Lipoprotein particle concentration measured by nuclear magnetic resonance spectroscopy is associated with gestational age at delivery: a prospective cohort study.

OBJECTIVE: To estimate the association between lipoprotein particle concentrations in pregnancy and gestational age at delivery. DESIGN: Prospective cohort study. SETTING: The study was conducted in the USA at the University of North Carolina. POPULATION: We assessed 715 women enrolled in the Pregnancy, Infection, and Nutrition study from 2001 to 2005. METHODS: Fasting blood was collected at two time points (<20 and 24-29 weeks of gestation). Nuclear magnetic resonance (NMR) quantified lipoprotein particle concentrations [low-density lipoprotein (LDL), high-density lipoprotein (HDL), very-low density lipoprotein (VLDL)] and 10 subclasses of lipoproteins. Concentrations were assessed as continuous measures, with the exception of medium HDL which was classified as any or no detectable level, given its distribution. Cox proportional hazards models estimated hazard ratios (HR) for gestational age at delivery adjusting for covariates. MAIN OUTCOME MEASURES: Gestational age at delivery, preterm birth (<37 weeks of gestation), and spontaneous preterm birth. RESULTS: At <20 weeks of gestation, three lipoproteins were associated with later gestational ages at delivery [large LDLNMR (HR 0.78, 95% CI 0.64-0.96), total VLDLNMR (HR 0.77, 95% CI 0.61-0.98), and small VLDLNMR (HR 0.78, 95% CI 0.62-0.98], whereas large VLDLNMR (HR 1.19, 95% CI 1.01-1.41) was associated with a greater hazard of earlier delivery. At 24-28 weeks of gestation, average VLDLNMR (HR 1.25, 95% CI 1.03-1.51) and a detectable level of medium HDLNMR (HR 1.90, 95% CI 1.19-3.02) were associated with earlier gestational ages at delivery. CONCLUSION: In this sample of pregnant women, particle concentrations of VLDLNMR , LDLNMR , IDLNMR , and HDLNMR were each independently associated with gestational age at delivery for all deliveries or spontaneous deliveries <37 weeks of gestation. These findings may help formulate hypotheses for future studies of the complex relationship between maternal lipoproteins and preterm birth. TWEETABLE ABSTRACT: Nuclear magnetic resonance spectroscopy may identify lipoprotein particles associated with preterm delivery.

Diet quality and its association with type 2 diabetes and major cardiometabolic risk factors among adults in China.

AIM: We examined the association between diet quality and diabetes and major cardiometabolic risks among adults in China. METHODS AND RESULTS: We developed the China Dietary Guideline Index (CDGI) based on the 2007 Chinese dietary guidelines and tailored the Alternate Healthy Eating Index 2010 (which we call the tAHEI) to assess diet quality. Our analysis linked the dietary intake and covariates measured in 2006 with CM risk factors measured in 2009. We used diet data the longitudinal China Health and Nutrition Survey 2006 collected in 3 consecutive 24-h recalls from 4440 adults aged 18 to 65 to calculate both the tAHEI and the CDGI scores. We performed multivariable logistic regressions to analyze the association of each 2006 score with diabetes, abdominal obesity, elevated blood pressure, and lipid-related cardiometabolic risk factors in 2009. After we adjusted for potential confounders, adults in the top quintile compared with the bottom quintile of the tAHEI scores showed 36% lower odds of high low-density lipoprotein cholesterol (LDL-C) (odds ratio [OR] 0.64; 95% confidence interval [CI] 0.46, 0.90] in men and 33% lower odds (OR 0.67; 95% CI 0.49, 0.91) in women, while the CDGI scores showed 35% lower odds of high LDL-C (OR 0.65; 95% CI 0.46, 0.92) in men only. Further, the CDGI scores indicated 55% lower odds of diabetes in the top versus the bottom quintile (OR 0.45; 95% CI 0.23, 0.87) in men only, whereas a null association was observed for the tAHEI scores for both sexes. Both index scores showed null associations with other cardiometabolic risk factors. CONCLUSIONS: Chinese diets that scored high on both the CDGI and the tAHEI showed similarly negative associations with high LDL-C risk, whereas only CDGI score was negatively related to diabetes risk in men.

Gestational weight gain in women with systemic lupus erythematosus.

Objective The objective of this study was to estimate the proportion of pregnant women with systemic lupus erythematosus meeting Institute of Medicine guidelines for gestational weight gain and determine correlates of adherence to guidelines. Methods Singleton, live births in the Hopkins Lupus Pregnancy Cohort 1987-2015 were included. Pre-pregnancy weight was the weight recorded 12 months prior to pregnancy/first trimester. Final weight was the last weight recorded in the third trimester. Adherence to Institute of Medicine guidelines (inadequate, adequate, or excessive) was based on pre-pregnancy body mass index. Fisher's exact test and analysis of variance determined factors associated with not meeting guidelines. Stepwise selection estimated predictors of gestational weight gain. Results Of the 211 pregnancies, 34%, 24% and 42% had inadequate, adequate and excessive gestational weight gain, respectively. In exploratory analyses, differences in Institute of Medicine adherence were observed by pre-pregnancy body mass index, race, elevated creatinine during pregnancy and pre-pregnancy blood pressure. Odds of inadequate and excessive gestational weight gain increased 12% with each 1 kg/m2 increase in pre-pregnancy body mass index. Lower maternal education was associated with increased odds of inadequate and excessive gestational weight gain. Conclusions As in the general population, most women with systemic lupus erythematosus did not meet Institute of Medicine guidelines. Our results identified predictors of gestational weight gain to aid in targeted interventions to improve guideline adherence in this population.

Maternal diet quality in pregnancy and neonatal adiposity: the Healthy Start Study.

BACKGROUND/OBJECTIVES: Poor maternal diet in pregnancy can influence fetal growth and development. We tested the hypothesis that poor maternal diet quality during pregnancy would increase neonatal adiposity (percent fat mass (%FM)) at birth by increasing the fat mass (FM) component of neonatal body composition. METHODS: Our analysis was conducted using a prebirth observational cohort of 1079 mother-offspring pairs. Pregnancy diet was assessed via repeated Automated Self-Administered 24-h dietary recalls, from which Healthy Eating Index-2010 (HEI-2010) scores were calculated for each mother. HEI-2010 was dichotomized into scores of ⩽57 and >57, with low scores representing poorer diet quality. Neonatal %FM was assessed within 72 h after birth with air displacement plethysmography. Using univariate and multivariate linear models, we analyzed the relationship between maternal diet quality and neonatal %FM, FM, and fat-free mass (FFM) while adjusting for prepregnancy body mass index (BMI), physical activity, maternal age, smoking, energy intake, preeclampsia, hypertension, infant sex and gestational age. RESULTS: Total HEI-2010 score ranged between 18.2 and 89.5 (mean: 54.2, s.d.: 13.6). An HEI-2010 score of ⩽57 was significantly associated with higher neonatal %FM (ß=0.58, 95% confidence interval (CI) 0.07-1.1, P<0.05) and FM (ß=20.74; 95% CI 1.49-40.0; P<0.05) but no difference in FFM. CONCLUSIONS: Poor diet quality during pregnancy increases neonatal adiposity independent of maternal prepregnancy BMI and total caloric intake. This further implicates maternal diet as a potentially important exposure for fetal adiposity.

Diet, physical activity and mental health status are associated with dysglycaemia in pregnancy: the Healthy Start Study.

AIMS: To examine the association between dysglycaemia and multiple modifiable factors measured during pregnancy. METHODS: The Healthy Start Study collected self-reported data on modifiable factors in early and mid-pregnancy (median 17 and 27 weeks gestation, respectively) from 832 women. Women received one point for each modifiable factor for which they had optimum scores: diet quality (Healthy Eating Index score ≥64), physical activity level (estimated energy expenditure ≥170 metabolic equivalent task-h/week), and mental health status (Perceived Stress Scale score <6 and Edinburgh Postnatal Depression Scale score <13). Dysglycaemia during pregnancy was defined as an abnormal glucose challenge result, ≥1 abnormal results on an oral glucose tolerance test, or a clinical diagnosis of gestational diabetes. Logistic regression models estimated odds ratios for dysglycaemia as a function of each factor and the total score, adjusted for age, race/ethnicity, pre-pregnancy BMI, history of gestational diabetes, and family history of Type 2 diabetes. RESULTS: In individual analyses, only physical activity was significantly associated with a reduced risk of dysglycaemia (adjusted odds ratio 0.67, 95% CI 0.44-1.00). We observed a significant, dose-response association between increasing numbers of optimal factors and odds of dysglycaemia (adjusted P=0.01). Compared with having no optimal modifiable factors, having all three was associated with a 73% reduced risk of dysglycaemia (adjusted odds ratio 0.27, 95% CI 0.08-0.95). CONCLUSIONS: An increasing number of positive modifiable factors in pregnancy was associated with a dose-response reduction in risk of dysglycaemia. Our results support the hypothesis that modifiable factors in pregnancy are associated with the risk of prenatal dysglycaemia.

Biomarker-predicted sugars intake compared with self-reported measures in US Hispanics/Latinos: results from the HCHS/SOL SOLNAS study.

OBJECTIVE: Measurement error in self-reported total sugars intake may obscure associations between sugars consumption and health outcomes, and the sum of 24 h urinary sucrose and fructose may serve as a predictive biomarker of total sugars intake. DESIGN: The Study of Latinos: Nutrition & Physical Activity Assessment Study (SOLNAS) was an ancillary study to the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) cohort. Doubly labelled water and 24 h urinary sucrose and fructose were used as biomarkers of energy and sugars intake, respectively. Participants' diets were assessed by up to three 24 h recalls (88 % had two or more recalls). Procedures were repeated approximately 6 months after the initial visit among a subset of ninety-six participants. SETTING: Four centres (Bronx, NY; Chicago, IL; Miami, FL; San Diego, CA) across the USA. SUBJECTS: Men and women (n 477) aged 18-74 years. RESULTS: The geometric mean of total sugars was 167·5 (95 % CI 154·4, 181·7) g/d for the biomarker-predicted and 90·6 (95 % CI 87·6, 93·6) g/d for the self-reported total sugars intake. Self-reported total sugars intake was not correlated with biomarker-predicted sugars intake (r=-0·06, P=0·20, n 450). Among the reliability sample (n 90), the reproducibility coefficient was 0·59 for biomarker-predicted and 0·20 for self-reported total sugars intake. CONCLUSIONS: Possible explanations for the lack of association between biomarker-predicted and self-reported sugars intake include measurement error in self-reported diet, high intra-individual variability in sugars intake, and/or urinary sucrose and fructose may not be a suitable proxy for total sugars intake in this study population.

Pregnancy intention and postpartum depression: secondary data analysis from a prospective cohort.

OBJECTIVE: To assess the relationship between unintended pregnancy and postpartum depression. DESIGN: Secondary analysis of data from a prospective pregnancy cohort. SETTING: The study was performed at the University of North Carolina prenatal care clinics. POPULATION/SAMPLE: Pregnant women enrolled for prenatal care at the University of North Carolina Hospital Center. METHODS: Participants were questioned about pregnancy intention at 15-19 weeks of gestation, and classified as having an intended, mistimed or unwanted pregnancy. They were evaluated for postpartum depression at 3 and 12 months postpartum. Log binomial regression was used to assess the relationship between unintended pregnancy and depression, controlling for confounding by demographic factors and reproductive history. MAIN OUTCOME MEASURES: Depression at 3 and 12 months postpartum, defined as Edinburgh Postpartum Depression Scale score >13. RESULTS: Data were analysed for 688 women at 3 months and 550 women at 12 months. Depression was more likely in women with unintended pregnancies at both 3 months (risk ratio [RR] 2.1, 95% confidence interval [95% CI] 1.2-3.6) and 12 months (RR 3.6, 95% CI 1.8-7.1). Using multivariable analysis adjusting for confounding by age, poverty and education level, women with unintended pregnancies were twice as likely to have postpartum depression at 12 months (RR 2.0, 95% CI 0.96-4.0). CONCLUSION: While many elements may contribute to postpartum depression, unintended pregnancy could also be a contributing factor. Women with unintended pregnancy may have an increased risk of depression up to 1 year postpartum.

Sociodemographic disparity in the diet quality transition among Chinese adults from 1991 to 2011.

BACKGROUND/OBJECTIVES: This study investigates secular trends in diet quality distribution and related socioeconomic disparity from 1991 to 2011 in the Chinese adult population. SUBJECTS/METHODS: The analysis uses the 1991-2011 China Health and Nutrition Survey data on 13 853 participants (6876 men and 6977 women) aged 18-65 with 56 319 responses. Dietary assessment was carried out over a 3-day period with 24-h recalls combined with a household food inventory. We tailored Alternative Healthy Eating Index 2010 (named as tAHEI) to measure diet quality and performed quantile regression to investigate shifts in tAHEI scores at different percentiles and used mixed-effect linear regression to examine average diet quality trend and potential sociodemographic disparity. RESULTS: The energy-adjusted mean tAHEI scores increased from 36.9 (36.7-37.1) points in 1991 to 50.3 (50.1-50.5) in 2011 for men (P<0.001) and from 35.6 (35.4-35.8) to 46.9 (46.7-47.1) for women (P<0.001). The covariate-adjusted score of polyunsaturated fatty acids increased by 6.8 (6.6, 7.0) and 7.0 (6.9, 7.2), and the score of long-chain (ω-3) fats increased by 5.3 (5.2, 5.4) and 5.3 (5.2, 5.5) in men and women, respectively, whereas the cereal fiber and red meat scores decreased slightly. Increasing tAHEI score occurred across the entire distribution, and diet quality transition varied across sociodemographic groups. CONCLUSIONS: Chinese diet quality is far from optimal, with moderate improvement over a 21-year period. Findings suggest that nutritional intervention should give priority to low-income, low-urbanized communities and southern provincial adults with low diet quality in China.

Applying recovery biomarkers to calibrate self-report measures of sodium and potassium in the Hispanic Community Health Study/Study of Latinos.

Measurement error in assessment of sodium and potassium intake obscures associations with health outcomes. The level of this error in a diverse US Hispanic/Latino population is unknown. We investigated the measurement error in self-reported dietary intake of sodium and potassium and examined differences by background (Central American, Cuban, Dominican, Mexican, Puerto Rican and South American). In 2010-2012, we studied 447 participants aged 18-74 years from four communities (Miami, Bronx, Chicago and San Diego), obtaining objective 24-h urinary sodium and potassium excretion measures. Self-report was captured from two interviewer-administered 24-h dietary recalls. Twenty percent of the sample repeated the study. We examined bias in self-reported sodium and potassium from diet and the association of mismeasurement with participant characteristics. Linear regression relating self-report with objective measures was used to develop calibration equations. Self-report underestimated sodium intake by 19.8% and 20.8% and potassium intake by 1.3% and 4.6% in men and women, respectively. Sodium intake underestimation varied by Hispanic/Latino background (P<0.05) and was associated with higher body mass index (BMI). Potassium intake underestimation was associated with higher BMI, lower restaurant score (indicating lower consumption of foods prepared away from home and/or eaten outside the home) and supplement use. The R2 was 19.7% and 25.0% for the sodium and potassium calibration models, respectively, increasing to 59.5 and 61.7% after adjusting for within-person variability in each biomarker. These calibration equations, corrected for subject-specific reporting error, have the potential to reduce bias in diet-disease associations within this largest cohort of Hispanics in the United States.

Applying recovery biomarkers to calibrate self-report measures of sodium and potassium in the hispanic community health study/study of latinos.

This corrects the article DOI: 10.1038/jhh.2016.98.

Biological determinants of pregnancy weight gain in a Filipino population.

Patterns of pregnancy weight gain and predictors of first trimester and total weight gain were investigated in a sample of 1367 women from Cebu, Philippines, with pregnancy intervals of < 2 y. The mean total weight gain based on actual measurements of prepregnant weight was 8.4 kg. Controlling for gestational week when weight was measured, multivariate-regression models predicted higher first trimester weight gain with higher parity, lower prepregnant body mass index (BMI), and longer nonpregnant intervals. Higher total weight gain was associated with longer nonpregnant intervals, lower prepregnant BMI, taller maternal stature, and relatively high dietary energy intakes. Lactation into the third trimester of pregnancy and maternal age over 35 y had significant negative effects on total weight gain. Given the importance of maternal weight gain in predicting birth outcome, this study provides information on modifiable risk factors that should be considered when developing maternal-infant health policy and programs.

PIP: A study of 1983-87 longitudinal data examined patterns of pregnancy weight gain and predictors of pregnancy weight gain among 1367 pregnant women from Cebu, the Philippines. Mean total weight gain was 8.4 kg. The women began gaining weight more slowly than did women in developed countries then caught up until 22-24 weeks gestation at which time their weight gain rate was considerably lower. Underweight women always gained more weight than normal and overweight women (e.g., during the 1st trimester, .07 kg/week vs. -.8 kg/week; p .05). During the 3rd trimester, women with an overlap of pregnancy and lactation gained much more weight than women with no overlap (.31 kg/week vs. .22 kg/week; p .05). The multivariate regression confirmed that women with a low prepregnant body mass index (BMI) gained more weight than did women with a normal or high BMI (p .01). Higher total weight gain during the 1st trimester was also linked to longer nonpregnant intervals (p .01). This was also true for total weight gain (p .01). A woman with a 6-month pregnancy interval gained 1.27 kg less during the entire pregnancy than a women with an 18-month pregnancy interval. Taller women gained more weight than did shorter women (p .01). Women who had high caloric intake gained more weight than did women who had low caloric intake (p .05). Women older than 35 gained less weight than younger women (p .01). Women who breast fed into the 3rd trimester of pregnancy gained 1.84 kg less than a woman who breast fed only into the 1st trimester (p .01). Women with any overlap of pregnancy and lactation gained more weight during the 3rd trimester than did women with no overlap, suggesting a rebound effect. Thus, public health programs should promote birth spacing and sound nutritional status and encourage breast-feeding pregnant mothers to consume more energy and nutrients to meet the demands of pregnancy and breast feeding.

Trends in breakfast consumption for children in the United States from 1965-1991.

We examined breakfast consumption patterns and trends between 1965 and 1991 for children (1-10 y old) and adolescents (11-18 y old) in the United States. The analysis was undertaken by pooling nationally representative samples obtained from the Nationwide Food Consumption Surveys of 1965 and 1977-1978 and the 1989-1991 Continuing Survey of Food Intakes by Individuals. Breakfast consumption, defined as the consumption of food, beverage, or both between 0500 and 1000, was the focus of the trends analysis. Descriptive results indicated a decline in breakfast consumption between 1965 and 1991, particularly for older adolescents aged 15-18 y; the rates for boys and girls declined from 89.7% and 84.4%, respectively, in 1965 to 74.9% and 64.7%, respectively, in 1991. Multivariate results indicated that breakfast consumption declined predominantly because of behavioral changes and not the population's changing sociodemographic patterns. The nutritional quality of foods consumed at breakfast has improved since 1965, with significant shifts toward consumption of lower-fat milk and smaller changes in other food groups. The improvement over time in the quality of food consumed at breakfast, however, is offset by the large percentage of persons aged > or = 11 y who do not presently consume breakfast. Given the association of obesity with less frequent breakfast consumption and the rise in obesity among persons of this age group, a renewed emphasis on the importance of breakfast is warranted.

Institute of Medicine maternal weight gain recommendations and pregnancy outcome in a predominantly Hispanic population.

OBJECTIVES: To describe gestational weight gain patterns by pre-pregnancy weight and trimester of pregnancy, and to examine the risk of preterm birth associated with pre-pregnancy weight and gestational weight gain using various definitions of adequacy based on the Institute of Medicine (IOM) standard. METHODS: We used data collected prospectively from 8736 pregnant women receiving care in public health clinics in the West Los Angeles area. Pre-pregnancy weight was based on self-report obtained at the initial visit. Maternal weight was measured at each prenatal visit, allowing for the calculation of total weight gain and the rate of weight gain during each trimester. RESULTS: Women underweight before pregnancy (body mass index less than 19.8) had the greatest risk of delivering preterm (crude relative risk 1.7, P < .05). Similarities in patterns of weight gain were seen between women of low weight and normal pre-pregnancy weight status, as well as between overweight and obese women. Compared to the IOM recommendations for total weight gain, 47.8% of underweight women and 36.6% of normal-weight women gained the recommended amount. In contrast, 52% and more than 75% of overweight and obese women, respectively, had excessive gains. Inadequate weight gain during the third trimester as opposed to excessive gain, defined specifically for each pre-pregnancy weight status, was predictive of preterm birth. CONCLUSIONS: Weight monitoring during pregnancy continues to have clinical applications for the prediction of poor birth outcomes. Weight gain less than 90% the IOM recommendation in the third trimester may serve as an indicator for identifying women at risk of delivering preterm.

Predictors of poor maternal weight gain from baseline anthropometric, psychosocial, and demographic information in a Hispanic population.

OBJECTIVE: To identify which baseline factors best predict poor maternal weight gain among Hispanics. SAMPLE: Pregnancy and outcome data collected prospectively from 4,791 Hispanic women attending public prenatal clinics in West Los Angeles, Calif, from 1983 through 1986. METHODS: Prepregnancy weight was categorized into weight status groups using body mass index (BMI). Poor total weight gain (based on a mean gestational age at last measurement, which was at 35 weeks) was defined as less than 21 lb for women with BMI less than 26 and less than 10 lb for women with BMI of 26 or greater. Analyses used Student's t test, chi 2, and multivariate regression techniques (linear and logistic). RESULTS: Poor total weight gain was identified in 29% of the women. For women who were underweight or normal weight before pregnancy, the only factor associated with increasing the risk of poor total weight gain was short stature (adjusted odds ratio [AOR] = 1.5, 95% confidence interval [CI] = 1.24, 1.84). The following factors decreased the risk: being US born (AOR = 0.61, 95% CI = 0.37, 1.00); being primiparous and under 29 years old (for < 20 years AOR = 0.69, 95% CI = 0.51, 0.92 and for 20 to 29 years AOR = 0.63, 95% CI = 0.49, 0.81); planning the pregnancy (AOR = 0.82, 95% CI = 0.67, 1.00); and having a close relative die during the pregnancy (AOR = 0.65, 95% CI = 0.44, 0.95). For obese and overweight women, physical abuse by the baby's father increased the risk (AOR = 3.19, 95% CI = 1.27, 8.01) of poor total weight gain, whereas receiving financial support from the baby's father decreased the risk (AOR = 0.59, 95% CI = 0.37, 0.95). APPLICATIONS/CONCLUSIONS: These baseline factors could aid in targeting nutrition and other social services earlier to pregnant Hispanic women. By strategically targeting pregnant women in greatest need of services, improvements in birth outcomes may be enhanced.

The Diet Quality Index revised: a measurement instrument for populations.

OBJECTIVE: To evaluate a revision of the Diet Quality Index called the Diet Quality Index Revised (DQI-R). DESIGN: The original Diet Quality Index was revised to reflect current dietary guidance, to incorporate improved methods of estimating food servings, and to develop and incorporate measures of dietary variety and moderation. The scoring of the original scale was reversed in direction and expanded to a 100-point scale to improve interpretability. METHODS/SUBJECTS: Data from the 1994 Continuing Survey of Food Intakes by Individuals were used. A sample of 3,202 adults aged 18 and older contributed 2 days of dietary intake data based on 24-hour recalls for the development and revision of various components of the DQI-R. STATISTICAL ANALYSES: Pearson correlation analyses, ordinary least squares regression analyses, and a nonparametric test to determine trends across ordered groups were used. RESULTS: The mean DQI-R score for the 1994 sample was 63.4 of a possible 100-point score. Sample respondents were more likely to have met dietary guidance in the areas of dietary cholesterol (66.9% met goal) and iron intakes (59.6% met goal) relative to the Recommended Dietary Allowances but less likely to have met goals related to fruit servings (19.6% met goal), grain servings (23.1% met goal), and calcium intakes (16.6% met goal) relative to the Recommended Dietary Allowance. There is a statistically significant quantitative and qualitative improvement in all components of the DQI-R as one moves from the lowest grouping of scores to the highest. For example, persons with DQI-R scores less than 40 consumed 43.9% of energy from fat, 72% of the Adequate Intake for calcium, and 6.7% of the recommended servings of fruit per day. In contrast, those with DQI-R scores greater than 80 consumed 24.2% of energy from fat, 101% of the Adequate Intake for calcium, and 137% of the recommended servings of fruit per day. APPLICATIONS: The DQI-R reflects the dietary guidance principles of macronutrient distribution, moderation, variety, and proportionality. Although the index was designed to monitor dietary changes in populations rather than individuals, each index component reflects an aspect of national dietary guidance. Calculation of DQI-R scores for an individual should provide an estimate of diet quality relative to national guidelines, and differences in scores over time should suggest improvement or decline in overall diet quality.

Three squares or mostly snacks--what do teens really eat? A sociodemographic study of meal patterns.

PURPOSE: To categorize U.S. adolescents' meal patterns and related differences in dietary quality. METHODS: Using data from the Continuing Survey of Food Intake by Individuals, 1989-1991, meal patterns from 3 days of adolescents' (ages 11-18 years) intake (n = 1310) were examined. Consistency of meal pattern intake and associated nutrient quality was determined. Logistic regression was used to examine the effects of several sociodemographic characteristics on meal pattern consistency. RESULTS: A higher percentage of adolescents consumed a meal pattern that included 3 meals/day than any other meal pattern: 57.4-58.7% on any given day. Forty-one percent of adolescents fell into the consistent (at least two meals on all 3 days), and only 3.5% fell into the inconsistent meal (one meal, with or without snacks, or snacks only, on all 3 days) pattern category. Logistic regression results indicated that being black [adjusted odds ratio (AOR) = 4.19, 95% confidence interval (CI) (1.90, 9.27)], older (15-18) [AOR = 1.41, 95% CI (1.19, 1.67)], and from a single-parent household [AOR = 2.60, 95% CI (1.23, 5.52)] were predictive of an inconsistent meal pattern. School lunch has a positive impact on intake, increasing a consistent meal pattern from 36.0% to 44.9%. CONCLUSIONS: Adolescents who consume at least two meals (with or without snacks) on a consistent basis have an adequate intake of calories and a more nutrient-dense diet with respect to calcium, iron, vitamin E, and fiber than those with other meal patterns. From the perspective of following a diet to prevent chronic diseases in adulthood, adolescents regardless of meal pattern, consume a diet that is too high in fat, sodium, and protein, and too low in fiber.

Gestational weight gain and predicted changes in offspring anthropometrics between early infancy and 3 years.

OBJECTIVE: To determine how gestational weight gain (GWG), categorized using the 2009 Institute of Medicine recommendations, relates to changes in offspring weight-for-age (WAZ), length-for-age (LAZ) and weight-for-length z-scores (WLZ) between early infancy and 3 years. METHODS: Women with singleton infants were recruited from the third cohort of the Pregnancy, Infection, and Nutrition Study (2001-2005). Term infants with at least one weight or length measurement during the study period were included (n = 476). Multivariable linear mixed effects regression models estimated longitudinal changes in WAZ, LAZ and WLZ associated with GWG. RESULTS: In early infancy, compared with infants of women with adequate weight gain, those of women with excessive weight gains had higher WAZ, LAZ and WLZ. Excessive GWG ≥ 200% of the recommended amount was associated with faster rates of change in WAZ and LAZ and noticeably higher predicted mean WAZ and WLZ that persisted across the study period. CONCLUSIONS: GWG is associated with significant differences in offspring anthropometrics in early infancy that persisted to 3 years of age. More longitudinal studies that utilize maternal and paediatric body composition measures are necessary to understand the nature of this association.

US adolescent food intake trends from 1965 to 1996.

OBJECTIVE: To examine adolescent food consumption trends in the United States with important chronic disease implications. METHODS: Analysis of dietary intake data from 4 nationally representative US Department of Agriculture surveys of persons aged 11 to 18 years (n = 12,498). RESULTS: From 1965 to 1996, a considerable shift occurred in the adolescent diet. Total energy intake decreased, as did the proportion of energy from total fat (39%-32%) and saturated fat (15%-12%). Concurrent increases occurred in the consumption of higher-fat potatoes and mixed dishes (pizza and macaroni and cheese). Lower-fat milks replaced higher-fat milks, but total milk consumption decreased by 36%. This decrease was accompanied by an increase in the consumption of soft drinks and noncitrus juices. An increase in high-fat potato consumption led to an increase in vegetable intake, but the number of servings for fruits and vegetables is still lower than the recommended 5 per day. Iron, folic acid, and calcium intakes continue to be below those recommended for girls. CONCLUSIONS: These trends, far greater than for US adults, may compromise the health of the future US population.