Objective: To identify and critique tools that assess Ca and/or dairy intake in children to ascertain the most accurate and reliable tools available. Design: A systematic review of the literature was conducted using defined inclusion and exclusion criteria. Articles were included on the basis that they reported on a tool measuring Ca and/or dairy intake in children in Western countries and reported on originally developed tools or tested the validity or reliability of existing tools. Defined criteria for reporting reliability and validity properties were applied. Setting: Studies in Western countries. Subjects: Children. Results: Eighteen papers reporting on two tools that assessed dairy intake, ten that assessed Ca intake and five that assessed both dairy and Ca were identified. An examination of tool testing revealed high reliance on lower-order tests such as correlation and failure to differentiate between statistical and clinically meaningful significance. Only half of the tools were tested for reliability and results indicated that only one Ca tool and one dairy tool were reliable. Validation studies showed acceptable levels of agreement (,100 mg difference) and/or sensitivity (62-83 %) and specificity (55-77 %) in three Ca tools. With reference to the testing methodology and results, no tools were considered both valid and reliable for the assessment of dairy intake and only one tool proved valid and reliable for the assessment of Ca intake. Conclusions: These results clearly indicate the need for development and rigorous testing of tools to assess Ca and/or dairy intake in children and adolescents.

Objective: To identify and critique tools for the assessment of Ca and/or dairy intake in adults, in order to ascertain the most accurate and reliable tools available. Design: A systematic review of the literature was conducted using defined inclusion and exclusion criteria. Articles reporting on originally developed tools or testing the reliability or validity of existing tools that measure Ca and/or dairy intake in adults were included. Author-defined criteria for reporting reliability and validity properties were applied. Setting: Studies conducted in Western countries. Subjects: Adults. Results: Thirty papers, utilising thirty-six tools assessing intake of dairy, Ca or both, were identified. Reliability testing was conducted on only two dairy and five Ca tools, with results indicating that only one dairy and two Ca tools were reliable. Validity testing was conducted for all but four Ca-only tools. There was high reliance in validity testing on lower-order tests such as correlation and failure to differentiate between statistical and clinically meaningful differences. Results of the validity testing suggest one dairy and five Ca tools are valid. Thus one tool was considered both reliable and valid for the assessment of dairy intake and only two tools proved reliable and valid for the assessment of Ca intake. Conclusions: While several tools are reliable and valid, their application across adult populations is limited by the populations in which they were tested. These results indicate a need for tools that assess Ca and/or dairy intake in adults to be rigorously tested for reliability and validity.

Background:Successful ageing relies on the prevention of frailty and chronic disease, many of whichhave a strong link with diet. Despite evidence suggesting diet is important in the management of frailty, there islittle evidence investigating the impact of a liberal diet on the prevention of frailty and development of chronicdiseases in the elderly. Objectives:To determine the impact of a liberal diet on the development of frailty andwhether this affects the incidence of obesity, diabetes, hypertension and hyperlipidaemia. Design:Secondary dataanalysis of the Australian Longitudinal Study of Ageing, 1992 to 2000. Setting:Random selection of older adultsfrom the South Australian electoral roll. Participants:1298 older Australians (629 women, 669 men), mean age77 years. Measurements:A validated food frequency questionnaire was used to measure the dietary exposure;liberal diet defined as: energy >10% estimated requirements; sodium >1600mg; total fat >35% energy; saturatedfat >10%; refined sugar >10%; fibre <38g males and <28g females. Frailty was determined using the Friedphenotype in combination with Cesari’s biological definition of frailty. Chronic disease outcomes were measuredby medication usage and obesity defined as BMI >30kg/m². Binary logistic regression was performed usingparticipants free of chronic disease at baseline to determine the impact of each dietary exposure independently,and combined, on the development of frailty and the incidence of chronic disease over the subsequent eight years.Results:Incidence of frailty after 8 years of follow up was 14%. The incidence of diabetes after 8 years of followup was 5.3%, hypertension 39%, hyperlipidaemia 15% and obesity 6%. A liberal energy intake adjusted for ageand sex, significantly reduced the risk of developing frailty eight years post baseline (OR 0.48, 95% CI 0.30,0.77). After adjustment for age, sex and body weight, a liberal saturated fat intake (>10% of energy) increasedthe risk of hyperlipidaemia (OR 2.11, 95% CI 1.27, 3.54). A liberal intake of sodium, total fat, refined sugar andfibre did not increase the risk of diabetes, hypertension, hyperlipidaemia or obesity. Conclusions:This studysuggests that a liberal intake of energy may decrease the risk of developing frailty in the elderly withoutincreasing the risk of developing obesity, diabetes, hypertension or hyperlipidaemia. Caution should remainhowever in the prescription of diets high in saturated fat as the link established with hyperlipidaemia in youngadults appears to be consistent in the elderly. Further research is required to explore the optimal sources of energyfor a liberalised diet and the effect of a liberalised diet on other diet related health conditions.