Percentage Of Total Energy Intake Research Articles

Nutritional status and food intake of HCV/HIV coinfected patients.

Hepatitis C virus (HCV) and human immunodeficiency virus (HIV) coinfection may cause nutrient deficiency and affect the nutritional status.Objetive: To assess nutritional status, and energy and macronutrient intake in HCV/HIV coinfected patients. Cross-sectional study on HIV/HCV-coinfected patients treated in a public hospital. Nutritional status was assessed by measurements of weight, height, waist circumference (WC), arm circumference (AC), triceps skinfold thickness (TST), non-dominant hand gripltrength (NDHGS), body mass index (BMI) and mid-upper arm circumference (MUAC). Dietary intake was assessed by 24-hour recall. Fifty-seven patients (59.6% women) with mean age of 46 ± 11.2 years were studied. According to BMI, more than half of patients were overweight or obese, and 41% of men and 68% of women had increased or substantially increased WC. The prevalence of malnutrition varied between the methods -10.5% (BMI), 29.8% (AC), 56.2% (TST), 17.6% (MUAC), and 12.3% (NDHGS). We found a high percentage of patients with inadequate intake of protein, fat and energy. The percentage of total energy intake (%TEI) from carbohydrates inversely correlated with WC and AC. A positive correlation was observed between %TEI from protein and NDHGS, and between %TEI from fat and BMI, WC and AC. We found a high prevalence of increased body weight and WC, and inadequate dietary intake in HCV/HIV coinfected patients. We observed a positive association between protein intake and muscle function, and between fat intake and obesity.

The effect of genotypical and phenotypical variation in taste sensitivity on liking of ice cream and dietary fat intake

Emerging evidence suggests fat can be perceived as a taste. G-protein coupled receptors as well as CD36, a fatty acid translocase, have been proposed to be involved in fat perception. Therefore, differences in number of receptors and genotype of CD36 have both been proposed to influence inter-individual fat taste perception. Fungiform papillae density (FPD) and PROP taster status are phenotypes related to receptor number. Previous authors have proposed an association between such phenotypes and CA6 (gustin) genotype, because the latter influences receptor cell proliferation. The effect of these factors on fat perception, preference and intake, requires further investigation. Therefore, the main aim of this study was to investigate the effects of taste sensitivity, including both genotypic and phenotypic variation, on liking of ice cream and dietary fat intake. Participants (n=136) age 18–55years were recruited in the UK. Hedonic liking results demonstrated that liking for ice cream was significantly affected by the fat content of the sample, and by demographic factors (gender, ethnicity, age) but not by the consumers CD36 rs1761667 or CA6 rs2274333 genotype, PROP taster status nor FPD. However, categorising taste sensitivity from participant responses to salt taste alone (rather than to salt and PROP) found significant differences, with low salt perceivers liking the high fat (20%) ice cream substantially more than medium- and high salt perceivers. This indicated that increased taste sensitivity reduced liking of high fat. Cluster analysis highlighted that one group of consumers (18%) liked higher fat ice cream, whereas another (30%) liked lower fat ice cream compared to the 52% of consumers that liked ice cream regardless of fat content. There was a significant association between these groups and salt taste sensitivity. Concerning recorded dietary intake, the high-fat liker group were found to have substantially higher dairy product consumption compared to high-fat dislikers. Fat intake as a percentage of total energy intake was significantly related to CA6 genotype, however the minor allele frequency at rs2274333 is too low to draw firm conclusions within this study population.

Added Sugars Intake Across the Distribution of US Children and Adult Consumers: 1977-2012

BackgroundPublic health organizations in the United States have recently increased focus on reducing population consumption of added sugars. ObjectiveThe objective of this study is to provide in-depth information on national trends in added sugars consumption and to examine both the mean and distribution of added sugars intake from 1977 to 2012. DesignWe conducted a descriptive study using six cross-sectional nationally representative surveys of food intake in the United States: the 1977-1978 National Food Consumption Survey (n=29,668), the 1989-1991 Continuing Survey of Food Intake by Individuals (n=14,827), the 1994-1998 Continuing Survey of Food Intake by Individuals (n=19,027), the 2003-2004 National Health and Nutrition Examination Survey (NHANES; n=8,273), the 2009-2010 NHANES (n=9,042), and the 2011-2012 NHANES (n=16,451). Statistical analysisWe examined the key dependent variables, calories from added sugars and percentage of total energy intake from added sugars, at the mean and by quintiles of added sugars consumption for children (2 to 18 years) and adults (19 years and older) across the survey years. We also examined trends in added sugars intakes from foods and beverages. We used ordinary least squares regression to examine linear trends between survey years and multinomial logistic regressions to examine sociodemographic characteristics by quintile of added sugars consumption. We adjusted estimates by race, income, sex, and education. ResultsThe US mean adjusted intake of added sugars remains high. In 2011-2012, children and adults consumed 326 kcal/day and 308 kcal/day, respectively, of added sugars, or 14% and 17%, respectively, of total their energy. For both children and adults, there was a considerable increase in calories from added sugars from 1977 to 2003, followed by a substantial decline from 2003 to 2012. There was no decline in the percentage of total energy intake from added sugars from 2003 to 2012. Changes over time were consistent across each quintile of added sugars consumption. The highest quintile of consumption was more likely to be male and in children was more likely to be non-Hispanic white. ConclusionsDespite a decline in consumption of added sugars since 2003 in the United States, mean adjusted added sugars intakes continue to be above the recommended level of 10% of the total energy intake. Changes in added sugars consumption from 1977 through 2012 occurred evenly across the distribution of added sugars intakes.

Recent Fast Food Consumption and Bisphenol A and Phthalates Exposures among the U.S. Population in NHANES, 2003-2010.

Background:Phthalates and bisphenol A (BPA) are widely used industrial chemicals that may adversely impact human health. Human exposure is ubiquitous and can occur through diet, including consumption of processed or packaged food.Objective:To examine associations between recent fast food intake and BPA and urinary metabolites of di(2-ethylhexyl) phthalate (ΣDEHPm) and diisononyl phthalate (DiNPm) among the U.S. population.Methods:We combined data on 8,877 participants from the National Health and Nutrition Examination Survey (NHANES 2003–2010). Using 24-hr dietary recall data, we quantified: a) fast food intake [percent of total energy intake (TEI) from fast food]; b) fast food-derived fat intake (percent of TEI from fat in fast food); and c) fast food intake by food group (dairy, eggs, grains, meat, and other). We examined associations between dietary exposures and urinary chemical concentrations using multivariate linear regression.Results:We observed evidence of a positive, dose–response relationship between fast food intake and exposure to phthalates (p-trend < 0.0001) but not BPA; participants with high consumption (≥ 34.9% TEI from fast food) had 23.8% (95% CI: 11.9%, 36.9%) and 39.0% (95% CI: 21.9%, 58.5%) higher levels of ΣDEHPm and DiNPm, respectively, than nonconsumers. Fast food-derived fat intake was also positively associated with ΣDEHPm and DiNPm (p-trend < 0.0001). After adjusting for other food groups, ΣDEHPm was associated with grain and other intake, and DiNPm was associated with meat and grain intake.Conclusion:Fast food may be a source of exposure to DEHP and DiNP. These results, if confirmed, could inform individual and regulatory exposure reduction strategies.Citation:Zota AR, Phillips CA, Mitro SD. 2016. Recent fast food consumption and bisphenol A and phthalates exposures among the U.S. population in NHANES, 2003–2010. Environ Health Perspect 124:1521–1528; http://dx.doi.org/10.1289/ehp.1510803

Dairy Based Desserts are Negatively Associated with Bone Mineral Density among Puerto Rican Adults

BackgroundDairy foods have been shown to be protective for bone health, as these foods are a rich source of many nutrients known to be beneficial to bone. The majority of research on dairy and bone health has been conducted in Caucasian populations. It is important to study these associations in Latino populations as they are at high risk for developing osteoporosis. Further, their dietary patterns differ from other ethnic populations.ObjectiveTo examine the association of total dairy and dairy food groups with bone mineral density (BMD) among older Puerto Rican adults from the Boston Puerto Rican Osteoporosis Study, an ancillary study to the Boston Puerto Rican Health Study (BPRHS).MethodsDiet was assessed at baseline of the BPRHS by a food frequency questionnaire, adapted and validated for use in this population. BMD (g/cm2) was measured by whole body dual energy x‐ray absorptiometry at the hip and lumbar spine, L2–L4 approximately 2y after baseline. Participants were excluded if their t‐scores were greater than −4.0, and/or their total energy intake was &gt;4,800 kcal/d or &lt;600 kcal/d. Therefore, our total sample with bone, diet and covariate measures was 883 for models of the hip and 864 for the lumbar spine. Dairy intake was categorized into four groups: total dairy, fluid dairy (milk and yogurt), cheese, and dairy dessert (combined intake of the following: pudding, ice cream, cheesecake, custard/flan, cream). To account for total energy, all dairy groups were calculated as percentage of total energy intake. Tertiles of each dairy group were created, where tertile 3 (T3) represents the highest intake, and tertile 1 (T1) represents the lowest intake. Generalized linear regression compared adjusted least‐squares mean BMD across tertiles of dairy food groups.ResultsAverage age was 60±7y (range: 46–79); average BMI 32±7 kg/m2; and 73% of the sample were women. The median percent energy intake from each dairy group, by tertile was: total dairy, T1 6.0%, T2 11.6%, T3 18.6%; fluid dairy, T1 2.0%, T2 5.9%, T3 11.7%; cheese, T1 0.7%, T2 2.7%, T3 6.0%; dairy dessert, T1 0.1%, T2 0.9%, T3 3.3%. Total dairy intake was not associated with BMD at any site after adjustment for covariates (p‐trend range: 0.43–0.64). In dairy food group analyses, BMD at the hip and spine did not differ across tertiles of fluid dairy intake (p‐trend range: 0.24–0.66) or cheese intake (p‐trend range: 0.16–0.35). A significant, negative association was observed between high intakes of dairy dessert with BMD at the femoral neck (T2vsT1, p=0.02; T3vsT1, p=0.02); total femur (T2vsT1, p=0.02; T3vsT1, p=0.04) and lumbar spine (T3vsT1, p=0.04) (Figure).ConclusionsTotal dairy intake is not associated with BMD in older Puerto Rican adults, despite their relatively high percentage contribution to total energy. However, higher intake of dairy desserts is negatively associated with BMD. Further investigation will explore why dairy desserts contribute to lower BMD in this population.Support or Funding InformationP01 AG023394P50 HL105185R01 AG027087

Free Sugars and Total Fat Are Important Characteristics of a Dietary Pattern Associated with Adiposity across Childhood and Adolescence

Background: The importance of dietary sugar compared with fat in the development of obesity is currently a topic of debate.Objective: We aimed to identify dietary patterns (DPs) characterized by high sugar content, high fat content, or both and their longitudinal associations with adiposity during childhood and adolescence.Methods: Participants were 6722 children from the ALSPAC (Avon Longitudinal Study of Parents and Children) who were born in 1991–1992. DPs were characterized by percentage of total energy intake (%E) from free sugars, %E from total fat, and dietary energy density (DED) and fiber density by using reduced rank regression at 7, 10, and 13 y of age. Total body fat mass was measured at 11, 13, and 15 y of age. Regression analyses were used to adjust for dietary misreporting, physical activity, and maternal social class.Results: Two major DPs were identified: higher z scores for DP1 were associated with greater DED, greater %E from free sugars and total fat, and lower fiber density; higher z scores for DP2 were associated with greater %E from free sugars but lower %E from total fat and DED. A 1-SD increase in z score for DP1 was associated with a mean increase in the fat mass index z score of 0.04 SD units (95% CI: 0.01, 0.07; P = 0.017) and greater odds of excess adiposity (OR: 1.12; 95% CI: 1.0, 1.25; P = 0.038). DP2 was not associated with adiposity.Conclusions: An energy-dense DP high in %E from total fat and free sugars is associated with greater adiposity in childhood and adolescence. This appears to confirm the role of both fat and sugar and provides a basis for food-based dietary guidelines to prevent obesity in children.

The contribution of subsidized food commodities to total energy intake among US adults.

The contribution of subsidized food commodities to total food consumption is unknown. We estimated the proportion of individual energy intake from food commodities receiving the largest subsidies from 1995 to 2010 (corn, soyabeans, wheat, rice, sorghum, dairy and livestock). Integrating information from three federal databases (MyPyramid Equivalents, Food Intakes Converted to Retail Commodities, and What We Eat in America) with data from the 2001-2006 National Health and Nutrition Examination Surveys, we computed a Subsidy Score representing the percentage of total energy intake from subsidized commodities. We examined the score's distribution and the probability of having a 'high' (≥70th percentile) v. 'low' (≤30th percentile) score, across the population and subgroups, using multivariate logistic regression. Community-dwelling adults in the USA. Participants (n 11 811) aged 18-64 years. Median Subsidy Score was 56·7 % (interquartile range 47·2-65·4 %). Younger, less educated, poorer, and Mexican Americans had higher scores. After controlling for covariates, age, education and income remained independently associated with the score: compared with individuals aged 55-64 years, individuals aged 18-24 years had a 50 % higher probability of having a high score (P<0·0001). Individuals reporting less than high-school education had 21 % higher probability of having a high score than individuals reporting college completion or higher (P=0·003); individuals in the lowest tertile of income had an 11 % higher probability of having a high score compared with individuals in the highest tertile (P=0·02). Over 50 % of energy in US diets is derived from federally subsidized commodities.

Associations of Protein Intake and Protein Source with Bone Mineral Density and Fracture Risk: A Population-Based Cohort Study.

High dietary protein has been hypothesized to cause lower bone mineral density (BMD) and greater fracture risk. Previous results are conflicting and few studies have assessed potential differences related to differing protein sources. To determine associations between total protein intake, and protein intake by source (dairy, non-dairy animal, plant) with BMD, BMD change, and incident osteoporotic fracture. Prospective cohort study (Canadian Multicentre Osteoporosis Study). Participants/Measures: Protein intake was assessed as percent of total energy intake (TEI) at Year 2 (1997-99) using a food frequency questionnaire (N=6510). Participants were contacted annually to ascertain incident fracture. Total hip and lumbar spine BMD was measured at baseline and Year 5. Analyses were stratified by group (men 25-49 y, men 50+ y, premenopausal women 25-49 y, and postmenopausal women 50+ y) and adjusted for major confounders. Fracture analyses were limited to those 50+ y. Intakes of dairy protein (with adjustment for BMI) were positively associated with total hip BMD among men and women aged 50+ y, and in men aged 25-49. Among adults aged 50+ y, those with protein intakes of <12% TEI (women) and <11% TEI (men) had increased fracture risk compared to those with intakes of 15% TEI. Fracture risk did not significantly change as intake increased above 15% TEI, and was not significantly associated with protein source. In contrast to hypothesized risk of high protein, we found that for adults 50+ y, low protein intake (below 15% TEI) may lead to increased fracture risk. Source of protein was a determinant of BMD, but not fracture risk.

The potential impact of animal protein intake on global and abdominal obesity: evidence from the Observation of Cardiovascular Risk Factors in Luxembourg (ORISCAV-LUX) study.

To examine the association of total animal protein intake and protein derived from different dietary sources (meat; fish and shellfish; eggs; milk products) with global and abdominal obesity among adults in Luxembourg. Binary logistic regression analysis was used to assess the relationship between animal protein intake (as a percentage of total energy intake) and global obesity (BMI ≥ 30.0 kg/m(2)) and abdominal obesity (waist circumference ≥ 102 cm for men and ≥ 88 cm for women), after controlling for potential confounders. Observation of Cardiovascular Risk Factors in Luxembourg (ORISCAV-LUX) study. The study population was derived from a national cross-sectional stratified sample of 1152 individuals aged 18-69 years, recruited between November 2007 and January 2009. There was an independent positive association between total animal protein intake and both global (OR = 1.18; 95% CI 1.12, 1.25) and abdominal obesity (OR = 1.14; 95% CI 1.08, 1.20) after adjustment for age, gender, education, smoking, physical activity and intakes of total fat, carbohydrate, fibre, and fruit and vegetables. Protein intakes from meat, fish and shellfish were positively associated with global and abdominal obesity with further adjustment for vegetal protein and other sources of animal-derived protein (all P < 0.01). Protein derived from eggs or milk products was unrelated to global or abdominal obesity. Our findings suggest that protein derived from animal sources, in particular from meat, fish and shellfish, may be associated with increased risk of both global and abdominal obesity among presumably healthy adults in Luxembourg. These findings suggest that lower animal protein intakes may be important for maintenance of healthy body weight.

Effects of dietary macronutrient distribution on resting and post-exercise metabolism

Background Previous research has demonstrated that habitual dietary macronutrient distribution affects energy substrate utilization at rest and during exercise. The primary purpose of the current study was to examine the relationships between habitual baseline macronutrient intakes, expressed relative to bodyweight and percentage of total energy intake, and metabolism at rest and after exercise in women. Methods Twenty recreationally active women (Mean ± SD; Age 24.6 ± 3.9 yrs; Height 164.4 ± 6.6 cm; Weight 62.7 ± 6.6 kg; BF% 28.2 ± 4.8%) volunteered for the current study. Prior to metabolic testing, participants completed strength testing to determine their 1RM for six resistance exercises and completed a 3-day dietary log. Participants were provided with detailed instructions for accurately logging food intake and portion sizes, and instructed to record their regular food intake on two week days and one weekend day. Logs were analyzed using The Food Processor software (ESHA Research, Salem, OR, USA). Body composition was determined using dual-energy X-ray absorptiometry (DXA). Exercise was prescribed using baseline strength data and heart rate reserve calculations. Respiratory exchange ratio (RER) and resting energy expenditure (REE) were analyzed via indirect calorimetry (Parvomedics TrueOne 2400) before exercise (PRE), and during minutes 0-10 (IP), 25-35 (30min), and 50-60 (60min) post-exercise. Bivariate correlations and independent samples t-tests were completed using SPSS software (Version 19.0; IBM, Somers, NY, USA). Participants were stratified based on fat intake as a percentage of total caloric intake (high fat > 35% of total kcals, n=11; low fat 1.3 g/kg, n=11; low fat 35% of kilocalories from fat had a significantly higher bench press 1RM (p=0.048) and lower RER at 30min (p=0.033) and 60 min (p=0.033). Participants consuming > 1.3 g/kg of fat per day trended toward lower fat mass (p=0.09) and BF% (p=0.07). Conclusions Results indicate that baseline macronutrient distribution impacts post-exercise energy metabolism in women. Higher fat and lower CHO intake was associated with greater post-exercise REE and lower post-exercise RER, indicating greater fat utilization. Higher fat intakes may also influence resistance exercise performance and body composition; participants with higher fat intake had a greater bench press 1RM and trended towards lower indices of adiposity. These results suggest that the relative contributions of CHO and fat to total caloric intake may have significant implications for metabolism and body composition in women. Future research should evaluate the effects of modulating habitual macronutrient distribution to impart favorable effects on energy metabolism, body composition, and resistance exercise performance in women.

Results from a dietary survey in an Indian T2DM population: a STARCH study

ObjectiveTo assess the dietary total and complex carbohydrate (CHO) contents in type-2 diabetes mellitus (T2DM) participants in India.SettingWe enrolled 796 participants in this cross-sectional, single-visit, multicentre, two-arm, single-country survey. Participants...

Changes in food choice during a successful weight loss trial in overweight and obese postpartum women.

To examine changes in intake across food groups during a weight loss trial that produced significant and sustainable weight loss in lactating women receiving dietary treatment. At 10-14 wk postpartum, 61 overweight and obese lactating Swedish women were randomized to a 12-wk dietary (D), exercise (E), combined (DE), or control (C) treatment. Food intake was assessed by 4-d weighed diet records which were used to examine changes in intake across seven food groups from baseline to 12 wk and 1 y after randomization. Differences in changes in food choice between women receiving dietary treatment (D+DE) and no dietary treatment (E+C) were examined using multivariate linear regression. At baseline, sweets and salty snacks contributed to 21±10 percent of total energy intake (E%). During the intervention period, women receiving dietary treatment reduced their E% from sweets and salty snacks and caloric drinks and increased their E% from vegetables more than did women not receiving dietary treatment (all P < 0.010). At 1 y, the increased E% from vegetables was maintained significantly higher among women receiving dietary treatment (P = 0.002). Lactating women receiving dietary treatment achieved sustainable weight loss through changes in food choice in line with current dietary guidelines.

Dietary lipid supply in Lebanon: Does it fit the Mediterranean diet profile?

Lipids supply between 30–40% of total energy intake of Lebanese people and about 40% of this is derived from imported vegetable oils (soybean, sunflower, and corn oils). In Lebanon, olive oil, mostly locally produced, contributed to a consistently low percentage of total energy intake (2.2% on average) for the past forty five years. Although Lebanon borders the Mediterranean Sea, the Lebanese diet is far from the traditional Mediterranean diet. Compared to other Mediterranean countries, Lebanon has one of the lowest fish and seafood consumption rates. This pattern of consumption favors an increased ratio of omega-6:omega-3 with a concomitant low intake of omega-9. Efforts should focus on ways to increase fish and olive oil consumption.

Sleep and energy intake in early childhood

Background And Objectives:Shorter sleep is associated with higher weight in children, but little is known about the mechanisms. The aim of this study was to test the hypothesis that shorter sleep was associated with higher energy intake in early childhood.Methods:Participants were 1303 families from the Gemini twin birth cohort. Sleep duration was measured using the Brief Infant Sleep Questionnaire when the children were 16 months old. Total energy intake (kcal per day) and grams per day of fat, carbohydrate and protein were derived from 3-day diet diaries completed by parents when children were 21 months old.Results:Shorter nighttime sleep was associated with higher total energy intake (P for linear trend=0.005). Children sleeping <10 h consumed around 50 kcal per day more than those sleeping 11–<12 h a night (the optimal sleep duration for children of this age). Differences in energy intake were maintained after adjustment for confounders. As a percentage of total energy intake, there were no significant differences in macronutrient intake by sleep duration. The association between sleep and weight was not significant at this age (P=0.13).Conclusions:This study provides the first evidence that shorter nighttime sleep duration has a linear association with higher energy intake early in life. That the effect is observed before emergence of associations between sleep and weight indicates that differences in energy intake may be a mechanism through which sleep influences weight gain.

Dietary advice for reducing cardiovascular risk.

Changes in population diet are likely to reduce cardiovascular disease and cancer, but the effect of dietary advice is uncertain. This review is an update of a previous review published in 2007. To assess the effects of providing dietary advice to achieve sustained dietary changes or improved cardiovascular risk profile among healthy adults. We searched the Cochrane Central Register of Controlled Trials, the Database of Abstracts of Reviews of Effects (DARE) and the HTA database on The Cochrane Library (Issue 4, 2010). We searched MEDLINE (Ovid) (1950 to week 2 October 2010) and EMBASE (Ovid) (1980 to Week 42 2010). Additional searches were done on CAB Health (1972 to December 1999), CVRCT registry (2000), CCT (2000) and SIGLE (1980 to 2000). Dissertation abstracts and reference lists of articles were checked and researchers were contacted. Randomised studies with no more than 20% loss to follow-up, lasting at least three months and involving healthy adults comparing dietary advice with no advice or minimal advice. Trials involving children, trials to reduce weight or those involving supplementation were excluded. Two review authors independently assessed trial quality and extracted data. Study authors were contacted for additional information. Forty-four trials with 52 intervention arms (comparisons) comparing dietary advice with no advice were included in the review; 18,175 participants or clusters were randomised. Twenty-nine of the 44 included trials were conducted in the USA. Dietary advice reduced total serum cholesterol by 0.15 mmol/L (95% CI 0.06 to 0.23) and LDL cholesterol by 0.16 mmol/L (95% CI 0.08 to 0.24) after 3 to 24 months. Mean HDL cholesterol levels and triglyceride levels were unchanged. Dietary advice reduced blood pressure by 2.61 mm Hg systolic (95% CI 1.31 to 3.91) and 1.45 mm Hg diastolic (95% CI 0.68 to 2.22) and 24-hour urinary sodium excretion by 40.9 mmol (95% CI 25.3 to 56.5) after 3 to 36 months but there was heterogeneity between trials for the latter outcome. Three trials reported plasma antioxidants, where small increases were seen in lutein and β-cryptoxanthin, but there was heterogeneity in the trial effects. Self-reported dietary intake may be subject to reporting bias, and there was significant heterogeneity in all the following analyses. Compared to no advice, dietary advice increased fruit and vegetable intake by 1.18 servings/day (95% CI 0.65 to 1.71). Dietary fibre intake increased with advice by 6.5 g/day (95% CI 2.2 to 10.82), while total dietary fat as a percentage of total energy intake fell by 4.48% (95% CI 2.47 to 6.48) with dietary advice, and saturated fat intake fell by 2.39% (95% CI 1.4 to 3.37).Two trials analysed incident cardiovascular disease (CVD) events (TOHP I/II). Follow-up was 77% complete at 10 to 15 years after the end of the intervention period and estimates of event rates lacked precision but suggested that sodium restriction advice probably led to a reduction in cardiovascular events (combined fatal plus non-fatal events) plus revascularisation (TOHP I hazards ratio (HR) 0.59, 95% CI 0.33 to 1.08; TOHP II HR 0.81, 95% CI 0.59 to 1.12). Dietary advice appears to be effective in bringing about modest beneficial changes in diet and cardiovascular risk factors over approximately 12 months, but longer-term effects are not known.

Solid Fat and Added Sugar Intake Among U.S. Children

Little is known about the role of location in U.S. children's excess intake of energy from solid fat and added sugar, collectively referred to as SoFAS.The goal of this study was to compare the SoFAS content of foods consumed by children from stores, schools, and fast-food restaurants and to determine whether trends from 1994 to 2010 differ across these locations.Children aged 2-18 years (N=22,103) from five nationally representative surveys of dietary intake from 1994 to 2010 were studied. SoFAS content was compared across locations for total intake and key foods. Regression models were used to test and compare linear trends across locations. Data were analyzed in 2012.The mean percentage of total energy intake consumed from each location that was provided by SoFAS remained above recommendations, despite significant improvements between 1994 and 2010 at stores (1994, 38.3%; 2004, 33.2%); schools (1994, 38.7%; 2004, 31.2%); and fast-food restaurants (1994, 34.6%; 2004, 34.6%). For each key food, SoFAS content decreased significantly at stores and schools, yet progress at schools was comparatively slower. Milk was higher in SoFAS at schools compared to stores because of shifts toward flavored milk at schools. Schools provided french fries that were higher in solid fat than store-bought versions and pizza that was not significantly different in SoFAS content than fast-food pizza. However, schools made significantly greater progress for sugar-sweetened beverages, as lower-sugar beverages replaced regular sodas. Key fast foods showed little improvement.These findings can inform future strategies targeted to the specific locations and foods where continued progress is needed to reduce children's SoFAS consumption.

Association of total protein intake with bone mineral density and bone loss in men and women from the Framingham Offspring Study

To examine (i) the association of percentage of total energy intake from protein (protein intake %) with bone mineral density (BMD, g/cm2) and bone loss at the femoral neck, trochanter and lumbar spine (L2-L4) and (ii) Ca as an effect modifier. The Framingham Offspring Study. Men (n 1280) and women (n 1639) completed an FFQ in 1992-1995 or 1995-1998 and underwent baseline BMD measurement by dual-energy X-ray absorptiometry in 1996-2000. Men (n 495) and women (n 680) had follow-up BMD measured in 2002-2005. Cohort study using multivariable regression to examine the association of protein intake % with each BMD, adjusting for covariates. Statistical interaction between protein intake % and Ca (total, dietary, supplemental) intake was examined. The mean age at baseline was 61 (sd 9) years. In the cross-sectional analyses, protein intake % was positively associated with all BMD sites (P range: 0·02-0·04) in women but not in men. Significant interactions were observed with total Ca intake (<800 mg/d v. ≥800 mg/d) in women at all bone sites (P range: 0·002-0·02). Upon stratification, protein intake % was positively associated with all BMD sites (P range: 0·04-0·10) in women with low Ca intakes but not in those with high Ca intakes. In the longitudinal analyses, in men, higher protein intake % was associated with more bone loss at the trochanter (P = 0·01) while no associations were seen in women, regardless of Ca intake. This suggests that greater protein intake benefits women especially those with lower Ca intakes. However, protein effects are not significant for short-term changes in bone density. Contrastingly, in men, higher protein intakes lead to greater bone loss at the trochanter. Longer follow-up is required to examine the impact of protein on bone loss.

Association between melanocortin-4 receptor mutations and eating behaviors in obese patients: a case–control study

Melanocortin-4 receptor (MC4R) gene mutations are involved in the leptin-melanocortin pathways that control food intake. The effect of these mutations on eating behavior phenotypes is still debated. To determine the association between functional MC4R mutations and eating behaviors, dietary intake and physical activity, we sequenced the MC4R gene in 4653 obese adults. Among them, 19 adults carriers of functional MC4R mutation were matched on age, sex and body mass index with two randomly-paired controls without MC4R mutation (n=57). We found that eating behaviors and physical activity did not differ between groups. In particular, cases were not at increased risk of binge eating disorders. Subjects carriers of MC4R mutation reported a higher proportion of dietary carbohydrates intakes (43.2±7.1 and 39.2±8.1% of total energy intake, respectively, P=0.048) and a lower proportion of dietary lipids (34.3±6.7 and 38.5±6.7% of total energy intake, respectively, P=0.018). In conclusion, mutation carriers differ from controls by a higher consumption of carbohydrates counterbalanced by a lower consumption of lipids expressed as percentage of total energy intake. However, functional MC4R mutations do not have a higher risk of compulsive eating contrary to what was previously suggested.

The Baltic Sea Diet Score: a tool for assessing healthy eating in Nordic countries.

The health-related effects of the Nordic diet remain mostly unidentified. We created a Baltic Sea Diet Score (BSDS) for epidemiological research to indicate adherence to a healthy Nordic diet. We examined associations between the score and nutrient intakes that are considered important in promoting public health. We also examined the performance of the BSDS under two different cut-off strategies. The cross-sectional study included two phases of the National FINRISK 2007 Study. Diet was assessed using a validated FFQ. Food and nutrient intakes were calculated using in-house software. Nine components were selected for the score. Each component was scored according to both sex-specific consumption quartiles (BSDS-Q) and medians (BSDS-M), and summed to give the final score values. A large representative sample of the Finnish population. Men (n 2217) and women (n 2493) aged 25 to 74 years. In the age- and energy-adjusted model, adherence to the diet was associated with a higher intake of carbohydrates (E%), and lower intakes of SFA (E%) and alcohol (E%, where E% is percentage of total energy intake; P < 0·01). Furthermore, the intakes of fibre, Fe, vitamins A, C and D, and folate were higher among participants who adhered to the diet (P < 0·05). After further adjustments, the results remained significant (P < 0·05) and did not differ remarkably between BSDS-Q and BSDS-M. The BSDS can be used as a measure of a healthy Nordic diet to assess diet-health relationships in public health surveys in Nordic countries.

Implementation of a nutrition education program in a handball team; consequences on nutritional status.

To evaluate nutritional status and dietary habits after implementation of a nutritional education program in professional handball players. Longitudinal study of 14 handball players evaluated with 72-h recall, a questionnaire on food consumption and anthropometric measures during 4 months. The intervention consisted of a nutrition education program. Energy intake was consistently below the recommended allowances. Macronutrient intakes as a percentage of total energy intake were below the recommended allowances for carbohydrates, and above recommended allowances for fats. Nutritional education was followed by a significant increase (p < 0.01) in total energy and macronutrient intakes, with no significant changes in macronutrient or micronutrient intakes after adjustment for energy intake. The imbalance in nutrient intake in handball players suggests that detailed re-analysis is needed to determine specific recommendations for this population. Nutritional education with continuous follow-up to monitor athletes' dietary habits may lead them to adopt appropriate nutritional habits to optimize dietary intakes. The lack of specific recommendations for micronutrient intakes in athletes leads to confusion regarding appropriate intakes; biochemical tests that yield normal values (albeit approaching cut-off values for deficiency) may disguise deficient status for some nutrients when strenuous exercise is involved. In-depth studies with nutrition education programs that include long-term follow-up are advisable to avoid deficiencies that can lead to irreversible damage in competitive athletes.