Journal of the American Dietetic Association

Published by Elsevier BV

Print ISSN: 0002-8223


Case Problem
  • Article

October 1999


34 Reads


The Solution Method

October 1997


52 Reads

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.

Snacking patterns among 1,800 adults and children

January 1995


148 Reads

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.

Cyberspace 101: taking a ride on the information superhighway

November 1997


22 Reads

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.

Rampersaud GC, Bailey LB & Kauwell GPA.Relationship of folate to colorectal and cervical cancer: review and recommendations for practitioners. J Am Diet Assoc 102: 1273-1282

October 2002


56 Reads

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.

Steinmetz KA, Potter JD. Vegetables, fruit, and cancer prevention: a review. J Am Diet Assoc 96, 1027-1039

November 1996


432 Reads

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.

Penniston KL, Tanumihardjo SA. Vitamin A in dietary supplements and fortified foods: too much of a good thing? J Am Diet Assoc 103, 1185-1187

October 2003


119 Reads

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.

Position of the American Dietetic Association, Society for Nutrition Education, and American School Food Service Association—Nutrition services: an essential component of comprehensive school health programs American Dietetic Association, Society for Nutrition Education, American School Food Service Association J Am Diet Assoc 2003 103 4 505 514

May 2003


93 Reads

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.

Feskanich D, Rockett HR, Colditz GA. Modifying the Healthy Eating Index to assess diet quality in children and adolescents. J Am Diet Assoc 104, 1375-1383

October 2004


160 Reads

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.

Fuhrman MP, Charney P, Mueller CM. Hepatic proteins and nutrition assessment. J Am Diet Assoc 104, 1258-1264

September 2004


379 Reads

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.

Frary CD, Johnson RK, Wang MQ. Food sources and intakes of caffeine in the diets of persons in the United States. J Am Diet Assoc 105, 110-113

February 2005


644 Reads

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.

Dietary supplements in weight reduction. J Am Diet Assoc 105:S80-86

June 2005


82 Reads

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 ( ) 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 ( ).

Nettleton JA, Katz R. n-3 Long-chain polyunsaturated fatty acids in type 2 diabetes: a review. J Am Diet Assoc 105, 428-440
  • Literature Review
  • Full-text available

April 2005


240 Reads

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.

Brecher SJ, Bender MM, Wilkening VL, McCabe NM, Anderson EM. Status of nutrition labeling, health claims, and nutrient content claims for processed foods: 1997 Food Label and Package Survey. J Am Diet Assoc 100, 1057-1062

October 2000


29 Reads









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.

Song WO, Chun OK, Kerver J, Cho S, Chung CE, Chung SJ. Ready-to-eat breakfast cereal consumption enhances milk and calcium intake in the US population. J Am Diet Assoc 106, 1783

November 2006


96 Reads

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.

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