Biomedical subjects

P S Haines

Publications and source records attributed to P S Haines.

At least 19 recordsLinked to original sources

PubMed2004

Nutrient intake and BMI as predictors of severity of ADL disability over 1 year in homebound elders.

PURPOSE: Although it is well-recognized that good nutrition is essential to health, quality of life, and disease management, evidence of the role of nutrition, especially dietary intake, in the development of health-related disability among the more vulnerable older men and women in the community is largely unavailable. METHODS: We examined self-reported and performance-based measures at baseline (demographic, psychosocial and health-related factors, BMI, burden of disease, dietary intake from 3 24-hour dietary recalls, lower extremity physical performance, and activities of daily living [ADL]) and 1-year follow-up (ADL) from a randomly recruited sample of homebound elders. Structural equation modeling was used to simultaneously evaluate the direct and indirect relationships among baseline factors and severity of disability in activities of daily living (ADL) at 1-year in 253 homebound elders. results: Almost 32% of the homebound sample reported increased severity of disability over 1 year. The full structural model fit the data very well and revealed that better summary intake of calcium, vitamin D, magnesium, and phosphorus was directly linked to better lower extremity performance (LEP) and indirectly to less severity of disability at one year, after controlling for baseline disability and the interrelationships of other factors. Greater BMI was directly associated with worse LEP and indirectly with greater severity of disability. CONCLUSIONS: The findings from this study acknowledge aspects of the complex direct and indirect relationships between nutrient intake, BMI, and disability among homebound elders. These results suggest that nutrient intake and BMI may be reasonable targets for intervention with multiple functional outcomes.

Activities of Daily Living↗

PubMed2001

Where's the fat? Trends in U.S. diets 1965-1996.

BACKGROUND: Controlling fat intake has been an ongoing health concern since the late 1950s. This study examines 30-year trends in food sources of fat intake. It focuses on both total fat and specific fatty acid classes to ascertain if there are trend differences by age, sex, or race/ethnicity. METHODS: Nationally representative cross-sectional U.S. Department of Agriculture surveys from 1965, 1977-1978, 1989-1991, and 1994-1996 form the basis of this analysis, which compares 45,357 adults aged 18 years and older. Food files linked over time are used to create comparable food groups and nutrient values. RESULTS: The proportion of fat in the diet from grain-based mixed dishes, higher-fat snack foods, and higher fat potatoes has increased to partially offset reductions in fat from dairy, red meat, and added fat categories. Food sources of fat differ by race/ethnicity and age. The percentage of fat from fast foods and ethnic foods increased over time from 1 to 11% of total fat. The ratio of visible to invisible fat declined considerably. CONCLUSION: While animal product-based sources of fat continue to require emphasis, the shift toward fast foods, fried foods, and grain-based mixed dish and edible oil sources requires more focus.

Adolescent↗

PubMed2001

The feasibility of using a telephone-administered survey for determining nutritional service needs of noninstitutionalized older adults in rural areas: time and costs.

PURPOSE: This study examined response, participation, time, and costs for a telephone-administered survey to obtain comprehensive information on general health, eating habits, living environment, and functional status from a sample of older persons in a rural North Carolina county. DESIGN AND METHODS: A probability sample of persons aged 60 years and older from the most recent electoral rolls were mailed a personalized letter, which was followed by telephone contact to recruit them into a contemporaneous survey that used a modified version of the Nutrition Screening Initiative's Level I and II screens. Time requirements and costs associated with the completion of surveys were calculated. RESULTS: Seventy-six percent of the persons contacted by telephone (residents of 96% of county precincts) completed the survey. Because minority elders were more likely to lack a working telephone, they were underrepresented in the sample. With 555 calling attempts (58% of surveys completed on first attempt), we estimated a cost of $10.65 per completed survey. IMPLICATIONS: Telephone-administered surveying of older adults may be considered as an appropriate component of an overall community-based service strategy. The estimation of the constituents of nutritional risk, by geographic area, economic status, or ethnicity, may aid in providing estimates of service needs and procuring and allocating resources. Additional methods of data collection are necessary in order to target older persons without telephone service.

Aged↗

PubMed2000

Correlates of serum lycopene in older women.

Experimental and epidemiological evidence suggests that lycopene, a predominant carotenoid found in human serum, may reduce the risk of certain cancers. We examined the association of dietary, physiological, and other factors with serum lycopene concentrations in a subsample of 946 postmenopausal women participating in the Women's Health Initiative. Pearson partial correlation coefficients and linear regression coefficients were calculated after adjustment for age, ethnicity, and serum low-density-lipoprotein (LDL) cholesterol. Serum lycopene was correlated with serum LDL cholesterol (r = 0.23) and dietary lycopene (r = 0.17, both p < 0.001). Individual food items found to be correlated with serum lycopene after adjustment included fresh tomatoes or tomato juice (r = 0.11), cooked tomatoes, tomato sauce, or salsa (r = 0.17), and spaghetti with meat sauce (r = 0.19, all p < 0.01). Age and body mass index were negatively associated with serum lycopene levels (both p < 0.001). Serum lycopene levels were highest in the summer and highest for those living in the northeastern United States. If we postulate that high serum lycopene levels reduce cancer risk, it becomes apparent that we have limited ability to detect this association from studies of lycopene intake. An understanding of factors associated with serum lycopene levels can be useful for the interpretation of studies of dietary lycopene and disease risk.

Aged↗

PubMed1999

Dietary patterns and trends in the United States: the UNC-CH approach.

Over the past 2 decades our group of nutrition and economics researchers at the University of North Carolina at Chapel Hill has used a wide array of methods to study eating patterns and dietary trends. Our focus has been on characterising the way diet has changed over time and identifying some of the major factors underlying these trends. The complexity of this undertaking has led us to develop a number of unique systems for classifying foods and assessing the overall quality of diet. We have also addressed the challenges that exist when measuring changes in both the food supply and food-related behaviors over time. This paper summarises some of the methodological work related to food grouping, overall diet quality indices, and trends research as well as the challenges we still face in this arena.

Diet↗

PubMed1999

The Diet Quality Index revised: a measurement instrument for populations.

OBJECTIVE: To evaluate a revision of the Diet Quality Index called the Diet Quality Index Revised (DQI-R). DESIGN: The original Diet Quality Index was revised to reflect current dietary guidance, to incorporate improved methods of estimating food servings, and to develop and incorporate measures of dietary variety and moderation. The scoring of the original scale was reversed in direction and expanded to a 100-point scale to improve interpretability. METHODS/SUBJECTS: Data from the 1994 Continuing Survey of Food Intakes by Individuals were used. A sample of 3,202 adults aged 18 and older contributed 2 days of dietary intake data based on 24-hour recalls for the development and revision of various components of the DQI-R. STATISTICAL ANALYSES: Pearson correlation analyses, ordinary least squares regression analyses, and a nonparametric test to determine trends across ordered groups were used. RESULTS: The mean DQI-R score for the 1994 sample was 63.4 of a possible 100-point score. Sample respondents were more likely to have met dietary guidance in the areas of dietary cholesterol (66.9% met goal) and iron intakes (59.6% met goal) relative to the Recommended Dietary Allowances but less likely to have met goals related to fruit servings (19.6% met goal), grain servings (23.1% met goal), and calcium intakes (16.6% met goal) relative to the Recommended Dietary Allowance. There is a statistically significant quantitative and qualitative improvement in all components of the DQI-R as one moves from the lowest grouping of scores to the highest. For example, persons with DQI-R scores less than 40 consumed 43.9% of energy from fat, 72% of the Adequate Intake for calcium, and 6.7% of the recommended servings of fruit per day. In contrast, those with DQI-R scores greater than 80 consumed 24.2% of energy from fat, 101% of the Adequate Intake for calcium, and 137% of the recommended servings of fruit per day. APPLICATIONS: The DQI-R reflects the dietary guidance principles of macronutrient distribution, moderation, variety, and proportionality. Although the index was designed to monitor dietary changes in populations rather than individuals, each index component reflects an aspect of national dietary guidance. Calculation of DQI-R scores for an individual should provide an estimate of diet quality relative to national guidelines, and differences in scores over time should suggest improvement or decline in overall diet quality.

Adolescent↗

PubMed1996

A comparison of dietary trends among racial and socioeconomic groups in the United States.

BACKGROUND: There may be dietary differences among racial and socioeconomic groups in the United States. METHODS: Using data from a representative sample of adults, we compared dietary trends among blacks and whites of varying socioeconomic status. We developed comparable measures of diet and of the consumption of macronutrients and food groups for 6061 participants in the 1965 Nationwide Food Consumption Surveys, 16,425 in the 1977-1978 Nationwide Food Consumption Surveys, and 9920 in the 1989-1991 Continuing Survey of Food Intake by Individuals (all conducted by the U.S. Department of Agriculture). The primary outcome was the score (range, 0 to 16) on the Diet Quality Index, a composite of eight food-and-nutrient-based recommendations from the National Academy of Sciences. A score of 4 or less was considered to indicate a relatively more healthful diet, and a value of 10 or more a relatively less healthful diet. RESULTS: Overall dietary quality improved in all groups, from a mean Diet Quality Index score of 7.4 in 1965 to 6.4 in 1989-1991. In 1965, blacks of low socioeconomic status and, to a lesser extent, whites of low socioeconomic status had better diets than whites of high socioeconomic status. By the 1989-1991 survey, the differences among racial and socioeconomic groups had narrowed. In 1965, 9.3 percent of whites of low socioeconomic status, 16.4 percent of blacks of low socioeconomic status, and 4.7 percent of whites of high socioeconomic status had mean scores of 4 or less. In the 1989-1991 survey the respective percentages were 19.9, 23.5, and 20.0. Fat consumption decreased in all groups. The consumption of fruits and vegetables varied little over time, except for an increase among blacks of medium and high socioeconomic status. The consumption of grains and legumes increased over time among whites of medium and high socioeconomic status and declined among blacks of low socioeconomic status. CONCLUSIONS: In 1965, there were large differences among groups in dietary quality, with whites of high socioeconomic status eating the least healthful diet, as measured by the index, and blacks of low socioeconomic status the most healthful. By the 1989-1991 survey, the diets of all groups had improved and were relatively similar.

Adult↗

PubMed1996

Trends in breakfast consumption of US adults between 1965 and 1991.

OBJECTIVE: To examine breakfast consumption patterns and trends between 1965 and 1991 for adults in the United States. DESIGN: Trends analysis pooling three cross-sectional surveys. SETTING: Nationally representative samples obtained from the Nationwide Food Consumption Survey (NFCS) of 1965, the NFCS of 1977-1978, and the 1989-1991 Continuing Survey of Food Intakes by Individuals. SUBJECTS: Adults aged 18 years and older: 6,274 in 1965, 18,033 in 1977-1978, and 10,812 in 1989-1991. All results reflect use of sampling weights, so results reflect nationally representative samples in each time period. MAIN OUTCOME MEASURES: Breakfast consumption, defined as the consumption of food and/or beverage between the hours of 5 AM and 9 AM, was the focus of the trends analysis. Population prevalence rates are reported for the entire population and population subgroups. STATISTICAL ANALYSIS PERFORMED: Probit analysis was used to identify factors associated with changes in breakfast consumption over time. RESULTS: Breakfast consumption declined in the 26-year period between 1965 and 1991 from 86% to 75% for US adults. Breakfast consumption increased with age, and the age differential increased over time. Urban-rural and South-non-South differences in breakfast consumption narrowed over time, whereas black-nonblack and college-noncollege differences increased slightly or remained constant. The nutritional quality of food consumed at breakfast has improved since 1965. CONCLUSIONS: Although part of the decline in breakfast consumption can be explained by personal and demographic determinants, other unknown factors contributed to the trends. Elucidation of such factors is necessary to predict differences in breakfast as a health-related behavior.

Adolescent↗

PubMed1994

Health lifestyle patterns of U.S. adults.

BACKGROUND: Reaching national health objectives depends upon our ability to encourage the performance of multiple good health behaviors. There are cognitive, social, and biological reasons for expecting health behaviors to cluster. However, few studies have found significant associations among health behaviors, with the exception of the documented link between smoking and alcohol consumption. METHODS: We used cluster analysis to identify population subgroups with similar patterns of diet quality, physical activity, alcohol consumption, and cigarette smoking. This is the first study of health behavior interrelationships to include a measure of overall diet quality and a large sample from a nationally representative survey of U.S. adults. RESULTS: We identified seven health behavior typologies: 10% of the sample (health promoting lifestyle) had an overall healthy lifestyle, 25% had a good diet but sedentary activity level, 18% had fair diet but high activity level (fitness lifestyle). Individuals in the passive lifestyle cluster (25%) had no active health promoting activities but did avoid risk taking health behaviors. Six percent of the sample were in a drinking cluster, 15% in a smoking cluster, and 2% had a hedonic lifestyle characterized by heavy drinking and smoking. These lifestyle clusters could be characterized by demographic and socioeconomic factors. CONCLUSIONS: This research indicates that it is possible to identify a discrete number of health lifestyles in a population sample of U.S. adults. Understanding past, present, and changing health lifestyles may provide insights for health behavior research and information for the development and targeting of public health programs that can impact on multifactorial chronic diseases.

Adult↗

PubMed1994

Diet quality index: capturing a multidimensional behavior.

OBJECTIVE: Data for 5,484 adults (aged 21 years and older) who participated in the 1987-88 Nationwide Food Consumption Survey (NFCS) were used to develop an index of overall dietary intake that related to the major, diet-related, chronic diseases in the United States. The low response rate of the 1987-88 NFCS has raised concerns about potential bias, but this large data set is useful for methodologic studies and research that does not attempt to generalize the results to the US population. ANALYSES: Dietary recommendations from the 1989 National Academy of Sciences publication Diet and Health were stratified into three levels of intake for scoring. Individuals who met a dietary goal were given a score of zero. Those who did not meet a goal, but had a fair diet, were given one point, and those who had a poor diet were given two points. These points were summed across eight diet variables to score the index from zero (excellent diet) to 16 (poor diet). RESULTS: Lower index scores were positively associated with high intakes of other important measures of diet quality (eg, fiber, vitamin C). We found that single nutrients (such as dietary fat) were not necessarily associated with other measures of diet quality. CONCLUSION: We concluded that this index ranking of overall dietary patterns was reflective of total diet quality, though substantial misclassification can result from using single nutrients or foods as indicators of diet quality.

Adult↗

PubMed1993

Physician-based diet counseling for cholesterol reduction: current practices, determinants, and strategies for improvement.

BACKGROUND: Physicians face increasing pressure to counsel their hypercholesterolemic patients about diet. To design effective physician-based treatment programs, a better understanding of current dietary counseling practice and its determinants is needed. METHODS: Using a survey previously tested for reliability and validity, we examined the relationship of dietary knowledge, attitudes, beliefs, organizational barriers, and treatment practices for cholesterol management among 60 resident and attending physicians practicing in the general medicine clinic of a university medical center that serves primarily rural and disadvantaged patients. The survey was administered in October of 1988 prior to the release of the National Cholesterol Education Program Guidelines. RESULTS: The response rate was 100%. Ninety-two percent of physicians surveyed believe that dietary treatment effectively lowers cholesterol and 68% feel responsible for providing such therapy. However, most (72%) feel ill-prepared to give diet counseling, lack confidence in their ability to help patients make meaningful dietary changes (95%), and cite organizational barriers, such as limited time (72%) or inadequate educational materials (47%). Physicians were more likely to report behaviorally focused diet counseling practices if they felt prepared to counsel (r = 0.42, P < 0.001), were confident in their counseling skills (r = 0.39, P < 0.01), or reported personally following a prudent diet (r = 0.36, P < 0.01). We discuss the implications of these findings and how they should guide the design of physician-based dietary interventions for cholesterol reduction.

Counseling↗

PubMed1992

Nutrition education for cardiovascular disease prevention among low income populations--description and pilot evaluation of a physician-based model.

Low income Americans are at greatest risk for coronary heart disease but have least access to health promotion programs for life style modification. Primary care physicians may represent one of the few sources of preventive care available to the poor. However, the majority of physicians feel unprepared to help patients achieve dietary change, and few existing nutrition intervention programs address the special needs of low literacy populations. The Food for Heart Program was developed to facilitate dietary counseling experienced by primary care physicians who care for low literacy patients and to overcome barriers to behavior change faced by patients. The program consists of three components: (1) a validated dietary risk assessment that rapidly identifies atherogenic eating habits and requires no nutritional expertise to administer or interpret, (2) a structured diet treatment program that is culturally specific for a southern patient population and links practical behavior change recommendations with results of the diet assessment, and (3) a system for monitoring and reinforcement that prompts physicians to review progress, reinforce prior messages, and reward positive change. Behavior change theory is used to guide the intervention and readability of the material has been assessed at the 5-6th grade level. An evaluation study of the Food for Heart Program suggests that it has a positive impact on physician counseling and that patients are responding favorably to these efforts.

Cardiovascular Diseases↗

PubMed1992

Dietary changes in older Americans, 1977-1987.

This study compares dietary practices of persons aged greater than or equal to 65 y surveyed as part of the 1977-78 and 1987-88 Nationwide Food Consumption Surveys. Intakes of high-fat beef and pork, whole milk, and white bread decreased with increases in low-fat beef, pork, poultry and fish, low-fat milk, and whole-grain breads. However, consumption of many important sources of calories and fat (high-fat desserts, butter, and margarine) and fiber (fruits, high-fiber cereals, and vegetables) changed little between 1977 and 1987. The food-consumption trends translated into modest changes in overall nutrient intake. Gender differences were small and contradict the prevailing feeling that women are changing their diets more rapidly than are men. The authors suggest that public health messages have focused too heavily on foods to avoid while not giving adequate guidance for how to plan and prepare meals that will enable older Americans to meet the current diet and health recommendations.

Aged↗

PubMed1992

Socioeconomic and behavioral correlates of body mass index in black adults: the Pitt County Study.

BACKGROUND: Obesity is more prevalent among Black women than Black men, but there is little information on the correlates of obesity in Blacks. This study describes the relations of sociodemographic factors and health behaviors to body mass index in a southern, Black population. METHODS: In 1988, a community probability sample of 1784 Black adults, aged 25 to 50, was examined in Pitt County, NC. RESULTS: More women than men were at least 20% overweight (57% vs 36%). The relation of socioeconomic status (a composite of education and occupation) to age-adjusted body mass index level was inverse in women but not in men. Body mass index did not differ with either current energy intake or energy expenditure. Smokers and drinkers had lower age-adjusted levels than non-smokers and abstainers. CONCLUSIONS: Since the excess body mass index levels associated with low socioeconomic status in women could not be explained after controlling for adverse health behaviors, further epidemiologic study of risk factors for obesity in Black women is recommended.

Adult↗

PubMed1992

Eating patterns and energy and nutrient intakes of US women.

A longitudinal multivariate analysis was used to determine whether differences in energy and nutrient intakes were present for women classified into different eating patterns. Ten multidimensional eating patterns were created based on the proportion of energy consumed at home and at seven away-from-home locations. Data were from 1,120 women aged 19 through 50 years who were surveyed up to six times over a 1-year period as part of the 1985 Continuing Survey of Food Intake by Individuals, US Department of Agriculture. Data from 5,993 days were analyzed. To examine differences in energy and nutrient intakes, longitudinal multivariate analyses were used to control for eating pattern and factors such as demographics, season, and day of week. Younger women in the Fast Food eating pattern consumed the greatest intakes of energy, total fat, saturated fat, cholesterol, and sodium. Well-educated, higher-income women in the Restaurant pattern consumed diets with the highest overall fat density. Nutrient densities for dietary fiber, calcium, vitamin C, and folacin were particularly low in away-from-home eating patterns. In contrast, moderately educated, middle-aged and middle-income women in the Home Mixed eating pattern (70% at home, 30% away from home) consumed the most healthful diets. We conclude that knowledge of demographics such as income and education is not enough to target dietary interventions. Rather, educational efforts must consider both demographics and the location of away-from-home eating. This will allow development of behavioral change strategies that consider food choices dictated by the eating environment as well as personal knowledge and attitude factors related to adoption of healthful food choices.

Adult↗

PubMed1991

Alcohol consumption and blood pressure in black adults: the Pitt County Study.

While there is a clear consensus in the epidemiologic literature on the direct association between alcohol consumption and blood pressure, the shape of this relation and its strength in blacks are uncertain. Therefore, the association between alcohol and blood pressure was examined in a community-based random sample of 1,784 black adults aged 25 to 50 years living in eastern North Carolina. These individuals were interviewed in 1988 for a study of psychosocial and dietary risk factors for elevated blood pressure. Alcohol consumption was estimated from responses to a food frequency questionnaire and was divided into four categories, which ranged from abstention (52% of the sample) to greater than or equal to seven drinks/week (12%). After adjustment for age and body mass, the systolic blood pressure of adults reporting greater than or equal to seven drinks/week exceeded that of nondrinkers by 6.8 mmHg for men and women (p less than 0.001). There was no evidence of a threshold effect, and similar patterns were observed for diastolic blood pressure. Being in the highest category of alcohol consumption was related to low socioeconomic status, lower social integration, and higher levels of socioeconomic stressors. These data are consistent with a graded association between alcohol and blood pressure in black adults and suggest the importance of social factors underlying this association.

Adult↗

PubMed1991

Socioeconomic status and electrolyte intake in black adults: the Pitt County Study.

BACKGROUND: Although the inverse association between socioeconomic status (SES) and blood pressure has often been observed, little is known about the relationship between SES and dietary risk factors for elevated blood pressure. Therefore, this study described the distribution of dietary intakes of sodium, potassium, and calcium and examined the association between electrolyte intake and SES among 1784 Black men and women aged 25 to 50 residing in eastern North Carolina. METHODS: Household interviews were conducted in 1988 to obtain information on psychosocial and dietary correlates of blood pressure. Electrolyte intake (mg/day) was assessed using a food frequency questionnaire adapted to reflect regional and ethnic food preferences. SES was categorized into three levels defined by the participant's educational level and occupation. RESULTS: After adjustment for age and energy intake, potassium and calcium intake increased with increasing SES for both sexes. Sodium intake was high for all groups and did not vary markedly with SES, but sodium to potassium and sodium to calcium ratios decreased with increasing SES. In addition, high SES individuals were more likely to believe that diet affects risk for disease and to report less salt use at the table and less current sodium consumption than in the past. CONCLUSION: These data indicate that nutritional beliefs as well as the consumption of electrolytes are associated with SES in Black adults.

Adult↗

PubMed1991

A brief dietary assessment to guide cholesterol reduction in low-income individuals: design and validation.

Low-income Americans are at greatest risk for coronary heart disease. Dietary assessment methods are needed that can efficiently and effectively guide diet counseling to reduce serum cholesterol in this population. The Dietary Risk Assessment is a brief food frequency questionnaire designed to guide an intervention program for cholesterol reduction. It can easily be administered and scored in 10 to 15 minutes by persons who are not trained in nutrition. The assessment is culturally specific for a low-income southern population, identifies positive as well as problematic dietary behaviors, is easily interpreted, and measures potential barriers to dietary change. The assessment was validated against 3 days of dietary recall data in a sample of 42 low-income individuals recruited from the waiting room of an ambulatory care clinic. A Keys score, which measures the serum-cholesterol-raising potential of the diet, was calculated for each patient from their recall data. The Keys and Dietary Risk Assessment scores were significantly correlated (r = .60, P less than .001). We conclude that the Dietary Risk Assessment can rank individuals by level of dietary atherogenic risk adequately to guide a dietary treatment program for low-income patients, an underserved population with a high prevalence of diet-induced elevations in serum cholesterol.

Cholesterol↗