Validation of the Updated GloboDiet Version by Protein and Potassium Intake for the German National Nutrition Monitoring.

(1) Background: The German version of GloboDiet, a software for a computer-based assessment of 24 h recalls, was intensively updated. Therefore, validation is required prior to its use in the upcoming data collection within the German National Nutrition Monitoring. (2) Methods: For this purpose, the cross-sectional ErNst study with 109 participants (57 women and 52 men) was conducted. The study provided data on 24 h GloboDiet recalls and 24 h urine samples from the same day. Protein and potassium intake, known as eligible validation markers, were compared to the measured excretion in urine. To assess the agreement between intake and excretion, the following statistical methods were used: Wilcoxon rank tests, confidence intervals, Spearman correlations, and Bland-Altman plots. (3) Results: Overall, the updated German GloboDiet version showed valid estimates of protein intake. Regarding potassium, results were ambiguous and differed depending on the statistical method applied. While the Bland-Altman plot showed a good agreement between 24 h recalls and urine samples for potassium, the correlation was weak, suggesting that 24 h recalls may underestimate true intake. (4) Conclusions: Despite the partly ambiguous results, the updated GloboDiet version linked to the current German Nutrient Database provides valid estimates of nutrient intake.

Assessment of Energy and Nutrient Intake and the Intestinal Microbiome (ErNst Study): Protocol and Methods of a Cross-sectional Human Observational Study.

BACKGROUND: On the national level, nutritional monitoring requires the assessment of reliable representative dietary intake data. To achieve this, standardized tools need to be developed, validated, and kept up-to-date with recent developments in food products and the nutritional behavior of the population. Recently, the human intestinal microbiome has been identified as an essential mediator between nutrition and host health. Despite growing interest in this connection, only a few associations between the microbiome, nutrition, and health have been clearly established. Available studies paint an inconsistent picture, partly due to a lack of standardization. OBJECTIVE: First, we aim to verify if food consumption, as well as energy and nutrient intake of the German population, can be recorded validly by means of the dietary recall software GloboDiet, which will be applied in the German National Nutrition Monitoring. Second, we aim to obtain high-quality data using standard methods on the microbiome, combined with dietary intake data and additional fecal sample material, and to also assess the functional activity of the microbiome by measuring microbial metabolites. METHODS: Healthy female and male participants aged between 18 and 79 years were recruited. Anthropometric measurements included body height and weight, BMI, and bioelectrical impedance analysis. For validation of the GloboDiet software, current food consumption was assessed with a 24-hour recall. Nitrogen and potassium concentrations were measured from 24-hour urine collections to enable comparison with the intake of protein and potassium estimated by the GloboDiet software. Physical activity was measured over at least 24 hours using a wearable accelerometer to validate the estimated energy intake. Stool samples were collected in duplicate for a single time point and used for DNA isolation and subsequent amplification and sequencing of the 16S rRNA gene to determine microbiome composition. For the identification of associations between nutrition and the microbiome, the habitual diet was determined using a food frequency questionnaire covering 30 days. RESULTS: In total, 117 participants met the inclusion criteria. The study population was equally distributed between the sexes and 3 age groups (18-39, 40-59, and 60-79 years). Stool samples accompanying habitual diet data (30-day food frequency questionnaire) are available for 106 participants. Current diet data and 24-hour urine samples for the validation of GloboDiet are available for 109 participants, of which 82 cases also include physical activity data. CONCLUSIONS: We completed the recruitment and sample collection of the ErNst study with a high degree of standardization. Samples and data will be used to validate the GloboDiet software for the German National Nutrition Monitoring and to compare microbiome composition and nutritional patterns. TRIAL REGISTRATION: German Register of Clinical Studies DRKS00015216; https://drks.de/search/de/trial/DRKS00015216. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/42529.

Attitudes, perceptions and behaviours regarding meat consumption in Germany: results of the NEMONIT study.

Meat consumption in Germany is presently higher than recommended for a healthy and sustainable nutrition. Therefore, the aim of the present study was to explore German consumers' attitudes, perceptions and behaviours regarding meat consumption based on data from 1807 participants (20-80 years) of the NEMONIT study (2012/13). Data were obtained using computer-assisted telephone interviews including 24-h recalls and a food-frequency questionnaire (FFQ). The majority (97 %) of the participants were meat consumers and most of them stated that an ideal meal should contain meat. Their main motives for meat consumption were good taste, usual habit and the perception of meat as a healthy and satiable food. The stated meat consumption frequency was higher than the 'desired' consumption frequency, answered in a FFQ. Most participants would agree with two meat meals per week, but only 17 % assumed that the German population would agree. Therefore, framework conditions do not motivate people enough to reduce their meat consumption. Options for action which can be implemented in daily routine are needed. Meat is still a largely appreciated food in Germany, but the results indicate a potential for behavioural changes which must be exploited urgently to reduce meat consumption to a healthy and sustainable level.

Association between body mass index and macronutrients differs along the body mass index range of German adults: results from the German National Nutrition Survey II.

The aim of the present study was to determine whether the association between body mass index (BMI) and the intake of macronutrients varies along the BMI distribution of German adults. Based on a sample of 9214 men and women aged 18-80 years from the representative cross-sectional German National Nutrition Survey (NVS) II, quantile regression was used to investigate the association between BMI and the intake of macronutrients independent of energy intake and other predictors. In both sexes, BMI was positively associated with the intake of total protein and animal protein over its entire range and negatively associated with vegetable protein. A negative association between BMI and the intake of polysaccharides was found along the entire range of BMI in men. There was a weak negative association between BMI and the intake of total fat and saturated fatty acids observed in normal-weight-range women only. In conclusion, the association between BMI and the intake of macronutrients varies along the BMI range. Animal protein intake is positively associated with BMI independent of energy intake in both sexes whereas only in men an inverse association of polysaccharide intake with BMI was shown.

Meat consumers and non-meat consumers in Germany: a characterisation based on results of the German National Nutrition Survey II.

Meat consumption in high-income countries is increasingly discussed due to its impact on environment and health as well as ethical considerations. The present paper aims to provide information on meat consumption behaviour, sociodemographic factors related to meat consumption and its associations with health and nutritional behaviour, based on the German National Nutrition Survey II. For 12 915 participants aged 18-80 years, food consumption was assessed by two 24-h recalls and further data by interviews. Participants were distinguished in non-meat consumers and meat consumers; meat consumers were further differentiated as low and high meat consumers (<86 g/d and ≥86 g/d). Group differences were analysed using binary logistic and linear regression models. More non-meat consumers were found among women, young and more educated persons. They showed equal or more preferable health characteristics, had a similar energy intake but ate more plant-based foods compared with meat consumers. More high meat consumers were found among men, young and middle-aged and lower-educated persons. Compared with low meat consumers, they showed equal or less preferable health characteristics, had a higher energy intake and ate more potatoes and sauces/spices and less of most other food groups in relation to their energy intake. To conclude, sociodemographic groups differ in their meat consumption and differences in meat consumption go together with differences in health behaviour and other food consumption.

Comparison of food consumption and nutrient intake assessed with three dietary assessment methods: results of the German National Nutrition Survey II.

PURPOSE: Comparison of food consumption, nutrient intake and underreporting of diet history interviews, 24-h recalls and weighed food records to gain further insight into specific strength and limitations of each method and to support the choice of the adequate dietary assessment method. METHODS: For 677 participants (14-80 years) of the German National Nutrition Survey II confidence intervals for food consumption and nutrient intake were calculated on basis of bootstrapping samples, Cohen's d for the relevance of differences, and intraclass correlation coefficients for the degree of agreement of dietary assessment methods. Low energy reporters were identified with Goldberg cut-offs. RESULTS: In 7 of 18 food groups diet history interviews showed higher consumption means than 24-h recalls and weighed food records. Especially mean values of food groups perceived as socially desirable, such as fruit and vegetables, were highest for diet history interviews. For "raw" and "cooked vegetables", the diet history interviews showed a mean consumption of 144 and 109 g/day in comparison with 68 and 70 g/day in 24-h recalls and 76 and 75 g/day in weighed food records, respectively. For "fruit", diet history interviews showed a mean consumption of 256 g/day in comparison with 164 g/day in 24-h recalls and 147 g/day in weighed food records. No major differences regarding underreporting of energy intake were found between dietary assessment methods. CONCLUSIONS: With regard to estimating food consumption and nutrient intake, 24-h recalls and weighed food records showed smaller differences and better agreement than pairwise comparisons with diet history interviews.

Identification of Requirements for Computer-Supported Matching of Food Consumption Data with Food Composition Data.

This paper identifies the requirements for computer-supported food matching, in order to address not only national and European but also international current related needs and represents an integrated research contribution of the FP7 EuroDISH project. The available classification and coding systems and the specific problems of food matching are summarized and a new concept for food matching based on optimization methods and machine-based learning is proposed. To illustrate and test this concept, a study has been conducted in four European countries (i.e., Germany, The Netherlands, Italy and the UK) using different classification and coding systems. This real case study enabled us to evaluate the new food matching concept and provide further recommendations for future work. In the first stage of the study, we prepared subsets of food consumption data described and classified using different systems, that had already been manually matched with national food composition data. Once the food matching algorithm was trained using this data, testing was performed on another subset of food consumption data. Experts from different countries validated food matching between consumption and composition data by selecting best matches from the options given by the matching algorithm without seeing the result of the previously made manual match. The evaluation of study results stressed the importance of the role and quality of the food composition database as compared to the selected classification and/or coding systems and the need to continue compiling national food composition data as eating habits and national dishes still vary between countries. Although some countries managed to collect extensive sets of food consumption data, these cannot be easily matched with food composition data if either food consumption or food composition data are not properly classified and described using any classification and coding systems. The study also showed that the level of human expertise played an important role, at least in the training stage. Both sets of data require continuous development to improve their quality in dietary assessment.

Predictors of BMI Vary along the BMI Range of German Adults - Results of the German National Nutrition Survey II.

OBJECTIVE: The objective of the study was to identify predictors of BMI in German adults by considering the BMI distribution and to determine whether the association between BMI and its predictors varies along the BMI distribution. METHODS: The sample included 9,214 adults aged 18-80 years from the German National Nutrition Survey II (NVS II). Quantile regression analyses were conducted to examine the association between BMI and the following predictors: age, sports activities, socio-economic status (SES), healthy eating index-NVS II (HEI-NVS II), dietary knowledge, sleeping duration and energy intake as well as status of smoking, partner relationship and self-reported health. RESULTS: Age, SES, self-reported health status, sports activities and energy intake were the strongest predictors of BMI. The important outcome of this study is that the association between BMI and its predictors varies along the BMI distribution. Especially, energy intake, health status and SES were marginally associated with BMI in normal-weight subjects; this relationships became stronger in the range of overweight, and were strongest in the range of obesity. CONCLUSIONS: Predictors of BMI and the strength of these associations vary across the BMI distribution in German adults. Consequently, to identify predictors of BMI, the entire BMI distribution should be considered.

Trends in food consumption and nutrient intake in Germany between 2006 and 2012: results of the German National Nutrition Monitoring (NEMONIT).

The German National Nutrition Monitoring (NEMONIT) is a longitudinal and nationwide study to assess changes in food consumption and nutrient intake in Germany. A sample of 1840 participants (baseline age: 14-80 years) was drawn from the nationally representative German National Nutrition Survey (NVS) II (2005-2007). The participants have been interviewed by telephone annually since 2008. Food consumption was assessed by two 24-h recalls in the NVS II and the 4 years of NEMONIT (2008-2012/2013), respectively. Energy and nutrient intakes were calculated using the German Nutrient Database 3.02. Diet quality was evaluated using the Healthy Eating Index-NVS (HEI-NVS) II. Time trends were analysed by generalised estimating equation. Consumption of fruit/fruit products and fruit juice/nectar among men and women decreased, whereas consumption of water, soft drinks and coffee/tea increased over the 6-year period. Furthermore, increased consumption of confectionery and animal fats was observed among women. HEI-NVS II did not change since NVS II in both sexes. There were no changes in energy and protein intakes, but carbohydrate intake declined while fat intake increased over time. Regarding micronutrients, a decreasing intake of thiamin, riboflavin and vitamin B6 was observed in both sexes, but intake of Mg, Fe and niacin increased among women over time. In conclusion, food consumption and nutrient intake remained relatively stable between 2005-2007 and 2012/2013 within this German cohort. A few favourable and unfavourable changes were observed. Compared with national dietary guidelines, consumption of food of plant origin remained too low and consumption of meat/meat products remained too high in Germany.

Food consumption of adults in Germany: results of the German National Nutrition Survey II based on diet history interviews.

The second German National Nutrition Survey (NVS II) aimed to evaluate food consumption and other aspects of nutritional behaviour of a representative sample of the German population, using a modular design with three different dietary assessment methods. To assess usual food consumption, 15,371 German speaking subjects 14-80 years of age completed a diet history interview between November 2005 and November 2006. With reference to the guidelines of the German Nutrition Society (DGE), NVS II observed that the German population did not eat enough foods of plant origin, especially vegetables and consumed too much of meat and meat products. While generally similar food consumption is observed in other European countries, consumption of bread, fruit juices/nectars and beer is higher in Germany. On average, men consumed two times more meat and soft drinks as well as six times more beer than women did, whereas the consumption of vegetables, fruit as well as herbal/fruit tea was higher in women. Older participants showed a lower consumption of meat, fruit juice/nectars, soft drinks and spirits as well as a higher consumption of fish, vegetables, fruit, and herbal/fruit tea than adolescents and younger adults did. There are also differences in food consumption with regard to socio-economic status (SES). Persons with higher SES consumed more vegetables, fruit, fish, water, coffee/tea and wine, while persons with lower SES consumed more meat and meat products, soft drinks and beer. In general, the food consumption of women, the elderly and the higher SES group tends to be closer to the official dietary guidelines in Germany.

Comparison of two dietary assessment methods by food consumption: results of the German National Nutrition Survey II.

PURPOSE: To further characterise the performance of the diet history method and the 24-h recalls method, both in an updated version, a comparison was conducted. METHODS: The National Nutrition Survey II, representative for Germany, assessed food consumption with both methods. The comparison was conducted in a sample of 9,968 participants aged 14-80. Besides calculating mean differences, statistical agreement measurements encompass Spearman and intraclass correlation coefficients, ranking participants in quartiles and the Bland-Altman method. RESULTS: Mean consumption of 12 out of 18 food groups was higher assessed with the diet history method. Three of these 12 food groups had a medium to large effect size (e.g., raw vegetables) and seven showed at least a small strength while there was basically no difference for coffee/tea or ice cream. Intraclass correlations were strong only for beverages (>0.50) and revealed the least correlation for vegetables (<0.20). Quartile classification of participants exhibited more than two-thirds being ranked in the same or adjacent quartile assessed by both methods. For every food group, Bland-Altman plots showed that the agreement of both methods weakened with increasing consumption. CONCLUSIONS: The cognitive effort essential for the diet history method to remember consumption of the past 4 weeks may be a source of inaccurateness, especially for inhomogeneous food groups. Additionally, social desirability gains significance. There is no assessment method without errors and attention to specific food groups is a critical issue with every method. Altogether, the 24-h recalls method applied in the presented study, offers advantages approximating food consumption as compared to the diet history method.

Estimation of dietary intake of bis(2-ethylhexyl)phthalate (DEHP) by consumption of food in the German population.

In the study presented here, we evaluated the exposure of the German population aged 14-80 years to bis(2-ethylhexyl)phthalate (DEHP) from consumption of food by means of deterministic and probabilistic estimations. The study was performed on the basis of an extensive review of literature from around the world reporting measured data on DEHP in food, as well as official German food control data. Only data from individual measurements were considered and used for fitting of distributions. A wide range of concentrations in non-representative samples are reported in the literature. On the basis of the available DEHP concentration data, 37 food categories were characterized which covered all major food classes. Food consumption data were taken from the diet history interviews of the German National Nutrition Survey II (Nationale Verzehrsstudie II) which was performed in 2005/2006 in a representative study population of 15,371 and is the most recent data source of this kind in Germany. Average DEHP intake was estimated deterministically using data on measured concentrations in food (medians and means) and food consumption (means). A total dietary exposure to DEHP of 3.6 (median based) and 9.3µg/kg of BW per day (based on mean values) was estimated deterministically. In addition, distributions of both concentrations and consumption figures were fitted using the @RISK best fit tool for further probabilistic estimations. This approach resulted in estimates within the same range: the estimated median DEHP intake in the whole population (both non-consumers and consumers of the foods considered) was 10.2, the arithmetic mean 14.0 and the 95th percentile 28.6µg/kg of BW per day. The respective estimates for consumers only were 12.4, 18.7 and 36.5µg/kg of BW per day. These results demonstrate that the probabilistic approach is able to estimate broader ranges of exposure even when using data representing an average intake. Moreover, it reflects the uncertainties of the estimation due to insufficient analytical data on concentrations of DEHP in food.

Relative validation of a food frequency questionnaire for national health and nutrition monitoring.

BACKGROUND: Validation of a food frequency questionnaire (FFQ) is important as incorrect information may lead to biased associations. Therefore the relative validity of an FFQ developed for use in the German Health Examination Survey for Adults 2008-2011 (DEGS) was examined. METHODS: Cross-sectional comparisons of food consumption data from the FFQ and from two 24-hour recalls were made in a sample of 161 participants (aged 18 to 80 years) of an ongoing nationwide survey, the German National Nutrition Monitoring (NEMONIT). The data collection took place from November 2008 to April 2009. RESULTS: Spearman rank correlations between the FFQ and the 24-hour dietary recalls ranged from 0.15 for pizza to 0.80 for tea, with two third of the correlation coefficients exceeding 0.30. All correlation coefficients were statistically significant except those for pizza and cooked vegetables. The proportion of participants classified into the same or adjacent quartile of intake assessed by both methods varied between 68% for cooked vegetables and 94% for coffee. There were no statistically significant differences in food consumption estimates between both methods for 38% of the food groups. For the other food groups, the estimates of food consumption by the FFQ were not generally higher or lower than estimates from the 24-hour dietary recalls. CONCLUSIONS: The FFQ appears to be reasonably valid in the assessment of food consumption of German adults. For some food groups, such as raw and cooked vegetables, relative risks estimates should be interpreted with caution because of the poor ranking agreement.

Effect of age on plasma homocysteine concentrations in young and elderly subjects considering serum vitamin concentrations and different lifestyle factors.

OBJECTIVES: The aim of this study was to investigate whether an increase in total homocysteine (tHcy) concentration with increasing age is due to diminishing serum concentrations of pyridoxal-5-phosphate (PLP), vitamin B-12, and folate. The possible influence of different lifestyle factors on tHcy concentration was considered. METHODS: Plasma tHcy, serum concentrations of pyridoxal-5-phosphate, vitamin B-12, and folate, intake of coffee and tea, alcohol, and methionine, as well as cigarette smoking, were determined in 252 elderly subjects (60-87 years old) of the longitudinal study on nutrition and health status in an aging population in Giessen (GISELA) and 99 young adults (20-34 years old) of the study on health and nutrition of young adults (GEJE). RESULTS: Mean plasma tHcy concentrations were significantly higher in elderly than in young female subjects (9.7 +/- 1.9 micromol/L vs. 9.0 +/- 1.6 micromol/L, p < 0.05), but there was no difference between elderly and young men (10.6 +/- 2.1 micromol/L vs. 10.7 +/- 2.6 micromol/L). No differences in tHcy were observed between young and elderly subjects after adjustment for serum concentrations of PLP, vitamin B-12, and folate. Multiple linear regression analysis revealed a significant influence of age only in elderly, but not in younger subjects. CONCLUSION: Higher tHcy concentrations in the elderly, in comparison to younger women, are due to lower serum concentrations of PLP, vitamin B-12, and folate, whereas within the age group of elderly subjects alone tHcy concentrations increase with age irrespective of serum vitamin concentrations.

A new equation especially developed for predicting resting metabolic rate in the elderly for easy use in practice.

BACKGROUND: Equations published in the literature for predicting resting metabolic rate (RMR) in older individuals were exclusively derived from studies with small samples of this age group. AIM: of the present investigation was therefore to compare the measured RMR of a relatively large group of older females and males with values for RMR calculated from the most commonly used WHO [1] equations. Furthermore, on the basis of the data collected by our study group a new equation for calculating RMR in the elderly was to be developed. Variables used in this equation should be easily and exactly determinable in practice. SUBJECTS AND METHODS: RMR was measured by indirect calorimetry after an overnight fast in a sample of 179 female (age 67.8 +/- 5.7 y, BMI 26.4 +/- 3.7 kg/m(2)) and 107 male (age 66.9 +/- 5.1 y, BMI 26.3 +/- 3.1 kg/m(2)) participants in the longitudinal study on nutrition and health status in an aging population of Giessen, Germany. The subjects were at least 60 years old, did not suffer from thyroid dysfunction, and were not taking thyroid hormones. Stepwise multiple linear regression analysis was used to estimate the best predictors of RMR. RESULTS: In females there was no significant difference between our measured RMR (5504 +/- 653 kJ/d) and RMR predicted with the WHO [1] equation (5458 +/- 440 kJ/d), whereas in males measured RMR (6831 +/- 779 kJ/d) was significantly higher than calculated RMR (6490 +/- 550 kJ/d). Results of regression analysis, considering body weight, body height, age, and sex, showed that RMR is best calculated by the following equation: RMR [kJ/d]= 3169 + 50.0 x body weight [kg] - 15.3 x age [y] + 746 x sex [female = 0, male = 1]. The variables of this equation accounted for 74 % (R(2)) of the variance in RMR and predicted RMR within +/- 486 kJ/d (SEE). CONCLUSION: On the basis of the data determined in a large group of older individuals, we offer a new equation for calculating RMR in the elderly that is both easy and accurate for use in practice.