A computer-based approach for assessing dietary supplement use in conjunction with dietary recalls

doi:10.1016/j.jfca.2007.05.004

Journal of Food Composition and Analysis

Volume 21, Supplement, February 2008, Pages S78-S82

https://doi.org/10.1016/j.jfca.2007.05.004 Get rights and content

Abstract

In response to the need to assess both food and supplemental sources of nutrients, we have expanded the capabilities of nutrition data system for research (NDSR) software to allow for assessing dietary supplement use. A Dietary Supplement Assessment Module allows for the automated collection and coding of dietary supplement use. The module is designed for use in conjunction with the software's 24-hour dietary recall features. The medication inventory method, commonly used in pharmaceutical research, served as the basis for the module's assessment approach. In adapting this approach for use in our software we designed a tiered structure that involves first screening for use of dietary supplements, then collecting product detail (e.g. full name of product, number of times taken, etc.), and finally reviewing the information with the participant. Results from a demonstration study conducted to evaluate the module indicate the assessment approach is acceptable to both participants and interviewers. Collecting dietary supplement use information significantly increases interview time, especially for those using multiple products. A validation study is needed to determine whether the new method results in accurate estimation of nutrient intake from supplemental sources.

Introduction

In populations where the use of dietary supplements is common, it is critical that methods to assess nutrient intake capture both food and supplemental sources. The importance of assessing both these sources of nutrients is illustrated in a recent research report by Archer et al. (2005), in which nutrient intake estimates from only foods were compared with nutrient intakes from food and supplemental sources combined. In that study of middle-aged men and women in the US, 52% of participants reported use of at least one dietary supplement. Among those who reported use of a dietary supplement, nutrient intake estimates based only on food sources were substantially lower than those that accounted for both food and supplemental sources. For example, among men who reported using a vitamin C-containing dietary supplement, mean vitamin C intake from only foods was 134 mg/day, whereas, mean vitamin C intake from food and supplemental sources combined was 623 mg/day.

In response to the critical need to assess both food and supplemental sources of nutrients in population studies, we have expanded the capabilities of the nutrition data system for research (NDSR) software to allow for assessing dietary supplement use, with a dietary supplement assessment module (DSAM) that allows for the automated collection and coding of dietary supplement use. The module is designed for use in conjunction with the software's 24-hour dietary recall features, thus facilitating the assessment of both food and supplemental sources of nutrients. In this paper the dietary supplement assessment approach incorporated in the module is described, and results from a demonstration study conducted as an evaluation of the method are provided.

Section snippets

Assessment approach

To guide the approach to assessing dietary supplement use we first identified criteria for it, and then reviewed the literature to select a method that most closely met these criteria. The method selected was then modified and refined, so that it more completely met the needed criteria.

Four basic criteria were identified. The first criterion was that the approach must be appropriate for both in-person and telephone 24-hour dietary recalls, including unscheduled (unannounced) telephone recalls.

Results

Demographic characteristics of participants in the demonstration study are presented in Table 1. More females than males participated in the study. Participants were mostly white and well educated. The number of dietary supplements reported by participants ranged from 0 to 32 (although one of the study eligibility criteria was regular use of dietary supplements, one participant reported that he did not use any dietary supplements the day prior to the interview).

The amount of time required to

Discussion and conclusion

The DSAM developed for use in conjunction with the collection of 24-hour dietary recalls may be a feasible and useful tool for comprehensively assessing nutrient intake. The tiered dietary supplement inventory approach incorporated into the module appears to be acceptable to both participants and interviewers, although it is important to note that study participants were predominately Caucasian and well educated. It is possible that the approach may not work as well among lower income and more

References (17)

S.L. Archer et al.
Association of dietary supplement use with specific micronutrient intakes among middle-aged American men and women: The INTERMAP study
Journal of the American Dietetic Association
(2005)
G. Block et al.
Collection of dietary supplement data and implications for analysis
American Journal of Clinical Nutrition
(1994)
J. Dwyer et al.
Food and dietary supplement databases for what we eat in America-NHANES
Journal of Nutrition
(2003)
S. Park et al.
Allowing for variations in multivitamin supplement composition improves nutrient intake estimates for epidemiologic studies
Journal of Nutrition
(2006)
B. Psaty et al.
Assessing the use of medications in the elderly: methods and initial experience in the Cardiovascular Health Study. The Cardiovascular Health Study Collaborative Research Group
Journal of Clinical Epidemiology
(1992)
K. Radimer
National nutrition data: contributions and challenges to monitoring dietary supplement use in women
Journal of Nutrition
(2003)
K. Radimer et al.
Nonvitamin, nonmineral dietary supplements: issues and findings from NHANES III
Journal of the American Dietetic Association
(2000)
N. Smith et al.
The reliability of medication inventory methods compared to serum levels of cardiovascular drugs in the elderly
Journal of Clinical Epidemiology
(1999)

There are more references available in the full text version of this article.

Cited by (44)

Adaptation and study protocol for harvest for health together Arizona: A mentored community garden intervention for survivors of cancer
2024, Contemporary Clinical Trials Communications
Current health behavior recommendations for skin cancer prevention, treatment, and survivorship are the same for survivors of other cancers; they include eating a healthy diet, being physically active, maintaining a healthy weight, and minimizing ultraviolet (U.V.) exposure. Few interventions exist to support health behaviors beyond U.V. exposure. We adapted Harvest for Health, a home-based mentored gardening intervention for cancer survivors, for implementation in Arizona as a community-based intervention.
Stakeholder-informed adaptations for Harvest for Health Together Arizona (H4H2-AZ) included updating intervention materials to be relevant to the arid desert environment, emphasizing the importance of sun safety in cancer survivorship, and shifting from a home-based to a community-based delivery model. Participants will be enrolled in cohorts aligned with growing seasons (e.g., spring, monsoon, fall) and matched to an individual 30 ft² community garden plot for two growing seasons (6 months). Original intervention components retained are: 1) Master Gardeners deliver the intervention providing one-to-one mentorship and 2) gardening materials and supplies provided. This pilot six-month single-arm intervention will determine feasibility, acceptability, and appropriateness of an evidence-based adapted mentored community gardening intervention for survivors of skin cancer as primary outcomes. Secondary outcomes are to explore the effects on cancer preventive health behaviors and health-related quality of life.
This pilot single-arm intervention will determine feasibility, acceptability, and appropriateness of an evidence-based adapted mentored community gardening intervention for survivors of skin cancer. If successful, the intervention could be widely implemented throughout existing Master Gardener programs and community garden networks for survivors of other cancers.
ClinicalTrials.gov identifier: NCT05648604. Trial registered on December 13, 2022.
Identification of Dietary Supplements Associated with Blood Metabolites in the Hispanic Community Health Study/Study of Latinos Cohort Study
2023, Journal of Nutrition
Metabolomics approaches have been widely used to define the consumption of foods but have less often been used to study exposure to dietary supplements.
This study aimed to identify dietary supplements associated with metabolite levels and to examine whether these metabolites predicted incident diabetes risk.
We studied 3972 participants from a prospective cohort study of 18–74-y-old Hispanic/Latino adults. At a baseline examination, we ascertained use of dietary supplements using recall methods and concurrently, a serum metabolomic panel. After adjustment for potential confounders, we identified dietary supplements associated with metabolites. We then examined the association of these metabolites with incident diabetes at the 6-y study examination.
We observed a total of 110 dietary supplement–metabolite associations that met the criteria for statistical significance adjusted for age, sex, field center, Hispanic/Latino background, body mass index, diet, smoking, physical activity, and number of medications (adjusted P < 0.05). This included 13 metabolites uniquely associated with only one dietary supplement ingredient. Vitamin C had the most associated metabolites (n = 15), including positive associations with oxalate, tartronate, threonate, and isocitrate, which were each in turn protective for the risk of incident diabetes. Vitamin C was also associated with higher N-acetylvaline level, which was an unfavorable diabetes risk factor. Other findings related to branched chain amino acid related compounds including α-hydroxyisovalerate and 2-hydroxy-3-methylvalerate, which were inversely associated with thiamine or riboflavin intake and also predicted higher diabetes risk. Vitamin B12 had an inverse association with γ-glutamylvaline, levels of which were positively associated with the risk of diabetes.
Our data point to potential metabolite changes associated with vitamin C and B vitamins, which may have favorable metabolic effects. Knowledge of blood metabolites that can be modified by dietary supplement intake may aid understanding the health effects of dietary supplements and identify potential biological mediators.
Randomized Controlled Feasibility Trial of Late 8-Hour Time-Restricted Eating for Adolescents With Type 2 Diabetes
2023, Journal of the Academy of Nutrition and Dietetics
No trial has tested the effects of late time-restricted eating (lTRE) on glycemic control or body composition in adolescents with type 2 diabetes (T2D).
The objective of the current study was to examine the feasibility, acceptability, and preliminary efficacy of lTRE compared with a prolonged eating window in adolescents with T2D.
A 12-week, randomized, controlled, feasibility study of lTRE compared with control in adolescents with obesity and new-onset T2D was conducted.
Eligible participants were 13 to 21 years of age with a diagnosis of T2D, on metformin monotherapy, recruited from Children’s Hospital Los Angeles, between January 2021 and December of 2022. From 36 eligible participants, 27 were enrolled (75% recruitment rate; age, 16.5 ± 1.7 years; hemoglobin A1c [HbA1c], 6.6% ± 0.9%; 22/27 [81%] Hispanic, 17/27 [63%] female, 23/27 [85%] public insurance; all P-values > 0.05), and 23 of 27 completed the protocol.
Participants wore a continuous glucose monitor (CGM) daily and were randomized to 1 of 2 meal-timing schedules for 12-weeks: (1) lTRE (eating all food between 12:00 pm and 20:00 pm without calorie counting or recommended daily caloric intake) or (2) Control (eating over a period of 12 or more hours per day).
Study recruitment, retention, and adherence to intervention arms were captured to operationalize feasibility. Glucose control (HbA1c), weight loss (%BMI_p95), total body fat mass on dual-energy X-ray absorptiometry, sleep, and dietary intake were explored as secondary outcomes.
Analyses were based on the intention-to-treat population. Between-group differences in clinical outcomes were assessed using mixed-effects longitudinal regression models.
Overall adherence to the 8-hour lTRE was 6.2 ± 1.1 d/wk, and control was 5.9 ± 0.9 d/wk. Participants assigned to lTRE indicated that limiting their eating window did not negatively affect their daily functioning, and no adverse events were reported. In this pilot study, lTRE led to a reduction in %BMI_p95 (−3.4%; 95%confidence interval [CI], ‒6.1, ‒0.7, P = 0.02), HbA1c (−0.4%; 95%CI, ‒0.9, ‒0.01; P = 0.06), and alanine transaminase (ALT; –31.1 U/L; 95%CI, ‒60, ‒2; P = 0.05) within the group. There was no significant difference observed between lTRE and control across these measures (all P > 0.05). The lTRE group had a ‒271.4 (95% CI, ‒565.2, 5.2) kcal/day energy reduction compared with a +293.2 (95% CI, 30.4, 552.7) kcal/day increase in Control (P = 0.01). There were no significant changes observed in sleep or eating behaviors over the study period between groups.
Recruitment and retention rates suggest a trial of lTRE in adolescents with T2D was feasible. lTRE was seen as acceptable by participants, and adherence was high. A revised intervention, building on the successful elements of this pilot alongside adapting implementations strategies to augment adherence and engagement, should therefore be considered.
Daily 100% watermelon juice consumption and vascular function among postmenopausal women: A randomized controlled trial
2021, Nutrition, Metabolism and Cardiovascular Diseases
Citation Excerpt :
Dietary intake was closely monitored by three-day food diaries submitted during the two-week run-in period as well as by unannounced 24-h diet recalls during the washout and treatment periods. Diet recalls were administered using a multi-pass method that has been validated for use in older adults (Nutrition Data System for Research Software Version 2015) [35]. Adherence to supplement and placebo was assessed by log forms with check-off boxes for each dose.
Watermelon juice is a rich food source of cardioprotective compounds such as arginine, citrulline, and lycopene. Preventative interventions are warranted as risk of cardiovascular disease increases among women after menopause, and age alone is an independent risk factor for vascular dysfunction. Thus, this study evaluated the effects of 100% watermelon juice on measures of vascular function.
In this randomized, double-blind, placebo-controlled, crossover trial, 21 healthy postmenopausal women were randomized to consume two 360 mL servings of 100% watermelon juice per day or an isocaloric placebo for four weeks. Following a two-week washout period, they consumed the other beverage for an additional four weeks. Before and after each treatment arm, a fasting blood sample was taken for measurement of serum arginine, citrulline, lycopene, glucose, and insulin. Assessments of vascular function included pulse pressure, pulse wave velocity, 24-h ambulatory blood pressure, and flow-mediated dilation. General linear mixed models with intent-to-treat analyses were used to examine the effects of the intervention.
Despite a significant treatment effect for circulating lycopene (p = 0.002), no changes in arginine, citrulline, or any vascular measures were observed. Although the juice intervention resulted in a slight but significant increase in fasting serum glucose (p = 0.001), changes in glucose homeostasis were not clinically significant.
In contrast to findings from previous studies in younger adults and those with pre-existing hypertension, measures of vascular function in this cohort of healthy postmenopausal women were not impacted by supplemental watermelon juice.
NCT03626168.
Rationale, design and study protocol of the ‘Strong Families Start at Home’ feasibility trial to improve the diet quality of low-income, ethnically diverse children by helping parents improve their feeding and food preparation practices
2020, Contemporary Clinical Trials Communications
There is an urgent need to create effective interventions that help parents establish a healthy diet among their children early in life, especially among low-income and ethnically and racially diverse families. U.S. children eat too few fruits, vegetables and whole grains, and too many energy dense foods, dietary behaviors associated with increased morbidity from chronic diseases. Parents play a key role in shaping children's diets. Best practices suggest that parents should involve children in food preparation, and offer, encourage and model eating a variety of healthy foods. In addition, while parents help to shape food preferences, not all children respond in the same way. Certain child appetitive traits, such as satiety responsiveness (sensitivity to internal satiety signals), food responsiveness (sensitivity to external food cues), and food fussiness may help explain some of these differences. Prior interventions to improve the diet of preschool children have not used a holistic approach that targets the home food environment, by focusing on food quality, food preparation, and positive feeding practices while also acknowledging a child's appetitive traits. This manuscript describes the rationale and design for a 6-month pilot randomized controlled trial, Strong Families Start at Home, that randomizes parents and their 2-to 5-year old children to either a home-based environmental dietary intervention or an attention-control group. The primary aim of the study is to explore the feasibility and acceptability of the intervention and evaluation and to determine the intervention's preliminary efficacy on child diet quality, feeding practices, and availability of healthy foods in the home.
Variation of serum lycopene in response to 100% watermelon juice: An exploratory analysis of genetic variants in a randomized controlled crossover study
2020, Current Developments in Nutrition
Watermelon, a rich source of lycopene, has garnered attention for cardioprotective effects including cholesterol reduction and promotion of redox balance. It is unknown whether 100% watermelon juice may represent a food-first approach to confer cardioprotective benefits of lycopene.
This study examined influences of 100% watermelon juice on serum lycopene, lipids, and antioxidant capacity. Secondly, the study explored genetic influences on lycopene metabolism and bioavailability.
A placebo-controlled, randomized, double-blind, crossover trial with postmenopausal women (n = 16, mean ± SD age: 60 ± 4.1 y) assessed effects of 100% watermelon juice on mechanistic and clinical outcomes influencing vascular function. Participants maintained low-lycopene diets for a 1-wk run-in period and throughout the study. Morning and evening consumption of 100% watermelon juice provided a daily dose of 14.4 ± 0.34 mg lycopene. Study arms of 4 wk were separated by a 2-wk washout period. Saliva was collected for genetic analysis of single nucleotide polymorphisms, and fasting blood samples were taken pre– and post–study arms. Statistical analyses included mixed models, linear regression, and nonparametric tests.
Serum lycopene exhibited a significant treatment effect (P = 0.002) along with notable interindividual responses; however, significant improvements in serum lipids or antioxidant capacity were not observed. Genetic variant rs6564851 in the β-carotene 15,15’-oxygenase-1 (BCO1) gene was associated with changes in lycopene such that TT homozygotes exhibited a significantly greater increase (β ± SE: 13.4 ± 1.6, P = 1.4 × 10^–06).
Watermelon juice supplementation did not result in improvements in serum lipids or antioxidant capacity; however, results support findings in which watermelon juice significantly, yet differentially, increased circulating lycopene. Genetics appears to explain some of the variability. Given that dose has been shown to overcome individual responsiveness to lycopene interventions, future investigations with varying doses of lycopene-rich foods would be strengthened by genotyping so as to establish personalized nutrition recommendations. This trial was registered at clinicaltrials.gov as NCT03626168.

View all citing articles on Scopus

^☆: Funding: This project was supported through cooperative agreement U24-HL061778 with the Office of Dietary Supplements and NHLBI at the National Institutes of Health, Bethesda, MD.

View full text

ReportA computer-based approach for assessing dietary supplement use in conjunction with dietary recalls☆

Abstract

Introduction

Section snippets

Assessment approach

Results

Discussion and conclusion

Journal of the American Dietetic Association

American Journal of Clinical Nutrition

Journal of Nutrition

Journal of Nutrition

Journal of Clinical Epidemiology

Journal of Nutrition

Journal of the American Dietetic Association

Journal of Clinical Epidemiology

Report
A computer-based approach for assessing dietary supplement use in conjunction with dietary recalls☆