Trends in use of vitamin and mineral supplements in the United State: the 1987 and 1992 National Health Interview Surveys.
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Biomedical subjects
A F Subar
Publications and source records attributed to A F Subar.
Zinc intake and sources in the US adult population: 1976-1980.
OBJECTIVE: To determine levels of intake and food sources of zinc in 1976-80 in US adults between the ages of 19 and 74. METHODS: Dietary data from 24-hour recalls collected in the Second National Health and Nutrition Examination Survey were analyzed. Levels of zinc intake were compared between demographic subgroups using analysis of variance. The contribution of individual foods to overall zinc consumed was also estimated. RESULTS: Mean daily intakes (+/- SEM) were 15.5 mg +/- 0.4 and 9.8 mg +/- 0.2 in white men and women, respectively. Mean daily intake estimates in black men and women (12.3 mg +/- 0.8 and 7.8 mg +/- 0.3, respectively) were significantly lower. Lower intakes were observed in women versus men, in older (65 to 74 years) versus younger (19 to 34 years) age groups, and among people with lower versus higher education and income levels. Lower zinc intakes in women and older persons could be mainly attributed to lower overall energy intake compared with gender and age counterparts. However, lower intakes in blacks and persons with lower education or income levels were not explained by differences in energy intake and may be attributed to differences in food selections. Meat and milk products contributed the majority of zinc in recalled diets, accounting for 56 and 60% of total zinc intake in blacks and whites, respectively. CONCLUSIONS: Levels and sources of zinc intake in 1976-80 were higher than in more recent national surveys, suggesting that zinc intakes may be declining. Population groups more likely to have lower intakes were women, older adults, blacks, and those with lower levels of education and higher poverty levels.
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US adults' fruit and vegetable intakes, 1989 to 1991: a revised baseline for the Healthy People 2000 objective.
OBJECTIVES: This study provides revised baseline data for the Healthy People 2000 objective related to fruit and vegetable intakes, accounting for fruits and vegetable intakes, accounting for fruits and vegetables from all sources and measuring servings in a manner consistent with current dietary guidance. METHODS: Dietary data from 8181 adults in the US Department of Agriculture's 1989-1991 Continuing Surveys of Food Intakes by Individuals were examined. All foods were disaggregated into their component ingredients; all fruit and vegetable ingredients were assigned specific weights to correspond to a serving as defined by current dietary guidance materials; and the number of servings was tallied. RESULTS: While mean intakes of fruits and vegetables--4.3 servings per day--were not far from the Year 2000 objective, only 32% of American adults' intakes met the objective. When more stringent standards were set either to compensate for higher calorie levels or to achieve the balance between fruits and vegetables suggested in current guidance, only 24% and 12%, respectively, met the recommendations. CONCLUSIONS: These results suggest a need to develop strategies for overcoming barriers to eating fruits and vegetables.
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Fruit and vegetable intake among adults in 16 states: results of a brief telephone survey.
A brief food frequency questionnaire was used to assess daily fruit and vegetable consumption among 23,699 adults in 16 US states sampled in a random-digit dialing telephone survey. Men consumed fewer servings per day (3.3) than did women (3.7). Only 20% of the population consumed the recommended 5 or more daily servings. Intakes varied somewhat by state and were lower among the young and the less educated. Efforts are needed to improve fruit and vegetable consumption among all Americans, especially younger adults and those with lower levels of education.
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Differences in reported food frequency by season of questionnaire administration: the 1987 National Health Interview Survey.
We assessed seasonal reporting bias in a 59-item food frequency questionnaire (FFQ) administered throughout 1 year using data from the 1987 National Health Interview Survey (N = 20,143 adults). Few meaningful differences were found in the proportion of individuals reporting rarely or never consuming a food by season of questionnaire administration. Seasonal reporting bias is evident in FFQs, however, and appears to be due to reporting most recent consumption. Using gender-specific median servings per week, an analysis using logistic regression showed that the estimated proportion of individuals reporting food intake at greater than the yearly median differed between any two seasons by at least 5% of the population for 22 foods. We compared gender-specific quintiles of selected nutrients/food groups for the whole year and each season; these showed that quintile assignment never varied by more than one adjacent quintile. The most frequent shift in quintile assignment, involving as many as 18.5% of women in the summer, occurred for citrus fruits. The intake biases are small and do not greatly affect population estimates if the FFQ is administered in all seasons, but they may somewhat affect classification of individuals into quantiles for some foods/nutrients.
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US dietary patterns associated with fat intake: the 1987 National Health Interview Survey.
OBJECTIVES: This research used food frequency data to investigate dietary patterns associated with fat intake. METHODS: Data from the 1987 National Health Interview Survey of 20,143 adults were used to determine correlations between fat (adjusted for kilocalories) and both nutrient and food group intakes. Median food and nutrient intakes were determined within quartiles of percentage of kilocalories from fat. RESULTS: Intakes of vegetables, fruits, cereals, fish/chicken, low-fat milk, alcoholic beverages, vitamin C, percentage of kilocalories from carbohydrates, carotenoids, folate, dietary fiber, carbohydrates, and vitamin A decreased as percentage of kilocalories from fat increased. Intakes of salty snacks, peanuts, processed and red meats, whole milk and cheese, desserts, eggs, fried potatoes, table fats, cholesterol, vitamin E, sodium, protein, and energy increased with percentage of kilocalories from fat. Results by demographic subgroups showed few differences from those found in the total population. CONCLUSIONS: Fat intake is consistently associated with specific dietary patterns. Such patterns need to be evaluated concurrently in studies of diet and chronic disease.
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Nutrient and food group intake by tobacco use status: the 1987 National Health Interview Survey.
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Adult↗
Dietary patterns associated with a low-fat diet in the national health examination follow-up study: identification of potential confounders for epidemiologic analyses.
To identify systematically the nutrient and food group intakes associated with a low-fat diet, the authors used the detailed dietary information collected from 10,306 individuals aged 32-86 years in the 1982-1984 National Health Epidemiologic Follow-up Study. Intakes of vitamin C and percentages of calories from carbohydrates, dietary fiber, poultry, low-fat dairy products, fruits, vegetables, cereals, and whole grains were markedly higher, while intakes of protein, total fat, saturated fat, oleic and linoleic acids, cholesterol, sodium, all red meats, high-fat dairy products, eggs, nuts, white bread, fried potatoes, desserts, fats, and oils were much lower in the quartile with the lowest percentage of calories from fat. These dietary patterns associated with a low-fat diet were essentially constant across strata of age, sex, race, and socioeconomic status. This study suggests that individuals on a low-fat diet substitute certain carbohydrate-rich foods such as fruits and vegetables for fat. Given these associations between low-fat diets and other dietary factors independently associated with certain cancers, these dietary factors should be considered potential confounders in studies of dietary fat and these cancers.
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Does beta-carotene explain why reduced cancer risk is associated with vegetable and fruit intake?
Increased intake of vegetables, fruits, and carotenoids and elevated blood levels of beta-carotene are consistently associated with reduced risk of lung cancer in epidemiologic studies. Epidemiologic research also suggests that carotenoids may reduce the risk of other cancers, although the evidence is less extensive and consistent. The simplest explanation is that beta-carotene is protective. However, the possible roles of other carotenoids, other constituents of vegetables and fruits, and associated dietary patterns have not been adequately explored. To evaluate these alternative hypotheses, we are undertaking three lines of research. (a) With dietary data from the 1987 National Health Interview Survey and the 1982-1984 Epidemiologic Follow-up of the first National Health and Nutrition Examination Study, we have determined which food groups and nutrients are highly correlated with vegetable and fruit intake. (b) We have developed and characterized a liquid chromatography method for optimal recovery and resolution of the common carotenoids in blood, specifically lutein, zeaxanthin, beta-cryptoxanthin, lycopene, alpha-carotene, and beta-carotene. (c) In a population-based case-control study of lung cancer in white men in New Jersey, we are assessing whether estimates of the intake of the individual carotenoids might produce stronger inverse associations than estimates of provitamin A carotenoids based on current food composition tables.
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Nutrition and cancer prevention knowledge, beliefs, attitudes, and practices: the 1987 National Health Interview Survey.
This article examines the nutrition and cancer prevention knowledge, beliefs, attitudes, and self-reported dietary changes of a US national probability sample. The data were drawn from the Cancer Control Supplement of the 1987 National Health Interview Survey, which was answered by 22,043 adults. Thirty-five percent of the sample reported that they had made dietary changes in the past 1 to 5 years for health reasons. Respondents reported eating more vegetables, fruit, lower-fat meats, and whole grains/fiber and less high-fat meats, fats, sweets/snacks, salty foods, refined grain products, alcohol, and dairy products. Those who did not make any dietary changes most often said the reason was that they enjoyed the food they were presently eating and did not want to make any changes. More than 90% of the sample agreed that diet and disease were related and 73% knew that diet and cancer were related, yet 44% believed there was nothing a person could do to reduce the risk of getting cancer or didn't know what could be done. In response to open-ended questions about foods that either increase or decrease cancer risk, vegetables, whole grains/fiber, fruit, and lower-fat meats were thought to decrease risk, and high-fat meats, fats, alcohol, sweets/snacks, and additives were thought to increase cancer risk. We found education and income levels to be the major demographic variables that have an impact on cancer prevention knowledge, attitudes, and beliefs. People with lower incomes and at lower educational levels should be targeted for education about cancer risk reduction.
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Estimates of nutrient intake from a food frequency questionnaire: the 1987 National Health Interview Survey.
Nutrient intake data are reported from a 60-item food frequency questionnaire administered in the 1987 National Health Interview Survey to a representative sample of US adults 18 to 99 years of age (n = 22,080). These data provide for the first time an estimate of the distribution of usual nutrient intakes in a national probability sample. For several nutrients, 10% to 25% of respondents may habitually consume substantially less than the Recommended Dietary Allowance, despite apparently adequate group means. Hispanics reported higher energy and carbohydrate intakes and a lower percentage of energy from fat than blacks or whites (35.6%, 38.4%, and 38.7% of energy from fat for Hispanics, blacks, and whites, respectively.) Whites had lower cholesterol intake than the other two groups, and blacks had a higher intake of sweets. Alcohol intake was lower among women and persons older than 65 years, but no other differences in alcohol intake emerged. Use of adjustment factors improved nutrient intake estimates from this shortened questionnaire to levels similar to those obtained from other national dietary surveys. The nutrient intake data from this research can be used to compare demographic subgroups and to describe the mean and distribution of nutrient intake. Furthermore, this research provides national reference data to investigators who use this or related questionnaires in nutrition research.
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Vitamin E intakes and sources in the United States.
Twenty-four-hour-recall data from 11,658 adults interviewed in the Second National Health and Nutrition Examination Survey (NHANES II) were used to estimate intakes of vitamin E and polyunsaturated fatty acids (PUFAs) in the United States. Although mean intakes of vitamin E were close to the recommended dietary allowance for both men and women (9.6 and 7.0 mg/d, respectively), median intakes were considerably lower (7.3 and 5.4 mg/d). If a ratio of vitamin E to PUFAs of greater than or equal to 0.4 is considered desirable, 23% of men and 15% of women had diets with low ratios. Ratios tended to decrease as PUFAs in the diet increased. The fruits-and-vegetables group and the fats-and-oils group each provided 20% of the vitamin E in the US diet. Increasing food choices from the fruits-and-vegetables group would provide low-fat sources of vitamin E for individuals whose intakes are likely to be inadequate.
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Use of vitamin and mineral supplements: demographics and amounts of nutrients consumed. The 1987 Health Interview Survey.
Data from the 1987 National Health Interview Survey show that 51.1% of the adults aged 18-99 years in the United States consumed a vitamin/mineral supplement in the past year, but that only 23.1% did so daily. Whites, women, and older individuals were more likely than blacks, men, and younger individuals to consume supplements regularly. Multivitamins were the most commonly consumed supplement, followed by vitamin C, calcium, vitamin E, and vitamin A. Results suggest that supplementation practices have changed little since the 1970s. Results regarding the amounts of nutrients obtained from supplements show that a food frequency type of methodology collects reasonably accurate data reflecting intake of supplements over the past year. Few, if any, individuals were consuming nutrients in amounts considered toxic. Although vitamin and mineral supplementation is a common health habit, it appears not to pose a significant health risk for most of the population.
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Food and nutrient intake differences between smokers and non-smokers in the US.
Data from the Second National Health and Nutrition Examination Survey were analyzed to determine food and nutrient intake differences between current smokers (also categorized as light, moderate, and heavy smokers) and non-smokers. Smokers in several age-race-sex categories have lower intakes of vitamin C, folate, fiber, and vitamin A than non-smokers, and intake tended to decrease as cigarette consumption increased, particularly for vitamin C, fiber, and folate. Smokers were less likely to have consumed vegetables, fruits (particularly fruits and vegetables high in vitamins C and A), high fiber grains, low fat milk, and vitamin and mineral supplements than non-smokers. A negative linear trend was found between smoking intensity and intake of several categories of fruits and vegetables. These data suggest that the high cancer risk associated with smoking is compounded by somewhat lower intake of nutrients and foods which are thought to be cancer protective.
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Folate intake and food sources in the US population.
Dietary data from 24-h recalls collected in the Second National Health and Nutrition Examination Survey (NHANES II) were analyzed to determine intake and food sources of folate in US adults between ages 19 and 74 y. Mean daily folate intake was 242 +/- 2.8 micrograms (means +/- SEM) for all adults, 281 +/- 3.6 micrograms for males, and 207 +/- 2.9 micrograms for females. Daily intake per 1000 kcal was 130 +/- 1.3 micrograms for all adults 122 +/- 1.3 micrograms for males, and 137 +/- 1.7 micrograms for females. Based on the Recommended Dietary Allowance of 400 micrograms/d, our results suggest that folate intake in the United States is low, particularly among women and blacks. Intake by age, education, and poverty index is discussed. Orange juice, white breads, dried beans, green salad, and ready-to-eat breakfast cereals are the major food sources of folate on a given day, contributing 37% of total folate intake.
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The contribution of enrichment and fortification to nutrient intake of women.
A volunteer group of 162 women aged 25 to 49 years was recruited from three suburban supermarkets in central New York state. The women completed 3-day food records, which were analyzed for total nutrient intake and contribution of eight nutrients from three sources: (a) nutrients naturally present in food, (b) enriched/fortified foods with a standard of identity (FF + SI), and (c) fortified foods without standards of identity (FF-SI). Subjects were placed into study groups of high-, moderate-, and low-fortifiers on the basis of frequency of intake of highly fortified foods (FF-SI) which, unlike FF + SI, are not staple foods and may represent selective dietary nutrient addition by the consumer. For all groups, mean intakes of riboflavin, niacin, and vitamins A and C were greater than 100% of the RDAs without nutrient addition. Mean thiamin intake met the RDA only when the nutrient addition from FF + SI was included. Mean intakes of iron, calcium, and vitamin D were all below the RDA even when all sources of intake were included. No significant differences between study groups were found for total nutrient intake. With the exceptions of vitamin C, vitamin D, and calcium, high- and moderate-fortifiers had significantly greater (p less than .01) nutrient intake from fortification. Low-fortifiers had significantly greater (p less than .05) intake from naturally occurring vitamins A and C than high-fortifiers.
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Psychosocial factors associated with fruit and vegetable consumption.
PURPOSE: This study examined the relationship between various psychosocial factors and fruit and vegetable consumption. DESIGN: The 5 A Day Baseline Survey, conducted in August 1991, just before the initiation of the 5 A Day for Better Health Program, obtained data on adults' intakes of, and their knowledge, perceptions, and attitudes regarding, fruits and vegetables. SETTING: The survey was conducted by telephone. SUBJECTS: Subjects were 2811 adults (response rate, 43%) aged 18 years and older in the 48 coterminous United States. MEASURES: Fruit and vegetable intake was measured as self-reported frequency of use; most of the psychosocial variables were measured using Likert scales. RESULTS: This study estimates that only 8% of American adults thought that five or more servings of fruits and vegetables were needed for good health. Of the factors studied, the most important in determining someone's fruit and vegetable intake were the number of servings they thought they should have in a day, whether they liked the taste, and whether they had been in the habit of eating many fruits and vegetables since childhood. These few factors accounted for 15% more of the variation in fruit and vegetable consumption than did demographic variables alone (8%). CONCLUSIONS: Nutrition education should stress the need to eat five or more servings of fruits and vegetables per day because few adults are aware of this recommendation and such knowledge is strongly associated with increased intake. Furthermore, efforts to increase the palatability of fruits and vegetables, especially among children, should be promoted.
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Association of awareness, intrapersonal and interpersonal factors, and stage of dietary change with fruit and vegetable consumption: a national survey.
PURPOSE: To examine associations of awareness, intrapersonal and interpersonal factors, and stage of change with consumption of fruits and vegetables. DESIGN: Nationally representative, random digit dial survey conducted in 1997 with a response rate of 44.5%. Psychosocial correlates of fruit and vegetable consumption were assessed using regression analyses. SETTING: United States. SUBJECTS: A total of 2605 adults who were 18 years and older. MEASURES: Awareness of the "5 A Day for Better Health" program and its message, along with stage of change; taste preferences; self-efficacy; and perceived benefits, barriers, threats, social support, and norms related to fruit and vegetable consumption. RESULTS: Awareness and intrapersonal and interpersonal factors explained 24% of the variance in fruit and vegetable consumption beyond the 9% explained by demographic characteristics. Knowledge of the 5 A Day message was associated with a 22% increase in fruit and vegetable consumption. Self-efficacy for eating fruits and vegetables and taste preferences (affect) were the factors most consistently and strongly associated with both higher consumption and higher likelihood of being in action or maintenance stages of change. Affect and perceived barriers were more strongly associated with increased vegetables and salad than fruit. CONCLUSIONS: Dietary intervention programs to increase fruit and vegetable consumption should emphasize the 5 A Day message, increased self-efficacy, and ways to make vegetables more palatable and easily accessible. Understanding the factors that influence dietary choices should be used when designing dietary interventions.
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