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Objective:To evaluate the impact of a multi-level, multi-component (MLMC) adult obesity intervention on beverage intake in Native American adults living in five geographically and culturally diverse tribal communities.Design:A 14-month, community-randomised, MLMC design was utilised, with three communities randomised to Intervention and two communities randomised to Comparison. FFQ were administered pre- and post-interventions, and difference-in-differences (DiD) analysis was used to assess intervention impact on beverage intake.Setting:The intervention took place within food stores, worksites, schools and selected media outlets located in the five communities. Key activities included working with store owners to stock healthy beverages, display and dispersal of educational materials, support of policies that discouraged unhealthy beverage consumption at worksites and schools and taste tests.Participants:Data were collected from 422 respondents between the ages of 18 and 75 living in the five communities pre-intervention; of those, 299 completed post-intervention surveys. Only respondents completing both pre- and post-intervention surveys were included in the current analysis.Results:The DiD for daily servings of regular, sugar-sweetened soda from pre- to post-intervention was significant, indicating a significant decrease in Intervention communities (P < 0·05). No other changes to beverage intake were observed.Conclusions:Large, MLMC obesity interventions can successfully reduce the intake of regular, sugar-sweetened soda in Native American adults. This is important within modern food environments where sugar-sweetened beverages are a primary source of added sugars in Native American diets.

ObjectiveTrinidad and Tobago has experienced an epidemiological transition over recent decades characterised by reduced rates of communicable diseases but rapidly increasing rates of obesity and non-communicable chronic diseases. The objective of the present study was to investigate the changes in energy and nutrient supply that have taken place in Trinidad and Tobago between 1961 and 2007.DesignFood balance sheets for each year between 1961 and 2007 were downloaded from the FAOSTAT database and daily per capita supply for seventeen food commodity groupings was calculated. After appropriate coding, energy and nutrient supply were determined using dietary analysis software.SettingFAO food balance sheets for Trinidad and Tobago from 1961 to 2007.SubjectsNone.ResultsThe food supply in 2007 provided an extra 1561 kJ (373 kcal)/capita per d than it did in 1961. Energy from carbohydrate as a percentage of total energy fell from 62 % in 1961 to 57 % in 2007, whereas energy from fat as a percentage of total energy increased from 26 % to over 30 % and now lies at the upper end of WHO recommendations. Sugars increased from 20 % to over 26 % of total energy and are well above WHO recommendations. When expressed on a nutrient density basis, supplies of vitamin A, folate and Ca are lower than WHO recommendations.ConclusionsNutritional imbalances in the Trinidadian food supply need to be addressed to combat the rise in nutrition-related chronic disease that is projected to cause increased disability and premature death in the country in the coming years.

ObjectiveTo assess the validity of a 161-item quantitative FFQ (QFFQ) that was developed to evaluate dietary risk factors for a colorectal adenoma case–control study.DesignA cross-sectional validation study of the QFFQ against 4 d food diary using Pearson correlation coefficients, cross-classification, weighted κ statistics and Bland–Altman plotting.SettingTwo hospitals in São Paulo, Brazil.SubjectsNinety-seven healthy Japanese-Brazilian adults (40–75 years) were recruited. One participant was excluded from the analysis due to unusual energy intake report.ResultsMean daily nutrient intakes from the QFFQ were higher than from the food diary. The mean Pearson correlation coefficient for nutrient intakes between the QFFQ and the average of the 4 d food diary was 0·43, and increased to 0·45 after correcting correlations for attenuation due to residual day-to-day variation in the food diary measurements. Adjustment for total energy and further adjustment for age and gender decreased the correlation; however, 77 % of observations remained in the same or adjacent quartiles with a mean weighted κ of 0·22. Bland–Altman plots on loge-transformed data showed no linear trend between the differences and means for energy, fat, protein, total folate and vitamin C. Compared with the food diary, the QFFQ showed consistently reasonable performance for dietary fibre, total folate, retinol, riboflavin and vitamin C.ConclusionsThis investigation supports the relative validity of the QFFQ as a method for assessing long-term dietary intake. The instrument will be a useful tool in the analysis of diet–adenoma associations in the case–control study.

ObjectiveTo compare dietary intake and quality among adult Inuit by smoking status.DesignA cross-sectional study using data from a validated quantitative FFQ.SettingThree isolated communities in Nunavut, Canada.SubjectsAdult Inuit (n208), aged between 19 and 79 years, from randomly selected households.ResultsAverage energy intake did not differ between male smokers (n22) and non-smokers (n14; 16 235 kJ and 13 503 kJ;P= 0·18), but was higher among female smokers (n126) compared with non-smokers (n46; 12 704 kJ and 8552 kJ;P< 0·0001). Average daily nutrient intakes were similar among men and higher among female smokers compared with non-smokers for all nutrients (P≤ 0·05) exceptn-3 fatty acids, vitamin A, vitamin D and Se. Female smokers had lower intake densities of thiamin, niacin, vitamin B6, folate, Mg, Na (P≤ 0·05), protein,n-3 fatty acids, cholesterol, Fe (P≤ 0·01), vitamin B12and Se (P≤ 0·001). Between 20 % and 50 % of male and female smokers were below the Dietary Reference Intake (DRI) for Ca, folate, Mg and vitamins A and K, and more than 50 % were below the DRI for fibre and vitamin E. The proportion of smokers below the DRI was lower for all nutrients, except fibre and folate among men. Among smokers, non-nutrient-dense foods and traditional foods contributed less to energy (−2·1 % and −2·0 %, respectively).ConclusionsAdult smokers consumed fewer nutrient-dense, traditional foods, but had increased energy intake, which likely contributed to fewer dietary inadequacies compared with non-smokers. Promoting traditional food consumption supplemented with market-bought fruits and vegetables is important to improve dietary quality, especially among smokers.

ObjectivesTo characterize dietary intake for Navajo adults, to identify foods for a nutritional intervention programme and to develop a culturally appropriate quantitative FFQ (QFFQ) for evaluating the impact of the intervention programme.DesignA cross-sectional study was conducted using 24 h dietary recalls.SettingNavajo Nation, USA.SubjectsSeventy-nine (forty men, thirty-nine women) aged 18–71 years completed 24 h dietary recalls.ResultsThe median daily energy intake was 11 585 kJ (2769 kcal) for men and 8519 kJ (2036 kcal) for women. The greatest contributors to energy were fried potato dishes, sweetened juices/drinks, regular pop, bread, tortillas and burritos (contributing approximately 30 % of total energy intake). The mean number of meat servings was over twice that recommended (2–3 servings recommendedv. 7·4 consumed by men and 5·3 by women). The mean servings of vegetables were well below the recommendation of 3–5 servings (1·0 serving for men and 1·2 servings for women). The final QFFQ contains 177 food and drink items.ConclusionsOur study found that major contributors to total energy, fat and sugar intakes in the Navajo Nation included mostly processed meats and sweetened drinks. A nutritional intervention will target these foods and promote acceptable and healthier alternatives. In addition, we were able to identify foods and beverages for inclusion on a culturally appropriate QFFQ to assess dietary intake. This QFFQ will be used to evaluate the effectiveness of our intervention on food and food group consumption and nutrient intake.

ObjectiveWhile corner store-based nutrition interventions have emerged as a potential strategy to increase healthy food availability in low-income communities, few evaluation studies exist. We present the results of a trial in Baltimore City to increase the availability and sales of healthier food options in local stores.DesignQuasi-experimental study.SettingCorner stores owned by Korean-Americans and supermarkets located in East and West Baltimore.SubjectsSeven corner stores and two supermarkets in East Baltimore received a 10-month intervention and six corner stores and two supermarkets in West Baltimore served as comparison.ResultsDuring and post-intervention, stocking of healthy foods and weekly reported sales of some promoted foods increased significantly in intervention stores compared with comparison stores. Also, intervention storeowners showed significantly higher self-efficacy for stocking some healthy foods in comparison to West Baltimore storeowners.ConclusionsFindings of the study demonstrated that increases in the stocking and promotion of healthy foods can result in increased sales. Working in small corner stores may be a feasible means of improving the availability of healthy foods and their sales in a low-income urban community.

ObjectiveTo demonstrate how dietary data collected from 24-hour dietary recalls were incorporated into the development of a quantitative food-frequency questionnaire (QFFQ) for the Apache in Arizona.DesignA cross-sectional study was first conducted using 24-hour dietary recalls to identify foods for inclusion on a QFFQ that would be used to evaluate a nutrition intervention.SettingThe White Mountain and San Carlos Apache reservations in East-central Arizona.SubjectsThe 24-hour dietary recalls were collected from a random sample of 53 adults (34 women and 19 men).ResultsA QFFQ was developed that included all foods reported by two or more respondents, plus traditional and seasonal foods. Portion size was assessed using familiar household units and culturally appropriate food models. The final instrument contains 155 foods. Frequency of consumption is assessed using eight categories ranking from ‘never or less than once a month’ to ‘2 or more times a day’. Nutrient intakes and the five major food sources of energy, fat and sugar are presented.ConclusionThe QFFQ developed is complete and up-to-date for assessing usual food and nutrient intake for the Apache in Arizona. The instrument will be used to evaluate a food store-based nutrition intervention to reduce risk of chronic diseases.

ObjectivesTo determine the relationship of diet to overweight and obesity among populations of African origin.Design and settingCross-sectional data were obtained from adults aged 25–74 years in rural Cameroon (n = 686), urban Cameroon (n = 975), Jamaica (n = 924) and Afro-Caribbeans in the UK (n = 257). Dietary data were collected using food-frequency questionnaires specifically designed for each site. Body mass index (BMI) was used as a measure of overweight.ResultsThe expected gradient in the distribution of overweight across sites was seen in females (rural Cameroon, 9.5%; urban Cameroon, 47.1%; Jamaica, 63.8%; UK, 71.6%); however, among males overweight was less prevalent in Jamaica (22.0%) than urban Cameroon (36.3%). In developing countries increased risks of overweight (BMI ≥ 25 kg m− 2) were influenced by higher energy (urban Cameroonian men) and protein (Jamaican women) intakes. No dietary variables were associated with obesity (BMI ≥ 30 kg m− 2) in Cameroon or Jamaica. In the UK, energy intakes were inversely related with overweight whereas increased risks of being overweight were associated with higher protein (men) and fat (women) intakes. Similarly, whereas higher protein and fat intakes in UK men and women were associated with obesity, carbohydrate intakes were associated with decreased risks of obesity in men.ConclusionsDiet and overweight were associated in the UK but few dietary variables were related to overweight in Jamaica and the Cameroon. These findings suggest that associations between diet and overweight/obesity are not generalisable among populations.

ObjectiveTo examine how factors related to the home food environment and individual characteristics are associated with healthy food purchasing among low-income African American (AA) youth.SubjectsA total of 206 AA youth (ninety-one boys and 115 girls), aged 10–14 years, and their primary adult caregivers.SettingFourteen Baltimore recreation centres in low-income neighbourhoods.DesignCross-sectional study. We collected information about food purchasing, the home food environment, sociodemographic and psychosocial factors drawn from social cognitive theory. Multivariable logistic regression was used to examine the factors associated with the frequency and proportion of healthy food purchases in all youth and stratified by gender. Low-fat or low-sugar foods were defined as healthy.ResultsYouth purchased an average of 1·5 healthy foods (range = 0–15) in the week before the interview, comprising an average of 11·6 % (range = 0–80 %) of total food purchases. The most commonly purchased healthy foods included water and sunflower seeds/nuts. Healthier food-related behavioural intentions were associated with a higher frequency of healthy foods purchased (OR = 1·4, P < 0·05), which was stronger in girls (OR = 1·9, P < 0·01). Greater caregiver self-efficacy for healthy food purchasing/preparation was associated with increased frequency of healthy purchasing among girls (OR = 1·3, P < 0·05). Among girls, more frequent food preparation by a family member (OR = 6·6, P < 0·01) was associated with purchasing a higher proportion of healthy foods. No significant associations were observed for boys.ConclusionsInterventions focused on AA girls should emphasize increasing food-related behavioural intentions. For girls, associations between caregiver self-efficacy and home food preparation suggest the importance of the caregiver in healthy food purchasing.

OBJECTIVE: To assess the validity of a 148-item quantitative FFQ (QFFQ) that was developed for the Barbados National Cancer Study (BNCS) to determine dietary intake over 12 months and examine the dietary risk factors. DESIGN: A cross-sectional validation study of the QFFQ against 4 d food diaries. Spearman's rank correlations (ρ), intra-class correlation coefficients (ICC) and weighted κ were computed as measures of concordance, adjusting for daily variations in the food diaries. Cross-classification tables and Bland-Altman plots were created for further assessment. SETTING: BNCS is a case-control study of environmental risk factors for breast and prostate cancer in a predominantly African-origin population in Barbados. SUBJECTS: Fifty-four individuals (21 years and older) were recruited among controls in the BNCS who were frequency-matched on sex and age group to breast and prostate cancer cases. RESULTS: Similar mean daily energy intake was derived from the food diary (8201 kJ (1960 kcal)) and QFFQ (7774 kJ (1858 kcal)). Rho for energy and macronutrients ranged from 0·66 (energy) to 0·17 (dietary fibre). The percentage of energy from carbohydrates and protein showed the highest and lowest ICC among macronutrients (0·63 and 0·27, respectively). The highest weighted κ was observed for energy (0·45). When the nutrient intake was divided into quartiles, approximately 34 % of the observations were in the same quartile. CONCLUSIONS: This investigation supports the validity of the QFFQ as a method for assessing long-term dietary intake except for dietary fibre, folate, vitamins A, E and B12. The instrument will be a useful tool in the analysis of diet-cancer associations in the BNCS.

Objective: European governments have yet to introduce mandatory folic acid fortification of foods for neural tube defect prevention because of uncertainty about the long-term safety of high intake of folic acid. Novel folate-enriched eggs have been proposed as offering a practical way of increasing intake of natural folates, which do not have the same safety concerns as synthetic folic acid. Our objective was to estimate the potential increase in folate supply that could occur in European Union (EU) countries if normal eggs were replaced by folate-enriched eggs. Design: FAOSTAT data on daily per capita availability of eggs were linked to mean folate concentrations of un-enriched and folate-enriched eggs from three representative feeding trials from the recent literature. Setting: Data were collated in Microsoft Excel. Subjects: The study used food balance sheets for Europe for 1961‐2003 and for twenty-six individual EU countries for 2003. Results: There has been little variation in egg supply in Europe over the past 40 years, with eggs providing only about 1?3‐1?6% of total energy. In 2003, the average per capita egg supply across twenty-six EU countries was 32?8g/d, equivalent to a little over half an egg. Even if the folate concentrations of all eggs across the EU were increased two- to threefold, per capita folate supply would increase only by about 25 mg/d. Conclusions: At current enrichment levels, the availability of novel folate-enriched eggs will have little impact on folate supply in EU countries. In the absence of mandatory fortification, additional natural folate sources are needed urgently.

ObjectivesTo characterise the diet of First Nations in north-western Ontario, highlight foods for a lifestyle intervention and develop a quantitative food-frequency questionnaire (QFFQ).DesignCross-sectional survey using single 24 h dietary recalls.SettingEight remote and semi-remote First Nations reserves in north-western Ontario.Subjects129 First Nations (Oji-Cree and Ojibway) men and women aged between 18 and 80 years.ResultsThe greatest contributors to energy were breads, pasta dishes and chips (contributing over 20 % to total energy intake). ‘Added fats’ such as butter and margarine added to breads and vegetables made up the single largest source of total fat intake (8·4 %). The largest contributors to sugar were sugar itself, soda and other sweetened beverages (contributing over 45 % combined). The mean number of servings consumed of fruits, vegetables and dairy products were much lower than recommended. The mean daily meat intake was more than twice that recommended. A 119-item QFFQ was developed including seven bread items, five soups or stews, 24 meat- or fish-based dishes, eight rice or pasta dishes, nine fruits and 14 vegetables. Frequency of consumption was assessed by eight categories ranging from ‘Never or less than one time in one month’ to ‘two or more times a day’.ConclusionWe were able to highlight foods for intervention to improve dietary intake based on the major sources of energy, fat and sugar and the low consumption of fruit and vegetable items. The QFFQ is being used to evaluate a diet and lifestyle intervention in First Nations in north-western Ontario.

ObjectiveTo develop a quantitative food-frequency questionnaire (QFFQ) for the Barbados National Cancer Study (BNCS) that will permit examination of associations of diet with breast and prostate cancer.DesignPopulation intake data from the year 2000 Barbados Food Consumption and Anthropometric Surveys (BFCAS 2000) were used to derive a list of foods consumed by the population. A 192-item draft QFFQ was developed from this list.SettingBarbados, West Indies provides an ideal environment to understand cancer risk in African-origin populations, with high relevance to African-Americans. The BNCS is a population-based case–control study examining risk factors for breast and prostate cancer in such populations.SubjectsA total of 1600 persons, 18 years and older, completed a 24-hour recall in the BFCAS 2000. Fifty of 63 randomly selected residents (79% response rate) gave additional updated information on foods consumed.ResultsThe 50 participants provided a one-time 24-hour recall and completed the draft QFFQ. The final instrument contains 148 items: breads, cakes, cereals = 17; rice, pastas, noodles = 8; dairy = 10; meat, fish, poultry = 42; fruit = 16; vegetables = 26; soft drinks = 14; alcoholic beverages = 5; others = 10. Additional questions include supplement use and food preparation methods such as grilling.ConclusionThe final instrument is concise, complete and the most up-to-date for assessing the food and nutrient intake of African-origin Barbadians and the associations with breast and prostate cancer.

ObjectiveThis study assessed and compared heath-related behaviours and nutrient and food group intakes between US-born and Korea-born Korean American women.Design and subjectsCross-sectional analyses were performed for ethnic Koreans who participated in the Multiethnic Cohort Study in Hawaii and Los Angeles in 1993–1996. The sample included 492 Korean American women aged 45–75 years who were born in the USA (n= 274) or Korea (n= 218). Participants were recruited using driver's license files as a primary sampling source and completed a self-administered questionnaire, including a quantitative food frequency section.ResultsThe proportion overweight or obese was 31.4% in US-born and 9.4% in Korea-born women. US-born women had higher intakes of total fat and fat as a percentage of energy, and lower intakes of sodium, vitamin C, β-carotene and carbohydrate as a percentage of energy, than Korea-born women. Comparing intakes of food group servings from the Food Guide Pyramid, US-born women reported more whole grains, red meat and nuts, and less soy products, than did Korea-born women. US-born women also consumed fewer vegetables and fruit than those born in Korea. Few women in either group reported intakes that met the recommendations for dairy foods. Intake of discretionary fat from the Pyramid tip was higher in US-born than in Korea-born women.ConclusionsThese findings indicate that the acculturation of Korean immigrants affects dietary intakes in ways that may alter risks of several chronic diseases. Further studies will be necessary to examine the effects of dietary acculturation on disease patterns.

Objective:To explore British African-Caribbean (AfC) nutrient intake by migration status (place of birth), diet (traditional Caribbean or more European) and age and relate this ecologically to coronary heart disease (CHD) mortality rates.Design:Cross-sectional.Setting:Inner-city Manchester, UK.Subjects:Two hundred and fifty-five adults of AfC origin aged 25–79 years, randomly sampled from population registers.Results:Caribbean-born people (mean age 56, and mean time in Britain 30 years) had significantly lower per cent energy from total and saturated fat than younger British-born AfC people (mean age 29 years) (31.3% vs. 35%, difference in total fat 3.7%, 95%CI 2–5%; in saturated fat 10.9% vs. 12.6%, difference 1.7%, 95%CI 1–2.5%). The Caribbean-born group also ate more fruit (+84 g day−1, 95%CI 36–132 g day−1) and green vegetables (+26 g day−1, 95%CI 3–49 g day−1). Men following a traditional diet (>= 5 days week−1) similarly had a lower per cent energy from fat, at 30.4%, than less traditional eaters, at 33.1% (difference 2.7%, 95%CI 0.7–4.8%). African-Caribbean women, at relatively greater CHD risk than AfC men, had higher body mass indices (BMIs) than AfC men. Compared with national data, AfC subjects consumed some 7% and 5% less energy from total fat and saturated fat, respectively, with over 9% more from carbohydrate. However, there was marked convergence towards the national average in the youngest AfC groups aged 25–34 years, whatever their place of birth.Conclusions:Caribbean birthplace has an independent effect on total fat intake and percentage of energy from fat. Together with higher fruit and vegetable intake, these results are consistent with the dietary fat/antioxidant/CHD hypothesis.