Debra Keast - Academia.edu (original) (raw)

Papers by Debra Keast

The FASEB Journal, 2010

Dietary food patterns recommended for children and adults include two/three daily servings of dai... more Dietary food patterns recommended for children and adults include two/three daily servings of dairy foods to provide important bone building nutrients, namely calcium (Ca), phosphorus (P), and vita...

The Journal of Pediatrics, 2012

Objective To examine if children use supplements to fill gaps in nutritionally inadequate diets o... more Objective To examine if children use supplements to fill gaps in nutritionally inadequate diets or whether supplements contribute to already adequate or excessive micronutrient intakes from foods. Study design Data were analyzed for children (2-18 years) from the National Health and Nutrition Examination Survey 2003-2006, a nationally representative, cross-sectional survey (n = 7250). Diet was assessed using two 24-hour recalls, and dietary supplement use was assessed with a 30-day questionnaire. Results Prevalence of supplements use was 21% (<2 years) and 42% (2-8 years). Supplement users had higher micronutrient intakes than nonusers. Calcium and vitamin D intakes were low for all children. Inadequate intakes of phosphorus, copper, selenium, folate, and vitamins B-6 and B-12 were minimal from foods alone among 2-8 year olds. However, among 9-18 year olds, a higher prevalence of inadequate intakes of magnesium, phosphorus, and vitamins A, C, and E were observed. Supplement use increased the likelihood of intakes above the upper tolerable intake level for iron, zinc, copper, selenium, folic acid, and vitamins A and C. Conclusions Even with the use of supplements, more than a one-third of children failed to meet calcium and vitamin D recommendations. Children 2-8 years old had nutritionally adequate diets regardless of supplement use. However, in children older than 8 years, dietary supplements added micronutrients to diets that would have otherwise been inadequate for magnesium, phosphorus, vitamins A, C, and E. Supplement use contributed to the potential for excess intakes of some nutrients. These findings may have implications for reformulating dietary supplements for children.

Journal of the Academy of Nutrition and Dietetics, 2012

Background-More than half of US adults use dietary supplements. Some reports suggest that supplem... more Background-More than half of US adults use dietary supplements. Some reports suggest that supplement users have higher vitamin intakes from foods than nonusers, but this observation has not been examined using nationally representative survey data. Objective-The purpose of this analysis was to examine vitamin intakes from foods by supplement use and how dietary supplements contribute to meeting or exceeding the Dietary Reference Intakes for selected vitamins using data from the National Health and Nutrition Examination Survey among adults (aged ≥19 years) in 2003-2006 (n=8,860). Results-Among male users, mean intakes of folate and vitamins A, E, and K from food sources were significantly higher than among nonusers. Among women, mean intakes of folate and vitamins A, C, D, and E from foods were higher among users than nonusers. Total intakes (food and supplements) were higher for every vitamin we examined among users than the dietary vitamin intakes of nonusers. Supplement use helped lower the prevalence of intakes below the Estimated Average Requirement for every vitamin we examined, but for folic acid and vitamins A, B-6, and C, supplement use increased the likelihood of intakes above the Tolerable Upper Intake Level. Conclusions-Supplement use was associated with higher mean intakes of some vitamins from foods among users than nonusers, but it was not associated with the prevalence of intakes less than the Estimated Average Requirement from foods. Those who do not use vitamin supplements had significantly higher prevalence of inadequate vitamin intakes; however, the use of supplements can contribute to excess intake for some vitamins.

The American Journal of Clinical Nutrition, 2011

Background: Dietary supplement use is extensive in US adults. Some reports suggested that supplem... more Background: Dietary supplement use is extensive in US adults. Some reports suggested that supplement users had higher nutrient intakes from the diet than did nonusers, but to our knowledge this finding has not been examined in nationally representative survey data. Objective: In this analysis, we examined mineral intakes from the diet by supplement-use categories and how these supplements contributed to meeting or exceeding Dietary Reference Intakes for selected minerals. Design: Data from adults (19 y of age; n = 8860) who participated in NHANES 2003-2006, a nationally representative, cross-sectional survey, were examined. Supplement use was defined as the participant's self-reported use of a supplement that contained one or more selected minerals. Results: Dietary intakes of minerals from food sources were higher for magnesium, copper, potassium, and selenium in male supplement users than in nonusers. For women, dietary intakes of minerals from food sources were higher for users than for nonusers for each mineral examined except for selenium. In women, users of calcium-containing dietary supplements were much more likely to meet the Estimated Average Requirement (EAR) than were nonusers. Even after consideration of supplement use, .14% of adults had inadequate intakes for calcium and magnesium on the basis of the percentage of adults with usual intakes less than the EAR. The prevalence of adults who exceeded the tolerable upper intake level (UL) for calcium, zinc, iron, and magnesium was higher in users than in nonusers. Conclusions: Individuals who used mineral-containing dietary supplements had higher mineral intakes from food sources in the diet than did nonusers. For all minerals examined, and particularly for calcium and magnesium in men and women and iron in women, supplement use decreased the prevalence of intake inadequacy for each respective mineral; however, supplements contributed to risk of potentially excessive intakes for calcium, iron, zinc, and magnesium.

The FASEB Journal, 2007

Background – Choline, an essential nutrient, is present in human milk and important for brain fun... more Background – Choline, an essential nutrient, is present in human milk and important for brain function. Adequate intakes (AIs) for choline were established by the IOM in 1998, but nationally repres...

Circulation, 2015

Despite public health efforts to decrease risk of cardiovascular disease by promoting healthier d... more Despite public health efforts to decrease risk of cardiovascular disease by promoting healthier dietary patterns, Americans persistently under-consume vegetables. Discovering feasible, achievable strategies to increase vegetable intake can contribute to improved dietary patterns and health outcomes. Tomatoes are the most consumed non-starchy vegetable in the US and also contribute the greatest porportion of vegetables to the USDA Food Pattern (MyPlate). Despite tomatoes’ dietary importance, little is known about tomato consumption by form. Tomato forms and amounts consumed in the US were determined by examining the intakes of adults 19 years and older (n = 16,252) in the National Health and Nutrition Examination Survey, 2005-06, 2007-08, and 2009-10. The forms of tomatoes in foods participants reported were divided into two categories: tomato products and raw. Foods containing tomato products were further divided into four subgroups: 1) canned tomatoes as main ingredients, 2) canned...

Nutrients, 2021

Treatment with prebiotics, a type of dietary fiber, was recently shown to increase antibody conce... more Treatment with prebiotics, a type of dietary fiber, was recently shown to increase antibody concentrations following influenza vaccination in a meta-analysis of clinical trials. In observational epidemiologic studies it is not possible to estimate intake of prebiotics, but quantifying intake of dietary fiber is routine. Our objective was to investigate the potential effect of dietary fiber on immunogenicity. We examined serum antibody concentrations (Measles, Mumps, Rubella, and Varicella) in relation to dietary fiber in more than 12,000 subjects in the U.S. National Health and Nutrition Examination Survey (NHANES) for the period 1999–2004. Data from one (1999–2002) or two (2003–2004) dietary recalls were used to calculate fiber intake. For Mumps the adjusted percentage difference in antibody concentration per interquartile range intake in energy-adjusted dietary fiber was 6.34% (95% confidence interval, 3.10, 9.68). Fiber from grain-based foods was more positively associated than f...

Journal of the American Dietetic Association, 2007

Learning Outcome: To understand longitudinal trends in calcium intake as males and females progre... more Learning Outcome: To understand longitudinal trends in calcium intake as males and females progress from middle adolescence to young adulthood. Text: National data indicate calcium intakes of many young adults are less than recommended. This study aimed to describe changes in the intake of calcium and dairy during the transition from middle adolescence to young adulthood and identify factors associated with change in intake. The sample consisted of 704 male and 867 female participants in a population-based, longitudinal study (Project EAT). Participants completed surveys and food frequency questionnaires in Minnesota high schools in 1998-1999 (mean ageϭ15.9) and by mail in 2003-2004 (mean ageϭ20.4 years). Mixed regression models were used to estimate the mean of individual differences in intake across time. Regression models adjusted for energy intake and demographic characteristics were used to examine the association of selected factors measured at baseline with changes in calcium intake. During the transition to young adulthood, mean daily calcium intakes of males and females respectively decreased by 77 mg/1000 kcal and 42 mg/1000 kcals. Although males increased their cheese intake, males and females reduced their intakes of total dairy and milk. Among females, change in calcium intake was inversely associated with baseline television viewing (pϽ0.01) and positively associated with baseline concern for health (pϽ0.01) and mealtime milk availability (pϽ0.001). Among males, change in calcium intake was inversely associated with baseline lactose intolerance (pϽ0.001) and positively associated with baseline taste preference for milk (pϽ0.01) and mealtime milk availability (pϽ0.01). Results suggest interventions for adolescents should target the practice of serving calcium-rich foods at mealtime along with other gender-specific factors.

The Journal of Nutrition, 2011

Limited data are available on the source of usual nutrient intakes in the United States. This ana... more Limited data are available on the source of usual nutrient intakes in the United States. This analysis aimed to assess contributions of micronutrients to usual intakes derived from all sources (naturally occurring, fortified and enriched, and dietary supplements) and to compare usual intakes to the Dietary Reference Intake for U.S. residents aged $2 y according to NHANES 2003-2006 (n = 16,110). We used the National Cancer Institute method to assess usual intakes of 19 micronutrients by source. Only a small percentage of the population had total usual intakes (from dietary intakes and supplements) below the estimated average requirement (EAR) for the following: vitamin B-6 (8%), folate (8%), zinc (8%), thiamin, riboflavin, niacin, vitamin B-12, phosphorus, iron, copper, and selenium (,6% for all). However, more of the population had total usual intakes below the EAR for vitamins A, C, D, and E (34, 25, 70, and 60%, respectively), calcium (38%), and magnesium (45%). Only 3 and 35% had total usual intakes of potassium and vitamin K, respectively, greater than the adequate intake. Enrichment and/or fortification largely contributed to intakes of vitamins A, C, and D, thiamin, iron, and folate. Dietary supplements further reduced the percentage of the population consuming less than the EAR for all nutrients. The percentage of the population with total intakes greater than the tolerable upper intake level (UL) was very low for most nutrients, whereas 10.3 and 8.4% of the population had intakes greater than the UL for niacin and zinc, respectively. Without enrichment and/or fortification and supplementation, many Americans did not achieve the recommended micronutrient intake levels set forth in the Dietary Reference Intake.

Journal of the Academy of Nutrition and Dietetics, 2014

Background Even in an era of obesity and dietary excess, numerous shortfall micronutrients have b... more Background Even in an era of obesity and dietary excess, numerous shortfall micronutrients have been identified in the diets of US children and adolescents. To help tailor strategies for meeting recommendations, it is important to know what foods contribute greatly to micronutrient intakes. Data are lacking on specific contributions made by added nutrients. Objective Our aims were to examine the impact of fortification on nutrient adequacy and excess among US children and adolescents and to rank food sources of added nutrient intake and compare rankings with those based on total nutrient intake from foods. Design and statistical analyses Data were from 7,250 respondents 2 to 18 years old in the National Health and Nutrition Examination Survey 2003-2006. Datasets were developed that distinguished nutrient sources: intrinsic nutrients in foods; added nutrients in foods; foods (intrinsic plus added nutrients); and total diet (foods plus supplements). The National Cancer Institute method was used to determine usual intakes of micronutrients by source. The impact of fortification on the percentages of children having intakes less than the Estimated Average Requirement and more than the Upper Tolerable Intake Level was assessed by comparing intakes from intrinsic nutrients to intakes from intrinsic plus added nutrients. Specific food sources of micronutrients were determined as sample-weighted mean intakes of total and added nutrients contributed from 56 food groupings. The percentage of intake from each grouping was determined separately for total and added nutrients. Results Without added nutrients, a high percentage of all children/adolescents had inadequate intakes of numerous micronutrients, with the greatest inadequacy among older girls. Fortification reduced the percentage less than the Estimated Average Requirement for many, although not all, micronutrients without resulting in excessive intakes. Data demonstrated the powerful influence of fortification on food-source rankings. * This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-No Derivative Works License, which permits non-commercial use, distribution, and reproduction in any medium, provided the original author and source are credited.

J Sch Health, 2010

Competitive foods/beverages are those in school vending machines, school stores, snack bars, spec... more Competitive foods/beverages are those in school vending machines, school stores, snack bars, special sales, and items sold à la carte in the school cafeteria that compete with United States Department of Agriculture (USDA) meal program offerings. Grouping à la carte items with less nutritious items allowed in less regulated venues may obfuscate analysis of the school competitive food environment. Excluding à la carte items from competitive foods, the objectives were to: (1) assess competitive food use by gender, ethnicity, eligibility for free or reduced-price meals, and participation in school meals programs, (2) determine differences between grade levels in energy intakes obtained from food sources, (3) determine the nutrient intake derived from competitive foods for students who consumed them, and (4) determine energy-adjusted differences in 24-hour nutrient intakes of protein, calcium, iron, and other selected nutrients between competitive food consumer and nonconsumers. Competitive foods/beverages use, excluding à la carte items, was examined using the third School Nutrition Dietary Assessment Study (SNDA III), a nationally representative sample of 2309 schoolchildren in grades 1 to 12. Mean nutrient intakes were adjusted for energy intake and other covariates, and differences between consumers and nonconsumers of competitive items were determined using analysis of variance and sudaan. Excluding à la carte items, 22% of schoolchildren consumed competitive items in a representative school day and use was highest in high school. Consumers of competitive items other than à la carte had significantly higher mean energy, sugar intakes, and lower sodium, dietary fiber, B vitamins, and iron intakes than nonconsumers. Use of competitive foods/beverages, excluding à la carte, was detrimental to children&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s diet quality.

The Faseb Journal, Apr 1, 2012

The Faseb Journal, Apr 1, 2011

ABSTRACT Abstract Background: Previous reports have shown that metabolic syndrome and some metabo... more ABSTRACT Abstract Background: Previous reports have shown that metabolic syndrome and some metabolic syndrome components are associated with serum 25-hydroxyvitamin D [25(OH)D]. Methods: Using the National Health and Nutrition Examination Surveys (NHANES), 2003-2006, we evaluated the associations of vitamin D intake (n=3543) and vitamin D status [25(OH)D; n=3529], with the prevalence of metabolic syndrome and its components in adults 20 years and older. Exclusion criteria included nonfasted subjects, those pregnant and/or lactating, and, for intake analyses, those with unreliable 24-h recall records. Subjects were separately classified into quartiles of vitamin D intake (both including and excluding supplements) and serum 25(OH)D. Logistic regression was used to determine odds ratios (OR) for metabolic syndrome after adjusting for multiple confounders. Results: Those in the highest quartile of serum 25(OH)D had 60% lower odds for metabolic syndrome as compared to those in the lowest quartile [OR=0.40; 95% confidence interval (CI) 0.27, 0.59]. Elevated waist circumference (OR=0.57; 95% CI 0.39, 0.84), low high-density lipoprotein cholesterol (HDL-C) (OR=0.54; 95% CI 0.39, 0.75), and high homeostasis model assessment of insulin resistance (HOMA-IR) (OR=0.40; 95% CI 0.29, 0.55) were the main components associated with serum 25(OH)D. Compared with the lowest vitamin D intake quartile (excluding supplements), those in the highest intake quartile had 28% lower odds for metabolic syndrome (OR=0.72; 95% CI 0.58, 0.90). No components of metabolic syndrome were significantly associated with dietary intake of vitamin D with supplements included or excluded. Conclusions: We conclude that higher 25(OH)D, and, to a lesser degree, greater dietary vitamin D intake, are associated with reduced prevalence of metabolic syndrome.