Validation of the Diet Satisfaction Questionnaire: a new measure of satisfaction with diets for weight management.

OBJECTIVE: The Diet Satisfaction Questionnaire was developed to fill the need for a validated measure to evaluate satisfaction with weight-management diets. This paper further develops the questionnaire, examining the factor structure of the original questionnaire, cross-validating a revised version in a second sample and relating diet satisfaction to weight loss during a 1-year trial. METHODS: The 45-item Diet Satisfaction Questionnaire (DSat-45) uses seven scales to assess characteristics that influence diet satisfaction: Healthy Lifestyle, Convenience, Cost, Family Dynamics, Preoccupation with Food, Negative Aspects, and Planning and Preparation. It was administered five times during a 1-year weight-loss trial (n = 186 women) and once as an online survey in a separate sample (n = 510 adults). Confirmatory factor analysis was used to assess and refine the DSat-45 structure, and reliability and validity data were examined in both samples for the revised questionnaire, the DSat-28. Associations were examined between both DSat questionnaires and weight loss in the trial. RESULTS: Internal consistency (reliability) was moderate for the DSat-45. Confirmatory factor analysis showed improved fit for a five-factor structure, resulting in the DSat-28 that retained four of the original scales and a shortened fifth scale. This revised questionnaire was reliable in both samples. Weight loss across the year-long trial was positively related to satisfaction with Healthy Lifestyle, Preoccupation with Food, and Planning and Preparation in both versions of the questionnaire. CONCLUSIONS: Measures of reliability and validity were improved in the more concise DSat-28 compared to the DSat-45. This shorter measure should be used in future work to evaluate satisfaction with weight-management diets.

Early predictors of weight loss in a 1-year behavioural weight-loss programme.

Objective: Identifying early predictors of weight loss is key for developing personalized treatment. However, few individual factors have been identified that predict weight loss during intervention, other than early weight loss itself. Methods: Women with overweight or obesity (n = 186, mean ± SD age 50.0 ± 10.6 years, body mass index 34.0 ± 4.2 kg m-2) participated in the Portion-Control Strategies Trial, a 1-year randomized controlled weight-loss trial with three intervention groups. Early changes in eating behaviours and psychological factors were evaluated by questionnaires at baseline and Month 1. The influence of these early changes on the trajectory of weight loss from baseline to Months 3 and 12 was assessed by random coefficients models. Results: Although there were no differences in weight loss between intervention groups at the end of the trial, certain individual factors were shown to predict both early weight loss at Month 3 and longer-term weight loss at Month 12. Across all participants, increases in dietary restraint and healthy lifestyle ratings in the first month predicted more rapid weight loss from baseline to Month 3 (P < 0.05) and also predicted more rapid weight loss and slower regain from baseline to Month 12 (both P < 0.01). Early attendance and changes in disinhibition were not associated with subsequent weight loss. Conclusions: Changes in psychological and behavioural measures, such as restraint, in the first month of weight loss intervention predicted longer-term weight loss in women. Early additional support or tailored treatment could promote long-term success by reinforcing these behaviours.

The structure of genetic and environmental risk factors for fears and phobias.

BACKGROUND: Although prior genetic studies of interview-assessed fears and phobias have shown that genetic factors predispose individuals to fears and phobias, they have been restricted to the DSM-III to DSM-IV aggregated subtypes of phobias rather than to individual fearful and phobic stimuli. METHOD: We examined the lifetime history of fears and/or phobias in response to 21 individual phobic stimuli in 4067 personally interviewed twins from same-sex pairs from the Virginia Adult Twin Study of Psychiatric and Substance Abuse Disorders (VATSPSUD). We performed multivariate statistical analyses using Mx and Mplus. RESULTS: The best-fitting model for the 21 phobic stimuli included four genetic factors (agora-social-acrophobia, animal phobia, blood-injection-illness phobia and claustrophobia) and three environmental factors (agora-social-hospital phobia, animal phobia, and situational phobia). CONCLUSIONS: This study provides the first view of the architecture of genetic and environmental risk factors for phobic disorders and their subtypes. The genetic factors of the phobias support the DSM-IV and DSM-5 constructs of animal and blood-injection-injury phobias but do not support the separation of agoraphobia from social phobia. The results also do not show a coherent genetic factor for the DSM-IV and DSM-5 situational phobia. Finally, the patterns of co-morbidity across individual fears and phobias produced by genetic and environmental influences differ appreciably.

Within-litter variance in early rat pup-mother interactions and adult offspring responses to novelty.

Siblings share similar genetics and environments, however, their behavior can be quite different. To determine if within-litter variance in neonatal-maternal interactions predict adult sibling behavioral variance, we observed mother-pup interactions during postnatal days 1-8 in four Sprague-Dawley rat litters and measured adult offspring behavioral responses to social and physical novelty. Our results indicate that pup and maternal behavior varied by at least twofold within each litter, and that specific pup behaviors within each litter (perioral contact) were associated with increased maternal licking. Furthermore, siblings that received more licks and made more perioral contact during postnatal days 1-8 had longer latencies to approach novel objects in adulthood than siblings that received less licking and made less perioral contact. This within-litter variance in postnatal mother and pup behavior and offspring adult behavior indicates that early social dynamics within families are an important area to examine to understand the development of sibling variance.

Prevention of antibiotic-associated diarrhoea by a fermented probiotic milk drink.

OBJECTIVE: To study the preventive effect of a milk drink fermented with multistrain probiotics on antibiotic associated diarrhoea (AAD). DESIGN: Double-blind placebo controlled study. SETTING: University Hospital of North Norway. SUBJECTS AND METHODS: Of 853 patients treated with antibiotics, 87 met the inclusion criteria, and were randomized to ingestion of a fermented milk drink containing LGG, La-5 and Bb-12 (n=46) or placebo with heat-killed bacteria (n=41), during a period of 14 days. A diary was recorded, and stool samples were collected for microbiological analyses. RESULTS: Sixty-three patients completed the study according to the protocol; two patients (5.9%) in the treatment group and eight (27.6%) in the placebo group developed AAD (P=0.035). The relative risk of developing AAD was 0.21 (95% confidence interval: 0.05-0.93) when given probiotic milk drink. CONCLUSION: A fermented multistrain probiotic milk drink may prevent four of five cases of AAD in adult hospitalized patients. SPONSORSHIP: TINE BA, Oslo, Norway.

Relative validation of a pre-coded food diary among children, under-reporting varies with reporting day and time of the day.

OBJECTIVE: The aim of this study was to validate intake of energy, macro- and micronutrients assessed from pre-coded food diaries (PFDs) by using weighed records (WRs) as the reference method among a group of Norwegian 9-year-olds. We also examined how under-reporters (UR) differed from acceptable reporters (AR) according to the energy intake during the 4-day recording period and energy intake distribution during the day. SUBJECTS AND DESIGN: One hundred 9-year-olds, 45 girls and 55 boys, were recruited to complete a 4-day record with a PFD followed 3 days later with a 4-day WR. RESULTS: There were no differences between energy and nutrient intake from the two recording methods among boys, but girls reported significantly higher intakes with PFD compared with WR. The median Spearman correlation coefficient between PFD and WR for energy and nutrients was 0.43 for girls and 0.49 for boys. Twelve participants were classified as UR with the PDF method. Energy percentages from macronutrients were not significantly different between UR and AR with the PFD method. UR had significantly lower energy intake in the last two recording days and from 1000 to 2200 hours during the day compared to AR. CONCLUSIONS: The PFD method is promising as a tool for assessing food intake in large surveys among children. The present study indicates that the PFD gives more valid data for boys than girls according to the group intake and ranking of nutrient intake when WR is the reference method. However, UR seemed to develop a study fatigue during the day and during the recording period. Increased awareness about the tendency of study fatigue can lead to more specific instructions on how participants can handle the problem.

[Folate and health--new knowledge and new recommendation]. / Folat og helse--ny kunnskap og nye anbefalinger.

The dietary intake of folate in Norway is not optimal with regard to minimizing the risk of birth defects (especially neural-tube defects), and poSsibly also cardiovascular diseases and other diseases. The National Nutrition Council has therefore initiated a project to evaluate the status of folate in Norway and to recommend actions for necessary improvement. A protective effect of folic acid supplements on neural-tube defects has been found in observational studies and clinical trials. The effects of folate on cardiovascular diseases and cancer are less certain. The estimated average intake of folate from foods in Norway is lower than the recommended 300 micrograms per day for adult women and men, and remarkably lower than the 400 micrograms per day recommended for pregnant and lactating women. Thus, with the aim of minimizing the risk for neural-tube defects, the National Nutrition Council now recommends that all women who are planning pregnancy or who are likely to become pregnant have an intake of at least 400 micrograms folate per day. Because it may be difficult to achieve this through diet alone, and because an additional risk-lowering effect of folic acid supplementation has been shown, a folic acid supplement of 400 micrograms per day is recommended for this group. The supplement should be taken one month before conception and during the first two months of pregnancy. Fortification of foods with folate is not recommended because some groups may then exceed the recommended upper intake level.

Dietary factors and the incidence of hip fracture in middle-aged Norwegians. A prospective study.

Dietary data from a prospective study were used to relate factors influencing calcium balance (estimates of dietary calcium intake, protein intake from nondairy animal sources (meat, fish, and eggs), and coffee consumption) to the incidence of hip fracture. During the years 1977-1983, women and men born between 1925 and 1940 and living in one of three Norwegian counties were invited to a cardiovascular screening that included a dietary survey. The attendance rate at screening was 91.1%, and 90.7% of these persons (19,752 women and 20,035 men) filled in and returned a semiquantitative dietary questionnaire. This cohort was followed for an average of 11.4 years (range, 0.01-13.8 years) with respect to hip fracture, defined as cervical or trochanteric fracture. During follow-up, 213 hip fractures were identified, excluding fractures associated with high-energy trauma and metastatic bone disease. There was no clear association between calcium intake or nondairy animal protein intake and hip fracture in this cohort. However, an elevated risk of fracture was found in women with a high intake of protein from nondairy animal sources in the presence of low calcium intake (relative risk = 1.96 (95% confidence interval 1.09-3.56) for the highest quarter of nondairy protein intake and the lowest quarter of calcium intake vs. the three lower quarters of protein intake and the three higher quarters of calcium intake). Women who drank nine or more cups of coffee per day also had an increased risk of fracture, while there was no association between coffee consumption and hip fracture in men. Although these findings do not necessarily imply causal relations, they suggest the presence of risk factors for hip fracture that act through a negative calcium balance in this population.

Dietary factors and risk of colon cancer: a prospective study of 50,535 young Norwegian men and women.

The relationship of meat, fish, fat, fibre or calcium consumption to the risk of colon cancer was examined in a prospective study conducted by the Norwegian National Health Screening Service. Between 1977 and 1983, 50,535 Norwegian men and women aged 20-54 attended the health screening and completed a semi-quantitative questionnaire about food frequency. During a mean follow-up of 11.4 years, 143 cases of colon cancer were identified for analyses through a link with the Norwegian Cancer Registry. The relative risk of colon cancer was 3.5 (95% CI, 1.02-11.9) in women who consumed sausages as their main meal five or more times a month, compared with the risk in those who reported a consumption frequency of less than once a month. There was an increase in the relative risk with increasing frequency of consumption (P for linear trends = 0.03). Among men, the association was not statistically significant, but the trend was in the same direction as that of the women. The frequency of consuming meat meals in general, including meat stews, roasted meat, meat balls, fish or milk, was not associated with a risk of colon cancer. No trends in relative risks of colon cancer were found to be associated with intake of total energy intake or with energy-adjusted intake of total fat, saturated fat, monounsaturated fat, dietary fibre or calcium. In conclusions, this prospective study provided no evidence of association between intake of meat, fish, fat, energy, fibre or calcium and risk of colon cancer, although an increased risk with frequent consumption of sausages was suggested.

Nutrition promotion and dietary change at off-shore oil installations in the Norwegian sector of the North Sea.

OBJECTIVE: This paper examines whether diet had changed at platforms in the Norwegian sector of the North Sea between 1985 and 1993 and if this was caused by nutrition promotive activities, including the use of a health handbook (HHB). DESIGN: The report is based on two cross-sectional surveys, one in 1985 and one in 1993, with special reference to cardiovascular risk. Standardised questionnaires, structured and open interviews were used, incorporating information on food intake and availability, and socioeconomic variables. SUBJECTS AND SETTING: The study population was 194 healthy men in 1985 and 336 in 1993. The mean age was 35 years in 1985 (range 18-57) and 38 (range 21-59) in 1993. RESULTS: From 1985 to 1993 the mean intake of foods and nutrients changed in the same direction as recommended by the Norwegian National Nutrition Council and according to the HHB. The mean energy percentage from fat was 12% lower in 1993 than in 1985. Overall 56% of the workers said they had changed diet since 1985. Those who had changed, consumed more cereals, fruits, more low fat milk, and more fruit juice, and had lower energy percentage from fat, lower intake of dietary cholesterol, more intake of vitamin C and dietary fibre in 1993 than those who had not changed. About 70% of those who had received the HHB had changed their diet, against 50% of those who had not. The use of the HHB was inversely related to intake of energy, energy from fat, and dietary cholesterol, and positively related to vitamin C and dietary fibre. CONCLUSION: It is concluded that the dietary changes are likely to be caused by the interventions, including the HHB.

Dietary fat and the risk of breast cancer: a prospective study of 25,892 Norwegian women.

In this prospective study, the relationship between energy and fat consumption and the risk of breast cancer was examined. Between 1977 and 1983, 31,209 Norwegian women, 20 to 54 years of age attended a health screening. The attendees were given a food-frequency questionnaire to be completed at home, and this was returned by 25,892 (83%). During the 7 to 13 years of follow-up, 248 cases of breast cancer were identified for analysis by linkage to the Norwegian Cancer Registry. The relative risk of women who ate meat more than 5 times a week, as compared with those who consumed meat twice or less than twice a week, was 2.44. Consumers of 0.75 litres or more of full-fat milk daily had a relative risk of 2.91 compared with those who consumed 0.15 litres or less. A positive relationship was found between those reporting the highest quartile of mono-unsaturated fat consumption and the risk of breast cancer. The main foods contributing to the mono-unsaturated fat index were edible fats, meat and milk.

Supplementation with wheat selenium induces a dose-dependent response in serum and urine of a Se-replete population.

In spite of a rather modest dietary intake of selenium (80 micrograms/10 MJ), Norwegian serum Se levels are among the highest in Europe. As part of an ongoing study of Se bioavailability, effects of different doses of wheat Se were investigated in eighteen healthy, Norwegian women. The participants were given Se-rich bread providing 100, 200 and 300 micrograms Se daily for 6 weeks. About 50% of the Se intake was excreted in the urine by week 6, compared with 67% before the intervention started. Serum Se increased by 20, 37 and 53 micrograms/l respectively, in the three group (P less than 0.001). The blood response and renal clearance results compare well with data obtained from less Se-replete populations, and support the hypothesis that selenomethionine from the diet is incorporated into a non-specific amino acid pool. Our study indicates that the intake of wheat Se is the main determinant of blood Se levels in Norway.

Coffee consumption and the risk of breast cancer. A prospective study of 14,593 Norwegian women.

The association between coffee consumption and the incidence rate of breast cancer has been analysed in 152 incident cases of breast cancer that developed among 14,593 Norwegian women during a mean follow-up of 12 years. At the time of inquiry they were between 35 and 51 years of age, and at the end of follow-up between 46 and 63. There was an overall weak negative association between daily intake of coffee and risk of breast cancer, which was not statistically significant. However, the association with coffee varied, depending on the body mass index (BMI) of the women. In the lean (Quetelet less than 24; population mean) there was an inverse relation between coffee intake and risk of breast cancer (chi 2 trend = 5.07, P = 0.02). In this group, women who reported drinking 5 cups or more per day had an age-adjusted IRR of 0.5 (95% confidence intervals, 0.3 and 0.9) compared to women who had 2 cups or less. In women with Quetelet's index equal to or greater than 24 there was a positive relation between coffee intake and breast cancer risk (chi 2 trend = 2.33, P = 0.13), where the corresponding age-adjusted IRR was 2.1 (95% confidence intervals, 0.8 and 5.2). This interaction effect between coffee intake and BMI was statistically significant (chi 2 interaction = 10.2, 3 d.f., P = 0.02). In summary, the results of this study suggest that coffee consumption reduces the risk of breast cancer in lean women, whereas coffee might have the opposite effect in relatively obese women.

Frequency of meat and fish intake and risk of breast cancer in a prospective study of 14,500 Norwegian women.

The association between the frequency of meat and fish intake and the incidence rate of breast cancer has been analyzed in 152 incident cases that developed among 14,500 Norwegian women during 11 to 14 years of follow-up. At the time of dietary inquiry they were between 35 and 51 years of age. A positive association was observed between the frequency of overall meat intake and breast cancer risk. There was an age-adjusted incidence rate ratio (IRR) of 1.8 (95% confidence limits, 1.1 and 3.1) for women who had a main meal with meat 5 times or more per week compared to women who had 2 meat dinners or less per week, and this association displayed a linear trend (chi 2 trend = 4.30, p = 0.04). No association was detected between the overall frequency of fish for dinner and breast cancer risk (chi 2 trend = 1.39, p = 0.24), but there was an inverse relation with the frequency of main meals containing fish in poached form. The age-adjusted IRR was 0.7 (95% confidence limits, 0.4 and 1.0) for women who had poached fish for dinner at least 5 times per month compared to women who had fish in this form twice monthly or less often (chi 2 trend = 3.56, p = 0.06). The positive association with meat may be in accordance with the hypothesis that dietary fat increases the risk of breast cancer. Although there was no association with overall fish intake, the inverse relation with poached fish might deserve further investigation.

Coffee, dietary habits, and serum cholesterol among men and women 35-49 years of age.

The relations between coffee and dietary habits and between coffee, dietary habits, and serum cholesterol were examined in 11,912 men and 12.328 women aged 35-49 years in the Cardiovascular Disease Risk Factor Study in Oppland, southern Norway, 1976-1978. Dietary data are based on results from a self-administered questionnaire. In both sexes, the dietary pattern of persons with a high coffee consumption differed from that of persons with a low coffee consumption: Heavy coffee drinkers had a higher consumption of bread, potatoes, and butter or margarine per slice of bread and more frequent use of hard margarine; men had a higher consumption of eggs and a lower consumption of skim milk. These results suggest a higher total food and fat consumption and a lower ratio of polyunsaturated to saturated fatty acids among heavy coffee drinkers. However, only 20% of the variation in coffee consumption was explained by dietary and lifestyle variables. The study confirmed a positive relation between serum cholesterol and use of butter or hard margarine (p less than 0.001) and between serum cholesterol and coffee consumption (p less than 0.001). Bread consumption and milk consumption were negatively correlated to serum cholesterol. The negative association with skim milk was significant only in women (p less than 0.01).