Journal of the American Dietetic Association

2010-08-01

This Month in the Journal of the American Dietetic Association

2010-08-01

A Garden of Variety

Linda Van Horn — 2010-08-01

August is a time for savoring all the bounty from a carefully cultivated and well-stocked garden. Ranging from apricots to zucchini, the choices are ripe for picking. This month's Journal is likewise a diverse array of topics filled with ripened choices that can nourish your intellectual curiosity.

ADA Value: Customer Focus

Judith C. Rodriguez — 2010-08-01

One of the deep secrets of life is that all that is really worth doing is what we do for others.—Lewis Carroll One of the American Dietetic Association's four core values is Customer Focus, meaning we are determined to “meet the needs and exceed the expectations of all customers.” According to the BNET Business Dictionary, customer focus is “considered to be one of the keys to business success” (). Having a customer focus means having a belief in the spirit and tactics for achieving it. The whole organization must believe in and apply, in all our activities, a customer-focused approach. For ADA, our customers are members, but also the public and the collaborators who share our vision of health promotion through food and nutrition.

Next on the Menu: Labeling Law Could Mean New Career Opportunities for RDs

Tony Peregrin — 2010-08-01

The registered dietitians (RDs) of the American Dietetic Association (ADA) are always alert to new ways to improve the health of Americans and enhance the profile of the dietetics profession. So when President Obama signed the Health Care Reform bill into law, RDs—particularly those with an entrepreneurial spirit—saw an opportunity.

Instant Mentoring: Sharing Wisdom and Getting Advice Online with E-Mentoring

Susie An, Ryan Lipscomb — 2010-08-01

The concept behind mentoring has existed since as early as ancient Greece, when Odysseus placed his friend Mentor in charge of his son Telemachus while he went off to fight in the Trojan War in the late 12th century BC. Obviously, we've come a long way since the days of Homer's Odyssey, but only recently have technological advances allowed for changes in the way mentoring is conducted, removing the necessity of meeting face-to-face whenever the mentee has a question or the mentor an idea to share. E-mail and the Internet have opened up new avenues for mentors and mentees to find and connect with each other—whether they work in the same office or on opposite sides of the globe. Today, nearly everything can be done through the Internet, from talking to friends across the world to ordering take-out from a neighborhood restaurant to paying bills without leaving your desk—but what about getting personalized training or advice to advance your career as a food and nutrition professional? Web-based mentoring, or e-mentoring, if used correctly, shows that online mentoring relationships can be just as productive and fulfilling as traditional ones (). After establishing the basics of the traditional mentoring relationship in last month's Journal, this article concludes our two-part series on mentoring in the modern workplace by exploring the nuances of mentoring online.

State Regulatory Specialist: A New Addition to Your Affiliate Public Policy Panel

Juliana Smith — 2010-08-01

The goal of the American Dietetic Association's (ADA's) affiliate public policy panels is to strengthen the grassroots structure of ADA to include a more comprehensive approach to shaping nutrition public policy. The panels develop a strong public policy agenda to increase grassroots influence in state initiatives impacting the registered dietitian (RD). The public policy panel, developed in 2006 by the Legislative and Public Policy Committee Grassroots Task Force, consists of several volunteer positions that work collaboratively with the affiliate president and leadership to help advance important federal and state legislative and policy issues.

The Importance of Being Choline

Clarie B. Hollenbeck — 2010-08-01

A discussion of the importance of choline first appeared in the 7th edition of the Recommended Dietary Allowances in 1968 (); however, it was not until 1998 that an adequate intake was established for choline (). At that time there was only a single study in normal men cited that provided evidence of a deleterious effect of a choline-deficient diet in humans (); data on women, infants, children, and older individuals were not available. Since that publication, additional evidence has accumulated about potential deleterious effects of choline deficiencies in men and premenopausal and postmenopausal women (). Scant data exist regarding choline needs of women during pregnancy and lactation or for infants and children, life stages when choline requirements might be expected to be increased. The review by Caudill () in this issue of the Journal adds to the discussion and argues the importance of choline during pregnancy and lactation for fetal and infant development and health.

Dietary Behavior Assessment: Historical and Recent Innovations

Barbara E. Millen — 2010-08-01

Assessment of nutritional status involves the consideration of a complex array of factors across four major domains: dietary behavior, physical anthropometry, clinical history and examinations, and biochemical parameters (). Registered dietitians possess the unique training to guide and implement these assessments and to provide the careful interpretation of data needed to achieve the most accurate appraisal of nutritional risk in individuals and populations. Techniques of dietary behavior assessment and methodological validation are particularly important topics given their broad applications in nutrition research and clinical settings and relatively recent advances that may have profound practice implications.

Validation and Calibration of a Semiquantitative Food Frequency Questionnaire Designed for Adolescents

Marina Campos Araujo, Edna Massae Yokoo, Rosangela Alves Pereira — 2010-08-01

Abstract: Background: Epidemiologic studies must have a reliable method for evaluating food intake; therefore, valid, precise, and practical instruments are essential.Objective: To assess the relative validity and estimate the calibration factors of a semiquantitative food frequency questionnaire (FFQ) for adolescents.Design: Validation and calibration study.Subjects/settings: This study enrolled 169 adolescents from Rio de Janeiro, Brazil. A set of three food records was used as the reference method.Statistical analyses performed: The relative validity was analyzed according to weighted κ values for the quartile categorization of energy and nutrient intakes, Pearson correlation coefficients, and the Bland-Altman method. To estimate the calibration factors for the FFQ, linear regression models, including the food record means as dependent variables and the FFQ estimations as independent variables were developed for boys and girls.Results: The weighted κ values ranged from 0.28 to 0.44 for the raw data and from 0.16 to 0.39 for the deattenuated and energy-adjusted data. The Pearson correlation coefficients ranged from 0.33 to 0.46, and the mean agreement varied from 62% to 143%. The calibration factors estimated for boys ranged from 0.15 to 0.48, and the factors estimated for girls ranged from 0.14 to 0.47. The mean energy and nutrient intakes estimated by the calibrated FFQ were similar to the means estimated by the food records; however, the standard deviations were smaller for the calibrated FFQ estimations.Conclusions: The tested FFQ is a suitable tool for ranking energy and nutrients intake in the studied group. Calibration factors are needed to estimate energy and nutrient intake means and should be used to correct raw data as well as association measurements based on FFQ data.

Shortening the Retention Interval of 24-Hour Dietary Recalls Increases Fourth-Grade Children's Accuracy for Reporting Energy and Macronutrient Intake at School Meals

2010-08-01

Abstract: Background: Accurate information about children's intake is crucial for national nutrition policy and for research and clinical activities. To analyze accuracy for reporting energy and nutrients, most validation studies utilize the “conventional approach,” which was not designed to capture errors of reported foods and amounts. The “reporting-error-sensitive approach” captures errors of reported foods and amounts.Objective: To extend results to energy and macronutrients for a validation study concerning retention interval (elapsed time between to-be-reported meals and the interview) and accuracy for reporting school-meal intake, the conventional and reporting-error-sensitive approaches were compared.Design and participants/setting: Fourth-grade children (n=374) were observed eating two school meals, and interviewed to obtain a 24-hour recall using one of six interview conditions from crossing two target periods (prior 24 hours and previous day) with three interview times (morning, afternoon, and evening). Data were collected in one district during three school years (2004-2005, 2005-2006, and 2006-2007).Main outcome measures: Report rates (reported/observed), correspondence rates (correctly reported/observed), and inflation ratios (intruded/observed) were calculated for energy and macronutrients.Statistical analyses performed: For each outcome measure, mixed-model analysis of variance was conducted with target period, interview time, their interaction, and sex in the model; results were adjusted for school year and interviewer.Results: With the conventional approach, report rates for energy and macronutrients did not differ by target period, interview time, their interaction, or sex. With the reporting-error-sensitive approach, correspondence rates for energy and macronutrients differed by target period (four P values <0.0001) and the target period by interview-time interaction (four P values <0.0001); inflation ratios for energy and macronutrients differed by target period (four P values <0.0001), and inflation ratios for energy and carbohydrate differed by the target period by interview-time interaction (both P values <0.005).Conclusions: Shortening the retention interval of dietary recalls increases accuracy for reporting energy and macronutrients. For validation studies, it is best to obtain reference information from a method that provides details about foods and amounts consumed and to use an analytic approach that captures errors of reported foods and amounts.

Brief Telephone Intervention Increases Soy Intake in Peri- and Postmenopausal US Women: The Herbal Alternatives Trial (HALT)

2010-08-01

Abstract: Objective: Effective dietary intervention strategies that can be widely disseminated and have the potential for sustainable dietary modifications are needed. The purpose of this study was to describe and evaluate the effectiveness of a telephone-based soy intervention.Design: A randomized controlled trial comparing self-reported intake and serum measures of soy during a 1-year dietary soy (Soy) to fruit and vegetable (Placebo) intervention conducted in two of five arms from the Herbal Alternatives Trial between May 2001 and September 2004.Subjects/setting: One hundred sixty-three peri- and postmenopausal women (mean age=52 years) consuming self-selected diets in the Pacific Northwest, United States.Intervention: Five telephone contacts with a registered dietitian during a 12-month intervention with the goal to increase soy food consumption to two servings daily.Main outcome measures: Change from baseline in self-reported soy servings and serum isoflavone (daidzein and genistein) concentrations were estimated using analysis of variance and generalized estimating equations. Proportions of participants achieving the intervention goal were compared using χ2 tests.Results: Ninety-four percent (n=74) of participants in the Soy arm and 89% (n=75) in the Placebo arm completed the trial, and slightly more than one third (n=27) received five phone contacts. Mean (±standard deviation) intakes of soy were similar for the Soy and Placebo arms at baseline (0.6±1.0 vs 0.4±0.8 servings/day; P>0.05). At 12-month follow-up visit, mean±standard deviation servings of soy per day were 1.6±1.4 for the Soy intervention compared to 0.5±0.9 within the Placebo arm (P<0.001). There were concomitant increases in serum isoflavones at 3 and 6 months from baseline in the Soy arm only, with approximately twofold increases in both daidzein (mean=66.4 nmol/L, 95% confidence interval [CI]: 39.0 to 93.9 [mean 16.9 ng/mL, 95% CI: 9.9 to 23.8]) and genistein (mean=100.4 nmol/L, 95% CI: 60.9 to 139.9 [mean 27.1 ng/mL, 95% CI: 16.5 to 37.8]) concentrations. Mean weight changed by <1 kg during the 12-month period in each group and physical activity remained stable, suggesting that participants incorporated soy foods into their diet by substituting for nonsoy foods rather than adding them to their diet.Conclusions: A brief telephone-based intervention with a focused message delivered by a registered dietitian is a feasible approach for encouraging targeted dietary changes, such as an increase in soy intake among peri- and postmenopausal women.

Pre- and Postnatal Health: Evidence of Increased Choline Needs

Marie A. Caudill — 2010-08-01

Abstract: Choline, a micronutrient found in food, serves as the starting material for several important metabolites that play key roles in fetal development, particularly the brain. Although human beings' requirement for choline is unknown, an Adequate Intake level of 425 mg/day was established for women with upward adjustments to 450 and 550 mg/day during pregnancy and lactation, respectively. The importance of choline in human development is supported by observations that a human fetus receives a large supply of choline during gestation; pregnancy causes depletion of hepatic choline pools in rats consuming a normal diet; human neonates are born with blood levels that are three times higher than maternal blood concentrations; and large amounts of choline are present in human milk. The development of the central nervous system is particularly sensitive to choline availability with evidence of effects on neural tube closure and cognition. Existing data show that the majority of pregnant (and presumably lactating) women are not achieving the target intake levels and that certain common genetic variants may increase requirements for choline beyond current recommendations. Because choline is not found in most varieties of prenatal vitamins (or regular multivitamins), increased consumption of choline-rich foods may be needed to meet the high pre- and postnatal demands for choline.

Place of Dairy Products in the Chinese-American Family Food System

Nan Lv, J. Lynne Brown — 2010-08-01

Abstract: Chinese Americans have a high risk of osteoporosis and their calcium intake is substantially below the daily recommendation. However, little has been done to reduce the risk of this hard-to-reach population. This theory-based qualitative study explored how first-generation Chinese American couples with children view dairy products, how they use them in their family food system, and how these uses influence their dietary behavior or intake. Twenty couples, recruited from weekend Chinese schools at three locations in Pennsylvania, were interviewed. Taste, texture, and use of additives and growth hormones appeared to be more important influences on dairy choice than lactose intolerance. In these families, parental use of food rules and power to influence food patterns affected family flexibility about dairy use. Father's power, his views of dairy products, and his preference for Chinese-based dinners had a greater influence than those of his wife or children on the use of dairy-based dinner dishes. In contrast, choices at breakfast or lunch and for snacks were more flexible and could include dairy products. Nutrition educators can encourage introduction of dairy products into the traditional dietary pattern of Chinese Americans by offering opportunities to taste unfamiliar dairy products, demonstrating use of dairy products to prepare familiar foods, including both parents in any intervention or at least in tasting recipes, and providing information on importance of calcium to bone health and amount of calcium needed from reputable sources.

Substituting Brown Rice for White Rice to Lower Diabetes Risk: A Focus-Group Study in Chinese Adults

2010-08-01

Abstract: Whole-grain products, such as brown rice, have been associated with lower risk of diabetes. However, information is lacking on the acceptability of substituting brown rice for white rice. This study assessed the awareness and acceptability of brown rice in Chinese adults, and examined the feasibility of introducing brown rice into the diet through a large, long-term randomized clinical trial to lower risk of type 2 diabetes. Thirty-two Chinese adults residing in Shanghai participated in this quantitative and qualitative study using questionnaires and focus-group discussions. Most participants (30 of 32) consumed white rice daily and only a few (n=8) had tried brown rice previously. Before tasting, most participants considered brown rice inferior to white rice in terms of taste and quality. However, after tasting brown rice and learning about its nutritional value, the majority indicated greater willingness to consume brown rice. Main barriers to acceptance were the perception of rough texture and unpalatable taste, as well as higher price. All participants suggested that large-scale promotion was needed to change societal attitudes toward brown rice. In addition, most participants (27 of 32) expressed willingness to participate in a future long-term brown rice intervention study. These results provide valuable information for the design of the future brown rice intervention trial and highlight the importance of increasing awareness about the nutritional value of brown rice.

Point-of-Purchase Nutrition Information Influences Food-Purchasing Behaviors of College Students: A Pilot Study

Marjorie R. Freedman, Rachel Connors — 2010-08-01

Abstract: The goal of point-of-purchase (POP) nutrition information is to help consumers make informed, healthful choices. Despite limited evaluation, these population-based approaches are being advocated to replace traditional, more expensive, individual behavior-change strategies. Few studies have examined the effect of POP information on buying patterns of college students, a group with high obesity rates and poor eating habits. This quasi-experimental pilot project sought to determine whether the “Eat Smart” POP program affected food-purchasing habits of multiethnic college students shopping at an on-campus convenience store. Baseline sales data of foods in the cereal, soup, cracker, and bread categories were collected for 6 weeks during Fall 2008. After Winter break, a few food items within each of these food categories were labeled as healthful using a “Fuel Your Life” shelf tag, and sales data were then collected for 5 weeks. In each of the four food categories, nontagged foods were available at the identical price as tagged items. Following intervention, there were increased sales of tagged items (measured as a percentage of total sales) in the cereal, soup, and cracker categories, while sales of bread decreased. Although none of these changes were statistically significant, the intervention resulted in a 3.6%±1.6% (P=0.082) increase in the percentage of sales from tagged items. Thus, providing POP nutrition information in a college campus convenience store may promote healthful food choices. A longer study examining the effect of POP on sales of items in other food categories is warranted.

The Beverage Intake Questionnaire: Determining Initial Validity and Reliability

2010-08-01

Abstract: Consuming energy-containing beverages may lead to weight gain, yet research investigating this issue is limited. An easily administered beverage intake assessment tool could facilitate research on this topic. The purpose of this cross-sectional investigation was to determine the validity and reliability of a self-administered beverage intake questionnaire (BEVQ) that estimates mean daily intake of beverages consumed across 19 beverage categories. Participants (N=105; aged 39±2 years) underwent assessments of height, weight, body mass index, and dietary intake using 4-day food intake records from June 2008 to June 2009. The BEVQ was completed at two additional visits (BEVQ1, BEVQ2). Urine samples were collected to objectively determine total fluid intake and encourage accurate self-reporting. Validity was assessed by comparing BEVQ1 with food intake record results; reliability was assessed by comparing BEVQ1 and BEVQ2. Analyses included descriptive statistics, bivariate correlations, paired samples t tests, and independent samples t tests. Self-reported water and total beverage intake (in grams) were not different between the BEVQ1 and food intake records (mean difference 129±77 g [P=0.096] and 61±106 g [P=0.567], respectively). Total beverage and sugar-sweetened beverage energy intake were significantly different, although mean differences were small (63 and 44 kcal, respectively). Daily consumption (in grams) of water (r=0.53), total beverages (r=0.46), and sugar-sweetened beverages (r=0.49) determined by the BEVQ1 were correlated with reported intake determined by the food intake record, as was energy from total beverages (r=0.61) and sugar-sweetened beverages (r=0.59) (all P values <0.001). Reliability was demonstrated, with correlations (P<0.001) detected between BEVQ1 and BEVQ2 results. The BEVQ is a valid, reliable, and rapid self-administered dietary assessment tool.

Food Label Use and Its Relation to Dietary Intake among US Adults

Nicholas Jay Ollberding, Randi L. Wolf, Isobel Contento — 2010-08-01

Abstract: Rates of diet-related chronic disease combined with the lack of current data on patterns of food label use by the US population warrant re-examination of the use and potential influence of this public health tool. The purpose of this study was to describe the prevalence of food label use and the association between food label use and nutrient intake in a nationally representative sample of US adults who participated in the 2005-2006 National Health and Nutrition Examination Survey. Data on food label use were collected during the interview portion of the survey, and nutrient intake was estimated using the average of two 24-hour dietary recalls. In this sample, 61.6% of participants reported using the Nutrition Facts panel, 51.6% looked at the list of ingredients, 47.2% looked at serving size, and 43.8% reviewed health claims at least sometimes when deciding to purchase a food product. There were significant differences (P<0.05) in food label use across all demographic characteristics examined. Significant differences (P<0.05) in mean nutrient intake of total energy, total fat, saturated fat, cholesterol, sodium, dietary fiber, and sugars were observed between food label users and non-users with label users reporting healthier nutrient consumption. The greatest differences observed were for total energy and fat and for use of specific nutrient information on the food label. Despite food label use being associated with improved dietary factors, label use alone is not expected to be sufficient in modifying behavior ultimately leading to improved health outcomes.

Automated Camera-Phone Experience with the Frequency of Imaging Necessary to Capture Diet

Lenore Arab, Ashley Winter — 2010-08-01

Abstract: Camera-enabled cell phones provide an opportunity to strengthen dietary recall through automated imaging of foods eaten during a specified period. To explore the frequency of imaging needed to capture all foods eaten, we examined the number of images of individual foods consumed in a pilot study of automated imaging using camera phones set to an image-capture frequency of one snapshot every 10 seconds. Food images were tallied from 10 young adult subjects who wore the phone continuously during the work day and consented to share their images. Based on the number of images received for each eating experience, the pilot data suggest that automated capturing of images at a frequency of once every 10 seconds is adequate for recording foods consumed during regular meals, whereas a greater frequency of imaging is necessary to capture snacks and beverages eaten quickly.

Accepting Gifts: Let ADA's Professional Code of Ethics Be Your Guide

Dianne Killebrew — 2010-08-01

On the surface it might seem harmless to accept a gift from industry. However, it's important to consider the long-term consequences of short-term thinking. Principle 18 from the American Dietetic Association's (ADA's) Code of Ethics speaks to the responsibilities of the profession with regard to accepting gifts: “The dietetics practitioner does not invite, accept, or offer gifts, monetary incentives, or other considerations that affect or reasonably give an appearance of affecting his/her professional judgment” (). In 2002, Coyle reported on studies surrounding “industry influence on physician objectivity and behavior, particularly prescribing practices, formulary choices, and assessment of medical information,” in which research showed “a strong correlation between receiving industry benefits (gifts) and favoring their products” (). For registered dietitians (RDs) and dietetic technicians, registered (DTRs), there is a need to be mindful of potential biases and whether a gift-giving relationship is ethically appropriate. Professionally and ethically, clinical judgment decisions must be based on scientific, evidence-based guidelines.

Position of the American Dietetic Association: Local Support for Nutrition Integrity in Schools

2010-08-01

Abstract: It is the position of the American Dietetic Association (ADA) that schools and communities have a shared responsibility to provide students with access to high-quality, affordable, nutritious foods and beverages. School-based nutrition services, including the provision of meals through the National School Lunch Program and the School Breakfast Program, are an integral part of the total education program. Strong wellness policies promote environments that enhance nutrition integrity and help students to develop lifelong healthy behaviors. ADA actively supported the 2004 and proposed 2010 Child Nutrition reauthorization which determines school nutrition policy. ADA believes that the Dietary Guidelines for Americans should serve as the foundation for all food and nutrition assistance programs and should apply to all foods and beverages sold or served to students during the school day. Local wellness policies are mandated by federal legislation for all school districts participating in the National School Lunch Program. These policies support nutrition integrity, including a healthy school environment. Nutrition integrity also requires coordinating nutrition education and promotion and funding research on program outcomes. Registered dietitians and dietetic technicians, registered, and other credentialed staff, are essential for nutrition integrity in schools to perform in policy-making, management, education, and community-building roles. A healthy school environment can be achieved through adequate funding of school meals programs and through implementation and evaluation of strong local wellness policies.

August 2010 People & Events

2010-08-01

2010 ADA Food & Nutrition Conference & Expo November 6-9, 2010; Boston, MA

Erratum

2010-08-01

In the article “Development of a Diet Quality Index with Special Reference to Micronutrient Adequacy for Adolescent Girls Consuming a Lacto-Vegetarian Diet” by Chiplonkar and Tupe that appeared in the June 2010 Journal (pp 926-931), there is an error in Table 1 on page 928. The AMQI score for “Food variety based on all subgroups and weekly variety in vegetables and fruits” should be 5, not 50, for the scoring criteria ≥10, and 0 rather than a blank line for the scoring criteria <5.

August 2010 Classified Advertisements

2010-08-01

Where Can I Find Resources to Assist in the Determination of Pediatric Energy Needs that Account for Physical Activity of Child and Adolescent Athletes?

Eleese Cunningham — 2010-08-01

Registered dietitians and dietetic technicians, registered, are advocates for healthy eating and physical activity for children and adolescents early in their development. For children under the age of 6 years, active forms of play meet their need for physical activity. As children grow older, participation in organized sports can have physical and social benefits for children. The Federal Government's first-ever Physical Activity Guidelines for Americans () included the following key recommendations for children and adolescents aged 6 to 17 years:

Journal of the American Dietetic Association

Table of Contents

This Month in the Journal of the American Dietetic Association

A Garden of Variety

ADA Value: Customer Focus

Next on the Menu: Labeling Law Could Mean New Career Opportunities for RDs

Instant Mentoring: Sharing Wisdom and Getting Advice Online with E-Mentoring

State Regulatory Specialist: A New Addition to Your Affiliate Public Policy Panel

The Importance of Being Choline

Dietary Behavior Assessment: Historical and Recent Innovations

Validation and Calibration of a Semiquantitative Food Frequency Questionnaire Designed for Adolescents

Shortening the Retention Interval of 24-Hour Dietary Recalls Increases Fourth-Grade Children's Accuracy for Reporting Energy and Macronutrient Intake at School Meals

Brief Telephone Intervention Increases Soy Intake in Peri- and Postmenopausal US Women: The Herbal Alternatives Trial (HALT)

Pre- and Postnatal Health: Evidence of Increased Choline Needs

Place of Dairy Products in the Chinese-American Family Food System

Substituting Brown Rice for White Rice to Lower Diabetes Risk: A Focus-Group Study in Chinese Adults

Point-of-Purchase Nutrition Information Influences Food-Purchasing Behaviors of College Students: A Pilot Study

The Beverage Intake Questionnaire: Determining Initial Validity and Reliability

Food Label Use and Its Relation to Dietary Intake among US Adults

Automated Camera-Phone Experience with the Frequency of Imaging Necessary to Capture Diet

Accepting Gifts: Let ADA's Professional Code of Ethics Be Your Guide

Position of the American Dietetic Association: Local Support for Nutrition Integrity in Schools

August 2010 People & Events

Erratum

August 2010 Classified Advertisements

Where Can I Find Resources to Assist in the Determination of Pediatric Energy Needs that Account for Physical Activity of Child and Adolescent Athletes?