Nutritional Profiles of U.S. Adults With Suboptimal Dietary Creatine Intake

Objectives We determined the prevalence of inadequate dietary intake of creatine and described nutritional profiles of individuals with low creatine intake in U.S. adults using data from the 2017–2018 National Health and Nutrition Examination Survey (NHANES) round. Methods Data for this study were obtained from the latest round of NHANES 2017–2018. Detailed dietary intake information from adult NHANES participants was obtained by dietary interview component through two 24-hour dietary recall interviews. To calculate creatine intake, we first identified meat-based protein foods using 8-digit USDA food codes organized in five database subgroups using dietary interview entry for individual foods. Next, we recorded the gram weight of each food/individual component containing meat-based protein, and calculated the net intake of meat-based protein for each respondent by merging all relevant food items on daily basis. Individual values for total grams of creatine consumed per day for each respondent were computed using the average amount of creatine (3.88 g/kg) across all sources of meat-based protein. A threshold for dietary intake of creatine was set at 1.00 gram per day, with respondents were classified into two subpopulations with the suboptimal intake of creatine (<1.00 g/day) or recommended intake (dietary creatine ³ 1.00 g/day). Results Among 4,004 NHANES adult participants that reported detailed dietary intake information, 2,611 (65.2%) were calculated to have dietary creatine intake below recommended levels of 1.00 g/day. The average daily creatine intake in this subpopulation was 0.52 ± 0.26 g (95% confidence interval, from 0.51 to 0.53). This was accompanied by a significantly lower dietary intake of meat-based protein, as compared to participants whose dietary creatine intake was equal to or above recommended levels (20.1 ± 10.2 g/day vs. 67.1 ± 30.4 g/day; P < 0.001). Conclusions The large-scale rate of suboptimal dietary creatine intake found in this cross-sectional study warrants additional research, and calls for immediate public health measures fostering creatine-rich foods in human nutrition. Funding Sources None.

Assessment of the contribution of calcium and vitamin D in the diet of the elderly

Introduction. The rate of aging and the possible coexistence of diet-related diseases are largely determined by the nutrition and lifestyle of the elderly. Therefore, it is important to assess the degree of coverage of organism demand for such nutrients as calcium and vitamin D in the elderly population. Aim. The aim of the study was to determine the impact of age on calcium and vitamin D supply in daily alimentary rations of the elderly as well as their nutritional behaviour in terms of consumption of products which are the source of these nutrients. Material and methods. The study involved 42 subjects aged from 60 to 85 years. The vitamin D and calcium content in daily food rations was assessed with the method of a 24-hour dietary interview carried out in triplicate. Results. The nutrition of the elderly turned out to be inappropriate in terms of supplying the organism with calcium and vitamin D, and this was not age dependent. The average calcium and vitamin D supply in the daily food rations was estimated at 455.53 mg/day and 2.31 μg/day, respectively. The demand for calcium was covered in the range of 31-60% of RDA in over 60% of the elderly and the vitamin D demand was met in 30% of AI in over 80% of the subjects. Conclusions. The assessment of the daily food rations indicates a necessity for increasing the intake of calcium- and vitamin D-rich food products and dietary supplementation with these components.

Ingesting Self-Grown Produce and Seropositivity for Hepatitis E in the United States

Background. Hepatitis E virus (HEV) is a major cause of hepatitis in developing and industrialized countries worldwide. The modes of HEV transmission in industrialized countries, including the United States, remain largely unknown. This study is aimed at evaluating the association between HEV seropositivity and consumption of self-grown foods in the United States. Methods. Cross-sectional data was extracted from the 2009–2012 National Health and Nutrition Examination Survey (NHANES). Data from the dietary interview and the serum HEV IgG and IgM enzyme immunoassay test results were linked and examined. Univariate and multivariable logistic regression models were used to evaluate the significance and effect size of an association between self-grown food consumption and hepatitis E seropositivity. Results. The estimated HEV seroprevalence in the civilian, noninstitutionalized US population was 6.6% in 2009–2012, which corresponds to an estimated hepatitis E national seroprevalence of 17,196,457 people. Overall, 10.9% of participants who ingested self-grown foods had positive HEV antibodies versus 6.1% of participants who did not consume self-grown foods (P<0.001; odds ratio (OR) 1.87; 95% CI 1.41–2.48). In the age-stratified multivariable analysis, the correlation between ingesting self-grown foods and HEV seropositivity was significant for participants 40–59 years old, but not overall, or for those < 40 years or ≥60 years. Conclusions. Ingesting self-grown food, or simply the process of gardening/farming, may be a source of zoonotic HEV transmission.

Diet misreporting can be corrected: confirmation of the association between energy intake and fat-free mass in adolescents

Subjective energy intake (sEI) is often misreported, providing unreliable estimates of energy consumed. Therefore, relating sEI data to health outcomes is difficult. Recently, Börnhorst et al. compared various methods to correct sEI-based energy intake estimates. They criticised approaches that categorise participants as under-reporters, plausible reporters and over-reporters based on the sEI:total energy expenditure (TEE) ratio, and thereafter use these categories as statistical covariates or exclusion criteria. Instead, they recommended using external predictors of sEI misreporting as statistical covariates. We sought to confirm and extend these findings. Using a sample of 190 adolescent boys (mean age=14), we demonstrated that dual-energy X-ray absorptiometry-measured fat-free mass is strongly associated with objective energy intake data (onsite weighted breakfast), but the association with sEI (previous 3-d dietary interview) is weak. Comparing sEI with TEE revealed that sEI was mostly under-reported (74 %). Interestingly, statistically controlling for dietary reporting groups or restricting samples to plausible reporters created a stronger-than-expected association between fat-free mass and sEI. However, the association was an artifact caused by selection bias – that is, data re-sampling and simulations showed that these methods overestimated the effect size because fat-free mass was related to sEI both directly and indirectly via TEE. A more realistic association between sEI and fat-free mass was obtained when the model included common predictors of misreporting (e.g. BMI, restraint). To conclude, restricting sEI data only to plausible reporters can cause selection bias and inflated associations in later analyses. Therefore, we further support statistically correcting sEI data in nutritional analyses. The script for running simulations is provided.

A score that verifies adherence to a gluten-free diet: a cross-sectional, multicentre validation in real clinical life

A dietary interview performed by expert personnel is the best method to check whether patients with coeliac disease follow a strict gluten-free diet (GFD). We previously developed a score based on four fast and simple questions that can be administered even by non-expert personnel. The aim of the present study is to verify the reliability of our questionnaire in a new cohort of patients. The questionnaire has a five-level score. From March 2008 to January 2011, the questionnaire was administered to 141 coeliac patients on a GFD, who were undergoing re-evaluation. The score obtained was compared with persistence of both villous atrophy and endomysial antibodies (EMA). The rate of lower scores was higher among the patients with persistence of either villous atrophy (Fisher's exact, P < 0·001; test for trend, P < 0·001) or positive EMA (Fisher's exact, P = 0·001; test for trend, P = 0·018). Given that the coeliac patients have been well instructed on what a GFD means and on how to follow it, our questionnaire is a reliable and simple method to verify compliance to a GFD.

A gluten-free diet score to evaluate dietary compliance in patients with coeliac disease

A dietary interview performed by expert personnel is considered to be the most appropriate tool to check whether patients with coeliac disease follow a strict gluten-free diet. However, we currently have no straightforward and non-subjective method for performing such a dietary interview. We therefore developed a fast questionnaire based on four simple questions with a five-level score (0–IV). To verify whether our questionnaire is an efficient tool, we applied it to 168 coeliac patients (126 females and 42 males; mean age 42·4 (sd 12·9) years) on a gluten-free diet (median 82, 25th–75th percentile 50–108, range 15–389 months). The score we obtained was compared with the persistence of both villous atrophy and endomysial antibodies while on a gluten-free diet. A comparison with survival of the patients was also performed. Patients were interviewed over the phone by non-expert personnel. The questionnaire was completed in less than 1 min. The lowest results were significantly more frequent among the patients with a persistence of both villous atrophy and positive endomysial antibodies. Death risk was also significantly correlated with the lowest score results. We conclude that our questionnaire is a reliable and simple method of verifying compliance with a gluten-free diet.

Children's estimates of food portion size: the effect of timing of dietary interview on the accuracy of children's portion size estimates

For food intakes to be converted into nutrient intakes a measure or estimate of the amount of food consumed is required. A number of methods have been developed to assist subjects in providing an estimate of portion size. Children's ability to use perception, conceptualisation and memory skills to estimate food portion size has not been investigated systematically. The aim of the present study was to test the effect of the timing of a dietary interview on the accuracy of estimates of food portion sizes made by children, using food photographs, food models and an interactive portion size assessment system, developed for use with children and based on portion sizes of foods consumed by children. Children (n 108) aged 4–14 years were supplied with known quantities of foods and asked to estimate the portion size of each food using each of the three portion size assessment tools. Interviews took place (a) with the food in view, (b) just after the child had eaten the food or (c) 24 h after the child had eaten the food. There were no significant differences in children's ability to estimate food portion size (either as served or as eaten) with timing of interview. That is, children were as accurate in their estimates of portion size 24 h after consuming the food as when the food was in view. Under these conditions many children were able to estimate food portion size utilising perception, conceptualisation and memory skills.