Development of a Web-App for the Ecological Momentary Assessment of Dietary Habits among College Students: The HEALTHY-UNICT Project

The transition from adolescence to adulthood is a critical period for the development of healthy behaviors. Yet, it is often characterized by unhealthy food choices. Considering the current pandemic scenario, it is also essential to assess the effects of coronavirus disease-19 (COVID-19) on lifestyles and diet, especially among young people. However, the assessment of dietary habits and their determinants is a complex issue that requires innovative approaches and tools, such as those based on the ecological momentary assessment (EMA). Here, we describe the first phases of the “HEALTHY-UNICT” project, which aimed to develop and validate a web-app for the EMA of dietary data among students from the University of Catania, Italy. The pilot study included 138 students (mean age 24 years, SD = 4.2; 75.4% women), who used the web-app for a week before filling out a food frequency questionnaire with validation purposes. Dietary data obtained through the two tools showed moderate correlations, with the lowest value for butter and margarine and the highest for pizza (Spearman’s correlation coefficients of 0.202 and 0.699, respectively). According to the cross-classification analysis, the percentage of students classified into the same quartile ranged from 36.9% for vegetable oil to 58.1% for pizza. In line with these findings, the weighted-kappa values ranged from 0.15 for vegetable oil to 0.67 for pizza, and most food categories showed values above 0.4. This web-app showed good usability among students, assessed through a 19-item usability scale. Moreover, the web-app also had the potential to evaluate the effect of the COVID-19 pandemic on students’ behaviors and emotions, showing a moderate impact on sedentary activities, level of stress, and depression. These findings, although interesting, might be confirmed by the next phases of the HEALTHY-UNICT project, which aims to characterize lifestyles, dietary habits, and their relationship with anthropometric measures and emotions in a larger sample of students.

Developing a Dietary Lifestyle Ontology (DILON) to Improve the Interoperability of Dietary Data (Preprint)

BACKGROUND Dietary habits offer crucial information on one's health and form a considerable part of the Patient-Generated Health Data (PGHD). Dietary data are collected through various channels and formats; thus, interoperability is a significant challenge to reusing the data. The vast scope of dietary concepts and colloquial style of expression add difficulty to the standardization task. Common Data Elements (CDE) with metadata annotation and ontological structuring of dietary concepts address the interoperability issues of dietary data to some extent. However, challenges remaining in making culture-specific dietary habits and questionnaire-based dietary assessment data interoperable require additional efforts. OBJECTIVE The main goal of this study was to address the interoperability challenge in dietary concepts by combining ontological curation of dietary concepts and metadata annotation of questionnaire-based dietary data. Specifically, this study aimed to develop a Dietary Lifestyle Ontology (DILON) and demonstrated the improved interoperability of questionnaire-based dietary data by annotating its main semantics with DILON. METHODS By analyzing 1158 dietary assessment data elements (367 in Korean and 791 in English), 515 dietary concepts were extracted and used to construct DILON. To demonstrate the utility of DILON in improving the interoperability of multi-cultural questionnaire-based dietary data, ten Competency Questions (CQs) were developed that identified data elements that share the same dietary topics and measurement qualities. As the test cases, 68 dietary habit data elements from Korean and English questionnaires were instantiated and annotated with the dietary concepts in DILON. The competency questions were translated into Semantic Query-enhanced Web Rule Language (SQWRL), and the query results were reviewed for accuracy. RESULTS DILON was built with 260 concept classes and 486 instances and successfully validated with ontology validation tools. A small overlap (72 concepts) in the concepts extracted from the questionnaires in two languages indicates the need to pay closer attention to representing culture-specific dietary concepts. The SQWRL queries reflecting the 10 CQs yielded the correct results. CONCLUSIONS Ensuring the interoperability of dietary lifestyle data is a demanding task due to its vast scope and variations in expression. This study demonstrated that, when combined with common data elements and semantic metadata annotation, ontology can effectively mediate the interoperability of dietary data generated in different cultural contexts and expressed in various styles.

Maternal energy-adjusted fatty acid intake during pregnancy and the development of cow’s milk allergy in the offspring

Cow’s milk allergy (CMA) is one of the earliest manifestations of allergic diseases. Early dietary factors, like maternal diet during pregnancy, may play a role in the development of allergic diseases in the offspring. We aimed to investigate the association between maternal intake of fatty acids during pregnancy and the risk of CMA in the offspring. Our study was conducted in a population-based cohort, the Finnish Type 1 Diabetes Prediction and Prevention study. We collected the maternal dietary data by a validated food frequency questionnaire. We obtained the information on CMA in the study participants (n=448) from registers and from the parents. Dietary data and information on CMA were available for 4921 children. We used logistic regression in the analyses and fatty acid intakes were energy adjusted. The maternal intake of saturated fatty acids, monounsaturated fatty acids, polyunsaturated fatty acids (PUFA), n-3 PUFA, n-6 PUFA, trans fatty acids, ratio of n-3 PUFA to n-6 PUFA or ratio of linoleic acid to alpha-linolenic acid were not associated with the risk of CMA in the offspring when adjusted for perinatal factors, background factors, parental history of asthma or allergic rhinitis and infant animal contacts. The intake of alpha-linolenic acid was associated with a decreased risk (OR 0.72; 95%CI 0.56-0.93) of CMA in the offspring of mothers without a history of allergic rhinitis or asthma. In conclusion the maternal intake of fatty acids during pregnancy is not associated with the risk of CMA in the offspring.

Pulses Twice a Week in Replacement of Meat Modestly Increases Diet Sustainability

The French food-based dietary guidelines recommend eating pulses at least twice a week and to reduce meat consumption. This study assessed the impact on the sustainability characteristics (nutrition, cost, environment) of individual diets of meeting the pulse guideline. Dietary data of 2028 adults from the Esteban survey were completed with the nutritional content (considering bioavailability on iron, zinc and protein), price and environmental impacts of foods. When the pulse guideline (i.e., 57 g/day) was not met, two substitution scenarios raised the quantity of pulses to the recommended level, in replacement of an equivalent portion of (i) starches or (ii) meat. Only 9.6% of the participants reached the pulse guideline. Diet sustainability characteristics improved with the meat scenario (nutritional indicators improved; diet cost, greenhouse gas emissions and acidification decreased), while several indicators deteriorated with the starches scenario. Zinc available for absorption slightly decreased in both scenarios while iron available for absorption decreased in the meat scenario only. Increasing pulse consumption to two portions/week could modestly improve the sustainability of diets when pulses replace meat but not starches. Cultural acceptability of that substitution still needs to be proven, and iron and zinc status of individuals at risk of deficiency should be monitored.

PREFERENCE FOR DRY FISH AMONG ADOLESCENT GIRLS

Dry fish consumption is traditionally part of the diets in Andhra Pradesh. The present study aims at understanding the current trend in dry fish consumption in the context of urbanization. The study comprised of 490 college going adolescent girls (non-vegetarians) from Andhra Pradesh, India. The dietary data was elicited by the Food frequency method. The study points that dry fish is preferred by adolescents in both urban and rural areas of Andhra Pradesh.

Enteral Ca-Intake May Be Low and Affects Serum-PTH-Levels in Pre-school Children With Chronic Kidney Disease

Treatment of chronic kidney disease (CKD) mineral bone disorder (MBD) is challenging in growing children due to the high amount of calcium needed for normal bone mineralization and the required dietary phosphate restriction, which often includes intake of calcium-rich products such as milk. Therefore, enteral calcium-intake (Ca-I) was calculated.Patients: We looked at pediatric CKD-Patients aged 0–6 years.Design: We used a retrospective analysis of Ca-I from dietary data collections. Ca-I below 60% or above 100% of the D-A-CH and the KDOQI reference values were considered as severe Ca deficiency or Ca overload, respectively.Results: We had 41 children, median age 1.1 (range 0-5.8) years, body weight 7.3 (2.4–19.9) kg, and length 68 (48-105) cm at the time of first dietary data collection. Renal function was classified as CKD stage III in 20, IV in 28, V in 44, and VD in 142 dietary data collections. At the first dietary data collection, 5 children were in the CKD stage III, 10 in IV, 9 in V, and 17 were on dialysis. Only one child progressed to a higher CKD stage. In total, 234 dietary data collections were analyzed, and 65 follow-up collections were available from 33 children after a time interval of 26 (1–372) days. The median caloric intake was 120 (47–217)% of D-A-CH RDI. In 149 (63.6%) of the dietary data collections, enteral Ca-I was below the target (<100% of the D-A-CH and KDOQI RDI). Severe Ca-deficiency was found in 11 (26%) and 4 (12%) of the children at the first and second dietary data collection, respectively. In total, 11 children were on Ca-containing phosphate binders. In dietary data collection 1 and 2, there were seven children. From these, 4/7 and 4/7 patients had an enteral total Ca-I above the 100% D-A-CH-limit or above the KDOQI limit, respectively. Absolute dietary Ca-I and Ca-I normalized to body weight correlated negatively with PTH (r = −0.196, p < 0.005 and r = −0.13, p < 0.05).Conclusion: Enteral Ca-I should repeatedly be monitored in CKD children because many may may otherwise be underexposed to enteral calcium and overexposed when calcium-containing phosphate binders are given. Our findings suggest a major impact of dietary calcium supply on bone health in pediatric CKD.

Long-Term Trends in Ultra-Processed Food Consumption by Cardiometabolic Disease Status in the Framingham Offspring Study

Objectives Ultra-processed foods currently provide the majority of calories in the U.S. and are closely linked with cardiometabolic diseases. Yet, little is known regarding consumption trends among individuals with and without cardiometabolic diseases. The current analyses examined longitudinal trends in diet processing level from 1991–2008 within the Framingham Heart Study Offspring Cohort by disease status. Methods Analyses were conducted using dietary data serially collected by a food frequency questionnaire at study exams every 4 years between 1991–2008. The analytical sample included 2893 adults with valid dietary data for ≥3 exams (mean age: 54.0 y). Based on the NOVA framework, foods were classified as unprocessed/minimally processed foods, processed culinary ingredients (salt, sugar, fats and oils), culinary preparations (homemade baked goods and dishes), processed foods and ultra-processed foods. Consumption of each processing level (servings/d) were examined by calculating means, standard deviations and p-values for trends over the 4 exams. Mixed effects models with subject-specific random intercepts were used to account for within-subject correlation. Trends were stratified by prevalent cardiometabolic disease (CVD, diabetes, hypertension). Results Among individuals with cardiometabolic diseases, over 17 years of follow-up, consumption of ultra-processed foods (7.9–6.1 servings/d) and minimally processed foods (11.2–10.6 servings/d) decreased (p-trend < 0.001). Intakes of processed foods, culinary ingredients and culinary preparations changed minimally during the study period. Trends were similar among individuals without cardiometabolic diseases (ultra-processed foods 7.3 to 5.8 servings/d) and minimally processed foods (11.3–11.0 servings/d) (p-trend < 0.001). Conclusions Consumption of ultra-processed foods, a putative cardiovascular risk factor, remained high throughout the 1990s and 2000s, among aging adults, regardless of the cardiometabolic disease status. Yet, processing level has not been addressed in federal or clinical dietary guidelines. Future investigations should determine if dietary recommendations distinguishing ultra-processed from moderately and minimally processed foods facilitate healthier food choices. Funding Sources None.

The Cost of Conducting a 24-Hour Dietary Recall Using INDDEX24, a Mobile Dietary Assessment Platform, Compared to Pen-and-Paper in Viet Nam and Burkina Faso

Objectives Dietary data are rarely collected in low- and middle-income countries due to complexity, cost, and time burden. To facilitate the collection and use of individual dietary data, the International Dietary Data Expansion (INDDEX) Project has developed INDDEX24, a novel dietary assessment platform to collect and analyze 24-hr dietary recall (24HR) data. This study assessed the cost and cost-efficiency (cost per respondent) of INDDEX24 compared to the traditional pen-and-paper interview (PAPI) approach to collecting and processing 24HR data. Methods Conducted alongside validation studies of the INDDEX24 platform in Viet Nam and Burkina Faso, we carried out activity-based costing studies to estimate and compare the cost of using INDDEX24 and PAPI to conduct a 24HR survey. We defined and costed a series of activities required to complete data collection and prepare the datasets, including development of dietary reference data, survey preparation, training, survey execution, data entry, and data cleaning and processing. Results In Viet Nam, the total economic cost of the 24HR was $111,004 ($755/respondent, n = 147) using INDDEX24 and $120,483 ($820/respondent, n = 147) using the PAPI modality. In Burkina Faso, the total cost of the 24HR using INDDEX24 was $78,043 ($538/respondent, n = 145) and $78,933 ($541/respondent, n = 146) using PAPI. The higher costs in Viet Nam were primarily driven by the preparation of dietary reference data, which was an extensive and nationally focused effort, whereas in Burkina it was regionally focused and benefited from previous development of relevant dietary data. In both countries, while INDDEX24 had higher costs associated with survey preparation (including purchasing tablets and a CommCare subscription), these costs were more than offset by the higher PAPI costs associated with data entry and data cleaning and processing. Conclusions In two distinct contexts, the cost of conducting a 24HR was lower (Viet Nam) or approximately equivalent (Burkina Faso) using INDDEX24 than using PAPI. As the INDDEX24 dietary reference database is populated with reference data from which future users of INDDEX24 can draw, the cost of using INDDEX24 will likely decline further. Funding Sources The INDDEX Project is implemented by the Tufts University Friedman School of Nutrition Science and Policy with funding from The Bill & Melinda Gates Foundation.

Abstract P126: Identifying Successful Predictors Of Body Fat Reduction In The Dietfits Trial

Background: Reducing excess body fat is important for overall health, but individual success at reducing body fat varies considerably. Because dietary modification plays a key role in reducing body fat and maintaining a healthy body weight, there has been speculation if one particular dietary pattern is superior to another for losing weight. Previously we reported no significant differences in the effectiveness of either a low-carbohydrate diet or a low-fat diet for weight loss in the DIETFITs Trial. However, there is less literature that has specifically focused on body fat reduction. Therefore the purpose of this study was to assess if 12-month dietary changes were associated with body fat reduction. Methods: Participants were men and women with overweight or obesity that participated in the DIETFITS trial, a randomized clinical trial comparing the effectiveness of a healthy low-fat diet to a healthy low-carbohydrate diet for weight loss. The primary outcome was body fat percent loss, which was measured with dual-energy x-ray absorptiometry (DEXA) scans. Demographic information was collected from online surveys at baseline, dietary data were assessed from participants 24-hour recalls, and physical activity was assessed with the Stanford Seven-Day Physical Activity Recall questionnaire. Linear regression models were conducted to assess the association between changes in energy intake, dietary fat, and carbohydrates with body fat reduction, while controlling for demographic variables and physical activity. Results: Data were available for 272 participants with DEXA scans and dietary data. In the main model both baseline physical activity (coef = -0.26, p = 0.016) and changes in physical activity (coef = -0.36, p < 0.01) were significantly associated with body fat reduction. When stratified by dietary assignment, changes in physical activity remained significant for each group (low-carb group: coef = -0.30, p = 0.002 and low-fat group coef = -0.35, p = 0.006), while changes in dietary fat, as a percentage of energy intake, was associated with body fat reduction in the low-fat group only (coef = 0.15, p = 0.006). Race was also significantly associated with body fat reduction in all models, indicating non-White participants gained more body fat at the end of the intervention compared to Whites. Conclusions: The reduction in body fat appears to be mostly driven from participants increasing their physical activity levels. Identifying other predictors of body fat reduction warrant further study.

Twenty-Five-Year Trends in Dietary Patterns among Chinese Adults from 1991 to 2015

Poor dietary habits have been shown to be associated with a range of chronic diseases and can potentially be a major contributor to non-communicable diseases (NCDs) mortality. We therefore aimed to identify the prevailing dietary patterns among Chinese adults and to evaluate trends in dietary patterns from 1991 to 2015. We used data collected in the China Health and Nutrition Survey (CHNS). Dietary patterns were identified using factor analysis of data from three consecutive 24 h dietary recalls. We studied 29,238 adults aged 18 and above with complete demo-graphic and dietary data. Three distinct dietary patterns were identified: southern (high intakes of rice, vegetables, and pork), modern (high intakes of fruits, dairy products, cakes, cookies, and pastries), and meat (high intakes of organ meats, poultry, and other livestock meat). The southern pattern score decreased (mean ± SD scores in 1991: 0.11 ± 1.13; scores in 2015: −0.22 ± 0.93). The modern pattern score (mean ± SD scores in 1991: −0.44 ± 0.59; scores in 2015: 0.21 ± 1.01) and meat pattern score (mean ± SD scores in 1991: −0.18 ± 0.98; scores in 2015: 0.27 ± 0.91) increased. We observed that China has experienced a shift from traditional dietary patterns to western dietary patterns.