U.S.S.R. and U.S. nutrient intake, plasma lipids, and lipoproteins in men ages 40-59 sampled from Lipid Research Clinics populations

Correlates of high-density lipoprotein (HDL) cholesterol and other lipids and lipoproteins were studied in white men ages 40-59 who were part of the 15% random sample recalled to Visit 2 of the Lipid Research Clinics Program Prevalence Study. Standardized examinations were conducted by two U.S.S.R. and nine U.S. clinics. Mean plasma lipid and lipoprotein cholesterol levels differed significantly between the two countries, with the U.S.S.R. subpopulations having higher mean total plasma and HDL cholesterol levels and HDL/total cholesterol ratios and lower mean triglyceride levels and low-density lipoprotein (LDL)/HDL cholesterol ratios than the U.S. subpopulations. Small, but statistically significant, differences were found in some dietary components. The U.S.S.R. sample had a significantly higher intake of saturated fatty acids, carbohydrates, complex carbohydrates, and kilocalories/kilogram body weight and a significantly lower intake of total fat, polyunsaturated fatty acids, protein, and polyunsaturated/saturated fat ratio. The multiple regression models tested were not major predictors for total plasma cholesterol or LDL cholesterol. Characteristics associated with higher HDL cholesterol levels in both countries were lean body mass, ethanol consumption, abstinence from cigarette smoking, and lower dietary consumption of carbohydrates.     

US dietary patterns associated with fat intake: the 1987 National Health Interview Survey.

OBJECTIVES. This research used food frequency data to investigate dietary patterns associated with fat intake. METHODS. Data from the 1987 National Health Interview Survey of 20,143 adults were used to determine correlations between fat (adjusted for kilocalories) and both nutrient and food group intakes. Median food and nutrient intakes were determined within quartiles of percentage of kilocalories from fat. RESULTS. Intakes of vegetables, fruits, cereals, fish/chicken, low-fat milk, alcoholic beverages, vitamin C, percentage of kilocalories from carbohydrates, carotenoids, folate, dietary fiber, carbohydrates, and vitamin A decreased as percentage of kilocalories from fat increased. Intakes of salty snacks, peanuts, processed and red meats, whole milk and cheese, desserts, eggs, fried potatoes, table fats, cholesterol, vitamin E, sodium, protein, and energy increased with percentage of kilocalories from fat. Results by demographic subgroups showed few differences from those found in the total population. CONCLUSIONS. Fat intake is consistently associated with specific dietary patterns. Such patterns need to be evaluated concurrently in studies of diet and chronic disease.     

Nutrient Contribution of the School Lunch Program: Implications for Healthy People 2000

Cardiovascular disease-related nutrients were quantified in a school lunch program over a 15-year period. Methods included 24-hour dietary recall, menu weights, and recipe analysis. School lunch was eaten by 93% of students. School lunches provided 23% of daily kilocalories and 24%, 29%, and 20% of daily fat, protein, and carbohydrate intake, respectively, saturated fat and cholesterol from school lunch were 27% and 24% of daily total. School lunch provided 7% of daily sucrose and 32% of daily sodium. Children not eating school lunch had significantly greater polyunsaturated (p less than .001), carbohydrate (p less than .05), and sucrose (p less than .001) intakes. Though the school lunch contributed less than one-third of daily total nutrients, intakes of diet components related to cardiovascular disease risk were excessive. Sixty percent to 80% of children exceed daily total fat, saturated fat, cholesterol, and sodium intakes over recommended levels. Schools can influence childhood cardiovascular disease risk by providing students healthier foods, with education to promote positive lifestyles.     

The effects of race, household income, and parental education on nutrient intakes of 9- and 10-year-old girls NHLBI growth and health study

Nutrient intakes of 2149 black and white, 9- and 10-year-old girls varied by race, household income, and parental education. Of the three variables, higher education was most consistently associated with more desirable levels of nutrient intakes, that is, lower percentage of dietary fat and higher levels of vitamin C, calcium, and potassium. Higher income was related to higher intakes of vitamin C, but lower intakes of calcium and iron. Higher income was associated with lower percentage of dietary fat. After adjustment for income and education, race was associated with intakes of calcium, vitamin C, and to a lesser extent, percentages of kilocalories from total fat and polyunsaturated fat, and potassium. Black girls had a significantly lower intake of calcium (720 versus 889 mg) and a higher intake of vitamin C (91 versus 83 mg).Proportions of the cohort with inadequate or excessive intakes of micronutrients and macronutrients were also estimated. A high proportion of girls exceeded the recommended intake level of 30% of kilocalories from total fat (90% of black girls; 84% of white girls) and 10% of kilocalories from saturated fat (92 and 93%, respectively). Low intakes of calcium (40% of black girls and 20% of white girls) and zinc (36 and 38%, respectively) commonly were found for girls of both races.     

Calories, fat and cholesterol: intake patterns in the US population by race, sex and age.

Nutrient intakes were investigated for Blacks and Whites using data from the NHANES II survey (1976-80). Intake of energy, total fat, saturated fat, dietary cholesterol, P/S ratio, and per cent of calories derived from total and saturated fat are examined by sex and age, both in absolute terms and per unit of body weight. For most age and sex categories, Blacks are found to have a lower intake of energy and fats than Whites; however, Blacks have a consistently higher intake of dietary cholesterol. The ratio of polyunsaturated fats to saturated fats is higher in females than in males, but all age-sex groups are substantially below recommended levels. Per cent of calories from total and saturated fat are similar in most age-sex groups. Possible explanations of the observed patterns include activity level and metabolic differences.     

Cholesterol, saturated fatty acids, polyunsaturated fatty acids, sodium, and potassium intakes of the United States population

The USDA's 1977-1978 Nationwide Food Consumption Survey was utilized to assess dietary intake levels of cholesterol, fatty acids, sodium, and potassium by several age/sex groups of the U.S. population. Results indicated that mean cholesterol intakes for all male age groups of 12 yr and older exceeded 300 mg/day while the mean intakes of females and children were less than 300 mg/day. However, approximately 30% of each age group of adult females exceeded 300 mg cholesterol per day and only about one-third of the adult males had average intakes of less than 300 mg/day. Between 39% and 44% of total kilocalories were obtained from fat consumption with saturated fatty acids contributing 13-15%, polyunsaturated fatty acids contributing 5-6% and oleic acid contributing 12-14% of total kilocaloric intake. We found that 90% of children ages 6-11 yr and adult females had saturated fatty acids intakes of less than 40 gm/day; 90% of all men had intakes of less than 55 gm/day. At least 90% of all age/sex groups averaged intakes of polyunsaturated fatty acids of less than 26 gm/day. Average daily sodium intakes for each age/sex group (excluding table salt) were within the limits considered safe and adequate. However, approximately 4% of each age group of adult females and about 25% of each of the three younger adult male groups had average sodium intakes of 4000 mg/day or more. Average daily potassium intakes were somewhat low, ranging from 1584 mg/day for children ages 0-5 yr to 2735 mg/day for males ages 51-64 yr.     

Consistency of the Willett semiquantitative food frequency questionnaire and 24-hour dietary recalls in estimating nutrient intakes of preschool children.

A study was performed to determine the utility of the Willett semiquantitative food frequency questionnaire for assessing the habitual diets of preschool children. Children (n = 224) were recruited mainly through a New York City hospital-based pediatric practice during 1986-1987. The children's ages at baseline were 44-60 months; 50% were male, and 91% were Hispanic. Over a 12-month period, the Willett food frequency questionnaire was administered twice to each child's parent, and a 24-hour dietary recall was conducted four times. For energy and eight nutrients, group mean intakes derived from food frequency questionnaires were 1.4-1.9 times higher than those from 24-hour recalls. Group mean estimates of nutrient density of total and saturated fat, potassium, and calcium did not differ between the two methods. Correlations between methods for crude nutrient intakes (unadjusted for energy consumption) ranged from 0.16 (polyunsaturated fat in boys) to 0.60 (potassium in girls). Correlations generally decreased when intakes were adjusted for energy consumption. Adjustment for energy intake and residual intraindividual variability yielded correlations of 0.48 for total calories, 0.35 for total fat, and 0.37 for saturated fat. For intake of energy and nine nutrients, of those children classified into the highest quintile by dietary recall, 28.9-40.9% were so classified by the Willett questionnaire, and 48.9-68.9% were classified into the highest two quintiles. When data were expressed as nutrient densities, agreement was high for potassium and calcium and fair for saturated fat, cholesterol, and protein. The moderately low consistency of nutrient intake estimates across dietary assessment methods in this study may be due, in large part, to residual intraindividual variability in both the recall data and the food frequency data.     

Validity of DISHES 98, a computerised dietary history interview: energy and macronutrient intake

OBJECTIVE: To estimate the relative validity of a computerised dietary history instrument (DISHES 98). SETTINGS: Munich and Berlin. SUBJECTS: A total of 148 persons aged 19-59 y recruited from two research centres. DESIGN: A relative validation study. Energy and macronutrient intakes obtained with DISHES 98 were compared to those assessed with 3-day weighed dietary records and with a 24 h dietary recall. RESULTS: Intakes of energy, total, saturated and monounsaturated fat, polysaccharides and alcohol were significantly higher and intake of dietary fibre was significantly lower with the 3-day records than with DISHES 98. For intakes of total, animal and vegetable protein, total carbohydrates, mono- and disaccharides and cholesterol the mean difference between DISHES 98 and the 3-day dietary records was less than 5% of the intake with DISHES 98. Pearson's correlation coefficients between DISHES 98 and 3-day records varied from 0.34 for intake of polyunsaturated fat to 0.69 for intake of disaccharides and from 0.27 for polyunsaturated fat to 0.65 for total carbohydrates between DISHES 98 and the 24 h recall. The proportion of participants classified into the same or adjacent quintile of intake varied between 66.9% for polyunsaturated fat and 90.4% for alcohol comparing DISHES 98 and 3-day records and between 60.2% for polyunsaturated fat and 78.4% for total carbohydrates comparing DISHES 98 and 24 h recalls. CONCLUSION: The observed differences between DISHES 98 and the other methods are in an acceptable range for assessing dietary intake in epidemiologic studies.     

Fifteen-year time trends in energy and macronutrient intake in German children and adolescents: results of the DONALD study

The DONALD study (Dortmund Nutritional and Anthropometric Longitudinally Designed study) gives the opportunity to evaluate long-term food and nutrient intake data on the basis of 3 d weighed dietary records of infants, children and adolescents since 1985. In this paper, we examine changes in energy and macronutrient intakes (protein, fat, saturated, mono- and polyunsaturated fatty acids, carbohydrates and added sugars) of 795 2-18-year-old subjects between 1985 and 2000 (4483 records). No significant changes in intakes of energy and of protein, polyunsaturated fatty acids and added sugars (as % energy intake, E %) were found. Fat intake decreased significantly in all age groups (between -0.20 and -0.26 E %/year), as well as intake of saturated fatty acids (between -0.11 and -0.14 E %/year) and monounsaturated fatty acids (between -0.07 and -0.014 E %/year). This decline was compensated for by a significant increase in carbohydrate intake (between +0.18 and +0.27 E %/year). The changes in macronutrient intake were mainly due to a decreased consumption of fats-oils (between -0.29 and -1.26 g/year) and meat-fish-eggs (between -0.21 and -2.92 g/year), whereas consumption of bread-cereals (between +0.12 and +2.42 g/year) and potatoes-pasta-rice (between +0.15 and +2.26 g/year) increased slightly. However, since recommended fat intake and fatty acid composition was not reached at the end of the study period by far, further efforts will be necessary to improve macronutrient composition and to stabilize favourable dietary habits.     

Trends in nutrient intake of 10-year-old children over two decades (1973-1994) : the Bogalusa Heart Study

Dietary intakes of 10-year-old children were examined in seven cross-sectional surveys to observe secular trends in nutrient intake and food consumption patterns over 2 decades (1973-1994). Total energy intake remained unchanged from 1973 to 1994. However, when expressed as energy per kilogram body weight, intake decreased from 65.5 kcal in 1973 to 55.4 kcal in 1994 because children's weight increased. A significant trend was noted in ponderal index, which increased from 12.31 (1973-1974) to 13.71 (1992-1994), with an actual weight gain of 1.45 kg from 1973 to 1979 and 2.71 kg from 1981 to 1994. Linear trends also were noted for total fat (negative), saturated fat (negative), dietary cholesterol (negative), polyunsaturated fat (positive), and total carbohydrate (positive). There was a significant increase in percent energy from protein and carbohydrate and a significant decrease in percent energy from fat, primarily saturated and monounsaturated fat. Trends in nutrient intakes of children reflected trends in food consumption. The percentage of total fat from fats/oils, mixed meats, eggs, milk, pork, and desserts decreased, while that from poultry, cheese, and snacks increased. Although more children met dietary recommendations for total fat, saturated fat, and dietary cholesterol, the vast majority continued to exceed prudent diet recommendations.     

Nutrient intakes and cholesterol values of the parents in a prospective randomized child-targeted coronary heart disease risk factor intervention trial--the STRIP project.

OBJECTIVE: To analyze food consumption, nutrient intakes and serum cholesterol concentrations of the parents in a child-targeted CHD intervention trial, during which the age of children increased from 7 months to 5 y. DESIGN AND SUBJECTS: The children were randomized to an intervention group (n = 540) or a control group (n = 522) at six months of age. The intervention families were counseled at 3-6 month intervals to reduce their child's intake of saturated fat and cholesterol. Dietary issues were discussed with the control families only briefly. The parents' food consumption was analyzed by 24 h dietary recall at the child's age of 7 and 13 months and at 2, 3, 4, and 5 y. Nutrient intakes were calculated using the Micro-Nutrica program. RESULTS: The mothers and fathers of the intervention children used less butter, more margarine and more skim milk than those of the control children (P < 0.001 for all measurements). After the onset of counseling, the intervention mothers consumed continuously less fat (1.4 E% less at the child's age of 5 y), less saturated fat (1.5 E% less at the child's age of 5 y) and more polyunsaturated fat (0.5 E% more at the child's age of 5 y) than the control mothers (P = 0.008, P < 0.001 and P < 0.001 for trend, respectively). After the child's age of 13 months the intervention fathers also had a continuously lower fat intake (2.4 E% less at the child's age of 5 y) and consumed less saturated fat (1.5 E% less at the child's age of 5 y) than the control fathers (P < 0.001 for trend for both measurements). The serum cholesterol concentration of the intervention mothers was consistently lower than that of the control mothers during the intervention (at child's age of 5 y 4.86 and 5.09 mmol/L, respectively; P for trend = 0.03), while the values of the intervention and control fathers showed no differences. CONCLUSIONS: Continuous dietary intervention begun in infancy and focused on modification of the child's diet according to the current principles of preventive cardiology, was accompanied by a moderate decrease in the intake of total and saturated fat in the parents, but serum cholesterol concentration diminished consistently only in the mothers of the intervention children.     

Dietary intake of fats and fatty acids for the United States population: 1999-2000

This report presents dietary intake estimates for fats and fatty acids from the National Health and Nutrition Examination Survey, 1999-2000, for the U.S. population. These include: total fat; total saturated, monounsaturated, and polyunsaturated fat; individual fatty acids; and cholesterol. Fat intakes are estimated from one 24-hour dietary recall interview. Population means, medians, and standard errors of the mean are weighted to produce national estimates and are presented by sex and age groups. Assessment of dietary intakes is an important part of monitoring the nutritional status of the U.S. population.     

Studies of consistency of dietary intake during the first four years of life in a prospective analysis: Bogalusa Heart Study.

The consistency of intake levels for several dietary components over a 5-year period (age 6 months to 4 years) in a biracial infant-early childhood cohort has been demonstrated. Young children with high intakes of selected dietary components associated with risk of cardiovascular disease (e.g., total fat, saturated fat, dietary cholesterol) continue to have higher intakes as they mature than do their peers. Spearman rank correlation coefficients at a significant level are noted between ages 2 and 4 for the following nutrients: total protein (r = 0.65), animal protein (r = 0.46), total sugar (r = 0.39), sucrose (r = 0.37), starch (r = 0.33), total fat (r = 0.53), saturated fatty acid (SFA, r = 0.48), polyunsaturated fatty acid (PUFA, r = 0.43), and cholesterol (r = 0.49). At 2 years of age, some 47-65% of those in the upper tertile for total fat, SFA, and cholesterol intake remain in the upper tertile at age 4. Persistence of eating behaviors appears to begin as early as age 2, in part because of parental control over food patterns. These observations have implications for reduction of early cardiovascular risk factors in children and adoption of a more prudent dietary intake through consumer education.     

Composition of diet in relation to fat intake of children aged 1–7 years

Very little data are available on the diet of Finnish pre-school children from the last decade. In this study, food consumption data for 77 1–7-year-old Finnish children were collected by means of 3-day estimated food records. In the younger age group (<4 years), on average 15% of total energy was supplied by protein, 36% by fat, 49% by carbohydrates and 14% by sucrose. In the older age group (≥4 years), the proportions were 15%, 34%, 51% and 17%, respectively. Compared with the Nordic nutrition recommendations, the average proportions of fat and sucrose were too high and those of carbohydrate too low. Intakes of vitamins and minerals met or exceeded the recommended allowances, except for iron in the younger age group, and vitamin D in both age groups. Energy and nutrient intakes were compared among children with different proportions of fat in their diet (less than 30%, 30–34%, 35–39%, 40% or more of total energy). There was no difference in the energy intake per kg of body weight between the fat intake groups, and with respect to vitamin and mineral intakes the only differences were in the intakes of vitamin C and selenium. Only in the lowest fat intake group were the proportions of fat, saturated fatty acids and carbohydrates and the intake of cholesterol in accordance with or close to the recommendations. The results of this study support the growing evidence of the nutritional adequacy of a balanced, low-fat diet for pre-school children.     

Analysis of macrocomponents and fatty acids in the market basket of male adolescents in The Netherlands

During a period of 2 1/2 years, every 3 months 221 different food items forming a "market basket" were purchased, prepared, and classified into 23 food commodity groups. The "market basket" was based on a study of the dietary intake of 18-year-old men. In the (homogenized) food groups, the contents of protein, fat, and available carbohydrates were determined as well as the fatty acid composition. The mean daily amounts of the macrocomponents (as a percentage of the mean daily energy value of the total diet) were 14% for protein, 35% for fat, 47% for total available carbohydrates, and 4% for alcohol. The total diet contained 24 gm dietary fiber. The fatty acid composition of the Dutch male adolescents' diet resembles the fatty acid composition of the Dutch "national diet" and the typical American diet: approximately 15% of total calories as saturated fatty acids, 5% as polyunsaturated fatty acids (PUFA), and a polyunsaturated to saturated fatty acids ratio of 0.33. The results, as compared with the recommendations for a healthy diet, show that a decreased consumption of saturated fat, a higher consumption of PUFA, a higher dietary fiber intake, and a higher consumption of complex carbohydrates would be advisable for male Dutch adolescents.     

Dietary Studies of Children: The Bogalusa Heart Study Experience

For more than 20 years the Bogalusa Heart Study has been collecting data on children's dietary intakes in a biracial community. The macronutrient contribution of children's diets is similar to that in diets of adolescents: 13% of energy from protein, 49% from carbohydrate, and 38% from fat. As children get older, mean intakes of vitamins and minerals per 1,000 kcal decrease. Ten-year-old children in 1987-1988 were 3 lb heavier than 10-year-olds in 1973-1974. Yet total energy intakes remained virtually the same from 1973 to 1988. The composition of macronutrients shifted over the 15-year period, with an increase in the percentage of energy from protein and carbohydrate and a decrease in the percentage of energy from total fat, particularly saturated fat. Dietary cholesterol intake also decreased as a result of a decrease in egg consumption. Although the diets of children changed positively from 1973 to 1988, more than 75% of children consumed more total fat, saturated fat, and cholesterol than the recommended amounts. School meals had a major impact on the diets of children. School breakfast and lunch, together, contributed approximately 50% of the day's total intake of energy, protein, cholesterol, carbohydrate, and sodium. About 40% of daily total fat intake came from school breakfast and lunch. The diets of children in the Bogalusa study are similar to those reported in national studies of children. What might be different, however, are the types of foods consumed and their contribution to intakes of specific nutrients. An understanding of the diet and nutrition habits of children is critical to the planning of intervention strategies that will assist us in meeting our dietary goals for Healthy People 2000. J Am Diet Assoc. 1995; 95:1127-1133.     

Comparison of nutrient intakes of selected populations in the United States and Israel: the Lipid Research Clinics prevalence study

Nutrient intakes of 2,772 US and 2,680 Jerusalem participants of the Lipid Research Clinics Program were assessed by 24-h dietary recall in men aged 15-19 and 40-59 yr and women aged 15-19 and 35-59 yr. Energy intake was higher in the US than in Jerusalem. In Jerusalem intake of total fat ranged between 32.2-33.7% of kcal, of saturated fatty acids (SFA) between 9.8-10.9%, of polyunsaturated fatty acids (PFA) between 7.9-8.6%, of carbohydrates between 50.5-53.9%, and of starch between 24.0-30.5%. The P:S ratio ranged between 0.80 and 1.01. The corresponding ranges for the US were 38.8-40.8% for fat, 14.3-15.9% for SFA, 5.9-6.8% for PFA, 38.9-46.2% for carbohydrates, 17.0-17.9% for starch, and 0.40-0.53 for the P:S ratio. Intake of cholesterol (mg/1000 kcal) was higher in Jerusalem than in the US. These data address the feasibility of reducing fat in diets of free-living, Western populations.     

Brief communication: dietary habits of first-year medical students as determined by computer software analysis of three-day food records.

Nutrition training for medical students has long been a low priority for most medical schools. Given the growing body of knowledge linking health promotion to proper dietary habits, there is a need to increase the quantity and quality of nutrition training for medical students. In the present study, first-year medical students recorded food intake for 3 days and analyzed their diets for nutrient contents with a computer software program. Use of the interactive software created a personalized approach to increasing nutrition knowledge as the students became aware of their own dietary habits. Female students had a low consumption of kilocalories, dietary fiber, calcium, iron, zinc, potassium, and polyunsaturated fat. Male students exceeded current recommended intakes for fat, saturated fat, cholesterol, and sodium.     

Lack of efficacy of a food-frequency questionnaire in assessing dietary macronutrient intakes in subjects consuming diets of known composition

BACKGROUND: We compared the validity of a semiquantitative food-frequency questionnaire in assessing intakes of macronutrients (absolute amounts and percentages of energy) by 19 subjects fed natural-food diets of known composition. In small subsets (n = 5 or 6), we also tested 3-d diet records. OBJECTIVE: The objective of this study was to investigate the efficacy of food-frequency questionnaires and diet records in subjects fed natural-food diets of known composition. DESIGN: Each subject consumed 3 different diets for >/=6 wk and self-reported his or her food intake by using a food-frequency questionnaire and a diet record. The diets varied in their chemically analyzed contents of fat (15-35% energy), saturated fat (5-14%), monounsaturated fat (5-14.5%), polyunsaturated fat (2.5-10.5%), carbohydrate (49-68%), and cholesterol (108-348 mg/d). RESULTS: The food-frequency questionnaire significantly underestimated fat, saturated fat, monounsaturated fat, and protein intakes and significantly overestimated carbohydrate intake with the high-fat diet. The percentage of energy from fat was significantly underestimated for the high-fat diet and significantly overestimated for the very-low-fat diet. Estimates from the food-frequency questionnaire differed significantly from actual intakes for fat (absolute and percentage), saturated fat (absolute and percentage), monounsaturated fat (absolute and percentage), and protein (percentage) in the high-fat diet and for polyunsaturated fat (absolute and percentage), saturated fat (percentage), fiber (absolute), and cholesterol (daily absolute; in mg/d) in the lower-fat diet. Estimates from the diet records better agreed with actual intakes than did estimates from the food-frequency questionnaire except for monounsaturated fat (absolute and percentage) in the high-fat diet and polyunsaturated fat (percentage) in the lower-fat diet and the very-low-fat diet. CONCLUSION: Our data indicated that the food-frequency questionnaire did not provide reliable estimates of absolute amounts of dietary fats or cholesterol.     

Changes in macronutrient intake among HIV-infected children between 1995 and 2004

BACKGROUND: Nutritional concerns in HIV-infected children have evolved, from wasting to obesity and insulin resistance. However, little is known about the diet of these children during this evolution. OBJECTIVE: We analyzed dietary macronutrient intake in HIV-infected children over nearly 10 y. DESIGN: HIV-infected children underwent periodic longitudinal nutritional assessments between 1995 and 2004. Sex-specific initial and final means or proportions and time trends in macronutrient intakes were estimated with regression analyses. RESULTS: Three hundred thirty nutritional records from 49 males and 411 from 67 females were analyzed. Caloric intake exceeded the estimated energy requirement (EER) for ideal body weight in 1995 by 62% for males and 39% for females and decreased by 3% of the EER per year in males (P = 0.02) and by 2% in females (P = 0.004). In 2004, caloric intake still remained >19% above the EER in both groups. Protein intake was nearly 400% of the recommended dietary allowance (RDA) for ideal body weight in 1995 among both males and females and decreased by 13% of the RDA per year for males (P = 0.001) and by 21% per year for females (P < 0.001). However, daily protein intake still exceeded the RDA by >60% in both groups in 2004. Females consumed more energy from carbohydrates (P = 0.05) and sugar (P = 0.10) and less from monounsaturated (P = 0.04), polyunsaturated (P = 0.05), saturated (P = 0.03), and total (P = 0.10) fat in 2004 than in 1995. CONCLUSION: Excessive caloric intake and a shift in dietary composition toward carbohydrates in females suggest that continued monitoring of diet in HIV-infected children is important to avoid increased nutritional risk.