Showing papers in "Journal of The American Dietetic Association in 2008"

Development of the Healthy Eating Index-2005.

Abstract: The Healthy Eating Index (HEI) is a measure of diet quality as specified by Federal dietary guidance, and publication of the Dietary Guidelines for Americans 2005 necessitated its revision. An interagency working group based the HEI-2005 on the food patterns found in MyPyramid. Diets that meet the least restrictive of the food-group recommendations, expressed on a per 1,000 calorie basis, receive maximum scores for the nine adequacy components of the index: total fruit (5 points), whole fruit (5 points), total vegetables (5 points), dark green and orange vegetables and legumes (5 points), total grains (5 points), whole grains (5 points), milk (10 points), meat and beans (10 points), and oils (10 points). Lesser amounts are prorated linearly. Population probability densities were examined when setting the standards for minimum and maximum scores for the three moderation components: saturated fat (10 points), sodium (10 points), and calories from solid fats, alcoholic beverages (ie, beer, wine, and distilled spirits), and added sugars (20 points). Calories from solid fats, alcoholic beverages, and added sugars is a proxy for the discretionary calorie allowance. The 2005 Dietary Guideline for saturated fat and the Adequate Intake and Tolerable Upper Intake Level for sodium, expressed per 1,000 calories, were used when setting the standards for those components. Intakes between the maximum and minimum standards are prorated. The HEI-2005 is a measure of diet quality as described by the key diet-related recommendations of the 2005 Dietary Guidelines. It has a variety of potential uses, including monitoring the diet quality of the US population and subpopulations, evaluation of interventions, and research.

Evidence-Based Practice Recommendations for Nutrition-Related Management of Children and Adults with Cystic Fibrosis and Pancreatic Insufficiency: Results of a Systematic Review

Abstract: The Cystic Fibrosis Foundation established a process of systematic review of evidence to inform the development of clinical care guidelines and encourage evidence-based practice. The Subcommittee on Growth and Nutrition reviewed the evidence in two areas: energy intake and dosing for pancreatic enzyme replacement therapy. Evidence-based recommendations are presented here. Also, an ad hoc working group conducted a review of the literature and performed new analyses using the Cystic Fibrosis Foundation Patient Registry to update the recommendations for growth and weight-status monitoring. These Registry data-based recommendations are presented.

A Systematic Review of the Relationship between Acculturation and Diet among Latinos in the United States: Implications for Future Research

Abstract: Dietary intake is an important determinant of obesity and numerous chronic health conditions. A healthful diet is an essential component of chronic disease self-management. Researchers have indicated that the healthfulness of the Latino diet deteriorates during the acculturation process. However, given the many operationalizations of acculturation, conclusive evidence regarding this relationship is still lacking. This comprehensive and systematic literature review examines the relationship between acculturation and diet by examining national, quantitative, and qualitative studies involving Latinos living in the United States. Studies of diet included those that examined dietary intake using one of several validated measures (eg, food frequency questionnaire, 24-hour dietary recall, or dietary screener) and/or dietary behaviors (eg, away-from-home-eating and fat avoidance). Articles were identified through two independent searches yielding a final sample of 34 articles. Articles were abstracted by two independent reviewers and inter-rater reliability was assessed. Analyses examined the extent to which various measures of acculturation (ie, acculturation score, years in the United States, birthplace, generational status, and language use) were associated with macronutrient intake, micronutrient intake, and dietary behaviors. Several relationships were consistent irrespective of how acculturation was measured: no relationship with intake of dietary fat and percent energy from fat; the less vs more acculturated consumed more fruit, rice, beans, and less sugar and sugar-sweetened beverages. Additional observed relationships depended on the measure of acculturation used in the study. These findings suggest a differential influence of acculturation on diet, requiring greater specificity in our dietary interventions by acculturation status.

Evaluation of the Healthy Eating Index-2005.

Abstract: Background The Healthy Eating Index (HEI), a measure of diet quality as specified by federal dietary guidance, was revised to conform to the Dietary Guidelines for Americans 2005 The HEI has several components, the scores of which are totaled Objective The validity and reliability of the HEI-2005 were evaluated Design Validity was assessed by answering four questions: Does the HEI-2005 1) give maximum scores to menus developed by experts; 2) distinguish between groups with known differences in diet quality—smokers and nonsmokers; 3) measure diet quality independently of energy intake, a proxy for diet quantity; and 4) have more than one underlying dimension? The relevant type of reliability, internal consistency, was also assessed Subjects Twenty-four−hour recalls from 8,650 participants, aged 2 years and older, in the National Health and Nutrition Examination Survey, 2001-2002 were analyzed to answer questions 2 to 4 Results were weighted to consider sample design and nonresponse Statistical analyses T tests determined differences in scores between smokers and nonsmokers Pearson correlation coefficients determined the relationship between energy intake and scores Principal components analysis determined the number of factors that comprise the HEI-2005 Cronbach's coefficient α tested internal consistency Results HEI-2005 scores are at or very near the maximum levels for all sets of exemplary menus with one exception; the Harvard menus scored low on the milk component because these menus intentionally include only small amounts of milk products Nine of 12 component scores were lower for smokers than nonsmokers The correlations of component scores were virtually independent of energy intake ( Conclusions The HEI-2005 is a valid measure of diet quality Potential uses include population monitoring, evaluation of interventions, and research The individual component scores provide essential information in addition to that provided by the total score

The evidence for dietary prevention and treatment of cardiovascular disease.

Abstract: During the past few decades numerous studies have reported the atherogenic potential of saturated fatty acids, trans -fatty acids, and cholesterol, and beneficial effects of fiber, phytostanols/phytosterols, n-3 fatty acids, a Mediterranean diet, and other plant-based approaches. The purpose of this article is to provide a comprehensive and systematic review of the evidence associated with key dietary factors and risk of cardiovascular disease—an umbrella term encompassing diseases that affect the heart and blood vessels, including coronary heart disease, coronary artery disease, dyslipidemia, and hypertension—in conjunction with the work of the American Dietetic Association Evidence Analysis Library review on diet and lipids, updated with new evidence from the past 2 years. The criteria used and results cited provide scientific rationale for food and nutrition professionals and other health professionals for counseling patients. Details of these searches are available within the American Dietetic Association Evidence Analysis Library online (http://adaevidencelibrary.com). Potential mechanisms and needs for future research are summarized for each relevant nutrient, food, or food component.

Advances in celiac disease and gluten-free diet.

Abstract: Celiac disease is becoming an increasingly recognized autoimmune enteropathy caused by a permanent intolerance to gluten. Once thought to be a rare disease of childhood characterized by diarrhea, celiac disease is actually a multisystemic disorder that occurs as a result of an immune response to ingested gluten in genetically predisposed individuals. Screening studies have revealed that celiac disease is most common in asymptomatic adults in the United States. Although considerable scientific progress has been made in understanding celiac disease and in preventing or curing its manifestations, a strict gluten-free diet is the only treatment for celiac disease to date. Early diagnosis and treatment, together with regular follow-up visits with a dietitian, are necessary to ensure nutritional adequacy and to prevent malnutrition while adhering to the gluten-free diet for life. The purpose of this review is to provide clinicians with current updated information about celiac disease, its diverse clinical presentation and increased prevalence, the complex pathophysiology and strong genetic predisposition to celiac disease, and its diagnosis. This review focuses in detail on the gluten-free diet and the importance of intense expert dietary counseling for all patients with celiac disease. Recent advances in the gluten-free diet include food allergen labeling as well as the US Food and Drug Administration's proposed definition of the food-labeling term gluten-free. The gluten-free diet is complex and patients need comprehensive nutrition education from a skilled dietitian.

Metabolic syndrome and its association with diet and physical activity in US adolescents.

Abstract: Background Research on the metabolic syndrome and its association with lifestyle behaviors in adolescents is important for identifying subgroups of youth at whom interventions should be targeted. Objective To examine the relationship of metabolic syndrome with diet and physical activity in US adolescents. Design A sample of 4,450 12- to 19-year-olds was obtained from 4-year combined data of the National Health and Nutrition Examination Survey 1999-2002. Method The metabolic syndrome was defined as having three or more of the following conditions: waist circumference ≥90th percentile for age/sex, fasting blood glucose ≥100 mg/dL (5.6 mmol/L), blood triglycerides ≥110 mg/dL (≥1.2 mmol/L), HDL cholesterol ≤35 mg/dL (0.9 mmol/L), and systolic/diastolic blood pressure ≥90th percentile for height or taking antihypertensive drugs. Diet quality was assessed using the Healthy Eating Index and its components, and nutrient intakes. The association between the metabolic syndrome and physical activity was presented as the prevalence of metabolic syndrome by different physical activity levels. Results Overall prevalence of metabolic syndrome among US adolescents was 3.5%. More males than females (5.1% vs 1.7%; P P P Conclusion Results support the need to engage adolescents in regular physical activity and healthful dietary practices to prevent excessive weight gain. Weight control should be recommended as the first-line intervention to decrease metabolic syndrome in adolescents.

Motivators and Barriers to Healthful Eating and Physical Activity among Low-Income Overweight and Obese Mothers

Abstract: Low-income women who are overweight and obese are at high risk for long-term retention of weight gain during pregnancy, in part because they may have poor diets and inadequate physical activity, both of which may be exacerbated by stressful situations. This study identified motivators and barriers to healthful eating and physical activity among low-income overweight and obese non-Hispanic black and non-Hispanic white mothers. Qualitative data were collected via eight focus group interviews. Eighty low-income overweight and obese non-Hispanic black (n=41) and non-Hispanic white (n=39) mothers, age 18 to 35 years, were recruited from the Special Supplemental Nutrition Program for Women, Infants, and Children sites in six counties in Michigan. Personal appearance, fit in clothes, inability to play with their children, and social support were motivating factors for healthful eating and physical activity. Stressful experiences triggered emotional eating and reduced participants' ability to practice these behaviors. Other factors—for example, wanting quick weight-loss results—made it difficult for these mothers to follow recommended healthful lifestyle practices. Nutrition educators can address these concerns by including information about ways to deal with stress and emotional eating and emphasizing the benefits of healthful eating and physical activity in their program plans.

Eating Slowly Led to Decreases in Energy Intake within Meals in Healthy Women

Abstract: Although reducing eating rate is frequently advocated for control of food intake and thus body weight, empirical evidence is extremely limited and inconsistent. We sought to compare the impact of slow and quick eating rates on development of satiation in healthy women. In a randomized design, 30 healthy women (22.9±7.1 years; body mass index [calculated as kg/m 2 ] 22.1±2.9) were studied on two test visits to compare slow and quick eating rates. Satiation was examined as the main outcome, using the objective measure of energy intake during ad libitum meals. At designated times, subjects also rated perceived hunger, satiety, desire to eat, thirst and meal palatability on visual analogue scales. Slow rates of ingestion led to significant decreases in energy intake (quick: 645.7±155.9 kcal; slow: 579.0±154.7 kcal; P P P P P =0.04; but not significant after Bonferroni adjustment). Ad libitum energy intake was lower when the meal was eaten slowly, and satiety was higher at meal completion. Although more study is needed, these data suggest that eating slowly may help to maximize satiation and reduce energy intake within meals.

Probiotics and prebiotics in dietetics practice.

Abstract: Probiotics and prebiotics share a unique role in human nutrition, largely centering on manipulation of populations or activities of the bacteria that colonize our bodies. Benefits of regular consumption of probiotics or prebiotics include enhanced immune function, improved colonic integrity, decreased incidence and duration of intestinal infections, down-regulated allergic response, and improved digestion and elimination. Research has shown that probiotics and prebiotics may be useful in achieving these and other positive effects, provided that proper strain, product selection, and dosing guidelines of commercial products are followed. There is a need to consolidate the basic and applied research on probiotics and prebiotics into useful tools for food and nutrition professionals. Information on probiotic species, applications for specific strains, dosages and forms, safety, and shelf life is not sufficiently summarized to allow practical and consistent recommendations to be made by most food and nutrition professionals. In addition, prebiotic fibers-although providing nutraceutical and nutritional value-are a group of diverse carbohydrate ingredients that are poorly understood in regard to their origin, fermentation profiles, and dosages required for health effects. The science and practice-based guidelines presented here will enhance clinician and client understanding of probiotics and prebiotics, with the aim of improving appropriate recommendation and informed use of these emerging dietary ingredients and the products containing them.

Weight Gain Prevention: Identifying Theory-Based Targets for Health Behavior Change in Young Adults

Abstract: Young adults attending college are more vulnerable to weight gain than the general population. We sought to identify health behavior change targets related to weight management in college students. Based on the Social Cognitive Theory model for health behavior change, we investigated the health-related lifestyle behaviors and physiological characteristics of this population. Forty-three college students (18.3±0.1 years) completed a series of quantitative assessments (eg, body weight and composition, cardiorespiratory fitness, and diet and activity habits) and structured qualitative assessments (ie, structured interview or focus group). Participants were predominantly normal weight (mean body mass index 22.2±0.4) and fit (maximal oxygen consumption 50.5±1.5 mL/kg/minute). However, healthful eating and physical activity were not considered high priorities, despite having ample free time, high exercise self-efficacy, positive outcome expectations for exercise, and a desire to exercise more. Participants reported that regularly engaging in exercise was difficult. This may have been due to poor planning/time management, satisfaction with body image, lack of accountability, and feelings of laziness. Dietary patterns generally met recommendations but were low in fruits, vegetables, and whole grains. Social support for exercise and healthful dietary habits were important factors associated with health behaviors. Students reported a decline in exercise and dietary habits relative to high school, which may have contributed to college weight gain. Our results suggest that this population may not have adequate self-regulatory skills, such as planning and self-monitoring, to maintain healthful behaviors in the college environment. Food and nutrition professionals working with young adults attending college may use these findings to guide the behavioral therapy component of their weight management medical nutrition therapy goals and outcomes.

Relative reliability and validity of the Block Kids Questionnaire among youth aged 10 to 17 years.

Abstract: This cross-sectional study tested the reliability and validity of the Block Kids Questionnaire to assess diet during the past 7 days. Within a 7-day period, 10- to 17-year-old children and adolescents completed two 24-hour dietary recalls by telephone, followed by the Block Kids Questionnaire at the end of the week. Test–retest reliability was assessed using intraclass correlations for 18 participants who completed a second Block Kids Questionnaire 1 month later. Validity of the Block Kids Questionnaire compared to the 24-hour dietary recall was assessed for the whole sample and by age group using paired t tests and Pearson correlation coefficients adjusted for attenuation and energy intake. Participants were 83 children and adolescents (57% Hispanic, 21% African-American, and 23% white; 53% were female subjects, mean age 13 years). The Block Kids Questionnaire mean daily consumption values were higher for percent energy from carbohydrate, and servings of fruit, 100% fruit juice, and vegetables, and lower for all other categories compared to the 24-hour dietary recall. All reliability intraclass correlations were >0.30, except percent energy from protein and fruit/vegetable servings. Significant differences in the means between the two dietary assessment methods were noted for most nutrients/food groups. The adjusted correlation coefficients ranged from 0.69 for percent energy from carbohydrate to –0.03 for grain servings, with 60% of the food group servings 12 years were higher than those aged ≤12 years. These results suggest that the Block Kids Questionnaire has validity for some nutrients, but not most food groups assessed, and appears more useful for adolescents.

Family Meals: Perceptions of Benefits and Challenges among Parents of 8- to 10-Year-Old Children

Abstract: The study purpose was to examine parental perceptions of the mealtime environment in families with school-aged children and identify strategies to improve the dietary quality of meals. Cross-sectional surveys were completed by a convenience sample of 107 parents (86% mothers, 14% fathers) of 8- to 10-year-old children who were recruited from afterschool child care programs/elementary schools. SAS (version 9.1) was used to produce descriptive frequencies of parental reports of positive and negative perceptions of mealtime. Parents reported frequent family meals; however, they indicated that family dinners were eaten at full-service restaurants, purchased from fast-food establishments, or picked up as takeout foods at least weekly (47.0%, 28.3%, and 23.8%, respectively). Conflicts about food were problematic for some families (40.2% on at least some days), and appeared to be related to children's food pickiness. Parents reported many benefits of family meals, including time for conversation, feelings of togetherness, shared nutrition, and ceremony. Areas where parents desired change included assistance with meal planning, food preparation, and clean-up; spending more time at meals; assistance with children's food pickiness; new recipes and meal ideas; and decreasing conflict at mealtimes. Findings suggest that interventions to increase family meal frequency and promote healthful foods at mealtimes should address promoting food acceptance among children, sharing responsibilities among parents and children for meal planning and preparation, decreasing conflict at meals, and eating out healthfully.

Sources of Food Group Intakes among the US Population, 2001-2002

Abstract: Background Food guides are typically built around a system of food groups. Accordingly, the US Department of Agriculture's MyPyramid includes both food groups and subgroups, as well as an allowance for discretionary calories, in its guidance. Objective To identify the major dietary contributors to food group intake in the US population. Methods This cross-sectional study used 2001-2002 National Health and Nutrition Examination Survey data to determine weighted population proportions for the contribution of each subgroup to its MyPyramid food group (ie, proportion), and the contribution of specific foods to the subgroups oils, solid fats, and added sugars (ie, major contributors). Food codes associated with each food were sorted into 96 categories, termed specific foods, and were linked to the MyPyramid Equivalents Database to obtain food group equivalents. Results In regard to proportion, dark green vegetables (6%), orange vegetables (5%), and legumes (6%) fell well short of recommended levels. Intake of whole grains (10% of total) was far below the recommendation that at least half of all grains be whole. In regard to major contributors, top sources of oils were potato chips, salad dressing, and nuts/seeds; major contributors of solid fats were grain-based desserts, cheese, and sausages. Sweetened carbonated beverages provided 37% of added sugars. Conclusions Americans do not, in general, consume the most nutrient-dense forms of basic food groups, instead consuming foods that are high in solid fats and added sugars. The main culprits—the foods that contribute most to discrepancies between recommendations and actual intake—are sweetened carbonated beverages and other sweetened beverages, grain-based desserts, nonskim dairy products, and fatty meats.

Resistant starch intakes in the United States.

Abstract: Objective Dietary fiber represents a broad class of undigested carbohydrate components. The components vary in chemical and physical nature and in their physiological outcomes. Resistant starch is starch that escapes digestion in the small intestine and that may be fermented in the large intestine. The purpose of this study was to estimate consumption of resistant starch by the US population and to identify key sources of dietary resistant starch. Design A database of resistant starch concentrations in foods was developed from the publicly available literature. These concentrations were linked to foods reported in 24-hour dietary recalls from participants in the 1999-2002 National Health and Nutrition Examination Surveys and estimates of resistant starch intakes were generated. Subjects The study population included 18,305 nonbreastfeeding individuals in the United States. Statistical analysis The dietary intake of resistant starch was determined for 10 US subpopulations defined by age, sex, and race/ethnicity. Three estimates of resistant starch intake were made for each person based on the minimum, mean, and maximum concentrations of resistant starch in the foods consumed. Results Americans aged 1 year and older were estimated to consume approximately 4.9 g resistant starch per day based on mean resistant starch concentrations (range 2.8 to 7.9 g resistant starch per day). Breads, cooked cereals/pastas, and vegetables (other than legumes) contributed 21%, 19%, and 19% of total resistant starch intake, respectively, and were top sources of resistant starch. Conclusions Findings from this study suggest that the estimated intake of resistant starch by Americans is approximately 3 to 8 g per person per day. These estimates of resistant starch intake provide a valuable reference for researchers and food and nutrition professionals and will allow for more accurate estimates of total intakes of carbohydrate compounds that escape digestion in the small intestine.

Nine out of 10 Food Advertisements Shown During Saturday Morning Children’s Television Programming Are for Foods High in Fat, Sodium, or Added Sugars, or Low in Nutrients

Abstract: A 2005 review by the Institute of Medicine of the National Academies concluded that food marketing influences children's food preferences, consumption, and health. Given the powerful influence of marketing on children's diets, this cross-sectional study examined the types of foods, the nutritional quality of those foods, and the marketing techniques and messages used in food advertising during Saturday morning children's television programming. During 27.5 hours of programming in May 2005, 49% of advertisements shown were for food (281 food advertisements out of 572 total advertisements). The most commonly advertised food categories were ready-to-eat breakfast cereal and cereal bars (27% of all food advertisements), restaurants (19% of food advertisements), and snack foods (18% of food advertisements). Ninety-one percent of food advertisements were for foods or beverages high in fat, sodium, or added sugars or were low in nutrients. Cartoon characters were used in 74% of food advertisements, and toy or other giveaways were used in 26% of food advertisements. About half of food advertisements contained health/nutrition or physical activity messages and 86% of food advertisements contained emotional appeals. This study provides food and nutrition professionals with information about the amount and types of food children are encouraged to eat during Saturday morning television programming. The findings can help food and nutrition professionals counsel children about healthful eating and/or develop programs or policies to balance those advertisements with healthful eating messages.

A large randomized individual and group intervention conducted by registered dietitians increased adherence to Mediterranean-type diets: the PREDIMED study.

Abstract: Objective To assess the effectiveness of an intervention aimed to increase adherence to a Mediterranean diet. Design A 12-month assessment of a randomized primary prevention trial. Subjects/settings One thousand five hundred fifty-one asymptomatic persons aged 55 to 80 years, with diabetes or ≥3 cardiovascular risk factors. Intervention Participants were randomly assigned to a control group or two Mediterranean diet groups. Those allocated to the two Mediterranean diet groups received individual motivational interviews every 3 months to negotiate nutrition goals, and group educational sessions on a quarterly basis. One Mediterranean diet group received free virgin olive oil (1 L/week), the other received free mixed nuts (30 g/day). Participants in the control group received verbal instructions and a leaflet recommending the National Cholesterol Education Program Adult Treatment Panel III dietary guidelines. Main outcome measures Changes in food and nutrient intake after 12 months. Statistical analyses Paired t tests (for within-group changes) and analysis of variance (for between-group changes) were conducted. Results Participants allocated to both Mediterranean diets increased their intake of virgin olive oil, nuts, vegetables, legumes, and fruits ( P P P Conclusions A 12-month behavioral intervention promoting the Mediterranean diet can favorably modify an individual's overall food pattern. The individual motivational interventions together with the group sessions and the free provision of high-fat and palatable key foods customary to the Mediterranean diet were effective in improving the dietary habits of participants in this trial.

Role of physical activity in diabetes management and prevention.

Abstract: During recent years, evidence supporting the vital role of physical activity in the prevention and treatment of diabetes has been accumulating. Physical activity is recognized to produce multiple general and diabetes-specific health benefits. Yet despite the multitude of benefits, many people are physically inactive. As the prevalence of overweight and obesity, prediabetes, and type 2 diabetes has continued to rise at an alarming rate, physical inactivity has become an urgent public health concern. The purpose of this article is to review the physical activity/exercise research in diabetes and summarize the current exercise recommendations. This information can be used by clinicians to make safe and effective recommendations for integrating physical activity/exercise into self-management plans for individuals with diabetes or at risk for its development.

Parental Feeding Practices Predict Authoritative, Authoritarian, and Permissive Parenting Styles

Abstract: Background Our goal was to identify how parental feeding practices from the nutrition literature link to general parenting styles from the child development literature to understand how to target parenting practices to increase effectiveness of interventions. Stand-alone parental feeding practices could be targeted independently. However, parental feeding practices linked to parenting styles require interventions treating underlying family dynamics as a whole. Objective To predict parenting styles from feeding practices and to test three hypotheses: restriction and pressure to eat are positively related whereas responsibility, monitoring, modeling, and encouraging are negatively related to an authoritarian parenting style; responsibility, monitoring, modeling, and encouraging are positively related whereas restriction and pressure to eat are negatively related to an authoritative parenting style; a permissive parenting style is negatively linked with all six feeding practices. Design Baseline data of a randomized-controlled intervention study. Subjects/setting Two hundred thirty-nine parents (93.5% mothers) of first-grade children (134 boys, 105 girls) enrolled in rural public schools. Measures Parental responses to encouraging and modeling questionnaires and the Child Feeding Questionnaire, as well as parenting styles measured by the Parenting Styles and Dimensions Questionnaire. Statistical analyses Correlation and regression analyses. Results Feeding practices explained 21%, 15%, and 8% of the variance in authoritative, authoritarian, and permissive parenting, respectively. Restriction, pressure to eat, and monitoring (negative) significantly predicted an authoritarian style (Hypothesis 1); responsibility, restriction (negative), monitoring, and modeling predicted an authoritative style (Hypothesis 2); and modeling (negative) and restriction significantly predicted a permissive style (Hypothesis 3). Conclusions Parental feeding practices with young children predict general parenting styles. Interventions that fail to address underlying parenting styles are not likely to be successful.

Why Eat at Fast-Food Restaurants: Reported Reasons among Frequent Consumers

Abstract: A convenience sample of adolescents and adults who regularly eat at fast-food restaurants were recruited to participate in an experimental trial to examine the effect of nutrition labeling on meal choices. As part of this study, participants were asked to indicate how strongly they agreed or disagreed with 11 statements to assess reasons for eating at fast-food restaurants. Logistic regression was conducted to examine whether responses differed by demographic factors. The most frequently reported reasons for eating at fast-food restaurants were: fast food is quick (92%), restaurants are easy to get to (80%), and food tastes good (69%). The least frequently reported reasons were: eating fast food is a way of socializing with family and friends (33%), restaurants have nutritious foods to offer (21%), and restaurants are fun and entertaining (12%). Some differences were found with respect to the demographic factors examined. It appears that in order to reduce fast-food consumption, food and nutrition professionals need to identify alternative quick and convenient food sources. As motivation for eating at fast-food restaurants appears to differ somewhat by age, sex, education, employment status, and household size, tailored interventions could be considered.

Restricted-carbohydrate diets in patients with type 2 diabetes: a meta-analysis.

Abstract: Many current popular weight-loss diets advocate restricting carbohydrates, but risks and benefits of these diets for patients with diabetes is unclear. We searched for articles published in English between 1980 and April 2006 regarding carbohydrate-restricted diets that included and reported separate results for adult, nonpregnant patients with type 2 diabetes. Articles were limited to studies completed in the United States and Canada. Available data on study design; carbohydrate composition of diet; duration of diet; and the outcomes of weight, lipid levels (total, low-density lipoprotein and high-density lipoprotein cholesterol, and triglycerides), hemoglobin A1c percent and/or fasting glucose were extracted. A total of 56 studies or reviews were evaluated. Thirteen studies met our inclusion criteria. Meta-regression analyses show that hemoglobin A1c, fasting glucose, and some lipid fractions (triglycerides) improved with lower carbohydrate-content diets. Overall effect on weight was equivocal among the studies evaluated in this meta-analysis. Randomized, controlled studies of restricted-carbohydrate diets in patients with diabetes need to be conducted in order to evaluate the overall sustainability of outcomes and long-term safety.

Dietary patterns derived by hybrid clustering method in older people: association with cognition, mood, and self-rated health.

Abstract: Background Several nutritional factors, including dietary fatty acids, antioxidants, and folates, have been related to pathological brain aging. Dietary patterns that represent a combination of foods may better predict disease risk than single foods or nutrients. Objective To identify dietary patterns by a mixed clustering method and to analyze their relationship with cognitive function, depressive symptoms, and self-rated health in older people. Design Cross-sectional population-based study. Subjects/setting Subjects included 1,724 elderly community dwellers living in Bordeaux, France from 2001 to 2002. Statistical analysis Cluster analysis, combining hybrid clustering, and research for stable groups during the k-means step on mean number of weekly servings of 20 predetermined food groups, separately in men and women. Results Five dietary clusters were identified in each sex. A "healthy" cluster characterized by higher consumption of fish in men (n=157; 24.3%) and fruits and vegetables in women (n=267; 24.8%) had significantly lower mean number of errors to Mini Mental State score after adjustment for socio-demographic variables (β=−0.11; 95% confidence interval [CI], −0.22 to −0.004 in men; β=−0.13; 95% CI, −0.22 to −0.04 in women). The same cluster was associated with borderline significance with lower depressive symptoms in women (β=−0.16; 95% CI, −0.33 to 0.007). Men in the "pasta eaters" cluster (n=136; 21%) had higher depressive symptoms (β=0.26; 95% CI, 0.06 to 0.46) and higher risk to report poor health (polytomous regression, odds ratio [OR]=1.91; 95% CI, 1.21 to 3.01) than the "healthy" cluster. Women in the "biscuits and snacking" cluster (n=162; 15%) had greater risk of poor perceived health (OR=1.69; 95% CI, 1.15 to 2.48) compared to "healthy" eaters. Additional adjustment for body mass index and medication use strengthened these associations. Conclusions Sex-specific dietary patterns derived by hybrid clustering method are associated with fewer cognitive and depressive symptoms and better perceived health in older people.

Overweight and Obesity Are Associated with Emotion- and Stress-Related Eating as Measured by the Eating and Appraisal Due to Emotions and Stress Questionnaire

Abstract: Objective Identify if constructs from the Eating and Appraisal Due to Emotions and Stress Model, including Emotion and Stress Related Eating, Appraisal of Ability and Resources to Cope, and Appraisal of Outside Influences and Stressors, were related to overweight and obesity. Design Data were collected from a cross-sectional study using the Eating and Appraisal Due to Emotions and Stress Questionnaire. Subjects/Setting Convenience sample from a southeastern public university, including staff and faculty (n=822) with ages ranging from 18 to 83 years and 55.8% of the sample being overweight or obese. Statistical analysis performed Total sum scores were given to each construct and converted to quartiles. Lower quartiles represented higher stress- or emotion-related eating and more compromised appraisal skills or resources to cope. χ 2 Analyses were used to identify variables associated with overweight and obesity. Forward stepwise logistic regression (n=783) was used to identify the independent association of each significant variable with overweight and obesity. Results A model including race, sex, life stage, and job category as covariates, with a cumulative R 2 of 0.075 was produced. Emotion- and Stress-Related Eating remained in the model during stepwise regression producing a cumulative R 2 =0.265. Individuals scoring in the lowest quartiles for Emotion- and Stress-Related Eating were 13.38 times more likely to be overweight or obese, compared with individuals scoring in the highest quartiles. Conclusions The Eating and Appraisal Due to Emotions and Stress Model construct of Emotion- and Stress-Related Eating as measured by the Eating and Appraisal Due to Emotions and Stress Questionnaire can be used to assess nontraditional factors that contribute to overweight and obesity.

Drinking flavored or plain milk is positively associated with nutrient intake and is not associated with adverse effects on weight status in US children and adolescents.

Abstract: Objective Little research has been conducted on health effects associated with consumption of flavored milk The purposes of this study were to compare nutrient intakes and body measures among children and adolescents drinking flavored milk (with or without plain milk), exclusively plain milk, and no milk Design Data used in the study included intakes reported in 24-hour dietary recalls and height and weight measurements collected during a physical examination in the 1999-2002 National Health and Nutrition Examination Surveys The milk drinking status of each person was identified, and nutrient intakes and body mass index (BMI) measures were determined by milk drinking status Subjects The study population included 7,557 children and adolescents aged 2 to 18 years Statistical analysis Comparisons among mean milk intakes, energy and nutrient intakes, and BMI measures by milk drinking status were completed using linear regression analysis Results Children and adolescents who included flavored milk in their diets reported higher total milk intakes than consumers of exclusively plain milk ( P P P Conclusions Findings from this study suggest that consumption of either flavored or plain milk is associated with a positive influence on nutrient intakes by children and adolescents and is not associated with adverse effects on BMI measures

Dietary Intakes in North Carolina Child-Care Centers: Are Children Meeting Current Recommendations?

Abstract: The purpose of this study was to determine whether food consumed by children while in center-based child care meets the new MyPyramid food group recommendations for children 2 to 5 years of age. Dietary observation of 117 children from 20 child-care centers throughout North Carolina was conducted. The type and amount of food served to and consumed by children was observed and assessed using Nutrition Data System for Research (NDS-R) software (version 2005, Nutrition Coordinating Center, University of Minnesota, Minneapolis). Portion sizes were then compared to the new MyPyramid food group recommendations to see whether 1/2 to 2/3 (for time spent in full-day child care) of the recommended amounts were consumed. On average, of the five main food groups, children consumed only the 1/2 to 2/3 recommendation for milk. Children also consumed less than 13% of MyPyramid recommendations for whole grains and 7% of MyPyramid recommendations for dark vegetables. Also noteworthy, 50% of milk consumed was whole milk and 75% of the meat consumed was of the high-fat or fried variety. Overall, our data suggest that children are not consuming recommended amounts of whole grains, fruits (excluding 100% fruit juice), or vegetables while attending full-time child care, and are consuming excess amounts of saturated fat and added sugar.

Dietary intake and parents' perception of mealtime behaviors in preschool-age children with autism spectrum disorder and in typically developing children.

Abstract: Parents of children with autism spectrum disorder (ASD) frequently report that their children have selective eating behaviors and refuse many foods, which could result in inadequate nutrient intake. This preliminary cross-sectional descriptive study investigated dietary intake and parents' reported perception of food behaviors of 20 3- to 5-year-old children with ASD. Twenty typically developing children matched for sex, age, and ethnicity were also studied as a case-control comparison. Nutrient intake determined from 3-day food records was adjusted for day-to-day variation to determine the estimate of usual intake distribution for the two groups. This distribution was compared with the Estimated Average Requirement or Adequate Intake recommendations. The reported food behaviors and use of vitamin or mineral supplements were compared for matched pairs using the exact McNemar test. Nutrient intake was similar for both groups of children, with the majority of children consuming more than the recommended amounts for most nutrients. Nutrients least likely to be consumed in recommended amounts were vitamin A, vitamin E, fiber, and calcium. Children with ASD were more likely to consume vitamin/mineral supplements than typically developing children. Compared with parents of typically developing children, parents of children with ASD were more likely to report that their children were picky eaters and resisted trying new foods, and they were less likely to describe their children as healthy eaters or that they eat a variety of foods. Despite the similar and generally adequate nutrient intake for the 40 children in this study, parents of children with ASD had more negative perceptions of their children's dietary behaviors.

Examining the nutritional quality of breakfast cereals marketed to children.

Abstract: There are both public health and food industry initiatives aimed at increasing breakfast consumption among children, particularly the consumption of ready-to-eat cereals. The purpose of this study was to determine whether there were identifiable differences in nutritional quality between cereals that are primarily marketed to children and cereals that are not marketed to children. Of the 161 cereals identified between January and February 2006, 46% were classified as being marketed to children (eg, packaging contained a licensed character or contained an activity directed at children). Multivariate analyses of variance were used to compare children's cereals and nonchildren's cereals with respect to their nutritional content, focusing on nutrients required to be reported on the Nutrition Facts panel (including energy). Compared to nonchildren's cereals, children's cereals were denser in energy, sugar, and sodium, but were less dense in fiber and protein. The proportion of children's and nonchildren's cereals that did and did not meet national nutritional guidelines for foods served in schools were compared using χ 2 analysis. The majority of children's cereals (66%) failed to meet national nutrition standards, particularly with respect to sugar content. t tests were used to compare the nutritional quality of children's cereals with nutrient-content claims and health claims to those without such claims. Although the specific claims were generally justified by the nutritional content of the product, there were few differences with respect to the overall nutrition profile. Overall, there were important differences in nutritional quality between children's cereals and nonchildren's cereals. Dietary advice for children to increase consumption of ready-to-eat breakfast cereals should identify and recommend those cereals with the best nutrient profiles.

Alcohol Consumption by Aging Adults in the United States: Health Benefits and Detriments

Abstract: The most rapidly growing segment of the US population is that of older adults (> or =65 years). Trends of aging adults (those aged > or =50 years) show that fewer women than men consume alcohol, women consume less alcohol than men, and total alcohol intake decreases after retirement. A U- or J-shaped relationship between alcohol intake and mortality exists among middle-aged (age 45 to 65 years) and older adults. Thus, alcohol can be considered either a tonic or a toxin in dose-dependent fashion. Active areas of research regarding the possible benefits of moderate alcohol consumption among aging individuals include oxidative stress, dementia, psychosocial functioning, dietary contributions, and disease prevention. Yet, due to the rising absolute number of older adults, there may be a silent epidemic of alcohol abuse in this group. Dietary effects of moderate and excessive alcohol consumption are reviewed along with mechanisms by which alcohol or phytochemicals modify physiology, mortality, and disease burden. Alcohol pharmacokinetics is considered alongside age-related sensitivities to alcohol, drug interactions, and disease-related physiological changes. International guidelines for alcohol consumption are reviewed and reveal that many nations lack guidelines specific to older adults. A review of national guidelines for alcohol consumption specific to older adults (eg, those offered by the National Institute on Alcohol Abuse) suggests that they may be too restrictive, given the current literature. There is need for greater quantification and qualification of per capita consumption, consumption patterns (quantity, frequency, and stratified combinations), and types of alcohol consumed by older adults in the United States.

Obesity-Related Hypoferremia Is Not Explained by Differences in Reported Intake of Heme and Nonheme Iron or Intake of Dietary Factors that Can Affect Iron Absorption

Abstract: Hypoferremia is more prevalent in obese than nonobese adults, but the reason for this phenomenon is unknown. To elucidate the role dietary factors play in obesity-related hypoferremia, the intake of heme and nonheme iron and the intake of other dietary factors known to affect iron absorption were compared cross-sectionally from April 2002 to December 2003 in a convenience sample of 207 obese and 177 nonobese adults. Subjects completed 7-day food records, underwent phlebotomy for serum iron measurement, and had body composition assessed by dual-energy x-ray absorptiometry, during a 21-month period. Data were analyzed by analysis of covariance and multiple linear regression. Serum iron (mean±standard deviation) was significantly lower in obese than nonobese individuals (72.0±61.7 vs 85.3±58.1 μg/dL [12.888±11.0443 vs 15.2687±10.3999 μmol/L]; P P P P =0.01), which may increase absorption of nonheme iron, and less calcium (766.2±665.0 vs 849.0±627.2 mg/day; P =0.038), which may decrease nonheme iron absorption, than nonobese subjects. Groups did not significantly differ in intake of other dietary factors that can impact absorption of iron, including phytic acid, oxalic acid, eggs, coffee, tea, zinc, vegetable protein, or copper. After accounting for demographic covariates and dietary factors expected to affect iron absorption, fat mass ( P =0.007) remained a statistically significant negative predictor of serum iron. This cross-sectional, exploratory study suggests that obesity-related hypoferremia is not associated with differences in reported intake of heme and nonheme iron or intake of dietary factors that can affect iron absorption.

Underreporting of Energy Intake in Brazilian Women Varies According to Dietary Assessment: A Cross-Sectional Study Using Doubly Labeled Water

Abstract: Objective Underreporting of energy intake is prevalent in food surveys, but there is controversy about which dietary assessment method provides greater underreporting rates. Our objective is to compare validity of self-reported energy intake obtained by three dietary assessment methods with total energy expenditure (TEE) obtained by doubly labeled water (DLW) among Brazilian women. Design We used a cross-sectional study. Subjects/setting Sixty-five females aged 18 to 57 years (28 normal-weight, 10 overweight, and 27 obese) were recruited from two universities to participate. Main outcome measures TEE determined by DLW, energy intake estimated by three 24-hour recalls, 3-day food record, and a food frequency questionnaire (FFQ). Statistical analyses performed Regression and analysis of variance with repeated measures compared TEE and energy intake values, and energy intake-to-TEE ratios and energy intake−TEE values between dietary assessment methods. Bland and Altman plots were provided for each method. χ 2 test compared proportion of underreporters between the methods. Results Mean TEE was 2,622 kcal (standard deviation [SD]=490 kcal), while mean energy intake was 2,078 kcal (SD=430 kcal) for the diet recalls; 2,044 kcal (SD=479 kcal) for the food record and 1,984 kcal (SD=832 kcal) for the FFQ (all energy intake values significantly differed from TEE; P Conclusions The FFQ produced greater under- and overestimation of energy intake. Underreporting of energy intake is a serious and prevalent error in dietary self-reports provided by Brazilian women, as has been described in studies conducted in developed countries.