JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION

HANDBOOK OF OBESITY TREATMENT

Handbook of Obesity Treatment edited by TA Wadden, MD Stunkard is reviewed. Favorable book review. OBESITY, NONFICTION

ANNUAL REVIEW OF NUTRITION, VOLUME 22

Annual Review of Nutrition, Volume 22 edited by McCormick, Donald B; Bier, Dennis M; Cousins, Robert J is reviewed. Favorable book review. NONFICTION, NUTRITION, REFERENCE BOOKS

RESEARCH ACTIVITIES AND PERSPECTIVES OF RESEARCH MEMBERS OF THE AMERICAN DIETETIC ASSOCIATION

MYERS ESTHER F; BEYER PETER L; GEIGER CONSTANCE J

The American Dietetic Association (ADA) has always supported research as the foundation of dietetics practice (see sidebar 'History of ADA Research'). Research is incorporated into many Association documents (see sidebar 'Current ADA, Commission on Accreditation of Dietetic Education [CADE] and Commission on Dietetic Registration [CDR] Initiatives and Documents Related to Research'). During Fall 2001 and early 2002, the ADA Research Committee developed and began implementing its plan of work. The committee (a) explored the philosophy and roles of the Association and its members related to research; (b) initiated a process to develop a research agenda for the Association (1); (c) carried out several research-related initiatives of the House of Delegates (HOD), the Board of Directors (BOD), and other units of the Association; and (d) prepared a report to the HOD. The committee realized they had limited knowledge of the current activities of dietetics professionals involved in research and needed their comments regarding the ADA's research priorities. Therefore, the committee identified the need to survey members of the Association regarding research activities, interests, and perspectives. RESEARCH, DIET

POSITION OF THE AMERICAN DIETETIC ASSOCIATION: FOOD AND WATER SAFETY

GERALD BONNIE L; PERKIN JUDY E

It is the position of the American Dietetic Association that the public has the right to a safe food and water supply. The Association supports collaboration among dietetics professionals, academics, representatives of the agriculture and food industries, and appropriate government agencies to ensure the safety of the food and water supply by providing education to the public and industry, promoting technologic innovation and applications, and supporting further research. Numerous bacterial, viral, and chemical food and water threats exist with certain populations such as the elderly, children, pregnant women, those in institutionalized settings, and the immune compromised being at high risk. Recent outbreaks of food and waterborne disease and threats of bioterrorism have focused attention on the safety of US food and water systems. The US government and other entities have developed programs to address challenges associated with maintaining food and water safety. Safety initiatives such as the Pathogen Reduction/Hazard Analysis Critical Point (HACCP), revisions to the Food Code, and the National Primary Drinking Water Regulations provide a framework to evaluate current and future challenges to the safety of food and water systems. Dietetics professionals should take a proactive role in ensuring that appropriate food and water safety practices are followed and can also assume major roles in food and water safety education and research. J Am Diet Assoc. 2003; 103:1203-1218. FOOD SAFETY, DIET

ADHERENCE TO THE FOOD GUIDE PYRAMID RECOMMENDATIONS AMONG JAPANESE AMERICANS, NATIVE HAWAAIANS, AND WHITES: RESULTS FROM THE MULTIETHNIC COHORT STUDY

SHARMA SANGITA; MURPHY SUZANNE P; WILKENS LYNNE R; SHEN LUCY

The Food Guide Pyramid is designed to help Americans make healthful food choices. Whereas national data have been collected to examine adherence to the pyramid recommendations in whites, African-Americans, and Latinos, there are virtually no data available for Japanese Americans or Native Hawaiians. Here we present data on intakes of the Food Guide Pyramid food groups (as servings per day) as well as of the components of the pyramid tip (discretionary fat, added sugar, and alcohol) in these ethnic groups and examine adherence to each of the food group recommendations. Degree of adherence to the fruit group recommendation was similar among the ethnic groups and energy-intake categories, but adherence to the other recommendations was greatest for those consuming more than 2,800 kilocalories per day. However, subjects in this energy-intake group also consumed more than three times as much discretionary fat, added sugar, and alcohol. J Am Diet Assoc. 2003; 103:1195-1198. FOOD, STUDIES, MINORITY & ETHNIC GROUPS

FITNESS, DIETARY INTAKE, AND BODY MASS INDEX IN URBAN NATIVE AMERICAN YOUTH

GRAY AMY; SMITH CHERY

This study investigated correlations among physical fitness, dietary intakes, activity levels, and body mass index (BMI) for 155 urban Native American youth, ages 5 to 18 years. Heights, weights, skinfold measurements, activity level, balance times, and dietary intakes were assessed. Presidential Physical Fitness (PPF) testing was completed with 82 youth. Age groups were examined for differences in energy and macronutrient intake, sedentary activities, activity level, and PPF achievement. Pearson and Spearman p correlations were examined among dietary intakes, fitness, balance, and activity levels. The majority of youth (63%) were at risk for overweight or already overweight, and 59% were sedentary. BMI was correlated with age and PPF achievement for all youth, and with physical activity and frequency of television viewing for youth ages 9 to 18 years. No correlation was found between dietary intake and activity level. Culturally appropriate interventions for obesity should start early, focusing on decreasing sedentary activity and increasing opportunities for fitness. JAm Diet Assoc. 2003; 103:1187-1191. PHYSICAL FITNESS, DIET, NATIVE NORTH AMERICANS, CHILDREN & YOUTH

VITAMIN A IN DIETARY SUPPLEMENTS AND FORTIFIED FOODS: TOO MUCH OF A GOOD THING?

PENNISTON KRISTINA L; TANUMIHARDJO SHERRY A

Vitamin A consumption by many Americans is quite high, in part because of the consumption of fortified foods and the use of vitamin supplements. Most multivitamin supplements provide two or more times the recommended dietary allowance (RDA) for vitamin A because the daily value (DV) is based on 1968 and not current RDAs. Consumption of just one multivitamin often provides excessive vitamin A, the majority of it as preformed vitamin A esters. Given recent epidemiologic evidence that suggests a link between chronic intakes of vitamin A that exceed the RDA and hip fractures, it may be time to reexamine food and supplement fortification policies and to discontinue the clinical practice of prescribing two multivitamins to the elderly and other patients whose needs for certain micronutrients are high. VITAMIN A, DIET, FOOD

DEVELOPMENT AND EVALUATION OF CULTURAL FOOD FREQUENCY QUESTIONNAIRES FOR SOUTH ASIANS, CHINESE, AND EUROPEANS IN NORTH AMERICA

KELEMEN LINDA E; ANAND SONIA S; VUKSAN VLADIMIR; YI QILONG

We developed three ethnic food frequency questionnaires (FFQs) to characterize the diets of South Asian, Chinese, and European immigrants. FFQs were developed from foods reported in the diet records and recalls of 29 South Asians, 25 Chinese, and 20 Europeans participating in a pilot study from 1995-1996 in Hamilton, Ontario, Canada. The FFQ and a seven-day diet record were then administered to 342 South Asians, 317 Chinese, and 346 Europeans participating in the Study of Health Assessment and Risk in Ethnic groups (SHARE) in three Canadian centers from 1996-1998. For FFQ validation, a subset of these participants completed a second seven-day diet record and second FFQ 8 to 10 months later. The FFQ generally underestimated macronutrient and overestimated micronutrient intake compared with the records. Consumtion of most macronutrients was lower among South Asians. Energy-adjusted deattenuated correlation coefficients between the records and second FFQ ranged from 0.32 to 0.73 (South Asians), 0.17 to 0.84 (Chinese), and 0.30 to 0.83 (Europeans). The FFQs generally performed well and will be used to investigate diet-disease relations in SHARE. Lower correlations for dietary fats among Chinese persons (0.17 to 0.31) may be improved with more direct questions on the FFQ regarding brand, type, and amount of oil consumed in stirfry servings. J Am Diet Assoc. 2003; 103: 1178-1184. CULTURE, FOOD, QUESTIONNAIRES

BENEFITS OF FISH OIL SUPPLEMENTATION FOR HEMODIALYSIS PATIENTS

VERGILI-NELSEN JOYCE MARCLEY

A literature review on fish oil supplementation in the population undergoing chronic hemodialysis therapy suggests that supplementation may be beneficial for various challenges to health and well-being prevalent in this population. One study indicated that pruritus symptoms improved with fish oil supplementation, but not with supplementation with two other oils. In a study designed to determine whether fish oils could prevent vascular access graft thrombosis, graft patency rates were ~76% in the fish oil and ~15% in the placebo group (P>.03). In a pilot study, subjects given fish oil required 16% less erythropoietin and experienced a 3.6% increase in serum albumin levels. Some studies suggest that fish oil supplementation in hemodialysis patients is cardioprotective, with one study finding that 'fish eaters' are half as likely to die as 11 non-fish eaters.' Potential risks of supplementation include gastrointestinal distress, prolonged bleeding, and vitamin A toxicity, although the likelihood of serious side effects is probably low. Dietitians are in a position to advise physicians and/or patients regarding appropriate dosages and ways to minimize risks when supplementation seems warranted. Future research could compare the benefits of fish consumption with those of fish oil supplementation and explore the benefits of other n-3 fatty acid sources, such as flaxseed. DIET, FISH, PATIENTS, HEMODIALYSIS

QUESTIONS RELATED TO THE DIETARY REFERENCE INTAKES

CUNNINGHAM ELEESE

Since the release of the Dietary Reference Intakes (DRI), the Knowledge Center has received numerous DRI questions. The following information answers DRI questions with resources that are easily accessible to ADA members. DIET, STUDIES

NUTRIENT INTAKES AND PHYSICAL GROWTH OF CHILDREN WITH PHENYLKETONURIA UNDERGOING NUTRITION THERAPY

ACOST PHYLLIS B; YANNICELLI STEVEN; SINGH RANI; MOFIDI SHIDEH

Objective To evaluate nutrient intakes, plasma phenylalanine (PHE) and tyrosine (TYR) concentrations, and physical growth of children with phenylketonuria undergoing nutrition management. Design Children were fed three different medical foods during a one-year study. Subjects/setting Children were evaluated at baseline and every three months in metabolic clinics. Children's diets were managed at home. Statistical analyses Intakes of medical foods and nutrients, number of diaries with nutrients <67% and <100% of Recommended Dietary Intakes (RDl), and mean plasma PHE and TYR concentrations were compared among groups using two-way ANOVA. X-squared test compared the percentage of plasma PHE and TYR concentrations in each group in specific categories. Height and body mass index were plotted against National Center for Health Statistics reference data; means were compared among groups. Tukey's test compared groups with significant treatment effects. Results Mean intakes of nutrients, except energy by all groups and vitamin B-12 by the Periflex-fed group, met or exceeded RDIs. The oldest children tended to have the highest PHE intakes and plasma PHE concentrations. Mean length or height z score indicated normal linear growth. Mean body mass index z scores at study end suggested many children were overweight. Applications Dietitians should prescribe adequate medical food and encourage children with phenylketonuria to ingest all prescribed daily. Linear growth of children, where mean protein equivalent intakes ranged from 113% to 129% of RDI, was normal, demonstrating the need for a protein intake greater than RDIs when an elemental diet is the primary protein source. Dietitians should prescribe and carefully monitor energy intake, physical activity, and weight. DIET, PHYSICAL GROWTH, CHILDREN & YOUTH

PERSONALITY CHARACTERISTICS AS PREDICTORS OF UNDERREPORTING OF ENERGY INTAKE ON 24-HOUR DIETARY RECALL INTERVIEWS

NOVOTNY JANET A; RUMPLER WILLIAM V; RIDDICK HOWARD; HEBERT JAMES R

Objective To identify characteristics associated with misreporting of energy intake during 24-hour dietary recalls (24HR). Design Ninety-eight subjects were administered two 24HRs. Energy expenditure was determined by doubly labeled water (44 subjects) or intake balance (54 subjects). Data on subjects' physical, lifestyle, and psychosocial characteristics were also collected. Subjects/setting At the Beltsville Human Nutrition Research Center 52 women and 46 men were administered 24HR and completed lifestyle and personality questionnaires and a memory test. Physical characteristics such as weight, percent body fat, and total energy expenditure were measured. Statistical analysis The influences of subject parameters on energy misreporting were assessed by linear regression and Pearson product-moment correlation analysis for continuous variables and by ANOVA for discrete variables. Stepwise regression was used to identify key factors in underreporting. Results Factors particularly important in predicting underreporting of energy intake include factors indicating dissatisfaction with body image; for example, a 398 kcal/day underreport in subjects attempting weight loss during the past year with a nearly 500 kcal/day underreport in women. Overall, women underreported by 393 kcal/day relative to men and women evinced a social desirability bias amounting to a 26 kcal underreport for each point on the social desirability scale. Gender differences also were evident in the effect of percent body fat (with men underreporting about 16 kcal/ day/percent body fat) and in departure from self-reported ideal body weight (with women underreporting about 21 kcal/ day/kg). ENERGY, DIET, RESEARCH

COMPARISON OF DIGITAL PHOTGRAPHY TO WEIGHED AND VISUAL ESTIMATION OF PORTION SIZES

WILLIAMSON DONALD A; ALLEN H RAYMOND; MARTIN PAMELA DAVIS; ALFONSO ANTHONY J

Objective The primary goal was to test the validity of digital photography for measuring food portion sizes compared with weighed foods and with direct visual estimation. Samples A total of 60 test meals consisting of 10 different portion sizes from six different university cafeteria menus were prepared and weighed. Design Food selections and plate waste, as estimated by digital photography and direct visual estimation, were compared with weighed foods. For each method, three observers independently estimated portion sizes of each food. Observers expressed the portion sizes as a percentage of a standard serving. These percentages were multiplied by the weight of the standard portion to yield estimated weights. Statistical analyses To test validity, the estimates of food weights derived from both methods were compared with weighed foods using correlations and were compared with each other using Bland-Altman regression analysis. Results For the digital photography and direct visual estimation methods, estimates of the portion sizes for food selections, plate waste, and food intake were highly correlated with weighed foods. Both methods tended to yield small overestimates or underestimates. Bland-Altman regression found the two estimation methods to yield comparable results (bias less than 1.5 g). Applications/conclusions These findings support the validity of the digital photography method for measuring portion sizes. Digital photography may be most useful for measuring food intake in settings that allow for the direct observation of food selections and plate waste but require minimum disruption of the eating environment, and allow unhurried estimates of portion sizes DIET, RESEARCH

A MESSAGE TO THE RESTAURANT INDUSTRY: IT'S TIME TO 'STEP UP TO THE PLATE'

POWERS CATHERINE H; HESS MARY ABBOTT

Restaurant industry sales are projected to reach a record $426.1 billion in 2003, marking the 12th consecutive year of real growth (1). It is no coincidence that along with this steady increase in dining out has come unprecedented weight gain among both adults and children, as well as a dangerous rise in the incidence of diet-related diseases. Other lifestyle factors, such as lack of physical activity, have also contributed to the situation. Although you cannot ensure that your customers exercise every day, you can help them eat healthfully. That is why we are asking you, as an industry, to step up to the plate and redouble your efforts to accommodate the nutrition needs of all Americans, particularly those of the growing number of health-conscious customers you serve every day. RESTAURANTS, INDUSTRY

SUSTAINING DEMAND FOR MEDICAL NUTRITION THERAPY SERVICES: ARE YOU MEETING THE REQUIREMENTS?

MICHALCZYK DOROTHY

If you keep on doing what you have always done, you will get what you have always got.' Embracing change and seeking out practice resources are critical aspects of achieving a successful dietetics practice and ensuring marketplace demand for medical nutrition therapy (MNT). Practitioners who have struggled to demonstrate the value of their services may not have sought out evidence-based guides for practice/protocols or implemented necessary systems to effectively provide MNT and create consumer demand. Practitioners who define gaps in nutrition services, determine their causes, design and implement improvements, assess their impact, and sustain and enhance improvements can impact their practice's bottom line. Those who adopt the habit of seeking out and marshaling practice resources can maintain marketability for MNT services provided in the outpatient or private practice settings and help to position MNT for future coverage and reimbursement opportunities. NUTRITION, THERAPY

MEDICARE REFORM AND ITS IMPACT ON PROVIDERS

SMITH RON

New advances in medical care, a financially unsustainable health care structure, and a growing beneficiary group that will demand full access to high-quality care will combine to force major changes in Medicare. With those changes, the pressures for nutrition professionals to develop evidence-based practices will be irresistible. In order to meet the challenges ahead, dietitians will have to transform their profession-reform simply will not be enough. MEDICARE, REFORMS

CARRIE LEA CHENEY: 1950-2003

Carrie Lea Cheney, PhD, RD, Contributing Editor of the Journal of the American Dietetic Association from 1996 to 2002, passed away Mar 14, 2003. DEATHS, EDITORS

OBITUARIES: CONNIE SAMUELS, RD, MARCH 29, 2003

Connie Samuels, RD, died Mar 29, 2003, at the age of 49, in Columbus OH, after a nine year battle with cancer. She was a renal dietitian with Doctor's Hospital North for over 13 years, where she was known as a compassionate advocate for her patients. DEATHS, SCIENTISTS

COMMUNITY-BASED DIETETICS PROFESSIONALS

MATHIEU JENNIFER

There are many steps that dietetics professionals who are interested in working in a community setting can take to achieve and maintain a successful career. And for professionals already established in a nonclinical setting, there are key points to focus on when working to keep a high caliber of community dietitians. DIET, COMMUNITY

RESULTS OF THE HOME FOOD SAFETY-IT'S IN YOUR HANDS 2002 SURVEY: COMPARISONS TO THE 1999 BENCHMARK SURVEY AND HEALTHY PEOPLE 2010 FOOD SAFETY BEHAVIORS OBJECTIVE

CODY MILDRED M; HOGUE MARY ANNE

Foodborne illness is both a widespread public health and economic problem and a clinical problem. Estimates of foodborne illness from the Centers for Disease Control and Prevention suggest that, on average, Americans suffer from foodborne illness about once every five years. Even more conservative estimates imply that individuals in the United States are likely to experience foodborne illness at least once within their lifetime. Although individuals who have weakened immune systems are more susceptible to foodborne illness and typically exhibit more severe consequences from these illnesses, all individuals exhibit susceptibility to major pathogens. FOOD SAFETY, POLLS & SURVEYS

WELCOME TO THE NEW JOURNAL WEB SITE!

THORPE MELISSA

As the premier source for the practice and science of food, nutrition, and dietetics, the Journal of the American Dietetic Association welcomes you to learn about the recently redesigned and updated Web site located at www.adajournal.org. The journal's web site is discussed. WEB SITES, MAGAZINES, DIET

FOOD SAFETY: PERSPECTIVES OF ADA EXPERTS

EDGE MARIANNE SMITH

To position ADA members as leaders in providing food- and nutrition-related services and information, ADA must, in the words of one of our six strategic goals, proactively focus on emerging areas of food and nutrition. ADA's strategic planning process has helped us identify several emerging areas requiring our close attention, one of which is food safety. There is so much for dietetics professionals to know about developments in food safety; and since September is National Food Safety Month, it is the perfect time to look at this crucial topic. FOOD SAFETY, TRENDS

BACK TO SCHOOL: EDUCATING THE JOURNAL ABOUT ITSELF...

VAN HORN LINDA

The Board of Editors (BOE) held an unprecedented mid-year meeting in June in Chicago to consider new ways to enhance an already good publication and increase its value to you, the remders and interested food and nutrition colleagues. A pre-meeting survey revealed that while the BOE believes that the Journal currently provides good professional coverage in the diverse areas of practice and research, they feel that there is a need to further and more clearly address very specific Research and Practice areas, Applications, ADA Emerging Areas of Interest, Reviews, and Management. The BOE also expressed the desire to shorten the time from manuscript submission to publication. ANNUAL MEETINGS, MAGAZINES