The present study evaluated the association of two measures of diet quality with BMI and waist circumference (WC), overall and by education level, among Mexican men and women.

We constructed two a priori indices of diet quality, the Mexican Diet Quality Index (MxDQI) and the Mexican Alternate Healthy Eating Index (MxAHEI), which we examined relative to BMI and WC. We computed sex-specific multivariable linear regression models for the total sample and by education level.

Mexico.

Mexican men (n 954) and women (n 1356) participating in the Mexican National Health and Nutrition Survey 2012.

Total dietary scores were not associated with BMI in men and women, but total MxDQI was inversely associated with WC in men (−0·10, 95 % CI −0·20, −0·004 cm). We also found that some results differed by education level in men. For men with the lowest education level, a one-unit increase in total MxDQI and MxAHEI score was associated with a mean reduction in BMI of 0·11 (95 % CI −0·18, 0·04) and 0·18 (95 % CI −0·25, −0·10) kg/m2, respectively. Likewise, a one-unit increase in total MxDQI and MxAHEI score was associated with a mean change in WC of −0·30 (95 % CI −0·49, −0·11) and −0·53 (95 % CI −0·75, −0·30) cm, respectively, in men with the lowest level of education. In women, the association of diet quality scores with BMI and WC was not different by education level.

Our findings suggest that a higher diet quality in men with low but not high education is associated with lower BMI and WC.

The Canada Health Act requires reasonable access to all medically necessary therapies. No information is available to assess the current access to neuromodulation across Canada. This study quantifies the current rate of deep brain stimulation (DBS) for the entire country of Canada. Analyses were performed to determine whether there were differences in access based on provincial or territorial location, rural or non-rural region, or socioeconomic status.

All implanted DBS devices in Canada over a 2-year epoch (January 2015 to December 2016) were supplied by either Boston Scientific or Medtronic. Investigators received anonymized data from these companies, including patient age and home residence region. The 2016 Statistics Canada census data were used to determine the rate of DBS surgery and whether access was related to provincial location, rural versus non-rural region or socioeconomic status.

A total of 722 patients were studied. The rate of DBS surgery for the entire country was ten per million population per year. Saskatchewan was significantly above (374%) the national average, whereas Quebec (40%) and Newfoundland & Labrador (32%) were significantly below the national average. No patients from the three territories received DBS. There were no significant differences in access from rural versus non-rural areas or in regions within provinces with different socioeconomic status.

This is the first study to quantify all patients receiving DBS within an entire country. The current rate of DBS surgery within Canada is ten cases per million per year. Statistically significant regional differences were discovered and discussed.

Eating away from home is associated with poor diet quality, in part due to less healthy food choices and larger portions. However, few studies account for the potential additional contribution of differences in food composition between restaurant- and home-prepared dishes. The present study aimed to investigate differences in nutrients of dishes prepared in restaurants v. at home.

Eight commonly consumed dishes were collected in twenty of each of the following types of locations: small and large restaurants, and urban and rural households. In addition, two fast-food items were collected from ten KFC, McDonald’s and food stalls. Five samples per dish were randomly pooled from every location. Nutrients were analysed and energy was calculated in composite samples. Differences in nutrients of dishes by preparation location were determined.

Hunan Province, China.

Na, K, protein, total fat, fatty acids, carbohydrate and energy in dishes.

On average, both the absolute and relative fat contents, SFA and Na:K ratio were higher in dishes prepared in restaurants than households (P < 0·05). Protein was 15 % higher in animal food-based dishes prepared in households than restaurants (P<0·05). Quantile regression models found that, at the 90th quantile, restaurant preparation was consistently negatively associated with protein and positively associated with the percentage of energy from fat in all dishes. Moreover, restaurant preparation also positively influenced the SFA content in dishes, except at the highest quantiles.

These findings suggest that compared with home preparation, dishes prepared in restaurants in China may differ in concentrations of total fat, SFA, protein and Na:K ratio, which may further contribute, beyond food choices, to less healthy nutrient intakes linked to eating away from home.

Clinical research studies of behavioral variant frontotemporal dementia (bvFTD) often use Alzheimer disease (AD) as a comparison group for control of dementia variables, using tests of cognitive function to match the groups. These two dementia syndromes, however, are very different in clinical manifestations, and the comparable severity of these dementias may not be reflected by commonly used cognitive scales such as the Mini-Mental State Examination (MMSE).

We evaluated different measures of dementia severity and symptoms among 20 people with bvFTD compared to 24 with early-onset AD.

Despite similar ages, disease-duration, education, and cognitive performance on two tests of cognitive function, the MMSE and the Montreal Cognitive Assessment (MoCA), the bvFTD participants, compared to the AD participants, were significantly more impaired on other measures of disease severity, including function (Functional Assessment Questionnaire (FAQ)), neuropsychiatric symptoms (Neuropsychiatric Inventory (NPI)), and global dementia stage (Clinical Dementia Rating Scales (CDRs)). However, when we adjusted for the frontotemporal lobar degeneration-CDR (FTLD-CDR) in the analyses, the two dementia groups were comparable across all measures despite significant differences on the cognitive scales.

We found tests of cognitive functions (MMSE and MoCA) to be insufficient measures for ensuring comparability between bvFTD and AD groups. In clinical studies, the FTLD-CDR, which includes additional language and behavior items, may be a better overall way to match bvFTD and AD groups on dementia severity.

To assess how breast-feeding and dietary diversity relate to infant length-for-age Z-score (LAZ) and weight-for-age Z-score (WAZ).

Breast-feeding, dietary and anthropometric data from the Cebu Longitudinal Health and Nutrition Survey were analysed using sex-stratified fixed-effects longitudinal regression models. A dietary diversity score (DDS) based on seven food groups was classified as low (<4) or high (≥4). The complementary feeding patterns were: (i) non-breast-fed with low DDS (referent); (ii) breast-fed with low DDS; (iii) non-breast-fed with high DDS; and (iv) breast-fed with high DDS (optimal). Interactions between age, energy intake and complementary feeding patterns were included.

Philippines.

Infants (n 2822) measured bimonthly from 6 to 24 months.

Breast-feeding (regardless of DDS) was significantly associated with higher LAZ (until 24 months) and WAZ (until 20 months). For example, at 6 months, breast-fed boys with low DDS were 0·246 (95 % CI 0·191, 0·302) sd longer and 0·523 (95 % CI 0·451, 0·594) sd heavier than the referent group. There was no significant difference in size between breast-fed infants with high v. low DDS. Similarly, high DDS conferred no advantage in LAZ or WAZ among non-breast-fed infants. There were modest correlations between the 7-point DDS and nutrient intakes but these correlations were substantially attenuated after energy adjustment. We elucidated several interactions between sex, age, energy intake and complementary feeding patterns.

These results demonstrate the importance of prolonged breast-feeding up to 24 months. The DDS provided qualitative information on infant diets but did not confer a significant advantage in LAZ or WAZ.

We examined the association between dietary patterns and diabetes using the strengths of two methods: principal component analysis (PCA) to identify the eating patterns of the population and reduced rank regression (RRR) to derive a pattern that explains the variation in glycated Hb (HbA1c), homeostasis model assessment of insulin resistance (HOMA-IR) and fasting glucose.

We measured diet over a 3 d period with 24 h recalls and a household food inventory in 2006 and used it to derive PCA and RRR dietary patterns. The outcomes were measured in 2009.

Adults (n 4316) from the China Health and Nutrition Survey.

The adjusted odds ratio for diabetes prevalence (HbA1c≥6·5 %), comparing the highest dietary pattern score quartile with the lowest, was 1·26 (95 % CI 0·76, 2·08) for a modern high-wheat pattern (PCA; wheat products, fruits, eggs, milk, instant noodles and frozen dumplings), 0·76 (95 % CI 0·49, 1·17) for a traditional southern pattern (PCA; rice, meat, poultry and fish) and 2·37 (95 % CI 1·56, 3·60) for the pattern derived with RRR. By comparing the dietary pattern structures of RRR and PCA, we found that the RRR pattern was also behaviourally meaningful. It combined the deleterious effects of the modern high-wheat pattern (high intakes of wheat buns and breads, deep-fried wheat and soya milk) with the deleterious effects of consuming the opposite of the traditional southern pattern (low intakes of rice, poultry and game, fish and seafood).

Our findings suggest that using both PCA and RRR provided useful insights when studying the association of dietary patterns with diabetes.

Caregivers report early disturbances in social behavior among patients with behavioral variant frontotemporal dementia (bvFTD); however, there are few direct observational studies of these social behavioral disturbances. This study aimed to identify social behavioral themes in bvFTD by direct observation in naturalistic interactions. The identification of these themes can help caregivers and clinicians manage the social behavioral disturbances of this disease.

Researchers observed 13 bvFTD patients in their homes and community-based settings and recorded field notes on their interpersonal interactions. A qualitative analysis of their social behavior was then conducted using ATLAS.ti application and a constant comparison method.

Qualitative analysis revealed the following themes: (1) diminished relational interest and initiation, indicating failure to seek social interactions; (2) lack of social synchrony/intersubjectivity, indicating an inability to establish and maintain interpersonal relationships; and (3) poor awareness and adherence to social boundaries and norms. These themes corresponded with changes from caregiver reports and behavioral scales.

This analysis indicates that real-world observation validates the diagnostic criteria for bvFTD and increases understanding of social behavioral disturbances in this disorder. The results of this and future observational studies can highlight key areas for clinical assessment, caregiver education, and targeted interventions that enhance the management of social behavioral disturbances in bvFTD.

The aim of the present study was to assess the concurrent and construct validity of two diet-quality indices, a modified Mediterranean diet score (mMDS) and a Mediterranean-like diet score (MLDS) additionally incorporating unhealthy food choices, as determined by an FFQ.

A validation study assessing FFQ intake estimates compared with ten or more unannounced 24 h recalls. Pearson's correlation coefficients, intraclass correlation coefficients (ICC), Bland–Altman plots and the limits of agreement method were used to assess the between-method agreement of scores. Construct validity was shown using associations between nutrient intakes derived from multiple 24 h recalls and the mMDS and MLDS derived from the FFQ.

Gerona, Spain.

A total of 107 consecutively selected participants from a population-based cross-sectional survey.

Pearson's correlations for the energy-adjusted mMDS and MLDS compared with multiple recalls were 0·48 and 0·62, respectively. The average FFQ energy-adjusted mMDS and MLDS were 102 % and 98 % of the recall-based mMDS and MLDS estimates, respectively. The FFQ under- and overestimated dietary recall estimates of the energy-adjusted MLDS by 28 % and 25 %, respectively, with slightly wider boundaries for the mMDS (31 % and 34 %). The ICC, which assesses absolute agreement, was similar to Pearson's correlations (mMDS = 0·48 and MLDS = 0·61). The mean differences between methods were similar across the range of average ratings for both scores, indicating the absence of bias. The FFQ-derived mMDS and MLDS correlated in the anticipated directions with intakes of eleven (73·3 %) and thirteen of fifteen nutrients (86·7 %), respectively.

The FFQ provides valid estimates of diet quality as assessed by the mMDS and MLDS.

To estimate the dietary intake of total polycyclic aromatic hydrocarbons (PAH) and benzo(a)pyrene (BaP), and to characterise factors associated with higher intake during pregnancy. Recent studies suggest that prenatal exposure to PAH is associated with adverse reproductive outcomes. Other than tobacco smoke and occupational exposures, diet is the main source of human PAH exposure.

Prospective birth cohort study. Dietary exposure to total PAH and BaP was calculated combining food consumption data and estimated PAH concentrations in foods. One-way ANOVA was used to assess differences in intake among non-smokers, passive or active smokers. Linear regression was used to assess factors related to higher intake, and associations between dietary PAH and birth weight.

Sabadell, Spain, 2004–2006.

Women (n 657) recruited during the first trimester of pregnancy.

The mean dietary intake of BaP and total PAH was significantly higher among active (0·199 and 10·207 μg/d, respectively) and passive smokers (0·196 and 9·458 μg/d) than among non-smokers (0·181 and 8·757 μg/d; P value < 0·005). Maternal age, educational level and region of origin were also associated with higher BaP intake. In all women, major contributors to PAH intake were processed/cured meats, cereals/potatoes and shellfish. Elevated first trimester dietary BaP was associated with a significant reduction in birth weight (fourth v. first quartile: β = −142·73 g, P value < 0·05).

Active and passive smokers had higher dietary PAH exposure during pregnancy because of higher intake of processed meats and shellfish. As tobacco smoke is an additional route of PAH exposure, the added dietary burden in these women is of concern.

To analyse the relationship between maternal intakes of fish and other seafood during pregnancy and child neurodevelopment at age 4 years. Although pregnant women are advised to limit seafood intakes because of possible neurotoxin contamination, several studies suggest that overall maternal seafood intakes are associated with improved child neurodevelopment, perhaps because of higher DHA intakes.

The study uses data from a prospective birth cohort study. Maternal seafood intakes were assessed using a semi-quantitative FFQ administered shortly after delivery. Multivariate linear regression was used to estimate associations between seafood consumption and scores on the McCarthy Scales of Children’s Abilities (MCSA). Analyses were stratified by breast-feeding duration as breast milk is a source of DHA during the postnatal phase of the brain growth spurt.

Menorca, Spain, 1997–2001.

Full-term children (n 392) with data on maternal diet in pregnancy, breast-feeding duration and neurodevelopment at age 4 years.

Among children breast-fed for <6 months, maternal fish intakes of >2–3 times/week were associated with significantly higher scores on several MCSA subscales compared with intakes ≤1 time/week. There was no association among children breast-fed for longer periods. Maternal intakes of other seafood (shellfish/squid) were, however, inversely associated with scores on several subscales, regardless of breast-feeding duration.

The study suggests that moderately high intakes of fish, but not other seafood, during pregnancy may be beneficial for neurodevelopment among children breast-fed for <6 months. Further research in other populations with high seafood intakes and data on additional potential confounders are needed to confirm this finding.

Research in industrialised countries has documented a high prevalence of underreported energy intakes associated with characteristics such as obesity. This paper examines the prevalence, patterns and impact of energy under- and overreporting on diet–obesity relationships in a middle-income developing country.

A 70-item food-frequency questionnaire was used. Underreporters had reported energy intakes < 1.35 × basal metabolic rate (BMR), overreporters > 2.4 × BMR. Multinomial models were used to identify characteristics associated with implausible reporting. Intakes were compared across reporting groups to assess evidence of bias. Associations between diet and obesity were compared with and without adjustment for implausible reporting.

Spanish Town, neighbouring the capital city of Kingston, Jamaica.

Eight hundred and ninety-one Jamaican adults, aged 25–75 years, were randomly recruited.

More women than men (38.6% vs. 22.5%) underreported, but more men overreported energy (23.7% vs. 16.0%). Underreporting was positively associated with obesity, special diets, smoking and age; age was inversely associated with overreporting. Underreporters estimated lower energy from potentially socially undesirable food groups (e.g. snacks) and higher intakes of ‘healthy’ foods (e.g. fruit) than did plausible reporters. For some of these food groups, significant differences in intakes among normal-weight versus obese subjects observed among plausible reporters were absent when implausible reporters were included. In models of food group–obesity associations, adjusting for implausible energy yielded more credible results that more closely resembled findings in plausible reporters.

Energy under- and overreporting are highly prevalent in Jamaica. Adjusting for implausible reporting may help to reduce bias in diet–health outcome associations.