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Casavale KO, Anderson-Villaluz D, Ahuja JK, Chakrabarti S, Gibbs K, Hopperton K, Parnel S, Pehrsson PR, Stanton M, Vargas AJ. Perspective: The Human Milk Composition Initiative - Filling Crucial Gaps in Data on and Related to Human Milk in the United States and Canada. Adv Nutr 2023; 14:1253-1254. [PMID: 37499981 PMCID: PMC10721460 DOI: 10.1016/j.advnut.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 07/20/2023] [Indexed: 07/29/2023] Open
Affiliation(s)
- Kellie O Casavale
- Center for Food Safety and Applied Nutrition, Food and Drug Administration, United States Department of Health and Human Services, College Park, MD, United States
| | - Dennis Anderson-Villaluz
- Office of Disease Prevention and Health Promotion, Office of the Assistant Secretary for Health, United States Department of Health and Human Services, Rockville, MD, United States
| | - Jaspreet K Ahuja
- Methods and Application of Food Composition Laboratory, Beltsville Human Nutrition Research Center, Agricultural Research Services, United States Department of Agriculture, Beltsville, MD, United States
| | - Subhadeep Chakrabarti
- Nutrition Premarket Assessment Division, Bureau of Nutritional Sciences, Food Directorate, Health Products and Food Branch, Health Canada, Ottawa, Ontario, Canada
| | - Kimberlea Gibbs
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, United States
| | - Kathryn Hopperton
- Nutrition Premarket Assessment Division, Bureau of Nutritional Sciences, Food Directorate, Health Products and Food Branch, Health Canada, Ottawa, Ontario, Canada
| | - Sophie Parnel
- Nutrition Premarket Assessment Division, Bureau of Nutritional Sciences, Food Directorate, Health Products and Food Branch, Health Canada, Ottawa, Ontario, Canada
| | - Pamela R Pehrsson
- Methods and Application of Food Composition Laboratory, Beltsville Human Nutrition Research Center, Agricultural Research Services, United States Department of Agriculture, Beltsville, MD, United States
| | - Melanie Stanton
- Nutrition Premarket Assessment Division, Bureau of Nutritional Sciences, Food Directorate, Health Products and Food Branch, Health Canada, Ottawa, Ontario, Canada
| | - Ashley J Vargas
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, United States.
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Bailey RL, Stang JS, Davis TA, Naimi TS, Schneeman BO, Dewey KG, Donovan SM, Novotny R, Kleinman RE, Taveras EM, Bazzano L, Snetselaar LG, de Jesus J, Casavale KO, Stoody EE, Goldman JD, Moshfegh AJ, Rhodes DG, Herrick KA, Koegel K, Perrine CG, Pannucci T. Dietary and Complementary Feeding Practices of US Infants, 6 to 12 Months: A Narrative Review of the Federal Nutrition Monitoring Data. J Acad Nutr Diet 2022; 122:2337-2345.e1. [PMID: 34688966 PMCID: PMC10851078 DOI: 10.1016/j.jand.2021.10.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 10/05/2021] [Accepted: 10/13/2021] [Indexed: 10/20/2022]
Abstract
Complementary foods and beverages (CFBs) are key components of an infant's diet in the second 6 months of life. This article summarizes nutrition and feeding practices examined by the 2020 Dietary Guidelines Advisory Committees during the CFB life stage. Breastfeeding initiation is high (84%), but exclusive breastfeeding at 6 months (26%) is below the Healthy People 2030 goal (42%). Most infants (51%) are introduced to CFBs sometime before 6 months. The primary mode of feeding (ie, human milk fed [HMF]; infant formula or mixed formula and human milk fed [FMF]) at the initiation of CFBs is associated with the timing of introduction and types of CFBs reported. FMF infants (42%) are more likely to be introduced to CFBs before 4 months compared with HMF infants (19%). Different dietary patterns, such as higher prevalence of consumption and mean amounts, were observed, including fruit, grains, dairy, proteins, and solid fats. Compared with HMF infants of the same age, FMF infants consume more total energy (845 vs 631 kcal) and protein (22 vs 12 g) from all sources, and more energy (345 vs 204 kcal) and protein (11 vs 6 g) from CFBs alone. HMF infants have a higher prevalence of risk of inadequate intakes of iron (77% vs 7%), zinc (54% vs <3%), and protein (27% vs <3%). FMF infants are more likely to have an early introduction (<12 months) to fruit juice (45% vs 20%) and cow's milk (36% vs 24%). Registered dietitian nutritionists and nutritional professionals should consider tailoring their advice to caregivers on dietary and complementary feeding practices, taking into account the primary mode of milk feeding during this life stage to support infants' nutrient adequacy. National studies that address the limitations of this analysis, including small sample sizes and imputed breast milk volume, could refine findings from this analysis.
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Affiliation(s)
- Regan L Bailey
- Department of Nutrition Science, Purdue University, West Lafayette, IN.
| | - Jaime S Stang
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota - Twin Cities, MN
| | - Teresa A Davis
- United States Department of Agriculture/Agricultural Research Service Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Timothy S Naimi
- Section of General Internal Medicine, Boston University Medical Center, Boston, MA
| | | | - Kathryn G Dewey
- Department of Nutrition, University of California, Davis, CA
| | - Sharon M Donovan
- Department of Food Science and Human Nutrition, Endowed Chair in Nutrition and Health, University of Illinois, Urbana-Champaign, IL
| | - Rachel Novotny
- Department Human Nutrition Food and Animal Science, University of Hawai'i at Mānoa, Honolulu, HI
| | - Ronald E Kleinman
- Harvard Medical School, Boston, MA; Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts
| | - Elsie M Taveras
- Department of Pediatrics, Harvard Medical School, Boston, MA; Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital, Boston, MA
| | - Lydia Bazzano
- Tulane Center for Lifespan Epidemiology Research, New Orleans, LA
| | - Linda G Snetselaar
- Department of Epidemiology, Endowed Chair in Preventive Nutrition Education, University of Iowa, Iowa City, IA
| | - Janet de Jesus
- Office of Disease Prevention and Health Promotion, US Department of Health and Human Services, Rockville, MD
| | - Kellie O Casavale
- Office of Nutrition and Food Labeling, Center for Food Safety and Applied Nutrition, Food and Drug Administration, US Department of Health and Human Services, College Park, MD
| | - Eve E Stoody
- Center for Nutrition Policy and Promotion, Food and Nutrition Service, US Department of Agriculture, Alexandria, VA
| | - Joseph D Goldman
- Food Surveys Research Group, Agricultural Research Service, US Department of Agriculture, Beltsville, MD
| | - Alanna J Moshfegh
- Food Surveys Research Group, Agricultural Research Service, US Department of Agriculture, Beltsville, MD
| | - Donna G Rhodes
- Food Surveys Research Group, Agricultural Research Service, US Department of Agriculture, Beltsville, MD
| | - Kirsten A Herrick
- Risk Factor Assessment Branch, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD
| | - Kristin Koegel
- Center for Nutrition Policy and Promotion, Food and Nutrition Service, US Department of Agriculture, Alexandria, VA
| | - Cria G Perrine
- Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention, Atlanta, GA
| | - TusaRebecca Pannucci
- Food Surveys Research Group, Agricultural Research Service, US Department of Agriculture, Beltsville, MD
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Hamner HC, Nelson JM, Sharma AJ, Jefferds MED, Dooyema C, Flores-Ayala R, Bremer AA, Vargas AJ, Casavale KO, de Jesus JM, Stoody EE, Scanlon KS, Perrine CG. Improving Nutrition in the First 1000 Days in the United States: A Federal Perspective. Am J Public Health 2022; 112:S817-S825. [PMID: 36122314 PMCID: PMC9612192 DOI: 10.2105/ajph.2022.307028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2022] [Indexed: 11/04/2022]
Abstract
The first 1000 days begins with pregnancy and ends at the child's second birthday. Nutrition throughout the life course, and especially during the first 1000 days, supports maternal health and optimal growth and development for children. We give a high-level summary of the state of nutrition in the first 1000 days in the United States. We provide examples where continued efforts are needed. We then discuss select opportunities to strengthen federal research and surveillance, programs, and communication and dissemination efforts aimed at improving nutrition and positively, and equitably, influencing the health and well-being of mothers and children. (Am J Public Health. 2022;112(S8):S817-S825. https://doi.org/10.2105/AJPH.2022.307028).
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Affiliation(s)
- Heather C Hamner
- Heather C. Hamner, Jennifer M. Nelson, Andrea J. Sharma, Maria Elena D. Jefferds, Carrie Dooyema, Rafael Flores-Ayala, and Cria G. Perrine are with the Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA. Andrew A. Bremer and Ashley J. Vargas are with the Pediatric Growth and Nutrition Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD. Kellie O. Casavale is with the Office of Nutrition and Food Labeling, Center for Food Safety and Applied Nutrition, Food and Drug Administration, College Park, MD. Janet M. de Jesus is with the Office of Disease Prevention and Health Promotion, US Department of Health and Human Services, Rockville, MD. Eve E. Stoody is with the Center for Nutrition Policy and Promotion, Food and Nutrition Service, US Department of Agriculture, Alexandria, VA. Kelley S. Scanlon is with the Office of Policy Support, Food and Nutrition Service, US Department of Agriculture, Alexandria, VA
| | - Jennifer M Nelson
- Heather C. Hamner, Jennifer M. Nelson, Andrea J. Sharma, Maria Elena D. Jefferds, Carrie Dooyema, Rafael Flores-Ayala, and Cria G. Perrine are with the Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA. Andrew A. Bremer and Ashley J. Vargas are with the Pediatric Growth and Nutrition Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD. Kellie O. Casavale is with the Office of Nutrition and Food Labeling, Center for Food Safety and Applied Nutrition, Food and Drug Administration, College Park, MD. Janet M. de Jesus is with the Office of Disease Prevention and Health Promotion, US Department of Health and Human Services, Rockville, MD. Eve E. Stoody is with the Center for Nutrition Policy and Promotion, Food and Nutrition Service, US Department of Agriculture, Alexandria, VA. Kelley S. Scanlon is with the Office of Policy Support, Food and Nutrition Service, US Department of Agriculture, Alexandria, VA
| | - Andrea J Sharma
- Heather C. Hamner, Jennifer M. Nelson, Andrea J. Sharma, Maria Elena D. Jefferds, Carrie Dooyema, Rafael Flores-Ayala, and Cria G. Perrine are with the Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA. Andrew A. Bremer and Ashley J. Vargas are with the Pediatric Growth and Nutrition Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD. Kellie O. Casavale is with the Office of Nutrition and Food Labeling, Center for Food Safety and Applied Nutrition, Food and Drug Administration, College Park, MD. Janet M. de Jesus is with the Office of Disease Prevention and Health Promotion, US Department of Health and Human Services, Rockville, MD. Eve E. Stoody is with the Center for Nutrition Policy and Promotion, Food and Nutrition Service, US Department of Agriculture, Alexandria, VA. Kelley S. Scanlon is with the Office of Policy Support, Food and Nutrition Service, US Department of Agriculture, Alexandria, VA
| | - Maria Elena D Jefferds
- Heather C. Hamner, Jennifer M. Nelson, Andrea J. Sharma, Maria Elena D. Jefferds, Carrie Dooyema, Rafael Flores-Ayala, and Cria G. Perrine are with the Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA. Andrew A. Bremer and Ashley J. Vargas are with the Pediatric Growth and Nutrition Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD. Kellie O. Casavale is with the Office of Nutrition and Food Labeling, Center for Food Safety and Applied Nutrition, Food and Drug Administration, College Park, MD. Janet M. de Jesus is with the Office of Disease Prevention and Health Promotion, US Department of Health and Human Services, Rockville, MD. Eve E. Stoody is with the Center for Nutrition Policy and Promotion, Food and Nutrition Service, US Department of Agriculture, Alexandria, VA. Kelley S. Scanlon is with the Office of Policy Support, Food and Nutrition Service, US Department of Agriculture, Alexandria, VA
| | - Carrie Dooyema
- Heather C. Hamner, Jennifer M. Nelson, Andrea J. Sharma, Maria Elena D. Jefferds, Carrie Dooyema, Rafael Flores-Ayala, and Cria G. Perrine are with the Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA. Andrew A. Bremer and Ashley J. Vargas are with the Pediatric Growth and Nutrition Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD. Kellie O. Casavale is with the Office of Nutrition and Food Labeling, Center for Food Safety and Applied Nutrition, Food and Drug Administration, College Park, MD. Janet M. de Jesus is with the Office of Disease Prevention and Health Promotion, US Department of Health and Human Services, Rockville, MD. Eve E. Stoody is with the Center for Nutrition Policy and Promotion, Food and Nutrition Service, US Department of Agriculture, Alexandria, VA. Kelley S. Scanlon is with the Office of Policy Support, Food and Nutrition Service, US Department of Agriculture, Alexandria, VA
| | - Rafael Flores-Ayala
- Heather C. Hamner, Jennifer M. Nelson, Andrea J. Sharma, Maria Elena D. Jefferds, Carrie Dooyema, Rafael Flores-Ayala, and Cria G. Perrine are with the Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA. Andrew A. Bremer and Ashley J. Vargas are with the Pediatric Growth and Nutrition Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD. Kellie O. Casavale is with the Office of Nutrition and Food Labeling, Center for Food Safety and Applied Nutrition, Food and Drug Administration, College Park, MD. Janet M. de Jesus is with the Office of Disease Prevention and Health Promotion, US Department of Health and Human Services, Rockville, MD. Eve E. Stoody is with the Center for Nutrition Policy and Promotion, Food and Nutrition Service, US Department of Agriculture, Alexandria, VA. Kelley S. Scanlon is with the Office of Policy Support, Food and Nutrition Service, US Department of Agriculture, Alexandria, VA
| | - Andrew A Bremer
- Heather C. Hamner, Jennifer M. Nelson, Andrea J. Sharma, Maria Elena D. Jefferds, Carrie Dooyema, Rafael Flores-Ayala, and Cria G. Perrine are with the Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA. Andrew A. Bremer and Ashley J. Vargas are with the Pediatric Growth and Nutrition Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD. Kellie O. Casavale is with the Office of Nutrition and Food Labeling, Center for Food Safety and Applied Nutrition, Food and Drug Administration, College Park, MD. Janet M. de Jesus is with the Office of Disease Prevention and Health Promotion, US Department of Health and Human Services, Rockville, MD. Eve E. Stoody is with the Center for Nutrition Policy and Promotion, Food and Nutrition Service, US Department of Agriculture, Alexandria, VA. Kelley S. Scanlon is with the Office of Policy Support, Food and Nutrition Service, US Department of Agriculture, Alexandria, VA
| | - Ashley J Vargas
- Heather C. Hamner, Jennifer M. Nelson, Andrea J. Sharma, Maria Elena D. Jefferds, Carrie Dooyema, Rafael Flores-Ayala, and Cria G. Perrine are with the Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA. Andrew A. Bremer and Ashley J. Vargas are with the Pediatric Growth and Nutrition Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD. Kellie O. Casavale is with the Office of Nutrition and Food Labeling, Center for Food Safety and Applied Nutrition, Food and Drug Administration, College Park, MD. Janet M. de Jesus is with the Office of Disease Prevention and Health Promotion, US Department of Health and Human Services, Rockville, MD. Eve E. Stoody is with the Center for Nutrition Policy and Promotion, Food and Nutrition Service, US Department of Agriculture, Alexandria, VA. Kelley S. Scanlon is with the Office of Policy Support, Food and Nutrition Service, US Department of Agriculture, Alexandria, VA
| | - Kellie O Casavale
- Heather C. Hamner, Jennifer M. Nelson, Andrea J. Sharma, Maria Elena D. Jefferds, Carrie Dooyema, Rafael Flores-Ayala, and Cria G. Perrine are with the Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA. Andrew A. Bremer and Ashley J. Vargas are with the Pediatric Growth and Nutrition Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD. Kellie O. Casavale is with the Office of Nutrition and Food Labeling, Center for Food Safety and Applied Nutrition, Food and Drug Administration, College Park, MD. Janet M. de Jesus is with the Office of Disease Prevention and Health Promotion, US Department of Health and Human Services, Rockville, MD. Eve E. Stoody is with the Center for Nutrition Policy and Promotion, Food and Nutrition Service, US Department of Agriculture, Alexandria, VA. Kelley S. Scanlon is with the Office of Policy Support, Food and Nutrition Service, US Department of Agriculture, Alexandria, VA
| | - Janet M de Jesus
- Heather C. Hamner, Jennifer M. Nelson, Andrea J. Sharma, Maria Elena D. Jefferds, Carrie Dooyema, Rafael Flores-Ayala, and Cria G. Perrine are with the Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA. Andrew A. Bremer and Ashley J. Vargas are with the Pediatric Growth and Nutrition Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD. Kellie O. Casavale is with the Office of Nutrition and Food Labeling, Center for Food Safety and Applied Nutrition, Food and Drug Administration, College Park, MD. Janet M. de Jesus is with the Office of Disease Prevention and Health Promotion, US Department of Health and Human Services, Rockville, MD. Eve E. Stoody is with the Center for Nutrition Policy and Promotion, Food and Nutrition Service, US Department of Agriculture, Alexandria, VA. Kelley S. Scanlon is with the Office of Policy Support, Food and Nutrition Service, US Department of Agriculture, Alexandria, VA
| | - Eve E Stoody
- Heather C. Hamner, Jennifer M. Nelson, Andrea J. Sharma, Maria Elena D. Jefferds, Carrie Dooyema, Rafael Flores-Ayala, and Cria G. Perrine are with the Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA. Andrew A. Bremer and Ashley J. Vargas are with the Pediatric Growth and Nutrition Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD. Kellie O. Casavale is with the Office of Nutrition and Food Labeling, Center for Food Safety and Applied Nutrition, Food and Drug Administration, College Park, MD. Janet M. de Jesus is with the Office of Disease Prevention and Health Promotion, US Department of Health and Human Services, Rockville, MD. Eve E. Stoody is with the Center for Nutrition Policy and Promotion, Food and Nutrition Service, US Department of Agriculture, Alexandria, VA. Kelley S. Scanlon is with the Office of Policy Support, Food and Nutrition Service, US Department of Agriculture, Alexandria, VA
| | - Kelley S Scanlon
- Heather C. Hamner, Jennifer M. Nelson, Andrea J. Sharma, Maria Elena D. Jefferds, Carrie Dooyema, Rafael Flores-Ayala, and Cria G. Perrine are with the Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA. Andrew A. Bremer and Ashley J. Vargas are with the Pediatric Growth and Nutrition Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD. Kellie O. Casavale is with the Office of Nutrition and Food Labeling, Center for Food Safety and Applied Nutrition, Food and Drug Administration, College Park, MD. Janet M. de Jesus is with the Office of Disease Prevention and Health Promotion, US Department of Health and Human Services, Rockville, MD. Eve E. Stoody is with the Center for Nutrition Policy and Promotion, Food and Nutrition Service, US Department of Agriculture, Alexandria, VA. Kelley S. Scanlon is with the Office of Policy Support, Food and Nutrition Service, US Department of Agriculture, Alexandria, VA
| | - Cria G Perrine
- Heather C. Hamner, Jennifer M. Nelson, Andrea J. Sharma, Maria Elena D. Jefferds, Carrie Dooyema, Rafael Flores-Ayala, and Cria G. Perrine are with the Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA. Andrew A. Bremer and Ashley J. Vargas are with the Pediatric Growth and Nutrition Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD. Kellie O. Casavale is with the Office of Nutrition and Food Labeling, Center for Food Safety and Applied Nutrition, Food and Drug Administration, College Park, MD. Janet M. de Jesus is with the Office of Disease Prevention and Health Promotion, US Department of Health and Human Services, Rockville, MD. Eve E. Stoody is with the Center for Nutrition Policy and Promotion, Food and Nutrition Service, US Department of Agriculture, Alexandria, VA. Kelley S. Scanlon is with the Office of Policy Support, Food and Nutrition Service, US Department of Agriculture, Alexandria, VA
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Ahuja JKC, Casavale KO, Li Y, Hopperton KE, Chakrabarti S, Hines EP, Brooks SPJ, Bondy GS, MacFarlane AJ, Weiler HA, Wu X, Borghese MM, Ahluwalia N, Cheung W, Vargas AJ, Arteaga S, Lombo T, Fisher MM, Hayward D, Pehrsson PR. Perspective: Human Milk Composition and Related Data for National Health and Nutrition Monitoring and Related Research. Adv Nutr 2022; 13:2098-2114. [PMID: 36084013 PMCID: PMC9776678 DOI: 10.1093/advances/nmac099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 04/18/2022] [Accepted: 09/07/2022] [Indexed: 01/28/2023] Open
Abstract
National health and nutrition monitoring is an important federal effort in the United States and Canada, and the basis for many of their nutrition and health policies. Understanding of child exposures through human milk (HM) remains out of reach due to lack of current and representative data on HM's composition and intake volume. This article provides an overview of the current national health and nutrition monitoring activities for HM-fed children, HM composition (HMC) and volume data used for exposure assessment, categories of potential measures in HM, and associated variability factors. In this Perspective, we advocate for a framework for collection and reporting of HMC data for national health and nutrition monitoring and programmatic needs, including a shared vision for a publicly available Human Milk Composition Data Repository (HMCD-R) to include essential metadata associated with HMC. HMCD-R can provide a central, integrated platform for researchers and public health officials for compiling, evaluating, and sharing HMC data. The compiled compositional and metadata in HMCD-R would provide pertinent measures of central tendency and variability and allow use of modeling techniques to approximate compositional profiles for subgroups, providing more accurate exposure assessments for purposes of monitoring and surveillance. HMC and related metadata could facilitate understanding the complexity and variability of HM composition, provide crucial data for assessment of infant and maternal nutritional needs, and inform public health policies, food and nutrition programs, and clinical practice guidelines.
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Affiliation(s)
- Jaspreet K C Ahuja
- Methods and Application of Food Composition Laboratory, Beltsville Human Nutrition Research Center, Agricultural Research Services, US Department of Agriculture, Beltsville, Maryland, USA.
| | - Kellie O Casavale
- Center for Food Safety and Applied Nutrition, Food and Drug Administration, US Department of Health and Human Services, College Park, Maryland, USA
| | - Ying Li
- Methods and Application of Food Composition Laboratory, Beltsville Human Nutrition Research Center, Agricultural Research Services, US Department of Agriculture, Beltsville, Maryland, USA
| | - Kathryn E Hopperton
- Nutrition Premarket Assessment Division, Bureau of Nutritional Sciences, Food Directorate, Health Products and Food Branch, Health Canada, Ottawa, Ontario, Canada
| | - Subhadeep Chakrabarti
- Nutrition Premarket Assessment Division, Bureau of Nutritional Sciences, Food Directorate, Health Products and Food Branch, Health Canada, Ottawa, Ontario, Canada
| | - Erin P Hines
- Reproductive and Developmental Toxicology Branch, Public Health and Integrated Toxicology Division, US Environmental Protection Agency, Chapel Hill, North Carolina, USA
| | - Stephen P J Brooks
- Nutrition Research Division, Bureau of Nutritional Sciences, Food Directorate, Health Products and Food Branch, Health Canada, Ottawa, Ontario, Canada
| | - Genevieve S Bondy
- Bureau of Chemical Safety, Food Directorate, Health Products and Food Branch, Health Canada, Ottawa, Ontario, Canada
| | - Amanda J MacFarlane
- Nutrition Research Division, Bureau of Nutritional Sciences, Food Directorate, Health Products and Food Branch, Health Canada, Ottawa, Ontario, Canada
| | - Hope A Weiler
- Nutrition Research Division, Bureau of Nutritional Sciences, Food Directorate, Health Products and Food Branch, Health Canada, Ottawa, Ontario, Canada
| | - Xianli Wu
- Methods and Application of Food Composition Laboratory, Beltsville Human Nutrition Research Center, Agricultural Research Services, US Department of Agriculture, Beltsville, Maryland, USA
| | - Michael M Borghese
- Environmental Health Sciences and Research Bureau, Health Canada, Ottawa, Ontario, Canada
| | - Namanjeet Ahluwalia
- National Center for Health Statistics, Centers for Disease Control and Prevention, Department of Health and Human Services, Hyattsville, Maryland, USA
| | - Winnie Cheung
- Nutrition Premarket Assessment Division, Bureau of Nutritional Sciences, Food Directorate, Health Products and Food Branch, Health Canada, Ottawa, Ontario, Canada
| | - Ashley J Vargas
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA
| | - Sonia Arteaga
- Environmental influences on Child Health Outcomes (ECHO) Program, Office of the Director, National Institutes of Health, Bethesda, Maryland, USA
| | - Tania Lombo
- Maternal Adolescent Pediatric Research Branch, Prevention Science Program, Division of AIDS, National Institute of Allergy and Infectious Diseases (NIAID), Bethesda, Maryland, USA
| | - Mandy M Fisher
- Environmental Health Sciences and Research Bureau, Health Canada, Ottawa, Ontario, Canada
| | - Deborah Hayward
- Nutrition Premarket Assessment Division, Bureau of Nutritional Sciences, Food Directorate, Health Products and Food Branch, Health Canada, Ottawa, Ontario, Canada
| | - Pamela R Pehrsson
- Methods and Application of Food Composition Laboratory, Beltsville Human Nutrition Research Center, Agricultural Research Services, US Department of Agriculture, Beltsville, Maryland, USA
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5
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Bailey RL, Leidy HJ, Mattes RD, Heymsfield SB, Boushey CJ, Ahluwalia N, Cowan AE, Pannucci T, Moshfegh AJ, Goldman JD, Rhodes DG, Stoody EE, de Jesus J, Casavale KO. Frequency of Eating in the US Population: A Narrative Review of the 2020 Dietary Guidelines Advisory Committee Report. Curr Dev Nutr 2022; 6:nzac132. [PMID: 36110105 PMCID: PMC9469881 DOI: 10.1093/cdn/nzac132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 07/22/2022] [Accepted: 08/17/2022] [Indexed: 11/13/2022] Open
Abstract
Background A person's daily nutrient intake and overall nutritional status are determined by a complex interplay of the types and amounts of foods ingested in combination with the timing and frequency of eating. Objectives The aim was to summarize frequency of eating occasion data examined by the 2020 Dietary Guidelines Advisory Committee, the macronutrient contributions they provide, and meal frequency relative to dietary quality among the US population (≥2 y), with a focus on sex, age, race/Hispanic origin, and income. Methods Demographic and 24-h recall data from the 2013-2016 NHANES were examined. An eating occasion was defined as "any ingestive event (e.g., solid food, beverage, water) that is either energy yielding or non-energy yielding"; all eating occasions were further divided into discrete meals and snacks. Frequency of meals and snacks was defined as "the number of daily EOs [eating occasions]," respectively. Diet quality was assessed via the Healthy Eating Index (HEI)-2015. Results Most Americans consume 2 (28%) to 3 (64%) meals on a given day and >90% consume 2 to 3 snacks on that day. Adult, Hispanic, and non-Hispanic Black and lower-income (<131% family poverty-to-income ratio) Americans had a lower frequency of eating than children or adolescents, non-Hispanic White, and non-Hispanic Asian Americans and higher-income Americans, respectively. Americans who reported 3 meals on a given day consumed a diet higher in dietary quality than Americans who consumed 2 meals on a given day (HEI-2015: 61.0 vs. 55.0), regardless of population subgroup. Conclusions The frequency of the types of eating occasions differs according to age, race and Hispanic origin, and income. Dietary quality is associated with the number of meals consumed. Healthy dietary patterns can be constructed in a variety of ways to suit different life stages, cultural practices, and income levels; improved diet quality and careful consideration of nutrient density when planning meals are warranted.
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Affiliation(s)
- Regan L Bailey
- Institute for Advancing Health through Agriculture, Texas A&M University, College Station, TX, USA
| | - Heather J Leidy
- Departments of Nutritional Sciences and Pediatrics, Dell Medical School, University of Texas at Austin, Austin, TX, USA
| | - Richard D Mattes
- Institute for Advancing Health through Agriculture, Texas A&M University, College Station, TX, USA
| | - Steven B Heymsfield
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, USA
| | - Carol J Boushey
- Epidemiology Program, University of Hawaii Cancer Center, Honolulu, HI, USA
| | - Namanjeet Ahluwalia
- Division of Health and Nutrition Examination Surveys, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, MD, USA
| | - Alexandra E Cowan
- Institute for Advancing Health through Agriculture, Texas A&M University, College Station, TX, USA
| | - TusaRebecca Pannucci
- Center for Nutrition Policy and Promotion, Food and Nutrition Services, US Department of Agriculture, Alexandria, VA, USA
| | - Alanna J Moshfegh
- Agricultural Research Service, US Department of Agriculture, Beltsville, MD, USA
| | - Joseph D Goldman
- Agricultural Research Service, US Department of Agriculture, Beltsville, MD, USA
| | - Donna G Rhodes
- Agricultural Research Service, US Department of Agriculture, Beltsville, MD, USA
| | - Eve E Stoody
- Center for Nutrition Policy and Promotion, Food and Nutrition Services, US Department of Agriculture, Alexandria, VA, USA
| | - Janet de Jesus
- Office of Disease Prevention and Health Promotion, US Department of Health and Human Services, Rockville, MD, USA
| | - Kellie O Casavale
- Office of Nutrition and Food Labeling, Center for Food Safety and Applies Nutrition, Food and Drug Administration, US Department of Health and Human Services, College Park, MD, USA
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6
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Dewey KG, Pannucci T, Casavale KO, Davis TA, Donovan SM, Kleinman RE, Taveras EM, Bailey RL, Novotny R, Schneeman BO, Stang J, de Jesus J, Stoody EE. Development of Food Pattern Recommendations for Infants and Toddlers 6-24 Months of Age to Support the Dietary Guidelines for Americans, 2020-2025. J Nutr 2021; 151:3113-3124. [PMID: 34195834 PMCID: PMC10918427 DOI: 10.1093/jn/nxab201] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 05/19/2021] [Accepted: 05/28/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Developing food-based dietary guidelines (FBDGs) for infants and toddlers is a complex task that few countries have attempted. OBJECTIVES Our objectives are to describe the process of food pattern modeling (FPM) conducted to develop FBDGs for the Dietary Guidelines for Americans, 2020-2025 for infants 6 to <12 mo and toddlers 12 to <24 mo of age, as well as the implications of the results and areas needing further work. METHODS The US 2020 Dietary Guidelines Advisory Committee, with the support of federal staff, conducted FPM analyses using 5 steps: 1) identified energy intake targets; 2) established nutritional goals; 3) identified food groupings and expected amounts, using 3 options for the amount of energy from human milk in each age interval; 4) estimated expected nutrient intakes for each scenario, based on nutrient-dense representative foods; and 5) evaluated expected nutrient intakes against nutritional goals. RESULTS For human milk-fed infants (and toddlers), example combinations of complementary foods and beverages were developed that come close to meeting almost all nutrient recommendations if iron-fortified infant cereals are included at 6 to <12 mo of age. These combinations would also be suitable for formula-fed infants. For toddlers not fed human milk, 2 patterns were developed: the Healthy US-Style Pattern and the Healthy Vegetarian Pattern (a lacto-ovo vegetarian pattern). Achieving nutrient recommendations left virtually no remaining energy for added sugars. CONCLUSIONS It is challenging to meet all nutrient needs during these age intervals. Added sugars should be avoided for infants and toddlers <2 y of age. Further work is needed to 1) establish a reference human milk composition profile, 2) update and strengthen the DRI values for these age groups, and 3) use optimization modeling, in combination with FPM, to identify combinations of foods that meet all nutritional goals.
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Affiliation(s)
- Kathryn G Dewey
- Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - TusaRebecca Pannucci
- Office of Nutrition Guidance and Analysis, Center for Nutrition Policy and Promotion, Food and Nutrition Service, USDA, Alexandria, VA, USA
| | - Kellie O Casavale
- Office of Nutrition and Food Labeling, Center for Food Safety and Applied Nutrition, US FDA, College Park, MD, USA
| | - Teresa A Davis
- USDA/Agricultural Research Service Children’s Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Sharon M Donovan
- Department of Food Science and Human Nutrition, University of Illinois, Urbana-Champaign, IL, USA
| | - Ronald E Kleinman
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Elsie M Taveras
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Regan L Bailey
- Department of Nutrition Science, Purdue University,West Lafayette, IN, USA
| | - Rachel Novotny
- Department of Human Nutrition, Food and Animal Sciences, College of Tropical Agriculture and Human Resources, University of Hawaii at Manoa, Honolulu, HI, USA
| | | | - Jamie Stang
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota,Minneapolis, MN, USA
| | - Janet de Jesus
- Office of Disease Prevention and Health Promotion, US Department of Health and Human Services, Rockville,MD, USA
| | - Eve E Stoody
- Office of Nutrition Guidance and Analysis, Center for Nutrition Policy and Promotion, Food and Nutrition Service, USDA, Alexandria, VA, USA
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7
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Bailey RL, Ard JD, Davis TA, Naimi TS, Schneeman BO, Stang JS, Dewey KG, Donovan SM, Novotny R, Snetselaar LG, de Jesus J, Casavale KO, Pannucci T, Stoody EE. A Proposed Framework for Identifying Nutrients and Food Components of Public Health Relevance in the Dietary Guidelines for Americans. J Nutr 2021; 151:1197-1204. [PMID: 33693925 PMCID: PMC8324230 DOI: 10.1093/jn/nxaa459] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/11/2020] [Accepted: 12/31/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Identification of nutrients of public health concern has been a hallmark of the Dietary Guidelines for Americans (DGA); however, a formal systematic process for identifying them has not been published. OBJECTIVES We aimed to propose a framework for identifying "nutrients or food components" (NFCs) of public health relevance to inform the DGA. METHODS The proposed framework consists of 1) defining terminology; 2) establishing quantitative thresholds to identify NFCs; and 3) examining national data. The proposed framework utilizes available data from 3 key data sources or "prongs": 1) dietary intakes; 2) biological endpoints; and 3) clinical health consequences such as prevalence of health conditions, directly or indirectly through validated surrogate markers. RESULTS In identifying potential NFCs of public health concern, the 2020 DGA Committee developed a decision-tree framework with suggestions for combining the 3 prongs. The identified NFCs of public health concern for Americans ≥1 y old included fiber, calcium (≥2 y old), vitamin D, and potassium for low intakes and sodium, added sugars, and saturated fats (≥2 y old) for high intakes that were associated with adverse health consequences. Iron was identified among infants ages 6-12 mo fed human milk. For reproductive-aged and pregnant females, iron (all trimesters) and folate (first trimester) were identified for low intake, based on dietary and biomarker data (iron) or the severity of the consequence (folic acid and neural tube defects). Among pregnant women, low iodine was of potential public health concern based on biomarker data. Other NFCs that were underconsumed, overconsumed, and pose special challenges were identified across the life course. CONCLUSIONS The proposed decision-tree framework was intended to streamline and add transparency to the work of this and future Dietary Guidelines Advisory Committees to identify NFCs that need to be encouraged or discouraged in order to help reduce risk of chronic disease and promote health and energy balance in the population.
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Affiliation(s)
- Regan L Bailey
- Department of Nutrition Science, Purdue University, West Lafayette, IN, USA
| | - Jamy D Ard
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston Salem, NC, USA
| | - Teresa A Davis
- USDA/Agricultural Research Service Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Tim S Naimi
- Section of General Internal Medicine, Boston University Medical Center, Boston, MA, USA
| | - Barbara O Schneeman
- (Emeritus) Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - Jaime S Stang
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota—Twin Cities, Minneapolis, MN, USA
| | - Kathryn G Dewey
- (Emeritus) Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - Sharon M Donovan
- Department of Food Science and Human Nutrition, University of Illinois, Urbana-Champaign, IL, USA
| | - Rachel Novotny
- Department of Human Nutrition, Food and Animal Sciences, University of Hawaiʻi at Mānoa, Honolulu, HI, USA
| | - Linda G Snetselaar
- Department of Preventive Nutrition Education, University of Iowa, Iowa City, IA, USA
| | - Janet de Jesus
- Office of Disease Prevention and Health Promotion, NIH, US Department of Health and Human Services, Rockville, MD, USA
| | - Kellie O Casavale
- Office of Nutrition and Food Labeling, Center for Food Safety and Applied Nutrition, FDA, US Department of Health and Human Services, College Park, MD, USA
| | - TusaRebecca Pannucci
- Center for Nutrition Policy and Promotion, Food and Nutrition Services, USDA, Alexandria, VA, USA
| | - Eve E Stoody
- Center for Nutrition Policy and Promotion, Food and Nutrition Services, USDA, Alexandria, VA, USA
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8
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Casavale KO, Ahuja JKC, Wu X, Li Y, Quam J, Olson R, Pehrsson P, Allen L, Balentine D, Hanspal M, Hayward D, Hines EP, McClung JP, Perrine CG, Belfort MB, Dallas D, German B, Kim J, McGuire M, McGuire M, Morrow AL, Neville M, Nommsen-Rivers L, Rasmussen KM, Zempleni J, Lynch CJ. NIH workshop on human milk composition: summary and visions. Am J Clin Nutr 2019; 110:769-779. [PMID: 31274142 PMCID: PMC6895543 DOI: 10.1093/ajcn/nqz123] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 05/27/2019] [Indexed: 12/19/2022] Open
Abstract
Nationally representative data from mother-child dyads that capture human milk composition (HMC) and associated health outcomes are important for advancing the evidence to inform federal nutrition and related health programs, policies, and consumer information across the governments in the United States and Canada as well as in nongovernment sectors. In response to identified gaps in knowledge, the National Institute of Diabetes and Digestive and Kidney Diseases of the NIH sponsored the "Workshop on Human Milk Composition-Biological, Environmental, Nutritional, and Methodological Considerations" held 16-17 November 2017 in Bethesda, Maryland. Through presentations and discussions, the workshop aimed to 1) share knowledge on the scientific need for data on HMC; 2) explore the current understanding of factors affecting HMC; 3) identify methodological challenges in human milk (HM) collection, storage, and analysis; and 4) develop a vision for a research program to develop an HMC data repository and database. The 4 workshop sessions included 1) perspectives from both federal agencies and nonfederal academic experts, articulating scientific needs for data on HMC that could lead to new research findings and programmatic advances to support public health; 2) information about the factors that influence lactation and/or HMC; 3) considerations for data quality, including addressing sampling strategies and the complexities in standardizing collection, storage, and analyses of HM; and 4) insights on how existing research programs and databases can inform potential visions for HMC initiatives. The general consensus from the workshop is that the limited scope of HM research initiatives has led to a lack of robust estimates of the composition and volume of HM consumed and, consequently, missed opportunities to improve maternal and infant health.
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Affiliation(s)
- Kellie O Casavale
- Office of Disease Prevention and Health Promotion, US Department of Health and Human Services, Rockville, MD, USA,Address correspondence to KOC (e-mail: ). Present address for KOC: US Food and Drug Administration, Center for Food Safety and Applied Nutrition, College Park, MD, USA
| | - Jaspreet K C Ahuja
- Nutrient Data Laboratory, Beltsville Human Nutrition Research Center, Agricultural Research Service, US Department of Agriculture, Beltsville, MD, USA
| | - Xianli Wu
- Nutrient Data Laboratory, Beltsville Human Nutrition Research Center, Agricultural Research Service, US Department of Agriculture, Beltsville, MD, USA
| | - Ying Li
- Nutrient Data Laboratory, Beltsville Human Nutrition Research Center, Agricultural Research Service, US Department of Agriculture, Beltsville, MD, USA
| | - Julia Quam
- Office of Disease Prevention and Health Promotion, US Department of Health and Human Services, Rockville, MD, USA
| | - Richard Olson
- Office of Disease Prevention and Health Promotion, US Department of Health and Human Services, Rockville, MD, USA
| | - Pamela Pehrsson
- Nutrient Data Laboratory, Beltsville Human Nutrition Research Center, Agricultural Research Service, US Department of Agriculture, Beltsville, MD, USA
| | - Lindsay Allen
- Western Human Nutrition Research Center, Agricultural Research Service, US Department of Agriculture, Davis, CA, USA
| | - Douglas Balentine
- Center for Food Safety and Applied Nutrition, US Food and Drug Administration, US Department of Health and Human Services, College Park, MD, USA
| | - Manjit Hanspal
- Environmental influences on Child Health Outcomes (ECHO) program, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD, USA
| | - Deborah Hayward
- Bureau of Nutritional Sciences, Health Products and Food Branch, Health Canada, Ottawa, Ontario, Canada
| | - Erin Pias Hines
- National Center for Environmental Assessment, US Environmental Protection Agency, Research Triangle Park, NC, USA
| | - James P McClung
- US Army Research Institute of Environmental Medicine, Natick, MA, USA
| | - Cria G Perrine
- Centers for Disease Control and Prevention; US Department of Health and Human Services, Atlanta, GA, USA
| | | | - David Dallas
- School of Biological and Population Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA
| | - Bruce German
- Department of Food Science and Technology, University of California, Davis, Davis, CA, USA
| | - Jae Kim
- Divisions of Neonatology and Pediatric Gastroenterology, University of California, San Diego, San Diego, CA, USA
| | - Mark McGuire
- College of Agricultural and Life Sciences, University of Idaho, Moscow, ID, USA
| | - Michelle McGuire
- School of Biological Sciences, Washington State University, Pullman, WA, USA,Present address for Michelle McGuire: University of Idaho, Moscow, ID, USA
| | - Ardythe L Morrow
- Center for Interdisciplinary Research in Human Milk and Lactation, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Margaret Neville
- Department of Physiology and Biophysics, University of Colorado, Denver, Denver, CO, USA
| | | | | | - Janos Zempleni
- Nebraska Center for the Prevention of Obesity Diseases, University of Nebraska–Lincoln, Lincoln, NE, USA
| | - Christopher J Lynch
- Office of Nutrition Research, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD, USA
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9
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Spill MK, Callahan EH, Shapiro MJ, Spahn JM, Wong YP, Benjamin-Neelon SE, Birch L, Black MM, Cook JT, Faith MS, Mennella JA, Casavale KO. Caregiver feeding practices and child weight outcomes: a systematic review. Am J Clin Nutr 2019; 109:990S-1002S. [PMID: 30982865 DOI: 10.1093/ajcn/nqy276] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND As part of the USDA-Department of Health and Human Services Pregnancy and Birth to 24 Months Project, we conducted systematic reviews (SRs) on topics important for health and nutrition of young children. OBJECTIVES The purpose of the present SR was to examine the relation between caregiver feeding practices in children from birth to 24 mo and child weight gain, size, and body composition. METHODS A search of articles published from January 1980 to January 2017 in 4 databases identified 8739 references. Nutrition Evidence Systematic Review (NESR) analysts used the Nutrition Evidence Library Risk of Bias Assessment Tool to assess potential bias in the studies, and a Technical Expert Collaborative graded the body of evidence using the NESR grading rubric. RESULTS Twenty-seven articles were included in this review (8 controlled trials, 19 longitudinal cohort studies). Moderate evidence from randomized controlled trials suggests that providing responsive feeding guidance to teach mothers to recognize and respond appropriately to children's hunger and satiety cues can lead to "normal" weight gain and/or "normal" weight status in children aged ≤2 y compared with children whose mothers did not receive responsive feeding guidance. Moderate evidence from longitudinal cohort studies indicates an association between maternal feeding practices and the child's weight status and/or weight gain, but the direction of effect has not been adequately studied. Restrictive feeding practices are associated with increased weight gain and higher weight status, and pressuring feeding practices are associated with decreased weight gain and lower weight status. Evidence suggests that a mother's feeding practices are related to concerns about her child's body weight. CONCLUSIONS This review highlights the importance of the interaction between caregivers and infants and toddlers related to child feeding practices on children's weight outcomes. Research is needed on more diverse populations with consistent methodological app-roaches and objective measures.
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Affiliation(s)
| | | | | | | | | | | | | | - Maureen M Black
- University of Maryland School of Medicine, Baltimore, MD.,RTI International, Baltimore, MD
| | | | | | | | - Kellie O Casavale
- US Department of Health and Human Services, Office of Disease Prevention and Health Promotion, Rockville, MD
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10
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Raghavan R, Dreibelbis C, Kingshipp BL, Wong YP, Abrams B, Gernand AD, Rasmussen KM, Siega-Riz AM, Stang J, Casavale KO, Spahn JM, Stoody EE. Dietary patterns before and during pregnancy and maternal outcomes: a systematic review. Am J Clin Nutr 2019; 109:705S-728S. [PMID: 30982868 DOI: 10.1093/ajcn/nqy216] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 07/11/2018] [Accepted: 08/06/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Hypertensive disorders of pregnancy (HDP) and gestational diabetes mellitus (GDM) are common maternal complications during pregnancy, with short- and long-term sequelae for both mothers and children. OBJECTIVE Two systematic review questions were used to examine the relation between 1) dietary patterns before and during pregnancy, 2) HDP, and 3) GDM. METHODS A search was conducted from January 1980 to January 2017 in 9 databases including PubMed, Embase, and Cochrane. Two analysts independently screened articles using a priori inclusion and exclusion criteria; data were extracted from included articles, and risk of bias was assessed. After qualitative synthesis, a conclusion statement was drafted for each question and the evidence supporting the conclusion was graded. RESULTS Of the 9103 studies identified, 8 [representing 4 cohorts and 1 randomized controlled trial (RCT)] were included for HDP and 11 (representing 6 cohorts and 1 RCT) for GDM. Limited evidence in healthy Caucasian women with access to health care suggests dietary patterns before and during pregnancy that are higher in vegetables, fruits, whole grains, nuts, legumes, fish, and vegetable oils and lower in meat and refined grains are associated with reduced risk of HDP, including preeclampsia and gestational hypertension. Limited but consistent evidence suggests certain dietary patterns before pregnancy are associated with reduced risk of GDM. These protective dietary patterns are higher in vegetables, fruits, whole grains, nuts, legumes, and fish and lower in red and processed meats. Most of the research was conducted in healthy, Caucasian women with access to health care. Insufficient evidence exists on the associations between dietary patterns before and during pregnancy and risk of HDP in minority women and those of lower socioeconomic status, and dietary patterns during pregnancy and risk of GDM. CONCLUSIONS Although some conclusions were drawn from these systematic reviews, more research is needed to address gaps and limitations in the evidence.
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Affiliation(s)
| | | | | | | | - Barbara Abrams
- Division of Epidemiology, University of California Berkeley School of Public Health, Berkeley, CA
| | - Alison D Gernand
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA
| | | | - Anna Maria Siega-Riz
- Department of Family, Community and Mental Health Systems, University of Virginia School of Nursing, Charlottesville, VA
| | - Jamie Stang
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN
| | - Kellie O Casavale
- Office of Disease Prevention and Health Promotion, US Department of Health and Human Services, Rockville, MD
| | | | - Eve E Stoody
- Food and Nutrition Service, USDA, Alexandria, VA
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11
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Stoody EE, Spahn JM, Casavale KO. The Pregnancy and Birth to 24 Months Project: a series of systematic reviews on diet and health. Am J Clin Nutr 2019; 109:685S-697S. [PMID: 30982878 DOI: 10.1093/ajcn/nqy372] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Nutrition exposures during the earliest stages of life are integral to growth and development and may continue to affect health through adulthood. The purpose of the Pregnancy and Birth to 24 Months (P/B-24) Project was to conduct a series of systematic reviews on diet and health for women who are pregnant and for infants and toddlers from birth to 24 mo of age. The P/B-24 Project was a joint initiative led by the USDA and the US Department of Health and Human Services. The USDA's Nutrition Evidence Systematic Review team, previously known as the Nutrition Evidence Library, carried out the series of systematic reviews in collaboration with programmatic and scientific experts. Systematic review questions were prioritized based on federal policy, program, or guidance needs, potential to support the development of healthy dietary intake, and public health importance. Systematic reviews were conducted on specific topics related to dietary intake before and during pregnancy, infant milk feeding practices, complementary feeding, flavor exposures, and infant/toddler feeding practices. Across the reviews, relationships were observed between P/B-24 diet exposures and a variety of outcomes of public health importance. Evidence showed links between dietary intake before and during pregnancy, during the period of human milk or infant formula feeding, and through introduction of complementary foods and beverages and health outcomes. Additionally, the reviews on flavor exposure and infant/toddler feeding practices highlight the importance of maternal diet during pregnancy and lactation and caregiver feeding strategies and practices. Systematic reviews are an important tool to inform our understanding of the body of evidence related to diet and health, and scientists can use the P/B-24 Project reviews to continue to advance research in these areas.
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Affiliation(s)
- Eve E Stoody
- USDA, Food and Nutrition Service, Alexandria, VA
| | | | - Kellie O Casavale
- United States Department of Health and Human Services, Office of Disease Prevention and Health Promotion, Rockville, MD
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12
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Spill MK, Johns K, Callahan EH, Shapiro MJ, Wong YP, Benjamin-Neelon SE, Birch L, Black MM, Cook JT, Faith MS, Mennella JA, Casavale KO. Repeated exposure to food and food acceptability in infants and toddlers: a systematic review. Am J Clin Nutr 2019; 109:978S-989S. [PMID: 30982874 DOI: 10.1093/ajcn/nqy308] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Repeated exposure has been found to be an effective strategy to increase acceptability of foods in older children and adults, but little is known about its effectiveness in the birth to 24-mo population. OBJECTIVES This systematic review was conducted to examine the effects of repeated exposure to a single or multiple foods on acceptance of those or other foods among infants and toddlers. METHODS A search was conducted for peer-reviewed articles related to food acceptability, flavor, taste, and infants and toddlers in 12 databases (e.g., PubMed, Embase, Cochrane, and CINAHL) with a date range of January 1980 to July 2017. The Nutrition Evidence Library (NEL) Bias Assessment Tool was used to assess potential bias in the included studies, and the NESR grading rubric was used to grade evidence supporting the conclusion statement. RESULTS From the 10,844 references obtained, 21 studies (19 controlled trials and 2 longitudinal cohort studies) published from 1980 to 2015 were included in this review. Moderate evidence indicates that tasting a single vegetable or fruit or multiple vegetable(s) or fruit(s) 1 food per day for 8-10 or more days is likely to increase acceptability of an exposed food (indicated by an increase in intake or faster rate of feeding after comparison with before the exposure period) in infants and toddlers 4-24 mo old. The effect of repeated exposure on acceptability is likely to generalize to other foods within the same food category but not foods from a different food category. Findings are based on the effects of repeated exposure to mostly vegetables with some findings on repeated exposure to fruits. CONCLUSION This review advances the understanding of early food experiences and the development of food acceptability. Additional research is needed using diverse foods and textures with a focus on the transition to table foods.
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Affiliation(s)
| | | | | | | | | | | | - Leann Birch
- Department of Foods and Nutrition, University of Georgia, Athens, GA
| | - Maureen M Black
- Department of Pediatrics, University of Maryland School of Medicine and RTI International, Baltimore, MD
| | - John T Cook
- Department of Pediatrics, Boston University School of Medicine, Boston, MA
| | - Myles S Faith
- Department of Counseling, School and Educational Psychology, Graduate School of Education, University at Buffalo, Buffalo, NY
| | | | - Kellie O Casavale
- United States Department of Health and Human Services, Office of Disease Prevention and Health Promotion, Rockville, MD
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13
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Raghavan R, Dreibelbis C, Kingshipp BL, Wong YP, Abrams B, Gernand AD, Rasmussen KM, Siega-Riz AM, Stang J, Casavale KO, Spahn JM, Stoody EE. Dietary patterns before and during pregnancy and birth outcomes: a systematic review. Am J Clin Nutr 2019; 109:729S-756S. [PMID: 30982873 DOI: 10.1093/ajcn/nqy353] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Maternal diet before and during pregnancy could influence fetal growth and birth outcomes. OBJECTIVE Two systematic reviews aimed to assess the relationships between dietary patterns before and during pregnancy and 1) gestational age at birth and 2) gestational age- and sex-specific birth weight. METHODS Literature was searched from January, 1980 to January, 2017 in 9 databases including PubMed, Embase, and Cochrane. Two analysts independently screened articles using predetermined inclusion and exclusion criteria. Data were extracted from included articles and risk of bias was assessed. Data were synthesized qualitatively, a conclusion statement was drafted for each question, and evidence supporting each conclusion was graded. RESULTS Of the 9103 studies identified, 11 [representing 7 cohorts and 1 randomized controlled trial (RCT)] were included for gestational age and 21 (representing 19 cohorts and 2 RCTs) were included for birth weight. Limited but consistent evidence suggests that certain dietary patterns during pregnancy are associated with a lower risk of preterm birth and spontaneous preterm birth. These protective dietary patterns are higher in vegetables; fruits; whole grains; nuts, legumes, and seeds; and seafood (preterm birth, only), and lower in red and processed meats, and fried foods. Most of the research was conducted in healthy Caucasian women with access to health care. No conclusion can be drawn on the association between dietary patterns during pregnancy and birth weight outcomes. Although research is available, the ability to draw a conclusion is restricted by inconsistency in study findings, inadequate adjustment of birth weight for gestational age and sex, and variation in study design, dietary assessment methodology, and adjustment for key confounding factors. Insufficient evidence exists regarding dietary patterns before pregnancy for both outcomes. CONCLUSIONS Maternal dietary patterns may be associated with a lower preterm and spontaneous preterm birth risk. The association is unclear for birth weight outcomes.
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Affiliation(s)
| | | | | | | | - Barbara Abrams
- Division of Epidemiology, University of California Berkeley School of Public Health, Berkeley, CA
| | - Alison D Gernand
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA
| | | | - Anna Maria Siega-Riz
- Department of Family, Community and Mental Health Systems, University of Virginia School of Nursing, Charlottesville, VA
| | - Jamie Stang
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN
| | - Kellie O Casavale
- Office of Disease Prevention and Health Promotion, US Department of Health and Human Services, Rockville, MD
| | | | - Eve E Stoody
- Food and Nutrition Service, USDA, Alexandria, VA
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14
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Abstract
: media-1vid110.1542/5984243449001PEDS-VA_2018-2274Video Abstract BACKGROUND: In 2009, the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) revised its food packages to align with updated nutrition science. Understanding how these revisions may impact current consumption patterns could be important. METHODS Dietary data from the 2011-2014 NHANES were used to estimate the percentage of children who were aged 12 to 23 months consuming selected food and beverage categories on any given day by age and WIC status (children who were on WIC, those who were eligible for but not receiving WIC benefits, and those who were not eligible for WIC). RESULTS Consumption of food and beverage categories differed by WIC status. On a given day, a lower percentage of children who were eligible for but did not receive WIC benefits consumed vegetables (excluding white potatoes; 42.3%) and grains (76.5%) compared with children who were participating in WIC (vegetables [excluding white potatoes]: 60.4%; grains: 85.5%) and those who were not eligible for WIC benefits (vegetables [excluding white potatoes]: 58.1%; grains: 87.2%; P < .05). A lower percentage of both children who were eligible for but not receiving WIC benefits and those who were participating in WIC consumed fruits (57.6% and 70.6%, respectively) and snacks (45.9% and 48.5%, respectively) than those who were not eligible for WIC (fruits: 86.4%; snacks: 69.1%; P < .05). A lower percentage of children who were receiving WIC consumed dairy than children who were not eligible for WIC (91.7% and 97.2%, respectively; P < .05). A higher percentage of those who were receiving WIC consumed 100% juice (70.6%) than children who were eligible for but not receiving WIC (51.6%) and children who were not eligible for WIC (50.8%; P < .05). CONCLUSIONS Improving early WIC participation and retention could positively impact some diet-related disparities among young children who are eligible for WIC.
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Affiliation(s)
- Heather C Hamner
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia;
| | - Courtney Paolicelli
- Food and Nutrition Service, United States Department of Agriculture, Alexandria, Virginia; and
| | - Kellie O Casavale
- Office of Disease Prevention and Health Promotion, United States Department of Health and Human Services, Rockville, Maryland
| | - Melanie Haake
- Food and Nutrition Service, United States Department of Agriculture, Alexandria, Virginia; and
| | - Anne Bartholomew
- Food and Nutrition Service, United States Department of Agriculture, Alexandria, Virginia; and
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Spahn JM, Callahan EH, Spill MK, Wong YP, Benjamin-Neelon SE, Birch L, Black MM, Cook JT, Faith MS, Mennella JA, Casavale KO. Influence of maternal diet on flavor transfer to amniotic fluid and breast milk and children's responses: a systematic review. Am J Clin Nutr 2019; 109:1003S-1026S. [PMID: 30982867 DOI: 10.1093/ajcn/nqy240] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 07/11/2018] [Accepted: 08/14/2018] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Maternal diet during pregnancy and lactation may provide the earliest opportunity to positively influence child food acceptance. OBJECTIVE Systematic reviews were completed to examine the relation among maternal diet during pregnancy and lactation, amniotic fluid flavor, breast-milk flavor, and children's food acceptability and overall dietary intake. DESIGN A literature search was conducted in 10 databases (e.g., PubMed, Embase, Cochrane, and CINAHL) to identify articles published from January 1980 to June 2017. Data from each included study were extracted, risk of bias assessed, evidence synthesized qualitatively, conclusion statements developed, and strength of the evidence graded. RESULTS Eleven and 15 articles met a priori criteria for inclusion to answer questions related to maternal diet during pregnancy and lactation, respectively. CONCLUSIONS Limited but consistent evidence indicates that flavors (alcohol, anise, carrot, garlic) originating from the maternal diet during pregnancy can transfer to and flavor amniotic fluid, and fetal flavor exposure increases acceptance of similarly flavored foods when re-exposed during infancy and potentially childhood. Moderate evidence indicates that flavors originating from the maternal diet during lactation (alcohol, anise/caraway, carrot, eucalyptus, garlic, mint) transmit to and flavor breast milk in a time-dependent manner. Moderate evidence indicates that infants can detect diet-transmitted flavors in breast milk within hours of a single maternal ingestion (alcohol, garlic, vanilla, carrot), within days after repeated maternal ingestion (garlic, carrot juice), and within 1-4 mo postpartum after repeated maternal ingestion (variety of vegetables including carrot) during lactation. Findings may not generalize to all foods and beverages. Conclusions cannot be drawn to describe the relationship between mothers' diet during either pregnancy or lactation and children's overall dietary intake.
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Affiliation(s)
| | | | | | | | | | | | - Maureen M Black
- University of Maryland, College Park, MD and RTI International
| | | | | | | | - Kellie O Casavale
- US Department of Health and Human Services, Office of Disease Prevention and Health Promotion, Rockville, MD
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16
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Affiliation(s)
| | - Richard Olson
- US Department of Health and Human Services, Washington, DC
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17
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Mosher AL, Piercy KL, Webber BJ, Goodwin SK, Casavale KO, Olson RD. Dietary Guidelines for Americans: Implications for Primary Care Providers. Am J Lifestyle Med 2016; 10:23-35. [PMID: 30202257 PMCID: PMC6124854 DOI: 10.1177/1559827614521755] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Revised: 12/04/2013] [Accepted: 12/06/2013] [Indexed: 11/17/2022] Open
Abstract
In the United States, high rates of obesity and chronic disease impose serious consequences on the population's health and health care system. Primary care providers are critical to broad prevention efforts aiming to reduce the burden of chronic disease in the nation and play an important role in addressing lifestyle behaviors that can result in illness and premature death. Unhealthy dietary behaviors largely contribute to morbidity and mortality in the United States despite national efforts to improve the nutritional quality of the typical American diet. This article discusses a comprehensive set of national evidence-based recommendations known as the Dietary Guidelines for Americans that can support primary care providers' efforts to improve patient outcomes through optimal nutrition and healthy lifestyle behaviors. This article also describes basic behavioral counseling techniques primary care providers can incorporate into time-limited patient encounters to help improve the dietary and physical activity behaviors of their patients.
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Affiliation(s)
- Amber L. Mosher
- Amber L. Mosher, MPH, RD, Office of Disease Prevention and Health Promotion, US Department of Health and Human Services, 1101 Wootton Parkway, Tower Oaks Bldg, Suite LL 100, Rockville, MD 20852; e-mail:
| | - Katrina L. Piercy
- Office of Disease Prevention and Health Promotion, US Department of Health and Human Services, Rockville, Maryland (ALM, KLP, SKG, KOC, RDO)
- Uniformed Services University of the Health Sciences, Bethesda, Maryland (BJW)
| | - Bryant J. Webber
- Office of Disease Prevention and Health Promotion, US Department of Health and Human Services, Rockville, Maryland (ALM, KLP, SKG, KOC, RDO)
- Uniformed Services University of the Health Sciences, Bethesda, Maryland (BJW)
| | - Stephanie K. Goodwin
- Office of Disease Prevention and Health Promotion, US Department of Health and Human Services, Rockville, Maryland (ALM, KLP, SKG, KOC, RDO)
- Uniformed Services University of the Health Sciences, Bethesda, Maryland (BJW)
| | - Kellie O. Casavale
- Office of Disease Prevention and Health Promotion, US Department of Health and Human Services, Rockville, Maryland (ALM, KLP, SKG, KOC, RDO)
- Uniformed Services University of the Health Sciences, Bethesda, Maryland (BJW)
| | - Richard D. Olson
- Office of Disease Prevention and Health Promotion, US Department of Health and Human Services, Rockville, Maryland (ALM, KLP, SKG, KOC, RDO)
- Uniformed Services University of the Health Sciences, Bethesda, Maryland (BJW)
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Altman J, Spahn J, Stoody EE, Rihane C, Casavale KO, Olson R. Laying the foundation for expanding the Dietary Guidelines for Americans to address children from birth to 24 months and women who are pregnant. J Acad Nutr Diet 2015; 115:693-694. [PMID: 25911339 DOI: 10.1016/j.jand.2015.03.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Indexed: 10/23/2022]
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Rahavi E, Stoody EE, Rihane C, Casavale KO, Olson R. Updating the dietary guidelines for Americans: status and looking ahead. J Acad Nutr Diet 2015; 115:180-182. [PMID: 25636216 DOI: 10.1016/j.jand.2014.11.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Indexed: 10/24/2022]
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20
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Guenther PM, Kirkpatrick SI, Reedy J, Krebs-Smith SM, Buckman DW, Dodd KW, Casavale KO, Carroll RJ. The Healthy Eating Index-2010 is a valid and reliable measure of diet quality according to the 2010 Dietary Guidelines for Americans. J Nutr 2014; 144:399-407. [PMID: 24453128 PMCID: PMC3927552 DOI: 10.3945/jn.113.183079] [Citation(s) in RCA: 532] [Impact Index Per Article: 53.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2013] [Revised: 09/17/2013] [Accepted: 12/27/2013] [Indexed: 11/14/2022] Open
Abstract
The Healthy Eating Index (HEI), a measure of diet quality, was updated to reflect the 2010 Dietary Guidelines for Americans and the accompanying USDA Food Patterns. To assess the validity and reliability of the HEI-2010, exemplary menus were scored and 2 24-h dietary recalls from individuals aged ≥2 y from the 2003-2004 NHANES were used to estimate multivariate usual intake distributions and assess whether the HEI-2010 1) has a distribution wide enough to detect meaningful differences in diet quality among individuals, 2) distinguishes between groups with known differences in diet quality by using t tests, 3) measures diet quality independently of energy intake by using Pearson correlation coefficients, 4) has >1 underlying dimension by using principal components analysis (PCA), and 5) is internally consistent by calculating Cronbach's coefficient α. HEI-2010 scores were at or near the maximum levels for the exemplary menus. The distribution of scores among the population was wide (5th percentile = 31.7; 95th percentile = 70.4). As predicted, men's diet quality (mean HEI-2010 total score = 49.8) was poorer than women's (52.7), younger adults' diet quality (45.4) was poorer than older adults' (56.1), and smokers' diet quality (45.7) was poorer than nonsmokers' (53.3) (P < 0.01). Low correlations with energy were observed for HEI-2010 total and component scores (|r| ≤ 0.21). Cronbach's coefficient α was 0.68, supporting the reliability of the HEI-2010 total score as an indicator of overall diet quality. Nonetheless, PCA indicated multiple underlying dimensions, highlighting the fact that the component scores are equally as important as the total. A comparable reevaluation of the HEI-2005 yielded similar results. This study supports the validity and the reliability of both versions of the HEI.
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21
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Guenther PM, Casavale KO, Reedy J, Kirkpatrick SI, Hiza HAB, Kuczynski KJ, Kahle LL, Krebs-Smith SM. Update of the Healthy Eating Index: HEI-2010. J Acad Nutr Diet 2013; 113:569-80. [PMID: 23415502 DOI: 10.1016/j.jand.2012.12.016] [Citation(s) in RCA: 940] [Impact Index Per Article: 85.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Accepted: 12/21/2012] [Indexed: 12/25/2022]
Abstract
The Healthy Eating Index (HEI) is a measure of diet quality in terms of conformance with federal dietary guidance. Publication of the 2010 Dietary Guidelines for Americans prompted an interagency working group to update the HEI. The HEI-2010 retains several features of the 2005 version: (a) it has 12 components, many unchanged, including nine adequacy and three moderation components; (b) it uses a density approach to set standards, eg, per 1,000 calories or as a percentage of calories; and (c) it employs least-restrictive standards; ie, those that are easiest to achieve among recommendations that vary by energy level, sex, and/or age. Changes to the index include: (a) the Greens and Beans component replaces Dark Green and Orange Vegetables and Legumes; (b) Seafood and Plant Proteins has been added to capture specific choices from the protein group; (c) Fatty Acids, a ratio of polyunsaturated and monounsaturated to saturated fatty acids, replaces Oils and Saturated Fat to acknowledge the recommendation to replace saturated fat with monounsaturated and polyunsaturated fatty acids; and (d) a moderation component, Refined Grains, replaces the adequacy component, Total Grains, to assess overconsumption. The HEI-2010 captures the key recommendations of the 2010 Dietary Guidelines and, like earlier versions, will be used to assess the diet quality of the US population and subpopulations, evaluate interventions, research dietary patterns, and evaluate various aspects of the food environment.
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Affiliation(s)
- Patricia M Guenther
- Center for Nutrition Policy and Promotion, US Department of Agriculture, Alexandria, VA 22302, USA.
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Hiza HAB, Casavale KO, Guenther PM, Davis CA. Diet quality of Americans differs by age, sex, race/ethnicity, income, and education level. J Acad Nutr Diet 2012; 113:297-306. [PMID: 23168270 DOI: 10.1016/j.jand.2012.08.011] [Citation(s) in RCA: 520] [Impact Index Per Article: 43.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2011] [Accepted: 08/09/2012] [Indexed: 12/14/2022]
Abstract
An index that assesses the multidimensional components of the diet across the lifecycle is useful in describing diet quality. The purpose of this study was to use the Healthy Eating Index-2005, a measure of diet quality in terms of conformance to the 2005 Dietary Guidelines for Americans, to describe the diet quality of Americans by varying sociodemographic characteristics in order to provide insight as to where diets need to improve. The Healthy Eating Index-2005 scores were estimated using 1 day of dietary intake data provided by participants in the 2003-2004 National Health and Nutrition Examination Survey. Mean daily intakes of foods and nutrients, expressed per 1,000 kilocalories, were estimated using the population ratio method and compared with standards that reflect the 2005 Dietary Guidelines for Americans. Participants included 3,286 children (2 to 17 years), 3,690 young and middle-aged adults (18 to 64 years), and 1,296 older adults (65+ years). Results are reported as percentages of maximum scores and tested for significant differences (P ≤ 0.05) by age, sex, race/ethnicity, income, and education levels. Children and older adults had better-quality diets than younger and middle-aged adults; women had better-quality diets than men; Hispanics had better-quality diets than blacks and whites; and diet quality of adults, but not children, generally improved with income level, except for sodium. The diets of Americans, regardless of socioeconomic status, are far from optimal. Problematic dietary patterns were found among all sociodemographic groups. Major improvements in the nutritional health of the American public can be made by improving eating patterns.
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Affiliation(s)
- Hazel A B Hiza
- US Department of Agriculture, Center for Nutrition Policy and Promotion, Alexandria, VA 22302, USA.
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