Evaluation of brief dietary questions to estimate vegetable and fruit consumption - using serum carotenoids and red-cell folate

Objective To evaluate responses to self-administered brief questions regarding consumption of vegetables and fruit by comparison with blood levels of serum carotenoids and red-cell folate.

Design A cross-sectional study in which participants reported their usual intake of fruit and vegetables in servings per day, and serum levels of five carotenoids (α-carotene, β-carotene, β-cryptoxanthin, lutein/zeaxanthin and lycopene) and red-cell folate were measured. Serum carotenoid levels were determined by high-performance liquid chromatography, and red-cell folate by an automated immunoassay system.

Settings and subjects Between October and December 2000, a sample of 1598 adults aged 25 years and over, from six randomly selected urban centres in Queensland, Australia, were examined as part of a national study conducted to determine the prevalence of diabetes and associated cardiovascular risk factors.

Results Statistically significant (P<0.01) associations with vegetable and fruit intake (categorised into groups: ≤1 serving, 2–3 servings and ≥4 servings per day) were observed for α-carotene, β-carotene, β-cryptoxanthin, lutein/zeaxanthin and red-cell folate. The mean level of these carotenoids and of red-cell folate increased with increasing frequency of reported servings of vegetables and fruit, both before and after adjusting for potential confounding factors. A significant association with lycopene was observed only for vegetable intake before adjusting for confounders.

Conclusions These data indicate that brief questions may be a simple and valuable tool for monitoring vegetable and fruit intake in this population.

Food and activity in out of school hours care in Victoria

Objective: To describe characteristics of the Victorian out of school hours care (OSHC) sector to assess its potential role in promoting healthy lifestyles to children and their families.

Design: Written questionnaires were sent to 1100 Victorian OSHC programs to collect information about the services, foods and activities offered to children, the training and resources utilised by staff and the type of information sent home to parents/guardians.

Subjects: A total of 426 Victorian OSHC coordinators completed questionnaires in the present descriptive study (39% response rate).

Setting: Out of school hours care provides care for 5–12 years olds before school, after school and/or during school holidays.

Results: Over 80% of coordinators reported offering fruit, breads, cereals, and milk and dairy products. One-third offer vegetables as part of meals or snacks. One-third reported offering cakes, biscuits and/or slices, and chips and/or pastries. About 17% reported offering water, whereas 24% reported offering cordial/soft drinks and fruit juice. Cooking was offered as an after-school activity by about half of those surveyed. Active games were common (62%) as were indoor active games and sports (36%). Sedentary activities were also commonplace (37–51%). Only about 30% of OSHC coordinators had participated in nutrition and/or physical activity training in the previous two years. Few OSHC programs sent home health information to parents/guardians.

Conclusion and application: Opportunities exist to help Victorian OSHC programs with nutrition and physical activity information, resources and training. Although the findings of the present study are specific to Victoria, they highlight the potential role of the growing OSHC sector to help improve the health of Australian children.

A provisional database for the silicon content of foods in the United Kingdom

Si may play an important role in bone formation and connective tissue metabolism. Although biological interest in this element has recently increased, limited literature exists on the Si content of foods. To further our knowledge and understanding of the relationship between dietary Si and human health, a reliable food composition database, relevant for the UK population, is required. A total of 207 foods and beverages, commonly consumed in the UK, were analysed for Si content. Composite samples were analysed using inductively coupled plasma–optical emission spectrometry following microwave-assisted digestion with nitric acid and H2O2. The highest concentrations of Si were found in cereals and cereal products, especially less refined cereals and oat-based products. Fruit and vegetables were highly variable sources of Si with substantial amounts present in Kenyan beans, French beans, runner beans, spinach, dried fruit, bananas and red lentils, but undetectable amounts in tomatoes, oranges and onions. Of the beverages, beer, a macerated whole-grain cereal product, contained the greatest level of Si, whilst drinking water was a variable source with some mineral waters relatively high in Si. The present study provides a provisional database for the Si content of UK foods, which will allow the estimation of dietary intakes of Si in the UK population and investigation into the role of dietary Si in human health.

Dietary intakes and food sources of Omega-6 and Omega-3 polyunsaturated fatty acids.

Both n−6 and n−3 polyunsaturated fatty acids (PUFA) are recognized as essential nutrients in the human diet, yet reliable data on population intakes are limited. The aim of the present study was to ascertain the dietary intakes and food sources of individual n−6 and n−3 PUFA in the Australian population. An existing database with fatty acid composition data on 1690 foods was updated with newly validated data on 150 foods to estimate the fatty acid content of foods recorded as eaten by 10,851 adults in the 1995 Australian National Nutrition Survey. Average daily intakes of linoleic (LA), arachidonic (AA), α-linolenic (LNA), eicosapentaenoic (EPA), docosapentaenoic (DPA), and docosahexaenoic (DHA) acids were 10.8, 0.052, 1.17, 0.056, 0.026, and 0.106 g, respectively, with longchain (LC) n−3 PUFA (addition of FPA, DPA, and DHA) totaling 0.189 g; median intakes were considerably lower (9.0 g LA, 0.024 g AA, 0.95 g LNA, 0.008 g EPA, 0.006 g DPA, 0.015 g DHA, and 0.029 g LC n−3 PUFA). Fats and oils, meat and poultry, cereal-based products and cereals, vegetables, and nuts and seeds were important sources of n−6 PUFA, while cereal-based products, fats and oils, meat and poultry, cereals, milk products, and vegetable products were sources of LNA. As expected, seafood was the main source of LC n−3 PUFA, contributing 71%, while meat and eggs contributed 20 and 6%, respectively. The results indicate that the majority of Australians are failing to meet intake recommendations for LC n−3 PUFA (>0.2 g per day) and emphasize the need for strategies, to increase the availability and consumption of n−3-containing foods.

An index of diet and eating patterns is a valid measure of diet quality in an Australian population

Diet indices represent an integrated approach to assessing eating patterns and behaviors. The aim of this study was to develop a comprehensive food-based dietary index to reflect adherence to healthy eating recommendations, evaluate the construct validity of the index using nutrient intakes, and evaluate this index in relation to sociodemographic factors, health behaviors, risk factors, and self-assessed health status. Data were analyzed from adult participants of the Australian National Nutrition Survey who completed a 108-item FFQ and a food habits questionnaire (n = 8220). The dietary guideline index (DGI) consisted of 15 items reflecting the dietary guidelines, including dietary indicators of vegetables and legumes, fruit, total cereals, meat and alternatives, total dairy, beverages, sodium, saturated fat, alcoholic beverages, and added sugars. Diet quality was incorporated using indicators relating to whole-grain cereals, lean meat, reduced/low fat dairy, and dietary variety. We investigated associations between the DGI score, sociodemographic factors, health behaviors, chronic disease risk factors, and nutrient intakes. We found associations between the DGI scores and sex, age, income, area-level socioeconomic disadvantage, smoking, physical activity, waist:hip ratio, systolic blood pressure (males only), and self-assessed health status (females only) (all P < 0.05). Higher DGI scores were associated with lower intakes of energy, total fat, and saturated fat and higher intakes of fiber, β-carotene, vitamin C, folate, calcium, and iron (P < 0.05). This food-based dietary index is able to discriminate across a variety of sociodemographic factors, health behaviors, and self-assessed health and reflects intakes of key nutrients.

Dietary patterns of adolescents and risk of obesity and hypertension

Increasingly, measures of dietary patterns have been used to capture the complex nature of dietary intake and investigate its association with health. Certain dietary patterns may be important in the prevention of chronic disease; however, there are few investigations in adolescents. The aim of this study was to describe the dietary patterns of adolescents and their associations with sociodemographic factors, nutrient intakes, and behavioral and health outcomes. Analysis was conducted using data collected in the 1995 Australian National Nutrition Survey of participants aged 12–18 y who completed a 108-item FFQ (n = 764). Dietary patterns were identified using factor analysis and associations with sociodemographic factors and behavioral and health outcomes investigated. Factor analysis revealed 3 dietary patterns labeled a fruit, salad, cereals, and fish pattern; a high fat and sugar pattern; and a vegetables pattern, which explained 11.9, 5.9, and 3.9% of the variation in food intakes, respectively. The high fat and sugar pattern was positively associated with being male (P < 0.001), the vegetables pattern was positively associated with rural region of residence (P = 0.004), and the fruit, salad, cereals, and fish pattern was inversely associated with age (P = 0.03). Dietary patterns were not associated with socioeconomic indicators. The fruit, salad, cereals, and fish pattern was inversely associated with diastolic blood pressure (P = 0.0025) after adjustment for age, sex, and physical activity in adolescents ≥16 y. This study suggests that specific dietary patterns are already evident in adolescence and a dietary pattern rich in fruit, salad, cereals, and fish pattern may be associated with diastolic blood pressure in older adolescents.

Is a healthy diet affordable and accessible in the city of Yarra, Victoria Australia? An analysis of cost disparity and nutritional choices

This study aimed to examine cost disparity and nutritional choices within the
City of Yarra (Yarra), targeting three suburbs that have low- and high-rise
estates: Richmond, Fitzroy, and Collingwood. The healthy food basket
(HFB) was modeled on the Queensland Healthy Food Access Basket for a
six-person family for a fortnight and was constructed to include food items
that are common to ethnic groups living in Yarra. The HFB food item costs
were sampled across 29 food outlets in Yarra. The average cost of HFB per fortnight
for a family of six was significantly lower in Richmond (Mean = $419.26)
than in Collingwood (Mean = $519.28) and in Fitzroy (Mean = $433.98). While
costs for cereal groups, dairy, meats and alternatives, and non-core were
comparable across the suburbs, significant differences were noticed for fruit,
legumes and vegetables. Geographic location alone explained 54% of the
variance in HFB price (F_2,26 = 15.23, p < 0.001) and 32.7% in the variance of
fruit, vegetable and legumes (F_2,26 = 7.72, p < 0.001). The effect of geographic
location remained consistent after controlling for the type of food
outlets. The type of food outlets had a non-significant effect on the variance
of prices. Richmond had a greater number variety of fruit, vegetables, and
legumes (F_{2, 26} = 5.7, p < 0.01) and an overall lower number of missing items
(F_{2, 26} = 3.9, p < 0.05) than Collingwood and Fitzroy. The diversity of food
available in the three suburbs was more likely to reflect the Vietnamese,
Chinese and East-Timorese shopping pattern than the rest of other ethnic

Is the perception of time pressure a barrier to healthy eating and physical activity among women?

Objectives To describe the proportion of women reporting time is a barrier to healthy eating and physical activity, the characteristics of these women and the perceived causes of time pressure, and to examine associations between perceptions of time as a barrier and consumption of fruit, vegetables and fast food, and physical activity.
Design A cross-sectional survey of food intake, physical activity and perceived causes of time pressure.
Setting A randomly selected community sample.
Subjects A sample of 1580 women self-reported their food intake and their perceptions of the causes of time pressure in relation to healthy eating. An additional 1521 women self-reported their leisure-time physical activity and their perceptions of the causes of time pressure in relation to physical activity.
Results Time pressure was reported as a barrier to healthy eating by 41 % of the women and as a barrier to physical activity by 73 %. Those who reported time pressure as a barrier to healthy eating were significantly less likely to meet fruit, vegetable and physical activity recommendations, and more likely to eat fast food more frequently.
Conclusions Women reporting time pressure as a barrier to healthy eating and physical activity are less likely to meet recommendations than are women who do not see time pressure as a barrier. Further research is required to understand the perception of time pressure issues among women and devise strategies to improve women’s food and physical activity behaviours.

An evaluation of the reported sodium content of Australian food products

We assessed the sodium content of Australian food items, trends over time and compared this content with sodium targets established by the UK Food Standards Agency and that of similar food items in the UK. The sodium content indicated on food labels were collected from 2005 to 2007. Fifty-three percent of food products had sodium levels above the targets. Food sub-categories containing <20% of products meeting the targets were white bread, wholemeal bread, cream cheese, low fibre breakfast cereal, savoury snack biscuits, hot dogs, sausages, canned soup, canned beans and spaghetti and canned vegetables. There was an indication that Australia had a lower number of food products that met the sodium targets compared to the UK (46% vs. 56%) and over half remain above the recommended target. A reduction in the sodium content of bread, low fibre breakfast cereals, and a number of processed snack, meat and canned goods is needed to reduce the average salt intake to 6 g day⁻¹.

Children's fruit and vegetable intake : Associations with the neighbourhood food environment

Objective : To examine associations between availability of different types of food outlets and children's fruit and vegetable intake.
Method : Parents of 340 5–6 and 461 10–12 year-old Australian children reported how frequently their child ate 14 fruits and 13 vegetables in the last week in 2002/3. A geographic information system (GIS) was used to determine the availability of the following types of food outlets near home: greengrocers; supermarkets; convenience stores; fast food outlets; restaurants, cafés and takeaway outlets. Logistic regression analyses examined the likelihood of consuming fruit ≥ 2 times/day and vegetables ≥ 3 times/day, according to access to food outlets.
Results : Overall, 62.5% of children ate fruit ≥ 2 times/day and 46.4% ate vegetables ≥ 3 times/day. The more fast food outlets (OR = 0.82, 95%CI = 0.67–0.99) and convenience stores (OR = 0.84, 95%CI = 0.73–0.98) close to home, the lower the likelihood of consuming fruit ≥ 2 times/day. There was also an inverse association between density of convenience stores and the likelihood of consuming vegetables ≥ 3 times/day (OR = 0.84, 95%CI = 0.74–0.95). The likelihood of consuming vegetables ≥ 3 times/day was greater the farther children lived from a supermarket (OR = 1.27, 95%CI = 1.07–1.51) or a fast food outlet (OR = 1.19, 95%CI = 1.06–1.35).
Conclusion : Availability of fast food outlets and convenience stores close to home may have a negative effect on children's fruit and vegetable intake.

Takeaway food consumption, diet quality and abdominal obesity in young adults

Background - Takeaway food consumption is associated with a higher BMI and poorer diet quality in the USA but little is known about the association in Australians.
Objective - To examine if takeaway food consumption is associated with abdominal obesity and poorer diet quality in young Australian adults.
Design - A national sample of 1,277 men and 1,585 women aged 26-36 completed a self-administered questionnaire on demographic and lifestyle factors, a 127 item food frequency questionnaire, and usual frequency of fruit, vegetable and takeaway food consumption. Dietary intake was compared with the dietary recommendations of the Australian Guide to Healthy Eating. A pedometer was worn for seven days. Waist circumference was measured and moderate abdominal obesity was defined as ≥94 cm for men and ≥80 cm for women. Prevalence ratios (PR) were calculated using log binomial regression with eating takeaway food once a week or less as the reference group.
Outcomes - Consumption of takeaway food twice a week or more was reported by more men (37.9%) than women (17.7%). Participants eating takeaway food at least twice a week were less likely to meet the guidelines for vegetables (P<0.05 men and women), fruit (P<0.001 men and women), dairy (P<0.01 men and women), extra foods (P=0.001 men and women), breads and cereals (P<0.05 men only), lean meats and alternatives (P<0.05 women only) and overall met significantly fewer dietary guidelines (P<0.001 men and women) than participants eating takeaway less than twice per week. After adjusting for confounding variables (age, physical activity, TV viewing, and employment status) consuming takeaway food twice a week or more was associated with a 31% higher prevalence of moderate abdominal obesity in men (PR 1.31; 95% CI: 1.07, 1.61) and a 25% higher prevalence in women (PR 1.25; 95% CI: 1.04, 1.50).
Conclusion - Eating takeaway food twice a week or more was associated with poorer diet quality and a higher prevalence of moderate abdominal obesity in both young men and young women.

Dietary portfolio approach to reducing the risk of cardiovascular disease : the polymeal revisited

Aims: The Polymeal was first proposed as a 'tastier and safer' alternative to a polypharmacy approach to cardiovascular disease risk reduction. The present study aimed to examine the affordability of the Polymeal, and to propose modifications based on economic considerations, and the latest scientific evidence, to achieve consistency with current public health recommendations.

Methods: Prices for each food component specified in the Polymeal were obtained from a major and independent supermarket chain in a representative middle socioeconomic demographic region of metropolitan Melbourne, Australia. Items included fish (114 g, four times/week), fruits and vegetables (400 g/day), dark chocolate (100 g/day), garlic (2.7 g/day), almonds (68 g/day) and red wine (150 mL/day). Prices were calculated using an average of the major brands, or the most commonly eaten fruits, vegetables or fish. Modifications of the Polymeal were proposed based on published research and public health recommendations since the Polymeal was first proposed.

Results: Average price of the Polymeal was AU$11.89 per day falling to AU$8.46 if the cheapest food items were chosen. Modifications to the Polymeal included: consuming fish oil capsules instead of fish, reduction in the quantity of dark chocolate and removal of red wine. These modifications halved the cost of the Polymeal, while choosing the cheapest food items further lowered the cost to AU$3.49 per day. Modification of the Polymeal gave substantial reductions in both energy and saturated fat (51% and 84%, respectively).

Conclusion: The modified Polymeal is a more affordable variation of the Polymeal, which takes into account current scientific evidence and public health recommendations.

Weight, physical activity and dietary behavior change in young mothers : short term results of the HeLP-her cluster randomized controlled trial

Background
Preventing weight gain rather than treating established obesity is an important economic and public health response to the rapidly increasing rates of obesity worldwide. Treatment of established obesity is complex and costly requiring multiple resources. Preventing weight gain potentially requires fewer resources to reach broad population groups, yet there is little evidence for successful interventions to prevent weight gain in the community. Women with children are an important target group because of high rates of weight gain and the potential to influence the health behaviors in family members.

Methods
The aim of this cluster randomized controlled trial was to evaluate the short term effect of a community-based self-management intervention to prevent weight gain. Two hundred and fifty mothers of young children (mean age 40 years ± 4.5, BMI 27.9 kg/m2 ± 5.6) were recruited from the community in Melbourne, Australia. The intervention group (n = 127) attended four interactive group sessions over 4 months, held in 12 local primary schools in 2006, and was compared to a group (n = 123) receiving a single, non-interactive, health education session. Data collection included self-reported weight (both groups), measured weight (intervention only), self-efficacy, dietary intake and physical activity.

Results
Mean measured weight decreased significantly in the intervention group (-0.78 kg 95% CI; -1.22 to -0.34, p < 0.001). Comparing groups using self-reported weight, both the intervention and comparison groups decreased weight, -0.75 kg (95% CI; -1.57 to 0.07, p = 0.07) and -0.72 kg (95% CI; -1.59 to 0.14 p = 0.10) respectively with no significant difference between groups (-0.03 kg, 95% CI; -1.32 to 1.26, p = 0.95). More women lost or maintained weight in the intervention group. The intervention group tended to have the greatest effect in those who were overweight at baseline and in those who weighed themselves regularly. Intervention women who rarely self-weighed gained weight (+0.07 kg) and regular self-weighers lost weight (-1.66 kg) a difference of -1.73 kg (95% CI; -3.35 to -0.11 p = 0.04). The intervention reported increased physical activity although the difference between groups did not reach significance. Both groups reported replacing high fat foods with low fat alternatives and self-efficacy deteriorated in the comparison group only.

Conclusion
Both a single health education session and interactive behavioral intervention will result in a similar weight loss in the short term, although more participants in the interactive intervention lost or maintained weight. There were small non-significant changes to physical activity and changes to fat intake specifically replacing high fat foods with low fat alternatives such as fruit and vegetables. Self-monitoring appears to enhance weight loss when part of an intervention.

Takeaway food consumption and its associations with diet quality and abdominal obesity : a cross-sectional study of young adults

Background : Few studies have investigated the associations of takeaway food consumption with overall diet quality and abdominal obesity. Young adults are high consumers of takeaway food so we aimed to examine these associations in a national study of young Australian adults.

Methods : A national sample of 1,277 men and 1,585 women aged 26–36 completed a self-administered questionnaire on demographic and lifestyle factors, a 127 item food frequency questionnaire, usual daily frequency of fruit and vegetable consumption and usual weekly frequency of takeaway food consumption. Dietary intake was compared with the dietary recommendations from the Australian Guide to Healthy Eating. Waist circumference was measured for 1,065 men and 1,129 women. Moderate abdominal obesity was defined as ≥ 94 cm for men and ≥ 80 cm for women. Prevalence ratios (PR) were calculated using log binomial regression. Takeaway food consumption was dichotomised, with once a week or less as the reference group.

Results : Consumption of takeaway food twice a week or more was reported by more men (37.9%) than women (17.7%, P < 0.001). Compared with those eating takeaway once a week or less, men eating takeaway twice a week or more were significantly more likely to be single, younger, current smokers and spend more time watching TV and sitting, whereas women were more likely to be in the workforce and spend more time watching TV and sitting. Participants eating takeaway food at least twice a week were less likely (P < 0.05) to meet the dietary recommendation for vegetables, fruit, dairy, extra foods, breads and cereals (men only), lean meat and alternatives (women only) and overall met significantly fewer dietary recommendations (P < 0.001). After adjusting for confounding variables (age, leisure time physical activity, TV viewing and employment status), consuming takeaway food twice a week or more was associated with a 31% higher prevalence of moderate abdominal obesity in men (PR: 1.31; 95% CI: 1.07, 1.61) and a 25% higher prevalence in women (PR: 1.25; 95% CI: 1.04, 1.50).

Conclusion : Eating takeaway food twice a week or more was associated with poorer diet quality and a higher prevalence of moderate abdominal obesity in young men and women.

Food patterns associated with blood lipids are predictive of coronary heart disease : the Whitehall II study

Analysis of the epidemiological effects of overall dietary patterns offers an alternative approach to the investigation of the role of diet in CHD. We analysed the role of blood lipid-related dietary patterns using a two-step method to confirm the prospective association of dietary pattern with incident CHD. Analysis is based on 7314 participants of the Whitehall II study. Dietary intake was measured using a 127-item FFQ. Reduced rank regression (RRR) was used to derive dietary pattern scores using baseline serum total and HDL-cholesterol, and TAG levels as dependent variables. Cox proportional hazard regression was used to confirm the association between dietary patterns and incident CHD (n 243) over 15 years of follow-up. Increased CHD risk (hazard ratio (HR) for top quartile: 2·01 (95 % CI 1·41, 2·85) adjusted for age, sex, ethnicity and energy misreporting) was observed with a diet characterised by high consumption of white bread, fried potatoes, sugar in tea and coffee, burgers and sausages, soft drinks, and low consumption of French dressing and vegetables. The diet-CHD relationship was attenuated after adjustment for employment grade and health behaviours (HR for top quartile: 1·81; 95 % CI 1·26, 2·62), and further adjustment for blood pressure and BMI (HR for top quartile: 1·57; 95 % CI 1·08, 2·27). Dietary patterns are associated with serum lipids and predict CHD risk after adjustment for confounders. RRR identifies dietary patterns using prior knowledge and focuses on the pathways through which diet may influence disease. The present study adds to the evidence that diet is an important risk factor for CHD.