Validation of 24-hour recalls assisted by food records in third-grade children

Objective The objective of the study was to validate the use of 24-hour recalls assisted by food records as a dietary assessment tool for use with third-grade children.

Design Trained staff observed children during mealtime at school, and parents observed and recorded what children ate in their presence. The following day children participated in a 24-hour recall interview. Children's ability to recall what they consumed during a 24-hour period was compared with observational data collected during the same period.

Setting All data were collected in elementary school settings at four sites involved in the Child and Adolescent Trial for Cardiovascular Health.

Subjects The sample of 49 children was self-selected, based on parents' willingness to observe and record their child's food intake.

Main outcome measures Recalled and observed data for energy and nutrient levels were compared using mean energy and nutrient analysis and quartile classification. In addition, recalled and observed foods were compared by meal type and estimation of portion size.

Statistical analysis performed Paired t tests, Pearson and Spearman correlations, and classification analysis were used to compare recalled and observed data.

Results Comparison of observed and recalled food intakes showed no significant differences in percentage of energy from total fat, saturated fat, monounsaturated fat, and polyunsaturated fat or in the amount of sodium consumed, although there were differences in energy intakes. Spearman rank order correlations between recalled and observed nutrients ranged from .45 to .79. A 77.9% agreement was found across all meals in the food items children recalled having consumed compared with those adults actually observed them consuming.

Conclusions We conclude that the 24-hour recall assisted by food records is a valid method for assessing the dietary intake of children as young as 8 years old for the purpose of group comparison.     

Validity of self-reported dietary intake at school meals by American Indian children: the Pathways Study

OBJECTIVE: To examine the validity of a modified diet record-assisted 24-hour recall in third-grade (8 to 10 years old) American Indian children. DESIGN: The children were trained to record their food intake using diet records, and then they recalled their 24-hour food intakes, using the diet records as memory prompts, during interviews by trained staff using the Minnesota Nutrition Data System (NDS; version 2.6, 1993, Food database version 8A, Nutrient database version 23; Nutrition Coordinating Center, University of Minnesota, Minneapolis). The modified method added training in portion size estimation. Direct observation of the children's intakes during school meals was used to validate the accuracy of their self-reported recalls. SUBJECTS: Eighty third-grade children recruited from schools from four of the American Indian Nations participating in the Pathways Study.Statistical analyses performed Pearson correlations were used for nutrient level data. A mixed regression model (PROC MIXED), with no other fixed effects and site as a random effect, was used to test the null hypothesis that the difference between recalled and observed intakes was zero (H(o): beta(o)=0). Food intake data were obtained from the Nutrition Data System Record Reports. RESULTS: There were no significant differences between recalled and observed energy intakes for the school meals combined or for either meal individually. Percentages of energy intake from fat, protein, and carbohydrate from recalls were not significantly different from those observed for the combined school meals. Pearson correlations for energy and energy-providing nutrients ranged from 0.52 to 0.86 for both meals, from 0.55 to 0.86 for school lunch, and from 0.61 to 0.86 for school breakfast. Agreement between recalled and observed food items was 75%. Children recalled 57% of food quantities within +/-10% of observed quantities. CONCLUSIONS: At the group level, American Indian children were able to accurately report the macronutrient proportions of their total energy intake, and their reporting of total energy intake (+13% of criterion) compares favorably with that of other ethnic groups of children of similar age. They were able to accurately recall the majority of foods that they were independently observed consuming during school meals.     

Nutrient intake of Head Start children: home vs. school

OBJECTIVE: To determine mean intake of energy and protein, total fat, saturated fat, percent energy from total and saturated fat, cholesterol, carbohydrate, calcium, iron, zinc, folate, vitamins A, C, E, B-6 and B-12, thiamin, niacin, riboflavin, magnesium, sodium and fiber of preschool Head Start children at school and away from school. DESIGN: Twenty-four-hour food intakes for 358 Head Start children were obtained by observing food intake at school and acquiring intake recalls from parents or guardians specifying food their children consumed for the balance of the day. After determining group estimates of energy and nutrient intake, mean intake was compared to standard nutrient recommendations for the entire 24-hour day, i.e., for the time the children were in school and for the remaining hours away from school ("home" intake). SUBJECTS: The 358 Head Start children attended school either half-day (2- to 3-hour AM and PM sessions) or all-day (5 to 6 hours). STATISTICAL ANALYSES: Differences in nutrient intake among class times were analyzed using one-way analysis of variance (ANOVA) followed by Tukey's multiple comparison test. Differences with a p-value <0.05 (two-tailed) were considered to be statistically significant. Total energy, protein, calcium, iron, zinc, vitamins A, C, E, B6, and B12, thiamin, niacin, riboflavin as well as folate and magnesium were compared to the Recommended Dietary Allowances for the 4- to 6-year-old age group. Other standards that were used for comparisons included the National Cholesterol Education Program (fat, saturated fat and cholesterol), the 1989 National Research Council's Diet and Health Report (carbohydrate and sodium) and the recommendation for fiber proposed by the American Health Foundation. RESULTS: At school, half-day children consumed up to 25% of the daily recommendation for energy and nutrients, while all-day children achieved at least a third of the recommended intakes. When intakes at home and school were combined, all three groups of children (AM, PM and all-day) exceeded dietary recommendations for protein, vitamins and minerals. Energy intake remained below 100% of the recommendation, while intake of total fat, saturated fat and cholesterol exceeded recommendations. APPLICATION: Further research is required to explore energy needs and determine nutritional status and nutrient needs of minority and low-income preschool children. Strategies are required to increase nutrient density, but not fat density, of meals and snacks served to children who attend day care for part of the day. Finally, school meals and nutrition education programs such as Team Nutrition should broaden their base to include healthful eating habits for all school children, including the very youngest children in preschool programs.     

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.     

Food and nutrient intakes of primary school children: a comparison of school meals and packed lunches

Background New school meal standards are currently being phased in by the government in an attempt to improve the nutritional composition of school food. However, no standards are applied to packed lunches. The present study aimed to compare the food and nutrient intakes of primary school children eating a school meal with those taking a packed lunch. Methods A sample of 120 children, aged 6–11 years, was observed once at a lunch time and all items consumed were recorded. Nutrient analysis was performed, and differences in nutrient intake between those children consuming packed lunches and school meals were determined. Results Mean energy and protein intakes were similar. The amount of energy provided by starchy carbohydrate was also similar but, compared with school meals, packed lunches provided twice as much energy from sugar (P < 0.001). School meals on average provided more energy from fat (P < 0.001), but intakes of saturated fat were lower in the school meals group (P = 0.021). Packed lunches provided more sodium (P < 0.001), calcium (P < 0.001) and iron (P = 0.016) than the school meals. Very few packed lunches contained vegetables, and fruit intake was particularly low for those having a school meal. Conclusions Children taking a packed lunch to school were consuming approximately double the amount of sugar and 50% more sodium and saturated fat in their midday meal compared with those having a school lunch. However packed lunches were providing children with more calcium, iron and fruit.     

Nutrient Intakes among Children and Adolescents Eating Usual Pizza Products in School Lunch Compared with Pizza Meeting HealthierUS School Challenge Criteria

Pizza is a popular food that can contribute to high intakes of saturated fat and sodium among children and adolescents. The objective of this study was to compare daily nutrient intakes when a pizza product meeting the US Department of Agriculture's criteria for competitive food entrées under the HealthierUS School Challenge (HUSSC) was substituted for usual pizza products consumed during foodservice-prepared school lunch. The study used National Health and Nutrition Examination Survey (2005-2008) dietary recall data from a cross-sectional sample of US children and adolescents (age 5 to 18 years, n=337) who ate pizza during school lunch on 1 day of dietary recall. Daily nutrient intakes based on the consumption of usual pizza products for school lunch (pre-modeled) were compared with intakes modeled by substituting nutrient values from an HUSSC whole-grain pizza product (post-modeled). Paired t tests were used to make the comparison. Post-modeled intakes were lower in daily energy, carbohydrate, total fat, saturated fat, cholesterol, and sodium compared with pre-modeled intakes among children and adolescents (P<0.01). Protein, dietary fiber, vitamin A, and potassium intakes were higher in the post-modeled intake condition compared with the pre-modeled condition (P<0.01). Substituting the healthier pizza product for usual pizza products may significantly improve dietary quality of children and adolescents eating pizza for school lunch, indicating that it could be an effective approach to improve the nutritional quality of school lunch programs.     

Quality of food eaten in English primary schools: school dinners vs packed lunches

OBJECTIVE: To compare the food and nutrient intakes of primary school children eating school dinners and packed lunches. SUBJECTS: Six-hundred and twenty-one 7-year-old children participating in the Avon Longitudinal Study of Parents and Children in South West England. METHODS: Diet was assessed by 3-day unweighed food record. RESULTS: The composition of both types of school meals compared unfavourably with dietary guidelines. Intakes of energy, non-starch polysaccharides (NSP), calcium, iron, folate, retinol equivalents, zinc, copper, magnesium, iodine and riboflavin were too low, and intakes of total and saturated fat were too high. However, children who ate school dinners had higher lunchtime intakes of protein, starch, NSP and most vitamins and minerals and lower intakes of sugar (14.2 and 20.9% of energy in school dinners and packed lunches, respectively, P<0.001) and saturated fat (12.0 and 16.2%, P<0.001). Only around half of the recommended amount of fruit and vegetables was eaten by children having either type of school meal. There were also differences in the whole day's nutrient intake according to school meal type. Children eating packed lunches had lower daily intakes of potassium and zinc, and higher intakes of sugar and saturated fat. Differences in nutrient intake were independent of maternal education. CONCLUSIONS: The food and nutrient content of both school dinners and packed lunches needed improvement. However, the standard of food brought from home by children was, if anything, worse than that served at school. Recent moves to improve school dinners will need to be complemented by education about what constitutes a healthy packed lunch.     

Dietary sources of fats and cholesterol in US children aged 2 through 5 years.

OBJECTIVES. This study of lipid intakes among preschool children (1) analyzed the contributions of 38 food groups to fat, saturated fat, and cholesterol intakes; (2) estimated the effects of food substitutions on intakes; and (3) examined demographic differences in food group intake and food group sources of these lipids. METHODS. The sample consisted of 547 children, aged 2 to 5 years, from the US Department of Agriculture''s 1985 and 1986 Continuing Surveys of Food Intakes by Individuals. Dietary information for 4 nonconsecutive days throughout a year was used. All foods were classified into groups and the lipids contributed from each group were computed. RESULTS. Over 80% of the children consumed more total fat, saturated fats, and cholesterol than is recommended. The major source of total fat and saturated fats was whole milk; the major sources of dietary cholesterol were eggs and whole milk. Children''s food consumption patterns differed by region of the country and race/ethnicity, providing opportunities to refine nutrition education interventions and evaluations. CONCLUSIONS. By substituting lower-fat foods for the major sources of saturated fats, significant reductions in preschool children''s intakes of saturated fats, fat, and dietary cholesterol could be achieved.     

Children's nutritional intake as part of the Eat Well Do Well scheme in Kingston‐upon‐Hull – a pilot study

In April 2004 Hull City Council introduced free healthy school meals for all primary and special schools in an attempt to reduce health inequalities. This pilot study aimed to compare nutritional intake between those children consuming a free healthy school meal and those consuming a packed lunch brought from home. The study compared two schools from different socio‐economic areas and considered the impact of lunch on total daily food and nutrient intakes in these children. Fieldwork was undertaken over five consecutive days in each school. Seven hundred and thirty‐five lunches were weighed and photographed before and after consumption to assess actual food intake vs. wastage. One hundred and forty‐seven children aged 8‐to‐11‐years participated from two primary schools. Five‐day food diaries were completed by a small number of participants (n = 20) receiving school meals (n = 10) and packed lunches (n = 10) from the two schools selected. While the lunches provided at the two schools met the majority of the nutritional guidelines for school meals, children ate only a small amount, often leaving the potatoes and vegetables behind; therefore, their intakes were below recommended levels. Children from both schools who opted for packed lunch consumed significantly more energy, fat, sugar and sodium but with this more micronutrients than children who had a free healthy school meal. Statistical differences (P < 0.01) were found between the two schools, with children from the less affluent school consuming less food from the school meal and therefore obtaining a lower nutrient intake from lunch than children from the more affluent school. Findings from a small number of food diaries suggest that the differences in intakes between those having a school meal and those having a packed lunch were compensated for by other food consumed during the day, such that daily nutrient intakes were not significantly different. This study suggests that many children may not be consuming sufficient amounts of the food provided in schools. Therefore, it cannot be assumed that the provision of school meals that conform to the School Food Trust guidelines will be of nutritional benefit to all children concerned. Bearing this in mind, more needs to be done to provide menus that are both healthy and enjoyable for children, so that they will want to consume the foods provided. Parents also need more advice regarding how they can provide their children with a healthy packed lunch, possibly via the introduction of a government‐led packed lunch policy, particularly in schools from areas of lower socio‐economic status. Although there was only a small sample of food diaries in this study, the findings suggest that socio‐economic demographics may exert more of an influence on the total daily nutrient intake of children than the type of lunch consumed.     

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.     

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.     

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.     

Consumption of 'extra' foods by Australian children: types, quantities and contribution to energy and nutrient intakes

OBJECTIVE: To measure the types and quantities of energy-dense, nutrient-poor 'extra' foods consumed by Australian children and adolescents and their contribution to total energy and nutrient intakes. DESIGN, SETTING AND SUBJECTS: We used data from 3007 children, aged 2-18 years, who participated in the nationally representative 1995 National Nutrition Survey. Intake was determined by 24-h recall and 'extra' foods were defined using principles outlined in the Australian Guide to Healthy Eating (AGHE) and by applying cut points for maximum amounts of fat and sugar within each food category. RESULTS: All children (99.8%) consumed at least one 'extra' food and the most commonly consumed were margarine, sugar-sweetened soft drinks, cordials and sugar. 'Extra' foods contributed 41% of daily energy intake. Those foods contributing most to energy intake were fried potatoes (4.2%), sugar-sweetened soft drinks (3.3%), ice cream/ice confection (3.1%) and cordials (2.7%). Age and sex were important determinants of 'extra' food intake, with males and older children generally consuming more and different types of, 'extra' foods than females and younger children. 'Extra' foods contributed 19% protein, 47% total fat, 47% saturated fat, 54% sugar, and approximately 20-25% of selected micronutrients to the diet. Calcium and zinc intakes from core foods were below 70% of the recommended dietary intakes for adolescent girls. CONCLUSIONS: 'Extra' foods are over-consumed at two to four times the recommended limits and contribute excessively to the energy, fat and sugar intakes of Australian children, while providing relatively few micronutrients. This is of concern in terms of children's weight and nutrient status.     

Development and validation of an instrument to assess child dietary fat intake

BACKGROUND: brief dietary assessment instrument to assess dietary intakes of total fat, saturated fatty acids (SFA), and cholesterol in young children was developed and validated. METHODS: Young children and their parent or primary caretaker were recruited from a general primary care health center and local Head Start programs. Dietary records, entered and analyzed using the Minnesota Nutrition Data System, were used to calculate children's mean dietary intakes. Stepwise linear regression analysis was used to select questionnaire items that best predicted total fat, SFA, and dietary cholesterol intakes. RESULTS: This yielded a 17-item Child Dietary Fat Questionnaire (CDFQ); 9 questions correlated with total fat intake (r = 0.68, P < 0.0001); 15 questions correlated with SFA intake (r = 0.75, P < 0.0001); and 4 questions correlated with dietary cholesterol intake (r = 0.57, P < 0.0001). The test-retest reliabilities of the CDFQ in predicting children's dietary intakes of total fat, SFA, and cholesterol were 0.41, 0.66, and 0.64, respectively. The criterion-based validity of the CDFQ, evaluated against 4 days of dietary records, yielded correlations of 0.54 (P < 0.0001) for total fat, 0.36 (P < 0.01) for SFA, and 0.55 (P < 0. 0001) for dietary cholesterol intake. CONCLUSIONS: The 17-item CDFQ is a brief, easy-to-use dietary assessment instrument that could be used to identify children with high, as well as low, dietary intakes of total fat, SFA, and/or cholesterol.     

Impact of Adopting Lower-Fat Food Choices on Energy and Nutrient Intakes of American Adults

Objective To evaluate the energy and nutrient intake of free-living men and women who choose foods consistent with different fat-reduction strategies.Design For each year of the Continuing Survey of Food Intake by Individuals from 1989 through 1991, food codes were used to sort respondents by type of milk; type of meats; and type of cheese, yogurt, salad dressing, cake, and pudding (ie, full-fat or fat-modified products) consumed.Subjects A nationally representative sample of 3,313 men and 3,763 women who completed 3-day intake records and consumed either a reduced-fat or full-fat food from at least 1 of the 3 fat-reduction strategy categories.Statistical analysis performed Analysis of variance with the Scheffé test was used to analyze differences in energy and nutrient intake between exclusive users, mixed users, and nonusers of each strategy or combined strategies.Results Regardless of fat-reduction strategy, men and women who used them reported significantly lower intakes of total fat (up to 18 g lower), saturated fat (up to 12 g lower), cholesterol (up to 75 ing lower) and energy compared with nonusers. Exclusive users of single strategies met or approached recommendations of the National Cholesterol Education Program for total fat, saturated fat, and cholesterol intake; micronutrient intake varied depending on the strategy used. Skim milk users had the most favorable micronutrient intake, whereas lean meat users reported inadequate intake of zinc (men 6396 and women 59% of the Recommended Dietary Allowances [RDAs]) and female users of fat-modified products reported inadequate intakes of vitamin E (64% of RDA) and zinc (65% of RDA). Multiple-strategy users achieved National Cholesterol Education Program goals and reported adequate micronutrient intakes and significantly lower energy intake. Mixed users of fat-modified products compared with nonusers of any fat-modified products had adequate micronutrient intake and lower intakes of total fat (32% vs 36% of energy for men and 32% vs 35% of energy for women) and saturated fat (11% vs 13% of energy for men and 11% vs 12% of energy for women). In addition, nonusers of any fat-modified strategy had the highest cholesterol and energy intake and the lowest intake of. many micrbnutrients.Applications A variety of fat-reduction strategies can be implemented to reduce energy, total fat, saturated fat, and cholesterol intake. Some of the strategies were associated with an inadequate micronutrient intake, so additional dietary guidance is needed to ensure that all nutrient requirements are met. Furthermore, people who do not use any fat-reduction strategy or those who exclusively use lean meats or fat-modified products would benefit from understanding how to balance their food choices. J Am Diet Assoc. 1999;99:177–183.     

Variability in percent energy from fat throughout the day: Implications for application of total diet goals

In spite of the general agreement that dietary recommendations apply to the diet over time, the quantitative levels for total and saturated fat have been used in establishing federal policy related to intakes for a single day, meal, and even an individual food. Application of these recommendations uniformly to meals across a day implies that fat intake is uniform throughout the day. This analysis of the 1985 Continuing Survey of Food Intakes by Individuals demonstrates that percent energy intake from fat across eating occasions within a day is not uniform. Percent energy intake from total and saturated fat is lower at the morning meal and at snacks among women at all levels of fat consumption, suggesting that fat is restricted more often at these two eating occasions. Intake of total and saturated fat was also more variable at these two eating occasions. These findings suggest that restricting fat intake at these eating occasions and liberalizing fat intake at midday and evening meals occurs commonly and may be an effective fat-reduction strategy. Daily variability in percent energy from fat should be considered in designing dietary fat reduction interventions and in applying quantitative recommendations for percent energy from total and saturated fat in nutrition guidance directed to individual meals.     

Diet diversity and nutrient intake

Variety is espoused as a key to dietary adequacy, yet data from new shortcut dietary measures suggest that intakes of relatively few foods can accurately classify individuals according to nutrient intake. This study examines diet diversity, caloric intake, and nutrient density values as contributors to the level of selected nutrients in the diets of 1,747 white men and 1,898 white women, 18 to 34 years old, completing the 24-hour recall in NHANES II. Nutrient intake was directly related to both number of foods eaten and total calories consumed, as well as to nutrient density values. For fat, saturated fat, and potassium, higher caloric consumption alone may account for substantial differences in nutrient intakes between the lowest and highest quartiles. For cholesterol, calcium, and vitamin A, differences in dietary density were more important in explaining nutrient intake differences. Both caloric intake and nutrient density influence sodium intake from food sources. For some nutrients, an overall measure of diversity may be useful for estimating intakes. For others, nutrient-specific diversity indexes would likely be needed. Knowledge of specific foods in diets with high levels of nutrients could aid the construction of food frequency instruments.     

Food-based dietary guidelines--the Austrian perspective

Presently, no national dietary guidelines--neither food- nor nutrient-based--exist for Austria. Usually, the recommendations of the German Society of Nutrition are used instead. The determination of national characteristics of nutritional behaviour and food consumption can reveal starting-points for the improvement of nutritional status in Austria. Seven-day weighed records (children and adolescents, n = 2.173) and 24-h-recalls (adults, n = 2.488) were used for the evaluation of nutrient intake and food consumption. For a sub-sample of children and adolescents, results from laboratory assessment of biomarkers were also available (n = 1.400). Based on fat intake, the age groups were divided into low fat intake (less than 25th percentile = 28-34% fat energy) and high-fat eaters (greater than 75th percentile = 38-45% fat energy). Approximately 75% of the Austrian population have fat intakes above 30% of energy intake, older age groups having a higher prevalence of high fat intakes. Intakes of saturated fatty acids reach 40-46% of total fat. The usual intake of dietary fibre in the Austrian population is between 17-21 g/d; some individuals are able to achieve the recommended intakes for dietary fibre, but do not represent a significant majority of the population. The mean intakes of fruits are clearly higher in children and adolescents (10% of total food intake) than in adults (2-6%). Differences in the intake of selected nutrients in foods between low and high fat consumers, unexpectedly, did not result in different plasma concentrations of cholesterol, nor did it result in differences in fat soluble vitamins. Therefore, one of the primary dietary guidelines for Austria should be the reduction of fat consumption, which is also associated with increasing intakes of fruits and vegetables, increasing intakes of dietary fibre and decreasing intakes of cholesterol.     

The contribution of foods from outside the home to the nutrient intake of young adolescents

Eating patterns in the UK are changing, not least of these changes is the increase in food availability and choice outside the home. Eating outside the home is not a new phenomenon; limited data are available for adults and for the population as a whole, but no such data exist for children. Information on food choices and purchasing is valuable in identifying relevant targets for effective change. This paper reports the dietary intake and the percentage of total intake from home and away from home (identifying as outside sources, school meals, other homes, school tuck-shops and shops or cafes for 379 11–12-year-old schoolchildren in 1990), as well as the nutrient density of intakes from each food source. Each child completed two 3-day dietary records between January and July 1990, and was interviewed after each 3-day record by one dietitian. The purpose of the interview was to verify and enlarge upon the information recorded in order to obtain a quantitative record of food intake and to determine the source of each food item. Food tables were used to calculate nutrient intake. Sources of food outside the home accounted for approximately 30% of their total energy intake. Food from home had the highest micronutrient density of all the sources. The nutrient density of school meals compared well with food from home; school meals were lower in non-milk extrinsic sugars although higher in fat and lower in protein, non-starch polysaccharides, iron and retinol equivalents. Foods purchased from shops/cafes or school tuck-shops were of poor nutrient quality for all nutrients measured. Children from ‘low’ social groups had intakes of a lower nutrient density from home than children from ‘high’ social groups and also obtained a greater proportion of their total diet from shops or cafes. Although the popularity of the different food sources outside the home varied with gender and social group, the quality of intake obtained did not, suggesting that children followed peer group food preferences outside the home rather than food habits taught at home.     

Weight-for-height measurement and saturated fatty acid intake are predictors of serum cholesterol level in children.

To assess the relationship of serum cholesterol level to anthropometric measurements and dietary intake, we measured serum cholesterol, height, weight, triceps skinfold, and 24-hour dietary intake in 80 children (mean age = 9.8 years) during April 1989. The mean serum cholesterol level was 3.95 mmol/l. In comparison with national data, weight-for-height and triceps skinfold measurements exceeded the 90th percentile in 18 (23%) and 26 (33%) of the children, respectively. Mean cholesterol and fat intakes were 114 mg/1,000 kcal and 36% of energy, respectively. In multiple stepwise regression analyses, weight-for-height measurement and saturated fatty acid intake were most predictive of serum cholesterol levels. Diets of children who consumed 30% of energy or less from fat (low-fat group) met or exceeded the Recommended Dietary Allowances except for energy and vitamin E and were higher in percentage of energy from carbohydrate, dietary fiber, magnesium, iron, and copper than were diets of children who consumed 31% of energy or more from fat (high-fat group). Children in the high-fat group ate more red/processed meats, baked desserts, and fats/oils than children in the low-fat group. Our data indicate that programs to reduce risk of cardiovascular disease in children may need to focus on maintaining ideal body weight and reducing saturated fatty acid intake.