Heather A. Eicher-Miller

Food insecurity is associated with iron deficiency anemia in US adolescents

BACKGROUND Food insecurity, a condition of low or very low food security, is associated with decreased nutrient intake and poor health, which can lead to nutrient deficiency in children, including iron deficiency and iron deficiency anemia. OBJECTIVE The purpose of this study was to formally investigate the current relation of iron status and food security status among children aged 3-19 y (n = 11,247). DESIGN Participants of the National Health and Nutrition Examination Survey 1999-2004 were classified for food security status by using the US Childrens Food Security Scale and the US Household Food Security Scale. Iron deficiency was defined as > or =2 abnormal values for transferrin saturation, serum ferritin, and erythrocyte protoporphyrin, with the addition of abnormal hemoglobin to classify iron deficiency anemia. RESULTS The odds of iron deficiency anemia among children aged 12-15 y were 2.95 times (95% CI: 1.18, 7.37; P = 0.02) those for children in households with food insecurity among children compared with children in households with food security among children. CONCLUSIONS The results of this study indicate a continuing need for successful interventions to reduce iron deficiency anemia among food-insecure children and to improve food security among children.

Food insecurity is associated with diet and bone mass disparities in early adolescent males but not females in the United States

Food insecurity is associated with decreased nutrient intake and poor health and possibly low bone mass in children. The purpose of this study was to formally investigate the relationship of diet, bone mass, and food insecurity among children aged 8-19 y (n = 5270). The data used in this cross-sectional study were drawn from children participating in the NHANES 2001-2004. Data were collected from homes and NHANES mobile examination centers across the United States. Food security status was classified using the US Childrens Food Security Scale and the US Household Food Security Scale. Dietary measures were quantified by 24-h dietary recall and bone mineral content (BMC) was determined with whole body DXA. Results indicated that males 8-11 y from households with food insecurity among children were 2.5 times [OR = 2.5 (95% CI = 1.1-5.8)] more likely to have fewer than the USDA Food Guide recommended servings of dairy foods, 2.3 times [OR = 2.3 (95% CI = 1.3-4.0)] more likely to have less than the estimated average requirement for calcium intake, and more likely to have a significantly lower estimated total body (P = 0.04), trunk (P = 0.05), lumbar spine (P = 0.02), pelvis (P = 0.05), and left arm (P = 0.05) BMC compared with males 8-11 y old from households with food security among children. Calcium-related dietary factors and BMC did not differ among females by food security status. These results are evidence that health disparities persist among 8- to 11-y-old, food-insecure boys. Successful interventions to improve diet and bone health and reduce food insecurity among children are a continuing need in the United States.

Iron Deficiency Is Associated with Food Insecurity in Pregnant Females in the United States: National Health and Nutrition Examination Survey 1999-2010

Food-insecure pregnant females may be at greater risk of iron deficiency (ID) because nutrition needs increase and more resources are needed to secure food during pregnancy. This may result in a higher risk of infant low birth weight and possibly cognitive impairment in the neonate. The relationships of food insecurity and poverty income ratio (PIR) with iron intake and ID among pregnant females in the United States were investigated using National Health and Nutrition Examination Survey 1999-2010 data (n=1,045). Food security status was classified using the US Food Security Survey Module. One 24-hour dietary recall and a 30-day supplement recall were used to assess iron intake. Ferritin, soluble transferrin receptor, or total body iron classified ID. Difference of supplement intake prevalence, difference in mean iron intake, and association of ID and food security status or PIR were assessed using χ(2) analysis, Student t test, and logistic regression analysis (adjusted for age, race, survey year, PIR/food security status, education, parity, trimester, smoking, C-reactive protein level, and health insurance coverage), respectively. Mean dietary iron intake was similar among groups. Mean supplemental and total iron intake were lower, whereas odds of ID, classified by ferritin status, were 2.90 times higher for food-insecure pregnant females compared with food-secure pregnant females. Other indicators of ID were not associated with food security status. PIR was not associated with iron intake or ID. Food insecurity status may be a better indicator compared with income status to identify populations at whom to direct interventions aimed at improving access and education regarding iron-rich foods and supplements.

Temporal Dietary Patterns Derived among the Adult Participants of the National Health and Nutrition Examination Survey 1999-2004 Are Associated with Diet Quality

BACKGROUND Temporal dietary patterns, the distribution of energy or nutrient intakes observed over a period of time, is an emerging area of dietary patterns research that incorporates time of dietary intake with frequency and amount of intake to determine population clusters that may have similar characteristics or outcomes related to diet quality. OBJECTIVE We examined whether differences in diet quality were present between clusters of individuals with similar daily temporal dietary patterns. DESIGN The first-day 24-hour dietary recall data from the cross-sectional National Health and Nutrition Examination Survey, 1999-2004, were used to determine proportional energy intake, time of intake, frequency of intake occasions, and mean diet quality. PARTICIPANTS/SETTING Data from 9,326 US adults aged 20 to 65 years were included. STATISTICAL ANALYSES PERFORMED The mean diet quality, classified by the Healthy Eating Index-2005, of participant clusters with similar temporal dietary patterns derived on the basis of individual proportional energy intake, time of intake, and frequency of intake, were inferentially compared using multiple linear regression that controlled for potential confounders and other covariates (P<0.05/6). RESULTS Diet quality differences were present between US population clusters exhibiting similar daily temporal dietary patterns (P<0.001 with one exception, which was P=0.08). Participant characteristics of race/ethnicity, age, household poverty-income ratio, and body mass index were associated with the temporal dietary patterns. The cluster representing the temporal dietary pattern with proportionally equivalent energy consumed during three evenly spaced eating occasions had a significantly greater mean total Healthy Eating Index-2005 score compared with the other temporal dietary pattern clusters. CONCLUSIONS Temporal dietary patterns are associated with differences in US adult daily diet quality, demonstrating that elements beyond food and nutrient intake, such as time, can be incorporated with dietary patterns to determine links to diet quality that enhance knowledge of the complicated interplay of time and dietary patterns.

Energy and Nutrient Intakes from Processed Foods Differ by Sex, Income Status, and Race/Ethnicity of US Adults

BACKGROUND The 2010 Dietary Guidelines for Americans (DGA) recommends nutrients to increase and to decrease for US adults. The contributions processed foods make to the US intake of nutrients to increase and decrease may vary by the level of processing and by population subgroup. OBJECTIVE The hypotheses that the intakes of nutrients to increase or decrease, as specified by the DGA, are contributed exclusively from certain processed food categories and consumed differentially by population subgroups by sex, poverty-income ratio (ratio of household income to poverty threshold), and race/ethnicity was tested along with the hypothesis that specific processed food categories are responsible for nutrient intake differences between the population subgroups. DESIGN The 24-hour dietary recall data from the cross-sectional 2003-2008 National Health and Nutrition Examination Survey was used to determine population subgroup energy and nutrient intake differences among processed food categories defined by the International Food Information Council Foundation Continuum of Processed Foods. PARTICIPANTS/SETTING Fifteen thousand fifty-three US adults aged ≥19 years. STATISTICAL ANALYSES PERFORMED The mean daily intake of energy and nutrients from processed food categories reported by population subgroups were compared using regression analysis to determine covariate-adjusted least square means. RESULTS Processed food categories that contributed to energy and nutrient intake differences within subgroups did not uniformly or exclusively contribute nutrients to increase or decrease per DGA recommendations. The between-group differences in mean daily intake of both nutrients to increase and decrease contributed by the various processed food categories were diverse and were not contributed exclusively from specific processed food categories. CONCLUSIONS Recommendations for a diet adhering to the DGA should continue to focus on the energy and nutrient content, frequency of consumption, and serving size of individual foods rather than the level of processing.

Processed Food Contributions to Energy and Nutrient Intake Differ among US Children by Race/Ethnicity

This study determined and compared the mean daily intake of energy and nutrients from processed foods by level of processing (minimally processed; processed for preservation, nutrient enhancement, and freshness; mixtures of combined ingredients; ready-to-eat processed foods; and prepared foods/meals) among non-Hispanic white, non-Hispanic black, and Mexican American US children. Data from participants 2–18 years old (n = 10,298) of the nationally representative cross-sectional National Health and Nutrition Examination Survey 2003–2008 with a complete one day, 24-h dietary recall were used to determine mean intake of energy and nutrients recommended for increase and decrease, as per the 2010 Dietary Guidelines for Americans, among child race/ethnic groups by category of food processing. Regression analysis was used to estimate and compare covariate-adjusted (gender, age, and poverty-income-level) least square means (p < 0.05/3 race/ethnic groups). All children, regardless of race or ethnicity consumed processed foods. Approximately 66% to 84% of total daily energy, saturated fat, cholesterol, fiber, total sugar, added sugars, calcium, vitamin D, potassium, and sodium intake are contributed by one of the five categories of processed foods. Clinicians and policy should primarily advise consideration of the energy and nutrient composition of foods, rather than the processing level, when selecting a healthy diet for children.

B-vitamin status and bone mineral density and risk of lumbar osteoporosis in older females in the United States

BACKGROUND Previous data suggest that elevated serum total homocysteine (tHcy) may be a risk factor for bone fracture and osteoporosis. Nutritional causes of elevated tHcy are suboptimal B-vitamin status. To our knowledge, this is the first nationally representative report on the relation of B vitamins and bone health from a population with folic acid fortification. OBJECTIVE The purpose of this analysis was to examine the relation between B-vitamin status biomarkers and bone mineral density (BMD), risk of osteoporosis, and biomarkers of bone turnover. DESIGN We examined the relation of tHcy, methylmalonic acid (MMA), and serum/red blood cell folate and total-body and lumbar spine BMD in women aged ≥50 y participating in the NHANES 1999-2004 (n = 2806), a nationally representative cross-sectional survey. These are the only years with concurrent measurement of tHcy and whole-body dual-energy X-ray absorptiometry. We also examined B-vitamin biomarkers relative to bone turnover markers, bone alkaline phosphatase, and urinary N-terminal cross-linked telopeptide of type I collagen in a 1999-2002 subset with available data (n = 1813). RESULTS In comparison with optimal concentrations, women with elevated tHcy were older with lower serum vitamin B-12, red blood cell folate, and dietary micronutrient intakes and had significantly higher mean ± SE markers of bone turnover (bone alkaline phosphatase: 15.8 ± 0.59 compared with 14.0 ± 0.25 μg/L; urinary N-terminal cross-linked telopeptide of type I collagen: 48.2 ± 2.9 compared with 38.9 ± 0.90 nmol bone collagen equivalents per mmol creatinine/L). Elevated MMA (OR: 1.88; 95% CI: 1.10, 3.18) and tHcy (OR: 2.17; 95% CI: 1.14, 4.15) were related to increased risk of lumbar osteoporosis. When examined as a continuous variable, tHcy was negatively associated, serum folates were positively associated, and MMA and vitamin B-12 were not significantly associated with lumbar and total-body BMD. CONCLUSION In this nationally representative population of older US women with high exposure to B vitamins through food fortification and dietary supplements, only elevated tHcy and MMA were independently associated with risk of lumbar spine osteoporosis.

Applied Visual Analytics for Exploring the National Health and Nutrition Examination Survey

The National Health and Nutrition Examination Survey (NHANES) is a research program to assess the health and nutritional status of the population in the United States. In this work, we present a visual analytics system designed to help researchers explore patterns and form hypotheses within the NHANES dataset. The visualization component of the environment is an extension of traditional scatter plot matrices. Since the upper portion of the scatter plot matrix is a redundant encoding, we utilize this space, to show the projected N-dimensional clustering of points. The rows and columns of the matrix are automatically ordered using information about the cluster projection in each space as a means of showing the most meaningful dimensions. A comparison module has also been included that allows the user to compare groupings of people to the 2010 Dietary Guidelines for Americans. This tool enhances the analysis work by aiding discovery and hypothesis formation.

Usual Nutrient Intakes from the Diets of US Children by WIC Participation and Income: Findings from the Feeding Infants and Toddlers Study (FITS) 2016

Abstract Background A recent report of the National Academies of Sciences, Engineering, and Medicine (NASEM) outlined priority nutrients for infants and children participating in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Objective The objective of this study was to assess usual nutrient intakes from foods and beverages (not supplements) among US children aged <4 y by WIC participation status. Methods A national random sample of children aged <4 y (n = 3,235) from the Feeding Infants and Toddlers Study (FITS) 2016 was categorized by WIC participation status (participants, lower-income nonparticipants, or higher-income nonparticipants) and age (younger infants aged 0–5.9 mo, older infants aged 6–11.9 mo, toddlers aged 12–23.9 mo, or preschoolers aged 24–47.9 mo). All participants contributed one 24-h dietary recall, with a second recall from a representative subsample (n = 799). Usual intakes and compliance with federal dietary recommendations were estimated by using the National Cancer Institute method. Differences between WIC participants and either lower-income nonparticipants or higher-income nonparticipants were tested using t tests. Results The diets of infants (aged <12 mo) were nutritionally adequate in general. Older infants participating in WIC had higher compliance with iron and vitamin D guidelines than either group of nonparticipants and greater compliance with calcium, zinc, and potassium guidelines than higher-income nonparticipants. WIC toddlers had a higher risk of inadequate calcium and excessive sodium intakes than higher-income nonparticipants. Eight percent of WIC toddlers exceeded added sugar guidelines compared with either nonparticipant group (∼2%). WIC toddlers and preschoolers had a lower risk of inadequate vitamin D intake than lower-income nonparticipants, but inadequacy was >75% across all subgroups. WIC preschoolers had higher compliance with saturated fat guidelines but lower compliance with sodium and added sugar guidelines than higher-income nonparticipants. Conclusions WIC participants had better intakes of iron (ages 6–23.9 mo), zinc and potassium (ages 6–11.9 mo), saturated fat (ages 24–47.9 mo), and vitamin D (all ages). Regardless of WIC participation status, most infants and children met the calcium and zinc guidelines, but large proportions had intakes not meeting the recommendations for iron (ages 6–11.9 mo), vitamin D, potassium, fiber, saturated fat, and sodium.

How Often and How Much? Differences in Dietary Intake by Frequency and Energy Contribution Vary among U.S. Adults in NHANES 2007–2012

The objective of this study was to determine the top frequently reported foods or beverages and the top foods or beverages grouped by broad and specific What We Eat In America (WWEIA) categories for adult age groups of 19 to 35 years, 36 to 55 years, and ≥65 years (n = 16,399) using data drawn from the cross-sectional, WWEIA, National Health And Nutrition Examination Survey (NHANES) 2007–2012 and to compare intake of broad WWEIA categories ranked by frequency and by energy contribution among these adult age groups. Ranking, unadjusted and weighted frequencies, and the proportion of reported foods or energy out of all reported foods or energy were determined and stratified by age. The Rao–Scott modified chi-square was used to test for significant differences among age groups. Results support dietary quality differences by age; intake of broad WWEIA categories was significantly different among age groups by frequency for alcohol, water, and condiment/sauces. Energy contributions significantly differed among age groups for protein foods, snacks/sweets, and beverages. Frequently reported foods and beverages may be used to inform the creation of search tools used for automatic and user-verified identification of foods and beverages in mobile- or technology-based dietary assessment.