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Validation of food variety as an indicator of diet quality assessed with a food frequency questionnaire for Western Mali.

OBJECTIVE: To assess the validity of two diet quality indexes-food variety score (FVS) and diet diversity score (DDS) in Western Mali. DESIGN: In two separate studies (A and B), FVS and DDS were derived from a food frequency questionnaire (FFQ) and were compared with the same scores and with measures of nutrient adequacy derived from 2-day weighed records (WR). SETTING: Two rural, adjacent villages in Mali, West Africa. SUBJECTS: In study A (1996), 48 women and 27 men (15-59 y) participated. Study B (1999) included 34 women and 36 men (15-45 y). RESULTS: Spearman's correlation coefficients between FVS from the FFQ and WR for men were 0.5 in study A and 0.4 in study B. The corresponding correlations for DDS were 0.2 and 0.4, respectively. Correlations for women were lower, especially in study B. Classification into quartiles was also best for men. Correlations for the two diet variety scores from the FFQ with nutrient adequacy from the WR in study A were about 0.3 for men, but lower for women. In study B, these correlations were around 0.5 for men, whereas for women there was no association. CONCLUSION: FVS and DDS can be assessed by our FFQ. The two diet variety scores reflect diet quality and are simple tools that can be used for monitoring. The validation study gave better results for men than for women, which has implications for further use of these instruments.

Adolescent↗

Physical characteristics and feeding skills as predictors of adequacy of nutrient intakes of mentally retarded individuals.

Characteristics common to mentally retarded adults with marginal or inadequate nutrient intakes who may be high risk for specific nutrient deficiencies were identified. Although physiological and psychological influences, feeding practices, and weight status were not found to influence the average nutrient intakes of the sample population, intakes of iron, calcium, and riboflavin were affected by sex of the resident. Inadequate intakes of these key nutrients may predispose this vulnerable population to nutrient-related disorders.

Adolescent↗

Dietary diversity score in adolescents - a good indicator of the nutritional adequacy of diets: Tehran lipid and glucose study.

The purpose of this study was to determine dietary diversity and its relation to dietary adequacy in 10-18 year-old adolescents of district 13 of Tehran during the period 1999-2001. After excluding for over and under reporters, dietary intake assessment was conducted on 304, 10-18 year old individuals, participants of Tehran Lipid and Glucose Study. A dietary diversity score was calculated as part of the pyramid serving database that is categorized into 23 broad food groups. Each of the 5 broad food categories received a maximum diversity score of 2 of the 10 possible score points. To be counted as a "consumer " for any of the food groups categories, a respondent needed to consume one-half serving, as defined by Food Guide Pyramid quantity criteria, at any time during a 2-day survey period. The nutrient adequacy ratio for a given nutrient is the ratio of a subject's intake to the current recommended allowance for the subject's sex and age category. Weight and height were measured and BMI was calculated. Student's t-test was used to compare the means. Those variables which had normal distribution were tested by Pearson correlation coefficient and the others were tested by the Spearman correlation coefficient. Mean +/-SD of dietary diversity score (DDS) was 6.25 +/- 1.08 (range 0-10). The maximum and minimum scores of dietary diversity were related to the fruit (1.46+/-0.61) and bread-grain (0.95+/-0.27) groups, respectively. Significant positive correlation was observed between DDS and the mean adequacy ratio (MAR) (r =0.42, P <0.001). Fifty percent of people had DDS >or = 6. In people with a DDS of six or over, BMI was higher (19.81 +/- 4.08vs18.95+/- 3.30 Kg/m(2), P<0.01) than others. There was a significant and positive correlation between DDS and most of the nutrient adequacy ratios (NARs). It is concluded that DDS is an appropriate method to evaluate nutrient intake adequacy in this group of adolescents.

Adolescent↗

Food variety--a good indicator of nutritional adequacy of the diet? A case study from an urban area in Mali, West Africa.

OBJECTIVE: This study assesses whether a simple count of food items and food groups can predict the nutritional adequacy of the diet in an economically poor country. DESIGN: A three-day weighed record of children. SETTING: Koutiala town, in Southeastern Mali. SUBJECTS: Seventy-seven children, 13-58 months of age. One child was excluded owing to an extraordinarily low food variety. INTERVENTION: The study was conducted in April August 1995. Data from this study were used to create two different indices: Food Variety Score (FVS), a simple count of food items, and Dietary Diversity Score (DDS), a count of food groups. Mean Adequacy Ratio (MAR) was calculated as an indicator for nutrient adequacy, and used to validate FVS and DDS. RESULTS: Mean (s.d.) FVS was 20.5 (3.8) and mean (s.d.) DDS was 5.8 (1.1). A positive correlation was found both between FVS and MAR (Pearson 0.33, P < 0.001) and DDS and MAR (Pearson 0.39, P < 0.001). With cut-off points for FVS at 23 and for DDS at 6, the indices have high ability to identify those with a nutritionally inadequate diet. MAR increased with increasing FVS and DDS. FVS needs to be at least 15 or DDS at least 5 to give a satisfactory MAR. CONCLUSION: Although a simple count of food items or food groups cannot give a full picture of the adequacy of the nutrient intake, the results from this study show that the food scores can give a fairly good assessment of the nutritional adequacy of the diet, particularly if combined. Such indicators are important for identification of vulnerable groups in areas where people normally eat from a shared bowl, which makes detailed dietary intake studies difficult, time consuming and expensive.

Child Nutritional Physiological Phenomena↗

A rapid dietary screening device for clinics.

A rapid dietary screening device was developed for use in clinics and tested for validity, reliability, and acceptability. Validity was tested using dietary information from 29 8-day weighed food diaries. For each diary, a score was derived by calculating a mean Nutrient Adequacy Ratio (NAR) for nine nutrients. Dietary information from each diary was also entered on the Dietary Intake Form (DIF). The relationship of the mean NAR and DIF scores had a positive correlation of 0.83. Reliability was determined by testing undergraduate students in a non-nutrition course twice, two weeks apart. Forty repeated paired food group and total dietary scores revealed positive correlations, with r = 0.81 for total dietary score, 0.91 for dairy products, 0.78 for protein, 0.80 for fruits and vegetables, and 0.88 for bread. Acceptability of DIF was measured by the time it took to fill out and evaluate it, as well as by the percentage of incomplete DIFs. The subjects included 135 women aged 12 to 50 years from three Northeastern Oklahoma Planned Parenthood clinics. The mean time to fill out and evaluate the DIF was 4 to 7 minutes. Seventy-nine percent of the individuals tested were able to complete the DIF. Dietary patterns could not be predicted in this population by age, income level, education level, race, or clinic site. The DIF provides a rapid, valid, reliable, and acceptable method of identifying the individual with a poor diet. Because it does not require the expertise of a nutritionist either for its completion or for its evaluation, this device permits the dietitian to allocate her/his time more effectively under time and cost limitations.

Adolescent↗

Household participation in the Food Stamp and WIC programs increases the nutrient intakes of preschool children.

We examined the effects of household participation in the Food Stamp and WIC Nutrition Programs on the nutrient intakes of preschoolers using data from the 1989-1991 Continuing Survey of Food Intake by Individuals. Nonbreastfeeding children, 1-4 y of age, with 3 d of dietary data and whose households had incomes < 130% of the poverty level were included in the study sample (n = 499). Nutrient adequacy ratios for each of 15 nutrients were the dependent variables in multiple regression models that controlled for the following: age, sex and ethnicity of the individual; income, size and location of the household; schooling of the household head; home ownership; school lunch and breakfast participation; and season in which the interview was conducted. WIC benefits positively influenced (P < 0. 05) the intakes of 10 nutrients. For iron and zinc, the average increase due to WIC represented 16.6 and 10.6%, respectively, of the preschooler recommended dietary allowance (RDA) for these nutrients. The same analyses of the Food Stamp Program revealed increases in five nutrients. For iron and zinc, the average increase due to Food Stamps represented 12.3 and 9.2%, respectively, of the preschooler RDA. The effects of the WIC Program on the intakes of iron and zinc were greater than that of cash income, and neither program affected the intakes of fat, saturated fat or cholesterol.

Adult↗

Variability in selected indexes of overall diet quality.

We examined the intra- and interindividual variability in selected measures of overall diet quality in relation to socio-demographic, lifestyle, and health-related characteristics. Three days of dietary data from the Continuing Survey of Food Intakes by Individuals (CSFII), 1989-91 (7841 respondents, 3337 men and 4504 women, aged > or = 19 years), were examined. Measures of overall diet quality were: 1. the Dietary Diversity Score (DDS), a measure of variety among the major food groups; 2. the Overall Variety Score (OVS), examined the number of nutrient-dense foods reported; and 3. the Nutrient Adequacy Score (NAS100), evaluated the number of nutrients consumed at least at the level of the RDA from a total of 11. The ratio of intra- to interindividual variance for DDS, OVS, and NAS100 was 1.66, 1.09, and 1.21, respectively, indicating higher intraindividual variability relative to interindividual variability. For each of the three scores, gender, income, education, and smoking were associated with greater intraindividual variability; however, age, and special diet status were associated with lower variability. Thus, the reliability of a given dietary assessment protocol for evaluating "usual" diet quality is likely to vary by the socio-demographic and lifestyle characteristics of the study population.

Adult↗

Dietary diversity is associated with child nutritional status: evidence from 11 demographic and health surveys.

Simple indicators reflecting diet quality for young children are needed both for programs and in some research contexts. Measures of dietary diversity are relatively simple and were shown to be associated with nutrient adequacy and nutritional status. However, dietary diversity also tends to increase with income and wealth; thus, the association between dietary diversity and child nutrition may be confounded by socioeconomic factors. We used data from 11 recent Demographic and Health Surveys (DHS) to examine the association between dietary diversity and height-for-age Z-scores (HAZ) for children 6-23 mo old, while controlling for household wealth/welfare and several other potentially confounding factors. Bivariate associations between dietary diversity and HAZ were observed in 9 of the 11 countries. Dietary diversity remained significant as a main effect in 7 countries in multivariate models, and interacted significantly with other factors (e.g., child age, breast-feeding status, urban/rural location) in 3 of the 4 remaining countries. Thus, dietary diversity was significantly associated with HAZ, either as a main effect or in an interaction, in all but one of the countries analyzed. These findings suggest that there is an association between child dietary diversity and nutritional status that is independent of socioeconomic factors, and that dietary diversity may indeed reflect diet quality. Before dietary diversity can be recommended for widespread use as an indicator of diet quality, additional research is required to confirm and clarify relations between various dietary diversity indicators and nutrient intake, adequacy, and density, for children with differing dietary patterns.

Africa↗

Beverage choices affect adequacy of children's nutrient intakes.

OBJECTIVE: To assess the relationship between beverage choices and the adequacy of nutrient intakes among children and adolescents. DESIGN: Beverages reported in 24-hour recall records were classified as milk, 100% juice, fruit-flavored drinks, or carbonated sodas. Recommended intakes were based on Recommended Dietary Allowances or Dietary Reference Intakes. PARTICIPANTS: Four thousand seventy children aged 2 to 5, 6 to 11, and 12 to 17 years participating in the 1994-96 Continuing Survey of Food Intakes by Individuals. STATISTICAL ANALYSIS: The likelihood of achieving recommended intakes of selected nutrients on the day of recall was assessed with multiple logistic regression including ounces of milk, juice, fruit-flavored drinks, and carbonated sodas in the model while controlling for sex, age in years, race/ethnic group, household income, and total energy intake. RESULTS: Milk consumption was positively (P<.0001) associated with the likelihood of achieving recommended vitamin A, folate, vitamin B(12), calcium, and magnesium intakes in all age strata. Juice consumption was positively (P< or =. 001) associated with achieving recommended vitamin C and folate intakes in all age strata and magnesium intakes among children aged 6 years and older. Carbonated soda consumption was negatively (P< or =. 01) associated with achieving vitamin A intake in all age strata, calcium in children younger than 12 years, and magnesium in children aged 6 years and older. CONCLUSION: Beverage choice can have a significant effect on the nutrient adequacy of the diets of children and adolescents.

Adolescent↗

Exposure assessment error and its handling in nutritional epidemiology.

Exposure assessment is the weakest element in nutritional epidemiologic studies. In the absence of an adequate arsenal of biomarkers of intake in the United States, food frequency questionnaires are widely used to assess habitual frequency of consumption of foods. These tools need to be designed for the population under study, based on prior information on the eating behavior of the population. The questions to be addressed to insure appropriate application of these tools are presented. The influence of various sources and types of measurement error on various scientific hypotheses is addressed. In assessment of nutrient adequacy, information on intra- to interindividual variation of the nutrient or substance of interest is essential. Risk assessment requires examination of sources and extent of bias and differential and nondifferential measurement error within the study. The theory required for error correction is well developed, but rarely carried out because of lack of software and lack of information needed to calibrate the measures.

Bias↗

Dental caries and beverage consumption in young children.

OBJECTIVE: Dental caries is a common, chronic disease of childhood. The impact of contemporary changes in beverage patterns, specifically decreased milk intakes and increased 100% juice and soda pop intakes, on dental caries in young children is unknown. We describe associations among caries experience and intakes of dairy foods, sugared beverages, and nutrients and overall diet quality in young children. METHODS: Subjects (n = 642) are members of the Iowa Fluoride Study, a cohort followed from birth. Food and nutrient intakes were obtained from 3-day diet records analyzed at 1 (n = 636), 2 (n = 525), 3 (n = 441), 4 (n = 410), and 5 (n = 417) years and cumulatively for 1 through 5 (n = 396) years of age. Diet quality was defined by nutrient adequacy ratios (NARs) and calculated as the ratio of nutrient intake to Recommended Dietary Allowance/Adequate Intake. Caries were identified during dental examinations by 2 trained and calibrated dentists at 4 to 7 years of age. Examinations were visual, but a dental explorer was used to confirm questionable findings. Caries experience was assessed at both the tooth and the surface levels. Data were analyzed using SAS. The Wilcoxon rank sum test was used to compare food intakes, nutrient intakes, and NARs of subjects with and without caries experience. Logistic and Tobit regression analyses were used to identify associations among diet variables and caries experience and to develop models to predict caries experience. Not all relationships between food intakes and NARs and caries experience were linear; therefore, categorical variables were used to develop models to predict caries experience. Food and beverage intakes were categorized as none, low, and high intakes, and NARs were categorized as inadequate, low adequate, and high adequate. RESULTS: Subjects with caries had lower median intakes of milk at 2 and 3 years of age than subjects without caries. Subjects with caries had higher median intakes of regular (sugared) soda pop at 2, 3, 4, and 5 years and for 1 through 5 years; regular beverages from powder at 1, 4, and 5 years and for 1 through 5 years; and total sugared beverages at 4 and 5 years than subjects without caries. Logistic regression models were developed for exposure variables at 1, 2, 3, 4, and 5 years and for 1 through 5 years to predict any caries experience at 4 to 7 years of age. Age at dental examination was retained in models at all ages. Children with 0 intake (vs low and high intakes) of regular beverages from powder at 1 year, regular soda pop at 2 and 3 years, and sugar-free beverages from powder at 5 years had a decreased risk of caries experience. High intakes of regular beverages from powder at 4 and 5 years and for 1 through 5 years and regular soda pop at 5 years and for 1 through 5 years were associated with significantly increased odds of caries experience relative to subjects with none or low intakes. Low (vs none or high) intakes of 100% juice at 5 years were associated with decreased caries experience. In general, inadequate intakes (vs low adequate or high adequate intakes) of nutrients (eg, riboflavin, copper, vitamin D, vitamin B(12)) were associated with increased caries experience and low adequate intakes (vs inadequate or high adequate intakes) of nutrients (eg, vitamin B(12), vitamin C) were associated with decreased caries experience. An exception was vitamin E; either low or high adequate intakes were associated with increased caries experience at various ages. Multivariable Tobit regression models were developed for 1- through 5-year exposure variables to predict the number of tooth surfaces with caries experience at 4 to 7 years of age. Age at dental examination showed a significant positive association and fluoride exposure showed a significant negative association with the number of tooth surfaces with caries experience in the final model. Low intakes of nonmilk dairy foods (vs high intakes; all subjects had some nonmilk dairy intakes) and high adequate intakes of vitamin C (vs inadequate and low adequate intakes) were associated with fewer tooth surfaces having caries experience. High intakes of regular soda pop (vs none and low intakes) were associated with more tooth surfaces having caries experience. CONCLUSIONS: Results of our study suggest that contemporary changes in beverage patterns, particularly the increase in soda pop consumption, have the potential to increase dental caries rates in children. Consumption of regular soda pop, regular powdered beverages, and, to a lesser extent, 100% juice was associated with increased caries risk. Milk had a neutral association with caries. Associations between different types of sugared beverages and caries experience were not equivalent, which could be attributable to the different sugar compositions of the beverages or different roles in the diet. Our data support contemporary dietary guidelines for children: consume 2 or more servings of dairy foods daily, limit intake of 100% juice to 4 to 6 oz daily, and restrict other sugared beverages to occasional use. Pediatricians, pediatric nurse practitioners, and dietitians are in a position to support pediatric dentists in providing preventive guidance to parents of young children.

Carbonated Beverages↗

Dietary supplements in weight reduction.

We summarize evidence on the role of dietary supplements in weight reduction, with particular attention to their safety and benefits. Dietary supplements are used for two purposes in weight reduction: (a) providing nutrients that may be inadequate in calorie-restricted diets and (b) for their potential benefits in stimulating weight loss. The goal in planning weight-reduction diets is that total intake from food and supplements should meet recommended dietary allowance/adequate intake levels without greatly exceeding them for all nutrients, except energy. If nutrient amounts from food sources in the reducing diet fall short, dietary supplements containing a single nutrient/element or a multivitamin-mineral combination may be helpful. On hypocaloric diets, the addition of dietary supplements providing nutrients at a level equal to or below recommended dietary allowance/adequate intake levels or 100% daily value, as stated in a supplement's facts box on the label, may help dieters to achieve nutrient adequacy and maintain electrolyte balance while avoiding the risk of excessive nutrient intakes. Many botanical and other types of dietary supplements are purported to be useful for stimulating or enhancing weight loss. Evidence of their efficacy in stimulating weight loss is inconclusive at present. Although there are few examples of safety concerns related to products that are legal and on the market for this purpose, there is also a paucity of evidence on safety for this intended use. Ephedra and ephedrine-containing supplements, with or without caffeine, have been singled out in recent alerts from the Food and Drug Administration because of safety concerns, and use of products containing these substances cannot be recommended. Dietitians should periodically check the Food and Drug Administration Web site ( www.cfsan.fda.gov ) for updates and warnings and alert patients/clients to safety concerns. Dietetics professionals should also consult authoritative sources for new data on efficacy as it becomes available ( ods.od.nih.gov ).

Anti-Obesity Agents↗

Selenium deficiency associated with cardiomyopathy: a complication of the ketogenic diet.

PURPOSE: The ketogenic diet (KD) is an efficacious treatment for intractable epilepsy, associated with infrequent side effects. The KD is known to be deficient in most vitamins and minerals and may be deficient in trace minerals. We report biochemical selenium deficiency in nine patients on the KD, including one who developed cardiomyopathy. METHODS: A whole-blood selenium level was obtained on the symptomatic patient after noting the patient's poor appearance on physical examination. Children already treated and children beginning the KD were then evaluated prospectively for selenium status by measuring whole-blood or serum selenium as part of routine laboratory evaluation every 3 months. RESULTS: The index case had no detectable whole-blood selenium. Cardiac physical examination and ECG were normal, but the echocardiogram revealed cardiomyopathy. Thirty-nine additional children had the selenium status evaluated. Eight had selenium levels below the normal range (six initially, and two developed low selenium levels on serial testing). They were referred for cardiology evaluations, which were normal. Selenium supplementation improved levels in all children. Low levels were seen in some children after only a few months of treatment. CONCLUSIONS: The nutrient adequacy of the currently used KD has not been fully evaluated. The nutrient content of KD with usual supplements may not meet Recommended Dietary Allowances (RDA) for selenium and may not provide other trace minerals in adequate amounts. At our center, selenium deficiency was found in 20% of the patients evaluated. Screening for selenium deficiency is suggested if the patient KD regimen does not meet > or =75% of the RDA or if the child is symptomatic. Nutrient supplementation should provide adequate trace elements for children treated with the KD. The KD requires close monitoring of the overall nutritional status.

Adolescent↗

Adolescents involved in weight-related and power team sports have better eating patterns and nutrient intakes than non-sport-involved adolescents.

OBJECTIVE: To examine eating habits and energy and nutrient intake among adolescents participating in weight-related and power team sports and non-sport-involved adolescents. DESIGN: Data were drawn from Project EAT (Eating Among Teens), which was conducted with 4,746 adolescents from 31 middle and high schools in the Minneapolis/St Paul metropolitan area. SETTING: Urban secondary schools. SUBJECTS: Adolescents reporting participation in a weight-related sport, a power team sport, or no consistent participation in a sport. MAIN OUTCOME MEASURES: Meal and snack frequency, mean energy and nutrient intake, and mean physical activity. STATISTICAL ANALYSES PERFORMED: Analyses were conducted by sex across the three groups. General linear models were used to compare mean energy and nutrient intake, composite nutrient adequacy, and mean physical activity across the three groups. Percentages of youth meeting nutrient recommendations were compared across the three groups using chi(2) tests. RESULTS: For both males and females, youth involved in weight-related sports ate breakfast more frequently than non-sport-involved peers (females: 3.6 and 3.2 times per week, respectively, P<0.01; males: 4.7 and 3.7 times per week, respectively, P<0.01). Weight-related and power team sport-involved youth also had higher mean protein, calcium, iron, and zinc intakes than non-sport-involved peers. However, adolescent females had low calcium intake, regardless of sports involvement (weight-related sports 1,091 mg/day, power team sports 1,070 mg/day, and non-sport-involved 1,028 mg/day, P<0.05). CONCLUSIONS: Sport-involved adolescents have better eating habits and nutrient intake than their non-sport-involved peers. However, they are still in need of nutrition interventions, particularly around calcium intake.

Adolescent↗

Nutrient requirements for preterm infant formulas.

Achieving appropriate growth and nutrient accretion of preterm and low birth weight (LBW) infants is often difficult during hospitalization because of metabolic and gastrointestinal immaturity and other complicating medical conditions. Advances in the care of preterm-LBW infants, including improved nutrition, have reduced mortality rates for these infants from 9.6 to 6.2% from 1983 to 1997. The Food and Drug Administration (FDA) has responsibility for ensuring the safety and nutritional quality of infant formulas based on current scientific knowledge. Consequently, under FDA contract, an ad hoc Expert Panel was convened by the Life Sciences Research Office of the American Society for Nutritional Sciences to make recommendations for the nutrient content of formulas for preterm-LBW infants based on current scientific knowledge and expert opinion. Recommendations were developed from different criteria than that used for recommendations for term infant formula. To ensure nutrient adequacy, the Panel considered intrauterine accretion rate, organ development, factorial estimates of requirements, nutrient interactions and supplemental feeding studies. Consideration was also given to long-term developmental outcome. Some recommendations were based on current use in domestic preterm formula. Included were recommendations for nutrients not required in formula for term infants such as lactose and arginine. Recommendations, examples, and sample calculations were based on a 1000 g preterm infant consuming 120 kcal/kg and 150 mL/d of an 810 kcal/L formula. A summary of recommendations for energy and 45 nutrient components of enteral formulas for preterm-LBW infants are presented. Recommendations for five nutrient:nutrient ratios are also presented. In addition, critical areas for future research on the nutritional requirements specific for preterm-LBW infants are identified.

Child Development↗

Dietary and anthropometric assessment of adults with cerebral palsy.

Research on nutrition and cerebral palsy (CP) has been directed at newborns and young children, leaving practitioners with a limited understanding of the nutritional status of the adult population. The purpose of this study was to determine the anthropometric profile and nutrient intakes of 86 adults with cerebral palsy. When compared with growth standards for healthy individuals, the mean body fat percentages and body mass indexes of both men and women with CP were within the normal range. However, 40% of the sample had heights below the 5th percentile for their age and gender, indicating permanent growth stunting. In general, the diets of these individuals were similar to the typical American diet. Both men and women had low nutrient adequacy ratios (NARs) for calcium (0.86 and 0.76, respectively); the women also had low NARs for iron (0.69) and niacin (0.86). Although nutrients obtained from supplements were not included in the NAR score, 26% of the men and 50% of the women reported using nutritional supplements. Fifty-five percent of the sample reported feeding problems. Multivariate analysis illustrated that individuals who participated in regular exercise programs had significantly higher mean adequacy ratios and lower body fat percentages than those who did not exercise regularly.

Adipose Tissue↗

Nutrient intakes of infants and toddlers.

OBJECTIVES: To assess the nutrient adequacy of the diets of US infants and toddlers 4 to 24 months of age. DESIGN: Descriptive analysis of the usual nutrient intakes of infants and toddlers using 24-hour recall data from the 2002 Feeding Infants and Toddlers Study. SUBJECTS: A national random sample of 3,022 infants and toddlers, with 2 days of recall available for 703 sample members. Sample sizes by age were: infants 4 to 6 months (n=862), infants 7 to 11 months (n=1,162), and toddlers 12 to 24 months (n=998). STATISTICAL ANALYSES PERFORMED: Using the personal computer version of the Software for Intake Distribution Estimation, we estimated (where applicable) the percentage of infants and toddlers with usual intakes below the estimated average requirement, compared the means of usual nutrient intake distributions with adequate intake levels, and compared the 99th percentile of usual intake distributions with tolerable upper intake levels. RESULTS: For infants under 12 months of age, mean usual intakes exceeded the adequate intake for all nutrients. For toddlers 12 to 24 months of age, the estimated prevalence of inadequacy was low for most nutrients; however, 58% of toddlers had usual vitamin E intakes less than the estimated average requirement. Mean energy intake exceeded the estimated energy requirement by 10% for infants 4 to 6 months, 23% for infants 7 to 12 months, and 31% for toddlers 12 to 24 months of age. The discrepancy between mean energy intake and the estimated energy requirement for infants 4 to 6 months of age was larger for infants fed solids than for infants consuming only breast milk or formula. Fiber intakes of toddlers were below the adequate intake. APPLICATIONS: Studies should examine whether parents overreport foods consumed by infants and toddlers, and whether infants and toddlers are consuming more energy than required. Additional research is indicated to substantiate some of the new Dietary Reference Intakes for infants and children 1 to 3 years of age.

Breast Feeding↗

Variability of nutrient intake over a 3-day period.

This study was designed to assess the magnitude of variation in nutrient intake of individuals over a 3-day period. It is based on an analysis of 3-day food intake records of 21,867 participants in the Nationwide Food Consumption Study (NFCS), 1977-78. Results from a subsample of 7,287 subjects showed a significantly greater variation from the median than from the mean for protein, vitamin A, and iron. Fewer than 30% of the respondents had intakes of any of the 11 nutrients studied within +/- 15% of the mean on all days. For all nutrients except energy and magnesium, less than 50% of the respondents had intakes within +/- 25% of the mean. Variability in intake was greatest for vitamins A and C, with 85% and 82% of respondents, respectively, having low and high daily intakes deviating by more than 25% from the mean. These findings document that 1-day food records alone are of limited value in assessing nutrient adequacy of an individual and quantify the magnitude of the variation over a 3-day period. The more adequate the mean nutrient intake, the less variability in intake from day to day. Similarly, the more consistent the meal pattern, the less the variability in intake.

Diet↗