Dietary Fiber Intake Is Inversely Associated with Periodontal Disease among US Adults.

BACKGROUND: Approximately 47% of adults in the United States have periodontal disease. Dietary guidelines recommend a diet providing adequate fiber. Healthier dietary habits, particularly an increased fiber intake, may contribute to periodontal disease prevention. OBJECTIVE: Our objective was to evaluate the relation of dietary fiber intake and its sources with periodontal disease in the US adult population (≥30 y of age). METHODS: Data from 6052 adults participating in NHANES 2009-2012 were used. Periodontal disease was defined (according to the CDC/American Academy of Periodontology) as severe, moderate, mild, and none. Intake was assessed by 24-h dietary recalls. The relation between periodontal disease and dietary fiber, whole-grain, and fruit and vegetable intakes were evaluated by using multivariate models, adjusting for sociodemographic characteristics and dentition status. RESULTS: In the multivariate logistic model, the lowest quartile of dietary fiber was associated with moderate-severe periodontitis (compared with mild-none) compared with the highest dietary fiber intake quartile (OR: 1.30; 95% CI: 1.00, 1.69). In the multivariate multinomial logistic model, intake in the lowest quartile of dietary fiber was associated with higher severity of periodontitis than dietary fiber intake in the highest quartile (OR: 1.27; 95% CI: 1.00, 1.62). In the adjusted logistic model, whole-grain intake was not associated with moderate-severe periodontitis. However, in the adjusted multinomial logistic model, adults consuming whole grains in the lowest quartile were more likely to have more severe periodontal disease than were adults consuming whole grains in the highest quartile (OR: 1.32; 95% CI: 1.08, 1.62). In fully adjusted logistic and multinomial logistic models, fruit and vegetable intake was not significantly associated with periodontitis. CONCLUSIONS: We found an inverse relation between dietary fiber intake and periodontal disease among US adults ≥30 y old. Periodontal disease was associated with low whole-grain intake but not with low fruit and vegetable intake.

Nut Consumption Among U.S. Youth, 2009-2012.

About one-third of U.S. youth consumed nuts on a given day in 2009­2012. Older youth were less likely to consume nuts than younger youth. More non-Hispanic white than non-Hispanic black or Hispanic youth consumed nuts. More youth living in households at or above 350% of the poverty level consumed nuts than youth in households below 130% poverty or at 130% up to 350% of the poverty level. Although previous guidance suggested that timing of the introduction of nuts into children's diets may play a role in allergies, this guidance has recently been revised. There is a lack of evidence linking early introduction of nuts to development of allergy. This analysis did not include infants under the age of 1 year but did find that consumption of nuts was higher among younger children. More than one-third of nut consumption among youth (39.5%) occurs as a single-item food (i.e., not as an ingredient in other foods). Nuts are an alternate source of protein, especially for youth. Nuts are also high in mono- and polyunsaturated fats and fiber, and are a rich source of antioxidants such as selenium and vitamin E. Some nuts, especially walnuts and pumpkin seeds, are good sources of omega-3 fatty acids.

Fruit Consumption by Youth in the United States.

OBJECTIVES: To describe the contribution of whole fruit, including discrete types of fruit, to total fruit consumption and to investigate differences in consumption by sociodemographic characteristics. METHODS: We analyzed data from 3129 youth aged 2 to 19 years from the National Health and Nutrition Examination Survey, 2011 to 2012. Using the Food Patterns Equivalents Database and the What We Eat in America 150 food groups, we calculated the contribution of whole fruit, 100% fruit juices, mixed fruit dishes, and 12 discrete fruit and fruit juices to total fruit consumption. We examined differences by age, gender, race and Hispanic origin, and poverty status. RESULTS: Nearly 90% of total fruit intake came from whole fruits (53%) and 100% fruit juices (34%) among youth aged 2 to 19 years. Apples, apple juice, citrus juice, and bananas were responsible for almost half of total fruit consumption. Apples accounted for 18.9% of fruit intake. Differences by age were predominately between youth aged 2 to 5 years and 6 to 11 years. For example, apples contributed a larger percentage of total fruit intake among youth 6 to 11 years old (22.4%) than among youth 2 to 5 years old (14.6%), but apple juice contributed a smaller percentage (8.8% vs 16.8%), P < .05. There were differences by race and Hispanic origin in intake of citrus fruits, berries, melons, dried fruit, and citrus juices and other fruit juices. CONCLUSIONS: These findings provide insight into what fruits US youth are consuming and sociodemographic factors that may influence consumption.

More than half of US youth consume seafood and most have blood mercury concentrations below the EPA reference level, 2009-2012.

BACKGROUND: Consuming seafood has health benefits, but seafood can also contain methylmercury, a neurotoxicant. Exposure to methylmercury affects children at different stages of brain development, including during adolescence. OBJECTIVE: The objective was to examine seafood consumption and blood mercury concentrations in US youth. METHODS: In the 2009-2012 NHANES, a cross-sectional nationally representative sample of the US population, seafood consumption in the past 30 d and blood mercury concentrations on the day of examination were collected from 5656 youth aged 1-19 y. Log-linear regression was used to examine the association between frequency of specific seafood consumption and blood mercury concentration, adjusting for race/Hispanic origin, sex, and age. RESULTS: In 2009-2012, 62.4% ± 1.4% (percent ± SE) of youth consumed any seafood in the preceding month; 38.4% ± 1.4% and 48.5% ± 1.5% reported consuming shellfish and fish, respectively. In 2009-2012, the geometric mean blood mercury concentration was 0.50 ± 0.02 µg/L among seafood consumers and 0.27 ± 0.01 µg/L among those who did not consume seafood. Less than 0.5% of youth had blood mercury concentrations ≥5.8 µg/L. In adjusted log-linear regression analysis, no significant associations were observed between frequency of breaded fish or catfish consumption and blood mercury concentrations, but frequency of consuming certain seafood types had significant positive association with blood mercury concentrations: high-mercury fish (swordfish and shark) [exponentiated ß coefficient (expß): 2.40; 95% CI: 1.23, 4.68]; salmon (expß: 1.41; 95% CI: 1.26, 1.55); tuna (expß: 1.38; 95% CI: 1.29, 1.45); crabs (expß: 1.35; 95% CI: 1.17, 1.55); shrimp (expß: 1.12; 95% CI: 1.05, 1.20), and all other seafood (expß: 1.23; 95% CI: 1.17, 1.32). Age-stratified log-linear regression analyses produced similar results. CONCLUSION: Few US youth have blood mercury concentrations ≥5.8 µg/L, although more than half of US youth consumed seafood in the past month.

Nut consumption among U.S. adults, 2009-2010.

Data from the National Health and Nutrition Examination Survey, 2009-2010. Almost 40% (38.2%) of adults consumed nuts on a given day. More non-Hispanic white (43.6%) than non-Hispanic black (23.7%) or Hispanic (25.5%) adults consumed nuts. Approximately 80% of nuts consumed (84.0% by men and 79.7% by women) were nuts or seeds as single-item foods or nut butters.

Fruit and vegetable consumption of U.S. Youth, 2009-2010.

KEY FINDINGS: Data from the National Health and Nutrition Examination Survey, 2009-2010. More than three-quarters of youth aged 2-19 years (77.1%) consumed fruit on a given day. Almost 92% of youth aged 2-19 years consumed vegetables on a given day. Nine out of 10 children aged 2-5 years consumed fruit, while only 6 out of 10 adolescents consumed fruit on a given day. More children aged 2-5 years than adolescents consumed vegetables on a given day. The Dietary Guidelines for Americans (DGA), 2010 encourage Americans, including youth, to increase their consumption of fruits and vegetables. Individuals are encouraged to "eat a variety of vegetables, especially dark-green and red and orange vegetables." Fruits and vegetables are sources of many under-consumed nutrients and consuming fruits and vegetables is associated with a decreased risk of chronic disease (1-3). This report examines the percentage of youth aged 2-19 years who consumed fruits and vegetables on a given day in 2009-2010, using data from one 24-hour dietary recall interview.

Seafood consumption and blood mercury concentrations in adults aged ≥20 y, 2007-2010.

BACKGROUND: Seafood is part of a healthy diet, but seafood can also contain methyl mercury-a neurotoxin. OBJECTIVE: The objective was to describe seafood consumption in US adults and to explore the relation between seafood consumption and blood mercury. DESIGN: Seafood consumption, obtained from a food-frequency questionnaire, and blood mercury data were available for 10,673 adults who participated in the 2007-2010 NHANES-a cross-sectional nationally representative sample of the US population. Seafood consumption was categorized by type (fish or shellfish) and by frequency of consumption (0, 1-2, 3-4, or ≥5 times/mo). Linear trends in geometric mean blood mercury concentrations by frequency of seafood consumption were tested. Logistic regression analyses examined the odds of blood mercury concentrations ≥5.8 µg/L (as identified by the National Research Council) based on frequency of the specific type of seafood consumed (included in the model as continuous variables) adjusted for sex, age, and race/Hispanic origin. RESULTS: In 2007-2010, 83.0% ± 0.7% (±SE) of adults consumed seafood in the preceding month. In adults consuming seafood, the blood mercury concentration increased as the frequency of seafood consumption increased (P < 0.001). In 2007-2010, 4.6% ± 0.39% of adults had blood mercury concentrations ≥5.8 µg/L. Results of the logistic regression on blood mercury concentrations ≥5.8 µg/L showed no association with shrimp (P = 0.21) or crab (P = 0.48) consumption and a highly significant positive association with consumption of high-mercury fish (adjusted OR per unit monthly consumption: 4.58; 95% CI: 2.44, 8.62; P < 0.001), tuna (adjusted OR: 1.14; 95% CI: 1.10, 1.17; P < 0.001), salmon (adjusted OR: 1.14; 95% CI: 1.09, 1.20; P < 0.001), and other seafood (adjusted OR: 1.12; 95% CI: 1.08, 1.15; P < 0.001). CONCLUSION: Most US adults consume seafood, and the blood mercury concentration is associated with the consumption of tuna, salmon, high-mercury fish, and other seafood.

Trends in sugar-sweetened beverage consumption among youth and adults in the United States: 1999-2010.

BACKGROUND: Reducing sugar-sweetened beverage (SSB) consumption is a recommended strategy to promote optimal health. OBJECTIVE: The objective was to describe trends in SSB consumption among youth and adults in the United States. DESIGN: We analyzed energy intake from SSBs among 22,367 youth aged 2-19 y and 29,133 adults aged ≥20 y who participated in a 24-h dietary recall as part of NHANES, a nationally representative sample of the US population with a cross-sectional design, between 1999 and 2010. SSBs included soda, fruit drinks, sports and energy drinks, sweetened coffee and tea, and other sweetened beverages. Patterns of SSB consumption, including location of consumption and meal occasion associated with consumption, were also examined. RESULTS: In 2009-2010, youth consumed a mean (±SE) of 155 ± 7 kcal/d from SSBs, and adults consumed an age-adjusted mean (±SE) of 151 ± 5 kcal/d from SSBs--a decrease from 1999 to 2000 of 68 kcal/d and 45 kcal/d, respectively (P-trend < 0.001 for each). In 2009-2010, SSBs contributed 8.0% ± 0.4% and 6.9% ± 0.2% of daily energy intake among youth and adults, respectively, which reflected a decrease compared with 1999-2000 (P-trend < 0.001 for both). Decreases in SSB consumption, both in the home and away from home and also with both meals and snacks, occurred over the 12-y study duration (P-trend < 0.01 for each). CONCLUSION: A decrease in SSB consumption among youth and adults in the United States was observed between 1999 and 2010.

Dietary supplement use among infants, children, and adolescents in the United States, 1999-2002.

OBJECTIVE: To describe dietary supplement use among US children. DESIGN: Analysis of nationally representative data from the 1999-2002 National Health and Nutrition Examination Survey (NHANES). SETTING: Home interviews and a mobile examination center. PARTICIPANTS: Children from birth through 18 years who participated in NHANES (N=10,136). MAIN EXPOSURE: Frequency of use of any dietary supplement product. OUTCOME MEASURE: Prevalence of use and intake of key nutrients from supplements among children. RESULTS: In 1999-2002, 31.8% of children used dietary supplements, with the lowest use reported among infants younger than 1 year (11.9%) and teenagers 14 to 18 years old (25.7%) and highest use among 4- to 8-year-old children (48.5%). Use was highest among non-Hispanic white (38.1%) and Mexican American (22.4%) participants, lowest among non-Hispanic black participants (18.8%), and was not found to differ by sex. The type of supplement most commonly used was multivitamins and multiminerals (18.3%). Ascorbic acid (28.6%), retinol (25.8%), vitamin D (25.6%), calcium (21.1%), and iron (19.3%) were the primary supplemental nutrients consumed. Supplement use was associated with families with higher incomes; a smoke-free environment; not being certified by the US Department of Agriculture Special Supplemental Nutrition Program for Women, Infants and Children in the last 12 months; lower child body mass index; and less daily recreational screen time (television, video games, computers, etc) (P<.005). The highest prevalence of supplement use (P<.005) was in children who were underweight or at risk for underweight (P<.005). CONCLUSIONS: More than 30% of children in the United States take dietary supplements regularly, most often multivitamins and multiminerals. Given such extensive use, nutrient intakes from dietary supplements must be included to obtain accurate estimates of overall nutrient intake in children.

Antioxidant activity and total phenolic content of aqueous and methanolic extracts of Jordanian plants: an ICBG project.

As part of an International Cooperative Biodiversity Groups (ICBG) program to study Jordan's biodiversity, the relative levels of antioxidant activity and the total phenolic content of aqueous and methanolic extracts of a total of 95 plant species, all of Jordanian origin and those collected at random, have been measured. The total phenolic content of aqueous and methanolic extracts of the investigated plant species ranged from 4.4 to 78.3 mg and from 2.1 to 52.8 mg gallic acid equivalents g(-1) dry weight, respectively, while the total antioxidant capacity ranged from 20.0 to 916.7 and from 15.1 to 915.6 micromol Trolox equivalents g(-1) dry weight, respectively. Based on this collection, approximately 5% of assayed plants showed high levels of antioxidant activity. There was a significant linear correlation between antioxidant activity and total phenolic content for aqueous and methanolic extracts, suggesting that phenolic compounds were the predominant antioxidant components in the investigated plant species. Interestingly, a few of the collected plants had high-antioxidant activity yet "low" phenolic content includes Ceratonia siliqua and Viscum cruciatum. These plants may serve as sources of antioxidants with new chemotypes.

An alternative to dietary data exclusions.

OBJECTIVE: To examine an alternative to exclusion of apparently implausible data when examining the relationship of dietary energy density to total energy intake and of energy intake to body mass index (BMI). The objective is to show the advantages of retaining all available data but stratifying based on level of energy intake. SUBJECTS/SETTINGS: We examined 24-hour dietary recall data obtained from 7,720 adult participants (18 to 64 years old) in the nationally representative National Health and Nutrition Examination Survey (NHANES) 1999-2002. MAIN OUTCOME MEASURES: The relationship of energy density to energy intake, and of energy intake to BMI was assessed using linear regression models adjusting for age, sex, smoking status, and exercise. A sensitivity analysis was done to determine whether the relationship differed when generally accepted exclusionary criteria were applied. STATISTICAL ANALYSIS PERFORMED: Although the relationship of energy density to energy intake is similar across a large range of energy intakes, it differs at very low levels of energy intake. Energy intake is much less dependent on energy density at low intakes. The relationship of energy intake to BMI is different at both high and low levels of intake. Furthermore, the nature of the relationship between BMI and energy intake differs based on reporting status (whether reported energy intake is consistent with energy expenditure estimation). CONCLUSIONS: Instead of excluding observations based on energy intake, examining all the data but stratifying by level of intake may be more informative of population nutrient intake.

Variability in the yield of benzophenanthridine alkaloids in wildcrafted vs cultivated bloodroot (Sanguinaria canadensis L.).

Populations of bloodroot [Sanguinaria canadensis L. (Papaveraceae)] are found throughout the eastern forests of North America, with particular abundance in the southern Appalachian Mountains. Increasingly, it is finding use in Europe as a nonantibiotic animal feed supplement to promote weight gain. As efforts to cultivate this herb are underway, there is a need to understand the effect of agronomic permutations on both the dry mass rhizome yield and the yield of benzophenanthridine alkaloids. Month-to-month variability of the concentration of the alkaloids sanguinarine and chelerythrine in both cultivated and wildcrafted bloodroot was examined. The alkaloid yield was consistently higher, but more variable, in wildcrafted plants. On average, cultivated rhizomes were both larger and more consistently sized than those that were wildcrafted. The concentration of a suite of trace elements was measured in soil that was collected concomitantly with each plant accession. Differences in element profiles were compared against alkaloid yields.

Changes in beverage intake between 1977 and 2001.

OBJECTIVE: To examine American beverage consumption trends and causes. METHODS: Nationally representative data from the 1977-1978 Nationwide Food Consumption Survey, the 1989-1991 and 1994-1996 (also for children aged 2 to 9 years in 1998) Continuing Surveys of Food Intake by Individuals (CSFII), and 1999-2001 National Health and Nutrition Examination Survey were used in this study. The sample consisted of 73,345 individuals, aged >or=2 years. For each survey year, the percentage of total energy intake from meals and snacks was calculated separately for respondents aged 2 to 18 years, 19 to 39, 40 to 59, and >or=60. The percentage of energy intake by location (at home consumption or preparation, vending, store eaten out, restaurant/fast food, and school), as well as for specific beverages was computed separately for all age groups. The proportion consumed, mean portion size, and number of servings were calculated. RESULTS: For all age groups, sweetened beverage consumption increased and milk consumption decreased. Overall, energy intake from sweetened beverages increased 135% and was reduced by 38% from milk, with a 278 total calorie increase. These trends were associated with increased proportions of Americans consuming larger portions, more servings per day of sweetened beverage, and reductions in these same measures for milk. CONCLUSIONS: There is little research that has focused on the beneficial impacts of reduced soft drink and fruit drink intake. This would seem to be one of the simpler ways to reduce obesity in the United States.

Consumption of high-fructose corn syrup in beverages may play a role in the epidemic of obesity.

Obesity is a major epidemic, but its causes are still unclear. In this article, we investigate the relation between the intake of high-fructose corn syrup (HFCS) and the development of obesity. We analyzed food consumption patterns by using US Department of Agriculture food consumption tables from 1967 to 2000. The consumption of HFCS increased > 1000% between 1970 and 1990, far exceeding the changes in intake of any other food or food group. HFCS now represents > 40% of caloric sweeteners added to foods and beverages and is the sole caloric sweetener in soft drinks in the United States. Our most conservative estimate of the consumption of HFCS indicates a daily average of 132 kcal for all Americans aged > or = 2 y, and the top 20% of consumers of caloric sweeteners ingest 316 kcal from HFCS/d. The increased use of HFCS in the United States mirrors the rapid increase in obesity. The digestion, absorption, and metabolism of fructose differ from those of glucose. Hepatic metabolism of fructose favors de novo lipogenesis. In addition, unlike glucose, fructose does not stimulate insulin secretion or enhance leptin production. Because insulin and leptin act as key afferent signals in the regulation of food intake and body weight, this suggests that dietary fructose may contribute to increased energy intake and weight gain. Furthermore, calorically sweetened beverages may enhance caloric overconsumption. Thus, the increase in consumption of HFCS has a temporal relation to the epidemic of obesity, and the overconsumption of HFCS in calorically sweetened beverages may play a role in the epidemic of obesity.

The sweetening of the world's diet.

OBJECTIVE: Using data from many countries in the world combined with in-depth U.S. dietary data, we explored trends in caloric sweetener intake, the role of urbanization and income changes in explaining these trends, and the contribution of specific foods to these changes. RESEARCH METHODS AND PROCEDURES: Food disappearance data from 103 countries in 1962 and 127 in 2000 were coupled with urbanization and gross national income per capita data in pooled regression analysis to examine associations between these factors and caloric sweetener intake. Three nationally representative surveys from 1977 to 1978, 1989 to 1991, and 1994 to 1996 plus 1998 are used to examine caloric sweetener intake trends in the United States and the foods responsible for these changes. RESULTS: Increased consumption of caloric sweetener is one element in the world's dietary changes, represented by a 74-kcal/d increase between 1962 and 2000. Urbanization and income growth represent 82% of the change. U.S. data show an 83-kcal/d increase of caloric sweetener consumed-a 22% increase in the proportion of energy from caloric sweetener. Of this increase, 80% comes from sugared beverages; restaurant and fast food sources are represented in greater proportions. DISCUSSION: Caloric sweetener use has increased considerably around the world. Beverage intake seems to be a major contributor.

Patterns and trends in food portion sizes, 1977-1998.

CONTEXT: While general consensus holds that food portion sizes are increasing, no empirical data have documented actual increases. OBJECTIVE: To determine trends in food portion sizes consumed in the United States, by eating location and food source. DESIGN, SETTING, AND PARTICIPANTS: Nationally representative data from the Nationwide Food Consumption Survey (1977-1978) and the Continuing Survey of Food Intake by Individuals (1989-1991, 1994-1996, and 1998). The sample consists of 63 380 individuals aged 2 years and older. MAIN OUTCOME MEASURE: For each survey year, average portion size consumed from specific food items (salty snacks, desserts, soft drinks, fruit drinks, french fries, hamburgers, cheeseburgers, pizza, and Mexican food) by eating location (home, restaurant, or fast food). RESULTS: Portion sizes vary by food source, with the largest portions consumed at fast food establishments and the smallest at other restaurants. Between 1977 and 1996, food portion sizes increased both inside and outside the home for all categories except pizza. The energy intake and portion size of salty snacks increased by 93 kcal (from 1.0 to 1.6 oz [28.4 to 45.4 g]), soft drinks by 49 kcal (13.1 to 19.9 fl oz [387.4 to 588.4 mL]), hamburgers by 97 kcal (5.7 to 7.0 oz [161.6 to 198.4 g]), french fries by 68 kcal (3.1 to 3.6 oz [87.9 to 102.1 g]), and Mexican food by 133 kcal (6.3 to 8.0 oz [178.6 to 226.8 g]). CONCLUSION: Portion sizes and energy intake for specific food types have increased markedly with greatest increases for food consumed at fast food establishments and in the home.

Trends in food locations and sources among adolescents and young adults.

BACKGROUND: The aim of this study was to determine overall trends of total energy intake by food location and food type in diets of adolescents and young adults. METHODS: This study used a nationally representative sample of 16,810 individuals, ages 12-29 from the 1977 to 1978 Nationwide Food Consumption Survey and the 1989-1991 and 1994-1996 Continuing Surveys of Food Intake by Individuals. For each survey year, the percentage of total energy intake from meals and snacks was calculated for adolescents ages 12-18 and young adults ages 19-29. The percentage of energy intake by location and for specific food group was computed for both age groups, separately. RESULTS: Both adolescents and young adults are obtaining less of their energy intake at home and more at restaurants and fast food places. This is predominantly seen among calories from snacking occasions for adolescents and both meals and snacks among the older age group. Significant increases in consumption of pizza, cheeseburgers, and salty snacks and decreases in consumption of desserts and certain milk and meat products by both age groups are shown. CONCLUSIONS: To improve the diets of adolescents and young adults, healthy food choices outside the home need to be as readily available as the foods which have increased in popularity over the past 20 years.

Trends in energy intake in U.S. between 1977 and 1996: similar shifts seen across age groups.

OBJECTIVE: To determine the trends in locations and food sources of Americans stratified by age group for both total energy and the meal and snack subcomponents. RESEARCH METHODS AND PROCEDURES: Nationally representative data was taken from the 1977 to 1978 Nationwide Food Consumption Survey and the 1989 to 1991 and 1994 to 1996 (and 1998 for children age 2 through 9) Continuing Surveys of Food Intake by Individuals. The sample consisted of 63,380 individuals, age 2 and up. For each survey year, the percentage of total energy intake from meals and snacks was calculated separately for 2- to 18-year-olds, 19- to 39-year-olds, 40- to 59-year-olds, and those 60 years and older. The percentage of energy intake by location (at-home consumption or preparation, vending, store eaten out, restaurant/fast-food, and school) and by specific food group was computed for all age groups separately. RESULTS: The trends in location and food sources were almost identical for all age groups. Key dietary behavior shifts included greater away-from-home consumption; large increases in total energy from salty snacks, soft drinks, and pizza; and large decreases in energy from low- and medium-fat milk and medium- and high-fat beef and pork. DISCUSSION: Total energy intake has increased over the past 20 years, with shifts away from meals to snacks and from at-home to away-from-home consumption. The similarity of changes across all age groups furthers the assertion that broad-based environmental changes are needed to improve the diets of Americans.