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American Journal of Epidemiology 01/2002; 154(12 Suppl):S60-9. · 5.22 Impact Factor
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E A Yetley
Nutrition Reviews 02/2001; 59(1 Pt 2):S33-4. · 4.47 Impact Factor
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ABSTRACT: We evaluated the possible role of niacin fortification of the US food supply and other concurrent influences in eliminating the nutritional deficiency disease pellagra.
We traced chronological changes in pellagra mortality and morbidity and compared them with the development of federal regulations, state laws, and other national activities pertaining to the fortification of cereal-grain products with niacin and other B vitamins. We also compared these changes with other concurrent changes that would have affected pellagra mortality or morbidity.
The results show the difficulty of evaluating the effectiveness of a single public health initiative such as food fortification without controlled experimental trials. Nonetheless, the results provide support for the belief that food fortification played a significant role in the elimination of pellagra in the United States.
Food fortification that is designed to restore amounts of nutrients lost through grain milling was an effective tool in preventing pellagra, a classical nutritional deficiency disease, during the 1930s and 1940s, when food availability and variety were considerably less than are currently found in the United States.
American Journal of Public Health 06/2000; 90(5):727-38. · 3.93 Impact Factor
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E A Yetley
Public health reviews 02/2000; 28(1-4):147-50.
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ABSTRACT: There is a critical need to estimate dietary folate intakes for nutrition monitoring and food safety evaluations, but available intake data are seriously limited by several factors.
Our objective was to update 2 national food consumption surveys to reflect folate intakes as a result of the recently initiated food fortification program and to correct folate intakes for the apparently higher bioavailability of synthetic folic acid (SFA; ie, folate added to foods or from dietary supplements) than of naturally occurring folate so as to express intakes as dietary folate equivalents.
It was not possible to chemically analyze foods, so adjustments were made to food-composition data by using information about food ingredients and characteristics. Total folate intakes were estimated for several sex and age groups by using the modified data coupled with dietary supplement use.
Within the limitations of the data, our findings suggested that 67-95% of the population met or surpassed the new estimated average requirement, depending on the sex and age group and survey. Nonetheless, some subgroups had estimated intakes below these standards. Estimated SFA intakes suggested that approximately 15-25% of children aged 1-8 y, depending on the survey, had intakes above the newly established tolerable upper intake level. We estimated that 68-87% of females of childbearing age had SFA intakes below the recommended intake of 400 microgram/d, depending on the age group and survey.
There is a need to explore ways to improve folate intakes in targeted subgroups, including females of childbearing age, while not putting other population groups at risk of excessive intakes.
American Journal of Clinical Nutrition 09/1999; 70(2):198-207. · 6.67 Impact Factor
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ABSTRACT: The US Food and Drug Administration review that provided the basis for authorizing a food-label health claim linking the risk of cancer to dietary fat intake illustrated several considerations in the use of epidemiologic data, and observational data in particular, to support dietary recommendations. The review suggested the need for clear and established criteria for judging the quality of observational human data as well as the importance of making the evaluation process for individual studies transparent and organized. The review, which provided for a claim in the absence of controlled human studies, also suggested that observational data may play a greater role when the nature of the relation to be described by a health-claim statement is broad and general rather than targeted and specific. Of particular importance was the relevance of available data to the questions inherent in showing a diet-disease relation, the need to consider the totality of the evidence, and the key role that existing authoritative reports must play in establishing the basis for relation.
American Journal of Clinical Nutrition 07/1999; 69(6):1357S-1364S. · 6.67 Impact Factor
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ABSTRACT: The Food and Drug Administration has several options that will assist the Public Health Service in implementing its September 1992 recommendation that all women of childbearing age consume 0.4 mg folic acid daily to reduce their risk of having a pregnancy affected with a neural tube defect. The FDA can authorize the use of a health claim on labels and in the labeling of foods that characterizes the relationship between a nutrient and a health-related condition. Fortification of cereal-grain products with folic acid is a second option that has the potential for reaching most women of childbearing age without requiring them to change their food selection patterns. Consideration of these options has been intertwined with rapid developments in the scientific database that is the foundation of the health claim, by conflicting opinions regarding the effectiveness for women in the target population of FDA's proposed level of cereal-grain fortification, by lack of systematic safety data regarding the impact of fortification on persons in the general population and by changes in the regulatory environment in which the agency acts.
Journal of Nutrition 04/1996; 126(3):765S-772S. · 3.92 Impact Factor
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ABSTRACT: This article uses folic acid as an example to illustrate some of the complex issues and general principles that emerge when evaluating fortification of the food supply as one possible means to address a public health recommendation.
Distributions of current daily folate intakes from conventional foods and dietary supplements were estimated. Intakes that might result from fortification of cereal-grain products and ready-to-eat cereals at various levels for eight age-gender groups were also estimated by using the US Department of Agriculture's 1987-1988 Nationwide Food Consumption Survey.
The results illustrate that fortification of the US food supply tends to increase folate intakes of consumers at the high end of the intake distribution curves in the general population to a greater extent than it affects consumers at the low end of the intake distribution curves in the target population.
The effectiveness of food fortification options for a target population and the safety for the general population impose conflicting challenges that must be considered concurrently when making decisions about fortifying the US food supply.
American Journal of Public Health 06/1995; 85(5):660-6. · 3.93 Impact Factor
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ABSTRACT: The Nutrition Labeling and Education Act of 1990 states, in part, that a product is misbranded if it bears a claim that characterizes the relationship of a nutrient to a disease or health-related condition (health claim), unless the claim is made in accordance with Food and Drug Administration (FDA) regulations. In response to the new law, on January 6, 1993, the FDA promulgated regulations that described general requirements for health claims on foods in conventional food forms and specific requirements for seven authorized health claim topics. Three authorized claims are related to heart disease: dietary saturated fat and cholesterol and coronary heart disease; fruits, vegetables and grain products that contain fiber, particularly soluble fiber, and risk of coronary heart disease and sodium and hypertension. The general requirements regulation specifies the scientific standard for assessing the validity of claims, criteria for the qualification of claims, conditions for disqualification and general labeling requirements for health claims. Approval for health claims is based on the totality of publicly available scientific evidence and significant agreement among experts qualified by scientific training and experience to evaluate the relationship. On January 4, 1994, the FDA finalized similar requirements for health claims on dietary supplements.
Journal of Nutrition 04/1995; 125(3 Suppl):679S-685S. · 3.92 Impact Factor
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ABSTRACT: Examination of the per capita disappearance data for sweeteners and other sources of fructose showed that during the past two decades there was a considerable increase in the availability of free fructose in the food supply. However, the availability of the total amount of fructose, which includes both free and bound fructose, has remained relatively constant. Estimates of the average daily intake of fructose, based on the 1977-78 USDA Nationwide Food Consumption Survey, ranged from 15 g for infants to 54 g for males aged 15-18 y with a mean of 37 g for the total population. These values represent 7-9% of the energy intake (8% for the total population). For most sex/age groups nonalcoholic beverages (eg, soft drinks and fruit-flavored drinks) and grain products (eg, sweet bakery products) were the major sources of fructose; fruits and fruit products were the major sources of naturally occurring fructose; nonalcoholic beverages were the major sources of added fructose.
American Journal of Clinical Nutrition 12/1993; 58(5 Suppl):737S-747S. · 6.67 Impact Factor
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ABSTRACT: To determine whether normal physiologic changes associated with hormone fluctuations over the menstrual cycle affect concentrations of iron-status indicators, we examined data from 1712 women aged 18-44 y from the Second National Health and Nutrition Examination Survey (NHANES II) after adjusting for potential confounders. Adjusted mean values of hemoglobin (Hb), transferrin saturation (TS), and serum ferritin (SF) were lowest for women whose blood was drawn during menses and highest for women examined in luteal or late luteal phase of the menstrual cycle (Hb = 130 vs 133 g/L; TS = 21.2% vs 24.8%, P < 0.01 for both; and SF = 17.2 vs 24.0 micrograms/L, P < 0.05). The prevalence estimate of impaired iron status was significantly higher for women whose blood was drawn during the menstrual phase than for women whose blood was drawn during the luteal and late luteal phases. Our findings suggest that the phases of the menstrual cycle affect the concentration or values of iron-status indicators. These cyclic variations in indicators of iron status are a potential source of error when iron status is assessed in large population surveys that include women of reproductive age.
American Journal of Clinical Nutrition 12/1993; 58(5):705-9. · 6.67 Impact Factor
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ABSTRACT: The 1980 Food and Drug Administration Vitamin and Mineral Supplement Use Survey and the 1986 National Health Interview Survey used similar questions and procedures to estimate and identify trends in the prevalence and magnitude of supplement usage in the United States. A comparison of the two surveys reveals that prevalence of supplement use among adults decreased slightly, from 42% in 1980 to 38% in 1986. The magnitude of supplement use has also decreased; users reported taking a mean of 2.15 supplements in 1980 compared with a mean of 1.77 in 1986. The prevalence of supplement users identified as light users increased from 42% in 1980 to 57% in 1986. Supplement usage was more likely and more intense among individuals who had one or more health problems and among individuals who perceived their health as very good or excellent. The findings indicate that supplement usage remains a widespread behavior linked to popular conceptions of good health and well-being but one that is susceptible to change.
Journal of the American Dietetic Association 10/1992; 92(9):1096-101. · 3.59 Impact Factor
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ABSTRACT: We classified a nationally representative sample of persons aged 4 years and older as high or moderate consumers of added sugars (ie, sugars added to foods by processors or consumers). Intake of added sugars was determined on the basis of grams consumed per kilogram of body weight (g/kg) and on the basis of percent of dietary energy from added sugars (% kcal). Regardless of the intake measure used, high consumers of added sugars had a significantly lower percentage of dietary energy from fat than did moderate consumers of added sugars. Persons defined by the % kcal measure as high consumers of added sugars took in lower percentages of the Recommended Dietary Allowances (RDAs) for 11 vitamins and minerals; these high consumers had body weights similar to those of their moderate counterparts. Persons defined as high consumers by the g/kg measure consumed greater percentages of the RDAs than did their moderate counterparts; these high consumers more frequently selected foods from categories likely to contain sugar-rich foods but weighed significantly less than did moderate consumers. Thus, different approaches to defining intake of added sugars revealed two patterns of high consumption of added sugars with different levels of nutritional risk. Conditions of overweight were not associated with high intake of added sugars. Educational efforts, therefore, should focus on those consumers who tend to substitute foods rich in added sugars for more nutritionally desirable foods.
Journal of the American Dietetic Association 07/1992; 92(6):708-13. · 3.59 Impact Factor
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ABSTRACT: Two types of data may be used to estimate trends in food and nutrient intake by the US population: per capita food supply estimates and survey estimates of individual intake. Because these data vary markedly in measurement goals and methods, we examined whether trends in food supply and survey intake estimates for fat, carbohydrate, and protein are reflective of one another.
The data selected for comparison included all available survey estimates of mean intake by the US population (i.e., periodic estimates from 1965 to 1988) and all available per capita food supply estimates from a comparable time period (i.e., annual estimates from 1965 to 1985).
The two types of data generally did not reflect the same trends. Furthermore, expressing macronutrient levels as percentage of calories rather than in grams affected the trend relationships.
Our findings indicate that caution is needed in the selection and application of available data to estimate trends in macronutrient intake by the US population and in the interpretation of these data with regard to public health research, policies, and programs.
American Journal of Public Health 07/1992; 82(6):862-6. · 3.93 Impact Factor
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Vital and health statistics. Ser. 4: Documents and committee reports 04/1992;
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ABSTRACT: Four consumer focus group sessions, with a total of 40 participants, were conducted to gather information on the utility and appropriateness of selected components of nutrition label formats. The formats reviewed were bar graphs, pie charts, numeric listings, and adjectival descriptors such as high and low. Participants were asked to compare food labels using various format types and to discuss the utility and interpretability of the formats. The outcomes suggested that these consumers did not find pie charts useful. They considered bar graphs confusing or unnecessary when numeric values were provided. Participants expressed concern that adjectival descriptors could be misleading. The numeric listing format they considered the most useful consisted of two columns of numbers: one listing the amounts of food components present in a serving of the food, and a second listing either the percentage of the label reference value (eg, the US Recommended Daily Allowance) or the quantity established as the label reference value. Participants repeatedly stressed their interest in a simple label. The results form one component of the Food and Drug Administration's efforts to evaluate nutrition label formats and will be used in conjunction with ongoing experimental and quantitative research studies.
Journal of the American Dietetic Association 02/1992; 92(1):62-6. · 3.59 Impact Factor
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Nutrition Reviews 12/1991; 49(11):323-31. · 4.47 Impact Factor
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ABSTRACT: A 1986 nationwide survey of 11,775 adults 18 y or older and 1877 children 2-6 y old identified approximately 3400 different (unique) vitamin and mineral supplement products being taken. The most commonly included nutrient listed on the product labels was vitamin C, which was present in 50% of the unique products examined. Calcium and iron were the most commonly included minerals and were present in 25% of the unique products examined. Prenatal and children's chewable products came in a relatively narrow potency range and generally contained nutrients in amounts approximating or less than the US recommended daily allowances. These products also contained significant minimum amounts of nutrients. Potencies of products not targeted for use by these special groups, particularly those products that were self-prescribed, varied widely and ranged from insignificant to extremely large amounts of nutrients. Units used to declare product potency or to prescribe the dosage varied.
American Journal of Clinical Nutrition 11/1991; 54(4):750-9. · 6.67 Impact Factor
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ABSTRACT: The association between age and serum vitamin A concentrations in children was examined by using total serum vitamin A values from the second National Health and Nutrition Examination Survey (NHANES II) and serum retinol values for Mexican Americans from the Hispanic HANES. Analyses included multivariate strategies to identify confounders of serum vitamin A. After the effect of the use of vitamin-mineral supplements on total serum vitamin A values was controlled for, the data indicated that younger children (aged 4-5 y) have lower serum vitamin A concentrations than do older children (aged 9-11 y) regardless of whether the measure was total serum vitamin A or serum retinol. This relationship was systematic across the distribution of values and suggested that the difference may be due to normal physiological events. A different interpretive criterion may be needed for younger and older children when serum vitamin A is used to indicate vitamin A status.
American Journal of Clinical Nutrition 09/1990; 52(2):353-60. · 6.67 Impact Factor
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ABSTRACT: To evaluate the need for and potential public health impact of selective labeling of foods containing tropical oils (TOs), we examined trend changes in use of TOs in the United States from 1963 to 1985 and estimated current intakes of total fat (FI) and saturated fatty acids (SFAI) attributable to TOs. Although world production of TO has increased rapidly since 1970, use in the United States has not followed the world trend. A large portion of TOs in the United States was used in nonfood products. Estimates of current intake of TOs by selected US population groups revealed only minor contribution of TOs to the daily FI and SFAI in the United States. In 1985 the most reasonable estimate of the average FI from all three TOs represented less than 4% of total daily FI or less than 2% of daily energy intake. Three TOs combined contributed less than or equal to 8% to the daily SFAI of the three sex and/or age groups examined.
American Journal of Clinical Nutrition 06/1990; 51(5):738-48. · 6.67 Impact Factor
