Dietary Goals Research Articles

Culturally tailored intervention for rural African Americans with type 2 diabetes.

The purpose of this pilot study was to evaluate a culturally tailored intervention for rural African Americans. Social Cognitive Theory provided the framework for the study. Twenty-two participants were recruited and randomly assigned to either Group or Individual diabetes self-management (DSME). Group DSME included story-telling, hands-on activities, and problem-solving exercises. Individual DSME sessions focused on goal-setting and problem-solving strategies. Sessions were offered in an accessible community center over a 10-week period. Outcomes included glycosylated hemoglobin (A1C), self-care actions, self-efficacy level, goal attainment, and satisfaction with DSME. Participants in both Group and Individual DSME improved slightly over the 3-month period in self-care activities, A1C level, and goal attainment. Although differences were not statistically significant, trends indicate improved scores on dietary actions, foot care, goal attainment, and empowerment for those experiencing Group DSME. The culturally tailored approach was well received by all participants. Improvements among those receiving Individual DSME may indicate that brief sessions usinga culturally tailored approach could enhance self-care and glycemic control. Additional testing among more participants over a longer time period is recommended.

Calcium, magnesium, potassium and sodium intakes in Japanese children aged 3 to 5 years.

The present study aimed to evaluate in preschool children the intakes of Ca, Mg that possibly affect health and tooth formation and the intakes of K and Na that may affect lifestyle-related diseases. Information on dietary intake was collected from 90 preschool children (15 boys and 15 girls each in the 3-, 4- and 5-year old groups) on 3 separate days in the school fiscal year 1999 (April 1999 to March 2000) by the duplicate-diet technique. The Ca, Mg, K, and Na concentrations were determined by atomic absorption spectrometry using wet-ashed samples. The medians of mean daily intakes of Ca, Mg, K and Na in 3- to 5-year-old children were 432 mg, 110 mg, 1.18 g and 1.60 g, respectively, and no significant differences with regard to gender were observed. Seasonal varia-tion of intake was seen for each mineral. Calcium intake in most preschool children did not meet adequate intake (AI), probably due to low intakes of milk and dairy products in Japan. Magnesium intake was below the estimated average requirement (EAR) in 13.3% of the subjects, while the K intake met the AI. Sodium intake in a quarter of preschool children exceeded the tentative dietary goal. We concluded that in Japanese children aged 3-5 years; Ca intake is low, Na intake is high, and K intake is adequate, but some children could be at risk for Mg deficiency.

Diet quality of persons living with HIV/AIDS on highly active antiretroviral therapy

This study sought to assess the diet quality of individuals living with HIV/AIDS who were receiving antiretroviral therapy in São Paulo, Brazil. This cross-sectional study involved 56 HIV-infected adults. Demographic and anthropometric data were collected, and diet quality was measured using the Healthy Eating Index (HEI), modified for Brazilians, which included ten components: adequacy of intake of six different food groups, total fat, cholesterol, dietary fibre and dietary variety. Among the individuals assessed, 64.3% of the participants had a diet needing improvement, while 8.7% had a poor diet. The overall HEI score was 68.3 points (SD = 14.9). Mean scores were low for fruits, vegetables, dairy products and dietary fibre; and high for meats and eggs, total fat and cholesterol. The overall HEI score was higher among individuals who were not overweight (P = 0.003), who were also more likely to achieve dietary goals for dairy products (P = 0.039) and grains (P = 0.005). Most of these adults living with HIV/AIDS had diets that required improvement, and being overweight was associated with poorer diet quality. Nutritional interventions aimed at maintaining healthy body weight and diet should be taken into account in caring for HIV-infected people.

Completing the clinical governance cycle in dietetic gastroenterology outpatients

Background: To overcome high rates of non‐attendance, inappropriate referrals and long waiting times, an audit was undertaken of a dietetic outpatients clinic for gastroenterology patients in 2003 and then repeated in 2007. The aim of the first audit was to identify referral source, types of patient, attendance rates and if dietary advice had a positive outcome. This study aimed evaluated changes since 2003.Method: The clinic diary was used to identify patients booked to attend in 2003 and 2007. Information was retrieved from the patient's record on source of referral, types of referral, waiting times, attendance rates and dietary goals achieved. The results were compared to determine if changes had improved service delivery. The data were analyzed in Microsoft Excel (2003) and the attendance rates were compared using chi‐squared statistics.Results: There were 92 new patients in 2003 and 69 patients in 2007; data were obtained for n = 77 in 2003 and n = 55 in 2007. There was an increase in referrals from gastroenterologists (n = 31, 55%) in 2007 compared with 2003 (n = 23, 34%). Waiting times improved between the two audits with 44% being seen within 3 months in 2003 compared to 51% in 2007. Attendance rates improved by 30% when the two audits were compared and in both years 2003 and 2007 (p = 0.009), a positive outcome was recorded for the majority of patients who had completed their treatment episodes 78% and 63% respectively. Types of patients referred to Gastroenterology clinic Type of referral 2003 2007 Irritable bowel syndrome 4 (5) 12 (21) Inflammatory bowel disease 15 (19) 7 (12) Bariatric surgery 0 11 (20) Pancreatitis 13 (16) 9 (16) Gastric surgery 7 (9) 1 (2) General GI 28 (36) 13 (23) Non‐gastro 10 (12) 2 (3) Discussion: The literature on the audit cycle in dietetic outpatients is limited. The baseline results in 2003 lead to the production of guidelines and the subsequent audit in 2007 demonstrated an improvement in clinical effectiveness. There was incomplete retrieval of records for the 2007 audit that led to missing data.Conclusion: Guidelines for the clinic improved appropriateness of referrals and the focus of the clinic. The procedural changes have decreased non‐attendance and improved waiting times for patients. The changes implemented have improved service delivery for the patients and maximised the resources available for a specialist clinic by effectively utilising the skills of a Specialist gastroenterology dietitian.

The effectiveness of nutrition interventions on dietary outcomes by relative social disadvantage: a systematic review

Objective:To determine whether nutrition interventions widen dietary inequalities across socioeconomic status groups.Design:Systematic review of interventions that aim to promote healthy eating.Data sources:CINAHL and MEDLINE were searched between 1990 and 2007.Review...

Dietary Reference Intakes (DRIs) in Japan.

Following the comprehensive systematic review of domestic and overseas scientific evidence, the "Dietary Reference Intakes for Japanese, 2005 (DRI-J)" was published in April, 2005. The DRIs-J were prepared for health individuals and groups and designed to present a reference for intake values of energy and 34 nutrients to maintain and promote health and to prevent lifestyle-related diseases and illness due to excessive consumption of either energy or nutrients. The DRI-J also includes a special chapter for basic knowledge of DRIs. The energy recommendation is provided as an estimated energy requirement (EER), while five indices were used for nutrients: Estimated average requirement (EAR), recommended dietary allowance (RDA), adequate intake (AI), tolerable upper intake level (UL), and tentative dietary goal for preventing lifestyle-related [chronic non-communicable] diseases (DG). Whilst the first four indices are same as the ones used in other countries, DG is unique index in Japan, which was set as a reference value for preventing non-communicable diseases such as cardiovascular (including hypertension), major types of cancer and osteoporosis. This report (DRI-J) is the first dietary guidance in Japan, which applied evidence-based approach utilizing a systematic review process. Only a few articles from within Japan and other Asian countries could be used for its establishment. The project to establish the DRI-J revealed a severe lack of researchers and publications focused upon establishing DRIs for Japanese. Further review is therefore required in preparation for the next revision scheduled in 2010.

Evaluation of an interactive, Internet-based weight loss program: a pilot study

The Internet can access a large number of consumers in a more cost-effective manner than other information delivery channels. In this pilot study, we assessed whether an online weight reduction program including dietary advice plus exercise (ED) was more effective in reducing weight than an exercise-only program (EX) >12 weeks. Participants were randomized to either the ED or EX group and attended a center for anthropometric measurements and dietary assessment. Both groups wore a pedometer and set weekly goals to increase daily steps through an interactive Web site. The ED group set weekly dietary goals via the Web site and received tailored e-mail assistance. Seventy-three participants commenced and 53 (73%) completed the study [EX n = 26; ED n = 27; body mass index-mean (standard deviation): 29.7 (2.5) kg m(-2), age 46.3 (10.8); 21% male]. Percent weight changes were EX, 2.1 (0.6)% and ED, 0.9 (0.6)% (P = 0.15). Both groups increased their daily steps with no difference between groups. Only the ED group significantly reduced their energy intake. Despite a greater fall in energy intake reported by the ED group and a similar increase in physical activity in both groups, setting individual dietary goals did not enhance weight loss.

Development of web‐based nutrition education system for prevention and management of childhood obesity

Increase in childhood obesity is a serious problem worldwide. To combat this issue, web‐based nutrition education may be effective due to easy access and availability to children. We developed a website consisting of 3 parts; 1) to self‐assess obesity index, dietary intake and behavior, energy consumption, food frequency, nutrition knowledge, and the stages of behavioral change. This site also provides messages on the assessment results and advice for improvements; 2) to keep follow‐up records for a user to establish dietary and exercise goals, and to maintain follow‐up records of dietary intake and exercise; and 3) to allow children to study by providing tailored information and games. For this entire system, a screening instrument (dietary behavior, nutrition knowledge and etc.) was developed and the reliability was tested. A database including nutrients of 500 common cooked foods was created to calculate dietary intake, and a database with energy expenditure of 165 physical activities was developed to calculate energy expenditure. Message source files designed for all potential feedback for each individual were also created. Our web‐based tailored nutrition education system can be used by a child alone or with parents or teachers who desire to control body weight through healthy eating habits and physical activities.Research Support: Korea Research Foundation Grant (2005‐KRF‐204‐C00102)

Compliance to an Exchange‐list Mediterranean Diet

A Greek‐Mediterranean dietary pattern has great potential for cancer prevention. We developed an exchange list diet that would target key nutrient intakes of the Mediterranean eating pattern. The goals were to replace half of usual polyunsaturated fat intake with monounsaturated fats (MUFA) and to increase intakes of a wide variety of fruits and vegetables, including dark green vegetables, allium vegetables and herbs. A total of 69 women, ages 25–59, were enrolled in the study and randomized to the Mediterranean diet or not for 6 months. Subjects in the Mediterranean diet arm received individualized telephone counseling. Menus were provided as examples, but the diets were self‐selected. Compliance to the dietary goals was assessed by 7‐day food records and by levels of plasma fatty acids, lipids and carotenoids. The women were able to make large changes. Intake of MUFA increased by 48% without a change in overall fat intake. Fatty acids levels in plasma changed in the same direction as dietary fatty acids, but were smaller in magnitude. Intakes of carotenoids more than doubled in the Mediterranean diet arm, and plasma total carotenoids increased by 65%. A statistical model was developed to identify clustered outcome variables. This modified Mediterranean diet will be tested for its effects on markers of cancer risk in future studies.Supported by AICR grant #03B043.

Dietary intake of older patients in hospital and at home: the validity of patient kept food diaries.

To investigate the validity of a patient kept food diary in relation to weighted intakes and to measure dietary intakes of older people both in hospital and after discharge at home. A randomly selected cohort of hospitalised elderly patients was recruited. All patients were instructed how to keep a record of all food and drink consumed and any leftovers. Food diaries were kept for up to seven days in hospital and for seven days in the community. In 18 consecutive patients dietary records were compared with weighed intake. Associate Teaching Hospital, United Kingdom. A total of 116 patients participated in the study (median age 77 years, range 66-86 yrs; 49 female). We found significant correlations between food diary and weighted macronutrient intakes both in hospital and in the community. Overall the food diary predicted within+/-17% weighted energy intakes in 70% of individuals. Compared with the National Diet and Nutrition Survey for free-living elderly people in the UK (1998), we found more or less similar energy and micronutrient intakes in hospital, but lower intakes at home. Patients kept food diaries can be used to identify those at risk of undernutrition and monitor those on nutritional support. It can also be used for nutritional education and for achieving dietary goals.

Nutritional Education and Exercise Treatment Based on Cognitive Behavioral Treatment in the Saku Control Obesity Program (SCOP)

BACKGROUND: Long-term weight loss is difficult to maintain, but recently cognitive behavioral therapy has been shown to be effective for long-term weight loss and maintenance.METHODS: The 119 participants, who had been assigned to program to lose weight, were interviewed by dieticians regarding their motivation for weight loss and psychological status and self-corrected problems with their eating activities and exercises, following recognition of problems, discussing solutions, and devising personal dietary plans and exercise plan to loose weight at 1.0-2.0 kg per month.RESULTS: In women, the prevalence of motivation to resolve the situation (n = 44, 84.6%) was significantly higher than that of men (n = 33, 67.3%; p < 0.05). In men, awareness of the need to keep healthy by oneself was significantly associated with the motivation to resolve the situation (p = 0.002) and the availability of support from others (p = 0.004). Thirty problems and 29 dietary goals were set by participants. The percentages of intake of alcohol (p < 0.05) and intake of sweets (p < 0.01) as the problems and decrease of intake in specified foods (p < 0.01) and snacks (p = 0.05) as dietary goals were significantly different between men and women. Women with BMI over 31 kg/m² set fewer additional steps as exercise goals than those with BMI under 29 kg/m² (p < 0.05).CONCLUSIONS: The characters of subjects such as psychological status and the problems and the target recognized by participants were different between gender and the degree of obesity.

Unrealistic weight loss expectations in candidates for bariatric surgery

Unrealistic expectations of weight loss are prevalent in obese patients and can negatively affect their adherence to dietary and health goals. We sought to examine the expectations and perceived notions about weight loss in candidates for bariatric surgery. A total of 284 consecutive and prospective bariatric patients were surveyed using a validated Goals and Relative Weights questionnaire before an educational seminar. The participants categorized their weight loss expectations as "dream," "happy," "acceptable," and "disappointed" and rated the effect of surgically-induced weight loss on 21 indicators of health, quality of life, social functioning, and self-image on a 1-10 scale. The data are presented as the mean +/- standard deviation. Of the 284 patients, 230 were women and 54 were men (age 45 +/- 10 years; body mass index 50 +/- 8 kg/m(2)). These patients stated that their "dream" weight would be 89% +/- 8% excess body weight loss and that 77% +/- 9%, 67% +/- 10%, 49% +/- 14% excess body weight loss would be their "happy," "acceptable," and "disappointed" weight, respectively. Participants ranked health, fitness, body image, work performance, and self-confidence as the most important benefits of bariatric surgery. Women had greater "happy" and "acceptable" weight loss expectations and put more emphasis on physical presence (r = .17-.33, P <.01). Younger patients put more emphasis on attractiveness and improvements in social and sex life after bariatric surgery (r = .15-.19, P <.01). The results of our study have shown that although the candidates for bariatric surgery understand its benefits, they have unrealistic expectations of weight loss. In our study, the patients' most modest weight loss expectation, the "disappointed" weight, was equivalent to what providers would consider a successful weight loss outcome after bariatric surgery. Setting realistic expectations is an important aspect of the preoperative evaluation and education, especially for younger women.

The "Goal Setting Approach" for Overweight and Obese Patients: Results of a Retrospective Cohort Study in a Dietetic Consultation

Purpose: To describe the performance of a dietary procedure based on a cognitive behavioral approach among overweight or obese patients. Methods: Standardized 45 minutes consultations were conducted by a dietician to obese (n=139) and overweight (n=56) patients followed between 1998 and 2003 at the dietetic consultation of the Outpatient clinic of the University Hospitals of Geneva. Outcome measures were the proportion of eating behavior changes and weight change over time. Results: Patients attended a mean of 7 consultations and reached on average 57% of their dietary behavioral goals. At the end of follow-up, 36 (19%) patients had lost at least 5% of initial weight (mean weight change 8 kg SD 3.9) and 8 (4%) had gained at least 5% of initial weight. Major life events, night eating syndrome, and a lower proportion of reached goals were associated with weight gain. Conclusions: Dietetic treatment based on behavioral goal setting shows encouraging results in terms of weight evolution and is compatible with standard care reimbursement in many countries. Dieticians and other health professionals could focus on behavioral goals to be achieved in the short term.

Revised dietary guidelines for Koreans.

With rapidly changing dietary environment, dietary guidelines for Koreans were revised and relevant action guides were developed. First, the Dietary Guidelines Advisory Committee was established with experts and government officials from the fields of nutrition, preventive medicine, health promotion, agriculture, education and environment. The Committee set dietary goals for Koreans aiming for a better nutrition state of all after a thorough review and analysis of recent information related to nutritional status and/or problems of Korean population, changes in food production/supply, disease pattern, health policy and agricultural policy. Then, the revised dietary guidelines were proposed to accomplish these goals in addition to 6 different sets of dietary action guides to accommodate specific nutrition and health problems of respective age groups. Subsequently, these guidelines and guides were subjected to the focus group review, consumer perception surveys, and a public hearing for general and professional comments. Lastly, the language was clarified in terms of public understanding and phraseology. The revised Dietary guidelines for Koreans are as follows: eat a variety of grains, vegetables, fruits, fish, meat, poultry and dairy products; choose salt-preserved foods less, and use less salt when you prepare foods; increase physical activity for a healthy weight, and balance what you eat with your activity; enjoy every meal, and do not skip breakfast; if you drink alcoholic beverages, do so in moderation; prepare foods properly, and order sensible amounts; enjoy our rice-based diet.

A Family-based Intervention to Promote Healthy Lifestyles in an Aboriginal Community in Canada

Obesity is a major public health problem in North America, particularly in Aboriginal people. To determine if a household-based lifestyle intervention is effective at reducing energy intake and increasing physical activity among Aboriginal families after 6 months. Randomized, open trial of 57 Aboriginal households recruited between May 2004 and April 2005 from the Six Nations Reserve in Ohsweken, Canada. Aboriginal Health Counsellors made regular home visits to assist families in setting dietary and physical activity goals. Additional interventions included provision of filtered water, a physical activity program for children, and educational events about healthy lifestyles. 57 households involving 174 individuals were randomized to intervention or usual care. Intervention households decreased consumption of fats, oils and sweets compared to usual care households (-4.9 servings per day vs. -3 servings/day, p=0.006), and this was associated with a reduction in trans fatty acids (-0.2 vs. +0.6 grams/day, p=0.02). Water consumption increased (+0.3 vs. -0.1 servings/day, p<0.04) and soda pop consumption decreased (-0.3 vs. -0.1 servings/day, p=0.02) in intervention households compared to usual care. A trend toward increased knowledge about healthy dietary practices in children, increased leisure-time activity and decreased sedentary behaviours was observed, although these differences were not statistically significant. A household-based intervention is associated with some positive changes in dietary practices and activity patterns. A larger and longer-term intervention which addresses both individual change and structural barriers in the community is needed.

The Polyp Prevention Trial–Continued Follow-up Study: No Effect of a Low-Fat, High-Fiber, High-Fruit, and -Vegetable Diet on Adenoma Recurrence Eight Years after Randomization

The Polyp Prevention Trial (PPT) was a multicenter randomized clinical trial to evaluate the effects of a high-fiber (18 g/1,000 kcal), high-fruit and -vegetable (3.5 servings/1,000 kcal), and low-fat (20% of total energy) diet on the recurrence of adenomatous polyps in the large bowel over a period of 4 years. Although intervention participants reported a significantly reduced intake of dietary fat, and increased fiber, fruit, and vegetable intakes, their risk of recurrent adenomas was not significantly different from that of the controls. Since the PPT intervention lasted only 4 years, it is possible that participants need to be followed for a longer period of time before treatment differences in adenoma recurrence emerge, particularly if diet affects early events in the neoplastic process. The PPT-Continued Follow-up Study (PPT-CFS) was a post-intervention observation of PPT participants for an additional 4 years from the completion of the trial. Of the 1,905 PPT participants, 1,192 consented to participate in the PPT-CFS and confirmed colonoscopy reports were obtained on 801 participants. The mean time between the main trial end point colonoscopy and the first colonoscopy in the PPT-CFS was 3.94 years (intervention group) and 3.87 years (control group). The baseline characteristics of 405 intervention participants and 396 control participants in the PPT-CFS were quite similar. Even though the intervention group participants increased their fat intake and decreased their intakes of fiber, fruits, and vegetables during the PPT-CFS, they did not go back to their prerandomization baseline diet (P < 0.001 from paired t tests) and intake for each of the three dietary goals was still significantly different from that in the controls during the PPT-CFS (P < 0.001 from t tests). As the CFS participants are a subset of the people in the PPT study, the nonparticipants might not be missing completely at random. Therefore, a multiple imputation method was used to adjust for potential selection bias. The relative risk (95% confidence intervals) of recurrent adenoma in the intervention group compared with the control group was 0.98 (0.88-1.09). There were no significant intervention-control group differences in the relative risk for recurrence of an advanced adenoma (1.06; 0.81-1.39) or multiple adenomas (0.92; 0.77-1.10). We also used a multiple imputation method to examine the cumulative recurrence of adenomas through the end of the PPT-CFS: the intervention-control relative risk (95% confidence intervals) for any adenoma recurrence was 1.04 (0.98-1.09). This study failed to show any effect of a low-fat, high-fiber, high-fruit and -vegetable eating pattern on adenoma recurrence even with 8 years of follow-up. (Cancer Epidemiol Biomarkers Prev 2007;16(9):1745-52).

A randomized clinical trial of a standard versus vegetarian diet for weight loss: the impact of treatment preference

With obesity rampant, methods to achieve sustained weight loss remain elusive. To compare the long-term weight-loss efficacy of 2 cal and fat-restricted diets, standard (omnivorous) versus lacto-ovo-vegetarian, and to determine the effect of a chosen diet versus an assigned diet. A randomized clinical trial was conducted with 176 adults who were sedentary and overweight (mean body mass index, 34.0 kg/m(2)). Participants were first randomly assigned to either receive their preferred diet or be assigned to a diet group and second, were given their diet of preference or randomly assigned to a standard weight-loss diet or a lacto-ovo-vegetarian diet. Participants underwent a university-based weight-control program consisting of daily dietary and exercise goals plus 12 months of behavioral counseling followed by a 6-month maintenance phase. Percentage change in body weight, body mass index, waist circumference, low- and high-density lipoprotein, glucose, insulin and macronutrient intake. The program was completed by 132 (75%) of the participants. At 18 months, mean percentage weight loss was greater (P=0.01) in the two groups that were assigned a diet (standard, 8.0% (s.d., 7.8%); vegetarian, 7.9% (s.d., 8.1%)) than in those provided the diet of their choice (standard, 3.9% (s.d., 6.1%); vegetarian, 5.3% (s.d., 6.2%)). No difference was observed in weight loss between the two types of diet. Over the 18-month program, all groups showed significant weight loss. Participants assigned to their dietary preference did not have enhanced treatment outcomes. However, all groups lost weight with losses ranging from 4 to 8% at 18 months.

Portuguese households’ diet quality (adherence to Mediterranean food pattern and compliance with WHO population dietary goals): trends, regional disparities and socioeconomic determinants

To evaluate households' diet-quality trends and regional disparities, as well as to identify the influence of its socioeconomic determinants. Two dietary indexes were applied: a revised Healthy Diet Indicator version (HDIr) and the Mediterranean Adequacy Index (MAI). The socioeconomic differences between households with low-diet quality (if their scoring in HDIr or MAI was below the national median) and the remaining ones were analysed by means of logistic regression. Representative samples of households among each region were analysed. Adherence to a Mediterranean diet was poor in all Portuguese regions; the proportion of households adhering to it has diminished in the North, Centre, Lisbon and Tejo valley. The proportion of households with high HDIr decreased in the North, Centre, Lisbon and Tejo valley and Algarve. In multivariate analysis, households whose head had secondary or higher education, living in semi-urban or urban areas, from the Azores region, within the higher income or outside home food expenditures groups were more likely to be in low-quality diet. The decreasing adherence to a Mediterranean food pattern and the diminishing compliance with World Health Organization dietary goals show that Portuguese households have reduced their diet quality. The observed influence of urbanization and region on diet quality highlights the importance of considering regional nutrition strategies.

Predictors of Dietary Change and Maintenance in the Women’s Health Initiative Dietary Modification Trial

Objective To identify predictors of dietary change to and maintenance of a low-fat eating pattern (<20% energy from fat, ≥5 servings fruits/vegetables daily, and ≥6 servings grains daily) among a cohort of postmenopausal women. Candidate predictors included intrapersonal, interpersonal, intervention program characteristics, and clinical center. Design Longitudinal study within the Women’s Health Initiative Dietary Modification Trial. Dietary change was evaluated after 1 year of participation in the Women’s Health Initiative Dietary Modification Trial, and dietary maintenance after 3 years. Subjects Postmenopausal women aged 50 to 79 years at baseline who were randomized to the intervention arm of the Women’s Health Initiative Dietary Modification Trial (n=19,541). Statistical analysis Univariate and multivariate linear regression analysis was performed and associations evaluated between candidate predictors and each of the three dietary goals: percent energy from fat, fruit/vegetable servings, and grain servings. Results Year 1 (change) predictors of percent energy from fat ( P<0.005) included being younger (β=2.12; 70 to 79 years vs 50 to 59 years), more educated (β=–.69; college vs high school), more optimistic (β=–.07), attending more sessions (β=–.69), and submitting more self-monitoring records (β=–.74). At year 3 (maintenance), the predictors of percent energy from fat ( P<0.005) included attending more sessions (β=–.65) and submitting more self-monitoring scores (β=–.71). The analytic model predicted 22% of the variance in fat intake at year 1 and 27% at year 3 ( P<0.01). Conclusions The strongest predictors of dietary change and maintenance were attending intervention sessions and self-monitoring dietary intake. Novel was the finding that optimism predicted dietary change.

Promoting Healthy Diets and Tackling Obesity and Diet-Related Chronic Diseases: What are the Agricultural Policy Levers?

Diet-related chronic diseases are now a serious global public health problem. Public health groups are calling for the agricultural sector to play a greater role in tackling the threat. To identify potential points of policy intervention in the agricultural sector that could be leveraged to promote healthy diets and tackle obesity and diet-related chronic diseases. A review of the literature on the dietary implications of agriculture, a conceptual analysis of the issues, and the identification of relevant examples. There are two main potential points of intervention in the agricultural sector that could be leveraged to promote healthy diets: agricultural policies and agricultural production practices. Agricultural policies and practices affect diet through their influence on food availability, price, and nutrient quality, which in turn affects food choices available to consumers. Agricultural policies amenable to intervention include input, production, and trade policies; agricultural production practices amenable to intervention include crop breeding, crop fertilization practices, livestock-feeding practices, and crop systems diversity. It is well-known that agricultural policies and production practices influence what farmers choose to grow. Agricultural policies and production practices could also play a role in influencing what consumers choose to eat. To identify how agricultural policies and practices can usefully contribute toward promoting healthy diets and tackling obesity and diet-related chronic diseases, health policymakers need to examine whether current agricultural policies and production practices are contributing to-or detracting from-efforts to attain dietary goals; where and how could agricultural intervention help achieve dietary goals; and whether there are trade-offs between these interventions and other important concerns, such as undernutrition and the livelihoods of agricultural producers. Given the potential of agriculture to contribute to large-scale, population-level dietary improvements, these questions warrant closer attention from health policymakers.