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Biomedical subjects

Diane C Mitchell

Publications and source records attributed to Diane C Mitchell.

At least 19 recordsLinked to original sources

Assessing the effect of underreporting energy intake on dietary patterns and weight status.

OBJECTIVES: To identify misreporting among older rural adults using a prediction algorithm and to compare dietary patterns of underreporters and plausible reporters. DESIGN: In this cross-sectional study, diet information was assessed by five 24-hour recalls collected over 10 months. All foods were classified into 24 food subgroups. Demographic, health, and anthropometric data were collected via home visit. SETTING: Rural Pennsylvania. SUBJECTS: One hundred seventy-nine community-dwelling adults, aged 66 to 87 years. STATISTICAL ANALYSIS: Cluster analysis. RESULTS: Underreporters (n=43) were more likely than plausible reporters (n=133) to be overweight and less educated but did not differ by sex. Underreporters consumed fewer servings across the majority of food groups. Two dietary patterns were determined for all and plausible reporters, in both cases one of higher and one of lower nutrient density. Using only plausible reporters to determine dietary patterns was very similar to using all reporters. The correlation between energy intake and weight status was improved for plausible-reporting women, but not men. CONCLUSIONS: Dietary patterns of plausible reporters were generally similar to that of all reporters; however, correlations with energy intake and weight status improved for women using only plausible reporters. Individuals may not accurately report dietary intake. Those obtaining diet reports should be aware of reporting errors before making decisions about dietary adequacy.

Aged↗

Dairy and dairy-related nutrient intake during middle childhood.

OBJECTIVE: To characterize patterns of dairy intake among girls in middle childhood. DESIGN: Longitudinal data were used to characterize girls' patterns of dairy intake at age 5, 7, 9, and 11 years. SUBJECTS: Participants were 151 girls from predominately middle-class and exclusively non-Hispanic white families living in central Pennsylvania. STATISTICAL ANALYSES: Intakes of dairy, energy, macronutrients, vitamin D, calcium, and phosphorus were assessed using three 24-hour dietary recalls in 151 non-Hispanic white girls at age 5, 7, 9, and 11 years. Analyses of changes over time were conducted using repeated measures analysis of variance. McNemar's chi(2) test was used to analyze change in percentage of dairy consumers over time. RESULTS: From age 5 to 11 years, girls' total dairy intake remained stable. Total milk consumption declined, due to a decline in intake of milk as a beverage, while intakes of cheese and dairy desserts increased. Much of the decline in milk intake from age 5 to 11 years, especially for milk as a beverage, was due to a reduction in the percentage of girls consuming milk as a beverage, not simply due to a decline in the servings of milk as a beverage consumed by consumers. On average, girls met vitamin D recommendations over time; however, by age 9 and 11 years girls failed to meet calcium and phosphorus recommendations. CONCLUSIONS: Although girls' dairy intake was stable over time, at age 7, 9, and 11 years girls did not meet the recommended three servings per day, leading to suboptimal intakes of calcium and phosphorus at age 9 and 11 years. Increasing milk intake among all children should continue to be a major focus of interventions.

Analysis of Variance↗

Comparative strategies for using cluster analysis to assess dietary patterns.

OBJECTIVES: To characterize dietary patterns using two different cluster analysis strategies. DESIGN: In this cross-sectional study, diet information was assessed by five 24-hour recalls collected over 10 months. All foods were classified into 24 food subgroups. Demographic, health, and anthropometric data were collected via home visit. SUBJECTS: One hundred seventy-nine community-dwelling adults, aged 66 to 87 years, in rural Pennsylvania. STATISTICAL ANALYSIS: Cluster analysis was performed. RESULTS: The methods differed in the food subgroups that clustered together. Both methods produced clusters that had significant differences in overall diet quality as assessed by Healthy Eating Index (HEI) scores. The clusters with higher HEI scores contained significantly higher amounts of most micronutrients. Both methods consistently clustered subgroups with high energy contribution (eg, fats and oils and dairy desserts) with a lower HEI score. Clusters resulting from the percent energy method were less likely to differentiate fruit and vegetable subgroups. The higher diet quality dietary pattern derived from the number of servings method resulted in more favorable weight status. CONCLUSIONS: Cluster analysis of food subgroups using two different methods on the same data yielded similarities and dissimilarities in dietary patterns. Dietary patterns characterized by the number of servings method of analysis provided stronger association with weight status and was more sensitive to fruit and vegetable intake with regard to a more healthful dietary pattern within this sample. Public health recommendations should evaluate the methodology used to derive dietary patterns.

Aged↗

Girls' dairy intake, energy intake, and weight status.

We explored the relationships among girls' weight status, dairy servings, and total energy intake. The hypothesis that consuming dairy could reduce risk for overweight was evaluated by comparing energy intake and weight status of girls who met or consumed less than the recommended three servings of dairy per day. Participants included 172 11-year-old non-Hispanic white girls, assessed cross-sectionally. Intakes of dairy, calcium, and energy were measured using three 24-hour recalls. Body mass index and body fat measures from dual-energy x-ray absorptiometry were obtained. Because preliminary analyses suggested systematic underreporting of energy intake, the relationships among dairy servings and measures of weight status were examined for the total sample and for subsamples of under-, plausible, and overreporters. Data for the total sample provided support for the hypothesized relationship among weight status, dairy servings, and energy intake. Thirty-nine percent of girls reported consuming the recommended >/=3 servings of dairy per day; these girls also reported higher energy intake but had lower body mass index z scores and body fat than the girls who consumed fewer than three dairy servings each day. Among plausible reporters, no relationship between dairy intake and weight status was noted. This discrepancy may be attributable to a high percentage (45%) of overweight underreporters in the total sample. Our findings reveal that reporting bias, resulting from the presence of a substantial proportion of underreporters of higher weight status, can contribute to obtaining spurious associations between dairy intake and weight status. These findings underscore the need for randomly controlled trials to assess the role of dairy in weight management.

Absorptiometry, Photon↗

Understanding reporting bias in the dietary recall data of 11-year-old girls.

OBJECTIVE: This study describes patterns of bias in self-reported dietary recall data of girls by examining differences among girls classified as under-reporters, plausible reporters, and over-reporters on weight, dietary patterns, and psychosocial characteristics. RESEARCH METHODS AND PROCEDURES: Participants included 176 girls at age 11 and their parents. Girls' weight and height were measured. Three 24-hour dietary recalls and responses to psychosocial measures were collected. Plausibility cut-offs for reported energy intake as a percentage of predicted energy requirements were used to divide the sample into under-reporters, plausible reporters, and over-reporters. Differences among these three groups on dietary and psychosocial variables were assessed to examine possible sources of bias in reporting. RESULTS: Using a +/-1 standard deviation cut-off for energy intake plausibility, 50% of the sample was categorized as plausible reporters, 34% as under-reporters, and 16% as over-reporters. Weight status of under-reporters was significantly higher than that of plausible reporters and over-reporters. With respect to reported dietary intake, under-reporters were no different from plausible reporters on intakes of foods with higher nutrient densities and lower energy densities and were significantly lower than plausible reporters on intakes of foods with lower nutrient densities and higher energy densities. Over-reporters reported significantly higher intakes of all food groups and the majority of subgroups, relative to plausible reporters. Under-reporters had significantly higher levels of weight concern and dietary restraint than both plausible reporters and over-reporters. DISCUSSION: Techniques to categorize plausible and implausible reporters can and should be used to provide an improved understanding of the nature of error in children's dietary intake data and account for this error in analysis and interpretation.

Adiposity↗

Girls' calcium intake is associated with bone mineral content during middle childhood.

We examined longitudinally the association between calcium intake and total body bone mineral content (TBBMC) in 151 non-Hispanic white girls. Intakes of dairy, energy, and calcium were assessed using three 24-h dietary recalls in girls at ages 5, 7, 9, and 11 y. We assessed their total-body bone mineral content with dual-energy X-ray absorptiometry at ages 9 and 11 y. Dairy foods comprised the major contributor (70%) to calcium intake over the 6-y period; 28% of calcium came from other foods, and 2% from supplements. By age 9 and 11 y, the majority of girls did not meet calcium recommendations. Higher calcium intake at ages 7 and 9 y was associated with higher TBBMC at age 11 y. Calcium intake at age 9 y was also positively associated with TBBMC gained from age 9 to 11 y. Calcium intake at age 11 y was not correlated with TBBMC at the same age. Relations between calcium intake and TBBMC did not differ for total calcium and for calcium from dairy sources, likely reflecting the fact that dairy products were the major source of calcium in this sample. Results from the present study provide new longitudinal evidence that calcium intake, especially calcium from dairy foods, can have a favorable effect on girls' TBBMC during middle childhood.

Adolescent↗

Beverage caffeine intakes in young children in Canada and the US.

PURPOSE: Throughout childhood there is a shift from predominantly milk-based beverage consumption to other types of beverages, including those containing caffeine. Although a variety of health effects in children and adults have been attributed to caffeine, few data exist on caffeine intake in children aged one to five years. METHODS: Because beverages provide about 80% of total caffeine consumed in children of this age group, beverage consumption patterns and caffeine intakes were evaluated from two beverage marketing surveys: the 2001 Canadian Facts study and the 1999 United States Share of Intake Panel study. RESULTS: Considerably fewer Canadian children than American children consume caffeinated beverages (36% versus 56%); Canadian children consume approximately half the amount of caffeine (7 versus 14 mg/day in American children). Differences were largely because of higher intakes of carbonated soft drinks in the US. CONCLUSIONS: Caffeine intakes from caffeinated beverages remain well within safe levels for consumption by young children.

Beverages↗

Dietary fiber intake by American preschoolers is associated with more nutrient-dense diets.

OBJECTIVE: To illustrate and discuss implications of the new Diet Reference Intakes for fiber, relative to a nationally representative sample of American preschoolers. DESIGN: Cross-sectional study using the Continuing Survey of Food Intake by Individuals 1994-1996, 1998. SUBJECTS: Children 2 through 5 years of age who provided 2 days of dietary intake data (N=5,437) were grouped and 2- and 3-year-olds (n=2,805) were compared with 4- and 5-year-olds. STATISTICAL ANALYSIS: Descriptive analysis (mean+/-standard error) was used to describe the sample and to rank children into quartiles of dietary fiber intake. Nonparametric test for trend was employed to examine significance level of observed changes in nutrient and food group consumption by increasing fiber intake quartiles. RESULTS: Main contributors to dietary fiber intakes were low-fiber fruits and legumes. Children in the high-fiber quartile consumed diets with higher nutrient and fiber density and increased number of servings of Food Guide Pyramid food groups. Many children in this population did not meet intake recommendations of "age plus five," and most lacked the 14 g/1,000 kcal of energy consumed, even after considering a hypothetical estimated average of 5 g/day functional fiber. CONCLUSIONS: Children would benefit from diets higher in fiber. Newly recommended intake levels are only met by a few and further studies need to be conducted to provide evidence for a recommended intake level of fiber in children. Average consumption of functional fiber in children has to be examined.

Age Distribution↗

Agricultural dust exposure and respiratory symptoms among California farm operators.

OBJECTIVE: To study whether dust exposure in California agriculture is a risk factor for respiratory symptoms. METHODS: A population-based survey of 1947 California farmers collected respiratory symptoms, occupational and personal exposures. Associations between dust and respiratory symptoms were assessed by logistic regression models. RESULTS: The prevalence of persistent wheeze was 8.6%, chronic bronchitis 3.8%, chronic cough 4.2%, and asthma 7.8%. Persistent wheeze was independently associated with dust in a dose-response fashion odds ratio, 1.2 (95% confidence interval[CI]=0.8-2.0) and 1.8 (95% CI=1.1-3.2) for low and high time in dust. A borderline significant association between chronic bronchitis and dust exposure was found. Asthma was associated with keeping livestock, but not with dust exposure. CONCLUSIONS: Occupational dust exposure among California farmers, only one third of whom tended animals, was independently associated with chronic respiratory symptoms.

Agricultural Workers' Diseases↗

The quality of girls' diets declines and tracks across middle childhood.

BACKGROUND: Food group intakes by US children are below recommendations and micronutrient inadequacies have been reported. There are few longitudinal data that focus on developmental changes in food and nutrient intake from early to middle childhood. We examined changes in nutrient and food group intakes over time and the tracking of intakes across middle childhood in a longitudinal sample of girls. METHODS: Three multiple-pass 24-hour diet recalls were conducted in a sample of 181 non-Hispanic White girls at ages 5, 7, and 9 years. Food and nutrient data were averaged across 3 days. Analyses of time effects were conducted using repeated measures analysis of variance and tracking of intakes was assessed via rank analysis. RESULTS: We found significant decreases in nutrient densities (intakes per 1000 kcal) of vitamins C and D, calcium, phosphorus, magnesium and zinc at age 9. Girls maintained their relative quartile positions for these micronutrients from ages 5-9. Analysis of food group data showed similar trends. At age 9, significantly fewer girls were meeting the recommendations for dairy, fruit and vegetable servings than at age 5 and girls also tended to remain in their respective quartiles over time, especially for fruit and dairy intakes. CONCLUSIONS: These results highlight the importance of developing healthy eating practices during early childhood when caretakers have considerable control over children's food intake.

Journal Article↗

Dietary patterns in women treated for breast cancer who successfully reduce fat intake: the Women's Intervention Nutrition Study (WINS).

OBJECTIVE: The objectives of this study were to assess the types of dietary changes made by women who successfully reduced their fat intake in response to low-fat diet instruction and to evaluate the effects of these changes on nutrient intake. DESIGN: Two hundred women enrolled in the low-fat intervention arm of the Women's Intervention Nutrition Study (WINS) were randomly selected. Woman whose baseline fat intake was less than 20% energy from fat were excluded from the study, resulting in a total population of 163. These women were categorized into either the strictly adherent (SA) (those who met their fat gram goal and reported less than 20 % calories from fat, n=50) or the not strictly adherent (NSA) (those who exceeded their fat gram goal and reported 20% or greater calories from fat, n=113) group. The food choices made by SA and NSA subjects were analyzed to identify those that promoted greater adherence. SUBJECTS/SETTING: The participants were free-living women who had been instructed to follow a diet that would meet a specific fat gram goal calculated to provide 15% of calories from fat. STATISTICAL ANALYSES PERFORMED: Descriptive statistics were used to describe food groups and subgroups. t tests were used to determine statistical significance between and within groups. chi(2) analysis was used to assess differences in demographic variables. RESULTS: There were no marked differences in food patterns of the SA and NSA subjects when compared with the Food Guide Pyramid (FGP) recommendations. Both met FGP serving recommendations at baseline. At 12 months, both showed reductions in the number of servings from fats and oils; SA subjects showed a greater reduction (from 4.18+/-3.6 to 3.0+/-2.4) as well as a reduction in servings from the bread group intake (5.7+/-2.2 to 4.8+/-2.1). Evaluation of food subgroups from within FGP groups showed strategies that promoted fat reduction, such as reducing portion sizes of high-fat foods. The use of these strategies was greater in the SA subjects. The reduction in fat intake had little impact on nutrient adequacy. SA and NSA subjects reduced energy intake from baseline to follow-up, with SA subjects reporting lower intakes. There were few differences in nutrient intakes between the SA and NSA subjects at either time period. CONCLUSIONS: The results from this study suggest specific strategies that promote successful reduction in fat intake without compromising nutrient intake. This information can be used to guide others in making dietary changes.

Adult↗

Portion size of common foods predicts energy intake among preschool-aged children.

This study evaluated the relationship of food intake behaviors to total energy intake among children aged 2 to 5 years old (N=5447) who participated in the Continuing Survey of Food Intakes by Individuals, 1994-1996, 1998 (CSFII 94-96, 98). Food intake behaviors examined were portion size for 10 commonly eaten foods, number of eating occasions per day, and number of foods consumed per day. Using regression models, we examined these eating behaviors as predictors of energy intakes with adjustment for body weight. Eating behaviors and body weight were positively related to energy intake, together explaining 38% to 39% of the variability. Portion size alone accounted for 17% to 19% of the variance in energy intake, whereas body weight predicted only 4%. Feeding recommendations should highlight the importance of age-appropriate portion sizes and provide guidance on the frequency of eating and number of foods consumed.

Age Factors↗

Persistent oral health problems associated with comorbidity and impaired diet quality in older adults.

Chewing, swallowing, and mouth pain (CSP) are identified as indicators of nutritional risk in older adults. Previous research has shown that oral health problems in community-living older rural adults were associated with increased hospitalization. The purpose of this study was to characterize older adults with self-reported persistent CSP problems at baseline and one-year follow-up. Participants were from the Geisinger Rural Aging Study, either with persistent oral problems (PCSP; n=22) or without problems (NCSP; n=125). Demographic, health, and anthropometric data were collected via home visit; diet information was assessed by five, 24-hour recalls collected over 10 months. PCSP subjects reported almost twice the number of medications (4.2 vs 2.6, respectively, P=.008) and diseases (7.0 vs 4.2, respectively, P=.001), with higher occurrence of type 2 diabetes mellitus, peptic ulcers/gastritis, and angina. PCSP participants had lower Healthy Eating Index scores (66.6 vs 70.6, respectively, P=.04), significantly lower intakes of vitamin A, and higher prevalence of inadequate intakes of vitamins B-6 and A. These results indicate that impaired intake of certain foods and nutrients is associated with persistent oral health problems. Oral status is an important component of overall health and should be monitored for intervention.

Aged↗

More favorable dietary patterns are associated with lower glycemic load in older adults.

OBJECTIVE: Glycemic load represents the total glycemic effect of the diet and may reduce the risk for chronic disease by affecting the risk for obesity and by altering metabolic endpoints. The food choices associated with lower-glycemic-load diets have received little investigation. Therefore, the purpose of this research was to examine the food patterns associated with lower-glycemic-load diets to establish targeted intervention messages. SUBJECTS/SETTING: A random sample (n=179; 81 male and 98 female subjects) of older adults > or =65 years of age in the Geisinger Rural Aging study, a nutritional risk screening study. METHODS: Standardized methodology was used to calculate the glycemic load from data obtained in five 24-hour recalls. Statistical analysis t tests compared dietary patterns between male and female subjects from two eating pattern clusters identified in previous cluster analysis based on food group intake. RESULTS: The mean (+/-standard deviation) glycemic load for the entire sample was 115.6 (+/-39.9). Two clusters were identified, and male and female subjects in one cluster had a lower glycemic load (113.7+/-44.2 and 94.0+/-27.5, respectively) than male and female subjects in the second cluster (139.9+/-38.8 and 110.7+/-35.9, respectively) ( P <.01). Participants in the lower-glycemic-load cluster consumed more carbohydrate from cereal, fruits, vegetables, and milk, whereas those in the higher-glycemic-load cluster consumed more breads and desserts. CONCLUSIONS: Promoting appropriate portions of nutrient-dense carbohydrate foods, particularly whole grain, fruits, vegetables, and dairy foods, may offer reasonable guidance for lowering the glycemic load of the diet among older adults. A lower-glycemic-load diet may reduce the risk for obesity and many chronic diseases.

Aged↗

Hypertension-related dietary patterns of rural older adults.

BACKGROUND: Prevalence of hypertension is greater in older adults, and increased intake of fruits, vegetables, and dairy-good sources of potassium, calcium, and magnesium-can reduce blood pressure. This study examined the hypertension-related dietary patterns of older adults. METHODS: A cohort of 180 Pennsylvania adults (aged >/=65), 90 with hypertension, were randomly selected from the Geisinger Rural Aging Study (GRAS). Data were collected by trained interviewers at a home visit. Dietary assessment used five 24-h recalls. We compared the characteristics and dietary intake of people with hypertension to those without hypertension and compared their intakes to current recommendations. RESULTS: Mean intakes of all participants were less than two thirds of the DRI for calcium and magnesium and fell far short of the 3,500 mg of potassium recommended for prevention and treatment of hypertension. Participants with hypertension consumed less sodium than controls. Both groups ate fewer fruits and vegetables than recommended but reached the dairy recommendation. Calcium intake was mainly from high-fat dairy products, beans were the top source of potassium and magnesium. CONCLUSIONS: Older adults with hypertension should be guided to choose more low-fat dairy products and other low-fat calcium sources and to increase intakes of beans, dark green leafy vegetables, and other potassium and magnesium sources.

Aged↗

Meeting calcium recommendations during middle childhood reflects mother-daughter beverage choices and predicts bone mineral status.

BACKGROUND: Longitudinal data regarding the influence of beverage intakes on calcium adequacy are lacking. OBJECTIVE: This study evaluated calcium intake from ages 5 to 9 y as a function of mother-daughter beverage choices and as a predictor of bone mineral status. DESIGN: Intakes of energy, calcium, milk, sweetened beverages, fruit juices, and non-energy-containing beverages were measured with the use of three 24-h dietary recalls in 192 non-Hispanic white girls aged 5, 7, and 9 y and their mothers. Calcium intakes from ages 5 to 9 y were categorized as either meeting or falling below recommended adequate intakes (AIs). The girls' bone mineral status was assessed with dual-energy X-ray absorptiometry at age 9 y. RESULTS: The mean 5-y calcium intake was related to bone mineral density at age 9 y (beta = 0.27, P < 0.001). The girls who met the AI for calcium were not heavier (P = 0.83) but had higher energy intakes (P < 0.0001) than did the girls who consumed less than the AI. Compared with the girls who consumed less than the AI, the girls who met the AI consumed, on average, almost twice as much milk (P < 0.0001), had smaller decreases in milk intake (P < 0.01), and consumed 18% less sweetened beverages (P < 0.01) from ages 5 to 9 y; the 2 groups did not differ significantly in juice and non-energy-containing beverage intakes. The girls who met the AI were also served milk more frequently than were the girls who consumed less than the AI (P < 0.0001) and had mothers who drank milk more frequently (P < 0.01) than did the mothers of the girls who consumed less than the AI. CONCLUSIONS: These findings provide new longitudinal evidence that calcium intake predicts bone mineral status during middle childhood and reflects mother-daughter beverage choice patterns that are established well before the rapid growth and bone mineralization observed in adolescence.

Animals↗

Dietary patterns of rural older adults are associated with weight and nutritional status.

OBJECTIVES: To characterize dietary patterns of rural older adults and relate patterns to weight and nutritional status. DESIGN: Cross-sectional. SETTING: Rural Pennsylvania. PARTICIPANTS: One hundred seventy-nine community-dwelling adults aged 66 to 87 years. MEASUREMENTS: A home visit was conducted to collect demographic, health behavior, and anthropometric data and a blood sample. Five 24-hour dietary recall were administered. Cluster analysis classified participants into dietary patterns using food subgroup servings. Chi-square, analysis of covariance, and logistic regression were used to assess differences across clusters. RESULTS: A low-nutrient-dense cluster (n=107), with higher intake of breads, sweet breads/desserts, dairy desserts, processed meats, eggs, and fats/oils, and a high-nutrient-dense cluster (n=72) with higher intake of cereals, dark green/yellow vegetables, other vegetables, citrus/melons/berries, fruit juices, other fruits, milks, poultry, fish, and beans, were identified. Those in the high-nutrient-dense cluster had lower energy intake; higher energy-adjusted intake of fiber, iron, zinc, folate, and vitamins B(6), B(12), and D; higher Healthy Eating Index scores; higher plasma vitamin B(12) levels; and a lower waist circumference. Those with a low-nutrient-dense dietary pattern were twice as likely to be obese, twice as likely to have low plasma vitamin B(12) levels, and three to 17 times more likely to have low nutrient intake. CONCLUSION: This study provides support for recommending a high-nutrient-dense dietary pattern for older adults. Behavioral interventions encouraging diets characterized by high-nutrient-dense foods may improve weight and nutritional status of older adults.

Aged↗

Relative validity of food frequency questionnaire nutrient estimates in the Black Women's Health Study.

PURPOSE: The Black Women's Health Study (BWHS) was designed to investigate determinants of health and disease in US black women. More than 64,000 women are enrolled in the BWHS cohort. This study assessed the relative validity of the 68-item food frequency questionnaire (FFQ) used in the BWHS baseline questionnaire. METHODS: Four hundred and eight BWHS enrollees were asked to provide three telephone, 24-hour recalls and one written 3-day food diary over a one-year period. Means and Pearson correlations were computed to compare estimates for energy, total fat, saturated fat, protein, carbohydrate, dietary fiber, calcium, iron, vitamin C, folate, beta-carotene, and vitamin E from the FFQ, recalls, and diaries. RESULTS: Mean energy intake (kcal) was higher for the diary (1716) than the FFQ (1601) or recalls (1510). Other nutrient estimates (% kcal or per 1000 kcal) were similar across methods, except beta-carotene (FFQ higher). Correlations (energy-adjusted, except for energy, and corrected for intraperson variation) between the FFQ and the recalls were higher than for the diary data and were between 0.5 and 0.8, except for energy and vitamin E (both <0.3). CONCLUSION: The BWHS FFQ will support meaningful analyses of diet-health associations for 10 of the 11 energy-adjusted nutrient intake variables analyzed.

Adult↗