Volume 37 Issue 1, January/February 2012

Nutrition Perspectives USDA Unveils Historic

Improvements to Meals Served in America's Schools

Table of Contents

School Meals continued on page 2

USDA Unveils Historic Improvements to Meals Served in America’s Schools

1

Physical Activity, School Performance May Be Linked 3

Early Dietary Experience Shapes Salt Preference of Infants and Preschoolers

4

Parents, Physicians, Disagree On What the Doctor Ordered for Childhood Weight Management

6

Mediterranean Diet Appears to Be Associated with Reduced Small Vessel Damage in the Brain

8

Walnut Diet Delivers Promising Results In Mice with Prostate Cancer

9

Top Off Breakfast with – Chocolate Cake? 10

Switching to Water, Diet Beverages Can Tip the Scales 12

Prevalence of Obesity in U.S. Still High, With Little Change in Recent Years

13

Resources: Food Hero: Helpful Messages for Healthy Eating

14

New and Updated Nutrition Resources 15

University of California at Davis, Department of Nutrition, Cooperative Extension, and Center for Health and Nutrition Research

1

First Lady Michelle Obama and Agriculture Secretary Tom Vilsack unveiled new standards for school meals that will result in healthier meals for kids across the nation. The new meal requirements will raise standards for the first time in more than fifteen years and improve the health and nutrition of nearly 32 million kids that participate in school meal programs every school day. The healthier meal requirements are a key component of the Healthy, Hunger-Free Kids Act, which was championed by the First Lady as part of her Let's Move! campaign and signed into law by President Obama.

"As parents, we try to prepare decent meals, limit how much junk food our kids eat, and ensure they have a reasonably

2

balanced diet," said First Lady Michelle Obama. "And when we're putting in all that effort the last thing we want is for our hard

work to be undone each day in the school cafeteria. When we send our kids to school, we expect that they won't be eating the kind of fatty, salty, sugary foods that we try to keep them from eating at home. We want the food they get at school to be the same kind of food we would serve at our own kitchen tables."

"Improving the quality of the school meals is a critical step in

building a healthy future for our kids," said Vilsack. "When it comes to our children, we must do everything possible to provide them the nutrition they need to be healthy, active and ready to

The new meal pattern increases the amount of

fruits and vegetables required in meals, among

other changes.

Volume 37

2

4

by the Institute of Medicine —a gold standard for evidence-based health analysis. The standards were also updated with key changes from the 2010 Dietary Guidelines for Americans – the Federal government's benchmark for nutrition – and aimed to foster the kind of healthy changes at school that many parents are already trying to encourage at

home, such as making sure that kids are offered both fruits and vegetables each day, more whole grains, and portion sizes and calorie counts designed to maintain a healthy weight.

USDA received an unprecedented 132,000 public comments on its proposed standards (available on the web at www.regulations.gov) – and made modifications to the proposed rule where appropriate. USDA Under Secretary Kevin Concannon said: "We know that robust

public input is essential to developing successful standards and the final standards took a number of suggestions from stakeholders, school food service professions and parents to make important operational changes while maintaining nutritional integrity."

The new standards are expected to cost $3.2 billion over the next five years -- less than half of the estimated cost of the proposed rule and are just one of five major components of the Healthy Hunger

School Meals (Continued from page 1)

Sheri Zidenberg-Cherr, Ph.D., Nutrition Specialist, Anna Jones, Ph.D Candidate., and staff prepare NUTRITION PERSPECTIVES. This newsletter is designed to provide research-based information on ongoing nutrition and food-related programs. It is published bimonthly (six times annually) as a service of the UC Davis Center for Health and Nutrition Research, the University of California Cooperative Extension and the United States Department of Agriculture. NUTRITION PERSPECTIVES is available online, free of charge, at http://nutrition.ucdavis.edu/perspectives. Questions or comments on articles may be addressed to: NUTRITION PERSPECTIVES, Department of Nutrition, University of California, Davis, CA 95616-8669. Phone:(530) 752-3387; FAX: (530) 752-8905.

Editor Sheri Zidenberg-Cherr, Ph.D. Nutrition Specialist Manag ing Ed itor Anna Jones, Ph.D Candidate.

3

face the future – today we take an important step towards that goal."

The final standards make the same kinds of practical changes that many parents are already encouraging at home, including:

• Ensuring students are offered both fruits and vegetables every day of the week;

• Substantially increasing offerings of whole grain-rich foods;

• Offering only fat-free or low-fat milk varieties;

• Limiting calories based on the age of children being served to ensure proper portion size; and

• Increasing the focus on reducing the amounts of saturated fat, trans fats and sodium.

A sample lunch menu with a before and after comparison is available to view and download in PDF (http://www.fns.usda.gov/cnd/Governance/Legislation/cnr_chart.pdf) and JPG formats (http://www.fns.usda.gov/cnd/Governance/Legislation/cnr_chart.jpg).

USDA built the new rule around recommendations from a panel of experts convened

The new meal pattern limits the type of milk sold to fat-free plain or flavored milk, or low-fat plain

milk.

School Meals continued on page 3

Issue 1, January/February 2012

3

2

four interventional studies for review. Twelve of the studies were conducted in the United States, plus

one in Canada and one in South Africa. Sample sizes ranged from 53 to about 12,000 participants between the ages of 6 years and 18 years. Follow-up varied from eight weeks to more than five years.

"According to the best-evidence synthesis, we found strong evidence of a significant positive relationship between physical activity and academic performance. The findings of one high-quality intervention study and one high-quality observational study suggest that being more physically active is positively related to improved academic performance in children," the authors comment.

Background information in the article suggests that exercise may help cognition by

1

A systematic review of previous studies suggests that there may be a positive relationship between physical activity and the academic performance of children, according to a report in the Archives of Pediatrics & Adolescent Medicine (1).

Amika Singh, Ph.D., of the Vrije Universiteit University Medical Center, EMGO Institute for Health and Care Research, Amsterdam, the Netherlands, and colleagues reviewed evidence about the relationship between physical activity and academic performance because of concerns that pressure to improve test scores may often mean more instructional time for classroom subjects with less time for physical activity.

The authors identified 10 observational and

School Meals (Continued from page 2)

Physical Activity continued on page 4

5

Free Kids Act, now implemented or under development, that will work together to reform school nutrition. In addition to the updated meal standards, unprecedented improvements to come include:

• The ability to take nutrition standards beyond the lunchline for the first time ever, foods and beverages sold in vending machines and other venues on school campuses will also contribute to a healthy diet;

• Increased funding for schools – an additional 6 cents a meal is the first real increase in 30 years – tied to strong performance in serving improved meals;

6

• Common-sense pricing standards for schools to ensure that revenues from non-Federal sources keep pace with the Federal commitment to healthy school meals and properly align with costs; and

• Training and technical assistance to help schools achieve and monitor compliance.

The final nutrition standards released today also provide more time for schools to implement key changes, which will be largely phased in over a three-year period, starting in School Year 2012-2013. For example, schools will be permitted to focus on changes in the lunches in the first year, with most changes in breakfast phased in during future years.

Source: USDA New Releases; Jan. 25, 2012; http://www.usda.gov/wps/portal/usda/usdahome?contentid=2012/01/0023.xml.

Physical Activity, School Performance May Be Linked

There was strong evidence indicating that physical activity was related to

improved academic performance in children.

Volume 37

4

Early Dietary Experience Shapes Salt Preference of Infants and Preschoolers

1

Researchers from the Monell Center report that 6-month-old infants who have been introduced to starchy table foods – which often contain added salt – have a greater preference for salty taste than do infants not yet eating these foods (1). Reflecting their greater liking for salty taste, the exposed infants consumed 55 percent more salt during a preference test than did infants not yet introduced to starchy foods.

At preschool age, the same infants were more likely to consume plain salt, demonstrating the enduring influence of early dietary exposure. The findings highlight the potentially significant role of early dietary experience in shaping the salty taste preferences of infants and young children.

“More and more evidence is showing us that the first months of life constitute a sensitive period for shaping flavor preferences. In light of the health consequences of excess sodium intake, we asked if the effect of early experience extended to salt,” said lead author Leslie J. Stein, Ph.D., a physiological psychologist at Monell.

Salt continued on page 5

3

increasing blood and oxygen flow to the brain, increasing levels of norepinephrine and endorphins to decrease stress and improve mood, and increasing growth factors that help create new nerve cells and support synaptic plasticity.

Still, "relatively few studies of high methodological quality have explored the relationship between physical activity and academic performance," the authors conclude. No study in their systematic review used an objective measure of physical activity.

"More high-quality studies are needed on the dose-response relationship between physical activity and academic performance and on the explanatory mechanisms, using reliable and valid measurement instruments to assess this relationship accurately," the authors conclude.

Physical Activity (Continued from page 3)

Reference: 1. Slater SJ, Nicholson L, Chriqui J, et al. The Impact of State Laws and District Policies on Physical Education and Recess Practices in a

Nationally Representative Sample of US Public Elementary Schools. Arch Pediatr Adolesc Med; Dec 5, 2011. [Epub ahead of print].

Source: Archives News Releases; Dec. 5, 2011; http://pubs.ama-assn.org/media/2011a/1205.dtl#2.

Decreasing physical activity in order to increase classroom time may be counter-productive when

it comes to test scores.

The first months of life constitute a sensitive period for shaping flavor

preferences.

Issue 1, January/February 2012

5

2

It has been estimated that reducing sodium intakes could prevent more than 100,000 deaths annually and save billions in medical costs in the United States alone. Beginning as early as 1969, the U.S. government has issued statements calling for a reduction in sodium intake. To date, the call to reduce salt intake has not been successful, in part because humans like the taste of salt.

“Salty taste tells us about the presence of sodium, a critical nutrient needed for survival,” said senior author Gary Beauchamp, Ph.D., a behavioral biologist at Monell. “However, many authorities say that most people eat too much salt. Because it’s been so hard to change adult intakes, we asked whether preferences might be influenced earlier in life through experience with salty food. If so, this may point to the development of public health initiatives that could help people reduce their salt intake.”

In the study, published in the American Journal of Clinical Nutrition, salt preference of 61 infants was tested at both 2 and 6 months of age. At each age, the infant was allowed to drink from three bottles for two minutes each. One bottle contained water, another contained a moderate concentration of salt (one percent, about the saltiness of commercial chicken noodle soup) and the third bottle had a higher concentration of salt (two percent, which tastes extremely salty to adults).

Preference for salty taste was calculated at each age by comparing the amount the infant consumed of a given salt solution to the amount of water it consumed. Thus, if the infant drank more of the one percent salt solution than water, it was considered to have a preference for the one percent solution.

Salt (Continued from page 4)

3

Two-month-old infants were either indifferent to (1 percent) or rejected (2 percent) the salt solutions. At 6 months, salty taste preference of the same infants was related to previous exposure to starchy table food. The 26 infants already eating starchy foods preferred both salt solutions to water, while the 35 babies who had not yet been introduced

to these foods remained indifferent to or continued to reject the salt solutions.

The researchers focused on starchy table foods because they include processed foods, such as breakfast cereals, bread and crackers, which frequently are used as beginning foods and often contain added salt. Exposure to other types of table foods, such as fruit, was not associated with an increased preference for the taste of salt.

“Our findings suggest that early dietary experience influences the preference for salty taste,” said Stein.

To explore whether the early effect extended into childhood, 26 of the children returned at preschool age. Mothers completed questionnaires about the children’s dietary behaviors, which revealed that the 12 children who were introduced to starchy table foods before six months of age were more likely to lick salt from foods and also were likely to eat plain salt. These findings suggest that the early dietary exposure was related to an increased affinity for the taste of salt several years later.

“It’s important to note that our conclusions are limited by the correlational nature of the study,” said Stein. “Experimental studies are now needed to address the important question of how children and adults come to prefer high levels of salt in their food.”

Children who were introduced to starchy table foods before six months

of age were more likely to lick salt from foods or eat plain salt.

Salt continued on page 5

Volume 37

6

2

the study's lead author. "Reviews of medical records and patient surveys are commonly used as proxies for actually being inside an examination room and observing the visit. But before we use these methods to figure out what happens during a patient visit, we first need to make sure that what we measure reflects what actually happened."

Nearly one-third of the estimated 75 million children in the United States between the ages of 2 and 19 are overweight or obese -- 17 percent are obese and 15 percent are overweight. Overweight and obesity are risk factors for the development of multiple health conditions in children and adults, such as diabetes and heart disease.

Modifying children's food intake and increasing their levels of physical activity

are cornerstones of weight management and obesity prevention, and a key source of advice on weight management and weight loss is physician counseling on nutrition and physical activity.

In fact, doctors are required to provide such counseling to address this serious health concern. Counseling for nutrition and physical activity for children and adolescents is a quality measure in the

1

Parents of overweight children and their pediatricians agree that doctors routinely provide weight-management counseling -- but they disagree on just what the doctor actually ordered, a study by researchers at UC Davis has found (1).

Pediatricians often under report, and patients' parents overreport, weight-management counseling.

The rigorous study, which involved the use of parent questionnaires, audiotapes of well-child visits during which the weight-management counseling was delivered, and examination of electronic health records, found that parents tend to overreport and doctors under report the counseling delivered on weight, nutrition and physical activity.

The study on the "Accuracy of parental report and electronic health record documentation as measures of diet and physical activity counseling," was published in the journal Academic Pediatrics.

"It's important to find ways to accurately understand what occurs during medical care," said Ulfat Shaikh, director of Healthcare Quality Integration at the UC Davis Schools of Health and

Parents, Physicians, Disagree On What The Doctor Ordered For Childhood Weight Management

Salt (Continued from page 5)

Reference: 1. Stein LJ, Cowart BJ, and Beauchamp GK. The development of salty taste acceptance is related to dietary experience in human

infants: a prospective study. Am J Clin Nutr; Jan. 2012; 95(1): 123-9.

Source: Monell Center News Releases; Dec. 20, 2011; http://www.monell.org/news/news_releases/early_salt.

Parents continued on page 7

The study observed well-child visits and examined health records to determine if weight, nutrition, or physical activity counseling took

place.

Issue 1, January/February 2012

7

3

Healthcare Effectiveness Data and Information Set, a widely used set of performance measures in the managed care industry, developed and maintained by the National Committee for Quality Assurance (NCQA). The counseling also is a criterion for "meaningful use" of electronic health records under the American Recovery and Reinvestment Act of 2009.

To assess how frequently physicians provided weight-management counseling, Shaikh and her colleagues at UC Davis enrolled 198 diverse children between 2 and 12 years of age who were seen for well-child visits in the general pediatrics outpatient clinic at UC Davis Children's Hospital. The children averaged 5 ½ years of age, roughly divided evenly between boys and girls.

The children's parents were informed that the study would assess their perspectives about the well-child visit. The 38 treating physicians in the clinic were informed that parent education would be assessed for these patients, but the topics that would be evaluated were not specified.

With parents' and physicians' full knowledge, audiotape recorders were placed in the examination rooms in inconspicuous locations. The researchers audiotaped each complete visit for study participants. After the well-child visits a research assistant entered the examination room and provided parents with a questionnaire to complete before they departed the clinic.

The researchers then compared the parental reports of counseling on the questionnaires, the audiotaped records, and what information was included in the electronic health record by the

Parents (Continued from page 6)

4

physician after the conclusion of the well-child visit. The study found significant differences between what the parents reported, what was recorded on the audiotapes, and what appeared in the electronic health record.

Parents, in general, tended to remember and report discussing a wide variety of topics with

greater frequency than was recorded in the audiotapes, indicating a high level of "false positive" reports.

For example, 90 percent of parents reported receiving counseling on weight management on the questionnaires; the audiotaped assessments indicated that the topics were discussed 87 percent of the time; the medical record documented these discussions at only 39 percent. Parents indicated that their pediatricians discussed consumption of fruits and vegetables 80 percent of the time; the audiotaped assessments recorded these discussions at 77

percent; but the medical record documentation indicated these discussions took place only 44 percent of the time.

Documentation of counseling in medical records is important because it serves as a memory aid to physicians when they talk to families at future visits, said Shaikh, who also is an associate professor of pediatrics. Knowing what lifestyle goals were set during the last visit helps physicians follow-up on these goals and provide support to patients and their families to help them make lifestyle changes and maintain a healthy weight. Detailed documentation in the health record also helps to improve communication between clinicians and patients, thereby improving clinical care.

While weight management was discussed 87 percent of the time, these discussions were recorded in medical

records 39 percent of the time.

Parents continued on page 8

Volume 37

8

Mediterranean Diet Appears to Be Associated With Reduced Small Vessel Damage in the Brain

1

Consumption of a Mediterranean-style diet is associated with a reduced burden of white matter hyperintesity volume, a marker of small vessel damage in the brain, according to a report in the February issue of Archives of Neurology (1).

White matter hyperintensities (WMHs) visible on brain magnetic resonance imaging (MRI) are markers of chronic small vessel damage, according to background information in the article. "Although diet may be an important predictor of vascular disease, little is known about the possible association between dietary habits and WMHs," the authors write. "Studies have suggested that consumption of a MeDi [Mediterranean Diet] is associated with a reduced risk of the metabolic syndrome, coronary heart disease, stroke and cognitive disorders, but no

2

studies to date, to our knowledge, have examined the association between a MeDi and WMH volume (WMHV)."

Hannah Gardener, Sc.D., of the University of Miami Miller School of Medicine, and colleagues evaluated data from 966 participants in the Northern Manhattan Study to examine the association between a MeDi and WMHV. Participants were given a food frequency questionnaire to assess dietary patterns during the previous year, and answers were used to determine a MeDi compliance score. The WMHV was measured by quantitative brain MRI.

Results of the survey showed that 11.6 percent of participants scored 0 to 2 on the MeDi scale, 15.8 percent scored 3, 23 percent scored 4,

Mediterranean-style diets have been associated with reduced risk of

cardiovascular disease, and may also reduce small vessel damage in the brain.

5

Documentation in medical records of counseling on weight, nutrition and physical activity also is now used by insurers as a measurement of whether counseling has been provided and is tied to physician payment.

The study suggests that for health-care professionals, medical record documentation may inaccurately underestimate the counseling that patients receive. The study also suggests that what

6

goes into electronic medical records may vary depending upon nuances in electronic health record tools and templates used by physicians.

"Parental report via the use of a questionnaire administered immediately following the patient visit is a more valid method of assessing physician counseling on weight, nutrition and physical activity in pediatric primary care, compared to medical record documentation," Shaikh said.

Parents (Continued from page 7)

Reference: 1. Shaikh U, Nettiksimmons J, Bell RA, et al. Accuracy of Parental Report and Electronic Health Record Documentation as Measures of

Diet and Physical Activity Counseling. Acad Pediatr. 2011 Dec 22.

Source: UC Davis Health System Newsroom; Jan. 3, 2012; http://www.ucdmc.ucdavis.edu/publish/news/newsroom/6077.

Mediterranean continued on page 9

Issue 1, January/February 2012

9

2

approximately half that of the mice consuming the soybean oil diet. Overall, the rate of tumor growth was 28 percent lower in the walnut-fed mice.

A low-fat diet is frequently recommended for reducing a man's risk for developing or slowing growth of existing prostate cancer, but the UC Davis study suggests that excluding walnuts, which are high in fat but rich in omega-3 polyunsaturated fats, antioxidants and other plant chemicals, may mean foregoing a

protective effect of walnuts on tumor growth.

"If additional research determines that walnuts have the same effect in men as they do in mice, adhering to a diet that excludes

1

Mice genetically programmed to develop prostate cancer had smaller, slower growing tumors if they consumed a diet containing walnuts, UC Davis researchers report in the current issue of the British Journal of Nutrition (1).

UC Davis researchers, with colleagues at the USDA Western Regional Research Center in Albany, Calif., assessed tumor size in mice fed different diets for 9, 18 and 24 weeks. They found that the mice that consumed the human equivalent of 2.8 ounces of whole walnuts daily, gained weight at the same rate as mice fed a soybean oil diet formulated to match the nutrients, fat levels and fatty acid profiles of the walnut diet. At 18 weeks, however, the tumor weight of the walnut-fed group was

Walnut Diet Delivers Promising Results In Mice With Prostate Cancer

Compared to mice in the control group, mice in the walnut group had 28 percent lower

tumor growth.

3

23.5 percent scored 5, and 26.1 percent scored 6 to 9. Women had lower MeDi scores than men and participants who reported moderate to heavy levels of physical activity were more likely to report greater consumption of a MeDi. Participants with MeDi scores of 6 or higher also had lower BMI.

These results suggest a lower burden of WMHV among participants with a greater consumption of a MeDi. This association was independent of sociodemographic and vascular risk factors including physical activity, smoking, blood lipid levels, hypertension, diabetes, history of cardiac disease and BMI. Additionally, after adjustment, the only component of the MeDi score that was

4

independently associated with WMHV was the ratio of monounsaturated to saturated fat.

"In summary, the current study suggests a possible protective association between increased consumption of a MeDi and small vessel damage," the authors conclude. "The associations with WMHV may be driven by the favorable ratio of monounsaturated fat consumption over saturated fat. However, the results of the analysis of the individual MeDi scale components suggests that the overall dietary pattern, rather than any of the individual components, may be more etiologically relevant in relation to WMHV."

Mediterranean (Continued from page 8)

Reference: 1. Gardener H, Scarmeas N, Gu Y, et al. Mediterranean diet and white matter hyperintensity volume in the Northern Manhattan Study.

Arch Neurol; Feb. 2012; 69(2): 251-6.

Source: Archives News Releases; Feb. 13, 2012; http://pubs.ama-assn.org/media/2012a/0213.dtl#4.

Walnut continued on page 10

Volume 37

10

Top Off Breakfast with -- Chocolate Cake?

1

A full breakfast that includes a sweet dessert contributes to weight loss success, say Tel Aviv University (TAU) researchers (1).

When it comes to diets, cookies and cake are off the menu. Now, in a surprising discovery, researchers from TAU have found that dessert, as part of a balanced 600-calorie breakfast that also includes proteins and carbohydrates, can

3

walnuts to lower fat would mean that prostate cancer patients could miss out on the beneficial effects of walnuts," said lead author Paul Davis, a research nutritionist in the Department of Nutrition at UC Davis and researcher with the UC Davis Cancer Center.

Prostate cancer is the second most common cancer in American men. One in six men will be diagnosed with the cancer, most commonly in later life. But relatively few — one in 36 — will die from the disease because most tumors do not spread beyond the local site, according to the National Cancer Institute.

"These characteristics of prostate cancer make adding walnuts to a diet attractive as part of prostate cancer prevention," Davis said.

Davis added that some studies have hinted that walnuts may prevent the actual formation of tumors. "But more immediately, our findings suggest that eating a diet containing walnuts may slow prostate tumor

4

growth so that the tumor remains inside the prostate capsule. If proven applicable in humans, men with prostate cancer could die of other causes -- hopefully old age."

The researchers found no single constituent responsible for the beneficial effects of walnuts. For example, the study found effects on multiple signaling and metabolic pathways related to tumor growth and metabolism and that walnut-fed mice had lower blood insulin-like growth factor (IGF-1), a protein strongly associated with prostate cancer.

Walnut-fed mice also had lower LDL cholesterol (the bad cholesterol). High LDL is an established heart disease risk factor, and has more recently been linked to tumor growth, suggesting that the same food that promotes a healthy heart can be helpful to patients with prostate cancer. Finally, distinct differences were noted in the way the liver, a major source of IGF-1 and cholesterol, metabolized the walnut diet compared with the soybean oil diet, despite the diets' nutritional similarities.

Walnut (Continued from page 9)

Reference: 1. Davis PA, Vasu VT, Gohil K, et al. A high-fat diet containing whole walnuts (Juglans regia) reduces tumour size and growth along with

plasma insulin-like growth factor 1 in the transgenic adenocarcinoma of the mouse prostate model. Br J Nutr; Jan. 2012; 16: 1-9.

Source: UC Davis Health System Newsroom; Jan. 24, 2012; http://www.ucdmc.ucdavis.edu/publish/news/newsroom/6150.

2

help dieters to lose more weight — and keep it off in the long run.

They key is to indulge in the morning, when the body's metabolism is at its most active and we are better able to work off the extra calories throughout the day, say Prof. Daniela Jakubowicz, Dr. Julio Wainstein and Dr. Mona Boaz of Tel Aviv University's Sackler Faculty of Medicine and the Diabetes Unit

Breakfast continued on page 11

Issue 1, January/February 2012

11

3

at Wolfson Medical Center, and Prof. Oren Froy of Hebrew University Jerusalem.

Attempting to avoid sweets entirely can create a psychological addiction to these same foods in the long-term, explains Prof. Jakubowicz. Adding dessert items to breakfast can control cravings throughout the rest of the day. Over the course of a 32 week-long study, detailed in the journal Steroids, participants who added dessert to their breakfast — cookies, cake, or chocolate — lost an average of 40 lbs. more than a group that avoided such foods. What's more, they kept off the pounds longer.

A meal in the morning provides energy for the day's tasks, aids in brain functioning, and kick-starts the body's metabolism, making it crucial for weight loss and maintenance. And breakfast is the meal that most successfully regulates ghrelin, the hormone that increases hunger, explains Prof. Jakubowicz. While the level of ghrelin rises before every meal, it is suppressed most effectively at breakfast time.

Basing their study on this fact, the researchers hoped to determine whether meal time and composition impacted weight loss in the short and long term, says Prof. Jakubowicz, or if it was a simple matter of calorie count.

One hundred and ninety three clinically obese, non-diabetic adults were randomly assigned to one of two diet groups with identical caloric intake — the men consumed 1600 calories per day and the women 1400. However, the first group was given a low carbohydrate diet including a small 300 calorie breakfast, and the second was given a 600 calorie breakfast high in protein and carbohydrates, always including a dessert item (i.e. chocolate).

Breakfast (Continued from page 10)

4

Halfway through the study, participants in both groups had lost an average of 33 lbs. per person. But in the second half of the study, results differed drastically. The participants in the low-carbohydrate group regained an average of 22 lbs. per person, but participants in the group with a

larger breakfast lost another 15 lbs. each. At the end of the 32 weeks, those who had consumed a 600 calorie breakfast had lost an average of 40 lbs. more per person than their peers.

One of the biggest challenges that people face is keeping weight off in the long-term, says Prof. Jakubowicz. Ingesting a higher proportion of our daily calories at breakfast makes sense. It’s not only good for body function, but it also alleviates cravings. Highly restrictive diets that forbid desserts and carbohydrates are initially effective, but often cause dieters to stray from their food plans as a result of

withdrawal-like symptoms. They wind up regaining much of the weight they lost during the diet proper.

Though they consumed the same daily amount of calories, "the participants in the low carbohydrate diet group had less satisfaction, and felt that they were not full," she says, noting that their cravings for sugars and carbohydrates were more intense and eventually caused them to cheat on the diet plan. "But the group that consumed a bigger breakfast, including dessert, experienced few if any cravings for these foods later in the day."

Ultimately, this shows that a diet must be realistic to be adopted as part of a new lifestyle. Curbing cravings is better than deprivation for weight loss success, Prof. Jakubowicz concludes.

Participants in the low-carbohydrate group were more likely to regain

wait by the end of the study, compared to the group that ate a

larger breakfast containing dessert.

Breakfast continued on page 12

Volume 37

12

Water continued on page 13

Switching to Water, Diet Beverages Can Tip the Scales

1

Making a simple substitution of water or diet soft drinks for drinks with calories can help people lose 4 to 5 pounds, a new University of North Carolina at Chapel Hill study shows (1).

The study, published in the American Journal of Clinical Nutrition, compared weight loss for 318 overweight or obese people, who were divided into three groups: those who switched from calorie-laden beverages to diet soft drinks; those who switched to water; and those who were not counseled to change beverages but received general information about healthy choices that could lead to weight loss. All three groups attended monthly group sessions and had access to a group-specific website for 6 months.

“Substituting noncaloric beverages – whether it’s water, diet soft drinks or something else – can be a clear and simple change for people who want to lose or maintain weight,” said study author Deborah Tate, Ph.D., associate professor of nutrition and of health behavior at the UNC Gillings School of Global Public Health and member of the Lineberger Comprehensive Cancer Center. “If this were done on a large scale, it could significantly reduce the increasing public health problem of obesity.”

Tate and colleagues undertook the study to provide scientific evidence of whether eliminating calories from beverages is an effective weight loss

2

tool that health-care providers and nutritional counselors could recommend. The study, known as

CHOICE, or Choosing Healthy Options Consciously Everyday, is believed to be the first randomized controlled trial using noncaloric beverage substitution alone as the primary weight loss strategy in overweight adults.

“It does help,” Tate said. “We learned that both water and diet sodas have some benefits, but they may be different. People who really like the sweet flavor or carbonation or caffeine of sodas may be more likely to stick with the change if they are drinking diet sodas as opposed to water only, but drinking water was associated with some other important health improvements like reduced blood sugar.”

All three groups experienced small reductions in weight and waist

circumference during the 6-month study.

However, people who switched to calorie-free beverages were twice as likely to lose 5 percent or more of their body weight than those who were not counseled to change beverages. People in the group who drank mostly water had lower fasting glucose levels and better hydration levels than the control group.

Tate said that that percentage of weight loss and lower blood sugar levels were important

Breakfast (Continued from page 11) Reference: 1. Jakubowicz D, Froy O, Wainstein J, and Boaz M. Meal timing and composition influence ghrelin levels, appetite scores and weight

loss maintenance in overweight and obese adults. Steroids; Mar. 10, 2012; 77(4): 323-31.

Source: American Friends of Tel Aviv University News; Feb. 7, 2012; http://www.aftau.org/site/News2?page=NewsArticle&id=15967.

Substituting water or diet soft drinks for drinks with

calories can help people lose 4 to 5 pounds.

Issue 1, January/February 2012

13

Water (Continued from page 12)

Obesity continued on page 14

3

because they are associated with clinical improvements in risk factors for obesity-related chronic diseases.

The study also noted that while participants’ weight loss was less than reductions observed in more intensive, clinic-based behavioral lifestyle modification programs, the UNC study required minimal self-monitoring and prompted people to change just one aspect of their diets (beverages) – an approach consistent with other findings

Prevalence of Obesity in U.S. Still High, With Little Change in Recent Years

1

There has not been significant change in the prevalence of obesity in the U.S., with data from 2009-2010 indicating that about one in three adults and one in six children and teens are obese; however, there have been increases in certain demographics, according to two studies being published by the Journal of the American Medical Association(1,2).

Katherine M. Flegal, Ph.D., Cynthia L. Ogden, Ph.D., M.R.P., and colleagues with the Centers for Disease Control and Prevention, Hyattsville, Md., analyzed data from the 2009-2010 National Health and Nutrition Examination Survey (NHANES) to determine rates of obesity in the U.S. In the analysis for prevalence among adults, rates of obesity (defined as a body

References: 1. Tate DF, Turner-McGrievy G, Lyons E, et al. Replacing caloric beverages with water or diet beverages for weight loss in adults: main

results of the Choose Healthy Options Consciously Everyday (CHOICE) randomized clinical trial. Am J Clin Nutr; Mar. 2012; 95(3): 555-63.

Source: University of North Carolina Chapel Hill News; Feb. 13, 2012; http://uncnews.unc.edu/content/view/5088/107/.

2

mass index [BMI] of 30 or greater) were compared with data from 1999-2008. NHANES includes measured heights and weights for 5,926 adult men and women from a nationally representative sample of the U.S. population in 2009-2010 and for 22,847 men and women in 1999-2008.

In 2009-2010, the age-adjusted average BMI was 28.7 for men and women. The researchers found that overall, the age-adjusted obesity prevalence was 35.7 percent. Among men, the prevalence was 35.5 percent, and within race/ethnicity groups, prevalence ranged from 36.2 percent among non-Hispanic white men to 38.8 percent among non-Hispanic black men. There were significant increases in

obesity for men over the period 1999-2000 through

4

recommending small but potentially more sustainable lifestyle changes that people can make to improve their health.

“Substituting specific foods or beverages that provide a substantial portion of daily calories may be a useful strategy for modest weight loss or weight gain prevention,” Tate said. “Beverages may be ideal targets, but keep in mind, the strategy will only work if the person doesn’t make up for the lost calories some other way.”

While prevalence of obesity has held steady overall, some groups are still

experiencing increases.

Volume 37

14

Food Hero: Helpful Messages for Healthy Eating

1

The newly updated Food Hero website (http://www.foodhero.org) is an online resource for people who want to eat healthy meals, and it is the center of the Oregon State University Extension Service Food Hero campaign.

"The idea is to use the Internet to connect with people and offer them tools for healthy eating," said Lauren Tobey, OSU nutrition specialist. "Right now, there are things they can do to make healthy, kid-friendly meals for their families."

2

Food Hero is a research-based social marketing campaign aimed at parents who use

the Internet and have kids under the age of 18 living in their homes, Tobey said. "Our

secondary population is the children in the families."

The goal is simple: show parents and their kids how easy it is to eat more fruits and vegetables,

whether fresh, frozen or canned. The website provides recipes, tips and tools on

how to prepare meals that are low cost, simple and fast. The entire site is in both English and Spanish.

Food Hero continued on page 15

Resources

Obesity (Continued from page 13)

3

2009-2010.

For women, the prevalence of obesity was 35.8 percent, and the range was from 32.2 percent among non-Hispanic white women to 58.5 percent among non-Hispanic black women. Over the period from 1999 through 2010, obesity showed no significant increase among women overall, but increases were statistically significant for non-Hispanic black women and Mexican American women. For both men and women, the most recent 2 years (2009-2010) did not differ significantly from

References: 1. Flegal KM, Carroll MD, Kit BK, and Ogden CL. Prevalence of obesity and trends in the distribution of body mass index among US

adults, 1999-2010. JAMA; Feb. 1, 2012; 307(5): 491-7. 2. Ogden CL, Carroll MD, Kit BK, and Flegal KM. Prevalence of obesity and trends in body mass index among US children and

adolescents, 1999-2010. JAMA; Feb. 1, 2012; 307(5): 483-90.

Source: JAMA News Releases; Jan. 17, 2012; http://pubs.ama-assn.org/media/2012jer/0117.dtl#1.

4

the previous 6 years (2003-2008).

The age-adjusted prevalence of overweight and obesity combined (BMI 25 or greater) was 68.8 percent overall, 73.9 percent among men, and 63.7 percent among women.

"Obesity prevalence shows little change over the past 12 years, although the data are consistent with the possibility of slight increases," the authors write.

Issue 1, January/February 2012

15

1

Keep Food Safe Blog (http://www.foodsafety.gov/blog/blog.html) This resource is produced by the U.S. Department of Health and Human Services and the Food and Drug Administration and provides practical tips to help consumers stay food safe. Recent entries include “Challenge yourself to cook safe! Tips for cooking in a microwave or conventional oven,” “Cupid is Coming! Tips for a Romantic—and Safe—Dinner” and “Is Your Food Safe to Eat for the Big Game?”

New and Updated Nutrition Resources

2

Academy of Nutr it ion and Dietet ics Consumer and Lifestyle App Reviews (http://www.eatright.org/appreviews/) Thousands of apps are available for smart phones, but which ones for diet and lifestyle, but which ones are actually helpful and provide trustworthy information? Dietitians at the Academy of Nutrition and Dietetics have reviewed some of the most popular apps for diabetes, gluten-free diets, and weight management for scientific accuracy.

3

"A long-term goal is that foodhero.org becomes the WebMD of healthy eating," Tobey said.

Fourteen OSU county Extension offices in Harney, Jackson, Josephine, Klamath, Linn/Benton, Marion/Polk/Yamhill, Multnomah, Tillamook, Umatilla/Morrow and Washington are participating and have aprons, table covers, community posters, postcards and cookbooks to use in their communities.

Billboards and grocery store displays point to the Food Hero website for tools on what families can do immediately to make healthy food choices. In Multnomah County bus shelters and benches, as well as movie theaters pilot the how-to-eat-well information because the county has the largest population in the state using SNAP (Supplemental Nutrition Assistance Program, formerly the Food Stamp program).

4

The idea for Food Hero came in 2009 after OSU surveyed Oregon people eligible for SNAP. Results showed that although 81 percent of those surveyed said they wanted to serve more balanced meals, they tended to not eat recommended amounts of fruits and vegetables. In addition, the largest percentage of those surveyed (47 percent) want to find healthy food choice information online.

"A diet rich in fruits and vegetables may reduce the risk of chronic disease, such as some types of cancer, heart disease and stroke. It also can help people maintain a healthy weight," Tobey said.

The Food Hero campaign is funded through the USDA Supplemental Nutrition Assistance Program in partnership with the U.S. Department of Agriculture, Oregon Department of Human Services and OSU Extension.

Food Hero (Continued from page 14)

Source: Oregon State University News and Research Communications; Feb. 9, 2012; http://oregonstate.edu/ua/ncs/archives/2012/feb/food-hero-helpful-messages-healthy-eating

Source: University of Missouri News Bureau; May 9, 2011; http://munews.missouri.edu/news-releases/2011/0509-parsley-celery-carry-

Volume 37 Issue 1, January/February 2012

Nutrition Perspectives University of California, Davis

Nutrition Department One Shields Ave Davis, CA 95616

(9099)

The University of California prohibits discrimination or harassment of any person on the basis of race, color, national origin, religion, sex, gender identity, pregnancy (including childbirth, and medical conditions related to pregnancy or childbirth), physical or mental disability, medical condition (cancer-related or genetic characteristics), ancestry, marital status, age, sexual orientation, citizenship, or service in the uniformed services (as defined by the Uniformed Services Employment and Reemployment Rights Act of 1994: service in the uniformed services includes membership, application for membership, performance of service, application for service, or obligation for service in the uniformed services) in any of its programs or activities.

University policy also prohibits reprisal or retaliation against any person in any of its programs or activities for making a complaint of discrimination or sexual harassment or for using or participating in the investigation or resolution process of any such complaint.

University policy is intended to be consistent with the provisions of applicable State and Federal laws.

Inquiries regarding the University’s nondiscrimination policies may be directed to the Affirmative Action/Equal Opportunity Director, University of California, Agriculture and Natural Resources, 1111 Franklin Street, 6th Floor, Oakland, CA 94607, (510) 987-0096.

University of California, Davis

Nutrition Perspectives Nutrition Department

One Shields Ave. Davis, CA 95616

Phone:

530.752.3387

Fax: 530.752.8905