Absolute Energy Intake Research Articles

EFFECTS OF MILK AS A RECOVERY DRINK FOLLOWING EXERCISE ON SUBSEQUENT APPETITE AND ENERGY INTAKE IN FEMALE RECREATIONAL EXERCISERS

Several studies have highlighted the beneficial effects of milk and dairy product consumption in the alleviation of exercise-induced muscle damage, post-exercise soreness sensations and indeed the satiating effects on subsequent...

Effect of Short-term Exercise on Appetite, Energy Intake and Energy-regulating Hormones.

Objective(s) : The purpose of this study was to investigate effects of short-term aerobic exercise on energy intake, appetite and energy-regulating hormones in free-living men and women. Sixteen (eight men, eight women) sedentary young normal weight subjects participated in two experimental conditions with two days apart: five days control with no exercise, and five days exercise (55% MHRR for 45 min/day). Subjects recorded dietary intake using a food diary and self-weighed intake during each five days. Appetite questionnaire (visual analogue scale) was completed each morning in the fasted state. Blood samples were taken in the morning on the 6th day in fasting status after control and exercise conditions. No significant changes were found in absolute energy intake, appetite rate and level of acylated ghrelin and leptin between conditions in both sexes. In women, insulin concentration decreased significantly after exercise. Relative energy intake was significantly lower after exercise in men. On average, women compensated for about 23% of the exercise-induced energy deficit but men did not (-10%). Our findings show that low-intensity exercise for five consecutive days cannot create a negative energy balance in women. It seems that women are more resistant to exercise-induced energy deficit.

Does diet-beverage intake affect dietary consumption patterns? Results from the Choose Healthy Options Consciously Everyday (CHOICE) randomized clinical trial

Little is understood about the effect of increased consumption of low-calorie sweeteners in diet beverages on dietary patterns and energy intake. We investigated whether energy intakes and dietary patterns were different in subjects who were randomly assigned to substitute caloric beverages with either water or diet beverages (DBs). Participants from the Choose Healthy Options Consciously Everyday randomized clinical trial (a 6-mo, 3-arm study) were included in the analysis [water groups: n = 106 (94% women); DB group: n = 104 (82% women)]. For energy, macronutrient, and food and beverage intakes, we investigated the main effects of time, treatment, and the treatment-by-time interaction by using mixed models. Overall, the macronutrient composition changed in both groups without significant differences between groups over time. Both groups reduced absolute intakes of total daily energy, carbohydrates, fat, protein, saturated fat, total sugar, added sugar, and other carbohydrates. The DB group decreased energy from all beverages more than the water group did only at month 3 (P-group-by-time < 0.05). Although the water group had a greater reduction in grain intake at month 3 and a greater increase in fruit and vegetable intake at month 6 (P-group-by-time < 0.05), the DB group had a greater reduction in dessert intake than the water group did at month 6 (P-group-by-time < 0.05). Participants in both intervention groups showed positive changes in energy intakes and dietary patterns. The DB group showed decreases in most caloric beverages and specifically reduced more desserts than the water group did. Our study does not provide evidence to suggest that a short-term consumption of DBs, compared with water, increases preferences for sweet foods and beverages. This trial was registered at clinicaltrials.gov as NCT01017783.

Winter Reduction in Body Mass in a Very Small, Nonhibernating Mammal: Consequences for Heat Loss and Metabolic Rates

Low temperatures in northern winters are energetically challenging for mammals, and a special energetic burden is expected for diminutive species like shrews, which are among the smallest of mammals. Surprisingly, shrews shrink their body size in winter and reduce body and brain mass, an effect known as Dehnel's phenomenon, which is suggested to lower absolute energy intake requirements and thereby enhance survival when food availability is low. Yet reduced body size coupled with higher body-surface-to-mass ratio in these tiny mammals may result in thermoregulatory heat production at a given temperature constituting a larger proportion of the total energy expenditure. To evaluate energetic consequences of reduced body size in winter, we investigated common shrews Sorex araneus in northeastern Poland. Average body mass decreased by 19.0% from summer to winter, and mean skull depth decreased by 13.1%. There was no difference in Dehnel's phenomenon between years despite different weather conditions. The whole-animal thermal conductance (proportional to absolute heat loss) in shrews was 19% lower in winter than in summer; the difference between the two seasons remained significant after correcting for body mass and was caused by improved fur insulation in winter. Thermogenic capacity of shrews, although much enhanced in winter, did not reach its full potential of increase, and this corresponded with relatively mild subnivean temperatures. These findings indicate that, despite their small body size, shrews effectively decrease their costs of thermoregulation. The recorded decrease in body mass from summer to winter resulted in a reduction of overall resting metabolic rate (in thermoneutrality) by 18%. This, combined with the reduced heat loss, should translate to food requirements that are substantially lower than would be the case if shrews did not undergo seasonal decrease in body mass.

Under- and Over-Reporting of Energy Intake in Slovenian Adolescents

To examine under- and over-reporting of energy intake (EI) among adolescents and to compare relative food and nutrient intakes of under-reporters (UR), over-reporters (OR), and the whole population to acceptable reporters (AR). All adolescents completed food frequency questionnaires at regional health centers, and a subgroup also completed a 3-day weighed dietary protocol at home. This study is a part of the first national representative study on dietary habits of Slovenian adolescents. In total, 2,813 adolescents entering high school (10% of the population); participation rate was 95%. Absolute EI and relative intakes of food and nutrients. Prodi (version 5.2 expert plus, Nutri-Science, Stuttgart, Germany, 2004) software was used to evaluate dietary intakes; t test, analysis of variance, and Mann-Whitney testing were used for differences between means, and chi-square was used for differences between proportions. Level of significance was set at P = .05. The prevalence of UR and OR was 34% and 10% among boys, and 27% and 11% among girls. Under-reporters reported lower energy percentage from carbohydrates, higher energy percentage from fats and proteins, and higher micronutrient densities than AR. Under-reporting and over-reporting are widespread among Slovenian adolescents. Exclusion of UR and OR does not influence mean value of EI when assessing the diet of a group as a whole.

Dietary habits and health status of African‐Caribbean adults

Although African-Caribbeans in the UK are more likely to suffer from a number of diet-related health conditions, including obesity, hypertension and type II diabetes, there have been few dietary studies on this group. The present study is based on a small survey of food and nutrient intakes and traditional dietary habits of African-Caribbean adults living in Staffordshire. A questionnaire, designed to collect demographic data and information on medical status, physical activities, dietary, cooking and food shopping habits was administered to a convenience sample of 39 adults. Detailed information on food intakes was gathered using a modified existing Food Frequency Questionnaire with 169 items. Height and weight were measured for the calculation of body mass index. The average age of the subjects was 47 years (range 19-65 years). The prevalence of obesity was 39% and one-third of subjects reported having at least one health condition. Physical activities, outside of work, were undertaken by 95% of the sample. Traditional foods were used by 92% of respondents, including fruit and vegetables purchased at markets outside of their local area. A wide variety of foods were consumed and the percentages of energy provided by fats and carbohydrates (30% and 53%, respectively) appeared to be meeting government recommendations. However, absolute energy intakes were high and salt consumption, often in the form of commercial seasonings, exceeded government recommendations. The positive aspects of the diets of this population need to be encouraged. Interventions need to focus on ways of reducing total energy intakes, as well as levels of salt consumption.

What do babies eat? Evaluation of a food frequency questionnaire to assess the diets of infants aged 12 months

To evaluate the relative validity of an FFQ for assessing nutrient intakes in 12-month-old infants. The FFQ was developed to assess the diets of infants born to women in the Southampton Women's Survey (SWS), a population-based survey of young women and their offspring. The energy and nutrient intakes obtained from an interviewer-administered FFQ were compared with those obtained from 4 d weighed diaries (WD). A sub-sample of fifty infants (aged 1 year) from the SWS had their diets assessed by both methods. The FFQ recorded the frequencies and amounts of foods and drinks consumed by the infants over the previous 28 d; milk consumption was recorded separately. The WD recorded the weights of all foods and drinks consumed by the infants on 4 d following the FFQ completion. The Spearman rank correlation coefficients for intakes of energy, macronutrients and eighteen micronutrients, determined by the two methods, ranged from r = 0.25 to 0.66. Bland-Altman statistics showed that mean differences between methods were in the range +5% to +60% except for vitamin D (+106%). Differences in micronutrient intake were partly explained by changes in patterns of milk consumption between the two assessments. Although there were differences in absolute energy and nutrient intakes between methods, there was reasonable agreement in the ranking of intakes. The FFQ is a useful tool for assessing energy and nutrient intakes of healthy infants aged around 12 months.

A low reported energy intake is associated with metabolic syndrome

Metabolic syndrome (MS) may be associated with the presence of an energy-sparing metabolism that predisposes to the excess accumulation of body fat. This study examined the relationship between reported energy intake and obesity in individuals with and without MS. Ninety consecutive non-diabetic obese subjects were divided into 2 groups based on the presence (MS+: no.=50) or absence (MS-: no.=40) of MS. The study design was cross-sectional. The 3-day food record method was used to assess the subjects' usual energy intake and the Diet Readiness Test (DRT) was also administered. Compared to the MS- group, the MS+ group had a significantly higher body weight, body mass index (mean+/-SEM: 39.1+/-1.3 vs 31.5+/-0.9, p<0.001) and fat mass. The absolute energy intake of the MS+ group (8629+/-331 kJ/24h) did not differ from that of the MS- group (8571+/-515 kJ/24h; p=ns). The daily energy intake normalized for the fat-free mass (FFM) size was higher in the MS- group (163+/-8 kJ/kg-FFM x 24h) than in the MS+ group (138+/-4 kJ/kg-FFM x 24h; p<0.03). The DRT test results were similar in both groups except that section 6 (exercise patterns and attitudes) score was lower in the MS+ group (10.0+/-0.5) than in the MS- group (11.9+/-0.5; p<0.01). The results of this study support the hypothesis that subjects with MS have an energy-sparing metabolism.

What do babies eat? Evaluation of a food frequency questionnaire to assess the diets of infants aged 6 months

To evaluate the relative validity of a food frequency questionnaire (FFQ) for assessing nutrient intakes in 6-month-old infants. The FFQ was developed to assess the diets of infants born to women in the Southampton Women's Survey (SWS), a population-based survey of young women and their offspring. The energy and nutrient intakes obtained from an interviewer-administered FFQ were compared with those obtained from a 4-day weighed diary. A sub-sample of 50 infants aged 6 months from the SWS had their diets assessed by both methods. The FFQ recorded the frequencies and amounts of milks, baby foods, regular foods and drinks consumed by the infants over the previous seven days. The diaries recorded the weights of all foods and drinks consumed by the infants on four separate days within 15 days following FFQ completion. Spearman rank correlation coefficients for intakes of energy, macronutrients and 18 micronutrients, determined by the two methods, ranged from r = 0.39 to 0.86; adjustment for energy intake tended to increase the correlation coefficients, range r(a) = 0.55 to 0.89. Bland-Altman statistics showed that mean differences between methods were in the range of -12.5% to +12.5% except for vitamin B12 (-18.9%). Although there were differences in absolute energy and nutrient intakes between methods, Spearman rank correlation coefficients indicated reasonable agreement in the ranking of intakes. The interviewer-administered FFQ is a useful tool for assessing energy and nutrient intakes of healthy infants aged about 6 months.

Neonatal food restriction permanently alters rat body dimensions and energy intake

Neonatal food restriction (FR) in rats, by means of increased litter size, has been used as a model for developmental programming by several investigators. However, the results reported have been inconsistent and difficult to compare between studies. In the present study, we aim to characterize the effects of this model throughout life in both sexes of one particular strain. On the second day of life, Wistar rat pups were randomly assigned to a litter of 10 (control) or 20 (FR). All litters had an equal number of males and females, and pups were weaned on day 25. Body dimensions and food intake were measured regularly until the age of one year. Serum leptin levels were determined in four subsets of different ages. FR acutely reduced growth in all body dimensions and serum leptin levels. Despite catch-up after weaning, all these parameters remained reduced throughout life. Male and female FR rats had a significantly reduced absolute energy intake throughout life. Male FR rats had significantly higher energy intake adjusted for body weight immediately after weaning. During catch-up growth, both FR males and females showed significantly enhanced feed efficiency. These results suggest that neonatal food restriction programmed both male and female Wistar rats to remain small and lean in adult life, with a lower food intake. Low neonatal leptin levels may play a mechanistic role in this process.

Energy intake and resting energy expenditure in adult male rats after early postnatal food restriction

Both in man and in animal models, changes in food intake and body composition in later life have been reported after alterations in perinatal nutrition. Therefore, we hypothesised that early postnatal undernutrition in the rat induces permanent changes in energy balance. Food restriction (FR) during lactation was achieved by enlarging litter size to twenty pups, whereas control animals were raised in litters containing ten pups. Energy intake and resting energy expenditure were determined in adult males. Early postnatal FR resulted in acute growth restriction followed by incomplete catch-up in body weight, body length and BMI. At the age of 12 months, middle-aged FR males had significantly lower absolute resting energy expenditure (200 v. 216 kJ/24 h, P = 0.009), absolute energy intake (281 v. 310 kJ/24 h, P = 0.001) and energy intake adjusted for BMI (284 v. 305 kJ/24 h, P = 0.016) than controls, whereas resting energy expenditure adjusted for BMI did not differ significantly between the groups (204 v. 211 kJ/24 h, P = 0.156). The amount of energy remaining for other functions was lower in FR males (80 v. 94 kJ/24 h, P = 0.044). Comparable data were obtained at the age of 6 months. These results indicate that in rats energy balance can be programmed by early nutrition. A low early postnatal food intake appears to programme these animals for a low energy intake and to remain slender in adult life.

Dietary determinants of obesity

Dietary determinants of obesity

Acute effects of knowledge-based work on feeding behavior and energy intake

The aim of this study was to evaluate the impact of knowledge-based work (KBW) on feeding behavior and spontaneous energy intake with the use of a repeated measures/within-subjects design. We used a two-session protocol including an ad libitum buffet preceded by either rest in a sitting position for 45 min or a cognitive task (reading a document and writing a summary of 350 words using a computer) over the same time period. In this regard, 15 healthy Laval University female students (mean age = 24.1 ± 2.2 years, mean BMI = 24.0 ± 4.3 kg/m 2) were recruited to participate in this study. Anthropometric variables, energy expenditure, heart rate, blood pressure, food intake (dietary record), and appetite sensation markers were measured at each testing session, and two questionnaires [Three-Factor Eating Questionnaire (TFEQ) and State–Trait Anxiety Inventory (STAI)] were administered. In addition, a buffet-type meal was used to measure spontaneous energy intake and macronutrient preferences. We found that the mean energy expenditure of the two conditions was about comparable (difference of 13 kJ between the two tasks) whereas the mean ad libitum energy intake after the KBW task exceeded that measured after rest by 959 kJ ( p < 0.01). Although a higher absolute energy intake was observed for the three macronutrients after the KBW task ( p < 0.05), no specific preference was detected, as reflected by the comparable percent of energy from each macronutrient in the two conditions. No significant difference in appetite sensation markers was observed between the two conditions, although the subjects ate more in the buffet-type meal after the KBW task. Furthermore, the subjects did not compensate by decreasing food intake for the rest of the day, suggesting a net caloric surplus. We also observed negative correlations between cognitive dietary restraint (TFEQ) and spontaneous energy intake in both conditions. In conclusion, our results demonstrate that mental work solicited by KBW has the potential to induce a higher spontaneous energy intake. This also raises the possibility that KBW adds a new component to sedentariness that might further accentuate the positive energy balance that is more likely to occur when one is inactive.

The Assessment of Dietary Habits in Obese Women: Influence of Eating Behavior Patterns

The objective of this cross-sectional, observational study was to compare the dietary history and the 7-day record method to assess dietary habits in obese women. The second goal was to investigate whether eating behavior characteristics influence self-reported dietary intake. The study took place at the Obesity Outpatient Clinic, University Hospital Gasthuisberg, Leuven, Belgium. Subjects were 137 obese women with a mean age of 40 ± 12 years and a mean body mass index of 38.2 ± 6.0 kg/m2. Dietary intake was assessed both by the dietary history and by the 7-day record method. Resting energy expenditure was measured by continuous indirect calorimetry. Physical activity level was estimated using the Baecke questionnaire. To study different aspects of eating behaviour, the “Dutch Eating Behaviour Questionnaire” was used. Absolute energy intake, as assessed by the 7-day record, was consistently lower than with the dietary history method. Sixteen percent of the obese women were overreporters while 66% clearly underreported energy intake, using dietary history as standard method. Restrained eating was associated with underreporting, while all aspects of emotional and external eating behavior were significantly higher in the group of overreporters. No relationship could be observed between the degree of underreporting and age, body weight or body mass index. Energy intake, as assessed by the dietary history method, correlated better with measured energy expenditure in obese subjects than the 7-day record. Eating behavior characteristics influence the accuracy of self-reported dietary intake in obese women. This study was supported in part by the Fonds voor Wetenschappelijk Onderzoek – Vlaanderen (Project G.0178.96 and ‘Krediet aan Navorsers’ 1.5.006.95).

Association of Energy Intake and Energy Balance with Postmenopausal Breast Cancer in the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial

Energy restriction remains one of the most effective ways known to prevent breast cancer in animal models. However, energy intake has not been consistently associated with risk of breast cancer in humans. In a prospective study, we assessed whether energy intake, body size, and physical activity each independently influence breast cancer risk in postmenopausal women and estimated the joint effect of combinations of these individual factors. As part of the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial, 38,660 women, ages 55 to 74 years and recruited from 10 centers in the United States during 1993 to 2001, were randomized to the screening arm of the trial. At baseline, the women completed a self-administered questionnaire, including a food frequency questionnaire. During follow-up from 1993 to 2003, 764 incident breast cancer cases were ascertained. Women in the highest quartile of energy intake (> or = 2,084 kcal/d) compared with those in the lowest quartile (<1,316 kcal/d) had a significantly increased risk for breast cancer [multivariate relative risk (RR), 1.25; 95% confidence interval (95% CI), 1.02-1.53; P(trend continuous) = 0.03]. Current body mass index (BMI) was also positively and significantly associated with risk (multivariate RR comparing >30 kg/m2 with <22.5 kg/m2, 1.35; 95% CI, 1.06-1.70; P(trend) = 0.01). Women with > or = 4 hours/wk of vigorous recreational physical activity had a significantly reduced risk of breast cancer compared with those who reported no recreational physical activity (multivariate RR, 0.78; 95% CI, 0.60-0.99; P(trend) = 0.15). None of these associations with individual energy balance measures was substantially confounded by the other two measures. When we estimated the joint effect of all three variables, women with the most unfavorable energy balance (the highest energy intake, highest BMI, and least physical activity) had twice the risk (RR, 2.10; 95% CI, 1.27-3.45) of women with the most favorable energy balance (the lowest energy intake, lowest BMI, and most physical activity). Although our estimates of absolute energy intake, based on a food frequency questionnaire, are imperfect, these results suggest that energy intake, in addition to BMI and physical activity may be independently associated with breast cancer risk. In addition, these three aspects of energy balance may act jointly in determining breast cancer risk.

Subcutaneous Ghrelin Enhances Acute Food Intake in Malnourished Patients Who Receive Maintenance Peritoneal Dialysis

Anorexia and malnutrition confer significant morbidity and mortality to patients with end-stage kidney disease but are resistant to therapy. The aim of this study was to determine whether subcutaneous administration of ghrelin, an appetite-stimulating gut hormone, could enhance food intake in patients who are receiving maintenance peritoneal dialysis and have evidence of malnutrition. The principal outcome measure was energy intake during a measured study meal. Secondary outcome measures were BP and heart rate and 3-d food intake after intervention. Nine peritoneal dialysis patients with mild to moderate malnutrition (mean serum albumin 28.6 +/- 5.0 g/L, total cholesterol 4.4 +/- 0.6 mmol/L, subjective global assessment score of 5.7 +/- 1.7) were given subcutaneous ghrelin (3.6 nmol/kg) and saline placebo in a randomized, double-blind, crossover protocol. Administration of subcutaneous ghrelin significantly increased the group mean absolute energy intake, compared with placebo, during the study meal (690 +/- 190 versus 440 +/- 250 kcal; P = 0.0062). When expressed as proportional energy increase for each individual, ghrelin administration resulted in immediate doubling of energy intake (204 +/- 120 versus 100%; P = 0.0319). Administration of ghrelin maintained a nonsignificant increase in energy intake over 24 h after intervention (2009 +/- 669 versus 1579 +/- 330 kcal) and was not followed by subsequent underswing (1790 +/- 370 versus 1670 +/- 530 and 1880 +/- 390 versus 1830 +/- 530 kcal on days 2 and 3, respectively). Ghrelin administration resulted in a significant fall in mean arterial BP (P = 0.0030 by ANOVA). There were no significant adverse events during the study. Subcutaneous ghrelin administration enhances short-term food intake in dialysis patients with mild to moderate malnutrition.

Structure of dietary measurement error: results of the OPEN biomarker study.

Multiple-day food records or 24-hour dietary recalls (24HRs) are commonly used as "reference" instruments to calibrate food frequency questionnaires (FFQs) and to adjust findings from nutritional epidemiologic studies for measurement error. Correct adjustment requires that the errors in the adopted reference instrument be independent of those in the FFQ and of true intake. The authors report data from the Observing Protein and Energy Nutrition (OPEN) Study, conducted from September 1999 to March 2000, in which valid reference biomarkers for energy (doubly labeled water) and protein (urinary nitrogen), together with a FFQ and 24HR, were observed in 484 healthy volunteers from Montgomery County, Maryland. Accounting for the reference biomarkers, the data suggest that the FFQ leads to severe attenuation in estimated disease relative risks for absolute protein or energy intake (a true relative risk of 2 would appear as 1.1 or smaller). For protein adjusted for energy intake by using either nutrient density or nutrient residuals, the attenuation is less severe (a relative risk of 2 would appear as approximately 1.3), lending weight to the use of energy adjustment. Using the 24HR as a reference instrument can seriously underestimate true attenuation (up to 60% for energy-adjusted protein). Results suggest that the interpretation of findings from FFQ-based epidemiologic studies of diet-disease associations needs to be reevaluated.

Family resemblance in breakfast energy intake: the Stanislas Family Study.

There seems to be a consensus that family influences on dietary habits are important. However, no data relative to breakfast have been published yet. To investigate whether and how breakfast energy intake aggregates within French families. A total of 398 families of the Stanislas Family Study who filled in a 3 day food consumption diary were selected. Absolute and relative breakfast energy intakes (BEI in kcal/day and RBEI in percentage of daily intake, respectively) were both studied. By using a variance component analysis, no genetic influence was shown in family aggregation of both BEI and RBEI. Intra-generation common environmental contribution to total phenotypic variance of BEI and RBEI was higher than inter-generation; both were increased with frequency of sharing breakfast. Furthermore frequency of sharing breakfast contributed to increase family resemblance in breakfast energy intake, particularly in offspring for BEI and RBEI, and in spouses for RBEI. Smoking habits, alcohol consumption, BMI or physical activity were related to family resemblance, but after adjustment on each factor degrees of resemblance were almost unchanged. General findings of this study were that family aggregation in breakfast absolute and relative energy intakes was significant within Stanislas families. Family resemblance depended on inter- and intra-generation components and was modified by the number of shared breakfasts. Our study confirmed that familial habits act on family resemblance in both absolute and relative breakfast energy intakes, so that family should be a favorite unit for health and diet promotion programs. Kellogg's PA, France.

The validity of dietary assessment in general practice.

OBJECTIVE: To validate a range of dietary assessment instruments in general practice. METHODS: Using a randomised block design, brief assessment instruments and more complex conventional dietary assessment tools were compared...

Decreasing Traditional Food Use Affects Diet Quality for Adult Dene/Métis in 16 Communities of the Canadian Northwest Territories ,

We assessed diets in 16 Dene/Métis communities in the Canadian Arctic. We described nutrient intakes and identified nutrients at risk among adult Dene/Métis, evaluated the influence of traditional food on diet quality, and examined the direction of dietary change by comparing intergenerational and between-community differences in dietary intake. Diet varied according to sex, age and community. Nutrients of possibly inadequate intake (irrespective of subject sex, age or community) included calcium, vitamin A and folic acid. Dietary fiber intake was also of concern. Traditional food (animals and plants harvested from the local environment) was consumed on 65.4% of interview days; on those days intakes of iron, zinc and potassium were higher (P< 0.05) and those of sodium, fat, saturated fat and sucrose were lower (P< 0.05) than on days when market food only was consumed. In this population, the shift away from traditional food towards a diet composed exclusively of market food was characterized by an increase (P< 0.05) in absolute energy intake and an increase (P< 0.01) in the relative contributions of carbohydrate (particularly sucrose), fat and saturated fat. This pattern of change calls for initiatives to document the current health status of this population and to prevent potential negative health consequences of dietary change.