Barriers and facilitators for consumer adherence to the dietary guidelines for Americans: the HEALTH study.

The majority of the US population does not meet recommendations for consumption of milk, whole grains, fruit, and vegetables. The goal of our study was to understand barriers and facilitators to adherence to the Dietary Guidelines for Americans for four nutrient-rich food groups in fifth-grade children and unrelated adult caregivers across six sites in a multistate study. A total of 281 unrelated adult caregivers (32% African American, 33% European American, and 35% Hispanic American) and 321 children (33% African American, 33% European American, and 34% Hispanic American) participated in 97 Nominal Group Technique sessions. Nominal Group Technique is a qualitative method of data collection that enables a group to generate and prioritize a large number of issues within a structure that gives everyone an equal voice. The core barriers specific to unrelated adult caregivers were lack of meal preparation skills or recipes (whole grains, fruit, vegetables); difficulty in changing eating habits (whole grains, fruit, vegetables), cost (milk, whole grains, fruit, vegetables), lack of knowledge of recommendation/portion/health benefits (milk, vegetables), and taste (milk, whole grains, vegetables). Specific to children, the core barriers were competing foods (ie, soda, junk foods, sugary foods [whole grains, milk, fruit, vegetables]), health concerns (ie, milk allergy/upset stomach [milk]), taste/flavor/smell (milk, whole grains, fruit, vegetables), forget to eat them (vegetables, fruit), and hard to consume or figure out the recommended amount (milk, fruit). For both unrelated adult caregivers and children, reported facilitators closely coincided with the barriers, highlighting modifiable conditions that could help individuals to meet the Dietary Guidelines for Americans.

Energy density, nutrient adequacy, and cost per serving can provide insight into food choices in the lower Mississippi Delta.

OBJECTIVE: To compare differences across food groups for food cost, energy, and nutrient profiles of 100 items from a cross-sectional survey of 225 stores in 18 counties across the Lower Mississippi Delta of Arkansas, Louisiana, and Mississippi. METHODS: Energy, nutrient, and cost profiles for food items were calculated by using Naturally Nutrient Rich methodology and converting price per 100 g edible portion to price per serving. Foods were grouped into 6 food groups. Mean differences were compared with ANOVA. RESULTS: Significant differences existed by food group for each measure. Energy density was highest for fats/oils/sweets, whereas nutrient density was highest for vegetables. Price per serving was lowest for fats/oils/sweets and highest for meats. CONCLUSIONS AND IMPLICATIONS: Educational messages focusing on a complete diet should consider the role of food costs and provide specific recommendations for increasing nutrient-dense foods by replacing a portion of the meat serving at meals with culturally acceptable lower-cost nutrient-dense foods.

Academic partnerships and key leaders emerging from communities in the lower Mississippi Delta (LMD): a community-based participatory research model.

Collaboratively, the nutritional health problems of the Lower Mississippi Delta (LMD) region were examined and opportunities identified for conducting research interventions. To combat the nutritional health problems in the LMD, community residents yielded to a more comprehensive and participatory approach known as community-based participatory research (CBPR). Community residents partnered with academic researchers and other organizational entities to improve the overall quality of diet and health in their respective communities using CBPR. The collaborative work in the LMD focused on interventions conducted in each of three specific communities across three states: Marvell, Arkansas (Marvell NIRI), and its surrounding public school district; Franklin Parish in Louisiana (Franklin NIRI); and the city of Hollandale, Mississippi (Hollandale NIRI). This paper examined some of the research interventions conducted in Franklin, Hollandale, and Marvell NIRI respectively, how leadership emerged from each of these communities, and lessons learned as a result of the CBPR model.

Simulated reductions in consumption of sugar-sweetened beverages improves diet quality in Lower Mississippi Delta adults.

BACKGROUND: Although the effects of replacing sugar-sweetened beverages (SSBs) with water on energy intake and body weight have been reported, little is known about how these replacements affect diet quality. OBJECTIVE: To simulate the effects of replacing SSBs with tap water on diet quality and total energy intake of Lower Mississippi Delta (LMD) adults. DESIGN: Retrospective analysis of cross-sectional dietary intake data using a representative sample of LMD adults (n=1,689). Diet quality was measured using the Healthy Eating Index-2005 (HEI-2005) scores that were computed using the population ratio method. The effects of substituting SSBs with water on diet quality were simulated by replacing the targeted items' nutrient profile with tap water's profile. RESULTS: Simulating the replacement of SSBs with tap water at 25, 50, and 100% levels resulted in 1-, 2.3-, and 3.8-point increases, respectively, in the HEI-2005 total score. Based on a mean daily intake of 2,011 kcal, 100% substitution of SSBs with tap water would result in 11% reduction in energy intake. CONCLUSIONS: Replacing SSBs with water could substantially improve the diet quality of the LMD adult population and potentially lead to significant weight loss overtime. Prioritizing intervention efforts to focus on the replacement of SSBs with energy-free drinks may be the most efficacious approach for conveying potentially substantial health benefits in this and similar disadvantaged populations.

A simulation study of the potential effects of healthy food and beverage substitutions on diet quality and total energy intake in Lower Mississippi Delta adults.

The majority of adult diets in the United States, particularly the South, are of poor quality, putting these individuals at increased risk for chronic diseases. In this study, simulation modeling was used to determine the effects of substituting familiar, more healthful foods and beverages for less healthy ones on diet quality and total energy intake in Lower Mississippi Delta (LMD) adults. Dietary data collected in 2000 for 1689 LMD adults who participated in the Foods of Our Delta Study were analyzed. The Healthy Eating Index-2005 (HEI-2005) was used to measure diet quality. The effects of substituting targeted foods and beverages with more healthful items on diet quality were simulated by replacing the targeted items' nutrient profile with their replacements' profile. For the single food and beverage groups, 100% replacement of grain desserts with juice-packed fruit cocktail and sugar-sweetened beverages with water resulted in the largest improvements in diet quality (4.0 and 3.8 points, respectively) and greatest decreases in total energy intake (98 and 215 kcal/d, respectively). The 100% substitution of all food and beverage groups combined resulted in a 12.0-point increase in HEI-2005 score and a decrease of 785 kcal/d in total energy intake. Community interventions designed to improve the diet of LMD adults through the use of familiar, healthy food and beverage substitutions have the potential to improve diet quality and decrease energy intake of this health disparate population.

Food and beverage choices contributing to dietary guidelines adherence in the Lower Mississippi Delta.

OBJECTIVES: The objectives of the present study were to evaluate diet quality among Lower Mississippi Delta (LMD) residents using the Healthy Eating Index-2005 (HEI-2005) and to identify the top five dietary sources contributing to HEI-2005 components. Demographic differences in HEI-2005 scores were also explored. DESIGN: Diet quality was evaluated using HEI-2005. Demographic differences in HEI-2005 scores were investigated using multivariable regression models adjusting for multiple comparisons. The top five dietary sources contributing to HEI-2005 components were identified by estimating and ranking mean MyPyramid equivalents overall and by demographic characteristics. SETTING: Dietary data, based on a single 24 h recall, from the Foods of Our Delta Study 2000 (FOODS 2000) were used in the analyses. SUBJECTS: FOODS 2000 adult participants 18 years of age or older. RESULTS: Younger age was the largest determinant of low diet quality in the LMD with HEI-2005 total and seven component scores declining with decreasing age. Income was not a significant factor for HEI-2005 total or component scores. The top five dietary sources differed by all five of the demographic variables, particularly for total vegetables and energy from solid fats, alcoholic beverages and added sugars (SoFAAS). Soft drinks were the leading source of SoFAAS energy intake for all demographic groups. CONCLUSIONS: The assessment of diet quality and identification of top dietary sources revealed the presence of demographic differences for selected HEI-2005 components. These findings allow identification of food patterns and culturally appropriate messaging and highlight the difficulties of treating this region as a homogeneous population.

Food shopping perceptions, behaviors, and ability to purchase healthful food items in the lower Mississippi delta.

OBJECTIVE: To examine the agreement between perceptions, behaviors, and ability to purchase healthful food in the Lower Mississippi Delta (LMD). DESIGN: A regional food store survey of healthful food options in supermarkets, small/medium stores, and convenience stores. Focus group discussions were conducted on shopping perceptions and behaviors. SETTING: Counties in Arkansas, Louisiana, and Mississippi. PARTICIPANTS: Eighty-one LMD residents, 18-60+ years of age. MAIN OUTCOME MEASURE: Perceptions of healthful food and ability to acquire these food items across store types. ANALYSIS: Focus group data were analyzed using thematic coding. Summary food store statistics were weighted, and estimates were constructed using SUDAAN 9. Data triangulation was achieved by comparing focus group findings with food availability data. RESULTS: A majority (> 85%) of supermarkets had selected vegetables, breads, and cereals perceived as healthful, whereas availability was limited in small to medium grocery stores and convenience stores. Skim milk, perceived as healthful, was limited in all store types. CONCLUSIONS AND IMPLICATIONS: Limited availability and perceived costs of healthful food in the LMD influenced purchasing behaviors. Attitudes and perceptions should be incorporated into intervention development to improve food choices in conjunction with increasing the availability of healthful food in the LMD.

Evaluation of a breastfeeding peer support program for fathers of Hispanic participants in a Texas special supplemental nutrition program for women, infants, and children.

A mother's decision to breastfeed and the duration of breastfeeding depends on different factors; among them are the support of her husband or male partner and other social support. There have been different types of support programs for mothers and few have targeted fathers. In 2002, the Texas Special Supplemental Nutrition Program for Women, Infants, and Children introduced an innovative approach for encouraging breastfeeding among mothers and their spouses. The pilot Peer Dad Program targeted fathers to promote and support their spouse in breastfeeding. This cohort study evaluated duration of breastfeeding among Hispanic couples who enrolled in the pilot Peer Dad Program (n=101) and those who did not enroll (n=99). Structured interviews were conducted with Special Supplemental Nutrition Program for Women, Infants, and Children participants and their male partners. Unconditional logistic regression was used to estimate the likelihood of continuing breastfeeding past 6 months associated with participation in the Peer Dad Program and significant predictors. Mothers whose partner participated in the pilot Peer Dad Program were no more likely to continue breastfeeding past 6 months (odds ratio 1.44, 95% confidence interval 0.82 to 2.54) compared with mothers who received peer counseling only. The percentage of women in the intervention group (63.4%) who breastfed for 6 months or longer compared with women in the control group (54.6%) was not significant (P=0.20). Although other studies suggest that father's support lengthens breastfeeding duration, our study, which targeted Hispanic fathers, found no association due to its small sample size. Further research with larger studies is needed to establish this association.

Does a six-month pedometer intervention improve physical activity and health among vulnerable African Americans? A feasibility study.

BACKGROUND: Race/ethnic-specific physical activity patterns and biological responses to physical activity is one of the most understudied, yet critical aspects related to the development and adoption of physical activity recommendations. METHODS: In this 6-month community walking intervention targeting African Americans, participants wore a pedometer and maintained a pedometer diary for the study duration. Outcome measures included height, weight, percent body fat, waist circumference, blood pressure, lipids and glucose. ANOVA, Pearson Correlations, and Kruskal-Wallis tests were used to examine changes in steps/day over each month of the intervention and explore associations among pedometer-determined physical activity and anthropometric/biological change scores from month 1 to 6. RESULTS: The 83 participants were primarily African American (98%) women (94%). There was a significant increase in the average step/day beginning with 6665 (SD = 3396) during month 1 and increasing to 9232 (SD = 3670) steps/day during month 6 (F = 4.5, P < .0001). Associations among step counts and anthropometric/biological change scores were not significant. CONCLUSIONS: While this intervention resulted in significant increases in steps/day; it exemplifies that physical activity standards may be unachievable for some vulnerable, minority communities. Methodological considerations for exploring associations between changes in pedometer-determined step counts and anthropometric/biological outcomes are emphasized through this study.

Development and evaluation of WillTry. An instrument for measuring children's willingness to try fruits and vegetables.

This paper describes the development and evaluation of the WillTry instrument, a psychometric tool designed to measure children's willingness to try fruits and vegetables. WillTry surveys were interviewer-administered to 284 children in an elementary school and summer day camps located in rural Mississippi and Arkansas (United States) communities. Factor analysis was used to determine construct dimensionality. Additional evaluation included internal consistency, test-retest reliability, and predictive validity. Factor analysis suggested a single dimension for the food items. The WillTry food scale had substantial reliability (intraclass correlation coefficients between 0.61 and 0.80) and sufficient internal consistency (Cronbach's alpha > or = 0.70). Results of the regression analysis for percent consumption of foods offered on WillTry response confirmed the predictive validity of the instrument. The results of these analyses provide psychometric evidence for the use of the WillTry instrument as a measure of willingness to try fruits and vegetables in rural, southern US children 5-14 years of age.

Validity and calibration of food frequency questionnaires used with African-American adults in the Jackson Heart Study.

OBJECTIVE: To examine the relative validity of two food frequency questionnaires (FFQs) developed for use in investigating diet and disease relationships within the adult African-American population in the southern United States. DESIGN: Cross-sectional analyses of dietary nutrient intake data, comparing four 24-hour dietary recalls with an FFQ developed by the Lower Mississippi Delta Nutrition Intervention Research Initiative, and its shorter version adapted for use in the Jackson Heart Study. SUBJECTS: A representative subset of participants (n=499, aged 35 to 81 years) from the baseline Jackson Heart Study cohort (N=5,302) was selected for this study. Data collection took place between winter 2000 and spring 2004. STATISTICAL ANALYSES: Pearson's correlation coefficients (energy adjusted and de-attenuated) for 26 nutrients estimates from each of the FFQs, comparing them with the mean of four 24-hour dietary recalls. The ability of the FFQs to rank individuals based on nutrient intakes was compared to that of the mean of four 24-hour dietary recalls and attenuation coefficients were also calculated. RESULTS: Median nutrient intake estimates tended to be higher on the long and lower on the short FFQ compared to the median for the mean of four 24-hour dietary recalls. Energy adjusted and deattenuated correlations of FFQ intake estimates with recalls ranged from 0.20 for sodium to 0.70 for carbohydrate for the short FFQ and from 0.23 for polyunsaturated fat to 0.75 for dietary fiber and magnesium for the long. Attenuation coefficients for men on average were 0.42 for the short and 0.49 for the long FFQ. For women, these were 0.31 for the short and 0.42 for the long FFQ. CONCLUSIONS: Both FFQs appear to be reasonably valid for assessment of dietary intake of adult African Americans in the South. The Lower Mississippi Delta Nutrition Intervention Research Initiative FFQ exhibited higher intake estimates and stronger correlations with recalls than the Jackson Heart Study FFQ for most nutrients analyzed, more so for women than men.

The "Rolling Store:" an economical and environmental approach to the prevention of weight gain in African American women.

OBJECTIVE: To test the feasibility of the "Rolling Store," an innovative food-delivery intervention, along with a nutrition education program to increase the consumption of healthy foods (fruits and vegetables) to prevent weight gain in African American women. METHODS: Forty eligible African American women were enrolled in the study and randomized to intervention or control groups. A trained peer educator and a Rolling Store operator implemented the study protocol at a local community center. RESULTS: The program retention rate was 93%. Participants in the intervention group lost a mean weight of 2.0 kg, while participants in the control group gained a mean weight of 1.1 kg at six months. Overall participants showed a mean decrease in weight of -.4 kg (standard deviation 3.0 kg), but the intervention group lost significantly more weight and had a decreased body mass index at six months. In the intervention group, the average number of servings consumed per day of fruits/ fruit juice and vegetables significantly increased at six months. CONCLUSIONS: The Rolling Store, at least on the small scale on which it was implemented, is a feasible approach to producing weight loss and improvements in healthy eating when combined with an educational program in a small community center.

Personalizing nutrigenomics research through community based participatory research and omics technologies.

Personal and public health information are often obtained from studies of large population groups. Risk factors for nutrients, toxins, genetic variation, and more recently, nutrient-gene interactions are statistical estimates of the percentage reduction in disease in the population if the risk were to be avoided or the gene variant were not present. Because individuals differ in genetic makeup, lifestyle, and dietary patterns than those individuals in the study population, these risk factors are valuable guidelines, but may not apply to individuals. Intervention studies are likewise limited by small sample sizes, short time frames to assess physiological changes, and variable experimental designs that often preclude comparative or consensus analyses. A fundamental challenge for nutrigenomics will be to develop a means to sort individuals into metabolic groups, and eventually, develop risk factors for individuals. To reach the goal of personalizing medicine and nutrition, new experimental strategies are needed for human study designs. A promising approach for more complete analyses of the interaction of genetic makeups and environment relies on community-based participatory research (CBPR) methodologies. CBPR's central focus is developing a partnership among researchers and individuals in a community that allows for more in depth lifestyle analyses but also translational research that simultaneously helps improve the health of individuals and communities. The USDA-ARS Delta Nutrition Intervention Research program exemplifies CBPR providing a foundation for expanded personalized nutrition and medicine research for communities and individuals.

Serum carotenoid and tocopherol concentrations vary by dietary pattern among African Americans.

BACKGROUND: Intakes and biochemical concentrations of carotenoids and tocopherols have been associated with chronic diseases. OBJECTIVE: To describe dietary patterns in Jackson Heart Study participants and to determine if biochemical measurements of antioxidants differ across these. DESIGN: Cross-sectional analysis of data for 373 African-American men and women (age 35 to 80 years), participating in the Diet and Physical Activity Substudy of the Jackson Heart Study. METHODS: Dietary intake was assessed with a region specific food frequency questionnaire. Patterns were defined by cluster analysis of food groups, as percent of energy intake. RESULTS: Four dietary patterns were identified: fast food, Southern, prudent, and juice. Individuals in the fast-food pattern (n=153) had significantly lower serum concentrations of lutein plus zeaxanthin and beta-cryptoxanthin; those in the Southern cluster (n=99) had significantly lower serum alpha-carotene; and those in the prudent (n=63) and juice (n=58) clusters had significantly higher serum alpha-carotene and beta-cryptoxanthin (P<0.05) relative to those in at least one other cluster (all P<0.05). The juice cluster also had higher serum alpha-tocopherol concentrations relative to the fast-food cluster. CONCLUSIONS: Diets high in fast foods, snacks, soft drinks, and meat were associated with relatively low concentrations of carotenoids and alpha-tocopherol. This pattern contained the largest number of participants, and could contribute to the extensive health disparities seen in this region.

Perceptions of factors influencing healthful food consumption behavior in the Lower Mississippi Delta: focus group findings.

OBJECTIVE: To identify perceptions of Lower Mississippi Delta (LMD) residents regarding factors that influence a change in healthful food consumption behavior to assist in planning sustainable nutrition interventions in the LMD. DESIGN: Nine focus groups were conducted with LMD residents in 9 counties in Arkansas, Louisiana, and Mississippi. One focus group was held in each county on the topical area of behavioral change. SETTING: Nine counties in Arkansas, Louisiana, and Mississippi. PARTICIPANTS: The study population included 91 persons, 85 females and 6 males (18-60+ years of age), of whom 71 were African Americans, 17 were Caucasians, and 3 were Hispanics, who participated in the focus group discussions. ANALYSIS: Data analyses were completed by general and specific content coding. Data were reviewed for emerging themes for each topic. The Social Cognitive Theory served as the framework for understanding the determinants of a change in healthful food consumption behavior. RESULTS: The study showed considerable variability in perceptions that are influenced by both personal and external factors. These factors include health concerns, family influence, and need for and availability of nutrition information. Participants were interested in learning about healthful eating, food preparation skills, and portion control. CONCLUSIONS: Focus groups in the LMD identified many important themes relevant to the development of nutrition interventions in these communities. These data will be used to guide the community-based participatory interventions that will be developed and implemented in the LMD. The findings could be applicable to other researchers designing interventions for similar populations.

Community--academia partnerships to promote nutrition in the lower Mississippi delta: community members' perceptions of effectiveness, barriers, and factors related to success.

This study examined the perceptions of community members' engaged in community-academia partnerships involved in developing nutrition interventions in three communities in the Lower Mississippi Delta. Perceptions on effectiveness of the partnerships were investigated. Six focus group interviews were conducted, with 33 participants that included 27 females and 6 males. The data were analyzed by content coding. Emerging themes were identified and related to accomplishments, barriers to success, and factors related to success of the partnerships. Accomplishments included the establishment of active committees, positive changes in health behavior related to food choices, and participation in community events. Barriers to success included the slow pace of intervention implementation, difficulties with understanding the role of the community in the participatory research process, the decision-making processes, and project name recognition. Factors related to success were tangible benefits to the community, participation that was representative, simplification of the research process, and the decision-making processes.

Carotenoid intakes, assessed by food-frequency questionnaires (FFQs), are associated with serum carotenoid concentrations in the Jackson Heart Study: validation of the Jackson Heart Study Delta NIRI Adult FFQs.

OBJECTIVES: Intake and status of carotenoids have been associated with chronic disease. The objectives of this study were to examine the association between carotenoid intakes as measured by two regional food-frequency questionnaires (FFQs) and their corresponding measures in serum, and to report on dietary food sources of carotenoids in Jackson Heart Study (JHS) participants. DESIGN: Cross-sectional analysis of data for 402 African American men and women participating in the Diet and Physical Activity Sub-Study (DPASS) of the JHS. RESULTS: Mean serum carotenoid concentrations and intakes in this population were comparable to those reported for the general US population. After adjustment for covariates, correlations between serum and dietary measures of each carotenoid, for the average of the recalls (deattenuated), the short FFQ and the long FFQ, respectively, were: 035 and 0-carotene; 026 and 0-carotene; 017 and 0-carotene; 034 and 0-cryptoxanthin; 015 and 037, 014 for lycopene. Major dietary sources of -carotene and lutein plus zeaxanthin, mustard, turnip and collard greens; of beta-cryptoxanthin, orange juice; and of lycopene, tomato juice. CONCLUSIONS: On average, carotenoid intakes and serum concentrations are not lower in this southern African American population than the general US population. The two regional FFQs developed for a southern US population and used as dietary assessment tools in the JHS appear to provide reasonably valid information for most of these carotenoids.

Poverty and food intake in rural America: diet quality is lower in food insecure adults in the Mississippi Delta.

OBJECTIVE: To determine if measures of diet quality differ between food insecure and food secure adults in a rural high-risk population. DESIGN: Random digit dialing telephone survey of a cross-section of the population designed to collect data on food intake, household demographics, and food security status. SETTING: A representative sample of adults who live in 36 counties in the Lower Mississippi Delta region of Arkansas, Louisiana, and Mississippi. SUBJECTS: One thousand six hundred seven adults, both white and African American. MAIN OUTCOME MEASURES: Food security status and diet quality, as defined by adherence to the Healthy Eating Index and Dietary Reference Intakes by determinations from self-reported food intake (1 day intake). STATISTICAL ANALYSES: Regression analysis, t tests, Wald statistic, and beta tests were employed. RESULTS: Food secure adults scored higher on Healthy Eating Index than food insecure adults (P=0.0001), but the regression model showed no differences when multiple factors were included. Food secure individuals consistently achieved higher percentages of the Dietary Reference Intakes (specifically Estimated Average Requirements and Adequate Intakes) than food insecure individuals, with the greatest differences seen for vitamin A (P<0.0001), copper (P=0.0009), and zinc (P=0.0022) and very little difference for vitamins C (P=0.68) and E (P=0.32). Both populations consumed diets extremely low in fiber. CONCLUSIONS: Food insecurity is associated with lower quality diets in this population. It is acknowledged that serious limitations are associated with the use of one 24-hour recall and for comparison between food intake and assessment of food security. These findings still suggest a pressing need for nutrition interventions to improve dietary intake in these at-risk impoverished individuals.

Total alpha-tocopherol intakes are associated with serum alpha-tocopherol concentrations in African American adults.

African Americans in the southern United States have a high prevalence of chronic disease. Tocopherol intake and status have been associated with protection against several chronic diseases. Our objectives were, therefore, to examine the association between tocopherol intakes as measured by 2 regional FFQ and their corresponding concentrations in serum and to report on dietary sources of tocopherols in 404 men and women participating in the cross-sectional Diet and Physical Activity Sub-Study of the Jackson Heart Study. A large proportion (49% of men and 66% of women) reported dietary supplement use. Only 5.8% of men and 4.5% of women met the estimated average requirement (EAR) for vitamin E from foods alone, whereas 44.2% men and 49.2% women met it from foods and supplements. Total (diet + supplement) intake of alpha-tocopherol was associated with its corresponding measure in serum. Vitamin E supplement use, sex, serum cholesterol, education, and BMI, but not gamma-tocopherol intakes, were associated with serum gamma-tocopherol. For delta-tocopherol, associated variables included sex and serum cholesterol. The top food sources of alpha- and gamma-tocopherol were snack chips and the top food source of delta-tocopherol was margarine. Despite prevalent vitamin E supplement use, more than one-half of this population did not meet the EAR for alpha-tocopherol intake and very few met it from food alone. Supplement use was associated with higher alpha- but lower gamma-tocopherol concentration in serum. The possible health implications of this difference in relative tocopherol subtypes require further study.