Exploring culturally acceptable, nutritious, affordable, and low climatic impact diet for Japanese diets: Proof of concept of applying a new modelling approach using Data Envelopment Analysis

A future sustainable dietary pattern for Japanese is yet undefined. This study aimed to explore more sustainable Japanese diets, that are nutritious, affordable, and with low greenhouse gas emissions (GHGE) and particular emphasis on cultural acceptability. A newly developed Data Envelopment Analysis diet model was applied to 4-d dietary record data among 184 healthy Japanese men and 185 women volunteers aged 21–69 y. Alternative diets were calculated as the linear combinations of observed diets. Firstly, for each individual, four modelled diets were calculated that maximised cultural acceptability (i.e. minimize dietary change from observed diet), maximised nutritional quality assessed by the Nutrient-Rich Food Index (NRF), minimized monetary diet costs, or minimized diet-related GHGE. The final modelled diet combined all four indicators. In the first four models, the largest improvement was obtained for each targeted indicator separately, while relatively small improvements or unwanted changes were observed for other indicator. When all indicators were aimed to optimize, the NRF score and diet-related GHGE was improved by 8–13% with the lower monetary cost than observed diets, although the percentage improvement was a bit smaller than the separate models. The final modelled diets demanded increased intakes for whole grains, fruits, milk/cream/yoghurt, legumes/nuts, and decreased intakes for red and processed meat, sugar/confectionaries, alcoholic and sweetened beverages, and seasonings in both sexes. In conclusion, more sustainable dietary patterns considering several indicators are possible for Japanese while total improvement is moderate due to trade-offs between indicators and methodological limitation of DEA diet model.

Number of Days Required to Estimate Habitual Vegetable Variety: A Cross-Sectional Analysis Using Dietary Records for 7 Consecutive Days

The aim of this cross-sectional study was to examine the number of days required to estimate habitual vegetable variety by conducting a multiday, dietary record. Sixty respondents from three groups in Japan (rural residents, general students, and nutrition students) participated in the study using a self-administered questionnaire in September 2018. To measure vegetable variety, the number of different vegetables consumed was extracted from the dietary records of seven consecutive days. Differences in the number of vegetables consumed and the capture proportion over seven consecutive days between groups were examined using repeated measures analysis of variance and one-way analysis of variance. The vegetable variety between each day was also compared using Pearson’s correlation coefficient. The vegetable variety based on dietary records for seven consecutive days confirmed the differences between groups by repeated measurements (p = 0.013). However, there was no significant difference among groups in the capture proportion per survey day based on seven consecutive days. Furthermore, there were significant correlations between the number of vegetables consumed over seven consecutive days and that consumed on two or more days (r > 0.50, p < 0.01) and especially three or more days in all groups (r > 0.70, p < 0.001). The present study suggested that a dietary survey over two or more days could provide an estimate of habitual vegetable variety.

Evaluating Mobile Apps For Dietary and Food Timing Assessment For Use in Research and Clinical Assessment (Preprint)

UNSTRUCTURED Abstract: Over the last decade, health apps have become an increasingly popular tool utilized by clinicians and researchers to track food consumption and exercise. However, as consumer apps have primarily focused on tracking dietary intake and exercise, many lack technological features to facilitate the capture of critical food timing details. To determine a viable app that recorded both dietary intake and food timing for use in our clinical study, we evaluated the timestamp data, usability, privacy policies, accuracy of nutrient estimates, and general features of 11 mobile apps for dietary assessment. Apps were selected using a keyword search of related terms and the following apps were reviewed: Bitesnap, Cronometer, DiaryNutrition, DietDiary, FoodDiary, FoodView, Macros, MealLogger, myCircadianClock, MyFitnessPal, and MyPlate. Our primary goal was identifying apps that record food timestamps, which 8 of the reviewed apps did (73%). Of those, only 4/11 (36%) allowed users to edit the timestamps, an important feature. Next, we sought to evaluate the usability of the apps, using the System Usability Scale (SUS) across 2 days, with 82% of the apps receiving favorable scores for usability (9/11 apps). To enable use in research and clinic settings, the privacy policies of each app were systematically reviewed using common criteria with 1 Health Insurance Portability and Accountability Act (HIPAA) compliant app (Cronometer). Furthermore, protected health information is collected by 9/11 (81%) of the apps. Lastly, to assess the accuracy of nutrient estimates generated by these apps, we selected 4 sample food items and one researcher’s 3-day dietary record to input into each app. The caloric and macronutrient estimates of the apps were compared to nutrient estimates provided by a registered dietitian using the Nutrition Data System for Research (NDSR). Compared to the 3-day food record, the apps were found to consistently underestimate calories and macronutrients compared to NDSR. Overall, we find the Bitesnap app to provide flexible dietary and food timing functionality capable for research or clinical use with the majority of apps lacking in necessary food timing functionality or user privacy.

Intake of micronutrients and fatty acids of vegetarian, vegan, and omnivorous children (1–3 years) in Germany (VeChi Diet Study)

Purpose There is an ongoing debate whether vegetarian (VG) and especially vegan (VN) diets are nutritionally adequate in early childhood. Hence, the Vegetarian and Vegan Children Study (VeChi Diet Study) aimed to assess the food and nutrient intake of VG and VN infants. Methods The study examined the diets of 1–3-year-old VG, VN, and omnivorous (OM) children (n = 430). Dietary intake was assessed via a 3-day weighed dietary record and compared between groups using ANCOVA. Lifestyle data were collected using a questionnaire. Here, the results of micronutrient and fatty acid intakes are presented. Results Most nutrient intakes (with and without supplements) differed significantly between VN children and the two other groups, with a more favourable overall micronutrient intake in VN, followed by VG children, [e.g., the highest intake of vitamin E (8.3 mg/d vs. VG 7.4 mg/d and OM 5.1 mg/d), vitamin B1 (569 µg/d vs. VG 513 µg/d and OM 481 µg/d), folate (143 µg/d vs. VG 116 µg/d and OM 108 µg/d), magnesium (241 mg/d vs. VG 188 mg/d and OM 164 mg/d), and iron (8.9 mg/d vs. VG 7.3 mg/d and OM 6.0 mg/d)] as well as fat quality [highest intake of polyunsaturated fatty acids (8.7 E% vs. VG 6.9 E% and OM 4.5 E%) and lowest intake of saturated fatty acids (9.1 E% vs. VG 11.9 E% and OM 14.0 E%)]. In contrast, OM children had the highest intake of vitamin B2 (639 µg/d vs. VG 461 µg/d and VN 429 µg/d), calcium (445 mg/d vs. VG 399 mg/d and VN 320 mg/d), iodine (47 µg/d vs. VG 33 µg/d and VN 31 µg/d), and DHA (35.4 mg/d vs. VG 16.6 mg/d and VN 18.4 mg/d). Without supplementation, OM children had the highest average vitamin B12 intake (1.5 µg/d vs. VG 0.6 µg/d and VN 0.2 µg/d), whereas VN children had the highest average vitamin B12 intake with supplementation (73.8 µg/d vs. VG 1.3 µg/d and OM 1.7 µg/d). Without supplementation, none of the groups’ median intakes met the harmonised Average Requirement (h-AR) for vitamin D and iodine. Moreover, VG and VN children did not achieve h-ARs for vitamin B2, vitamin B12, and iron—if a low absorption of iron is anticipated; VN children also did not do so for calcium. Conclusion In early childhood, VN and VG diets can provide most micronutrients in desirable amounts and a preferable fat quality compared to an OM diet. Special focus should be paid to (potentially) critical nutrients, particularly vitamin D, iodine, and DHA for all children regardless of diet, as well as vitamin B2, vitamin B12, calcium, and iron for VG and VN children. Trail registration This study was registered with the German Clinical Trials Register (DRKS00010982) on (September 2, 2016).

Comparison of the Diet Photograph Record to Weighed Dietary Record and 24 h Dietary Recall for Estimating Energy and Nutrient Intakes Among Chinese Preschoolers

This study aimed to assess the relative validity of the diet photograph record (DP) for measuring the energy and nutrient intakes against the weighed dietary record (WD) and the 24 h dietary recall (HR) in the Chinese preschoolers. In this study, 40 preschool children aged 4–6 years and their parents were recruited from a kindergarten in southwest China. Dietary intake of the preschoolers on a same day, as estimated by the DP and the HR were compared with the WD. These three methods were administered by the three group of investigators independently. The mean differences, correlation coefficients, cross-classifications, and weighted κ, as well as the Bland–Altman plots were performed to assess the differences and agreements among the estimates from the DP, the HR, and the WD. For the DP and the HR, the estimates of energy and nutrient intakes were moderate to high correlated with the WD, with the higher coefficients ranging from 0.73 to 0.94 for the DP. Both the methods tended to underestimate the dietary intake, but the differences from the known weights using the DP were significantly smaller than those using the HR. The weighed κ values ranking the preschoolers ranged from 0.48 to 0.80 for the DP and ranged from 0.28 to 0.64 for the HR. Furthermore, the Bland–Altman plots indicated a better agreement between the DP and the WD for estimating energy and nutrient intakes. This DP is a valid tool for measuring energy and nutrient intakes among the preschoolers.

Dietary Sodium Intake Is Positively Associated with Sugar-Sweetened Beverage Consumption in Chinese Children and Adolescents

Sugar-sweetened beverage (SSB) consumption among children and adolescents is steadily increasing in China, while the main taste of Chinese food is salty. The present study aimed to determine the relationships between SSB and total fluid consumption and dietary sodium and salt intake among children and adolescents in China. The data were obtained from a cross-sectional investigation in 2015. A total of 3958 participants were included. A 24-h dietary record for three consecutive days was collected to determine the SSB intake and food consumption across school days and rest days. After adjusting for age, sex, yearly household income, maternal education, intentional physical exercise, and instances of eating out in the last week, the dietary sodium intake was positively associated with the SSB consumption (p < 0.05), but salt was not. After stratifying by sex, grades, and puberty status, the associations between dietary sodium intake and SSB consumption were significant in girls, in grades 1–5 and before puberty (p < 0.05). Dietary sodium intake was positively associated with SSB consumption in Chinese children and adolescents, particularly in young children. A reduction of the sodium intake might help reduce SSB consumption among children and adolescents.

Relationship between diet, oxidative stress, and inflammation in ankylosing spondylitis

Objectives: This study aims to investigate the relationship between disease activity, dietary phytochemical index (DPI), and serum total oxidant status (TOS) and total antioxidant status (TAS) in patients with ankylosing spondylitis (AS). Patients and methods: Between August 2020 and January 2021, a total of 37 patients (23 males, 14 females; mean age: 39.3±9.4 years; range, 21 to 61 years) with AS and 36 age-, sex-, and body mass index-matched healthy individuals (24 males, 12 females; mean age: 37.9±8.9 years; range, 20 to 60 years) were included. Serum TAS (μmoLTroloxEq/L) and TOS (μmoL H2O2Eq/L) measurements were performed and the oxidative stress index (OSI) was calculated. Dietary evaluation was made from a one-day dietary record and DPI was calculated. Results: Serum TAS level in AS patients was significantly lower than the healthy group (p=0.003). Serum TOS level was similar in both groups. The OSI of patients was significantly higher than the controls (p=0.035). The mean DPI, polyunsaturated fatty acid, n-3 fatty acid, and vitamin C intake of patients were significantly lower than controls (p=0.042, p=0.033, and p=0.022, respectively). A moderate positive correlation was found between the TAS level and DPI of the control group (r=0.352, p=0.035). According to medications, no significant difference was seen between the groups in terms of patients’ characteristics, DPI, and laboratory tests and there was no correlation between DPI, TAS, TOS, and OSI. Conclusion: Lower DPI and lower n-3 fatty acid and vitamin C intake in patient group demonstrated that patients with AS should pay more attention to their diet to increase serum antioxidant status.

Environmental Intervention in a University Canteen with Focus on Decision Guidance—Effects on Sale and Daily Consumption of Vegetables and Fruit

The purpose of the study was to evaluate whether an environmental intervention in a university canteen changes the sale and daily consumption of vegetables and fruit among canteen users. The intervention focused on decision guidance, including a positive incentive and nudging. In a pretest−posttest-design, daily sales data of pieces (pcs) of vegetable components and fruit, as well as the sale per main component (pcs/mc), were assessed. Here, 20 opening days were analyzed, each after the intervention (t1) and in the same period of the previous year (t0). Vegetable and fruit consumption were assessed in a controlled pretest−posttest design (3-day-dietary-record, t0 and t1). The intervention group (IG; n = 46) visited the canteen ≥ once/week, and the control group (CG; n = 49) < once/week. At t1, the sale of absolute vegetable components did not change (t0: 132.3 ± 49.7 pcs, p > 0.05), but more per main component were sold at t1 (t0: 0.54 ± 0.09, Δ: 0.09 ± 0.13 pcs/mc, p < 0.05). In addition, the sale of fruit (t0: 17.4 ± 11.6, Δ: 8.3 ± 10.8 pcs, p < 0.05; t0: 0.07 ± 0.03, Δ: 0.05 ± 0.07 pcs/mc, p < 0.001) increased after the intervention. The total consumption of vegetables (IG, t0: 260 ± 170 g/d, CG, t0: 220 ± 156 g/d; p > 0.05) and fruit (IG, t0: 191 ± 109 g/d; CG, t0: 186 ± 141 g/d; p > 0.05), however, did not change. To effectively change daily consumption, the intervention needs to be expanded.

Comprehensive versus standard care in post-severe acute kidney injury survivors, a randomized controlled trial

Background Currently, there is a lack of evidence to guide optimal care for acute kidney injury (AKI) survivors. Therefore, post-discharge care by a multidisciplinary care team (MDCT) may improve these outcomes. This study aimed to demonstrate the outcomes of implementing comprehensive care by a MDCT in severe AKI survivors. Methods This study was a randomized controlled trial conducted between August 2018 to January 2021. Patients who survived severe AKI stage 2–3 were enrolled and randomized to be followed up with either comprehensive or standard care for 12 months. The comprehensive post-AKI care involved an MDCT (nephrologists, nurses, nutritionists, and pharmacists). The primary outcome was the feasibility outcomes; comprising of the rates of loss to follow up, 3-d dietary record, drug reconciliation, and drug alert rates at 12 months. Secondary outcomes included major adverse kidney events, estimated glomerular filtration rate (eGFR), and the amount of albuminuria at 12 months. Results Ninety-eight AKI stage 3 survivors were enrolled and randomized into comprehensive care and standard care groups (49 patients in each group). Compared to the standard care group, the comprehensive care group had significantly better feasibility outcomes; 3-d dietary record, drug reconciliation, and drug alerts (p < 0.001). The mean eGFR at 12 months were comparable between the two groups (66.74 vs. 61.12 mL/min/1.73 m2, p = 0.54). The urine albumin: creatinine ratio (UACR) was significantly lower in the comprehensive care group (36.83 vs. 177.70 mg/g, p = 0.036), while the blood pressure control was also better in the comprehensive care group (87.9% vs. 57.5%, p = 0.006). There were no differences in the other renal outcomes between the two groups. Conclusions Comprehensive care by an MDCT is feasible and could be implemented for severe AKI survivors. MDCT involvement also yields better reduction of the UACR and better blood pressure control. Trial registration Clinicaltrial.gov: NCT04012008 (First registered July 9, 2019).

Dietary Intake Adequacy and Food Sources of Nutrients Involved in the Methionine-Methylation Cycle in Women of Childbearing Age from the ANIBES Spanish Population

Growing evidence confirms choline as a critical perinatal nutrient. However, intake levels of choline and betaine among the Spanish fertile population remain unknown. Given their role in one-carbon metabolism with potential epigenetic effects, the aim of the present study was to evaluate the dietary intakes, their adequacy to existing guidelines and the main food sources together with other micronutrients involved in the methylation-methionine cycle (vitamin B6, folates and vitamin B12) in women of childbearing age. The ANIBES study, a cross-sectional study of a representative sample of women of childbearing age (18–45 years, n = 641) resident in Spain, was used. The sample was divided into younger women (18–30 years, n = 251) and older women (31–45 years, n = 390). Dietary intake was assessed by a three-day dietary record by using a tablet device. Total median intakes for the total sample were 303.9 mg/d for choline; 122.6 mg/d for betaine; 1.3 mg/d for vitamin B6; 140.8 μg/d for folates, and 3.8 μg/d for vitamin B12. The older subgroup showed significantly higher choline (p < 0.05), betaine (p < 0.001) and folates (p < 0.05) intakes than younger women. Main food sources for the whole sample were meat and meat products for choline (28.3%), vitamin B6 (25.7%) and vitamin B12 (22.8%); cereals and derivatives (79.9%) for betaine; vegetables (20.0%) for folates. Overall intake adequacy was only observed for vitamin B12, with a very limited number of participants showing adequate intakes for all the other micronutrients. These results illustrate there is a relevant need to raise awareness about optimizing the status of the methionine cycle-related vitamins and cofactors in this potentially vulnerable population.