 Dietary Habits
Healthy People
20107
- Reduce
growth retardation among low-income children under age 5 years from
8% to 5%.
- Reduce
iron deficiency among young children aged 1 to 2 from 9% to 5%, among
children aged 3-4 from 4% to 1%, and among non pregnant women aged
12-44 from 11% to 4%.
- Increase
the proportion of persons aged 2 years and older who consume at least
two daily servings of fruit from 28% to 75%
- Increase
the proportion of persons aged 2 years and older who consume at least
three daily servings of vegetables, with at least one-third being
dark green or deep yellow vegetables, from 3% to 50%.
- Increase
the proportion of persons aged 2 years and older who consume at least
six daily servings of grain products, with at least three being whole
grain, to from 7% to 50%.
- Increase
the proportion of persons aged 2 years and older who consume less
than ten percent of calories from saturated fat from 36% to 75%.
- Increase
the proportion of persons aged 2 years and older who consume no more
than 30 percent of calories from fat to from 33% to 75%.
- Increase
the proportion of persons aged 2 years and older who consume 2,400
mg or less of sodium daily to from 21% to 65%.
- Increase
the proportion of persons aged 2 years and older who meet dietary
recommendations for calcium fromm 46% to 75% (U.S. Department of Health
and Human Services, 2000).
Growth retardation
Growth retardation,
defined as height for age less than the 5th percentile, reflects
chronic undernutrition. Weight for height is impacted before height
for age falls. In addition to undernutrition, growth retardation
may reflect the presence of infectious disease, chronic disease, and
poor health.7
During the development
of the new growth charts, an expert panel concluded that growth variation
among racial/ethnic groups was not sufficient to warrant race/ethnic
specific growth charts. According to the Pediatric Nutrition Surveillance
System, the prevalence of growth retardation is higher than expected
among low income children during the first five years of life and varies
by ethnic/racial group.
Growth Retardation
among Children Under 5 Years of Age by Race (Pediatric Nutrition Surveillance
System).
| Low
Income Children Under Age 5 Years, 1997 |
< Age 5 |
< Age 1 |
Aged
1 Year |
Aged
2-4 |
| Total
|
8
|
10
|
9
|
6
|
| American
or Alaska Native
|
8
|
9
|
7
|
9
|
| Asian
or Pacific Islander
|
9
|
9
|
11
|
8
|
| Black,
non-Hispanic
|
9
|
15
|
10
|
5
|
| White,
non-Hispanic
|
8
|
10
|
9
|
6
|
| Hispanic
|
7
|
7
|
8
|
5
|
U.S.
Department of Health and Human Services. (2000) Healthy People 2010
(Conference Edition, in Two Volumes). Washington, DC: January 2000.
- Growth retardation
is three times more prevalent than expected among low income Black infants
under one year of age.
- Growth retardation
is twice as prevalent as expected among low income white children under
one year of age and Black and Asian or Pacific Islander children aged
1 year.
Iron Deficiency
and Anemia
The prevalence of
iron deficiency varies by age, gender, race/ethnicity and income.
- The prevalence
of iron deficiency among lower income children under 5 and women of
childbearing years is about 170% that of their higher income counterparts.
- The prevalence
of iron deficiency among Black and Mexican women of childbearing age
and children under age five is 1.7 to 6 times higher than their white
counterparts.
A study of 485
toddlers ages 1-3 years olds in the New York area reported that 35%
had iron insufficient stores to some degree and 10% had iron deficiency
anemia.95
An examination of
records of children treated at Children's Hospital in Philadelphia with
a diagnosis of severe iron deficiency anemia noted a high prevalence
among Southeast Asians who comprised 40% of the patients with iron deficiency
but only 1% of the total patients.
Interestingly, African
American children comprised 5% of the children with iron deficiency
anemia but 48% of the population.96
Dietary factors
contributing to iron deficiency anemia in young children are
- Use
of cow's milk during the first year of life.
- Excessive intake of milk (24 oz. per day meets the calcium needs of
1- 5 year olds).
- Excessive intake
of fruit juice or drinks.
- Insufficient
intake of foods high in iron after 4-6 months of age such as iron
fortified infant cereals and meat and meat alternatives.95,97
Macronutrient and
Sodium Intake
Average intakes
of fat, saturated fat, sodium, and cholesterol among children and adolescents
are higher than current recommendations.
Among fifth graders
in the Bogalusa Heart Study, total fat intake was 35.8% and saturated
fat made up 12.5% of the daily calories consumed. In that population
of participants, 80% exceeded total fat recommendations, and 70% exceeded
saturated fat recommendations.99
According to the
National Food Consumption Survey and the CSFII from 1965 to 1996, egg
and lean meat consumption declined and grain intake of adolescents increased
primarily through high fat mixed dishes such as pizza, macaroni and
cheese, and certain ethnic dishes.
 Milk
intake decreased and was replaced by a dramatic increase in soft drinks
and other sweetened beverages. Raw fruit intake declined but juice
intake increased.99
From 1977-1996,
the number of snacks and energy density of snacks consumed daily by
children and adolescents increased significantly. The energy contribution
of snacks increased from about 20% of calories to 25% of calories and
the proportion of fat increased from about 17% of total fat to 22%.100
Reports of ethnic/racial
variations in fat and cholesterol intake report inconsistent findings.
- Although percent
calories from fat, and cholesterol and sodium intakes did not vary by
race/ethnicity among third grade CATCH participants, energy intake was
highest among Blacks and lowest among Hispanics 101
- NHANES reported
a higher percentage of energy from fat for Black and Mexican American
girls and Black boys than for White girls and boys. The ethnic
differences in percent calories from fat were seen as early as 6-9 years
of age for females and by 10-13 years of age in males.102
Mean Macronutrient
and Sodium Intake of Males by Age and Race/ethnicity, NHANES 1988-1991
| |
Cholesterol
(mg)
|
%
total calories fat
|
%
total calories saturated fat
|
Fiber
(grams)
|
Sodium
(mg)
|
| |
White
|
Black
|
MA*
|
White
|
Black
|
MA*
|
White
|
Black
|
MA*
|
White
|
Black
|
MA*
|
White
|
Black
|
MA*
|
| 3-5
years
|
179
|
220
|
273
|
32.7
|
35.2
|
32.2
|
12.7
|
13.0
|
12.2
|
11.02
|
11.60
|
13.39
|
2,616
|
2,605
|
2,632
|
| 6-11
years
|
211
|
277
|
299
|
33.8
|
35.6
|
34.1
|
12.9
|
12.8
|
12.8
|
13.09
|
12.75
|
15.66
|
3,093
|
3,091
|
3,059
|
| 12-15
years
|
262
|
327
|
343
|
32.7
|
34.9
|
35.2
|
12.4
|
12.2
|
13.2
|
15.09
|
14.23
|
17.44
|
3,974
|
3,287
|
3,853
|
| 16-19
years
|
362
|
409
|
371
|
34.4
|
36.8
|
34.8
|
12.8
|
12.8
|
12.3
|
17.38
|
16.3
|
21.16
|
4,949
|
4,300
|
3,750
|
* MA=Mexican
American
McDowell
MA, Briefel RR, Alaimo K, Biscof AM, Caughman CR, Carroll MD, Loria
CM. (1994)
Energy
and macronutrient intakes of person ages 2 months and over in the United
State: Third National Health and Nutrition Examination Survey, Phase
1, 1988-91.
Advance
data from vital and health statistics: No 255. Hyattsville, Maryland: National Center for Health Statistics.
Alaimo
K, McDowell MA, Briefel RR, Bischof AM, Caughman CR, Loria CM & Johnson CL (1994). Dietary intake of vitamins, minerals, and fiber of
persons ages 2 months and over in the United States: Third National
Health and Nutrition Examination Survey, Phase I. 1988-1991. Advance
data from vital and health statistics, no 258, Hyattsville, Maryland:
National Center for Health Statistics
Mean Macronutrient
and Sodium Intake of Females by Age and Race/ethnicity, NHANES 1988-1991
| |
Cholesterol
(mg)
|
%
total calories fat
|
%
total calories saturated fat
|
Fiber
(grams)
|
Sodium
(mg)
|
| |
White
|
Black
|
MA*
|
White
|
Black
|
MA*
|
White
|
Black
|
MA*
|
White
|
Black
|
MA*
|
White
|
Black
|
MA*
|
| 3-5
years
|
171
|
222
|
264
|
32.7
|
35.2
|
34.2
|
12.4
|
12.7
|
13.1
|
9.97
|
11.30
|
11.75
|
2,299
|
2,807
|
2,318
|
| 6-11
years
|
205
|
234
|
247
|
34.2
|
35.5
|
34.3
|
12.8
|
12.5
|
13.0
|
11.47
|
11.96
|
14.17
|
2,795
|
3,123
|
2,783
|
| 12-15
years
|
181
|
275
|
238
|
32.5
|
37.9
|
34.7
|
11.6
|
13.3
|
13.1
|
10.81
|
12.02
|
13.14
|
2,790
|
3,553
|
2,765
|
| 16-19
years
|
204
|
232
|
287
|
34.1
|
36.2
|
34.8
|
12.2
|
12.7
|
12.5
|
11.96
|
12.08
|
15.06
|
2,967
|
3,320
|
2,937
|
* MA=Mexican
American
McDowell
MA, Briefel RR, Alaimo K, Biscoff AM, Caughman CR, Carroll MD, Loria
CM. (1994) Energy and macronutrient intakes of person ages 2 months
and over in the United State: Third National Health and Nutrition Examination
Survey, Phase 1, 1988-91. Advance data from vital and health statistics:
No 255. Hyattsville, Maryland: National Center for Health Statistics.
Alaimo
K, McDowell MA, Briefel RR, Bischof AM, Caughman CR, Loria CM & Johnson CL (1994). Dietary intake of vitamins, minerals, and fiber of
persons ages 2 months and over in the United States: Third National
Health and Nutrition Examination Survey, Phase I. 1988-1991. Advance
data from vital and health statistics, no 258, Hyattsville, Maryland:
National Center for Health Statistics
Food Group and
Vitamin/Mineral Intake
 Dietary
intakes of children and adolescents do not meet current food guide pyramid
guidelines according to the CSFII, 1989-1991.103 Over 45%
met none or only one food group recommendation and only 5% met the recommendations
for four or more food groups.
- White
children were more likely than Black or Hispanic children to meet
recommendations for grains and dairy products, but less likely than
Black children to meet recommendations for vegetables.
- Higher income children were more likely to meet recommendations for
fruit and dairy products. Meeting food group recommendations
was associated with micronutrient intakes above the RDA and fiber
intake above the average.
- Those
who met none of the recommendations had vitamin B6, calcium,
iron, and zinc intakes below the RDA and the lowest fiber intake.
- Discretionary
fat and sugar supplied 40% of calories and did not vary by race/ethnicity.
According the CSFII,
only 20% of children consumed 5 or more servings of fruits and vegetables. Fruit and fruit juice accounted for one-third of fruit and vegetable
intake with 16% of juice sweetened. French fries accounted for
almost one-fourth of all vegetables and about 14% of all fruit and vegetables. Fruit and vegetable consumption increased slightly with income.104
Several statewide
and national studies have reported ethnic differences in food group
consumption patterns.
- Birmingham,
AL Longitudinal Study of Childhood Obesity
A study of 95 Black and White children in Alabama noted that Black
children consumed 40% less dairy products but 50% more fruit and 25%
more vegetables.105
- Minnesota Adolescent
Health Survey
The
Minnesota Health Survey examined demographic factors, psychosocial
factors and health behaviors associated with fruit and vegetable consumption. Inadequate fruit and vegetable intake was defined as consumption of
fruit or vegetables less than once a day.
Overall
17% reported inadequate intake of both vegetables and fruit. Racial/ethnic differences in inadequate fruit and inadequate vegetable
consumption were noted.106
Percentage of participants
Minnesota Adolescent Health Survey reporting inadequate fruit and vegetable
consumption by race
| |
Fruit
Total % Inadequate
|
Vegetable
Total % Inadequate
|
| Race
|
|
|
|
|
| White
|
28,950
|
28.6
|
28,896
|
35.3
|
| African American
|
2,625
|
23.4
|
2,620
|
48.2
|
| Hispanic
|
343
|
26.4
|
344
|
41.9
|
| American Indian
|
560
|
29.3
|
553
|
42.7
|
| Asian American
|
1,061
|
27.0
|
1,055
|
28.0
|
Neumark-Sztainer
D, Story M, Resnick MD, & Blum RW. (1996) Correlates of fruit and
vegetable consumption among adolescents. Preventive Medicine 25: 497-505
- Asian Americans
were less likely to report inadequate fruit and vegetable consumption.
- African Americans
were most likely to report adequate fruit consumption but also most
likely to report inadequate vegetable consumption.
- Navajo Health
and Nutrition Survey, 1991-1992; Zuni adolescents:
Mean Intake of
Macronutrients by 12-19 year old participants in the Navajo Health and
Nutrition Survey, 1991-1992 and Zuni 11th and 12th graders
| |
Navajo
Females (N = 73)
|
Zuni
Females (N = 31)
|
Navajo
Males (N =89)
|
Zuni
Males
(N=
19)
|
| Energy from fat(%)
|
31
|
34
|
33
|
38
|
| Energy
from saturated fat(%)
|
11
|
12
|
11
|
13
|
| Cholesterol,
(mg)
|
316
|
170
|
388
|
281
|
| Fiber
(g)
|
17
|
10
|
14
|
16
|
Cole
SM, Teufel-Shone NI, Ritenbaugh CK, Yzenbaard RA & Cockerham DL.
(2001). Dietary intake of Zuni adolescents. J Am Diet Assoc 101:802-806.
- Overall, mean
intakes of fat and cholesterol exceeded current dietary recommendations
while fiber was less than recommended. The one exception was
Zuni females' intake of cholesterol, which met recommendations.107,108
- 70% of Zuni males
and 80% of Zuni females did not consume the minimum recommended amount
of fiber. 107
- For Zuni males
sugared drinks accounted for 13%, salty snacks 8% and sweets 3.7%
of total calories. For Zuni females sugared drinks accounted
for 20.7% , salty snacks 4.1%, and sweets 4.9% of total calories.
- Navajo adolescents
consumed 15% of total calories as foods of low nutritional value such
as soft drinks, candy, desserts and snacks, and added fat.108
The major factors
impacting food choices among the Navajo living on the Reservation are
cost, availability and shelf life.
- Cereals are consumed
infrequently because they are expensive
- Dairy products
are consumed infrequently due to their perishability and to lactose
intolerance.
- Fresh fruits
and vegetables were consumed on average less than two times daily
due to their perishability, lack of availability, and cost.
- Youth
Risk Behavior Surveillance Program
The Youth Risk Behavior
Surveillance Program noted ethnic differences in fruit and vegetable
and dairy food consumption.
Percentage of high
school students who had eaten > 5 servings of fruit and vegetables
and drank > 3 glasses of milk during the past week by race/ethnicity,
YRBS
| |
Eaten > 5 servings of fruit and vegetables
|
Drank > 3glasses of milk
|
| White, non
Hispanic
|
22.5
|
19.6
|
| Black , non
Hispanic
|
27.8
|
10.8
|
| Hispanic
|
24.0
|
15.8
|
Centers
for Disease Control and Prevention. CDC Surveillance Summaries. January
9, 2000. MMWR 2000;49(No. SS-5).
Mean Nutrient
Intake of Males by Age and Race/ethnicity, NHANES 1988-1991
| |
Calcium
(mg)
|
Iron
(mg)
|
Vitamin
C (mg)
|
Vitamin
A (RE)
|
| |
White
|
Black
|
Mexican
American
|
White
|
Black
|
Mexican
American
|
White
|
Black
|
Mexican
American
|
White
|
Black
|
Mexican
American
|
| 3-5
years
|
928
|
757
|
984
|
12.48
|
10.58
|
12.88
|
97
|
124
|
115
|
907
|
728
|
850
|
| 6-11
years
|
1041
|
834
|
1037
|
14.84
|
12.18
|
14.59
|
107
|
120
|
108
|
962
|
879
|
926
|
| 12-15
years
|
1179
|
870
|
1135
|
20.50
|
13.23
|
17.44
|
129
|
131
|
125
|
1349
|
839
|
1147
|
| 16-19
years
|
1373
|
1076
|
1128
|
19.22
|
15.16
|
17.61
|
99
|
170
|
126
|
992
|
833
|
931
|
Mean Nutrient Intake
of Females by Age and Race/ethnicity, NHANES 1988-1991
| |
Calcium
(mg)
|
Iron
(mg)
|
Vitamin
C (mg)
|
Vitamin
A (RE)
|
| |
White
|
Black
|
Mexican
American
|
White
|
Black
|
Mexican
American
|
White
|
Black
|
Mexican
American
|
White
|
Black
|
Mexican
American
|
| 3-5
years
|
827
|
727
|
829
|
11.29
|
12.13
|
10.31
|
97
|
118
|
106
|
764
|
536
|
731
|
| 6-11
years
|
879
|
755
|
958
|
13.08
|
11.89
|
12.50
|
84
|
112
|
100
|
835
|
548
|
766
|
| 12-15
years
|
801
|
737
|
872
|
12.13
|
12.79
|
12.14
|
79
|
109
|
98
|
676
|
512
|
778
|
| 16-19
years
|
866
|
725
|
816
|
11.90
|
12.89
|
12.38
|
90
|
117
|
114
|
925
|
477
|
672
|
Alaimo
K, McDowell MA, Briefel RR, Bischof AM, Caughman CR, Loria CM & Johnson CL (1994). Dietary intake of vitamins, minerals, and fiber of
persons ages 2 months and over in the United States: Third National
Health and Nutrition Examination Survey, Phase I. 1988-1991. Advance
data from vital and health statistics, no 258, Hyattsville, Maryland:
National Center for Health Statistics
A study in Worcester,
Massachusetts provides insight into the dietary practices of Vietnamese
adolescents (Weicha et al, 2001)
Food intake of
Worcester, Massachusetts adolescents by race, 1993.
| |
White
(N = 1615
|
Black
(N = 263)
|
Hispanic
(N = 545)
|
Vietnamese
(N = 226)
|
| Fruit intake
Mean servings daily
|
1.24
|
1.12
|
1.17
|
1.68
|
| Vegetable
intake
Mean servings daily
|
1.24
|
1.04
|
0.93
|
1.43
|
| Dairy
food intake
Mean servings daily
|
2.33
|
2.01
|
2.07
|
1.29
|
| Fruits and
vegetables
% > 5 servings daily
|
15.1
|
11.1
|
10.8
|
28.4
|
| Dairy
products
% > 3 servings daily
|
27.4
|
26.7
|
27.2
|
8.5
|
Weicha
JM, Kink A, Wiecha J,& Herber J. Differences in dietary patterns
of Vietnamese, White, African-American, and Hispanic adolescents in
Worcester, Mass. J. Am Diet Assoc 101:248-251.
 Adolescents
in this survey consumed less fruits and vegetables than adolescents
in the CSFII
- Fruit intake
of Vietnamese youth was 35.5% and vegetable intake 15.3% greater than
white youth.
- Dairy product
intake of Vietnamese youth was 44% less than white youth.
- Acculturation
was associated with greater fruit and vegetable intake among Vietnamese
youth.
- Although their
diet was higher in fruit and vegetables than any other racial/ethnic
group, 72% of Vietnamese adolescents did not meet the recommended
five servings per day.
Diet and Blood
Pressure
Dietary patterns
may put urban minority adolescents at risk for the development of hypertension
according to two studies.
- Adolescents
with blood pressure (BP) measurements at or above the 90th percentile with low folate intakes also had lower intakes of potassium,
calcium, magnesium, and vitamins in comparison with at risk adolescents
with high folate intakes. Even with similar sodium intakes and
BMI measurements, the low folate intake group had higher BP levels
than the adolescents in the high folate intake group. Thus,
diets low in multiple nutrients may contribute to the development
of hypertension in at risk adolescents. Similar observations
were noted in the DASH trial.109
- Simons-Morton
et al110 reported inverse associations between calcium, magnesium, and potassium
and BP. After controlling for all nutrients, total fat was directly
and fiber inversely associated with blood pressure.
Dieting and other
weight control practices
 Body
weight dissatisfaction, dieting and disordered eating behaviors (use
of vomiting, diet pills, laxatives or diuretics) are prevalent among
children and adolescents and vary by race/ethnicity.111,112,113,114,115,116,117
Normal weight White
girls were more likely than Black girls to consider themselves overweight
and want to weigh less.
Additionally normal
weight Black girls were more likely than White girls to want to gain
weight.
This may reflect
cultural differences in ideal body shape. In general, African
American women do not perceive overweight as unhealthy or unattractive.116
Adolescents using
extreme weight control behaviors have less healthy diet and exercise
patterns and are more likely to engage in other health compromising
behaviors.112,113 For example, dieting up to once a week doubled the risk of initiating
smoking.111
Percentage of high
school students who engaged in behaviors associated with weight control
by sex and race/ethnicity, Youth Risk Behavior Survey, 1999
| |
Exercised
to lose weigh or to avoid gaining weight
|
Ate
less food, fewer calories, or foods low in fat to lose weight or
to avoid gaining weight
|
Fasted
to lose weight or to avoid gaining weight
|
Took
diet pills, powders, or liquids to lose weight or avoid gaining
weight
|
Took
laxatives or vomited to lose weight or to avoid gaining weight
|
| |
Female
|
Male
|
Female
|
Male
|
Female
|
Male
|
Female
|
Male
|
Female
|
Male
|
| White
|
70.0
|
48.7
|
60.3
|
25.1
|
19.0
|
5.7
|
11.7
|
4.5
|
7.0
|
1.5
|
| Black
|
58.6
|
47.6
|
43.4
|
25.3
|
17.7
|
8.9
|
6.9
|
4.1
|
6.8
|
3.4
|
| Hispanic
|
65.1
|
55.5
|
51.0
|
29.3
|
17.6
|
6.6
|
11.0
|
6.4
|
6.4
|
4.0
|
| Total
|
67.4
|
49.5
|
56.1
|
25.0
|
18.8
|
6.4
|
10.9
|
4.4
|
7.5
|
2.2
|
Centers
for Disease Control and Prevention. CDC Surveillance Summaries. January
9, 2000. MMWR 2000;49(No. SS-5).
Overall, white adolescents
are more likely to engage in weight control behaviors than black or Hispanics.
|
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Last
modified on Wednesday April 14 2004