Phosphorus Additives in Food Products: The Case for Improved Transparency (P24-001)
Lea Borgi
Harvard Medical School, MA
Objectives: Increased intake of dietary phosphorus has been associated with a higher mortality risk, especially in patients with chronic kidney disease or on dialysis. Organic phosphorus, occurring naturally in food, is less well absorbed than inorganic phosphorus, found as an additive or preservative in several food products, and is almost completely absorbed. Phosphorus additives have different nomenclatures, usually listed in the ingredient label of a food product. This analysis will highlight the widespread presence of phosphorus additives in different foods, even those considered “healthy” by government agencies, emphasizing the need for improved phosphorus transparency in food products.
Methods: Over 314,000 food and beverage products were analyzed through the use of Label Insight's Open Data Initiative. Label Insight promotes transparency between brands and consumers through its food composition database. These products represent >80% of all food products sold in the United States in the last few years. Nutrient composition, ingredient listing, marketing, and certification attributes were also available for analysis.
Results: Forty-seven phosphorus additives were found in the database by searching the raw ingredient attribute. More than 52,000 products contained at least one phosphorus additive, with monocalcium phosphate being the most common additive. Among products bearing the American Heart Association heart-check mark their packaging to indicate a heart-healthy choice, >3000 contained at least one phosphorus additive.
Conclusions: Phosphorus additives are widely used by the food industry. Their existence in so many food products, even those labeled as “heart-healthy,” make it difficult for consumers (and patients) to know what products align with their needs and chronic diseases. It is therefore imperative to have more transparency from the food industry, as well as additional phosphate data on food packages.
Online Food Marketing: An Examination of Canadian Online Grocery Store Flyers (P24-002)
Beatriz Franco-Arellano,1 Xulin Liu,1 Giovana Molon-Leites,2 and Mary L'Abbe1
1University of Toronto, Canada; and 2Universidade Federal de Ciências da Saúde de Porto Alegre, Brazil
Objective: The aim of this study was to examine foods and beverages most advertised in Canadian online grocery stores flyers per food category, season, type of store, and proportion of products marketed to children.
Methods: Online flyers from 4 Canadian grocery stores (2 mainstream retailers and 2 discount chains) were collected from each retailers' website, during 5 consecutive weeks in spring and fall 2017, for a total of 10 wk. The University of Toronto postal code was used to consistently capture products advertised within the same geographic area. Product information (e.g., product name) was extracted from flyers. Supplements, baby food products, or nonfood products (e.g., toiletries) were not extracted. A total of 8237 products were classified into 22 food categories, defined by Health Canada's Table of Reference Amounts for Food. Foods and beverages were identified as
foods marketed to children if labels included child-oriented graphics. Proportions and chi-square tests were computed with the use of R.
Results: The number of products advertised was similar in spring (50%) and fall (50%). Mainstream stores advertised more products (71%) than discount chains (29%). Bakery (13.5%), meats (13.2%), and dairy products (10.5%) were the top 3 food categories most advertised, whereas dessert toppings and fillings (0.2%), eggs (0.4%), and legumes (0.8%) were the categories least promoted. Six percent of products were identified as marketed to children (n = 512), mostly advertised during the fall (P = 0.001) and predominantly in bakery products (20%), sugars and sweets (15%), and desserts (11%). In addition, it was found that discount chains advertised more products marketed to children (7%) than mainstream stores (5.8%), relative to the number of products in each flyer (P = 0.001).
Conclusions: The contemporary Canadian diet, characterized by overconsumption of refined grains and meats, as well as underconsumption of legumes and fruits, was reflected in the prevalence of food categories most and least advertised in online weekly grocery flyers. Almost 48% of foods marketed to kids were advertised in discretionary foods. Encouraging healthier food categories in grocery flyers might help consumers to choose healthier food choices and to support strategies aiming to reduce obesity, currently affecting 54% of adults and 23% of children in Canada.
Funding Sources
CIHR Frederick Banting and Charles Best Canada Graduate Scholarship (BF-A), Department of Nutritional Sciences Graduate Student Fellowship (BF-A), EW McHenry Research Chair Operating Grant (ML).
A New Food and Nutrition Policy for Portugal: Implementation and First Results (P24-003)
Maria Joao Gregorio,1,2,3 Pedro Graça,1,2 Maria Joao Gregorio,1,2,3 Sofia Mendes de Sousa,1 and Jose Camolas1
1Directorate-General of Health of Portugal; 2Faculty of Nutrition and Food Sciences, University of Porto, Portugal; and 3EpiDoC Unit, CEDOC, NOVA Medical School, Portugal
Objective: This study describes the implementation process of the new Integrated Strategy for the Promotion of Healthy Eating (EIPAS) in Portugal and its first results in terms of main measures and achievements.
Methods: EIPAS, which was launched in 2017, was based on a consensus agreed to by an interministerial group, including ministries of finance, internal affairs, education, health, economy, agriculture, and sea. This working group, led by the health sector, worked for >1 y and identified difficulties and opportunities for intervention as well as priority areas. The framework produced was based on the recommendations from the WHO European Food and Nutrition Action Plan 2015–2020 and from the EU High Level Group on Nutrition and Physical Activity. This strategy was also based on the last Portuguese dietary intake survey (2015/16). EIPAS also reflects findings from a public hearing involving stakeholders, including the food industry.
Results: EIPAS was published as a law and is intended to improve the dietary habits of the population. It considers the challenge proposed by the WHO of “health in all policies” and has 3 main goals: 1) to promote healthy food environments in public settings; 2) to promote food reformulation, namely in terms of sugar, salt, and trans fatty acids; and 3) to promote literacy and autonomy for healthy consumer choices. To achieve these goals a set of 51 measures was proposed and distributed by the 7 ministries involved. Under the scope of this strategy, Portugal has already implemented several measures, including the following: 1) a definition of standards for food offer at all public health care facilities; 2) implementation of a sugar tax on sweetened beverages; 3) implementation of a voluntary agreement with the bakery industry to reduce salt in bread to values of 1.0 g/100 g of bread; 4) design of an interpretative model for front-of-pack labeling; and 5) improvements in the nutritional quality of the national food aid program for low-income groups.
Conclusions: For the first time Portugal has a nutrition policy based on the WHO concept of “health in all policies” and on national data for food intake. Some measures are already in place, whereas others are in preparation. The capacity to implement all of the 51 measures and the inherent difficulties this policy faces make this process an authentic political and social laboratory that deserves to be followed.
Modeling the Impact of Adding a Serving of Dairy Foods to the Healthy Mediterranean-Style Eating Pattern in the 2015 Dietary Guidelines for Americans (P24-004)
Julie Hess,1 Victor Fulgoni,2 and Emily Radlowski3
1National Dairy Council, IL; 2Nutrition Impact LLC, MI; and 3Dominican University, IL
Objective: Dairy foods are one of the top food sources of calcium, potassium, and vitamin D in US diets, and the Dietary Guidelines for Americans (DGA) has recommended 3 daily servings of low-fat or fat-free dairy foods for Americans aged ≥9 y since 2005. However, the Healthy Mediterranean-Style Eating Pattern (HMEP) in the 2015 DGA recommends that adults eating <2400 kcal/d consume only 2 daily servings of dairy foods. Two servings of dairy foods do not provide enough calcium, potassium, and vitamin D to meet dietary reference intakes (DRIs). Our objective was to assess the nutrient adequacy of alternative models of the 1600, 2000, and 2400 kcal HMEP that include 3 servings of dairy foods.
Methods: By conducting diet modeling based on food composites, or consumption-weighted average nutrient contents for each food group from the Scientific Report of the 2015 Dietary Guidelines Advisory Committee, we created alternative models of the 1600, 2000, and 2400 kcal HMEP. We assessed these models for nutrient adequacy and compared them with the Healthy US-Style Eating Pattern and the HMEP.
Results: The addition of a serving of dairy foods to the 1600, 2000, and 2400 kcal/d HMEP had largely beneficial effects on the nutrient profiles of these diets and increased the amounts of several nutrients, including calcium, vitamin D, potassium, vitamin A, phosphorus, riboflavin, vitamin B-12, zinc, and magnesium. Most of our models increased the saturated fat and sodium content as well. However, except for one model, these nutrients remained within the ranges recommended in the 2015 DGA.
Conclusion: The addition of a serving of dairy food to the 1600, 2000, and 2400 kcal HMEP brings their nutrient profiles closer to the DRIs for calcium, vitamin D, and potassium.
Funding Sources
This study was supported by the National Dairy Council, Rosemont, IL.
Development of Evidence-Based School Lunch Best Practices: A Critical Review (P24-005)
Jillian Joyce, Brooke Cull, Cindy Logan, Richard Rosenkranz, and Sara Rosenkranz
Kansas State University
Objectives: The National School Lunch Program (NSLP) was developed to provide healthy food to children within the school setting. Lunches served in participating schools must meet NSLP nutrition standards. Research has shown that in school lunches meeting NSLP standards, there may be significant variation in dietary quality (DQ), which is associated with child and adult weight status, chronic disease risk, and academic performance. Thus, this study had the following objectives: 1) to review previous research on child DQ recommendations and techniques for effective implementation of healthy school lunches; and 2) to determine best practices for healthy school lunches, based on the evidence.
Methods: Relevant studies, published in the last 10 y, were systematically identified with the use of PubMed and Scopus. Keywords and search strategies were determined a priori with professional librarian assistance. Two independent reviewers assessed included studies for methodologic quality, according to Academy of Nutrition and Dietetics Evidence Analysis Library criteria. Results were summarized and used to determine best practices for schools planning healthy lunches.
Results: Twenty-one articles met inclusion criteria, 14 related to DQ and 7 related to implementation. The average quality of included studies was neutral. Best practices to improve DQ of school lunches included increasing dairy, fruit, nonstarchy vegetables, nuts, seeds, whole grains, lean meat, poultry, eggs, and fish, and decreasing/minimizing red meat, processed meat, total fat, saturated fat, salt, refined grains, and prefried/fried foods. Implementation techniques that improve selection and consumption of healthy foods included use of nudge strategies and Smarter Lunchrooms interventions; increasing normativeness, convenience, and attractiveness; including students in planning and implementation; and marketing healthy foods to schoolchildren.
Conclusions: The current review resulted in the determination of evidence-based best practices, including implementation techniques, for planning healthy school lunches. If used during menu and service planning processes, these best practices may help to improve school lunch DQ and increase selection and consumption of the resulting higher-quality school lunches by schoolchildren.
Consumption of Foods Derived from Subsidized Commodities and Adverse Cardiometabolic Risk among US Adults Based on 24-Hour Dietary Recall, 2009–2014 (P24-006)
Whitney Leet,1 Mohammed Ali,1 Venkat Narayan,1 Kai McKeever Bullard,2 and Karen Rae Siegel2
1 Emory University, GA; and 2CDC
Objective: Prior analyses based on 2001–2006 NHANES have shown associations between individual consumption of the most subsidized commodities (corn, soybeans, wheat, rice, sorghum, dairy, and livestock) and cardiometabolic risk. Here, we re-evaluate this association for 2009–2014 to determine whether and the extent to which the associations remain.
Methods: This study included 12,629 US adults aged 18–64 y who participated in NHANES 2009–2014. We used NHANES and 4 federal databases (Food Patterns Equivalency Database, Food Intakes Converted to Retail Commodities, What We Eat in America, and National Nutrient Database for Standard Reference) to estimate grams of the subsidized commodities consumed per day and created a subsidy score, ranging from 0.0–1.0, with 0.0 indicating 0% of total energy intake came from subsidized commodities and 1.0 indicating 100% of total energy intake came from subsidized commodities. Cardiometabolic risk factors were obesity [body mass index (BMI, kg/m2) ≥30], abdominal adiposity [waist-height ratio (WHtR) ≥0.49, cut-off for tertile 1], hypertension [blood pressure (BP) ≥140/90 mm Hg or use of BP-lowering medication], dyslipidemia (nonHDL cholesterol ≥160 mg/dL or use of lipid-lowering medication), and dysglycemia [self-reported diabetes or glycated hemoglobin (HbA1c) ≥5.7%].
Results: Among US adults, 50.8% of total calories consumed were derived from subsidized food commodities during 2009–2014. The subsidy score was positively associated with BMI, WHtR, nonHDL cholesterol, and HbA1c (P < 0.05) based on the use of linear regression. Adjusting for age, sex, and race/ethnicity, adults in the highest quartile of the subsidy score had higher probabilities of obesity [prevalence ratio (PR) 1.36; 95% CI: 1.19, 1.55], abdominal adiposity (PR 1.35; 95% CI: 1.12, 1.63), and dysglycemia (PR 1.49; 95% CI: 1.28, 1.73) compared with adults in the lowest quartile.
Conclusions: Consumption of subsidized food commodities greater than or equal to half of total caloric intake continues to be associated with adverse cardiometabolic risk.
Supporting Images/Graphs
The Influence of Sodium Warning Labels on Menu Item Choices, Perceptions, Knowledge, and Recall (P24-007)
Aviva Musicus,1 Alyssa Moran,1 Hannah Lawman,2 and Christina Roberto3
1Harvard TH Chan School of Public Health, MA; 2Philadelphia Department of Public Health; and 3Perelman School of Medicine, University of Pennsylvania
Objectives: There is growing interest in policies that require chain restaurants to display sodium warning labels on menus. This study examined how different label designs influence consumer meal choices, perceptions, and knowledge.
Methods: A series of 3 randomized controlled experiments were conducted with a total of 6241 demographically and educationally diverse adults in an online setting. Adults were randomly assigned to a control condition (calorie label only) or one of 2–10 (depending on the study) different calorie-plus-sodium-warning label conditions with varying warning label designs. Participants placed hypothetical dinner orders from a fast-food and a full-service chain menu, rated perceptions of menu items, answered questions about sodium content, and reported recall of the labels.
Results: There were no significant differences in sodium content ordered across all conditions, but participants who saw traffic light and stop sign labels ordered the least amount of sodium. Compared with calorie labels alone, sodium warning labels led participants to perceive high-sodium meals (containing >2300 mg Na) as significantly saltier and higher in sodium. Exposure to the warning labels also led to significantly stronger beliefs that eating high-sodium meals often would lead to high blood pressure. The labels also improved participants’ ability to identify which of 2 meals was higher in sodium compared with the calorie labels alone.
Conclusions: Sodium warning labels may increase consumer knowledge about sodium content and modify perceptions of high-sodium items, but more research is needed to determine whether they influence behavior. A traffic light or stop sign label with warning text may be most helpful to consumers.
Supporting Images/Graphs
Sodium Warning Label Conditions
Funding Sources
A Musicus is supported by the National Institute of Environmental Health Sciences of NIH under Training Grant 5T32ES007069-37. A Moran is supported by the National Institute of Diabetes and Digestive and Kidney Diseases of NIH under Training Grant 5T32DK007703-22. The content of this article is solely the responsibility of the authors and does not necessarily represent the official views of NIH.
FIGURE P24-007-1.
Situation of Developing Vietnamese Dietician Related System by Vietnam Nutrition System Establishment Project (P24-009)
Huy Do Nguyen,1 Tuyen Danh,1 Yasuhiro Kido,2 Ha Thanh Son,3 Kei Kuriwaki,4 Eriko Kondoh,4 Yukio Shigemune,4 and Hideki Matsumoto5
1The National Institute of Nutrition, Vietnam; 2Kanazawa Gakuin University, Japan; 3Ministry of Health, Vietnam; 4The Ajinomoto Foundation, Japan; and 5Institute for Innovation, Ajinomoto Co., Inc., Japan
Objective: Vietnamese children are suffering from a double burden of malnutrition (DBM), with a lack of vital nutrients resulting in numbers of children with stunting and low body weight in rural areas, and an expanding middle-income population in urban areas leading to an increase in the number of overweight or obese children. These social issues are considered to occur as a result of insufficient knowledge and awareness of nutrition among Vietnamese citizens. To solve this problem, the National Institute of Nutrition and the Ajinomoto Group launched the Vietnam Nutrition System Establishment Project (VINEP) in 2011 with the aim of fostering nutritional human resources and utilizing these as the evangelists of accurate information about nutrition. Beginning in 2017, the Ajinomoto Foundation became the main organizer of VINEP.
Methods: VINEP comprises the following three steps of activities: 1) establishment of dietitian training courses (DTC) in the university network; 2) establishment of nutrition-related regulations; and 3) nationwide expansion of an established nutritional system.
Results: Through these activities, the country's first DTC was established at Hanoi Medical University in 2013 under the Ministry of Education and Training (MOET); as of 2017, 4 universities offered DTCs. The Sub-Vietnamese Dietetic Association was established as a precursor to the Vietnam Dietetic and Nutrition Association under the Vietnam Nutrition Association in 2014. The project also works alongside the government to hold nutrition-related workshops regularly, leading to the enactment of the first legal occupational status of dietitians in 2015. The country's first 43 qualified dietitians (Level III under the job code) were created in August 2017. At present, VINEP's activity is focused on establishing a national “Nutrition Standard” for dietitians to work effectively at hospitals.
Conclusion: Through the improvement of nutritional infrastructure to convey accurate nutritional information about nutritional system enhancements, VINEP contributes to raising awareness and disseminating accurate nutrition knowledge to the whole country. Through such efforts, dietitians who have acquired proper knowledge of nutrition will help Vietnamese citizens to improve their nutrition on their own initiative.
Supporting Images/Graphs
VINEP plate
FIGURE P24-007-1.
Food and Drug Administration Review of Stevia as a Generally Recognized as Safe Food Ingredient (P24-010)
Judy Perrier
US FDA
Stevia rebaudiana (Bertoni) Bertoni, known as stevia, is a plant native to South America that has been cultivated for hundreds of years and used traditionally to sweeten local teas and medicines. Since 1995, stevia has been imported and sold as a dietary supplement, becoming popular in the United States as a noncaloric sweetener for teas and weight-loss blends. As of 2008, when the FDA did not object to the use of highly purified steviol glycosides obtained from stevia leaves after the review of Generally Recognized as Safe (GRAS) notifications, these substances have been widely used as a general-purpose sweetener in a variety of foods. Subsequently, the FDA has reviewed >50 GRAS notices and has not objected to the use of various high-purity steviol glycosides as sweeteners and flavor modifiers in food. The constituents of stevia leaves responsible for its sweet taste are steviol glycosides, a group of highly sweet diterpene glycosides, each of which has its own unique taste profile and sweetness potency that is ≥200 times sweeter than sucrose. Stevia leaves contain a complex mixture of steviol glycosides including stevioside, rebaudioside A, rebaudioside B, rebaudioside C, rebaudioside D, rebaudioside E, rebaudioside F, rebaudioside M, steviolbioside, dulcoside A, and rubusoside that can be extracted and processed to high-purity ingredients. All steviol glycosides are glycosylated derivatives of the aglycone steviol and differ from each other by the number of glycoside moieties and bonding order. The safety of stevia-derived sweeteners has been extensively studied and reported in the scientific literature. Results from several toxicologic studies in animals along with clinical studies in humans support the safety of high-purity (>95%) steviol glycosides. The Joint FAO/WHO Expert Committee on Food Additives, in its review of steviol glycosides at the 69th meeting in 2008, established an acceptable daily intake for steviol glycosides as 4 mg · kg body weight–1 · d–1 expressed as steviol equivalents.
The FDA does not consider whole-leaf stevia to be GRAS for sweetener use in food due to inadequate toxicologic information. As such, whole-leaf and crude stevia extracts are the subject of an Import Alert in the United States and are not permitted for sweetener use in US commerce.
Funding Sources
US FDA.
Compliance with Nutrition Standards by Childcare Centers and Homes in California: Trends from 2008 to 2016 (P24-011)
Lorrene D Ritchie,1 Sallie Yoshida,2 Elyse Homel Vitale,3 Danielle Lee,4 Klara Gurzo,4 Kyle Ritchie,4 and Kenneth Hecht4
1Nutrition Policy Institute, University of California; 2The Sarah Samuels Center for Public Health Research & Evaluation, CA; 3California Food Policy Advocates; and 4University of California, Division of Agriculture and Natural Resources
Objectives: Because one-quarter of children are overweight or obese by the time they enter kindergarten, licensed childcare, where nearly 1 million California preschoolers receive much of their daily nutrition, provides a key opportunity for obesity prevention. The first major revisions to the federal Child and Adult Care Food Program (CACFP) nutrition standards go into effect by October 2018. In California, the Healthy Beverages in Childcare Act also applies; it includes standards on water, 100% juice, milk, and sugary drinks. The aim of this study was to assess compliance and barriers to implementing these standards.
Methods: In 2008, 2012, and 2016 we conducted statewide surveys (>400 sites per time point, 30% response rate, randomly selected from state databases) of foods and beverages served in licensed childcare centers and homes in California. In addition, 16 interviews were conducted with childcare stakeholders to better understand barriers and facilitators to compliance. Finally, results were shared with a convening of experts to inform policy and program next steps.
Results: Compliance was assessed on 8 CACFP standards for children 1–5 y old and 7 CACFP standards for infants <12 mo old. Compliance in 2016 was fairly high (>60% of sample) for most individual standards, more so for sites that participate in CACFP compared with those that do not. However, compliance for all CACFP standards was relatively low (<15%). Compliance was highest for beverage standards covered by both the state and federal policy. Based on logistic regression, compliance with all 4 beverage standards increased significantly (P < 0.05) since 2008. Parent and child preferences were factors most often identified as barriers to implementing standards.
Conclusion: Opportunities identified to support compliance included increasing funding for nutrition; establishing technical assistance grants for providers to learn how best to communicate standards to families; updating state licensing regulations to reflect new CACFP standards; and ensuring administrative flexibility and streamlining.
Funding Sources
Robert Wood Johnson Foundation Healthy Eating Research.
Comparing Safe Intakes Established by the Food and Nutrition Board—Institute of Medicine Compared with the Environmental Protection Agency (P24-012)
Jill E Ryer-Powder and Lynne Ausman
Friedman School of Nutrition Science and Policy, Tufts University, MA
Objectives: The Food and Nutrition Board of the Institute of Medicine (FNB) establishes Tolerable Upper Intake Levels (ULs) for nutrients, defined as “the highest level of daily nutrient intake that is likely to pose no risk of adverse health effects to almost all individuals in the general population.” The Environmental Protection Agency (EPA) establishes oral reference doses (RfDs) for chemicals in the environment, defined as “an estimate with uncertainty spanning perhaps an order of magnitude of a daily oral exposure to the human population including sensitive subgroups that is likely to be without an appreciable risk of deleterious effects during a lifetime.” The objectives of this study are as follow: 1) to compare ULs with RfDs for elements; 2) to examine the basis for the levels; and 3) to determine if results support establishing a uniform approach to setting safe levels for elements in food and the environment.
Methods: Current ULs and RfDs for male adults were obtained from the National Institutes of Health-Office of Dietary Supplements and EPA websites, respectively. ULs were compared with RfDs. A ratio was developed to calculate differences in values. For each element, differences in the value of each UL and RfD were assessed based on the following criteria: 1) studies relied upon, 2) critical adverse health effect, 3) no observable adverse effect level (NOAEL) or lowest observable adverse effect level (LOAEL), and 4) uncertainty factor (UF).
Results: The difference in UL/RfD ratios ranged from 0.7 to 5.7. The largest differences were seen with copper, fluoride, molybdenum, and vanadium. The bases for the differences were selection of studies, critical adverse health effects, selection NOAELs or LOAELs, and UFs.
Conclusions: The FNB and EPA rely on similar methodologies to set “safe” levels for intake of elements. Both select relevant studies, derive a NOAEL or LOAEL, and divide the level by a UF to account for uncertainties (e.g., extrapolation from animals to humans and susceptibility to adverse effects). Although the intent of ULs and RfDs is to use the weight of the evidence to define a safe upper limit of exposure, different results were obtained for certain elements. It may be prudent for agencies to harmonize the setting of safe levels of nutrients for exposure via the diet and environment.
Median Serving Size of Ready-to-Eat Cereal over a 12-Year Period (P24-013)
Jessica D Smith, Neha Jain, Vipra Vanage, Farhat Pathan, Mitesh Sharma, Elizabeth Bell, Nort Holschuh, and Kathy Wiemer
General Mills, Inc.
Background: As part of nutrition label reform (NLR), the US FDA updated the reference amounts customarily consumed (RACC) for >20 food categories, including ready-to-eat cereal (RTEC). NLR increased the RACC of medium-weight RTEC from 30 to 40 g and for heavy-weight RTEC from 55 to 60 g. RACCs are required to be based on recent US consumption data, yet the most recent data available at the time of NLR were NHANES 2003–08.
Objective: Here we report the median intake of 2 categories of RTECs, medium-weight RTEC (20 to <43 g/cup) and heavy-weight RTEC (≥43 g/cup), based on 6 NHANES cycles (2003–2004 through to 2013–2014) for the total population ≥4 y and for children aged 4–12 y. The median intake of RTECs eaten was calculated based on 24-h recalls recorded on day 1. For individuals with more than one RTEC eating occasion, the mean serving size of their eating occasions was used.
Results: We found that the median intake of medium-weight RTECs for the population ≥4 y over the 12-y period 2003–2014 was 36.7 g. This was a modest increase compared with the 1993 RACC of 30 g (22% higher). The median intake in the most recent cycle, NHANES 2013–2014, was 32.2 g (7% higher than the 1993 RACC). Among children aged 4–12 y, the median intake of medium-weight RTECs from 2003–2014 was 30.8 g (3% difference from 30 g). The most recent (NHANES 2013–2014) median intake for children was 29.2 g and the highest median intake was 38.5 g in 2003–2004. For heavy-weight RTECs, the median intake over the 11-y period 2003–2014 for the total population was 55.5 g (1% difference from the 1993 RACC of 55 g) and for children it was 43.5 g (–21% difference from 55 g).
Conclusions: We observed a modestly higher median intake of medium-weight RTECs based on 12 y of NHANES data for the total population but little evidence that children ate more than the 30 g 1993 RACC for medium-weight RTECs. There was no evidence to support an increased serving size of heavy-weight RTECs for the total population, and children have consistently had a heavy-weight RTEC intake ∼20% lower than the 1993 RACC. The public health impact of increasing the RACC for these 2 categories of RTECs, in light of little data to support an increased intake, remains to be seen.
Funding Sources
This study was funded by General Mills, Inc. and the Bell Institute of Health, Nutrition and Food Safety.
Supporting Images/Graphs
