Search PubMed⌕ Search

Biomedical subjects

Richard P Troiano

Publications and source records attributed to Richard P Troiano.

17 recordsLinked to original sources
PubMed2006

A comparison of two dietary instruments for evaluating the fat-breast cancer relationship.

BACKGROUND: Previous research suggests food diaries may be more efficient than food frequency questionnaires (FFQ) in detecting a dietary fat-breast cancer relationship. We assessed this further using 4 day food records (FRs) and FFQs in a large sample. METHODS: Participants were from the non-intervention group of the dietary modification component of the Women's Health Initiative Clinical Trial: 603 breast cancer cases and 1206 controls matched on age, clinic, and length of follow-up. Relative risks (RRs) were estimated using unconditional logistic regression, adjusted for confounders and for the selection into the trial of women with an FFQ report exceeding 32% calories from fat. Direct comparison of the statistical power of the two instruments used the standardized log RR. An alternative analysis after removing subjects with missing covariate data was also conducted. RESULTS: The RR estimate for breast cancer in the top quintile of total fat intake, adjusted for confounders and total energy, was 1.82 (P for trend 0.02) for the FR but 0.67 for the FFQ (P for trend 0.24). Following adjustment for selection, estimates were 2.09 (P for trend 0.008) for the FR (alternative: 2.54, P for trend 0.006) and 1.71 (P for trend 0.18) for the FFQ (alternative: 1.24, P for trend 0.41). Similar results were seen for fat subtypes, particularly unsaturated fats. Comparisons showed higher statistical power for the FR than the FFQ (e.g. total fat, P = 0.08: alternative P = 0.01). CONCLUSIONS: Alternative instruments, such as FRs, may be preferable to FFQs for evaluating diet-disease relationships in cohort studies. The results support a positive association between dietary fat and breast cancer.

Aged↗
PubMed2006

Active transportation increases adherence to activity recommendations.

BACKGROUND: Levels of physical activity (PA) contribute to health status and outcomes directly and indirectly via the effects of PA on obesity and other risk factors. Much past surveillance has focused on leisure-time physical activity (LTPA), but this may bias estimates of prevalence. This study explores inclusion of non-leisure-time walking and bicycling (NLTWB) used for transportation on the prevalence of adherence to PA recommendations and the magnitude of apparent disparities in adherence for California adults. METHODS: Results of the 2001 California Health Interview Survey, a large (n = 55,151) telephone survey were analyzed in 2005 using tabulation and logistic regression. RESULTS: Higher levels of LTPA were associated with youth, males, education, income, Pacific Islanders, and non-Hispanic (NH) whites. Inclusion of NLTWB reduced these differences for all five variables. The largest decreases in disparities in adherence occurred for race/ethnicity, education, and income, with decreases in adherence differences from approximately 18% to 7% for NH white vs Latino, approximately 27% to 16% for more than high school versus less than high school, and approximately 25% to 11% for more than 300% versus less than 100% of poverty level. Logistic regression comparing adherence gives similar results. For example, in respondents with more than high school education versus less than high school education (referent), the odds ratio changed from 2.23 (95% confidence interval [CI] = 2.0-2.4) to 1.7 (1.6-1.9) after the inclusion of NLTWB. CONCLUSIONS: Assessment of PA in multiple domains is required to understand differences in total levels of PA for people with different incomes, education levels, and racial/ethnic backgrounds. Inclusion of NLTWB reduces but does not eliminate disparities in adherence to recommended levels of PA.

Adolescent↗
PubMed2006

Physical activity and acculturation among adult Hispanics in the United States.

Understanding the prevalence and demographic correlates of physical activity is important for public health and epidemiological research. This analysis examines the association between acculturation and physical activity in a large (approximately 5,000) sample of Hispanic adults from the 2000 National Health Interview Survey. Scores for eight questions concerning language use were summed to produce an acculturation index. Factor analysis indicated that these questions assessed a single underlying construct. Self-reported adherence to recommendations concerning leisure time physical activity increased from 22. 6% in the least acculturated tertile to 47% in the most acculturated tertile. In contrast, prevalence of walking or bicycling for errands decreased from 25.2 to 18.2%, and prevalence of standing or walking during most of the day decreased from 82.8 to 65.6% as acculturation increased. Thus, patterns of physical activity associated with leisure versus nonleisure time differed among Hispanics with varying acculturation levels. Alternatively, cultural factors may have differential effects on responses to questions concerning leisure and nonleisure time physical activity. In either case, assessing both types of activity is important for monitoring and understanding Hispanic health behaviors and interpreting epidemiological studies that involve physical activity in Hispanics.

Acculturation↗
PubMed2005

Accelerometer use in physical activity: best practices and research recommendations.

Researchers are increasingly interested in the potential of accelerometers to improve our ability to measure and understand the health impacts of physical activity. Although accelerometers have been available commercially for more than 25 yr, broad consensus about how to use these tools has not been established. At a scientific conference in December 2004, a number of scientists were invited to present papers, serve as reactors or moderators to papers, present posters of original research, or serve as members of an audience knowledgeable about the use of accelerometers. During 2 1/2 d, information about best practices of accelerometer use was presented and suggestions for future research were made. From the collective experience of papers presented and discussions held, five areas of accelerometer use were described. This paper summarizes the best practices and future research needs from those five areas: monitor selection, quality, and dependability; monitor use protocols; monitor calibration; analysis of accelerometer data; and integration with other data sources. Suggestions for reporting standards for journal articles also are presented.

Acceleration↗
PubMed2004

Adjustments to improve the estimation of usual dietary intake distributions in the population.

We reexamined the current practice in estimating the distribution of usual dietary nutrient intakes from population surveys when using self-report dietary instruments, particularly the 24-h recall (24HR), in light of the new data from the Observing Protein and Energy Nutrition Study. In this study, reference biomarkers for energy (doubly labeled water) and protein [urinary nitrogen (UN)], together with multiple FFQs and 24HRs, were administered to 484 healthy volunteers. By using the reference biomarkers to estimate the distributions for energy and protein, the data confirmed previous reports that FFQs generally do not give an accurate impression of the distribution of usual dietary intake. The traditional method applied to 24HRs performed poorly because of underestimating the mean and overestimating the SD of the usual energy and protein intake distributions, and, although the National Research Council and the Iowa State University methods generally give better estimates of the shape of the distribution, they did not improve the estimates of the mean (10-15% underestimation for energy and 6-7% underestimation for protein). Results for urinary potassium, a putative biomarker for potassium intake, and reported potassium intake did not display this underestimation and may reflect either differential underreporting of foods or inadequacy of the potassium biomarker. A large controlled feeding study is required to validate conclusively the potassium biomarker. For energy intake, adjusting its 24HR-based distribution by using the UN biomarker appeared to capture the usual intake distribution quite accurately. Incorporating UN assessments into nutritional surveys, therefore, deserves serious consideration.

Adult↗
PubMed2003

Water turnover in 458 American adults 40-79 yr of age.

Despite recent interest in water intake, few data are available on water metabolism in adults. To determine the average and range of usual water intake, urine output, and total body water, we administered 2H oxide to 458 noninstitutionalized 40- to 79-yr-old adults living in temperate climates. Urine was collected in a subset of individuals (n = 280) to measure 24-h urine production using p-aminobenzoic acid to ensure complete collection. Preformed water intake was calculated from isotopic turnover and corrected for metabolic water and insensible water absorption from humidity. Preformed water intake, which is water from beverages and food moisture, averaged 3.0 l/day in men (range: 1.4-7.7 l/day) and 2.5 l/day in women (range: 1.2-4.6 l/day). Preformed water intake was lower in 70- to 79 (2.8 l/day)- than in 40- to 49-yr-old men and was lower in 70- to 79 (2.3 l/day)- than in 40- to 49- and 50- to 59-yr-old women. Urine production averaged 2.2 l/day in men (range: 0.6-4.9 l/day) and 2.2 l/day in women (0.9-6.0 l/day). There were no age-related differences in results in women, but 60- to 69-yr-old men had significantly higher urine output than 40- to 49- and 50- to 59-yr-old men. Only the 70- to 79-yr-old group included sufficient blacks for a racial analysis. Blacks in this age group showed significantly lower preformed water intake than did whites. Whites had significantly higher water turnover rates than blacks as well. Multivariate regression indicated that age, weight, height, and body mass index explained <12% of the gender-specific variance in water input or urine output, yet repeat measures indicated that within-individual coefficient of variation was 8% for preformed water intake (n = 22) and 9% for 24-h urine production (n = 222). These results demonstrate that water turnover is highly variable among individuals and that little of the variance is explained by anthropometric parameters.

4-Aminobenzoic Acid↗
PubMed2003

Structure of dietary measurement error: results of the OPEN biomarker study.

Multiple-day food records or 24-hour dietary recalls (24HRs) are commonly used as "reference" instruments to calibrate food frequency questionnaires (FFQs) and to adjust findings from nutritional epidemiologic studies for measurement error. Correct adjustment requires that the errors in the adopted reference instrument be independent of those in the FFQ and of true intake. The authors report data from the Observing Protein and Energy Nutrition (OPEN) Study, conducted from September 1999 to March 2000, in which valid reference biomarkers for energy (doubly labeled water) and protein (urinary nitrogen), together with a FFQ and 24HR, were observed in 484 healthy volunteers from Montgomery County, Maryland. Accounting for the reference biomarkers, the data suggest that the FFQ leads to severe attenuation in estimated disease relative risks for absolute protein or energy intake (a true relative risk of 2 would appear as 1.1 or smaller). For protein adjusted for energy intake by using either nutrient density or nutrient residuals, the attenuation is less severe (a relative risk of 2 would appear as approximately 1.3), lending weight to the use of energy adjustment. Using the 24HR as a reference instrument can seriously underestimate true attenuation (up to 60% for energy-adjusted protein). Results suggest that the interpretation of findings from FFQ-based epidemiologic studies of diet-disease associations needs to be reevaluated.

Adult↗
PubMed2003

Using intake biomarkers to evaluate the extent of dietary misreporting in a large sample of adults: the OPEN study.

This paper describes the Observing Protein and Energy Nutrition (OPEN) Study, conducted from September 1999 to March 2000. The purpose of the study was to assess dietary measurement error using two self-reported dietary instruments-the food frequency questionnaire (FFQ) and the 24-hour dietary recall (24HR)-and unbiased biomarkers of energy and protein intakes: doubly labeled water and urinary nitrogen. Participants were 484 men and women aged 40-69 years from Montgomery County, Maryland. Nine percent of men and 7% of women were defined as underreporters of both energy and protein intake on 24HRs; for FFQs, the comparable values were 35% for men and 23% for women. On average, men underreported energy intake compared with total energy expenditure by 12-14% on 24HRs and 31-36% on FFQs and underreported protein intake compared with a protein biomarker by 11-12% on 24HRs and 30-34% on FFQs. Women underreported energy intake on 24HRs by 16-20% and on FFQs by 34-38% and underreported protein intake by 11-15% on 24HRs and 27-32% on FFQs. There was little underreporting of the percentage of energy from protein for men or women. These findings have important implications for nutritional epidemiology and dietary surveillance.

Adult↗
PubMed2003

Comparison of estimated renal net acid excretion from dietary intake and body size with urine pH.

OBJECTIVE: The aim of this study was to examine whether estimated net acid excretion (NAE) from two dietary assessment instruments can predict urine pH in healthy volunteers. DESIGN: The Observing Protein and Energy Nutrition (OPEN) study, which was designed to assess dietary measurement error, included men and women aged 40 to 69 years. Participants were asked to complete two food frequency questionnaires (FFQs) and two 24-hour recalls at approximately three-month intervals, and to return two 24-hour urine samples during the same period. NAE was estimated using a previously described equation. The estimates obtained from the different dietary assessment measures were correlated with actual urine pH. SUBJECTS/SETTING: Four hundred eighty-four subjects were enrolled in the OPEN study. All participants were included in this study on urine pH, given that they had all completed at least one dietary assessment and one urine sample. The study took place in Montgomery County, MD, between September 1999 and March 2000. RESULTS: Correlation coefficients between NAE estimates using the FFQ data and the average of two urine pH measures were -0.34 and -0.39 for women and men, respectively. Removing within-person variance in the urine pH levels resulted in a deattenuated overall correlation of -0.50 for the FFQ. Correlations between the 24-hour recall estimates of NAE were -0.41 and -0.32 for women and men, respectively. For the 24-hour recalls, the deattenuated overall correlation was -0.50. APPLICATION/CONCLUSIONS: Our findings suggest that FFQs provide adequate dietary data to estimate renal NAE and could be used as a surrogate for urinary pH levels in large epidemiologic studies.

Acids↗
PubMed2003

Patterns of health behavior in U.S. adults.

BACKGROUND: Associations between health-related behaviors are important for two reasons. First, disease prevention and health promotion depend on understanding both prevalence of health behaviors and associations among such behaviors. Second, behaviors may have synergistic effects on disease risk. METHODS: We document patterns of adherence to recommendations concerning five behaviors (physical activity, tobacco use, alcohol consumption, fruit and vegetable consumption, and dietary fat intake) in U.S. adults (n = 15,425) using data from the Third National Health and Nutrition Examination Survey. Division of individuals into categories associated with adherence or nonadherence to lifestyle recommendations results in 32 patterns of adherence/nonadherence. RESULTS: Proportions of U.S. adults with 21 of 32 behavior patterns characterized here deviated from proportions expected if health behaviors are independent of each other. The two extreme patterns, all adherence (5.9%) and all nonadherence (4.9%), were found in about double the proportion expected. Age, gender, race/ethnicity, education, and income were associated with a number of patterns, including the two extremes. CONCLUSIONS: This analysis of behavior patterns highlights population subgroups of public health importance, provides a benchmark for studies of multivariate associations between health behaviors, and supports a multidimensional model of health behavior.

Adult↗
PubMed2003

A comparison of a food frequency questionnaire with a 24-hour recall for use in an epidemiological cohort study: results from the biomarker-based Observing Protein and Energy Nutrition (OPEN) study.

BACKGROUND: Most large cohort studies have used a food frequency questionnaire (FFQ) for assessing dietary intake. Several biomarker studies, however, have cast doubt on whether the FFQ has sufficient precision to allow detection of moderate but important diet-disease associations. We use data from the Observing Protein and Energy Nutrition (OPEN) study to compare the performance of a FFQ with that of a 24-hour recall (24HR). METHODS: The OPEN study included 484 healthy volunteer participants (261 men, 223 women) from Montgomery County, Maryland, aged 40-69. Each participant was asked to complete a FFQ and 24HR on two occasions 3 months apart, and a doubly labelled water (DLW) assessment and two 24-hour urine collections during the 2 weeks after the first FFQ and 24HR assessment. For both the FFQ and 24HR and for both men and women, we calculated attenuation factors for absolute energy, absolute protein, and protein density. RESULTS: For absolute energy and protein, a single FFQ's attenuation factor is 0.04-0.16. Repeat administrations lead to little improvement (0.08-0.19). Attenuation factors for a single 24HR are 0.10-0.20, but four repeats would yield attenuations of 0.20-0.37. For protein density a single FFQ has an attenuation of 0.3-0.4; for a single 24HR the attenuation factor is 0.15-0.25 but would increase to 0.35-0.50 with four repeats. CONCLUSIONS: Because of severe attenuation, the FFQ cannot be recommended as an instrument for evaluating relations between absolute intake of energy or protein and disease. Although this attenuation is lessened in analyses of energy-adjusted protein, it remains substantial for both FFQ and multiple 24HR. The utility of either of these instruments for detecting important but moderate relative risks (between 1.5 and 2.0), even for energy-adjusted dietary factors, is questionable.

Adult↗
PubMed2002

The association between urban form and physical activity in U.S. adults.

BACKGROUND: Physical inactivity is associated with multiple adverse health outcomes. Results from the transportation literature suggest that aspects of the urban environment may influence walking for transportation. In this paper we examine the association between a proxy measure of the urban environment and walking behavior. METHODS: We analyzed the association between home age and walking behavior in U.S. adults using data from the Third National Health and Nutrition Examination Survey. Logistic regression was used to estimate odds ratios and 95% confidence intervals and to control for the effects of gender, race/ethnicity, age, education level, household income, and activity limitations. RESULTS: Adults who lived in homes built before 1946 and from 1946 to 1973 were significantly more likely to walk 1+ miles > or =20 times per month than those who lived in homes built after 1973. This association was present among people living in urban and suburban counties, but absent among those living in rural counties. The association was also found in models that controlled for gender, race/ethnicity, age, education, income, and any health-related activity limitation. Other forms of leisure-time physical activity were not independently associated with home age. CONCLUSIONS: These results support the hypothesis that environmental variables influence walking frequency and suggest that home age may be a useful proxy for features of the urban environment that influence physical activity in the form of walking. Such proxy measures could facilitate testing ecologic models of health behavior using survey data.

Adult↗
PubMed2002

Stature and pubertal stage assessment in American boys: the 1988-1994 Third National Health and Nutrition Examination Survey.

PURPOSE: To describe current stature and pubertal development in North American boys, and to compare these measures with measures observed approximately 30 years ago. METHODS: We analyzed data (i.e., height, weight, and Tanner Stage) from the Third National Health and Nutrition Examination Survey (NHANES III), conducted between 1988-1994, and compared it to the National Health Examination Survey, Cycles II and III (HES II/III), conducted from 1963-1965 and 1966-1970. The surveys included physical examination and questionnaire components, employed cross-sectional designs, and are nationally representative. We used logistic regression to calculate median age at onset of pubertal stages. RESULTS: NHANES III included 2481 boys aged 8 to 18 years. HES II comprised 3010 boys aged 8-11 years and HES III comprised 3514 boys aged 12-17 years. The mean heights of the oldest boys in both surveys did not differ significantly; however, at younger ages, boys in the more recent survey were taller (average height difference among those aged 8-14 years was 2.0 cm). Boys in NHANES III were also heavier and had higher body mass index than those in HES II/III. The median estimated ages of onset of pubertal stages in NHANES III were 9.9, 12.2, 13.6, and 15.8 years for genital stages 2-5, respectively, and 11.9, 12.6, 13.6, and 15.7 years for pubic hair stages 2-5, respectively. For some stages, the median estimated age of onset of puberty was earlier among boys in NHANES III than among those in HES III. CONCLUSIONS: Differences in mean height at young ages, but not at older ages, suggest that the rate of growth among boys in NHANES III was faster than that of boys in the earlier surveys. This finding, coupled with the finding of earlier ages of onset of some pubertal stages, suggests that boys of this generation may be maturing more rapidly than did boys in the past.

Adolescent↗
PubMed2002

Summary of the 2000 Surgeon General's listening session: toward a national action plan on overweight and obesity.

OBJECTIVE: To provide insight into discussions at the Surgeon General's Listening Session, "Toward a National Action Plan on Overweight and Obesity," and to complement The Surgeon General's Call to Action to Prevent and Decrease Overweight and Obesity. RESEARCH METHODS AND PROCEDURES: On December 7 and 8, 2000, representatives from federal, state, academic, and private sectors attended the Surgeon General's Listening Session and were given an opportunity to recommend what to include in a national plan to address overweight and obesity. The public was invited to comment during a corresponding public comment period. The Surgeon General's Listening Session was also broadcast on the Internet, allowing others to view the deliberations live or access the archived files. Significant discussion points from the Listening Session have been reviewed by representatives of the federal agencies and are the basis of this complementary document. RESULTS: Examples of issues, strategies, and barriers to change are discussed within five thematic areas: schools, health care, family and community, worksite, and media. Suggested cooperative or collaborative actions for preventing and decreasing overweight and obesity are described. An annotated list of some programmatic partnerships is included. DISCUSSION: The Surgeon General's Listening Session provided an opportunity for representatives from family and community groups, schools, the media, the health-care environment, and worksites to become partners and to unite around the common goal of preventing and decreasing overweight and obesity. The combination of approaches from these perspectives offers a rich resource of opportunity to combat the public health epidemic of overweight and obesity.

Body Mass Index↗