Advances in Nutrition

This report confirms that food insecurity remains an important and challenging issue among American households, especially in those headed by single parents and reporting below-poverty income levels. Importantly, although some at-risk households utilize federal and community-based food assistance programs, many do not. Finding ways to close this gap between nutritional need and utilization of food assistance networks must remain an important goal for both federal and private agencies and organizations during this difficult economic period.

There is increasing concern about potential adverse effects of caffeine in children. Our understanding of caffeine intake relies on studies dating to the late 1990s. This article synthesizes information from national studies since then to describe caffeine consumption, its association with sociodemographic factors, key dietary sources including caffeine-containing energy drinks (CCEDs), and trends in caffeine intake and sources among US children. Findings from the Kanter Worldpanel (KWP) Beverage Consumption Panel and the NHANES showed that caffeine consumption prevalence was generally consistent across studies and over time; more than one-half of 2- to 5-y-olds and ∼75% of older children (>5 y) consumed caffeine. The usual intakes of caffeine were 25 and 50 mg/d for children and adolescents aged 2-11 and 12-17 y, respectively (NHANES 2007-2010). Caffeine consumption correlated with age and was higher in non-Hispanic white children. The key sources of caffeine were soda and tea as well as flavored dairy (for children aged <12 y) and coffee (for those aged ≥12 y). The frequency of CCED use varied (2-30%) depending on study setting, methods, and demographic characteristics. A statistically significant but small decline in caffeine intake was noted in children overall during the 10- to 12-y period examined; intakes remained stable among older children (≥12 y). A significant increasing trend in CCED and coffee consumption and a decline in soda intake were noted (1999-2010). In 2009-2010, 10% of 12- to 19-y-olds and 10-25% of caffeine consumers (aged 12-19 y) had intakes exceeding Canadian maximal guidelines. Continued monitoring can help better understand changes in caffeine consumption patterns of youth. © 2015 American Society for Nutrition.

The recommended changes in standards for menu planning put forth by the IOM, if effectively implemented, would substantially improve the alignment of school meals with current science-based nutrition recommendations. Specifically, they would moderate energy intake, encourage greater fruit and vegetable consumption, provide additional whole grains and fewer refined grains, limit saturated and trans fats, and gradually reduce sodium intake levels to those recommended by leading nutrition authorities. Stallings concludes, “Since the school meal programs were last updated, we've gained greater understanding of children's nutritional needs and the dietary factors that contribute to obesity, heart disease, and other chronic health problems. The changes recommended in this report are needed to assure parents that schools are providing healthful, satisfying meals.” Copies of the full report are available for purchase at http://www.nap.edu/catalogue.php?record_id = 12751; a free full version, summary version, and podcast of this report are available at http://www.nap.edu/openbook.php?record_id = 12751&page = 1. The Child Nutrition and WIC Reauthorization Act of 2004 (Public Law 108–265) can be found at http://www.fns.usda.gov/cnd/governance/legislation/historical/pl_108-265.pdf.

Vegetables, especially white potatoes, provide significant levels of key nutrients of concern, such as potassium and dietary fiber. Per capita availability (PCA) data for vegetables-often used as a proxy for vegetable consumption-show that vegetable consumption, including consumption of white potatoes, declined in the past decade. Using dietary data for participants in the NHANES 2009-2010, we examined total vegetable, white potato, and French-fried potato consumption among all age-gender groups as well as mean energy, potassium, and dietary fiber intakes. Mean total energy intake for the US population (≥2 y old) was 2080 kcal/d, with white potatoes and French-fried potatoes providing ∼4% and ∼2% of total energy, respectively. Individuals who consumed white potatoes had significantly higher total vegetable and potassium intakes than did nonconsumers. In addition, the proportion of potassium and dietary fiber contributed by white potatoes was higher than the proportion that they contributed to total energy. Among white potato consumers aged 14-18 y, white potatoes provided ∼23% of dietary fiber and ∼20% of potassium but only ∼11% of total energy in the diet. The nutrient-dense white potato may be an effective way to increase total vegetable consumption and potassium and dietary fiber intake.

National, state, and local institutions that procure, distribute, sell, and/or serve food to employees, students, and the public are increasingly capitalizing on existing operational infrastructures to create healthier food environments. Integration of healthy nutrition standards and other recommended practices [e.g., energy (kilocalories) postings at point-of-purchase, portion size restrictions, product placement guidelines, and signage] into new or renewing food service and vending contracts codifies an institution's commitment to increasing the availability of healthful food options in their food service venues and vending machines. These procurement requirements, in turn, have the potential to positively influence consumers' food-purchasing behaviors. Although these strategies are becoming increasingly popular, much remains unknown about their context, the processes required to implement them effectively, and the factors that facilitate their sustainability, especially in such broad and diverse settings as schools, county government facilities, and cities. To contribute to this gap in information, we reviewed and compared nutrition standards and other best practices implemented recently in a large school district, in a large county government, and across 10 municipalities in Los Angeles County. We report lessons learned from these efforts.

This brief report provides contemporary evidence that, for the average adult, eating away from home is associated with increased caloric intake and reduced diet quality. The effects vary depending on which meals are consumed away from home. For instance, eating breakfast out was associated with decreased whole grains and dairy products and increased calories from saturated fat and added sugars. Although the effects seem to be similar between men and women and do not depend on weight status, eating out appears to be somewhat more detrimental for dieters than for nondieters. On a positive note, some unhealthy trends related to eating outside the home seem to be decreasing, perhaps in response to healthier food options and more careful food choices.

Although some will insist that the 2010 Dietary Guidelines for Americans offers the same “moderation, variety, and balance” mantra as provided previously, this argument is clearly unfounded. Rather, this document represents an important step forward for nutrition scientists, public health professionals, and the general public. As our first Dietary Guidelines document based on a systematic, evidence-based review of the literature embedded in a holistic view of the complexity of our food environment, this publication will serve well to inform individual Americans which dietary patterns are proven effective in improving health outcomes. It will also provide a versatile template by which public health agencies can design, implement, and evaluate nutrition-related programs; and food manufacturers can contribute by developing and marketing more healthful food items. We can be encouraged that nutrition scientists will continue to not only get it right but also get it better. After all, as scientific understanding of how health and nutrition are related evolves, so should our dietary recommendations.

This report provides concrete and actionable recommendations related to policies affecting obesity risk in very early childhood. Specifically, these recommendations target measures that can be taken outside the home and call on government at all levels to support healthy eating among young children through guidelines and promotion efforts. The report also highlights myriad gaps in research knowledge, but concludes that “the urgency of the issue of obesity in young children demands that action be taken now with the best available evidence.”

This report not only provides a veritable treasure trove of national and international data concerning breastfeeding rates, benefits, and barriers, it also carefully and deliberately enlists the aid of all sectors of U.S. society in realizing more effective national breastfeeding policies and implementation steps. Of particular importance to nutrition researchers are the action items that emphasize the need for improved and expanded breastfeeding-related research and surveillance. Indeed, as stated in the document: “Increasing the number of scientists properly trained to study breastfeeding could allow both current and new researchers to design and carry out scientifically sound and rigorous studies on breastfeeding topics.” These federally-sanctioned statements, goals, and strategies may prove invaluable to advancing evidence-based research in the discipline and should be of great interest to all researchers and clinicians in the fields of human milk, lactation, and maternal/infant health.

Relevance and background Over the past half century, food preparation methods and consumption patterns have moved steadily away from reliance on relatively simple, basic foods to dependence on more prepared, processed, and “convenience” foods. At the same time, nutrition concerns in the United States have transitioned from primarily nutrient deficiencies to a combination of positive energy balance, nutrient imbalances, and overconsumption of food components associated with chronic, degenerative diseases. Consequently, since the early 1970s and in response to the 1969 White House Conference on Food, Nutrition and Health, the FDA has responded to consumer demand by requiring certain nutrition-related information be provided on food packaging. What is required and how it must be presented has evolved tremendously since that time, but the main goal of federal regulations in this regard has remained the provision of consumer-friendly nutrition information to improve health. In one of its most recent attempts to accomplish this goal, Congress directed the CDC to undertake a study in collaboration with the Institute of Medicine (IOM) to examine and provide recommendations regarding front-of-package nutrition rating systems and symbols. This initiative was implemented in 2 phases. In Phase I, an expert committee reviewed front-ofpackage systems being used in the United States and abroad and considered their purpose, overall merits, and scientifi cu nderpinnings. Among other findings, they concluded that the most critical nutritional components to include in front-of-package nutrition rating systems are calories, saturated fat and trans fats, and sodium; they found insufficient evidence that other nutrients and food components (including total fat, cholesterol, added sugars, vitamins, and minerals other than sodium) should be included. After the publication of the Phase I report (IOM, 2010), Phase II was collaboratively commenced by the CDC, FDA, and the U.S. Department of Agriculture’s Center for Nutrition Policy and Promotion. The findings and recommendations of the Phase II initiative are the subject of the publication reviewed here. Objectives and approach The tasks of the Phase II committee were as follows.