Development and Validation of the Guide for Effective Nutrition Interventions and Education (GENIE): A Tool for Assessing the Quality of Proposed Nutrition Education Programs.

OBJECTIVE: To develop and validate the Guide for Effective Nutrition Interventions and Education (GENIE), a checklist of research-based quality indicators for nutrition education programs. DESIGN: A prospective test of criterion validity and inter-rater reliability of a new tool comparing expert assessments and trained reviewer GENIE scores of the same nutrition education proposals. PARTICIPANTS: Ten nutrition education experts; 13 volunteer reviewers. VARIABLES MEASURED: GENIE's face, content, and criterion validity and inter-rater reliability compared using expert assessments and reviewer objective and subjective scores. ANALYSIS: Reviewer scores compared using Spearman correlation. Inter-rater reliability tested using intra-class correlation (ICC), Cronbach alpha, and ANOVA. Criterion validity tested using independent t test and point bi-serial correlation to compare reviewer with expert scores. RESULTS: Correlation found between total objective and total subjective scores. Agreement found between reviewers across proposals and categories considering subjective scores (F = 7.21, P < .001; ICC = 0.76 [confidence interval, 0.53-0.92]) and objective scores (F = 7.88, P < .001; ICC = 0.82 [confidence interval, 0.63-0.94]). Relationship was not significant (r = .564, P = .06) between expert and reviewer proposal scoring groups (high, medium, and low). CONCLUSIONS AND IMPLICATIONS: Results support the validity and reliability of GENIE as a tool for nutrition education practitioners, researchers, and program funding agencies to accurately assess the quality of a variety of nutrition program plans.

A comparison of three methods of determination of energy density of elite figure skaters.

Dietary energy density (kcal/g) is defined as available dietary energy per unit weight or volume of food. The consumption of energy-dense foods has been associated with increased obesity risk and with excessive weight gain. The objectives of this study were to compare how dietary energy density, calculated using three different methods relates to food choices and nutrient composition of the diets of elite figure skaters. Participants were 159 elite figure skaters attending training camps. Mean age was 18.4 y for boys (n = 79) and 15.9 y for girls (n = 80). Heights and weights were measured to calculate body-mass indices (BMI). Dietary intakes were based on 3-d food records analyzed using the Nutritionist IV program. Mean energy intakes were 2326 kcal/d for boys and 1545 kcal/d for girls. Dietary energy density,,based on foods and caloric beverages only, was 1.0 kcal/g. Dietary ED was positively associated with percent energy from fat and negatively with percent energy from sugar. The main sources of dietary energy in this group were baked goods, cereals, regular soda, low-fat milk, fruit juices, bagels and pizza. Percent energy from fast foods was associated with higher dietary energy density, whereas percent energy from dairy products, soft drinks, vegetables, and fruit was associated with lower dietary energy density. These results are consistent with past observations; higher energy density diets were higher in fat. In contrast, there was a negative relationship between sugar content and energy density of the diet.

Dietary intake, body image perceptions, and weight concerns of female US International Synchronized Figure Skating Teams.

The objectives of the study were to determine the nutrient intakes and to examine body image perceptions and weight concerns of elite female US international synchronized skaters. One hundred and twenty-three skaters (mean age = 17.0 +/- 2.1 y; BMI = 21.32 +/- 2.13) representing six US international synchronized skating teams from the 1998 competitive season participated in the study. Nutrient intakes were determined from 3-d dietary records. Body image perceptions were assessed from responses to silhouette drawings. Skaters completed an emotional and physical self-appraisal. Weight concerns were assessed using a self-administered validated weight history questionnaire. The reported energy intake was 26 kcal/kg. The contribution of carbohydrate, fat, and protein to total energy intake was 62%, 23%, and 15% for younger (14-18 y) and 62%, 24%, and 14%, respectively, for the older (19-30 y))skaters. Significant differences (P < 0.001) were observed between perceived ideal and current body shapes. The greater the dissatisfaction with physical and emotional self, the larger the discrepancy between current versus desired body shape. Results suggest that sports nutritionists should not only assess nutrition factors but also examine psychosocial and emotional correlates related to body image and weight concerns of synchronized skaters.

Infant feeding practices and early flavor experiences in Mexican infants: an intra-cultural study.

OBJECTIVES: The study explored the maternal beliefs and practices related to pregnancy, breastfeeding, and infant feeding among women living in several regions in Mexico. We hypothesized that, despite the culinary diversity within Mexico, there would be similar patterns in the types of flavors and foods eaten by mothers and fed to infants. DESIGN: A structured interview was conducted through personal interviews with mothers during routine visits to their local family medical units. The units were located in four regions in Mexico that represent the diversity of culinary practices characteristic of the country. SUBJECTS: A random sample of 101 women whose infants ranged in age from 6 days to 9 months. RESULTS: Although the vast majority of mothers knew of its benefits and nursed their infants, breastfeeding during the first week of life was not exclusive; approximately one third of the infants were also fed teas, water, and/or formula. The feeding of teas continued throughout infancy in three of the regions, but the flavor of the tea differed. There were also regional similarities in the foods chosen and avoided during pregnancy and lactation and the type of first foods offered to the infants. CONCLUSIONS: The similarities in the types of foods fed to infants and eaten more of by mothers during pregnancy suggest that these cultural and regional practices contribute to the development of strong preferences for regional cuisines. The foods eaten by the mother during pregnancy and lactation form the basis of the child's weaning patterns.

Developmental milestones and self-feeding behaviors in infants and toddlers.

OBJECTIVES: To identify ages at which gross motor developmental milestones and fine motor skills required for self-feeding were reported by primary caregivers and to relate these self-feeding skills to energy and nutrient intakes. DESIGN: Cross-sectional survey of households with infants/toddlers, ages 4 to 24 months. SUBJECTS/SETTING: Telephone survey using a national random sample of infants and toddlers (n=3,022). METHODS: Primary caregivers reported their children's food intake (one 24-hour recall), the ages when caregivers reported self-feeding skills were shown, and the number of teeth. STATISTICAL ANALYSES PERFORMED: Children's reported ages for gross motor developmental milestones, self-feeding skills, and the number of erupted teeth were summarized. Using t tests, differences in energy and nutrient intake were determined by age groupings and by the absence or presence of each self-feeding skill. RESULTS: Self-feeding skills achieved in the first 2 years and details about age ranges at which developmental readiness to self-feed were evidenced are described. The ages at which children were reported to show gross motor developmental milestones and eruption of teeth occurred within expected age ranges. A majority of the children who were reported to show developmental readiness to self-feed at an earlier age (7 to 14 months) had higher intakes of energy and most nutrients than those who did not. By 15 to 18 months, most of the children were reported to show comparable self-feeding skills regardless of whether they self-fed earlier or later. APPLICATIONS/CONCLUSIONS: Assuming a variety of nutritious foods are offered to infants and toddlers, caregivers may encourage self-feeding without concern for jeopardizing energy and nutrient adequacy. In the first year, the addition of foods that require chewing should reflect the number of erupted teeth.

Prevalence of picky eaters among infants and toddlers and their caregivers' decisions about offering a new food.

OBJECTIVES: To determine the prevalence of infants and toddlers who were considered picky eaters, the predictors of picky eater status and its association with energy and nutrient intakes, food group use, and the number of times that caregivers offered a new food before deciding their child disliked it. DESIGN: Cross-sectional survey of households with infants and toddlers (ages four to 24 months) was conducted. SUBJECTS/SETTING: National random sample of 3,022 infants and toddlers. METHODS: Data included caregiver's socioeconomic and demographic information, infants' and toddlers' food intake (24-hour recall), ethnicity, and caregivers' reports of specified times that new foods were offered before deciding the child disliked it. STATISTICAL ANALYSES: For picky and nonpicky eaters, t tests were used to determine significant mean differences in energy and nutrient intakes. Logistic regression was used to predict picky eater status, and chi(2) tests were used for differences in the specified number of times that new foods were offered. RESULTS: The percentage of children identified as picky eaters by their caregivers increased from 19% to 50% from four to 24 months. Picky eaters were reported at all ages for both sexes, all ethnicities, and all ranges of household incomes. On a day, both picky and nonpicky eaters met or exceeded current age-appropriate energy and dietary recommendations. Older children were more likely to be picky. Those in the higher weight-for-age percentiles were less likely to be picky. The highest number of times that caregivers offered a new food before deciding the child disliked it was three to five. APPLICATIONS/CONCLUSIONS: Dietetics professionals need to be aware that caregivers who perceive their child as a picky eater are evident across gender, ethnicity, and household incomes. When offering a new food, mothers need to provide many more repeated exposures (eg, eight to 15 times) to enhance acceptance of that food than they currently do.

Food preferences, dieting behaviors, and body image perceptions of elite figure skaters.

The objectives of this study were to determine food preferences, body image perceptions, dieting behaviors, and nutrient intakes of elite male and female figure skaters. Male (n = 23) and female (n = 26) figure skaters completed a food preference checklist, a questionnaire examining their demographics, dieting behaviors and body image perceptions, and 3-d food records. Male skaters had a higher preference (score > or = 6) for grains, fruit, meat, dairy, fats, and sweets. Female skaters had higher preference for grains and fruits. Of the female skaters, 30% considered themselves overweight and indicated a preference for a thinner body contour. Both male and female skaters expressed a preference for leaner body contours for members of the opposite gender. Total energy intake, total fat (females) and dietary fiber were below the dietary recommendations. Vitamin E, vitamin D, folate (females), pantothenic acid (females), calcium (females), magnesium, potassium, and phosphorus (females) were less than two-thirds of the dietary recommendations. Macronutrient intake of male skaters was associated with preferences for the grain group, although no association was observed among female skaters. Results suggest that these behaviors and attitudes need to be assessed and addressed among figure skaters, given their impact on dietary intakes and overall well-being.

Use of dietary supplements by elite figure skaters.

The present study examined the prevalence of dietary supplement use among elite figure skaters, gender differences in supplement use, and differences in nutrient intake of supplement users versus non-users. Male (n = 46) and female (n = 59) figure skaters completed a supplement survey and 3-day food records. Descriptive analysis, chi-square test, and independent t tests were used to analyze the data. Sixty-five percent of male (n = 30) and 76% of female (n = 45) figure skaters reported use of supplements. Forty-seven percent of males and 55% of females reported daily use of supplements. Multivitamin-mineral supplements were the most popular dietary supplements consumed by figure skaters. Significant gender differences were observed in the use of multivitamin-mineral supplements (61% males vs. 83% females, p < .05). Echinacea and ginseng were popular herbal supplements used by these skaters. The 3 main reasons given by male figure skaters for taking supplements were: to provide more energy (41%), to prevent illness or disease (34%), and to enhance performance (21%). Among female figure skaters, the 3 main reasons given were: to prevent illness or disease (61%), to provide more energy (39%), and to make up for an inadequate diet (28%). Significant differences (p < .05) were observed in protein, total fat, saturated fat, polyunsaturated fat intakes, and % energy from carbohydrate and total fat of male supplement users versus non-users, with supplement users having higher intakes except for percent energy from carbohydrate. Sodium was the only nutrient significantly different (p < .05) among female supplement users versus non-users, with supplement users having lower intakes. Given the popularity of dietary supplements, it is important to understand the factors influencing athletes' use of supplements, their knowledge and attitudes regarding supplements, dosage of supplements used, and the effectiveness of these dietary supplements in meeting the goals of the athletes.

Children's food preferences: a longitudinal analysis.

OBJECTIVE: To compare children's food preferences longitudinally and identify factors related to food preferences. DESIGN: Mothers completed the Food Preference Questionnaire for children at 2 to 3 years of age (T1), 4 years (T2), and 8 years (T3) and for themselves at T1 and T3. Both groups completed a Food Neophobia Scale at T3. SUBJECTS: 70 child/mother pairs who had participated continuously in the longitudinal study. STATISTICAL ANALYSES PERFORMED: Changes in food preferences over time were tested with paired t tests and correlations. Consistency percentages were calculated by summing the consistent matches (like/like) for each food between two time periods. Similarly, concordance percentages were calculated for child/mother pairs by summing the concordant matches for each food. General linear models were developed to identify influences on children's food preferences. RESULTS: Although children liked most foods, the number of liked foods did not change significantly during the 5 to 5.7 years of the study. The strongest predictors of the number of foods liked at age 8 years (R2=0.74) were the number liked at 4 years (P<.0001) and the food neophobia score (P=.0003). Newly tasted foods were more likely to be accepted between T1 and T2 than T2 and T3. Mothers' and children's food preferences were significantly but moderately related. Foods disliked by mothers tended not to be offered to children. APPLICATIONS/CONCLUSIONS: The important role of children's early food preferences is confirmed by this study. Mothers influence children via their own preferences, which may limit foods offered to children.

Contribution of meals and snacks to nutrient intake of male and female elite figure skaters during peak competitive season.

OBJECTIVE: To examine the contribution of breakfast, lunch, dinner and snack to the macronutrient and micronutrient intake of elite male and female figure skaters during their competitive season. SUBJECTS: Male (n = 46) and female (n = 48) figure skaters who participated in the 1999 U.S. National Figure Skating Championships completed the study. METHODS: Each athlete completed three-day food records, during the athlete's competitive season. Food records were analyzed using Nutritionist V software. Macronutrient and micronutrient contributions from meals were assessed. RESULTS: Lunch and dinner meals were the main contributors to the total calorie intake of these skaters (27% and 32%, respectively). Likewise, lunch and dinner were the main contributors to the total protein (27% and 41%), carbohydrate (26% and 29%), fat (30% and 32%), saturated fat (29% and 32%) and polyunsaturated fat (31% and 32%) intakes. Dinner was the main source of the monounsaturated fat (34%), cholesterol (40%) and dietary fiber (34%). Breakfast was the main source of dietary folate (36%), whereas iron and calcium intakes were mainly contributed by breakfast and dinner (29% and 32%, 27% and 29%, respectively). CONCLUSION: These elite figure skaters appear to be starting their day with low energy reserves and therefore need to be educated about the benefits of consuming breakfast. These athletes also need to be educated about consuming adequate calories throughout the day in order to meet the energy needs of their activity. It is thus important to monitor eating patterns throughout the day to ensure adequate energy intake to sustain the physical and mental aspects of the athletes' training and performance.

Elevated plasma 4-pyridoxic acid in renal insufficiency.

BACKGROUND: Renal insufficiency is associated with altered vitamin B-6 metabolism. We have observed high concentrations of 4-pyridoxic acid, the major catabolite of vitamin B-6 metabolism, in plasma during renal insufficiency. OBJECTIVE: The objective was to evaluate the renal handling of 4-pyridoxic acid and the effects of renal dysfunction on vitamin B-6 metabolism. DESIGN: We measured the renal clearance of 4-pyridoxic acid and creatinine in 17 nonpregnant, 17 pregnant, and 16 lactating women. We then examined the influence of vitamin B-6 or alkaline phosphatase activity on the ratio of 4-pyridoxic acid to pyridoxal (PA:PL) in plasma in 10 men receiving a low (0.4 mg pyridoxine.HCl/d) or high (200 mg pyridoxine.HCl/d) vitamin B-6 intake for 6 wk, in 10 healthy subjects during a 21-d fast, in 1235 plasma samples from 799 people screened for hypophosphatasia, and in 67 subjects with a range of serum creatinine concentrations. RESULTS: Renal clearance of 4-pyridoxic acid was 232 +/- 94 mL/min in nonpregnant women, 337 +/- 140 mL/min in pregnant women, and 215 +/- 103 mL/min in lactating healthy women. These values were approximately twice the creatinine clearance, indicating that 4-pyridoxic acid is at least partially eliminated by tubular secretion. Elevated plasma creatinine concentrations were associated with marked elevations in 4-pyridoxic acid and PA:PL. PA:PL was not affected by wide variations in vitamin B-6 intake or by the wide range of pyridoxal-P concentrations encountered while screening for hypophosphatasia. CONCLUSIONS: Plasma 4-pyridoxic acid concentrations are markedly elevated in renal insufficiency. Plasma PA:PL can distinguish between increases in 4-pyridoxic acid concentrations due to increased dietary intake and those due to renal insufficiency.