Journal of the American Dietetic Association

Published by Elsevier
Online ISSN: 0002-8223
Publications
Article
This study describes changes observed during a 2-year period in participants enrolled in The Solution Method, a developmental skills training program for adult weight management. This intervention is the adult application of a model of treatment previously used only in the management of pediatric obesity (The Shapedown Program). Developmental skills training integrates understandings and methods from developmental, family systems, biomedical, genetic, and behavioral theories of the etiology of obesity. Twenty-two subjects (mean age = 43.4 +/- 8.5 years and mean body mass index = 33.1 +/- 5.3) completed a group intervention based on this method, which was conducted by a registered dietitian and a mental health professional. Questionnaire responses indicated the extent to which their weight was a medical and/ or psychosocial risk. Subjects attended 2-hour weekly sessions for an average of 18 weeks during which they were trained in six developmental skills: strong nurturing, effective limits, body pride, good health, balanced eating, and mastery living. Data, which were collected at the beginning of treatment and at 3, 6, 12, and 24 months, included weight, blood pressure, 7-day exercise recalls, and responses to depression and functioning (psychosocial, vocational, and economic) questionnaires. Participants' weights decreased throughout the 2-year period of the study: mean weight change was -4.2 kg (3 months), -6.0 kg (6 months), -7.0 kg (12 months), and -7.9 kg (24 months). In addition, compared with baseline values, systolic and diastolic blood pressure, exercise, and depression improved throughout the study period. These improvements were statistically significant at 24 months for weight (P < .01), systolic blood pressure (P < .02), diastolic blood pressure (P < .001), and exercise (P < .001); the results were not statistically significant for depression. Most participants reported improvement in a broad range of aspects of functioning. We conclude that this application of developmental skills training for adult weight management may produce significant long-term beneficial effects.
 
Article
The concept of nutrient density (ratio of nutrients per 1,000 kcal) is suggested as one on which the Recommended Dietary Allowances could well he based.
 
Article
To study snacking behavior, including frequency, time of day, location, and qualities sought in snack choices. A survey questionnaire was designed for use by trained telephone interviewers to interview adults and for self-administration by students in the fifth and sixth grades. A national random sample was drawn of 1,510 adults, and a nonrandom sample was drawn of 290 fifth and sixth graders attending schools in four states. Adults were randomly selected by a computerized telephone directory system from 48 states (Hawaii and Alaska were excluded). The five schools surveyed were selected to represent a major inner city (Atlanta, Ga), a suburban area (Englewood, NJ), a midsize city (two schools in St Louis, Mo), and a rural area (Hickman, Calif). The majority of children in all age groups snacked at least once daily. Morning was the least common and afternoon was the most common time for snacking. Almost all snacking occurred at home. In the selection of snacks, taste outranked nutrition as the most important characteristic of a snack. Fruits were popular with all age groups, but overall they were chosen less often at snacktime than foods from other categories. Snacking should be targeted with specific nutrition education messages that address the influences of time of day, location, and qualities of foods on snack choices.
 
Article
All you need to explore cyberspace is a computer, a modem, a phone line, and a local "on-ramp" to the infohighway. A litserv is an interactive mailing list that distributes information to a large number of people at the same time. Once you subscribe, you receive copies of all messages sent into listserv and have the opportunity to post questions and comments for other subscribers. Dietetics Online: A Network of Dietetic/Nutrition Professionals offers a range of cutting-edge services. Online marketing can reach a potentially larger audience for a fraction of the cost of traditional means and expand your business geographically.
 
Article
Evidence suggests that folate may play a role in cancer prevention. A plausible mechanism for prevention lies in the integral role that folate plays in deoxyribonucleic acid (DNA) synthesis and methylation. DNA methylation most likely regulates gene expression. Abnormal methylation, specifically hypomethylation, has been associated with tumorigenesis. The availability of methyl groups needed for adequate DNA methylation may be negatively influenced by low folate status, alcohol intake, or genetic polymorphisms that affect folate metabolism. Observational studies evaluating the association between folate and risk for colorectal and cervical cancers or precancerous conditions have produced conflicting results, and clinical trial data are needed to confirm a cause-and-effect relationship. However, several studies show interesting associations between cancer risk and factors that influence methyl group availability. Although data relating folate to cancer risk remain equivocal, when coupled with the other potential health benefits associated with folate, evidence supports recommending that people consume folate-rich foods such as fruits and vegetables. People consuming alcohol on a daily basis may especially benefit from additional folate in their diets.
 
Article
In this review of the scientific literature on the relationship between vegetable and fruit consumption and risk of cancer, results from 206 human epidemiologic studies and 22 animal studies are summarized. The evidence for a protective effect of greater vegetable and fruit consumption is consistent for cancers of the stomach, esophagus, lung, oral cavity and pharynx, endometrium, pancreas, and colon. The types of vegetables or fruit that most often appear to be protective against cancer are raw vegetables, followed by allium vegetables, carrots, green vegetables, cruciferous vegetables, and tomatoes. Substances present in vegetables and fruit that may help protect against cancer, and their mechanisms, are also briefly reviewed; these include dithiolthiones, isothiocyanates, indole-3-carbinol, allium compounds, isoflavones, protease inhibitors, saponins, phytosterols, inositol hexaphosphate, vitamin C, D-limonene, lutein, folic acid, beta carotene, lycopene, selenium, vitamin E, flavonoids, and dietary fiber. Current US vegetable and fruit intake, which averages about 3.4 servings per day, is discussed, as are possible noncancer-related effects of increased vegetable and fruit consumption, including benefits against cardiovascular disease, diabetes, stroke, obesity, diverticulosis, and cataracts. Suggestions for dietitians to use in counseling persons toward increasing vegetable and fruit intake are presented.
 
Article
Vitamin A consumption by many Americans is quite high, in part because of the consumption of fortified foods and the use of vitamin supplements. Most multivitamin supplements provide two or more times the recommended dietary allowance (RDA) for vitamin A because the daily value (DV) is based on 1968 and not current RDAs. Consumption of just one multivitamin often provides excessive vitamin A, the majority of it as preformed vitamin A esters. Given recent epidemiologic evidence that suggests a link between chronic intakes of vitamin A that exceed the RDA and hip fractures, it may be time to reexamine food and supplement fortification policies and to discontinue the clinical practice of prescribing two multivitamins to the elderly and other patients whose needs for certain micronutrients are high.
 
Article
It is the position of the American Dietetic Association (ADA), the Society for Nutrition Education (SNE), and the American School Food Service Association (ASFSA) that comprehensive nutrition services must be provided to all of the nation's preschool through grade twelve students. These nutrition services shall be integrated with a coordinated, comprehensive school health program and implemented through a school nutrition policy. The policy should link comprehensive, sequential nutrition education; access to and promotion of child nutrition programs providing nutritious meals and snacks in the school environment; and family, community, and health services' partnerships supporting positive health outcomes for all children. Childhood obesity has reached epidemic proportions and is directly attributed to physical inactivity and diet. Schools can play a key role in reversing this trend through coordinated nutrition services that promote policies linking comprehensive, sequential nutrition education programs, access to and marketing of child nutrition programs, a school environment that models healthy food choices, and community partnerships. This position paper provides information and resources for nutrition professionals to use in developing and supporting comprehensive school health programs. J Am Diet Assoc. 2003;103:505-514.
 
Article
The Healthy Eating Index (HEI) is a scoring system used by the US government to assess adherence to the Dietary Guidelines for Americans. We examined the ability of the HEI to monitor diet quality among youth. We modified and simplified the HEI for use by older children and adolescents. The new Youth Healthy Eating Index (YHEI) focuses on food quality and assesses both healthful and unhealthful foods and eating behaviors. Both HEI and YHEI scores were calculated from a food frequency questionnaire that was mailed to participants in the Growing Up Today Study in 1996. Girls (n=8,807) and boys (n=7,645) 9 to 14 years of age who are children of participants in the Nurses Health Study II cohort and who reside across the United States. Mean HEI and YHEI scores were calculated by sex and age, and associations with age, body mass index, activity, inactivity, energy intake, and several nutrients were assessed with Pearson correlations. Linear regression was used to examine the contributions of the individual HEI and YHEI components toward the total scores. The HEI score was highly correlated with total energy intake ( r =0.67), indicating a strong association with quantity of food consumption. In contrast, the YHEI was not strongly correlated with energy intake ( r =0.12) but was inversely associated with time spent in inactive pursuits ( r =-0.27). The HEI component for variety in food selection accounted for 60% of the variation in the total score and several HEI components were highly correlated with each other, particularly those for total and saturated fat ( r =0.78). To successfully monitor diet in a population of children and adolescents, the HEI may benefit from modifications that focus on food quality and include assessments of unhealthful foods. Further research is needed to determine the dietary elements that are most related to health in diverse populations of youth.
 
Article
Serum hepatic protein (albumin, transferrin, and prealbumin) levels have historically been linked in clinical practice to nutritional status. This paradigm can be traced to two conventional categories of malnutrition: kwashiorkor and marasmus. Explanations for both of these conditions evolved before knowledge of the inflammatory processes of acute and chronic illness were known. Substantial literature on the inflammatory process and its effects on hepatic protein metabolism has replaced previous reports suggesting that nutritional status and protein intake are the significant correlates with serum hepatic protein levels. Compelling evidence suggests that serum hepatic protein levels correlate with morbidity and mortality. Thus, serum hepatic protein levels are useful indicators of severity of illness. They help identify those who are the most likely to develop malnutrition, even if well nourished prior to trauma or the onset of illness. Furthermore, hepatic protein levels do not accurately measure nutritional repletion. Low serum levels indicate that a patient is very ill and probably requires aggressive and closely monitored medical nutrition therapy.
 
Article
This study provides information on the caffeine intakes of a representative sample of the US population using the US Department of Agriculture 1994 to 1996 and 1998 Continuing Survey of Food Intakes by Individuals. The percentage of caffeine consumers of the total sample (N=18,081) and by age and sex groups and for pregnant women were determined. Among caffeine consumers (n=15,716), the following were determined: mean intakes of caffeine (milligrams per day and milligrams per kilogram per day) for all caffeine consumers, as well as for each age and sex group and pregnant women; mean intakes (milligrams per day) of caffeine by food and beverage sources; and the percent contribution of each food and beverage category to total caffeine intake for all caffeine consumers, as well as each age and sex group and pregnant women. Eight-seven percent of the sample consumed food and beverages containing caffeine. On average, caffeine consumers' intakes were 193 mg caffeine per day and 1.2 mg caffeine per kilogram of body weight per day. As age increased, caffeine consumption increased among people aged 2 to 54 years. Men and women aged 35 to 64 years were among the highest consumers of caffeine. Major sources of caffeine were coffee (71%), soft drinks (16%), and tea (12%). Coffee was the major source of caffeine in the diets of adults, whereas soft drinks were the primary source for children and teens.
 
Article
We summarize evidence on the role of dietary supplements in weight reduction, with particular attention to their safety and benefits. Dietary supplements are used for two purposes in weight reduction: (a) providing nutrients that may be inadequate in calorie-restricted diets and (b) for their potential benefits in stimulating weight loss. The goal in planning weight-reduction diets is that total intake from food and supplements should meet recommended dietary allowance/adequate intake levels without greatly exceeding them for all nutrients, except energy. If nutrient amounts from food sources in the reducing diet fall short, dietary supplements containing a single nutrient/element or a multivitamin-mineral combination may be helpful. On hypocaloric diets, the addition of dietary supplements providing nutrients at a level equal to or below recommended dietary allowance/adequate intake levels or 100% daily value, as stated in a supplement's facts box on the label, may help dieters to achieve nutrient adequacy and maintain electrolyte balance while avoiding the risk of excessive nutrient intakes. Many botanical and other types of dietary supplements are purported to be useful for stimulating or enhancing weight loss. Evidence of their efficacy in stimulating weight loss is inconclusive at present. Although there are few examples of safety concerns related to products that are legal and on the market for this purpose, there is also a paucity of evidence on safety for this intended use. Ephedra and ephedrine-containing supplements, with or without caffeine, have been singled out in recent alerts from the Food and Drug Administration because of safety concerns, and use of products containing these substances cannot be recommended. Dietitians should periodically check the Food and Drug Administration Web site ( www.cfsan.fda.gov ) for updates and warnings and alert patients/clients to safety concerns. Dietetics professionals should also consult authoritative sources for new data on efficacy as it becomes available ( ods.od.nih.gov ).
 
Article
Historically, epidemiologic studies have reported a lower prevalence of impaired glucose tolerance and type 2 diabetes in populations consuming large amounts of the n-3 long-chain polyunsaturated fatty acids (n-3 LC-PUFAs) found mainly in fish. Controlled clinical studies have shown that consumption of n-3 LC-PUFAs has cardioprotective effects in persons with type 2 diabetes without adverse effects on glucose control and insulin activity. Benefits include lower risk of primary cardiac arrest; reduced cardiovascular mortality, particularly sudden cardiac death; reduced triglyceride levels; increased high-density lipoprotein levels; improved endothelial function; reduced platelet aggregability; and lower blood pressure. These favorable effects outweigh the modest increase in low-density lipoprotein levels that may result from increased n-3 LC-PUFA intake. Preliminary evidence suggests increased consumption of n-3 LC-PUFAs with reduced intake of saturated fat may reduce the risk of conversion from impaired glucose tolerance to type 2 diabetes in overweight persons. Reported improvements in hemostasis, slower progression of artery narrowing, albuminuria, subclinical inflammation, oxidative stress, and obesity require additional confirmation. Expected health benefits and public health implications of consuming 1 to 2 g/day n-3 LC-PUFA as part of lifestyle modification in insulin resistance and type 2 diabetes are discussed.
 
Article
The Food and Drug Administration (FDA) conducts studies of food labels as part of its ongoing monitoring of the nutritional status of the US population. In 1994 FDA nutrition labeling rules were implemented and in 1997 the Food Label and Package Survey characterized various aspects of the labeling of processed, packaged foods, including nutrition labeling, health claims, and nutrient content claims. For the survey, FDA selected a multistage, representative sample of food products from the SCAN-TRACK food sales database (AC Nielsen Co, Schaumburg, Ill). FDA identified 58 product groups and selected those product classes from the database that accounted for 80% of sales in each group. From each product class, FDA selected the 3 top-selling product brands and randomly selected follower brands. Based on label information from a final sample of 1,267 food products, FDA determined the percentage of products sold that bear Nutrition Facts labels, health claims, and nutrient content claims. The purpose of this article was to present FDA findings regarding the status of food labels 3 years after implementation of the nutrition labeling rules. Nutrition-labeled products accounted for an estimated 96.5% of the annual sales of processed, packaged foods. An additional 3.4% of products sold were exempt from labeling regulations. Nutrient content claims and health claims appeared on an estimated 39% and 4%, respectively, of the products sold. Dietitians and other health care professionals can use this survey information to identify food types with specific label information and to assist the US consumer in making more varied and healthful food choices in the marketplace.
 
Article
Inadequate intake of calcium-rich foods among US adults and children is a public health concern. Fluid milk is one of the best calcium sources because of its bioavailability and its versatility as both a beverage and a complement to various solid foods. One of the foods commonly consumed with milk is ready-to-eat breakfast cereal (RTEC). We aimed to establish the association between the intake of RTEC, milk, and calcium within the context of the most current population dietary practices. We hypothesized that RTEC consumption facilitates milk consumption and is associated with adequacy of calcium intake in the US population. The most recent National Health and Nutrition Examination Survey, 1999-2000, data set was used as the source of data for this research. US subjects aged 4 years and older (n=7,403), excluding pregnant and/or lactating women. Data were stratified according to sex and age (4 to 8 years, 9 to 13 years, 14 to 18 years, 19 to 30 years, 31 to 50 years, 51 to 70 years, and 71+ years), and then by consumption of breakfast, RTEC, and milk. SAS (release 8.1, 2000, SAS Institute Inc, Cary, NC) and SUDAAN (release 8.0.2, 2003, Research Triangle Institute, Research Triangle Park, NC) were used to calculate sample weighted means, standard errors, and population percentages. Multiple regression and multiple logistic regression models, with controls for covariates, were used to determine the predictability of total calcium intake from breakfast consumption compared to breakfast nonconsumption, and from inclusion of RTEC and milk in the breakfast meal compared with breakfast meal content without RTEC and milk. RTEC was predominantly consumed at breakfast. Average calcium intake at breakfast was seven times greater when RTEC was consumed with milk than when RTEC was consumed without milk. In multiple regression analyses, breakfast consumption, and milk consumption with or without RTEC all strongly predicted total daily calcium intake (P<0.05) while controlling for covariates. The percentage of respondents below the Adequate Intake level for calcium was higher for non-RTEC breakfast consumers than for RTEC breakfast consumers in all age-sex categories except those older than age 70 years, and girls aged 9 to 13 years. Consumption of RTEC at breakfast was associated with greater daily intake of both milk and calcium in all age and sex groups in the US population.
 
Article
To determine the effects of offering universal-free school breakfast in elementary schools on students' dietary outcomes. Experimental study with random assignment of 153 matched elementary schools in six school districts. Treatment schools offered universal-free school breakfast, and control schools continued to operate the traditional means-tested School Breakfast Program. Twenty-four-hour dietary recalls were collected from sample students near the end of the first year. About 30 students in second through sixth grades were randomly selected from each school (n=4,358). Free school breakfasts were made available to all students in treatment schools, regardless of family income, for three consecutive school years (2000-2001 to 2002-2003). Breakfast consumption and food and nutrient intake. Hierarchical mixed-models and logistic regression, adjusting for age, sex, minority status, and income eligibility for the regular school meal programs, were used to estimate effects. Despite a significant increase in school breakfast participation among sample students in treatment schools (from 16% to 40%, P<0.01), the rate of breakfast skipping did not differ between groups (4% overall). Treatment school students were more likely to consume a nutritionally substantive breakfast (P<0.01), but dietary intakes over 24 hours were essentially the same. Making universal-free school breakfast available in elementary schools did not change students' dietary outcomes after nearly 1 year. To improve children's diets overall, efforts should focus on ensuring all students have access to a healthful breakfast, at home or at school.
 
Article
Some psychological predictors of eating behaviors have been shown to affect usefulness of methods for dietary assessment. Therefore, this study was conducted to determine the association of dietary restraint and disinhibition with dietary recall accuracy for total energy, fat, carbohydrate, and protein. In a cross-sectional study, data were obtained from 79 male and 71 female non-Hispanic whites and African-American volunteers. Participants selected and consumed all foods for a 1-day period under observation and actual intake was determined. The following day, each participant completed a telephone 24-hour recall using the US Department of Agriculture Multiple-Pass method to obtain recalled intake. The Eating Inventory, which measures dietary restraint and disinhibition, was administered prior to eating any food in the study. Repeated measures analyses of variance were used to determine if dietary restraint or disinhibition were independent predictors of recall accuracy. The mean (+/-standard deviation) age and body mass index of the participants was 43+/-12 years and 29+/-5.5 (calculated as kg/m2), respectively. On average, men overreported intake of energy by 265 kcal and women by 250 kcal; both groups also overreported intake of protein, carbohydrate, and fat. When controlling for body mass index, sex, and race, restraint was a significant independent predictor of energy intake (P=0.004) and negatively correlated with energy intake (r=-0.23, P<0.001). Unlike intake of carbohydrate or protein, fat intake was significantly and negatively associated with dietary restraint (P<0.001; r=-0.3). Dietary restraint did not affect accuracy of recall of intake of energy, fat, carbohydrate, or protein, but was significantly associated with intake of energy and fat. Disinhibition was not related to intake or accuracy. Dietetics professionals should consider dietary restraint a possible reason for a lower than expected estimate of energy intake when using 24-hour recalls.
 
Article
It is the position of the American Dietetic Association (ADA) and Dietitians of Canada (DC) that dietary fat for the adult population should provide 20% to 35% of energy and emphasize a reduction in saturated fatty acids and trans-fatty acids and an increase in n-3 polyunsaturated fatty acids. ADA and DC recommend a food-based approach for achieving these fatty acid recommendations; that is, a dietary pattern high in fruits and vegetables, whole grains, legumes, nuts and seeds, lean protein (ie, lean meats, poultry, and low-fat dairy products), fish (especially fatty fish high in n-3 fatty acids), and use of nonhydrogenated margarines and oils. Implicit to these recommendations for dietary fatty acids is that unsaturated fatty acids are the predominant fat source in the diet. These fatty acid recommendations are made in the context of a diet consistent with energy needs (ie, to promote a healthful body weight). ADA and DC recognize that scientific knowledge about the effects of dietary fats on human health is incomplete and take a prudent approach in recommending a reduction in those fatty acids that increase risk of disease, while promoting intake of those fatty acids that benefit health. Registered dietitians play a pivotal role in translating dietary recommendations for fat and fatty acids into healthful dietary patterns for different population groups.
 
Article
Intakes and related biochemical indexes of ascorbic acid, thiamin, riboflavin, pyridoxine, vitamin B-12, and folic acid were examined for adequacy in 30 normal children aged 40 to 108 months. Comparisons were made between intake and biochemical index values of children who reported regular use of vitamin supplements and those who reported none. Three-day food records provided nutrient intake data; blood samples, drawn following an overnight fast, were analyzed for biochemical indexes. Student's t-test and the Pearson r were used for comparisons. Mean intakes of most nutrients differed significantly between the supplemented and nonsupplemented groups only when supplements were considered. Mean biochemical indexes differed significantly for riboflavin (p less than .005). Correlations between intakes and respective biochemical indexes were significant for riboflavin (p less than .01) and vitamin B-12 (p less than .01) in the supplemented group and for folate with RBC folate (p less than .005) in the nonsupplemented group. No deficiencies in either group were evident from biochemical indexes; improvement in indexes with supplement use was interpreted as being only relative and not suggestive that such use is beneficial.
 
Article
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 <0.18. Overall, the majority of the correlation coefficients for children aged >12 years were higher than those aged < or =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.
 
Article
The objective of this study was to evaluate a computerized food frequency questionnaire (FFQ) that estimates calcium intake among Asian, Hispanic, and non-Hispanic white youth. A computerized FFQ based on a list of 80 foods with corresponding food photos was evaluated for 4 consecutive weeks. The evaluation study consisted of computerized FFQs during weeks 1 and 4, and 24-hour dietary recalls during each of weeks 2 and 3. Subjects were a convenience sample of Asian (29%), Hispanic (36%), and non-Hispanic white (35%) youth, age 11 to 18 years, living in northern Utah (N=161). Paired t tests, percent agreement, Pearson correlation coefficients of transformed calcium intake values (using ladder of transformation), deattenuated Pearson correlation coefficients, and Spearman correlation coefficients were used to evaluate the computerized FFQ. The correlation of calcium intakes estimated by the first and second computerized FFQ, 1 month apart, was 0.72 (transformed Pearson's r) for the total sample (N=161). Correlations within subgroups were: for males, r=0.59; females, r=0.81; 11- to 14-year-olds, r=0.66; 15- to 18-year-olds, r=0.82; Asians, r=0.73; Hispanics, r=0.76; and non-Hispanic whites, r=0.61. The correlation of calcium intakes estimated by the second computerized FFQ and the mean of two 24-hour dietary recalls was 0.56 (deattenuated, transformed Pearson's r) for the total sample. Correlations were also significant for males (r=0.50), females (r=0.57), 11- to 14-year-olds (r=0.56), 15- to 18-year-olds (r=0.59), Asians (r=0.63), Hispanics (r=0.55), and non-Hispanic whites (r=0.57). This computerized FFQ was found to be reliable in estimating calcium intake among a multiethnic youth population in the United States.
 
Article
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 My-Pyramid. 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 pro-rated 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 pro-rated. 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.
 
Article
Isoflavones are derived from dietary sources and considered to promote health by preventing the onset of such chronic diseases as cardiovascular disease, cancer, and osteoporosis. Valid and reliable estimation of isoflavone intake is a prerequisite to establishing biological functions of isoflavones on health risks. This study aimed to validate the approach of estimating dietary isoflavone intake with respective urinary isoflavone concentrations in US adults. Data from the US Department of Agriculture isoflavone database and dietary recalls of 2,908 US adults with urinary isoflavone data in the 1999-2002 National Health and Nutrition Examination Survey were used. Dietary isoflavone was consumed by only 35% of adults in a day with an average intake of 3.1 mg/day, which resulted in a mean intake of 1.0 mg/day for all US adults. The isoflavone intakes were from genistein (55%), diadzein (35%), glycitein (7%), biochanin A (2%), and formononetin (2%). Both daily total and energy adjusted isoflavone intake differed by race/ethnicity subgroups (P<0.05) and was associated positively with income (P<0.01) and inversely with body mass index (P<0.05). Geometric mean urinary isoflavone concentration was 5.0 ng/mL among isoflavone consumers and the urinary genistein and daidzein excretion correlated with their isoflavone intake levels (P<0.01). In large population-based studies, estimated dietary isoflavone intake can be validated by urinary isoflavones. Further studies are needed at an individual level to validate dietary isoflavone intake by urinary isoflavone concentration.
 
Article
Programs to alleviate malnutrition in children in developing countries need revision. Intervention field trials in Thailand, Tunisia, and Guatemala, based on amino acid fortification and supplementary vitamins and minerals, have had little effect on children. In fact, it is often a misconception that frank deficiencies are common characteristics of malnutrition in developing countries.Rather, stunted growth--caused by caloric deficiency often in the presence of adequate food supplies--may be the most prevalent form of malnutrition. The situation occurs when the customary staple food--for instance, rice in Thailand--has such a high caloric density that children cannot eat enough food to meet their needs. Knowledge is not vet available on ways to solve this dilemma. Nevertheless nutritionists must come forward and be willing to contribute their knowledge and expertise in the shaping of national and international nutrition policies to improve the healthand well-being of populations.
 
Article
This article examines the reliability and construct validity of questions assessing mediating factors of fruit and vegetable consumption among 11- and 12-year-old children (N=207). Internal consistencies were good for most scales, ranging from 0.56 to 0.94. Intraclass correlation coefficients between test and retest were acceptable, ranging from 0.39 to 0.90. Concerning predictive validity, preferences and perceived parental and peer behavior were significantly associated with fruit and vegetable consumption. Self-efficacy in difficult situations and a variety of available fruit were significantly correlated with fruit consumption, while permissive eating practices and obligation rules were significantly correlated with vegetable consumption. General attitudes, outcome expectations, selection efficacy, and encouraging practices were not associated with fruit or vegetable consumption.
 
Article
It is the position of the American Dietetic Association that children ages 2 to 11 years should achieve optimal physical and cognitive development, attain a healthy weight, enjoy food, and reduce the risk of chronic disease through appropriate eating habits and participation in regular physical activity. The health status of American children has generally improved over the past three decades. However, the number of children who are overweight has more than doubled among 2- to 5-year-old children and more than tripled among 6- to 11-year-old children, which has major health consequences. This increase in childhood overweight has broadened the focus of dietary guidance to address children's over consumption of energy-dense, nutrient-poor foods and beverages and physical activity patterns. Health promotion will help reduce diet-related risks of chronic degenerative diseases, such as cardiovascular disease, type 2 diabetes, cancer, obesity, and osteoporosis. This position paper reviews what US children are eating and explores trends in food and nutrient intakes as well as the impact of school meals on children's diets. Dietary recommendations and guidelines and the benefits of physical activity are also discussed. The roles of parents and caregivers in influencing the development of healthy eating behaviors are highlighted. The American Dietetic Association works with other allied health and food industry professionals to translate dietary recommendations and guidelines into achievable, healthful messages. Specific recommendations to improve the nutritional well-being of children are provided for dietetics professionals, parents, and caregivers.
 
Article
Measuring children's dietary behavior is central to evaluating interventions and identifying predictors and outcomes of dietary behaviors. Systematic biases may obscure or inflate associations with self-reported intakes. To identify cognitive, behavioral, and social correlates of bias in children's reporting of breakfast items on a self-completion questionnaire. Cross-sectional survey. Children completed standardized tests of episodic memory, working memory, and attention, and a questionnaire assessing attitudes toward breakfast. Teachers completed a classroom behavior measure. Associations between measures and children's underreporting of breakfast foods (ie, cereals, bread, milk, fruits, sweet items, and potato chips) on a self-completion questionnaire relative to validated 24-hour recall were examined. Subjects were aged 9 to 11 years (n=678). Data were collected from 111 schools throughout Wales in 2005. A larger percentage of less-healthful breakfast items (ie, sweet snacks and potato chips) than more healthful items (ie, fruit, cereals, bread, and milk) were omitted from questionnaire self-reports. Children from lower socioeconomic status schools omitted more items than those from wealthier schools (Kruskal-Wallis H=12.51, P<0.01), with omissions twice as high for less-healthful items than for more-healthful items within the lowest socioeconomic status schools. Those with positive attitudes (H=23.85, P<0.001), better classroom behavior (H=6.26, P<0.05), and better episodic memory (H=8.42, P<0.05) omitted fewer items than those with negative attitudes, poorer behavior, and poorer episodic memory. Children who ate more items omitted more than those who ate fewer (H=47.65, P<0.001). No differences were observed in terms of attention and working memory. Episodic memory, classroom behavior, attitudes, socioeconomic status, and total items consumed are associated with bias in questionnaire self reports. Such biases have implications for examination of associations between breakfast eating and cognitive and behavioral factors, examination of effect modification by socioeconomic status in intervention trials, and for the sensitivity of measures to detect intervention effects.
 
Article
Recent studies have concluded that Native North American children have higher proportions of overweight and obesity than children from the general North American population. This study presents anthropometric data on a representative sample of children from the Mohawk Nation that can be used for comparison with other Native American populations. This is a cross-sectional study comparing distributions of anthropometric characteristics of Mohawk children to the corresponding age and gender data from the Second National Health and Nutrition Examination Survey (NHANES II). Weight, height, triceps and subscapular skinfold thickness, and waist and hip circumferences were measured in 527 children. All children in grades 1 to 6 (aged 6 to 11 years) in the 3 elementary schools of 2 Mohawk communities in Canada, for whom parental consent was obtained, were enrolled in the present study. There were no exclusion criteria. With a participation rate of 83%, the 527 children enrolled in this study represent an unbiased sample of the population from 2 Mohawk territories. Compared with children studied in NHANES II, Mohawk children were similar in height and triceps skinfolds but were generally heavier, had thicker subscapular skinfolds, and had greater waist and hip circumferences. These differences were greater in older children. Mohawk children who had extreme-high weight values compared with their population means were heavier than their NHANES II counterparts. Results indicated that, on average, Mohawk children seem to be slightly heavier than children in NHANES II. Except for those with extreme overweight values, Mohawk children show less variation of weight and body mass index than children in NHANES II. Finally, overweight Mohawk children seem to be more likely to carry their excess body fat truncally, compared with overweight children from NHANES II. Health practitioners working with Native American populations should be careful when assessing childhood obesity. Simple comparisons of weight or body mass index with NHANES standards may lead to inappropriate risk assessments.
 
Article
To determine the accuracy of mothers' reports of their children's weights and heights. Cross-sectional survey of Mexican Americans in five southwestern states. Interviews were held with mothers of 2,578 children aged 6 months to 11 years old. Sensitivity and specificity of categories formed from reported values, and correlation of reported and measured values. Probability of mothers answering "don't know" was 24% for children's weights and 51% for heights. On the average, mothers overestimated weights at the 15th percentile or lower for age and sex and underestimated weights at the 85th percentile or higher. On the average, they underestimated heights. Categories of low and high weight, height, and body mass index were created by applying absolute-value cutoffs to reported values. All the categories had low sensitivity or specificity. Age-group-specific correlation coefficients between reported and measured values ranged from .79 to .89 for weight and from .32 (for 6- through 23-month-olds) to .70 (for 9- through 11-year-olds) for height. The use of categories formed by applying absolute-value cutoffs to mother-reported values results in frequent misclassification of individuals. Therefore, such categories should not be used to estimate relative risks associated with weight, height, and body mass index. The good correlation of mother-reported and measured weights indicates that despite their inaccuracies, reported weights well reflect the relative ranking of measured weights. Thus, the use of reported weights as a continuous variable in multivariate analyses might cause only small errors in the coefficient for weight.
 
Article
Twenty-three fruits, 33 vegetables, 41 grain products, 7 legumes, 4 nuts, and 9 miscellaneous foods were analyzed by an accurate chemical method to determine their dietary fiber content and composition. The mean (+/- standard deviation) dietary fiber content of fruits was 1.4 +/- 0.7 g/100 g (fresh weight); of vegetables, 2.0 +/- 0.8 g; of 32 refined grains (less than 5% fiber), 2.3 +/- 1.0 g; of legumes, 4.0 +/- 0.7 g; and of nuts, 6.4 +/- 2.1 g; the dietary fiber content of nine higher-fiber grains (greater than 5%) was variable. The soluble fiber fraction averaged 23% of the total fiber in refined grains, 3% in nuts, and 13% to 20% in the other food groups. Dietary fiber composition of every food group was heterogenous. Pectin, which was negligible in grains, constituted approximately 15% to 30% of the fiber in fruits, vegetables, legumes, and nuts. Hemicelluloses composed about half of the total fiber in grains, and approximately 25% to 35% of total fiber in other foods. Cellulose was one third or less of the total fiber in most foods, except for legumes, in which it was about one half. Values for total dietary fiber content generally agree with those reported previously. The soluble fiber fraction was lower than what has been reported because the distribution of total fiber between the soluble and insoluble fractions is determined by the method of analysis. The analyses used in this study demonstrated that the concentration of dietary fiber in many frequently consumed foods is 1% to 3%. The generally similar fiber concentrations of food within a group--fruits, vegetables, refined grains, and legumes--suggest that an average value for the fiber concentration in that group can be used to rank food intakes and histories into low, medium, or high dietary fiber contents.
 
Article
The purpose of this study was to examine associations among dietary supplement use and dietary/activity patterns in a representative sample of adolescents by sex and race/ethnicity, a research area where extant data is limited. Cross-sectional, multistage, probability-based sample of 11th graders in Texas during 2004-2005 (n=6,422; 48.8% white/other, 37% Hispanic, and 14.2% African American; 50.6% boys; mean age 16.7 years). Classrooms. MAIN VARIABLES ASSESSED: Dietary supplement use, dietary/activity patterns, and anthropometrics. Multiple logistic regression models (odds ratios [ORs] and 95% confidence intervals [CIs]). Dietary supplement users reported healthy dietary and physical activity behaviors overall, yet sex- and race/ethnicity-specific differences were seen in associations among specific diet/activity behaviors and supplement use. In whites/others and Hispanics, but not African Americans, supplement use was associated with higher diet quality scores (OR 2.93, 95% CI 1.74 to 4.95 for whites/others; OR 3.93, 95% CI 2.26 to 6.83 for Hispanics), and regular consumption of breakfast (OR 2.27, 95% CI 1.40 to 3.66 for whites/others; OR 1.96, 95% CI 1.11 to 3.46 for Hispanics) and low-fat foods (OR 3.02, 95% CI 1.53 to 5.98 for whites/others; OR 3.59, 95% CI 1.11 to 11.6 for Hispanics). Supplement use was not associated with body mass index or with sedentary behaviors overall, but was associated with less television viewing only in whites/others (OR 0.53, 95% CI 0.33 to 0.84). For physical activity, boys and whites/others showed positive associations between supplement use and all indicators examined, but girls, Hispanics and African Americans showed mixed patterns of associations. Supplement use was associated with higher weight preference only in boys (OR 2.47, 95% CI 1.24 to 4.90), and vegetarian diets only in girls (OR 2.96, 95% CI 1.35 to 6.47). Dietary and activity patterns associated with dietary supplement use may vary by sex- and racial/ethnic subpopulation, especially amongst African American youth. These findings together with further research on psychosocial and attitudinal characteristics associated with adolescent supplement use can enhance the development of targeted and tailored health communications about supplement use in adolescent subpopulations.
 
Article
This article provides an overview of five decades (1936 through 1987) of publications on individual dietary assessment methodology, such as dietary histories, estimated and weighed food records, food frequency questionnaires, and 24-hour recalls. Representative studies were selected to characterize data collection and analyses methods of each decade. During the 1930s and 1940s, dietary intake methodology was in its initial stages; popular methods were the dietary history technique and lengthy food records. The 1950s were characterized by extensive comparisons of methodologies, which now often included shorter-term food records and 24-hour recalls. The 1960s ushered in large scale epidemiological studies, the food frequency technique, and use of computer technology for computation; the 24-hour recall was still widely used in that decade and the next. Advances of the 1970s and 1980s include expansion of nutrient databases, sophisticated statistical techniques for analysis, and refinement of data collection methodologies for analysis, and refinement of data collection methodologies. The chronological approach used in this review not only highlights progress of each decade but also identifies the repetitive efforts of some studies. The need for creative approaches is emphasized as current research needs are identified.
 
Baseline ethnic distribution of Healthier Options for Public Schoolchildren study children by intervention condition (N2,494) 
Article
Childhood obesity and related health consequences continue to be major clinical and public health issues in the United States. Schools provide an opportunity to implement obesity prevention strategies to large and diverse pediatric audiences. Healthier Options for Public Schoolchildren was a quasiexperimental elementary school-based obesity prevention intervention targeting ethnically diverse 6- to 13-year-olds (kindergarten through sixth grade). Over 2 school years (August 2004 to June 2006), five elementary schools (four intervention, one control, N=2,494, 48% Hispanic) in Osceola County, FL, participated in the study. Intervention components included integrated and replicable nutrition, physical activity, and lifestyle educational curricula matched to state curricula standards; modified school meals, including nutrient-dense items, created by registered dietitians; and parent and staff educational components. Demographic, anthropometric, and blood pressure data were collected at baseline and at three time points over 2 years. Repeated measures analysis showed significantly decreased diastolic blood pressure in girls in the intervention group compared to controls (P<0.05). Systolic blood pressure decreased significantly for girls in the intervention group compared to controls during Year 1 (fall 2004 to fall 2005) (P<0.05); while not statistically significant the second year, the trend continued through Year 2. Overall weight z scores and body mass index z scores decreased significantly for girls in the intervention group compared to controls (P<0.05 and P<0.01, respectively). School-based prevention interventions, including nutrition and physical activity components, show promise in improving health, particularly among girls. If healthy weight and blood pressure can be maintained from an early age, cardiovascular disease in early adulthood may be prevented.
 
Article
This study assessed how 8- to 13-year-old children categorized and labeled grain foods and how these categories and labels were influenced by child characteristics. The main hypotheses were that children categorized foods in consistent ways and these food categories differed from the professional food categories. A set of 71 cards with pictures and names of grain foods from eight professionally defined food groups was sorted by each child into piles of similar foods. There were 149 8- to 13-year-old children (133 English-speaking, 16 Spanish-speaking) in this exploratory study. One-way analysis of variance and Robinson matrices for identification of clusters of food items were calculated. Children created a mean (+/-standard deviation) of 8.3+/-3.8 piles with 8.6+/-9.1 cards per pile. No substantial differences in Robinson clustering were detected across subcategories for each of the demographic characteristics. For the majority of the piles, children provided "taxonomic-professional" (34.5%) labels, such as bread for the professional category of breads, rolls, and tortillas, or "script" (26.1%) labels, such as breakfast for the professional category of pancakes, waffles, and flapjacks. These categories may be used to facilitate food search in a computerized 24-hour dietary recall for children in this age group.
 
Top-cited authors
Patricia M. Guenther
  • University of Utah
Ruth E Patterson
  • University of California, San Diego
Leann L Birch
  • Pennsylvania State University
Paula Ziegler
  • College of Saint Elizabeth
Cheryl L Perry
  • University of Texas Health Science Center at Houston, School of Public Health, Austin Regional Campus