Development of the VEGANScreener, a Tool for a Quick Diet Quality Assessment among Vegans in Europe.

BACKGROUND: Plant-based diets are not inherently healthy. Similar to omnivorous diets, they may contain excessive amounts of sugar, sodium, and saturated fats, or lack diversity. Moreover, vegans might be at risk of inadequate intake of certain vitamins and minerals commonly found in foods that they avoid. We developed the VEGANScreener, a tool designed to assess the diet quality of vegans in Europe. METHODS: Our approach combined best practices in developing diet quality metrics with scale development approaches and involved the following: (a) narrative literature synthesis, (b) evidence evaluation by an international panel of experts, and (c) translation of evidence into a diet screener. We employed a modified Delphi technique to gather opinions from an international expert panel. RESULTS: Twenty-five experts in the fields of nutrition, epidemiology, preventive medicine, and diet assessment participated in the first round, and nineteen participated in the subsequent round. Initially, these experts provided feedback on a pool of 38 proposed items from the literature review. Consequently, 35 revised items, with 17 having multiple versions, were suggested for further consideration. In the second round, 29 items were retained, and any residual issues were addressed in the final consensus meeting. The ultimate screener draft encompassed 29 questions, with 17 focusing on foods and nutrients to promote, and 12 addressing foods and nutrients to limit. The screener contained 24 food-based and 5 nutrient-based questions. CONCLUSIONS: We elucidated the development process of the VEGANScreener, a novel diet quality screener for vegans. Future endeavors involve contrasting the VEGANScreener against benchmark diet assessment methodologies and nutritional biomarkers and testing its acceptance. Once validated, this instrument holds potential for deployment as a self-assessment application for vegans and as a preliminary dietary screening and counseling tool in healthcare settings.

Bridging barriers to advance multisector approaches to improve food security, nutrition and population health in Nepal: transdisciplinary perspectives.

BACKGROUND: Understanding stakeholders' perceptions is crucial to the development and implementation of any intervention. However, a structured approach to eliciting stakeholder insights into complex, multisector issues of food security, household environment and health is lacking in many low and middle-income countries. This qualitative, workshop-based participatory study explores stakeholders' experiences of developing and implementing multisector interventions to provide transdisciplinary lessons for future developments in low and middle-income countries. METHODS: Participants were purposely selected based on their involvement in, or exposure to, the multisector intervention. Participants with interests in agriculture, nutrition, household air-quality, drinking water-quality and health from academic institutes, government and developmental organisations were brought together at a one-day workshop to participate in a series of discussions on issues relating to food security, nutrition, household environment and health in Nepal. All group discussions were audio-recorded and transcribed, and a thematic qualitative analysis performed to identify relevant themes. RESULTS: The government's ongoing Multisector Nutrition Plan, stakeholders' willingness to work together, availability of local infrastructure for cross-institutional inputs and increasing global movement towards transdisciplinary approaches were identified by the 33 workshop participants, representing 23 organisations as key factors determining success of transdisciplinary work. Fragmentation, lack of research-based and practice-based evidence, limited transdisciplinary knowledge amongst sectoral stakeholders, short-term funding and lack of knowledge-sharing mechanisms were identified as barriers, often creating systematic problems for successful implementation. Stakeholders suggested methods to bring about success included: improved knowledge, both amongst policy-makers and implementers, of food security and its linkage with nutrition, household environments, health and hygiene; investment in collaborative practice-based research and evidence-based practice; and strengthened transdisciplinary collaboration between multi-stakeholders, such as researchers, implementers and beneficiaries, throughout the intervention development and implementation process. CONCLUSIONS: This study suggests that multisector approach needs to adapt to take into account the experiences and views of the stakeholders concerned. The paper offers recommendations for successful development and implementation of future multisector interventions in Nepal that can be extrapolated to other low and middle-income countries, and lays foundations for future transdisciplinary working to support realisation of the recommendations.

The Twazon Arabic Weight Loss App: App-Based Intervention for Saudi Women With Obesity.

BACKGROUND: By 2022, it is estimated that the rate of female obesity (78%) in Saudi Arabia will almost double that of males (41%). Despite being mainly attributed to poor diet, sedentary lifestyle, and a lack of health awareness, behavioral modification interventions are relatively new to the population; bariatric surgery continues to be the treatment of choice for comorbidities. However, neither pre nor postoperative diet and exercise are promoted. Evidence-informed mobile health (mHealth) weight loss apps and interventions may be an effective tool for delivering a culturally relevant intervention. OBJECTIVE: This study aimed to determine the feasibility of a weight loss intervention that tests the effectiveness of Twazon, an originally designed Arabic weight-loss app that promotes lifestyle modification specific to Arab populations. METHODS: A pre-post single-arm pilot study was carried out among a sample of 240 overweight volunteer Saudi women residing in Riyadh, Saudi Arabia who used the Twazon app over a 4-month period. Anthropometric, diet, and physical activity measures were assessed 3 times: baseline, 2-months and 4-months; frequency of app use and system usability were evaluated during the 2 latter data collection periods. Repeated measures analysis of variance was used to identify changes over time. RESULTS: A total of 40 participants completed the 4-month intervention with an attrition rate of 83%. An evaluation of the frequency of app use fostered 2 groups: engaged users (65%) and unengaged users (35%). At 4 months, the engaged users experienced more successful outcomes; body weight was lowered on average by 1.3 (SD 0.6) kg (P=.18), waist circumference (WC) was reduced by 4.9 (SD 1.1) cm (P<.001), and daily energy consumption was decreased by >600 calories (P=.002). Unengaged users experienced minor changes in body weight, WC, and reduced energy intake. CONCLUSIONS: The findings have demonstrated that engagement with the Twazon app renders positive changes in body weight, WC, and energy intake. mHealth weight loss apps and interventions have the potential to be effective in promoting weight loss and healthy lifestyle modification in Saudi Arabia and similar populations.

Relationship Between Evidence Requirements, User Expectations, and Actual Experiences: Usability Evaluation of the Twazon Arabic Weight Loss App.

BACKGROUND: Saudi Arabia has faced a steady growth in the prevalence of obesity. The concurrent and ubiquitous use of mobile technology, such as smartphones and apps, provides an opportunity for the implementation of mHealth technology, a method for delivering behavioral interventions. Despite their effectiveness in promoting lifestyle and diet modification, culturally adapted weight loss apps and related interventions are lacking in Gulf Cooperation Council countries. OBJECTIVE: The objective of our study was to identify the relationship between adherence to evidence-informed practices, potential user expectations, and actual user experiences in order to enhance the understanding of the overall usability of the Twazon Arabic weight loss app. METHODS: In 2 previous studies, 39 Saudi women were recruited for focus group discussions and 240 Saudi women were recruited for an app-based weight loss intervention. Usability of the Twazon Arabic weight loss app was evaluated by analyzing the opinions and experiences of 26 participants who engaged with the Twazon app for 4 months; the System Usability Scale (SUS) and word clouds were used. The results were triangulated with potential user expectations obtained in the focus group discussion and with the findings from an Arabic app screening for evidence-informed practices. RESULTS: The average reported SUS score was 69.3. The most favored features were the calorie counter, step counter, and physical activity calorie counter. The features in need of improvement were the social network, notifications, and the Twazon Saudi Food Database. Twazon users preferred and found useful 7 of the 13 evidence-informed weight loss practices that were integrated into the features of the app. CONCLUSIONS: Triangulation identified the most notable relationship to be the disparity between user experience and 2 of the evidence-informed practices, namely a minimum weight loss goal of 0.5 to 1 kg/week and social support; no relationship was found between user expectations and evidence-informed weight loss practices. The overall usability of the Twazon Arabic weight loss app ranged between high marginal and acceptable, indicating that some improvements to the app should be considered for implementation in future app-based weight loss interventions of this kind.

Effect of increasing fruit and vegetable intake by dietary intervention on nutritional biomarkers and attitudes to dietary change: a randomised trial.

PURPOSE: Low fruit and vegetable consumption is linked with an increased risk of death from vascular disease and cancer. The benefit of eating fruits and vegetables is attributed in part to antioxidants, vitamins and phytochemicals. Whether increasing intake impacts on markers of disease remains to be established. This study investigates whether increasing daily intake of fruits, vegetables and juices from low (approx. 3 portions), to high intakes (approx. 8 portions) impacts on nutritional and clinical biomarkers. Barriers to achieving the recommended fruit and vegetable intakes are also investigated. METHOD: In a randomised clinical trial, the participants [19 men and 26 women (39-58 years)] with low reported fruit, juice and vegetable intake (<3 portions/day) were randomised to consume either their usual diet or a diet supplemented with an additional 480 g of fruit and vegetables and fruit juice (300 ml) daily for 12 weeks. Nutritional biomarkers (vitamin C, carotenoids, B vitamins), antioxidant capacity and genomic stability were measured pre-intervention, at 4-, 8- and 12 weeks throughout the intervention. Samples were also taken post-intervention after a 6-week washout period. Glucose, homocysteine, lipids, blood pressure, weight and arterial stiffness were also measured. Intake of fruit, fruit juice and vegetables was reassessed 12 months after conducting the study and a questionnaire was developed to identify barriers to healthy eating. RESULTS: Intake increased significantly in the intervention group compared to controls, achieving 8.4 portions/day after 12 weeks. Plasma vitamin C (35%), folate (15%) and certain carotenoids [α-carotene (50%) and ß-carotene (70%) and lutein/zeaxanthin (70%)] were significantly increased (P < 0.05) in the intervention group. There were no significant changes in antioxidant capacity, DNA damage and markers of vascular health. Barriers to achieving recommended intakes of fruits and vegetables measured 12 months after the intervention period were amount, inconvenience and cost. CONCLUSION: While increasing fruit, juice and vegetable consumption increases circulating level of beneficial nutrients in healthy subjects, a 12-week intervention was not associated with effects on antioxidant status or lymphocyte DNA damage. TRIAL REGISTRATION: This trial was registered at Controlled-Trials.com; registration ISRCTN71368072.

Assessing the relative validity of the Scottish Collaborative Group FFQ for measuring dietary intake in adults.

OBJECTIVE: To assess the relative validity of the latest version of the Scottish Collaborative Group (SCG) FFQ (version 6.6) in adults living in Scotland. DESIGN: A cross-sectional validation study. Participants completed the self-administered, 169-item SCG FFQ followed by a 7 d, non-weighed food diary. Energy and energy-adjusted macronutrients and micronutrients were examined for relative validity through Spearman's correlation, the percentage of classification into thirds of intake, Cohen's weighted kappa (κ w) and Bland-Altman analysis. SETTING: General population living in Scotland. SUBJECTS: Ninety-six adults aged 18-65 years. RESULTS: Spearman's correlation coefficients ranged from 0·21 (retinol) to 0·71 (Mg). A median of 52 % of adults were correctly classified into thirds of intake (range: 42 % (PUFA, MUFA and Fe) to 64 % (percentage energy from carbohydrates)) and 8 % were grossly misclassified into opposite thirds of intake (range: 3 % (carbohydrates, percentage energy from carbohydrates) to 19 % (thiamin)). Values of κ w ranged between 0·20 (PUFA, ß-carotene) to 0·55 (percentage energy from carbohydrates). In the Bland-Altman analysis, the smallest limits of agreement, when expressed as a percentage of the mean intake from the FFQ and food diary, were seen for the main macronutrients carbohydrates, fat and protein. CONCLUSIONS: As in the previous validation study more than 10 years ago, the FFQ gave higher estimates of energy and most nutrients than the food diary, but after adjustment for energy intake the FFQ could be used in place of non-weighed food diaries for most macronutrients and many micronutrients in large-scale epidemiological studies.

Type and extent of trans-disciplinary co-operation to improve food security, health and household environment in low and middle income countries: systematic review.

BACKGROUND: Although linkages have been found between agricultural interventions and nutritional health, and the development of clean fuels and improved solid fuel stoves in reducing household air pollution and adverse health effects, the extent of the potential of combined household interventions to improve health, nutrition and the environment has not been investigated. A systematic review was conducted to identify the extent and type of community-based agricultural and household interventions aimed at improving food security, health and the household environment in low and middle income countries. METHODS: A systematic search of Ovid MEDLINE, PUBMED, EMBASE and SCOPUS databases was performed. Key search words were generated reflecting the "participants, interventions, comparators, outcomes and study design" approach and a comprehensive search strategy was developed following "Preferred Reporting Items for Systematic Reviews and Meta-Analyses" recommendations. Any community-based agricultural and/or household interventions were eligible for inclusion if the focus was to improve at least one of the outcome measures of interest. All relevant study designs employing any of these interventions (alone/in combination) were included if conducted in Low and middle income countries. Review articles, and clinical and occupational studies were excluded. RESULTS: A total of 123 studies were included and grouped into four intervention domains; agricultural (n = 27), air quality (n = 34), water quality (n = 32), and nutritional (n = 30). Most studies were conducted in Asia (39.2 %) or Africa (34.6 %) with the remaining 26.1 % in Latin America. Very few studies (n = 11) combined interventions across more than one domain. The majority of agricultural and nutritional studies were conducted in Africa and Asia, whereas the majority of interventions to improve household air quality were conducted in Latin America. CONCLUSIONS: It is clear that very little trans-disciplinary research has been done with the majority of studies still being discipline specific. It also appears that certain low and middle income countries seem to focus on domain-specific interventions. The review emphasizes the need to develop holistic, cross-domain intervention packages. Further investigation of the data is being conducted to determine the effectiveness of these interventions and whether interdisciplinary interventions provide greater benefit than those that address single health or community problems.

Dietary factors and biomarkers of systemic inflammation in older people: the Lothian Birth Cohort 1936.

Epidemiological studies have reported inverse associations between various single healthy diet indices and lower levels of systemic inflammation, but rarely are they examined in the same sample. The aim of the present study was to investigate the potential relationships between biomarkers of systemic inflammation (C-reactive protein (CRP) and fibrinogen) and overall foods (dietary patterns), single foods (fruits and vegetables), and specific nutritive (antioxidants) and non-nutritive (flavonoids) food components in the same narrow-age cohort of older adults. The dietary intake of 792 participants aged 70 years from the Lothian Birth Cohort 1936 was assessed using a 168-item FFQ. Models were adjusted for age, sex, childhood cognitive ability, lifestyle factors and history of disease. Using logistic regression analyses, CRP (normal v. elevated) was favourably associated (at P< 0·05) with the 'health-aware' (low-fat) dietary pattern (unstandardised ß = (0·200, OR 0·82, 95 % CI 0·68, 0·99) and fruit intake (unstandardised ß = (0·100, OR 0·91, 95 % CI 0·82, 0·99), including flavonoid-rich apples (unstandardised ß = (0·456, OR 0·63, 95 % CI 0·439, 0·946). Using linear regression analyses, fibrinogen (continuous) was inversely associated (at P< 0·05) with the Mediterranean dietary pattern (standardised ß = (0·100), fruit intake (standardised ß = (0·083), and combined fruit and vegetable intake (standardised ß = (0·084). We observed no association between food components (antioxidant nutrients or specific flavonoid subclasses) and inflammatory markers. In the present cross-sectional study, nutrient-dense dietary patterns were associated with lower levels of systemic inflammation in older people. The results are consistent with dietary guidelines that promote a balanced diet based on a variety of plant-based foods.

Resourcefulness, Desperation, Shame, Gratitude and Powerlessness: Common Themes Emerging from A Study of Food Bank Use in Northeast Scotland.

There is growing policy maker and public concern about current trends in food bank use in Scotland. Yet little is known about the experiences of those seeking help from food banks in this country. This research aimed to address this issue by studying the use and operation of a food bank situated in a rich northeast city during January and June 2014. The study aimed to establish who was seeking help from the food bank, their reasons for doing so, and what those who did thought of, and dealt with the food they received from it. Consequently, an audit of the food bank's client database, four months of participant observation based in the food bank, and seven face-to-face interviews with current and former food bank clients were conducted. The audit revealed that clients came from a range of socio-economic backgrounds, with men more likely to access it compared to women. Debt and social security benefit delays were cited as the main reasons for doing so. Qualitative data confirmed that sudden and unanticipated loss of income was a key driver of use. Resourcefulness in making donated food last as long as possible, keeping fuel costs low, and concern to minimise food waste were commonly described by participants. Desperation, gratitude, shame and powerlessness were also prevalent themes. Furthermore, clients were reluctant to ask for food they normally ate, as they were acutely aware that the food bank had little control over what it was able offer. Insights from this study suggest that recent UK policy proposals to address food poverty may have limited impact, without concomitant effort to address material disadvantage. Research is urgently required to determine the precise nature and extent of household level food insecurity in Scotland, and to consider monitoring for adverse physical and mental health outcomes for those affected by it.

Sustainable diets for the future: Can we contribute to reducing greenhouse gas emissions by eating a healthy diet?

BACKGROUND: Food systems account for 18-20% of UK annual greenhouse gas emissions (GHGEs). Recommendations for improving food choices to reduce GHGEs must be balanced against dietary requirements for health. OBJECTIVE: We assessed whether a reduction in GHGEs can be achieved while meeting dietary requirements for health. DESIGN: A database was created that linked nutrient composition and GHGE data for 82 food groups. Linear programming was used iteratively to produce a diet that met the dietary requirements of an adult woman (19-50 y old) while minimizing GHGEs. Acceptability constraints were added to the model to include foods commonly consumed in the United Kingdom in sensible quantities. A sample menu was created to ensure that the quantities and types of food generated from the model could be combined into a realistic 7-d diet. Reductions in GHGEs of the diets were set against 1990 emission values. RESULTS: The first model, without any acceptability constraints, produced a 90% reduction in GHGEs but included only 7 food items, all in unrealistic quantities. The addition of acceptability constraints gave a more realistic diet with 52 foods but reduced GHGEs by a lesser amount of 36%. This diet included meat products but in smaller amounts than in the current diet. The retail cost of the diet was comparable to the average UK expenditure on food. CONCLUSION: A sustainable diet that meets dietary requirements for health with lower GHGEs can be achieved without eliminating meat or dairy products or increasing the cost to the consumer.

The association of dietary intake of purine-rich vegetables, sugar-sweetened beverages and dairy with plasma urate, in a cross-sectional study.

INTRODUCTION: Hyperuricemia is a strong risk factor for gout. The incidence of gout and hyperuricemia has increased recently, which is thought to be, in part, due to changes in diet and lifestyle. Objective of this study was to investigate the association between plasma urate concentration and: a) food items: dairy, sugar-sweetened beverages (SSB) and purine-rich vegetables; b) related nutrients: lactose, calcium and fructose. METHODS: A total of 2,076 healthy participants (44% female) from a population-based case-control study in Scotland (1999-2006) were included in this study. Dietary data was collected using a semi-quantitative food frequency questionnaire (FFQ). Nutrient intake was calculated using FFQ and composition of foods information. Urate concentration was measured in plasma. RESULTS: Mean urate concentration was 283.8±72.1 mmol/dL (females: 260.1±68.9 mmol/dL and males: 302.3±69.2 mmol/dL). Using multivariate regression analysis we found that dairy, calcium and lactose intakes were inversely associated with urate (p = 0.008, p = 0.003, p = 0.0007, respectively). Overall SSB consumption was positively associated with urate (p = 0.008), however, energy-adjusted fructose intake was not associated with urate (p = 0.66). The intake of purine-rich vegetables was not associated to plasma urate (p = 0.38). CONCLUSIONS: Our results suggest that limiting purine-rich vegetables intake for lowering plasma urate may be ineffectual, despite current recommendations. Although a positive association between plasma urate and SSB consumption was found, there was no association with fructose intake, suggesting that fructose is not the causal agent underlying the SSB-urate association. The abundant evidence supporting the inverse association between plasma urate concentration and dairy consumption should be reflected in dietary guidelines for hyperuricemic individuals and gout patients. Further research is needed to establish which nutrients and food products influence plasma urate concentration, to inform the development of evidence-based dietary guidelines.

Diet, environmental factors, and lifestyle underlie the high prevalence of vitamin D deficiency in healthy adults in Scotland, and supplementation reduces the proportion that are severely deficient.

Vitamin D deficiency has recently been implicated as a possible risk factor in the etiology of numerous diseases, including nonskeletal conditions. In humans, skin synthesis following exposure to UVB is a potent source of vitamin D, but in regions with low UVB, individuals are at risk of vitamin D deficiency. Our objectives were to describe the prevalence of vitamin D deficiency and to investigate determinants of plasma 25-hydroxyvitamin D (25-OHD) concentrations in a high northern latitude country. Detailed dietary, lifestyle, and demographic data were collected for 2235 healthy adults (21-82 y) from Scotland. Plasma 25-OHD was measured by liquid chromatography-tandem MS. Among study participants, 34.5% were severely deficient (25-OHD <25 nmol/L) and 28.9% were at high risk of deficiency (25-40 nmol/L). Only 36.6% of participants were at low risk of vitamin D deficiency or had adequate levels (>40 nmol/L). Among participants who were taking supplements, 21.3% had a May-standardized 25-OHD concentration >50 nmol/L, 54.2% had 25-50 nmol/L, and 24.5% had <25 nmol/L, whereas this was 15.6, 43.3, and 41%, respectively, among those who did not take supplements (P < 0.0001). The most important sources of vitamin D were supplements and fish consumption. Vitamin D deficiency in Scotland is highly prevalent due to a combination of insufficient exposure to UVB and insufficient dietary intake. Higher dietary vitamin D intake modestly improved the plasma 25-OHD concentration (P = 0.02) and reduced the proportion of severely deficient individuals (P < 0.0001). In regions with low UVB exposure, dietary and supplement intake may be much more important than previously thought and consideration should be given to increasing the current recommended dietary allowance of 0-10 µg/d for adults in Scotland.

Alcohol intake and cognitive abilities in old age: the Lothian Birth Cohort 1936 study.

OBJECTIVE: Moderate alcohol consumption has been associated with better cognitive performance in late adulthood, possibly by improving vascular health. Few studies have examined the potentially confounding roles of prior cognitive ability and social class in this relationship. METHOD: Participants were 922 healthy adults about 70 years old in the Lothian Birth Cohort 1936 study, for whom there are IQ data from age 11. Alcohol consumption was obtained by self-report questionnaire. Cognitive outcome measures included general cognitive ability, speed of information processing, memory, and verbal ability. RESULTS: Moderate to substantial drinking (>2 units/day) was associated with better performance on cognitive tests than low-level drinking (≤2 units/day) or nondrinking in men and women. After adjusting for childhood IQ and adult social class, most of these associations were removed or substantially attenuated. After full adjustment, a small, positive association remained between overall alcohol intake and memory (women and men) and verbal ability (women only). Women's overall alcohol intake was derived almost exclusively from wine. In men, effects differed according to beverage type: wine and sherry-port consumption was associated with better verbal ability, but beer was associated with a poorer verbal ability and spirits intake was associated with better memory. CONCLUSIONS: Prior intelligence and socioeconomic status influence both amount and type of alcohol intake and may partly explain the link between alcohol intake and improved cognitive performance at age 70. Alcohol consumption was found to make a small, independent contribution to memory performance and verbal ability, but these findings' clinical significance is uncertain.

Flavonoid intake in relation to cognitive function in later life in the Lothian Birth Cohort 1936.

Previous studies have suggested a link between flavonoid intake and better cognitive function in later life but have not been able to control for possible confounding by prior intelligence quotient (IQ). The aim of the present study was to address this issue in a cross-sectional survey of 1091 men and women born in 1936, in whom IQ was measured at age 11 years. At the age of 70 years, participants carried out various neuropsychological tests and completed a FFQ. Associations between test scores and nutrient intake were assessed by linear regression with adjustment for potentially confounding variables. Total fruit, citrus fruits, apple and tea intakes were initially found to be associated with better scores in a variety of cognitive tests, but the associations were no longer statistically significant after adjusting for confounding factors, including childhood IQ. Flavanone intake was initially found to be associated with better scores in verbal fluency (P = 0·003, with standardised regression coefficient 0·10), but, again, the association was no longer statistically significant after adjusting for confounding factors. These findings do not support a role for flavonoids in the prevention of cognitive decline in later life. Studies of diet and cognitive function should include measurement of potential confounding variables, including prior IQ wherever possible.

A systematic review of salicylates in foods: estimated daily intake of a Scottish population.

Several studies suggest that natural salicylates in plant-based foods may benefit health. However, large variation in published values of the salicylate content of foods means that relating dietary intakes to disease risk is problematical. Consequently, we have systematically reviewed the available literature using prescribed selection criteria. By combining these literature values with in-house analysis, we have constructed a food composition database describing median salicylate values for 27 different types of fruits, 21 vegetables, 28 herbs, spices and condiments, 2 soups and 11 beverages. Application of a validated food frequency questionnaire estimated median dietary intakes of 4.42 (range 2.90-6.27) and 3.16 (2.35-4.89) mg/day for Scottish males and females, respectively. Major dietary sources of salicylates were alcoholic beverages (22%), herbs and spices (17%), fruits (16%), non-alcoholic beverages including fruit juices (13%), tomato-based sauces (12%) and vegetables (9%). Application of the database to populations with differing dietary habits and disease risk profiles may provide further evidence for the role of dietary salicylates in the prevention of chronic diseases.

Caffeine, cognition, and socioeconomic status.

There is interest in age-related cognitive decline and environmental risk factors for Alzheimer's disease (AD). This interest is focused on individual differences in exposure to agents that may harm or protect cognitive function. Caffeine is used as a short acting mental stimulant and may possess longer-term properties that protect against age-related decline and, possibly, AD. The current study aimed to: 1) examine current cognitive function in a narrow age range sample (n=351) without dementia (MMSE>25) who are, by reason of age, entering the period of increased risk of AD; and 2) link cognitive function to self-reported intake of caffeine and socioeconomic status (SES). Possible confounding by gender, childhood intelligence, education, and symptoms of anxiety and depression was introduced into the statistical model. There were significant differences between SES groups in caffeine intake (p< 0.05) and cognitive performance (p< 0.001). Higher quartiles of caffeine intake were associated with slower digit symbol speed (F =3.38, p< 0.02) but this finding was removed after allowing for SES. The results are discussed in terms of the withdrawal effects of caffeine during cognitive testing and strong links between SES and cognitive performance. No evidence in support of cognitive enhancing effects of caffeine was found.

Dietary flavonoid intake and colorectal cancer: a case-control study.

Diets rich in flavonoids may reduce the risk of developing colorectal cancer. Flavonoids are widely distributed in foods of plant origin, though in the UK tea is the main dietary source. Our objective was to evaluate any independent associations of total dietary and non-tea intake of four flavonoid subclasses and the risk of developing colorectal cancer in a tea-drinking population with a high colorectal cancer incidence. A population-based case-control study (264 cases with histologically confirmed incident colorectal cancer and 408 controls) was carried out. Dietary data gathered by FFQ were used to calculate flavonoid intake. Adjusted OR and 95 % CI were estimated by logistic regression. No linear association between risk of developing colorectal cancer and total dietary flavonol, procyanidin, flavon-3-ol or flavanone intakes was found, but non-tea flavonol intake was inversely associated with colorectal cancer risk (OR 0.6; 95 % CI 0.4, 1.0). Stratification by site of cancer and assessment of individual flavonols showed a reduced risk of developing colon but not rectal cancer with increasing non-tea quercetin intake (OR 0.5; 95 % CI 0.3, 0.8; P(trend) < 0.01). We concluded that flavonols, specifically quercetin, obtained from non-tea components of the diet may be linked with reduced risk of developing colon cancer.

Caffeine consumption and cognitive function at age 70: the Lothian Birth Cohort 1936 study.

OBJECTIVE: To investigate the association between caffeine consumption and cognitive outcomes in later life. METHODS: Participants were 923 healthy adults from the Lothian Birth Cohort 1936 Study, on whom there were intelligence quotient (IQ) data from age 11 years. Cognitive function at age 70 years was assessed, using tests measuring general cognitive ability, speed of information processing, and memory. Current caffeine consumption (using multiple measures of tea, coffee, and total dietary caffeine) was obtained by self-report questionnaire, and demographic and health information was collected in a standardized interview. RESULTS: In age- and sex-adjusted models, there were significant positive associations between total caffeine intake and general cognitive ability and memory. After adjustment for age 11 IQ and social class, both individually and together, most of these associations became nonsignificant. A robust positive association, however, was found between drinking ground coffee (e.g., filter and espresso) and performance on the National Adult Reading Test (NART, p = .007), and the Wechsler Test of Adult Reading (WTAR, p = .02). No gender effects were observed, contrary to previous studies. Generally, higher cognitive scores were associated with coffee consumption, and lower cognitive scores with tea consumption, but these effects were not significant in the fully adjusted model. CONCLUSIONS: The present study is rare in having childhood IQ in a large sample of older people. The results suggest that the significant caffeine intake-cognitive ability associations are bidirectional-because childhood IQ and estimated prior IQ are associated with the type of caffeine intake in old age-and partly confounded by social class.