Adherence to the Dietary Guidelines for Americans and risk of major chronic disease in men.

BACKGROUND: The Dietary Guidelines for Americans and the food guide pyramid aim to reduce the risk of major chronic disease in the United States, but data supporting their overall effectiveness are sparse. The healthy eating index (HEI) measures the concordance of dietary patterns with these guidelines. OBJECTIVE: We tested whether a high HEI score (range: 0-100; 100 is best) calculated from a validated food-frequency questionnaire (HEI-f) could predict lower risk of major chronic disease in men. DESIGN: A cohort of US male health professionals without major disease completed detailed questionnaires on food intake and other risk factors for heart disease and cancer in 1986 and repeatedly during the 8-y follow-up. Major chronic disease outcome was defined as incident major cardiovascular disease (stroke or myocardial infarction, n = 1092), cancer (n = 1661), or other non-trauma-related deaths (n = 366). RESULTS: The HEI-f was weakly inversely associated with risk of major chronic disease [comparing highest with lowest quintile of the HEI-f, relative risk (RR) = 0.89; 95% CI: 0.79, 1.00; P: < 0.001 for trend]. The HEI-f was associated with moderately lower risk of cardiovascular disease (RR = 0.72; 95% CI: 0.60, 0.88; P: < 0.001) but was not associated with lower cancer risk. CONCLUSIONS: The HEI-f was only weakly associated with risk of major chronic disease, suggesting that improvements to the HEI may be warranted. Further research on the HEI could have implications for refinements to the Dietary Guidelines for Americans and the food guide pyramid.

Adherence to the Dietary Guidelines for Americans and risk of major chronic disease in women.

BACKGROUND: Little is known about the overall health effects of adherence to the Dietary Guidelines for Americans. The healthy eating index (HEI), developed at the US Department of Agriculture, measures how well Americans' diets conform to these guidelines. OBJECTIVE: We tested whether the HEI (scores range from 0 to 100; 100 is best) calculated from food-frequency questionnaires (HEI-f) would predict risk of major chronic disease in women. DESIGN: A total of 67272 US female nurses who were free of major disease completed detailed questionnaires on diet and chronic disease risk factors in 1984 and repeatedly over 12 y. Major chronic disease was defined as fatal or nonfatal cardiovascular disease (myocardial infarction or stroke, n = 1365), fatal or nonfatal cancer (n = 5216), or other nontraumatic deaths (n = 496), whichever came first. We also examined cardiovascular disease and cancer as separate outcomes. RESULTS: After adjustment for smoking and other risk factors, the HEI-f score was not associated with risk of overall major chronic disease in women [relative risk (RR) = 0.97; 95% CI: 0.89, 1.06 comparing the highest with the lowest quintile of HEI-f score]. Being in the highest HEI-f quintile was associated with a 14% reduction in cardiovascular disease risk (RR = 0.86; 95% CI: 0.72, 1. 03) and was not associated with lower cancer risk (RR = 1.02; 95% CI: 0.93, 1.12). CONCLUSION: These data suggest that adherence to the 1995 Dietary Guidelines for Americans, as measured by the HEI-f, will have limited benefit in preventing major chronic disease in women.

Mistakes were made: misperception as a barrier to reducing overweight.

OBJECTIVE: To examine the agreement between individuals' weight status as measured by their body mass index (BMI) and their perceptions of their weight status in the US population. DESIGN: Data from the third National Health and Nutrition Examination Survey, 1988-94 (NHANES III), were used to cross-tabulate actual weight status and self-assessed weight status, identifying population proportions that underassessed or overassessed weight status. The study accounts for gender and socioeconomic and demographic variables to identify subpopulations in which relatively large numbers of individuals misperceive their weight status. MEASUREMENTS: Survey data included clinically measured height and weight. BMI was categorized (overweight, healthy weight, or underweight) following conventional cutpoints. In addition, each surveyed individual was asked to assess their own (categorical) weight status. SUBJECTS: NHANES III is representative of the US population. The sample included 7758 males and 8451 females aged 20 y or above after excluding women who were pregnant or breastfeeding. RESULTS: We show that large segments of the US population misperceive their weight status. The mix of misperceptions differs by gender, with men who are obese or overweight more likely than obese or overweight women to underassess their weight status. Women who are healthy weight/underweight are more likely than men to believe they are overweight. In addition to the gender differences, underassessors are more frequently found among those aged 65 y and over, individuals with relatively low education levels, lower income levels, and among non-Hispanic black subjects. Overassessors are more frequently found among women less than 65 y old (between the ages of 35 and 64 y for men), individuals with higher education levels, higher income levels, and among non-Hispanic white subjects. CONCLUSIONS: Information programs linking overweight and obesity with health risks might fail to induce diet and lifestyle changes if individuals fail to recognize they are overweight or obese. While there are large number of individuals who fail to recognize their overweight or obese status, there are indicator variables that can help identify this subpopulation. Thus, it is possible to first target a message that would attempt to correct misperceptions. If successful, the size of the population susceptible to a weight-health risk information program could increase.

Modelling nutrition knowledge, attitudes, and diet-disease awareness: the case of dietary fibre.

Understanding how nutrition knowledge and attitudes vary across different population groups is critical for designing and evaluating nutrition education programmes and monitoring the nation's progress toward dietary goals. In this paper we use the Diet and Health Knowledge component of the USDA Continuing Survey of Food Intakes by Individuals to examine consumer knowledge of dietary fibre, fibre consumption attitudes and the awareness of fibre-related health problems. We use a latent variable probit model to estimate the relationships between an individuals's socio-demographic characteristics and his or her fibre knowledge, attitude and disease-awareness. The results suggest that the demographic profile of persons least knowledgeable about the fibre content of foods is low income, male, Black, Hispanic, smoker and low education levels. Add to this list younger individuals and one has a good description of those who lack information on the importance of eating plenty of grain products as well as those who lack awareness of fibre/disease links. The research suggests that messages about increasing fibre intake may have greatest success when targeted to individuals with some or all of these characteristics.

Consumer misperceptions of diet quality.

OBJECTIVE: This study compares consumers' self-perceived diet quality with calculated diet quality to assess the degree of consumer misperception regarding one's own diet quality and to identify factors associated with such misperception. DESIGN: The perceived diet quality was measured by consumers' self-perception of the overall healthfulness of their diet. The calculated diet quality was measured by the Healthy Eating Index, a 10-component indicator of overall diet quality developed from 3 consecutive days of 1-day 24-hour dietary recall and 2-day diet record. SUBJECTS/SETTINGS: Measures of perceived and calculated diet quality were obtained for a sample of 2862 household meal planners/preparers from the 1989-90 Continuing Survey of Food Intake by Individuals and the Diet and Health Knowledge Survey. OUTCOME: Dietary misperception was assessed by classifying respondents based on categories of perceived and calculated diet quality into three groups: optimists, realists, and pessimists. STATISTICAL ANALYSES: Bivariate statistical tests and multivariate logistic regression were used for comparing the characteristics of optimists with the other two groups. RESULTS: An estimated 40% of the population of household meal planner/preparers were optimists who perceived the quality of their diets to be better than their calculated diet quality. In multivariate analysis, household size, gender, education, smoking status, perceived health status, importance of nutrition in grocery shopping, and belief about the need for dietary change were found to be significant predictors of being optimistic about diet quality. Nutritionists and health professionals need to be aware of this misperception and alert dietary optimists about their false perceptions of diet quality.

Choose a variety of grains daily, especially whole grains: a challenge for consumers.

The 2000 edition of Nutrition and Your Health: Dietary Guidelines for Americans is the first to include a specific guideline for grain foods, separate from fruits and vegetables, and recognize the unique health benefits of whole grains. This paper describes and evaluates major tools for assessing intakes of total grains and whole grains, reviews current data on who consumes grain foods and where, and describes individual- and market-level factors that may influence grain consumption. Aggregate food supply data show that U.S. consumers have increased their intake of grain foods from record low levels in the 1970s, but consumption of whole-grain foods remains low. Data on individual intakes show that consumption of total grains was above the recommended 6 serving minimum in 1994-1996, but consumption of whole grains was only one third of the 3 daily servings many nutritionists recommend. Increased intake of whole-grain foods may be limited by a lack of consumer awareness of the health benefits of whole grains, difficulty in identifying whole-grain foods in the marketplace, higher prices for some whole-grain foods, consumer perceptions of inferior taste and palatability, and lack of familiarity with preparation methods. In July 1999, the U.S. Food and Drug Administration authorized a health claim that should both make it easier for consumers to identify and select whole-grain foods and have a positive effect on the availability of these foods in the marketplace.