Joseph D. Goldman

Current Status of Vitamin E Nutriture

Abstract: Vitamin E intake status requires reassessment because the recommended levels have been increased and take into account only the α‐tocopherol form of vitamin E. A database of α‐tocopherol values for more than 7,000 foods was developed and applied to dietary data from the National Health and Nutrition Examination Survey 1999‐2000. Usual intake distributions were determined and evaluated for adequacy. Ninety percent or more of the adults studied had their usual intakes below the current Estimated Average Requirement. Several observations—the prevalence of inadequate intakes of vitamin E, absence of signs of deficiency in the U.S. population, and increasing evidence that vitamin E helps reduce chronic disease risk—point to a need for further research.

A New Database Facilitates Characterization of Flavonoid Intake, Sources, and Positive Associations with Diet Quality among US Adults

BACKGROUND Epidemiologic studies demonstrate inverse associations between flavonoid intake and chronic disease risk. However, lack of comprehensive databases of the flavonoid content of foods has hindered efforts to fully characterize population intakes and determine associations with diet quality. OBJECTIVES Using a newly released database of flavonoid values, this study sought to describe intake and sources of total flavonoids and 6 flavonoid classes and identify associations between flavonoid intake and the Healthy Eating Index (HEI) 2010. METHODS One day of 24-h dietary recall data from adults aged ≥ 20 y (n = 5420) collected in What We Eat in America (WWEIA), NHANES 2007-2008, were analyzed. Flavonoid intakes were calculated using the USDA Flavonoid Values for Survey Foods and Beverages 2007-2008. Regression analyses were conducted to provide adjusted estimates of flavonoid intake, and linear trends in total and component HEI scores by flavonoid intake were assessed using orthogonal polynomial contrasts. All analyses were weighted to be nationally representative. RESULTS Mean intake of flavonoids was 251 mg/d, with flavan-3-ols accounting for 81% of intake. Non-Hispanic whites had significantly higher (P < 0.001) intakes of total flavonoids (275 mg/d) than non-Hispanic blacks (176 mg/d) and Hispanics (139 mg/d). Tea was the primary source (80%) of flavonoid intake. Regardless of whether the flavonoid contribution of tea was included, total HEI score and component scores for total fruit, whole fruit, total vegetables, greens and beans, seafood and plant proteins, refined grains, and empty calories increased (P < 0.001) across flavonoid intake quartiles. CONCLUSIONS A new database that permits comprehensive estimation of flavonoid intakes in WWEIA, NHANES 2007-2008; identification of their major food/beverage sources; and determination of associations with dietary quality will lead to advances in research on relations between flavonoid intake and health. Findings suggest that diet quality, as measured by HEI, is positively associated with flavonoid intake.

Monitoring Sodium Intake of the US Population: Impact and Implications of a Change in What We Eat in America, National Health and Nutrition Examination Survey Dietary Data Processing

Accurate monitoring of US sodium intake requires familiarity with national dietary data collection and processing procedures. This article describes a data processing step that impacts sodium intake estimates, reasons for discontinuing the step, and implications of its discontinuation. This step, termed salt adjustment, was performed in US Department of Agriculture (USDA) dietary intake surveys from 1985 through 2008. In What We Eat in America (WWEIA), the dietary intake interview component of the National Health and Nutrition Examination Survey (NHANES), the salt content of specific foods was reduced on the basis of a question about household use of salt in cooking. For individuals whose households used salt in cooking occasionally or less often, some or all of the salt attributable to home preparation was removed from foods that typically have salt added during preparation and were obtained from the store. The growing availability of preprepared foods in stores challenges the validity of using store purchase as a proxy indicator of home food preparation, and increased restaurant/fast-food consumption implies fewer reported foods are eligible for the procedure. In addition, USDAs Automated Multiple-Pass Method for the 24-hour dietary recall provides accurate sodium intake estimates without applying the salt-adjustment step. The final WWEIA, NHANES data release to contain salt-adjusted sodium data was 2007-2008. When assessing the effectiveness of sodium-reduction efforts over time, the nutrition community (eg, researchers, analysts, providers) must be aware of this change in WWEIA, NHANES beginning in 2009-2010 and account for it using appropriate baseline estimates.

Characterizing the Dietary Landscape of Children, 12 to 35 Months Old

Dietary intakes in childhood are one of several factors that influence food and beverage choices later in life. Nationally representative dietary data of US children aged 1 and 2 years (toddlers) (n = 469) participating in the “What We Eat in America” component of the 2011-2012 National Health and Nutrition Examination Survey were analyzed to assess food, beverage, and nutrient intakes. Dietary intakes were collected using 24-hour dietary recall interview conducted by proxy that was usually the mother. Mean and distribution of usual nutrient intakes, percentage meeting dietary reference intakes, meal and snack patterns, and intakes of foods and beverages were estimated. The energy intake of toddlers was 1335 kcal/d. Usual nutrient intakes of vitamins D and E were less than the recommended intake levels by 86% and 62% of toddlers, respectively. Almost all toddlers (96%) had usual intakes less than the recommendations for dietary fiber and potassium, and 71% exceeded the upper level for sodium. Mean daily intake of added sugars was 10% of daily energy intake, with approximately 40% of toddlers exceeding that level. Mean daily snack occasion of toddlers was 3.1, which contributed one-third of their daily energy intake. Beverages contributed one-fourth of their daily energy intake. On the basis of 1 day of dietary recall, milk, water, and 100% fruit juice were the top beverages consumed by toddlers. Soft drinks were consumed by 14% of toddlers. Grain products, protein foods, and mixed dishes were each consumed by at least three-fourths of the toddlers. A greater proportion of toddlers consumed fruit (71%) compared with vegetables (57%). Nearly 1 in 3 toddlers consumed candy, and 2 in 5 consumed cakes/cookies/pastries. More than one-third consumed savory snacks, including chips, popcorn, and pretzels, and an equal proportion consumed crackers. Although the dietary intakes of toddlers met the recommendations for many nutrients, the consumption of food and beverage choices that were not nutrient dense may merit concern. Less healthy choices, introduced at early ages, may shape dietary habits across the life-span.

Fruit and vegetable intake of US adults estimated by two methods: What We Eat In America, National Health and Nutrition Examination Survey 2009-2012.

OBJECTIVE Estimates of fruit and vegetable (FV) consumption vary depending on intake definition, which may be determined by research purpose. Researchers have used two methods to evaluate intake: epidemiological and behavioural. The present study describes FV intake by adults using epidemiological v. behavioural approaches. DESIGN One-day dietary intake data from What We Eat In America, National Health and Nutrition Examination Survey 2009-2012 were used. Sample weights were used to produce nationally representative estimates. FV intake (in cup-equivalents (CE)) was estimated using the Food Patterns Equivalents Database. The epidemiological method considered all FV after disaggregating foods and beverages. The behavioural method included foods that provided at least 0·2 CE FV per 100 g, and excluded sources high in fat, added sugar and Na. SETTING Nationally representative survey of the US population. SUBJECTS Adults (n 10 563) aged ≥20 years. RESULTS For epidemiological v. behavioural, fruit intake was 1·1 v. 1·0 CE for males and 1·0 v. 0·9 CE for females. Vegetable intake was 1·8 v. 1·1 CE for males and 1·5 v. 1·0 CE for females. CONCLUSIONS The definition of FV intake affects estimates of consumption by the population and is an important consideration when planning and comparing research studies. The method used should align with research goals to assure accurate interpretation and validity of results.

Association between dietary protein intake and grip strength among adults aged 51 years and over: What We Eat in America, National Health and Nutrition Examination Survey 2011-2014

Introduction Distributing daily protein intake evenly across meals (∼25–30g/meal) has been suggested to improve muscle mass. The aim of this research is to examine the association between grip strength, total protein intake and its distribution across day’s meals in older adults. Methods Nationally representative dietary intake data of adults aged 51 years and older (n = 4,123) who participated in What We Eat in America, NHANES 2011–2014 were analyzed. Protein intake per day and per eating occasion (breakfast, lunch, dinner, and snack) were determined. Combined grip strength was calculated and expressed in kilograms. Grip strength of individuals consuming ≥25g protein at 1 eating occasion was compared with those consuming same level of protein at 2 and 3 or more eating occasions. Grip strength of individuals in quartile 1 of daily protein intake was compared to those in the other quartiles. All associations were examined without and with adjustment for age, race/ethnicity, physical activity, health status, and smoking status. The comparison involving eating occasions and protein intake quartiles were further adjusted for daily protein intake and energy intake, respectively. Results Only 33% of men and 19% of women had protein intake of ≥25g at 2 or more eating occasions. These individuals also had higher grip strength and daily protein intake. Grip strength was positively associated with consumption of ≥25g protein at 2 eating occasions as compared to consumption of same level of protein at 1 eating occasion (p<0.05) in unadjusted model, but not when adjusted. Grip strength was positively associated with daily protein intake among women in quartiles 3 and 4 (p<0.05) of protein intake in both unadjusted and adjusted models compared to lowest protein intake. Among men, grip strength was associated with daily protein intake in quartiles 3 and 4 (p<0.05) in the unadjusted model, but not when adjusted. Conclusion In a nationally representative sample of older adults, consuming ≥25g protein at 2 or more eating occasions was not associated with grip strength. However, higher daily protein intake was positively associated with grip strength in women.

Dietary Mineral Intake Ratios and Bone Health in Adults

Fruit and vegetable consumption has consistently been identified as a favorable dietary strategy for bone health. Diets high in fruits and vegetables tend to be high in several minerals that are advantageous for bone health, including potassium, calcium, and magnesium, and low in sodium. The role of calcium in bone health has been well-characterized. However, there are few studies examining the link between potassium, magnesium, and sodium and bone. Moreover, characterizing the relationships between individual mineral intakes and their ratios and health outcomes is important due to the interactive effects of these minerals. Therefore, the aim of this study was to characterize the relationships between sodium, potassium, calcium, and magnesium intake and their ratios and bone mineral density and fracture incidence in a representative sample of US adults. We used data from the National Health and Nutrition Examination Survey (NHANES), 2013–2014, for these analyses. We included adult men and women ≥40 years of age, who were not pregnant or lactating, with complete and plausible data (n = 2617). Diet was assessed using two 24-h dietary recalls. Total femur and femoral neck areal bone mineral density (aBMD) were assessed using DXA, and fracture incidence after age 20 years was determined by self-report. A model for predicting bone outcomes was developed using the following explanatory variables: age, race, height, weight, and smoking status (yes/no). Relationships between individual mineral intakes and mineral intake ratios and bone outcomes were assessed by adding each of these terms to the basic regression model separately. Body weight explained the largest proportion of the variance in total femur aBMD (29% in women, 21% in men) and femoral neck aBMD (22% in women, 15% in men), and race explained the largest proportion of the variance in fracture incidence in both women (3%) and men (2%). Sodium, potassium, calcium, and magnesium intakes were positive predictors of aBMD in men (all p 0.05). Randomized, controlled, full-feeding studies are required to determine the effect of mineral consumption from food as well as the ratio of their intakes on bone outcomes. Such findings would have important implications for making dietary recommendations and designing dietary interventions for reducing fracture risk.