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L Reaves, LM Steffen, JT Dwyer, LS Webber, LA Lytle, DM Hoelscher, HA Feldman, M Zive, SK Osganian

Vitamin Supplement Intake is Related to Dietary Intake and Physical Activity: The Child and Adolescent Trial for Cardiovascular Health (CATCH). L Reaves, LM Steffen, JT Dwyer, LS Webber, LA Lytle, DM Hoelscher, HA Feldman, M Zive, SK Osganian.

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L Reaves, LM Steffen, JT Dwyer, LS Webber, LA Lytle, DM Hoelscher, HA Feldman, M Zive, SK Osganian

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  1. Vitamin Supplement Intake is Related to Dietary Intake and Physical Activity:The Child and Adolescent Trial for Cardiovascular Health (CATCH) L Reaves, LM Steffen, JT Dwyer, LS Webber, LA Lytle, DM Hoelscher, HA Feldman, M Zive, SK Osganian This study was funded by National Institutes of Health grant #RO1-HL66643 JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Reaves, et al. J Am Diet Assoc. Volume 106, Dec. 2006

  2. Vitamin Supplement Intake is Related to Dietary Intake and Physical Activity: The Child and Adolescent Trial for Cardiovascular Health (CATCH) Study Objective • To explore the relationships of vitamin and mineral supplement use with dietary intake of selected food groups, physical activity and other lifestyle behaviors, and weight status in the CATCH study. JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Reaves, et al. J Am Diet Assoc. Volume 106, Dec. 2006

  3. Vitamin Supplement Intake is Related to Dietary Intake and Physical Activity: The Child and Adolescent Trial for Cardiovascular Health (CATCH) The CATCH Study, 1991-1994 • Originally, CATCH was a randomized controlled trial, multi-center intervention evaluating the effectiveness of an elementary school-based cardiovascular health promotion program • Enrolled 5,106 ethnically diverse students grades 3-5 • Fifty six intervention schools, 40 control schools in California, Louisiana, Minnesota, and Texas • Follow-up surveys were conducted in years 1996-97 and 2000-01 JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Reaves, et al. J Am Diet Assoc. Volume 106, Dec. 2006

  4. Vitamin Supplement Intake is Related to Dietary Intake and Physical Activity: The Child and Adolescent Trial for Cardiovascular Health (CATCH) Current Study Population • The 2000-01 survey utilized a cross-sectional study design • Exclusions include: • 41 students with outlying energy intakes • 178 with other missing data • 229 students who did not return consent forms • 177 who dropped out of the study • 1,968 students who moved out of survey area or did not participate in the 2000-01 follow-up survey • 2,761 subjects were included in these analyses, which was 54% of the original cohort. JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Reaves, et al. J Am Diet Assoc. Volume 106, Dec. 2006

  5. Vitamin Supplement Intake is Related to Dietary Intake and Physical Activity: The Child and Adolescent Trial for Cardiovascular Health (CATCH) Data Collection • Height and weight were measured and BMI calculated kg/m2 • Vitamin supplement use and activity behaviors were assessed by the Health Behavior Survey • Dietary intake was assessed by the Rockett Youth/Adolescent food frequency questionnaire (FFQ) JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Reaves, et al. J Am Diet Assoc. Volume 106, Dec. 2006

  6. Assessed vitamin and mineral supplement use. Vitamin supplement users were classified as adolescents who reported consuming any vitamin or mineral supplement regularly. Yes or No Current Smoking Yes or No Assessed physical activities and TV watching. Physical activity: Sedentary: less than 3 days a week of activity Active: 4 or more days per week of activity Team sports or other organized sports participation Yes or No TV watching categories: < 1 hour per day > 1 hour per day Vitamin Supplement Intake is Related to Dietary Intake and Physical Activity: The Child and Adolescent Trial for Cardiovascular Health (CATCH) Health Behavior Survey JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Reaves, et al. J Am Diet Assoc. Volume 106, Dec. 2006

  7. Vitamin Supplement Intake is Related to Dietary Intake and Physical Activity: The Child and Adolescent Trial for Cardiovascular Health (CATCH) Youth/Adolescent FFQ • Food list included 149 items • Foods were grouped into 10 food categories: • Whole grains- ready-to-eat breakfast cereal containing at least 25% whole grain or bran by weight, cooked oatmeal, dark bread, brown rice, bulger, kasha, couscous, bran, wheat germ, and popcorn • Refined grains- ready to eat breakfast cereals with less than 25% whole grain or bran, white bread, bagels, muffins, rolls, pasta, white rice, pancakes and waffles, and doughnuts • Fruit and fruit juice - 10 different fruits and juices JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Reaves, et al. J Am Diet Assoc. Volume 106, Dec. 2006

  8. Vitamin Supplement Intake is Related to Dietary Intake and Physical Activity: The Child and Adolescent Trial for Cardiovascular Health (CATCH) Youth/Adolescent FFQ • Vegetables- 24 vegetables, legumes, and nuts • Dairy- milk, cheese, yogurt, and ice cream • Meat- included red and processed meats and poultry • Fish and seafood – any type of fish or seafood • Fried foods- fried food eaten away from home and french fries • Soft drinks- included high sugar carbonated soda and fruit drinks • Desserts- cakes, cookies, bars, and pies JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Reaves, et al. J Am Diet Assoc. Volume 106, Dec. 2006

  9. Vitamin Supplement Intake is Related to Dietary Intake and Physical Activity: The Child and Adolescent Trial for Cardiovascular Health (CATCH) Statistical Methods • Differences in characteristics between vitamin users and non-users were tested using: • Student’s T-tests for continuous variables • Mantel-Haenszel chi2 for categorical variables • Linear regression models calculated average daily intake of nutrients and foods controlling for age, sex, race, site, school, and energy intake. • Quintiles of food intake were created for all food groups. • A food index was created to reflect intakes of food groups: • An individual was assigned the sum of scores of 0-4 that corresponded to the quintile of intakes in whole grain, fruit, vegetables, dairy and fish (Q1=0, Q2=1, Q3=2, Q4=3, and Q5=4) and reversed for meat, fried food, soft drinks, and dessert intakes (Q1=4, Q2=3, Q3=2, Q4=1, and Q5=0) JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Reaves, et al. J Am Diet Assoc. Volume 106, Dec. 2006

  10. Vitamin Supplement Intake is Related to Dietary Intake and Physical Activity: The Child and Adolescent Trial for Cardiovascular Health (CATCH) Statistical Methods • Logistic regression models evaluated the relationship of vitamin supplement use with weight status, smoking, physical activity behaviors, TV watching, and dietary intake controlling for age, sex, race, site, school and energy intake. JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Reaves, et al. J Am Diet Assoc. Volume 106, Dec. 2006

  11. Vitamin Supplement Intake is Related to Dietary Intake and Physical Activity: The Child and Adolescent Trial for Cardiovascular Health (CATCH) What are the differences between vitamin supplement users and non-users? Results JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Reaves, et al. J Am Diet Assoc. Volume 106, Dec. 2006

  12. Table 1. Characteristics of adolescent vitamin supplement users and nonusers: CATCH 2001 JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Reaves, et al. J Am Diet Assoc. Volume 106, Dec. 2006

  13. Table 2. Characteristics of adolescent vitamin supplement users and nonusers: CATCH 2001 JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Reaves, et al. J Am Diet Assoc. Volume 106, Dec. 2006

  14. Table 3. Characteristics of adolescent vitamin supplement users and nonusers: CATCH 2001 JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Reaves, et al. J Am Diet Assoc. Volume 106, Dec. 2006

  15. Table 4. Nutrient intake of adolescent vitamin supplement users and nonusers: CATCH 2001 JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Reaves, et al. J Am Diet Assoc. Volume 106, Dec. 2006

  16. Table 5. Food intake of adolescent vitamin supplement users and nonusers: CATCH 2001 JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Reaves, et al. J Am Diet Assoc. Volume 106, Dec. 2006

  17. Table 6. Food intake of adolescent vitamin supplement users and nonusers: CATCH 2001 JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Reaves, et al. J Am Diet Assoc. Volume 106, Dec. 2006

  18. Table 7. Lifestyle activities associated with use of vitamin supplements among adolescents : CATCH 2001 *Logistic regression models adjusted for age, sex, race, site, and school, and energy intake JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Reaves, et al. J Am Diet Assoc. Volume 106, Dec. 2006

  19. Table 8. Likelihood of using vitamin supplements across quintiles of food intake among adolescents: CATCH 2001 JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Reaves, et al. J Am Diet Assoc. Volume 106, Dec. 2006

  20. Table 9. Likelihood of using vitamin supplements across quintiles of food intake among adolescents: CATCH 2001 JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Reaves, et al. J Am Diet Assoc. Volume 106, Dec. 2006

  21. Vitamin Supplement Intake is Related to Dietary Intake and Physical Activity: The Child and Adolescent Trial for Cardiovascular Health (CATCH) Conclusions • 1 in 4 adolescents reported using vitamin supplements in our study. • Supplement use among adolescents varied between race, gender, dietary intake, and health behaviors. • Compared to non-users, vitamin supplement users consumed healthier diets, watched less TV, were more physically active, and had a healthier weight status. JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Reaves, et al. J Am Diet Assoc. Volume 106, Dec. 2006

  22. Vitamin Supplement Intake is Related to Dietary Intake and Physical Activity: The Child and Adolescent Trial for Cardiovascular Health (CATCH) Recommendations • Because many adolescents use vitamin supplements, registered dietitians should remember that they contribute to total nutrient intake and should ask about the frequency of use, type of supplements taken, and reasons why they are used. • Healthy adolescents who have more healthy dietary patterns are more likely to be vitamin supplement users, therefore these individuals are likely at lower risk of having poor nutritional status than non-users. • Supplements are not substitutes for healthy dietary patterns, and adolescents should be encouraged to adopt such healthy patterns rather than rely on vitamin supplementation for adequate nutrient intake. JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Reaves, et al. J Am Diet Assoc. Volume 106, Dec. 2006

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