Total Grams Of Fat Research Articles

0299 The Effects of Chronic Sleep Restriction on Calorie and Macronutrient Intake

Abstract Introduction Chronic sleep restriction (CSR) has been associated with increased calorie intake and increased consumption of fats and carbohydrates, with inconsistent changes in protein. However, the majority of studies have either been observational field studies with no sleep intervention, or laboratory-based studies where food availability may not have reflected participants’ real-world choices. We hypothesized that calorie, fat, and carbohydrate intake would increase during a week of imposed CSR compared to a week of sleep satiation (SS) among individuals living in their home environment. Methods Twelve healthy participants (6 females) kept a fixed sleep-wake schedule, with a constant waketime, at home for four weeks (actigraphy confirmed compliance). During weeks one and three, participants maintained 9 hours in bed. During weeks two and four, participants were randomly assigned to experimental weeks of 5 and 9 hours of time-in-bed in a crossover design. Participants documented their food consumption during both experimental weeks using a picture-based meal logging application (MealLogger). Intake of calories and macronutrients were classified by two blinded evaluators. Descriptive statistics were calculated in SAS (Cary, NC). Results Participants averaged 4.43 ± 0.33 (SD) hours of sleep per night during CSR compared to 7.42 ± 0.42 hours during SS. Participants consumed a daily average of 1812 ± 672 kilocalories, 71 ± 31 grams of total fat, 217 ± 69 grams of carbohydrates, and 84 ± 40 grams of protein during CSR, compared to 1682 ± 514 kilocalories, 68 ± 23 grams of total fat, 198 ± 61 grams of carbohydrates, and 77 ± 32 grams of protein during SS. Conclusion Preliminary descriptive findings suggest that, on average, participants consumed more calories, from an increase in consumption of each macronutrient group, during a week of sleep restriction compared to a week of sleep satiation. Further analysis is needed to determine whether these differences are statistically different and to identify when calories were consumed in each of the experimental conditions. Support (If Any) Supported by the Force Health Protection Program of the Office of Naval Research (SAA2402925-1, Contract Award no. N0001418IP00050) and the NASA Airspace Operations and Safety Program, System-Wide Safety.

Multi-Level, Multi-Component Intervention Improves Dietary Intake in Native American Adults

ObjectivesTo assess impact of a multi-level, multi-component (MLMC) intervention on dietary intake in Native American adults. MethodsA MLMC obesity intervention ([blinded for review]) was implemented among Native American adults in six rural tribal communities in the US Southwest and Midwest. [Blinded for review] included institutional level components, demonstrations, and distribution of educational media/materials in food stores, worksites, and schools. Communities were randomized to intervention (Group 1; n = 3) or control (Group 2; n = 3). Data collection surveys included a semi-quantitative Block food frequency questionnaire and an Adult Impact Questionnaire for demographics and anthropometrics. This analysis assessed change in daily energy and macronutrient intake from baseline to follow-up, daily intake of types of dietary fat, and daily servings of food groups as defined by the 2015–2020 Dietary Guidelines for Americans using multilevel mixed-effects linear regression with clustering at the community level. All models were adjusted for age, gender, education, Material Style of Life score (proxy for socio-economic status), smoking, and baseline dependent variable of interest. Results492 participants completed both baseline and post-intervention surveys: 31 were excluded due to reports of daily caloric intake outside of established cut-offs (<500 kcal or >7000 kcal per day), and 15 were excluded due to incomplete data, for a total n = 446 for this analysis. The between group effect was significant for change in energy intake (–188.21 kcal; P = 0.050), total grams of carbohydrate (–22.48 g; P = 0.047), total grams of fat (–8.82 g; P = 0.044), and total grams of saturated fat (–3.19 g; P = 0.031), with greater decreases observed in Group 1. Change in total grams of sugar trended towards significance (–12.06 g; P = 0.057); similarly, greater decreases were observed in Group 1. Change in daily servings of fats and sweets was also significantly different between groups (–0.39 servings; P = 0.036), with greater decreases observed in Group 1. ConclusionsMLMC interventions can significantly impact dietary intake among rural Native American adults. This is especially important given the high risk of obesity and other diet-related chronic diseases among Native American adults. Funding SourcesNational Heart, Lung, and Blood Institute

Is the Ultra-Processed Foods Consumption Associated With the Total Amount of Nutrients Consumed?: Findings From the Korea National Health and Nutrition Examination Survey

Abstract Objectives It has been shown that the consumption of ultra-processed foods(UPF) is positively associated with the amount of added sugar consumption, and the incidence of various noncommunicable diseases. Most of the previous studies were published in Western countries. This study aims to analyze the association between UPF consumption and the consumption of sugar, sodium, fat, and calories among the Asian population. Methods The food consumption data collected by 24-hour recalls in nationally representative samples of 6308 were analyzed. Foods were categorized into 4 groups according to the degree of process and the NOVA classification suggested by Monteiro in 2019 was used. Microsoft Excel 2019 and Stata 16.0 were used for the analysis. Results The consumed weight of UPF was 106 grams in the 1st quintile group; whereas 1044 grams in the 5th quintile group. The total mean caloric intake among 1st and 5th quintiles of UPF consumption were 1418 kcal and 2895 kcal, respectively. The percentages of energy consumed through total sugar were 10.6% in 1st quintile and 11.2% in 5th quintile groups. The percentages of energy consumed from free sugar were 3.7% and 8.7% in 1st and 5th quintiles, respectively. The absolute amount of total fat and saturated fat consumptions were 24.7 grams and 7.2 grams among 1st quintile group. On the contrary, 74.4 grams of total fat and 25.3 grams of saturated fat were consumed among 5th quintile group. The percentages of energy consumed from fat were 15.7% and 23.1% in 1st and 5th quintiles, respectively. Lastly, 2311 mg of sodium (1629 mg/1000 kcal) were consumed in 1st quintile group; whereas 4787 mg of sodium (1653 mg/1000 kcal) were consumed in 5th quintile group. Conclusions It is found that as the level of UPF consumption increases, the consumption of calories, sugars, sodium in absolute amount, and fat increase. The absolute amount of UPF consumption is lower in South Korea than in other Western countries. However, the UPF consumption is alarming among the highest consumption group. Since the use of UPF is expected only to increase due to its convenience and taste, it would be important to monitor the subgroup of the population who have high levels of UPF consumption. Funding Sources This research is supported by the National Food Safety Information Service.

0271 Effects of Experimentally Shortened Sleep on Dietary Outcomes in Adolescents

Abstract Introduction Adolescents who sleep less may consume more calories during the day; however, shortened sleep may have greater impact on the dietary quality of foods, particularly foods high in sugar content. This study examined the impact of shortened sleep on total caloric intake, macronutrients of food (fats, proteins, carbohydrates), added sugars consumed, and glycemic load/index of foods consumed. Methods 110 adolescents (ages 14–17, M = 15.73(1.80); 63.6% female) underwent a within-subject counterbalanced experimental sleep manipulation, spending either 6.5 or 9.5 hours/night in bed for five nights. During each sleep period, adolescents completed three dietary recalls (reporting amounts and types of foods consumed over a 24-hour period) administered by dietary core study staff. We conducted a series of repeated-measure general linear models comparing averaged weekly dietary outcomes of interest by sleep condition. We also explored whether experimental order of the sleep conditions, family income, or adolescent gender, body mass index (BMI), or race moderated the main effects of sleep condition on dietary outcomes. Alpha was set at .05 for primary analyses and .01 for exploratory analyses. Results We observed a main effect of sleep on carbohydrates (p=.038) and added sugars (p=.009) consumed, as well as the glycemic index (p=.013) and glycemic load (p=.009) of foods consumed. We did not observe a main effect of sleep on total calories or total grams of fat or protein consumed. Exploratory analysis found no significant interactions of the moderators with sleep condition on dietary outcomes. Conclusion Adolescents are consuming more carbohydrates, added sugars, and foods higher in glycemic index and load when sleep restricted, compared to well-rested, despite eating comparable amounts of calories. Sleep restricted adolescents may be drawn to foods that provide quick releases of energy to counteract sleepiness experienced during the day. Support R01 HL120879

Impact of the 2017 Child and Adult Care Food Program Meal Pattern Requirement Change on Menu Quality in Tribal Early Care Environments: The Food Resource Equity and Sustainability for Health Study.

ABSTRACTBackgroundNative American (NA) children have a high prevalence of obesity contributing to lifespan health disparities. Dietary intake is important to promote healthy weight gain, growth, and development. In 2017, the USDA enforced changes to the Child and Adult Care Food Program (CACFP). The CACFP provides reimbursement to qualifying Early Care and Education (ECE) programs that serve foods that uphold the program's nutrition requirements.ObjectiveThis study had the following 2 objectives: 1) Describe a novel index to evaluate ECE menus based on revised CACFP requirements (accounting for food substitutions) and best practices for 3- to-5-y-old children, and 2) analyze CACFP requirement and best practice compliance and nutrient changes in 9 NA ECE programs before and after enforcement of the revised CACFP requirements.MethodsThis longitudinal study is within a larger community-based participatory research study. Menus and meals served were evaluated for 1 wk at each of 9 programs before and after enforcement of the revised meal patterns. Nutrient analysis, CACFP requirement and best practice compliance, and substitution quality were evaluated. Differences were determined using a paired t-test or Wilcoxon matched test. This trial was registered at clinicaltrials.gov as NCT03251950.ResultsTotal grams of fiber consumed increased (5.0 ± 1.2 compared with 5.9 ± 0.8 g, P = 0.04) and total grams of sugar consumed decreased (53.8 ± 12.6 compared with 48.4 ± 7.9 g, P = 0.024), although room for further improvement exists. Although total grams of fat remained unchanged, grams of saturated fat significantly increased (7.8 ± 1.4 compared with 10.5 ± 3.4, P = 0.041). Other nutrients remained unchanged. Overall CACFP requirement and best practice compliance scores improved, although this finding was not statistically significant. No significant changes in food quality associated with substitutions occurred.ConclusionsThis study provides early evidence to support the beneficial impact of the revised CACFP requirements. Understanding barriers to compliance within rural NA communities would be an important next step in enhancing the health of vulnerable children.

To Text or Not to Text: Electronic Message Intervention to Improve Treatment Adherence Versus Matched Historical Controls.

BackgroundEnsuring treatment adherence is important for the internal validity of clinical trials. In intervention studies where touch points decrease over time, there is even more of an adherence challenge. Trials with multiple cohorts offer an opportunity to innovate on ways to increase treatment adherence without compromising the integrity of the study design, and previous cohorts can serve as historical controls. Electronically delivered nudges offer low-cost opportunities to increase treatment adherence.ObjectiveThis study aimed to evaluate the effectiveness of electronic messages (e-messages) on treatment adherence to the last cohort of a parent weight loss intervention during the second half of a year-long trial, when intervention checkpoint frequency decreases. Treatment adherence is measured by intervention class attendance and adherence to the intervention diet.MethodsAll participants in the last cohort (cohort 5, n=128) of a large randomized weight loss study were offered an e-message intervention to improve participant adherence during the last 6 months of a 1-year weight loss program. Overall, 3 to 4 electronic weekly messages asked participants about intervention diet adherence. A propensity score model was estimated using 97 participants who opted to receive e-messages and 31 who declined in cohort 5 and used to pair match cohort 5 e-message participants to a historical control group from cohorts 1 to 4. Moreover, 88 participants had complete data, yielding 176 participants in the final analyses. After matching, intervention and matched control groups were compared on (1) proportion of class attendance between the 6 and 12 month study endpoints, (2) diet adherence, as measured by total carbohydrate grams for low-carbohydrate (LC) and total fat grams for low-fat (LF) diets at 12 months, and (3) weight change from 6 to 12 months. The dose-response relationship between the proportion of text messages responded to and the 3 outcomes was also investigated.ResultsCompared with matched controls, receiving e-messages had no effect on (1) treatment adherence; class attendance after 6 months +4.6% (95% CI −4.43 to 13.68, P=.31), (2) adherence; LC −2.5 g carbohydrate, 95% CI −29.9 to 24.8, P=.85; LF +6.2 g fat, 95% CI −4.1 to 17.0, P=.26); or on (3) the secondary outcome of weight change in the last 6 months; +0.3 kg (95% CI −1.0 to 1.5, P=.68). There was a positive significant response correlation between the percentage of messages to which participants responded and class attendance (r=.45, P<.001).ConclusionsAlthough this e-message intervention did not improve treatment adherence, future studies can learn from this pilot and may incorporate more variety in the prompts and more interaction to promote more effective user engagement. Uniquely, this study demonstrated the potential for innovating within a multicohort trial using propensity score–matched historical control subjects.Trial RegistrationClinicalTrials.gov NCT01826591; https://clinicaltrials.gov/ct2/show/NCT01826591International Registered Report Identifier (IRRID)RR2-10.1016/j.cct.2016.12.021

Dietary Fat Intake Predicts Aortic Stiffness Independent of Physical Activity

PURPOSE: To determine if increased dietary fat consumption predicts aortic stiffness independent of physical activity. METHODS: Men and women 18-60 years of age were recruited for this cross-sectional study. Body mass, height, body fat percentage (bioelectrical impedance analysis), aortic stiffness (carotid-femoral Pulse Wave Velocity; cfPWV), habitual dietary intake (NIH’s validated Dietary History Questionnaire-II; DHQ-II), and physical activity (International Physical Activity Questionnaire; IPAQ) were assessed for all subjects. Univariate linear regression analyses were implemented to determine dietary correlations with cfPWV, and partial correlations were employed to adjust for traditional risk factors using SAS 9.4. RESULTS: The study population consisted of predominately young men and women (23.5 ± 7.9 years, 70.0% female) with a normal body mass index (BMI = 23.6 ± 4.3 kg/m2) and mean cfPWV of 5.8 ± 0.9 meters/second. Weekly physical activity was estimated at 5,547.6 ± 5,478.2 MET-minutes per week. Habitual daily caloric intake was 1,921.0 ± 798.9 calories, consisting of 46.0 ± 0.1% carbohydrate, 36.8 ± 0.1% fat, and 16.3 ± 0.0% protein. Greater consumption of total discretionary solid fat was associated with increased cfPWV (R2 = 0.155, P = 0.031). However, total calories from dietary fat (R2 = 0.093, P = 0.101), total grams of fat (R2 = 0.047, P = 0.248), and total discretionary oil fat (R2 = 0.008, P = 0.650) were not associated with cfPWV. The correlation between discretionary solid fat and cfPWV remained after adjustment for age, body fat percentage, BMI, and physical activity (R2 = 0.160, P = 0.043). Among food choices contributing to the increased discretionary calories from solid fat, cheese intake was positively correlated with cfPWV (R2 = 0.134, P = 0.047). Additionally, specific fatty acids that predicted cfPWV included trans fatty acid, trans-hexadecenoic acid (R2 = 0.179, P = 0.020), and monounsaturated fatty acids, hexadecenoic acid (R2 = 0.148, P = 0.036) and myristoleic acid (R2 = 0.206, P = 0.012). CONCLUSIONS: Increased dietary discretionary fat consumption within the habitual diet predicts aortic stiffness independent of physical activity. Cheese consumption and specific fatty acids may be novel contributors to increased aortic stiffness independent of regular physical activity.

Abstract P358: Dietary Fat Quality and Risk of CHD in the 28 Year Follow-up of a Large Prospective Study of US Women

Background: The importance of fat quality is reflected in the recent 2010 Dietary Guidelines for Americans, which recommend reducing saturated fat intake, and replacing this with polyunsaturated fat. Health effects of dietary fat are often estimated as an isocaloric substitution with carbohydrates (nutrient density models). Expressing fat intake as a % of total fat instead better quantifies fat quality, in overall diet and individual foods, and may provide an alternative approach to evaluate associated disease risk. We evaluated this novel measure of dietary fat quality, the % of fat type relative to total fat intake, on CHD risk among women in the Nurses' Health Study. Methods: We followed 84,531 women, free of chronic disease at baseline, from 1980-2008. Data on diet and other factors were ascertained every 2-4 years via questionnaires. For saturated and polyunsaturated fats, fat quality was calculated as grams of fat type / grams of total fat, and included in Cox proportional hazards models with total fat (fat density model), to estimate the association between fat intake and risk of CHD. We also estimated these associations using traditional nutrient density models, with isocaloric replacement of fat with carbohydrates. Results: Over 28 years, there were 3373 cases of CHD. A greater proportion of fat intake as saturated fat was associated with higher risk of CHD (p, trend&lt;0.001) ( Table ). Conversely, a greater proportion of fat intake as polyunsaturated fat was associated with lower risk (p, trend&lt;0.001), which was seen for both N-6 and N-3 fats. Compared with nutrient density models, RR obtained from fat density models were greater in magnitude for saturated and N-3 fats, but similar in magnitude for total and N-6 polyunsaturated fat. Conclusions: Saturated and polyunsaturated fat, quantified as a % of total fat, were significantly associated with CHD risk. This novel measure of dietary fat may aid in the translation of dietary recommendations of fat quality and may provide guidance in distinguishing foods based on fat quality.

The Effect of Nutrient‐Based Standards on Competitive Foods in 3 Schools: Potential Savings in Kilocalories and Grams of Fat*

The study investigated how nutrient standards affected the number of kilocalories and grams of fat and saturated fat in competitive foods offered and sold in 3 high schools. The study is a quasi-experimental design with 3 schools serving as the units of assignment and analysis. The effect of the nutrient standards was measured by the change in kilocalories and grams of fat and saturated fat in offerings and purchases of competitive foods pre- and postimplementation of the standards. A paired sample t-test was used to compare kilocalories and grams of fat and saturated fat pre- and postimplementation of nutrition standards. After the implementation of the nutrition standards, students in 3 high schools purchased significantly smaller numbers of kilocalories and grams of fat and saturated fat, during the postpolicy school year of 2007-2008 than during the prepolicy school year of 2004-2005. Using nutrient standards to guide the selection of competitive foods offered in school cafeterias may positively affect intake of kilocalories, total grams of fat, and total saturated fat of those foods. The quantitative assessment is novel and demonstrates the reduction in kilocalories and fat in both the competitive food offerings and purchases as a result of nutrient standards.

Associations of Dietary Intake and Physical Activity with Sleep Disordered Breathing in the Apnea Positive Pressure Long-term Efficacy Study (APPLES)

The purpose of this study was to examine whether dietary habits and physical activity patterns were independently associated with severity of sleep disordered breathing (SDB) in adults diagnosed with obstructive sleep apnea. Data collected from 320 adults participating in an ancillary study of The Apnea Positive Pressure Long-term Efficacy Study were analyzed as a cross-sectional assessment at study baseline. The respiratory disturbance index (RDI) was used as a measure of the severity of sleep disordered breathing. Separate linear regression models were fitted using RDI as the independent variable and various preselected components of dietary intake and physical activity as the dependent variables. The results indicated that even after adjusting for BMI, age, and daytime sleepiness, subjects with very severe and extremely severe SDB (RDI > or =50) consumed a diet that was higher in cholesterol, protein, total fat, and total saturated fatty acids. These findings were most evident among women. For all participants, those with RDI > or =50 in comparison to those <50, on average consumed 88.16 more mg of cholesterol per day (95% CI: 44.45 to 131.86, p < 0.001). Among the women participants only, those with RDI > or =50 in comparison to those <50, on average consumed 21.96 more grams of protein (95% CI: 2.64 to 41.29, p = 0.026), 27.75 more grams of total fat (95% CI: 3.38 to 52.11, p = 0.026), and 9.24 more grams of saturated fatty acids (95% CI: 0.67 to 17.80, p = 0.035). Furthermore, those with an RDI > or =50 had a 224.58 greater caloric expenditure than those with RDI <50 from all activities including work and sleep (95% CI: 40.98 to 408.18, p = 0.017). Although significant results were seen in a reduction of physical activity from recreational activities, this finding was explained by the increase in BMI associated with higher levels of RDI.

Relative fat oxidation is higher in children than adults.

BackgroundPrepubescent children may oxidize fatty acids more readily than adults. Therefore, dietary fat needs would be higher for children compared with adults. The dietary fat recommendations are higher for children 4 to 18 yrs (i.e., 25 to 35% of energy) compared with adults (i.e., 20 to 35% of energy). Despite this, many parents and children restrict dietary fat for health reasons.MethodsThis study assessed whether rates of fat oxidation are similar between prepubescent children and adults. Ten children (8.7 ± 1.4 yr, 33 ± 13 kg mean ± SD) in Tanner stage 1 and 10 adults (41.6 ± 8 yr, 74 ± 13 kg) were fed a weight maintenance diet for three days to maintain body weight and to establish a consistent background for metabolic rate measurements (all foods provided). Metabolic rate was measured on three separate occasions before and immediately after breakfast and for 9 hrs using a hood system (twice) or a room calorimeter (once) where continuous metabolic measurements were taken.ResultsDuring all three sessions whole body fat oxidation was higher in children (lower RQ) compared to adults (mean RQ= 0.84 ± .016 for children and 0.87 ± .02, for adults, p < 0.02). Although, total grams of fat oxidized was similar in children (62.7 ± 20 g/24 hrs) compared to adults (51.4 ± 19 g/24 hrs), the grams of fat oxidized relative to calorie expenditure was higher in children (0.047 ± .01 g/kcal, compared to adults (0.032 ± .01 p < 0.02). Females oxidized more fat relative to calorie expenditure than males of a similar age. A two way ANOVA showed no interaction between gender and age in terms of fax oxidation.ConclusionThese data suggest that fat oxidation relative to total calorie expenditure is higher in prepubescent children than in adults. Consistent with current dietary guidelines, a moderate fat diet is appropriate for children within the context of a diet that meets their energy and nutrient needs.

Low-Fat Dietary Pattern and Risk of Invasive Breast Cancer: The Women???s Health Initiative Randomized Controlled Dietary Modification Trial

Despite a longstanding belief that a low-fat diet can reduce the risk of breast cancer, no controlled intervention trials have been reported. This randomized, controlled, primary prevention trial, based on the Women's Health Initiative cohort, enrolled 48,835 postmenopausal women 50 to 79 years of age at 40 U.S. clinical centers in the years 1993-2005. Forty percent of participants received a diet designed to lower the intake of total fat to 20% of energy, provide at least 5 servings daily of fruit and vegetables, and include at least 6 daily servings of grains. There was no explicit weight loss goal. The remaining 60% of women continued on their usual diets. The intervention group took part in an intensive behavioral modification program administered by a specially trained nutritionist. Participants received an individualized goal of total fat grams based on height and were trained to monitor their dietary intake. The comparison women were given informational materials, including dietary guidelines. At baseline, dietary and other variables, including body weight, were nearly identical in the intervention and control groups. Women in the diet group had a small decrease in energy consumption. The difference between groups in change from baseline in the percentage of energy from fat ranged from 10.7% after 12 months to 8.1% at year 6. The intervention group ate more fruits and vegetables, but there was less difference in grain consumption. The annualized incidence rate of invasive breast cancer during an average follow up of 8.1 years was 0.42% in the intervention group and 0.45% in the comparison group. The hazard ratio was 0.91% with a 95% confidence interval of 0.83 to 1.01. Rates of total cancer (excluding non-melanoma skin cancer), breast cancer mortality, and total mortality all were slightly lower for the intervention group, but the differences were not significant at the 0.05 level. Women who actively participated in the dietary intervention program and those consuming a high-fat diet at baseline had lower hazard ratios. The breast cancer risk also was lower in women with a relatively high baseline percentage of energy from fat. Tumor grade and size, lymph node status, and stage of breast cancers all were similar in the intervention and comparison groups. A lower hazard ratio was noted for progesterone receptor-negative tumors, but there was no apparent association with estrogen receptor status. A low-fat diet failed to lessen the risk of invasive breast cancer in this large trial of postmenopausal women during a follow up averaging approximately 8 years. Nevertheless, the trends observed, although not statistically significant, warrant longer-term studies. Any beneficial effects of reduced fat intake might take years to fully emerge.

Sources of Dietary Fat in Middle Schools

Background. The current study uses an ecological approach to describe the food environment at 24 middle schools and multiple food sources' dietary fat contribution. Methods. Five consecutive days were sampled for collection of school meals, a la carte, and student store data. Bag lunch contents were observed on 3 days. Measurement included grams of saturated and total fat plus sales or participation data. Results. Average total fat grams per meal were 21 g (SD = 2) for bag lunches, 14 g (SD = 5) for Type A breakfast, and 31 g (SD = 8) for Type A lunches. Average fat grams per item were 13 g (SD = 3) for a la carte and 6 g (SD = 2) for student stores. Students purchased or brought to school a mean of 26 g (SD = 3) of total and 8 g (SD = 1) of saturated fat. Contributions to total fat grams were 42% by Type A lunches, 27% by a la carte foods, 25% by bag lunches, 3% by Type A breakfast, and 2% by student stores. Findings for saturated fat were similar. Conclusions. Middle school students eat excessive amounts of fat at school, and multiple sources of food must be considered to understand the school food environment.

The role of dietary calcium and other nutrients in moderating body fat in preschool children.

To assess preschool children's food consumption (24-60 months) and relate these findings to body composition at 70+/-2 months. A longitudinal study of children's dietary intakes for selected nutrients and servings of dairy products. Fifty-three white children participating in a longitudinal study (2-96 months) of children's food practices and growth. Using in-home interviews and trained interviewers, 18 days of dietary data and measured height and weight of each child at 6 month intervals were collected. Body composition was determined by dual energy X-ray absorptiometry. Dietary fat was 30-33% of energy with saturated and monounsaturated fat intakes>10% and polyunsaturated<10%. Adjusting for body mass index (BMI), GLM models to predict percent body fat (%BF) or grams of total fat (gTF) with mean longitudinal calcium intake (%BF: R2=0.51, F=7.88, P<0.0001; gTF: R2=0.51, F=9.84, P=0.0001) or total servings of dairy products (%BF: R2=0.47, F=6.93, P<0.0001; gTF: R2=0.47, F=8.31, P<0.0001) as independent variables gave significant results. Higher mean longitudinal calcium (mg/day) intakes and more servings/day of dairy products were associated with lower body fat. Males had significantly less body fat (P=0.01) than females. Higher longitudinal intakes of calcium, monounsaturated fat, and servings of dairy products were associated with lower body fat.

Validation of Fatex - A Quick Diet Assessment Tool

LEARNING OUTCOME: To examine the validation of a diet assessment tool used to quickly determine the saturated fat and cholesterol content of a patient's diet from 3-day food records. FATEX (Fat Exchange System) was developed to assist a nutrition counselor to quickly calculate fat and cholesterol components of a patient's diet using a spreadsheet computer program. Utilizing an expanded food group system similar to diabetic exchanges, the counselor examines food records to determine the number of servings a patient has consumed from each food group and enters the information into the spreadsheet program. A printout of nutrient information for calories (CAL); grams of total fat (FAT); grams of saturated fat (SFA); and mg. of dietary cholesterol (CHOL) can be obtained, allowing comparison to Step 1-National Cholesterol Education Program (NCEP) diet guidelines. FATEX was validated for these four nutrients against the Minnesota Nutrition Data System (NDS), version 2.4 with 67 patients who received a Step 1 NCEP diet instruction from a registered dietitian (RD). Patients were asked to keep a 3-day food record and return it at their next visit. Records were reviewed with the patient by an RD and analyzed using both systems. CAL, FAT, SFA and CHOL values were compared for each of the 3 days (n=201) as well as the 3-day average (n=67) for each patient. A paired t-test comparison between these two systems validated the FATEX against NDS for CAL, SFA and CHOL. Results for the comparison of 1-day analysis were CAL (p<.001); SFA (p<.001)and CHOL (p<01). Significant results were likewise found when comparing 3-day averages, with CAL (p<001); SFA (p<.001); and CHOL (p=.01). For both 1-day and 3-day averages, FAT analysis using the FATEX system for these patients could not be validated against the NDS system. Factors influencing the variability of FAT do not appear to be consistently high or low for either system. Rather the differences in fat analysis seem to be related to variations in the estimate of fat used in food preparation by the RD compared with coding rules applied by the NDS system. FATEX appears to be a valid tool to analyze SFA and CHOL content of diets for hyperlipidemic patients that can be useful for comparing the diet to NCEP guidelines as well as for monitoring diet changes over time

Profitability and Acceptability of Fat- and Sodium-Modified Hot Entrees in a Worksite Cafeteria

Objectives To compare the acceptability of fat- and sodium-modified entrees before and after implementation of a marketing program and to determine the effect offering and marketing these healthful entrees had on total cafeteria and entree sales in a worksite cafeteria. Design The research was conducted in five phases, including sales data collection, acceptance testing of unmodified hot entrees, acceptance testing of modified entrees, and implementation of a marketing campaign for promoting low-fat, sodium-controlled food selections. Setting The Kansas Farm Bureau and Affiliated Services (KFB) employee cafeteria. Subjects KFB employees who ate lunch in the employee cafeteria and were willing to participate in the study. Main outcome measures Sales data (percent of customers purchasing a modified entree and sales of modified entree as a percent of total sales); nutrient analysis data (energy, grams of total fat, percent of energy from fat, milligrams of cholesterol, and milligrams of sodium); and acceptability data (11 characteristics were measured using a seven-point hedonic scale). Statistical analysis performed General linear model analysis of variance was used to compare sales data from phases 1 to 5 and to compare acceptability data from phases 2 to 4. Results No significant differences in sales data were observed during the 7-month study. No significant changes in overall acceptability were found for any entree. However, customers tended to rate overall acceptability higher when entrees were marketed as lower in fat and sodium. Applications/conclusions Customers in worksite cafeterias may be more willing to tolerate changes in flavor attributes when modified entrees are marketed as “healthful” and nutrition information is available. J Am Diet Assoc. 1997;97:391–395.

Change in Nutrient Intakes, Number of Servings, and Contributions of Total Fat from Food Groups in 4- to 10-Year-Old Children Enrolled in a Nutrition Education Study

Objective To determine change in nutrient intakes, number of servings, and contributions of total fat from food groups in children who lowered their dietary fat intake. Design A research and demonstration study designed to lower plasma low-density lipoprotein cholesterol level. There were four study groups: two intervention and two control groups. All children had hypercholesterolemia except for those in one control group. Three 24-hour dietary recalls were collected on randomly assigned days over a 2-week period at baseline and 3 months after the intervention. Subjects Three hundred three 4- to 10-year old children from suburbs north of Philadelphia, Pa. Interventions One intervention involved a home-based, parent-child autotutorial program (PCAT group) with audiotaped stories and print materials for the children and their families; the other intervention involved one face-to-face counseling session with a registered dietitian (counseling group). Outcome measures Change in mean nutrient intakes compared with the Recommended Dietary Allowance (RDA); change in number of servings and mean grams of total fat contributed from 10 different food groups. Statistical analyses performed Analyses of variance and χ 2 analyses. Results Children in every study group had mean intakes of all nutrients (except vitamin D) greater than 67% of the RDA 3 months after the baseline measurement. Several food groups (ie, meats, dairy products, fats/oils, and desserts) provided less total fat to the diets of children who reduced their dietary lipid intake after 3 months (ie, PCAT and counseling groups). These children also reduced the mean number of servings selected from these food groups. Within these same food groups, some children consumed fewer servings of higher fat foods and more servings of lower fat foods. Applications/conclusions Children who lowered their dietary fat intake after intervention reported both quantitative and qualitative changes in food choices from several food groups. These choices did not significantly reduce their nutrient intakes. J Am Diet Assoc. 1996; 96:865-873.

Improving nutrition knowledge in a drug and alcohol rehabilitation setting through group nutrition education

Although excellent opportunities exist for controlled nutrition education studies in the drug and alcohol rehabilitation setting, few studies have been conducted on this population. The purpose of this study was to evaluate the effectiveness of group nutrition education on improving nutrition knowledge and awareness in a drug and alcohol rehabilitation setting. A pilot test was administered to foodservice personnel and adapted for the study. One hundred fifty two residents were divided into 8 groups of approximately 20 each. A ten question pre-test was administered to each group followed by a nutrition education session. In addition to the group nutrition education, menu items were nutritionally analyzed by computer and cards were displayed on trayline listing total calories, total fat grams, percentage of calories from fat, and milligrams of sodium for each item. A post-test (n=112) was administered one week later. Pre-test and post-test data were statistically compared using the Student's t test for paired data and a statistically significant difference was found between pre-test and post-test scores (mean scores = 40.9 & 65.4 respectively; p<.001). Anecdotal evidence indicates an increased interest in nutrition by the residents. This study demonstrates that nutrition education can be effectively integrated into a drug and alcohol rehabilitation program producing increased nutrition knowledge and awareness.

Antiobesity Surgery: Is a Structured Support Group Desirable? Preliminary.

The relevance of a post-gastroplasty physician-and dietitian-supervised support group for weight loss, dietary habits, dietary knowledge, and exercise has been assessed. Two post vertical banded gastroplasty groups were compared: those who did (n = 10) and those who did not (n = 11) attend a monthly post-gastroplasty support session. A 55-point questionnaire plus a 24-hour dietary recall and food frequency analysis were employed. Addressed were dietary and exercise history, eating habits, and factual dietary knowledge. At the time following surgery of this study (support: mean 29.7 vs no support: mean 34.9 months, NS), there was no difference in weight loss between the two groups. There was no difference in the two groups between preoperative, length of time from surgery to interview or weight at Interview. Those who attended the support group consumed significantly fewer calories (1559 +/- 320 vs 2278 +/- 271, p </= 0.5), total grams of fat a day (57 +/- 19 vs lie +/- 17, p </= 0.5), fat as percentage of total diet (26 +/- 4 vs 44 +/- 2, p </= 0.0005, and saturated fat as percentage of total diet 8 +/- 1 vs 17 +/- 2, p </= 0.0005). Attendees were more physically active than those who did not attend (236+/-49 vs 115+/-46 minutes exercise per week, p </= 0.05). Of those attending the seven monthly group session, 80% stated that it was easy to determine the fat content of food from the food label, compared to 36% in the non-support group (p </= 0.05). This suggests that to the postoperative period studied, weight loss is determined by the operation itself. However, we show that those who do attend are better informed, make wiser food choices, and are more physically active. To determine whether the difference in dietary habits and nutritional knowledge will result in an improved long-term weight loss, requires a more prolonged follow-up.

The revised NWLRC fat intake scale: A quick way to assess cholesterol-lowering diets

Two years ago, we reported on the validity, reporducibility, and ability of a short questionnaire, the FIS, to assess intake and changes in dietary fat among men on cholesterol-lowering diets. We now report on an updated version (FIS2) that incorporates additional information on the effect of diet on lipids. The FIS2 contains 12 questions concerning the quantity or type of fat containing foods usually eaten. The score, obtained by adding the 12 responses, can range from 12 to 44. When used in a worksite cholesterol screening of over 7000 employees, it proved to be a quick, efficient, inexpensive way to estimate intake of cholesterol-raising dietary components. When dietitians interviewed persons with low scores on the phone, the questions were a useful guide to estimate if an individual was following the guidelines for a cholesterol-lowering diet. Correlations between each of the 12 questions and the total score were highly significant, with responses to summary questions about the fat content of food eaten at home and away from home having higher correlations than did the specific food groups. A subset of hypercholesterolemic adults, 248 men and 119 women, repeated the questionnaire along with a 4-day food record. Correlations between the scale score and nutrients the scale was predicted to assess were: grams of total fat (.51), g saturated fat (.53), g monounsaturated fat (.49), % calories from total (.43), saturated (.42), and monounsaturated (.41) fat, Key's score (.41) and mg cholesterol (.46). Correlations were lower, .07 to .21, for selected nutrients the scale was not intended to assess. In general, correlations were slightly higher for the updated 12 item questionnaire than for the previous 9 item version. This tool provides a quick, cost effective way to assess diet. It is also useful to guide counseling and goal setting for cholesterol-lowering diets.