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Impact of commercial eating on nutrient adequacy.

The purpose of this study was to investigate the impact of eating away from home (at commercial establishments) on nutrient adequacy by examining frequency of eating away from home, the nutritional value of foods eaten both away and at home, and the nutritional adequacy of the daily diets of individuals. Data from 3,500 individuals, 15 years of age or older, interviewed in the fall quarter of the 1977-78 Nationwide Food Consumption Survey were used. Results indicate that although the nutrient density of food eaten away from home was lower than that of food eaten at home, the persons studied did not eat out frequently enough to influence the adequacy of their diets significantly. The low nutrient density of food eaten away from home does suggest, however, that individuals could be putting themselves at risk of some nutrient inadequacies (particularly of calcium and vitamins A, B-6, and C) or of caloric excess if they substantially increase their frequency of eating away from home. Teenagers and senior citizens seem most vulnerable to potential nutritional inadequacies.

Adolescent

Validation of a nutrient adequacy score for use with women and children.

The purpose of this study was to develop and validate a nutrient adequacy score to be used by nutrition programs for women and children. The study population included 1,431 children, teenagers, and pregnant and lactating women. A dietary score was developed to be limited if certain targeted subgroups of major food groups were not included. Scores were related to Mean Adequacy Ratios (MARs), truncated indexes of the percent of the Recommended Dietary Allowances for protein, calcium, iron, magnesium, phosphorus, vitamin A, thiamin, riboflavin, vitamin B-6, vitamin B-12, and vitamin C through the use of correlation/regression analysis. Separate analyses were run for each of nine different population segments. Regression coefficients were used to generate predicted MAR values that were, in turn, used to categorize individuals according to certain cut-off points. Individuals were also categorized by their actual MARs, according to the same cut-off points. These categorizations provided the basis for validating the score. The score correctly classified 69% to 98% of the persons in each population segment. The score was most sensitive for population segments that have a large proportion of persons below a particular cut-off. Just as important, the score was simple to implement, requiring just three steps from assessing the food frequency to determining risk.

Adolescent

Nutrient adequacy of low fat intakes for children: the Bogalusa Heart Study.

Nutritional adequacy is important when diets and dietary alterations are recommended for children. Concern is expressed that low fat intakes may have deleterious effects on growth and development and may be deficient in total calories and essential nutrients. In a study of the effect of variation in percent fat in the diet, a sample of 871 ten-year-olds was stratified according to four different fat intakes: less than 30% of total kilocalories (kcal), 30% to 35% kcal, 35% to 40% kcal, and greater than 40% kcal. The race/sex distribution was similar within each fat intake group. Fourteen percent of the sample had fat intakes less than 30% of total calories. The amount of calories from breakfast, dinner, and snacks was higher in the children with fat intakes greater than 40% of total calories than those with lower fat intakes. The energy intake of all race/sex groups fell within the recommended range. The low fat intake group was eating 25% less calories than the high fat intake group (1800 kcal vs 2400 kcal). The percentage of calories from carbohydrate, specifically sugar, was greater in the low fat intake group compared with the high fat intake group. Percentage of calories from protein was approximately 13% for all groups. Fiber and starch were the same across all fat intakes.(ABSTRACT TRUNCATED AT 250 WORDS)

Child

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

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 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

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

Diet intervention methods to reduce fat intake: nutrient and food group composition of self-selected low-fat diets.

A multicentered pilot study was conducted to test an intervention protocol designed to reduce fat intake to 15% of energy intake. Eligible subjects were postmenopausal women with stage II breast cancer whose baseline fat intake was more than 30% of energy intake. The low-fat diet intervention protocol consisted of bi-weekly individual counseling sessions with emphasis on substitution of lower-fat foods for high-fat foods and maintenance of nutritional adequacy. Nutrient intakes were calculated from 4-day food records collected at baseline and after 3 months of diet intervention. Mean daily fat intake for the 17 patients on the low-fat diet dropped significantly from 38.4 +/- 4.3% of energy intake at baseline to 22.8 +/- 7.8% at 3 months (p less than .001). A 25% reduction in mean energy intake, from 1,840 +/- 419 kcal at baseline to 1,365 +/- 291 kcal at 3 months, was accompanied by significant increases in protein and carbohydrate as percent of energy intake. A mean weight loss of 2.8 kg and a 7.7% reduction in serum cholesterol were observed; both changes were significant at the p less than .01 level. Absolute intakes of zinc and magnesium were significantly reduced. However, mean intake on the low-fat diet for 14 vitamins and minerals, including zinc and magnesium, exceeded two-thirds of the 1989 Recommended Dietary Allowances (RDAs). When expressed as nutrient density (i.e., amount of nutrient per 1,000 kcal), increases were observed for all micronutrients. These results support the hypothesis that a nutritionally adequate low-fat diet can be successfully implemented in a highly motivated, free-living population.

Aged

Development of a diet low in vitamin K-1 (phylloquinone).

As part of a metabolic study aimed at inducing a subclinical vitamin K deficiency in healthy adults, we designed a diet containing less than 10 micrograms/day of vitamin K-1 (phylloquinone). Two-day menus were constructed from a vitamin K-1 food database developed in our laboratory. This diet offers palatability and provides nutrient adequacy; that is, it meets the Recommended Dietary Allowances for protein and all other vitamins and minerals. An interesting feature of the diet is that the vitamin K-1 level can be kept very low while still fulfilling a large range of energy needs (1,800 to 3,400 kcal/day). The diet proved useful in altering apparent nutritional status for vitamin K-1; after ingestion of the diet for 6 days, plasma concentrations of vitamin K-1 decreased by 80% and fell below the established normal range. Given the well documented drug-nutrient interaction between vitamin K and warfarin--a vitamin K antagonist routinely used in the management of thromboembolic diseases--the dietary information presented in this report may provide useful information for patients undergoing warfarin therapy.

Adult

Trace element deficiencies in cattle.

Deficiency of cobalt, copper, iron, iodine, manganese, selenium, or zinc can cause a reduction in production. Reduced production occurs most commonly when a deficiency corresponds to the phases of growth, reproduction, or lactation. Because of environmental, nutrient, disease, genetic, and drug interactions, deficiencies of single or multiple elements can occur even when the levels recommended by the National Research Council for these nutrients are being fed. Additionally, random supplementation of trace elements above National Research Council recommendations is not justified because of the negative interaction among nutrients and potential toxicosis. Evaluation of trace element status can be difficult because many disease states will alter blood analytes used to evaluate nutrient adequacy. Proper dietary and animal evaluation, as well as response to supplementation, are necessary before diagnosing a trace element deficiency.

Animals

The diet and moderate exercise trial (DAMET): results after 24 weeks.

W.H.O. and U.S. Dept. of Health and Human Services advocate a fat-modified, fruits and vegetable-enriched diet in conjunction with mode-rate physical activity for fitness and health. The Diet and Moderate Exercise Trial (DAMET) is a randomized and controlled study and has provided scientific proof, possibly for the first time, to the above hypothesis (based on epidemiologic studies, short clinical trials and experimental studies) that the new approach can cause modulation of risk factors of coronary heart disease (CHD) as well as improve fitness. In the DAMET, 231 group A and 232 group B patients with risk factors of CHD were administered a prudent diet for 4 weeks, group A patients in addition were also given at least 400 g/day of fruits and vegetables that are rich in dietary fibre and antioxidants such as vitamins A, C, E, carotene and copper, selenium and magnesium. Fruits and vegetables were administered in a foods-to-eat approach by asking the patients to eat these foods before meals when they were hungry to allow better nutrient adequacy. After 4 weeks, group A patients also did moderate exercise such as brisk walking and spot running compared to no such advice to group B for another 20 weeks. After a follow-up period of 24 weeks, adding exercise to diet was associated with a significant decrease in blood total cholesterol (8.9%) and LDL-cholesterol (6.7%) and triglycerides (11.9%) and a marked increase in HDL-cholesterol (16.5%). Mean blood pressures, fasting blood glucose, body weight, body mass index, waist-to-hip ratio and subcutaneous fat also showed a significant decrease in group A, leading to a significant decrease in 12-year CHD risk. A long-term follow-up may be necessary to demonstrate the role of this new approach in decreasing cardiovascular morbidity and mortality.

Blood Pressure

An eating plan and update on recommended dietary practices for the endurance athlete.

This article presents a six-group exchange food plan for the endurance athlete. The plan allows approximately 1,850, 3,460, and 3,760 kcal for a weight reduction diet, general training diet, and carbohydrate-loading intake plan, respectively. Because complex carbohydrate is the primary source of fuel, the training diet and the carbohydrate-loading diet contain 500 g and 600 g carbohydrate, respectively, whereas in the weight reduction plan more than 60% of total energy is carbohydrate. Overall nutrient adequacy of the exchanges and fluid needs for the athlete are discussed. Recommendations and protocol for current dietary practices are given. Dietitians are encouraged to assess the caloric needs of their clients and to individualize the suggested plans in accordance with the needs of each athlete.

Diet

Consequences of utilizing reduced nutrient data bases for estimating dietary adequacy.

The USDA Nutrient Data Base (NDB) used to calculate dietary intake in the Nationwide Food Consumption Survey of Individuals 1977-1978 (NFCS) was reduced to two levels. Both reduced data bases were used in analysis of 3-day dietary records collected on 7,914 individuals during the first quarter of that survey. Baseline nutrient intake values for energy and 14 nutrients for 22 sex-age groups were calculated prior to NDB reduction. After reduction, nutrient intake values were again calculated. The magnitude of variation was determined, and ANOVA was used to evaluate those variations at both substitution levels. The NDB reductions resulted in significant alterations in calculated nutrient intake and interactions between NDB type and various sex-age groups. However, the magnitude of the differences in calculated nutrient levels between the original and reduced data bases was, generally, quite small. The notable exception was in the under-1-year sex-age group. On the basis of this study, predictions of nutritional adequacy for the NFCS using the smaller data bases would show essentially the same trends as obtained from the original data base.

Analysis of Variance

Evaluation of the Nutrient Guide as a dietary assessment tool.

The purpose of this study was to evaluate the validity of the Nutrient Guide as a quantitative estimate of dietary adequacy. Using 24-hour dietary recalls of 300 men, food group and overall diet scores based on the Nutrient Guide were compared with nutrient adequacy ratios for eight nutrients and a mean adequacy ratio derived from nutrient analysis. Caloric, fat, and sodium intakes estimated using Nutrient Guide ratings were also compared with nutrient Nutrient Guide ratings were also compared with nutrient analysis estimates. Correlations between food group scores and nutrient adequacy ratios were all positive and significant. Regression analyses revealed a strong linear relationship between caloric, fat, and sodium intakes estimated by the two methods and a curvilinear relationship between mean adequacy ratio and total diet score. These results suggest that the Nutrient Guide can be used to provide a reasonable estimate of adequacy for the nutrients upon which the guide is currently based. Food group and total diet scores in either the upper or lower ends of the score ranges seemed to be better predictors of individual nutrient or overall dietary adequacy than did mid-range scores, which slightly underestimated dietary adequacy of the selected nutrients.

Diet

Body composition and nutrient intakes of college men and women basketball players.

Computer analysis of diet records was used to compare adequacy of nutrient intake for 16 male and 10 female intercollegiate basketball players. Significant differences (p less than .05) between men and women were observed for the provision of nutrients from food alone; mean percent RDAs of all nutrients except vitamins A and D was greater for men. This was due primarily to caloric intakes by the men, which averaged twice those of the women. Nutrient supplements had a significant effect on the women's total intake. With the exceptions of energy, protein, and vitamin C, differences between men and women in percent RDAs were eliminated when the contribution of nutrient supplements was included. The data made apparent the need for dietitians familiar with sports nutrition to counsel female athletes on means of obtaining nutrients via an adequate diet.

Adolescent

Nutrient intake of low-income, black families in southwestern Mississippi.

A dietary intake study for 250 low-income households in Claiborne County in southwestern Mississippi was conducted from June through August 1974. Data were obtained during daily home visits for seven days by trained college students. The adequacy of nutrient intake for individuals was evaluated by comparing the data with the 1974 Recommended Dietary Allowances by age and sex. The data was also compared with those of the Ten-State Nutrition Survey and HANES. Mean intakes of protein, vitamin A, thiamin, riboflavin, and ascorbic acid for all subjects were above the RDAS; those of energy, calcium, iron, and preformed niacin were below the allowances. Whereas calcium was the nutrient least adequately consumed by all persons, protein was most adequately consumed. Sixty per cent of children had calcium intakes below two-thirds of the allowance. By sex, 66.7 per cent of all males and 73.3 per cent of all females had calcium intakes below two-thirds of the standard. None of children received less than two-thirds of the allowance for protein. Nutrient intake was low for a substantial number of the subjects. Adolescents, ages eleven to eighteen years, of both sexes had the poorest diets for all nutrients. Regarding the sex difference, females had better nutrient intakes than did males for all nutrients except calcium and iron.

Adolescent

Low-burden metrics for monitoring healthy diets among nonpregnant females aged 15 to 49 years: a multicountry validation analysis using quantitative 24-hour dietary intake data.

BACKGROUND: Limited nationally representative quantitative dietary intake data and a lack of consensus on lower-burden tools and metrics hinder high-frequency monitoring of healthy diets globally. OBJECTIVES: This study aimed to evaluate the comparative construct validity and potential complementarity of low-burden metrics of a healthy diet among nonpregnant females aged 15 to 49 y. METHODS: Quantitative 24-h dietary intake data collected from 77,118 adolescent and adult females across 27 countries were used to construct low-burden metrics and reference metrics of dietary intake. Associations between mean-standardized low-burden measures or indicators and reference metrics were assessed using linear and logistic mixed-effect models, with Spearman's &#x3c1; used for survey-level rank correlations. Test characteristics identified low-burden indicators best differentiated adherence to reference indicators. RESULTS: An indicator reflecting nonconsumption of sweet foods and/or sweet beverages was most robustly associated with greater adherence to <10% energy from free sugars in upper-middle-income countries {odds ratio [OR] [95% confidence interval (CI)]: 5.35 [5.05, 5.66]}. Food group diversity score (FGDS) was most strongly associated with and differentiated higher mean adequacy ratio of micronutrients [&#x3b2; of 1-standard deviation (SD) change: &#x223c;11 percentage points (9, 12); &#x3c1;: 0.79], whereas noncommunicable disease-Protect score best reflected consumption of &#x2265;400 g/d of fruits and vegetables [range OR of 1-SD changes (95% CI): 2.56-3.01 (2.40, 3.13) in lower-middle and high-income countries, respectively; &#x3c1;: 0.56]. FGDS and Global Diet Quality Score Positive were most consistently associated with achieving &#x2265;25 g/d of fiber and &#x2265;3510 mg/d of potassium across contexts. CONCLUSIONS: Low-burden data collection tools yield valid metrics, enabling high-frequency monitoring of healthy diets across contexts. Specifically, avoiding sweet foods and/or sweet beverages is an indicator for adherence to WHO free sugar guidelines among nonpregnant females in upper-middle-income countries, whereas metrics reflecting nutritious food group diversity strongly reflect better micronutrient adequacy and adherence to WHO guidelines for fruits and vegetables, fiber, and potassium intakes within and across contexts.

Humans