Dietary patterns and changes in body mass index and waist circumference in adults

Reported food intake and distribution of body fat: a repeated cross-sectional study

Background

Body mass, as well as distribution of body fat, are predictors of both diabetes and cardiovascular disease. In Northern Sweden, despite a marked increase in average body mass, prevalence of diabetes was stagnant and myocardial infarctions decreased. A more favourable distribution of body fat is a possible contributing factor.

This study investigates the relative importance of individual food items for time trends in waist circumference (WC) and hip circumference (HC) on a population level.

Methods

Independent cross-sectional surveys conducted in 1986, 1990, 1994 and 1999 in the two northernmost counties of Sweden with a common population of 250000. Randomly selected age stratified samples, altogether 2982 men and 3087 women aged 25–64 years. Questionnaires were completed and anthropometric measurements taken. For each food item, associations between frequency of consumption and waist and hip circumferences were estimated. Partial regression coefficients for every level of reported intake were multiplied with differences in proportion of the population reporting the corresponding levels of intake in 1986 and 1999. The sum of these product terms for every food item was the respective estimated impact on mean circumference.

Results

Time trends in reported food consumption associated with the more favourable gynoid distribution of adipose tissue were increased use of vegetable oil, pasta and 1.5% fat milk. Trends associated with abdominal obesity were increased consumption of beer in men and higher intake of hamburgers and French fried potatoes in women.

Conclusion

Food trends as markers of time trends in body fat distribution have been identified. The method is a complement to conventional approaches to establish associations between food intake and disease risk on a population level.

High body mass index and dietary pattern are associated with childhood asthma

The increasing prevalence of asthma has coincided with an increase of body mass index (BMI) in both children and adults. We investigated the relationship between BMI and the symptom prevalence of asthma and the possible influences of dietary pattern. This was a community-based, cross-sectional study of 24,260 school children aged 6-12 years. Prevalences of asthma and potential confounding factors were assessed using a Korean version of the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire which was completed by parents. We analyzed the relationship between BMI and symptoms of asthma and the possible influences of dietary pattern. A significant positive association between high BMI and previous 12-month prevalence of wheeze remained in boys (adjusted odds ratio, 1.610; 95% confidence interval, 1.274-2.033) but not in girls. In addition, there were significant associations between high BMI and lifetime prevalence of wheeze, previous 12-month wheeze, exercise-induced wheeze, diagnosis, and treatment of asthma. There were significant associations between high BMI and previous 12-month wheeze regardless of breast-milk feeding or whole-milk feeding. Frequent intake of fresh seafood, fresh fruits, and vegetables was associated with reduced prevalence of current asthma symptoms and was also associated with decreased BMI. These results indicate that BMI may be an independent risk factor for the development of asthma symptoms in boys. Intake of fresh seafood, fresh fruit, and vegetables, which may be associated with decreased BMI, may contribute to protect against the development of asthma symptoms in Korean elementary schoolchildren.

Vegetarische Ernährung: Präventives Potenzial und mögliche Risiken

INTRODUCTION

As shown in the first part of this article, consuming high amounts of fruits, vegetables, whole grains and nuts can lower the risk for several chronic diseases. However, the relevance of animal foods consumed within a vegetarian diet is less well-known.

MATERIALS AND METHODS

We followed a nutritive and a metabolic-epidemiological approach to obtain dietary recommendations. A MEDLINE-research was performed for all animal food groups relevant with a vegetarian diet (key words: "eggs", "milk", "dietary pattern" "vegetarian diet", "cancer", "cardiovascular disease", "diabetes mellitus", "osteoporosis", "vitamin D", "vitamin B(12)", "iron", "iodine"). All relevant food groups were characterized regarding their nutrient content and rated with respect to the available metabolic-epidemiological evidence.

RESULTS

Based on the evidence criteria of the WHO/FAO, colorectal cancer risk reduction by a high intake of milk and milk products is assessed as probable, while a higher risk of prostate and ovarial carcinomas is also probable. The evidence of a risk-increasing effect of eggs relating to cardiovascular disease, colorectal cancer and breast cancer is assessed as probable. As the data of prospective cohort studies suggest, a prudent diet pattern characterized high in fruits, vegetables, whole grains and nuts is associated with a lower risk of coronary heart disease and diabetes mellitus type 2. In contrast, there is no overall association between prudent diet pattern and risk of breast cancer or colorectal cancer. The critical key nutrients for vegetarians are vitamin D and B12, iodine and iron.

CONCLUSION

For the first time evidence based dietary recommendations were provided for persons on a vegetarian diet in the D-A-CH-region.

Adults with healthier dietary patterns have healthier beverage patterns

There is an absence of research examining associations between food and beverage intake patterns and most research has centered on soft drinks, whereas research on overall beverage patterns is absent. Using data from the National Health and Nutrition Examination Survey 99-02 for adults aged 19 y and older, we independently examined beverage and food intake patterns, as well as their interrelations. Cluster analysis generated mutually exclusive intake patterns for beverages and foods. Multinomial logistic regression models provided the odds of a given beverage pattern for each food pattern; we then compared the probability of a given beverage pattern for each food pattern. Six beverage and 6 food patterns emerged. Beverage patterns revealed that calorically sweetened, non caloric, and diet beverages tended to be consumed independently of one another. Being in the Snacks and High-Fat Foods cluster increased the odds of being in the Coffee and Soda (odds ratio (OR): 1.62 [95% CI: 1.27-2.06]) or Nutrients and Soda (OR: 1.51 [95% CI: 1.14-2.00]) beverage clusters and decreased the odds of being in the Water and Tea (OR: 0.51 [95% CI: 0.52-0.97]) cluster relative to the odds of being in the Water, Coffee, and Tea cluster. The opposite was true for the Vegetable pattern. Furthermore, persons who had a healthier food pattern had a higher probability of having a non caloric beverage pattern than persons who did not. Increasing awareness of both the contribution of calorie-containing beverages to overall energy intake and dietary patterns associated with these beverages helps inform policies targeted at reducing energy intake in the population.

Adherence to a Mediterranean diet is associated with reduced 3-year incidence of obesity

Few studies have prospectively examined dietary patterns and adult weight change, and results to date are inconsistent. This study examines whether a Mediterranean diet (MD) pattern is associated with reduced 3-y incidence of obesity using data from the Spanish cohort of the European Prospective Investigation into Cancer and Nutrition (EPIC-Spain). The sample included 17,238 women and 10,589 men not obese and aged 29-65 y at baseline (1992-96). Height and weight were measured at baseline; weight was self-reported in a follow-up survey a mean of 3.3 y later. Detailed dietary history data, collected using a validated method, were used to construct a MD score. Logistic regression models were used to estimate odds of becoming overweight or obese. Among initially overweight subjects, 7.9% of women and 6.9% of men became obese, whereas 13.8% of normal weight men and 23.0% women became overweight. High MD adherence was associated with significantly lower likelihood of becoming obese among overweight subjects, with stronger associations after adjusting for underreporting of dietary data. Associations (odds ratios with 95% CI) were similar in women (0.69, 0.54-0.89) and men (0.68, 0.53-0.89). Adjusting for the plausibility of reported dietary intakes increased the magnitude of these associations, which were approximately 0.8 without this adjustment. MD adherence was not associated with incidence of overweight in initially normal-weight subjects. Nonetheless, results suggest that promoting eating habits consistent with MD patterns may be a useful part of efforts to combat obesity.

Dietary patterns in patients with advanced cancer: implications for anorexia-cachexia therapy

BACKGROUND

Severe malnutrition and wasting are considered hallmarks of advanced malignant disease, and clinical research into anorexia-cachexia therapy and nutritional support for cancer patients is ongoing. However, information on typical dietary intakes and food choices for this population is notably lacking; proposed therapies for anorexia and wasting are not framed within the context of current intake.

OBJECTIVE

The objective of the study was to characterize the food intake patterns of patients with advanced cancer.

DESIGN

Patients with advanced cancer (n = 151) recruited from a regional cancer center and palliative-care program completed a 3-d dietary record a mean (+/-SD) 8 +/- 7 mo before death. Food items were categorized according to macronutrient content and dietary use and subsequently entered into cluster analysis.

RESULTS

Wide variations in intakes of energy (range: 4-53 kcal . kg body wt(-1) . d(-1); x +/- SD: 25.1 +/- 10.0 kcal . kg body wt(-1) . d(-1)) and protein (range: 0.2-2.7 g . kg body wt(-1) . d(-1); x +/- SD: 1.0 +/- 0.4 g . kg body wt(-1) . d(-1)) were observed. Even the subjects with the highest intakes had a recent history of weight loss, which suggests that the diets of those persons were consistently inadequate for weight maintenance. Cluster analysis found 3 dietary patterns that differed in food choice and caloric intake. Low intakes and a high risk of weight loss were associated with decreased frequency of eating and dietary profiles with little variety and unusually high proportions of liquids.

CONCLUSION

These data provide a glimpse into dietary habits toward the end of life. Unique dietary patterns were found in this nutritionally vulnerable patient population.

Longitudinal changes in food patterns predict changes in weight and body mass index and the effects are greatest in obese women

The prevalence of obesity is increasing in most parts of the world. The objective of this study was to examine whether changes in food patterns were associated with changes in BMI among women over 9 y. Data were from 33,840 women participating in the Swedish Mammography Cohort in 1987 and 1997. Diet was assessed with a FFQ at both time points and 4 food patterns were derived using confirmatory factor analysis (Healthy, Western/Swedish, Alcohol, and Sweets). Our exposure variables were defined as change in factor score for each food pattern from 1987 to 1997. Our outcome variable was defined as change in BMI during the same period, and we also examined change in weight. Normal weight and overweight women had positive changes in weight and BMI during follow-up, whereas obese women had negative changes in BMI and weight; we observed a significant interaction between change in food patterns and baseline BMI. Obese subjects who increased their factor score for the Healthy pattern had larger decreases in BMI (beta = -0.18 kg/m(2) for a 1 unit increase in SD score, CI: -0.26 to -0.10; P < 0.0001), whereas normal weight and overweight women who increased their Healthy pattern score had smaller increases in BMI (-0.05 kg/m(2) and -0.11 kg/m(2), respectively; P < 0.05 for both). Obese women who increased their Healthy pattern score >3 SD had almost a 4 kg decrease in weight and a 1 unit decrease in BMI at follow-up. In conclusion, changes in eating patterns were significantly related to changes in BMI over 9 y and the effect was modified by baseline BMI. Pattern analysis is helpful in generating hypotheses regarding the role of diet in obesity, and additional research is needed to understand which elements of our patterns are protective or risk factors for weight gain.

Comparative strategies for using cluster analysis to assess dietary patterns

OBJECTIVES

To characterize dietary patterns using two different cluster analysis strategies.

DESIGN

In this cross-sectional study, diet information was assessed by five 24-hour recalls collected over 10 months. All foods were classified into 24 food subgroups. Demographic, health, and anthropometric data were collected via home visit.

SUBJECTS

One hundred seventy-nine community-dwelling adults, aged 66 to 87 years, in rural Pennsylvania.

STATISTICAL ANALYSIS

Cluster analysis was performed.

RESULTS

The methods differed in the food subgroups that clustered together. Both methods produced clusters that had significant differences in overall diet quality as assessed by Healthy Eating Index (HEI) scores. The clusters with higher HEI scores contained significantly higher amounts of most micronutrients. Both methods consistently clustered subgroups with high energy contribution (eg, fats and oils and dairy desserts) with a lower HEI score. Clusters resulting from the percent energy method were less likely to differentiate fruit and vegetable subgroups. The higher diet quality dietary pattern derived from the number of servings method resulted in more favorable weight status.

CONCLUSIONS

Cluster analysis of food subgroups using two different methods on the same data yielded similarities and dissimilarities in dietary patterns. Dietary patterns characterized by the number of servings method of analysis provided stronger association with weight status and was more sensitive to fruit and vegetable intake with regard to a more healthful dietary pattern within this sample. Public health recommendations should evaluate the methodology used to derive dietary patterns.

Dietary quality predicts adult weight gain: findings from the Framingham Offspring Study

OBJECTIVE

We tested the hypothesis that dietary quality, measured by adherence to the Dietary Guidelines, was related to weight change in adults.

RESEARCH METHODS AND PROCEDURES

Dietary intake was assessed among 2245 adult men and women (average age, 49 to 56 years) in the Framingham Offspring cohort. Three-day dietary records were collected in 1984 to 1988 and again in 1991 to 1996. Weight change was measured over 8 years after each assessment. A five-point diet quality index (DQI) was computed based on mean nutrient intake levels from each set of diet records. One DQI point was contributed for each of five nutrients if intake met Dietary Guidelines for total and saturated fat, cholesterol, sodium, and carbohydrate. Gender-specific generalized estimating equations pooled data across the two assessments to relate DQI to 8-year weight gain.

RESULTS

Men and women with higher DQI scores gained less weight during follow-up (p < 0.05). Average gain over 8 years was approximately 3 pounds among those with highest scores, compared with 5 to 8 pounds among those with lower scores. Smoking cessation was an important predictor of weight gain, accounting for about a 5- to 9-pound difference in weight gain.

DISCUSSION

A high-quality diet, one that is consistent with the Dietary Guidelines, may help curb rising rates of obesity at the population level. Poor compliance with the Guidelines, rather than the guidelines themselves, is likely responsible for the weight gain observed in the American population. Adoption of an eating pattern consistent with the Dietary Guidelines should facilitate population weight control if sustained long term.

Dietary patterns and changes in body weight in women

OBJECTIVE

Our objective was to examine the association between adherence to dietary patterns and weight change in women.

RESEARCH METHODS AND PROCEDURES

Women (51,670, 26 to 46 years old) in the Nurses' Health Study II were followed from 1991 to 1999. Dietary intake and body weight were ascertained in 1991, 1995, and 1999. A Western pattern, characterized by high intakes of red and processed meats, refined grains, sweets and desserts, and potatoes, and a prudent pattern, characterized by high intakes of fruits, vegetables, whole grains, fish, poultry, and salad dressing, were identified with principal component analysis, and associations between patterns and change in body weight were estimated.

RESULTS

Women who increased their Western pattern score had greater weight gain (multivariate adjusted means, 4.55 kg for 1991 to 1995 and 2.86 kg for 1995 to 1999) than women who decreased their Western pattern score (2.70 and 1.37 kg for the two time periods), adjusting for baseline lifestyle and dietary confounders and changes in confounders over time (p < 0.001 for both time periods). Furthermore, among women who increased their prudent pattern score, weight gain was smaller (multivariate-adjusted means, 1.93 kg for 1991 to 1995 and 0.66 kg for 1995 to 1999) than among women who decreased their prudent pattern score (4.83 and 3.35 kg for the two time periods) (p < 0.001). The largest weight gain between 1991 and 1995 and between 1995 and 1999 was observed among women who decreased their prudent pattern score while increasing their Western pattern score (multivariate adjusted means, 6.80 and 4.99 kg), whereas it was smallest for the opposite change in patterns (0.87 and -0.64 kg) (p < 0.001).

DISCUSSION

Adoption of a Western dietary pattern is associated with larger weight gain in women, whereas a prudent dietary pattern may facilitate weight maintenance.

Normal-weight adults consume more fiber and fruit than their age- and height-matched overweight/obese counterparts

OBJECTIVES

To assess differences in dietary intake of overweight/obese subjects and sex-, age-, and height-matched controls and to identify dietary components associated with increased deposition of body fat.

DESIGN/SUBJECTS

A convenience sample of 52 overweight/obese and 52 normal-weight adults matched for sex, age (+/-1 year), and height (+/-1 inch) were recruited from the local area. Dietary intake was assessed with the Block 60-item food frequency questionnaire, physical activity was measured by the Yale Physical Activity Survey, and percent body fat was measured via dual-energy x-ray absorptiometry.

STATISTICAL ANALYSES PERFORMED

Independent t tests compared between-group consumption of dietary components. The ability of dietary components to predict percent body fat before and after controlling for age-, sex-, and physical activity-related energy expenditure and other macronutrients was assessed with multiple regression analyses. Spearman correlation coefficients examined relationships among nutrients, Food Guide Pyramid servings, and percent body fat.

RESULTS

Overweight/obese subjects consumed more total fat, saturated fat, and cholesterol and less carbohydrate, complex carbohydrate, and dietary fiber than control subjects. Reported intake of dietary fiber was inversely related to percent body fat without (R(2)=0.052, P=0.02) and with (R(2)=0.045, P=0.013) control for potential confounding factors. Servings of fruit per day were negatively related to percent body fat (r=-0.40, P<0.01).

CONCLUSIONS

These findings suggest that the composition of a diet, especially low dietary fiber and fruit intake, plays a role in the etiology of obesity.

Trends of food intake in Portugal, 1987–1999: results from the National Health Surveys

OBJECTIVE

To assess trends of food intake in Portugal.

DESIGN

Analysis of three cross-sectional studies: 1987, 1995-1996 and 1998-1999.

SETTING

Representative samples of free-living individuals.

SUBJECTS

64 734 men and 71 282 women.

INTERVENTIONS

Food intake was assessed by questionnaires inquiring the number of meals and which foodstuffs (fish, meat, milk, rice/pasta/potatoes, soup, vegetables and fruit) had been consumed the day before.

RESULTS

Age-adjusted average number of meals decreased from 3.3+/-0.1 in 1987 to 2.9+/-0.1 in 1998-1999 in both genders (P<0.001). In men, the percentage of subjects consuming meat, milk and potatoes/rice/pasta increased from 73, 66 and 91% in 1987 to 83, 74 and 95% in 1998-1999, respectively. The percentage of subjects consuming soup and fish decreased from 70 and 56% in 1987 to 62 and 53% in 1998-1999, respectively. In women, the percentage of subjects consuming meat, milk, potatoes/rice/pasta and vegetable increased from 70, 66, 89 and 71% in 1987 to 78, 77, 93 and 83% in 1998-1999, respectively. The percentage of subjects consuming soup and fish decreased from 70 and 55% in 1987 to 64 and 53% in 1998-1999, respectively. These trends were more pronounced in the younger age, which also displayed a higher frequency of snacking. Multivariate analysis adjusting for age group, region and educational level showed that the consumption of meat, milk and vegetables increased and the consumption of soup, fish and fruit decreased in 1998-1999 relative to 1995-1996.

CONCLUSIONS

Within a decade, the Portuguese dietary pattern has changed considerably, shifting from a traditional, south European to a more Westernized, protein-rich diet.

SPONSORSHIP

The Unidade de Nutrição e Metabolismo of the Instituto de Medicina Molecular is partially funded by a grant from the FCT (Fundação para a Ciência e a Tecnologia) ref. RUN 437.

The feasibility and utility of grocery receipt analyses for dietary assessment

Objective

To establish the feasibility and utility of a simple data collection methodology for dietary assessment.

Design

Using a cross-sectional design, trained data collectors approached adults (~20 – 40 years of age) at local grocery stores and asked whether they would volunteer their grocery receipts and answer a few questions for a small stipend ($1).

Methods

The grocery data were divided into 3 categories: "fats, oils, and sweets," "processed foods," and "low-fat/low-calorie substitutions" as a percentage of the total food purchase price. The questions assessed the shopper's general eating habits (eg, fast-food consumption) and a few demographic characteristics and health aspects (eg, perception of body size).

Statistical Analyses Performed. Descriptive and analytic analyses using non-parametric tests were conducted in SAS.

Results

Forty-eight receipts and questionnaires were collected. Nearly every respondent reported eating fast food at least once per month; 27% ate out once or twice a day. Frequency of fast-food consumption was positively related to perceived body size of the respondent (p = 0.02). Overall, 30% of the food purchase price was for fats, oils, sweets, 10% was for processed foods, and almost 6% was for low-fat/low-calorie substitutions. Households where no one was perceived to be overweight spent a smaller proportion of their food budget on fats, oils, and sweets than did households where at least one person was perceived to be overweight (p = 0.10); household where the spouse was not perceived to be overweight spent less on fats, oils, and sweets (p = 0.02) and more on low-fat/low-calorie substitutions (p = 0.09) than did households where the spouse was perceived to be overweight; and, respondents who perceived themselves to be overweight spent more on processed foods than did respondents who did not perceive themselves to be overweight (p = 0.06).

Conclusion

This simple dietary assessment method, although global in nature, may be a useful indicator of dietary practices as evidenced by its association with perceived weight status.

Long-term stability of food patterns identified by use of factor analysis among Swedish women

Limited data exist on the reproducibility of food patterns measured by factor analysis as well as on the use of stability of patterns over time. Our primary objective was to explore the long-term stability of food patterns derived by confirmatory factor analysis among 33,840 women participating in the Swedish Mammography Cohort. Our secondary objective was to compare factor solutions from confirmatory factor analysis with those derived by use of exploratory factor analysis. Diet was assessed by a food frequency questionnaire in 1987 and 1997, and food patterns were derived by the use of exploratory and confirmatory factor analysis. We observed four major food patterns (Healthy, Western/Swedish, Alcohol, and Sweets) at both time points. Correlations between confirmed food patterns in 1987 and 1997 were 0.37 for the Healthy pattern, 0.27 for the Western/Swedish pattern, 0.54 for the Alcohol pattern, and 0.44 for the Sweets pattern (P < 0.0001 for all associations). Patterns derived by the use of exploratory factor analysis were strongly associated with those derived by the use of confirmatory factor analysis (r >/= 0.90, P < 0.0001, for all associations). The patterns derived in this study were similar to those derived in other studies, indicating reproducibility of food patterns across populations. Our study suggests that food patterns measured by the use of confirmatory factor analysis are reproducible over time, and weaker correlations observed may reflect natural changes in eating behavior, the food supply, and/or perceptions of what is considered healthy. Testing whether patterns measured over a long time period can be used in analytic studies is the next step in assessing the validity of this method.

Nutritional influences on inflammation and type 2 diabetes risk

There is a clear role for inflammation in the development of type 2 diabetes and its associated co-morbidities. Circulating inflammatory markers such as C-reactive protein, sialic acid, and interleukin- 6 are all significant independent predictors of disease. A number of nutritional components are hypothesized to modulate inflammation, and hence impact on disease risk. The most extensively studied nutrients are the long-chain n-3 polyunsaturated fatty acids. However, evidence is also emerging with respect to whole grain or low glycemic index foods and antioxidant vitamins. Obesity, resulting from long-term dietary energy excess, is also strongly linked to raised inflammatory status and type 2 diabetes. To date, much of the evidence for the effect of nutrients or foods on disease risk has been based on epidemiological associations. However, the links among diet, inflammation, and type 2 diabetes are supported by some data from human dietary intervention trials and/or mechanistic studies in animals. Further research is required to quantify the precise role and refine the evidence base. However, the proposed "anti-inflammatory" strategies to tackle type 2 diabetes are broadly consistent with current public health nutrition guidelines: to achieve and maintain a healthy weight, to reduce saturated fat, to increase the proportion of less refined forms of carbohydrate, and to increase intake of fruits and vegetables.

Predictors of weight gain in a Mediterranean cohort: the Seguimiento Universidad de Navarra Study 1

BACKGROUND

High consumption of sugar-sweetened drinks has been associated with weight gain and obesity in the United States. This trend may also be affecting populations with different eating patterns who increasingly are adopting typical US dietary patterns.

OBJECTIVE

We assessed whether the consumption of sweetened drinks and other food items increased the likelihood of weight gain in a Mediterranean population.

DESIGN

This was a prospective cohort analysis of 7194 men and women with a mean age of 41 y who were followed-up for a median of 28.5 mo with mailed questionnaires. Dietary exposure was assessed with a previously validated semiquantitative food-frequency questionnaire.

RESULTS

During follow-up, we observed that 49.5% of the participants increased their weight (x weight gain: 0.64 kg; 95% CI: 0.55, 0.73 kg). In the participants who had gained > or =3 kg in the 5 y before baseline, the adjusted odds ratio of subsequent weight gain for the fifth quintile compared with the first quintile of sugar-sweetened soft drink consumption was 1.6 (95% CI: 1.2, 2.1; P for trend = 0.02). This association was absent in the participants who had not gained weight in the 5-y period before baseline. The consumption of hamburgers, pizza, and sausages (as a proxy for fast-food consumption) was also independently associated with weight gain (adjusted odds ratio for the fifth compared with the first quintile = 1.2; 95% CI: 1.0, 1.4; P for trend = 0.05). We also found a significant, but weaker, association between weight gain and both red meat and sweetened fruit juice consumption.

CONCLUSION

In a Mediterranean cohort, particularly in the participants who had already gained weight, an increased consumption of sugar-sweetened soft drinks and of hamburgers, pizza, and sausages was associated with a higher risk of additional subsequent weight gain.

Dietary Patterns of Young, Low-Income US Children

OBJECTIVE

The purpose of this study was to identify dietary patterns of young, low-income US children, describe differences in diet quality between identified patterns, and make targeted food recommendations to improve diet quality.

DESIGN

Dietary patterns were assessed using dietary variables from the Pyramid Servings Database within the Continuing Survey of Food Intakes by Individuals 1994-1996, 1998. Healthy Eating Index (HEI) scores were used to validate identified dietary patterns.

SUBJECTS/SETTING

Two subsamples of low-income children, aged 2 to 3 years (n = 1,242) and 4 to 8 years (n = 1,506), were selected from the Continuing Survey of Food Intakes by Individuals data.

STATISTICAL ANALYSIS

Cluster analysis was performed to determine unique dietary patterns within the two subsamples. Linear regression analyses were used to compare energy intake, discretionary fat, added sugars, and HEI scores across cluster groups. Descriptive statistics were computed for each cluster.

RESULTS

Cluster analysis identified six and seven distinct dietary patterns for the younger and older children, respectively. Four patterns were similar for both age groups. For the 2- to 3-year-old children, energy intake, overall HEI scores, and nine of the 10 HEI component scores differed among the four most prevalent dietary patterns. Among the older children, energy intake and six of the HEI component scores differed between the four most prevalent clusters but not overall HEI.

CONCLUSIONS

Neither age group had a cluster of children who followed a balanced/moderate diet pattern consistent with Food Guide Pyramid recommendations. Children consuming almost every pattern identified could benefit by reducing added sugars and discretionary fat and increasing low-fat, low-sugar options from the vegetables, fruits, meat, and milk groups.

How to measure dietary intake and food habits in adolescence: the European perspective

AIM

This paper deals with some methodological aspects of data collection in the context of measuring dietary intake in individuals in their adolescence life stage.

METHOD

Experiences from three partners of the HELENA project in dietary intake measurement in children and adolescents are presented in this paper with emphasis on characteristics of under-reporting, long-term diet measurement and food patterns (Dortmund DONALD group), influences of survey duration on under-reporting (Ghent group) and meal habits (Spanish AVENA group).

RESULTS

Under-reporters in the DONALD Study, particularly female adolescents, had a significantly higher body mass index (BMI) than non-under-reporters; BMI could not be explained by different long-term dietary patterns during childhood and adolescence clustered according to fat consumption; consumers of fast food had higher BMI values than nonconsumers. In the Ghent experience, the decline in population mean energy intake as calculated over selected clusters of days is 184 kcal (6.5%) in boys and 116 (5.6%) in girls; the cluster of 1 recording day and the cluster of 3 recording days were not significantly different but they were both significantly different from the 7-day cluster; no significant interaction was observed between the effect of time and BMI. In the AVENA Study, the percentage of adolescents skipping breakfast was higher in females (8.6%) than in males (3.5%, P<0.001); higher BMI values were observed in those skipping breakfast than in those notskipping breakfast, but differences were statistically significant in males at 15 y and in females at 14 and 17 y; adolescents avoiding some food groups for breakfast had higher BMI values (carbohydrates, fruits and pastries in males and milk, fruits and pastries in females).

CONCLUSION

Dietary and nutrient intake data in the HELENA project will be obtained by means of repeated 24-h dietary recalls. Data from HELENA might be a basis for developing complex approaches like Healthy Eating Indices.

Consistent dietary patterns identified from childhood to adulthood: the cardiovascular risk in Young Finns Study

Dietary patterns are useful in nutritional epidemiology, providing a comprehensive alternative to the traditional approach based on single nutrients. The Cardiovascular Risk in Young Finns Study is a prospective cohort study with a 21-year follow-up. At baseline, detailed quantitative information on subjects' food consumption was obtained using a 48 h dietary recall method (n 1768, aged 3-18 years). The interviews were repeated after 6 and 21 years (n 1200 and n 1037, respectively). We conducted a principal component analysis to identify major dietary patterns at each study point. A set of two similar patterns was recognised throughout the study. Pattern 1 was positively correlated with consumption of traditional Finnish foods, such as rye, potatoes, milk, butter, sausages and coffee, and negatively correlated with fruit, berries and dairy products other than milk. Pattern 1 type of diet was more common among male subjects, smokers and those living in rural areas. Pattern 2, predominant among female subjects, non-smokers and in urban areas, was characterised by more health-conscious food choices such as vegetables, legumes and nuts, tea, rye, cheese and other dairy products, and also by consumption of alcoholic beverages. Tracking of the pattern scores was observed, particularly among subjects who were adolescents at baseline. Of those originally belonging to the uppermost quintile of pattern 1 and 2 scores, 41 and 38 % respectively, persisted in the same quintile 21 years later. Our results suggest that food behaviour and concrete food choices are established already in childhood or adolescence and may significantly track into adulthood.

Identification of a food pattern characterized by high-fiber and low-fat food choices associated with low prospective weight change in the EPIC-Potsdam cohort

The aim of the study was to identify a dietary pattern predictive of subsequent annual weight change by using dietary composition information. Study subjects were 24,958 middle-aged men and women of the European Prospective Investigation into Cancer and Nutrition-Potsdam cohort. To derive dietary patterns, we used the reduced rank regression method with 3 response variables presumed to affect weight change: fat density, carbohydrate density, and fiber density. Annual weight change was computed by fitting a linear regression line to each person's body weight data (baseline, and 2- and 4-y follow-up) and determining the slope. In linear regression models, the pattern score was related to annual weight change. We identified a food pattern of high consumption of whole-grain bread, fruits, fruit juices, grain flakes/cereals, and raw vegetables, and of low consumption of processed meat, butter, high-fat cheese, margarine, and meat to be predictive of subsequent weight change. Mean annual weight gain gradually decreased with increasing pattern score (P for trend < 0.0001), i.e., subjects scoring high for the pattern maintained their weight or gained significantly less weight over time compared with subjects with an opposite pattern. However, the prediction of annual weight change by the food pattern was significant only in nonobese subjects. In this study population, we identified a food pattern characterized by high-fiber and low-fat food choices that can help to maintain body weight or at least prevent excess body weight gain.

Risk of overweight and obesity among semivegetarian, lactovegetarian, and vegan women

BACKGROUND

Observational studies suggest that a plant-based diet is inversely related to body mass index (BMI), overweight, and obesity.

OBJECTIVE

Our objective was to examine the BMI (kg/m(2)) and risk of overweight and obesity of self-defined semivegetarian, lactovegetarian, and vegan women.

DESIGN

Data analyzed in this cross-sectional study were from 55459 healthy women participating in the Swedish Mammography Cohort. Women were asked whether they considered themselves to be omnivores (n = 54257), semivegetarians (n = 960), lactovegetarians (n = 159), or vegans (n = 83), and this question was the main exposure variable in this study. In secondary analyses, we reclassified women as lactovegetarians on the basis of food intakes reported on the food-frequency questionnaire.

RESULTS

The prevalence of overweight or obesity (BMI >/= 25) was 40% among omnivores, 29% among both semivegetarians and vegans, and 25% among lactovegetarians. In multivariate, adjusted logistic regression analyses, self-identified vegans had a significantly lower risk of overweight or obesity [odds ratio (OR) = 0.35; 95% CI: 0.18, 0.69] than did omnivores, as did lactovegetarians (OR = 0.54; 95% CI: 0.35, 0.85) and semivegetarians (OR = 0.52; 95% CI: 0.43, 0.62). Risk of overweight or obesity remained significantly lower among lactovegetarians classified on the basis of the food-frequency questionnaire (OR = 0.48; 95% CI: 0.30, 0.78).

CONCLUSIONS

Even if vegetarians consume some animal products, our results suggest that self-identified semivegetarian, lactovegetarian, and vegan women have a lower risk of overweight and obesity than do omnivorous women. The advice to consume more plant foods and less animal products may help individuals control their weight.

Potential effects of the next 100 billion hamburgers sold by McDonald's

BACKGROUND

McDonald's has sold >100 billion beef-based hamburgers worldwide with a potentially considerable health impact. This paper explores whether there would be any advantages if the next 100 billion burgers were instead plant-based burgers.

METHODS

Nutrient composition of the beef hamburger patty and the McVeggie burger patty were obtained from the McDonald's website; sales data were obtained from the McDonald's customer service.

RESULTS

Consuming 100 billion McDonald's beef burgers versus the same company's McVeggie burgers would provide, approximately, on average, an additional 550 million pounds of saturated fat and 1.2 billion total pounds of fat, as well as 1 billion fewer pounds of fiber, 660 million fewer pounds of protein, and no difference in calories.

CONCLUSIONS

These data suggest that the McDonald's new McVeggie burger represents a less harmful fast-food choice than the beef burger.

Choice and availability of takeaway and restaurant food is not related to the prevalence of adult obesity in rural communities in Australia

OBJECTIVES

To establish whether choice and availability of takeaway and restaurant food consumption are associated with increased obesity.

DESIGN

Crossroads Undiagnosed Disease Study: a cross-sectional study undertaken between June 2001 and March 2003.

SETTING

A regional centre and six shire capitals of variables size in rural Victoria, Australia.

PARTICIPANTS

In total, 1454 residents of randomly selected households.

MEASUREMENTS

Obesity (by body mass index (BMI) or waist circumference), weekly recreational activity, self-reported frequency of takeaway consumption, number of local takeaway and restaurant food outlets in the area.

RESULTS

The prevalence of obesity ranged from 25.5-30.8% and was higher than the general Australian population among both men and women. Those in the regional centre were less likely than those in large and small shire capitals to participate in recreational activity of 150 min or more (39.7 vs 48.4%, 46.0% respectively, P=0.023) and yet reported better access to facilities and amenities for physical activity. Recreational activity of > or =150 min/week was associated with 0.75 (0.58-0.97) fold less risk of obesity. BMI was unrelated to takeaway consumption. Waist circumference was significantly lower among those eating no takeaways, but similar whether takeaways were consumed <1/month or > or =1/week. Increased takeaway consumption was associated with increased consumption of higher fat preparations of dairy and meat products. Availability of takeaway outlets and restaurants was unrelated to obesity.

CONCLUSION

The obesity epidemic exists among those without significant consumption of or availability to takeaway foods. In a setting of easy availability of food, the obesity epidemic relates strongly to reduced physical activity, but not to consumption of takeaway food.

Dietary patterns and lifestyle factors in the Norwegian EPIC cohort: The Norwegian Women and Cancer (NOWAC) study

OBJECTIVE

To identify different dietary patterns in Norway using a combination of cluster and factor analysis.

DESIGN

Cross-sectional study.

SETTING

Nation-wide, population-based study.

SUBJECTS

The Norwegian EPIC cohort is a subcohort of the Norwegian Women and Cancer study (NOWAC), and consist 37.226 women aged 41-56 y who answered a food frequency questionnaire (FFQ) in 1998.

INTERVENTIONS

The associations among 50 food variables were first investigated by using principal component analysis. Five important factors were found. The five principal components were then used as input in the cluster analysis. Different socioeconomic and lifestyle variables were examined.

RESULTS

Six clusters of dietary patterns were found, and were labelled accordingly: 'traditional fish eaters', 'healthy eaters', 'average, less fish, less healthy', 'Western', 'traditional bread eaters', and 'alcohol users'. The traditional fish eaters and the traditional bread eaters were both highly represented in the north and west of Norway and were more likely to be present among persons with lower income and lower education. The healthy and the alcohol drinkers were found mostly in the south and east and were more likely to have higher income. Persons in the alcohol group were more likely to be current smokers. The western group had the highest percentage of three or more persons in the household and the shortest time since last birth, indicating that families with children dominate this group.

CONCLUSION

Our data indicate six different dietary patterns in Norway, each with different socio-demographic and lifestyle characteristics.

SPONSORSHIP

The Norwegian Cancer Society (E 04038/006).

Changes in intake of fruits and vegetables in relation to risk of obesity and weight gain among middle-aged women

OBJECTIVE

To examine the changes in intake of fruits and vegetables in relation to risk of obesity and weight gain among middle-aged women.

DESIGN

Prospective cohort study with 12 y of follow-up conducted in the Nurses' Health Study.

SUBJECTS

A total of 74,063 female nurses aged 38-63 y, who were free of cardiovascular disease, cancer, and diabetes at baseline in 1984.

MEASUREMENTS

Dietary information was collected using a validated food frequency questionnaire, and body weight and height were self-reported.

RESULTS

During the 12-y follow-up, participants tended to gain weight with aging, but those with the largest increase in fruit and vegetable intake had a 24% of lower risk of becoming obese (BMI> or =30 kg/m2) compared with those who had the largest decrease in intake after adjustment for age, physical activity, smoking, total energy intake, and other lifestyle variables (relative risk (RR), 0.76; 95% confidence interval (CI), 0.69-0.86; P for trend <0.0001). For major weight gain (> or =25 kg), women with the largest increase in intake of fruits and vegetables had a 28% lower risk compared to those in the other extreme group (RR, 0.72; 95% CI, 0.55-0.93; P=0.01). Similar results were observed for changes in intake of fruits and vegetables when analyzed separately.

CONCLUSIONS

Our findings suggest that increasing intake of fruits and vegetables may reduce long-term risk of obesity and weight gain among middle-aged women.

Carbohydrates and dietary fiber

The most widely spread eating habit is characterized by a reduced intake of dietary fiber, an increased intake of simple sugars, a high intake of refined grain products, an altered fat composition of the diet, and a dietary pattern characterized by a high glycemic load, an increased body weight and reduced physical activity. In this chapter the effects of this eating pattern on disease risk will be outlined. There are no epidemiological studies showing that the increase of glucose, fructose or sucrose intake is directly and independently associated with an increased risk of atherosclerosis or coronary heart disease (CHD). On the other hand a large number of studies has reported a reduction of fatal and non-fatal CHD events as a function of the intake of complex carbohydrates--respectively 'dietary fiber' or selected fiber-rich food (e.g., whole grain cereals). It seems that eating too much 'fast' carbohydrate [i.e., carbohydrates with a high glycemic index (GI)] may have deleterious long-term consequences. Indeed the last decades have shown that a low fat (and consecutively high carbohydrate) diet alone is not the best strategy to combat modern diseases including atherosclerosis. Quantity and quality issues in carbohydrate nutrient content are as important as they are for fat. Multiple lines of evidence suggest that for cardiovascular disease prevention a high sugar intake should be avoided. There is growing evidence of the high impact of dietary fiber and foods with a low GI on single risk factors (e.g., lipid pattern, diabetes, inflammation, endothelial function etc.) as well as also the development of the endpoints of atherosclerosis especially CHD.

Food and drinking patterns as predictors of 6-year BMI-adjusted changes in waist circumference

Few studies have investigated the prospective associations between diet or drinking patterns and abdominal obesity; we therefore investigated whether food and beverage groups or patterns predicted 6-year changes in waist circumference (WC) and whether these associations were independent of concurrent changes in BMI as a measure of general obesity. The subjects were 2300 middle-aged men and women with repeated measurements of dietary intake, BMI and WC from 1982 to 1993. Intakes from ten food groups and from coffee, tea, wine, beer and spirits were assessed; gender-specific food factors were identified by factor analyses. Multiple linear regression analyses were done before and after adjustment for concurrent changes in BMI. A high intake of potatoes seemed to prevent gain in WC for men, while a high intake of refined bread was associated with gain in WC for women. The association persisted for refined bread, but not for potatoes, after adjustment for concurrent BMI changes. Among women, but not men, high intakes of beer and spirits were associated with gain in WC in both models. A high intake of coffee for women and moderate to high intake of tea for men were associated with gain in WC, but the associations were weakened, especially for women, after adjustment for BMI changes. None of the food factors was associated with WC changes. Based on the present study, we conclude that very few food items and no food patterns seem to predict changes in WC, whereas high intakes of beer and spirits among women, and moderate to high tea intake among men, may promote gain in WC.

Adherence to the traditional mediterranean diet is inversely associated with body mass index and obesity in a spanish population

The Mediterranean diet is a healthy eating pattern with protective effects on chronic diseases. The purpose of this study was to assess the relation between BMI and obesity and the level of adherence to the traditional Mediterranean diet. The subjects were Spanish men (n = 1547) and women (n = 1615) aged 25-74 y who were examined in 1999-2000, in a population-based, cross-sectional survey in the northeast of Spain (Girona). Dietary intake was assessed using a FFQ. A Mediterranean diet score, including foods considered to be characteristic components of the traditional Mediterranean diet (vegetables, fruits, pulses, nuts, fish, meat, cereals, olive oil, and wine) was created. An increase of 5 U in the dietary score was associated with a change in the BMI of 0.43 (P = 0.030) and 0.68 (P = 0.007), after controlling for potential confounders, in men and women, respectively. The obesity risk decreased in men (P = 0.010) and women (P = 0.013) with increasing adherence to the traditional Mediterranean dietary pattern. The population in the top tertile of this score were less likely to be obese in both genders [odds ratio (OR) and (95% CI): 0.61 (0.40-0.92) in men; 0.61 (0.40-0.93) in women] after adjusting for potential confounders. These data suggest that the traditional Mediterranean dietary pattern is inversely associated with BMI and obesity. This finding may be useful in the development of dietary approaches for dietary counseling and the prevention of obesity.

Obesity and Nutrition in Women Throughout Adulthood

Nutritional challenges are particularly relevant to women. Almost 62% of women are overweight; of these women, 33% are obese. The incidence of obesity is even greater in non-Hispanic Black and Mexican American women. Women who are overweight or obese experience a greater number of adverse health outcomes, including an increased incidence of cardiovascular disease and breast and colon cancer. Dietary patterns influence health outcomes, with a heart-healthy pattern having the most positive health outcomes. Health care providers should encourage women to consume a diet high in fruits and vegetables and low in total and saturated fats.

Whole grain intake and insulin sensitivity: evidence from observational studies

Observational studies have found that diets rich in whole-grain foods are associated with improved insulin sensitivity. The improved insulin sensitivity may be mediated in part by magnesium and dietary fiber, two nutrients found in whole-grain foods. By incorporating whole-grain foods into the diet, therefore, insulin sensitivity might be improved.

Associations of empirically derived eating patterns with plasma lipid biomarkers: a comparison of factor and cluster analysis methods

BACKGROUND

Despite the growing use of patterning methods in nutritional epidemiology, a direct comparison of factor and cluster analysis methods has not been performed.

OBJECTIVE

Our main objective was to compare patterns derived from the cluster and factor analysis procedures with measures of plasma lipids.

DESIGN

This cross-sectional study included 459 healthy subjects who participated in the Baltimore Longitudinal Study of Aging and had measures of diet and plasma lipids. Eating patterns were derived by using both factor and cluster analysis methods.

RESULTS

In separate multivariate-adjusted regression models, subjects in the healthy cluster had lower plasma triacylglycerols than did those not in the healthy cluster (beta = -15.97; 95% CI: -29.51, -2.43; P < 0.05), and factor 1 (reduced-fat dairy products, fruit, and fiber) was inversely related to plasma triacylglycerols (beta = -7.02 mg/dL for a one-unit increase in z score; 95% CI: -12.92, -1.12; P < 0.05). Those in the alcohol cluster had higher total cholesterol concentrations than did those not in the alcohol cluster (beta = 12.81; 95% CI: 2.74, 22.88; P < 0.05), and factor 2 (protein and alcohol) was also directly associated with total cholesterol (beta = 1.59 for a one-unit increase in z score; 95% CI: 0.55, 2.63; P < 0.05). The multivariate model containing all of the clusters was not significantly different from the model containing all of the factors in predicting each lipid outcome.

CONCLUSION

Our study provides evidence of comparability between cluster and factor analysis methods in relation to plasma lipid biomarkers.

Dietary patterns of Hispanic elders are associated with acculturation and obesity

The association of dietary patterns and obesity, particularly in Hispanics, is relatively poorly understood. This large U.S. population subgroup has a high prevalence of obesity and associated chronic conditions, and Hispanics are changing their dietary practices as they acculturate. Our objectives were 1) to identify dietary patterns among elderly Hispanics in Massachusetts, compared with those of non-Hispanic whites; 2) to associate dietary patterns with acculturation; and 3) to associate dietary patterns with total and central obesity. We used a representative sample of 449 Puerto Rican and 133 Dominican elders and a neighborhood-based sample of 243 non-Hispanic white elders, aged 60 to 92 y, from the cross-sectional Massachusetts Hispanic Elders Study. Obesity and central obesity were assessed with BMI (kg/m2) and waist circumference measurement, respectively. Acculturation was assessed by evaluating language use. Usual diet was assessed with a food frequency questionnaire specifically designed for use with this population. Dietary patterns were defined by cluster analysis of food group variables. We identified five clusters of individuals by dietary pattern, with proportionately greater energy intake from 1) fruit and breakfast cereal, 2) starchy vegetables, 3) rice, 4) whole milk and 5) sweets, respectively. Hispanics were less likely to follow the fruit and cereal or sweets patterns, and more likely to follow the starchy vegetables or milk patterns, than were non-Hispanic whites. Only Hispanics followed the rice pattern. Among Hispanics, acculturation was positively associated with the fruit and cereal pattern, and negatively with the rice pattern. Total and central obesity were positively associated with the rice pattern. Longitudinal studies are needed to clarify the causal nature of these associations.

Food patterns measured by factor analysis and anthropometric changes in adults

BACKGROUND

Sixty-five percent of US adults are overweight, and 31% of these adults are obese. Obesity results from weight gains over time; however, dietary determinants of weight gain remain controversial.

OBJECTIVE

Our objective was to examine whether food patterns derived from exploratory factor analysis are related to anthropometric changes. We hypothesized that we would derive a healthy food pattern and that it would predict smaller changes in body mass index (BMI; in kg/m(2)) and waist circumference (in cm) than would other food patterns in models adjusted for baseline anthropometric measures.

DESIGN

The subjects were 459 healthy men and women participating in the Baltimore Longitudinal Study of Aging. Diet was assessed by using 7-d dietary records, from which 40 food groups were formed and entered into a factor analysis.

RESULTS

Six food patterns were derived. Factor 1 (reduced-fat dairy products, fruit, and fiber) was most strongly associated with fiber (r = 0.39) and loaded heavily on reduced-fat dairy products, cereal, and fruit and loaded moderately on fruit juice, nonwhite bread, nuts and seeds, whole grains, and beans and legumes. In a multivariate-adjusted model in which the highest and lowest quintiles were compared, factor 1 was inversely associated with annual change in BMI (beta = -0.51; 95% CI: -0.82, -0.20; P < 0.05; P for trend < 0.01) in women and inversely associated with annual change in waist circumference (beta = -1.06 cm; 95% CI: -1.88, -0.24 cm; P < 0.05; P for trend = 0.04) in both sexes.

CONCLUSION

Our results suggest that a pattern rich in reduced-fat dairy products and high-fiber foods may lead to smaller gains in BMI in women and smaller gains in waist circumference in both women and men.

A longitudinal study of food intake patterns and obesity in adult Danish men and women

OBJECTIVE

The aim of this study was to test the hypothesis that specific food intake patterns or changes in food intake patterns were related to future changes in body mass index (BMI).

DESIGN

Longitudinal observational study, with clinical and questionnaire examinations at baseline and two follow-up surveys, after 5 and 11 years.

SUBJECTS

In all, 3785 men and women attended at baseline, of which 2436 aged 30-60 y attended all three examinations.

MEASUREMENTS

A 26-item food frequency questionnaire, standardised measurements of height and weight and a lifestyle questionnaire. Food intake patterns were identified by factor analysis. Regression models including: scores on each factor, BMI, smoking, leisure time physical activity, education, parity, age; and as outcomes: baseline BMI, BMI change between baseline, 5- and 11-y follow-up and obesity at 11-y follow-up, respectively.

RESULTS

For men, three factors labelled 'Green', 'Sweet' and 'Traditional', and for women, two factors labelled 'Green' and 'Sweet-Traditional' were identified. Scores on the 'Sweet' and 'Sweet-Traditional' factors were inversely associated with baseline BMI. For men, baseline 'Traditional' factor score and, for women, baseline 'Sweet-Traditional' factor score was inversely associated with subsequent 11- and 5-y BMI change, respectively. Using the three examinations, a more advanced longitudinal model, which included preceding changes in BMI and factor scores, was tested but no significant associations between factor scores, changes in factor scores and subsequent BMI changes or obesity were found.

CONCLUSION

In this longitudinal study of a Danish population, food intake factors could not consistently predict changes in BMI or obesity development.

Modifications in food-group consumption are related to long-term body-weight changes

BACKGROUND

Dietary patterns play an important role in the control of body weight.

OBJECTIVE

The aim of this study was to verify whether changes in some dietary patterns over a 6-y follow-up period would be associated with weight changes.

DESIGN

A sample of 248 volunteers of the Québec Family Study were measured twice (visit 1: 1989-1994; visit 2: 1995-2000). Body weight, percentage body fat, subcutaneous skinfold thicknesses, and waist circumference measurements as well as 3-d dietary and physical activity records were obtained at each visit. At visit 2, all participants filled out a food-based questionnaire examining changes in the consumption of 10 food categories. To further investigate the relation between changes in food-group consumption and body-weight changes, a total of 51 food subcategories were identified from dietary records.

RESULTS

A self-reported decrease in the consumption of food in the fat group or an increase in consumption in the fruit group from the food-based questionnaire predicted a lower increase in body weight and adiposity indicators over time. A more detailed examination of the change in food groups between diet records revealed that increases in the consumption of whole fruit as well as skimmed milk and partly skimmed milk were the 2 food patterns that negatively correlated with the changes of each body weight-related indicator.

CONCLUSIONS

These results show that changes in the consumption of some specific food groups are associated with body-weight changes. Such specific eating patterns could help to improve obesity treatment and prevention.

Dietary calcium and dairy modulation of adiposity and obesity risk

Dietary calcium plays a key role in the regulation of energy metabolism and obesity risk. This appears to be mediated primarily by dietary calcium modulation of circulating calcitriol, which in turn regulates adipocyte intracellular calcium ([Ca2+]i). Increased [Ca2+]i stimulates lipogenic gene expression and activity and inhibits lipolysis, resulting in increased adipocyte lipid accumulation. Since calcitriol stimulates adipocyte Ca2+ influx, low calcium diets promote adiposity, while dietary calcium-suppression of calcitriol reduces adiposity. These concepts are confirmed in controlled rodent studies as well as by epidemiological and clinical trial data, all of which confirm protection from obesity with high calcium intakes. Moreover, dairy sources of calcium exert markedly greater effects which are most likely attributable to additional bioactive compounds in dairy which act synergistically with calcium to attenuate adiposity.

A high-whey-protein diet reduces body weight gain and alters insulin sensitivity relative to red meat in wistar rats

A high-protein diet can reduce body weight and increase insulin sensitivity, but whether the type of dietary protein affects these outcomes is unknown. We hypothesized that feeding insulin-resistant rats a high-protein diet (32%) containing whey protein concentrate (WPC) would reduce body weight and tissue lipid levels and increase insulin sensitivity more than a diet containing red meat (RM). Rats were fed a high-fat diet (300 g fat/kg diet) for 9 wk, then switched to a diet containing either 80 or 320 g protein/kg diet, provided by either WPC or RM, for 6 wk (n = 8). The rats were then killed after overnight food deprivation. High dietary protein reduced energy intake (P < 0.001) and visceral (P < 0.001), subcutaneous (P < 0.001), and carcass fat (P < 0.05). Increasing the dietary density of WPC, but not of RM, reduced body weight gain by 4% (P < 0.001). Dietary WPC also reduced plasma insulin concentration by 40% (P < 0.05) and increased insulin sensitivity, compared to RM (P < 0.05). These findings support the conclusions that a high-protein diet reduces energy intake and adiposity and that whey protein is more effective than red meat in reducing body weight gain and increasing insulin sensitivity.

Healthy Eating Index and obesity

BACKGROUND

There is a continuing need to examine the relationship between diet quality and health in the population. The Healthy Eating Index (HEI) has been developed as a composite measure of diet quality by the US Department of Agriculture.

OBJECTIVES

The first objective was to use the HEI to assess the diet quality of a representative sample of the US population and population groups. The second objective was to examine the association between HEI and obesity.

DESIGN

Cross-sectional analysis of data from 10 930 adults who participated in the Third National Health and Nutrition Examination Survey. Sociodemographic, physical activity, dietary, and health data were used in the analysis. Diet quality was assessed with the HEI score, ranging from 0 to 100, based on 10 dietary criteria. A low HEI score indicates poor diet.

RESULTS

A majority of survey participants had a low HEI score. The percentage of individuals classified as having a poor diet varied by age, gender, race/ethnicity, income, and education. A low HEI score was associated with overweight and obesity. There was a graded increase in the odds ratio of obesity across the HEI category after adjusting for age, gender, race/ethnicity, physical activity, smoking, alcohol use, income, and education.

CONCLUSIONS

An index of diet quality, such as HEI, may provide a comprehensive assessment of diet in the population. Since the HEI is based on the US Dietary Guidelines, the use of these guidelines as a way to improve health should be emphasized. However, the overall effectiveness of these guidelines in disease prevention needs to be studied further.

Diet and obesity

PURPOSE OF REVIEW

Obesity continues to increase in the United States and worldwide. There is controversy surrounding different dietary patterns used to promote weight loss, and none has emerged as clearly more effective. This paper briefly reviews the factors that influence energy intake and dietary treatments used to promote weight loss.

RECENT FINDINGS

Increasing portion size, eating away from home, and consuming a variety of high-energy dense foods appear to increase energy intake. Hormonal influences on diet continue to be explored. Very-low-calorie diets and low-carbohydrate diets lead to greater initial weight loss, but long-term results are no better than more moderate calorie-restricted diets. A program using meal replacements appears to lead to weight loss slightly greater than calorie-restricted diets and offers one option to treat obesity. Dietary patterns low in energy density and glycemic index have potential in treating obesity and should be studied further.

SUMMARY

Clearly, a dietary pattern that prescribes a lower total energy intake is necessary for weight loss, and this pattern should be sustainable to maintain weight loss. Although many dietary programs can achieve short-term loss of weight, dietary treatment should be recommended that emphasizes lifestyle changes and is consistent with other dietary guidelines to promote long-term health. Features consistent with this are a dietary pattern low in total calories, saturated fat, and refined carbohydrate; moderate in whole grains; and high in low-energy dense vegetables and fruits. Future studies should explore dietary strategies and combination therapies that contribute to weight loss, long-term weight maintenance, and improved health.

Incorporating Dairy Foods into Low and High Fat Diets Increases the Postprandial Cholecystokinin Response in Men and Women

The postprandial period is a dynamic state of hormone and lipoprotein metabolism that can be influenced by dietary composition. The objective of this study was to determine whether the source of dietary fat [dairy (D) vs. nondairy (ND)] would modify the lipemic, insulin and cholecystokinin (CCK) response to high or low fat meals. Men and women (n = 24) consumed 4 test meals with a similar polyunsaturated:saturated (P:S; 0.12:1) fat ratio. The diets were high (38% energy) or low (20% energy) in fat, with or without fat from dairy sources. CCK responses were greater after consumption of meals containing D than ND, and for high compared with low fat meals. Women had higher CCK responses than men and were more sensitive to the differences in dietary treatments. Consumption of low fat meals resulted in greater insulin responses than high fat meals. However, after consumption of the low fat meals, the insulin response of D was about half of the ND response; no differences in insulin response were detected after the high fat meals. Triacylglyceride response was influenced primarily by the fat content of the diet. Consumption of dairy products containing fat was associated with an enhanced CCK response, which may have implications for the regulation of food intake. Blunting glucose and insulin response in low fat meals containing fat from dairy products may be useful for glycemic control.