Energy density, portion size, and eating occasions: contributions to increased energy intake in the United States, 1977-2006.
Energy density, portion size, and eating occasions: contributions to increased energy intake in the United States, 1977-2006.
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DOI：
10.1371/journal.pmed.1001050
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发表时间：
2011-06
期刊：
影响因子：
15.8
通讯作者：
Popkin BM
中科院分区：
文献类型：
--
作者：
Duffey KJ;Popkin BM
Kiyah Duffey 和 Barry Popkin 使用三项调查的数据发现，饮食场合和份量的变化始终是 30 年来每日总能量摄入变化的主要原因。相互竞争的理论试图解释总能量（TE）摄入量的变化；然而，尚未对这些解释进行严格、全面的审查。我们的目标是检查能量密度 (ED)、份量 (PS) 和饮食次数 (EO) 对每日 TE 变化的相对贡献。使用全国食品消费调查（1977-78）、个人食物摄入量持续调查（1989-91）和全国健康与营养检查调查（1994-98和2003-06）针对成年人（年龄≥19岁）的全国代表性数据，我们对TE（kcal/d）进行数学分解，以了解每个组成部分的相对贡献——PS （克/EO）、ED（千卡/克/EO）和 EO（数量）——TE 随时间的变化。 1977-78 年和 2003-06 年间，TE 摄入量（+570 kcal/d）和每日 EO 数量（+1.1）有所增加。平均 PS 在 1977-78 年和 1994-98 年期间有所增加，然后在 1994-98 年和 2003-06 年之间略有下降，而平均 ED 在 1977-78 年和 1989-91 年之间保持稳定，然后在 1989-91 年和 1994-98 年之间略有下降。分解统计模型的估计表明，在 1977-78 年和 1989-91 年间，PS 的年化变化对 TE 的增加贡献了近 15 kcal/d/y，而 EO 的变化仅占 4 kcal/d/y。 1994-98 年和 2003-06 年间，EO 变化导致 TE 年化变化增加 39 kcal/d/y，PS 变化导致 TE 年化变化下降 1 kcal/d/y。虽然所有三个组成部分都在一定程度上促成了 TE 30 年的变化，但 EO 和 PS 的变化占了大部分变化。这些发现表明减少美国成年人能量失衡的努力有了新的重点。 请参阅文章后面的编辑摘要 自 20 世纪 70 年代中期以来，许多国家的肥胖人群（身体脂肪比例不健康的人群）比例急剧增加。在美国，这一比例自 1980 年以来翻了一番，美国成年人中有三分之一（超过 7200 万人）现在被归类为肥胖。也就是说，他们的体重指数（BMI，身体脂肪的指标，通过将一个人的体重（公斤）除以身高（米）的平方计算）大于30。与健康体重的人（BMI在18.5至25之间）相比，肥胖者和超重者（BMI在25至29.9之间）患糖尿病、心脏病和中风的风险更高，而且往往更年轻。人们因摄入能量（千卡或千卡）超过日常活动所需的食物和饮料而变得不健康的肥胖。在这种情况下，身体会将多余的能量转化为脂肪储存。由于肥胖会导致疾病和过早死亡，因此必须制止并在可能的情况下扭转肥胖流行趋势。但在制定预防肥胖的公共卫生政策之前，我们需要了解导致这一流行病的原因。许多专家认为，无论体力活动如何变化，每日从食物和饮料中摄入的能量总量的增加足以解释自 20 世纪 70 年代以来观察到的人口体重增加。但为什么总能量摄入增加了呢？提出了三个主要原因——正餐和零食（进食场合）频率的增加、典型食物和饮料份量的增加以及所消耗的食物和饮料的能量密度的变化。在这项研究中，研究人员利用美国食品调查的数据来检验这三个变量对 1977 年至 2006 年间每日总能量摄入变化的相对贡献。研究人员使用一种称为“数学分解”的技术来分析在 1977-78 年、1989-91 年、1994-98 年和 2003-06 年进行的食品调查中收集的美国成年人的横截面、具有全国代表性的膳食摄入数据。横断面调查在一个时间点对一群人进行调查；食品调查收集有关个人在 24 小时内消耗的所有食品和饮料的信息。平均每日总能量摄入量从1977-78年的1,803大卡增加到2003-06年的2,374大卡，增加了570大卡。仅在研究的最后十年中，平均每日能量摄入量就增加了 229 kcal。 1977-78年和1989-91年间，份量的变化导致每日总能量摄入量每年增加近15 kcal，而进食次数的变化仅导致增加4 kcal。相比之下，从1994-98年到2003-06年，进食次数的变化导致每日总能量摄入量每年增加39大卡，而份量的变化则导致每日能量摄入量每年减少1大卡。在 30 年的研究期间，食物和饮料能量密度的变化导致每日总能量摄入量略有下降。这些研究结果表明，虽然过去30年食物和饮料的能量密度、份量以及每天正餐和零食的数量都对美国成年人平均每日总能量摄入量的变化做出了贡献，但饮食次数和份量的增加是造成这一变化的主要原因。这些发现的准确性可能会受到食品调查中自我报告的使用（人们往往低估“垃圾”食品的卡路里含量）以及用于评估每日能量摄入各组成部分相对贡献的数学公式的影响。然而，这些研究结果表明，预防美国成年人（以及其他发达国家成年人）肥胖的努力应集中于减少人们白天消耗的正餐和零食的数量，以此来减少近期能量摄入增加造成的能量失衡。请通过此摘要的在线版本访问这些网站：http://dx.doi.org/10.1371/journal.pmed.1001050。美国疾病控制和预防中心提供有关超重和肥胖各个方面的信息（包括一些西班牙语信息） 英国国家卫生服务选择网站还提供有关肥胖的详细信息 国际肥胖工作组提供有关全球肥胖流行情况的信息 美国农业部的 MyPyramid.gov 网站提供个人健康饮食计划；体重控制信息网络是美国国家糖尿病、消化和肾脏疾病研究所为公众和健康专业人员提供的信息服务（英语和西班牙语） MedlinePlus 提供有关肥胖的更多信息的链接（英语和西班牙语）
Using data from three surveys, Kiyah Duffey and Barry Popkin found that changes in eating/drinking occasions and portion size consistently account for most of the change in daily total energy intake over a 30-year period. Competing theories attempt to explain changes in total energy (TE) intake; however, a rigorous, comprehensive examination of these explanations has not been undertaken. Our objective was to examine the relative contribution of energy density (ED), portion size (PS), and the number of eating/drinking occasions (EOs) to changes in daily TE. Using cross-sectional nationally representative data from the Nationwide Food Consumption Survey (1977–78), Continuing Survey of Food Intakes of Individuals (1989–91), and National Health and Nutrition Examination Surveys (1994–98 and 2003–06) for adults (aged ≥19 y), we mathematically decompose TE (kcal/d) to understand the relative contributions of each component—PS (grams/EO), ED (kcal/g/EO) and EO(number)—to changes in TE over time. There was an increase in TE intake (+570 kcal/d) and the number of daily EOs (+1.1) between 1977–78 and 2003–06. The average PS increased between 1977–78 and 1994–98, then dropped slightly between 1994–98 and 2003–06, while the average ED remained steady between 1977–78 and 1989–91, then declined slightly between 1989–91 and 1994–98. Estimates from the decomposition statistical models suggest that between 1977–78 and 1989–91, annualized changes in PS contributed nearly 15 kcal/d/y to increases in TE, while changes in EO accounted for just 4 kcal/d/y. Between 1994–98 and 2003–06 changes in EO accounted for 39 kcal/d/y of increase and changes in PS accounted for 1 kcal/d/y of decline in the annualized change in TE. While all three components have contributed to some extent to 30-y changes in TE, changes in EO and PS have accounted for most of the change. These findings suggest a new focus for efforts to reduce energy imbalances in US adults. Please see later in the article for the Editors' Summary Since the mid 1970s, the proportion of people who are obese (people who have an unhealthy proportion of body fat) has increased sharply in many countries. In the US, the proportion has doubled since 1980, and a third of all US adults—more than 72 million people—are now classified as obese. That is, they have a body mass index (BMI, an indicator of body fat calculated by dividing a person's weight in kilograms by their height in meters squared) of greater than 30. Compared to people with a healthy weight (a BMI between 18.5 and 25), obese individuals and overweight people (who have a BMI between 25 and 29.9) have an increased risk of developing diabetes, heart disease, and stroke and tend to die younger. People become unhealthily fat by consuming food and drink that contains more energy (kilocalories, or kcal) than they need for their daily activities. In these circumstances, the body converts the excess energy into fat stores. Because obesity causes illness and premature death, it is essential that the obesity epidemic is halted and, if possible, reversed. But before public health policies can be formulated to prevent obesity, we need to understand what is driving the epidemic. Many experts believe that increases in the total daily intake of energy from food and drink, irrespective of changes in physical activity, are enough to explain the observed increases in weight at the population level since the 1970s. But why has total energy intake increased? Three main causes have been proposed—an increase in the frequency of meals and snacks (eating occasions), increases in the typical food and drink portion sizes, and changes in the energy density of the foods and drinks consumed. In this study, the researchers use data from US food surveys to examine the relative contributions made by these three variables to changes in daily total energy intake between 1977 and 2006. The researchers used a technique called “mathematical decomposition” to analyze cross-sectional, nationally representative dietary intake data for US adults collected in food surveys undertaken in 1977–78, 1989–91, 1994–98, and 2003–06. Cross-sectional surveys examine a group of people at a single time point; food surveys collect information about all the food and drink consumed by individuals over a 24-hour period. The average daily total energy intake increased from 1,803 kcal in 1977–78 to 2,374 kcal in 2003–06, an increase of 570 kcal. In the last decade of the study alone, the average daily energy intake increased by 229 kcal. Between 1977–78 and 1989–91, changes in portion size accounted for an annual increase in the daily total energy intake of nearly 15 kcal, whereas changes in the number of eating occasions accounted for an increase of just 4 kcal. By contrast, between 1994–98 and 2003–06, changes in the number of eating occasions accounted for an annual increase in daily total energy intake of 39 kcal, whereas changes in portion size accounted for an annual decrease in daily energy intake of 1 kcal. Changes in the energy density of food and drink accounted for a slight decrease in daily total energy intake over the 30-year study period. These findings indicate that, although the energy density of food and drink, portion size, and the number of meals and snacks per day have all contributed to changes in the average daily total energy intake of US adults over the past 30 years, increases in the number of eating occasions and in portion size have accounted for most of the change. The accuracy of these findings may be affected by the use of self-reporting in the food surveys (people tend to underestimate the calorie content of “junk” food) and by the mathematical formula used to assess the relative contribution of each component of daily energy intake. Nevertheless, these findings suggest that efforts to prevent obesity among US adults (and among adults in other developed countries) should focus on reducing the number of meals and snacks people consume during the day as a way to reduce the energy imbalance caused by recent increases in energy intake. Please access these Web sites via the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.1001050. The US Centers for Disease Control and Prevention provides information on all aspects of overweight and obesity (including some information in Spanish) The UK National Health Service Choices Web site also provides detailed information about obesity The International Obesity Taskforce provides information about the global obesity epidemic The US Department of Agriculture's MyPyramid.gov Web site provides a personal healthy eating plan; the Weight-control Information Network is an information service provided for the general public and health professionals by the US National Institute of Diabetes and Digestive and Kidney Diseases (in English and Spanish) MedlinePlus has links to further information about obesity (in English and Spanish)
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