Biomedical subjects

Gladys Block

Publications and source records attributed to Gladys Block.

43 records · Page 3Linked to original sources

PubMed2002

Food intake characteristics of hemodialysis patients as obtained by food frequency questionnaire.

OBJECTIVES: Food frequency questionnaires (FFQ) are frequently used in epidemiologic studies of nutrition and food intake. However, the use of FFQs in patients receiving maintenance dialysis has not been extensively studied. We hypothesize that FFQ is a useful tool to assess the food intake differences between patients receiving dialysis and patients not receiving dialysis. DESIGN: Matched exposed-unexposed study with case-controlled design. SETTING: Outpatient dialysis unit affiliated with a tertiary-care community medical center. PATIENTS: From a pool of 102 maintenance hemodialysis (MHD) outpatients in a community dialysis unit, 30 adult MHD outpatients (15 men, 15 women, aged 55.8 +/- 14.6 years) were selected randomly as case subjects. They included 16 African Americans, 8 whites, 4 Hispanics, and 2 Asians. Eleven MHD patients took the multivitamin, Nephrovite (R&D Laboratories, Marina del Rey, CA), regularly. From an archive of 1,610 nondialytic individuals with known FFQ data, 30 control subjects were selected randomly to match the age, race, and sex of the case subjects. INTERVENTION: We used Block's FFQ (version 98), an 8-page self-administered questionnaire that has been widely used in epidemiologic studies. A group of trained research assistants supervised the FFQ administration and interviewed those patients who were not able to answer all of the questions without assistance. Student t test was used to compare group means in form of daily dietary intake, and conditional logistic regression was used to calculate odds ratios for predetermined dichotomizing cutoff levels. MAIN OUTCOME MEASURES: Food intake characteristics of MHD patients as compared with control patients not receiving dialysis. RESULTS: Statistically significant differences between MHD case subjects and nondialytic control subjects were observed between the amounts of daily intake for vitamin C (84 +/- 63 mg/d v 127 +/- 70 mg/d, P = .01), dietary fiber (12 +/- 6 g/d v 18 +/- 11 g/d, P = .02), potassium (2,024 +/- 1,088 mg/d v 2,701 +/- 1,429 mg/d, P = .04), cryptoxanthin (56 +/- 88 microg/d v 140 +/- 118 microg/d, P = .003), and lycopene (2,052 +/- 2,234 microg/d v 4,524 +/- 3,979 microg/d, P = .004). These data indicate that MHD patients had a significantly lower intake of vitamin C, dietary fibers, potassium, and 2 of the carotenoid compounds when compared with individuals not receiving dialysis. Moreover, the daily intake of vitamin B(6) was significantly higher in MHD patients probably because of the high pyridoxine content in Nephrovite. By using the conditional logistic regression analysis, the odds ratios for lower than predetermined cutoff levels in patients receiving dialysis were significant for vitamin C, potassium, and the 2 previously mentioned carotenoids (odds ratio between 3.50 and 7.50, P < .05). CONCLUSIONS: Patients receiving dialysis may consume significantly lower amounts of potassium, vitamin C, and dietary fibers as well as lower amounts of some carotenoids. The FFQ seems to be a useful tool to compare dietary intake of MHD patients with other groups, although it may underestimate the amount of daily protein and energy intake and, hence, may not be an accurate tool for individual assessment of food intake. More studies are required to evaluate the validity of the FFQ in dialysis patients. The lower vitamin C, fiber, and carotenoid intake of MHD patients may be atherogenic. Hence, the hypothesis is proposed that prescribed restrictions in potassium in MHD patients may lead to reduced fruit and vegetable intake, leaving meat and fats as the main source of calories. This may contribute to atherosclerosis and increased cardiovascular morbidity and mortality in these patients. This hypothesis needs to be evaluated in future studies.

Ascorbic Acid↗

PubMed2002

Long-term effects of nutrient intervention on markers of bone remodeling and calciotropic hormones in late-postmenopausal women.

BACKGROUND: Adequate intakes of calcium and vitamin D reduce bone loss and fracture risk in the elderly. Other nutrients also affect bone health, and adequate intakes may influence bone turnover and balance. OBJECTIVE: We compared the long-term effects on bone turnover markers and calciotropic hormones of a multinutrient supplement, a calcium and vitamin D supplement, and dietary instruction aimed at increasing calcium intake through foods. DESIGN: Ninety-nine healthy postmenopausal women participated in a 3-y, randomized trial, receiving either 1) supplemental calcium (1450 mg/d) and vitamin D [10 microg (400 IU)/d], 2) calcium, vitamin D, and other nutrients (multinutrient supplement), or 3) dietary instruction (dietary control group). Data are from 83 subjects who completed the trial. RESULTS: Increases over baseline in calcium intakes and serum 25-hydroxyvitamin D concentrations were sustained over 3 y in all treatment groups. Circulating parathyroid hormone concentrations were reduced at year 1 in all treatment groups but trended toward baseline thereafter. Bone turnover markers followed a similar pattern, and none of the changes in biochemical concentrations differed significantly between groups. CONCLUSIONS: All 3 interventions offer long-term feasibility for increasing calcium intake and serum 25-hydroxyvitamin D concentrations. The dietary addition of micronutrients implicated in skeletal physiology confers no obvious bone-sparing effect in healthy postmenopausal women beyond that of calcium and vitamin D alone. The attenuation over time in suppression of parathyroid hormone and bone turnover might help explain why nutrient intervention tends to have less of a bone-sparing effect than do skeletally active medications such as estrogen or bisphosphonates.

Aged↗

PubMed2002

Ascorbic acid, blood pressure, and the American diet.

A large controlled study supported by the NIH, the DASH study (Dietary Approaches to Stop Hypertension), demonstrated that a diet rich in fruits and vegetables can reduce blood pressure in persons with moderate elevation in blood pressure (BP). Fruits and vegetables are important sources of antioxidants such as vitamin C and carotenoids. We conducted a study in which we fed people a diet deficient in vitamin C for 30 days, followed for another 30 days by a diet adequate in vitamin C. Their blood levels of vitamin C and blood pressure (BP) were tracked. Plasma vitamin C was inversely related to diastolic blood pressure one month later (correlation = -0.48, P < 0.0001). Persons whose blood levels of vitamin C went down the furthest on depletion had the highest blood pressure one month later. Persons in the lowest one-fourth of the plasma vitamin C distribution had diastolic BP 7 mm Hg higher than did those in the upper one-fourth of the plasma ascorbic acid distribution. Multivariate control for age, body mass index, other plasma antioxidants, and dietary energy, calcium, fiber, sodium, and potassium did not reduce the plasma vitamin C effect. We believe that this indicates that the tissue stores of vitamin C may be important in regulating blood pressure. It is often thought that Americans' intake of vitamin C is ample, since the average intake is about 100 mg/day. However, this average level obscures the fact that substantial numbers of people actually have habitually low intake levels and low blood levels. African Americans tend to have low blood levels of vitamin C as well as the highest risk of hypertension. Low intake of antioxidant-rich fruits and vegetables may be one of the causes of hypertension.

Adult↗

PubMed2002

Antioxidant supplementation decreases lipid peroxidation biomarker F(2)-isoprostanes in plasma of smokers.

Free radicals in cigarette smoke (CS) cause oxidative damage to proteins, DNA, and lipids, contributing to the pathobiology of atherosclerosis, heart disease, and cancer. In vitro studies have shown that antioxidants quench free radicals and ameliorate certain aspects of biomolecular damage caused by CS. It is hypothesized that a combination of antioxidants is more effective than a single antioxidant, due to their interactions. To investigate whether supplemental antioxidants reduce CS-related lipid peroxidation in vivo and whether they are more effective in combination, we conducted an intervention study in smokers. In a randomized double-blind placebo-controlled trial, we investigated whether vitamin C or an antioxidant mixture containing vitamin C, alpha-lipoic acid, and vitamin E decreases plasma F(2)-isoprostane levels, an index of oxidant stress, in smokers. Plasma of 126 smokers (mean age, 46 years; age range, 20-78 years) was analyzed for F(2)-isoprostanes at baseline and after intervention with antioxidants and placebo. In smokers with a body mass index (BMI) above the median, 2 months of daily supplementation with 500 mg of vitamin C decreased plasma F(2)-isoprostane levels by 28.8 pmol/liter when compared with the placebo group (P = 0.001); levels in the mixture group were 7.45 pmol/liter lower after treatment, but this difference was not statistically significant (P = 0.14). There was no treatment effect in smokers with a low BMI. BMI was significantly positively associated with plasma F(2)-isoprostane levels (trend P = 0.001). Antioxidants decrease smoking-related lipid peroxidation markers of oxidative stress in humans with high BMI. Our results do not indicate that an antioxidant combination is more effective than vitamin C alone. The intake of antioxidants may help prevent smoking-related diseases. Smoking cessation should still be considered the most effective way to prevent smoking-related diseases.

Adult↗

PubMed2001

Association among SF36 quality of life measures and nutrition, hospitalization, and mortality in hemodialysis.

Patients on maintenance hemodialysis (MHD) often show substantial reductions in quality of life (QoL). The SF36 (Short Form with 36 questions), a well-documented, self-administered QoL scoring system that includes eight independent scales and two main dimensions, has been widely used and validated. In 65 adult outpatients on MHD, the SF36 and its scales and dimensions, scored as a number between 0 and 100, and the nutritional and inflammatory state measured by subjective global assessment, near-infrared (NIR) body fat, body mass index (BMI), and pertinent laboratory values, including hemoglobin, albumin, and C-reactive protein were assessed. Twelve-month prospective hospitalization rates and mortality were used as the clinical outcomes. Multivariate (case-mix) adjusted correlation coefficients were statistically significant between SF36 scores and serum albumin and hemoglobin concentrations. There were significant inverse correlations between SF36 scores and the BMI and NIR body fat percentage. Hypoalbuminemic, anemic, and obese patients on MHD had a worse QoL. Prospective hospitalizations correlated significantly with the SF36 total score and its two main dimensions (r between -0.28 and -0.40). The Cox proportional regression relative risk of death for each 10 unit decrease in SF36 was 2.07 (95% CI, 1.08 to 3.98; P = 0.02). Of the eight components and two dimensions of the SF36, the Mental Health dimension and the SF36 total score had the strongest predictive value for mortality. Thus, in patients on MHD the SF36 appears to have significant associations with measures of nutritional status, anemia, and clinical outcomes, including prospective hospitalization and mortality. Even though obesity, unlike undernutrition, is not generally an indicator of poor outcome in MHD, the SF36 may detect obese patients on MHD at higher risk for morbidity and mortality.

Adult↗

PubMedDate not supplied

Variation in nutrient intakes by ethnicity: results from the Study of Women's Health Across the Nation (SWAN).

OBJECTIVE: To use food frequency questionnaires to summarize the macro- and micronutrient intakes of women of diverse ethnicity in the Study of Women's Health Across the Nation. DESIGN: The Study of Women's Health Across the Nation is a multisite, multiethnic, community-based, longitudinal study of midlife women at seven geographic locations in the USA. The cohort is made up of participants with African, Caucasian, Chinese, Hispanic, and Japanese ethnic backgrounds. The Block Food Frequency Questionnaire was modified to accommodate ethnic-specific diets and was administered by interview. Descriptive statistics for macro- and micronutrient intakes were calculated, and variation in nutrient intakes by ethnic group was assessed using multivariable models, with Bonferonni correction for multiple comparisons. RESULTS: The crude and energy-adjusted distributions of all 28 nutrients studied differed statistically by ethnicity ( < 0.001). In many cases the magnitude of the variation was small. For example, the difference between the highest and lowest mean energy intakes was approximately 135 kcal (African American vs. Hispanic). Other differences were substantial: the energy-adjusted total fat intake in Chinese women was at least 10% lower than all other ethnic groups except the Japanese women (all pair-wise comparisons; < 0.01). CONCLUSIONS: Knowledge of variation in nutrient intake is critical to the understanding of how diet and health are related. The broad range of nutrient intakes reported by these participants will permit exploration of the associations between diet, menopause, and health and consideration of the role of dietary factors in explaining health-related differences among women of diverse ethnicity.

Adult↗

PubMedDate not supplied

Effect of antioxidant intake on sperm chromatin stability in healthy nonsmoking men.

Oxidative stress is detrimental to sperm function and a significant factor in the etiology of male infertility. This report examines the association between dietary and supplementary intake of the antioxidants vitamin C, vitamin E, and beta-carotene and sperm chromatin integrity. Eighty-seven healthy male volunteers donated semen samples, completed food-frequency questionnaires, and provided information about their sociodemographic characteristics, medical and reproductive histories, and lifestyle habits. Sperm chromatin integrity was measured using the DNA fragmentation index (DFI) and related parameters, obtained from the sperm chromatin structure assay (SCSA). SCSA measures the susceptibility of sperm DNA to acid-induced denaturation in situ. After adjusting for age and duration of abstinence, there was no dose-response association between any DFI outcome and any antioxidant intake measure. Non-dose-related associations were found between beta-carotene intake and both the standard deviation of DFI (SD DFI) and the percent of immature sperm. Participants with moderate, but not high, beta-carotene intake had an increase in SD DFI compared with participants with low intake (adjusted means 206.7 and 180.5, respectively; P = .03), as well as an increase in the percentage of immature sperm (adjusted means 6.9% and 5.0%, respectively; P = .04). If antioxidant intake in the range studied is indeed beneficial for fertility in healthy men, it does not appear to be mediated through the integrity of sperm chromatin. The results of this study do not preclude possible beneficial effects of high antioxidant intake on sperm chromatin integrity for men with fertility problems.

Adult↗