Assessment of the effect of fat-modified foods on diet quality in adults, 19 to 50 years, using data from the Continuing Survey of Food Intake by Individuals

Fat-reduction strategies and the role of fat-modified foods in the US diet were assessed using a nationally representative survey: the 1996 US Department of Agriculture Continuing Survey of Food Intakes by Individuals. A sample of 878 men and 853 women was included. The sample was divided into low fat and high fat based on the Dietary Guideline's cutoff poin of 30% or less of energy from total fat. The survey sample was further stratified in nonusers, low-users or high-users of fat-modified foods. Approximately 10% of 7,000 foods were classified as fat-modified. There was a 400 to 500 kcal difference in energy intake of individuals consuming low-fat compared with high-fat diets. Adults who were users of fat-modified foods consumed more nutrient-dense diets, with higher intakes of vitamin A, folate, and iron. Not all fat-reduction strategies were equally effective in reducing fat and maintaining nutrient intake. Nonusers of fat-modified foods who consumed a low-fat diet tended to do so by substituting carbohydrate, in part from carbonated beverages, for fat. Both men and women consuming a low-fat diet had lower average BMIs; this difference between individuals consuming low-fat vs high-fat diets was significant for women who were high-users of fat-modified foods. The data suggest that a low-fat diet with high use of fat-modified foods may be one strategy for achieving adequate nutrient intake while maintaining weight in the desirable BMI range of 19 to 25.     

Improved diet quality with peanut consumption

OBJECTIVE: To evaluate the diet quality of free-living men, women, and children choosing peanuts and peanut products. DESIGN: Using data reported in the Continuing Survey of Food Intake by Individuals and Diet and Health Knowledge Survey (CSFII/DHKS) from 1994-1996, food codes were used to sort respondents by use or nonuse of peanuts. SUBJECTS: A nationally representative sample of 4,751 men, 4,572 women, and 4,939 children (boys and girls, 2-19 yrs) who completed 2-day intake records. Measures of Outcome: The two-sample t test was used to analyze differences between peanut users and nonusers for energy, nutrient intakes, Health Eating Index (HEI) scores, and body mass index (BMI). RESULTS: Peanut users (24% of CSFII/DHKS) had higher intakes (p < 0.001) of protein, total fat, polyunsaturated fat (PUFA), monounsaturated fat, (MUFA) (p < 0.01), fiber, vitamin A, vitamin E, folate, calcium, magnesium, zinc, and iron. Percent of energy from saturated fat was not significantly different for men, women or girls and was slightly lower (p < 0.01) for boys. Dietary cholesterol of peanut users was lower for all population groups; this decrease was significant for both men (p < 0.01) and children (p < 0.001). The HEI was calculated as a measure of overall nutrient profile of the diets and was significantly greater for peanut users (men 61.4, women, 65.1, children 66.8) compared to nonusers (men 59.9, women 64.1, children 64.7) for men (p = 0.0074) and children (p < 0.001). Energy intake was significantly higher in all population groups of peanut users (p < 0.001; boys: p < 0.01); however mean BMI for peanut users was lower for all gender/age categories (women: p < 0.05; children: p < 0.001). CONCLUSIONS: These results demonstrate improved diet quality of peanut users, indicated by the higher intake of the micronutrients vitamin A, vitamin E, folate, calcium, magnesium, zinc, and iron and dietary fiber, and by the lower intake of saturated fat and cholesterol. Despite a higher energy intake over a two-day period, peanut consumption was not associated with a higher BMI.     

Use of low-fat foods by people with diabetes decreases fat, saturated fat, and cholesterol intakes

OBJECTIVE: To investigate the effect of providing free access to several fat-modified foods on dietary energy and macronutrient intake in people with and without diabetes mellitus. DESIGN: Five low-fat or no-fat products or their regular-fat counterparts were provided to volunteers to take home and use for 3 days (low-fat condition or regular-fat condition) in a repeated-measures crossover design. People with diabetes were case matched to people without diabetes. Food intakes were determined through a weighed food diary and by weighing the food provided before consumption and the uneaten portions after consumption. SUBJECTS: Thirty men and women, aged 20 to 60 years, with (n = 15) and without (n = 15) diabetes participated. STATISTICAL ANALYSES: Repeated-measures analysis of variance was used to determine the effects of diabetes and use of fat-modified foods on nutrient and energy intake. RESULTS: People with diabetes responded the same way to fat-modified foods as people without diabetes. There was a significant reduction in the grams of fat consumed during the low-fat condition compared with the regular-fat condition (average decrease = 8 g, P < .05). Energy intake from experimental foods was significantly lower during the low-fat condition (271 +/- 181 kcal) compared with the regular-fat condition (353 +/- 256 kcal), but total energy intake was not different. Percentage of energy from fat was significantly decreased in the low-fat condition (27 +/- 7) compared with the regular-fat condition (34 +/- 9; P < .05). There was a corresponding increase in the percentage of energy from carbohydrates in the low-fat condition compared with the regular-fat condition, but no significant increase in grams of carbohydrate consumed. Cholesterol and saturated fat intakes were significantly less in the low-fat condition than in the regular-fat condition. CONCLUSION: Consumption of fat-modified foods by individuals with diabetes may help decrease intake of fat, cholesterol, and saturated fat.     

Dietary Intake of Modernizing Samoans: Implications for Risk of Cardiovascular Disease

Objective To describe the dietary intake of American and Western Samoans, with emphasis on nutrients conventionally related to risk factors for cardiovascular disease.Design Cross-sectional dietary survey. Intake estimates were based on 24-hour recall interviews.Subject Community-based samples of 946 men and women (455 American Samoans, 491 Western Samoans) aged 25 to 55 years.Statistical analyses Tests of differences in means (t tests) and proportions (Chi² tests). Correlation and multivariate linear regression analyses were conducted to describe correlates of energy and nutrient intakes.Results Few differences were noted between the energy and nutrient intakes of men and women, but substantial differences were found between residents of American Samoa and those of the less modernized country of Western Samoa. American Samoans consumed significantly more energy as carbohydrate (47% vs 44%) and protein (18% vs 13%) and less as fat (36% vs 46%) and saturated fat (16% vs 30%). Energy-adjusted intakes of cholesterol and sodium were higher among American Samoans. These differences persisted after adjustment for age, gender, years of education, occupation, and categories of a 10-point material lifestyle score. Samoans in the lowest category of material lifestyle had significantly lower energy-adjusted intakes of protein, cholesterol, and sodium and higher intakes of saturated fat than those in the upper 2 categories. Additional analyses described the contribution of specific foods to the intakes of energy and macronutrients.Conclusions/applications The observed energy and nutrient intake patterns are consistent with previously reported levels of obesity and risk factors for cardiovascular disease among Samoans and suggest dietary modification for those at highest risk. Dietetics practitioners who counsel Samoan and other Pacific Islander clients should be aware of these intake patterns, which seem particularly malleable to levels of personal income. More generally, results from this study illustrate that the food choices of certain ethnic groups may be profoundly affected by the process of modernization within a country or by migration to a more economically developed locale. J Am Diet Assoc. 1999;99:184–190.     

Accuracy of energy intake data estimated by a multiple-pass, 24-hour dietary recall technique

Objective This study examined the accuracy of a multiplepass, 24 hour dietary recall method for estimating energy intakes of men and women by comparing it with energy intake required for weight maintenance.Design Threeday, multiplepass, 24-hour recalls were obtained on randomly selected days during a selfselected diet period when subjects were preparing their own meals and during a controlled diet period when all meals were provided by the study. During the dietary intervention, weight was maintained; body weight and dietary intake were monitored closely, thereby allowing estimation of the energy intake required for weight maintenance.Subjects/setting Seventyeight men and women (22 to 67 years old) from the Dietary Effects on Lipoprotein and Thrombogenic Activity (DELTA) study participated in this study. All 24-hour recalls were collected using a computerassisted, interactive, multiplepass telephone interview technique. Energy requirements for each individual were determined by the energy content of the DELTA study foods provided to maintain weight.Statistical analysis Paired and independent t tests were conducted to examine differences among study variables. Agreement between recalled energy intake and weight maintenance energy intake was analyzed using the BlandAltman technique.Results Compared with weight maintenance energy intake, during the selfselected diet period men and women underestimated energy intake by 11% and 13%, respectively. During the controlled diet period, men underestimated energy intake by 13%, whereas women overestimated energy by 1.3%.Applications/conclusions Men had a tendency to underestimate energy intake irrespective of the recording period. The accuracy of the recalled energy intake of women may be influenced by recording circumstances. Researchers should examine the factors influencing underreporting and overreporting by individuals and their impact on macronutrient and micronutrient intakes. Also, strategies need to be developed to minimize underreporting and overreporting. J Am Diet Assoc. 2000; 100:303-308,311.     

Nutrient contributions of dairy foods in the United States, Continuing Survey of Food Intakes by Individuals, 1994-1996, 1998

OBJECTIVE: This study was designed to quantify the impact of dairy foods on nutrient intakes in the United States. SUBJECTS: Data were from 17959 respondents to the 1994-1996, 1998 Continuing Survey of Food Intakes by Individuals (CSFII).Statistical analyses Nutrient intakes were quantified by quartile of dairy food intake. Also, dairy intakes were compared in people who met vs did not meet intake recommendations for select nutrients. Finally, the direct contribution of dairy foods/ingredients to calcium and lipid intakes was determined. SAS and SUDAAN software were used. Data were weighted. Energy intake was a covariable in regression models. RESULTS: Intake of all micronutrients examined, except vitamin C, was higher with increasing quartile of total dairy and milk intake, controlling for energy intake. Calcium was the only micronutrient positively associated with cheese intake. Fat intake either did not differ or was lower among people in quartile 2, 3, or 4 vs quartile 1 of total dairy and milk intake, whereas fat was higher as quartile of cheese intake increased. Dietary cholesterol was lower as intakes of any of the dairy categories increased; the opposite was true for saturated fat. Dairy foods/ingredients directly contributed an average of 51% of dietary calcium, 19% of total fat, 32% of saturated fat, and 22% of cholesterol. CONCLUSIONS: Total dairy and milk intakes were associated with higher micronutrient intakes without adverse impact on fat or dietary cholesterol. Results reinforce the strong nutritional profile of dairy-rich diets, although results with saturated fat and with cheese suggest that it would be useful to modify product composition and/or eating patterns to optimize nutritional contributions of dairy products.     

Combined effects of saturated fat and cholesterol intakes on serum lipids: Tehran Lipid and Glucose Study

ObjectiveThis study investigated the combined effect of saturated fat and cholesterol intake on serum lipids among Tehranian adults.MethodsIn 443 subjects ≥18 y, dietary intake was assessed. Height and weight were measured and body mass index was calculated. Serum cholesterol, triacylglycerol, high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol levels were calculated. Cholesterol intakes ≥300 mg/d and saturated fat intakes ≥7% of total energy were defined as high intakes. Individuals were categorized into four groups based on cholesterol and saturated fat intakes.ResultsSubjects' mean age was 40.1 ± 14.6 y; those in whom cholesterol and saturated fat intake was normal had significantly less energy and fat intake than those with high cholesterol and saturated fat intakes (P < 0.01). Saturated fat intake had a significant effect on serum total and HDL-C levels. Subjects with a normal saturated fat intake had significantly less serum total and HDL-C than those who had high saturated fat intake (P < 0.01 and P < 0.05, respectively). Adjusting for age, sex, and body mass index, the main effect of cholesterol intake on HDL-C was significant (P = 0.05). Mean serum HDL-C was lower in subjects who had normal cholesterol intake than in those with high cholesterol intake.ConclusionThese results show that cholesterol and saturated fat intakes have no combined effect on serum low-density lipoprotein cholesterol level, whereas cholesterol intake per se affects serum HDL-C level.     

Population Nutrient Intake Approaches Dietary Recommendations: 1991 to 1995 Framingham Nutrition Studies

Objective To estimate population nutrient intake levels and to assess adherence to current dietary recommendations for health promotion and disease prevention.Design Cross-sectional analysis of nutrient intake estimated from 3-day food records. Median macronutrient and micronutrient intake levels for men, women, and the total population are reported along with the proportions of men and women who achieved intakes compatible with nutrient goals defined by published guidelines.Setting Adult participants (2,520: 1,375 women and 1,145 men) in the Framingham Offspring-Spouse Study surveyed between 1991 and 1995.Statistical analyses χ² Analyses were used to test for gender differences in the proportions of persons who had intakes that met nutrient guidelines.Results Population intake levels of certain key nutrients, including total and saturated fat, appear to be approaching recommended levels. High proportions of the Framingham population (70% or more) met current recommendations for intakes of protein, polyunsaturated and monounsaturated fat, cholesterol, alcohol, vitamins C and B-12, and folacin. About half or fewer met guidelines for carbohydrate; total and saturated fat; fiber; beta carotene; vitamins A, E, and B-6; calcium; and sodium. Important gender differences in the proportion of those meeting nutrient guidelines were observed for 12 of the 18 nutrients examined, including carbohydrate; total, saturated, and monounsaturated fat; cholesterol; fiber; sodium; calcium; and several vitamins.Conclusions Although progress has been made toward achieving population adherence to preventive nutrition recommendations, large proportions of adults fall short of guidelines for some key nutrients. Differences in adherence rates between men and women suggest areas for gender-specific, targeted nutrition messages and behavioral interventions.     

Impact of receiving blood cholesterol test results on dietary change

Introduction: The study objective was to determine the impact of receivin results of a blood cholesterol test on changes in dietary behaviors among individuals participating in a Health Risk Appraisal Program.Methods: This randomized trial of maintenance employees at six hospitals included two groups: Group 1 received their blood cholesterol test results at the pretest; Group 2 received results only at the posttest (16–20 weeks later). The pretest interview included (1) a 24-hour dietary recall; (2) an evaluation of dietary behaviors and suggestions on how to change; (3) height, weight, and blood cholesterol measurement. Five hundred employees participated, and 429 eligible employees completed both pretest and posttest interviews.Results: Blood cholesterol levels decreased by 4.8% (P < .001) and saturated fat intake decreased by 7.4% (P < .05). Regression analyses indicated that individuals more likely to have lowered saturated fat intake had higher pretest saturated fat intakes, had a family history of high blood cholesterol, and were light-maintenance employees (P < .05); no other variables were associated (receiving blood cholesterol test results, previous blood cholesterol test, pretest blood cholesterol levels, personal history of heart disease, BMI, age, gender, tobacco/alcohol use). Among subjects with normal cholesterol levels, those not receiving blood test results reduced saturated fat intake more than those receiving test results; both groups had similar saturated fat intakes (>12%) greater than recommended intake (<10%).Conclusions: Screening programs should include an assessment of saturated fat intake as screening for blood cholesterol may provide normocholesterolemic subjects with a false sense of security.     

Variability in percent energy from fat throughout the day: Implications for application of total diet goals

In spite of the general agreement that dietary recommendations apply to the diet over time, the quantitative levels for total and saturated fat have been used in establishing federal policy related to intakes for a single day, meal, and even an individual food. Application of these recommendations uniformly to meals across a day implies that fat intake is uniform throughout the day. This analysis of the 1985 Continuing Survey of Food Intakes by Individuals demonstrates that percent energy intake from fat across eating occasions within a day is not uniform. Percent energy intake from total and saturated fat is lower at the morning meal and at snacks among women at all levels of fat consumption, suggesting that fat is restricted more often at these two eating occasions. Intake of total and saturated fat was also more variable at these two eating occasions. These findings suggest that restricting fat intake at these eating occasions and liberalizing fat intake at midday and evening meals occurs commonly and may be an effective fat-reduction strategy. Daily variability in percent energy from fat should be considered in designing dietary fat reduction interventions and in applying quantitative recommendations for percent energy from total and saturated fat in nutrition guidance directed to individual meals.     

Do Users of Dietary Supplements Differ From Nonusers in Their Food Consumption?

The objective of the study was to analyse macronutrient and food intakes of regular users (310 men, 495 women) and nonusers (1136 men, 1269 women) of vitamin and mineral supplements, aged 18-79 years. These, were participants of the German Nutrition Survey, which was part of the German National Health Interview and Examination Survey 1998. Information on dietary behaviour including supplementation habits was assessed using a validated computerised dietary history method (DISHES 98). There were no major differences in macronutrient intakes between regular users and nonusers. After adjustment for age, energy intake, smoking, sport activity, socio-economic status and East/West German residence, regular supplement use was associated with a higher consumption of drinking water. Among men, a higher consumption of vegetable fat, poultry and fruit/vegetable juice, and among women, a higher consumption of fish, milk products, fruits and tea was also associated with regular supplement use. An inverse association was observed between regular supplement use and the consumption of coffee among women. Significant differences in food consumption between regular users and nonusers were observed, indicating a tendency for a healthier food choice among regular users.     

Dietary fat reduction strategies.

In this study, we used computer modeling to identify which techniques designed to achieve dietary fat reduction were the most effective in meeting the dietary recommendations of the American Heart Association Step-One diet. Menus were developed for men and nonpregnant, nonlactating women, 25 to 50 years old, according to the Continuing Survey of Food Intakes by Individuals (with 36% and 37% of energy from fat for men and women respectively). The menus were modified realistically using the Minnesota Nutrition Data System. The following five strategies were applied: skim milk replaced whole milk and 2%-fat milk (SKM); medium-fat meat exchanges replaced higher-fat ones (MMtEx); lean meat exchanges replaced higher-fat ones (LMtEx); fat-modified products were used (FMP); and 2%-fat milk replaced whole milk (LFM). For men, strategies LMtEx, SKM + LMtEx, SKM + LMtEx + FMP, LMtEx + FMP, LMtEx + FMP + LFM, and LMtEx + LFM reduced energy by 195 to 415 kcal and achieved the targeted level of energy from fat (less than or equal to 30 +/- 1%) and cholesterol (less than 300 mg) while maintaining 67% or more of the Recommended Dietary Allowances for other nutrients. For women, however, no single strategy achieved the goal. Certain combinations of strategies, SKM + LMtEx, SKM + FMP, SKM + MMtEx + FMP, reduced energy by 150 to 268 kcal and achieved the targeted dietary fat and cholesterol goals while maintaining 67% or more of the Recommended Dietary Allowances for other nutrients. All strategies led to a reduction in both saturated fatty acids (to 9% to 10% of energy) and monounsaturated fatty acids.(ABSTRACT TRUNCATED AT 250 WORDS)     

Dietary fat reduction strategies used by a group of adults aged 50 years and older

OBJECTIVE: To investigate the fat-reduction strategies used by a group of older adults who successfully made and maintained positive dietary changes for 5 years or longer. DESIGN: Participants completed 2 copies of a self-administered food frequency questionaire: The first copy assessed diet before they began making changes and the second copy assessed diet after initiation of healthful dietary changes. Positive food changes were identified from the food frequency questionnaires. During in-person interviews, participants placed food changes onto a time line according to the nearest estimated date of initiation of the change. SUBJECTS: Participants were 65 free-living older adults (aged >50 years) who had maintained substantial changes to decrease fat intake in their diet for at least 5 years. Statistical analyses performed Quantitative and qualitative data were used to identify the fat-reduction strategies and to confirm and validate the fat-reduction strategy model. Confirmatory factor analysis was performed to confirm the new model. The Kuder-Richardson-20 reliability coefficient (kr) was used to determine internal consistency of the scales developed for the study. RESULTS: The majority of participants decreased their fat intake gradually, at different time points in their lives, and over a long period of time (5 to 43 years). Mean percent energy intake from fat decreased from 44.3 +/- 5.9% before dietary improvement to 25.9 +/- 7.1% at the time of the study. The final model consisted of 5 fat-reduction strategies with 63 food changes. The strategies were: increase summer fruits (4 items; kr=0.66), increase vegetables and grains (14 items; kr=0.79), decrease recreational foods (14 items; kr=0.76), decrease cooking fat (20 items; kr=0.86), and use fat-modified foods (11 items; kr=0.80). APPLICATIONS/CONCLUSIONS: Dietetics professionals should base their advice on the dietary strategies used by consumers rather than hypothetical premises such as food or nutrient groupings. Nutrition education interventions will have better chances for success if they are based on a set of customized programs that guide appropriate consumer segments through a series of small, comfortable, and sustainable dietary changes over a prolonged period of time.     

Combined effects of dietary fat and birth weight on serum cholesterol concentrations: the Hertfordshire Cohort Study

BACKGROUND: Blood cholesterol responses to the manipulation of dietary fat vary widely between persons. Although epidemiologic evidence suggests that prenatal growth and nutrition influence adult cholesterol homeostasis, whether prenatal growth modifies the association between dietary fat intake and serum cholesterol concentration in adults is unknown. OBJECTIVE: The aim was to examine the relation between fat intake and serum cholesterol concentrations in men and women whose birth weights were known. DESIGN: We studied a cohort of men and women aged 59-71 y. Diet was assessed with a food-frequency questionnaire. Total, HDL-, and LDL-cholesterol concentrations and the ratio of HDL to LDL cholesterol were measured in fasting blood samples from 574 men and 562 women who did not have coronary heart disease. RESULTS: Total and saturated fat intakes were not associated with serum cholesterol concentrations in men or women. However, subdivision by birth weight showed associations in men but not in women. High intakes of total and saturated fat were associated with reduced HDL-cholesterol concentrations in men with birth weights < or =3.2 kg (7 lb) but not in men with higher birth weights. Similar effects on the HDL-to-LDL cholesterol ratio were observed (P for interaction = 0.02 for total fat and 0.01 for saturated fat). When 32 men taking cholesterol-lowering medication were excluded, the interactions were strengthened (P = 0.008 and 0.006, respectively). CONCLUSION: The adverse effects of high intakes of total and saturated fat on serum cholesterol concentrations in men may be confined to those with lower birth weights.     

Longitudinal study of dietary intakes and plasma lipids in healthy elderly men and women.

Dietary intakes and blood lipid concentrations were assessed in elderly men (n = 65) and women (n = 92) from 1980 through 1989. Mean age in 1980 was 70 y (range 60-84 y). Health and socioeconomic status was above that found in the general US elderly population. Cross-sectional and longitudinal changes in variables were determined by using least-squares linear regression. No significant cross-sectional differences in energy (kJ/kg), protein (g/kg), total fat, and carbohydrate intake with age was noted. Significant longitudinal decreases in total fat, saturated and polyunsaturated fatty acids, and cholesterol intakes were noted in both men and women. Significant decreases in total, HDL, and LDL plasma cholesterol concentrations were noted over time in both men and women. Ratios of both total and LDL cholesterol to HDL cholesterol increased over time. The decrease in total fat and cholesterol intakes were significantly correlated with the decrease in total plasma cholesterol.     

Women and Men with Hypercholesterolemia Respond Similarly to an American Heart Association Step 1 Diet

Objective To compare serum lipid level responses of women and men with hypercholesterolemia to an American Heart Association (AHA) step 1 diet.Design Sixty-three women and 99 men with varying degrees of hypercholesterolemia were instructed on an AHA step 1 diet. Subjects were followed up on a biweekly basis with individual visits and group classes for 8 weeks.Setting Outpatient clinic facility of the Metabolic Research Group, University of Kentucky, Lexington.Subjects/samples Through community cholesterol screenings, we recruited 76 women and 108 men aged 30 to 70 years who were within 80% to 130% of their ideal body weight. Serum cholesterol levels were between 5.17 mmol/L and 8.99 mmol/L and serum triglyceride levels when subjects were fasting were less than 5.08 mmol/L. Sixty-three women and 99 men completed the study.Intervention Subjects followed an AHA step 1 diet (30% of energy from fat, 50 to 60% of energy from carbohydrate, 10 to 20% of energy from protein, and less than 300 mg cholesterol per day) for 8 weeks.Main outcome measures Serum lipid levels, nutrient intake, and body weight.Statistical analyses performed Subjects were divided into three groups according to initial serum cholesterol levels (mild=5.17 to 6.17 mmol/L; MODERATE=6.20 to 6.95 mmol/L; SEVERE = 6.98 mmol/L). Within-individual changes in nutrient intakes, body weights, and serum lipid levels were analyzed using dependent t tests. Between-group comparisons were made using analysis of variance (ANOVA). When significant differences were found using ANOVA, differences between groups were evaluated with the Tukey test.Results All subjects tolerated the diet well and average dietary adherence was good, as assessed by a food frequency questionnaire and analysis of 3-day diet records. Serum total cholesterol levels decreased 9.2% overall for women (P<.001) and 7.2% for men (P<.001); serum low-density lipoprotein cholesterol levels decreased 9.2% for women and 9.8% for men; and serum high-density lipoprotein cholesterol levels decreased 3.6% for women and 2.8% for men. Mean serum triglyceride levels decreased significantly for women but not for men. No significant differences were found in the responses of women and men in the corresponding groups. Women and men with higher initial serum cholesterol values showed significantly greater hypocholesterolemic responses to diet than those with lower initial serum cholesterol values.Applications/conclusions The findings of this study confirm the beneficial role of dietary intervention for reducing atherogenic serum lipid levels in women and men. J Am Diet Assoc. 1995; 95:436–441.     

Dietary intake, supplement use, and survival among women diagnosed with early-stage breast cancer

Previous studies examining the relationship between micronutrient intakes and survival following diagnosis of breast cancer have reported mixed results. This may be partly due to considerable variance in amounts of micronutrients consumed from diet and supplements across studies. Early-stage breast cancer survivors (N = 3081) completed four 24-h dietary and supplement recalls at the baseline assessment (1995 to 2000) and were followed for a median of 9.0 yr. Mean micronutrient intakes were compared to dietary reference intakes (DRI) to assess micronutrient adequacy for both users and nonusers of supplements. Cox regressions were performed to assess whether intakes of selected micronutrients were associated with all-cause mortality. Four hundred and twelve deaths occurred between baseline and August 2009. Among these women, more supplement users had adequate micronutrient intakes than nonusers for 15 out of 17 micronutrients. Less than 10% of supplement users (<2% of nonsupplement users) reported levels that exceeded the tolerable upper limit for each micronutrient except magnesium. After adjusting for age, tumor characteristics, and health status variables, micronutrient intakes were not significantly associated with all-cause mortality. Dietary supplements may improve overall micronutrient intakes of breast cancer survivors. However, vitamin and mineral intakes were not associated with all-cause mortality.     

Trends in serum total cholesterol and dietary fat intakes in New Zealand between 1989 and 2009

Objective : To describe trends in serum cholesterol and dietary fat intakes for New Zealand adults between 1989 and 2008/09. Methods : Serum total cholesterol concentrations and dietary fat intakes were analysed for 9,346 New Zealanders aged 15–98 years (52% women) who participated in three national surveys in 1989, 1997 and 2008/09. Results : Population mean serum cholesterol decreased from 6.15 mmol/L in 1989 to 5.39 mmol/L in 2008/09. Mean saturated fat intake decreased from 15.9% of energy intake in 1989 to 13.1% in 2008/09. Between 1997 and 2008/09, unsaturated fat intake increased and fat from butter and milk decreased. Older adults had the largest decrease in serum cholesterol (1.35 mmol/L). Conclusions : The decrease in serum cholesterol is substantially larger than reported for many other high‐income countries, and occurred in parallel with changes in dietary fat intakes and, for older adults, increased use of cholesterol‐lowering medications. Implication : Given the demonstrated role of reduced saturated fat intake on lowering serum cholesterol, and as population average serum cholesterol levels and saturated fat intakes exceed recommended levels, initiatives to further encourage reductions in saturated fat are imperative.