European Journal of Clinical Nutrition (2003) 57, 249–259

ß 2003 Nature Publishing Group All rights reserved 0954–3007/03 $25.00

www.nature.com/ejcn

ORIGINAL COMMUNICATION
Interaction of body mass index and attempt to lose
weight in a national sample of US adults: association
with reported food and nutrient intake, and
biomarkers
AK Kant1*

1
Department of Family, Nutrition and Exercise Sciences, Queens College of the City University of New York, Flushing,
New York, USA

Objective: This study examined the interaction between body mass index (BMI) and attempting to lose weight for reporting of:
(1) macro- and micronutrient intake; (2) intake of low-nutrient-density foods; and (3) serum biomarkers of dietary exposure and
cardiovascular disease risk.
Methods: Dietary, anthropometric and biochemical data were from the third National Health and Nutrition Examination Survey
(1988 – 1994), n ¼ 13 095. Multiple regression methods were used to examine the independent associations of BMI, trying to
lose weight, or the interaction of BMI – trying to lose weight with reported intakes of energy, nutrients, percentage energy from
low-nutrient-density foods (sweeteners, baked and dairy desserts, visible fats and salty snacks), and serum concentrations of
vitamins, carotenoids and lipids.
Results: BMI was an independent positive predictor (P < 0.05) of percentage of energy from fat, saturated fat, but a negative
predictor of the ratio of reported energy intake to estimated expenditure for basal needs (EI=BEE), percentage of energy from
carbohydrate and alcohol (men only), and serum concentrations of folate, vitamin C, vitamin E and most carotenoids in both
men and women. Trying to lose weight was a negative predictor (P < 0.05) of EI=BEE, intake of energy, and energy density, but
not micronutrient intake. Higher mean serum ascorbate, vitamin E, lutein=zeaxanthin, and other carotenoids (men only)
concentrations were associated with trying to lose weight (P < 0.05) in both men and women. Few adverse BMI-trying to lose
weight interaction effects were noted.
Conclusions: There was little evidence of increased nutritional risk in those reportedly trying to lose weight irrespective of
weight status.
Sponsorship: NIH research grant (R03 CA81604) and a USDA NRICGP award (NYR-9700611).
European Journal of Clinical Nutrition (2003) 57, 249 – 259. doi:10.1038=sj.ejcn.1601549

Keywords: weight loss; dieting; junk food intake; low-nutrient-density foods; dietary patterns; serum vitamins; serum
carotenoids; serum lipids; NHANES III

Introduction National Institutes of Health, 1998). Not surprisingly, there-

Increasing prevalence of obesity is a global public health
problem, and weight control is recommended to alleviate
the health risks associated with adiposity (WHO, 2000;
*Correspondence: AK Kant, Department of Family, Nutrition, and Exercise
Sciences, Remsen Hall, Room 306E, Queens College of the City University
of New York, Flushing, NY 11367, USA.
E-mail: ashima_kant@qc.edu
Received 11 October 2001; revised 29 May 2002;
accepted 4 June 2002
fore, a large proportion of overweight individuals report
attempting weight loss in national surveys (Serdula et al,
1999). However, a substantial number of non-overweight
individuals also report attempts at weight control
(Neumark-Sztainer et al, 2000). For instance, nearly 45% of
subjects classified as non-overweight were attempting weight
control, as were about 60% of moderately or very overweight
subjects in a recently reported study (Neumark-Sztainer
et al, 2000). The NIH Technology Assessment Conference
Panel (1992) identified the need for understanding the
 BMI – trying to lose weight and nutritional profiles
AK Kant
250
consequences of attempting weight loss in individuals who
are not overweight. It has been suggested that the perception
of dieting behaviors and consequently nutrient intake of
dieters may differ by weight status (Neumark-Sztainer et al,
1997). However, remarkably little is known about the effect
of interaction of relative body weight and attempting weight
control on food and nutrient profiles. It is hypothesized that
nutritional risk profile of non-overweight respondents
attempting weight control may differ from those of over-
weight respondents attempting weight control.
Examination of dietary and nutrient intake in relation to
body weight and weight control efforts is complicated by the
acknowledged problem of dietary misreporting resulting in
biased estimates of self-reported intakes of energy and foods
considered nutritional undesirables (Lissner et al, 2000).
Therefore, it is important to include possible biomarkers of
dietary exposure to validate self-reported intakes when
examining nutritional health in relation to body weight
and weight control behaviors. The purpose of this study
was to examine, in a nationally representative sample of
US adults, the relation of body mass index and attempting to
lose weight with: (1) macro- and micronutrient intake;
(2) intake of low-nutrient-density foods; and (3) serum bio-
markers of dietary exposure and cardiovascular disease risk.
Methods
This study used data from the third National Health and
Nutrition Examination Survey (NHANES III), 1988 – 1994.
The NHANES III is a multistage stratified probability sample
of the non-institutionalized, civilian US population, aged 2
months and over (National Center for Health Statistics, 1994).
The survey was conducted by the National Center for Health
Statistics (NCHS), and included administration of a question-
naire at home and a full medical exam along with a battery of
tests in a special mobile examination center (MEC). Demo-
graphic and medical history information was obtained during
the household interview. The MEC exam included a physical
and dental exam, dietary interview, body measurements and
collection of blood and urine samples. Body weight, height
and circumference at various body sites were measured using
standardized procedures in the MEC. During the MEC exam
respondents were asked a global question related to weight
control, ‘Are you currently trying to lose weight’?
Dietary assessment method
A 24 h dietary recall was collected by a trained dietary inter-
viewer in a MEC interview using an automated, micro-
computer-based interview and coding system (National
Center for Health Statistics, 1994). The type and amount of
foods consumed were recalled using aids such as abstract food
models, special charts, measuring cups and rulers to help in
quantifying the amounts consumed. Special probes were used
to help recall commonly forgotten items such as condiments,
accompaniments, fast foods and alcoholic beverages.
European Journal of Clinical Nutrition
Analytic sample
All adults aged 20 y and over were eligible for inclusion
(n ¼ 17 030) in this study. A complete and reliable dietary
recall (as determined by NCHS) was not available for 1051
respondents, leaving 15 979 eligible for inclusion. We further
excluded respondents stating that food intake on recalled
day was ‘much less’ or ‘much more’ than usual (n ¼ 2245),
women who were pregnant (n ¼ 282) or nursing (n ¼ 91),
those missing information on body weight (n ¼ 33) or
height (n ¼ 16), and those missing information on whether
trying to lose weight at the time of the survey (n ¼ 305).
Some respondents were in more than one exclusion cate-
gory. The final analytic sample comprised 13 095 respon-
dents (6298 men and 6797 women).
Assessment of intake of low-nutrient-density foods
Because of the prevailing hypothesis about misreporting of
nutritional undesirables in relation to body weight, it
was especially interesting to examine the intake of low-
nutrient-density foods. To determine the intake of low-
nutrient-density foods, it was necessary to identify foods
belonging to this category from those reported in the 24 h
dietary recall. As a first step, the 4265 foods reported by adult
survey respondents were classified as belonging to one or
more of the five major food groups (dairy, fruit, grain, meat
and vegetable) or the low-nutrient-density foods group using
methods we have described previously (Kant et al, 1991;
Kant, 2000). Briefly, the assignment of foods into the various
groups was dependent on their nutrient content and uses in
the diet. The dairy group included milk, yogurt, cheese and
buttermilk but excluded butter, cream cheese and dairy
desserts. The fruit group included all fresh, frozen, dried
and canned fruits and fruit juices but excluded fruit drinks.
The grain group included all breads, cereals, pastas and rice,
but excluded pastries. The meat group included meat, poul-
try, fish, eggs and meat alternates such as dried beans, nuts
and seeds. The vegetable group included all raw or cooked
fresh, frozen and canned vegetables and juices. Mixed dishes
containing foods from several groups were grouped into all
the relevant groups. Foods excluded from these major food
groups were grouped into the low-nutrient-density foods
group. The low-nutrient-density foods were further placed
into four subgroups as follows: (1) visible fat — butter, oil,
dressings, gravies, etc.; (2) sweeteners — sugar, syrup, candy,
carbonated and non-carbonated sweetened drinks, etc.; (3)
baked and dairy desserts — cookies, cakes, pies, pastries, ice
cream, puddings, cheese cakes, etc.; and (4) salted snacks —
potato, corn, tortilla chips, etc.
The NHANES III nutrient database for individual foods,
which is derived from the US Department of Agriculture’s
Survey Nutrient Data base (National Center for Health
Statistics, 1997), was used to determine energy and nutrient
content of all foods. The nutrients examined included:
vitamins A, E, B6, folate and C, and the minerals iron and
calcium. The intake of each nutrient was compared with the

respective age – sex-specific standard available. The standards
used were 1989 Recommended Dietary Allowance (RDA) for
protein, and Dietary Reference Intakes (DRIs) for vitamins A,
E, C, B6 folate, iron, and calcium (Food and Nutrition Board,
1989, 1997, 1998, 2000, 2001).
As an estimate of dietary misreporting, a ratio of reported
energy intake (EI) to energy expenditure for basal needs
(BEE) was computed. BEE was estimated using age – sex –
weight specific equations according to Schofield (1985).
Data on serum concentrations of vitamin C, folate, car-
otenoids and lipid were obtained from the NCHS public
release compact disc (National Center for Health Statistics,
1996, 1998). The methods used to measure these serum
analytes and their associated errors have been described in
NCHS publications (National Center for Health Statistics,
1996, 1998). Folate, ascorbate, and the carotenoids —
a-carotene, b-carotene, b-cryptoxanthin, lutein=zeaxanthin
and lycopene — were chosen because the dietary intake of
these nutrients is believed to be a determinant of serum
concentration of the respective nutrient and thus can serve
as biomarker of dietary exposure (Food and Nutrition Board,
1998, 2000). Serum lipids are known to be related to BMI and
one reason for advocating weight loss is to improve serum
lipid profiles (National Institutes of Health, 1998).
Statistical analyses
The mean daily energy, percent energy from macronutrients,
percentage energy from low-nutrient-density food groups
(separately and combined), mean percentage of the popula-
tion meeting the RDA or DRI of selected nutrients, mean
serum concentration of selected vitamers and analytes,
adjusted for multiple covariates, were obtained by weighted
tertiles of BMI and response to question about whether trying
to lose weight at the time of the survey, separately for men
and women. All covariates for inclusion in the various multi-
ple regression models were decided a priori based on known
relationships of dietary, socio-demographic, lifestyle and
biological variables. The estimates of nutrient and food
group intake were adjusted for age (continuous), race (non-
Hispanic white, non-Hispanic black, Mexican-American,
other), education (continuous), smoking status (never,
former, current), and level of weekly recreational physical
activity (none, 1 – 2 times=week, > 2 times=week), whether
changed diet for medical reasons in the past 12 months (yes,
no), self-reported history of diabetes, hypertension or heart
disease (yes, no). The estimates of mean serum analyte con-
centrations were adjusted for age (continuous), race (non-
Hispanic white, non-Hispanic black, Mexican American,
other), hours of fasting before phlebotomy, supplement use
in the last 24 h before phlebotomy (yes, no, unknown),
supplement use in the past month (yes, no), whether chan-
ged diet for medical reasons in the past 12 months (yes, no),
self-reported history of diabetes, hypertension or heart dis-
ease (yes, no), dietary intake of folate, vitamin C, vitamin E
and carotenoids for serum folate, vitamin C, vitamin E and
BMI – trying to lose weight and nutritional profiles
AK Kant
251
carotenoids (all continuous), respectively, smoking status
(vitamin C and carotenoids), and alcohol intake (HDL-cho-
lesterol only), serum triglycerides and cholesterol (carote-
noids and serum vitamin E). The procedure used to obtain
covariate-adjusted estimates and standard errors from survey
data is based on Taylor linearization methods according to
Graubard and Korn (1999). All statistical analyses were per-
formed using SAS (SAS Institute Inc., 2000), and software
designed for analysis of survey data (SUDAAN; Shah et al,
1997). This software generates variance estimates that are
corrected for multi-stage stratified probability design of com-
plex surveys. Sample weights provided by the NCHS to
correct for differential probabilities of selection, non-cover-
age, and non-response were used in all analyses to obtain
point estimates (National Center for Health Statistics, 1994).
The independent association of BMI, and attempting
weight loss or the interaction of BMI with attempting
weight loss, with intake of foods, nutrients and serum
analytes was examined using regression procedures to
adjust for multiple covariates mentioned above. Linear
regression procedures were used when the outcome variables
were continuous (eg dietary nutrient intake, or serum nutri-
ent concentration). For categorical outcomes such as
whether or not standard of a nutrient intake was met, we
used logistic regression procedures. In these regression
models, BMI was entered as a continuous variable and
attempting to lose weight as a categorical (yes, no) variable,
along with a BMI – trying to lose weight interaction term. If
the interaction term was non-significant (P  0.05), regres-
sion models were run again after excluding the interaction
term from the model.
Results
Sociodemographic profile
Table 1 lists the percentage of the population in categories of
various sociodemographic variables by tertiles of BMI, by
response to question about whether trying to lose weight at
the time of the survey. Approximately 34% of the population
answered yes to trying to lose weight. A higher proportion of
 50 y olds, and women in each tertile of BMI were trying to
lose weight at the time of survey. The proportion of non-
whites, those with < 12 y of education, and no regular
weekly physical activity increased with increasing BMI. A
smaller proportion of those answering yes to trying to lose
weight reported no regular weekly physical activity. In each
BMI tertile, a higher proportion of those trying to lose
weight had never smoked. The proportion reporting vita-
min=mineral supplement use in the past month decreased
with increasing BMI, but within each tertile of BMI, a higher
proportion of those attempting weight loss reported supple-
ment use. The proportion with self-reported health as excel-
lent or very good decreased with increasing BMI, which was
consistent with increase in self-reported history of diabetes,
hypertension, or heart disease with increasing BMI. In each
BMI tertile, nearly 75% of those trying to lose weight at the
European Journal of Clinical Nutrition
 BMI – trying to lose weight and nutritional profiles
AK Kant
252
Table 1 Sociodemographic characteristics of respondents by weighted tertiles of body mass index (BMI) and by answer to question
about trying to lose weight; NHANES III, 1988 – 1994

Weighted tertiles of body mass index

First tertile Second tertile Third tertile

Are you currently trying to lose weight?

Yes No Yes No Yes No

Median BMI 22.3 21.5 25.9 25.6 31.9 30.7

Min, max BMI  23.6  23.6 23.7 – 27.8 23.7 – 27.8 27.9 – 63.3 27.9 – 68.5
n 430 3294 1279 3137 2603 2352
b
Women 87  1.7 57  1.2 60  2.3 32  1.4 57  1.6 45  1.8
50 y age 86  1.9 71  1.8 68  2.3 61  1.6 57  2.3 56  2.2
Non-Hispanic white 86  2.1 80  1.2 80  1.7 78  1.6 74  1.7 76  1.6
< 12 y education 11  1.9 22  1.1 18  1.9 28  1.9 26  1.5 31  1.6
a
Poverty index ratio (PIR) < 1.0 8  1.7 12  1.0 10  1.3 11  1.0 11  0.8 14  1.3
Never smoked 50  3.9 45  1.3 51  2.1 42  1.5 48  1.5 44  1.6
Level of weekly recreational physical activity
None 14  2.6 21  1.2 18  1.7 21  1.4 23  1.6 27  1.4
1 – 2 times=week 83  2.6 76  1.1 80  1.8 77  1.4 75  1.5 70  1.4
> 2 times=week 3  1.0 3  0.4 2  0.7 2  0.5 2  0.3 2  0.6
Used vitamin=mineral supplements 55  3.1 44  1.5 50  2.1 38  1.5 45  1.5 32  1.6
in the past month
Changed diet past 12 months 14  2 12  0.8 26  1.6 14  1.2 33  1.7 17  1.4
of medical reasons
Self-reported history of diabetes= 12  2.4 17  0.8 26  1.6 26  1.5 46  1.6 40  2.0
hypertension=heart disease
Excellent or very good self-reported 71  3.5 58  1.6 59  2.3 53  1.7 42  1.4 41  2.0
health status
Tried to lose weight in the last 78  2.4 15  0.9 73  1.6 22  1.3 79  1.0 38  1.7
12 month
Consider self overweight 60  3.4 12  0.8 80  1.8 41  1.1 93  1.0 82  1.4
a
Poverty index ratio: computed by the National Center for Health Statistics from poverty threshold for the calendar year, family income, and other
family data provided by the respondents to measure income status. PIR of < 1 suggests that family income adjusted for family factors was below
poverty level.
b
Values are percentages.

time of the survey had also tried weight control in the 12
months before the survey.
Energy and macronutrient intake
BMI and attempting weight loss interaction. In women,
the difference in percentage energy from protein between
those trying to lose weight and not trying to lose weight
increased while differences in alcohol intake declined with
increasing BMI (Table 2).
Reported intake of low-nutrient-density foods
BMI and attempting weight loss interaction. At higher
BMI, men trying to lose weight reported lower percentage
energy from all low-nutrient-density foods and desserts.
Women trying to lose weight reported a higher Percentage
energy from visible fats at higher BMI (Table 3).
Independent effect of trying to lose weight. Women trying
to lose weight reported lower percentage energy from the
sweeteners subgroup.

Independent effect of BMI. BMI was related positively with

percentage energy from fat, saturated fat, but inversely with
EI=BEE, percentage energy from carbohydrate and alcohol
(men only).
Independent effect of trying to lose weight. Men and women
trying to lose weight had lower EI=BEE, intake of energy, and
energy density of all foods and beverages reported, and dietary
fiber than those not trying to lose weight.
Percentage of the population meeting the standard of
nutrient intake
BMI and attempting weight loss interaction. At higher
BMI, a greater proportion of men attempting weight loss
mentioned all five food groups on the survey day, but a
smaller proportion of men reported the estimated average
requirement (EAR) for iron (Table 4).

European Journal of Clinical Nutrition

 BMI – trying to lose weight and nutritional profiles
AK Kant
253
Table 2 Adjusteda mean  s.e.m. of intake of energy and macronutrients by weighted tertiles of body mass index, and by answer to question about
trying to lose weight, by sex; NHANES III, 1988 – 1994

Weighted tertiles of body mass index

First tertile Second tertile Third tertile

Are you currently trying to lose weight?

Yes No Yes No Yes No P1 P2 P3

Men 71 1568 503 1977 1023 1156

Women 359 1726 776 1160 1580 1196

Body mass index

Men 22.5  0.20 21.7  0.06 26.1  0.09 25.6  0.04 32.3  0.24 31.2  0.20
Women 22.1  0.12 20.9  0.08 25.7  0.05 25.6  0.06 33.5  0.15 33.3  0.34
Age (y) adjusted for race only
Men 38.6  1.59 41.3  0.80 42.4  1.07 44.8  0.59 48.1  0.85 46.7  0.65 0.0002 NS* NS
Women 36.8  1.05 43.6  0.79 45.6  1.07 53.0  1.10 48.7  0.74 51.2  1.04 0.0000 0.0000 NS
Ratio of energy intake to estimated expenditure for basal needs (EI:BEE)
Men 1.54  0.12 1.69  0.04 1.35  0.03 1.50  0.02 1.26  0.02 1.43  0.03 0.0000 0.0000 NS
Women 1.32  0.04 1.45  0.03 1.24  0.02 1.31  0.03 1.05  0.01 1.19  0.02 0.0000 0.0000 NS
Energy (kcal)
Men 2481  211 2699  63 2375  60 2654  45 2503  47 2838  71 NS 0.0000 NS
Women 1689  51 1818  35 1728  29 1806  40 1647  20 1848  29 NS 0.0000 NS
Energy (kcals)=100 g of any food or beverage consumed
Men 103  8.8 97  1.2 91  1.9 95  1.1 91  1.7 94  1.3 NS 0.01 NS
Women 88  2.4 93  1.1 85  1.4 90  1.4 85  1.0 92  1.8 NS 0.0000 NS
Percentage energy from fat
Men 33  2.0 33  0.4 33  0.7 34  0.3 35  0.5 35  0.3 0.0007 NS NS
Women 33  0.8 33  0.4 33  0.4 33  0.4 34  0.3 35  0.5 0.0000 NS NS
Percentage energy from saturated fat
Men 11  0.9 11  0.14 11  0.3 11  0.1 12  0.2 12  0.1 0.002 NS NS
Women 11  0.3 11  0.16 11  0.2 11  0.1 11  0.1 12  0.2 0.0003 NS NS
Percentage energy from carbohydrate
Men 47  2.9 49  0.5 48  0.9 49  0.4 47  0.8 47  0.5 0.03 NS NS
Women 50  0.8 51  0.4 51  0.6 52  0.5 50  0.4 50  0.6 0.0001 NS NS
Percentage energy from protein
Men 15  0.7 15  0.2 16  0.3 15  0.1 16  0.3 15  0.3 NS NS NS
Women 15  0.2 15  0.2 16  0.3 15  0.2 16  0.3 15  0.2 — — 0.02
Percentage energy from alcohol
Men 7.1  3.9 3.6  0.4 4.3  0.5 3.4  0.2 3.1  0.3 3.3  0.3 0.001 NS NS
Women 3.9  0.5 2.2  0.2 2.5  0.3 1.8  0.3 1.7  0.3 1.3  0.3 — — 0.009
Dietary fiber (g)
Men 17.9  1.3 20.8  0.4 18.1  0.7 20.0  0.4 19.0  0.5 19.5  0.5 NS 0.02 NS
Women 14.3  0.5 15.4  0.4 14.6  0.3 14.6  0.4 13.4  0.3 14.0  0.3 0.02 0.03 NS
a
Estimates were adjusted for age in y (continuous), race (non-Hispanic white, non-Hispanic black, Mexican-American, other) education in y (continuous), smoking
status (never, former, current) and level of weekly recreational physical activity (none, 1 – 2 times=week, > 2 times=week), whether changed diet for medical reasons
in the past 12 months ( yes, no) self-reported history of diabetes=hypertension=heart disease ( yes, no). Those missing information on a covariate (n ¼ 80) were
excluded from the fully adjusted models. These adjusted models had 6252 men and 6763 women.
P1, significance of the regression coefficient for BMI (continuous) in regression models without the interaction term.
P2, significance of the regression coefficient for currently trying to lose weight ( yes, no, with no as reference) in regression models without the interaction term.
P3, significance of the regression coefficient for interaction of BMI  trying to lose weight.
*P was  0.05.
The sex-specific linear regression models for testing the independent effects of BMI and trying to lose weight or the interaction of BMI and trying to lose weight now
status included each nutrient=food group variable as a continuous outcome and all the covariates mentioned above as independent predictors along with BMI
(continuous), trying to lose weight now ( yes, no), and BMI  trying to lose weight now term. If the interaction was not significant, separate models after excluding
the interaction term were run to determine the main effect of BMI and trying to lose weight now status.

Independent effect of BMI. With increasing BMI, a smaller
proportion of men and women reported < 10% energy from
saturated fat, RDA for protein, and EAR for vitamin C.
Women at higher BMI were less likely to report all five
food groups,  30% energy from fat or EAR for folate. With
increasing BMI, a higher proportion of men met the EAR for
vitamin E.
Independent effect of trying to lose weight. A lower propor-
tion of men and women attempting weight loss met the RDA

European Journal of Clinical Nutrition

 BMI – trying to lose weight and nutritional profiles
AK Kant
254
Table 3 Adjusteda mean  s.e.m. of percentage energy from low-nutrient-density food groups by weighted tertiles of body mass index, and
by answer to question about trying to lose weight, by sex; NHANES III, 1988 – 1994

Weighted tertiles of body mass index

First tertile Second tertile Third tertile

Are you currently trying to lose weight?

Yes No Yes No Yes No P1 P2 P3

Men 71 1568 503 1977 1023 1156

Women 359 1726 776 1160 1580 1196

Percentage energy from all low-nutrient-density foods

Men 23  2.5 25  0.6 24  0.7 25  0.5 23  0.8 27  0.9 — — 0.01
Women 24  0.9 26  0.5 26  0.8 26  0.6 25  0.6 27  0.7 NS NS NS
Percentage energy from low-nutrient-density subgroups
Sweeteners (candy, sugar, jams, syrup, sweetened beverages, etc)
Men 8.7  1.9 9.0  0.4 8.8  0.5 9.4  0.5 8.5  0.6 9.5  0.5 NS NS NS
Women 7.6  0.6 8.7  0.3 9.2  0.7 9.5  0.4 8.3  0.3 10.2  0.6 NS 0.02 NS
Baked and dairy desserts (Cookies, cakes, pies, dairy desserts, etc)
Men 8.0  1.6 8.9  0.5 8.0  0.9 8.4  0.4 7.2  0.5 9.6  0.7 — — 0.04
Women 8.3  0.9 9.2  0.3 8.9  0.4 9.7  0.5 8.2  0.5 9.0  0.6 NS NS NS
Visible fats (butter, margarine, oil, gravies, dressing, etc)
Men 3.7  0.7 5.2  0.3 5.3  0.5 5.2  0.3 5.7  0.3 5.2  0.3 NS NS NS
Women 5.5  0.5 5.6  0.2 5.5  0.4 5.2  0.3 6.0  0.3 5.1  0.4 — — 0.03
Salty snacks (corn, potato chips, etc)
Men 2.4  0.7 1.7  0.2 2.4  0.4 2.1  0.1 2.1  0.4 2.3  0.3 NS NS NS
Women 2.4  0.4 2.4  0.2 2.5  0.3 2.0  0.2 2.3  0.2 2.7  0.3 NS NS NS
a
Estimates were adjusted for age in y (continuous), race (non-Hispanic white, non-Hispanic black, Mexican-American, other) education in y
(continuous), smoking status (never, former, current) and level of weekly recreational physical activity (none, 1 – 2 times=week, > 2 times=week),
whether changed diet for medical reasons in the past 12 months ( yes, no) self-reported history of diabetes=hypertension=heart disease ( yes, no).
Those missing information on a covariate (n ¼ 80) were excluded from the fully adjusted models. These adjusted models had 6252 men and 6763
women.
P1, significance of the regression coefficient for BMI (continuous) in regression models without the interaction term.
P2, significance of the regression coefficient for currently trying to lose weight now ( yes, no, with no as reference) in regression models without the
interaction term.
P3, significance of the regression coefficient for interaction of BMI  trying to lose weight.
*P was 0.05.
The sex-specific linear regression models for testing the independent effects of BMI and trying to lose weight or the interaction of BMI and trying to
lose weight included each nutrient=food group variable as a continuous outcome and all the covariates mentioned above as independent predictors
along with BMI (continuous), trying to lose weight now ( yes, no), and BMI  trying to lose weight now term. If the interaction was not significant,
separate models after excluding the interaction term were run to determine the main effect of BMI and trying to lose weight now status.

for protein. A higher proportion of women trying to lose
weight reported  30% energy from fat, but a lower propor-
tion met the EAR for vitamin E.
Serum analyte concentrations
Table 5 lists the multiple covariate adjusted mean  SE
of serum concentration of folate, vitamin C, vitamin E,
a-carotene, b-carotene, b-cryptoxanthin, lutein=zeaxanthin,
lycopene, total cholesterol, low-density-lipoprotein (LDL)
cholesterol and high-density-lipoprotein (HDL) cholesterol,
by tertiles of BMI, by response to question about whether
trying to lose weight at the time of the survey, by sex.
BMI and attempting weight loss interaction. In men
attempting weight loss, serum total and LDL-cholesterol
were lower and HDL-cholesterol was higher at higher BMI.
Independent effect of BMI. BMI was a significant negative
predictor of serum folate, vitamin C, vitamin E, a-carotene,
b-carotene, b-cryptoxanthin, lutein=zeaxanthin and lyco-
pene (women only) concentrations in both men and
women. In women, serum concentrations of total and
LDL-cholesterol were related positively and HDL-cholesterol
were related inversely with BMI.
Independent effect of trying to lose weight. Trying to
lose weight was an independent positive predictor of
serum ascorbate, vitamin E and lutein=zeaxanthin concen-
trations in both men and women. In men, trying to
lose weight was a positive predictor of RBC folate,
serum a-carotene, b-carotene and b-cryptoxanthin
concentrations.

European Journal of Clinical Nutrition

 BMI – trying to lose weight and nutritional profiles
AK Kant
255
Table 4 Adjusteda mean percentage  s.e.m. of the population meeting the standard of nutrient intake by weighted tertiles of
body mass index, and by answer to question about trying to lose weight, by sex; NHANES III, 1988 – 1994

Weighted tertiles of body mass index

First tertile Second tertile Third tertile

Are you currently trying to lose weight?

Yes No Yes No Yes No P1 P2 P3

Men 71 1568 503 1977 1023 1156

Women 359 1726 776 1160 1580 1196

Reported food from the dairy, grain, fruit, vegetable, meat or alternate groups
Men 50  6 42  2 36  3 38  2 36  2 32  2 — — 0.03
Women 40  3 44  2 45  2 39  2 39  2 33  2 0.002 NS NS
Reported  30% energy from fat
Men 27  8 35  2 35  3 34  2 30  2 26  2 NS NS NS
Women 40  4 38  2 41  2 36  2 36  2 27  2 0.0000 0.0008 NS
Reported  10% energy from saturated fat
Men 34  10 41  2 38  3 40  2 33  2 29  2 0.003 NS NS
Women 45  4 41  2 43  2 40  2 36  2 32  2 0.0002 NS NS
Met recommended dietary allowance (RDA) for protein
Men 83  5 88  1 78  3 80  2 58  2 72  2 0.0000 0.0000 NS
Women 70  4 78  1 59  3 65  2 40  2 43  2 0.0000 0.009 NS
Met estimated average requirement (EAR) for vitamin C
Men 54  6 59  2 58  3 54  2 56  3 49  3 0.003 NS NS
Women 61  3 59  2 58  2 56  2 52  2 52  2 0.003 NS NS
Met EAR for folate
Men 43  8 43  2 41  4 41  2 42  3 36  3 NS NS NS
Women 19  2 25  2 22  2 24  2 20  2 19  1 0.01 NS NS
Met EAR for vitamin B6
Men 80  5 83  1 79  2 82  1 82  2 82  2 NS NS NS
Women 62  3 63  2 60  3 65  2 62  2 60  2 NS NS NS
Met EAR for vitamin A
Men 56  8 64  2 57  3 58  2 63  2 59  2 NS NS NS
Women 57  4 62  1 59  2 64  1 59  2 54  2 NS NS NS
Met EAR for vitamin E
Men 29  6 33  2 30  3 31  2 39  2 36  2 0.02 NS NS
Women 14  2 16  1 15  2 16  2 15  1 18  2 NS 0.03 NS
Met adequate intake (AI) for calcium
Men 33  7 36  2 32  4 34  2 35  3 39  3 NS NS NS
Women 15  2 19  1 18  2 22  2 16  2 16  2 NS NS NS
Met EAR for iron
Men 96  1 97  1 97  1 98  1 95  1 98  1 — — 0.007
Women 83  2 85  1 83  2 88  1 84  1 83  2 NS NS NS
a
Estimates were adjusted for age in y (continuous), race (non-Hispanic white, non-Hispanic black, Mexican-American, other) education in y
(continuous), smoking status (never, former, current) and level of weekly recreational physical activity (none, 1 – 2 times=week, > 2
times=week), whether changed diet for medical reasons in the past 12 months ( yes, no) self-reported history of diabetes=hypertension=heart
disease ( yes, no). Those missing information on a covariate (n ¼ 80) were excluded from the fully adjusted models. These adjusted models
had 6252 men and 6763 women.
P1, significance of the regression coefficient for BMI (continuous) in regression models without the interaction term.
P2, significance of the regression coefficient for currently trying to lose weight ( yes, no, with no as reference) in regression models without
the interaction term.
P3, significance of the regression coefficient for interaction of BMI  trying to lose weight.
*P was  0.05.
The sex-specific logistic regression models for testing the independent effects of BMI and trying to lose weight or the interaction of BMI and
currently trying to lose weight status included each nutrient=food group variable as a dichotomous outcome and all the covariates
mentioned above as independent predictors along with BMI (continuous), trying to lose weight now ( yes, no), and BMI  trying to lose
weight now term. If the interaction was not significant, separate models after excluding the interaction term were run to determine the main
effect of BMI and currently trying to lose weight now status.

European Journal of Clinical Nutrition

 BMI – trying to lose weight and nutritional profiles
AK Kant
256
Table 5 Adjusteda mean  s.e.m. of the serum concentrations of selected vitamins, carotenoids, and lipids by weighted tertiles of body mass index, and
by answer to question about trying to lose weight, by sex; NHANES III, 1988 – 1994

Weighted tertiles of body mass index

First tertile Second tertile Third tertile

Are you currently trying to lose weight?

Yes No Yes No Yes No P1 P2 P3

Serum vitamins
Serum ascorbate (mmol=l) n ¼ men 5811; women 6267
Men 43.4  3.52 41.7  1.07 40.0  1.68 38.8  1.09 37.8  1.50 35.0  1.45 0.0000 0.03 NS*
Women 50.4  1.86 49.2  0.91 51.2  1.39 47.9  1.88 45.2  1.29 40.9  1.52 0.0000 0.0003 NS
Serum folate (nmol=l) n ¼ men 6041; women 6484
Men 15.0  1.49 14.5  0.45 14.8  0.64 14.6  0.50 14.2  0.57 13.4  0.54 0.0001 NS NS
Women 17.3  0.59 18.0  0.57 18.0  0.89 17.4  0.71 15.8  0.68 15.1  0.79 0.0000 NS NS
RBC folate (nmol=l) n ¼ men 6048; women 6495
Men 428  33 429  9 451  11 428  9 472  12 436  12 NS 0.0009 NS
Women 466  15 469  8 490  15 466  15 491  12 464  15 NS NS NS
Serum vitamin E (mmol=l) n ¼ men 5992; women 6406
Men 28.3  0.94 26.9  0.42 28.1  0.72 26.7  0.37 27.0  0.68 25.5  0.45 0.0001 0.0007 NS
Women 29.6  0.75 28.8  0.42 28.3  0.46 28.3  0.49 26.9  0.43 25.5  0.47 0.0000 0.01 NS

Serum carotenoids
Serum a-carotene (mmol=l) n ¼ men 5971; women 6406
Men 0.087  0.011 0.096  0.004 0.093  0.008 0.080  0.002 0.072  0.003 0.061  0.002 0.0000 0.01 NS
Women 0.113  0.005 0.114  0.004 0.109  0.004 0.104  0.005 0.081  0.003 0.081  0.004 0.0000 NS NS
Serum b-carotene (mmol=l) n ¼ men 5971; women 6406
Men 0.319  0.032 0.383  0.014 0.367  0.031 0.325  0.012 0.300  0.021 0.254  0.006 0.0000 0.04 NS
Women 0.510  0.026 0.514  0.014 0.424  0.011 0.460  0.022 0.350  0.014 0.346  0.017 0.0000 NS NS
Serum b-cryptoxanthin (mmol=l) n ¼ men 5971; women 6405
Men 0.169  0.014 0.178  0.005 0.170  0.005 0.160  0.004 0.144  0.005 0.133  0.004 0.0000 0.007 NS
Women 0.190  0.007 0.192  0.006 0.183  0.006 0.176  0.007 0.150  0.005 0.143  0.005 0.0000 NS NS
Serum lutein=zeaxanthin (mmol=l) n ¼ men 5971; women 6406
Men 0.423  0.032 0.420  0.010 0.432  0.015 0.389  0.005 0.359  0.013 0.321  0.008 0.0000 0.0000 NS
Women 0.448  0.016 0.428  0.008 0.430  0.014 0.381  0.008 0.335  0.006 0.323  0.007 0.0000 0.0001 NS
Serum lycopene (mmol=l) n ¼ men 5971; women 6406
Men 0.473  0.036 0.449  0.010 0.468  0.012 0.462  0.009 0.448  0.015 0.448  0.012 NS NS NS
Women 0.440  0.015 0.431  0.007 0.430  0.010 0.420  0.010 0.395  0.010 0.388  0.011 0.0000 NS NS

Serum lipids
Serum total cholesterol (mmol=l) n ¼ men 6024; women 6464
Men 5.11  0.17 4.97  0.04 5.26  0.06 5.26  0.04 5.36  0.06 5.43  0.05 — — 0.004
Women 5.17  0.06 5.14  0.04 5.42  0.05 5.48  0.04 5.51  0.05 5.52  0.05 0.0000 NS NS
Serum low density lipoprotein cholesterol (mmol=l) n ¼ men 2598; women 2834
Men 3.93  0.14 3.12  0.04 3.35  0.08 3.44  0.04 3.47  0.07 3.48  0.05 — — 0.01
Women 2.97  0.08 3.06  0.05 3.24  0.06 3.32  0.06 3.46  0.06 3.50  0.06 0.0000 NS NS
Serum high density lipoprotein (HDL) cholesterol (mmol=l) n ¼ men 5976; women 6424
Men 1.30  0.09 1.32  0.01 1.18  0.02 1.18  0.02 1.08  0.02 1.07  0.02 — — 0.000
Women 1.58  0.03 1.55  0.02 1.43  0.02 1.39  0.01 1.30  0.01 1.27  0.01 0.0000 NS NS
a
All estimates were adjusted for age in y (continuous), race (non-Hispanic white, non-Hispanic black, Mexican-American, other) hours of fasting before phlebotomy,
supplement use in the 24 h before phlebotomy ( yes, no, unknown), and supplement use in the past month ( yes, no), whether changed diet for medical reasons in
the past 12 months ( yes, no), self-reported history of diabetes/hypertension/heart disease ( yes, no). In addition, serum/RBC folate, and vitamin E estimates were
adjusted for intake of dietary folate, and dietary vitamin E (all continuous), respectively. Serum vitamin C and carotenoid were adjusted for smoking status (never,
former, current) and intake of dietary vitamin C and carotenoids. HDL cholesterol models also included alcohol intake. Vitamin E and carotenoid estimates were also
adjusted for serum cholesterol and triglycerides.
P1, significance of the regression coefficient for BMI (continuous) in regression models without the interaction term.
P2, significance of the regression coefficient for currently trying to lose weight ( yes, no, with no as reference) in regression models without the interaction term.
P3, significance of the regression coefficient for interaction of BMI  trying to lose weight now.
*P was  0.05.
The sex-specific logistic regression models for testing the independent effects of BMI and trying to lose weight or the interaction of BMI and trying to lose weight
now status included each serum analyte as a continuous outcome and all the covariates mentioned above as independent predictors along with BMI (continuous),
trying to lose weight now ( yes, no), and BMI  trying to lose weight now term. If the interaction was not significant, separate models after excluding the interaction
term were run to determine the main effect of BMI and trying to lose weight now status.

European Journal of Clinical Nutrition


Discussion
The interaction effects of BMI and trying to lose weight were
generally small, with a slightly higher proportion of men
trying to lose weight at higher BMI reporting all five food
groups but a lower mean percentage of energy from low-
nutrient-density foods. To my knowledge, other studies
where food and nutrient intake profiles of those attempting
weight loss in relation to body weight have been examined
are not available for comparison. Energy intake is the only
variable for which a weight status – trying to lose weight
interaction has been reported previously. Neumark-Sztainer
reported no differences in the energy intake reported by
non-overweight current dieters vs non-dieters, but energy
intake of overweight current dieters was lower than that of
non-dieters (Neumark-Sztainer et al, 1997). Such a finding
suggests that weight status modified the relation of energy
intake with dieting status. This interaction was not observed
in the present study. Notably, however the question used to
elicit weight loss behavior as well as the method of dietary
assessment differed in the two studies.
The observations of lower reported energy intake, energy
density, and EI=BEE ratio in those trying to lose weight are
consistent with the expected changes in food selection with
weight loss attempts (Andersson et al, 2000). However, the
extent to which these results reflect reporting bias vs actual
dietary behaviors cannot be ascertained without independent
validation of dietary intakes. With the exception of an
increased risk of not meeting the weight-based protein stan-
dard (0.8 g=kg body weight), attempting weight loss was not
associated with a significantly increased risk of inadequate
intake of the nutrients examined despite lower energy intake
(except vitamin E in women and iron in men at higher BMI). A
trend for a lower proportion of those attempting weight loss
meeting the calcium standard was noted but did not reach
statistical significance. Ritt et al (1979) also identified iron and
calcium as nutrients at risk in diets used for weight control.
More recently, vitamin E, calcium, iron and zinc were identi-
fied as nutrients that were consumed at lower levels from a
well-planned, energy-restricted diet (Benzera et al, 2001). Con-
versely, Neumark-Sztainer et al (1996) reported higher intakes
of many micronutrients estimated from a 60-item food fre-
quency questionnaire in adult dieters relative to non-dieters.
There are few published reports where changes in serum
vitamer status of subjects trying to control weight have been
investigated to enable comparison with results of the present
study. Notably, trying to lose weight was a positive indepen-
dent predictor of serum ascorbate, vitamin E and most
carotenoids in both men and women trying to lose weight,
which supports the notion of better dietary selections with
attempting weight loss. Also, at higher BMI, there was a
suggestion of improvement in serum lipid profiles in men
trying to lose weight.
Although BMI was not a significant predictor of total
energy intake, it was a strong inverse predictor of EI=BEE
independent of trying to lose weight status, confirming
that energy reporting relative to requirement for basal
BMI – trying to lose weight and nutritional profiles
AK Kant
257
expenditure was lower at higher BMI (Lissner et al, 2000).
BMI was not an independent predictor of percentage of
energy intake from all low-nutrient-density foods combined
or most low-nutrient-density subgroups in women; in men
low-nutrient-density food reporting showed an interaction of
BMI with trying to lose weight (Table 3). These results do not
support the suggestion that BMI, especially in women, was
associated with differential reporting of nutritionally unde-
sirable low-nutrient-density foods as a proportion of the total
energy intake. These results differ from other reports where
BMI was an independent negative predictor of intake of
sugar, fat or other low-nutrient-density foods (Slattery et al,
1992; Drewnowski et al, 1997a; Macdiarmid et al, 1998). Con-
sistent with other reports, in the present study, BMI was an
independent positive predictor of percentage of energy from
total fat, but negative predictor of percentage of energy from
carbohydrate and alcohol (men only; Miller et al, 1990, 1994;
Slattery et al, 1992; Ortega et al, 1995; Lissner et al, 1998).
Increased prevalence of low serum folate in overweight
relative to non-overweight subjects and the negative asso-
ciation of BMI with plasma ascorbate and b-carotene noted
in this study has been previously reported (Hotzel 1986;
Moor de Burgos et al, 1992; Hebert et al, 1994; Drewnowski
et al, 1997b; Wallstrom et al, 2001). Published reports on the
relation of serum vitamin E and BMI are inconsistent. While
the findings of Moor de Burgos et al (1992) are in accord with
our results, Wallstrom et al (2001) reported a positive
association of cholesterol adjusted BMI with serum toco-
pherol in men and no relation in women. Little has been
published on possible explanations for the BMI effect on
circulating vitamers and carotenoids. Putative reasons may
include increased utilization, dilution, redistribution, or
tissue sequestration of these nutrients (Hebert et al, 1994).
Recent data on vitamin D metabolism in association with
adiposity suggest that tissue sequestration of fat soluble
analytes may partially explain lower circulating levels
(Wortsman et al, 2000).
The strengths of this study include a large, nationally
representative sample of US adults for whom information
on most major confounders of BMI – diet association, along
with objective markers of nutrient intake, was available.
Limitations that warrant a cautious interpretation of results
of this study include the following. The estimates of food
and nutrient intake for men in the first tertile of BMI who
answered yes to attempting weight loss may be somewhat
unreliable due to small numbers. The question ‘Are you
currently trying to lose weight?’ does not specifically probe
how the weight loss is being attempted or the duration or
efficacy of these attempts. A positive response to the
question probably includes individuals using non-dietary
strategies which will probably attenuate the relation of this
variable with dietary and biochemical outcomes. Although it
is notable that consistent with expectation, energy intake
and energy density in those attempting weight loss was
lower. Also, in a recent survey, over 90% of those reporting
attempts at weight control included dietary strategies
European Journal of Clinical Nutrition
 BMI – trying to lose weight and nutritional profiles
AK Kant
258
(Serdula et al, 1999). It is also possible that some individuals,
especially at higher BMI, replied affirmatively to trying to
lose weight due to their perception of it being the expected
or desired response. Thus it is likely that the reliability of this
response for classifying individuals as whether or not weight
loss was being attempted differs by BMI status. One can
nevertheless argue that a positive response to this question
may at least be an indicator for concern about body weight,
which may in turn relate to dietary behaviors as is evident
from the data presented.
All methods of dietary assessment, including the 24 h
recall used in NHANES III, have several inherent measure-
ment errors (Bingham, 1987). Estimates from 24 h dietary
recall are generally reliable for assessing groups, but not
individuals. Accordingly, in the present analyses, the
conclusions are limited to groups. Nevertheless, because
the estimates presented are not adjusted for within-subject
variability in reported food intake, measurement error may
have contributed to the inability to find significant
differences. The results presented in Table 4 warrant cautious
interpretation as prevalence of inadequacy of micronutrients
from a single dietary measurement tends to be over-
estimated. Thus, it is preferable to interpret this table as
indicating trends rather than prevalence estimates. In the
present study, dietary ascorbate, folate, vitamin E and
carotenoid intake was a significant independent predictor of
serum concentration of the respective nutrients, providing
an independent validation of the estimated dietary intake.
These results suggest that for most examined food,
nutrient, and biomarker outcomes nutritional health was
not compromised in those reportedly trying to lose weight
irrespective of weight status. On the average, reporting of
lower intake of energy, and energy density in those
concerned about their weight was not associated with lower
micronutrient intake irrespective of the degree of adiposity,
suggesting a more judicious pattern of food selection. If the
differences in dietary behaviors of those concerned about
body weight are not largely due to reporting bias, these
behaviors may help in decreasing the risk of subsequent
major weight gain in groups of varying BMI. To my know-
ledge, no prospective studies of such groups have been pub-
lished. These results provide little evidence for discouraging
attempts to lose weight on nutritional grounds. However, this
study did not focus on psychological or other physical con-
sequences, if any, of adopting reported dietary behaviors by
those concerned about body weight. Further work is needed
on evaluation of nutritional status using biomarkers in rela-
tion to BMI, changes in biomarkers and variation in nutri-
tional risk due to different strategies for weight management
and repeated attempts at weight control.
Acknowledgements
I thank Daniel F Heitjan, Columbia University, School of
Public Health, New York, for statistical consultation, and Lisa
L Kahle for expert programming assistance.
European Journal of Clinical Nutrition
References
Andersson I, Lennernas M & Rossner S (2000): Meal pattern and risk
factor evaluation in one-year completers of a weight reduction
program for obese men — the ‘Gustaf’ study. J. Intern. Med. 247,
30 – 38.
Benzera LM, Nieman DC, Nieman CM et al (2001): Intakes of most
nutrients remain at acceptable levels during a weight management
program using the food exchange system. J. Am. Diet. Assoc. 101,
554 – 558, 561.
Bingham SA (1987): The dietary assessment of individuals: methods,
accuracy, new techniques and recommendations. Nutr. Abstr. Rev.
(Ser. A), 705 – 742.
Drewnowski A, Henderson SA, Shore BA et al (1997a): The fat –
sucrose seesaw in relation to age and dietary variety of French
adults. Obes. Res. 5, 511 – 518.
Drewnowski A, Rock CL, Henderson SA et al (1997b): Serum beta
carotene and vitamin E as biomarkers of vegetable and fruit intake
in a community-based sample of French adults. Am. J. Clin. Nutr.
65, 1796 – 1802.
Food and Nutrition Board (1989): National Research Council Recom-
mended Dietary Allowances, 10th edn. Washington, DC: National
Academy Press.
Food and Nutrition Board (1997): Dietary Reference Intakes for
Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride.
Washington, DC: National Academy Press.
Food and Nutrition Board (1998): Dietary Reference Intakes for
Thiamin Riboflavin, Vitamin B-6, Folate, Vitamin B-12, Pantothenic
acid, Biotin, and Choline. Washington, DC: National Academy
Press.
Food and Nutrition Board (2000): Dietary Reference Intakes for Vitamin
C, Vitamin E, Selenium, and Carotenoids. Washington, DC: National
Academy Press.
Food and Nutrition Board (2001): Dietary Reference Intakes for Vitamin
A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Molyb-
denum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC:
National Academy Press.
Graubard BI & Korn EL (1999): Predictive margins with survey data.
Biometrics 55, 652 – 659.
Hebert JR, Hurley TG, Hsieh J et al (1994): Determinants of plasma
vitamins and lipids: the working well study. Am. J. Epidemiol. 140,
132 – 147.
Hotzel D (1986): Suboptimal nutritional status in obesity (selected
nutrients). Biblithica Nutr. Dieta 37, 36 – 41.
Kant AK (2000): Consumption of energy-dense, nutrient-poor foods
in the US population: effect on nutrient profiles. Am. J. Clin. Nutr.
72, 929 – 936.
Kant AK, Schatzkin A, Block G, Ziegler RG & Nestle M (1991): Food
group intake patterns and associated nutrient profiles of the US
population. J. Am. Diet. Assoc. 91, 1532 – 1537.
Lissner L, Lindroos AK & Sjostrom L (1998): Swedish subjects (SOS):
an obesity intervention study with a nutritional perspective. Eur. J.
Clin. Nutr. 52, 316 – 322.
Lissner L, Heitmann BL & Bengtsson C (2000): Population studies of
diet and obesity. Br. J. Nutr. 83, S21 – S24.
Macdiarmid JI, Vail A & Blundell JE (1998): The sugar – fat
relationship revisited: differences in consumption between
men and women of varying BMI. Int. J. Obes. Res. 22, 1053 –
1061.
Miller WC, Lindeman AK, Wallace J & Niederpruem M (1990): Diet
composition, energy intake, and exercise in relation to body fat in
men and women. Am. J. Clin. Nutr. 52, 426 – 430.
Miller WC, Niederpruem MG, Wallace JP & Lindeman AK (1994):
Dietary fat, sugar, and fiber predict body fat content. J. Am. Diet.
Assoc. 94, 612 – 615.
Moor de Burgos A, Wartanowicz M & Ziemlanski S (1992): Blood
vitamin and lipid levels in overweight and obese women. Eur. J.
Clin. Nutr. 46, 803 – 808.
National Center for Health Statistics (1994): Plan and operation of
the Third National Health and Nutrition Examination Survey,
1988 – 94. Vital Health Stat. 1 (32).

National Center for Health Statistics (1996): Third National Health
and Nutrition Examination Survey, 1988 – 1994. NHANES III Labora-
tory Data File(CD-ROM, Series 11, no. 1A). Hyattsville, MD:
Centers for Disease Control and Prevention.
National Center for Health Statistics (1997): Third National Health
and Nutrition Examination Survey, l988 – 1994. NHANES III
(CD-ROM, Series 11, no. 1A). Hyattsville, MD: Centers for Disease
Control and Prevention.
National Center for Health Statistics (1998): Third National Health
and Nutrition Examination Survey, 1988 – 1994. NHANES III Second
Laboratory Data File (CD-ROM. Series 11, no. 2A). Hyattsville, MD:
Centers for Control and Prevention.
National Institutes of Health (1998): Clinical guidelines on the
identification, evaluation, and treatment of overweight and
obesity in adults: the evidence reports. Obes. Res. 6(Suppl 2):
51S – 209S.
Neumark-Sztainer D, French SA & Jeffrey RW (1996): Dieting for
weight loss: Associations with nutrient intake among women.
J. Am. Diet. Assoc. 96, 1172 – 1175.
Neumark-Sztainer D, Jeffery RW & French SA (1997): Self-reported
dieting: How should we ask? What does it mean? Associations
between dieting and reported energy intake. Int. J. Eat. Disord. 22,
437 – 449.
Neumark-Sztainer D, Rock CL, Thornquist MD et al (2000): Weight-
control behaviors among adults and adolescents: associations with
dietary intake. Prev. Med. 30, 381 – 391.
NIH Technology Assessment Conference Panel (1992): Methods for
voluntary weight loss and control. Ann. Intern. Med. 116,
942 – 949.
BMI – trying to lose weight and nutritional profiles
AK Kant
259
Ortega RM, Redondo MR, Zamora MJ, Lopez-Sobaler AM & Andres P
(1995): Eating behavior and energy and nutrient intake in over-
weight=obese and normal weight Spanish elderly. Ann. Nutr.
Metab. 39, 371 – 378.
Ritt RS, Jordan HA & Levitz LS (1979): Changes in nutrient intake
during a behavioral weight control program. J. Am. Diet. Assoc. 74,
326 – 330.
SAS Institute Inc. (2000): SAS User’s Guide. Release 8. Cary, NC: SAS
Institute Inc.
Schofield WN (1985): Predicting basal metabolic rate, new stand-
ards and review of previous work. Hum. Nutr. Clin. Nutr. 39C,
5S – 41S.
Serdula MK, Mokdad AH, Williamson DF, Galuska DA, Mendelein JM
& Heath GW (1999): Prevalence of attempting weight loss and
strategies for controlling weight. JAMA 282, 1353 – 1358.
Shah BV, Barnwell BG & Bieler GS (1997): SUDAAN User’s Manual.
Release 7.5. Research Triangle Park, NC: Research Triangle Institute.
Slattery ML, McDonald A, Bild DE et al (1992): Associations of body
fat and its distribution with dietary intake, physical activity,
alcohol, and smoking in blacks and whites. Am. J. Clin. Nutr. 55,
943 – 994.
Wallstrom P, Wirfalt E, Lahmann PH, Gullberg B, Janzon L &
Berglund G (2001): Serum concentrations of b-carotene and
a-tocopherol are associated with diet, smoking, and general and
central adiposity. Am. J. Clin. Nutr. 73, 777 – 785.
WHO (2000): Obesity: Preventing and Managing the Global Epidemic.
WHO Technical Report Series 10.894 Geneva: WHO.
Wortsman J, Matsuoko LY, Chen TC, Lu Z & Holick MF (2000):
Decreased bioavailability of vitamin D in obesity. Am. J. Clin.
Nutr. 72, 690 – 693.
European Journal of Clinical Nutrition