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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.

Presents several medical-related letters to the editor as of June 20, 2001. Intensity of physical activity and the risk of coronary heart disease; Brassica vegetables and breast cancer risk; Histamine poisoning from seafood; Others.

Abstract: 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. [Copyright &y& Elsevier]

Approximately two thirds of U.S. adults and one fifth of U.S. children are obese or overweight. During 1980--2004, obesity prevalence among U.S. adults doubled, and recent data indicate an estimated 33% of U.S. adults are overweight (body mass index [BMI] 25.0-29.9), 34% are obese (BMI >or=30.0), including nearly 6% who are extremely obese (BMI >or=40.0). The prevalence of being overweight among children and adolescents increased substantially during 1999-2004, and approximately 17% of U.S. children and adolescents are overweight (defined as at or above the 95% percentile of the sex-specific BMI for age growth charts). Being either obese or overweight increases the risk for many chronic diseases (e.g., heart disease, type 2 diabetes, certain cancers, and stroke). Reversing the U.S. obesity epidemic requires a comprehensive and coordinated approach that uses policy and environmental change to transform communities into places that support and promote healthy lifestyle choices for all U.S. residents. Environmental factors (including lack of access to full-service grocery stores, increasing costs of healthy foods and the lower cost of unhealthy foods, and lack of access to safe places to play and exercise) all contribute to the increase in obesity rates by inhibiting or preventing healthy eating and active living behaviors. Recommended strategies and appropriate measurements are needed to assess the effectiveness of community initiatives to create environments that promote good nutrition and physical activity. To help communities in this effort, CDC initiated the Common Community Measures for Obesity Prevention Project (the Measures Project). The objective of the Measures Project was to identify and recommend a set of strategies and associated measurements that communities and local governments can use to plan and monitor environmental and policy-level changes for obesity prevention. This report describes the expert panel process that was used to identify 24 recommended strategies for obesity prevention and a suggested measurement for each strategy that communities can use to assess performance and track progress over time. The 24 strategies are divided into six categories: 1) strategies to promote the availability of affordable healthy food and beverages), 2) strategies to support healthy food and beverage choices, 3) a strategy to encourage breastfeeding, 4) strategies to encourage physical activity or limit sedentary activity among children and youth, 5) strategies to create safe communities that support physical activity, and 6) a strategy to encourage communities to organize for change.

Objective: To examine the prevalence and association of activity/participation limitation with trying to lose weight and weight loss practices (eating fewer calories, physical activity, or both) among overweight and obese adults in the United States., Research Methods and Procedures: Eligible adults were 20 years of age or older with a body mass index (BMI) >or= 25 kg/m(2) (n = 5608) who responded to standard physical functioning questions included in the 1999-2002 National Health and Nutrition Examination Survey, a continuous survey of the civilian non-institutionalized US population., Results: Obese (BMI >or= 30) men with vs. without activity/participation limitations were more likely to try to lose weight (OR = 1.59, 95% CI 1.05-2.41). This was not the case for overweight women and men (BMI 25-29.9), or obese women. Among adults trying to lose weight, reducing calorie consumption was common (63%-73%, men, 67%-76%, women). Overweight women with vs without activity/participation limitations had significantly reduced likelihood of attaining recommended physical activity (OR = 0.56, 95% CI 0.36-0.89). Obese adults were more likely to try to lose weight if they attributed their limitation to body weight (OR = 1.78, 95% CI 1.11-2.88) or diabetes (OR = 1.86, 95% CI 1.01-3.43) compared to other causes. Overweight and obese adults who attributed activity/participation limitations to mental health, musculoskeletal, or cardiovascular problems were equally likely to attempt weight loss when respondents with each condition were compared to respondents without the condition., Discussion: These results verify the importance of adequate subjective health assessment when developing individual weight loss plans, and may help guide weight management professionals in the development and delivery of more personalized care.

Background: Trying to lose weight is a concern for many Americans, but motivation for weight loss is not fully understood. Clinical assessment for obesity treatment is primarily based on measures of body size and physical comorbidities; however, these factors may not be enough to motivate individuals to lose weight. Health-related quality of life (HRQOL) may have a role in an individual's decision to try to lose weight. The objective of this study was to examine the prevalence and association of HRQOL measures as independent moderators of weight loss practices among overweight and obese men and women., Research Methods and Procedures: Data were from the 2003 Behavioral Risk Factor Surveillance System, an annual state-based telephone survey of the civilian noninstitutionalized population of adults 20 years of age or older with BMI > or = 25.0 kg/m2 (n = 111,456) who responded to 4 standard HRQOL measures that assessed general health status, physical health, mental health, and activity limitation in the past 30 days., Results: Among men with BMI 25-34.9 kg/m2, the odds of trying to lose weight increased for the moderate vs best category of HRQOL but not for the poorest vs best category, and no associations were noted for men with BMI > or = 35 kg/m2. Women with BMI 25-34.9 kg/m2 had reduced odds and decreasing associated trends in the prevalence of trying to lose weight with poorer general health, increased physically unhealthy days, and increased activity limitation days. Conversely, women with 1-13 vs 0 mentally unhealthy days had greater odds of trying to lose weight. Among those trying to lose weight, reducing calories was common (52%-69%, men; 56%-69%, women). Among men, with the exception of recent mental health, poorer levels of HRQOL measures were associated with diminished attainment of recommended physical activity levels. Among women, poorer general health status was associated with diminished attainment of recommended physical activity levels., Discussion: With the exception of recent mental health, HRQOL was differentially associated with trying to lose weight among men and women. Specifically, moderately poor HRQOL among men and better HRQOL among women were associated with trying to lose weight. Consideration of these influences on weight loss may be useful in the treatment and support of obese patients.

Objective: To examine the relation of family income, expressed relative to the poverty threshold, to the prevalence of childhood overweight, and to determine whether the association differs by race/ethnicity and time period., Subjects and Methods: Most analyses were based on 2- to 19-year-old participants (n=10,409) in the US National Health and Nutrition Examination Survey (NHANES) from 1999 to 2004. Additional analyses were performed using NHANES data collected from 1971 to 1994 to determine whether family income showed similar associations with childhood overweight (body mass index [BMI] for age > or = CDC 95th percentile) over this time period., Results: The relation of family income to childhood overweight differed (P < .001) by race/ethnicity in 1999-2004. As compared with children below the poverty level (annual family income of about $19,200), the odds of overweight among children from families with incomes of 4 or more times the poverty threshold were 0.63 (white children) and 0.51 (Mexican-American children). Among black children, however, overweight was positively associated (odds ratio of 1.12) with family income. Although family income was not associated with childhood overweight in 1971-1974, the observed associations also differed by race/ethnicity in the 1976-1980 and 1988-1994 surveys. Furthermore, the association changed during the past few decades among Mexican-American children (P = .03 for secular trend), but not among white or black children., Discussion: Although family income is related to childhood overweight, the association varies by race/ethnicity. Additional information on the reasons for these racial/ethnic differences may help in the development of appropriate interventions.

Background: Low micronutrient levels observed with increasing adiposity may result from inadequate nutrient intake and/or alterations in nutrient metabolism., Objective: To examine the association between body mass index (BMI) and micronutrient levels among a nationally representative sample of US adults aged > or = 19 years., Design: Using nationally representative cross-sectional data from the National Health and Nutrition Examination Survey III (NHANES III), we examined odds ratios of low micronutrient levels using logistic regression adjusting for covariates., Measurements: Nutritional biomarker levels (as indicated by serum levels of total carotenoids, alpha-carotene, beta-carotene, beta-cryptoxanthin, lutein/zeaxanthin, lycopene, vitamin E, vitamin C, selenium, vitamin A, vitamin D, folate, vitamin B12, and red blood cell folate) among men and nonpregnant women, by BMI category., Results: Overweight and obese adults had higher odds of low levels for a number of nutrients compared with normal-weight adults. Odds of being low in multiple micronutrients was most common among overweight and obese premenopausal women., Conclusion: These findings underscore the need for further assessment of specific micronutrient inadequacies among persons who are overweight or obese. Specifically, research is needed to determine whether these inadequacies are due to insufficient dietary intake, altered metabolic processes, or both.

Context: There are scant data on patterns of multivitamin use among US adults in terms of body mass index (BMI) or whether one is trying to lose weight., Objective: To examine multivitamin use and beliefs about multivitamin use among adults according to BMI and to determine whether use by body weight differs if one is trying to lose weight., Design: Cross-sectional multivariate analysis of the HealthStyles consumer survey. The final analytic sample consisted of 2239 women and 1532 men., Main Outcome Measures: Prevalence and odds of multivitamin use by demographic and behavioral characteristics including BMI, use by weight loss intent, and among users, reasons for use., Results: 63.7% of women and 52.9% of men reported multivitamin use (taking 1 or more multivitamin per week). Obese women were less likely than normal-weight women to use multivitamins; no differences according to BMI category were detected for men. Among women who were not trying to lose weight, obese women were less likely than normal-weight women to use multivitamins (odds ratio = 0.63, CI 0.41-0.98). Assessment of reasons for use found that compared among women not trying to lose weight, those trying to lose weight were more likely to report multivitamin use because It is important for my health., Conclusions: This descriptive analysis adds to the limited literature on multivitamin use according to both body weight and attempting to lose weight. Multivitamin use was common and decreased with increasing BMI. This may be because fewer obese people consider vitamins "important for their health".

Context: Although low-carbohydrate, high-protein (LCHP) diets reemerged as popular diets, there are scant data on patterns of use in the general US population., Objective: We examined the prevalence of reported LCHP diet use (eg, Sugar Busters, The Zone, The Carbohydrate Addict's Diet, The Atkins Diet), associated weight control behaviors, diet duration, and amount of weight loss while on the diet., Design: Population-based cross-sectional survey., Setting: Telephone survey of US adults conducted from September 2002 to December 2002 (N = 9300)., Main Outcome Measures: We used multivariable logistic regression models to determine predictors of current LCHP diet use., Results: At the time of the survey, 12.5% of Americans reported ever using a LCHP diet, and 3.4% reported current use. Prevalence of current use was similar across sex, race/ethnicity, and education levels. Among those trying to lose weight (n = 3790), 5.9% reported currently using an LCHP diet. Among current users, mean weight loss was 18.3 (median, 11.7) lb, with 18.2% reporting > or = 30 lb weight loss, 34.0% > or = 20 lb weight loss, and 8.8% no weight loss. More men than women reported a duration of use of more than 12 months (42.2% vs 29.6%, P = .04) and median duration was greater in men than women (5.7 vs 2.8 months, P = .08). Among those trying to control weight, a significantly higher proportion of current LCHP diet users reported eating fewer calories and meeting physical activity recommendations (38.0%) compared with nonusers (29.8%)., Conclusions: LCHP diets were equally prevalent across sociodemographic subgroups and many users reported significant weight loss. Approximately 40% of male users and 30% of female users reported long-term use of the diet, suggesting that for some, this dietary approach may be well tolerated.

Background: During the past 20 years, adult obesity rates have doubled in the United States. The National Institutes of Health (NIH) issued guidelines in 1998 recommending that healthcare professionals advise obese patients to lose weight. We examined trends in physician counseling for weight loss during 1994-2000, characteristics of obese adults receiving advice to lose weight in 2000, and the association in 2000 between receiving advice and attempting to lose weight., Methods: We analyzed 1994, 1996, 1998, and 2000 data from the Behavioral Risk Factor Surveillance System (BRFSS), a state-based telephone survey of noninstitutionalized adults from 48 states and the District of Columbia. We limited the analysis to obese respondents who had visited physicians for a routine medical checkup during the previous 12 months (n = 61,968)., Results: Among obese patients, the proportion who received advice to lose weight decreased from 42.3% (se = 0.79) in 1994 to 40.3% (se = 0.55) in 2000. We observed declines in receipt of advice for almost all subgroups. Respondents in the youngest and oldest age groups and those without health insurance had the largest significant declines. Patients who reported receiving advice to lose weight had 2.8 the odds of trying to lose weight as those who did not receive advice (95% confidence interval, 2.5, 3.2)., Conclusion: Despite the 1998 NIH guidelines and increases in morbid obesity, the proportion of obese persons who reported being counseled by a healthcare professional has declined slightly. Because counseling might be associated with weight loss attempts, barriers to counseling need to be identified and addressed.

Americans' consumption of fruits and vegetables has increased slightly over the last 10 years, but most people still do not meet the Dietary Guidelines recommendation to consume 5 to 9 servings per day. New and innovative strategies are needed if we are to significantly increase the mean population intake of fruits and vegetables. To help formulate such strategies as well as to evaluate evidence and identify research gaps, the American Cancer Society and the Centers for Disease Control and Prevention convened the Fruit and Vegetable Environment, Policy, and Pricing Workshop, which brought together experts in how environmental change, policy, and pricing affect fruit and vegetable consumption. The papers in this supplement consist of a review of environmental interventions to improve nutrition and papers covering pricing and consumer value and how fruit and vegetable consumption can be promoted at worksites, restaurants, grocery stores and other community settings, and schools. Conclusions from the workshop were that existing intervention strategies need to be evaluated, promising example programs need to be disseminated, and new innovative interventions and programs need to be created and evaluated.