The effect of keeping food records on eating patterns.
Explore the source record for details and available documents.
Aged↗
Biomedical subjects
R E Patterson
Publications and source records attributed to R E Patterson.
Olestra Postmarketing Surveillance Study: design and baseline results from the sentinel site.
OBJECTIVE: To describe the design of the Olestra Postmarketing Surveillance Study (OPMSS) and to present baseline results from the sentinel site. The purpose of the OPMSS is to monitor consumption patterns of olestra-containing snacks and to determine whether consumption affects nutritional status. DESIGN: The OPMSS combines repeated cross-section, random-digit dial telephone surveys before and after the market release of olestra-containing foods as well as intensive dietary and clinical assessments on a subsample of survey participants. SUBJECTS: Data are from baseline telephone (n = 1,962) and clinical (n = 1,069) assessment of participants (aged 18 to 74 years) in the Marion County, Indiana, sentinel site. Mean age of participants in the telephone survey was 43.2 years; 19% of respondents were black and 29% had completed college. STATISTICAL ANALYSIS: Analyses examined associations among savory snack use, fruit and vegetable consumption, and demographic and health-related characteristics. Data from the telephone survey were adjusted to be representative of the Marion County population. RESULTS: Almost 96% of the population surveyed had eaten savory snacks in the month before the survey: 74% had eaten regular-fat, 26% fat-reduced, and 78% nonfat types. Total snack consumption did not differ by gender, education, or race. Residents younger than 35 years ate snacks 16 times a month compared with 12 times a month among older residents. Types of snacks consumed differed markedly by demographic characteristics. Male, younger, and less educated residents ate more regular-fat snacks; female, white, and college-educated residents ate more nonfat snacks. In general, residents practicing healthful behaviors, including not smoking, eating fruits and vegetables, and exercising, also ate fewer regular-fat and more nonfat snacks. Fat intake was also related linearly to use of snack foods, ranging from 33.2% of energy among those consuming 1 serving per month or less to 36.8% among those consuming 20 or more servings per month. APPLICATIONS/CONCLUSIONS: Procedures for recruitment and nutrition assessment appear adequate for evaluating the impact of olestra consumption on nutritional status. Nutritionists should be aware that there is potential for relatively high olestra consumption, given that almost 35% of Marion County residents eat snack foods at least 20 times a month. Consumers eating at least 20 servings of snacks per month derived more than 12% of their total energy and fat from snack foods, which suggests that substituting olestra snacks could substantially reduce intakes of fat and energy.
Adolescent↗
Demographic and psychosocial predictors of fruit and vegetable intakes differ: implications for dietary interventions.
OBJECTIVE: The National Cancer Institute (Rockville, Md) has launched a nationwide initiative--5 A Day for Better Health--to encourage consumption of fruits and vegetables. Because the tastes and culinary uses of fruits and vegetables differ, however, it is not known whether a general 5-A-Day message is an effective intervention strategy. This study examined whether there are differences between the demographic and psychosocial correlates of fruit and vegetable intakes. DESIGN: Data are from the Washington State Cancer Risk Behavior Survey (1995-1996), a cross-sectional, random-digit-dial telephone survey representative of the adult population of Washington State. SUBJECTS/SETTING: Interviews were completed with 1,450 adults. Data were collected about demographic characteristics, health status, health-related behavior, fruit and vegetable intakes, and the following diet-related psychosocial factors: beliefs, motives, barriers, attitudes, and stages of dietary change. STATISTICAL ANALYSES: Multivariate linear regression analysis was used to test whether the associations of demographic characteristics and psychosocial factors with fruit intake differed from associations with vegetable intake. RESULTS: In general, health status, health-related behavior, and psychosocial factors were more strongly associated with fruit intakes than vegetable intakes. For example, regular exercisers consumed 0.44 more daily servings of fruits and 0.36 more servings of vegetables than nonexercisers. Compared with those in the preaction stage of dietary change, adults in the maintenance stage consumed 0.99 more daily servings of fruits and 0.68 more servings of vegetables. Intrinsic motivations for eating a healthful diet (eg, to feel better) were strongly associated with both fruit and vegetable intakes, and these associations were stronger for fruit. Extrinsic motivations were not associated with either fruit or vegetable intakes. APPLICATIONS: Dietary interventions based on a general 5-A-Day message may be more effective in increasing fruit intakes than vegetable intakes. Targeted interventions that focus specifically on vegetables are probably necessary. Intrinsic motives for eating a healthful diet should be key components of interventions to increase fruit and vegetable intakes.
Adult↗
Impact of work site health promotion on stages of dietary change: the Working Well Trial.
The stages of change construct has been applied to healthful dietary behavior in cross-sectional studies. This report examines associations of stages of change with diet prospectively and addresses whether (1) baseline stage of change predicts participation, (2) forward changes in stage movement were greater in treatment work sites, and (3) change in stage was associated with adoption of healthful diets, using data from a cohort of 11,237 employees. Findings indicate that persons in later stages of change reported higher participation levels. Employees from intervention work sites who were in preaction stages at baseline were much more likely to shift into action and maintenance stages than controls. Changes in dietary stage of change were associated with decreases in fat intake and increases in fiber, fruit and vegetable intake. Net change in diet due to the intervention was modest. Stage of change appears to be useful for understanding mediators of health promotion intervention effectiveness.
Adult↗
Trends in food label use associated with new nutrition labeling regulations.
OBJECTIVES: This study compared use of food labels before and after implementation of new Food and Drug Administration regulations in 1994. METHODS: Data were obtained by random-digit-dial surveys of Washington State residents in 1993 (n = 1001) and 1996 (n = 1450). RESULTS: After implementation of the new regulations, usual label use increased significantly, by 8.5 percentage points in women and 11.3 percentage points in men. More respondents looked for information on fat content and fewer failed to use labels because they "take too much time" or "are too hard to understand. CONCLUSIONS: Use of food labels and satisfaction with their content have increased, but 70% of adults still want labels to be easier to understand.
Adolescent↗
Cancer-related behavior of vitamin supplement users.
Epidemiological studies suggest that certain vitamin supplements may reduce the risk of some cancers. However, observational studies can be compromised by confounding, because supplement use is related to other factors that affect cancer risk. The purpose of this paper is to identify cancer-related behaviors that could confound studies of the associations between vitamin supplement use and cancer risk. Data are from a random digit dial survey to monitor cancer risk behavior in adults in Washington State (n = 1449). Unconditional logistic regression was used to examine whether regular supplement users were more likely to practice other cancer-related behaviors than nonusers, after adjustment for age, education, and smoking. Among women, supplement users were more likely to have had a sigmoidoscopy [odds ratio (OR), 2.3; 95% confidence interval (CI), 1.2-4.5], hemoccult (OR, 2.3; CI, 1.5-3.5), or mammogram (OR, 1.5; CI, 1.0-2.1) in the past 2 years. Among men, supplement users were twice as likely to have had a prostate-specific antigen test (OR, 2.2; CI, 1.3-3.7) and to regularly take aspirin (OR, 1.7; CI, 1.1-2.6). Supplement users were statistically significantly more likely to exercise regularly, eat four or more servings of fruits and vegetables per day, follow a low-fat diet pattern, and believe in a connection between diet and cancer. The association was especially strong for fruits and vegetables (women, OR, 1.9; and CI, 1.3-2.6; men, OR, 2.4; CI, 1.6-3.8). Those investigating the benefits and risks of vitamin and mineral supplements need to be aware of the lifestyle characteristics of supplement users to assess the potential for bias in their studies.
Adult↗
Associations of demographic and health-related characteristics with prostate cancer screening in Washington State.
This report describes associations of demographic and health-related characteristics with use of prostate cancer screening. Data are from a random-digit dial survey of Washington State residents. Analyses are restricted to men ages 40-79 years (n = 332) and examine both digital rectal examination (DRE) and blood tests for prostate-specific antigen (PSA) in the previous 2 years. Results are adjusted to be representative of the state's population. In 1996, 53.6% of men received either DRE, PSA, or both. Among those screened, 42% received DRE alone, 15% PSA alone, and 43% both PSA and DRE, and the percentages of men receiving PSA increased markedly with age (30%, ages 40-49 years; 58%, ages 50-59 years; and 77%, ages 60-79 years). After control for other demographic characteristics, the relative odds for any prostate cancer screening were 5.5 for ages 60-79 versus 40-49 years, 2.4 for 16+ versus < or = 12 years of education, and 4.0 for 2+ versus no physician visits in the previous 2 years (all P < 0.05). Characteristics generally associated with good health, including regular exercise and low fat and high fruit and vegetable intakes, were also significantly associated with prostate cancer screening. In conclusion, in 1996, approximately one-half of the men in Washington State over age 40 years had received prostate cancer screening in the previous 2 years. Few men were screened with PSA alone, and the use of PSA as part of prostate cancer screening increased markedly with age. Because PSA screening increases detection of prostate cancer, epidemiological studies of health behavior and cancer risk must carefully control for screening history to avoid detection bias.
Adult↗
Measurement error from assessing use of vitamin supplements at one point in time.
Although many epidemiologic studies ask about current use of vitamin supplements, long-term use is usually the exposure of etiologic interest. We conducted a mailed survey to investigate the relation between current and long-term (10-year) supplement use (N = 325 adults). Estimates of current daily intake for supplemental micronutrients were roughly twice that of average daily intake over the past 10 years. Correlations between current intake and long-term intake from supplements alone were 0.77, 0.75, and 0.65 for vitamin C, vitamin E, and calcium, respectively. A measure of supplement use at one point in time incorporates measurement error that will attenuate measures of association.
Aged↗
Vitamin supplements and cancer risk: the epidemiologic evidence.
This report reviews published epidemiologic research on the associations of vitamin and mineral supplementation with cancer risk. Although the literature on nutrition and cancer is vast, few reports to date have addressed supplemental nutrients directly (seven clinical trials, 16 cohort, and 36 case-control studies). These studies offer insight into effects of nutrients that are distinguishable from effects of other biologically active compounds in foods. Randomized clinical trials have not shown significant protective effects of beta-carotene, but have found protective effects of: alpha-tocopherol against prostate cancer; mixtures of retinol/zinc and beta-carotene/alpha-tocopherol/selenium against stomach cancer; and selenium against total, lung, and prostate cancers. Cohort studies provide little evidence that vitamin supplements are associated with cancer. Case-control studies have reported an inverse association between bladder cancer and vitamin C; oral/pharyngeal cancer and several supplemental vitamins; and several cancers and vitamin E. A randomized clinical trial, a cohort study, and a case-control study have all found inverse associations between colon cancer and vitamin E. Overall, there is modest evidence for protective effects of nutrients from supplements against several cancers. Future studies of supplement use and cancer appear warranted; however, methodologic problems that impair ability to assess supplement use and statistical modeling of the relation between cancer risk and supplement use need attention.
Case-Control Studies↗
Using a brief household food inventory as an environmental indicator of individual dietary practices.
OBJECTIVES: This study examined whether foods in household pantries are an indicator of house-hold members' diet. METHODS: In a random-digit-dial survey, the presence in the house of 15 high-fat foods was assessed with whoever answered the phone. A randomly selected household member was surveyed about diet-related behaviors (n = 1002). RESULTS: Individuals in the precontemplation stage of dietary change had more high-fat foods in their pantry than those in maintenance (means of 7.4 and 5.8, respectively). Individuals with low-fat pantries had an intake of 32% energy from fat vs 37% for those with high-fat pantries. CONCLUSIONS: Household food inventories are a practical and valid approach to monitoring dietary behaviors in community-based studies.
Adult↗
Relationship between vitamin and calcium supplement use and colon cancer.
The relationship between vitamin supplement use and colon cancer was assessed in a population-based case-control study among men and women aged 30-62 years. Cases were 251 men and 193 women diagnosed with colon cancer in 1985-1989 in three counties in the Seattle metropolitan area who were identified from the Surveillance, Epidemiology, and End Results cancer registry. Controls were 233 men and 194 women identified by random digit dialing. Supplement use was assessed by questions on frequency, duration, and dose per day (for individual supplements) or type (for multivitamins) during the 10-year period ending 2 years before diagnosis. All results were adjusted for age and sex and were not confounded by other measured behaviors. The average daily intake of supplemental vitamins A, C, E, folic acid, calcium, and multivitamins during the reference period were each associated with reduced risk of colon cancer (all P for trend < 0.03). The strongest associations were for use of vitamin E (odds ratio, 0.43; 95% confidence interval, 0.26-0.71 for > or = 200 IU/day versus none) and multivitamins (odds ratio, 0.49; 95% confidence interval, 0.35-0.69 for daily use versus no use; both P for trend < 0.001). These two associations were also significant using a stricter test of trend limited to supplement users, which reduces the effect of colinearity among these exposures. Because almost all vitamin D supplementation comes from multivitamin pills, the association of vitamin D use with colon cancer could not be distinguished from that of multivitamin use. Clinical trials or cohort studies with long-term assessment would be needed before public health recommendations could be made about supplement use.
Adenocarcinoma↗
Low-fat diet practices of older women: prevalence and implications for dietary assessment.
OBJECTIVE: To evaluate the importance of information on low-fat diet practices and consumption of reduced-fat foods for accurate assessment of energy and fat intakes using a semiquantitative food frequency questionnaire (FFQ). SUBJECTS: Subjects were 7,419 women, aged 50 to 79 years, who filled out an FFQ as part of eligibility screening for a diet modification component and/or a hormone replacement trial in a multicenter study of chronic disease prevention in postmenopausal women (Women's Health Initiative). STATISTICAL ANALYSIS: For 26 FFQ questions, we recoded the low-fat diet choices of participants to a high-fat counterpart and recalculated energy and fat intakes. We then determined the decrease in energy and nutrient estimates attributable to adding low-fat options to the FFQ. RESULTS: Low-fat diet practices were widespread in this population. For example, 69% of respondents rarely or never ate skin on chicken, 76% rarely or never ate fat on meat, 36% usually drank nonfat milk, 52% usually ate low-fat or fat-free mayonnaise, 59% ate low-fat chips/snacks, and 42% ate nonfat cheese. These low-fat choices had substantial effects on energy and nutrient estimates. Absolute decreases (and mean percentage decreases) for energy and nutrient measures attributable to adding low-fat diet options to the FFQ were 196 kcal (11.4%) energy, 9 percentage points in percentage energy from fat (22.3%), 23.2 g fat (29.0%), and 9.6 g saturated fat (32.5%). Black and Hispanic women and women of lower socioeconomic status reported significantly fewer low-fat diet practices than white women and women of higher socioeconomic status. CONCLUSION: Failure to collect information on low-fat diet practices with an FFQ will result in an upward bias in estimates of energy and fat intake, and the amount of error will vary by the personal characteristics of respondents.
Black or African American↗
Aerospace air pollution issues.
Practitioners of aerospace medicine are mindful of the environmental effects, particularly air pollution, caused by aviation and spaceflight operations. To an aerospace medicine specialist, the environment includes not only the air, water, and soil of the earth, but also the cabin milieu of aircraft and space vehicles where crews must work, sleep, and in some cases, live. Consequently, this article will address the following areas of concern: cabin air quality of aircraft, cabin air quality of space vehicles, noise, air pollution, and aerial spraying.
Aerospace Medicine↗
Do beliefs, knowledge, and perceived norms about diet and cancer predict dietary change?
OBJECTIVES: We hypothesized that belief in an association between diet and cancer, knowledge of dietary recommendations and food composition, and perceived norms would predict healthful dietary changes. METHODS: Data are from a population-based sample of Washington State residents (n = 607). Psychosocial constructs measured at baseline (1989/90) were used to predict changes in dietary practices, fat intake, fiber intake, and weight over 3 years. RESULTS: Adults who strongly believed in a diet-cancer connection decreased the percentage of energy consumed from fat by 1.20 percentage points and increased fiber intake by 0.69 g, compared with decreases of 0.21 percentage points and 0.57 g among those with no belief (P < .05). Adults with knowledge of the National Cancer Institute fat and fiber goals decreased their percentage of energy from fat by 1.70 points compared with an increase of 0.27 points among those with little knowledge (P < .05). Food composition knowledge and perceived pressure to eat a healthful diet were not significant predictors of changes in fat intake, fiber intake, or weight. CONCLUSIONS: Interventions that increase the public's beliefs in diet and health associations and communicate diet recommendations can encourage healthful dietary change.
Adult↗
Diagnosis of coronary artery disease in women: roles of three dimensional imaging with magnetic resonance or positron emission tomography.
Diagnosis and assessment of coronary artery disease (CAD) is especially difficult in women. The history of chest discomfort and various noninvasive tests each have particular problems, which indicate the need to consider more accurate tests such as cardiac magnetic resonance imaging (MRI) and positron emission tomography (PET). MRI of cardiac function at rest and during dobutamine stress has good accuracy, and MR Myocardial perfusion imaging (MPI) with gadolinium DTPA looks promising. The most exciting MR method is cineangiography (MRA), which images blood flow through the coronary arterial lumen as an intense signal. In an initial clinical trial this method showed excellent sensitivity and fair specificity in patients in whom adequate images could be obtained. MR spectroscopy (MRS) has imaged changes in high energy phosphates in patients with severe coronary stenoses during handgrip exercise, but is still experimental. PET MPI corrects the images for attenuation problems that limit the use of other radionuclide imaging procedures in women more than in men. Many studies show excellent sensitivity and specificity to diagnose CAD by PET MPI. In view of its clinical validation and the safety of dipyridamole relative to dobutamine, PET MPI appears to be the best test for assessing CAD in women. The greater accuracy of PET (or perhaps of fully developed MRI/MRA systems) will produce better clinical outcomes and cost-effectiveness for most patients than will less accurate modalities, despite their higher initial cost.
Contrast Media↗
Attenuation artifacts in SPECT: effect of wrap-around lung in 180 degrees cardiac studies.
UNLABELLED: We estimated that in 75%-90% of PET 82Rb patients the left lung appeared to wrap around the anterior aspect of the left ventricle. We used clinical PET 82Rb myocardial perfusion studies as the input to a SPECT computer simulation model to determine if patients with left lung wrap-around displayed consistent artifacts in reconstructed SPECT images. In particular, we sought an explanation for the hot lateral wall seen in SPECT images from normal female and male patients. METHODS: Attenuated SPECT 201Tl emission data were simulated from a mid-ventricular slice in 10 randomly selected clinical PET 82Rb studies with left lung wrap-around. In these same cases, the influence of left lung wrap-around was removed by assigning the left lung an attenuation coefficient which matched that of the heart. Five randomly selected clinical PET 82Rb studies without left lung wrap-around were also processed with our model. RESULTS: In all 10 cases with left lung wrap-around, reconstructed SPECT images showed the hot lateral wall artifact with a mean septal-to-lateral wall count ratio of 0.86. With left lung wrap-around removed in the same 10 patients, reconstructed images did not show hot lateral wall (mean septal-to-lateral wall count ratio = 1.07). The 5 cases without left lung wrap-around did not show hot lateral wall (mean septal-to-lateral wall count ratio = 1.04) and the ratios changed little with the filling of the left lung (mean septal-to-lateral wall count ratio = 1.05). CONCLUSION: Results of our PET-to-SPECT computer simulation model showed that the hot lateral wall artifact found in SPECT myocardial perfusion images was related to the orientation and positions of the left ventricle and the left lung.
Artifacts↗
Comparison of cost-effectiveness and utility of exercise ECG, single photon emission computed tomography, positron emission tomography, and coronary angiography for diagnosis of coronary artery disease.
BACKGROUND: To compare cost-effectiveness and utility of four clinical algorithms to diagnose obstructive coronary atherosclerotic heart disease (CAD), we compared exercise ECG (ExECG), stress single photon emission computed tomography (SPECT), positron emission tomography (PET), and coronary angiography. METHODS AND RESULTS: Published data and a straightforward mathematical model based on Bayes' theorem were used to compare strategies. Effectiveness was defined as the number of patients with diagnosed CAD, and utility was defined as the clinical outcome, ie, the number of quality-adjusted life years (QALY) extended by therapy after the diagnosis of CAD. Our model used published values for costs, accuracy, and complication rates of tests. Analysis of the model indicates the following results. (1) The direct cost (fee) for each test differs considerably from total cost per delta QALY. (2) As pretest likelihood of CAD (pCAD) in the population increases, there is a linear increase in cost per patient tested but a hyperbolic decrease in cost per effect and cost per utility unit, ie, increased cost-effectiveness and decreased cost per utility unit. (3) At pCAD < 0.70, analysis of the model indicates that stress PET is the most cost-effective test, with the lowest cost per utility, followed by SPECT, ExECG, and angiography, in that order. (4) Above a threshold value of pCAD of 0.70 (for example, middle-aged men with typical angina), proceeding directly to angiography as the first test showed the lowest cost per effect or utility. This quantitative model has the advantage of estimating a threshold value of pCAD (0.70) at which the rank order of cost-effectiveness and cost per utility unit change. The model also allows substitution of different values for any variable as a way to account for the uncertainties of clinical data, ie, changing costs, test accuracy and risk, etc. This procedure, called sensitivity analysis, showed that the rank order of cost-effectiveness did not change despite changes in several variables. CONCLUSIONS: (1) Estimation of total costs of diagnostic tests for CAD requires consideration not only of the direct cost of the test per se (eg, test fees) but also of the indirect and induced costs of management algorithms based on the test (eg, cost/delta QALY). (2) It is essential to consider the clinical history (pCAD) when selecting the clinical algorithm to make a diagnosis with the lowest cost per effect or cost per utility unit. (3) Stress PET shows the lowest cost per effect or cost per utility unit in patients with pCAD < 0.70. (4) Angiography shows the lowest cost per effect or cost per utility unit in patients with pCAD > 0.70.
Adult↗
Psychosocial correlates of healthful diets: baseline results from the Working Well Study.
BACKGROUND: This report examines psychosocial factors related to selection of healthful diets. Understanding why people select healthful diets can lead to rational design and evaluation of nutrition intervention programs. METHODS: Data are from 16,287 respondents to the baseline survey for the Working Well Trial, a randomized, controlled trial of worksite-based health promotion. The psychosocial constructs we measured were predisposing factors (beliefs, perceived benefits, and motivation; 5 items, Cronbach's alpha = 0.65) and enabling factors (barriers, norms, and social support; 6 items, Cronbach's alpha = 0.57). The healthful diet outcomes were intakes of fat, fiber, and servings of fruits and vegetables (from a food frequency questionnaire) and intention and self-efficacy to decrease fat and increase fruits and vegetables. RESULTS: Based on a 5-point scale (1 = low to 5 = high), the mean predisposing factor scale score was much higher than the enabling factor scale score (3.77 vs 2.50, P < 0.001). Comparing respondents in the highest category of the predisposing scale to those in the lowest, mean percentage of energy from fat was 22.4% lower (-9 percentage points), fiber was 85.2% higher (+4.6 g/1,000 kcal), and fruits and vegetables were 100% higher (+1.6 servings/day) (all trends, P < 0.001). Associations were similar, but much weaker, for the enabling scale. Multiple regression models, which included covariates related to diet and the predisposing and enabling scales, explained a total of between 13 and 26% of the variance in diet and intention to change diet. After control for covariates, the predisposing scale remained a significant and strong predictor of diet and intention to change diet but the enabling scale explained small and nonsignificant amounts of variance. CONCLUSIONS: Predisposing factors are strong predictors of current diet and intention to change diet. Final results from the Working Well Trial will provide more information on whether enabling factors can be enhanced by intervention and whether these changes result in healthier eating patterns.
Adult↗