Dietary supplement use among infants, children, and adolescents in the United States, 1999-2002.

OBJECTIVE: To describe dietary supplement use among US children. DESIGN: Analysis of nationally representative data from the 1999-2002 National Health and Nutrition Examination Survey (NHANES). SETTING: Home interviews and a mobile examination center. PARTICIPANTS: Children from birth through 18 years who participated in NHANES (N=10,136). MAIN EXPOSURE: Frequency of use of any dietary supplement product. OUTCOME MEASURE: Prevalence of use and intake of key nutrients from supplements among children. RESULTS: In 1999-2002, 31.8% of children used dietary supplements, with the lowest use reported among infants younger than 1 year (11.9%) and teenagers 14 to 18 years old (25.7%) and highest use among 4- to 8-year-old children (48.5%). Use was highest among non-Hispanic white (38.1%) and Mexican American (22.4%) participants, lowest among non-Hispanic black participants (18.8%), and was not found to differ by sex. The type of supplement most commonly used was multivitamins and multiminerals (18.3%). Ascorbic acid (28.6%), retinol (25.8%), vitamin D (25.6%), calcium (21.1%), and iron (19.3%) were the primary supplemental nutrients consumed. Supplement use was associated with families with higher incomes; a smoke-free environment; not being certified by the US Department of Agriculture Special Supplemental Nutrition Program for Women, Infants and Children in the last 12 months; lower child body mass index; and less daily recreational screen time (television, video games, computers, etc) (P<.005). The highest prevalence of supplement use (P<.005) was in children who were underweight or at risk for underweight (P<.005). CONCLUSIONS: More than 30% of children in the United States take dietary supplements regularly, most often multivitamins and multiminerals. Given such extensive use, nutrient intakes from dietary supplements must be included to obtain accurate estimates of overall nutrient intake in children.

Fruit and vegetable assessment: performance of 2 new short instruments and a food frequency questionnaire.

OBJECTIVE: To evaluate the ability of 2 new short assessment instruments and a food frequency questionnaire (FFQ) to measure intake of fruit and vegetables. The "All-Day" screener asks frequency and portion size questions about 9 food items. The "By-Meal" screener is similar, except that it asks about 2 of those 9 food items in terms of mealtime. DESIGN: Survey participants completed 4 telephone-administered 24-hour dietary recalls over 1 year, a self-administered FFQ 1 to 2 months later, and 1 of 2 self-administered screeners after an additional 7 months. SUBJECTS/SETTING: Participating were 202 men and 260 women aged 20 to 70 years living throughout the United States. STATISTICAL ANALYSES: Fruit and vegetable intakes measured by each screener and the FFQ were compared with true usual intake based on a measurement error model with 24-hour dietary recalls as the reference instrument. RESULTS: Estimates of median daily servings of fruit and vegetables were as follows: For men: True intake (5.8) vs All-Day screener (5.0), By-Meal screener (5.5), and FFQ (6.6); for women: true intake (4.2) vs All-Day screener (5.0), By-Meal screener (5.4), and FFQ (6.2). Estimated correlations between the test instruments and true intake were as follows: For men: All-Day screener (0.66), By-Meal screener (0.67), FFQ (0.68); for women: All-Day screener (0.51), By-Meal screener (0.53), and FFQ (0.54). APPLICATIONS/CONCLUSIONS: Both screeners might be useful to estimate median intakes of fruit and vegetable servings in US populations, but they might be less useful in accurately ranking individuals. More research is needed before using the screeners in ethnic or low-literacy populations.

Total folate and folic acid intake from foods and dietary supplements in the United States: 2003-2006.

BACKGROUND: The term total folate intake is used to represent folate that occurs naturally in food as well as folic acid from fortified foods and dietary supplements. Folic acid has been referred to as a double-edged sword because of its beneficial role in the prevention of neural tube defects and yet possible deleterious effects on certain cancers and cognitive function. Previous monitoring efforts did not include folic acid from dietary supplements and are therefore not complete. OBJECTIVE: Our objective was to combine data on dietary folate (as measured by two 24-h recalls) and folic acid from dietary supplements (collected with a 30-d frequency questionnaire) with the use of the bias-corrected best power method to adjust for within-person variability. DESIGN: The National Health and Nutrition Examination Survey (NHANES) is a nationally representative, cross-sectional survey. Linear contrasts were constructed to determine differences in dietary and total folate intake for age and racial-ethnic groups by sex; prevalence of inadequate and excessive intakes is presented. RESULTS: In 2003-2006, 53% of the US population used dietary supplements; 34.5% used dietary supplements that contained folic acid. Total folate intake (in dietary folate equivalents) was higher for men (813 +/- 14) than for women (724 +/- 16) and higher for non-Hispanic whites (827 +/- 19) than for Mexican Americans (615 +/- 11) and non-Hispanic blacks (597 +/- 12); 29% of non-Hispanic black women had inadequate intakes. Total folate and folic acid intakes are highest for those aged > or =50 y, and 5% exceed the Tolerable Upper Intake Level. CONCLUSIONS: Improved total folate intake is warranted in targeted subgroups, which include women of childbearing age and non-Hispanic black women, whereas other population groups are at risk of excessive intake.

Measurement of household food security in the USA and other industrialised countries.

OBJECTIVE: To describe the history and current status of household food security measurement. CONCLUSIONS: In the 1980s evidence of rising levels of hunger was a concern for many, but disputed by some, Americans. Acknowledgement and quantification of hunger was hindered by the lack of an accepted definition and measure of hunger. Qualitative research at Cornell provided a conceptual framework, description, definition and survey items for hunger. The Community Childhood Hunger Identification Project developed an instrument used in numerous communities. Based upon these initiatives, widely accepted definitions of hunger and food insecurity, and the US Household Food Security Module for its measurement, now exist. The module classifies households as food-secure, or food-insecure without hunger or with moderate or severe hunger, and contains household-, adult- and child-referent items. Its inclusion in the Current Population Survey (CPS) since 1995 has yielded annual estimates of food insecurity. A six-item short form of the module, for surveys with severe time constraints, classifies households only as food-secure or food-insecure without or with hunger and contains no child-specific items. Surveys using the 18-item or short-form module can compare results with published national data from the CPS. Information about the module is available at http://www.ers.usda.gov/briefing/foodsecurity and http://www.fns.usda/fsec. Current research on food security measurement includes measurement of individual food insecurity and hunger, module performance regarding hunger duration and frequency, performance of the module in population sub-groups, and the effect of translations on module meaning and performance. National surveys in Canada, New Zealand and Australia also have measured food security.

National nutrition data: contributions and challenges to monitoring dietary supplement use in women.

Survey data from three nationally representative surveys--the National Health and Nutrition Examination Survey, National Health Interview Survey and Continuing Survey of Food Intakes by Individuals--indicate that, in general, women are greater consumers of dietary supplements than men in terms of overall prevalence of use and number of supplements taken. However, monitoring dietary supplement use over time and aggregation or comparison of findings over different surveys is hampered by a lack of comparability between survey data collection and analysis. Differences exist in the types of dietary supplements queried, use of a referent time frame, specificity regarding the supplement taken and level of detail collected relating to personal usage. Some comparability in supplement data collection may be possible but some inconsistencies may persist because of differences in survey goals or collection procedures. Collection of data on dietary supplement use is challenging and collection of very detailed and precise data are time consuming and expensive. Consequently, the level of detail and precision necessary for monitoring, research, and policy uses is an issue that should be addressed in view of the high monetary and time costs of detailed dietary supplement data collection, as well as increased demands on survey respondent time.

Weight change and the risk of late-onset breast cancer in the original Framingham cohort.

OBJECTIVE: Adult weight gain has been associated with a twofold risk of postmenopausal breast cancer. Data are limited regarding whether weight gain at specific periods of marked changes in estrogen- and insulin-related hormones have different risk associations. This study assesses the relation of adult weight change overall and at specific, hormonally relevant times with diagnosis of a first breast cancer after age 55 (late onset). METHODS: Framingham study data were used to assess premenopausal (25-44 yr), perimenopausal (45-55 yr), postmenopausal (after 55 yr), and adult lifetime (from 25 yr) weight change in relation to late-onset breast cancer in 2,873 women followed for up to 48 yr, with 206 late-onset breast cancers. RESULTS: Adult lifetime weight gain was associated with an increased risk of late-onset breast cancer (P trend = 0.046). Weight gain during specific time periods was not associated with breast cancer. Data suggested a possible decreased risk of breast cancer with weight loss from ages 25 to 44 and 45 to 55 yr (relative risk = 0.4 [0.2-1.2] and 0.5 [0.3-0.9], respectively). CONCLUSION: These data confirm prior reports of an association between adult lifetime weight gain and increased risk of late-onset breast cancer and support current recommendations to avoid adult weight gain.