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Background Although prenatal iron-containing supplements have been associated with lower anemia prevalence in later pregnancy, few trials have examined the effect of supplements on the anemia status of post-partum women and their infants. Objective We compared the effects of folic acid alone (FA), iron-folic acid (IFA) and multiple micronutrients (MMN) when provided to pregnant women with no or mild anemia on the hemoglobin levels of post-partum women and their infants at 6 and 12 months of age. We also examined the potential modifying effect of maternal hemoglobin concentration at enrollment. Methods A double-blind randomized controlled trial was conducted in China; 18,775 nulliparous women with a hemoglobin concentration > 100 g/L were randomly assigned to receive daily FA (400 [mu]g); IFA (FA, Fe 30 mg), or MMN (FA, Fe and 13 micronutrients) from before 20 gestational weeks until delivery. Results Compared with daily prenatal FA, supplementation with IFA or MMN did not affect the prevalence of anemia at 4-6 weeks post-partum (27.2%, 26.8%, and 26.3%, respectively). At 6 months of age, the anemia prevalence in infants was 6.9%, 6.7%, and 6.7%, respectively. Findings were similar at 12 months of age. Among both post-partum women and infants, findings were similar across all levels of hemoglobin at enrollment. Conclusions Compared to FA alone, prenatal IFA and MMN provided to women with no or mild anemia did not affect anemia in women post-partum or their infants regardless of baseline maternal hemoglobin concentration at enrollment., Author(s): Mary K. Serdula [sup.1], Yubo Zhou [sup.2] [sup.3], Hongtian Li [sup.2] [sup.3], Jian-meng Liu [sup.2] [sup.3], Zuguo Mei [sup.1] Author Affiliations: (1) Division of Nutrition, Physical Activity and Obesity, [...]

Consuming an adequate amount of iodine during pregnancy is critical for fetal neurologic development. Even a mild deficiency can impair cognitive ability. Important sources of iodine in the United States include dairy products and iodized salt. Although the U.S. population has traditionally been considered iodine sufficient, median urinary iodine concentrations (UIC) have decreased 50% since the 1970s. We analyzed 2001-2006 NHANES data from urine iodine spot tests for pregnant (n = 326), lactating (n = 53), and nonpregnant, nonlactating (n = 1437) women of reproductive age (15-44 y). We used WHO criteria to define iodine sufficiency (median UIC: 150-249/ [micro]g/L among pregnant women; [greater than or equal to] 100 [micro]g/L among lactating women; and 100-199 [micro]g/L among nonpregnant, nonlactating women). The iodine status of pregnant women was borderline sufficient (median UIC = 153 [micro]g/L; 95% CI = 105-196), while lactating (115 [micro]g/L; 95% Cl = 62-162) and nonpregnant, nonlactating (130 [micro]g/L; 95% CI = 117-140) women were iodine sufficient. Dairy product consumption was an important contributor to iodine status among both pregnant and nonpregnant, nonlactating women, and those who do not consume dairy products may be at risk for iodine deficiency. Although larger samples are needed to confirm these findings, these results raise concerns about the iodine status of pregnant women and women of reproductive age who are not consuming dairy products. Iodine levels among U.S. women should be monitored, particularly among subgroups at risk for iodine deficiency. doi: 10.3945/jn.109.120147.

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.

In large epidemiologic studies, information on breastfeeding practice is often collected from maternal recall through interviews, but there is concern about the accuracy of the data, especially when mothers are asked to recall their practices from many years earlier. This review examines the validity and reliability of maternal recall of breastfeeding history using 11 studies published between 1966 and 2003 in English with a sample of 10 or more. Validity is the degree to which recall compares with a validation standard or reference, and reliability refers to the degree to which the breastfeeding practices obtained by recall are repeatable over time. The existing studies suggest that maternal recall is a valid and reliable estimate of breastfeeding initiation and duration, especially when the duration of breast-feeding is recalled after a short period ([less than or equal to] 3 years). Validity and reliability of maternal recall for the age at introduction of food and fluids other than breast milk are less satisfactory. Further and more extensive studies on maternal recall of breastfeeding history and ways to improve such recall are warranted. Key words: breastfeeding, maternal recall, reliability, validity doi: 10.1301/nr.2005.apr.103-110

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 [...]

Objectives. We examined trends in fruit and vegetable consumption in the United States. Methods. A 6-item food frequency questionnaire was used to assess consumption among 434121 adults in 49 states and the District of Columbia who were sampled in random-digit-dialed telephone surveys administered in 1994, 1996, 1998, and 2000. Results. Although the geometric mean frequency of fruit and vegetable consumption declined slightly, the proportion of respondents consuming fruits and vegetables 5 or more times per day did not change. With the exception of the group aged 18 to 24 years, which experienced a 3-percentage-point increase, little change was seen among sociodemographic subgroups. Conclusions. Frequency of fruit and vegetable consumption changed little from 1994 to 2000. If increases are to be achieved, additional efforts and new strategies will be needed.

Objective. We quantified maternal misclassification of child weight status and examined determinants associated with maternal perceptions of child weight status. Methods. Data from the Third National Health and Nutrition Examination Survey (1988-1994) were used. The sample included 5500 children (aged 2-11 years) with maternal interview data. Maternal perceptions of children&apos;s weight status were compared with measured weights and statures from which body mass index (BMI; weight/[stature.sup.2]; kg/[m.sup.2]) percentiles and z scores were determined. Frequency analyses determined the percentages of mothers considering their child to be "overweight," "underweight," or "about the right weight." Multivariable logistic regression analyses determined predictors of maternal misclassification of overweight children ([greater than or equal to] 95th BMI-for-age percentile) and those at risk for overweight ([greater than or equal to] 85th to Results. Nearly one third (32.1%) of mothers reported their overweight child as "about the right weight." Younger children and those with lower BMI-for-age z scores had significantly greater odds of maternal under-classification of child overweight status. For children at risk for overweight, 14.0% of mothers reported sons to be "overweight," whereas 29.0% considered daughters to be "overweight." Odds of maternal misclassification of at-risk children as "overweight" were significantly greater for daughters, older children, children with higher BMI-for-age z scores, and children whose mothers had a lower BMI. Race/ethnicity was not a significant predictor in either model. Conclusions. Nearly one third of mothers misclassify overweight children as being lower than their measured weight status. Mothers are more likely to identify daughters who are at risk of overweight as being "overweight" than they are sons. Pediatrics 2003;111:1226-1231; maternal perception, child, overweight, obesity, weight status, body weight, mother-child relations., ABBREVIATIONS. NHANES III, Third National Health and Nutrition Examination Survey; CDC, Centers for Disease Control and Prevention; NCHS, National Center for Health Statistics; BMI, body mass index. The prevalence of [...]

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.

Beriberi is caused by thiamine (vitamin B1) deficiency. This disease was common during the 1800s and early 1900s, especially in Asia, where polished rice was and continues to be the […]

Binge drinking appears to be increasing among Americans, even those over 25 years of age. An analysis of data from the Behavioral Risk Factor Surveillance System surveys taken in 1993 and 2001 showed that the number of binge drinking episodes per person per year increased 35% between 1995 and 2001. Binge drinkers were 14 times more likely to drive while under the influence of alcohol than non-binge drinkers.

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.

Accurate assessment of infant feeding is needed for clinical practice and research. We identified 32 studies that evaluated the validity of direct observation, test weighing, or doubly labeled water methods. Correlations with validation standards were highest for doubly labeled water and test weighing, and lowest for observation. Cost and availability of isotope may limit the doubly labeled water method to research studies, whereas observation may be useful for clinical practice. Test weighing could be applied to either setting, but it may be practical to sample less frequently over 24 hours. Validity results and intended use of the measurement should be considered when selecting a method. Key Words: doubly labeled water, test weighing, breast milk, validity, human milk

A 13-item questionnaire designed for quick telephone administration was evaluated for use in surveillance of fat intake in the United States. Study populations included 560 middle-aged and older adults from Beaver Dam, WI, 252 middle-aged and older women from Wisconsin, 73 young, low income Hispanic women from Chicago, IL, 52 older adults from Arizona and 135 younger adults from Augusta, GA. Correlations between fat scores and fat intakes measured by multiple food records or recalls or by more extensive food frequency questionnaires ranged from 0.33 to 0.60, similar to results from other published questionnaire validation studies. Correlations with percentage of energy from fat were lower (0.26 to 0.42), except for the Chicago population, for which there was no correlation (-0.02). There was no systematic variation in correlations among other subgroups defined by demographic and health-related characteristics, including race (black vs. white). Most, but not all, of the substantial differences in fat intakes among subgroups were identified by the questionnaire. The questionnaire will not capture small differences in intakes among groups and is inappropriate when the sample size is limited or for populations with diets substantially different from the typical U.S. diets, such as the Chicago population. However, with attention to its limitations, the questionnaire is useful for surveillance. INDEXING KEY WORDS: humans; surveillance; diet; epidemiologic methods; fats

A study of the total mortality of 4,614 women and 3,573 men, using the NHANES I Epidemiologic Follow-Up Study data, revealed the role of average alcohol consumption in protecting middle-aged men from ischemic heart disease mortality. However, after eliminating previously diseased people, the protective influence of moderate alcohol consumption on total mortality was negligible.

Descriptive and logistic regression analyses of the cross-sectional survey data concerning 3,072 participants of both genders in the South Carolina Cardiovascular Disease Prevention Project reveals that alcohol consumers are more likely to take part in health preventive measures such as weight loss and community physical activity programs. This shows that the partial protection these alcohol consumers attain from cardiovascular diseases is due to their physical activity levels which differ from those of nondrinkers.

In this study, data collected in 1989 in a random-digit dialing telephone survey of 60 590 adults in 38 states and the District of Columbia were analyzed. Approximately 38% of women and 24% of men reported that they were currently trying to lose weight. Methods reported were counting calories (24% of women, 14% of men), participating in organized weight loss programs (10%, 3%), taking special supplements (10%, 7%), taking diet pills (4%, 2%), and fasting for 24 hours or longer (5%, 5%). Among both sexes, only half of those trying to lose weight reported using the recommended method of caloric restriction combined with physical activity. (Am J Public Health. 1994;84:1821-1824), About one-half of American adults seem to use the recommended combination of reducing calories and increasing exercise in their attempts to control their weight. A telephone interview survey of 60,590 adults in Washington, DC, and 38 states in 1989 indicated that 24.3% of the men and 38.4% of the women were trying to lose weight at the time of the survey. About 52% of the men and about 48% of the women said they were increasing their activity levels and lowering their calorie consumption. About 4% of the women and about 2% of the men were taking diet pills to try to lose weight. Ten percent of the women, but only 3.5% of the men belonged to an organized weight loss program.

Fewer than a third of those who should be treated for high blood cholesterol (HBC) may be receiving any treatment. Based on information from telephone interviews with 154,735 randomly-selected adults, the percentage of adults screened for HBC rose from 46.6% at the beginning of 1988 to 62.1% at the end of 1990. The percentage notified that their blood cholesterol level was high rose from 9.9% to 17.2%, and the percentage being treated for HBC rose from 7.6% to 11.7%. Based on these figures, about 28% of the estimated people who needed treatment were receiving it. Men, blacks and people between the ages of 20 and 39 were the least likely to be treated, and people with multiple risk factors for coronary heart disease were the most likely to be treated. Almost 40% of the 126,571 people who visited a physician for preventive care in the previous two years had not been tested for HBC. These missed opportunities were most common among women who visited obstetricians/gynecologists for their routine care and among young adults., Objective.--To investigate recent trends in the percentage and characteristics of patients being treated by a physician for high blood cholesterol (HBC) and to assess missed clinical opportunities to screen for HBC. Design, Setting, Participants.--Telephone interviews of 154735 adults in 37 states that participated in the Behavioral Risk Factor Surveillance System during 1988-1990 to assess trends in the percentage of patients treated for HBC by a physician. An opportunity was considered missed if a person did not report being screened for HBC despite seeing a physician for preventive care in the last 2 years. Results.--Between the first quarter of 1988 and the last quarter of 1990, the percentage of persons treated by a physician for HBC increased from 7.6% to 11.7% (P Conclusions.--Fewer than one third of persons who need treatment for HBC as estimated by data from the second National Health and Nutrition and Nutrition Examination Survey are receiving treatment. Better use of clinical opportunities to screen for HBC could substantially accelerate the progress in identifying persons, young adults in particular, who are likely to benefit from cholesterol reduction.

* Objective.--To determine if there were trends in underweight, short stature, and obesity among 1- through 5-year-old Mescalero (NM) Apache Indian children from 1968 through 1988. Design.--Cross-sectional review of hospital clinic charts for five cohorts. Setting.--General pediatric outpatient clinic at the Mescalero Indian Health Service Hospital. Participants.--Sixty-nine patients aged 1 through 5 years in 1968, 1973, 1978, 1983, or 1988 for whom weight and height were recorded during a well-child visit that occurred in the respective year. Selection Procedures.--Approximately half the charts were screened for eligibility through systematic sampling for all years except 1988; for 1988 all available charts were screened for eligibility for the study. Interventions.--None. Measurements and Results.--We found trends of decreasing prevalence of both underweight (defined as weight-for-height below the fifth percentile) and short stature (defined as height-for-age below the fifth percentile) based on the Centers for Disease Control/World Health Organization growth reference. We found no secular trends in obesity (weight-for-height above the 95th percentile), although the prevalences throughout the 21-year period were as much as two to four times higher than expected when compared with the Centers for Disease Control/World Health Organization reference. There has been an upward shift in both weight-for-height and height-for-age distributions since 1968, indicating that Mescalero children today are, on average, heavier and taller. Conclusions.--Underweight and short stature decreased among Mescalero preschool children from 1968 through 1988, suggesting nutritional improvements. However, given the current high prevalence of obesity, it is recommended that surveillance of nutritional status be continued and appropriate interventions be developed to treat and prevent obesity in this population. (AJDC. 1992;146:1194-1198)

Objectives. Although attempted weight loss is common, little is known about the goals and durations weight loss attempts and the rates of achieved weight loss in the general population. Methods. Data were collected by telephone in 1989 from adults aged 18 years and older in 39 states and the District of Columbia. Analyses were carried out separately for the 6758 men and 14 915 women who reported currently trying to lose weight. Results. Approximately 25% of the men respondents and 40% of the women respondents reported that they were currently trying to lose weight. Among men, a higher percentage of Hispanics (31%) than of Whites (25%) or Blacks (23%) reported trying to lose weight. Among women, however, there were no ethnic differences in prevalence. The average man wanted to lose 30 pounds and to weigh 178 pounds; the average woman wanted to lose 31 pounds and to weigh 133 pounds. Black women wanted to lose an average of 8 pounds more than did White women, but Black women's goal weight was 10 pounds heavier. The average rate of achieved weight loss was 1.4 pounds per week for men and 1.1 pounds per week for women; these averages, however, may reflect only the experience of those most successful at losing weight. Conclusions. Attempted weight loss is a common behavior, regardless of age, gender, or ethnicity, and weight loss goals are substantial; however, obesity remains a major public health problem in the United States. (Am J Public Health 1992; 82:1251-1257)