Journal of the Academy of Nutrition and Dietetics

2012-05-01

Socioeconomic, Ethnic, Cultural, and Other Influences on Eating Behavior: Complex Considerations

Linda Van Horn — 2012-05-01

One diet does not fit all. Not only do nutrient needs vary by sex, age, and health status, environmental conditions predicated by socioeconomics, ethnicity, acculturation, and food security strongly influence food choices, amounts, access, and preparation techniques that can adversely alter an otherwise healthy eating pattern. This month, the Journal devotes attention to several of these factors and conditions with varying degrees of standardized data collection but a common goal of raising consciousness about their importance.

Collaboration and Building Bonds

Sylvia A. Escott-Stump — 2012-05-01

The Academy of Nutrition and Dietetics presents to the world a broad, inclusive, and all-encompassing message: Eat Right. Conveying this message and making it come alive for our clients, patients, and all people requires that each of us work, not alone, but as part of a team: our peers, health professional partners, researchers, educators, legislators, clients, and the general public.

Truth, Lies, and Rumors in the Media: Consider the Source

John Gregerson — 2012-05-01

ROCK STAR JON BON JOVI DID not die on December 19, 2011. And former Arizona Congresswoman Gabrielle Giffords is still alive, although on January 8, 2011, 4 hours after she was shot and wounded at a Safeway supermarket in Casas Adobes, AZ, Barbara Klein, a newscaster with Washington, DC–based National Public Radio (NPR), announced that, “Congresswoman Gabrielle Giffords of Arizona has been shot and killed during a public event in Tucson, Ariz” ().

Added Sugars and Risk of Colorectal Cancer

John S. White — 2012-05-01

In a recent paper, Annema and colleagues () concluded that risk of colorectal cancer (CRC) is associated with high intake of fruit juice, possibly due to added sugars. By inaccurately reporting results from the 2007 World Cancer Research Fund/American Institute for Cancer Research (AICR) report () and relying on a food frequency questionnaire covering a 10-year span, the authors exaggerated the cancer risks of added sugars (specifically glucose and fructose), fruit juices, and foods containing sugars.

Author's Response

2012-05-01

It appears to us that Dr White is confusing (a) what we have written in a peer-reviewed paper in a reputable journal, with (b) the interpretation of that paper in trade magazines. It is very unfortunate that portions of the media took a sensational, negative angle on our study. Our emphasis was always on the positive health outcomes of increased consumption of brassica vegetables, and our main aim was to look at the association between intake of fruit and vegetables and colorectal cancer (CRC) according to the location of the cancer, as previous studies have not taken the site of CRC into account. Fruit juice consumption was a very minor part of the study and high-fructose corn syrup was not mentioned by us.

Socioeconomic and Racial/Ethnic Disparity in Americans' Adherence to Federal Dietary Recommendations

Qi Zhang, Youfa Wang — 2012-05-01

Racial/ethnic and socioeconomic disparities in obesity and other chronic diseases are constant features of the US population and warrant continuous research on the linkage and causation between social demographic factors and distant health outcomes, and on related interventions. Many believe that the racial/ethnic and socioeconomic disparity in dietary intake is an important intermediate factor contributing to the disparities in obesity and other lifestyle-related diseases (). Kirkpatrick and colleagues () provide some new evidence on differences in food group-based dietary intakes across race/ethnicity and income groups in terms of meeting the US Department of Agriculture (USDA) dietary recommendations ().

Understanding and Addressing Barriers to Healthy Eating among Low-Income Americans

Sharon I. Kirkpatrick — 2012-05-01

Food insecurity is a serious public health problem in the United States. An estimated 15% of US households experienced food insecurity in 2010, consistent with the figures for 2008 and 2009 (). In each of the past 3 years, >5% of households fell into the most severe category of food insecurity, known as very low food security (previously referred to as food insecurity with hunger), meaning that one or more members of the household experienced disrupted eating patterns and reduced food intake because the household lacked resources for food (). The rates of food insecurity documented during the past 3 years mark the highest levels since national monitoring began in 1995. Given the tight link between food insecurity and poverty (), this is not surprising in the context of deteriorating economic conditions and rising food costs during recent years. Participation in federal nutrition assistance programs and use of emergency food programs also have increased in recent years ().

Dietary Intervention Targeting Increased Fiber Consumption for Metabolic Syndrome

2012-05-01

METABOLIC SYNDROME IS HIGHLY PREVALENT in the United States and is a harbinger of diabetes and cardiovascular disease. With the staggering rise in diet-related chronic diseases such as diabetes and cardiovascular disease, simple and effective dietary intervention strategies are needed. National dietary recommendations are ever-changing and complex, which can be overwhelming and confusing for individuals who are trying to prevent or manage a chronic condition. Some evidence suggests that healthy changes in one area of diet are associated with healthy changes in other untargeted areas of diet (). There is an opportunity to bridge a dietetics research gap by testing a simple dietary message focusing on fiber intake to improve risk factors for metabolic syndrome.

Income and Race/Ethnicity Are Associated with Adherence to Food-Based Dietary Guidance among US Adults and Children

Sharon I. Kirkpatrick, Kevin W. Dodd, Jill Reedy, Susan M. Krebs-Smith — 2012-05-01

Abstract: Background: Income and race/ethnicity are associated with differences in dietary intakes that may contribute to health disparities among members of the US population. Objective: To examine alignment of intakes of food groups and energy from solid fats, added sugars, and alcohol with the 2005 Dietary Guidelines for Americans and MyPyramid, by family income and race/ethnicity. Design: Data from the National Health and Nutrition Examination Survey, a cross-sectional, nationally representative survey, for 2001-2004. Participants/setting: Persons aged ≥2 years for whom reliable dietary intake data were available (n=16,338) were categorized by income (lowest, middle, and highest) and race/ethnicity (non-Hispanic white, non-Hispanic black, and Mexican American). Statistical analyses performed: The National Cancer Institute method was used to estimate the proportions of adults and children in each income and race/ethnic group whose usual intakes met the recommendations. Results: Higher income was associated with greater adherence to recommendations for most food groups; the proportions meeting minimum recommendations among adults in the highest income group were double that observed for the lowest income group for total vegetables, milk, and oils. Fewer differences by income were apparent among children. Among the race/ethnic groups, the proportions meeting recommendations were generally lowest among non-Hispanic blacks. Marked differences were observed for milk—15% of non-Hispanic black children met the minimum recommendations compared with 42% of non-Hispanic white children and 35% of Mexican-American children; a similar pattern was evident for adults. One in five Mexican-American adults met the dry beans and peas recommendations compared with approximately 2% of non-Hispanic whites and non-Hispanic blacks. Most adults and children consumed excess energy from solid fats and added sugars irrespective of income and race/ethnicity. Conclusions: The diets of some subpopulations, particularly individuals in lower-income households and non-Hispanic blacks, are especially poor in relation to dietary recommendations, supporting the need for comprehensive strategies to enable healthier dietary intake patterns.

Increasing Supplemental Nutrition Assistance Program/Electronic Benefits Transfer Sales at Farmers' Markets with Vendor-Operated Wireless Point-of-Sale Terminals

2012-03-19

Abstract: Background: Supplemental Nutrition Assistance Program (SNAP) (formerly Food Stamp Program) participants can use their benefits at many farmers' markets. However, most markets have only one market-operated wireless point-of-sale (POS) card swipe terminal for electronic benefits transfer (EBT) transactions. It is not known whether providing each farmer/vendor with individual wireless POS terminals and subsidizing EBT fees will increase SNAP/EBT purchases at farmers' markets. Objective: To evaluate the effects of multiple vendor-operated wireless POS terminals (vs a single market-operated terminal) on use of SNAP benefits at an urban farmers' market. Design: Time-series analyses of SNAP/EBT sales. Setting: The Clark Park farmers' market in West Philadelphia, PA, which accounts for one quarter of all SNAP/EBT sales at farmers' markets in Pennsylvania. Intervention: Vendors were provided with individual wireless POS terminals for 9 months (June 2008-February 2009.) The pilot program covered all equipment and wireless service costs and transaction fees associated with SNAP/EBT, credit, and debit sales. Main outcome measure: Monthly SNAP/EBT sales at the Clark Park farmers' market. Statistical analyses: SNAP/EBT sales data were collected for 48 months (January 2007-December 2010). Time-series regression analysis was used to estimate the effect of the intervention period (June 2008-February 2009) on SNAP/EBT sales, controlling for seasonal effects and total SNAP benefits issued in Philadelphia. Results: The intervention was associated with a 38% increase in monthly SNAP/EBT sales. Effects were greatest during the busy fall market seasons. SNAP/EBT sales did not remain significantly higher after the intervention period. Conclusions: Providing individual wireless POS terminals to farmers' market vendors leads to increased sales. However, market vendors indicated that subsidies for equipment costs and fees would be needed to break even. Currently, SNAP provides some support for these services for supermarket and other SNAP retailers with landline access, but not for farmers' markets.

Trends in Dietary Fiber Intake in the United States, 1999-2008

Dana E. King, Arch G. Mainous, Carol A. Lambourne — 2012-05-01

Abstract: Background: Intake of dietary fiber has been recommended for many years as part of the guidelines from the American Heart Association, the Institute of Medicine, and other groups. The recommended Adequate Intake for dietary fiber for adults is 25 to 38 g/day (14 g/1,000 kcal/day). Objective: To determine the average daily intake of dietary fiber among adults during the past decade and, specifically, to document progress toward national goals. Design: Cross-sectional weighted data from the National Health and Nutrition Examination Survey among adults aged 18 years and older. Participants/setting: Data were collected from noninstitutionalized adults aged 18 years and older using a nationally representative, complex, multistage, probability-based survey of people living in the United States that was conducted by the National Center for Health Statistics. Main outcome measures: Daily dietary fiber intake by members of the US population based on 2-year groupings of the continuous survey from 1999 to 2008. Results: Mean daily dietary fiber intake for 1999-2000 was 15.6 g/day, for 2001-2002 intake was 16.1g/day, for 2003-2004 intake was 15.5 g/day, for 2005-2006 intake was 15.8 g/day, and for 2007-2008 intake was 15.9 g/day. Participants with obesity (body mass index ≥30) consistently reported lower fiber intake than did individuals with normal weight or overweight (14.6 to 15.4 g/day and 15.6 to 16.8 g/day, respectively; P<0.0001). Mexican Americans had significantly higher intake in 1999-2000 than non-Hispanic whites (18.0 vs 16.1g/day; P<0.05), but Mexican Americans' intake did not increase over time (17.7 g/day in 2007-2008). Non-Hispanic blacks had fiber intake of 12.5 g/day at baseline that increased modestly to 13.1 g/day by 2007-2008. Conclusions: Daily fiber intake generally has not progressed toward national goals during the past decade, but there are some differences according to health and social factors. Additional clinical practice and public health strategies are needed.

US Acculturation Is Associated with Health Behaviors and Obesity, but not Their Change, with a Hotel-Based Intervention among Asian-Pacific Islanders

2012-05-01

Abstract: Background: Immigration to the United States has been associated with obesity, yet the relationship of acculturation to obesity and energy balance (ie, physical activity/dietary intake) in adults is a complex issue. Limited longitudinal data are available on immigrant Asians and Pacific Islanders. Design: Analyses were conducted on baseline data and change data from baseline to 24 months in the hotel-based cluster-randomized Work, Weight and Wellness trial involving 15 control and 15 intervention hotels on the island of Oahu, Hawaii. Sample: Participants were adult employees of predominantly Asian and Pacific Islander ancestry who were assessed one or more times over the course of 24 months. The full sample consisted of 4,236 hotel workers (about 40% of hotel workforce) at baseline, 3,502 hotel workers at Year 1 and 2,963 hotel workers at the 24-month follow up. One thousand one hundred fifteen hotel workers had at least two measurements, and were included in the analysis. Intervention: The Work, Weight, and Wellness trial was designed to promote weight loss via motivation and support for increases in physical activity and increased access to and consumption of healthy low-fat/low-energy foods. The measure of acculturation consisted of a score that was a compilation of a participant's age when he or she immigrated to the United States, country of birth, language spoken at home, and years of education. Statistical analyses: We used mixed effect regression models for cross-sectional baseline models and longitudinal multilevel regression analysis of change in diet and physical activity behaviors and obesity over time using a random intercept. Estimates of the intervention effect are expressed as an annual rate of change for all study outcomes. Results: At baseline acculturation was positively associated with body mass index; physical activity level; and fruit, meat, and sweetened drink intake level. In analyses of change across 24 months, acculturation did not significantly influence change in dietary intake or indexes of obesity (ie, body mass index or waist-to-height ratio). However physical activity increased significantly more in the intervention group during the course of the intervention compared with the control group, which decreased activity, when sociodemographic factors (including acculturation) and food intake behavior were controlled for.

Examination of Vitamin Intakes among US Adults by Dietary Supplement Use

Regan Lucas Bailey, Victor L. Fulgoni, Debra R. Keast, Johanna T. Dwyer — 2012-05-01

Abstract: Background: More than half of US adults use dietary supplements. Some reports suggest that supplement users have higher vitamin intakes from foods than nonusers, but this observation has not been examined using nationally representative survey data. Objective: The purpose of this analysis was to examine vitamin intakes from foods by supplement use and how dietary supplements contribute to meeting or exceeding the Dietary Reference Intakes for selected vitamins using data from the National Health and Nutrition Examination Survey among adults (aged ≥19 years) in 2003-2006 (n=8,860). Results: Among male users, mean intakes of folate and vitamins A, E, and K from food sources were significantly higher than among nonusers. Among women, mean intakes of folate and vitamins A, C, D, and E from foods were higher among users than nonusers. Total intakes (food and supplements) were higher for every vitamin we examined among users than the dietary vitamin intakes of nonusers. Supplement use helped lower the prevalence of intakes below the Estimated Average Requirement for every vitamin we examined, but for folic acid and vitamins A, B-6, and C, supplement use increased the likelihood of intakes above the Tolerable Upper Intake Level. Conclusions: Supplement use was associated with higher mean intakes of some vitamins from foods among users than nonusers, but it was not associated with the prevalence of intakes less than the Estimated Average Requirement from foods. Those who do not use vitamin supplements had significantly higher prevalence of inadequate vitamin intakes; however, the use of supplements can contribute to excess intake for some vitamins.

Using the Health Belief Model to Develop Culturally Appropriate Weight-Management Materials for African-American Women

2012-05-01

Abstract: African-American women have the highest prevalence of adult obesity in the United States. They are less likely to participate in weight-loss programs and tend to have a low success rate when they do so. The goal of this project was to explore the use of the Health Belief Model in developing culturally appropriate weight-management programs for African-American women. Seven focus groups were conducted with 50 African-American women. The Health Belief Model was used as the study's theoretical framework. Participants made a clear delineation between the terms healthy weight, overweight, and obese. Sexy, flirtatious words, such as thick, stacked, and curvy were often used to describe their extra weight. Participants accurately described the health risks of obesity. Most believed that culture and genetics made them more susceptible to obesity. The perceived benefits of losing weight included reduced risk for health problems, improved physical appearance, and living life to the fullest. Perceived barriers included a lack of motivation, reliable dieting information, and social support. Motivators to lose weight included being diagnosed with a health problem, physical appearance, and saving money on clothes. Self-efficacy was primarily affected by a frustrated history of dieting. The data themes suggest areas that should be addressed when developing culturally appropriate weight-loss messages, programs, and materials for African-American women.

Dietary Energy Density and Body Weight in Adults and Children: A Systematic Review

2012-04-05

Abstract: Energy density is a relatively new concept that has been identified as an important factor in body weight control in adults and in children and adolescents. The Dietary Guidelines for Americans 2010 encourages consumption of an eating pattern low in energy density to manage body weight. This article describes the systematic evidence-based review conducted by the 2010 Dietary Guidelines Advisory Committee (DGAC), with support from the US Department of Agriculture's Nutrition Evidence Library, which resulted in this recommendation. An update to the committee's review was prepared for this article. PubMed was searched for English-language publications from January 1980 to May 2011. The literature review included 17 studies (seven randomized controlled trials, one nonrandomized controlled trial, and nine cohort studies) in adults and six cohort studies in children and adolescents. Based on this evidence, the 2010 Dietary Guidelines Advisory Committee concluded that strong and consistent evidence in adults indicates that dietary patterns relatively low in energy density improve weight loss and weight maintenance. In addition, the committee concluded that there was moderately strong evidence from methodologically rigorous longitudinal cohort studies in children and adolescents to suggest that there is a positive association between dietary energy density and increased adiposity. This review supports a relationship between energy density and body weight in adults and in children and adolescents such that consuming diets lower in energy density may be an effective strategy for managing body weight.

Daily Self-Monitoring of Body Weight, Step Count, Fruit/Vegetable Intake, and Water Consumption: A Feasible and Effective Long-Term Weight Loss Maintenance Approach

2012-05-01

Abstract: Maintenance of weight loss remains a challenge for most individuals. Thus, practical and effective weight-loss maintenance (WTLM) strategies are needed. A two-group 12-month WTLM intervention trial was conducted from June 2007 to February 2010 to determine the feasibility and effectiveness of a WTLM intervention for older adults using daily self-monitoring of body weight, step count, fruit/vegetable (F/V) intake, and water consumption. Forty weight-reduced individuals (mean weight lost=6.7±0.6 kg; body mass index [calculated as kg/m2] 29.2±1.1), age 63±1 years, who had previously participated in a 12-week randomized controlled weight-loss intervention trial, were instructed to record daily body weight, step count, and F/V intake (WEV [defined as weight, exercise, and F/V]). Experimental group (WEV+) participants were also instructed to consume 16 fl oz of water before each main meal (ie, three times daily), and to record daily water intake. Outcome measures included weight change, diet/physical activity behaviors, theoretical constructs related to health behaviors, and other clinical measures. Statistical analyses included growth curve analyses and repeated measures analysis of variance. Over 12 months, there was a linear decrease in weight (β=−0.32, P<0.001) and a quadratic trend (β=0.02, P<0.01) over time, but no group difference (β=−0.23, P=0.08). Analysis of the 365 days of self-reported body weight for each participant determined that weight loss was greater over the study period in the WEV+ group than in the WEV group, corresponding to weight changes of −0.67 kg and 1.00 kg, respectively, and an 87% greater weight loss (β=−0.01, P<0.01). Overall compliance to daily tracking was 76%±5%. Daily self-monitoring of weight, physical activity, and F/V consumption is a feasible and effective approach for maintaining weight loss for 12 months, and daily self-monitoring of increased water consumption may provide additional WTLM benefits.

Depression Severity, Diet Quality, and Physical Activity in Women with Obesity and Depression

2012-05-01

Abstract: Major depressive disorder (MDD) is prevalent in clinical weight-loss settings and predicts poor weight-loss outcomes. It is unknown whether the severity of depressive symptoms among those with MDD is associated with diet quality or physical activity levels. This knowledge is important for improving weight-loss treatment for these patients. It was hypothesized that more severe depression is associated with poorer diet quality and lower physical activity levels among individuals with obesity and MDD. Participants were 161 women with current MDD and obesity enrolled in the baseline phase of a weight-loss trial between 2007 and 2010. Depression severity was measured with the Beck Depression Inventory II. The Alternate Healthy Eating Index was applied to data from three 24-hour diet recalls to capture overall diet quality. Daily metabolic equivalents expended per day were calculated from three 24-hour physical activity recalls. Greater depression severity was associated with poorer overall diet quality (estimate=−0.26, standard error 0.11; P=0.02), but not with physical activity (estimate=0.07, standard error 0.05; P=0.18), in linear regression models controlling for income, education, depression-related appetite change, binge eating disorder, and other potential confounds. Associations with diet quality were primarily driven by greater intake of sugar (r=0.20; P<0.01), saturated fat (r=0.21; P<0.01), and sodium (r=0.22; P<0.01). More severe depression was associated with poorer overall diet quality, but not physical activity, among treatment-seeking women with MDD and obesity. Future studies should identify mechanisms linking depression to diet quality and determine whether diet quality improves with depression treatment.

Limited Percentages of Adults in Washington State Meet the Dietary Guidelines for Americans Recommended Intakes of Fruits and Vegetables

Myduc L. Ta, Juliet VanEenwyk, Lillian Bensley — 2012-05-01

Abstract: Nutritious diets that include sufficient intake of fruits and vegetables promote health and reduce risk for chronic diseases. The 2005 Dietary Guidelines for Americans recommend four to 13 servings of fruits and vegetables daily for energy intake levels of 1,000 to 3,200 kcal, including seven to 13 servings for 1,600 to 3,000 kcal/day as recommended for adults aged ≥25 years. The 2006-2007 Washington Adult Health Survey, a cross-sectional study designed to measure risk factors for cardiovascular disease among a representative sample of Washington State residents aged ≥25 years, included a food frequency questionnaire (FFQ). The FFQ included approximately 120 food items and summary questions for fruits and vegetables that were used to compute energy intake and two measures of fruit and vegetable intake. Measure 1 was computed as the sum of intake of individual FFQ fruit and vegetable items; Measure 2 combined the summary questions with selected individual FFQ fruit and vegetable items. Depending on the measure used, approximately 14% to 22% of 519 participants with complete information met the guidelines for fruits, 11% to 15% for vegetables, and 5% to 6% for both fruits and vegetables. Participants aged ≥65 years and women were more likely to meet recommendations, compared with younger participants and men. Despite decades of public health attention, the vast majority of Washington State residents do not consume the recommended amount of fruits or vegetables daily. These findings underscore the need for developing and evaluating new approaches to promote fruit and vegetable consumption.

Use of Vendedores (Mobile Food Vendors), Pulgas (Flea Markets), and Vecinos o Amigos (Neighbors or Friends) as Alternative Sources of Food for Purchase among Mexican-Origin Households in Texas Border Colonias

Joseph R. Sharkey, Wesley R. Dean, Cassandra M. Johnson — 2012-05-01

Abstract: There is a paucity of studies acknowledging the existence of alternative food sources, and factors associated with food purchasing from three common alternative sources: vendedores (mobile food vendors), pulgas (flea markets), and vecinos/amigos (neighbors/friends). This analysis aims to examine the use of alternative food sources by Mexican-origin women from Texas-border colonias and determine factors associated with their use. The design was cross-sectional. Promotora-researchers (promotoras de salud trained in research methods) recruited 610 Mexican-origin women from 44 colonias and conducted in-person surveys. Surveys included participant characteristics and measures of food environment use and household food security. Statistical analyses included separate logistic regressions, modeled for food purchase from mobile food vendors, pulgas, or neighbors/friends. Child food insecurity was associated with purchasing food from mobile food vendors, while household food security was associated with using pulgas or neighbors/friends. School nutrition program participants were more likely to live in households that depend on alternative food sources. Efforts to increase healthful food consumption such as fruits and vegetables should acknowledge all potential food sources (traditional, convenience, nontraditional, and alternative), especially those preferred by colonia residents. Current findings support the conceptual broadening of the retail food environment, and the importance of linking use with spatial access (proximity) to more accurately depict access to food sources.

Use of Concept Mapping to Explore the Influence of Food Security on Food Buying Practices

Renee E. Walker, Ichiro Kawachi — 2012-05-01

Abstract: Paradoxically, individuals with food insecurity have been observed to have higher rates of obesity compared with their counterparts with food security. The factors influencing food purchasing behaviors in households with food security vs food insecurity are poorly understood. Using the mixed methods approach of concept mapping, we examined the perceptions and preferences driving the food purchasing behaviors of households with food security vs food insecurity. Twenty-six men and women with food security and 41 men and women with food insecurity from four neighborhoods in Boston, MA, completed the concept mapping process during 2010. Prevalence of overweight and obesity was greater among participants with food insecurity (80.5%) compared with those with food security (61.5%). Participants identified 163 unique factors that influenced their food purchasing behavior. Using multivariate analyses, these factors were grouped into eight unique concepts or clusters that reflected their perceptions of factors hindering healthy eating. Average cluster ratings were similar between participants with food security and food insecurity, suggesting that similar food purchasing behaviors are employed and are perceived similarly in how they hinder or promote healthy eating. The use of emergency food assistance programs may play a role in minimizing the burden of food insecurity while providing access to foods with varying degrees of nutritional quality that may be associated with increased risk of overweight and obesity observed in individuals and households with food insecurity.

Factors Associated with Weight Resilience in Obesogenic Environments in Female African-American Adolescents

2012-05-01

Abstract: This study used a descriptive, cross-sectional analysis to examine a social ecological model of obesity among African-American female adolescents residing in obesogenic environments. The goal was to identify factors that promote weight resilience, defined as maintaining a healthy body weight despite living in an environment that encourages inactivity and undermines healthy weight behaviors. During 2005 to 2008, weight-resilient (n=32) and obese (n=35) African-American female adolescents (12 to 17 years) living in Detroit, MI, and their caregivers completed measures of individual, family, and extrafamilial weight-resilience factors. Variables related to weight resilience in bivariate analyses were subjected to multivariate analysis using logistic regression to test the hypothesis that these factors independently predicted adolescent membership into the weight-resilient or obese group. As hypothesized, the odds of an adolescent being weight resilient were predicted by lower caregiver body mass index (calculated as kg/m2) (odds ratio [OR]=0.790; 95% confidence interval [CI]: 0.642 to 0.973), lower caregiver distress (OR=0.796; 95% CI: 0.635 to 0.998), higher caregiver monitoring and supervision of exercise (OR=5.746; 95% CI: 1.435 to 23.004), more frequent full-service grocery store shopping (OR=5.147; 95% CI: 1.137 to 23.298), and more peer support for eating (OR=0.656; 95% CI: 0.445 to 0.969). Contrary to prediction, lower eating self-efficacy (OR=0.597; 95% CI: 0.369 to 0.965) also predicted weight resilience. The model correctly classified 92.5% of all cases. Findings suggest that increasing psychosocial weight-resilience factors across multiple systems might be an important intervention strategy for obese African-American female adolescents residing in obesogenic environments.

Personalized Diet Management Can Optimize Compliance to a High-Fiber, High-Water Diet in Children with Refractory Functional Constipation

2012-05-01

Abstract: Diet modification to increase water and fiber consumption is considered an important component in the management of constipation. This prospective randomized study aimed to evaluate the compliance of 86 children with refractory functional constipation (mean age 4.4 years, range 1 to 11 years)—to a high-fiber, high-water diet following either physician's dietary advice (PI group) (n=42) or physician's dietary advice plus personalized diet management by a registered dietitian (DM group) (n=44). Dietary intake was assessed by a 24-hour dietary recall at baseline and 1 month later. The changes in water and fiber consumption were used as compliance criteria. DM group had comparable anthropometric measurements; sex distribution; and baseline intakes of energy, macronutrient, water, and dietary fiber compared with the PI group. Comparison of nutrient intakes between the two visits within each group showed a significant increase in fiber consumption in both groups that was more pronounced in the DM group. Water, energy, and carbohydrate consumption increased significantly only in the DM group. Multivariate regression analysis revealed that the intervention group was the only significant independent predictor for the change in fiber and water consumption after controlling for age, sex, and weight-for-age z score. Children receiving personalized diet management for refractory functional constipation achieved better compliance in increasing fiber and water consumption.

Consensus Statement of the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition: Characteristics Recommended for the Identification and Documentation of Adult Malnutrition (Undernutrition)

2012-05-01

Abstract: The Academy of Nutrition and Dietetics (Academy) and the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) recommend that a standardized set of diagnostic characteristics be used to identify and document adult malnutrition in routine clinical practice. An etiologically based diagnostic nomenclature that incorporates a current understanding of the role of the inflammatory response on malnutrition's incidence, progression, and resolution is proposed. Universal use of a single set of diagnostic characteristics will facilitate malnutrition's recognition, contribute to more valid estimates of its prevalence and incidence, guide interventions, and influence expected outcomes. This standardized approach will also help to more accurately predict the human and financial burdens and costs associated with malnutrition's prevention and treatment, and further ensure the provision of high quality, cost effective nutritional care.

Position of the Academy of Nutrition and Dietetics: Use of Nutritive and Nonnutritive Sweeteners

Cindy Fitch, Kathryn S. Keim — 2012-05-01

Abstract: It is the position of the Academy of Nutrition and Dietetics that consumers can safely enjoy a range of nutritive sweeteners and nonnutritive sweeteners (NNS) when consumed within an eating plan that is guided by current federal nutrition recommendations, such as the Dietary Guidelines for Americans and the Dietary Reference Intakes, as well as individual health goals and personal preference. A preference for sweet taste is innate and sweeteners can increase the pleasure of eating. Nutritive sweeteners contain carbohydrate and provide energy. They occur naturally in foods or may be added in food processing or by consumers before consumption. Higher intake of added sugars is associated with higher energy intake and lower diet quality, which can increase the risk for obesity, prediabetes, type 2 diabetes, and cardiovascular disease. On average, adults in the United States consume 14.6% of energy from added sugars. Polyols (also referred to as sugar alcohols) add sweetness with less energy and may reduce risk for dental caries. Foods containing polyols and/or no added sugars can, within food labeling guidelines, be labeled as sugar-free. NNS are those that sweeten with minimal or no carbohydrate or energy. They are regulated by the Food and Drug Administration as food additives or generally recognized as safe. The Food and Drug Administration approval process includes determination of probable intake, cumulative effect from all uses, and toxicology studies in animals. Seven NNS are approved for use in the United States: acesulfame K, aspartame, luo han guo fruit extract, neotame, saccharin, stevia, and sucralose. They have different functional properties that may affect perceived taste or use in different food applications. All NNS approved for use in the United States are determined to be safe.

Practice Paper of the Academy of Nutrition and Dietetics Abstract: Communicating Accurate Food and Nutrition Information

Diane Quagliani, Mindy Hermann — 2012-05-01

Abstract: Consumers are increasingly interested in food and nutrition information, and the channels for receiving information are expanding at a fast pace. This scenario provides new opportunities for registered dietitians (RDs) to reach diverse audiences with credible nutrition messages. However, it is also more challenging to be heard in an increasingly competitive communications environment where information is sometimes inaccurate but believed by the public. RDs must actively take steps to position themselves as reliable sources of science-based food and nutrition information and communicate through a variety of new media and traditional channels. RDs are uniquely qualified to evaluate and interpret nutrition research within the context of the body of science, and appropriately translate the findings into positive and practical food and diet advice for the public. Resources are provided to help RDs evaluate nutrition research, stay abreast of the latest food and nutrition information, and effectively communicate science-based information in a variety of formats.

May 2012 People & Events

2012-05-01

2012 Food & Nutrition Conference & Expo October 6-9, 2012 Philadelphia, PA

Erratum

2012-05-01

In the March 2012 issue of the Journal of the Academy of Nutrition and Dietetics, the name of one of the authors of the Review article “Rethinking Iron Regulation and Assessment in Iron Deficiency, Anemia of Chronic Disease, and Obesity: Introducing Hepcidin” (pages 391-400) was misspelled. The correct spelling of the second author's name is Cenk Pusatcioglu.

Erratum

2012-05-01

The Research and Professional Brief article, “Away-from-Home Family Dinner Sources and Associations with Weight Status, Body Composition, and Related Biomarkers of Chronic Disease among Adolescents and Their Parents,” by Jayne A. Fulkerson, PhD, and colleagues that appeared in the December 2011 issue of the Journal (pages 1892-1897), contains an error on page 1895. The sentence that reads, “Significantly higher mean adolescent metabolic risk cluster z scores (P<0.05) and higher mean HDL-C levels (P<0.05) were also observed when family dinner was purchased at takeout sources at least weekly” is incorrect. The correct sentence is as follows: “Significantly higher mean adolescent metabolic risk cluster z scores (P<0.05) and lower mean HDL-C levels (P<0.05) were also observed when family dinner was purchased at takeout sources at least weekly.”

May 2012 New in Review

2012-05-01

Periodicals page 763 Sites in Review page 770

May 2012 Classified Advertisements

2012-05-01

What Is the Appropriate Distribution of Macronutrients for a Patient with Diabetes?

Wendy Marcason — 2012-05-01

WHILE THE EFFECTIVENESS of medical nutrition therapy (MNT) in the management of diabetes has been well established, the ideal macronutrient distribution to improve glycemic control has been in question for many years. The American Diabetes Association established guidelines in 2001 stating that there was not one specific mix of macronutrients for all people with diabetes. A recent article published in Diabetes Care () reviewed the scientific literature from 2001 to 2010 regarding this question. The researchers reviewed almost 100 studies that discussed the kind and amount of carbohydrates, fat, protein, and specific foods and overall eating patterns that would have a possible impact on gylcemic control. The authors noted how difficult it was to get a true picture of the effects of the macronutrients on glycemic control since many factors can influence the results. Variability in study methodology, including measurement of dietary intake, retention rates, and confounding by weight loss, limits comparisons as to how macronutrient distribution independent of weight loss affects outcomes of interest. In the article, the authors defined the terms “conventional” or “traditional” macronutrient distribution as 55% to 65% carbohydrate, less than or equal to 30% fat, and 10% to 20% protein (). It is interesting to note that research studies have shown people with diabetes typically consume only 45% of total calories from carbohydrates (). Although in many instances there were not statistically significant differences between dietary approaches, improvements were often seen from baseline to follow-up in both intervention groups, supporting the idea that several different macronutrient distributions may lead to improvement in glycemic control ().

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What Is the Appropriate Distribution of Macronutrients for a Patient with Diabetes?