Away from home meals: associations with biomarkers of chronic disease and dietary intake in American adults, NHANES 2005-2010.

BACKGROUND: Away from home (AFH) meals are known to be energy-dense and of poor diet quality. Both direct and indirect exposure (for example, neighborhood restaurant density) to AFH meals have been implicated as contributors to higher body weight and adverse health outcomes. OBJECTIVE: To examine the association of frequency of eating AFH and fast-food meals with biomarkers of chronic disease and dietary intake. DESIGN: This cross-sectional study used frequency of AFH and fast-food meal and biomarker data from the NHANES 2005-2010. Information on weekly frequency of AFH and fast-food meals was collected via questionnaire during the household interview. The metabolic biomarkers examined included body mass index (BMI), serum cholesterol (total, high-density lipoprotein (HDL) and low-density lipoprotein (LDL)), triglycerides, glycohemoglobin and fasting glucose (n=8314, age⩾20, National Health and Nutrition Examination Surveys (NHANES) 2007-2010). Biomarkers of dietary exposure included serum concentrations of vitamins A, D, E, C, B-6, B-12, folate and carotenoids (n=4162; 2005-2006). Multiple linear and logistic regression methods adjusted for complex survey methodology and covariates. RESULTS: American adults reported a mean of 3.9 (95% confidence interval 3.7, 4.0) AFH and 1.8 (1.6, 1.9) fast-food meals/week. Over 50% of adults reported ⩾3 AFH and >35% reported ⩾2 fast-food meals/week. The mean BMI of more frequent AFH or fast-food meal reporters was higher (Ptrend⩽0.0004). Serum concentrations of total, LDL and HDL-cholesterol were related inversely with frequency of AFH meals (P<0.05). Frequencies of fast-food meals and serum HDL-cholesterol were also related inversely (P=0.0001). Serum concentrations of all examined micronutrients (except vitamin A and lycopene) declined with increasing frequency of AFH meals (P<0.05); women and ⩾50-year olds were at higher risk. CONCLUSIONS: Reporters of frequent AFH and fast-food meals had higher BMI and lower concentrations of HDL-cholesterol; however, profiles of other biomarkers did not indicate higher metabolic risk. However, the serum concentrations of nutrients with mostly plant foods as sources declined with increasing AFH meal frequency.

Energy density of diets reported by American adults: association with food group intake, nutrient intake, and body weight.

OBJECTIVE: Recent reports suggest that dietary energy density may play a role in regulation of food intake. However, little is known about the energy density of diets consumed by free-living populations; therefore, the purpose of this study was to examine demographic, health, and nutritional correlates of energy density of self-reported diets. RESEARCH METHODS AND PROCEDURES: Using data from the NHANES III (n=13 400), dietary energy density was defined three ways: (1) energy content (kJ/g) of all foods and beverages reported or ED1, (2) energy content (kJ/g) of all foods and energy yielding beverages or ED2, and (3) energy content (kJ/g) of all foods (no beverages) or ED3. Multiple linear or logistic regression methods were used to examine the association of energy density with intake of energy, nutrients, food groups, and body mass index (BMI). We computed the ratios of within- to between-person variance for the three energy density variables using the second recall obtained from the second exam subsample of NHANES III (n=1037). RESULTS: The mean ED1, ED2, and ED3, respectively, were 3.84+/-0.02, 5.45+/-0.03, and 8.03+/-0.03. Dietary intakes of energy, fat, and low-nutrient-density foods were related positively, but amounts of micronutrients, fruit, and vegetables were related inversely with all types of energy density (P<0.0001). ED2 and ED3 were modest positive predictors of BMI in both men and women (P< or =0.03). The ratios of within- to between-person components of variance for ED1, ED2, and ED3 were 1.34, 2.05, and 1.53, respectively. DISCUSSION: High-energy-density diets in the US were characterized by low fruit and vegetable intake, and high BMI.

Interaction of body mass index and attempt to lose weight in a national sample of US adults: association with reported food and nutrient intake, and biomarkers.

OBJECTIVE: This study examined the interaction between body mass index (BMI) and attempting to lose weight for reporting of: (1) macro- and micronutrient intake; (2) intake of low-nutrient-density foods; and (3) serum biomarkers of dietary exposure and cardiovascular disease risk. METHODS: Dietary, anthropometric and biochemical data were from the third National Health and Nutrition Examination Survey (1988-1994), n=13 095. Multiple regression methods were used to examine the independent associations of BMI, trying to lose weight, or the interaction of BMI-trying to lose weight with reported intakes of energy, nutrients, percentage energy from low-nutrient-density foods (sweeteners, baked and dairy desserts, visible fats and salty snacks), and serum concentrations of vitamins, carotenoids and lipids. RESULTS: BMI was an independent positive predictor (P<0.05) of percentage of energy from fat, saturated fat, but a negative predictor of the ratio of reported energy intake to estimated expenditure for basal needs (EI/BEE), percentage of energy from carbohydrate and alcohol (men only), and serum concentrations of folate, vitamin C, vitamin E and most carotenoids in both men and women. Trying to lose weight was a negative predictor (P<0.05) of EI/BEE, intake of energy, and energy density, but not micronutrient intake. Higher mean serum ascorbate, vitamin E, lutein/zeaxanthin, and other carotenoids (men only) concentrations were associated with trying to lose weight (P<0.05) in both men and women. Few adverse BMI-trying to lose weight interaction effects were noted. CONCLUSIONS: There was little evidence of increased nutritional risk in those reportedly trying to lose weight irrespective of weight status.

Weight-loss attempts and reporting of foods and nutrients, and biomarkers in a national cohort.

OBJECTIVE: This study examined the reported intake of foods and nutrients, and biomarkers of dietary exposure and cardiovascular disease in relation to history of trying to lose weight. METHODS: Dietary, anthropometric and biochemical data were from the third National Health and Nutrition Examination Survey (1988-1994), n=13 092. The history of attempting weight loss variable was created as follows: trying to lose currently and tried in the past 12 months (Y/Y); trying to lose currently, but not tried in the past 12 months (Y/N), not trying currently, but tried in the past 12 months (N/Y); not trying now and not tried in the past 12 months (N/N). Multiple regression methods were used to examine the independent association of history of trying to lose weight with reported intakes of energy, nutrients, percentage energy from low-nutrient-dense foods (sweeteners, baked and dairy desserts, visible fats and salty snacks), and serum concentrations of vitamins, carotenoids and lipids. RESULTS: Men and women in the Y/Y group reported lower energy intake relative to the N/N group (P<0.0000). However, the reported percentage energy from fat and carbohydrate by the Y/Y group did not differ from the N/N group. Percentage of energy from low-nutrient-dense foods was lower in men in the Y/Y group but not women. The relative odds of reporting the estimated average requirement (EAR) of folate, and vitamins A, B(6), B(12), C, E and iron and adequate intake (AI) of calcium were not adversely affected by history of trying to lose weight in men. In women, the odds of meeting the folate and vitamin E EAR were lower in the Y/Y group. Some history of weight loss categories were significant positive predictors of serum vitamin and carotenoid concentrations, or unrelated to cardiovascular disease risk biomarkers. CONCLUSIONS: There was little evidence for increased nutritional risk in those reporting repeat attempts at weight loss.

Consumption of energy-dense, nutrient-poor foods by adult Americans: nutritional and health implications. The third National Health and Nutrition Examination Survey, 1988-1994.

BACKGROUND: Current dietary guidance recommends limiting the intake of energy-dense, nutrient-poor (EDNP) foods, but little is known about recent consumption patterns of these foods. OBJECTIVE: The contribution of EDNP foods to the American diet and the associated nutritional and health implications were examined. DESIGN: Data from the third National Health and Nutrition Examination Survey (n = 15611; age >/=20 y) were used. EDNP categories included visible fats, nutritive sweeteners and sweetened beverages, desserts, and snacks. The potential independent associations of EDNP food intake with intakes of energy, macronutrients, micronutrients, and serum vitamin, lipid, and carotenoid profiles were examined with linear and logistic regression procedures. RESULTS: EDNP foods supplied approximately 27% of energy intake; alcohol provided an additional 4%. The relative odds of consuming foods from all 5 food groups and of meeting the recommended dietary allowance or daily reference intake for protein and several micronutrients decreased with increasing EDNP food intake (P: < 0.0001). Energy intake and percentage of energy from fat were positively related to EDNP intake. Serum concentrations of vitamins A, E, C, and B-12; folate; several carotenoids; and HDL cholesterol were inversely related (P:

A prospective study of diet quality and mortality in women.

CONTEXT: Most studies of diet and health care have focused on the role of single nutrients, foods, or food groups in disease prevention or promotion. Few studies have addressed the health effects of dietary patterns, which include complex mixtures of foods containing multiple nutrients and nonnutrients. OBJECTIVE: To examine the association of mortality with a multifactorial diet quality index. DESIGN AND SETTING: Data from phase 2 (1987-1989) of a prospective cohort study of breast cancer screening, the Breast Cancer Detection Demonstration Project, with a median follow-up of 5.6 years. PARTICIPANTS: A total of 42,254 women (mean age, 61.1 years) who completed the food frequency questionnaire portion of the survey. MAIN OUTCOME MEASURE: All-cause mortality by quartile of Recommended Food Score (RFS; the sum of the number of foods recommended by current dietary guidelines [fruits, vegetables, whole grains, low-fat dairy, and lean meats and poultry] that were reported on the questionnaire to be consumed at least once a week, for a maximum score of 23). RESULTS: There were 2065 deaths due to all causes in the cohort. The RFS was inversely associated with all-cause mortality. Compared with those in the lowest quartile, subjects in the upper quartiles of the RFS had relative risks for all-cause mortality of 0.82 (95% confidence interval [CI], 0.73-0.92) for quartile 2, 0.71 (95% CI, 0.62-0.81) for quartile 3, and 0.69 (95% CI, 0.61-0.78) for quartile 4 adjusted for education, ethnicity, age, body mass index, smoking status, alcohol use, level of physical activity, menopausal hormone use, and history of disease (chi2 for trend = 35.64, P<.001 for trend). CONCLUSIONS: These data suggest that a dietary pattern characterized by consumption of foods recommended in current dietary guidelines is associated with decreased risk of mortality in women.

Relation of age and self-reported chronic medical condition status with dietary nutrient intake in the US population.

OBJECTIVE: To examine the association of nutrient intake with age and self-reported chronic medical condition status in a large, nationally representative sample. METHODS: We used data from the Continuing Survey of Food Intakes by Individuals, 1989-1991. The analytic sample included subjects aged > or =25 years with 3 days of dietary data, and medical condition information (n=7,207). A positive response to having been informed by a doctor of having diabetes, heart disease, high blood pressure, cancer, osteoporosis, and stroke indicated the presence of chronic medical condition(s) (n=2,368). Sex-specific linear and logistic regression analyses adjusted for multiple covariates were used to examine the relation of age and morbidity status with nutrient intake. RESULTS: In men, age was associated with an increased risk of consuming <100% of the Recommended Dietary Allowance (RDA) of vitamin E, vitamin B12, calcium, zinc, and iron (p<0.05), and self-reported morbidity was associated with an increased risk of consuming <100% of the RDA of protein. Relative to men, women were more likely to report less than the RDA of most nutrients examined; however, neither age nor chronic disease status were associated with increased likelihood of reporting <100% of the RDA of any of the nutrients examined. In women, the probability of reporting <100% of the RDA of vitamin A, vitamin B6, folate, vitamin C, and iron, and in men, the probability of reporting <100% of the RDA of vitamin C, declined with age (p<0.05). No adverse effect of age and chronic disease interaction on intake of most nutrients was noted in men or women. CONCLUSIONS: Chronologic age and morbidity were associated with an increased risk of inadequate intake of several nutrients in free-living, independent men but not in women.

Variability in selected indexes of overall diet quality.

We examined the intra- and interindividual variability in selected measures of overall diet quality in relation to socio-demographic, lifestyle, and health-related characteristics. Three days of dietary data from the Continuing Survey of Food Intakes by Individuals (CSFII), 1989-91 (7841 respondents, 3337 men and 4504 women, aged > or = 19 years), were examined. Measures of overall diet quality were: 1. the Dietary Diversity Score (DDS), a measure of variety among the major food groups; 2. the Overall Variety Score (OVS), examined the number of nutrient-dense foods reported; and 3. the Nutrient Adequacy Score (NAS100), evaluated the number of nutrients consumed at least at the level of the RDA from a total of 11. The ratio of intra- to interindividual variance for DDS, OVS, and NAS100 was 1.66, 1.09, and 1.21, respectively, indicating higher intraindividual variability relative to interindividual variability. For each of the three scores, gender, income, education, and smoking were associated with greater intraindividual variability; however, age, and special diet status were associated with lower variability. Thus, the reliability of a given dietary assessment protocol for evaluating "usual" diet quality is likely to vary by the socio-demographic and lifestyle characteristics of the study population.

Evening eating and subsequent long-term weight change in a national cohort.

OBJECTIVE: To examine the association of proportion of daily energy consumed in the evening with weight change over 10 y of follow-up. DESIGN: The data used were from the First National Health and Nutrition Examination Survey (NHANES I, 1971-75) Epidemiologic Follow-up Study (NHEFS, 1982-84). The analytic cohort included 2580 men and 4567 women aged 25-74 y at baseline (NHANES I, 1971-75). The proportion of energy consumed in the evening (after 5 pm) was estimated from a 24 h dietary recall obtained a baseline. Weight change was defined as the difference between the follow-up and baseline weights. RESULTS: Mean +/- s.e. of percent energy from evening food intake was 46 +/- 0.29 in the analytic cohort. After adjustment for multiple covariates, percent energy from evening food intake and weight change were unrelated in both men and women. CONCLUSION: Extent of evening eating was not a significant predictor of 10 y weight change in the NHEFS cohort.

Indexes of overall diet quality: a review.

This article reviews the published indexes of overall diet quality. Approaches used for measuring overall diet quality include those based on examination of the intake of nutrients, food groups, or a combination of both. A majority of the indexes have been examined in relation to nutrient adequacy only; few have been evaluated for assessment of quality according to current dietary guidelines, namely, a diet relatively low in fat that meets energy and nutrient needs. The indexes of overall diet quality were related to the risk of disease more strongly than individual nutrients or foods.

Evening eating and its relation to self-reported body weight and nutrient intake in women, CSFII 1985-86.

OBJECTIVE: We investigated the association of extent of daily energy intake from evening food intake with self-reported body weight and nutrient intake. DESIGN: Using data from the 1985-86 CSFII, we estimated the proportion of daily energy from foods/beverages reportedly consumed after 5 p.m. on 4 non-consecutive days by 1802 women, aged 19-50 years. RESULTS: The mean +/- SE of 4-day average energy from evening food intake was 46 +/- 0.4%. Body mass index was not associated with percent energy from evening food intake in unadjusted or multiple-covariate-adjusted regression analyses. In multiple-covariate-adjusted regression models, percent energy from fat, protein, and grams of alcohol reported were positively associated with percent energy from evening food intake (p < 0.05); while percent energy from carbohydrate, and percent RDA of vitamins C, B-6, and folate were inversely associated with evening eating. CONCLUSIONS: The results do not support the hypothesis regarding the association of relative weight with percent energy from evening food intake. However, statistically significant differences in intake of some nutrients in relation to extent of evening food intake were noted.

Frequency of eating occasions and weight change in the NHANES I Epidemiologic Follow-up Study.

OBJECTIVE: To examine the association of frequency of eating occasions with prospective, and retrospective weight change. DESIGN: Data from the NHANES I (1971-75) Epidemiologic Follow-up Study (NHEFS, 1982-84) (n = 7147) was used. Weight change was defined as the difference between the weight measured at follow-up in 1982-84 and the weight measured at baseline in 1971-75. Baseline frequency of eating occasions was estimated by summation of actual times at which food was reported consumed in a 24-h dietary recall. Follow-up frequency of eating was estimated from subject responses at follow-up to number of meals and snacks consumed daily. RESULTS: Men and women reported (mean +/- s.e.) baseline frequency of 5.3 +/- 0.06 and 4.9 +/- 0.03 eating occasions, respectively. Frequency of eating occasions at follow-up was 3.6 +/- 0.02 occasions in both men and women. Baseline body mass index and frequency of eating were inversely related in multivariate regression analyses in both men and women (P < 0.02). Regression analyses adjusted for multiple covariates showed no association between weight change and frequency of eating at baseline or follow-up. CONCLUSION: Baseline frequency and subsequent weight change or follow-up frequency and preceding weight change were unrelated in the NHEFS cohort.

Dietary diversity and subsequent cause-specific mortality in the NHANES I epidemiologic follow-up study.

OBJECTIVES: Human diets tend to be complex mixtures of foods and nutrients. Therefore, we examined the relation of a measure of overall diet quality (independent of intake of individual foods or nutrients) with mortality from cardiovascular disease (CVD), cancer, and non-CVD, non-cancer (other) causes. METHODS: We used data from the NHANES I Epidemiologic follow-up study (n = 10,337; median follow-up time = 14 years; age 25-74 years at baseline), and included 988 CVD, 571 cancer, and 910 other cases. The 24-hour dietary recalls obtained at baseline were scored for quality using a dietary diversity score (DDS). The DDS (range 0-5) counts the number of major food groups--dairy, meat, grain, fruit, and vegetable consumed daily. RESULTS: Age-adjusted risk of mortality from all three causes (except cancer in women) was inversely related with DDS in both men and women. Adjustment for multiple covariates attenuated the relative risk estimates slightly for CVD and cancer mortality, but markedly for other mortality. CONCLUSIONS: The results are suggestive of an increased risk of CVD and cancer mortality associated with diets characterized by omission of several major food groups.

Proportion of energy intake from fat and subsequent weight change in the NHANES I Epidemiologic Follow-up Study.

We examined the association of percent energy intake from fat with subsequent weight change in 2580 men and 4567 women, using data from the National Health and Nutrition Examination Survey (NHANES) I Epidemiologic Follow-up Study (NHEFS). Weight change was defined as the difference between the follow-up weight (NHEFS, 1982-1984) and the baseline weight (NHANES I, 1971-1974). Fat intake was estimated from a 24-h dietary recall obtained at baseline. Regression analyses adjusted for potential confounders showed no significant association of percent fat energy with weight change in men. Among women aged < 50 y, the inverse relation of percent fat energy with weight change was significant (beta = -0.052, P = 0.04). After exclusion of respondents with any morbidity from the analytic cohort, percent fat energy and weight change were positively associated in men (beta = 0.046, P = 0.05), but not in women. In conclusion, percent fat energy intake and weight change were inversely related in women aged < 50 y in the NHEFS cohort, but positively associated in men without any morbidity.

Consumption of energy-dense, nutrient-poor foods by the US population: effect on nutrient profiles.

OBJECTIVE: To examine the association of consumption of foods from the fats, sweets, and the alcohol group ("other group) with nutrient profiles. METHODS: Using data from the NHANES II survey of 1976-80, we categorized the foods reported to be consumed by adults (n = 11,528) into six groups: meat, dairy, grain, fruit, vegetable, and "other." RESULTS: Nearly one-third of total daily energy intake was contributed by foods from the "other" category. As the proportion of daily energy intake from "other" foods increased, total daily energy intake also increased, as did the percent energy from carbohydrate and alcohol. However, percent energy from fat and protein, intake of all examined micronutrients (except vitamin E), nutrient density, and the proportion of the population meeting the RDA of various nutrients declined with increasing intake of "other" foods. Respondents were more likely to report no servings as well as less than the recommended servings of foods from the major food groups with increasing intake of "other" foods. CONCLUSION: The data suggest that consumption of foods from the "other" group displaced nutrient-dense foods from the diets of NHANES II respondents.

Dietary diversity and subsequent mortality in the First National Health and Nutrition Examination Survey Epidemiologic Follow-up Study.

We examined the relation of dietary diversity to subsequent all-cause mortality by using data from the First National Health and Nutrition Examination Survey (NHANES I) Epidemiologic Follow-up Study, 1982-1987. The analytic cohort consisted of 4160 men and 6264 women (including 2556 deaths), 25-74 y at baseline (1971-1975). Twenty-four-hour dietary recalls were evaluated for variety among the five major food groups: dairy, meat, grain, fruit, and vegetable, with a dietary diversity score (DDS); consumption of each food group contributed 1 point to a maximum possible DDS of 5. Age-adjusted risk of mortality was inversely related to DDS (P < or = 0.0009) in men and women. The inverse diversity-mortality association was adjusted for potential confounders: education, race, smoking status, and dietary fiber intake; the relative risk of mortality in men and women consuming two or fewer food groups was 1.5 (95% CI 1.2-1.8) and 1.4 (95% CI 1.1-1.9), respectively. In conclusion, diets that omitted several food groups were associated with an increased risk of mortality.

Does cancer survival differ for older patients?

The relation of age to 5-year relative survival rates was examined for leading sites of cancer resulting in death among 127,554 patients; data from 1978 to 1982 were studied for four areas of the Surveillance, Epidemiology and End Results program of the National Cancer Institute. Overall and stage-stratified relative survival rates declined with advancing patient age for cancer of the lung, prostate, pancreas, bladder, oral cavity, uterus, cervix, ovary, and large bowel (women only). In men, this trend was not explained by age differences in stage of diagnosis, whereas, among women, age was associated with more advanced disease for most sites examined. Although overall survival rates were lower in black patients compared with white patients, the age-survival and age-stage trends were similar in the two racial groups.

Dietary diversity in the US population, NHANES II, 1976-1980.

The extent of diversity in the diets of black and white adults (n = 11,658) aged 19 to 74 years was evaluated from 24-hour dietary recalls obtained in the second National Health and Nutrition Examination Survey. Each 24-hour recall was evaluated for the consumption of items from the dairy, meat, grain, fruit, and vegetable groups (Food Group Score). A second scoring method (Serving Score) evaluated every recall for consumption of at least two servings each from dairy, meat, fruit, and vegetable groups and four servings from the grain group. Only a third of the population surveyed reported consuming foods from all the food groups on the survey day; less than 3% reported consuming foods from all food groups in at least the recommended amount. Blacks scored lower on both types of diet diversity scores than whites. Both types of diversity scores showed a significant trend to increase with increasing income and level of education. Failure to consume any foods from the dairy, meat, grain, fruit, and vegetable groups was reported by 24%, 6%, 5%, 46%, and 18%, respectively, of the population on the survey day. The proportion of the population consuming at least the desired number of servings from each of these food groups was 51%, 71%, 29%, 29%, 61%, respectively. The results emphasize the need for major public campaigns directed at increasing the diversity of US diets. Special target groups include minorities and those with limited income and formal education.

Food group intake patterns and associated nutrient profiles of the US population.

We developed a method for evaluating food group intake patterns using dietary recall data (n = 11,529) from the second National Health and Nutrition Examination Survey. We used this method to examine the relationship of these food group intake patterns to nutrient intake and to selected biochemical indexes of nutritional status. We evaluated each 24-hour dietary intake recall for the presence or omission of five broad food groups--dairy, meat, grain, fruit, and vegetable. The five most prevalent patterns and the proportion of the population reporting them was as follows: all food groups, 33.6%; no fruit, 23.9%; no dairy and fruit, 9.0%; no dairy, 8.0%; and no fruit and vegetable, 5.6%. In the most prevalent pattern, all food groups were consumed; this was the only pattern that provided mean amounts of all of the key vitamins and minerals at levels greater than or equal to the Recommended Dietary Allowances (RDAs). This pattern also was reported by the lowest proportion of individuals consuming less than 100% RDA of the key nutrients. Patterns in which both fruit and vegetables were consumed were associated with highest levels of serum vitamin C. The consistency of these results indicates that screening diets for food group consumption can quickly provide meaningful information about their quality.