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This study examined the use of behavioral design strategies to improve healthier food sales.A quasi-experimental, one-group, repeated measures design examined changes in food sales following behavioral design adjustments.United States military base hospital dining facility.U.S. military service members, retirees, and civilian employees.Behavioral design changes included placement, layout, messaging, default healthy bundling, a stoplight rating system, strategic positioning of healthy items on menu boards, and an increase in healthier snacks.Food sales were assessed by point-of-sales data.T-tests examined total sales of each food adjusted weekly between baseline and intervention and intervention and post-intervention. 16 food items targeted by the intervention were examined. Weekly food sales were calculated for the 18-week baseline, 18-week intervention, and 9-week post-intervention. Further, analysis estimated negative binomial models for food item sales.The hospital dining facility served 600 to 900 meals per day. Weekly foods sales decreased during the intervention for desserts, cooked starches, hummus, and yogurt (P < 0.01). Sales increased during the intervention for fruit cups, cooked vegetables, vegetable and turkey burgers, grilled chicken, packaged salads, French fries, hamburgers, and hot dogs (P < 0.02).This study demonstrates that a mixture of behavioral design strategies can be operationalized with reasonable fidelity and can lead to increases in the sales of some healthy foods in military worksites. [ABSTRACT FROM AUTHOR]

We assessed the adequacy of nutrient intakes of 135 rural Bangladeshi breast-fed infants 6-12 mo of age and examined nutritional trade-offs due to possible displacement of breast milk by complementary foods. Observers completed 12-h daytime measurements of breast milk and complementary food intakes; data for the previous 12 h were obtained from maternal recall, yielding estimates of total 24-h intakes. On average, infants were mildly wasted (mean [+ or -] SD weight-for-length Z-score = -0.92 [+ or -] 0.88) and moderately stunted (length-for-age Z-score = -1.49 [+ or -] 0.96). Total energy intakes at 6-8 and 9-12 mo were 88 and 86% of absolute energy requirements (k J/d), 106 and 105% of requirements per kg body weight, and 97 and 94% of requirements per kg median weight-for-length, respectively. Breast milk contributed 78% of energy intake at 6-8 mo and 75% at 9-12 mo. Mean meal frequency and energy density of complementary foods were generally consistent with recommendations, but only small amounts of food were offered. Nevertheless, only 72% of the food energy offered was consumed. Total energy intake was positively correlated with meal frequency, quantity consumed per meal, and energy intake from breast milk, but not with energy density of complementary foods. Energy intake from complementary foods was inversely related to energy intake from breast milk. The diets fell short of recommended intakes for numerous vitamins and minerals. We conclude that although greater intakes of complementary foods were associated with higher total energy intake, micronutrient intake remained low due to the low micronutrient density of the complementary foods consumed and the partial displacement of breast milk. KEY WORDS: * infant dietary intake * Bangladesh * breast-feeding * complementary food * malnutrition

Purpose: Sugar-sweetened beverage (SSB) consumption is high among U.S. adults and is associated with obesity. Given that more than 100 million Americans consume food or beverages at work daily, the worksite may be a venue for interventions to reduce SSB consumption. However, the level of support for these interventions is unknown. We examined associations between workday SSB intake and employees' support for worksite wellness strategies (WWSs).Design: We conducted a cross-sectional study using data from Web-based annual surveys that gather information on health-related attitudes and behaviors.Setting: Study setting was the United States.Subjects: A total of 1924 employed adults (≥18 years) selected using probability-based sampling.Measures: The self-reported independent variable was workday SSB intake (0, <1 or ≥1 times per day), and dependent variables were employees' support (yes/no) for the following WWSs: (1) accessible free water, (2) affordable healthy food/drink, (3) available healthy options, and (4) less available SSB.Analysis: Multivariable logistic regression was used to control for sociodemographic variables, employee size, and availability of cafeteria/vending machine.Results: About half of employees supported accessible free water (54%), affordable healthy food/drink (49%), and available healthy options (46%), but only 28% supported less available SSB. Compared with non-SSB consumers, daily SSB consumers were significantly less supportive of accessible free water (adjusted odds ratio, .67; p < .05) or less available SSB (odds ratio, .49; p < .05).Conclusion: Almost half of employees supported increasing healthy options within worksites, although daily workday SSB consumers were less supportive of certain strategies. Lack of support could be a potential barrier to the successful implementation of certain worksite interventions. [ABSTRACT FROM AUTHOR]

Context: Fruit and vegetable intake is an important part of a healthy diet and is associated with numerous positive health outcomes. MyPyramid provides recommendations for fruit and vegetable consumption based on individual calorie requirements as determined by an individual's age, sex, and physical activity level., Objectives: To determine (1) median fruit and vegetable consumption from all dietary sources among adolescent and adult consumers and the percentage of adolescents and adults meeting individual recommended intake levels based on caloric requirements and (2) consumption levels among various demographic groups, intake levels from subtypes of fruits and vegetables, and primary contributors to fruit and vegetable intake., Design: Analysis of 2-day, 24-hour recall data from the 2003-2004 National Health and Nutrition Examination Survey (NHANES), a continuous, nationally representative, cross-sectional survey., Results: This study included dietary contributions of fruits and vegetables from all dietary sources. Fewer than 1 in 10 Americans meet their calorie-specific MyPyramid fruit or vegetable recommendations. Higher intake was not observed in subgroups with higher recommendations for fruit and vegetable consumption based on caloric requirements. The primary contributors to total fruit intake were whole fruits among adults and fruit juices among adolescents. The largest single contributor to overall fruit intake was orange juice. Potatoes dominated vegetable consumption, particularly among adolescents, in whom fried potatoes increased the median vegetable intake from 0.72 cup to 1.21 cups per day. Dark green and orange vegetables and legumes accounted for a small portion of vegetable intake, and few people met the recommendations., Conclusions: Few American adolescents or adults reported consuming the recommended amounts of fruits or vegetables. Increasing consumption will probably require multifaceted approaches that augment educational campaigns with policy and environmental strategies aimed at the food system at large, from farm to plate, including schools, worksites, and retail establishments. Increasing America's fruit and vegetable consumption is an important public health strategy for weight management and reduction of risk for chronic disease.

Context: High fructose intake has been associated with increased de novo lipogenesis in the liver as well as increased plasma triglycerides, insulin resistance, and obesity. Fructose occurs naturally in fruits and vegetables; however, it is added to many processed foods as table sugar (sucrose) and high-fructose corn syrup. Dietary data from a nationally representative sample in 1977-1978 estimated that mean consumption of fructose was 37 g/day (8% of total intake). Little is known about more recent fructose consumption patterns., Objective: We determined the amount and sources of dietary fructose among US adults and children., Design: We examined fructose consumption patterns by sex, age group, race/ethnicity, socioeconomic status, and body mass index for 21,483 children and adults. We used a single 24-hour dietary recall administered in the third National Health and Examination Survey (NHANES)., Main Outcome Measure: Weighted estimates of fructose intake were tested for significant differences (P < .05) between groups., Results: The mean consumption of fructose was estimated to be 54.7g/day (range, 38.4-72.8) and accounted for 10.2% of total caloric intake. Consumption was highest among adolescents (12-18 years) at 72.8 g/day (12.1% of total calories). One fourth of adolescents consumed at least 15% of calories from fructose. The largest source of fructose was sugar-sweetened beverages (30%) followed by grains (22%) and fruit or fruit juice (19%)., Conclusions: Over 10% of Americans' daily calories were from fructose. These results, when compared with a previous nationally representative study, suggest that fructose consumption has increased. Further research is needed to understand the impact of increased intake of fructose on human health.

Introduction: Eating a diet high in fruits and vegetables as part of an overall healthful diet can help lower chronic disease risk and aid in weight management. Increasing the percentage of Americans who consume enough fruits and vegetables every day is part of the Healthy People 2010 objectives for the nation. Assessing trends in consumption of these foods is important for tracking public health initiatives to meet this goal and for planning future objectives., Methods: We assessed total and sex-specific changes in daily consumption of fruits and vegetables among 1,227,969 adults in the 50 U.S. states and the District of Columbia who participated in the Behavioral Risk Factor Surveillance System from 1994 through 2005. To estimate changes in consumption according to dietary recommendations that were in place during the years examined, we used geometric mean and the percentage of people eating fruits or vegetables or both five or more times per day. Estimates were standardized for sex, age, and race/ethnicity and analyzed by multivariate regression., Results: From 1994 through 2005, the geometric mean frequency of consumption of fruits and vegetables declined slightly (standardized change: men and women, -0.22 times/day; men, -0.26 times/day; women, -0.17 times/day). The proportion of men and women eating fruits or vegetables or both five or more times per day was virtually unchanged (men, 20.6% vs 20.3%; women, 28.4% vs 29.6%); however, we found small increases for men aged 18 to 24 years and for women who were aged 25 to 34 years, non-Hispanic black, or nonsmokers. Consumption of fruit juice and non-fried potatoes declined for both sexes., Conclusion: The frequency of fruit and vegetable consumption changed little from 1994 through 2005. If consumption is to be increased, we must identify and disseminate promising individual and environmental strategies, including policy change.

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".