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Snacking may play a role in weight control. The associations of timing and frequency of snacking with observed weight change and nutrient intake were assessed in an ancillary study to a 12-month randomized controlled trial in Seattle, WA. Overweight-to-obese postmenopausal women (n=123) enrolled in the two dietary weight-loss arms from 2007 to 2008 with complete data at 12 months were included in these analyses. Generalized linear models were used to test the associations between snacking and weight loss (percent) and nutrient intake at the 12-month time point. Participants were, on average, 58 years old and mainly non-Hispanic white (84%). Ninety-seven percent reported one or more snacks per day. Weight loss (percent) was significantly lower among mid-morning (10:30 am to 11:29 am) snackers (7.0%, 95% confidence interval: 4.3 to 9.7) compared to non–mid-morning snackers (11.4%, 95% confidence interval: 10.2 to 12.6; P =0.005). A higher proportion of mid-morning snackers reported more than one snack per day (95.7%), compared to afternoon (82.8%) and evening (80.6%) snackers, although differences were not statistically significant ( P >0.05). Women who reported two or more snacks per day vs one or no snacks per day had higher fiber intake ( P =0.027). Afternoon snackers had higher fruit and vegetable intake compared to non–afternoon-snackers ( P =0.035). These results suggest that snack meals can be a source for additional fruits, vegetables, and fiber-rich foods; however, snacking patterns might also reflect unhealthy eating habits and impede weight-loss progress. Future dietary weight-loss interventions should evaluate the effects of timing, frequency, and quality of snacks on weight loss.

Nutrient-related anemia among postmenopausal women is preventable; recent data on prevalence are limited.To investigate the association between nutrient intakes and anemia prevalence, in relation to both incidence and persistence, in a longitudinal sample of postmenopausal women. We hypothesized that anemia prevalence, incidence, and persistence would be greater among women reporting lower intake of vitamin B-12, folate, and iron.Prospective cohort analysis.The observational cohort of the Women's Health Initiative, including 93,676 postmenopausal women, aged 50 to 79 years, who were recruited across the United States at 40 clinical study sites. Women were enrolled between 1993 and 1998; data collection for these analyses continued through 2000.Anemia was defined as a blood hemoglobin concentration of12.0 g/dL (120.0 g/L). Persistent anemia was defined as anemia present at each measurement time point. Diet was assessed by food frequency questionnaire for iron, folate, B-12, red meat, and cold breakfast cereal; inadequacies were based on dietary reference intakes for women older than age 50 years.Descriptive statistics (mean ± standard deviation) were used to characterize the population demographics, anemia rates, and diet. Unconditional logistic regression was used to investigate associations between diet and incident and persistent anemia. Associations are presented as odds ratio and 95% confidence intervals.Anemia was identified in 3,979 (5.5%) of the cohort. Inadequate intakes of multiple anemia-associated nutrients were less frequent in non-Hispanic whites (7.4%) than other race/ethnic groups (inadequacies demonstrated in 14.6% to 16.3% of the sample). Age, body mass index, and smoking were associated with anemia. Women with anemia reported lower intakes of energy, protein, folate, vitamin B-12, iron, vitamin C, and red meat. Multiple (more than a single nutrient) dietary deficiencies were associated with a 21% greater risk of persistent anemia (odds ratio 1.21, 95% confidence interval 1.05 to 1.41) and three deficiencies resulted in a 44% increase in risk for persistent anemia (odds ratio 1.44, 95% confidence interval 1.20 to 1.73).Inadequate nutrient intake, a modifiable condition, is associated with greater risk for anemia in postmenopausal women participating in the Observational Study of the Women's Health Initiative. Efforts to identify and update incidence estimates for anemia-associated nutrient deficiencies in aging women should be undertaken.

Acute effects of high-sugar/low-fiber meals vs low-sugar/high-fiber meals on hormones and behavior were studied in 10 overweight Latina females, age 11 to 12 years, using a crossover design. In this exploratory pilot study, participants arrived fasted at an observation laboratory on two occasions and randomly received either a high-sugar/low-fiber meal or a low-sugar/high-fiber meal at each visit. Glucose, insulin, and leptin were assayed from serum drawn at 0, 15, 30, 60, 90, and 120 minutes. Ad libitum snacks were provided at 120 minutes. Physical activity was measured using an observational system that provides data on time spent lying down, sitting, standing, walking, and in vigorous activity. Data were collected between March 2005 and July 2006. In the high-sugar/low-fiber condition, glucose and leptin levels decreased more slowly, glucose levels were higher at 60 minutes (111.2 mg/dL vs 95.4 mg/dL, P=0.03), and leptin levels were higher at 90 minutes (49.3 ng/mL vs 46.7 ng/mL, P=0.017) than in the low-sugar/high-fiber condition. Meals did not affect insulin or ad libitum dietary intake. Sitting, standing, lying down, and vigorous activity differed by condition, but not walking. Participants were significantly more active in the first 30 to 60 minutes after the high-sugar/low-fiber meal, but after 60 minutes there was a trend for activity to be lower after the high-sugar/low-fiber meal vs the low-sugar/high-fiber meal. High-sugar meals sustain glucose and leptin levels longer, which may play an important role in modulating levels of physical activity in this group at high risk for obesity-related disease.

Previous studies have shown that sociodemographic characteristics can be determinants of healthful eating. However, health characteristics such as smoking status have not been well studied. The objective of this research, therefore, was to determine predictors of diet quality in postmenopausal women. We included 164 overweight or obese postmenopausal women aged 50 to 75 years living in and around Seattle, WA, and intake, measured by food frequency questionnaire, was used to calculate scores for the Diet Quality Index and Healthy Eating Index. Information on sociodemographic factors and health behaviors was collected by self-administered questionnaire. Body mass index was computed using duplicate measures of height and weight. Percent body fat was measured by dual-energy x-ray absorptiometry. Following data collection, one-way analysis of variance, χ 2 , and Pearson correlations were used to compare means of diet quality scores across participant characteristics. We found that predictors of better diet quality in this study population were higher education and former smoking history (compared to never-smokers); there was no evidence for a relationship with income level. Individuals with higher-quality diets were more likely to have lower body mass index or percent body fat. Based on the results of this study, education level and smoking history are predictors of diet quality among overweight and obese postmenopausal women. These findings add to the increasing evidence for targeting public health interventions to individuals with lower education because this group stands to benefit from improved dietary intake. In addition, these results suggest that the timing of smoking cessation is a possible teachable moment for food and nutrition professionals.

Environmental measures of food availability are surrogates of consumption. Such measures may be useful among populations for whom standard dietary assessment is difficult. The objective of this cross-sectional study was to test whether a measure of the household dietary environment would perform as well as or better than a standard fruit and vegetable assessment among ethnically diverse rural women. Participants were 154 non-Hispanic white, 157 Hispanic, and 102 Native American adult women residing in rural Washington state. Participants completed an interviewer-administered household inventory of fruits and vegetables and a standard measure of fruit and vegetable intake used in the 5 A Day for Better Health Program. Pearson correlation coefficients assessed the validity of the measures against biomarkers of fruit and vegetable consumption (serum carotenoids). Pearson correlations were poor to modest between the household inventory and serum carotenoids ( r =0.06 to 0.22) and between the 5 A Day responses and serum carotenoids ( r =−0.08 to 0.17). There were no differences by ethnic group; both short tools performed poorly compared with the biomarkers across Hispanic, non-Hispanic white, and Native-American participants. In conclusion, both the household inventory and the popular 5 A Day measure were poor indicators of fruit and vegetable intake in this sample of ethnically diverse rural women.

To examine associations of diet with acculturation among Hispanic immigrants from Mexico to Washington state and to compare dietary patterns of Hispanic with non-Hispanic white residents.Data are part of the baseline assessment for a community-randomized cancer prevention trial. The Fat-Related Diet Habits questionnaire and the National 5-A-Day for Better Health program dietary assessment instruments were used to collect data on fat and fruit and vegetable intake, respectively. Data were also collected on demographic characteristics and acculturation status.A total of 1,689 adult Hispanic and non-Hispanic white residents of 20 communities in the Yakima Valley, WA, completed in-person interviews.Mixed model regression analyses tested associations of acculturation with diet. These models compared the fat and the fruit and vegetable intake of Hispanics vs non-Hispanic white residents. Additional analyses compared the diets of highly acculturated Hispanics with low-acculturated Hispanics. All models included age, sex, income, and education and were also adjusted for the random effect of community.Dietary patterns varied by ethnicity and acculturation status. On average, compared with non-Hispanic white residents, Hispanics consumed one more serving of fruits and vegetables per day (P.001). Dietary habits changed as Hispanics acculturated to the United States. Highly acculturated Hispanics ate fewer servings of fruits and vegetables per day compared with those not highly acculturated (P.05). Highly acculturated Hispanics had slightly higher, but not statistically significant, scores on the Fat-Related Diet Habits questionnaire, which corresponds to a higher fat intake, compared with low-acculturated Hispanics. The early dietary changes made on acculturation included adding fat at the table to breads and potatoes.Nutrition professionals should encourage their Hispanic clients to maintain their traditional dietary practices, such as a high intake of fruits and vegetables and eating bread and potatoes without added fat.

To investigate the prevalence and predictors of changes in diet, physical activity, and dietary supplement use among cancer patients. Design/subjects Telephone interviews of a population-based sample of 126 breast, 114 prostate, and 116 colorectal cancer patients from the state of Washington.Logistic regression was used to estimate the odds ratio as a measure of the association of participant characteristics with lifestyle changes in the 12 months before the interview.Overall, 66.3% of patients reported making lifestyle changes: 40.4% made one or more dietary changes, 20.8% added new physical activity, and 48.0% started taking new dietary supplements. Compared with men, women were 2.2 times more likely to take new dietary supplements (P.01). Compared with patients aged 35 to 59, those aged 60 to 69 and 70 or older were statistically significantly less likely to make dietary changes (odds ratio = 0.39 and 0.54, respectively) or to take new supplements (odds ratio = 0.42 and 0.69, respectively). Compared with patients who received only one medical treatment, those receiving three or more treatments were more likely to make dietary changes (odds ratio = 2.6) or to start new physical activity (odds ratio = 3.0). Patients diagnosed 12 to 24 months before the interview were as likely to report making lifestyle changes as those diagnosed within one year of the interview. Having a stronger desire for personal control or internal locus of control predicted use of new dietary supplements (P for trend.05 for both). Applications/conclusions Cancer survivors are likely to be making lifestyle changes and represent a group that could benefit from counseling on diet and physical activity.

Objective Anecdotal evidence exists that the public is becoming skeptical about nutrition messages. This article examines whether there is a backlash against dietary recommendations and whether it is associated with less healthful diets. Design/participants Data are from a 1997-1998 Washington State random-digit-dial survey of 1,751 adults designed to monitor attitudes and behavior related to cancer risk and prevention. Statistical analyses Responses to the nutrition backlash survey were weighted to reflect the Washington State population. Linear regression was used to examine associations of nutrition backlash with fat and fruit and vegetable intake. Results This survey did not find strong evidence that nutrition backlash was widespread. However, 70% of respondents thought that Americans are obsessed with the fat in their diet and that the government should not tell people what to eat. More than a quarter agreed with the statement that eating low-fat foods takes the pleasure out of eating. Nutrition backlash was associated with less healthful diets: individuals showing high backlash had a fat-related diet habits score of 2.11 compared with a score of 1.73 among those showing low backlash (P for trend=.001), which corresponds to a difference of roughly 4 percentage points in percentage energy from fat. Individuals showing high backlash reported eating only 2.72 servings of fruits and vegetables per day, compared with 3.35 servings among those showing low backlash (P for trend=.001). Applications/conclusions Nutrition professionals need to ensure that dietary recommendations are clear and positive to avoid the possibility that consumers may disregard nutrition messages entirely. J Am Diet Assoc. 2001; 101:37-41 .

Objective To describe patterns of caretaker-child communication during children's caretaker-assisted dietary recall interviews. Design Data are from transcriptions of audiotaped, caretaker-assisted, 24-hour dietary recalls. Statements were coded to provide quantified measures of caretaker-child interaction. Subjects/setting Thirty-four children aged 7 to 11 years who were enrolled (with their caretakers) at the San Diego site of the Olestra Post-marketing Surveillance Study. Statistical analyses Measures of participation for caretaker-child pairs were compared using Mann-Whitney tests; χ 2 tests were conducted to examine within-group differences. Mean numbers of statement types were compared with t tests. Differences between contributions of caretakers and children within caretaker-child pairs were examined using Wilcoxon signed rank tests. Results Caretakers contributed primarily by adding food details and, secondarily, by prompting children. Children rejected a notable proportion of items added by caretakers, and children's knowledge of food details was considerable. Gender made little difference, although the presence of a male caretaker was associated with a reduced proportion of details contributed by children. Applications In assessing children's dietary intake, questions should be directed toward children, even when caretakers are present. Nutrition professionals must clarify expectations for caretakers from the outset, intervene as needed to limit caretaker participation, probe for children's disagreement with caretakers' additions, and question the basis for caretakers' additions. If feasible, caretakers should be excused toward the end of the interview so children may privately make alterations to the record. J Am Diet Assoc. 2000; 100:428-433.

Objective The Nutrition Labeling and Education Act of 1990 mandated that standardized nutrition information appear on almost all packaged foods manufactured after May 1994. This study describes the demographic and diet-related psychosocial correlates of nutrition label use, and examines the relationship between label use and diet. Design/subjects Data are from a random-digit-dial telephone survey of 1,450 adult residents of Washington State. The questionnaire assessed nutrition label use, fat-related diet habits, fruit and vegetable consumption, diet-related psychosocial factors, health behavior, and demographic characteristics. Statistical analyses Analyses examined associations of demographic characteristics with nutrition label use; diet-related psychosocial factors and health behavior with nutrition label use, controlled for demographic characteristics; and nutrition label use with fat and fruit and vegetable intake, controlled for demographic characteristics and psychosocial factors. Results Nutrition label use was significantly higher among women, residents younger than 35 years, and residents with more than a high school education. When controlled for demographic characteristics, the strongest predictors of label use were believing in the importance of eating a low-fat diet, believing in an association between diet and cancer, and being in the maintenance stage of change for adopting a low-fat diet. Label use was significantly associated with lower fat intake and, after controlling for all demographic, psychosocial, and behavioral variables, explained 6% of the variance in fat intake ( P Applications/conclusion Persons successfully limiting their fat intake use nutrition labels, suggesting that the new nutrition labels are helpful. Dietetics professionals can use the results of this study to emphasize to their clients the importance of reading nutrition labels in maintaining a low-fat diet. J Am Diet Assoc. 1999;99:45-50,53 .

Objective To describe the design of the Olestra Postmarketing Surveillance Study (OPMSS) and to present baseline results from the sentinel site. The purpose of the OPMSS is to monitor consumption patterns of olestra-containing snacks and to determine whether consumption affects nutritional status. Design The OPMSS combines repeated cross-section, random-digit dial telephone surveys before and after the market release of olestra-containing foods as well as intensive dietary and clinical assessments on a subsample of survey participants. Subjects Data are from baseline telephone (n=1,962) and clinical (n=1,069) assessment of participants (aged 18 to 74 years) in the Marion County, Indiana, sentinel site. Mean age of participants in the telephone survey was 43.2 years; 19% of respondents were black and 29% had completed college. Statistical analysis Analyses examined associations among savory snack use, fruit and vegetable consumption, and demographic and health-related characteristics. Data from the telephone survey were adjusted to be representative of the Marion County population. Results Almost 96% of the population surveyed had eaten savory snacks in the month before the survey: 74% had eaten regular-fat, 26% fat-reduced, and 78% nonfat types. Total snack consumption did not differ by gender, education, or race. Residents younger than 35 years ate snacks 16 times a month compared with 12 times a month among older residents. Types of snacks consumed differed markedly by demographic characteristics. Male, younger, and less educated residents ate more regular-fat snacks; female, white, and college-educated residents ate more nonfat snacks. In general, residents practicing healthful behaviors, including not smoking, eating fruits and vegetables, and exercising, also ate fewer regular-fat and more nonfat snacks. Fat intake was also related linearly to use of snack foods, ranging from 33.2% of energy among those consuming 1 serving per month or less to 36.8% among those consuming 20 or more servings per month. Applications/conclusions Procedures for recruitment and nutrition assessment appear adequate for evaluating the impact of olestra consumption on nutritional status. Nutritionists should be aware that there is potential for relatively high olestra consumption, given that almost 35% of Marion County residents eat snack foods at least 20 times a month. Consumers eating at least 20 servings of snacks per month derived more than 12% of their total energy and fat from snack foods, which suggests that substituting olestra snacks could substantially reduce intakes of fat and energy. J Am Diet Assoc. 1998;98:1290–1296 .

Reducing the concentration of polyamines (spermine, spermidine, and putrescine) in the body pool may slow the cancer process. Because dietary spermine, spermidine, and putrescine contribute to the body pool of polyamines, quantifying them in the diet is important. Limited information about polyamine content of food is available, especially for diets in the United States. This brief report describes the development of a polyamine database linked to the Fred Hutchinson Cancer Center food frequency questionnaire (FFQ). Values for spermine, spermidine, and putrescine were calculated and reported per serving size (nmol/serving). Of the foods from the database that were evaluated, fresh and frozen corn contain the highest levels of putrescine (560,000 nmol/serving and 902,880 nmol/serving) and spermidine (137,682 nmol/serving and 221,111 nmol/serving), and green pea soup contains the highest concentration of spermine (36,988 nmol/serving). The polyamine database and FFQ were tested with a convenience sample (n=165). Average daily polyamine intakes from the sample were: 159,133 nmol/day putrescine, 54,697 nmol/day spermidine, and 35,698 nmol/day spermine. Orange and grapefruit juices contributed the greatest amount of putrescine (44,441 nmol/day) to the diet. Green peas contributed the greatest amount of spermidine (3,283 nmol/day) and ground meat contributed the greatest amount of spermine (2,186 nmol/day). Development of this database linked to an FFQ provides a means of estimating polyamine intake and contributes to investigations relating polyamines to cancer.

Reading nutrition labels on food packages may improve food choices and enable healthful dietary practices. This report describes the prevalence of nutrition label use and its association with demographic, behavioral, and psychological factors and diet among African-American adults.Self-reported data from a population-based cross-sectional survey of 658 African Americans, aged 20 to 70 years, in North Carolina. An 11-page questionnaire assessed nutrition label use, fruit and vegetable consumption, total and saturated fat intakes, fat-related dietary behaviors, diet-related psychosocial factors, and demographic and behavioral characteristics.Chi2 tests and logistic regression analyses examined associations of demographic, psychosocial, and behavioral factors with nutrition label use. Linear regression was used to estimate the variation in diet explained by label use.The mean age of participants was 43.9+/-11.6 years, 41% were men, 37% were college graduates, and 75% were overweight/obese. Seventy-eight percent of respondents read nutrition labels when they purchased packaged foods. Nutrition label use was significantly higher among participants who were women, older, educated beyond high school, and obese (P.05). After adjusting for demographic characteristics, the strongest psychosocial predictors of nutrition label use were healthful eating self-efficacy, strong belief in a diet-cancer relationship, and trying to lose weight. Usual/often label users had higher fruit and vegetable consumption and lower fat intakes (P.001), and nutrition labels explained 2% to 17% of the variance in dietary intake.Nutrition information on packaged foods appears to be a useful way to conduct point-of-purchase nutrition education among African Americans in North Carolina. Most respondents used food labels at least sometimes, but only about half usually or often did so. Efforts should be made to determine how all consumers could use nutrition labels effectively.

The US immigrant population is growing dramatically, making the health status of racial/ethnic minorities an increasingly important public health issue. Immigration to the United States is usually accompanied by environmental and lifestyle changes that can markedly increase chronic disease risk. In particular, adoption of US dietary patterns that tend to be high in fat and low in fruits and vegetables is of concern. The process by which immigrants adopt the dietary practices of the host country--called "dietary acculturation"--is multidimensional, dynamic, and complex; in addition, it varies considerably, depending on a variety of personal, cultural, and environmental attributes. Therefore, to intervene successfully on the negative aspects of dietary acculturation, it is important to understand the process and identify factors that predispose and enable it to occur. In this report, we give an overview of acculturation, define dietary acculturation and present a model for how it occurs, discuss measurement issues related to dietary acculturation, review the literature relating acculturation to eating patterns, and provide a case study illustrating how information on acculturation can be used to design dietary interventions in 2 markedly different immigrant groups. Finally, we give applications for nutrition researchers and dietetic practitioners. Studies investigating associations of acculturation with disease risk should identify and intervene on those steps in the acculturation process that are most strongly associated with unhealthful dietary changes. Practitioners working with immigrants should determine the degree to which dietary counseling should be focused on maintaining traditional eating habits, adopting the healthful aspects of eating in Western countries, or both.