We aimed to identify dietary patterns in a Danish adult population and assess the reproducibility of the dietary patterns identified. Baseline data of 3372 women and 3191 men (30–60 years old) from the population-based survey Inter99 was used. Food intake, assessed by a FFQ, was aggregated into thirty-four separate food groups. Dietary patterns were identified by principal component analysis. Confirmatory factor analysis and Bland Altman plots were used to assess the reproducibility of the dietary patterns identified. The Bland Altman plots were used as an alternative and new method. Two factors were retained for both women and men, which accounted for 15·1–17·4 % of the total variation. The ‘Traditional’ pattern was characterised by high loadings ( ≥ 0·40) on paté or high-fat meat for sandwiches, mayonnaise salads, red meat, potatoes, butter and lard, low-fat fish, low-fat meat for sandwiches, and sauces. The ‘Modern’ pattern was characterised by high loadings on vegetables, fruit, mixed vegetable dishes, vegetable oil and vinegar dressing, poultry, and pasta, rice and wheat kernels. Small differences were observed between patterns identified for women and men. The root mean square error approximation from the confirmatory factor analysis was 0·08. The variation observed from the Bland Altman plots of factors from explorative v. confirmative analyses and explorative analyses from two sub-samples was between 18·8 and 47·7 %. Pearson's correlation was >0·89 (P < 0·0001). The reproducibility was better for women than for men. We conclude that the ‘Traditional’ and ‘Modern’ dietary patterns identified were reproducible.

A number of methods have been developed to assist subjects in providing an estimate of portion size but their application in improving portion size estimation by children has not been investigated systematically. The aim was to develop portion size assessment tools for use with children and to assess the accuracy of children's estimates of portion size using the tools. The tools were food photographs, food models and an interactive portion size assessment system (IPSAS). Children (n 201), aged 4–16 years, were supplied with known quantities of food to eat, in school. Food leftovers were weighed. Children estimated the amount of each food using each tool, 24 h after consuming the food. The age-specific portion sizes represented were based on portion sizes consumed by children in a national survey. Significant differences were found between the accuracy of estimates using the three tools. Children of all ages performed well using the IPSAS and food photographs. The accuracy and precision of estimates made using the food models were poor. For all tools, estimates of the amount of food served were more accurate than estimates of the amount consumed. Issues relating to reporting of foods left over which impact on estimates of the amounts of foods actually consumed require further study. The IPSAS has shown potential for assessment of dietary intake with children. Before practical application in assessment of dietary intake of children the tool would need to be expanded to cover a wider range of foods and to be validated in a ‘real-life’ situation.

Serum ratios to cholesterol of lathosterol, and of cholestanol, campesterol and sitosterol measure respective relative cholesterol synthesis and absorption, but their clinical applicability is not known in evaluation of cholesterol metabolism under different dietary conditions. We compared relative synthesis and absorption of cholesterol to the respective absolute ones in healthy male volunteers (n 29) on four subsequent diets: baseline home (HD), low-cholesterol low-fat (LCLF), high-cholesterol low-fat (HCLF) and low-cholesterol high-fat (LCHF). Serum lipids, lipoproteins, sterols, fractional cholesterol absorption and sterol synthesis were examined. HCLF and LCHF decreased fractional cholesterol absorption by approximately 23–27 % from baseline HD (P < 0·05) and increased the levels of total and LDL-cholesterol in serum from LCLF by approximately 9–14 % (P < 0·05). On HCLF, bile acid synthesis was high (P < 0·05 for each), and absolute cholesterol synthesis tended to be higher than on HD and LCHF (NS). Relative synthesis was positively associated with absolute cholesterol synthesis, but inversely with relative absorption during each diet (P < 0·05). The relative absorption markers were interrelated in each diet, and were also associated with fractional absorption of cholesterol in each diet but HD. In conclusion, relative markers of cholesterol absorption and synthesis reflect changes in cholesterol metabolism despite the amount of dietary fat and cholesterol consumed, but their validity with this respect is strengthened by controlled diets in metabolic studies. Additions of cholesterol and fat to a diet low in fat and cholesterol cause practically equal changes in the serum lipid profiles, whereas synthesis of cholesterol (NS) and bile acids (P < 0·05) were higher with the high-cholesterol feeding.

Diet is a major aspect of glycaemic control in type 2 diabetes, particularly among the elderly. The objective of this study was to describe the food habits of elderly diabetic subjects compared with non-diabetic ones and to examine the difference between their nutritional behaviour and nutritional recommendations. This study was based on the Three City (3C) community-based cohort. The food habits of 1336 participants aged 65 or over, including 149 diabetic subjects, were evaluated using a FFQ and a 24 h recall of food consumption. For both sexes, intake of carbohydrates was lower for diabetic compared to non-diabetic subjects, essentially due to a lower intake of mono-/disaccharides. For diabetic men, this was compensated for by a higher intake of protein whereas women had a lower energy intake overall. Fibre intake was also higher in diabetic men. There was no absolute increase in fats intake, neither for men nor for women, and distribution of subtypes of fats (saturated, monounsaturated and polyunsaturated) did not differ between diabetic and non-diabetic subjects. Carbohydrates provided 40·5 % of energy intake in diabetic men and 43·9 % in diabetic women. Contrary to nutritional recommendations for diabetic subjects, for approximately two-thirds of the diabetic subjects carbohydrates represented less than 45 % of daily energy intake. Although food habits of elderly diabetic subjects differed from those of non-diabetic ones, these habits are not totally in line with nutritional recommendations. These results should be taken into account to adapt nutritional advice given to the diabetic population.

There is growing interest in the use of dietary patterns as measures of exposure in studies of diet–disease relationships. However, relatively little is known about the impact of the type of dietary assessment method on the patterns observed. Using FFQ and food diary data collected from 585 women in early pregnancy we used principal component analysis to define dietary patterns. The first pattern was very similar in both datasets and was termed the ‘prudent’ diet. The second pattern, whilst comparable for the FFQ and food diaries, showed greater variation in coefficients than the prudent pattern; it was termed the ‘Western’ diet. Differences between the FFQ and diary scores were calculated for each woman for both the prudent and Western diet patterns. Of the differences in the prudent diet score, 95 % lay within ± 1·58 sd of the mean, and 95 % of the differences in the Western diet scores lay within ± 2·22 sd of the mean. Pearson's correlation coefficients were 0·67 (P < 0·001) for the prudent diet score and 0·35 (P < 0·001) for the Western diet score. The agreement between the FFQ and diary scores was lowest amongst respondents who were younger, had lower educational attainment and whose diaries were coded as ‘poor, probably incomplete’, although these effects were small. The first two dietary patterns identified in this cohort of pregnant women appear to be defined similarly by both FFQ and diary data, suggesting that FFQ data provide useful information on dietary patterns.

The manufacture of garments is the main industry in Bangladesh and employs 1·6 million female workers. Due to the indoor lifestyle and low dietary intake of calcium, we hypothesised that they are at risk of low vitamin D and bone mineral status. Two hundred female garment workers (aged 18–36 years) were randomly selected. Serum 25-hydroxyvitamin D (S-25OHD), serum intact parathyroid hormone (S-iPTH), serum calcium (S-Ca), serum phosphate (S-P) concentration and serum alkaline phosphatase activity (S-ALP) were measured from fasting samples. Bone indexes of hip and spine were measured by dual-energy X-ray absorptiometry. The mean S-25OHD (36·7 nmol/l) was low compared to that recommended for vitamin D sufficiency. About 16 % of the subjects were found to be vitamin D-deficient (S-25OHD < 25 nmol/l). We observed a high prevalence (88·5 %) of vitamin D insufficiency (S-25OHD < 50 nmol/l) as well as a significant inverse relationship between S-25OHD and S-iPTH (r − 0·25, P ≤ 0·001). A decrease in S-25OHD ( < 38 nmol/l) and an increase in S-iPTH (>21 ng/l) was associated with progressive reduction in bone mineral density at the femoral neck and lumbar spine. According to the WHO criteria, the mean T-score of the femoral neck and lumbar spine of the subjects were within osteopenic range. We observed that subjects with a bone mineral density T-score < − 2·5 had a trend of lower values of BMI, waist–hip circumference, mid-upper-arm circumference, S-25OHD and higher S-iPTH and S-ALP. The high prevalence of hypovitaminosis D and low bone mineral density among these subjects are indicative of higher risk for osteomalacia or osteoporosis and fracture.

Few studies have examined the longitudinal nature of dietary patterns obtained using principal components analysis (PCA); the methods used are inconsistent. This paper investigates the methodologies used to assess stability and changes in such patterns. Pregnant women recorded frequency of consumption of various food items as part of regular self-completed questionnaires in the Avon Longitudinal Study of Parents and Children. This was repeated when their children were 4 years of age; 8953 women provided data at both times. Dietary patterns were identified using PCA and component scores were calculated at each time point. Additional ‘applied’ scores were created at 4 years using the loadings obtained from the PCA on the pregnancy data. Correlations were similar for each component across the time points, though slightly larger using the applied method. The applied scores were considerably lower on average than those obtained from separate PCA at 4 years. Women's scores decreased on ‘health conscious’ and ‘confectionery’ components while ‘processed’ and ‘vegetarian’ scores both increased over the 4-year period. In contrast, applied scores were systematically lower for all components. When split into quintiles, weighted κ was slightly higher between pregnancy and applied 4-year scores compared to the separate scores. In this cohort it was felt that the ‘applied’ method to obtain scores at the second time point was inappropriate, primarily due to the differences in FFQ between the two time points. We recommend that future studies using such ‘applied’ scores compare them with cross-sectional scores and consider the implications of any differences.

Although many epidemiological studies have examined the association of dietary glycaemic index (GI) and glycaemic load (GL) with health outcomes, information on the reproducibility and relative validity of these variables estimated from dietary questionnaires is extremely limited. We examined the reproducibility and relative validity of dietary GI and GL assessed with a self-administered diet-history questionnaire (DHQ) in adult Japanese. A total of ninety-two Japanese women and ninety-two Japanese men aged 31–76 years completed the DHQ (assessing diet during the preceding month) and 4 d dietary records (DR) in each season over a 1-year period (DHQ1–4 and DR1–4, respectively) and the DHQ at 1 year after completing DHQ1 (DHQ5). We used intraclass correlations between DHQ1 and DHQ5 to assess reproducibility, and Pearson correlations between the mean of DR1–4 and mean of DHQ1–4 and between the mean of DR1–4 and DHQ1 to assess relative validity. Reproducibility correlations for dietary GI and GL were 0·57 and 0·69 among women and 0·65 and 0·58 among men, respectively. Validity correlations for dietary GI and GL assessed by DHQ1–4 were 0·72 and 0·66 among women and 0·65 and 0·71 among men, respectively. Corresponding correlations for DHQ1 were 0·53 and 0·58 among women and 0·57 and 0·60 among men, respectively. White rice was the major contributor to GI and GL in both methods (49–64 %). These data indicate reasonable reproducibility and relative validity of dietary GI and GL assessed by a DHQ for Japanese adults, whose dietary GI and GL are primarily determined by the GI of white rice.

Folate is key in one-carbon metabolism, disruption of which can interfere with DNA synthesis, repair, and methylation. Efficient one-carbon metabolism requires other B vitamins and the optimal activity of enzymes including 5,10-methylenetetrahydrofolate reductase (MTHFR). We report a population-based case–control study of folate intake, related dietary factors and MTHFR polymorphisms (C677T, A1298C) and colorectal cancer in a population with relatively high colorectal cancer incidence and relatively low folate intake. A total of 264 cases with histologically confirmed incident colorectal cancer and 408 controls participated. There was no clear trend in risk with reported intakes of total, or dietary, folate, riboflavin, vitamin B12 or vitamin B6, nor were there interactions between folate intake and the other B vitamins or alcohol. For C677T, risk decreased with increasing variant alleles (multivariate OR for CT v. CC = 0·77 (95 % CI 0·52, 1·16); OR for TT v. CC = 0·62 (95 % CI 0·31, 1·24)), which, although not statistically significant, was consistent with previous studies. For A1298C, compared with AA subjects, CC subjects had modest, non-significant, reduced risk (multivariate OR = 0·81 (95 % CI 0·45, 1·49)). There were significant interactions between total folate and C677T (P = 0·029) and A1298C (P = 0·025), and total vitamin B6 and both polymorphisms (C677T, P = 0·016; A1298C, P = 0·033), although the patterns observed differed from previous studies. Seen against the setting of low folate intake, the results suggest that the role of folate metabolism in colorectal cancer aetiology may be more complex than previously thought. Investigation of particular folate vitamers (for example, tetrahydrofolate, 5,10-methylenetetrahydrofolate) may help clarify carcinogenesis pathways.

For food intakes to be converted into nutrient intakes a measure or estimate of the amount of food consumed is required. A number of methods have been developed to assist subjects in providing an estimate of portion size. Children's ability to use perception, conceptualisation and memory skills to estimate food portion size has not been investigated systematically. The aim of the present study was to test the effect of the timing of a dietary interview on the accuracy of estimates of food portion sizes made by children, using food photographs, food models and an interactive portion size assessment system, developed for use with children and based on portion sizes of foods consumed by children. Children (n 108) aged 4–14 years were supplied with known quantities of foods and asked to estimate the portion size of each food using each of the three portion size assessment tools. Interviews took place (a) with the food in view, (b) just after the child had eaten the food or (c) 24 h after the child had eaten the food. There were no significant differences in children's ability to estimate food portion size (either as served or as eaten) with timing of interview. That is, children were as accurate in their estimates of portion size 24 h after consuming the food as when the food was in view. Under these conditions many children were able to estimate food portion size utilising perception, conceptualisation and memory skills.

We aimed to describe the vitamin D status of young women living in two Chinese cities in the spring – Beijing in the north (latitude 39° north) and Hong Kong (latitude 22° north) in the south. We also examined the relationship between serum 25-hydroxyvitamin D and parathyroid hormone (PTH) concentrations to determine a threshold for serum 25-hydroxyvitamin D above which there is no further suppression of PTH. Finally, we examined whether dietary Ca intake influences this relationship. Non-pregnant women aged 18–40 years (n 441) were recruited between February and June. Fasting blood was collected and dietary intakes were assessed using 5 d food records. Mean serum 25-hydroxyvitamin D concentration was lower in Beijing than Hong Kong women (29 v. 34 nmol/l; P < 0·001). Vitamin D deficiency ( ≤  25 nmol/l) was indicated in 40 % of Beijing and 18 % of Hong Kong women, and over 90 % of women in both cities were insufficient ( ≤ 50 nmol/l). Mean Ca and vitamin D intakes were 478 mg/d and 2·0 μg/d, respectively. The relationship between 25-hydroxyvitamin D concentration and PTH was linear throughout the range with a slope of − 0·36 (different from 0; P < 0·001; R 0·26), with no apparent threshold. There was no influence of Ca intake on the relationship between 25-hydroxyvitamin D and PTH concentration. Vitamin D deficiency is common and insufficiency is very common in non-pregnant women in Hong Kong and Beijing during spring. Serum 25-hydroxyvitamin D was inversely associated with PTH with no apparent threshold. Strategies such as vitamin D fortification or supplementation may be required.

It remains unclear what long-term effects of substituting carbohydrates at the expense of protein or fat may have with regard to diabetes risk. Our objective was to evaluate carbohydrate intake in predicting type 2 diabetes using substitution models for fat and protein. We conducted a prospective cohort study of 9702 men and 15 365 women aged 35–65 years and free of diabetes at baseline (1994–8) who were followed for incident type 2 diabetes until 2005. Dietary intake of macronutrients was estimated with a validated FFQ. We estimated the relative risk (RR) using Cox proportional hazards analysis. During 176 117 person-years of follow-up we observed 844 incident cases of physician-confirmed type 2 diabetes. After adjustment for age, BMI, waist circumference, potential lifestyle and dietary confounders, substituting 5 % of energy intake from total, saturated, or monounsaturated fat with carbohydrates was not associated with diabetes risk. In contrast, substituting carbohydrates for protein or PUFA was inversely related to diabetes risk (RR for 5 % energy substitution of protein 0·77 (95 % CI 0·64, 0·91); RR for PUFA 0·83 (95 % CI 0·70, 0·98)). These associations appeared to be similar for men and women, but gained statistical significance only among men for protein (RR 0·78 (95 % CI 0·61, 0·99)). Restricted cubic spline regression did not indicate non-linearity of these associations (P for non-linearity in full cohort was 0·353 and 0·349). In conclusion, a higher carbohydrate intake at the expense of protein and PUFA might be associated with decreased diabetes risk.

Since any significant modification in the Se status, leading to changes in the activity of the seleno-enzymes, may have important consequences on the susceptibility of tissues to oxidative stress, considerable efforts have been made upon increasing Se dietary intake. In this respect, an important debate is still open about the bioavailability and the effectiveness of Se, and more generally nutrients, in supplements compared with foods. Using male Wistar rats, we have compared the effectiveness of two different diets in which an adequate Se content (0·1 mg/kg) was achieved by adding the element as sodium selenite or as component of a lyophilized Se-enriched food, in the counteraction of an oxidative stress induced by intraperitoneal administration of adriamycin. Both Se-enriched diets were able to reduce the consequences of the oxidative stress in liver, mainly by increasing glutathione peroxidase activity. This increase was more evident in rats fed on the diet enriched with the lyophilized food, probably due to the different chemical forms of Se, or to other components of the food itself. Although further studies are needed, data herein presented may contribute to the characterization of the effectiveness of Se from different sources, foods or supplements, in the light of dietary advice to the population concerning improvement of Se intake.

The WHO recommends limiting non-milk extrinsic sugars (NMES) consumption to ≤ 10 % energy to reduce the risk of unhealthy weight gain and dental caries, and to restrict frequency of intake to ≤ 4 times/d to reduce risk of dental caries. Older adults, especially those from low-income backgrounds, are at increased risk of dental caries, yet there is little information on sugars intake (frequency of intake and food sources) in this age group. The aim of this report is to present baseline data from a community-based dietary intervention study of older adults from socially deprived areas of North East England, on the quantity and sources of total sugars, NMES, and intrinsic and milk sugars, and on frequency of NMES intake. Dietary intake was assessed using two 3-d estimated food diaries, completed by 201 participants (170 female, thirty-one male) aged 65–85 years (mean 76·7 (sd 5·5) years) recruited from sheltered housing schemes. Total sugars represented 19·6 %, NMES 9·3 %, and intrinsic and milk sugars 10·3 % of daily energy intake. Eighty-one (40·3 %) exceeded the NMES intake recommendation. Mean frequency of NMES intake was 3·4 times/d. The fifty-three participants (26·4 %) who exceeded the frequency recommendation ( ≤ 4 times/d) obtained a significantly greater percentage of energy from NMES compared with those participants who met the recommendation. The food groups ‘biscuits and cakes’ (18·9 %), ‘soft drinks’ (13·1 %) and ‘table sugar’ (11·1 %) made the greatest contributions to intakes of NMES. Interventions to reduce NMES intake should focus on limiting quantity and frequency of intake of these food groups.

The aim of the present study was to describe dietary patterns in a representative sample from Puna and Quebrada of Humahuaca, Jujuy, Argentina. A cross-sectional nutritional survey was carried out in a representative sample (n 1236) of individuals from these regions. For the present study, only children aged 2–9 years (n 360), adolescents aged 10–18 years (n 223) and adults aged 18 years or over (n 465) were considered. Breast-fed children, pregnant women and lactating women were excluded. Dietary data collection methods comprised one 24 h recall and a semi-quantitative FFQ. We used principal component (PC) analyses to identify prevailing dietary patterns. Multiple linear regression analyses were performed to assess the determinants of the identified dietary patterns. Two dominant PC were identified: PC1 reflected a ‘Western-like’ diet with an emphasis on not-autochthon foods. This pattern tended to be present in urban areas of the Quebrada region and was associated with a younger age, a higher level of development, and a worse diet quality. PC2 reflected an ‘Andean-like’ diet including a variety of autochthon crops. This was preferred by individuals living in rural areas from Puna with a high level of development during the post-harvest season, and was associated with a greater diet quality. These results suggest that the nutrition transition phenomenon is a reality in certain sectors of this population and might be one of the leading causes of the observed double burden of malnutrition.

Forty to fifty per cent of skeletal mass, accumulated during childhood and adolescence, is influenced by sunlight exposure, physical activity, lifestyle, endocrine status, nutrition and gender. In view of scarce data on association of nutrition and lifestyle with hypovitaminosis D in Indian children and adolescents, an in-depth study on 3127 apparently healthy Delhi schoolgirls (6–18 years) from the lower (LSES, n 1477) and upper socioeconomic strata (USES, n 1650) was carried out. These girls were subjected to anthropometry and clinical examination for hypovitaminosis D. Girls randomly selected from the two strata (LSES, n 193; USES, n 211) underwent detailed lifestyle, dietary, biochemical and hormonal assessment. Clinical vitamin D deficiency was noted in 11·5 % girls (12·4 % LSES, 10·7 % USES). USES girls had significantly higher BMI than LSES counterparts. Prevalence of biochemical hypovitaminosis D (serum 25-hydroxyvitamin D < 50 nmol/l) was seen in 90·8 % of girls (89·6 % LSES, 91·9 % USES, NS). Mean intake of energy, protein, fat, Ca, vitamin D and milk/milk products was significantly higher in USES than LSES girls. Conversely, carbohydrate, fibre, phytate and cereal intakes were higher in LSES than USES girls. Physical activity and time spent outdoors was significantly higher in LSES girls (92·8 v. 64 %, P = 0·000). Significant correlation between serum 25-hydroxyvitamin D and estimated sun exposure (r 0·185, P = 0·001) and percentage body surface area exposed (r 0·146, P = 0·004) suggests that these lifestyle-related factors may contribute significantly to the vitamin D status of the apparently healthy schoolgirls. Hence, in the absence of vitamin D fortification of foods, diet alone appears to have an insignificant role.

Epidemiological data suggest that a diet rich in animal foods may be associated with an increased risk of several cancers, including cancers of the prostate, colorectum and breast, but the possible mechanism is unclear. It is hypothesised that phytanic acid, a C20 branched-chain fatty acid found predominantly in foods from ruminant animals, may be involved in early cancer development because it has been shown to up regulate activity of α-methylacyl-coenzyme A racemase, an enzyme commonly found to be over-expressed in tumour cells compared with normal tissue. However, little is known about the distribution of plasma phytanic acid concentrations or its dietary determinants in the general population. The primary aim of the present cross-sectional study was to determine circulating phytanic acid concentrations among ninety-six meat-eating, lacto-ovo-vegetarian and vegan women, aged 20–69 years, recruited into the Oxford component of the European Prospective Investigation into Cancer and Nutrition (EPIC-Oxford). Meat-eaters had, on average, a 6.7-fold higher geometric mean plasma phytanic acid concentration than the vegans (5·77 v. 0·86 μmol/l; P < 0·0001) and a 47 % higher mean concentration than the vegetarians (5·77 v. 3·93 μmol/l; P = 0·016). The strongest determinant of plasma phytanic acid concentration appeared to be dairy fat intake (r 0·68; P < 0·0001); phytanic acid levels were not associated with age or other lifestyle factors. These data show that a diet high in fat from dairy products is associated with increased plasma phytanic acid concentration, which may play a role in cancer development.

A WHO report on diet, nutrition and the prevention of chronic diseases recommended that frequency of consumption of foods and/or drinks containing free sugars should be limited to a maximum of four times per d. In addition, they recommended a reduction in the intake of free sugars to a maximum of no more than 10 % of energy intake. These recommendations were developed with the aim of reducing the prevalence of dental caries. The aim of the present study was to establish if there is a quantitative relationship between energy from added sugars and frequency of added sugars intakes in Irish children, teenagers and adults. In addition, the intake of added and total sugars and main contributors to added sugar intakes were examined. Data for the present analysis were based on the North/South Ireland Food Consumption Survey (n 1379; aged 18–64 years), the National Children's Food Survey (n 594; aged 5–12 years) and the National Teen Food Survey (n 441; aged 13–17 years) which used 7 d food diaries to collect food and beverage intake data in representative samples of Irish adults, children and teenagers respectively. Results showed that in adults, frequency of intake of added sugar intake of four times per d corresponded to a mean added sugar intake of 9 %, which was similar to the WHO recommendation. In children and teenagers, a frequency of intake of four times per d corresponded to a mean added sugar intake of 14·6 and 12·4 % respectively and was therefore not in agreement with the WHO recommendation.

The study examines the relationship between fruit and vegetable intake (g/d) and CVD risk factors in urban south Indians. The study population comprised of 983 individuals aged ≥ 20 years selected from the Chennai Urban Rural Epidemiological Study (CURES), a population-based cross-sectional study on a representative population of Chennai in southern India. Fruit and vegetable intake (g/d) was measured using a validated semi-quantitative FFQ. Linear regression analysis revealed that after adjusting for potential confounders such as age, sex, smoking, alcohol, BMI and total energy intake, the highest quartile of fruit and vegetable intake (g/d) showed a significant inverse association with systolic blood pressure (β = − 2·6 (95 % CI − 5·92, − 1·02) mmHg; P = 0·027), BMI (β = − 2·3 (95 % CI − 2·96, − 1·57) kg/m2; P < 0·0001), waist circumference (β = − 2·6 (95 % CI − 3·69, − 1·46) cm; P < 0·0001), total cholesterol (β = − 50 (95 % CI − 113·9, − 13·6) mg/l; P = 0·017) and LDL-cholesterol concentration (β = − 55 (95 % CI − 110·8, − 11·1) mg/l; P = 0·039) when compared with the lowest quartile. A higher intake of fruit and vegetables explained 48 % of the protective effect against CVD risk factors. Increased intake of fruits and vegetables could play a protective role against CVD in Asian Indians who have high rates of premature coronary artery disease.

Evidence exists that a more acidic diet is detrimental to bone health. Although more precise methods exist for measurement of acid–base balance, urine pH reflects acid–base balance and is readily measurable but has not been related to habitual dietary intake in general populations. The present study investigated the relationship between urine pH and dietary acid–base load (potential renal acid load; PRAL) and its contributory food groups (fruit and vegetables, meats, cereal and dairy foods). There were 22 034 men and women aged 39–78 years living in Norfolk (UK) with casual urine samples and dietary intakes from the European Prospective Investigation into Cancer and Nutrition (EPIC)-Norfolk FFQ. A sub-study (n 363) compared pH in casual samples and 24 h urine and intakes from a 7 d diary and the FFQ. A more alkaline diet (low PRAL), high fruit and vegetable intake and lower consumption of meat was significantly associated with a more alkaline urine pH before and after adjustment for age, BMI, physical activity and smoking habit and also after excluding for urinary protein, glucose, ketones, diagnosed high blood pressure and diuretic medication. In the sub-study the strongest relationship was found between the 24 h urine and the 7 d diary. In conclusion, a more alkaline diet, higher fruit and vegetable and lower meat intake were related to more alkaline urine with a magnitude similar to intervention studies. As urine pH relates to dietary acid–base load its use to monitor change in consumption of fruit and vegetables, in individuals, warrants further investigation.