There is strong evidence that the intake of EPA and DHA reduces the risk of adverse cardiac events. Fish and fish oil capsules are not necessarily an ideal source of EPA and DHA for every individual. The aim of the present study was to evaluate the effect of a convenience drink enriched with 500 mg EPA and DHA on the n-3 index, a biomarker of EPA and DHA status in an individual. Of the 190 subjects with atherosclerotic disease screened between February and June 2009, 50 were recruited based on an n-3 index < 5 %. Participants were randomly assigned to receive a convenience drink supplemented either with n-3 fatty acids (n 40, 200 mg EPA and 300 mg DHA) or placebo (n 10, 1·1 g linoleic acid, C18 : 2n-6, from maize oil) daily for 8 weeks. The primary end point was a change in the n-3 index. Intention-to-treat analysis was done. After 8 weeks of daily intake of 200 mg EPA+300 mg DHA, the mean n-3 index increased from 4·37 (sd 0·51) to 6·80 (sd 1·45) % (P < 0·001). Interindividual variability in response was high (CV of the Δ, cv = 0·21). The control group showed no change in the n-3 index. The results showed that daily intake of a convenience drink supplemented with n-3 fatty acids leads to a significant increase of the n-3 index with high interindividual variability in response. Dose and preparation used were safe, well tolerated and highly palatable.

Serotonergic hypofunction is associated with a depressive mood state, an increased drive to eat and preference for sweet (SW) foods. High-trait anxiety individuals are characterised by a functional shortage of serotonin during stress, which in turn increases their susceptibility to experience a negative mood and an increased drive for SW foods. The present study examined whether an acute dietary manipulation, intended to increase circulating serotonin levels, alleviated the detrimental effects of a stress-inducing task on subjective appetite and mood sensations, and preference for SW foods in high-trait anxiety individuals. Thirteen high- (eleven females and two males; anxiety scores 45·5 (sd 5·9); BMI 22·9 (sd 3·0)kg/m2) and twelve low- (ten females and two males; anxiety scores 30·4 (sd 4·8); BMI 23·4 (sd 2·5) kg/m2) trait anxiety individuals participated in a placebo-controlled, two-way crossover design. Participants were provided with 40 g α-lactalbumin (LAC; l-tryptophan (Trp):large neutral amino acids (LNAA) ratio of 7·6) and 40 g casein (placebo) (Trp:LNAA ratio of 4·0) in the form of a snack and lunch on two test days. On both the test days, participants completed a stress-inducing task 2 h after the lunch. Mood and appetite were assessed using visual analogue scales. Changes in food hedonics for different taste and nutrient combinations were assessed using a computer task. The results demonstrated that the LAC manipulation did not exert any immediate effects on mood or appetite. However, LAC did have an effect on food hedonics in individuals with high-trait anxiety after acute stress. These individuals expressed a lower liking (P = 0·012) and SW food preference (P = 0·014) after the stressful task when supplemented with LAC.

Increased intake of marine long-chain n-3 PUFA (n-3 LCPUFA) may decrease the risk of CVD and reduce mortality by lowering serum TAG and blood pressure (BP). Furthermore, n-3 LCPUFA may affect novel CVD risk markers related to inflammation and vascular function. The objective of the present study was to examine the effect of farmed trout on novel and traditional CVD risk markers in healthy men, and to evaluate whether this was affected by the aquacultural feed regime. We performed a parallel, 8-week intervention study in which sixty-eight healthy male volunteers were randomised to consume either a daily meal with 150 g farmed trout raised on either marine or vegetable-based feed, or a reference meal containing 150 g chicken. Twenty-four hour BP, pulse wave velocity, augmentation index, fatty acid composition of erythrocyte (RBC), and concentrations of TAG, HDL-cholesterol, LDL-cholesterol, glucose, insulin, C-reactive protein (CRP) and other markers of inflammation were measured at weeks 0 and 8. RBC content of total n-3 LCPUFA, both EPA and DHA, was significantly higher among men consuming trout raised on marine feed compared with men consuming the vegetable-fed trout or chicken. The three intervention groups did not differ significantly with respect to any of the other outcome variables, although there were trends towards associations between the changes in RBC n-3 LCPUFA and those in BP and CRP. In the present study, we conclude that we could not confirm the fish oil-induced reduction in CVD risk markers after daily consumption of trout with high or low n-3 LCPUFA content. However, trout raised on vegetable-based feed had less pronounced impact on RBC n-3 LCPUFA status.

Poor nutrient intake during pregnancy can adversely affect both infant and maternal health. The aim was to investigate the efficacy of multiple-micronutrient supplementation during pregnancy in a socially deprived population in the developed world. We conducted a randomised, double-blind, placebo-controlled trial of multiple-micronutrient supplementation including 20 mg Fe and 400 μg folic acid, from the first trimester of pregnancy in 402 mothers, in East London, UK. Nutrient status was measured at recruitment, and at 26 and 34 weeks of gestation. Infants were weighed at birth. At recruitment the prevalence of anaemia was 13 %, vitamin D insufficiency 72 %, thiamin deficiency 12 % and folate deficiency 5 %, with no differences between groups. Only 39 % of women completed the study; rates of non-compliance were similar in both groups. Intention-to-treat analysis showed that participants receiving treatment had higher mean Hb at 26 weeks of gestation (110 (sd 10) v.108 (sd 10) g/l; P = 0·041) and 34 weeks of gestation (113 (sd 12) v.109 (sd 10) g/l; P = 0·003) and packed cell volume concentrations at 26 weeks of gestation (0·330 (sd 0·025) v. 0·323 (sd 0·026) l/l; P = 0·011) and 34 weeks of gestation (0·338 (sd 0·029) v. 0·330 (sd 0·028) l/l; P = 0·014) compared with controls. Analysis of compliant women showed supplemented women had higher median concentrations of serum ferritin, erythrocyte folate and 25-hydroxyvitamin D later in gestation than controls. In the compliant subset (n 149), placebo mothers had more small-for-gestational age (SGA) infants (eight SGA v. thirteen; P = 0·042) than treatment mothers. Baseline micronutrient deficiencies were common; the multiple-micronutrient supplement was well-tolerated and improved nutrient status. Multiple-micronutrient supplements from early pregnancy may be beneficial and larger studies are required to assess impact on birth outcomes and infant development.

Predictive power, for total and vascular mortality, of selected indices measured at baseline in the British National Diet and Nutrition Survey (community-living subset) of People Aged 65 Years and Over was tested. Mortality status and its primary and underlying causes were recorded for 1100 (mean age 76·7 (sd 7·5) years, 50·2 % females) respondents from the baseline survey in 1994–5 until September 2008. Follow-up data analyses focussed especially on known predictors of vascular disease risk, together with intakes and status indices of selected nutrients known to affect, or to be affected by, these predictors. Total mortality was significantly predicted by hazard ratios of baseline plasma concentrations (per sd) of total homocysteine (tHcy) (95 % CI) 1·19 (1·11, 1·27), pyridoxal phosphate 0·90 (0·81, 1·00), pyridoxic acid 1·10 (1·03, 1·19), α1-antichymotrypsin 1·21 (1·13, 1·29), fibrinogen 1·14 (1·05, 1·23), creatinine 1·20 (1·10, 1·31) and glycosylated Hb 1·23 (1·14, 1·32), and by dietary intakes of energy 0·87 (0·80, 0·96) and protein 0·86 (0·77, 0·97). Prediction patterns and significance were similar for primary-cause vascular mortality. The traditional risk predictors plasma total and HDL cholesterol were not significant mortality predictors in this age group, nor were the known tHcy-regulating nutrients, folate and vitamin B12 (intakes and status indices). Model adjustment for known risk predictors resulted in the loss of significance for some of the afore-mentioned indices; however, tHcy 1·34 (1·04, 1·73) remained a significant predictor for vascular mortality. Thus, total and primary vascular mortality is predicted by energy and protein intakes, and by biochemical indices including tHcy, independent of serum folate or vitamin B12.

Previous studies have suggested that daidzein's metabolites, equol and O-desmethylangolensin (O-DMA), rather than daidzein itself may contribute to the beneficial effects of soya foods in the prevention of CVD. The present study aims to assess the proportion of equol and O-DMA producers, and to compare differences in anthropometric factors, serum lipids, glucose and uric acid between producers and non-producers in Chinese adults aged 20–69 years. For the present cross-sectional study, 202 subjects (100 women and 102 men) were recruited. Twenty-four-hour urinary daidzein and its metabolites were determined in these subjects while on their usual diet and again after a 3-d isoflavone challenge. Fasting serum lipids, glucose and uric acid were examined on their usual diet. Three days of 24 h dietary recalls were used to assess dietary intakes. Of the 202 subjects, 27 (13·4 %) and 27 (13·4 %) excreted equol and O-DMA on their usual diet, and 101 (50 %) and 94 (46·5 %) produced equol and O-DMA after a load of 80 mg/d isoflavones. Equol producers showed lower serum uric acid ( − 10·2 %, P = 0·001), TAG ( − 29·5 %, P = 0·007) and waist:hip ratio ( − 2·6 %, P = 0·032), and tended to have higher HDL cholesterol (6·3 %, P = 0·069) compared with equol non-producers. There were no significant differences in serum lipids, glucose and uric acid between O-DMA producers and non-producers. In conclusion, equol phenotypes might influence cardiovascular risk.

The prevalence of hypertension has increased over the past decade in many developed and developing countries, including China. This increase may be associated with changes in lifestyle, including dietary patterns. We evaluated the association of dietary patterns with blood pressure (BP) by using data from a large, population-based cohort study of middle-aged and elderly Chinese men, the Shanghai Men's Health Study. The present cross-sectional analysis includes 39 252 men who reported no prior history of hypertension, diabetes, CHD, or stroke nor use of antihypertensive drugs at study enrolment. Three dietary patterns, ‘vegetable’, ‘fruit and milk’ and ‘meat’, were derived using factor analysis. The fruit and milk diet was inversely associated with both systolic and diastolic BP (Ptrend < 0·001). The adjusted mean systolic BP was 2·9 mmHg lower (95 % CI − 3·4, − 2·4), and diastolic BP was 1·7 mmHg lower (95 % CI − 2·0, − 1·4) for men in the highest quintile of the ‘fruit and milk’ pattern compared with men in the lowest quintile. This inverse association was more evident among heavy drinkers; the highest quintile of the ‘fruit and milk’ pattern was associated with a 4·1 mmHg reduction in systolic BP v. a 2·0 mmHg reduction among non-drinkers (Pinteraction = 0·003) compared to the lowest quintile. The corresponding reductions in diastolic BP were 2·0  v. 1·3 mmHg (Pinteraction = 0·011). The ‘fruit and milk’ pattern was associated with a lower prevalence of both pre-hypertension and hypertension, and the associations appeared to be stronger among drinkers. Results of the present study suggest an important role for diet in the prevention of hypertension.

In the UK, South Asian adults have increased risks of CHD, type 2 diabetes and central obesity. Black African-Caribbeans, in contrast, have increased risks of type 2 diabetes and general obesity but lower CHD risk. There is growing evidence that these risk differences emerge in early life and that nutritional factors may be important. We have therefore examined the variations in nutritional composition of the diets of South Asian, black African-Caribbean and white European children, using 24 h recalls of dietary intake collected during a cross-sectional survey of cardiovascular health in eighty-five primary schools in London, Birmingham and Leicester. In all, 2209 children aged 9–10 years took part, including 558 of South Asian, 560 of black African-Caribbean and 543 of white European ethnicity. Compared with white Europeans, South Asian children reported higher mean total energy intake; their intakes of total fat, polyunsaturated fat and protein (both absolute and as proportions of total energy intake) were higher and their intakes of carbohydrate as a proportion of energy (particularly sugars), vitamin C and D, Ca and haem Fe were lower. These differences were especially marked for Bangladeshi children. Black African-Caribbean children had lower intakes of total and saturated fat (both absolute and as proportions of energy intake), NSP, vitamin D and Ca. The lower total and saturated fat intakes were particularly marked among black African children. Appreciable ethnic differences exist in the nutritional composition of children's diets, which may contribute to future differences in chronic disease risk.

Recommendations for whole-grain (WG) intake are based on observational studies showing that higher WG consumption is associated with reduced CVD risk. No large-scale, randomised, controlled dietary intervention studies have investigated the effects on CVD risk markers of substituting WG in place of refined grains in the diets of non-WG consumers. A total of 316 participants (aged 18–65 years; BMI>25 kg/m2) consuming < 30 g WG/d were randomly assigned to three groups: control (no dietary change), intervention 1 (60 g WG/d for 16 weeks) and intervention 2 (60 g WG/d for 8 weeks followed by 120 g WG/d for 8 weeks). Markers of CVD risk, measured at 0 (baseline), 8 and 16 weeks, were: BMI, percentage body fat, waist circumference; fasting plasma lipid profile, glucose and insulin; and indicators of inflammatory, coagulation, and endothelial function. Differences between study groups were compared using a random intercepts model with time and WG intake as factors. Although reported WG intake was significantly increased among intervention groups, and demonstrated good participant compliance, there were no significant differences in any markers of CVD risk between groups. A period of 4 months may be insufficient to change the lifelong disease trajectory associated with CVD. The lack of impact of increasing WG consumption on CVD risk markers implies that public health messages may need to be clarified to consider the source of WG and/or other diet and lifestyle factors linked to the benefits of whole-grain consumption seen in observational studies.

The authors automated the selection of foods in a computer system that compiles and processes tailored FFQ. For the selection of food items, several methods are available. The aim of the present study was to compare food lists made by MOM2, which identifies food items with highest between-person variance in intake of the nutrients of interest without taking other items into account, with food lists made by forward regression. The name MOM2 refers to the variance, which is the second moment of the nutrient intake distribution. Food items were selected for the nutrients of interest from 2 d of recorded intake in 3524 adults aged 25–65 years. Food lists by 80 % MOM2 were compared to those by 80 % explained variance for regression on differences between the number and type of food items, and were evaluated on (1) the percentage of explained variance and (2) percentage contribution to population intake computed for the selected items on the food list. MOM2 selected the same food items for Ca, a few more for fat and vitamin C, and a few less for carbohydrates and dietary fibre than forward regression. Food lists by MOM2 based on 80 % of variance in intake covered 75–87 % of explained variance for different nutrients by regression and contributed 53–75 % to total population intake. Concluding, for developing food lists of FFQ, it appears sufficient to select food items based on the contribution to variance in nutrient intake without taking covariance into account.

Two types of relatively high-protein diets, with a normal or low proportion of carbohydrates, have been shown effective for weight loss. The objective was to assess the significance of the presence or absence of carbohydrates and the proportion of fat in high-protein diets for affecting appetite suppression, energy expenditure, and fat oxidation in normal-weight subjects in energy balance. Subjects (aged 23 (sd 3) years and BMI 22·0 (sd 1·9) kg/m2) were stratified in two groups. Each was offered two diets in a randomised cross-over design: group 1 (n 22) – normal protein (NP; 10, 60 and 30 % energy (En%) from protein, carbohydrate and fat), high protein (HP; 30, 40 and 30 En%); group 2 (n 23) – normal protein (NP-g; 10, 60 and 30 En%), high protein, carbohydrate-free (HP-0C; 30, 0 and 70 En%) for 2 d; NP-g and HP-0C were preceded by glycogen-lowering exercise (day 1). Appetite was measured throughout day 2 using visual analogue scales (VAS). Energy expenditure (EE) and substrate oxidation (respiratory quotient; RQ) were measured in a respiration chamber (08.00 hours on day 2 until 07.30 hours on day 3). Fasting plasma β-hydroxybutyrate (BHB) concentration was measured (day 3). NP-g and NP did not differ in hunger, EE, RQ and BHB. HP-0C and HP v. NP-g and NP, respectively, were lower in hunger (P < 0·05; P < 0·001) and RQ (P < 0·01; P < 0·001) and higher in EE (P < 0·05; P = 0·07) and BHB (P < 0·05; P < 0·001). Hunger and RQ were lower with HP-0C than HP (693 (sd 208) v. 905 (sd 209) mm VAS × 24 h, P < 0·01; 0·76 (sd 0·01) v. 0·81 (sd 0·02), P < 0·01); BHB was higher (1349 (sd 653) v. 332 (sd 102) μmol/l; P < 0·001). ΔHunger, ΔRQ, and ΔBHB were larger between HP-0C–NP-g than between HP–NP ( − 346 (sd 84) v. − 107 (sd 52) mm VAS ×  24 h, P < 0·01; − 0·09 (sd 0·00) v. − 0·05 (sd 0·00), P < 0·001; 1115 (sd 627) v. 104 (sd 42) μmol/l, P < 0·001). In conclusion, appetite suppression and fat oxidation were higher on a high-protein diet without than with carbohydrates exchanged for fat. Energy expenditure was not affected by the carbohydrate content of a high-protein diet.

Few studies have addressed the relation between dietary patterns and colorectal cancer in Japan. We investigated dietary patterns in relation to colorectal cancer risk in a community-based case–control study. The association with dietary patterns was also examined for different sites of colorectal cancer. Data were derived from the Fukuoka Colorectal Cancer Study, including 800 cases and 775 controls interviewed from September 2000 to December 2003. The cases were admitted to one of the participating hospitals for the first surgical treatment during this period. We identified dietary patterns using principal component analysis of intakes of twenty-nine items of food groups and specific foods. Quartile categories of each dietary pattern were used, and non-dietary lifestyle factors and total energy intake were adjusted for in the analysis. We identified three dietary patterns: prudent, high-fat and light-meal patterns. The prudent dietary pattern characterised by high intakes of vegetables, fruits, seafoods and soya foods showed a nearly significant protective association with the overall risk of colorectal cancer (trend P = 0·054), and it was statistically significantly related to a decreased risk of distal colon cancer (trend P = 0·002), but not to that of either proximal colon or rectal cancer. The high-fat and light-meal dietary patterns were not materially related to the overall or site-specific risk of colorectal cancer. In summary, a prudent dietary pattern was associated with a decreased risk of colorectal cancer, especially with that of distal colon cancer, in a fairly large case–control study in Japan.

Cross-sectional studies suggest that dietary supplement use is associated with favourable demographic and lifestyle factors and certain health conditions. However, factors that affect the consistency of supplement use have not been investigated in prospective cohort studies. The aim of the present study was to seek baseline demographic, lifestyle and health-status predictors of subsequent consistent vitamin and/or mineral supplement use. A total of 8968 men and 10 672 women of the European Prospective Investigation into Cancer and Nutrition (EPIC)-Heidelberg cohort, who answered the supplement-use questions in the baseline survey and two follow-up surveys, were categorised into three groups: consistent, inconsistent and never users. At baseline, 28·5 % of men and 38·6 % of women reported vitamin and/or mineral supplement use. After a median follow-up of 8·5 years, 14·6 % of men and 22·9 % of women were consistent users. During follow-up, 36·0 % of male and 26·6 % of female initial users stopped supplement use, whereas 27·8 % of male and 39·4 % of female initial non-users started supplement use. Women were more likely to be consistent users than men. Older age ( ≥ 50 years), lower BMI ( < 25 kg/m2) and self-reported hyperlipidaemia were common predictors of consistent use for both sexes. Additional predictors included higher educational level for men, and being more physically active and higher lifetime alcohol consumption for women. Consistent users had the highest intake of dairy products, fish, fruits and vegetables, and wine but the lowest intake of total meat. We concluded that supplement use is a fairly unstable behaviour in free-living individuals. Individuals with a favourable lifestyle and healthier diet are more likely to show consistent supplementation.

Socioeconomic differences in overweight are well documented, but most studies have only used one or two indicators of socioeconomic position (SEP). The aim of the present study was to explore the relative importance of indicators of SEP (occupation, education and income) in explaining variation in BMI and waist:hip ratio (WHR), and the mediating effect of work control and lifestyle factors (dietary patterns, smoking and physical activity). The Oslo Health Study, a cross-sectional study, was carried out in 2000–1, Oslo, Norway. Our sample included 9235 adult working Oslo citizens, who attended a health examination and filled in two complementary FFQ with < 20 % missing responses to food items. Four dietary patterns were identified through factor analysis, and were named ‘modern’, ‘Western’, ‘traditional’ and ‘sweet’. In multivariate models, BMI and WHR were inversely associated with education (P < 0·001/P < 0·001) and occupation (P = 0·002/P < 0·001), whereas there were no significant associations with income or the work control. The ‘modern’ (P < 0·001) and the ‘sweet’ (P < 0·001) dietary patterns and physical activity level (P < 0·001) were inversely associated, while the ‘Western’ dietary pattern (P < 0·001) was positively associated with both BMI and WHR. These lifestyle factors could not fully explain the socioeconomic differences in BMI or WHR. However, together with socioeconomic factors, they explained more of the variation in WHR among men (21 %) than among women (7 %).

The effect of consuming different amounts of whey protein on appetite and energy intake was investigated in two separate studies using randomised, crossover designs. Healthy-weight men and women (range: BMI 19·0–25·0 kg/m2, age 19·4–40·4 years) consumed one of four 400 ml liquid preloads, followed by an ad libitum test meal 90 min later. In study 1, preloads were 1675 kJ with 12·5, 25 or 50 % of energy from protein, and in study 2, preloads were 1047 kJ with 10, 20 or 40 % energy from protein. Flavoured water was used as the control in both the studies. Appetite ratings were collected immediately before 30, 60 and 90 min after consuming the preloads; and immediately, 30 and 60 min after consuming the test meal. In study 1, energy intake following the control preload (4136 (sem 337) kJ) was significantly higher than each of the 12·5 % (3520 (sem 296) kJ), 25 % (3384 (sem 265) kJ) and 50 % (2853 (sem 244) kJ) protein preloads (P < 0·05). Intake after the 12·5 % preload was significantly higher than following 25 and 50 % preloads (P < 0·05). In study 2, energy intake following the control preload (4801 (sem 325) kJ) was higher than following the 10 % (4205 (sem 310) kJ), 20 % (3988 (sem 250) kJ) and 40 % (3801 (sem 245) kJ) protein preloads (P < 0·05). There were no differences in subjective appetite ratings between preloads in either study. These findings indicate a dose–response effect of protein content of the preload on energy intake at a subsequent meal.

The UK Food Standards Agency (FSA) convened an international group of scientific experts to review three Agency-funded projects commissioned to provide evidence for the relative contributions of two sources, dietary vitamin D intake and skin exposure to UVB rays from sunlight, to vitamin D status. This review and other emerging evidence are intended to inform any future risk assessment undertaken by the Scientific Advisory Committee on Nutrition. Evidence was presented from randomised controlled trials to quantify the amount of vitamin D required to maintain a serum 25-hydroxy vitamin D (25OHD) concentration >25 nmol/l, a threshold that is regarded internationally as defining the risk of rickets and osteomalacia. Longitudinal evidence was also provided on summer sunlight exposure required to maintain 25OHD levels above this threshold in people living in the British Isles (latitude 51°–57°N). Data obtained from multi-level modelling of these longitudinal datasets showed that UVB exposure (i.e. season) was the major contributor to changes in 25OHD levels; this was a consistent finding in two Caucasian groups in the north and south of the UK, but was less apparent in the one group of British women of South Asian origin living in the south of the UK. The FSA-funded research suggested that the typical daily intake of vitamin D from food contributed less than UVB exposure to average year-round 25OHD levels in both Caucasian and Asian women. The low vitamin D status of Asian women has been acknowledged for some time, but the limited seasonal variation in Asian women is a novel finding. The Workshop also considered the dilemma of balancing the risks of vitamin D deficiency (from lack of skin exposure to sunlight in summer) and skin cancer (from excessive exposure to sunlight with concomitant sunburn and erythema). Cancer Research UK advises that individuals should stay below their personal sunburn threshold to minimise their skin cancer risk. The evidence suggests that vitamin D can be produced in summer at the latitude of the UK, with minimal risk of erythema and cell damage, by exposing the skin to sunlight for a short period at midday, when the intensity of UVB is at its daily peak. The implications of the new data were discussed in the context of dietary reference values for vitamin D for the general population aged 4–64 years. Future research suggestions included further analysis of the three FSA-funded studies as well as new research.

Whole cereal grain foods are rich in phytate, a Ca chelator, and could increase the risk of hip fracture. The objective of the present study was to investigate the association between baseline whole grain intake and incident hip fracture. In the present study, 29 192 women who at baseline in 1986 were aged 55–69 years, free of diabetes, and reported a plausible energy intake of 2508–20 900 kJ/d and reported no fracture since the age of 35 years were followed. Hip fracture (n 746) was self-reported in five questionnaires through 2004. Of 1451 hip fractures identified passively by Medicare linkage through 31 December 2004 (Medicare hip fracture), 507 had also been self-reported. Whole grain intake was inversely related to Medicare hip fracture (Ptrend = 0·02), but it was unrelated to self-reported hip fracture (Ptrend = 0·27). The hazard ratio in the highest to lowest quintile of whole grain intake for incident Medicare-only hip fracture (n 944) was 0·66 (95 % CI 0·53, 0·82) after adjustment for age, energy intake, education, BMI, waist-to-hip ratio, farm residence, physical activity, oestrogen use, smoking, alcohol use, history of cancer and other dietary variables. Medicare-only cases may have failed to self-report due to severe illness; hazard ratio for total mortality after hip fracture was 2·92 (2·37, 3·59) for Medicare-only cases v. Medicare-confirmed self-reported cases. In conclusion, in this cohort, the inverse association between whole grain intake and hip fracture was explained by ascertainment bias. Whole grain intake may increase the ability to respond to a questionnaire and self-report hip fracture, and could reflect less undocumented frailty.

n-3 Fatty acids have clinical benefits. The primary aim of the present study was the assessment of infection in patients who underwent major high-risk elective gastrointestinal surgery receiving postoperatively fish oil (FO)-supplemented parenteral nutrition (PN), compared with those receiving a standard olive oil (OO) emulsion. The secondary aims were the assessment of anti-inflammatory response and evaluation of tolerance and safety of these emulsions. A prospective, randomised, double-blind study was performed in patients requiring at least 5 d of PN. An isoenergetic and isoproteic formula was administered: group A received OO alone, while group B received OO that was partially replaced with FO (16·6 %, w/w). End points were outcome measures (mortality, sepsis, infection, hospitalisation days and PN duration), inflammatory response (C-reactive protein (CRP), prealbumin and leucocytes) and safety (TAG and glucose metabolism, and liver and kidney function). Statistical analysis was done using Student's t test and Fisher's exact test (P < 0·05). Twenty-seven patients were evaluated, with thirteen patients receiving FO. In this group, a significantly lower incidence of infections was found (23·1 v. 78·6 %, P = 0·007). CRP, prealbumin and leucocytes were not significantly different between the groups. There were no differences in safety parameters. We conclude that high-risk surgical patients receiving FO-supplemented PN for 5 d present a lower incidence of infection. Emulsions were safe and well tolerated.

Clinical manifestations of lactase (LCT) deficiency include intestinal and extra-intestinal symptoms. Lactose hydrogen breath test (H2-BT) is considered the gold standard to evaluate LCT deficiency (LD). Recently, the single-nucleotide polymorphism C/T− 13 910 has been associated with LD. The objectives of the present study were to evaluate the agreement between genetic testing of LCT C/T− 13 910 and lactose H2-BT, and the diagnostic value of extended symptom assessment. Of the 201 patients included in the study, 194 (139 females; mean age 38, range 17–79 years, and 55 males, mean age 38, range 18–68 years) patients with clinical suspicion of LD underwent a 3–4 h H2-BT and genetic testing for LCT C/T− 13 910. Patients rated five intestinal and four extra-intestinal symptoms during the H2-BT and then at home for the following 48 h. Declaring H2-BT as the gold standard, the CC− 13 910 genotype had a sensitivity of 97 % and a specificity of 95 % with a κ of 0·9 in diagnosing LCT deficiency. Patients with LD had more intense intestinal symptoms 4 h following the lactose challenge included in the H2-BT. We found no difference in the intensity of extra-intestinal symptoms between patients with and without LD. Symptom assessment yielded differences for intestinal symptoms abdominal pain, bloating, borborygmi and diarrhoea between 120 min and 4 h after oral lactose challenge. Extra-intestinal symptoms (dizziness, headache and myalgia) and extension of symptom assessment up to 48 h did not consistently show different results. In conclusion, genetic testing has an excellent agreement with the standard lactose H2-BT, and it may replace breath testing for the diagnosis of LD. Extended symptom scores and assessment of extra-intestinal symptoms have limited diagnostic value in the evaluation of LD.

Traditional analysis of food intake usually fails to show an association between energy and nutrient intake and indicators of obesity. The analysis of food patterns can contribute to the understanding of the association between eating habits and anthropometric indicators. A population-based cross-sectional study was carried out on a low-income neighbourhood in the Rio de Janeiro metropolitan area, and 1009 subjects between 20 and 65 years of age completed an FFQ. Dietary patterns were identified by means of factor analysis, and their associations with BMI and waist circumference (WC) were ascertained by applying a linear regression analysis. Three main dietary patterns were identified: a mixed pattern, which included cereals, fish and shrimp, vegetables, roots, fruits, eggs, meat and caffeinated beverages; a Western pattern, which consisted of ‘fast foods’, soft drinks, juices, cakes, cookies, milk and dairy, sweets and snacks; a traditional pattern, which included rice, beans, bread, sugar, fats and salad dressings. After adjusting for age and energy intake, we found that the traditional dietary pattern was inversely associated with BMI (β = − 1·14, P < 0·001) and WC (β = − 14·9, P = 0·002) among females. Additionally, a positive association between the Western pattern and WC (β = 12·8, P = 0·02) was observed for females. A diet based on rice and beans may have a protective role against weight gain in women.