Metabolic impact of 100% fruit juice consumption on antioxidant/oxidant status and lipid profiles of adults: An Evidence-Based review.

One hundred percent fruit juice (FJ) contains bioactive compounds with antioxidant activity. As such, this fruit form has the potential to improve antioxidant status and mediate outcomes influenced by redox status. A systematic review of the literature published between 1995 and 2013 was conducted using PubMed database to evaluate associations between intake of 100% FJ and markers of antioxidant/oxidant status and blood lipid levels in healthy, free-living adults ≥18 years. Data extraction and analysis was conducted according to the Academy of Nutrition and Dietetics Evidence Analysis Process. Limited evidence from ten clinical trials meeting inclusion/exclusion criteria suggests potential improvements in a variety of antioxidant or oxidants biomarkers postconsumption of 100% FJ. Weak evidence from five studies suggests that one or more blood lipid measures may be positively influenced by consumption of 100% FJ. Heterogeneity in study methodology including biomarkers, 100% FJ type, dosage, and intervention duration precludes the ability to make evidence-based recommendations regarding a specific dose-duration-juice effect. Key characteristics in study designs were identified which must either be controlled or statistically adjusted for in future investigations in order to obtain a more accurate understanding of the complex relationship between metabolic outcomes and consumption of 100% FJ in context of a healthy dietary pattern.

Impact of 100% Fruit Juice Consumption on Diet and Weight Status of Children: An Evidence-based Review.

Consumption of 100% fruit juice remains controversial for its potential adverse impact on weight and displacement of essential foods in the diets of children. A systematic review of the literature published from 1995-2013 was conducted using the PubMed database to evaluate associations between intake of 100% fruit juice and weight/adiposity and nutrient intake/adequacy among children of 1 to 18 years of age. Weight status outcome measures included body mass index (BMI), BMI z-score, ponderal index, obesity, weight gain, adiposity measures, and body composition. Nutrient outcome measures included intake and adequacy of shortfall nutrients. Data extraction and analysis was conducted according to the Academy of Nutrition and Dietetics Evidence Analysis Process. Twenty-two studies on weight status provided evidence that did not support an association between 100% fruit juice consumption and weight/adiposity in children after controlling for energy intake. Limited evidence from eight studies suggests that children consuming 100% fruit juice have higher intake and adequacy of dietary fiber, vitamin C, magnesium, and potassium. Differences in methodology and study designs preclude causal determination of 100% fruit juice as sole influencer of weight status or nutrient intake/adequacy of shortfall nutrients. In context of a healthy dietary pattern, evidence suggests that consumption of 100% fruit juice may provide beneficial nutrients without contributing to pediatric obesity.

Differing statistical approaches affect the relation between egg consumption, adiposity, and cardiovascular risk factors in adults.

BACKGROUND: Associations between food patterns and adiposity are poorly understood. OBJECTIVE: Two statistical approaches were used to examine the potential association between egg consumption and adiposity. METHODS: Participants (n = 18,987) aged ≥19 y were from the 2001-2008 NHANES who provided 24-h diet recall data, body mass index (BMI) and waist circumference (WC)-determined adiposity measures, and blood pressure, circulating insulin, glucose, and lipid concentrations were considered cardiovascular risk factors (CVRFs). Covariate-adjusted least-squares means ± SEs were generated. RESULTS: The first statistical approach categorized participants into egg consumers or nonconsumers. Consumers had higher mean BMI (in kg/m(2); 28.7 ± 0.19; P = 0.006) and WC (98.2 ± 0.43 cm; P = 0.002) than did nonconsumers (28.2 ± 0.10 and 96.9 ± 0.23 cm, respectively). Second, cluster analysis identified 8 distinct egg consumption patterns (explaining 39.5% of the variance in percentage of energy within the food categories). Only 2 egg patterns [egg/meat, poultry, fish (MPF)/grains/vegetables and egg/MPF/grains], consumed by ≤2% of the population, drove the association (compared with the no-egg pattern) between egg consumption and BMI and WC. Another analysis controlled for the standard covariates and the other food groups consumed with eggs in those 2 egg patterns. Only the egg/MPF/other-grains pattern remained associated with BMI and WC (both P ≤ 0.0063). The pattern analyses identified associations between an egg pattern (egg/MPF/other grains/potatoes/other beverages) and diastolic blood pressure (DBP) and serum LDL cholesterol (both P ≤ 0.0063). A final analysis was conducted by adding percentage of energy from fast foods and medication use for diabetes to the covariates. The association between the egg/MPF/grains pattern and BMI and the egg/MPF/potatoes/other beverages and DBP and LDL cholesterol disappeared. CONCLUSIONS: Care needs to be taken with data interpretation of diet and health risk factors and the choice of statistical analyses and covariates used in the analyses because these studies are typically used to generate hypotheses. Additional studies are needed to better understand these relations.

Tree Nut consumption is associated with better adiposity measures and cardiovascular and metabolic syndrome health risk factors in U.S. Adults: NHANES 2005-2010.

INTRODUCTION: Previous research has shown inconsistencies in the association of tree nut consumption with risk factors for cardiovascular disease (CVD) and metabolic syndrome (MetS). OBJECTIVE: To determine the association of tree nut consumption with risk factors for CVD and for MetS in adults. METHODS: NHANES 2005-2010 data were used to examine the associations of tree nut consumption with health risks in adults 19+ years (n = 14,386; 51% males). Tree nuts were: almonds, Brazil nuts, cashews, filberts [hazelnuts], macadamias, pecans, pine nuts, pistachios, and walnuts. Group definitions were non-consumers < » ounce/day and consumers of ≥ » ounce/day tree nuts using data from 24-h dietary recalls. Means and ANOVA (covariate adjusted) were determined using appropriate sample weights. Using logistic regression, odds ratios of being overweight (OW)/obese (OB) (body mass index [BMI] >25/<30 and ≥30, respectively) and having CVRF or MetS, were determined. RESULTS: Tree nut consumption was associated with lower BMI (p = 0.004), waist circumference (WC) (p = 0.008), systolic blood pressure (BP) (p = 0.001), Homeostatic Model Assessment-Insulin Resistance (p = 0.043), and higher high density lipoprotein-cholesterol (p = 0.022), compared with no consumption, and a lower likelihood of OB (-25%), OW/OB (-23%), and elevated WC (-21%). CONCLUSIONS: Tree nut consumption was associated with better weight status and some CVRF and MetS components.

Consumption of apples is associated with a better diet quality and reduced risk of obesity in children: National Health and Nutrition Examination Survey (NHANES) 2003-2010.

BACKGROUND: Most children do not meet the recommendation for fruit consumption. Apples are the second most commonly consumed fruit in the US; however, no studies have examined the association of total apple products, apples, apple sauce, and 100 % apple juice consumption on diet quality and weight/adiposity in children. METHODS: The purpose of this study was to examine the association between various apple consumption forms with diet quality and weight/adiposity in a nationally representative sample of children. Participants were children 2-18 years of age (N = 13,339) from the National Health and Nutrition Examination Survey 2003-2010. Intake was determined using a single interview administered 24-h diet recall. Apple product consumption was determined using the cycle-appropriate USDA Food and Nutrient Database for Dietary Studies food codes. Total diet quality and component scores were determined using the Healthy Eating Index-2010 (HEI). Anthropometrics were determined using standard methods. Covariate adjusted linear and logistic regressions were used to compare apple product consumers with non-consumers; sample weights were used. Probability was set at <0.01. RESULTS: Approximately 26 % of the population (n = 3,482) consumed some form of apple products. Consumers of apple products, whole apples, apple sauce, and 100 % apple juice had higher HEI scores than non-consumers: 50.4 ± 0.4 v 41.9 ± 0.3, 52.5 ± 0.5 v 42.7 ± 0.3, 52.1 ± 0.8 v 47.2 ± 0.4, and 51.4 ± 0.6 v 46.5 ± 0.4, respectively. Apple products and whole apple consumers had lower BMI z-scores than non-consumers: 0.4 ± 0.04 v 0.5 ± 0.03 and 0.3 ± 0.1 v 0.5 ± 0.02, respectively. Apple products and whole apple consumers were 25 % (0.59-0.95 99(th) CI) and 30 % (0.52-0.95 99(th) CI), respectively, were less likely to be obese than non-consumers. CONCLUSIONS: Consumption of any form of apples contributed to the fruit recommendation of children and improved diet quality. Apples should be included in the diets of children as a component of an overall healthy diet.

The nutrient density approach to healthy eating: challenges and opportunities.

The term 'nutrient density' for foods/beverages has been used loosely to promote the Dietary Guidelines for Americans. The 2010 Dietary Guidelines for Americans defined 'all vegetables, fruits, whole grains, fat-free or low-fat milk and milk products, seafood, lean meats and poultry, eggs, beans and peas (legumes), and nuts and seeds that are prepared without added solid fats, added sugars, and sodium' as nutrient dense. The 2010 Dietary Guidelines for Americans further states that nutrient-dense foods and beverages provide vitamins, minerals and other substances that may have positive health effects with relatively few (kilo)calories or kilojoules. Finally, the definition states nutrients and other beneficial substances have not been 'diluted' by the addition of energy from added solid fats, added sugars or by the solid fats naturally present in the food. However, the Dietary Guidelines Advisory Committee and other scientists have failed to clearly define 'nutrient density' or to provide criteria or indices that specify cut-offs for foods that are nutrient dense. Today, 'nutrient density' is a ubiquitous term used in the scientific literature, policy documents, marketing strategies and consumer messaging. However, the term remains ambiguous without a definitive or universal definition. Classifying or ranking foods according to their nutritional content is known as nutrient profiling. The goal of the present commentary is to address the research gaps that still exist before there can be a consensus on how best to define nutrient density, highlight the situation in the USA and relate this to wider, international efforts in nutrient profiling.

Snacking patterns, diet quality, and cardiovascular risk factors in adults.

BACKGROUND: The relationship of snacking patterns on nutrient intake and cardiovascular risk factors (CVRF) in adults is unknown. The aim of this study was to examine the associations of snacking patterns with nutrient intake, diet quality, and a selection of CVRF in adults participating in the 2001-2008 National Health and Nutrition Examination Survey. METHODS: 24-hour dietary recalls were used to determine intake and cluster analysis was used to identify the snacking patterns. Height and weight were obtained and the health indices that were evaluated included diastolic and systolic blood pressure, high density lipoprotein-cholesterol, low density lipoprotein cholesterol, triacylglycerides, blood glucose, and insulin. RESULTS: The sample was participants (n = 18,988) 19+ years (50% males; 11% African-Americans; 72% white, 12% Hispanic-Americans, and 5% other). Cluster analyses generated 12 distinct snacking patterns, explaining 61% of the variance in snacking. Comparisons of snacking patterns were made to the no snack pattern. It was found that miscellaneous snacks constituted the most common snacking pattern (17%) followed by cakes/cookies/pastries (12%) and sweets (9%). Most snacking patterns were associated with higher energy intakes. Snacking patterns cakes/cookies/pastries, vegetables/legumes, crackers/salty snacks, other grains and whole fruit were associated with lower intakes of saturated fatty acids. Added sugars intakes were higher in the cakes/cookies/pastries, sweets, milk desserts, and soft drinks patterns. Five snack patterns (cakes/cookies/pastries, sweets, vegetable/legumes, milk desserts, soft drinks) were associated with lower sodium intakes. Several snack patterns were associated with higher intakes of potassium, calcium, fiber, vitamin A, and magnesium. Five snacking patterns (miscellaneous snacks; vegetables/legumes; crackers/salty snacks; other grains; and whole fruit) were associated with better diet quality scores. Alcohol was associated with a lower body mass index and milk desserts were associated with a lower waist circumference. No snack patterns were associated with other CVRF studied. CONCLUSIONS: Overall, several snacking patterns were associated with better diet quality than those consuming no snacks. Yet, the majority of the snacking patterns were not associated with CVRF. Education is needed to improve snacking patterns in terms of nutrients to limit in the diet along with more nutrient-dense foods to be included in snacks.

The relationship of breakfast skipping and type of breakfast consumed with overweight/obesity, abdominal obesity, other cardiometabolic risk factors and the metabolic syndrome in young adults. The National Health and Nutrition Examination Survey (NHANES): 1999-2006.

OBJECTIVE: To examine the association between breakfast skipping and type of breakfast consumed with overweight/obesity, abdominal obesity, other cardiometabolic risk factors and the metabolic syndrome (MetS). DESIGN: Cross-sectional. Three breakfast groups were identified, breakfast skippers (BS), ready-to-eat-cereal (RTEC) consumers and other breakfast (OB) consumers, using a 24 h dietary recall. Risk factors were compared between the breakfast groups using covariate-adjusted statistical procedures. SETTING: The 1999­2006 National Health and Nutrition Examination Survey, USA. SUBJECTS: Young adults (20­39 years of age). RESULTS: Among these young adults (n 5316), 23.8% were BS, 16.5% were RTEC consumers and 59.7% were OB consumers. Relative to the BS, the RTEC consumers were 31%, 39%, 37%, 28%, 23%, 40% and 42% less likely to be overweight/obese or have abdominal obesity, elevated blood pressure, elevated serum total cholesterol, elevated serum LDL-cholesterol, reduced serum HDL-cholesterol or elevated serum insulin, respectively. Relative to the OB consumers, the BS were 1.24, 1.26 and 1.44 times more likely to have elevated serum total cholesterol, elevated serum LDL-cholesterol or reduced serum HDL-cholesterol, respectively. Relative to the OB consumers, the RTEC consumers were 22%, 31% and 24% less likely to be overweight/ obese or have abdominal obesity or elevated blood pressure, respectively. No difference was seen in the prevalence of the MetS by breakfast skipping or type of breakfast consumed. CONCLUSIONS: Results suggest that consumption of breakfast, especially that included an RTEC, was associated with an improved cardiometabolic risk profile in U.S. young adults. Additional studies are needed to determine the nature of these relationships.

Characterizing lunch meals served and consumed by pre-school children in Head Start.

OBJECTIVE: To examine the variability of food portions served and consumed by African-American and Hispanic-American pre-school children attending Head Start. DESIGN: Cross-sectional. SETTING: Food consumption by pre-schoolers (n 796) enrolled in sixteen Head Start centres in Houston, Texas (51 % boys, 42 % African-American, mean age 4 years) were assessed during 3 d of lunch meals using digital photography. Descriptive statistics and multilevel regression models, adjusting for classroom and school clustering effects, were determined. SUBJECTS: Head Start pre-schoolers aged 3­5 years. RESULTS: Mean amount served was 2428 kJ (580 kcal) and 572 g. Mean intake was 1421 kJ (339 kcal) and 331 g: 20 % protein, 46 % carbohydrate and 34 % fat. Plate waste was 43 % (range: 38 % (fruit) to 61 % (vegetables)). Mean CV of food served was 29 %: 33 % for entrées, 44 % for vegetables, 60 % for fruit and 76 % for starches. Mean CV of food consumed was 46 %: 58 % for entrées, 86 % for fruit, 96 % for vegetables and 111 % for starches. Total gram amount of food served was positively correlated with consumption (r = 0·43, P < 0·001). CONCLUSIONS: Plate waste and variation in amounts served and consumed were substantial; amounts served were associated with amounts consumed. Large portion sizes may contribute to paediatric obesity by promoting excessive intake at meals. Understanding factors influencing portion sizes provides insight about specific intervention strategies that can be used in obesity prevention programmes.

Diet quality is inversely related to cardiovascular risk factors in adults.

The goal of the study was to determine if there was an association between diet quality and cardiovascular risk factors (CVRF) in adults. NHANES 2001-2008 data were used to compare diet quality, as determined by using 2005 Healthy Eating Index (HEI-2005) scores, and CVRF in adults aged ≥19 y (n = 18,988; 51% men, 50% white, 21% African American, 25% Hispanic American, 4% other). HEI-2005 scores were calculated by using one 24-h dietary recall collected from the participants. Weight and adiposity, blood pressure, and CVRF were measured. Regression analyses were conducted to assess the linear relationship of CVRF and HEI-2005 scores by using appropriate covariates accounting for sample weights and the complex sample design of NHANES. OR were calculated for HEI quartiles and CVRF. BMI (P < 0.0001), waist circumference (WC) (P < 0.0001), diastolic blood pressure (P = 0.0002), C-reactive protein (P = 0.0016), total cholesterol (P = 0.0006), LDL cholesterol (P = 0.0039), and metabolic syndrome (P = 0.0035) were inversely associated with HEI-2005. HDL cholesterol significantly (P = 0.0048) increased across HEI-2005 quartiles. Compared with the lowest HEI-2005 quartile, individuals with the highest diet quality (HEI-2005 quartile 4) were less likely to be overweight or obese (34%) or have elevated WC (35%), elevated blood pressure (26%), metabolic syndrome (35%), and decreased HDL-cholesterol concentrations (21%). Data suggest that diet quality is inversely associated with several CVRF.

100% orange juice consumption is associated with better diet quality, improved nutrient adequacy, decreased risk for obesity, and improved biomarkers of health in adults: National Health and Nutrition Examination Survey, 2003-2006.

BACKGROUND: Consumption of 100% orange juice (OJ) has been positively associated with nutrient adequacy and diet quality, with no increased risk of overweight/obesity in children; however, no one has examined these factors in adults. The purpose of this study was to examine the association of 100% OJ consumption with nutrient adequacy, diet quality, and risk factors for metabolic syndrome (MetS) in a nationally representative sample of adults. METHODS: Data from adults 19+ years of age (n = 8,861) participating in the National Health and Nutrition Examination Survey 2003-2006 were used. The National Cancer Institute method was used to estimate the usual intake (UI) of 100% OJ consumption, selected nutrients, and food groups. Percentages of the population below the Estimated Average Requirement (EAR) or above the Adequate Intake (AI) were determined. Diet quality was measured by the Healthy Eating Index-2005 (HEI-2005). Covariate adjusted logistic regression was used to determine if consumers had a lower odds ratio of being overweight or obese or having risk factors of MetS or MetS. RESULTS: Usual per capita intake of 100% OJ was 50.3 ml/d. Among consumers (n = 2,310; 23.8%), UI was 210.0 ml/d. Compared to non-consumers, consumers had a higher (p < 0.05) percentage (% ± SE) of the population meeting the EAR for vitamin A (39.7 ± 2.5 vs 54.0 ± 1.2), vitamin C (0.0 ± 0.0 vs 59.0 ± 1.4), folate (5.8 ± 0.7 vs 15.1 ± 0.9), and magnesium (51.6 ± 1.6 vs 63.7 ± 1.2). Consumers were also more likely to be above the AI for potassium (4.1 ± 0.8 vs 1.8 ± 0.2). HEI-2005 was significantly (p < 0.05) higher in consumers (55.0 ± 0.4 vs 49.7 ± 0.3). Consumers also had higher intakes of total fruit, fruit juice, whole fruit, and whole grain. Consumers had a lower (p < 0.05) mean body mass index (27.6 ± 0.2 vs 28.5 ± 0.1), total cholesterol levels (197.6 ± 1.2 vs 200.8 ± 0.75 mg/dL), and low density lipoprotein-cholesterol levels (112.5 ± 1.4 vs 116.7 ± 0.93 mg/dL). Finally, compared to non-consumers of 100% OJ, consumers were 21% less likely to be obese and male consumers were 36% less likely to have MetS. CONCLUSION: The results suggest that moderate consumption of 100% OJ should be encouraged to help individuals meet the USDA daily recommendation for fruit intake and as a component of a healthy diet.

Fruit juice consumption is associated with improved nutrient adequacy in children and adolescents: the National Health and Nutrition Examination Survey (NHANES) 2003-2006.

OBJECTIVE: To examine the contribution of 100 % fruit juice (FJ) consumption to dietary adequacy of shortfall nutrients by children and adolescents. DESIGN: Cross-sectional. SETTING: Secondary analysis of data from the 2003-2006 National Health and Nutrition Examination Survey (NHANES). SUBJECTS: Children and adolescents aged 2-18 years (n 7250). Usual intake, determined from two 24 h dietary recalls, was calculated using the National Cancer Institute method. The population was dichotomized into consumers or non-consumers of 100 % FJ. The age/gender-specific percentage of the two consumption groups with intakes less than the Estimated Average Requirement or that exceeded the Adequate Intake for selected nutrients was determined. A Z-statistic for differences in population proportions was used to determine significance (P < 0.05). RESULTS: Children aged 2-5 years had the highest percentage of 100 % FJ consumers (71.1 %), followed by children aged 6-12 years (57.0 %) and adolescents aged 13-18 years (44.5 %). Compared with 100 % FJ consumers, a significantly higher percentage of non-consumers had intakes below the Estimated Average Requirement for vitamin A (24.4 (SE 2.5) % v. 42.2 (SE 2.5) %), vitamin C (0.1 (SE 0.2) % v. 38.9 (SE 4.1) %), folate (8.8 (SE 1.5) % v. 22.1 (SE 2.4) %), P (11.6 (SE 2.1) % v. 21.3 (SE 2.6) %) and Mg (25.8 (SE 1.7) % v. 46.1 (SE 2.0) %). A greater percentage of 100 % FJ consumers exceeded the Adequate Intake for K (2.4 (SE 0.5) v. 0.5 (SE 0.2) %) compared with non-consumers. CONCLUSIONS: Consumption of 100 % FJ is associated with improved nutrient adequacy and can contribute to a healthy diet.

Resemblance of dietary intakes of snacks, sweets, fruit, and vegetables among mother-child dyads from low income families.

The objective of this study was to determine the correlation between intake of snacks, sweets, fruit, vegetables, and energy in low-income mother-child dyads. This was a secondary analysis of data collected from Head Start centers in Houston, Texas and Birmingham, Alabama. Twenty four hour dietary recalls for one weekend day were collected from mother (mean 31.8 yrs [range: 20.1-72.4 yrs])-child (mean 4.4 yrs [range 2.8-5.8 yrs]) dyads (N=650). Means±SD were calculated for intake of food categories and energy. Pearson's partial correlation coefficients were used to detect associations between the intakes of the dyads. Main outcome measures were the correlations between the intake of snacks, sweets, fruit, vegetables, and energy in the mother-child dyads. Partial correlations showed that children's intake of snacks, sweets, fruit, vegetables, and energy were all correlated with the mother's intake of these foods/energy (all p<0.001). Children's intake of fruit was correlated with the mother's intake of vegetables (p<0.001); children's energy intake was correlated with mother's intake of sweets, fruit, and vegetables (all p<0.001). It is important that food and nutrition professionals provide the guidance needed that encourages intake of nutrient-dense snacks and fruit and vegetables in mothers so they can model healthier food consumption behaviors for their children.

Nut consumption is associated with decreased health risk factors for cardiovascular disease and metabolic syndrome in U.S. adults: NHANES 1999-2004.

BACKGROUND: Few recent epidemiologic studies have assessed the effect that nut consumption (including tree nuts and peanuts) has on health risks, including metabolic syndrome (MetS). OBJECTIVE: This study compared the health risk for cardiovascular disease, type 2 diabetes, and MetS of nut consumers with that of nonconsumers. DESIGN: Adults 19+ years (n = 13,292) participating in the 1999-2004 National Health and Nutrition Examination Survey were used. Intake from 24-hour recalls was used to determine intake. Nut/tree nut consumers consumed ≥»; ounce per day. Covariate-adjusted means, standard errors, and prevalence rates were determined for the nut consumption groups. RESULTS: The prevalence of nut consumers was 18.6% ± 0.7% and 21.0% ± 0.9% in those 19-50 years and 51 years and older, respectively. Nut consumption was associated with a decreased body mass index (27.7 kg/m(2) ± 0.2 vs 28.1 ± 0.1 kg/m(2), p < 0.05), waist circumference (95.6 ± 0.4 cm vs 96.4 ± 0.3 cm, p < 0.05), and systolic blood pressure (121.9 ± 0.4 mmHg vs 123.20 ± 0.3 mmHg, p < 0.01) compared with nonconsumers. Tree nut consumers also had a lower weight (78.8 ± 0.7 kg vs 80.7 ± 0.3 kg, p < 0.05). Nut consumers had a lower percentage of two risk factors for MetS: hypertension (31.5% ± 1.0% vs 34.2% ± 0.8%, p < 0.05) and low high density lipoprotein-cholesterol (HDL-C) (29.6% ± 1.0% vs 34.8% ± 0.8%, p < 0.01). Tree nut consumers had a lower prevalence of four risk factors for MetS: abdominal obesity (43.6% ± 1.6% vs 49.5% ± 0.8%, p < 0.05), hypertension (31.4% ± 1.2% vs 33.9% ± 0.8%, p < 0.05), low HDL-C (27.9% ± 1.7% vs 34.5% ± 0.8%, p < 0.01), high fasting glucose (11.4% ± 1.4% vs 15.0% ± 0.7%, p < 0.05), and a lower prevalence of MetS (21.2% ± 2.1% vs 26.6% ± 0.7%, p < 0.05). CONCLUSION: Nut/tree nut consumption was associated with a decreased prevalence of selected risk factors for cardiovascular disease, type 2 diabetes, and MetS.

Diet quality is positively associated with 100% fruit juice consumption in children and adults in the United States: NHANES 2003-2006.

BACKGROUND: One hundred percent fruit juice (100% FJ) has been viewed by some as a sweetened beverage with concerns about its effect on weight. Little regard has been given to the contribution of 100% FJ to diet quality. METHODS: In this study data from the 2003-2006 National Health and Nutrition Examination Survey were used to examine the association of 100% FJ consumption with diet quality in participants 2-5 years of age (y) (n = 1665), 6-12 y (n = 2446), 13-18 y (n = 3139), and 19+y (n = 8861). Two 24-hour dietary recalls were used to determine usual intake using the National Cancer Institute method. Usual intake, standard errors, and regression analyses (juice independent variable and Healthy Eating Index-2005 [HEI-2005] components were dependent variables), using appropriate covariates, were determined using sample weights. RESULTS: The percentage of participants 2-5 y, 6-12 y, 13-18 y, and 19+y that consumed 100% FJ was 71%, 57%, 45%, and 62%, respectively. Usual intake of 100% FJ (ounce [oz]/day) among the four age groups was: 5.8 ± 0.6, 2.6 ± 0.4, 3.7 ± 0.4, and 2.4 ± 0.2 for those in age groups 2-5 y, 6-12 y, 13-18 y, and 19+y, respectively. Consumption of 100% FJ was associated with higher energy intake in 6-12 y, 13-18 y, and 19+y; and higher total, saturated, and discretionary fats in 13-18 y participants. Consumption of 100% FJ was associated with higher total HEI-2005 scores in all age groups (< 0.0001). In 100% FJ consumers, total and whole fruit consumption was higher and intake of added sugars was lower in all age groups. CONCLUSIONS: Usual intake of 100% FJ consumption exceeded MyPyramid recommendations for children 2-5 y, but was associated with better diet quality in all age groups and should be encouraged in moderation as part of a healthy diet.

Consumption of whole grains is associated with improved diet quality and nutrient intake in children and adolescents: the National Health and Nutrition Examination Survey 1999-2004.

OBJECTIVE: To examine the association of consumption of whole grains (WG) with diet quality and nutrient intake in children and adolescents. DESIGN: Secondary analysis of cross-sectional data. SETTING: The 1999-2004 National Health and Nutrition Examination Survey. SUBJECTS: Children aged 2-5 years (n 2278) and 6-12 years (n 3868) and adolescents aged 13-18 years (n 4931). The participants were divided into four WG consumption groups: ≥ 0 to < 0·6, ≥ 0·6 to < 1·5, ≥ 1·5 to < 3·0 and ≥ 3·0 servings/d. Nutrient intake and diet quality, using the Healthy Eating Index (HEI)-2005, were determined for each group from a single 24 h dietary recall. RESULTS: The mean number of servings of WG consumed was 0·45, 0·59 and 0·63 for children/adolescents at the age of 2-5, 6-12 and 13-18 years, respectively. In all groups, HEI and intakes of energy, fibre, vitamin B6, folate, magnesium, phosphorus and iron were significantly higher in those consuming ≥ 3·0 servings of WG/d; intakes of protein, total fat, SFA and MUFA and cholesterol levels were lower. Intakes of PUFA (6-12 years), vitamins B1 (2-5 and 13-18 years), B2 (13-18 years), A (2-5 and 13-18 years) and E (13-18 years) were higher in those groups consuming ≥ 3·0 servings of WG/d; intakes of added sugars (2-5 years), vitamin C (2-5 and 6-12 years), potassium and sodium (6-12 years) were lower. CONCLUSIONS: Overall consumption of WG was low. Children and adolescents who consumed the most servings of WG had better diet quality and nutrient intake.

Relationship between whole grain and fiber consumption and body weight measures among 6- to 18-year-olds.

OBJECTIVES: To examine the relationship between whole grain and fiber consumption and body weight measures in children 6 to 12 (n=3868) and adolescents 13 to 18 (n=4931) years old. STUDY DESIGN: Combined 1999 to 2004 National Health and Nutrition Examination Survey data were analyzed. Mean body mass index (BMI), BMI percentile, BMI z-score, waist circumference, and prevalence of overweight/obesity were compared across categories of whole grain consumption (0 to <0.6, >or=0.6 to <1.5, >or=1.5 to <3, and >or=3 servings) with (1) a sex, ethnicity, and total energy intake-adjusted model and (2) a cereal fiber plus model 1 covariates profile. RESULTS: Mean whole grain intake was 0.59 and 0.63 servings/d among children 6 to 12 years and adolescents 13 to 18 years, respectively. In children, consumption of >or=3 servings of whole grain was not associated with body weight measures; however, consumption of 1.5 to <3 servings was positively associated with all weight measures. In adolescents, BMI z-score was significantly lower in the highest whole grain consumption group compared with the lowest 2 groups; BMI percentile and waist circumference (model 1 only) were also significantly lower in the highest whole grain consumption group. CONCLUSIONS: Overall consumption of whole grain was below current recommendations of at least 3 servings per day. Only in adolescents was this level of whole grain intake associated with lower BMI z-scores.

Relationship between 100% juice consumption and nutrient intake and weight of adolescents.

PURPOSE: This study investigated the associations among 100% juice consumption, nutrient intake, and measures of weight in adolescents. DESIGN: A cross-sectional secondary analysis of data from adolescents aged 12 to 18 years (n = 3939) participating in the National Health and Nutrition Examination Survey 1999-2002 was conducted to assess nutrient and weight in categories of 100% juice consumption. METHODS: Least square means and logistic regression analyses were generated, and were adjusted for gender, age, ethnicity, and energy intake. Analyses were Bonferroni corrected with an effective p value of .0125. RESULTS: Twenty-eight percent of adolescents (51% male, 42% Hispanic, 25% non-Hispanic white, 29% non-Hispanic black) consumed 100% juice the day of the recall. The mean amount of 100% juice consumed was 3.7 ounces (2.2% of energy intake). Compared with non-juice consumers, carbohydrate, fiber, vitamins C and B6, folate, potassium, copper, magnesium, and iron intakes of juice consumers were higher, and intakes of fat and saturated fatty acids were lower. Those consuming greater than 6 ounces of juice consumed more servings of fruit and less discretionary fat and added sugar than nonconsumers. No differences were found in weight by juice consumption group. CONCLUSION: In conclusion, when compared with non-juice consumers, adolescents consuming 100% juice did not show mean increased weight measures. Juice provided valuable nutrients, and consumption was associated with lower intakes of total fat, saturated fatty acids, discretionary fat, and added sugars and with higher intakes of whole fruit; however, consumption was not associated with decreased intake of milk, meat, or grains.

Nutrient intake, introduction of baby cereals and other complementary foods in the diets of infants and toddlers from birth to 23 months of age.

INTRODUCTION: Understanding which foods are introduced in the diet and when provides valuable information on complementary feeding. Fortified baby rice cereal is the most common first solid food given to infants, often followed by other baby cereals. The objective of this study was to examine food patterns among infants and toddlers consuming rice or non-rice baby cereals versus non-consumers. METHODS: NHANES 2001-2014 data were used to assess dietary intake, nutrient adequacy, and food specific patterns of infants and toddlers. Groups were: baby cereal non-consumers (n = 3,910), non-rice baby cereal consumers (n = 711), and rice baby cereal consumers (n = 966). Those consuming both non-rice cereal and rice cereal were included in the rice cereal group (n = 9, 48, 61, and 10 for those 0-3, 4-6, 7-11, and 12-23 mos, respectively). Least-square means ± SEs were determined for nutrient intake and food group consumption by using covariate controlled regression analyses (p < 0.01). RESULTS: Baby cereal consumer groups, compared to non-consumers, had higher intakes of carbohydrates, iron, calcium, magnesium, zinc, and vitamin E, with lower percentage having intakes below the Estimated Average Requirement for iron, calcium, and vitamin E. Infants 0-3 mos and 4-6 mos in both baby cereal consumption groups consumed other solid foods, including baby foods and beverages, sweetened beverages, coffee and tea, 100% juice, vegetables (excluding potatoes), fruit, sugars, milk and yogurt, and mixed dishes. The baby cereal consumers and non-consumers groups had intakes aligned with the "American diet". Baby cereal non-consumers had a significantly higher percentage of exclusively breast fed at ages 0-3 mos and a lower percentage formula fed. CONCLUSION: This study provides detailed information on the introduction of baby cereals which was associated with better nutrient intakes and other complementary foods and intakes of nutrients that require special attention during early life. Further, cow's milk products and solid foods were introduced prior to the American Academy of Pediatrics' age recommendations.

Relationship of added sugars intakes with physiologic parameters in adults: an analysis of national health and nutrition examination survey 2001-2012.

INTRODUCTION: Consumption of added sugars (AS) has been associated with increased risk for liver disease and risk factors for cardiovascular disease. The objective of this study was to further understand the relationship of AS intake with liver enzymes and risk factors for cardiovascular disease in adults (n = 29,687) participating in the National Health and Nutrition Examination Survey (NHANES) 2001-2012. METHODS: Individual usual intake (IUI) of AS was estimated using the Markov Chain Monte Carlo ratio method using two days of 24-hour dietary recalls gathered using standardized protocols. Subjects were separated into six consumption groups: 0 to <5%, 5 to <10%, 10 to <15%, 15 to <20%, 20 to <25% and ≥25% of energy as added sugars. Linear and group trends were determined using regression analyses for liver enzymes, cardiovascular risk factors, weight parameters, glucose, metabolic syndrome, and C-reactive protein. Logistic regression calculated odds ratios for these biomarkers above established risk levels (p < 0.01). RESULTS: There was an inverse group trend association with AS IUI for lower body mass index (beta = -0.12 kg/m2 across AS intake groups); % overweight/obese or % obese also showed inverse group trend (-1.44, -0.77, % units across AS intake groups, respectively). Liver enzymes did not show a significant association with AS IUI. Mean plasma glucose levels (mg/dL) showed an inverse linear (beta = -0.13 mg/dL per AS intake); and group association with energy from AS IUI (beta = -0.71mg/d L across AS intake groups). There was no association of AS intake with the risk of elevated uric acid levels; however, the odds of reduced uric acid levels was 17% lower with increasing intake of energy from AS IUI in group trend analysis only (0.83; 0.72-0.95 [99th CI]). CONCLUSION: Although it is sensible to consume AS in moderation, results suggested that higher intakes of AS were not consistently associated with physiologic parameters. Since the data were cross-sectional, they cannot be used to assess cause and effect. Thus, additional studies are warranted to confirm these findings with more rigorous study designs.