Food Science Challenge: Translating the Dietary Guidelines for Americans to Bring About Real Behavior Change

Nutrition and Food Science - An Obvious but Little-Appreciated Partnership: Lessons Learned from the Road Less Traveled.

Introduction: The 2015 Dietary Guidelines for Americans (DGA) recommends consuming low-fat or fat-free dairy foods due to concerns about excess intake of energy, which can lead to overweight or obesity, and saturated fat, a type of fat that can increase blood levels of low-density lipoprotein cholesterol, a blood biomarker used to predict cardiovascular disease risk. The 2015 DGA recommends limiting intake of saturated fats to less than 10% of calories per day and balancing energy intake. Hypothesis: The objective of this study was to assess the impact of replacing one serving of fat-free dairy foods provided in current models of the 2000-calorie Healthy U.S.-Style Eating Pattern (HUSEP) with one serving of whole- or reduced-fat dairy foods. We hypothesized that this replacement would still result in an eating pattern within calorie, saturated fat, and sodium limits. Methods: Utilizing the same food pattern modeling procedures used for the 2015 DGA, we assessed the energy and nutrient composition of six alternative models of the 2000-calorie HUSEP. In each pattern, we replaced 1 of the 3 servings of the USDA’s fat-free dairy food composite with whole- or reduced-fat dairy products or whole-/reduced-fat dairy composites. The 6 replacement models included replacements with: 1) a whole-fat dairy food composite, 2) a reduced-fat dairy food composite, 3) whole milk, 4) reduced-fat milk, 5) whole-fat cheese, and 6) reduced-fat cheese. Results: In all 6 models, the amount of saturated fat did not exceed 10% of total calories. In models 2, 3, and 4, saturated fat was 9% of total calories. The amount of energy increased slightly in all models. The original HUSEP provided 2003 calories, and the 6 models in this study provided an additional 45 (Model 4) to 94 (Model 5) additional calories. The amount of sodium also increased. The original HUSEP provides 1787 mg of sodium, and these models provided between 2082 and 2683 mg of sodium. While still lower than the current average sodium intake (3,440 mg/d), the amount of sodium in Models 1, 2, 5, and 6 exceeds 2,300 mg/d, the Chronic Disease Risk Reduction Intake level for sodium. Conclusions: Results of this study indicate that some reduced- and whole-fat dairy foods, especially milk, can fit into calorie-balanced healthy eating patterns that also align with saturated fat and sodium recommendations. Allowing some flexibility in fat level of dairy food servings aligns with the 2010 DGA recommendation that calories from solid fats and added sugars are best used to increase the palatability of nutrient-dense foods, which includes milk, cheese, and yogurt.

Using digital imagery to quantify students’ added sugar intake at lunch in Title I schools with universal free meals

The Supplemental Nutrition Assistance Program-Education (SNAP-Ed) program aims to improve nutritional intakes of low-income individuals (<185% poverty threshold). The objective of this study was to describe the compliance with Dietary Guidelines for Americans (DGA) recommendations for fruits, vegetables, and whole grains among SNAP-Ed eligible (n = 3142) and ineligible (n = 3168) adult women (19–70 years) nationwide and SNAP-Ed participating women in Indiana (n = 2623), using the NHANES 2007–2012 and Indiana SNAP-Ed survey data, respectively. Sensitivity analysis further stratified women by race/ethnicity and by current SNAP participation (<130% poverty threshold). Nationally, lower-income women were less likely to meet the fruit (21% vs. 25%) and vegetable (11% vs. 19%) guidelines than higher-income women, but did not differ on whole grains, which were ~5% regardless of income. The income differences in fruit and vegetable intakes were driven by non-Hispanic whites. Fewer SNAP-Ed-eligible U.S. women met fruit (21% vs. 55%) and whole grain (4% vs. 18%) but did not differ for vegetable recommendations (11% vs. 9%) when compared to Indiana SNAP-Ed women. This same trend was observed among current SNAP participants. Different racial/ethnic group relationships with DGA compliance were found in Indiana compared to the nation. Nevertheless, most low-income women in the U.S. are at risk of not meeting DGA recommendations for fruits (79%), vegetables (89%), and whole grains (96%); SNAP-Ed participants in Indiana had higher compliance with DGA recommendations. Increased consumption of these three critical food groups would improve nutrient density, likely reduce calorie consumption by replacing high calorie choices, and improve fiber intakes.

Little is known about the potential health economic impact of increasing the proportion of total grains consumed as whole grains to align with Dietary Guidelines for Americans (DGA) recommendations. Health economic analysis estimating difference in costs developed using (1) relative risk (RR) estimates between whole grains consumption and outcomes of cardiovascular disease (CVD) and a selected component (coronary heart disease, CHD); (2) estimates of total and whole grains consumption among US adults; and (3) annual direct and indirect medical costs associated with CVD. Using reported RR estimates and assuming a linear relationship, risk reductions per serving of whole grains were calculated and cost savings were estimated from proportional reductions by health outcome. With a 4% reduction in CVD incidence per serving and a daily increase of 2.24 oz-eq of whole grains, one-year direct medical cost savings were estimated at US$21.9 billion (B) (range, US$5.5B to US$38.4B). With this same increase in whole grains and a 5% reduction in CHD incidence per serving, one-year direct medical cost savings were estimated at US$14.0B (US$8.4B to US$22.4B). A modest increase in whole grains of 0.25 oz-eq per day was associated with one-year CVD-related savings of $2.4B (US$0.6B to US$4.3B) and CHD-related savings of US$1.6B (US$0.9B to US$2.5B). Increasing whole grains consumption among US adults to align more closely with DGA recommendations has the potential for substantial healthcare cost savings.

Diet Quality and Associations with Food Security among Women Eligible for Indiana Supplemental Nutrition Assistance Program-Education

Criterion‐based dietary indices generally have an untested assumption that all index components have equal health contributions. This assumption was tested for the association between adherence to 2005 Dietary Guidelines for Americans (DGA) and atherosclerosis progression, using data from 225 postmenopausal women with established heart disease in the Estrogen and Atherosclerosis Progression Trial conducted between 1996 and 2000. At the baseline and endpoint, diameters of coronary arteries were measured by quantitative angiography. Adherence to the key DGA recommendations was measured by the DGA Adherence Index (DGAI), where each component was weighted equally, and the modified DGAI (wDGAI), where each component was weighted by its relation to atherosclerosis progression. By mixed model regression analyses, the DGAI was found not associated with atherosclerosis progression (p=0.44). In contrast, wDGAI was inversely associated; one standard deviation difference of wDGAI was related to 0.049 mm less narrowing of coronary arteries (p=0.004). Adherence to the DGA recommendations assigned differential weights based on their relationships with the outcome was significantly associated with reduced atherosclerosis progression. Assuming equity of associations of all DGA recommendations with health outcomes may limit our ability to identify relationships of the DGA with chronic disease prevention.Grant Funding SourceU.S. Department of Agriculture, Agricultural Research Service (No. 58‐1950‐7‐707)

Objective:The federal Child and Adult Care Food Program (CACFP) sets minimum nutrition and portion size standards for meals served in participating childcare programs. CACFP has been associated with more nutritious meals served. It is unclear, however, whether CACFP results in children’s dietary intake being aligned with national recommendations. We assess whether children’s dietary intake in CACFP-participating childcare centres meets benchmarks set by the Dietary Guidelines for Americans (DGA).Design:This is a cross-sectional study. We used direct observation to estimate quantities of foods/beverages served and consumed per child. Mean amounts served per child per day were compared with CACFP portion size requirements for each component (fruits, vegetables, milk and meat/meat alternate). Mean amounts of foods/beverages consumed were compared with DGA recommendations (energy content, fruits, vegetables, whole/refined grains, dairy, protein and added sugars). One sample t-tests evaluated if quantities served and consumed were different from CACFP and DGA standards, respectively.Setting:Six CACFP-participating childcare centres.Participants:2–5 year-old children attending childcare.Results:We observed forty-six children across 166 child meals. Most meals served met CACFP nutrition standards. Compared with CACFP portion size standards, children were served more grains at breakfast and lunch; more fruits/vegetables at lunch but less at breakfast and snack and less dairy at all eating occasions. Compared with DGA recommendations, children under-consumed every food/beverage category except grains during at least one eating occasion.Conclusions:Children were served quantities of foods/beverages mostly consistent with CACFP portion size requirements, but had sub-optimal intake relative to DGA. More research is needed to help children consume healthy diets in childcare.

Participation in the CACFP Ensures Availability but not Intake of Nutritious Foods at Lunch in Preschool Children in Child-Care Centers

The Dietary Guidelines for Americans (DGA) were developed to reduce or prevent many types of chronic illness, including cancer, heart disease and diabetes. Healthcare provider recommendations may be influenced by understanding of and adherence to the DGA, which may be incorporated into provider training, medical and dental clinical curricula—although few studies have evaluated adherence to the DGA among dental students. This approved retrospective study of voluntary student responses from a first-year dental school nutrition course included a short dietary and exercise survey administered as part of the DGA learning module. A total of N = 299 students completed the voluntary nutrition survey, yielding a response rate of 91.4%. Daily fruit and vegetable intake, dairy and whole grain servings among UNLV-SDM students were significantly lower than the DGA recommendations but higher than U.S. averages for 18–30-year-olds—although neither group met DGA recommendations. This study represents one of the first to evaluate the dietary intake of U.S. dental students for comparison with the DGA for positive health behaviors. These data demonstrate a lack of adherence to the DGA among highly educated dental students and the need for the curricular inclusion of diet and nutrition into the dental school curriculum.

Effects of a behavioral intervention that emphasizes spices and herbs on adherence to recommended sodium intake: results of the SPICE randomized clinical trial

Introduction: Consuming a nutrient poor diet can negatively affect the health status of an individual. Recent increases in African immigration into the U.S. has called for more research on the health and health behaviors of this growing population. Little is known about how acculturation (as measured by place of birth and length of time in the country) affects nutrient intake and diet quality among Non-Hispanic Blacks in the U.S. We aim to address this gap in knowledge by studying the association between acculturation, nutrient intake, and diet quality among a large sample of Non-Hispanic Black adults. Hypothesis: We hypothesize that foreign-born (FB) Blacks who immigrated to the U.S. less than 10 years ago are more likely to meet national recommendations for diet and nutrient intake compared to FB Blacks who immigrated more than 10 years ago and U.S. born Blacks. Methods: We analyzed cross-sectional data from the 2005-2016 cycles of the National Health and Nutrition Examination Survey (NHANES). The analytical sample comprised 7,073 Non-Hispanic Blacks who we categorized into three groups: FB Blacks less than 10 years (3.35%), FB Blacks greater than 10 years (7.42%), and U.S. born Blacks (89.23%). We analyzed each participant’s 24-hour recall data to determine if they met 2015-2020 Dietary Guidelines for Americans (DGA) recommendations for intake of specific nutrients (e.g., saturated fat, fiber, sugar, cholesterol, sodium, etc.). We used logistic regression to assess differences across the three groups in regards to odds of meeting DGA recommendations for nutrient intake. Results: Compared to U.S. born blacks and FB Blacks (≥10 years), FB Blacks (&lt;10 years) had significantly higher odds of meeting DGA recommendations for most nutrients after adjusting for all covariates (e.g., age, gender, education level, poverty level, etc.). Specifically, FB Blacks (&lt;10 years) had significantly higher odds of meeting recommendations for saturated fat (OR: 2.7; 95% CI: 1.6-4.6), cholesterol (OR: 1.7; 95% CI: 1.2-2.5) and sodium intake (OR: 2.2; 95% CI: 1.2-4.3) compared to U.S. born Blacks. FB Blacks (≥ 10 years) had significantly higher odds of meeting recommendations for total fat and dietary fiber compared to U.S. born Blacks. Conclusion: FB Blacks (&lt;10 years) had higher odds of meeting DGA guidelines for nutrient intake compared FB Blacks (≥10 years) and U.S. born Blacks. These findings further highlight the importance of acculturation and its impact on dietary intake among immigrant populations. Future studies should evaluate how acculturation influences overall health status and chronic disease risk across the African diaspora in the U.S.

Background: The 2015–2020 Dietary Guidelines for Americans (DGA) recommend that the general population should consume about 8 ounces (oz.) per week of a variety of seafood, providing approximately 250 mg per day of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), and that pregnant and lactating women should consume 8–12 oz. per week of seafood. Methods: We determined the usual intakes, percentage not meeting recommendations, and trends in EPA and DHA intakes among childbearing-age and pregnant women (15–44 years of age) using the NHANES cycles 2001–2002 through 2013–2014. Results: For the childbearing-age women, the mean usual intake of seafood was 0.44 ± 0.02 oz. equivalent per day and 100% of the population was below the DGA recommendation. Mean usual intakes of EPA, DHA, and combined EPA and DHA from foods and dietary supplements combined were 26.8 ± 1.4, 62.2 ± 1.9, and 88.1 ± 3.0 mg per day, respectively. Over 95% of the sample did not meet the daily intakes of 250 mg EPA and DHA. Similar results were observed for pregnant women. After controlling for covariates, there were slight but significant increases in EPA and DHA intakes from foods and dietary supplements over the 14-year span among childbearing-age (p = 0.005) and pregnant women (p = 0.002). Conclusions: It was estimated that a majority of U.S. childbearing-age and pregnant women consumed significantly lower amounts of seafood than what the DGA recommends, which subsequently leads to low intakes of EPA and DHA; in addition, dietary supplement use has not eliminated the nutrient shortfall.

To assess maternal dietary intake during pregnancy and adherence to the 2020-2025 pregnancy-specific Dietary Guidelines for Americans (DGA). This was a retrospective observational study. The study population consisted of women who gave birth to term infants (>37 weeks of gestation). Participants were given the Dietary Screener Questionnaire (DSQ) after birth and asked to recall their dietary intake in the last month of pregnancy. Participants' estimated dietary intakes were then compared to the 2020-2025 DGA which includes specific recommendations for pregnant women. Out of 51women who completed the DSQ, none consumed the recommended amounts of all surveyed dietary factors. Specifically, only one woman (2%) met the recommended intake of fruits, 11 women (22%) met the recommended intake of calcium, 25 women (49%) exceeded the recommended upper limit for added sugar intake,and none of the women (0%) met the intake of vegetables, whole grains, dairyand fiber. Women in our study did not adhere to the pregnancy-specific DGA recommendations in the last month of pregnancy. Our findings underscore the need to increase maternal nutritional awareness and education to improve adherence to the DGA.

Physiological Limitations of Protein Foods Ounce Equivalents and the Underappreciated Role of Essential Amino Acid Density in Healthy Dietary Patterns