Trends in fruit and vegetable consumption among adults in 16 US states: Behavioral Risk Factor Surveillance System, 1990-1996

OBJECTIVES

This study examined trends in fruit and vegetable consumption among adults in 16 US states.

METHODS

Data from telephone surveys were used to stratify respondents by sociodemographic and health-related characteristics.

RESULTS

The proportion of adults who consumed fruits and vegetables at least 5 times daily was 19%, 22%, and 23% in 1990, 1994, and 1996, respectively. While the proportion increased among those with active leisure-time physical activities and normal weight, it remained almost the same among inactive people and dropped among the obese.

CONCLUSIONS

Progress in fruit and vegetable intake from 1990 to 1994 was encouraging, but it changed little between 1994 and 1996.

Nutrient intakes and dietary patterns of young children by dietary fat intakes

OBJECTIVE

To determine whether low fat intake is associated with increased risk of nutritional inadequacy in children 2 to 8 years old and to identify eating patterns associated with differences in fat intake.

STUDY DESIGN

Using 2 days of recall from the Continuing Survey of Food Intake by Individuals (CSFII), 1994 to 1996, we classified 2802 children into quartiles of energy intake from fat (<29%, 29% to 31.9% [defined as moderate fat], 32% to 34.9%, and > or =35%) and compared nutrient intakes, the proportion of children at risk for inadequate intakes, Food Pyramid servings, and fat content per serving across quartiles.

RESULTS

More children in quartile 2 were at risk for inadequate intakes of vitamin E, calcium, and zinc than children in higher quartiles (P <.0001); more children in quartiles 3 and 4 were at risk for inadequate intakes of vitamins A and C and folate (P <.001). Fruit intake decreased across quartiles (P <.0001); whereas vegetable, meat, and fat-based condiment intakes increased (P <.0001). Fat per serving of grain, vegetables, dairy, and meat increased across quartiles (P <.0001).

CONCLUSIONS

Moderate-fat diets were not consistently associated with an increased proportion of children at risk for nutritional inadequacy, and higher-fat diets were not consistently protective against inadequacy. Dietary fat could be reduced by judicious selection of lower-fat foods without compromising nutritional adequacy.

Trends in body weight among American Indians: findings from a telephone survey, 1985 through 1996

OBJECTIVES

This study compared trends in body mass index for American Indian men and women across selected regions of the United States.

METHODS

Self-reported data were collected from the Behavioral Risk Factor Surveillance System.

RESULTS

Among women in the Dakotas, New Mexico and Arizona, and Washington and Oregon, average adjusted body mass index increased significantly by 0.1 to 0.2 units per year. Among men in Alaska and the Dakotas, average adjusted body mass index also increased significantly by 0.1 to 0.2 units each year.

CONCLUSIONS

Because of rapid increases in average body mass index, some American Indian populations could be burdened by an increased incidence of chronic disease.

Comparison of 4 questionnaires for assessment of fruit and vegetable intake

OBJECTIVE

This study compared fruit and vegetable assessments derived from 4 self-administered questionnaires.

METHODS

Among 102 adolescents, servings of fruits and vegetables assessed by 4 questionnaires were compared with estimates from 24-hour recalls.

RESULTS

The prevalence of consuming 5 or more servings of fruits and vegetables a day was underestimated by the questionnaires. Questionnaires asking subjects to recall their diet over the previous year were more effective in ranking subjects (r's > or = .42) than those assessing previous-day diet (r's > or = .30).

CONCLUSIONS

Brief assessments of fruit and vegetable intake are more useful for ranking subjects than for estimating prevalence of consumption of 5 or more servings per day.

Dietary surveillance for states and communities

Information about dietary behaviors, attitudes, and knowledge is important for state and local health agencies because national monitoring lacks the local representativeness and timeliness necessary to catalyze community interest and to design, target, and evaluate dietary intervention programs. Currently, however, both methods and resources are limited for surveying diet in the population of a state or community. Brief assessments are included in the Youth Risk Behavior Surveillance System for adolescents, which is conducted by state departments of education, and in the Behavioral Risk Factor Surveillance System for adults, which is operated by state departments of health. More quantitatively precise measurements are being made by a few states and communities but personnel and financial resources for such surveys are limited. Nutritionists in state and local health agencies should explore the possibility of developing public-private partnerships with food producers, retailers, and marketers to collect information about dietary determinants and behaviors in states and communities. Better standardization of dietary assessment methods is needed, as is development of better methods to identify attitudes about diet and barriers to dietary improvement. Most important, though, dietary surveillance in states and communities must be more strongly tied to intervention programs intended to improve nutrition in those populations.

Prevalence of alcohol-impaired driving. Results from a national self-reported survey of health behaviors

OBJECTIVE

To estimate how frequently adults in the United States drive while impaired by alcohol.

DESIGN

Telephone survey.

SETTING

The 49 states (and the District of Columbia) that participated in the Behavioral Risk Factor Surveillance System (BRFSS) in 1993.

PARTICIPANTS

A total of 102,263 noninstitutionalized adults aged 18 years or older.

MAIN OUTCOME MEASURES

The percentage of respondents who reported alcohol-impaired driving; number of episodes of alcohol-impaired driving per 1000 adult population; and total number of episodes of alcohol-impaired driving-each by age, sex, race, level of education, and state.

RESULTS

Overall, 2.5% of adults reported an estimated 123 million episodes of alcohol-impaired driving in 1993. This corresponds to 655 episodes of alcohol-impaired driving for each 1000 adults (range among states per 1000 adults, 165-1550). Alcohol-impaired driving was most frequent among men aged 21 to 34 years (1739 episodes per 1000 adults) and was nearly as frequent among men aged 18 to 20 years (1623 episodes per 1000 adults), despite legislation in all states that prohibited the sale of alcohol to persons younger than age 21 years in 1993.

CONCLUSIONS

Alcohol-impaired driving is common even among underage persons. Strict enforcement of laws that discourage alcohol-impaired driving is needed along with community and patient education to reduce the prevalence of alcohol-impaired driving and prevent injuries and deaths from alcohol-related motor vehicle crashes. Data from the BRFSS, an ongoing source of national and state-specific data on the number of episodes of alcohol-impaired driving, are potentially useful for monitoring trends and evaluating the effect of future efforts to reduce alcohol-impaired driving.

Trends in overweight among US adults from 1987 to 1993: a multistate telephone survey

OBJECTIVES

Using data from the Behavioral Risk Factor Surveillance System, this study describes trends in the prevalence of overweight between 1987 and 1993.

METHODS

Data were examined from 33 states participating in an ongoing telephone survey of health behaviors of adults (n = 387,704). Self-reported weights and heights were used to calculate sex-specific prevalence estimates of overweight for each year from 1987 to 1993. Time trends were evaluated with the use of linear regression.

RESULTS

Between 1987 and 1993, the age-adjusted prevalence of overweight increased by 0.9% per year for both sexes (from 21.9% to 26.7% among men and from 20.6% to 25.4% among women). The increasing linear trend was observed in all subgroups of the population but was most notable for Black men (1.5% per year) and men living in the Northeast (1.4% per year). Secular changes in smoking and leisure-time physical activity did not entirely account for the increase in overweight.

CONCLUSIONS

The prevalence of overweight among American adults increased by 5% between 1987 and 1993. Efforts are needed to explore the causes of this adverse trend and to find effective strategies to prevent obesity.

Subclinical health effects in a population exposed to excess vitamin D in milk

To evaluate subclinical health effects of excess vitamin D, a cross-sectional study was conducted of persons consuming milk from a dairy that had overfortified milk for at least 4 years. Milk consumption, sunlight exposure, medical symptoms, serum 25-hydroxyvitamin D (25[OH]D), serum and urinary calcium, and indicators of renal function were measured. Increased milk consumption was associated with increased serum 25(OH)D and urinary calcium. However, the prevalences of elevated serum 25(OH)D and calcium were no greater than expected, and data indicated normal renal function. It was concluded that most persons exposed to excess vitamin D exhibited no measurable adverse subclinical effects.

Evaluation of a brief telephone questionnaire to estimate fruit and vegetable consumption in diverse study populations

We evaluated the use of a six-item telephone questionnaire to estimate fruit and vegetable intakes in five diverse populations. Researchers administered the telephone questionnaire to persons who had previously undergone more extensive dietary assessment. The study population included 553 middle-aged and older adults in Beaver Dam, WI; 252 middle-aged and older women throughout Wisconsin; 150 parents of school children in Augusta, GA; 73 low-income, Hispanic mothers in Chicago, IL; and 51 older adults in Arizona. Spearman correlation coefficients between total fruit and vegetable intakes measured by the brief telephone survey and by more extensive food frequency questionnaires were 0.47 (Augusta), 0.48 (Arizona), 0.56 (Wisconsin), and 0.57 (Beaver Dam). Correlations between intakes measured by the brief telephone survey and by multiple diet records or recalls were 0.29 (Arizona), 0.46 (Chicago), and 0.54 (Beaver Dam). With the exception of Arizona, mean daily fruit and vegetable intakes measured by the telephone survey were similar to intakes estimated by multiple diet records or recalls and lower than those estimated by extensive food frequency questionnaires. Although caution may be needed in interpreting dietary reports from some ethnic subgroups, this brief telephone questionnaire may be useful for surveillance of fruit and vegetable intake in the United States.

The accuracy of parental reports of their children's intake of fruits and vegetables: validation of a food frequency questionnaire with serum levels of carotenoids and vitamins C, A, and E

It has been recommended that U.S. children increase their dietary intake of fruits and vegetables. Measuring diets of children to support and evaluate nutritional interventions can be a difficult task, however. We administered to 97 parents of children age 6-10 years a food frequency questionnaire on their children's usual dietary intake over the previous 3 months. We then compared these reports by parents of their children's intakes of fruits and vegetables, and the derived estimates of intake of carotenoids and vitamins C, A, and E, with the children's serum levels of carotenoids and vitamins C, A, and E. The dietary reports of intakes of 35 fruits and vegetables showed Spearman rank-order correlations of 0.30 with serum carotenoids and 0.34 with serum vitamin C. Children in the highest quartile for intake of fruits and vegetables according to their parents' food frequency reports had 35% higher carotene levels and 31% higher vitamin C levels in their serum than did children in the lowest quartile for intake of fruits and vegetables. We conclude that parental reports of young children's diets using food frequency methods are accurate enough to be useful in nutritional screening and dietary surveillance of fruit and vegetable intake.

Assessing consumption of high-fat foods: the effect of grouping foods into single questions

Questionnaires on the frequency of consumption of foods are commonly used to measure dietary intake in epidemiologic research. To reduce the burden on respondents, questionnaires are often shortened by combining inquiries on similar foods into a single question. The effect of this practice on the reporting of dietary intake has never been investigated, however. To address this issue, we used two food frequency questionnaires in a telephone survey designed to rank adult residents of Alabama by their intake of dietary fat. One questionnaire included 29 questions about separate high-fat foods, whereas the other grouped these same foods into 14 questions. Compared with the 443 respondents interviewed using the 29-item separated-foods questionnaire, the 465 respondents responding to the 14-item grouped-foods questionnaire reported lower average intakes of the foods. In addition, a substantially higher percentage of respondents to the grouped-foods questionnaire reported never consuming the foods.

Trends in alcohol consumption by pregnant women. 1985 through 1988

To examine trends in alcohol consumption among pregnant women, we examined data collected from 21 states participating in the Behavioral Risk Factor Surveillance System for 4 consecutive years: 1985 through 1988. Overall, 429 (25%) of 1712 pregnant women and 19,903 (55%) of 36,057 nonpregnant women 18 to 45 years of age reported using alcohol in the previous month. Pregnant women who used any alcohol reported consuming a median of four drinks per month, whereas nonpregnant women who used any alcohol reported nine. The prevalence of alcohol consumption among pregnant women declined steadily, from 32% in 1985 to 20% in 1988, but the median number of drinks per month for pregnant women who drank did not change. No decline was observed among the less educated or those under the age of 25 years. In 1988, the prevalence of alcohol use among pregnant women remained highest among smokers (37%) and the unmarried (28%). Although the overall consumption of alcohol by pregnant women in the United States appears to be declining, special efforts are needed to reduce alcohol use among pregnant women who are smokers, unmarried, less educated, or younger, women who may already be at high risk of a poor pregnancy outcome.

Stature and weight status of children in an urban kindergarten population

To assess the prevalence of growth problems among school entrants in an urban population who were not preselected on poverty or other nutritional risk criteria, we analyzed height and weight measurements for 5170 4- and 5-year-old children (91.9% black, 5.5% white, and 2.6% Hispanic) who enrolled in District of Columbia public school kindergartens in the Fall of 1985. Compared to the National Center for Health Statistics reference, the white girls and boys were of average height, Hispanic girls were of average height, and Hispanic boys were shorter than average. The black girls and boys were taller than average. In light of published evidence for black-white differences in the timing and duration of growth, we tentatively attributed this tall stature to advanced skeletal maturation of the black children relative to the predominantly white United States population growth standards. Underweight was virtually absent in this population. Excess overweight was noted in all sex-racial/ethnic subgroups, particularly among Hispanic children. However, the extent to which overweight (high weight-for-height percentile) represents obesity in kindergarten-aged children and in different racial/ethnic groups needs clarification before the implications of the finding of excess overweight can be fully understood. Overall, the growth of these children was on a par with the National Center for Health Statistics growth reference population.

Identifying the malnourished within Peru: regional variation in the performance of a nutrition indicator

Malnourished children may also have siblings at increased risk of poor health. Early identification of siblings at risk could lead to timely intervention to prevent the development of malnutrition or other potentially life-threatening events. In a nationwide survey conducted in Peru in 1984, stunting in an older sibling (defined as height/age less than or equal to 3.00 SD of the NCHS/CDC reference median) was evaluated as an indicator for stunting in a target sibling (next youngest) sibling) (n = 3284). The prevalence of stunting was much higher in target siblings who had an older sibling with stunting compared to those whose older sibling was not stunted, with prevalence ratios of 8.5 in Lima, 4.7 in urban areas, and 2.5 in rural areas. Screening indices (sensitivity, specificity, and predictive value positive) also showed marked variation across regions. The variation in this indicator's performance across regions demonstrates the importance of evaluating screening tools within the populations where they will be applied. Regional variations in the performance of malnutrition indicators should be anticipated because malnutrition is the result of a complex, multifactorial process.

Ethnic group differences in nutritional status of young children from low-income areas of an urban county

A nutrition assessment survey was undertaken among 566 preschool children from randomly selected low income households located within an urban county. The purpose of the survey was to determine the prevalence of selected nutrition problems and to identify relationships among ethnic and economic variables and nutritional status. Underweight was identified in 1.8%, overweight in 15.4%, and short stature in 13.1% of children. Southeast Asian children had a higher prevalence of short stature than the other ethnic groups. Low hemoglobin values were identified in 4.3%, low hematocrit in 6.9%, and elevated erythrocyte protoporphyrin in 6.0% of children. The prevalence of elevated EP was significantly higher among Southeast Asian children than non-Southeast Asians and likely was due to iron deficiency. Results of the survey suggest that Southeast Asian children constitute the group at highest nutritional risk in the low income areas surveyed.