Linda E. Cleveland

Dietary intake of whole grains.

Objective: The objective of this study was to provide national estimates of whole-grain intake in the United States, identify major dietary sources of whole grains and compare food and nutrient intakes of whole-grain consumers and nonconsumers. Methods: Data were collected from 9,323 individuals age 20 years and older in USDA’s 1994–96 Continuing Survey of Food Intakes by Individuals through in-person interviews on two non-consecutive days using a multiple-pass 24-hour recall method. Foods reported by respondents were quantified in servings as defined by the Food Guide Pyramid using a new database developed by the USDA. Whole-grain and nonwhole-grain servings were determined based on the proportion, by weight, of the grain ingredients in each food that were whole grain and nonwhole grain. Sampling weights were applied to provide national probability estimates adjusted for differential rates of selection and nonresponse. Then, t tests were used to assess statistically significant differences in intakes of nutrients and food groups by whole-grain consumers and nonconsumers. Results: According to the 1994–96 survey, U.S. adults consumed an average of 6.7 servings of grain products per day; 1.0 serving was whole grain. Thirty-six percent averaged less than one whole-grain serving per day based on two days of intake data, and only eight percent met the recommendation to eat at least three servings per day. Yeast breads and breakfast cereals each provided almost one-third of the whole-grain servings, grain-based snacks provided about one-fifth, and less than one-tenth came from quick breads, pasta, rice, cakes, cookies, pies, pastries and miscellaneous grains. Whole-grain consumers had significantly better nutrient profiles than nonconsumers, including higher intakes of vitamins and minerals as percentages of 1989 Recommended Dietary Allowances and as nutrients per 1000 kilocalories, and lower intakes of total fat, saturated fat and added sugars as percentages of food energy. Consumers were significantly more likely than nonconsumers to meet Pyramid recommendations for the grain, fruit and dairy food groups. Conclusion: Consumption of whole-grain foods by U.S. adults falls well below the recommended level. A large proportion of the population could benefit from eating more whole grain, and efforts are needed to encourage consumption.

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.

Method for assessing food intakes in terms of servings based on food guidance.

We describe a method for comparing food intakes reported in surveys with recommendations given in the US Department of Agricultures food guide pyramid. Such comparison was previously difficult because many foods are eaten as mixtures that cannot be categorized into pyramid food groups and because food intake data and food recommendations are expressed in different units of measurement. We developed a recipe file showing ingredients at multiple levels of breakdown and used it to disaggregate food mixtures into their ingredients so that they could be placed into pyramid food groups. Food-specific weight consistent with the pyramid definitions for serving sizes were derived from the food code book of the 1989-1991 Continuing Survey of Food Intakes by Individuals and used to develop a serving-weight file. Data collected from 8181 adults aged > or = 20 y in the survey were used to estimate the mean number of servings from pyramid food groups and percentages of the population meeting pyramid recommendations. The mean numbers of servings were close to the minimum recommendations for the grain, vegetable, and meat groups and well below the minimum recommendations for the fruit and dairy groups. large proportions of adults (43-72%) failed to meet the dietary recommendations. Our method has several nutrition monitoring and nutrition education applications.

EFFECT OF SNACKING FREQUENCY ON ADOLESCENTS' DIETARY INTAKES AND MEETING NATIONAL RECOMMENDATIONS

PURPOSE To determine how snacking level impacts intake of nutrients and food groups and assists in meeting recommendations outlined in the U.S. Department of Agricultures MyPyramid Food Guidance System. METHODS Dietary data based on 24-hour recall from 4357 adolescents 12-19 years of age participating in the National Health and Nutrition Examination Survey 2001-2004 (NHANES) were analyzed. Regression analyses were applied to examine the effect of snacking on nutrient and food group intake and to determine its effect on the likelihood of meeting MyPyramid recommendations. RESULTS Food energy, carbohydrate, total sugars, and vitamin C intake were positively associated, whereas protein and fat intake were negatively associated, with snacking frequency. Fruit intake increased, whereas solid fat intake decreased, as snacking incidence rose. Increasing snacking frequency was also associated with a greater likelihood of meeting milk and oil recommendations for boys and meeting fruit recommendations for both genders. Non-Hispanic black adolescents were less likely to meet their milk recommendations at low and high snacking levels and more likely to meet their fruit recommendations at high levels only. Foods consumed as snacks provided 12-39% of the days total number of portions of the five MyPyramid food groups, 35% of total discretionary calorie intake, and 43% of total added sugar intake. CONCLUSIONS Snacking frequency affects intake of macronutrients and a few micronutrients and promotes consumption of fruits. Top food choices for snacks provide an excess of discretionary calories in the form of added sugars and fats. Modification of these choices would assist adolescents in consuming diets more consistent with national recommendations.

Updated US Department of Agriculture Food Patterns meet goals of the 2010 dietary guidelines.

The US Department of Agriculture Food Patterns were updated for the 2010 Dietary Guidelines for Americans to meet new nutrition goals and incorporate results of food pattern modeling requested by the Dietary Guidelines Advisory Committee. The purpose of this article is to describe the process used and changes in the updated patterns. Changes include renaming the Meat and Beans and Milk Groups to the Protein Foods and Dairy Groups, respectively, to be more encompassing of foods in each. Vegetable subgroups now provide more achievable intake recommendations. Calcium-fortified soymilk is now included in the Dairy Group because of its similarity to foods in that group. Increased amounts of seafoods are recommended in the Protein Foods Group, balanced by decreased amounts of meat and poultry. A limit on calories from solid fats and added sugars is included, replacing the previous discretionary calorie allowance and emphasizing the need to choose nutrient-dense forms of foods. Lacto-ovo vegetarian and vegan patterns that meet nutrition goals were created by making substitutions in the Protein Foods Group, and for vegan patterns, in the Dairy Group. Patterns identify food choices that meet nutritional needs within energy allowances and encourage choosing a variety of foods. They rely on foods in nutrient-dense forms, including a limited amount of calories from solid fats and added sugars. The Food Patterns provide a useful template for educating consumers about healthful food choices while highlighting a large gap between choices many Americans make and healthy eating patterns.

Dietary Behaviors Associated With Total Fat and Saturated Fat Intake

OBJECTIVE To estimate percentages of US adults who have adopted behaviors promoted by dietary guidance about how to reduce fat intake, and to assess relationships between these behaviors and intake of energy from total and saturated fat. DESIGN Relationships were examined between intake of total and saturated fat from two 24-hour recalls in the US Department of Agricultures 1994-1996 Continuing Survey of Food Intakes by Individuals and responses to 19 fat-related behavior questions on the follow-up Diet and Health Knowledge Survey (DHKS). SUBJECTS Data are from a national sample of 5,649 individuals 20 years of age and older. STATISTICAL ANALYSES PERFORMED Multiple regression models are used to identify dietary behaviors, demographic factors, and personal characteristics that are determinants of fat intake. RESULTS In this study, the percentage of US adults who consistently followed the low-fat behaviors ranged from 8% to 70%. The most highly adopted behaviors (45% or more of adults) included trimming fat from meat, removing skin from chicken, and eating chips infrequently. The least highly adopted behaviors (15% or less of adults) included eating baked or boiled potatoes without added fat, avoiding butter or margarine on breads, eating low-fat instead of regular cheeses, and having fruit for dessert when dessert is eaten. Together, the 19 fat-related behavior questions on the DHKS formed a statistically significant predictor for total fat and saturated fat intake, expressed as a percent of energy (P<.0001). Key behaviors in terms of their predicted effect on lowering both total and saturated fat intake were never adding fat to baked or boiled potatoes, not eating red meats, eating less than 3 eggs per week, and never eating chicken fried. Predicted effects of these key behaviors in terms of lowering fat intake as a percentage of energy were > or = 1.5 percentage points for total fat and > or = 0.5 percentage point for saturated fat. CONCLUSIONS Results have applications for designing brief fat assessment instruments and for identifying key nutrition education messages that promote important fat-lowering behaviors.

Method for identifying differences between existing food intake patterns and patterns that meet nutrition recommendations

This article describes a mathematical model that takes an existing food intake pattern and develops a new pattern that meets a specified set of nutrition recommendations with the minimum change possible. The model examines multiple recommendations simultaneously and considers foods as they are currently eaten, so it can provide practitioners with new insights about strategies for implementing recommendations. The model shows serving units per day by food group in both existing and new intake patterns and the recommendations responsible for changes. Recommendations of the National Research Council are used, and sodium-restricted (< or = 2,400 mg) and sodium-unrestricted patterns are compared. Food intake data are from 915 nonpregnant, nonlactating women 19 to 50 years old who participated in the US Department of Agricultures 1985 Continuing Survey of Food Intake by Individuals. The sodium-restricted pattern contains proportionately more dairy products, fruit, and red meat and proportionately less grain products, fish, and vegetables than the unrestricted-sodium pattern. Nutrition recommendations responsible for changes in the existing pattern include those for saturated fatty acids (< 10% kcal), carbohydrate (> or = 55% kcal), zinc (100% of Recommended Dietary Allowance [RDA]), potassium (> or = 3,500 mg/day), and vitamin E (100% RDA), in addition to sodium. Implications of the sodium recommendation for food selection and preparation, especially of food mixtures and commercially prepared products, are discussed.

Evaluation of portion size estimation aids used for meat in dietary surveys

Abstract In three studies, individuals used various PSEAs (bean bag, peg board, ruler, sausage diagram, and size grid) to estimate portion sizes for three different categories of meat (intact cuts of meat, ribs, and link-type sausages). For intact cuts of meat, individuals generally were able to estimate length and width accurately, but had more difficulty estimating thickness regardless of the PSEA used. For ribs, while no PSEA provided an average estimation error less than +40%, a correlation existed between the portion size and average perceived size category (r = +0.89). For link-type sausage portions, a sausage diagram provided average estimations within 15%, decreased the variability of individual errors when compared to a ruler, and was used more frequently than any other PSEA. Results indicate that using PSEAs in conjunction with other estimation strategies for portion estimation is likely to be an effective way to collect consumption data for meats in large-scale dietary surveys.

Impact of Typical Rather than Nutrient-Dense Food Choices in the US Department of Agriculture Food Patterns

BACKGROUND The US Department of Agriculture (USDA) Food Patterns, released as part of the 2010 Dietary Guidelines for Americans, are designed to meet nutrient needs without exceeding energy requirements. They identify amounts to consume from each food group and recommend that nutrient-dense forms-lean or low-fat, without added sugars or salt-be consumed. Americans fall short of most food group intake targets and do not consume foods in nutrient-dense forms. Intake of calories from solid fats and added sugars exceed maximum limits by large margins. OBJECTIVE Our aim was to determine the potential effect on meeting USDA Food Pattern nutrient adequacy and moderation goals if Americans consumed the recommended quantities from each food group, but did not implement the advice to select nutrient-dense forms of food and instead made more typical food choices. DESIGN Food-pattern modeling analysis using the USDA Food Patterns, which are structured to allow modifications in one or more aspects of the patterns, was used. Nutrient profiles for each food group were modified by replacing each nutrient-dense representative food with a similar but typical choice. Typical nutrient profiles were used to determine the energy and nutrient content of the food patterns. RESULTS Moderation goals are not met when amounts of food in the USDA Food Patterns are followed and typical rather than nutrient-dense food choices are made. Energy, total fat, saturated fat, and sodium exceed limits in all patterns, often by substantial margins. With typical choices, calories were 15% to 30% (ie, 350 to 450 kcal) above the target calorie level for each pattern. Adequacy goals were not substantially affected by the use of typical food choices. CONCLUSIONS If consumers consume the recommended quantities from each food group and subgroup, but fail to choose foods in low-fat, no-added-sugars, and low-sodium forms, they will not meet the USDA Food Patterns moderation goals or the 2010 Dietary Guidelines for Americans.

Recommended dietary allowances as standards for family food plans

Abstract The United States Department of Agricultures (USDA) 1977–78 Nationwide Food Consumption Survey included low-income households. Large proportions of this population had intakes that failed to meet the Recommended Dietary Allowances (RDA) for vitamin A, vitamin B-6, calcium, magnesium, and iron. To examine dietary changes required to meet the RDA, we used a computer programmed with a mathematical model that plans diets based on reported consumption patterns. Consumption patterns of children one to two years old, teenage girls, and women required the greatest changes to meet the RDA. Compared to diets in consumption patterns, the diets planned for these categories included large quantities of red meats, breakfast cereals, and legumes and small quantities of fats and sweets. We had particular difficulty meeting the RDA for vitamin E, vitamin B-6, folacin, calcium, iron, and zinc. Based on our findings from this and earlier studies of households at all income levels, we present the adaptations to the RDA that we are using to revise the USDA family food plans.