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PubMed2007

Multivitamin-multimineral supplements' effect on total nutrient intake.

Use of multivitamin-multimineral supplements is widespread and can contribute substantially to total nutrient intakes. In the Hawaii-Los Angeles Multiethnic Cohort (MEC), 48% of men and 56% of women without chronic diseases reported use of multivitamin supplements at least weekly over the past year. We calculated the prevalence of nutrient adequacy for 17 nutrients based on responses to a self-administered quantitative food-frequency questionnaire administered to MEC participants at baseline in 1993-1996. Although the prevalence of nutrient adequacy from food only was higher for multivitamin supplement users (n = 21,056) than for nonusers (n = 69,715), differences averaged only 2 percentage points. For multivitamin users, the prevalence of adequacy improved by an average of 8 percentage points for both men and women when intake from supplements was included. Users were also more likely to have potentially excessive intakes, particularly for iron, zinc, vitamin A, and niacin. The 26,735 MEC participants in Hawaii who answered an open-ended question about multivitamin use in 1999-2001 reported using 1246 different products. The nutrient profile of these products varied widely, and the composition of products at the 90th percentile was 10-fold greater than the composition at the median for some nutrients. We conclude that analyses of nutrient adequacy and excess for supplement users should be extended to national samples and that composition data on actual supplements used are preferable to assuming a default nutrient profile for multivitamin supplements. Multivitamin products could be better formulated to reduce the prevalence of inadequacy and also to reduce the risk of excessive intakes.

Chronic Disease↗
PubMed1992

Maternal employment and the quality of young children's diets: empirical evidence based on the 1987-1988 Nationwide Food Consumption Survey.

Data from 442 children, aged 2 to 5, who were participants in the 1987-1988 Nationwide Food Consumption Survey, were examined to determine the effect of maternal employment on the quality of their diets. Diet quality was assessed by examining nutrient adequacy and nutrient overconsumption using the 3-day average of one 24-hour recall and 2 days of written diet records. To assess dietary adequacy, a mean adequacy ratio of the four nutrients (zinc, vitamin E, iron, and calcium) for which 30% or more of the children fell below 77% of the Recommended Dietary Allowances was constructed. Percent calories from fat and saturated fat, and intake of cholesterol and sodium were examined to assess overconsumption. Multiple correlation regression analysis was used to control for household income, maternal education and age, child's age, race, number of siblings aged 5 or younger, presence of male head of household, and number of meals eaten away from home. Maternal employment did not contribute significantly to the variation in any of the dietary variables. Although a number of dietary problems existed among the sample children, the variation in intakes of these nutrients was not directly related to maternal employment status.

Analysis of Variance↗
PubMed2005

Diet quality in young children is influenced by beverage consumption.

BACKGROUND: Replacement of milk with sugar-containing beverages could affect calcium intake and overall diet quality. OBJECTIVE: To describe dairy food, 100% juice and added sugar beverage intakes, contributions of dairy foods to diet quality, and effects of beverages on diet quality in young children. METHODS: We surveyed participants in the Iowa Fluoride Study (n = 645) at ages 1, 2, 3, 4 and 5 years and calculated intakes for 1-5 years (i.e. weighted averages). Nutrient, dairy food and beverage intakes were obtained from 3-day diaries; nutrient adequacy ratios were calculated as the nutrient intake to Recommended Dietary Allowance/Adequate Intake ratio; and dairy-dependent percentages were calculated as fractions of total diet nutrient adequacy ratios (truncated at 1) not met by non-dairy foods. RESULTS: Milk intakes were inversely associated with intakes of juice drinks (2, 4, 5 and 1-5 years), soda pop (2, 3, 4, 5 and 1-5 years) and added sugar beverages (2, 3, 4, 5 and 1-5 years). Dairy dependent fractions of 1-5 year nutrient adequacy ratios were 68% for calcium and 61% for vitamin D. Higher 1-5 year calcium adequacy was predicted by higher energy, higher other dairy and lower added sugar beverage intakes while higher vitamin D adequacy was predicted by higher energy and higher other dairy intakes. Overall diet quality was predicted by higher energy, higher other dairy, lower 100% juice and lower added sugar beverage intakes. CONCLUSIONS: Dairy foods remain an important source of calcium and vitamin D, while added sugar beverages and, to a lesser extent, 100% juice decrease diet quality of young children.

Animals↗
PubMed2003

Operationalizing dietary diversity: a review of measurement issues and research priorities.

Dietary diversity (DD) is universally recognized as a key component of healthy diets. There is still, however, a lack of consensus on how to measure and operationalize DD. This article reviews published literature on DD, with a focus on the conceptual and operational issues related to its measurement in developing countries. Findings from studies of the association between DD and individual nutrient adequacy, child growth and/or household socioeconomic factors are summarized. DD is usually measured using a simple count of foods or food groups over a given reference period, but a number of different groupings, classification systems and reference periods have been used. This limits comparability and generalizability of findings. The few studies that have validated DD against nutrient adequacy in developing countries confirm the well-documented positive association observed in developed countries. A consistent positive association between dietary diversity and child growth is also found in a number of countries. Evidence from a multicountry analysis suggests that household-level DD diversity is strongly associated with household per capita income and energy availability, suggesting that DD could be a useful indicator of food security. The nutritional contribution of animal foods to nutrient adequacy is indisputable, but the independent role of animal foods relative to overall dietary quality for child growth and nutrition remains poorly understood. DD is clearly a promising measurement tool, but additional research is required to improve and harmonize measurement approaches and indicators. Validation studies are also needed to test the usefulness of DD indicators for various purposes and in different contexts.

Cultural Diversity↗
PubMed2003

Nutritional importance of animal source foods.

Animal source foods can provide a variety of micronutrients that are difficult to obtain in adequate quantities from plant source foods alone. In the 1980s, the Nutrition Collaborative Research Support Program identified six micronutrients that were particularly low in the primarily vegetarian diets of schoolchildren in rural Egypt, Kenya and Mexico: vitamin A, vitamin B-12, riboflavin, calcium, iron and zinc. Negative health outcomes associated with inadequate intake of these nutrients include anemia, poor growth, rickets, impaired cognitive performance, blindness, neuromuscular deficits and eventually, death. Animal source foods are particularly rich sources of all six of these nutrients, and relatively small amounts of these foods, added to a vegetarian diet, can substantially increase nutrient adequacy. Snacks designed for Kenyan schoolchildren provided more nutrients when animal and plant foods were combined. A snack that provided only 20% of a child's energy requirement could provide 38% of the calcium, 83% of the vitamin B-12 and 82% of the riboflavin requirements if milk was included. A similar snack that included ground beef rather than milk provided 86% of the zinc and 106% of the vitamin B-12 requirements, as well as 26% of the iron requirement. Food guides usually recommend several daily servings from animal source food groups (dairy products and meat or meat alternatives). An index that estimates nutrient adequacy based on adherence to such food guide recommendations may provide a useful method of quickly evaluating dietary quality in both developing and developed countries.

Animals↗
PubMed2006

Food variety and dietary diversity scores in children: are they good indicators of dietary adequacy?

OBJECTIVE: To assess whether a food variety score (FVS) and/or a dietary diversity score (DDS) are good indicators of nutrient adequacy of the diet of South African children. METHODS: Secondary data analyses were undertaken with nationally representative data of 1-8-year-old children (n = 2200) studied in the National Food Consumption Study in 1999. An average FVS (mean number of different food items consumed from all possible items eaten) and DDS (mean number of food groups out of nine possible groups) were calculated. A nutrient adequacy ratio (NAR) is the ratio of a subject's nutrient intake to the estimated average requirement calculated using the Food and Agriculture Organization/World Health Organization (2002) recommended nutrient intakes for children. The mean adequacy ratio (MAR) was calculated as the sum of NARs for all evaluated nutrients divided by the number of nutrients evaluated, expressed as a percentage. MAR was used as a composite indicator for micronutrient adequacy. Pearson correlation coefficients between FVS, DDS and MAR were calculated and also evaluated for sensitivity and specificity, with MAR taken as the ideal standard of adequate intake. The relationships between MAR and DDS and between anthropometric Z-scores and DDS were also evaluated. RESULTS: The children had a mean FVS of 5.5 (standard deviation (SD) 2.5) and a mean DDS of 3.6 (SD 1.4). The mean MAR (ideal = 100%) was 50%, and was lowest (45%) in the 7-8-year-old group. The items with the highest frequency of consumption were from the cereal, roots and tuber group (99.6%), followed by the 'other group' (87.6%) comprising items such as tea, sugar, jam and sweets. The dairy group was consumed by 55.8%, meat group by 54.1%, fats by 38.9%, other vegetables by 30.8%, vitamin-A-rich by 23.8%, other fruit by 22%, legumes and nuts by 19.7% and eggs by 13.3%. There was a high correlation between MAR and both FVS (r = 0.726; P < 0.0001) and DDS (r = 0.657; P < 0.0001), indicating that either FVS or DDS can be used as an indicator of the micronutrient adequacy of the diet. Furthermore, MAR, DDS and FVS showed significant correlations with height-for-age and weight-for-age Z-scores, indicating a strong relationship between dietary diversity and indicators of child growth. A DDS of 4 and an FVS of 6 were shown to be the best indicators of MAR less than 50%, since they provided the best sensitivity and specificity. CONCLUSION: Either FVS or DDS can be used as a simple and quick indicator of the micronutrient adequacy of the diet.

Age Distribution↗
PubMed2006

Simple measures of dietary variety are associated with improved dietary quality.

The objective of this study was to identify a measure of dietary variety that was associated with improved dietary quality and easily understood by consumers. Dietary quality was measured by nutrient adequacy and intakes of added sugars, saturated fat, cholesterol, and sodium. We developed four definitions of dietary variety: (a) a count of basic commodities consumed; (b) a count of food codes reported; (c) a count of five Food Guide Pyramid (FGP) food groups consumed; and (d) a count of 22 FGP subgroups consumed. The analysis sample included 4,964 men and 4,797 women aged 19 years and older who participated in the Continuing Survey of Food Intakes by Individuals 1994-96. For each day of dietary data, we examined associations of each type of dietary variety with several measures of dietary quality using Spearman's correlations and multivariate linear regression models. After adjusting for energy intake and the number of FGP food group servings, all types of dietary variety were positively associated with mean nutrient adequacy across 15 nutrients, but associations were strongest for commodity-based variety and for 22 FGP subgroup consumption variety. Likewise, all variety measures were inversely associated with intakes of added sugars and saturated fat, with commodity-based variety and 22 FGP subgroup variety the strongest. We conclude that variety measured using 22 FGP subgroups is preferable because it is a good predictor of dietary quality, is relatively simple to calculate, and is easy to explain to consumers.

Adult↗
PubMed2005

Nutrient intake adequacy in schoolchildren from a Mediterranean area (southern Spain). Influence of the use of the school canteen.

The aim of the present study was to compare dietary adequacy in 521 schoolchildren in Granada (Spain) with national recommendations and to determine possible differences regarding gender or the use of the school canteen. A food record was used for four consecutive days to evaluate the intake of nutrients and foods. With regard to boys' and girls' intake of the main groups of foods, we observed a tendency for the boys to consume greater quantities of dairy products, cereals, potatoes, and fruit, although the differences were not statistically significant. The children who lunched at school consumed fish, eggs, dairy products, vegetables, and cereals more frequently than those who did so at home. The mean daily intake of energy and nutrients indicates that the studied population exceeded the recommended limits in the proportion of energy derived from protein and fat, while carbohydrate intake was slightly deficient. The children who lunched at school showed a more favorable profile for energy and nutrient intake, with a significantly higher intake of energy, carbohydrates, total fat, polyunsaturated fatty acids (PUFA), monounsaturated fatty acids (MUFA), vitamins B, and E, and calcium, with respect to the children who had lunch at home.

Animals↗
PubMed2002

Dietary Reference Intakes: summary of applications in dietary assessment.

OBJECTIVE: To summarise the applications and appropriate use of Dietary Reference Intakes (DRIs) as guidance for nutrition and health research professionals in the dietary assessment of groups and individuals. DESIGN: Key points from the Institute of Medicine report, Dietary Reference Intakes: Applications in Dietary Assessment, are summarised in this paper. The different approaches for using DRIs to evaluate the intakes of groups vs. the intakes of individuals are highlighted. RESULTS: Each of the new DRIs is defined and its role in the dietary assessment of groups and individuals is described. Two methods of group assessment and a new method for quantitative assessment of individuals are described. Illustrations are provided on appropriate use of the Estimated Average Requirement (EAR), the Adequate Intake (AI) and the Tolerable Upper Intake Level (UL) in dietary assessment. CONCLUSIONS: Dietary assessment of groups or individuals must be based on estimates of usual (long-term) intake. The EAR is the appropriate DRI to use in assessing groups and individuals. The AI is of limited value in assessing nutrient adequacy, and cannot be used to assess the prevalence of inadequacy. The UL is the appropriate DRI to use in assessing the proportion of a group at risk of adverse health effects. It is inappropriate to use the Recommended Dietary Allowance (RDA) or a group mean intake to assess the nutrient adequacy of groups.

Child↗
PubMed1995

Antioxidant vitamin adequacy in relation to consumption of sugars.

OBJECTIVE: To investigate the prevalence of antioxidant vitamin inadequacy and low fibre intakes according to total, intrinsic, extrinsic and milk-sugar consumption groups. DESIGN: Age- and sex-stratified cross-sectional study of coronary risk factors and diet. Based on a personal health and food frequency questionnaire with a clinic attendance for body measurements. SETTING: Ten general practitioners' surgeries from each of 22 Scottish districts (12 Mainland Health Boards) surveyed during 1984-1986. SUBJECTS: 11,626 men and women aged 25-64 years who participated in the baseline Scottish Heart Health (SHHS) and MONICA studies. Overall response rate was 69% after one reminder letter. MAIN OUTCOME MEASURES: Both the mean daily intakes of fibre and vitamins A (retinol and carotenes), C and E, and the percentage of each sex group who fall below the dietary reference values for each nutrient are reported according to fifths of dietary sugars. The percentage of the population variation in vitamin and fibre intake which can be explained by consumption of the different sugars is provided from multiple analysis of variance techniques. RESULTS: Intrinsic sugar intake is positively related to antioxidant vitamin and fibre intake (correlation coefficients, r, between 0.1 and 0.61 apart from retinol, r = -0.06), due to their mutual occurrence in fresh fruits and vegetables, while consumption of milk sugars tends to be weekly inversely related to antioxidant vitamin and fibre intake (apart from vitamin C, r = 0.02-0.06). Both low and high extrinsic sugar intake seems to be associated with poorer antioxidant vitamin and fibre-containing diets compared with a consumption of extrinsic sugar of between 6.5 and 15.6% energy for men and 4.8 and 11.6% energy for women. Intake of different sugar types is related to the antioxidant nutrient adequacy of a diet independent of age, smoking habit, total energy intake, alcohol consumption, weight and height. Fibre intake is below the recommended value at all levels of dietary sugars. CONCLUSIONS: Prevalence of antioxidant vitamin adequacy is significantly related to dietary sugar intake. However, relatively low extrinsic sugar consumption appears equally associated with a poor quality diet as does a relatively high intake. It may be concluded that the dietary reference values for sugars err on the cautions side, with respect to their effect on antioxidant nutrient adequacy.

Adult↗
PubMed2003

Ethnic differences in the nutrient intake adequacy of premenopausal US women: results from the Third National Health Examination Survey.

OBJECTIVE: To examine the adequacy of dietary intake of calcium; folate; and vitamins C, D, E, B-6, and B-12 in premenopausal US women of differing ethnicity. DESIGN: Analyses of single and duplicate 24-hour recalls were conducted to determine dietary intake during the Third National Health and Nutrition Examination Survey. SUBJECTS: Three thousand five hundred eighty-five randomly selected women aged 20 to 50 years from across the United States who were not pregnant or lactating were examined between 1988 and 1994. STATISTICAL ANALYSES: Usual nutrient intake distributions were estimated using the Iowa State University method for adjustment of the distribution. The Estimated Average Requirement cut-point method was used to determine the proportion of women with inadequate intake for each nutrient in each ethnic group. RESULTS: More than 75% of women irrespective of ethnic group had usual intakes of calcium lower than the new Adequate Intake. More than 90% of the women had inadequate intakes of folate and vitamin E from food sources alone. More than half of smokers had inadequate intakes of vitamin C. Intakes of vitamins B-6 and B-12 were low in less than 10% of these women. APPLICATIONS/CONCLUSIONS: This article provides evidence that a high proportion of premenopausal US women are underconsuming a variety of nutrients. Dietary intakes alone are not currently adequate to meet the new recommended intakes. Nutritional supplement use is widespread and effective, but does not eliminate the concerns for at-risk populations. Awareness of the general inadequacies in intakes of vitamin E and folic acid at large, and in many women vitamin C as well, can help direct individual dietary recommendations and place the emphasis in group counseling on nutrients that are of widespread concern. In addition, foods rich in vitamins B-6 and of general nutritional benefit should be emphasized among African American women in the United States as a substantial proportion of this group is still showing inadequate intakes from foods.

Adult↗