Persistent disparities over time in the distribution of sugar-sweetened beverage intake among children in the United States.

Background: Recent research suggests that sugar-sweetened beverage (SSB) consumption has been declining among US children aged 2-18 y. However, most studies focused on changes in mean intake, ignore high SSB consumers and do not examine intake among vulnerable groups and, including adolescents, low-income households, and several racial/ethnic minorities. Objective: The aim was to estimate usual SSB intake from NHANES surveys from 2003-2004 to 2013-2014 to examine shifts at both the median and 90th percentile among US children, evaluating the extent to which intake disparities in total SSBs and subtypes have persisted. Design: Children 2-18 y from NHANES 2003, 2005, 2007, 2009, 2011 and 2013. SSBs were all non-diet beverages sweetened with sugars including revising all beverages to as consumed status and excluding soy and dairy based beverages. The NCI usual intake method was used to estimate usual intake from two 24-hour recalls. A 2-part correlated model accounted for nonconsumers. Quantile regression was then used to examine differences in SSB usual intakes at the 50th and 90th percentiles by race-ethnicity, and examine interactions indicating whether racial-ethnic disparities in intake were modified by income. Results: Despite considerable declines, children's SSB intake remains high, particularly among heavy consumers. Among adolescents, median SSB intake in 2013-2014 was on the order of 150-200 kcal/d, and heavy intake at the 90th percentile was on the order of 250-300 kcal/d. There were important disparities in intake that persisted over time. Although high household income was associated with lower SSB intake in non-Hispanic white (NHW) children, intakes of non-Hispanic black (NHB) and Mexican-American (MA) children from these households were similar to or higher than those from poor households. There were also large racial/ethnic differences in the types of SSBs consumed. The consumption of regular sodas by NHB children was somewhat lower than among MA and NHW children, whereas fruit drink intake was markedly higher. Conclusions: Overall, these findings suggest that, despite recent declines, strategies are needed to further reduce SSB consumption, and particularly heavy intake, especially among NHB children where fruit drinks also are key source of SSBs.

The association of trajectories of protein intake and age-specific protein intakes from 2 to 22 years with BMI in early adulthood.

No study has analysed how protein intake from early childhood to young adulthood relate to adult BMI in a single cohort. To estimate the association of protein intake at 2, 11, 15, 19 and 22 years with age- and sex-standardised BMI at 22 years (early adulthood), we used linear regression models with dietary and anthropometric data from a Filipino birth cohort (1985-2005, n 2586). We used latent growth curve analysis to identify trajectories of protein intake relative to age-specific recommended daily allowance (intake in g/kg body weight) from 2 to 22 years, then related trajectory membership to early adulthood BMI using linear regression models. Lean mass and fat mass were secondary outcomes. Regression models included socioeconomic, dietary and anthropometric confounders from early life and adulthood. Protein intake relative to needs at age 2 years was positively associated with BMI and lean mass at age 22 years, but intakes at ages 11, 15 and 22 years were inversely associated with early adulthood BMI. Individuals were classified into four mutually exclusive trajectories: (i) normal consumers (referent trajectory, 58 % of cohort), (ii) high protein consumers in infancy (20 %), (iii) usually high consumers (18 %) and (iv) always high consumers (5 %). Compared with the normal consumers, 'usually high' consumption was inversely associated with BMI, lean mass and fat mass at age 22 years whereas 'always high' consumption was inversely associated with male lean mass in males. Proximal protein intakes were more important contributors to early adult BMI relative to early-childhood protein intake; protein intake history was differentially associated with adulthood body size.

Highly Processed and Ready-to-Eat Packaged Food and Beverage Purchases Differ by Race/Ethnicity among US Households.

BACKGROUND: Racial/ethnic disparities in dietary quality persist among Americans, but it is unclear whether highly processed foods or convenience foods contribute to these inequalities. OBJECTIVE: We examined the independent associations of race/ethnicity with highly processed and ready-to-eat (RTE) food purchases among US households. We determined whether controlling for between-group differences in purchases of these products attenuated associations between race/ethnicity and the nutritional quality of purchases. METHODS: The 2000-2012 Homescan Panel followed US households (n = 157,142) that scanned their consumer packaged goods (CPG) food and beverage purchases. By using repeated-measures regression models adjusted for sociodemographic characteristics, we examined time-varying associations of race/ethnicity with processed and convenience food purchases, expressed as a percentage of calories purchased. We estimated associations between race/ethnicity and saturated fat, sugar, or energy density of total purchases with and without adjustment for processed and convenience food purchases. RESULTS: Compared with white households, black households had significantly lower purchases of highly processed foods (-4.1% kcal) and RTE convenience foods (-4.9% kcal) and had higher purchases of basic processed foods, particularly cooking oils and sugar (+5.4% kcal), foods requiring cooking/preparation (+4.5% kcal), and highly processed beverages (+7.1% kcal). Hispanics also had lower purchases of highly processed and RTE foods than whites. Blacks had CPG purchases with significantly higher median sugar (+2.2% kcal) and energy density (+72 kcal/1000 g), whereas Hispanics had purchases with lower saturated fat (-0.6% kcal) and energy density (-25 kcal/1000 g) than whites. Racial/ethnic differences remained significant after adjustment for processed and convenience food purchases. CONCLUSIONS: In our study, compared with white households, both black and Hispanic households had lower purchases of highly processed and RTE foods, yet had total CPG purchases with differing nutritional quality. Our findings suggest that highly processed convenience foods are associated with, but cannot fully explain, racial/ethnic disparities in the nutritional quality of CPG purchases.

Longitudinal analysis of dietary patterns in Chinese adults from 1991 to 2009.

In the present study, we aimed to identify the changes or stability in the structure of dietary patterns and tracking, trends and factors related to the adherence to these dietary patterns in China from 1991 to 2009. We analysed dietary data collected during seven waves of the China Health and Nutrition Survey and included 9253 adults with complete dietary data for three or more waves. Dietary intake assessment was carried out over a 3 d period with 24 h recalls and a household food inventory. Using factor analysis in each wave, we found that the structure of the two dietary patterns identified remained stable over the studied period. The traditional southern dietary pattern was characterised by high intakes of rice, fresh leafy vegetables, low-fat red meat, pork, organ meats, poultry and fish/seafood and low intakes of wheat flour and maize/coarse grains and the modern high-wheat dietary pattern was characterised by high intakes of wheat buns/breads, cakes/cookies/pastries, deep-fried wheat, nuts/seeds, starchy root/tuber products, fruits, eggs/egg products, soya milk, animal-based milk and instant noodles/frozen dumplings. Temporal tracking (maintenance of a relative position over time) was higher for the traditional southern dietary pattern, whereas adherence to the modern high-wheat dietary pattern had an upward trend over time. Higher income, education and urbanicity levels were positively associated with both the dietary patterns, but the association became weaker in the later years. These results suggest that even in the context of rapid economic changes in China, the way people chose to combine their foods remained relatively stable. However, the increasing popularity of the modern high-wheat dietary pattern, a pattern associated with several energy-dense foods, is a cause of concern.

Low-calorie- and calorie-sweetened beverages: diet quality, food intake, and purchase patterns of US household consumers.

BACKGROUND: Few studies have investigated the diet quality of consumers of low-calorie-sweetened (LCS) and calorie-sweetened (CS) beverages. OBJECTIVE: The objective was to examine the dietary quality and adherence to dietary purchasing and consumption patterns of beverage consumers from 2000 to 2010. DESIGN: We analyzed purchases for 140,352 households from the Homescan longitudinal data set 2000-2010 and dietary intake from NHANES 2003-2010 (n = 34,393). We defined mutually exclusive consumer profiles as main exposures: LCS beverages, CS beverages, LCS & CS beverages, and non/low consumers. As main outcomes, we explored dietary quality by using total energy and macronutrients (kcal/d). We performed factor analyses and applied factor scores to derive dietary patterns as secondary outcomes. Using multivariable linear (NHANES) and random-effects (Homescan) models, we investigated the associations between beverage profiles and dietary patterns. RESULTS: We found "prudent" and "breakfast" patterns in Homescan and NHANES, "ready-to-eat meals/fast-food" and "prudent/snacks/LCS desserts" patterns in Homescan, and "protein/potatoes" and "CS desserts/sweeteners" patterns in NHANES. In both data sets, compared with non/low consumers, both CS- and LCS-beverage consumers had a significantly higher total energy from foods, higher energy from total and SFAs, and lower probability of adherence to prudent and breakfast patterns. In Homescan, LCS-beverage consumers had a higher probability of adherence to 2 distinct patterns: a prudent/snacks/LCS dessert pattern and a ready-to-eat meals/fast-food purchasing pattern. CONCLUSIONS: Our findings suggest that overall dietary quality is lower in LCS-, CS-, and LCS & CS-beverage consumers relative to non/low consumers. Our study highlights the importance of targeting foods that are linked with sweetened beverages (either LCS or CS) in intervention and policy efforts that aim to improve nutrition in the United States.

Dietary and sociodemographic determinants of bisphenol A urine concentrations in pregnant women and children.

Bisphenol A (BPA) exposure during early life may have endocrine-disrupting effects, but the dietary and sociodemographic predictors of BPA exposure during pregnancy and childhood remain unclear. Our aim was to evaluate the correlations between, and sociodemographic and dietary predictors of, serial urinary BPA concentrations measured during pregnancy and childhood in a Spanish birth cohort study. BPA was measured in two spot urine samples collected from 479 women during the first and third trimester of pregnancy and in one urine sample from their 4-year old children (n=130). Average dietary intakes were reported in food frequency questionnaires during the first and third pregnancy trimester and at age 4years. Multivariate mixed models and linear regression models were used to estimate associations between sociodemographic and dietary factors and BPA concentrations. A small, but statistically significant correlation was found between serial maternal BPA concentrations measured during pregnancy (r=0.17). Pregnant women who were younger, less-educated, smoked, and who were exposed to second-hand tobacco smoke (SHS) had higher BPA concentrations than others. BPA concentrations were also higher in children exposed to SHS. High consumption of canned fish during pregnancy was associated with 21% [GM ratio=1.21; 95%CI 1.02, 1.44] and 25% [GM ratio=1.25; 95%CI 1.05, 1.49] higher urinary BPA concentrations in the first and third pregnancy trimester, respectively, compared to the lowest consumption group. This study suggests that canned fish may be a major source of BPA during pregnancy in Spain, a country of high canned fish consumption. Further evaluation of specific BPA exposure sources in the sociodemographic group of younger women who smoke, are exposed to SHS, and have a low educational level is needed. Studies identifying sources of exposure would benefit from repeat BPA measurements and questionnaires specifically focused on dietary and packaging sources.

A comparative analysis of dietary intakes during pregnancy in Europe: a planned pooled analysis of birth cohort studies.

BACKGROUND: There is growing evidence that despite the absence of marked deficiencies, diet during pregnancy has important implications for maternal and child health in industrialized countries. At present, relatively little is known about prevailing patterns of intake across groups with diverse sociodemographic and lifestyle patterns in these settings. OBJECTIVES: The aims of this study were to develop methods for the standardization of food group intake data and to describe the process of applying these methods to existing pregnancy cohort studies, which included >200,000 women across Europe. DESIGN: The study developed a detailed standardization protocol to harmonize intakes of selected food groups, which included fruit, vegetables, meats, seafood, and dairy products. Standardization is necessary to facilitate valid comparisons of intake patterns and disparities across countries and will lead to the development of harmonized databases for possible future pooled analyses. RESULTS: On the basis of comparisons with previously coordinated multicountry studies, preliminary data suggest that the standardization process yielded sufficiently comparable intake data, which indicate differences in food cultures across the countries that participated. CONCLUSIONS: This project provides lessons on the feasibility of harmonizing dietary intake data from existing studies, which can be applied in future post hoc standardization efforts. The data yielded in this analysis will also provide useful information for the development of food and nutrition policies for pregnant women in Europe, including the identification of population subgroups in which dietary inadequacies during pregnancy may be widespread.

Breastfeeding, long-chain polyunsaturated fatty acids in colostrum, and infant mental development.

BACKGROUND: Breastfeeding has been associated with improved neurodevelopment in children. However, it remains unknown to what extent nutritional advantages of breast milk may explain this relationship. OBJECTIVE: We assessed the role of parental psychosocial factors and colostrum long-chain polyunsaturated fatty acid (LC-PUFA) levels in the relationship between breastfeeding and children's neurodevelopment. METHODS: A population-based birth cohort was established in the city of Sabadell (Catalonia, Spain) as part of the INMA-INfancia y Medio Ambiente Project. A total of 657 women were recruited during the first trimester of pregnancy. Information about parental characteristics and breastfeeding was obtained by using a questionnaire, and trained psychologists assessed mental and psychomotor development by using the Bayley Scales of Infant Development in 504 children at 14 months of age. RESULTS: A high percentage of breastfeeds among all milk feeds accumulated during the first 14 months was positively related with child mental development (0.37 points per month of full breastfeeding [95% confidence interval: 0.06-0.67]). Maternal education, social class, and intelligence quotient only partly explained this association. Children with a longer duration of breastfeeding also exposed to higher ratios between n-3 and n-6 PUFAs in colostrum had significantly higher mental scores than children with low breastfeeding duration exposed to low levels. CONCLUSIONS: Greater levels of accumulated breastfeeding during the first year of life were related to higher mental development at 14 months, largely independently from a wide range of parental psychosocial factors. LC-PUFA levels seem to play a beneficial role in children's mental development when breastfeeding levels are high.

Development and validation of the Infant Feeding Style Questionnaire.

This study describes and validates the Infant Feeding Style Questionnaire (IFSQ), a self-report instrument designed to measure feeding beliefs and behaviors among mothers of infants and young children. Categorical confirmatory factor analysis was used to estimate latent factors for five feeding styles, laissez-faire, restrictive, pressuring, responsive and indulgent, and to validate that items hypothesized a priori as measures of each style yielded well-fitting models. Models were tested and iteratively modified to determine the best fitting model for each of 13 feeding style sub-constructs, using a sample of 154 low-income African-American mothers of infants aged 3-20 months in North Carolina. With minor changes, models were confirmed in an independent sample of 150 African-American first-time mothers, yielding a final instrument with 39 questions on maternal beliefs, 24 questions on behaviors and an additional 20 behavioral items pertaining to solid feeding for infants over 6 months of age. Internal reliability measures for the sub-constructs ranged from 0.75 to 0.95. Several sub-constructs, responsive to satiety cues, pressuring with cereal, indulgent pampering and indulgent soothing, were inversely related to infant weight-for-length z-score, providing initial support for the validity of this instrument for assessing maternal feeding beliefs and behaviors that may influence infant weight outcomes.

Overweight exceeds underweight among women in most developing countries.

BACKGROUND: It is generally believed that overweight is less prevalent than undernutrition in the developing world, particularly in rural areas, and that it is concentrated in higher socioeconomic status (SES) groups. OBJECTIVE: The purpose of this study was to examine patterns of adult female overweight and underweight in the developing world by using categories of urban or rural status and SES strata. DESIGN: Body mass index (BMI; in kg/m(2)) data collected in 36 countries from 1992 to 2000 by nationally representative cross-sectional surveys of women aged 20-49 y (n = 148579) were classified as indicating underweight (BMI < 18.5) and overweight (BMI >/= 25). Associations between the nutritional status of urban and rural women and each country's per capita gross national income (GNI) and level of urbanization were explored in the overall sample and among different SES groups. RESULTS: Overweight exceeded underweight in well over half of the countries: the median ratio of overweight to underweight was 5.8 in urban and 2.1 in rural areas. Countries with high GNIs and high levels of urbanization had not only high absolute prevalences of overweight but also small urban-rural differences in overweight and very high ratios of overweight to underweight. In the more-developed countries, overweight among low-SES women was high in both rural (38%) and urban (51%) settings. Even many poor countries, countries in which underweight persists as a significant problem, had fairly high prevalences of rural overweight. CONCLUSIONS: In most developing economies, prevalences of overweight in young women residing in both urban and rural areas are higher than those in underweight women, especially in countries at higher levels of socioeconomic development. Research is needed to assess male and child overweight to understand the dynamics facing these groups as well.

Income, education, and blood pressure in adults in Jamaica, a middle-income developing country.

BACKGROUND: At present, little is known about how socioeconomic status (SES) is related to blood pressure (BP) and hypertension in developing countries. This cross-sectional study examined associations between SES and BP in 2082 adults from a peri-urban area of Jamaica, a middle-income developing country. METHODS: Hypertension (systolic BP >/=140 mmHg, diastolic BP >/=90 mmHg or current hypertensive medication use) was estimated based on self-reported medication use and the mean of the second and third of three manual BP measurements. Income and education were self-reported. Linear or logistic regressions were used to estimate multivariate associations between BP or hypertension and SES. RESULTS: Hypertension prevalence was 20% in men and 28% in women. In both men and women, the income distributions of BP and hypertension were non-linear, indicating elevated levels in low as well as in high-income groups. In contrast to the negative relationships typical for industrialized countries, multivariate-adjusted BP and hypertension were highest in the wealthiest women. In men with some high school education, income was positively associated with BP, while there were negative associations in men with lesser education. Unlike women, mean BP were highest in poor men with limited education. Low SES men were also least likely to receive diagnosis and treatment. CONCLUSIONS: Socioeconomic status is related to BP and hypertension in Jamaica, although relationships are non-linear. Behavioural and environmental factors that explain elevated BP among both low and high SES adults in developing countries must be identified to develop effective prevention strategies.