Dieting Habits of Men.

There is little research involving the US male population regarding weight control and behavior that may affect weight status. Gender-specific weight-control programs for men aren't the standard. Our study objectives were to survey dieting and health habits of an adult male employee population and to determine if the population would be interested in gender-specific programming. Demographics, weight-control practices and interest in gender-specific weight-control programs were examined cross sectionally. A 50-question web-based survey was posted via email from October 2-30, 2014 to male employees at a Mid-Atlantic university. Statistical analyses included frequencies, means and percentages. Chi square and t tests were conducted. The 254 participants were ages 18-65+ years, predominantly white, college educated with annual incomes above $50,000. Sources of nutrition knowledge ranged from a high of web sites (65 %) to a low of registered dietitians (9 %). Macronutrient restrictions reported for dieting were carbohydrates 77 %, fats 40 % and protein 19 %. The >30 age group was more likely to have: decreased amount of food intake P = .001), reducing overall calories (P = .047), skipping meals (P = .006) or trying commercial programs (P = .011). There was nothing of significance for those <30. Among all respondents, interest in gender-specific programs was compared with these variables: current weight satisfaction (P = .032), education (P = .008), income (P = . 006) and BMI (P = .004). Men who were dissatisfied with their weight were most likely to be interested in a gender-specific weight control program, especially those over age 30 years. Further research should address whether offering male-specific diet programs would offer incentive and motivation for males to lose and maintain weight loss.

Complementary and alternative medicine use and nutrient intake among individuals with multiple sclerosis in the United States.

Individuals with multiple sclerosis (MS) often use complementary and alternative medicine (CAM). However, specific CAM therapies used within this population have not been thoroughly described, particularly the use of supplements, herbal remedies, and dietary modifications. The aim of this pilot study was to determine the prevalence of specific types of CAM used by adults with MS in the United States. Participants included adults who were diagnosed with MS at least 1 year prior to study enrollment. CAM use was measured using the CAM Supplement of the National Health Interview Survey, and nutrient intake was assessed using an Automated Self-Administered 24-h Recall. This study found that a majority (77 %, n = 27) of the sample used CAM within the past 12 months, the most prevalent type being vitamins/minerals (88.9 %, n = 24), nonvitamin, nonmineral, natural products (NP) (44.4 %, n = 12), relaxation techniques (33.3 %, n = 9), and special diets (29.6 %, n = 8). Regarding diet, median percent calories from fat (37 %) and saturated fat (12 %) were higher than current recommendations, while dietary fiber intake met only 87 % of the adequate intake. Participants following the Paleo (7.4 %, n = 2) diet did not meet the Estimated Average Requirement (EAR) for vitamins D and E, while those on the Swank diet (7.4 %, n = 2) were below the EAR for vitamins C, A, E, and folate. The results support previous findings that CAM therapies are commonly used by individuals with MS. Inadequate intakes of certain vitamins and minerals by those following the Swank and Paleo diet suggest these diets may be too restrictive, thus further research is warranted.

Sodium intake of special populations in the Healthy Aging in Neighborhoods of Diversity Across the Life Span (HANDLS) study.

OBJECTIVE: The sodium intake of participants of the Healthy Aging in Neighborhoods of Diversity across the Life Span study who were in three of the special population groups identified by the Dietary Guidelines for Americans, 2010 (those with hypertension, African Americans, and those ≥51years) was analyzed to determine if they met sodium recommendations. METHODS: The sample included 2152 African American and White subjects, aged 30-64years. Major dietary sources of sodium for each group were determined from two 24-hour dietary recalls, and dietary intakes were compared with sodium recommendations. Dietary potassium was also evaluated. RESULTS: The intakes of the groups studied exceeded 1500mg of sodium while their potassium intakes were lower than the Adequate Intake of 4700mg. The major contributors of sodium included "cold cuts, sausage, and franks," "protein foods," and yeast breads. CONCLUSIONS: Excessive sodium intake characterized the diet of an urban, socioeconomically diverse population who are hypertensive or at risk for having hypertension. These findings have implications for health professionals and the food industry.

Sodium recommendations for special populations and the resulting implications.

Based on the most recent Dietary Guidelines for Americans, sodium recommendations are set at 2,300 mg for the general population and 1,500 mg for special populations. However, sodium intake among adults has been shown to be much higher than this; on average 3,436 mg. The Centers for Disease Control and Prevention notes that special populations (those with hypertension, African Americans, and those 40 years of age and older) make up 70% of adults in the United States. Excess sodium in the diet has been shown to contribute to problems such as blood pressure abnormalities, kidney function problems, and congestive heart failure, which account for a large sum of health care costs in the United States. The purpose of this review and accompanying three case studies was to explore if adherence to the sodium recommendations for special populations is feasible. Current literature shows that while a food industry-wide sodium reduction would help reduce overall sodium intake, adherence to low-sodium diets is difficult for the majority of individuals. Three case studies were completed which looked at subjects with a sodium recommendation of 1,500 mg. None of the participants met the recommendation, were aware of their daily sodium intake or knew how much they should be consuming. The snapshot provided by these case studies suggests further research is warranted. Because of the current state of sodium in the American diet, a combination of personal interventions coupled with widespread industry sodium reduction would be the most beneficial way to reduce dietary sodium for most individuals.

Nutrition assessment of horse-racing athletes.

Athletes involved in horse racing face weight restrictions like wrestlers and dancers; however, the literature is sparse pertaining to nutritional habits of jockeys. The practice of "making weight" causes these athletes to engage in potentially unhealthy practices. A gap in nutritionally sound practices and methods used by jockeys was identified and a desire for nutrition education was expressed to Cooperative Extension of Delaware by representatives of the riders at Delaware Park Race Track. Nutrition assessment was done using the Nutrition Care Process. Twenty jockeys were interviewed using an assessment form developed to target areas of disordered eating. Body mass index (BMI), mean weight loss on race day, methods of weight loss and ease of weight maintenance were examined. The jockeys were also asked for areas they wished to receive nutrition education on in the future. The BMI of the 20 jockeys ranged from 17.0 to 21.4 during racing season, with only one jockey in the "underweight" category. This range increased to 19.1-24.0 when the riders were not riding. The most common method of weight loss was the use of steam rooms, to lose an average 2.5 lb in 1 day. Eight of 20, the most common response, reported it very easy to maintain their racing weight. The jockeys reported interest in future education sessions on meal planning and healthy food ideas. The assessment was used as the basis to develop nutrition education materials and presentations for the riders at the race track.

Following a calorie-restricted diet may help in reducing healthcare students' fat-phobia.

Data from National Health and Nutrition Examination Survey 2005/2006 show that 32.7% of US adults are overweight (BMI 25.0-29.9), 34.3% are obese (BMI 30-39.9), and 5.9% are extremely obese (BMI >or= 40). For the first time, the number of obese American adults is greater than those who are merely overweight. Negative attitudes and fat phobia toward the overweight exist not only in the general population, but also among health professionals including dietitians and dietetics students. The purpose of this study was to determine if fat phobia might be reduced among future professionals by putting students on a calorie-restricted diet for a short period. Forty dietetics and health promotion students enrolled in a university obesity course completed the Fat Phobia Scale test before and after following a calorie restricted diet for 1 week (1,200 calories and 1,500 calories for women and men, respectively). Students also reflected their thoughts about following such a diet via brief journal entries. Results showed the change in fat phobias after following a calorie-restricted diet was significant. Many journal entries reflected a newfound respect for individuals struggling to lose weight and change in prior negative attitudes. Students reported that this experience would impact their future dealings with overweight/obese clients. It may be useful to incorporate this type of activity into the training of nutrition and other health professional students to increase sensitivity and reduce existing biases and negative attitudes toward overweight/obese clients.

Effect of race and predictors of socioeconomic status on diet quality in the HANDLS Study sample.

PURPOSE: To examine effects of race and predictors of socioeconomic status (SES) on nutrient-based diet quality and their contribution to health disparities in an urban population of low SES. DESIGN: Data were analyzed from a sample of the Healthy Aging in Neighborhoods of Diversity Across the Life Span (HANDLS) Study participants examining effects of age, sex, race, income, poverty income ratio, education, employment, and smoking status on nutrient-based diet quality as measured by a micronutrient composite index of nutrient adequacy ratios and a mean adequacy ratio. Regression models were used to examine associations and t tests were used to look at racial differences. SUBJECTS: African American and white adults ages 30 to 64 years residing in 12 predefined census tracts in Baltimore, Maryland. RESULTS: Sex, age, education, poverty income ratio, and income were statistically significant predictors of diet quality for African Americans, while sex, education, and smoking status were statistically significant for whites. African Americans had lower mean adequacy ratio scores than whites (76.4 vs. 79.1). Whites had significantly higher nutrient adequacy ratios scores for thiamin, riboflavin, folate, B12, vitamins A and E, magnesium, copper, zinc, and calcium, while African Americans had higher vitamin C scores. CONCLUSION: Education significantly impacted diet quality in the HANDLS sample, but race cannot be discounted. Whether the racial differences in diet quality are indicative of cultural differences in food preferences, selection, preparation, and availability, or disparities in socioeconomic status remains unclear.

The Relationship of Diet Quality with Proportion of Daily Energy Contributed by Sandwiches Varies by Age over Adulthood in Racially and Socioeconomically Diverse Adults.

Sandwiches are considered a staple in diets of United States adults. Previous research with Healthy Aging in Neighborhoods of Diversity across the Life Span study participants revealed that 16% consume a sandwich dietary pattern providing with 44% of their daily energy. Yet, little is known about the effect of sandwiches on diet quality over time. The study objectives were to determine the relationship of energy contributed by sandwiches to diet quality in this socioeconomically and racially diverse sample categorized by age (<50 years and ≥50 years at baseline) and to describe patterns of sandwich consumption over ~12 years. The analyses included a series of linear mixed-effects regression models, with age as the time variable centered at 50 years. In each model, the main outcome was Healthy Eating Index-2010 score with up to three scores, while the main predictor was % total energy from sandwiches (0, >0-20%, >20%) measured concurrently at each visit. Diet quality of older men with income <125% poverty improved over time for those consuming >0-20% and >20% energy from sandwiches compared to young women with incomes >125% poverty who were non-reporters of sandwiches (ß ± SE: 10.93 ± 5.27, p = 0.01; 13.11 ± 4.96, p = 0.01, respectively). The three most common sandwich types reported, in descending order, were cold cuts, beef, and poultry.

Aspects of Dietary Diversity Changes across Adulthood in Racially Diverse Adults.

Knowledge of various aspects of dietary diversity (DD)-an essential healthful dietary component-across adulthood is limited. This study examined three DD aspects over time in racially diverse adults. Participants were from the National Institute on Aging, Healthy Aging in Neighborhoods of Diversity across the Life Span study. DD measures were calculated at baseline (N = 2177), and first and second examination follow-ups (N = 2140 and N = 2066, respectively) using two 24-h recalls. The count was based on the consumption of ≥50% of an equivalent from 21 food groups. Evenness was derived using the Berry-Index adjusted by the food's health value; dissimilarity, by Mahalanobis Distance. Mixed-effects linear regression models were conducted to test changes in DD across adulthood, adjusting for sex, race, poverty status and education as fixed effects, and adjusting for smoking, age and energy as time-dependent variables. Only dissimilarity showed significant interactions of time × race (p = 0.0005), and time × poverty status (p = 0.0325), indicating a slower rate of increase over time in dissimilarity scores among Whites compared with African-Americans and those with income >125% poverty versus <125% poverty. A significant interaction between time×energy (p < 0.0001) was noted for both evenness and dissimilarity scores. To our knowledge, this is the first study to document the differential change in dissimilarity scores by race and income over time.

Food Label Knowledge, Usage and Attitudes of Older Adults.

Few recent studies have investigated food label practices in older adults. This cross-sectional study surveyed adults, 60 years and older in Delaware (n = 100, 82% female, 74% between 60 and 79 years, 49% Caucasian, 45% African Americans) to examine associations between food label knowledge, attitudes, and usage patterns. A 28-item questionnaire assessed knowledge, attitudes, usage, and demographic information. Bivariate analysis results showed food label knowledge was associated with education and monthly income. Those reporting a high school education or less incorrectly identified calorie (P < 0.05) and carbohydrate information (P < 0.03). Monthly income ≤$2000 was associated with incorrectly interpreting carbohydrate information (P < 0.03). Label usage was associated with being female (P < 0.001), having a high school education or less (P < 0.000), being 70 years or older (P < 0.05), and having a monthly income ≤$2000 (P < 0.001). Respondent's usage and perceived label comprehension was high; however less than half could correctly interpret label information. When shown samples of the US Food and Drug Administration's proposed new labels, subjects had a very favorable attitude toward the new changes. Increasing nutrition knowledge through education interventions appropriate for older adult consumers may improve comprehension of information on the food labels.

Snacking and Diet Quality Are Associated With the Coping Strategies Used By a Socioeconomically Diverse Urban Cohort of African-American and White Adults.

BACKGROUND: Stress affects health-related quality of life through several pathways, including physiological processes and health behaviors. There is always a relationship between stress (the stimulus) and coping (the response). The relationship between snacking and snackers' diet quality and stress coping is a topic overlooked in research. OBJECTIVE: The study was primarily designed to determine whether energy provided by snacks and diet quality were associated with coping behaviors to manage stress. DESIGN: We analyzed a baseline cohort of the Healthy Aging in Neighborhoods of Diversity across the Life Span study (2004 to 2009). PARTICIPANTS: The sample was composed of 2,177 socioeconomically diverse African-American and white adults who resided in Baltimore, MD. MAIN OUTCOME MEASURES: Energy from snacks was calculated from 2 days of 24-hour dietary recalls collected using the US Department of Agriculture's Automated Multiple Pass Method. Snack occasions were self-reported as distinct eating occasions. Diet quality was evaluated by the Healthy Eating Index-2010. STATISTICAL ANALYSES PERFORMED: Multiple regression analyses were used to determine whether coping factors were associated with either energy provided by snacks or Healthy Eating Index-2010, adjusting for age, sex, race, socioeconomic status, education, literacy, and perceived stress. Coping was measured by the Brief COPE Inventory with instrument variables categorized into three factors: problem-focused coping, emotion-focused coping, and use of support. Perceived stress was measured with the 4-item Perceived Stress Scale. RESULTS: Adjusting for perceived stress and selected demographic characteristics, emotion-focused coping strategies were associated with greater energy intakes from snacks (P=0.020), and use of coping strategies involving support was positively associated with better diet quality (P=0.009). CONCLUSIONS: Energy contributed by snacks and diet quality were affected by the strategy that an individual used to cope with stress. The findings suggest that health professionals working with individuals seeking guidance to modify their eating practices should assess a person's coping strategies to manage stress.

Complementary and alternative medicine education in dietetics programs: existent but not consistent.

This descriptive survey was undertaken to determine the inclusion of complementary and alternative medicine topics into undergraduate didactic dietetics education. The response rate was 34% (n=92) of all directors (N=273) of didactic and coordinated dietetics programs. Almost all programs (n=81; 88%) include complementary and alternative medicine instruction in some form in their curricula; the majority of content is integrated into already existing nutrition courses. The nutrition courses most often containing complementary and alternative medicine were medical nutrition therapy, advance nutrition, and community nutrition. Topics addressed were varied and included herbal supplements, functional foods, Native-American healing, and quackery in medicine. Most directors indicated that complementary and alternative medicine is an important component of dietetics education, yet many indicated that students are not being adequately prepared in this area. The mean familiarity of program directors with complementary and alternative medicine competencies for dietetics practice was 6 on a scale, with 10 being the most knowledgeable. Respondents also identified whether complementary and alternative medicine and dietary supplement competencies were being addressed at all in their curricula. Lack of time seemed to be the limiting factor to incorporation of complementary and alternative medicine topics into the curricula. Evidence from this study indicates that current curricula are providing some complementary and alternative medicine content, but a core of knowledge is lacking. The complementary and alternative medicine competencies for entry-level dietetics practice anticipated by 2006 will be useful in helping educators adequately meet the needs of future professionals in the area of complementary and alternative medicine.

Health Literacy and Education Predict Nutrient Quality of Diet of Socioeconomically Diverse, Urban Adults.

BACKGROUND: Research has shown that health literacy may be a stronger predictor of health than age, employment status, education level, race, and income. Evidence supports a strong link between low health literacy and poor dietary management of chronic diseases. OBJECTIVE: The aim was to evaluate the relationship of micronutrient quality of diet, health numeracy and health literacy in White and African American adults randomly selected from 13 Baltimore neighborhoods. DESIGN: Cross-sectional analysis of Wave 3 (2009-2013) of the longitudinal Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study initiated in 2004. MAIN OUTCOME MEASURES: Health literacy was measured using the Rapid Estimate of Adult Literacy in Medicine (REALM). Health numeracy was measured using the numeracy subscale of the Test of Functional Health Literacy in Adults (TOFHLA). Nutrient-based diet quality was measured using Mean Adequacy Ratio (MAR-S) scores calculated from 17 micronutrients from diet plus dietary supplement intake. STATISTICAL ANALYSES: The relationship of MAR-S scores to the health literacy measures were explored with multiple ordinary least square regression models, adjusting for a number of potential confounders. RESULTS: REALM but not numeracy was associated with MAR-S; significant covariates included age, current cigarette smoking status, and energy intake. The interactions of race and educational attainment, and REALM and educational attainment were significant, with the relationship between REALM and MAR-S becoming stronger as education level increased. CONCLUSION: There is a synergistic relationship between health literacy and educational attainment in predicting nutrient-based diet quality. Education was a stronger predictor for Whites compared to African Americans emphasizing the need for health professionals to focus on both education and literacy when creating and providing diet and health-related interventions and resources.

Incorporating human genetics into dietetics curricula remains a challenge.

This descriptive survey was undertaken to assess integration of genetics into undergraduate didactic dietetic education. The response rate was 35% (n=82) of all directors (N=232) of accredited or approved Didactic Programs in Dietetics. Although most directors (n=58 of 82) agreed that genetics is an important component of dietetics education, they expressed concerns about already-crowded curricula and lack of time, resources, and knowledge. Thirty-eight directors indicated that they had no familiarity with the core competencies in genetics for all health professionals. Genetics is included in some way in 69 of the 82 programs that responded. Courses in which genetics was most likely to be incorporated included nutrition, physiology, microbiology, and biochemistry. Only four directors reported a required course entirely devoted to genetics. Programs were most likely to meet the knowledge competency of the role of genetic factors in maintaining health and preventing disease and least likely to address the genetic counseling process and indications for referral to specialists. Applications of genetics in dietetics will continue to grow in importance. Evidence from this study indicates that current curricula provide little to no genetics content. Nutrition faculty must become more knowledgeable about genetics before being expected to increase genetics content in entry-level dietetics curricula.

Health professionals hold positive attitudes toward biotechnology and genetically engineered foods.

Few biotechnology processes have elicited the degree of controversy that genetic manipulation of food through recombinant DNA technology has. Research has shown that consumers turn to health professionals for answers to questions regarding health and nutrition. This study sought to assess the knowledge, attitudes, and beliefs of physicians (MDs/DOs), nurse practitioners (NPs), and registered dietitians (RDs) toward food biotechnology and genetic engineering (GE). Six hundred three-part, self-administered surveys were sent to health professionals holding active professional licenses. Statistical analysis included analysis of variance with Tukey's HSD and Scheffe's post hoc tests. Attitudes toward GE were positive. MDs held more positive attitudes than NPs or RDs (p = .000). MDs and NPs supported the use of GE to improve plant resistance to pests; RDs tended to support nutritional-improvement technology. All groups supported the use of GE to produce human medicines and the current Food and Drug Administration (FDA) labeling policy. No profession was more knowledgeable than another. Biotechnology holds the potential to positively affect human health. All health professionals can facilitate or diminish this process through their understanding of the technology and their ability to communicate effectively about the science and issues associated with biotechnology.

Depression and Cognitive Impairment Are Associated with Low Education and Literacy Status and Smoking but Not Caffeine Consumption in Urban African Americans and White Adults.

Background: Recent research has linked caffeine consumption with a lower risk for depression and cognitive decline. However, no studies have examined the relationship in an African American compared to a white, socioeconomically diverse representative urban sample. Methods: Data from a cross-sectional study were used to determine the associations of caffeine use with depressive symptomatology and cognition in a sample of 1,724 participants in the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study. The United States Department of Agriculture's Automated Multiple Pass Method was used by trained interviewers to collect two, in-person 24-hour dietary recalls. Depressive symptoms and global cognition were assessed using two well-validated measures: the Center for Epidemiologic Studies Depressive Scale (CES-D) and Mini Mental State Examination (MMSE), respectively. Usual caffeine intake was based on both recalls. Data were analyzed with t- and chi-square tests, correlation analysis, and ordinal logistic regression. Results: African Americans consumed significantly less caffeine than did whites (89.0±3.2 and 244.0±8.7 mg respectively). Caffeine consumption was not associated with depressive symptomatology or global cognition. Age, less than 5th grade literacy, and less than high school education were significantly associated with both depressive symptoms and cognitive function. Smokers had a 43% greater risk for depression but only a 3% higher risk for cognitive impairment. Conclusion: The low level of dietary caffeine intake in combination with smoking among HANDLS study participants may have influenced the lack of association with depressive symptomatology or global cognition. For this sample, low literacy and education appear more highly associated with depressive symptoms and cognitive function than caffeine intake.

Health literacy education and training: a student-professional collaboration.

A Healthy People 2010 objective is to improve the health literacy of persons with inadequate or marginal literacy skills. We designed a nutrition education module for dietetics students that allowed learning about health literacy while teaching this information to interested practitioners. Students designed a workshop for nutritionists by conducting a learning needs assessment and then developing learning objectives, content/methods, and process/outcome objectives. Students presented interactive sessions on using literacy assessment tools and developing low-literacy education materials. Handout packets included a list of relevant literacy Web sites. Evaluations unanimously rated the workshop as excellent or good. By helping teach others, students' learning experience was enhanced.

Use of a web site to increase knowledge and awareness of hunger-related issues.

The purpose of this study was to determine the current level of knowledge and awareness of hunger-related issues among a convenience sample of Delawareans. We also assessed whether raising knowledge and awareness of the hunger problem through the FBD's newly designed web site would encourage participation in antihunger activities. Via e-mail, 1,719 individuals were invited to participate in a three-phase, online survey, and 392 agreed. Phase-I questions were answered prior to viewing the web site, phase II (n=217) immediately afterward, and phase III (n=61) six weeks later. Responses indicated a high level of awareness about general hunger issues but specific knowledge proved to be at a lower level. No statistically significant differences were noted when data were collapsed across gender, age, educational level, or work setting. In a six-week post-survey, 41% of subjects were motivated by the web site to engage in an antihunger activity; 34% had told others about the web site and indicated it may be a useful tool in antihunger outreach efforts for the FBD.

The Kids Café: a program to reduce child hunger.

Hunger and food insecurity affect nearly 12 million children in the United States. Poverty is the foremost reason for hunger and food insecurity, but even the working poor sometimes have difficulty providing enough food for their household. Undernourished children may not present with severe clinical symptoms, but their ability to learn and psychosocial behavior can be affected. Feeding programs such as Kids Café can help decrease child hunger while improving learning and overall health. Kids Café's are operated by local food banks and sponsored by America's Second Harvest in partnership with ConAgra Foods, Inc. This article reviews the problem of child hunger and describes the Kids Café Program.

Should you recommend a low-carb, high-protein diet?

Despite the billions of dollars spent each year on weight-loss diets and products, few individuals maintain their weight loss after initiating popular diet programs. One diet that has raised safety concerns among the scientific community is the low-carbohydrate, high-protein diet. This article evaluates the scientific validity of this diet so that clinicians can appropriately advise patients.