Comparison of planned menus and centre characteristics with foods and beverages served in New York City child-care centres.

OBJECTIVE: The present study evaluated the extent to which child-care centre menus prepared in advance correspond with food and beverage items served to children. The authors identified centre and staff characteristics that were associated with matches between menus and what was served. DESIGN: Menus were collected from ninety-five centres in New York City (NYC). Direct observation of foods and beverages served to children were conducted during 524 meal and snack times at these centres between April and June 2010, as part of a larger study designed to determine compliance of child-care centres with city health department regulations for nutrition. SETTING: Child-care centres were located in low-income neighbourhoods in NYC. RESULTS: Overall, 87 % of the foods and beverages listed on the menus or allowed as substitutions were served. Menu items matched with foods and beverages served for all major food groups by >60 %. Sweets and water had lower match percentages (40 and 32 %, respectively), but water was served 68 % of the time when it was not listed on the menu. The staff person making the food and purchasing decisions predicted the match between the planned or substituted items on the menus and the foods and beverages served. CONCLUSIONS: In the present study, child-care centre menus included most foods and beverages served to children. Menus planned in advance have potential to be used to inform parents about which child-care centre to send their child or what foods and beverages their enrolled children will be offered throughout the day.

Comparison of children's food and beverage intakes with national recommendations in New York City child-care centres.

OBJECTIVE: The present study compared foods and beverages provided to and consumed by children at child-care centres in New York City (NYC) with national nutrition recommendations. DESIGN: The study used survey, observational and centre record data collected from child-care centres. Food and beverage intakes from two days of observation and amounts of energy and nutrients were estimated using the US National Cancer Institute's Automated Self-Administered 24 h Recall system. SETTING: Meal and snack time at 108 child-care centres in low-income communities in NYC. SUBJECTS: Children aged 3-4 years old in classrooms selected by the directors of the participating child-care centres. RESULTS: Foods and beverages provided to and consumed by children (n 630) met >50 % of the Dietary Reference Intake (DRI) for most nutrients. Intakes of fibre and vitamins D and E were 50 % of the recommended average daily intake amounts for total grains, fruits and fruit juices, and dairy, but <50 % of the recommended amounts for whole grains, protein foods and vegetables. Intake of oils was below the allowance for energy levels, but foods and beverages with solid fats and added sugars exceeded the limits by 68 %. CONCLUSIONS: Providing more whole grains, vegetables and low-fat dairy and fewer foods with solid fats and added sugars may improve children's diet quality when at child-care centres. Centre staff may need training, resources and strategies in order to meet the nutrition recommendations.

Dietary variety is inversely associated with body adiposity among US adults using a novel food diversity index.

BACKGROUND: Consuming a variety (vs. monotony) of energy-poor, nutrient-dense foods may help individuals adhere to dietary patterns favorably associated with weight control. OBJECTIVE: The objective of this study was to examine whether greater healthful food variety quantified using the US Healthy Food Diversity (HFD) index favorably influenced body adiposity. METHODS: Men and nonpregnant, nonlactating women aged ≥20 y with two 24-h recalls from the cross-sectional NHANES 2003-2006 (n = 7470) were included in this study. Dietary recalls were merged with the MyPyramid Equivalent database to generate the US HFD index, which ranges from 0 to ∼1, with higher scores indicative of diets with a higher number and proportion of healthful foods. Multiple indicators of adiposity including BMI, waist-to-height ratio, android-to-gynoid fat ratio, fat mass index (FMI), and percentage body fat were assessed across US HFD index quintiles. ORs and 95% CIs were computed with use of multivariable logistic regression (SAS v. 9.3). RESULTS: The US HFD index was inversely associated with most adiposity indicators in both sexes. After multivariable adjustment, the odds of obesity, android-to-gynoid ratio >1, and high FMI were 31-55% lower (P-trend < 0.01) among women in quintile 5 vs. quintile 1 of the US HFD index. Among men, the odds of obesity, waist-to-height ratio ≥0.5, and android-to-gynoid ratio >1 were 40-48% lower (P-trend ≤ 0.01) in quintile 5 vs. quintile 1 of the US HFD index. CONCLUSIONS: Higher US HFD index values were inversely associated with indicators of body adiposity in both sexes, indicating that greater healthful food variety may protect against excess adiposity. This study explicitly recognizes the potential benefits of dietary variety in obesity management and provides the foundation to support its ongoing evaluation.

Assessment of a government-subsidized supermarket in a high-need area on household food availability and children's dietary intakes.

OBJECTIVE: To assess the impact of a new government-subsidized supermarket in a high-need area on household food availability and dietary habits in children. DESIGN: A difference-in-difference study design was utilized. SETTING: Two neighbourhoods in the Bronx, New York City. Outcomes were collected in Morrisania, the target community where the new supermarket was opened, and Highbridge, the comparison community. SUBJECTS: Parents/caregivers of a child aged 3-10 years residing in Morrisania or Highbridge. Participants were recruited via street intercept at baseline (pre-supermarket opening) and at two follow-up periods (five weeks and one year post-supermarket opening). RESULTS: Analysis is based on 2172 street-intercept surveys and 363 dietary recalls from a sample of predominantly low-income minorities. While there were small, inconsistent changes over the time periods, there were no appreciable differences in availability of healthful or unhealthful foods at home, or in children's dietary intake as a result of the supermarket. CONCLUSIONS: The introduction of a government-subsidized supermarket into an underserved neighbourhood in the Bronx did not result in significant changes in household food availability or children's dietary intake. Given the lack of healthful food options in underserved neighbourhoods and need for programmes that promote access, further research is needed to determine whether healthy food retail expansion, alone or with other strategies, can improve food choices of children and their families.

Development and evaluation of the US Healthy Food Diversity index.

Varied diets are diverse with respect to diet quality, and existing dietary variety indices do not capture this heterogeneity. We developed and evaluated the multidimensional US Healthy Food Diversity (HFD) index, which measures dietary variety, dietary quality and proportionality according to the 2010 Dietary Guidelines for Americans (DGA). In the present study, two 24 h dietary recalls from the 2003-6 National Health and Nutrition Examination Survey (NHANES) were used to estimate the intake of twenty-six food groups and health weights for each food group were informed by the 2010 DGA. The US HFD index can range between 0 (poor) and 1 - 1/n, where n is the number of foods; the score is maximised by consuming a variety of foods in proportions recommended by the 2010 DGA. Energy-adjusted Pearson's correlations were computed between the US HFD index and each food group and the probability of adequacy for fifteen nutrients. Linear regression was run to test whether the index differentiated between subpopulations with differences in dietary quality commonly reported in the literature. The observed mean index score was 0·36, indicating that participants did not consume a variety of healthful foods. The index positively correlated with nutrient-dense foods including whole grains, fruits, orange vegetables and low-fat dairy (r 0·12 to 0·64) and negatively correlated with added sugars and lean meats (r - 0·14 to - 0·23). The index also positively correlated with the mean probability of nutrient adequacy (r 0·41; P< 0·0001) and identified non-smokers, women and older adults as subpopulations with better dietary qualities. The US HFD index may be used to inform national dietary guidance and investigate whether healthful dietary variety promotes weight control.

Associations between dietary variety and measures of body adiposity: a systematic review of epidemiological studies.

Dietary variety is positively correlated with energy intake in most studies. However, the associations between dietary variety and measures of body adiposity are inconsistent in the literature, which limits the development of clear national nutrition recommendations regarding dietary variety. In the present systematic review, we critically evaluate the associations between dietary variety and measures of body adiposity among healthy adults within the existing literature. We conducted a systematic search of the MEDLINE and Web of Science databases in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement to examine these associations. We identified twenty-six studies in total that investigated the associations between dietary variety and body adiposity measures. Total variety was non-significantly associated with body adiposity in most studies, while variety in recommended foods was either inversely associated (six out of ten studies) or non-significantly associated (three out of ten studies) with body adiposity. Conversely, variety in non-recommended foods (i.e. sources of added sugars and solid fats) increased the likelihood of excess adiposity in most studies (six out of nine studies). Definitions and measurement of dietary variety were inconsistent across studies and contributed to some of the discrepancies noted in the literature. In conclusion, among the studies that met the inclusion criteria for the present review, dietary variety was inconsistently associated with body adiposity in diverse populations. Using consistent and specific definitions of dietary variety may help provide further insight into the associations between dietary variety and excess adiposity before definitive public health messages are ma

Consumer purchasing patterns in response to calorie labeling legislation in New York City.

BACKGROUND: Obesity is a major public health threat and policies aimed at curbing this epidemic are emerging. National calorie labeling legislation is forthcoming and requires rigorous evaluation to examine its impact on consumers. The purpose of this study was to examine whether point-of-purchase calorie labels in New York City (NYC) chain restaurants affected food purchasing patterns in a sample of lower income adults in NYC and Newark, NJ. METHODS: This study utilized a difference-in-difference design to survey 1,170 adult patrons of four popular chain restaurants in NYC and Newark, NJ (which did not introduce labeling) before and after calorie labeling was implemented in NYC. Receipt data were collected and analyzed to examine food and beverage purchases and frequency of fast food consumption. Descriptive statistics were generated, and linear and logistic regression, difference-in-difference analysis, and predicted probabilities were used to analyze the data. RESULTS: A difference-in-difference analysis revealed no significant favorable differences and some unfavorable differences in food purchasing patterns and frequency of fast food consumption between adult patrons of fast food restaurants in NYC and Newark, NJ. Adults in NYC who reported noticing and using the calorie labels consumed fast food less frequently compared to adults who did not notice the labels (4.9 vs. 6.6 meals per week, p <0.05). CONCLUSION: While no favorable differences in purchasing as a result of labeling were noted, self-reported use of calorie labels was associated with some favorable behavioral patterns in a subset of adults in NYC. However, overall impact of the legislation may be limited. More research is needed to understand the most effective way to deliver calorie information to consumers.

Vitamin E intake and risk of esophageal and gastric cancers in the NIH-AARP Diet and Health Study.

We investigated the association of dietary alpha-tocopherol, gamma-tocopherol and supplemental vitamin E intake with the risk of esophageal squamous cell carcinoma (n = 158), esophageal adenocarcinoma (n = 382), gastric cardia adenocarcinoma (n = 320) and gastric noncardia adenocarcinoma (GNCA; n = 327) in the NIH-AARP Diet and Health Study, a cohort of approximately 500,000 people. Data on dietary and supplemental vitamin E intake were collected using a validated questionnaire at baseline and were analyzed using Cox regression models. Intakes were analyzed as continuous variables and as quartiles. For dietary alpha-tocopherol, we found some evidence of association with decreased esophageal squamous cell carcinoma and increased esophageal adenocarcinoma risk in the continuous analyses, with adjusted hazard ratios and 95% confidence intervals of 0.90 (0.81-0.99) and 1.05 (1.00-1.11), respectively, per 1.17 mg (half the interquartile range) increased intake. However, in quartile analyses, the p value for trend was nonsignificant for both these cancers. There was no association between dietary alpha-tocopherol and gastric cardia adenocarcinoma or GNCA. We observed no statistically significant associations with gamma-tocopherol. For supplemental vitamin E, the results were mainly null, except for a significantly lower risk of GNCA with higher doses of supplemental vitamin E. An increase of 71 mg/day (half the interquartile range) in supplemental vitamin E had an hazard ratio (95% confidence interval) of 0.92 (0.85-1.00) and the p value for trend in the quartile analysis was 0.015.

Supplemental and dietary vitamin E intakes and risk of prostate cancer in a large prospective study.

Supplemental vitamin E (alpha-tocopherol) has been linked to lower prostate cancer incidence in one randomized trial and several, although not all, observational studies. The evidence regarding dietary intake of individual vitamin E isoforms and prostate cancer is limited and inconclusive, however. We prospectively examined the relations of supplemental vitamin E and dietary intakes of alpha-, beta-, gamma-, and delta- tocopherols to prostate cancer risk among 295,344 men, ages 50 to 71 years and cancer-free at enrollment in 1995 to 1996, in the NIH-AARP Diet and Health Study. At baseline, participants completed a questionnaire that captured information on diet, supplement use, and other factors. Proportional hazards models were used to estimate relative risks (RR) and 95% confidence intervals (95% CI) of prostate cancer. During 5 years of follow-up, 10,241 incident prostate cancers were identified. Supplemental vitamin E intake was not related to prostate cancer risk (for >0-99, 100-199, 200-399, 400-799, and > or = 800 IU/d versus never use: RR, 0.97, 0.89, 1.03, 0.99, and 0.97 (95% CI, 0.87-1.07) respectively; Ptrend = 0.90). However, dietary gamma-tocopherol, the most commonly consumed form of vitamin E in the United States, was significantly inversely related to the risk of advanced prostate cancer (for highest versus lowest quintile: RR, 0.68; 95% CI, 0.56-0.84; Ptrend = 0.001). These results suggest that supplemental vitamin E does not protect against prostate cancer, but that increased consumption of gamma-tocopherol from foods is associated with a reduced risk of clinically relevant disease. The potential benefit of gamma-tocopherol for prostate cancer prevention deserves further attention.

The Introduction of a Supermarket via Tax-Credits in a Low-Income Area.

PURPOSE: Interest and funding continue to grow for bringing supermarkets to underserved areas, yet little is known about their impact. DESIGN: A quasi-experimental study was used to determine the impact of a new supermarket opening as a result of tax and zoning incentives. SETTING: The study took place in the South Bronx, New York City, New York. SUBJECTS: Studied were residents of two South Bronx neighborhoods deemed high need. MEASURES: Food purchasing and consumption were examined via surveys and 24-hour dietary recalls before and at two points after the supermarket opened (1-5, 13-17 months). ANALYSIS: Data were analyzed using difference-in-difference models controlling for gender, race and ethnicity, age, education, marital status, and self-reported income. Ordinary least squares and logistic regression models were estimated for continuous and binary outcomes, respectively. RESULTS: At baseline, 94% to 97% of consumers shopped at a supermarket. There was a 2% increase in this behavior in the intervention community ( p < .05) not seen in the comparison community. One year later there was a 7% net increase in eating at home ( p < .1) and a 20% decrease in drinking sugary beverages ( p < .05), but no appreciable change in fruit/vegetable consumption or overall dietary quality. CONCLUSION: The new supermarket did not result in substantial or broad changes in purchasing patterns or nutritional quality of food consumed, though smaller, positive changes were observed over a 1-year period. Future work should examine different contexts and a broader set of outcomes, including economic development.

A prospective study of lycopene and tomato product intake and risk of prostate cancer.

BACKGROUND: Dietary lycopene and tomato products may reduce risk of prostate cancer; however, uncertainty remains about this possible association. METHODS: We evaluated the association between intake of lycopene and specific tomato products and prostate cancer risk in the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial, a multicenter study designed to investigate cancer early detection methods and etiologic determinants. Participants completed both a general risk factor and a 137-item food frequency questionnaire at baseline. A total of 1,338 cases of prostate cancer were identified among 29,361 men during an average of 4.2 years of follow-up. RESULTS: Lycopene intake was not associated with prostate cancer risk. Reduced risks were also not found for total tomato servings or for most tomato-based foods. Statistically nonsignificant inverse associations were noted for pizza [all prostate cancer: relative risk (RR), 0.83; 95% confidence interval (95% CI), 0.67-1.03 for >or=1 serving/wk versus < 0.5 serving/mo; P(trend)=0.06 and advanced prostate cancer: RR, 0.79; 95% CI, 0.56-1.10; P(trend)=0.12] and spaghetti/tomato sauce consumption (advanced prostate cancer: RR=0.81, 95% CI, 0.57-1.16 for >or=2 servings/wk versus<1 serving/mo; P(trend)=0.31). Among men with a family history of prostate cancer, risks were decreased in relation to increased consumption of lycopene (P(trend)=0.04) and specific tomato-based foods commonly eaten with fat (spaghetti, P(trend)=0.12; pizza, P(trend)=0.15; lasagna, P(trend)=0.02). CONCLUSIONS: This large study does not support the hypothesis that greater lycopene/tomato product consumption protects from prostate cancer. Evidence for protective associations in subjects with a family history of prostate cancer requires further corroboration.

Predictors for research involvement among registered dietitians.

OBJECTIVE: The primary aim of this study was to measure registered dietitians' (RDs') research involvement (by creating a research score) and to determine whether their perceptions, attitudes, and knowledge of evidence-based practice and key antecedent factors (eg, sociodemographic characteristics, education and training, professional experiences, and employment setting) predicted their research involvement. DESIGN: This cross-sectional, descriptive study used the Dietitian Research Involvement Survey and followed the Tailored Design Method. SUBJECTS/SETTING: This study surveyed 258 randomly selected RDs from seven dietetic practice groups of the American Dietetic Association. STATISTICAL ANALYSES PERFORMED: Descriptive statistics, bivariate relationships, and multiple linear regression analyses were conducted to test whether perceptions, attitudes, and knowledge of evidence-based practice score and antecedent factors predicted the research score of dietitians. RESULTS: Perceptions, attitudes, and knowledge of evidence-based practice score (r = 0.59, P < 0.0005), level of education (r = 0.53, P < 0.0005), taking a research course (r = 0.40, P < 0.0005), last time read research (r = 0.35, P < 0.0005), frequency of professional reading (r = 0.32, P < 0.0005), primary area of practice (r = 0.14, P = 0.02), association memberships (r = 0.14, P = 0.02), and dietetic practice group affiliation (r = 0.14, P = 0.02) were significantly correlated with research score. Using multivariate linear regression, the perceptions, attitudes, and knowledge of evidence-based practice score (beta = 0.48, P < 0.0005) and level of education (beta = 0.39, P < 0.0005) were identified as the strongest predictors of research score. CONCLUSIONS: Involvement in research by RDs is largely determined by their perceptions, attitudes, and knowledge of evidence-based practice and their level of education. Additional education and training related to research methodology and design, and evidence-based practice, is essential for greater participation in research activities by RDs.

Evidence-based practice: what are dietitians' perceptions, attitudes, and knowledge?

OBJECTIVE: The objective of this study was to measure dietitians' perceptions, attitudes, and knowledge of evidence-based practice (PAK score), and to determine whether antecedent factors (eg, sociodemographic characteristics, education and training, professional experiences, and employment setting) predicted PAK score. DESIGN: This cross-sectional, descriptive study used the Dietitian Research Involvement Survey following the Tailored Design Method. SUBJECTS/SETTING: This study surveyed 500 randomly selected registered dietitians from seven dietetic practice groups of the American Dietetic Association. STATISTICAL ANALYSES PERFORMED: Bivariate relationships were examined between antecedent factors and PAK score. Multiple linear regression analyses were conducted to test whether these factors predicted PAK score. RESULTS: Higher PAK scores were associated with registered dietitians who completed more years of education (r=0.28, P<.0005), had taken a research course (r=0.28, P<.0005), frequently read research articles (r=0.41, P<.0005), earned an advanced-level board certification (r=0.18, P=.004), worked full-time (r=0.26, P<.0005), or belonged to professional organizations (r=0.18, P=.003). The strongest predictors for PAK score were "last time read research" (beta=.33, P<.0005), work status (beta=.20, P<.0005), level of education (beta=.19, P=.001), and association memberships (beta=.14, P=.01). CONCLUSIONS: Results indicated that dietitians' ability to incorporate an evidence-based approach is largely determined by their education and training, work experience, and professional association involvement. This study identified a need to integrate concepts and principles of evidence-based practice into dietetics curriculums so that practitioners are able to routinely apply research findings to clinical practice.

Dietary patterns associated with colon and rectal cancer: results from the Dietary Patterns and Cancer (DIETSCAN) Project.

BACKGROUND: An analysis of dietary patterns or combinations of foods may provide insight regarding the influence of diet on the risk of colon and rectal cancer. OBJECTIVE: A primary aim of the Dietary Patterns and Cancer (DIETSCAN) Project was to develop and apply a common methodologic approach to study dietary patterns and cancer in 4 European cohorts: the Alpha-Tocopherol Beta-Carotene Cancer Prevention Study (Finland-ATBC), the Netherlands Cohort Study (NLCS) on Diet and Cancer, the Swedish Mammography Cohort (SMC), and the Ormoni e Dieta nella Eziologia dei Tumori (Italy-ORDET). Three cohorts (ATBC, NLCS, and SMC) provided data on colon and rectal cancer for the present study. DESIGN: The cohorts were established between 1985 and 1992; follow-up data were obtained from national cancer registries. The participants completed validated semiquantitative food-frequency questionnaires at baseline. RESULTS: Exploratory factor analysis, conducted within each cohort, identified 3-5 stable dietary patterns. Two dietary patterns-Vegetables and Pork, Processed Meats, Potatoes (PPP)-were common across all cohorts. After adjustment for potential confounders, PPP was associated with an increased risk of colon cancer in the SMC women (quintile 4(multivariate) relative risk: 1.62; 95% CI: 1.12, 2.34; P for trend = 0.01). PPP was also associated with an increased risk of rectal cancer in the ATBC men (quintile 4(multivariate) relative risk: 2.21; 95% CI: 1.07, 4.57; P for trend = 0.05). Neither pattern was associated with the risk of colon or rectal cancer in the NLCS women and men. CONCLUSION: Although certain dietary patterns may be consistent across European countries, associations between these dietary patterns and the risk of colon and rectal cancer are not conclusive.

Measures of acculturation are associated with cardiovascular disease risk factors, dietary intakes, and physical activity in older Chinese Americans in New York City.

Cardiovascular disease (CVD) is the leading cause of death in the U.S. and affects Chinese Americans disproportionately compared to other ethnic groups in the American population. Studies of immigrant populations have shown that risk factors for CVD, including diet and physical activity, differ by acculturation. This cross-sectional study evaluated whether two measures of acculturation (region of birthplace, length of residence in the U.S.) were associated with CVD risk factors, dietary intakes, and physical activity of 125 older Chinese Americans who participated in health fairs conducted in NYC. In this study, mean waist circumference differed significantly by birthplace. Mean systolic and diastolic blood pressure differed significantly by length of residence in the U.S. Mean intake of vitamin B6, folate and calcium differed significantly by birthplace: Chinese Americans from Hong Kong had the highest mean vitamin B6 intake whereas older Chinese Americans from Northern China had the highest folate and calcium intakes. Mean intake of riboflavin differed significantly by length of residence in the U.S. with Chinese Americans adults who lived in the U.S. less than 10 years having the highest mean intake. Mean dairy intake of Chinese Americans differed significantly by birthplace, with adults from northern China having the highest mean dairy intake. Vigorous-intensity physical activity differed significantly by birthplace, with adults from Hong Kong reporting the most daily minutes of vigorous-intensity physical activity. This study suggests that acculturation may be associated with the cardiovascular health of older Chinese Americans living in NYC.

Calorie labeling, fast food purchasing and restaurant visits.

OBJECTIVE: Obesity is a pressing public health problem without proven population-wide solutions. Researchers sought to determine whether a city-mandated policy requiring calorie labeling at fast food restaurants was associated with consumer awareness of labels, calories purchased and fast food restaurant visits. DESIGN AND METHODS: Difference-in-differences design, with data collected from consumers outside fast food restaurants and via a random digit dial telephone survey, before (December 2009) and after (June 2010) labeling in Philadelphia (which implemented mandatory labeling) and Baltimore (matched comparison city). Measures included: self-reported use of calorie information, calories purchased determined via fast food receipts, and self-reported weekly fast-food visits. RESULTS: The consumer sample was predominantly Black (71%), and high school educated (62%). Postlabeling, 38% of Philadelphia consumers noticed the calorie labels for a 33% point (P < 0.001) increase relative to Baltimore. Calories purchased and number of fast food visits did not change in either city over time. CONCLUSIONS: While some consumers report noticing and using calorie information, no population level changes were noted in calories purchased or fast food visits. Other controlled studies are needed to examine the longer term impact of labeling as it becomes national law.

Nutrition practices and children's dietary intakes at 40 child-care centers in New York City.

Early childhood is a critical time to establish nutrition habits to prevent obesity. At least half of US children spend time in care outside of the home, where little is known about their dietary intakes and nutrition environment. The purpose of this study was to evaluate nutrition practices of group child-care centers in New York City and to assess whether dietary intakes of children at these centers meet nutrition recommendations. In 2005 and 2006, student research assistants administered surveys to directors of 40 child-care centers in three underserved communities (Central Brooklyn, East/Central Harlem, South Bronx) and in Manhattan, gathered menus, and observed beverages and foods consumed by 240 3- and 4-year-old children. Almost all centers provided beverages and foods recommended by national guidelines, including reduced-fat milk, 100% fruit juice, and whole grains. Some centers also provided higher-fat milk and sugar-sweetened beverages, but no centers provided soda. Drinking water was available in classrooms at only half of the centers. From observations at meal and snack times between 8 AM to 2 PM, <50% of children ate at least half of the daily recommended intake for each of five main food groups, with only 17% of children eating at least half of the daily recommended intake for vegetables and only 5% of children eating at least half of the daily recommended intake for vitamin E. Although many centers provided healthful beverages and foods to children, further efforts are needed to make water available as a beverage throughout the day and to improve dietary intakes, especially of vegetables and vitamin E-containing foods.

Neighborhoods and obesity in New York City.

Recent studies reveal disparities in neighborhood access to food and fitness facilities, particularly in US cities; but few studies assess the effects of multiple neighborhood factors on obesity. This study measured the multilevel relations between neighborhood food availability, opportunities and barriers for physical activity, income and racial composition with obesity (BMI> or =30 kg/m(2)) in New York City, controlling for individual-level factors. Obesity rates varied widely between neighborhoods, ranging from 6.8% to 31.7%. Obesity was significantly (p<0.01) associated with neighborhood-level factors, particularly the availability of supermarkets and food stores, fitness facilities, percent of commercial land use and area income. These findings are consistent with the growing literature showing that area income and availability of food and physical activity resources are related to obesity.