The Relationship of Breakfast Skipping and Type of Breakfast Consumption with Nutrient Intake and Weight Status in Children and Adolescents: The National Health and Nutrition Examination Survey 1999-2006

Background

National data comparing nutrient intakes and anthropometric measures in children/adolescents in the United States who skip breakfast or consume different types of breakfasts are limited.

Objective

To examine the relationship between breakfast skipping and type of breakfast consumed with nutrient intake, nutrient adequacy, and adiposity status.

Subjects

Children aged 9 to 13 years (n=4,320) and adolescents aged 14 to 18 years (n=5,339).

Design

Cross-sectional data from the National Health and Nutrition Examination Survey 1999-2006.

Methods

Breakfast consumption was self-reported. A 24-hour dietary recall was used to assess nutrient intakes. Mean adequacy ratio (MAR) for micronutrients and anthropometric indexes were evaluated. Covariate-adjusted sample-weighted means were compared using analysis of variance and Bonferroni's correction for multiple comparisons among breakfast skippers (breakfast skippers), ready-to-eat (RTE) cereal consumers, and other breakfast (other breakfast) consumers.

Results

Twenty percent of children and 31.5% of adolescents were breakfast skippers; 35.9% of children and 25.4% of adolescents consumed RTE cereal. In children/adolescents, RTE cereal consumers had lower intakes of total fat and cholesterol and higher intakes of total carbohydrate, dietary fiber, and several micronutrients (P<0.05 for all) than breakfast skippers and other breakfast consumers. RTE cereal consumers had the highest MAR for micronutrients, and MAR was the lowest for breakfast skippers (P<0.05). In children/adolescents, breakfast skippers had higher body mass index-for-age z scores (P<0.05) and a higher waist circumference (P<0.05) than RTE cereal and other breakfast consumers. Prevalence of obesity (body mass index ≥95th percentile) was higher in breakfast skippers than RTE cereal consumers (P<0.05) in children/adolescents and was higher in other breakfast consumers than RTE cereal consumers only in adolescents (P<0.05).

Conclusions

RTE cereal consumers had more favorable nutrient intake profiles and adiposity indexes than breakfast skippers or other breakfast consumers in US children/adolescents.     

Markers for the Validation of Reported Dietary Intake in Adults with Cystic Fibrosis

Objective

To identify different markers in order to validate the assessment of dietary intake in adults with cystic fibrosis (CF).

Design

Cross-sectional survey.

Setting

Tertiary care.

Subjects

We assessed 37 adults with CF whose nutritional and respiratory condition was stable and 37 healthy adults, matched for age, sex, and nutritional status.

Interventions

A consecutive, 7-day, prospective dietary survey was given to all the participants. Anthropometric variables were measured and a fasting blood sample was drawn to measure the composition of the serum phospholipid fatty acids by gas chromatography. We also measured fecal fat and nitrogen at 72 hours and 24-hour urine nitrogen.

Results

The ratio of energy intake to basal metabolic rate expenditure was significantly greater in the patients (2.1±0.4) than the controls (1.79±0.4) and the percentage of patients with the ratio of energy intake to basal metabolic rate lower than 1.55 was 24% in the controls (n=9) vs 8% in the patients (n=3). Fecal nitrogen correlated significantly with total energy and the intake of carbohydrates, lipids, and proteins. In the patients, total dietary energy and fat and protein intake correlated positively with fecal fat. The protein and fat intake and fecal nitrogen and fat correlated significantly with urine nitrogen. In the controls, significant correlations were seen between different parameters of intake and the percentage of certain serum phospholipid fatty acids. These correlations in the patients were either absent or less marked.

Conclusions

Use in persons with CF of the energy intake to basal metabolic rate ratio, measurement of fecal fat and nitrogen at 72 hours and of urine nitrogen may be useful to validate dietary surveys. The serum phospholipid fatty acid profile, however, may be less useful for this purpose in these patients.     

Resemblance in Dietary Intakes between Urban Low-Income African-American Adolescents and Their Mothers: The Healthy Eating and Active Lifestyles from School to Home for Kids Study

Objectives

To examine the association and predictors of dietary intake resemblance between urban low-income African-American adolescents and their mothers.

Methods

Detailed dietary data collected from 121 child-parent pairs in Chicago during fall 2003 were used. The association was assessed using correlation coefficients, kappa, and percentage of agreement, as well as logistic regression models.

Results

Overall, the association was weak as indicated by correlations and other measures. None of the mother-son correlations for nutrients and food groups were greater than 0.20. Mother-daughter pairs had stronger correlations (0.26 for energy and 0.30 for fat). The association was stronger in normal-weight mothers than in mothers with overweight or obesity. Logistic models showed that mother being a current smoker, giving child more pocket money, and allowing child to eat or purchase snacks without parental permission or presence predicted a higher probability of resemblance in undesirable eating patterns, such as high-energy, high-fat, and high-snack intakes (P<0.05).

Conclusions

Mother-child diet association was generally weak, and varied considerably across groups and intake variables in this homogenous population. Some maternal characteristics seem to affect the association.     

US Adolescents and MyPyramid: Associations between Fast-Food Consumption and Lower Likelihood of Meeting Recommendations

Objective

To determine whether fast-food consumption is associated with adolescents' food group intakes and likelihood of meeting recommendations outlined in the MyPyramid Food Guidance System.

Design

Data from two 24-hour recalls collected in What We Eat in America, National Health and Nutrition Examination Survey 2003-2004 were analyzed. Fast-food consumers were divided into tertiles based on the proportion of 2-day energy intake derived from fast food.

Subjects

Adolescent boys and nonpregnant girls aged 12 to 19 years (n=1,956).

Statistical analyses performed

All statistical analyses included sample weights to account for the survey design. Regression analyses were used to detect associations between fast-food consumption and both food group intakes and percentages of individuals meeting MyPyramid recommendations, and to predict odds of meeting recommendations by fast-food consumption level.

Results

Fast-food consumption was associated negatively with MyPyramid fruit and milk group intakes (boys and girls) and positively with discretionary energy and solid fats (girls only). Negative associations were also found between fast-food consumption and percentages of adolescents meeting recommendations for milk (boys), fruits (girls), and vegetables and discretionary energy (boys and girls). Compared with those consuming no fast food, adolescents in the highest tertile of energy from fast food were less likely to meet recommendations for vegetables (odds ratio [OR]=0.16, 95% confidence interval [CI]: 0.05 to 0.52 for boys; OR=0.18, 95% CI: 0.04 to 0.79 for girls) and discretionary energy (OR=0.41, 95% CI: 0.22 to 0.77 for boys; OR=0.04, 95% CI: 0.01 to 0.24 for girls). No relationships were found between fast-food consumption and grains, meat/beans, and oils.

Conclusions

Adolescents' intakes, whether containing fast food or not, need improvement. Fast food is one factor that impacts adolescents' intake of MyPyramid groups and their likelihood of meeting recommendations. Awareness of fast-food's role in discrepancies between adolescent intakes and MyPyramid recommendations can aid professionals in designing effective strategies to improve adolescents' diets.     

Whole-Grain Intake Correlates among Adolescents and Young Adults: Findings from Project EAT

Background

National survey data indicate few adolescents or young adults consume whole grains in the amount recommended to prevent chronic disease and maintain a healthful weight. Interventions are needed to address this gap; however, little is known about what modifiable factors influence whole-grain intake among youth.

Objective

This study aimed to identify socioenvironmental, personal, and behavioral correlates of whole-grain intake among adolescents and young adults.

Design

Data for this cross-sectional analysis were drawn from Project EAT (Eating Among Teens)-II, the second wave of a population-based study in Minnesota. Mailed surveys and food frequency questionnaires were completed by male (44.8%) and female (55.2%) participants in 2003-2004, including 792 adolescents (mean age=17.2 years) and 1,686 young adults (mean age=20.5 years). Linear regression models adjusted for demographic characteristics were used to identify factors associated with energy-adjusted daily intake of whole grains.

Results

Mean daily intake of whole grains was lower than recommended among adolescents (males: 0.59±0.04 servings, females: 0.61±0.04 servings) and young adults (males: 0.68±0.03 servings, females: 0.58±0.03 servings). Home availability of whole-grain bread, self-efficacy to consume ≥3 daily servings of whole grains, and preference for the taste of whole-grain bread were positively associated with whole-grain intake during adolescence and young adulthood across sex. Conversely, fast-food intake was associated with lower intake of whole grains among adolescents and young adults of both sexes. The factors examined in this study explained 28% to 34% of variance in whole-grain intake across sex and the two age groups.

Conclusions

The findings suggest nutrition interventions should address the availability of whole-grain foods in homes and restaurants. In addition, young people should be provided with opportunities to taste a variety of whole-grain foods to enhance taste preferences and self-efficacy to consume whole-grain products.     

Predictors of Dietary Change and Maintenance in the Women’s Health Initiative Dietary Modification Trial

Objective

To identify predictors of dietary change to and maintenance of a low-fat eating pattern (<20% energy from fat, ≥5 servings fruits/vegetables daily, and ≥6 servings grains daily) among a cohort of postmenopausal women. Candidate predictors included intrapersonal, interpersonal, intervention program characteristics, and clinical center.

Design

Longitudinal study within the Women’s Health Initiative Dietary Modification Trial. Dietary change was evaluated after 1 year of participation in the Women’s Health Initiative Dietary Modification Trial, and dietary maintenance after 3 years.

Subjects

Postmenopausal women aged 50 to 79 years at baseline who were randomized to the intervention arm of the Women’s Health Initiative Dietary Modification Trial (n=19,541).

Statistical analysis

Univariate and multivariate linear regression analysis was performed and associations evaluated between candidate predictors and each of the three dietary goals: percent energy from fat, fruit/vegetable servings, and grain servings.

Results

Year 1 (change) predictors of percent energy from fat (P<0.005) included being younger (β=2.12; 70 to 79 years vs 50 to 59 years), more educated (β=-.69; college vs high school), more optimistic (β=-.07), attending more sessions (β=-.69), and submitting more self-monitoring records (β=-.74). At year 3 (maintenance), the predictors of percent energy from fat (P<0.005) included attending more sessions (β=-.65) and submitting more self-monitoring scores (β=-.71). The analytic model predicted 22% of the variance in fat intake at year 1 and 27% at year 3 (P<0.01).

Conclusions

The strongest predictors of dietary change and maintenance were attending intervention sessions and self-monitoring dietary intake. Novel was the finding that optimism predicted dietary change.     

Development and Validation of a Comprehensive Semi-Quantitative Food Frequency Questionnaire that Includes FODMAP Intake and Glycemic Index

Background

Fermentable, short chain carbohydrates (FODMAPs) have been identified as triggers for functional gastrointestinal symptoms. In addition, excess FODMAP consumption has been implicated in the onset of Crohn's disease, and animal studies suggest that a low glycemic index diet can impair absorption of fructose, a major dietary FODMAP. Such hypotheses cannot be tested without the ability to quantify FODMAP ingestion with a validated dietary assessment tool.

Objective

To assess the validity and reproducibility of a 297-item comprehensive, semi-quantitative food frequency questionnaire (FFQ) in estimating intake of macro- and micronutrients, FODMAPs, and glycemic index/load.

Subjects/setting

One hundred healthy participants were recruited to complete the FFQ on two occasions, plus four 1-week food diaries kept during a 12-month period. Participants exhibiting major dietary change during the study period or low energy reporting on the FFQ were excluded.

Main outcome measures

Validation and reproducibility of the semi-quantitative FFQ by comparison with the mean of four 1-week food diaries.

Statistical analyses performed

Validation was assessed using Wilcoxon signed rank test, Spearman's correlation, Bland-Altman, and weighted κ statistics. Reproducibility was examined using Shrout-Fleiss intraclass correlation coefficient.

Results

Seventy-two participants fulfilled inclusion and exclusion criteria. Demographics of the participants were comparable with 2006 Australian Census data. Consistent with other reported FFQs, the FFQ overestimated nutrient intake by a mean 140% (range=95% to 249%). However, based on the other analyses performed, it demonstrated validity for intake of sugars, fiber, alcohol, glycemic index, glucose, FODMAPs, calcium, folate, phosphate, potassium, iron, and magnesium; moderate validation for energy, total fat, saturated fat, carbohydrates, sodium, thiamin, sucrose, and retinol; poor validation for protein, mono/polyunsaturated fat, starch, glycemic load, niacin, and zinc. Riboflavin intake was not validated. Intraclass correlation coefficients for reproducibility ranged from 0.352 to 0.928.

Conclusions

The FFQ was validated for assessment of a wide range of nutrients, including the new class of carbohydrates, FODMAPs, and glycemic index. This provides a useful tool for dietary research, particularly in the area of gastroenterological disorders.     

Physical activity and dietary behavior change in Internet-based weight loss interventions: comparing two multiple-behavior change indices

Objective

To investigate the effects of two Internet-based weight loss interventions on physical activity (PA) and dietary behaviors using two approaches for computing combined behavior change.

Method

Participants were 352 overweight/obese women and men completing 12-month interventions in San Diego, California during 2002-2007. Moderate-to-vigorous PA (MVPA) and sedentary time were measured with accelerometers, and dietary fat and fruit and vegetable intake were assessed with food frequency questionnaires. Longitudinal analyses tested the effect of the intervention on combined health behavior change quantified using a standardized residualized change index (SRCI) and a risk factor change index (RFCI).

Results

At baseline, participants engaged in an average of 153 min/week of MVPA and 525 min/day of sedentary time, and consumed 37% of calories from fat and < 3 fruits and vegetables per day. The interventions had a significant effect on combined behavior change as measured with each approach (p < 0.001). The intervention effect was larger (p < 0.001) when evaluated using the SRCI (standardized regression coefficient [Beta] = 0.30) than the RFCI (β = − 0.18).

Conclusion

Interventions that target both PA and dietary behaviors appear effective. The SRCI was more sensitive for evaluating the intervention, but the RFCI may be easier to use for communicating public health significance.     

Effect of synergic dietary calcium enrichment and induced ferropenic anemia on antioxidant enzymes activity in rats

Objective

The aim of this study was to examine the synergism of dietary calcium enrichment (added to goat's or cow's milk) and induced nutritional ferropenic anemia on oxidative status.

Methods

Control rats and rats with induced nutritional ferropenic anemia were fed for 14 d with diets containing normal (5000 mg/kg) or double (10 000 mg/kg) the recommended calcium content. Thiobarbituric acid-reactive substances in plasma were measured, as were the activities of the antioxidant enzyme catalase, copper/zinc superoxide dismutase, and glutathione peroxidase in erythrocyte cytosol.

Results

Dietary calcium enrichment did not affect oxidative stress as assessed by thiobarbituric acid-reactive substances; however, it significantly upregulated the activities of some antioxidant enzymes examined in the erythrocyte cytosol. In particular, adding calcium to standard or milk-based diets significantly increased glutathione peroxidase activity in control and anemic rats and copper/zinc superoxide dismutase activity in control rats.

Conclusion

The increased activities of glutathione peroxidase and copper/zinc superoxide dismutase induced by dietary calcium enrichment suggest that calcium supplementation may protect against oxidative stress even in nutritionally induced ferropenic anemia.     

Seasonal Variation in Fruit and Vegetable Consumption in a Rural Agricultural Community

Background

Seasonal variation in fruit and vegetable consumption has been documented in a limited number of previous investigations and is important for the design of epidemiologic investigations and in the evaluation of intervention programs.

Objective

This study investigates fruit and vegetable consumption behaviors among Hispanic farmworkers and non-farmworkers in a rural agricultural community.

Design

A larger study recruited 101 farmworker families and 100 non-farmworker families from the Yakima Valley in Washington State between December 2004 and October 2005. All families were Hispanic. An in-person administered questionnaire collected information on consumption of locally grown fruits and vegetables and sources of obtaining fruits and vegetables. Data on dietary intake asked whether or not the respondent had consumed a given fruit or vegetable in the past month. Data were collected longitudinally, coinciding with three agricultural seasons: thinning (summer), harvest (fall), and nonspray (winter).

Statistical analyses performed

Generalized estimating equations were used to test for statistical significance between proportions of the population who consumed a given fruit or vegetable across agricultural seasons. Multivariable logistic regression was performed and corresponding odds ratios and 95% confidence intervals are reported.

Results

The proportion of respondents who ate apples, pears, plums, peaches, apricots, peppers, corn, and cucumbers was highest in the fall harvest season, whereas the proportions of those who ate cherries and asparagus were highest in the summer thinning season. Compared to non-farmworkers, a higher proportion of farmworkers reported having eaten peaches, apricots, cherries, green beans, carrots, peppers, corn, pumpkin, squash, and onions, in the past month.

Conclusions

Epidemiologic investigations and public health interventions that examine the consumption of fruits and vegetables should consider seasonal variation in consumption patterns, especially in agricultural communities.     

Unintended pregnancy and associated maternal preconception, prenatal and postpartum behaviors

Background

This study was conducted to determine the relationship between unintended pregnancy and maternal behaviors before, during and after pregnancy.

Study Design

Data were analyzed from a stratified random sample of 9048 mothers who delivered live born infants between 2001 and 2006 and completed the Pregnancy Risk Assessment Monitoring System (PRAMS) survey 2 to 9 months after delivery. Binary and ordinal logistic regression methods with appropriate survey weights were used to control for socio-demographic factors.

Results

Compared to women with intended pregnancies, mothers with unwanted pregnancies were more likely to consume less than the recommended amount of preconception folic acid [adjusted odds ratio (OR) 2.39, 95% confidence interval (CI) 1.7-3.2], smoke prenatally (OR 2.03, 95% CI 1.5-2.9), smoke postpartum (OR 1.86, 95% CI 1.35-2.55) and report postpartum depression (OR 1.98, 95% CI 1.48-2.64); they were less likely to initiate prenatal care during the first trimester (OR 0.34, 95% CI 0.3-0.5) and breastfeed for 8 or more weeks (OR 0.74, 95% CI 0.57-0.97). Compared to women with intended pregnancies, women with mistimed pregnancies were also more likely to consume inadequate folic acid, delay prenatal care and report postpartum depression.

Conclusion

Even after controlling for multiple socio-demographic factors, unwanted and mistimed pregnancies were associated with unhealthy perinatal behaviors.     

Adolescent and Young Adult Vegetarianism: Better Dietary Intake and Weight Outcomes but Increased Risk of Disordered Eating Behaviors

Objective

Examine characteristics of current and former adolescent and young adult vegetarians and investigate the relationships between vegetarianism, weight, dietary intake, and weight-control behaviors.

Design

Cross-sectional analysis using data from a population-based study in Minnesota (Project EAT-II: Eating Among Teens).

Setting

Participants completed a mailed survey and food frequency questionnaire in 2004.

Participants

Males and females (n=2,516), ages 15-23 years.

Main outcome measures

Weight status, dietary intake (fruit, vegetables, fat, calories), unhealthful weight-control behaviors.

Analysis

Multiple regression models controlling for socioeconomic status and sex were used to test for significant differences between current, former, and never vegetarians within the younger and older cohort.

Results

Participants were identified as current (4.3%), former (10.8%), and never (84.9%) vegetarians. Current vegetarians in the younger and older cohorts had healthier dietary intakes than nonvegetarians with regard to fruits, vegetables, and fat. Among young adults, current vegetarians were less likely than never vegetarians to be overweight or obese. Adolescent and young adult current vegetarians were more likely to report binge eating with loss of control when compared to nonvegetarians. Among adolescents, former vegetarians were more likely than never vegetarians to engage in extreme unhealthful weight-control behaviors. Among young adults, former vegetarians were more likely than current and never vegetarians to engage in extreme unhealthful weight-control behaviors.

Conclusions and implications

Adolescent and young adult vegetarians may experience the health benefits associated with increased fruit and vegetable intake and young adults may experience the added benefit of decreased risk for overweight and obesity. However, current vegetarians may be at increased risk for binge eating with loss of control, while former vegetarians may be at increased risk for extreme unhealthful weight-control behaviors. It would be beneficial for clinicians to inquire about current and former vegetarian status when assessing risk for disordered eating behaviors.     

Estimating the impact of pictorial health warnings and “plain” cigarette packaging: Evidence from experimental auctions among adult smokers in the United States

Objective

To estimate differences in demand for cigarette packages with different packaging and health warning label formats.

Methods

Adult smokers (n = 404) in four states participated in experimental auctions. Participants bid on two of four experimental conditions, each involving a different health warning label format but with the same warning message: (1) text on 50% of pack side; (2) text on 50% of the pack front and back; (3) text with a graphic picture on 50% of the pack front and back; and (4) same as previous format, but without brand imagery.

Results

Mean bids decreased across conditions (1: $3.52; 2: $3.43; 3: $3.11; 4: $2.93). Bivariate and multivariate random effects models indicated that there was no statistically significant difference in demand for packs with either of the two text only warnings; however, demand was significantly lower for both packs with prominent pictorial warnings, with the lowest demand associated with the plain, unbranded pack.

Conclusions

Results suggest that prominent health warnings with graphic pictures will reduce demand for cigarettes. Regulators should not only consider this type of warning label, but also plain packaging policies for tobacco products.     

Carbohydrate Intake and Overweight and Obesity among Healthy Adults

Background

Little is known about the dietary habits of people with optimal body weight in communities with high overweight and obesity prevalence.

Objective

To evaluate carbohydrate intake in relation to overweight and obesity in healthy, free-living adults.

Design

We used a cross-sectional analysis.

Subjects/setting

The Canadian Community Health Survey Cycle 2.2 is a cross-sectional survey of Canadians conducted in 2004-2005. There were 4,451 participants aged 18 years and older with anthropometric and dietary data and no comorbid conditions in this analysis.

Main outcome measures

Outcome variables were body mass index (BMI; calculated as kg/m²) and overweight or obesity status (dichotomous) defined as BMI ≥25 compared with BMI <25 based on measured height and weight. Diet was evaluated by 24-hour dietary recall based on the Automated Multi-Pass Method.

Statistical analyses performed

Weighted regression models with bootstrapping and cubic splines were used. Outcome variables were BMI and overweight or obesity, and predictors were daily nutrient intake. Adjustment for total energy intake, age, leisure time energy expenditure, sex, smoking, education, and income adequacy was performed.

Results

Risk of overweight and obesity was decreased in all quartiles of carbohydrate intake compared to the lowest intake category (multivariate odds ratio quartile 2=0.63; 95% confidence interval: 0.49 to 0.90; odds ratio quartile 3=0.58; 95% confidence interval: 0.41 to 0.82; odds ratio quartile 4=0.60; 95% confidence interval: 0.42 to 0.85). Spline analyses revealed lowest risk among those consuming 290 to 310 g/day carbohydrates.

Conclusions

Consuming a low-carbohydrate (approximately <47% energy) diet is associated with greater likelihood of being overweight or obese among healthy, free-living adults. Lowest risk may be obtained by consuming 47% to 64% energy from carbohydrates.     

The Relationship of Ready-to-Eat Cereal Consumption to Nutrient Intake, Blood Lipids, and Body Mass Index of Children as They Age through Adolescence

Objective

To examine sex differences and longitudinal changes in ready-to-eat (RTE) cereal and breakfast consumption in the Dietary Intervention Study in Children, and the relationship between RTE cereal intake with nutrient intake, blood lipids, and body mass index (BMI).

Design

Secondary analyses based on data from Dietary Intervention Study in Children, a randomized, controlled, multicenter, clinical trial with five sets of three 24-hour recalls.

Subjects/setting

Children (n=660) from six clinics aged 8 to 10 years at study entry. Participants had serum low-density lipoprotein cholesterol levels between the 80th and 98th percentiles for age, and were followed for a mean of 7.5 years.

Intervention

Children were randomized to a total fat- and saturated fat-modified dietary intervention or usual care.

Statistical analyses

Frequency of RTE cereal and breakfast consumption was examined by sex and age. Mixed models by sex were used to examine the relationship of RTE cereal consumption to average daily intake of nutrients, blood lipids, and BMI.

Results

For all children, RTE cereal and breakfast consumption declined with age. Boys consumed RTE cereal more often compared with girls. Except for energy, RTE cereal consumption was positively associated with all measures of nutrients for both sexes. In boys, higher RTE cereal consumption was associated with lower total and low-density lipoprotein cholesterol levels and lower BMI.

Conclusions

Food and nutrition professionals should continue to educate youth and their parents on the nutritional benefits of routinely eating RTE cereal.     

Contribution of dietary supplements to nutrient adequacy among children in Hawaii

Objectives

To quantify the use of dietary supplements over a 24-hour and 1-month time frame, to determine the contribution of dietary supplements to the prevalence of dietary nutrient adequacy in the population, and to identify factors associated with supplement use, including characteristics of caregivers.

Design

Cross-sectional study.

Subjects/setting

Children aged 8 to 11 years from four primarily Native Hawaiian and Pacific Islander communities on Oahu (n=115) and the island of Hawaii (n=70).

Methods

A 24-hour food recall and a dietary supplement record were collected and analyzed for each child. Demographic and supplement use data were collected for each caregiver.

Statistical analyses

Significant differences between supplement users and nonusers were determined by χ² analysis. Prevalence of dietary nutrient adequacy with and without intake from dietary supplements was calculated using PC-Side software (version 1.02, 2001, Department of Statistics and Center for Agricultural and Rural Development, Iowa State University, Ames).

Results

Use of any dietary supplement by children in the previous day and month was 26% (n=48) and 40% (n=74), respectively. Prevalence of dietary nutrient adequacy from foods alone ranged from 33% to 100%, and increased to 59% to 100% when the nutrient contribution from dietary supplements was included. The largest increases in nutrient adequacy were for vitamins A, E, and C. Use of dietary supplements was most strongly associated with use of dietary supplements by caregivers, as well as with younger age of child, and greater years of caregiver education.

Conclusions

Dietary supplements are being used by a large percentage of these children in Hawaii and use is associated with use by their caregivers. The nutrient contribution from dietary supplements increased the prevalence of nutrient adequacy for several nutrients.     

Consumption of Whole-Grain Cereals during Weight Loss: Effects on Dietary Quality, Dietary Fiber, Magnesium, Vitamin B-6, and Obesity

Objective

While various weight-management approaches produce weight loss, they may differ in dietary quality. We monitored changes in nutrient intakes in overweight and obese subjects on three different weight-management programs.

Design

Randomized clinical trial (pilot study) with two 12-week phases: phase 1, weekly counseling; phase 2, monitoring only.

Subjects/setting

One hundred eighty nonsmoking, sedentary overweight and obese adults began this outpatient study; 134 (body mass index [calculated as kg/m²]=30.9±2.4; age=42.3±1.2 years) were used in analyses.

Intervention

Twenty-four weeks of exercise only (control group), hypocaloric diet plus exercise, or hypocaloric diet with fiber-rich whole-grain cereals plus exercise.

Main Outcome Measures

At weeks 0, 12, and 24, diet quality was assessed by 3-day food records and body weight was measured.

Statistical Analyses Performed

Three-way analysis of variance with repeated measures.

Results

The hypocaloric diet with fiber-rich whole-grain cereals plus exercise decreased energy intake more than exercise only (P=0.032). By week 12, the hypocaloric diet with fiber-rich whole-grain cereals plus exercise and the hypocaloric diet plus exercise decreased total fat more than exercise only, which was sustained in the hypocaloric diet with fiber-rich whole-grain cereals plus exercise at 24 weeks (P<0.001). At weeks 12 and 24, the hypocaloric diet with fiber-rich whole-grain cereals plus exercise reduced saturated fat intake more than exercise only. The hypocaloric diet with fiber-rich whole-grain cereals plus exercise increased total fiber, insoluble fiber (both P<0.001), magnesium (P=0.004), and vitamin B-6 (P=0.002) intakes more than the hypocaloric diet plus exercise and exercise only. Calcium and vitamin E intakes were inadequate in all groups. Weight loss was similar in the hypocaloric diet with fiber-rich whole-grain cereals plus exercise and the hypocaloric diet plus exercise.

Conclusions

Weight-reduction strategies may be associated with reduced intake of micronutrients, such as calcium and vitamin E. However, a hypocaloric diet with fiber-rich whole-grain cereal is effective for improving or maintaining other aspects of dietary quality during weight loss.