Diet Quality of Preschoolers in Greece Based on the Healthy Eating Index: The GENESIS Study

Background

The current study aimed to assess the diet quality of Greek preschoolers and the potential role of several sociodemographic factors related to it.

Methods

A representative sample of 2,287 Greek children aged 2 to 5 years (from the Growth, Exercise, and Nutrition Epidemiological Study In preSchoolers) was used in this work. Dietary intake data was obtained using a combination of techniques comprising weighed food records, 24-hour recalls, and food diaries. A Healthy Eating Index (HEI) score was calculated summing the individual scores (0 to 10) assigned to each one of 10 index components.

Results

Eighty percent of participants had an HEI score <50 (ie, “poor” diet), 0.4% had an HEI score >80 (ie, “good” diet), and the overall mean HEI score was 59. HEI scores were significantly higher among boys, children aged 4 to 5 years, children participating in moderate to vigorous physical activities for more than 3 hours per week, children living in rural or small towns, and those whose mothers were employed and had higher educational status (>12 years). HEI score was also found to be strongly associated with several macronutrient and micronutrient intakes.

Conclusions

Based on HEI scores, the vast majority of Greek preschoolers was found to have a poor diet. Moreover, low HEI scores were associated with low levels of physical activity, low vegetable intake, high saturated fat intake, lower maternal educational level, and unemployment status.     

Whole-Grain Consumption Is Associated with Diet Quality and Nutrient Intake in Adults: The National Health and Nutrition Examination Survey, 1999-2004

Background

The consumption of whole grains and its association with nutrient intake has not been assessed in a recent nationally representative population.

Objective

To examine the association of consumption of whole grains, using the new whole-grain definition, with diet quality and nutrient intake in a recent, nationally representative sample of adults.

Design

Secondary analysis of cross-sectional data from 1999-2004 National Health and Nutrition Examination Survey.

Participants and methods

Adults aged 19 to 50 years (n=7,039) and aged 51 years and older (n=6,237).

Main outcome measures

Participants were divided into four whole-grain consumption groups: ≤0 to <0.6, ≥0.6 to <1.5, ≥1.5 to <3.0, and ≥3.0 servings (ounce equivalents)/day. Macro- and micronutrient intakes and diet quality, using the Healthy Eating Index, were determined for each group.

Statistical analyses

Sample weights were applied. The percentages of adults in whole-grain consumption groups were calculated. The covariates used were energy, ethnicity, sex, and age. Least-square means were calculated. P for linear trend analysis was determined using whole-grain intake as a linear covariate. A P value of ≤0.05 was considered significant.

Results

Adults aged 19 to 50 and 51+ years consumed a mean of 0.63 and 0.77 servings of whole grains per day, respectively. For both age groups, diet quality and intake of energy, fiber, and polyunsaturated fatty acids were significantly higher in those consuming the most servings of whole grains. Intake of total sugars (19 to 50 year age group only), added sugars, saturated fatty acids, monounsaturated fatty acids, and cholesterol was significantly lower in those consuming the most servings of whole grains. Intake of all micronutrients, except vitamin B-12 and sodium, was higher among individuals who consumed the most servings of whole grains.

Conclusions

Overall consumption of whole grains in the US population was low using the recently updated whole-grain definition. Adults who consumed the most servings of whole grains had better diet quality and nutrient intakes.     

Young unmarried men's understanding of female hormonal contraception

Background

A better understanding of men's attitudes, norms and behaviors regarding women's use of hormonal contraception is needed.

Study Design

We conducted contraceptive life-history interviews with 41 ethnically diverse males ages 18-25 years which detailed up to six heterosexual relationships, focusing on knowledge, attitudes, norms and behaviors regarding hormonal contraception use, decision making and communication.

Results

Men's attitudes, norms and behaviors associated with hormonal contraceptive decisions and use varied greatly across participants and their relationships. Findings suggest a mixture of attitudes and practices regarding the importance of communication around contraception influenced by sexual experiences, age and relationship type. Many men demonstrated limited knowledge about contraceptives and identified improving contraceptive knowledge as an essential step in facilitating contraceptive communication.

Conclusions

Increased awareness about young men's understanding of and perceived roles regarding hormonal contraception will help in designing services that address contraceptive adherence, contraceptive communication and incorrect or inadequate contraceptive knowledge.     

First- and Second-Trimester WIC Participation Is Associated with Lower Rates of Breastfeeding and Early Introduction of Cow's Milk during Infancy

Background

Existing literature suggests prenatal participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) may reduce breastfeeding among low-income mothers. However, little is known about whether the timing of WIC entrance during pregnancy influences infant feeding decisions.

Objective

This study assesses the association between the timing of prenatal participation in WIC and various infant feeding practices, including breastfeeding initiation, breastfeeding for at least 4 months, exclusive breastfeeding, formula feeding, and early introduction of cow's milk and solid food.

Design

Cross-sectional survey matching of birth certificate data to mothers' interviews 9 months after the child's birth. Mothers provided information on participation in the WIC program, infant feeding practices, and sociodemographic characteristics.

Subjects

A nationally representative sample of 4,450 births in 2001 from the Early Childhood Longitudinal Survey-Birth Cohort.

Analyses

Multivariate logistic regression techniques (using STATA 9.0 SE, Stata Company, College Station, TX) estimated the relationship between the timing of prenatal WIC participation and infant feeding practices.

Results

Entry into the WIC program during the first or second trimester of pregnancy is associated with reduced likelihood of initiation of breastfeeding and early cow's milk introduction; and entry during the first trimester is associated with reduced duration of breastfeeding. WIC participation at any trimester is positively related to formula feeding.

Conclusions

Prenatal WIC participation is associated with a greater likelihood of providing babies infant formula rather than breastmilk after birth. Findings also indicate that there are critical prenatal periods for educating women about the health risks of early cow's milk introduction. Given the health implications of feeding infants cow's milk too early, WIC may be successful in educating women on the health risks of introducing complementary foods early, even if direct counseling on cow's milk is not provided.     

Evaluation of the Healthy Eating Index-2005

Background

The Healthy Eating Index (HEI), a measure of diet quality as specified by federal dietary guidance, was revised to conform to the Dietary Guidelines for Americans 2005. The HEI has several components, the scores of which are totaled.

Objective

The validity and reliability of the HEI-2005 were evaluated.

Design

Validity was assessed by answering four questions: Does the HEI-2005 1) give maximum scores to menus developed by experts; 2) distinguish between groups with known differences in diet quality—smokers and nonsmokers; 3) measure diet quality independently of energy intake, a proxy for diet quantity; and 4) have more than one underlying dimension? The relevant type of reliability, internal consistency, was also assessed.

Subjects

Twenty-four−hour recalls from 8,650 participants, aged 2 years and older, in the National Health and Nutrition Examination Survey, 2001-2002 were analyzed to answer questions 2 to 4. Results were weighted to consider sample design and nonresponse.

Statistical analyses

T tests determined differences in scores between smokers and nonsmokers. Pearson correlation coefficients determined the relationship between energy intake and scores. Principal components analysis determined the number of factors that comprise the HEI-2005. Cronbach's coefficient α tested internal consistency.

Results

HEI-2005 scores are at or very near the maximum levels for all sets of exemplary menus with one exception; the Harvard menus scored low on the milk component because these menus intentionally include only small amounts of milk products. Nine of 12 component scores were lower for smokers than nonsmokers. The correlations of component scores were virtually independent of energy intake (< ∣.22∣). Multiple factors underlie the HEI-2005. Coefficient α was .43. The α value for all tests was .01.

Conclusions

The HEI-2005 is a valid measure of diet quality. Potential uses include population monitoring, evaluation of interventions, and research. The individual component scores provide essential information in addition to that provided by the total score.     

Postmarketing study of ORTHO EVRA and levonorgestrel oral contraceptives containing hormonal contraceptives with 30 mcg of ethinyl estradiol in relation to nonfatal venous thromboembolism

Background

Concern has been raised that the risk of venous thromboembolism (VTE) in users of the ORTHO EVRA^® patch is higher compared to users of oral contraceptives (OCs).

Study Design

We identified idiopathic cases of VTE and controls, matched on age and index date, from among women in the United States PharMetrics/IMS and MarketScan databases who were current users of the patch or levonorgestrel-containing OCs with 30 mcg of ethinyl estradiol. We calculated odds ratios (ORs) and 95% confidence intervals (CIs).

Results

The ORs (95% CI) for VTE in users of the patch compared to levonorgestrel-containing OCs were 2.0 (0.9-4.1) and 1.3 (0.8-2.1) in the PharMetrics and MarketScan databases, respectively. ORs (95% CI) restricted to women aged 39 years or younger were 1.4 (0.6-3.0) and 1.2 (0.7-2.0), respectively.

Conclusion

These results provide evidence that the risk of idiopathic VTE in users of the patch is not materially different than that of users of levonorgestrel-containing OCs in women aged 39 years or younger. We cannot rule out some increase in the risk in women aged 40 years or older.     

Nutrient Adequacy and Diet Quality in Non-Overweight and Overweight Hispanic Children of Low Socioeconomic Status: The Viva la Familia Study

Objective

The role of diet quality and nutrient adequacy in the etiology of childhood obesity is poorly understood. The specific aims of these analyses were to assess overall diet quality and nutrient adequacy, and test for association between weight status and diet in children from low socioeconomic status (SES) Hispanic families at high risk for obesity.

Design

A cross-sectional study design was used to assess dietary intake in low-SES Hispanic children with and without overweight who were enrolled in the Viva la Familia Study. Multiple-pass 24-hour dietary recalls were recorded on two random, weekday occasions. Diet quality was evaluated according to the Dietary Guidelines for Americans. Nutrient adequacy was assessed using z scores based on estimated average requirement or adequate intake.

Subjects/setting

The study included 1,030 Hispanic children and adolescents, aged 4 to 19 years, in Houston, TX, who participated between November 2000 and August 2004.

Statistical analysis

STATA software (version 9.1, 2006, STATA Corp, College Station, TX) was used for generalized estimating equations and random effects regression.

Results

Diet quality did not adhere to the Dietary Guidelines for Americans for fat, cholesterol, saturated fatty acids, fiber, added sugar, and sodium. Although energy intake was significantly higher in children with overweight, food sources, diet quality, macro- and micronutrient composition were similar between non-overweight and overweight children. Relative to estimated average requirements or adequate intake levels, mean nutrient intakes were adequate (70% to 98% probability) in the children without and with overweight, except for vitamins D and E, pantothenic acid, calcium, and potassium, for which z scores cannot be interpreted given the uncertainty of their adequate intake levels.

Conclusions

Whereas the diets of low-SES Hispanic children with and without overweight were adequate in most essential nutrients, other components of a healthful diet, which promote long-term health, were suboptimal. Knowledge of the diets of high-risk Hispanic children will inform nutritional interventions and policy.     

Effects of progesterone, levonorgestrel and medroxyprogesterone acetate on apoptosis in human endometrial endothelial cells

Background

We evaluated apoptosis in human endometrial endothelial cells (HEECs) incubated with progesterone, levonorgestrel (LNG) and medroxyprogesterone acetate (MPA).

Study Design

HEECs were cultured to near confluence, and the progestogens were added.

Setting

Academic Department of Obstetrics and Gynecology.

Patients

No patients were involved.

Interventions

Progestogens at 5-, 250- and 500-ng/mL concentrations were added to incubations of HEECs for 12, 24 and 48 h.

Main Outcome Measure

Apoptosis based on terminal deoxynucleotidyl transferase-mediated deoxy-UTP nick-end labeling (TUNEL), and semiquantification of Bax and Bcl-2.

Results

No apoptosis was found by TUNEL, Bax and Bcl-2 after 12 h incubation with any progestogen. TUNEL increased after incubation for 24 and 48 h with progesterone 500 ng/mL; LNG 250, 500 ng/mL and all concentrations of MPA (p<.001), Bax increased and Bcl-2 decreased at all concentrations of MPA and the two highest concentrations of LNG at 48 h (p<.05).

Conclusion

MPA results in apoptosis of HEECs.     

Diet Based on the Japanese Food Guide Spinning Top and Subsequent Mortality among Men and Women in a General Japanese Population

Background

The Japanese Food Guide Spinning Top was developed by the Japanese Ministry of Health, Labor, and Welfare and the Ministry of Agriculture, Forestry, and Fishery to promote healthful diets.

Objective

Adherence to the Japanese Food Guide Spinning Top was evaluated in terms of future mortality in a prospective cohort study.

Design

A prospective cohort study among men and women in a general Japanese population.

Subjects/setting

The cohort consisted of 13,355 men and 15,724 women residing in Takayama, Japan, in 1992. At baseline, a food frequency questionnaire was administered, and adherence to the food guide was measured based on consuming the recommended number of servings of grains, vegetables, fish and meat, milk, and fruits, as well as total daily energy intake and energy from snacks and alcoholic beverages. Higher scores indicated better adherence to the recommendations on a scale of 0 to 70. Based on data obtained from the Office of the National Vital Statistics, deaths occurring among members of the cohort were prospectively noted from 1992 to 1999.

Statistical analyses performed

To assess the magnitude of association of adherence scores with subsequent mortality, a Cox proportional hazard model was applied to estimate hazard ratios (HRs) with 95% confidence intervals (CIs).

Results

Among women, the adherence score was significantly associated with a lower risk of mortality from all causes (comparing highest and lowest quartiles of the score, HR 0.78, 95% CI 0.65 to 0.94, P for trend 0.01) in a multivariate analysis; noncardiovascular, noncancer causes (HR 0.69, 95% CI 0.50 to 0.96, P for trend 0.04) and cardiovascular disease (HR 0.76, 95% CI 0.56 to 1.04, P for trend0.05). No statistically significant association was observed between the adherence score and mortality among men.

Conclusions

The results suggest that diets based on the food guide have the benefit of reducing future mortality in women.     

Using different approaches to conducting postal questionnaires affected response rates and cost-efficiency

Objective

To compare three different approaches for consent in postal questionnaire in terms of response rate, time consumption, and cost-efficiency, and to collect a demographic questionnaire for dropout analyses.

Study Design and Setting

Population survey in Sweden. Mothers and fathers (n = 600) of three hundred 3-year olds were divided into three groups. One group was asked to Actively Agree to participate in a cover letter and send consent back to receive the main questionnaire. The second group received the cover letter, the consent, and the main questionnaire in the initial mailings, Direct Delivery. The third group received the cover letter and consent form in which they were asked to Actively Decline participation within 7 days if they did not want to participate. Otherwise, they were sent the main questionnaire. All parents were asked to fill in a demographic questionnaire regardless of whether they wanted to complete the main questionnaire.

Results

The highest response rate was in the Actively Decline mode. The cost-efficiency for this approach was 1.52 compared with Direct Delivery and 1.29 compared with Actively Agree.

Conclusion

Researchers can improve the response rate, time consumption, and cost-efficiency and obtain a demographic questionnaire for dropout analysis by using the Actively Decline approach for postal questionnaires.     

Whole-Grain Intake Correlates among Adolescents and Young Adults: Findings from Project EAT

Background

National survey data indicate few adolescents or young adults consume whole grains in the amount recommended to prevent chronic disease and maintain a healthful weight. Interventions are needed to address this gap; however, little is known about what modifiable factors influence whole-grain intake among youth.

Objective

This study aimed to identify socioenvironmental, personal, and behavioral correlates of whole-grain intake among adolescents and young adults.

Design

Data for this cross-sectional analysis were drawn from Project EAT (Eating Among Teens)-II, the second wave of a population-based study in Minnesota. Mailed surveys and food frequency questionnaires were completed by male (44.8%) and female (55.2%) participants in 2003-2004, including 792 adolescents (mean age=17.2 years) and 1,686 young adults (mean age=20.5 years). Linear regression models adjusted for demographic characteristics were used to identify factors associated with energy-adjusted daily intake of whole grains.

Results

Mean daily intake of whole grains was lower than recommended among adolescents (males: 0.59±0.04 servings, females: 0.61±0.04 servings) and young adults (males: 0.68±0.03 servings, females: 0.58±0.03 servings). Home availability of whole-grain bread, self-efficacy to consume ≥3 daily servings of whole grains, and preference for the taste of whole-grain bread were positively associated with whole-grain intake during adolescence and young adulthood across sex. Conversely, fast-food intake was associated with lower intake of whole grains among adolescents and young adults of both sexes. The factors examined in this study explained 28% to 34% of variance in whole-grain intake across sex and the two age groups.

Conclusions

The findings suggest nutrition interventions should address the availability of whole-grain foods in homes and restaurants. In addition, young people should be provided with opportunities to taste a variety of whole-grain foods to enhance taste preferences and self-efficacy to consume whole-grain products.     

Brief Telephone Intervention Increases Soy Intake in Peri- and Postmenopausal US Women: The Herbal Alternatives Trial (HALT)

Objective

Effective dietary intervention strategies that can be widely disseminated and have the potential for sustainable dietary modifications are needed. The purpose of this study was to describe and evaluate the effectiveness of a telephone-based soy intervention.

Design

A randomized controlled trial comparing self-reported intake and serum measures of soy during a 1-year dietary soy (Soy) to fruit and vegetable (Placebo) intervention conducted in two of five arms from the Herbal Alternatives Trial between May 2001 and September 2004.

Subjects/setting

One hundred sixty-three peri- and postmenopausal women (mean age=52 years) consuming self-selected diets in the Pacific Northwest, United States.

Intervention

Five telephone contacts with a registered dietitian during a 12-month intervention with the goal to increase soy food consumption to two servings daily.

Main outcome measures

Change from baseline in self-reported soy servings and serum isoflavone (daidzein and genistein) concentrations were estimated using analysis of variance and generalized estimating equations. Proportions of participants achieving the intervention goal were compared using χ² tests.

Results

Ninety-four percent (n=74) of participants in the Soy arm and 89% (n=75) in the Placebo arm completed the trial, and slightly more than one third (n=27) received five phone contacts. Mean (±standard deviation) intakes of soy were similar for the Soy and Placebo arms at baseline (0.6±1.0 vs 0.4±0.8 servings/day; P>0.05). At 12-month follow-up visit, mean±standard deviation servings of soy per day were 1.6±1.4 for the Soy intervention compared to 0.5±0.9 within the Placebo arm (P<0.001). There were concomitant increases in serum isoflavones at 3 and 6 months from baseline in the Soy arm only, with approximately twofold increases in both daidzein (mean=66.4 nmol/L, 95% confidence interval [CI]: 39.0 to 93.9 [mean 16.9 ng/mL, 95% CI: 9.9 to 23.8]) and genistein (mean=100.4 nmol/L, 95% CI: 60.9 to 139.9 [mean 27.1 ng/mL, 95% CI: 16.5 to 37.8]) concentrations. Mean weight changed by <1 kg during the 12-month period in each group and physical activity remained stable, suggesting that participants incorporated soy foods into their diet by substituting for nonsoy foods rather than adding them to their diet.

Conclusions

A brief telephone-based intervention with a focused message delivered by a registered dietitian is a feasible approach for encouraging targeted dietary changes, such as an increase in soy intake among peri- and postmenopausal women.     

The Alberta Physical Activity and Breast Cancer Prevention Trial: quality of life outcomes

Objective

Interventions for disease prevention should also be evaluated for quality of life (QoL) effects. Few exercise trials have examined QoL in the context of primary disease prevention. Here, we report the QoL outcomes from the Alberta Physical Activity and Breast Cancer Prevention (ALPHA) Trial.

Methods

The ALPHA trial was a randomized controlled trial in Calgary and Edmonton, Canada between May 2003 and July 2007 that compared an exercise intervention to a sedentary lifestyle among 320 sedentary, postmenopausal women. The exercise group was asked to perform moderate-to-vigorous intensity aerobic exercise 45 min/day, 5 days/week for 1 year. QoL was assessed by the short form-36 health survey.

Results

Compared to the control group, the exercise group maintained significantly better physical functioning (p < 0.001), general health (p < 0.001), vitality (p = 0.002), and bodily pain (p = 0.020) by 4-5 points which exceeds the 3.0 minimally important difference for these scales. Changes in body composition partially mediated the intervention effects. Antidepressant use and the presence of comorbidities moderated some intervention effects.

Conclusions

A 1-year moderate-to-vigorous aerobic exercise program prevents declines in the physical aspects of QoL in postmenopausal women. Exercise may have a potentially important advantage for breast cancer prevention compared to other lifestyle or biomedical interventions.     

Predictors of Dietary Change and Maintenance in the Women’s Health Initiative Dietary Modification Trial

Objective

To identify predictors of dietary change to and maintenance of a low-fat eating pattern (<20% energy from fat, ≥5 servings fruits/vegetables daily, and ≥6 servings grains daily) among a cohort of postmenopausal women. Candidate predictors included intrapersonal, interpersonal, intervention program characteristics, and clinical center.

Design

Longitudinal study within the Women’s Health Initiative Dietary Modification Trial. Dietary change was evaluated after 1 year of participation in the Women’s Health Initiative Dietary Modification Trial, and dietary maintenance after 3 years.

Subjects

Postmenopausal women aged 50 to 79 years at baseline who were randomized to the intervention arm of the Women’s Health Initiative Dietary Modification Trial (n=19,541).

Statistical analysis

Univariate and multivariate linear regression analysis was performed and associations evaluated between candidate predictors and each of the three dietary goals: percent energy from fat, fruit/vegetable servings, and grain servings.

Results

Year 1 (change) predictors of percent energy from fat (P<0.005) included being younger (β=2.12; 70 to 79 years vs 50 to 59 years), more educated (β=-.69; college vs high school), more optimistic (β=-.07), attending more sessions (β=-.69), and submitting more self-monitoring records (β=-.74). At year 3 (maintenance), the predictors of percent energy from fat (P<0.005) included attending more sessions (β=-.65) and submitting more self-monitoring scores (β=-.71). The analytic model predicted 22% of the variance in fat intake at year 1 and 27% at year 3 (P<0.01).

Conclusions

The strongest predictors of dietary change and maintenance were attending intervention sessions and self-monitoring dietary intake. Novel was the finding that optimism predicted dietary change.     

Eight Self-Administered 24-Hour Dietary Recalls Using the Internet Are Feasible in African Americans and Whites: The Energetics Study

Objective

To support research and to provide food and nutrition practitioners with a strong foundation for nutrient-based counseling, there is a need for affordable automated 24-hour dietary recalls. Multiple days of intake, along with repeated reports over time, are needed to achieve stable indicators of individual intakes and to support evaluation of success in meeting dietary goals because of intraindividual intake variability. Little information has been published on subject responses, participation rates, and the perceived subject burden of repeated 24-hour recalls. Our aim was to determine the willingness of subjects to conduct eight 24-hour recalls via the Internet.

Design

A study to validate a Web-based, automated, self-administered 24-hour recall (DietDay, Centrax Corporation, Chicago, IL).

Subjects/setting

Two-hundred and sixty-one white and African-American subjects within 50 miles of the University of California-Los Angeles participated in the study. Subjects completed 3 DietDays at the study visits and another 5 days on their own. The last 2 DietDays were completed 1 and 2 months after the final clinic visit. Subjects were notified by automatic e-mail of the need for DietDay completion, and nonresponders were followed up with personalized e-mails and phone calls.

Results

The perceived subject burden was minimal and, even after completing six recalls, 92% were willing to continue reporting their daily diets 1 and 2 months later. White subjects had a slightly higher rate of return, with 94% completing all eight recalls, compared to 91% of African-American subjects. Participants were able to access the Internet in their homes, offices, library, or homes of friends or family. It is also of interest that 82% of subjects believed the 24-hour recall was superior to a diet history in reflecting their normal diet.

Conclusion

These results open up new opportunities for food and nutrition practitioners to strengthen their nutritional counseling in an efficient and affordable manner without additional time investment.     

Interrelationships of Added Sugars Intake, Socioeconomic Status, and Race/Ethnicity in Adults in the United States: National Health Interview Survey, 2005

Background

The consumption of added sugars (eg, white sugar, brown sugar, and high-fructose corn syrup) displaces nutrient-dense foods in the diet. The intake of added sugars in the United States is excessive. Little is known about the predictors of added sugar intake.

Objective

To examine the independent relationships of socioeconomic status and race/ethnicity with added sugar intake, and to evaluate the consistency of relationships using a short instrument to those from a different survey using more precise dietary assessment.

Design

Cross-sectional, nationally representative, interviewer-administered survey.

Subjects/setting

Adults (aged ≥18 years) participating in the 2005 US National Health Interview Survey Cancer Control Supplement responding to four added sugars questions (n=28,948).

Statistical analyses performed

The intake of added sugars was estimated using validated scoring algorithms. Multivariate analysis incorporating sample weights and design effects was conducted. Least squares means and confidence intervals, and significance tests using Wald F statistics are presented. Analyses were stratified by sex and controlled for potential confounders.

Results

The intake of added sugars was higher among men than women and inversely related to age, educational status, and family income. Asian Americans had the lowest intake and Hispanics the next lowest intake. Among men, African Americans had the highest intake, although whites and American Indians/Alaskan Natives also had high intakes. Among women, African Americans and American Indians/Alaskan Natives had the highest intakes. Intake of added sugars was inversely related to educational attainment in whites, African Americans, Hispanic men, and American Indians/Alaskan Native men, but was unrelated in Asian Americans. These findings were generally consistent with relationships in National Health and Nutrition Examination Survey 2003-2004 (using one or two 24-hour dietary recalls).

Conclusions

Race/ethnicity, family income, and educational status are independently associated with intake of added sugars. Groups with low income and education are particularly vulnerable to diets with high added sugars. Differences among race/ethnicity groups suggest that interventions to reduce intake of added sugars should be tailored. The National Health Interview Survey added sugars questions with accompanying scoring algorithms appear to provide an affordable and useful means of assessing relationships between various factors and added sugars intake.