Accuracy and cost-effectiveness of the INDDEX24 Dietary Assessment Platform in Viet Nam.

Technology-enabled approaches to conducting 24-h dietary recalls (24HR) may reduce dietary assessment bottlenecks in low-resource settings. However, few studies have assessed their performance relative to conventional pen-and-paper interview (PAPI) approaches and none have validated performance against a benchmark (e.g. weighed food record (WFR)) in a low- and middle-income country (LMIC). This study assessed relative accuracy and cost-effectiveness of INDDEX24, a technology-enabled approach to conducting 24HR, compared with a PAPI approach and against an observer WFR. Women aged 18-49 years from northern Viet Nam (n 234) were randomly assigned to be interviewed using INDDEX24 or PAPI 24HR following a WFR. The two one-sided t test approach assessed the equivalence of each recall modality to the benchmark. Difference-in-differences analysis compared the recall-benchmark results across modalities. Cost per percentage point of accuracy for INDDEX24 and PAPI was derived from accuracy results and the cost to conduct the 24HR. The PAPI and INDDEX24 24HR were statistically equivalent to the WFR for all nutrients except vitamin A. INDDEX24 diverged significantly less than PAPI from the WFR for Fe (0·9 v. -1·3 mg) and PAPI diverged less for protein (-3·7 v. 7·9 g). At the individual level, 26 % of PAPI and 32 % of INDDEX24 respondents had energy intakes within +/- 10 % of the WFR. INDDEX24 cost $111 004 and the PAPI cost $120 483 (USD 2019), making INDDEX24 more cost-effective across most indicators. INDDEX24 was an accurate and cost-effective method for assessing dietary intake in the study context and represents a preferred alternative to PAPI 24HR in Viet Nam and other LMIC.

The impact of a community social marketing campaign on children's meal orders and consumption: main outcomes from a group randomised controlled trial.

OBJECTIVE: Restaurants may be important settings for interventions to reduce children's energy intake. The objective of this study was to test the impact of a parent-focused social marketing campaign to promote healthy children's meals on calories ordered and consumed by children at quick-service restaurants (QSR). DESIGN: Using a repeated cross-sectional study design, two urban communities were randomised to intervention (IN) v. control (C) condition. A community-wide social marketing campaign was implemented in the IN community to empower Black and Latinx mothers who frequent QSR (priority population) to select healthier options for their child. SETTING: Data were collected in 2016 at QSR located within the communities pre- and post-IN and analysed in 2017. PARTICIPANTS: Parents (n 1686; n 819 and n 867 for I and C conditions, respectively) were recruited after placing their QSR order; a survey, receipt and their child's leftovers were collected. RESULTS: Calories ordered did not differ significantly between the IN and C conditions (changeadj = -146·4 kJ (-35·0 kcal); 95 % CI -428·0 kJ (-102·3 kcal), 134·6 kJ (32·2 kcal)). In a sub-analysis of only the priority audience, children in the IN community ordered significantly fewer calories compared to C children in unadjusted models (changeunadj = -510·4 kJ (-122·0 kcal); 95 % CI -1013·4 kJ (-242·2 kcal), -7·5 kJ (-1·8 kcal)), but the trend did not persist after adjusting for covariates (changeadj = -437·2 kJ (-104·5 kcal); 95 % CI -925·5 kJ (-221·2 kcal), 50·6 kJ (12·1 kcal)). Calories consumed followed similar trends. CONCLUSION: The campaign did not significantly reduce children's QSR calories ordered or consumed. However, a quantitatively important mean reduction in calories was suggested among the priority audience, indicating potential for community-wide promotion of healthful children's meals.

Community coalition efforts to prevent childhood obesity: two-year results of the Shape Up Under 5 study.

BACKGROUND: Cross-sector collaborations and coalitions are promising approaches for childhood obesity prevention, yet there is little empirical evidence about how they affect change. We hypothesized that changes in knowledge of, and engagement with, childhood obesity prevention among coalition members can diffuse through social networks to influence policies, systems, and environments. METHODS: We studied a community coalition (N = 16, Shape Up Under 5 "SUU5 Committee") focused on early childhood obesity prevention in Somerville, MA from 2015-17. Knowledge, engagement, and social network data were collected from Committee members and their network contacts (n = 193) at five timepoints over two years. Policy, systems, and environment data were collected from the SUU5 Committee. Data were collected via the validated COMPACT Stakeholder-driven Community Diffusion survey and analyzed using regression models and social network analysis. RESULTS: Over 2 years, knowledge of (p = 0.0002), and engagement with (p = 0.03), childhood obesity prevention increased significantly among the SUU5 Committee. Knowledge increased among the Committee's social network (p = 0.001). Significant changes in policies, systems, and environments that support childhood obesity prevention were seen from baseline to 24 months (p = 0.003). CONCLUSION: SUU5 had positive effects on "upstream" drivers of early childhood obesity by increasing knowledge and engagement. These changes partially diffused through networks and may have changed "midstream" community policies, systems, and environments.

Validation of the INDDEX24 mobile app v. a pen-and-paper 24-hour dietary recall using the weighed food record as a benchmark in Burkina Faso.

Effective nutrition policies require timely, accurate individual dietary consumption data; collection of such information has been hampered by cost and complexity of dietary surveys and lag in producing results. The objective of this work was to assess accuracy and cost-effectiveness of a streamlined, tablet-based dietary data collection platform for 24-hour individual dietary recalls (24HR) administered using INDDEX24 platform v. a pen-and-paper interview(PAPI) questionnaire, with weighed food record (WFR) as a benchmark. This cross-sectional comparative study included women 18-49 years old from rural Burkina Faso (n 116 INDDEX24; n 115 PAPI). A WFR was conducted; the following day, a 24HR was administered by different interviewers. Food consumption data were converted into nutrient intakes. Validity of 24HR estimates of nutrient and food group consumption was based on comparison with WFR using equivalence tests (group level) and percentages of participants within ranges of percentage error (individual level). Both modalities performed comparably estimating consumption of macro- and micronutrients, food groups and quantities (modalities' divergence from WFR not significantly different). Accuracy of both modalities was acceptable (equivalence to WFR significant at P < 0·05) at group level for macronutrients, less so for micronutrients and individual-level consumption (percentage within ±20 % for WFR, 17-45 % for macronutrients, 5-17 % for micronutrients). INDDEX24 was more cost-effective than PAPI based on superior accuracy of a composite nutrient intake measure (but not gram amount or item count) due to lower time and personnel costs. INDDEX24 for 24HR dietary surveys linked to dietary reference data shows comparable accuracy to PAPI at lower cost.

Weighed Plate Waste Can Accurately Measure Children's Energy Consumption from Food in Quick-Service Restaurants.

BACKGROUND: Quick-service restaurants (QSRs) serve one-third of US children on any given day, yet no methods can directly measure energy (kcal) consumed in QSRs. Weighed plate waste is one feasible option, but the accuracy is unknown. OBJECTIVE: The objective of this study was to determine the accuracy of weighed plate waste for measuring children's energy consumption in QSRs. METHODS: Children's plate waste (entrées and sides) was collected for a larger study assessing a community-wide health messaging campaign to inform parents' orders for children in QSRs; a subsample (n = 194) was used for validation. Gross energy left over estimated by weighed plate waste combined with restaurant-stated nutrition information was compared to gross energy determined by bomb calorimetry, the gold-standard energy assessment technique. Analyses were conducted at the meal level (all food items, combined) and stratified by the number of items per meal (1, 2, or 3). Pearson correlations and paired t tests analyzed agreement; Bland-Altman statistics examined differences between energy estimations for the total and stratified subsample. RESULTS: Overall, significant agreement was observed between weighed plate waste and bomb calorimetry (r = 0.99, P < 0.001). On average, weighed plate waste underestimated energy content by <2 kcal compared with bomb calorimetry (mean percent difference ± SD of 0.3% ± 10.7%); 94% of estimations fell within the limits of agreement (-23.5 to 26.8 kcal), and 63% and 24% of estimations differed by <10 or <20 net kcal, respectively. Although stratification by item number showed slight variation, mean differences for all strata were <5 kcal (t test P > 0.80), suggesting the accuracy of weighed plate waste for measuring meals of various sizes. CONCLUSIONS: Weighed plate waste is an accurate and valid field technique for measuring children's energy consumption from food in QSRs. Future improvements to capturing beverages, self-serve condiments, and sharing behaviors may improve the overall feasibility and accuracy.

Dissemination of healthy kids out of school principles for obesity prevention: A RE-AIM analysis.

Health-promoting behaviors for childhood obesity prevention are needed across multiple environments where children spend time, including out-of-school time (OST). Therefore Healthy Kids Out of School (HKOS) developed intervention strategies to promote three evidence-based principles (Drink Right, Move More, Snack Smart) for obesity prevention in OST. The strategies were developed with stakeholder input, disseminated, and evaluated (2012-2015) in two volunteer-led OST organizations, Boy Scouts of America (BSA) and 4-H, across three US states using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework. Mixed methods were used involving surveys, key informant interviews, and organizational-level data collection. Sixty out of 81 (74.1%) BSA districts and 4-H counties reaching 84,590 children (72% of children participating in BSA and 4-H in three states) adopted the strategies. 530 surveys completed by local OST leaders at baseline and 294 at follow-up showed the percentage of programs offering healthy beverages and opportunities for physical activity increased from baseline to follow-up (beverages 26% baseline, 35% follow-up, odds ratio (OR) 1.53; physical activity 31% baseline, 45% follow-up, OR 1.79; all p < 0.05). The increasing trend for healthy snacks was statistically non-significant (p = 0.09). Leaders interviewed reported the strategies were easy to implement, a good fit with their program, facilitated success, and they expected to maintain the changes. Integration of HKOS customized materials (BSA patch and 4-H pin) on BSA and 4-H national websites is a broader indicator of maintenance. Intervention strategies developed with stakeholder input and disseminated with training can effectively facilitate healthy environments for children, and have potential for national scale.

Disparities in moderate-to-vigorous physical activity among girls and overweight and obese schoolchildren during school- and out-of-school time.

BACKGROUND: Increasing physical activity (PA) during the school day and out-of-school time are critical strategies for preventing childhood obesity and improving overall health. The purpose of the present investigation was to examine schoolchildren's volume and type of PA during school-time and out-of-school, compared to national recommendations and differences by sex and weight status. METHODS: This cross-sectional analysis included 517 3(rd)-5(th) grade schoolchildren from 13 New England elementary schools (October 2013-January 2014). Demographics were collected by parent questionnaire. Measured height and weight were used to categorize child weight status. Accelerometer data were collected over 7 days. PA was coded as total activity counts and minutes of sedentary, light, and moderate-to-vigorous physical activity (SED, LPA, MVPA) during 1) school, 2) weekday out-of-school, 3) weekend, and 4) total daily time. Multivariable mixed models were used to examine associations between sex and weight status and total counts, SED, LPA, and MVPA, controlling for demographics, wear-time, and clustering within schools. RESULTS: 453 participants (60.5% girls; mean age 9.1 years; 30.5% overweight/obese) had valid accelerometer wear time (≥3 days, ≥ 10 h/day). Few children achieved 60 min total daily (15.0%) or school-time (8.0 %) MVPA recommendations. For all time-of-day categories, girls achieved fewer MVPA minutes than boys (p < .0001), and overweight/obese participants achieved fewer MVPA minutes than normal/underweight participants (p = 0.05). Minutes of LPA declined by grade-level (p < .05) and were lower in girls than boys during school-time only (p < .05). CONCLUSION: Disparities in MVPA by sex and weight status across school and out-of-school time highlight the need for programs with equitable reach.

Children's perceptions of weight, obesity, nutrition, physical activity and related health and socio-behavioural factors.

OBJECTIVE: Approximately one-third of children in the USA are either overweight or obese. Understanding the perceptions of children is an important factor in reversing this trend. DESIGN: An online survey was conducted with children to capture their perceptions of weight, overweight, nutrition, physical activity and related socio-behavioural factors. SETTING: Within the USA. SUBJECTS: US children (n 1224) aged 8-18 years. RESULTS: Twenty-seven per cent of children reported being overweight; 47·1% of children overestimated the rate of overweight/obesity among US children. A higher percentage of self-classified overweight children (81·9%) worried about weight than did self-classified under/normal weight children (31·1%). Most children (91·1%) felt that it was important to not be overweight, for both health-related and social-related reasons. The majority of children believed that if someone their age is overweight they will likely be overweight in adulthood (93·1%); get an illness such as diabetes or heart disease in adulthood (90·2%); not be able to play sports well (84·5%); and be teased or made fun of in school (87·8%). Children focused more on food/drink than physical activity as reasons for overweight at their age. Self-classified overweight children were more likely to have spoken with someone about their weight over the last year than self-classified under/normal weight children. CONCLUSIONS: Children demonstrated good understanding of issues regarding weight, overweight, nutrition, physical activity and related socio-behavioural factors. Their perceptions are important and can be helpful in crafting solutions that will resonate with children.

Reliability and Validity of Digital Images to Assess Child Dietary Intake in a Quick-Service Restaurant Setting.

BACKGROUND: Development of methods to accurately measure dietary intake in free-living situations-restaurants or otherwise-is critically needed to understand overall dietary patterns. OBJECTIVE: This study aimed to develop and test reliability and validity of digital images (DI) for measuring children's dietary intake in quick-service restaurants (QSRs), validating against weighed plate waste (PW) and bomb calorimetry (BC). DESIGN: In 2016, cross-sectional data were collected at two time points within a randomized controlled trial assessing children's leftovers in QSRs from parents of 4- to 12-year-old children. PARTICIPANTS/SETTING: Parents (n = 640; mean age = 35.9 y; 70.8% female) consented and agreed to provide their child's PW for digital imaging, across 11 QSRs in Massachusetts in areas with low socioeconomic status and ethnically diverse populations. OUTCOME MEASURES: Outcome measures were interrater reliability for DIs, correspondence between methods for energy consumed and left over, and correspondence between methods across varying quantities of PW. ANALYSES PERFORMED: Intraclass correlations, percent agreement, Spearman correlations, Wilcoxon signed rank tests, and Bland-Altman plots were used. RESULTS: Interrater reliability ratings for DIs had substantial intraclass correlations (ICC = 0.94) but not acceptable exact percent agreement (80.2%); DI and PW energy consumed were significantly correlated (r = 0.96, P < 0.001); DI slightly underestimated energy consumed compared with PW (Mdiff = -1.61 kcals, P < 0.001). Bland-Altman plots showed high DI-PW correspondence across various energy amounts and revealed few outliers. Energy left over by BC was highly correlated with DI (r = 0.87, P < 0.001) and PW (r = 0.90, P < 0.001); and mean differences were not significantly different from DI (Mdiff = 9.77 kcal, P = 0.06) or PW (Mdiff = -2.84 kcal, P = 0.20). CONCLUSIONS: Correspondence was high between PW and DI assessments of energy consumed, and high with BC energy left over. Results demonstrate reliability and practical validity of digital images for assessing child meal consumption in QSR settings.

Implementation of nutrition and physical activity-related policies and practices on college campuses participating in the Healthier Campus initiative.

Objective: To evaluate implementation of nutrition/physical activity-related policies/practices at colleges participating in a healthy campus initiative and campus health leaders' perceptions of policies/practices' support for student health and ease of/barriers to implementation. Participants: Health leaders at colleges participating in the Healthier Campus Initiative (HCI), with completed or ongoing three-year HCI commitments. Methods: Surveys asked which of 41 guidelines were implemented and perceptions around support for student health and ease of/barriers to implementation. Qualitative interviews explored similar domains. Results: Campuses with completed HCI commitments (n = 17) averaged 27.6 guidelines implemented, versus 21.1 on campuses with commitments ongoing (n = 13; p = 0.003). Perceived support for student health and implementation ease varied by guideline. Common implementation barriers included financial costs and time. Interviews largely reinforced these findings. Conclusions: Completion of a campus environmental change initiative may be associated with more health-supporting practices. Campuses may benefit from implementing coordinated policy/practice changes supporting healthy eating and physical activity.

Validation of a web-based dietary questionnaire designed for the DASH (dietary approaches to stop hypertension) diet: the DASH online questionnaire.

OBJECTIVE: With the upsurge in online dietary modification programmes, online dietary assessment tools are needed to capture food intake. Although the DASH (Dietary Approaches to Stop Hypertension) diet is recommended by the US Department of Agriculture, there are no online instruments that capture DASH food servings. Our objective was to assess the validity of a new, short, online dietary questionnaire developed to capture intake of DASH food servings. The DASH Online Questionnaire (OLQ) was validated against the well-known Block Food Frequency Questionnaire (FFQ). DESIGN: This was a cross-sectional validation of the DASH OLQ, which contained eleven food groups (breakfast cereals; dairy; drinks; fats and oils; fruits; grains and snacks; meat, fish and poultry; mixed dishes; sweets; vegetables; and nuts, seeds and legumes). Each subject completed a DASH OLQ once weekly for four weeks and one 98.2 Block FFQ (110 questions) between weeks 2 and 4. DASH OLQ were averaged and then compared with the Block FFQ for nutrient intakes as well as intakes of DASH food groups. SETTING: Boston University Medical Center, Boston, Massachusetts. SUBJECTS: One hundred and ninety-one faculty and staff at Boston University Medical Center aged 20-70 years. RESULTS: There were significant positive correlations between the Block FFQ and the DASH OLQ for all food groups ranging from r = 0.8 for the nuts/seeds/legumes category to r = 0.3 for vegetables and mixed dishes. A comparison of nutrient intakes found strong positive correlations in all nutrient categories. Of particular interest in the DASH diet and the web-based nutrition and physical activity programme were total fat (r = 0.62), total carbohydrate (r = 0.67), total K (r = 0.68), total Ca (r = 0.69), total vitamin C (r = 0.60) and total energy intake (r = 0.68). CONCLUSIONS: The DASH OLQ captures food and nutrient intake well in relation to the more established Block FFQ.

Behavioral Correlates of Empirically-Derived Dietary Patterns among University Students.

Given the importance of young adulthood in establishing lifelong dietary habits, it is imperative to better understand potential underlying drivers of dietary behavior in the university-age population. Dietary patterns have been associated with disease risk, but behavioral predictors of dietary pattern adherence are poorly understood, especially among emerging adults. This study aims to evaluate health-related behaviors associated with dietary pattern scores among freshmen participating in the Tufts Longitudinal Health Study (TLHS; n = 630). We previously derived dietary patterns using principal components analysis and orthogonal rotation from dietary intake data. Health-related behavior data were collected via survey. All data were collected during the Spring semesters of 1998⁻2007. Unadjusted linear models were used to determine associations between dietary pattern scores and health-related behaviors. Significant correlates were retained in multivariable regression models, which were adjusted for demographic characteristics. We found that never eating meals away from home was associated with higher adherence to the Prudent and lower adherence to the Western and Alcohol patterns. Intention to lose weight was negatively associated with the Western pattern, while intention to gain weight was positively associated with all dietary patterns. These findings suggest that intervention efforts aimed at improving eating out behaviors and engaging in healthy weight management strategies may promote healthier dietary patterns among university students.

Intake of whole grains, refined grains, and cereal fiber measured with 7-d diet records and associations with risk factors for chronic disease.

BACKGROUND: Research studies examining foods are important, because they account for biological interactions that might otherwise be lost in the analysis of individual nutrients. Single-nutrient studies are also needed to explore the mechanisms by which foods may be protective. OBJECTIVE: Our objective was to examine associations between whole grains, refined grains, and cereal fiber and chronic disease risk factors. DESIGN: In a cross-sectional analysis of participants in the Baltimore Longitudinal Study of Aging, associations between dietary intakes and risk factors were examined with multivariate linear regression analysis. Dietary intakes were assessed with 7-d dietary records and quantified in g/d. RESULTS: Compared with subjects in the lowest quintile (Q1) of whole-grain intake, subjects in the highest quintile (Q5) had lower body mass index (BMI; in kg/m(2); Q1: 25.5; Q5: 24.8; P for trend <0.0001) and weight (Q1: 75.0 kg; Q5: 72.4 kg; P for trend = 0.004) and smaller waist circumference (Q1: 87.4 cm; Q5: 85.0 cm; P for trend = 0.002). Whole grains were also inversely associated with total cholesterol (P for trend = 0.02), LDL cholesterol (P for trend = 0.04), and 2-h glucose (P for trend = 0.0006). Associations between cereal fiber and anthropometrics and plasma lipids were similar. In subgroup analyses, refined grains were positively associated with fasting insulin among women (P for trend = 0.002). CONCLUSIONS: Similar associations of whole grains and cereal fiber with weight, BMI, waist circumference, plasma cholesterol, and 2-h glucose were observed, suggesting that cereal fiber and its constituents may in part mediate these relations. Refined grains were associated with fasting insulin among women but not men. Additional research should explore potential interaction effects with BMI, sex, age, and genes.

Comparative Study of a New Dietary Screener to Assess Food Groups of Concern in Children.

BACKGROUND: Although there are several valid and reliable dietary screeners to measure child intake patterns, there is a paucity of brief assessment tools targeting under- and overconsumed foods. OBJECTIVE: To compare the Fueling Learning through Exercise study (FLEX) dietary questionnaire, a screener designed to assess consumption patterns in third to fifth graders, to a validated dietary assessment tool. METHODS: The FLEX dietary questionnaire was developed to assess fruit, vegetable, snack, and beverage consumption and was compared to the Block Kids Food Screener (BKFS). Correlations were analyzed using Pearson correlation coefficient. Agreement was assessed using Bland-Altman plots. RESULTS: The sample (n = 63) had mean age of 9.9 years (SD 0.7). Most participants were non-Hispanic white (70%) and eligible for free/reduced price lunch (57%). Correlations between food group categories were significant for all groups ( P < .05) except fruits ( r = 0.51) and sugar-sweetened beverages (SSBs) ( r = 0.21). We found moderate-to-strong correlations between reported vegetable, salty snack, sweet snack, total beverage, milk, and fruit juice consumption (0.62, 0.59, 0.69, 0.47, 0.48, and 0.46, respectively). The FLEX screener reported systematically higher mean servings per day (0.24-1.1) compared to the BKFS (0.05-0.51). CONCLUSION: Based on these correlations, the FLEX dietary questionnaire performs similarly to a validated tool in assessing intake of under- and overconsumed food groups in a diverse third to fifth grade population. Overall serving size discrepancies are likely due to more relevant food items on the FLEX questionnaire and a more child-friendly format. This study highlights the need to update older diet screeners to reflect current child consumption patterns.

Cross-Sectional Associations between Empirically-Derived Dietary Patterns and Indicators of Disease Risk among University Students.

The transition from adolescence to adulthood is a unique period during which lifelong dietary habits are shaped. Dietary patterns (DPs) among young adults attending college have not been adequately described, and associations between DPs and indicators of disease risk are not well understood in this age group. Dietary data were collected from undergraduates participating in the Tufts Longitudinal Health Study (TLHS; 1998-2007) by Food Frequency Questionnaire (FFQ; n = 1323). DPs were derived using principal components analysis with varimax rotation. Scree plots; eigenvalues; factor loadings; and previous studies were used to determine and label the DPs retained. Cross-sectional relationships between DP scores and anthropometric measures (percent body fat (PBF) and (BMI) and lipid biomarkers (total; HDL and LDL cholesterol; and triglycerides) were assessed with multivariable regression models; adjusted for demographics; physical activity; smoking; intention to gain/lose weight; and total energy intake. Effect modification by sex was tested. Three DPs were identified: Prudent; Western; and Alcohol. Greater adherence to the Prudent DP was associated with favorable anthropometric outcomes. The Alcohol DP was associated with a favorable lipid profile. Associations between the Western DP and blood lipids differed by sex; with unfavorable impact observed only among males. Our findings add to the literature linking DPs in young adults with measurable adiposity and cardiometabolic outcomes; suggesting that improving nutrition among college students could reduce chronic disease risk.

Breakfast cereal fortified with folic acid, vitamin B-6, and vitamin B-12 increases vitamin concentrations and reduces homocysteine concentrations: a randomized trial.

BACKGROUND: High homocysteine and low B vitamin concentrations have been linked to the risk of vascular disease, stroke, and dementia and are relatively common in older adults. OBJECTIVE: We assessed the effect of breakfast cereal fortified with folic acid, vitamin B-6, and vitamin B-12 on vitamin and homocysteine status. DESIGN: A randomized, double-blind trial was conducted in 189 volunteers aged 50-85 y. The subjects had no history of hypertension, anemia, asthma, cancer, or cardiovascular or digestive disease and did not regularly consume multiple or B vitamin supplements or highly fortified breakfast cereal. Subjects were randomly assigned to consume 1 cup (0.24 L) breakfast cereal fortified with 440 microg folic acid, 1.8 mg vitamin B-6, and 4.8 microg vitamin B-12 or placebo cereal for 12 wk. Blood was drawn at 0, 2, 12, and 14 wk. Methionine-loading tests were conducted at baseline and week 14. RESULTS: Final baseline-adjusted plasma homocysteine concentrations were significantly lower and B vitamin concentrations were significantly higher in the treatment group than in the placebo group (P < 0.001). The percentage of subjects with plasma folate concentrations < 11 nmol/L decreased from 2% to 0%, with vitamin B-12 concentrations < 185 pmol/L from 9% to 3%, with vitamin B-6 concentrations < 20 nmol/L from 6% to 2%, and with homocysteine concentrations > 10.4 micromol/L (women) or > 11.4 micromol/L (men) from 6.4% to 1.6%. The percentage of control subjects with values beyond these cutoff points remained nearly constant or increased. CONCLUSIONS: In this relatively healthy group of volunteers, consumption of 1 cup fortified breakfast cereal daily significantly increased B vitamin and decreased homocysteine concentrations, including post-methionine-load homocysteine concentrations.

Intake of alpha-tocopherol is limited among US adults.

OBJECTIVE: To examine alpha-tocopherol intake and food sources of alpha-tocopherol in the US population relative to current Dietary Reference Intakes for vitamin E. DESIGN: We analyzed food source and intake data from the 1994 to 1996 Continuing Survey of Food Intakes by Individuals (CSFII) with added values for alpha-tocopherol from the US Department of Agriculture National Nutrient Database for Standard Reference Release 15. SUBJECTS: Data from 5,056 men and 4,703 women aged 20 years and older were obtained from the 1994 to 1996 CSFII. STATISTICAL ANALYSES PERFORMED: The complex design and sampling weights of the CSFII survey were taken into account to calculate the mean alpha-tocopherol intake from diet, the SEM, and the percent of the Estimated Average Requirements (EARs) for alpha-tocopherol intake by age group and region. RESULTS: Only 8.0% of men and 2.4% of women in the United States met the new EARs for vitamin E intake from foods alone. Regionally, only 5.8% of men and 2.1% of women in the South met these EARs, relative to 9.0% and 2.6%, respectively, in the Northeast. Top contributors of alpha-tocopherol for men and women included ready-to-eat cereal, sweet baked products, white bread, beef, oils, and salad dressing. APPLICATIONS/CONCLUSIONS: The majority of men and women in the United States fail to meet the current recommendations for vitamin E intake. Many of the top contributors are not particularly high sources of alpha-tocopherol but are consumed frequently. Greater inclusion of sources such as nuts, seeds, and vitamin E-rich oils, could improve intake of alpha-tocopherol.

Mediterranean diet, healthy eating index 2005, and cognitive function in middle-aged and older Puerto Rican adults.

Adherence to a Mediterranean diet has recently been shown to protect against cognitive decline and dementia. It remains unclear, however, whether such protection extends to different ethnic groups and middle-aged individuals and how it might compare with adherence to the US Department of Agriculture's 2005 Dietary Guidelines for Americans (measured with Healthy Eating Index 2005 [HEI 2005]). This study examined associations between diet quality, as assessed by the Mediterranean diet and HEI 2005, and cognitive performance in a sample of 1,269 Puerto Rican adults aged 45 to 75 years and living in the Greater Boston area of Massachusetts. Dietary intake was assessed with a food frequency questionnaire specifically designed for and validated with this population. Adherence to the Mediterranean diet was assessed with a 0- to 9-point scale, and the HEI 2005 score was calculated with a maximum score of 100. Cognitive performance was measured with a battery of seven tests and the Mini Mental State Examination was used for global cognitive function. Greater adherence to the Mediterranean diet was associated with higher Mini Mental State Examination score (P trend=0.012) and lower likelihood (odds ratio=0.87 for each additional point; 95% CI 0.80 to 0.94; P<0.001) of cognitive impairment, after adjustment for confounders. Similarly, individuals with higher HEI 2005 score had higher Mini Mental State Examination score (P trend=0.011) and lower odds of cognitive impairment (odds ratio=0.86 for each 10 points; 95% CI 0.74 to 0.99; P=0.033). In conclusion, high adherence to either the Mediterranean diet or the diet recommended by the US Department of Agriculture 2005 Dietary Guidelines for Americans can protect cognitive function in middle-aged and older adults.

Dietary intake of vitamin B-6, plasma pyridoxal 5'-phosphate, and homocysteine in Puerto Rican adults.

BACKGROUND: Vitamin B-6 is an important cofactor in many metabolic processes. However, vitamin B-6 intake and plasma status have not been well studied in the Puerto Rican population, a group with documented health disparities. OBJECTIVE: To assess dietary intake of vitamin B-6, food sources, and plasma status of pyridoxal 5'-phosphate (PLP), and their associations with plasma homocysteine in 1,236 Puerto Rican adults, aged 45 to 75 years, living in the greater Boston area. DESIGN: Baseline data were analyzed cross-sectionally. METHOD: Questionnaire data were collected by home interview. Dietary intake was assessed with a semiquantitative food frequency questionnaire. Plasma PLP and homocysteine were assayed from blood samples collected in the home. RESULTS: The mean daily intake of vitamin B-6 was 2.90 ± 1.28 mg for men and 2.61 ± 1.29 mg for women (P<0.001). Approximately 11% were deficient (PLP <4.94 ng/mL [PLP <20 nmol/L]) and another 17% insufficient (PLP ≥ 4.94 but <7.41 ng/mL [PLP ≥ 20 but <30 nmol/L]). Household income below the poverty threshold, physical inactivity, and current smoking were significantly associated with lower plasma PLP (P<0.05). Food groups contributing most to vitamin B-6 intake included ready-to-eat cereals, poultry, rice, potatoes, and dried beans. However, only intake of ready-to-eat cereals and use of supplements with vitamin B-6 were significantly associated with plasma PLP sufficiency (≥ 7.41 vs <7.41 ng/mL [PLP ≥ 30 vs <30 nmol/L], P<0.01). Both vitamin B-6 intake and PLP were significantly associated with plasma total homocysteine (P<0.001). The association between PLP and homocysteine remained statistically significant after further adjustment for plasma vitamin B-12 and folate (P=0.028). CONCLUSIONS: Given the known importance of vitamin B-6 to health, the high prevalence of low vitamin B-6 status in this Puerto Rican population is of concern. Further work is needed to clarify the potential role that insufficient vitamin B-6 may have in relation to the observed health disparities in this population.

Whole grain intake: The Baltimore Longitudinal Study of Aging.

Our objective was to identify major dietary sources of whole grains and to describe the construction of a database of whole grain content of foods. Dietary information was collected with 7-d food records from men and women in the Baltimore Longitudinal Study of Aging, mean age 62.1 +/- 16.0 years, who participated in the dietary assessment portion of the study (n = 1516), and estimates of whole grain intake were obtained from a newly developed database. The Pyramid Servings database and 1994-1996 Continuing Survey of Food Intakes by Individuals (CSFII) recipe ingredients database were then used to calculate both servings and gram weights of whole grain intakes. Mean intakes of whole grains, refined grains, and total grains, as well as frequency of intake for major whole grain food groups and whole grain content for each group, were calculated. Top contributors of whole grains were ready-to-eat breakfast cereals (made with whole grain as well as bran), hot breakfast cereals (made with whole grain), multi-grain bread, and whole wheat bread. While more research is needed to better understand the benefits of whole grains, the development of research tools, including databases to accurately assess whole grain intake, is a critical step in completing such research.