Joanne F. Guthrie

National trends in soft drink consumption among children and adolescents age 6 to 17 years: prevalence, amounts, and sources, 1977/1978 to 1994/1998.

OBJECTIVES Trends between 1977/1978 and 1994/1998 in the prevalence, amounts, and sources of soft drink consumption were examined among youth age 6 to 17 years. DESIGN Dietary intake data were examined from three national surveys: the Nationwide Food Consumption Survey 1977/1978 (n=8,908), and the combined Continuing Survey of Food Intakes by Individuals 1994/1996, and the Supplemental Childrens Survey 1998 (n=3,177). Soft drinks were defined as carbonated beverages (all United States Department of Agriculture database codes starting with 924) and included flavored waters and juice drinks. Subjects/Setting A national sample of youth ages 6 to 17 years were interviewed for each of the 3 surveys. STATISTICAL ANALYSIS t tests were conducted to examine between-survey changes in soft drink consumption and sources of soft drinks. RESULTS The prevalence of soft drink consumption among youth ages 6 to 17 years increased 48%, from a prevalence of 37% in 1977/1978 to 56% in 1994/1998. Mean intake of soft drinks more than doubled, from 5 fl oz to 12 fl oz per day. Although the home environment remained the largest source of childrens soft drink access, an increasing share was obtained from restaurants and fast-food establishments (+53%), vending machines (+48%), and other sources (+37%). CONCLUSIONS Away-from-home sources of soft drink are an important factor for dietitians to consider when evaluating the dietary intake and nutritional status of youths.

Who uses nutrition labeling, and what effects does label use have on diet quality?

Abstract Information on the characteristics of individuals using nutrition labeling and the effects of label use on diet quality can be used to guide the development of more effective consumer education programs. For this study, data from the U.S. Department of Agricultures (USDA) 1989 Continuing Survey of Food Intakes by Individuals (CSFII) and Diet and Health Knowledge Survey (DHKS) were used to identify socioeconomic, demographic, and health-related characteristics and the nutrition-related knowledge and attitudes that were associated with label use. This analysis employed a theoretical model of determinants of label use that was based on an economic model of information search. Characteristics found to be positively associated with the likelihood of using nutrition labeling were having at least some college education, being female, living with others rather than living alone, being more knowledgeable about nutrition, believing that following the principles of the Dietary Guidelines for Americans is important, and being more concerned about nutrition and product safety and less about taste when shopping for food. Having identified the characteristics of label users, this information was used in a model of nutrient consumption that was based on consumer demand theory. A selectivity analysis was employed to correct for potential self-selection bias on label use. Label use appeared to be associated with the consumption of diets that were higher in vitamin C and lower in cholesterol. However, label use in 1989 did not significantly influence the intake of 24 other food components investigated.

Overview of the Diets of Lower- and Higher-Income Elderly and Their Food Assistance Options

With the elderly becoming an ever-larger proportion of the American population, their dietary well-being is of increasing concern. In particular, lower-income elderly may face special challenges in maintaining a healthful diet. This group makes up a sizeable proportion of the elderly population; we estimate that almost 1 in 5 (19%) of the elderly have household incomes at or below 130% of the federal poverty level, the income level that generally qualifies a household to participate in the federal Food Stamp Program. Here we examine the dietary intakes and related behaviors, as well as the food security status, of lower- and higher-income elderly and review major US government food and nutrition assistance programs that can be of benefit to the elderly, particularly those of low income. Our subjects are individuals 60 years of age and over, living in community (noninstitutionalized) settings. Data on dietary intakes and behaviors were obtained from the US Department of Agricultures Continuing Survey of Food Intakes by Individuals (CSFII), 1994-96. Food security data were obtained from the 1999 Current Population Survey (CPS), conducted by the US Census Bureau. For both the CSFII and the CPS, sampling weights were used to generate nationally representative estimates. We found that lower-income elderly consume significantly fewer calories than higher-income elderly, fewer servings of major Food Guide Pyramid food groups, and most nutrients. Approximately 6% of elderly households report some degree of food insecurity. Although food and nutrition assistance programs can benefit elderly individuals, many do not participate. Many lower-income elderly also face physiological and social obstacles to obtaining a healthful diet. How best to meet these varied needs is a challenge for nutrition educators, researchers, and policy makers.

Relationship of Diet-Health Attitudes and Nutrition Knowledge of Household Meal Planners to the Fat and Fiber Intakes of Meal Planners and Preschoolers

Abstract The relationship of household meal planners’ diet-health attitudes and nutrition knowledge to their fat and fiber intakes and to the intakes of 2- to 5-year-old children in the households was examined using data from the 1989–91 Continuing Survey of Food Intake by Individuals and Diet Health Knowledge Survey (CSFII/DHKS). Selected households (n = 478) provided 24-hour diet recalls and the households’ main meal planners responded to the DHKS. Meal planner attitude variables were defined according to the Health Belief Model and selected CSFII/DHKS questions served as proxy measures. The relationship of meal planners’ attitudes and knowledge to meal planners’ and childrens fat and fiber consumption at home and in the total diet was analyzed using multiple regression. Several diet-health attitude variables were significantly related to meal planners’ fat and fiber intakes and relationships were similar for foods eaten at home and for foods eaten in the total diet. Knowledge was significantly related to meal planners’ and childrens home fat intake (p

US Food assistance programs and trends in children's weight

OBJECTIVES. High rates of overweight and obesity among low-income children have led some to question whether participation in US domestic food assistance programs contributes to this health problem. We use multiple years of data to examine trends in childrens body weight and participation in the Food Stamp Program (FSP) or Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Specifically, we assess whether a consistent relationship between program participation and body weight exists over time. METHODS. Data from multiple waves of the National Health and Nutrition Examination Surveys (NHANES) are used to examine the relationship between childrens body weight and food assistance programs between 1976 and 2002. Linear regression models are used to estimate BMI and logit models are used to predict the probabilities of at-risk of overweight and overweight. Food assistance program participants (either FSP or WIC participants depending on age) are compared with income eligible non-participants and higher income children. RESULTS. Results show no systematic relationship over time between FSP participation and weight status for school-aged children (age 5-17). For children aged 2-4, no differences in weight status between WIC participants and eligible non-participants were found. However, recent data show some differences between WIC participants and higher income children. CONCLUSIONS. Our analysis does not find evidence of a consistent relationship between childhood obesity and participation in the FSP or WIC programs.

Impact on energy, sodium and dietary fibre intakes of vegetables prepared at home and away from home in the USA

OBJECTIVE To examine how increasing vegetable consumption from foods prepared at home (FAH) and foods prepared away from home (FAFH) would impact energy, dietary fibre and Na (sodium) intakes in the U.S.A. DESIGN Using data from the 2003–2004 U.S. National Health and Nutrition Examination Survey, dietary intake data from two separate days were fitted with a first-difference (fixed-effects) model. Vegetables consumed from all sources, including mixed foods and juices, were disaggregated and expressed as amounts equivalent to one cup of whole vegetables. SETTING Nationally representative sample of the U.S. population. SUBJECTS Individuals aged 2 years and above reporting 2 d of dietary intake data in 2003–2004 (n 7647). RESULTS Holding constant the total amount of food consumed, consuming an additional cup of tomatoes and potatoes from FAFH increases energy intake by respectively 1522 and 665 kJ, as compared with 246 and 367 kJ for FAH. Each additional cup of tomatoes from FAH is associated with an additional 179 mg of Na, compared with 113 mg for FAFH. All vegetable consumption increases fibre intake, except for potatoes and tomatoes from FAFH. Dark green and orange vegetables from FAH add the largest amount of fibre (1.38 g/cup). CONCLUSIONS Because U.S. consumers frequently consume vegetables as part of mixed foods that add energy and Na, heavier consumption of vegetables as currently prepared raises the energy content and Na density of the overall diet. This is particularly true for vegetables prepared away from home.

Integrating Behavioral Economics into Nutrition Education Research and Practice

Nutrition education has a long history of being informed by economic thinking, with the earliest nutrition education guides incorporating household food budgeting into nutrition advice. Behavioral economics research goes beyond that traditional role to provide new insights into how consumers make choices. These insights have numerous potential applications for nutrition interventions to promote healthy food choices consistent with the US Dietary Guidelines for Americans. Research to test the value of such applications can contribute to the development of evidence-based nutrition education practice called for in federal nutrition education programs.

CONTRIBUTIONS OF NONALCOHOLIC BEVERAGES TO THE U.S. DIET

This report analyzes consumer demand and nutritional issues associated with nonalcoholic beverages purchased for at-home use by looking at demographic variables such as household size, household income, education level, and region. The beverages include milk, carbonated soft drinks, bottled water, fruit juices, fruit drinks, coffee, tea, and isotonics (sports drinks). The reports focus is on the impact of nutritional quality from beverage purchase choices that a household makes, looking at the households availability of calories, calcium, vitamin C, and caffeine from these beverage choices. Using the Daily Values on the Nutrition Facts portion of the food label as a reference, we find that nonalcoholic beverages purchased for at-home consumption provided, on a per-person basis: 10 percent of daily value for calories; 20 percent of the daily value for calcium; 70 percent of daily value for vitamin C. Statistical analyses included the use of descriptive cross-tabulations and regression analyses, with profiles of households that were more or less likely to purchase the beverages, as well as key determinants associated with the probability of purchasing selected beverages.

WIC and Non-WIC infants and children differ in usage of some WIC-provided foods

Abstract Background USDAs Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides expert-chosen supplemental foods to improve the diets and health of low-income infants and children <5 y of age, but dietary behaviors of WIC participants are not well characterized. Objective The purpose of this analysis was to examine differences in food consumption patterns between WIC participants and nonparticipants. Methods FITS 2016 is a nationwide cross-sectional study of children <4 y (n = 3235). Data were weighted to provide US population–representative results. Children were categorized as WIC participants or nonparticipants, with the latter divided into lower- and higher-income nonparticipants. Group differences were assessed via the Wald test (demographics) and Rao-Scott modified chi-square test (breastfeeding prevalence). Differences in percentage consuming WIC-provided and selected other foods between WIC participants and nonparticipants were evaluated with the use of ORs and 95% CIs. Results WIC infants were less likely to breastfeed than were higher-income nonparticipants at 0–5.9 mo (45% compared with 74%) and less likely than both nonparticipant groups at 6–11.9 mo (30% compared with 49–60%). WIC 6- to 11.9-mo-olds were more likely to consume infant cereals and vegetables than were lower-income nonparticipants. WIC 12 to 23.9-mo-olds were more likely to drink whole milk (which WIC provides at this age) than were nonparticipants (72% compared with 59–64%), whereas WIC participants 24–47.9 mo were more likely to drink low- and nonfat milks (which WIC provides at this age) than were nonparticipants (45% compared with 13–22%). WIC participants 6–47.9 mo were more likely to drink juice than were nonparticipants. Conclusions Continued improvements in early dietary patterns are warranted for WIC and non-WIC children. Breastfeeding among WIC participants is a continuing challenge. Findings suggest that baby-food cereals, vegetables, and fruits (all provided by WIC) contribute importantly to WIC infants’ diets, whereas WIC children are more likely to use lower-fat milks after 2 y of age than are non-WIC participants.

Understanding School Food Service Characteristics Associated with Higher Competitive Food Revenues Can Help Focus Efforts To Improve School Food Environments

Many school food services sell extra foods and beverages, popularly referred to as “competitive foods,” in addition to USDA school meals. On the basis of national survey data, most competitive foods and beverages selected by students are of low nutritional value. Recent federal legislation will allow schools that participate in USDA school meal programs to sell competitive foods only if the food items they sell meet nutrition standards based on the Dietary Guidelines for Americans. Concerns have been raised about the potential effects of limiting competitive foods on local school food service finances. However, national data indicate that only in a subset of schools do food services receive large amounts of revenues from competitive foods. These food services are typically located in secondary schools in more affluent districts, serving higher proportions of students who do not receive free or reduced price meals. Compared to other food services, these food services couple higher competitive food revenues with lower school meal participation. Increasing school meal participation could increase meal revenues to offset any loss of competitive food revenues. Replacing less-healthful competitive items with healthier options could also help maintain school food service revenues while improving the school food environment. Nationally consistent nutrition standards for competitive foods may encourage development and marketing of healthful products.