Margaret L. Bogle

A regional food-frequency questionnaire for the US Mississippi Delta

OBJECTIVEnTo describe food sources of nutrient intake for white and African American adults in the Lower Mississippi Delta (LMD), and their use in the development of a regional food-frequency questionnaire (FFQ) based on an earlier version of the National Cancer Institutes Health Habits and History Questionnaire.nnnDESIGNnWe ranked food sources of energy, macronutrients, vitamins and minerals, and examined portion size distributions for 842 white and 857 African American residents aged 19 years and older, using 24-hour dietary intake recall data from a telephone survey of 36 LMD counties. These values were used to develop a regional FFQ, which was then field-tested with 100 subjects and revised to improve interpretability.nnnSETTINGnThe LMD region of the USA.nnnSUBJECTSnWhite and African American adult residents of the LMD.nnnRESULTSnLMD African Americans obtained more of their energy and nutrient intakes from poultry, processed meat, salty snacks, fruit drinks, pork and cornbread; and less from milk, alcohol, legumes, salad dressing, butter/margarine and sweetened tea than did white residents. Regional foods not on nationally used FFQs included grits, turnip greens, okra, ham hocks, chitterlings, crawfish, catfish, cracklings, jambalaya, potato logs, chicken and dumplings, and sweet potato pie. Based on responses during field-testing, the questionnaire was also designed to add four portion sizes for each food item, presented as questions, rather than in grid format.nnnCONCLUSIONSnRegional food use patterns differ from national patterns and furthermore differ between African American and white adults in the LMD. The resulting Delta NIRI FFQ for Adults should contribute to improved assessment of usual intake for use in studies of diet and health in this region.

Perceptions of Factors Influencing Healthful Food Consumption Behavior in the Lower Mississippi Delta: Focus Group Findings

OBJECTIVEnTo identify perceptions of Lower Mississippi Delta (LMD) residents regarding factors that influence a change in healthful food consumption behavior to assist in planning sustainable nutrition interventions in the LMD.nnnDESIGNnNine focus groups were conducted with LMD residents in 9 counties in Arkansas, Louisiana, and Mississippi. One focus group was held in each county on the topical area of behavioral change.nnnSETTINGnNine counties in Arkansas, Louisiana, and Mississippi.nnnPARTICIPANTSnThe study population included 91 persons, 85 females and 6 males (18-60+ years of age), of whom 71 were African Americans, 17 were Caucasians, and 3 were Hispanics, who participated in the focus group discussions.nnnANALYSISnData analyses were completed by general and specific content coding. Data were reviewed for emerging themes for each topic. The Social Cognitive Theory served as the framework for understanding the determinants of a change in healthful food consumption behavior.nnnRESULTSnThe study showed considerable variability in perceptions that are influenced by both personal and external factors. These factors include health concerns, family influence, and need for and availability of nutrition information. Participants were interested in learning about healthful eating, food preparation skills, and portion control.nnnCONCLUSIONSnFocus groups in the LMD identified many important themes relevant to the development of nutrition interventions in these communities. These data will be used to guide the community-based participatory interventions that will be developed and implemented in the LMD. The findings could be applicable to other researchers designing interventions for similar populations.

Carotenoid intakes, assessed by food-frequency questionnaires (FFQs), are associated with serum carotenoid concentrations in the Jackson Heart Study: validation of the Jackson Heart Study Delta NIRI Adult FFQs

OBJECTIVESnIntake and status of carotenoids have been associated with chronic disease. The objectives of this study were to examine the association between carotenoid intakes as measured by two regional food-frequency questionnaires (FFQs) and their corresponding measures in serum, and to report on dietary food sources of carotenoids in Jackson Heart Study (JHS) participants.nnnDESIGNnCross-sectional analysis of data for 402 African American men and women participating in the Diet and Physical Activity Sub-Study (DPASS) of the JHS.nnnRESULTSnMean serum carotenoid concentrations and intakes in this population were comparable to those reported for the general US population. After adjustment for covariates, correlations between serum and dietary measures of each carotenoid, for the average of the recalls (deattenuated), the short FFQ and the long FFQ, respectively, were: 035 and 0-carotene; 026 and 0-carotene; 017 and 0-carotene; 034 and 0-cryptoxanthin; 015 and 037, 014 for lycopene. Major dietary sources of -carotene and lutein plus zeaxanthin, mustard, turnip and collard greens; of beta-cryptoxanthin, orange juice; and of lycopene, tomato juice.nnnCONCLUSIONSnOn average, carotenoid intakes and serum concentrations are not lower in this southern African American population than the general US population. The two regional FFQs developed for a southern US population and used as dietary assessment tools in the JHS appear to provide reasonably valid information for most of these carotenoids.

Food and Beverage Choices Contributing to Dietary Guidelines Adherence in the Lower Mississippi Delta

OBJECTIVESnThe objectives of the present study were to evaluate diet quality among Lower Mississippi Delta (LMD) residents using the Healthy Eating Index-2005 (HEI-2005) and to identify the top five dietary sources contributing to HEI-2005 components. Demographic differences in HEI-2005 scores were also explored.nnnDESIGNnDiet quality was evaluated using HEI-2005. Demographic differences in HEI-2005 scores were investigated using multivariable regression models adjusting for multiple comparisons. The top five dietary sources contributing to HEI-2005 components were identified by estimating and ranking mean MyPyramid equivalents overall and by demographic characteristics.nnnSETTINGnDietary data, based on a single 24 h recall, from the Foods of Our Delta Study 2000 (FOODS 2000) were used in the analyses.nnnSUBJECTSnFOODS 2000 adult participants 18 years of age or older.nnnRESULTSnYounger age was the largest determinant of low diet quality in the LMD with HEI-2005 total and seven component scores declining with decreasing age. Income was not a significant factor for HEI-2005 total or component scores. The top five dietary sources differed by all five of the demographic variables, particularly for total vegetables and energy from solid fats, alcoholic beverages and added sugars (SoFAAS). Soft drinks were the leading source of SoFAAS energy intake for all demographic groups.nnnCONCLUSIONSnThe assessment of diet quality and identification of top dietary sources revealed the presence of demographic differences for selected HEI-2005 components. These findings allow identification of food patterns and culturally appropriate messaging and highlight the difficulties of treating this region as a homogeneous population.

Development and evaluation of WillTry. An instrument for measuring children's willingness to try fruits and vegetables ☆

This paper describes the development and evaluation of the WillTry instrument, a psychometric tool designed to measure childrens willingness to try fruits and vegetables. WillTry surveys were interviewer-administered to 284 children in an elementary school and summer day camps located in rural Mississippi and Arkansas (United States) communities. Factor analysis was used to determine construct dimensionality. Additional evaluation included internal consistency, test-retest reliability, and predictive validity. Factor analysis suggested a single dimension for the food items. The WillTry food scale had substantial reliability (intraclass correlation coefficients between 0.61 and 0.80) and sufficient internal consistency (Cronbachs alpha > or = 0.70). Results of the regression analysis for percent consumption of foods offered on WillTry response confirmed the predictive validity of the instrument. The results of these analyses provide psychometric evidence for the use of the WillTry instrument as a measure of willingness to try fruits and vegetables in rural, southern US children 5-14 years of age.

Using national dietary data to measure dietary changes.

OBJECTIVEnTo demonstrate that dietary datasets from the Continuing Survey of Food Intakes by Individuals, a US population survey, allow comparisons with national data and provide food composition datasets that can be used to generate similar dietary data.nnnDESIGNnTwo studies are described: the Lower Mississippi Delta Nutrition Intervention Research Initiative (Delta NIRI), which used a 24-hour recall, and a Department of Defense Military Nutrition Research Task, which used 3-day dietary records. Both studies used the same food composition tables.nnnSETTINGnRural Lower Mississippi Delta and an Army post.nnnSUBJECTSnFour hundred and nine residents (adults and children) from the rural Delta region of Arkansas, Louisiana and Mississippi, and 74 career soldiers from the Sergeants Major Academy, Fort Bliss, Texas.nnnRESULTSnThe Delta NIRI study found that fruit and vegetable consumption for these rural residents was lower than that found nationally. Additionally, the quality of vegetable servings is of concern since a large percentage came from french fries and potato chips. In the Sergeants Major Academy study, the national survey food composition tables allowed for easy analysis of intake data and comparisons with dietary recommendations.nnnCONCLUSIONSnStrategies similar to those used for the Delta NIRI and Military Nutrition Research Task can be used widely, allowing comparisons of defined populations with nationally distributed data. Additionally, measurement of dietary change is more efficient when the same protocol is used subsequently to collect more data, a method similar to that used by the US Department of Agriculture to describe food consumption patterns from one survey to another.

A Simulation Study of the Potential Effects of Healthy Food and Beverage Substitutions on Diet Quality and Total Energy Intake in Lower Mississippi Delta Adults

The majority of adult diets in the United States, particularly the South, are of poor quality, putting these individuals at increased risk for chronic diseases. In this study, simulation modeling was used to determine the effects of substituting familiar, more healthful foods and beverages for less healthy ones on diet quality and total energy intake in Lower Mississippi Delta (LMD) adults. Dietary data collected in 2000 for 1689 LMD adults who participated in the Foods of Our Delta Study were analyzed. The Healthy Eating Index-2005 (HEI-2005) was used to measure diet quality. The effects of substituting targeted foods and beverages with more healthful items on diet quality were simulated by replacing the targeted items nutrient profile with their replacements profile. For the single food and beverage groups, 100% replacement of grain desserts with juice-packed fruit cocktail and sugar-sweetened beverages with water resulted in the largest improvements in diet quality (4.0 and 3.8 points, respectively) and greatest decreases in total energy intake (98 and 215 kcal/d, respectively). The 100% substitution of all food and beverage groups combined resulted in a 12.0-point increase in HEI-2005 score and a decrease of 785 kcal/d in total energy intake. Community interventions designed to improve the diet of LMD adults through the use of familiar, healthy food and beverage substitutions have the potential to improve diet quality and decrease energy intake of this health disparate population.

Simulated reductions in consumption of sugar-sweetened beverages improves diet quality in Lower Mississippi Delta adults

Background Although the effects of replacing sugar-sweetened beverages (SSBs) with water on energy intake and body weight have been reported, little is known about how these replacements affect diet quality. Objective To simulate the effects of replacing SSBs with tap water on diet quality and total energy intake of Lower Mississippi Delta (LMD) adults. Design Retrospective analysis of cross-sectional dietary intake data using a representative sample of LMD adults (n=1,689). Diet quality was measured using the Healthy Eating Index-2005 (HEI-2005) scores that were computed using the population ratio method. The effects of substituting SSBs with water on diet quality were simulated by replacing the targeted items’ nutrient profile with tap waters profile. Results Simulating the replacement of SSBs with tap water at 25, 50, and 100% levels resulted in 1-, 2.3-, and 3.8-point increases, respectively, in the HEI-2005 total score. Based on a mean daily intake of 2,011 kcal, 100% substitution of SSBs with tap water would result in 11% reduction in energy intake. Conclusions Replacing SSBs with water could substantially improve the diet quality of the LMD adult population and potentially lead to significant weight loss overtime. Prioritizing intervention efforts to focus on the replacement of SSBs with energy-free drinks may be the most efficacious approach for conveying potentially substantial health benefits in this and similar disadvantaged populations.

Association between barriers and facilitators to meeting the Dietary Guidelines for Americans and body weight status of caregiver–child dyads: the Healthy Eating and Lifestyle for Total Health Study

BACKGROUNDnFew Americans meet the Dietary Guidelines for Americans (DGA), yet a large percentage are overweight.nnnOBJECTIVEnThe goal of this research was to examine the association between barriers and facilitators to meeting the DGA and weight in a multisite study.nnnDESIGNnThis was a cross-sectional study in which 836 caregiver-child dyads among 3 race/ethnic groups completed the questionnaire across 6 sites participating in the HEALTH (Healthy Eating and Lifestyle for Total Health) Study. Barriers and facilitators to meeting the DGA were assessed by using a validated questionnaire developed specifically for the HEALTH Study. Heights and weights were measured. A series of bivariate regression analyses were conducted to examine the association between caregiver body mass index (BMI) or child BMI z score and the barriers and facilitators to meeting the DGA, adjusting for appropriate covariates in the models. Path analysis was used to examine the relation of caregiver and child barriers and facilitators to their relative BMIs.nnnRESULTSnIn children, the BMI z score was associated positively (P < 0.001) with total barriers and negatively (P < 0.001) with total facilitators. In caregivers, BMI was associated positively only with total barriers (P < 0.0001). For each of the 8 MyPyramid components, barriers consistently were associated positively (P < 0.0001) and facilitators were associated negatively (P < 0.001) with BMI z score in children (with the exception of the fruit and physical activity components). For caregivers, most of the barriers to meeting recommendations for meats and beans; solid fats, alcohol, and added sugars; and physical activity components were associated positively (P < 0.01) with BMI. Path analyses show that caregiver facilitators were significantly related to childrens facilitators to meeting DGA recommendations (standardized β: 0.12; P < 0.001).nnnCONCLUSIONnTo our knowledge, our findings are among the first to show associations between weight and barriers and/or facilitators to meeting the DGA in a national, large sample of caregiver-child dyads. This trial was registered at clinicaltrials.gov as NCT02725970.