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Fortified blended foods (FBFs) were introduced into the Food for Peace program (also known as US Public Law 480) in the 1960s. Minimal changes have since been made to their formulations. A Food Aid Quality Enhancement Project to assess the nutritional adequacy of FBEs for vulnerable populations was conducted, and the findings indicate that FBFs do not meet the nutritional needs of infants and young children between the ages of 6 and 24 months. Improvements are also needed for FBFs intended for school-aged children and adults. Two separate products would better meet the varying nutritional needs of diverse groups of beneficiaries. Proposed here is a two-step strategy for better addressing the needs of today's food aid beneficiaries: 1) improving FBFs for general distribution to households, schools, and emergency settings, with potential efficiencies gained in manufacturing and formulation to reduce costs; 2) developing new products for infants and young children, which would deliver the nutrient density required for growth and development. doi: 10.1111/j.1753-4887.2010.00288.x

Current micronutrient levels in Public Law 480 fortified blended foods (FBF) may not be appropriate for all food aid beneficiaries, particularly infants and/or young children and pregnant and/or lactating women. A simulation model was developed to determine the micronutrient fortification levels to include in FBF for food aid programs with the goal of reducing the risk of inadequate micronutrient intakes without exceeding the tolerable upper intake level (UL) for any recipient group. For each micronutrient, the age and gender group with the highest daily Recommended Nutrient Intake (RNI) relative to energy requirement was identified and the effect of providing different percentages of that RNI (66, 75, and 100%) was simulated. In this modeling exercise, we also examined consumption of the FBF at 25 (the usual level), 50, and 100% of daily energy requirement. Results indicated that 2 FBF products are needed: a complementary food for age 6-36 mo and a supplementary food for the older groups. Both of the FBF could be fortified to supply at least 75% of the RNI to all groups, without exceeding the UL for most nutrients, if consumed at 25% of the energy requirement. Even if consumed at 50% of energy requirements, mean intakes of most micronutrients would not exceed the UL, although at 100% of the energy requirement, several micronutrients were undesirably high. We conclude that fortifying an FBF to provide 75% of the RNI would be appropriate for most micronutrients, but this level of fortification would not be appropriate for long-term consumption of the FBF at 100% of the energy requirements. J. Nutr. 140: 355-365, 2010. doi: 10.3945/jn.109.106146.

Children often consume foods from outside the home (OH foods), which can decrease the accuracy of dietary recalls collected from the parents. The objectives of this study were to describe the types and composition of OH foods consumed by rural school-aged Kenyan children, to assess their contribution to the daily intake of the child, and to evaluate the ability of the mother to estimate intake of OH foods. To capture any seasonal differences, the study was conducted twice, once during a food shortage season and again during the subsequent harvest season. School children were asked to recall the types and amounts of OH foods consumed on the previous day. Mothers were asked to report on the types and amounts of all foods consumed by their children during the day of interest. OH foods contributed 13 and 19% of daily energy intake in the food shortage and harvest seasons, respectively, but mothers missed 77 and 41% of the OH energy intake. OH foods were most likely to be fruits (guavas, mangoes, and wild fruit) and starchy foods (bread and fried wheat dough). Nutrients most likely to be under-reported on the mothers' recalls were vitamin C (59 and 26% was missed in the food shortage and harvest seasons, respectively) and vitamin A (~22% was missed in both seasons). To ensure that all food intake is recalled, it is important that school children be included in dietary assessment interviews about their own intakes.

Food guides to help consumers make healthy choices have recently been released in three countries: Japan, Canada, and the United States. The visual symbol that introduces key concepts is a spinning top in Japan, a rainbow in Canada, and a pyramid in the United States. The main features of the new guides are given in printed consumer resources, and more detailed information is available at related websites. Although the process of developing the guides varied among the countries, the resulting recommended food patterns are remarkably consistent. Key words: dietary guidance, food guides, food patterns

A randomized, controlled school feeding study was conducted in rural Embu District, Kenya to test for a causal link between animal-source food intake and changes in micronutrient nutrition and growth, cognitive, and behavioral outcomes. Twelve primary schools were randomly assigned to 1 of 4 groups. Children in Standard I classes received the local plant-based dish githeri as a midmorning school snack supplemented with meat, milk, or fat added to equalize energy content in all feedings. The Control children received no feedings but participated in data collection. Main outcome measures assessed at baseline and longitudinally were 24-h food intake recall, anthropometry, cognitive function, physical activity, and behaviors during school free play. For cognitive function, the Meat group showed the steepest rate of increase on Raven's Progressive Matrices scores and in zone-wide school end-term total and arithmetic test scores. The Plain githeri and Meat groups performed better over time than the Milk and Control groups (P < 0.02-0.03) on arithmetic tests. The Meat group showed the greatest increase in percentage time in high levels of physical activity and in initiative and leadership behaviors compared with all other groups. For growth, in the Milk group only younger and stunted children showed a greater rate of gain in height. The Meat group showed near doubling of upper midarm muscle area, and the Milk group a smaller degree of increase. This is the first randomized, controlled feeding study to examine the effect of meat- vs. milk- vs. plant-based snacks on functional outcomes in children.

Three snacks were designed to improve nutrient intakes among school-age children living in rural Kenya. Snacks containing animal-source foods (milk and meat) provided more nutrients than an equicaloric vegetarian snack. The vegetarian snack provided extra vitamin A (primarily from fortified cooking fat; the milk snack was rich in calcium, vitamin A, and vitamin B-12; and the meat snack supplied vitamin B-12, iron, and zinc. When changes in intakes from baseline to the feeding period were compared across the 4 groups, total energy intake increased the most for children in the meat group and the least for children in the control group. Differences in energy intakes across the 3 feeding groups were primarily caused by decreases in home intake for the vegetarian and milk snack groups. It is important to evaluate the change in home intakes as well as intakes from the foods provided by the study when evaluating the effect of feeding programs on nutrient adequacy.

The high prevalence of vitamin B-12 deficiency in many regions of the world is becoming recognized as a widespread public health problem, but it is not known to what extent this deficiency results from a low intake of the vitamin or from its malabsorption from food. In rural Kenya, where a previous study identified a high prevalence of inadequate vitamin B-12 intakes, this study examined whether plasma vitamin B-12 concentrations were associated with dietary sources of the vitamin at baseline and could be increased by supplementation with animal source foods (ASF). The 4 experimental groups in 503 school children were: 1) control (no food provided); 2) githeri (a maize and bean staple with added oil); 3) githeri + meat (githeri + minced beef); or 4) githeri + milk (githeri + milk). Feedings were isocaloric. Dietary data were collected at baseline, and biochemical data at baseline and after 1 and 2 y of feeding. Baseline plasma vitamin B-12 concentration was 193.6 [+ or -] 105.3 pmol/L and correlated with % energy from ASF (r = 0.308, P < 0.001). The odds ratio for low plasma vitamin B-12 (

Differences in BMI among ethnic groups may be partially explained by the consumption of energy-dense foods, which influences energy intake in controlled laboratory studies. However, the role of dietary energy density (ED, kJ/g) in freeliving persons is less understood. Our objective was to determine whether ED is related to current BMI and the risk for overweight and obesity and whether these relations are consistent among ethnic groups. We calculated ED from responses to a quantitative food frequency questionnaire and validated the measures against multiple 24-h recalls. Subjects consisted of 191,023 participants in the Hawaii-Los Angeles Multiethnic Cohort who were African American, Native Hawaiian, Japanese American, Latino, or Caucasian. Mean ED varied from a low of 4.62 kJ/g in Japanese American men to a high of 5.08 kJ/g in African American men. Mean BMI was lowest in Japanese Americans of both sexes and highest in Native Hawaiian men and African American women. After adjusting for the amount of food consumed per day, age, current smoking status, physical activity, chronic disease, and education, a 1 kJ/g increase in ED was associated with an increase in BMI of ~1 kg/[m.sup.2] in each ethnic sex group. This same increase in ED was associated with a significantly increased risk of being overweight in all ethnic sex groups, varying from 4% in African American men to 34% in Japanese American women. Our findings suggest that consumption of an energy dense diet is a risk factor for higher BMI in both men and women across ethnic groups.

Collecting detailed data on dietary supplement use is time-consuming for study participants and investigators, and this is particularly difficult for multivitamin use because of the many different formulations available. Therefore, many studies simply ask about the frequency of multivitamin use and assign default nutrient composition values to obtain nutrient intakes. Multivitamin supplements are important contributors to total nutrient intakes, but it is not known how default values affect the accuracy of intake estimation. In this study, nutrient intakes were calculated from multivitamins consumed by 26,735 multivitamin users who provided detailed information like product name(s) and frequency of use on a mailed questionnaire. We then recalculated the intakes, using 2 different assumptions about the composition of the multivitamin supplements: 1) a single default composition for all products; and 2) four default compositions, 1 for each subtype of multivitamin, i.e., one-a-day with minerals, one-a-day without minerals, B-complex or stress multivitamins, and antioxidant combinations. A total of 1246 different brands of multivitamins were reported and nutrient composition varied widely. Spearman correlation coefficient analyses, using the 4 default nutrient profiles compared with actual nutrient intakes, were >0.5 (P < 0.001) for 12 of 15 nutrients examined. However, correlations using the single default were lower, with only 5 correlations >0.5. Our findings suggest that a questionnaire designed to assess the composition profiles for 4 types of multivitamin products substantially improves the accuracy of nutrient-intake estimates over one that uses a single default nutrient profile for all multivitamin products. KEY WORDS: * multivitamin supplements * nutrient intakes * supplement composition

A recent report describes a new paradigm for planning the dietary intakes of groups, the goals of which are to achieve low prevalences of both inadequate and excessive intakes. However, there are many challenges involved in properly implementing these methods, and pilot studies are urgently needed. For individuals, the target for nutrient intakes is usually the Recommended Dietary Allowance (RDA); for nutrients without an RDA, the Adequate Intake (AI) can be used. Intakes should be planned so they do not exceed the Tolerable Upper Intake Level (UL). Several applications illustrating how to use the DRIs for planning the diets of individuals have been published, so this review will focus primarily on the methods that are recommended for planning the diets of groups. [c] 2005 International Life Sciences Institute doi: 10.1301/nr.2005.aug.267-271

Dietary patterns have been used to identify typical combinations of foods that may be associated with disease risks. We defined dietary patterns among 195,298 participants of the Multiethnic Cohort Study in Hawaii and Los Angeles in 1993-1996. Intakes of Food Guide Pyramid groups were calculated from a quantitative FFQ for subjects of 5 ethnic groups (African Americans, Hawaiians, Japanese Americans, Latinos, and whites). Three distinct dietary patterns, 'Fat and Meat,' 'Vegetables,' and 'Fruit and Milk,' were identified by exploratory factor analysis with a varimax rotation and validated by confirmatory factor analysis. Similar factor loadings were found for each of 10 ethnic-gender groups in stratified analyses. The odds ratios (OR) for being above the median scores for each factor were calculated. Age, gender, and ethnicity had relatively strong associations with dietary patterns whereas education showed only weak associations. BMI [greater than or equal to] 30 was strongly positively associated with the Fat and Meat pattern (OR = 2.14, 95% CI: 2.08-2.20, vs. BMI < 25). Current smokers showed a positive association with the Fat and Meat pattern (OR = 1.67, CI: 1.62-1.72, vs. nonsmokers) and inverse associations with the Vegetables (OR = 0.66, CI: 0.64-0.68) and Fruit and Milk patterns (OR = 0.53, CI: 0.52-0.55). Physical activity was positively associated with the Vegetables and Fruit and Milk patterns but not with the Fat and Meat pattern. These findings support the hypothesis that dietary patterns are influenced by interrelated sociocultural, demographic, and other lifestyle factors and may be useful in investigations of diet-disease relations. KEY WORDS: * dietary patterns * factor analysis * food frequency questionnaire * ethnicity

Soy consumption may be related to lower breast cancer risk as assessed by breast density. The aims of this 2-y trial were to examine the effects of soy foods and lifetime soy intake on mammographic density. After 220 premenopausal women were randomly assigned to the intervention or control group, the former group consumed 2 daily servings of soy foods equivalent to 50 mg of isoflavones and the latter consumed their regular diet. The respective dropout rates were 15.6 and 12.6%; adherence to the study regimen was high, We assessed lifetime soy intake with a questionnaire and measured breast density in screening mammograms obtained at baseline and at the end of the trial for 98 intervention and 103 control women using a computer-assisted method. None of the mammographic outcomes differed significantly by experimental group. The total area of the breast increased and the size of the dense areas decreased significantly over time in both groups. After 2 y, the mean percentage density had decreased by 2.8 and 4.1.% in intervention and control women, respectively. Women who reported eating more soy during their lives had higher percentage densities than women whose diet included little soy; this difference was significant only in Caucasians. Lower soy intake during early life and higher soy intake during adulthood predicted a greater reduction in the percentage density during the study period. After 2 y of intervention, we observed no significant differences in mammographic densities by intervention status, but it appears that soy consumption throughout life may have some effect on breast density. J. Nutr. 134: 3089-3094, 2004. KEY WORDS: * soy * intervention * mammographic density, breast cancerrisk * early life nutrition

Despite guidance to consume a variety of foods, the role of dietary variety in ensuring nutrient adequacy is unclear. The aim of this study was to determine whether a commodity-based measure of dietary variety was associated with the probability of nutrient adequacy after adjusting for energy and food group intakes. Subjects were 4969 men and 4800 women [greater than or equal to] 19 y old who participated in the Continuing Survey of Food Intakes for Individuals 1994-1996. Using 24-h recall data, the mean probability of adequacy across 15 nutrients was calculated using the Dietary Reference Intakes. Dietary variety was defined using a commodity-based method similar to that used for the Healthy Eating Index (HEI). Associations were examined in gender-specific multivariate regression models. Energy intake was a strong predictor of the mean probability of adequacy in models controlled for age, BMI, education level, and ethnicity (model [R.sup.2] = 0.60 and 0.54 for men and women, respectively). Adding the number of servings from each of the 5 Food Guide Pyramid (FGP) groups to the models significantly improved the model fit ([R.sup.2] = 0.69 and 0.66 for men and women). Adding dietary variety again significantly improved the model fit for both men and women ([R.sup.2] = 0.73 and 0.70, respectively). Variety counts within the dairy and grain groups were most strongly associated with improved nutrient adequacy. Dietary variety as defined by the HEI contributes an additional component of dietary quality that is not captured by FGP servings or energy intake. KEY WORDS: * dietary variety * nutrient adequacy * food group servings * CSFII 1994-1996

Previous observational studies in developing countries have suggested that diet quality, particularly increased animal source food (ASF) consumption, is positively associated with child cognitive development. This report presents findings from a study in rural Kenya, designed to test the impact of three different diets on the cognitive development of school children. Twelve schools with a total of 555 Standard 1 children (equivalent to U.S. Grade 1) were randomized to one of four feeding interventions: Meat, Milk, Energy or Control (no feeding). Feeding continued for seven school terms (21 mo), and cognitive tests were administered before the commencement of feeding and during every other term of feeding. Hierarchical linear random effects models and associated methods were used to examine the effects of treatment group on changes in cognitive performance over time. Analyses revealed that children receiving supplemental food with meat significantly outperformed all other children on the Raven's Progressive Matrices. Children supplemented with meat, and children supplemented with energy, outperformed children in the Control group on tests of arithmetic ability. There were no group differences on tests of verbal comprehension. Results suggest that supplementation with animal source food has positive effects on Kenyan children's cognitive performance. However, these effects are not equivalent across all domains of cognitive functioning, nor did different forms of animal source foods produce the same beneficial effects. Implications of these findings for supplementation programs in developing countries are discussed. KEY WORDS: * supplementation * animal source foods * cognitive development * Kenya * schoolers

A previous longitudinal three-country study in Egypt, Kenya and Mexico found significant positive associations between intake of animal source foods (ASF) and growth, cognitive development and physical activity. To test for a causal relationship, a controlled school feeding intervention study was designed to test the hypotheses that ASF would improve micronutrient status, growth and cognitive function in Kenyan primary school children. Twelve rural Kenyan schools with 554 children were randomized to four feeding interventions using a local vegetable stew as the vehicle. The groups were designated as Meat, Milk, Energy and Control, who received no feedings. Feeding was carried out on school days for seven terms during 21 mo. Preintervention baseline measures included nutritional status, home food intake, anthropometry, biochemical measures of micronutrient status, malaria, intestinal parasites, health status and cognitive and behavioral measures. The measurements of each child were repeated at intervals over 2 y. Baseline data revealed stunting and underweight in [Tilde]30% of children and widespread inadequate intakes and/or biochemical evidence of micronutrient deficiencies, particularly of iron, zinc, vitamins A and B-12, riboflavin and calcium. Little or no ASF were eaten and fat intake was low. Malaria was present in 31% of children, and hookworm, amebiasis and giardia were widely prevalent. The outcomes measured were rates of change or increase during the intervention in cognitive function, growth, physical activity and behavior and micronutrient status. Hierarchical linear random effects modeling was used for analysis of outcomes. KEY WORDS: * animal source foods * growth * development * micronutrients * Kenya

Animal source foods (ASF) can provide micronutrients in greater amounts and more bioavailable forms compared to plant source foods, but their intake is low in many poor populations. However, the impact of ASF on micronutrient status of undernourished populations has not been assessed. Supplemental meat (60-85 g/d), milk (200-250 mL/d) or energy (isocaloric with the meat and milk, 240-300 kcal/d) were randomly assigned to 555 undernourished school children aged 5-14 y in a rural malaria-endemic area of Kenya, at one school meal daily for one school year. Blood and stool samples were collected at baseline and after 1 y to assess stool parasites, malaria, hemoglobin, serum or plasma C-reactive protein, ferritin, iron, zinc, copper, vitamin B-12, folate and retinol, and erythrocyte riboflavin. At baseline, there was a high prevalence of micronutrient deficiencies (iron, zinc, vitamins A and B-12 and riboflavin), yet plasma ferritin was low in few children, and none had low serum copper. At the end of the year of supplementation, plasma vitamin B-12 concentrations were significantly increased in children fed the Meat or Milk meal; prevalence of severe plus moderate deficiency fell from 80.7% at baseline to 64.1% in the Meat group and from 71.6 to 45.1% in the Milk group, respectively. No significant improvement was observed in the status of other micronutrients compared to the Energy and Control groups, although malaria and other infections may have obscured effects. Supplementation with small amounts of meat or milk reduced the high prevalence of vitamin B-12 deficiency in these children. KEY WORDS: * meat * milk * vitamin B-12 * micronutrients * Kenya * malaria

Observational studies of dietary patterns and growth and studies with milk supplementation have shown that children consuming diets containing animal source foods grow better. This study evaluates the growth of 544 Kenyan schoolchildren (median age 7.1 y) after 23 mo of food supplementation with a meat, milk or energy supplement (~1255 kJ) compared to a control group without a supplement. Multivariate analyses controlled for covariates compared gain in weight, height, weight-for-height Z-score (WHZ), height-for-age Z-score (HAZ), mid-upper-arm circumference, triceps and subscapular skinfolds, mid-upper-arm muscle and mid-upper-arm fat area. Children in each of the supplementation groups gained ~0.4 kg (10%) more weight than children in the Control group. Children in the Meat, Milk and Energy groups gained 0.33, 0.19 and 0.27 cm more, respectively, in mid-upper-arm circumference than children in the Control group. Children who received the Meat supplement gained 30-80% more mid-upper-arm muscle area than children in the other groups, and children who received the milk supplement gained 40% more mid-upper-arm muscle area than children who did not receive a supplement. No statistically significant overall effects of supplementation were found on height, HAZ, WHZ or measures of body fat. A positive effect of the milk supplement on height gain could be seen in the subgroup of children with a lower baseline HAZ ([is less than or equal to]-1.4). The results indicate that food supplements had a positive impact on weight gain in the study children and that the addition of meat increased their lean body mass. KEY WORDS: * animal source foods * growth * body composition * schoolchildren * Kenya

Animal source foods can provide a variety of micronutrients that are difficult to obtain in adequate quantities from plant source foods alone. In the 1980s, the Nutrition Collaborative Research Support Program identified six micronutrients that were particularly low in the primarily vegetarian diets of schoolchildren in rural Egypt, Kenya and Mexico: vitamin A, vitamin B-12, riboflavin, calcium, iron and zinc. Negative health outcomes associated with inadequate intake of these nutrients include anemia, poor growth, rickets, impaired cognitive performance, blindness, neuromuscular deficits and eventually, death. Animal source foods are particularly rich sources of all six of these nutrients, and relatively small amounts of these foods, added to a vegetarian diet, can substantially increase nutrient adequacy. Snacks designed for Kenyan schoolchildren provided more nutrients when animal and plant foods were combined. A snack that provided only 20% of a child's energy requirement could provide 38% of the calcium, 83% of the vitamin B-12 and 82% of the riboflavin requirements if milk was included. A similar snack that included ground beef rather than milk provided 86% of the zinc and 106% of the vitamin B-12 requirements, as well as 26% of the iron requirement. Food guides usually recommend several daily servings from animal source food groups (dairy products and meat or meat alternatives). An index that estimates nutrient adequacy based on adherence to such food guide recommendations may provide a useful method of quickly evaluating dietary quality in both developing and developed countries. KEY WORDS: * animal source foods * schoolers * dietary quality * micronutrients

Dietary Reference Intakes (DRIs) are now available for energy, macronutrients, fiber, vitamins, and minerals, and can be used to plan diets for individuals. This article defines the four DRIs (the Estimated Average Requirement, the Recommended Dietary Allowance, the Adequate Intake, and the Tolerable Upper Intake Level), and describes two other reference standards--the Estimated Energy Requirement and the Acceptable Macronutrient Distribution Range. Planning diets for individuals involves identifying the appropriate nutrient intake goals, translating the nutrient goals into food intake (and supplement use, if warranted), assessing the plan, and revising it if required. This process is illustrated using case studies of a female vegetarian marathon runner and an older male smoker. Key words: diet planning, recommended intakes, energy, macronutrients, vitamins, minerals

Objective: To report 6 psychometric properties of food behavior checklist (FBC) items and then to use these properties to systematically reduce the number of items on this evaluation tool. Design: Random assignment to the intervention and control groups. Setting: Low-income communities. Participants: Women (N = 132) from limited-resource families. Main Outcome Measures: Reliability, internal consistency, baseline differences by ethnicity, sensitivity to change, and criterion and convergent validity of subscales. Results: The fruit and vegetable subscale showed a significant correlation with serum carotenoid values (r = .44, P < .001), indicating acceptable criterion validity. Milk, fat/cholesterol, diet quality, food security, and fruit/vegetable subscales showed significant correlations with dietary variables. Nineteen items have acceptable reliability. Twenty items showed no baseline differences by ethnic group. Eleven of the 15 items expected to show change following the intervention demonstrated sensitivity to change. Conclusions and Implications: This brief food behavior checklist (16 items) is easy to administer to a client group, has an elementary reading level (fourth grade), and has a low respondent burden in addition to meeting requirements for validity, reliability, and sensitivity to change. This study establishes a process that can be used by other researchers to develop and further refine instruments for use in community health promotion interventions. KEY WORDS: evaluation, food behaviors, Expanded Food and Nutrition Education Program (EFNEP), low income

Intake data from the combined CSFII/NHANES survey will be used for many different purposes, each with specific data requirements and appropriate analytic methods. For monitoring and surveillance, the availability of Dietary Reference Intakes will allow estimates of the prevalence of inadequate intakes and the prevalence of intakes with a risk of adverse effects. The accuracy of the nutrient intake estimates will be enhanced by the 5-pass dietary recall methodology, availability of quantified dietary supplement intake data and expanded food and supplement composition data. Food-level dietary monitoring will be improved by using new databases to calculate servings of food groups from the Food Guide Pyramid and intakes of food commodities. Another major strength of the survey is the ability to relate intake data to health measures for individuals. Inferences will continue to be limited by a lack of usual intake for each individual, but the attenuation will be less with 2 d of data than with only 1 d, as in the past. Better data collection and analysis will also lead to more informed nutrition policies and programs. Innovative methods of analyzing the data should be investigated to minimize the effects of underreporting, provide better estimates of usual intake at both the group and individual levels and accurately combine nutrient intakes from foods and supplements. Future modifications to the intake collection methods might be considered to allow larger sample sizes for certain subgroups, more detailed information on supplement use, an expanded food frequency questionnaire, a different number of recall days and incorporation of diet and health knowledge questions. KEY WORDS: * dietary surveys * dietary assessment * nutrition monitoring * Dietary Reference Intakes

New Dietary Reference Intakes (DRIs) are being set by the Institute of Medicine, and represent a new way of defining nutrient intake recommendations. For the first time, the recommendations for the United States and Canada allow the calculation of the probability of adequacy for an individual, and the prevalence of inadequacy for a population. In addition, possible excessive consumption of many nutrients can be evaluated. The goal of this review is to provide a practical guide to the proper uses of the new DRIs when assessing intakes. Key Words: Dietary Reference Intakes, DRIs, nutrients, assessing intakes

The term Dietary Reference Intakes (DRIs) refers to a set of 4 nutrient-based reference values intended primarily for use in assessing and planning diets. The DRIs, the outcome of the [...]

To develop national nutrition policies, it is necessary to know what Americans are eating and which segments of the population may be at nutritional risk of underconsumption (eg, of micronutrients) [...]

In the United States, the number of elderly who live alone has increased dramatically since 1960 (1). As of 1986, approximately 30% of persons 65 years and older lived alone; [...]

The impact of sociodemographic, health-related, and behavioral variables on the dietary adequacy of the younger old (65 to 84 years, N = 2496) and oldest old (85 years and older, N = 159) was investigated using data from the Nationwide Food Consumption Survey 1977-78. The percent of individuals with poor diets (defined as mean three-day intake below 67% of the 1989 Recommended Dietary Allowances for at least five of the nine nutrients examined) was greater for women (18%) than for men (13%) and for the oldest old (21%) than for the younger old (16%). Better diet quality was associated both with increased quantity and with increased nutrient density of diets. Multivariate analyses identified two factors of importance for nutrient quality for both the younter and oldest old: mean energy intake and percent of calories from ready-to-eat cereal. Positive predictors of energy intake for both age groups included: number of meals, percent of calories from snacks, and money per person spent on food by the household. These results suggest that nutritional guidance for older Americans should focus on maintenance of adequate (but not excessive) energy intakes by consuming three meals a day plys snacks. Selection of foods of high nutrient density, such as fortified ready-to-eat cereals, should be emphasized, particularly when energy intakes are low. Nutrition programs should target individuals at risk of low food intakes: women, the oldest old, and persons in poor health, on weight-loss diets, or with inadequate money for food.

Alcohol plays a notable role in the dietary intakes of some Americans. One study estimated that consumption of alcohol among the drinking-age population in the United States contributes about 160 [...]

Objectives To evaluate the validity of food behavior items, using a biological measure (serum carotenoids) as the criterion for validity of fruit and vegetable intake, and the results from multiple [...]

Although individuals with poor food security might be expected to have reduced food intake, and thus reduced body fat and less likelihood of being overweight, these associations have not been adequately studied. The purpose of the current study was to examine the relationship between food insecurity and overweight as measured by body mass index (BMI) using data from the nationally representative 1994-1996 Continuing Survey of Food Intakes by Individuals (CSFII). Overweight was defined as BMI [is greater than] 27.3 kg/[m.sup.2] for women and 27.8 kg/[m.sup.2] for men. Food insecurity was related to overweight status for women (n = 4509, P [is less than] 0.0001), but not for men (n = 4970, P = 0.44). Excluding the 11 severely insecure women, the prevalence of overweight among women increased as food insecurity increased, from 34% for those who were food secure (n = 3447), to 41% for those who were mildly food insecure (n = 966) and to 52% for those who were moderately food insecure (n = 86). Food insecurity remained a significant predictor of overweight status, after adjustment for potentially confounding demographic and lifestyle variables (P [is less than] 0.01). In a logistic regression analysis, mildly insecure women were 30% more likely to be overweight than those who were food secure [odds ratio (OR) 1.3, P = 0.005]. Thus, food insecurity had an unexpected and paradoxical association with overweight status among women with a higher prevalence of overweight among the food insecure, and a resulting potential for increased incidence of obesity-related chronic diseases. Given that the rates of both overweight and food insecurity are on the rise, this research area warrants further investigation. J. Nutr. 131: 1738-1745, 2001. KEY WORDS: * overweight * obesity * food security * food insecurity * food insufficiency * humans

The number and proportion of older U.S. adults who live alone have increased dramatically in the past three decades, and there is concern that these individuals may have particularly poor dietary quality. We examined the association of four living arrangements (living with a spouse only, with a spouse plus someone else, with someone other than a spouse or living alone) with dietary quality (the number of low nutrients out of a possible 15, with low defined as [is less than] 67% of the recommended dietary allowance) among 6525 U.S. adults aged 50-64 y and those [is greater than or equal to] 65 y in the third National Health and Nutrition Examination Survey (NHANES III 1988-1994). Among non-Hispanic Caucasian adults, those who lived with a spouse only had better dietary quality, with significant differences ranging from 0.8 to 1.5 fewer low nutrients compared with those with other living arrangements. Effects of living arrangements on dietary quality were also seen among non-Hispanic African-Americans, Mexican-Americans, and those of 'other' races, but differences were significant only for African-American men aged [is greater than] 65 y living with a spouse plus others (1.6 additional low nutrients compared with those living with a spouse only). Energy intake was strongly associated with dietary quality, but did not account for the associations between living arrangements and dietary quality. Although middle-aged and older adults with living arrangements other than living with a spouse only (including those living alone) tended to have poorer dietary quality, the effects varied substantially across age, gender and ethnic categories. J. Nutr. 130: 2256-2264, 2000. KEY WORDS: * older adults * living arrangements * dietary quality * nutrient intake * NHANES III

This article highlights the discussion of the issues that had been raised during the International Life Sciences Institute North America- and USDA Agricultural Research Service-sponsored workshop surrounding the consumption of fructose. One conclusion of the discussion was that the metabolic effects of high-fructose corn syrup (HFCS) and sucrose appear to be similar in humans. However, there have been few studies directly comparing the effects of fructose to other caloric sweeteners, such as glucose, HFCS, and sucrose. Differential effects may include those related to insulin sensitivity, triglyceride and lipoprotein levels, and glycated protein levels. Further exploration of the differences between nutritive sweeteners should be the basis of a research agenda. Studies should also further investigate factors that might affect the results, such as the amount and form of the sweetener consumed, the macronutrient composition of the basal diet, the length of the study, and the characteristics of the subjects. Meanwhile, health professionals could help consumers by providing simple messages, such as the importance of consuming lower levels of energy, including those from all caloric sweeteners.

Food group consumption in the elderly (65 years of age or older) was examined using data from the food frequency questionnaire administered as part of the 1982-84 National Health and Nutrition Examination Survey's (NHANES I) Epidemiologic Followup Study (NHEFS). The number of daily servings from each food group was determined for each individual by adjusting reported frequency of consumption of food from that group (daily, weekly, monthly, yearly, and never) to a daily basis. Mean daily servings for the population of 2653 elderly were calculated for 95 NHEFS food groups combined into 32 nutritionally similar food groups, and six food groups used for current dietary guidance. Older adults reported mean daily servings greater than 1.0 for five of the 32 groups: coffee/tea, vegetable fats, non-citrus fruits, citrus fruits, and refined grains. A comparison of actual servings consumed daily with the recommended servings of six food groups indicated too few servings of dairy and grain products and adequate servings of fruits, vegetables, and protein foods. These results may be used to design nutrition education programs targeted to the elderly population.

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides supplemental foods, nutrition education, and referrals to low-income pregnant, breast-feeding, and postpartum women, infants, and children (ages 1 to 5 years). Despite many changes that have occurred since WIC's inception in 1972, the WIC food packages remain largely unchanged. The US Department of Agriculture's Food and Nutrition Service asked the Institute of Medicine (IOM) to form a committee to complete a 2-phase evaluation of the current WIC food packages. The goal of this evaluation was to develop a set of practical recommendations for changes in the foods or amounts of foods provided to better address the nutritional deficits and challenges of the WIC target population and to enhance food acceptability and nutritional quality. Phase I included an assessment of nutritional needs of WIC subgroups and development of a set of criteria to use in revising the food packages. Phase 2 included developing specific recommendations related to changes in the food packages. In this session, members of the IOM Committee to Review the WIC Food Packages will present highlights from their final report, including findings and recommendations from both phases. The implications of the IOM Committee's report for nutrition education and breast-feeding promotion in the WIC setting will also be discussed.

In support of pharmacologic, epidemiological, and clinical studies concerned with the assessment of the role of dietary phytoestrogens in the prevention of chronic diseases, we extended our existing methods for the measurement of soy isoflavonoids (1) to the analysis of a variety of predominant flavonoids and mammalian lignans in foods and human plasma and urine using high-performance liquid chromatography (HPLC) with photo-diode array detection combined with electrospray ionization mass spectrometry (ESI/MS). More than 130 commonly consumed foods in Hawaii were screened for levels of flavones (apigenin, luteolin), flavonols (kampferol, quercetin, myricetin), flavanones (hesperetin, naringenin), and anthocyanidins (pelargonidin, cyanidin, delphinidin) after hydrolytic extraction. These flavonoids in addition to isoflavonoids (daidzein, glycitein, genistein, dihydrodaidzein, dihydrogenistein, O-desmethylangolensin) and lignans (enterodiol, enterolactone) could also be determined with the same techniques in human plasma and urine after enzymatic hydrolysis. When selectively monitoring molecular ions using HPLC/ESI/MS in negative mode limits of quantitation in biological fluids averaged 0.1 pmol at an injection volume of 5-10 [micro]L. Limits of quantitation 10-40-fold lower were achieved by monitoring predominant first-generation daughter ions through selected reaction monitoring. Inter- and intraassay variability for biological fluids was found to be 6-15% for levels over 100 nmol/L and 5-22% for levels under 100 nmol/L. Applications of this methodology in ongoing epidemiological and clinical studies confirmed our previous finding (2) on decrease in breast cancer risk in Chinese women with high soy isoflavone or lignan excretion (3) and established the feasibility of urinary quercetin to be used as a reliable biomarker for onion consumption.

As part of a randomized dietary intervention study that examines the association of soyfood intake with breast cancer risk, we are evaluating the feasibility of adherence to a soy-based diet in premenopausal women (n = 213, aged 34-46 y). The study design includes an increase of dietary soy intake to two servings per day (50 mg isoflavones/d) for 2 y in the intervention group. Compliance with this intervention is measured by self-reported soy intake logs, repeated randomly timed 24-h recalls, and analysis of urinary isoflavone excretion. We used HPLC with photo diode array detection to determine isoflavone concentration in foods and urinary isoflavone excretion in overnight urine samples at baseline and 2, 6, and 12 mo. At baseline the two groups did not differ in dietary soy intake. Women in the intervention group chose from six different soyfoods provided at no cost. Intake logs show a strong preference for soymilk (38%) and tofu (31%) over soy nuts (16%), soy protein bars (19%), and soy protein powder (4%). Food logs showed that participants in the intervention group consume soyfoods, on average, twice per day and at least one serving on 68 of 70 d. According to the 24-h recalls, the estimated isoflavone intake is 9 times higher in the intervention group than in the control group. Increases in isoflavone intake shown by comparisons of 24-h recalls with baseline food frequency questionnaires are sevenfold within the intervention group and slight in the control group. Urinary isoflavone excretion results showed no difference between groups at baseline, no change in the control group for followup samples (n = 242), and a statistically significant fivefold increase for women in the intervention group (n = 243). These data indicate a very high level of compliance with the study regimen at this stage.

Although the title of this book implies that it provides nutritional guidance for sedentary individuals, it addresses a far more interesting topic--the effect of a sedentary life-style on the health [...]