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Gender differences in selected dietary intakes and eating behaviors in rural communities in Wyoming, Montana, and Idaho

Gender differences in selected dietary intakes and eating behaviors in rural communities in Wyoming, Montana, and Idaho
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  Gender differences in selected dietary intakes and eatingbehaviors in rural communities in Wyoming, Montana,and Idaho Michael Liebman a, *, Kori Propst a , Sylvia A. Moore b , Suzanne Pelican a ,Betty Holmes c , Mary K. Wardlaw c , Linda M. Melcher a , Julie C. Harker d ,Phyllis M. Dennee e , Tim Dunnagan f  a  Department of Family and Consumer Sciences (Human Nutrition), University of Wyoming, Box 3354University Station, Laramie, Wyoming, 82071, USA b  Division of Medical Education and Public Health, University of Wyoming, Laramie, Wyoming 82071, USA c WIN the Rockies, University of Wyoming, Laramie, Wyoming 82071, USA d  Idaho State Coordinator, WIN the Rockies, Rexburg, Idaho 83440, USA e  Montana State University Extension Service, Bozeman, Montana 59717, USA f   Department of Health and Human Development, Montana State University, Bozeman, Montana 59717, USA Abstract A series of food frequency and eating behavior-related questions were used to assess specificcharacteristics of a healthy eating pattern among 1,817 adults recruited from six rural communities inWyoming, Montana, and Idaho. A high percentage of respondents reported low consumption fre-quencies for fruits and vegetables, whole-grain breads and cereals, and milk. Compared to men,women reported higher intakes of fruits and vegetables except for potatoes, higher intakes of high-fiber cereals, and lower intakes of milk and sweetened beverages such as soft drinks. Overall,these data suggested that the diets of female respondents were more nutrient-dense, with the exceptionof milk-derived calcium, and likely to be higher in dietary fiber, phytochemicals, and variousmicronutrients. Women also were less likely to order super-sized portions when given the opportunityand indicated that foods eaten at dinner were prepared at home more of the time. The overall genderdifferences in dietary intakes and eating behaviors were consistent with the previously reported higherprevalence of overweight in men than in women within this study population. © 2003 Elsevier Inc.All rights reserved. Keywords:  Dietary intakes; Fruit; Vegetable; Whole-grain; Milk; Gender* Corresponding author. Tel.:  1-307-766-5597; fax:  1-307-766-5686.  E-mail address: (M. Liebman). Nutrition Research 23 (2003) 991–1002 0271-5317/03/$ – see front matter © 2003 Elsevier Inc. All rights reserved.doi:10.1016/S0271-5317(03)00080-0  1. Introduction Recommendations for a healthy diet include liberal consumption of fruits and vegetables,whole-grain breads and cereals [1], and calcium-rich dairy products [2]. Dietary diversity has been emphasized to encourage the consumption of numerous types of foods, especially fruitsand vegetables of varying color [3,4]. These foods are rich in micronutrients as well asnon-nutrient, physiologically active, protective components of plants, often referred to asphytochemicals [1,4]. Other characteristics of healthy eating patterns include limited con-sumption of sweetened beverages, such as soft drinks, and appropriate portion control, onedimension of which relates to not ordering super-sized portions when given the opportunity.Dietary recommendations may be spurring many individuals to adopt a healthier, morevaried diet, including increased consumption of fruits and vegetables; however, many arestill not meeting the recommended number of servings [5,6]. Men and women may becharacterized by different dietary patterns, particularly in terms of the above-mentionedfeatures of a healthy diet. While many studies have focused on the nutritional adequacy of the American diet, few have specifically assessed how dietary intakes differ between menand women.The primary objective of this study was to examine gender differences in the intake of various food items, specifically, fruits and vegetables, whole-grain breads and cereal prod-ucts, milk, and sweetened beverages such as soft drinks. A secondary objective was to assessgender differences in specific eating-related behaviors such as ordering super-sized portionswhen given the opportunity, eating foods prepared at home, and doing other activities, suchas watching television, while eating. The results presented in this paper are derived from across-sectional survey intended to provide baseline data collected as part of Wellness In theRockies (WIN the Rockies), a health improvement project conducted in Wyoming, Montana,and Idaho. An analysis of gender differences in dietary intakes could aid in identification of prospective foci for nutrition education, as well as help to define eating behaviors that maybe contributing to the current obesity epidemic. 2. Subjects and methods The initial WIN the Rockies cross-sectional survey was developed to assess attitudes andbehaviors in the areas of eating, physical activity, and body image and was carried out in thefall of 2001. After being pilot-tested, the 57-item survey was mailed to approximately 600randomly selected households in each of six rural communities, two each in Wyoming,Montana, and Idaho. Populations of the communities ranged from approximately 4,100 to8,500. In an attempt to ensure random sampling within selected households, the directionswhich accompanied the survey specified that the survey should be completed by theindividual in the household over the age of 18 with the most recent birthday. An incentive($1.00 cash) was included with each survey in light of the previously reported finding thatproviding an incentive as small as one to two dollars with the initial mailing of the surveyinstrument can increase response rate by up to 5-8% [7]. Paid advertisements announcing the 992  M. Liebman et al. / Nutrition Research 23 (2003) 991–1002  mailing of the survey were placed in local newspapers and aired on local radio stations. Localyouth groups were recruited to distribute promotional posters throughout each community.Follow-up reminder post cards were mailed to households that received the survey, andphone calls were made to encourage return of the surveys. Of the 3,529 surveys that weremailed, 1,817 were returned for a response rate of 51.5%. The study population consisted of 928 males and 889 females, ranging in age from 18 to 99 years, with 680 and 1,137individuals  50 years and  50 years, respectively.The questionnaire elicited sociodemographic information (including gender, age, race,education, employment status), self-reported height and weight, and a series of questions inthe areas of dietary intake/eating behaviors, physical activity, and body image. To fulfill theabove-stated objectives for the present study, only data generated from the dietary intake/ eating behaviors section of the questionnaire were used. Body mass indices (BMI) werecalculated as weight (in kilograms)/height (in meters) 2 .Questions in the general area of dietary intake/eating behaviors inquired about therespondent’s frequency of consumption of sweetened beverages, fruits and vegetables, milk,and whole grains. The six fruit and vegetable-related questions were almost identical to thoseasked in the Behavioral Risk Factor Surveillance System (BRFSS) [8] and were worded asfollows: [1] “How often do you drink 100% fruit or vegetable juices such as apple, orange,grapefruit, or tomato?” [2] “Not counting juice, how often do you eat fruit?” [3] “How often do you eat green salad?” [4] “How often do you eat potatoes, not including french fries, friedpotatoes, or potato chips?” [5] “How often do you eat carrots?” and [6] “Not counting carrots, potatoes or salad, how often do you eat vegetables?” A question related to theconsumption of french fries, fried potatoes, or potato chips was not incorporated into thesurvey because of the project’s emphasis on assessing the consumption of fruits andvegetables that are markers for a healthy diet.One of the sweetened beverage questions asked about consumption of soft drinks or sodapop (regular or diet); the additional question in this area asked about the consumption of sweetened beverages other than soft drinks (e.g., Kool-Aid®, Snapple®, Sunny Delight®).One question related to frequency of ordering a “super-sized” portion when having theoption, and other questions related to frequency of home food preparation and eating whileengaging in another activity such as watching television.Data analysis for a particular variable was confined to those respondents who answeredthe relevant question, and no attempt was made to impute any missing values. However,missing demographic values were imputed for a small number of cases (  25) whereinformation about age, gender, race, or educational attainment was not provided. 2.1. Statistics In three instances, two or more questions from the dietary intake/eating behavior sectionof the questionnaire were combined to create composite variables. Composite variables werecreated for sweetened beverage consumption (which included the separate questions for softdrinks and for sweetened beverages other than soft drinks), for fruits and vegetables (whichincluded six separate questions regarding specific types of fruits, vegetables, or juices), and 993  M. Liebman et al. / Nutrition Research 23 (2003) 991–1002  for whole grains (which included separate questions for high-fiber cereals and for whole-grain breads).The association between gender and 17 separate dietary intake/eating behavior-relatedvariables, including the three composite variables, was assessed by multivariable linearregression, after controlling for potentially confounding variables such as age, race, level of education, and BMI. These variables and gender as the independent variable were enteredinto each of 17 regressions to assess whether there were significant gender differences ineach dietary intake or eating behavior-related variable. All statistical analyses were com-pleted through use of software from SAS (Statistical Analysis System, Institute, Inc., Cary,NC). 3. Results The results for frequencies of consumption of specific dietary intake variables in the totalsubject population are summarized in Table 1. Over 45% of the respondents consumed fruitor vegetable juices one or fewer times per week, while the corresponding figure for fruits, notcounting juice, was approximately 34%. In terms of vegetable consumption, the approximatepercentage of respondents who reported consumption levels of one or fewer times per week  Table 1Frequency of consumption of specific dietary intakes in total subject population*Dietary intake variable Less thanonce perweek ornever, %Once perweek, %2-5 timesper week,%5 or moretimes perweek, %2 or moretimes perday, %Fruit or vegetable juices 30.1 15.3 22.8 27.8 3.6Fruits, not counting juice 15.6 18.2 31.7 23.7 10.7Green salad 27.7 24.2 37.9 9.4Potatoes, not fried 23.5 29.0 40.6 6.5Carrots 48.6 27.2 19.2 4.7Other vegetables 6.8 14.3 36.2 33.1 9.4Whole-grain breads 32.1 12.4 22.6 23.9 8.6High-fiber cereals 38.4 16.1 24.2 20.1Milk 26.3 8.3 17.3 30.3 16.2Soft drinks (soda pop) 36.5 11.6 16.8 20.5 14.1Sweetened beverages otherthan soft drinks61.0 11.0 12.7 10.2 4.5* The survey questions related to specific dietary intakes were worded as follows: (1) “How often do you drink 100% fruit or vegetable juices such as apple, orange, grapefruit, or tomato?” (2) “Not counting juice, how oftendo you eat fruit?” (3) “How often do you eat green salad?” (4) “How often do you eat potatoes, not includingfrench fries, fried potatoes, or potato chips?” (5) “How often do you eat carrots?” (6) “Not counting carrots,potatoes or salad, how often do you eat vegetables?” (7) “How often do you eat whole-grain breads such as wholewheat, rye or pumpernickel?” (8) How often do you eat high-fiber cereal, either hot or cold, such as bran cereal,raisin bran, shredded wheat, oat bran, or oatmeal?” (9) “How often do you drink milk?” (10) “How often do youdrink soft drinks or soda pop (regular or diet)?” (11) How often do you drink sweetened beverages other than softdrinks (soda pop), for example, Kool-aid, Snapple, Sunny Delight, sweetened teas, etc.?”994  M. Liebman et al. / Nutrition Research 23 (2003) 991–1002  were: green salad (52%), potatoes (not including french fries, fried potatoes, or potato chips)(53%), carrots (76%), and other vegetables (not counting carrots, potatoes, or salad) (21%).Frequencies of intakes of fiber-rich breads and cereals were low in a relatively highpercentage of respondents (i.e., one or fewer times per week were reported by 45% of respondents for whole-grain breads and by 55% of respondents for high-fiber cereals). Only16% of respondents consumed milk two or more times per day, while 52% consumed lessthan one serving per day, and 35% consumed no more than one serving per week. Thirty-fivepercent of the respondents consumed soft drinks at least five or more times per week whereasthe corresponding figure for sweetened beverages other than soft drinks was 15%.The results for frequency of consumption of dietary intakes variables by gender aresummarized in Table 2. The impact of gender on all dietary intake/eating behavior-relatedvariables after controlling for age, race, level of education, and BMI was assessed bymultivariable regression analyses. The scale variables for dietary intakes/eating behaviors arethe dependent variables in these regressions. These results are summarized in Table 3.Compared to men, women were less likely to consume both soft drinks (i.e., soda pop) andsweetened beverages other than soft drinks.In terms of fruits and vegetables, women reported higher intakes of carrots; vegetablesother than carrots, potatoes or salad; 100% fruit or vegetables juices; and fruit not counting Table 2Frequency of consumption of specific dietary intakes by gender*Dietary Variable Gender Less thanonce perweek ornever, %Once perweek, %2-5 timesper week, %5 ormoretimes perweek, %2 ormoretimes perday, %Fruit or vegetable juices Women 28.1 13.5 22.4 31.6 4.1Men 32.2 17.0 23.3 24.1 3.1Fruits, not counting juice Women 12.9 13.7 31.1 26.3 15.9Men 18.1 22.5 32.2 21.1 5.8Green salad Women 27.0 22.8 37.9 11.1Men 28.4 25.4 37.9 7.8Potatoes, not fried Women 25.7 29.7 37.9 6.2Men 21.4 28.3 43.1 6.8Carrots Women 45.5 27.8 20.0 5.9Men 51.4 26.6 18.3 3.6Other vegetables Women 5.0 12.8 34.1 34.7 12.9Men 8.5 15.6 38.3 31.6 5.9Whole-grain breads Women 30.5 12.2 21.5 26.8 8.7Men 33.5 12.6 23.6 21.1 8.6High-fiber cereals Women 35.4 16.5 25.4 21.0Men 41.4 15.7 23.1 19.2Milk Women 28.8 8.7 16.3 28.7 15.5Men 23.9 8.0 18.3 31.9 16.8Soft drinks (soda pop) Women 41.3 11.3 15.1 19.7 12.2Men 31.9 12.0 18.5 21.2 16.0Sweetened beverages other than Women 65.2 9.9 11.4 8.9 4.2soft drinks Men 57.1 12.0 14.0 11.5 4.9* The survey questions related to specific dietary intakes are provided in the footnote to Table 1.995  M. Liebman et al. / Nutrition Research 23 (2003) 991–1002
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