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Background: Laboratory-based investigations indicate that the consumption of foods with a low energy density (kcal/g) decreases energy intake. Although low-energy-dense diets are recommended for weight management, relations between energy density, energy intake, and weight status have not been clearly shown in free-living persons. Objectives: A representative US sample was used to determine whether dietary energy density is associated with energy intake, the weight of food consumed, and body weight and to explore the influence of food choices (fruit, vegetable, and fat consumption) on energy density and body weight. Design: A cross-sectional survey of adults (n = 7356) from the 1994-1996 Continuing Survey of Food Intakes by Individuals and two 24-h dietary recalls were used. Results: Men and women with a low-energy-dense diet had lower energy intakes ([approximately equal to] 425 and 275 kcal/d less, respectively) than did those with a high-energy-dense diet, even though they consumed more food ([approximately equal to] 400 and 300 g/d more, respectively). Normal-weight persons had diets with a lower energy density than did obese persons. Persons with a high fruit and vegetable intake had the lowest energy density values and the lowest obesity prevalence. Conclusions: Adults consuming a low-energy-dense diet are likely to consume more food (by weight) but to have a lower energy intake than do those consuming a higher-energy-dense diet. The energy density of a variety of dietary patterns, including higher-fat diets, can be lowered by adding fruit and vegetables, Our findings support the hypothesis that a relation exists between the consumption of an energy-dense diet and obesity and provide evidence of the importance of fruit and vegetable consumption for weight management. KEY WORDS Energy density, obesity, weight management, food patterns, fruit and vegetables, Continuing Survey of Food Intakes by Individuals, CSFII

Although obesity is increasing to epidemic proportions in many developed countries, some of these same countries are reporting substantial reductions in tobacco use. Unlike tobacco, food and physical activity are essential to life. Yet similar psychological, social, and environmental factors as well as advertising pressures influence the usage patterns of all 3. These similarities suggest that there may be commonalities between factors involved in controlling obesity and tobacco. This review, therefore, seeks to draw lessons from the tobacco experience for the organization of more successful obesity control. Smoking cessation counseling by physicians has been found to be one of the most clinically effective and cost-effective of all disease prevention interventions. When used alone, however, it cannot decrease the cultural acceptability of tobacco and the pressures and cues to smoke. Research and evaluation have shown the key elements of tobacco control to be (1) clinical intervention and management, (2) educational strategies, (3) regulatory efforts, (4) economic approaches, and (5) the combination of all of these into comprehensive programs that address multiple facets of the environment simultaneously. For each element, we present the evidence outlining its importance for tobacco control, discuss its application to date in obesity control, and suggest areas for further research. Viewing all of the elements involved and recognizing their synergistic effects draws researchers and practitioners back from an exclusive concentration on their particular setting to consider how they might seek to influence other settings in which individuals and populations must negotiate desired changes in nutrition and physical activity. KEY WORDS Tobacco control, obesity control, smoking cessation, smoking cessation counseling, obesity counseling, physical activity, nutrition, health promotion, health education, health policy, prevention, health economics

Background: Between 1990 and 1993, fear of ethnic persecution led 83 000 ethnic Nepalese to flee from Bhutan to refugee camps in Nepal, where they remained at the time of this study. Reported cases of angular stomatitis (AS), ie, thinning or fissuring at the mouth angles, increased 6-fold from December 1998 to March 1999, from 5.5 to 35.6 cases per 1000 per month. This increase came after the removal of a fortified cereal from rations. Objectives: The main objectives were to assess the prevalence of AS and of low concentrations of riboflavin, folate, vitamin B- 12, and iron by using biochemical measures; to determine whether riboflavin status was associated with AS; and to assess the potential of AS as a screening measure for low riboflavin concentrations. Design: In October 1999, we performed a survey among a random sample of 463 adolescent refugees in which we conducted interviews and physical examinations and obtained blood specimens for riboflavin assessment. Riboflavin status was assessed with the erythrocyte glutathione reductase (EC 1.6.4.2) activity coefficient. After we excluded those adolescents who had taken vitamins during the past month, 369 were eligible for analyses. Results: AS was common (26.8%; 95% CI: 22.3, 31.3), the prevalence of low riboflavin concentrations was high (85.8%; 80.7, 90.9), and riboflavin status was associated with AS. Adolescents with AS had significantly lower riboflavin concentrations than did adolescents without AS (P = 0.02). The adjusted odds ratio for AS and low riboflavin concentrations was 5.1 (1.55, 16.5). Conclusion: Globally, riboflavin deficiency is rare. Its emergence in food-dependent populations can be a harbinger of other B-vitamin deficiencies. KEY WORDS Stomatitis, folic acid, Nepal, refugees, riboflavin, riboflavin deficiency

To assess the effect of hemolysis on serum retinol concentrations determined by direct fluorometry, we assayed 196 blood samples from children 6-72-mo of age with various grades of hemolysis for serum retinol by both fluorescence and HPLC. Mean serum retinol concentrations determined by HPLC did not differ significantly according to hemolysis grade; however, fluorometric values did. Additionally, serum retinol concentrations obtained from HPLC and those obtained from direct fluorometry were significantly different in samples with severe hemolysis. Multivariate-regression analysis showed that hemolysis grade was a significant predictor of the difference in mean serum retinol values determined by the two methods. Although severe hemolysis interfered with determinations of serum retinol by direct fluorometry, this method is still a viable choice for field studies of vitamin A status. Am J Clin Nutr 1997;66:1160-4.

Background: Pharmacotherapy is recommended for the treatment of obese persons with a body mass index of 30 kg/[m.sup.2] or higher or a body mass index of at least 27 kg/[m.sup.2] plus an obesity-related comorbid condition. Objective: To estimate the prevalence of use of prescription weight loss pills in the United States in 1996-1998. Design: 1998 Behavioral Risk Factor Surveillance System, a nationally representative telephone survey. Setting: United States. Participants: 139 779 adults 18 years of age and older. Measurements: Self-reported pill use for 1996-1998, body mass index (current and before pill use), age, sex, and race or ethnicity. Results: The 2-year prevalence of pill use was 2.5% (95% Cl, 2.1% to 2.9%), or 4.6 million U.S. adults. Use was higher in women than in men (4.0% vs. 0.9%, respectively) and highest among Hispanic respondents (3.2%). Of pill users, 25% were not overweight (body mass index [is less than] 27 kg/[m.sup.2]) before using pills. Conclusions: Nearly 5 million U.S. adults used prescription weight loss pills in 1996-1998. However, one quarter of users were not overweight, suggesting that weight loss pills may be inappropriately used, especially among women, white persons, and Hispanic persons.

Background: Mexican American females have a higher prevalence of iron deficiency than do non-Hispanic white females. Objective: The objective was to estimate the prevalence of iron deficiency anemia and examine potential reasons for this difference between Mexican American (n = 1194) and non-Hispanic white (n = 1183) females aged 12-39 y. Design: We used data from the third National Health and Nutrition Examination Survey (1988-1994). Iron deficiency anemia was defined as abnormal results from [is greater than or equal to] 2 of 3 tests (erythrocyte protoporphyrin, transferrin saturation, and serum ferritin) and a low hemoglobin concentration. We used multiple logistic regression to adjust for factors that were more prevalent in Mexican American females and significantly associated with iron deficiency anemia. Results: The prevalence of iron deficiency anemia was 6.2 [+ or -] 0.8% ([bar]x [+ or -] SE) in Mexican American females and 2.3 [+ or -] 0.4% in non-Hispanic white females. Mean dietary iron intake, mean serum vitamin C concentrations, and the proportion of females using oral contraceptives were similar in the 2 groups. Age [is less than] 20 y and education were not associated with iron deficiency anemia. After adjustment for poverty level, parity, and iron supplement use, the prevalence of iron deficiency anemia was 2.3 times higher in Mexican American than in non-Hispanic white females (95% CI: 1.4, 3.9). In those with a poverty income ratio (based on household income) [is greater than] 3.0, however, the prevalence of iron deficiency anemia was 2.6 + 0.9% in Mexican American and 1.9 [+ or -] 0.6% in non-Hispanic white females (NS). Conclusion: Although much of the ethnic disparity in iron deficiency anemia remains unexplained, factors associated with household income may be involved. Am J Clin Nutr 2000;72:963-8. KEY WORDS Mexican females, non-Hispanic white females, nutrition, iron, poverty index ratio, obesity, iron supplements, vitamin C supplements, iron deficiency anemia, third National Health and Nutrition Examination Survey, NHANES III

Objective: To examine trends in height among 5- to 17-year-old children between 1973 and 1992. Design: A panel design consisting of 7 cross-sectional surveys. Participants: All schoolchildren residing in Bogalusa, La, were eligible. A total of 24 070 examinations were performed. Results: During the study period, the mean height of schoolchildren increased by 0.70 cm per decade independently of race, sex, and age. Trends were most pronounced among preadolescents, blacks, and boys, with 9- to 12-year-old black boys showing a height increase of 1.8 cm per decade. We observed a decrease in the number of relatively short children ([is less than] 10th percentile of height) and an increase in the number of tall children ([is greater than] 90th percentile of height). Because a secular trend was not seen among the 15- to 17-year-old children, our findings likely reflect an acceleration of maturation. Conclusions: It has generally been assumed that secular increases in height among schoolchildren in the United States ceased by the mid-1900s. Our findings, which may be due to various environmental factors, demonstrate that care must be taken when using nonconcurrent reference data to assess the growth of children. Additional study is needed to determine if these secular trends are continuing and to examine possible explanations and consequences of these trends. Arch Pediatr Adolesc Med. 2000; 154:155-161, After dramatic increases in the height of children and adults over the previous century, the increases were considered to stop in the 1950's and 1960's, but that may have only been a temporary pause. Between 1973 and 1992, trends toward height increase returned. The largest increases were among African-American boys between five and eight years old, and both boys and girls between nine and 12 years old. Increases among white children were half as large. However, there was no significant increase for children of any race or sex in the 13- to 17-year-old range.