The scientific basis of recent US guidance on sugars intake

Most fruits and dairy products are high in sugars, and thus naturally occurring sugars are consumed as part of a healthy diet. Sugars are also added to foods during processing or preparation, primarily to enhance taste. Monosaccharides and disaccharides added to foods are chemically indistinguishable from naturally occurring forms. However, concern has been expressed about the apparent increasing consumption of added sugars and their possible role in displacing or diluting nutrients in the diet and contributing to the epidemic of obesity in developed countries. One of the 2000 Dietary Guidelines for Americans states, "Choose beverages and foods to moderate your intake of sugars." The Dietary Guidelines Advisory Committee discussed whether to specify added sugars rather than the broader term sugars but decided that it was not possible to conclude that added sugars per se play a negative role in the public's health. The Dietary Guidelines Advisory Committee issued a call for more definitive studies of the role of sugars in current diets and the potential effect of a reduction in added sugars on both dietary quality and energy intake. The American Heart Association recently released a statement advising consumers to limit sugars consumption. The macronutrient report for the dietary reference intakes addresses many of these same issues; the expert panel concluded that it was not appropriate to set a tolerable upper intake level for added sugars but suggested a maximal intake level of 25% of energy from added sugars because of concerns about reduced intakes of essential micronutrients.     

Diet, prevalence and 10-year mortality from coronary heart disease in 871 middle-aged men. The Zutphen Study

The Zutphen Study is a longitudinal investigation among middle-aged men of relationships between diet, other risk characteristics, and coronary heart disease (CHD). In 1960, dietary data were collected by the cross-check dietary history method. CHD mortality data were collected during 10 years of follow-up. The 14 men with CHD at baseline consumed 524 kcal/day less than the 857 CHD-free men. During 10 years of follow-up, 30 men who were initially free of CHD died from CHD. Those men consumed 273 kcal/day less than men who did not die from CHD. The inverse relationship between energy intake and CHD became stronger when energy intake was expressed per kg of body weight. Dietary cholesterol per 1000 kcal was significantly positively related to CHD, while vegetable protein, polysaccharides, and dietary fiber were significantly inversely related to CHD. These relationships were no longer statistically significant when energy intake per kg of body weight was added to the logistic model. The inverse relationship between energy intake per kg of body weight and CHD became insignificant when subscapular skinfold and serum cholesterol were added to the logistic model. It is concluded that the influence of energy intake per kg of body weight on CHD is mediated through other risk characteristics: subscapular skinfold and serum cholesterol.     

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.     

Consumption of a dehydrated ration for 31 days at moderate altitudes: energy intakes and physical performance

Energy intake, body weight, maximal work capacity, and measures of muscle strength and endurance were obtained from eight men who consumed a high-carbohydrate (CHO) dehydrated ration during a 31-day period of high activity at moderate altitudes. Data were collected 2 months before exposure to moderate altitudes (PRE), multiple times during the month's expedition at moderate altitudes (ALT), and after return from the expedition (RET). Work capacity per kilogram of body weight increased significantly from the PRE phase to the ALT phase. Mean energy intake averaged 2,354 +/- 71, 3,430 +/- 79, and 3,384 +/- 117 kcal/day during PRE, ALT, and RET, respectively; mean CHO intake during ALT was 595 +/- 13 g/day. Mean weight loss and reduction in body fat were significant: 1.9 +/- 0.9 kg and 18.9 +/- 10.1%, respectively. Energy deficits calculated from changes in body weight and composition during ALT ranged from 473 to 963 kcal/day, whereas the energy deficit estimated from the Harris-Benedict equation was only 194 kcal/day. The rigorous physical activity and exposure to moderate altitudes necessitated a high energy intake, approximating 3,800 kcal/day. The results indicate that physical performance and nutritional status are maintained when a high-CHO diet, consisting primarily of commercially available dehydrated foods, is consumed over a 31-day period of rigorous activity. However, weight loss and gastrointestinal distress were noted. These events might be minimized when a dehydrated ration is consumed, if dietary fat is substituted for some of the CHO.     

Dietary energy density is associated with energy intake and weight status in US adults

BACKGROUND: Laboratory-based investigations indicate that the consumption of foods with a low energy density (kcal/g) decreases energy intake. Although low-energy-dense diets are recommended for weight management, relations between energy density, energy intake, and weight status have not been clearly shown in free-living persons. OBJECTIVES: A representative US sample was used to determine whether dietary energy density is associated with energy intake, the weight of food consumed, and body weight and to explore the influence of food choices (fruit, vegetable, and fat consumption) on energy density and body weight. DESIGN: A cross-sectional survey of adults (n = 7356) from the 1994-1996 Continuing Survey of Food Intakes by Individuals and two 24-h dietary recalls were used. RESULTS: Men and women with a low-energy-dense diet had lower energy intakes (approximately 425 and 275 kcal/d less, respectively) than did those with a high-energy-dense diet, even though they consumed more food (approximately 400 and 300 g/d more, respectively). Normal-weight persons had diets with a lower energy density than did obese persons. Persons with a high fruit and vegetable intake had the lowest energy density values and the lowest obesity prevalence. CONCLUSIONS: Adults consuming a low-energy-dense diet are likely to consume more food (by weight) but to have a lower energy intake than do those consuming a higher-energy-dense diet. The energy density of a variety of dietary patterns, including higher-fat diets, can be lowered by adding fruit and vegetables. Our findings support the hypothesis that a relation exists between the consumption of an energy-dense diet and obesity and provide evidence of the importance of fruit and vegetable consumption for weight management.     

Effects of energy or protein restriction on weight and composition of diabetic and control rats

Adult (170 ± 1 g) male Sprague-Dawley diabetic (50 mg/kg of streptozotocin) and control rats were fed for 21 days a diet with adequate protein (28%) at three restricted levels of intake (34, 45 or 57 kcal/day), or were fed at a single level of intake (ad libitum) diets containing different percentages of protein (2.25, 5.5 and 11.1). When dietary protein was adequate (28%), but energy intake was severely restricted (34 kcal/day), diabetic and control rats lost 80 ± 5 and 100 ± 6 g/kg ^0.75 in body weight, respectively. Diabetic and control rats lost 110 ± 4 and 139 ± 7 g/kg ^0.75 in body weight, respectively, when energy was unrestricted and dietary protein was at a submaintenance level (2.25%). Body weight of diabetic and control rats did not differ when dietary protein was adequate (28%) and energy intake was moderately restricted (45 kcal/day) or when energy intake was unrestricted and dietary protein was at a maintenance level (5.5%). This study showed that diabetic rats fared as well as or better than their control counterparts when the intake of either energy or protein was moderately or severely restricted.     

Adequacy of the diet outside the home for a cohort of young male soldiers in France

A food consumption survey with weighed dietary record was undertaken for 3 consecutive days, in February and in June in two dining rooms of French land forces in Strasbourg and near Bordeaux, with 172 and 565 persons, respectively. Recommended daily allowances (RDAs) are covered on average for energy, protein, phosphorus and iron; however, calcium and magnesium intakes do not satisfy the RDAs. Food consumption of French land forces is similar to that of the whole population: contribution of energy from fat and especialy saturated fatty acids and sugars is high while the intake of complex carbohydrates and dietary fibre is low. Estimates of energy daily intakes from the corps budget nutritional survey, based on monthly accountancy data of foods consumed in the dining rooms are on average 34 ± 5% higher compared to the weighed dietary record survey.     

Frequency of Sweet and Salty Snack Food Consumption Is Associated with Higher Intakes of Overconsumed Nutrients and Weight-For-Length z Scores During Infancy and Toddlerhood

BackgroundCurrent dietary guidelines recommend avoiding foods and beverages with added sugars and higher sodium before age 2 years.ObjectiveThe aim was to describe daily snack food intake (frequency and total energy) and the associations with overconsumed nutrients (added sugars, sodium, and saturated fats) and child weight-for-length z scores.DesignA cross-sectional, secondary analysis of baseline data from an ongoing longitudinal intervention was conducted.Participants and settingA sample of 141 caregivers with infants (aged 9 to 11 months) and toddlers (aged 12 to 15 months) was recruited in Buffalo, NY, between 2017 and 2019.Main outcome measuresThree 24-hour dietary recalls were used to categorize 'sweet and salty snack foods' or 'commercial baby snack foods' based on the US Department of Agriculture What We Eat in America food group classifications and estimate nutrient intakes. Child recumbent length and weight were measured by trained researchers.Statistical analysisDaily frequency (times/day), energy (kcal/day), and overconsumed nutrients from snack food intake were calculated. Multivariable regression models examined associations between the frequency of and energy from snack food intake with overconsumed nutrients and child weight-for-length z scores.ResultsInfants consumed snack foods on average 1.2 times/day contributing 5.6% of total daily energy, 19.6% of added sugars, and 6.8% of sodium. Toddlers consumed snack foods on average 1.4 times/day contributing 8.9% of total daily energy, 40.0% of added sugars, and 7.2% of sodium. In adjusted models including all children, greater frequency of sweet and salty snack food intake, but not commercial baby snack foods, was associated with higher weight-for-length z scores.ConclusionsSnack foods are frequently consumed by infants and toddlers and contribute to the intake of overconsumed nutrients such as added sugars and sodium. Given the current guidelines to avoid added sugars and higher sodium before age 2 years, additional recommendations related to nutrient-dense snack intake may be beneficial.     

Energy and macronutrient intake in lean and obese middle-aged men (the Zutphen study)

Relationships between dietary variables and indicators of body fatness were examined in a cohort of 871 middle-aged men in Zutphen, The Netherlands. Men in the highest quartile of the sum of two skinfolds or the Quetelet index distribution consumed on average 300 to 400 kcal less than men in the lowest quartile. Univariate analyses showed that the lower intake of the men in the highest quartiles was occasioned by a lower intake of almost all the macronutrients except alcohol. Multivariate analyses confirmed the inverse relationship between energy intake per kg body weight and indicators for body fatness, and the positive relationship between alcohol and these indicators. It is concluded that obese middle-aged men have a lower energy intake but a higher alcohol intake than their lean counterparts.     

The effects of dieting on food and nutrient intake of lactating women

The purpose of this report was to identify and evaluate dietary changes in women who were participating in a study on the effects of weight loss in overweight lactating women on the growth of their infants. Women were randomly assigned at 4 weeks postpartum to either restrict energy intake by 500 kcal/day (diet and exercise group) or to maintain usual dietary intake (control group) for 10 weeks. The diet and exercise group significantly decreased fats, sweetened drinks, sweets and desserts, snack foods, and energy intake. Micronutrient intake decreased in the diet and exercise group; however, mean intakes were not significantly different from those of the control group except for calcium and vitamin D. Both groups consumed less than 76% of the Recommended Dietary Allowance for vitamins E and C at the end of the study. Mean intake of all other nutrients was adequate in both groups. These results suggest that overweight lactating women can restrict their energy intake by 500 kcal per day by decreasing consumption of foods high in fat and simple sugars. However, they must be advised to increase their intakes of foods high in calcium and vitamin D. Increased intake of fruits and vegetables should also be recommended to all lactating women, as well as multivitamin and calcium supplements to those who do not consume adequate amounts of these foods.     

Associations between added sugars and micronutrient intakes and status: further analysis of data from the National Diet and Nutrition Survey of Young People aged 4 to 18 years

Added sugars are often viewed as 'empty calories', negatively impacting micronutrient intakes, yet reviews consider the evidence inconclusive. This study aimed to quantify associations between dietary added sugars (as a percentage of energy) and micronutrient intake and biochemical status in the National Diet and Nutrition Survey. Using data from 1688 British children aged 4-18 years who completed 7 d weighed dietary records in 1997, micronutrient intakes were examined across quintiles of added sugars. After excluding low energy reporters, mean dietary intakes of most nutrients exceeded the reference nutrient intake, except for zinc. Compared with quintile 1 (9% added sugars), high consumers in quintile 5 (23% added sugars) had micronutrient intakes ranging from 24% lower to 6% higher (mean 14% lower). Zinc intakes in quintile 1 v. quintile 5 averaged 93% v. 78% of reference nutrient intake; magnesium 114% v. 94%; iron 115% v. 100%; and vitamin A 111% v. 92%, respectively. Plasma levels of magnesium, zinc and carotenoids did not vary across quintiles, but weak negative correlations were observed with serum ferritin and transferrin saturation. Plasma selenium was inversely correlated with added sugars (r -0.17; P < 0.0001) but there was no association with glutathione peroxidase. The impact of added sugars on micronutrient intakes appears modest overall but may have relevance for children consuming inadequate amounts of nutrient-rich foods coupled with a diet high in added sugars (approximately 23%). Further work is needed to explore the impact of different sources of added sugars and to refine assessments of inadequate intakes and status.     

Correlates of Dietary Energy Sources with Cardiovascular Disease Risk Markers in Mexican School-Age Children

Dietary and lifestyle changes in Mexico have been linked to an increase in chronic diseases such as obesity and cardiovascular disease. Important dietary changes such as an increase in the consumption of energy-dense foods (high in oils, animal or processed fats, and sugars) have been recently reported. The objective of this study was to identify how key dietary energy sources correlated with other indexes of cardiovascular disease in a Mexican school-age population. From 2004 to 2006, a convenience sample (n=228) of 9- to 13-year-olds, 48.2% girls and 51.8% boys, from three public urban schools were included. Anthropometric, blood pressure, and dietary assessment (two multiple pass 24-hour recalls) were done. More than half of children did not meet the fruit and vegetable recommended intake. High-fat dairy foods (14% of total energy intake), refined carbohydrates (13.5%), red/processed meat (8.5%), added sugars/desserts (7%), corn tortilla (6.5%), and soft drinks/sweetened beverages (5%) were the highest dietary energy sources consumed. In a subgroup of children (n=185), a fasting blood sample was collected for biochemical analysis. A positive association was observed between glucose and diastolic blood pressure with the intake of soft drinks/sweetened beverages, insulin concentrations and the intake of white bread, and triglyceride concentrations with the intake of added fats. Unhealthful dietary energy sources are frequently consumed by these children. Culturally competent nutrition counseling should be offered to Mexican-American children and their families with a significant risk of cardiovascular disease. Efforts should be made to design and implement nutrition education and health promotion strategies in schools.     

Low Calorie Beverage Consumption Is Associated with Energy and Nutrient Intakes and Diet Quality in British Adults

It is unclear whether consumption of low-calorie beverages (LCB) leads to compensatory consumption of sweet foods, thus reducing benefits for weight control or diet quality. This analysis investigated associations between beverage consumption and energy intake and diet quality of adults in the UK National Diet and Nutrition Survey (NDNS) (2008–2011; n = 1590), classified into: (a) non-consumers of soft drinks (NC); (b) LCB consumers; (c) sugar-sweetened beverage (SSB) consumers; or (d) consumers of both beverages (BB), based on 4-day dietary records. Within-person data on beverage consumption on different days assessed the impact on energy intake. LCB consumers and NC consumed less energy and non-milk extrinsic sugars than other groups. Micronutrient intakes and food choices suggested higher dietary quality in NC/LCB consumers compared with SSB/BB consumers. Within individuals on different days, consumption of SSB, milk, juice, and alcohol were all associated with increased energy intake, while LCB and tea, coffee or water were associated with no change; or reduced energy intake when substituted for caloric beverages. Results indicate that NC and LCB consumers tend to have higher quality diets compared with SSB or BB consumers and do not compensate for sugar or energy deficits by consuming more sugary foods.     

Defining and interpreting intakes of sugars

This paper clarifies the myriad of terminologies used to describe intakes of sugars by American consumers. In addition, it carefully critiques information sources used to explain and interpret consumption levels. Sugars are incorporated into foods for their biological, sensory, physical, and chemical properties. By chemical definition, the sugars normally consumed are the monosaccharides and disaccharides: glucose, fructose, galactose, sucrose, lactose, maltose, and trehalose. US governmental agencies use 4 terms to describe sugars: added sugars, caloric sweeteners, sugar, and sugars. Different sources are included when measuring sugars. Knowledge regarding intakes of sugars relies on food intake surveys (primarily dietary recalls) and economic food availability estimates. Although intake data may underestimate actual consumption, availability data tend to overestimate it. Furthermore, the sugars contents of many foods appearing in composition databases are derived from the summation of recipe ingredients rather than from actual measurements. Intakes of sugars over time (trends) must be viewed within the context of varying definitions, changes in food composition, changes in dietary intake methods, and acknowledged increases in the underreporting of intake. Agreement is needed to identify one common definition to describe intakes of sugars. Convergence between intake data and economic availability data would more accurately depict consumption. Precise amounts of sugars within currently available foods should be measured, not calculated. Without a common language, accurate and precise measurements, and consensus among scientists, educators, regulatory agencies, and the public, conversations regarding any health effects of sugars may lead to continued misunderstandings.     

Delay discounting and intake of ready-to-eat and away-from-home foods in overweight and obese women

A shift from home-prepared to away-from-home and ready-to-eat foods has occurred in recent decades, which has implications for obesity and health. This study tested whether delay discounting, a facet of impulsivity reflecting sensitivity to immediate reward, is associated with the frequency of consumption and typical amount consumed of home-prepared, away-from-home, and ready-to-eat foods among overweight and obese women. Seventy-eight participants completed a binary choice task assessing discounting of delayed monetary rewards. Nutrient analysis of weighed food records characterized dietary intake over seven consecutive days. Foods were categorized as home-prepared, away-from-home, or ready-to-eat by a registered dietitian from information provided by participants. Delay discounting was not associated with the frequency of consuming home-prepared, away-from-home, and ready-to-eat foods as reflected in the percentages of recorded foods or total energy intake from each category. However, once consuming away-from-home and ready-to-eat foods (but not home-prepared foods), impulsive women consumed more energy than less impulsive women. Exploratory analyses indicated that more impulsive women chose away-from-home foods with a higher energy density (kcal/g). Impulsivity was associated with the quantity of away-from-home and ready-to-eat foods consumed, but not the frequency of their consumption. Home food preparation may be critical to weight control for impulsive individuals.     

Energy density at a buffet-style lunch differs for adolescents born at high and low risk of obesity

The energy density (ED; kcal/g) of foods, when manipulated in the laboratory, affects short-term energy intake. The aim of this study was to examine if, when given a choice, dietary ED (foods only) and energy intake (expressed as a percentage of subjects' estimated daily energy requirement; EER) at a self-selected, single meal differ for teens born with a different familial predisposition to obesity and as a function of their sex. Subjects (13 males, 17 females) were 12 years of age and born at high risk (HR; n = 15) or low risk (LR; n = 15) for obesity based on maternal pre-pregnancy body mass index (BMI; kg/m²). The buffet meal, served for lunch and consumed ad libitum, consisted of a variety of foods and beverages with a range in ED. HR subjects consumed a more energy-dense meal (foods only) than LR subjects (1.84 vs. 1.42 kcal/g; P = 0.02) and males consumed a more energy-dense meal than females (1.83 vs. 1.43 kcal/g; P = 0.03). Total energy intake, when expressed as a percentage of subjects' daily EER, did not differ between HR and LR subjects (42% vs. 33%; P = 0.16). Males, compared to females, consumed ~ 59% more energy from foods and beverages during the meal (46 vs. 29%; P = 0.008). During a single multi-item lunch meal, teens with a familial predisposition to obesity and males, independent of their obesity risk status, self-selected a more energy-dense meal. Familial risk for obesity, through either genetic or environmental pathways, may facilitate a more energy-dense diet.     

Associations between Consumption of Ultra-Processed Foods and Intake of Nutrients Related to Chronic Non-Communicable Diseases in Mexico

BackgroundUltra-processed foods are highly palatable and can be consumed anywhere at any time, but typically have a poor nutritional profile. Therefore, their contribution to total energy intake has been proposed as an indicator for studying overall dietary quality.ObjectiveThe aim of this study was to investigate the associations between the energy contribution from ultra-processed foods and the intake of nutrients related to chronic non-communicable diseases in Mexico.DesignThis study used a secondary analysis of cross-sectional data from the 2012 Mexican National Health and Nutrition Survey.Participants/settingThis study included participants aged 1 year and older (n=10,087) who had completed a 1-day 24-hour recall.Main outcome measuresIntake from added sugar (% kcal), total fat (% kcal), saturated fat (% kcal), protein (% kcal), dietary fiber (g/1,000 kcal), and dietary energy density (kcal/g) were measured.Statistical analysisMultiple linear regression models adjusted for sociodemographic variables were fitted to assess the association between quintiles of energy contribution from ultra-processed foods and nutrient intake.ResultsMean reported energy contribution from ultra-processed foods to the Mexican population’s diet ranged from 4.5% kcal in quintile 1 (Q1) to 64.2% kcal in quintile 5 (Q5). An increased energy contribution from ultra-processed foods was positively associated with intake from added sugar (Q1: 7.4% kcal; Q5: 17.5% kcal), total fat (Q1: 30.6% kcal; Q5: 33.5% kcal) and saturated fat (Q1: 9.3% kcal; Q5: 13.2% kcal), as well as dietary energy density (Q1: 1.4 kcal/g; Q5: 2.0 kcal/g) (P≤0.001); and inversely associated with intake from protein (Q1: 15.1% kcal; Q5: 11.9% kcal) and dietary fiber (Q1: 16.0 g/1,000 kcal; Q5: 8.4 g/1,000 kcal) (P≤0.001).ConclusionsIn the Mexican population, an increased energy contribution from ultra-processed foods was associated with a lower dietary quality with regard to intake of nutrients related to chronic non-communicable diseases. Future research is needed to identify barriers to eating a variety of unprocessed and minimally processed foods for the Mexican population, as well as effective public health strategies and policies to overcome these barriers.     

Adult dietary characteristics affecting iron intake: a comparison based on iron density

Food frequency information from 762 Utahns, aged 24 to 80 years, selected from the general population using a random digit dialing technique was studied to determine the characteristics of diets that provide 18 mg iron/2,000 kcal, the Recommended Dietary Allowances (RDAs) of iron and energy for women aged 23 to 50 years. The diets were divided into three categories according to iron per 1,000 kcal: category 1, 9.0 mg or more iron; category 2, 6.0 to 8.99 mg iron; and category 3, 5.99 mg or less iron. Twenty-seven percent of the women and 16% of the men reported consuming diets containing more than 9 mg iron/1,000 kcal. Six percent of the women consumed 18 mg iron daily. Total energy intake decreased dramatically as iron density increased, as did intake of protein, carbohydrate, and fat. However, the percentage of energy consumed as protein and carbohydrate increased in the high-iron density categories. Individuals in the high-iron density categories consumed greater proportions of their iron and energy from vegetable, fruit, and cereal products; those in the low-iron density category consumed more pastries, beverages, sweets, and added fats, i.e., high-calorie foods. When fortified breakfast cereals were removed from the diets, only 14% of the women and 6% of the men consumed diets that provided at least 9 mg iron per 1,000 kcal. Women can meet the RDA for iron from their diets if they consume the recommended amount of energy distributed across food groups as follows: cereals, 14% to 16%; vegetables, at least 11%; meat, fish, poultry, and eggs, 16% to 18%.(ABSTRACT TRUNCATED AT 250 WORDS)     

Prospective study of dietary energy density and weight gain in women

BACKGROUND: Little is known about the long-term effects of dietary energy density (ED) on weight gain. OBJECTIVE: The objective was to assess the long-term relation between changes in dietary ED and age-related weight gain. DESIGN: We conducted a prospective study of 50 026 women (x +/- SD age: 36.5 +/- 4.6 y) in the Nurses' Health Study II followed from 1991 to 1999. Dietary ED and body weight were ascertained in 1991, 1995, and 1999. Total dietary ED was calculated by dividing each subject's daily energy intake (kcal) by the reported weight (g) of all foods consumed. RESULTS: Dietary ED was positively correlated with saturated fat (r = 0.16), trans fat (r = 0.15), and the glycemic index (r = 0.16), but was inversely correlated with vegetable protein (r = -0.30), vegetables (r = -0.27), and fruit (r = -0.17). ED was not significantly correlated with total fat intake as a percentage of energy (r = 0.08). Women who increased their dietary ED during follow-up the most (5th quintile) had a significantly greater multivariate-adjusted weight gain than did those who decreased their dietary ED (1st quintile) (8-y time period: 6.42 kg compared with 4.57 kg; P for trend < 0.001). However, the amount of weight change over time varied considerably according to the ED values of individual foods and beverages. CONCLUSION: A high dietary ED reflects a dietary pattern higher in saturated and trans fats and refined carbohydrates. Increases in dietary ED were associated with greater weight gain among middle-aged women during 8 y of follow-up. However, public health recommendations cannot be made simply on the basis of ED values of individual foods and beverages.     

Dietary restraint and disinhibition do not affect accuracy of 24-hour recall in a multiethnic population

Some psychological predictors of eating behaviors have been shown to affect usefulness of methods for dietary assessment. Therefore, this study was conducted to determine the association of dietary restraint and disinhibition with dietary recall accuracy for total energy, fat, carbohydrate, and protein. In a cross-sectional study, data were obtained from 79 male and 71 female non-Hispanic whites and African-American volunteers. Participants selected and consumed all foods for a 1-day period under observation and actual intake was determined. The following day, each participant completed a telephone 24-hour recall using the US Department of Agriculture Multiple-Pass method to obtain recalled intake. The Eating Inventory, which measures dietary restraint and disinhibition, was administered prior to eating any food in the study. Repeated measures analyses of variance were used to determine if dietary restraint or disinhibition were independent predictors of recall accuracy. The mean (+/-standard deviation) age and body mass index of the participants was 43+/-12 years and 29+/-5.5 (calculated as kg/m2), respectively. On average, men overreported intake of energy by 265 kcal and women by 250 kcal; both groups also overreported intake of protein, carbohydrate, and fat. When controlling for body mass index, sex, and race, restraint was a significant independent predictor of energy intake (P=0.004) and negatively correlated with energy intake (r=-0.23, P<0.001). Unlike intake of carbohydrate or protein, fat intake was significantly and negatively associated with dietary restraint (P<0.001; r=-0.3). Dietary restraint did not affect accuracy of recall of intake of energy, fat, carbohydrate, or protein, but was significantly associated with intake of energy and fat. Disinhibition was not related to intake or accuracy. Dietetics professionals should consider dietary restraint a possible reason for a lower than expected estimate of energy intake when using 24-hour recalls.