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Objective Dietary supplements are not recommended as part of a weight-loss program due to concerns about efficacy and safety. This study sought to assess prevalence and duration of nonprescription weight-loss supplement use, associated weight-control behaviors, discussion of use with a health care professional, and specific ingredient use. Participants and design Adults aged [greater than or equal to] 18 years (n=9,403) completed a cross-sectional population-based telephone survey of health behaviors from September 2002 through December 2002. Statistical analyses performed Both [chi square] and t tests were conducted for categorical and mean comparisons and multiple variable logistic regression was used to determine significant predictors. Results An estimated 15.2% of adults (women 20.6%, men 9.7%) had ever used a weight-loss supplement and 8.7% had past year use (women 11.3%, men 6.0%); highest use was among women aged 18 to 34 years (16.7%). In regression models, use was equally prevalent among race/ethnic groups and education levels. One in 10 (10.2%) of users reported [greater than or equal to] 12 month use, with less frequent long-term use in women (7.7%) than men (15.0%), P=0.01. Almost one third (30.2%) of users discussed use during the past year; 73.8% used a supplement containing a stimulant including ephedra, caffeine, and/or bitter orange. Conclusions Use of supplements for losing weight seems to be common among many segments of the US adult population. Many adults are long-term users and most do not discuss this practice with their physician. Most of the weight-loss supplements taken contain stimulants. Qualified professionals should inquire about use of supplements for weight loss to facilitate discussion about the lack of efficacy data, possible adverse effects, as well as to dispel misinformation that may interfere with sound weight-management practices.

Objective This study investigated food choices made by individuals consuming diets differing in energy density and explores relationships between energy density and diet quality. Design Cross-sectional, nationally representative survey. Subjects 7,500 adults (older than 19 years) in the 1994-1996 Continuing Survey of Food Intakes by Individuals. Statistical analysis Energy density values were calculated from reported food intake. Subjects were classified as consuming a low-energy-density diet, medium-energy-density diet, or high-energy-density diet using tertile cutoffs. For each group, the percentage consuming various foods/beverages and the mean amount of foods/beverages they consumed was determined along with mean nutrient intakes. Results Compared with participants consuming a high-energy-density diet, those with a low-energy-density diet had a lower energy intake but consumed more food, by weight, from most food groups. A low-energy-density diet included a relatively high proportion of foods high in micronutrients and water and low in fat, such as fruits and vegetables. Subjects with a low-energy-density diet consumed fewer (nonwater) beverages such as caloric carbonated beverages. They also consumed less fat and had higher intakes of several important micronutrients, including vitamins A, C, and B-6, folate, iron, calcium, and potassium. Conclusions These analyses further demonstrate the beneficial effects of a low-energy-density diet, which was associated with lower energy intakes, higher food intakes, and higher diet quality than a high-energy-density diet. To achieve a low-energy-density diet, individuals should be encouraged to eat a variety of fruits and vegetables as well as low-fat/reduced-fat, nutrient-dense, and/or water-rich grains, dairy products, and meats/meat alternatives.

Dietary energy density [kcal/g (kJ/g)] influences energy intake under controlled laboratory conditions. Little is known about the energy density of the diets of free-living persons. Because energy density investigations are a relatively new endeavor, there are neither standard calculation methods nor published nationally representative values. This paper examines the calculation of energy density based on systematic exclusion of beverage categories, presents data on variability, and compares values by sex, age, and race/ethnicity in a representative sample of U.S. adults. Mean daily dietary energy density values for adults (aged > 19 y) were calculated using two 24-h recalls from the Continuing Survey of Food Intakes by Individuals 1994-1996 based on food, food and liquid meal replacements, food and alcohol, food and juice, food and milk, food and juice and milk, food and energy-containing beverages, and food and all beverages. Energy density varied by calculation method, ranging from 0.94 to 1.85 kcal/g (3.93-7.74 kJ/g). Intraindividual-to-interindividual CV ratios were highest for the food and energy-containing beverages calculation. Men reported diets with a higher energy density than women for all calculation methods (P < 0.0001). There were differences by race/ethnicity and an inverse linear trend for age. These data indicate that beverage inclusion schemes should be clearly defined when reporting energy density values. In epidemiologic studies, calculations based on food and all beverages and food and energy-containing beverages may diminish associations with outcome variables. These nationally representative data, which provide an important frame of reference for other studies, indicate that dietary energy density differs by sex, age, and race/ethnicity. KEY WORDS: * energy density * intraindividual variation * methodology * diet

Objective. Although many studies have found that childhood levels of body mass index (BMI; kg/[m.sup.2]) are associated with adult levels, it has been reported that childhood BMI is not associated with adult adiposity. We further examined these longitudinal associations. Design. Cohort study based on examinations between 1973 and 1996. Setting. Bogalusa, Louisiana. Participants. Children (2610; ages 2-17 years old) who were followed to ages 18 to 37 years; the mean follow-up was 17.6 years. Main Outcome Measures. BMI-for-age and triceps skinfold thickness (SF) were measured in childhood. Subscapular and triceps SFs were measured among adults, and the mean SF was used as an adiposity index. Adult obesity was defined as a BMI [greather than or equal to] 30 kg/[m.sup.2] and adult overfat as a mean SF in the upper (gender-specific) quartile. Results. Childhood levels of both BMI and triceps SF were associated with adult levels of BMI and adiposity. The magnitude of these longitudinal associations increased with childhood age, but the BMI levels of even the youngest (ages 2-5 years) children were moderately associated (r = 0.33-0.41) with adult adiposity. Overweight (BMI-for-age [greater than or equal to] 95th centile) 2- to 5-year-olds were >4 times as likely to become overfat adults (15 of 23 [65%]), as were children with a BMI < 50th centile (30 of 201 [15%]). Even after accounting for the triceps SF of children, BMI-for-age provided additional information on adult adiposity. Conclusions. Childhood BMI is associated with adult adiposity, but it is possible that the magnitude of this association depends on the relative fatness of children. Pediatrics 2005;115:22-27; body mass index, obesity, adult adiposity, Bogalusa Heart Study, longitudinal study, skin folds., ABBREVIATIONS. BMI, body mass index; SF, skinfold thickness. Despite the limitations of weight-height indices, (1,2) they are widely used as indicators of adiposity. Several investigators have found that childhood body [...]

Guidelines for counseling obese patients are presented, based on a model developed by the National Institutes of Health. It involves assessing obesity risk, asking about readiness to lose weight, helping patients design a weight loss program, establishing an appropriate treatment, and following up on a regular basis. Obesity is a chronic condition and may require long-term treatment.

The number of Americans with morbid obesity increased from less than 1 percent in 1990 to 2% in 2000, according to data from the Behavioral Risk Factor Surveillance System survey. Morbid obesity is defined as a body mass index (BMI) of 40 or more. People with normal weights have a BMI of 25 or less. People with morbid obesity have the most severe health problems and are twice as likely to die prematurely as people who are only moderately obese.

We used nationally representative data from the third National Health and Nutrition Examination Survey (NHANES III) to examine the relationship between low iron stores (serum ferritin < 12 [micro]g/L) and dietary patterns that might affect iron status among Mexican American (MA) and non-Hispanic white (NHW) girls and women of reproductive age (12-39 y). Dietary data from the qualitative food-frequency questionnaire were used to classify subjects into three categories (using the 25th and 75th quartile values for NHW) for intake of heme iron, nonheme iron, iron absorption enhancers, and iron absorption inhibitors. The prevalence of low iron stores was 17.4% among MA (n = 1368) and 7.9% among NHW (n = 1473). Compared with high intake, the adjusted odds ratio (OR) for low iron stores was 1.80 [95% confidence interval (CI), 1.24-2.62] for medium intake of heme iron and 0.48 (95% CI, 0.25-0.91) for low intake of nonheme iron (plus iron supplement). Compared with no use, use of vitamin C supplements was associated with half the risk of low iron stores (OR = 0.50; 95% CI, 0.29-0.87). Similar results were found after income and parity were controlled for, except that the protective effect of vitamin C supplements was no longer significant. Even after adjustment for sociodemographic and dietary factors, MA women remained at increased risk for low iron stores (OR = 1.80; 95% CI, 1.30-2.49) indicating that the reasons for the higher prevalence of iron deficiency in MA women warrants further investigation. J. Nutr. 132: 996-1001, 2002. KEY WORDS: * iron deficiency * dietary supplements * anemia * diet assessment * women

The food system is a widely used concept, but few systematic frameworks model the full scope and structure of the food and nutrition system. Bibliographic searches, a modified Delphi technique, focus groups and interviews with experts on the topic were conducted to identify existing models of agriculture, food, nutrition, health and environmental systems. These models were examined, classified and synthesized into an integrated conceptual model of the food and nutrition system. Few existing models broadly described the system and most focused on one disciplinary perspective or one segment of the system. Four major types of models were identified: food chains, food cycles, food webs and food contexts. The integrated model developed here included three subsystems (producer, consumer, nutrition) and nine stages (production, processing, distribution, acquisition, preparation, consumption, digestion, transport, metabolism). The integrated model considers the processes and transformations that occur within the system and relationships between the system and other systems in the biophysical and social environments. The integrated conceptual model of the food and nutrition system presents food and nutrition activities as part of a larger context and identifies linkages among the many disciplines that deal with the food and nutrition system. Key words - model, food, nutrition, health, agriculture, diet, systems

National surveys conducted since 1982 were used to assess maternal and child obesity in Latin American and Caribbean countries and in U.S. residents of Mexican descent. Obesity in women, a body mass index (BMI) [greater than or equal to]30 kg/[m.sup.2], was 3% in Haiti, 8-10% in eight Latin American countries and 29% in Mexican Americans. Median BMI for Latin American women were near or above the 50th percentile of the general U.S. population; values exceeded the 75th percentile in the case of Mexican Americans. The prevalence of overweight (>1 SD above mean weight-for-height) in children 1-5 y of age ranged from 6% in Haiti to 24% in Peru among 13 countries. Overweight occurred in 24% of Mexican-American children. Prevalences of overweight in children and of obesity in women were greater in urban areas and in households of higher socioeconomic status. Overweight in children increased with higher maternal education; however, in some countries, obesity in women decreased with higher education. No general pattern of change over time was observed in eight countries in overweight in children. Obesity in women increased in the three countries with such data and in Mexican-American women and children. There was a tendency for greater national incomes to be associated with greater obesity levels in women and with lower levels of stunting in children. Levels of obesity in the region indicate a public health concern, particularly among women, considering that studies have identified mortality and morbidity risks associated with obesity in adults. KEY WORDS: overweight obesity Latin America and Caribbean Mexican Americans

Background. Childhood obesity is related to adult levels of lipids, Upoproteins, blood pressure, and insulin and to morbidity from coronary heart disease (CHD). However, the importance of the age at which obesity develops in these associations remains uncertain. Objective and Design, We assessed the longitudinal relationship of childhood body mass index (BMI, kg/[m.sup.2]) to adult levels of lipids, insulin, and blood pressure among 2617 participants. All participants were initially examined at ages 2 to 17 years and were reexamined at ages 18 to 37 years; the mean follow-up was 17 years. Results. Of the overweight children (BMI [is greater than or equal to] 95th percentile), 77% remained obese ([is greater than or equal to] 30 kg/[m.sup.2]) as adults. Childhood overweight was related to adverse risk factor levels among adults, but associations were weak (r ~ 0.1-0.3) and were attributable to the strong persistence of weight status between childhood and adulthood. Although obese adults had adverse levels of lipids, insulin, and blood pressure, levels of these risk factors did not vary with childhood weight status or with the age ([is less than or equal to] 8 years, 12-17 years, or [is greater than or equal to] 18 years) of obesity onset. Conclusions. Additional data are needed to assess the independent relationship of childhood weight status to CHD morbidity. Because normal-weight children who become obese adults have adverse risk factor levels and probably will be at increased risk for adult morbidity, our results emphasize the need for both primary and secondary prevention. Pediatrics 2001;108:712-718; obesity, BMI, childhood, longitudinal, lipids, blood pressure, insulin., ABBREVIATIONS. CHD, coronary heart disease; BMI, body mass index; HDL, high-density lipoprotein. Childhood obesity is associated cross-sectionally with various risk factors for coronary heart disease (CHD).[1,2] Several longitudinal associations have [...]

Doctors should be aware that some of their overweight patients may take non-prescription diet pills, including phenylpropanolamine (PPA) and ephedra. In a survey of 14,679 patients, 7% said they were taking non-prescription diet pills, 2% said they were using PPA, and 1% said they were using ephedra.

ABSTRACT This study evaluated the validity and reliability of a modified qualitative dietary fat index questionnaire (QFQ) in an adolescent minority population. The QFQ was administered to study participants twice [...]

ABSTRACT There is essentially no ideal method of dietary assessment. Physiologic methods (ie, doubly labeled water) probably come closest, but high cost, participant burden, and limited information limit their use. [...]

Traditional methods for assessing dietary behavior such as 24-hour dietary recalls, diet records, and food frequency questionnaires may not measure what we want to know about dietary behaviors of a [...]

The dairy industry spends about $225 million each year promoting its products, but historically, it has resisted explicit promotion of lowfat milk. This study examines the potential nutritional and industry benefits associated with greater use of lowfat milk by the U.S. population. The 1989 Continuing Survey of Food Intakes by Individuals (CSFII) was used to examine the association between types of milk, intake of lipids and calcium, and quantity of milk consumed. Results show that compared with whole milk drinkers, lowfat milk drinkers obtain less fat, saturated fat, and cholesterol from milk. However, lowfat milk drinkers are more likely than their counterparts to exceed the recommended levels of fat and saturated fat from all food sources. Lowfat milk drinkers consumed one-third to one-half more milk on the recalled day than whole-milk drinkers consumed. These results are consistent with other evidence that the dairy industry may derive economic benefits from promoting lowfat milk; the nutritional benefits are less clear. Additional study is warranted in this area: the effects of milk type on milk intake and dietary substitutions. Nutrition education should continue to promote specific dietary changes within the context of the total diet., For the past few decades, public-private partnerships have emerged as an important element of nutrition and public health strategies (14,17). Similarly, the Institute of Medicine has recommended the negotiation of [...]

Objective. To assess secular trends in menarcheal age between 1973 and 1994 and to determine whether childhood levels of height, weight, and skinfold thicknesses can account for racial (white/ black) differences in menarcheal age. Methods. Data from 7 cross-sectional examinations of school-aged children, with menarcheal age obtained through interviews, were used for both cross-sectional (11 218 observations) and longitudinal (n = 2058) analyses. In the latter analyses, the baseline examination was performed between ages 5.0 and 9.9 years, and the mean follow-up was 6 years. Results. Black girls experienced menarche, on average, 3 months earlier than did white girls (12.3 vs 12.6 years), and during the 20-year study period, the median menarcheal age decreased by approximately 9.5 months among black girls versus approximately 2 months among white girls. As compared with 5- to 9-year-old white girls, black girls were taller and weighed more, characteristics that were predictive of a relatively early (before age 11.0 years) menarche. However, even after adjustment for weight, height, and other characteristics, the rate of early menarche remained 1.4-fold higher among black girls than among white girls. Conclusions. Additional study of the determinants of menarcheal age is needed, as the timing of pubertal maturation may influence the risk of various diseases in adulthood. Pediatrics 2002;110(4). URL: http://www. pediatrics.org/cgi/content/full/110/4/e43; menarche, obesity, blacks, height, secular trend.

Objective. In a previous study of the role of various predictors of adult obesity, we found that relatively tall children had a higher body mass index (BMI; kg/[m.sup.2]) in early adulthood. In this study, the objective was to determine whether childhood height is related to adult adiposity and whether the association is independent of childhood levels of BMI and triceps skinfold thickness. Methods. The longitudinal relations of childhood height to relative weight and skinfold (sum of subscapular and triceps) thicknesses in adulthood were examined in a larger sample (N = 1055) of 2- to 8-year-olds who were followed for an average of 18 years. Results. Compared with children whose heights were below the gender- and age-specific median, a child with a height-for-age above the 95th percentile (P) was approximately 2.5 times as likely to have a BMI [greater than or equal to] 30 kg/[m.sup.2] and approximately 5 times as likely to have a skinfold sum >90th P in adulthood. Although height and adiposity were associated (r = 0.29) among children, the observed longitudinal relations persisted after controlling for BMI and the triceps skinfold thickness in childhood. For example, among children with the same BMI, each 10-cm difference in height was associated with differences in adulthood of 0.9 kg/[m.sup.2] for BMI and 4 mm for the skinfold sum. Conclusions. Although these results need to be confirmed in other studies, it is possible that information on childhood height could be used to identify more accurately children who are likely to be obese in later life. Pediatrics 2002;109(2). URL: http://www.pediatrics.org/ cgi/content/full/109/2/e23; body mass index, skinfold thickness, children, longitudinal study, height, obesity.