The relationship between household income and dietary intakes of 1-10 year old urban Malaysian

BACKGROUND/OBJECTIVES

Diet plays an important role in growth and development of children. However, dietary intakes of children living in either rural or urban areas can be influenced by household income. This cross-sectional study examined energy, nutrient and food group intakes of 749 urban children (1-10 years old) by household income status.

SUBJECTS/METHODS

Children''s dietary intakes were obtained using food recall and record for two days. Diet adequacy was assessed based on recommended intakes of energy and nutrients and food group servings.

RESULTS

For toddlers, all nutrients except dietary fiber (5.5 g) exceeded recommended intakes. Among older children (preschoolers and school children), calcium (548 mg, 435 mg) and dietary fiber (7.4 g, 9.4 g) did not meet recommendations while percentage of energy from total fat and saturated fats exceeded 30% and 10%, respectively. The mean sodium intakes of preschoolers (1,684 mg) and school children (2,000 mg) were relatively high. Toddlers in all income groups had similar energy and nutrient intakes and percentages meeting the recommended intakes. However, low income older children had lowest intakes of energy (P < 0.05) and most nutrients (P < 0.05) and highest proportions that did not meet recommended energy and nutrient intakes. For all food groups, except milk and dairy products, all age groups had mean intakes below the recommended servings. Compared to middle and high income groups, low income preschoolers had the lowest mean intake of fruits (0.07 serving), meat/poultry (0.78 serving) and milk/dairy products (1.14 serving) while low income toddlers and school children had the least mean intake of fruits (0.09 serving) and milk/dairy products (0.54 serving), respectively.

CONCLUSION

Low socioeconomic status, as indicated by low household income, could limit access to adequate diets, particularly for older children. Parents and caregivers may need dietary guidance to ensure adequate quantity and quality of home food supply and foster healthy eating habits in children.     

The effect of pre‐pregnancy lifestyle counselling on food intakes and association between food intakes and gestational diabetes in high‐risk women: results from a randomised controlled trial

Background

Healthy diets before and during pregnancy have been suggested to reduce the risk of gestational diabetes (GDM ). Several lifestyle intervention studies for pregnant women have reported dietary improvements after counselling. However, evidence concerning the effect of counselling initiated before pregnancy on diets is limited.

Methods

This randomised controlled study explored whether pre‐pregnancy lifestyle counselling influenced food intakes, as well as whether changes in food intakes were associated with GDM . The participants comprised 75 women with prior GDM and/or a body mass index ≥ 30 kg m^–2. Women were randomised into a control or an intervention group, and their food intakes were followed from pre‐pregnancy to early pregnancy using a food frequency questionnaire. The control and intervention groups were combined to assess the association between changes in food intakes and GDM . The diagnosis of GDM was based on a 75‐g oral glucose tolerance test conducted in the first and second trimester of pregnancy.

Results

Pre‐pregnancy lifestyle counselling showed no major overall effect on food intakes. The intake of low‐fat cheese increased significantly in women who did not develop GDM compared to women who did after adjusting for potential confounders (P = 0.028). This association was not observed for regular‐fat cheese.

Conclusions

The findings obtained in the present study suggest that an increased intake of low‐fat but not regular‐fat cheese between pre‐pregnancy and early pregnancy is associated with a lower risk of GDM in high‐risk women.

     

Disparities exist between the dietary intake of Indigenous Australian women during pregnancy and the Australian dietary guidelines: the Gomeroi gaaynggal study

Background

Little is known about the adequacy of nutrient intakes and the overall diet quality of Indigenous Australian pregnant women. The aim of this cross‐sectional study was to assess nutrient sufficiency and diet quality, as measured using the Australian Recommended Food Score (ARFS ), in pregnant women from the Gomeroi gaaynggal cohort (n = 58).

Methods

Maternal dietary intake during pregnancy was assessed using the Australian Eating Survey Food Frequency Questionnaire, which was self‐administered in the third trimester. Diet quality was determined using the ARFS . Food group servings and nutrient intakes were compared to the Australian Guide to Health Eating (AGHE ) and Australian Nutrient Reference Values (NRV s). The current analysis examined the adequacy of usual intakes from food sources only, excluding supplements.

Results

None of the women met all AGHE daily food group serving recommendations. The highest alignment rates were for dairy (33%), meat/alternatives (31%) and vegetables (29.3%). Almost 93% of participants exceeded the recommended intake of energy‐dense, nutrient‐poor foods and percentage energy from saturated fat was high (15%). Of the five key nutrients for optimal reproductive health (folate, iron, calcium, zinc and fibre), the nutrients with the highest percentage of pregnant women achieving the NRV s were zinc (77.6%) and folate (68.9%), whereas iron was the lowest. Only one person achieved all NRV s (folate, iron, calcium, zinc and fibre) important in pregnancy. The median ARFS was 28 points (maximum of 73).

Conclusions

Although the small cohort limits the generalisability of the findings of the present study, the data obtained indicate that the diets of these Indigenous pregnant women are inadequate. Therefore, strategies aiming to optimise nutrient intakes of Indigenous pregnant women are needed urgently.

     

The effectiveness of workplace dietary modification interventions: A systematic review

Objective

To evaluate the effectiveness of workplace dietary modification interventions alone or in combination with nutrition education on employees' dietary behaviour, health status, self-efficacy, perceived health, determinants of food choice, nutrition knowledge, co-worker support, job satisfaction, economic cost and food-purchasing patterns.

Method

Data sources included PubMed, Medline, Embase, Psych Info., Web of Knowledge and Cochrane Library (November 2011). This review was guided by the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. Studies were randomised controlled trials and controlled studies. Interventions were implemented for at least three months. Cochrane Collaboration's risk of bias tool measured potential biases. Heterogeneity precluded meta-analysis. Results were presented in a narrative summary.

Results

Six studies conducted in Brazil, the USA, Netherlands and Belgium met the inclusion criteria. Four studies reported small increases in fruit and vegetable consumption (≤ half serving/day). These studies involved workplace dietary modifications and three incorporated nutrition education. Other outcomes reported included health status, co-worker support, job satisfaction, perceived health, self-efficacy and food-purchasing patterns. All studies had methodological limitations that weakened confidence in the results.

Conclusion

Limited evidence suggests that workplace dietary modification interventions alone and in combination with nutrition education increase fruit and vegetable intakes. These interventions should be developed with recommended guidelines, workplace characteristics, long-term follow-up and objective outcomes for diet, health and cost.     

Dietary diversity and adequacy of women caregivers in a peri-urban informal settlement in South Africa

Objective

Simple measures reflecting dietary quality are preferred for assessment of dietary intakes in low-income communities, e.g. dietary diversity that reflects a healthy, varied, nutritious diet, associated with nutrient adequacy. A strong association between household income and food access suggests dietary diversity assessment as one of the indicators of household food security. The aim of this study was to assess the food security situation of black women in an informal settlement by exploring their food access capabilities through dietary diversity measures and the coping strategies they employ to cope with poverty and hunger.

Methods

A randomly selected sample of black women living in an informal settlement completed a pretested socio-demographic questionnaire (socio-economic circumstances) and validated questionnaires (1-wk quantified food frequency questionnaire: diversity measures; 24-h recall: nutrient intake; Cornell Hunger Scale: coping strategies). Food variety scores and food group diversity scores were calculated from frequency analyses for all foods and food groups. Nutrient adequacy ratios for various nutrients and the mean adequacy ratio for their diet were calculated. Relationships between dietary diversity and nutritional adequacy were investigated with Pearson correlations. Food variety score cut points were tested for sensitivity and specificity against nutritional adequacy.

Results

Intakes were deficient for all nutrients except carbohydrates. Individual mean ± SD nutrient adequacy ratios ranging between 0.15 ± 0.18 and 0.95 ± 0.19 confirmed the poor dietary quality. Zero to 40 individual foods were consumed, but the mean ± SD food variety score was only 3.17 ± 1.21, indicating low food diversity, as did the low dietary diversity score (2.82 ± 0.99) using 0 to 6 food groups.

Conclusions

Limited food access and food variety in poor households resulted in inadequate nutrient intakes (low nutrient adequacy ratios), confirmed by poor dietary diversity (food variety score and food group diversity score). Dietary diversity assessment can successfully replace traditional dietary assessment tools in poverty-stricken or low-income communities where quick assessments are often required to assess the greatest need.     

Lower-Energy-Density Diets Are Associated with Higher Monetary Costs per Kilocalorie and Are Consumed by Women of Higher Socioeconomic Status

Objective

Diets of lower energy density are associated with higher diet quality, lower body weights, and better health outcomes. This study examined associations among dietary energy density, energy-adjusted diet costs, and socioeconomic indicators of study participants.

Design

In this cross-sectional study, energy and nutrient intakes for 164 men and women aged 25 to 65 years were obtained using a food frequency instrument between June 2005 and September 2006. Dietary energy density (kcal/g) was calculated with and without beverages. Energy-adjusted diet costs ($/2,000 kcal) were calculated using food prices in Seattle, WA. Tertile splits of energy density and energy cost were analyzed using tests for linear trend. Linear regression models tested the association between education, income, and dietary variables, adjusting for age and sex.

Results

Diets of lower energy density were associated with higher absolute nutrient intakes. Diets of lower energy density were also associated with higher energy-adjusted diet costs. Conversely, highest energy density diets were associated with lower intakes of micronutrients and fiber and lower costs. Education and household income showed a negative association with dietary energy density in regression models. Education and household incomes showed a positive association with the energy-adjusted cost of the diet. Education was a stronger predictor of both energy density and energy cost than was household income.

Conclusions

Higher-quality diets were not only more costly per kilocalorie but were also consumed by persons of higher educational level. The influence of diet quality on health, observed in some epidemiologic studies, might be modulated by unobserved indexes of socioeconomic status.     

Comparison of dietary intake of overweight postpartum mothers practicing breastfeeding or formula feeding

Background

Weight gain in the postpartum period is a risk factor for long-term obesity. Investigations of dietary intake among lactating and nonlactating overweight women might identify nutritional concerns specific to this population.

Objective

To compare nutrient, meal, and snack intakes, food-group servings and prevalence of dieting among fully breastfeeding (BF), mixed breast and formula feeding (MF), and formula feeding (FF) overweight and obese women. The second aim was to compare nutrient intakes and food-group servings to the Dietary Reference Intake and MyPyramid recommendations, respectively.

Design

Data were collected from September 2004 through April 2006 in Durham, NC. Infant feeding practices and dietary information were collected on 450 women between 6 and 9 weeks postpartum. Two 24-hour dietary recalls were completed by phone, using Nutrition Data Systems for Research. Analysis of covariance was used to compare infant feeding groups in dietary quality (nutrient intake per 1,000 kcal) and food-group servings, controlling for prepregnancy body mass index, race, age, education, income, and marital status. χ² analysis was performed to determine differences in meal and snack intake and dieting among infant feeding groups.

Results

BF women consumed more energy (2,107±50 kcal) than MF (1,866±56 kcal) or FF (1,657±50 kcal) women (P<0.001). Adjusted nutrient intake did not differ between groups. All groups were at risk for inadequate intakes of vitamins A, E, C, and folate and did not meet recommended servings of all food groups. BF women consumed lunch and snacks more frequently, were less likely to diet, and reported higher intakes of grains and desserts than MF and FF women.

Conclusions

To help increase intakes of nutrients lacking in the diet and prevent postpartum weight gain, overweight women should be encouraged to increase fruits, vegetables, low-fat dairy, whole grains, legumes, and healthy types of fat, while decreasing refined grains, regular soda, sweetened beverages, and desserts.     

Cluster Analysis Defines Distinct Dietary Patterns for African-American Men and Women

Background

African Americans have a higher prevalence of diet-related chronic diseases than the general US population. Recent evidence suggests that examining dietary patterns rather than specific nutrients may better allow public health professionals to translate national dietary goals into practical dietary recommendations that are culturally relevant and sex-specific.

Objective

To examine and characterize the dietary patterns of African-American men and women using cluster analysis.

Design

Participants older than the age of 18 years were recruited from a variety of locations and completed a self-administered questionnaire.

Subjects/setting

Seven-hundred sixty-three African-American men and women in North Central Florida.

Statistical analyses performed

Cluster analysis was done with the VARCLUS procedure and Ward's clustering approach in the Statistical Analysis System program. The pseudo-t² statistic was then used to identify the optimal numbers of clusters of men and women with distinctive food-consumption patterns.

Results

Cluster analyses identified six clusters of men with 13 distinctive dietary patterns and six clusters of women with 15 distinctive dietary patterns. Pairwise comparisons of group means indicated notable differences in intakes between clusters of women in all but two food clusters. Pairwise comparisons of group means indicated notable differences in intakes between clusters of men in all but two food clusters.

Conclusions

The study illustrated that cluster analysis can be used to identify groups of African Americans with unique patterns of food consumption. They also suggest that a single “typical” eating pattern does not exist for African Americans and that dietary pattern vary by sex.     

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.     

Household Food Insecurity Is Not Associated with Overall Diet Quality Among Pregnant Women in NHANES 1999–2008

Objective

Analyze the association between household food security status and diet quality during pregnancy.

Methods

Cross-sectional analysis of pregnant women from the National Health and Nutrition Examination Survey from 1999 to 2008. Of the 1158 pregnant women with complete household food security information, we analyzed 688 women who had complete dietary information and household incomes ≤300 % of the Federal Poverty Level (FPL). Diet quality was measured by the Alternate Healthy Eating Index modified for Pregnancy (AHEI-P) from 1 to 2 24 h dietary recalls. Multivariate linear and logistic regression models were implemented to assess the association between household food security status and AHEI-P, adjusting for age, nativity, marital status, race/ethnicity, education, and household income.

Results

Among women with household incomes ≤300 % of the FPL, 19 % were food insecure and 4 % were marginally food secure. The mean AHEI-P score was 41.9 (95 % CI 40.4, 43.3). Household food insecurity was not associated with overall diet quality. However, living in a food insecure household compared to a food secure household was associated with a 2.3 (1.3, 4.1) greater odds of having a calcium component score greater than the median intake of calcium scores among food secure women in the sample.

Conclusions for Practice

In a nationally representative sample of pregnant women, 80 % lived in a fully food secure household. Improving household food security during pregnancy is a public health opportunity to improve health outcomes; however household food security status may not be associated with overall diet quality.

     

Sodium intake of special populations in the Healthy Aging in Neighborhoods of Diversity Across the Life Span (HANDLS) study

Objective

The sodium intake of participants of the Healthy Aging in Neighborhoods of Diversity across the Life Span study who were in three of the special population groups identified by the Dietary Guidelines for Americans, 2010 (those with hypertension, African Americans, and those ≥ 51 years) was analyzed to determine if they met sodium recommendations.

Methods

The sample included 2152 African American and White subjects, aged 30–64 years. Major dietary sources of sodium for each group were determined from two 24-hour dietary recalls, and dietary intakes were compared with sodium recommendations. Dietary potassium was also evaluated.

Results

The intakes of the groups studied exceeded 1500 mg of sodium while their potassium intakes were lower than the Adequate Intake of 4700 mg. The major contributors of sodium included “cold cuts, sausage, and franks,” “protein foods,” and yeast breads.

Conclusions

Excessive sodium intake characterized the diet of an urban, socioeconomically diverse population who are hypertensive or at risk for having hypertension. These findings have implications for health professionals and the food industry.     

Alcoholic Beverage Consumption, Nutrient Intakes, and Diet Quality in the US Adult Population, 1999-2006

Background

Little is known about associations between alcoholic beverage consumption, nutrient intakes, and diet quality, although each has been independently associated with chronic disease outcomes.

Objective

This study examines cross-sectional relationships between alcoholic beverage consumption, nutrient intakes, and diet quality (Healthy Eating Index-2005 [HEI-2005] scores) in the US adult population.

Methods

Data were from four cycles of the National Health and Nutrition Examination Survey (1999-2006). Weighted multiple regression analyses, adjusted for age, race/ethnicity, education, smoking status, and body mass index included 8,155 men and 7,715 women aged ≥20 years who reported their past-year alcoholic beverage consumption and 24-hour dietary intake. Alcoholic beverage consumption was defined by drinking status (never, former, current drinker) and, among current drinkers, by drinking level (number of drinks per day, on average: men <1 to ≥5; women <1 to ≥3).

Results

Among men, there was no association between drinking status and intakes of energy, most nutrients, or total HEI-2005 score. Among women, former and current (compared to never) drinkers had significantly higher intakes of energy and several nutrients, and current drinkers had significantly lower total HEI-2005 scores (current drinkers 58.9; never drinkers 63.2). Among current drinkers of both sexes, as drinking level increased, intakes of energy and several nutrients significantly increased, whereas total HEI-2005 scores significantly decreased (from 55.9 to 41.5 in men, and from 59.5 to 51.8 in women).

Conclusions

Among men and women, increasing alcoholic beverage consumption was associated with a decline in total diet quality as measured by the HEI-2005, apparently due to higher energy intake from alcohol as well as other differences in food choices. Educational messages should focus on nutrition and chronic disease risk associated with high consumption of alcoholic beverages and poor food choices, including excessive energy intake.     

High Intake of Nonmilk Extrinsic Sugars Is Associated With Protein and Micronutrient Dilution in Home-Dwelling and Institutionalized Older People

Background

High dietary sugar intake may compromise protein and micronutrient intakes in people with low energy intakes. The results of micronutrient dilution studies in older people have been few and conflicting. We examined the nutritional status and nutrient intakes associated with nonmilk extrinsic sugars (NMES) intakes in older people representing a broad spectrum of both healthy and vulnerable older populations.

Validity of a food frequency questionnaire to estimate long-chain polyunsaturated fatty acid intake among Japanese women in early and late pregnancy

Background

The relative validity of food frequency questionnaires for estimating long-chain polyunsaturated fatty acid (LC-PUFA) intake among pregnant Japanese women is currently unclear. The aim of this study was to verify the external validity of a food frequency questionnaire, originally developed for non-pregnant adults, to assess the dietary intake of LC-PUFA using dietary records and serum phospholipid levels among Japanese women in early and late pregnancy.

Validation of a food frequency questionnaire for Japanese pregnant women with and without nausea and vomiting in early pregnancy

Background

No previous study has shown the validity of a food frequency questionnaire (FFQ) in early pregnancy with consideration of nausea and vomiting during pregnancy (NVP). The aim of this study was to evaluate the validity of a FFQ in early pregnancy for Japanese pregnant women.

Validity and reliability of a self-administered food frequency questionnaire for the JPHC study: The assessment of amino acid intake

Background

The Japanese database of food amino acid composition was revised in 2010 after a 24-year interval. To examine the impact of the 2010 revision compared with that of the 1986 revision, we evaluated the validity and reliability of amino acid intakes assessed using a food frequency questionnaire (FFQ).

Measurement of unmet need for family planning: longitudinal analysis of the impact of fertility desires on subsequent childbearing behaviors among urban women from Uttar Pradesh,India

Background

The measure of unmet need relies on women's reported fertility desires; previous research has demonstrated that fertility desires may be fluid and not firm.

Study Design

Our study uses recently collected longitudinal data from four cities in Uttar Pradesh, India, to examine whether women's fertility desires and family planning (FP) use at baseline predict pregnancy/birth experience in the 2-year follow-up period.

Results

Multivariate models demonstrate that women who were using any method of FP and reported an intention to stop childbearing were the least likely to experience a pregnancy/birth in the 2-year follow-up period. The stated desire to delay childbearing, whether or not the woman was using FP, did not distinguish pregnancy/birth experience. Ninety-two percent of pregnancies/births over the follow-up period were considered “wanted then” suggesting post-hoc rationalization of the pregnancy/birth even among those women who reported a desire to stop childbearing 2 years earlier.

Conclusions

More nuanced assessments of fertility intentions may be needed to adequately gauge latent FP needs. Non-users of FP may be ambivalent about future childbearing and the timing of future births; these women may not have an unmet need for FP as typically defined.     

Analysis of nutritional adequacy of local foods for meeting dietary requirements of children aged 6-23 months in rural central Tanzania

Background

Under nutrition remains a serious problem among children in Sub-Saharan Africa. Analysing how diets composed of local foods could achieve nutritional goals for infants and young children in low-income settings is essential. The objective of this study was to analyse how local foods can be used rationally and to what extent these foods can be supplemented to achieve nutrient requirements for children aged 6 – 23 months in resource-poor settings.

Methods

A cross-sectional study was carried out to estimate dietary intakes of 400 children aged 6-23 months using a 12-h weighed dietary record, 24-h dietary recalls, and 7-days food records. Anthropometric measurements on each subject were also taken. Analyses were done to establish the level of nutrient intake, and nutritional status of the study population using Microsoft Excel 2013 and ProPAN software version 2.0.

Results

The results showed that the prevalence of stunting, wasting and underweight for children aged 6–23 months was 30–41%, 1.5–3% and 4–9%, respectively. In addition, the results showed that diets that were consumed by the subjects comprised of local foods met vitamin A, vitamin C, protein and energy requirements for children aged 6–23 months. However, the extent of deficit in iron, zinc and calcium in baseline diets was large and difficult to meet under the existing feeding practices.

Conclusions

The study shows that local foods in the study area have a potential to achieve recommended dietary intakes of some essential nutrients, and that interventions are needed to meet the required amount of iron, zinc and calcium for children aged 6–23 months. The interventions we propose here may encourage changes in traditional feeding habits and practices of the target population. Possible intervention options are (1) supplementation of local foods with nutrient-dense foods that are not normally consumed in the locality (2) providing new avenues for increasing the production and wide consumption of local nutrient-dense foods, or optimizing the way local diets are constituted so as to achieve nutrient recommendations for infants and young children.

     

Breakfast skipping and breakfast type are associated with daily nutrient intakes and metabolic syndrome in Korean adults

BACKGROUND/OBJECTIVES

Emerging evidence shows that eating breakfast and breakfast types may be associated with health outcomes and dietary intakes in various populations. The aim of this study was to investigate the association between breakfast types in Korean adults with their daily nutrient intakes and health outcomes.

SUBJECTS/METHODS

A total of 11,801 20- to 64-year-old adults (age 42.9 ± 11.8 yrs [mean ± standard error of the mean]; male 41.1%, female 58.9%) in 2007-2009 Korean National Health and Nutrition Survey data were divided into 5 groups based on breakfast types in a 24-hr dietary recall: rice with 3 or more side dishes (Rice3+, 35.3%), rice with 0-2 side dishes (Rice0-2, 34.73%), noodles (1.56%), bread and cereal (6.56%), and breakfast skipping (21.63%). Daily nutrient intakes and the risk of metabolic syndrome were compared among five groups.

RESULTS

Compared with Korean Recommended Nutrient Intake levels, the breakfast-skipping group showed the lowest intake level in most nutrients, whereas the Rice3+ group showed the highest. Fat intake was higher in the bread and noodle groups than in the other groups. When compared with the Rice3+ group, the odds ratios for the risk of obesity and metabolic syndrome were increased in the breakfast skipping, Rice0-2, and noodle groups after controlling for confounding variables.

CONCLUSIONS

The rice-based breakfast group showed better nutritional status and health outcomes when eating with 3 or more side dishes. Nutrition education is needed to emphasize both the potential advantage of the rice-based, traditional Korean diet in terms of nutritional content and the importance of food diversity.