Snacking patterns influence energy and nutrient intakes but not body mass index.

OBJECTIVE: To study dietary intake and body mass index (BMI) patterns among US adults, stratified by snacking patterns. DESIGN: The 1994-1996 Continuing Survey of Food Intakes by Individuals (CSFII) provided the study sample. Snacking episodes were defined as a 'food and/or beverage break', and subjects were classified as morning, afternoon, evening, multiple or never snackers. SUBJECTS/SETTING: Our study included data from 1756 men and 1511 women who provided two nonconsecutive, multiple-pass 24-h dietary recalls. STATISTICAL ANALYSES: Mean values of each subject's two 24-h recalls were used for analyses, and data were analysed using the Statistical Package for the Social Sciences (SPSS) for Windows and SUDAAN. RESULTS: Compared with women, men were more likely to be evening, multiple or never snackers. Male multiple snackers had significantly higher energy intakes than did afternoon and never snackers, whereas female multiple snackers had higher energy intakes than did morning, evening and never snackers. At the same time, male and female multiple snackers had more prudent energy-adjusted intakes of protein, cholesterol, calcium and sodium. Coffee, cola, milk, ice cream and fruits were among the most frequently consumed snacks by men and women. The BMI did not differ significantly across snacker categories. CONCLUSIONS: These data indicate that snacking patterns have some effects on energy and nutrient intakes but not on BMI. Snack food choices remain a concern, especially beverages, including those that are sweetened. Vegetables and fruits as snacks should be encouraged.

Differences in dietary patterns of nonsmoking adults married to smokers vs. nonsmokers.

PURPOSE: To compare dietary intakes of nonsmoking adults married to smokers or nonsmokers. DESIGN: Respondents to the U.S. Department of Agriculture's Continuing Survey of Food Intakes by Individuals (CSFII), 1994 to 1996 (response rate = 76.1% for 2 days of dietary intake). Nonsmoking adults aged 18 and older were grouped according to the smoking status of their spouse. SETTING: In-home interviews in all 50 states and Washington, D.C. SUBJECTS: The selected sample included 757 men and 754 women who were married to nonsmokers, and 197 men and 262 women who were married to smokers. MEASURES: Selected demographic variables, food group servings, food energy, and densities of selected nutrients were compared using chi 2 and analysis of covariance. RESULTS: Men and women married to smokers had greater (p < or = .025) energy-adjusted intakes of total and saturated fat but significantly lower (p < or = .05) energy-adjusted intakes of fiber and vitamin A. Men married to smokers consumed significantly more (p < .025) energy-adjusted cholesterol and ethanol but significantly less calcium (p = .026); women married to smokers consumed significantly less (p = .014) energy-adjusted folate. Men married to smokers consumed significantly more (p < or = .05) alcoholic beverages, coffee, and soft drinks; women married to smokers consumed significantly less water (p = .014) but more cheese and table sweeteners (p < or = .05). CONCLUSIONS: Nonsmoking men and women who were married to smokers had compromised dietary intakes. Nonsmoking men whose wives smoked, in particular, had unhealthy diets due to elevated intakes of fat and cholesterol and low intakes of vitamin A, calcium, and fiber. Health professionals should continue to provide tobacco cessation instruction and dietary guidance, but also be aware of at-risk patients' immediate family members who likely share an increased risk of disease because of poor diet quality and exposure to environmental tobacco smoke.

Breastfeeding-related onset, flare, and relapse of rheumatoid arthritis.

The beneficial effects of pregnancy on rheumatoid arthritis have been known for decades. Only recently, however, have lactation and prolactin been targeted as predictors of onset, flare, or relapse of arthritis. Among genetically susceptible women, breastfeeding is associated with an increased risk of rheumatoid arthritis, particularly after the first pregnancy. Dietary interventions may reduce symptoms experienced by arthritic women.

More Americans are eating "5 a day" but intakes of dark green and cruciferous vegetables remain low.

Epidemiological investigations repeatedly show that the regular consumption of dark green and cruciferous vegetables, tomatoes and citrus fruits in particular is related to reduced cancer risk. We used the 1994-1996 Continuing Survey of Food Intakes by Individuals to examine the types of fruits and vegetables consumed by Americans. The analytic sample population, which consisted of 4806 men and women (25-75 y old) who completed two nonconsecutive 24-h recalls, consumed 3.6 +/- 2.3 servings of vegetables and 1.6 +/- 2.0 servings of fruit daily. Iceberg lettuce, tomatoes, French fried potatoes, bananas and orange juice were the most commonly consumed fruits and vegetables, accounting for nearly 30% of all fruits and vegetables consumed. The most popular items, lettuce and tomatoes, were consumed by 39-42% of the sample population during the reporting period. Fewer respondents (16-24%) consumed French fried potatoes, bananas or orange juice. Only 3% of the sample consumed broccoli during the reporting period. White potato consumption averaged 1.1 servings daily, with French fried potatoes representing 0.4 serving. Tomato product consumption averaged 0.5 serving daily, dark green vegetable consumption averaged 0.2 serving daily and citrus, berries or melon consumption amounted to nearly 0.8 serving daily. These data indicate that Americans are consuming more fruits and vegetables but that dark green and cruciferous vegetable intake is low.

Low intakes of vegetables and fruits, especially citrus fruits, lead to inadequate vitamin C intakes among adults.

OBJECTIVE: To determine vitamin C intakes among adults and to identify differences in dietary intake associated with vitamin C consumption. DESIGN: This cross-sectional study compared vitamin C intake, nutrient intake, and food group choices of adults with low (<30 mg/d), marginal (30-60 mg/d), and desirable (>60 mg/d) vitamin C intakes. SUBJECTS: Data from 2472 men and 2334 women aged 25-75 y were obtained from the 1994-1996 Continuing Survey of Food Intakes by Individuals (CSFII). RESULTS: Overall, 18% of the sample had low vitamin C intakes, 24% had marginal intakes, and 58% had desirable intakes. In addition to consuming less vitamin C, adults with low vitamin C intakes consumed significantly less (P

Antioxidant intakes and smoking status: data from the continuing survey of food intakes by individuals 1994-1996.

BACKGROUND: Cigarette smoking is a major risk factor for several chronic oxidative diseases that can be ameliorated by antioxidants. OBJECTIVES: This study identified the typical dietary intakes and the major food group contributors of the antioxidants beta-carotene, vitamin C, and vitamin E by smoking status. DESIGN: The 1994-1996 Continuing Survey of Food Intakes by Individuals (CSFII) provided the current sample (n = 6749), who were categorized as non- (n = 3231), former (n = 1684), and current (n = 1834) smokers. In the CSFII, individuals' food intakes were estimated with two 24-h dietary recalls. Data were analyzed by using a chi-square test with a simultaneous Fisher's z test, analysis of variance with Scheffe's test, multivariate analysis of covariance, and analysis of covariance with Bonferroni adjustment for multiple comparisons. RESULTS: The sample consisted of 3707 men and 3042 women. Current smokers tended to be younger with less education and lower incomes than nonsmokers and former smokers. The average body mass index (in kg/m(2)) of current smokers was 25.8, the lowest of the 3 groups. Current smokers had the lowest dietary antioxidant intake. Fatty foods such as luncheon meats, condiments and salad dressings, and ground beef contributed more to the antioxidant intakes of current smokers than to those of the other 2 groups, whereas fruit and vegetables contributed less. Current smokers consumed the fewest numbers of servings of all nutrient-bearing groups in the food guide pyramid, except the meat group. CONCLUSION: Future interventions should target the clustering of cigarette smoking and other unhealthy lifestyle habits, eg, an imprudent diet.

Clustering of lifestyle behaviors: the relationship between cigarette smoking, alcohol consumption, and dietary intake.

PURPOSE: To examine relationships between cigarette smoking, alcohol use, and dietary intake. DESIGN: Respondents to the U.S. Department of Agriculture's Continuing Survey of Food Intakes by Individuals, a nationwide probability sample conducted from January 1994 through January 1997 (n = 23,602; response rate = 80%), were selected. Adults ages 19 years and older were grouped according to their smoking and drinking habits. Selected demographic variables, food group servings, food energy, and densities of selected nutrients were compared. SETTING: In-home interviews were conducted in the 50 states and the District of Columbia. SUBJECTS: The selected sample (n = 6745) included 3229 nonsmokers, 1701 former smokers, and 1808 current smokers, and 2284 abstainers, 2713 occasional drinkers, 1000 moderate drinkers, and 748 liberal drinkers. MEASURES: Responses to standard questionnaires were examined by Student's t-test, chi 2, one-way analysis of variance, and univariate and multivariate analyses of covariance. RESULTS: Men were more likely than women to be current smokers and liberal drinkers (64% vs. 40% and 62% vs. 38%). For both, the use of cigarettes and alcohol was closely related. An additive relationship was observed between smoking/drinking classification and lower food group servings and nutrient intakes. Although cigarette and alcohol use may have been underreported, these findings support previous ones showing poor food choices along with lower nutrient intakes as smoking and drinking increase. CONCLUSIONS: Smoking and drinking habits may alter individuals' food selections and nutrient intakes. Future interventions for health promotion may achieve greater success by targeting multiple risk factors simultaneously or sequentially.

Intakes of vitamin C, vegetables and fruits: which schoolchildren are at risk?

OBJECTIVE: The purpose of this study was to determine vitamin C intakes among American schoolchildren. We investigated the leading sources of vitamin C in children's diets, the leading vegetables and fruits consumed by children and differences in dietary intake associated with vitamin C consumption. METHODS: Data from 1,350 7- to 12-year-old and 908 13- to 18-year-old schoolchildren were obtained from the 1994-1996 Continuing Survey of Food Intakes by Individuals (CSFII). The children were stratified by age and gender and then split into three vitamin C consumption groups based upon two 24-hour recalls: low (0 to 30.0 mg), marginal (30.1 to 59.9 mg), and desirable (>60.0 mg). Data were analyzed by tabulation and by ANOVA followed by post hoc Scheffe's test. Outcome measures included food groups and energy-adjusted intakes of micro- and macronutrients. RESULTS: Among the 7- to 12-year-olds, 12% of boys and 13% of girls had mean vitamin C intakes that were less than 30 mg/day, and, among 13- to 18-year-olds, 14% of boys and 20% of girls had low vitamin C intakes. In addition to consuming significantly more vitamin C, children with desirable vitamin C intakes also consumed significantly more (p <0.001) energy-adjusted folate and vitamin B6; children with low vitamin C intakes tended to have significantly greater (p <0.001) energy-adjusted intakes of fat and saturated fat. Children with desirable vitamin C intakes consumed significantly more (p <0.006) high-vitamin C fruit juice, low-vitamin C vegetables and whole milk. Children with low vitamin C intakes on average consumed two daily servings of vegetables and fruits, of which less than 1/5 of a serving was citrus, while children with desirable vitamin C intakes consumed an average of one daily serving of citrus. CONCLUSIONS: A considerable number of children drastically under-consumed vitamin C and total vegetables and fruits. Overall, children with desirable vitamin C intakes had healthier diets, including more milk and vegetables, than did their peers with low vitamin C intakes. Health care professionals should continue to promote at least five daily servings of vegetables and fruits and should advise parents that at least one of these should be rich in vitamin C.

Using standardized patients to train and evaluate dietetics students.

Faced with a dwindling number of clinical sites for training dietetics students, we incorporated a standardized patient scenario of a 17-year-old pregnant woman into a nutrition counseling course. A young woman was hired to be the patient and was trained extensively. Each student signed up for a 20-minute block of time to assess her and provide nutrition instruction, after which the standardized patient and course instructor provided individualized feedback to each student. Students then completed a brief questionnaire related to the standardized patient session. Overall, student response to the standardized patient session was positive, and students believed standardized patients should be included formally in undergraduate training. The students noted that the standardized patient session allowed them to be trained and evaluated objectively. Because of their ease in building rapport with the standardized patient, students reported that they were able to provide more in-depth education. They also appreciated the immediate and detailed performance review provided by the standardized patient and the instructor. We conclude that standardized patient sessions provide a great service to dietetics students, and plans to develop another standardized patient scenario that students can follow up throughout the continuum of care are underway.

Cigarette use during adolescence: effects on nutritional status.

Despite numerous anti-tobacco campaigns, smoking among adolescents continues to be a predominant public health issue. This report details the interrelationships between adolescence, smoking, and nutrition and health. Current data indicate that most smokers become nicotine-dependent as adolescents, which places them at risk for chronic diseases associated with continuous oxidative damage. Additionally, nicotine has antidepressant and hypermetabolic effects, which may be of particular importance during adolescence because nicotine use leads to increased dependence on tobacco, contributes to difficulty in smoking cessation, and promotes weight gain following smoking cessation.

The 'age+5' rule: comparisons of dietary fiber intake among 4- to 10-year-old children.

OBJECTIVE: To determine children's sources of dietary fiber and to identify the food group choices made by those who met the "age+5" rule, which recommends that children daily consume an amount of fiber that is equal to their age plus an additional 5 g fiber. DESIGN: This study used 24-hour dietary recalls and 1-day food records to assess the nutrient intake and food group choices of children who did and did not meet the recommendations of the age+5 rule. SUBJECTS: The 1989-1991 US Department of Agriculture Continuing Survey of Food Intakes by Individuals provided the study sample of 603 children between the ages of 4 and 6 years and 782 children between the ages of 7 and 10 years. STATISTICAL ANALYSES: Differences in nutrient and food group intakes between age categories were determined by t tests. RESULTS: Only 45% of 4- to 6-year-olds and 32% of 7- to 10-year-olds consumed adequate fiber to meet the age+5 rule. Those who met the age+5 rule did so by consuming significantly more high- and low-fiber breads and cereals, fruits, vegetables, legumes, nuts, and seeds. Children with low fiber intakes had significantly higher energy-adjusted intakes of fat and cholesterol, whereas those who met the age+5 rule had significantly higher energy-adjusted intakes of dietary fiber, vitamins A and E, folate, magnesium, and iron. APPLICATIONS: The majority of the children had low intakes of dietary fiber, suggesting that they are at risk for future chronic disease. Parents and school foodservice personnel should strive to offer fiber-rich foods to children so their acceptance and consumption of them will be increased.

Nutritional and socioeconomic factors in relation to prostate cancer mortality: a cross-national study.

BACKGROUND: Large international variations in rates of prostate cancer incidence and mortality suggest that environmental factors have a strong influence on the development of this disease. The purpose of this study was to identify predictive variables for prostate cancer mortality in data from 59 countries. METHODS: Data on prostate cancer mortality, food consumption, tobacco use, socioeconomic factors, reproductive factors, and health indicators were obtained from United Nations sources. Linear regression models were fit to these data. The influence of each variable fit in the regression models was assessed by multiplying the regression coefficient b by the 75th (X75) and 25th (X25) percentile values of the variable. The difference, bX75 - bX25, is the estimated effect of the variable across its interquartile range on mortality rates measured as deaths per 100000 males aged 45-74 years. Reported P values are two-sided. RESULTS: Prostate cancer mortality was inversely associated with estimated consumption of cereals (bX75 - bX25 = -7.31 deaths; P = .001), nuts and oilseeds (bX75 - bX25 = -1.72 deaths; P = .003), and fish (bX75 - bX25 = -1.47 deaths; P = .001). In the 42 countries for which we had appropriate data, soy products were found to be significantly protective (P = .0001), with an effect size per kilocalorie at least four times as large as that of any other dietary factor. Besides variables related to diet, we observed an association between prostate cancer mortality rates and a composite of other health-related, sanitation, and economic variables (P = .003). CONCLUSIONS: The specific food-related results from this study are consistent with previous information and support the current dietary guidelines and hypothesis that grains, cereals, and nuts are protective against prostate cancer. The findings also provide a rationale for future study of soy products in prostate cancer prevention trials.

Nutrient Intake Report: a coordination of patient dietary assessment between physicians and registered dietitians.

The Nutrient Intake Report (NIR) is based on a 7-day dietary recall questionnaire used previously in research for dietary assessment and adapted for clinical use. Used to provide information and counseling as part of total patient care, the NIR acts as a cornerstone for dietary education and interaction between physician, registered dietitian, and patient. The NIR is ordered by physicians or registered dietitians, scanned and assessed by a registered dietitian, and incorporated into the laboratory section of the medical record. It documents the patient's dietary intake in the context of his or her diagnosis and general health status. The NIR also opens a dialogue between physicians and registered dietitians. Incorporation of the NIR into the medical record makes the work of the registered dietitian available to other health practitioners, which is welcome in an era when licensing and reimbursement are contingent on systematic documentation of dietary assessment and its role in patient care.