Publications by authors named "Regan L Bailey"

115 Publications

Association of food insecurity with dietary intakes and nutritional biomarkers among US children, National Health and Nutrition Examination Survey (NHANES) 2011-2016.

Am J Clin Nutr 2021 May 8. Epub 2021 May 8.

Department of Nutrition Science, Purdue University, West Lafayette, IN, USA.

Background: Food insecurity is associated with poorer nutrient intakes from food sources and lower dietary supplement use. However, its association with total usual nutrient intakes, inclusive of dietary supplements, and biomarkers of nutritional status among US children remains unknown.

Objective: The objective was to assess total usual nutrient intakes, Healthy Eating Index-2015 (HEI-2015) scores, and nutritional biomarkers by food security status, sex, and age among US children.

Methods: Cross-sectional data from 9147 children aged 1-18 y from the 2011-2016 NHANES were analyzed. Usual energy and total nutrient intakes and HEI-2015 scores were estimated using the National Cancer Institute method from 24-h dietary recalls.

Results: Overall diet quality was poor, and intakes of sodium, added sugars, and saturated fat were higher than recommended limits, regardless of food security status. Food-insecure girls and boys were at higher risk of inadequate intakes for vitamin D and magnesium, and girls also had higher risk for inadequate calcium intakes compared with their food-secure counterparts, when total intakes were examined. Choline intakes of food-insecure children were less likely to meet the adequate intake than those of their food-secure peers. No differences by food security status were noted for folate, vitamin C, iron, zinc, potassium, and sodium intakes. Food-insecure adolescent girls aged 14-18 y were at higher risk of micronutrient inadequacies than any other subgroup, with 92.8% (SE: 3.6%) at risk of inadequate intakes for vitamin D. No differences in biomarkers for vitamin D, folate, iron, and zinc were observed by food security status. The prevalence of iron deficiency was 12.7% in food-secure and 12.0% in food-insecure adolescent girls.

Conclusions: Food insecurity was associated with compromised intake of some micronutrients, especially among adolescent girls. These results highlight a need for targeted interventions to improve children's overall diet quality, including the reduction of specific nutrient inadequacies, especially among food-insecure children. This study was registered at clinicaltrials.gov as NCT03400436.
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http://dx.doi.org/10.1093/ajcn/nqab113DOI Listing
May 2021

Fewer US adults had low or transitional vitamin B12 status based on the novel combined indicator of vitamin B12 status compared with individual, conventional markers, NHANES 1999-2004.

Am J Clin Nutr 2021 May 8. Epub 2021 May 8.

Centers for Disease Control and Prevention (CDC), National Center for Environmental Health, Atlanta, GA, USA.

Background: Elevated plasma methylmalonic acid (MMA) and/or total homocysteine (tHcy), as well as low serum vitamin B12 and/or holotranscobalamin (holoTC) are indicative of vitamin B12 deficiency. Combined indicators (cB12), which pool some or all 4 markers into an index, may be a more reliable diagnostic tool to overcome inconclusive diagnoses with individual markers.

Objectives: We aimed to describe different cB12 score combinations and estimate the prevalence of low or transitional vitamin B12 status compared with individual markers.

Design: Using cross-sectional data for B12, MMA, and tHcy in persons ≥20 y participating in NHANES 1999-2004 (n = 12,335), we examined raw and covariate-adjusted regression models to assess determinants of 3cB12 (all 3 markers) and combinations of 2cB12 (2 markers).

Results: 3cB12 was significantly associated with B12 (Spearman r = 0.75), MMA (r = -0.70), and tHcy (r = -0.59). The 3cB12 reference interval (2.5th to 97.5th percentile) was -0.538 to 1.60. In covariate-adjusted models, we found no association of 3cB12 with age; adult females and users of B12 supplements had higher, while adults with advanced chronic kidney disease had lower 3cB12 levels regardless of race-Hispanic origin group (self-reported). Only 2.7% of adults had low or transitional vitamin B12 status using the proposed cB12 cutoff of ≤-0.5, while the prevalence of low (or low-normal) status depended on the selected individual marker and its cutoff: 2.2% and 13% for B12 < 148 and 148-222 pmol/L, respectively; 6.0% for MMA exceeding an age-specific cutoff (250-320 nmol/L); and 8.4% for tHcy > 13 µmol/L. The reference intervals for B12, MMA, and tHcy overlapped from the low (<-2.5) to the transitional (-2.5 to -0.5) and to the adequate (>-0.5) cB12 categories.

Conclusions: Vitamin B12 deficiency may be overestimated among US adults when individual, conventional markers are used. When only 2 markers are available, the combination of B12 and MMA provides results comparable to 3cB12.
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http://dx.doi.org/10.1093/ajcn/nqab122DOI Listing
May 2021

Perspective: Impact of the National Academy of Sciences, Engineering, and Medicine Report on the Process for the 2020 Dietary Guidelines Advisory Committee.

Adv Nutr 2021 Mar 18. Epub 2021 Mar 18.

Center for Nutrition Policy and Promotion, Food and Nutrition Services, US Department of Agriculture, Alexandria, VA, USA.

The National Academy of Sciences, Engineering, and Medicine (NASEM) recommended steps to redesign the process of developing the Dietary Guidelines for Americans (DGA) are based on 5 guiding principles (enhance transparency; promote diversity of expertise and experience; support a deliberative process; manage biases and conflicts of interest; and adopt state-of-the-art processes and methods). Using these principles and recommendations, the USDA and HHS updated the process for developing the 2020-2025 Dietary Guidelines, including the process for appointing members and managing the work of the 2020 Dietary Guidelines Advisory Committee. Modifications included having public comment on the topics and questions to be addressed by the Federal Advisory Committee, reviewing professional and financial activities on potential appointees to the committee prior to their appointment, redesigning the website to provide status updates on the work of the committee as analytical frameworks and draft conclusions were developed, strengthening the approaches for conducting systematic reviews, and adding a public meeting for discussion of the final report before its submission to the Secretaries of the USDA and HHS. Because the DGA is reviewed and updated every 5 y, it is possible to learn from each cycle what works well and where improvements in the process can be implemented. The current article illustrates, from the perspective of the advisory committee, the impact of the NASEM report on the development of the scientific report by examining changes in the process consistent with the 5 principles.
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http://dx.doi.org/10.1093/advances/nmab023DOI Listing
March 2021

Overview of dietary assessment methods for measuring intakes of foods, beverages, and dietary supplements in research studies.

Authors:
Regan L Bailey

Curr Opin Biotechnol 2021 Mar 10;70:91-96. Epub 2021 Mar 10.

Department of Nutrition Science, Purdue University, 700 West State St., West Lafayette, IN 47906, United States. Electronic address:

Measuring the dietary intakes of individuals for research and monitoring purposes is notoriously challenging and is subject to both random and systematic measurement error. In this review, the strengths and limitations of current methods to assess dietary and supplemental exposures are described. Traditional methods of dietary assessment include food records, food frequency questionnaires, 24-hour recalls, and screening tools; digital and mobile methods that leverage technology are available for these traditional methods. Ultimately, the choice of assessment method is dependent upon the research question, the study design, sample characteristics, and the size of the sample, to name just a few. Despite their challenges, dietary assessment tools are an important dimension of nutrition research and monitoring.
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http://dx.doi.org/10.1016/j.copbio.2021.02.007DOI Listing
March 2021

A Proposed Framework for Identifying Nutrients and Food Components of Public Health Relevance in the Dietary Guidelines for Americans.

J Nutr 2021 May;151(5):1197-1204

Center for Nutrition Policy and Promotion, Food and Nutrition Services, USDA, Alexandria, VA, USA.

Background: Identification of nutrients of public health concern has been a hallmark of the Dietary Guidelines for Americans (DGA); however, a formal systematic process for identifying them has not been published.

Objectives: We aimed to propose a framework for identifying "nutrients or food components" (NFCs) of public health relevance to inform the DGA.

Methods: The proposed framework consists of 1) defining terminology; 2) establishing quantitative thresholds to identify NFCs; and 3) examining national data. The proposed framework utilizes available data from 3 key data sources or "prongs": 1) dietary intakes; 2) biological endpoints; and 3) clinical health consequences such as prevalence of health conditions, directly or indirectly through validated surrogate markers.

Results: In identifying potential NFCs of public health concern, the 2020 DGA Committee developed a decision-tree framework with suggestions for combining the 3 prongs. The identified NFCs of public health concern for Americans ≥1 y old included fiber, calcium (≥2 y old), vitamin D, and potassium for low intakes and sodium, added sugars, and saturated fats (≥2 y old) for high intakes that were associated with adverse health consequences. Iron was identified among infants ages 6-12 mo fed human milk. For reproductive-aged and pregnant females, iron (all trimesters) and folate (first trimester) were identified for low intake, based on dietary and biomarker data (iron) or the severity of the consequence (folic acid and neural tube defects). Among pregnant women, low iodine was of potential public health concern based on biomarker data. Other NFCs that were underconsumed, overconsumed, and pose special challenges were identified across the life course.

Conclusions: The proposed decision-tree framework was intended to streamline and add transparency to the work of this and future Dietary Guidelines Advisory Committees to identify NFCs that need to be encouraged or discouraged in order to help reduce risk of chronic disease and promote health and energy balance in the population.
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http://dx.doi.org/10.1093/jn/nxaa459DOI Listing
May 2021

Trends in Nutrient- and Non-Nutrient-Containing Dietary Supplement Use among US Children from 1999 to 2016.

J Pediatr 2021 04 17;231:131-140.e2. Epub 2020 Dec 17.

Department of Nutrition Science, Purdue University, West Lafayette, IN.

Objectives: To characterize dietary supplement use among US children, including product type, motivations, user characteristics, and trends over time with a primary focus on non-vitamin/non-mineral dietary supplements (NVNM).

Study Design: Overall, NVNM, and vitamin and/or mineral dietary supplement only (VM-only) use; motivations for use; and trends in use over time were examined in children (≤19 years of age) using the National Health and Nutrition Examination Survey 1999-2016 data (n = 42 510).

Results: Between 1999 and 2016, overall dietary supplement and VM-only dietary supplement use among all children remained relatively stable at ∼30%; yet, NVNM dietary supplement use increased from 2.9% to 6.4%, mainly due to increased use of omega-3 polyunsaturated fatty acids. NVNM use was greater in boys than in girls (3.9% vs 3.3%), and greater in older children than in younger children (P < .0001), the opposite of what was observed with VM-only dietary supplement use. Although both user groups shared 2 primary motivations, both motivations were reported by a significantly greater percent of vitamin and/or mineral dietary supplement users vs NVNM users: to maintain health (38.7% vs 23.1%) and to improve health (33.1% vs 22.6%). NVNM users were much more likely to use dietary supplement for relaxation, stress, and sleep; for mental health; and for colon and bowel health.

Conclusions: Although the prevalence of any dietary supplement and VM-only dietary supplement use among US children has both remained stable, the prevalence of NVNM use has increased substantially over time. Yet, NVNM use remains relatively low overall. NVNM use exhibited different patterns by sex, age, and motivations when compared with vitamin and/or mineral dietary supplement use. Despite increasing NVNM use, high-quality evidence supporting their use is lacking, especially in children.
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http://dx.doi.org/10.1016/j.jpeds.2020.12.021DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8005463PMC
April 2021

Knowledge gaps in understanding the metabolic and clinical effects of excess folates/folic acid: a summary, and perspectives, from an NIH workshop.

Am J Clin Nutr 2020 11;112(5):1390-1403

Division of Geriatrics and Clinical Gerontology, National Institute on Aging, National Institutes of Health, Bethesda, MD, USA.

Folate, an essential nutrient found naturally in foods in a reduced form, is present in dietary supplements and fortified foods in an oxidized synthetic form (folic acid). There is widespread agreement that maintaining adequate folate status is critical to prevent diseases due to folate inadequacy (e.g., anemia, birth defects, and cancer). However, there are concerns of potential adverse effects of excess folic acid intake and/or elevated folate status, with the original concern focused on exacerbation of clinical effects of vitamin B-12 deficiency and its role in neurocognitive health. More recently, animal and observational studies have suggested potential adverse effects on cancer risk, birth outcomes, and other diseases. Observations indicating adverse effects from excess folic acid intake, elevated folate status, and unmetabolized folic acid (UMFA) remain inconclusive; the data do not provide the evidence needed to affect public health recommendations. Moreover, strong biological and mechanistic premises connecting elevated folic acid intake, UMFA, and/or high folate status to adverse health outcomes are lacking. However, the body of evidence on potential adverse health outcomes indicates the need for comprehensive research to clarify these issues and bridge knowledge gaps. Three key research questions encompass the additional research needed to establish whether high folic acid or total folate intake contributes to disease risk. 1) Does UMFA affect biological pathways leading to adverse health effects? 2) Does elevated folate status resulting from any form of folate intake affect vitamin B-12 function and its roles in sustaining health? 3) Does elevated folate intake, regardless of form, affect biological pathways leading to adverse health effects other than those linked to vitamin B-12 function? This article summarizes the proceedings of an August 2019 NIH expert workshop focused on addressing these research areas.
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http://dx.doi.org/10.1093/ajcn/nqaa259DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7657327PMC
November 2020

Dairy intake and bone health across the lifespan: a systematic review and expert narrative.

Crit Rev Food Sci Nutr 2020 Sep 14:1-47. Epub 2020 Sep 14.

Department of Nutrition Science, Purdue University, West Lafayette, Indiana, USA.

Over the past 30-years, the U.S. Dietary Guidelines for Americans have included recommendations around dairy consumption, largely based on meeting recommendations for calcium intake with the intended purpose of osteoporosis prevention. Although dairy products provide more bone-beneficial nutrients (e.g., calcium, magnesium, potassium, zinc, phosphorus, and protein) per unit of energy than any other food group, the relevance of dairy products for long-term bone health and fracture prevention has resurged as some observational studies have suggested consumption to be associated with a greater risk of fractures. Given this controversy, we sought to synthesize the evidence on dairy consumption and bone health across the lifespan. We searched the PubMed, EMBASE, Web of Science, and Cochrane Central Register of Controlled Trials databases for English-language publications through June 2, 2020. Case-controlled, cross-sectional, prospective cohort or nestled case-control (or case cohort), and clinical trials reporting the effect of dairy products on bone mineral density, bone mineral content, and/or fractures were included in the systematic review. Two reviewers independently performed data extractions. Data from 91 publications, including 30 RCTs, 28 prospective cohorts, 23 cross-sectional studies, and 10 case-control studies were included in the systematic review. We assigned a "D" grade or "insufficient evidence" for the effect of dairy in infants and toddlers (0- to <36-months), children (3- to <10-years), and young adults (19- to <50-years). A "C" grade or "limited evidence" was assigned for the effect of dairy in adolescents (10- to <19-years). A "B" grade or "moderate" evidence was assigned for the effect of dairy in middle aged to older adults (≥50-years). Research on bone mass in adults between the ages of 20- to 50-years and individuals from other ethnic groups apart from Chinese females and Caucasians is greatly needed. Daily intake of low or nonfat dairy products as part of a healthy habitual dietary pattern may be associated with improved BMD of the total body and at some sites and associated with fewer fractures in older adults.
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http://dx.doi.org/10.1080/10408398.2020.1810624DOI Listing
September 2020

Nutritional contributions of food pantries and other sources to the diets of rural, Midwestern food pantry users in the USA.

Br J Nutr 2021 Apr 2;125(8):891-901. Epub 2020 Sep 2.

Department of Nutrition Science, Purdue University, West Lafayette, IN47907, USA.

Food pantries provide free food to individuals at nutritional risk given lack of available foods. Frequent use of food pantries is associated with higher dietary quality; however, neither the nutrient contributions of food pantries to participant diets nor their relationship with household food security are known. This cross-sectional analysis used secondary data from rural food pantry participants, including sociodemographic characteristics, household food security and 24-h recalls. Mean intakes of selected food groups and nutrients from food pantries, supermarkets, other stores and restaurants, and other were compared by one-way ANCOVA. Interaction effects of household food security with food sources were evaluated by two-way ANCOVA. About 40 % of participants' dietary intake came from food pantries. Mean intakes of fibre (P < 0·0001), Na (P < 0·0001), fruit (P < 0·0001), grains (P < 0·0001) and oils (P < 0·0001) were higher from food pantries compared with all other sources, as were Ca (P = 0·004), vitamin D (P < 0·0001) and K (P < 0·0001) from food pantries compared with two other sources. Percentage total energy intake (%TEI) from added sugars (P < 0·0001) and saturated fat (P < 0·0001) was higher from supermarkets than most other sources. Significant interaction effects were observed between food sources and household food security for vegetables (P = 0·01), Na (P = 0·01) and %TEI from saturated fat (P = 0·004), with food-insecure participants having significantly higher intakes from food pantries and/or supermarkets compared with all other sources. Future interventions may incorporate these findings by providing education on purchasing and preparing healthy meals on limited budgets, to complement foods received from pantries, and by reducing Na in pantry environments.
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http://dx.doi.org/10.1017/S0007114520003372DOI Listing
April 2021

High folic acid or folate combined with low vitamin B-12 status: potential but inconsistent association with cognitive function in a nationally representative cross-sectional sample of US older adults participating in the NHANES.

Am J Clin Nutr 2020 12;112(6):1547-1557

Department of Nutritional Sciences, Rutgers University, New Brunswick, NJ, USA.

Background: Potential safety concerns relative to impaired cognitive function may exist when high folic acid exposures are combined with low vitamin B-12 status.

Objectives: We aimed to examine the relation of the coexistence of high folate and low vitamin B-12 status with cognitive function, utilizing various definitions of "high" folate status.

Methods: Cross-sectional data from older adults (≥60 y; n = 2420) from the 2011-2014 NHANES were analyzed. High folate status was defined as unmetabolized serum folic acid (UMFA) > 1 nmol/L or serum total folate > 74.1 nmol/L, and low vitamin B-12 status as methylmalonic acid > 271 nmol/L or serum vitamin B-12 < 150 pmol/L. Logistic regression models estimated ORs of scoring low on 1 of 4 cognitive tests: the Digit Symbol Substitution Test (DSST), the Consortium to Establish a Registry for Alzheimer's Disease Delayed Recall (CERAD-DR) and Word Learning tests, and the Animal Fluency test (AF).

Results: A significant interaction was observed relative to scoring low on the DSST (<34; UMFA; P-interaction = 0.0071) and AF (serum folate; P-interaction = 0.0078) for low vitamin B-12 and high folate status. Among those with low vitamin B-12, high UMFA or high serum total folate was associated with higher risk of scoring low on the DSST (OR: 2.16; 95% CI: 1.05, 4.47) and the AF (OR: 1.93; 95% CI: 1.08, 3.45). Among those with "normal" vitamin B-12, higher UMFA or serum total folate was protective on the CERAD-DR. In noninteraction models, when high folate and normal vitamin B-12 status was the reference group, low vitamin B-12 combined with high UMFA was associated with greater risk based on the DSST (<34, OR: 2.87; 95% CI: 1.85, 4.45; <40, OR: 2.22; 95% CI: 1.31, 3.75) and AF (OR: 1.97; 95% CI: 1.30, 2.97); but low vitamin B-12 and lower UMFA (OR: 1.69; 95% CI: 1.16, 2.47) was also significantly associated for DSST < 40 risk.

Conclusions: Low vitamin B-12 was associated with cognitive impairment both independently and in an interactive manner with high folate for certain cognitive performance tests among older adults.
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http://dx.doi.org/10.1093/ajcn/nqaa239DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8184300PMC
December 2020

Dietary Quality and Usual Intake of Underconsumed Nutrients and Related Food Groups Differ by Food Security Status for Rural, Midwestern Food Pantry Clients.

J Acad Nutr Diet 2020 09 20;120(9):1457-1468. Epub 2020 Jul 20.

Background: Food pantry users represent a predominantly food insecure population, yet dietary intake may differ among food secure (FS), low FS, and very low FS clients. Usual intake of food groups and nutrients by food security status has not previously been compared among food pantry clients.

Objective: This study aimed to estimate the usual intakes of underconsumed nutrients (ie, potassium; dietary fiber; choline; magnesium; calcium; vitamins A, D, E, and C; and iron) and related food groups (ie, vegetables, fruits, whole grains, and dairy) and dietary quality, and to evaluate their relationship with food security status.

Design: This cross-sectional, secondary analysis used baseline data from a prior intervention study (Clinical Trial Registry: NCT03566095). A demographic questionnaire, the US Household Food Security Survey Module, and up to three 24-hour dietary recalls on nonconsecutive days, including weekdays and weekends, were collected.

Participants/setting: This community-based study included a convenience sample of adult, midwestern food pantry clients (N=579) recruited from August to November 2014.

Main Outcome Measures: Main outcomes evaluated were Healthy Eating Index-2010 scores and usual intakes of underconsumed nutrients and related food groups.

Statistical Analyses Performed: Linear regression models and the National Cancer Institute method, adjusting for confounders, were used to estimate associations of food security with diet quality and usual intake, respectively.

Results: Being FS was associated with a higher whole grains HEI-2010 score and higher mean usual intake of whole grains compared with being low FS. Being FS was associated with higher usual intakes of iron and dairy compared with being very low FS. Being FS was associated with a higher mean usual intake of dark green vegetables compared with being low FS and very low FS. Usual intakes were below federal guidance for all subgroups of food security.

Conclusions: Although food security status may differentiate dietary intake among food pantry clients, improvements are needed among all clients.
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http://dx.doi.org/10.1016/j.jand.2020.04.011DOI Listing
September 2020

Diet Quality and Associations with Food Security among Women Eligible for Indiana Supplemental Nutrition Assistance Program-Education.

J Nutr 2020 08;150(8):2191-2198

Department of Nutrition Science, Purdue University, West Lafayette, IN, USA.

Background: The diet quality among adults receiving nutrition education lessons through Supplemental Nutrition Assistance Program-Education (SNAP-Ed) is currently unknown.

Objectives: The objectives of this study were to characterize the diet quality of Indiana SNAP-Ed-eligible women; estimate their mean usual intake of fruits, vegetables, dairy, and whole grains compared to Dietary Guidelines for Americans (DGA) recommendations; and determine if these dietary outcomes differed by food security status.

Methods: SNAP-Ed paraprofessionals recruited participants from August 2015 to May 2016 for this secondary analysis of cross-sectional data collected as the baseline assessment for a randomized controlled trial. Participants were SNAP-Ed-eligible women aged ≥18 y interested in nutrition education lessons. Dietary outcomes were assessed by one or two 24-h dietary recalls. The Healthy Eating Index (HEI)-2010 was used to characterize diet quality. Mean usual intake of food groups was estimated using the National Cancer Institute Method. Food security status was classified using the US Household Food Security Survey Module. Data were analyzed in October 2019.

Results: Mean ± SEM HEI-2010 total score was 42 ± 0.9 for the study sample. Mean ± SE usual intake of servings of fruits (0.61 ± 0.08 cups [144.32 ± 18.93 mL]), vegetables [1.4 ± 0.10 cups (331.2 ± 23.66 mL)], dairy [1.5 ± 0.11 cups (354.88 ± 26.02 mL)], and whole grains [0.48 ± 0.06 ounces (13.61 ± 1.70 g)] did not differ by food security subgroup. Mean HEI-2010 total score was significantly higher by 4.8 ± 2.0 points for the food-secure than for the food-insecure subgroup (P = 0.01). Mean HEI-2010 component scores were 1.1 ± 0.5 points higher for whole grain (P = 0.01) and 1.0 ± 0.5 points higher for dairy (P = 0.05) in the food-secure than in the food-insecure subgroup. The proportions of the study sample not meeting the DGA recommendations for food group intake were ≥85% for both food-secure and -insecure subgroups.

Conclusions: Indiana SNAP-Ed-eligible women reported poor diet quality, highlighting their need for nutrition interventions aiming to improve food security and diet as per DGA recommendations in low-income populations.
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http://dx.doi.org/10.1093/jn/nxaa171DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7690761PMC
August 2020

Examination of different definitions of snacking frequency and associations with weight status among U.S. adults.

PLoS One 2020 17;15(6):e0234355. Epub 2020 Jun 17.

Department of Nutrition Science, College of Health and Human Sciences, Purdue University, West Lafayette, Indiana, United States of America.

Snacks, while widely consumed in the United States (U.S.), do not have a standard definition, complicating research to understand associations, if any, with weight status. Therefore, the purpose of this study was to examine the association between snacking frequency and weight status using various snacking definitions that exist in the scientific literature among U.S. adults (NHANES 2013-2016; ≥20y n = 9,711). Four event-based snacking definitions were operationalized including participant-defined snacks, eating events outside of meals, and operationally defined snacks based on absolute thresholds of energy consumed (>50 kcal). Weight status was examined using body mass index (BMI), waist circumference, and sagittal abdominal diameter risk. Logistic regression models examined snacking frequency and associations with weight status. Outcomes varied by the definition of a snack employed, but the majority of findings were null. Mean energy from snacks was significantly higher among women with obesity compared to women with normal weight when a snack was defined as any event outside of a typical mealtime (i.e. other than breakfast, lunch, dinner, super, brunch), regardless of whether or not it contributed ≥50 kcal. Further investigation into ingestive behaviors that may influence the relationship between snacking frequency and weight status is needed.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0234355PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7299329PMC
September 2020

Older adults with obesity have higher risks of some micronutrient inadequacies and lower overall dietary quality compared to peers with a healthy weight, National Health and Nutrition Examination Surveys (NHANES), 2011-2014.

Public Health Nutr 2020 09 29;23(13):2268-2279. Epub 2020 May 29.

Department of Nutrition Science, Purdue University, West Lafayette, IN47907, USA.

Objective: To evaluate total usual intakes and biomarkers of micronutrients, overall dietary quality and related health characteristics of US older adults who were overweight or obese compared with a healthy weight.

Design: Cross-sectional study.

Setting: Two 24-h dietary recalls, nutritional biomarkers and objective and subjective health characteristic data were analysed from the National Health and Nutrition Examination Survey 2011-2014. We used the National Cancer Institute method to estimate distributions of total usual intakes from foods and dietary supplements for eleven micronutrients of potential concern and the Healthy Eating Index (HEI)-2015 score.

Participants: Older adults aged ≥60 years (n 2969) were categorised by sex and body weight status, using standard BMI categories. Underweight individuals (n 47) were excluded due to small sample size.

Results: A greater percentage of obese older adults compared with their healthy-weight counterparts was at risk of inadequate Mg (both sexes), Ca, vitamin B6 and vitamin D (women only) intakes. The proportion of those with serum 25-hydroxyvitamin D < 40 nmol/l was higher in obese (12 %) than in healthy-weight older women (6 %). Mean overall HEI-2015 scores were 8·6 (men) and 7·1 (women) points lower in obese than in healthy-weight older adults. In addition, compared with healthy-weight counterparts, obese older adults were more likely to self-report fair/poor health, use ≥ 5 medications and have limitations in activities of daily living and cardio-metabolic risk factors; and obese older women were more likely to be food-insecure and have depression.

Conclusions: Our findings suggest that obesity may coexist with micronutrient inadequacy in older adults, especially among women.
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http://dx.doi.org/10.1017/S1368980020000257DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7429309PMC
September 2020

Dairy intake is not associated with improvements in bone mineral density or risk of fractures across the menopause transition: data from the Study of Women's Health Across the Nation.

Menopause 2020 08;27(8):879-886

Department of Nutrition Science, Purdue University, West Lafayette, IN.

Objective: Menopause represents a period in which bone deterioration is accelerated; thus, primary prevention strategies to address age-related bone loss are crucial. Dairy products contain more than a dozen essential nutrients, including calcium, phosphorus, vitamin D, and high-quality protein, as well as bioactive compounds that may promote bone mineralization. However, the relationship between dairy consumption and bone health across the menopause transition remains largely unknown. The purpose of this analysis was to estimate the change in lumbar spine and femoral neck bone mineral density and the risk of bone fracture by the frequency of dairy intakes among women across the menopausal transition using the publicly available data from the Study of Women's Health Across the Nation.

Methods: We analyzed total dairy foods in four categories of <0.5, 0.5 to <1.5, 1.5 to <2.5, and ≥2.5 servings/d or <1.5 and ≥1.5 servings/d. A general linear model was used to estimate the association of dairy intake with the 10-year bone mineral density loss rate and a linear mixed model was used to estimate the annualized bone mineral density loss rate of the femoral neck and lumbar spine. A Cox proportional hazard model was applied to calculate hazard ratios and 95% confidence intervals of the nontraumatic fractures. Poisson regression was used to determine the relative risks and 95% confidence intervals of the nontraumatic fractures. The models were controlled for race/ethnicity, age, height, weight, smoking status, physical activity, alcohol consumption, calcium use, menopausal status, and total caloric intake.

Results: No significant differences in bone mineral density change were observed, regardless of baseline menopausal status. No significant differences in the risk of nontraumatic fracture were observed.

Conclusions: In this group of US women undergoing the menopausal transition, dairy food intake was neither associated with femoral and spine bone mineral density loss nor the risk of fractures.
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http://dx.doi.org/10.1097/GME.0000000000001555DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7386862PMC
August 2020

Redesigning an Undergraduate Nutrition Course through Active Learning and Team-Based Projects Enhances Student Performance.

Curr Dev Nutr 2020 Apr 16;4(4):nzaa039. Epub 2020 Mar 16.

Department of Nutrition Science, Purdue University, West Lafayette, IN, USA.

Team-based active learning has been associated with enhanced communication and critical thinking skills, and improved clinical competency in other allied-health disciplines, but little is known about this pedagogical technique in nutrition. This study compared content retention and perceptions of a team-based, active learning course redesign intervention in an undergraduate nutrition class pre- ( = 32) and post- ( = 43) intervention. Assessment scores improved overall (69% to 75%;  < 0.01) and within 3 content domains: dietary guidelines (75% to 84%;  = 0.03), the exchange system (38% to 49%;  < 0.01), and dietary assessment (59% to 73%;  < 0.01). Thus, incorporation of team-based active learning was effective in improving content knowledge in undergraduate nutrition students as assessed by performance on exam questions overall and in some but not all content domains. Nonsignificant changes in student evaluations suggest that this is an acceptable, noninferior strategy to facilitate learning in undergraduate courses.
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http://dx.doi.org/10.1093/cdn/nzaa039DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7164483PMC
April 2020

Evaluation of environmental performance of dietary patterns in the United States considering food nutrition and satiety.

Sci Total Environ 2020 Jun 9;722:137672. Epub 2020 Mar 9.

Department of Food Science, Purdue University, 745 Agriculture Mall Drive, West Lafayette, IN 47907, USA; Environmental and Ecological Engineering, Purdue University, 500 Central Drive, West Lafayette, IN 47907, USA. Electronic address:

Food production substantially depletes the environment in different ways, but little is known about how overall dietary patterns relate to these environmental impacts. The objective of this study was to evaluate the environmental performance of different dietary patterns among U.S. adults using life cycle assessment (LCA). A "typical" dietary pattern was compared with those recommended by the Dietary Guidelines for Americans, including "healthy U.S.", Mediterranean and lacto-ovo vegetarian. Supplemental functional units (FUs) were applied to incorporate the functions of food to provide nutrition and satiety, namely Nutrient Rich Foods Index 9.3 (NRF9.3), Nutritional Quality Index (NQI), and Fullness Factor™ (FF). Life cycle inventory data was collected for 14 food categories consisting of 76 component foods, and their midpoint environmental impacts were calculated, with particular focus on global warming potential. Diets in accordance with different patterns were constructed from selected component foods at a reference energy amount of 2000 kcal. Vegetarian diets on average generated the lowest carbon footprint regardless of the FU. However, large possible variations in the environmental profiles of the compared diets were identified due to the wide range of food choices within a pattern, which showed highly different nutrition and satiety scores even within the same food category. Animal products, including meat and dairy especially, and discretionary foods were identified as the specific food categories that contributed the most to the global warming potential. Discretionary foods consistently exhibited higher impacts on the basis of nutritional FUs due to their low nutrient density. The results can be implied as practical guidelines to help reduce the carbon footprint associated with current U.S. diets without compromising their nutritional adequacy and satiety.
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http://dx.doi.org/10.1016/j.scitotenv.2020.137672DOI Listing
June 2020

Harmonizing Micronutrient Intake Reference Ranges for Dietary Guidance and Menu Planning in Complementary Feeding.

Curr Dev Nutr 2020 Mar 4;4(3):nzaa017. Epub 2020 Feb 4.

Johns Hopkins University School of Medicine, Baltimore, MD, USA.

There are no published harmonized nutrient reference values for the complementary feeding period. The aim of the study was to develop proposals on adequate and safe intake ranges of micronutrients that can be applied to dietary guidance and menu planning. Dietary intake surveys from 6 populous countries were selected as pertinent to the study and reviewed for data on micronutrients. The most frequently underconsumed micronutrients were identified as iron, zinc, calcium, magnesium, phosphorus, potassium, and vitamins A, B6, B12, C, D, E, and folate. Key published reference values for these micronutrients were identified, compared, and reconciled. WHO/FAO values were generally identified as initial nutrient targets and reconciled with nutrient reference values from the Institute of Medicine and the European Food Standards Authority. A final set of harmonized reference nutrient intake ranges for the complementary feeding period is proposed.
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http://dx.doi.org/10.1093/cdn/nzaa017DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7059853PMC
March 2020

Dietary Supplement Use and Its Micronutrient Contribution During Pregnancy and Lactation in the United States.

Obstet Gynecol 2020 03;135(3):623-633

Department of Nutrition Science, Purdue University, West Lafayette, Indiana; the Office of Dietary Supplements, National Institutes of Health, Bethesda, Maryland; the Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, Utah; and the Department of Pediatrics, School of Medicine, University of Colorado, Aurora, Colorado.

Objective: To estimate the prevalence of use and the micronutrient contribution of dietary supplements among pregnant, lactating, and nonpregnant and nonlactating women in the United States.

Methods: Cross-sectional data from 1,314 pregnant, 297 lactating, and 8,096 nonpregnant and nonlactating women (aged 20-44 years) in the 1999-2014 National Health and Nutrition Examination Survey were combined to produce statistically reliable, nationally representative estimates. Information about dietary supplements used in the past 30 days was collected through an interviewer-administered questionnaire and in-home inventory. The prevalence of nutrient-specific supplement use, mean daily nutrient intakes from supplements among users, and motivations for supplement use were assessed. Differences by age, income, and trimester within pregnant women were also tested.

Results: Seventy-seven percent of pregnant women and 70% of lactating women used one or more dietary supplements, whereas 45% of nonpregnant and nonlactating women used supplements. In particular, 64% of pregnant and 54% of lactating women used prenatal supplements. Mean intakes of thiamin, riboflavin, niacin, folic acid, vitamins B6, B12, and C, iron, and zinc from supplements alone were at or above their respective recommended dietary allowances (RDAs) among pregnant and lactating supplement users. About half of pregnant and 40% of lactating women took supplements based on the recommendation of a health care provider. Among pregnant women, those in their first trimester, aged 20-34 years, or in a lower-income family were less likely to use supplements compared with their counterparts.

Conclusion: The majority of pregnant and lactating women used dietary supplements, which contributed many nutrients in doses above the RDAs. Although inadequate Intakes of folate and iron are of concern among pregnant women who are not using supplements, supplement users often consumed high doses, suggesting a potential need of health care providers to discuss dietary supplement use and the recommended doses of nutrients during pregnancy and lactation.
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http://dx.doi.org/10.1097/AOG.0000000000003657DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7138460PMC
March 2020

Frequently Consumed Foods and Energy Contributions among Food Secure and Insecure U.S. Children and Adolescents.

Nutrients 2020 Jan 23;12(2). Epub 2020 Jan 23.

Department of Nutrition Science, Purdue University, 700 W State St, West Lafayette, IN 47907, USA.

Food insecurity is associated with nutritional risk in children. This study identified and compared the most frequently consumed foods, beverages, and food groups and their contributions to energy intake among U.S. children and adolescents (6-11, 12-17 years) by food security status. Dietary intake from the day-1, 24-h dietary recall, and household child food security status were analyzed in the 2007-2014 National Health and Nutrition Examination Survey ( = 8123). Foods and beverages were classified into food categories, ranked, and compared by weighted proportional frequency and energy contribution for food security groups by age. Significant differences between household child food security groups were determined using the Rao-Scott modified chi-square statistic. The weighted proportional frequency of beverages (including diet, sweetened, juice, coffee, and tea) and their energy was significantly higher among food insecure compared with food secure while the reverse was true for water frequency among 12-17 years. Beverage and mixed dish frequency were higher among food insecure compared with food secure 6-11 years while the reverse was true for frequency and energy from snacks. Frequency-differentiated intake patterns for beverages and snacks by food security across age groups may inform dietary recommendations, population-specific dietary assessment tools, interventions, and policy for food insecure children.
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http://dx.doi.org/10.3390/nu12020304DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7070395PMC
January 2020

Ready-to-eat cereal fortification: a modelling study on the impact of changing ready-to-eat cereal fortification levels on population intake of nutrients.

Public Health Nutr 2020 08 20;23(12):2165-2178. Epub 2020 Jan 20.

Department of Nutrition Science, Purdue University, West Lafayette, IN, USA.

Objective: Ready-to-eat (RTE) cereal is an important source of nutrients in the American diet. Recent regulatory changes to labelling requirements may impact the fortification of RTE cereal. We used an evidence-based approach to optimize the fortification of RTE cereal considering current dietary patterns and nutrition policy.

Design: A US modelling study of cross-sectional data from the National Health and Nutrition Examination Survey (NHANES) 2013-2014. The percentage of the population below the Estimated Average Requirement (EAR) and above the Upper Tolerable Intake Level (UL) was modelled under three scenarios: baseline, zero fortification and optimized fortification.

Setting: USA.

Participants: Toddlers aged 1-3 years, n 559; children aged 4-12 years, n 1540; adolescents aged 13-18 years, n 992; and adults aged ≥19 years, n 576.

Results: Comparing current with optimized fortification, nutrient/100 g RTE cereal decreased for vitamin A, thiamin, riboflavin, niacin, vitamin B6, folic acid, vitamin B12, Ca and Fe (by 2-82 %). The amount of vitamins C and D increased (by 13 and 50 %, respectively). Among RTE cereal eaters, these changes resulted in modest increases in the percentage of the population aged ≥1 year below the EAR (+0·5 to +11·5 percentage points). Decreases were observed in the percentage of the population above the UL.

Conclusions: Fortification of RTE cereal can be optimized to provide key nutrients and minimize the percentage of the population below the EAR and above the UL. Dietary intake modelling is useful to ensure that RTE cereal continues to help the population meet their nutrient needs.
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http://dx.doi.org/10.1017/S1368980019003690DOI Listing
August 2020

Calcium Supplement Use Is Associated With Less Bone Mineral Density Loss, But Does Not Lessen the Risk of Bone Fracture Across the Menopause Transition: Data From the Study of Women's Health Across the Nation.

JBMR Plus 2020 Jan 15;4(1):e10246. Epub 2019 Nov 15.

Department of Nutrition Science Purdue University West Lafayette IN USA.

Diet is a modifiable factor that is related to bone mass and risk for fractures; however, the use of calcium supplements for bone health is controversial, with little scientific agreement. The purpose of this analysis was to estimate the change in lumbar spine and femoral neck BMD and the risk of bone fracture by the use of calcium supplements among the Study of Women's Health Across the Nation (SWAN) participants. SWAN is a multicenter, multiethnic, community-based longitudinal cohort designed to examine the health of women across the menopause transition ( = 1490; aged 42 to 52 years at baseline in 1996 to 1997 and followed annually until 2006 to 2008). A mixed-effect model for repeated measures was used to estimate annualized BMD change across time between supplement users and nonusers, unadjusted or fully adjusted (age, race, height, weight, menopausal status [pre-, early peri-, late peri-, and postmenopausal], DXA scanner mode, alcohol intake, vitamin D supplement use, smoking, and physical activity) and a log-linear model with repeated measures was used to estimate the relative risk of fracture by calcium supplement use. All models were also stratified by baseline menopausal status. In fully adjusted models, calcium supplement use was associated with less annualized loss of femoral neck BMD (-0.0032 versus -0.0040 g/cm/year;  < .001) and lumbar spine BMD (-0.0046 versus -0.0053 g/cm/year, = 0.021) in the complete cohort. However, this protective association of calcium supplement use with BMD loss was significant only among premenopausal women (femoral neck: -0.0032 versus -0.0042 g/cm/year; = 0.002; lumbar spine: -0.0038 versus -0.0050 g/cm/year, = 0.001); no significant differences in BMD were observed among women who were early perimenopausal by calcium supplement use at baseline. No significant differences in the relative risk of fracture were observed, regardless of baseline menopausal status. The use of calcium supplements was associated with less BMD loss over more than a decade, but was not related to the risk of incident bone fracture across the menopause transition. © 2019 The Authors. published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research.
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http://dx.doi.org/10.1002/jbm4.10246DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6957983PMC
January 2020

Total Usual Micronutrient Intakes Compared to the Dietary Reference Intakes among U.S. Adults by Food Security Status.

Nutrients 2019 Dec 22;12(1). Epub 2019 Dec 22.

Interdepartmental Nutrition Program, Purdue University, 700 W. State Street, West Lafayette, IN 47907, USA.

This study examined total usual micronutrient intakes from foods, beverages, and dietary supplements (DS) compared to the Dietary Reference Intakes among U.S. adults (≥19 years) by sex and food security status using NHANES 2011-2014 data ( = 9954). DS data were collected via an in-home interview; the NCI method was used to estimate distributions of total usual intakes from two 24 h recalls for food and beverages, after which DS were added. Food security status was categorized using the USDA Household Food Security Survey Module. Adults living in food insecure households had a higher prevalence of risk of inadequacy among both men and women for magnesium, potassium, vitamins A, B6, B12, C, D, E, and K; similar findings were apparent for phosphorous, selenium, and zinc in men alone. Meanwhile, no differences in the prevalence of risk for inadequacy were observed for calcium, iron (examined in men only), choline, or folate by food security status. Some DS users, especially food secure adults, had total usual intakes that exceeded the Tolerable Upper Intake Level (UL) for folic acid, vitamin D, calcium, and iron. In conclusion, while DS can be helpful in meeting nutrient requirements for adults for some micronutrients, potential excess may also be of concern for certain micronutrients among supplement users. In general, food insecure adults have higher risk for micronutrient inadequacy than food secure adults.
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http://dx.doi.org/10.3390/nu12010038DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7019721PMC
December 2019

Comparison of 4 Methods to Assess the Prevalence of Use and Estimates of Nutrient Intakes from Dietary Supplements among US Adults.

J Nutr 2020 04;150(4):884-893

Department of Nutrition Science, Purdue University, West Lafayette, IN, USA.

Background: Accurate and reliable methods to assess prevalence of use of and nutrient intakes from dietary supplements (DSs) are critical for research, clinical practice, and public health monitoring. NHANES has been the primary source of DS usage patterns using an in-home inventory with a frequency-based DS and Prescription Medicine Questionnaire (DSMQ), but little is known regarding DS information obtained from 24-h dietary recalls (24HRs).

Methods: The objectives of this analysis were to compare results from 4 different methods for measuring DS use constructed from two data collection instruments (i.e., DSMQ and 24HR) and to determine the most comprehensive method for measuring the prevalence of use and estimating nutrient intakes from DS for selected nutrients. NHANES 2011-2014 data from US adults (aged ≥19 y; n = 11,451) were used to examine the 4 combinations of methods constructed for measuring the prevalence of use of and amount of selected nutrients from DSs (i.e., riboflavin, vitamin D, folate, magnesium, calcium): 1) DSMQ, 2) 24HR day 1, 3) two 24HRs (i.e., mean), and 4) DSMQ or at least one 24HR.

Results: Half of US adults reported DS use on the DSMQ (52%) and on two 24HRs (mean of 49%), as compared with a lower prevalence of DS use when using a single 24HR (43%) and a higher (57%) prevalence when combining the DSMQ with at least one 24HR. Mean nutrient intake estimates were highest using 24HR day 1. Mean supplemental calcium from the DSMQ or at least one 24HR was 372 mg/d, but 464 mg/d on the 24HR only. For vitamin D, the estimated intakes per consumption day were higher on the DSMQ (46 μg) and the DSMQ or at least one 24HR (44 μg) than those on the 24HR day 1 (32 μg) or the mean 24HR (31 μg). Fewer products were also classed as a default or reasonable match on the DSMQ than on the 24HR.

Conclusions: A higher prevalence of use of DSs is obtained using frequency-based methods, whereas higher amounts of nutrients are reported from a 24HR. The home inventory results in greater accuracy for products reported. Collectively, these findings suggest that combining the DSMQ with at least one 24HR (i.e., DSMQ or at least one 24HR) is the most comprehensive method for assessing the prevalence of and estimating usual intake from DSs in US adults.This trial was registered at clinicaltrials.gov as NCT03400436.
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http://dx.doi.org/10.1093/jn/nxz306DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7138661PMC
April 2020

Breakfast Consumption Is Positively Associated with Usual Nutrient Intakes among Food Pantry Clients Living in Rural Communities.

J Nutr 2020 03;150(3):546-553

Department of Nutrition Science, Purdue University, West Lafayette, IN, USA.

Background: Breakfast consumption has declined over the past 40 y and is inversely associated with obesity-related diet and health outcomes. The breakfast pattern of food pantry clients and its association with diet is unknown.

Objective: The objective is to investigate the association of breakfast consumption with diet quality and usual nutrient intakes among food pantry clients (n = 472) living in rural communities.

Methods: This was an observational study using cross-sectional analyses. English-speaking participants ≥18 y (or ≥19 y in Nebraska) were recruited from 24 food pantries in rural high-poverty counties in Indiana, Michigan, Missouri, Nebraska, Ohio, and South Dakota. Participants were surveyed at the pantry regarding characteristics and diet using 24-h recall. A second recall was self-completed or completed via assisted phone call within 2 wk of the pantry visit. Participants were classified as breakfast skippers when neither recall reported breakfast ≥230 kcal consumed between 04:00 and 10:00; breakfast consumers were all other participants. The Healthy Eating Index-2010 was modeled with breakfast pattern using multiple linear regression. Mean usual intake of 16 nutrients was estimated using the National Cancer Institute Method and compared across breakfast pattern groups. Usual nutrient intake was compared with the Estimated Average Requirement (EAR) or Adequate Intake (AI) to estimate the proportion of population not meeting the EAR or exceeding the AI.

Results: A total of 56% of participants consumed breakfast. Compared with breakfast skippers, breakfast consumers had 10-59% significantly higher usual mean intakes of all nutrients (P ≤ 0.05), and had 12-21% lower prevalence of at-risk nutrient intakes except for vitamin D, vitamin E, and magnesium.

Conclusions: Adult food pantry clients living in rural communities experienced hardships in meeting dietary recommendations. Breakfast consumption was positively associated with usual nutrient intakes in this population. This trial was registered at clinicaltrials.gov as NCT03566095.
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http://dx.doi.org/10.1093/jn/nxz258DOI Listing
March 2020

Current Sodium Intakes in the United States and the Modelling of Glutamate's Incorporation into Select Savory Products.

Nutrients 2019 Nov 7;11(11). Epub 2019 Nov 7.

Department of Nutrition Science, Purdue University, West Lafayette, IN 47907, USA.

Most Americans have dietary sodium intakes that far exceed recommendations. Given the association of high sodium with hypertension, strategies to reduce sodium intakes are an important public health target. Glutamates, such as monosodium glutamate, represent a potential strategy to reduce overall intakes while preserving product palatability; therefore, this project aimed to model sodium replacement with glutamates. The National Cancer Institute method was used to estimate current sodium intakes, and intakes resulting from glutamate substitution (25%-45%) in a limited set of food groups for which substitution is possible. Data sets for individuals aged ≥1 year enrolled in the U.S. National Health and Nutrition Examination Survey 2013-2016 ( = 16,183) were used in the analyses. Glutamate substitution in accordance with the U.S. Department of Agriculture's food codes was modeled by conservatively altering estimates of sodium intake reductions derived from the published, peer-reviewed literature. The addition of glutamates to certain food categories has the potential to reduce the population's sodium intake by approximately 3% overall and by 7%-8% among consumers of ≥1 product category in which glutamates were substituted for sodium chloride. Although using glutamates to substitute the amount of sodium among certain food groups may show modest effects on intakes across the population, it is likely to have a more substantial effect on individuals who consume specific products.
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http://dx.doi.org/10.3390/nu11112691DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6893472PMC
November 2019

Fruits, vegetables, and health: A comprehensive narrative, umbrella review of the science and recommendations for enhanced public policy to improve intake.

Crit Rev Food Sci Nutr 2020 3;60(13):2174-2211. Epub 2019 Jul 3.

D&V Systematic Evidence Review, Bronx, New York, USA.

Fruit and vegetables (F&V) have been a cornerstone of healthy dietary recommendations; the 2015-2020 U.S. Dietary Guidelines for Americans recommend that F&V constitute one-half of the plate at each meal. F&V include a diverse collection of plant foods that vary in their energy, nutrient, and dietary bioactive contents. F&V have potential health-promoting effects beyond providing basic nutrition needs in humans, including their role in reducing inflammation and their potential preventive effects on various chronic disease states leading to decreases in years lost due to premature mortality and years lived with disability/morbidity. Current global intakes of F&V are well below recommendations. Given the importance of F&V for health, public policies that promote dietary interventions to help increase F&V intake are warranted. This externally commissioned expert comprehensive narrative, umbrella review summarizes up-to-date clinical and observational evidence on current intakes of F&V, discusses the available evidence on the potential health benefits of F&V, and offers implementation strategies to help ensure that public health messaging is reflective of current science. This review demonstrates that F&V provide benefits beyond helping to achieve basic nutrient requirements in humans. The scientific evidence for providing public health recommendations to increase F&V consumption for prevention of disease is strong. Current evidence suggests that F&V have the strongest effects in relation to prevention of CVDs, noting a nonlinear threshold effect of 800 g per day (i.e., about 5 servings a day). A growing body of clinical evidence (mostly small RCTs) demonstrates effects of specific F&V on certain chronic disease states; however, more research on the role of individual F&V for specific disease prevention strategies is still needed in many areas. Data from the systematic reviews and mostly observational studies cited in this report also support intake of certain types of F&V, particularly cruciferous vegetables, dark-green leafy vegetables, citrus fruits, and dark-colored berries, which have superior effects on biomarkers, surrogate endpoints, and outcomes of chronic disease.
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http://dx.doi.org/10.1080/10408398.2019.1632258DOI Listing
September 2020

Associations between Snacking and Weight Status among Adolescents 12-19 Years in the United States.

Nutrients 2019 Jun 29;11(7). Epub 2019 Jun 29.

Center for Obesity Research and Education, Temple University, Philadelphia, PA 19140, USA.

Snacking is a significant contributor to energy intake among adolescents, but its association with weight status is unclear. To elucidate this association, data from 6545 adolescents (12-19 years) in the 2005-2016 National Health and Nutrition Examination Survey (NHANES) were analyzed. The mean number of daily snack occasions, mean snack size, and mean snack energy density were examined by weight classification (body mass index (BMI)-for-age percentiles: normal weight (NW) <85th; overweight (OW) ≥85th to <95th; obese (OB) ≥95th). Models included all snacking parameters, mean meal size, demographic characteristics, survey cycle year, and dietary reporting accuracy. Adolescents with NW consumed fewer snacks daily (1.69 (0.02) snacks/day) and smaller snacks per occasion (262.32 (4.41) calories (kcal)/snack) compared to adolescents with OW (1.85 (0.05) snacks/day, = 0.005; 305.41 (8.84) kcal/snack, < 0.001), and OB (1.97 (0.05) snacks/day; 339.60 (10.12) kcal/snack, both < 0.001). Adolescents with OW and OB also consumed more added sugar, saturated fat and sodium from snacks, but had lower mean energy density per snack compared to snacks consumed by NW adolescents. US adolescents with OW and OB consume more snacks daily and more calories at each snacking occasion compared to adolescents with NW. Future studies should examine the prospective associations between snacking and weight status and impact on overall diet quality.
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http://dx.doi.org/10.3390/nu11071486DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6682988PMC
June 2019

The Dietary Supplement Label Database: Recent Developments and Applications.

J Nutr 2018 08 3;148(Suppl 2):1428S-1435S. Epub 2018 Aug 3.

Division of Health and Nutrition Examination Surveys/Analysis Branch, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, MD.

Objective: To describe the history, key features, recent enhancements, and common applications of the Dietary Supplement Label Database (DSLD).

Background And History: Although many Americans use dietary supplements, databases of dietary supplements sold in the United States have not been widely available. The DSLD, an easily accessible public-use database was created in 2008 to provide information on dietary supplement composition for use by researchers and consumers.

Rationale: Accessing current information easily and quickly is crucial for documenting exposures to dietary supplements because they contain nutrients and other bioactive ingredients that may have beneficial or adverse effects on human health. This manuscript details recent developments with the DSLD to achieve this goal and provides examples of how the DSLD has been used.

Recent Developments: With periodic updates to track changes in product composition and capture new products entering the market, the DSLD currently contains more than 71,000 dietary supplement labels. Following usability testing with consumer and researcher user groups completed in 2016, improvements to the DSLD interface were made. As of 2017, both a desktop and mobile device version are now available. Since its inception in 2008, the use of the DSLD has included research, exposure monitoring, and other purposes by users in the public and private sectors.

Future Directions: Further refinement of the user interface and search features to facilitate ease of use for stakeholders is planned.

Conclusions: The DSLD can be used to track changes in product composition and capture new products entering the market. With over 71,000 DS labels it is a unique resource that policymakers, researchers, clinicians, and consumers may find valuable for multiple applications.
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http://dx.doi.org/10.1093/jn/nxy082DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6597011PMC
August 2018