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Individual-level quantitative dietary data can provide suitably disaggregated information to identify the needs of all population sub-groups, which can in turn inform agricultural, nutrition, food safety, and environmental policies and programs. The purpose of this discussion paper is to provide an overview of dietary surveys conducted in low- and middle-income countries (LMICs) from 1980 to 2019, analyzing their key characteristics to understand the trends in dietary data collection across time. The present study analyzes the information gathered by the Food and Agriculture Organization of the United Nations/World Health Organization Global Individual Food consumption data Tool (FAO/WHO GIFT). FAO/WHO GIFT is a growing repository of individual-level dietary data and contains information about dietary surveys from around the world, collected through published survey results, literature reviews, and direct contact with data owners. The analysis indicates an important increase in the number of dietary surveys conducted in LMICs in the past four decades and a notable increase in the number of national dietary surveys. It is hoped that this trend continues, together with associated efforts to validate and standardize the dietary methods used. The regular implementation of dietary surveys in LMICs is key to support evidence-based policies for improved nutrition.

ObjectiveA wide variety of methods are available to assess dietary intake, each one with different strengths and weaknesses. Researchers face multiple challenges when diet and nutrition need to be accurately assessed, particularly in the selection of the most appropriate dietary assessment method for their study. The goal of the current collaborative work is to present a collection of available resources for dietary assessment implementation.Design/Setting/ParticipantsAs a follow-up to the 9th International Conference on Diet and Physical Activity Methods held in 2015, developers of dietary assessment toolkits agreed to collaborate in the preparation of the present paper, which provides an overview of each toolkit. The toolkits presented include: the Diet, Anthropometry and Physical Activity Measurement Toolkit (DAPA; UK); the National Cancer Institute’s (NCI) Dietary Assessment Primer (USA); the Nutritools website (UK); the Australasian Child and Adolescent Obesity Research Network (ACAORN) method selector (Australia); and the Danone Dietary Assessment Toolkit (DanoneDAT; France). An at-a-glance summary of features and comparison of the toolkits is provided.ResultsThe present review contains general background on dietary assessment, along with a summary of each of the included toolkits, a feature comparison table and direct links to each toolkit, all of which are freely available online.ConclusionsThis overview of dietary assessment toolkits provides comprehensive information to aid users in the selection and implementation of the most appropriate dietary assessment method, or combination of methods, with the goal of collecting the highest-quality dietary data possible.

We determined the nutritional adequacy and overall quality of the diets of adult patients with eosinophilic esophagitis (EoE). Dietary intakes stratified by sex and age were compared to Dietary Reference Values (DRV). Overall diet quality was assessed by two independent Diet-Quality-Indices scores, the PANDiet and DHD-index, and compared to age- and gender-matched subjects from the general population. Lastly, food and nutrient intakes of EoE patients were compared to intakes of the general population. Saturated fat intake was significantly higher and dietary fiber intake significantly lower than the DRV in both males and females. In males, the DRV were not reached for potassium, magnesium, selenium, and vitamins A and D. In females, the DRV were not reached for iron, sodium, potassium, selenium, and vitamins A, B2, C and D. EoE patients had a significantly lower PANDiet and DHD-index compared to the general population, although the relative intake (per 1000 kcal) of vegetables/fruits/olives was significantly higher (yet still up to 65% below the recommended daily amounts) and alcohol intake was significantly lower compared to the general Dutch population. In conclusion, the composition of the habitual diet of adult EoE patients has several pro-inflammatory and thus unfavorable immunomodulatory properties, just as the general Dutch population, and EoE patients had lower overall diet quality scores than the general population. Due to the observational character of this study, further research is needed to explore whether this contributes to the development and progression of EoE.

Background and aimsThis paper describes the data resource profile of South Asia Biobank (SAB), which was set up in South Asia from November 2018 to March 2020, to identify the risk factors and their complex interactions underlying the development of type-2 diabetes mellitus, cardiovascular disease and other chronic diseases in South Asians.Data resource basicsThis cross-sectional population-based study has recruited 52713 South Asian adults from 118 surveillance sites at five centres of excellence in South Asia (Bangladesh, North India, South India, Pakistan and Sri Lanka). Structured assessments of participants included six complementary domains: i). Registration and consent; ii). Questionnaire (information on behavioural risk factors, personal and family medical history, medications, socioeconomic status); iii). Physical measurements (height, weight, waist and hip circumference and bio-impedance for body fat composition, blood pressure, cardiac evaluation, retinal photography, respiratory evaluation); iv). Biological samples (blood and urine); v). Physical activity monitoring and vi). Dietary intake by a 24-hour recall. Aliquots of whole blood, serum, plasma, and urine were put into storage at −80°C for further analysis.Key resultsThe prevalence of obesity is 6.6% in Bangladesh, 19.7% in India, 33.9% in Pakistan and 15.7% in Sri Lanka. The prevalence of diabetes is 11.5%, 27.7%, 25.3%, and 24.8%, and the prevalence of hypertension is 26.7%, 36.9%, 44.5%, 35.0% in Bangladesh, India, Pakistan and Sri Lanka respectively.Collaboration and data accessSAB is the first comprehensive biobank of South Asian individuals. Collected data are available to the global scientific community upon request.

International audience; Background: Recent changes in Egyptian dietary habits can be attributed to more urban and sedentary lifestyles and to alterations in the dietary and economic context. The mean BMI of Egyptian women is one of the highest worldwide, and 50% have iron deficiency. Objective: The aim was to quantify food and nutrient intakes of urban Egyptian women and conduct a detailed analysis of micronutrients commonly consumed in inadequate amounts, such as iron, vitamin D, and folate. Methods: Urban Egyptian women aged 19-30 y (n = 130) were recruited during 2016-2017. Energy needs were estimated using the Henry equation, assuming a low physical activity level (1.4). Dietary intakes and iron bioavailability were estimated from a 4-d food diary. Macronutrient intakes were compared with WHO/FAO population goals and micronutrient intakes with Egyptian recommendations. Iron needs were determined for each subject. Results: The mean BMI (kg/m 2) was 27.9 ± 4.9. The mean total energy intake (TEI; 2389 ± 715 kcal/d) was significantly higher than needs (2135 ± 237 kcal/d; P = 0.00018). Total fat (33%TEI) and SFA (11%TEI) intakes were slightly higher than population goals (15-30%TEI and

In recent years, evidence has emerged about the importance of healthy fluid intake in children for physical and mental performance and health, and in the prevention of obesity. Accurate data on water intake are needed to inform researchers and policymakers and for setting dietary reference values. However, to date, there are few published data on fluid or water intakes in children. This is due partly to the fact that drinking water is not always reported in dietary surveys. The aim of this paper is to review the current status of the literature and highlight the challenges of assessing total fluid intake in children and adolescents. From the dietary assessment literature it is apparent that children present unique challenges to assessing intake due to ongoing cognitive capacity development, limited literacy skills, difficulties in estimating portion sizes and multiple caregivers during any 1 day making it difficult to track intakes. As such, many issues should be considered when assessing total fluid intakes in children or adolescents. Various methods to assess fluid intakes exist, each with its own strengths and weaknesses; the ultimate choice of method depends on the research question and resources available. Based on the literature review, it is apparent that if the research focus is to assess only fluid intake, a fluid-specific method, such as a diary or record, appears to be a feasible approach to provide an accurate estimate of intakes.

Background: The mechanisms responsible for calorie restriction-induced improvement in insulin sensitivity have not been fully elucidated. Greater insight can be achieved through deep biological phenotyping of subjects undergoing calorie restriction, and integration of big data.\ud \ud Materials and Methods: An integrative approach was applied to investigate associations between change in insulin sensitivity and factors from host, microbiota and lifestyle after a 6-week calorie restriction period in 27 overweight or obese adults (ClinicalTrials.gov: NCT01314690). Partial least squares regression was used to determine associations of change (week 6 – baseline) between insulin sensitivity markers and lifestyle factors (diet and physical activity), subcutaneous adipose tissue (sAT) gene expression, metabolomics in serum, urine and feces, and gut microbiota composition. ScaleNet, a network learning approach based on spectral consensus strategy (SCS, developed by us) was used for reconstruction of biological networks.\ud \ud Results: A spectrum of variables from lifestyle factors (10 nutrients), gut microbiota (10 metagenomics species) and host multi-omics (metabolic features: 84 from serum, 73 from urine, and 131 from feces; and 257 subcutaneous adipose tissue gene probes) most associated with insulin sensitivity were identified. Biological network reconstruction using SCS, highlighted links between changes in insulin sensitivity, serum branched chain amino acids, sAT genes involved in endoplasmic reticulum stress and ubiquitination, and gut metagenomic species. Linear regression analysis to model how changes of select variables over the calorie restriction period contribute to changes in insulin sensitivity, showed greatest contributions from gut metagenomic species and fiber intake.\ud \ud Conclusions: This work has enhanced previous knowledge on links between host glucose homeostasis, lifestyle factors and microbiota, and has identified potential biomarkers that may be used in future studies to predict and improve individual response to weight-loss interventions. Furthermore, this is the first study showing integration of the wide range of data presented herein, identifying 115 variables of interest with respect to insulin sensitivity from the initial input, consisting of 9,986 variables.

Purpose In recent years, evidence has emerged about the importance of healthy fluid intake in children for physical and mental performance and health, and in the prevention of obesity. Accurate data on water intake are needed to inform researchers and policymakers and for setting dietary reference values. However, to date, there are few published data on fluid or water intakes in children. This is due partly to the fact that drinking water is not always reported in dietary surveys. The aim of this paper is to review the current status of the literature and highlight the challenges of assessing total fluid intake in children and adolescents. Results From the dietary assessment literature it is apparent that children present unique challenges to assessing intake due to ongoing cognitive capacity development, limited literacy skills, difficulties in estimating portion sizes and multiple caregivers during any 1 day making it difficult to track intakes. As such, many issues should be considered when assessing total fluid intakes in children or adolescents. Various methods to assess fluid intakes exist, each with its own strengths and weaknesses; the ultimate choice of method depends on the research question and resources available. Based on the literature review, it is apparent that if the research focus is to assess only fluid intake, a fluid-specific method, such as a diary or record, appears to be a feasible approach to provide an accurate estimate of intakes.

Objective Digestive symptoms are reported to result from a wide range of dietary components. Dietary pattern analysis is a useful method of considering the entire diet, rather than individual foods or nutrients, providing an opportunity to take interactions into account. The objective was to investigate the relationship between diet, digestive symptoms and health-related quality of life (HRQoL) in women reporting minor digestive symptoms, using a dietary pattern approach. Research methods Analysis was performed on dietary and digestive symptoms data collected in France. Females (n=308, aged 18-60yrs) reporting a bowel movement frequency within the normal range (3-21 stools/week) but with minor digestive symptoms in the previous month were investigated. Dietary data was collected using three 24-hr recalls. K-means was used to divide the dietary data into clusters. The frequency of digestive symptoms (abdominal discomfort or pain, bloating, flatulence, borborygmi) and bowel movements were evaluated over a two week period. HRQoL was also assessed. Results Four dietary clusters were identified and characterized as: Cluster 1 ‘Unhealthy’, Cluster 2 ‘Balance’, Cluster 3 ‘Healthy’ and Cluster 4 ‘Convenience’. Analysis showed no differences in the frequency of digestive symptoms according to dietary cluster, except for flatulence (p=0.030) which was more frequent in the Unhealthy and Convenience clusters. No significant differences were observed in HRQoL according to dietary clusters. Conclusions Our results demonstrate that even within a relatively homogeneous sample of French women, distinct dietary patterns can be identified but without significant differences in digestive symptoms (except for flatulence), and HRQoL.

ObjectiveTo adapt and evaluate a nutrient-based diet quality index (PANDiet) for UK young children and to determine the nutritional adequacy of their diets according to consumption of young child formula (YCF) and commercial infant foods (CIF).DesignContent and construct validity of the PANDiet were assessed by studying associations between the PANDiet and its components, energy intake, food intakes, and child and maternal characteristics. Four groups of children were defined according to their intake of YCF and CIF: (i) no consumption; (ii) consumption of YCF; (iii) consumption of CIF; and (iv) consumption of YCF and CIF. Child and maternal characteristics, PANDiet scores and food intakes of these four groups were compared.SettingSecondary analysis of data from the UK Diet and Nutrition Survey of Infants and Young Children (DNSIYC, 2011).SubjectsYoung children (n1152) aged 12–18 months.ResultsThe PANDiet was adapted to the UK based on twenty-five nutrients. A lower PANDiet score was linked to lower intakes of YCF, CIF, vegetables and fruits. Determinants of having a lower score were being older, having siblings and having a younger mother with a lower educational level. Compared with children consuming neither YCF nor CIF, PANDiet scores were higher in children consuming CIF (+1·4), children consuming YCF (+7·2) and children consuming YCF and CIF (+7·8; allPConclusionsThe PANDiet is a valid indicator of the nutrient adequacy of the diet of UK young children. Consuming CIF was not found to be associated with lower nutritional adequacy whereas consuming YCF was associated with higher nutritional adequacy.

There is interest in discovering root traits associated with acclimation to nutrient stress. Large root systems, such as in adult maize, have proven difficult to be phenotyped comprehensively and over time, causing target traits to be missed. These challenges were overcome here using aeroponics, a system where roots grow in the air misted with a nutrient solution. Applying an agriculturally relevant degree of low nitrogen (LN) stress, 30-day-old plants responded by increasing lengths of individual crown roots (CRs) by 63%, compensated by a 40% decline in CR number. LN increased the CR elongation rate rather than lengthening the duration of CR growth. Only younger CR were significantly responsive to LN stress, a novel finding. LN shifted the root system architectural balance, increasing the lateral root (LR)-to-CR ratio, adding ∼70 m to LR length. LN caused a dramatic increase in second-order LR density, not previously reported in adult maize. Despite the near-uniform aeroponics environment, LN induced increased variation in the relative lengths of opposing LR pairs. Large-scale analysis of root hairs (RHs) showed that LN decreased RH length and density. Time-course experiments suggested the RH responses may be indirect consequences of decreased biomass/demand under LN. These results identify novel root traits for genetic dissection.

Breakfast is an important source of micronutrients in the diet and its consumption has been linked to positive health outcomes. The present analysis investigated the contribution that breakfast cereals make to the nutrient intakes of the materially deprived (low income) UK population.Data for 3728 respondents aged 2 years and over from the UK Low Income Diet and Nutrition Survey (2003-2005) were analysed. Nutrient intakes of consumers and non-consumers of breakfast cereal were compared.Breakfast cereals were consumed by 49% of men, 58% of women, 80% of boys and 80% of girls, and median intakes were: 35, 25, 29 and 21 g/d, respectively. Consumers of breakfast cereals had higher intakes of thiamin, riboflavin, niacin, biotin, folate, vitamin B(6), vitamin B(12), iron and zinc than non-consumers. Breakfast cereal consumption was also related to higher intakes of calcium, attributable to higher milk consumption. The intake of wholegrain and high-fibre breakfast cereals was associated with a higher intake of non-starch polysaccharides. Intakes of niacin, biotin, calcium and zinc were higher but that of vitamin B(6) was lower among consumers of exclusively wholegrain and high-fibre breakfast cereals compared with consumers of other breakfast cereals. There were no significant differences observed in intakes of non-milk extrinsic sugars according to type of breakfast cereal consumed.Breakfast cereals make a significant contribution to the micronutrient intake of the low-income UK population.

The aim of this analysis was to investigate the strength of the association between sugar intake and treatment for dental decay in children in Scotland, and the impact of tooth brushing frequency on this association. The Survey of Sugar Intake among Children in Scotland was carried out in 2006 in those aged 3–17 years. Diet was assessed using the Scottish Collaborative Group FFQ, and interviews were carried out by trained fieldworkers who asked about dental health. A total of 1700 interviews were carried out, and 1512 FFQ were returned. Of the children, 56 % had received treatment for decay (fillings or teeth removed due to decay). Intake of non-milk extrinsic sugars (NMES), but not total sugar, increased the risk of having had treatment for decay: adjusted OR 1·84 (95 % CI 1·28, 2·64) for the highest ( ≥ 20·0 % food energy)v. lowest ( ≤ 14·8 % food energy) tertile of NMES intake. This raised risk remained in children who reported brushing their teeth at least twice a day. Compared with children who reported brushing their teeth at least twice a day and were in the lowest tertile of NMES intake, children who reported brushing their teeth once a day or less and were in the highest tertile of NMES intake were over three times more likely to have received treatment for decay (adjusted OR 3·39, 95 % CI 1·97, 5·82). In order to improve dental health in children in Scotland, dental health strategies must continue to stress the importance of both reduced NMES intake and good oral hygiene.

ObjectiveTo assess the intake and sources of non-milk extrinsic sugars (NMES) and fat among children in Scotland in relation to socio-economic status, and to estimate the changes in diet required to achieve recommended levels of intake.DesignCross-sectional survey with diet assessed by semi-quantitative FFQ.SettingEighty postcode sectors across Scotland.SubjectsChildren (n 1398) aged 3–17 years recruited from the Child Benefit register (76 % of those contacted).ResultsThe mean intake of NMES of 17·4 (95 % CI 17·0, 17·8) % food energy was considerably higher than the UK recommended population average of 11 % food energy. The mean intake of total fat of 32·9 (95 % CI 32·7, 33·2) % food energy met the recommended population average of no more than 35 % food energy, while the mean intake of SFA of 13·8 (95 % CI 13·7, 14·0) % food energy was above the recommended population average of no more than 11 % food energy. Despite clear socio-economic gradients in the mean daily consumption of many ‘healthy’ and ‘unhealthy’ food groups, socio-economic differences in NMES as a percentage of food energy were limited and there was no significant variation in the intake of total fat or SFA as a percentage of food energy with socio-economic status. Modelling of the data showed that removing sugar-sweetened soft drinks and increasing fruit and vegetable intake by 50 % would not restore the intake of NMES and SFA to recommended levels.ConclusionsMajor changes in the intake of many food groups will be required to bring the NMES and saturated fat intake in line with current dietary recommendations.

The Survey of Sugar Intake among Children in Scotland was carried out in May to September 2006. The present study aimed to identify dietary patterns in school-aged children from the survey and investigate associations with socio-economic factors, obesity and physical activity. Habitual diet was assessed using the Scottish Collaborative Group FFQ. Height and weight were measured by trained fieldworkers. A total of 1233 FFQ were available for analysis. Dietary patterns were identified by age (5–11 and 12–17 years) and sex using principal components analysis. Associations between factor scores and socio-economic status, education level of the main food provider, physical activity levels and BMI category (based on UK 1990 charts) were examined. Three dietary patterns were identified in each age and sex group. ‘Healthier’ patterns loading highly for fruit and vegetables were significantly associated with higher socio-economic status and higher education levels of the main food provider whereas more ‘unhealthy’ patterns (‘snacks’ and ‘puddings’) were associated with lower socio-economic status and lower education levels of the main food provider. There was no consistent association between dietary patterns and BMI group or time spent in physical activity. However, inactivity (screen time) was inversely associated with ‘healthier’ patterns in all age and sex groups and positively associated with ‘puddings’ and ‘snacks’ in girls aged 5–11 years. Clear dietary patterns can be identified in school-age children in Scotland, which are consistently related to socio-economic factors and inactivity. This has implications for targeting health promotion at subgroups in terms of lifestyle changes required.

Current lifestyles and the choice and availability of foods may influence the eating patterns of children. The aim of this study was to investigate the meal and snacking patterns of school-aged children in Scotland.A sub-sample of 156 children (5-17 years) from the national Survey of Sugar Intake among Children in Scotland completed a 4-day non-weighed diet diary. Meals and snacks were defined using a food-based classification system based on 'core' and 'non-core' foods. The first eating event containing a solid food item up to and including 0900 hours (1100 hours on weekend days) was defined as breakfast. Frequency of meal and snack consumption was compared between age, sex, body mass index (BMI) and socio-economic sub-groups, between term-time and school holidays and between weekdays and weekend days. Intakes of total fat, saturated fatty acids (SFA) and non-milk extrinsic sugars (NMES) on these days were also compared.Children ate a median of 3.3 meals plus 2.0 snacks per day, which did not vary between age and BMI groups. In all, 83% of children ate breakfast on all 4 days. Boys ate more meals than girls but the number of snacks was similar. Children from lower socio-economic groups tended to eat more meals and fewer snacks. Snacks accounted for 21% of the total daily energy intake, 22% of total fat, 24% of SFA and 39% of NMES intake. Daily intake of energy, total fat, SFA and NMES did not differ between term-time and holidays or weekdays and weekend days.Children tended to follow a traditional pattern of three meals a day, which was consistent between age and BMI subgroups and between school term-time and holidays.

ObjectivesLow-income households in the UK concentrate factors associated with poor record-keeping such as lower literacy, numeracy and English language skills. The present study aimed to (1) compare the validity and acceptability of three dietary survey methods against appropriate reference measures and (2) identify a method which was both valid and acceptable in low-income households.DesignCross-sectional design comparing three 4-day dietary survey methods (multiple-pass 24-hour recall, food checklist and semi-weighed method) against a 4-day weighed inventory and other reference measures within subjects.SettingLondon, UK, 2001.SubjectsLow-income households were selected using a doorstep screening questionnaire in 18 of the 60 most deprived neighbourhoods in London. Results are based on 384 respondents (159 males, 225 females) aged 2–90 years in 240 households. Respondents were mainly White (48%), Black or Black British (31%) or Asian or Asian British (9%).ResultsThe dietary survey method preferred by interviewers was the 24-hour recall. Most respondents preferred the food checklist. Compared with the weighed inventory, repeat 24-hour recalls and the food checklist yielded higher estimates of energy and nutrient intakes. The semi-weighed method was least liked and yielded the lowest estimates of intake.ConclusionsBased partly on evidence presented here and partly on evidence to be presented in later publications, four multiple-pass 24-hour recalls were recommended as the most appropriate method for a national study of diet and nutrition in low-income households in the UK.

Budget standards are specified baskets of goods and services which, when priced, can represent predefined living standards. ‘Low cost but acceptable’ (LCA) is a minimum income standard, adequate to provide warmth and shelter, a healthy and palatable diet, social necessities, social integration, avoidance of chronic stress and the maintenance of good health (physical, mental and social) in a context of free access to good-quality health care, good-quality education and social justice. The LCA food budget standard identifies a basket of foods and corresponding menus which provides (for a given household composition) a palatable diet that is consistent with prevailing cultural norms, and that satisfies existing criteria for health in relation to dietary reference values, food-based dietary guidelines and safe levels of alcohol consumption. Two previous studies that explored the relationship between diet and food expenditure in low-income households suggested that the amount spent on food was a good predictor of dietary adequacy, growth and health in children. The current paper will focus on diet and measures of deprivation in 250 low-income households in London. Households were screened for material deprivation (e.g. no car, no fixed line telephone, in receipt of Income Support) using a doorstep questionnaire. Diet was assessed using four 24 h recalls based on the ‘triple pass’ method. Expenditure on food and other aspects of household circumstances were assessed by face-to-face interview. Food expenditure in these households was characterized in relation to food budget standards. Further analyses explored the relationships between food expenditure and dietary adequacy, growth in children and measures of deprivation.

Background:\ud Despite the widespread recognition that obesity in pregnant women is associated with adverse outcomes for mother and child, there is no intervention proven to reduce the risk of these complications. The primary aim of this randomised controlled trial is to assess in obese pregnant women, whether a complex behavioural intervention, based on changing diet (to foods with a lower glycemic index) and physical activity, will reduce the risk of gestational diabetes (GDM) and delivery of a large for gestational age (LGA) infant. A secondary aim is to determine whether the intervention lowers the long term risk of obesity in the offspring.\ud \ud Methods/Design:\ud Multicentre randomised controlled trial comparing a behavioural intervention designed to improve glycemic control with standard antenatal care in obese pregnant women.\ud \ud Inclusion criteria; women with a BMI ≥30 kg/m2 and a singleton pregnancy between 15+0 weeks and 18+6 weeks’ gestation. Exclusion criteria; pre-defined, pre-existing diseases and multiple pregnancy. Randomisation is on-line by a computer generated programme and is minimised by BMI category, maternal age, ethnicity, parity and centre. Intervention; this is delivered by a health trainer over 8 sessions. Based on control theory, with elements of social cognitive theory, the intervention is designed to improve maternal glycemic control. Women randomised to the control arm receive standard antenatal care until delivery according to local guidelines. All women have a 75 g oral glucose tolerance test at 27+0- 28+6 weeks’ gestation.\ud \ud Primary outcome; Maternal: diagnosis of GDM, according to the International Association of Diabetes in Pregnancy Study Group (IADPSG) criteria. Neonatal; infant LGA defined as >90th customised birth weight centile.\ud \ud Sample size; 1546 women to provide 80% power to detect a 25% reduction in the incidence of GDM and a 30% reduction in infants large for gestational age.\ud \ud Discussion:\ud All aspects of this protocol have been evaluated in a pilot randomised controlled trial, with subsequent optimisation of the intervention. The findings of this trial will inform whether lifestyle mediated improvement of glycemic control in obese pregnant women can minimise the risk of pregnancy complications.

Identifying the dietary changes with the greatest potential for improving diet quality is critical to designing efficient nutrition communication campaigns. Our objective was to simulate the effects of different types of dietary substitutions to improve diet quality at the individual level. Starting from the observed diets of 1330 adults participating in the national French Nutrition and Health Survey (Etude Nationale Nutrition Sante), we simulated the effects of 3 different types of food and beverage substitutions with graded implementation difficulty for the consumer in a stepwise dietary counseling model based on the improvement in the PAN Diet index, which measures diet quality in terms of nutrient adequacy. In scenario 1, substitutions of a food or beverage for its "lighter" version resulted in a modest improvement in the PAN Diet score (Delta = +3.3 +/- 0.1) and a decrease in energy intake (Delta = -114 +/- 2 kcal/d). In scenario 2, substitutions of a food or beverage within the same food subgroup resulted in a marked improvement in the PANDiet score (Delta = +26.4 +/- 0.2) with no significant change in energy intake. In this second scenario, the improvement in nutrient adequacy was due to substitutions in many subgroups, with no single subgroup contributing >8% to the increase in the PANDiet score. In scenario 3, substitutions of a food or beverage within the same food group resulted in the greatest improvement in the PANDiet score (Delta = +31.8 +/- 0.2) but with an increase in energy intake (Delta = +204 +/- 9 kcal/d). In this third scenario, the improvement in nutrient adequacy was largely due to substitutions of fish for meat and processed meat (similar to 30% of the increase in the PANDiet score). This study shows that a strategy based on simple substitutions within food subgroups is effective in rapidly improving the nutritional adequacy of the diet of French adults and could be used in public health nutrition actions.

Background Associations between dietary patterns, metabolic and inflammatory markers and gut microbiota are yet to be elucidated. Objectives We aimed to characterize dietary patterns in overweight and obese subjects and evaluate the different dietary patterns in relation to metabolic and inflammatory variables as well as gut microbiota. Design Dietary patterns, plasma and adipose tissue markers, and gut microbiota were evaluated in a group of 45 overweight and obese subjects (6 men and 39 women). A group of 14 lean subjects were also evaluated as a reference group. Results Three clusters of dietary patterns were identified in overweight/obese subjects. Cluster 1 had the least healthy eating behavior (highest consumption of potatoes, confectionary and sugary drinks, and the lowest consumption of fruits that was associated also with low consumption of yogurt, and water). This dietary pattern was associated with the highest LDL cholesterol, plasma soluble CD14 (p = 0.01) a marker of systemic inflammation but the lowest accumulation of CD163+ macrophages with anti-inflammatory profile in adipose tissue (p = 0.05). Cluster 3 had the healthiest eating behavior (lower consumption of confectionary and sugary drinks, and highest consumption of fruits but also yogurts and soups). Subjects in this Cluster had the lowest inflammatory markers (sCD14) and the highest anti-inflammatory adipose tissue CD163+ macrophages. Dietary intakes, insulin sensitivity and some inflammatory markers (plasma IL6) in Cluster 3 were close to those of lean subjects. Cluster 2 was in-between clusters 1 and 3 in terms of healthfulness. The 7 gut microbiota groups measured by qPCR were similar across the clusters. However, the healthiest dietary cluster had the highest microbial gene richness, as evaluated by quantitative metagenomics. Conclusion A healthier dietary pattern was associated with lower inflammatory markers as well as greater gut microbiota richness in overweight and obese subjects. Trial Registration ClinicalTrials.gov NCT01314690

BackgroundExisting diet quality indices often show theoretical and methodological limitations, especially with regard to validation.ObjectiveTo develop a diet quality index based on the probability of adequate nutrient intake (PANDiet) and evaluate its validity using data from French and US populations.Material and methodsThe PANDiet is composed of adequacy probabilities for 24 nutrients grouped into two sub-scores. The relationship between the PANDiet score and energy intake were investigated. We evaluated the construct validity of the index by comparing scores for population sub-groups with 'a priori' differences in diet quality, according to smoking status, energy density, food intakes, plasma folate and carotenoid concentrations. French and US implementations of the PANDiet were developed and evaluated using national nutritional recommendations and dietary surveys.ResultsThe PANDiet was not correlated with energy for the French implementation (r = -0.02, P>0.05) and correlated at a low level for the US implementation (r = -0.11, PConclusionsThe PANDiet provides a single score that measures the adequacy of nutrient intake and reflects diet quality. This index is adaptable for use in different countries and relevant at the individual and population levels.

In 1998, a review for the Ministry of Agriculture Fisheries and Food (the predecessor of the Food Standards Agency) was published evaluating the relative merits of different dietary assessment methods against a series of factors likely to affect compliance or accuracy in low-income households. The review informed the design of a method comparison study carried out in London, UK, in 2001, in which the validity and acceptability of 4 d dietary assessment methods based on 24 h recalls, food checklists and a semi-weighed method were compared with 4 d weighed inventories and other reference measures. Results were based on observations in 384 respondents (159 males, 225 females) aged 2–90 years in 240 households. Outcomes of the comparison study included evaluations of each method made by respondents, interviewers and researchers. These findings were used in the present paper to update and extend the 1998 review. Additional factors not included in the 1998 review have been considered. This updated and extended review provides the basis for discussion of the relative merits of approaches to dietary assessment in low-income households in developed economies. The evidence presented here and elsewhere suggests that the 24 h recall is the method best suited for dietary assessment in low-income households, followed by the weighed inventory, food checklist and lastly the semi-weighed method.