BACKGROUND:Population-based studies have shown that vegetarians have lower body mass index than nonvegetarians, suggesting that vegetarian diet plans may be an approach for weight management. However, a perception exists that vegetarian diets are deficient in certain nutrients. OBJECTIVE:To compare dietary quality of vegetarians, nonvegetarians, and dieters, and to test the hypothesis that a vegetarian diet would not compromise nutrient intake when used to manage body weight. DESIGN:Cross-sectional analysis of National Health and Nutrition Examination Survey (1999-2004) dietary and anthropometric data. Diet quality was determined using United States Department of Agriculture's Healthy Eating Index 2005. Participants included adults aged 19 years and older, excluding pregnant and lactating women (N = 13,292). Lacto-ovo vegetarian diets were portrayed by intakes of participants who did not eat meat, poultry, or fish on the day of the survey (n = 851). Weight-loss diets were portrayed by intakes of participants who consumed 500 kcal less than their estimated energy requirements (n = 4,635). Mean nutrient intakes and body mass indexes were adjusted for energy, sex, and ethnicity. Using analysis of variance, all vegetarians were compared to all nonvegetarians, dieting vegetarians to dieting nonvegetarians, and nondieting vegetarians to nondieting nonvegetarians. RESULTS:Mean intakes of fiber, vitamins A, C, and E, thiamin, riboflavin, folate, calcium, magnesium, and iron were higher for all vegetarians than for all nonvegetarians. Although vegetarian intakes of vitamin E, vitamin A, and magnesium exceeded that of nonvegetarians (8.3 ± 0.3 vs 7.0 ± 0.1 mg; 718 ± 28 vs 603 ± 10 μg; 322 ± 5 vs 281 ± 2 mg), both groups had intakes that were less than desired. The Healthy Eating Index score did not differ for all vegetarians compared to all nonvegetarians (50.5 ± 0.88 vs 50.1 ± 0.33, P = 0.6). CONCLUSIONS:These findings suggest that vegetarian diets are nutrient dense, consistent with dietary guidelines, and could be recommended for weight management without compromising diet quality.
Background Changes in eating habits could potentially be contributing to vitamin D insufficiency among US adults.Objective Describe secular trends in vitamin D intake from food sources during the past 25 years.Design Trends in dietary vitamin D intake from 1980-1982 to 2007-2009 were examined using data collected from the Minnesota Heart Survey, a surveillance study of trends in risk factors for cardiovascular disease among probability samples of adults aged 25 to 74 years in the Minneapolis-St Paul, MN, metropolitan area. Surveys were conducted in 1980-1982, 1985-1987, 1990-1992, 1995-1997, 2000-2002, and 2007-2009. One 24-hour recall was collected from survey participants during each survey period.Results Vitamin D intake from food sources decreased between 1980-1982 and 2007-2009 among men, with age-adjusted mean vitamin D intake decreasing from 7.24 mu g/day in 1980-1982 to 6.15 mu g/day in 2007-2009 (P for trend <0.001). A decrease was also observed among women (4.77 mu g/day in 1980-1982 in comparison to 4.53 mu g/day in 2007-2009; P for trend <0.001).Conclusions Results suggest that vitamin D intake from food sources has been on the decline during the past 25 years among men and women, potentially contributing to vitamin D insufficiency. J Am Diet Assoc. 2011;111:1329-1334.
Reduced-calorie diets are difficult to follow because they often require elimination of certain foods, leading to poor compliance and limited success. However, a low-calorie, nutrient-dense diet has the potential to accommodate a daily snack without exceeding energy requirements, even during weight loss. This pilot study evaluated the effects of a reduced-calorie diet including either a daily dark chocolate snack or a non-chocolate snack on anthropometric and body composition measurements. In a randomized clinical trial, 26 overweight and obese (body mass index ≥25 to ≤43) premenopausal women were assigned to a reduced-calorie diet that included either a daily dark chocolate snack or non-chocolate snack (n=13 per group) for 18 weeks. At baseline and end of study, body weight and waist and hip circumferences were measured along with fat mass, lean mass, and body fat percentage by dual-energy x-ray absorptiometry. Energy and macronutrient intakes were estimated from 4-day food records. Within- and between-group changes from baseline were analyzed using paired t tests and independent t tests, respectively. Women in both snack groups reduced estimated daily energy intake (P<0.001). Women in both the dark chocolate snack and non-chocolate snack groups, respectively, experienced decreases (P<0.001) in body weight (-5.1 vs -5.1 kg), hip circumference (-5.8 vs -5.4 cm), waist circumference (-5.7 vs -3.5 cm), fat mass (-3.9 vs -3.6 kg), and body fat percentage (-3.4% vs -3.1%), with no change in lean mass. Improvements in anthropometric and body composition measurements among overweight and obese premenopausal women can be achieved with a reduced-calorie diet including either a daily dark chocolate snack or non-chocolate snack.
Communities are being encouraged to develop locally based interventions to address environmental risk factors for obesity. Online public directories represent an affordable and easily accessible mechanism for mapping community food environments, but may have limited utility in rural areas. The primary aim of this study was to evaluate the efficacy of public directories vs rigorous onsite field verification to characterize the community food environment in 32 geographically dispersed towns from two rural states covering 1,237.6 square miles. Eight types of food outlets were assessed in 2007, including food markets and eating establishments, first using two publically available online directories followed by onsite field verification by trained coders. χ(2) and univariate binomial regression were used to determine whether the proportion of outlets accurately listed varied by food outlet type or town population. Among 1,340 identified outlets, only 36.9% were accurately listed through public directories; 29.6% were not listed but were located during field observation. Accuracy varied by outlet type, being most accurate for big box stores and least accurate for farm/produce stands. Overall, public directories accurately identified fewer than half of the food outlets. Accuracy was significantly lower for rural and small towns compared to mid-size and urban towns (P<0.001). In this geographic sample, public directories seriously misrepresented the actual distribution of food outlets, particularly for rural and small towns. To inform local obesity-prevention efforts, communities should strongly consider using field verification to characterize the food environment in low-population areas.
High-protein preloads have been shown to enhance satiety, but little is known about the satiating effects of protein in more typical situations when meals are consumed ad libitum. To investigate the effects of protein in amounts commonly consumed over a day, a crossover study was conducted in 2008. In this experiment, 18 normal-weight women consumed ad libitum lunch and dinner entrées 1 day a week that were covertly varied in protein content (10%, 15%, 20%, 25%, or 30% energy). Entrées were manipulated by substituting animal protein for starchy ingredients and were matched for energy density, fat content, palatability, and appearance. Unmanipulated breakfasts and evening snacks were consumed ad libitum. Participants rated their hunger and fullness before and after meals as well as the taste and appearance of entrées. Data were analyzed using a mixed linear model. Results showed that mean 24-hour protein intake increased significantly across conditions, from 44±2 g/day in the 10% protein condition to 82±6 g/day in the 30% condition. Daily energy intake did not differ significantly across the 10% to 30% protein conditions (means 1,870±93, 1,887±93, 1,848±111, 1,876±100, and 1,807±98 kcal in the 10%, 15%, 20%, 25%, and 30% energy groups, respectively). There were no significant differences in hunger and fullness ratings across conditions or in taste and appearance ratings of the manipulated entrées. This study showed that varying the protein content of several entrées consumed ad libitum did not differentially influence daily energy intake or affect ratings of satiety.
In the early 20th century, there were only three recognized professions: medicine, clergy, and the law. Today, dietetics is considered a profession along with engineering, accounting, dentistry, social work, and occupational therapy. Every profession sets a minimum level of education and skill development, demonstrated competency, self-regulation, a code of ethics, and standards for credentialing. Yet being a professional member and being perceived as a professional are two different things. Ideally, professionals are respected for their energy, intuition, vision, conviction, humility, passion, and evidence of continual learning. Clients, colleagues, employers, and the general public expect a certain demeanor, behavior, and image from those who call themselves professionals. James R. Ball writes that professionalism takes a lifelong commitment to competency, excellence, honorable values, standards, ethics, upright character, determination, service mentality, and even a touch of class (1Ball J.R. Professionalism Is for Everyone: Five Keys to Being a True Professional. Goals Institute, Reston, VA2008Google Scholar). So, how do we know if we are acting professionally? If professionalism is one key to career success, how do we demonstrate it to one and all? This is important to ask. We must work hard to help others recognize our capabilities and to increase the demand for our services (2Professionalism: The Key to Career Success. Dep-Line Dietetic Educators of Practice DPG newsletter; Summer 2009.Google Scholar). What can each of us do to put registered dietitians at the top of the list of the most trusted and respected health professionals? How can we seize the opportunity for every family to recognize and have access to the essential “three D's”—a doctor, a dentist, and a dietitian? We already have much going for us: a scientific education, supervised practice for competency, the credential, and continuing education requirements to enhance our credibility. Indeed, membership in an association like ADA offers unparalleled resources for building and maintaining professional expertise. No one can question our technical knowledge. Yet we must also exude confidence, leadership, and genuine enthusiasm. Positive body language, a focus on needs of “the client,” a can-do attitude, and effective communication techniques will project the message: You can trust me. Your nutritional well-being is my concern. I care. Professionalism doesn't mean excessive bragging or “selling yourself.” But it does mean making yourself memorable and trustworthy. Ask yourself: When I think of the person I admire most, what are the traits I think about? Is that person highly capable? Respectable? Trustworthy? An exemplary dietitian who comes to mind is Laura E. Matarese, PhD, RD, LDN, CNSD, FADA, director of nutrition at the Intestinal Rehabilitation and Transplant Center, Thomas E. Starzl Transplantation Institute at the University of Pittsburgh Medical Center. In a recent conversation, she discussed her love for working with patients. “It is rewarding to change someone's life. It is also fulfilling to simplify your knowledge so patients can understand and incorporate important changes into their lives.” The enlightened professional conveys that message of trust within the first few seconds of meeting someone face to face. Fortunately, these refined qualities can be learned and internalized. By paying attention to people around you who model professional behavior, you can emulate them. Be willing to conduct a self-assessment of your shortcomings and then address each one. “Learning how to deal effectively with people is no different than learning organic chemistry,” says Dr Matarese. “These are skill sets that can be learned.” We possess the technical knowledge needed to be successful. We have the cognitive ability. But do we have the emotional intelligence that we need to make an indelible mark? Do we have the capacity for recognizing our own feelings and those of others, for motivating ourselves, for managing emotions in ourselves and in our relationships? According to Harvard researcher and author Daniel Goleman, intelligence quotient (IQ) is only 10% to 15% of job or life success. Other factors, including emotional intelligence, make up the rest (3Goleman D. Emotional Intelligence: 10th Anniversary Edition; Why It Can Matter More Than IQ. Bantam, New York, NY2006Google Scholar). I promise to address different emotional intelligence qualities over the next few months. Whether we are visiting Capitol Hill, a food bank, a hospital patient, or a local school, emotional intelligence will help us take our rightful place as one of the essential “three D's” for every citizen.
Background Dairy products have been perceived as having the potential to cause adverse effects in individuals with Crohn's disease (CD) and are often avoided, potentially increasing the risk of osteoporosis and related morbidity associated with inadequate dietary calcium intake. Objective To evaluate the self-reported effects of dairy products on CD symptoms and to determine whether these effects differed between types of dairy products consumed and disease state or location. Design Secondary analysis of dietary survey and clinical data from participants in the Genes and Diet in Inflammatory Bowel Disease study based in Auckland, New Zealand. Subjects/setting One hundred and sixty-five men and women diagnosed with CD for which both dietary survey data and clinical information were available. Statistical analyses performed χ2 analysis was conducted to assess whether significant differences in the proportions of responses relating to a worsening of CD symptoms from individual dairy products were evident between individuals with active or quiescent CD, or ileal or colonic disease locations. Odds ratios with confidence interval were calculated to determine whether CD location was associated with risk of any type of adverse reaction to milk products. Logit scales were utilized to depict self-reported CD symptoms associated with individual dairy product consumption for ileal and colonic CD patients. Results Dairy products had no effect on self-reported CD symptoms for most people. Dairy products with a high fat content were most frequently reported to worsen perceived CD symptoms. Clinically, self-reported CD activity status did not influence responses to dairy products; however, colonic inflammation was more frequently associated with adverse CD effects in comparison to ileal CD involvement. Conclusions Research outcomes question the necessity of dairy product avoidance in CD patients and illustrate the highly individual nature of dairy product tolerance in this clinical population.
Background It is widely presumed that competitive foods foods offered for sale in schools in addition to reimbursable federal meals programs-provide revenue that is essential to maintain school foodservices. However, evidence is lacking to demonstrate whether competitive foods sales truly improve foodservice financial viability.Objective The aim of this research was to assess whether or not competitive foods sales have an overall positive financial effect on school foodservice finances.Design and statistical analyses This observational study used a multivariate time series analysis of annual foodservice financial data from repeated observations of 344 Minnesota public school districts between 2001 and 2008 (N=2,695). First, revenue from competitive foods was assessed in terms of whether or not such revenue displaced or complemented revenue from reimbursable meals. Second, profit from competitive foods was assessed in terms of whether or not such profit displaced or increased total school foodservice profit.Results Fixed effects models indicated small but significant negative relationships between competitive foods sales and reimbursable meals revenue, as well as overall foodservice profit. A 10% increase in competitive foods revenue was associated with a 0.1% decrease in reimbursable meals revenue (P<0.05). A 10% increase in competitive foods profit was associated with a 0.7% decrease in overall foodservice profit among schools with profitable competitive sales (P<0.10).Conclusions Study findings suggest that competitive foods can have a negative effect on school foodservice finances. Better understanding of foodservice finances could influence current approaches to improve school nutrition. Improved recordkeeping may be necessary to ensure that public funds are not used to subsidize schools' competitive offerings. J Am Diet Assoc. 2011;111:851-857.
Certain aspects of the home environment as well as individuals' knowledge of energy balance are believed to be important correlates of various dietary and physical activity behaviors, but no known studies have examined potential relationships between these correlates. This study evaluated cross-sectional associations between characteristics of the home environment and energy balance knowledge among 349 youth/parent pairs recruited from the Minneapolis/St Paul, MN, metropolitan area from September 2006 to June 2007. Linear regression models adjusted for student grade and highest level of parental education were used to compare data from home food, physical activity, and media inventories (parent-reported) with energy balance knowledge scores from youth and parent questionnaires. Paired energy balance knowledge (average of youth and parent knowledge scores) was associated with all home food availability variables. Paired knowledge was also significantly associated with a media equipment availability and accessibility summary score (β=-1.40, P=0.005), as well as an activity-to-media ratio score (β=0.72, P=0.003). Youth and/or parent knowledge alone was not significantly associated with most characteristics of the home environment, supporting the importance of developing intervention strategies that target the family as a whole.
Employed parents' work and family conditions provide behavioral contexts for their food choices. Relationships between employed parents' food-choice coping strategies, behavioral contexts, and dietary quality were evaluated. Data on work and family conditions, sociodemographic characteristics, eating behavior, and dietary intake from two 24-hour dietary recalls were collected in a random sample cross-sectional pilot telephone survey in the fall of 2006. Black, white, and Latino employed mothers (n=25) and fathers (n=25) were recruited from a low/moderate income urban area in upstate New York. Hierarchical cluster analysis (Ward's method) identified three clusters of parents differing in use of food-choice coping strategies (ie, Individualized Eating, Missing Meals, and Home Cooking). Cluster sociodemographic, work, and family characteristics were compared using χ(2) and Fisher's exact tests. Cluster differences in dietary quality (Healthy Eating Index 2005) were analyzed using analysis of variance. Clusters differed significantly (P≤0.05) on food-choice coping strategies, dietary quality, and behavioral contexts (ie, work schedule, marital status, partner's employment, and number of children). Individualized Eating and Missing Meals clusters were characterized by nonstandard work hours, having a working partner, single parenthood and with family meals away from home, grabbing quick food instead of a meal, using convenience entrées at home, and missing meals or individualized eating. The Home Cooking cluster included considerably more married fathers with nonemployed spouses and more home-cooked family meals. Food-choice coping strategies affecting dietary quality reflect parents' work and family conditions. Nutritional guidance and family policy needs to consider these important behavioral contexts for family nutrition and health.
A recent finding of low levels of docosahexaenoic acid (DHA) in the milk of lactating Hispanic and non-Hispanic white women in New Mexico prompted a study of the DHA content of the breast milk and diets of American Indian women in the state. Nineteen urban American Indian women (18 to 40 years) who had been lactating for 1 to 6 months and who were attending clinics at the University of New Mexico Hospital were enrolled in a cross-sectional study that was conducted between June 2005 and February 2009. Descriptive statistics and correlations were performed. The mean fat content of the breast milk was 4.67±1.9 g/dL and the mean DHA proportion of the milk fat was 0.097%±0.035%, which is a low value relative to international norms. The low DHA content of the milk could be accounted for by the women's low dietary intake of DHA (median=30 mg). The DHA percentage in the women's milk fat was positively correlated with dietary intake of DHA (r=0.67; P<0.001). This study shows that the DHA content of the breast milk of urban American Indian women attending clinics at a university hospital in New Mexico is well below levels widely acknowledged as being healthful for infants who rely mainly on breast milk for their supply of DHA.
This issue of the Journal of the American Dietetic Association features an article by Mangano and colleagues entitled “Calcium Intake in the United States from Dietary and Supplemental Sources Across Adult Age Groups: New Estimates from the National Health and Nutrition Examination Survey 2003-2006” (1). Its scope and purpose overlap with a recent article by Bailey and colleagues (2), which also examined total calcium intakes across age groups using the same National Health and Nutrition Examination Survey (NHANES) data. We drew upon these papers to reflect on key issues relevant to assessing nutrient intakes among populations and to consider the evidence on calcium intakes among Americans. S. M. Krebs-Smith is branch chief, Risk Factor Monitoring and Methods Branch, Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD S. I. Kirkpatrick is a fellow, Risk Factor Monitoring and Methods Branch, Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD
What could be more nutrient dense than a vegetarian diet? In this era of obesity and heightened interest in reducing excess calorie intake, the interest in increasing fruits and vegetables and reducing foods with added sugar and solid fats would seem to point to the benefit of more vegetarian meals. This month, Farmer and colleagues (p 819) investigate this question by considering a diet absent of meat, poultry, or fish based on the National Health and Nutrition Examination Survey data from 1999-2004. They reviewed data for adults over age 19 years and compared those whose intake reflected vegetarian vs nonvegetarian patterns. Lacto-ovo vegetarians vs nonvegetarians were considered. While this cross-sectional analysis can only reflect associations, not causality, there are some interesting and useful observations that can apply to diet counseling and intervention efforts that may be focused on enhancing overall nutrient intake within a reduced or calorie controlled environment. Please also be sure to check out the interesting Research Editorial by Thedford and Raj (p 816).Questions of nutrient density and overall nutrition quality arise in the study by Kreider and colleagues (p 828) as they explore whether adherence to a meal replacement–based diet program with encouragement to increase physical activity was as effective as a meal plan–based diet and supervised exercise program in sedentary obese women. Emphasis on the physical activity aspect of this study illustrates benefits, especially in previously sedentary populations. The usefulness of meal replacement as a potential key to portion control and simplification of diet intervention has been gaining research attention (1Rock C.L. Flatt S.W. Sherwood N.E. Karanja N. Pakiz B. Thomson C.A. Effect of a free prepared meal and incentivized weight loss program on weight loss and weight loss maintenance in obese and overweight women: a randomized controlled trial.JAMA. 2010; 304: 1803-1810Google Scholar, 2Lee K. Lee J. Bae W.K. Choi J.K. Kim H.J. Cho B. Efficacy of low-calorie, partial meal replacement diet plans on weight and abdominal fat in obese subjects with metabolic syndrome: A double blind randomized controlled trial of two diet plans—One high in protein and one nutritionally balanced.Int J Clin Pract. 2009; 63: 195-201Google Scholar, 3Mattes R.D. Ready-to-eat cereal used as a meal replacement promotes weight loss in human.J Am Coll Nutr. 2002; 21: 570-577Google Scholar). The overall nutrient density compared across studies and approaches would be of interest, especially related to sodium, sugar, and other ingredients associated with processed foods.Eating Less Salt?Along with eating fewer calories, there is emphasis on the need to reduce sodium. On average, Americans consume around 3,400 mg sodium per day, well above the US Dietary Guidelines recommendation of 2,300 mg per day; the Japanese are reported to consume even more sodium, around 4,600 mg per day (4Anderson C.A. Appel L.J. Okuda N. Brown I.J. Chan Q. Zhao L. Ueshima H. Kesteloot H. Miura K. Curb J.D. Yoshita K. Elliott P. Yamamoto M.E. Stamler J. Dietary sources of sodium in China, Japan, the United Kingdom and the United States, women and men aged 40-59 years: The INTERMAP study.J Am Diet Assoc. 2010; 110: 736-745Google Scholar). This month, Otsuka and colleagues (p 844) report results from a longitudinal investigation of community-dwelling middle-aged and elderly Japanese people regarding their overall intake of sodium. Data collected as part of the National Institute for Longevity Sciences Longitudinal Study of Aging were compared over the course of 8 years among participants living in Obu-shi and Higashiura-cho, Aichi Prefecture, Japan. Three-day dietary records were collected and foods were weighed and measured to help increase the accuracy of these data. Results showed decreases among men but increases among women in certain age groups, regardless of reduced calorie intake. Associated blood pressure changes and the implications for future diet and intervention efforts aimed at improving overall health are discussed.Changing of the BoardThis month marks the time when changes take place on our Board of Editors. Unlike last year when several changes were made as several members had earned well-deserved time off, this year we have only one retiring member and one new member.We would like to express our sincere appreciation to:Julie Eichenberger Gilmore, PhD, RDTerm 2008-2011University of IowaInstitute for Clinical & Translational ScienceIowa City, IAAnd welcome our newest Editorial Board member:Frances E. Thompson, PhD, MPHEpidemiologistRisk Factor Monitoring and Methods BranchApplied Research Program Division of Cancer Control and Population SciencesNational Cancer InstituteBethesda, MDDr Thompson's research interests focus on dietary assessment methodology, including evaluating existing methods and developing new methods, and research design in epidemiologic studies, particularly related to cancer prevention and obesity.Best regards. What could be more nutrient dense than a vegetarian diet? In this era of obesity and heightened interest in reducing excess calorie intake, the interest in increasing fruits and vegetables and reducing foods with added sugar and solid fats would seem to point to the benefit of more vegetarian meals. This month, Farmer and colleagues (p 819) investigate this question by considering a diet absent of meat, poultry, or fish based on the National Health and Nutrition Examination Survey data from 1999-2004. They reviewed data for adults over age 19 years and compared those whose intake reflected vegetarian vs nonvegetarian patterns. Lacto-ovo vegetarians vs nonvegetarians were considered. While this cross-sectional analysis can only reflect associations, not causality, there are some interesting and useful observations that can apply to diet counseling and intervention efforts that may be focused on enhancing overall nutrient intake within a reduced or calorie controlled environment. Please also be sure to check out the interesting Research Editorial by Thedford and Raj (p 816). Questions of nutrient density and overall nutrition quality arise in the study by Kreider and colleagues (p 828) as they explore whether adherence to a meal replacement–based diet program with encouragement to increase physical activity was as effective as a meal plan–based diet and supervised exercise program in sedentary obese women. Emphasis on the physical activity aspect of this study illustrates benefits, especially in previously sedentary populations. The usefulness of meal replacement as a potential key to portion control and simplification of diet intervention has been gaining research attention (1Rock C.L. Flatt S.W. Sherwood N.E. Karanja N. Pakiz B. Thomson C.A. Effect of a free prepared meal and incentivized weight loss program on weight loss and weight loss maintenance in obese and overweight women: a randomized controlled trial.JAMA. 2010; 304: 1803-1810Google Scholar, 2Lee K. Lee J. Bae W.K. Choi J.K. Kim H.J. Cho B. Efficacy of low-calorie, partial meal replacement diet plans on weight and abdominal fat in obese subjects with metabolic syndrome: A double blind randomized controlled trial of two diet plans—One high in protein and one nutritionally balanced.Int J Clin Pract. 2009; 63: 195-201Google Scholar, 3Mattes R.D. Ready-to-eat cereal used as a meal replacement promotes weight loss in human.J Am Coll Nutr. 2002; 21: 570-577Google Scholar). The overall nutrient density compared across studies and approaches would be of interest, especially related to sodium, sugar, and other ingredients associated with processed foods. Eating Less Salt?Along with eating fewer calories, there is emphasis on the need to reduce sodium. On average, Americans consume around 3,400 mg sodium per day, well above the US Dietary Guidelines recommendation of 2,300 mg per day; the Japanese are reported to consume even more sodium, around 4,600 mg per day (4Anderson C.A. Appel L.J. Okuda N. Brown I.J. Chan Q. Zhao L. Ueshima H. Kesteloot H. Miura K. Curb J.D. Yoshita K. Elliott P. Yamamoto M.E. Stamler J. Dietary sources of sodium in China, Japan, the United Kingdom and the United States, women and men aged 40-59 years: The INTERMAP study.J Am Diet Assoc. 2010; 110: 736-745Google Scholar). This month, Otsuka and colleagues (p 844) report results from a longitudinal investigation of community-dwelling middle-aged and elderly Japanese people regarding their overall intake of sodium. Data collected as part of the National Institute for Longevity Sciences Longitudinal Study of Aging were compared over the course of 8 years among participants living in Obu-shi and Higashiura-cho, Aichi Prefecture, Japan. Three-day dietary records were collected and foods were weighed and measured to help increase the accuracy of these data. Results showed decreases among men but increases among women in certain age groups, regardless of reduced calorie intake. Associated blood pressure changes and the implications for future diet and intervention efforts aimed at improving overall health are discussed. Along with eating fewer calories, there is emphasis on the need to reduce sodium. On average, Americans consume around 3,400 mg sodium per day, well above the US Dietary Guidelines recommendation of 2,300 mg per day; the Japanese are reported to consume even more sodium, around 4,600 mg per day (4Anderson C.A. Appel L.J. Okuda N. Brown I.J. Chan Q. Zhao L. Ueshima H. Kesteloot H. Miura K. Curb J.D. Yoshita K. Elliott P. Yamamoto M.E. Stamler J. Dietary sources of sodium in China, Japan, the United Kingdom and the United States, women and men aged 40-59 years: The INTERMAP study.J Am Diet Assoc. 2010; 110: 736-745Google Scholar). This month, Otsuka and colleagues (p 844) report results from a longitudinal investigation of community-dwelling middle-aged and elderly Japanese people regarding their overall intake of sodium. Data collected as part of the National Institute for Longevity Sciences Longitudinal Study of Aging were compared over the course of 8 years among participants living in Obu-shi and Higashiura-cho, Aichi Prefecture, Japan. Three-day dietary records were collected and foods were weighed and measured to help increase the accuracy of these data. Results showed decreases among men but increases among women in certain age groups, regardless of reduced calorie intake. Associated blood pressure changes and the implications for future diet and intervention efforts aimed at improving overall health are discussed. Changing of the BoardThis month marks the time when changes take place on our Board of Editors. Unlike last year when several changes were made as several members had earned well-deserved time off, this year we have only one retiring member and one new member.We would like to express our sincere appreciation to:Julie Eichenberger Gilmore, PhD, RDTerm 2008-2011University of IowaInstitute for Clinical & Translational ScienceIowa City, IAAnd welcome our newest Editorial Board member:Frances E. Thompson, PhD, MPHEpidemiologistRisk Factor Monitoring and Methods BranchApplied Research Program Division of Cancer Control and Population SciencesNational Cancer InstituteBethesda, MDDr Thompson's research interests focus on dietary assessment methodology, including evaluating existing methods and developing new methods, and research design in epidemiologic studies, particularly related to cancer prevention and obesity.Best regards. This month marks the time when changes take place on our Board of Editors. Unlike last year when several changes were made as several members had earned well-deserved time off, this year we have only one retiring member and one new member. We would like to express our sincere appreciation to: Julie Eichenberger Gilmore, PhD, RD Term 2008-2011 University of Iowa Institute for Clinical & Translational Science Iowa City, IA And welcome our newest Editorial Board member: Frances E. Thompson, PhD, MPH Epidemiologist Risk Factor Monitoring and Methods Branch Applied Research Program Division of Cancer Control and Population Sciences National Cancer Institute Bethesda, MD Dr Thompson's research interests focus on dietary assessment methodology, including evaluating existing methods and developing new methods, and research design in epidemiologic studies, particularly related to cancer prevention and obesity. Best regards.
Studies considering the impact of food-size variations on consumption have predominantly focused on portion size, whereas very little research has investigated variations in food-item size, especially at snacking occasions, and results have been contradictory. This study evaluated the effect of altering the size of food items (ie, small vs large candies) of equal-size food portions on short-term energy intake while snacking. The study used a between-subjects design (n=33) in a randomized experiment conducted in spring 2008. In a psychology laboratory (separate cubicles), participants (undergraduate psychology students, 29 of 33 female, mean age 20.3±2 years, mean body mass index 21.7±3.7) were offered unlimited consumption of candies while participating in an unrelated computerized experiment. For half of the subjects, items were cut in two to make the small food-item size. Food intake (weight in grams, kilocalories, and number of food items) was examined using analysis of variance. Results showed that decreasing the item size of candies led participants to decrease by half their gram weight intake, resulting in an energy intake decrease of 60 kcal compared to the other group. Appetite ratings and subject and food characteristics had no moderating effect. A cognitive bias could explain why people tend to consider that one unit of food (eg, 10 candies) is the appropriate amount to consume, regardless of the size of the food items in the unit. This study suggests a simple dietary strategy, decreasing food-item size without having to alter the portion size offered, may reduce energy intake at snacking occasions.
Differences in health incidences and outcomes for racial and ethnic minorities are commonly referred to as health disparities ( 1 National Cancer InstituteHealth Disparities Defined. http://www.cdc.gov/cancer/healthdisparities/basic_info/index.htmDate: 2009 Google Scholar ). When these differences are a result of systemic or unjust distribution of resources, they are considered health inequities that are unfair, unjust, and yet reversible. Outcomes present as variances that include the incidence, prevalence, mortality, and burden of disease among specific population groups in the United States. Health equity requires that everyone have equal opportunity to attain health regardless of his or her social status or circumstance ( 2 Commission on Social Determinants of HealthClosing the gap in a generation: Health equity through action on the social determinants of health. Final Report of the Commission on Social Determinants of Health. World Health Organization, Geneva, Switzerland2008 Google Scholar ).
A reliance on self-reported dietary intake measures is a common research limitation, thus the need for dietary biomarkers. Added-sugar intake may play a role in the development and progression of obesity and related comorbidities; common sweeteners include corn and sugar cane derivatives. These plants contain a high amount of ¹³C, a naturally occurring stable carbon isotope. Consumption of these sweeteners, of which sugar-sweetened beverages are the primary dietary source, might be reflected in the δ¹³C value of blood. Fingerstick blood represents an ideal substrate for bioassay because of its ease of acquisition. The objective of this investigation was to determine if the δ¹³C value of fingerstick blood is a potential biomarker of added-sugar and sugar-sweetened beverage intake. Individuals aged 21 years and older (n = 60) were recruited to attend three laboratory visits; assessments completed at each visit depended upon a randomly assigned sequence (sequence one or two). The initial visit included assessment of height, weight, and dietary intake (sequence one: beverage intake questionnaire, sequence two: 4-day food intake record). Sequence one participants completed a food intake record at visit two, and nonfasting blood samples were obtained via routine fingersticks at visits one and three. Sequence two participants completed a beverage intake questionnaire at visit two, and provided fingerstick blood samples at visits two and three. Samples were analyzed for δ¹³C value using natural abundance stable isotope mass spectrometry. δ¹³C value was compared to dietary outcomes in all participants, as well as among those in the highest and lowest tertile of added-sugar intake. Reported mean added-sugar consumption was 66 ± 5 g/day, and sugar-sweetened beverage consumption was 330 ± 53 g/day and 134 ± 25 kcal/day. Mean fingerstick δ¹³C value was -19.94‰ ± 0.10‰, which differed by body mass index status. δ¹³C value was associated (all P < 0.05) with intake of total added sugars (g, r = 0.37; kcal, r = 0.37), soft drinks (g, r = 0.26; kcal, r = 0.27), and total sugar-sweetened beverage (g, r = 0.28; kcal, r = 0.35). The δ¹³C value in the lowest and the highest added-sugar intake tertiles were significantly different (mean difference = -0.48‰; P = 0.028). Although there are several potential dietary sources for blood carbon, the δ¹³C value of fingerstick blood shows promise as a noninvasive biomarker of added-sugar and sugar-sweetened beverage intake based on these findings.
In 2008, 34% of adults (1.46 billion) globally were overweight and obese (body mass index [BMI]≥25); of these, an equal proportion (502 million) were obese. This translates to a twofold increase over the last 30 years. Whereas the increase in mean BMI in high-income countries was highest in the United States, Nauru in the Oceania reported the greatest gain in BMI globally ( 1 Finucane M.M. Stevens G.A. Cowan M.J. Danaei G. Lin J.K. Paciorek C.J. Singh G.M. Gutierrez H.R. Lu Y. Bahalim A.N. Farzadfar F. Riley L.M. Ezzati M. National, regional, and global trends in body-mass index since 1980: Systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 9·1 million participants. Lancet. 2011; 377: 557-567 Google Scholar ). China is expected to have the largest number of overweight and obese individuals in 2030 ( 2 Kelly T. Yang W. Chen C.S. Reynolds K. He J. Global burden of obesity in 2005 and projections to 2030. Int J Obes (Lond). 2008; 32: 1431-1437 Google Scholar ). R. W. Kimokoti is a research assistant professor, Department of Nutrition, Simmons College Boston, MA. B. E. Millen is president, Boston Nutrition Foundation and University Millennium Nutrition, Inc, Westwood, MA; previously she was a professor, Department of Family Medicine, Boston University School of Medicine, and professor, Division of Graduate Medical Sciences, Boston University School of Medicine, Boston, MA.
