Dietary sources of fats and cholesterol in US children aged 2 through 5 years

Meeting 24-Hour Movement and Dietary Guidelines: Prevalence, Correlates and Association with Weight Status among Children and Adolescents: A National Cross-Sectional Study in China

China is confronted with a “double burden” of underweight and overweight/obesity in children and adolescents. This study aimed to investigate the prevalence and correlates of meeting 24 h movement and dietary guidelines among Chinese children and adolescents. Further, the study aimed to examine the association of meeting 24 h movement and dietary guidelines with weight status in Chinese children and adolescents. A total of 34,887 Chinese children and adolescents were involved. Only 2.1% of participants met the 24 h movement guidelines. Compared to those who met all three 24 h movement guidelines, those who only met the sleep duration guideline was significantly associated with a higher risk of underweight (p < 0.05), and those who only met the moderate-to-vigorous physical activity, or screen time guidelines were significantly associated with a higher risk of overweight/obesity (p < 0.05). Compared with those meeting the dietary guidelines, those who did not meet the soft drink intake guideline had a significantly lower risk of underweight (p < 0.05), those who did not meet the fruit intake guideline had a significantly lower risk of overweight/obesity (p < 0.05), and those who did not meet the milk intake guideline showed a significantly higher risk of overweight/obesity (p < 0.001). These findings indicate a significant association between meeting the 24 h movement and dietary guidelines and weight status among Chinese children and adolescents.

Maternal Perceptions of Self-Weight and Child Weight May Influence Milk Choice of Participants in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)

Objective

To examine the association between maternal perceptions of self-weight and child weight status and milk consumption behavior of Hispanic WIC participants.

Methods

Mixed methods design with phone survey (n=529) and one-on-one interviews (n=35). Demographic characteristics, Chi-square, and thematic analyses were conducted.

Results

More than half of overweight mothers misperceived their own weight status as well as those of their children. Mothers who perceived their child to be overweight were more likely to make a healthier food choice for their family, namely, choosing reduced-fat milk instead of whole milk. Qualitative interviews revealed a cultural preference for larger size children, and mothers defined healthy weight for their child as a function of (1) the child's ability to be as active as other children their age, regardless of child's BMI, and (2) the pediatrician's opinion of the child's weight status.

Conclusions

Maternal perception of self-weight and child weight status seems to guide milk choices. Mothers may have some level of recognition of overweight in themselves and their child, thus adopting healthier milk choices. Culturally related perceptions should be considered when designing obesity prevention strategies, and the role of a pediatrician cannot be understated when developing obesity prevention programs for Hispanic families.

Ethnicity and Diet of Children: Development of Culturally Sensitive Measures

Obesity is a growing global concern. Examining dietary habits of individuals can facilitate the development of important prevention approaches, which are needed to decrease the incidence of obesity and other related diseases and improve quality of life indices. Because food preferences and dietary habits vary across cultures, it is essential that prevention programs are based on specific populations. Using both ethnographic and quantitative methods, food-consumption patterns were investigated among 1,125 children in the Commonwealth of the Northern Mariana Islands. Differences were observed related to food frequency, age of children, and grade level. Exploratory factor analyses suggested that the individual foods were best organized into food-consumption groups that reflected cultural characteristics rather than more commonly referenced food organizational systems. In addition to developmental differences in food consumption patterns, results suggest that the ethnicity of parents may play a role in the diet of children.

Adding a Social Marketing Campaign to a School-Based Nutrition Education Program Improves Children's Dietary Intake: A Quasi-Experimental Study

BACKGROUND

Evidence supports the use of social marketing campaigns to improve nutrition knowledge and reinforce the effects of nutrition education programs. However, the additional effects of parent-focused social marketing with nutrition education have received little attention.

OBJECTIVE

Our aim was to assess the impact of the Iowa Nutrition Network's school-based nutrition education program (Building and Strengthening Iowa Community Support for Nutrition and Physical Activity [BASICS]) and the benefits of adding a multichannel social marketing intervention (BASICS Plus) to increase parent-directed communication.

DESIGN AND INTERVENTION

A quasi-experimental design with three study conditions compared a school-based nutrition education program (BASICS) with a school-based and social marketing intervention (BASICS Plus) and a no-treatment comparison group.

PARTICIPANTS/SETTING

The study included 1,037 third-grade students attending 33 elementary schools and their parents.

MAIN OUTCOME MEASURES

Measures included parents' reports of their children's in-home consumption of fruits and vegetables (F/V) and use of low-fat/fat-free milk. Data on F/V were collected using a modified version of the University of California Cooperative Extension Food Behavior Checklist; and data on milk use were collected using two questions from the National Health and Nutrition Examination Survey.

STATISTICAL ANALYSES

Multilevel, mixed-effect regression models that account for correlation within repeated measures and children within school were used to compare the mean change over time in the outcome variable for one study group with the mean change over time for another study group.

RESULTS

Children in BASICS increased mean consumption of fruit by 0.16 cups (P=0.04) compared with children in the comparison group. Children in BASICS Plus increased mean consumption of fruit by 0.17 cups (P=0.03) and mean consumption of vegetables by 0.13 cups (P=0.02). Children in BASICS Plus were 1.3 times (P=0.05) more likely to use low-fat/fat-free milk than children in either the BASICS group or the comparison group.

CONCLUSIONS

Gaining parents' attention and engaging them in healthy eating practices for their children can be a useful way to increase the effectiveness of school-based nutrition education programs. This study demonstrates the benefits of incorporating a parent-focused social marketing campaign in nutrition education interventions.

Evaluating the Impact of Six Supplemental Nutrition Assistance Program Education Interventions on Children’s At-Home Diets

Background. Nutrition education in the Supplemental Nutrition Assistance Program Education (SNAP-Ed) is designed to promote healthy eating behaviors in a low-income target population. Purpose. To evaluate the effectiveness of six SNAP-Ed interventions delivered in child care centers or elementary school settings in increasing participating children’s at-home fruit and vegetable (F/V) consumption by 0.3 cups per day and use of fat-free or low-fat milk instead of whole or reduced-fat milk during the prior week. Method. Clustered randomized or quasi-experimental clustered trials took place in child care centers or elementary schools between 2010 and 2012. Parents of children at intervention and control sites completed baseline and follow-up surveys about their child’s at home F/V consumption and other dietary behaviors. Results. One of the six interventions was successful in meeting the objective of increasing children’s F/V consumption by 0.3 cups per day. For three of the six interventions, there was a small but statistically significant increase in F/V consumption and/or use of low-fat or fat-free milk. Conclusion. Although not all interventions were effective, these findings suggest that it is possible for some SNAP-Ed interventions to improve dietary habits among low-income children among some families. The effective interventions appear to have benefited from implementation experience and sustained efforts at intervention refinement and improvement.

Dietary sources of energy, solid fats, and added sugars among children and adolescents in the United States

OBJECTIVE

The objective of this research was to identify top dietary sources of energy, solid fats, and added sugars among 2- to 18-year-olds in the United States.

METHODS

Data from the National Health and Nutrition Examination Survey, a cross-sectional study, were used to examine food sources (percentage contribution and mean intake with standard errors) of total energy (data from 2005-2006) and energy from solid fats and added sugars (data from 2003-2004). Differences were investigated by age, sex, race/ethnicity, and family income, and the consumption of empty calories-defined as the sum of energy from solid fats and added sugars-was compared with the corresponding discretionary calorie allowance.

RESULTS

The top sources of energy for 2- to 18-year-olds were grain desserts (138 kcal/day), pizza (136 kcal/day), and soda (118 kcal/day). Sugar-sweetened beverages (soda and fruit drinks combined) provided 173 kcal/day. Major contributors varied by age, sex, race/ethnicity, and income. Nearly 40% of total energy consumed (798 of 2,027 kcal/day) by 2- to 18-year-olds were in the form of empty calories (433 kcal from solid fat and 365 kcal from added sugars). Consumption of empty calories far exceeded the corresponding discretionary calorie allowance for all sex-age groups (which range from 8% to 20%). Half of empty calories came from six foods: soda, fruit drinks, dairy desserts, grain desserts, pizza, and whole milk.

CONCLUSIONS

There is an overlap between the major sources of energy and empty calories: soda, grain desserts, pizza, and whole milk. The landscape of choices available to children and adolescents must change to provide fewer unhealthy foods and more healthy foods with less energy. Identifying top sources of energy and empty calories can provide targets for changes in the marketplace and food environment. However, product reformulation alone is not sufficient-the flow of empty calories into the food supply must be reduced.

Dietary cholesterol and coronary artery disease: a systematic review

Coronary heart disease (CHD) remains one of the leading causes of death in the United States and other industrialized nations. A better understanding of modifiable risk factors for CHD is critical in order to effectively prevent this disease. Dietary factors known to influence the risk of CHD include saturated fats, trans-fats, and polyunsaturated fatty acids. Although higher plasma levels of low-density lipoprotein cholesterol are associated with an increased risk of coronary disease and lipid-lowering therapy has been shown to reduce the risk of cardiovascular disease, the relation between dietary cholesterol and the risk of CHD is not clearly understood. This article reviews the current evidence on the association between dietary cholesterol and the risk of CHD.

Dietary recommendations for children and adolescents: a guide for practitioners

Since the American Heart Association last presented nutrition guidelines for children, significant changes have occurred in the prevalence of cardiovascular risk factors and nutrition behaviors in children. Overweight has increased, whereas saturated fat and cholesterol intake have decreased, at least as percentage of total caloric intake. Better understanding of children's cardiovascular risk status and current diet is available from national survey data. New research on the efficacy of diet intervention in children has been published. Also, increasing attention has been paid to the importance of nutrition early in life, including the fetal milieu. This scientific statement summarizes current available information on cardiovascular nutrition in children and makes recommendations for both primordial and primary prevention of cardiovascular disease beginning at a young age.

Dietary sources of nutrients among rural Native American and white children

OBJECTIVE

To identify important food sources of energy, fiber, and major macro- and micronutrients among rural Native American and white children.

DESIGN

In a 1997 cross-sectional study, food frequency questionnaire data were collected during in-person interviews with caregivers of young children.

SUBJECTS/SETTING

Participants included a representative sample of 329 rural Native American and non-Hispanic white children aged 1 through 6 years living in northeastern Oklahoma.

STATISTICAL ANALYSES

The percentage that each of 85 food items contributed to the population intake of 10 dietary constituents was calculated for the total sample and by age and race/ethnicity. Percentages are presented in descending rank order for foods providing at least 2% of the total sample intake. Z scores were used to assess age and racial/ethnic differences in food sources.

RESULTS

Primary energy sources among study children were milk, cheese, white breads, salty snacks, nondiet soft drinks, hot dogs, candy, and sweetened fruit drinks. Diets showed poor food variety. With few exceptions (eg, milk, cheese, 100% orange juice, ready-to-eat cereals, peanuts/peanut butter, and dried beans), top sources of most dietary constituents were low-nutrient-dense high-fat foods and refined carbohydrates. Solid fruits and vegetables contributed minimally to nutrient and fiber intake. There were few differences in food sources by age or race/ethnicity.

CONCLUSIONS

Among rural Native American and white children in northeastern Oklahoma, food sources of nutrients appear less healthful than found in national samples. Sugar-sweetened beverages, high-fat foods, and refined carbohydrates are displacing more nutrient-dense alternatives, increasing children's risk for childhood obesity, type 2 diabetes, and adult chronic disease.

Sources of Energy and Nutrients in the Diets of Infants and Toddlers

OBJECTIVE

To identify major sources of energy and 24 nutrients and dietary constituents in the diets of US infants and toddlers and to describe shifts in major nutrient sources as children age.

DESIGN

Data from 24-hour recalls collected in the 2002 Feeding Infants and Toddlers Study were analyzed to determine the percentage contribution of foods and supplements to total intakes of energy, nutrients, and other dietary constituents. A total of 3,586 unique foods and dietary supplements were reported. Reported foods and supplements were classified into 71 groups based on similarities in nutrient content and use. Nine-hundred seventy-nine food mixtures were disaggregated into their ingredients and ingredients were classified into one of the 71 groups using the same decision rules that guided classification of foods analyzed at the whole food level.

SUBJECTS/SETTING

A national random sample of 3,022 US infants and toddlers 4 to 24 months of age.

STATISTICAL ANALYSES PERFORMED

The population proportion formula was used to determine the percentage contribution of each of the 71 groups to total intakes. This was done by summing the weighted amount of a given nutrient provided by a given group for all individuals in the sample and dividing by the total weighted amount of that nutrient consumed by all individuals from all foods and supplements. Groups that provided at least 1% of the nutrient in question were rank-ordered. Separate tabulations were prepared for three age groups (4-5 months, 6-11 months, and 12-24 months).

RESULTS

Infant formula, breast milk, and milk are major contributors of energy and most nutrients in the diets of infants and toddlers. Among toddlers, juices and fruit-flavored drinks are the second and third most important sources of energy. Fortified foods make substantial contributions to intakes of many essential nutrients, and these contributions increase as children age. For example, among toddlers, fortified grain-based foods make substantial contributions to intakes of vitamin A, iron, and folate, relative to foods that are naturally rich in these nutrients. Supplements also make substantial contributions to intakes of vitamins and selected minerals, particularly among toddlers.

CONCLUSIONS

In assessing dietary intakes of infants and toddlers, dietetics professionals need to carefully consider contributions of fortified foods and supplements. Dietetics professionals should educate caregivers of infants and toddlers about the importance of foods (rather than just nutrients) in promoting health and about the importance of early feeding practices in the development of lifelong eating habits. Caregivers should be encouraged to avoid relying on fortified foods and supplements to meet nutrient needs and educated about the potential risk of excessive intakes. Caregivers of toddlers and infants over 4 to 6 months of age who are consuming solid foods should be encouraged to feed a wide variety of fruits, vegetables, and whole grains, as well as foods naturally rich in iron.

Dietary Recommendations for Children and Adolescents

Since the American Heart Association last presented nutrition guidelines for children, significant changes have occurred in the prevalence of cardiovascular risk factors and nutrition behaviors in children. Overweight has increased, whereas saturated fat and cholesterol intake have decreased, at least as percentage of total caloric intake. Better understanding of children’s cardiovascular risk status and current diet is available from national survey data. New research on the efficacy of diet intervention in children has been published. Also, increasing attention has been paid to the importance of nutrition early in life, including the fetal milieu. This scientific statement summarizes current available information on cardiovascular nutrition in children and makes recommendations for both primordial and primary prevention of cardiovascular disease beginning at a young age.

The effect of participation in the WIC program on preschoolers' diets

OBJECTIVE

To evaluate nutrient, food intake, and snacking behavior by participation in the WIC (Special Supplemental Nutrition Program for Women, Infants, and Children) program.

STUDY DESIGN

Secondary data analysis of a nationally representative cross-sectional survey conducted by USDA in 1994 to 1996 and 1998.

METHODS

Statistical analysis was performed correcting for sample design effects and weighting for children in two income groups (<130%, n=1772 and 130% to 185% of poverty, n=689).

RESULTS

Among WIC participants, the prevalence of snacking was significantly lower (68%) compared with nonparticipants (72%) (chi(2)=5.9, P=.01). For those <130% of poverty, WIC had a beneficial effect on the intake of fat, carbohydrates, added sugar, and fruit from the total diet as well as on added sugar from snacks. These were independent of food stamp participation. For those with higher incomes, the beneficial effects were limited to added sugar, iron density, and fruit intake for the total diet. A similar significant effect of decreased added sugar intake from snacks was also seen.

CONCLUSIONS

Our results are in line with previous research showing beneficial effects of WIC participation among preschoolers, primarily for nutrients targeted by the program. This study shows that the effect can reach beyond those targeted nutrients.

The Interaction Model of Client Health Behavior as a Conceptual Guide in the Explanation of Children's Health Behaviors

This study used the Interaction Model of Client Health Behavior (IMCHB) as a conceptual guide to explain the correlates of children's diet and physical activity and explore the relationships of sex with their diet and physical activity of the school-aged child. A descriptive correlational study was conducted on 371 fifth-grade students and their parents. Information on the family's demographics, health experience, social influence, and environmental resources was collected, as well as data on the children's intrinsic motivation, cognitive appraisal, and affective response to food/physical activity. Children's self-reports on diet and physical activity were collected, as were parents' self-reports on health habits. Food preferences and diet self-efficacy explained the most variance in diet behavior for girls and boys. Girls scored healthier on food preferences and diet self-efficacy than did boys, but no difference was detected in their diet behavior. Girls participated in more low-intensity physical activity, but boys participated in more high-intensity physical activity than did girls. Findings provide strong support for the use of the IMCHB to explain children's diet but weak support for the explanation of children's physical activity. Further study of additional factors predictive of physical activity is indicated.

Effect of combinations of fish meal and feather meal on milk fatty acid content and nitrogen utilization in dairy cows

The effect of supplemental fishmeal in combination with feathermeal at two different proportions in the diet on milk docosahexaenoic acid (DHA) content was investigated. Recently, benefits to human health have been attributed to the consumption of this fatty acid, which is normally present in marine lipids. Six Holstein cows past peak lactation were used in a Latin square design with a 2 x 3 factorial arrangement of treatments. Fish- and feathermeals were prepared as pellets at 4:1 and 1:4 combinations and offered at 3.75, 11.75, and 27% of the diet. The supplements were top-dressed onto a basal diet based on corn silage that was progressively replaced by supplement. Nitrogen balance measures were made during the experiment because of the wide range in crude protein content of experimental diets. Milk protein content increased with level of supplementation in the diet reflecting the protein quality of the supplements used. There was overall higher milk DHA content when cows consumed the supplement containing more fishmeal than feather meal. Milk DHA content increased in a quadratic fashion, as more of either supplement was included in the diet. Apparent transfer efficiency of DHA from diet to milk declined with increasing amount of DHA in the diet. Results from this experiment suggest that transfer of docosahexaenoic acid from diet to milk may depend on diet composition and quantity present in the diet.

Food sources of nutrients in the diet of Spanish children: the Four Provinces Study

The aim of the present study was to assess the principal food sources of energy and nutrients among Spanish children. We used a cross-sectional study design, based on results obtained from a food-frequency questionnaire. The sample included 1112 children, aged 6-7 years, from Cadiz, Madrid, Orense and Murcia, Spain. Children were selected through random cluster-sampling in schools. We analysed the percentage contributed by each food item to total energy and nutrient intake. The most important food sources were: white bread in the case of carbohydrate (13.4 %); olive oil in the case of total lipids (18.3 %) and monounsaturated fatty acids (29.2 %); whole milk in the case of protein (10.2 %) and saturated fatty acids (14.9 %); chips (French fried potatoes) in the case of polyunsaturated fatty acids (30.4 %). The greatest proportion of Na, consumed in excess, came from salt added to meals. Ham ranked second as a source of saturated fats. Fruits and green leafy vegetables proved to have great relevance as sources of fibre and vitamins, though with regard to the latter, it was observed that fortified foods (breakfast cereals, dairy products, fruit juices, etc.) had come to play a relevant role in many cases. In conclusion, the nutritional profile of Spanish school-aged children aged 6-7 years could be improved by nutritional policies targeted at limiting their consumption of ham (cured or cooked) and of salt added to meals, replacing whole milk with semi-skimmed milk, encouraging the consumption of products rich in complex carbohydrates already present in children's diets (bread, pasta, rice) and promoting less fatty ways of cooking food.

Predictors of dietary milk fat intake by preschool children

BACKGROUND

High-fat whole milk is the major dietary source of total and saturated fat for young children. Children from low-income families have higher total and saturated fat intakes and their parents have higher rates of cardiovascular disease compared with children from higher income families. We identified factors that predict the use of either high-fat whole milk or low-fat (1% and/or skim) milk by children to facilitate the development of targeted intervention strategies to reduce their dietary fat intakes.

METHODS

Adults (91% mothers) with children > or =1 through <5 years of age, participating in the Supplemental Nutrition Program for Women, Infants, and Children (WIC) at 50 agencies throughout New York State, completed questionnaires.

RESULTS

Most (75%) of the 1,938 children drank whole milk, while only 6.9% consumed exclusively 1% and/or skim milk. The children tended to drink the same type of milk as other family members. In multivariate logistic regression, use of whole milk was associated with younger child age, black race or Hispanic ethnicity, parent/guardian belief that whole milk was healthier for children over 2, and parent/guardian having never tried reduced-fat milks (all P < 0.0001). In contrast, use of 1% and/or skim milk was associated with older child age, female gender, nonblack race, older parent/guardian age, parent/guardian belief that reduced-fat milks were healthier for children over 2, and parent/guardian having tried 1%-fat milk (all P < 0.01).

CONCLUSIONS

Individualized family-based strategies are needed to target specific behaviors and/or health beliefs held by different parent groups. For example, taste testing might be an effective strategy for parents who have never tasted reduced-fat milk. Interventions to overcome cultural barriers to the use of low-fat milk may require changing parental health beliefs, in addition to providing education about the health benefits of low-fat milk.

Development and validation of an instrument to assess child dietary fat intake

BACKGROUND

brief dietary assessment instrument to assess dietary intakes of total fat, saturated fatty acids (SFA), and cholesterol in young children was developed and validated.

METHODS

Young children and their parent or primary caretaker were recruited from a general primary care health center and local Head Start programs. Dietary records, entered and analyzed using the Minnesota Nutrition Data System, were used to calculate children's mean dietary intakes. Stepwise linear regression analysis was used to select questionnaire items that best predicted total fat, SFA, and dietary cholesterol intakes.

RESULTS

This yielded a 17-item Child Dietary Fat Questionnaire (CDFQ); 9 questions correlated with total fat intake (r = 0.68, P < 0.0001); 15 questions correlated with SFA intake (r = 0.75, P < 0.0001); and 4 questions correlated with dietary cholesterol intake (r = 0.57, P < 0.0001). The test-retest reliabilities of the CDFQ in predicting children's dietary intakes of total fat, SFA, and cholesterol were 0.41, 0.66, and 0.64, respectively. The criterion-based validity of the CDFQ, evaluated against 4 days of dietary records, yielded correlations of 0.54 (P < 0.0001) for total fat, 0.36 (P < 0.01) for SFA, and 0.55 (P < 0. 0001) for dietary cholesterol intake.

CONCLUSIONS

The 17-item CDFQ is a brief, easy-to-use dietary assessment instrument that could be used to identify children with high, as well as low, dietary intakes of total fat, SFA, and/or cholesterol.

Community measures of low-fat milk consumption: comparing store shelves with households

OBJECTIVES

This study examined the relationship between the proportion of milk in food stores that is low-fat and consumption of low-fat milk in the community.

METHODS

Data were gathered from 503 stores across 53 New York State zip codes. In 19 zip codes, a telephone survey measured household low-fat milk use. Census data were obtained to examine sociodemographic predictors of the percentage of low-fat milk in stores.

RESULTS

The proportion of low-fat milk in stores was directly related to low-fat milk consumption in households and to the median income and urban level of the zip code.

CONCLUSIONS

These results support using food store shelf-space observations to estimate low-fat milk consumption.

Dietary sources of nutrients among US children, 1989-1991

OBJECTIVE

To identify major food sources of nutrients and dietary constituents for US children.

METHODS

Twenty-four-hour dietary recalls were collected from a nationally representative sample of children age 2 to 18 years (n = 4008) from the US Department of Agriculture's 1989-1991 Continuing Survey of Food Intakes by Individuals. For each of 16 dietary constituents, the contribution of each of 113 food groups was obtained by summing the amount provided by the food group for all individuals and dividing by total intake from all food groups for all individuals.

RESULTS

Milk, yeast bread, cakes/cookies/quick breads/donuts, beef, and cheese are among the top 10 sources of energy, fat, and protein. Many of the top 10 sources of carbohydrate (yeast bread, soft drinks/sodas, milk, ready-to-eat cereal, cakes/cookies/quick breads/donuts, sugars/syrups/jams, fruit drinks, pasta, white potatoes); protein (poultry, ready-to-eat cereal, pasta); and fat (potato chips/corn chips/popcorn) also contributed >2% each to energy intakes. Ready-to-eat cereal is among the top contributors to folate, vitamin A, vitamin C, iron, and zinc intakes. Fruit drinks, containing little juice, contribute approximately 14% of total vitamin C intakes.

CONCLUSIONS

Fortified foods are influential contributors to many vitamins and minerals. Low nutrient-dense foods are major contributors to energy, fats, and carbohydrate. This compromises intakes of more nutritious foods and may impede compliance with current dietary guidance.

Dietary sources of nutrients among US adults, 1989 to 1991

OBJECTIVE

To identify major food sources of 27 nutrients and dietary constituents for US adults.

DESIGN

Single 24-hour dietary recalls were used to assess intakes. From 3,970 individual foods reported, 112 groups were created on the basis of similarities in nutrient content or use. Food mixtures were disaggregated using the US Department of Agriculture (USDA) food grouping system.

SUBJECTS/SETTING

A nationally representative sample of adults aged 19 years or older (n = 10,638) from USDA's 1989-91 Continuing Survey of Food Intakes by Individuals. ANALYSES PERFORMED: For each of 27 dietary components, the contribution of each food group to intake was obtained by summing the amount provided by the food group for all respondents and dividing by total intake from all food groups for all respondents.

RESULTS

This article updates previous work and is, to the authors' knowledge the first to provide such data for carotenes, vitamin B-12, magnesium, and copper. Beef, yeast bread, poultry, cheese, and milk were among the top 10 sources of energy, fat, and protein. The following other major sources also contributed more than 2% to energy intakes: carbohydrate: yeast bread, soft drinks/soda, cakes/cookies/ quick breads/doughnuts, sugars/syrups/jams, potatoes (white), ready-to-eat cereal, and pasta; protein: pasta; and fat: margarine, salad dressings/mayonnaise, and cakes/ cookies/quick breads/doughnuts. Ready-to-eat cereals, primarily because of fortification, were among the top 10 food sources for 18 of 27 nutrients.

APPLICATIONS/CONCLUSIONS

These analyses are the most current regarding food sources of nutrients and, because of disaggregation of mixtures, provide a truer picture of contributions of each food group.

Promoting the selection of low-fat milk in elementary school cafeterias in an inner-city Latino community: evaluation of an intervention

OBJECTIVES

This study examined the effects of a school-based intervention designed to promote the consumption of low-fat white milk at lunchtime in 6 elementary schools in an inner-city, primarily Latino neighborhood.

METHODS

A multifaceted intervention based on social marketing techniques was delivered at 3 randomly selected schools. The school was the unit of assignment and analysis; 6902 children were involved in the study. Milk selection and consumption were measured by sampling discarded milk and/or tallying milk carton disappearance at baseline, immediately postintervention, and at 3 to 4 months follow-up.

RESULTS

Immediately postintervention, the mean proportion of sampled milk cartons that contained low-fat milk increased in the intervention schools, from 25% to 57%, but remained constant at 28% in the control schools. Differences between intervention and control schools remained significant at 3 to 4 months follow-up. The intervention was not associated with a decrease in overall milk consumption.

CONCLUSIONS

A school-based intervention can lead to significant increases in student consumption of low-fat milk.

1% or less: a community-based nutrition campaign

OBJECTIVE

The authors evaluated the effectiveness of a community education campaign to encourage a switch from high-fat (whole and 2%) milk to low-fat (1%, 1/2%, and skim) milk as a way to reduce consumption of saturated fat.

METHODS

Milk sales data were collected from supermarkets in the intervention and comparison communities for three one-month time periods: at baseline, immediately following the campaign, and six months after the campaign. In addition, trained volunteers conducted pre- and post-intervention telephone surveys.

RESULTS

Overall milk sales increased by 16% in the intervention cities following the campaign and remained high at follow-up. Low-fat milk's market share increased from 18% of overall milk sales at baseline to 41% of overall milk sales in the month following the end of the campaign, an increase in market share that was sustained at the six-month follow-up. In the post-intervention telephone survey, 38.2% of those respondents who reported drinking high-fat milk at baseline reported having switched to low-fat milk.

CONCLUSION

A focused message communicated through paid advertising, public relations activities, and community-based education programs increased low-fat and overall milk consumption in one community.

Risk factors for cardiovascular disease in children with type I diabetes: Part II

Diabetes is a major risk factor for premature morbidity and mortality caused by cardiovascular disease (CVD). In Part I of this two part series, physiologic risk factors for cardiovascular disease in children with diabetes were presented. In Part II lifestyle CVD risk factors in children with diabetes will be discussed. Dietary factors, smoking behavior, and activity level are the risk factors most amenable to intervention. Two case studies are included to show clinical application of the data presented.

Impact of adopting lower-fat food choices on nutrient intake of American children

OBJECTIVE

To compare the overall nutrient intake of American children (ages 2 to 19) who exclusively use skim milk instead of 1%, 2%, or whole milk; lean meats instead of higher-fat meats; or fat-modified products instead of full-fat products.

STUDY DESIGN

A unique sorting procedure was used to categorize respondents to the 1989-1991 Continuing Survey of Food Intake by Individuals according to reported use or nonuse of certain fat-reduction strategies. Differences in intake of 23 macronutrients and micronutrients, as well as energy, by exclusive users, mixed users, and nonusers of each strategy were statistically analyzed using analysis of variance with Scheffe's test. The number of fat-reduction strategies used by the children as well as demographic characteristics also were analyzed.

RESULTS

Only a small number of children qualified as exclusive users of skim milk (3%), lean meats (2%), and fat-modified products (1%). Energy intakes for all children were below 100% of the recommended dietary allowance. However, children (n = 85) who used skim milk exclusively in place of higher-fat milks closely approximated the current dietary recommendations (30% energy from fat, less than 10% from saturated fat, and less than 300 mg cholesterol) while maintaining adequate micronutrient intake and without significantly impacting energy. Children (n = 52) who used lean meats in place of higher-fat meats achieved the guideline for total fat; however, energy intake was 70% of the recommended dietary allowance and vitamin E was 63%. Children (n = 20) who use only fat-modified versions of cheese, salad dressing, cake, pudding, and yogurt made no significant impact on their energy, fat, or micronutrient intake. Of the 3299 children in the data set, only 3 qualified as users of two fat-reduction strategies and none qualified as users of all three strategies. Exclusive users of skim milk, lean meat, or fat-modified products were more likely to be female, white, and live in families with higher incomes. Those using skim milk or lean meat exclusively also were more likely to be older, whereas those exclusively using fat-modified products were younger. Furthermore, those using skim milk or fat-modified products exclusively were more likely to live in households where the head had more years of education, whereas those exclusively using lean meats were from households headed by those with slightly less years of education.

CONCLUSIONS

Despite the inherent limitations of population-based food surveys (including issues of underreporting, lack of biological markers and accurate anthropometric measures, and limited nutrient databases), these results provide insight into the rate of use of certain lower-fat food choices by children and suggest exclusive use can facilitate achievement of contemporary dietary recommendations. The impact of using these fat-reduction strategies on children's overall nutrient intake differs depending on the strategy used. Use of skim milk is an economical single-food strategy that facilitates achievement of contemporary dietary guidelines while maintaining nutrient adequacy. Professional guidance is recommended for children who exclusively use lean meats to assure adequate intake of energy and vitamin E. The impact of fat-modified products needs to be monitored closely as the number of such products increases in the marketplace. Results of this study can be used by health professionals working with children and their parents to highlight the overall efficacy of dietary recommendations while alerting them to potential pitfalls.

The availability of low-fat milk in an inner-city Latino community: implications for nutrition education

Substitution of low-fat for whole milk is an important strategy for reducing saturated fat consumption, but intake of whole milk remains high among Latinos. To assess whether this is related to the unavailability of low-fat milk, we surveyed 251 grocery stores (bodegas) and 25 supermarkets in a predominantly low-income, urban Latino community. Low-fat milk was available in 73% of bodegas and 96% of supermarkets, but it constituted only 15% of total milk volume in bodegas and 37% of that volume in supermarkets. Since lack of availability was not a major obstacle to increasing low-fat milk consumption, public health nutrition campaigns should focus on increasing consumer demand.