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Relationships between use of television during meals and children's food consumption patterns.

OBJECTIVE: We examined relationships between the presence of television during meals and children's food consumption patterns to test whether children's overall food consumption patterns, including foods not normally advertised, vary systematically with the extent to which television is part of normal mealtime routines. METHODS: Ninety-one parent-child pairs from suburbs adjacent to Washington, DC, recruited via advertisements and word of mouth, participated. Children were in the fourth, fifth, or sixth grades. Socioeconomic data and information on television use were collected during survey interviews. Three nonconsecutive 24-hour dietary recalls, conducted with each child, were used to construct nutrient and food intake outcome variables. Independent sample t tests were used to compare mean food and nutrient intakes of children from families in which the television was usually on during 2 or more meals (n = 41) to those of children from families in which the television was either never on or only on during one meal (n = 50). Multiple linear regression models, controlling for socioeconomic factors and other covariates, were used to test strength of associations between television and children's consumption of food groups and nutrients. RESULTS: Children from families with high television use derived, on average, 6% more of their total daily energy intake from meats; 5% more from pizza, salty snacks, and soda; and nearly 5% less of their energy intake from fruits, vegetables, and juices than did children from families with low television use. Associations between television and children's consumption of food groups remained statistically significant in multiple linear regression models that controlled for socioeconomic factors and other covariates. Children from high television families derived less of their total energy from carbohydrate and consumed twice as much caffeine as children from low television families. There continued to be a significant association between television and children's consumption of caffeine when these relationships were tested in multiple linear regression models. CONCLUSION: The dietary patterns of children from families in which television viewing is a normal part of meal routines may include fewer fruits and vegetables and more pizzas, snack foods, and sodas than the dietary patterns of children from families in which television viewing and eating are separate activities.

Adult↗

Association of occlusal, periodontal, and dietary factors with the presence of non-carious cervical dental lesions.

PURPOSE: To investigate in vivo the relationship of occlusal stress factors, periodontal health status, and acidic dietary patterns to the presence of non-carious cervical lesions (NCCL) in a convenience sample of undergraduate clinic, adult dental patients. MATERIALS AND METHODS: Forty three subjects who met the entry criteria were admitted into the study; 178 teeth exhibiting NCCL were evaluated. A dietary assessment focusing on acidic food/beverage intake was used to evaluate nutritional intake over the most recent 24-hour period. Periodontal evaluation included intraoral measurement of gingival attachment loss, assessment of tooth mobility, and radiographic interpretation of percent bone loss using the Schei ruler method. Among the occlusal factors evaluated were shape and orientation of NCCL, presence and location of wear facets, and symptoms and characteristics of centric and eccentric occlusal function. RESULTS: 95% of teeth examined exhibited functional wear facets, indicating a systematic relationship with presence of NCCL (Chi Square = 16.9, P < 0.0001); 48% displayed buccal or incisal facets; 64% were accompanied by balancing interferences in lateral excursion; 98.3% had mobility scores < or = 1; there was no significant association between mobility and facets present (Chi Square = 3.04, P = 0.21); and, no relationship with dietary patterns was found. Group function, that may evolve with age, and/or traumatic occlusion factors may be related to etiology of NCCL. Longitudinal controlled clinical trials are needed to confirm suspected etiologies and establish treatment guidelines for non-carious cervical lesions.

Adult↗

Physical activity and colon cancer: confounding or interaction?

PURPOSE: Although physical activity has been consistently inversely associated with colon cancer incidence, the association of physical activity with other diet and lifestyle factors that may influence this association is less well understood. Confounding and effect modification are examined to better understand the physical activity and colon cancer association. METHODS: Based on hypothesized biological mechanisms whereby physical activity may alter risk of colon cancer, we evaluated confounding and effect modification using data collected as part of a case-control study of colon cancer (N = 1993 cases and 2410 controls). We examined associations between total energy intake, fiber, calcium, fruit and vegetables, red meat, whole grains as well as dietary patterns along with cigarette smoking, alcohol consumption, BMI, and use of aspirin and/or NSAIDs and physical activity. RESULTS: No confounding was observed for the physical activity and colon cancer association. However, differences in effects of diet and lifestyle factors were identified depending on level of physical activity. Most striking were statistically significant interactions between physical activity and high-risk dietary pattern and vegetable intake, in that the relative importance of diet was dependent on level of physical activity. The predictive model of colon cancer risk was improved by using an interaction term for physical activity and other variables, including BMI, cigarette smoking, energy intake, dietary fiber, dietary calcium, glycemic index, lutein, folate, vegetable intake, and high-risk diet rather than using models that included these variables as independent predictors with physical activity. In populations where activity levels are high, the estimate of risk associated with high vegetable intake was 0.9 (95% CI 0.6-1.3), whereas in more sedentary populations the estimate of risk associated with high vegetable intake was 0.6 (95% CI 0.5-0.9). CONCLUSIONS: Physical activity plays an important role in the etiology of colon cancer. Its significance is seen by its consistent association as an independent predictor of colon cancer as well as by its impact on the odds ratios associated with other factors. Given these observations, it is most probable that physical activity operates through multiple biological mechanisms that influence the carcinogenic process.

Adult↗

Exercise and biomarkers for cancer prevention studies.

The International Agency for Research on Cancer estimates that 25% of cancer cases worldwide are caused by overweight or obesity and a sedentary lifestyle. These lifestyle patterns may increase cancer risk by several mechanisms including increased estrogens and testosterone, hyperinsulinemia and insulin resistance, increased inflammation, and depressed immune function. Several randomized clinical trials have shown that physical activity and diet interventions can change biomarkers of cancer risk. In a controlled physical activity trial, we found decreases in serum estrogen, testosterone, and insulin in overweight, sedentary postmenopausal women with a 1-y exercise program consisting of moderate-intensity aerobic exercise, 45 min/d, 5 d/wk. In another controlled trial in middle-aged to older persons, we found that a 1-y exercise intervention of 60 min/d, 6 d/wk, reduced colon crypt cell proliferation in men who adhered closely to the program. Only 1 trial, the Women's Health Initiative Dietary Modification Trial, has published results of a dietary intervention on breast cancer incidence and reported a statistically nonsignificant 9% reduction in invasive breast cancer incidence in postmenopausal women following a low-fat dietary pattern for 8-12 y. Other trials under way are testing effects of weight loss, physical activity, and dietary patterns on other cancer biomarkers. The NCI-funded Transdisciplinary Research on Energetics and Cancer centers are exploring novel research into mechanisms linking energy balance with cancer risk and prevention. The worldwide trends toward increasing overweight and obesity and decreasing physical activity may lead to an increased incidence of several cancers unless other means of risk reduction counteract these effects. Thus, adoption of lifestyle changes by individuals and populations may have a large impact on the future incidence of cancer.

Biomarkers↗

Cariogenicity depends more on diet than the prevailing mutans streptococcal species.

This review aims to compare the occurrence and distribution of mutans streptococci in Africa, Europe, and North America and in addition will try to offer explanations for existing relationships among salivary mutans streptococci counts, dietary patterns, and dental caries. The literature reveals that salivary mutans streptococci counts in child populations of the three continents are comparable. The distribution of mutans streptococci species, with a predominance of S. mutans followed by S. sobrinus, and the virtual absence of other mutans streptococci species are also comparable. Although it is widely believed that diet has an important effect on mutans streptococci counts, this review provides evidence that this does not hold true when variations in dietary patterns are moderate, as they normally are in real-life situations. Since the diets of the child populations in the three continents vary moderately, a strong dietary-induced effect on salivary mutans streptococci counts cannot be expected. The observed analogous salivary mutans streptococci counts in these child populations are thus 'not surprising' but are in accordance with the conceptual expectation. The differences in caries experience in children of the three continents cannot be explained by the prevailing mutans streptococci species but instead should be attributed to differences in the cariogenicity of the various diets. The fact that the cariogenicity of the diet determines the development of dental caries while hardly affecting the mutans streptococci counts explains the limited value of the latter as an indicator of dental caries. The reviewed literature shows that mutans streptococci are ubiquitous in children aged 7 years and older in Africa, Europe, and North America. Mutans streptococci should therefore be considered as belonging to the indigenous microflora of the human mouth.

Adolescent↗

Nutritional factors in human cancers.

A variety of external factors interacting with genetic susceptibility influence the carcinogenesis process. External factors including oxidative compounds, electrophilic agents, and chronic infections may enhance genetic damage. In addition, various hormonal factors which influence growth and differentiation are critically important in the carcinogenic process. Diet and nutrition can influence these processes directly in the gastrointestinal tract by providing bioactive compounds to specific tissues via the circulatory system, or by modulating hormone levels. Differences in certain dietary patterns among populations explain a substantial proportion of cancers of the colon, prostate and breast. These malignancies are largely influenced by a combination of factors related to diet and nutrition. Their causes are multifactorial and complex, but a major influence is the widespread availability of energy-dense, highly processed and refined foods that are also deplete in fiber. These dietary patterns in combination with physical inactivity contribute to obesity and metabolic consequences such as increased levels of IGF-1, insulin, estrogen, and possibly testosterone. These hormones tend to promote cellular growth. For prostate cancer, epidemiologic studies consistently show a positive association with high consumption of milk, dairy products, and meats. These dietary factors tend to decrease 1.25(OH)2 vitamin D, a cell differentiator, and low levels of this hormone may enhance prostate carcinogenesis. While the nutritional modulation of growth-enhancing and differentiating hormones is likely to contribute to the high prevalence of breast, colorectal, prostate, and several other cancers in the Western world, these cancers are relatively rare in less economically developed countries, where malignancies of the upper gastrointestinal tract are quite common. The major causes of upper gastrointestinal tract cancers are likely related to various food practices or preservation methods other than refrigeration, which increase mucosal exposure to irritants or carcinogens.

Antioxidants↗

Popular weight-loss diets: from evidence to practice.

The increasing number of overweight and obese individuals has become one of the leading public health concerns in many countries around the world. Concomitant with this increase in the prevalence of obesity has been the rise in the number of weight-loss diets, many of which alter macronutrient composition, but with the majority focused on carbohydrate restriction. Low-carbohydrate diets are attractive because they promise rapid weight loss without having to count calories and compromise the consumption of many palatable foods. By contrast, traditional dietary recommendations for weight loss endorse a fat-restricted and calorie-restricted diet high in complex carbohydrates. Evidence indicates that low-carbohydrate diets could be better in terms of short-term weight loss relative to traditional low-fat diets, but little is known about their long-term utility and safety. Diets based on the traditional Mediterranean dietary pattern are becoming increasingly popular because of their healthful benefits, particularly regarding cardiovascular outcomes. Mediterranean diets encourage consumption of a variety of palatable foods, optimizing adherence and sustainability. In this Review we discuss the current evidence on the efficacy of low-fat, low-carbohydrate and Mediterranean dietary patterns for weight loss, their potential mechanisms of action and important clinical considerations.

Aged↗

[Analysis on the dietary lipid pattern in different areas of China].

Based on the "Total Diet Study" conducted in 1990, food samples from urban and rural inhabitants in the four regions of China(North I, North II, South I and South II) were analyzed separately. The results showed that, except the status in South II, the amount of fat and cholesterol intake existed obvious differences between urban and rural inhabitants in the same region. The dietary fat and cholesterol intake of rural inhabitants in North II region was obvious inadequate. Dietary fat intake of urban inhabitants was high and the cholesterol intake was higher than the level of 300 mg per capita. The results showed that the ratio of polyunsaturated fatty acids was relatively low but the ratio of monounsaturated fatty acids was relatively high for dietary fat in two southern regions. It might be beneficial to increase plant oil which contains high amount of polyunsaturated fatty acids for the inhabitants in southern regions. From these results, we concluded that the dietary lipids intake of Chinese inhabitants was generally appropriate. Considering the great difference in economic development and dietetic culture, the dietary suggestions should be different regions to regions.

Cholesterol↗

Effects of antioxidant-rich foods on vascular reactivity: review of the clinical evidence.

The foods and nutrients discussed in this paper are components of dietary patterns that have been associated with lower cardiovascular disease risk. The focus of this review is on the effects of antioxidant foods on vascular health and discussion of their potential mechanisms of action. The foods reviewed include fruits and vegetables, red grapes and red wine, tea, cocoa/chocolate, and olive oil. The primary challenge in studying the cardioprotective components of a dietary pattern is in identifying mechanism(s) of action as well as the bioactive nutrients responsible. In selecting papers for this review, we focused on studies of whole foods and beverages that met the following criteria: 1) they are commonly consumed in typical diets, 2) they appear to have direct antioxidant effects, and 3) they have demonstrated effects on endothelial function in several human studies. The evidence presented herein suggests that dietary consumption of fruits and vegetables, red grapes and red wine, tea, chocolate, and olive oil may improve vascular reactivity, in part, by attenuating the adverse effects of oxidation on endothelial function. Additional research is needed to better understand the mechanism(s) by which antioxidant-rich foods and beverages favorably affect endothelial function and the extent to which this reflects direct antioxidant effects.

Antioxidants↗

Acculturation and dietary practices among Korean Americans.

OBJECTIVE: Examine variation in dietary practices and nutritional intakes of Korean Americans at different acculturation levels. DESIGN: Cross-sectional mail survey. SUBJECTS/SETTING: US national sample of 348 Korean Americans (46% of the Korean American sample to whom questionnaires were delivered). STATISTICAL ANALYSIS PERFORMED: Analysis of variance, Pearson correlation, Spearman rank correlation, chi 2 test, and multiple regression analysis. RESULTS: Korean Americans who were more acculturated consumed more American food and less Korean food. American foods such as oranges, low-fat milk, bagels, tomatoes, and bread were consumed regularly by Korean Americans; Korean foods such as rice, kimchi, garlic, green onions, and Korean soup were also consumed regularly. American foods were adopted the most at breakfast and the least at dinner. Bicultural people regularly incorporated more different types of foods into their diet. Despite significant differences in dietary practices, dietary quality did not vary by acculturation status. APPLICATION/CONCLUSIONS: Acculturation was influential in the dietary patterns of Korean Americans. Specific information about Korean diet related to acculturation status can be used by dietitians who work with Korean Americans. Dietitians can benefit from gathering and applying specific information about Korean diets and diets of other ethnic groups; they also need to recognize the changing nature of dietary patterns as acculturation occurs.

Acculturation↗

Lifetime dietary change and its relation to increase in weight in Spanish women.

INTRODUCTION: Changes in dietary patterns and a decrease in physical activity have occurred in Western countries. These are factors in the variation in body composition observed in populations, characterized by a progressive accumulation of fat with age and a consequent increase in the risk of suffering from common chronic illnesses such as obesity, cardiovascular disease and cancer. OBJECTIVE: To investigate weight gain throughout the life-cycle and its relation to modifications in dietary patterns, analyzing the causes of these modifications and their implications for patterns of adult overweight and obesity. DESIGN: Cross-sectional sample of Spanish women from a socio-economically disadvantaged class. SUBJECTS: 1037 healthy perimenopausal women (age: 45-65 y). MEASUREMENTS: Juvenile body mass index (BMI), current BMI, food frequency questionnaire, retrospective food habits. RESULTS AND CONCLUSIONS: Of these women, 48.8% had changed their dietary habits during their lifetime. A change in diet due to migration or marriage occurred at approximately 20 years of age and was characterized by an increased frequency of consumption of foods rich in protein and complex carbohydrates, while a change due to illness occurred at around 50 years of age and was characterized by a decrease in the consumption of these types of food. The change in dietary behavior due to migration was associated with weight gain. Weight gain was also inversely associated with BMI during youth; women who in their youth had a BMI<18.5 kg/m2 gained an average of 21.4 kg, compared with those with a BMI>27 kg/m2 in their youth, who gained an average of 5.4 kg. International Journal of Obesity (2000)24, 14-19

Aged↗

Relative validity and reproducibility of a 14-item semi-quantitative food frequency questionnaire for cardiovascular prevention.

BACKGROUND: Dietary habits play a major role in cardiovascular disease risk but few simple nutrition assessment tools are available for clinical practice. We developed a 14-item food frequency questionnaire to evaluate dietary patterns in relation with coronary risk in a French population. DESIGN AND METHODS: This food frequency questionnaire gave different scores of intake: saturated fatty acids (six questions), mono-unsaturated fatty acids, Omega-3 and Omega-6/Omega-3 polyunsaturated fatty acids (five questions), and fruits and vegetables (three questions). Validity was assessed against a 7-day dietary history (n = 49 subjects) and against biomarkers (n = 181). The food frequency questionnaire was also administered twice with an interval of 15 days to evaluate its reproducibility (n = 20). RESULTS: Validity against dietary history was assessed with Spearman correlation coefficients which ranged from 0.47 (fruits and vegetables) to 0.63 (polyunsaturated fatty acids/saturated fatty acids) (all P < 0.05), with a mean value of 0.54. On average, 39% of the subjects were classified in the same quartile with the food frequency questionnaire and the dietary history and 84% in the same or adjacent quartile. Biomarker-based validity using Spearman correlation coefficients varied from 0.21 (saturated fatty acids) to 0.53 (Omega-3 polyunsaturated fatty acids) (all P < 0.05), with a mean value of 0.35. On average, 37% of the participants were classified in the same quartile with the food frequency questionnaire and the corresponding biomarkers and 73% in the same or adjacent quartile. Reproducibility assessed by the intraclass correlation coefficient ranged from 0.71 (mono-unsaturated fatty acids) to 0.93 (global score), with a mean value of 0.81. CONCLUSION: We validated a short food frequency questionnaire for dietary pattern assessment in coronary prevention.

Adult↗

The use of indexes evaluating the adherence to the Mediterranean diet in epidemiological studies: a review.

The purpose of this paper is to review some of the methods that several epidemiological studies use to evaluate the adherence of a population to the Mediterranean diet pattern. Among these methods, diet indexes attempt to make a global evaluation of the quality of the diet based on a traditional Mediterranean reference pattern, described as a priori, general and qualitative. The Mediterranean diet indexes, hence, summarise the diet by means of a single score that results from a function of different components, such as food, food groups or a combination of foods and nutrients. The reviewed evaluation methods can be classified into three categories depending on the way they are calculated: (1) those based on a positive or negative scoring of the components, (2) those that add or substract standardised components, and (3) those that are based on a ratio between components. Dietary scores have been used to explore the multiple associations between the Mediterranean diet, as an integral entity, and health parameters such as life expectancy or the incidence of obesity, cardiovascular diseases and some types of cancers. Moreover, these indexes are also useful tools to measure food consumption trends and to identify the involved factors, as well as to develop comprehensive public health nutrition recommendations. A more precise and quantitative definition of the Mediterranean diet is required if the adherence to such a dietary pattern is intended to be more accurately measured. Other aspects of the Mediterranean diet indexes should also be taken into account, like the inclusion of typical Mediterranean foods such as nuts and fish and the validation of the dietary pattern approach by using biomarkers.

Biomarkers↗

The Florence city sample: dietary and life-style habits of a representative sample of adult residents. a comparison with the EPIC-Florence volunteers.

A representative sample of the general population residing in the city of Florence was invited to participate in the local section of the EPIC study with two major aims: i) to carry out a population-based survey on dietary and life-style habits in this urban area of Tuscany, Central Italy; ii) to compare these results with a large series of EPIC volunteers residing in the same municipality in order to evaluate the differences between the two groups. A random sample of 500 residents (250 women) aged 40-64 years, was invited to participate in the study; 362/500 (72.4%) accepted and followed the EPIC protocol. The distribution of selected individual characteristics (including measured weight and height) showed a high prevalence of being overweight in men (52.2%) and obesity in both sexes (17.4% in men and 12.5% in women). A dietary pattern characterized by a high consumption of red meat, processed meats, olive oil and wine emerged in both sexes; the consumption of vegetables and fresh fruit was approximately 200 and 300 g/day, respectively. The estimated mean intakes of macronutrients reflected this pattern, with a high mean intake of total fat and protein. The mean contribution to total caloric intake provided by fat was 30.9% and 33.6% in these randomly sampled men and women, respectively. The results were compared with those of 9,123 Florence residents aged 40-64 years and enrolled as EPIC volunteers. Current smokers and less educated subjects were less represented among male volunteers, who, in general, showed a healthier dietary pattern (more fresh fruit and less spirits). Female volunteers were taller and heavier and consumed more fresh fruit but also more beef and less carbohydrates. Other statistically significant differences emerged, but the absolute values of these differences were usually modest and the two groups appeared remarkably similar. Overall, our results suggest that the large EPIC-Florence cohort was not strictly selected and showed a total caloric intake and a range of dietary variability similar to that of the general population of the same area.

Adult↗

[Lipid metabolism, features of nutrition and risk factors of ischemic heart disease in cohorts of Canadian Inuits and Taimyr Nganasans].

Lipids metabolism and blood lipid profiles in native populations of Northern Asia (Nganasans, n = 43) and Northern Canada (Inuits, n = 151) have been studied. Estimation of serum PUFA of omega-6 and omega-3 series in Nganasans testifies to shifting of their diet to "western" type. Three types of dietary patterns have been observed in inuits: traditional one (among age group of 40-69), "western" (among age group of 18-29) and intermediate, transitional (among age group of 30-39). Age differences in concentrations of total cholesterol, summarized fraction of low density and very low density lipoproteins in Nganasans and Inuits were similar, however, Inuits had higher levels of blood lipids including HDL-cholesterol. Concentrations of apoB lipoproteins were significantly higher in Inuits, however, apoA-1/apoB ratios were estimated as more than 1.0 in both groups and the differences were not significant. Correlation between fatty acid composition and lipid profiles in Inuits who followed traditional diet testify to non-atherogenic type of nutrition. Despite to favorable blood lipid profiles in Northern native population, hypercholesterolemia was found in 2% of Nganasans and 10% of Inuits, while hypo-alpha-cholesterolemia was found in 25% Nganasans and in 5% of Inuits. Thus, changes in dietary patterns of native populations of the Far North have a great influence on blood concentrations of PUFAs of omega-3 series. Changes in the dietary fatty acid composition are considered to be one of the possible reasons of dislipoproteinemia.

Adolescent↗

Can a Mediterranean diet moderate the development and clinical progression of coronary heart disease? A systematic review.

BACKGROUND: It has been suggested that adherence to a Mediterranean diet reduces all causes of mortality, especially death rates due to coronary heart disease. In this review we summarize the findings of observational studies that evaluated the effect of the Mediterranean dietary pattern in the primary and secondary prevention of coronary heart disease. MATERIAL/METHODS: We retrieved published results from prospective and case-control studies which evaluated the association between adherence to a Mediterranean diet and the occurrence of coronary heart disease outcomes. RESULTS: The benefits from the Mediterranean diet were significant in all studies. The reduction in the risk of coronary heart disease varied from 8% to 45%, depending on the increment used by the investigators in the presentation of their results. CONCLUSIONS: The systematically reviewed studies reveal a cardio-protective effect of the Mediterranean diet and point to this dietary pattern as highly appropriate for public health objectives.

Coronary Disease↗

Mediterranean dietary components and body mass index in adults: the peel nutrition and heart health survey.

Diet is a lifestyle factor that contributes to the risk of overweight/obesity and cardiovascular disease. The objective of this study was to examine the hypothesis that a Mediterranean-type dietary pattern (M) is associated with healthy body weights in a large suburban municipality in Ontario. A random cross-sectional sample of 759 adults, 18 to 65 years of age, participated in a telephone survey, which included questions on the frequency of consumption of 60 food categories. Principal components analysis showed that food categories aggregated into six low-order dietary factors and two high-order dietary patterns. The M pattern reflected higher consumption of fruits and vegetables, olive oil and garlic, and fish and shellfish. The non-M pattern reflected high fat/nutrient poor, meats and poultry, and foods high in added sugars. The M-score was inversely related to body mass index (BMI) (p = 0.027). After adjustment for gender, education, income and marital status, a higher M-score predicted a lower BMI in the 40 to 49 year age group. Heart health promotion strategies aimed at preventing adult obesity should emphasize components of a Mediterranean-type diet pattern.

Adolescent↗

Effects of dietary intake, appetite, and eating habits on dialysis and non-dialysis treatment days in hemodialysis patients: cross-sectional results from the HEMO study.

OBJECTIVE: To evaluate differences between dietary energy intake (DEI), dietary protein intake (DPI), appetite, dietary patterns, and eating habits during dialysis treatment days (DD) and non-dialysis treatment days (NDD) in 1,901 adults receiving maintenance hemodialysis who were enrolled in the baseline phase of the National Institutes of Health-sponsored Hemodialysis (HEMO) study. DESIGN: A cross-sectional analysis of participants at baseline (before randomization). SETTING: Fifteen clinical centers across the United States. MEASUREMENTS: DEI, DPI, and self-reported assessment of appetite, dietary patterns, and eating habits. RESULTS: For the entire study cohort, total mean (+/- SD) DEI (1,566 +/- 636 kcal/day) and weight-adjusted DEI (23.2 +/- 9.5 kcal/kg/day) were significantly higher (P <.0001) on NDD than on DD (1,488 +/- 620 kcal/day and 22.2 +/- 9.6 kcal/kg/day), respectively. Similarly, DPI was significantly higher (P <.0001) on NDD (65.0 +/- 29.0 g/day and 0.96 +/- 0.43 g/kg/day) than on DD (60.2 +/- 26.5 g/day and 0.90 +/- 0.41 g/kg/day). On DD and NDD, the mean weight-adjusted DEI for the entire cohort was less than the HEMO study standard of care (SOC) of > or =28 kcal/kg/day, whereas on NDD, several subgroups reported dietary protein intakes that were closer to the study's SOC. These included men, patients under 50 years of age, nonblack participants, those without diabetes, those with a normal or mild Index of Co-Existing Disease score, and those on dialysis for more than 5 years. Protein and energy intakes declined with worsening self-reported appetites in both DD and NDD after adjusting for other subgroup effects. CONCLUSION: Dietary energy and protein intakes of HEMO study participants were lower on DD than on NDD, and also lower than the SOC on both days, particularly with regard to energy intake. People receiving maintenance hemodialysis should be counseled to consume adequate amounts of energy and protein daily, especially on DD. Practitioners should monitor closely those patients who report poor appetite and should intervene appropriately.

Adult↗