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Objective To determine whether dietary intakes of children enrolled in Head Start programs differ from those of children not attending preschool or children in non–Head Start programs. Design Using data from the 1999-2004 National Health and Nutrition Examination Survey, low-income, 3- to 5-year-old children were categorized into one of four preschool groups: Head Start (n=184), non–Head Start (n=189), past preschool (n=193), and no preschool (n=384). Total nutrient intakes were calculated using 24-hour parental recalls. Statistical analyses performed Mean macronutrient and micronutrient intakes were compared across groups and the percentage of children not meeting Recommended Dietary Allowances (RDAs) were calculated. Multivariate logistic regression was used to evaluate the relationship between preschool group and likelihood of not meeting dietary guidelines. Results Many children did not meet the RDA for folate (20.5%), vitamin A (39.7%), vitamin E (79.7%), calcium (40.2%), iron (28.8%), and potassium (90.8%). Compared with the other preschool groups, Head Start children had lower mean protein, saturated fat, riboflavin, calcium, and phosphorous intakes. The greatest differences in intake were observed between Head Start participants and no-preschool children. Multivariate analyses demonstrated an association between Head Start and inadequate intake of protein, thiamin, riboflavin, niacin, calcium, and selenium. Conclusions Compared with other low-income children, those in Head Start programs appear to be at greater risk for not meeting the RDA for several key vitamins and minerals. These differences in diet quality may present an opportunity for Head Start programs to enhance nutrition in this student population.

Background Population-based studies have shown that vegetarians have lower body mass index than nonvegetarians, suggesting that vegetarian diet plans may be an approach for weight management. However, a perception exists that vegetarian diets are deficient in certain nutrients. Objective To compare dietary quality of vegetarians, nonvegetarians, and dieters, and to test the hypothesis that a vegetarian diet would not compromise nutrient intake when used to manage body weight. Design Cross-sectional analysis of National Health and Nutrition Examination Survey (1999-2004) dietary and anthropometric data. Diet quality was determined using United States Department of Agriculture's Healthy Eating Index 2005. Participants included adults aged 19 years and older, excluding pregnant and lactating women (N=13,292). Lacto-ovo vegetarian diets were portrayed by intakes of participants who did not eat meat, poultry, or fish on the day of the survey (n=851). Weight-loss diets were portrayed by intakes of participants who consumed 500 kcal less than their estimated energy requirements (n=4,635). Mean nutrient intakes and body mass indexes were adjusted for energy, sex, and ethnicity. Using analysis of variance, all vegetarians were compared to all nonvegetarians, dieting vegetarians to dieting nonvegetarians, and nondieting vegetarians to nondieting nonvegetarians. Results Mean intakes of fiber, vitamins A, C, and E, thiamin, riboflavin, folate, calcium, magnesium, and iron were higher for all vegetarians than for all nonvegetarians. Although vegetarian intakes of vitamin E, vitamin A, and magnesium exceeded that of nonvegetarians (8.3±0.3 vs 7.0±0.1 mg; 718±28 vs 603±10 μg; 322±5 vs 281±2 mg), both groups had intakes that were less than desired. The Healthy Eating Index score did not differ for all vegetarians compared to all nonvegetarians (50.5±0.88 vs 50.1±0.33, P =0.6). Conclusions These findings suggest that vegetarian diets are nutrient dense, consistent with dietary guidelines, and could be recommended for weight management without compromising diet quality.

The accuracy of stated energy contents of reduced-energy restaurant foods and frozen meals purchased from supermarkets was evaluated. Measured energy values of 29 quick-serve and sit-down restaurant foods averaged 18% more than stated values, and measured energy values of 10 frozen meals purchased from supermarkets averaged 8% more than originally stated. These differences substantially exceeded laboratory measurement error but did not achieve statistical significance due to considerable variability in the degree of underreporting. Some individual restaurant items contained up to 200% of stated values and, in addition, free side dishes increased provided energy to an average of 245% of stated values for the entrees they accompanied. These findings suggest that stated energy contents of reduced-energy meals obtained from restaurants and supermarkets are not consistently accurate, and in this study averaged more than measured values, especially when free side dishes were taken into account. If widespread, this phenomenon could hamper efforts to self-monitor energy intake to control weight, and could also reduce the potential benefit of recent policy initiatives to disseminate information on food energy content at the point of purchase.

The purpose of this pilot study was to evaluate the differences in weight control behaviors, dietary intake, and physical activity between overweight adolescents who lost weight and overweight adolescents who did not lose weight. This cross-sectional study compared 62 overweight adolescents who lost weight in the past with 68 overweight adolescents who did not lose weight. Youth responded to questions regarding weight control behaviors during the past year, physical activity, sedentary activity, and dietary intake. Results showed that adolescents who lost weight were more likely to report using healthful weight control behaviors such as drinking less soda and increasing their exercise level, self-weighing, consuming diets higher in protein, and spending less time watching television compared to overweight adolescents who did not lose weight. Unhealthful weight control behaviors and specific weight loss plans were not associated with weight loss in these teenagers. Adolescents would benefit from hearing this information to prevent the development of these behaviors. Providers should advise adolescents to engage in healthful weight control behaviors, such as increasing physical activity and decreasing the amount of time spent watching television, to assist with weight management.

Background Little is known about the dietary intake of school employees, a key target group for improving school nutrition. Objective To investigate selected dietary variables and weight status among elementary school personnel. Design Cross-sectional, descriptive study. Subjects/setting Elementary school employees (n373) from 22 schools in a suburban parish (county) of southeastern Louisiana were randomly selected for evaluation at baseline of ACTION, a school-based worksite wellness trial. Methods Two 24-hour dietary recalls were administered on nonconsecutive days by registered dietitians using the Nutrition Data System for Research. Height and weight were measured by trained examiners and body mass index calculated as kg/m 2 . Statistical analyses performed Descriptive analyses characterized energy, macronutrient, fiber, and MyPyramid food group consumption. Inferential statistics (t tests, analysis of variance, 2 ) were used to examine differences in intake and compliance with recommendations by demographic and weight status categories. Results Approximately 31% and 40% of the sample were overweight and obese, respectively, with higher obesity rates than state and national estimates. Mean daily energy intake among women was 1,862492 kcal and among men was 2,668796 kcal. Obese employees consumed more energy (288 kcal, P0.001) and more energy from fat (P0.001) than those who were normal weight. Approximately 45% of the sample exceeded dietary fat recommendations. On average, only 9% had fiber intakes at or above their Adequate Intake, which is consistent with the finding that more than 25% of employees did not eat fruit, 58% did not eat dark-green vegetables, and 45% did not eat whole grains on the recalled days. Only 7% of employees met the MyPyramid recommendations for fruits or vegetables, and 14% of the sample met those for milk and dairy foods. Conclusions These results suggest that greater attention be directed to understanding and improving the diets of school employees given their high rates of overweight and obesity, poor diets, and important role in student health. J Am Diet Assoc. 2009;109:1548-1556.

Hand-held personal digital assistant (PDA)-based food diaries have been developed for self-monitoring of dietary intake, but the accuracy of these diaries is unclear for patients with diabetes. The aim of the study was to assess the accuracy and feasibility of use of a new PDA-based food diary, including food photographs. The study included 44 Japanese participants without diabetes (mean age 23 years) and 16 Japanese patients with type 2 diabetes (mean age 53 years). The PDA-based food diary was used for 7 consecutive days. Information about all dietary intake on the 7th day of PDA self-monitoring was collected by a 24-hour recall interview on the 8th day. The PDA-based data for dietary intake on the 7th day were then compared to the 24-hour recall data for the same period. Feasibility was assessed based on the frequency and timeliness of self-monitoring. There was no significant difference in daily totals for energy, protein, carbohydrate, and fat between the two methods in each group. Pearson's correlation and intraclass correlation coefficients showed strong significant relationships for all variables between the two methods in both groups. Bland-Altman plots did not indicate any bias in estimated daily caloric intake. Participants recorded 98% of their meals in the PDA, with 75% of entries recorded within 6 hours after the meal starting time. The findings suggest that the PDA-based food diary is a potential clinical method to estimate dietary intake and may be a beneficial tool for self-monitoring of dietary intake.

Background Weight loss through dietary modification is key to type 2 diabetes self-management, yet few nationally representative data exist on dietary trends among people with diabetes. Objective To examine dietary changes, via nutrient intakes, among US adults with diabetes between 1988 and 2004. Design Nutrition data from the cross-sectional National Health and Nutrition Examination Surveys (Phase I: 1988-1990 and Phase II: 1991-1994) and 1999-2004 of adults with self-reported diabetes were examined. Twenty-four–hour dietary recall data were used to assess changes in energy; carbohydrate; protein; total, saturated, polyunsaturated, and monounsaturated fat; cholesterol; fiber; sodium; and alcohol intake. Statistical analyses Consumption of total energy and specific nutrients per day were estimated by survey, controlled for age and sex, using multiple linear regression and adjusted means (with standard errors). Results Between 1988 and 2004 there was no significant change in self-reported total energy consumption among adults with self-reported diabetes (1,941 kcal/day in 1988-1990 to 2,109 kcal/day in 2003-2004, P for trend=0.22). However, there was a significant increase in the consumption of carbohydrate (209 g/day in 1988-1990 to 241 g/day in 2003-2004; P for trend=0.02). In analyses stratified by age group, changes in dietary consumption were noted among persons aged 45 to 64 years; specifically, increases in total energy (1,770 to 2,100 kcal/day, P for trend=0.01) and carbohydrate consumption (195 to 234 g/day, P for trend=0.02). Conclusions Despite recommendations to lose weight, daily energy consumption by individuals with diabetes showed no significant change, except in individuals aged 45 to 64 years, where an increase was observed. Overall, there was an increase in carbohydrate consumption. Emphasizing the equal importance of energy reduction and changes in dietary composition for people with diabetes is important for optimal self-management.

It is the position of the American Dietetic Association that appropriately planned vegetarian diets, including total vegetarian or vegan diets, are healthful, nutritionally adequate, and may provide health benefits in the prevention and treatment of certain diseases. Well-planned vegetarian diets are appropriate for individuals during all stages of the life cycle, including pregnancy, lactation, infancy, childhood, and adolescence, and for athletes. A vegetarian diet is defined as one that does not include meat (including fowl) or seafood, or products containing those foods. This article reviews the current data related to key nutrients for vegetarians including protein, n-3 fatty acids, iron, zinc, iodine, calcium, and vitamins D and B-12. A vegetarian diet can meet current recommendations for all of these nutrients. In some cases, supplements or fortified foods can provide useful amounts of important nutrients. An evidence- based review showed that vegetarian diets can be nutritionally adequate in pregnancy and result in positive maternal and infant health outcomes. The results of an evidence-based review showed that a vegetarian diet is associated with a lower risk of death from ischemic heart disease. Vegetarians also appear to have lower low-density lipoprotein cholesterol levels, lower blood pressure, and lower rates of hypertension and type 2 diabetes than nonvegetarians. Furthermore, vegetarians tend to have a lower body mass index and lower overall cancer rates. Features of a vegetarian diet that may reduce risk of chronic disease include lower intakes of saturated fat and cholesterol and higher intakes of fruits, vegetables, whole grains, nuts, soy products, fiber, and phytochemicals. The variability of dietary practices among vegetarians makes individual assessment of dietary adequacy essential. In addition to assessing dietary adequacy, food and nutrition professionals can also play key roles in educating vegetarians about sources of specific nutrients, food purchase and preparation, and dietary modifications to meet their needs.

Objective Nursing facilities often provide enhanced or fortified foods as part of a "food-first" approach to increasing nutrient intakes in residents with inadequate intakes or who are experiencing weight loss. The study objective was to determine whether energy and protein enhancement of a small number of menu items would result in increased three-meal (breakfast, lunch, and supper) calorie and protein intakes in long-term care residents. Design A randomized cross-over design was used to compare investigator-weighed food intakes under three menu conditions: control (no meals enhanced); lunch only enhanced; and both breakfast and lunch enhanced. Two breakfast foods (juice and hot cereal) and two lunch foods (soup and potato side dish) were chosen for enhancement. Subjects/setting Participants were 33 nursing home residents from a facility in South Florida (average age=87.3 years). Statistical analysis Repeated-measures analysis of variance was used to test the effects of the within-subjects factor (control, lunch enhanced, breakfast and lunch enhanced conditions), the between-subjects factor (smaller vs bigger eater), and the interaction on intakes (gram, kilocalories, and protein). Results Results revealed that bigger eaters consumed considerably more calories when breakfast foods, but not lunch foods, were enhanced. Smaller eaters achieved an increase in energy intake when either breakfast or lunch was enhanced. Overall daily protein intakes were not substantially increased by food enhancement. These data suggest that for an enhanced food program to be most effective for smaller eaters, who are at greatest risk for undernutrition and weight loss, it should include several enhanced foods at more than one meal.

Background African Americans have a higher prevalence of diet-related chronic diseases than the general US population. Recent evidence suggests that examining dietary patterns rather than specific nutrients may better allow public health professionals to translate national dietary goals into practical dietary recommendations that are culturally relevant and sex-specific. Objective To examine and characterize the dietary patterns of African-American men and women using cluster analysis. Design Participants older than the age of 18 years were recruited from a variety of locations and completed a self-administered questionnaire. Subjects/setting Seven-hundred sixty-three African-American men and women in North Central Florida. Statistical analyses performed Cluster analysis was done with the VARCLUS procedure and Ward's clustering approach in the Statistical Analysis System program. The pseudo- t 2 statistic was then used to identify the optimal numbers of clusters of men and women with distinctive food-consumption patterns. Results Cluster analyses identified six clusters of men with 13 distinctive dietary patterns and six clusters of women with 15 distinctive dietary patterns. Pairwise comparisons of group means indicated notable differences in intakes between clusters of women in all but two food clusters. Pairwise comparisons of group means indicated notable differences in intakes between clusters of men in all but two food clusters. Conclusions The study illustrated that cluster analysis can be used to identify groups of African Americans with unique patterns of food consumption. They also suggest that a single "typical" eating pattern does not exist for African Americans and that dietary pattern vary by sex.

Banked donor milk may be a reasonable substitute for mother's milk for human infants. No data on the macronutrient composition of banked donor milk have been reported. This study determined the composition of donated milk from a large number of banked donor milk samples and compared it to the reported values for macronutrients in mature breast milk. During a 9-month sampling period (May 2006 through February 2007) from a nationwide milk bank network, 415 sequential samples from 273 unique donors were analyzed for fat, protein, and lactose content, as well as energy density. Descriptive statistics were computed, including mean, standard deviation, coefficient of variation, median, and range. Percentiles were determined from the empirical distribution of the data. A ninety-five percent confidence interval was computed using standard, large sample (Gaussian) methods. Banked donor milk mean values (in weight/volume) were found to be 1.16%±0.25% for protein, 3.22%±1.00% for fat, 7.80%±0.88% for lactose, and mean total energy was 65±11 kcal/dL. Banked donor milk macronutrient content was found to differ from the values reported in the literature for mature human milk. Unformulated banked donor milk alone, similar to mother's milk alone, does not have sufficient macronutrient content or energy density to sustain a very-low-birth-weight preterm infant. Fortification could make up for these shortcomings, perhaps making formulated banked donor milk a better choice for preterm infants than bovine-based formulas when mother's milk is unavailable.

The MyPyramid food guidance system provides recommended food intake patterns for members of each sex at various age and activity levels. These food intake patterns are based on recommendations of the Dietary Guidelines for Americans 2005. Actual consumption patterns of American adults compared to MyPyramid recommendations indicate that substantial changes are needed to meet the goals of MyPyramid. One method for encouraging dietary change, known as the small steps approach, involves small, gradual changes to meet a desired endpoint. Menu modeling was used to evaluate the effects of gradual dietary changes on diet quality. Seven days of baseline menus were developed to model the intake of adult women aged 31 to 50 years. Incremental changes were made to each baseline menu to create a series of three transitional menus and a final target menu. Target menus met MyPyramid energy and nutrient intake goals. Diet quality was measured for each baseline, transitional, and target menu using the Healthy Eating Index-2005. The average Healthy Eating Index-2005 score for baseline menus compared to target menus increased by more than 50 points with incremental increases observed for each transitional menu. This analysis demonstrates that small, practical changes in food choices that bring consumers closer to meeting MyPyramid recommendations result in gradual and dramatic improvements in diet quality. Food and nutrition professionals can use menu modeling to provide concrete examples and specific guidance for making progressive changes in food selections to meet current dietary recommendations.

This study investigated which methods patients and parents used to determine phenylalanine (Phe) intake and the relationship between the methods applied, age, and blood Phe concentration, as this practice had not been studied before in relation to metabolic control.A questionnaire was sent to 327 Dutch phenylketonuria patients (age 0-29 years) to investigate the method used to determine Phe intake (either by estimation, exact measurement, or a combination of both). Mean blood Phe concentration of each individual patient was related to the method reported to be used. Three different age groups (= 10-15 years, and >= 16 years) were distinguished. The response rate for the questionnaires was 73%. In these 188 patients, data for both Phe concentrations and questionnaires could be used. Of these, 75 used exact measurement, 75 used estimation, and 38 used both methods. The number of patients that estimated Phe intake clearly increased with age. Whatever method was used, an increase in Phe concentrations was seen with age. During childhood, exact measurement was used more frequently, and from adolescence on estimation was used more frequently. The method (exact measurement and/or estimation) did not result in statistically different Phe concentrations in any of the three age groups, although blood Phe concentration tended to be lower in adolescence using exact measurement. Data suggest that estimation and exact measurement of Phe intake are both reliable methods. Therefore, in addition to exact measurement, patients should be instructed in both methods at an early age, so that both methods can be used adequately.

The health and quality-of-life implications of overweight and obesity span all ages in the United States. We investigated the association between dietary protein intake and loss of lean mass during weight loss in postmenopausal women through a retrospective analysis of a 20-week randomized, controlled diet and exercise intervention in women aged 50 to 70 years. Weight loss was achieved by differing levels of caloric restriction and exercise. The diet-only group reduced caloric intake by 2,800 kcal/week, and the exercise groups reduced caloric intake by 2,400 kcal/week and expended approximately 400 kcal/week through aerobic exercise. Total and appendicular lean mass was measured using dual energy x-ray absorptiometry. Linear regression analysis was used to examine the association between changes in lean mass and appendicular lean mass and dietary protein intake. Average weight loss was 10.8+/-4.0 kg, with an average of 32% of total weight lost as lean mass. Protein intake averaged 0.62 g/kg body weight/day (range=0.47 to 0.8 g/kg body weight/day). Participants who consumed higher amounts of dietary protein lost less lean mass and appendicular lean mass (r=0.3, P=0.01 and r=0.41, P0.001, respectively). These associations remained significant after adjusting for intervention group and body size. Therefore, inadequate protein intake during caloric restriction may be associated with adverse body-composition changes in postmenopausal women.

In patients with type 2 diabetes mellitus (DM), the factors associated with under- or overreporting of protein intake in nutrition assessment tools, as well as the variability of diet records, have not been fully established. The aim of this cross-sectional study was to evaluate factors associated with under- or overreporting of protein intake and its variability in patients with type 2 DM. Protein intake was estimated in 205 patients (aged 59.8±9.6 years) using 3-day weighed diet records and 24-hour nitrogen output (criterion standard). Twenty-three patients repeated the 3-day weighed diet records three times. Clinical, nutrition, and lifestyle evaluations were performed. Coefficients of variation were calculated for protein intake. Factors associated with under- and overreporting were assessed using multivariate logistic regression models. Coefficients of variation for protein intake estimated by weighed diet records or nitrogen output were similar (11.9% vs 11.3%; P >0.05). Using Beaton's formula, a difference of 16.5% in protein intake between two 3-day weighed diet records was acceptable. The lowest A1c test tertile (≤6.9%) was associated with protein intake underreporting (odds ratio [OR]=0.40; 95% confidence interval [CI]=0.16 to 0.99; P =0.046] after adjustment for sex, age, employment status, and living alone. Male sex (OR=6.66; 95% CI: 2.08 to 22.07; P =0.002), A1c test (OR=1.29; 95% CI: 1.02 to 1.64; P =0.036), and body mass index (OR=0.89; 95% CI: 0.80 to 0.994; P =0.039), adjusted for physical and employment status, education, and preparing one's own meals, were associated with overreporting. In conclusion, in patients with type 2 DM, a difference >16.5% in protein intake between two 3-day weighed diet records should be interpreted as a true discrepancy. Poor glucose control and male sex increase the chance of inaccurate 3-day weighed diet records.

Objective It is now well-established that individuals misreport their dietary intake. We propose a new method (National Research Council-Biomarker [NRC-B]) for estimating population distributions of usual dietary intake from national survey 24-hour recall data, using additional biomarker data from an external study to adjust for such dietary misreporting. Statistical analyses performed NRC-B is an extension of the NRC method, and is based upon two developed assumptions: the ratio of the mean of true intake to that of reported intake is equal in the survey and external biomarker study; and the ratio of the variance of true intake to that of reported intake is equal in these two studies. NRC-B adjusts the usual intake distribution both for within-person variation and for bias (underreporting) that occur with 24-hour recall reports. Using doubly labeled water ( 2 H 2 18 O) measurements from the Observing Protein and Energy Nutrition study, we applied NRC-B to data on energy intake for adults aged 40 to 69 years from two national surveys, the Continuing Survey of Food Intakes by Individuals and National Health and Nutrition Examination Survey. We compared the results with the NRC and traditional methods that used only the survey data to estimate dietary intake distributions. Results Estimated distributions from NRC-B and NRC were much narrower and less skewed than from the traditional method. However, unlike NRC, the median of the NRC-B based distribution was higher by 8% to 16% than the traditional method in our examples. Conclusions The proposed method adjusts for the well-documented problem of underreporting of energy intake.

There are only a few studies assessing the nutrient intake of Greek children in the literature. Therefore, the aim of this study was to assess the nutrient adequacy of the diets of a representative sample of 2,374 toddlers and preschoolers with full anthropometric and dietary intake data. Usual nutrient intakes were calculated after adjusting raw data for within-person variance and correcting for underreporting. The percentages of children meeting or not meeting recommendations for energy and nutrient intakes were estimated. Differences in mean values were tested with one-way analysis of variance, while χ 2 and Fisher exact tests were used to explore the association between categorical variables. For both fat and carbohydrate, a substantial percentage of toddlers and preschoolers had usual intakes outside the acceptable macronutrient distribution range, whereas protein was less than this range. "At risk of overweight" and "overweight" children consumed more total energy, protein, and fat compared with their normal-weight counterparts, whereas no differences were found for micronutrient intakes. The estimated prevalence of inadequacy was found to be between 10% and 25% for niacin, vitamin E, and folate. Usual intakes exceeding the Tolerable Upper Intake Levels were recorded for zinc and copper.

Objective To describe the nutrient and food composition of the diets tested in the Optimal Macronutrient Intake Trial to Prevent Heart Disease (OmniHeart). Design Two center, randomized, three-period crossover, controlled feeding trial that tested the effects of three healthful diet patterns on blood pressure, serum lipid levels, and estimated cardiovascular risk. Subjects/setting One hundred sixty-four participants with prehypertension and hypertension. During the 19 weeks of feeding, participants were required to consume only food prepared as part of the trial. Intervention The OmniHeart trial studied three diet patterns that differed in macronutrient composition: a carbohydrate-rich diet similar to the Dietary Approaches to Stop Hypertension diet (58% carbohydrate, 15% protein, and 27% fat), a higher protein diet that had 10% more protein and 10% less carbohydrate (48% carbohydrate, 25% protein, and 27% fat), and a higher unsaturated fat diet that had 10% more unsaturated fat and 10% less carbohydrate (48% carbohydrate, 15% protein, and 37% fat). Each diet contained 6% saturated fat and 100 to 200 mg cholesterol. Sodium was 2,300 mg at the 2,100 kcal energy level and was indexed across energy levels. Calcium, magnesium, and potassium were consistent with recommendations for the Dietary Approaches to Stop Hypertension diet and also indexed to energy levels. Each diet pattern met the major nutrient recommendations set by the Dietary Guidelines for Americans 2005 . The 10% protein increase in the higher protein diet emphasized plant protein; however, meat and dairy food sources were also increased somewhat. Olive oil, canola oil, and olive oil spread were used liberally to achieve the unsaturated fat content of the higher unsaturated fat diet. The 10% reduction in carbohydrate in the higher protein diet and the higher unsaturated fat diet was achieved by replacing some fruits with vegetables, reducing sweets, and using smaller portions of grain products. All three diets reduced blood pressure, total and low-density lipoprotein cholesterol levels, and estimated coronary heart disease risk. Conclusions The OmniHeart diet patterns offer substantial flexibility in macronutrient intake that should make it easier to eat a heart-healthy diet and reduce cardiovascular disease risk.

We assessed the impact of a pilot middle school a la carte intervention on food and beverage purchases, kilocalories, fat, carbohydrate, and protein sold per student, and nutrient density of the foods sold. A la carte sales were obtained from six middle schools in three states for 1 baseline week and daily during the 6-week intervention. Intervention goals included reducing sizes of sweetened beverages and chips, and increasing the availability of water and reduced-fat/baked chips. Nutrients sold per day were computed and weekly nutrient means per student and per number of items sold were calculated and compared between baseline and week 6. Five schools achieved all goals at 6 weeks. Four schools showed increases in the percentage of kilocalories from protein and decreases in the amount of sweetened beverages sold; five showed substantial increases in water sales. Changes in regular chips varied by school. There were significant changes in energy density of foods sold. School foodservice changes in middle school snack bar/a la carte lines can be implemented and can lead to a reduction in the caloric density of foods purchased.

Objective It is unknown whether dietary patterns or macronutrient composition contribute to the observed differences in rates of overweight and obesity among Hispanic and non-Hispanic white women in the United States. We assessed the association of dietary patterns and macronutrient composition with overweight and obesity in Hispanic and non-Hispanic white women. Design Cross-sectional analysis of dietary data from a case-control study of breast cancer. Participants Population-based control participants (871 Hispanic and 1,599 non-Hispanic white women) from the southwestern United States who completed the diet and other components of the interview and whose anthropometric measurements were available. Main outcome measures Body mass index (BMI; calculated as kg/m 2 ), weight status (overweight, BMI 25 to 29.9; obese, BMI>30). Statistical analyses performed Dietary patterns were defined using factor analysis. Associations of dietary patterns and macronutrient composition with overweight and obesity as compared with normal weight were assessed with logistic regression. Results Hispanic women reported consuming more energy, a greater proportion of energy from fat and vegetable protein, less alcohol, and less energy from animal protein compared with non-Hispanic white women. Western and dieter patterns were associated with higher prevalence of overweight and obesity; the Prudent dietary pattern was associated with a 29% lower prevalence of overweight and a halving of the prevalence of obesity similarly in Hispanic and non-Hispanic white women. Higher proportions of energy from protein (odds ratio [OR] 1.81, 95% confidence interval [CI] 1.28 to 2.56) and animal protein (OR 2.10 95% CI 1.47 to 2.98) were associated with a greater risk of overweight; greater proportions of energy from fat (OR 2.28, 95% CI 1.27 to 4.08), protein (3.55 95% CI 2.38 to 5.29), or animal protein (3.44 95% CI 2.31 to 5.14) were associated with higher risk of obesity among non-Hispanic white women only. Conclusions A Western dietary pattern was associated with greater risk and a Prudent diet with reduced risk of overweight and obesity. To reduce risk of overweight and obesity, Hispanic women should maintain healthful aspects of a native Hispanic diet, and non-Hispanic white women should replace animal protein with vegetable protein.

Validation study data are used to illustrate that conclusions about children's reporting accuracy for energy and macronutrients over multiple interviews (ie, time) depend on the analytic approach for comparing reported and reference information-conventional, which disregards accuracy of reported items and amounts, or reporting-error-sensitive, which classifies reported items as matches (eaten) or intrusions (not eaten), and amounts as corresponding or overreported.Children were observed eating school meals on 1 day (n=12), or 2 (n=13) or 3 (n=79) nonconsecutive days separated byor=25 days, and interviewed in the morning after each observation day about intake the previous day. Reference (observed) and reported information were transformed to energy and macronutrients (ie, protein, carbohydrate, and fat), and compared.For energy and each macronutrient: report rates (reported/reference), correspondence rates (genuine accuracy measures), and inflation ratios (error measures).Mixed-model analyses.Using the conventional approach for analyzing energy and macronutrients, report rates did not vary systematically over interviews (all four P values0.61). Using the reporting-error-sensitive approach for analyzing energy and macronutrients, correspondence rates increased over interviews (all four P values0.04), indicating that reporting accuracy improved over time; inflation ratios decreased, although not significantly, over interviews, also suggesting that reporting accuracy improved over time. Correspondence rates were lower than report rates, indicating that reporting accuracy was worse than implied by conventional measures.When analyzed using the reporting-error-sensitive approach, children's dietary reporting accuracy for energy and macronutrients improved over time, but the conventional approach masked improvements and overestimated accuracy. The reporting-error-sensitive approach is recommended when analyzing data from validation studies of dietary reporting accuracy for energy and macronutrients.

In individuals with chronic kidney disease, high-protein diets have been shown to accelerate renal deterioration, whereas low-protein diets increase the risk of protein malnutrition. Vegetarian diets have been promoted as a way to halt progression of kidney disease while maintaining adequate nutrition. We review the literature to date comparing the effects of animal and vegetable protein on kidney function in health and disease. Diets with conventional amounts of protein, as well as high-protein diets, are reviewed. The literature shows that in short-term clinical trials, animal protein causes dynamic effects on renal function, whereas egg white, dairy, and soy do not. These differences are seen both in diets with conventional amounts of protein and those with high amounts of protein. The long-term effects of animal protein on normal kidney function are not known. Although data on persons with chronic kidney disease are limited, it appears that high intake of animal and vegetable proteins accelerates the underlying disease process not only in physiologic studies but also in short-term interventional trials. The long-term effects of high protein intake on chronic kidney disease are still poorly understood. Several mechanisms have been suggested to explain the different effects of animal and vegetable proteins on normal kidney function, including differences in postprandial circulating hormones, sites of protein metabolism, and interaction with accompanying micronutrients.

A randomized controlled trial previously conducted in radiation oncology patients demonstrated that nutrition intervention had a beneficial impact on body weight, nutritional status, and quality of life compared with standard practice, but it did not report on dietary intake data.To determine the impact of nutrition intervention compared with standard practice on dietary intake in outpatients receiving radiotherapy.Prospective, randomized, controlled trial.Sixty consecutive radiation oncology outpatients (51 men and nine women; age 61.9+/-14 years [mean+/-standard deviation]).Australian private radiotherapy facility.Patients were randomly assigned to receive either nutrition intervention (n=29) (nutrition counseling following the American Dietetic Association [ADA] medical nutrition therapy [MNT] protocol for radiation oncology) or standard practice (n=31) (general nutrition talk and booklet).Dietary intake (protein, energy, fiber) assessed at baseline and at 4, 8, and 12 weeks after starting radiotherapy.Repeated-measures analysis of variance done on an intention to treat basis.The nutrition intervention group had a higher mean total energy (P=0.029) and protein intake (P0.001) compared with the standard practice group. Mean intake per kilogram of body weight for the nutrition intervention group ranged from 28 to 31 kcal/kg/day compared with 25 to 29 kcal/kg/day for the standard practice group (P=0.022). The nutrition intervention group had a higher mean protein intake (1.1 to 1.3 g/kg/day) compared with the standard practice group (1.0 to 1.1 g/kg/day) (P=0.001). Although the change in fiber intake between the groups was not significant, there was a trend in the anticipated direction (P=0.083).Intensive nutrition intervention following the ADA MNT protocol results in improved dietary intake compared with standard practice and seems to beneficially impact nutrition-related outcomes previously observed in oncology outpatients receiving radiotherapy. The ADA MNT protocol for radiation oncology is a useful guide to the level of nutrition support required.

Objectives Dysphagia affects 35% to 60% of the institutionalized elderly population. This study aimed at evaluating the nutrient intake of frail institutionalized elderly persons with dysphagia and to assess the impact of Sainte-Anne's Hospital Advanced Nutritional Care program on dietary intake and weight. Design A 12-week intervention study. Subjects/setting Ninety-three individuals residing in a Montreal, Canada, long-term care facility who were aged at least 65 years were evaluated. Seventeen subjects with a body mass index (BMI; calculated as kg/m 2 ) 7.5% within 3 months and with dysphagia were included. Intervention The treated group (n=8; aged 82.5±4.41 years, weight 55.9±12.1 kg, BMI 22.4±3.93) received Sainte-Anne's Hospital reshaped minced- or pureed-texture foods with thickened beverages where required. The control group (n=9; aged 84.6±3.81 years, weight 54.3±7.49 kg, BMI 21.2±2.31) maintained traditional nourishment. Main Outcome Measures Macronutrient and micronutrient intake, weight, and BMI were measured at baseline, 6 weeks, and 12 weeks. Statistics Student t tests were performed to evaluate change within and between groups. Results The treatment and control groups were similar at baseline, having a mean age of 82.5±4.41 years vs 84.6±3.81 years and BMI of 22.4±3.93 vs 21.2±2.31, respectively. The average weight in the treated group increased compared to the control group (3.90±2.30 vs –0.79±4.18 kg; P =0.02). Similarly, the treated group presented an increased intake of energy, proteins, fats, total saturated fats, monounsaturated fats, potassium, magnesium, calcium, phosphorus, zinc, vitamin B-2, and vitamin D compared to control subjects ( P Conclusion Institutionalized elderly patients with dysphagia can eat better and increase body weight via a diversified, modified in texture, and appealing oral diet that meets their nutrition needs.

This study examines the cross-sectional associations between cardiorespiratory fitness and the metabolic syndrome with adjustment for macronutrient intake from 3-day dietary records.Cross-sectional study.Women and men who had a comprehensive medical examination, including a symptom-limited maximal treadmill exercise test, and completed 3-day dietary records at the Cooper Clinic, Dallas, TX.Metabolic syndrome as defined by the National Cholesterol Education Program Adult Treatment Panel III criteria.Analysis of variance was used to examine differences in continuous data. General linear analysis was used to examine linear trends. Mantel-Haenszel chi(2) analyses were used to examine differences in categorical data. Logistic regression was used to estimate odds ratios and 95% confidence intervals.After adjusting for sex and age, cardiorespiratory fitness was inversely associated with the prevalence of metabolic syndrome (P0.001). Adjustment for macronutrient intake and other potential confounding variables did not alter the association between cardiorespiratory fitness and prevalent metabolic syndrome.Cardiorespiratory fitness is inversely associated with the prevalence of metabolic syndrome. Patients should be encouraged to increase their physical activity to decrease their risk for metabolic syndrome and coronary heart disease.

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 χ 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.

Some psychological predictors of eating behaviors have been shown to affect usefulness of methods for dietary assessment. Therefore, this study was conducted to determine the association of dietary restraint and disinhibition with dietary recall accuracy for total energy, fat, carbohydrate, and protein. In a cross-sectional study, data were obtained from 79 male and 71 female non-Hispanic whites and African-American volunteers. Participants selected and consumed all foods for a 1-day period under observation and actual intake was determined. The following day, each participant completed a telephone 24-hour recall using the US Department of Agriculture Multiple-Pass method to obtain recalled intake. The Eating Inventory, which measures dietary restraint and disinhibition, was administered prior to eating any food in the study. Repeated measures analyses of variance were used to determine if dietary restraint or disinhibition were independent predictors of recall accuracy. The mean (+/-standard deviation) age and body mass index of the participants was 43+/-12 years and 29+/-5.5 (calculated as kg/m2), respectively. On average, men overreported intake of energy by 265 kcal and women by 250 kcal; both groups also overreported intake of protein, carbohydrate, and fat. When controlling for body mass index, sex, and race, restraint was a significant independent predictor of energy intake (P=0.004) and negatively correlated with energy intake (r=-0.23, P0.001). Unlike intake of carbohydrate or protein, fat intake was significantly and negatively associated with dietary restraint (P0.001; r=-0.3). Dietary restraint did not affect accuracy of recall of intake of energy, fat, carbohydrate, or protein, but was significantly associated with intake of energy and fat. Disinhibition was not related to intake or accuracy. Dietetics professionals should consider dietary restraint a possible reason for a lower than expected estimate of energy intake when using 24-hour recalls.

Objective This study was undertaken to test the hypothesis that specific meal and snack patterns are associated with selected nutrient intakes in US adults. Design Using the 24-hour dietary recall from the Third National Health and Nutrition Examination Survey, meal and snack patterns were described in relation to nutrient intakes. Subjects The study included US adults aged 20 years or older (n=15,978). Statistical Analyses Performed All statistical analyses accounted for the survey design and sample weights. Linear regression analyses controlled for confounding factors, including energy intakes. Wald F tests were used for determination of significance between means of nutrient intakes by daily eating frequency or meal pattern groups. Results Daily eating frequency was positively related to carbohydrate, folic acid, vitamin C, calcium, magnesium, iron, potassium, and fiber intakes and inversely related to protein, total fat, cholesterol, and sodium intakes. Meal patterns were further categorized into the five most commonly reported meal and snack combinations by population percentages including breakfast (B), lunch (L), dinner (D), and ≥2 snacks (S) (31.6%); B, L, D and 1 S (15.4%); B, D and ≥2 S (13.1%); B, L, D (8.3%); and L, D and ≥2 S (7.6%). Groups reporting B, L, D and 1 S and B, L, D and ≥2 S had the highest intakes of all micronutrients examined except cholesterol, vitamin B-6, and sodium. Breakfast skippers (L, D and ≥2 S) had the lowest intakes of all micronutrients examined except sodium. Conclusions Findings from this cross-sectional survey suggest that meal and snack patterns may be markers for nutrient intakes and therefore diet quality. Complete nutrient intakes should be considered in investigations of meal patterns and health outcomes.

International audience; Objectives: The Dietary Guidelines for Americans 2005 recommended that consumers give priority to nutrient dense foods, those that contain substantial amounts of key nutrients in relation to the dietary energy they provide. This study developed a scoring system to estimate the nutritional adequacy of vegetables and fruits, on a per weight, per calorie, and per unit cost basis. Data: we used a French national food composition database for 637 foods, including 129 vegetables and fruits. Mean national retail prices were obtained for each food. Methods: The nutrient adequacy score was defined as the mean of percent daily values for 16 nutrients, based on 100 g of food. The nutrient density score and the nutrient to- price ratio were the mean of percent daily values for 16 nutrients, expressed per 100 kcal and per 1 euro of food, respectively. Relationships between energy density of vegetables and fruits, nutrient adequacy score, nutrient density score, and nutrient-to-price ratio were tested using linear regression. Results: Energy density and nutrient density score were negatively correlated, confirming the widely accepted notion that energy-dense foods tend to be nutrient-poor. As expected, fruits and vegetables had the highest nutrient density score because they were nutrient-rich in relation to their low energy content. They also had a relatively high nutrient-to-price ratio, showing that they provided nutrients at a reasonable cost when compared with other foods. Conclusions: Foods ranked differently when nutritional adequacy was calculated per weight (nutrient adequacy score), per calorie (nutrient density score), or per unit cost (nutrient-to-price ratio). The present results showed that although fruits and vegetables are an expensive source of dietary energy, they provide key nutrients at a reasonable cost

The aim of this study was to identify sources of nutrients in diets of young Swedish vegans and omnivores. Three months of dietary intakes were investigated by diet history interviews. Volunteers were recruited through advertising and visits to schools in the city of Umeå, Sweden. Thirty vegans, 15 female and 15 male, aged 17.5+/-1.0 years, were compared with 30 sex-, age-, and height-matched omnivores. Vegans had different sources of nutrients than young omnivores and relied to a great extent on dietary supplements as a source of vitamin B-12, vitamin D, calcium, and selenium. Dietary intake of vegetables, fruits, and berries exceeded 500 g/day for 21 of the 30 vegans, whereas the same held true for only 1 of the 30 omnivores. Instead of animal products, young vegans rely on dietary supplements, legumes, vegetables, fruits, and berries as sources of nutrients.

The impact of a low-carbohydrate/high-protein diet compared with a high-carbohydrate/low-fat diet on ratings of hunger and cognitive eating restraint were examined. Overweight premenopausal women consumed a low-carbohydrate/high-protein (n=13) or high-carbohydrate/low-fat diet (n=15) for 6 weeks. Fasting body weight (BW) was measured and the Eating Inventory was completed at baseline, weeks 1 to 4, and week 6. All women experienced a reduction in BW (P

Greater average weight losses (2.5 kg over 12 weeks) have been reported for low-carbohydrate diets (90 g/day) compared with traditional low-fat (25% of energy), hypocaloric diets, implying a 233 kcal/day greater energy deficit. It has therefore been suggested that a low-carbohydrate diet may provide a metabolic advantage (an increase in energy expenditure), resulting in a positive effect on weight loss and maintenance. However, a review of studies in which 24-hour energy expenditure was measured did not provide evidence to support a metabolic advantage of low-carbohydrate diets and showed little evidence of a metabolic advantage of high-protein (25% of energy) diets. Nonetheless, diets high in protein, but either low or modest in carbohydrate, have resulted in greater weight losses than traditional low-fat diets. We speculate that it is the protein, and not carbohydrate, content that is important in promoting short-term weight loss and that this effect is likely due to increased satiety caused by increased dietary protein. It has been suggested that the increased satiety might help persons to be more compliant with a hypocaloric diet and achieve greater weight loss. The current evidence, combined with the need to meet all nutrient requirements, suggests that hypocaloric weight-loss diets should be moderate in carbohydrate (35% to 50% of energy), moderate in fat (25% to 35% of energy), and protein should contribute 25% to 30% of energy intake. More studies of the efficacy of weight-loss and weight-maintenance diets that address protein content are needed. In addition, controlled studies of total energy expenditure or physical activity measured under free-living conditions that directly compare high-protein diets with those containing low and moderate carbohydrate content should also be performed.

Objective The objective of this study was to compare estimated nutrient intakes from 3-day food records vs Food Frequency Questionnaire (FFQ) in a large cohort of individuals living with human immunodeficiency virus (HIV) infection. Design Dietary data from 315 HIV-positive participants enrolled in a longitudinal cohort study were collected. Nutrient intake data estimated from the Block FFQ were compared with multiple 3-day food records done over the same time period. Subjects/setting Participants enrolled in Nutrition for Healthy Living, an ongoing cohort study based in Boston, MA, were studied. Statistical analyses performed Using 3-day food records as the gold standard, we compared estimated nutrient intakes between the two assessment methods by (a) median of individual differences in intake, (b) correlation coefficients, (c) quintile ranking, and (d) intakes less than the Dietary Reference Intakes. Nutrient intake estimates between the two methods were compared using Spearman, Pearson, and deattenuated correlation coefficients. Results Median reported intakes of all macronutrients and most micronutrients were significantly less on the FFQ for both men and women. Deattenuated correlations were less than 0.5 for 86% of the men and for 68% of the women. Mean percent agreement for quintile ranking was 30%. Conclusions In this large cohort of HIV-infected adults, we found significant differences between FFQs and food records in estimates of absolute dietary intakes, correlation coefficients, quintile rankings, and proportions of subjects consuming less than the Dietary Reference Intakes. These findings have implications for the interpretation and application of dietary intake data from FFQs in specialized populations.

Reducing red meat intake to lower serum cholesterol may also lower iron and zinc intake. Eighty-six seventh and eighth graders who enrolled in a study comparing serum ferritin, zinc, and cholesterol levels were randomized to a low-fat eating pattern emphasizing either lean beef or lean poultry and fish. Serum data and three 24-hour recalls were collected at baseline and 3 months. The lean beef group ate significantly more beef [26 (4, 37) g/d; P.01] and both groups reduced total and saturated fat intake. Although serum ferritin level change between baseline and intervention was significantly different between the lean beef and lean poultry and fish groups (median [interquartile range] 0.7 [-6, 8] and -6.8 [-12, 2] microg/dL, respectively), the drop in the lean poultry and fish group was not clinically significant. No differences were observed in iron and zinc intake or in serum zinc and cholesterol levels. Teenagers eating diets low in saturated fat may benefit from adequate amounts of lean red meat.

Background The Block98 food frequency questionnaire (FFQ) has been validated for dietary assessment of usual intakes in adults, but not in children. Objective To assess the agreement of the Block98 FFQ and 3-day diet records for measuring dietary intakes in young girls. Subjects/setting Healthy 4- to 9-year-old girls (N=61; 6.5±1.6 years) were recruited from the Athens/Clarke county area in Georgia. Design Dietary intakes were measured using the Block98 FFQ and 3-day diet records, with nutrient analysis of the 3-day diet records conducted using the Food Processor computer program (ESHA; version 7.21, 1998, ESHA Research, Salem, OR). The Block98 FFQ was completed by a trained interviewer and parent, with input from the child, if able. Food models and portion size pictures were used to increase reporting accuracy. Statistical analysis Paired sample t tests and simple regression were conducted to determine whether the two diet instruments reported similar values for energy and macronutrients. Results Block98 FFQ overestimated intakes from 3-day diet records for energy (2,180±692 vs 1,749±328 kcal), protein (68.3±25.9 vs 57.9±14.8 g/day), carbohydrate (298.7±97.0 vs 244.7±46.1 g/day) and fat (83.6±30.5 vs 62.3±14.7 g/day) ( P r =0.40 to 0.55). Applications/conclusions The Block98 FFQ agreed weakly to moderately with the 3-day diet records, and resulted in consistently higher intakes of all nutrients. These findings suggest that additional work is needed to develop a FFQ that reflects young children's energy and macronutrient intakes.

Objective The aim of this study was to examine whether estimated net acid excretion (NAE) from two dietary assessment instruments can predict urine pH in healthy volunteers. Design The Observing Protein and Energy Nutrition (OPEN) study, which was designed to assess dietary measurement error, included men and women aged 40 to 69 years. Participants were asked to complete two food frequency questionnaires (FFQs) and two 24-hour recalls at approximately three-month intervals, and to return two 24-hour urine samples during the same period. NAE was estimated using a previously described equation. The estimates obtained from the different dietary assessment measures were correlated with actual urine pH. Subjects/Setting Four hundred eighty-four subjects were enrolled in the OPEN study. All participants were included in this study on urine pH, given that they had all completed at least one dietary assessment and one urine sample. The study took place in Montgomery County, MD, between September 1999 and March 2000. Results Correlation coefficients between NAE estimates using the FFQ data and the average of two urine pH measures were −0.34 and −0.39 for women and men, respectively. Removing within-person variance in the urine pH levels resulted in a deattenuated overall correlation of −0.50 for the FFQ. Correlations between the 24-hour recall estimates of NAE were −0.41 and −0.32 for women and men, respectively. For the 24-hour recalls, the deattenuated overall correlation was −0.50. Application/Conclusions Our findings suggest that FFQs provide adequate dietary data to estimate renal NAE and could be used as a surrogate for urinary pH levels in large epidemiologic studies. J Am Diet Assoc. 2003;103:1001-1007.

Objective To evaluate acceptance of soy-enhanced compared with traditional menus by preschool children. Soy-enhanced foods were substituted on a traditional cycle menu, and the amount eaten, energy, and nutrient values for traditional and soy-enhanced lunches were compared. Design A traditional three-week cycle menu, using the Child and Adult Care Food Program (CACFP) meal pattern guidelines, was used to develop a comparable soy-enhanced menu. Traditional and soy-enhanced lunches were randomly assigned to respective days. Foods were portioned onto individual plates using standardized measuring utensils. Individual plate waste techniques were used to collect food waste. Subjects/setting Participants were preschool children, three to six years of age and of white and Hispanic origin, attending a part-day Head Start program. Statistical analyses performed Analysis of covariance was used to adjust lunch and food intakes for differences in average amounts of foods served. The Nutrient Data System was used to calculate energy and nutrient content of lunches. Analysis of variance was used to calculate differences in amounts eaten, energy values, and nutrient values of traditional and soy-enhanced lunches and foods. Data analyses were performed with the Statistical Analysis Software (version 8.0, 1999, SAS Institute, Cary, NC). Results Soy-enhanced foods were successfully substituted for 23 traditional foods included in the cycle menus. Soy-enhanced foods tended to be higher in energy, protein, and iron. Traditional lunches tended to be higher in fat, saturated fat, and vitamin A. Consumption was significantly less for energy, protein, fiber, and iron from foods eaten from traditional compared with soy-enhanced lunch menus. Applications/conclusions Acceptance of soy-enhanced lunches was shown because there were no significant differences in the average amount eaten (grams per meal) between traditional and soy-enhanced lunches. Preschool programs can substitute soy-enhanced for traditional foods, which will add variety to the diet without sacrificing taste, energy, or nutrient value. The fat and energy content of the lunches was higher than recommended, and soy-enhanced foods were not always lower in fat. There is a need for the food industry and foodservice personnel to address the energy and fat content of all foods served in lunches to preschool children because a few extra calories added to the daily intakes can contribute to weight gain. J Am Diet Assoc. 2003;103:346-351.

Nutritional status, eating behaviors and menstrual function was examined in 23 nationally ranked female adolescent volleyball players using a health/weight/ dieting/menstrual history questionnaire, the Eating Disorder Inventory (EDI), and the Body Shape Questionnaire (BSQ). Nutrient and energy intakes (El) and energy expenditure (EE) were determined by 3-d weighed food records and activity logs. Iron (Fe), vitamins C, B12, and Folate status were assessed using serum and whole blood. Mean El (2248 +/- 414 kcal/d) was less than EE (2815 +/- 306 kcal/d). Mean carbohydrate (5.4 +/-1.0g/kg/d) and protein (1.1+/-0.3g/kg/d) intakes were below recommended levels for highly active women. Mean intakes for folate, Fe, Ca, Mg, and Zn were less than the respective RDAs/DRIs and almost 50% of the athletes were consuming less than the RDAs/DRIs for the B-complex vitamins and vitamin C. Three athletes presented with Fe deficiency anemia (Hb12 mg/dL), while marginal vitamin B12 status (200 pg/ml) and vitamin C status (28 mmol/L) were found in 1 and 4 athletes, respectively. Approximately 1/2 of the athletes reported actively "dieting". Mean BSQ and EDI subscales scores were within the normal ranges; yet, elevated scores on these scales were reported by 26% and 35% of athletes, respectively. Past or present amenorrhea was reported by 17% of the athletes and 13% and 48%, reported past or present oligomenorrhea and "irregular" menstrual cycles, respectively. These results indicate that elite adolescent volleyball players are at risk for menstrual dysfunction and have energy and nutrient intakes that place them at risk for nutritional deficiencies and compromised performance.

Recent studies in adults suggest that individual dietary fatty acids differ markedly in their effects on serum lipids and lipoprotein levels. However, these associations have rarely been studied in children.To assess, using regression procedures, the associations in children between specific fatty acids and nonfasting serum lipids and cholesterol after controlling for total energy and total fat intake,The sample consisted of 1,182 children who participated in the Child and Adolescent Trial for Cardiovascular Health. The sample was equally distributed across 4 sites (Louisiana, Texas, Minnesota, California). The sample was 48% boys; 71% white, 15% Hispanic-American, 10% African-American, 2% Asian, and 2% from other or unspecified racial/ethnic heritage.In this randomized multicenter trial with 56 intervention and 40 control elementary schools, food record-assisted 24-hour dietary recalls and serum lipid measurements were collected for each child at baseline (3rd grade) and at the 5th grade follow-up.Repeated-measures analysis of variance was used to evaluate the association between nutrient composition of the diet and serum lipids. Independent dietary variables included amount and type of fat, individual fatty acids, protein, carbohydrate, and fiber. The dependent variables were the absolute values of serum total cholesterol (TC) and high-density lipoprotein cholesterol (HDL-C) both at baseline (3rd grade) and at follow-up (5th grade).Increased total fat (b=0.053; P.03) was associated with increased TC in the model when energy was held constant, whereas increased carbohydrate was associated with decreased TC (b=-0.021, P.02) and HDL-C (b=-0.010, P.005) levels. Increased total protein (b=0.017, P.05) was associated with increased HDL-C when energy was held constant. Saturated fat (b=0.004, P.04), unsaturated fat (b=0.004, P.03), and myristic fatty acid (b=0.021, P.01) all increased TC in the model when total fat and total energy were held constant.We conclude that using a modeling approach, the effect of diet on serum lipids in children is similar to that observed in adults. Total fat and saturated fat were positively associated with TC and HDLC levels, saturated fat was positively associated with TC, and carbohydrate was inversely associated with both TC and HDL-C. In the statistical model, substitution of unsaturated fatty acids, monounsaturated fatty acids, or oleic acid for saturated fat, while holding total fat and energy constant, slightly lowered TC. In contrast, substitution of total fat for carbohydrate in the model increased TC and, thus, did not seem to be associated with an apparent health advantage except for HDL-C elevating effects. However, consumption of individual fats tends to be highly correlated, and we were unable to determine if these biological effects were operating independently.

Objective Evaluate the baseline nutrient intake of an HIV positive population that includes significant representation from women and minorities, and determine the relationship between state of disease and nutritional intake. Design Baseline data from a prospective study (Nutrition for Healthy Living). Subjects Individuals with HIV in the Boston and Rhode Island area (n=516); 25% were women and 30% were minorities. Methods Nutrient intakes from 3-day food records, which included vitamin/mineral supplements, were estimated by gender and nonwhite vs white categories, after grouping by CD4 lymphocyte counts. Statistical Analyses Spearman correlation coefficients, Wilcoxon signed rank test, Wilcoxon rank sum test, χ 2 test, and restricted cubic spline model were used for data analyses as indicated. Results Macronutrient but not micronutrient intake was statistically and inversely associated with decreasing CD4 cell counts. The median intake of micronutrients was higher in the study sample compared with the same age and gender group in NHANES III data; however, 25% to 35% of the women in our study sample had dietary intakes of less than 75% of the DRIs for vitamins A, C, E and B-6, and iron and zinc. White men had statistically higher values of all micronutrients compared with nonwhite men. Body mass index for men and women ranged from 23 to 25. Conclusions/Applications Median values for micronutrient intake from food plus vitamin/mineral supplements were adequate in the overall population studied, but a large percent of women and minorities had inadequate nutrient intakes and would benefit from dietary assessment and counseling. J Am Diet Assoc. 2002;102:203-211.

Medical nutrition therapy for people with diabetes should be individualized, with consideration given to the individual's usual food and eating habits, metabolic profile, treatment goals and desired outcomes. Monitoring of metabolic parameters, including glucose, HbA1c, lipids, blood pressure, body weight, and renal function, when appropriate, as well as quality of life is essential to assess the need for changes in therapy and ensure successful outcomes. Ongoing nutrition self-management education and care needs to be available for individuals with diabetes. Additionally many areas of nutrition and diabetes require additional research.