Showing papers in "Journal of The American Dietetic Association in 2011"

Self-Monitoring in Weight Loss: A Systematic Review of the Literature

Abstract: Self-monitoring is the centerpiece of behavioral weight loss intervention programs This article presents a systematic review of the literature on three components of self-monitoring in behavioral weight loss studies: diet, exercise, and self-weighing This review included articles that were published between 1993 and 2009 that reported on the relationship between weight loss and these self-monitoring strategies Of the 22 studies identified, 15 focused on dietary self-monitoring, one on self-monitoring exercise, and six on self-weighing A wide array of methods was used to perform self-monitoring; the paper diary was used most often Adherence to self-monitoring was reported most frequently as the number of diaries completed or the frequency of log-ins or reported weights The use of technology, which included the Internet, personal digital assistants, and electronic digital scales were reported in five studies Descriptive designs were used in the earlier studies whereas more recent reports involved prospective studies and randomized trials that examined the effect of self-monitoring on weight loss A significant association between self-monitoring and weight loss was consistently found; however, the level of evidence was weak because of methodologic limitations The most significant limitations of the reviewed studies were the homogenous samples and reliance on self-report In all but two studies, the samples were predominantly white and women This review highlights the need for studies in more diverse populations, for objective measures of adherence to self-monitoring, and for studies that establish the required dose of self-monitoring for successful outcomes

Dieting and Disordered Eating Behaviors from Adolescence to Young Adulthood: Findings from a 10-Year Longitudinal Study

Abstract: Background Disordered eating behaviors are prevalent in adolescence and can have harmful consequences. An important question is whether use of these behaviors in adolescence sets the pattern for continued use into young adulthood. Objective To examine the prevalence and tracking of dieting, unhealthy and extreme weight control behaviors, and binge eating from adolescence to young adulthood. Design Population-based, 10-year longitudinal study (Project EAT-III: Eating Among Teens and Young Adults, 1999-2010). Participants/setting The study population included 2,287 young adults (55% girls, 52% nonwhite). The sample included a younger group (mean age 12.8±0.7 years at baseline and 23.2±1.0 years at follow-up) and an older group (mean age 15.9±0.8 at baseline and 26.2±0.9 years at follow-up). Statistical analyses performed Longitudinal trends in prevalence of behaviors were tested using generalized estimating equations. Tracking of behaviors were estimated using the relative risk of behaviors at follow-up given presence at baseline. Results In general, the prevalence of dieting and disordered eating was high and remained constant, or increased, from adolescence to young adulthood. Furthermore, behaviors tended to track within individuals and, in general, participants who engaged in dieting and disordered eating behaviors during adolescence were at increased risk for these behaviors 10 years later. Tracking was particularly consistent for the older girls and boys transitioning from middle adolescence to middle young adulthood. Conclusions Study findings indicate that disordered eating behaviors are not just an adolescent problem, but continue to be prevalent among young adults. The tracking of dieting and disordered eating within individuals suggests that early use is likely to set the stage for ongoing use. Findings suggest a need for both early prevention efforts before the onset of harmful behavioral patterns as well as ongoing prevention and treatment interventions to address the high prevalence of disordered eating throughout adolescence and young adulthood.

What role can child-care settings play in obesity prevention? A review of the evidence and call for research efforts.

Abstract: Given the widespread use of out-of-home child care and an all-time high prevalence of obesity among US preschool-aged children, it is imperative to consider the opportunities that child-care facilities may provide to reduce childhood obesity. This review examines the scientific literature on state regulations, practices and policies, and interventions for promoting healthy eating and physical activity, and for preventing obesity in preschool-aged children attending child care. Research published between January 2000 and July 2010 was identified by searching PubMed and MEDLINE databases, and by examining the bibliographies of relevant studies. Although the review focused on US child-care settings, interventions implemented in international settings were also included. In total, 42 studies were identified for inclusion in this review: four reviews of state regulations, 18 studies of child-care practices and policies that may influence eating or physical activity behaviors, two studies of parental perceptions and practices relevant to obesity prevention, and 18 evaluated interventions. Findings from this review reveal that most states lack strong regulations for child-care settings related to healthy eating and physical activity. Recent assessments of child-care settings suggest opportunities for improving the nutritional quality of food provided to children, the time children are engaged in physical activity, and caregivers' promotion of children's health behaviors and use of health education resources. A limited number of interventions have been designed to address these concerns, and only two interventions have successfully demonstrated an effect on child weight status. Recommendations are provided for future research addressing opportunities to prevent obesity in child-care settings.

Trends in Energy Intake among US Children by Eating Location and Food Source, 1977-2006

Abstract: Background Little is known about the influence of location of food consumption and preparation upon daily energy intake of children. Objective To examine trends in daily energy intake by children for foods eaten at home or away from home, by source of preparation, and for combined categories of eating location and food source. Subjects The analysis uses data from 29,217 children aged 2 to 18 years from the 1977-1978 Nationwide Food Consumption Survey, 1989-1991 and 1994-1998 Continuing Survey of Food Intakes by Individuals, and 2003-2006 National Health and Nutrition Examination Surveys. Methods Nationally representative weighted percentages and means of daily energy intake by eating location were analyzed for trends from 1977 to 2006. Comparisons by food source were examined from 1994 to 2006. Analyses were repeated for three age groups: 2 to 6 years, 7 to 12 years, and 13 to 18 years. Difference testing was conducted using a t test. Results Increased energy intake (+179 kcal/day) by children from 1977-2006 was associated with a major increase in energy eaten away from home (+255 kcal/day). The percentage of daily energy eaten away from home increased from 23.4% to 33.9% from 1977-2006. No further increase was observed from 1994-2006, but the sources of energy shifted. The percentage of energy from fast food increased to surpass intake from schools and become the largest contributor to foods prepared away from home for all age groups. For foods eaten away from home, the percentage of daily energy from stores increased to become the largest source of energy eaten away from home. Fast food eaten at home and store-bought food eaten away from home increased significantly. Conclusions Eating location and food source significantly influence daily energy intake for children. Foods prepared away from home, including fast food eaten at home and store-prepared food eaten away from home, are fueling the increase in total energy intake. However, further research using alternative data sources is necessary to verify that store-bought foods eaten away from home are increasingly store-prepared.

The 2011 Dietary Reference Intakes for Calcium and Vitamin D: What Dietetics Practitioners Need to Know

Abstract: The Institute of Medicine Committee to Review Dietary Reference Intakes for Calcium and Vitamin D comprehensively reviewed the evidence for both skeletal and nonskeletal health outcomes and concluded that a causal role of calcium and vitamin D in skeletal health provided the necessary basis for the 2011 Estimated Average Requirement (EAR) and Recommended Dietary Allowance (RDA) for ages older than 1 year For nonskeletal outcomes, including cancer, cardiovascular disease, diabetes, infections, and autoimmune disorders, randomized clinical trials were sparse, and evidence was inconsistent, inconclusive as to causality, and insufficient for Dietary Reference Intake (DRI) development The EAR and RDA for calcium range from 500 to 1,100 and 700 to 1,300 mg daily, respectively, for ages 1 year and older For vitamin D (assuming minimal sun exposure), the EAR is 400 IU/day for ages older than 1 year and the RDA is 600 IU/day for ages 1 to 70 years and 800 IU/day for 71 years and older, corresponding to serum 25-hydroxyvitamin D (25OHD) levels of 16 ng/mL (40 nmol/L) for EARs and 20 ng/mL (50 nmol/L) or more for RDAs Prevalence of vitamin D inadequacy in North America has been overestimated based on serum 25OHD levels corresponding to the EAR and RDA Higher serum 25OHD levels were not consistently associated with greater benefit, and for some outcomes U-shaped associations with risks at both low and high levels were observed The Tolerable Upper Intake Level for calcium ranges from 1,000 to 3,000 mg daily, based on calcium excretion or kidney stone formation, and from 1,000 to 4,000 IU daily for vitamin D, based on hypercalcemia adjusted for uncertainty resulting from emerging risk relationships Urgently needed are evidence-based guidelines to interpret serum 25OHD levels relative to vitamin D status and intervention

Position of the American Dietetic Association: benchmarks for nutrition in child care.

Abstract: It is the position of the American Dietetic Association that child-care programs should achieve recommended benchmarks for meeting children's nutrition needs in a safe, sanitary, and supportive environment that promotes optimal growth and development. Use of child care has become increasingly common and is now the norm for the majority of families in the United States. Therefore, it is essential that registered dietitians; dietetic technicians, registered; and other food and nutrition practitioners work in partnership with child-care providers and families of children in child care to meet children's nutrition needs and provide them with models of healthful eating and active lifestyles. This Position Paper provides guidance for food and nutrition practitioners, health professionals, and child-care providers regarding recommendations for nutritional quality of foods and beverages served; menus, meal patterns, and portion sizes; food preparation and service; physical and social environment; nutrition training; nutrition consultation; physical activity and active play; and working with families. This Position Paper targets children aged 2 to 5 years attending child-care programs and highlights opportunities for food and nutrition practitioners to promote healthful eating in child care through both intervention and policy-based initiatives.

A systematic review of behavioral interventions to promote intake of fruit and vegetables.

Abstract: Fruit and vegetable (F/V) intake in the United States remains below recommended levels despite evidence of the health benefits of regular consumption. Efforts to increase F/V intake include behavior-based interventions. A systematic review of MEDLINE PubMed and PsycINFO databases (2005–2010) was conducted to identify behavior-based intervention trials designed to promote F/V intake. Using predetermined limits and selection criteria, 34 studies were identified for inclusion. Behavior-based interventions resulted in an average increase in F/V intake of +1.13 and +0.39 servings per day in adults and children, respectively. Interventions involving minority adults or low-income participants demonstrated average increases in daily F/V consumption of +0.97 servings/day, whereas worksite interventions averaged +0.8 servings/day. Achieving and sustaining F/V intake at recommended levels of intake across the population cannot be achieved through behavior-based interventions alone. Thus, efforts to combine these interventions with other approaches including social marketing, behavioral economics approaches, and technology-based behavior change models should be tested to ensure goals are met and sustained.

Young adults and eating away from home: associations with dietary intake patterns and weight status differ by choice of restaurant.

Abstract: Background Young adults report frequent away-from-home eating; however, little is known regarding what types of restaurants are patronized or whether associations with dietary intake and weight status differ according to restaurant type. Objective This cross-sectional study in a diverse sample of young adults examines sociodemographic differences in the frequency of eating at different types of fast-food and full-service (server brings food to table) restaurants. In addition, this study examines whether associations between away-from-home eating, dietary intake, and weight status differ according to restaurant type. Design There were 1,030 men and 1,257 women (mean age=25.3 years) who participated in Project EAT-III (Eating and Activity in Teens and Young Adults). Participants were members of a longitudinal cohort who completed baseline surveys at schools in Minneapolis/St Paul, MN, and completed the EAT-III surveys online or by mail in 2008-2009. Main outcome measures Height, weight, and usual dietary intake were self-reported. Statistical analyses performed Regression models adjusted for sociodemographic characteristics were used to examine associations between frequency of restaurant use, dietary intake, and weight status. Results More frequent use of fast-food restaurants that primarily served burgers and french fries was associated with higher risk for overweight/obesity; higher intake of total energy, sugar-sweetened beverages, and fat; and with lower intake of healthful foods and key nutrients. For example, those who reported burger-and-fries restaurant use on three or more occasions per week consumed nearly one additional sugar-sweetened beverage per day compared to those who reported burger-and-fries restaurant use on less than one occasion per week. More frequent use of fast-food restaurants that primarily served sandwiches/subs was related to a few markers of poorer diet quality, but unrelated to weight status. More frequent use of full-service restaurants was also unrelated to weight status and related to higher intake of vegetables. Conclusions There may be a need for interventions to promote healthier food choices among young adults who report frequent burger-and-fries restaurant use.

LA Sprouts: A Gardening, Nutrition, and Cooking Intervention for Latino Youth Improves Diet and Reduces Obesity

Abstract: Evidence demonstrates that a gardening and nutrition intervention improves dietary intake in children, although no study has evaluated the effect of this type of intervention on obesity measures. The objective of this pilot study was to develop and test the effects of a 12-week, after-school gardening, nutrition, and cooking program (called LA Sprouts) on dietary intake and obesity risk in Latino fourth- and fifth-grade students in Los Angeles, CA. One hundred four primarily Latino children (mean age 9.8±0.7 years), 52% boys and 59% overweight, completed the program (n=70 controls, n=34 LA Sprouts participants). Weight, height, body mass index, waist circumference, body fat (via bioelectrical impendence), blood pressure, and dietary intake (via food frequency screener) were obtained at baseline and postintervention. LA Sprouts participants received weekly 90-minute, culturally tailored, interactive classes for 12 consecutive weeks during spring 2010 at a nearby community garden, whereas control participants received an abbreviated delayed intervention. Compared to subjects in the control group, LA Sprouts participants had increased dietary fiber intake (+22% vs −12%; P =0.04) and decreased diastolic blood pressure (−5% vs −3%; P =0.04). For the overweight subsample, LA Sprouts participants had a significant change in dietary fiber intake (0% vs −29%; P =0.01), reduction in body mass index (−1% vs +1%; P =0.04) and less weight gain (+1% vs +4%; P =0.03) compared to those in the control group. We conclude that a gardening, nutrition, and cooking intervention is a promising approach to improve dietary intake and attenuate weight gain in Latino children, particularly in those who are overweight.

Diet and Asthma: Nutrition Implications from Prevention to Treatment

Abstract: Asthma is characterized by lung airway inflammation initiated and perpetuated by an inappropriate immune response, increased airway responsiveness, and variable airflow obstruction. In Western countries there has been a marked increase in asthma prevalence such that it has become a public health concern. It has been hypothesized that the increase may be due to changing antioxidant intake, increasing dietary ratio of n-6:n-3 polyunsaturated fatty acids (PUFA), and vitamin D deficiency (and supplementation). Observational studies have reported associations between asthma and dietary antioxidants (vitamin E, vitamin C, carotenoids, selenium, polyphenols, and fruit), PUFA, and vitamin D. However, supplementing the diets of adults with asthma with antioxidants and n-3 PUFA has minimal, if any, clinical benefit. Currently there is insufficient evidence to support the use of nutrient supplements to complement conventional treatment; however, results of ongoing studies are awaited, and additional research is required, particularly in children. Interest in the potential of dietary intervention during pregnancy to reduce the likelihood of childhood asthma has increased. A small number of cohort studies have highlighted associations between childhood asthma and reduced maternal intake of some nutrients (vitamin E, vitamin D, selenium, zinc, and PUFA) during pregnancy. Although vitamin D intervention studies during pregnancy are ongoing and two intervention studies suggest that dietary PUFA manipulation during pregnancy may be advantageous, further trials are needed to establish if modification of maternal nutrient intake during pregnancy can be used as a healthy, low cost, public health measure to reduce the prevalence of childhood asthma.

Multiple sociodemographic and socioenvironmental characteristics are correlated with major patterns of dietary intake in adolescents.

Abstract: Background Few studies have used dietary pattern analysis, a useful method to summarize dietary intake, in adolescents. Objective Examine sociodemographic and socioenvironmental correlates of habitual dietary patterns. Design Data for this cross-sectional/prospective analysis were drawn from Project EAT (Eating Among Teens), a population-based study. Subjects/setting Project EAT-I (Time 1), collected data on 4,746 adolescents in 1998-1999. Project EAT-II (Time 2) resurveyed 53% (n=2,516) of the original cohort 5 years later in 2003-2004. Dietary intake was assessed using the Youth/Adolescent Food Frequency Questionnaire. Main outcome measures/statistical analysis performed Factor analysis identified four dietary patterns at Time 1 (vegetable, fruit, starchy food, and snack food) and Time 2 (vegetable and fruit, fast food, starchy food, and snack food). Linear regression was used to examine the relationship of Time 1 socioeconomic status and race (mutually adjusted) on factor scores for each dietary pattern, and then of Time 1 socioenvironmental characteristics (adjusted for socioeconomic status and race) on these factor scores. Results In prospective analyses, socioeconomic status, family meal frequency, and home availability of healthy food were positively associated with the vegetable and fruit and starchy food patterns and inversely associated with the fast food pattern. Home availability of unhealthy food was inversely associated with the vegetable and fruit and starchy food patterns and positively associated with the fast food and snack food patterns. Maternal, paternal, and peer support for healthy eating were positively associated with the vegetable and fruit pattern and inversely associated with the fast food pattern. Similar associations were seen in cross-sectional analyses. Conclusions Multiple correlates of dietary patterns were identified. Health professionals should target these factors to improve the dietary quality of habitual eating practices in adolescents by encouraging parents to decrease home availability of unhealthy food while increasing availability of healthy food, family meal frequency, and parental support for healthy eating.

Green Tea Catechins Decrease Total and Low-Density Lipoprotein Cholesterol: A Systematic Review and Meta-Analysis

Abstract: Green tea catechins (GTCs) have been studied in randomized control trials for their lipid-lowering effects. Studies, however, have been small and demonstrated conflicting results. The objective of this study was to perform a systematic review and meta-analysis of randomized controlled trials evaluating the relationship between GTCs and serum lipid levels, including total, low-density lipoprotein (LDL), high-density lipoprotein (HDL) cholesterol, and triglycerides. A systematic literature search of MEDLINE, EMBASE, Cochrane CENTRAL, and the Natural Medicines Comprehensive Database was conducted through March 2010. Randomized controlled trials evaluating GTCs vs control in human beings and reporting efficacy data on at least one of the aforementioned serum lipid endpoints were included. Weighted mean differences for changes from baseline (with 95% confidence intervals [CIs]) for lipid endpoints were calculated using random-effects models. Twenty trials (N=1,415) met all inclusion criteria. Upon meta-analysis, GTCs at doses ranging from 145 to 3,000 mg/day taken for 3 to 24 weeks reduced total (-5.46 mg/dL [-0.14 mmol/L]; 95% CI -9.59 to -1.32) and LDL cholesterol (-5.30 mg/dL [-0.14 mmol/L]; 95% CI -9.99 to -0.62) compared to control. GTCs did not significantly alter HDL cholesterol (-0.27 mg/dL [-0.007 mmol/L]; 95% CI -1.62 to 1.09) or triglyceride (3.00 mg/dL [-0.034 mmol/L]; 95% CI -2.73 to 8.73) levels. The consumption of GTCs is associated with a statistically significant reduction in total and LDL cholesterol levels; however, there was no significant effect on HDL cholesterol or triglyceride levels.

Nutrition Knowledge: A Mediator between Socioeconomic Position and Diet Quality in Australian First-Time Mothers

Abstract: Background Mothers are important role models for eating and are gatekeepers of food in the home. An understanding of maternal dietary behaviors could assist in the promotion of healthy eating for both mother and child. Objective To investigate the independent contribution of socioeconomic position to nutrition knowledge and diet quality, and the contribution of nutrition knowledge to diet quality; and to assess nutrition knowledge as a mediator between socioeconomic position and diet quality. Subjects/setting Subjects included first-time Australian mothers residing in Melbourne, Australia (n=527). Design Cross-sectional data from the Melbourne InFANT (Infant Feeding, Activity, and Nutrition Trial) Program. Methods A self-completed validated food-frequency questionnaire recorded dietary intake during the past year and a diet quality score was developed. Maternal education was used to classify socioeconomic position. Regression analyses were undertaken to assess associations between socioeconomic position and nutrition knowledge score; socioeconomic position and diet score; and nutrition knowledge score and diet score. Baron and Kenny's approach to mediation analyses was used to assess nutrition knowledge as a mediator. Results Overall maternal diet quality was poor, with average diet quality scores of 52.4, 52.9, and 57.1 out of a possible 80, in the low, medium, and high socioeconomic groups, respectively. Maternal diet quality was significantly better in mothers of high socioeconomic position as compared with the low socioeconomic position group ( P Conclusions Poor maternal dietary quality may have implications for both mother and child, and socioeconomic position and nutrition knowledge are likely to be important. Effective interventions to support mothers to achieve healthy diets for themselves and their families are needed.

Dietary patterns and survival of older adults.

Abstract: Background Recent research has linked overall dietary patterns to survival in older adults. Objectives The objective of this study was to determine the dietary patterns of a cohort of older adults, and to explore associations of these dietary patterns with survival over a 10-year period. A secondary goal was to evaluate participants' quality of life and nutritional status according to their dietary patterns. Design The Health, Aging, and Body Composition Study is a prospective cohort study of 3,075 older adults. In this study, all-cause mortality was assessed from baseline through Year 10. Food intake was estimated with a modified Block food frequency questionnaire, and dietary patterns of 2,582 participants with complete data were derived by cluster analysis. Results Six dietary pattern clusters were identified, including a Healthy Foods cluster, characterized by higher intake of low-fat dairy products, fruit, whole grains, poultry, fish, and vegetables. Both the High-Fat Dairy Products and Sweets and Desserts clusters had a 1.4-fold higher risk of mortality than the Healthy Foods cluster after adjusting for potential confounders. The Healthy Foods cluster also had significantly more years of healthy life and more favorable levels of selected nutritional biomarkers than the other clusters. Conclusions A dietary pattern consistent with current guidelines to consume relatively high amounts of vegetables, fruit, whole grains, poultry, fish, and low-fat dairy products may be associated with superior nutritional status, quality of life and survival in older adults.

How much of racial/ethnic disparities in dietary intakes, exercise, and weight status can be explained by nutrition- and health-related psychosocial factors and socioeconomic status among US adults?

Abstract: Large disparities exist in obesity and other chronic diseases across racial/ethnic and socioeconomic status (SES) groups in the United States. This study examined how much of racial/ethnic differences in diet, exercise, and weight status could be explained by nutrition- and health-related psychosocial factors (NHRPF) and SES among US adults. Nationally representative data of 4,356 US adults from the 1994-1996 Continuing Survey of Food Intakes by Individuals and the Diet and Health Knowledge Survey were used. NHRPF were assessed using 24 questions and related index scores. Dietary intakes were assessed using two nonconsecutive 24-hour dietary recalls. The US Department of Agriculture 2005 Healthy Eating Index was applied to evaluate diet quality. Body mass index was calculated based on self-reported weight and height. SES was assessed using education and household income. Americans with higher SES had better NHRPF and Healthy Eating Index scores. There were some small racial/ethnic differences in NHRPF, including making food choices and awareness of nutrition-related health risks. Multivariable linear and logistic regression models revealed some racial/ethnic differences in diet, exercise, and body mass index, but few of these disparities was explained by NHRPF, whereas SES explained some. The odds ratio of body mass index ≥25 for non-Hispanic blacks compared with whites decreased by 38% after SES was adjusted for. For exercise, we found a smaller change (9.5%) in the racial/ethnic differences when controlling for SES. In conclusion, NHRPF may explain very few, but SES may contribute some of the racial/ethnic disparities in diet, exercise, and weight status in the United States.

Health Literacy is associated with Healthy Eating Index Scores and Sugar-Sweetened Beverage Intake: Findings from the Rural Lower Mississippi Delta

Abstract: Background Although health literacy has been a public health priority area for more than a decade, the relationship between health literacy and dietary quality has not been thoroughly explored. Objective To evaluate health literacy skills in relation to Healthy Eating Index (HEI) scores and sugar-sweetened beverage (SSB) consumption while accounting for demographic variables. Design Cross-sectional survey. Participants/setting A community-based proportional sample of adults residing in the rural Lower Mississippi Delta. Methods Instruments included a validated 158-item regional food frequency questionnaire and the Newest Vital Sign (scores range 0 to 6) to assess health literacy. Statistical analyses performed Descriptive statistics, analysis of variance, and multivariate linear regression. Results Of 376 participants, the majority were African American (67.6%), without a college degree (71.5%), and household income level R 2 =0.24; F =18.8; P R 2 =0.15; F =6.3; P Conclusions Although health literacy has been linked to numerous poor health outcomes, to our knowledge this is the first investigation to establish a relationship between health literacy and HEI scores and SSB consumption. Our study suggests that understanding the causes and consequences of limited health literacy is an important factor in promoting compliance to the Dietary Guidelines for Americans.

Identifying Clusters of College Students at Elevated Health Risk Based on Eating and Exercise Behaviors and Psychosocial Determinants of Body Weight

Abstract: Weight gain and an increase in overweight and obesity in college students raise serious health concerns. Weight management interventions for college-age men and women might be more effective if they were tailored to subgroups of students with similar behavioral and psychosocial characteristics associated with body weight status. The purpose of this study was to use cluster analysis to identify homogenous subgroups of college-aged men and women enrolled in a weight gain prevention study (Project WebHealth) using baseline data collected in 2008. Project WebHealth was a 15-month nutrition and physical activity intervention designed to decrease the rate of unwanted weight gain in 1,689 college students at eight geographically diverse universities in the United States. Outcome measures included anthropometrics, fruit and vegetable intake, physical activity, cardiorespiratory fitness, and psychosocial variables associated with weight status in college students. Cluster analysis was performed separately by sex using a two-step clustering procedure using weight-related eating and exercise behaviors and psychosocial variables. Cluster groupings were validated against students' measured weight status and waist circumference as indicators of health risk. The study design was cross-sectional. Results showed that three similar clusters were identified for each sex. Validity of the cluster solution was supported by significant group differences in body mass index and waist circumference with the High Risk cluster at elevated health risk compared to the others. For men, variability in eating competence and cognitive restraint scores contributed most to the difference between clusters, whereas for women, emotional eating and uncontrolled eating scores did. These findings could be used to improve effectiveness of messages and interventions by tailoring them to subgroups of college students with similar behavioral and psychosocial characteristics associated with elevated health risk.

The Effect of Grape Seed Extract on Cardiovascular Risk Markers: A Meta-Analysis of Randomized Controlled Trials

Abstract: Recent animal studies have suggested that grape seed extract has beneficial effects on the cardiovascular system. Randomized trials in human beings have yielded conflicting results. The objective of this systematic review was to assess the effect of grape seed extract on changes in blood pressure, heart rate, lipid levels, and C-reactive protein (CRP) levels. We searched MEDLINE (January 1, 1950, through October 31, 2010), Agricola (January 1, 1970, through October 31, 2010), Scopus (January 1, 1996, through October 31, 2010), and the Cochrane Central Register of Controlled Trials (through October 31, 2010) for randomized controlled trials in human beings of grape seed extract reporting efficacy data on at least one of the following end points: systolic or diastolic blood pressure, heart rate, total cholesterol, low-density or high-density lipoprotein cholesterol, triglycerides, or CRP. A manual search of references from primary and review articles was performed to identify additional relevant trials. For all endpoints except CRP, the mean change in each parameter from baseline was treated as a continuous variable and the effect size was calculated as the weighted mean difference between the means in the grape seed extract and control groups. Data on CRP were pooled as a standardized mean difference. Nine randomized, controlled trials (N=390) met the inclusion criteria, and a meta-analysis was conducted. Upon meta-analysis, grape seed extract significantly lowered systolic blood pressure (weighted mean difference −1.54 mm Hg (95% confidence interval −2.85 to −0.22, P =0.02]), and heart rate (weighted mean difference −1.42 bpm (95% confidence interval −2.50 to −0.34, P =0.01]). No significant effect on diastolic blood pressure, lipid levels, or CRP was found. No statistical heterogeneity was observed for any analysis ( I 2 P >0.05 for all), except for the effect on diastolic blood pressure ( P =0.046). Based on the currently available literature, grape seed extract appears to significantly lower systolic blood pressure and heart rate, with no effect on lipid or CRP levels. Larger randomized, double-blinded trials evaluating different dosages of grape seed extract and for longer follow-up durations are needed.

Location, location, location: eye-tracking evidence that consumers preferentially view prominently positioned nutrition information.

Abstract: Background Nutrition Facts labels can keep consumers better informed about their diets' nutritional composition, however, consumers currently do not understand these labels well or use them often. Thus, modifying existing labels may benefit public health. Objective The present study tracked the visual attention of individuals making simulated food-purchasing decisions to assess Nutrition Facts label viewing. Primary research questions were how self-reported viewing of Nutrition Facts labels and their components relates to measured viewing and whether locations of labels and specific label components relate to viewing. Design The study involved a simulated grocery shopping exercise conducted on a computer equipped with an eye-tracking camera. A post-task survey assessed self-reported nutrition information viewing, health behaviors, and demographics. Subjects/setting Individuals 18 years old and older and capable of reading English words on a computer (n=203) completed the 1-hour protocol at the University of Minnesota during Spring 2010. Statistical analyses Primary analyses included χ 2 , analysis of variance, and t tests comparing self-reported and measured viewing of label components in different presentation configurations. Results Self-reported viewing of Nutrition Facts label components was higher than objectively measured viewing. Label components at the top of the label were viewed more than those at the bottom, and labels positioned in the center of the screen were viewed more than those located on the sides. Conclusions Nutrition Facts label position within a viewing area and position of specific components on a label relate to viewing. Eye tracking is a valuable technology for evaluating consumers' attention to nutrition information, informing nutrition labeling policy (eg, front-of-pack labels), and designing labels that best support healthy dietary decisions.

Position of the American Dietetic Association: Nutrition Intervention in the Treatment of Eating Disorders

Abstract: It is the position of the American Dietetic Association that nutrition intervention, including nutritional counseling by a registered dietitian (RD), is an essential component of team treatment of patients with anorexia nervosa, bulimia nervosa, and other eating disorders (EDs) during assessment and treatment across the continuum of care. Diagnostic criteria for EDs provide important guidelines for identification and treatment. In addition, individuals may experience disordered eating that extends along a range from food restriction to partial conditions to diagnosed EDs. Understanding the roles and responsibilities of RDs is critical to the effective care of individuals with EDs. The complexities of EDs, such as epidemiologic factors, treatment guidelines, special populations, and emerging trends highlight the nature of EDs, which require a collaborative approach by an interdisciplinary team of mental health, nutrition, and medical specialists. RDs are integral members of treatment teams and are uniquely qualified to provide medical nutrition therapy for the normalization of eating patterns and nutritional status. However, this role requires understanding of the psychologic and neurobiologic aspects of EDs. Advanced training is needed to work effectively with this population. Further efforts with evidenced-based research must continue for improved treatment outcomes related to EDs, along with identification of effective primary and secondary interventions. This paper supports the "Practice Paper of the American Dietetic Association: Nutrition Intervention in the Treatment of Eating Disorders" published online at www.eatright.org/positions.

Associations of Infant Feeding Practices and Picky Eating Behaviors of Preschool Children

Abstract: Picky eating behaviors are prevalent during childhood and are often linked to nutritional problems. However, information on the determinants of picky eating behaviors during infancy, when food acceptance patterns develop, is scarce. This study was conducted to evaluate the impact of infant feeding practices on the development of picky eating behaviors during preschool years. Baseline survey data from the Synergistic Theory and Research on Obesity and Nutrition Group Kids (STRONG Kids) program were used for this retrospective data analysis. Primary caregiver-child dyads were recruited from child-care centers in Eastern Illinois between February and July of 2009. A total of 129 self-reported responses from mothers of preschool-aged children were analyzed. Logistic regression was used to evaluate the association between infant feeding practices and picky eating behaviors. Children who were introduced to complementary foods before 6 months of age had 2.5 times higher odds of developing food neophobia and limited variety of foods (95% confidence interval [CI]: 1.01 to 5.93 and 1.06 to 5.73, respectively). Children who were breastfed exclusively for 6 months had lower odds of developing a preference for specific food-preparation methods by 78% (95% CI: 19% to 94%), food rejection by 81% (95% CI: 31% to 94%), and food neophobia by 75% (95% CI: 11% to 93%). Breastfeeding and introduction of complementary foods after 6 months of age reduced the odds of picky eating during early childhood. This study documents an association between infant-feeding practices and the development of picky eating behaviors in early childhood.

Grains, Vegetables, and Fish Dietary Pattern Is Inversely Associated with the Risk of Metabolic Syndrome in South Korean Adults

Abstract: Background Dietary patterns are critical in the prevention and management of chronic diseases. Objective We examined the association between habitual dietary patterns and the risk of metabolic syndrome in South Korean adults. Design The study sample was composed of 9,850 Korean adults (aged ≥19 years) who participated in the second and third Korean National Health and Nutrition Examination Survey. Dietary data were assessed by the 24-hour recall method. Metabolic syndrome was defined by the joint of interim statement of the International Diabetes Federation and the American Heart Association/National Heart, Lung, and Blood Institute. Results Four dietary patterns were derived using factor analysis (white rice and kimchi pattern; meat and alcohol pattern; high fat, sweets, and coffee pattern; and grains, vegetables, and fish pattern). Each dietary pattern explained 8.6%, 6.7%, 5.7%, and 5.7% of the variation in food intakes, respectively. The meat and alcohol pattern was adversely associated with hypertriglyceridemia ( P for trend 0.01) and elevated blood pressure ( P for trend 0.01) after adjustments for potential risk factors of metabolic syndrome such as age, sex, body mass index, energy intake, alcohol intake, smoking status, and physical activity. In contrast, the grains, vegetables, and fish pattern was associated with lower risk of hypertriglyceridemia ( P for trend 0.0002) and was also inversely associated with the risk of metabolic syndrome after adjusting for risk factors of the metabolic syndrome ( P for trend 0.02). Conclusions Our study suggests that a specific Korean dietary pattern that includes grains, vegetables, and fish may be associated with lower risk of metabolic syndrome in South Korean adults.

Influence of placement of a nutrition logo on cafeteria menu items on lunchtime food Choices at Dutch work sites.

Abstract: This study investigated the effectiveness of labeling foods with the Choices nutrition logo on influencing cafeteria menu selection and the behavioral determinants of menu choices in work site cafeterias in the Netherlands. A cluster randomized controlled trial was conducted. Intervention cafeterias (n=13), where the Choices logo was used to promote healthier eating for a 3-week period, were compared with control cafeterias (n=12), which offered the same menu without the logo. Sales data were collected daily for 9 weeks, from March to May 2009. In addition, employees from one intervention and one control company completed an online questionnaire at baseline and after the intervention (n=368) in which the behavioral determinants of food choice (ie, attitude, self-efficacy, and intention) and logo use were measured. Generalized estimating equation analyses, χ 2 tests, t tests and linear regression analyses were performed. No nutritionally meaningful intervention effects were found in the sales of sandwiches, soups, snacks, fruit, and salads. Also, no significant differences in behavioral determinants were found. "Intention to eat healthier" and "paying attention to product information" were positively associated with self-reported consumption of foods with the Choices logo at lunch. The intervention did not have a significant effect on employees' lunchtime food choices. Labeling healthy choices might be useful for health-conscious employees in the volitional phase of behavior change. Further research should focus on the possible health benefits of menu reformulation in the catering sector.

A Vegetarian Dietary Pattern as a Nutrient-Dense Approach to Weight Management: An Analysis of the National Health and Nutrition Examination Survey 1999-2004

Abstract: Background Population-based studies have shown that vegetarians have lower body mass index than nonvegetarians, suggesting that vegetarian diet plans may be an approach for weight management. However, a perception exists that vegetarian diets are deficient in certain nutrients. Objective To compare dietary quality of vegetarians, nonvegetarians, and dieters, and to test the hypothesis that a vegetarian diet would not compromise nutrient intake when used to manage body weight. Design Cross-sectional analysis of National Health and Nutrition Examination Survey (1999-2004) dietary and anthropometric data. Diet quality was determined using United States Department of Agriculture's Healthy Eating Index 2005. Participants included adults aged 19 years and older, excluding pregnant and lactating women (N=13,292). Lacto-ovo vegetarian diets were portrayed by intakes of participants who did not eat meat, poultry, or fish on the day of the survey (n=851). Weight-loss diets were portrayed by intakes of participants who consumed 500 kcal less than their estimated energy requirements (n=4,635). Mean nutrient intakes and body mass indexes were adjusted for energy, sex, and ethnicity. Using analysis of variance, all vegetarians were compared to all nonvegetarians, dieting vegetarians to dieting nonvegetarians, and nondieting vegetarians to nondieting nonvegetarians. Results Mean intakes of fiber, vitamins A, C, and E, thiamin, riboflavin, folate, calcium, magnesium, and iron were higher for all vegetarians than for all nonvegetarians. Although vegetarian intakes of vitamin E, vitamin A, and magnesium exceeded that of nonvegetarians (8.3±0.3 vs 7.0±0.1 mg; 718±28 vs 603±10 μg; 322±5 vs 281±2 mg), both groups had intakes that were less than desired. The Healthy Eating Index score did not differ for all vegetarians compared to all nonvegetarians (50.5±0.88 vs 50.1±0.33, P =0.6). Conclusions These findings suggest that vegetarian diets are nutrient dense, consistent with dietary guidelines, and could be recommended for weight management without compromising diet quality.

Away-from-Home Family Dinner Sources and Associations with Weight Status, Body Composition, and Related Biomarkers of Chronic Disease among Adolescents and Their Parents

Abstract: Information regarding associations between types of away-from-home family meal sources and obesity and other chronic diseases could help guide dietetics practitioners. The present study describes the purchase frequency of away-from-home food sources for family dinner (fast food, other restaurant purchases, home delivery, and takeout foods) and associations with weight status and percent body fat among adolescents (n=723) and parents (n=723) and related biomarkers of chronic disease among adolescents (n=367). A cross-sectional study design was used with baseline parent surveys and anthropometry/fasting blood samples from two community-based obesity studies (2006-2008) in Minnesota. Logistic regression and general linear modeling assessed associations between frequency of family dinner sources (weekly vs none in past week) and outcomes (parent and adolescent overweight/obesity and percent body fat; adolescent metabolic risk cluster z score, cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein, triglycerides, fasting glucose, insulin, and systolic blood pressure. Models accounted for clustering and adjusted for study allocation, baseline meal frequency, and demographic characteristics. The odds of overweight/obesity were considerably greater when families reported at least one away-from-home dinner purchase in the past week (odds ratio=1.2 to 2.6). Mean percent body fat, metabolic risk cluster z scores, and insulin levels were significantly greater with weekly purchases of family dinner from fast-food restaurants (P<0.05). Mean percent body fat, metabolic risk cluster z scores, and high-density lipoprotein levels were significantly higher for families who purchased weekly family dinner from takeout sources (P<0.05). Although frequent family dinners may be beneficial for adolescents, the source of dinners is likely as important in maintaining a healthy weight. Interventions should focus on encouragement of healthful family meals.

Faster Self-Reported Speed of Eating Is Related to Higher Body Mass Index in a Nationwide Survey of Middle-Aged Women

Abstract: This study is the first nationwide population survey to explore the association between speed of eating and degree of obesity. The objective was to cross-sectionally examine the relationship between self-reported speed of eating and body mass index (BMI; calculated as kg/m 2 ) in a nationally representative sample of New Zealand women. In May 2009, a sample of 2,500 New Zealand women aged 40 to 50 years was randomly selected from the nationwide electoral rolls. A 66% participation rate was achieved. Potential participants were mailed a self-administered questionnaire containing questions on self-reported speed of eating, demographics, health conditions, menopause status, physical activity, height, and weight. Univariate models were used to examine the associations between demographic, health and behavioral variables, and BMI, while a multivariate model was developed to investigate the relationship between self-reported speed of eating and BMI. After adjusting for age, smoking status, menopause status, thyroid condition, ethnicity, socioeconomic status, and physical activity, BMI statistically significantly increased by 2.8% (95% confidence interval: 1.5% to 4.1%; P

Nutrition Practices and Children's Dietary Intakes at 40 Child-Care Centers in New York City

Abstract: Early childhood is a critical time to establish nutrition habits to prevent obesity. At least half of US children spend time in care outside of the home, where little is known about their dietary intakes and nutrition environment. The purpose of this study was to evaluate nutrition practices of group child-care centers in New York City and to assess whether dietary intakes of children at these centers meet nutrition recommendations. In 2005 and 2006, student research assistants administered surveys to directors of 40 child-care centers in three underserved communities (Central Brooklyn, East/Central Harlem, South Bronx) and in Manhattan, gathered menus, and observed beverages and foods consumed by 240 3- and 4-year-old children. Almost all centers provided beverages and foods recommended by national guidelines, including reduced-fat milk, 100% fruit juice, and whole grains. Some centers also provided higher-fat milk and sugar-sweetened beverages, but no centers provided soda. Drinking water was available in classrooms at only half of the centers. From observations at meal and snack times between 8 am to 2 pm,

Dietary fiber and nutrient density are inversely associated with the metabolic syndrome in US adolescents

Abstract: Background There is no consensus as to whether low dietary intakes of saturated fat or cholesterol, or high intakes of dietary fiber are related to a lower prevalence of metabolic syndrome (MetS) in adolescent children. Objective To determine whether a fiber-rich diet as measured by a fiber index (grams fiber/1,000 kcal) is associated with lower rates of MetS among adolescents vs a diet low in saturated fat or cholesterol as measured by a saturated fat index (grams saturated fat/1,000 kcal) and a cholesterol index (milligrams cholesterol/1,000 kcal), respectively. Design/participants/setting Cross-sectional analysis of 12- to 19-year-old boys and girls (N=2,128) who participated in the National Health and Nutrition Examination Survey 1999-2002. Outcomes and statistical analyses The prevalence of MetS (abnormal values of three or more of the following: waist circumference, blood pressure, fasting serum high-density lipoprotein cholesterol, triglycerides, and glucose) was compared across quintiles of the dietary indexes (fiber index, saturated fat index, and cholesterol index) derived from 24-hour recalls. χ 2 tests determined the prevalence across dietary quintiles, and multivariate logistic regression evaluated the association of the dietary indexes with MetS. Weighted analyses were used controlling for sex, age, ethnicity, and family income. Significance was set at P ≤0.05. Results The overall prevalence of MetS was 6.4% (n=138). There was a graded inverse association between the fiber index and MetS ( P P ≤0.043). Neither the saturated fat index ( P =0.87) nor the cholesterol index ( P =0.22) was significantly associated with MetS. Conclusions Higher intakes of dietary fiber, but not low intakes of saturated fat or cholesterol are related to the MetS in adolescents. These findings suggest that to reduce the risks for MetS in adolescents, it is more important to emphasize a paradigm that promotes the inclusion of fiber-rich, nutrient-dense, plant-based foods vs what foods to restrict or exclude as is commonly done when the focus is on total fat, cholesterol, or saturated fat intake.

Behavioral Contexts, Food-Choice Coping Strategies, and Dietary Quality of a Multiethnic Sample of Employed Parents

Abstract: Employed parents' work and family conditions provide behavioral contexts for their food choices. Relationships between employed parents' food-choice coping strategies, behavioral contexts, and dietary quality were evaluated. Data on work and family conditions, sociodemographic characteristics, eating behavior, and dietary intake from two 24-hour dietary recalls were collected in a random sample cross-sectional pilot telephone survey in the fall of 2006. Black, white, and Latino employed mothers (n=25) and fathers (n=25) were recruited from a low/moderate income urban area in upstate New York. Hierarchical cluster analysis (Ward's method) identified three clusters of parents differing in use of food-choice coping strategies (ie, Individualized Eating, Missing Meals, and Home Cooking). Cluster sociodemographic, work, and family characteristics were compared using χ 2 and Fisher's exact tests. Cluster differences in dietary quality (Healthy Eating Index 2005) were analyzed using analysis of variance. Clusters differed significantly ( P ≤0.05) on food-choice coping strategies, dietary quality, and behavioral contexts (ie, work schedule, marital status, partner's employment, and number of children). Individualized Eating and Missing Meals clusters were characterized by nonstandard work hours, having a working partner, single parenthood and with family meals away from home, grabbing quick food instead of a meal, using convenience entrees at home, and missing meals or individualized eating. The Home Cooking cluster included considerably more married fathers with nonemployed spouses and more home-cooked family meals. Food-choice coping strategies affecting dietary quality reflect parents' work and family conditions. Nutritional guidance and family policy needs to consider these important behavioral contexts for family nutrition and health.

Characteristics of Family Mealtimes Affecting Children's Vegetable Consumption and Liking

Abstract: Research has documented an association between family mealtimes and higher dietary quality in school-aged children and adolescents. However, there is little understanding of the specific characteristics of mealtimes that are beneficial and a lack of research with preschool-aged children. This cross-sectional study conducted in the United Kingdom in 2008 examined associations between mealtime characteristics and preschoolers' vegetable consumption and liking. Four hundred and thirty-four primary caregivers of children aged 2 to 5 years reported on children's vegetable intake and liking and completed a questionnaire on frequency of family meals, food preparation, and the social and environmental context of family mealtimes. Univariate and multiple linear regression analyses assessed mealtime variables and children's vegetable intake and liking. Multiple regression analysis revealed children's vegetable consumption was predicted by eating approximately the same food as their parents (β=.14; P ≤0.01), using ready-made sauces (β=−.12; P ≤0.05), and cooking from scratch (β=.11; P ≤0.05), accounting for 21% of the variance (with covariates). Children's liking for vegetables was predicted by eating approximately the same food as their parents (β=.15; P ≤0.01) and use of preprepared dishes (β=−.15; P ≤0.01), accounting for 8% of the variance (with covariates). Frequency of family mealtimes was unrelated to children's vegetable consumption or liking in this sample. This contrasts with findings in older children and adolescents, where frequency of family mealtimes is related to dietary quality and intake. In preschool-aged children, it seems emphasis should be placed on encouraging parents to provide home-cooked meals that mirror those eaten by the adults in the family to improve vegetable intake.