Ronette Briefel

Energy and fat intakes of children and adolescents in the united states: data from the national health and nutrition examination surveys.

BACKGROUND Dietary factors related to body weight and chronic disease risk are of interest because of recent increases in the prevalence of overweight. OBJECTIVE Secular trends in energy and fat intakes of youths aged 2-19 y were assessed. Current intakes were compared with recommendations. DESIGN Dietary 24-h recall data from the third National Health and Nutrition Examination Survey (1988-1994) and earlier national surveys were examined. RESULTS Mean energy intake changed little from the 1970s to 1988-1994 except for an increase among adolescent females. Over the same time period, the mean percentage of energy from total and saturated fat decreased, but remained above recommendations, with overall means of 33.5% of energy from fat and 12.2% of energy from saturated fat. In 1988-1994, approximately 1 in 4 youths met the recommendations for intakes of fat and saturated fat and 3 in 4 met the recommendation for cholesterol intake. Beverages contributed 20-24% of energy across all ages and soft drinks provided 8% of energy in adolescents. Except for adolescent girls, beverage energy contributions were generally higher among overweight than nonoverweight youths; soft drink energy contribution was higher among overweight youths than among nonoverweight youths for all groups. CONCLUSIONS The lack of evidence of a general increase in energy intake among youths despite an increase in the prevalence of overweight suggests that physical inactivity is a major public health challenge in this age group. Efforts to increase physical activity and decrease nonnutritive sources of energy may be important approaches to counter the rise in overweight prevalence.

Dietary methods research in the third National Health and Nutrition Examination Survey: underreporting of energy intake.

Assessment of diet is a critical component of the third National Health and Nutrition Examination Survey (NHANES III), which was designed to describe the health and nutritional status of the US population. We analyzed data collected with the primary dietary assessment instrument used in NHANES III, the 24-h recall, for 7769 nonpregnant adults aged > or = 20 y to investigate underreporting of total energy intake. Underreporting was addressed by computing a ratio of energy intake (EI) to estimated basal metabolic rate (BMRest). EI:BMRest was 1.47 for men and 1.26 for nonpregnant women; a population level of 1.55 is expected for a sedentary population. About 18% of the men and 28% of the women were classified as underreporters. Underreporting of energy intake was highest in women and persons who were older, overweight, or trying to lose weight. Underreporting varied according to smoking status, level of education, physical activity, and the day of the week the 24-h recall covered. Additionally, underreporting was associated with diets lower in fat (P < 0.01) and alcohol (P < 0.01 in women) when expressed as a percentage of total energy intake.

School Food Environments and Practices Affect Dietary Behaviors of US Public School Children

BACKGROUND Changes to school food environments and practices that lead to improved dietary behavior are a powerful strategy to reverse the childhood obesity epidemic. OBJECTIVES To estimate the effects of school food environments and practices, characterized by access to competitive foods and beverages, school lunches, and nutrition promotion, on childrens consumption of sugar-sweetened beverages, low-nutrient energy-dense foods, and fruits/vegetables at school. DESIGN Cross-sectional study using data from the third School Nutrition Dietary Assessment Study, a nationally representative sample of public school districts, schools, and children in school year 2004-2005. Data from school principals and foodservice directors, school menu analysis, and on-site observations were used to characterize school food environments and practices. Dietary intake was assessed using 24-hour recalls. SUBJECTS/SETTING The sample consists of 287 schools and 2,314 children in grades one through 12. STATISTICAL ANALYSES PERFORMED Ordinary least squares regression was used to identify the association between school food environments and practices (within elementary, middle, and high schools) and dietary outcomes, controlling for other school and child/family characteristics. RESULTS Sugar-sweetened beverages obtained at school contributed a daily mean of 29 kcal in middle school children and 46 kcal in high school children across all school children. Attending a school without stores or snack bars was estimated to reduce sugar-sweetened beverage consumption by 22 kcal per school day in middle school children (P<0.01) and by 28 kcal in high school children (P<0.01). The lack of a pouring rights contract in a school reduced sugar-sweetened beverage consumption by 16 kcal (P<0.05), and no à la carte offerings in a school reduced consumption by 52 kcal (P<0.001) in middle school children. The most effective practices for reducing energy from low-energy, energy-dense foods were characteristics of the school meal program; not offering french fries reduced low-nutrient, energy-dense foods consumption by 43 kcal in elementary school children (P<0.01) and sugar-sweetened beverage consumption by 41 kcal in high school children (P<0.001). CONCLUSIONS To improve childrens diet and reduce obesity continued changes to school food environments and practices are essential. Removing sugar-sweetened beverages from school food stores and snack bars, improving à la carte choices, and reducing the frequency of offering french fries merit testing as strategies to reduce energy from low-nutrient, energy-dense foods at school.

Nutrient Intakes of US Infants, Toddlers, and Preschoolers Meet or Exceed Dietary Reference Intakes

OBJECTIVES To assess the usual nutrient intakes of 3,273 US infants, toddlers, and preschoolers, aged 0 to 47 months, surveyed in the Feeding Infants and Toddlers Study (FITS) 2008; and to compare data on the usual nutrient intakes for the two waves of FITS conducted in 2002 and 2008. DESIGN The FITS 2008 is a cross-sectional survey of a national random sample of US children from birth through age 47 months. Usual nutrient intakes derived from foods, beverages, and supplements were ascertained using a telephone-administered, multiple-pass 24-hour dietary recall. SUBJECTS Infants aged birth to 5 months (n=382) and 6 to 11 months (n=505), toddlers aged 12 to 23 months (n=925), and preschoolers aged 24 to 47 months (n=1,461) were surveyed. METHODS All primary caregivers completed one 24-hour dietary recall and a random subsample (n=701) completed a second 24-hour dietary recall. The personal computer version of the Software for Intake Distribution Estimation was used to estimate the 10th, 25th, 50th, 75th, and 90th percentiles, as well as the proportions below and above cutoff values defined by the Dietary Reference Intakes or the 2005 Dietary Guidelines for Americans. RESULTS Usual nutrient intakes met or exceeded energy and protein requirements with minimal risk of vitamin and mineral deficiencies. The usual intakes of antioxidants, B vitamins, bone-related nutrients, and other micronutrients were adequate relative to the Adequate Intakes or Estimated Average Requirements, except for iron and zinc in a small subset of older infants, and vitamin E and potassium in toddlers and preschoolers. Intakes of synthetic folate, preformed vitamin A, zinc, and sodium exceeded Tolerable Upper Intake Level in a significant proportion of toddlers and preschoolers. Macronutrient distributions were within acceptable macronutrient distribution ranges, except for dietary fat, in some toddlers and preschoolers. Dietary fiber was low in the vast majority of toddlers and preschoolers, and saturated fat intakes exceeded recommendations for the majority of preschoolers. The prevalence of inadequate intakes, excessive intake, and intakes outside the acceptable macronutrient distribution range was similar in FITS 2002 and FITS 2008. CONCLUSIONS In FITS 2008, usual nutrient intakes were adequate for the majority of US infants, toddlers, and preschoolers, except for a small but important number of infants at risk for inadequate iron and zinc intakes. Diet quality should be improved in the transition from infancy to early childhood, particularly with respect to healthier fats and fiber in the diets of toddlers and preschoolers.

Food Consumption Patterns of Infants and Toddlers Where Are We Now

OBJECTIVES To describe current infant-feeding practices and current food group consumption patterns of infants and toddlers and to compare 2008 data with 2002 data to identify shifts in these practices and food consumption over time. DESIGN The Feeding Infants and Toddlers Study (FITS) 2008 is a cross-sectional survey of a national random sample of US children from birth up to age 4 years. Data for three age subgroups (infants 4 to 5.9 months and 6 to 11.9 months and toddlers 12 to 23.9 months) were used from the 2002 (n=2,884) and 2008 surveys (n=1,596). STATISTICAL METHODS All analyses use sample weights that reflect the US population aged 4 to 24 months. Descriptive statistics (means, proportions, and standard errors) and t tests were calculated using SUDAAN (release 9, 2005, Research Triangle Park Institute, Research Triangle Park, NC). RESULTS These data show a higher percentage of infants receiving breast milk from 4 to 11.9 months of age with a concurrent decreasing percentage of infants receiving formula, which is significantly different from data for the 9- to 11.9-month-old age group. The use of complementary foods also appears to be delayed in FITS 2008: There is a significantly lower proportion of infants consuming infant cereal at 9 to 11.9 months in FITS 2008 compared to 2002 data. Fruit and vegetable consumption remains lower than desired. Significant reductions in the percentage of infants and toddlers consuming any desserts or candy, sweetened beverages, and salty snacks were seen in 2008. CONCLUSIONS The findings presented here provide important insights to the content of messages and types of interventions that are still needed to improve the diets of infants and toddlers.

Total energy intake of the US population: the third National Health and Nutrition Examination Survey, 1988-1991.

The third National Health and Nutrition Examination Survey (NHANES III) was conducted to assess the health and nutritional status of the US population. As part of the nutritional status assessment, reliable 24-h dietary recalls were collected for 14,801 examined persons. Mean (+/- SEM) energy intakes are reported for persons aged > or = 2 mo by age, sex, and race-ethnicity. Males had higher mean energy intakes than did females. Energy intakes peaked during late adolescence and young adulthood and declined thereafter. Energy intake patterns were similar among non-Hispanic whites, non-Hispanic blacks, and Mexican Americans. Underreporting was addressed by computing a ratio of energy intake (EI) to estimated basal metabolic rate (BMRest). This ratio (EI:BMRest) was 1.47 for adult males and 1.26 for nonpregnant adult females. Overweight adults had a lower mean EI:BMRest (1.09 in females and 1.28 in males). Underreporting in food consumption surveys remains problematic among females and overweight persons.

Food Consumption Patterns of Young Preschoolers: Are They Starting Off on the Right Path?

OBJECTIVE To describe the food consumption patterns of US children aged 2 and 3 years. DESIGN Descriptive analysis of data collected in the Feeding Infants and Toddlers Study 2008 based on a single 24-hour dietary recall collected by telephone. SUBJECTS A national random sample of children aged 2 and 3 years (n=1,461). STATISTICAL ANALYSES PERFORMED The percentage of children consuming foods from specific food groups was estimated for the full sample of children aged 2 and 3 years and separately by year of age. RESULTS About a third of 2-year-olds and a quarter of 3-year-olds consumed whole milk at least once in a day. About 70% of 2- and 3-year-olds consumed vegetables as a distinct food item at least once in day. French fries and other fried potatoes were the most commonly consumed vegetable. Almost three quarters of children (73%) consumed fruit as a distinct food item at least once in a day, and 59% consumed 100% juice. Fresh fruit was the most commonly consumed type of fruit. About 85% of children consumed some type of sweetened beverage, dessert, sweet, or salty snack in a day. Percentages of children consuming such foods were consistently higher for 3-year-olds than for 2-year-olds. CONCLUSIONS Parents and caregivers should be encouraged to expose young children to a wide variety of fruits and vegetables, whole grains, low-fat dairy products, and healthier fats, and to limit consumption of low-nutrient, energy-dense foods and beverages. Dietary guidance should stress the fact that children in this age group have high nutrient needs and relatively low energy requirements, leaving little room for such foods. Parents need advice that is specific, practical, and actionable.

The Feeding Infants and Toddlers Study 2008: Study Design and Methods

OBJECTIVE Describe the study design, data collection methods, 24-hour dietary recall protocol, and sample characteristics of the Feeding Infants and Toddlers Study (FITS) 2008. DESIGN A cross-sectional study designed to obtain information on the diets and feeding patterns of US infants, toddlers, and preschoolers ages birth to 47 months. Telephone interviews with parents and caregivers were conducted from June 2008 through January 2009 and included a household interview to recruit the household and collect information on household and child demographics and nutrition-related characteristics, and a dietary interview, including a 24-hour dietary recall collected using the 2008 Nutrition Data System for Research. A second dietary recall was collected on a random subsample to estimate usual nutrient intake distributions. Data collection instruments were built on those used in FITS 2002, with expanded survey content to address emerging issues in childhood nutrition and obesity. The dietary protocol was improved to increase reporting accuracy on portion sizes, and a bridging study was conducted to test effects of the changes in the food model booklet and protocol since FITS 2002 (n=240 cases aged 4 to 23 months). SUBJECTS A national random sample of 3,273 infants, toddlers, and preschoolers from birth up to age 4 years, with 2 days of dietary intake data for 701 cases. RESULTS Among sampled households with an age-eligible child, the response rate was 60% for the recruitment interview. Of recruited households, the response rate for the dietary interview was 78%. CONCLUSIONS The FITS 2008 provides rigorous, well-tested methods and survey questions for nutrition researchers to use in other dietary studies of young children. FITS 2008 findings on the food and nutrient intakes of US children from birth up to age 4 years can inform dietetics practitioners, pediatric health practitioners, and policymakers about the dietary issues of young children.

Treatment approach and HbA1c control among US adults with type 2 diabetes: NHANES 1999-2004

ABSTRACT Objective: To examine the distribution of diabetic medications among adults with type 2 diabetes, and the association between glucose control and treatment approach in the US population. Methods: Interview and prescription medication data from the 1999–2004 National Health and Nutrition Examination Survey (NHANES) were used to determine the treatment approach for US adults with type 2 diabetes. Mean glycosylated hemoglobin (HbA1c) and the proportion of adults meeting recommended guidelines for glucose control were estimated for each treatment approach. The most important study limitation was that participants were not asked what type of diabetes they had. Among adults with diabetes, a classification algorithm was used to identify those with type 2 diabetes. Results: During 1999–2004, approximately 60% of adults with type 2 diabetes used oral agents only to manage their diabetes. The distribution of oral treatment therapies changed over time (p < 0.01); the most prevalent treatment shifted from sulfonylurea monotherapy in 1999–2000 (23.0%) to any oral agent regimen containing thiazolidinedione (TZD) in 2003–2004 (21.4%). Overall, only 52.2% of adults with type 2 diabetes met the American Diabetes Association (ADA) goal for HbA1c control (<7.0%) during 1999–2004. Across oral agent treatment categories, the proportion with HbA1c controlled at the 7.0 level was significantly lower (p < 0.01) for those on triple therapy (31.9%) (TZD, sulfonylurea, and metformin), than those on metformin alone (62.2%), likely reflecting a progressive treatment approach of prescribing additional medications for those with uncontrolled HbA1c levels. Conclusions: Use of multiple oral agents among adults with type 2 diabetes has increased (sulfonylurea and metformin, p = 0.03, triple therapy, p = 0.02). However, nearly half of adults with type 2 diabetes have HbA1c levels above ADA guidelines for control, indicating that available treatments could be used more optimally, and new diabetic agents may be needed.

Assessment of the US diet in national nutrition surveys: national collaborative efforts and NHANES

The National Nutrition Monitoring and Related Research Program includes conducting national surveys to estimate the dietary intake and nutritional status of the US population. As part of this program, a 10-y comprehensive plan has been developed to strengthen nutrition-monitoring efforts in the United States. Emphasis is placed on improving coordination and comparability among data collection methods across federal agencies and on conducting relevant research. Current collaborative efforts between the US Departments of Health and Human Services (DHHS) and Agriculture (USDA) include coordinating the national food-consumption surveys in the areas of planning population coverage, by using comparable dietary intake methods, and targeting research toward improving dietary methods. The National Health and Nutrition Examination Survey (NHANES) contributes population data on diet, nutritional status, and health outcomes to the Nutrition Monitoring Program. The third NHANES (1988-1994) includes 40,000 noninstitutionalized people aged > or = 2 mo and oversamples blacks, Mexican Americans, children, and elderly people and uses an automated 24-h recall as the primary dietary instrument. Assessing dietary intake in heterogeneous populations in national surveys poses many methodologic, statistical, and interpretive issues and highlights the need for specific research to improve dietary assessment methods.