The use of innovative technologies is deemed to improve dietary assessment in various research settings. However, their relative merits in nutritional epidemiological studies, which require accurate ...quantitative estimates of the usual intake at individual level, still need to be evaluated.
To report on the inventory of available innovative technologies for dietary assessment and to critically evaluate their strengths and weaknesses as compared with the conventional methodologies (i.e. Food Frequency Questionnaires, food records, 24-hour dietary recalls) used in epidemiological studies.
A list of currently available technologies was identified from English-language journals, using PubMed and Web of Science. The search criteria were principally based on the date of publication (between 1995 and 2011) and pre-defined search keywords.
Six main groups of innovative technologies were identified ('Personal Digital Assistant-', 'Mobile-phone-', 'Interactive computer-', 'Web-', 'Camera- and tape-recorder-' and 'Scan- and sensor-based' technologies). Compared with the conventional food records, Personal Digital Assistant and mobile phone devices seem to improve the recording through the possibility for 'real-time' recording at eating events, but their validity to estimate individual dietary intakes was low to moderate. In 24-hour dietary recalls, there is still limited knowledge regarding the accuracy of fully automated approaches; and methodological problems, such as the inaccuracy in self-reported portion sizes might be more critical than in interview-based applications. In contrast, measurement errors in innovative web-based and in conventional paper-based Food Frequency Questionnaires are most likely similar, suggesting that the underlying methodology is unchanged by the technology.
Most of the new technologies in dietary assessment were seen to have overlapping methodological features with the conventional methods predominantly used for nutritional epidemiology. Their main potential to enhance dietary assessment is through more cost- and time-effective, less laborious ways of data collection and higher subject acceptance, though their integration in epidemiological studies would need additional considerations, such as the study objectives, the target population and the financial resources available. However, even in innovative technologies, the inherent individual bias related to self-reported dietary intake will not be resolved. More research is therefore crucial to investigate the validity of innovative dietary assessment technologies.
The EPIC-Soft program (the software initially developed to conduct 24-h dietary recalls (24-HDRs) in the European Prospective Investigation into Cancer and Nutrition (EPIC) Study) was recommended as ...the best way to standardize 24-HDRs for future pan-European dietary monitoring. Within European Food Consumption Validation (EFCOVAL), EPIC-Soft was adapted and further developed on various aspects that were required to optimize its use. In this paper, we present the structure and main interview steps of the EPIC-Soft program, after implementation of a series of new specifications deemed to satisfy specific requirements of pan-European monitoring surveys and other international studies.
Updates to optimize the EPIC-Soft program were ascertained according to the following stepwise approach: (1) identification of requested specifications to be potentially implemented through an ad hoc 'EPIC-Soft specifications questionnaire' sent to past, current and possible future users of the software; (2) evaluation of the specifications in collaboration with two ad hoc task force groups and through a workshop; (3) development of a technical solution for each retained specification; (4) implementation of the specifications by software developers; (5) testing and amendment of bugs.
A number of new specifications and facilities were implemented to EPIC-Soft program. In addition, the software underwent a full reprogramming and migration to a modern Windows environment, including changes in its internal architecture and user interface. Although the overall concept and structure of the initial software were not changed substantially, these improvements ease the current and future use of EPIC-Soft and increase further its adaptation to other countries and study contexts.
EPIC-Soft is enriched with further functions and facilities expected to fulfil specific needs of pan-European dietary monitoring and risk assessment purposes. The validity, feasibility and relevance of this software for different national and international study designs, and the logistical aspects related to its implementation are reported elsewhere.
To compare macronutrient intakes out of home-by location-to those at home and to investigate differences in total daily intakes between individuals consuming more than half of their daily energy out ...of home and those eating only at home.
Data collected through 24-h recalls or diaries among 23 766 European adults. Participants were grouped as 'non-substantial', 'intermediate' and 'very substantial out-of-home' eaters based on energy intake out of home. Mean macronutrient intakes were estimated at home and out of home (overall, at restaurants, at work). Study/cohort-specific mean differences in total intakes between the 'very substantial out-of-home' and the 'at-home' eaters were estimated through linear regression and pooled estimates were derived.
At restaurants, men consumed 29% of their energy as fat, 15% as protein, 45% as carbohydrates and 11% as alcohol. Among women, fat contributed 33% of energy intake at restaurants, protein 16%, carbohydrates 45% and alcohol 6%. When eating at work, both sexes reported 30% of energy from fat and 55% from carbohydrates. Intakes at home were higher in fat and lower in carbohydrates and alcohol. Total daily intakes of the 'very substantial out-of-home' eaters were generally similar to those of individuals eating only at home, apart from lower carbohydrate and higher alcohol intakes among individuals eating at restaurants.
In a large population of adults from 11 European countries, eating at work was generally similar to eating at home. Alcoholic drinks were the primary contributors of higher daily energy intakes among individuals eating substantially at restaurants.
To outline and discuss the main results and conclusions of the European Food Consumption Validation (EFCOVAL) Project.
The EFCOVAL Project was carried out within the EU Sixth Framework Program by ...researchers in 11 EU countries. The activities focused on (1) the further development of the EPIC-Soft software (the software developed to conduct 24-h dietary recalls (24-HDRs) in the European Prospective Investigation into Cancer and Nutrition (EPIC) Study) and the validation of the 2-day non-consecutive 24-HDR method using EPIC-Soft, (2) defining and investigating the applicability of the most appropriate dietary assessment method to younger age groups and expanding the applicability of the software for use in exposure assessment of some potentially hazardous chemicals and (3) to improve the methodology and statistical methods that estimate usual intake distributions from short-term dietary intake information and develop a methodology to quantify uncertainty in usual intake distributions.
The preexisting EPIC-Soft application was reprogrammed into a Windows environment and more than 60 new specifications were implemented in the software. A validation study showed that two non-consecutive EPIC-Soft 24-HDRs are suitable to estimate the usual intake distributions of protein and potassium of European adult populations. The 2-day non-consecutive 24-HDRs in combination with a food propensity questionnaire also appeared to be appropriate to rank individuals according to their fish and fruit and vegetable intake in a comparable way in five European centers. Dietary intake of (young) children can be assessed by the combination of EPIC-Soft 24-HDRs and food recording booklets. The EPIC-Soft-standardized method of describing foods is useful to estimate dietary exposure to potentially hazardous chemicals such as specific flavoring substances. With the developed Multiple Source Method, repeated non-consecutive 24-HDR data in combination with food propensity data can be used to estimate the population distribution of the usual intake by estimating the individual usual intakes.
The findings provide sufficient evidence to conclude that the repeated 24-HDR using EPIC-Soft for standardization in combination with a food propensity questionnaire and modeling of usual intake is a suitable method for pan-European surveillance of nutritional adequacy and food safety among healthy adults and maybe in children aged 7 years and older. To facilitate this methodology in other European countries, the next step is to provide and standardize an implementation plan that accounts for maintenance and updates, sampling designs, national surveillance programs, tailored capacity building and training, and linkage to food composition and occurrence databases.
IntroductionUnconjugated Bilirubin (UCB), the end product of heme catabolism, is a powerful antioxidant. A mild chronic elevation of circulating UCB, known as Gilbert’s Syndrome (GS), is a relatively ...common condition affecting 5%–10% (depending on ethnicity and gender) of the adult population. Individuals with endogenously elevated UCB appear to be at lower risk of developing certain diseases where oxidative stress has been implicated in the disease process, such as cancer.Material and methodsWe investigated the association between pre-diagnostic plasma UCB concentrations and risk of colorectal cancer (CRC) development in a case-control study nested within the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort, a multicenter prospective study carried out in 23 centres from 10 European countries including 5 19 978 participants.Plasma UCB was measured by High Performance Liquid Chromatography (HPLC) in 1387 cases and 1387 controls matched on age, centre, follow-up time, time of blood collection, fasting status and menopausal status in women.Odds ratios (OR) and 95% confidence intervals (CI) for CRC risk were estimated using multivariable conditional logistic regression models stratified by sex, which were adjusted for potential confounders. UCB was Log2- transformed when used as a continuous variable to improve linearity.Results and discussionsIn a multivariable model that included potential confounding factors, higher Log2- transformed UCB, corresponding to a doubling of UCB concentration, was associated with increased CRC risk in men (OR=1.27; 95% CI: 1.05,1.52; p=0.01) whereas an inverse association with CRC risk was observed in women (OR=0.83; 95% CI: 0.70,0.99; p=0.04).ConclusionThese results suggest that higher levels of circulating UCB may confer protection against CRC in women but may elevate risk in men. Additional studies are necessary to confirm these findings and to further investigate potential underlying mechanisms for the role of circulating UCB in CRC development.
The overall objective of the European Food Consumption Validation (EFCOVAL) Project was to further develop and validate a trans-European food consumption method to be used for the evaluation of the ...intake of foods, nutrients and potentially hazardous chemicals within the European population.
The EFCOVAL Project was carried out by 13 institutes from 11 European countries. The main activities were centered on the three main objectives of the project organized in different sub-projects.
In EFCOVAL, EPIC-Soft (the software developed to conduct 24-h dietary recalls (24-HDRs) in the European Prospective Investigation into Cancer and Nutrition (EPIC) Study) was reprogrammed and adapted according to prioritized specifications, resulting in a software program working under the Windows operating system. In parallel of the EPIC-Soft development, the repeated 24-HDR method using EPIC-Soft and a food propensity questionnaire was evaluated against biomarkers in 24-h urine collections and in blood samples among adults from Belgium, the Czech Republic, (the South of) France, the Netherlands and Norway. As a result from an expert workshop on a proposed dietary assessment method for children (4-12 years), the suggested method was tested in a feasibility study in Denmark and Spain among children of 4-5, 7-8 and 12-13 years. To ensure that collected data had sufficient detail in food description for the assessment of additives and contaminants to foods the EPIC-Soft databases were adapted. Finally, the EFCOVAL Consortium developed a statistical tool (Multiple Source Method) for estimating the usual intake and distribution, which has been tested using real food consumption data and compared with three other statistical methods through a simulation study. In addition, a methodology was developed to quantify uncertainty due to portion-size estimation in usual intake distributions.
The findings of EFCOVAL provide sufficient evidence to conclude that the repeated 24-HDR using EPIC-Soft for standardization in combination with a food propensity questionnaire and modeling of usual intake is a suitable method for pan-European surveillance of nutritional adequacy and food safety among healthy adults and maybe in children aged 7 years and older.
To examine the associations of socioeconomic status (SES) with dietary intake and health related factors in pregnant women. A total of 261 pregnant women attending maternity clinics in Austria. ...Descriptive cross-sectional survey using a self-administered questionnaire in combination with an interview to assess dietary intake (24-hour-recall). In the linear regression models, women with a higher level of education showed a higher intake of dietary fibre (P = 0.015), folate (P = 0.048), beta-carotene (P = 0.008), and calcium (P = 0.003), whereas the intake of total fat (P = 0.039) was lower. The mean reported prepregnancy Body Mass Index (BMI) of lower educated women (23.6 kg m⁻²) was significantly higher (p for trend = 0.018) than that of women with medium or high levels of education (21.7 and 21.6 kg m⁻², respectively). The manual occupation group was more than four times less likely to engage in structured physical activity compared with the nonmanual occupation group (adjusted odds ratio for manual group = 0.23, 95% CI: 0.08; 0.87). Education is a strong and independent predictor of nutrient intake and BMI in pregnant women. The use of occupation and household income in addition to education improves the description of socioeconomic inequalities in diet and health related factors.
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