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PubMed1991

Diet and peripheral arterial occlusive disease: the role of poly-, mono-, and saturated fatty acids.

A case-control study concerning the association between diet and peripheral arterial occlusive disease was conducted in Athens, Greece. The case series consisted of 100 patients with this disease, whereas controls were 100 patients with conditions requiring minor surgical care who were admitted to the same teaching hospital. Diet was ascertained through a semiquantitative food frequency questionnaire. Nutrient intakes for individuals were estimated by multiplying the nutrient content of a selected typical portion size for each specified food item by the frequency that the food was used per month and summing these estimates for all food items. Data were analyzed using multiple logistic regression procedures, controlling for total energy intake by taking nutrient residuals and by using multivariate nutrient density models. Saturated fatty acids (odds ratio (OR) and 95% confidence interval (CI) contrasting the 75th centile (upper) with the 25th centile = 1.96 and 1.14-3.39), proteins (OR = 2.86, 95% CI 1.47-5.55), and dietary cholesterol (OR = 6.07, 95% CI 2.74-13.46) were associated with increased risk of peripheral arterial occlusive disease, whereas polyunsaturated fatty acids (OR = 0.48, 95% CI 0.24-0.93) and crude fiber (OR = 0.33, 95% CI 0.17-0.64) were related to reduced risk. Monounsaturated fatty acids and, by inference, olive oil occupy an intermediate neutral position between polyunsaturates and saturates (corresponding OR = 1.14, 95% CI 0.68-1.91). Higher intakes of fiber and vitamin C were associated with lower risk of peripheral arterial occlusive disease. The low occurrence of atherosclerotic diseases in Greece and other Mediterranean countries may be due to the substitution of olive oil in place of saturated fats and/or the consumption of a diet high in vegetables, fruits, and other fiber-containing foods.

Arterial Occlusive Diseases↗
PubMed1991

Validation of a quantitative diet history method in Hawaii.

The validity of a quantitative diet history method was evaluated among 262 men and women from the five major ethnic groups of Hawaii (Japanese, Caucasian, Chinese, Filipino, and Hawaiian) in 1984-1987. The reference data included four 1-week food records obtained at approximately 3-month intervals. The diet history was administered 6 months after the fourth week of food records and included 47 foods that were major sources of protein, fat, cholesterol, vitamins A and C, and beta-carotene. Photographs showing three portion sizes were utilized for quantifying intakes in the food records and the diet history. Generally, among all ethnic-sex groups, intakes from the diet history were greater than those from the record sets, particularly for the vitamins. Agreement was measured by the intraclass correlation coefficient (rl) and the weighted kappa statistic (kappa w), and consistency was measured by Spearman's rank correlation (rho). For the total group, the rl's ranged from 0.48 for vitamin A to 0.61 for cholesterol. The kappa w's were generally lower than the rl's, whereas the rho's were higher, ranging from 0.52 for vitamin C to 0.64 for cholesterol. Agreement among the ethnic-sex groups varied, with the Chinese females and the Japanese males having the higher rl's, and the Hawaiian males and females having the lowest values. The results provide evidence that the quantitative diet history gives reasonably accurate estimates of the usual dietary intakes among the major ethnic groups of Hawaii.

Aged↗
PubMed2006

Nutritional management of patients after bariatric surgery.

Bariatric surgery is currently the most effective method of sustainable weight loss among morbidly obese patients. The types of bariatric surgeries can be divided into three categories: restrictive procedures, malabsorptive procedures, and combination (restrictive and malabsorption) procedures. In general, patients undergoing restrictive procedures have the least risk for long-term diet-related complications, whereas patients undergoing malabsorptive procedures have the highest risk. For many patients, the benefits of weight loss, such as decreased blood glucose, lipids, and blood pressure and increased mobility, will outweigh the risks of surgical complications. Most diet-related surgical complications can be prevented by adhering to strict eating behavior guidelines and supplement prescriptions. Eating behavior guidelines include restricting portion sizes, chewing foods slowly and completely, eating and drinking separately, and avoiding foods that are poorly tolerated. Supplement prescriptions vary among practitioners and usually involve at least a multivitamin with minerals. Some practitioners may add other supplements only as needed for diagnosed deficiencies; others may prescribe additional prophylactic supplements. The most common nutrient deficiencies are of iron, folate, and vitamin B12. However, deficiencies of fat-soluble vitamins have been reported in patients with malabsorption procedures, and thiamin deficiency has been reported among patients with very poor intake and/or nausea and vomiting. Frequent monitoring of nutrition status for all patients can aid in preventing severe clinical deficiencies.

Anemia, Iron-Deficiency↗
PubMed2006

Weight loss and diet plans.

This article examines popular diet plans for weight loss and provides information about their efficacy. Diets covered include: very-low-calorie and low-calorie diets; low-fat and very-low-fat diets; moderate-fat, low-calorie diets; and low-carbohydrate, high-protein diets. The importance of portion size and behavioral change is also discussed.

Caloric Restriction↗
PubMed2004

Diet and obesity.

PURPOSE OF REVIEW: Obesity continues to increase in the United States and worldwide. There is controversy surrounding different dietary patterns used to promote weight loss, and none has emerged as clearly more effective. This paper briefly reviews the factors that influence energy intake and dietary treatments used to promote weight loss. RECENT FINDINGS: Increasing portion size, eating away from home, and consuming a variety of high-energy dense foods appear to increase energy intake. Hormonal influences on diet continue to be explored. Very-low-calorie diets and low-carbohydrate diets lead to greater initial weight loss, but long-term results are no better than more moderate calorie-restricted diets. A program using meal replacements appears to lead to weight loss slightly greater than calorie-restricted diets and offers one option to treat obesity. Dietary patterns low in energy density and glycemic index have potential in treating obesity and should be studied further. SUMMARY: Clearly, a dietary pattern that prescribes a lower total energy intake is necessary for weight loss, and this pattern should be sustainable to maintain weight loss. Although many dietary programs can achieve short-term loss of weight, dietary treatment should be recommended that emphasizes lifestyle changes and is consistent with other dietary guidelines to promote long-term health. Features consistent with this are a dietary pattern low in total calories, saturated fat, and refined carbohydrate; moderate in whole grains; and high in low-energy dense vegetables and fruits. Future studies should explore dietary strategies and combination therapies that contribute to weight loss, long-term weight maintenance, and improved health.

Journal Article↗
PubMed1994

Diet and the risk of breast cancer in Spain.

A case-control study of the role of diet in the cause of breast cancer was conducted between 1988 and 1991 in Navarra, North Spain; 100 women with breast cancer and 100 hospital controls admitted during the same period were interviewed, using a food frequency-consumption questionnaire. Cases reported significantly lower consumption of fruits, vegetables and fish; relative risk (RR) for persons in the lowest tertile of consumers was: fruits, RR = 3.83, confidence limit (CL) = 9.12-1.66, P = 0.01; vegetables, RR = 1.92, CL = 4.57-0.80, P = 0.09; fish, RR = 0.32, CL = 6.31-0.83, P = 0.05. The risk increased for persons in the highest tertile of processed meat intake, RR = 3.20, P = 0.05. Nutrient intakes for individuals were estimated by multiplying the nutrient content of a selected typical portion size for each specified food item by the frequency that the food was used per month, and adding these estimates for all food items. Cases reported significantly less frequent consumption of vitamin C (ascorbic acid) and monounsaturated fatty acid; after controlling for total calorie intake, the RR was estimated for consumption of vitamin C (RR = 0.40, CL = 0.2-0.9), and monounsaturated fatty acid (RR = 0.30, CL = 0.1-1.08).

Adult↗
PubMed2002

Institutional feeding of the elderly.

Not only is there a high prevalence of malnutrition among the elderly admitted to hospital and other institutions, but nutritional status seems to decline during admission, not only as a result of disease but also problems with catering and feeding policies, which are not well-geared to the needs of the sick. This results in high food wastage rates and inadequate macro- and micronutrient intakes to meet requirements. In the elderly, decreased portion size and increased energy, protein and micronutrient density have been shown to be effective in decreasing wastage and improving intake. Other strategies for improving intake are reviewed, including a better environment, a reduction in drugs causing anorexia, help with eating, and less interruption of meals by procedures and ward rounds. Targets for nutritional intake and aims of feeding are reviewed.

Aged↗
PubMed2003

Methodology of dietary assessment in athletes: concepts and pitfalls.

PURPOSE OF REVIEW: Evaluation of an athlete's diet is important in both clinical practice and research. The main purpose of this review is to provide health professionals with guidance regarding the special issues that are likely to be encountered when assessing the dietary intake of sportspersons. RECENT FINDINGS: A number of methods may be used for the dietary assessment of individuals and/or groups of athletes, including retrospective (diet recall, food-frequency questionnaire, and diet history) and prospective (diet record, duplicate portion) techniques. A 3-4-day estimated diet record is the most widely used approach, but collection of single or multiple diet recalls is also common. Care must be taken, however, to ensure that days of diet monitoring accurately reflect usual food consumption during the period of interest. Under-reporting of habitual energy intake is widespread among athletes, and its magnitude should be carefully addressed when interpreting the results of dietary assessment. Other issues, specifically related to sportspersons, that are often neglected include adequacy of standard portion sizes, frequency of snacking, fluid intake, supplement use, weight-control practices, and seasonality of sport activities and food consumption. SUMMARY: There are subtle methodological differences in the dietary assessment of athletes and non-athletes, which, when taken into consideration, may substantially increase the quality of intake data and optimise the outcome of dietary intervention.

Diet↗
PubMed2006

Obesity prevention and treatment practices of U.S. obstetrician-gynecologists.

OBJECTIVE: To describe obesity prevention and treatment practices of U.S. obstetrician-gynecologists. METHODS: A cross-sectional survey was mailed to 1,806 practicing members of the American College of Obstetricians and Gynecologists (ACOG) in February-April 2005. RESULTS: Of the 900 respondents who returned questionnaires, 82% reported using body mass index (BMI) to assess obesity; 80% reported counseling patients about weight control and 84% about physical activity "most of the time" or "often." Most reported counseling patients about diet; the most frequently recommended dietary strategies were changing eating patterns, limiting intake of specific foods, and controlling portion size. About 27% reported referring their patients for behavioral therapy "most of the time" or "often," and 35% reported ever prescribing weight loss medications to obese patients. More than 85% counseled patients about pregnancy weight gain, and 64% used the patients' prepregnancy BMI to modify their recommendations "most of the time" or "often." Respondents who completed their residency after 1996 were more likely to use patients' BMI to screen for obesity than those who finished earlier. Respondents who believed that they could help their patients lose weight (44%) were more likely to counsel their patients to do so (P < .001). CONCLUSION: A majority of obstetrician-gynecologists appear to use BMI to screen for obesity and to counsel their patients about weight control, diet, and physical activity. Many, however, do not prescribe weight loss medications or refer patients to behavioral weight loss therapy. Obstetrician-gynecologists who believe they can help patients lose weight are more likely to follow recommendations for the treatment of obesity. LEVEL OF EVIDENCE: III.

Adult↗
PubMed2006

Recent developments in diet and gout.

PURPOSE OF REVIEW: Gout is the most common inflammatory arthritis in men, affecting approximately 1-2% of adult men in Western countries. United States gout prevalence has approximately doubled over the past two decades. In recent years, key prospective epidemiological and open-labeled dietary studies, coupled with recent advances in molecular biology elucidating proximal tubular urate transport, have provided novel insights into roles of diet and alcohol in hyperuricemia and gout. This review focuses on recent developments and their implications for clinical practice, including how we advise patients on appropriate diets and alcoholic beverage consumption. RECENT FINDINGS: Studies have observed an increased risk of gout among those who consumed the highest quintile of meat, seafood and alcohol. Although limited by confounding variables, low-fat dairy products, ascorbic acid and wine consumption appeared to be protective for the development of gout. SUMMARY: The most effective forms of dietary regimen for both hyperuricemia and gout flares remains to be unidentified. Until confirmed by a large, controlled study, it is prudent to advise patients to consume meat, seafood and alcoholic beverages in moderation, with special attention to food portion size and content of non-complex carbohydrates which are essential for weight loss and improved insulin sensitivity.

Beer↗
PubMed1993

Dietary assessment methods evaluated in the Malmö food study.

A study to evaluate the relative validity of two dietary assessment methods, to be used in a prospective cohort study on diet and cancer, was conducted in a random sample of the Malmö population during 1984-1985. The study compared (i) a long, self-administered 'food-use questionnaire' (about 250 food items), asking for frequency of consumption of food and beverages and for usual portion size estimated with the help of a booklet of food pictures, and (ii) a combined method involving a shorter food frequency questionnaire (about 130 food items) and a 2-week diet diary, with (iii) a reference method requiring 18 days of weighed food records. The results indicated that subject compliance was quite good for both methods and, in particular, that the diet diary was well accepted. Both methods produced fairly good correlations with the reference method, of the order of 0.40 to 0.60 for most nutrients after adjustment for energy. Both methods tended to overestimate intake of fat, protein and carbohydrates as well as of vitamins and minerals.

Aged↗
PubMed1995

The HLA-A3, Cw6,B47,DR7 extended haplotypes in salt losing 21-hydroxylase deficiency and in the Old Order Amish: identical class I antigens and class II alleles with at least two crossover sites in the class III region.

The HLA-B47,DR7 haplotype in congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency contains a deletion of most of the active CYP21 gene and the entire adjacent C4B gene. The C4A gene produces a protein which is electrophoretically C4A but antigenically C4B. In the Old Order Amish, the HLA-B47,DR7 haplotype contains no deletion, but is immunologically identical to the CAH haplotype in both areas flanking the crossover region. We compared some of the genes in the MHC Class II and Class III regions in the Amish and CAH-linked haplotypes to define further the relationships between the two. The complement factor B (Bf) proteins differed, but no Bf RFLPs were identified. The complement factor 2 genes exhibited different BamHI RFLPs. Analyses of the tumor necrosis factor-alpha genes revealed the same NcoI restriction patterns. The RD genes contained microsatellites of the same size. Portions of the MHC Class II DR and DQ, and Class III CYP21 and C4 alleles were sequenced. The exon 2 sequences of DQ2 and DR7 were identical in the two haplotypes. In the Amish haplotype, both CYP21 and C4 gene pairs were present and functionally normal. The CAH haplotype had two sequence crossovers: from CYP21P to CYP21 in the 7th intron, and from C4A to C4B between codons 1106 (exon 26) and 1157 (exon 28). A model is proposed which accounts for the CAH-linked mutant haplotype arising from a nonmutant homologue via three crossings-over.

Adrenal Hyperplasia, Congenital↗
PubMed2005

Barriers to following dietary recommendations in Type 2 diabetes.

AIMS: To evaluate barriers to following dietary recommendations in patients with Type 2 diabetes. METHODS: We conducted focus groups and surveys in urban and suburban VA and academic medical centres. For the written survey, a self-administered questionnaire was mailed to a random sample of 446 patients with diabetes. For the focus groups, six groups of patients with diabetes (three urban, three suburban) were conducted, with 6-12 participants in each group. The focus groups explored barriers across various types of diabetes self-management; we extracted all comments relevant to barriers that limited patients' ability to follow a recommended diet. RESULTS: The written survey measured the burden of diabetes therapies (on a seven-point rating scale). Moderate diet was seen as a greater burden than oral agents (median 1 vs. 0, P = 0.001), but less of a burden than insulin (median 1 vs. 4, P < 0.001). A strict diet aimed at weight loss was rated as being similarly burdensome to insulin (median 4 vs. 4, P = NS). Despite this, self-reported adherence was much higher for both pills and insulin than it was for a moderate diet. In the focus groups, the most commonly identified barrier was the cost (14/14 reviews), followed by small portion sizes (13/14 reviews), support and family issues (13/14 reviews), and quality of life and lifestyle issues (12/14 reviews). Patients in the urban site, who were predominantly African-American, noted greater difficulties communicating with their provider about diet and social circumstances, and also that the rigid schedule of a diabetes diet was problematic. CONCLUSIONS: Barriers to adherence to dietary therapies are numerous, but some, such as cost, and in the urban setting, communication with providers, are potentially remediable. Interventions aimed at improving patients' ability to modify their diet need to specifically address these areas. Furthermore, treatment guidelines need to consider patients' preferences and barriers when setting goals for treatment.

Diabetes Mellitus, Type 2↗
PubMed2005

Food choices at lunch during the third year of life: high selection of animal and starchy foods but avoidance of vegetables.

AIM: The objective was to show patterns of food selection by 2- to 3-y-old children for a wide variety of foods in a self-service cafeteria and to assess the effect of individual variables (gender, BMI, mode of feeding after birth and rank in sibship). METHODS: In a nursery self-service canteen, food choices at lunch made by children (n=418, 24-36 mo; 109 observations per child on average) were recorded by trained assistants who monitored portion size. An offer of eight dishes (animal products, starchy foods, combination dishes, vegetables and dairy products), excluding dessert-type foods, was proposed. Choice level was calculated for each food. Analysis of variance was used to compare choices for the various foods and to assess the effect of the individual variables. RESULTS: The choice of a food largely depended upon its nature: animal products, starchy foods and their combinations were widely chosen, whereas vegetables were not often selected; the choice for dairy products depended upon the type. The mode of preparation of the food influenced its choice. Segmenting products were identified; however, except for cheeses, a given child did not refuse an entire food category. Children's characteristics did not explain the choice variability. CONCLUSION: At the age of 2 to 3 y, children preferentially choose animal products and starchy foods and avoid vegetables; the high individual variability of their food choices could be related to previous food experiences.

Cheese↗
PubMed2005

Food choices at lunch during the third year of life: increase in energy intake but decrease in variety.

AIM: Modelling the evolution between the ages of 2 and 3 y of the energy intake and the variety of free food choices at lunch time in relation to children's and context variables. METHODS: One-year follow-up from 2 to 3 y old. In a nursery canteen, food choices at lunch were recorded by trained assistants who monitored portion size. Energy intake and food variety were estimated. Three hundred and ninety-five children were studied, for 112 meals and over 10 mo on average. Mixed models of analysis of variance were used to take into account the longitudinal character of the data. RESULTS: From 2 to 3 y, energy intake increased. Variety decreased during the first 7 mo and then remained constant. The individual variability in mean values and in evolution was high for both variables. Energy was positively linked to BMI at 2 y. Variety was slightly higher for girls and increased with duration of breastfeeding. Energy was higher in September to November than in December-January. Variety was maximal in December-January and in June-July. CONCLUSION: During the third year of life, while energy intake increases, the restriction of food variety appears to be a normal transition phase. Long duration of breastfeeding is associated with higher food variety.

Age Factors↗
PubMed2005

Dietitians and exercise professionals in a childhood obesity treatment team.

UNLABELLED: There has been a remarkable increase in the prevalence of childhood obesity in most countries in recent years, which indicates that modern lifestyle is the triggering factor for genetic susceptibility. This report focuses on the two main environmental factors, nutrition and physical activity, that could influence paediatric obesity development, and how health professionals can address these aspects in the management of childhood obesity in a multidisciplinary treatment team. First, the role of a nutrition expert in the multidisciplinary obesity team is discussed and then the importance of physical activity in the treatment of paediatric obesity. The part on nutrition highlights some interesting areas in this field, namely glycaemic index, high-protein diet, fast foods, portion sizes and soft-drink consumption. Dietary treatment in childhood obesity should be combined with changes in physical activity to promote long-term weight loss. Research on the physical activity of children and adolescents indicates some significant changes over the last decades, which are also reviewed. Factors such as sports club participation and television viewing are discussed. The appropriate physical activity level and effective physical activity programmes are also presented. Physical activity can be promoted in childhood obesity treatment in many ways. Practical advice regarding physical activity programme and the role of exercise professionals in childhood obesity treatment team is given. CONCLUSION: For successful obesity management, the child should be assessed and treated by a multidisciplinary team, including a physician, dietitian, exercise expert, nurse and behavioural therapist.

Adolescent↗
PubMed1998

Environmental contributions to the obesity epidemic.

The current epidemic of obesity is caused largely by an environment that promotes excessive food intake and discourages physical activity. Although humans have evolved excellent physiological mechanisms to defend against body weight loss, they have only weak physiological mechanisms to defend against body weight gain when food is abundant. Control of portion size, consumption of a diet low in fat and energy density, and regular physical activity are behaviors that protect against obesity, but it is becoming difficult to adopt and maintain these behaviors in the current environment. Because obesity is difficult to treat, public health efforts need to be directed toward prevention.

Animals↗
PubMed2005

Dietary intake and the risk of gastro-oesophageal reflux disease: a cross sectional study in volunteers.

BACKGROUND: Although diet has been associated with gastro-oesophageal reflux disease (GORD), the role of dietary components (total energy, macro and micronutrients) is unknown. We examined associations of GORD symptoms with intakes of specific dietary components. METHODS: We conducted a cross sectional study in a sample of employees (non-patients) at the Houston VAMC. The Gastro Esophageal Reflux Questionnaire was used to identify the onset, frequency, and severity of GORD symptoms. Dietary intake (usual frequency of consumption of various foods and portion sizes) over the preceding year was assessed using the Block 98 food frequency questionnaire. Upper endoscopy was offered to all participants and oesophageal erosions recorded according to the LA classification. We compared the dietary intake (macronutrients, micronutrients, food groups) of participants with or without GORD symptoms, or erosive oesophagitis. Stepwise multiple logistic regression analyses were used to examine associations between nutrients and GORD symptoms or oesophageal erosions, adjusting for demographic characteristics, body mass index (BMI), and total energy intake. RESULTS: A total of 371 of 915 respondents (41%) had complete and interpretable answers to both heartburn and regurgitation questions and met validity criteria for the Block 98 FFQ. Mean age was 43 years, 260 (70%) were women, and 103 (28%) reported at least weekly occurrences of heartburn or regurgitation. Of the 164 respondents on whom endoscopies were performed, erosive oesophagitis was detected in 40 (24%). Compared to participants without GORD symptoms, daily intakes of total fat, saturated fat, cholesterol, percentage of energy from dietary fat, and average fat servings were significantly higher in participants with GORD symptoms. In addition, there was a dose-response relationship between GORD and saturated fat and cholesterol. The effect of dietary fat became non-significant when adjusted for BMI. However, high saturated fat, cholesterol, or fat servings were associated with GORD symptoms only in participants with a BMI >25 kg/m2 (effect modification). Fibre intake remained inversely associated with the risk of GORD symptoms in adjusted full models. Participants with erosive oesophagitis had significantly higher daily intakes of total fat and protein than those without it (p<0.05). CONCLUSIONS: In this cross sectional study, high dietary fat intake was associated with an increased risk of GORD symptoms and erosive oesophagitis while high fibre intake correlated with a reduced risk of GORD symptoms. It is unclear if the effects of dietary fat are independent of obesity.

Adolescent↗