Showing papers in "Journal of The American Dietetic Association in 2003"
TL;DR: Frequency of family meals was positively associated with intake of fruits, vegetables, grains, and calcium-rich foods and negatively associated with soft drink consumption and Sociodemographic characteristics associated with more frequent family meals appeared to play an important role in promoting positive dietary intake among adolescents.
Abstract: Objective To examine family meal patterns and associations with sociodemographic characteristics and dietary intake in adolescents. Design A population-based cross-sectional study design was employed. Adolescents completed the Project EAT (Eating Among Teens) survey and the Youth and Adolescent Food Frequency Questionnaire within their schools. Subjects/setting The study population included 4,746 middle and high school students from Minneapolis/St. Paul public schools with diverse racial and socioeconomic backgrounds. Statistical analyses Associations were examined using cross tabulations, log-linear modeling, and linear regressions. Results There was a wide distribution in the frequency of family meals during the previous week: never (14.0%), 1 or 2 times (19.1%), 3 to 6 times (40.1%), and 7 or more times (24.8%). Sociodemographic characteristics associated with more frequent family meals included gender (boys), school level (middle school), race (Asian American), mother's employment status (not employed), and socioeconomic status (high). Frequency of family meals was positively associated with intake of fruits, vegetables, grains, and calcium-rich foods and negatively associated with soft drink consumption. Positive associations were also seen between frequency of family meals and energy; protein (percentage of total calories); calcium; iron; folate; fiber; and vitamins A, C, E, and B-6. Conclusions Family meals appear to play an important role in promoting positive dietary intake among adolescents. Feasible ways to increase the frequency of family meals should be explored with adolescents and their families. J Am Diet Assoc. 2003;103:317-322.
850 citations
TL;DR: Adults and children who reported eating fast food had higher intake of energy, fat, saturated fat, sodium, carbonated soft drink, and lower intake of vitamins A and C, milk, fruits and vegetables than those who did not reported eatingfast food.
Abstract: Objective To examine the dietary profile associated with fast-food use. To compare the dietary intake of individuals on the day that they ate fast food with the day that fast food was not eaten. Design Cross-sectional study design. The dietary intake of individuals who reported eating fast food on one or both survey days was compared with those who did not report eating fast food. Among the individuals who reported eating fast food, dietary intake on the day when fast food was eaten was compared with the day when fast food was not eaten. Weighted comparison of mean intakes and pairwise t-test were used in the statistical analysis. Subjects/setting Data from 17,370 adults and children who participated in the 1994-1996 and 1998 Continuing Survey of Food Intakes by Individuals. Dietary intake data were collected by 2 non-consecutive 24-hour dietary recalls. Results Fast-food use was reported by 37% of the adults and 42% of the children. Adults and children who reported eating fast food had higher intake of energy, fat, saturated fat, sodium, carbonated soft drink, and lower intake of vitamins A and C, milk, fruits and vegetables than those who did not reported eating fast food ( P Conclusions Consumers should be aware that consumption of high-fat fast food may contribute to higher energy and fat intake, and lower intake of healthful nutrients.
795 citations
TL;DR: In this paper, the authors describe the four steps of the ADA's Nutrition Care Process and the overarching framework of the Nutrition Care Model that illustrates the context within which the nutrition care process occurs.
Abstract: The establishment and implementation of a standardized Nutrition Care Process (NCP) and Model were identified as priority actions for the profession for meeting goals of the ADA Strategic Plan to “Increase demand and utilization of services provided by members” and “Empower members to compete successfully in a rapidly changing environment” (1). Providing high-quality nutrition care means doing the right thing at the right time, in the right way, for the right person, and achieving the best possible results. Quality improvement literature shows that, when a standardized process is implemented, less variation and more predictability in terms of outcomes occur (2). When providers of care, no matter their location, use a process consistently, comparable outcomes data can be generated to demonstrate value. A standardized Nutrition Care Process effectively promotes the dietetics professional as the unique provider of nutrition care when it is consistently used as a systematic method to think critically and make decisions to provide safe and effective nutrition care (3). This article describes the four steps of ADA’s Nutrition Care Process and the overarching framework of the Nutrition Care Model that illustrates the context within which the Nutrition Care Process occurs. In addition, this article provides the rationale for a standardized process by which nutrition care is provided, distinguishes between the Nutrition Care Process and Medical Nutrition Therapy (MNT), and discusses future implications for the profession.
414 citations
TL;DR: Intervention strategies to increase vegetable intake should focus on predictors of neophobia and pickiness, especially those subject to change, as well as environmental or experiential factors subject to changes.
Abstract: Objective Vegetable intake among children is well below recommended levels. We assessed whether food neophobia and pickiness contribute to low vegetable intake in school-aged girls and if there are distinct predictors for neophobia and pickiness. Children with food neophobia are reluctant to eat new foods whereas picky children resist eating many familiar foods. Design/subjects Participants were 192 7-year-old girls and their parents, recruited for a study of girls' nutrition and development. We examined relationships between food neophobia and pickiness and assessed whether these variables predicted girls' vegetable consumption and predictors of food neophobia and pickiness. Analyses The data were analyzed using a two-step process. First, we used a two-way analysis of variance to assess whether girls who scored high or low on food neophobia and pickiness measures had different levels of vegetable consumption. We used multiple regression analysis to determine predictors of food neophobia and pickiness in the girls. Results Girls with both food neophobia and pickiness consumed fewer vegetables (1.1±0.1) than girls with neither neophobia nor pickiness (1.6±0.1). Neophobia and pickiness were modestly related in this sample, but had different predictors. Girls with food neophobia were more anxious and had mothers with food neophobia. Picky girls had mothers with less variety in their vegetable intake (r=−0.22) and mothers who perceived their family to have little time to eat healthful foods (r=0.36). In addition, picky eaters were breastfed for fewer than 6 months (r=−0.25). Pickiness was predicted primarily by environmental or experiential factors subject to changes; neophobia was predicted by more enduring and dispositional factors. Applications Because food neophobia and pickiness negatively influence vegetable intake, intervention strategies to increase vegetable intake should focus on predictors of neophobia and pickiness, especially those subject to change. J Am Diet Assoc. 2003;103:692-698.
389 citations
TL;DR: Suggested strategies for overcoming barriers included support from parents and school staff, better planning, time management, self-motivation, education, restructuring the physical environment, and greater variety of physical activities.
Abstract: The goal was to have children and adolescents identify and rank the major perceived benefits of and barriers to healthful eating and physical activity and to suggest strategies for overcoming barriers. Semistructured, in-depth focus groups were undertaken using standardized questions and prompts. Students in grades 2 through 11(ages 7 through 17; N=213) from 34 randomly selected schools participated in 38 focus groups. Major benefits of healthful eating included improvements to cognitive and physical performance, fitness, endurance, psychological benefits, physical sensation (feeling good physically), and production of energy. Barriers included convenience, taste, and social factors. Benefits of physical activity included social benefits, enhancement of psychological status, physical sensation, and sports performance. Barriers included a preference for indoor activities, lack of energy and motivation, time constraints, and social factors. Suggested strategies for overcoming barriers included support from parents and school staff, better planning, time management, self-motivation, education, restructuring the physical environment, and greater variety of physical activities. J Am Diet Assoc. 2003;103:497-501.
381 citations
TL;DR: In this paper, the authors examined trends between 1977/1978 and 1994/1998 in the prevalence, amounts, and sources of soft drink consumption among youth age 6 to 17 years.
Abstract: Objectives Trends between 1977/1978 and 1994/1998 in the prevalence, amounts, and sources of soft drink consumption were examined among youth age 6 to 17 years. Design Dietary intake data were examined from three national surveys: the Nationwide Food Consumption Survey 1977/1978 (n=8,908), and the combined Continuing Survey of Food Intakes by Individuals 1994/1996, and the Supplemental Children's Survey 1998 (n=3,177). Soft drinks were defined as carbonated beverages (all United States Department of Agriculture database codes starting with 924) and included flavored waters and juice drinks. Subjects/Setting A national sample of youth ages 6 to 17 years were interviewed for each of the 3 surveys. Statistical analysis t tests were conducted to examine between-survey changes in soft drink consumption and sources of soft drinks. Results The prevalence of soft drink consumption among youth ages 6 to 17 years increased 48%, from a prevalence of 37% in 1977/1978 to 56% in 1994/1998. Mean intake of soft drinks more than doubled, from 5 fl oz to 12 fl oz per day. Although the home environment remained the largest source of children's soft drink access, an increasing share was obtained from restaurants and fast-food establishments (+53%), vending machines (+48%), and other sources (+37%). Conclusions Away-from-home sources of soft drink are an important factor for dietitians to consider when evaluating the dietary intake and nutritional status of youths.
357 citations
TL;DR: This paper offers a review of current scientific research regarding the potential cardiovascular health benefits of flavonoids found in cocoa and chocolate, and recommends by health professionals to encourage individuals to consume a wide range of phytochemical-rich foods, which can include dark chocolate in moderate amounts.
Abstract: This paper offers a review of current scientific research regarding the potential cardiovascular health benefits of flavonoids found in cocoa and chocolate. Recent reports indicate that the main flavonoids found in cocoa, flavan-3-ols and their oligomeric derivatives, procyanidins, have a variety of beneficial actions, including antioxidant protection and modulation of vascular homeostasis. These findings are supported by similar research on other flavonoid-rich foods. Other constituents in cocoa and chocolate that may also influence cardiovascular health are briefly reviewed. The lipid content of chocolate is relatively high; however, one third of the lipid in cocoa butter is composed of the fat stearic acid, which exerts a neutral cholesterolemic response in humans. Cocoa and chocolate contribute to trace mineral intake, which is necessary for optimum functioning of all biologic systems and for vascular tone. Thus, multiple components in chocolate, particularly flavonoids, can contribute to the complex interplay of nutrition and health. Applications of this knowledge include recommendations by health professionals to encourage individuals to consume a wide range of phytochemical-rich foods, which can include dark chocolate in moderate amounts.
349 citations
TL;DR: The greater energy content of larger food portions could be contributing to the increasing prevalence of overweight and the need for greater emphasis on the relationship of portion size to energy intake as a factor in weight maintenance.
Abstract: The greater energy content of larger food portions could be contributing to the increasing prevalence of overweight. Prevention guidelines recommend ″sensible" portion sizes but do not define them. The US Department of Agriculture (USDA) defines standard serving sizes for dietary guidance, and the Food and Drug Administration (FDA) defines standard servings for food labels. To use these standards in counseling, nutritionists must know the sizes of portions available in the marketplace. We determined marketplace portion sizes, identified changes in these sizes with time, and compared current marketplace portions with federal standards. Most marketplace portions exceed standard serving sizes by at least a factor of 2 and sometimes 8-fold. Portions have increased over time; those offered by fast-food chains, for example, often are 2 to 5 times larger than the original size. The discrepancy between marketplace portions and standard servings suggests the need for greater emphasis on the relationship of portion size to energy intake as a factor in weight maintenance. J Am Diet Assoc. 2003;103:231-234.
346 citations
TL;DR: In this article, the authors compared the validity of digital photography and direct visual estimation for measuring food portion sizes compared with weighed foods and with direct visual estimators, and found that both methods tended to yield small overestimates or underestimates.
Abstract: Objective The primary goal was to test the validity of digital photography for measuring food portion sizes compared with weighed foods and with direct visual estimation. Samples A total of 60 test meals consisting of 10 different portion sizes from six different university cafeteria menus were prepared and weighed. Design Food selections and plate waste, as estimated by digital photography and direct visual estimation, were compared with weighed foods. For each method, three observers independently estimated portion sizes of each food. Observers expressed the portion sizes as a percentage of a standard serving. These percentages were multiplied by the weight of the standard portion to yield estimated weights. Statistical analyses To test validity, the estimates of food weights derived from both methods were compared with weighed foods using correlations and were compared with each other using Bland-Altman regression analysis. Results For the digital photography and direct visual estimation methods, estimates of the portion sizes for food selections, plate waste, and food intake were highly correlated with weighed foods. Both methods tended to yield small overestimates or underestimates. Bland-Altman regression found the two estimation methods to yield comparable results (bias less than 1.5 g). Applications/conclusions These findings support the validity of the digital photography method for measuring portion sizes. Digital photography may be most useful for measuring food intake in settings that allow for the direct observation of food selections and plate waste but require minimum disruption of the eating environment, and allow unhurried estimates of portion sizes.
344 citations
TL;DR: Cancer survivors are likely to be making lifestyle changes and represent a group that could benefit from counseling on diet and physical activity, according to a population-based sample of patients from the state of Washington.
Abstract: Objective To investigate the prevalence and predictors of changes in diet, physical activity, and dietary supplement use among cancer patients. Design/subjects Telephone interviews of a population-based sample of 126 breast, 114 prostate, and 116 colorectal cancer patients from the state of Washington. Analysis Logistic regression was used to estimate the odds ratio as a measure of the association of participant characteristics with lifestyle changes in the 12 months before the interview. Results Overall, 66.3% of patients reported making lifestyle changes: 40.4% made one or more dietary changes, 20.8% added new physical activity, and 48.0% started taking new dietary supplements. Compared with men, women were 2.2 times more likely to take new dietary supplements (P
325 citations
Journal Article•
TL;DR: This position paper reviews the current scientific data related to key nutrients for vegetarians including protein, iron, zinc, calcium, vitamin D, riboflavin, vitamin B-12, vitamin A, n-3 fatty acids, and iodine and suggests that a vegetarian, including vegan, diet can meet current recommendations for all of these nutrients.
Abstract: It is the position of the American Dietetic Association and Dietitians of Canada that appropriately planned vegetarian diets are healthful, nutritionally adequate, and provide health benefits in the prevention and treatment of certain diseases. Approximately 2.5% of adults in the United States and 4% of adults in Canada follow vegetarian diets. A vegetarian diet is defined as one that does not include meat, fish, or fowl. Interest in vegetarianism appears to be increasing, with many restaurants and college foodservices offering vegetarian meals routinely. Substantial growth in sales of foods attractive to vegetarians has occurred and these foods appear in many supermarkets. This position paper reviews the current scientific data related to key nutrients for vegetarians including protein, iron, zinc, calcium, vitamin D, riboflavin, vitamin B-12, vitamin A, n-3 fatty acids, and iodine. A vegetarian, including vegan, diet can meet current recommendations for all of these nutrients. In some cases, use of fortified foods or supplements can be helpful in meeting recommendations for individual nutrients. Well-planned vegan and other types of vegetarian diets are appropriate for all stages of the life-cycle including during pregnancy, lactation, infancy, childhood, and adolescence. Vegetarian diets offer a number of nutritional benefits including lower levels of saturated fat, cholesterol, and animal protein as well as higher levels of carbohydrates, fibre, magnesium, potassium, folate, antioxidants such as vitamins C and E, and phytochemicals. Vegetarians have been reported to have lower body mass indices than non-vegetarians, as well as lower rates of death from ischemic heart disease, lower blood cholesterol levels, lower blood pressure, and lower rates of hypertension, type 2 diabetes, and prostate and colon cancer. While a number of federally funded and institutional feeding programs can accommodate vegetarians, few have foods suitable for vegans at this time. Because of the variability of dietary practices among vegetarians, individual assessment of dietary intakes of vegetarians is required. Dietetics professionals have a responsibility to support and encourage those who express an interest in consuming a vegetarian diet. They can play key roles in educating vegetarian clients about food sources of specific nutrients, food purchase and preparation, and any dietary modifications that may be necessary to meet individual needs. Menu planning for vegetarians can be simplified by use of a food guide that specifies food groups and serving sizes.
TL;DR: Messages and advice aimed at reducing time spent in sedentary activities should be targeted at television/video use instead of time spent reading, doing homework, or using a computer.
Abstract: Objective To describe the demographic characteristics of adolescent boys and girls who engage in three sedentary behaviors (television/video use, computer use, and reading/homework), and to explore how each sedentary activity is associated with body mass index (BMI), dietary behaviors, and leisure time physical activity. Design This study draws on data collected from Project EAT (Eating Among Teens), a school-based survey examining personal, behavioral, and socioenvironmental factors that are associated with nutritional intake among adolescents. Subjects The study sample consists of 4,746 middle and high school students from 31 public schools in a metropolitan area of the upper Midwest. All students were invited to participate. The overall response rate for Project EAT was 81.5%. Data collection was completed during the 1998-1999 school year. Statistical analyses Multivariate linear regression was used for examining associations between independent and dependent variables, controlling for age, race/ethnicity, and socioeconomic status. All differences were considered statistically significant at P Results Among boys, television/video use and time spent reading/doing homework were positively associated with BMI ( P P P P P Applications/Conclusions Messages and advice aimed at reducing time spent in sedentary activities should be targeted at television/video use instead of time spent reading, doing homework, or using a computer. Nutrition education should incorporate messages about the influence of the media and advertising on dietary behaviors.
TL;DR: Of the calculation standards tested, the Mifflin standard provided an accurate estimate of actual resting metabolic rate in the largest percentage of nonobese and obese individuals and therefore deserves consideration as the standard for calculating resting metabolic rates in obese and nonobesity adults.
Abstract: Objective To evaluate several equations for predicting resting metabolic rate against measured values in obese and nonobese people. Design Resting metabolic rate was measured with indirect calorimetry. Four calculation standards using various combinations of weight, height, and age were used to predict resting metabolic rate: a) Harris-Benedict equation, b) Harris-Benedict equation using adjusted body weight in obese individuals, c) Owen, and d) Mifflin. Main outcome was percentage of subjects whose calculated metabolic rate was outside a ±10% limit from measured values. Subjects/setting 130 nonhospitalized adult volunteers grouped by degree of obesity (range of body mass index, 18.8 to 96.8). Statistical analysis performed Analysis of proportions was used to determine differences in the percentage of subjects estimated accurately by each equation; α was set at 0.05. Results Calculated resting metabolic rate was more than 10% different from measured in 22% of subjects using the Mifflin equation, 33% using the Harris-Benedict equation ( P =.05 vs Mifflin), and 35% using the Owen equation ( P Applications/conclusion Of the calculation standards tested, the Mifflin standard provided an accurate estimate of actual resting metabolic rate in the largest percentage of nonobese and obese individuals and therefore deserves consideration as the standard for calculating resting metabolic rate in obese and nonobese adults. Use of adjusted body weight in the Harris-Benedict equation led to less overestimation by that equation in obese people at the expense of increased incidence of underestimation.
TL;DR: The findings facilitate the design of more effective nutrition interventions to promote appropriate gestational weight gain and the long-term health of women and their infants.
Abstract: Objective The research addresses two questions: Are potentially modifiable psychosocial and behavioral factors related to gestational weight gain? Do the same factors relate to both excessive and insufficient weight gain? Design Prospective cohort study that followed women from early pregnancy until two years postpartum. Data were collected through mailed questionnaires and an audit of the medical record. Subjects/setting The sample included 622 healthy adult women who gave birth to live singleton infants. Subjects were recruited from all women who registered for prenatal care in a hospital and primary care clinic system serving a 10-county area of Upstate New York. Statistical analyses performed Multiple linear and logistic regression with adjustment for timing of measurements and length of gestation were performed. Results Only 38% of women gained an amount of weight in pregnancy that was within the range recommended by the Institute of Medicine. Valid and easily implemented measures of change in food intake and physical activity from prepregnancy and cigarette smoking during pregnancy were each significantly (P
TL;DR: Most questions on the SBNM secondary questionnaire were found to have acceptable reproducibility, whereas validation of food choice behaviors showed results similar to or better than other dietary assessment instruments for this age group.
Abstract: Objective To evaluate the reproducibility and validity of the School-Based Nutrition Monitoring (SBNM) secondary level student questionnaire. Design Reproducibility was evaluated using a test-retest study design by administering the questionnaire on the same day (morning and afternoon, n=254) and, when appropriate, 9 to 14 days apart (n=259). Validity was assessed by comparing foods selected on the questionnaire with foods reported from a single 24-hour recall covering the same referent period (yesterday) in 209 students. Subjects/setting Eighth grade students in middle schools from central Texas were used: male and female, approximately 75% white, for the reproducibility study, with 15% Hispanic, 6% African American; for the validation study, approximately 38% white, 41% Hispanic, and 17% African American. Statistical analysis Spearman rank order correlation, κ statistic, and percentage agreement were used for both reproducibility and the validation. Results For the reproducibility study, agreement for questions about food intake ″yesterday" were 70% to 98%, with κ statistics ranging from 0.54 to 0.93 and correlations between 0.66 and 0.97. Questions on recent physical activity had high agreement (66% to 89%) as did ″usual" physical activity items, weight loss, and food selection behaviors. Nutrition knowledge items showed relatively weaker reliability: agreements ranged from 47% to 92%, with κ statistics between 0.30 and 0.56. Attitude questions had weaker agreement (50% to 87%), κ statistics (0.27 to 0.52), and correlations (0.33 to 0.63). For the validation study, correlation coefficients ranged from 0.32 for breads to 0.68 for milk and beans. Percentage agreement ranged from 38% for breads to 89% for gravy. Applications/conclusions Most questions on the SBNM secondary questionnaire were found to have acceptable reproducibility, whereas validation of food choice behaviors showed results similar to or better than other dietary assessment instruments for this age group. This questionnaire is a useful epidemiologic tool for surveillance, assessing broad intervention effects among groups or providing needs assessment data on selected nutrition and physical activity-related constructs. J Am Diet Assoc. 2003;103:186-194.
TL;DR: Amounts of foods consumed per eating occasion are widely used for the formation of public policy, counseling, and dietary assessment and changes in amounts consumed should be monitored to evaluate the need for revisions in policy and diet assessment protocols.
Abstract: Objective To compare quantities consumed per eating occasion in 1989-1991 and 1994-1996 was the objective of this study. Design This study was a comparison over time. Subjects/setting Subjects were respondents in the Continuing Survey of Food Intakes by Individuals (CSFII) in 1989-1991 or 1994-1996. Intake data were processed and analyzed to provide estimates of amounts of commonly eaten foods consumed per eating occasion. Statistical analyses performed Approximate t tests were used to compare quantities of foods consumed by 1989-1991 and 1994-1996 survey respondents. Analyses were conducted for all persons aged 2 years and over and for 10 age and sex groups. Significance was set at .001. Results Significant differences in amounts consumed were reported for approximately one third of the 107 foods examined. Larger amounts were reported in 1994-1996 by all persons aged 2 years and over and selected age/sex subgroups for several foods including soft drinks, coffee, tea, and ready-to-eat cereal. Smaller amounts were reported for fewer foods: margarine, mayonnaise, chicken, macaroni and cheese, and pizza. Applications/conclusions Amounts of foods consumed per eating occasion are widely used for the formation of public policy, counseling, and dietary assessment. Changes in amounts consumed should be monitored to evaluate the need for revisions in policy and diet assessment protocols. J Am Diet Assoc. 2003;103:41-47.
TL;DR: Mean intake of vitamin D in the United States was estimated from food and food plus supplements and compared with recommended intake levels and the highest intakes were reported by male teenagers and female adults.
Abstract: Mean intake of vitamin D in the United States was estimated from food and food plus supplements and compared with recommended intake levels. US men, nonpregnant and nonlactating women, and nonbreastfeeding children aged 1 year and older who participated in the Third National Health and Nutrition Examination Survey (NHANES III, 1988-1994) or the Continuing Survey of Food Intakes by Individuals 1994-1996, 1998 (CSFII 1994-1996, 1998) were included in the estimates. Intake of vitamin D from food sources and dietary supplements was not meeting recommended levels. The lowest intakes of vitamin D from food were reported by female teenagers and female adults. The highest intakes of vitamin D from food sources were reported by male teenagers. Dairy products were the primary sources of both vitamin D and calcium. Additional food fortification as well as dietary and supplement guidance are needed for the general population.
TL;DR: Results show that dental health is closely associated with nutritional status and suggest that status of dentition should be considered in nutritional counseling and assessment of older adults.
Abstract: Objective This study was designed to examine associations between the number of posterior occlusal pairs of teeth and the nutritional status of older adults participating in the third National Health and Nutrition Examination Survey (NHANES III) survey. Design Impaired dentition was assessed by number of posterior occluding pairs of teeth (grinding teeth, n=8 pairs) and complete denture status. Nutritional status was measured by nutrient intake, Healthy Eating Index (HEI) score, serum values, and body mass index (BMI). Subjects/setting Data from 5,958 participants in NHANES III ages 50 years and over with dental examination were included in the analysis. Statistical analyses performed Analysis of covariance and multivariate linear regression analyses were performed to examine associations between number of tooth pairs and nutritional status indicators controlled for potential confounders. Results Compared with individuals with five to eight posterior occluding pairs (HEI=68.2), those with impaired dentition (no posterior pairs, one to four pairs remaining, or full dentures) had consistently lower HEI scores (HEI=64.3, 66.5, and 66.5, respectively), consumed fewer servings of fruits, and had lower serum values of beta carotene and ascorbic acid. Participants with one to four posterior pairs also had a higher mean BMI (28.0) than those with five or more pairs (27.2). Participants in one or more groups with impaired dentition had lower dietary intake levels of vitamin A, carotene, folic acid, and vitamin C, and scored less well on diet variety, cholesterol, and sodium components of the HEI. Applications/conclusions Results show that dental health is closely associated with nutritional status and suggest that status of dentition should be considered in nutritional counseling and assessment of older adults. J Am Diet Assoc. 2003;103:61-66.
TL;DR: Children should be strongly encouraged to regularly include calcium-rich foods and beverages in their diets, and intakes of carbonated beverages and other sweetened beverages were negatively related.
Abstract: Objective To determine if dietary calcium was negatively related to children's body fat (BF), if BF indexes and calcium intakes changed over time, and to identify variables related to BF and calcium intake. Design Percent BF and kg BF were assessed by dual energy x-ray absorptiometry (DEXA) in 8-year-old children. In a prospective design, height, weight, dietary intakes, and related variables were monitored longitudinally from ages 2 months to 8 years during in-home interviews. Subjects Fifty-two white children, (n=25 boys, 27 girls) participated in a longitudinal study with their mothers. At 8 years of age, mean BMI was 17.3±2.1 (standard deviation) for boys and 17.1±2.5 for girls. Analyses Regression analysis of all variables, followed by further regression analysis on selected models. Results At 8 years, percent BF was 22.7±6.7 for boys and 26.2±7.9 for girls, as assessed by DEXA. Dietary calcium (mg) and polyunsaturated fat intake (g) were negatively related to percent BF ( P =.02 to .04) in 3 statistical models, which predicted 28% to34% of the variability in BF among children. Variables positively associated with percent BF were total dietary fat (g) or saturated fat (g), female gender, sedentary activity (hours/day), father's BMI, and mothers' percent BF. Calcium intakes were significantly correlated over time. Dietary variety was positively related to calcium intake, and intakes of carbonated beverages and other sweetened beverages were negatively related. Applications/conclusions Children should be strongly encouraged to regularly include calcium-rich foods and beverages in their diets.
TL;DR: This study can help nutrition educators design appropriate educational programs for first-generation Chinese Americans that can facilitate the adoption of more healthful dietary practices and should consider the dietary changes of Chinese-American participants, such as skipping breakfast and increased consumption frequency of fats, sweets, and soft drinks.
Abstract: Objective To obtain information about dietary pattern change of Chinese Americans in Pennsylvania and its relationship with demographic characteristics and acculturation indicators. Design A cross-sectional self-administered survey. Subjects A convenience sample of 399 Chinese Americans. Statistical analyses performed t Tests, analysis of variance with Tukey post-hoc tests, Spearman rank correlation, and χ 2 test. Results After immigration, Chinese Americans increased consumption frequency of all seven food groups (grains, vegetables, fruits, meat/meat alternatives, dairy products, fats/sweets, and beverages) and Western foods while consumption frequency of traditional Chinese foods decreased. Dietary variety also increased after immigration. Higher education and higher income levels were associated with a larger increase in consumption frequency of grains, vegetables, and fruits. Persons who resided in the United States for a longer period of time shared a greater increase in their consumption frequencies of vegetables, fats/sweets, and beverages. Persons with better English proficiency had a greater increase in their consumption frequency of grains, fruits, meat/meat alternatives, and fats/sweets. Conclusions This study can help nutrition educators design appropriate educational programs for first-generation Chinese Americans that can facilitate the adoption of more healthful dietary practices. Nutrition educators should consider the dietary changes of Chinese-American participants, such as skipping breakfast and increased consumption frequency of fats, sweets, and soft drinks, which were observed in this study. For example, acculturated first-generation Chinese Americans should be encouraged to decrease fats, sweets, and soft-drink consumption. Less-acculturated persons should be encouraged to maintain their healthful dietary pattern and increase consumption of vegetables and fruits.
TL;DR: The gluten-free diet impacted various lifestyle aspects of the quality of life for individuals with celiac disease, and Frequencies and cross-tabulations indicated several areas of negative impact in maintaining a gluten- free diet.
Abstract: The objective of this study was to determine the effects of a gluten-free diet, examining food consumption and limitations on quality of life for those with celiac disease. Twenty-nine items on self-administered questionnaires queried demographics, lifestyle, and food use. Some items were from the Rand Survey (Rand Corporation, Santa Monica, CA). Most responses used three- or five-point Likert scales. They were mailed to members of the Westchester Celiac Sprue Support Group. Of the 274 responses, 253 were usable and were the basis of the compiled results. Seventy-four percent of the respondents were female; 42% were between the ages of 36 and 55 years of age, and 46% were more than 55 years of age. Frequencies and cross-tabulations indicated several areas of negative impact in maintaining a gluten-free diet. They included the difficulties of dining out (86%), travel (82%), and impact on family (67%) and less of a negative impact on career or work (41%). The gluten-free diet impacted various lifestyle aspects of the quality of life for individuals with celiac disease.
TL;DR: A motivational training program, developed in such a way that subjects are comfortable reporting intake of foods considered socially undesirable, in combination with confrontation with earlier results of dietary assessment and use of portion size measurement aids, can be used to attenuate underreporting.
Abstract: Objective The aim of this study was to quantify underreporting of energy intake in Brazilian women; identify underreporting determinants; find out if underreporting was selective and; test if a motivational multimethod training, in combination with providing the subjects some results from the prior recording period, was able to reduce underreporting. Design Energy intake (EI) was assessed by a 7-day diet record. Energy expenditure (EE) was calculated by heart rate monitoring. EI:EE ratio lower than one in subjects who did not lose weight in one month was considered underreporting. Underreporting was correlated with anthropometric, behavioral, and psychological parameters. Food and nutrient consumption was compared between underreporters and non-underreporters. A focus group investigated the main causes of underreporting. Subjects were told that the earlier food records' results were unrealistic and submitted to a motivational training. Then, they were reevaluated for underreporting. Subjects Subjects were recruited by advertisements for a physical activity program. Thirty-eight healthy women, 13 normal-weight (34%), 13 overweight (34%), and 12 obese (32%), enrolled in the study. Three subjects (2 normal-weight and 1 obese) (8%) withdrew. Statistical analyses performed Analysis of variance, paired t tests, and simple linear regression. Results Seventeen women (49%) underreported their EI by 21%. A significant negative correlation was found between social desirability and EI:EE. Undereating, errors in portion sizes estimation and the inconvenience of having to record everything that was eaten seemed to explain underreporting. Mean portion sizes did not differ for underreporters and nonunderreporters. Fewer self-reported years of education was correlated with underreporting only among normal-weight women. Training and confrontation with earlier results reduced underreporting rate to 33%, but did not affect macronutrient densities. Applications/conclusions Subjects tended to report their intake in a socially desirable way, by eating or reporting less frequently foods considered unhealthful or fattening, like sweets and fried foods. Inclusion of social desirability score as a covariate in studies that rely on self-reports of food intake may be useful. A motivational training program, developed in such a way that subjects are comfortable reporting intake of foods considered socially undesirable, in combination with confrontation with earlier results of dietary assessment and use of portion size measurement aids, can be used to attenuate underreporting.
TL;DR: In this article, a randomized block design was used to determine whether kefir improves lactose digestion and tolerance in adults with lactose maldigestion, which is a fermented milk beverage that contains different cultures than yogurt.
Abstract: Objective Kefir is a fermented milk beverage that contains different cultures than yogurt. The objective of this study was to determine whether kefir improves lactose digestion and tolerance in adults with lactose maldigestion. Design Randomized block design. Subjects Fifteen healthy, free-living adults with lactose maldigestion. Main outcome measures Breath hydrogen excretion and lactose intolerance symptoms were monitored hourly for 8 hours after each test meal. Intervention Subjects were fed test meals consisting of 20 g lactose portions of milk (2% reduced fat), plain and raspberry flavored kefir, and plain and raspberry flavored yogurt, each following an overnight (12 hour) fast. Statistical analysis Mixed model ANOVA was performed on raw or transformed data, followed by Tukey HSD post hoc tests (when appropriate). Significance was defined as P
TL;DR: By age 13, adolescents drank more carbonated soft drinks than 100% fruit juice, milk, or fruit drinks and ades, and increased consumption of nutrient-dense beverages and water as part of a varied diet should be encouraged.
Abstract: The American Academy of Pediatrics (AAP) recently issued recommendations for 100% fruit juice consumption for children and adolescents. National survey data (1994-1996, 1998 Continuing Survey of Food Intakes by Individuals) were used to evaluate intake of 100% fruit juice for comparison with AAP recommendations. Mean daily intakes of 100% fruit juice were 0.9, 4.6, and 3.4 ounces in children aged <6 months, 6 months-6 years, and 7-18 years, respectively, which fall within AAP recommendations for these age groups. At age 5, mean intake of fruit drinks and ades exceeded that of 100% fruit juice (P=.009). Carbonated soft drink intake exceeded that of 100% fruit juice at age 5 and of milk at age 13 (P<.04). By age 13, adolescents drank more carbonated soft drinks than 100% fruit juice, milk, or fruit drinks and ades. Increased consumption of nutrient-dense beverages (100% fruit juice, milk) and water as part of a varied diet should be encouraged.
TL;DR: For example, this article found that children need direct messages to motivate them to change their exercise and eating habits, as well as tips on cooperating with their parents to achieve fitness goals.
Abstract: Childhood overweight is at an all-time high in the United States. In an effort to better understand children's, parents', and teachers' attitudes, perceptions, and behaviors about preventing overweight in childhood and to explore potential avenues for communicating overweight prevention messages, qualitative research was conducted with these three groups in 2000. Our research consisted of three progressive phases, each building on information obtained from the previous phase: 16 focus groups, in-home observations, in-depth interviews and diaries ; 10 qualitative interview sessions. Both parents and children indicated that encouragement and ?small victoriesﾔ to sustain involvement in getting more fit were critical to success. The findings also suggest that children need direct messages to motivate them to change their exercise and eating habits, as well as tips on cooperating with their parents to achieve fitness goals. Parents need to learn how to talk about eating and exercise habits with their children in positive and encouraging ways and to learn how to help their children maintain efforts to get fit. Teachers consider it essential that parents support healthful lifestyles at home. Parents and children need positive, realistic approaches to getting fit, such as answers to questions about healthful lifestyles; ideas for physical games and activities the family can enjoy together; attainable goals and small steps to healthful eating; healthful meal, snack, and recipe suggestions; incentive ideas for getting kids active; and referral services for local support groups. Parents and children need to work together in addressing the overweight prevention issue and need effective tools to facilitate this cooperative effort
TL;DR: Body image and fatness are key factors on which health professionals should focus when seeking predictors of underreporting of dietary intake, and health care professionals involved in weight loss counseling may achieve better success if treatment includes generating a more positive body image.
Abstract: Objective To identify characteristics associated with misreporting of energy intake during 24-hour dietary recalls (24HR). Design Ninety-eight subjects were administered two 24HRs. Energy expenditure was determined by doubly labeled water (44 subjects) or intake balance (54 subjects). Data on subjects' physical, lifestyle, and psychosocial characteristics were also collected. Subjects/setting At the Beltsville Human Nutrition Research Center 52 women and 46 men were administered 24HR and completed lifestyle and personality questionnaires and a memory test. Physical characteristics such as weight, percent body fat, and total energy expenditure were measured. Statistical analysis The influences of subject parameters on energy misreporting were assessed by linear regression and Pearson product-moment correlation analysis for continuous variables and by ANOVA for discrete variables. Stepwise regression was used to identify key factors in underreporting. Results Factors particularly important in predicting underreporting of energy intake include factors indicating dissatisfaction with body image; for example, a 398 kcal/day underreport in subjects attempting weight loss during the past year with a nearly 500 kcal/day underreport in women. Overall, women underreported by 393 kcal/day relative to men and women evinced a social desirability bias amounting to a 26 kcal underreport for each point on the social desirability scale. Gender differences also were evident in the effect of percent body fat (with men underreporting about 16 kcal/day/percent body fat) and in departure from self-reported ideal body weight (with women underreporting about 21 kcal/day/kg). Applications/conclusions Body image and fatness are key factors on which health professionals should focus when seeking predictors of underreporting of dietary intake. Dietary interviews must be conducted to minimize bias related to subjects' tendencies to win approval and avoid censure by the interviewer. In addition, dissatisfaction with body image may lead to underestimation of food intake, therefore reducing likelihood of success in weight loss. Thus, health care professionals involved in weight loss counseling may achieve better success if treatment includes generating a more positive body image.
TL;DR: The consumption of ready-to-eat cereals at breakfast should be encouraged as a component of an eating pattern that promotes the maintenance of healthful body weights and nutrient intakes in children.
Abstract: Objective To examine the relationship between ready-to-eat cereal consumption habits and body mass index of a sample of children aged 4 to 12 years. Design Fourteen-day self-reported food diary records were obtained from a sample of 2,000 American households from February 1998 through February 1999. Height and weight of the family members were also self-reported. Subjects/setting The sample population of 603 children, aged 4 to 12 years, was broken into tertiles based on cereal consumption over the 14 days: (three or fewer, four to seven, or eight or more servings). Statistical analysis Logistic regression and analysis of variance were used to determine associations between frequency of ready-to-eat cereal consumption and body mass index or nutrient intakes. Results More than 90% of children aged 4 to 12 years consumed ready-to-eat cereal at least once in the two-week collection period. Within tertiles of consumption, children in the upper tertile had lower mean body mass indexes than those in the lowest tertile consistently across all age groups ( P P Applications The consumption of ready-to-eat cereals at breakfast should be encouraged as a component of an eating pattern that promotes the maintenance of healthful body weights and nutrient intakes in children.
TL;DR: Both the frequency and complexity of at-home food preparation were positively related to women's energy and nutrient intakes and their consumption of fruits and vegetables, grain products, and meat and alternates, indicating the need for nutrition professionals to become effective advocates for policy reforms to lessen economic constraints on poor households.
Abstract: A secondary analysis of data from a study of nutritional vulnerability among 153 women in families seeking charitable food assistance was undertaken to estimate the extent and nutritional significance of at-home food preparation activity for these women. At-home food preparation was estimated from women's reported food intakes from three 24-hour recalls. The relationships between food preparation and energy and nutrient intake, food intake, and 30-day household food security status were characterized. Almost all participants (97%) consumed foods prepared from scratch at least once during the three days of observation; 57% did so each day. Both the frequency and complexity of at-home food preparation were positively related to women's energy and nutrient intakes and their consumption of fruits and vegetables, grain products, and meat and alternates. The intakes by women in households with food insecurity with hunger reflected less complex food preparation but no less preparation from scratch than women in households where hunger was not evident, raising questions about the extent to which food skills can protect very poor families from food insecurity and hunger. Our findings indicate the need for nutrition professionals to become effective advocates for policy reforms to lessen economic constraints on poor households.
TL;DR: In this article, the authors investigated the effect of 3-months' daily administration of high doses of sucralose, a non-nutritive sweetener, on glycemic control in subjects with type 2 diabetes.
Abstract: Objective To investigate the effect of 3-months' daily administration of high doses of sucralose, a non-nutritive sweetener, on glycemic control in subjects with type 2 diabetes. Design A multicenter, double-blind, placebo-controlled, randomized study, consisting of a 6-week screening phase, a 13-week test phase, and a 4-week follow-up phase. Subjects/setting Subjects with type 2 diabetes (age range 31 to 70 years) entered the test phase of this study; 128 subjects completed the study. The subjects were recruited from 5 medical centers across the United States and were, on average, obese. Intervention Subjects were randomly assigned to receive either placebo (cellulose) capsules (n=69) or 667 mg encapsulated sucralose (n=67) daily for the 13-week test phase. All subjects blindly received placebo capsules during the last 4 weeks of the screening phase and for the entire 4-week follow-up phase. Main outcome measures Glycated hemoglobin (HbA1c), fasting plasma glucose, and fasting serum C-peptide were measured approximately every 2 weeks to evaluate blood glucose homeostasis. Data were analyzed by analysis of variance using repeated measures. Results There were no significant differences between the sucralose and placebo groups in HbA1c, fasting plasma glucose, or fasting serum C-peptide changes from baseline. There were no clinically meaningful differences between the groups in any safety measure. Conclusions This study demonstrated that, similar to cellulose, sucralose consumption for 3 months at doses of 7.5 mg/kg/day, which is approximately three times the estimated maximum intake, had no effect on glucose homeostasis in individuals with type 2 diabetes. Additionally, this study showed that sucralose was as well-tolerated by the study subjects as was the placebo.
TL;DR: This position paper provides information and resources for nutrition professionals to use in developing and supporting comprehensive school health programs.
Abstract: It is the position of the American Dietetic Association (ADA), the Society for Nutrition Education (SNE), and the American School Food Service Association (ASFSA) that comprehensive nutrition services must be provided to all of the nation's preschool through grade twelve students These nutrition services shall be integrated with a coordinated, comprehensive school health program and implemented through a school nutrition policy The policy should link comprehensive, sequential nutrition education; access to and promotion of child nutrition programs providing nutritious meals and snacks in the school environment; and family, community, and health services' partnerships supporting positive health outcomes for all children Childhood obesity has reached epidemic proportions and is directly attributed to physical inactivity and diet Schools can play a key role in reversing this trend through coordinated nutrition services that promote policies linking comprehensive, sequential nutrition education programs, access to and marketing of child nutrition programs, a school environment that models healthy food choices, and community partnerships This position paper provides information and resources for nutrition professionals to use in developing and supporting comprehensive school health programs J Am Diet Assoc 2003;103:505-514