Proportion Of Total Energy Intake Research Articles

Abstract MP48: Consumption of Low-Calorie Sweeteners Among Infants, Toddlers, and Preschoolers in the United States, NHANES 2013-2018

Introduction: Research has highlighted the rising consumption of low-calorie sweeteners (LCSs) and their possible negative health implications. While the American Academy of Pediatrics advises against beverages with LCSs for children under 5y, little is known about current consumption patterns among infants and young children in the United States. Objectives: To estimate the prevalence, frequency, and top sources of LCS intake among U.S. infants and young children and to investigate associations between LCS consumption and energy and macronutrient intake. Methods: We used one 24-h dietary recall from 3117 children aged 0-5y in the National Health and Nutrition Examination Survey (NHANES) 2013-18 to describe the prevalence and their frequency of consuming foods and beverages containing LCSs. We also compared total energy and macronutrient intake as a proportion of total energy intake (TEI) between LCS consumers and non-consumers. Complex survey procedures and sample weights were applied for all analyses. F-tests were used to compare consumption estimates across sociodemographic subgroups. Results: Thirty percent of all U.S. children aged 0-5y consumed foods and/or beverages with LCSs, including 17.5% of infants (0-1y), 34.3% of toddlers (2 and 3y), and 34.5% of preschoolers (4 and 5y). Prevalence of LCS consumption tended to be highest among non-Hispanic Blacks children and those from households with higher educational attainment or a higher family income. Among consumers, mean frequency of any LCS product, LCS beverages (LCSBs) only, and LCS foods (LCSFs) only was 1.4, 1.4, and 1.1 times/day, respectively, and did not differ by age. The most consumed of all LCSBs were fruit drinks (71.9%) and the most consumed of all LCSFs was yogurt (not-Greek) (59.5%). Compared to non-consumers, LCS consumers had higher intake of total energy, 1516 vs. 1316 kcal/day (p<.0001), carbohydrates, 54.0% vs 52.4% TEI (p=.0005), and added sugar, 3.3% vs. 2.1% TEI (p<.0001) but significantly lower intake of total fat and saturated fat, 33.1% vs 34.9% TEI (p<.0001) and 12.0% vs 13.1% TEI (p<.0001), respectively. Conclusions: LCS consumption is prevalent among infants and young children in the U.S. and fruit drinks and yogurt are the main sources. These results highlight the need for further research to understand long-term implications of this consumption. Funding sources: None.

Distribution of energy intake across the day and weight loss: A systematic review and meta-analysis.

Consuming a greater proportion of total energy intake earlier in the day rather than in the evening is proposed to positively influence weight loss and health, potentially due to greater synchronization of human body circadian rhythms. This systematic review provides an update on existing evidence regarding earlier distributed eating patterns in weight loss interventions. Using a robust search strategy in five electronic databases, nine randomized controlled trials investigating the impact of energy intake distribution on weight loss were identified. Following critical appraisal, a random-effects meta-analyses found that, in the context of an energy-reduced diet, distributing energy intake with a focus on earlier intake resulted in significantly greater weight loss (-1.23 kg; 95% CI 2.40, -0.06, p = 0.04). Improvements in HOMA-IR, fasting glucose, and LDL cholesterol were also seen. The current study provides a timely update on the evidence linking distribution of total daily energy intake and health, showing that a focus on earlier intakes can result in greater short-term weight loss compared with later intakes. Future studies are needed to elucidate the impact that earlier intakes may have on weight management and metabolic health.

Nutritional intake and food sources in an adult urban Kenyan population.

Urbanisation is hastening the transition from traditional food habits to less healthy diets, which are becoming more common among Kenyans. No up-to-date studies on usual dietary intake and the main food sources of adult Kenyans are available. The aim of the present study was to identify the main food sources of nutrients in the diet of urban adult Kenyans and explore potential associations with demographic variables including age, sex, level of education, occupation and body mass index. The study adopted a cross-sectional design. The dietary intake of 486 adult Kenyans from Nairobi was assessed using a validated, culture-sensitive, semi-quantitative food frequency questionnaire. Binary logistic regression models were used to evaluate associations between food sources and demographic variables. Macronutrient intakes as a proportion of total energy intake (TEI) were within international dietary guidelines. Cereals and grain products (34.0%), sugar, syrups, sweets and snacks (9.8%), fruits (9.7%) and meat and eggs (8.8%) were the major contributors to TEI. Cereals and grain products contributed 42.5% to carbohydrates, followed by fruits (12.4%) and sugar, syrups, sweets and snacks (10.6%). The most important sources of protein and total fat were cereals and grain products (23.3% and 19.7%, respectively) and meat and eggs (22.0% and 18.7%, respectively). Sex, age and level of education were associated with the choice of food groups. Although macronutrient intakes were within guidelines, the Kenyan diet was revealed to be high in sugars, salt and fibre, with differences in food sources according to demographic variables. These results can act as an incentive to national authorities to implement nutritional strategies aiming to raise awareness of healthier dietary patterns among Kenyans.

331 Dietary methionine restriction: an approach to treating obesity that does not involve food restriction

Abstract Dietary methionine restriction (MR) produces an integrated series of metabolic and physiological responses that develop quickly after introducing the diet. Collectively, these responses to the diet improve many biomarkers of metabolic health. Two prominent physiological responses are increases in energy intake and expenditure, with the larger effect on energy expenditure slowing ongoing fat deposition by increasing the proportion of total energy intake required for maintenance of existing tissue. A significant remaining obstacle in implementing dietary MR in a translational context will be to develop methionine-restricted diets that are palatable to higher metazoans.

Effects of 20-year infancy-onset dietary counselling on cardiometabolic risk factors in the Special Turku Coronary Risk Factor Intervention Project (STRIP): 6-year post-intervention follow-up

Primordial and primary prevention is the cornerstone for cardiometabolic health. In the randomised, controlled Special Turku Coronary Risk Factor Intervention Project (STRIP; n=1116), a 20-year dietary counselling intervention was given to children biannually from infancy, and cardiometabolic health benefits had been observed among the participants in the intervention group. Here, we report on the key results of the first follow-up done 6 years after the end of the intervention, at age 26 years. The randomised controlled STRIP study recruited children at age 5 months from well-baby clinics in Turku, Finland, and randomly assigned them to either an intervention or control group; group allocation was unmasked. The intervention introduced participants to a heart-healthy diet, characterised by low proportional intake of saturated fat and cholesterol, by dietary counselling and nutrition education sessions to parents and children from the age of 7 months to 20 years. Children in the control group received only the basic health education given at Finnish well-baby clinics and school health care. We assessed diet, lifestyle, and cardiometabolic risk factor data, including blood pressure, anthropometry, serum biochemistry (lipids, apolipoproteins, glucose, and insulin), and homoeostatic model assessment of insulin resistance (HOMA-IR) in the participants at age 26 years. 1116 children were included in the original STRIP study, of whom 551 provided data at the age 26 years follow-up, and data for 507 participants were analysed (243 in the intervention group and 264 in the control group). At follow-up, those who had been in the intervention group had slightly lower mean intake of saturated fat as a proportion of total energy intake than the control group (13·0% [SD 3·3] vs 13·7% [3·6], p=0·049). A higher proportion of participants in the intervention group achieved the targeted monounsaturated and polyunsaturated fat to saturated fat ratio of more than 2:1 than the control group (78 [39%] of 200 vs 70 [30%] of 235; risk ratio [RR] 1·16 [95% CI 1·01-1·33]; p=0·035). A higher proportion of intervention group participants met the ideal total cholesterol concentration of less than 5·17 mmol/L (194 [81%] of 240 vs 187 [72%] of 261; RR 1·45 [1·05-2·01], p=0·024) and optimal LDL cholesterol concentration of less than 3·0 mmol/L (166 [69%] of 240 vs 158 [61%] of 251; RR 1·30 [1·03-1·66], p=0·031). Those who received the intervention had lower glucose (5·00 mmol/L [SD 0·43] vs 5·07 mmol/L [0·46], p=0·040) and HOMA-IR (median 1·44 [IQR 1·09-1·91] vs 1·62 [1·22-2·09], p=0·037) than the participants in the control group. Previously observed intervention effects during the 20-year counselling were largely maintained into adulthood 6 years after the withdrawal of the intervention. Dietary counselling introduced in infancy thus provided a sustained benefit to diet quality and cardiometabolic risk factor levels. Academy of Finland, Juho Vainio Foundation, Finnish Foundation for Cardiovascular Research, Finnish Ministry of Education and Culture, Finnish Cultural Foundation, Sigrid Jusélius Foundation, Special Governmental grants for Health Sciences Research (Turku University Hospital), Yrjö Jahnsson Foundation, Finnish Medical Foundation, and Turku University Foundation.

Energy intake from unhealthy snack food/beverage among 12‐23‐month‐old children in urban Nepal

Unhealthy snack food and beverage (USFB) consumption among young children has been noted in many low‐income and middle‐income countries (LMIC), however, there is a lack of information on the contribution of these foods to children's diets in these contexts. This study describes the nutrient profiles and costs of snacks consumed by young children in Kathmandu Valley, Nepal, and assesses the proportion of total energy intake from nonbreastmilk foods (%TEI‐NBF) contributed by USFB and factors associated with high USFB consumption. A cross‐sectional survey was conducted among 745 randomly sampled primary caregivers of children aged 12–23 months. Of 239 unique snack foods and beverages consumed, 180 (75.3%) were classified as unhealthy based on nutrient profiling, with 158 of these being commercially branded. Median cost/100 kcal of USFB was lower as compared with healthy snacks. Ninety‐one percent of children had consumed a USFB in the previous 24 hr, with these foods contributing a mean %TEI‐NBF of 24.5 ± 0.7 among all children. Biscuits (10.8%), candy/chocolate (3.5%), and savoury snacks (3.4%) provided the largest %TEI‐NBF. Children who were older, female, or from the poorest households had significantly higher odds of high USFB consumption, whereas children whose caregivers were of upper caste/ethnicity or had achieved tertiary education had lower odds of consumption than other children. To reduce USFB consumption, interventions should seek to further understand social/cultural drivers of feeding practices, target disadvantaged populations, and ensure caregivers are fully aware of the nutritional quality of food products they choose for their children.

Association between breast milk intake at 9-10months of age and growth and development among Malawian young children.

World Health Organization recommends exclusive breastfeeding for infants for the first 6months of life, followed by introduction of nutritious complementary foods alongside breastfeeding. Breast milk remains a significant source of nourishment in the second half of infancy and beyond; however, it is not clear whether more breast milk is always better. The present study was designed to determine the association between amount of breast milk intake at 9-10months of age and infant growth and development by 12-18months of age. The study was nested in a randomized controlled trial conducted in Malawi. Regression analysis was used to determine associations between breast milk intake and growth and development. Mean (SD) breast milk intake at 9-10months of age was 752 (244)g/day. Mean (SD) length-for-age z-score at 12months and change in length-for-age z-score between 12 and 18months were -1.69 (1.0) and -0.17 (0.6), respectively. At 18months, mean (SD) expressive vocabulary score was 32 (24) words and median (interquartile range) skills successfully performed for fine, gross, and overall motor skills were 21 (19-22), 18 (16-19), and 38 (26-40), respectively. Breast milk intake (g/day) was not associated with either growth or development. Proportion of total energy intake from breast milk was negatively associated with fine motor (β=-0.18, p=.015) but not other developmental scores in models adjusted for potential confounders. Among Malawian infants, neither breast milk intake nor percent of total energy intake from breast milk at 9-10months was positively associated with subsequent growth between 12 and 18months, or development at 18months.

Using the protein leverage hypothesis to understand socioeconomic variation in obesity.

The protein leverage hypothesis (PLH) predicts that protein appetite will stimulate excess energy intake, and consequently obesity, when the proportion of protein in the diet is low. Experimental studies support the PLH, but whether protein leverage can be used to understand socioeconomic (SES) variation in obesity is unknown. The objective of this study was to test two hypotheses from the PLH under non-experimental conditions. Consistent with the PLH, we expect that (1) absolute protein intake will be similar across populations, here defined as SES groups and, (2) the proportion of protein in the diet will be inversely associated with energy intake. This was a cross-sectional study conducted in a random sample of 135 low-, middle-, and high-SES women in Costa Rica. Anthropometry was used to calculate body mass index (BMI). Twenty-four-hour dietary recalls were used to measure dietary intake. The prevalence of obesity varied between low- (38.8%), middle- (43.9%), and high- (17.8%) SES women. Absolute protein intake was similar across low- (58.5 g), middle- (59.4 g), and high- (65.6 g) SES women (p = 0.12). Protein intake as a proportion of total energy intake was inversely associated with total energy intake only among middle- (r = -0.37, p = 0.02) and high- (r = -0.36, p = 0.01) SES women. Consistent with the PLH, absolute protein intake was similar across SES groups. The relationship between the proportion of protein in the diet and total energy intake should be studied further in the context of real world conditions that may influence protein leverage.

Temporal eating patterns: a latent class analysis approach

BackgroundThere is some evidence that large energy intakes towards the end of the day are associated with adverse health outcomes, however, studies of temporal eating patterns across the day are rare. This study examines the temporal eating patterns of Australian adults using latent class analysis (LCA), as a novel approach.MethodsDietary data (n = 2402 men and n = 2840 women, ≥19 years) from two 24-h recalls collected during the 2011–12 Australian National Nutrition and Physical Activity Survey were analyzed. LCA was performed to identify distinct temporal eating patterns based on whether or not an eating occasion (EO) occurred within each hour of the day. F and adjusted-chi2 tests assessed differences in sociodemographic and eating patterns (e.g., meal, snack and EO frequency) between latent classes.ResultsThree patterns, labelled “Conventional” (men: 43%, women: 41%), “Later lunch” (men: 34%, women: 34%) and “Grazing” (men: 23%, women: 25%) were identified. Men and women with a “Grazing” pattern were significantly younger (P < 0.001) and a higher proportion were from major cities (P < 0.01) and were not married (men only, P = 0.01), compared to the “Conventional” and “Later lunch” patterns. The “Grazing” pattern was also characterized by a higher EO frequency (P < 0.01) and snack frequency (P < 0.001) and consumption of a higher proportion of total energy intake from snacks but a lower proportion of total energy intake from meals (P < 0.001).ConclusionsThis study identified three distinct temporal eating patterns in adults that varied by age, EO frequency, snack frequency and energy intake pattern. LCA is a useful approach to capture differences in EO timing across the day. Future research should examine associations between temporal eating patterns and health.

Perceptions of food availability and self-reported dietary intake in urban Costa Rican women: A Pilot Study

&lt;strong&gt;Background:&lt;/strong&gt; In Latin America, obesity is rising among women of low socioeconomic status (SES). Food availability and dietary intake are thought to be important contributors. In Costa Rica, few studies have investigated food availability, dietary intake, or how they vary by SES. &lt;strong&gt;Objectives:&lt;/strong&gt; The purpose of this study in San José, Costa Rica was to (1) evaluate women’s perceptions of food availability and, (2) describe dietary intake in women from low- and high-SES areas of the city. &lt;strong&gt;Methods:&lt;/strong&gt; Thirty non-pregnant, non-lactating women between 25 and 50 years were recruited in March 2013 from a low- and high-SES canton. Structured, qualitative interviews assessed perceptions of food availability in 17 of the 30 women. Quantitative 24-hour dietary recalls assessed dietary intake in all 30 women. &lt;strong&gt;Results:&lt;/strong&gt; Many women from the low-SES canton reported that they would include more chicken and fish in their diet if cost were not a barrier. Protein intake as a proportion of total energy intake was significantly greater in women from the high- versus low-SES canton (17% SD=5 vs. 13 SD=3, &lt;em&gt;p&lt;/em&gt; = 0.02). Protein intake from animal source foods was significantly greater in women from the high-SES canton (38 g SD=22 vs. 21 SD=11, &lt;em&gt;p&lt;/em&gt; = 0.02). &lt;strong&gt;Conclusion:&lt;/strong&gt; Protein intake was greater in high-SES women and this may be due to the perceived cost of animal source foods.

Higher proportion of total and fat energy intake during the morning may reduce absolute intake of energy within the day. An observational study in free-living Japanese adults

Background: Although the distribution of energy intake throughout the day appears to impact overall daily energy intake, little is known about the ad libitum distribution of energy intake. Objective: Our aim was to investigate associations between the distribution of energy intake during the day and subsequent or overall energy intake, and food choice in free-living adults. Design: A total of 119 women and 116 men completed 16-day semi-weighed dietary records. The longitudinal dietary intake data for each participant were analyzed using a mixed model to examine the effect of energy intake at various times of day on subsequent or overall energy intake. Results: Mean proportion of total energy intake in the morning (4:00 a.m.–10:29 a.m.), afternoon (10:30 a.m.–4:59 p.m.) and evening (5:00 p.m.–3:59 a.m.) meal was 22.6%, 33.8% and 43.6% in men, and 24.7%, 36.5%, 38.8% in women, respectively. Proportion of energy intake (%) in the morning meal was significantly and negatively associated with energy intake (kcal) in the subsequent afternoon and evening meals, and consequently in the whole day in both sexes. This significant and negative association was also observed for proportion of energy intake (%) of fat, but not of carbohydrate or protein, in both sexes. Proportion of energy intake (%) in the morning meal was negatively associated with overall energy intake (kcal) from the group of meats, fish, and eggs in both sexes, and from the group of confectioneries and soft drinks in women. Conclusions: More energy in the morning meal may reduce energy intake, especially that from fat, in the subsequent meals, and consequently in the whole day.

Examining Trends in Meal Patterns between 1995 and 2011 Using Two National Surveys

BackgroundWhile international research suggests that meal patterns of the population may be changing, possibly with adverse health consequences, little is known about the meal patterns of Australians. The aim of this study was to examine the changes in meal patterns of Australians between 1995 and 2011.Methods: Data from two nationally representative Australian surveys were used (1995 National Nutrition Survey, 10851 adults 蠅19 years, n=2986 children/adolescents 2‐18 years; 2011‐2013 National Nutrition and Physical Activity Survey, 8964 adults 蠅19 years, 2783 children/adolescents 2‐18 years). Dietary intake was assessed via 24‐hour recall and respondents and eating occasions (EOs) including meals and snacks were reported. Frequency of meals, snacks and all EOs, time between EOs and energy intake (EI) from meals, snacks and all EOs were compared between the two surveys using an F‐test. All results were weighted, adjusted for sample design effects and presented as means and Taylor linearized standard errors.Results: Overall, there was little change in frequency of total EOs over time. Time between EOs decreased among women but not men between 1995 and 2011‐12 (181 [1.15] vs 171 [1.29], P&lt;0.001) and among children (164 [1.40] vs 157 [1.47], P=0.001). The proportion of total EI from meals decreased in both children and adults between 3‐7% (P&lt;0.001) whereas the proportion of total EI from snacks increased between 3‐7% (P&lt;0.001).ConclusionsOverall, only small changes in meal patterns have occurred between 1995 and 2011 among children and adults. However, increases in the proportion of energy from snacks warrants further investigation. Future research will examine changes in nutrient profiles of meals and snacks over time.

Dietary Intake Of Athletes Seeking Nutrition Advice At A Major International Competition

Dietary intake can play an important role in athlete’s preparation for competition. However, there is currently limited data on the dietary intake of athletes from varying countries and sports while attending and competing at a major international competition. PURPOSE: To investigate the dietary intake of athletes who sought nutrition advice from dieticians located at a nutrition kiosk in the dining hall at the Delhi 2010 Commonwealth Games. METHODS: Four Australian Registered Dieticians based at the main dining hall nutrition kiosk performed a 24hr recall on a standard proforma with athletes who approached the nutrition kiosk for assistance. Dietary analysis was conducted using FoodWorks (Xyris Pty Ltd). RESULTS: A total of 30 athletes representing 15 countries (Africa, Caribbean, India, United Kingdom, and Oceania) and 12 sports (endurance, power/sprint, racquet, skill, team, and weight category) approached the kiosk prior to competition, with the majority requesting advice for weight management and making weight (n = 21). Overall, athletes reported consuming carbohydrate within the range of 1.0 - 9.0g/kg BW (M = 4.1g/kg BW) which contributed to 49% TE (range 14% - 79%), protein intake from 0.3 - 4.3g/ kg BW (M = 1.8g/kg BW) and 22% TE (range 8% - 48%), and fat intake from 9.5 - 130g (M = 68.6g, 28% TE). Athletes in weight category sports (n = 9) reported the lowest energy intake (M = 6909kJ, range 2384 - 14,560kJ), however had the highest contribution of energy from protein (M = 1.5g/kg BW, 26% TE), and lowest from carbohydrate (M = 2.9g/kg BW, 48% TE), and fat (M = 48.8g, 23% TE). The majority of athletes reported consuming 3 main meals (n = 23, 77%), with a high proportion of total energy intake at these meals versus snacks (M = 86% vs. 14% TE, SD = 12.2). Five athletes did not consume any snacks. Sports drinks were consumed mid meal by 14 athletes and contributed to over half of the TE between meals (M = 55%, SD = 32). CONCLUSIONS: The reported dietary intake of a sample of athletes requiring assistance at this large scale competition event suggests that a number of these athletes do not meet current, evidence based recommendations. Further investigation of the dietary intake of athletes prior to competition will assist with refi ning the nutrition support required to assist with meeting these recommendations.

Effect of a Low‐Intensity Parent‐Focused Nutrition Intervention on Dietary Intake of 2‐ to 5‐Year Olds

Community-based nutrition interventions aimed at influencing child dietary intake are rarely evaluated. We hypothesised that providing self-directed nutrition and parenting resources to parents living in rural northern New South Wales, Australia, would positively affect the dietary patterns of children ages 2 to 5 years. A total of 146 parent-child dyads (76 boys, ages 2.0-5.9 years) were randomly assigned to either a 12-month parent-centred intervention involving self-directed education provided in CD and DVD formats, or a participant-blinded control group who received generic nutrition and physical activity information. Data were collected at baseline, 3, and 12 months. Total reported energy from nutrient-dense food groups and percentage energy from energy-dense, nutrient-poor foods were high at baseline relative to estimated total energy expenditure for child age. Using random effects modelling, there were significant group-by-time effects for a reduction in mean (standard deviation) total energy intake (EI) at 12 months (-461 kJ/day (196); P = 0.04). An intervention group-by-time effect on carbohydrate intake (-17.4 g/day (10.6); P < 0.05) was largely attributable to decreased consumption of breads and cereals (-180 g/day (80); P = 0.007). Decreases in energy-dense, nutrient-poor foods were not statistically significant. The proportion of total EI from noncore foods in children in rural New South Wales is high and did not improve in response to a low-intensity nutrition intervention. Parents reported small changes in consumption frequency for core and noncore food intakes, leading to a reduction in total EI. Strategies to increase resource use such as prompting via e-mail are required to further explore the effectiveness of nutrition resource dissemination at a population level.

High-Fat Diet Is Associated with Obesity-Mediated Insulin Resistance and β-Cell Dysfunction in Mexican Americans

Consumption of energy-dense, nutrient-poor foods has contributed to the rising incidence of obesity and may underlie insulin resistance and β-cell dysfunction. Macronutrient intake patterns were examined in relation to anthropometric and metabolic traits in participants of BetaGene, a family-based study of obesity, insulin resistance, and β-cell dysfunction in Mexican Americans. Dietary intake, body composition, insulin sensitivity (SI), and β-cell function [Disposition Index (DI)] were assessed by food-frequency questionnaires, dual-energy X-ray absorptiometry, and intravenous glucose-tolerance tests, respectively. Patterns of macronutrient intake were identified by using a K-means model based on the proportion of total energy intake per day attributable to carbohydrate, fat, and protein and were tested for association with anthropometric and metabolic traits. Among 1150 subjects aged 18–65 y (73% female), tertiles of fat intake were associated with greater adiposity and lower SI, after adjustment for age, sex, and daily energy intake. Moreover, 3 distinct dietary patterns were identified: “high fat” (35% fat, 44% carbohydrate, 21% protein; n = 238), “moderate fat” (28% fat, 54% carbohydrate, 18% protein; n = 520), and “low fat” (20% fat, 65% carbohydrate, 15% protein; n = 392). Compared with the low-fat group, the high-fat group had higher age- and sex-adjusted mean body mass index, body fat percentage, and trunk fat and lower SI and DI. Further adjustment for daily energy intake by matching individuals across dietary pattern groups yielded similar results. None of the observed associations were altered after adjustment for physical activity; however, associations with SI and DI were attenuated after adjustment for adiposity. These findings suggest that high-fat diets may contribute to increased adiposity and concomitant insulin resistance and β-cell dysfunction in Mexican Americans.

Diet and blood lipids in 1–4 year-old children

Background and aimEarly nutrition may programme blood lipid levels and thereby later cardiovascular health of children. The objective here was to evaluate the effects of maternal dietary counselling during pregnancy and breastfeeding on dietary intakes and blood lipid values in 1–4 year-old children. Further, the nutritional determinants of children's lipid profiles were assessed. Methods and resultsMothers were randomised into dietary counselling or control groups at the first trimester of pregnancy. Their children were followed up clinically at 1, 2 and 4 years of age, by three-day food records and analyses of total cholesterol, HDL cholesterol and apolipoproteins A-I and B as well as lipoprotein (a). In general, the mean intake of saturated fatty acids as a proportion of total energy intake (E%) was higher than the recommended, while the mean intake of polyunsaturated fatty acids was low in children's diet. Over the first years, girls had higher concentration of non-HDL cholesterol than boys; 2.64 mmol/l (95% CI 2.54–2.74) vs. 2.49 (2.38–2.60); p = 0.038. Maternal dietary counselling was not reflected in the children's lipid values. Children's monounsaturated fatty acid intake (E%) correlated with apoA-I (p = 0.048) and, furthermore, there was a negative correlation between polyunsaturated fatty acid intake (E%) and apoB (p = 0.046). ConclusionChildren's dietary fatty acid intake, but not maternal dietary counselling was shown to be related to blood apolipoproteins in children.

Interstitial glucose profile associated with symptoms attributed to hypoglycemia by otherwise healthy women

Background:Reports of postprandial symptoms attributed to hypoglycemia by otherwise healthy individuals appear to be relatively common in UK women. Whether these symptoms are related to blood glucose is a contentious issue, which periodic ambulatory blood glucose measurement has failed to resolve. Objective:The authors investigated, using continuous glucose monitoring technology, whether postprandial symptoms are associated with interstitial glucose concentrations (IG) in the hypoglycemic range or with a previous fall in IG. Design:Thirty healthy nonobese women (age 20-48 y) who reported symptoms attributable to hypoglycemia and 20 nonsymptomatic controls wore a subcutaneous probe in abdominal fat for 4-7 d (median: 5 d) and kept a diet and activity diary during this time. Results:Twenty women reported postprandial symptoms; 41 episodes were recorded. When symptomatic, IG was ≤3.3 mmol/L in 5% of cases. A significant fall in IG over the preceding 60 min was observed before autonomic symptoms (P < 0.005). The proportion of total energy intake derived from dietary fat in the symptomatic group was higher than that in the controls (P < 0.05). The proportion of total sugars was similar between groups; however, the meal preceding symptoms had a higher percentage of energy derived from total sugars when compared with the individuals' diet over the study period (P < 0.05). Conclusions:Most symptoms attributable to hypoglycemia were not associated with an IG concentration in the hypoglycemic range. A previous fall in IG may be implicated in the etiology of autonomic symptoms, with the consumption of meals high in sugars potentially playing a role in symptom initiation.

The possible role of sugar-sweetened beverages in obesity etiology: a review of the evidence

Over the second half of the last century, soft drinks and other sugar-sweetened beverages (SSB) have assumed an increasingly significant proportion of total energy intake in the US and most ‘westernized’ populations. These beverages are heavily marketed to youth and adults. As such, obesity researchers and public health activists and officials have targeted SSB as one of the primary culprits in the escalating rates of obesity. The purpose of this review is to summarize the evidence from human studies on the topic of SSB and body weight regulation, including a brief review of the purported physiological mechanisms, nutritional surveillance and ecological studies, and a more extensive review of the cross-sectional, prospective and experimental studies in humans to date. The equivocal evidence on this topic makes it difficult to draw firm conclusions regarding the role of SSB in the etiology of obesity. Many of the prospective and experimental studies are of unsatisfactory methodological rigor. Some have drawn analogies between the fight against the food industry and the fight against the tobacco industry. However, the complexity of our food supply and of dietary intake behavior, and how diet relates to other behaviors, makes the acquisition of clear and consistent scientific data on the topic of specific dietary factors and obesity risk especially elusive. Only more high-quality randomized trials on this topic will provide the necessary data to more completely evaluate the possible link between changes in SSB intake and obesity risk.

Foods contributing to energy intake in the US: data from NHANES III and NHANES 1999–2000

Efforts to reduce the trend of increasing obesity in the United States should be more effective when informed by knowledge of the dietary patterns that are associated with this result. The purpose of this analysis is to describe the foods and food groups that contribute the most to population intake of energy. Two representative surveys were examined, the Third National Health and Nutrition Examination Survey (NHANES III), conducted in 1988–1994, and the NHANES from 1999–2000. All foods reported in these surveys were recoded into 144 food items. Foods were also further recoded into 23 food groups. Food items and groups were then ranked according to the proportion of total energy intake contributed by that food item or group. The #1 contributor of energy intake in both time periods was soft drinks, which contributed 7.1% of energy intake in 1999–2000. Among food groups, “Sweets, desserts” contributed the most to energy intake. Three nutrient-poor food groups, “Sweets, desserts”, “Soft drinks” and “Alcoholic beverages” contributed almost 25% of all the energy consumed in the US population. Efforts to reduce obesity should focus on both individual and policy actions to reduce the importance of nutrient-poor foods in the US diet.

フィットネスクラブにおける行動療法を用いた肥満改善プログラムの有効性

During a six-month period, a weight reduction program using behavior therapy was conducted for elderly women at a fitness club. Participants were divided into three groups: (1) Group 1, underwent behavior modification: (2) Group2; underwent nutritional education and traditional exercise guidance, and (3) Group 3, undertook neither behavioral modification nor nutritional education. The results indicated that a significant reduction in weight and fat free mass, as well as an increase in physical fitness was observed in the behavior modification group compared to Group 2 that did not undergo behavior modification. Behavior modification improved the attendance in the programmed, reduced the role of snacks as a proportion of total energy intake and promoted exercise outside the fitness club. Moreover, after terminating the program, continued use of the fitness club was significantly higher in the behavior modification group. The frequency of using the fitness club and weight maintenance after the terminating the program was negatively correlated. (r= -.68, p<.001)