Circadian timing of eating and BMI among adults in the American Time Use Survey.

BACKGROUND/OBJECTIVES: Experimental studies of time-restricted eating suggest that limiting the daily eating window, shifting intake to the biological morning, and avoiding eating close to the biological night may promote metabolic health and prevent weight gain. SUBJECTS/METHODS: We used the Eating & Health Module of the 2006-2008 and 2014-2016 American Time Use Survey to examine cross-sectional associations of timing of eating in relation to sleep/wake times as a proxy for circadian timing with body mass index (BMI). The analytical sample included 38 302 respondents (18-64 years; BMI 18.5-50.0 kg/m2). A single 24-hour time use diary was used to calculate circadian timing of eating variables: eating window (time between first and last eating activity); morning fast (time between end of sleep and start of eating window); and evening fast (time between end of eating window and start of sleep). Multinomial logistic regression and predictive margins were used to estimate adjusted population prevalences (AP) by BMI categories and changes in prevalences associated with a one-hour change in circadian timing of eating, controlling for sociodemographic and temporal characteristics. RESULTS: A one-hour increase in eating window was associated with lower adjusted prevalence of obesity (AP = 27.1%, SE = 0.1%). Conversely, a one-hour increase in morning fast (AP = 28.7%, SE = 0.1%) and evening fast (AP = 28.5%, SE = 0.1%) were each associated with higher prevalence of obesity; interactions revealed differing patterns of association by combination of eating window with morning/evening fast (p < 0.0001). CONCLUSIONS: Contrary to hypotheses, longer eating windows were associated with a lower adjusted prevalence of obesity and longer evening fasts were associated with a higher prevalence of obesity. However, as expected, longer morning fast was associated with a higher adjusted prevalence of obesity. Studies are needed to disentangle the contributions of diet quality/quantity and social desirability bias in the relationship between circadian timing of eating and BMI.

Clock Time of First Eating Episode and Prospective Risk of All-Cause Mortality in US Adults.

BACKGROUND: There is increasing recognition that a morning or evening preference is associated with time of eating, metabolic health, and morbidity. However, few studies have examined the association of time of eating with mortality. OBJECTIVES: To examine the association of time of first recalled ingestive episode with the prospective risk of all-cause mortality. METHODS: We used mortality-linked data from the NHANES conducted in 1988-1994 and 1999-2014 (n = 34,609; age ≥ 40 years). The exposure was quartiles (Q1-Q4) of clock time of first eating episode self-reported in the baseline 24-hour dietary recall. The outcome was follow-up time from the date of NHANES examination to the date of death or end of the follow-up period (31 December 2015). We used proportional hazards regression methods to determine the independent association of time of first eating episode with relative hazard of all-cause mortality, with adjustments for multiple covariates and the complex survey design. Multiple linear regression methods were used to examine the associations of time of first eating episode with baseline cardiometabolic biomarkers and dietary attributes. RESULTS: In this national cohort, with a median age of ∼55 years (95% CI: 54.6-55.4 years) at baseline and a median follow-up of 8.3 years (IQR, 8.75 years), there were 10,303 deaths. The median times of first eating episodes in Q1-Q4 were 05:45, 07:00, 08:00, and 10:00, respectively. Covariate-adjusted relative hazards of mortality in Q1 to Q3 of the time of the first eating episode were 0.88 (95% CI: 0.81-0.96), 0.88 (95% CI: 0.81-0.95), 0.94 (95% CI: 0.87-1.02), with Q4 as the referent (P = 0.0008). Qualitative dietary attributes were inversely related with the time of the first eating episode; however, BMI and serum concentrations of glycemic biomarkers increased with later times of first eating episode (P ≤ 0.0001). CONCLUSIONS: Recall of an earlier time of the first eating episode by ≥40-year-old US participants was suggestive of a small relative survival advantage in this observational study.

Secular trends in regional differences in nutritional biomarkers and self-reported dietary intakes among American adults: National Health and Nutrition Examination Survey (NHANES) 1988-1994 to 2009-2010.

OBJECTIVE: To understand the contribution of regional differentials in dietary exposures to regional gradients in health, we examined 20-year trends in the association of US census region of residence with nutritional biomarkers and dietary intakes of American adults. DESIGN: Observational. SETTING: The biomarker and 24 h dietary recall data were from the National Health and Nutrition Examination Surveys (NHANES) conducted during 1988-1994 and 1999-2010. The US census region was operationalized as Northeast, Midwest, South and West. Nutritional biomarker outcomes were serum folate, vitamins B6, B12, C, D and E, and carotenoids; dietary outcomes were intakes of nutrients, food groups and eating patterns. SUBJECTS: US adults, n>8000-40 000 for biomarkers and >43 000 for dietary outcomes. RESULTS: The interactions of survey time period and region were not significant for the examined biomarker and dietary outcomes, indicating similar secular trends among regions. The main effect of region was significant for all nutritional biomarkers except serum vitamin B6, most dietary micronutrients, food groups and eating patterns (P<0·001). The mean serum folate, vitamins B12, C and E, and all carotenoid (except lycopene) biomarker levels, and intakes of dietary fibre, vitamins A, E, C and B6, folate, K, Ca, Mg and Fe, fruits, vegetables and whole grains, were higher in the West and Northeast regions, relative to the South and Midwest regions. CONCLUSIONS: Overall, the regional gradients in dietary exposure, expressed objectively as biomarkers or as self-reported nutrient and food group intakes, paralleled trajectories reported for health outcomes and were remarkably persistent over time.

Complementary and compensatory dietary changes associated with consumption or omission of plain water by US adults.

We examined within-person and between-person differences in self-selected diets of free-living individuals when they choose to consume or not to consume plain water. We used 2-days of dietary data from the NHANES 2005-2012 for this study. For within-person analyses, we compared recalls of respondents who reported water in one of the two available recalls (n = 1875 men and 1479 women). For between-person analysis, we compared dietary recalls of respondents who reported water in two, one of two, or zero of two recalls (n = 8632 men and 8907 women). The outcomes examined included reported intakes of 24-h energy from foods, beverages, and dietary and eating pattern attributes. We used covariate-adjusted regression methods for both types of analyses. For within-person analyses, the regression models included separate person-level fixed effects. Relative to the water day, on the no-water day, amount of beverages and energy contribution of beverages were significantly higher in both men (106 kcal) and women (43 kcal) (P ≤ 0.002). However, the water and the no-water days did not differ in 24-h energy intake, or the amount and energy from reported foods (P > 0.05). Energy density of foods, servings of fruits or vegetables and eating patterns did not differ between the water and the no-water day in both men and women (P > 0.05). For between-person analysis, however, intakes of energy and energy density of foods were higher, but density of sodium, potassium, and magnesium were lower among those who reported no water in both recalls. Overall, beverages partially substituted for plain water on the no-water day but qualitative dietary characteristics and eating patterns, which may relate to habitual food intake and personal preferences, were not appreciably different within individuals.

Family income and education were related with 30-year time trends in dietary and meal behaviors of American children and adolescents.

Recent survey data reveal the persistence of long-acknowledged socioeconomic status (SES) differentials in the prevalence of obesity in U.S. children and adolescents. We examined 30-y changes in the association of dietary and meal behaviors with family income and education to understand the possible contribution of these trends to SES trends in obesity rates in 2- to 19-y-old Americans. We used dietary and SES data for 2- to 19-y olds from the NHANES 1971-1974 to 2003-2008 (n = 39,822). The secular changes in the independent association of family income and education with 24-h dietary behaviors [energy intake (kcal), amount of foods and beverages (g), percent energy from all beverages and from nutritive beverages, and energy density of foods] and 24-h meal behaviors [number of eating occasions, energy from snack episodes (%), and mention of breakfast] were examined using multivariable regression methods. The secular increase in energy intake and food and beverage amount was significant in the lowest family SES categories. The positive association of family income and education with intakes of energy, food amounts, and beverage energy, noted in 1971-1974 or 1976-1980, was not observed in later surveys. There was an age gradient in changes in most diet and SES associations over time, with largest adverse changes in 12- to 19-y olds. Higher education was associated with lower energy from snack episodes, breakfast skipping, and energy density of foods and these associations did not change over time. Overall, these results suggest both income and education differentials in secular increases in food amounts and energy intakes.

20-Year trends in dietary and meal behaviors were similar in U.S. children and adolescents of different race/ethnicity.

Recent survey data reveal persistent race/ethnic disparities in prevalence of adiposity in U.S. children and adolescents. We examined race/ethnic differentials in time trends in dietary behaviors of Americans 2-19 y of age to understand if these trends track those observed for body weight. We used dietary data from the NHANES 1988-1994, 1999-2002, and 2003-2008 (n = 24,131) to examine changes in reported energy intake, amount of foods and beverages, number of eating occasions, and percent of energy from foods and beverages, among non-Hispanic white, non-Hispanic black, and Mexican American 2-19 y olds. Multivariable regression analyses appropriate for complex surveys were used to examine these associations. The secular increase in mean number of eating occasions was significant (P-trend < 0.0001) in all age and race/ethnic groups; however, a corresponding increase in the amount of foods and beverages, or total energy intake was not observed. In non-Hispanic black and Mexican American 2-5 and 12-19 y olds, the secular increase in number of eating occasions, and in non-Hispanic black 12-19 y olds, the increase in percent of energy from all beverages or non-nutritive beverages were greater relative to non-Hispanic whites. In conclusion, the observed race/ethnic differences in trajectory of changes in dietary behaviors over past 20 y were modest and were not accompanied by a significant increase in energy intake. Cautious interpretation is urged due to potential underreporting of dietary intake in national surveys. There was a suggestion of convergence in some race/ethnic differentials in dietary behaviors due to greater relative changes in possibly adverse behaviors in non-Hispanic blacks, especially adolescents.

Self-Reported Olfactory Dysfunction and Diet Quality: Findings from the 2011-2014 National Health and Nutrition Examination Survey (NHANES).

We identified associations between self-reported olfactory dysfunction (OD) and dietary attributes in participants aged ≥40 years (n = 6,356) from the nationally representative 2011-2014 National Health and Nutrition Examination Survey (NHANES). The chemosensory questionnaire and 24-h dietary recalls were administered by trained interviewers. OD was defined as self-report of either smell problems in the last year, worse smell relative to age 25, or perceiving phantom odors. Dietary outcomes included Healthy Eating Index 2015 score (HEI) with adequacy and moderation components (higher scores indicated higher diet quality), dietary diversity, energy density, and intake of major food groups. Survey-weighted linear regression models estimated OD-diet associations, adjusting for socio-demographic, lifestyle, and clinical factors. Adjusted mean difference (95% CI) between those with versus without OD, showed that adults with OD had significantly lower HEI moderation score (-0.67 (-1.22, -0.11)) and diets higher in energy density (0.06 (0.00, 0.11)), and percent energy from saturated fat (0.47 (0.12, 0.81)), total fat (0.96 (0.22, 1.70)), and added sugar (1.00 (0.33, 1.66)). Age and sex-stratified analyses showed that younger females (40-64 years) primarily accounted for the associations with diet quality and total/saturated fat intake. These findings inform dietary screening and recommendations for adults who report OD, including those experiencing transient or persistent smell loss with COVID-19.

Patterns of recommended dietary behaviors predict subsequent risk of mortality in a large cohort of men and women in the United States.

Recommendations for intake of fruits and vegetables, whole grains, lean meats, and low-fat dairy form the underpinning of dietary guidance for health promotion. We examined the association of a summary index of food consumption behaviors compatible with the spirit of prevailing dietary guidance and mortality. We used data from the NIH-American Association of Retired Persons cohort (n = 350,886), aged 50-71 y and disease free at baseline in 1995-1996, to examine the association of a dietary behavior score (DBS) with mortality after 10.5 y of follow-up (deaths, n = 29,838). The DBS included 6 equally weighted components derived from responses to questions on usual dietary behaviors related to consumption of fruits, vegetables, low-fat dairy, whole grains, lean meat and poultry, and discretionary fat. The covariate-adjusted association of DBS and mortality from all causes, cancer, and coronary heart disease was examined using Cox proportional hazards regression methods. Compared with those in the lowest one-fifth of DBS, the multivariate-adjusted relative risk of mortality in the highest one-fifth of the DBS was 0.75 (95% CI, 0.70-0.80) in women and 0.79 (95% CI, 0.75-0.83) in men (P-trend < 0.0001). The inverse association of DBS and mortality was significant in both genders in nearly all categories of covariates. Similar trends were observed for DBS associations with mortality from cancer and heart disease. Nearly 12% of the covariate-adjusted population risk of mortality was attributable to nonconformity with dietary recommendations. Adoption of recommended dietary behaviors was associated with lower mortality in both men and women independent of other lifestyle risk factors.

Within-person compensation for snack energy by US adults, NHANES 2007-2014.

BACKGROUND: Most Americans snack and some snack several times a day; however, compensatory dietary and eating behaviors associated with snacking in free-living individuals are poorly understood. OBJECTIVE: The aim of the study was to examine within-person differences in reported energy intake and eating patterns on a snack day relative to a no-snack day. METHODS: We used 2 d of dietary recall data from the NHANES 2007-2014 to replicate the crossover nutrition study paradigm in a natural setting. Respondents reporting a snack episode in only one of two available dietary recalls were eligible for inclusion in the study (n = 1,917 men and 1,860 women). We used multivariable regression methods to compare within-person differences in quantitative, qualitative, and eating pattern outcomes between the snack and no-snack recall days. RESULTS: On the snack day, snack episodes provided (mean difference and 95% CI) 493 (454, 532) kcal of energy in men and 360 (328, 392) kcal in women. The 24-h energy intake on snack day was higher by 239 (140, 337) kcal in men and 219 (164, 273) kcal in women (P < 0.0001). On the snack day, both men and women were more likely to skip main meals and reported lower energy intake from main meals (P < 0.0001); however, the energy density of foods or beverages reported on the snack compared with no-snack days were not different. Fruit servings were higher on the snack day (P ≤ 0.0004), but intakes of vegetables and key micronutrients did not differ. The 24-h ingestive period was longer on the snack day (P < 0.0001). CONCLUSIONS: Free-living men and women partially compensated for snack energy by decreasing energy intake from main meals without adverse associations with qualitative dietary characteristics or time of meal consumption. Women compensated to a smaller extent than men. Thus, over the long term, snack episodes may contribute to positive energy balance, and the risk may be higher in women.

Associations of lifestyle and physiologic factors with prostate-specific antigen concentrations: evidence from the National Health and Nutrition Examination Survey (2001-2004).

Studies suggest inverse associations between obesity and prostate-specific antigen (PSA). However, there is little evidence whether factors related to obesity, including lifestyle (diet and physical activity) and physiologic factors (insulin resistance and metabolic syndrome), influence PSA. We used dietary, physical activity, and serum PSA, insulin, glucose, and lipid data for men >40 years from the National Health and Nutrition Examination Survey (2001-2004; N = 2,548). Energy, fat, and carbohydrate intakes were estimated from a 24-hour dietary recall. Men were considered as having metabolic syndrome based on the Adult Treatment Panel III criteria. Leisure-time physical activity and doctor-diagnosed hypertension were self-reported. Body mass index was calculated from measured weight and height. We computed the geometric mean PSA (ng/mL), adjusted for age, race, and body mass index, by tertile of energy, fat, and carbohydrate intake and level of physical activity, and among men with and without insulin resistance and metabolic syndrome in the whole population and by race. The geometric mean PSA (95% confidence interval) among men in the lowest tertile of energy was 1.05 (0.97-1.1) relative to 0.85 (0.8-0.9) in the highest tertile (P = 0.0002) in the whole population. The PSA concentrations were lower among overweight men with higher versus lower energy intake (P = 0.001). The PSA concentrations in men with insulin resistance was lower [0.87 (0.8-0.9)] relative to men without insulin resistance [0.98 (0.9-1.1)] at P = 0.04. All associations were in similar directions within racial subgroups. No associations were observed between the other lifestyle and physiologic factors. Additional studies are required to confirm these results and to investigate the potential mechanisms that may explain these relationships.

Eating patterns of US adults: Meals, snacks, and time of eating.

The objective of this paper is to update knowledge of eating patterns of US adults with sex and ethnicity specific estimates and discuss the implications of reported patterns with respect to current resurgence of interest in the topic. The eating patterns data were from the NHANES 2009-2014 (n = 15,341 adults). Overall, American adults reported 4.96 ±â€¯0.03 eating episodes in the recall. Women were more likely to report each of the three main meals and all three meals plus one or more snacks relative to men (P < 0.0001). Relative to other ethnic groups, non-Hispanic blacks were less likely to report each meal or a snack or all three meals, and the foods reported for meals and snacks were higher in energy density (P = 0.0001). Of the three meals, the dinner meal, and among snacks, the after-dinner snack, were reported by the highest percentage of Americans; these two eating episodes provided nearly 45% of the 24-h energy intake. The average dinnertime was 6:24 pm, and the average time of the last eating episode of the 24-h ingestive period was 8:18 pm. Given these findings, adoption of eating patterns that advocate less frequent eating and shift in the time of eating are likely to present a challenge. We know little about the validity of eating patterns determined from 24-h recalls or questionnaire instruments. The extent of within person variability and reporting errors in different eating pattern components also need further research.

A prospective study of frequency of eating restaurant prepared meals and subsequent 9-year risk of all-cause and cardiometabolic mortality in US adults.

Restaurant prepared foods are known to be energy-dense and high in fat and sodium, but lower in protective nutrients. There is evidence of higher risk of adiposity, type II diabetes, and heart disease in frequent consumers of restaurant meals. However, the risk of mortality as a long-term health consequence of frequent consumption of restaurant meals has not been examined. We examined the prospective risk of all-cause and coronary heart disease, cerebrovascular disease and diabetes (cardiometabolic) mortality in relation to frequency of eating restaurant prepared meals in a national cohort. We used frequency of eating restaurant prepared meals information collected in the National Health and Nutrition Examination Surveys, conducted from 1999-2004, with mortality follow-up completed through Dec. 31, 2011 (baseline age ≥ 40y; n = 9107). We estimated the relative hazard of all-cause and cardiometabolic mortality associated with weekly frequency of eating restaurant meals using Cox-proportional hazards regression methods to adjust for multiple covariates. All analyses accounted for complex survey design and included sample weights. Over 33% of all respondents reported eating ≥3 restaurant prepared meals/week. In this cohort, 2200 deaths due to all causes and 665 cardiometabolic deaths occurred over a median follow-up of 9 years. The covariate-adjusted hazard ratio of all cause or cardiometabolic mortality in men and women reporters of <1 or 1-2 restaurant prepared meals did not differ from those reporting ≥3 meals/week (P>0.05). The results were robust to effect modification by baseline BMI, years of education, and baseline morbidity. Expectedly, the 24-h dietary intakes of whole grains, fruits, dietary fiber, folate, vitamin C, potassium and magnesium at baseline were lower, but energy, energy density, and energy from fat were higher in more frequent restaurant meal reporters (P<0.05). Baseline serum HDL cholesterol, folate, and some carotenoids were inversely associated with the frequency of eating restaurant prepared meals (P<0.05); however, serum concentrations of total cholesterol, triglycerides, fasting glucose, insulin, glycated hemoglobin, and c-reactive protein were unrelated (P<0.05). The weekly frequency of eating restaurant prepared meals and prospective risk of mortality after 9 years were not related in this cohort.

Trends in black-white differentials in dietary intakes of U.S. adults, 1971-2002.

BACKGROUND: Disparities in the health status of blacks and whites have persisted despite considerable gains in improved health of the U.S. population. Tracking changes in black-white differentials in dietary attributes over time may help in understanding the contribution of diet to these disparities. METHODS: Data were used from four National Health and Nutrition Examination Surveys conducted between 1971 and 2002 for trends in self-reported intakes of energy, macronutrients, micronutrients, fruits and vegetables, and the energy density of foods among U.S. non-Hispanic black (n=7099) and white (n=23,314) men and women aged 25 to 74 years. Logistic and linear regression methods were used to adjust for multiple covariates and survey design. RESULTS: Energy intake, amount of food, and carbohydrate energy increased, whereas percentage of energy from protein, fat, and saturated fat decreased over time in all race and gender groups (p<0.001). In whites and in black women, energy density increased (p<0.001) in parallel to increases in obesity prevalence. In all surveys, black men and women reported lower intakes of vegetables, potassium, and calcium (p<0.001) than their white counterparts. In men, the race differential in calcium intake increased across surveys (p=0.004). CONCLUSIONS: Dietary intake trends in blacks and whites from 1971 to 2002 were similar, which suggests that previously identified dietary risk factors that differentially affect black Americans have not improved in a relative sense.

A prospective study of water intake and subsequent risk of all-cause mortality in a national cohort.

BACKGROUND: Water, an essential nutrient, is believed to be related to a variety of health outcomes. Published studies have examined the association of fluid or beverage intake with risk of mortality from coronary diseases, diabetes, or cancer, but few studies have examined the association of total water intake with all-cause mortality. OBJECTIVE: We examined prospective risk of mortality from all causes in relation to intakes of total water and each of the 3 water sources. DESIGN: We used public-domain, mortality-linked water intake data from the NHANES conducted in 1988-1994 and 1999-2004 for this prospective cohort study (n = 12,660 women and 12,050 men; aged ≥25 y). Mortality follow-up was completed through 31 December 2011. We used sex-specific Cox proportional hazards regression methods that were appropriate for complex surveys to examine the independent associations of plain water, beverage water, water in foods, and total water with multiple covariate-adjusted risk of mortality from all causes. RESULTS: Over a median of 11.4 y of follow-up, 3504 men and 3032 women died of any cause in this cohort. In men, neither total water intake nor each of the individual water source variables (plain water, water in beverages, and water in foods) was independently related with risk of all-cause mortality. In women, risk of mortality increased slightly in the highest quartile of total or plain water intake but did not approach the Bonferroni-corrected level of significance of P < 0.002. CONCLUSIONS: There was no survival advantage in association with higher total or plain water intake in men or women in this national cohort. The slight increase in risk of mortality noted in women with higher total and plain water intakes may be spurious and requires further investigation.

Secular trends in patterns of self-reported food consumption of adult Americans: NHANES 1971-1975 to NHANES 1999-2002.

BACKGROUND: The contributors to trends in increasing prevalence of obesity in the US population are poorly understood. OBJECTIVE: We examined secular trends in food consumption behaviors to understand their possible contribution to increasing energy intakes and adiposity in the American population. DESIGN: We used dietary data from 4 consecutive National Health and Nutrition Examination Surveys (NHANES) to examine trends (1971-2002) in frequency of eating episodes, meal and snack consumption, quantity of food consumed, and the energy density of foods reported by adult Americans (n = 39 094). Logistic and linear regression methods were used to adjust for multiple covariates and survey design. RESULTS: The reported number of all eating episodes increased slightly in women from 4.90 in 1971-1975 to 5.04 in 1999-2002 (P for trend = 0.002). The amount (in g) of foods and beverages consumed, the energy density of foods, and energy intake per eating episode increased, but the mention of breakfast declined in both sexes (P for trend < 0.0001). The observed trends in mention of a snack (in men) and percentage of energy from evening food intake (in women) were downward. The amount (in g) of foods and their energy density were independent positive correlates of obesity in combined data from all surveys (P for trend < 0.0001). CONCLUSIONS: Our results do not support large increases in eating frequency, snacking, or evening eating by the American population from 1971 to 2002. The quantity of foods and their energy density increased beginning in NHANES III (1988-1994) with trajectories roughly parallel to the rates of prevalence of obesity in the US population. However, we urge cautious interpretation of these results because of concurrent changes in dietary methods during this period.

Diet quality and subsequent cancer incidence and mortality in a prospective cohort of women.

BACKGROUND: We have previously reported on the utility of the Recommended Foods Score (RFS), a measure of overall diet quality, in detecting associations between diet and mortality in a cohort of older women. Using additional follow-up, we have now extended our analysis to detailed studies of associations between RFS and the mortality and incidence from common cancers. METHODS: The RFS, the sum of 23 recommended food items consumed at least weekly, was computed from a 62-item food frequency questionnaire completed at baseline by 42 254 women with a mean age of 61 years. Multivariate adjusted relative risk (RR) of cancer mortality and incidence of the cancers for which we were able to obtain data in relation to quartiles of RFS were examined using proportional hazards regression analyses after a median follow-up period of 9.5 years. RESULTS: We observed that RFS was inversely associated with total mortality (RR = 0.8; P < 0.001) cancer mortality (RR = 0.74; P < 0.001) as well as mortality from cancers of the breast (RR = 0.75; P < 0.06), colon/rectum (RR = 0.49; P < 0.01) and lung (RR = 0.54; P < 0.001). The risk of incident lung cancer (RR = 0.62; P < 0.001) was reduced in women in the highest vs the lowest quartile of RFS; for incident cancers of the breast, colorectum, endometrium, ovaries, and bladder, there was no RFS association. CONCLUSION: A dietary pattern reflecting a higher RFS was associated with decreased overall mortality in women, specifically cancers of the lung, colon/rectum, and to a lesser extent breast. Incidence was only decreased for lung cancers. These observations are consistent with the hypothesis that a high RFS dietary pattern, or associated lifestyle factors, might affect cancer progression and survival.

40-year trends in meal and snack eating behaviors of American adults.

BACKGROUND: Understanding changes in profiles of eating behaviors over time may provide insights into contributors to upward trajectories of obesity in the US population. Yet little is known about whether or not characteristics of meal and snack eating behaviors reported by adult Americans have changed over time. OBJECTIVE: To examine time trends in the distribution of day's intake into individual meal and snack behaviors and related attributes in the US adult population. DESIGN: The study was observational with cross-sectional data from national surveys fielded over 40 years. PARTICIPANTS/SETTING: Nationally representative dietary data from nine National Health and Nutrition Examination Surveys conducted from 1971-1974 to 2009-2010 (N=62,298 participants aged 20-74 years) were used to describe eating behaviors. OUTCOMES EXAMINED: The respondent-labeled eating behaviors examined included main meals (breakfast, lunch, and dinner), and snacks (before breakfast, between breakfast and lunch, between lunch and dinner, after dinner, or other). For each eating behavior, percent of reporters, relative contribution to 24-hour energy intake, the clock time of report, and intermeal/snack intervals were examined. STATISTICAL ANALYSIS: Multivariable logistic and linear regression methods for analysis of complex survey data adjusted for characteristics of respondents in each survey. RESULTS: Over the 40-year span examined reports of each individual named main meal (or all three main meals) declined, but reports of only two out of three meals or the same meal more than once increased; the percentage of 24-hour energy from snacks reported between lunch and dinner or snacks that displaced meals increased; clock times of breakfast and lunch were later, and intervals between dinner and after-dinner snack were shorter. Changes in several snack reporting behaviors (eg, report of any snack or ≥2 snacks), were significant in women only. CONCLUSIONS: Several meal and snack eating behaviors of American adults changed over time, with a greater change in snack behaviors of women relative to men.

Within-person comparison of eating behaviors, time of eating, and dietary intake on days with and without breakfast: NHANES 2005-2010.

BACKGROUND: Breakfast omission is known to be associated with lower 24-h energy intake. However, little is known about downstream eating behaviors subsequent to skipping breakfast in free-living individuals. OBJECTIVE: We replicated the traditional crossover design of nutrition studies in a naturalistic setting to compare within-person differences in self-reported eating behaviors, energy intake, and other dietary characteristics of individuals on a day that included breakfast with a day that omitted breakfast. DESIGN: We used cross-sectional dietary data for 2132 adult respondents who reported breakfast in only one of 2 dietary recalls in the NHANES 2005-2010. Dietary outcomes examined included meal- and snack-eating behaviors, clock time of eating episodes, and intakes of energy, macronutrients, and food groups. Regression methods accounted for replicate diet measurements, covariates, and survey-design characteristics. RESULTS: The breakfast meal provided a mean of 508 kcal in men and 374 kcal in women, but differences in 24-h energy intakes between the breakfast and no-breakfast day were 247 and 187 kcal, respectively. Energy intakes at the lunch meal were higher on the no-breakfast day (202 kcal in men and 121 kcal in women), and the reported time of lunch was ∼35 min earlier. The energy contribution of dinner or its reported time did not differ. A higher number of energy-adjusted servings of fruit and whole grains were reported on the breakfast day, but the energy and macronutrient density of reported foods were not different. CONCLUSIONS: In free-living American adults, the eating time for lunch was earlier, and the lunch meal provided more energy on the no-breakfast day than on the breakfast day. Although the quality of dietary selections reflected in the energy and macronutrient density of a day's intake did not differ between the breakfast and the no-breakfast day, breakfast skippers may need encouragement to consume fruit and whole grains at other eating episodes.

Reported consumption of low-nutrient-density foods by American children and adolescents: nutritional and health correlates, NHANES III, 1988 to 1994.

OBJECTIVE: To examine the contribution of foods of modest nutritional value to the diets of American children and adolescents. METHODS: The data were from the third National Health and Nutrition Examination Survey, 1988 to 1994, and included 4852 children and adolescents, aged 8 to 18 years. Foods reported in the 24-hour dietary recall were grouped into the following low-nutrient-density (LND) food categories: visible fat; table sweeteners, candy, and sweetened beverages; baked and dairy desserts; salty snacks; and miscellaneous. The independent association of the number of LND foods mentioned in the recall with intake of food groups, macronutrients, micronutrients, and body mass index was examined by means of regression procedures to adjust for multiple covariates. RESULTS: The LND foods contributed more than 30% of daily energy, with sweeteners and desserts jointly accounting for nearly 25%. Intakes of total energy and percentage of energy from carbohydrate and fat related positively, but percentage of energy from protein and dietary fiber (in grams) related inversely to the reported number of LND foods (P<.05). The reported number of LND foods was a negative predictor (P<.001) of the amount of nutrient-dense foods reported. The mean amount of reported intake of several micronutrients-vitamins A, B6, and folate, and the minerals calcium, magnesium, iron, and zinc-declined (P<.05) with increasing tertiles of reported number of LND foods. The LND food reporting was not a significant predictor of body mass index. CONCLUSION: High LND food reporting was related to higher energy intake but lower amounts of the 5 major food groups and most micronutrients.

Dietary patterns and health outcomes.

A systematic review of the literature on dietary patterns (multiple dietary components operationalized as a single exposure) in relation to nutrient adequacy, lifestyle and demographic variables, and health outcome was conducted. Most of the published reports on the subject have used one of two methods to determine dietary patterns: (a) diet indexes or scores that assess compliance with prevailing dietary guidance as dietary patterns, and (b) data-driven methods that use factor or cluster analysis to derive dietary patterns. Irrespective of the approach used, patterns characterized by fruit/vegetable/whole grain/fish/poultry consumption generally have been reported to relate to micronutrient intake, and to selected biomarkers of dietary exposure and disease risk in the expected direction. Age, income, and education have been reported to be among positive predictors of the so-called more healthful dietary patterns. An inverse association of healthful dietary patterns with all-cause mortality and cardiovascular disease risk was reported in most studies. However, the magnitude of risk reduction was modest and was attenuated after control for confounders. Few published studies showed an association between risk of most incident cancers and dietary patterns. Both of the currently used approaches for extracting dietary patterns have limitations, are subject to dietary measurement errors, and have not generated new diet and disease hypotheses.