Jeffrey S Hampl

Vitamin C Deficiency and Depletion in the United States: The Third National Health and Nutrition Examination Survey, 1988 to 1994

OBJECTIVES We sought to determine prevalence rates of vitamin C deficiency and depletion in the United States. METHODS We used data from the Third National Health and Nutrition Examination Survey to assess intake of dietary, supplemental, and serum vitamin C. RESULTS Mean intakes and serum levels of vitamin C were normal; however, vitamin C deficiency and depletion were common (occurring among 5%-17% and 13%-23% of respondents, respectively). Smokers, those who did not use supplements, and non-Hispanic Black males had elevated risks of vitamin C deficiency, while Mexican Americans had lower risks. CONCLUSIONS Health professionals should recommend consumption of vegetables and fruits rich in vitamin C and should recommend supplementation for individuals at risk of vitamin C deficiency.

Intakes of vitamin C, vegetables and fruits: Which schoolchildren are at risk?

OBJECTIVE The purpose of this study was to determine vitamin C intakes among American schoolchildren. We investigated the leading sources of vitamin C in childrens diets, the leading vegetables and fruits consumed by children and differences in dietary intake associated with vitamin C consumption. METHODS Data from 1,350 7- to 12-year-old and 908 13- to 18-year-old schoolchildren were obtained from the 1994-1996 Continuing Survey of Food Intakes by Individuals (CSFII). The children were stratified by age and gender and then split into three vitamin C consumption groups based upon two 24-hour recalls: low (0 to 30.0 mg), marginal (30.1 to 59.9 mg), and desirable (>60.0 mg). Data were analyzed by tabulation and by ANOVA followed by post hoc Scheffes test. Outcome measures included food groups and energy-adjusted intakes of micro- and macronutrients. RESULTS Among the 7- to 12-year-olds, 12% of boys and 13% of girls had mean vitamin C intakes that were less than 30 mg/day, and, among 13- to 18-year-olds, 14% of boys and 20% of girls had low vitamin C intakes. In addition to consuming significantly more vitamin C, children with desirable vitamin C intakes also consumed significantly more (p <0.001) energy-adjusted folate and vitamin B6; children with low vitamin C intakes tended to have significantly greater (p <0.001) energy-adjusted intakes of fat and saturated fat. Children with desirable vitamin C intakes consumed significantly more (p <0.006) high-vitamin C fruit juice, low-vitamin C vegetables and whole milk. Children with low vitamin C intakes on average consumed two daily servings of vegetables and fruits, of which less than 1/5 of a serving was citrus, while children with desirable vitamin C intakes consumed an average of one daily serving of citrus. CONCLUSIONS A considerable number of children drastically under-consumed vitamin C and total vegetables and fruits. Overall, children with desirable vitamin C intakes had healthier diets, including more milk and vegetables, than did their peers with low vitamin C intakes. Health care professionals should continue to promote at least five daily servings of vegetables and fruits and should advise parents that at least one of these should be rich in vitamin C.

Low intakes of vegetables and fruits, especially citrus fruits, lead to inadequate vitamin C intakes among adults.

Objective: To determine vitamin C intakes among adults and to identify differences in dietary intake associated with vitamin C consumption.Design: This cross-sectional study compared vitamin C intake, nutrient intake, and food group choices of adults with low (<30 mg/d), marginal (30–60 mg/d), and desirable (>60 mg/d) vitamin C intakes.Subjects: Data from 2472 men and 2334 women aged 25–75 y were obtained from the 1994–1996 Continuing Survey of Food Intakes by Individuals (CSFII).Results: Overall, 18% of the sample had low vitamin C intakes, 24% had marginal intakes, and 58% had desirable intakes. In addition to consuming less vitamin C, adults with low vitamin C intakes consumed significantly less (P≤0.001) energy-adjusted (ie nutrient/1000 kcal) folate, fiber, β-carotene, and vitamin B6, and significantly more (P<0.001) fat. Compared to adults with low intakes, adults with desirable vitamin C intakes consumed significantly more (P≤0.001) high-vitamin C fruit juice and low-vitamin C vegetables, while consuming significantly less (P≤0.009) soft drinks, coffee/tea and alcoholic beverages. On average, adults with desirable vitamin C intakes consumed more than five daily servings of vegetables and fruits, of which more than one was citrus. Adults with low and marginal vitamin C intakes consumed less than one-fifth of a serving of citrus.Conclusions: A considerable number of adults under-consume vitamin C and total vegetables and fruits. Nutritionists should continue to promote five to nine daily servings of vegetables and fruits, at least one of which should be rich in vitamin C.European Journal of Clinical nutrition (2000) 54, 573–578

Position of the American Dietetic Association: The Role of Dietetics Professionals in Health Promotion and Disease Prevention

In the United States, the leading determinants of morbidity and mortality are rooted in behavioral choices related to eating habits, exercise, tobacco, alcohol consumption, and stress reduction. Scientific data consistently provide evidence that diet plays an important role in health promotion and disease prevention. Healthy eating habits--coupled with other healthful lifestyle behaviors--have the potential to reduce the risk of chronic disease. Health care typically assumes a curative or treatment role in the United States. However, dietetics professionals are shaping an alternate view of health, which includes developing healthy public policies, creating safe and supportive environments, building communities and coalitions, and reorienting health services to include health promotion as a primary approach to delivering health care. Individual-level approaches, such as counseling and group education, have been employed most often in modifying health behaviors. However, population-level approaches that affect availability of or access to healthy foods, opportunities for physical activity, and other healthy lifestyle determinants also are important. Dietetics professionals have pivotal roles in both individual- and population-level approaches.

Using Standardized Patients to Train and Evaluate Dietetics Students

Faced with a dwindling number of clinical sites for training dietetics students, we incorporated a standardized patient scenario of a 17-year-old pregnant woman into a nutrition counseling course. A young woman was hired to be the patient and was trained extensively. Each student signed up for a 20-minute block of time to assess her and provide nutrition instruction, after which the standardized patient and course instructor provided individualized feedback to each student. Students then completed a brief questionnaire related to the standardized patient session. Overall, student response to the standardized patient session was positive, and students believed standardized patients should be included formally in undergraduate training. The students noted that the standardized patient session allowed them to be trained and evaluated objectively. Because of their ease in building rapport with the standardized patient, students reported that they were able to provide more in-depth education. They also appreciated the immediate and detailed performance review provided by the standardized patient and the instructor. We conclude that standardized patient sessions provide a great service to dietetics students, and plans to develop another standardized patient scenario that students can follow up throughout the continuum of care are underway.

Race-, gender- and age-specific differences in dietary micronutrient intakes of US children.

Race-, gender- and age-specific differences in dietary micronutrient intakes of 1- to 10-year-old US children were evaluated. Three-day, dietary intakes from the US Department of Agricultures Continuing Survey of Food Intakes by Individuals were evaluated. Data from 1895 children (967 males, 928 females; 1540 Whites, 355 Blacks) who resided in the 48 conterminous states were analyzed. Micronutrient intakes, intakes as percent of the Recommended Dietary Allowance (RDA) and percent of children who consumed ≤67% of the RDA were computed. Black males compared with White males, Black females compared with White females and White females compared with White males had significantly lower dietary intakes for several micronutrients. More Black males than White males had intakes ≤67% of the RDA for vitamin E, calcium and zinc. Blacks and female children were at a greater risk for vitamin A, vitamin E, calcium, iron and zinc deficiency.

Women, Infants, and Children Cash Value Voucher (CVV) Use in Arizona: A Qualitative Exploration of Barriers and Strategies Related to Fruit and Vegetable Purchases

OBJECTIVE Women, Infants, and Children (WIC) cash value vouchers (CVV) have been inconsistently redeemed in Arizona. The objective of this study was to explore perceived barriers to use of CVV as well as strategies participants use to overcome them. DESIGN Eight focus groups were conducted to explore attitudes and behaviors related to CVV use. SETTING Focus groups were conducted at 2 WIC clinics in metro-Phoenix, AZ. PARTICIPANTS Participants in WIC who were at least 18 years of age and primarily responsible for buying and preparing food for their households. PHENOMENON OF INTEREST Perceived barriers to CVV use and strategies used to maximize their purchasing value. ANALYSIS Transcripts were analyzed using a general inductive approach to identify emergent themes. RESULTS Among 41 participants, multiple perceived barriers emerged, such as negative interactions in stores or confusion over WIC rules. Among experienced shoppers, WIC strategies also emerged to deal with barriers and maximize CVV value, including strategic choice of times and locations at which to shop and use of price-matching, rewards points, and other ways to increase purchasing power. CONCLUSIONS AND IMPLICATIONS Arizona WIC participants perceived barriers that limit easy redemption of CVV. Useful strategies were also identified that could be important to explore further to improve WIC CVV purchasing experiences.

Macronutrients, cholesterol, sodium and fiber intakes of 1–10 year old children by age, gender and race

Abstract Intakes of energy, macronutrients, cholesterol, sodium and dietary fiber were evaluated among 1–10 year old US children stratified by age, gender and race. The USDAs 1989–1991 Continuing Survey of Food Intakes by Individuals (CSFII) data sets supplied the study sample. Caregivers of 1,895 children residing in the 48 conterminous states provided one 24-hour recall and two 1-day food records to describe the childrens dietary intake. Blacks compared to Whites and females compared to males consumed less energy. Children consumed 46–52%, 15–17%, 34–38%, 13–15%, 5–6%, 12–15% of energies from carbohydrates, proteins, fats, saturated fat, polyunsaturated fat and monounsaturated fat, respectively. Intakes of fat, saturated fat and cholesterol (mg/1000 Kcal) exceeded current recommendations. Intake ratio of polyunsaturated fat to saturated fat was lower than recommendation. Cholesterol intakes were higher and dietary fiber intakes were lower among Blacks compared to Whites. Dietary patterns of children were less favorable for cardiovascular health. To achieve recommended intake patterns, significant modifications are needed in childrens diets concerning fat, sodium and fiber.

Adolescents report television characters do not influence their self-perceptions of body image, weight, clothing choices or food habits

Purpose – Social cognitive theory (SCT) suggests that the observation of role models prompts the formation of beliefs that will govern future behaviors. The paper’s objective is to explore the perceived influence of television media on feelings about eating habits, body image, clothing styles, and physical attractiveness attributes by high schools students in terms of SCT. Design/methodology/approach – Data on attitudes and perceptions were collected using an online survey of a convenience sample of high school students (n ¼ 467) to determine influence of television media characters on behaviors. Findings – The results of this survey suggest that high school students do not indiscriminately model behaviors depicted by television programs, but may selectively incorporate some views that fit with their reality such as the importance of attractiveness in romantic partners, but not influences of clothing styles or eating habits. Research limitations/implications – Recognition of the fictional quality of television characters does not refute that they have influence on the high school respondents, but it does suggest some degree of cognitive recognition about the lack of reality of television characters. The convenience sample of adolescents may be more media-savvy than others because of associations with high-school journalism programs.

Nutrient Intake Report: a coordination of patient dietary assessment between physicians and registered dietitians

The Nutrient Intake Report (NIR) is based on a 7-day dietary recall questionnaire used previously in research for dietary assessment and adapted for clinical use. Used to provide information and counseling as part of total patient care, the NIR acts as a cornerstone for dietary education and interaction between physician, registered dietitian, and patient. The NIR is ordered by physicians or registered dietitians, scanned and assessed by a registered dietitian, and incorporated into the laboratory section of the medical record. It documents the patients dietary intake in the context of his or her diagnosis and general health status. The NIR also opens a dialogue between physicians and registered dietitians. Incorporation of the NIR into the medical record makes the work of the registered dietitian available to other health practitioners, which is welcome in an era when licensing and reimbursement are contingent on systematic documentation of dietary assessment and its role in patient care.