Impact of adopting lower-fat food choices on nutrient intake of American children

Effects of providing a nutrition education program for teenagers: dietary and physical activity patterns

This study enhanced nutritional knowledge in an education program and encouraged healthy dietary habits and regular physical activity among teenagers. A total of 203 adolescents from a secondary school in Hong Kong took part in the study. Their Body Mass Index, dietary habits, and physical exercise pattern were recorded and examined before and after the health education program. The prevalence of overweight and obesity, together with the fat composition, were high among the participants before the nutrition education program. There was a marked gain in knowledge upon its completion. A follow-up action conducted 3 months later revealed positive outcomes in relation to the diet and physical activity level. The teenagers were able to take control of their health and requested the tuck shop to sell more healthy food and reduce the supply of unhealthy items. The educational initiatives in dietary habits and physical activities proved to be effective in encouraging the teenagers to eat more healthily and to adopt an active lifestyle.

Sources of saturated fat and sucrose in the diets of Swedish children and adolescents in the European Youth Heart Study: strategies for improving intakes

OBJECTIVE

To compare macronutrient intakes of Swedish children and adolescents to population goals; to identify the major sources of energy, fat, saturated fat and sucrose; and to simulate the effect adherence to current food-based dietary guidelines (FBDG) would have on saturated fat and sucrose intakes.

DESIGN

Cross-sectional study. From 24 h recall data, food groups contributing most to energy, fat, saturated fat and sucrose were identified. Based on the prevailing consumption of foods mentioned in the FBDG, we simulated five scenarios: changes in milk and yoghurt; cheese; energy-dense, nutrient-dilute foods; soft drinks; and burger and sausage consumption.

SETTING

Stockholm and Örebro (Sweden) in 1998-1999.

SUBJECTS

Children (n 551, 9·6 years) and adolescents (n 569, 15·5 years) participating in the European Youth Heart Study.

RESULTS

Intakes of saturated fat and sucrose exceeded population goals in all age and gender subgroups. Compliance to the goal for saturated fat was lower in children, particularly boys. Compliance to the sucrose goal was lower among adolescents. The major sources of energy, fat, saturated fat and sucrose in the diet reflect not only the traditional Swedish diet but also the influence of energy-dense, nutrient-dilute foods. The simulations suggest that a combination of FBDG is required to bring both saturated fat and sucrose intakes in line with recommendations.

CONCLUSIONS

Widespread adherence to a combination of FBDG could theoretically bring mean intakes in line with population goals. The effect on overall nutrient intakes as well as consumer acceptance of such changes needs to be considered.

Overview of methods used to evaluate the adequacy of nutrient intakes for individuals and populations

The objective of the present paper is to review the methods of measuring micronutrient intake adequacy for individuals and for populations in order to ascertain best practice. A systematic review was conducted to locate studies on the methodological aspects of measuring nutrient adequacy. The results showed that for individuals, qualitative methods (to find probability of adequacy) and quantitative methods (to find confidence of adequacy) have been proposed for micronutrients where there is enough data to set an average nutrient requirement (ANR). If micronutrients do not have ANR, an adequate intake (AI) is often defined and can be used to assess adequacy, provided the distribution of daily intake over a number of days is known. The probability of an individual's intake being excessive can also be compared with the upper level of safe intake and the confidence of this estimate determined in a similar way. At the population level, adequacy can be judged from the ANR using the probability approach or its short cut – the estimated average requirement cut-point method. If the micronutrient does not have an ANR, adequacy cannot be determined from the average intake and must be expressed differently. The upper level of safe intake can be used for populations in a similar way to that of individuals. All of the methodological studies reviewed were from the American continent and all used the methodology described in the Institute of Medicine publications. The present methodology should now be adapted for use in Europe.

Diet-specific social support among rural adolescents

OBJECTIVE

The relationships among primary sources of social support in adolescents' environments (family and friends) and eating behaviors (fat and fiber consumption) were examined in a sample of rural adolescents.

DESIGN

Cross-sectional baseline health surveys were administered in classrooms as part of a larger randomized trial evaluating a cancer education program.

SETTING

Data were collected in middle schools drawn from 22 rural counties in Virginia and New York.

PARTICIPANTS

1942 sixth graders with a modal age of 12 years, roughly equal gender distribution, and racially diverse (53% white, 37% black).

MAIN OUTCOME MEASURE

Variables included a 10-item scale of social support from family and friends for healthy eating, a brief food frequency questionnaire estimating daily grams of fat and fiber intake, and demographics (age, gender, race).

ANALYSIS

Hierarchical multiple regressions and analyses of variance (ANOVAs).

RESULTS

Controlling for demographics, family and friend support were found to significantly predict fat (P < .05) and fiber (P < .01) intake. Black respondents reported higher support from friends than did white adolescents (F = 47.49, P < .01).

IMPLICATIONS FOR RESEARCH AND PRACTICE

Support for healthful eating was related to healthful dietary practices and differed among racial subgroups. Identifying and fostering sources of positive support for healthful eating is critical to developing effective health promotion programs targeting high-risk adolescents.

Saturated fat in the diet of Spanish children: relationship with anthropometric, alimentary, nutritional and lipid profiles

Objective

To compare the anthropometric, alimentary, nutritional and lipid profiles and global diet quality of Spanish children according to saturated fat intake.

Design

This was a cross-sectional study. Food data were collected using a food-frequency questionnaire.

Subjects and methods

The sample included 1112 children of both sexes, aged between 6 and 7 years, selected by means of random cluster sampling in schools. The plasma lipid profile included measurements of low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides, apolipoprotein A1 (apoA1) and apolipoprotein B (apoB). Global diet quality was evaluated by the Dietary Variety Index (DVI) and the Healthy Eating Index (HEI).

Results

Energy intake, DVI and HEI of children from the lower quartile of saturated fat intake (LL) were higher (P < 001) than in the remaining children (UL). However, there were no significant differences in average height or weight between groups. The UL children had lower intakes of meat, fish, vegetables, fruits and olive oil and a higher intake of dairy products (P < 0.001). The intakes of fibre, vitamins C, D, B6, E and folic acid were higher in the LL children, who had lower intakes of vitamin A and calcium. The ratios LDL-C/HDL-C and apoB/apoA1 were lower (P = 0.04) in the LL children (1.87 and 0.52, respectively) than in the UL children (2.02 and 0.54, respectively).

Conclusions

The growth rate of children does not seem to be affected by the level of saturated fat intake. Furthermore, at the levels of intake observed in this study, diets with less saturated fat are associated with better alimentary, nutritional and plasma lipid profiles.

Dietary recommendations for children and adolescents: a guide for practitioners

Since the American Heart Association last presented nutrition guidelines for children, significant changes have occurred in the prevalence of cardiovascular risk factors and nutrition behaviors in children. Overweight has increased, whereas saturated fat and cholesterol intake have decreased, at least as percentage of total caloric intake. Better understanding of children's cardiovascular risk status and current diet is available from national survey data. New research on the efficacy of diet intervention in children has been published. Also, increasing attention has been paid to the importance of nutrition early in life, including the fetal milieu. This scientific statement summarizes current available information on cardiovascular nutrition in children and makes recommendations for both primordial and primary prevention of cardiovascular disease beginning at a young age.

Position of the American Dietetic association: fat replacers

It is the position of the American Dietetic Association that the majority of fat replacers, when used in moderation by adults, can be safe and useful adjuncts to lowering the fat content of foods and may play a role in decreasing total dietary energy and fat intake. Moderate use of low-calorie, reduced-fat foods, combined with low total energy intake, could potentially promote dietary intake consistent with the objectives of Healthy People 2010 and the 2005 Dietary Guidelines for Americans . The obesity epidemic in the nation has been attributed to energy imbalance, mainly because of increased food consumption and/or sedentary lifestyle, or both. Evidence suggests that lowering total energy intake along with a reduction in total fat intake can have a substantial impact on body weight and risk of chronic diseases. Fat replacers are used to provide some or all of the functional properties of fat, while providing fewer calories than the fat being replaced, and are used in a variety of products, from baked goods to frozen desserts. Fat replacers can be effective only if they lower the total caloric content of the food and if the consumer uses these foods as part of a balanced meal plan. Consumers should not be led to believe that fat- and calorie-reduced products can be consumed in unlimited amounts. Fat replacers are most useful when they help with calorie control and when their use encourages the consumption of foods delivering important nutrients.

Position of the American Dietetic Association: Dietary guidance for healthy children ages 2 to 11 years

It is the position of the American Dietetic Association that children ages 2 to 11 years should achieve optimal physical and cognitive development, attain a healthy weight, enjoy food, and reduce the risk of chronic disease through appropriate eating habits and participation in regular physical activity. The health status of American children has generally improved over the past three decades. However, the number of children who are overweight has more than doubled among 2- to 5-year-old children and more than tripled among 6- to 11-year-old children, which has major health consequences. This increase in childhood overweight has broadened the focus of dietary guidance to address children's over consumption of energy-dense, nutrient-poor foods and beverages and physical activity patterns. Health promotion will help reduce diet-related risks of chronic degenerative diseases, such as cardiovascular disease, type 2 diabetes, cancer, obesity, and osteoporosis. This position paper reviews what US children are eating and explores trends in food and nutrient intakes as well as the impact of school meals on children's diets. Dietary recommendations and guidelines and the benefits of physical activity are also discussed. The roles of parents and caregivers in influencing the development of healthy eating behaviors are highlighted. The American Dietetic Association works with other allied health and food industry professionals to translate dietary recommendations and guidelines into achievable, healthful messages. Specific recommendations to improve the nutritional well-being of children are provided for dietetics professionals, parents, and caregivers.

Selected lower-fat foods positively impact nutrient quality in diets of free-living Americans

OBJECTIVE

To compare nutrient profiles of Continuing Survey of Food Intake by Individuals (CSFII) respondents who reported use of regular and lower-fat versions of selected foods with those not reporting intake of these foods.

SUBJECTS

American children (ages 2 to 19) and adults completing two days of recalls for the 1994 to 1996 CSFII.

DESIGN

Dietary intakes were reviewed for selected foods for which regular (high) and modified-fat versions were available. Foods included added table fats (eg, salad dressings, margarine, creams), desserts, snacks, cheeses, and yogurts. Respondents were divided into non-users (none of these foods reported), mixed users (lower-fat and high-fat foods), and high-fat (only) users.

STATISTICAL ANALYSES PERFORMED

Weighted data were used for descriptive analyses. Unweighted data were used for reported nutrient intake, nutrient density, fat intakes, and Food Guide Pyramid comparisons. A P value of < or =.01 was selected to determine whether group differences were statistically significant. Post hoc analyses were conducted to identify where differences were found.

RESULTS

Respondents reporting inclusion of any selected lower-fat food had significantly lower fat intake (P<.01) than exclusive high-fat users (male respondents: 31.5% vs 35.1%; female respondents: 30.3% vs 34.4%; children: 30.6% vs 33.4%). In general, mixed users had higher micronutrient intakes than high-fat users. Specifically, mixed users reported higher intakes of most B vitamins; vitamins A, C, and folate; the minerals calcium, phosphorus, magnesium, iron, and zinc; and fiber. These differences were associated with higher intakes of milk, fruits, and grains.

APPLICATIONS/CONCLUSIONS

This research supports the "all foods can fit" paradigm and validates recommending lower-fat foods (including snacks, desserts, cheeses, yogurt, and added table fats) to American consumers to reduce total fat to moderate levels while ensuring adequacy for most micronutrients.

The role of fats in the lifecycle stages: adolescence and young adulthood

Advice supporting regular physical activity, healthy food choices and smoking avoidance is definitely warranted in adolescents, particularly where early negative eating trends are evident. A difference in emphasis may be required for males and females with respect to physical activity and diet. The amount of dietary fat is important in maintaining energy balance, and the type of fat is important in reducing the development of heart disease. Low-fat foods are suitable at this lifestage, but it is also important to avoid sources of "hidden" saturated fatty acids (biscuits and fast foods) and to include sources of polyunsaturated and monounsaturated fatty acids (oils, margarine, lean meat, poultry and nuts).

Fat content of the diet among pre-school children in Britain; relationship with food and nutrient intakes

OBJECTIVE

To investigate the relationship between the percentage of energy from fat and food and nutrient intakes at 18 and 43 months of age.

DESIGN

Diet was assessed using a 3 day unweighed food record. The children were divided into quartiles of fat intake as a percentage of energy (QFI), and food and nutrient intakes in the different QFIs were compared.

SUBJECTS

A total of 1026 children at 18 months and 863 children at 43 months, taking part in the Avon Longitudinal Study of Pregnancy and Childhood, participated.

RESULTS

At 18 months the mean (s.d.) fat intake was 31.2 (2.8) % of energy in the lowest QFI and 43.1 (2.2) % in the highest. Energy intake increased slightly with increasing QFI. The percentage of energy derived from total sugar, and in particular non-milk extrinsic sugar fell as QFI increased, as did the ratio of polyunsaturated to saturated fatty acids. Intakes of retinol equivalents and zinc increased significantly with increasing QFI, while intakes of iron and most water soluble vitamins fell. There was a particularly marked fall in vitamin C intake as fat intake increased, from 11.8 mg/MJ in the lowest QFI, to 6.0 mg/MJ in the highest (P<0.001). Consumption of whole milk increased substantially with percentage energy from fat, from 51 g/MJ in the lowest QFI to 116 g/MJ in the highest (P<0.001), while consumption of fruit and fruit juice fell. The results obtained at 43 months were very similar.

CONCLUSIONS

The chances of a suboptimal intake of zinc and retinol were higher at lower fat intakes. However, intakes of the fat-soluble vitamins E and D were unrelated to fat intake and intakes of iron and vitamin C fell as fat intakes increased. Some suggestions for improving diet in this age group have been given.

SPONSOR

University of Bristol.

Comparison of dietary intake among overweight and non-overweight schoolchildren

OBJECTIVE

To determine differences in dietary intake between overweight and non-overweight schoolchildren and differences in consumption during the day and in the course of the week.

RESEARCH METHODS AND PROCEDURES

Using a cross-sectional design, 32 schoolchildren (11-y-old) were selected at random. The parents of children recorded dietary intake for a week using the food weighing method. The children were considered to be overweight when the weight for height was higher than 90th percentile.

RESULTS

Some 46.9% of examined schoolchildren were considered overweight. Percentage energy intake reported was significantly lower in the overweight group compared to the non-overweight children (8948.7 vs 9590.1 kJ/day; P<0.01). Carbohydrate intake was significantly greater in the non-overweight schoolchildren (250.9+/-58.8 vs 222.1+/-77.4 g/day; P<0.01). The difference in protein intake between week and weekend days was significant (81.6+/-25.5 in the week days vs 73.9+/-21.4 g/day in the weekend days; P<0.05).

DISCUSSION

The data suggest the belief that overweight children eat more than non-overweight children is not correct. These findings suggest that the positive energy balance causing overweight is due possibly to a low energy output.

Dietary approaches to the treatment of the overweight pediatric patient

A review of recently published studies on the dieting practices of children and adolescents examines the impact those practices are having on the overall health of youth who are overweight and those who are not. Recommendations for improving the nutritional quality of children's diets are made based on the food consumption patterns of youngsters ages 2 to 18 years. If implemented, these recommendations would lower calories, fat, saturated fat, and cholesterol, while improving nutrient density. Guidelines for the treatment of childhood overweight from four organizations are presented in chart form.

Diet quality, nutrient intake, weight status, and feeding environments of girls meeting or exceeding recommendations for total dietary fat of the American Academy of Pediatrics

OBJECTIVES

To compare the diet quality and weight status of girls consuming diets meeting the recommendation of the American Academy of Pediatrics for dietary fat with those of girls consuming >30% of energy from fat and to examine relationships between girls' dietary fat intake, mothers' nutrient intakes, and mothers' child-feeding practices.

DESIGN

Participants were 192 white girls and their mothers, who were divided into 2 groups: >30% of energy from fat (high fat [HF]) or </=30% of energy from fat (low fat [LF]), based on girls' 3-day dietary recalls. Girls' food group and nutrient intakes, Healthy Eating Index, body mass index, and mothers' nutrient intakes and child-feeding practices were compared.

RESULTS

Girls with HF diets consumed fewer fruits, more meat, and more fats and sweets and had lower Healthy Eating Index scores than did the girls in the LF group. Mothers of girls in the HF group had higher fat intakes than did those in the LF group. Girls and mothers in the HF group had lower intakes of fiber and vitamins A, C, B6, folate, and riboflavin. Mothers in the HF group reported using more restriction and pressure to eat in feeding their daughters. Girls in the HF group showed greater increase in body mass index and skinfold thickness from age 5 to 7 years.

CONCLUSION

These findings provide additional support for the recommendation of the American Academy of Pediatrics to limit total dietary fat. Findings reveal that mothers' use of controlling feeding practices are not effective in fostering healthier diets among girls and that mothers' own eating may be more influential than their attempts to control the intake of their daughters. dietary fat, dietary quality, nutrient intake, overweight, feeding practices, children.

Mechanisms of vitamin E regulation: research over the past decade and focus on the future

This paper discusses the developments in human vitamin E research since 1990. New methodologies such as the use of stable isotopes, advances in vitamin E measurements, and isolation and cloning of specific alpha-tocopherol binding proteins have facilitated investigation of alpha-tocopherol absorption, metabolism, and transport in humans in vivo. Changes in food production in the United States and dietary intake impacted vitamin E availability and intake. Epidemiologic and therapeutic studies have pointed to its role in disease prevention and in healing processes. Specific molecular functions of alpha-tocopherol have been the most recent and surprising new findings and are an important area for future experimentation. Given the aging of the American population and the potential role for alpha-tocopherol in preventive medicine, the study of the molecular functions of vitamin E promises to provide some of the most exciting discoveries of the next decade.

Impact of adopting lower-fat food choices on energy and nutrient intakes of American adults

OBJECTIVE

To evaluate the energy and nutrient intake of free-living men and women who choose foods consistent with different fat-reduction strategies.

DESIGN

For each year of the Continuing Survey of Food Intake by Individuals from 1989 through 1991, food codes were used to sort respondents by type of milk; type of meats; and type of cheese, yogurt, salad dressing, cake, and pudding (i.e., full-fat or fat-modified products) consumed.

SUBJECTS

A nationally representative sample of 3,313 men and 3,763 women who completed 3-day intake records and consumed either a reduced-fat or full-fat food from at least 1 of the 3 fat-reduction strategy categories.

STATISTICAL ANALYSIS PERFORMED

Analysis of variance with the Scheffé test was used to analyze differences in energy and nutrient intake between exclusive users, mixed users, and nonusers of each strategy or combined strategies.

RESULTS

Regardless of fat-reduction strategy, men and women who used them reported significantly lower intakes of total fat (up to 18 g lower), saturated fat (up to 12 g lower), cholesterol (up to 75 mg lower) and energy compared with nonusers. Exclusive users of single strategies met or approached recommendations of the National Cholesterol Education Program for total fat, saturated fat, and cholesterol intake; micronutrient intake varied depending on the strategy used. Skim milk users had the most favorable micronutrient intake, whereas lean meat users reported inadequate intake of zinc (men 63% and women 59% of the Recommended Dietary Allowances [RDAs]) and female users of fat-modified products reported inadequate intakes of vitamin E (64% of RDA) and zinc (65% of RDA). Multiple-strategy users achieved National Cholesterol Education Program goals and reported adequate micronutrient intakes and significantly lower energy intake. Mixed users of fat-modified products compared with nonusers of any fat-modified products had adequate micronutrient intake and lower intakes of total fat (32% vs 36% of energy for men and 32% vs 35% of energy for women) and saturated fat (11% vs 13% of energy for men and 11% vs 12% of energy for women). In addition, nonusers of any fat-modified strategy had the highest cholesterol and energy intake and the lowest intake of many micronutrients.

APPLICATIONS

A variety of fat-reduction strategies can be implemented to reduce energy, total fat, saturated fat, and cholesterol intake. Some of the strategies were associated with an inadequate micronutrient intake, so additional dietary guidance is needed to ensure that all nutrient requirements are met. Furthermore, people who do not use any fat-reduction strategy or those who exclusively use lean meats or fat-modified products would benefit from understanding how to balance their food choices.

Assessment of energy intake underreporting by doubly labeled water and observations on reported nutrient intakes in children

OBJECTIVE

To compare reported energy intake with energy expenditure using doubly labeled water (DLW). Additionally, we compared reported nutrient intakes of our subject population with national survey population data from the third National Health and Nutrition Examination Survey (NHANES III).

DESIGN

This was a cross-sectional study of children, balanced by race and gender, primarily characterized by 4 body types: lean, obese, centrally fat, or peripherally fat.

SUBJECTS/SETTING

Children (n=118; mean age=10 years) kept 8-day food records, with nutritionists recording weekday school lunch intakes. These subjects, assisted by their parents, recorded all breakfasts, dinners, snacks, and weekend lunches.

STATISTICAL ANALYSES PERFORMED

Data were analyzed using least squares analysis of variance with the general linear models procedure. Tukey's test was used for multiple comparisons of predicted treatment means.

RESULTS

Mean daily energy intake was underreported by 17% to 33% of energy expenditure. The tendency to underreport increased with age. Underreporting occurred in all groups and subgroups studied. Reported mean intakes of vitamin A, vitamin E, vitamin B-6, calcium, zinc, and copper were less than 70% of the Recommended Dietary Allowance (RDA) for African-American girls, whereas African-American boys reported similarly low intakes of copper. On average, white girls reported intakes less than 70% of the RDA for zinc and copper, whereas white boys reported low intakes of copper (60% of the RDA). Reported intakes in general were somewhat lower than those reported in NHANES III.

APPLICATIONS/CONCLUSIONS

Dietetics professionals may modify the nutritional advice they give to patients/subjects based on food intake records and other data. For children, particularly, it is imperative that ethnic and gender differences be taken into consideration and that all foods eaten be accounted for as much as possible.