CVD is the leading cause of death worldwide. Diet is a key modifiable component in the development of CVD. No official UK diet quality index exists for use in UK nutritional epidemiological studies. The aims of this study are to: (i) develop a diet quality index based on components of UK dietary reference values (DRV) and (ii) determine the association between the index, the existing UK nutrient profile (NP) model and a comprehensive range of cardiometabolic risk markers among a British adult population. A cross-sectional analysis was conducted using data from the Airwave Health Monitoring Study (n 5848). Dietary intake was measured by 7-d food diary and metabolic risk using waist circumference, BMI, blood lipid profile, glycated Hb (HbA1c) and blood pressure measurements. Diet quality was assessed using the novel DRV index and NP model. Associations between diet and cardiometabolic risk were analysed via multivariate linear models and logistic regression. A two-point increase in NP score was associated with total cholesterol (β −0·33 mmol/l, P<0·0001) and HbA1c (β −0·01 %, P<0·0001). A two-point increase in DRV score was associated with waist circumference (β −0·56 cm, P<0·0001), BMI (β −0·15 kg/m2, P<0·0001), total cholesterol (β −0·06 mmol/l, P<0·0001) and HbA1c (β −0·02 %, P=0·002). A one-point increase in DRV score was associated with type 2 diabetes (T2D) (OR 0·94, P=0·01) and obesity (OR 0·95, P<0·0001). The DRV index is associated with overall diet quality and risk factors for CVD and T2D, supporting its application in nutritional epidemiological studies investigating CVD risk in a UK population.

Fish consumption is the major dietary source of EPA and DHA, which according to rodent experiments may reduce body fat mass and prevent obesity. Only a few human studies have investigated the association between fish consumption and body-weight gain. We investigated the association between fish consumption and subsequent change in body weight. Women and men (n 344 757) participating in the European Prospective Investigation into Cancer and Nutrition were followed for a median of 5·0 years. Linear and logistic regression were used to investigate the associations between fish consumption and subsequent change in body weight. Among women, the annual weight change was 5·70 (95 % CI 4·35, 7·06), 2·23 (95 % CI 0·16, 4·31) and 11·12 (95 % CI 8·17, 14·08) g/10 g higher total, lean and fatty fish consumption per d, respectively. The OR of becoming overweight in 5 years among women who were normal weight at enrolment was 1·02 (95 % CI 1·01, 1·02), 1·01 (95 % CI 1·00, 1·02) and 1·02 (95 % CI 1·01, 1·04) g/10 g higher total, lean and fatty consumption per d, respectively. Among men, fish consumption was not statistically significantly associated with weight change. Adjustment for potential over- or underestimation of fish consumption did not systematically change the observed associations, but the 95 % CI became wider. The results in subgroups from analyses stratified by age or BMI at enrolment were not systematically different. In conclusion, the present study suggests that fish consumption has no appreciable association with body-weight gain.

Certain epidemiological and experimental studies suggest that n-3 fatty acids and folate can reduce blood pressure (BP). We investigated the effect of a daily supplementation with dietary doses of B-vitamins or n-3 fatty acids for 5 years on BP in patients with a history of CVD who participated in the Supplémentation en Folates et Omega-3 trial. The patients (n 2501; 1987 men and 514 women) were randomly assigned in a 2 × 2 factorial design to one of four groups: B-vitamins (5-methyl-THF (560 μg); vitamin B6 (3 mg) and vitamin B12 (20 μg)) and a placebo capsule for n-3 fatty acids; n-3 fatty acids (600 mg of EPA and DHA at a ratio of 2:1) and a placebo capsule for B-vitamins; both B-vitamins and n-3 fatty acids; or placebo capsules for both treatments. The patients took two capsules daily in a double-blind manner for a median duration of 4·7 years. At baseline and annual examination for 5 years, the patients underwent a clinical examination where BP and clinical and biological parameters were assessed. No effect of supplementation with either n-3 PUFA or B-vitamins on BP was observed in crude and adjusted multivariate models. Change in BP was not associated with change in homocysteine. In conclusion, the present results do not support the routine use of dietary supplements containing B-vitamins, or of n-3 fatty acids, to reduce BP in people with prior CVD.

Whether there are differences between countries in the validity of self-reported diet in relation to BMI, as evaluated using recovery biomarkers, is not well understood. We aimed to evaluate BMI-related reporting errors on 24 h dietary recalls (24-HDR) and on dietary questionnaires (DQ) using biomarkers for protein and K intake and whether the BMI effect differs between six European countries. Between 1995 and 1999, 1086 men and women participating in the European Prospective Investigation into Cancer and Nutrition completed a single 24-HDR, a DQ and one 24 h urine collection. In regression analysis, controlling for age, sex, education and country, each unit (1 kg/m2) increase in BMI predicted an approximately 1·7 and 1·3 % increase in protein under-reporting on 24-HDR and DQ, respectively (both P < 0·0001). Exclusion of individuals who probably misreported energy intake attenuated BMI-related bias on both instruments. The BMI effect on protein under-reporting did not differ for men and women and neither between countries on both instruments as tested by interaction (all P>0·15). In women, but not in men, the DQ yielded higher mean intakes of protein that were closer to the biomarker-based measurements across BMI groups when compared with 24-HDR. Results for K were similar to those of protein, although BMI-related under-reporting of K was of a smaller magnitude, suggesting differential misreporting of foods. Under-reporting of protein and K appears to be predicted by BMI, but this effect may be driven by ‘low-energy reporters’. The BMI effect on under-reporting seems to be the same across countries.

Flavonols, flavanones and flavones (FLAV) are sub-classes of flavonoids that exert cardioprotective and anti-carcinogenic properties in vitro and in vivo. We aimed to estimate the FLAV dietary intake, their food sources and associated lifestyle factors in ten European countries participating in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. FLAV intake and their food sources for 36 037 subjects, aged between 35 and 74 years, in twenty-seven study centres were obtained using standardised 24 h dietary recall software (EPIC-SOFT). An ad hoc food composition database on FLAV was compiled using data from US Department of Agriculture and Phenol-Explorer databases and was expanded using recipes, estimations and flavonoid retention factors in order to increase its correspondence with the 24 h dietary recall. Our results showed that the highest FLAV-consuming centre was the UK health-conscious group, with 130·9 and 97·0 mg/d for men and women, respectively. The lowest FLAV intakes were 36·8 mg/d in men from Umeå and 37·2 mg/d in women from Malmö (Sweden). The flavanone sub-class was the main contributor to the total FLAV intake ranging from 46·6 to 52·9 % depending on the region. Flavonols ranged from 38·5 to 47·3 % and flavones from 5·8 to 8·6 %. FLAV intake was higher in women, non-smokers, increased with level of education and physical activity. The major food sources were citrus fruits and citrus-based juices (especially for flavanones), tea, wine, other fruits and some vegetables. We concluded that the present study shows heterogeneity in intake of these three sub-classes of flavonoids across European regions and highlights differences by sex and other sociodemographic and lifestyle factors.

Nutritional recommendations call for balanced, diversified consumption of starchy foods and increased whole-grain food intake. Their efficiency may depend on sociodemographic and socioeconomic factors, for which little information is available. The aim of the present study was to investigate the relationship between sociodemographic and socioeconomic characteristics and starchy food consumption in a large general population of French adults. Dietary intake was assessed using at least six 24-h dietary records collected, during a 2-year period, from 4574 men and women aged 45–60 years who participated in the Supplémentation en VItamines Minéraux et AntioXydants cohort study in 1995–7. Compliance with the recommendation ( ≥ 3 and < 6 servings/d), non-consumption of whole-grain products, variety and daily cost were compared across sociodemographic and socioeconomic categories using logistic regression and covariance analyses. About 55 % of subjects complied with the starchy food recommendation, with little variation across sociodemographic characteristics. Consumption of whole-grain products was less likely in men (P = 0·001), in subjects with a lower education level (P-trend = 0·01) and in those belonging to intermediate occupational categories (P = 0·02). The variety of starchy food intake increased with education level (P-trend = 0·0002) and was lowest for manual workers (P = 0·03). The proportion of daily food cost spent on starchy foods decreased with occupational category (P < 0·0001), and was higher in rural areas (P = 0·0004). The starchy food budget spent on potatoes decreased with the educational level (P-trend = 0·007), whereas it increased for rice and unsweetened breakfast cereals (P-trend = 0·001 for both). Public recommendations concerning starchy food variety and whole-grain intake should specifically target subjects with a lower education level and/or occupational category.

Dietary energy density (ED) may be a good predictor of weight gain because of its association with the regulation of appetite control signals. Among the participants of the ‘SUpplementation en VItamines et Mineraux AntioXydants’ prospective study, 2707 subjects were included in the present study. Changes in weight, waist circumference (WC), hip circumference (HC) and waist:hip ratio were calculated using measured data collected in 1995/1996 and 2001/2002. The mean changes in various anthropometric indicators according to baseline body-weight status (BMI <  or ≥ 25 kg/m2) and sex-specific tertiles of baseline ED level or 6-year changes in ED were compared by covariance analysis. In overweight subjects, weight gain was positively associated with high dietary ED at baseline (P for trend  =  0·03) and with increasing ED during the follow-up (P for trend  =  0·0008). Both the WC and HC changes were also positively related to baseline ED and change in ED in overweight subjects. However, the relationships observed for the WC and HC changes were no longer significant after adjustment for weight change. These results support the hypothesis of a deleterious effect of high-energy-dense diets on weight change for overweight subjects. This relationship could be mediated by physical activity level. Further research needs to be performed in other populations to determine whether ED could be effective strategies to prevent weight gain.

Increased fruit and vegetable consumption has become a health priority in many countries. Therefore, data investigating the influence of different types of fruits and vegetables on serum antioxidant levels would be useful. The objective of the study was to assess the relationship between fruit and vegetable consumption and vitamin serum antioxidant concentrations. Specific fruit and vegetable groups are evaluated. A total of 3521 subjects (1487 men and 2034 women), aged 35–60 years, participating in the SU.VI.MAX cohort were included in this study. Blood samples of participants were analysed for β-carotene, vitamin C and α-tocopherol. Each subject had completed at least six dietary records during the first 2 years of the study. It was found that women had higher mean β-carotene and vitamin C serum concentrations than men, but lower α-tocopherol serum concentrations. Serum β-carotene and vitamin C concentrations were positively correlated with consumption of both fruit and vegetables, as well as with most of the fruit and vegetable groups tested. These relationships persisted after adjustment for confounding factors. Regression analysis showed a linear dose–response relationship. Root vegetables and citrus fruits were particularly associated with β-carotene serum status as were citrus fruits for vitamin C. Fruit and vegetable consumption was either not or weakly associated with α-tocopherol serum concentrations. These results describe antioxidant serum concentrations according to fruit and vegetable consumption in a large sample and support the findings of previous studies involving a more limited number of subjects.