A low-fat intake and greater activity level are associated with lower weight regain 3 years after completing a very-low-calorie diet

OBJECTIVE: To examine the roles of diet, exercise, and lifestyle factors in determining long-term weight regain after weight loss with a very-low-calorie diet (VLCD). SUBJECTS: Twenty-seven of 38 women who lost weight with a VLCD. DESIGN: Graduates of a weight loss intervention study returned for follow-up 3 years after program completion. Percentage of initial weight loss that was regained was correlated with subjects' fat intake (assessed via 7-day food records and a Diet Habit Survey), energy intake (assessed via 7-day food records), activity level and lifestyle factors (assessed via questionnaires) that are supportive of weight loss maintenance. STATISTICAL ANALYSES PERFORMED: Regression analysis was used to assess the relationship of weight regain with fat intake, activity level, and energy intake. Contingency table analysis was used to assess the association between weight regain and lifestyle factors. RESULTS: Subjects followed experienced a -20.7kg+/-9.2kg (-19.2%+/-7%) (mean+/-standard deviation) weight change during the original VLCD program and a 13.9kg+/-11.3kg (76.6%+/-52.1%) weight change 3 years post-VLCD. Fat intake, assessed by a 7-day food diary, was positively correlated with weight regain at 3 years (r=0.66, P=.0004). Less weight regain was also seen with a lower percent fat intake as reflected by a higher Diet Habit Survey score (r=-0.55, P=.004). Women with the lowest tertile of reported fat intake (<25% of energy) from the Diet Habit Survey regained the least amount of weight (P=.05). Activity level was negatively correlated with weight regain (r=-0.53, P=.005). After correction for multiple comparisons, there was no association between total energy intake and weight regain. Lifestyle factors were also not associated with weight regain.Applications/conclusions: Identifying strategies to maintain weight loss is crucial because of the negative health effects and increasing prevalence of obesity. For women who have lost weight on a VLCD, limiting dietary fat intake and maintaining physical activity are both important factors for the prevention of weight regain. To promote better weight loss outcomes, registered dietitians should help clients who have lost weight limit their fat intake to less than 30% of energy and encourage high activity levels.     

A Worksite Program for Overweight Middle-Aged Men Achieves Lesser Weight Loss With Exercise Than With Dietary Change

Objective To compare changes in total and regional body composition using dual energy X-ray absorptiometry (DEXA) after subjects lost weight through change in diet or exercise.Design A 12-month, randomized, controlled study of two weight-loss interventions — low-fat diet ad libitum or moderate, unsupervised exercise — in free-living, middle-aged men. Compliance was determined at monthly measurement sessions through food records and activity logs; DEXA scans were performed every 3 months.Subjects/setting Fifty-eight overweight men (mean body mass INDEX=29.0±2.6; mean AGE=43.4±5.7 years) recruited from a national corporation were assigned randomly to diet, exercise, or control groups.Interventions One group reduced dietary fat to 26.4% of energy intake but kept activity unchanged; another group self-selected aerobic exercise (three sessions per week at 65% to 75% maximum heart rate) but kept diet unchanged. A control group maintained weight.Main outcome measures At 12 months, measurements of weight, total and regional fat mass and lean mass, energy intake, and percentage dietary fat; physical activity indexes. Statistical analyses Results were analyzed using paired t tests and analysis of variance.Results Mean weight loss was 6.4±3.3 kg in dieters and 2.6+3.0 kg in exercisers; control subjects maintained weight. DEXA scans revealed that 40% of dieters’ weight loss was lean tissue; more than 80% of weight lost by exercisers was fat. Exercisers maintained limb lean tissue and lost fat mass.Conclusions Greater total weight and lean tissue loss occurred when subjects lost weight through a low-fat diet consumed ad libitum than when subjects participated in unsupervised aerobic exercise. Use of DEXA enabled identification of progressive total and regional changes in fat and lean tissue. J Am Diet Assoc. 1997; 97:37–42.     

Behavioral and body size correlates of energy intake underreporting by obese and normal-weight women

Objective To examine behavioral and body size influences on the underreporting of energy intake by obese and normal-weight women.Design Seven-day estimated food records were kept by subjects before they participated in a 49-day residential study. Self-reported energy intake was compared with energy intake required to maintain a stable body weight during the residential study (reference standard). Energy intake bias and its relationship to various body size and behavioral measures were examined.Subjects Twenty-two, healthy, normal-weight (mean body mass index [BMI]=21.3) and obese (mean BMI=34.2) women aged 22 to 42 years were studied.Statistical analyses Analysis of variance, paired t test, simple linear regression, and Pearson correlation analyses were conducted.Results Mean energy intake from self-reported food records was underreported by normal-weight (−9.7%) and obese (−19.4%) women. BMI correlated inversely with the energy intake difference for normal-weight women (r=−.67, P=.02), whereas the Beck Depression Inventory correlated positively with the energy intake difference for obese women (r=.73, P<.01).Conclusion/applications Results suggest that body size and behavioral traits play a role in the ability of women to accurately self-report energy intake. BMI appears to be predictive of underreporting of energy intake by normal-weight women, whereas emotional factors related to depression appear to be more determinant of underreporting for obese women. Understanding causative factors of the underreporting phenomenon will help practicing dietitians to devise appropriate and realistic diet intervention plans that clients can follow to achieve meaningful change. J Am Diet Assoc. 1999;99:300-306.     

Dietary Intake and Counseling, Weight Maintenance, and the Course of HIV Infection

Objective To define relationships among dietary intake and counseling, weight maintenance, and the clinical course of patients infected with the human immunodeficiency virus(HIV).Design A prospective cohort study in an HIV clinic in a county hospital.Subjects HIV-infected patients (68 with and 40 without acquired immunodeficiency syndrome [AIDS]) who had a good performance status and no chronic diarrhea were assessed at entry to the study and after 6 months. The following assessments were made: energy and nutrient intake based on 7-day food records, anthropometric measurements, immunologic function as lymphocyte T-cell subpopulations (ratio of CD4 to CD8), and serum cholesterol level. Patients were monitored to determine clinical outcome.Intervention All patients received standardized dietary counseling designed to address identified intake deficiencies and maintain body weight.Main outcome measures Changes in energy and nutrient intake, body weight, and clinical outcome (ie, time to AIDS-defining illness and overall survival time).Statistical analyses performed Group differences (HIV group vs AIDS group) were sought using χ² analyses and Student's t test. A multivariate regression model was used to determined the best predictors of clinical outcome.Results At baseline, total energy intake (based on 30 kcal/kg usual body weight) was adequate in both HIV and AIDS patients (101±4% and 103±5% [mean±standard deviation] of need, respectively). Despite dietary counseling and continued maintenance of energy intake, body weight, serum cholesterol level, and CD4 level progressively decreased. Consequently, saturated fat intake was found to be inversely related (P<.01) to serum cholesterol level. Clinical outcome (after 3.5 years) was associated with baseline ratio of CD4 to CD8 (P<.0001), weight (P<.01), and serum cholesterol level (P<.001). Multivariate analysis related ratio of CD4 to CD8 (P<.001) and weight maintenance (P<.001) to favorable outcome in the final model.Applications Weight loss in patients with HIV infection is independently prognostic of clinical outcome, and development of hypocholesterolemia is not favorable for clinical outcome. Because weight loss progresses despite conventional dietary counseling to identify energy need, interventions earlier in the disease course should be considered along with increased target levels for energy intake. J Am Diet Assoc. 1995; 95:428–432, 435.     

Body Composition, Dietary Intake, and Energy Expenditure in Nonobese, Prepubertal Children of Obese and Nonobese Biological Mothers

Objective To determine differences in dietary intake, resting energy expenditure, activity level, fat-free mass, and percentage body and abdominal fat in nonobese children of obese mothers compared with nonobese children of nonobese mothers.Design Cross-sectional comparison study. Children's food diaries were analyzed to determine average energy and nutrient content. Resting energy expenditure of children was measured by means of indirect calorimetry. Children's activity levels were estimated through questionnaires administered during interviews. Dual-energy x-ray absorptiometry was used to estimate body composition of children.Subjects Mothers of subjects responded to advertisements and were recruited as nonobese (body mass INDEX=20 to 25) or obese (body mass index ≥30). Offspring included in the study were prepubertal and nonobese (10th to 90th percentile of weight for height by gender). Twelve pairs of children could be matched for weight, gender, and age.Statistical analysis performed Wilcoxon signed rank tests were used to determine differences between the 2 groups of children.Results Percentage abdominal fat was greater (median DIFFERENCE=3.15, P=.001) and fat-free mass was lower (median DIFFERENCE=1.19, P=.04) in children of obese mothers compared with children of nonobese mothers. No statistically significant differences between the 2 groups of children were found for dietary intake, resting energy expenditure, activity level, or percentage body fat.Applications/conclusions The significantly higher percentage of abdominal fat and lower fat-free mass in children of obese mothers may contribute to obesity onset. Use of dual-energy x-ray absorptiometry as a screening tool for nonobese, prepubertal children with an obese parent will help to identify those at risk. Education and lifestyle changes can then be implemented to help prevent the onset of obesity. J Am Diet Assoc. 1999;99:58-65.     

The Gustaf Study: Repeated, Telephone-Administered 24-hour Dietary Recalls of Obese and Normal-Weight Men — Energy and Macronutrient Intake and Distribution Over the Days of The Week

Objective A dietary survey of obese and control men was conducted through 24-hour dietary recalls administered by telephone at 12 times selected randomly over a period of 3 months. Energy and macronutrient intake and distribution were studied for all days of the week.Subjects Eighty-six obese men, 20 to 60 years old, body mass index (BMI)= 37.7±4.4 (mean±standard deviation) from the waiting list of the outpatient clinic and 61 normal-weight (BMI= 23.0±1.9), age-matched men selected randomly from the Stockholm County Census Bureau.Main outcome measures Energy and macronutrient intake, intakes by energy tertiles, and distribution over the days of the week.Statistical analyses Nonparametric tests were used because of skewed distribution of most food data.Results A median daily energy intake of 2,700 kcal was found in both groups. The obese men reported a higher protein (P<.001) and a lower alcohol (P<.001) intake than the control subjects. Both groups reported a maximum intake of energy and macronutrients on Saturdays. When separated into tertiles according to reported energy intake, the obese men in tertile 3 reported a higher intake from fat (% energy, P<.001) and a lower intake from protein (P<.01) compared with men in tertile 1. Normal-weight men in tertile 3 reported a higher intake from fat (% energy, P<.01) compared with men in tertile 1.Conclusions When reported energy intake was compared with calculated total daily energy expenditure, there was a greater discrepancy in the obese group than in the control group. The normal-weight men may have had a special interest in food and health, and this group may not reflect the population at large. J Am Diet Assoc. 1996; 96:686–692.     

Diet Composition Related to Body Fat in a Multivariate Study of 203 Men

Objective To assess whether usual diet (especially intake of dietary fat, carbohydrate, and fiber) was related to body fat percentage in healthy men.Design A written questionnaire provided data on demographic and lifestyle characteristics. Dietary fat, carbohydrate, protein, and fiber intakes were analyzed using the National Cancer Institute food frequency questionnaire. Percentage of body fat was determined using three-site skinfold measurements, and a submaximal treadmill test was used to estimate aerobic fitness.Subjects Subjects were 203 healthy men (14.0±5.3% mean body fat) aged 21 to 71 years. The subjects were chosen from randomly selected districts within Utah County and volunteered for free diet and fitness evaluations.Statistical analysis Multiple regression analysis determined the extent to which the individual diet components predicted body composition before and after controlling for energy intake, fitness level, body weight, and age. Multivariate analysis of variance was used to compare relative body fat groups in regard to dietary variables.Results Reported intakes of carbohydrate (P=.0085, R²=.022), complex carbohydrate (P=.0127,R²=.024), and fiber (P=.002, R²=.03) were inversely associated with body fat after controlling for age, energy intake, and fitness level. Energy intake was positively related to body fat after controlling for age, fitness level, and body weight. When subjects were separated into low-, moderate-, and high-body-fat groups, the fattest subjects reported eating significantly more dietary fat (P=.05) and less carbohydrate (P=.01), complex carbohydrate (P=.01), and fiber (P=.005) than the leanest subjects. No significant difference in reported energy intake was noted across body fat groups.Applications Composition of the diet may play a role in obesity beyond energy intake in men over the long-term. Lifestyle changes for men should probably include modifications in diet composition, especially increased consumption of foods high in complex carbohydrate and fiber. J Am Diet Assoc. 1996; 96:771–777.     

Persons Successful at Long-term Weight Loss and Maintenance Continue to Consume a Low-energy, Low-fat Diet

Objectives To describe the dietary intakes of persons who successfully maintained weight loss and to determine if differences exist between those who lost weight on their own vs those who received assistance with weight loss (eg, participated in a commercial or self-help program or were seen individually by a dietitian). Intakes of selected nutrients were also compared with data from the third National Health and Nutrition Examination Survey (NHANES III) and the 1989 Recommended Dietary Allowances (RDAs).Subjects Subjects were 355 women and 83 men, aged 18 years or older, primarily white, who had maintained a weight loss of at least 13.6 kg for at least 1 year, and were the initial enrollees in the ongoing National Weight Control Registry. On average, the participants had lost 30 kg and maintained the weight loss for 5.1 years.Methods A cross-sectional study in which subjects in the registry completed demographic and weight history questionnaires as well as the Health Habits and History Questionnaire developed by Block et al. Subjects’ dietary intake data were compared with that of similarly aged men and women in the NHANES III cohort and to the RDAs. Adequacy of the diet was assessed by comparing the intake of selected nutrients (iron; calcium; and vitamins C, A, and E) in subjects who lost weight on their own or with assistance.Results Successful maintainers of weight loss reported continued consumption of a low-energy and low-fat diet. Women in the registry reported eating an average of 1,306 kcal/day (24.3% of energy from fat); men reported consuming 1,685 kcal (23.5% of energy from fat). Subjects in the registry reported consuming less energy and a lower percentage of energy from fat than NHANES III subjects did. Subjects who lost weight on their own did not differ from those who lost weight with assistance in regards to energy intake, percent of energy from fat, or intake of selected nutrients (iron; calcium; and vitamins C, A, and E). In addition, subjects who lost weight on their own and those who lost weight with assistance met the RDAs for calcium and vitamins C, A, and E for persons aged 25 years or older.Applications Because continued consumption of a low-fat, low-energy diet may be necessary for long-term weight control, persons who have successfully lost weight should be encouraged to maintain such a diet. J Am Diet Assoc. 1998;98:408–413.     

Evaluation of Predicted and Measured Energy Requirements in Burned Children

Objective The energy predictions of nine calculations for pediatric patients were compared with measured resting energy expenditure (MREE) by means of indirect calorimetry to determine the optimal means of energy projection in the burn population younger than 3 years of age.Methodology Nutritional sufficiency and maintenance of preburn weight were factors in the confirmation of energy needs. Demographic factors were also studied: preburn weight, percent burn, percent third-degree burn, and age. Group 1 consisted of 24 patients younger than 3 years of age (range=7 months to 2.6 years) with a percent burn of 30.6±2.0 and percent third-degree burn of 21.9±2.6. Group 2, consisting of 24 patients 5 to 10 years old matched by percent burn and percent third-degree burn, was included to determine whether differences between actual and projected needs were evident in older, prepubescent patients.Statistical analysis Analysis of variance was used to ascertain the most reliable multiplier for MREE needed to maintain at least 95% of preburn weight at discharge while ensuring adequate nutrition. Multiple regression analysis was used to determine the relationship between energy requirement and body weight, percent burn, and age. Results An additional 30% of MREE provided a consistent ratio of actual energy intake to required intake. MREE × 1.3 was used as a guide to study the existing calculations. For both groups, the four equations that predicted energy in healthy children most often underestimated MREE × 1.3, whereas the five formulas for children with burns tended to overpredict energy. Regression analysis yielded two new sets of equations using age, preburn weight, and percent burn (<3 YEARS=Mayes 1 [r².71], 5 to 10 YEARS=Mayes 3 [r²=.70] or percent third-degree burn (<.3 YEARS=Mayes 2 [r²=.68], 5 to 10 YEARS=Mayes 4 [r²=.67]).Conclusions The application of a 30% factor to MREE is supported in burn patients younger than 10 years of age. Standard energy projections do not provide an accurate assessment of energy needs in the pediatric burn population; thus, two sets of equations that more closely predict energy needs are proposed. J Am Diet Assoc. 1996; 96:24-29.     

Using Cluster Analysis to Examine Dietary Patterns: Nutrient Intakes, Gender, and Weight Status Differ Across Food Pattern Clusters

Objective This study explored the usefulness of cluster analysis in identifying food choice patterns of three groups of adults in relation to their energy intake.Design Food frequency data were converted to percentage of total energy from 38 food groups and entered into a cluster analysis procedure. Subjects in the emerging food group patterns were compared in terms of weight status, demographics, and the nutrition composition of their usual diet.Setting Data were collected as part of three studies in two US metropolitan areas using identical protocols. Participants were university employees (103 women and 99 men) who volunteered for a reliability study of health behavior questionnaires and moderately obese volunteers (223 women and 101 men) to two weight-loss studies who were recruited by newspaper advertisements.Statistical analysis performed Subjects were clustered according to food energy sources using the FASTCLUS procedure in the Statistical Analysis System. One-way analysis of variance and χ² analysis were then performed to compare the weight status, nutrient intakes, and demographics of the food patterns.Results Six food pattern clusters were identified. Subjects in the two clusters associated with high consumption of pastry and meat had significantly higher fat intakes (P=.0001). Subjects in two other clusters, those associated with high intake of skim milk and a broad distribution of energy sources had significantly higher micronutrient levels (P=.0001). Body mass index and the distribution of gender were also significantly different across clusters.Conclusions The success of cluster analysis in identifying dietary exposure categories with unique demographic and nutritional correlates suggests that the approach may be useful in epidemiologic studies that examine conditions such as obesity, and in the design of nutrition interventions. J Am Diet Assoc. 1997:97:272–279.     

A Longitudinal Study of Children’s Juice Intake and Growth: The Juice Controversy Revisited

Objectives To determine associations between children’s longitudinal juice intake and growth parameters at age 72 months and to determine children’s beverage intake patterns over time.Subjects/setting White children (n=72) residing in the vicinity of a Southern US city participated in a longitudinal study.Methods Seven in-home interviews were conducted per child when each child was between 24 and 72 months of age. The 7 sets of 3-day dietary data were analyzed for beverage intake, categorized as juice (100% juice only), milk, carbonated beverages, and other drinks (eg, lemonade, tea, juice drinks). The following growth parameters were determined for each child at age 72 months: height, weight, body mass index (measured as kg/m²), and ponderal index (measured as kg/m³); the 3 latter are measures of overweight.Statistical analyses Associations between longitudinal juice intake and each growth parameter were tested with general linear models. Repeated measures analysis of variance tested changes in beverage intakes over time.Results There were no statistically significant associations between juice and children’s height, weight, or body mass index, as tested by general linear models. Children’s longitudinal juice intake was negatively related to ponderal index (β=0.065, P=.050). Children’s juice intake decreased significantly between ages 2 and 6 years, from 6.8 to 3.6 oz/day (P=.0001); intakes of carbonated beverages and other drinks increased from 1.7 to 3.8 oz/day (P=.0016) and from 2.7 to 6.2 oz/day (P=.0001), respectively.Applications/conclusions Children’s longitudinal juice intake was not associated with either short stature or overweight. As juice consumption decreased, intakes of less nutritious beverages increased. Consumption of 100% juices should be encouraged by health professionals and parents/caregivers. J Am Diet Assoc. 2001; 101:432-437.     

Dietary Fiber Intakes and Insulin Requirements Pregnant Women with Type 1 Diabetes

Objective To determine whether higher dietary fiber intake (water soluble and insoluble) is associated with lower insulin requirements and better glycemic control in pregnant women with type 1 diabetes consuming a self-selected diet.Design A longitudinal, observational study.Subjects Pregnant women (n=141) with type 1 diabetes participating in an interdisciplinary program examining the effects of glycemic control on pregnancy outcome (Diabetes and Pregnancy Program, University of Cincinnati Medical Center).Measurements We determined total, water soluble and insoluble fiber intakes f, om 3-day food records kept each trimester during pregnancy. Outcome measures were insulin dose, pre-meal blood glucose, and glycated hemoglobin concentrations.Statistical analyses Correlation coefficients, multiple regression, mixed-model analysis of variance.Results Mean intakes (g/day) of total, water soluble fiber, and insoluble fiber were 14.0 (range, 1.8-33.1), 4.8 (range, 0.6-10.5) and 9.0 (range, 1.1-24.0), respectively. In the second and third trimesters of pregnancy, insulin requirements were inversely associated with total, water soluble, and insoluble fiber intakes; the correlation coefficients ranged from −0.22 to −0.17 (P=.02 to 0.08). Insulin requirements associated with a higher fiber intake (20.5 g/day) were 16% to 18% lower than for a lower fiber intake (8.1 g/ day). These relations remained after adjustment for body weight, disease severity and duration, insulin type, and study year in the second (P=.03 to 0.10) but not in the third trimester. Pre-meal blood glucose and glycated hemoglobin concentrations were not associated with fiber intake.Conclusions Among pregnant women with type 1 diabetes, higher fiber intake is associated with lower daily insulin requirements. Dietary fiber intake should be considered when counseling patients about the management of blood glucose concentrations. J Am Diet Assoc. 2001; 101: 305-310.     

Cross-Validation of Prediction Equations for Resting Energy Expenditure in Young, Healthy Children

Objective To examine the accuracy of several prediction equations for resting energy expenditure (REE) in children.Design REE was measured in 113 prepubertal children (60 girls and 53 boys aged 3.9 to 7.8 years old, weighing 14.7 to 30.0 kg) using indirect calorimetry and compared with values estimated from the prediction equations of Altman and Dittmer, The Food and Agriculture Organization/World Health Organization/United Nations University (FAO/WHO/UNU), Maffeis et al, and Harris and Benedict.Statistical analysis Measured REE (MREE) was compared with predicted REE (FREE) by means of regression analysis. Prediction equations were considered accurate if the regression of MREE vs FREE was not significantly different from the line of identity (slope=l.0; INTERCEPT=0). Precision was assessed by the multiple correlation coefficient of the regression of MREE vs FREE.Results MREE was 938±119 kcal/day, and FREE was 1,057+224 kcal/day for the Altman and Dittmer equations, 956±84 kcal/day for the FAO/WHO/UNU equations, 948±64 kcal/day for the equations of Maffeis et al, and 954+102 kcal/day for the Harris-Benedict equations. The regression of MREE vs FREE was significantly different from the line of identity for all prediction equations except the FAO/WHO/UNU equations (slope=0.96, P=.735; INTERCEPT=–15 kcal/day, P=.885 for girls and SLOPE=1.08, P=.635; INTERCEPT=-62 kcal/day, P=.635 for boys). None of the equations was precise for MREE vs FREE (for all, R²<.6). For the FAO/WHO/UNU equations, less than half of the predictions were within ±50 kcal/day but 99% were within 200 kcal/day.Conclusion Most prediction equations for REE in children do not accurately or precisely estimate REEs. The exception is the FAO/WHO/UNU equations, which are reasonably accurate and precise for practical purposes. J Am Diet Assoc. 1997;97: 140–145.     

Impact of Adopting Lower-Fat Food Choices on Energy and Nutrient Intakes of American Adults

Objective To evaluate the energy and nutrient intake of free-living men and women who choose foods consistent with different fat-reduction strategies.Design For each year of the Continuing Survey of Food Intake by Individuals from 1989 through 1991, food codes were used to sort respondents by type of milk; type of meats; and type of cheese, yogurt, salad dressing, cake, and pudding (ie, full-fat or fat-modified products) consumed.Subjects A nationally representative sample of 3,313 men and 3,763 women who completed 3-day intake records and consumed either a reduced-fat or full-fat food from at least 1 of the 3 fat-reduction strategy categories.Statistical analysis performed Analysis of variance with the Scheffé test was used to analyze differences in energy and nutrient intake between exclusive users, mixed users, and nonusers of each strategy or combined strategies.Results Regardless of fat-reduction strategy, men and women who used them reported significantly lower intakes of total fat (up to 18 g lower), saturated fat (up to 12 g lower), cholesterol (up to 75 ing lower) and energy compared with nonusers. Exclusive users of single strategies met or approached recommendations of the National Cholesterol Education Program for total fat, saturated fat, and cholesterol intake; micronutrient intake varied depending on the strategy used. Skim milk users had the most favorable micronutrient intake, whereas lean meat users reported inadequate intake of zinc (men 6396 and women 59% of the Recommended Dietary Allowances [RDAs]) and female users of fat-modified products reported inadequate intakes of vitamin E (64% of RDA) and zinc (65% of RDA). Multiple-strategy users achieved National Cholesterol Education Program goals and reported adequate micronutrient intakes and significantly lower energy intake. Mixed users of fat-modified products compared with nonusers of any fat-modified products had adequate micronutrient intake and lower intakes of total fat (32% vs 36% of energy for men and 32% vs 35% of energy for women) and saturated fat (11% vs 13% of energy for men and 11% vs 12% of energy for women). In addition, nonusers of any fat-modified strategy had the highest cholesterol and energy intake and the lowest intake of. many micrbnutrients.Applications A variety of fat-reduction strategies can be implemented to reduce energy, total fat, saturated fat, and cholesterol intake. Some of the strategies were associated with an inadequate micronutrient intake, so additional dietary guidance is needed to ensure that all nutrient requirements are met. Furthermore, people who do not use any fat-reduction strategy or those who exclusively use lean meats or fat-modified products would benefit from understanding how to balance their food choices. J Am Diet Assoc. 1999;99:177–183.     

Dietary Assessment Instruments are Susceptible to Intervention-associated Response Set Bias

Objective Evaluations of trials of the effectiveness of dietary intervention programs may be compromised by response set biases, such as those attributable to social desirability. Participants who receive a behavioral intervention may bias their reports of diet to appear in compliance with intervention goals. This study examined whether responses to standard dietary assessment instruments could be affected by a brief dietary intervention.Design We assigned 192 undergraduate students randomly to (a) see a 17-minute videotape on the consequences of eating a high-fat diet or a placebo videotape on workplace management and (b) receive preintervention and post-intervention assessments or only postintervention assessment. Dietary assessments included 4 independent measures of fat intake.Results Among women, bias (intervention minus control) was −9.7 g fat (from a short food frequency questionnaire) and −0.6 high-fat foods (from a questionnaire about use of 23 foods in the previous day) (P<.05 for both). No results were significant among men or for 2 instruments that measured more qualitative aspects of fat-related dietary habits.Applications Even a modest dietary intervention can affect responses to dietary assessment instruments. Nutritionists should recognize that assessment of adherence to dietary change recommendations, when based on dietary self-report, can be overestimated as a result of response set biases. J Am Diet Assoc. 1998;98:40-43.     

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.     

Decreased Fat and Nitrogen Losses in Patients with AIDS Receiving Medium-Chain-Triglyceride-Enriched Formula Vs Those Receiving Long-Chain-Triglyceride-Containing Formula

Objective The purpose of this study was to compare two enteral formulas, differing only in fat source, for product acceptance, tolerance, and effect on fat malabsorption and nutritional status in subjects with acquired immune deficiency syndrome (AIDS).Design The double-blind, randomized 15-day trial was divided into a 3-day period in which solid food was consumed followed by a 12-day experimental period in which liquid formulas were consumed.Setting/subjects Twenty-three men and one woman with AIDS and fat malabsorption completed the study. The study was conducted in the General Clinical Research Center, University of Alabama Hospital, University of Alabama at Birmingham. Laboratory assays were performed in the Department of Nutrition Sciences.Interventions After 3 days of consuming a controlled, solid food diet containing 100 g fat per day from mixed sources to document fat malabsorption, subjects were randomly assigned to one of two groups. Each group received a liquid formula containing 35% of energy as fat for 12 days. One group received a formula containing 85% medium-chain triglycerides (MCTs) and the control group received a formula containing 100% long-chain triglycerides.Main outcome measures Determinations included stool number, consistency, weight, and fat and nitrogen content; urine nitrogen and creatinine levels; and body weight.Statistical analysis performed Subject demographic and other baseline characteristics were compared using two-sample t tests; stool and urine assessments were compared between groups at the initial experimental period using two-sample t tests; changes from initial to final experimental periods were assessed by means of analysis of covariance; changes in pooled intake, body weight, and the number and consistency of bowel movements were also assessed using analysis of covariance. All statistical tests were two-tailed and considered significant at P<.05.Results Within-group comparisons indicated that subjects fed the MCT formula showed significantly decreased stool fat and stool nitrogen content (P=.01 and P=.03, respectively) and increased fat absorption (P=.03), whereas those fed the control formula did not. Differences in stool fat between the groups were not statistically significant. However, the difference in fat absorption from the initial to final formula period was significant (P=.04). Subjects consuming the MCT formula also tended to have a decreased number of bowel movements and abdominal symptoms, whereas subjects fed the control formula showed no improvement. All subjects maintained their body weights.Applications There may be advantages to using an MCT-based formula in the treatment of AIDS-associated malabsorption.     

Estimation of Individual Intakes of Folate in Women of Childbearing Age With and Without Simulation of Folic Acid Fortification

Objectives The objectives of this study were to examine variability of folate intake in order to estimate the number of days needed to accurately estimate intakes in women of childbearing age and to simulate the effect of folic acid fortification of cereals and grains on individual folate intake.Design Observational study of food intake over a 60-day period.Sampling A convenience sample of 21 women completed food records on randomly assigned days within a 60-day period.Outcomes measured Folate intake and variance ratios of folate intake.Statistical analysis Repeated measures analysis of variance.Results Six days of food records were needed to describe folate intake of these women of childbearing age (18 to 45 years) with 20% attenuation of a correlation coefficient between dietary folate intake and another biological variable. Seven days of records were needed with simulated folic acid fortification (assuming fortification of 140 μg folic acid per 100 g flour) and 5 days were needed with supplements containing 200 to 400 μg folic acid in addition to folic acid fortification. Food folate intake was 288±195 μg; only 2 of the participants consumed the recommended 400 μg. With fortification, folate intake increased to 550±279 μg without supplements and 609±327 μg with supplements.Applications Individual intakes of folate should be assessed with at least 7 days of dietary records (20% attenuation). In this sample, when folic acid fortification was added to dietary intake, routine supplementation was not necessary to achieve folate intakes of 400 μg in the majority of participants. The practice of routine folic acid supplementation should be considered carefully to ensure that individual intakes of folate do not exceed the upper limits of safety. J Am Diet Assoc. 1998;98:985-988.     

Estimated Intakes of Trans Fatty and Other Fatty Acids in the US Population

Objective To estimate mean level of trans fatty acid intakes using a representative sample of the US population.Design The study used food intake data from the 1989-1991 Continuing Survey of Food Intakes by Individuals (CSFII) and the trans fatty acid contents of specific foods calculated from a database compiled by the US Department of Agriculture (USDA) to estimate the mean level and deciles of trans fatty acid intake of the representative US population.Subjects/setting Trans fatty acid intakes were estimated for each subject (N=11,258) in the CSFII data who completed both a 24-hour recall and a 2-day food record.Statistical analyses performed Weights developed by USDA for the survey were used for all data analyses. The Technical Assessment Systems (TAS) International Diet Research System (TAS-DIET), software developed by TAS, was used to derive weighted estimates of the mean and percentiles of the intake distribution. PC CARP, software designed by Iowa State University, was used to estimate standard errors.Results Mean percentage of energy ingested as trans fatty acids was 2.6% and the mean percentage of total fat ingested as trans fatty acids was 7.4%. Across all age and gender groups examined, estimates ranged from 2.6% to 2.8% and 7.1% to 7.9%, respectively.Applications/conclusions Dietetics practitioners can use the representative data of this study to help clients achieve desired changes in consumption levels of trans fatty acids.J Am Diet Assoc. 1999;99:166–174.