Alcohol consumption is a modifiable risk factor for non-communicable diseases. This study aimed to characterize alcohol consumers at the nutritional, anthropometric, and sociodemographic levels. Data from 9218 participants from Argentina, Brazil, Chile, Colombia, Costa Rica, Ecuador, Peru, and Venezuela participating in “Latin American Health and Nutrition Study (ELANS)”, a multi-country, population-based study, were used. Dietary intake was collected through two, 24 h recalls. Participants were classified into consumers (n = 1073) and non-alcohol consumers (n = 8145) using a cut-off criterium of ≥15 g/day of alcohol consumption calculated from the estimation of their usual daily intake. Among alcohol consumers, the mean alcohol consumption was 69.22 ± 2.18 grams (4.6. beverages/day), contributing to 484.62 kcal, which corresponded to 16.86% of the total energy intake. We found that the risk of alcohol consumption was higher in young and middle-aged men from low and middle socioeconomic status. Argentine, Brazil, and Chile had the highest percentage of consumers, while Ecuador showed the highest alcohol consumption. Alcohol drinkers were characterized by having higher body weight and wider neck, waist, hips circumferences. Alcohol drinkers had a higher energy intake, with macronutrients providing relatively less energy at the expense of the energy derived from alcohol. Alcohol drinkers showed lower and higher consumptions of healthy and unhealthy food groups, respectively. In addition, adequacy ratios for all micronutrients assessed were lower in alcohol consumers. All these deleterious effects of alcohol on nutritional and anthropometric parameters increased with the number of alcoholic beverages consumed daily. Altogether, these findings suggest that limiting alcohol consumption can contribute to reducing the risk of obesity, metabolic syndrome, and diet-related diseases. / Universidad de Costa Rica / Revisión por pares

This study investigated Kuwait food system. Firstly the current dietary consumption of a representative sample of the Kuwaiti population was assessed. Secondly the effects of the 1990 Gulf war on Kuwait's food and nutrition system were investigated. The major part of this study was a National Diet and Nutrition Survey of people aged 20 to 65 years, which is the largest and most detailed survey ever undertaken of the diet and nutritional status of adult people in Kuwait. A food frequency questionnaire was delivered to 491 subjects (response rate 81.8%, 278 female and 213 male). In addition, a sample of 383 (response rate 207 female and 176 male) were interviewed using a 24 hour recall method. This study aimed to provide a comprehensive cross-sectional picture of the dietary habits and nutritional status of the population of Kuwait. The energy and nutrient intakes in the survey were compared with the US RDA.

Yes / Background: National guidelines emphasize healthy eating to promote wellbeing and prevention of non-communicable diseases. The perceived healthiness of food is determined by many factors affecting food intake. A positive perception of healthy eating has been shown to be associated with greater diet quality. Internet-based methodologies allow contact with large populations. Our present study aims to design and a short nutritional perception questionnaire, to be used as a screening tool for assessing nutritional status, and to predict an optimal level of personalisation in nutritional advice delivered via the Internet. Methods: Data from all participants who were screened and then enrolled into the Food4Me proof-of-principle study (n=2369) were used to determine the optimal items for inclusion in a novel screening tool, the Nutritional Perception Screening Questionnaire-9 (NPSQ9). Exploratory and confirmatory factor analyses were performed on anthropometric and biochemical data and on dietary indices acquired from participants who had completed the Food4Me dietary intervention (n=1153). Baseline and intervention data were analysed using linear regression and linear mixed regression, respectively. Results: A final model with 9 NPSQ items was validated against the dietary intervention data. NPSQ9 scores were inversely associated with BMI (β=-0.181, p<0.001) and waist circumference (Β=-0.155, p<0.001), and positively associated with total carotenoids (β=0.198, p<0.001), omega-3 fatty acid index (β=0.155, p<0.001), Healthy Eating Index (HEI) (β=0.299, p<0.001) and Mediterranean Diet Score (MDS) (β=0. 279, p<0.001). Findings from the longitudinal intervention study showed a greater reduction in BMI and improved dietary indices among participants with lower NPSQ9 scores. Conclusions: Healthy eating perceptions and dietary habits captured by the NPSQ9 score, based on 9 questionnaire items, were associated with reduced body weight and improved diet quality. Likewise, participants with a lower score achieved greater health improvements than those with higher scores, in response to personalised advice, suggesting that NPSQ9 may be used for early evaluation of nutritional status and to tailor nutritional advice. / European Union’s Seventh Framework Programme for 23 research, technological development and demonstration (grant agreement no. 265494). "la Caixa" Banking Foundation through a grant.

Background: The consequences of poor nutrition are well known and of wide concern. Governments and public health agencies utilise food and diet surveillance data to make decisions that lead to improvements in nutrition. These surveys often utilise complex sample designs for efficient data collection. There are several challenges in the statistical analysis of dietary intake data collected using complex survey designs, which have not been fully addressed by current methods. Firstly, the shape of the distribution of intake can be highly skewed due to the presence of outlier observations and a large proportion of zero observations arising from the inability of the food diary to capture consumption within the period of observation. Secondly, dietary data is subject to variability arising from day-to-day individual variation in food consumption and measurement error, to be accounted for in the estimation procedure for correct inferences. Thirdly, the complex sample design needs to be incorporated into the estimation procedure to allow extrapolation of results into the target population. This thesis aims to develop novel statistical methods to address these challenges, applied to the analysis of iron intake data from the UK National Diet and Nutrition Survey Rolling Programme (NDNS RP) and UK national prescription data of iron deficiency medication. Methods: 1) To assess the nutritional status of particular population groups a two-part model with a generalised gamma (GG) distribution was developed for intakes that show high frequencies of zero observations. The two-part model accommodated the sources of data variation of dietary intake with a random intercept in each component, which could be correlated to allow a correlation between the probability of consuming and the amount consumed. 2) To identify population groups at risk of low nutrient intakes, a linear quantile mixed-effects model was developed to model quantiles of the distribution of intake as a function of explanatory variables. The proposed approach was illustrated by comparing the quantiles of iron intake with Lower Reference Nutrient Intakes (LRNI) recommendations using NDNS RP. This thesis extended the estimation procedures of both the two-part model with GG distribution and the linear quantile mixed-effects model to incorporate the complex sample design in three steps: the likelihood function was multiplied by the sample weightings; bootstrap methods for the estimation of the variance and finally, the variance estimation of the model parameters was stratified by the survey strata. 3) To evaluate the allocation of resources to alleviate nutritional deficiencies, a quantile linear mixed-effects model was used to analyse the distribution of expenditure on iron deficiency medication across health boards in the UK. Expenditure is likely to depend on the iron status of the region; therefore, for a fair comparison among health boards, iron status was estimated using the method developed in objective 2) and used in the specification of the median amount spent. Each health board is formed by a set of general practices (GPs), therefore, a random intercept was used to induce correlation between expenditure from two GPs from the same health board. Finally, the approaches in objectives 1) and 2) were compared with the traditional approach based on weighted linear regression modelling used in the NDNS RP reports. All analyses were implemented using SAS and R. Results: The two-part model with GG distribution fitted to amount of iron consumed from selected episodically food, showed that females tended to have greater odds of consuming iron from foods but consumed smaller amounts. As age groups increased, consumption tended to increase relative to the reference group though odds of consumption varied. Iron consumption also appeared to be dependent on National Statistics Socio-Economic Classification (NSSEC) group with lower social groups consuming less, in general. The quantiles of iron intake estimated using the linear quantile mixed-effects model showed that more than 25% of females aged 11-50y are below the LRNI, and that 11-18y girls are the group at highest of deficiency in the UK. Predictions of spending on iron medication in the UK based on the linear quantile mixed-effects model showed areas of higher iron intake resulted in lower spending on treating iron deficiency. In a geographical display of expenditure, Northern Ireland featured the lowest amount spent. Comparing the results from the methods proposed here showed that using the traditional approach based on weighted regression analysis could result in spurious associations. Discussion: This thesis developed novel approaches to the analysis of dietary complex survey data to address three important objectives of diet surveillance, namely the mean estimation of food intake by population groups, identification of groups at high risk of nutrient deficiency and allocation of resources to alleviate nutrient deficiencies. The methods provided models of good fit to dietary data, accounted for the sources of data variability and extended the estimation procedures to incorporate the complex sample survey design. The use of a GG distribution for modelling intake is an important improvement over existing methods, as it includes many distributions with different shapes and its domain takes non-negative values. The two-part model accommodated the sources of data variation of dietary intake with a random intercept in each component, which could be correlated to allow a correlation between the probability of consuming and the amount consumed. This also improves existing approaches that assume a zero correlation. The linear quantile mixed-effects model utilises the asymmetric Laplace distribution which can also accommodate many different distributional shapes, and likelihood-based estimation is robust to model misspecification. This method is an important improvement over existing methods used in nutritional research as it explicitly models the quantiles in terms of explanatory variables using a novel quantile regression model with random effects. The application of these models to UK national data confirmed the association of poorer diets and lower social class, identified the group of 11-50y females as a group at high risk of iron deficiency, and highlighted Northern Ireland as the region with the lowest expenditure on iron prescriptions.

Thesis (M.Sc.) - University of KwaZulu-Natal, Pietermaritzburg, 2009. / Full text also available online. Scroll down for electronic link.

abstract: The rate of obesity has increased noticeably in China since the 1980s, brought about by the "After Mao" revolution. This dissertation examines the social determinants of obesity and weight gain among men and women, using 1991-2009 waves of the longitudinal China Health and Nutrition Survey. The first study emphasizes that rapid technological adoption at home may also have the potential to lead to obesity epidemics. I hypothesize that adopting household technology is a factor in weight gain, independent from daily calorie consumption and energy expenditure in exercise. The results show household technology ownership and weight gain are linked, while changes in overall energy intake and exercise may not function as mediators for this relationship. Future public health policy may evaluate interventions that are focused on increasing low-intensity activities impacted by household technologies. My second study discusses whether obesity wage penalties seen in Western societies, such as wage reductions for obese individuals, are observed in modern China. The results indicate that obese women are not subject to wage penalties, while current male obesity rates may be worsened by heightened economic outcomes and greater social acceptance by customers and colleagues. With increasing interpersonal interactions in the workplace in Chinese industries, and the lack of public awareness of the risks of obesity, Chinese public health strategies for preventing and controlling obesity should target male non-manual laborers, the most vulnerable population in the future. The third study analyzes the impact of parental and own socioeconomic status on adult body weight and extends the research by estimating the influence of intergenerational social mobility on current body mass index. In the context of increasing social inequality in China, the study shows parental SES, own SES, and social mobility to be negatively associated with body mass index among women; while respondent's SES is positively associated with body mass index among men. The study results support the theory that parental SES has a more significant impact on current body weight for men and women after controlling social mobility; indicating that social mobility may function as a mediator for the relationship between parental SES and current body mass index. / Dissertation/Thesis / Doctoral Dissertation Sociology 2014

Although higher dietary intake of MUFA has been shown to improve glycaemic control and lipid profiles, whether MUFA consumption from different sources is linked to the development of type 2 diabetes (T2D) remains unclear. We aimed to prospectively assess the associations of plant-derived MUFA (P-MUFA) and animal-derived MUFA (A-MUFA) intakes with T2D risk in a nationwide oriental cohort. Overall, 15 022 Chinese adults, aged andhe;20 years, from the China Health and Nutrition Survey (CHNS 1997-2011) were prospectively followed up for a median of 14 years. Consumption of MUFA from plant and animal sources was assessed using 3-d 24-h recalls in each survey, and the cumulative average of intake was calculated. Multivariable-adjusted Cox models were constructed to estimate the hazard ratios (HR) of T2D according to quartiles of MUFA intake. P-MUFA were mainly consumed from cooked vegetable oils, fried bread sticks and rice, while A-MUFA were mainly consumed from pork, lard and eggs. Intake of P-MUFA was associated with a higher risk of T2D (HRQ4 v. Q1 1-50 (95 % CI 1-18, 1-90); Ptrend = 0-0013), whereas A-MUFA showed no significant association (HRQ4 v. Q1 0-84 (95 % CI 0-59, 1-20); Ptrend = 0-30). When further considering the cooking method of food sources, consumption of P-MUFA from fried foods was positively associated with T2D risk (HRQ4 v. Q1 1-60 (95 % CI 1-26, 2-02); Ptrend = 0-0006), whereas non-fried P-MUFA were not associated. Intake of MUFA from fried plant-based foods may elevate T2D risk among the Chinese population.

Made available in DSpace on 2014-08-20T13:58:01Z (GMT). No. of bitstreams: 1 SAMANTA_WINCK_MADRUGA_dissertacao.pdf: 758831 bytes, checksum: 861d7f5231fc60c8a7680294bd36e0d6 (MD5) Previous issue date: 2006-11-10 / OBJECTIVE: To verify the prevalence of inadequate dietary fiber consumption habit and evaluate its association with socioeconomic, demographic and behavioral characteristics. DESIGN: A cross-sectional population-based study. SETTINGS: Pelotas-RS. The city holds nearly 320.000 inhabitants and is located in Southern Brazilian. SUBJECTS: A representative sample of the population was selected by a two-stage strategy; 3993 subjects (≥ 10 years) were interviewed. RESULTS: Sample was mostly female, white skin color and nearly 70% belonged to C socioeconomic level or lower. Inadequate dietary fiber consumption habit was positive for 65.6% (CI95% 64.2 67.1) of the sample. A higher prevalence was observed among men and teenagers. Adjusted analysis for the overall sample showed an association between inadequate fiber consumption habit and male, adolescents, lower socioeconomic level, current smoker, sufficiently active and people having under four daily meals. The age group-stratified analysis showed different associated factors. For the adolescents group, living alone was a risk factor to inadequate dietary fiber consumption, for the adults group sex (male), current smoker, sufficiently active and under four daily meals and, among the elderly just sex (male) and current smoker. Lower socioeconomic level was associated to the outcome in all groups. CONCLUSIONS: Inadequate fiber consumption habit is highly prevalent in the population. We must highlight that, although inadequate intake is very common, teenagers are at a higher risk, suggesting public health actions focusing this particular age group. Public health initiatives to improve eating patterns, concerning fiber consumption habits, must consider the contrast derived from associated factors. / O consumo diário de fibras faz parte do que se chama de uma dieta saudável . É um item alimentar importante na prevenção e controle de doenças crônicas tais como Diabete Mellitus, doenças do coração, colesterol e triglicerídeos elevados, além de ter papel fundamental no funcionamento do trânsito gastrointestinal prevenindo e tratando a prisão de ventre (constipação), complicação tão comum entre as pessoas atualmente. Além disso, um consumo ideal de fibras está cientificamente comprovado como fator auxiliar na perda de peso. O presente estudo investigou o hábito inadequado de consumo de fibras alimentares e seus fatores associados, na população de Pelotas-RS, como parte da dissertação de Mestrado em Epidemiologia pela Universidade Federal de Pelotas. A pesquisa ocorreu entre os meses de outubro e dezembro de 2005, quando 1507 domicílios de nossa cidade foram visitados. Desta forma, 3993 indivíduos com idade igual ou maior que 10 anos responderam ao questionário. A pesquisa mostrou que aproximadamente 65% da população não consome fibras alimentares adequadamente, sendo que os homens consomem menos alimentos ricos em fibras (71%) do que as mulheres (62%). A pesquisa mostra ainda que os adolescentes (10 - 19 anos) foram os que apresentaram maior percentual de hábito inadequado de consumo de fibras alimentares (78%) quando comparados aos adultos (64%) e aos idosos (55%). Os indivíduos de menor nível socioeconômico também 85 apresentaram maiores percentuais de consumo inadequado em relação aos níveis socioeconômicos mais altos. O trabalho ainda concluiu que fumar, ser sedentário, realizar menos de quatro refeições diárias e fazer refeições fora de casa, apresentam maiores riscos de consumir um dieta pobre em fibras alimentares. Sendo assim, recomenda-se que campanhas e programas de saúde pública sejam realizados no sentido de incentivar o consumo de alimentos ricos em fibras principalmente entre escolares e adolescentes pois existem evidências de que hábitos alimentares adquiridos na infância e adolescência podem ser precursores de hábitos saudáveis na vida adulta.