Ethnic differences in the nutrient intake adequacy of premenopausal US women: results from the Third National Health Examination Survey

Comparison of Dietary Micronutrient Intakes by Body Weight Status among Mexican-American and Non-Hispanic Black Women Aged 19-39 Years: An Analysis of NHANES 2003-2014

The objective of the current study was to examine micronutrient intake from foods in women of childbearing age and to better understand potential nutritional problems varied by body weight status in minority women. A sample of women aged 19-39 years from the National Health and Nutrition Examination Surveys (NHANES) 2003-2014 was analyzed. Dietary intakes of 13 micronutrients were estimated using the National Cancer Institute method. Mexican-American and non-Hispanic Black women were categorized into normal/under-weight, overweight, or obese groups according to their body mass index (BMI). Mexican-American and non-Hispanic Black women had lower dietary intakes for vitamins A, B2, B6, B12, and D, folate, calcium, and magnesium than non-Hispanic Whites. Among Mexican-Americans, obese women had the lowest dietary intake of vitamins A, B2, C and D. Obese non-Hispanic Black women had significantly lower dietary intakes of iron and zinc than their normal/under-weight counterparts. Comparable percentages (>30%) of Mexican-American and non-Hispanic Black women had dietary intake less than the Estimated Average Requirements (EARs) for several key nutrients including vitamin A, C and D, folate, calcium and magnesium, and the percentages varied by body weight status. These results indicate micronutrient inadequacies persist among and within racial/ethnic and body weight groups.

Decreased Nutrient Intake Is Associated With Premature Cervical Remodeling

OBJECTIVE

To examine the direct relationship between nutrient intake and cervical remodeling.

DESIGN

Longitudinal descriptive design.

SETTING

Maternal-fetal medicine clinic in a Midwestern urban city.

PARTICIPANTS

Forty-seven pregnant African American women.

METHODS

Participants completed the Block brief food frequency questionnaire at 19 to 24 weeks and 27 to 29 weeks gestation and had quantitative ultrasonic attenuation estimates at 19 to 21 weeks, 23 to 25 weeks, 27 to 29 weeks, 31 to 33 weeks, and 35 to 37 weeks gestation.

RESULTS

Trajectory mixture models identified two subpopulations within our sample: those at risk (n = 36) and at less risk (n = 11) for premature cervical remodeling. More participants in the less-risk group consumed the dietary reference intake for calcium, vitamin A, folate, vitamin E, zinc, and vitamin D than in the at-risk group. The percentage of participants in the less-risk group who consumed the recommended dietary reference intake for vitamin E was twice the percentage of women in the at-risk group (82% and 44%, respectively; p = .004). Mean intake of calcium was almost 1.3 times more (p = .05) and for zinc was 1.5 times more (p = .04) in the less-risk group than in the at-risk group.

CONCLUSION

Practitioners can inform women that certain nutrients, particularly zinc, calcium, and vitamin E, could be important to the health of the cervix and inhibit premature cervical remodeling, which in turn may help prevent preterm birth.

Dietary nutrients and anthropometry of Dene/Métis and Yukon children

OBJECTIVE

To describe nutrient intakes and anthropometry of 10-12-year-old Dene/Métis and Yukon children in the Canadian Arctic.

STUDY DESIGN

24 h-recall interviews (n = 222 interviews) were conducted on Canadian Dene/Métis and Yukon children in five communities during two seasons in 2000-2001; the children were measured for height and weight (n = 216).

METHODS

Assessment of nutrient adequacy used Dietary Reference Intakes (DRIs) including cut-point procedures. Anthropometric measurements (height and weight) were assessed and body mass index (BMI) was compared to the 2000 CDC Growth Charts.

RESULTS

Thirty-two percent of the children were above the 85th percentile of BMI-for-age. More than 50 percent of children were below the Estimated Average Requirement (EAR) for vitamins A and E, phosphorus and magnesium; mean intakes were below the Adequate Intake (AI) for vitamin D, calcium, dietary fiber, omega-6 fatty acids, and omega-3 fatty acids. Nutrients that were probably adequate for some gender/season groups were protein, carbohydrate, iron, copper, selenium, zinc, manganese, riboflavin and vitamins B6 and C.

CONCLUSIONS

Excessive prevalence of overweight and inadequacy of some nutrients were observed among Dene/Métis and Yukon children, suggesting a necessity for dietary improvement. However, many nutrients were adequate, in some cases probably due to continued traditional food use.

Association between Plasma 25-Hydroxyvitamin D, Ancestry and Aggressive Prostate Cancer among African Americans and European Americans in PCaP

BACKGROUND

African Americans (AAs) have lower circulating 25-hydroxyvitamin D3 [25(OH)D3] concentrations and higher prostate cancer (CaP) aggressiveness than other racial/ethnic groups. The purpose of the current study was to examine the relationship between plasma 25(OH)D3, African ancestry and CaP aggressiveness among AAs and European Americans (EAs).

METHODS

Plasma 25(OH)D3 was measured using LC-MS/MS (Liquid Chromatography Tandem Mass Spectrometry) in 537 AA and 663 EA newly-diagnosed CaP patients from the North Carolina-Louisiana Prostate Cancer Project (PCaP) classified as having either 'high' or 'low' aggressive disease based on clinical stage, Gleason grade and prostate specific antigen at diagnosis. Mean plasma 25(OH)D3 concentrations were compared by proportion of African ancestry. Logistic regression was used to calculate multivariable adjusted odds ratios (OR) and 95% confidence intervals (95%CI) for high aggressive CaP by tertile of plasma 25(OH)D3.

RESULTS

AAs with highest percent African ancestry (>95%) had the lowest mean plasma 25(OH)D3 concentrations. Overall, plasma 25(OH)D3 was associated positively with aggressiveness among AA men, an association that was modified by calcium intake (ORT 3vs.T1: 2.23, 95%CI: 1.26-3.95 among men with low calcium intake, and ORT 3vs.T1: 0.19, 95%CI: 0.05-0.70 among men with high calcium intake). Among EAs, the point estimates of the ORs were <1.0 for the upper tertiles with CIs that included the null.

CONCLUSIONS

Among AAs, plasma 25(OH)D3 was associated positively with CaP aggressiveness among men with low calcium intake and inversely among men with high calcium intake. The clinical significance of circulating concentrations of 25(OH)D3 and interactions with calcium intake in the AA population warrants further study.

Mapping low intake of micronutrients across Europe

Achieving an understanding of the extent of micronutrient adequacy across Europe is a major challenge. The main objective of the present study was to collect and evaluate the prevalence of low micronutrient intakes of different European countries by comparing recent nationally representative dietary survey data from Belgium, Denmark, France, Germany, The Netherlands, Poland, Spain and the United Kingdom. Dietary intake information was evaluated for intakes of Ca, Cu, I, Fe, Mg, K, Se, Zn and the vitamins A, B₁, B₂, B₆, B₁₂, C, D, E and folate. The mean and 5th percentile of the intake distributions were estimated for these countries, for a number of defined sex and age groups. The percentages of those with intakes below the lower reference nutrient intake and the estimated average requirement were calculated. Reference intakes were derived from the UK and Nordic Nutrition Recommendations. The impact of dietary supplement intake as well as inclusion of apparently low energy reporters on the estimates was evaluated. Except for vitamin D, the present study suggests that the current intakes of vitamins from foods lead to low risk of low intakes in all age and sex groups. For current minerals, the study suggests that the risk of low intakes is likely to appear more often in specific age groups. In spite of the limitations of the data, the present study provides valuable new information about micronutrient intakes across Europe and the likelihood of inadequacy country by country.

Ethnic differences in grains consumption and their contribution to intake of B-vitamins: results of the Multiethnic Cohort Study

BACKGROUND

Research indicates that a diet rich in whole grains may reduce the risk of prevalent chronic diseases, including cardiovascular disease, diabetes, and some cancers, and that risk for these diseases varies by ethnicity. The objective of the current study was to identify major dietary sources of grains and describe their contribution to B vitamins in five ethnic groups.

METHODS

A cross-sectional mail survey was used to collect data from participants in the Multiethnic Cohort Study in Hawaii and Los Angeles County, United States, from 1993 to 1996. Dietary intake data collected using a quantitative food frequency questionnaire was available for 186,916 participants representing five ethnic groups (African American, Latino, Japanese American, Native Hawaiian and Caucasian) aged 45-75 years. The top sources of grain foods were determined, and their contribution to thiamin, riboflavin, niacin, vitamin B6, and folic acid intakes were analyzed.

RESULTS

The top source of whole grains was whole wheat/rye bread for all ethnic-sex groups, followed by popcorn and cooked cereals, except for Native Hawaiian men and Japanese Americans, for whom brown/wild rice was the second top source; major contributors of refined grains were white rice and white bread, except for Latinos. Refined grain foods contributed more to grain consumption (27.1-55.6%) than whole grain foods (7.4-30.8%) among all ethnic-sex groups, except African American women. Grain foods made an important contribution to the intakes of thiamin (30.2-45.9%), riboflavin (23.1-29.2%), niacin (27.1-35.8%), vitamin B6 (22.9-27.5%), and folic acid (23.3-27.7%).

CONCLUSIONS

This is the first study to document consumption of different grain sources and their contribution to B vitamins in five ethnic groups in the U.S. Findings can be used to assess unhealthful food choices, to guide dietary recommendations, and to help reduce risk of chronic diseases in these populations.

A systematic review on micronutrient intake adequacy in adult minority populations residing in Europe: the need for action

This systematic review evaluated micronutrient intake inadequacy of ten micronutrients for adult ethnic minority populations residing in Europe. Pubmed was searched for studies, related references were checked and experts consulted. Ten studies were identified and six were included in the final analysis representing Albanian, Roma, Sub-Saharan African, South Asian and African-Caribbean minority groups. The Estimated Average Requirement cut point was applied to estimate inadequate intake. With the exception of a sub-Saharan African study, of seven micronutrients analysed, inadequate intakes were markedly elevated (>50 % of the population in most cases) in both genders for folate, vitamin B(12), calcium and iron (the latter in females only). A pressing need exists for intake adequacy studies with sound methodologies addressing ethnic minority groups in Europe. These populations constitute a vulnerable population for inadequate intakes and results substantiate the need for further investigation, interventions and policy measures to reduce their nutritional risk.

Racial/ethnic differences in dietary intake among WIC families prior to food package revisions

OBJECTIVE

To compare the diets of African American and Hispanic families in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) prior to the 2009 food package revisions.

METHODS

Mother-child dyads were recruited from 12 WIC sites in Chicago, IL. Individuals with 1 valid 24-hour recall were included in the analyses (n = 331 children, n = 352 mothers).

RESULTS

Compared to their African American counterparts, diets of Hispanic mothers and children were lower (P < .001) in percentage of calories from fat, added sugars, sodium, and sweetened beverages, but higher (P < .001) in vitamin A, calcium, whole grains, fruit, and total dairy. However, no groups met national recommendations for percentage of calories from saturated fat, fiber, sodium, whole grains, vegetables, and total dairy.

CONCLUSIONS AND IMPLICATIONS

There are racial/ethnic differences in dietary intake, and future research is needed to determine whether diets improve as a result of package revisions and whether uptake of these changes varies by race/ethnicity.

Randomized, controlled trial to examine the impact of providing yogurt to women enrolled in WIC

OBJECTIVE

Examine the impact of providing yogurt to women enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).

DESIGN

Randomized, controlled intervention trial.

SETTING

Two California WIC local agency sites.

PARTICIPANTS

511 pregnant, breast-feeding, or postpartum women.

INTERVENTION

Substitution of part of the WIC milk allowance with yogurt accompanied with educational materials.

MAIN OUTCOME MEASURES

Participants' consumption and attitudes regarding yogurt provision.

ANALYSIS

Chi-square, Fisher exact, and Student t test to compare pre- versus post-intervention responses. Nonparametric Wilcoxon, chi-square, and t test to compare changes in response in intervention versus controls. Analysis of covariance models to test the influence of language preference on outcomes.

RESULTS

Over 86% of women wanted to substitute some of their milk vouchers with yogurt. Among these, 62% reported preferring yogurt to milk. The majority (89%) redeemed the yogurt coupons. Compared to controls, intervention women reported a trend (P = .09) toward an increase in yogurt intake of 1.0 fl oz/day while not decreasing other dairy consumption. Those in the intervention group with the lowest tertile of yogurt intake at baseline increased yogurt consumption by 2.8 fl oz/day (P = .003) relative to controls with lowest intake.

CONCLUSIONS

Yogurt is likely to be a popular substitute for milk and could contribute to increased dairy intake among women if it were an option in WIC.

Residential exposure to traffic and spontaneous abortion

BACKGROUND

Studies have shown associations between air pollution or traffic exposure and adverse birth outcomes, such as low birth weight. However, very few studies have examined the effect of traffic emissions on spontaneous abortion (SAB).

OBJECTIVE

The goal of this study was to determine whether residential exposure to vehicular traffic was associated with SAB.

METHODS

Pregnant women from a prepaid health plan in California were recruited into a prospective cohort study in 1990-1991. Three measures of traffic exposure were constructed for the 4,979 participants using annual average daily traffic (AADT) counts near each residence and distance from residence to major roads. SAB was examined in relation to the traffic exposure measures using logistic regression adjusting for a number of demographic and lifestyle variables.

RESULTS

Of the traffic measures, maximum annual average traffic within 50 m showed the strongest association with SAB, although it was not statistically significant. The adjusted odds ratio (AOR) for the top 90th percentile (AADT greater than 15,199) versus the bottom 75th percentile (AADT = 0-1,089) was 1.18 [95% confidence interval (CI), 0.87-1.60]. However, subgroup analyses showed statistically significant associations for traffic with SAB among African Americans (AOR = 3.11; 95% CI, 1.26-7.66) and nonsmokers (AOR = 1.47; 95% CI, 1.07-2.04).

CONCLUSION

In this cohort, living within 50 m of a road with AADT of 15,200 or more was significantly associated with SAB among African Americans and nonsmokers. Further research is needed to confirm these results and possibly elucidate the mechanisms responsible for the findings.

The impact of dairy product consumption on nutrient adequacy and weight of Head Start mothers

OBJECTIVE

To assess the relationship of dairy product consumption on diet quality and weight of low-income women.

SETTING

Head Start centres in Texas and Alabama, USA.

DESIGN

Cross-sectional study. Women were divided into dairy consumption groups: < or =1, >1 to < or =2 and >2 servings/d. Nutrient intake/diet quality was determined by calculating the percentage meeting the Estimated Average Requirement, guidelines for fat and added sugar, and Mean Adequacy Ratio (MAR). Mean BMI was compared for the dairy consumption groups.

SUBJECTS

Mothers with children in Head Start; 609 African-Americans (43 %), Hispanic-Americans (32 %) and European-Americans (24 %).

RESULTS

Fifteen per cent of participants consumed >2 servings of dairy products and 57 % consumed < or =1 serving of dairy daily. Intakes of protein, vitamin D, riboflavin, P, Ca, K, Mg and Zn were significantly higher in those consuming >2 servings/d. Total SFA were higher and added sugars were lower in those consuming >2 servings of dairy products daily compared with those consuming < or =2 servings/d. Forty-one per cent of women consuming >2 servings of dairy daily had MAR scores under 85 compared with 94 % consuming < or =1 serving/d. Mean BMI was 30.36 kg/m2; there was no association between BMI and dairy product consumption.

CONCLUSIONS

Consumption of dairy products was low and was not associated with BMI in this low-income population. Higher levels of dairy product consumption were associated with higher MAR scores and improved intakes of Ca, K and Mg, which have been identified as shortfall nutrients in the diets of adults.

How dietary intake methodology is adapted for use in European immigrant population groups - a review

Immigrants comprise a noteworthy segment of the European population whose numbers are increasing. Research on the dietary habits of immigrants is critical for correctly providing diet counselling and implementing effective interventions. The aim of the present study was to identify the presently used methods and adaptations required for measuring dietary intake in European immigrant groups. A comprehensive review strategy included a structured MEDLINE search, related references and key expert consultations. The review targeted adults from non-European union (European union-15 countries) ethnic groups having the largest populations in Europe. As studies evaluating nutrient intake were scarce, papers evaluating intake at the level of foods were included. Forty-six papers were selected. Although Eastern Europe, Turkey, Africa (North, Sub-Saharan and Afro-Caribbean), Asia and Latin America represented the most numerous immigrant groups, papers on dietary intake were not available for all populations. Interview-administered FFQ and repeated 24 hour recalls were the most frequently applied instruments. Inclusion of ethnic foods and quantification of specific portion sizes of traditional foods and dishes in assessment tools as well as food composition databases were commonly identified problems. For FFQ, food list elaboration required particular consideration to reflect key ethnic foods and relative contribution to nutrient intake. Extra efforts were observed to overcome cultural barriers to study participation. Evaluating dietary intake of immigrant populations requires special attention to various methodological aspects (sampling, recruiting, instruments used, method of administration, food composition database, acculturation, etc.) so as to adequately address the range of socio-cultural factors inherent in these nutritionally at risk target groups.

Impact of dairy and sweetened beverage consumption on diet and weight of a multiethnic population of head start mothers

Mothers with children in Head Start play a critical role in providing healthful diets and modeling good dietary behaviors to their children, but there is little information available on their diet, especially on beverage consumption. The objective of this study was to assess the association of milk and sweetened beverage consumption with nutrient intake, dietary adequacy, and weight of a multiethnic population of Head Start mothers. Using a cross-sectional, secondary analysis, African-American (43%), Hispanic (33%), and white (24%) women (n=609) were divided into four beverage consumption groups: high milk/low sweetened beverage, high milk/high sweetened beverage, low milk/low sweetened beverage, and low milk/high sweetened beverage. Nutrient intake was determined by averaging 24-hour dietary recalls from 3 nonconsecutive days. Dietary adequacy was determined with the Mean Adequacy Ratio. Mean body mass index for the four beverage consumption groups was compared; there were no differences among the groups (overall mean+/-standard error=30.8+/-0.3). Women in the high milk/low sweetened beverage group had higher mean intakes of vitamins A, D, and B-6; riboflavin; thiamin; folate; phosphorus; calcium; iron; magnesium; and potassium (P<0.0125 for all) when compared with the other beverage consumption groups. Mean Adequacy Ratio was highest in the high milk/low sweetened beverage (71.8+/-0.8) and lowest in the low milk/high sweetened beverage (58.4+/-0.8) consumption groups (P<0.0125). Women in the high milk/low sweetened beverage group consumed more nutrient-dense foods. Overall consumption of milk was low. Consumption of high milk/low sweetened beverage was associated with improved nutrient intake, including the shortfall nutrients, ie, calcium, potassium, magnesium, and vitamin A.

Pass the fruits and vegetables! A community-university-industry partnership promotes weight loss in African American women

This article describes a community-university-industry partnership to alleviate food insecurity while promoting weight loss. Twenty-one overweight African American women are randomly assigned to experimental or control groups. Each receives supermarket gift cards and brief health education monthly for 3 months. The experimental group buys fresh produce only, whereas the control group buys any groceries. Data on weight, body mass index (BMI), waist-hip circumferences, and dietary intake are collected at baseline and months 1 to 3. Nine (43%) have complete data. Quantitative data reveal that the experimental group have lost significantly more weight (-6, +4 lbs), significantly reduced BMI (-1, +0.7), and eat significantly more raw, fresh produce (1.29, 0.15 cups). A focus group held at month 4 is rich with the meanings of participating, eating "well," and forming new habits. A nutrient-dense diet that is calorically balanced is the hallmark of health and well-being and may be related to weight loss in new ways. However, this diet is not always affordable by those most in need of it. The unexpected outcome of a statistical relationship among consuming raw, freshly prepared produce, weight loss, and BMI reduction within 3 months is not altogether explainable. There are obvious benefits, however, to these outcomes that support the continuing study of the phenomenon.

Vitamin D intake during pregnancy: association with maternal characteristics and infant birth weight

BACKGROUND

Vitamin D insufficiency is beginning to be recognized as a public health problem. It is plausible that some portion of the lower Vitamin D levels which characterize minority populations is related to diet.

AIMS

We examined and described total Vitamin D intake during pregnancy from the mean of three 24-hour recalls plus use of dietary supplements.

STUDY DESIGN

Prospective cohort.

SUBJECTS

2251 low income, minority gravidae from Camden, New Jersey, USA.

OUTCOME MEASURES

Differences in total Vitamin D intake by maternal ethnicity. BMI and other factors (age, parity) and associations of total Vitamin D intake with gestation duration and birth weight adjusted for gestation.

RESULTS AND CONCLUSIONS

Total Vitamin D intake was significantly lower for minority gravidae (African American, and Hispanic, mainly Puerto Rican), for parous women, and for women with pregravid BMIs consistent with obesity or being overweight. After control for energy, other nutrients, and other potential confounding variables, total intake of Vitamin D was associated with increased infant birth weight; gravidae below the current adequate intake (<5 microg/day or 200 IU) had infants with significantly lower birth weights (p<0.05). Additional intake of Vitamin D may be of importance since higher intake is associated with increased birth weight in a population at risk of adverse pregnancy outcomes.

Built environment and health behaviors among African Americans: a systematic review

CONTEXT

An overall understanding of environmental factors that affect weight-related behaviors and outcomes in African American adults is limited. This article presents a summarization of the literature on the built environment and its association with physical activity, diet, and obesity among African Americans.

EVIDENCE ACQUISITION

A systematic review was conducted by searching the PubMed electronic database from inception to July 31, 2007, reviewing bibliographies of eligible articles, and searching authors' personal databases using various search terms for the built environment, physical activity, diet, and obesity. Eligible articles were observational studies that included a study population >or=90% African American (or subgroup analysis), adults (>or=18 yrs), and were published in English; final article data abstraction occurred from October 2007 through February 2008.

EVIDENCE SYNTHESIS

A total of 2797 titles were identified from the initial search, and 90 were deemed eligible for abstract review. Of these, 17 articles were eligible for full review and ten met all eligibility criteria. The median sample size was 761 (234 to 10,623), and half of the articles included only African Americans. Light traffic, the presence of sidewalks, and safety from crime were more often positively associated with physical activity, although associations were not consistent (OR range = 0.53-2.43). Additionally, perceived barriers to physical activity were associated with obesity. The presence of supermarkets and specialty stores was consistently positively associated with meeting fruit and vegetable guidelines.

CONCLUSIONS

With relatively few studies in the literature focused on African Americans, more research is needed to draw conclusions on features of the built environment that are associated with physical activity, diet, and obesity.

Documenting the need for nutrition and health intervention for middle-aged and older adults in the Lower Mississippi Delta region

Multiple demographic, health, and environmental factors may influence the overall quality of diets among rural middle-aged and older adults. This project compared the diet quality of participants in Foods of Our Delta Survey (FOODS 2000) who were aged 55 years and older with national data. The data were assessed using 24-hour dietary recall methodology and a modified version of the United States Department of Agriculture Healthy Eating Index (HEI) that excluded the sodium component. The mean total Modified Healthy Eating Index (MHEI) study score was significantly lower than their counterparts from the national survey (61.0 +/- 0.68 vs. 65.6 +/- 3.65, P < 0.0001). Race and educational attainment were associated with higher MHEI scores. This study emphasized a critical need for implementing nutrition and health interventions in rural communities with special attention to subpopulations at risk.

Herbal and dietary supplement disclosure to health care providers by individuals with chronic conditions

BACKGROUND

Very little is known about herbal and dietary supplement disclosure in adults with chronic medical conditions, especially on a national level.

OBJECTIVE

To examine herbal and dietary supplement disclosure to conventional health care providers by adults with chronic medical conditions.

DESIGN

Data on herbal and dietary supplement use (N = 5456 users) in the previous year were used from the 2002 National Health Interview Survey. Bi-variable analyses compared characteristics between herbal and dietary supplement disclosers and nondisclosers. Multivariable logistic regression identified independent correlates of herbal and dietary supplement disclosure.

RESULTS

Overall, only 33% of herbal and dietary supplement users reported disclosing use of herbal and dietary supplements to their conventional health care provider. Among herbal and dietary supplement users with chronic conditions, less than 51% disclosed use to their conventional health care provider. Hispanic (adjusted odds ratio and 95% confidence interval = 0.70 [0.52, 0.94]) and Asian American (adjusted odds ratio and 95% confidence interval = 0.54 [0.33, 0.89]) adults were much less likely than non-Hispanic white Americans to disclose herbal and dietary supplement use. Having less than a high school education (adjusted odds ratio and 95% confidence interval = 0.61 [0.45, 0.82]) and not having insurance (adjusted odds ratio and 95% confidence interval = 0.77 [0.59, 1.00]) were associated with being less likely to disclose herbal and dietary supplement use.

CONCLUSION

Herbal and dietary supplement disclosure rates are low, even among adults with chronic conditions. These findings raise concerns about the safety of herbal and dietary supplements in combination with allopathic care. Future studies should focus on educating physicians about crosscultural care as well as eliciting information about herbal and dietary supplement use.

Ethnic differences in early pregnancy maternal n-3 and n-6 fatty acid concentrations: an explorative analysis

Ethnicity-related differences in maternal n-3 and n-6 fatty acid status may be relevant to ethnic disparities in birth outcomes observed worldwide. The present study explored differences in early pregnancy n-3 and n-6 fatty acid composition of maternal plasma phospholipids between Dutch and ethnic minority pregnant women in Amsterdam, the Netherlands, with a focus on the major functional fatty acids EPA (20 : 5n-3), DHA (22 : 6n-3), dihomo-gamma-linolenic acid (DGLA; 20 : 3n-6) and arachidonic acid (AA; 20 : 4n-6). Data were derived from the Amsterdam Born Children and their Development (ABCD) cohort (inclusion January 2003 to March 2004). Compared with Dutch women (n 2443), Surinamese (n 286), Antillean (n 63), Turkish (n 167) and Moroccan (n 241) women had generally lower proportions of n-3 fatty acids (expressed as percentage of total fatty acids) but higher proportions of n-6 fatty acids (general linear model; P < 0.001). Ghanaian women (n 54) had higher proportions of EPA and DHA, but generally lower proportions of n-6 fatty acids (P < 0.001). Differences were most pronounced in Turkish and Ghanaian women, who, by means of a simple questionnaire, reported the lowest and highest fish consumption respectively. Adjustment for fish intake, however, hardly attenuated the differences in relative EPA, DHA, DGLA and AA concentrations between the various ethnic groups. Given the limitations of this observational study, further research into the ethnicity-related differences in maternal n-3 and n-6 fatty acid patterns is warranted, particularly to elucidate the explanatory role of fatty acid intake v. metabolic differences.

Diet quality varies by race/ethnicity of Head Start mothers

BACKGROUND

Despite the key role that women from limited income families play as family food providers and their high risk for diet-related chronic diseases, there is a paucity of data about their diet quality and how it might vary by race/ethnicity.

OBJECTIVE

To compare nutrient and food intakes of multiethnic mothers with children in Head Start from Texas and Alabama.

DESIGN

Cross-sectional, secondary data analysis.

METHODS

The sample was 603 mothers, 33% Hispanic American from Texas; 19% African American from Texas; 24% African American from Alabama; and 24% white from Alabama who were interviewed from fall 2004 to spring 2005. Diet quality was evaluated by averaging 24-hour dietary recalls from 3 nonconsecutive days and calculating the percent meeting the Estimated Average Requirement, the Dietary Guidelines for fat and added sugar, and the mean adequacy ratio for eight nutrients. For multiple comparisons, the least square means statement was used for general linear model procedures, adjusted for age, body mass index, and energy intake.

RESULTS

The average mean adequacy ratio scores for diet quality were low overall, but 44% of Hispanic Americans had mean adequacy ratio scores <85, whereas 96% to 97% of other groups did. Most mothers exceeded 35% of energy from fat, with Hispanic Americans having the lowest percentage. Overall, 15% of mothers exceeded 25% of energy from added sugars, with Hispanic Americans having 5% with excess intakes. Energy intakes were highest for Hispanic Americans (2,017 kcal) and lowest for African Americans (1,340 kcal). The Hispanic Americans surveyed averaged 4.6 c fruit and vegetables per day compared to 3.2, 2.3, and 2.9 c/day among African Americans from Texas, African Americans from Alabama, and whites from Alabama, respectively.

CONCLUSIONS

Despite limited food resources, Hispanic-American mothers consumed adequate amounts of fruit and vegetables. There was considerable variation in diet quality among race/ethnic groups on a low income budget.

Trends in black-white differentials in dietary intakes of U.S. adults, 1971-2002

BACKGROUND

Disparities in the health status of blacks and whites have persisted despite considerable gains in improved health of the U.S. population. Tracking changes in black-white differentials in dietary attributes over time may help in understanding the contribution of diet to these disparities.

METHODS

Data were used from four National Health and Nutrition Examination Surveys conducted between 1971 and 2002 for trends in self-reported intakes of energy, macronutrients, micronutrients, fruits and vegetables, and the energy density of foods among U.S. non-Hispanic black (n=7099) and white (n=23,314) men and women aged 25 to 74 years. Logistic and linear regression methods were used to adjust for multiple covariates and survey design.

RESULTS

Energy intake, amount of food, and carbohydrate energy increased, whereas percentage of energy from protein, fat, and saturated fat decreased over time in all race and gender groups (p<0.001). In whites and in black women, energy density increased (p<0.001) in parallel to increases in obesity prevalence. In all surveys, black men and women reported lower intakes of vegetables, potassium, and calcium (p<0.001) than their white counterparts. In men, the race differential in calcium intake increased across surveys (p=0.004).

CONCLUSIONS

Dietary intake trends in blacks and whites from 1971 to 2002 were similar, which suggests that previously identified dietary risk factors that differentially affect black Americans have not improved in a relative sense.

Does food group consumption vary by differences in socioeconomic, demographic, and lifestyle factors in young adults? The Bogalusa Heart Study

OBJECTIVE

To examine if food group consumption varies by differences in socioeconomic, demographic, and lifestyle factors in young adults from a semirural setting in Louisiana.

DESIGN

Cross-sectional.

SUBJECTS

Young adults (n=1,266, 74% European American, 26% African American; 39% men, 61% women) aged 20 to 38 years, enrolled in the Bogalusa Heart Study.

MEASURES

Food group consumption was assessed by a food frequency questionnaire. Socioeconomic (eg, income and education), demographic (eg, age, sex, and ethnicity), and lifestyle (eg, marital status and physical activity) information was obtained by a self-administered questionnaire and the subjects were stratified according to these groups.

STATISTICAL ANALYSES

Analysis of covariance (adjusted for covariates) was used to detect differences in the mean servings of food groups consumed per day between the various socioeconomic, demographic, and lifestyle groups.

RESULTS

Compared to income$45,000 had lower consumption of burgers/sandwiches (P<0.05) and those with income levels from $30,001 to $45,000 had lower consumption of mixed dishes (P<0.05). Intake of cereals/breads (P<0.05), dairy products (P<0.01), fruits/100% fruit juices (P<0.001), and vegetables (P<0.001) was higher in subjects with >12 years of education. European-American men consumed more servings of dairy products (P<0.05) and sweetened beverages (P<0.05) than African-American men. European-American women consumed more servings of dairy products (P<0.05), vegetables (P<0.05), and fats (P<0.05) than African-American women. African Americans (men and women) consumed more servings of fruits/100% fruit juices (P<0.0001) than European Americans (men and women), respectively. Married individuals consumed more servings of snacks/desserts (P<0.05), but fewer servings of alcoholic beverages (P<0.0001) than those who were unmarried. Active individuals consumed more servings of fruits/100% fruit juices (P<0.05) and fewer servings of burgers/sandwiches (P<0.05) than inactive individuals.

CONCLUSIONS

These findings suggest that food group consumption varies by socioeconomic, demographic, and lifestyle factors in young adults from a semirural setting. Food and nutrition professionals who encounter diverse populations need to consider the influence of income, education, sex, ethnicity, marital status, and physical activity on food consumption patterns when planning diets, nutrition education programs, and interventions for young adults.

The use of external within-person variance estimates to adjust nutrient intake distributions over time and across populations

Objective:

To examine the utility of using external estimates of within-person variation to adjust usual nutrient intake distributions.

Design:

Analyses of the prevalence of inadequate intake of an example nutrient by the Estimated Average Requirement (EAR) cut-point method using three different methods of statistical adjustment of the usual intake distribution of a single 24-hour recall in Russian children in 1996, using the Iowa State University method for adjustment of the distribution. First, adjusting the usual intake distribution with day 2 recalls from the same 1996 sample (the correct method) second, adjusting the distribution using external variance estimates derived from US children in 1996; and third, adjusting the distribution using external estimates derived from Russian children of the same age in 2000. We also present prevalence estimates based on naïve statistical analysis of the unadjusted distribution of intakes.

Setting/subjects:

Children drawn from the Russia Longitudinal Monitoring Survey in 1996 and 2000 and from the 1996 Continuing Survey of Food Intakes by Individuals.

Results:

When the EAR cut-point method is applied to a single recall, the resulting prevalence estimate in this study is inflated by 100–1300%. When the intake distribution is adjusted using an external variance estimate, the prevalence estimate is much less biased, suggesting that any adjustment may give less biased estimates than no adjustment.

Conclusions:

In moderately large samples, adjusting distributions with external estimates of variances results in more reliable prevalence estimates than using 1–day data.

Perceptions and beliefs about body size, weight, and weight loss among obese African American women: a qualitative inquiry

The purpose of this qualitative study was to explore perceptions and beliefs about body size, weight, and weight loss among obese African American women in order to form a design of weight loss intervention with this target population. Six focus groups were conducted at a community health clinic. Participants were predominantly middle-aged with a mean Body Mass Index of 40.3 +/- 9.2 kg/m(2). Findings suggest that participants (a) believe that people can be attractive and healthy at larger sizes; (b) still feel dissatisfied with their weight and self-conscious about their bodies; (c) emphasize eating behavior as the primary cause for weight gain; (d) view pregnancy, motherhood, and caregiving as major precursors to weight gain; (e) view health as the most important reason to lose weight; (f) have mixed experiences and expectations for social support for weight loss; and (g) prefer treatments that incorporate long-term lifestyle modification rather than fad diets or medication.

Weight-related perceptions among patients and physicians: how well do physicians judge patients' motivation to lose weight?

BACKGROUND

Prior studies suggest that patients and physicians have different perceptions and expectations surrounding weight; however, few studies have directly compared patients' and physicians' perspectives.

OBJECTIVES

(1) To measure the extent to which obese patients and their physicians have discrepant weight-related perceptions, and (2) to explore patient and physician characteristics that may influence patient-physician discrepancy in motivation to lose weight.

DESIGN AND PARTICIPANTS

Four hundred and fifty-six obese patients (302 females; mean age = 55.1 years; mean BMI = 37.9) and their 28 primary care physicians (22 males, mean age = 44.1 years) from nonmetropolitan practices completed an anonymous survey after an office visit.

MEASURES

Weight-related perceptions included perceived weight status, health impact of weight, 1-year weight loss expectations, and motivation to lose weight. Correlates included patient and physician sex, age, and BMI; physicians' reported frequency, perceived patient preference, and confidence for weight counseling; and practice characteristics (e.g., years in practice).

RESULTS

Physicians assigned patients to heavier descriptive weight categories and reported a worse health impact than patients perceived for themselves, whereas patients believed they could lose more weight and reported a higher motivation to lose weight than their physicians perceived for patients (P < .001). Physicians who believed patients preferred to discuss weight more often (P = .001) and who saw more patients per week (P = .04) were less likely to underestimate patient motivation.

CONCLUSIONS

Patients reported more optimistic weight-related perceptions and expectations than their physicians. Further research is needed to determine how these patient-physician discrepancies may influence weight loss counseling in primary care.

Low Socioeconomic Status Is a Risk Factor for Cardiovascular Disease Among Adult Obstructive Sleep Apnea Syndrome Patients Requiring Treatment

STUDY OBJECTIVE

To evaluate the possible role of low socioeconomic status (SES) as a risk factor for cardiovascular disease (CVD) among obstructive sleep apnea syndrome (OSAS) patients requiring treatment.

DESIGN

Polysomnographic and demographic characteristics and associated morbidity were measured in 686 prospectively recruited adult OSAS patients from two regions in Israel.

SETTING

Two university-affiliated sleep laboratories.

MEASUREMENTS AND RESULTS

The multiple logistic regression (after adjusting for gender, body mass index [BMI], and smoking) revealed that the following are independent determinants for CVD in OSAS patients requiring treatment: each decrease in income level category (odds ratio [OR], 1.4; 95% confidence interval [CI], 1.1 to 1.7), age > or = 1 year (OR, 1.07; 95% CI, 1.04 to 1.1), hypertension (OR, 2.0; 95% CI, 1.3 to 3.1), and hyperlipidemia (OR, 3.7; 95% CI, 2.4 to 5.8); area under the receiver operating characteristic (ROC) = 81.9%. The multivariate determinants describing the low-SES OSAS patients included: minorities and immigrants combined (OR, 6.0; 95% CI, 2.9 to 12), female gender (OR, 2.4; 95% CI, 1.6 to 3.9), increased BMI (OR, 1.9; 95% CI, 1.3 to 2.9), unmarried status (OR, 1.9; 95% CI, 1.2 to 3.1), and years of education (> or = 1 year) [OR, 0.8; 95% CI, 0.7 to 0.8]; area under the ROC = 78.1%.

CONCLUSION

In addition to the already known traditional risk factors, low SES was found to be a novel independent risk factor for CVD among adult OSAS patients requiring treatment.

Salad and Raw Vegetable Consumption and Nutritional Status in the Adult US Population: Results from the Third National Health and Nutrition Examination Survey

OBJECTIVE

To examine the relationship between reported salad consumption and serum nutrient levels as well as dietary adequacy, as defined by nutrient intakes, in relation to the National Academy of Science Food and Nutrition Board Guidelines, in pre- and postmenopausal women and in men of comparable ages.

DESIGN

Analyses of 24-hour recalls were conducted to determine dietary intake using the Third National Health and Nutrition Examination Survey data. Salad consumption was assessed based on intakes of salad, raw vegetables, and salad dressing.

SUBJECTS

Nine thousand four hundred-six women and 8,282 men aged 18 to 45 years and older than 55 years were examined between 1988 and 1994.

STATISTICAL ANALYSES

Regressions were used to model associations between salad and raw vegetable consumption and selected serum nutrient outcomes. Usual nutrient intake distributions were estimated using the Iowa State University method for adjustment of the distribution. The Estimated Average Requirement method was used to determine the proportion of subjects with inadequate intake for each nutrient.

RESULTS

The consumption of salads, raw vegetables, and salad dressing was positively associated with above-median serum micronutrient levels of folic acid, vitamins C and E, lycopene, and alpha- and beta-carotene. Each serving of salad consumed was associated with a 165% higher likelihood to meet the recommended Dietary Allowance for vitamin C in women and 119% greater likelihood in men.

CONCLUSIONS

Salad consumers tended to have more favorable intakes of vitamins C and E, folic acid, and carotenoids, after adjustment for other differences. The significant and consistently higher serum values of these vitamins among salad consumers suggest that they are being well absorbed from salad. Salad, salad dressing, and raw vegetable consumption can be an effective strategy for enhancing nutritional adequacy and increasing vegetable consumption in the population at large.

"A lot of sacrifices:" work-family spillover and the food choice coping strategies of low-wage employed parents

Integrating their work and family lives is an everyday challenge for employed parents. Competing demands for parents' time and energy may contribute to fewer meals prepared or eaten at home and poorer nutritional quality of meals. Thus, work-family spillover (feelings, attitudes, and behaviors carried over from one role to another) is a phenomenon with implications for nutrition and health. The aim of this theory-guided constructivist research was to understand how low-wage employed parents' experiences of work-family spillover affected their food choice coping strategies. Participants were 69 black, white and Latino mothers and fathers in a Northeastern US city. We explored participants' understandings of family and work roles, spillover, and food choice strategies using open-ended qualitative interviews. Data analysis was based on the constant comparative method. These parents described affective, evaluative, and behavioral instances of work-family spillover and role overload as normative parts of everyday life and dominant influences on their food choices. They used food choice coping strategies to: (1) manage feelings of stress and fatigue, (2) reduce the time and effort for meals, (3) redefine meanings and reduce expectations for food and eating, and (4) set priorities and trade off food and eating against other family needs. Only a few parents used adaptive strategies that changed work or family conditions to reduce the experience of conflict. Most coping strategies were aimed at managing feelings and redefining meanings, and were inadequate for reducing the everyday hardships from spillover and role overload. Some coping strategies exacerbated feelings of stress. These findings have implications for family nutrition, food expenditures, nutritional self-efficacy, social connections, food assistance policy, and work place strategies.

Older Black Women Differ in Calcium Intake Source Compared to Age– and Socioeconomic Status–Matched White Women

Racial disparity in osteoporosis between older black and white women is well established; however, less is known regarding daily dietary and supplemental calcium intake in these populations. Moreover, racial differences in calcium intake are confounded by differences in socioeconomic status (SES). The objective of this study was to assess calcium intake and source in older black women (n=33) and white women (n=33), matched in age and SES. Calcium intake and source were evaluated by interview using a 46-item calcium food frequency questionnaire including all food groups and supplements. Black and white women were identical in SES and matched on age (black women 66.9+/-6.2 years vs white women 67.1+/-5.5 years [mean+/-standard deviation], P=0.85). No significant difference existed for dietary calcium intake between black and white women (974+/-524 vs 1,070+/-600 mg/day; P=0.65) or total calcium intake between black and white women (1,485+/-979 vs 1,791+/-887 mg/day; P=0.15). Dairy foods contributed most to dietary calcium intake in black and white women and differed by race (black women 402+/-269 mg/day, white women, 603+/-376 mg/day; P=0.02). Calcium intake from grains differed by race (black women 205+/-201 mg/day vs white women 130+/-234 mg/day; P=0.010) and fortified cereals were a major source of calcium for black women. Calcium supplementation contributed substantially to total calcium intake in both groups, with more white women (n=23, 70%) using supplements than black women did (n=19, 58%). However, no racial difference existed in supplemented calcium intake (black women, n=19; 889+/-605 vs white women, n=23; 1,034+/-460 mg/day; P=0.20). Our data suggest that total daily dietary and supplemental calcium intakes do not differ, but calcium intake from dairy foods and from grains differ in older black and white women matched in age and SES.

Using dietary reference intake-based methods to estimate prevalence of inadequate nutrient intake among female students in Brazil

The objective of this study was to estimate the prevalence of inadequate usual nutrient intake among female university students. This was a cross-sectional study in which 119 students at a public university in the State of São Paulo, Brazil, completed 3-day estimated food records. These were analyzed for nutrient content, and intake distributions were determined. Nutrient intake distributions were estimated using the National Research Council method. For nutrients for which an Estimated Average Requirement has been established, the Estimated Average Requirement cutpoint method was used to determine the proportion of students with inadequate intake. The students' food records indicated inadequate intakes of folate (99%), zinc (47%), and copper (33%). For approximately 95% of the students in this study, calcium was less than the Adequate Intake. The results showed the need for improvement in dietary choices to minimize the prevalence of inadequate intake of folate, zinc, copper, and calcium in this group.

Lipids and tocopherols in serum and liver of female rats fed diets containing corn oil or cottonseed oil

Growing female rats were fed diets containing either corn oil (CO) or cottonseed oil (CSO) to determine if the previously reported lowering effect of CSO versus CO on serum total cholesterol (TC) and high-density lipoprotein cholesterol (HDL-C) was sex specific and to compare the effect of these two oils on serum and tissue concentrations of RRR-alpha-tocopherol (alpha-T) and RRR-gamma-tocopherol (gamma-T), the two major tocopherols in these oils. In a 4-week study, groups of rats (n = 10 each) were fed diets containing 100 g/kg of either CO or CSO. TC was lower for group CSO than group CO. Serum concentrations of HDL-C, non-HDL-C, triglycerides (TGs), as well as the TC/ HDL-C ratio and the hepatic concentrations of cholesterol and TGs, were unaffected by diet. For serum and liver, between-group differences were noted for the concentrations of alpha-T (where values were higher for group CSO) and gamma-T (where values were lower for group CSO). These differences reflected differences between the oils in their concentrations of these tocopherols. Thus, CSO has a lowering effect on TC for both sexes, but on HDL-C for male animals only; replacement of CO with CSO results in changes in tocopherol status.

Evaluation of dietary intake data using the tolerable upper intake levels

We discuss the problem of assessing nutrient intake relative to the tolerable upper intake levels (UL) for the nutrient proposed by the Institute of Medicine and focus on 2 important topics: the estimation of usual nutrient intake distributions and the extent to which intakes above the UL can be considered risky. With the information that is currently available for most nutrients, it is not possible to estimate the proportion of individuals in a group with intakes that place them at risk. This is because the shape of the dose-response curve needed to carry out a risk assessment is unknown for most nutrients. Thus, intakes above UL cannot be declared to be unsafe. Intakes below the UL, however, are likely to pose no risk to individuals in the group. Because determining the proportion of individuals with intakes below the UL requires estimation of an upper-tail percentile of the intake distribution, the use of 1-d intake data or otherwise unadjusted intake data are likely to lead to severely biased estimates. It is important to remove within-individual variance in intakes from daily intakes so that the tails of the usual intake distribution are accurately estimated. Underreporting of the amount of nutrients consumed will tend to shift the estimated usual nutrient intake distribution downwards. In this case, the true proportion of individuals with intakes below the UL is likely to be overestimated.

Vitamin D intakes by children and adults in the United States differ among ethnic groups

Concerns about vitamin D status in the United States have resurfaced due to increasing reports of insufficiency and deficiency. Few foods contain vitamin D naturally, and currently few foods are fortified in the United States. Intakes of vitamin D in the United States from food and food plus supplements by age, sex, and race/ethnicity group were estimated. Individuals > or = 1 y old who participated in the 1999-2000 National Health and Nutrition Examination Survey (NHANES 1999-2000) were included in the analysis. Vitamin D intake by non-Hispanic (NH) white, NH black, Mexican American, and all individuals in the United States was estimated and compared with recommended levels. Vitamin D intakes were highest among children and teenagers, and lowest in the oldest age categories. Among children age 1-8 y, adequate intake (AI) levels for vitamin D from food were met or exceeded by 69% of Mexican American, 59% of NH white, and 48% of NH black subpopulations. Among adults > or = 51 y old, only 4% met or exceeded the AI from food alone. Few women 19-50 y old or men and women > or = 51 y old were estimated to consume recommended vitamin D levels from food. Mean dietary intakes of vitamin D from food plus supplements were consistently highest among NH white populations, although only small proportions of all those > or = 51 y old had intakes above the recommended levels. The large discrepancy between vitamin D intake by older individuals from food plus supplements and recommended levels, especially for NH black and Mexican American adults, warrants intervention.

Are ethnic differences in insulin sensitivity explained by variation in carbohydrate intake?

AIMS/HYPOTHESIS

Minority populations are disproportionately affected by diabetes. This health disparity may be due to less healthy diets and/or heritable factors in minority populations. These factors must be assessed concurrently to better appreciate their contribution to insulin sensitivity.

METHODS

We analysed overweight, healthy adults using the National Health and Nutrition Examination Survey 1999-2000. Means for dietary intake variables and insulin sensitivity were calculated by ethnicity. Linear regressions were performed to evaluate the association between ethnicity, dietary variables, dietary glycaemic index and insulin sensitivity. Fasting insulin was used to characterise insulin sensitivity.

RESULTS

Non-Hispanic whites have higher energy and fat intake, while Hispanics have higher carbohydrate intake and African-Americans have lower fibre intake. In unadjusted analyses both Hispanics and African-Americans have lower insulin sensitivity, but only Hispanics are more likely to have lower insulin sensitivity after controlling for dietary variables and BMI.

CONCLUSIONS/INTERPRETATION

Ethnic differences in insulin sensitivity remain after controlling for dietary differences and other factors, suggesting that inherent metabolic differences exist. Further studies are needed to define inherent metabolic factors, as well as other non-dietary factors that affect insulin sensitivity.

Fruit and Vegetable Intake during Pregnancy and Risk for Development of Sporadic Retinoblastoma

OBJECTIVE

Little is known about the causes of sporadic (noninherited) retinoblastoma. Rates seem to be somewhat higher among poorer populations in Mexico. Fruits and vegetables are important sources of carotenoids and folate. We examined whether decreased gestational maternal intake of fruits and vegetables may contribute to development of sporadic retinoblastoma.

METHODS

At the Instituto Nacional de Pediatria in Mexico City, we conducted a hospital-based case-control study to evaluate prenatal maternal diet. We examined dietary intake of fruits and vegetables of mothers of 101 children with retinoblastoma and 172 control children using a dietary recall questionnaire and published food nutrient content tables.

RESULTS

The reported number of mean daily servings of fruits and vegetables was lower among case mothers when compared with control mothers [vegetables: 2.28 in controls, 1.75 in cases (P < 0.01); fruits: 2.13 in controls, 1.59 in cases (P = 0.07)]. Mean daily maternal folate intake from both vegetables and fruits was higher in controls (103 microg) than in cases (48 microg; P < 0.05). Risk for having a child with retinoblastoma was increased for mothers consuming fewer than 2 daily servings of vegetables [odds ratios (OR), 3.4; 95% confidence interval (95% CI), 2.0-6.0] or with a low intake of folate (OR, 3.9; 95% CI, 2.1, 7.3), or lutein/zeaxanthin (OR, 2.6; 95% CI, 1.5-4.6) derived from fruits and vegetables.

CONCLUSIONS

Decreased intake of vegetables and fruits during pregnancy and the consequent decreased intake of nutrients such as folate and lutein/zeaxanthin, necessary for DNA methylation, synthesis, and retinal function, may increase risk for having a child with sporadic retinoblastoma.

The use of external within-person variance estimates to adjust nutrient intake distributions over time and across populations

OBJECTIVE

To examine the utility of using external estimates of within-person variation to adjust usual nutrient intake distributions.

DESIGN

Analyses of the prevalence of inadequate intake of an example nutrient by the Estimated Average Requirement (EAR) cut-point method using three different methods of statistical adjustment of the usual intake distribution of a single 24-hour recall in Russian children in 1996, using the Iowa State University method for adjustment of the distribution. First, adjusting the usual intake distribution with day 2 recalls from the same 1996 sample (the correct method); second, adjusting the distribution using external variance estimates derived from US children in 1996; and third, adjusting the distribution using external estimates derived from Russian children of the same age in 2000. We also present prevalence estimates based on naive statistical analysis of the unadjusted distribution of intakes.

SETTING/SUBJECTS

Children drawn from the Russia Longitudinal Monitoring Survey in 1996 and 2000 and from the 1996 Continuing Survey of Food Intakes by Individuals.

RESULTS

When the EAR cut-point method is applied to a single recall, the resulting prevalence estimate in this study is inflated by 100-1300%. When the intake distribution is adjusted using an external variance estimate, the prevalence estimate is much less biased, suggesting that any adjustment may give less biased estimates than no adjustment.

CONCLUSIONS

In moderately large samples, adjusting distributions with external estimates of variances results in more reliable prevalence estimates than using 1-day data.

Within- and between-person variation in nutrient intakes of Russian and U.S. children differs by sex and age

Within- and between-person variation in nutrient intake has been characterized in different adult populations, but little is known of country, age, or sex differences among children. The objectives of this study were as follows: 1) to describe the mean intake, within- and between-individual CV and variance ratios of nutrient intake among children ages 9-18 y old in Russia and the United States in 1996; 2) to compare the age and sex-related differences in nutrient intake variance within and between countries; and 3) to hypothesize about the feasibility of using within-individual variance estimates from one nationally representative sample to adjust the usual intake distributions in another nationally representative sample. Mean intakes of all nutrients except magnesium were significantly higher among U.S. children (P < 0.001); within-person variation was higher among the U.S. children, possibly indicating greater access to a wide array of foods. Strong differentials existed in variance components by sex in both countries, although not in the same direction, and differed by age in U.S. girls. Ratios of within- to between-person variance in 8 of 11 nutrients were lower among Russian (range: 0.9-1.6) than U.S. children (range: 1.4-1.7), suggesting that day-to-day bias may not affect Russian dietary recalls as strongly as in the United States. Researchers are encouraged to use these estimates to conduct sensitivity analyses of usual intake distributions in their own data when multiple days of data collection are not feasible.

Vitamin D, Calcium, and Mammographic Breast Densities

Vitamin D and calcium are being evaluated as potential breast cancer prevention agents. This study reports on the relation of dietary vitamin D and calcium to mammographic breast densities, one of the strongest breast cancer risk factors. Participants were women ages 40 to 60 years who had had a screening mammogram in Rhode Island and eastern Massachusetts (1989–1990). Diet was assessed by semiquantitative food frequency questionnaire, and the percentage of the breast showing densities was estimated visually by a single observer without information on subjects. Multivariate logistic regression was used to compare dietary intakes of vitamin D and calcium between women classified as having few densities (≤30% of the breast with density, n = 287) and extensive densities (≥70% of the breast with density, n = 256). For categories of increasing vitamin D intake (&lt;50, 50–99, 100–199, and ≥200 IU/d), adjusted odds ratios (OR) for extensive densities were 1.00 (reference), 0.51, 0.37, and 0.24, respectively (P for trend = 0.0005). For increasing calcium intake (&lt;500, 500–749, 750–999, and ≥1,000 mg/d), adjusted ORs were 1.00 (reference), 0.63, 0.25, and 0.24, respectively (P for trend = 0.0006). Combination of higher intakes of vitamin D and calcium (≥100 IU/d and ≥750 mg/d, respectively) were associated with a reduction of breast densities (OR, 0.28; 95% confidence interval, 0.15–0.54) compared with those consuming &lt;100 IU/d and &lt;750 mg/d. Increases in vitamin D and calcium intakes were associated with decreases in breast densities, suggesting that dietary vitamin D and calcium could reduce breast cancer risk possibly through influences on breast tissue morphology.

Ethnicity and race influence the folate status response to controlled folate intakes in young women

Population-based studies report differences in folate status indicators among Mexican American (MA), African American (AA) and Caucasian (CA) women. It is unclear, however, whether these differences are due to variations in dietary folate intake. The present study was designed to investigate the influence of ethnicity/race on folate status parameters in MA, AA, and CA women (18-45 y; n = 14 in each group) under conditions of strictly controlled folate intake. In addition, the adequacy of the 1998 folate U.S. recommended dietary allowance (RDA), 400 micro g/d as dietary folate equivalents (DFE), for non-Caucasian women was assessed. Subjects (n = 42) with the methylenetetrahydrofolate reductase 677 CC genotype consumed a low-folate diet (135 micro g DFE/d) for 7 wk followed by repletion with 400 (7 MA, 7 AA, 7 CA) or 800 micro g DFE/d (7 MA, 7 AA, 7 CA) for 7 wk. AA women had lower (P </= 0.05) blood folate concentrations and excreted less (P </= 0.05) urinary folate throughout folate depletion and repletion with 400 and/or 800 micro g DFE/d compared with MA and/or CA women. MA women had lower (P </= 0.05) plasma total homocysteine (tHcy) throughout folate depletion and during repletion with 400 micro g DFE/d relative to the other ethnic/racial groups. Repletion with the 1998 folate U.S. RDA led to normal blood folate and plasma tHcy for all 3 ethnic/racial groups. Collectively, these data demonstrate that ethnicity/race is an important determinant of folate status under conditions of strictly controlled dietary folate intake and support the adequacy of the 1998 folate U.S. RDA for the 3 largest ethnic/racial groups in the United States.

Vitamin D intake in the United States

Mean intake of vitamin D in the United States was estimated from food and food plus supplements and compared with recommended intake levels. US men, nonpregnant and nonlactating women, and nonbreastfeeding children aged 1 year and older who participated in the Third National Health and Nutrition Examination Survey (NHANES III, 1988-1994) or the Continuing Survey of Food Intakes by Individuals 1994-1996, 1998 (CSFII 1994-1996, 1998) were included in the estimates. Intake of vitamin D from food sources and dietary supplements was not meeting recommended levels. The lowest intakes of vitamin D from food were reported by female teenagers and female adults. The highest intakes of vitamin D from food sources were reported by male teenagers. Dairy products were the primary sources of both vitamin D and calcium. Additional food fortification as well as dietary and supplement guidance are needed for the general population.

Position of the American Dietetic Association and Dietitians of Canada: Nutrition and Women’s Health

It is the position of the American Dietetic Association (ADA) and Dietitians of Canada (DC) that women have specific nutritional needs and vulnerabilities and, as such, are at unique risk for various nutrition-related diseases and conditions. Therefore, the ADA and the DC strongly support research, health promotion activities, health services, and advocacy efforts that will enable women to adopt desirable nutrition practices for optimal health. Women are at risk for numerous chronic diseases and conditions that affect the duration and quality of their lives. Although women's health-related issues are multifaceted, nutrition has been shown to influence significantly the risk of chronic disease and to assist in maintaining optimal health status. Dietetics professionals strongly support research, health promotion activities, health services, and advocacy efforts that will enable women to adopt desirable nutrition practices for optimal health.

Dietary intake in the lower Mississippi delta region: results from the Foods of our Delta Study

OBJECTIVE

To collect and evaluate food intake data from a culturally diverse population and compare with national survey data.

DESIGN

The Foods Of Our Delta Study was a baseline, cross-sectional survey that utilized random-digit dialing methodology to identify the sample. Food intake was obtained from a 24-hour dietary recall administered by computer-assisted telephone interview using the multiple-pass method.

SUBJECTS/SETTING

One thousand seven hundred fifty-one adults and 485 children in the Lower Mississippi Delta (Delta) of Louisiana, Arkansas, and Mississippi.

STATISTICAL ANALYSES PERFORMED

Comparisons of subsets within the Delta were made using weighted t tests. Comparisons of the Delta with the overall US population from the US Department of Agriculture Continuing Survey of Food Intakes by Individuals and with the Dietary Reference Intakes were made using independent sample z tests of weighted estimates.

RESULTS

Energy intake did not differ between the Delta and the US populations. Intakes of protein were lower, fat higher, and certain micronutrients lower in Delta adults than in US adults. Delta adults had a 20% lower intake of fruits and vegetables than the US adults and generally poorer adherence to recommendations of the Food Guide Pyramid. African American Delta adults generally consumed less-optimal diets than white Delta adults. Delta children had diets similar to children of the Continuing Survey of Food Intakes by Individuals sample population, but lower intakes were noted for vitamins A, C, riboflavin, and B-6, and for calcium and iron.

APPLICATIONS/CONCLUSIONS

Data such as these will help drive intervention development in this rural region and perhaps set the stage for research in similarly impoverished areas.