Search

A self-administered food frequency questionnaire (FFQ) was developed to indicate weekly consumption of 64 foods. Reliability, validity, and usefulness of the tool to define a protein eating pattern were determined. Adolescents (N = 1,108) completed the FFQ during the Bogalusa Heart Study. Two-hour and 2-week reliability measures demonstrated consistency of intake of specific foods. Frequency of foods obtained from seven consecutive 24-hour recalls was compared with frequency obtained from the FFQ. A mean 50% agreement for both frequency and quantity of food intake was observed. Geometric means showed differences in mean number of protein foods by age of adolescent but the only significant difference was for beef intake of 15-year-olds. White children reported more servings of beef, cheese, and vegetables with meat than did black children. Black children reported more servings of eggs, luncheon meat, pork, poultry, and total protein than did white children. Boys reported a greater frequency of total protein foods, specifically, eggs, milk, and poultry, than did girls. Significant correlations were noted between low-density-lipoprotein cholesterol and intake of eggs and luncheon meat. We were able to quantitate the reliability and validity of the FFQ and to use it to explore the association of specific eating patterns with cardiovascular disease risk.

Is a fat-avoidance scale a useful tool for monitoring and tracking dietary fat selections of adults and children? Using a seven-point scale, we addressed this question with 341 preschool children and 421 of their parents participating in a longitudinal study of childhood behaviors in San Diego County, California. Milk type and cooking fat reported in the fat-avoidance scale was compared with data reported in a 24-hour food intake record. An overall 86% agreement for milk type and a 78% agreement for cooking fat were noted. Anglo preschoolers (n = 143) had significantly greater mean scores for fat and cholesterol avoidance than did Mexican-American preschoolers (n = 198). Anglo, but not Mexican-American, women avoided fat and cholesterol more often than did their male counterparts. A significantly higher sum score was noted for Anglo men and women and Mexican-American men as education increased. These findings indicate that the fat-avoidance scale has a relative validity compared with a 1-day food record, that fat avoidance can be measured, that differences can be noted in a biethnic sample of children and adults, and that the scale has potential for monitoring success in achieving a lower fat and cholesterol intake.

A model designed as primary hypertension prevention for children ranking high in blood pressure, selected from a total population, was applied to a semirural, biracial community. A Dietary/Exercise Alteration Program Trial (ADAPT), in combination with low-dose medication, was tested on 48 children aged 8-18 years who were randomly selected from 100 children consistently in the upper blood pressure decile. The interactive model a) focuses on a major public health problem that is measurable and modifiable, b) outlines a preventive approach to involve children and parents in establishing healthy life styles, and c) converts community limitations into resources. The comprehensive program was developed to support eating and exercise modifications accepted for hypertension treatment without placing children in a sick role. Sodium reduction, weight control, and regular exercise are the life-style changes promoted. Indicators for evaluating development and implementation of ADAPT are presented. The commitment to written pledges, ie, making simple behavioral changes, had a significant inverse association with post-treatment sodium and energy intakes in regression models that included the child's curriculum and physical activity class attendance. ADAPT represents an initial approach for developing primary preventive treatment of early essential hypertension in a pediatric population.

Dietary intakes of carbohydrate (CHO) and fiber were examined in children randomly selected from a biracial community-Bogalusa, LA. Intakes of CHO per 1,000 kcal were similar for both sexes and both races at ages 10 and 13 years. No group or race differences were found for nine components assessed in two cohorts of 10-year-old children examined three years apart. There were sex differences in sucrose (boys less than girls) and lactose (boys greater than girls) intakes. Comparison of 10- and 13-year-olds examined in 1976 showed a racial difference in fiber and starch intakes (black greater than white). Longitudinal comparisons of a cohort of 148 children examined at both 10 and 13 years showed lower lactose intakes over time. At both ages starch, fiber, and glucose intakes per 1,000 kcal were higher in black children, with higher sucrose/starch ratios in white children. The percent of calories from CHO and sugars was higher in Bogalusa children than values for US adults, but starch intakes were lower. None of the children's intakes was compatible with prudent dietary recommendations. Dietary CHO patterns of Bogalusa children reflect food market trends of increased use of simple CHO and decreased use of complex CHO.

Impact of vitamin supplements upon dietary intakes of eight vitamins was examined in 10- and 13-year-old children randomly selected from a biracial community, Bogalusa, LA. More younger children reported taking supplements daily (17%) than did adolescents (12%). Over 90% of the children surveyed had dietary intakes of vitamin E and niacin that met or exceeded the RDA. One-half to two-thirds of children using supplements had adequate intakes of ascorbic acid from diet alone. Children who most needed ascorbic acid supplements were the least likely to take them. One-quarter to one-half of the children did not consume the RDA levels of vitamin A, thiamine, and riboflavin. Adolescents had less adequate vitamin A intakes than younger children. In all surveys, a higher proportion of girls than boys had intakes that did not meet the RDA for vitamins B6 and B12. Vitamin intakes of Bogalusa children and adolescents were comparable to other U.S. surveys. Inclusion of vitamin E and niacin in supplements may be unnecessary.

Diets of four groups of 10-year-old children (no. = 871) from a biracial community were examined to document eating patterns and to note temporal trends in energy, protein, fat, and carbohydrate intakes. A 24-hour dietary recall method, incorporating numerous quality controls, was adapted for interviewing children. Protein provided 13%, fat 38%, and carbohydrate 49% of calories. Few racial differences in eating patterns were detected. Boys had higher energy intakes than girls, but after diets were adjusted per 1,000 kcal, no other sex differences in intake were found. Snacks yielded roughly one-third of daily energy intake, one-fifth of the day's protein, one-third of the fat, and two-fifths of the total carbohydrate intake. Density of macronutrients within the children's diets was consistent over time. Diets of children in the Bogalusa study typify the American eating pattern and are comparable with those found in major national surveys.

Cardiovascular risk factor variables were examined in a cohort of 440 infants from birth through 7 years of age. Anthropometric measures, BP, serum lipid and lipoprotein values, and dietary intake data were obtained according to detailed protocols. Various quality controls to ensure the collection of valid and reliable data were instituted. Participation remained high throughout the study with 80% of the children examined at 6 months and 60% at 7 years of age. Rates were slightly higher for black than for white children. Children born in the private hospital were more likely to continue in the study than children born in the charity hospital. Children of parents examined when the child was 2 years of age were more likely to be examined during the preschool phases, but parental examination was not related to child examination when the child was 7 years of age. As in studies of school-aged children, measurement errors were lowest for height, weight, and serum total cholesterol. Measurement errors for BP were highest at the younger ages, particularly for diastolic BP. Examination of a newborn cohort throughout time affords the opportunity to study early development of relationships and tracking of cardiovascular risk factors.

Although differences in hemoglobin levels between blacks and whites may be due in part to genetic influences, low hemoglobin levels in black girls of childbearing age may nevertheless constitute a health hazard. To study this problem, hemoglobin levels were examined in children of a biracial community not only before but also during and after puberty and menarche. At the same time, 24-hour dietary recalls of a representative group of 13-year-olds in the same population were examined with respect to the intake of iron and nutrients influencing iron absorption. In black girls, hemoglobin levels dropped after menarche, accompanied by a diet marginal in iron and in iron-absorption-promoting nutrients. Questions as to hemoglobin levels compatible with optimum health remain, and racial differences and genetic influences on levels should not be an excuse for failure to address this problem. More investigational studies are also needed to observe responses to an optimum dietary iron intake.

Diets of four groups of 10-year-old children (no. = 871, 30% black, 70% white) were examined over 10 years with 24-hour dietary recalls to study temporal trends in cholesterol, fat, and fatty acid intakes in a community. Boys had higher intakes per day and per kilogram body weight than girls for all nutrients (p less than .0001), but there were no sex differences in nutrients per 1,000 kcal. The only racial difference detected was a higher myristic acid intake in whites (p less than .02). There was a 16% decline in dietary cholesterol intake between 1978 and 1982. Three shifts in fatty acid intake increased the P:S ratio from 0.29 in 1973 to 0.45 in 1978: (a) a 5% decline in oleic acid, coupled with a 5% rise in linoleic acid; (b) a quadrupling of linolenic acid; and (c) less stearic and more myristic acid, with palmitic acid unchanged. Total fat intake provided 38% of the calories in each survey, but the changes in proportions of fatty acids paralleled trends in food consumption patterns and nutrient sources. Despite the changes, few children met prudent diet recommendations, and serum total cholesterol and very-low-density-lipoprotein cholesterol levels did not change over time.

The results of the current study indicate that data obtained by the dietary recall correlate highly with the children's weighed food intake if a parent or the primary caretaker providing the child's food responds to the interview. Meredith et al. found parents to be poor reporters of children's consumption outside the home. It is encouraging to note that parents can be reliable reporters of their children's food intake in the home environment. When errors did occur, they were errors in portion size, as 96% of foods eaten by the children were correctly identified by the parents. Parents under-reported only 4% of the time. This slight tendency to under-report is consistent with other reports of the validity of the 24-hour dietary recall. In younger children, parents appear to be reliable reporters of their children's in-home dietary intake. As children become older, they appear to be able to recall their own intake both within and outside the home. There are several possible explanations for these findings. First, several factors could have influenced the accuracy of parental reports of the child's intake during the day that we weighed foods. Because food was weighed in the homes, the parents undoubtedly attended more closely to their child's diet. Additionally, the dietary recalls were collected at the end of the day of observation. This was closer in time than most 24-hour recalls and may have reflected less memory decay than usual. Also, since our sample was primarily middle-class families who were well educated, the correspondence between actual vs. reported dietary intake may have been artificially enhanced.(ABSTRACT TRUNCATED AT 250 WORDS)

To investigate caffeine intake patterns in children, dietary intakes were examined for a biracial sample of 1,284 infants and children. Twenty-four-hour dietary recalls were completed by parents of children aged 6 months and repeated at ages 1, 2, 3, and 4 years; children 10 years old served as their own respondents and were surveyed at ages 13, 15, and 17 years. The sample was 60% white and 40% black. Additional cohorts of 10-year-olds (no. = 686) were studied for temporal trend. Whites consumed significantly more caffeine than blacks as early as 1 year and persisted at a higher intake level from 2 to 17 years. This trend continued whether intake was measured in total milligrams, milligrams per 1,000 kcal, or milligrams per kilogram body weight. Significant sex differences in caffeine intakes per 1,000 kcal occurred among 15- and 17-year-olds (girls greater than boys). Peak periods of consumption occurred at ages 2, 3, 13, and 17. Snacks contributed large quantities of caffeine, particularly for 10-year-olds. Most frequent sources of caffeine were regular carbonated beverages, chocolate-containing foods, and tea. Mean intakes of caffeine for 10-year-olds were consistent from 1973 to 1982. Those observations document caffeine intakes beginning early in life.

Chemical analysis of food actually eaten would be the most accurate method for analyzing the diets of children, but this technique is not feasible for most nutrition staffs. An improved 24-hr. dietary recall can be used by a small, well trained staff to collect more reliable data on a large number of school children. Vigilant monitoring of school lunch operations, incorporation of known recipes in the ETNV, and organizing probing techniques are necessary to insure the reliability of the tool. The low coefficients of variation of duplicate recalls noted in the study indicate that the error of measurement between interviewers is small, if the tool is carefully tested and sophisticated before use in the field and if observers are carefully trained by a written protocol.

Microcomputers provide an effective and efficient method for dietary data management and analysis. Since the selection of an appropriate software system is a confusing task, prospective users must have a clear statement of needs. Selection of software is simplified when specific data management tasks are defined. This article provides a model for listing dietary analysis needs and priorities. Sample dietary analysis tasks are listed for five areas of responsibility. Prospective users should consider the following characteristics for each system: validity of the data base, soundness of the program's internal operating procedures, clear and complete documentation, an easy-to-read computer output, and credibility of the developer. Characteristics that may vary in importance depending on the user's situation include ability to alter the data base, standard operating procedures, output features, and service policies. By looking carefully at needs and matching needs to available systems, dietitians can apply sophisticated dietary data management and analysis techniques to the nutrition needs of their clients.

A survey of children for cardiovascular risk factor variables has determined serum lipids and lipoproteins on some 5,000 children from birth through adolescence. Dietary studies have been conducted on a selected sample. Considerable variability of the serum lipids and lipoproteins occurs with significant relationships to age, race, and sex. Serum lipoproteins are altered with obesity especially in white children and a correlation of dietary intake of fat by infants and children had been noted with serum lipids and lipoproteins. A consistent ranking over time or tracking of the serum lipids and lipoproteins, especially beta-lipoprotein, occurs, and a clustering of multirisk factors including high levels of serum total cholesterol and beta-lipoproteins can be observed, especially in the older children. The trend toward increasing interrelationship of multirisk factors suggests an increasing environmental impact with age. The relationships of dietary components with risk factor variables are of a low order, even though children are consuming a relatively high fat, high cholesterol, high salt diet. Dietary factors are potentially the major environmental influence on the high incidence of coronary artery disease. The evidence of the relationship of diet to the serum lipid levels in children warrants further investigation in an effort to understand the precise role of diet in the prevention of adult cardiovascular disease.

Dietary patterns and racial differences in nutrient intake were observed in children 6 months to 4 years of age in the Bogalusa Heart Study. Even in this sample of young children, the composition of the intakes of the majority of children was not compatible with prudent recommendations of less than 35% and 10% of energy from total and saturated fat, respectively. Mean cholesterol intake of the 4-year-old children (390 mg) was approximately one half of the average daily adult levels. The polyunsaturated to saturated fatty acid ratio ranged from 0.41 to 0.53 and sucrose to starch ratio from 1.32 to 1.57, reflecting a high saturated fat and sucrose intake. White children had greater intakes of sucrose than black children; however, total fat and cholesterol intakes were greater in black children. Gender differences were noted among the 2, 3, and 4-year-old children: energy, sugar, and starch intakes were greater in boys, and cholesterol intake per 1,000 kcal was greater in girls. Mean intakes per 1,000 kcal in Bogalusa were higher for fat and carbohydrate and lower for protein than reported in the Second Health and Nutrition Examination Survey. However, when the National Research Council recommended dietary allowances for protein and energy are used for comparison, a more than adequate intake was noted in these children. The data found in this newborn-infant cohort contribute information regarding the early development of dietary habits that likely influence eating behavior in later childhood and adolescence.

A self-administered workbook for dietary assessment in small groups was compared with 24-hour dietary recall interviews. Forty-seven 10- to 18-year-olds, in groups of 5 to 8, recorded consumptions during the previous 24 hours and responded to individual recall interviews. Photographs and names of foods served as probes. Standardized food models were used to estimate portions. Nutritionists calculated gram amounts of foods and beverages consumed and analyzed diets for nutrient intakes. Significantly higher niacin (17.4 mg vs. 15.8 mg, p less than .05) and slightly higher protein, animal protein, carbohydrate, and cholesterol (N.S.) were estimated by the group workbook method. Correlations for individual dietary components ranged from 0.69 to 0.93. Dinner accounted for most differences, with statistically greater mean intakes of nine dietary components shown by the workbook method. Thirty-four dinner foods (8%) were not listed in common by the two methods. Sixty-six foods (15%) listed by the two methods had differing gram amounts. Improvements should include increased parental verification of the evening meal, additional training with food models, and periodic rest sessions. The workbook method may expand the time frame studied per individual and increase the number of eating periods examined. Replicate examinations per individual provide measurement of intra-individual variation. This method has applications in studies for which large samples or repeated measures are required.

Electrolyte and mineral intakes assessed by 24-hour dietary recall were examined for race and sex differences in cohorts of infants and school-age children at 6 months and at 1, 2, 3, 4, 10, 13, 15, and 17 years. A fourfold increase in sodium intake occurred from 6 months to 4 years, and potassium intake doubled. Sodium increased from 0.88 gm at 6 months to 3.21 gm at 4 years and 3.67 gm by 17 years; a slight increase for potassium was noted from 4 to 17 years for boys. Calcium intake was relatively constant from 6 months to 17 years. Boys had higher intakes of sodium and sodium per kilogram body weight than did girls. Black children at 2, 3, and 4 years had significantly higher sodium, potassium, calcium, phosphorus, and magnesium expressed as total intake and per kilogram body weight than white children did. At 6 months, 66% of the infants exceeded the National Research Council's recommended range for sodium. At 1 to 10 years, 90% to 100% and at 13 to 17 years, 60% to 65% exceeded the recommended range. In contrast, 58% to 77% of preschool children and only 5% to 20% of school-age children surpassed the recommended potassium range. Fifty percent to 70% of children more than 10 years old achieved the recommended range for potassium. Approximately half of the children 6 months through 4 years of age met the Recommended Dietary Allowance (RDA) for calcium. Sixty percent to 80% of adolescents ingested less than two-thirds the RDA. Girls had lower intakes than did boys.(ABSTRACT TRUNCATED AT 250 WORDS)

It is unknown how different calculation procedures for quantitating foods can influence variation in nutrient values. Precision of calculation and transcription, plus a double-checking procedure, is standard Bogalusa Heart Study protocol. These procedures likely would minimize human error. Nevertheless, converting gram weight values for food (BHS) into the closest household measure (NCC) could influence analysis. If calculation procedures are similar, different nutrient values in 2 food composition tables would then account for most variation in results. Consistently lower values for sucrose by the NCC likely reflect the program's carbohydrate rationale, i.e., the classification of total carbohydrate into 3 categories--sucrose, starch, and other. Sucrose may then be underestimated, as the other carbohydrate value "indicates combinations of sugars and/or sugars and starch," such as those found in commercial products. The ETNV total sucrose value is a sum of the naturally occurring sucrose and sucrose added in commercial preparations. For this small sample, the group means of selected nutrients by 2 dietary computer analyses systems are quite similar, with the exception of sucrose. With fairly large standard errors for most components, a large sample might create a statistically significant difference. Periodic comparability checks are essential to document quality and similarity of data bases. Quality control procedures in dietary methodology should be analogous to techniques for physiological and biochemical measures, e.g., the Centers for Disease Control and LRC methods and standards. Low-level correlations observed between dietary intakes and risk factor variables imply no association. Comparison and improvements of data bases are timely and should increase the probability of identifying associations between dietary components and indicators of diseases.

Racial differences in hemoglobin (Hgb) levels were explored in two groups of children at different maturational stages, the pre-adolescent (10-year-olds: Whites n = 160, Blacks n = 56,) and the adolescent (15-year-olds; Whites n = 60, Blacks n = 44). Mean Hgb levels were higher for Whites than Blacks in both age groups. When all the dietary components (i.e., iron, zinc, copper, folacin, ascorbic acid and vitamins B12, E and B6) were considered as a group, they accounted for 8.4 per cent of the Hgb variance in 10-year-olds and 10.1 per cent of variance in 15-year-olds. However, even after controlling for the variations in dietary patterns of the adolescents and pre-adolescents, race still accounted for a notable proportion of Hgb variance in both age groups (9.1 per cent in 10-year-olds and 7.0 per cent in 15-year-olds). Within each race, gender accounted for a greater percentage of the Hgb variance in the adolescents than in the pre-adolescents. Our results indicate that in all likelihood racial differences in Hgb levels during childhood exist independent of racial differences in intake of specific "blood building" nutrients and maturational changes.