Background Intake of trans fatty acids (TFAs) increases LDL cholesterol, decreases HDL cholesterol, and increases the risk of heart disease morbidity and mortality. Many food products potentially contain industrially produced or ruminant TFAs. However, little is known about the dietary sources of plasma TFA concentrations. Objective The objective of this study was to examine associations between foods consumed and plasma TFA concentrations using 24-h dietary recall data and plasma TFA measures among adults aged ≥20 y who participated in the NHANES 2009-2010 in the United States. Methods Over 4400 food products in the dietary interview data were categorized into 32 food and beverage groups/subgroups. Four major plasma TFAs (palmitelaidic acid, elaidic acid, vaccenic acid, linolelaidic acid) and the sum of the 4 TFAs (sumTFAs) were analyzed using GC-MS. Multivariable linear regression analyses were conducted to identify associations of plasma TFAs with all 32 food and beverage groups/subgroups, controlling for the potential confounding effects of 11 demographic, socioeconomic, behavioral, lifestyle, and health-related variables. Results Consumption of the following food groups/subgroups was significantly associated with elevated plasma TFA concentrations: cream substitutes (P < 0.001 for palmitelaidic acid, elaidic acid, vaccenic acid, and sumTFAs); cakes, cookies, pastries, and pies (P < 0.001 for elaidic acid, vaccenic acid, and sumTFAs; P < 0.05 for linolelaidic acid); milk and milk desserts (P < 0.01 for palmitelaidic acid and vaccenic acid; P < 0.05 for linolelaidic acid and sumTFAs); beef/veal, lamb/goat, and venison/deer (P < 0.01 for vaccenic acid; P < 0.05 for sumTFAs); and butters (P < 0.001 for palmitelaidic acid and vaccenic acid; P < 0.05 for sumTFAs). Conclusions The findings suggest that the above 5 food groups/subgroups could be the main dietary sources of plasma TFAs among adults in the United States in 2009-2010.

Few school-age youth consume the recommended amounts of fruits and vegetables, and increasing fruit and vegetable intake in children and adolescents is an important public health goal to maintain long-term good health and to decrease risk of chronic disease and obesity. School salad bars are an important tool to promote fruit and vegetable consumption among schoolchildren. Studies show that introduction of school salad bars increases the amount and variety of fruits and vegetables consumed by children in schools. However, many schools cannot afford the capital investment in the salad bar equipment. In 2010, the National Fruit & Vegetable Alliance (NFVA), United Fresh Produce Association Foundation, the Food Family Farming Foundation, and Whole Foods Market launched Let's Move Salad Bars to Schools (LMSB2S) in support of First Lady Michelle Obama's Let's Move! initiative. The goal of LMSB2S is to place 6000 salad bars in schools over 3 years. As of June, 2012, over 1400 new salad bar units have been delivered to schools across the United States, increasing access to fruits and vegetables for over 700,000 students. Any K through 12 school district participating in the National School Lunch Program is eligible to submit an application at www.saladbars2schools.org/. Requests for salad bar units ($2625 each unit) are fulfilled through grassroots fund raising in the school community and through funds raised by the LMSB2S partners from corporate and foundation sources. LMSB2S is a model for coalition-building across many government, nonprofit, and industry partners to address a major public health challenge.

Due to changing recommendations for fruit and vegetable (F/V) intake, public health and private organizations recognized the need to revise communications and programs that promote F/V consumption. This article describes formative research conducted in 2005 to develop a new identity for the 5 A Day Program, updated to the Fruits & Veggies—More Matters program. The objective was to re-brand the 5 A Day Program's campaign message to be adaptable, sustainable, and compelling, while leveraging the program's existing message dissemination infrastructure. Formative research included interviews with representatives from government, nonprofit organizations, and industry, and consumer perspectives from interviews, focus groups, and an online survey. Public health and private organizations agreed that a compelling emotional benefit was needed to motivate consumers to eat more F/V and that messaging needed to be used consistently among national, state, and local programs. Interviews and focus groups targeted mothers who believed they and their families were getting enough F/V, knew they could eat more, but needed to be convinced why they should do so. The most effective messages appealed to mothers' emotional needs to be responsible, leveraged functional intrinsic values of F/V, did not try to quantify "enough," and focused on small steps. When the Fruits & Veggies—More Matters slogan and graphic were viewed together, the majority (62%) said it increased their interest in eating more F/V. The Fruits & Veggies—More Matters brand offers numerous opportunities for promoting F/V consumption through this public health initiative.

CONTEXT:Fruit and vegetable intake is an important part of a healthy diet and is associated with numerous positive health outcomes. MyPyramid provides recommendations for fruit and vegetable consumption based on individual calorie requirements as determined by an individual's age, sex, and physical activity level.OBJECTIVES:To determine (1) median fruit and vegetable consumption from all dietary sources among adolescent and adult consumers and the percentage of adolescents and adults meeting individual recommended intake levels based on caloric requirements and (2) consumption levels among various demographic groups, intake levels from subtypes of fruits and vegetables, and primary contributors to fruit and vegetable intake.DESIGN:Analysis of 2-day, 24-hour recall data from the 2003-2004 National Health and Nutrition Examination Survey (NHANES), a continuous, nationally representative, cross-sectional survey.RESULTS:This study included dietary contributions of fruits and vegetables from all dietary sources. Fewer than 1 in 10 Americans meet their calorie-specific MyPyramid fruit or vegetable recommendations. Higher intake was not observed in subgroups with higher recommendations for fruit and vegetable consumption based on caloric requirements. The primary contributors to total fruit intake were whole fruits among adults and fruit juices among adolescents. The largest single contributor to overall fruit intake was orange juice. Potatoes dominated vegetable consumption, particularly among adolescents, in whom fried potatoes increased the median vegetable intake from 0.72 cup to 1.21 cups per day. Dark green and orange vegetables and legumes accounted for a small portion of vegetable intake, and few people met the recommendations.CONCLUSIONS:Few American adolescents or adults reported consuming the recommended amounts of fruits or vegetables. Increasing consumption will probably require multifaceted approaches that augment educational campaigns with policy and environmental strategies aimed at the food system at large, from farm to plate, including schools, worksites, and retail establishments. Increasing America's fruit and vegetable consumption is an important public health strategy for weight management and reduction of risk for chronic disease.

Objectives. Consumption of fruit and vegetables among children is generally below recommended levels. This evaluation addressed two questions: ( 1) To what extent did children's attitudes toward, familiarity with, and preferences for fruit and vegetables change during the school year? and ( 2) To what extent did children's consumption of fruit and vegetables change during the school year? Methods. During the 2004–2005 school year, the Mississippi Department of Education, Child Nutrition Programs initiated a pilot program to distribute free fruit and vegetables to students (kindergarten through 12th grade) during the school day. Data were collected in 2004–2005 within a one-group pretest/posttest design using a self-report questionnaire ( n=725) and 24-hour dietary recalls ( n=207) with a sample of students from five schools in Mississippi. Data were analyzed in 2006–2007. Results. Results showed greater familiarity with fruit and vegetables at all grade levels ( p<0.05) and increased preferences for fruit among eighth- and 10th-grade students ( p<0.01). Eighth-grade students also reported more positive attitudes toward eating fruit and vegetables ( p<0.01), increased perceived self-efficacy to eat more fruit ( p<0.01), and increased willingness to try new fruit. Finally, results showed increased consumption of fruit, but not vegetables, among eighth- and 10th-grade students ( p<0.001). Conclusions. Distributing free fruit and vegetables at school may be a viable component of a more comprehensive approach for improving students' nutrition attitudes and behaviors. More program emphasis is needed on ways to promote vegetable consumption.

INTRODUCTION:Eating a diet high in fruits and vegetables as part of an overall healthful diet can help lower chronic disease risk and aid in weight management. Increasing the percentage of Americans who consume enough fruits and vegetables every day is part of the Healthy People 2010 objectives for the nation. Assessing trends in consumption of these foods is important for tracking public health initiatives to meet this goal and for planning future objectives. METHODS:We assessed total and sex-specific changes in daily consumption of fruits and vegetables among 1,227,969 adults in the 50 U.S. states and the District of Columbia who participated in the Behavioral Risk Factor Surveillance System from 1994 through 2005. To estimate changes in consumption according to dietary recommendations that were in place during the years examined, we used geometric mean and the percentage of people eating fruits or vegetables or both five or more times per day. Estimates were standardized for sex, age, and race/ethnicity and analyzed by multivariate regression. RESULTS:From 1994 through 2005, the geometric mean frequency of consumption of fruits and vegetables declined slightly (standardized change: men and women, -0.22 times/day; men, -0.26 times/day; women, -0.17 times/day). The proportion of men and women eating fruits or vegetables or both five or more times per day was virtually unchanged (men, 20.6% vs 20.3%; women, 28.4% vs 29.6%); however, we found small increases for men aged 18 to 24 years and for women who were aged 25 to 34 years, non-Hispanic black, or nonsmokers. Consumption of fruit juice and non-fried potatoes declined for both sexes. CONCLUSION:The frequency of fruit and vegetable consumption changed little from 1994 through 2005. If consumption is to be increased, we must identify and disseminate promising individual and environmental strategies, including policy change.

Background: Fruit (F) and vegetable (V) intake is associated with reduced risk for chronic disease and improved weight management.Objectives: Determine the % of adolescents and adults meeting F and V recommendations based on MyPyramid caloric requirements and identify primary contributors to overall intake.Design: 2‐day 24 hour recall data (n=5,576) was examined from the nationally representative cross‐sectional 2003–04 National Health and Nutrition Examination Survey. All dietary sources were included.Results: 0.9% of adolescents and 2.9% of adults met their caloric specific recommendations for F and V. Increased recommendations due to increased caloric requirements were not paralleled by increases in consumption. Whole F were the primary contributors to adult intake, while F juices were the primary contributor to adolescent intake. The largest contributor to F intake was orange juice. Potatoes dominated V consumption, particularly among adolescents where fried potatoes accounted for over half the median intake. Dark green and orange V and legumes account for a small portion of V intake.Conclusions: Increasing consumption of F and V will require multifaceted approaches that augment educational campaigns with policy and environmental strategies aimed at the food system. Ultimately, the goal is to increase American's consumption of F and V by making the healthy choice the easy choice.

BACKGROUND:Increased away-from-home eating is associated with lower diet quality, and may contribute to the increasing prevalence of overweight and obesity. Healthier food choices in restaurants may help mitigate the rise in obesity and improve diet quality. This study sought to understand the views of executives at major U.S. restaurant chains regarding the process, motivation for, and challenges of offering healthier options on their menus.METHODS:The Healthy Menu Study used in-depth structured telephone interviews with 41 senior menu development and marketing executives at leading casual dining and fast-food restaurant chains. The interview guide covered menu trends, influences on introduction and continuation of new menu items, and barriers to adding healthy foods. Data analysis included tabulation of responses, identification of themes, and examination of subgroup differences.RESULTS:Growing sales and increasing profits are the most important considerations, mentioned by 61% of respondents; health and nutrition were noted as important by 21%. Restaurants may try to avoid losing groups with a "health seeker" by offering healthier foods (low in fat and calories, more fruits and vegetables) (27% of chains), but operators believe demand for healthier foods is not widespread. Additional obstacles to including healthier menu items are short shelf life of produce (46%), increased preparation time, low sales, and high labor costs.CONCLUSIONS:Not surprisingly, profit margins are the primary determinants of why restaurants do or do not add and continue to serve healthier food options. Without an increase in consumer demand, it is unlikely the restaurant industry will increase their offering of healthy food choices. Insight into the restaurant industry perspective is important for developing promising strategies to encourage healthier eating patterns.

Reducing caloric intake is the cornerstone of dietary therapy for long-term healthy weight management. Strategies individuals have typically used include limiting portion sizes, food groups, or certain macronutrients. Although such restrictive approaches can lead to weight loss in the short term, they can result in feelings of hunger or dissatisfaction, which can limit their acceptability, sustainability, and long-term effectiveness. An alternative positive strategy to manage energy intake is for individuals to eat more foods that are low in calories for a given measure of food—that is, they are low in energy density (kcal/g). Data have shown that people eat a fairly consistent amount of food on a day-to-day basis; therefore, the energy density of the foods an individual consumes influences energy intake. Encouraging patients to eat more foods low in energy density and to substitute these foods for those higher in energy density allows them to decrease their energy intake while eating sati sfying portions, thereby controlling hunger and lowering energy intake. This type of diet fi ts with the current Dietary Guidelines for Americans in that it incorporates high quantities of fruits, vegetables, and fiber, which are often suboptimal in typical low-calorie diets, and it provides ample intakes of numerous micronutrients. Moreover, studies have found that individuals who consume lower-energy-dense diets consume more food by weight and have lower body weights compared with individuals who consume higher-energy-dense diets. This chapter reviews the evidence supporting the use of diets rich in low-energy-dense foods for weight management and provides practical approaches to lowering the energy density of the diet.

Since 1990, Dietary Guidelines for Americans1U.S. Department of Health and Human ServicesU.S. Department of AgricultureDietary guidelines for Americans, 2005. 6th ed. U.S. Government Printing Office, Washington DC2005Google Scholar has recommended consuming at least two servings of fruits and three servings of vegetables daily. The 2005 release of the guidelines expanded the specificity of recommended intakes for individuals of different ages, genders, and levels of physical activity, increasing recommended fruit and vegetable intake for most of the population, and changed the recommendations to cups from servings. In this journal issue, two manuscripts provide estimates and describe trends in fruit and vegetable consumption in U.S. adults across a variety of race and demographic groups using National Health and Nutrition Examination Surveys (NHANES) data.2Kant A. Graubard B.I. Kumanyika S.K. Trends in black–white differentials in dietary intakes of U.S. adults, 1971–2002.Am J Prev Med. 2007; 32: 265-274Abstract Full Text Full Text PDF Scopus (114) Google Scholar, 3Casagrande S.S. Wang Y. Anderson C. Gary T.L. Have Americans increased their fruit and vegetable intake? The trends between 1988 and 2002.Am J Prev Med. 2007; 32: 257-264Abstract Full Text Full Text PDF PubMed Scopus (303) Google Scholar Their findings are similar to previous findings4Guenther P.M. Dodd K.W. Reedy J. Krebs-Smith S.M. Most Americans eat much less than recommended amounts of fruits and vegetables.J Am Diet Assoc. 2006; 106: 1371-1379Abstract Full Text Full Text PDF PubMed Scopus (484) Google Scholar, 5Patterson B.H. Block G. Rosenberger W.F. Pee D. Kahle L.L. Fruit and vegetables in the American diet: data from the NHANES II survey.Am J Public Health. 1990; 80: 1443-1449Crossref PubMed Scopus (234) Google Scholar and report that over time, the majority of U.S. adults continue to consume fewer than five servings of fruits and vegetables daily. This is a public health concern because consuming a diet high in fruits and vegetables is associated with a decreased risk of certain chronic diseases, such as cardiovascular disease, diabetes, and some cancers.6IARC Handbooks of Cancer Prevention.in: Fruits and vegetables. vol. 8. IARC Press, Lyon, France2003Google Scholar, 7Hung H.C. Joshipura K.J. Jiang R. et al.Fruit and vegetable intake and risk of major chronic disease.J Natl Cancer Inst. 2004; 96: 1577-1584Crossref PubMed Scopus (983) Google Scholar The NHANES I (1971–1975), II (1976–1980), III (1988–1994), and 1999–2002 are cross-sectional nationally representative surveys of the U.S. civilian, noninstitutionalized population that employ a complex, stratified, multistage probability cluster sampling design.8Centers for Disease Control and Prevention, National Center for Health Statistics. National health and nutrition examination survey. Hyattsville MD. Available at: www.cdc.gov/nchs/nhanes.htm.Google Scholar Dietary intake information is collected by a trained interviewer using a single 24-hour dietary recall. NHANES incorporates the most comprehensive approach for national dietary surveillance within the United States. These data are critical in their ability to track national dietary consumption patterns, as well as to provide key evidence to help form research directions aimed at improving dietary intake behaviors. Although other surveys exist for collecting national estimates of fruit and vegetable intake, NHANES is considered the most valid, because it uses a 24-hour dietary recall, considered the gold standard self-report, rather than a short fruit and vegetable screener. Previous behavioral intervention research has focused on increasing fruit and vegetable intake mostly through increasing knowledge and skills at the individual level with some environmental or policy components. Ammerman and colleagues9Ammerman A.S. Lindquist C.H. Lohr K.N. Hersey J. The efficacy of behavioral interventions to modify dietary fat and fruit and vegetable intake: a review of the evidence.Prev Med. 2002; 35: 25-41Crossref PubMed Scopus (358) Google Scholar found an average increase in fruit and vegetable consumption of 0.6 serving per day in an evidence-based review of the literature. Multicomponent school food environment interventions directed toward youth have been more successful increasing fruit consumption (0.2–0.6 servings daily) than vegetable consumption (0–0.3 servings daily).10French S.A. Stables G.J. Environmental interventions to promote vegetable and fruit consumption among youth in school settings.Prev Med. 2004; 36: 593-610Google Scholar Specifically with regard to particular settings, faith-based programs have had some success, as demonstrated by the original Black Churches United for Better Health11Campbell M.K. Demark-Wahnefried W. Symons M. et al.Fruit and vegetable consumption and prevention of cancer: the Black Churches United for Better Health Project.Am J Public Health. 1999; 89: 1390-1396Crossref PubMed Scopus (300) Google Scholar and Eat for Life12Resnicow K. Jackson A. Wang T. et al.A motivational interviewing intervention to increase fruit and vegetable intake through Black churches: results of the Eat for Life trial.Am J Public Health. 2001; 91: 1686-1693Crossref PubMed Scopus (394) Google Scholar interventions. These programs were merged into the Body and Soul Program that in an effectiveness trial showed up to a 1.4 serving difference in the change in fruit and vegetable consumption between treatment and control groups.13Resnicow K. Campbell M.K. Carr C. et al.Body and soul: a dietary intervention conducted through African-American churches.Am J Prev Med. 2004; 27: 97-105Abstract Full Text Full Text PDF PubMed Scopus (276) Google Scholar This successful program continues to be disseminated by the National Cancer Institute, African-American churches, and their partners across the United States.14National Cancer Institute, National Institutes of Health. Body and soul: a celebration of healthy eating and living. Available at: http://www.bodyandsoul.nih.gov/.Google Scholar More recent policy approaches such as the United States Department of Agriculture (USDA) Fruit and Vegetable Pilot Program15Buzby JC, Guthrie JF, Kantor LS. Evaluation of the USDA Fruit and Vegetable Pilot Program: report to Congress. Food Assistance and Nutrition Research Program, Food and Rural Economics Division, Economic Research Center, United States Department of Agriculture. Available at: http://www.fns.usda.gov/cnd/research/fv030063.pdf.Google Scholar hold promise for increasing fruit and vegetable consumption. The original project, to provide free fruits and vegetables to schoolchildren, was implemented in schools in four states and one Indian Tribal Organization (ITO). This project was made permanent in 2004 and in 2006 was expanded to 13 states and three ITOs. Increases in public awareness of the importance of and recommendations for fruit and vegetable consumption16Potter J.D. Finnegan J.R. Guinard J.-X. et al.5-A-Day for Better Health Program evaluation report (NIH Publication No. 01-4904). National Institutes of Health, National Cancer Institute, Bethesda MD2000Google Scholar, 17Stables G. Subar A.F. Patterson B.H. et al.Changes in fruit and vegetable consumption and awareness among U.S. adults: results of the 1991 and 1997 5-A-Day for better health program surveys.J Am Diet Assoc. 2002; 102: 809-817Abstract Full Text Full Text PDF PubMed Scopus (152) Google Scholar are yet to be accompanied by increased intake, demonstrating the need for a reinvigorated effort to promote fruit and vegetable consumption. On March 19, 2007, “Fruits & Veggies—More Matters” will be launched.18National Fruit and Vegetable Program. “Fruits & Veggies—More Matters.” Available at: http://www.fruitsandveggiesmatter.gov and http://www.fruitsandveggiesmorematters.org.Google Scholar This effort will build on the strong public–private partnership begun in 1991 by the 5-A-Day for Better Health Program. This program previously incorporated nutrition education and social marketing strategies to raise awareness of recommendations for fruit and vegetable consumption and sought to increase intake as well.19National Cancer Institute, National Institutes of Health5-A-Day for Better Health Program monograph (NIH Publication 01-5019). 2001Google Scholar Future research should evaluate which strategies are most effective for increasing fruit and vegetable consumption, with attention focused on environmental and policy activities that complement existing traditional education and communication strategies. Innovative programs to increase fruit and vegetable consumption such as community gardens, farmers markets, school gardens, farm-to-school, salad bars, policies for food provided at meetings, and access to supermarkets in low-income communities need to be evaluated to find best practices. A new call-to-action—such as “Fruits & Veggies—More Matters,” in combination with continued research at multiple levels as described above—is needed to first affect behavior and then help enable sustainable change. No financial conflict of interest was reported by the authors of this paper.

Objective This study investigated food choices made by individuals consuming diets differing in energy density and explores relationships between energy density and diet quality.Design Cross-sectional, nationally representative survey.Subjects 7,500 adults (older than 19 years) in the 1994-1996 Continuing Survey of Food Intakes by Individuals.Statistical analysis Energy density values were calculated from reported food intake. Subjects were classified as consuming a low-energy-density-diet, medium-energy-density diet, or high-energy-density diet using tertile cutoffs. For each group, the percentage consuming various foods/beverages and the mean amount of foods/beverages they consumed was determined along,with mean nutrient intakes.Results Compared with participants consuming a high-energy-density diet, those with a low-energy-density diet had a lower energy intake but consumed more food, by weight, from most food groups. A low-energy-density diet included a relatively high proportion of foods high in micronutrients and water and low in fat, such as fruits and vegetables. Subjects with a low-energy-density diet consumed fewer (nonwater) beverages such as caloric carbonated beverages. They also consumed less fat and had higher intakes of several important micronutrients, including vitamins A, C, and B-6, folate, iron, calcium, and potassium.Conclusions These analyses further demonstrate the beneficial effects of a low-energy-density diet, which was associated with lower energy intakes, higher food intakes, and higher diet quality than a high-energy-density diet. To achieve a low-energy-density diet, individuals should be encouraged to eat a variety of fruits and vegetables as well as low-fat/reduced-fat, nutrient-dense, and/or water-rich grains, dairy products, and meats/meat alternatives.

BACKGROUNDLaboratory-based investigations indicate that the consumption of foods with a low energy density (kcal/g) decreases energy intake. Although low-energy-dense diets are recommended for weight management, relations between energy density, energy intake, and weight status have not been clearly shown in free-living persons.OBJECTIVESA representative US sample was used to determine whether dietary energy density is associated with energy intake, the weight of food consumed, and body weight and to explore the influence of food choices (fruit, vegetable, and fat consumption) on energy density and body weight.DESIGNA cross-sectional survey of adults (n = 7356) from the 1994-1996 Continuing Survey of Food Intakes by Individuals and two 24-h dietary recalls were used.RESULTSMen and women with a low-energy-dense diet had lower energy intakes (approximately 425 and 275 kcal/d less, respectively) than did those with a high-energy-dense diet, even though they consumed more food (approximately 400 and 300 g/d more, respectively). Normal-weight persons had diets with a lower energy density than did obese persons. Persons with a high fruit and vegetable intake had the lowest energy density values and the lowest obesity prevalence.CONCLUSIONSAdults consuming a low-energy-dense diet are likely to consume more food (by weight) but to have a lower energy intake than do those consuming a higher-energy-dense diet. The energy density of a variety of dietary patterns, including higher-fat diets, can be lowered by adding fruit and vegetables. Our findings support the hypothesis that a relation exists between the consumption of an energy-dense diet and obesity and provide evidence of the importance of fruit and vegetable consumption for weight management.

Dietary energy density [kcal/g (kJ/g)] influences energy intake under controlled laboratory conditions. Little is known about the energy density of the diets of free-living persons. Because energy density investigations are a relatively new endeavor, there are neither standard calculation methods nor published nationally representative values. This paper examines the calculation of energy density based on systematic exclusion of beverage categories, presents data on variability, and compares values by sex, age, and race/ethnicity in a representative sample of U.S. adults. Mean daily dietary energy density values for adults (aged > 19 y) were calculated using two 24-h recalls from the Continuing Survey of Food Intakes by Individuals 1994-1996 based on food, food and liquid meal replacements, food and alcohol, food and juice, food and milk, food and juice and milk, food and energy-containing beverages, and food and all beverages. Energy density varied by calculation method, ranging from 0.94 to 1.85 kcal/g (3.93-7.74 kJ/g). Intraindividual-to-interindividual CV ratios were highest for the food and energy-containing beverages calculation. Men reported diets with a higher energy density than women for all calculation methods (P < 0.0001). There were differences by race/ethnicity and an inverse linear trend for age. These data indicate that beverage inclusion schemes should be clearly defined when reporting energy density values. In epidemiologic studies, calculations based on food and all beverages and food and energy-containing beverages may diminish associations with outcome variables. These nationally representative data, which provide an important frame of reference for other studies, indicate that dietary energy density differs by sex, age, and race/ethnicity.

Background. Nutrition interventions targeted to individuals are unlikely to significantly shift US dietary patterns as a whole. Environmental and policy interventions are more promising for shifting these patterns. We review interventions that influenced the environment through food availability, access, pricing, or information at the point-of-purchase in worksites, universities, grocery stores, and restaurants. Methods. Thirty-eight nutrition environmental intervention studies in adult populations, published between 1970 and June 2003, were reviewed and evaluated on quality of intervention design, methods, and description (e.g., sample size, randomization). No policy interventions that met inclusion criteria were found. Results. Many interventions were not thoroughly evaluated or lacked important evaluation information. Direct comparison of studies across settings was not possible, but available data suggest that worksite and university interventions have the most potential for success. Interventions in grocery stores appear to be the least effective. The dual concerns of health and taste of foods promoted were rarely considered. Sustainability of environmental change was never addressed. Conclusions. Interventions in “limited access” sites (i.e., where few other choices were available) had the greatest effect on food choices. Research is needed using consistent methods, better assessment tools, and longer durations; targeting diverse populations; and examining sustainability. Future interventions should influence access and availability, policies, and macroenvironments.

Objectives. We examined trends in fruit and vegetable consumption in the United States.Methods. A 6-item food frequency questionnaire was used to assess consumption among 434121 adults in 49 states and the District of Columbia who were sampled in random-digit-dialed telephone surveys administered in 1994, 1996, 1998, and 2000.Results. Although the geometric mean frequency of fruit and vegetable consumption declined slightly, the proportion of respondents consuming fruits and vegetables 5 or more times per day did not change. With the exception of the group aged 18 to 24 years, which experienced a 3-percentage-point increase, little change was seen among sociodemographic subgroups.Conclusions. Frequency of fruit and vegetable consumption changed little from 1994 to 2000. If increases are to be achieved, additional efforts and new strategies will be needed.

The Diet Quality Index (DQI) was developed to measure overall dietary patterns and to predict chronic disease risk. This study examined associations between DQI and short-term all-cause, all-circulatory-disease, and all-cancer mortality in the American Cancer Society Cancer Prevention Study II Nutrition Cohort, a cohort of US adults aged 50-79 years enrolled in a prospective study. After 4 years of follow-up (1992-1996), there were 869 deaths among 63,109 women and 1,736 deaths among 52,724 men. All study participants reported being disease free at baseline in 1992-1993. In age-adjusted Cox models, a higher DQI, which was indicative of a poorer quality diet, was positively related to all-cause and all-circulatory-disease mortality rates in both women and men and to cancer mortality in men only. However, in fully adjusted Cox models, only circulatory disease mortality was clearly positively related to DQI and only in women (medium-low-quality diet vs. highest-quality diet: rate ratio = 1.86, 95% confidence interval: 1.19, 2.89). Although trend tests indicated significant positive relations between DQI and all-cause mortality, effects were small (rate ratios = 1.31), and confidence intervals were wide, generally including 1.0. DQI was unrelated to cancer mortality. As currently constructed, the DQI may have limited ability to predict mortality.

Objective: Multivitamins contain several nutrients, including folic acid, which are hypothesized to reduce colon cancer risk. Previous epidemiologic studies have suggested that effects of multivitamins containing substantial amounts of folic acid (introduced in 1973) may not be evident until 15 or more years since first use. Methods: We examined the association between daily multivitamin use and colon cancer mortality among 806,397 US men and women in the Cancer Prevention Study II cohort who completed a questionnaire at enrollment in 1982 and were followed for mortality through 1998. Results: After multivariate adjustment, multivitamin use at enrollment showed little association with colon cancer mortality. After 15 years since first use of a multivitamin potentially containing folic acid, we observed slightly decreased risk of colon cancer mortality (rate ratio (RR) = 0.89, 95% confidence interval (CI) 0.80–0.99). Consistent with previous reports, this association was stronger among participants consuming two or more alcoholic drinks per day (RR = 0.71, 95% CI 0.56–0.91). Conclusion: Our results are consistent with a modest reduction in colon cancer mortality associated with use of folic acid-containing multivitamins among moderate to heavy alcohol users.