Relationships between the amount of total protein in human milk, the volume of produced milk and perinatal factors

The concentrations of total protein in human milk on the 5th or 6th day after full-term delivery were measured on 184 women, and the amount of protein per 24 hours was calculated by multiplying protein concentration by 24-hour milk production for the same day. Relationships between the amount of protein, milk volumes and perinatal factors were investigated. 1. The mean values (and standard deviations) for total protein concentration and amount per 24 hours, and milk volumes were 1.89 (0.37) g/dl, 6.60 (2.71) g/24h, 353 (144) ml/24h respectively. A significant negative correlation was found between the concentration of protein and milk volumes. The amount of protein per 24 hours showed a considerably high positive correlation with milk volumes rather than with total protein concentration. 2. Among perinatal factors, the age of the mother and whether the delivery was abnormal affected significantly both the amount of protein and milk volumes. The amount of protein and milk volumes of women 30-39 years old, who delivered abnormally were both significantly reduced. The amount of protein for women who had hemoglobin concentrations less than 11.5 g/dl in the latter period of pregnancy was significantly high. However, significant difference disappeared when those women who had both abnormal delivery and birth weight of their baby was more than [mean + 1SD] were excluded.     

A study on immunoglobulin A in human milk. Relationship between the amount of IgA and perinatal factors including food intake

The concentrations of IgA in human milk on the 5th or 6th day after delivery were measured in 117 women who delivered maturely, and the amount of IgA per 24 hours was calculated by multiplying the IgA concentration by the total milk volume of the same day. The relationship between the amount of IgA and perinatal factors, including food intake during the latter half of the pregnancy, were investigated. Subjects were divided into three groups (little, moderate, much) by the amount of IgA per 24 hrs and quantification theory II statistical analysis was applied to discriminate among the three groups using 13 factors concerning the perinatal period and food intake as explanatory variables. 1. The ratio of correct classification into the three groups was relatively high, suggesting that there is a relation between the amount of IgA in milk and perinatal and food intake factors. 2. Among the perinatal factors, the age, the gestation period and the number of experienced deliveries were effective for the amount of IgA. The obtained results showed that women 20-29 years old who had the first delivery after 38-40 weeks of gestation were liable to have the greatest amount of IgA in milk. 3. The amount of IgA of the women who ate less in the latter period of pregnancy compared with pre-pregnancy, or had a "less frequent intake of protein" was liable to be the greatest, and that of women with a "large volume" or "frequent protein intake" was liable to be greater than that of those with "the same volume" or "moderately frequent protein intake." The amount of IgA of the women with a "frequent intake of salted dried fish" was the greatest. The fact that the amounts of IgA of the women who "ate less" or had a "less frequent intake of protein" were liable to be the greatest was considered to show that toxemia or the tendency to near abortion or preterm delivery greatly affected the amount of IgA.     

Length of gestation and nutritional composition of human milk

A comparative analysis of the composition of milk produced during the first 14 days of lactation by mothers who deliver prematurely and those who deliver at term is described and these values are contrasted with the composition of donor milk specimens. Twenty-four-hour milk collections (days 3, 7, and 14 postpartum) were obtained from nine mothers delivered between 37 to 42 wk gestation (term) and from 14 mothers who delivered between 28 to 36 wk gestation (preterm). A single spot milk collection was obtained from nine mothers who were 6 to 10 months postpartum (donor). Term and preterm milk was compared on specific postpartum days using an analysis of covariance controlling for 24-h milk volume. The protein, carbohydrate, fat, and energy content varied in a similar fashion in term and preterm milk over the 14 postpartum days studied. Furthermore, there was no significant difference between the two milk groups on any single postpartum day evaluated in terms of protein, carbohydrate, fat, or energy concentration. The milk volumes were significantly greater from the mothers delivered at term on days 7 and 14 (p less than 0.01) and the protein content of both term and preterm milk was negatively correlated with milk volume (r = -0.6 or more on each day studied). The nutrient and energy composition of spot donor milk was highly variable and frequently quite different from either term or preterm 24-h milk collections. These data indicate that milk from mothers who deliver prematurely does not contain significantly different concentrations of nutrients or energy than milk from mothers delivered at term and suggest that the differences previously noted between the two groups may be related to 24-h milk volume.     

Development of a food frequency questionnaire in a probabilistic sample of adults from Niterói, Rio de Janeiro, Brazil

With the purpose of generating a list of foods for a food-frequency questionnaire, data from 24h dietary recalls on a typical day from a probabilistic sample of 1,724 adults of Niterói, Rio de Janeiro, Brazil, were analyzed. The frequency of food intake, the total intake of energy and macronutrients and the relative contribution of each food item to total energy and macronutrient intake were calculated. The most frequently reported food items (> 50% of adults) were rice, coffee, beans, refined canesugar, and bread. Whole milk was consumed more frequently then skimmed milk or semi-skimmed milk. Beef was consumed by more adults than chicken, pork or fish. Approximately 90% of energy and macronutrients intake was explained by 65 food items. The list of food items generated in the present analysis is similar to those found in other samples of adults from urban areas in Brazil. It may be possible to generate a core list of common foods with addition of regional foods to be used nationally in urban areas of the country.     

The yield and nutrient content of colostrum and milk of women from giving birth to 1 month post-partum

The intake of mammary secretion from delivery to day 5 post-partum was determined by test-weighing nine infants using an integrating electronic balance. The mean yield of colostrum for the first 24 h after birth was 37.1 (range 7.0-122.5) g and was 408 (range 98.3-775) and 705.4 (range 452.5-876) g/24 h on days 3 and 5 post-partum respectively. The milk yield of mothers on either day 14 or 28 post-partum was determined by test-weighing the mother. The mean milk yield was 1.156 (SD 0.167) kg/24 h. A significant correlation (P less than 0.001; r 0.85, n 42) was found between milk yield measured by test-weighing the infant and milk yield measured by test-weighing the mother, confirming that it is possible to obtain a similar estimate of milk consumed using either of the two methods of test-weighing. There was a significant positive correlation (P less than 0.001) between lactose concentration and milk yield for the first 5 d post-partum (r 0.76, n 22); a significant correlation (P less than 0.001) between protein concentration and milk yield (r-0.74, n 22) and no significant correlation between fat concentration and milk yield for the period studied. The calculated energy intake of infants during the first 24 h after birth was only 0.12 (range 0.02-0.29) mJ. This increased to 1.44 (range 0.83-2.18) and 2.99 (range 2.49-4.06) mJ/24 h by days 3 and 14-28 post-partum respectively.     

Appetite is not influenced by a unique milk peptide: caseinomacropeptide (CMP)

The milk protein, caseinomacropeptide (CMP), is a predominant breakdown product of casein in the human stomach, and may aid in the regulation of food intake. Using a human feeding study design, this project assessed the effects of CMP on satiety and satiation by measuring the amount of food consumed at meal times and through subjective motivation to eat questionnaires. The following beverage treatments were prepared: 0.4% CMP solution, 2.0% CMP solution, vehicle alone, and water containing colorant and clouding agent. Twenty male and 32 female adults were enrolled into the study using a Latin Square randomization. Treatment beverages and ad libitum lunches were consumed on four separate occasions at the Study Center. After lunch, subjects left the Study Center, and completed a standardized questionnaire every hour throughout the afternoon and evening to assess hunger and stomach fullness, and kept track of all food and beverages consumed. Under these experimental conditions, CMP had no effect on energy intake or weight of food consumed at lunch or for the remainder of the day. CMP also had no effect on subjective indicators of satiety. Intake of CMP before a midday meal has no effect on regulation of food intake over a short-term period.     

Plain water intake of Korean adults according to life style,anthropometric and dietary characteristic: the Korea National Health and Nutrition Examination Surveys 2008-2010

BACKGROUND/OBJECTIVES

The objective of the study was to provide useful insights into plain water intake of Korean adults according to life style, anthropometric, and dietary characteristics.

SUBJECTS/METHODS

The data from the 2008-2010 Korea National Health and Nutrition Examination Survey were used. The subjects were 14,428 aged 20-64 years. Water intake was estimated by asking the question "How much water do you usually consume per day?". Dietary intake was estimated by 24-hour dietary recall. A qualitative food frequency questionnaire including 63 food items was also administered.

RESULTS

The mean plain water intake for men and women were 6.3 cup/day and 4.6 cup/day, respectively. Plain water intake increased as lean body mass, waist circumference, and body mass index levels increased, except for percentage of body fat. As energy and alcohol intakes increased, plain water intake increased. As total weight of food intake and total volume of food intake increased, plain water intake increased. Plain water intake increased as consumption of vegetables increased. Plain water intake increased as frequencies of green tea, alcoholic drink, and all beverages were increased in men. Plain water intake increased with increased frequencies of green tea, milk, soy milk, and alcoholic drink and decreased frequencies of coffee and soda in women.

CONCLUSIONS

Our results suggest that persons who had a higher waist circumference or lean body mass and women with higher BMI consumed more plain water. The persons eating high quality diet, or the persons who had more vegetables, green tea, milk, soy milk, or alcoholic drink consumed more plain water.     

Food Consumption Patterns: Findings from the Malaysian Adult Nutrition Survey (MANS)

This study reports the food consumption patterns of adults aged 18 to 59 years in the Malaysian Adults Nutrition Survey (MANS) carried out between October 2002 and December 2003. A total of 6,742 subjects comprising 3,274 men and 3,468 women representing the northern, central , southern and east coast of Peninsular Malaysia as well as Sabah and Sarawak were interviewed. A semiquantitative food frequency questionnaire (FFQ) which consisted of 126 food items was used to evaluate the food consumption pattern (habitual food intake) of the respondents during the previous one- year period. The results demonstrate that nasi putih (cooked rice) was consumed by 97% of the population twice daily (average 2? plates per day). Other food items consumed daily were marine fish, (one medium fish per day), green leafy vegetables (one cup per day) and sweetened condensed milk (three teaspoons per day. The mean frequencies for daily intake of rice, leafy vegetables, marine fish, local kuih, anchovy (ikan bilis) and biscuits were significantly higher among the rural compared to the urban adults. In contrast, more urban dwellers consumed chicken and eggs more frequently than their rural counterparts. More men than women consumed chicken and eggs more frequently. Malaysian adults showed a satisfactory habit of drinking plain water, with 99% drinking at least six glasses of plain water daily. Other beverages such as tea (47%), coffee (28%), chocolate-based drinks (23%) and cordial syrup (11%) were also consumed on daily basis, however, in a smaller proportion of the population. There were differences in the prevalence of daily consumption of foods when comparing urban and rural population, and also between men and women. The prevalence of daily consumption of marine fish among rural and urban adults was 51% and 34% respectively. For sweetened condensed milk, men and women consumed 43% and 28% respectively; however, more women drank full cream milk than men. Between the age groups, 21% of adults below 20 years old consumed chicken at least once a day, while this pattern of intake was not shown in the older age groups. Our findings show that adults, aged 50 to 59 years old, had the highest prevalence of daily consumption of full cream milk with 24% while those aged 18 to 19 years old had the lowest prevalence of daily consumption at 15%. The food consumption pattern of Malaysian adults appears to be satisfactory. However, some changes in food habits are recommended especially in substituting the less wholesome sweetened condensed milk with the more nutritious full cream or skimmed milk.     

Meeting calcium recommendations during middle childhood reflects mother-daughter beverage choices and predicts bone mineral status

BACKGROUND: Longitudinal data regarding the influence of beverage intakes on calcium adequacy are lacking. OBJECTIVE: This study evaluated calcium intake from ages 5 to 9 y as a function of mother-daughter beverage choices and as a predictor of bone mineral status. DESIGN: Intakes of energy, calcium, milk, sweetened beverages, fruit juices, and non-energy-containing beverages were measured with the use of three 24-h dietary recalls in 192 non-Hispanic white girls aged 5, 7, and 9 y and their mothers. Calcium intakes from ages 5 to 9 y were categorized as either meeting or falling below recommended adequate intakes (AIs). The girls' bone mineral status was assessed with dual-energy X-ray absorptiometry at age 9 y. RESULTS: The mean 5-y calcium intake was related to bone mineral density at age 9 y (beta = 0.27, P < 0.001). The girls who met the AI for calcium were not heavier (P = 0.83) but had higher energy intakes (P < 0.0001) than did the girls who consumed less than the AI. Compared with the girls who consumed less than the AI, the girls who met the AI consumed, on average, almost twice as much milk (P < 0.0001), had smaller decreases in milk intake (P < 0.01), and consumed 18% less sweetened beverages (P < 0.01) from ages 5 to 9 y; the 2 groups did not differ significantly in juice and non-energy-containing beverage intakes. The girls who met the AI were also served milk more frequently than were the girls who consumed less than the AI (P < 0.0001) and had mothers who drank milk more frequently (P < 0.01) than did the mothers of the girls who consumed less than the AI. CONCLUSIONS: These findings provide new longitudinal evidence that calcium intake predicts bone mineral status during middle childhood and reflects mother-daughter beverage choice patterns that are established well before the rapid growth and bone mineralization observed in adolescence.     

Urinary isoflavonoid excretion is similar after consuming soya milk and miso soup in Japanese-American women

Based on the hypothesis that isoflavones are absorbed more efficiently from fermented than from non-fermented soya foods, we compared the urinary isoflavonoid excretion (UIE) after intake of miso soup or soya milk. We recruited twenty-one women with Japanese ancestry who consumed standardized soya portions containing 48 mg isoflavones. On day 1, half the women consumed soya milk, the other half started with miso soup. On day 3, the subjects ate the other soya food and on day 5, they repeated the first food. Each participant collected a spot urine sample before and an overnight urine sample after soya food intake. All urine samples were analysed for daidzein, genistein and equol using LC-MS and were expressed as nmol/mg creatinine. We applied mixed models to evaluate the difference in UIE by food while including the baseline values and covariates. Relative to baseline, both groups experienced significantly higher UIE after consuming any of the soya foods. We observed no significant difference in UIE when soya milk was compared to miso soup (P = 0.87) among all women or in the seven equol producers (P = 0.88). Repeated intake of the same food on different days showed high reproducibility within subjects. These preliminary results indicate similar UIE after consuming a fermented soya food (miso) as compared to a non-fermented soya food (soya milk). Therefore, recommendations favouring fermented soya foods are not justified as long as the intestinal microflora is capable of hydrolysing the isoflavone glucosides from non-fermented soya foods.     

Agrochemicals in the maternal blood, milk, and cord blood: a source of toxicants for prenates and neonates

The circulating blood, breast milk, and cord blood, collected 24–48 hr after child birth of nursing Indian mothers were examined for the presence of organochlorine insecticides (OCI). Significant levels of BHC and DDT were found in all milk, blood samples, and neonatal blood (cord blood) of mothers. No effect of social status, age, dietetic habits, or area of residence on the susceptibility of subjects examined to accumulate OCI was noticed. Significant correlations of total DDT and BHC levels were observed among maternal blood, neonatal blood, and breast milk. The presence of OCI in the cord blood indicates their passage across the placenta to prenates, whereas contamination of breast milk which is consumed by neonates could shed some light on a far greater daily intake of toxic agrochemicals by neonates.     

Fat and protein composition of mature milk in adolescents.

The levels of certain components, notably total protein, total fat, energy, and fatty acids, of mature milk from 48 adolescent and 44 adult mothers was studied. These two groups were subdivided into high and low socioeconomic level (SEL). All mothers were primiparous, eutrophic, and with term pregnancy; and their newborns weighted over 2500 g at birth. The age factor appeared to have significant influence on the concentration of total protein, with higher levels in the group of adolescent mothers possibly as a compensatory mechanism to maintain the caloric value of the milk. The fatty acid content was altered significantly by the SEL probably due to the direct effect of maternal diet. The milk in adolescent mothers of low SEL demonstrated higher concentration of lauric and myristic acids, while the milk in low SEL adults contained higher proportions of linoleic and linolenic acids. The milk in adult mothers of high SEL demonstrated higher concentrations of palmitic, palmitoleic, and oleic acids. The different feeding habits of two socioeconomic groups may explain these results. The regular intake of soya oil, corn oil, and margarine by the urban population in general resulted in higher levels of linoleic acid in the milk of all groups studied.     

Ethanol intake during lactation impairs milk production in rats and affects growth and metabolism of suckling pups.

From parturition, lactating Wistar rats were given 20% alcohol in drinking water and fed a solid diet ad lib (group AL). Pair-fed (PF) and control (C) rats were fed solid diet and given water ad lib (C). All animals were sacrificed on the 12th day of lactation. Ethanol treatment decreased food intake and milk production in lactating rats to a greater level than in PF rats, and a greater reduction in body weight of the AL pups was noted. Brain weight, protein concentration, and DNA content were also lower in pups of AL dams than of PF dams, whereas liver glycogen concentration was higher in the former. Pups from AL dams had higher circulating levels of beta-OH-butyrate, triglyceride, and free fatty acids than those from either C or PF dams. Plasma glucose concentration was lower in both PF and AL than in C pups, whereas the AL group had lower plasma protein concentration than any of the other groups. We conclude that maternal alcohol intake during lactation greatly impairs milk production, and although the known increase of lipid content in milk in rats studied under similar conditions allows an enhanced lipidic components in the pups, this adaptation does not allow normal growth and brain development.     

Maternal diet and selenium concentration in human milk from an Italian population

Background

Low selenium (Se) status is associated with several diseases. International organizations have proposed intakes of Se for general populations, including infants. Studies of the association of Se concentration in breast milk and maternal diet have yielded inconsistent results. We evaluated the relation between the intake of food items during pregnancy and Se concentration in human milk after delivery and compared infant intake of Se from breast milk with the recommended intakes.

Methods

This cross-sectional study was part of the baseline assessment of a prospective cohort of Italian mother–child pairs enrolled in 1999–2001. Se concentration was measured in the milk of 100 women included in the cohort and correlated with the intake of food items during pregnancy and lactation as reported in a food frequency questionnaire.

Results

Among foods consumed in pregnancy, only eggs had a positive, but weak, correlation with Se concentration in milk (r = 0.20, P = 0.04). Fish intake during lactation was also weakly correlated with Se in milk (r = 0.21, P = 0.04). Se content of breast milk in our population was lower than that noted in other international studies; however, very few children who were exclusively breastfed were estimated not to have met the recommended Se intake.

Conclusions

Future research should aim to verify whether infants in this part of Italy still meet the recommended nutrient intake of Se and to assess the influence of the concurrent diet of lactating mothers on the Se content of their milk.Key words: selenium, human milk, maternal diet     

Appalachian adolescents' eating patterns and nutrient intakes

Meal and snack patterns of 114 male and 111 female adolescents in a southern Appalachian state were examined from 24-hour food records kept on a school day. Breakfast was skipped by 34% of the respondents, and 27% either skipped lunch or ate a snack-type lunch. The evening meal and snacks, each of which contributed about one-third of the daily energy intake, were eaten by 94% and 89%, respectively. Girls' mean intakes of vitamin A, calcium, and iron were low at all eating occasions throughout the day. Boys' mean intakes of iron were low at breakfast, lunch, and snacks; their vitamin A intakes were low at lunch and snacks. Adolescents who prepared their own breakfasts consumed less energy, protein, fat, and niacin at that meal than did adolescents who ate breakfasts prepared by their mothers. However, adolescent-prepared breakfasts were higher in nutrient density for calcium, riboflavin, and thiamin. Evening meals prepared by adolescents were similar in total nutrient content to meals prepared by their mothers but lower in nutrient density for iron and thiamin. Evening meals prepared by adolescents were more likely to include a sandwich and less likely to include a vegetable than were meals prepared by mothers.     

The effect of milk and skim milk intake on serum lipids and apoproteins in postmenopausal females.

The effects of milk and skim milk intake on serum lipids, apoprotein levels and fatty acid composition were investigated in postmenopausal females. After a 25-day intake of 200 ml/day of whole milk, the milk group had increased HDL and LDL cholesterol levels, with a slight decrease in the proportion of 18:0 fatty acids in the phospholipid fraction. The skim milk group, which had consumed 20 g/day of skim milk for 25 days, showed no changes. After intake of 400 ml/day of whole milk for 29 days, LDL, HDL and total cholesterol concentrations were even more increased and the VLDL-phospholipid concentration was decreased, with significant increases in apoA-I, apoA-II and apoB concentrations. In the skim milk group, consuming 40 g of skim milk per day for 29 days, total cholesterol, atherogenic index, HDL-triglyceride concentrations were decreased and HDL-phospholipid, apoA-I and apoA-II concentrations were increased. Daily skim milk consumption, which is effective in preventing osteoporosis, and careful selection of foods should be recommended for Japanese postmenopausal women who consume more than 200 ml/day of whole milk.     

The role of breakfast in diet adequacy of the U.S. adult population

Breakfast consumption patterns of the U.S. adult population were examined by using the U.S.D.A. Nationwide Food Consumption Survey. Results indicated that approximately one-quarter of the adult population skipped breakfast regularly. For those adults who consumed breakfast, the four most commonly consumed breakfasts were eggs, bread, and coffee; ready-to-eat cereal with milk; coffee and bread; and eggs, bread, and milk. The sample was partitioned by six age/sex classes and by four breakfast consumption patterns. Assessments of average intakes of seven frequently underconsumed nutrients showed that omission of the breakfast meal had a significant negative impact, particularly among adult females, on the diet quality. Findings indicated that for all age/sex classes, consumption of ready-to-eat cereal at breakfast, whether frequently or on a more limited basis, increased the average daily intake levels of the underconsumed nutrients. Further, groups of adults who regularly consumed ready-to-eat cereal at breakfast had, on average, lower average daily intakes of fat and cholesterol. It was concluded that regular breakfast consumption greatly enhanced the overall diet quality of the U.S. adult population.     

The role of breakfast in diet adequacy of the U.S. adult population.

Breakfast consumption patterns of the U.S. adult population were examined by using the U.S.D.A. Nationwide Food Consumption Survey. Results indicated that approximately one-quarter of the adult population skipped breakfast regularly. For those adults who consumed breakfast, the four most commonly consumed breakfasts were eggs, bread, and coffee; ready-to-eat cereal with milk; coffee and bread; and eggs, bread, and milk. The sample was partitioned by six age/sex classes and by four breakfast consumption patterns. Assessments of average intakes of seven frequently underconsumed nutrients showed that omission of the breakfast meal had a significant negative impact, particularly among adult females, on the diet quality. Findings indicated that for all age/sex classes, consumption of ready-to-eat cereal at breakfast, whether frequently or on a more limited basis, increased the average daily intake levels of the underconsumed nutrients. Further, groups of adults who regularly consumed ready-to-eat cereal at breakfast had, on average, lower average daily intakes of fat and cholesterol. It was concluded that regular breakfast consumption greatly enhanced the overall diet quality of the U.S. adult population.     

Will dietary omega-3 fatty acids change the composition of human milk?

The most abundant long-chain polyunsaturated fatty acid in brain and retinal lipids is docosahexaenoic acid (DHA, C22:6 omega 3). It becomes incorporated into nerve tissues mostly in utero and during the 1st yr of life. DHA is derived in humans either performed in the diet or by hepatic synthesis from dietary linolenic acid (C18:3 omega 3). Since human milk contains DHA, this study was designed to see if increased dietary DHA would be reflected in a higher DHA content in human milk. Eight lactating women were given supplements of a fish oil concentrate rich in omega-3 fatty acids, including DHA (11% of fatty acids). Six women took 5 g/day of fish oil for 28 days; five women consumed 10 g/day for 14 days; and one woman consumed 47 g/day for 8 days. Each intake level of fish oil produced significant dose-dependent increases in the DHA content of milk and plasma. Base-line DHA levels in milk were 0.1 +/- 0.06% of total fatty acids. Five g/day of fish oil raised the levels to 0.5 +/- 0.1% (p less than 0.001); 10 g/day raised DHA levels to 0.8 +/- 0.1% (p less than 0.001); and 47 g/day produced DHA levels of 4.8%. The results of this study indicated that relatively low intakes of dietary DHA significantly elevated milk DHA content. This would clearly elevate the infant's DHA intake and might have implications for brain and retinal development.     

Title VII--Nutrition Program for the Elderly. I. Contribution to one day's dietary intake

Food records kept by 466 individuals participating in the federally funded Nutrition Program for the Elderly show that those eating at the meal site on the day of the food record consumed more energy, protein, and calcium than non-participants and participants who did not eat there on the day of the record. Dietary ratings, which included eight nutrients and energy, indicated they also had better overall diets than non-participants. Non-participants consumed more iron than participants. The daily intake of all nutrients, except calcium, of those eating at the meal site reflected what was offered. Between 40 and 50 per cent of the total daily intake was consumed at the meal center. Women consumed a significantly greater proportion of their daily intake of most nutrients from the food provided by program than the men. The desirability of providing a high proportion of the recommended allowances for protein and other nutrients through the meal program menus is emphasized. The results of the study demonstrated the importance of nutritionists in administrative roles at the state and area levels in determining the effectiveness of a meal program, since food intake reflected menu planning.