Comparing Self-Reported Dietary Intake to Provided Diet during a Randomized Controlled Feeding Intervention: A Pilot Study.

Systematic and random errors based on self-reported diet may bias estimates of dietary intake. The objective of this pilot study was to describe errors in self-reported dietary intake by comparing 24 h dietary recalls to provided menu items in a controlled feeding study. This feeding study was a parallel randomized block design consisting of a standard diet (STD; 15% protein, 50% carbohydrate, 35% fat) followed by either a high-fat (HF; 15% protein, 25% carbohydrate, 60% fat) or a high-carbohydrate (HC; 15% protein, 75% carbohydrate, 10% fat) diet. During the intervention, participants reported dietary intake in 24 h recalls. Participants included 12 males (seven HC, five HF) and 12 females (six HC, six HF). The Nutrition Data System for Research was utilized to quantify energy, macronutrients, and serving size of food groups. Statistical analyses assessed differences in 24 h dietary recalls vs. provided menu items, considering intervention type (STD vs. HF vs. HC) (Student's t-test). Caloric intake was consistent between self-reported intake and provided meals. Participants in the HF diet underreported energy-adjusted dietary fat and participants in the HC diet underreported energy-adjusted dietary carbohydrates. Energy-adjusted protein intake was overreported in each dietary intervention, specifically overreporting beef and poultry. Classifying misreported dietary components can lead to strategies to mitigate self-report errors for accurate dietary assessment.

Exploring fuel cell cathode materials using ab initio high throughput calculations and validation using carbon supported Pt alloy catalysts.

We employ a combined density functional theory (DFT) and experimental approach to screen different elements (M) and Pt3M alloys (M = Sc, Y, V, Nb, Ta, Ti, Zr, Hf, Cr, Fe, Ru, Os, Co, Rh, Ir, Ni, Pd, Cu, Ag, Au and Al) for oxygen reduction reaction (ORR) activity and stability. The results of the calculations are validated using a series of carbon supported alloy nanoparticles measured within membrane electrode assembly (MEA) environments. We assess the reliability of descriptors such as surface d-band centre and O adsorption energy as computed from DFT calculations. We also assess the stability of the alloy surfaces under different adsorbate environments as encountered under ORR conditions. Our calculations predict that under an oxygen atmosphere segregation of M to the surface is likely to occur. The calculated segregation energies correlate reasonably well with the amount of base metal leached in the carbon-supported catalysts and good correlation of computed O adsorption energies with ORR activity is also shown.

The Impact of a 4-Week Low-FODMAP and mNICE Diet on Nutrient Intake in a Sample of US Adults with Irritable Bowel Syndrome with Diarrhea.

BACKGROUND: A diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) has gained increasing acceptance for the treatment of irritable bowel syndrome but safety concerns have been raised regarding nutritional adequacy. Changes in nutrient intake during the elimination phase of the low-FODMAP diet remain predominantly unknown. OBJECTIVE: To determine changes in the mean reported daily nutrient content before and after 4 weeks of a low-FODMAP diet vs modified National Institute for Health and Clinical Excellence (mNICE) dietary intervention and to identify nutritional inadequacies based on comparison to the Dietary Reference Intakes in patients with irritable bowel syndrome-diarrhea subtype. DESIGN: Post hoc analysis of a randomized controlled trial entailing a 4-week trial period comparing the low-FODMAP and mNICE diets. PARTICIPANTS AND SETTING: A total of 78 patients (41 low FODMAP and 37 mNICE) meeting the Rome III criteria for irritable bowel syndrome-diarrhea subtype were consecutively recruited from gastroenterology and primary care clinics at the University of Michigan Medical Center between October 2012 and November 2015. METHODS: Participants randomized to the low-FODMAP arm were instructed to decrease their dietary intake of FODMAPs, whereas participants randomized to the mNICE intervention arm were instructed to eat small frequent meals, avoid trigger foods, and avoid excess alcohol and caffeine. MAIN OUTCOME MEASURES: Post hoc evaluation for presence of micronutrient deficiencies per Dietary Reference Intakes when implementing low-FODMAP vs mNICE dietary interventions. Dietary intake was analyzed via 3-day food diaries at baseline and during the final week of the assigned diet. STATISTICAL ANALYSES PERFORMED: A post hoc analysis utilizing either a t test or χ2 analysis was conducted between before and after data. RESULTS: Both diets resulted in fewer daily kilocalories consumed, fewer number of daily meals consumed, and less daily carbohydrate intake. Among the patients following the low-FODMAP diet, there was a statistically significant decrease from baseline in several micronutrients, which was not observed in the mNICE cohort. However, these differences in the low-FODMAP group remained significant only for riboflavin after correcting for calorie-adjusted nutrient intake. Comparing Dietary Reference Intakes of participants pre- and postintervention, fewer patients met the Dietary Reference Intakes for thiamin and iron in the low FODMAP group, and for calcium and copper in the mNICE group. CONCLUSIONS: During a 4-week dietary intervention, the mean daily intake of most micronutrients remained stable and within the Recommended Dietary Allowances for both diets. Although decrease in several micronutrients was observed with implementation of the low-FODMAP diet relative to the mNICE diet, most of these disappeared after adjusting for energy intake.

Deconstructing the Family Meal: Are Characteristics of the Mealtime Environment Associated with the Healthfulness of Meals Served?

BACKGROUND: Multiple studies and guidelines emphasize the benefits associated with family meals. However, family meals are not well defined and little research has been conducted to determine whether mealtime characteristics are associated with the healthfulness of foods served. OBJECTIVE: The objective of this study was to define and measure specific mealtime characteristics and examine whether these characteristics are associated with the healthfulness of meals served to young children from low-income families, as measured by the Healthy Meal Index (HMI). PARTICIPANTS/SETTING: Study participants included 272 young children from low-income families residing in southeast Michigan during 2011 to 2013. DESIGN: For this cross-sectional study, parents videorecorded 757 mealtimes that were coded for four mealtime variables and meal healthfulness using the HMI. Mealtime characteristics included Eating at a Table (vs not), Served Family-Style (vs not), TV Off (vs not), and Parent Partakes (sits and eats or drinks with child) (vs not). A Family Meal was defined as a meal that had all four measured mealtime characteristics. MAIN OUTCOME MEASURES: All meals were scored using the HMI, which has two components: the HMI Adequacy score (based on the presence of foods that are recommended for a healthy diet) and the HMI Moderation score (based on the absence of foods recommended to be consumed in moderation). The scores are summed to obtain the HMI Total score. STATISTICAL ANALYSES PERFORMED: Generalized estimating equations tested the associations of mealtime characteristics with HMI scores, controlling for child sex and age, and parent education and race/ethnicity. RESULTS: In adjusted models, Family Meals were positively associated with HMI Adequacy (P=0.02) and Total (P=0.05) scores. Eating at a Table was positively associated with HMI Moderation (P=0.01) and HMI Total (P=0.01) scores. Served Family-Style was positively associated with HMI Adequacy scores (P=0.04). TV Off was associated with higher HMI Total scores (P=0.05). Parent Partakes was not associated with HMI scores. CONCLUSIONS: Family Meals were associated with greater healthfulness of the foods served. Characteristics of mealtime that are commonly utilized to define Family Meal were differentially associated with meal healthfulness.

Association of Picky Eating With Weight Status and Dietary Quality Among Low-Income Preschoolers.

BACKGROUND: Picky eating is common in children. Few studies have examined predictors of picky eating, and the association of picky eating with weight status and dietary quality is inconsistent in the literature. We aimed to identify predictors of picky eating and to test the association of picky eating with child body mass index z-score (BMIz), dietary quality, and micronutrient intake. METHODS: This was a cross-sectional analysis of baseline data from a randomized controlled trial to prevent obesity among 506 preschoolers attending Head Start. Parents completed questionnaires to assess picky eating and child temperament. Three 24-hour dietary recalls were collected to assess dietary intake. Multivariate regression models assessed child, parent, and family predictors of picky eating; additional models tested adjusted associations of picky eating with child BMIz, dietary quality (measured using the Healthy Eating Index-2010), and micronutrient intake. RESULTS: Picky eating was predicted by male sex, older child age, and more difficult temperament but not race/ethnicity, maternal body mass index, maternal depressive symptoms, household food insecurity, or single parent home. Picky eating was not associated with child BMIz or micronutrient deficiencies; it was inversely associated with total Healthy Eating Index-2010 score and servings of whole fruit, total vegetables, greens and beans, and total protein foods. CONCLUSIONS: Pediatric providers should support parents in expanding the number of healthy foods the child eats to improve dietary quality, but reassure parents that picky eating is not associated with children's weight status or micronutrient deficiencies.

Effect of cation structure on the oxygen solubility and diffusivity in a range of bis{(trifluoromethyl)sulfonyl}imide anion based ionic liquids for lithium-air battery electrolytes.

This paper reports on the solubility and diffusivity of dissolved oxygen in a series of ionic liquids (ILs) based on the bis{(trifluoromethyl)sulfonyl}imide anion with a range of related alkyl and ether functionalised cyclic alkylammonium cations. Cyclic voltammetry has been used to observe the reduction of oxygen in ILs at a microdisk electrode and chronoamperometric measurements have then been applied to simultaneously determine both the concentration and the diffusion coefficient of oxygen in different ILs. The viscosity of the ILs and the calculated molar volume and free volume are also reported. It is found that, within this class of ILs, the oxygen diffusivity generally increases with decreasing viscosity of the neat IL. An inverse relationship between oxygen solubility and IL free volume is reported for the two IL families implying that oxygen is not simply occupying the available empty space. In addition, it is reported that the introduction of an ether-group into the IL cation structure promotes the diffusivity of dissolved oxygen but reduces the solubility of the gas.

Physical activity-related and weather-related practices of child care centers from 2 states.

BACKGROUND: Young children's physical activity (PA) is influenced by their child care environment. This study assessed PA practices in centers from Massachusetts (MA) and Rhode Island (RI), compared them to best practice recommendations, and assessed differences between states and center profit status. We also assessed weather-related practices. METHODS: Sixty percent of MA and 54% of RI directors returned a survey, for a total of 254. Recommendations were 1) daily outdoor play, 2) providing outdoor play area, 3) limiting fixed play structures, 4) variety of portable play equipment, and 5) providing indoor play area. We fit multivariable linear regression models to examine adjusted associations between state, profit status, PA, and weather-related practices. RESULTS: MA did not differ from RI in meeting PA recommendations (ß = 0.03; 0.15, 0.21; P = .72), but MA centers scored higher on weather-related practices (ß = 0.47; 0.16, 0.79; P = .004). For-profit centers had lower PA scores compared with nonprofits (ß = -0.20; 95% CI: -0.38, -0.02; P = .03), but they did not differ for weather (ß = 0.12; -0.19, 0.44; P = .44). CONCLUSIONS: More MA centers allowed children outside in light rain or snow. For-profit centers had more equipment­both fixed and portable. Results from this study may help inform interventions to increase PA in children.

Assessing foods offered to children at child-care centers using the Healthy Eating Index-2005.

The Healthy Eating Index-2005 (HEI-2005) has been applied primarily to assess the quality of individual-level diets but has recently been applied to environmental-level data as well. Currently, no studies have applied the HEI-2005 to foods offered in child-care settings. This cross-sectional study used the HEI-2005 to assess the quality of foods and beverages offered to preschool children (3 to 5 years old) in child-care centers. Two days of dietary observations were conducted and 120 children (six children per center) were observed at 20 child-care centers in North Carolina between July 2005 and January 2006. Data were analyzed between July 2011 and January 2012 using t tests. Mean total HEI-2005 score (59.12) was significantly (P<0.01) lower than the optimal score of 100, indicating the need to improve the quality of foods offered to children. All centers met the maximum score for milk. A majority also met the maximum scores for total fruit (17 of 20 centers), whole fruit (15 of 20 centers), and sodium (19 of 20 centers). Mean scores for total vegetable (mean=2.26±1.09), dark green/orange vegetables and legumes (mean=0.20±0.43), total grain (mean=1.09±1.25), whole grain (mean=1.29±1.65), oils (mean=0.44±0.25), and meat/beans (mean=0.44±0.25) were significantly lower than the maximum scores recommended (P<0.01). Mean scores for saturated fat (mean=3.32±3.41; P<0.01) and calories from solid fats and added sugars (mean=14.76±4.08; P<0.01) suggest the need to decrease the provision of foods high in these components. These findings indicate the need to improve the quality of foods offered to children at the centers to ensure that the foods provided contribute to children's daily nutrition requirements.

Nutrition practices and mealtime environments of North Carolina child care centers.

BACKGROUND: The majority of children in the United States attend out-of-home child care. However, little is known about the nutritional quality of foods served and the mealtime environments. METHODS: We assessed 96 child care centers over one full day using a researcher-administered structured observation and document review. We focused on eight nutrition domains: (1) fruits and vegetables, (2) whole grains, (3) high-sugar, high-salt, and high-fat foods, (4) beverages, (5) food availability and service, (6) staff behaviors, (7) training and education, and (8) policies. We computed daily means and frequencies for each domain. RESULTS: Seventy-five percent of centers participated in the Child and Adult Care Food Program, indicating they served low-income children. Centers enrolled 66 children on average; 60% were white, 28% were black, 4% were Native American, and 8% identified as mixed race. On the day of observation, seven centers did not serve a fruit and 15 did not serve a vegetable. Eighty centers served a high-sugar or high-salt food and 84 did not serve any whole grains. Five centers did not provide water indoors to children, 22 served juice twice, and 50 served whole milk. Seventeen centers had a vending machine on site visible to parents and children. Overall, children were served excessive juice, high-sugar and high-salt snack foods, and too much whole milk. CONCLUSIONS: Centers had room for improvement and could strive to serve more nutritious foods and create healthier mealtime environments for children.

Comparison of menus to actual foods and beverages served in North Carolina child-care centers.

Menus from child-care centers are an important source of information for parents, researchers, and child-care regulators, but previous research suggests that menus do not accurately represent foods served. The purpose of this study was to compare menus with actual foods and beverages served to children in child-care centers. Menus were collected and a dietary observation was conducted to document all foods and beverages served to children during the course of 1 day in 84 child-care centers in North Carolina in the fall of 2005. Frequencies of foods and beverages on the menus vs those served were computed by eating occasion, food category, and individual foods and beverages. Of the 254 meals and snacks served, 131 (52%) meals and snacks matched entirely what was stated on the menu. Of the 820 individual foods and beverages served, 710 (86.6%) matched those listed on the menus. An additional 110 foods and beverages were served but not listed on the menus. Grains, juice, and vegetables were served less often than indicated on the menus, and milk, protein-rich foods, fruits, mixed dishes, and foods of low nutritional value were served more often than listed on the menus. Overall, just over half of all meals and snacks matched menus, and nearly 90% of individual foods and beverages served matched those stated on menus. Parents of children in child care and dietetics practitioners providing consultation to child-care centers can encourage not only provision of healthy foods and beverages, but also accurate menus in child care.

Best-practice guidelines for physical activity at child care.

Research has indicated that the child care center is a very strong predictor of preschool-aged children's physical activity levels, making this an important setting to help young children obtain physical activity that is appropriate for their health and development. However, some evidence suggests that organized child care may not adequately support children's physical activity needs. Although many organizations provide recommendations, guidelines, or standards for motor skill development and physical activity opportunities, no set of guidelines exist that directly target the overall physical activity environment at child care. Because of the lack of comprehensive recommendations, the Nutrition and Physical Activity Self-assessment for Child Care best-practice guidelines for healthy weight development were created on the basis of an extensive review of existing guidelines, research evidence, and expert review. The purpose of this article is to present these physical activity best-practice guidelines and provide data on how these guidelines compare to current practice in a large sample (N = 96) of child care centers in North Carolina. These best-practice guidelines include recommendations for 8 unique components of the child care environment, including active opportunities, fixed play environment, portable play environment, sedentary opportunities, sedentary environment, staff behavior, staff training/education, and physical activity policies. Our results showed that only a few of the best-practice guidelines were achieved by a majority of the 96 North Carolina child care centers that participated in this study. Establishing comprehensive guidelines for physical activity at child care could result in higher activity levels and healthier children, but more research is needed.

Promotion of walking for transportation: a report from the Walk to School day registry.

BACKGROUND: In the US, promoting active transportation to school has received increased attention as a means of encouraging physical activity and preventing obesity among youth. However, little systematic evaluation of existing programs, such as Walk to School (WTS), has occurred. METHODS: WTS coordinators from across the US were surveyed (via web, mail, and telephone) about program activities, school and environmental characteristics, and perceived changes in children walking to school. As an exploratory aim, logistic regression analyses were used to examine program characteristics associated with perceived increases in children walking. RESULTS: From a database of 783 coordinators, 493 usable surveys were returned. Almost all respondents (98.2%) participated in a one-day WTS event. Other common activities included promotional activities (72.7%), safety trainings (49.6%), walkability audits (48.5%), and designated safe walking routes (46.5%). As part of their WTS efforts, 24.4% made policy changes and 38.4% made changes to the physical environment. Logistic regression analyses showed that policy changes, physical environment improvements, and number of activities were associated with the largest perceived increased in children walking to school. CONCLUSIONS: These findings help address the gap in knowledge about schools' participation in WTS programs, and suggest strategies to increase active transportation to school.

Improving nutrition and physical activity in child care: what parents recommend.

A large percentage of children in the United States spend part of their day in out-of-home child care. As rates of obesity continue to rise, especially among young children, child care has become a focus for nutrition and physical activity intervention. Parental involvement is an important component of these efforts. During summer 2006, parents of children in child care were surveyed to better understand their perceived quality of meals, snacks, and physical activity at the child-care center, and their recommendations for improvement. Parents of children who attended 94 licensed child-care centers in North Carolina were invited to complete a brief survey of perceived quality of meals, snacks, and physical activity at their centers using close-ended questions. Open-ended questions were used to identify suggestions for improvement. Five hundred eight parents from 91 child-care centers completed the questionnaire. The majority of parents reported quality of meals and snacks at the center as either excellent (30% meals, 27% snacks) or good (42% meals, 46% snacks). The main recommendations for improving meals and snacks were to increase fruits and vegetables and provide a variety of healthful foods. The majority of parents categorized the quality of physical activity at the center as excellent (36%) or good (46%), and suggested more structured, outdoor activities for children. Findings from this study provide insight into key areas of concern for parents regarding the nutrition and activity environment of child-care centers. This information may be used to create or modify interventions or policies and to help motivate parents to become advocates for change in child care.

Nutrition and physical activity in child care: results from an environmental intervention.

BACKGROUND: With evidence of increased levels of obesity in younger children, the child-care setting is an important intervention target. Few environmental interventions exist, and none target both diet and physical activity. The Nutrition and Physical Activity Self-Assessment for Child Care (NAP SACC) intervention was developed to fill this research and practice gap. DESIGN: Randomized controlled. SETTING/PARTICIPANTS: Health professionals (child-care health consultants) serving child-care centers in North Carolina were recruited (n=30), randomly assigned into intervention or delayed-intervention control groups, and trained to implement the NAP SACC program. Up to three child-care centers were recruited (n=84) from each consultant's existing caseload. INTERVENTION: Implemented in 2005, the NAP SACC intervention includes an environmental self-assessment, selection of areas for change, continuing education workshops, targeted technical assistance, and re-evaluation. Implementation occurred over a 6-month period. MAIN OUTCOME MEASURES: An observational instrument, Environment and Policy Assessment and Observation (EPAO), provided objective evidence of intervention impact and was completed by trained research staff blinded to study assignment. Data were collected in 2005 and 2006. Statistical analyses were conducted in 2006. RESULTS: Intention-to-treat analysis results were nonsignificant. Exploratory analyses using only centers that completed most of the NAP SACC program suggest an intervention effect. CONCLUSIONS: Factors in the intervention design, the fidelity of implementation, the selection of outcome measure, or a combination of these may have contributed to the lack of intervention effect observed. Because of this study's use of existing public health infrastructure and its potential for implementation, future studies should address strategies for improving effectiveness.

Validity and reliability of a school travel survey.

BACKGROUND: Despite the growing interest in active (ie, nonmotorized) travel to and from school, few studies have explored the measurement properties to assess active travel. We evaluated the criterion validity and test-retest reliability of a questionnaire with a sample of young schoolchildren to assess travel to and from school, including mode, travel companion, and destination after school. METHODS: To assess test-retest reliability, 54 children age 8 to 11 years completed a travel survey on 2 consecutive school days. To assess criterion validity, 28 children age 8 to 10 years and their parents completed a travel survey on 5 consecutive weekdays. RESULTS: Test-retest reliability of all questions indicated substantial agreement. The questions on mode of transport, where you will go after school, and how you will get there also displayed substantial agreement between parental and child reports. CONCLUSIONS: For this population, a questionnaire completed by school-age children to assess travel to and from school, including mode, travel companion, and destination after school, was reliably collected and indicated validity for most items when compared with parental reports.

Dietary intakes in North Carolina child-care centers: are children meeting current recommendations?

The purpose of this study was to determine whether food consumed by children while in center-based child care meets the new MyPyramid food group recommendations for children 2 to 5 years of age. Dietary observation of 117 children from 20 child-care centers throughout North Carolina was conducted. The type and amount of food served to and consumed by children was observed and assessed using Nutrition Data System for Research (NDS-R) software (version 2005, Nutrition Coordinating Center, University of Minnesota, Minneapolis). Portion sizes were then compared to the new MyPyramid food group recommendations to see whether 1/2 to 2/3 (for time spent in full-day child care) of the recommended amounts were consumed. On average, of the five main food groups, children consumed only the 1/2 to 2/3 recommendation for milk. Children also consumed less than 13% of MyPyramid recommendations for whole grains and 7% of MyPyramid recommendations for dark vegetables. Also noteworthy, 50% of milk consumed was whole milk and 75% of the meat consumed was of the high-fat or fried variety. Overall, our data suggest that children are not consuming recommended amounts of whole grains, fruits (excluding 100% fruit juice), or vegetables while attending full-time child care, and are consuming excess amounts of saturated fat and added sugar.

Reliability and validity of a nutrition and physical activity environmental self-assessment for child care.

BACKGROUND: Few assessment instruments have examined the nutrition and physical activity environments in child care, and none are self-administered. Given the emerging focus on child care settings as a target for intervention, a valid and reliable measure of the nutrition and physical activity environment is needed. METHODS: To measure inter-rater reliability, 59 child care center directors and 109 staff completed the self-assessment concurrently, but independently. Three weeks later, a repeat self-assessment was completed by a sub-sample of 38 directors to assess test-retest reliability. To assess criterion validity, a researcher-administered environmental assessment was conducted at 69 centers and was compared to a self-assessment completed by the director. A weighted kappa test statistic and percent agreement were calculated to assess agreement for each question on the self-assessment. RESULTS: For inter-rater reliability, kappa statistics ranged from 0.20 to 1.00 across all questions. Test-retest reliability of the self-assessment yielded kappa statistics that ranged from 0.07 to 1.00. The inter-quartile kappa statistic ranges for inter-rater and test-retest reliability were 0.45 to 0.63 and 0.27 to 0.45, respectively. When percent agreement was calculated, questions ranged from 52.6% to 100% for inter-rater reliability and 34.3% to 100% for test-retest reliability. Kappa statistics for validity ranged from -0.01 to 0.79, with an inter-quartile range of 0.08 to 0.34. Percent agreement for validity ranged from 12.9% to 93.7%. CONCLUSION: This study provides estimates of criterion validity, inter-rater reliability and test-retest reliability for an environmental nutrition and physical activity self-assessment instrument for child care. Results indicate that the self-assessment is a stable and reasonably accurate instrument for use with child care interventions. We therefore recommend the Nutrition and Physical Activity Self-Assessment for Child Care (NAP SACC) instrument to researchers and practitioners interested in conducting healthy weight intervention in child care. However, a more robust, less subjective measure would be more appropriate for researchers seeking an outcome measure to assess intervention impact.

An intervention to promote healthy weight: Nutrition and Physical Activity Self-Assessment for Child Care (NAP SACC) theory and design.

Health professionals are faced with the growing challenge of addressing childhood overweight. Few overweight prevention efforts have targeted young children, particularly children in child care settings. We describe the theory and development of a novel nutrition and physical activity environmental intervention. On the basis of findings from interviews and focus groups, a review of national recommendations and standards, and a review of the literature, we developed a nutrition and physical activity environmental self-assessment instrument to assess physical activity and nutrition policies and practices in child care settings. An intervention model was built around existing public health infrastructure to support use of the self-assessment instrument and encourage environmental changes at the child care level, and this intervention model became the Nutrition and Physical Activity Self-Assessment for Child Care (NAP SACC) program. The NAP SACC program was designed for dissemination and has potential for implementation in many settings. Broad interest in NAP SACC has been expressed by a number of states and institutions, and many groups are using NAP SACC intervention and materials. The NAP SACC program shows promise as a useful approach to promoting healthy weight behaviors in child care settings.

Development and reliability of an observation method to assess food intake of young children in child care.

To our knowledge, a direct observation protocol for assessing dietary intake among young children in child care has not been published. This article reviews the development and testing of a diet observation system for child care facilities that occurred during a larger intervention trial. Development of this system was divided into five phases, done in conjunction with a larger intervention study; (a) protocol development, (b) training of field staff, (c) certification of field staff in a laboratory setting, (d) implementation in a child-care setting, and (e) certification of field staff in a child-care setting. During the certification phases, methods were used to assess the accuracy and reliability of all observers at estimating types and amounts of food and beverages commonly served in child care. Tests of agreement show strong agreement among five observers, as well as strong accuracy between the observers and 20 measured portions of foods and beverages with a mean intraclass correlation coefficient value of 0.99. This structured observation system shows promise as a valid and reliable approach for assessing dietary intake of children in child care and makes a valuable contribution to the growing body of literature on the dietary assessment of young children.

Comparing the ex vivo fitness of CCR5-tropic human immunodeficiency virus type 1 isolates of subtypes B and C.

Continual human immunodeficiency virus type 1 (HIV-1) evolution and expansion within the human population have led to unequal distribution of HIV-1 group M subtypes. In particular, recent outgrowth of subtype C in southern Africa, India, and China has fueled speculation that subtype C isolates may be more fit in vivo. In this study, nine subtype B and six subtype C HIV-1 isolates were added to peripheral blood mononuclear cell cultures for a complete pairwise competition experiment. All subtype C HIV-1 isolates were less fit than subtype B isolates (P < 0.0001), but intrasubtype variations in HIV-1 fitness were not significant. Increased fitness of subtype B over subtype C was also observed in primary CD4(+) T cells and macrophages from different human donors but not in skin-derived human Langerhans cells. Detailed analysis of the retroviral life cycle during several B and C virus competitions indicated that the efficiency of host cell entry may have a significant impact on relative fitness. Furthermore, phyletic analyses of fitness differences suggested that, for a recombined subtype B/C HIV-1 isolate, higher fitness mapped to the subtype B env gene rather than the subtype C gag and pol genes. These results suggest that subtype B and C HIV-1 may be transmitted with equal efficiency (Langerhans cell data) but that subtype C isolates may be less fit following initial infection (T-cell and macrophage data) and may lead to slower disease progression.