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PubMed2005

Estimated urine pH and bladder cancer risk in a cohort of male smokers (Finland).

OBJECTIVE: Low urine pH may be an important risk factor for bladder cancer, although few studies have evaluated this association. We examined the relationship between estimated renal net acid excretion (NAE), an indirect measure of urine pH based on nutrient intake and anthropometry, and bladder cancer risk in the Alpha-Tocopherol, Beta-Carotene Cancer Prevention (ATBC) Study. METHODS: At baseline, 27,096 male smokers 50-69 years old completed a dietary questionnaire that assessed usual frequency of consumption and portion sizes for the previous 12 months, had height and weight measured, and provided a history of smoking. A total of 446 incident bladder cancer cases were identified during up to 17.4 years of follow-up. RESULTS: In multivariate proportional hazards models, the relative risk (RR) for bladder cancer was 1.15 (95% confidence interval (CI)=0.86-1.55) for individuals in the highest (i.e., most acidic) versus the lowest (i.e., least acidic) NAE quintile (p=0.38). Among men who smoked for more than 45 years, there was a suggestion of increased risk with higher NAE levels (RR=1.72, 95% CI=0.96-3.10, p=0.08). CONCLUSIONS: These findings do not indicate that urine pH is a major risk factor for bladder cancer, although certain subsets of individuals may be at increased risk.

Aged↗
PubMed1993

Validation of 24-hour recalls assisted by food records in third-grade children. The CATCH Collaborative Group.

OBJECTIVE: The objective of the study was to validate the use of 24-hour recalls assisted by food records as a dietary assessment tool for use with third-grade children. DESIGN: Trained staff observed children during mealtime at school, and parents observed and recorded what children ate in their presence. The following day children participated in a 24-hour recall interview. Children's ability to recall what they consumed during a 24-hour period was compared with observational data collected during the same period. SETTING: All data were collected in elementary school settings at four sites involved in the Child and Adolescent Trial for Cardiovascular Health. SUBJECTS: The sample of 49 children was self-selected, based on parents' willingness to observe and record their child's food intake. MAIN OUTCOME MEASURES: Recalled and observed data for energy and nutrient levels were compared using mean energy and nutrient analysis and quartile classification. In addition, recalled and observed foods were compared by meal type and estimation of portion size. STATISTICAL ANALYSIS PERFORMED: Paired t tests, Pearson and Spearman correlations, and classification analysis were used to compare recalled and observed data. RESULTS: Comparison of observed and recalled food intakes showed no significant differences in percentage of energy from total fat, saturated fat, monounsaturated fat, and polyunsaturated fat or in the amount of sodium consumed, although there were differences in energy intakes. Spearman rank order correlations between recalled and observed nutrients ranged from .45 to .79. A 77.9% agreement was found across all meals in the food items children recalled having consumed compared with those adults actually observed them consuming. CONCLUSIONS: We conclude that the 24-hour recall assisted by food records is a valid method for assessing the dietary intake of children as young as 8 years old for the purpose of group comparison.

Age Factors↗
PubMed1994

Accuracy of estimating food intake by observation.

OBJECTIVE: To determine the accuracy of direct observation in food-weight estimation as measured under controlled field conditions. DESIGN AND SUBJECTS: Ten local Nepalis were trained in observational techniques and tested in food-weight estimation during a 3-month training period and for 4 months after training. SETTING: The study was carried out in the Sarlahi District, a rural, central lowland region of Nepal that borders India. MAIN OUTCOME MEASURES: Thirty testing sessions (a total of 6,902 observations) were completed on more than 150 different foods. Estimates of observed food weight were compared with actual weights and were analyzed. STATISTICAL ANALYSES PERFORMED: Pearson's correlation coefficients were calculated to examine associations between estimated and actual weights. RESULTS: Observer estimates of food weights were highly correlated with actual weights (r = .96) for the entire testing period. The linear regression equation (y = .96x + 1.3) suggests that the relationship between actual and observed food weights (in grams) was also accurate. Most observers showed improvement with training. Substantial reductions in both mean and standard deviation of percentage error were achieved over time. Accuracy of estimates was influenced by characteristics of foods weighted; small quantities (less than 20 g), certain nonstaple foods, and foods of high volume but light weight had less accurate estimates. CONCLUSIONS: Direct observation is an important method for assessing dietary intake that does not rely on a respondents' ability to recall his or her own or another's food consumption. It is feasible to train local observers to make visual estimates of food weight, but the accuracy of their estimates varies by food and portion size.

Adult↗
PubMed1995

Reproducibility of an Italian food frequency questionnaire for cancer studies. Results for specific nutrients.

The reproducibility of measures of the intake of total energy and 27 selected nutrients from a quantitative food frequency questionnaire (FFQ) used in a case-control study on cancer of the breast, ovary, and digestive tract was evaluated. The results of two FFQ administrations at an interval of 3 to 10 months (median = 5.4 months) to 452 volunteers (144 males and 308 females; median age = 50 years) from three Italian provinces (Pordenone, Genoa, and Forì) were compared. Pearson correlation coefficients (r) between crude nutrient intake (unadjusted for energy) ranged from 0.50 for vegetable fat to 0.80 for alcohol, with most values falling between 0.60 and 0.70 (median r = 0.67). Adjustment of nutrient intakes for total energy slightly decreased most coefficients (median r = 0.60). The agreement between the two measurements did not differ substantially by sex, age, education, and interval between interviews. The contribution of specific FFQ components (i.e., frequency-only questions, open questions, portion size, and fat intake pattern) was also assessed separately with respect to the performance and reproducibility of nutrient measures, yielding, in general, very similar results. The seven questions concerning individual fat intake pattern, which were used to modulate the composition of various recipes, led, however, to a significant increase in mean daily intake of vegetable fat, oleic acid, and vitamin E, but a reduction of estimated daily intake of linoleic acid and polyunsaturated fatty acids.(ABSTRACT TRUNCATED AT 250 WORDS)

Case-Control Studies↗
PubMed2005

The effects of a low-fat, plant-based dietary intervention on body weight, metabolism, and insulin sensitivity.

PURPOSE: This study investigated the effect of a low-fat, plant-based diet on body weight, metabolism, and insulin sensitivity, while controlling for exercise in free-living individuals. SUBJECTS AND METHODS: In an outpatient setting, 64 overweight, postmenopausal women were randomly assigned to a low-fat, vegan diet or a control diet based on National Cholesterol Education Program guidelines, without energy intake limits, and were asked to maintain exercise unchanged. Dietary intake, body weight and composition, resting metabolic rate, thermic effect of food, and insulin sensitivity were measured at baseline and 14 weeks. RESULTS: Mean +/- standard deviation intervention-group body weight decreased 5.8 +/- 3.2 kg, compared with 3.8 +/- 2.8 kg in the control group (P = .012). In a regression model of predictors of weight change, including diet group and changes in energy intake, thermic effect of food, resting metabolic rate, and reported energy expenditure, significant effects were found for diet group (P < .05), thermic effect of food (P < .05), and resting metabolic rate (P < .001). An index of insulin sensitivity increased from 4.6 +/- 2.9 to 5.7 +/- 3.9 (P = .017) in the intervention group, but the difference between groups was not significant (P = .17). CONCLUSION: Adoption of a low-fat, vegan diet was associated with significant weight loss in overweight postmenopausal women, despite the absence of prescribed limits on portion size or energy intake.

Adult↗
PubMed2004

Effects of food attributes and feeding environment on acceptance, consumption and body weight: lessons learned in a twenty-year program of military ration research US Army Research (Part 2).

Twenty years of testing in the field has consistently revealed that food intake is inadequate when packaged military rations are fed as the sole source of food. Food intake is much lower and there is a loss of body weight. Conversely when these rations are fed to students or military personnel for periods ranging from 3 to 42 days in a cafeteria-like setting, food intake is comparable to levels of a control group provided with freshly prepared food. Under these conditions, body weight is maintained. In this review, the consumption pattern is considered in terms of characteristics of the food (acceptability, variety, portion size, beverages, serving temperature, appropriateness for time of day, monotony, and novelty) and the eating milieu (social interactions, time, ease of preparing and consuming a meal). The twenty-year program of military ration research has led us to conclude that both the food and the context must be considered in understanding and controlling food intake.

Eating↗
PubMed2004

Food acceptability in field studies with US army men and women: relationship with food intake and food choice after repeated exposures.

Laboratory data with single exposures showed that palatability has a positive relationship with food intake. The question addressed in this study is whether this relationship also holds over repeated exposures in non-laboratory contexts in more natural environments. The data were collected in four field studies, lasting 4-11 days with 307 US Army men and 119 Army women, and comprised 5791 main meals and 8831 snacks in total. Acceptability was rated on the nine point hedonic scale, and intake was registered in units of 1/4, 1/2, 3/4, or 1 or more times of the provided portion size. Correlation coefficients between individual acceptability ratings and intakes varied from 0.22 to 0.62 for the main meals (n=193-2267), and between 0.13 and 0.56 for the snacks (n=304-2967). The likelihood of choosing a meal for the second time was positively related to the acceptability rating of the meal when it was consumed for the first time. The results reinforce the importance of liking in food choice and food intake/choice behavior. However, the magnitude of the correlation coefficients between acceptability ratings and food intake suggest that environmental factors also have an important role in determining intake and choice.

Adult↗
PubMed2005

Behavioural determinants of obesity.

Obesity in children arises from a complex interplay between genetic susceptibility and behaviour, primarily relating to dietary habits and physical activity. Evidence for specific behavioural factors that promote or protect against excess weight gain in children is more limited than in adults, and the effects of growth and development are not clear. A number of behavioural risk factors has been postulated, including diets with a high energy density, high consumption of sugar-sweetened beverages, large portion sizes, eating patterns, high levels of sedentary behaviour and low levels of physical activity. However, most evidence is derived from cross-sectional studies which frequently yield conflicting results. More prospective studies with accurate measures of exposures and outcomes in terms of body composition are needed to provide more robust evidence on which to base interventions to achieve long-term behavioural change and prevent excess weight gains in children.

Carbonated Beverages↗
PubMed2005

Childhood obesity. Treatment options.

The prevalence of child and adolescent overweight and obesity is rapidly increasing and is associated with morbidity, both medical and psychosocial. Obesity is unlikely to resolve spontaneously. It is important that health professionals can assess obesity and initiate an action plan. The evidence base for what works best in the management of child and adolescent overweight and obesity is limited. It is uncertain whether protocols from clinical research trials can be translated into primary care. Dietary change, with an emphasis on lower fat intake and smaller portion size, should be commenced. There should be an increase in physical activity and a decrease in sedentary behaviours, combined with behavioural change and parental involvement. These are the elements of a lifestyle intervention. In the severely obese adolescent with obesity-related co-morbidity, the use of very low-energy diets and anti-obesity agents could be considered. Bariatric surgery may be indicated in carefully selected, older, severely obese adolescents.

Adolescent↗
PubMed2005

Assessment of dietary intake of flavouring substances within the procedure for their safety evaluation: advantages and limitations of estimates obtained by means of a per capita method.

The procedure for the safety evaluation of flavourings adopted by the European Commission in order to establish a positive list of these substances is a stepwise approach which was developed by the Joint FAO/WHO Expert Committee on Food Additives (JECFA) and amended by the Scientific Committee on Food. Within this procedure, a per capita amount based on industrial poundage data of flavourings, is calculated to estimate the dietary intake by means of the maximised survey-derived daily intake (MSDI) method. This paper reviews the MSDI method in order to check if it can provide conservative intake estimates as needed at the first steps of a stepwise procedure. Scientific papers and opinions dealing with the MSDI method were reviewed. Concentration levels reported by the industry were compared with estimates obtained with the MSDI method. It appeared that, in some cases, these estimates could be orders of magnitude (up to 5) lower than those calculated considering concentration levels provided by the industry and regular consumption of flavoured foods and beverages. A critical review of two studies which had been used to support the statement that MSDI is a conservative method for assessing exposure to flavourings among high consumers was performed. Special attention was given to the factors that affect exposure at high percentiles, such as brand loyalty and portion sizes. It is concluded that these studies may not be suitable to validate the MSDI method used to assess intakes of flavours by European consumers due to shortcomings in the assumptions made and in the data used. Exposure assessment is an essential component of risk assessment. The present paper suggests that the MSDI method is not sufficiently conservative. There is therefore a clear need for either using an alternative method to estimate exposure to flavourings in the procedure or for limiting intakes to the levels at which the safety was assessed.

Consumer Product Safety↗
PubMed2004

Disagreement of energy and macronutrient intakes estimated from a food frequency questionnaire and 3-day diet record in girls 4 to 9 years of age.

BACKGROUND: The Block98 food frequency questionnaire (FFQ) has been validated for dietary assessment of usual intakes in adults, but not in children. OBJECTIVE: To assess the agreement of the Block98 FFQ and 3-day diet records for measuring dietary intakes in young girls. SUBJECTS/SETTING: Healthy 4- to 9-year-old girls (N=61; 6.5+/-1.6 years) were recruited from the Athens/Clarke county area in Georgia. DESIGN: Dietary intakes were measured using the Block98 FFQ and 3-day diet records, with nutrient analysis of the 3-day diet records conducted using the Food Processor computer program (ESHA; version 7.21, 1998, ESHA Research, Salem, OR). The Block98 FFQ was completed by a trained interviewer and parent, with input from the child, if able. Food models and portion size pictures were used to increase reporting accuracy. STATISTICAL ANALYSIS: Paired sample t tests and simple regression were conducted to determine whether the two diet instruments reported similar values for energy and macronutrients. RESULTS: Block98 FFQ overestimated intakes from 3-day diet records for energy (2,180+/-692 vs 1,749+/-328 kcal), protein (68.3+/-25.9 vs 57.9+/-14.8 g/day), carbohydrate (298.7+/-97.0 vs 244.7+/-46.1 g/day) and fat (83.6+/-30.5 vs 62.3+/-14.7 g/day) (P<.05). Furthermore, the nutrients assessed using the two different methods were only moderately correlated (range: r=0.40 to 0.55). APPLICATIONS/CONCLUSIONS: The Block98 FFQ agreed weakly to moderately with the 3-day diet records, and resulted in consistently higher intakes of all nutrients. These findings suggest that additional work is needed to develop a FFQ that reflects young children's energy and macronutrient intakes.

Child↗
PubMed2004

Dietary patterns in women treated for breast cancer who successfully reduce fat intake: the Women's Intervention Nutrition Study (WINS).

OBJECTIVE: The objectives of this study were to assess the types of dietary changes made by women who successfully reduced their fat intake in response to low-fat diet instruction and to evaluate the effects of these changes on nutrient intake. DESIGN: Two hundred women enrolled in the low-fat intervention arm of the Women's Intervention Nutrition Study (WINS) were randomly selected. Woman whose baseline fat intake was less than 20% energy from fat were excluded from the study, resulting in a total population of 163. These women were categorized into either the strictly adherent (SA) (those who met their fat gram goal and reported less than 20 % calories from fat, n=50) or the not strictly adherent (NSA) (those who exceeded their fat gram goal and reported 20% or greater calories from fat, n=113) group. The food choices made by SA and NSA subjects were analyzed to identify those that promoted greater adherence. SUBJECTS/SETTING: The participants were free-living women who had been instructed to follow a diet that would meet a specific fat gram goal calculated to provide 15% of calories from fat. STATISTICAL ANALYSES PERFORMED: Descriptive statistics were used to describe food groups and subgroups. t tests were used to determine statistical significance between and within groups. chi(2) analysis was used to assess differences in demographic variables. RESULTS: There were no marked differences in food patterns of the SA and NSA subjects when compared with the Food Guide Pyramid (FGP) recommendations. Both met FGP serving recommendations at baseline. At 12 months, both showed reductions in the number of servings from fats and oils; SA subjects showed a greater reduction (from 4.18+/-3.6 to 3.0+/-2.4) as well as a reduction in servings from the bread group intake (5.7+/-2.2 to 4.8+/-2.1). Evaluation of food subgroups from within FGP groups showed strategies that promoted fat reduction, such as reducing portion sizes of high-fat foods. The use of these strategies was greater in the SA subjects. The reduction in fat intake had little impact on nutrient adequacy. SA and NSA subjects reduced energy intake from baseline to follow-up, with SA subjects reporting lower intakes. There were few differences in nutrient intakes between the SA and NSA subjects at either time period. CONCLUSIONS: The results from this study suggest specific strategies that promote successful reduction in fat intake without compromising nutrient intake. This information can be used to guide others in making dietary changes.

Adult↗
PubMed2004

Validity of self-reported dietary intake at school meals by American Indian children: the Pathways Study.

OBJECTIVE: To examine the validity of a modified diet record-assisted 24-hour recall in third-grade (8 to 10 years old) American Indian children. DESIGN: The children were trained to record their food intake using diet records, and then they recalled their 24-hour food intakes, using the diet records as memory prompts, during interviews by trained staff using the Minnesota Nutrition Data System (NDS; version 2.6, 1993, Food database version 8A, Nutrient database version 23; Nutrition Coordinating Center, University of Minnesota, Minneapolis). The modified method added training in portion size estimation. Direct observation of the children's intakes during school meals was used to validate the accuracy of their self-reported recalls. SUBJECTS: Eighty third-grade children recruited from schools from four of the American Indian Nations participating in the Pathways Study. Statistical analyses performed Pearson correlations were used for nutrient level data. A mixed regression model (PROC MIXED), with no other fixed effects and site as a random effect, was used to test the null hypothesis that the difference between recalled and observed intakes was zero (H(o): beta(o)=0). Food intake data were obtained from the Nutrition Data System Record Reports. RESULTS: There were no significant differences between recalled and observed energy intakes for the school meals combined or for either meal individually. Percentages of energy intake from fat, protein, and carbohydrate from recalls were not significantly different from those observed for the combined school meals. Pearson correlations for energy and energy-providing nutrients ranged from 0.52 to 0.86 for both meals, from 0.55 to 0.86 for school lunch, and from 0.61 to 0.86 for school breakfast. Agreement between recalled and observed food items was 75%. Children recalled 57% of food quantities within +/-10% of observed quantities. CONCLUSIONS: At the group level, American Indian children were able to accurately report the macronutrient proportions of their total energy intake, and their reporting of total energy intake (+13% of criterion) compares favorably with that of other ethnic groups of children of similar age. They were able to accurately recall the majority of foods that they were independently observed consuming during school meals.

Child↗
PubMed2004

The obesity crisis: don't blame it on the pyramid.

Since its release in 1992, the Food Guide Pyramid has become one of the most recognized nutrition education tools in US history. As such, it has been subject to criticism, particularly in several recent media reports that implicate it as the culprit in America's current obesity epidemic. What these reports often overlook, however, is that the diets of many Americans do not adhere to the dietary guidelines illustrated by the Pyramid, refuting the notion that the Pyramid is the cause of the nation's obesity problem. Data indicate that the more likely causes of escalating obesity rates are increased per capita caloric consumption and larger portion sizes, along with a lack of adequate physical activity. Although the Pyramid graphic was designed more than a decade ago, it still communicates three key concepts that continue to be the cornerstone of federal dietary guidance: variety, proportionality, and moderation. As such, it remains a viable and relevant nutrition education tool, especially when used by dietetics professionals as a component of individualized, comprehensive nutrition education and behavior modification interventions. As the United States Department of Agriculture begins to investigate whether the food intake patterns illustrated by the Pyramid are in need of updating, research is urgently needed to determine how nutrition education tools, including the Pyramid, can be most effectively implemented to help consumers adopt healthful eating behaviors and to improve the public health of America.

Adolescent↗
PubMed2004

Girls at risk for overweight at age 5 are at risk for dietary restraint, disinhibited overeating, weight concerns, and greater weight gain from 5 to 9 years.

OBJECTIVE: The goal of this study was to investigate the emergence of dietary restraint, disinhibited eating, weight concerns, and body dissatisfaction among girls from 5 to 9 years old, and to assess whether girls at risk for overweight at age 5 were at greater risk for the emergence of restraint, disinhibited overeating, weight concerns, and body dissatisfaction. DESIGN: Longitudinal data were used to assess the relationship between weight status and the development of dietary restraint, aspects of disinhibited overeating, weight concern, and body dissatisfaction at ages 5, 7, and 9 years. SUBJECTS: Participants were 153 girls from predominately middle class and exclusively non-Hispanic white families living in central Pennsylvania. Statistical analyses Differences in weight status, dietary restraint, disinhibition, weight concern, and body dissatisfaction between girls at risk (>85th percentile body mass index) or not at risk for overweight at age 5 were assessed using repeated measures analysis of variance at ages 5, 7, and 9 years. RESULTS: Girls who were at risk for overweight at age 5 reported significantly higher levels of restraint, disinhibition, weight concern, and body dissatisfaction by age 9. Girls at risk for overweight at age 5 also showed greater increases in weight status from 5 to 9 years of age. CONCLUSIONS: Higher levels of dietary restraint, weight concern, and body dissatisfaction among young girls at risk for overweight were accompanied by greater weight gain from 5 to 9 years of age, consistent with other recent findings suggesting that youths' attempts at weight control may promote weight gain. Positive alternatives to attempts at dietary restriction are essential to promoting healthful weight status among children, and should include encouraging physical activity, promoting children's acceptance of a variety of low-energy-density foods, and providing guides to appropriate portion sizes.

Analysis of Variance↗
PubMed2004

Dieting practices in high school students.

OBJECTIVE: The purpose of this research was to determine the patterns and frequency of dieting behaviors in a high school population in a metropolitan area. DESIGN: Dieting practices were assessed by using a survey instrument consisting of demographic questions and questions regarding dieting practices. SUBJECTS/SETTING: The survey was administered to 10th-grade male and female students at a multiethnic, urban, public high school in the Los Angeles area. One hundred fifty-three surveys were distributed in the classroom setting, with 146 usable surveys analyzed. STATISTICAL ANALYSES: Statistical analyses included simple frequencies, chi 2, Fisher exact test, t tests, and two-way analysis of variance. A significance level of.05 was used for all statistical analyses. RESULTS: The population with a body mass index greater than 25 was 26.6% and, therefore, at risk of being overweight. Of those who have tried dieting, 54.7% often diet to control their weight. Limiting portion size was practiced by about 34% of those who had tried dieting techniques. In addition, counting calories and counting grams of fat were reported by 31.4% and 41.9% of these students, respectively. Of interest, 64.8% of the students who had tried dieting reported that they tried to eat and/or purchase foods that were low in fat. Approximately, 44% of these students used meal skipping to control their weight. CONCLUSIONS: The high prevalence of dieting behaviors suggests that urban adolescents should be reached with appropriate interventions. Safe dieting strategies should be an integral part of any nutrition education and weight loss intervention.

Adolescent↗
PubMed2005

Beyond energy balance: there is more to obesity than kilocalories.

Using an epidemiologic model of the interactions between environmental agents and human hosts to explain obesity, we explored food, medications, physical inactivity, toxins, and viruses as environmental agents that interact with a genetically programmed host to disturb energy balance and cause obesity. Large portion sizes, high fat intakes, easy access to calorically sweetened beverages, and lack of any need to be physically active all play a role in the toxic environment that leads to obesity. The genetic and physiologic responses of a host determine whether or not this toxic environment will produce obesity. Reversing the current trends of obesity requires a new look at the limits of the energy balance concept, and a better understanding of how environmental factors acutely and chronically change the responses of susceptible hosts.

Drug-Related Side Effects and Adverse Reactions↗
PubMed2006

Using recall cues to improve measurement of dietary intakes with a food frequency questionnaire in an ethnically diverse population: an exploratory study.

OBJECTIVE: Intakes of foods based on responses to a revised food frequency questionnaire (FFQ) and the original Fred Hutchinson FFQ were compared. Revisions included the addition of foods (eg, corn tortillas), disaggregation of line items (eg, cookies vs cakes), replacing unfamiliar terms in the Spanish-language version, a food glossary, and written cues to help respondents recall their food intake. DESIGN: Adult men (46%) and women (n=105) of non-Hispanic African-American, Hispanic, and non-Hispanic white background (age range 30 to 60 years) completed two FFQs within a 1-month reference period. Participants were randomly assigned to receive the revised FFQ or Fred Hutchinson FFQ first. Primary outcome measures were frequency rates weighted by portion size for 34 foods and beverages. ANALYSES: Frequencies of food intake on the original and revised FFQs were estimated using robust means and compared using the Wilcoxon signed rank test. RESULTS: Significantly greater (P<0.05) dietary recall was obtained on the revised FFQ, on items in which foods were added or disaggregated, on traditionally Hispanic foods among Hispanic participants, and foods listed in the glossary. CONCLUSIONS: Revisions in the Fred Hutchinson FFQ resulted in significantly greater dietary recall. Despite increased length, participants believed that the food glossary and written cues were helpful in completing the revised FFQ.

Acculturation↗