Sources of bias in a dietary survey of children

OBJECTIVE: To compare non-responders and responders to a dietary survey with respect to demographic variables and intention to choose selected breakfast foods, and to examine if there was any systematic change in number of food items reported during a 7 d recording period. DESIGN: Cross-sectional survey. SETTING: M?lndal, Sweden. SUBJECTS: All pupils in 5th, 7th and 9th grades in the municipality were asked to complete a questionnaire during school hours. All those present (n = 1584, 92% of total) answered questions about lifestyle factors and about intentions, attitudes and beliefs concerning high-fibre bread and milk with varying fat content. All subjects in the initial sample were asked to fill in a 7 d record of food consumed. Acceptable food records were completed by 69% of the initial participants. RESULTS: Subjects not completing the food record differed significantly from participants with respect to demographic, lifestyle and dietary factors. Dropout was more common among those who reported not usually eating breakfast and among those intending to drink whole milk for breakfast. A decline in reported food items during the recording period was also observed. CONCLUSIONS: Two sources of bias were observed here, one indicating significant differences between non-participants and participants, the other suggesting the presence of a time-dependent trend in number of recorded foods. It is likely such biases are present in other dietary surveys involving schoolchildren, and should be taken into consideration in the design, analysis and interpretation of such studies.     

Impact of breakfast consumption on nutritional adequacy of the diets of young adults in Bogalusa, Louisiana: ethnic and gender contrasts

OBJECTIVE: To evaluate the impact of breakfast consumption patterns on the nutritional adequacy of diets of young adults and determine possible ethnic and gender differences. DESIGN AND SETTING: Cross-sectional survey of young adults in Bogalusa, La. SUBJECTS: Twenty-four-hour dietary recalls were collected from October 1988 through October 1991 on 504 young adults (mean age=23 years, 58% women, 70% white). STATISTICS: Analysis of variance and logistic regression techniques were used to investigate the relationship of breakfast consumption, ethnicity, and gender on dietary adequacy. The P values are from an analysis of variance model that adjusted for gender and ethnicity. RESULTS: Thirty-seven percent of young adults skipped breakfast. Of those who ate breakfast, 75% ate at home, 10% ate a fast-food breakfast, and 15% reported other sources. Mean energy intake from breakfast was 485 kcal; men consumed more energy than women (P<.001), and blacks consumed more energy than whites (P<.01). The breakfast meal provided an average of 13% of energy from protein, 55% from carbohydrate, 14% from sucrose, 34% from fat, and 12% from saturated fat. Whites consumed a breakfast higher in carbohydrate and sucrose than blacks, who consumed a breakfast higher in fat and saturated fat. Variations in breakfast foods consumed explained the racial differences in the nutrient composition of the breakfast meal. Young adults who skipped breakfast had lower total daily intakes of energy (P<.0001), protein per 1,000 kcal (P<.05), and saturated fat per 1,000 kcal (P<.01) than those who consumed breakfast. For all vitamins and minerals studied, a higher percentage of young adults who skipped breakfast did not meet two thirds of the Recommended Dietary Allowance than those who consumed a breakfast. APPLICATIONS: Encouraging consumption of breakfast, along with selection of more healthful breakfast food choices or snacks that are culturally appropriate, may be important strategies for improving the nutritional quality of young adults' diets.     

Cognitive, motivational, social, and environmental influences on children's food choices.

Tested a value–expectancy model of motivation regarding children's food choices by establishing associations between relevant beliefs and food choices, using 107 children (aged 5–13 yrs). Ss rated 15 foods in terms of possible choice criteria and social or environmental influences. Results show that Ss at the operational level of development tended to be characterized by health orientation in food choice, taste orientation, or multiple-motive orientation. Dietary quality was poorest in the taste-oriented group. Ss at the preoperational level tended to have 1 of 2 undifferentiated patterns of values across the correlational indices. The authors conclude that there is evidence of the viability of cognitive-motivational models to explain children's food choices. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sensory-specific satiety: comparison of taste and texture effects

The respective contributions of taste (saltiness and sweetness) and texture (the hardness dimension) to sensory-specific satiety (SSS) were compared. Sixteen male and 16 female, young, normal-weight adults rated the pleasantness of taste, pleasantness of texture and desire to eat on visual analog scales for eight test foods, were then given one of the foods to eat ad libitum for lunch, and re-rated the same parameters for the eight foods 2 and 20 min after the end of the meal. The experimental sets of eight test foods and four lunch foods were balanced for taste quality (salty vs. sweet) and texture quality (hard vs. soft). Lunch foods were the hard and soft versions of a salty food (ham and cheese sandwich on baguette vs. white bread) or of a sweet food (apples vs. applesauce). Sensory-specific satiety was observed for both saltiness and sweetness (e.g. pleasantness of the taste of, and desire to eat sweet test foods decreased significantly after eating a sweet lunch food and similarly for salty foods), and to a lesser extent for texture (e.g. pleasantness of the texture of, and desire to eat hard test foods decreased after eating a hard lunch food and similarly for one of the soft foods). The authors conclude texture-specific satiety may be a significant component of satiety.     

Cost and outcome analysis of home parenteral and enteral nutrition

BACKGROUND: Previous estimates of the cost of home parenteral and enteral nutrition (HPEN) have excluded hospitalization costs or were conducted abroad and have limited applicability in the United States. Few studies have used validated measures to determine the effect of home nutrition support on quality of life. METHOD: A cost and clinical outcome analysis was performed by retrospective review of charts of patients receiving HPEN from 1991 to 1996. Questionnaires to determine the influence of therapy on lifestyle (n = 41) and a general health status questionnaire, the short form 36-item survey (n = 39), were mailed to patients. RESULTS: The annual cost per patient for parenteral solutions was $55,193 +/- 30,596 (mean +/- SD) based on Medicare charges and for enteral tube feedings was $9605 +/- 9327. The annual cost of hospitalization ranged from zero to $140,220 in the parenteral nutrition group and from zero to $39,204 in the enteral nutrition group. The annual number of hospitalizations per patient for patients receiving parenteral nutrition ranged from 0.52 to 1.10, compared with 0 to 0.50 in the enteral nutrition population. The health status of HPEN patients was significantly lower (p < .05) in five of the eight short-form 36 health domains compared with the general population. The areas of lifestyle most frequently affected were travel, sleep, exercise and leisure. CONCLUSIONS: The majority of the cost of therapy was associated with the direct provision of nutrition, although in some patients the hospitalization expenditure exceeded this cost. Home nutrition support had a significant negative impact on a patient's quality of life and lifestyle.     

Comparing the effects of aspartame and sucrose on motivational ratings, taste preferences, and energy intakes in humans

This study compared the effects of four breakfast preloads on motivational ratings, taste preferences, and energy intakes of 24 normal-weight nondieting young men and women. The preloads, composed of creamy white cheese (fromage blanc), were either plain or sweetened with aspartame or sucrose. Their energy value was either 1255 or 2929 kJ (300 or 700 kcal). Taste preferences were measured before and 150 min after breakfast. Motivational ratings were obtained at 30-min intervals. The subjects ate lunch, snack, and dinner meals in the laboratory. The consumption of low-energy as opposed to high-energy breakfasts, regardless of sweetness, led to elevated motivational ratings and increased energy intakes at lunch. However, intakes at subsequent meals were the same for all preloads, and no overall compensation in energy was observed. Aspartame did not promote hunger or lead to increased energy intakes in normal-weight subjects.     

Class differences in the food rules mothers impose on their children: a cross-national study

Many studies indicate that children in middle-class families have healthier eating habits than children in lower class families. Class differences in food rules, which parents and especially mothers impose on their children, may underlie these social inequalities in food consumption. The present study uses education as a classifying variable and analyses whether mothers with higher education prescribe more "healthy" foodstuffs for their children and whether they restrict more "unhealthy" food items than less educated mothers. Moreover, the study examines whether higher class mothers consider health aspects more often and the preferences of their family members less often in their choice of food, and whether class differences in these considerations explain class differences in food rules. To answer these questions, questionnaires on the food practices of 849 women living in middle-class or lower class districts in Maastricht (the Netherlands), Liège (Belgium) and Aachen (Germany) were collected and analysed. The majority of mothers in each city prescribed primarily foods that were served at dinner like meat and vegetables, and most mothers limited their children's consumption of sweet foods, soft drinks and snacks. Higher class mothers restricted more foods, but prescribed as many food items as their lower class counterparts. Class differences in the number of restricted foods were partly, but not completely, explained by class differences in health and taste considerations. Despite national variations in dietary habits and possibly in the education of children, class differences in food rules and the explanatory power of health and taste considerations were comparable in the three cities.     

Comparison of price change and health message interventions in promoting healthy food choices.

This study examines the feasibility and effectiveness of an environmental intervention for improving diet by comparing the impact of health messages, lowered prices, and their combination on the purchase of healthy food items in a restaurant. Price decreases alone, rather than a combination of price decreases and health messages, were associated with a higher level of increased purchases of some healthy food items as compared with control items over a 4-month period. Price decreases may be a more powerful means than health messages of increasing consumption of healthy foods. Health messages may have paradoxical effects if foods labeled as healthy are assumed to taste bad. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The human mast cell line HMC-1 binds and responds to C3a but not C3a(desArg)

OBJECTIVE: To evaluate the breakfast intake of calcium and milk products and to determine whether these correlate with total intake of both calcium and milk products. METHODS: Food taken at breakfast and throughout the day was recorded using a 7 consecutive day food record in 200 schoolchildren aged between 9 and 13 years. RESULTS: 65.3% of boys and 80.5% of girls showed intakes of calcium which were lower than recommended. Milk products were the foods most frequently included in breakfast (95.5% of subjects included them in this meal). A relationship was seen between energy provided by breakfast and the quantities of milk products (r = 0.5735) and calcium (r = 0.6908) taken at this meal. A relationship was also seen between energy provided by breakfast and daily intake of milk products (r = 0.4633) and calcium (r = 0.4954). The percentage of intakes of calcium lower than those recommended decreased when breakfast provided > or = 20% of total energy intake, and when the consumption of milk products at breakfast was greater than the 50th percentile (200 ml). Subjects with breakfast milk product intakes > or = 200 ml showed higher intakes of the same over the rest of the day (233.3 +/-140.4 g) than did those who took lesser quantities of these foods at breakfast (161.5 +/- 100.6 g). Further, those who took > or = 25% of the recommended intake of calcium at breakfast showed greater intakes of the same over the rest of the day (600.4 +/- 213.8 mg compared to 510.8 +/- 200.7 mg in subjects with lower calcium intakes). CONCLUSIONS: The intake of milk products (r = 0.7587) and calcium (r = 0.7223) at breakfast correlates with the consumption of these foods in the whole diet. However, the total daily intake of milk products and calcium does not depend solely on breakfast intake. Subjects with the greatest intakes at breakfast also showed greater intakes over the rest of the day (r = 0.3953 for milk products and r = 0.4122 for calcium).     

A role for sweet taste: Calorie predictive relations in energy regulation by rats.

Animals may use sweet taste to predict the caloric contents of food. Eating sweet noncaloric substances may degrade this predictive relationship, leading to positive energy balance through increased food intake and/or diminished energy expenditure. These experiments were designed to test the hypothesis that experiences that reduce the validity of sweet taste as a predictor of the caloric or nutritive consequences of eating may contribute to deficits in the regulation of energy by reducing the ability of sweet-tasting foods that contain calories to evoke physiological responses that underlie tight regulation. Adult male Sprague-Dawley rats were given differential experience with a sweet taste that either predicted increased caloric content (glucose) or did not predict increased calories (saccharin). We found that reducing the correlation between sweet taste and the caloric content of foods using artificial sweeteners in rats resulted in increased caloric intake, increased body weight, and increased adiposity, as well as diminished caloric compensation and blunted thermic responses to sweet-tasting diets. These results suggest that consumption of products containing artificial sweeteners may lead to increased body weight and obesity by interfering with fundamental homeostatic, physiological processes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Variables affecting high school students' perceptions of school foodservice

OBJECTIVE: To determine if student satisfaction with high school foodservice is directly related to participation in the foodservice. DESIGN: A valid and reliable survey was conducted in a variety of classes such as English, history, and health science in grades 9 through 12, representing students aged 13 through 19 years. Students were asked 38 questions concerning variety of food, food quality, foodservice staff, aesthetics of the serving and dining area, and demographics. SUBJECTS/SETTING: The study was conducted with 1,823 students from 9 schools representing 4 geographic regions. STATISTICAL ANALYSIS: Stepwise multiple regression was used to determine the independent variables (attributes desired by the students) that most highly correlated with the dependent variable (satisfaction with the school foodservice overall). RESULTS: Variables most highly correlated with overall satisfaction were variety of food offered, flavor of food, attractiveness of food on the serving line, staff smiling and greeting students, quality of food choices, choices that allow students to meet cultural and ethnic preferences, courteousness of the staff, and quality of ingredients. Variety of food offered was the best predictor of satisfaction. A statistically significant difference was found (P<.01) between groups that never ate school lunch and those that ate school lunch 3 to 5 times per week on dining ambiance, food quality, and staff. The results indicate that satisfaction with foodservice is associated with purchase behavior in school foodservice programs. APPLICATIONS: School foodservice and nutrition programs are critically important for providing nutrition to millions of our future leaders. Today it is not enough to prepare healthful, good-tasting food. High school students are sophisticated and are exposed at an early age to a variety of dining experiences including fast foods, ethnic cuisine, and fine dining. These factors have influenced the attributes students use to evaluate school foodservice. To maintain participation levels and financial stability, school foodservice professionals should evaluate student satisfaction with food quality, variety, and other variables that affect overall satisfaction and participation. These data may then be incorporated into continuous quality improvement and strategic planning. Marketing must be incorporated into the strategic plan to influence student participation.     

Food poisoning. Causes, remedies, and prevention

Food producers and consumers must continue to take precautions against foodborne diseases, and early diagnosis and appropriate treatment of these illnesses are essential. Food products and water can become contaminated with microorganisms and toxins that make people ill, and the very young, the elderly, and immunocompromised individuals are especially susceptible. Education of healthcare providers, food handlers, and the public is critical in reducing the incidence and spread of foodborne illness. Changes in eating habits and lifestyle and increased availability of both domestic and imported foods have made food hazards a more complex public health issue. Although most foodborne illnesses can be avoided by safe food handling procedures (see box on page 134), risk reduction is very important at every step from source to table. A concerted effort is needed to ensure continuing safety of the food supply in the United States while also assuring access to a wide variety of healthful foods. Time will tell whether consumers will accept irradiation of meats. If accepted, irradiation could rank in importance with pasteurization of milk and chlorination of water as a public health measure.     

Food intakes of adult Melbourne Chinese

Food intake patterns of 545 adult Melbourne Chinese were studied in 1988 and 1989 using a 220-item food-frequency questionnaire appropriate for Chinese eating practices. Men and women were compared, adjusting for age, time in Australia and education. Men consumed more rice and alcoholic beverages as energy. In women, the energy intake was derived from foods of traditional Chinese types. There were two types of consumption patterns: in the first group were those who acculturated towards an Australian way of eating by replacing some traditional Chinese foods, such as rice, pork, leafy green and cruciferous vegetables, soups and tea, with 'new foods', such as wheat products, red meats and coffee; in the second were those who limited their intake to a handful of traditional Chinese foods as the major source of energy. The educated, the professional and those with an administrative profession, the Australian-born and those with a longer length of stay fitted into the first group, and were more acculturated towards Australia than those born in the People's Republic of China or Vietnam and who migrated at an older age. The first group may benefit from the best of both worlds, but may risk the diseases of an industrialised society. The second group may be trapped at a cultural crossroads and may be unable to make appropriate food choices. Public health efforts in Australia, where one in every five is overseas-born, should provide for nutrition and health education for new and aged migrants of non-European cultural backgrounds.     

Olestra Postmarketing Surveillance Study: design and baseline results from the sentinel site

OBJECTIVE: To describe the design of the Olestra Postmarketing Surveillance Study (OPMSS) and to present baseline results from the sentinel site. The purpose of the OPMSS is to monitor consumption patterns of olestra-containing snacks and to determine whether consumption affects nutritional status. DESIGN: The OPMSS combines repeated cross-section, random-digit dial telephone surveys before and after the market release of olestra-containing foods as well as intensive dietary and clinical assessments on a subsample of survey participants. SUBJECTS: Data are from baseline telephone (n = 1,962) and clinical (n = 1,069) assessment of participants (aged 18 to 74 years) in the Marion County, Indiana, sentinel site. Mean age of participants in the telephone survey was 43.2 years; 19% of respondents were black and 29% had completed college. STATISTICAL ANALYSIS: Analyses examined associations among savory snack use, fruit and vegetable consumption, and demographic and health-related characteristics. Data from the telephone survey were adjusted to be representative of the Marion County population. RESULTS: Almost 96% of the population surveyed had eaten savory snacks in the month before the survey: 74% had eaten regular-fat, 26% fat-reduced, and 78% nonfat types. Total snack consumption did not differ by gender, education, or race. Residents younger than 35 years ate snacks 16 times a month compared with 12 times a month among older residents. Types of snacks consumed differed markedly by demographic characteristics. Male, younger, and less educated residents ate more regular-fat snacks; female, white, and college-educated residents ate more nonfat snacks. In general, residents practicing healthful behaviors, including not smoking, eating fruits and vegetables, and exercising, also ate fewer regular-fat and more nonfat snacks. Fat intake was also related linearly to use of snack foods, ranging from 33.2% of energy among those consuming 1 serving per month or less to 36.8% among those consuming 20 or more servings per month. APPLICATIONS/CONCLUSIONS: Procedures for recruitment and nutrition assessment appear adequate for evaluating the impact of olestra consumption on nutritional status. Nutritionists should be aware that there is potential for relatively high olestra consumption, given that almost 35% of Marion County residents eat snack foods at least 20 times a month. Consumers eating at least 20 servings of snacks per month derived more than 12% of their total energy and fat from snack foods, which suggests that substituting olestra snacks could substantially reduce intakes of fat and energy.     

Adolescent breakfast skipping: an Australian study

Eating breakfast is important for the health and development of children and adolescents. This paper reports on the findings of an Australian survey of 699 thirteen-year-olds concerning the extent of skipping breakfast. Results indicated that approximately 12% of the sample skipped breakfast. Gender was the only statistically significant sociodemographic variable, with females skipping at over three times the rate of males. Skippers were more likely to be dissatisfied with their body shape and to have been on a diet to lose weight than were those who ate breakfast. However, in a follow-up telephone survey, the reasons given for skipping breakfast were almost exclusively lack of time and not being hungry in the morning. While North American school nutrition programs have considered poverty to be a key issue in breakfast skipping, these findings suggest that, for Australian adolescents, skipping breakfast is a matter of individual choice.     

Glutamate and the UMAMI taste: sensory, metabolic, nutritional and behavioural considerations. A review of the literature published in the last 10 years

Monosodium glutamate (MSG) is used increasingly often in processed foods and in home cooking in the Western world. This substance is responsible for a pleasurable taste sensation, the Umami taste. This review covers recent developments in sensory studies of glutamate effects, and traces the Umami taste from sensory receptors on the tongue to the brain. The metabolism of glutamic acid, as revealed from recent literature, is described. A specific section is devoted to safety issues. In addition, effects of glutamic salts on nutrition and ingestive behaviours are shown to be potent. Animal and human works are treated separately, with special attention to the specific methods used in both cases. Future areas of research include further investigation of sensory physiology, role of glutamate as an excitatory substance in the brain, acquisition of food likes and impact on long-term food selection, food intake, and body weight control.     

Nutrition support programs for young adult athletes

After graduating from college and entering the work force, young adult athletes often struggle with the task of fueling themselves optimally for top performance and weight control. The stresses and time constraints of work, family, and social responsibilities often result in eating fast foods on the run. These young adults can benefit from nutrition education programs in the worksite, at health clubs, in the community, and via the media. Dietitians who specialize in sport nutrition have particular appeal to these athletes, who are struggling to each well, exercise well, and stay lean yet put little time or effort into their food program. This article includes two case studies of young adults and the dietary recommendations that taught them how to make wise food choices, fuel themselves well for high energy, and control their weight.     

Relationship of nutrition knowledge and obesity in adolescence

BACKGROUND: The prevalence of obesity in adolescence is increasing. This study determined whether a lack of nutrition knowledge is correlated with obesity in adolescents. METHODS: We distributed a survey at three high schools to 292 9th-through 12th-grade students. The questionnaire examined the students' nutrition knowledge, food-related behaviors, and food preferences. The students' body mass indices (BMI) were calculated from self-reported weights and heights. Obesity was defined as a BMI greater than the 85th percentile, using criteria from the National Health and Nutrition Examination Survey II. RESULTS: Of 292 students contacted, 289 returned the survey. The population had a prevalence of obesity of 26%. There were no significant differences in nutrition knowledge between the obese and non-obese students with the exception that obese students were better able to identify high-fiber foods. In addition, obese students were more likely to report infrequent meals with their family. Otherwise, there were no significant differences in nutrition behaviors or food preferences. CONCLUSIONS: Overall nutrition knowledge did not differ between obese and non-obese adolescents.