Beverage choices affect adequacy of children's nutrient intakes

OBJECTIVE

To assess the relationship between beverage choices and the adequacy of nutrient intakes among children and adolescents.

DESIGN

Beverages reported in 24-hour recall records were classified as milk, 100% juice, fruit-flavored drinks, or carbonated sodas. Recommended intakes were based on Recommended Dietary Allowances or Dietary Reference Intakes.

PARTICIPANTS

Four thousand seventy children aged 2 to 5, 6 to 11, and 12 to 17 years participating in the 1994-96 Continuing Survey of Food Intakes by Individuals.

STATISTICAL ANALYSIS

The likelihood of achieving recommended intakes of selected nutrients on the day of recall was assessed with multiple logistic regression including ounces of milk, juice, fruit-flavored drinks, and carbonated sodas in the model while controlling for sex, age in years, race/ethnic group, household income, and total energy intake.

RESULTS

Milk consumption was positively (P<.0001) associated with the likelihood of achieving recommended vitamin A, folate, vitamin B(12), calcium, and magnesium intakes in all age strata. Juice consumption was positively (P< or =. 001) associated with achieving recommended vitamin C and folate intakes in all age strata and magnesium intakes among children aged 6 years and older. Carbonated soda consumption was negatively (P< or =. 01) associated with achieving vitamin A intake in all age strata, calcium in children younger than 12 years, and magnesium in children aged 6 years and older.

CONCLUSION

Beverage choice can have a significant effect on the nutrient adequacy of the diets of children and adolescents.

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.

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.

The costs and effects of a nutritional education program following work-site cholesterol screening

OBJECTIVES

The purpose of this study was to assess the costs and impact of a nutrition education program following a cholesterol screening.

METHODS

Forty work-sites were randomly assigned to one of two educational interventions: a "usual" intervention of 5 minutes of counseling, or a "special" intervention of 2 hours of behaviorally based education on dietary changes to lower serum cholesterol. Costs were monitored, and cholesterol levels were retested 6 and 12 months later.

RESULTS

The total per-person cost for screening and the educational intervention was about $50. Cholesterol levels differed little between the two intervention groups 6 months after screening, but after 12 months those in the special intervention worksites showed a 6.5% drop in cholesterol, whereas those at the usual intervention worksites showed a drop of only 3.0%. Hence a 3.5% cholesterol reduction was attributable to the special intervention.

CONCLUSIONS

A behaviorally based nutrition education program following cholesterol screening can have a meaningful impact on long-term cholesterol levels at a low cost. Nutrition education in work-sites may therefore be a useful way to lower the risk of heart disease in communities.

Tracking of serum cholesterol levels in a multiracial sample of preschool children

The relation of an initial measurement of serum total cholesterol to subsequent levels over a (mean) 13-month interval was examined in a multiracial (white, Hispanic, American Indian, and black) sample of 1680 one- to four-year-olds. Although the relation of the initial level to the final measurement (r = .54) did not vary by race, sex, relative weight, or changes in relative weight, the association increased with age at the time of the initial measurement (eg, r = .64 among 4-year-olds). Based on the initial and final total cholesterol determinations, the within-person standard deviation was 21 mg/dL and the coefficient of variation was 13%. Although the final total cholesterol level was within 5 mg/dL of the initial level for 18% of the children, the two determinations differed by greater than or equal to 25 mg/dL for about 35% of the children and by greater than or equal to 50 mg/dL for about 8%. Of the 149 children who had an initial cholesterol level greater than or equal to 200 mg/dL, 34% (about five times the expected number) had a follow-up level that was similarly elevated whereas 25% had a subsequent measurement below 170 mg/dL. The results indicate that although an initial cholesterol level in early life is moderately predictive of subsequent levels, it may be difficult to interpret a single total cholesterol determination because of substantial within-person variability.

Serum cholesterol levels in a multiracial sample of 7,439 preschool children from Arizona

BACKGROUND

The distribution and correlates of serum levels of total cholesterol were studied in cross-sectional analyses of 7,439 1 to 4 year olds examined through the Arizona Department of Health Services.

RESULTS

Mean cholesterol levels increased with age, and levels among 2 year olds approached those seen in adolescents. Racial and ethnic differences in cholesterol levels were observed: mean (age-adjusted) levels were 147 mg/dl among American Indians (n = 622), 153 mg/dl among Hispanics (n = 3165), 154 mg/dl among non-Hispanic whites (n = 3448), and 163 mg/dl among blacks (n = 204). Cholesterol levels were not associated either with obesity, as assessed by relative weight or the Quetelet index, or with breast-feeding during infancy. Very overweight (greater than or equal to 20 kg/m2) 3 and 4 year olds, however, tended to have higher mean levels of cholesterol than did other children. The proportion of children with borderline (170 to 199 mg/dl) or high (greater than or equal to 200 mg/dl) levels of cholesterol varied by race/ethnicity: borderline (high) levels were seen among 14% (3%) of American Indians and 29% (11%) of blacks. The proportions of white and Hispanic children having cholesterol levels between 170 and 199 mg/dl or greater than or equal to 200 mg/dl were midway between those seen among American Indians and blacks.

CONCLUSION

Additional information on the interrelationships of lipids and lipoproteins may aid in the identification of children who will be at increased risk for cardiovascular disease in adulthood.