Consumption of calcium-fortified cereal bars to improve dietary calcium intake of healthy women: randomized controlled feasibility study.

UNLABELLED: Calcium is an important structural component of the skeletal system. Although an adequate intake of calcium helps to maintain bone health and reduce the risk of osteoporosis, many women do not meet recommended daily intakes of calcium. Previous interventions studies designed to increase dietary intake of women have utilized primarily dairy sources of calcium or supplements. However, lactose intolerance, milk protein allergies, or food preferences may lead many women to exclude important dairy sources of dietary calcium. Therefore, we undertook a 9 week randomized crossover design trial to examine the potential benefit of including a non-dairy source of calcium in the diet of women. Following a 3 week run-in baseline period, 35 healthy women > 18 years were randomized by crossover design into either Group I or Group II. Group I added 2 calcium-fortified cereal bars daily (total of 400 mg calcium/day) (intervention) to their usual diet and Group II continued their usual diet (control). At the end of 3 weeks, diets were switched for another 3 weeks. Intakes of calcium and energy were estimated from 3-day diet and supplemental diaries. Wilcoxon signed-rank tests were used for within group comparisons and Mann Whitney U tests were used for between group comparisons of calcium and energy intake. Dietary calcium was significantly higher during intervention (1071 mg/d) when participants consumed 2 calcium-fortified cereal bars daily than during the baseline (720 mg/d, P <0.0001) or control diets (775 mg/d, P = 0.0001) periods. Furthermore, the addition of 2 calcium-fortified cereal bars daily for the 3 week intervention did not significantly increase total energy intake or result in weight gain. In conclusion, consumption of calcium-fortified cereal bars significantly increased calcium intake of women. Further research examining the potential ability of fortified cereal bars to help maintain and improve bone health of women is warranted. TRIAL REGISTRATION: ClinicalTrials.gov NCT01508689.

Vitamin D intakes of children differ by race/ethnicity, sex, age, and income in the United States, 2007 to 2010.

The 2007-2010 National Health and Nutrition Examination Survey was used to estimate vitamin D intakes of children 1 to 18 years old in the United States by race/ethnicity, sex, age, and family using 24-hour dietary intake recalls and dietary supplement use questionnaires. We hypothesized that total, dietary, and supplemental vitamin D intakes of children would differ by race/ethnicity, sex, age, and income. Statistical analyses of weighted data were performed using Statistical Analysis Software (V 9.2) to estimate means ± SE. Race and ethnic intake differences controlling for poverty income ratio (PIR), sex, and age were assessed by analysis of covariance. Total (dietary and supplement) vitamin D intake was greater in the high (7.9 ± 0.3 µg/d) vs the medium (6.5 ± 0.3 µg/d) income group, but not the low (7.2 ± 0.2 µg/d) PIR group. Total vitamin D intake of non-Hispanic (NH) white children (8.1 ± 0.2 µg/d) was greater than Hispanic (7.0 ± 0.2 µg/d) and NH black (5.9 ± 0.2 µg/d) children. Total vitamin D intake declined with age, and intake by boys was higher than girls. Only 17.4% of the children consumed supplements containing vitamin D. Overall, mean intake of vitamin D by all children in each age and ethnic group was lower than the estimated average requirement for vitamin D. Public health efforts should encourage consumption of foods high in vitamin D, expand the number of foods fortified, and target health messages to parents to increase use of vitamin D supplements by children.

Vitamin D intakes of adults differ by income, gender and race/ethnicity in the U.S.A., 2007 to 2010.

OBJECTIVE: To determine if dietary, supplemental and total vitamin D intakes in the USA are influenced by income, race/ethnicity or gender. DESIGN: Cross-sectional. US vitamin D intakes were estimated by poverty income ratio (PIR), race/ethnicity and gender using 24 h dietary intake recalls and dietary supplement use questionnaires. Statistical analyses of weighted data were performed using SAS (version 9.2) to estimate means and their standard errors. Race and ethnic intake differences controlling for PIR, gender and age were assessed by ANCOVA. SUBJECTS: Adults aged ≥19 years. SETTING: The 2007-2010 National Health and Nutrition Examination Survey, USA. RESULTS: Total (dietary and supplement) vitamin D intake was greater in the high (10.0 (se 0.30) µg/d) v. the medium (7.9 (se 0.3) µg/d) or the low (8.0 (se 0.3) µg/d) PIR categories. Total vitamin D intake of non-Hispanic Whites (10.6 (se 0.4) µg/d) was greater than that of Hispanics (8.1 (se 0.3) µg/d) and non-Hispanic Blacks (7.1 (se 0.3) µg/d). Supplemental vitamin D intake was greater by females (5.3 (se 0.2) µg/d) than by males (3.3 (se 0.2) µg/d). Participants with high income were more likely to be vitamin D supplement users (33.0%) than those with medium (22.5%) or low (17.6%) income. High-income non-Hispanic Whites had the lowest percentage (57%) not meeting the Estimated Average Requirement for vitamin D. Fortified milk and milk products provided 43.7% of the dietary vitamin D intake. CONCLUSIONS: Public health efforts should expand the number of vitamin D-fortified foods and encourage the consumption of foods high in vitamin D and use of supplements.

The relationship of breakfast skipping and type of breakfast consumed with overweight/obesity, abdominal obesity, other cardiometabolic risk factors and the metabolic syndrome in young adults. The National Health and Nutrition Examination Survey (NHANES): 1999-2006.

OBJECTIVE: To examine the association between breakfast skipping and type of breakfast consumed with overweight/obesity, abdominal obesity, other cardiometabolic risk factors and the metabolic syndrome (MetS). DESIGN: Cross-sectional. Three breakfast groups were identified, breakfast skippers (BS), ready-to-eat-cereal (RTEC) consumers and other breakfast (OB) consumers, using a 24 h dietary recall. Risk factors were compared between the breakfast groups using covariate-adjusted statistical procedures. SETTING: The 1999­2006 National Health and Nutrition Examination Survey, USA. SUBJECTS: Young adults (20­39 years of age). RESULTS: Among these young adults (n 5316), 23.8% were BS, 16.5% were RTEC consumers and 59.7% were OB consumers. Relative to the BS, the RTEC consumers were 31%, 39%, 37%, 28%, 23%, 40% and 42% less likely to be overweight/obese or have abdominal obesity, elevated blood pressure, elevated serum total cholesterol, elevated serum LDL-cholesterol, reduced serum HDL-cholesterol or elevated serum insulin, respectively. Relative to the OB consumers, the BS were 1.24, 1.26 and 1.44 times more likely to have elevated serum total cholesterol, elevated serum LDL-cholesterol or reduced serum HDL-cholesterol, respectively. Relative to the OB consumers, the RTEC consumers were 22%, 31% and 24% less likely to be overweight/ obese or have abdominal obesity or elevated blood pressure, respectively. No difference was seen in the prevalence of the MetS by breakfast skipping or type of breakfast consumed. CONCLUSIONS: Results suggest that consumption of breakfast, especially that included an RTEC, was associated with an improved cardiometabolic risk profile in U.S. young adults. Additional studies are needed to determine the nature of these relationships.

Do breakfast skipping and breakfast type affect energy intake, nutrient intake, nutrient adequacy, and diet quality in young adults? NHANES 1999-2002.

OBJECTIVE: To assess the impact of breakfast skipping and type of breakfast consumed on energy/nutrient intake, nutrient adequacy, and diet quality. DESIGN: Cross-sectional. SETTING: The National Health and Nutrition Examination Survey (NHANES), 1999-2002. SUBJECTS: Young adults (20-39 years, n = 2615). MEASURES: A 24-hour dietary recall was used, with breakfast defined as self-reported. Covariate-adjusted sample-weighted means for the entire day's energy/nutrient intakes, mean adequacy ratio (MAR) for nutrient intakes, and diet quality (i.e., Healthy Eating Index [HEI]-2005) scores were compared using analysis of variance and Bonferroni's correction (p < 0.0167) among breakfast skippers (BS), ready-to-eat-cereal breakfast consumers (RTECC), and other breakfast consumers (OBC). Energy/nutrient intakes and food consumption at breakfast were also compared (p ≤ 0.05). RESULTS: Twenty-five percent of young adults were BS, 16.5% were RTECC, and 58.4% were OBC. Intakes of total energy, percent energy from carbohydrate, and dietary fiber were higher in RTECC than in BS and OBC. Percent energy intake from added sugars was higher in BS than in RTECC and OBC. Compared with BS and RTECC, OBC consumed a lower percent energy from carbohydrates and total sugars, but consumed a higher percent energy from total fat and discretionary solid fats and had a higher cholesterol intake. Intakes of several micronutrients were higher in RTECC than in BS and OBC. Both MAR and total HEI scores were the highest in RTECC and higher in OBC than in BS. The HEI scores for intakes of whole fruits, total/whole grains, milk, and percent energy from solid fat/alcohol/added sugar were the highest in RTECC and higher in OBC than in BS. Compared with OBC, RTECC had a higher HEI score for the intake of saturated fat. At breakfast, RTECC consumed higher intakes of total fruits, whole grains, dairy products, carbohydrates and total sugars, dietary fiber, and several micronutrients than OBC, who consumed higher intakes of meat/poultry/fish, eggs, total fat, discretionary oils/solid fats, cholesterol, and sodium than RTECC. CONCLUSION: Thus, RTECC had more favorable nutrient intakes and better diet quality than BS and OBC.

The relationship of breakfast skipping and type of breakfast consumption with nutrient intake and weight status in children and adolescents: the National Health and Nutrition Examination Survey 1999-2006.

BACKGROUND: National data comparing nutrient intakes and anthropometric measures in children/adolescents in the United States who skip breakfast or consume different types of breakfasts are limited. OBJECTIVE: To examine the relationship between breakfast skipping and type of breakfast consumed with nutrient intake, nutrient adequacy, and adiposity status. SUBJECTS: Children aged 9 to 13 years (n=4,320) and adolescents aged 14 to 18 years (n=5,339). DESIGN: Cross-sectional data from the National Health and Nutrition Examination Survey 1999-2006. METHODS: Breakfast consumption was self-reported. A 24-hour dietary recall was used to assess nutrient intakes. Mean adequacy ratio (MAR) for micronutrients and anthropometric indexes were evaluated. Covariate-adjusted sample-weighted means were compared using analysis of variance and Bonferroni's correction for multiple comparisons among breakfast skippers (breakfast skippers), ready-to-eat (RTE) cereal consumers, and other breakfast (other breakfast) consumers. RESULTS: Twenty percent of children and 31.5% of adolescents were breakfast skippers; 35.9% of children and 25.4% of adolescents consumed RTE cereal. In children/adolescents, RTE cereal consumers had lower intakes of total fat and cholesterol and higher intakes of total carbohydrate, dietary fiber, and several micronutrients (P<0.05 for all) than breakfast skippers and other breakfast consumers. RTE cereal consumers had the highest MAR for micronutrients, and MAR was the lowest for breakfast skippers (P<0.05). In children/adolescents, breakfast skippers had higher body mass index-for-age z scores (P<0.05) and a higher waist circumference (P<0.05) than RTE cereal and other breakfast consumers. Prevalence of obesity (body mass index > or = 95th percentile) was higher in breakfast skippers than RTE cereal consumers (P<0.05) in children/adolescents and was higher in other breakfast consumers than RTE cereal consumers only in adolescents (P<0.05). CONCLUSIONS: RTE cereal consumers had more favorable nutrient intake profiles and adiposity indexes than breakfast skippers or other breakfast consumers in US children/adolescents.

A comparison of the effectiveness of soy protein isolate and fish oil for reducing the severity of retinoid-induced hypertriglyceridemia.

The effectiveness of soy protein isolate (SPI) to reduce the severity of retinoid-induced hypertriglyceridemia has been demonstrated in the rat, but not in human subjects. Because fish oil has been demonstrated to be effective at lowering serum triglyceride concentration in human subjects undergoing retinoid therapy, a study was conducted to compare the ability of SPI with that of fish oil to reduce the severity of retinoid-induced hypertriglyceridemia in the rat. Male Fischer 344 rats, n=8/group, were fed one of four isonitrogenous, isoenergetic diets, consisting of a control diet containing 24% casein +20% corn oil (C), and three 13-cis retinoic acid (13cRA)-supplemented diets containing 24% casein +20% corn oil (R), 24% SPI +20% corn oil (SR), and 24% casein +15% fish oil and 5% corn oil (FR). There was no effect of diet on food intake or final body weight. Serum triglyceride concentration for group R was higher (P<0.001) than for groups C, SR, and FR (7.20 vs. 2.50, 2.84, and 2.02 mmol/L, respectively); values for groups SR and FR did not differ for this parameter. The serum concentration of 13cRA for group R did not differ from that for groups SR and FR. Thus, SPI was as effective as fish oil in reducing the severity of retinoid-induced hypertriglyceridemia in an animal model, suggesting that it may be effective for this purpose in human subjects.