No available dietary assessment method is without error in measuring dietary intake. This has led to an increased interest in biological markers of dietary intake. This article is a review of the literature investigating whether the concentration of carotenoids in blood can serve as biological markers for the intake of fruit and vegetables. The literature indicates an association between intake of fruit and vegetables and the concentration of total carotenoids, alfa-carotene, beta-carotene, lutein and beta-cryptoxanthin in plasma. The same association was not observed for plasma lycopene. Results from several studies also indicate that plasma alfa-carotene and plasma total carotenoids are more suitable as biological markers of the intake of fruit and vegetables than the other carotenoids. As there are large individual variations in the plasma carotenoid response after intake, carotenoids in blood will be a better marker of intake at group level than individual level. Furthermore, the average value from several measurements of carotenoids in blood will be a better marker of long-term intake than a single measurement. Several factors in addition to fruit and vegetables influence the concentration of carotenoids in blood. It is important to assess these factors when carotenoids in blood are used as biological markers of the intake of fruit and vegetables.
Background/Objectives:A standardized methodology is important to enable consistent monitoring of dietary intake across European countries. For this reason, we evaluated the comparability of the assessment of usual food intake collected with two non-consecutive computerized 24-h dietary recalls (24-HDRs) and a food propensity questionnaire (FPQ) among five European centers.Subjects/Methods:Two 24-HDRs using EPIC-Soft (the software developed to conduct 24-HDRs in the European Prospective Investigation into Cancer and Nutrition (EPIC) Study) were performed to determine fish, fruit and vegetable (FV) consumed by 600 adults in Belgium (BE), the Czech Republic (CZ), France (FR), the Netherlands (NL) and Norway (NO) in a validation study. An FPQ was used to identify non-consumers. Information from the 24-HDRs and FPQ were used to estimate individual usual food intake by the Multiple Source Method (MSM). Blood samples were drawn to determine fatty acids in phospholipids and serum carotenoids as biomarkers of fish, and FV intake, respectively.Results:The pooled correlation between usual fish intake and eicosapentaenoic acid plus docosahexaenoic acid in phospholipids was 0.19 in men and 0.31 in women (P for heterogeneity >0.50) and center-specific correlations ranged between 0.08 (CZ) and 0.28 (BE and NO) in men, and between 0.19 (BE) and 0.55 (FR) in women. For usual FV intake, the pooled correlation with serum carotenoids was 0.31 in men and 0.40 in women (P for heterogeneity >0.10); the center-specific correlations varied between 0.07 (NO) and 0.52 (FR) in men, and between 0.25 (NL) and 0.45 (NO) in women.Conclusion:Two standardized 24-HDRs using EPIC-Soft and an FPQ appeared to be appropriate to rank individuals according to their fish and FV intake in a comparable way among five European centers.
OBJECTIVE: The goals of this study were to investigate whether children and adolescents can accurately estimate portion sizes of preweighed food by viewing photographs of food, and whether age influences the ability to estimate food portion sizes. SUBJECTS: A total of 63 male and female volunteers aged 9-19 y participated in the study. DESIGN: Each participant received a photographic booklet with photograph series of 13 food items. Participants over 10 y of age were asked to estimate portion sizes of food on 34 plates placed in front of them by comparing the different portions to corresponding photographs of food. Younger participants were asked to estimate portion sizes of food on 17 plates by comparing the portions to photographs. RESULTS: Participants made 2019 comparisons between actual food portion sizes and photographs of food portion sizes. On average, 60% of the comparisons were made correctly. A photograph directly adjacent to the photograph depicting the correct portion size was chosen in 35% of the comparisons and 5% of the comparisons were made incorrectly. Portion sizes were estimated more accurately when the actual served portions of food had exactly the same appearance as the foods portrayed in the photographic booklet. No differences existed between children's and adolescents' abilities to estimate portion sizes using photographs. CONCLUSIONS: Large variability may exist in an individual's capability of choosing a photograph that correctly depicts food portion sizes, but the error at the group level is quite small. These data indicate that a photographic booklet of foods can be a useful tool for portion size estimates in these age groups. SPONSORSHIP: The Norwegian Foundation for Health and Rehabilitation through Norwegian Health Association.
During the period 1.1.1967 to 31.12.1986, a total of 34 children with condylomata acuminata were treated in the County Hospitals in Copenhagen. Nineteen of these were treated during the last five years of the period. A retrospective study revealed that 12 of the children were under the age of two years when the condylomata appeared. In eight of these, one or both of the parents had condylomata at the time of the child's birth suggesting that infection of the child may have occurred during delivery. Among the remaining 22 children, a possible source of infection was revealed in only one case. In the children, condylomata were much more frequently localized perianally or anally than in adults. There was no evidence of sexual abuse in any of the children but systematic investigation with this in mind was not undertaken. The finding of condylomata in children raises the suspicion of sexual abuse but does not prove this. Investigation and treatment should, as a rule, be undertaken by a multidisciplinary team preferably in a paediatric department.
The lack of effective school-based interventions for preventing obesity in children has caused a call for longer duration of interventions and better reporting on design and evaluation methodology. The purpose of this paper is to present the development of the intervention, the design of the effectiveness study, and the test-retest reliability of the main outcome measures in the HEalth In Adolescents (HEIA) study.
The HEIA intervention programme was developed based on literature reviews, a social ecological framework, and focus groups. The intervention aimed to increase total physical activity (PA) and consumption of fruit and vegetables and to decrease screen time and consumption of sugar-sweetened beverages. The intervention programme consisted of a classroom component, including dietary behaviour lessons, computer tailoring, fruit/vegetable and PA breaks, and posters, and an environmental component including active transport campaigns, equipment, suggestions for easy improvements of schoolyards, inspirational courses for teachers (all with regards to PA), and fact sheets to parents. The effect of the intervention programme is evaluated in a cluster randomised controlled trial design (intervention = 12 schools, control = 25 schools) including process evaluation. Main outcomes include anthropometry, PA, screen time, and consumption of fruit, vegetables, and sugar-sweetened beverages. A 2-week test- retest study was conducted among 114 pupils. Determinants of the behaviours were assessed. Similar data were collected from parents. Children's PA was measured objectively by accelerometers.
The HEIA study represents a theoretically informed randomised trial comprising a comprehensive set of multilevel intervention components with a thorough evaluation using reliable outcome measures. The study will contribute to a better understanding of determinants of healthy weight development among young people and how such determinants can be modified.
OBJECTIVE: The aim of the nationwide study on dietary behaviour of adolescents was to describe and evaluate dietary habits, and relate that to other lifestyle factors. DESIGN AND SUBJECT: 1564 students in secondary schools completed a self-administered quantitative food frequency questionnaire in a school setting. RESULTS: The questionnaire showed an average energy intake of 15.8 and 9.9 MJ among boys and girls, respectively. Nearly 31% of the energy was supplied by fat and 11.4% by sugar. The average daily intake of micronutrients exceeded the Norwegian recommendations, except for vitamin D and iron in girls. 13.4% of the students had breakfast twice a week or less. These students had a higher percentage of energy from fat and sugar, and a lower intake of micronutrients, than students eating breakfast more often. Students who were daily smokers or fairly inactive had higher energy percentage from fat and sugar and lower intake of fibre, than non-smokers or physically active students. CONCLUSION: Half of the students consumed a diet with too much fat and two-thirds consumed too much sugar as compared to the recommendations. The girls had a diet with a higher nutrient density and a lower fat energy percentage than the boys. Finally, it seemed as if a healthy lifestyle was associated with a healthy diet.
In the interpretation of dietary trends, it is important to consider the potential effect of modifications in the dietary assessment method. Therefore, our objective was to explore the comparability of data obtained at two time points by a semi-quantitative FFQ (SFFQ) which has had slight modifications over time. In the national dietary surveys among Norwegian 2-year-olds, diet was assessed by an SFFQ which underwent modifications between the 1999 survey and the 2007 survey. In the present study, fifty-nine families with a 2-year-old child participated by completing both the SFFQ in a crossover design within a month's time. With regard to the reported intake of energy and nutrients, the largest significant differences observed between the two questionnaires were for carbohydrates and added sugar. According to intake of food groups, significant differences were observed for five out of sixteen food groups. Spearman's correlation coefficients for energy, nutrients and food groups ranged from 0.43 (Ca) to 0.85 (soft drinks). Most Bland-Altman plots indicated broad limits of agreement. The differences between the two questionnaires can be explained by changes in the questionnaires, changes in the food composition databases used and random variation. Comparing differences between the questionnaires by maternal educational level, number of children and type of day care revealed minor differences. In conclusion, this study showed that at the group level there was reasonable comparability between the two questionnaires, except for carbohydrates, added sugar and some food groups. Moreover, there were moderate to high correlations for energy, nutrients and food groups.
Background/Objectives:The aim of this study was to evaluate the estimated energy, nutrient and food intake from the suggested trans-European methodology for undertaking representative dietary surveys among schoolchildren: 2 × 24-h dietary recalls (24-HDRs) combined with a food-recording booklet (FRB), using EPIC-Soft pc-program (the software developed to conduct 24-HDRs in the European Prospective Investigation into Cancer and Nutrition (EPIC) Study), against a 7-day food-record (7-dFR) method among Danish schoolchildren.Subjects/Methods:A total of 74 children aged 7-8 years and 70 children aged 12-13 years were recruited through the Civil Registration System in Denmark. Each child and one of their parents completed two face-to-face 24-HDRs, combined with optional use of a FRB, followed by a 7-day-estimated FR.Results:Energy intake was significantly higher with the 24-HDR method than with the 7-dFR method for both age groups. Mean energy intake was 6% higher for the youngest (P=0.02) and 11% for the oldest children (P=0.01); underreporting of energy occurs among the oldest children, being less present with the 24-HDR method. The intakes of carbohydrate and dietary fiber (absolute and related to energy) were significantly higher with the 24-HDR than with the 7-dFR for both age groups (P
OBJECTIVE: The study was conducted to assess the reproducibility and validity of a 190-item self-administered quantitative food frequency questionnaire, used in a nation-wide study of adolescents. DESIGN AND SUBJECTS: Reproducibility study; 103 11th grade students (18 years) completed the questionnaire twice, with a 6-week interval. Validation study; 49 11th grade students filled in the questionnaire and kept 7-day weighed food records. RESULTS: Spearman rank correlations between the nutrient intakes from the two questionnaires varied from 0.63 (sugar energy percentage) to 0.91 (alcohol). The median coefficient was 0.85. The first questionnaire produced generally higher nutrient intake estimates than the second. Correlations between nutrient intake values from the records and the questionnaire ranged from 0.14 (vitamin D, non-significant, cod liver oil not included) to 0.66 (monounsaturated fatty acids). The median coefficient was 0.52. Adjustment for energy intake did not materially affect the correlations. On average 41% of the subjects were classified in the same quartile in the questionnaire and the records, and 2% in the opposite quartiles. However, the percentage of subjects in the same/opposite quartiles for vitamin D and fibre were 33/12 and 22/6, respectively. CONCLUSIONS: It is concluded that the questionnaire is able to rank subjects according to the tested nutrients, except vitamin D and fibre.