Adherence to dietary recommendations for saturated fat, fiber, and sodium is low in American Indians and other U.S. adults with diabetes

The objective of this article was to evaluate how well American Indians with diabetes met dietary recommendations and to compare adherence to dietary recommendations with those of U.S. adults with diabetes in the NHANES. Dietary intake in both studies was assessed using a 24-h recall questionnaire. Dietary intakes were evaluated against American Diabetes Association (ADA) dietary recommendations. The analysis sample consisted of 1008 participants from the Strong Heart Study (SHS) examined from 1997 to 1999 and 373 participants from NHANES examined from 1999 to 2000, all with diabetes. In both samples, intake of protein, PUFA, monounsaturated fatty acids, and carbohydrates met the 1997 ADA dietary recommendations. However, intakes of SFA as well as sodium were higher and dietary fiber intake was lower than recommended. In the SHS and NHANES, only 4.6 and 8.5% of persons with diabetes met recommendations for both SFA and fiber (P = 0.02), respectively. However, only 8.3% of the NHANES sample met the 2006 recommendations for SFA and fiber and none of the SHS sample met those recommendations. This cross-sectional study shows low adherence to ADA dietary recommendations for saturated fat, fiber, and sodium by American Indians with diabetes and by the broader U.S. population of adults with diabetes and shows that for American Indians with diabetes, programs to decrease SFA and increase fiber intakes are warranted.     

Intensively managed young children with type 1 diabetes consume high-fat,low-fiber diets similar to age-matched controls

Despite significant emphasis on nutrition, older children with diabetes demonstrate poor dietary quality. We tested the hypothesis that dietary quality in young children with type 1 diabetes (T1D) would be better than age-matched children in the US population. Dietary data from children with T1D (n = 67) aged 2 to 12 years attending a pediatric diabetes clinic were compared with a nationally representative, age-matched sample from the National Health and Nutrition Examination Survey (NHANES; n = 1691). Multiple 24-hour dietary recalls were used. Recommended intakes were based on national guidelines, and dietary quality was assessed using the Healthy Eating Index-2005. More children with T1D were overweight or obese compared with children participating in NHANES (42% vs 30%, P = .04). Greater proportions of children with T1D met daily recommendations for vegetables (22% vs 13%, P = .03), whole grains (12% vs 5%, P = .005), and dairy (55% vs 36%, P = .001) compared with NHANES children, whereas similar proportions met daily fruit recommendations (40% vs 33%, P = .2). Less than one-third of all children limited total fat to recommended levels; children with T1D consumed more saturated fat than did NHANES children (14% vs 12% total energy intake, P = .0009). Fiber intakes were very low in both groups. Compared with NHANES children, children with T1D had higher Healthy Eating Index-2005 scores (59.6 vs 49.7, P = .0006) primarily because of lower intakes of added sugars. The nutritional intake of young children with T1D remains suboptimal in the contemporary era of diabetes management. Despite focused nutrition management, young children with T1D consume high-fat, low-fiber diets comparable with youth in the general population.     

Dietary habits in type II diabetes mellitus: how is adherence to dietary recommendations?

OBJECTIVE: To clarify adherence of type II diabetic patients to dietary recommendations. SUBJECTS AND METHODS: The dietary habits of a group of 540 patients, with type II diabetes (male 322/female 218, mean age 61+/-5 years, body mass index (BMI) 29.7+/-5.2 kg/m(2); mean+/-s.d.) referring to six Italian diabetes centres were evaluated by means of a 3-day diet record (2 workdays, 1 holiday). Diet records were analysed according to Italian food composition tables and compared with the dietary recommendations of the Diabetes and Nutrition Study Group of the European Association for the study of Diabetes. RESULTS: Calorie intake was 1725+/-497 kcal (1800 for men, 1610 for women). Mean intake for each nutrient was close to the recommended amount, except for fibre (12/1000 vs 20 g/1000 kcal). Calculating the percentage of patients who complied with each recommendation, the intakes of saturated fat and fibre least reflected the dietary target: in 43% of patients saturated fat was >10% of total calories, in only 6% was fibre intake > or =20 g/1000 kcal (considered ideal), and in 25% it was > or =15 g/1000 kcal (acceptable). CONCLUSIONS: These results indicate that compliance to dietary recommendations is not completely satisfactory, even in Italy. Calorie intake is a bit elevated, given the high BMI of our diabetic population. As to dietary composition, there are two crucial issues: the high intake of saturated fat and--most importantly--the low intake of fibre. All strategies aiming to a proper implementation of guidelines should take these results into due account.     

Macronutrient intake of black and white adolescent girls over 10 years: the NHLBI Growth and Health Study

OBJECTIVE: To compare age-related changes in macronutrient and cholesterol intake between black and white girls, compare intakes with National Cholesterol Education Program (NCEP) recommendations, and examine sociodemographic associations with macronutrient intake. DESIGN: Cohort study with 3-day food records collected over 10 years. SUBJECTS: 2,379 girls, 1,166 white and 1,213 black, age 9 to 10 years at baseline, recruited from three geographic locations. Statistical Analysis Longitudinal generalized estimating equation (GEE) regression models examined the relationships of age, ethnicity, and sociodemographic factors with macronutrient and cholesterol intake and with percentage of girls meeting NCEP recommendations. RESULTS: Total and saturated fat intakes decreased with age, more in white girls than black girls, from 35.1% and 13.6% kcal at age 9 to 29.3% and 10.4% at age 19 for white girls and from 36.5% and 13.4% kcal at age 9 to 35.1% and 11.7% kcal at age 19 for black girls. Dietary cholesterol decreased with age, but decreased more in white girls than black girls (range 95 to 119 mg/1,000 kcal for white girls and 119 to 132 mg/1,000 kcal for black girls). Depending on age, 7% to 51% of white girls and 8% to 26% of black girls met NCEP recommendations for total fat (相似文献   

Acculturation and healthy lifestyle among Latinos with diabetes

PURPOSE Latinos have a high prevalence of diabetes and disproportionately experience diabetic complications. We sought to examine the association of acculturation on healthy lifestyle habits among the Latino population in the United States with diabetes.METHODS We studied Latino adults (aged ≥20 years) with previously diagnosed diabetes in the 1999–2004 National Health and Nutrition Examination Survey (unweighted N = 467; weighted N = 1,957,778). Healthy lifestyle habits were those consistent with recommendations of the American Diabetes Association (ADA) regarding exercise, smoking, obesity, and diet. Acculturation was measured with the Short Acculturation Scale, a validated 5-item scale assessing use of the Spanish language. Logistic regression analyses of acculturation and healthy behaviors were computed controlling for access to care, demographics, and disease characteristics.RESULTS In bivariate analyses, compared with their less-acculturated counterparts, individuals who were more-acculturated to any extent were less likely to have a higher fiber intake (9.4% vs 35.4%, P = .001) and lower saturated fat intake (17.2% vs 46.5%, P = .03). More-acculturated individuals were more likely to report leisure time exercise (59.2% vs 19.3%, P <.001), whereas the proportion of individuals who smoked did not differ. In logistic regression analyses using the 1994 ADA dietary guidelines, more-acculturated individuals were less likely than their less-acculturated counterparts to meet dietary criteria for saturated fat consumption (odds ratio, 0.13; 95% confidence interval [CI], 0.04–0.41). When using the stricter 2006 ADA dietary guidelines, more-acculturated individuals were less likely to have recommended consumption of both saturated fat (odds ratio, 0.06; 95% CI, 0.02–0.20) and fiber (odds ratio, 0.19; 95% CI, 0.08–0.48). Acculturation did not significantly influence exercise and smoking status in logistic regression analyses.CONCLUSIONS These results suggest that acculturation among diabetic Latinos to the general US culture is associated with adoption of some less desirable dietary habits.     

Are we achieving the dietary recommendations for diabetic patients? An audit of dietary advice to diabetic patients

An audit of the nutritional intake of people with diabetes treated either with insulin or oral hypoglycaemic agents, who had never been taught carbohydrate exchanges was undertaken. A total of 63 diabetic patients completed a 7-day food diary using household measures. Results indicated that 70% achieved the dietary recommendations for fat intake and 30% the recommendations for carbohydrate intake. The majority of the subjects also achieved the dietary recommendations for both non-milk extrinsic sugars and cholesterol, but they were less successful at meeting the recommendations for non-starch polysaccharides and protein. The standards used were the British Diabetic Association Recommendations (1992) and The Dietary Reference Values (1991). These results compare favourably with other studies both of people with diabetes and the general population.     

Income and race/ethnicity are associated with adherence to food-based dietary guidance among US adults and children

BackgroundIncome and race/ethnicity are associated with differences in dietary intakes that may contribute to health disparities among members of the US population.ObjectiveTo examine alignment of intakes of food groups and energy from solid fats, added sugars, and alcohol with the 2005 Dietary Guidelines for Americans and MyPyramid, by family income and race/ethnicity.DesignData from the National Health and Nutrition Examination Survey, a cross-sectional, nationally representative survey, for 2001-2004.Participants/settingPersons aged ≥2 years for whom reliable dietary intake data were available (n=16,338) were categorized by income (lowest, middle, and highest) and race/ethnicity (non-Hispanic white, non-Hispanic black, and Mexican American).Statistical analyses performedThe National Cancer Institute method was used to estimate the proportions of adults and children in each income and race/ethnic group whose usual intakes met the recommendations.ResultsHigher income was associated with greater adherence to recommendations for most food groups; the proportions meeting minimum recommendations among adults in the highest income group were double that observed for the lowest income group for total vegetables, milk, and oils. Fewer differences by income were apparent among children. Among the race/ethnic groups, the proportions meeting recommendations were generally lowest among non-Hispanic blacks. Marked differences were observed for milk—15% of non-Hispanic black children met the minimum recommendations compared with 42% of non-Hispanic white children and 35% of Mexican-American children; a similar pattern was evident for adults. One in five Mexican-American adults met the dry beans and peas recommendations compared with approximately 2% of non-Hispanic whites and non-Hispanic blacks. Most adults and children consumed excess energy from solid fats and added sugars irrespective of income and race/ethnicity.ConclusionsThe diets of some subpopulations, particularly individuals in lower-income households and non-Hispanic blacks, are especially poor in relation to dietary recommendations, supporting the need for comprehensive strategies to enable healthier dietary intake patterns.     

Overweight status and eating patterns among adolescents: where do youths stand in comparison with the healthy people 2010 objectives?

OBJECTIVES: This study determined the prevalence of Minnesota urban youths reaching the Healthy People 2010 objectives for obesity and intake of fat, calcium, fruits, vegetables, and grains and compared prevalence rates across sociodemographic characteristics. METHODS: The study sample included 4746 adolescents (aged 11-18 years) from the Minneapolis/St. Paul area who completed dietary surveys and participated in anthropometric measurements as part of a school-based population study. RESULTS: Considerable gaps were seen between the existing prevalence rates for obesity and nutrient and food patterns and the targeted Healthy People 2010 prevalence rates. For example, 12.5% of the girls and 16.6% of the boys had body mass index values at or greater than the 95th percentile (target = 5%). Only 29.5% of the girls and 42.5% of the boys were meeting the daily recommended intakes for calcium (target = 75%). Similarly, percentages of youths consuming the recommended amounts of fat, fruits, vegetables, and grains were lower than the targeted percentages. There were large sociodemographic disparities in obesity and eating patterns, particularly across race/ethnicity and socioeconomic status. CONCLUSIONS: Concerted public health efforts are needed to achieve the Healthy People 2010 objectives for obesity and nutrition and to reduce racial/ethnic and socioeconomic disparities.     

Dietary patterns of U.S. children: implications for disease prevention

Nutritional data from the second National Health and Nutrition Examination Survey (NHANES II) were analyzed to assess dietary patterns of a representative sample of U.S. children and youth ages 1-17 years. The data show that the average U.S. child's diet is relatively high in total and saturated fat and low in the ratio of polyunsaturated to saturated fat. These dietary patterns deviate from current dietary recommendations for the prevention of cardiovascular diseases. The percentage contributions of specific macronutrients to total energy intake (in kilocalories) were total fat, 35-36%; total carbohydrates, 49-51%; and protein, 15-16%. This is in contrast to current expert recommendations for children of 30% of kilocalories as total fat, 55% as carbohydrates, and 15% as protein. The observed intake of saturated fat in U.S. children was 13% of kilocalories vs a recommended level of 10% of kilocalories. The observed ratio of polyunsaturated to saturated fat intake was 0.4 vs a recommended ratio of 1.0. There were important racial differences in fat intakes, with blacks generally having higher cholesterol and total fat intakes. White children generally consumed more of their calories as carbohydrates than did black children, but there were no differences in protein intakes between the two groups. In summary, these data suggest that the average U.S. child's diet deviates from recommended dietary guidelines for fat and cholesterol intakes. Black children's dietary patterns appear less favorable for cardiovascular health than those of white children. However, the data also show that achieving recommended dietary intake patterns probably will not require drastic changes in the U.S. child's diet.     

Dietary Intake and Cardiometabolic Risk in Ethnically Diverse Urban Schoolchildren

Dietary factors vary widely among ethnic groups. However, the effect of specific nutrients on cardiometabolic risk is not well understood, especially in children. Four dietary factors known to influence cardiometabolic risk (ie, carbohydrate, saturated, monounsaturated, and polyunsaturated fat intake) were assessed by the Block Kids 2004 Food Frequency Questionnaire in a cross-sectional sample of racially diverse fourth- through eighth-grade students (n=148) in a Boston-area school district studied between January and April 2010. Fasting total cholesterol, low-density lipoprotein, high-density lipoprotein (HDL) cholesterol, triglyceride, C-reactive protein (CRP), and interleukin-6 (IL-6) levels, and body mass index z scores were measured. Differences in dietary factors and cardiometabolic risk factors were examined among the following racial/ethnic groups: white (39%), Hispanic (32%), black (8%), Asian (10%), and multiracial/other (11%). In bivariate analyses, total, saturated, and polyunsaturated fat intakes differed by race/ethnicity (P<0.05), with white and black children reporting saturated fat intakes above the recommended level. Forty-seven percent of children had at least one suboptimal cardiometabolic risk factor. HDL cholesterol, triglyceride, and IL-6 concentrations differed by race/ethnicity (P<0.05, P<0.01, and P<0.01, respectively), with Hispanics having low HDL cholesterol levels and high triglyceride levels, whereas Asians had high IL-6 levels. In multivariate analyses controlling for demographic characteristics, none of the dietary factors examined explained racial/ethnic differences in lipid profiles or inflammatory markers. Body mass index z score was associated with lower HDL cholesterol, higher triglyceride, higher CRP, and higher IL-6 levels (P<0.0001). Further research is warranted to determine the influence of dietary recommendations at a young age among different racial/ethnic groups on cardiometabolic health.     

Secular trends in dietary macronutrient intake in Minneapolis-St, Paul, Minnesota, 1980-1992

Trends in dietary macronutrient intake were evaluated in population-based surveys conducted in adults aged 25-74 years in 1980-1982, 1985-1987, and 1990-1992 in the seven-county Minneapolis-St. Paul metropolitan area. A 24-hour dietary recall (n = 6,499) was completed by a random 50% sample. The authors obtained energy intake for each macronutrient (protein, carbohydrate, fat, saturated fat, monounsaturated fat, polyunsaturated fat, and alcohol). Tine trends for percentage of total energy were analyzed using a generalized linear mixed model. While energy intake remained stable over time, macronutrient composition changed substantially. In 1980-1982, the caloric distribution for men comprised 15.8% protein, 39.4% fat, 40.9% carbohydrate, and 3.9% alcohol; similar findings were observed in women (15.7% protein, 38.9% fat, 43% carbohydrate, and 2.4% alcohol). From 1980 to 1992, total fat intake decreased 4.7% in men and 4.9% in women (p < 0.001). The decline was greatest for monounsaturated fat, although saturated and polyunsaturated fat intake also fell. During this same period, carbohydrate intake increased 5.7% and 5.8% in men and women, respectively (p < 0.001). Alcohol intake decreased in men and women (p < 0.01), while protein intake remained stable. In summary, the Minneapolis-St. Paul metropolitan area diet shifted substantially during the 1980s toward more carbohydrate and lower fat and alcohol intake.     

Fruit and vegetable intake: Few adolescent girls meet national guidelines

OBJECTIVE: To examine longitudinal changes in daily fruit and vegetable consumption among black and white adolescent girls and calculate the percent of girls who met the Healthy People 2010 recommendations. METHODS: Girls (1186 black and 1126 white) who participated in the National Heart, Lung, and Blood Institute Growth Health Study (NGHS) were included if they had completed a 3-day food diary for at least one of six annual assessments visits, beginning at ages 11 or 12. Mixed models estimated the association of visit and race with (a) average daily consumption of fruits and vegetables and (b) the probability of meeting intake recommendations on one or more out of 3 days. RESULTS: For girls of both races, fruit and vegetable consumption increased with age; white girls showed a greater increase in fruit and nutrient-rich vegetable intake than black girls. Across visits, girls consumed considerably fewer than the recommended daily servings of fruits (1.0-1.5), vegetables (1.7-2.5), or nutrient-rich vegetables (0.25). Most girls (95%) failed to meet Healthy People 2010 recommendations. CONCLUSIONS: Public health efforts are needed to meet Healthy People 2010 objectives.     

Nutrient contributions of dairy foods in the United States, Continuing Survey of Food Intakes by Individuals, 1994-1996, 1998

OBJECTIVE: This study was designed to quantify the impact of dairy foods on nutrient intakes in the United States. SUBJECTS: Data were from 17959 respondents to the 1994-1996, 1998 Continuing Survey of Food Intakes by Individuals (CSFII).Statistical analyses Nutrient intakes were quantified by quartile of dairy food intake. Also, dairy intakes were compared in people who met vs did not meet intake recommendations for select nutrients. Finally, the direct contribution of dairy foods/ingredients to calcium and lipid intakes was determined. SAS and SUDAAN software were used. Data were weighted. Energy intake was a covariable in regression models. RESULTS: Intake of all micronutrients examined, except vitamin C, was higher with increasing quartile of total dairy and milk intake, controlling for energy intake. Calcium was the only micronutrient positively associated with cheese intake. Fat intake either did not differ or was lower among people in quartile 2, 3, or 4 vs quartile 1 of total dairy and milk intake, whereas fat was higher as quartile of cheese intake increased. Dietary cholesterol was lower as intakes of any of the dairy categories increased; the opposite was true for saturated fat. Dairy foods/ingredients directly contributed an average of 51% of dietary calcium, 19% of total fat, 32% of saturated fat, and 22% of cholesterol. CONCLUSIONS: Total dairy and milk intakes were associated with higher micronutrient intakes without adverse impact on fat or dietary cholesterol. Results reinforce the strong nutritional profile of dairy-rich diets, although results with saturated fat and with cheese suggest that it would be useful to modify product composition and/or eating patterns to optimize nutritional contributions of dairy products.     

Use of low-fat foods by people with diabetes decreases fat, saturated fat, and cholesterol intakes

OBJECTIVE: To investigate the effect of providing free access to several fat-modified foods on dietary energy and macronutrient intake in people with and without diabetes mellitus. DESIGN: Five low-fat or no-fat products or their regular-fat counterparts were provided to volunteers to take home and use for 3 days (low-fat condition or regular-fat condition) in a repeated-measures crossover design. People with diabetes were case matched to people without diabetes. Food intakes were determined through a weighed food diary and by weighing the food provided before consumption and the uneaten portions after consumption. SUBJECTS: Thirty men and women, aged 20 to 60 years, with (n = 15) and without (n = 15) diabetes participated. STATISTICAL ANALYSES: Repeated-measures analysis of variance was used to determine the effects of diabetes and use of fat-modified foods on nutrient and energy intake. RESULTS: People with diabetes responded the same way to fat-modified foods as people without diabetes. There was a significant reduction in the grams of fat consumed during the low-fat condition compared with the regular-fat condition (average decrease = 8 g, P < .05). Energy intake from experimental foods was significantly lower during the low-fat condition (271 +/- 181 kcal) compared with the regular-fat condition (353 +/- 256 kcal), but total energy intake was not different. Percentage of energy from fat was significantly decreased in the low-fat condition (27 +/- 7) compared with the regular-fat condition (34 +/- 9; P < .05). There was a corresponding increase in the percentage of energy from carbohydrates in the low-fat condition compared with the regular-fat condition, but no significant increase in grams of carbohydrate consumed. Cholesterol and saturated fat intakes were significantly less in the low-fat condition than in the regular-fat condition. CONCLUSION: Consumption of fat-modified foods by individuals with diabetes may help decrease intake of fat, cholesterol, and saturated fat.     

Development of nutrition education tool: healthy eating index in Thailand

A healthful diet can reduce major risk factors for chronic diseases. To assess the dietary status of Thais and monitor changes in food consumption patterns, the Healthy Eating Index for Thais (THEI) is developed, an important tool for meeting the nutrition goals and determining people's overall diet quality. This index measures how well the diets of Thai people conform to the recommendations of the Food Guide Thailand Nutrition Flag. The THEI consists of 11 components, each representing different aspects of a healthful diet: Components 1-5 measure the degree to which a person's diet conforms to serving recommendations for the five major food groups of Thailand Nutrition Flag; Components 6, 7 and 8 measure total fat, saturated fat and added sugar consumption, respectively; Components 9 and 10 measure total cholesterol and sodium intake; and Component 11 examines variety in a person's diet. Each of the 11 components has a score ranging from 0 to 10, for a total score of 110. The dietary intake data from selected working adults were collected to derive the THEI scores. The average THEI score indicated that the diets of most people needed improvement and some individuals were more likely than others to consume a poor diet. This suggests a continued role for nutrition education and promotion efforts should result in a significant improvement of people's overall diet quality. In conclusion, the THEI is an useful index for describing overall diet quality for Thais and serves as a basic tool for providing nutrition education and promotion.