The context for choice: health implications of targeted food and beverage marketing to African Americans

Targeted marketing of high-calorie foods and beverages to ethnic minority populations, relative to more healthful foods, may contribute to ethnic disparities in obesity and other diet-related chronic conditions. We conducted a systematic review of studies published in June 1992 through 2006 (n = 20) that permitted comparison of food and beverage marketing to African Americans versus Whites and others. Eight studies reported on product promotions, 11 on retail food outlet locations, and 3 on food prices. Although the evidence base has limitations, studies indicated that African Americans are consistently exposed to food promotion and distribution patterns with relatively greater potential adverse health effects than are Whites. The limited evidence on price disparities was inconclusive.     

Barriers and Facilitators for Consumer Adherence to the Dietary Guidelines for Americans: The HEALTH Study

The majority of the US population does not meet recommendations for consumption of milk, whole grains, fruit, and vegetables. The goal of our study was to understand barriers and facilitators to adherence to the Dietary Guidelines for Americans for four nutrient-rich food groups in fifth-grade children and unrelated adult caregivers across six sites in a multistate study. A total of 281 unrelated adult caregivers (32% African American, 33% European American, and 35% Hispanic American) and 321 children (33% African American, 33% European American, and 34% Hispanic American) participated in 97 Nominal Group Technique sessions. Nominal Group Technique is a qualitative method of data collection that enables a group to generate and prioritize a large number of issues within a structure that gives everyone an equal voice. The core barriers specific to unrelated adult caregivers were lack of meal preparation skills or recipes (whole grains, fruit, vegetables); difficulty in changing eating habits (whole grains, fruit, vegetables), cost (milk, whole grains, fruit, vegetables), lack of knowledge of recommendation/portion/health benefits (milk, vegetables), and taste (milk, whole grains, vegetables). Specific to children, the core barriers were competing foods (ie, soda, junk foods, sugary foods [whole grains, milk, fruit, vegetables]), health concerns (ie, milk allergy/upset stomach [milk]), taste/flavor/smell (milk, whole grains, fruit, vegetables), forget to eat them (vegetables, fruit), and hard to consume or figure out the recommended amount (milk, fruit). For both unrelated adult caregivers and children, reported facilitators closely coincided with the barriers, highlighting modifiable conditions that could help individuals to meet the Dietary Guidelines for Americans.     

The 2005 Dietary Guidelines for Americans Adherence Index: development and application

The sixth edition of the Dietary Guidelines for Americans (DGA) was released in January 2005, with revised healthy eating recommendations for all adult Americans. We developed the 2005 Dietary Guidelines Adherence Index (DGAI) as a measure of adherence to the key dietary intake recommendations. Eleven index items assess adherence to energy-specific food intake recommendations, and 9 items assess adherence to "healthy choice" nutrient intake recommendations. Each item was scored from a minimum of 0 to a maximum of 1, depending on the degree of adherence to the recommendation. A score of 0.5 was given for partial adherence on most items or for exceeding the recommendation for energy-dense food items. The DGAI was applied to dietary data collected at the fifth examination of the Framingham Heart Study Offspring Cohort. The mean DGAI score was 9.6 (range 2.5-17.50). Those with higher DGAI scores were more likely to be women, older, multivitamin supplement users, and have a lower BMI and less likely to be smokers. The DGAI demonstrated a reasonable variation in this population of adult Americans, and by design this index was independent of energy consumption. The DGAI also demonstrated face validity based on the observed associations of the index with participant characteristics. Given these attributes, this index should provide a useful measure of diet quality and adherence to the new 2005 Dietary Guidelines for Americans.     

The 2005 Dietary Guidelines for Americans and risk of the metabolic syndrome

BACKGROUND: The 2005 Dietary Guidelines for Americans Index (DGAI) was created to assess adherence to the dietary recommendations of the 2005 Dietary Guidelines for Americans (DGA) in relation to chronic disease risk. OBJECTIVE: The objective was to assess the relation between dietary patterns consistent with the 2005 DGA as measured by the DGAI and both the prevalence of the metabolic syndrome (MetS) and individual MetS risk factors. DESIGN: DGAI scores and metabolic risk factors for MetS were assessed in a cross-sectional study of 3177 participants from the Framingham Heart Study Offspring Cohort. MetS was defined on the basis of the National Cholesterol Education Program Adult Treatment Panel III criteria. RESULTS: After adjustment for potential confounders, the DGAI score was inversely related to waist circumference (P for trend < 0.001), triacylglycerol concentration (P for trend = 0.005), both diastolic (P for trend = 0.002) and systolic (P for trend = 0.01) blood pressure, the prevalence of abdominal adiposity (P for trend < 0.001), and hyperglycemia (P for trend = 0.03). The prevalence of MetS was significantly lower in individuals in the highest DGAI quintile category than in those in the lowest category (odds ratio: 0.64; 95% CI: 0.47, 0.88; P for trend = 0.005) when those being treated for any of the risk factors were excluded. There was a significant interaction between DGAI score and age; the association between the DGAI score and MetS was confined largely to adults younger than 55 y (odds ratio: 0.57; 95% CI: 0.36, 0.92; P for trend < 0.01). CONCLUSIONS: A dietary pattern consistent with the 2005 DGA was associated with a lower prevalence of MetS-a potential risk factor for CVD.     

The 2000 Dietary Guidelines for Americans: foundation of US nutrition policy

The Dietary Guidelines for Americans form the foundation of US federal nutrition policy. The Food Guide Pyramid, the most widely distributed and best‐recognised nutrition education tool ever produced in the US, is based partially on the Dietary Guidelines. In addition, every federal nutrition programme in the United States uses the Dietary Guidelines as part of their nutrition standards. Federal law requires that the guidelines be reviewed every five years. The Dietary Guidelines Advisory Committee was charged with answering the question, ‘what should Americans eat to be healthy?’ After rigorously reviewing the scientific, peer‐reviewed literature the committee recommended a new set of guidelines for the year 2000. The guidelines are intended for healthy children (ages 2 years and older) and generally healthy adults of any age. The guidelines were expanded from seven in 1995 to ten in 2000. The 2000 Dietary Guidelines for Americans are; (1) aim for a healthy weight; (2) be physically active each day; (3) let the pyramid guide your food choices; (4) eat a variety of grains daily, especially whole grains; (5) eat a variety of fruits and vegetables daily; (6) keep foods safe to eat; (7) choose a diet that is low in saturated fat and cholesterol and moderate in total fat; (8) choose beverages and foods that moderate your intake of sugars; (9) choose and prepare foods with less salt; and (10) if you drink alcoholic beverages, do so in moderation.     

Development of the SoFAS (Solid Fats and Added Sugars) Concept: The 2010 Dietary Guidelines for Americans

The diets of most US children and adults are poor, as reflected by low diet quality scores, when compared with the recommendations of the Dietary Guidelines for Americans (DGAs). Contributing to these low scores is that most Americans overconsume solid fats, which may contain saturated fatty acids and added sugars; although alcohol consumption was generally modest, it provided few nutrients. Thus, the 2005 DGAs generated a new recommendation: to reduce intakes of solid fats, alcohol, and added sugars (SoFAAS). What precipitated the emergence of the new SoFAAS terminology was the concept of discretionary calories (a “calorie” is defined as the amount of energy needed to increase the temperature of 1 kg of water by 1°C), which were defined as calories consumed after an individual had met his or her recommended nutrient intakes while consuming fewer calories than the daily recommendation. A limitation with this concept was that additional amounts of nutrient-dense foods consumed beyond the recommended amount were also considered discretionary calories. The rationale for this was that if nutrient-dense foods were consumed beyond recommended amounts, after total energy intake was met then this constituted excess energy intake. In the 2010 DGAs, the terminology was changed to solid fats and added sugars (SoFAS); thus, alcohol was excluded because it made a minor contribution to overall intake and did not apply to children. The SoFAS terminology also negated nutrient-dense foods that were consumed in amounts above the recommendations for the specific food groups in the food patterns. The ambiguous SoFAS terminology was later changed to “empty calories” to reflect only those calories from solid fats and added sugars (and alcohol if consumed beyond moderate amounts). The purpose of this review is to provide an historical perspective on how the dietary recommendations went from SoFAAS to SoFAS and how discretionary calories went to empty calories between the 2005 and 2010 DGAs. This information will provide practitioners, as well as the public, with valuable information to better understand the evolution of SoFAS over time.     

Scientific and public health rationale for the Dietary Guidelines for Americans

The Dietary Guidelines for Americans, published by DHHS and USDA in 1980, have recently been reviewed by an expert committee that has recommended only minimal changes to scientifically update them. Initial efforts to develop dietary guidelines for prevention of diseases were fraught with controversy, some of which has continued. This controversy exemplifies a larger issue concerning the role that contemporary science, and specifically government, has in assuring and maintaining public health. Two broad questions need to be asked: what is the government's role in facilitating application of contemporary nutrition knowledge to public health, and what standard of scientific surety should be the basis for its application? Government's role in assuring public health and safety indirectly through information is well established. In deciding when the data are sufficient to inform the public, public health scientists must, at some point, make the leap of faith, even though some doubts may remain.     

An evaluation of the Dietary Guidelines for Americans in relation to cancer occurrence

BACKGROUND: Although scientific knowledge regarding the influence of nutritional factors on health and disease serves as the basis for specific recommendations included in the Dietary Guidelines for Americans, limited empirical epidemiologic data are available to verify that adherence to the cluster of nutrition-related behaviors included in the Dietary Guidelines will reduce the incidence of disease. OBJECTIVE: We examined the association of compliance with the Dietary Guidelines and incident cancers. DESIGN: Data from a population-based cohort of postmenopausal women (n = 34 708) were examined. A dietary guidelines index was derived as a summary measure of compliance with the Dietary Guidelines, and the association of this index and cancer incidence was examined for all cancers combined and for site-specific cancers with > 100 events. RESULTS: For all cancers combined, the relative risks associated with the upper 4 quintiles of the dietary guidelines index in reference to the bottom quintile were 0.95 (95% CI: 0.87, 1.05) for quintile 2, 0.88 (95% CI: 0.80, 0.97) for quintile 3, 0.88 (95% CI: 0.80, 0.96) for quintile 4, and 0.85 (95% CI: 0.77, 0.93) for quintile 5 (P for trend < 0.01). Similar patterns in relative risks were found for cancers of the colon, bronchus and lung, breast, and uterus. In contrast, ovarian cancer incidence was positively associated with the dietary guidelines index. CONCLUSION: Our findings suggest that adherence to the cluster of nutrition-related behaviors included in the Dietary Guidelines for Americans may be associated with a lower risk of cancer.     

Problems Encountered in Meeting the Recommended Dietary Allowances for Menus Designed According to the Dietary Guidelines for Americans

Forty-three menus that were to be used in a diet manual were designed to meet the requirements of a specific diet; provide 2,200 to 2,400 kcal, unless energy-restricted; meet the 1990 Dietary Guidelines for Americans; meet current recommendations for sodium (2 g to 3 g/day), cholesterol (≤300 mg/day), and fiber (20 g to 30 g/day); and meet or exceed the highest level for adults in the 1989 Recommended Dietary Allowances (RDAs). In addition, regular and low-fat, low-cholesterol menus for 1 week were collected from 11 hospitals throughout Arkansas. Menus were analyzed for energy, cholesterol, and 18 nutrients. Only 11% of the menus met the RDA for zinc. Half of the menus did not meet the RDA for vitamin B-6 and one third did not meet the RDA for iron. Zinc content of the menus was positively correlated (P<.001) with protein (r=.73) and with beef (r=.45). Vitamin B-6 was positively correlated with protein (r=.44, P<.001) and with all meat (r=.38, P<.01). Regular and low-fat, low-cholesterol hospital menus had the same nutrient inadequacies because they did not differ in total servings from any food group. These data indicate that the public may have difficulty choosing a diet that meets both the Dietary Guidelines and the RDAs. J Am Diet Assoc. 1995; 95:341-344, 347.     

Vitamin D, aging, and the 2005 Dietary Guidelines for Americans

The 2005 Dietary Guidelines for Americans recommend that older adults, people with dark skin, and those exposed to insufficient ultraviolet radiation (i.e., sunlight) consume extra vitamin D from vitamin D-fortified foods and/or supplements. Individuals in these high-risk groups should consume 25 microg (1000 IU) of vitamin D daily to maintain adequate blood concentrations of 25-hydroxyvitamin D, the biomarker for vitamin D status. This review considers recommendations for vitamin D-rich foods and dietary supplements, as well as specific problems with self-prescribing sun exposure or artificial sources of ultraviolet radiation to meet the vitamin D recommendations for older people.     

Consumers' understanding of the Dietary Guidelines for Americans: insights into the future.

The purpose of this study was to examine consumers' knowledge and understanding of the 1995 Dietary Guidelines for Americans and the sources from where consumers obtain their health information. A telephone survey was administered to 400 adults in the Twin Cities area in Minnesota. The number of guideline recommendations recalled per person was, on average, less than 2.5 of a total of 13 recommendations. Participants had difficulties interpreting the guidelines. Knowledge of the dietary fat guideline was especially poor. Only 17% of survey participants correctly stated the amount of total fat they should have in their diet. The total number of media sources used to obtain health information was the variable that best explained the variance in knowledge of the Dietary Guidelines recommendations. To effectively change dietary behavior, health educators must work effectively with the media to develop behavior-focused nutrition messages that are meaningful and clear to consumers.     

Adherence to the Dietary Guidelines for Americans and risk of major chronic disease in men

BACKGROUND: The Dietary Guidelines for Americans and the food guide pyramid aim to reduce the risk of major chronic disease in the United States, but data supporting their overall effectiveness are sparse. The healthy eating index (HEI) measures the concordance of dietary patterns with these guidelines. OBJECTIVE: We tested whether a high HEI score (range: 0-100; 100 is best) calculated from a validated food-frequency questionnaire (HEI-f) could predict lower risk of major chronic disease in men. DESIGN: A cohort of US male health professionals without major disease completed detailed questionnaires on food intake and other risk factors for heart disease and cancer in 1986 and repeatedly during the 8-y follow-up. Major chronic disease outcome was defined as incident major cardiovascular disease (stroke or myocardial infarction, n = 1092), cancer (n = 1661), or other non-trauma-related deaths (n = 366). RESULTS: The HEI-f was weakly inversely associated with risk of major chronic disease [comparing highest with lowest quintile of the HEI-f, relative risk (RR) = 0.89; 95% CI: 0.79, 1.00; P: < 0.001 for trend]. The HEI-f was associated with moderately lower risk of cardiovascular disease (RR = 0.72; 95% CI: 0.60, 0.88; P: < 0.001) but was not associated with lower cancer risk. CONCLUSIONS: The HEI-f was only weakly associated with risk of major chronic disease, suggesting that improvements to the HEI may be warranted. Further research on the HEI could have implications for refinements to the Dietary Guidelines for Americans and the food guide pyramid.     

Adherence to the Dietary Guidelines for Americans and risk of major chronic disease in women

BACKGROUND: Little is known about the overall health effects of adherence to the Dietary Guidelines for Americans. The healthy eating index (HEI), developed at the US Department of Agriculture, measures how well Americans' diets conform to these guidelines. OBJECTIVE: We tested whether the HEI (scores range from 0 to 100; 100 is best) calculated from food-frequency questionnaires (HEI-f) would predict risk of major chronic disease in women. DESIGN: A total of 67272 US female nurses who were free of major disease completed detailed questionnaires on diet and chronic disease risk factors in 1984 and repeatedly over 12 y. Major chronic disease was defined as fatal or nonfatal cardiovascular disease (myocardial infarction or stroke, n = 1365), fatal or nonfatal cancer (n = 5216), or other nontraumatic deaths (n = 496), whichever came first. We also examined cardiovascular disease and cancer as separate outcomes. RESULTS: After adjustment for smoking and other risk factors, the HEI-f score was not associated with risk of overall major chronic disease in women [relative risk (RR) = 0.97; 95% CI: 0.89, 1.06 comparing the highest with the lowest quintile of HEI-f score]. Being in the highest HEI-f quintile was associated with a 14% reduction in cardiovascular disease risk (RR = 0.86; 95% CI: 0.72, 1. 03) and was not associated with lower cancer risk (RR = 1.02; 95% CI: 0.93, 1.12). CONCLUSION: These data suggest that adherence to the 1995 Dietary Guidelines for Americans, as measured by the HEI-f, will have limited benefit in preventing major chronic disease in women.