Theresa A. Nicklas

Impact of Breakfast Consumption on Nutritional Adequacy of the Diets of Young Adults in Bogalusa, Louisiana: Ethnic and Gender Contrasts

OBJECTIVEnTo evaluate the impact of breakfast consumption patterns on the nutritional adequacy of diets of young adults and determine possible ethnic and gender differences.nnnDESIGN AND SETTINGnCross-sectional survey of young adults in Bogalusa, La.nnnSUBJECTSnTwenty-four-hour dietary recalls were collected from October 1988 through October 1991 on 504 young adults (mean age=23 years, 58% women, 70% white).nnnSTATISTICSnAnalysis of variance and logistic regression techniques were used to investigate the relationship of breakfast consumption, ethnicity, and gender on dietary adequacy. The P values are from an analysis of variance model that adjusted for gender and ethnicity.nnnRESULTSnThirty-seven percent of young adults skipped breakfast. Of those who ate breakfast, 75% ate at home, 10% ate a fast-food breakfast, and 15% reported other sources. Mean energy intake from breakfast was 485 kcal; men consumed more energy than women (P<.001), and blacks consumed more energy than whites (P<.01). The breakfast meal provided an average of 13% of energy from protein, 55% from carbohydrate, 14% from sucrose, 34% from fat, and 12% from saturated fat. Whites consumed a breakfast higher in carbohydrate and sucrose than blacks, who consumed a breakfast higher in fat and saturated fat. Variations in breakfast foods consumed explained the racial differences in the nutrient composition of the breakfast meal. Young adults who skipped breakfast had lower total daily intakes of energy (P<.0001), protein per 1,000 kcal (P<.05), and saturated fat per 1,000 kcal (P<.01) than those who consumed breakfast. For all vitamins and minerals studied, a higher percentage of young adults who skipped breakfast did not meet two thirds of the Recommended Dietary Allowance than those who consumed a breakfast.nnnAPPLICATIONSnEncouraging consumption of breakfast, along with selection of more healthful breakfast food choices or snacks that are culturally appropriate, may be important strategies for improving the nutritional quality of young adults diets.

Stages of Change for Increasing Fruit and Vegetable Consumption among Adults and Young Adults Participating in the National 5-a-Day for Better Health Community Studies:

Higher fruit and vegetable consumption is associated with a reduced risk of certain cancers and chronic diseases. The 5-a-Day for Better Health community studies are evaluating population-based strategies to achieving dietary behavior change using the stages-of-change model and associated theories. The authors present baseline comparisons of stages of change for fruit and vegetable consumption among adults and young adults in eight study sites representing diverse regions of the United States and diverse populations and settings. Three dominant stages, precontemplation, preparation, and maintenance, were found across sites. Women and those with college degrees were more likely to be in action/maintenance. Fruit and vegetable consumption, self-efficacy, and knowledge of the 5-a-Day recommendation were positively associated with more advanced stages of change in all study sites. The authors discuss the findings in relation to possible limitations of this and other dietary stages-of-change measures and suggest directions for future research.

Nutrient Intake of Head Start Children: Home vs. School

OBJECTIVEnTo determine mean intake of energy and protein, total fat, saturated fat, percent energy from total and saturated fat, cholesterol, carbohydrate, calcium, iron, zinc, folate, vitamins A, C, E, B-6 and B-12, thiamin, niacin, riboflavin, magnesium, sodium and fiber of preschool Head Start children at school and away from school.nnnDESIGNnTwenty-four-hour food intakes for 358 Head Start children were obtained by observing food intake at school and acquiring intake recalls from parents or guardians specifying food their children consumed for the balance of the day. After determining group estimates of energy and nutrient intake, mean intake was compared to standard nutrient recommendations for the entire 24-hour day, i.e., for the time the children were in school and for the remaining hours away from school (home intake).nnnSUBJECTSnThe 358 Head Start children attended school either half-day (2- to 3-hour AM and PM sessions) or all-day (5 to 6 hours).nnnSTATISTICAL ANALYSESnDifferences in nutrient intake among class times were analyzed using one-way analysis of variance (ANOVA) followed by Tukeys multiple comparison test. Differences with a p-value <0.05 (two-tailed) were considered to be statistically significant. Total energy, protein, calcium, iron, zinc, vitamins A, C, E, B6, and B12, thiamin, niacin, riboflavin as well as folate and magnesium were compared to the Recommended Dietary Allowances for the 4- to 6-year-old age group. Other standards that were used for comparisons included the National Cholesterol Education Program (fat, saturated fat and cholesterol), the 1989 National Research Councils Diet and Health Report (carbohydrate and sodium) and the recommendation for fiber proposed by the American Health Foundation.nnnRESULTSnAt school, half-day children consumed up to 25% of the daily recommendation for energy and nutrients, while all-day children achieved at least a third of the recommended intakes. When intakes at home and school were combined, all three groups of children (AM, PM and all-day) exceeded dietary recommendations for protein, vitamins and minerals. Energy intake remained below 100% of the recommendation, while intake of total fat, saturated fat and cholesterol exceeded recommendations.nnnAPPLICATIONnFurther research is required to explore energy needs and determine nutritional status and nutrient needs of minority and low-income preschool children. Strategies are required to increase nutrient density, but not fat density, of meals and snacks served to children who attend day care for part of the day. Finally, school meals and nutrition education programs such as Team Nutrition should broaden their base to include healthful eating habits for all school children, including the very youngest children in preschool programs.

Reliability and validity of the Child and Adolescent Trial for Cardiovascular Health (CATCH) Food Checklist: a self-report instrument to measure fat and sodium intake by middle school students.

OBJECTIVEnTo develop a scoring algorithm and evaluate the reliability and validity of scores from the Child and Adolescent Trial for Cardiovascular Health (CATCH) Food Checklist (CFC) as measures of total fat, saturated fat, and sodium intake in middle school students.nnnDESIGNnRandomized, controlled trial in which participants were assigned to 1 of 3 study protocols that varied the order of CFC and 24-hour dietary recall administration. Criterion outcomes were percent energy from total fat, percent energy from saturated fat, and sodium intake in milligrams.nnnSUBJECTS/SETTINGnA multiethnic sample (33% ethnic and racial minorities) of 365 seventh-grade students from 8 schools in 4 states.nnnSTATISTICAL ANALYSESnMultivariable regression models were used to calibrate the effects of individual food checklist items; bootstrap estimates were used for cross-validation; and kappa statistics, Pearson correlations, t tests, and effect sizes were employed to assess reliability and validity.nnnRESULTSnThe median same-day test-retest reliability kappa for the 40 individual CFC food items was 0.85. With respect to item validity, the median kappa statistic comparing student choices to those identified by staff dietitians was 0.54. Test-retest reliability coefficients ranged from 0.84 to 0.89 for CFC total nutrient scores. Correlations between CFC scores and 24-hour recall values were 0.36 for total fat, 0.36 for saturated fat, and 0.34 for sodium; CFC scores were consistent with hypothesized gender differences in nutrient intake.nnnAPPLICATIONS/CONCLUSIONSnThe CFC is a reliable and valid tool for measuring fat, saturated fat, and sodium intake in middle school students. Its brevity and ease of administration make the CFC a cost-effective way to measure middle school students previous days intake of selected nutrients in school surveys and intervention studies.

Nutrient Intake and Food Group Consumption of 10-Year-Olds by Sugar Intake Level: The Bogalusa Heart Study

OBJECTIVEnThe effect of total sugar intake on nutrient intake and food group consumption was examined in children.nnnMETHODSnTwenty-four hour dietary recalls were collected on a sample of 568 ten-year-olds from two cross-sectional surveys. The population was stratified according to total sugar intake quartiles: < or = 25th (46 g/1000 kcal), 25-50th (67 g/1000 kcal), 50-75th (81 g/1000 kcal) and > or = 75th (106 g/1000 kcal).nnnRESULTSnNo significant difference was shown in energy intakes across the quartiles and no significant race or gender differences were observed in mean total sugar intakes. However, with increasing total sugar intake, there was a significant linear decrease in mean intakes of protein, fat, saturated fat, starch, cholesterol, sodium, vitamins B6 and E, thiamin, niacin, iron, and zinc; and a significant linear increase in mean intakes of carbohydrate, fructose, lactose, sucrose, vitamin D, and calcium. Eating patterns reflected the differing nutrient intakes, with high sugar consumers having significantly higher intakes of total g of candy, beverages and milk and lower intakes of total g of meats, and cheese than lower sugar consumers. The nutritional quality of childrens diets high in total sugar appear to be adequate regarding vitamin and mineral intakes and are closer to meeting current dietary fat recommendations.

Assessing dietary intake in preschool children: The healthy start project - New York☆

Abstract Healthy Start is a three year research project designed to evaluate the effectiveness of a cardiovascular risk reduction program in minority and low-income children and their parents. Baseline 24-hour recall data was collected on 439 three to five year-old children during the Fall of 1995. The methodology used was a combined approach: observation of the children during mealtime to determine quantities of food eaten at school coupled with completion of a food record by the parent/guardian of the child for foods eaten away from school on the same day as the observation. The food record was reviewed by phone with the parent/guardian for accuracy and completeness. In the absence of a completed food record, the parent was asked to recall the childs intake on the day in question. School meal plus home meal intake was merged for each child to create the 24-hour intake. The collection method was done according to specific criteria. The mean caloric intake was 1449 kcal, with 15% of energy from protein, 54% from carbohydrate, 31% from fat and 12% from saturated fat. This combined approach methodology allows 24-hour intakes to be collected on young children in the school setting as well as the home environment.

Reducing Fat in Preschool Meals: Description of the Foodservice Intervention Component of Healthy Start

Abstract Healthy Start is a 3–year demonstration and education research project to evaluate the effectiveness of a coronary heart disease risk reduction program in Head Start centers in New York State. The primary goal of the program is to demonstrate that it is possible and safe to reduce young childrens intake of fat to desirable levels. The development and initial implementation of the nutrition intervention component of the program are described in this report. Nutrition intervention includes nutrition education for the childrens care givers and modifications in the foodservice operation in each of the studys six intervention sites. Recommendations are provided to guide educators in future research and practice.

Trends in dietary intake of sugars of 10-year-old children from 1973 to 1988: The bogalusa heart study

Abstract Trends in dietary intakes of total sugar of 10-year-old children were examined from 1973 to 1988 across six cross-sectional surveys. For whites only, a significant positive trend was shown in intakes of total sugar. A significant positive trend was observed in intakes of fructose with a negative trend in sucrose intakes. The total grams of fruits/fruit juices consumed significantly increased (p

Impact of Fat Reduction on Micronutrient Density of Children's Diets: the Catch Study

BACKGROUNDnThe purpose of this study was to examine the impact of fat reduction on vitamin and mineral density in the diets of groups of children who participated in the CATCH school-based intervention study for 2 1/2 years.nnnMETHODSnTwenty-four-hour dietary recalls were collected on 1,182 children residing in four states and with diverse ethnic backgrounds, at baseline when they were in third grade and again at follow-up when they were in fifth grade.nnnRESULTSnWith a 2.4% reduction in total fat intake from baseline levels in the intervention group, mean changes in vitamin and mineral intakes per 1,000 kcal of this group were small yet significant compared with the control group. As mean fat intake decreased, the nutrient density of most vitamins and minerals increased; the sole exceptions were vitamin E and sodium. Mean intake of all vitamins and minerals studied exceeded 2/3 of the RDA at both baseline and follow- up for both the intervention and the control groups. No significant differences were noted between treatment groups for the percentages of children meeting 2/3 or more of the RDA at both baseline and follow-up periods.nnnCONCLUSIONSnCATCH was successful in maintaining mean vitamin and mineral intakes of intervention group children when total dietary fat was reduced.

Trends in Nutrient Intake of 10-Year-Old Children From 1973-1994: The Bogalusa Heart Study

Abstract Twenty-four hour dietary recalls were obtained from 7 cohorts of 10 year-old-children (35% black, 65% white; N=1465) over a 21 year period. Secular trends in energy, macronutrient, cholesterol, and fatty acid intakes were compared with dietary recommendations and trends in food consumption patterns. Total energy intake was virtually the same over the study period (2054-2224 kcal); boys had higher intakes than girls. There was a negative trend for energy intake relative to body weight (65.5+28.6 [SD] to 55.4+26.1; p