class: center, middle, inverse, title-slide # .med[Associations between food groups and eating time slots by diabetes status in UK adults] ### .small[Chaochen Wang<sup>1</sup>, Suzana Almoosawi<sup>2</sup>, Luigi Palla<sup>3</sup> <br><br> 1. Aichi Medical University <br> 2. NNEdPro Global Centre for Nutrition and Health <br> 3. London School of Hygiene & Tropical Medicine ] ### .small[2020-02-21 16:30〜16:40 O-024<br> 京都大学国際科学イノベーション棟5F] --- class: middle, center # Conflit of Interest disclosure Chaochen Wang (AMU) <br> Suzana Almoosawi (NNEDPRO) <br> Luigi Palla (LSHTM) We have no, real or perceived, direct or indirect conflicts of interest that relate to this presentation. --- class: middle ## Background & Objectives .med[ - Eating late/having a late dinner was found to related with higher risk of obesity, hyperglycemia, metabolic syndrome, and diabetes. - The relationship between food choice and their time of consumption is still largely unknown. - Identify those unhealthy foods which might be chosen during night time would be helpful. - To investigate the relationships between **food** eaten by British adults, **time slots** and **type 2 diabetes (DM) status**. ] ??? NDNS RP: National Diet and Nutrition Survey Rolling Programme --- class: middle ## Data Source - the NDNS RP .med[ - NDNS RP (started from 2008): - On-going cross-sectional study - representative of UK population <br> about 1000/year - 4 consecutive days food diary - 6802 adults (age >= 19 years) - 2810 men and 3992 women - 749,026 recordings of food group entries - Time slots defined: <br> 6-9 am, 9-12 noon, 12-2 pm, 2-5 pm, 5-8 pm, <br> 8-10 pm and 10 pm-6 am. ] --- class: middle ## Methods and strategies .med[ - Generate hypotheses from (randomly selected) 50% of the food recordings then test using the other half - Correspondence analysis (CA) - Exploratory technique to look for associations between foods and time - Biplots in total sample and stratified by DM status - Logistic regression models using generalized estimating equation (GEE). - Estimation of effect size of the association ] --- class: middle, center, inverse # An one-day example of the food diary --- background-image: url("./img/Diary1.png") background-position: 50% 50% background-size: contain --- background-image: url("./img/Diary2.png") background-position: 50% 50% background-size: contain --- background-image: url("./img/Diary03.png") background-position: 50% 50% background-size: contain --- class: middle ## Definition of diabetes status <table class="table table-striped table-hover" style="margin-left: auto; margin-right: auto;"> <thead> <tr> <th style="text-align:center;"> DM Status </th> <th style="text-align:center;"> Self-reported </th> <th style="text-align:center;"> Glucose (mmol/L) </th> <th style="text-align:center;"> </th> <th style="text-align:center;"> HbA1c (%) </th> <th style="text-align:center;"> n </th> </tr> </thead> <tbody> <tr> <td style="text-align:center;font-weight: bold;"> Healthy </td> <td style="text-align:center;"> No </td> <td style="text-align:center;"> < 6.1 </td> <td style="text-align:center;"> AND </td> <td style="text-align:center;"> < 6.5 </td> <td style="text-align:center;"> 2626 </td> </tr> <tr> <td style="text-align:center;font-weight: bold;"> Pre-DM </td> <td style="text-align:center;"> No </td> <td style="text-align:center;"> 6.1 ~ 6.99 </td> <td style="text-align:center;"> </td> <td style="text-align:center;"> -- </td> <td style="text-align:center;"> 133 </td> </tr> <tr> <td style="text-align:center;font-weight: bold;"> Undiagnosed </td> <td style="text-align:center;"> No </td> <td style="text-align:center;"> >= 7.00 </td> <td style="text-align:center;"> OR </td> <td style="text-align:center;"> >= 6.5 </td> <td style="text-align:center;"> 99 </td> </tr> <tr> <td style="text-align:center;font-weight: bold;"> Diagnosed </td> <td style="text-align:center;"> Yes </td> <td style="text-align:center;"> -- </td> <td style="text-align:center;"> </td> <td style="text-align:center;"> -- </td> <td style="text-align:center;"> 227 </td> </tr> <tr> <td style="text-align:center;font-weight: bold;"> Unknown </td> <td style="text-align:center;"> NA </td> <td style="text-align:center;"> NA </td> <td style="text-align:center;"> </td> <td style="text-align:center;"> NA </td> <td style="text-align:center;"> 3717 </td> </tr> </tbody> </table> --- class: middle ### Food groups and contribution to calories .between[[link to full table: https://wangcc.me/CA-NDNSRP_fordiscuss/#12_food_groups](https://wangcc.me/CA-NDNSRP_fordiscuss/#12_food_groups)] .small[ <div id="htmlwidget-392e158fb32edfca45ef" style="width:100%;height:auto;" class="datatables html-widget"></div> <script type="application/json" data-for="htmlwidget-392e158fb32edfca45ef">{"x":{"filter":"none","fillContainer":false,"data":[["1","2","3","4","5","6","7","8","9","10","11","12","13","14","15","16","17","18","19","20","21","22","23","24","25","26","27","28","29","30","31","32","33","34","35","36","37","38","39","40","41","42","43","44","45","46","47","48","49","50","51","52","53","54","55","56","57","58","59","60"],["Pasta & Rice","White Bread","Chips","Cakes & Pastries","Veg not raw","Biscuits","Fruit","Misc./Vending","Chicken/turkey","Cheese","Beer lager","2% milk","Potatos other","JamsSpreads","Beef","HiFi cereals","WMeal Bread","Chocolate","Wine","Brown Bread","Butter","Eggs","Reg soft drinks","Spreads less-fat","Crisps","Sausages","Meat pastries","Bacon and ham","Yogurt","LoFi cereals","Nuts and seeds","Oily fish","Whole Milk","White fish, shellfish","Puddings","Other Milk Cream","Pork","Fruit juice","Margarine","Coated Chicken","Other white fish","Lamb","Burgers/kebabs","Ice cream","Salad and raw veg","Spirits and liqueurs","Other meat","Tea/Coffee/Water","Skimmed Milk","Sugar confectionery","Oth Bread","LowFat Spreads","Polyunsatu margarine","Liver","Dietary supplements","Diet soft drinks","1% milk","Smoothies","Artificial Sweeteners","Commercial toddlers foods"],[18353,18434,6749,7806,51317,13200,33903,48597,8863,10983,8199,57611,10113,37960,4987,8215,7193,6495,6967,6183,10203,7554,11387,12620,5664,3025,1979,8467,6776,4303,6259,2610,13628,1597,2291,6605,1832,6960,8742,1170,3703,1251,939,1816,33263,2698,1571,152108,9683,1820,932,3654,3179,454,13016,14155,1263,137,7518,66],["2.45%","2.46%","0.9%","1.04%","6.85%","1.76%","4.53%","6.49%","1.18%","1.47%","1.09%","7.69%","1.35%","5.07%","0.67%","1.1%","0.96%","0.87%","0.93%","0.83%","1.36%","1.01%","1.52%","1.68%","0.76%","0.4%","0.26%","1.13%","0.9%","0.57%","0.84%","0.35%","1.82%","0.21%","0.31%","0.88%","0.24%","0.93%","1.17%","0.16%","0.49%","0.17%","0.13%","0.24%","4.44%","0.36%","0.21%","20.31%","1.29%","0.24%","0.12%","0.49%","0.42%","0.06%","1.74%","1.89%","0.17%","0.02%","1%","0.01%"],["7.36%","6.8%","3.95%","3.59%","3.49%","3.49%","3.44%","3.44%","3.39%","3.13%","3.11%","2.73%","2.71%","2.55%","2.36%","2.25%","2.24%","2.19%","2.15%","2.12%","2.02%","2.02%","1.97%","1.78%","1.75%","1.62%","1.56%","1.55%","1.4%","1.17%","1.17%","1.15%","1.11%","1.05%","0.96%","0.91%","0.88%","0.88%","0.86%","0.75%","0.74%","0.72%","0.69%","0.65%","0.62%","0.6%","0.57%","0.37%","0.35%","0.34%","0.31%","0.28%","0.27%","0.14%","0.09%","0.07%","0.06%","0.04%","0.01%","0%"],["7.362%","14.166%","18.116%","21.701%","25.193%","28.678%","32.12%","35.555%","38.947%","42.074%","45.185%","47.916%","50.623%","53.171%","55.528%","57.777%","60.022%","62.215%","64.369%","66.484%","68.509%","70.532%","72.503%","74.283%","76.035%","77.659%","79.22%","80.769%","82.164%","83.338%","84.512%","85.666%","86.778%","87.824%","88.788%","89.698%","90.579%","91.459%","92.319%","93.073%","93.818%","94.535%","95.224%","95.873%","96.495%","97.096%","97.665%","98.033%","98.387%","98.732%","99.045%","99.327%","99.593%","99.734%","99.828%","99.897%","99.955%","99.99%","99.996%","100%"]],"container":"<table class=\"display\">\n <thead>\n <tr>\n <th> <\/th>\n <th>mfgLab<\/th>\n <th>n<\/th>\n <th>n.freq<\/th>\n <th>cal.Prop<\/th>\n <th>calcumprop<\/th>\n <\/tr>\n <\/thead>\n<\/table>","options":{"pageLength":6,"columnDefs":[{"className":"dt-right","targets":2},{"orderable":false,"targets":0}],"order":[],"autoWidth":false,"orderClasses":false,"lengthMenu":[6,10,25,50,100]}},"evals":[],"jsHooks":[]}</script> ] --- class: middle, center ### The full contingency table of food recordings and time slots .small[ <div id="htmlwidget-4a2cd10bfce1dde5d6ba" style="width:100%;height:auto;" class="datatables html-widget"></div> <script type="application/json" data-for="htmlwidget-4a2cd10bfce1dde5d6ba">{"x":{"filter":"none","fillContainer":false,"data":[["1% milk","2% milk","Artificial Sweeteners","Bacon and ham","Beef","Beer lager","Biscuits","Brown Bread","Burgers/kebabs","Butter","Cakes & Pastries","Cheese","Chicken/turkey","Chips","Chocolate","Coated Chicken","Commercial toddlers foods","Crisps","Diet soft drinks","Dietary supplements","Eggs","Fruit","Fruit juice","HiFi cereals","Ice cream","JamsSpreads","Lamb","Liver","LoFi cereals","LowFat Spreads","Margarine","Meat pastries","Misc./Vending","Nuts and seeds","Oily fish","Oth Bread","Other meat","Other Milk Cream","Other white fish","Pasta & Rice","Polyunsatu margarine","Pork","Potatos other","Puddings","Reg soft drinks","Salad and raw veg","Sausages","Skimmed Milk","Smoothies","Spirits and liqueurs","Spreads less-fat","Sugar confectionery","Tea/Coffee/Water","Veg not raw","White Bread","White fish, shellfish","Whole Milk","Wine","WMeal Bread","Yogurt"],[189,7513,920,209,3,11,417,540,0,812,182,131,19,19,52,0,3,11,361,4685,424,2631,992,2534,0,4639,1,10,1212,330,137,11,877,645,26,76,40,610,8,694,51,4,13,13,295,165,70,1416,12,3,983,40,14297,203,1195,1,1654,3,683,524],[137,6844,832,757,28,34,1173,567,14,876,597,381,96,96,349,6,3,270,679,1244,810,3012,592,1255,8,4477,3,14,704,323,317,68,1608,528,47,79,86,535,58,545,95,15,44,39,551,620,266,1047,14,9,1262,125,16103,669,1775,6,1584,11,674,435],[50,3262,467,1707,435,253,1130,1073,112,1243,778,1916,1011,624,470,115,15,875,1167,137,915,3700,536,102,93,2283,113,72,80,533,802,308,5795,466,414,162,257,446,604,1574,264,169,982,246,1052,5822,301,509,20,31,1776,113,10587,5299,2748,148,792,184,1178,803],[66,3986,591,453,254,440,1405,287,81,548,891,656,571,442,728,91,6,520,1076,74,378,2341,337,41,143,2504,72,20,37,151,448,140,2720,401,147,51,100,431,194,925,143,102,536,147,969,1878,151,626,10,71,549,243,11780,2559,908,72,851,178,296,326],[79,3124,410,906,1462,1014,813,363,219,1085,857,1563,2039,1727,522,300,11,443,1916,121,960,2937,650,43,399,2518,296,76,40,309,1946,349,9386,498,572,70,207,780,673,3934,753,475,2987,498,1396,6086,578,510,4,297,1049,164,10414,13693,1643,448,919,1317,474,808],[48,2530,337,213,306,1467,1013,178,49,385,465,644,544,376,834,64,4,501,1199,121,262,1793,294,69,210,1673,99,23,48,101,663,104,2990,394,151,19,78,386,244,1259,228,107,434,155,920,1814,111,436,4,518,424,165,7327,3022,660,85,645,1376,185,372],[35,1533,219,57,38,826,614,87,12,145,177,182,103,83,303,20,0,228,674,179,56,518,134,95,44,912,16,2,75,45,91,29,859,153,17,13,18,139,39,270,39,7,36,53,527,301,15,309,1,403,190,82,5544,314,280,5,442,376,92,114]],"container":"<table class=\"display\">\n <thead>\n <tr>\n <th> <\/th>\n <th>0600-0900<\/th>\n <th>0900-1200<\/th>\n <th>1200-1400<\/th>\n <th>1400-1700<\/th>\n <th>1700-2000<\/th>\n <th>2000-2200<\/th>\n <th>2200-0600<\/th>\n <\/tr>\n <\/thead>\n<\/table>","options":{"pageLength":4,"columnDefs":[{"className":"dt-right","targets":[1,2,3,4,5,6,7]},{"orderable":false,"targets":0}],"order":[],"autoWidth":false,"orderClasses":false,"lengthMenu":[4,10,25,50,100]}},"evals":[],"jsHooks":[]}</script> ] --- class: middle, center, inverse # CA biplots in total sample --- background-image: url("./img/TotalSampleCA.png") background-position: 50% 50% background-size: contain ??? - Correspondence analysis allows us to plot both the points of time and food in the same figure where here we see later time are in the upper side of the graph. And when food and time points are close together and away from the origin then it is suggested that there is an association. - Therefore, in the graph, food appears close to the time, means they were consumed at that time. - It seems that later time in the day (8 pm- 10pm-) are shown on the upper side of the plot. (later time slots (8pm - 10pm, 10pm - 6am) are different from the earlier hours) - During morning time people are having breakfast foods (cereals/milk) - Chocolate, Bear, Spirits, sugar candy, sweetened soft drinks are clouded around later times. <!-- --- --> <!-- background-image: url("./img/F201T7.png") --> <!-- background-position: 50% 50% --> <!-- background-size: contain --> <!-- ??? --> <!-- --- --> <!-- background-image: url("./img/F202T7.png") --> <!-- background-position: 50% 50% --> <!-- background-size: contain --> <!-- --- --> <!-- background-image: url("./img/F203T7.png") --> <!-- background-position: 50% 50% --> <!-- background-size: contain --> --- class: middle, center, inverse # Food group consumption and time slots <br> stratified by DM status --- background-image: url("./img/F60T7_nonDM.png") background-position: 50% 50% background-size: contain ??? - IN non-diabetes, sugar, beer, wine, crisps, sweetened soft drink, biscuits are more associated with night period time slots. --- background-image: url("./img/F60T7_DM.png") background-position: 50% 50% background-size: contain ??? - For Diagnosed DM patients (self-reported), beer, spirits, chocolate, biscuits, regular sweetened soft drinks appear close to time after 8 pm. --- background-image: url("./img/F60T7_UndiagDM.png") background-position: 50% 50% background-size: contain ??? - Among undiagnosed DM patients, sugar, chocolate, Beer, regular soft drinks, ice cream, biscuits, Puddings seems to appear to shown in later time slots. --- background-image: url("./img/F60T7_PreDM.png") background-position: 50% 50% background-size: contain --- class: middle ## Summary - Foods colored in **red** for further hypotheses testing - relatively unhealthy - possibly being consumed differently by DM status. - Sugar confectioneries, regular soft drinks, chocolates appear much further at the top of the figures among those with undiagnosed DM compared to the others. --- class:center OR (99% CI) for foods eaten at night (8pm - 6am) vs. earlier time, among total and according to DM status .small[ <div id="htmlwidget-5481c60e921a247acde3" style="width:100%;height:auto;" class="datatables html-widget"></div> <script type="application/json" data-for="htmlwidget-5481c60e921a247acde3">{"x":{"filter":"none","fillContainer":false,"data":[["1","2","3","4","5","6","7","8","9"],["Pudding","Sweetened <br>Soft drink","Sugar Conf.","Chocolate","Spirit","Beer","Ice cream","Biscuit","Crisp"],["1.38 <br>(1.03, 1.86)","1.74 <br>(1.47, 2.06)","1.92 <br>(1.38, 2.69)","3.19 <br>(2.69. 3.79)","11.1 <br>(8.37, 14.8)","7.19 <br>(5.87, 8.82)","2.38 <br>(1.79, 3.15)","1.91 <br>(1.67, 2.16)","1.55 <br>(1.27, 1.88)"],["1.50 <br>(1.10, 2.07)","1.72 <br>(1.43, 2.06)","1.63 <br>(1.14, 2.32)","3.10 <br>(2.57, 3.73)","10.9 <br>(8.01, 14.7)","7.49 <br>(6.02, 9.34)","2.45 <br>(1.82, 3.31)","1.78 <br>(1.55, 2.03)","1.56 <br>(1.27, 1.92)"],["0.89 <br>(0.16, 4.87)","1.87 <br>(0.97, 3.57)","2.10 <br>(0.52, 8.46)","4.07 <br>(2.02, 8.19)","8.48 <br>(2.26, 31.8)","4.05 <br>(2.00, 8.20)","3.32 <br>(0.75, 14.62)","3.51 <br>(2.16, 5.71)","1.95 <br>(0.79, 4.78)"],["1.81 <br>(0.41, 7.98)","2.72 <br>(1.44, 5.14)","13.07 <br>(4.59, 37.24)","2.52 <br>(0.95, 6.66)","7.51 <br>(1.99, 5.21)","7.87 <br>(3.51, 17.63)","0.98 <br>(0.14, 7.00)","2.75 <br>(1.35, 5.59)","1.37 <br>(0.37, 5.12)"],["0.58 <br>(0.14, 2.43)","1.38 <br>(0.65, 2.96)","5.10 <br>(2.15, 12.09)","5.13 <br>(2.55, 10.30)","36.8 <br>(7.36, 183.7)","6.32 <br>(2.29, 17.47)","1.65 <br>(0.54, 5.07)","2.44 <br>(1.54, 3.88)","1.16 <br>(0.49, 2.75)"]],"container":"<table class=\"display\">\n <thead>\n <tr>\n <th> <\/th>\n <th>H0<\/th>\n <th>Overall<\/th>\n <th>Healthy<\/th>\n <th>Pre-DM<\/th>\n <th>Undiag-DM<\/th>\n <th>DM<\/th>\n <\/tr>\n <\/thead>\n<\/table>","options":{"pageLength":3,"order":[],"autoWidth":false,"orderClasses":false,"columnDefs":[{"orderable":false,"targets":0}],"lengthMenu":[3,10,25,50,100],"rowCallback":"function(row, data) {\nvar value=data[0]; $(this.api().cell(row, 5).node()).css({'background-color':value == 3 ? \"yellow\" : value});\nvar value=data[0]; $(this.api().cell(row, 5).node()).css({'background-color':value == 2 ? \"yellow\" : value});\nvar value=data[0]; $(this.api().cell(row, 6).node()).css({'background-color':value == 1 ? \"yellow\" : value});\nvar value=data[0]; $(this.api().cell(row, 6).node()).css({'background-color':value == 3 ? \"yellow\" : value});\nvar value=data[0]; $(this.api().cell(row, 6).node()).css({'background-color':value == 5 ? \"yellow\" : value});\n}"}},"evals":["options.rowCallback"],"jsHooks":[]}</script> ] --- class: middle # Discussion (1) - All unhealthy foods emerged from CA were significantly more likely to be eaten after 8pm. - These included alcoholic/sweetened beverages, chocolates and other foods rich in added sugars and saturated fats. - Foods and drinks consumed in the evening/night time tend to be highly processed and easily accessible. --- class: middle # Discussion (2) - Assessing the relationships between less healthy foods and timing of eating is a first step towards identifying specific public health targets for behaviour change/modification. - Undiagnosed T2D patients might be at risk of causing/worsening their condition as they had higher odds to consume a number of less healthy foods during night time. - The survey cross-sectional nature warrants further investigations by longitudinal cohort studies. --- class: left, bottom, inverse background-image: url("./img/IMG_0258.png") background-position: 50% 50% background-size: contain # Thanks --- background-image: url("./img/MissDM.png") background-position: 50% 50% background-size: contain