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Purpose: Whole grains, generally recognised as healthy choices, are not included in most nutrient profiling systems. We tested modifications to the Nutri-Score algorithm to determine whether including whole grains would provide an improved measure of food, and overall diet quality., Methods: The whole-grain content of food, with a minimum cut-point of 25%, was added to the algorithm, following similar methods used to score other health-promoting components such as fibre. We applied and compared the original and the modified Nutri-Score to food composition and dietary intake data from Australia, France, the United Kingdom, and the United States., Results: At the food level, correlations between whole-grain content and food nutritional score were strengthened using the modified algorithm in Australian data, but less so for the other countries. Improvements were greater in grain-specific food groups. The largest shift in Nutri-Score class was from B to A (best score). At the dietary intake level, whole-diet nutritional scores for individuals were calculated and compared against population-specific diet-quality scores. With modifications, correlations with diet-quality scores were improved slightly, suggesting that the modified score better aligns with national dietary guidelines. An inverse linear relationship between whole-diet nutritional score and whole-grain intake was evident, particularly with modifications (lower whole-diet nutritional score indicative of better diet quality)., Conclusion: Including a whole-grain component in the Nutri-Score algorithm is justified to align with dietary guidelines and better reflect whole grain as a contributor to improved dietary quality. Further research is required to test alternative algorithms and potentially other nutrient profiling systems., (© 2021. The Author(s).)

Firefighting is strenuous work that results in considerable cardiovascular strain. Sudden cardiac events are the leading cause of duty-related death in the fire service. This cross-sectional study examined cardiometabolic measures and prevalence of risk factors in firefighters by age and sex and compare these data to the general population. Data obtained at medical exams (2015-2018) from 4279 male and 234 female career firefighters at four occupational health clinics in the United States were analyzed. Estimates for the general population were obtained using the 2015-16 National Health and Nutrition Examination Survey fasting subsample. Linear regression models stratified by sex with age modelled as a continuous variable were used to examine general trends. Point estimates across age groups (20-29, 30-39, 40-49, and 50-59 year olds) for cardiometabolic measures were reported. Among the total sample, 36% were obese and 25% had low HDL cholesterol. Females had significantly lower body mass index (BMI), LDL cholesterol, triglycerides and blood glucose than males. A significant quadratic relationship of age with BMI, total cholesterol, LDL cholesterol, and triglycerides was found in males with increasing values peaking between 45 and 50 years. Total cholesterol and LDL cholesterol increased with age among females. Blood glucose increased with age in both sexes. Firefighters had similar or better cardiometabolic health profiles than the US general population; however, both samples had a concerning prevalence of cardiometabolic risk factors among individuals ≥ 40 years of age. Health professionals and fire service members alike should consider prevention efforts among young firefighters and better treatment among older firefighters., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2021 Published by Elsevier Inc.)

Objective: This study examined cardiovascular disease risk factors by BMI category in firefighters, the association of BMI and age with risk factor prevalence, and the prevalence of risk factors by BMI category within age groups., Methods: Cardiovascular measures from the medical evaluations of 4,453 firefighters, performed between 2015 and 2018 at four occupational health clinics in the United States (South-West Cohort, Mid-Atlantic Cohort, South-East Cohort, and Mid-West Cohort), were analyzed cross-sectionally by BMI and age categories., Results: Among female firefighters with normal weight, 25% had high blood pressure, 8% had low high-density lipoprotein cholesterol, and 0% had high glucose, whereas the prevalence in female firefighters with obesity was 57%, 45%, and 11%, respectively. Among male firefighters, there were independent and significant associations of BMI and age for the prevalence of high blood pressure, high cholesterol, high triglycerides, and high glucose. Higher BMI category was associated with a higher prevalence of high blood pressure, high triglycerides, and low high-density lipoprotein cholesterol within all age groups and with a higher prevalence of high glucose and high cholesterol within ages 40 to 49 and 50 to 59 years., Conclusions: An increasing prevalence of risk factors with older age and higher BMI suggests that preventive strategies should be initiated in younger firefighters and aggressively promoted or mandated throughout firefighters' careers., (© 2021 The Authors. Obesity published by Wiley Periodicals LLC on behalf of The Obesity Society (TOS).)

Competing Interests: Conflicts of Interest: None declared.

Background: Research consistently finds that, on average, firefighters gain weight over time and some data indicate that younger firefighters are more likely to gain weight than older firefighters. The purpose of this study was to estimate the 5-year weight change among younger and older US firefighters., Methods: Data from two occupational medical exams separated by 5 years (2009-2016) were examined from a cohort of US career firefighters in Virginia (males, n = 589; females, n = 67). The cohort was grouped into two age categories (< 45 years and ≥ 45 years). Weight change subgroups were Loss (decrease of > 3% body weight), Stable (within ±3% body weight) and Gain (increase of > 3% body weight). Multinomial logistic regression models and linear regression models were conducted to examine differences in the probability of being in a particular weight change category, weight change overall and by weight change category between younger and older firefighters., Results: At baseline, 25 and 35% of younger (< 45 years) and older (≥ 45 years) were obese, respectively. Younger firefighters gained significantly (P < 0.05) more weight (3.0 ± 0.2 kg) than older firefighters (0.8 ± 0.5 kg). Younger firefighters were more likely to gain weight (53% versus 39%) and less likely (10% versus 20%) to lose weight as compared to older firefighters. Smaller weight gains were associated with age and BMI with the smallest increases observed in overweight and obese firefighters ≥45 years of age., Conclusions: Health care providers should be attentive to weight gain, even among young non-obese firefighters, and counsel firefighters to avoid the additive risks of being older and heavier. In addition, weight loss/management programs should be promoted in the fire service to encourage healthy body weight and to prevent unhealthy weight gain among both young and old firefighters alike.

Hypertension is a major risk factor for atherosclerotic cardiovascular disease and cardiac remodeling and is associated with an increased risk of sudden cardiac events, the leading cause of duty-related death in the fire service. We assessed systemic blood pressures and prevalence of hypertension among US firefighters by decade of life. Medical records of career firefighters (5063 males and 274 females) from four geographically diverse occupational health clinics were assessed. Hypertension was defined as systolic blood pressure ≥130 mmHg or diastolic blood pressure ≥80 mmHg, or taking antihypertensive medication. Results from the firefighter sample were compared to the US general population (2015-2016 and 2017-2018 National Health and Nutrition Examination Surveys). Among the total sample, 69% of firefighters met the criteria for hypertension and 17% were taking antihypertensive medications. Percentages of hypertensive male and female firefighters were 45% and 11% among 20-29 years old, respectively, and increased to 78% and 79% among 50-59 years old, respectively. Compared to the general population, male firefighters had a higher prevalence of hypertension ( p < 0.05) across all age groups (11-16% higher). In order to improve firefighter health and protect against sudden incapacitation in this public safety occupational group, increased efforts are necessary to screen for and manage high blood pressure.

Objective: Examine atherosclerotic cardiovascular disease (ASCVD) risk scores by age and weight status in career firefighters., Methods: Medical examinations for firefighters more than or equal to 40 years (n = 644) were examined. ASCVD 10-year risk scores were calculated from sex- and race-specific equations and were reported by three age (40 to 44.9, 45 to 49.9, more than or equal to 50 years) and weight (normal, overweight, obese) categories., Results: Mean risk scores were 1.8%, 3.5%, and 6.2% for firefighters 40 to 44.9, 45 to 49.9, and more than or equal to 50 years, respectively. The association of weight status with increased ASCVD risk was higher (P < 0.01) among older firefighters, where risk was 0.8% (95% confidence interval [CI]: 0.6 to 1.1) and 2.3% (95% CI: 2.0 to 2.6) among normal versus obese 40 to 44.9 year olds, and 4.1% (95% CI: 3.1 to 5.3) and 7.8% (95% CI: 6.7 to 8.9) among normal versus obese more than or equal to 50 year olds., Conclusions: While firefighters cannot avoid aging, physicians should counsel firefighters with weight-maintenance or weight-loss advice to prevent and manage elevated ASCVD risk.

Purpose: This study aimed to assess changes in cardiovascular disease (CVD) risk factors in firefighters who lost, maintained, or gained weight over 5 yr., Methods: Anthropometrics and biomarkers of CVD were measured during two occupational medical exams 4.8 yr apart in 656 career firefighters. Weight change subgroups were loss (decrease of >3% body weight), stable (within ±3% body weight), and gain (increase of >3% body weight). Changes in CVD risk factors in the total sample and within weight change subgroups were tested for statistical significance using paired t-tests., Results: After 5 yr, 12% of the sample lost weight, 38% maintained weight, and 50% gained weight. Firefighters on average had significant increases (P < 0.001) in body weight (2.5 ± 0.2 kg), body mass index (0.8 ± 0.1 kg·m), total cholesterol (5.5 ± 1.4 mg·dL), LDL cholesterol (5.2 ± 1.2 mg·dL), and blood glucose (2.1 ± 0.5 mg·dL). Firefighters who gained weight (6.6 ± 0.2 kg) had significant increases (P < 0.001) in total cholesterol (12.9 ± 1.8 mg·dL), LDL cholesterol (11.1 ± 1.6 mg·dL), and blood glucose (2.9 ± 0.7 mg·dL) with a significant decrease (P ≤ 0.01) in HDL cholesterol (-1.3 ± 0.4 mg·dL). Firefighters who lost weight (-7.2 ± 0.5 kg) had significant decreases (P < 0.05) in total cholesterol (-8.5 ± 3.9 mg·dL), LDL cholesterol (-6.7 ± 3.3 mg·dL), and blood pressure (systolic: -5.3 ± 1.3 mm Hg; diastolic -4.2 ± 1.0 mm Hg) with a significant increase (P < 0.05) in HDL cholesterol (2.3 ± 1.0 mg·dL)., Conclusions: Although improvements in cardiovascular health among firefighters who lost weight were found, 50% of the sample gained weight with adverse changes in measures of cardiovascular health. Given that sudden cardiac death is the most common cause of duty-related death among firefighters, with increased risk among obese firefighters, the amount of weight gain and the adverse changes in cardiovascular health suggest the need for improvements in health promotion programs for firefighters in the United States.

Objective: To examine changes in pulmonary function over a 5-year period in US firefighters., Methods: Spirometry values from occupational medical examinations separated by 5 years (2009 to 2016) were examined from 662 career firefighters in Virginia. Predicted values and expected 5-year changes in one-second forced expiratory volume (FEV1), forced vital capacity (FVC), and FEV1/FVC were estimated using reference equations generated from the Third National Health and Nutrition Examination Survey (NHANES III) data. Paired t-tests were used to identify significant changes over time and between the observed and expected changes., Results: FEV1 and FVC (percentage of predicted) decreased (P < 0.001) from 100.9 ± 0.6% to 92.3 ± 0.5% and 99.0 ± 0.6% to 91.9 ± 0.5%, respectfully. The observed decreases in FEV1, FVC, and FEV1/FVC were two to four times greater (P < 0.001) than the expected decrease over 5 years., Conclusion: Increased efforts are needed to ensure respiratory protection for US firefighters to minimize their risk of pulmonary damage.

Objective: To examine changes in measures of cardiovascular health in male and female firefighters over 5 years., Methods: Anthropometrics and biomarkers of cardiovascular health from two occupational medical exams separated by 5 years (2009 to 2016) were examined from a cohort of US career firefighters in Virginia (males, n = 603; females, n = 69). Changes over time were tested using paired t-tests and McNemar's tests., Results: At baseline, 29% of males and 10% of females were obese. Body weight and body mass index significantly increased (P < 0.05) in males (2.5 ± 0.2 kg) (0.8 ± 0.1 kg·m) and females (2.5 ± 0.8 kg) (1.0 ± 0.3 kg·m) over the 5-year period. The prevalence of obesity, hypercholesterolemia, hypertensive medication usage, and high blood glucose significantly increased in males over the 5-year period., Conclusions: While improvements in blood pressure were observed, large percentages of firefighters, particularly males, had cardiovascular disease risk factors that increased over time.

Objective: To evaluate the 2016 International Chefs Day cooking workshops Art on a Plate., Design: Nonexperimental pretest-posttest design SETTING: Art on a Plate workshops with children from 14 countries in Asia, America, and Europe., Participants: A total of 433 workshop participants aged 4-14 years (mean age, 8.6 years)., Intervention: Instructed by a chef, children in the workshops created a self-chosen design on their plate with a spinach-fruit salad., Main Outcome Measures: Before and after the workshop, a questionnaire assessing liking and willingness to eat or taste; hunger was assessed using the Teddy the Bear method and emotions were assessed using the Self-assessment Manikin. The event coordinator evaluated salad intake., Analysis: Linear and generalized linear (logit) mixed models were used to test statistical differences before and after the workshop., Results: The workshop resulted in a small increase in liking (n = 409; P = .02) and person control (n = 375; P < .001) and a decrease in hunger (n = 379; P < .001). A total of 30% of children increased their liking scores, 18% decreased them, and 52% did not change them. Significant associations of liking and change in liking with salad intake were in the expected direction., Conclusion and Implications: This study showed the positive effect of a cooking workshop on children's salad liking across a selection of countries worldwide. Further research and novel methods are needed to evaluate the long-term effectiveness of cooking activities in real-life settings across countries., (Copyright © 2019 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Food reformulation has been identified as a strategy to improve nutritional intakes; however, little is known about the potential impact of industry-wide reformulations. Objective: The aim of the study was to model the dietary impact of food and beverage reformulation following the Nestlé Nutritional Profiling System (NNPS) standards for children, adolescents, and adults in the United States and France. Design: Dietary intakes of individuals aged ≥4 y were retrieved from nationally representative surveys: the US NHANES 2011-2012 ( n = 7456) and the French Individual and National Survey on Food Consumption ( n = 3330). The composition of all foods and beverages consumed were compared with the NNPS standards for energy, total and saturated fats, sodium, added sugars, protein, fiber, and calcium. Two scenarios were modeled. In the first, the nutrient content of foods and beverages was adjusted to the NNPS standards if they were not met. In the second, products not meeting the standards were replaced by the most nutritionally similar alternative meeting the standards from the same category. Dietary intakes were assessed against local nutrient recommendations, and analyses were stratified by body mass index and socioeconomic status. Results: Scenarios 1 and 2 showed reductions in US adults' mean daily energy (-88 and -225 kcal, respectively), saturated fats (-4.2, -6.9 g), sodium (-406, -324 mg), and added sugars (-29.4, -35.8 g). Similar trends were observed for US youth and in France. The effects on fiber and calcium were limited. In the United States, the social gradient of added sugars intake was attenuated in both scenarios compared with the baseline values. Conclusions: Potential industry-wide reformulation of the food supply could lead to higher compliance with recommendations in both the United States and France, and across all socioeconomic groups. NNPS standards seemed to be especially effective for nutrients consumed in excess., (© 2017 American Society for Nutrition.)

Adolescents in Australia have a poor dietary intake, leading to large numbers of them being at risk for inadequate intake of micronutrients, and excessive intake of less healthful dietary components. This study examined dietary intakes at multiple eating occasions to identify opportunities for more targeted recommendations and strategies to improve dietary intakes among adolescents. Data from the first 24-h recall of 14-18 years old in the 2011-2012 National Nutrition and Physical Activity Survey were analysed ( n = 772). Participant-defined eating occasions were classified as breakfast, lunch, dinner or other eating occasions combined. The mean percent contribution to the total day intake of top shortfall nutrients (calcium, magnesium, vitamin A, iron), discretionary calories, saturated fat, free sugars and sodium, as well as nutrient density, the foods consumed and the percent of consumers at each eating occasion, were calculated. Breakfast had the lowest prevalence of consumers (81%), contributed the least to total daily energy (14.6%) and almost a quarter of daily calcium and iron. Other eating occasions combined contributed 47.5% of free sugars and were top contributors of daily calcium (34.6%) and magnesium (31.7%). Discretionary foods contributed 32.4% of the energy at lunch, and the sodium content at lunch was 415 mg/1000 kJ. Key opportunities identified for adolescents were to increase breakfast consumption, given the high nutrient densities of breakfasts consumed; improve overall lunch quality, particularly the sodium content; promote the intake of milk, fruit and a variety of vegetables at both lunch and dinner; maintain healthful choices at in-between meal eating occasions while focusing on decreasing the intake of discretionary foods.

Background: Emerging evidence suggests that the timing, amount at individual eating occasions, and distribution of protein and energy intakes throughout the day may affect health. Objective: We examined the timing, amounts, and distribution of protein and energy intakes throughout the day among participants aged 4-18 y in the United States in the context of chronobiology and nutrition. Methods: This cross-sectional analysis included 2532 participants aged 4-18 y who completed the first interviewer-administered 24-h dietary recall in NHANES 2013-2014. Descriptive statistics for intakes across the day were provided as percentiles, means ± SEMs, and percentages of nonconsumers. Statistical differences between intakes across the day were tested with the use of individual-level fixed-effects regression models. Cumulative distribution functions were used to examine the timing of the first and last caloric eating occasion. Results: Mean ± SEM protein (grams) and energy (percentage of the day) intakes were significantly higher ( P < 0.05) in the evening than in the morning among all age groups. The percentage of participants aged 4-8, 9-13, and 14-18 y who had their first eating occasion at or after 1100 was 4%, 14%, and 20%, respectively, and the percentage who had their last eating occasion at or after 2100 was 8%, 19%, and 34%, respectively. Conclusions: Protein and energy intakes among participants aged 4-18 y in this study were largest in the evening and midday and smallest in the morning and afternoon. Clinical trials are needed to assess any potential impact such dietary behaviors may have on health outcomes related to metabolic dysfunction in children and adolescents., Competing Interests: 2: Author disclosures: KC Mathias, S Almoosawi, and LG Karagounis are employed by the Nestlé Research Center, Switzerland, a member of Nestec Ltd. Nestec Ltd., a wholly owned affiliate of Nestlé S.A, provides professional assistance, research, and consulting services for food, dietary, dietetic, and pharmaceutical products of interest to Nestlé S.A., (© 2017 American Society for Nutrition.)

Background and Objective: Approximately 20% of US children and adolescents consume pizza on any given day; and pizza intake is associated with higher intakes of energy, sodium, and saturated fat. The reformulation of pizza products has yet to be evaluated as a viable option to improve diets of the US youth. This study modeled the effect on nutrient intakes of two potential pizza reformulation strategies based on the standards established by the Nestlé Nutritional Profiling System (NNPS)., Methods: Dietary intakes were retrieved from the first 24hr-recall of the National Health and Nutrition Examination Survey (NHANES) 2011-12, for 2655 participants aged 4-19 years. The composition of pizzas in the NHANES food database (n = 69) were compared against the NNPS standards for energy, total fat, saturated fat, sodium, added sugars, and protein. In a reformulation scenario, the nutrient content of pizzas was adjusted to the NNPS standards if these were not met. In a substitution scenario, pizzas that did not meet the standards were replaced by the closest pizza, based on nutrient content, that met all of the NNPS standards., Results: Pizzas consistent with all the NNPS standards (29% of all pizzas) were significantly lower in energy, saturated fat and sodium than pizzas that were not. Among pizza consumers, modeled intakes in the reformulation and substitution scenarios were lower in energy (-14 and -45kcal, respectively), saturated fat (-1.2 and -2.7g), and sodium (-143 and -153mg) compared to baseline., Conclusions: Potential industry wide reformulation of a single food category or intra-category food substitutions may positively impact dietary intakes of US children and adolescents. Further promotion and support of these complimentary strategies may facilitate the adoption and implementation of reformulation standards., Competing Interests: GM, KCM, AV, FM, and UL were employees of Nestec SA when conducting the study. MG and AD are consultants to Nestec SA and received financial compensation for their input to the study. There are no patents, products in development or marketed products to declare. This does not alter the authors' adherence to PLOS ONE policies on sharing data and materials.

Background: In the United States, the lunch meal contributes more than 20% of the daily intakes of most micronutrients for children and adolescents consuming lunch. Seven percent to 20% of children and adolescents in the United States do not eat lunch on a given day., Objective: To identify differences in total micro- and macronutrient intakes of children consuming and missing lunch on a given day., Design: Cross-sectional secondary analysis of the combined National Health and Nutrition Examination Surveys 2009-2010 and 2011-2012. Dietary intake was assessed using the first day 24-hour recall of each respondent., Participants and Settings: The National Health and Nutrition Examination Survey sample represents the total noninstitutionalized civilian population residing in the United States. The sample used in this study included 4,755 children aged 4 to 18 years with complete data for all analyses., Main Outcome Measures: Total day, lunch, and nonlunch micronutrients, macronutrients, solid fats, and added sugar intakes were examined., Statistical Analyses Performed: Linear regression models controlling for age, sex, race/ethnicity, household poverty status, and weekend were used to compare dietary intakes of lunch consumers and nonconsumers. Intakes from nonlunch sources were examined to determine the extent to which differences between lunch consumers and nonconsumers could be attributed to the lunch meal., Results: Missing lunch was associated with lower micronutrient intakes, with the lunch meal primarily responsible for the higher micronutrient intakes of lunch consumers compared with nonconsumers. Missing lunch was also associated with lower energy, fiber, and sodium intakes. Added sugar and solid fat intakes of lunch consumers and nonconsumers were not significantly different., Conclusions: This study identifies potential concerns for children missing lunch with respect to micronutrient intakes and shows that the lunches consumed by children in the United States are an important source of essential nutrients, but also less healthful dietary components., (Copyright © 2016 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.)

Background: Physical strength is associated with improved health outcomes in children. Heavier children tend to have lower functional strength and mobility. Physical activity can increase children's strength, but it is unknown how different types of electronic media use impact physical strength., Methods: Data from the NHANES National Youth Fitness Survey (NNYFS) from children ages 6-15 were analyzed in this study. Regression models were conducted to determine if screen-based sedentary behaviors (television viewing time, computer/video game time) were associated with strength measures (grip, leg extensions, modified pull-ups, plank) while controlling for potential confounders including child age, sex, BMI z-score, and days per week with 60+ minutes of physical activity. Grip strength and leg extensions divided by body weight were analyzed to provide measures of relative strength together with pull-ups and plank, which require lifting the body., Results: The results from the regression models showed the hypothesized inverse association between TV time and all strength measures. Computer time was only significantly inversely associated with the ability to do one or more pull-ups., Conclusions: This study shows that television viewing, but not computer/videogames, is inversely associated with measures of child strength while controlling for child characteristics and physical activity. These findings suggest that "screen time" may not be a unified construct with respect to strength outcomes and that further exploration of the potential benefits of reducing television time on children's strength and related mobility is needed.

The aim of this article is to describe a case report of Class III malocclusion treatment with lower first molar extraction. The 27-year-old Caucasian male patient presented a symmetric face with a straight profile, hyperdivergent growth pattern, molar and cuspid Class III relation, and an anterior crossbite as well as a mild crowding on cuspids area, in both upper and lower arches and a tendency to posterior crossbite. The treatment was performed by the use of Haas expansion appliance followed by an initial alignment and leveling of the upper and lower arches with a fixed edgewise appliance, extraction of lower teeth aiming the correction of the incisors proclination and end the treatment with a Class I molar relationship. It resulted in a significant change in the patient's profile, dentoalveolar Class III correction, upper arch expansion, leveling and alignment of the upper and lower arches, and improvement of tipping of the upper and lowers incisors. In cases of a dentoalveolar compensation in well positioned bone bases the treatment with fixed appliances is an alternative and extraction of lower teeth is considered.

Objective: This study evaluated the frequency of root resorption during the orthodontic treatment with Herbst appliance by Cone Beam Computed Tomography (CBCT)., Material and Methods: The sample comprised 23 patients (11 men, 12 women; mean ages 15.76±1.75 years) with Class II division 1 malocclusion, treated with Herbst appliance. CBCT was obtained before treatment (T0) and after Herbst treatment (T1). All the dental roots, except third molars, were evaluated, and apical root resorption was determined using the axial guided navigation method. Paired t-tests and Wilcoxon T Test were used to compare the dependent samples in parametric and nonparametric cases, respectively. Chi-Square Test with Yates' correction was used to evaluate the relationship between apical root resorption and gender. Results were considered at a significance level of 5%., Results: Apical resorption was detected by CBCT in 57.96% of 980 roots that underwent Herbst appliance treatment. All patients had minimal resorption and there was no statistical significance between the genders., Conclusion: CBCT three-dimensional evaluation showed association between Herbst appliance and minimal apical root resorption, mostly in the anchoring teeth, without clinical significance.

Objective: Determine the association of children's susceptibility to large food portion sizes with appetite regulation and obesity., Methods: Normal-weight and obese non-Hispanic black children (n = 100) aged 5-6 years were observed in four dinner conditions of varying portion size; portions of all foods (except milk) offered were: 100% (677 kcal), 150% (1015 kcal), 200% (1353 kcal), or 250% (1691 kcal) of those in the reference condition (100%). Condition order was randomly assigned to 2-4 children who ate together at each meal. Child height and weight were measured and caregiver reports of child appetite were obtained. Hierarchical growth curve models were used to estimate associations of meal energy intake with portion size condition, child weight status, and appetite regulation traits, controlling for demographics., Results: Total energy intake increased across conditions of increasing food portion size (P < 0.001). The effect of portion size condition on total energy intake varied with food responsiveness (P = 0.05) and satiety responsiveness (P < 0.05), but not weight status (P = 0.682). Children with lower satiety responsiveness and greater food responsiveness showed greater increases in meal energy across conditions., Conclusions: Children with poorer appetite regulation may be more vulnerable to obesogenic dietary environments offering large food portions than other children., (© 2015 The Obesity Society.)

Background: Monitoring changes in the nutritional content of food/beverage products and shifts in consumer purchasing behaviors is needed to measure the effectiveness of efforts by both food manufacturers and policy makers to improve dietary quality in the United States., Objective: To examine changes in the nutritional content (eg, energy, saturated fat, and sugar density) of ready-to-eat (RTE) grain-based dessert (GBD) products manufactured and purchased between 2005 and 2012., Design: Nutrition Facts panel information from commercial databases was linked to RTE GBD products purchased by households (N=134,128) in the Nielsen Homescan longitudinal dataset 2005-2012., Statistical Analysis: Linear regression models were used to examine changes in the energy, saturated fat, and sugar density of RTE GBD products manufactured in each year between 2005 and 2012. Random effects models controlling for demographics, household composition/size, and geographic location were used to examine changes in household purchases of RTE GBD products (in grams) and the average energy, saturated fat, and sugar density of RTE GBD products purchased., Results: The saturated fat density (grams/100 g) of RTE GBD products increased significantly from 6.5±0.2 in 2005 to 7.3±0.2 and 7.9±0.2 for pre-existing and newly introduced products in 2012, respectively. Between 2005 and 2012, the energy density (kilocalories/100 g) of RTE GBD products purchased decreased significantly from 433±0.2 to 422±0.2, the saturated fat density (grams/100 g) of products purchased increased significantly from 6.3±0.01 to 6.6±0.01, the sugar density (grams/100 g) of products purchased decreased significantly from 32.4±0.03 to 31.3±0.02, and household purchases of RTE GBD products (in grams) decreased by 24.1%±0.4%., Conclusions: These results highlight an opportunity for both food manufacturers and public health officials to develop new strategies to shift consumer purchases toward products with lower energy, saturated fat, and sugar densities in addition to decreasing overall purchases of RTE GBDs., (Copyright © 2015 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.)

Despite the historical rise and recent plateau of child overweight and obesity, levels remain exceedingly high. To understand these trends and identify targets for intervention it is important to examine concomitant trends in children's diets. The objective of our analysis was to describe 21-year trends in total energy intake and the major food and beverage sources of energy among 2- to 18-year-olds in the United States. Six nationally representative surveys were examined in 2012, the Continuing Survey of Food Intakes by Individuals (1989-1991 and 1994-1996, 1998) and the National Health and Nutrition Examination Survey (2003-2004, 2005-2006, 2007-2008, and 2009-2010). Total energy intake among US children and adolescents rose considerably from 1989 to 2004, and subsequently declined through 2010. Seven sources were consistently major contributors across all time points: sugar-sweetened beverages, pizza, full-fat milk, grain-based desserts, breads, pasta dishes, and savory snacks. Intakes of full-fat milk, meats and processed meat products, ready-to-eat cereals, burgers, fried potatoes, fruit juice, and vegetables decreased from 1989-2010 whereas intakes of nonfat milk, poultry, sweet snacks and candies, and tortilla- and corn-based dishes increased linearly over the 21-year period. Significant nonlinear time trends were observed with recent decreases in intakes of sugar-sweetened beverages, pizza, pasta dishes, breads and rolls, and savory snacks and recent increases in intake of fruit. Energy intakes of US children began to decline in 2003-2004 and continued to decline through 2009-2010. However, among preschool children (aged 2 to 5 years) and children from low-income families, total energy intakes in 2009-2010 still remained significantly higher than in 1989-1991., (Copyright © 2013 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.)

Background: Although consumption of sugar-sweetened beverages (SSBs) is associated with higher caloric intakes, the amount SSBs contribute to higher intakes has not been addressed., Purpose: To estimate the amount SSBs contribute to higher caloric intakes and determine how the diets of SSB consumers and nonconsumers differ., Methods: The What We Eat In America, NHANES 2003-2010 surveys were combined into a sample of 13,421 children; analyses were conducted in December 2012. To determine the contribution of SSBs to higher caloric intakes, total non-SSB intake (food + non-SSB beverages) of SSB consumers and nonconsumers were compared using linear regression models controlling for demographic and socioeconomic factors. Analyses also compared intakes between nonconsumers and SSB consumers with different amounts of SSB consumption., Results: For children aged 2-5 years and 6-11 years, total non-SSB intakes did not differ between nonconsumers and SSB consumers at any level of SSB consumption, indicating that SSBs were primarily responsible for the higher caloric intakes among SSB consumers. A similar finding was observed among children aged 12-18 years; however, both food and SSB contributed to higher caloric intakes of adolescents consuming ≥500 kcal of SSBs. Among those aged 12-18 years, higher intakes of foods (e.g., pizza, burgers, fried potatoes, and savory snacks) and lower intakes of non-SSB beverages (e.g., fluid milk and fruit juice) were associated with increased SSB intake., Conclusions: Sugar-sweetened beverages are primarily responsible for the higher caloric intakes of SSB consumers, and SSB consumption is associated with intake of a select number of food and beverage groups, some of which are often unhealthy (e.g., pizza and grain-based desserts)., (Copyright © 2013 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.)

Serving larger portions of energy-dense foods has been shown to promote children's energy intake at meals. Whether larger portions increase children's intake of both fruits and vegetables (F&V) is less clear. A 2×2 within-subjects design systematically varied portion sizes of fruit (75 vs 150 g) and vegetable (75 vs 150 g) side dishes served at dinner. Children's F&V liking was measured using a validated tasting method. Thirty children aged 4 to 6 years were tested in a laboratory setting at 5:00 pm on weekdays from November 2008 through March 2009. Mixed linear models were used to determine effects of fruit portion size, vegetable portion size, and their interaction on food and energy intakes. Data are presented as model-based means±standard error unless otherwise indicated. When portions were doubled, children increased their vegetable intake by 37% (12±4 g; P<0.01) and their fruit intake by 70% (41±6 g; P<0.01). Vegetable portion size effects were not influenced by offering more fruit and vice versa. Portion size effects were limited to children who liked that particular food. Total meal energy intake did not vary by portion size condition. These results indicate that serving larger F&V portions at meals can be used to promote young children's intake of both foods without influencing total meal energy intake. Effects were not seen in children who disliked F&V, suggesting a need to combine increased F&V portions with strategies to increase their acceptance.