The Accuracy of Portion Size Reporting on Self-Administered Online 24-Hour Dietary Recalls Among Women With Low Incomes.

BACKGROUND: Accurately estimating portion sizes remains a challenge in dietary assessment. Digital images used in online 24-hour dietary recalls may be conducive to accuracy. OBJECTIVE: The current analyses were conducted to examine the accuracy of portion size estimation by women with low incomes who completed 24-hour dietary recalls using the online Automated Self-Administered 24-hour Dietary Assessment Tool (ASA24) in the Food and Eating Assessment Study II. DESIGN: True dietary intake was observed for 3 meals on 1 day through a controlled feeding study conducted from May through July 2016. The following day, participants completed an unannounced 24-hour dietary recall using ASA24, independently or with assistance in a small-group setting. PARTICIPANTS/SETTING: Participants included 302 women aged 18 to 82 years living in the Washington, DC, area who met the income thresholds for the Supplemental Nutrition Assistance Program. MAIN OUTCOME MEASURES: The accuracy of portion size estimation was assessed by comparing the weight truly consumed (observed) and the weight reported for predetermined categories of foods and beverages. STATISTICAL ANALYSES PERFORMED: The differences between observed and reported portions were examined and linear regression tested differences by recall condition. Analyses were conducted by condition and repeated with stratification by racial/ethnic identity, education, and body mass index. RESULTS: On average across foods and beverages, reported portion sizes were 7.4 g (95% CI, 4.3-10.5) and 6.4 g (95% CI, 2.8-10.0) higher than observed portion sizes in the independent and assisted conditions, respectively. Portion sizes were overestimated for small pieces and shaped foods in both conditions, as well as for amorphous/soft foods in the assisted condition and underestimated for single-unit foods in both conditions. Misestimation was fairly consistent by participants' race/ethnicity, education, and body mass index, to varying magnitudes. CONCLUSIONS: Women with low incomes overestimated the amounts of foods and beverages consumed across several categories using online 24-hour dietary recalls with digital images to support portion size estimation. Assistance with ASA24 had little impact on accuracy.

New Exponential Scoring Functions for Diet Quality Indexes Solve Problems Caused by Truncation.

BACKGROUND: Diet quality indexes, including the Healthy Eating Index, assess diets based on usual dietary intakes and a scoring function. Nearly all diet quality indexes use scoring functions that have floors and ceilings, thereby truncating the scores and losing information about intakes outside the scoring range. This score truncation has 2 important impacts: 1) the index does not reflect all intakes; and 2) the assumption that measurement error in intake reporting has a neutral impact on the diet quality score cannot be upheld. OBJECTIVES: Our main objective was to devise new diet quality scoring functions that eliminate truncation and its attendant problems. METHODS: Seven desirable properties of a new scoring function were identified: 1) avoid truncations in component scoring to prevent information loss and to provide scoring sensitivity in the currently truncated regions; 2) reduce dependency on the accuracy of dietary standards; 3) minimize measurement error bias and subsequent misclassification; 4) relate plausibly to biological processes; 5) possess desirable mathematical and statistical properties; 6) have simple representations that are easy to calculate and add minimum artifacts of their own; and 7) otherwise closely mimic existing scoring functions. RESULTS: The recommended replacement for piecewise-linear scoring is a family of scoring functions based on exponentials. For components where higher intakes are better, the function is a single exponential. For components where lower intakes are better, the function is a concave-convex mirrored pair of exponentials. The proposed exponential scoring functions have all 7 desired properties. CONCLUSIONS: The proposed exponential scoring functions will improve the usefulness of dietary scoring indexes by eliminating truncations. Compared to existing scoring functions, the use of exponentials makes the scores more inclusive of very high and very low intakes, reduces measurement error bias, and is less sensitive to the exact placement of the scoring standards.

New Exponential Scoring Functions for Diet Quality Indexes Solve Problems Caused by Truncation.

BACKGROUND: Diet quality indexes, including the Healthy Eating Index, assess diets based on usual dietary intakes and a scoring function. Nearly all diet quality indexes use scoring functions that have floors and ceilings, thereby truncating the scores and losing information about intakes outside the scoring range. This score truncation has 2 important impacts: 1) the index does not reflect all intakes; and 2) the assumption that measurement error in intake reporting has a neutral impact on the diet quality score cannot be upheld. OBJECTIVES: Our main objective was to devise new diet quality scoring functions that eliminate truncation and its attendant problems. METHODS: Seven desirable properties of a new scoring function were identified: 1) avoid truncations in component scoring to prevent information loss and to provide scoring sensitivity in the currently truncated regions; 2) reduce dependency on the accuracy of dietary standards; 3) minimize measurement error bias and subsequent misclassification; 4) relate plausibly to biological processes; 5) possess desirable mathematical and statistical properties; 6) have simple representations that are easy to calculate and add minimum artifacts of their own; and 7) otherwise closely mimic existing scoring functions. RESULTS: The recommended replacement for piecewise-linear scoring is a family of scoring functions based on exponentials. For components where higher intakes are better, the function is a single exponential. For components where lower intakes are better, the function is a concave-convex mirrored pair of exponentials. The proposed exponential scoring functions have all 7 desired properties. CONCLUSIONS: The proposed exponential scoring functions will improve the usefulness of dietary scoring indexes by eliminating truncations. Compared to existing scoring functions, the use of exponentials makes the scores more inclusive of very high and very low intakes, reduces measurement error bias, and is less sensitive to the exact placement of the scoring standards.

Weight-related psychological inflexibility as a mediator between weight self-stigma and health-related outcomes.

Weight self-stigma, the internalization of negative societal stereotypes, is a problem among populations with high weight. Weight self-stigma is associated with psychological inflexibility and maladaptive health-related behaviors. In this study, the authors explore how weight-related psychological inflexibility may influence weight self-stigma and health-related outcomes in 79 adults with high weight. Participants were primarily White (92.4%) and female (82.3%), with an average age of 39.56 years and average body mass index of 33.78. The study uses baseline, self-report data from a larger trial. Results indicate that weight self-stigma was negatively correlated with maladaptive eating behaviors, weight, and mental health. Weight-related psychological inflexibility was found as a significant mediator for the relationship between weight self-stigma and emotional eating, sedentary behavior, and mental health. Weight-related psychological inflexibility did not mediate the relationships between weight self-stigma and other eating measures and physical activity. These results support targeting weight-related psychological inflexibility and weight self-stigma in interventions.

Healthy Eating Index-2015 Scores Among Adults Based on Observed vs Recalled Dietary Intake.

BACKGROUND: The construct and predictive validity of the Healthy Eating Index (HEI) have been demonstrated, but how error in reported dietary intake may affect scores is unclear. OBJECTIVE: These analyses examined concordance between HEI-2015 scores based on observed vs reported intake among adults. DESIGN: Data were from two feeding studies (Food and Eating Assessment STudy, or FEAST, I and II) in which true intake was observed for three meals on 1 day. The following day, participants completed an unannounced 24-hour dietary recall. PARTICIPANTS/SETTING: FEAST I (2012) included 81 men and women, aged 20 to 70 years, living in the Washington, DC, area. FEAST II (2016) included 302 women, aged 18 years or older, with low household incomes and living in the Washington, DC, area. In FEAST I, recalls were completed independently using the Automated Self-Administered 24-hour Dietary Assessment Tool (ASA24-2011) or interviewer-administered using the Automated Multiple-Pass Method. In FEAST II, recalls were completed using ASA24-2016, independently or in a small group setting with assistance. MAIN OUTCOME MEASURES: HEI-2015 scores were calculated using the population ratio method. STATISTICAL ANALYSES PERFORMED: T-tests determined whether differences between scores based on observed and reported intake were different from zero. FEAST I data were stratified by sex, and in FEAST II, analyses were repeated by education and body mass index (BMI). RESULTS: Differences in total HEI-2015 scores between observed and reported intake ranged from -1.3 to 5.8 points among those completing ASA24 independently in both studies, compared with -2.5 points in the small group setting. For interviewer-administered recalls, the differences were -1.1 for men and 2.3 for women. In FEAST II, total HEI-2015 scores derived from observed intake were lower than scores derived from reported intake among those who had completed high school or less (-3.2, SE 1.1, P<0.01) and those with BMI ≥ 30 (-2.8, SE 1.1, P = 0.01). CONCLUSIONS: HEI-2015 scores based on 24-hour dietary recall data are generally well estimated.

Higher Fruit and Vegetable Intake Is Associated with Participation in the Double Up Food Bucks (DUFB) Program.

Incentivizing fruit and vegetable (F&V) purchases may help address barriers to healthy eating among populations with low income. In a repeated measures natural experiment study, we examined whether participation in the Double Up Food Bucks (DUFB) program increased F&V consumption among Supplemental Nutrition Assistance Program (SNAP) recipients. Two hundred and twelve participants recruited at baseline through telephone calls were informed about the availability of DUFB at their local farmers' market (FM). F&V consumption frequency and DUFB use were obtained at baseline, mid FM, and end of FM season approximately 5 months later. Participants (N = 212) were primarily white (76.4%) women (77.3%) with an average age of 43.5 years. Only 34 participants opted to use the DUFB program. A linear mixed model showed a significant main effect of DUFB use (p = 0.001) and of time (p = 0.002), with a decrease in F&V intake over time. Compared to non-users, DUFB users had a significantly higher F&V consumption at baseline and midpoint (p = 0.02 and p = 0.02, respectively). F&V consumption was associated with participation in the DUFB program and higher F&V consumption frequency was observed prior to program use among program participants. Future interventions that specifically target SNAP recipients with low F&V intake to use the DUFB program are needed.

Effectiveness of Expanded Food and Nutrition Education Program in Changing Nutrition-Related Outcomes Among Adults With Low Income: A Systematic Review.

OBJECTIVE: To review the effect of the Expanded Food and Nutrition Education Program (EFNEP) in changing nutrition-related outcomes. METHODS: Relevant research conducted before December 2020 was identified using PubMed, Web of Science, Google Scholar, and the EFNEP Research Database. The methodological quality of each eligible study was assessed. RESULTS: Of the 406 studies found, 30 were eligible; 26 studies were on EFNEP, and 4 included both EFNEP and Supplemental Nutrition Assistance Program Nutrition Education (SNAP-Ed). The sample sizes ranged from 35 to 122,961. Outcome measures included consumption of food groups, nutrients, other nutrition-related behaviors, and food security. At least 1 immediate behavior change (P < 0.05) was reported in each study, but long-term maintenance of behavior change was not evident. DISCUSSION: This review found a consistent, immediate improvement in nutrition behaviors after program participation but poor retention over time. Overall, variation in programming and outcome measures, incomplete reporting, and generally low study quality by modern standards precluded strong conclusions. IMPLICATIONS FOR RESEARCH AND PRACTICE: This review identified the need for control groups, improved reporting of program protocols, theory-based curriculum, and measurement of long-term outcomes.

A randomized controlled trial of online acceptance and commitment therapy to improve diet and physical activity among adults who are overweight/obese.

Acceptance and commitment therapy (ACT) has shown benefit for improving diet, physical activity, and weight among adults who are overweight and obese. However, research to-date in this area has primarily evaluated ACT delivered through in-person interventions, which has more limited access relative to online formats. The present study evaluated an online guided self-help program that integrated ACT with nutrition education to improve healthy eating and physical activity. A sample of 79 adults who were overweight/obese was randomized to receive the 8-week ACT on Health program plus weekly phone coaching or to a waitlist. Participants completed 5.5 ACT sessions on average (out of 8) and reported moderately high program satisfaction. Participants in the ACT condition improved significantly more than the waitlist at posttreatment on the primary outcome of healthy eating index (HEI; based on 24-hr recall assessments) and almost all secondary outcomes assessing self-reported eating behaviors, weight, mental health, weight self-stigma, and psychological inflexibility. However, no intervention effects were found for self-reported physical activity. At 8-week follow-up, improvements were maintained for most outcomes in the ACT condition, but not for the HEI. Improvements in psychological inflexibility mediated treatment effects on some outcomes, but not HEI or weight. Overall, delivering ACT through online guided self-help combined with nutrition education appears promising for improving healthy eating, weight, and self-stigma, but results for physical activity and long-term behavior change are unclear, possibly due to limitations in the ACT on Health program.

A Qualitative Evaluation of Double Up Food Bucks Farmers' Market Incentive Program Access.

OBJECTIVE: Explore factors affecting access to and use of Double Up Food Bucks (DUFB), a farmers' market program that doubles Supplemental Nutrition Assistance Program benefits for use toward the purchase of fruits and vegetables (FV). DESIGN: Focus groups. SETTING: Metro and nonmetro counties in Utah and western Upstate New York. PARTICIPANTS: Nine groups composed of 62 low-income adults (3-9/group). PHENOMENA OF INTEREST: Satisfaction with, barriers to, and facilitators of program use; suggestions for improvement. ANALYSIS: Transcribed verbatim and coded thematically in NVivo 11 software according to template analysis. RESULTS: Program satisfaction was high and driven by FV affordability, perceived support of local farmers, positive market experiences, and high-quality FV. Primary barriers to using DUFB were lack of program information and inconvenient accessibility. Insufficient program communication was a consistent problem that elicited numerous suggestions regarding expansion of program marketing. Emergent topics included issues related to the token-based administration of DUFB and debate regarding stigma experienced during DUFB participation. CONCLUSIONS AND IMPLICATIONS: Results suggest that although DUFB elicits many points of satisfaction among users, program reach may be limited owing to insufficient program marketing. Even among satisfied users, discussion of barriers was extensive, indicating that program reach and impact may be bolstered by efforts to improve program accessibility.

An Evaluation of Inter-coder and Intra-coder Reliability for 24-Hour Dietary Recall Data Entered in WebNEERS.

OBJECTIVE: To evaluate inter-coder (between-coder) and intra-coder (within-coder) reliability among trained data coders who enter 24-hour dietary recall data collected through Expanded Food and Nutrition Education Program operations in the state of Georgia. DESIGN: This study employed multiple cross-sectional evaluations of inter-coder reliability and a short-term longitudinal evaluation of intra-coder reliability. PARTICIPANTS/SETTING: Study participants consisted of trained data coders (n = 9) who were employed during the 12-month period of evaluation. MAIN OUTCOME MEASURES: Primary outcome measures were inter-coder and intra-coder reliability across data entered into the Web-based Nutrition Education Evaluation and Reporting System. Statistical analyses were conducted using IBM SPSS 24. Descriptive statistics were generated and inter-coder and intra-coder reliability were assessed using 2-way mixed intraclass correlation coefficients. RESULTS: Results of this evaluation indicated good to excellent inter-coder reliability among all coders, and excellent intra-coder reliability among the majority of coders. However, some notable inconsistencies were identified within the intra-coder reliability analyses. CONCLUSIONS: Future strategies to improve data quality within Expanded Food and Nutrition Education Program operations might include enhanced training for data coders, implementation of error detection protocols, expansion of the Web-based Nutrition Education Evaluation and Reporting System database, and exploration of automated, computer-assisted administration of 24-hour dietary recalls.

The Provision of Assistance Does Not Substantially Impact the Accuracy of 24-Hour Dietary Recalls Completed Using the Automated Self-Administered 24-H Dietary Assessment Tool among Women with Low Incomes.

Background: Evidence is lacking informing the use of the Automated Self-Administered 24-h Dietary Assessment Tool (ASA24) with populations characterized by low income. Objective: This study was conducted among women with low incomes to evaluate the accuracy of ASA24 recalls completed independently and with assistance. Methods: Three hundred and two women, aged ≥18 y and with incomes below the Supplemental Nutrition Assistance Program thresholds, served themselves from a buffet; amounts taken as well as plate waste were unobtrusively weighed to enable calculation of true intake for 3 meals. The following day, women completed ASA24-2016 independently (n = 148) or with assistance from a trained paraprofessional in a small group (n = 154). Regression modeling examined differences by condition in agreement between true and reported foods; energy, nutrient, and food group intakes; and portion sizes. Results: Participants who completed ASA24 independently and those who received assistance reported matches for 71.9% and 73.5% (P = 0.56) of items truly consumed, respectively. Exclusions (consumed but not reported) were highest for lunch (at which participants consumed approximately 2 times the number of distinct foods and beverages compared with breakfast and dinner). Commonly excluded foods were additions to main dishes (e.g., tomatoes in salad). On average, excluded foods contributed 43.6 g (46.2 kcal) and 40.1 g (43.2 kcal) among those in the independent and assisted conditions, respectively. Gaps between true and reported intake were different between conditions for folate and iron. Within conditions, significant gaps were observed for protein, vitamin D, and meat (both conditions); vitamin A, iron, and magnesium (independent); and folate, calcium, and vegetables (assisted). For foods and beverages for which matches were reported, no difference in the gap between true and reported portion sizes was observed by condition (P = 0.22). Conclusions: ASA24 performed relatively well among women with low incomes; however, accuracy was somewhat lower than previously observed among adults with a range of incomes. The provision of assistance did not significantly impact accuracy.

Double Up Food Bucks Participation is Associated with Increased Fruit and Vegetable Consumption and Food Security Among Low-Income Adults.

OBJECTIVE: To evaluate the effect of the Utah Double Up Food Bucks (DUFB) program on fruit and vegetable (F&V) intake and food security status among Supplemental Nutrition Assistance Program (SNAP) recipients. METHODS: Data were collected in 2015, using a before-and-after study design. At the farmers' market, a convenience sample of SNAP recipients was recruited for a survey and a 4-week telephone follow-up survey. Differences between the 2 surveys in food security and F&V intake were tested using the Wilcoxon signed-rank test. RESULTS: Follow-up surveys were completed with 138 (40%) of the 339 baseline participants. Median F&V consumption increased from 2.82 times per day to 3.29 times per day (median, interquartile range 1.48-3.99 and 3.28-5.02, respectively, P = .002). The percentage of DUFB participants who were food secure increased by 15% (P = .001). CONCLUSIONS AND IMPLICATIONS: The present results add to the growing literature indicating farmers' market incentives are associated with increased F&V consumption and decreased food insecurity. Although more research is needed, farmers' market incentives may be an effective area of policy intervention.

Being Motivated by Nutrition Is Associated With Healthy Home Food Environment of Supplemental Nutrition Assistance Program (SNAP) Recipients.

OBJECTIVE: To examine the relationship between food shopping motivating factors and the home food environment (HFE). METHODS: Participants in the Supplemental Nutrition Assistance Program (n = 123) who were taking part in the Utah State Double-Up Food Bucks evaluation program were interviewed about their HFE, factors motivating shopping, and food security status. Composite HFE scores were derived from the Perceived Nutrition Environment Measure Survey questionnaire and food security score from the 6-item US Household Food Security Survey questionnaire. Analysis included multiple linear regression. RESULTS: Mean age was 46 ± 16.1 years. Regression models showed significant associations of being motivated by nutrition, education, and food security with HFE (ß = 4.70, P = .03; ß = 1.44, P = .06; and ß = 1.44, P = .06, respectively). CONCLUSION AND IMPLICATIONS: In-store interventions to improve perceived nutrition importance among shoppers may be a useful tool to improve home food supplies. Further research is recommended examining the association between food shopping motivators and the HFE in a larger population.

The Grocery Purchase Quality Index-2016 Performs Similarly to the Healthy Eating Index-2015 in a National Survey of Household Food Purchases.

BACKGROUND: Household food purchases are potential indicators of the quality of the home food environment, and grocery purchase behavior is a main focus of US Department of Agriculture (USDA) nutrition education programs; therefore, objective measures of grocery purchases are needed. OBJECTIVE: The objective of the study was to evaluate the Grocery Purchase Quality Index-2016 (GPQI-2016) as a tool for assessing grocery food purchase quality by using the Healthy Eating Index-2015 (HEI-2015) as the reference standard. DESIGN: In 2012, the USDA Economic Research Service conducted the National Household Food Acquisition and Purchase Survey. Members of participating households recorded all foods acquired for a week. Foods purchased at stores were mapped to the 29 food categories used in USDA Food Plans, expenditure shares were estimated, and GPQI-2016 scores were calculated. USDA food codes, provided in the survey database, were used to calculate the HEI-2015. PARTICIPANTS/SETTING: All households in the 48 coterminous states were eligible for the survey. The analytic sample size was 4,276 households. MAIN OUTCOME MEASURES: GPQI-2016 and HEI-2015 scores were compared. STATISTICAL ANALYSES PERFORMED: Correlation of scores was assessed using Spearman's correlation coefficient. Linear regression models with fixed effects were used to determine differences among various subgroups of households. RESULTS: The correlation coefficient for the total GPQI-2016 score and the total HEI-2015 score was 0.70. For the component scores, the strongest correlations were for Total and Whole Fruit (0.89 to 0.90); the weakest were for Dairy (0.67), Refined Grains (0.66), and Sweets and Sodas/Added Sugars (0.65) (all, P<0.01). Both the GPQI-2016 and HEI-2015 were significantly different among subgroups in expected directions. CONCLUSIONS: Overall, the GPQI-2016, estimated from a national survey of households, performed similarly to the HEI-2015. The tool has potential for evaluating nutrition education programs and retail-oriented interventions when the nutrient content and gram weights of foods purchased are not available.

Understanding the Experiences of Low-Income Individuals Receiving Farmers' Market Incentives in the United States: A Qualitative Study.

OBJECTIVE: The objective of this study was to identify benefits and barriers to using a farmers' market (FM) incentive program among program participants. DESIGN: In qualitative semistructured interviews, participants were asked about their experiences with shopping at FM, using FM incentives, barriers to fruit and vegetable (F&V) intake, and changes in dietary intake. Interviews were recorded and transcribed. Inductive content analysis was used to code, categorize, and develop themes based on the transcriptions. SETTING: A FM in Northern Utah. SUBJECTS: A convenience sample of participants ( n = 14) completed a 45- to 60-minute interview after receiving FM incentives for an 8-week intervention period. RESULTS: FM incentives reduced barriers associated with shopping at FM such as cost and accessibility among program participants. Incentives provided participants with greater spending flexibility, allowing parents to provide children with F&V that previously did not fit into their food budget. Participants reported greater family and community involvement when shopping at FM. However, the limited hours and days of operation were factors that reduced the use of FM among participants, even when incentives were provided. CONCLUSIONS: The perceived benefits and barriers to shopping at FM and receiving FM incentives should be considered by future programmers and funding agencies.

Increasing Fruit and Vegetable Intake among Children and Youth through Gardening-Based Interventions: A Systematic Review.

Although there are numerous health benefits associated with eating fruit and vegetables (F/V), few children are consuming recommended amounts. Gardening interventions have been implemented in various settings in an effort to increase children's F/V consumption by expanding knowledge, exposure, and preferences for a variety of F/V. The purpose of this review was to identify the effectiveness of gardening interventions that have been implemented to increase F/V consumption among children. A systematic review was conducted using four electronic databases: Web of Science, PubMed, Scopus, and the Cumulative Index to Nursing and Allied Health Literature. English language studies conducted in developed countries between January 2005 and October 2015 were included in this review. Included studies measured F/V consumption among children aged 2 to 15 years before and after implementation of a gardening intervention in a school, community, or afterschool setting. All study designs were included in this review. A total of 891 articles were identified through database searching and cross-referencing. After removing duplicates, 650 articles remained and were screened using inclusion and exclusion criteria. Twenty-seven full-text articles were analyzed and 14 articles were included in this review. Of the 14 articles reviewed, 10 articles found statistically significant increases in fruit or vegetable consumption among participants after implementation of a gardening intervention. However, many studies were limited by the use of convenience samples, small sample sizes, and self-reported measurements of F/V consumption. Although the evidence is mixed and fraught with limitations, most studies suggest a small but positive influence of gardening interventions on children's F/V intake. Future studies that include control groups, randomized designs, and assessments of F/V consumption over at least 1 year are needed to advance the literature on this topic.

Reducing Food Insecurity and Improving Fruit and Vegetable Intake Among Farmers' Market Incentive Program Participants.

OBJECTIVE: To determine whether participation in a farmers' market incentive pilot program had an impact on food security and fruit and vegetable (F&V) intake of participants. METHODS: Participants in the Supplemental Nutrition Assistance Program were eligible to receive a dollar-per-dollar match up to $10/wk in farmers' market incentives. The researchers used a pretest-posttest design to measure F&V intake and food security status of 54 adult participants before and after receiving farmers' market incentives. The 6-item Behavior Risk Factor Surveillance System questionnaire and US Household Food Security Survey Module were used to measure F&V intake and food security, respectively. Wilcoxon signed-rank test was used to compare scores of F&V intake. RESULTS: After receiving incentives, fewer individuals reported experiencing food insecurity-related behaviors. A significantly increased intake (P < .05) was found among selected vegetables. CONCLUSION AND IMPLICATIONS: Participation in a farmers' market incentive program was positively related to greater food security and intake of select vegetables among participants in the Supplemental Nutrition Assistance Program.

An energy-reduced dietary pattern, including moderate protein and increased nonfat dairy intake combined with walking promotes beneficial body composition and metabolic changes in women with excess adiposity: a randomized comparative trial.

Moderate protein and nonfat dairy intake within an energy-reduced diet (ERD) may contribute to health benefits achieved with body weight (BW) loss. The current study examined the effectiveness of a weight-loss/weight-loss maintenance intervention using an ERD with moderate dietary protein (30% of kcals) and increased nonfat dairy intake (4-5 svg/d), including yogurt (INT group) and daily walking compared to an ERD with standard protein (16-17% of kcals) and standard nonfat dairy intake (3 svg/d) (COM group) with daily walking. A randomized comparative trial with 104 healthy premenopausal women with overweight/obesity was conducted in a university setting. Women were randomized to INT group or COM group. Anthropometric measurements, as well as dietary intake, selected vital signs, resting energy expenditure, blood lipids, glucose, insulin, and selected adipose-derived hormones were measured at baseline, and weeks 2, 12, and 24. Targets for dietary protein and nonfat dairy intake, while initially achieved, were not sustained in the INT group. There were no significant effects of diet group on anthropometric measurements. Women in the INT group and COM group, respectively, reduced BW (-4.9 ± 3.2 and -4.3 ± 3.3 kg, P < 0.001) and fat mass (-3.0 ± 2.2 and -2.3 ± 2.3 kg, P < 0.001) during the 12-week weight-loss phase and maintained these losses at 24 weeks. Both groups experienced significant decreases in body mass index, fat-free soft tissue mass, body fat percentage, waist and hip circumferences and serum triglycerides, total cholesterol, and leptin (all P < 0.001). Healthy premenopausal women with excess adiposity effectively lost BW and fat mass and improved some metabolic risk factors following an ERD with approximately 20% protein and 3 svg/d of nonfat dairy intake.