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(1/912) Economic determinants and dietary consequences of food insecurity in the United States.

This paper reviews recent research on the economic determinants and dietary consequences of food insecurity and hunger in the United States. The new Current Population Study (CPS) food insecurity and hunger measure shows that hunger rates decline sharply with rising incomes. Despite this strong relationship, confirmed in other national datasets, a one-to-one correspondence between poverty-level incomes and hunger does not exist. In 1995, 13.1% of those in poverty experienced hunger and half of those experiencing hunger had incomes above the poverty level. Panel data indicate that those who are often food insufficient are much more likely than food-sufficient households to have experienced recent events that stress household budgets, such as losing a job, gaining a household member or losing food stamps. Cross-sectional work also demonstrates the importance of food stamps because benefit levels are inversely related to food insufficiency. Concern for the dietary consequences of domestic food insufficiency is well placed; recent research shows that the odds of consuming intakes <50% of the recommended dietary allowance (RDA) are higher for adult women and elderly individuals from food-insufficient households. Preschoolers from food-insufficient households do not consume significantly lower amounts than those from food-sufficient households, but mean intakes for the rest of members in those very same households are significantly lower for the food insufficient. This research highlights the importance of food insecurity and hunger indicators, further validates the use of self-reported measures and points to areas of need for future research and interventions.  (+info)

(2/912) Developing the effectiveness of an intersectoral food policy coalition through formative evaluation.

There is a difference between bringing parties together and making them work effectively. We present a case study of an intersectoral food policy Committee, part of a three-tiered coalition nested within local municipal government, which sought to promote and nutrition in a rapidly growing metropolitan region by tackling food supply issues in the first instance. This was new territory for all players. After 12 months, the group felt it was floundering and requested an evaluation. In-depth qualitative interviews with committee members (n = 21) and quantitative assessment of Committee processes revealed insufficient mechanisms for engaging new members, conflict between perceived roles for the group and a notable lack of confidence in the group's capacity to achieve its goals, or outcome efficacy. Feedback of the data and subsequent discussion led to a reform of project structure, stronger mechanisms to realize its goals and better incentive management, or ways to maximize the benefits and limit the costs for the diverse parties involved. The impact was reflected in a 4 year time series analysis of media releases, decision making and related municipal government actions. The study illustrates how theory-informed formative evaluation can help to improve health promotion practice.  (+info)

(3/912) Folate metabolism and requirements.

Folate functions in multiple coenzyme forms in acceptance, redox processing and transfer of one-carbon units, including nucleotides and certain amino acids. Folate-requiring metabolic processes are influenced by folate intake, intake of other essential nutrients, including vitamins B-12 and B-6, and at least one common genetic polymorphism. Estimates of folate requirements have been based on intakes associated with maintenance of normal plasma and erythrocyte folate concentrations and functional tests that reflect abnormalities in folate-dependent reactions. Dietary Reference Intakes for folate that have been developed recently are based primarily on metabolic studies in which erythrocyte folate concentration was considered the major indicator of adequacy. For adults >/=19 y, the Recommended Dietary Allowance (RDA) is 400 microg/d of dietary folate equivalents (DFE); for lactating and pregnant women, the RDAs include an additional 100 and 200 microg of DFE/d, respectively.  (+info)

(4/912) Food price policy can favorably alter macronutrient intake in China.

The rapid change in diets, physical activity and body composition in low income countries has led to the coexistence of large pockets of undernutrition and overnutrition. Public health strategies for addressing this situation may be necessary, and price policy options are examined for China. Longitudinal dietary data collected in China in 1989-1993 on a sample of 5625 adults aged 20-45 y were examined. Three-day averages of food group consumption and nutrient intake were used in longitudinal statistical models to examine separately the effects of food prices on the decision to consume each food group and then the amount consumed. The effects of changes in six food prices on the consumption of each of six food groups, not just the food group whose price had changed, and on three macronutrients were estimated. The effects show large and significant price effects. If the joint effects of the nutrition transition are to be considered, then there are clear tradeoffs among which foods to tax and which to subsidize. Most important is the effect of prices in reducing fat intake of the rich but not adversely affecting protein intake for the poor. Increases in the prices of pork, eggs and edible oils are predicted to lower fat intake. Only increases in pork prices led to reduced protein intakes. This raises questions about earlier policy changes being implemented in China and provides insight into an important and controversial area for public health policy.  (+info)

(5/912) Equations for predicting the energy requirements of healthy adults aged 18-81 y.

BACKGROUND: Recent studies have questioned the accuracy of using the current recommended dietary allowances (RDAs) to predict usual energy requirements in adults. OBJECTIVE: We developed equations to predict adult energy requirements from simple anthropometric and laboratory measures by using the doubly labeled water method to determine each subject's total energy expenditure (TEE), which is equal to usual energy requirements in weight-stable individuals. DESIGN: This was a cross-sectional study conducted with 93 healthy, free-living adults [44 men and 49 women; body mass index range (in kg/m2): 18.4-31.8] aged 18-81 y. Body fat and fat-free mass were measured by underwater weighing, physical activity was estimated by using activity monitors, and resting energy expenditure was determined by indirect calorimetry. Information on anthropometric variables and reported strenuous activity was also collected. RESULTS: Three regression equations were developed and verified for accuracy by using bootstrap analysis and doubly labeled water data published by other research groups. The first equation used information on only age, weight, height, and sex and had an SEE for prediction of TEE of 1.80 MJ/d. The second and third equations used different combinations of basic and laboratory data and had SEEs of 1.55 and 1.65 MJ/d, respectively. With use of the same analytic approaches, the RDAs for energy were shown to significantly underestimate usual energy needs by approximately 10%; the extent of underestimation was significantly greater for subjects with high TEEs than for subjects with low TEEs. CONCLUSION: Regression equations based on doubly labeled water measurements of TEE appear to be more accurate than the current RDAs for predicting energy requirements in healthy, nonobese adults living in affluent countries.  (+info)

(6/912) Racial bias in federal nutrition policy, Part II: Weak guidelines take a disproportionate toll.

Many diet-related chronic diseases take a disproportionate toll among members of racial minorities. Research shows the prevalence of diabetes, hypertension, cancer, and heart disease is higher among various ethnic groups compared with whites. The Guidelines and the Food Guide Pyramid, however, promote the use of multiple servings of meats and dairy products each day and do not encourage replacing these foods with vegetables, legumes, fruits, and grains. The Dietary Guidelines for Americans encourage a 30% caloric reduction in fat intake and make no provision for further reductions for those who wish to minimize health risks. Abundant evidence has shown that regular exercise combined with diets lower in fat and richer in plant products than is encouraged by the Dietary Guidelines for Americans are associated with reduced risk of these chronic conditions. While ineffective Dietary Guidelines potentially put all Americans at unnecessary risk, this is particularly true for those groups hardest hit by chronic disease.  (+info)

(7/912) Toward a new recommended dietary allowance for vitamin C based on antioxidant and health effects in humans.

The current recommended dietary allowance (RDA) for vitamin C for adult nonsmoking men and women is 60 mg/d, which is based on a mean requirement of 46 mg/d to prevent the deficiency disease scurvy. However, recent scientific evidence indicates that an increased intake of vitamin C is associated with a reduced risk of chronic diseases such as cancer, cardiovascular disease, and cataract, probably through antioxidant mechanisms. It is likely that the amount of vitamin C required to prevent scurvy is not sufficient to optimally protect against these diseases. Because the RDA is defined as "the average daily dietary intake level that is sufficient to meet the nutrient requirement of nearly all healthy individuals in a group," it is appropriate to reevaluate the RDA for vitamin C. Therefore, we reviewed the biochemical, clinical, and epidemiologic evidence to date for a role of vitamin C in chronic disease prevention. The totality of the reviewed data suggests that an intake of 90-100 mg vitamin C/d is required for optimum reduction of chronic disease risk in nonsmoking men and women. This amount is about twice the amount on which the current RDA for vitamin C is based, suggesting a new RDA of 120 mg vitamin C/d.  (+info)

(8/912) The role of epidemiology in developing nutritional recommendations: past, present, and future.

Observations of the relations between food choices and health have been made since ancient times, but epidemiology, which can be regarded as the science of systematically studying these relations, has played a key role in official nutritional guidance only in recent years. In the past 20 y the principal goal of nutritional guidance has changed from the prevention of nutritional deficiencies to the prevention of chronic diseases. This evolving purpose of nutritional guidance has demanded that nutritional epidemiology play an increasingly important role. Although no other type of nutritional science can equal epidemiology in the relevance of either the dietary exposures or the health outcomes, substantial problems limit the ability of nutritional epidemiology to convincingly prove causal associations. The classic criteria for causation are often not met by nutritional epidemiologic studies, in large part because many dietary factors are weak and do not show linear dose-response relations with disease risk within the range of exposures common in the population. The most important problem in nutritional epidemiology in the past has been the inaccuracy of dietary assessment. In the future, an additional problem will be the proliferation of hypotheses that can be tested in multiple ways among the many subgroups of the population that can be defined by factors such as age, sex, and genotype. Future progress in our understanding of the relations between diet and health will necessitate improved methods in nutritional epidemiology and a better integration of epidemiologic methods with those used in the clinical nutritional sciences.  (+info)