The impact of a long-term reduction in dietary energy density on body weight within a randomized diet trial

We examined the effect of dietary energy density change on body weight in participants of a randomized trial. Intervention participants markedly increased fruit and vegetable intake while reducing energy intake from fat. Participants were 2,718 breast cancer survivors, aged 26-74 yr, with baseline mean body mass index of 27.3 kg/m(2) (SD = 6.3). We assessed dietary intake by sets of four 24-h dietary recalls and validated with plasma carotenoid concentrations. Weight and height were measured at baseline, 1 yr, and 4 yr. Dietary energy density was calculated using food but excluding beverages. Intervention participants significantly reduced dietary energy density compared to controls and maintained it over 4 yr -- both in cross-sectional (P < 0.0001) and longitudinal (Group x Time interaction, P < 0.0001) analyses. Total energy intake or physical activity did not vary between groups. The intervention group had a small but significant weight loss at 1 yr (Group x Time interaction, P < 0.0001), but no between-group weight difference was observed at 4 yr. Our study showed that reducing dietary energy density did not result in a reduction in total energy intake and suggests that this strategy alone is not sufficient to promote long-term weight loss in a free-living population.     

Comparing advice to decrease both dietary fat and sucrose,or dietary fat only,on weight loss,weight maintenance and perceived quality of life

Abstract

This study compared two types of dietary advice on weight loss, weight maintenance and quality of life in Scottish women. One hundred and twenty-six overweight/obese sedentary women were randomly assigned to either: Group 1, reduced energy, fat and sucrose; Group 2, reduced energy and fat only; or Group 3, control. Subjects were followed up at 3 months and for a further 6 months weight maintenance. Groups 1 and 2 reported a decrease in energy intake, percentage energy fat, and increase in percentage energy total carbohydrate and protein (P <?0.001). Group 1 reduced percentage energy sucrose at 3 months (P <?0.001) but not at 9 months. Groups 1 and 2 lost body weight (2.81 kg [standard error of the mean, 0.406] and 2.6 kg [standard error of the mean, 0.506], respectively), body fat (P <?0.01) and reported increased quality of life (P <?0.05). Group 2 reported more positive changes. Both interventions were successful for weight reduction, and were maintained medium term. The associated increase in quality of life may be indicative of longer term compliance, predicting successful weight maintenance.     

Implementing a Low-Fat Eating Plan in the Women's Intervention Nutrition Study

The Women's Intervention Nutrition Study is a randomized clinical trial designed to evaluate if a lifestyle intervention targeting fat intake reduction influences breast cancer recurrence in women with early stage, resected disease receiving conventional cancer management. This report details the concept, content, and implementation of the low-fat eating plan used in the dietary intervention group of this trial. Intervention group participants were given a daily fat gram goal. The intervention was delivered by centrally trained, registered dietitians who applied behavioral, cognitive, and motivational counseling techniques. The low-fat eating plan was implemented in an intensive phase with eight biweekly (up to Month 4), individual counseling sessions followed by a maintenance phase (Month 5 up to and including Year 5) with registered dietitian visits every 3 months and optional monthly group sessions. Self-monitoring (daily fat gram counting and recording), goal setting, and motivational interviewing strategies were key components. Dietary fat intake was equivalent at baseline and consistently lower in the intervention compared with the control group at all time points (percent eneregy from fat at 60 months 23.2%±8.4% vs 31.2%±8.9%, respectively, P<0.0001) and was associated with mean 6.1 lb mean weight difference between groups (P=0.005) at 5 years (baseline and 5 years, respectively: control 160.0±35.0 and 161.7±32.8 lb; intervention 160.2±35.1 and 155.6±32.1 lb). Together with previously reported efficacy results, this information suggests that a lifestyle intervention that reduces dietary fat intake and is associated with modest weight loss may favorably influence breast cancer recurrence. The Women's Intervention Nutrition Study low-fat eating plan can serve as a model for implementing such a long-term dietary intervention in clinical practice.     

Long-Term Dietary Intake and Nutritional Deficiencies following Sleeve Gastrectomy or Roux-En-Y Gastric Bypass in a Mediterranean Population

BackgroundData on long-term dietary changes and nutritional deficiencies after sleeve gastrectomy (SG) in grade 3 obese patients are scarce.ObjectiveTo prospectively compare dietary changes and nutritional deficiencies in grade 3 obese patients 5 years after SG and Roux-en-y gastric bypass (GBP).Participants/settingThree hundred and fifty-five patients who had SG (n=61) or GBP (n=294) (May 2001-December 2006) at a Spanish university hospital.DesignLongitudinal, prospective, observational study.Primary outcomes/statistical analysesChanges in energy, macronutrient, and micronutrient intake, and weight loss were analyzed using mixed models for repeated measurements.ResultsAt the 5-year follow-up visit, the percentage of excess weight loss (P=0.420) and daily energy intake (P=0.826), as well as the proportion of energy from carbohydrates (P=0.303), protein (P=0.600), and fat (P=0.541) did not differ between surgical groups. Energy intake (P=0.004), baseline weight (P<0.001), and time period (P<0.001), but not the proportion of different macronutrients or the type of surgery, independently predicted the percentage excess weight loss over time. After SG or GBP, the mean daily dietary intake of calcium, magnesium, phosphorus, and iron was less than the current recommendations. Despite universal supplementation, the prevalence of nutritional deficiencies was comparable after SG or GBP, with 25-hydroxyvitamin D being the most commonly observed deficiency (SG, 93.3% to 100%; GBP, 90.9% to 85.7%, P=not significant). In an adjusted multivariate regression model, energy intake and lipid intake independently predicted plasma 25(OH)-vitamin D levels.ConclusionsData show that SG and GBP are associated with similar long-term weight loss with no differences in terms of dietary intake. Furthermore, data demonstrate that both types of surgeries carry comparable nutritional consequences.     

Changes in Food and Nutrient Intake and Diet Quality on a Low-Fat Vegan Diet Are Associated with Changes in Body Weight,Body Composition,and Insulin Sensitivity in Overweight Adults: A Randomized Clinical Trial

BackgroundConsuming different food groups and nutrients can have differential effects on body weight, body composition, and insulin sensitivity.ObjectiveThe aim was to identify how food group, nutrient intake, and diet quality change relative to usual-diet controls after 16 weeks on a low-fat vegan diet and what associations those changes have with changes in body weight, body composition, and measures of metabolic health.DesignSecondary analysis of a randomized clinical trial conducted between October 2016 and December 2018 in four replications.Participants/settingParticipants included in this analysis were 219 healthy, community-based adults in the Washington, DC, area, with a body mass index (BMI) between 28 and 40, who were randomly assigned to either follow a low-fat vegan diet or make no diet changes.InterventionA low-fat, vegan diet deriving approximately 10% of energy from fat, with weekly classes including dietary instruction, group discussion, and education on the health effects of plant-based nutrition. Control group participants continued their usual diets.Main outcome measuresChanges in food group intake, macronutrient and micronutrient intake, and dietary quality as measured by Alternate Healthy Eating Index-2010 (AHEI-2010), analyzed from 3-day diet records, and associations with changes in body weight, body composition, and insulin sensitivity were assessed.Statistical analyses performedA repeated-measure analysis of variance model that included the factors group, subject, and time was used to test the between-group differences throughout the 16-week study. Interaction between group and time was calculated for each variable. Within each diet group, paired comparison t tests were calculated to identify significant changes from baseline to 16 weeks. Spearman correlations were calculated for the relationship between changes in food group intake, nutrient intake, AHEI-2010 score, and changes in body weight, body composition, and insulin sensitivity. The relative contribution of food groups and nutrients to weight loss was evaluated using linear regression.ResultsFruit, vegetable, legume, meat alternative, and whole grain intake significantly increased in the vegan group. Intake of meat, fish, and poultry; dairy products; eggs; nuts and seeds; and added fats decreased. Decreased weight was most associated with increased intake of legumes (r = ?0.38; P < 0.0001) and decreased intake of total meat, fish, and poultry (r = +0.43; P < 0.0001). Those consuming a low-fat vegan diet also increased their intake of carbohydrates, fiber, and several micronutrients and decreased fat intake. Reduced fat intake was associated with reduced body weight (r = +0.15; P = 0.02) and, after adjustment for changes in BMI and energy intake, with reduced fat mass (r = +0.14; P = 0.04). The intervention group’s AHEI-2010 increased by 6.0 points on average, in contrast to no significant change in the control group (treatment effect, +7.2 [95% CI +3.7 to +10.7]; P < 0.001). Increase in AHEI-2010 correlated with reduction in body weight (r = 0.14; P = 0.04), fat mass (r = ?0.14; P = 0.03), and insulin resistance as measured by the Homeostasis Model Assessment (HOMA-IR; r = ?0.17; P = 0.02), after adjustment for changes in energy intake.ConclusionsWhen compared with participants’ usual diets, intake of plant foods increased, and consumption of animal foods, nuts and seeds, and added fats decreased on a low-fat vegan diet. Increased legume intake was the best single food group predictor of weight loss. Diet quality as measured by AHEI-2010 improved on the low-fat vegan diet, which was associated with improvements in weight and metabolic outcomes. These data suggest that increasing low-fat plant foods and minimizing high-fat and animal foods is associated with decreased body weight and fat loss, and that a low-fat vegan diet can improve measures of diet quality and metabolic health.     

Stages of Change for Reducing Dietary Fat Intake over 18 Months

Objective To describe the stages of change that take place over 18 months, using the criterion of fat intake ≤30% of total energy to define effective action and to investigate the effect of a single dietary feedback report on dietary fat reduction.Design Subjects were randomly assigned to experimental or control conditions and assessed at 0, 6, 12, and 18 months for fat intake and stage of change. Subjects in the experiment group received 1 feedback report at baseline; all subjects received a report at 12 months.Subjects Potential subjects (n=614) were recruited by mail from a random sample of nonsmoking adults (32% response rate). Subjects were excluded if consuming ≤30% of energy from fat or if pregnant or lactating (n=145). Although 83% of subjects (n=389) completed the 18-month study, only 296 provided complete data for all time points. The study was restricted to these 296.Intervention Dietary feedback reports plus brief educational materials were provided following the experiment design.Analyses Repeated measures analysis of variance with fat intake (percent of energy from fat) as the dependent variable and baseline stage and condition as independent variables. In addition, t tests were used to compare groups at specific time points.Results There was a main effect for time (F_3,286=39, P<.0001) and baseline stage (F_3,286=24, P<.0001), but no effect of feedback. There was a time-by-feedback interaction (F_4,286=4.7, P<.01). There was a short-term effect of feedback over 6 months (t=3.8, P<.001), but this effect was not significant at other time points. About 9% to 12% of subjects in the precontemplation or contemplation stages, 24% of subjects in the preparation stage, and 40% of unclassified subjects at baseline progressed to the action stage by 18 months. Between 12 and 18 months, subjects progressing at least 1 stage reduced their fat intake to a greater extent than subjects who failed to progress t=5.1, P<.0001).Implications Interventions targeted to stage of change have the potential for accelerating the rate of change for dietary fat reduction, but reaching the goal of fat intake ≤30% of total energy may require more intensive interventions than a single dietary feedback report. J Am Diet Assoc. 1998; 98:529–534.     

中国10个地区成年人腌制蔬菜摄入情况的流行病学特征分析

目的 描述中国慢性病前瞻性研究（CKB）队列10个地区不同种类腌制蔬菜摄入的地区、时间和人群分布特征。方法 CKB项目分别在2004-2008年、2008年和2013-2014年开展了基线调查、第一次和第二次重复调查。根据10个地区第二次重复调查对象的咸菜和酸泡菜平均摄入频率,将调查地区分为摄入咸菜为主地区、摄入酸泡菜为主地区和几乎不摄入腌制蔬菜地区。然后分别在前两组地区中运用logistic回归描述腌制蔬菜摄入的时间变化趋势和人群分布特征,并分析其他膳食特征的分布情况。结果 摄入咸菜为主地区包括青岛、哈尔滨、苏州、浙江项目点,而摄入酸泡菜为主地区包括甘肃、四川项目点,两类地区分别纳入204 036和105 573名基线调查对象。摄入咸菜为主地区在基线调查、第一次和第二次重复调查腌制蔬菜的平均摄入频率分别为3.1、3.3、1.8 d/周;摄入酸泡菜为主地区相应的频率为2.8、2.7、1.6 d/周,均呈下降趋势（P<0.001）。基线调查时两类地区的已婚、文化程度较低者腌制蔬菜摄入频率均更高;摄入咸菜为主地区年龄较大者腌制蔬菜摄入频率更高,而摄入酸泡菜为主地区相反（P<0.001）。随着腌制蔬菜摄入频率的增加,两类地区经常摄入辣食、口味偏咸等人群比例也呈增加趋势（P<0.05）。结论 CKB项目人群的腌制蔬菜摄入种类和水平存在明显的地区和人群分布差异,摄入频率呈下降趋势,且与其他膳食特征存在相关。     

Monitoring Dietary Change in a Low-Fat Diet Intervention Study: Advantages of Using 24-Hour Dietary Recalls vs Food Records

Objective The purpose of the study was to evaluate two methods of dietary assessment for monitoring change in fat intake in a low-fat diet intervention study.Design The two dietary assessment methods were a 4-day food record (4DFR) and an unannounced 24-hour dietary recall conducted by telephone interview (referred to as a telephone recall [TR]). Subjects were assigned randomly to either a low-fat diet intervention group or a control group that received no counseling about fat intake. Dietary data were collected at baseline, 6 months, and 12 months.Subjects Two hundred ninety postmenopausal women with localized breast cancer were recruited at seven clinical centers in the United States.Statistical analysis Analysis of variance was used to test for significant differences in mean fat and energy intakes.Results Three sources of error were identified: (a) an instrument effect, suggesting underreporting at baseline of approximately 8% in mean energy intake and 11% in mean fat intake in the TR group compared with the 4DFR group (P=.0001); (b) a repeated measures effect observed for the 4DFR, suggesting underreporting of approximately 7% for energy intake and 14% for fat intake in the control group at 6 and 12 months compared with baseline values (P<.001); and (c) an adherence effect (or compliance bias), suggesting greater compliance to the low-fat intervention diet when subjects were keeping food records than when estimates were based on the unannounced TR. Compared with the TR, the 4DFR overestimated the extent of fat reduction in the low-fat diet intervention group by 41% (P=.08) and 25% (P=.62) at 6 and 12 months, respectively.Application Multiple days of unannounced 24-hour recalls may be preferable to multiple-day food records for monitoring dietary change in diet intervention studies. J Am Diet Assoc. 1996; 96:574-579.     

Meal termination using oral sensory satisfaction: a study in non-obese women

Abstract

Non-obese individuals limit energy intake and maintain weight long-term. Knowledge of the mechanism they use to accomplish this could help in weight maintenance after weight loss and prevention of unneeded weight gain. The objective of the present study was to determine whether non-obese women use orosensory cues to limit short-term intake of high-energy density foods. Forty non-obese women consumed two high-energy rice puddings of equal energy density, one with high sugar and one with high fat. There were four study conditions. Participants ate until satisfied (basal), satisfied based on taste (taste), satisfied based on fullness (fullness) and while watching television (distraction). The participants were asked to refrain from eating and drinking after 2200. The treatments were done between 0830 and 0900. The order of treatments was randomized and all subjects completed all treatments. The quantity consumed and variation in hunger and taste intensity were the primary measures. Results were subjected to within subjects analysis of variance (ANOVA). Intake was significantly greater in the high-fat groups than in the high-carbohydrate groups (P = 0.0001). Study condition had a significant effect on intake (P = 0.0000) with the taste condition generally resulting in the lowest intake. Hunger intensity significantly decreased after meal intake (P = 0.0156). There was a significant effect of condition (P = 0.0001) with base and taste conditions showing the greatest decrease. In the taste condition, specifically, the intensity of taste and hunger declined after intake (P = 0.0000). These results indicate that taste satisfaction can limit meal intake in non-obese women. Taste satisfaction could be a mechanism that is used to reduce food intake to compensate for previous excess consumption.     

Dietary intakes associated with successful weight loss and maintenance during the Weight Loss Maintenance trial

Background

Dietary components effective in weight maintenance efforts have not been adequately identified.

Objective

To determine the effects of changes in dietary consumption on weight loss and maintenance during the Weight Loss Maintenance clinical trial.

Design

Weight Loss Maintenance was a randomized controlled trial. Successful weight loss participants who completed Phase I of the trial and lost 4 kg were randomized to one of three maintenance intervention arms in Phase II and followed for an additional 30 months.

Participants/setting

The multicenter trial was conducted from 2003 through 2007. This substudy included 828 successful weight loss participants.

Methods

The Block Food Frequency Questionnaire (FFQ) was used to assess nutrient intake levels and food group servings. Carbohydrates, proteins, fats, dietary fiber, fruit/vegetable, and dairy servings were utilized as predictor variables. The FFQ was collected on all participants at study entry (beginning of Phase I). Those randomized to Phase II completed the FFQ at three additional time points: randomization (beginning of Phase II), 12 months, and 30 months.

Intervention

The main intervention focused on long-term maintenance of weight loss using the Dietary Approaches to Hypertension diet. This substudy examined if changes to specific dietary variables were associated with weight loss and maintenance.

Statistical analyses performed

Linear regression models that adjusted for change in total energy examined the relationship between changes in dietary intake and weight for each time period. Site, age, race, sex, and a race–sex interaction were included as covariates.

Results

Participants who substituted protein for fat lost, on average, 0.33 kg per 6 months during Phase I (P<0.0001) and 0.07 kg per 6 months during Phase II (P<0.0001) per 1% increase in protein. Increased intake of fruits and vegetables was associated with weight loss in Phases I and II: 0.29 kg per 6 months (P<0.0001) and 0.04 kg per 6 months (P=0.0062), respectively, per 1-serving increase. Substitution of carbohydrates for fat and protein for carbohydrates were associated with weight loss during both phases. Increasing dairy intake was associated with significant weight loss during Phase II (−0.17 kg per 6 months per 1-serving increase, P=0.0002), but not during Phase I. Dietary fiber revealed no significant findings.

Conclusions

Increasing fruits, vegetables, and low-fat dairy may help achieve weight loss and maintenance.     

Head and Neck Cancer Patients Do Not Meet Recommended Intakes of Micronutrients without Consuming Fortified Products

This study assessed dietary and micronutrient intakes of head and neck cancer (HNC) patients at key points in the disease trajectory and evaluated the contribution of oral nutritional supplements (ONS) to micronutrient intake. HNC patients (n = 114) completed a three-day dietary record and a tool to assess Nutrition Impact Scores (NIS) at baseline, post-treatment, and follow-up. Foods were classified into food categories. Micronutrient, protein, and energy intakes were compared to European Society for Parenteral and Enteral Nutrition guidelines for cancer patients. The majority of patients did not meet recommended dietary intakes for vitamins D, E, C, folate, and magnesium at any study time point. Relative to baseline, the proportion of calories from milk, soup, and ONS significantly increased at post-treatment, while grain, meat, potato, baked dessert, and oil and sugar decreased (P < 0.03). At all study time points, patients categorized as high ONS consumers (>15% of total daily calories from ONS) had higher intakes of micronutrients (P < 0.003). They also had a higher NIS (P = 0.006) and experienced greater weight loss (P < 0.04) during the study, despite having similar energy intake to patients consuming <15% kcal from ONS. Fortification of usually consumed foods to improve micronutrient intake among cancer patients should be evaluated.     

A nutrition and physical activity intervention promotes weight loss and enhances diet attitudes in low-income mothers of young children

The purpose of this study was to evaluate a nutrition and physical activity program for reducing body weight and improving nutrition attitudes in mothers of young children. A convenience sample of 114 intervention mothers and 33 comparison mothers was recruited from public health clinics and community centers. Eligibility criteria included Hispanic, African American, or white ethnicity; body mass index of at least 25 kg/m²; low income (<200% of the federal poverty index); and youngest child aged 1 to 4 years. For intervention participants, height, weight, percentage of body fat, waist circumference, demographics, nutrition attitudes, and dietary intake were measured at weeks 0 and 8; height, weight, percentage of body fat, and waist circumference were reassessed at 6 months. Overweight mothers in the comparison group provided anthropometric and demographic data at weeks 0 and 8. Changes in anthropometrics, attitudes, and dietary intake were evaluated in intervention mothers. Anthropometric data of intervention vs comparison group mothers were examined. Differences in anthropometrics and attitude scores between weight loss responders (≥2.27 kg) and nonresponders (<2.27 kg) were assessed at week 8. Intervention participants lost weight (x = −2.7 kg; P < .001), whereas comparison mothers gained a slight amount of weight (x= 0.1 kg) by week 8. Weight loss responders had healthier eating attitudes (5.6 vs 5.2; P < .01) and fewer perceived barriers (2.4 vs 2.9; P < .05) than nonresponders postintervention. In conclusion, this dietary and physical activity curriculum is a valuable resource for weight management programs serving low-income women.     

Nutrition-Focused Wellness Coaching Promotes a Reduction in Body Weight in Overweight US Veterans

Diet plays a critical role in the pathogenesis of major chronic diseases common in populations of US veterans. The role of nutrition-focused wellness coaching in improving dietary behavior and/or reducing weight in overweight and obese US veterans is not known. At the San Francisco Veterans Affairs Medical Center, US veterans aged 25 to 80 years were randomized to receive nutrition coaching on eating behaviors at baseline only (control group, n=22) or an additional eight times over the course of 6 months (intervention group, n=28) in 2010-2011. Multiple coaching contacts decreased intake of energy, fat, and carbohydrate by 31% (P≤0.001) as evaluated by the 2005 Block food frequency questionnaire, which is composed of 111 food items. A weight loss of 5% from baseline (92.8 to 88.2 kg; P<0.01) was observed in the intervention group with mean body mass index decreasing from 30.4 to 28.9 (P<0.05). The control group showed a decrease in fat intake by 20% (P=0.01), but no statistically significant changes in intake of other nutrients or body weight (88.7 to 87.4 kg). Those in the intervention group reported diets at follow-up that were lower in cholesterol, saturated fat, sodium, sugar (P≤0.01), calcium (P< 0.05), and vitamin D (P<0.01), although when adjusted for energy (ie, nutrient density) calcium intake increased and vitamin D remained unchanged. Veterans' readiness to change eating behavior for weight loss improved with nutrition coaching. This study demonstrates that intermittent nutrition coaching can be an effective strategy to promote reductions in energy intake, body weight, and body mass index in overweight US veterans. Further research is needed to determine whether nutrition coaching improves other clinical outcomes and sustains weight loss.     

Using a personal digital assistant for self-monitoring influences diet quality in comparison to a standard paper record among overweight/obese adults

Self-monitoring has traditionally been done using a paper record, which can be tedious and burdensome. A personal digital assistant (PDA) with dietary software can provide an alternative to a paper record. The study aimed to describe the differences in dietary changes at 6 months between participants randomly assigned to use a paper record or PDA for self-monitoring in a clinical trial of weight-loss treatment. Self-monitoring adherence and changes in weight and diet were assessed between 2006 and 2009. The sample (n=192) was 84% female and 78% white, with a mean age of 49 years and body mass index (calculated as kg/m²) of 34.1. At baseline, the groups did not differ in energy intake, percent calories from fat, and number of servings of the examined food groups. At 6 months, both groups had significant reductions in weight, energy intake, and percent calories from total fat and saturated fatty acids (P<0.001); no between-group differences were found. Compared to the paper record group, the PDA group significantly increased consumption of fruit (P=0.02) and vegetables (P=0.04) and decreased consumption of refined grains (P=0.02). Interactions among self-monitoring and the two groups were found in relation to changes in percent calories from total fat (P=0.02), monounsaturated fatty acids (P=0.002), and trans-fatty acids (P=0.04). Frequent self-monitoring was significantly associated with total sugar (P=0.02) and added sugar (P=0.01) intake in both groups. Our findings suggest that use of a PDA for self-monitoring might improve self-awareness of behavior and dietary changes.     

Effects of cognitive-behavioral treatment for weight loss in family members

The possibility that lifestyle changes may be shared by the family members of subjects with obesity attending cognitive-behavioral treatment (CBT) for weight loss has been scarcely evaluated. The purpose of this study was to measure the changes in body weight, lifestyle habits, and stage of change toward physical activity in the family members of 149 subjects with overweight/obesity enrolled into a weekly group CBT for weight management in the years 2007-2008. 230 adult (aged >18 years) family members (129 spouses, 72 children (43 female, 29 male), 29 with a different family relationship) completed a self-administered questionnaire at baseline and soon after the end of the completion of their relatives' program (approximately 6 months later). The questionnaire consisted of qualitative information regarding food choices, estimation of energy and food intake, self-report of height and weight, and motivation toward physical activity. At baseline, self-reported body mass index was normal in 115 cases, in the range 25 to 29.9 in 80 and ≥30 in 35. Following CBT of their relatives, the family members significantly reduced their average daily energy intake (−232 kcal/day; P<0.001) and the reported body weight decreased on average by 1 kg (P=0.001). The analysis of food choices revealed a reduced average daily amount of energy from dressings (−40 kcal, P<0.001), main courses with cheese or fat meat (−24 kcal, P=0.002), refined carbohydrates (−16 kcal, P<0.001), bread (−58 kcal, P<0.001), breakfast biscuits (−23 kcal, P=0.005), chocolate (−7 kcal, P=0.024), and nonalcoholic beverages (fruit juices and carbonated drinks; −10 kcal; P=0.013), whereas fruit consumption was increased (+10 kcal; P=0.023). There was also a shift in the stage of change toward exercising. Body mass index changes of family members and CBT subjects were significantly correlated, mainly within spouses. In conclusion, CBT for weight loss positively influences the lifestyle habits of family members of participants, reducing energy intake and promoting a more favorable attitude toward physical activity.     

The diet quality of adult women participating in a behavioural weight‐loss programme

Background: Diet quality plays an important role in health and has been shown to impact the risk of heart disease and certain cancers. The present study aimed to examine baseline and 16‐week follow‐up levels of energy intake, energy density and diet quality, as measured by the Healthy Eating Index 2005 (HEI‐2005), in overweight and obese women participating in a behavioural weight‐loss programme. Methods: Sixty‐six women [mean (SD) age 48.6 (10.8) years; body mass index 31.8 (3.7) kg m^?2; 92% Caucasian] completed dietary measures at baseline and follow‐up. All participants received a 16‐week Internet Behavioural weight‐loss programme based on the core of the Diabetes Prevention Program. Dietary intake was measured using the 2005 Block food frequency questionnaire. Diet quality was calculated using the HEI‐2005. Paired t‐tests were used to determine changes over time. Results: There was a reduction in reported energy intake [7.867 (3.232) MJ versus 5.748 (1.775) MJ, P < 0.001] over the 16 weeks. Participants had an increase in diet quality [HEI score = 53.9 (9.9) versus 57.4 (10.6), P = 0.002] as well as a reduction in energy density [0.0088 (0.0021) MJ g^?1 to 0.0080 (0.0021) MJ g^?1 (P = 0.002)]. All micronutrient intakes decreased over the 16 weeks. Conclusions: Participation in a 16‐week behavioural weight‐loss programme significantly improved diet quality and reduced dietary energy density and energy intake in adult women. However, despite the overall increase in diet quality score, there were deficiencies in key micronutrients in the diets of most women at the conclusion of the 16‐week study.     

Calcium intake in the United States from dietary and supplemental sources across adult age groups: new estimates from the National Health and Nutrition Examination Survey 2003-2006

Background

Adequate lifelong calcium intake is essential in optimizing bone health. Recent National Health and Nutrition Examination Survey data were used to quantify variation in calcium intake across adult age groups and to relate age-associated changes in calcium intake with energy intake. Additional goals were to assess differences in dietary calcium intake between supplemental calcium users and nonusers and to evaluate associations between age and calcium density in the diet.

Design

This cross-sectional analysis determined calcium and energy intake for National Health and Nutrition Examination Survey respondents during 2003-2006. Diet was assessed with 24-hour recall and supplement use via questionnaire. Trends in median intakes for dietary calcium, total calcium, and energy across age categories were assessed using survey analysis methods. Nutrient density was represented using calcium to energy intake ratios.

Results

The analyses included data from 9,475 adults. When compared to the 19- to 30-year age group, median dietary calcium intake was lower in the ≥81-year age group by 23% in men (P<0.001) and by 14% in women (P=0.003). These reductions coincided with 35% and 28% decreases, respectively, in median energy intake (P<0.001 for each sex). In contrast, the frequency of calcium supplement use increased (P<0.001) with age in both men and women. Yet, among female supplement users, the decline in median dietary calcium intake was greater than in nonusers (P=0.02). Calcium density in the diet significantly increased relative to age in men and women (P<0.001 for each sex); however, dietary and total calcium to energy ratios were insufficient to meet target ratios inferred by adequate intake standards after age 50 years.

Conclusions

Although supplemental calcium use and calcium density were highest in older age groups, they were not sufficient in meeting recommended levels. New approaches to increasing the frequency and level of calcium supplement use to enhance calcium density in diets may be necessary to reduce osteoporosis risk among older Americans.     

LA Sprouts: a gardening, nutrition, and cooking intervention for Latino youth improves diet and reduces obesity

Evidence demonstrates that a gardening and nutrition intervention improves dietary intake in children, although no study has evaluated the effect of this type of intervention on obesity measures. The objective of this pilot study was to develop and test the effects of a 12-week, after-school gardening, nutrition, and cooking program (called LA Sprouts) on dietary intake and obesity risk in Latino fourth- and fifth-grade students in Los Angeles, CA. One hundred four primarily Latino children (mean age 9.8±0.7 years), 52% boys and 59% overweight, completed the program (n=70 controls, n=34 LA Sprouts participants). Weight, height, body mass index, waist circumference, body fat (via bioelectrical impendence), blood pressure, and dietary intake (via food frequency screener) were obtained at baseline and postintervention. LA Sprouts participants received weekly 90-minute, culturally tailored, interactive classes for 12 consecutive weeks during spring 2010 at a nearby community garden, whereas control participants received an abbreviated delayed intervention. Compared to subjects in the control group, LA Sprouts participants had increased dietary fiber intake (+22% vs −12%; P=0.04) and decreased diastolic blood pressure (−5% vs −3%; P=0.04). For the overweight subsample, LA Sprouts participants had a significant change in dietary fiber intake (0% vs −29%; P=0.01), reduction in body mass index (−1% vs +1%; P=0.04) and less weight gain (+1% vs +4%; P=0.03) compared to those in the control group. We conclude that a gardening, nutrition, and cooking intervention is a promising approach to improve dietary intake and attenuate weight gain in Latino children, particularly in those who are overweight.     

Dietary Intake of Soy Protein and Tofu in Association With Breast Cancer Risk Based on a Case-Control Study

Soy food and its constituents may protect against breast cancer, but the association between soy intake and decreased breast cancer risk is inconsistent. We evaluated the relationship between breast cancer risk and the dietary intake of soy protein as measured by total soy food and tofu intake. Histologically confirmed cases ( n = 362) were matched to controls by age (within 2 yr) and menopausal status. High soy protein intake was associated with reduced breast cancer risk in analyses adjusted for potential confounders including dietary factors among premenopausal women (odds ratio [OR] = 0.39 in the highest quintile, 95% confidence interval [CI] = 0.22–0.93, P for trend = 0.03) and postmenopausal women (OR = 0.22, 95% CI = 0.06–0.88, P for trend = 0.16). We also found an inverse association between total tofu intake and breast cancer risk among premenopausal women (for total tofu intake, OR = 0.23 in the highest quintile, 95% CI = 0.11–0.48, P for trend < 0.01; for at least 1 serving of tofu as the main ingredient per day, OR = 0.26, 95% CI = 0.13–0.55, P for trend < 0.01). We concluded that increased regular soy food intake at a level equivalent to traditional Korean consumption levels may be associated with a reduced risk of breast cancer, and this effect is more pronounced in premenopausal women.