Nutrient profiling can help identify foods of good nutritional quality for their price: a validation study with linear programming

Nutrient profiling ranks foods based on their nutrient content. They may help identify foods with a good nutritional quality for their price. This hypothesis was tested using diet modeling with linear programming. Analyses were undertaken using food intake data from the nationally representative French INCA (enquête Individuelle et Nationale sur les Consommations Alimentaires) survey and its associated food composition and price database. For each food, a nutrient profile score was defined as the ratio between the previously published nutrient density score (NDS) and the limited nutrient score (LIM); a nutritional quality for price indicator was developed and calculated from the relationship between its NDS:LIM and energy cost (in euro/100 kcal). We developed linear programming models to design diets that fulfilled increasing levels of nutritional constraints at a minimal cost. The median NDS:LIM values of foods selected in modeled diets increased as the levels of nutritional constraints increased (P = 0.005). In addition, the proportion of foods with a good nutritional quality for price indicator was higher (P < 0.0001) among foods selected (81%) than among foods not selected (39%) in modeled diets. This agreement between the linear programming and the nutrient profiling approaches indicates that nutrient profiling can help identify foods of good nutritional quality for their price. Linear programming is a useful tool for testing nutrient profiling systems and validating the concept of nutrient profiling.     

Meeting adequate intake for dietary calcium without dairy foods in adolescents aged 9 to 18 years (National Health and Nutrition Examination Survey 2001-2002)

BACKGROUND: In the United States, >50% of dietary calcium is provided by milk and milk products. Calcium intakes in the United States are inadequate for many children, and a large proportion do not drink milk or consume dairy products. However, no studies have addressed whether dairy-free diets can provide adequate calcium while meeting other nutrient recommendations. OBJECTIVE: To determine the highest calcium intake for adolescents obtained from dairy-free diets, and to examine the relationship between intakes of calcium-fortified foods, using citrus juice as an example, and maximal calcium intakes. DESIGN: In the National Health and Nutrition Examination Survey 2001 to 2002, 65 females and 62 males, aged 9 to 18 years, reported no intake of dairy. We used linear programming to generate diets with maximal calcium intake, while meeting Dietary Reference Intakes for a set of nutrients, limiting energy and fat intakes, and not selecting food quantities exceeding amounts usually eaten in the population. RESULTS: With food use and energy and fat constraints, diets formulated by linear programming provided 1,150 and 1,411 mg/day of calcium for girls and boys, respectively. With the Dietary Reference Intakes constraints, these decreased to 869 and 1,160 mg/day. When we introduced 1.5 servings of fortified juice to the diets, the highest calcium intake increased to 1,302 mg/day for girls and to 1,640 mg/day for boys. CONCLUSIONS: Adequate intake for calcium cannot be met with dairy-free diets while meeting other nutrient recommendations. To meet the adequate intake for calcium without large changes in dietary patterns, calcium-fortified foods are needed. In addition, greater physical activity and responsible sunlight exposure should be encouraged to promote vitamin D adequacy.     

A new reference method for the validation of the nutrient profiling schemes using dietary surveys

Nutrient profiles of foods are increasingly used as the scientific basis of nutritional labeling, health claims, or nutritional education. Nutrient profiling schemes are based on sets of rules, scores, or thresholds applied to the nutritional composition of foods. However, there is a lack of scientific validation of nutritional profiling schemes. To develop a reference method using existing dietary surveys, to define a set of indicator foods that are positively or negatively associated with a "healthy diet." Such indicator foods can be used both for establishing relevant nutrient profiles and for the validation of existing or future nutrient profiling schemes. The proposed validation method is based on food and nutrient intakes of adults participating in national dietary surveys in five EU countries: Belgium (n = 2,507), Denmark (n = 3,151), France (n = 1,474), Ireland (n = 1,379), and Italy (n = 1,513). The characterization of indicator foods is divided in two steps. First, "healthy diets" of individuals are identified in the five national dietary surveys by comparison to the Eurodiet reference intakes. Second, indicator foods associated positively or negatively to the "healthy diets" are determined. With a P-value of 10(-3) for the test of comparison of food intakes between the "most healthy eaters" and the "less healthy eaters," it was possible to identify 294 indicator foods out of 1,669 foods tested in the five countries. In all the countries except Italy, there were more indicator foods positively associated than indicator foods negatively associated with the "healthy diet." The food categories of these indicator foods were in good agreement with Food Based Dietary Guidelines like the USDA dietary guideline for Americans. A new reference method for the validation of profiling schemes was developed based on dietary intake data from using dietary surveys in five European countries. Only a minority of foods consumed in these dietary surveys could be used as indicator foods of healthy or unhealthy diets in order to subsequently test nutritional profiling schemes. Further work is needed to build a list of indicator foods that could be considered as a "gold standard."     

Testing the nutritional relevance of food‐based dietary guidelines with mathematical optimisation of individual diets

Mathematical optimisation of diets is generally used to translate nutrient‐based recommendations into healthy food choices but can also be used to assess the possible impact of food‐based dietary guidelines (FBDG) on nutrient intakes. Optimisation of individual diets, which allows individual variability of food consumption to be taken into account, generates more robust results and more realistic diets than population diet optimisation. It was used to simulate the impact on nutrient intakes of complying with the new French FBDGs. For each observed diet of adults in the French INCA2 survey, a new isoenergetic diet was designed to meet all food consumption frequencies recommended by the new French FBDGs, as interpreted by the constraints included in a model called DP2. Because the dairy food group is the only one whose guideline has been reduced (from 3 to 2 portions/day) compared to the previous FBDGs, an alternative model, called DP3, imposing 3 daily portions of dairy products instead of 2 was also tested. Diets optimised with the DP2 model had lower energy density and higher nutrient density than the observed diets, and inadequate intakes decreased for most vitamins and minerals. With the alternative DP3 model, the decrease in saturates was less pronounced than with 2 portions/day of dairy products (13.8%, 11.9% and 12.8% energy in observed diets and in DP2 and DP3, respectively), but calcium adequacy was improved instead of being worsened (51%, 58% and 16% of inadequacy in observed diets and in diets modelled with 2 portions/day and 3 portions/day of dairy products, respectively). Individual diet optimisation is a powerful tool for assessing the nutritional relevance of existing FBDGs and to test possible alternatives.     

The challenges of defining a healthy and ‘sustainable’ diet

Considerable debate exists about changes required to current diets to deliver simultaneous improvements for both human health and environmental sustainability. Media coverage has focussed largely on the environmental and health impacts of animal source foods, particularly red meat. However, animal source foods contribute notably to intakes of micronutrients (e.g. iron, zinc, iodine, calcium) in current UK diets, and evidence indicates nutrient intakes/status may be inadequate if appropriate substitutions are not made when restricting such foods in the diet, highlighting the need to consider the overall dietary pattern. Healthy and sustainable dietary patterns have been modelled based on nutritional adequacy alone (e.g. Eatwell Guide), or nutrition combined with environmental impact (e.g. WWF Livewell Plates). Studies have also considered other aspects, such as the health impact or cost, with some analyses providing ‘optimised’ diets representing the smallest required changes to current diets. Consistent changes are evident for most food groups (e.g. increases in fruit and vegetables, starchy carbohydrates, fish and – in most cases – beans, pulses and other legumes; decreases in red/processed meat, cheese and high‐fat/sugar foods). However, recommendations for dairy consumption (particularly milk) are less consistent. Methodological variation makes it difficult to directly compare recommendations to date, due to use of different data sources, environmental metrics and modelling assumptions/constraints, although reducing food waste is an important consideration regardless of dietary pattern. In the UK, adopting the government’s Eatwell Guide, which incorporates affordability and familiarity, appears a sensible direction of travel at the current time, likely to deliver nutritional, health and environmental benefits.     

The maximal amount of dietary alpha-tocopherol intake in U.S. adults (NHANES 2001-2002)

The current study was designed to determine the maximal amount of alpha-tocopherol intake obtained from food in the U.S. diet, and to examine the effect of different food group intakes on this amount. Data from 2138 men and 2213 women aged >18 y were obtained from the National Health and Nutrition Examination Survey (NHANES) 2001-2002. Linear programming was used to generate diets with maximal alpha-tocopherol intake, with the conditions of meeting the recommended daily allowances or adequate intakes for a set of nutrients, sodium and fat recommendations, and energy limits, and that were compatible with the observed dietary patterns in the population. With food use and energy constraints in models, diets formulated by linear programming provided 19.3-24.9 mg alpha-tocopherol for men and women aged 19-50 or >50 y. These amounts decreased to 15.4-19.9 mg with the addition of the sodium, dietary reference intake, and fat constraints. The relations between maximal alpha-tocopherol intake and food group intakes were influenced by total fat restrictions. Although meeting current recommendations (15 mg/d) appears feasible for individuals, dramatic dietary changes that include greater intakes of nuts and seeds, and fruit and vegetables, are needed. Careful selection of the highest vitamin E source foods within these groups could further increase the likelihood of meeting the current recommended daily allowance.     

A new reference method for the validation of the nutrient profiling schemes using dietary surveys

Nutrient profiles of foods are increasingly used as the scientific basis of nutritional labeling, health claims, or nutritional education. Nutrient profiling schemes are based on sets of rules, scores, or thresholds applied to the nutritional composition of foods. However, there is a lack of scientific validation of nutritional profiling schemes. To develop a reference method using existing dietary surveys, to define a set of indicator foods that are positively or negatively associated with a “healthy diet.” Such indicator foods can be used both for establishing relevant nutrient profiles and for the validation of existing or future nutrient profiling schemes. The proposed validation method is based on food and nutrient intakes of adults participating in national dietary surveys in five EU countries: Belgium (n = 2,507), Denmark (n = 3,151), France (n = 1,474), Ireland (n = 1,379), and Italy (n = 1,513). The characterization of indicator foods is divided in two steps. First, “healthy diets” of individuals are identified in the five national dietary surveys by comparison to the Eurodiet reference intakes. Second, indicator foods associated positively or negatively to the “healthy diets” are determined. With a P-value of 10^?3 for the test of comparison of food intakes between the “most healthy eaters” and the “less healthy eaters,” it was possible to identify 294 indicator foods out of 1,669 foods tested in the five countries. In all the countries except Italy, there were more indicator foods positively associated than indicator foods negatively associated with the “healthy diet.” The food categories of these indicator foods were in good agreement with Food Based Dietary Guidelines like the USDA dietary guideline for Americans. A new reference method for the validation of profiling schemes was developed based on dietary intake data from using dietary surveys in five European countries. Only a minority of foods consumed in these dietary surveys could be used as indicator foods of healthy or unhealthy diets in order to subsequently test nutritional profiling schemes. Further work is needed to build a list of indicator foods that could be considered as a “gold standard.”     

Dairy Products: How They Fit in Nutritionally Adequate Diets

Individual diet modeling with linear programming recently provided evidence that plant-based products, fish, and fresh dairy products consumption should be increased in the French population to reach nutrient-based recommendations. The aim of our study was to estimate the number of portions of the different milk-based food categories fitting into nutritionally adequate diets. Starting from the diet observed for each adult in the 1999 French Enquête Individuelle et Nationale sur les Consommations Alimentaires survey (n=1,171), an isocaloric nutritionally adequate diet was modeled that simultaneously met a whole set of nutrient constraints (based on nutrient recommendations) while deviating the least from the observed diet food content. Variations in weight, energy, and nutrients between observed and modeled diets were calculated for each food group (n=7), with a focus on milk-based products (n=4 categories). The diet optimization process increased the weights of three food groups: fruit and vegetables (+62%), starchy foods (+37%), and dairy products (+19%). Across milk-based food categories, the optimization increased yogurts (+60%) and milk (+17%) and decreased cheeses (?48%) without change to milk desserts. Cheeses represented one out of two consumed portions of milk-based products in observed diets, whereas in modeled diets cheeses, milk, and yogurts each represented about one portion per day. Milk desserts were similar before and after optimization, at approximately one portion per week. These results confirm that a large increase in intake of plant-based products is needed. They show that rebalancing the intake of milk-based products in favor of the least energy-dense ones (ie, yogurts and milk) will help individuals in this population reach nutritional adequacy.     

A cost constraint alone has adverse effects on food selection and nutrient density: an analysis of human diets by linear programming

Economic constraints may contribute to the unhealthy food choices observed among low socioeconomic groups in industrialized countries. The objective of the present study was to predict the food choices a rational individual would make to reduce his or her food budget, while retaining a diet as close as possible to the average population diet. Isoenergetic diets were modeled by linear programming. To ensure these diets were consistent with habitual food consumption patterns, departure from the average French diet was minimized and constraints that limited portion size and the amount of energy from food groups were introduced into the models. A cost constraint was introduced and progressively strengthened to assess the effect of cost on the selection of foods by the program. Strengthening the cost constraint reduced the proportion of energy contributed by fruits and vegetables, meat and dairy products and increased the proportion from cereals, sweets and added fats, a pattern similar to that observed among low socioeconomic groups. This decreased the nutritional quality of modeled diets, notably the lowest cost linear programming diets had lower vitamin C and beta-carotene densities than the mean French adult diet (i.e., <25% and 10% of the mean density, respectively). These results indicate that a simple cost constraint can decrease the nutrient densities of diets and influence food selection in ways that reproduce the food intake patterns observed among low socioeconomic groups. They suggest that economic measures will be needed to effectively improve the nutritional quality of diets consumed by these populations.     

Dietary-fat intake in the US population.

OBJECTIVE: This article looks at the food group choices by individuals grouped based on fat intake, saturated fat intake, and use of lowfat foods. METHODS: Food consumption data from USDA's National Food Consumption Surveys (NFCS) and the Continuing Survey of Food Intakes by Individuals (CSFII) were used to look at changes in the mean energy, percent calories from fat and saturated-fat and total-fat intakes over time. USDA's 1995 CSFII data were used to evaluate the diets of individuals grouped based on percent calories from fat and use of low-fat foods. Individuals six to 50 years old who had complete food intake records were included and five age-gender classifications were used. RESULTS: The percent of calories from total fat and saturated fat have steadily declined over the last 30 years, and the amount of fat in the diet has increased from 1989 to 1995. Those whose diets met the Dietary Guidelines Recommendations for fat and saturated fat had lower fat intakes. Except for adult males, those with low-fat diets had higher intakes of total-food amount. Also, lower saturated-fat intakes were associated with lower energy intakes. In general, high-fruit-and-grain-products consumption were seen in groups with low-fat intake. For those who included low-fat foods in their diets and also had low-fat intakes, rice and pasta were the major foods of choice for calories. Fried potatoes were one of the main sources of calories for high-fat groups. CONCLUSION: The study showed individuals whose diets included low-fat foods are more likely to have a diet that meets the dietary guidelines recommendations for fat and saturated fat.     

Food-based dietary guidelines can be developed and tested using linear programming analysis

Effective food-based dietary guidelines (FBDGs) are required to combat micronutrient deficiencies. This study aimed to develop a rigorous approach for designing population-specific FBDGs. A 4-phase approach based on linear programming analysis was used to design, test, and refine the FBDGs. This was illustrated for Malawian children. In phase I, the objective function minimized the difference in the energy contributed by different food groups between modeled and observed diets for 16 observed diet types, while preferentially selecting foods most often consumed. Constraints ensured nutrient adequacy and diet palatability. In phase II, the meal/snack patterns of the phase I modeled diets were examined to develop season-specific FBDGs. In phase III, the robustness of these FBDGs, for ensuring a nutritionally adequate diet, was tested. The objective function, in this analysis, minimized selected nutrient levels in the modeled diets (i.e., chose the "worst-case scenario"), while respecting the FBDGs, palatability, and energy constraints. The FBDGs were refined in phase IV. In the Malawian example used to illustrate our approach, the FBDGs promoted daily consumption of maize flour, small dry fish (>or=20 g), leaf relish, and 2-3 snacks. The last mentioned included mangoes, in the food-shortage season, and pumpkin in the food-plenty season. In addition, legume relish was recommended in the food-shortage season. The approach presented here can be used to design and then test the robustness of FBDGs for meeting nutrient recommendations.     

Evaluation of energy, nutrient and dietary fiber intakes of adolescent males

OBJECTIVE: The minimal data available on the current energy, nutrient and dietary fiber intakes of adolescent males challenges the development of effective nutrition education programs. There is a need for research into the current intakes of adolescent males and in particular their relation to the current Dietary Reference Intakes (DRIs). The primary objective of this study was to assess the diet of adolescent males and relate energy, nutrient and dietary fiber intakes to the DRIs. Secondary objectives were to relate energy, macronutrient and dietary fiber intakes to body mass index (BMI)-for-age percentile categories as well as to explore vitamin/mineral supplement use and soft drink consumption. METHODS: Three-day food records were completed by 180 healthy adolescent males for analysis of energy, nutrient and dietary fiber intakes from food and supplements. Following adjustment for intra-individual variability, nutrient intake percentile distributions were related to the DRIs. Energy, macronutrient and dietary fiber intakes were compared among BMI-for-age percentile categories and diets were evaluated for vitamin/mineral supplement use and soft drink consumption. RESULTS: Median intakes for percent energy from carbohydrate, fat and protein were within the Accepted Macronutrient Distribution Ranges. Intakes of micronutrients with Estimated Average Requirement values indicated that greater than 50% of subjects consumed inadequate amounts of vitamin A and vitamin B6, and greater than 75% of subjects consumed inadequate amounts of magnesium, phosphorus and zinc. Subjects classified as overweight had significantly lower energy and carbohydrate intakes compared with subjects classified as having an acceptable body weight. The prevalence of vitamin/mineral supplement use was 16.1% and 67% of subjects reported daily consumption of soft drinks. CONCLUSION: Results of this study reveal that adolescent males are consuming the recommended amounts of macronutrients but may be at risk for consuming inadequate levels of specific micronutrients. Nutrition education programs should consider targeting select micronutrients to improve nutritional intakes of adolescent males.     

Added sugars displaced the use of vital nutrients in the National Food Stamp Program Survey

Recent increases in consumption of added sugars in the US can reduce intake of vital nutrients and increase the overall energy intakes. A comprehensive framework is necessary for addressing the controversy surrounding the effects of added sugars on nutrient intakes while controlling for dietary knowledge, behavioral factors, and total energy intakes, especially among low-income households. This paper analyzed the proximate determinants of 1-wk availability (or use) of added sugars by 913 households participating in the National Food Stamp Program Survey conducted in 1996-97. In addition, households' use of protein; fiber; calcium; iron; beta-carotene; vitamins A, C, E, B-6, and B-12; folic acid; and potassium were explained by socioeconomic and behavioral factors and by added sugars use. Linear programming analyses were conducted for assessing the effects of food prices on added sugars use. Participation in Supplemental Food Program for Women, Infants and Children program, food stamp benefits, and consumption of low-fat diets were associated (P<0.05) with lower added sugars use. Furthermore, greater use of added sugars significantly lowered households' uses of protein; iron; vitamins A, C, B-6, and B-12; and potassium. Behavioral and socioeconomic variables such as adopting a low-fat diet, consuming fruits and vegetables, saving money at grocery stores, frequency of shopping trips, skipping meals, and food insecurity were often important predictors of nutrient use. Overall, the results indicated that added sugars should be discouraged in dietary guidelines, because their adverse effects on diet quality were evident in this low-income population.     

Increased Intake of Foods with High Nutrient Density Can Help to Break the Intergenerational Cycle of Malnutrition and Obesity

A workshop held at the University Medical Center in Groningen, The Netherlands, aimed at discussing the nutritional situation of the population in general and the role diet plays during critical windows in the life course, during which the body is programmed for the development of non-communicable diseases (NCDs). NCDs are increasingly prevalent as our society ages, and nutrition is well known to play an important role in determining the risk and the time of onset of many common NCDs. Even in affluent countries, people have difficulties to achieve adequate intakes for a range of nutrients: Economic constraints as well as modern lifestyles lead people to consume diets with a positive energy balance, but low in micronutrients, resulting in increasing prevalence of obesity and suboptimal nutritional status. Information about nutrient density, which refers to the content of micronutrients relative to energy in food or diets, can help identify foods that have a low calorie to nutrient ratio. It thus allows the consumption of diets that cover nutritional needs without increasing the risk of becoming obese. Given the impact a nutrient dense, low energy diet can have on health, researchers, food industry and governments jointly should develop options for affordable, appealing nutrient-rich food products, which, in combination with physical activity, allow for optimal health throughout the life-course.     

Disparities in Nutritional Adequacy of Diets between Different Socioeconomic Groups of Finnish Adults

Information on dietary adequacy is needed to assess food and nutrition security in a modern society, especially in the transition towards climate-friendly food systems. In this study, differences in the nutritional adequacy of diets among Finnish adults were evaluated in population groups of different education, income and urbanisation levels. The study used data from the FinDiet 2017 Survey (n = 1655, 18–74 years). Modelled usual intakes of foods and nutrients were evaluated relative to food-based dietary guidelines issued by the National Nutrition Council of Finland (FNNC) and with respect to nutrient adequacy following the Nordic Nutrition Recommendations and FNNC. For about half of the nutrients studied, intakes were found to be adequate. Intakes of protein, fat, saturated fatty acids and salt were estimated to be high. By contrast, inadequate intakes were seen in folate and vitamins A, D, B1, B2 and C in almost all groups studied. Groups with a higher education and income, groups that lived in urban areas and, in particular, women adhered more closely to recommended food consumption and nutrient intakes than others. However, major challenges posed by the Finnish diet are common to all groups studied, and only certain dietary features evaluated in view of nutritional adequacy are associated with socioeconomic differences.     

Sources of fiber and fat in diets of US women aged 19 to 50: implications for nutrition education and policy.

INTRODUCTION. Many women are not meeting dietary recommendations for fiber and fat intakes. Health educators need to know which foods are major sources of these nutrients. METHODS. This study analyzed the contributions of 27 food groups to fiber, fat, saturated fat, and cholesterol intakes of 2134 women aged 19 to 50 years in USDA's Continuing Survey of Food Intakes by Individuals, the 1985 and 1986 surveys (CSFII 85-86). RESULTS. Major determinants of fiber intake include frequency of use of certain food groups (vegetables, including potatoes, bread, fruit, soups, ready-to-eat cereal) and choice of particular foods within the larger food groups (e.g., whole grain bread, high fiber cereal). Major determinants of total fat, saturated fat, and cholesterol intakes included frequency of use of certain foods (sweet grains, beef, eggs, cheeses/cream, whole milks) and additions to foods (regular salad dressing and butter/margarine). Demographic characteristics were related to various food group consumption parameters. CONCLUSIONS. Information about the relationships between food group and nutrient intake and the effects of household income, race/ethnicity, and region of residence on food group intake indicate opportunities to refine nutritional education programs.     

The contribution of ready-to-eat cereals to daily nutrient intake and breakfast quality in a Mediterranean setting

OBJECTIVES: To examine if and how ready-to-eat cereals (RTEC) contribute to the quality of the diet of children, adolescents and young adults in a Mediterranean setting. METHODS: A random sample of 3534 subjects aged 2 to 24 years in Spain was studied. Food and nutrient intakes were determined by a 24 hour recall. RTEC consumption was assessed by a quantitative food frequency questionnaire. Additional questions on socioeconomic level and nutritional knowledge were administered. Cereal consumption was classified into non-consumers and daily intakes between 1 and 20g, 21 and 40g, and more than 40g. After excluding the underreporters the final sample consisted of 2852 individuals. RESULTS: About half of the population (49.8%) reported eating RTEC. Macronutrient profile improved with increasing cereal consumption. Intakes of thiamine, riboflavin and vitamin B6 increased significantly with increasing consumption of RTEC in all age-sex groups, whereas niacin and folate intake improved in almost all groups and calcium, iron and vitamin D in at least half of the groups. Except for magnesium, vitamin B12 and vitamin E in males, consumption of RTEC was significantly associated with increased coverage of the daily nutrient requirements for all micronutrients studied. Higher levels of RTEC consumption was associated with a greater consumption of dairy products, and related to better breakfast quality. CONCLUSIONS: Level of RTEC consumption is associated with a better nutritional profile in the diets of Spanish children, adolescents and young adults and a lower risk for inadequate micronutrient intakes. RTEC consumers have better quality breakfasts, in terms of both food choices as well as energy and nutrient content.     

Dietary habits and health status of African‐Caribbean adults

Background: Although African‐Caribbeans in the UK are more likely to suffer from a number of diet‐related health conditions, including obesity, hypertension and type II diabetes, there have been few dietary studies on this group. The present study is based on a small survey of food and nutrient intakes and traditional dietary habits of African‐Caribbean adults living in Staffordshire. Methods: A questionnaire, designed to collect demographic data and information on medical status, physical activities, dietary, cooking and food shopping habits was administered to a convenience sample of 39 adults. Detailed information on food intakes was gathered using a modified existing Food Frequency Questionnaire with 169 items. Height and weight were measured for the calculation of body mass index. Results: The average age of the subjects was 47 years (range 19–65 years). The prevalence of obesity was 39% and one‐third of subjects reported having at least one health condition. Physical activities, outside of work, were undertaken by 95% of the sample. Traditional foods were used by 92% of respondents, including fruit and vegetables purchased at markets outside of their local area. A wide variety of foods were consumed and the percentages of energy provided by fats and carbohydrates (30% and 53%, respectively) appeared to be meeting government recommendations. However, absolute energy intakes were high and salt consumption, often in the form of commercial seasonings, exceeded government recommendations. Conclusions: The positive aspects of the diets of this population need to be encouraged. Interventions need to focus on ways of reducing total energy intakes, as well as levels of salt consumption.     

Comparison of energy and protein intakes of older people consuming a texture modified diet with a normal hospital diet

BACKGROUND: There are very few studies looking at the energy and protein requirements of patients requiring texture modified diets. Dysphagia is the main indication for people to be recommended texture-modified diets. Older people post-stroke are the key group in the hospital setting who consume this type of diet. The diets can be of several consistencies ranging from pureed to soft textures. OBJECTIVE: To compare the 24-hour dietary intake of older people consuming a texture modified diet in a clinical setting to older people consuming a normal hospital diet. METHOD: Weighed food intakes and food record charts were used to quantify the patients' intakes, which were compared to their individual requirements. RESULTS: The oral intake of 55 patients was measured. Twenty-five of the patients surveyed were eating a normal diet and acted as controls for 30 patients who were prescribed a texture-modified diet. The results showed that the texture-modified group had significantly lower intakes of energy (3877 versus 6115 kJ, P < 0.0001) and protein (40 versus 60 g, P < 0.003) compared to consumption of the normal diet. The energy and protein deficit from estimated requirements was significantly greater in the texture-modified group (2549 versus 357 kJ, P < 0.0001; 6 versus 22 g, P = 0.013; respectively). CONCLUSION: These statistically significant results indicate that older people on texture-modified diets have a lower intake of energy and protein than those consuming a normal hospital diet and it is likely that other nutrients will be inadequate. All patients on texture-modified diets should be assessed by the dietitian for nutritional support. Evidence based strategies for improving overall nutrient intake should be identified.     

The overall nutritional quality of the diet is reflected in the growth of Nigerian children

Childhood malnutrition is widespread in the Sahel region of Africa. In Niger, the 1992 Population and Health Survey found that 32% of children under the age of five years had stunted growth and 16% had muscle wasting. Vitamin A deficiency and anemia are major health problems and it is thought that the rate of zinc deficiency is also high. However, very little is known about the dietary intakes of children. The aim of this study was to assess food consumption, energy and nutrient intake in weaned, preschool age children and to assess their risks of deficiency. Three surveys were conducted in periods of food shortage. Two of the surveys were carried out one year apart, in the rainy season (August to September). The third was conducted at the end of the subsequent dry season (July). Sixty children from rural areas (30 girls and 30 boys) aged 2 to 4 years of age at the start of the study (mean age 36.8 + 7.0 months) from the Ouallam district (western Niger) were studied in surveys 1 and 2, and thirty of these children were then studied in the third survey. Food intake was assessed using a modified weighed intake technique. All foods and beverages consumed by the child at each meal were recorded over three days. The raw ingredients of homemade family meals were weighed and the final cooked weight was also recorded. If the child ate from a shared bowl, the number of mouthfuls was counted and three mouthful samples were weighed. Total serving size was then calculated based on the number of mouthfuls and the mean mouthful weight. Snacks and meals eaten away from home were assessed by questioning the mother. Energy, protein, vitamin A, iron and zinc intakes were compared using the most relevant food composition data and the adequacy of the diet was determined from international recommendations for intake. Energy, iron and zinc requirements were adjusted for diets with a low level of digestibility. Protein requirements were adjusted according to the protein mix quality score (67%). The frequency of inadequate intake was calculated using the probability approach of Beaton (1985) or cutoff values roughly corresponding to the mean requirements for particular age/sex groups. Two overall diet scores were used: a nutritional quality score (NQS) and a diversity score (DS). The relationships between dietary intakes and scores, children's weights and heights were investigated. As expected, the children included in the study had monotonous diets, with few animal products, fats, fruits and vegetables other than green leaves (Figure 1). Cereals made up 80 to 90% of total energy, protein, iron and zinc intake. Green leaves supplied most of the vitamin A intake. Intakes were chronically inadequate, particularly during the rainy season, with only vitamin A intake being adequate (Table 1). Almost all the children were at high risk of zinc deficiency. Diet quality and diversity scores were correlated (Tables 2 and 3). About half the children had stunted growth (Table 4). Energy, protein and zinc intakes were highly and significantly correlated with the anthropometric status of the child one year later, particularly with height-for-weight Z scores, and with dietary NQS (Table 5). Both dietary scores were positively correlated with weight and height indices. However, only NQS was significantly associated with weight-for-height index, higher NQS scores being associated with higher growth indices. Diet quality also predicted the anthropometric status of the child one year later. Our findings suggest that both dietary scores are relevant but that the diversity of food eaten may be a better determinant of growth status if energy intake is close to meeting dietary requirements. Multiple dietary inadequacies are frequent among children from developing countries so scores of overall dietary quality may be more appropriate indicators than the intakes of specific nutrients. (ABSTRACT TRUNCATED)