Contribution of dietary supplements to nutrient adequacy among children in Hawaii

Objectives

To quantify the use of dietary supplements over a 24-hour and 1-month time frame, to determine the contribution of dietary supplements to the prevalence of dietary nutrient adequacy in the population, and to identify factors associated with supplement use, including characteristics of caregivers.

Design

Cross-sectional study.

Subjects/setting

Children aged 8 to 11 years from four primarily Native Hawaiian and Pacific Islander communities on Oahu (n=115) and the island of Hawaii (n=70).

Methods

A 24-hour food recall and a dietary supplement record were collected and analyzed for each child. Demographic and supplement use data were collected for each caregiver.

Statistical analyses

Significant differences between supplement users and nonusers were determined by χ² analysis. Prevalence of dietary nutrient adequacy with and without intake from dietary supplements was calculated using PC-Side software (version 1.02, 2001, Department of Statistics and Center for Agricultural and Rural Development, Iowa State University, Ames).

Results

Use of any dietary supplement by children in the previous day and month was 26% (n=48) and 40% (n=74), respectively. Prevalence of dietary nutrient adequacy from foods alone ranged from 33% to 100%, and increased to 59% to 100% when the nutrient contribution from dietary supplements was included. The largest increases in nutrient adequacy were for vitamins A, E, and C. Use of dietary supplements was most strongly associated with use of dietary supplements by caregivers, as well as with younger age of child, and greater years of caregiver education.

Conclusions

Dietary supplements are being used by a large percentage of these children in Hawaii and use is associated with use by their caregivers. The nutrient contribution from dietary supplements increased the prevalence of nutrient adequacy for several nutrients.     

Assessing Dietary Variety in Children: Development and Validation of a Predictive Equation

Background

Research indicates that the length of time needed to describe dietary diversity is approximately 2 weeks. This is the first study conducted to develop a dietary variety measurement tool that is sensitive to the effect of time on dietary variety without the burden of gathering data for 2 weeks.

Objective

To determine whether 3 days of 24-hour dietary recall logs collected during a 15-day period would predict food variety as well as 15 consecutive days. The study also determined which set of 3 days (consecutive vs interval days) within a 15-day period would better predict 15-day food variety.

Design

Prospective survey of the dietary practices of children.

Subjects/setting

Seventy-two children aged 9 to 12 years attending fourth and fifth grades in a public elementary school in a Midwestern town in the fall of 2005.

Main outcome measures

Predicted 15-day cumulative dietary variety score from 3 consecutive days and 3 interval days of dietary data.

Statistical analysis performed

Two prediction models were obtained from multiple linear regression analyses in which natural log-transformed (log_e) 15-day variety scores were regressed on log_e 3-day variety scores (consecutive and interval days). The ability of each model to predict the 15-day cumulative variety score was assessed by comparisons of mean bias, mean-squared error, coefficient of determination (R²), and Pearson product-moment correlation coefficients.

Results

Three days of dietary data accurately estimated dietary variety over time for this sample of 9- to 12-year-old children using the predictive equation generated in this study. Three interval days predicted 15-day food variety more precisely than 3 consecutive days.

Conclusions

The predictive equation is accurate in estimating food variety over time for this population and, if validated in independent samples, could be applied to similar populations.     

Nutrient Adequacy and Diet Quality in Non-Overweight and Overweight Hispanic Children of Low Socioeconomic Status: The Viva la Familia Study

Objective

The role of diet quality and nutrient adequacy in the etiology of childhood obesity is poorly understood. The specific aims of these analyses were to assess overall diet quality and nutrient adequacy, and test for association between weight status and diet in children from low socioeconomic status (SES) Hispanic families at high risk for obesity.

Design

A cross-sectional study design was used to assess dietary intake in low-SES Hispanic children with and without overweight who were enrolled in the Viva la Familia Study. Multiple-pass 24-hour dietary recalls were recorded on two random, weekday occasions. Diet quality was evaluated according to the Dietary Guidelines for Americans. Nutrient adequacy was assessed using z scores based on estimated average requirement or adequate intake.

Subjects/setting

The study included 1,030 Hispanic children and adolescents, aged 4 to 19 years, in Houston, TX, who participated between November 2000 and August 2004.

Statistical analysis

STATA software (version 9.1, 2006, STATA Corp, College Station, TX) was used for generalized estimating equations and random effects regression.

Results

Diet quality did not adhere to the Dietary Guidelines for Americans for fat, cholesterol, saturated fatty acids, fiber, added sugar, and sodium. Although energy intake was significantly higher in children with overweight, food sources, diet quality, macro- and micronutrient composition were similar between non-overweight and overweight children. Relative to estimated average requirements or adequate intake levels, mean nutrient intakes were adequate (70% to 98% probability) in the children without and with overweight, except for vitamins D and E, pantothenic acid, calcium, and potassium, for which z scores cannot be interpreted given the uncertainty of their adequate intake levels.

Conclusions

Whereas the diets of low-SES Hispanic children with and without overweight were adequate in most essential nutrients, other components of a healthful diet, which promote long-term health, were suboptimal. Knowledge of the diets of high-risk Hispanic children will inform nutritional interventions and policy.     

Protein dietary reference intakes may be inadequate for vegetarians if low amounts of animal protein are consumed

Objective

The health benefits of vegetarian diets are well-recognized; however, long-term adherence to these diets may be associated with nutrient inadequacies, particularly vitamins B12 and D, calcium, iron, zinc, and protein. The dietary reference intakes (DRIs) expert panels recommended adjustments to the iron, zinc, and calcium DRIs for vegetarians to account for decreased bioavailability, but no adjustments were considered necessary for the protein DRI under the assumption that vegetarians consume about 50% of protein from animal (dairy/egg) sources. This study examined dietary protein sources in a convenience sample of 21 young adult vegetarian women who completed food logs on 4 consecutive days (3 weekdays and 1 weekend day).

Methods

The daily contribution percentages of protein consumed from cereals, legumes, nuts/seeds, fruits/vegetables, and dairy/egg were computed, and the protein digestibility corrected amino acid score of the daily diets was calculated.

Results

The calculated total dietary protein digestibility score for participants was 82 ± 1%, which differed significantly (P < 0.001) from the DRI reference score, 88%, and the 4-d average protein digestibility corrected amino acid score for the sample was 80 ± 2%, which also differed significantly (P < 0.001) from the DRI reference value, 100%. The analyses indicated that animal protein accounted for only 21% of dietary protein.

Conclusion

This research suggests that the protein DRI for vegetarians consuming less than the expected amounts of animal protein (45% to 50% of total protein) may need to be adjusted from 0.8 to about 1.0 g/kg to account for decreased protein bioavailability.     

Methodology for adding glycemic index values to 24-hour recalls

Objective

To describe a standardized method to assign glycemic index (GI) values to food items, obtained from 3 × 24-h recalls among Aboriginal and Torres Strait Islander and non-Indigenous Australian children, which can be adapted for use with simple food composition databases.

Methods

Four published GI databases were used as the source of GI values. Changes were made to a previously published methodology for GI value assignment to accommodate the needs of the Many Rivers Diabetes Prevention Project.

Results

There were 1132 food items in the recall database. Two hundred nineteen (19.3%) food items were directly linked to the FoodWorks GI database and 545 (48.1%) items were assigned the GI value of a “closely related” food item in the four GI databases used. Among the top carbohydrate contributors, 113 (35.3%) items have a direct linkage with the FoodWorks GI database. The mean ± SEM dietary GI and glycemic load (GL) of the study population resulting from this methodology are 57.5 ± 0.3 and 143.4 ± 2.6, respectively.

Conclusion

This simple method provides opportunities for countries without food composition database that are comprehensive for GI/GL but which contain accurate information on carbohydrates in foods to assign high-quality GI values to food items in epidemiological studies based on 24-h recalls.     

Dietary Intakes and Physical Activity among Preschool-Aged Children Living in Rural American Indian Communities before a Family-Based Healthy Lifestyle Intervention

Objective

To report dietary intake and physical activity among preschool-aged children living in rural American Indian communities before participation in a family-based healthy lifestyle intervention and to compare data to current age-specific recommendations.

Subjects/design

One hundred thirty-five preschool-aged children, living in rural American Indian communities, provided diet and physical activity data before participating in a 2-year randomized healthy lifestyle intervention. Three 24-hour dietary recalls assessed nutrient and food and added sugar intake, which were compared to the National Academy of Science's Dietary Reference Intakes, the US Department of Agriculture's MyPyramid, and American Heart Association recommendations. Time watching television and moderate plus vigorous activity was compared to MyPyramid and American Academy of Pediatrics recommendations.

Statistical analysis

Nutrient, food group, added sugar intake, and time watching television and in moderate or vigorous activity were compared to recommendations by computing the percent of recommendations met. Nonparametric tests identified differences in diet and physical activity among age groups and normal and overweight children (body mass index <85th and ≥85th percentile).

Results

Average nutrient intakes met recommendations whereas food group intakes did not. Mean fruit and vegetable intakes for 2- to 3-year-olds were 0.36 c/day fruit and 0.45 c/day vegetables and, for 4- to 5-year-olds, 0.33 c/day fruit and 0.48 c/day vegetables. Both age groups reported consuming more than 50 g added sugar, exceeding the recommendation of 16 g. Overweight vs normal weight children reported significantly more sweetened beverage intake (8.0±0.10 vs 5.28±0.08 oz/day, P<0.01). On average, all children reported watching television 2.0 hours/day and significant differences were observed for total television viewing and nonviewing time between overweight and normal weight children (8.52±0.6 vs 6.54±0.6 hours/day, P<0.01). All children engaged in <20 minutes/day of moderate or vigorous activity.

Conclusions

Overall, children in this sample did not meet MyPyramid recommendations for fruits or vegetables and exceed added sugar intake recommendations. Television viewing time and time when the television was on in the home was highly prevalent along with low levels of moderate or vigorous activity. The Healthy Children Strong Families intervention we studied has potential for improving nutrition and physical activity among preschool-aged children living in rural American Indian communities.     

The Medicine Wheel Nutrition Intervention: A Diabetes Education Study with the Cheyenne River Sioux Tribe

Objective

The Northern Plains Indians of the Cheyenne River Sioux Tribe have experienced significant lifestyle and dietary changes over the past seven generations that have resulted in increased rates of diabetes and obesity. The objective of this study was to determine if Northern Plains Indians with type 2 diabetes mellitus who are randomized to receive culturally adapted educational lessons based on the Medicine Wheel Model for Nutrition in addition to their usual dietary education will have better control of their type 2 diabetes than a nonintervention, usual care group who received only the usual dietary education from their personal providers.

Design

A 6-month, randomized, controlled trial was conducted January 2005 through December 2005, with participants randomized to the education intervention or usual care control group. The education group received six nutrition lessons based on the Medicine Wheel Model for Nutrition. The usual care group received the usual dietary education from their personal providers.

Participants

One hundred fourteen Northern Plains Indians from Cheyenne River Sioux Tribe aged 18 to 65 years, with type 2 diabetes.

Methods

Weight, body mass index (BMI), hemoglobin A1c, fasting serum glucose and lipid parameters, circulating insulin, and blood pressure were measured at the beginning and completion. Diet histories, physical activity, and dietary satiety surveys were measured at baseline and monthly through completion. Differences were determined using Student t tests, χ² tests, and analysis of variance.

Results

The education group had a significant weight loss (1.4±0.4 kg, P≤0.05) and decrease in BMI (1.0±0.1, P≤0.05) from baseline to completion. The usual care group had no change in weight (0.5±0.5 kg) or BMI (0.5±0.2). There were no between group differences due to intervention in energy, carbohydrate, protein, and fat intake and physical activity.

Conclusions

The culturally based nutrition intervention promoted small but positive changes in weight. Greater frequency and longer duration of educational support may be needed to influence blood glucose and lipid parameters.     

Whole-Grain Ready-to-Eat Oat Cereal, as Part of a Dietary Program for Weight Loss, Reduces Low-Density Lipoprotein Cholesterol in Adults with Overweight and Obesity More than a Dietary Program Including Low-Fiber Control Foods

Objective

Weight loss and consumption of viscous fibers both lower low-density lipoprotein (LDL) cholesterol levels. We evaluated whether or not a whole-grain, ready-to-eat (RTE) oat cereal containing viscous fiber, as part of a dietary program for weight loss, lowers LDL cholesterol levels and improves other cardiovascular disease risk markers more than a dietary program alone.

Design

Randomized, parallel-arm, controlled trial.

Subjects/setting

Free-living, overweight and obese adults (N=204, body mass index 25 to 45) with baseline LDL cholesterol levels 130 to 200 mg/dL (3.4 to 5.2 mmol/L) were randomized; 144 were included in the main analysis of participants who completed the trial without significant protocol violations.

Intervention

Two portions per day of whole-grain RTE oat cereal (3 g/day oat b-glucan) or energy-matched low-fiber foods (control), as part of a reduced energy (∼500 kcal/day deficit) dietary program that encouraged limiting consumption of foods high in energy and fat, portion control, and regular physical activity.

Main outcome measures

Fasting lipoprotein levels, waist circumference, triceps skinfold thickness, and body weight were measured at baseline and weeks 4, 8, 10, and 12.

Results

LDL cholesterol level was reduced significantly more with whole-grain RTE oat cereal vs control (−8.7±1.0 vs −4.3±1.1%, P=0.005). Total cholesterol (−5.4±0.8 vs −2.9±0.9%, P=0.038) and non-high-density lipoprotein-cholesterol (−6.3±1.0 vs −3.3±1.1%, P=0.046) were also lowered significantly more with whole-grain RTE oat cereal, whereas high-density lipoprotein and triglyceride responses did not differ between groups. Weight loss was not different between groups (−2.2±0.3 vs −1.7±0.3 kg, P=0.325), but waist circumference decreased more (−3.3±0.4 vs −1.9±0.4 cm, P=0.012) with whole-grain RTE oat cereal. Larger reductions in LDL, total, and non-high-density lipoprotein cholesterol levels and waist circumference were evident as early as week 4 in the whole-grain RTE oat cereal group.

Conclusions

Consumption of a whole-grain RTE oat cereal as part of a dietary program for weight loss had favorable effects on fasting lipid levels and waist circumference.     

Health-At-Every-Size and Eating Behaviors: 1-Year Follow-Up Results of a Size Acceptance Intervention

Background

Poor long-term success observed with current weight-control strategies stresses the relevance to explore new weight management approaches.

Objective

To assess the effects of a Health-At-Every-Size (HAES) intervention on eating behaviors, appetite sensations, metabolic and anthropometric variables, and physical activity levels in women at 6-month and 1-year postintervention.

Design

Randomized controlled trial; measurements at baseline, at the end of the intervention period (4 months), and at 6-month and 1-year postintervention (10 months and 16 months, respectively). Intervention and testing took place from September 2003 to August 2006.

Participants/setting

Premenopausal overweight/obese women (n=144; mean age of 42.3±5.6 years), recruited from free-living, general community.

Intervention

Women were randomly assigned to: HAES group (n=48), social support group (n=48), or control group (n=48).

Main outcome measures

Eating behaviors (restraint, disinhibition, and susceptibility to hunger), appetite ratings (desire to eat, hunger, fullness, and prospective food consumption), anthropometric and metabolic variables (body mass index, waist and hip circumferences, blood lipid levels, and blood pressure), and engagement in moderate to intense physical activity (energy cost ≥1.2 kcal×kg⁻¹×15 minutes⁻¹ [≥4.8 metabolic equivalents]).

Statistical analyses performed

Changes for each dependent variable were assessed by linear mixed models according to a group (HAES vs social support vs control) by time (baseline vs 4 months vs 10 months vs 16 months) split-plot design.

Results

Situational susceptibility to disinhibition and susceptibility to hunger significantly decreased over time in both HAES group (−0.9±0.2 and −1.3±0.5, respectively) and the social support group (−0.4± 0.2 and −1.4±0.5, respectively). Although eating behavior scores observed at 16 months did not differ between HAES and social support groups (situational susceptibility to disinhibition: 2.5±0.2 in HAES group vs 2.7 ± 0.2 in social support group; susceptibility to hunger: 4.2±0.5 in both groups), they were lower in these groups than scores noted in the control group (3.3±0.2 for situational susceptibility to disinhibition and 5.9±0.5 for susceptibility to hunger).

Conclusions

These results suggest that, when compared to a control group, an HAES approach could have long-term beneficial effects on eating behaviors related to disinhibition and hunger. In addition, our study did not show distinctive effects of the HAES approach in comparison to a social support intervention.     

Development and Validation of a Comprehensive Semi-Quantitative Food Frequency Questionnaire that Includes FODMAP Intake and Glycemic Index

Background

Fermentable, short chain carbohydrates (FODMAPs) have been identified as triggers for functional gastrointestinal symptoms. In addition, excess FODMAP consumption has been implicated in the onset of Crohn's disease, and animal studies suggest that a low glycemic index diet can impair absorption of fructose, a major dietary FODMAP. Such hypotheses cannot be tested without the ability to quantify FODMAP ingestion with a validated dietary assessment tool.

Objective

To assess the validity and reproducibility of a 297-item comprehensive, semi-quantitative food frequency questionnaire (FFQ) in estimating intake of macro- and micronutrients, FODMAPs, and glycemic index/load.

Subjects/setting

One hundred healthy participants were recruited to complete the FFQ on two occasions, plus four 1-week food diaries kept during a 12-month period. Participants exhibiting major dietary change during the study period or low energy reporting on the FFQ were excluded.

Main outcome measures

Validation and reproducibility of the semi-quantitative FFQ by comparison with the mean of four 1-week food diaries.

Statistical analyses performed

Validation was assessed using Wilcoxon signed rank test, Spearman's correlation, Bland-Altman, and weighted κ statistics. Reproducibility was examined using Shrout-Fleiss intraclass correlation coefficient.

Results

Seventy-two participants fulfilled inclusion and exclusion criteria. Demographics of the participants were comparable with 2006 Australian Census data. Consistent with other reported FFQs, the FFQ overestimated nutrient intake by a mean 140% (range=95% to 249%). However, based on the other analyses performed, it demonstrated validity for intake of sugars, fiber, alcohol, glycemic index, glucose, FODMAPs, calcium, folate, phosphate, potassium, iron, and magnesium; moderate validation for energy, total fat, saturated fat, carbohydrates, sodium, thiamin, sucrose, and retinol; poor validation for protein, mono/polyunsaturated fat, starch, glycemic load, niacin, and zinc. Riboflavin intake was not validated. Intraclass correlation coefficients for reproducibility ranged from 0.352 to 0.928.

Conclusions

The FFQ was validated for assessment of a wide range of nutrients, including the new class of carbohydrates, FODMAPs, and glycemic index. This provides a useful tool for dietary research, particularly in the area of gastroenterological disorders.     

Validity and Calibration of Food Frequency Questionnaires Used with African-American Adults in the Jackson Heart Study

Objective

To examine the relative validity of two food frequency questionnaires (FFQs) developed for use in investigating diet and disease relationships within the adult African-American population in the southern United States.

Design

Cross-sectional analyses of dietary nutrient intake data, comparing four 24-hour dietary recalls with an FFQ developed by the Lower Mississippi Delta Nutrition Intervention Research Initiative, and its shorter version adapted for use in the Jackson Heart Study.

Subjects

A representative subset of participants (n=499, aged 35 to 81 years) from the baseline Jackson Heart Study cohort (N=5,302) was selected for this study. Data collection took place between winter 2000 and spring 2004.

Statistical analyses

Pearson's correlation coefficients (energy adjusted and de-attenuated) for 26 nutrients estimates from each of the FFQs, comparing them with the mean of four 24-hour dietary recalls. The ability of the FFQs to rank individuals based on nutrient intakes was compared to that of the mean of four 24-hour dietary recalls and attenuation coefficients were also calculated.

Results

Median nutrient intake estimates tended to be higher on the long and lower on the short FFQ compared to the median for the mean of four 24-hour dietary recalls. Energy adjusted and deattenuated correlations of FFQ intake estimates with recalls ranged from 0.20 for sodium to 0.70 for carbohydrate for the short FFQ and from 0.23 for polyunsaturated fat to 0.75 for dietary fiber and magnesium for the long. Attenuation coefficients for men on average were 0.42 for the short and 0.49 for the long FFQ. For women, these were 0.31 for the short and 0.42 for the long FFQ.

Conclusions

Both FFQs appear to be reasonably valid for assessment of dietary intake of adult African Americans in the South. The Lower Mississippi Delta Nutrition Intervention Research Initiative FFQ exhibited higher intake estimates and stronger correlations with recalls than the Jackson Heart Study FFQ for most nutrients analyzed, more so for women than men.     

A 24-h recall does not provide a valid estimate of absolute nutrient intakes for rural women in southern Ethiopia

Objective

To investigate the relative validity of a multiple-pass interactive 24-h recall (24-HR) for assessing nutrient intakes of a group of rural Ethiopian women.

Methods

Dietary intakes from a 24-HR were compared with weighed record (WR) intakes collected on the same day for 58 women of child-bearing age from three subsistence farming communities in Sidama. The impact of memory lapses, use of average recipe data, and inaccurate portion size estimates on 24-HR intakes was also assessed.

Results

Median daily intakes of energy and most nutrients (except fat and phytate) were lower (P < 0.05) by the 24-HR versus the WR. Controlling for energy densities decreased the discrepancies to lower than ±6%, except for vitamin C. No significant differences between the two methods existed for the contribution of six food groups to energy intakes (percentages). Fewer than 40% of 24-HR intakes were ±10% of the WR. After classifying intakes (per day) into quartiles, Cohen’s κ values were poor (<4.0) for protein, iron, retinol, and dietary fiber and fair (≥0.40 to ≤0.75) for energy and other nutrients; all values per megajoule were mostly fair. Bland-Altman plots confirmed a negative bias for daily energy and nutrient intakes with the 24-HR versus WRs. Discrepancies were attributed mainly to inaccurate portion size estimates.

Conclusion

In this setting, the 24-HR cannot be substituted for the WR to assess absolute nutrient intakes for a group or the prevalence of inadequate intakes but could be used for energy-adjusted intakes. Prior training may improve the accuracy of the 24-HR.     

Markers for the Validation of Reported Dietary Intake in Adults with Cystic Fibrosis

Objective

To identify different markers in order to validate the assessment of dietary intake in adults with cystic fibrosis (CF).

Design

Cross-sectional survey.

Setting

Tertiary care.

Subjects

We assessed 37 adults with CF whose nutritional and respiratory condition was stable and 37 healthy adults, matched for age, sex, and nutritional status.

Interventions

A consecutive, 7-day, prospective dietary survey was given to all the participants. Anthropometric variables were measured and a fasting blood sample was drawn to measure the composition of the serum phospholipid fatty acids by gas chromatography. We also measured fecal fat and nitrogen at 72 hours and 24-hour urine nitrogen.

Results

The ratio of energy intake to basal metabolic rate expenditure was significantly greater in the patients (2.1±0.4) than the controls (1.79±0.4) and the percentage of patients with the ratio of energy intake to basal metabolic rate lower than 1.55 was 24% in the controls (n=9) vs 8% in the patients (n=3). Fecal nitrogen correlated significantly with total energy and the intake of carbohydrates, lipids, and proteins. In the patients, total dietary energy and fat and protein intake correlated positively with fecal fat. The protein and fat intake and fecal nitrogen and fat correlated significantly with urine nitrogen. In the controls, significant correlations were seen between different parameters of intake and the percentage of certain serum phospholipid fatty acids. These correlations in the patients were either absent or less marked.

Conclusions

Use in persons with CF of the energy intake to basal metabolic rate ratio, measurement of fecal fat and nitrogen at 72 hours and of urine nitrogen may be useful to validate dietary surveys. The serum phospholipid fatty acid profile, however, may be less useful for this purpose in these patients.     

Higher Healthy Eating Index-2005 Scores Associated with Reduced Symptoms of Depression in an Urban Population: Findings from the Healthy Aging in Neighborhoods of Diversity Across the Life Span (HANDLS) Study

Background

Depression affects more than 15 million Americans in a given year. Compared to physical health, less is known about the affect of diet quality on symptoms of depression.

Objective

This study investigated the relationship between diet quality and reported symptoms of depression in a low-income urban population.

Subjects/setting

Subjects included 1,118 African-American and white adults, aged 30 to 64 years, living in Baltimore, MD, and represented a subsample of the initial examination and recruitment phase of the Healthy Aging in Neighborhoods of Diversity across the Life Span study.

Methods

Nutrition data were based on two 24-hour dietary recalls collected by trained interviewers using the US Department of Agriculture Automated Multiple Pass Method. Diet quality was calculated using the US Department of Agriculture Healthy Eating Index (HEI)-2005. Depressive symptoms were assessed by a trained interviewer using the Center for Epidemiologic Studies Depression scale.

Statistical analysis

Both linear and logistic regression analyses were used to examine whether or not diet quality was associated with depressive symptoms. The dependent variable was depressive symptoms and independent variables included HEI-2005, race, sex, age, education, income, and food-assistance program participation.

Results

Mean HEI-2005 score was 52.17±0.40 (out of 100). Mean Center for Epidemiologic Studies Depression scale score was 11.64±0.25 (out of 40). Diet quality was significantly associated with reported symptoms of depression. However, income was a significantly stronger predictor of depression compared to diet quality, education, and sex.

Conclusions

Registered dietitians should be aware of relationships between psychological status and nutritional health when assisting clients to better manage their food choices to improve their overall health and quality of life.     

Associations between Lifestyle Patterns and Body Mass Index in a Sample of Greek Children and Adolescents

Background

Although eating and physical activity behaviors have been previously individually investigated with regard to overweight in children, multidimensional lifestyle patterns, based on these behaviors, have not been explored.

Objective

To assess lifestyle patterns in relation to body mass index (BMI), in a nationally representative sample of the Greek pediatric population

Design

Cross-sectional study. Data were collected from May through July 2007.

Subjects

The sample consisted of 1,305 children and adolescents (ages 3 to 18 years).

Main outcome measures

Information on participants' dietary intake, eating behaviors, physical activity habits, and BMI were collected. Adherence to the Mediterranean diet guidelines was evaluated using the KIDMED Mediterranean diet quality index; the higher the score in this index the more favorable the dietary pattern. The Goldberg cut-off limits for the ratio of energy intake/basal metabolic rate were used to evaluate dietary low energy reporting and participants were accordingly classified as low-energy reporters.

Statistical analysis

Principal component analysis was performed to identify participants' lifestyle patterns. Associations between BMI and lifestyle patterns were further evaluated using multiple linear regression analyses, after controlling for potential confounders.

Results

Principal component analysis identified seven lifestyle patterns explaining 85% of the total variance of lifestyle habits. A lifestyle pattern characterized by higher eating frequency, breakfast consumption and higher KIDMED score was negatively associated with BMI (standardized β=−.125, P<0.001), after controlling for age, sex, and parental education. The association remained significant even when low-energy reporters were excluded from the analysis.

Conclusions

Results from the study suggest a potential intercorrelation and protective action of selected eating behaviors, namely eating frequency, breakfast consumption, and adherence to the Mediterranean diet, against overweight and obesity in children and adolescents.     

Brief Telephone Intervention Increases Soy Intake in Peri- and Postmenopausal US Women: The Herbal Alternatives Trial (HALT)

Objective

Effective dietary intervention strategies that can be widely disseminated and have the potential for sustainable dietary modifications are needed. The purpose of this study was to describe and evaluate the effectiveness of a telephone-based soy intervention.

Design

A randomized controlled trial comparing self-reported intake and serum measures of soy during a 1-year dietary soy (Soy) to fruit and vegetable (Placebo) intervention conducted in two of five arms from the Herbal Alternatives Trial between May 2001 and September 2004.

Subjects/setting

One hundred sixty-three peri- and postmenopausal women (mean age=52 years) consuming self-selected diets in the Pacific Northwest, United States.

Intervention

Five telephone contacts with a registered dietitian during a 12-month intervention with the goal to increase soy food consumption to two servings daily.

Main outcome measures

Change from baseline in self-reported soy servings and serum isoflavone (daidzein and genistein) concentrations were estimated using analysis of variance and generalized estimating equations. Proportions of participants achieving the intervention goal were compared using χ² tests.

Results

Ninety-four percent (n=74) of participants in the Soy arm and 89% (n=75) in the Placebo arm completed the trial, and slightly more than one third (n=27) received five phone contacts. Mean (±standard deviation) intakes of soy were similar for the Soy and Placebo arms at baseline (0.6±1.0 vs 0.4±0.8 servings/day; P>0.05). At 12-month follow-up visit, mean±standard deviation servings of soy per day were 1.6±1.4 for the Soy intervention compared to 0.5±0.9 within the Placebo arm (P<0.001). There were concomitant increases in serum isoflavones at 3 and 6 months from baseline in the Soy arm only, with approximately twofold increases in both daidzein (mean=66.4 nmol/L, 95% confidence interval [CI]: 39.0 to 93.9 [mean 16.9 ng/mL, 95% CI: 9.9 to 23.8]) and genistein (mean=100.4 nmol/L, 95% CI: 60.9 to 139.9 [mean 27.1 ng/mL, 95% CI: 16.5 to 37.8]) concentrations. Mean weight changed by <1 kg during the 12-month period in each group and physical activity remained stable, suggesting that participants incorporated soy foods into their diet by substituting for nonsoy foods rather than adding them to their diet.

Conclusions

A brief telephone-based intervention with a focused message delivered by a registered dietitian is a feasible approach for encouraging targeted dietary changes, such as an increase in soy intake among peri- and postmenopausal women.     

Resemblance in Dietary Intakes between Urban Low-Income African-American Adolescents and Their Mothers: The Healthy Eating and Active Lifestyles from School to Home for Kids Study

Objectives

To examine the association and predictors of dietary intake resemblance between urban low-income African-American adolescents and their mothers.

Methods

Detailed dietary data collected from 121 child-parent pairs in Chicago during fall 2003 were used. The association was assessed using correlation coefficients, kappa, and percentage of agreement, as well as logistic regression models.

Results

Overall, the association was weak as indicated by correlations and other measures. None of the mother-son correlations for nutrients and food groups were greater than 0.20. Mother-daughter pairs had stronger correlations (0.26 for energy and 0.30 for fat). The association was stronger in normal-weight mothers than in mothers with overweight or obesity. Logistic models showed that mother being a current smoker, giving child more pocket money, and allowing child to eat or purchase snacks without parental permission or presence predicted a higher probability of resemblance in undesirable eating patterns, such as high-energy, high-fat, and high-snack intakes (P<0.05).

Conclusions

Mother-child diet association was generally weak, and varied considerably across groups and intake variables in this homogenous population. Some maternal characteristics seem to affect the association.     

Dietary calcium intake and its relationship with adiposity and metabolic profile in hypertensive patients

Objective

An inverse relation between dietary calcium and adiposity has been found in several epidemiologic studies. Recent evidence has also suggested that a calcium-rich diet may have beneficial effects on insulin resistance and dyslipidemia. This study aimed to evaluate the association of dietary calcium intake with global adiposity, abdominal obesity, and metabolic profile in hypertensive patients.

Methods

In this cross-sectional study, 85 hypertensive patients 25 to 70 y old underwent clinical, dietary, anthropometric, and biochemical evaluations. Participants were stratified into the following two groups according to their usual dietary calcium intake: low calcium group (<800 mg/d) and high calcium group (≥800 mg/d).

Results

Fifty-seven participants (11 men and 46 women) were included in the final analyses. Subjects in the low calcium group compared with those in the high calcium group exhibited significantly higher levels of body mass index and percentage of body fat after adjustments for variables that could interfere with those adiposity parameters (P = 0.03 and 0.01, respectively). Patients in the high calcium group had a lower odds ratio for prevalent obesity than those in the low calcium group, even after controlling for potential confounders (P = 0.01). No significant differences were found in abdominal adiposity and metabolic profile between the two groups. Using data from all patients, an inverse and significant association was observed between dietary calcium intake and percentage of body fat, and it remained after controlling for confounders (P = 0.03).

Conclusions

The findings of the present study suggest that, in hypertensive patients, higher dietary calcium intake could be associated with lower global adiposity.     

Fourth Graders' Reports of Fruit and Vegetable Intake at School Lunch: Does Treatment Assignment Affect Accuracy?

Objective

Dietary interventions with children often use self-reported data to assess efficacy despite that objective methods rarely support self-report findings in validation studies. This study compared fourth graders' self-reported to observed lunch fruit and vegetable intake to determine if the accuracy of self-reported intake varied by treatment condition.

Design

Matched randomized follow-up design examined three treatment groups (high and low intensity interventions and control) post-intervention.

Subjects/setting

Three hundred seventy-nine middle-school children participating in a randomized controlled trial of a school-based fruit and vegetable intervention were observed during school lunch one day and asked to recall intake the following day.

Main outcome measures

Food items were coded as: “match,” “omission,” or “intrusion.” Students were classified as accurate if all food items matched, otherwise inaccurate. Matched foods' portions were compared for accuracy. Servings were computed for total fruit and vegetable intake.

Analyses

Accuracy for fruits and vegetables were compared in separate analyses and tested for multiple potential associates: treatment condition, sex, race, body mass index, subsidized meal eligibility, school district, fruit/vegetable availability, age, and test scores. Fitted multivariable regression models included variables found to be significant in univariate or χ² analyses.

Results

Variables found to be significant for fruit item accuracy were availability at lunch, body mass index, and subsidized lunch eligibility. For vegetable item accuracy, availability at lunch was significant. No differences were found for food portions or for efficacy of the intervention between the two methods of dietary data collection: observation and self-report.

Conclusions

Condition assignment did not bias recalled fruit and vegetable intakes among fourth graders.