools to measure diet; (2) use of smartphone apps to self-monitor diet; (3) improving the quality of dietary assessment through development of an online library of tools. A practical example of the development of a web-based tool to assess diet myfood24 (www.myfood24.org) will be given exploring its potential, limitations and challenges. The development of a new food composition database using back-of-pack information will be described. Smartphone apps used to measure diet with a focus on obesity will be reviewed. Many apps are unreliable in terms of tracking, and most are not evaluated. Accurate and consistent measurement of diet is needed for public health and epidemiology. The choice of the most appropriate dietary assessment method tends to rely on experience. The DIET@NET partnership has developed best practice guidelines for selection of dietary assessment tools, which aim to improve the quality, consistency and comparability of dietary data. These developments provide us with a step-change in our ability to reliably characterise food and nutrient intake in population studies. The need for high-quality, validated systems will be important to fully realise the benefits of new technologies

Maternal iron status in early pregnancy and birth outcomes : insights from the Baby's Vascular health and Iron in Pregnancy study

Date of Acceptance: 16/03/2015 Acknowledgements N. A. A. was funded by a Wellcome Trust Research Training Fellowship (WT87789). H. J. M. and H. E. H. are supported by the Scottish Government’s Rural and Environment Science and Analytical Services. N. A. B. S. is supported by Cerebra. The authors’ contributions are as follows: N. A. A. was responsible for organising the study conduct, data collection and database management, performed the statistical analysis, interpreted the results and drafted the paper. N. A. A., N. A. B. S., J. E. C., H. J. M. and D. C. G. contributed to the study concept and design, and interpretation of results. H. J. M. and H. E. H. analysed the laboratory samples. J. E. C. and D. C. G. provided advice on statistical strategy and analysis. All authors have fully participated in the reporting stage and have critically reviewed and approved the final draft of the paper. The authors declare no conflict of interestPeer reviewedPublisher PD

The monetary value of diets consumed by British adults: an exploration into sociodemographic differences in individual-level diet costs

OBJECTIVE: To describe the diet costs of adults in the National Diet and Nutrition Study (NDNS) and explore patterns in costs according to sociodemographic indicators. DESIGN: Cross-sectional diet diary information was matched to a database of food prices to assign a cost to each food or non-alcoholic beverage consumed. Daily diet costs were calculated, as well as costs per 10 MJ to improve comparability across differing energy requirements. Costs were compared between categories of sociodemographic variables and health behaviours. Multivariable regression assessed the effects of each variable on diet costs after adjustment. SETTING: The NDNS is a rolling dietary survey, recruiting a representative UK sample each year. The study features data from 2008-2010. SUBJECTS: Adults aged 19 years or over were included. The sample consisted of 1014 participants. RESULTS: The geometric mean daily diet cost was £2·89 (95 % CI £2·81, £2·96). Energy intake and daily diet cost were strongly associated. The mean energy-adjusted cost was £4·09 (95 % CI £4·01, £4·18) per 10 MJ. Energy-adjusted costs differed significantly between many subgroups, including by sex and household income. Multivariable regression found significant effects of sex, qualifications and occupation (costs per 10 MJ only), as well as equivalized household income, BMI and fruit and vegetable consumption on diet costs. CONCLUSIONS: This is the first time that monetary costs have been applied to the diets of NDNS adults. The findings suggest that certain subgroups in the UK - for example those on lower incomes - consume diets of lower monetary value. Observed differences were mostly in the directions anticipated

Formative evaluation of the usability and acceptability of myfood24 among adolescents: a UK online dietary assessments tool

BackgroundMyfood24 is a new online 24 h dietary assessment tool developed for use among the UK population. Limited information is available on the usability and acceptability of such tools. Hence this study aims to determine the usability and acceptability of myfood24 among British adolescents (11-18y) before and after making the improvements.MethodsA total of 84 adolescents were involved in two stages. In stage-I (beta-version of myfood24), 14 adolescents were recruited, 7 of whom (group-1) were asked to enter standardized tasks in a testing room with screen capture software. The remaining 7-adolescents (group-2) were asked to report their previous food intake using myfood24 at home. All participants then completed a usability and acceptability questionnaire. Stage-II was carried out after making amendments to the live-version of myfood24 in which 70 adolescents were asked to enter their food intake for two days and then complete the same questionnaire. Thematic analysis was conducted of observer comments and open-ended questions.ResultsNavigation, presentation errors and failure to find functions were the main usability issues identified in the beta-version. Significant improvements were found in the usability and acceptability of most functions after implementing certain features like a spell checker, auto-fill option, and adding ‘mouse hover’ to help with the use of some functions. Adolescents’ perceptions of searching food items, selecting food portion sizes and making a list function were significantly improved in the live-version. The mean completion time of myfood24 reduced from 31 (SD?=?6) minutes in the beta-version to 16 (SD?=?5) minutes in the live-version. The mean system usability score (SUS) of myfood24 improved from 66/100 (95 % CI 60, 73) in the beta-version to 74/100 (95 % CI 71, 77) in the live-version, which is considered as ‘good’. Of the adolescents in stage-II, 41 % preferred using myfood24 to the interviewer-administered 24 h recall because myfood24 was quicker, easier to use and provided the adolescents with privacy when reporting dietary intake.ConclusionConsidering adolescents’ feedback has helped in improving the usability and acceptability of the final-version of myfood24. myfood24 appears to support adolescents’ need in reporting their dietary intake, which may potentially improve the overall quality of adolescents’ self-reported dietary information

Impact of school lunch type on nutritional quality of English children's diets.

OBJECTIVE: Nutrient and food standards exist for school lunches in English primary schools although packed lunches brought from home are not regulated. The aim of the present study was to determine nutritional and dietary differences by lunch type. DESIGN: A cross-sectional survey was carried out in 2007 assessing diet using the Child and Diet Evaluation Tool (CADET), a validated 24 h estimated food diary. The data were analysed to determine nutritional and dietary intakes over the whole day by school meal type: school meals and packed lunches. SETTING: Fifty-four primary schools across England. SUBJECTS: Children (n 2709) aged 6-8 years. RESULTS: Children having a packed lunch consumed on average 11·0 g more total sugars (95 % CI 6·6, 15·3 g) and 101 mg more Na (95 % CI 29, 173 mg) over the whole day. Conversely, children having a school meal consumed, on average, 4·0 g more protein (95 % CI 2·3, 5·7 g), 0·9 g more fibre (NSP; 95 % CI 0·5, 1·3 g) and 0·4 mg more Zn (95 % CI 0·1, 0·6 mg). There was no difference in daily energy intake by lunch type. Children having a packed lunch were more likely to consume snacks and sweetened drinks; while children having a school meal were more likely to consume different types of vegetables and drink water over the whole day. CONCLUSIONS: Compared with children having a school meal, children taking a packed lunch to school consumed a lower-quality diet over the whole day, including higher levels of sugar and Na and fewer vegetables. These findings support the introduction of policies that increase school meal uptake

Urinary Deoxynivalenol Is Correlated with Cereal Intake in Individuals from the United Kingdom

Background Deoxynivalenol (DON) is a toxic fungal metabolite that frequently contaminates cereal crops. DON is toxic to animals, but the effects on humans are poorly understood, in part because exposure estimates are of limited precision. Objectives In this study we used the U.K. adult National Diet and Nutrition Survey to compare 24-hr urinary DON excretion with cereal intake. Methods One hundred subjects were identified for each of the following cereal consumption groups: low (mean, 107 g cereal/day; range, 88–125), medium (mean, 179 g/day; range, 162–195) and high (mean, 300 g/day; range, 276–325). DON was analyzed in 24-hr urine samples by liquid chromatography–mass spectrometry after purification on immunoaffinity columns. Results DON was detected in 296 of 300 (98.7%) urine samples. Cereal intake was significantly associated with urinary DON (p < 0.0005), with the geometric mean urinary levels being 6.55 μg DON/day [95% confidence interval (CI), 5.71–7.53]; 9.63 μg/day (95% CI, 8.39–11.05); and 13.24 μg/day (95% CI, 11.54–15.19) for low-, medium-, and high-intake groups, respectively. In multivariable analysis, wholemeal bread (p < 0.0005), white bread (p < 0.0005), “other” bread (p < 0.0005), buns/cakes (p = 0.003), high-fiber breakfast cereal (p = 0.016), and pasta (p = 0.017) were significantly associated with urinary DON. Wholemeal bread was associated with the greatest percent increase in urinary DON per unit of consumption, but white bread contributed approximately twice as much as wholemeal bread to the urinary DON levels because it was consumed in higher amounts. Conclusion The majority of adults in the United Kingdom appear to be exposed to DON, and on the basis of the urinary levels, we estimate that some individuals may exceed the European Union (EU) recommended maximum tolerable daily intake of 1,000 ng DON/kg (bw). This exposure biomarker will be a valuable tool for biomonitoring as part of surveillance strategies and in etiologic studies of DON and human disease risk

Nutrition and the circadian system

The human circadian system anticipates and adapts to daily environmental changes to optimise behaviour according to time of day and temporally partitions incompatible physiological processes. At the helm of this system is a master clock in the suprachiasmatic nuclei (SCN) of the anterior hypothalamus. The SCN are primarily synchronised to the 24-h day by the light/dark cycle; however, feeding/fasting cycles are the primary time cues for clocks in peripheral tissues. Aligning feeding/fasting cycles with clock-regulated metabolic changes optimises metabolism, and studies of other animals suggest that feeding at inappropriate times disrupts circadian system organisation, and thereby contributes to adverse metabolic consequences and chronic disease development. ‘High-fat diets’ (HFD) produce particularly deleterious effects on circadian system organisation in rodents by blunting feeding/fasting cycles. Time-of-day-restricted feeding, where food availability is restricted to a period of several hours, offsets many adverse consequences of HFD in these animals; however, further evidence is required to assess whether the same is true in humans. Several nutritional compounds have robust effects on the circadian system. Caffeine, for example, can speed synchronisation to new time zones after jetlag. An appreciation of the circadian system has many implications for nutritional science and may ultimately help reduce the burden of chronic diseases

Observational assessments of the relationship of dietary and pharmacological treatment on continuous measures of dysglycemia over 24 hours in women with gestational diabetes

Objectives: Studies that use continuous glucose monitoring (CGM) to monitor women with gestational diabetes (GDM), highlight the importance of managing dysglycemia over a 24-hour period. However, the effect of current treatment methods on dysglycemia over 24-hrs are currently unknown. This study aimed to characterise CGM metrics over 24-hrs in women with GDM and the moderating effect of treatment strategy. Methods: Retrospective analysis of CGM data from 128 women with GDM in antenatal diabetes clinics. CGM was measured for 7-days between 30-32 weeks gestation. Non-parametric tests were used to evaluate differences of CGM between periods of day (morning, afternoon, evening, and overnight) and between treatment methods (i.e., diet alone or diet+metformin). Exploratory analysis in a subgroup of 34 of participants was performed to investigate the association between self-reported macronutrient intake and glycaemic control. Results: Glucose levels significantly differed during the day (i.e., morning to evening; P<0.001) and were significantly higher (i.e., mean blood glucose and area under the curve [AUC]) and more variable (i.e., SD and CV) than overnight glucose levels. Morning showed the highest amount of variability (CV; 8.4% vs 6.5%, P<0.001 and SD; 0.49 mmol/L vs 0.38 mmol/L, P<0.001). When comparing treatment methods, mean glucose (6.09 vs 5.65 mmol/L; P<0.001) and AUC (8760.8 vs 8115.1 mmol/L.hr; P<0.001) were significantly higher in diet+metformin compared to diet alone. Finally, the exploratory analysis revealed a favourable association between higher protein intake (+1SD or +92 kcal/day) and lower mean glucose (-0.91 mmol/L p, P=0.02) and total AUC (1209.6 mmol/L.h, P=0.021). Conclusions: Glycemia varies considerably across a day, with morning glycemia demonstrating greatest variability. Additionally, our work supports that individuals assigned to diet+metformin have greater difficulty managing glycemia and results suggest that increased dietary protein may assist with management of dysglycemia. Future work is needed to investigate the benefit of increased protein intake on management of dysglycemia

Sitting time, fidgeting and all-cause mortality in the UK Women's Cohort Study

Introduction: Sedentary behaviours (including sitting) may increase risk of mortality independently of physical activity level. Little is known about how fidgeting behaviours might modify the association. Methods: Data were drawn from the UK Women’s Cohort Study. In 1999/2002, 12,778 women (age 37 to 78) provided data on average daily sitting time, overall fidgeting (irrespective of posture), and a range of relevant covariates including physical activity, diet, smoking status and alcohol consumption. Participants were followed for mortality over a mean of 12 years. Proportional hazards Cox regression models were used to estimate the relative risk of mortality in the high (vs. low) and medium (vs. low) sitting time groups. Results: Fidgeting modified the risk associated with sitting time (p value for interaction = 0.04), leading us to separate groups for analysis. Adjusting for a range of covariates, sitting for 7+ hours/day (vs. <5 hours/day) was associated with 30% increased risk of all-cause mortality (HR = 1.30, 95% CI 1.02, 1.66) only among women in the low fidgeting group. Among women in the high fidgeting group, sitting for 5/6 (vs. <5 hrs/day) was associated with decreased risk of mortality (HR = 0.63, 95% CI 0.43, 0.91), adjusting for a range of covariates. There was no increased risk of mortality from longer sitting time in the middle and high fidgeting groups. Conclusions: Fidgeting may reduce the risk of all-cause mortality associated with excessive sitting time. More detailed and better validated measures of fidgeting should be identified in other studies in order to replicate these findings and identity mechanisms, particularly measures that distinguish fidgeting in a seated from standing posture