Helen Smiciklas-Wright

Accuracy of Energy Intake Data Estimated by a Multiplepass, 24-hour Dietary Recall Technique

OBJECTIVE This study examined the accuracy of a multiple-pass, 24-hour dietary recall method for estimating energy intakes of men and women by comparing it with energy intake required for weight maintenance. DESIGN Three-day, multiple-pass, 24-hour recalls were obtained on randomly selected days during a self-selected diet period when subjects were preparing their own meals and during a controlled diet period when all meals were provided by the study. During the dietary intervention, weight was maintained; body weight and dietary intake were monitored closely, thereby allowing estimation of the energy intake required for weight maintenance. SUBJECTS/SETTING Seventy-eight men and women (22 to 67 years old) from the Dietary Effects on Lipoprotein and Thrombogenic Activity (DELTA) study participated in this study. All 24-hour recalls were collected using a computer-assisted, interactive, multiple-pass telephone interview technique. Energy requirements for each individual were determined by the energy content of the DELTA study foods provided to maintain weight. STATISTICAL ANALYSIS Paired and independent t tests were conducted to examine differences among study variables. Agreement between recalled energy intake and weight maintenance energy intake was analyzed using the Bland-Altman technique. RESULTS Compared with weight maintenance energy intake, during the self-selected diet period men and women underestimated energy intake by 11% and 13%, respectively. During the controlled diet period, men underestimated energy intake by 13%, whereas women overestimated energy by 1.3%. APPLICATIONS/CONCLUSIONS Men had a tendency to under-estimate energy intake irrespective of the recording period. The accuracy of the recalled energy intake of women may be influenced by recording circumstances. Researchers should examine the factors influencing underreporting and overreporting by individuals and their impact on macronutrient and micronutrient intakes. Also, strategies need to be developed to minimize underreporting and overreporting.

Dietary Patterns of Rural Older Adults Are Associated with Weight and Nutritional Status

Objectives: To characterize dietary patterns of rural older adults and relate patterns to weight and nutritional status.

Relative validity of food frequency questionnaire nutrient estimates in the Black Women's Health Study.

PURPOSE The Black Womens Health Study (BWHS) was designed to investigate determinants of health and disease in US black women. More than 64,000 women are enrolled in the BWHS cohort. This study assessed the relative validity of the 68-item food frequency questionnaire (FFQ) used in the BWHS baseline questionnaire. METHODS Four hundred and eight BWHS enrollees were asked to provide three telephone, 24-hour recalls and one written 3-day food diary over a one-year period. Means and Pearson correlations were computed to compare estimates for energy, total fat, saturated fat, protein, carbohydrate, dietary fiber, calcium, iron, vitamin C, folate, beta-carotene, and vitamin E from the FFQ, recalls, and diaries. RESULTS Mean energy intake (kcal) was higher for the diary (1716) than the FFQ (1601) or recalls (1510). Other nutrient estimates (% kcal or per 1000 kcal) were similar across methods, except beta-carotene (FFQ higher). Correlations (energy-adjusted, except for energy, and corrected for intraperson variation) between the FFQ and the recalls were higher than for the diary data and were between 0.5 and 0.8, except for energy and vitamin E (both <0.3). CONCLUSION The BWHS FFQ will support meaningful analyses of diet-health associations for 10 of the 11 energy-adjusted nutrient intake variables analyzed.

Girls' early sweetened carbonated beverage intake predicts different patterns of beverage and nutrient intake across childhood and adolescence.

BACKGROUND Information is limited on persistence of early beverage patterns throughout childhood and adolescence and their influence on long-term dietary intake. OBJECTIVE To describe changes in beverage intake during childhood and assess beverage and nutrient intake from ages 5 to 15 years among girls who were consuming or not consuming sweetened carbonated beverages (soda) at age 5 years. DESIGN/SUBJECTS Participants were part of a longitudinal study of non-Hispanic white girls and their parents (n=170) assessed biennially from age 5 to 15 years starting fall 1996. STATISTICAL ANALYSES At each assessment, intakes of beverages (milk, fruit juice, fruit drinks, soda, and tea/coffee), energy, macronutrients, and micronutrients were assessed using three 24-hour recalls. Analyses of longitudinal changes and the interaction between beverage type and age were conducted using a mixed modeling approach. Girls were categorized as either soda consumers or nonconsumers at age 5 years. A mixed modeling approach was used to assess longitudinal differences and patterns of change in beverage and nutrient intake between soda consumption groups. RESULTS Early differences in soda intake were predictive of later soda and milk intake and of differences in selected nutrients. Relative to girls who were not consuming soda beverages at age 5 years, soda consumers at age 5 years had higher subsequent soda intake, lower milk intake, higher intake of added sugars, lower protein, fiber, vitamin D, calcium, magnesium, phosphorous, and potassium from ages 5 to 15 years. CONCLUSIONS Soda consumption at age 5 years predicted patterns of nutrient intake that persisted during childhood and into adolescence. Diets of soda consumers were higher in added sugars and lower in protein, fiber, calcium, vitamin D, magnesium, phosphorous, and potassium. Findings provide a more complex picture regarding the emergence of early beverage patterns and their predictive effects on nutrient intake across childhood and adolescence.

The quality of girls' diets declines and tracks across middle childhood

BackgroundFood group intakes by US children are below recommendations and micronutrient inadequacies have been reported. There are few longitudinal data that focus on developmental changes in food and nutrient intake from early to middle childhood. We examined changes in nutrient and food group intakes over time and the tracking of intakes across middle childhood in a longitudinal sample of girls.MethodsThree multiple-pass 24-hour diet recalls were conducted in a sample of 181 non-Hispanic White girls at ages 5, 7, and 9 years. Food and nutrient data were averaged across 3 days. Analyses of time effects were conducted using repeated measures analysis of variance and tracking of intakes was assessed via rank analysis.ResultsWe found significant decreases in nutrient densities (intakes per 1000 kcal) of vitamins C and D, calcium, phosphorus, magnesium and zinc at age 9. Girls maintained their relative quartile positions for these micronutrients from ages 5–9. Analysis of food group data showed similar trends. At age 9, significantly fewer girls were meeting the recommendations for dairy, fruit and vegetable servings than at age 5 and girls also tended to remain in their respective quartiles over time, especially for fruit and dairy intakes.ConclusionsThese results highlight the importance of developing healthy eating practices during early childhood when caretakers have considerable control over childrens food intake.

Understanding reporting bias in the dietary recall data of 11-year-old girls

Objective: This study describes patterns of bias in self‐reported dietary recall data of girls by examining differences among girls classified as under‐reporters, plausible reporters, and over‐reporters on weight, dietary patterns, and psychosocial characteristics.

Development and evaluation of a method for calculating the Healthy Eating Index-2005 using the Nutrition Data System for Research

OBJECTIVE To develop and evaluate a method for calculating the Healthy Eating Index-2005 (HEI-2005) with the widely used Nutrition Data System for Research (NDSR) based on the method developed for use with the US Department of Agricultures (USDA) Food and Nutrient Dietary Data System (FNDDS) and MyPyramid Equivalents Database (MPED). DESIGN Cross-sectional. SETTING Non-institutionalized, community-dwelling adults aged 70 years and above. SUBJECTS Two hundred and seventy-one adults participating in the Geisinger Rural Aging Study (GRAS) and 620 age- and race-matched adults from the National Health and Nutrition Examination Survey 2001-2002 (NHANES) were included in the analysis. The HEI-2005 scores were generated using NDSR in GRAS and compared to scores generated using FNDDS and MPED in NHANES. RESULTS Similar total HEI-2005 scores (mean 62·0 (se 0·75) in GRAS v. 57·4 (se 0·55) in NHANES) were estimated, and the individual components most strongly correlated with total score in both samples were compared. Cronbachs coefficient α values of HEI-2005 were 0·52 in GRAS and 0·43 in NHANES. CONCLUSIONS Since NDSR is commonly used for educational purposes, in clinical settings and in nutrition research, it is important to develop methodology for assessing diet quality through the use of HEI-2005 with this dietary analysis software application and its accompanying food and nutrient database. Results from the present study show that HEI-2005 scores can be generated with NDSR using the method described in the present study and the detailed USDA Center for Nutrition Policy and Promotion technical report as guidance.

Nutritional guidance is needed during dietary transition in early childhood.

Objective. To assess dietary nutritional quality during dietary transition to a modified adult-style diet in the second year of life. Design. A total of 55 children from 12 to 18 months old and their parents were studied. Dietary intake and indices of growth were measured monthly. Dietary data were collected monthly and tabulated using the Minnesota Nutrient Data System. Data were evaluated using repeated-measures analysis of variance, time trend, and correlational analyses. Results. Mean energy intake increased from 12 to 18 months of age (926 ± 24 kcal to 1062 ± 33 kcal) with contributions from energy-yielding macronutrients remaining relatively constant. Throughout the study, fat intakes were below 30% of energy for 22% to 33% of the sample. Micronutrient intake patterns were diverse with intake for some nutrients (vitamins A, C, B6, B12, and D and calcium) remaining above recommended levels despite changes over the course of the study. Folate intakes increased from 79% of the recommended value at 12 months old to ∼100% at 18 months old. Zinc and vitamin E intakes were well below recommended levels throughout the study, and iron decreased markedly from 96% of the recommended level at 12 months old to 76% at 18 months old. Applications/Conclusions. These data show that intakes of some key nutrients are low during the period of dietary transition in early childhood, and intakes for some nutrients actually decrease despite increases in energy intake. Furthermore, because a considerable portion of children studied were consuming low-fat diets, it is clear that many parents are not following the only pediatric nutrition recommendations that currently exist. These findings argue strongly for the development of dietary guidance that not only addresses fat restriction, but also assists parents in selecting diets that support optimum growth and development in young children. nutrient intake, infants, dietary density.

Characterizing nutrient intakes of adolescents by sociodemographic factors.

PURPOSE The purpose of this study was to provide a description of the current dietary intake of a large sample of U.S. adolescents and to identify sociodemographic risk factors for nutrient intakes that did not meet recommended levels. METHODS The 1987-88 USDA Nationwide Food Consumption Survey was used to assess the nutrient intake of 933 adolescents aged 11 to 18 years. Analysis of covariance was used to determine the effect of the following on the nutrient intakes of males and females: household income and size, race, geographic region, degree of urbanization, and head of household status. Subject age was entered as a control variable. RESULTS Vitamin A, vitamin E, calcium, magnesium, and zinc were the nutrients most often consumed below recommended levels. In addition the females consumed low levels of phosphorus and iron. Percent calories from total fat and saturated fat and mean sodium intakes were above recommended levels for the majority of the sample. Females were more likely to meet cholesterol recommendations than males. Race and region affected the most nutrient intake variables. For the females, living in the south was a significant predictor for low intakes of several essential vitamins and minerals. CONCLUSIONS On average, the adolescents consumed diets that were low in several essential vitamins and minerals and high in some nutrients related to increased incidence of chronic disease. There were groups of teens who had dietary patterns that placed them at especially high risk, in particular the black and Southern females.

High-Soluble-Fiber Foods in Conjunction With a Telephone-Based, Personalized Behavior Change Support Service Result in Favorable Changes in Lipids and Lifestyles After 7 Weeks

OBJECTIVE To evaluate whether an intervention of foods high in soluble fiber from psyllium and/or oats plus a telephone-based, personalized behavior change support service improves serum lipids and elicits cholesterol-managing lifestyle changes vs usual care. DESIGN 7-week randomized, controlled intervention. SUBJECTS/SETTING 150 moderately hypercholesterolemic men and women, age range 25 to 70 years. INTERVENTION The intervention group consumed 4 servings/day of high-fiber foods and had weekly telephone conversations with a personal coach who offered support and guidance in making lifestyle changes consistent with the National Cholesterol Education Programs (NCEP) cholesterol-lowering guidelines. The usual care group received a handout describing the NCEP Step-1 diet. MAIN OUTCOME MEASURES Serum lipids and lipoproteins and self-reported lifestyle changes. STATISTICAL ANALYSES For physiologic and dietary changes, mixed linear models for repeated measures were applied. Models were simplified using analysis of covariance where age in years was the covariate. Traditional general linear models were used to assess lifestyle changes. RESULTS In the intervention group total cholesterol (TC) decreased 5.6%, low-density lipoprotein (LDL) cholesterol 7.1%, LDL/high-density lipoprotein (HDL) cholesterol ratio 5.6%, and triglycerides (TG) 14.2% (P<.0167); decreases in TC and LDL were significantly different from the usual care group. In the usual care group TC decreased 1.9%, LDL 1.2%, LDL/HDL 1.9%, and TG 4.4% (all not significant). The intervention group also reported an increase in their knowledge, ability, and confidence to make cholesterol-managing diet and exercise changes compared with the usual care group (P<.05). The intervention group had a greater decrease in energy intake from saturated fat (-1.6%) and increase in soluble fiber intake (7.3%) than the usual care group (P<.05). The intervention group reported an increase in exercise vs the usual care group (P<.05). Both intervention and control groups had a minimal reduction (<1%) in body weight compared with baseline (P<.0167). APPLICATIONS/CONCLUSIONS A 7-week intervention that includes both functional foods and individualized, interactive support for behavior change could be an effective model for dietitians to use with patients at risk for CVD, pending results of long-term studies.