Eating More … Nourishing Less

Abstract

The obesity epidemic in this country continues to rage. The National Center for Health Statistics reported that between 1980 and 2002, obesity prevalence doubled in adults over age 20 years and tripled in children and adolescents aged 6 to 19 years (1Ogden C.L. Carroll M.D. Curtin L.R. McDowell M.A. Tabak C.J. Flegal K.M. Prevalence of overweight and obesity in the United States, 1999-2004.JAMA. 2006; 295: 1549-1555Google Scholar). Data were analyzed from the National Health and Nutrition Examination Survey, a complex, multistage probability sample of noninstitutionalized males and females across ethnic groups. The only reported shred of hope was that among adult women (approximately one third of whom are obese), no significant increase in the rate of obesity was observed between 1999-2004, while the rate did increase in men and children overall, and especially among nonwhites (1Ogden C.L. Carroll M.D. Curtin L.R. McDowell M.A. Tabak C.J. Flegal K.M. Prevalence of overweight and obesity in the United States, 1999-2004.JAMA. 2006; 295: 1549-1555Google Scholar). Since previous data from the National Health and Nutrition Examination Survey had reported that overall self-reported energy intake among children and adolescents has not significantly increased, it is assumed that decreased physical activity may be a major factor in the growing obesity epidemic (2Troiano R.P. Briefel R.R. Carroll M.D. Bialostosky K. Energy and fat intakes of children and adolescents in the United States: Data from the National Health and Nutrition Examination Surveys.Am J Clin Nutr. 2000; 72: 1343S-1353SGoogle Scholar). Among the majority, intakes of total fat, saturated fat, and cholesterol were in excess of recommended amounts for that era and soft drinks contributed approximately 8% of calorie intake among overweight children (2Troiano R.P. Briefel R.R. Carroll M.D. Bialostosky K. Energy and fat intakes of children and adolescents in the United States: Data from the National Health and Nutrition Examination Surveys.Am J Clin Nutr. 2000; 72: 1343S-1353SGoogle Scholar). Since milk consumption simultaneously decreased during that time, the overall net intake of calcium, magnesium, vitamin D, and other related dairy nutrients also decreased as well. This pattern suggests that among overweight children nutrient quality is inferior despite adequate or excessive calorie intake. This pattern followed long term might be predicted to adversely influence risk factors for a variety of chronic diseases including metabolic syndrome. Yet, juxtaposed with that prospect are recent data from the Coronary Artery Risk Development in Young Adults Study documenting the absence of developing metabolic syndrome commonly associated with aging when there is no increase in body mass index (3Lloyd-Jones D.M. Liu K. Colangelo L.A. Yan L.L. Klein L. Loria C.M. Lewis C.E. Savage P. Consistently stable of decreased body mass index in young adulthood and longitudinal changes in metabolic syndrome components: The Coronary Artery Risk Development in Young Adults Study.Circulation. 2007; 115: 1004-1011Google Scholar). In other words, prevention of weight gain is a powerful way to reduce risk of metabolic syndrome that is often the precursor of hypertension, type 2 diabetes, dyslipidemia, and other cardiovascular diseases. Furthermore, if diet quality suffers in the face of advancing obesity, as is reported in this month’s Journal, are immunological compromises likely as well? What chance is there for experiencing healthful aging in the face of these adverse conditions? Do beverage patterns contribute to overall diet quality and body mass index in children? LaRowe and colleagues (p 1124) further explore these associations and suggest some age-related influences that impact overall nutrient quality and bear consideration. Roseman and colleagues (p 1139) also report on cross sectional data from 7-day recalls of fruits, vegetables, milk, soft drinks, and breakfast consumption in over 4,000 middle school students in Kentucky. Students with healthy weights exhibited eating patterns that included more fruits and vegetables, milk, and breakfast consumption than overweight students. Although no causal associations can be derived from these data, the associations of certain eating patterns and behavior are clearly worth noting. Similarly, Clarke and colleagues (p 1146) report predictors of weight loss in a tri-ethnic community of low-income mothers. The authors were interested in attitudes and behaviors rather than specific dietary patterns. Overall, less satisfaction with appearance and enhanced nutrition knowledge were important influences on weight loss in this population of low-income mothers. Also, Tinker and colleagues (p 1155) present data from the Women’s Health Initiative regarding the predictors of dietary change to maintenance of a low-fat diet. Data from over 19,500 women were analyzed. The women who best adhered to the diet were those who attended the most sessions and regularly self-monitored their diets. Another notable finding was the importance of optimism regarding successful outcomes. These and other topics this month will add sizzle to your summer reading. Best regards.