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Biomedical subjects

A W Caggiula

Publications and source records attributed to A W Caggiula.

At least 37 records · Page 2Linked to original sources
PubMed1994

Features of the nutrient database and analysis system for the Modification of Diet in Renal Disease Study.

This article describes the features of the nutrient database and analysis system developed for the Modification of Diet in Renal Disease (MDRD) Study and outlines the development process itself, an example of tailoring a database and analysis system for a complex, long-term clinical trial. The MDRD Study was a 15-center trial for men and women aged 18 to 70 years with chronic renal disease who were not on dialysis and who had not had a kidney transplant. The effects of three levels of protein and phosphorus intake and two levels of blood pressure management were assessed on the rate of decline in kidney function. This paper describes the development, structure, contents, and application of the nutrient database and analysis system that was used to enter, analyze, and report the MDRD Study dietary data.

Adolescent↗
PubMed1994

Coffee consumption: relationship to blood lipids in middle-aged women.

BACKGROUND: There is controversy about the relationship between coffee intake and blood lipids in women and many studies fail to control for potential confounding factors. METHODS: In 1983 and 1984, 541 randomly selected premenopausal women were recruited from a list of licenced drivers, aged 42-50, within selected areas in Allegheny County, Pennsylvania. They were invited to participate in a 5-year study of biological and behavioural changes associated with menopause. At baseline and the first follow-up visit, lipoprotein, lipid and apoprotein levels, physical activity, dietary intake and coffee consumption were measured. Pearson correlations between coffee consumption and the various lipid values were calculated. Multivariate analyses, which controlled for the potential confounding effects of body mass index, alcohol intake, percent of calories from carbohydrate and fat, number of cigarettes smoked per day, physical activity level, and age in months, were also employed to investigate the relationships. RESULTS: Mean coffee consumption for the group was 3.35 cups of coffee per day at baseline and 3.02 cups per day at follow-up. Results of analyses of correlation between coffee consumption and blood lipids as well as multiple regressions to control for menopausal status at follow-up were non-significant (P > 0.05) for all blood lipid values with the exception of triglycerides, which were inversely related to coffee consumption at follow-up. CONCLUSIONS: These results do not support a relationship between coffee consumption and lipoprotein, lipid or apoprotein levels with the exception of an inverse relationship between coffee consumption and triglyceride level at follow-up.

Adult↗
PubMed1993

Relation of caffeine intake to blood lipids in elderly women.

The relation of the consumption of caffeine from coffee, tea, and all caffeine-containing soft drinks (hereafter referred to as "cola") to blood lipid levels was studied in 1,035 white women ranging in age from 65 to 90 years (mean, 71.2 years) from October 1986 through October 1988. All study subjects were participants in the Pittsburgh, Pennsylvania, clinic of the Study of Osteoporotic Fractures. Fasting blood samples were tested for total cholesterol, triglycerides, apolipoproteins A-I and B-100, total high-density lipoprotein (HDL) cholesterol, and the HDL2 and HDL3 subfractions. Low-density lipoprotein (LDL) cholesterol was calculated using the Friedewald equation. Current consumption of coffee, tea, and cola was assessed by means of a self-administered personal habits questionnaire. Potential confounders, such as body mass index (weight (kg)/height (m)2), waist/hip ratio, smoking status, and alcohol intake were also measured for each woman. Analyses of variance and tests for mean differences revealed an inverse relation between the consumption of tea and apolipoprotein B-100 and a positive association between the consumption of cola and apolipoprotein B-100. Apolipoprotein A-I levels were found to be positively related to coffee consumption and negatively related to tea consumption. There was no consistent relation between caffeine consumption and total cholesterol, LDL cholesterol, total HDL cholesterol and its subfractions, or apolipoprotein B-100. Adjustment for potential confounders yielded no remaining significant associations between caffeine from any of the major beverage sources and any of the lipid fractions. In conclusion, the inconsistent relations between caffeine from various sources and blood lipids do not support a significant association of blood lipid levels with caffeine consumption in elderly women.

Aged↗
PubMed1992

Characteristics associated with compliance to cholesterol lowering eating patterns.

The achievement of high levels of adherence is the most important objective of nutrition intervention programs. In order to determine characteristics which were most highly related to adherence to a cholesterol lowering eating pattern, a group of 264 men were sampled. Participants had been enrolled for six years in a multi-risk reduction program for cardiovascular disease which included dietary intervention for blood cholesterol. They were asked to respond to 35 statements, each of which was designed to reflect one of seven characteristics: perception of threat of disease, cost-benefit of therapy, quality of care, social support, external environmental media, and internal as well as external health locus of control. There were seven possible responses to each statement, from strongly agree to strongly disagree. Using a reduced rank regression analysis the numerical answers to the items were treated as a set of predictors for the criterion measure, the food record rating (FRR) score which reflected compliance to a cholesterol lowering eating pattern. Overall the seven characteristics accounted for almost half of the variance in the FRR score (multiple R = 0.48). The most highly related characteristics were cost-benefit, quality of care and external environmental media. These results are highly consistent with those obtained in another population, and indicate the importance of minimizing the cost and increasing the benefits of cholesterol lowering programs by providing high quality treatment programs which emphasize tailoring the regimen to the individual. These results also support the importance of public information efforts such as the National Cholesterol Education Program.

Cholesterol, Dietary↗
PubMed1991

Potential for increasing high-density lipoprotein cholesterol, subfractions HDL2-C and HDL3-C, and apoprotein AI among middle-age women.

BACKGROUND: Studies have shown high-density lipoprotein cholesterol (HDL-C) to be a strong predictor of cardiovascular disease (CVD) risk. METHODS: Determinants of HDL-C and apoprotein AI concentrations were evaluated cross-sectionally in 1987 among 429 women, ages 45-54, from a population-based study of CVD risk factors through menopause (the Healthy Women Study, University of Pittsburgh). RESULTS: Subjects were healthy and not taking hormone replacement therapy. Results showed levels of HDL-C (mg/dl) to range from 23 to 117, HDL2-C from 0 to 53, HDL3-C from 16 to 66, and apoprotein AI from 87 to 204. Multivariate analyses which included age, cigarettes/day, alcohol intake (g/day), physical activity (Paffenbarger questionnaire), body mass index (BMI), and waist/hip ratio (WHR) showed that women who smoked greater than or equal to 20 cigarettes a day, reported little or no alcohol intake, expended less than 500 kcal/week, and were in the highest quintile of BMI and WHR had, on average, 33 mg/dl lower HDL-C than slender, nonsmoking women who drank moderately and exercised. HDL2-C showed a similar pattern, whereas the HDL3-C concentration had only a modest association with these factors. HDL-C was somewhat lower among women who had stopped menstruating than among premenopausal women. The apoprotein AI level was associated with alcohol intake (positively) and BMI (negatively). CONCLUSION: Theoretically, by raising their HDL-C by 10 mg/dl, women could reduce their CVD risk by as much as one-third (based on results from the Framingham Heart Study). As CVD is the leading cause of death among postmenopausal women, the potential impact of such a reduction in risk would be large.

Alcohol Drinking↗
PubMed1990

Influences of natural menopause on psychological characteristics and symptoms of middle-aged healthy women.

We investigated the psychological and symptom consequences of the natural menopause in a longitudinal study of 541 initially premenopausal healthy women. All women were given an extensive evaluation at baseline. After 3 years of follow-up, 69 women ceased cycling for 12 months; another 32 women had ceased cycling and had taken hormone replacement therapy for a total of 12 months. These women were reevaluated in a clinic examination identical with the baseline examination, as were 101 age-matched premenopausal control women. Comparison among groups at the baseline and follow-up examination showed that natural menopause led to few changes in psychological characteristics, with only a decline in introspectiveness and an increase in reports of hot flashes being apparent. We conclude that natural menopause did not have negative mental health consequences for the majority of middle-aged healthy women.

Adaptation, Psychological↗
PubMed1989

Menopause and risk factors for coronary heart disease.

Postmenopausal women are believed to have a higher risk of coronary artery disease than premenopausal women. In this study, we prospectively determined changes in coronary risk factors that were attributable to natural menopause in 541 healthy, initially premenopausal women 42 to 50 years of age. After approximately 2 1/2 years, 69 women had spontaneously stopped menstruating for at least 12 months, and 32 women had stopped natural menstruation and received hormone-replacement therapy for a period of at least 12 months. An equal number of age-matched premenopausal women in the study group served as controls. In women who had a natural menopause and did not receive hormone-replacement therapy, serum levels of high-density lipoprotein (HDL) cholesterol declined as compared with those of premenopausal controls (-0.09 vs. 0.00 mmol per liter; P = 0.01), and levels of low-density lipoprotein (LDL) cholesterol increased (+0.31 vs. +0.14 mmol per liter; P = 0.04). In menopausal women who received hormone-replacement therapy, HDL and LDL cholesterol levels did not change, but the levels of triglycerides (+0.42 vs. -0.04 mmol per liter; P less than 0.001), apolipoprotein A-I (+0.18 vs. +0.03 g per liter; P less than 0.01), and apolipoprotein A-II (+0.05 vs. -0.03 g per liter; P less than 0.05) increased as compared with premenopausal controls. Natural menopause did not affect blood pressure, plasma glucose or insulin levels, body weight, the total number of kilojoules consumed in the diet, or the total number of kilojoules expended in physical activity. These results suggest that a natural menopause has an unfavorable effect on lipid metabolism, which may contribute to an increase in the risk of coronary disease. Hormone-replacement therapy may prevent some of these changes.

Apolipoproteins A↗
PubMed1986

Increasing the use of meatless meals: a nutrition intervention substudy in the Multiple Risk Factor Intervention Trial (MRFIT).

Forty-seven participants from six MRFIT clinical centers were involved in a 3-month intensive dietary intervention program to determine the feasibility of increasing the use of meatless meals. The substudy was conducted late in the trial, and many dietary changes had already been made. The purpose, therefore, was to initiate ways to continue the maintenance of achieved serum cholesterol reductions and possibly effect additional decreases. The program consisted of an introductory session and three follow-up visits. Preplanning, contracting, self-monitoring, regular follow-up, and homemaker involvement were among techniques used to help participants incorporate meatless meals into routine dietary practices. Data collection included scores from a knowledge test administered at the introductory and final visits, number of meatless meals consumed per week as contracted at the first three visits and as reported at the last three visits, and serum cholesterol and weight determinations made at each visit. Knowledge related to meatless meal concepts, such as complementary proteins, appeared to improve as the majority of substudy participants scored higher on the post-test than on the pretest. Over the substudy duration, the mean number of contracted and reported weekly meatless meals in addition to breakfast was approximately four and five, respectively. Mean serum cholesterol drop was 2.6%, and mean weight loss was about 3 lb over the 3-month period. The approach was one of the intervention techniques used to maintain serum cholesterol reductions on a long-term basis, which has not been achieved in any other clinical trial with similar objectives. The described meatless meals program may prove useful to dietetic practitioners who counsel individuals in fat-modified food patterns.

Blood Pressure↗
PubMed1985

Evaluation of clinical skills for nutrition counseling.

This report describes the procedures for and feasibility of an evaluation program that provides a direct assessment of the use of specific clinical skills during an interview with a simulated patient. The specific aims of this evaluation were to assess untrained graduate students in nutrition on their application of a set of 31 specific clinical skills for resolving dietary adherence problems. Each student conducted two interviews with each of two different simulated patients with hyperlipidemia presenting typical problems following a diet low in saturated fat and cholestrol. The evaluation program provided analyses that identified the strengths and deficits of each student and the performance of the entire group. It is suggested that the evaluation program offers a practical, objective method for examining the entry-level clinical skills of students in training and may be useful in other educational programs (eg, in-service, continuing education workshops).

Cholesterol, Dietary↗
PubMed1985

The measurement of sodium and potassium intake.

Single- vs multiple-day food records were compared for estimates of intake for sodium, potassium, and calories; and the correspondence was assessed between sodium and potassium intake and 24-h urinary excretion. Fifty-five middle-aged adults, participating in a prerandomization assessment for a nutritional/behavioral intervention program on blood pressure completed a six-day food record and a 24-h urine collection. The group average for sodium, potassium, and calories obtained from one-day food records proved to be as good an estimate of the six-day average as did values from multiple day records. Similarly the one-day food record proved a good estimate of the mean 24-h urinary values for sodium and potassium. If properly collected and analyzed, a one-day food record is a good estimate of a population's intake of sodium and potassium while multiple days of recording are necessary to characterize individual intake.

Blood Pressure↗
PubMed1985

A comparison of three dietary methods for estimating vitamin A intake.

This study compared and evaluated vitamin A intake measured by three dietary methods (the 24-hour recall, the three-day food record, and a food frequency questionnaire) in 82 adult men enrolled in the Multiple Risk Factor Intervention Trial in Pittsburgh, Pennsylvania, during 1981. The dietary methods may be useful for group data, although differences were found: the food frequency questionnaire produced the highest mean daily estimate (7,876 +/- 569 IU) (mean +/- standard error), the 24-hour recall the intermediate daily estimate (6,944 +/- 602 IU), and the three-day food record the lowest daily estimate (5,137 +/- 470 IU). There was considerable variability between methods in individuals, suggesting that the intake of vitamin A estimated by one dietary method does not predict the intake estimated by another. At the individual level, a low significant correlation (rs = 0.28) occurred between the food frequency questionnaire and the three-day food record methods. Modest agreement in quartile ranking between these two methods indicated that 38% of the individuals fell into the same quartile, 73% into the same +/- one quartile, and 7% into opposite quartiles.

Diet Surveys↗
PubMed1984

Effects of antihypertensive therapy on plasma lipids and lipoproteins in the Multiple Risk Factor Intervention Trial.

The Multiple Risk Factor Intervention Trial was a randomized clinical trial that studied the efficacy of multiple risk factor reduction in lowering coronary heart disease mortality in high-risk men. Nutrition counseling based on a fat-modified eating pattern resulted in a significant reduction of total cholesterol and low-density lipoprotein cholesterol. However, based on further analysis not involving comparisons of randomized groups, the reduction in total cholesterol appeared to be blunted by the effects of the antihypertensive medication utilized in the stepped-care therapy in this study. The use of diuretics was associated with an increase in triglycerides and a lesser decrease in total plasma cholesterol when compared with non-diuretic users. The use of diuretic therapy was also associated with a slight decrease in high-density lipoprotein cholesterol, when compared with changes in those not receiving diuretic therapy. The combination of diuretics plus propranolol was related to a substantial decrease in high-density lipoprotein cholesterol in both the Special Intervention and Usual Care participants. The changes in lipoproteins for men receiving diuretic therapy are probably influenced substantially by nutritional factors, especially weight change. Concomitant nutritional changes must be considered when analyzing the short- and long-term effects of therapy with diuretics or other antihypertensive drugs on lipoprotein metabolism.

Adult↗
PubMed1984

Dietary approaches to the reduction of blood pressure: the independence of weight and sodium/potassium interventions.

This study was designed to determine the feasibility of teaching mildly hypertensive individuals to select a diet, using normally available food products, that either would produce a 5% reduction in percentage of overweight (without altering sodium (Na), potassium (K), or Na:K ratio) or would decrease Na to less than 70 mEq and increase K to greater than 100 mEq (without affecting weight) and to compare the resulting changes in blood pressure. Fifty-two participants with mild hypertension were randomly assigned to either a weight-loss or a Na:K intervention. Blood pressure, weight, 3-day diaries, and 24-h urinary excretion of Na and K were measured before and after an 8-week intervention. Participants in the weight-loss intervention had significantly greater changes in weight and calorie intake than those in the Na:K intervention, while changes in Na:K ratio were greatest in the intervention targeted for that change. The percentage of participants who were able to meet the dietary goals is presented and the implications of these data for the selection of dietary goals are discussed.

Blood Pressure↗
PubMed1978

Applying behavioral methods to nutritional counseling.

A brief survey of what appear to be the most effective and promising techniques of human behavioral change, as applied to nutritional counseling, is presented. Three critical environments of the patient require assessment and intervention: (a) The physical environment, or the physical setting in which the patient functions; (b) the social environment, or other people with whom the patient comes in contact; and (c) the private environment which consists of thoughts, emotions, and basic physiologic systems. Specific assessment and treatment procedures to effect change in each of these environments are outlined, and some suggestions are made concerning the appropriate use of self-help materials.

Behavior Therapy↗