Method for assessing food intakes in terms of servings based on food guidance

Personalized breast cancer onset prediction from lifestyle and health history information

We propose a method to predict when a woman will develop breast cancer (BCa) from her lifestyle and health history features. To address this objective, we use data from the Alberta's Tomorrow Project of 18,288 women to train Individual Survival Distribution (ISD) models to predict an individual's Breast-Cancer-Onset (BCaO) probability curve. We show that our three-step approach-(1) filling missing data with multiple imputations by chained equations, followed by (2) feature selection with the multivariate Cox method, and finally, (3) using MTLR to learn an ISD model-produced the model with the smallest L1-Hinge loss among all calibrated models with comparable C-index. We also identified 7 actionable lifestyle features that a woman can modify and illustrate how this model can predict the quantitative effects of those changes-suggesting how much each will potentially extend her BCa-free time. We anticipate this approach could be used to identify appropriate interventions for individuals with a higher likelihood of developing BCa in their lifetime.

Adherence to Food-Based Dietary Guidelines: A Systemic Review of High-Income and Low- and Middle-Income Countries

Research comparing the adherence to food-based dietary guidelines (FBDGs) across countries with different socio-economic status is lacking, which may be a concern for developing nutrition policies. The aim was to report on the adherence to FBDGs in high-income (HIC) and low-and-middle-income countries (LMIC). A systematic review with searches in six databases was performed up to June 2020. English language articles were included if they investigated a population of healthy children and adults (7–65 years), using an observational or experimental design evaluating adherence to national FBDGs. Findings indicate that almost 40% of populations in both HIC and LMIC do not adhere to their national FBDGs. Fruit and vegetables (FV) were most adhered to and the prevalence of adhering FV guidelines was between 7% to 67.3%. HIC have higher consumption of discretionary foods, while results were mixed for LMIC. Grains and dairy were consumed below recommendations in both HIC and LMIC. Consumption of animal proteins (>30%), particularly red meat, exceeded the recommendations. Individuals from HIC and LMIC may be falling short of at least one dietary recommendation from their country’s guidelines. Future health policies, behavioral-change strategies, and dietary guidelines may consider these results in their development.

Dietary patterns change over two years in early adolescent girls in Hawai'i

BACKGROUND AND OBJECTIVES

In investigating diet-disease relationships, examination of dietary patterns allows for conclusions to be drawn based on overall intake. This study characterized dietary patterns of early adolescent girls over a two-year period and examined the relationship between dietary patterns and body mass index (BMI).

METHODS AND STUDY DESIGN

Cross-sectional analyses were performed using longitudinal data from food records of early adolescent girls (n=148) 9 to 14 years in Hawai'i from the Female Adolescent Maturation (FAM) study. Dietary patterns were identified using principal component analysis (PCA). Pearson's correlations between BMI percentile and z-score and dietary pattern factor scores at Times 1 (2001-2002) and 2 (2002-2003) were calculated. For each dietary pattern, participants were divided into low, intermediate, and high scorers. Mean BMI percentiles and z-scores were compared between groups using analysis of covariance.

RESULTS

At Time 1, three patterns were identified, characterized by: (1) whole grains, nuts and seeds, added sugar; (2) non-whole grain, tomatoes, discretionary fat; and (3) deep yellow vegetables, other starchy vegetables, cooked dry beans/peas. At Time 2, three different dietary patterns emerged: (1) non-whole grains, meat, discretionary fat; (2) other vegetables, fish, eggs; and (3) whole grain, tomatoes, other vegetables. BMI percentile and z-score differed between high and low scorers on Time 1-Pattern 1 and Time 2-Pattern 3.

CONCLUSION

Results revealed changes in dietary patterns over time and an association between intake and BMI. Findings demonstrate the importance of frequent nutrition assessment to monitor changes in intake that may be improved to prevent obesity.

Girls' picky eating in childhood is associated with normal weight status from ages 5 to 15 y

BACKGROUND

Picky eating has been associated with lower weight status and limited food intake and variety in childhood. Little is known about how the persistence of picky eating in childhood is associated with changes in weight and food intake from childhood into adolescence.

OBJECTIVE

We determined whether picky eating identified in childhood was related to growth, nutrition, and parental use of pressure over a 10-y period.

DESIGN

Non-Hispanic white girls (n = 181) participated in a longitudinal study and were assessed biannually from ages 5 to 15 y. The Child Feeding Questionnaire was used to classify girls as persistent picky eaters or nonpicky eaters and to assess parental use of pressure to eat. Height and weight were measured to calculate body mass index (BMI) z scores at each occasion. Three 24-h dietary recalls obtained at each occasion were used to determine intakes of fruit and vegetables. With the use of repeated-measures analyses, differences between persistent picky eaters and nonpicky eaters in BMI z scores, dietary intake, and use of pressure were examined.

RESULTS

From ages 5 to 15 y, persistent picky eaters (n = 33; 18%) had lower BMI (tracking at the 50th percentile) than did nonpicky eaters (n = 148; tracking at the 65th percentile) (P = 0.02). Persistent picky eaters were less likely to be overweight into adolescence. Both groups consumed less than the recommended amounts of fruit and vegetables, although persistent picky eaters had lower intakes of vegetables than did nonpicky eaters at all time points (P = 0.02). Persistent picky eaters also received higher amounts of pressure (P = 0.01).

CONCLUSIONS

Findings that persistent picky eaters were within the normal weight range, were less likely to be overweight, and had similar fruit intakes to those of nonpicky eaters suggest that higher parental concerns about persistent picky eaters are unwarranted. All parents and children could benefit from evidence-based anticipatory guidance on alternatives to coercive feeding practices to increase fruit and vegetable consumption.

Association between intake of total vs added sugar on diet quality: a systematic review

CONTEXT

Given its potential effect on nutrient and energy density, the sugar content of the diet is a subject of controversy.

OBJECTIVE

The aim of this review was to examine the cross-sectional or prospective evidence for associations between the intake of total sugar or added sugar (high vs low intakes) and diet quality or nutrient intakes in the general population.

DATA SOURCES

The following databases were searched for English-language articles published between 1972 and 2012: CINAHL Plus, EBM Reviews, ERIC, MEDLINE, PREMEDLINE, PsycINFO, PubMed, and ScienceDirect.

STUDY SELECTION

The search identified studies that examined the association between intake of total sugar and/or added sugar and diet quality (n = 22) or nutrient intakes (n = 30).

DATA EXTRACTION

The following data were extracted: sample size and population, dietary assessment method, source of added sugar data, source of funding, comparator, association between total sugar or added sugar and diet quality, and the direction and magnitude of the association.

DATA SYNTHESIS

Of 22 studies, all except 1 found a higher intake of added sugar to be associated with poorer diet quality, and the exceptional study did not adjust for total energy intake. Twenty-one of 30 studies found a negative association between added sugar and micronutrient intakes. The same association was not found for total sugar intake.

CONCLUSION

Any negative association between dietary sugar and diet quality is better exposed by referring to added sugar rather than total sugar. There was substantial variation in features of study quality, including sample size, so the magnitude of the observed effect was generally small and may not be of clinical significance. Furthermore, the positive influence that core foods such as fruit and milk exert on total sugar values may bias the association between total sugar and diet quality.

One-year change in energy and macronutrient intakes of overweight and obese inner-city African American children: effect of community-based Taking Action Together type 2 diabetes prevention program

Taking Action Together (TAT) was a controlled community-based intervention protocol developed to reduce risk of T2DM among low-income, high BMI, 9-10 year old African American children. A secondary hypothesis of this study was that there would be greater improvements in the treatment group in dietary intakes and physical activity. To evaluate the primary study objectives, multiple linear regression models were employed, with 1 year change in dietary variables as dependent variables. Intervention group status was the independent variable of interest and BMIz was included as a covariate in all analyses to adjust for group differences in baseline obesity status of the children. The findings from this analysis suggest that 1 year change in dietary intakes in boys was associated with group intervention status, with boys in the treatment group reducing their intakes of energy and fat to a significantly greater extent than boys in the control group. Differences in energy intakes were not significant, however, for girls. Based on the differences in gender response to our comprehensive TAT intervention, we conclude that interventions designed for and delivered only to African American girls might be more successful than those delivered in mixed gender settings.

Food consumption of Sri Lankan adults: an appraisal of serving characteristics

Objective

The main aim of the present study was to identify food consumption in Sri Lankan adults based on serving characteristics.

Design

Cross-sectional study. Fruits, vegetables, starch, meat, pulses, dairy products and added sugars in the diet were assessed with portion sizes estimated using standard methods.

Setting

Twelve randomly selected clusters from the Sri Lanka Diabetes and Cardiovascular Study.

Subjects

Six hundred non-institutionalized adults.

Results

The daily intake of fruit (0·43), vegetable (1·73) and dairy (0·39) portions were well below national recommendations. Only 3·5 % of adults consumed the recommended 5 portions of fruits and vegetables/d; over a third of the population consumed no dairy products and fewer than 1 % of adults consumed 2 portions/d. In contrast, Sri Lankan adults consumed over 14 portions of starch and 3·5 portions of added sugars daily. Almost 70 % of those studied exceeded the upper limit of the recommendations for starch intake. The total daily number of meat and pulse portions was 2·78.

Conclusions

Dietary guidelines emphasize the importance of a balanced and varied diet; however, a substantial proportion of the Sri Lankan population studied failed to achieve such a recommendation. Nutrition-related diseases in the country may be closely correlated with unhealthy eating habits.

Food intake of European adolescents in the light of different food-based dietary guidelines: results of the HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) Study

Objective

Since inadequate food consumption patterns during adolescence are not only linked with the occurrence of obesity in youth but also with the subsequent risk of developing diseases in adulthood, the establishment and maintenance of a healthy diet early in life is of great public health importance. Therefore, the aim of the present study was to describe and evaluate the food consumption of a well-characterized sample of European adolescents against food-based dietary guidelines for the first time.

Design

The HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) Study is a cross-sectional study, whose main objective was to obtain comparable data on a variety of nutritional and health-related parameters in adolescents aged 12·5–17·5 years.

Setting

Ten cities in Europe.

Subjects

The initial sample consisted of more than 3000 European adolescents. Among these, 1593 adolescents (54 % female) had sufficient and plausible dietary data on energy and food intakes from two 24 h recalls using the HELENA-DIAT software.

Results

Food intake of adolescents in Europe is not optimal compared with the two food-based dietary guidelines, Optimized Mixed Diet and Food Guide Pyramid, examined in this study. Adolescents eat half of the recommended amount of fruit and vegetables and less than two-thirds of the recommended amount of milk (and milk products), but consume much more meat (and meat products), fats and sweets than recommended. However, median total energy intake may be estimated to be nearly in line with the recommendations.

Conclusion

The results urge the need to improve the dietary habits of adolescents in order to maintain health in later life.

Consumption of added sugars is decreasing in the United States

BACKGROUND

The consumption of added sugars (caloric sweeteners) has been linked to obesity, diabetes, and heart disease. Little is known about recent consumption trends in the United States or how intakes compare with current guidelines.

OBJECTIVE

We examined trends in intakes of added sugars in the United States over the past decade.

DESIGN

A cross-sectional study of US residents ≥2 y of age (n = 42,316) was conducted by using dietary data from NHANES 1999-2008 (five 2-y cycles) and data for added-sugar contents from the MyPyramid Equivalents Database. Mean intakes of added sugars (grams and percentage of total energy intake) were weighted to obtain national estimates over time across age, sex, and race-ethnic groups. Linear trends were tested by using Wald's F tests.

RESULTS

Between 1999-2000 and 2007-2008, the absolute intake of added sugars decreased from a mean (95% CI) of 100.1 g/d (92.8, 107.3 g/d) to 76.7 g/d (71.6, 81.9 g/d); two-thirds of this decrease, from 37.4 g/d (32.6, 42.1 g/d) to 22.8 g/d (18.4, 27.3 g/d), resulted from decreased soda consumption (P-linear trend <0.001 for both). Energy drinks were the only source of added sugars to increase over the study period (P-linear trend = 0.003), although the peak consumption reached only 0.15 g/d (0.08, 0.22 g/d). The percentage of total energy from added sugars also decreased from 18.1% (16.9%, 19.3%) to 14.6% (13.7%, 15.5%) (P-linear trend <0.001).

CONCLUSION

Although the consumption of added sugars in the United States decreased between 1999-2000 and 2007-2008, primarily because of a reduction in soda consumption, mean intakes continue to exceed recommended limits.

Consumption of added sugars and indicators of cardiovascular disease risk among US adolescents

BACKGROUND

Whereas increased carbohydrate and sugar consumption has been associated with higher cardiovascular disease risk among adults, little is known about the impact of high consumption of added sugars (caloric sweeteners) among US adolescents.

METHODS AND RESULTS

In a cross-sectional study of 2157 US adolescents in the National Health and Nutrition Examination Survey (NHANES) 1999 to 2004, dietary data from one 24-hour recall were merged with added sugar content data from the US Department of Agriculture MyPyramid Equivalents databases. Measures of cardiovascular disease risk were estimated by added sugar consumption level (< 10%, 10 to < 15%, 15 to < 20%, 20 to < 25%, 25 to < 30%, and ≥ 30% of total energy). Multivariable means were weighted to be representative of US adolescents and variances adjusted for the complex sampling methods. Daily consumption of added sugars averaged 21.4% of total energy. Added sugars intake was inversely correlated with mean high-density lipoprotein cholesterol levels (mmol/L) which were 1.40 (95% confidence interval [CI] 1.36 to 1.44) among the lowest consumers and 1.28 (95% CI 1.23 to 1.33) among the highest (P trend = 0.001). Added sugars were positively correlated with low-density lipoproteins (P trend =0.01) and geometric mean triglycerides (P trend = 0.05). Among the lowest and highest consumers, respectively, low-density lipoproteins (mmol/L) were 2.24 (95% CI 2.12 to 2.37) and 2.44 (95% CI 2.34 to 2.53), and triglycerides (mmol/L) were 0.81 (95% CI 0.74, 0.88) and 0.89 (95% CI 0.83 to 0.96). Among those overweight/obese (≥ 85th percentile body-mass-index), added sugars were positively correlated with the homeostasis model assessment (P linear trend = 0.004).

CONCLUSION

Consumption of added sugars among US adolescents is positively associated with multiple measures known to increase cardiovascular disease risk.

Americans do not meet federal dietary recommendations

A longstanding goal of dietary surveillance has been to estimate the proportion of the population with intakes above or below a target, such as a recommended level of intake. However, until now, statistical methods for assessing the alignment of food intakes with recommendations have been lacking. The purposes of this study were to demonstrate the National Cancer Institute's method of estimating the distribution of usual intake of foods and determine the proportion of the U.S. population who does not meet federal dietary recommendations. Data were obtained from the 2001-2004 NHANES for 16,338 persons, aged 2 y and older. Quantities of foods reported on 24-h recalls were translated into amounts of various food groups using the MyPyramid Equivalents Database. Usual dietary intake distributions were modeled, accounting for sequence effect, weekend/weekday effect, sex, age, poverty income ratio, and race/ethnicity. The majority of the population did not meet recommendations for all of the nutrient-rich food groups, except total grains and meat and beans. Concomitantly, overconsumption of energy from solid fats, added sugars, and alcoholic beverages ("empty calories") was ubiquitous. Over 80% of persons age ≥ 71 y and over 90% of all other sex-age groups had intakes of empty calories that exceeded the discretionary calorie allowances. In conclusion, nearly the entire U.S. population consumes a diet that is not on par with recommendations. These findings add another piece to the rather disturbing picture that is emerging of a nation's diet in crisis.

Caloric sweetener consumption and dyslipidemia among US adults

CONTEXT

Dietary carbohydrates have been associated with dyslipidemia, a lipid profile known to increase cardiovascular disease risk. Added sugars (caloric sweeteners used as ingredients in processed or prepared foods) are an increasing and potentially modifiable component in the US diet. No known studies have examined the association between the consumption of added sugars and lipid measures.

OBJECTIVE

To assess the association between consumption of added sugars and blood lipid levels in US adults.

DESIGN, SETTING, AND PARTICIPANTS

Cross-sectional study among US adults (n = 6113) from the National Health and Nutrition Examination Survey (NHANES) 1999-2006. Respondents were grouped by intake of added sugars using limits specified in dietary recommendations (< 5% [reference group], 5%-<10%, 10%-<17.5%, 17.5%-<25%, and > or = 25% of total calories). Linear regression was used to estimate adjusted mean lipid levels. Logistic regression was used to determine adjusted odds ratios of dyslipidemia. Interactions between added sugars and sex were evaluated.

MAIN OUTCOME MEASURES

Adjusted mean high-density lipoprotein cholesterol (HDL-C), geometric mean triglycerides, and mean low-density lipoprotein cholesterol (LDL-C) levels and adjusted odds ratios of dyslipidemia, including low HDL-C levels (< 40 mg/dL for men; < 50 mg/dL for women), high triglyceride levels (> or = 150 mg/dL), high LDL-C levels (> or = 130 mg/dL), or high ratio of triglycerides to HDL-C (> 3.8). Results were weighted to be representative of the US population.

RESULTS

A mean of 15.8% of consumed calories was from added sugars. Among participants consuming less than 5%, 5% to less than 17.5%, 17.5% to less than 25%, and 25% or greater of total energy as added sugars, adjusted mean HDL-C levels were, respectively, 58.7, 57.5, 53.7, 51.0, and 47.7 mg/dL (P < .001 for linear trend), geometric mean triglyceride levels were 105, 102, 111, 113, and 114 mg/dL (P < .001 for linear trend), and LDL-C levels modified by sex were 116, 115, 118, 121, and 123 mg/dL among women (P = .047 for linear trend). There were no significant trends in LDL-C levels among men. Among higher consumers (> or = 10% added sugars) the odds of low HDL-C levels were 50% to more than 300% greater compared with the reference group (< 5% added sugars).

CONCLUSION

In this study, there was a statistically significant correlation between dietary added sugars and blood lipid levels among US adults.

Beverage intake of girls at age 5 y predicts adiposity and weight status in childhood and adolescence

BACKGROUND

Increased consumption of sweetened beverage has been linked to higher energy intake and adiposity in childhood.

OBJECTIVE

The objective was to assess whether beverage intake at age 5 y predicted energy intake, adiposity, and weight status across childhood and adolescence.

DESIGN

Participants were part of a longitudinal study of non-Hispanic white girls and their parents (n = 170) who were assessed biennially from age 5 to 15 y. At each assessment, beverage intake (milk, fruit juice, and sweetened beverages) and energy intake were assessed by using three 24-h recalls. Percentage body fat and waist circumference were measured. Height and weight were measured and used to calculate body mass index. Multiple regression analyses were used to predict the girls' adiposity. In addition, at age 5 y, girls were categorized as consuming <1, > or =1 and <2, or > or =2 servings of sweetened beverages. A mixed modeling approach was used to assess longitudinal differences and patterns of change in sweetened beverage and energy intake, adiposity, and weight status by frequency of sweetened beverage intake.

RESULTS

Sweetened beverage intake at age 5 y, but not milk or fruit juice intake, was positively associated with adiposity from age 5 to 15 y. Greater consumption of sweetened beverages at age 5 y (> or =2 servings/d) was associated with a higher percentage body fat, waist circumference, and weight status from age 5 to 15 y.

CONCLUSION

These findings provide new longitudinal evidence that early intake of sweetened beverages predicts adiposity and weight status across childhood and adolescence.

Demographic and lifestyle factors associated with body mass index among children and adolescents

Cases of overweight and obesity among adults, adolescents, and children are escalating in the United States. Using data from the Continuing Survey of Food Intake for Individuals (CSFII) 1994-1996 and 1998, and the National Health and Nutrition Examination Survey III (NHANES), we developed multivariate regression models to examine the association between demographic and lifestyle variables (gender, race/ethnicity, age, family income, diet, and television viewing) and the body mass index (BMI) of children aged 6-11 years, and adolescents aged 12-19 years for CSFII and aged 12-16 years for NHANES. In the children's model, the statistically significant demographic predictors of BMI were age, race, gender, and family income. Among adolescents, the demographic predictors were age, race, and gender. Among the lifestyle variables, dietary factors were not associated with BMI in children. On the contrary, carbohydrates (less added sugars) had a statistically significant inverse relationship to BMI among adolescents. In both children and adolescents, television viewing was markedly associated with BMI, and participation in team sports was negatively associated with BMI. The overall process by which overweight develops is complex, and our four models explained only a small portion of total variance of BMI. The CSFII models explained 8.5% of the variance for children and 11.4% of the variance for adolescents. The NHANES models explained 8.8% of the variance for children and 12.5% of the variance for adolescents. Demographic variables accounted for roughly one-half of the explained variance for both children and adolescents. The rest of the explained variance was accounted for by television viewing, diet, and family income.

Microencapsulated foods as a functional delivery vehicle for omega-3 fatty acids: a pilot study

It is well established that the ingestion of the omega-3 (N3) fatty acids docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) positively benefit a variety of health indices. Despite these benefits the actual intake of fish derived N3 is relatively small in the United States. The primary aim of our study was to examine a technology capable of delivering omega-3 fatty acids in common foods via microencapsulation (MicroN3) in young, healthy, active participants who are at low risk for cardiovascular disease. Accordingly, we randomized 20 participants (25.4 ± 6.2 y; 73.4 ± 5.1 kg) to receive the double blind delivery of a placebo-matched breakfast meal (~2093 kJ) containing MicroN3 (450–550 mg EPA/DHA) during a 2-week pilot trial. Overall, we observed no differences in overall dietary macronutrient intake other than the N3 delivery during our treatment regimen. Post-test ANOVA analysis showed a significant elevation in mean (SE) plasma DHA (91.18 ± 9.3 vs. 125.58 ± 11.3 umol/L; P < 0.05) and a reduction in triacylglycerols (89.89 ± 12.8 vs. 80.78 ± 10.4 mg/dL; P < 0.05) accompanying the MicroN3 treatment that was significantly different from placebo (P < 0.05). In post study interviews, participants reported that the ingested food was well-tolerated, contained no fish taste, odor or gastrointestinal distress accompanying treatment. The use of MicroN3 foods provides a novel delivery system for the delivery of essential fatty acids. Our study demonstrates that MicroN3 foods promote the absorption of essential N3, demonstrate bioactivity within 2 weeks of ingestion and are well tolerated in young, active participants who are at low risk for cardiovascular disease.

Consumption of 'extra' foods by Australian adults: types, quantities and contribution to energy and nutrient intakes

OBJECTIVES

To identify the types and quantities of 'extra' foods, or energy-dense, nutrient-poor foods, consumed by Australian adults, and assess their contribution to total energy and nutrient intakes.

SUBJECT/METHODS

We used 24-h recall data from 10 851 adults, aged 19 years and over, who participated in the nationally representative 1995 National Nutrition Survey. 'Extra' foods were defined using principles outlined in the Australian Guide to Healthy Eating and by applying cut points for maximum amounts of fat and sugar within each food category.

RESULTS

'Extra' foods contributed to 36% of daily energy intake with the highest contributors being fried potatoes (2.8%), margarine (2.6%), cakes and muffins (2.5%), beer (2.4%), sugar-sweetened soft drinks (2.4%), and meat pies (2.2%). Both age and sex were important determinants of 'extra' foods intake; younger adults were more likely to consume sugar-sweetened soft drinks, fried potatoes, meat pies and savoury pastries, pizza, crisps, lollies and chocolate; whereas older adults were more likely to consume sweet and savoury biscuits, cakes and muffins, margarine and butter. In all age groups, 'extra' foods contributed more to energy intake for men than women. Overall, 'extra' foods contributed 16% protein, 41% total fat, 41% saturated fat, 47% sugar and approximately 20% of selected micronutrients to the diet.

CONCLUSIONS

'Extra' foods contribute excessively to the energy, fat and sugar intakes of Australian adults, while providing relatively few micronutrients. This is of concern for the increasing risk of overweight and chronic disease and poor micronutrient status.

Dietary energy density predicts women's weight change over 6 y

BACKGROUND

Dietary energy density (ED) is positively associated with energy intake, but little is known about long-term effects on weight change.

OBJECTIVE

We assessed whether dietary ED predicts weight change over 6 y among a sample of non-Hispanic, white women.

DESIGN

Participants were part of a 6-y longitudinal study (n = 186), assessed at baseline and biennially. ED (in kcal/g) was calculated from the energy content of all foods (excluding beverages) with the use of three 24-h recalls. Height and weight were measured in triplicate to calculate body mass index (BMI; in kg/m(2)). Repeated measures (PROC MIXED) were used to examine the influence of ED on weight change, before and after adjusting for initial weight status. Food choices were examined among subjects consuming low-, medium-, and high-ED diets at study entry.

RESULTS

ED did not change across time for a subject. ED was positively associated with weight gain and higher BMI over time; this association did not vary by BMI classification. Food group data showed that, compared with women consuming higher-ED diets, women consuming lower-ED diets reported significantly lower total energy intakes and consumed fewer servings of baked desserts, refined grains, and fried vegetables and more servings of vegetables, fruit, and cereal. Women consuming lower-ED diets ate more meals at the table and fewer meals in front of the television.

CONCLUSIONS

Findings indicate that consumption of a lower-ED diet moderates weight gain, which may promote weight maintenance. Consuming lower ED diets can be achieved by consuming more servings of fruit and vegetables and limiting intake of high-fat foods.

Food types in the diet and the nutrient intake of obese and non-obese children

BACKGROUND

Childhood obesity has reached epidemic proportions world-wide.

OBJECTIVE

To compare the types of food in the diet and the nutrient intake of obese children with those of non-obese children.

METHODS

A total of 95 obese and 592 non-obese children aged between 6 and 10 years participated in the study. A body mass index (BMI) value exceeding the 95th percentile for age and gender was taken as the criterion for obesity. Three-day food consumption was recorded and evaluated according to standard international recommendations.

RESULTS

Macronutrient intake was adequate in both obese and non-obese children. Energy intake of the obese children was significantly higher than that of the non-obese children. Micronutrient intake except fiber of both groups, calcium intake of obese children and vitamin A intake of non-obese children were higher than recommended amounts. The obese children consumed excessive fat and sugar, but less fruit and vegetables as compared to the non-obese children, and less than the recommendations of the food guide pyramid as adopted by the US Department of Food and Agriculture and the Department of Health and Human Services.

CONCLUSION

The implementation of educational programs on nutrition may be important for promoting knowledge about healthy eating among obese children.

Inflammation and exercise (INFLAME): study rationale, design, and methods

PURPOSE

The INFLAME study is designed to determine the effect of exercise training on elevated high-sensitivity C-Reactive Protein (CRP) concentrations in initially sedentary women and men.

METHODS

INFLAME will recruit 170 healthy, sedentary women and men with elevated CRP (>or=2.0 mg/L) to be randomized to either an exercise group or non-exercise control group. Exercising individuals will participate in four months of supervised aerobic exercise with a total energy expenditure of 16 kcal kg(-1) week(-1) (KKW). Exercise intensity will be 60-80% of maximal oxygen consumption (VO(2) max).

OUTCOME

The primary outcome will be changed in plasma CRP concentration. Secondary outcomes include visceral adiposity, the cytokines IL-6 and TNF-alpha, and heart rate variability (HRV) in order to examine potential biological mechanisms whereby exercise might affect CRP concentrations.

SUMMARY

INFLAME will help us understand the effects of moderate-to-vigorous exercise on CRP concentrations in sedentary individuals. To our knowledge this will be the largest training study specifically designed to examine the effect of exercise on CRP concentrations. This study has the potential to influence therapeutic applications since CRP measurement is becoming an important clinical measurement in Coronary Heart Disease risk assessment. This study will also contribute to the limited body of literature examining the effect of exercise on the variables of visceral adiposity, cytokines, and heart rate variability.

Examination of encapsulated phytosterol ester supplementation on lipid indices associated with cardiovascular disease

OBJECTIVE

As opposed to traditional food based delivery we examined the efficacy of ingesting encapsulated phytosterol esters on indices of lipid health in hypercholesterolemic adults.

METHODS

We performed a randomized, double-blinded, parallel-group, placebo-controlled, clinical intervention examining 54 men and women (20-70 y of age) with a low-density lipoprotein cholesterol (LDL-C) level > or =3.33 mmol/L. Participants were not taking cholesterol-lowering medications. Treatment consisted of ingesting 2.6 g of encapsulated phytosterol esters (n = 25) or a matching placebo (n = 29) for 12 wk.

RESULTS

Total cholesterol (TC) levels at baseline (mean +/- SD) were 6.29 +/- 0.7 mmol/L in the phytosterol group and 6.00 +/- 0.7 mmol/L in the placebo group. Baseline LDL-C levels were 4.27 +/- 0.7 mmol/L in the treatment group and 4.00 +/- 0.8 mmol/L in the placebo group. Analysis of variance and Tukey's least significant difference post hoc analyses revealed a significant within-group reduction in TC (-0.23 +/- 0.4 mmol/L, P < 0.05) and LDL-C (-0.22 +/- 0.5 mmol/L, P < 0.05) for the phytosterol treatment group. Mean reductions in TC and LDL-C were greater than placebo (P < 0.05). Percentages of change from baseline for TC were -3.52% (95% confidence interval -6.44 to -0.40) for phytosterol treatment and 2.64% (95% confidence interval 0.30-5.60) for placebo. Those for LDL-C were -5.00% (95% confidence interval -9.92 to -0.08) for phytosterol and 4.89 (95% confidence interval 0.24-9.5) for placebo. No other significant effects were observed.

CONCLUSION

Encapsulated phytosterol ester ingestion appears to positively modulate LDL-C. Given that the reduction in LDL-C was not as extensive as in food-based trials, future investigations should examine potential timing and dose issues relative to encapsulated delivery.

Prospective Study of Fruit and Vegetable Intake and Risk of Prostate Cancer

BACKGROUND

Several epidemiologic studies have reported associations between fruit and vegetable intake and reduced risk of prostate cancer, but the findings are inconsistent and data on clinically relevant advanced prostate cancer are limited.

METHODS

We evaluated the association between prostate cancer risk and intake of fruits and vegetables in 1338 patients with prostate cancer among 29,361 men (average follow-up = 4.2 years) in the screening arm of the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial. Participants completed both a general risk factor and a 137-item food-frequency questionnaire at baseline. Cox proportional hazards models were used to estimate relative risks (RRs) and 95% confidence intervals (CIs). All statistical tests were two-sided.

RESULTS

Vegetable and fruit consumption was not related to prostate cancer risk overall; however, risk of extraprostatic prostate cancer (stage III or IV tumors) decreased with increasing vegetable intake (RR = 0.41, 95% CI = 0.22 to 0.74, for high versus low intake; P(trend) = .01). This association was mainly explained by intake of cruciferous vegetables (RR = 0.60, 95% CI = 0.36 to 0.98, for high versus low intake; P(trend) = .02), in particular, broccoli (RR = 0.55, 95% CI = 0.34 to 0.89, for >1 serving per week versus <1 serving per month; P(trend) = .02) and cauliflower (RR = 0.48, 95% CI = 0.25 to 0.89 for >1 serving per week versus <1 serving per month; P(trend) = .03). We found some evidence that risk of aggressive prostate cancer decreased with increasing spinach consumption, but the findings were not consistently statistically significant when restricted to extraprostatic disease.

CONCLUSION

High intake of cruciferous vegetables, including broccoli and cauliflower, may be associated with reduced risk of aggressive prostate cancer, particularly extraprostatic disease.

Intake of added sugar and sugar-sweetened drink and serum uric acid concentration in US men and women

Fructose-induced hyperuricemia might have a causal role in metabolic syndrome, hypertension, and other chronic disease. However, no study has investigated whether sugar added to foods or sugar-sweetened beverages, which are major sources of fructose, are associated with serum uric acid concentration in free-living populations. We examined the relationship between the intakes of added sugars and sugar-sweetened beverages and serum uric acid concentrations in the National Health and Nutrition Examination Survey 2001-2002, a nationally representative sample of men and women. We included 4073 subjects (1988 men and 2085 women) >18 years of age in the current study. Dietary intake was assessed by a single 24-hour recall. We used multivariate linear regression to adjust for age, gender, intake of energy and alcohol, body mass index, use of diuretics, beta-blockers, and other covariates. Male subjects in the highest intake quartile of estimated intake of added sugars or sugar-sweetened drinks had higher plasma uric acid concentrations than those in the lowest intake quartiles (P<0.001 for both) after adjusting for potential confounders, whereas we did not observe significant associations for females (P for trend>0.2; P for interaction <0.01). Further research is needed to confirm causality of these associations and the observed difference by gender.

Consumption of ‘extra’ foods by Australian children: types, quantities and contribution to energy and nutrient intakes

OBJECTIVE

To measure the types and quantities of energy-dense, nutrient-poor 'extra' foods consumed by Australian children and adolescents and their contribution to total energy and nutrient intakes.

DESIGN, SETTING AND SUBJECTS

We used data from 3007 children, aged 2-18 years, who participated in the nationally representative 1995 National Nutrition Survey. Intake was determined by 24-h recall and 'extra' foods were defined using principles outlined in the Australian Guide to Healthy Eating (AGHE) and by applying cut points for maximum amounts of fat and sugar within each food category.

RESULTS

All children (99.8%) consumed at least one 'extra' food and the most commonly consumed were margarine, sugar-sweetened soft drinks, cordials and sugar. 'Extra' foods contributed 41% of daily energy intake. Those foods contributing most to energy intake were fried potatoes (4.2%), sugar-sweetened soft drinks (3.3%), ice cream/ice confection (3.1%) and cordials (2.7%). Age and sex were important determinants of 'extra' food intake, with males and older children generally consuming more and different types of, 'extra' foods than females and younger children. 'Extra' foods contributed 19% protein, 47% total fat, 47% saturated fat, 54% sugar, and approximately 20-25% of selected micronutrients to the diet. Calcium and zinc intakes from core foods were below 70% of the recommended dietary intakes for adolescent girls.

CONCLUSIONS

'Extra' foods are over-consumed at two to four times the recommended limits and contribute excessively to the energy, fat and sugar intakes of Australian children, while providing relatively few micronutrients. This is of concern in terms of children's weight and nutrient status.

Comparison of children's dietary intake patterns with US dietary guidelines

Monitoring dietary intake patterns among children is important in order to explore and prevent the onset of adult health problems. The aim of the present study was to compare children's dietary intakes with national recommendations and to determine whether sex or ethnic differences were evident. This was done using a methodology that allows assessment of intake from the major components of the Food Guide Pyramid developed by the United States Department of Agriculture (USDA: ). The sample studied included 110 African-American and Caucasian males and females (mean age 9·9 years, BMI 20·1 kg/m2) from Birmingham, AL, USA, who were participating in a study investigating the development of obesity. Dietary data were based on three 24 h recalls and food group intake was determined using the USDA Pyramid Servicing Database. The results indicated that a high percentage of subjects failed to meet the recommended number of servings from each of the food groups. For example, only 5 % and 9 % met fruit and dietary group recommendations respectively. Consumption of foods from the Pyramid ‘tip’ (including discretionary fat and added sugar) contributed almost 50 % of the diet. African-Americans were more likely to meet requirements for the meat group, with a higher proportion of Caucasians meeting dietary recommendations. Males were more likely to meet the vegetable group guidelines although females consumed more energy per day from discretionary fat. In conclusion, these results suggest that implementation of nutrition education programmes may be important for promoting healthy nutrition among American children.

Impact of disaggregation of composite foods on estimates of intakes of meat and meat products in Irish adults

Objective

To evaluate the impact of the disaggregation of composite foods on intake estimates of meat and individual meat categories and on the contribution of meat to nutrient intakes in Irish adults.

Design

Data were analysed from the North/South Ireland Food Consumption Survey, which used a 7-day food diary to estimate food intake. Of 742 food codes that contained meat, 320 were codes for meat consumed as an individual portion and 422 were composite foods and were disaggregated to estimate the meat content.

Subjects

A nationally representative sample of 475 men and 483 women (not pregnant or lactating) from the Republic of Ireland aged 18–64 years.

Results

The mean intake of meat was 134 g day−1in consumers (98.5%) and men (168 g day−1) consumed significantly more (P< 0.001) than women (102 g day−1). Mean intakes of meat were higher in subjects with manual skilled occupations (P< 0.01) and lower in those with third-level educational qualifications (P< 0.05). Without disaggregating meat from composite foods, meat intake was overestimated by 43% (57 g day−1) and varied widely by meat category. Meat disaggregated from composite foods contributed 25% of meat intake. The contribution meat made to nutrient intakes ranged from 29% for protein, vitamin B12, zinc and niacin to 20% for vitamin D, 16% for vitamin B6, 15% for thiamine and 14% for iron.

Conclusions

Failure to disaggregat meat from composite foods substantially overestimates meat intake, with a large variation between meat categories. This has important implications for estimates of meat intakes in nutritional epidemiological studies and for food safety purposes.

The importance of composite foods for estimates of vegetable and fruit intakes

Objective:

To evaluate the contribution of composite foods to vegetable and fruit intakes in Irish adults and to compliance with dietary guidelines for vegetable and fruit intake.

Design:

Data were analysed from the North/South Ireland Food Consumption Survey of 18–64-year-old adults (n= 1379; 662 men, 717 women), which used a 7-day food diary to estimate food intake.

Results:

The mean intake of vegetables (excluding potatoes) was 140g day−1(men 149g day−1; women 132g day−1), of fruit was 136 g day−1(men 133g day−1; women 140 g day−1) and of potatoes was 227 g day−1(men 296g day−1; women 163 g day−1). The mean daily intakes of vegetables, fruit and potatoes from composite foods were 37 g (26%), 6 g (5%) and 17 g (7%), respectively. The mean intake of vegetables from composite foods was unrelated to age or gender, but increased with increasing social class and level of education attained. The proportions of men and women meeting the recommendation for ≥400g day−1(5 servings of 80 g per day) of vegetables and fruit were 21% (15% excluding composite foods) and 19% (12% excluding composite foods), respectively. Compliance with the dietary recommendation decreased with decreasing levels of educational attainment and social class.

Conclusion:

Intakes of vegetables and fruit are low compared with current dietary recommendations, particularly in those of lower levels of educational attainment and social class. Composite foods are an important source of vegetables (less importantly of fruit) and should be included when estimating vegetable intakes. Failure to do so may result in bias in estimates of intake and of compliance with dietary guidelines for population groups, as well as misclassification of individuals by level of intake.

Girls' dairy intake, energy intake, and weight status

We explored the relationships among girls' weight status, dairy servings, and total energy intake. The hypothesis that consuming dairy could reduce risk for overweight was evaluated by comparing energy intake and weight status of girls who met or consumed less than the recommended three servings of dairy per day. Participants included 172 11-year-old non-Hispanic white girls, assessed cross-sectionally. Intakes of dairy, calcium, and energy were measured using three 24-hour recalls. Body mass index and body fat measures from dual-energy x-ray absorptiometry were obtained. Because preliminary analyses suggested systematic underreporting of energy intake, the relationships among dairy servings and measures of weight status were examined for the total sample and for subsamples of under-, plausible, and overreporters. Data for the total sample provided support for the hypothesized relationship among weight status, dairy servings, and energy intake. Thirty-nine percent of girls reported consuming the recommended >/=3 servings of dairy per day; these girls also reported higher energy intake but had lower body mass index z scores and body fat than the girls who consumed fewer than three dairy servings each day. Among plausible reporters, no relationship between dairy intake and weight status was noted. This discrepancy may be attributable to a high percentage (45%) of overweight underreporters in the total sample. Our findings reveal that reporting bias, resulting from the presence of a substantial proportion of underreporters of higher weight status, can contribute to obtaining spurious associations between dairy intake and weight status. These findings underscore the need for randomly controlled trials to assess the role of dairy in weight management.

Food Group Adherence Scores Assess Food Patterns Compared to US Department of Agriculture Food Guide

OBJECTIVE

The purpose of this study was twofold: (a) develop and test the potential usefulness of a new measure of dietary adherence to the US Department of Agriculture (USDA) Food Guide and (b) use this measure to assess the diets of children in the United States.

DESIGN

Using 2 days of food intake data from the 1994-1996, 1998 Continuing Survey of Food Intakes by Individuals, food group adherence scores for individual food groups were calculated based on intake and recommendations from the USDA Food Guide.

SUBJECTS

Two samples of children, age 2 to 3 years (n=2,815) and 4 to 8 years (n=3,769), were selected from the 1994-1996, 1998 Continuing Survey of Food Intakes by Individuals.

STATISTICAL ANALYSIS

Descriptive statistics were computed by age and sex. Linear regression analysis was used to detect significant differences in adherence scores and number of servings consumed between age groups after adjusting for factors that impact intake.

RESULTS

Comparing the two age groups, differences in the food group adherence scores for some food groups did not mimic the differences seen in mean number of servings from the same food group. For these two age groups of children, although the number of servings from the food groups significantly increased with increasing age, the adherence scores significantly decreased, reflecting decreased adherence to the recommended food patterns by age.

CONCLUSIONS/IMPLICATIONS

Results suggest adherence to the USDA Food Guide decreases with increasing age in young children in the United States. Adherence scores may be a useful tool to describe adherence to the new USDA Food Guide. These scores could be used in program evaluation, surveillance, and epidemiological studies of diet and health.

Understanding reporting bias in the dietary recall data of 11-year-old girls

OBJECTIVE

This study describes patterns of bias in self-reported dietary recall data of girls by examining differences among girls classified as under-reporters, plausible reporters, and over-reporters on weight, dietary patterns, and psychosocial characteristics.

RESEARCH METHODS AND PROCEDURES

Participants included 176 girls at age 11 and their parents. Girls' weight and height were measured. Three 24-hour dietary recalls and responses to psychosocial measures were collected. Plausibility cut-offs for reported energy intake as a percentage of predicted energy requirements were used to divide the sample into under-reporters, plausible reporters, and over-reporters. Differences among these three groups on dietary and psychosocial variables were assessed to examine possible sources of bias in reporting.

RESULTS

Using a +/-1 standard deviation cut-off for energy intake plausibility, 50% of the sample was categorized as plausible reporters, 34% as under-reporters, and 16% as over-reporters. Weight status of under-reporters was significantly higher than that of plausible reporters and over-reporters. With respect to reported dietary intake, under-reporters were no different from plausible reporters on intakes of foods with higher nutrient densities and lower energy densities and were significantly lower than plausible reporters on intakes of foods with lower nutrient densities and higher energy densities. Over-reporters reported significantly higher intakes of all food groups and the majority of subgroups, relative to plausible reporters. Under-reporters had significantly higher levels of weight concern and dietary restraint than both plausible reporters and over-reporters.

DISCUSSION

Techniques to categorize plausible and implausible reporters can and should be used to provide an improved understanding of the nature of error in children's dietary intake data and account for this error in analysis and interpretation.

The National Cancer Institute diet history questionnaire: validation of pyramid food servings

The performance of the National Cancer Institute's food frequency questionnaire, the Diet History Questionnaire (DHQ), in estimating servings of 30 US Department of Agriculture Food Guide Pyramid food groups was evaluated in the Eating at America's Table Study (1997-1998), a nationally representative sample of men and women aged 20-79 years. Participants who completed four nonconsecutive, telephone-administered 24-hour dietary recalls (n = 1,301) were mailed a DHQ; 965 respondents completed both the 24-hour dietary recalls and the DHQ. The US Department of Agriculture's Pyramid Servings Database was used to estimate intakes of pyramid servings for both diet assessment tools. The correlation (rho) between DHQ-reported intake and true intake and the attenuation factor (lambda) were estimated using a measurement error model with repeat 24-hour dietary recalls as the reference instrument. Correlations for energy-adjusted pyramid servings of foods ranged from 0.43 (other starchy vegetables) to 0.84 (milk) among women and from 0.42 (eggs) to 0.80 (total dairy food) among men. The mean rho and lambda after energy adjustment were 0.62 and 0.60 for women and 0.63 and 0.66 for men, respectively. This food frequency questionnaire validation study of foods measured in pyramid servings allowed for a measure of food intake consistent with national dietary guidance.

Dietary Patterns of Young, Low-Income US Children

OBJECTIVE

The purpose of this study was to identify dietary patterns of young, low-income US children, describe differences in diet quality between identified patterns, and make targeted food recommendations to improve diet quality.

DESIGN

Dietary patterns were assessed using dietary variables from the Pyramid Servings Database within the Continuing Survey of Food Intakes by Individuals 1994-1996, 1998. Healthy Eating Index (HEI) scores were used to validate identified dietary patterns.

SUBJECTS/SETTING

Two subsamples of low-income children, aged 2 to 3 years (n = 1,242) and 4 to 8 years (n = 1,506), were selected from the Continuing Survey of Food Intakes by Individuals data.

STATISTICAL ANALYSIS

Cluster analysis was performed to determine unique dietary patterns within the two subsamples. Linear regression analyses were used to compare energy intake, discretionary fat, added sugars, and HEI scores across cluster groups. Descriptive statistics were computed for each cluster.

RESULTS

Cluster analysis identified six and seven distinct dietary patterns for the younger and older children, respectively. Four patterns were similar for both age groups. For the 2- to 3-year-old children, energy intake, overall HEI scores, and nine of the 10 HEI component scores differed among the four most prevalent dietary patterns. Among the older children, energy intake and six of the HEI component scores differed between the four most prevalent clusters but not overall HEI.

CONCLUSIONS

Neither age group had a cluster of children who followed a balanced/moderate diet pattern consistent with Food Guide Pyramid recommendations. Children consuming almost every pattern identified could benefit by reducing added sugars and discretionary fat and increasing low-fat, low-sugar options from the vegetables, fruits, meat, and milk groups.

Food choices of low-income women during pregnancy and postpartum

OBJECTIVES

The purpose of this study was to examine dietary behavior during pregnancy and postpartum in a multiethnic sample of low-income women.

SUBJECTS

Participants were 149 Medicaid-qualified women (30% white, 24% African American, and 46% Hispanic; median age, 22 years).

DESIGN

Subjects were recruited into a longitudinal cohort design 0 to 1 days following delivery. Dietary choices during pregnancy and the first 6 months postpartum were assessed via validated food frequency questionnaires administered at 6 weeks and 6 months postpartum, respectively.

STATISTICAL ANALYSES PERFORMED

Frequencies and means were used for descriptive purposes. Paired and independent sample t tests were used for continuous variables; chi 2 and McNemar tests were used for categorical variables.

RESULTS

In all subjects, mean daily servings of grains (7.4 vs 6.2, P <.004), vegetables (2.5 vs 2.0, P <.002), and fruit (3.4 vs 1.7, P <.001) declined following childbirth, while the percentage of energy from fat (37.3% vs 38.4%, P <.023) and added sugar (14.4% vs 16.4%, P <.019) increased. Women who breastfed their infants at 6 months postpartum reported lower intakes of total fat (34.2% vs 37.9%, P <.005) during pregnancy and higher fruit (2.2 vs 1.6, P <.05) and vegetable (2.6 vs 1.8, P <.02) intakes in postpartum than those who bottle-fed. Also, a greater proportion of lactating than nonlactating women (66.7% vs 36.9%, P <.05) met recommendations for fruit intake during pregnancy.

CONCLUSIONS

The findings suggest that the transition from pregnancy to postpartum may be associated with a negative impact on dietary behavior that could compromise nutritional status in low-income women.

Comparative analysis of body mass index, consumption of fruits and vegetables, smoking, and physical activity among Florida residents

The purpose of this study was to compare body mass index (BMI), consumption of fruits and vegetables, smoking, and physical activity in residents of the 7 Florida counties with the highest reported BMI to residents of the 7 Florida counties with the lowest reported BMI utilizing 2002 data from the Florida Department of Health Behavioral Risk Factor Surveillance System. Results showed that survey respondents in counties with the lowest mean BMI consumed significantly more fruits and vegetables, compared to respondents in counties with the highest BMI. A positive relation between mean BMI and consumption of fruits and vegetables remained when controlled for physical activity, but not for smoking. Education about the importance of increased fruit and vegetable consumption, as well as physical activity, are important factors in the campaign against obesity.

Cholesterol-lowering effects of bovine serum immunoglobulin in participants with mild hypercholesterolemia

BACKGROUND

The consumption of milk products has been shown to lower cholesterol. The mechanism of action surrounding this observation has been attributed to the protein fraction of milk and serum.

OBJECTIVE

We examined the effect of an oral serum bovine immunoglobulin protein fraction (bIg) derived from US Department of Agriculture-approved beef (aged <30 mo) on lipid indexes in humans.

DESIGN

Participants included men and women (aged 25-70 y) with hypercholesterolemia (5.44-6.99 mmol/L) who were not receiving cholesterol-lowering medication. Treatment consisted of the randomized, double-blind, parallel-group, placebo-controlled administration of 5 g bIg for 6 wk in 52 participants (n = 26 each in treatment and control groups).

RESULTS

Mean (+/-SD) total cholesterol (TC) at baseline was 6.33 +/- 0.1 mmol/L for bIg and 6.16 +/- 0.1 mmol/L for placebo. A repeated-measures multivariate analysis of covariance covaried for change in total energy and alcohol intake and Tukey's post hoc examination of our data showed that the bIg-treated group had a significant reduction in TC at 3 wk (5.98 +/- 0.5 mmol/L; P < 0.05) and 6 wk (5.97 +/- 0.7 mmol/L; P < 0.05). The concentration at 6 wk was significantly different from that in the placebo group (P < 0.05). This reduction was largely due to a decrease in LDL cholesterol in the bIg-treated group from baseline (4.12 +/- 0.6 mmol/L) at 3 wk (3.92 +/- 0.7 mmol/L, P < 0.05) and at 6 wk (3.84 +/- 0.6 mmol/L, P < 0.05); the 6-wk concentration differed significantly between the treatment and placebo groups (P < 0.05). We observed no significant changes in the placebo group or in any other lipid indexes or markers associated with hepatorenal or cardiovascular function.

CONCLUSION

Consumption of bIg appears to positively modulate the primary lipid indexes associated with cardiovascular disease.

The obesity crisis: don't blame it on the pyramid

Since its release in 1992, the Food Guide Pyramid has become one of the most recognized nutrition education tools in US history. As such, it has been subject to criticism, particularly in several recent media reports that implicate it as the culprit in America's current obesity epidemic. What these reports often overlook, however, is that the diets of many Americans do not adhere to the dietary guidelines illustrated by the Pyramid, refuting the notion that the Pyramid is the cause of the nation's obesity problem. Data indicate that the more likely causes of escalating obesity rates are increased per capita caloric consumption and larger portion sizes, along with a lack of adequate physical activity. Although the Pyramid graphic was designed more than a decade ago, it still communicates three key concepts that continue to be the cornerstone of federal dietary guidance: variety, proportionality, and moderation. As such, it remains a viable and relevant nutrition education tool, especially when used by dietetics professionals as a component of individualized, comprehensive nutrition education and behavior modification interventions. As the United States Department of Agriculture begins to investigate whether the food intake patterns illustrated by the Pyramid are in need of updating, research is urgently needed to determine how nutrition education tools, including the Pyramid, can be most effectively implemented to help consumers adopt healthful eating behaviors and to improve the public health of America.

Validity and reliability of a behavior-based food coding system for measuring fruit, 100% fruit juice, vegetable, and sweetened beverage consumption: results from the Girls Health Enrichment Multisite Studies

BACKGROUND

This paper presents the rationale, reliability, and validity of a behavior-based food coding system for measuring fruit (F), juice (J), vegetable (V), sweetened beverage, and water consumption in children.

METHODS

Coding algorithms for FJV, sweetened beverages, and water were developed for use with the Nutrition Data System for Research (NDS-R). Two hundred and ten 8- to 10-year-old African American girls at four field centers completed two 24-h dietary recalls at baseline and at 12 weeks follow-up after a weight gain prevention intervention. Differences in mean baseline consumption of selected food variables and other selected nutrients across the four field centers were analyzed. Intraclass correlation coefficients (ICCs) for reliability across 2 days of food recalls and 12-week test-retest reliability correlations were calculated. For the purposes of this paper, nutrient intake estimates were considered construct validators of food intake, and validity was assessed by correlating the coded food variable servings with nutrient intake.

RESULTS

ICCs varied from zero (0.001 for beta carotene equivalents) to moderate (0.44 for sucrose), indicating substantial instability in consumption or reporting. Twelve-week test-retest correlations were slight to moderate (0.09 for lycopene to 0.49 for folate). FJV consumption was negatively related to percent energy from fat (r = -0.28; P = 0.001) and positively related to other nutrients. Sweetened beverage consumption was positively related to energy, sucrose, fructose, and vitamin C consumption.

CONCLUSIONS

This behavior-based food coding system demonstrated construct validity among 8- to 10-year-old African American girls and can measure the desired food groups.

Adherence to the Food Guide Pyramid recommendations among Japanese Americans, Native Hawaiians, and whites: results from the Multiethnic Cohort Study

The Food Guide Pyramid is designed to help Americans make healthful food choices. Whereas national data have been collected to examine adherence to the pyramid recommendations in whites, African-Americans, and Latinos, there are virtually no data available for Japanese Americans or Native Hawaiians. Here we present data on intakes of the Food Guide Pyramid food groups (as servings per day) as well as of the components of the pyramid tip (discretionary fat, added sugar, and alcohol) in these ethnic groups and examine adherence to each of the food group recommendations. Degree of adherence to the fruit group recommendation was similar among the ethnic groups and energy-intake categories, but adherence to the other recommendations was greatest for those consuming more than 2,800 kilocalories per day. However, subjects in this energy-intake group also consumed more than three times as much discretionary fat, added sugar, and alcohol.

Dietary intake and food sources of whole grains among US children and adolescents: data from the 1994-1996 Continuing Survey of Food Intakes by Individuals

OBJECTIVE

This study characterizes whole grain consumption among a nationally representative sample of US children and adolescents.

DESIGN

Data used in this study were collected as part of the 1994-1996 US Department of Agriculture Continuing Survey of Food Intakes by Individuals (CSFII).

SUBJECTS/SETTING

CSFII was designed to obtain a nationally representative sample of noninstitutionalized persons of all ages residing in the United States. Analyses reported in this article are limited to participants aged 2 to 18 years with two days of dietary recall data (n=4,802). Foods reported in the survey were quantified in servings as defined by the Food Guide Pyramid using the US Department of Agriculture Pyramid Servings Database, which contains reference data for each food reported in CSFII in servings per 100 g for 30 Pyramid food groups, including whole grain and total grain.

STATISTICAL ANALYSES

Means, frequencies, and logistic regression analyses were conducted as appropriate.

RESULTS

Average whole grain intake ranged from 0.8 servings per day for preschool-aged children to 1.0 servings per day for adolescents. Ready-to-eat cereals, corn and other chips, and yeast breads were found to be the major food sources of whole grains accounting for 30.9%, 21.7%, and 18.1% of whole grain intake respectively among those aged two to 18 years.

APPLICATIONS/CONCLUSIONS

Given the apparent low level of whole grain intake among most children and adolescents in the United States, interventions are needed to increase intake of whole-grain foods.

Food and life, pleasure and worry, among American college students: gender differences and regional similarities

Questionnaires on food attitudes and behavior were completed by 2,200 American undergraduates from 6 regionally dispersed college campuses. Results indicate that a substantial minority of women and a much smaller minority of men have major concerns about eating and food with respect to both weight and health. Overall, 14% of women reported being embarrassed to buy a chocolate bar in the store. A 6-factor structure emerged: weight concern, diet and health orientation, beliefs about the diet-health link, food negativity/importance of food as a source of pleasure in life, eating disordered behaviors, and natural/vegetarian food preferences. There were surprisingly few regional differences, virtually none if race and social class were taken into account. Gender was the strongest predictor of responses.

Parental weight status and girls' television viewing, snacking, and body mass indexes

OBJECTIVE

The purpose of this study was to examine whether television viewing (TVV) provides a context for patterns of snacking fostering overweight in young girls from overweight and non-overweight families.

RESEARCH METHODS AND PROCEDURES

Participants were 173 non-Hispanic white girls and their parents from central Pennsylvania, assessed longitudinally when girls were 5, 7, and 9 years old. Path analysis was used to test patterns of relationships among girls' TVV, snacking while watching television, snacking frequency, fat intake from energy-dense snack food, and girls' increase in body mass index (BMI) from age 5 to 9.

RESULTS

In both overweight and non-overweight families, girls who watched more television consumed more snacks in front of the television. In families where neither parent was overweight, television viewing was the only significant predictor of girls' increase in BMI. In families where one or both parents were overweight, girls who watched more television snacked more frequently, and girls who snacked more frequently had higher intakes of fat from energy-dense snacks, which predicted their increase in BMI from age 5 to 9. TVV did not directly predict girls' increase in BMI in girls from overweight families.

DISCUSSION

The results of this study support and extend previous findings that have shown that excessive television viewing and snacking patterns are risk factors for the development of overweight in children; however, patterns of relationships may differ based on parental weight status. For overweight families, TVV may provide a context for excessive snack consumption, in addition to inactivity.

Dietary intake in edentulous subjects with good and poor quality complete dentures

STATEMENT OF PROBLEM

Previous studies in complete denture wearers evaluated the relationship between diet and measures of chewing, yet only isolated nutrient intake was considered. This limited information makes the assessment of overall diet quality and the planning of interventions difficult.

PURPOSE

This study investigated the relationship of complete denture quality to masticatory performance, perceived ability to chew, and diet quality as measured by the Healthy Eating Index (HEI), an overall diet quality index.

MATERIAL AND METHOD

The study population comprised 54 complete denture wearers. Data were obtained from clinical examinations, masticatory performance measurements, and 2 non-consecutive 24-hour dietary recalls. (Masticatory performance data were not collected for 9 subjects because of time constraints, patient fatigue, or patient refusal. Statistical analysis showed no significant effect of their absence on the reported findings.) Based on a composite rating scale, subjects were divided into 3 denture quality groups described as good, medium, and poor. The outcome variables were the HEI and its components, plus selected nutrient and non-nutrient intake. Explanatory variables were quality of complete dentures, masticatory performance, and reported chewing ability. Data were analyzed with Kruskal-Wallis tests, Mann-Whitney U-tests, and Fisher exact tests. Because a large number of dietary components were examined, results were considered significant at alpha=.01.

RESULTS

Masticatory performance and perceived ability to chew were unrelated to diet quality. The good quality denture group had significantly better masticatory performance than the medium and poor quality groups, but the median HEI scores and dietary intakes were not significantly different among these 3 groups. Milk, vegetable, fruit, and grain intake scores were mainly responsible for the low overall HEI scores.

CONCLUSION

In the population evaluated, complete denture quality, food comminution capacity, and perceived chewing ability were not related to diet quality. The majority of subjects had deficient diets regardless of the technical quality of their dentures.

Maternal influences on 5- to 7-year-old girls' intake of multivitamin-mineral supplements

OBJECTIVE

To examine diet quality of girls who do or do not take multivitamin-mineral (MVM) supplements and to evaluate predictors of girls' MVM use, including maternal eating behaviors, MVM use, beliefs, attitudes, and perceptions about child feeding, eating, and health.

DESIGN

Participants were 192 mother and daughter pairs. Daughters were categorized as MVM supplement users or nonusers based on whether girls were consistently given MVM supplements at 5 and 7 years. Girls' and mothers' nutrient and food group intakes, maternal child-feeding practices, and maternal eating behavior were compared between the groups.

RESULTS

Mothers who used MVM supplements were more likely to give MVM supplements to daughters. Excluding nutrients from MVM supplements, MVM users and nonusers did not differ in vitamin and mineral intake, either for girls or mothers, and patterns of food group intake were similar for users and nonusers. Mothers of MVM users reported the following: higher levels of pressuring their daughters to eat healthier diets, more monitoring of daughters' food intake, more success in dieting for weight control, more positive evaluations of their success in eating healthy diets, and lower body mass indexes than mothers who did not give MVMs to daughters.

CONCLUSIONS

Daughters' MVM supplement use was predicted by mothers' beliefs, attitudes, perceptions, and practices regarding mothers' own eating and child feeding practices, rather than by daughters' diet quality. For both MVM users and nonusers, daughters' food group servings were below recommendations, whereas vitamin and mineral intakes exceeded recommendations, a pattern indicative of girls' relatively high intakes of fortified foods. Mothers should be encouraged to foster healthier patterns of food intake in daughters, rather than providing MVM supplements.

Choose beverages and foods to moderate your intake of sugars: the 2000 dietary guidelines for Americans--what's all the fuss about?

As part of the 2000 Dietary Guidelines for Americans, the public is advised to choose beverages and foods to moderate their intake of sugars. The term sugars is conventionally used to describe the mono- and disaccharides. However, the Dietary Guidelines for Americans distinguish between added sugars and other sources of carbohydrates. The concept of added sugars provides consumers with useful information, especially if they are trying to limit excessive use of caloric sweeteners. Added sugars are defined as sugars that are eaten separately at the table or used as ingredients in processed or prepared foods. Consumption of added sugars has increased steadily as documented by both food supply data and nationwide food consumption survey data. The largest source of added sugars in the U.S. diet is nondiet soft drinks, accounting for one third of total intake. Diets high in sugars have been associated with various health problems, including dental caries, dyslipidemias, obesity, bone loss and fractures, and poor diet quality. Research gaps are identified.