Candy consumption in childhood is not predictive of weight, adiposity measures or cardiovascular risk factors in young adults: the Bogalusa Heart Study.

BACKGROUND: There are limited data available on the longitudinal relationship between candy consumption by children on weight and other cardiovascular risk factors (CVRF) in young adults. The present study investigated whether candy consumption in children was predictive of weight and CVRF in young adults. METHODS: A longitudinal sample of children 10 years (n = 355; 61% females; 71% European-Americans, 29% African-Americans) who participated in cross-sectional surveys from 1973 to 1984 (baseline) and in one of two surveys (follow-ups) as young adults [19-38 years; mean (SD) = 23.6 (2.6) years] in Bogalusa, LA, were studied. Dietary data were collected using 24-h dietary recalls at baseline and at one follow-up survey; a food frequency questionnaire was used in the other follow-up survey. Candy consumers were those consuming any amount of candy. Candy consumption was calculated (g day(-1) ) from baseline 24-h dietary recalls, and was used as a covariate in the adjusted linear mixed models. Dependent variables included body mass index (BMI) and CVRF measured in young adults. RESULTS: At baseline, 92% of children reported consuming candy [46 (45) g day(-1)]; the percentage decreased to 67% [20 (30) g day(-1)] at follow-up. No longitudinal relationship was shown between baseline candy consumption and BMI or CVRF in young adults, suggesting that candy consumption was not predictive of health risks later in life. CONCLUSIONS: The consumption of nutrient rich foods consistent with dietary recommendations is important, although modest amounts of candy can be added to the diet without potential adverse long-term consequences to weight or CVRF. Additional studies are needed to confirm these results.

Measuring food intake with digital photography.

The digital photography of foods method accurately estimates the food intake of adults and children in cafeterias. When using this method, images of food selection and leftovers are quickly captured in the cafeteria. These images are later compared with images of 'standard' portions of food using computer software. The amount of food selected and discarded is estimated based upon this comparison, and the application automatically calculates energy and nutrient intake. In the present review, we describe this method, as well as a related method called the Remote Food Photography Method (RFPM), which relies on smartphones to estimate food intake in near real-time in free-living conditions. When using the RFPM, participants capture images of food selection and leftovers using a smartphone and these images are wirelessly transmitted in near real-time to a server for analysis. Because data are transferred and analysed in near real-time, the RFPM provides a platform for participants to quickly receive feedback about their food intake behaviour and to receive dietary recommendations for achieving weight loss and health promotion goals. The reliability and validity of measuring food intake with the RFPM in adults and children is also reviewed. In sum, the body of research reviewed demonstrates that digital imaging accurately estimates food intake in many environments and it has many advantages over other methods, including reduced participant burden, elimination of the need for participants to estimate portion size, and the incorporation of computer automation to improve the accuracy, efficiency and cost-effectiveness of the method.

Age, sex and ethnic differences in the prevalence of underweight and overweight, defined by using the CDC and IOTF cut points in Asian children.

BACKGROUND: No nationally representative data from middle- and low-income countries have been analyzed to compare the prevalence of underweight and overweight, defined by using the Centers for Disease Control and Prevention (CDC) and the International Obesity TaskForce (IOTF) body mass index cut points. OBJECTIVE: To examine the consistency in the prevalence of underweight and overweight, defined by using the CDC and IOTF cut points in Chinese, Indonesian and Vietnamese children. METHODS: We used data from 1600 Chinese, 11 756 Indonesian and 53 826 Vietnamese children aged 2-18 years, who participated in three recent, representative surveys in China, Indonesia and Vietnam. A smaller difference between prevalence and a higher kappa-statistic indicated a higher consistency level. RESULTS: The prevalence of underweight was higher with the IOTF than the CDC cut points; absolute differences in the Chinese, Indonesian and Vietnamese were 6, 10 and 13% (boys), and 10, 13 and 19% (girls), respectively. The prevalence of overweight was more consistent (absolute differences were <2%, except for the 2-5.9-year-old Chinese and Indonesian children (from 2 to <5%)). Values of kappa-statistic (from 0.55 to 0.88) varied by age, sex and ethnicity. The consistency was gradually improving from the Vietnamese to Indonesians and to Chinese boys and girls, from girls to boys, from the younger to older boys and from the older to younger girls. CONCLUSIONS: The age, sex and ethnic differences in the prevalence of underweight and overweight suggest a systematic evaluation of the cut points.

Tracking of overweight status from childhood to young adulthood: the Bogalusa Heart Study.

OBJECTIVE: To understand tracking of overweight status from childhood to young adulthood in a biracial sample. DESIGN: A longitudinal sample was created from cross-sectional surveys at two time points, childhood (baseline) and young adulthood (follow-up). SETTING: Bogalusa Heart Study, Louisiana, United States of America. SUBJECTS: A total of 841 young adults, 19-35 years (68% Euro-Americans (EA), 32% African-Americans (AA)) were studied. The same subjects had also participated in one of the five cross-sectional surveys at childhood (9-11 years). METHODS: Body mass index (BMI) was used to determine overweight status as per the Centers for Disease Control and Prevention standards. Change in the BMI status from childhood to young adulthood was used to group the participants into the following categories: normal weight to normal weight (NW-NW); normal weight to overweight (NW-OW); overweight to normal weight (OW-NW); and overweight to overweight (OW-OW). Tracking of overweight was defined by (1) correlations between baseline and follow-up BMI, (2) Cohen's kappa concordance test to determine the strength of tracking in BMI quartiles and (3) the percentage of individuals who remained in the same overweight status group from baseline to follow-up. RESULTS: From baseline to follow-up, the percentage of participants who were overweight increased from 24.7 to 57.7%. A total of 35.2% of the children shifted from normal weight in childhood to overweight in young adulthood (P < 0.0005). Baseline BMI was positively correlated with follow-up BMI (r = 0.66, P < 0.0005). A total of 61.9% of the participants in the highest BMI quartile in childhood remained in the highest BMI quartile in young adulthood. The strength of tracking in BMI quartiles was 27% for EA men (P < 0.0005), 23% for EA women (P < 0.0005), 27% for AA men (P<0.0005) and 35% for AA women (P < 0.0005). A total of 53.7% of the EA women remained in the NW-NW category and 31.2% of the AA women remained in the OW-OW category. The percentage tracking (NW-NW and OW-OW) was 72.8% in EA women, 59.6% in AA men, 59.5% in AA women and 48.8% in EA men (P < 0.0001). CONCLUSION: Childhood overweight tracked into young adulthood in this sample and the tracking of NW-NW and OW-OW was the most prominent among the EA women.

Tracking of serum lipids and lipoproteins from childhood to dyslipidemia in adults: the Bogalusa Heart Study.

Our data demonstrate that serum lipid and lipoprotein levels continue to track from childhood into young adulthood. The persistence and clustering of multiple CVD risk factors from childhood to adulthood and the impact of obesity in this regard point to the need for preventive measures aimed at developing healthy lifestyles early in life. Adverse levels of LDL-C in childhood persist over time, progress to adult dyslipidemias, and relate to obesity and hypertension as well. NCEP guidelines which classify CVD risk on the basis of LDL-C level, are helpful in targeting individuals at risk early in life.

Do adolescent vitamin-mineral supplement users have better nutrient intakes than nonusers? Observations from the CATCH tracking study.

OBJECTIVE: Describe whether users of vitamin-mineral supplements differed from nonusers in micronutrient intakes or in nutrition awareness. DESIGN: Cross-sectional, observational study. SUBJECTS: One thousand five hundred thirty-two students now in grade 8, who participated in the Third Child and Adolescent Trial for Cardiovascular Health tracking study and who also provided a single 24-hour dietary recall. STATISTICAL ANALYSES PERFORMED: Mixed-model analysis of covariance was used to ascertain if supplement users had higher vitamin and mineral intakes from food sources, and to examine if supplement users had better nutrition awareness than nonusers. RESULTS: The 24-hour recall showed that 17.6% of the students reported using vitamin-mineral supplements. Users reported a mean of 1.4 supplements, of which 47% were multivitamin or multimineral preparations, 37% were single nutrients, and 16% were combinations. White persons and residents of Minnesota and California were more likely to be supplement users. Users had higher micronutrient intakes from food sources for 16 of the 20 nutrients studied after adjusting for gender, race/ethnicity, site, treatment condition, and within-school variability. Users had higher scores on a health behavior survey for food choice and slightly but not significantly higher nutrition knowledge scores. CONCLUSIONS: Vitamin-mineral supplement use is prevalent among eighth-grade students. Users have higher nutrient intakes from foods, higher total intakes for several micronutrients, higher nutrition awareness, and differ in their demographic characteristics from nonusers.

Family and child-care provider influences on preschool children's fruit, juice, and vegetable consumption.

Children's intakes of fruit, juice, and vegetables (FJV) do not meet the recommended minimum of five daily servings, placing them at increased risk for development of cancer and other diseases. Because children's food preferences and practices are initiated early in life (e.g., 2-5 years of age), early dietary intervention programs may have immediate nutritional benefit, as well as reduce chronic disease risk when learned healthful habits and preferences are carried into adulthood. Families and child-care settings are important social environments within which food-related behaviors among young children are developed. FJV preferences, the primary predictor of FJV consumption in children, are influenced by availability, variety, and repeated exposure. Caregivers (parents and child-care providers) can influence children's eating practices by controlling availability and accessibility of foods, meal structure, food modeling, food socialization practices, and food-related parenting style. Much remains to be learned about how these influences and practices affect the development of FJV preferences and consumption early in life.

Reliability and validity of the Child and Adolescent Trial for Cardiovascular Health (CATCH) Food Checklist: a self-report instrument to measure fat and sodium intake by middle school students.

OBJECTIVE: To develop a scoring algorithm and evaluate the reliability and validity of scores from the Child and Adolescent Trial for Cardiovascular Health (CATCH) Food Checklist (CFC) as measures of total fat, saturated fat, and sodium intake in middle school students. DESIGN: Randomized, controlled trial in which participants were assigned to 1 of 3 study protocols that varied the order of CFC and 24-hour dietary recall administration. Criterion outcomes were percent energy from total fat, percent energy from saturated fat, and sodium intake in milligrams. SUBJECTS/SETTING: A multiethnic sample (33% ethnic and racial minorities) of 365 seventh-grade students from 8 schools in 4 states. STATISTICAL ANALYSES: Multivariable regression models were used to calibrate the effects of individual food checklist items; bootstrap estimates were used for cross-validation; and kappa statistics, Pearson correlations, t tests, and effect sizes were employed to assess reliability and validity. RESULTS: The median same-day test-retest reliability kappa for the 40 individual CFC food items was 0.85. With respect to item validity, the median kappa statistic comparing student choices to those identified by staff dietitians was 0.54. Test-retest reliability coefficients ranged from 0.84 to 0.89 for CFC total nutrient scores. Correlations between CFC scores and 24-hour recall values were 0.36 for total fat, 0.36 for saturated fat, and 0.34 for sodium; CFC scores were consistent with hypothesized gender differences in nutrient intake. APPLICATIONS/CONCLUSIONS: The CFC is a reliable and valid tool for measuring fat, saturated fat, and sodium intake in middle school students. Its brevity and ease of administration make the CFC a cost-effective way to measure middle school students' previous day's intake of selected nutrients in school surveys and intervention studies.

Trends in nutrient intake of 10-year-old children over two decades (1973-1994) : the Bogalusa Heart Study.

Dietary intakes of 10-year-old children were examined in seven cross-sectional surveys to observe secular trends in nutrient intake and food consumption patterns over 2 decades (1973-1994). Total energy intake remained unchanged from 1973 to 1994. However, when expressed as energy per kilogram body weight, intake decreased from 65.5 kcal in 1973 to 55.4 kcal in 1994 because children's weight increased. A significant trend was noted in ponderal index, which increased from 12.31 (1973-1974) to 13.71 (1992-1994), with an actual weight gain of 1.45 kg from 1973 to 1979 and 2.71 kg from 1981 to 1994. Linear trends also were noted for total fat (negative), saturated fat (negative), dietary cholesterol (negative), polyunsaturated fat (positive), and total carbohydrate (positive). There was a significant increase in percent energy from protein and carbohydrate and a significant decrease in percent energy from fat, primarily saturated and monounsaturated fat. Trends in nutrient intakes of children reflected trends in food consumption. The percentage of total fat from fats/oils, mixed meats, eggs, milk, pork, and desserts decreased, while that from poultry, cheese, and snacks increased. Although more children met dietary recommendations for total fat, saturated fat, and dietary cholesterol, the vast majority continued to exceed prudent diet recommendations.

Eating patterns, dietary quality and obesity.

Obesity among children has reached epidemic proportions. Today, an estimated one in four children in the United States is overweight. while 11% arc obese. Children who are overweight tend to remain so up to 20 years of age; in general, they have a 1.5- to twofold higher risk for becoming overweight as adults. The prevalence of overweight has increased approximately twofold in the 20-year period from 1974 to 1994, with the largest increases observed among 19- to 24-year-olds. The annual increases in weight and obesity that occurred from 1983 to 1994 were 50% higher than those from 1973 to 1982. Overweight youth are 2.4 times as likely to have a high serum total cholesterol level, and 43.5 times as likely to have three cardiovascular risk factors. Although the total energy intake of children has remained the same, and the macronutrient density of the diet has changed, the percentage of energy from fat has decreased, while that from carbohydrates and protein has increased. Children have been consuming lower amounts of fats/oils, vegetables/soups, breads/grains, mixed meats, desserts, candy, and eggs. and increasing amounts of fruits/fruit juices, beverages. poultry, snacks, condiments, and cheese. Changes in specific eating patterns may explain the increase in adiposity among children; e.g., increases have occurred in the number of meals eaten at restaurants, food availability, portion sizes, snacking and meal-skipping. Successful prevention and treatment of obesity in childhood could reduce the adult incidence of cardiovascular disease. Because substantial weight loss is difficult to maintain, the prevention of obesity by promoting healthier lifestyles should be one of our highest priorities in the new millennium.

Breakfast consumption with and without vitamin-mineral supplement use favorably impacts daily nutrient intake of ninth-grade students.

PURPOSE: To assess the contribution of breakfast consumption (with and without dietary supplement intake) on total daily nutrient intake of ninth-grade students. METHODS: Twenty-four-hour recall of dietary intake was collected from a random sample of 711 ninth-grade students attending 12 Archdiocesan high schools in New Orleans, Louisiana. Analysis of variance techniques, Pearson's Chi-square statistic, and Breznahn-Shapiro method with Scheffé probabilities were used to analyze nutrient intake data, dietary adequacy, and nonorthogonal comparisons, respectively. RESULTS: Nineteen percent of 15-year-olds skipped breakfast, with more females skipping breakfast than males (23% vs. 14%, respectively). Thirty-six percent of nonwhite females versus 20% white females skipped breakfast. Eleven percent of subjects took some type of dietary supplement, most commonly a multivitamin and mineral supplement. Among those who ate breakfast, average energy intake from breakfast was 437 kcal. Percentage of total daily energy intake was higher from fats and lower from carbohydrates for adolescents who skipped breakfast, compared with adolescents who consumed breakfast. The percentage of subjects consuming at least two-thirds of the Recommended Dietary Allowance was significantly lower among adolescents skipping breakfast than those consuming breakfast. CONCLUSION: Regardless of supplement use, breakfast consumption makes an important nutritional contribution to total daily intake of ninth-grade students. Encouraging breakfast consumption and healthful breakfast choices is an important step toward improving the nutritional quality of diets of this age group.

Process of conducting a 5-a-day intervention with high school students: Gimme 5 (Louisiana).

Gimme 5: A Fresh Nutrition Concept for Students (Gimme 5) was a 4-year intervention targeting increased fruit and vegetable consumption by high school students. Twelve schools were randomized to intervention or control conditions. The cohort (2,213 students; 56% female, 84% Euro-American) were followed from 9th to 12th grade. Interventions were composed of a school-based media campaign, classroom workshops, school meal modification, and parental involvement. For each of the four Gimme 5 intervention components, process evaluation measures were developed to assess program dose, penetration, and utilization, as well as external competing factors. Process evaluation results are presented to illustrate the various functions of process evaluation data. These include, but are not limited to, describing program implementation, quality control and monitoring, and explaining study outcomes. The implementation of process evaluation systems to complement the outcome measures in a high school-based intervention provides useful strategies for a more comprehensive approach to program evaluation.

Impact of dietary fat and fiber intake on nutrient intake of adolescents.

OBJECTIVE: To evaluate the impact of fat and fiber intake on energy and nutrient intake of 15-year-old adolescents. STUDY DESIGN: Twenty-four-hour dietary recalls were collected on a random sample of 15-year-olds. Subjects were then categorized into groups based on fat and fiber intake, with 319 students meeting criteria for 1 of 4 dietary intake quadrants: low fat, low fiber; low fat, high fiber; high fat, low fiber; and high fat, high fiber. Students with medium fat or fiber intakes were excluded from the study. Low-fat and high-fat intake were defined as <30% and >40% of total energy intake, respectively. Low- and high-fiber intake were defined as <15 g/day and >20 g/day, respectively. RESULTS: Low-fat and high-fiber intake had a minimal impact on energy intake and did not adversely affect nutrient intake. High-fiber intake was associated with greater likelihood of adequate intake of vitamins A, B6, B12, and C; niacin; thiamin; riboflavin; folacin; magnesium; iron; zinc; phosphorus; and calcium. High-fat intake was associated with greater likelihood of adequate vitamin B12 intake. Significant differences in fat and fiber intake distributions were found for ethnic background and gender, with more non-white than white students in the high-fat groups and more males than females in the high-fiber groups. CONCLUSIONS: A low-fat and high-fiber diet meeting current nutrition recommendations does not adversely affect energy or nutrient intake, increases nutrient density of the diet, and increases the likelihood of adequate intake for several key nutrients.

Stages of change for increasing fruit and vegetable consumption among adults and young adults participating in the national 5-a-Day for Better Health community studies.

Higher fruit and vegetable consumption is associated with a reduced risk of certain cancers and chronic diseases. The 5-a-Day for Better Health community studies are evaluating population-based strategies to achieving dietary behavior change using the stages-of-change model and associated theories. The authors present baseline comparisons of stages of change for fruit and vegetable consumption among adults and young adults in eight study sites representing diverse regions of the United States and diverse populations and settings. Three dominant stages, precontemplation, preparation, and maintenance, were found across sites. Women and those with college degrees were more likely to be in action/maintenance. Fruit and vegetable consumption, self-efficacy, and knowledge of the 5-a-Day recommendation were positively associated with more advanced stages of change in all study sites. The authors discuss the findings in relation to possible limitations of this and other dietary stages-of-change measures and suggest directions for future research.

Patterns in child and adolescent consumption of fruit and vegetables: effects of gender and ethnicity across four sites.

OBJECTIVES: Few studies have examined the association of gender and ethnicity with fruit and vegetable consumption. We examined these associations using baseline data from four school-based sites funded under the National Cancer Institute's 5 A Day for Better Health Program. METHODS: Diet was measured using 24-hour recalls at three sites and seven-day food records at one site. Demographics were obtained via self-report or school records. Regression analyses for clustered data were employed with fruit and vegetables combined and fruit and vegetables separately. RESULTS: Girls ate more fruit, more vegetables and more fruit and vegetables combined than boys at the Georgia site. Ethnicity was significant in two sites: In Georgia, African-Americans ate more fruit and more fruit and vegetables combined than European-Americans; in Minnesota, Asian-American/Pacific Islanders and African-Americans ate more fruit than European-Americans, and European-Americans and African-Americans ate more vegetables than Asian-Americans. No significant effects were found at the Alabama or Louisiana sites. CONCLUSIONS: Ethnicity was related to fruit and vegetable consumption in Georgia and Minnesota. Consistent with prior studies, gender was related to fruit and vegetable consumption, with girls consuming more servings than boys; however, this was observed at one site only, Georgia. Consumption levels were similar to national estimates for children and varied by region. Further studies are needed using a single methodology to facilitate regional comparisons.

Knowledge, attitudes, and practices related to fruit and vegetable consumption of high school students.

PURPOSE: To assess the level of nutrition knowledge, attitudes and practices related to fruit and vegetable consumption of high school students attending participating parochial schools in the New Orleans area. METHODS: The baseline data reported in this study, "Gimme 5: A Fresh Nutrition Concept for Students," represents one of the nine National Cancer Institute-funded projects from the national "5-A-Day for Better Health Program" initiated in 1991. A survey containing 22 nutrition-related items about fruit and vegetables was used to assess knowledge in 2213 students. RESULTS: On average, adolescents reported 39% correct knowledge scores. A significant ethnic effect (p < .001) was noted, with White adolescents scoring higher than African American adolescents. Significant ethnic differences in the frequency of fruit and vegetable consumption were also observed, with African-American adolescents reporting a lower mean consumption (2.17 servings) than white adolescents (2.69 servings). Consumption by Hispanic youth (2.48 servings) was similar to those in the "other" ethnic category (2.55 servings). Girls reported being more confident in their ability to eat five servings of fruits and vegetables per day than did boys (p < .05). CONCLUSIONS: Although the knowledge and consumption levels of adolescents with regard to fruits and vegetables were low, their attitudes toward learning about healthier eating practices were favorable.

Nutrient intake of Head Start children: home vs. school.

OBJECTIVE: To determine mean intake of energy and protein, total fat, saturated fat, percent energy from total and saturated fat, cholesterol, carbohydrate, calcium, iron, zinc, folate, vitamins A, C, E, B-6 and B-12, thiamin, niacin, riboflavin, magnesium, sodium and fiber of preschool Head Start children at school and away from school. DESIGN: Twenty-four-hour food intakes for 358 Head Start children were obtained by observing food intake at school and acquiring intake recalls from parents or guardians specifying food their children consumed for the balance of the day. After determining group estimates of energy and nutrient intake, mean intake was compared to standard nutrient recommendations for the entire 24-hour day, i.e., for the time the children were in school and for the remaining hours away from school ("home" intake). SUBJECTS: The 358 Head Start children attended school either half-day (2- to 3-hour AM and PM sessions) or all-day (5 to 6 hours). STATISTICAL ANALYSES: Differences in nutrient intake among class times were analyzed using one-way analysis of variance (ANOVA) followed by Tukey's multiple comparison test. Differences with a p-value <0.05 (two-tailed) were considered to be statistically significant. Total energy, protein, calcium, iron, zinc, vitamins A, C, E, B6, and B12, thiamin, niacin, riboflavin as well as folate and magnesium were compared to the Recommended Dietary Allowances for the 4- to 6-year-old age group. Other standards that were used for comparisons included the National Cholesterol Education Program (fat, saturated fat and cholesterol), the 1989 National Research Council's Diet and Health Report (carbohydrate and sodium) and the recommendation for fiber proposed by the American Health Foundation. RESULTS: At school, half-day children consumed up to 25% of the daily recommendation for energy and nutrients, while all-day children achieved at least a third of the recommended intakes. When intakes at home and school were combined, all three groups of children (AM, PM and all-day) exceeded dietary recommendations for protein, vitamins and minerals. Energy intake remained below 100% of the recommendation, while intake of total fat, saturated fat and cholesterol exceeded recommendations. APPLICATION: Further research is required to explore energy needs and determine nutritional status and nutrient needs of minority and low-income preschool children. Strategies are required to increase nutrient density, but not fat density, of meals and snacks served to children who attend day care for part of the day. Finally, school meals and nutrition education programs such as Team Nutrition should broaden their base to include healthful eating habits for all school children, including the very youngest children in preschool programs.

Atherosclerosis: a nutritional disease of childhood.

The development of coronary atherosclerosis begins in childhood. A clear relation between diet and cardiovascular disease risk has been demonstrated. Findings from the Bogalusa Heart Study indicate that most children still exceed national recommendations for intake of total and saturated fat. In addition, children's mean total energy intake is greater than energy expenditure, contributing to the high prevalence of obesity beginning in childhood. Even in childhood, obesity often occurs with other risk factors for cardiovascular disease, such as increased blood pressure, adverse changes in serum lipoproteins, and hyperinsulinemia. This clustering of risk factors has been linked to acceleration of atherosclerotic lesions in the coronary arteries of young individuals. Decreasing the incidence of coronary artery disease in mid and late life necessitates healthy habits in nutrition and lifestyle in early life. Public health measures to favorably alter lifestyle can have a major impact on heart disease prevention and should be pursued vigorously.

Nutrient intake and food group consumption of 10-year-olds by sugar intake level: the Bogalusa Heart Study.

OBJECTIVE: The effect of total sugar intake on nutrient intake and food group consumption was examined in children. METHODS: Twenty-four hour dietary recalls were collected on a sample of 568 ten-year-olds from two cross-sectional surveys. The population was stratified according to total sugar intake quartiles: < or = 25th (46 g/1000 kcal), 25-50th (67 g/1000 kcal), 50-75th (81 g/1000 kcal) and > or = 75th (106 g/1000 kcal). RESULTS: No significant difference was shown in energy intakes across the quartiles and no significant race or gender differences were observed in mean total sugar intakes. However, with increasing total sugar intake, there was a significant linear decrease in mean intakes of protein, fat, saturated fat, starch, cholesterol, sodium, vitamins B6 and E, thiamin, niacin, iron, and zinc; and a significant linear increase in mean intakes of carbohydrate, fructose, lactose, sucrose, vitamin D, and calcium. Eating patterns reflected the differing nutrient intakes, with high sugar consumers having significantly higher intakes of total g of candy, beverages and milk and lower intakes of total g of meats, and cheese than lower sugar consumers. The nutritional quality of children's diets high in total sugar appear to be adequate regarding vitamin and mineral intakes and are closer to meeting current dietary fat recommendations.

Impact of breakfast consumption on nutritional adequacy of the diets of young adults in Bogalusa, Louisiana: ethnic and gender contrasts.

OBJECTIVE: To evaluate the impact of breakfast consumption patterns on the nutritional adequacy of diets of young adults and determine possible ethnic and gender differences. DESIGN AND SETTING: Cross-sectional survey of young adults in Bogalusa, La. SUBJECTS: Twenty-four-hour dietary recalls were collected from October 1988 through October 1991 on 504 young adults (mean age=23 years, 58% women, 70% white). STATISTICS: Analysis of variance and logistic regression techniques were used to investigate the relationship of breakfast consumption, ethnicity, and gender on dietary adequacy. The P values are from an analysis of variance model that adjusted for gender and ethnicity. RESULTS: Thirty-seven percent of young adults skipped breakfast. Of those who ate breakfast, 75% ate at home, 10% ate a fast-food breakfast, and 15% reported other sources. Mean energy intake from breakfast was 485 kcal; men consumed more energy than women (P<.001), and blacks consumed more energy than whites (P<.01). The breakfast meal provided an average of 13% of energy from protein, 55% from carbohydrate, 14% from sucrose, 34% from fat, and 12% from saturated fat. Whites consumed a breakfast higher in carbohydrate and sucrose than blacks, who consumed a breakfast higher in fat and saturated fat. Variations in breakfast foods consumed explained the racial differences in the nutrient composition of the breakfast meal. Young adults who skipped breakfast had lower total daily intakes of energy (P<.0001), protein per 1,000 kcal (P<.05), and saturated fat per 1,000 kcal (P<.01) than those who consumed breakfast. For all vitamins and minerals studied, a higher percentage of young adults who skipped breakfast did not meet two thirds of the Recommended Dietary Allowance than those who consumed a breakfast. APPLICATIONS: Encouraging consumption of breakfast, along with selection of more healthful breakfast food choices or snacks that are culturally appropriate, may be important strategies for improving the nutritional quality of young adults' diets.