Survey language preference as a predictor of meeting fruit and vegetable objectives among Hispanic adults in the United States, Behavioral Risk Factor Surveillance System, 2009.

INTRODUCTION: Although Hispanics are a rapidly growing ethnic minority in the United States, the effect of acculturation on the proportion of Hispanics who meet national objectives for fruit and vegetable consumption has not been fully investigated. Our objective was to determine the extent to which ethnicity and acculturation (indicated by survey language preference) are associated with fruit and vegetable consumption among Hispanics in the United States. METHODS: Fruit and vegetable consumption among adult respondents to the 2009 Behavioral Risk Factor Surveillance System was determined from data collected from the 31 states and 2 territories that offered the fruit and vegetable screener in Spanish and English (n = 287,997). Logistic regression analyses were used to determine whether ethnicity (Hispanic vs non-Hispanic white) and survey language preference (English vs Spanish) were related to meeting objectives of consuming fruit 2 or more times per day and vegetables 3 or more times per day. RESULTS: More Hispanics (37.6%) than non-Hispanic whites (32.0%) and more Spanish-speaking Hispanics (41.0%) than English-speaking Hispanics (34.7%) ate fruit 2 or more times per day. Conversely, more non-Hispanic whites (28.5%) than Hispanics (18.9%) and more English-speaking Hispanics (21.8%) than Spanish-speaking Hispanics (15.8%) ate vegetables 3 or more times per day. All associations remained significant after controlling for covariates. CONCLUSION: Our findings have implications regarding how brief screeners can be used to determine possible dietary disparities among the Hispanic population in the United States and to monitor population goals to eliminate racial and ethnic health disparities.

Fruit and vegetable intake among adolescents and adults in the United States: percentage meeting individualized recommendations.

CONTEXT: Fruit and vegetable intake is an important part of a healthy diet and is associated with numerous positive health outcomes. MyPyramid provides recommendations for fruit and vegetable consumption based on individual calorie requirements as determined by an individual's age, sex, and physical activity level. OBJECTIVES: To determine (1) median fruit and vegetable consumption from all dietary sources among adolescent and adult consumers and the percentage of adolescents and adults meeting individual recommended intake levels based on caloric requirements and (2) consumption levels among various demographic groups, intake levels from subtypes of fruits and vegetables, and primary contributors to fruit and vegetable intake. DESIGN: Analysis of 2-day, 24-hour recall data from the 2003-2004 National Health and Nutrition Examination Survey (NHANES), a continuous, nationally representative, cross-sectional survey. RESULTS: This study included dietary contributions of fruits and vegetables from all dietary sources. Fewer than 1 in 10 Americans meet their calorie-specific MyPyramid fruit or vegetable recommendations. Higher intake was not observed in subgroups with higher recommendations for fruit and vegetable consumption based on caloric requirements. The primary contributors to total fruit intake were whole fruits among adults and fruit juices among adolescents. The largest single contributor to overall fruit intake was orange juice. Potatoes dominated vegetable consumption, particularly among adolescents, in whom fried potatoes increased the median vegetable intake from 0.72 cup to 1.21 cups per day. Dark green and orange vegetables and legumes accounted for a small portion of vegetable intake, and few people met the recommendations. CONCLUSIONS: Few American adolescents or adults reported consuming the recommended amounts of fruits or vegetables. Increasing consumption will probably require multifaceted approaches that augment educational campaigns with policy and environmental strategies aimed at the food system at large, from farm to plate, including schools, worksites, and retail establishments. Increasing America's fruit and vegetable consumption is an important public health strategy for weight management and reduction of risk for chronic disease.

Trying to lose or maintain weight during pregnancy-United States, 2003.

OBJECTIVES: Current pregnancy weight gain recommendations are for women to gain between 15 and 40 pounds; weight loss or weight maintenance is not recommended. However, for many women, overweight and obesity are chronic conditions, and commitment to weight loss or maintenance could override advice to gain weight during pregnancy. Our objective was to determine the prevalence of trying to lose or maintain weight among U.S. women during pregnancy. METHODS: The Behavioral Risk Factor Surveillance System is a state-based, random-digit-dialed telephone survey of noninstitutionalized, U.S. civilians aged > or =18 years. We identified women aged 18-44 years who reported being pregnant during 2003 (n = 2,464), assessed the prevalence of trying to lose or maintain weight and assessed independent associations with selected demographic, clinical, and behavioral factors using multinomial logistic regression. RESULTS: Among women who reported being pregnant, 7.5% (confidence interval [CI] = 5.7-9.8%) and 34.3% (CI = 31.0-37.7%) were trying to lose or maintain weight, respectively. Among women who reported trying to lose or maintain weight, exercise was a more prevalent weight control strategy than dietary change. After adjustment, women who drank alcohol during the past 30 days (Odds ratio [OR] = 8.86, CI: 4.51-17.42) or women who received advice in the past year to lose weight (OR = 9.10, CI: 3.20-25.87) were more likely to report trying to lose weight; women advised to maintain (OR = 0.20, CI: 0.07-0.60) or gain (OR = 0.04, CI: 0.01-0.23) weight were less likely to report trying to lose weight. CONCLUSIONS: Despite guidelines to gain weight during pregnancy, about 8% and 34% of U.S. pregnant women reported trying to lose or maintain weight, respectively. Providers may encounter an increasing number of pregnant women whose weight control intentions conflict with current guidelines for pregnancy weight gain. Further research in this area is warranted.

Dietary fructose consumption among US children and adults: the Third National Health and Nutrition Examination Survey.

CONTEXT: High fructose intake has been associated with increased de novo lipogenesis in the liver as well as increased plasma triglycerides, insulin resistance, and obesity. Fructose occurs naturally in fruits and vegetables; however, it is added to many processed foods as table sugar (sucrose) and high-fructose corn syrup. Dietary data from a nationally representative sample in 1977-1978 estimated that mean consumption of fructose was 37 g/day (8% of total intake). Little is known about more recent fructose consumption patterns. OBJECTIVE: We determined the amount and sources of dietary fructose among US adults and children. DESIGN: We examined fructose consumption patterns by sex, age group, race/ethnicity, socioeconomic status, and body mass index for 21,483 children and adults. We used a single 24-hour dietary recall administered in the third National Health and Examination Survey (NHANES). MAIN OUTCOME MEASURE: Weighted estimates of fructose intake were tested for significant differences (P < .05) between groups. RESULTS: The mean consumption of fructose was estimated to be 54.7g/day (range, 38.4-72.8) and accounted for 10.2% of total caloric intake. Consumption was highest among adolescents (12-18 years) at 72.8 g/day (12.1% of total calories). One fourth of adolescents consumed at least 15% of calories from fructose. The largest source of fructose was sugar-sweetened beverages (30%) followed by grains (22%) and fruit or fruit juice (19%). CONCLUSIONS: Over 10% of Americans' daily calories were from fructose. These results, when compared with a previous nationally representative study, suggest that fructose consumption has increased. Further research is needed to understand the impact of increased intake of fructose on human health.

Trends in fruit and vegetable consumption among U.S. men and women, 1994-2005.

INTRODUCTION: Eating a diet high in fruits and vegetables as part of an overall healthful diet can help lower chronic disease risk and aid in weight management. Increasing the percentage of Americans who consume enough fruits and vegetables every day is part of the Healthy People 2010 objectives for the nation. Assessing trends in consumption of these foods is important for tracking public health initiatives to meet this goal and for planning future objectives. METHODS: We assessed total and sex-specific changes in daily consumption of fruits and vegetables among 1,227,969 adults in the 50 U.S. states and the District of Columbia who participated in the Behavioral Risk Factor Surveillance System from 1994 through 2005. To estimate changes in consumption according to dietary recommendations that were in place during the years examined, we used geometric mean and the percentage of people eating fruits or vegetables or both five or more times per day. Estimates were standardized for sex, age, and race/ethnicity and analyzed by multivariate regression. RESULTS: From 1994 through 2005, the geometric mean frequency of consumption of fruits and vegetables declined slightly (standardized change: men and women, -0.22 times/day; men, -0.26 times/day; women, -0.17 times/day). The proportion of men and women eating fruits or vegetables or both five or more times per day was virtually unchanged (men, 20.6% vs 20.3%; women, 28.4% vs 29.6%); however, we found small increases for men aged 18 to 24 years and for women who were aged 25 to 34 years, non-Hispanic black, or nonsmokers. Consumption of fruit juice and non-fried potatoes declined for both sexes. CONCLUSION: The frequency of fruit and vegetable consumption changed little from 1994 through 2005. If consumption is to be increased, we must identify and disseminate promising individual and environmental strategies, including policy change.

A decay model for assessing polybrominated biphenyl exposure among women in the Michigan Long-Term PBB Study.

The Michigan Long-Term PBB Study was established following exposure to polybrominated biphenyls (PBBs) in the early 1970s. Serum samples from cohort members were analyzed for PBB during 1976-1993. More than 20 years following this industrial incident, some participants still had measurable serum PBB concentration levels. Thus, there is continuing interest in understanding the elimination of PBB from the body. In the present study, we estimated serum PBB decay and investigated the effects of covariates on serum PBB decay rates among 406 female cohort members. We developed a decay model using a general linear mixed model, which attributes unique intercept and slope estimates for each individual while borrowing information across individuals for predicting these quantities. Age at exposure and body mass index (BMI) at the initial measurement were time-independent covariates. Time since exposure, smoking history, pregnancy status, and breast-feeding status were time-dependent covariates. Higher BMI was associated with a slower decay rate; smokers had a faster decay rate than nonsmokers; and increasing age at exposure was marginally associated with a slower decay rate. Our results suggest a faster serum PBB decay rate for women who breast-fed during the interval between serum PBB measurements. To evaluate the predictive performance of our modeling approach, we compared the results from this model with those from a previously developed ordinary least squares (OLS) two-stage decay model. The mixed-effects decay model predicted the observed serum PBB concentration levels significantly better than the OLS two-stage decay model (mixed-effects model, r=0.93; OLS two-stage model, r=0.86; P<0.0001).

Dietary practices, dining out behavior, and physical activity correlates of weight loss maintenance.

INTRODUCTION: Loss of excess weight can improve blood lipids, insulin sensitivity, and blood pressure. However, data are scant on behavioral strategies related to maintenance of weight loss. We examined dietary practices, physical activity, and self-efficacy among adults self-reported to be successful at maintaining weight loss. METHODS: Using the 2004 Styles survey, a mailed survey of U.S. adults aged 18 years or older, we examined behaviors associated with weight loss maintenance among people who reported trying to lose weight. We analyzed data on number of daily fruit and vegetable servings, minutes per week of physical activity, dining out behavior, and confidence in one's ability to engage in behavioral strategies. We conducted frequency and multivariable logistic regression analyses. RESULTS: More men (35.5%) than women (27.7%) were classified as successful weight loss maintainers. Compared with adults who reported eating at a fast-food restaurant two or more times per week, adults who reported not eating at fast-food restaurants were more successful at weight loss maintenance (odds ratio, 1.62; 95% confidence interval, 1.09-2.42). Compared with adults who consumed fewer than five fruit and vegetable servings per day and were sedentary, adults who consumed fewer than five fruit and vegetable servings per day and accrued 420 minutes or more per week of physical activity or consumed five or more fruit and vegetable servings and accrued 150 minutes or more per week of activity were more successful at weight loss maintenance. CONCLUSION: The behavioral strategy of reducing consumption of fast foods could assist people in keeping weight off. The combined approach of consuming five or more fruit and vegetable servings per day and attaining 150 minutes or more per week of physical activity was a common strategy among adults successful at weight loss maintenance.

Using evaluation to guide successful development of an online training course for healthcare professionals.

AIM: The Centers for Disease Control and Prevention developed an online training course to address a lack of knowledge among healthcare professionals regarding the identification of patients at risk for hemochromatosis and recognition of its related early symptoms. A multilevel evaluation design was used to (a) guide course development, (b) test course efficacy, and (c) assess training impact. METHODS: Highly focused, brief evaluation activities with the intended audience (N = 642) provided a stream of qualitative and quantitative data that guided course design, development, and implementation. RESULTS: The training course had intended positive impacts on healthcare professionals' knowledge and perceived competence in recognizing, diagnosing, and treating hemochromatosis. Both physicians and nurses directly attributed changes in their clinical practice to course participation including increases in appropriate diagnostic biochemical testing for iron overload in new and existing patients. CONCLUSIONS: The hemochromatosis course is a successful learning tool that has the desired impact on learning and knowledge reinforcement. The evaluation conducted provided a stream of evidence that was useful in course development as well as assessment of training outcomes. The detailed evaluation plan description may serve as a template for assessing other online continuing education training courses that address public health issues.

Activity/participation limitation and weight loss among overweight and obese US adults: 1999 to 2002 NHANES.

OBJECTIVE: To examine the prevalence and association of activity/participation limitation with trying to lose weight and weight loss practices (eating fewer calories, physical activity, or both) among overweight and obese adults in the United States. RESEARCH METHODS AND PROCEDURES: Eligible adults were 20 years of age or older with a body mass index (BMI) >or= 25 kg/m(2) (n = 5608) who responded to standard physical functioning questions included in the 1999-2002 National Health and Nutrition Examination Survey, a continuous survey of the civilian non-institutionalized US population. RESULTS: Obese (BMI >or= 30) men with vs. without activity/participation limitations were more likely to try to lose weight (OR = 1.59, 95% CI 1.05-2.41). This was not the case for overweight women and men (BMI 25-29.9), or obese women. Among adults trying to lose weight, reducing calorie consumption was common (63%-73%, men, 67%-76%, women). Overweight women with vs without activity/participation limitations had significantly reduced likelihood of attaining recommended physical activity (OR = 0.56, 95% CI 0.36-0.89). Obese adults were more likely to try to lose weight if they attributed their limitation to body weight (OR = 1.78, 95% CI 1.11-2.88) or diabetes (OR = 1.86, 95% CI 1.01-3.43) compared to other causes. Overweight and obese adults who attributed activity/participation limitations to mental health, musculoskeletal, or cardiovascular problems were equally likely to attempt weight loss when respondents with each condition were compared to respondents without the condition. DISCUSSION: These results verify the importance of adequate subjective health assessment when developing individual weight loss plans, and may help guide weight management professionals in the development and delivery of more personalized care.

Health-related quality of life and weight loss practices among overweight and obese US adults, 2003 behavioral risk factor surveillance system.

BACKGROUND: Trying to lose weight is a concern for many Americans, but motivation for weight loss is not fully understood. Clinical assessment for obesity treatment is primarily based on measures of body size and physical comorbidities; however, these factors may not be enough to motivate individuals to lose weight. Health-related quality of life (HRQOL) may have a role in an individual's decision to try to lose weight. The objective of this study was to examine the prevalence and association of HRQOL measures as independent moderators of weight loss practices among overweight and obese men and women. RESEARCH METHODS AND PROCEDURES: Data were from the 2003 Behavioral Risk Factor Surveillance System, an annual state-based telephone survey of the civilian noninstitutionalized population of adults 20 years of age or older with BMI > or = 25.0 kg/m2 (n = 111,456) who responded to 4 standard HRQOL measures that assessed general health status, physical health, mental health, and activity limitation in the past 30 days. RESULTS: Among men with BMI 25-34.9 kg/m2, the odds of trying to lose weight increased for the moderate vs best category of HRQOL but not for the poorest vs best category, and no associations were noted for men with BMI > or = 35 kg/m2. Women with BMI 25-34.9 kg/m2 had reduced odds and decreasing associated trends in the prevalence of trying to lose weight with poorer general health, increased physically unhealthy days, and increased activity limitation days. Conversely, women with 1-13 vs 0 mentally unhealthy days had greater odds of trying to lose weight. Among those trying to lose weight, reducing calories was common (52%-69%, men; 56%-69%, women). Among men, with the exception of recent mental health, poorer levels of HRQOL measures were associated with diminished attainment of recommended physical activity levels. Among women, poorer general health status was associated with diminished attainment of recommended physical activity levels. DISCUSSION: With the exception of recent mental health, HRQOL was differentially associated with trying to lose weight among men and women. Specifically, moderately poor HRQOL among men and better HRQOL among women were associated with trying to lose weight. Consideration of these influences on weight loss may be useful in the treatment and support of obese patients.

Endometriosis among women exposed to polybrominated biphenyls.

PURPOSE: We examined the association between endometriosis and exposure to polybrominated biphenyls (PBBs) and polychlorinated biphenyls (PCBs) among women inadvertently exposed to PBBs in 1973. METHODS: Serum PBBs and PCBs were measured in the late 1970s. Women self-reported endometriosis at interview in 1997. We constructed Cox models to estimate the relative incidence of endometriosis in relation to PBB and PCB levels. RESULTS: Seventy-nine of 943 women (9%) reported endometriosis. Compared with women with low PBB exposure (or=4 ppb) (HR = 0.90; 95% CI, 0.51-1.59) exposure did not have increased incidence of endometriosis. Increased incidence of endometriosis was suggested among women exposed to moderate PCB (5-8 ppb) (HR = 1.67; 95% CI, 0.91-3.10) and high PCB (>or=8 ppb) (HR = 1.68; 95% CI, 0.95-2.98) levels compared with low PCB exposure (

Health behaviors of the young adult U.S. population: behavioral risk factor surveillance system, 2003.

INTRODUCTION: Health-risk behaviors such as eating poorly, being physically inactive, and smoking contribute to the leading causes of morbidity and mortality in the United States and are often established during adolescence and young adulthood. The objectives of this study were to characterize the health-risk behaviors of young adults (aged 18-24 years) using a large population-based survey of Americans and to determine if behaviors of this group differ by weight category, as assessed by body mass index (BMI). METHODS: Prevalence estimates for selected health-risk behaviors were calculated for respondents aged 18 to 24 years to the 2003 Behavioral Risk Factor Surveillance System (BRFSS). Respondents were categorized by BMI, and comparisons between sex and race and ethnicity were made within the overweight and obese categories. RESULTS: More than three quarters (78.4%) of respondents consumed fewer than five fruits and vegetables per day, 43.2% reported insufficient or no physical activity, 28.9% were current smokers, 30.1% reported binge drinking, and 11.9% reported frequent mental distress. One quarter (26.1%) of respondents were overweight, and 13.6% were obese. Of obese young adults, 67.2% reported that they currently were trying to lose weight; however, only 24.3% reported having received professional advice to lose weight. More obese women (34.2%) than obese men (16.7%) reported having received professional advice to lose weight. Only 19.1% of obese non-Hispanic white respondents had received professional advice to lose weight compared with 28.0% of obese Hispanic respondents and 30.6% of obese non-Hispanic black respondents. CONCLUSION: Many young adults engage in unhealthy behaviors, and differences exist in health-risk behaviors by BMI category and specifically by sex and race and ethnicity within BMI categories. The transition from adolescence to adulthood may be an opportune time for intervening to prevent future chronic disease.

Use of nonprescription dietary supplements for weight loss is common among Americans.

OBJECTIVE: Dietary supplements are not recommended as part of a weight-loss program due to concerns about efficacy and safety. This study sought to assess prevalence and duration of nonprescription weight-loss supplement use, associated weight-control behaviors, discussion of use with a health care professional, and specific ingredient use. PARTICIPANTS AND DESIGN: Adults aged > or =18 years (n=9,403) completed a cross-sectional population-based telephone survey of health behaviors from September 2002 through December 2002. STATISTICAL ANALYSES PERFORMED: Both chi2 and t tests were conducted for categorical and mean comparisons and multiple variable logistic regression was used to determine significant predictors. RESULTS: An estimated 15.2% of adults (women 20.6%, men 9.7%) had ever used a weight-loss supplement and 8.7% had past year use (women 11.3%, men 6.0%); highest use was among women aged 18 to 34 years (16.7%). In regression models, use was equally prevalent among race/ethnic groups and education levels. One in 10 (10.2%) of users reported > or =12 month use, with less frequent long-term use in women (7.7%) than men (15.0%), P=0.01. Almost one third (30.2%) of users discussed use during the past year; 73.8% used a supplement containing a stimulant including ephedra, caffeine, and/or bitter orange. CONCLUSIONS: Use of supplements for losing weight seems to be common among many segments of the US adult population. Many adults are long-term users and most do not discuss this practice with their physician. Most of the weight-loss supplements taken contain stimulants. Qualified professionals should inquire about use of supplements for weight loss to facilitate discussion about the lack of efficacy data, possible adverse effects, as well as to dispel misinformation that may interfere with sound weight-management practices.

Risk of spontaneous abortion among women exposed to polybrominated biphenyls.

Accidental contamination of livestock in Michigan in 1973 with polybrominated biphenyls (PBBs) led to the establishment of a registry of exposed individuals in 1976. At the time of enrollment, serum was collected and analyzed for PBBs and polychlorinated biphenyls (PCBs). In 1997, women aged 18 years or older and active in the registry were invited to participate in a telephone interview about their health. Using generalized estimating equations to account for correlated outcomes within the same woman, we assessed the risk of spontaneous abortion among 529 women with 1344 potentially exposed pregnancies. PBB and PCB exposure were not associated with risk of spontaneous abortion after adjusting for maternal age at conception, age at menarche, and prior infertility. Compared to pregnancies with PBB exposure below the limit of detection, those with levels above 2.9 ppb had a non-significant reduced odds of spontaneous abortion (adjusted OR=0.73; 95% CI=0.47-1.13). Compared to pregnancies with PCB exposure below the limit of detection, those with levels above 6.5 ppb had little difference in risk (adjusted OR=0.91; 95% CI=0.59-1.41). Maternal age at conception above 34 years was significantly associated with elevated risk of spontaneous abortion (OR=2.46; 95% CI=1.10-5.49). The effect of prior infertility was of borderline significance (OR=1.52; 95% CI=0.98-2.38). Older age at menarche was associated with decreased risk of spontaneous abortion (adjusted OR=0.58; 95% CI: 0.38-0.89, comparing menarche at 12-13 with menarche <12). Our results do not support an association between exposure to PBBs or PCBs and risk of spontaneous abortion.

Use of low-carbohydrate, high-protein diets among americans: correlates, duration, and weight loss.

CONTEXT: Although low-carbohydrate, high-protein (LCHP) diets reemerged as popular diets, there are scant data on patterns of use in the general US population. OBJECTIVE: We examined the prevalence of reported LCHP diet use (eg, Sugar Busters, The Zone, The Carbohydrate Addict's Diet, The Atkins Diet), associated weight control behaviors, diet duration, and amount of weight loss while on the diet. DESIGN: Population-based cross-sectional survey. SETTING: Telephone survey of US adults conducted from September 2002 to December 2002 (N = 9300). MAIN OUTCOME MEASURES: We used multivariable logistic regression models to determine predictors of current LCHP diet use. RESULTS: At the time of the survey, 12.5% of Americans reported ever using a LCHP diet, and 3.4% reported current use. Prevalence of current use was similar across sex, race/ethnicity, and education levels. Among those trying to lose weight (n = 3790), 5.9% reported currently using an LCHP diet. Among current users, mean weight loss was 18.3 (median, 11.7) lb, with 18.2% reporting > or = 30 lb weight loss, 34.0% > or = 20 lb weight loss, and 8.8% no weight loss. More men than women reported a duration of use of more than 12 months (42.2% vs 29.6%, P = .04) and median duration was greater in men than women (5.7 vs 2.8 months, P = .08). Among those trying to control weight, a significantly higher proportion of current LCHP diet users reported eating fewer calories and meeting physical activity recommendations (38.0%) compared with nonusers (29.8%). CONCLUSIONS: LCHP diets were equally prevalent across sociodemographic subgroups and many users reported significant weight loss. Approximately 40% of male users and 30% of female users reported long-term use of the diet, suggesting that for some, this dietary approach may be well tolerated.

Dietary and physical activity behaviors among adults successful at weight loss maintenance.

BACKGROUND: There is limited population-based data on behavioral factors found to be important for successful weight loss maintenance among adults. METHODS: Data from the 2004 Styles surveys, mailed to U.S. adults aged > or = 18 years were used to examine the difference in selected weight loss strategies and attitudes among persons who reported successful weight loss attempts (lost weight and able to keep it off) and persons who were not successful (previous attempts to lose weight were unsuccessful or they could not keep the lost weight off). Behaviors examined included modification of diet, leisure-time and sports activities, and self-monitoring, and barriers to weight management. RESULTS: Among adults who reported losing weight or trying to lose weight, 31.0% had been successful at both losing weight and maintenance after weight loss. Successful weight loss status differed by sex, age, and current weight status. Assessment of reported weight loss strategies, found that exercising > or = 30 minutes/day and adding physical activity to daily life were significantly higher among successful versus unsuccessful weight losers. Individuals who were successful at weight loss and maintenance were less likely to use over-the-counter diet products than those who were unsuccessful at weight loss. Significantly more successful versus unsuccessful weight losers reported that on most days of the week they planned meals (35.9% vs. 24.9%), tracked calories (17.7% vs. 8.8%), tracked fat (16.4% vs. 6.6%), and measured food on plate (15.9% vs. 6.7%). Successful losers were also more likely to weigh themselves daily (20.3% vs. 11.0%). There were a significantly higher proportion of successful losers who reported lifting weights (19.0%) versus unsuccessful (10.9%). The odds of being a successful weight loser were 48%-76% lower for those reporting exercise weight control barriers were influencing factors (e.g., no time, too tired to exercise, no one to exercise with, too hard to maintain exercise routine) compared to those who reported little or no influence of exercise; similarly, the odds were 48-64% lower for those who found certain dietary barriers to be influential (e.g., eat away from home too often, diet/health food costs too much). CONCLUSION: Self-monitoring strategies such as weighing oneself, planning meals, tracking fat and calories, exercising 30 or more minutes daily, and/or adding physical activity to daily routine may be important in successful weight loss maintenance. Leisure-time activities such as lifting weights or cooking/baking for fun are common strategies reported by those who were successful weight losers.

Anaemia, iron status and vitamin A deficiency among adolescent refugees in Kenya and Nepal.

OBJECTIVE: To investigate the prevalence of anaemia (haemoglobin<11.0 to 13.0 g dl(-1) depending on age and sex group), iron deficiency (transferrin receptor concentration>8.3 microg ml(-1)) and vitamin A deficiency (serum retinol <0.7 micromol l(-1)) in adolescent refugees. DESIGN: Cross-sectional surveys. SETTING: Kakuma refugee camp in Kenya and seven refugee camps in Nepal. SUBJECTS: Adolescent refugee residents in these camps. RESULTS: Anaemia was present in 46% (95% confidence interval (CI): 42-51) of adolescents in Kenya and in 24% (95% CI: 20-28) of adolescents in Nepal. The sensitivity of palmar pallor in detecting anaemia was 21%. In addition, 43% (95% CI: 36-50) and 53% (95% CI: 46-61) of adolescents in Kenya and Nepal, respectively, had iron deficiency. In both surveys, anaemia occurred more commonly among adolescents with iron deficiency. Vitamin A deficiency was found in 15% (95% CI: 10-20) of adolescents in Kenya and 30% (95% CI: 24-37) of adolescents in Nepal. Night blindness was not more common in adolescents with vitamin A deficiency than in those without vitamin A deficiency. In Kenya, one of the seven adolescents with Bitot's spots had vitamin A deficiency. CONCLUSIONS: Anaemia, iron deficiency and vitamin A deficiency are common among adolescents in refugee populations. Such adolescents need to increase intakes of these nutrients; however, the lack of routine access makes programmes targeting adolescents difficult. Adolescent refugees should be considered for assessment along with other at-risk groups in displaced populations.

Multivitamin use in relation to self-reported body mass index and weight loss attempts.

CONTEXT: There are scant data on patterns of multivitamin use among US adults in terms of body mass index (BMI) or whether one is trying to lose weight. OBJECTIVE: To examine multivitamin use and beliefs about multivitamin use among adults according to BMI and to determine whether use by body weight differs if one is trying to lose weight. DESIGN: Cross-sectional multivariate analysis of the HealthStyles consumer survey. The final analytic sample consisted of 2239 women and 1532 men. MAIN OUTCOME MEASURES: Prevalence and odds of multivitamin use by demographic and behavioral characteristics including BMI, use by weight loss intent, and among users, reasons for use. RESULTS: 63.7% of women and 52.9% of men reported multivitamin use (taking 1 or more multivitamin per week). Obese women were less likely than normal-weight women to use multivitamins; no differences according to BMI category were detected for men. Among women who were not trying to lose weight, obese women were less likely than normal-weight women to use multivitamins (odds ratio = 0.63, CI 0.41-0.98). Assessment of reasons for use found that compared among women not trying to lose weight, those trying to lose weight were more likely to report multivitamin use because It is important for my health. CONCLUSIONS: This descriptive analysis adds to the limited literature on multivitamin use according to both body weight and attempting to lose weight. Multivitamin use was common and decreased with increasing BMI. This may be because fewer obese people consider vitamins "important for their health".

Associations between body mass index and the prevalence of low micronutrient levels among US adults.

BACKGROUND: Low micronutrient levels observed with increasing adiposity may result from inadequate nutrient intake and/or alterations in nutrient metabolism. OBJECTIVE: To examine the association between body mass index (BMI) and micronutrient levels among a nationally representative sample of US adults aged > or = 19 years. DESIGN: Using nationally representative cross-sectional data from the National Health and Nutrition Examination Survey III (NHANES III), we examined odds ratios of low micronutrient levels using logistic regression adjusting for covariates. MEASUREMENTS: Nutritional biomarker levels (as indicated by serum levels of total carotenoids, alpha-carotene, beta-carotene, beta-cryptoxanthin, lutein/zeaxanthin, lycopene, vitamin E, vitamin C, selenium, vitamin A, vitamin D, folate, vitamin B12, and red blood cell folate) among men and nonpregnant women, by BMI category. RESULTS: Overweight and obese adults had higher odds of low levels for a number of nutrients compared with normal-weight adults. Odds of being low in multiple micronutrients was most common among overweight and obese premenopausal women. CONCLUSION: These findings underscore the need for further assessment of specific micronutrient inadequacies among persons who are overweight or obese. Specifically, research is needed to determine whether these inadequacies are due to insufficient dietary intake, altered metabolic processes, or both.

Iron supplement use and iron status among US adults: results from the third National Health and Nutrition Examination Survey.

BACKGROUND: Patients with hemochromatosis are instructed to avoid taking supplemental iron. Whether supplemental iron intakes lead to higher iron status among healthy persons remains less clear. OBJECTIVE: The objective was to ascertain whether supplemental iron intakes are associated with increases in iron transport (transferrin saturation) and stores (serum ferritin) among US adults aged > or = 19 y. DESIGN: We analyzed data for 5948 adults from whom a fasting serum sample was collected during the third National Health and Nutrition Examination Survey. We used multivariable linear regression and analysis of variance to assess the association of supplemental iron intake with iron transport and stores among men (aged 19-30 y or > 30 y) and women (nonpregnant premenopausal or postmenopausal); multiple comparison tests were also performed. RESULTS: Healthy adults who took supplements containing average daily amounts of iron at < or = 3 times the recommended dietary allowance (RDA) did not have significantly higher iron transport or stores than did those who did not take supplements. In younger men, the intake of > 32 mg Fe/d (> 4x RDA) was associated with mean transport iron concentrations that were significantly higher than those in persons who took 0 to < or = 24 mg Fe/d. In older men, the intake of > 32 mg Fe/d (> 4x RDA) was associated with mean iron stores that were significantly higher than those in persons who took 0 to < or = 24 mg Fe/d; a similar result was observed in postmenopausal women, but it was of borderline statistical significance. CONCLUSION: Supplement users should be made aware of the amount of iron necessary to satisfy dietary requirements and informed of the possible influence that excess iron intake can have on body iron stores and health.