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Tracking of energy and nutrient intakes from adolescence to young adulthood: the experiences of the Young Hearts Project, Northern Ireland.

OBJECTIVE: To assess tracking of energy and nutrient intakes between adolescence and young adulthood. DESIGN: Longitudinal study of a random sample of adolescents (aged 15 years at baseline). The extent of tracking of dietary intakes (assessed by diet history) was investigated using weighted kappa statistics (kappa). SETTING: Northern Ireland population survey. SUBJECTS: Adolescents who participated in the Young Hearts Project, Northern Ireland at age 15 years, and subsequently at young adulthood aged between 20 and 25 years (n=245 males, n=231 females). RESULTS: Despite overall increases in height and weight (both P<0.001), increases in body mass index in males (P<0.001) and body fatness in females (P<0.001), median reported intakes of energy (kJ kg(-1) day(-1)), carbohydrate (g day(-1)) and fat (g day(-1)) decreased (all P<0.001) over time. Expressed as nutrient densities (per MJ), diets at young adulthood were overall richer in thiamin, vitamin B6, total folate (all P<0.001), vitamin C (P<0.01) and vitamin D (P<0.05). Whereas the nutrient density of the males' diets decreased over time for calcium (P<0.05) and vitamin A (P<0.001), iron and riboflavin densities increased in the females' diet (P<0.001). Tracking of energy (MJ day(-1)) and nutrient intakes (expressed per MJ day(-1)) at the individual level was only poor to fair (all kappa<0.25), indicating substantial drift of subjects between the low, medium and high classes of intake with increasing age. CONCLUSIONS: These data suggest that individual dietary patterns exhibited at 15 years of age are unlikely to be predictive of dietary intakes at young adulthood.

Adolescent↗

Iron status of middle-aged women in five counties of rural China.

OBJECTIVE: To determine the relationships of dietary iron sources, other dietary factors, and lifestyle to iron status among premenopausal and recently postmenopausal Chinese women with widely varying regional dietary patterns. DESIGN: Cross-sectional. Subjects were interviewed, blood samples were drawn, and dietary intakes were measured by a 3-day dietary survey for subjects in the five survey counties. SETTING: Rural China. SUBJECTS: About 80 randomly selected subjects per county among women aged 32 66 y. MAIN OUTCOME MEASURES: Blood hemoglobin, plasma ferritin, and plasma iron. RESULTS: Total iron intake was relatively high (15-29 mg/d) compared to developed counties. Heme iron intake was negligible in two of the study counties. Overall levels of iron deficiency anemia were relatively low in these generally iron-stressed women. There was no clear statistical relationship between iron intake and physiological iron status. Although several measures of dietary intake (heme iron, dietary calcium, animal protein) were correlated with several measures of iron status before adjusting for survey county, only dietary animal protein was significantly positively correlated with plasma ferritin after adjusting for the possibly confounding factor of the survey county (r= 0.15, P = 0.009). Intakes of potential inhibitors of iron absorption, such as tea, even in very high amounts, were not correlated to iron status. Plasma ferritin was positively correlated with plasma retinol (P = 0.024) and cholesterol (P = 0.007). Systemic inflammatory response, as indicated by high plasma C-reactive protein levels, was shown to be raised in a group of subjects with apparently contradictory high levels of ferritin and low levels of hemoglobin (P = 0.03). CONCLUSIONS: Iron nutriture in these areas of rural China seemed more related to physiological factors such as inflammatory response, menses, plasma vitamin A and cholesterol, than to dietary factors.

Adult↗

Food intake patterns and risk of coronary heart disease: a prospective cohort study examining the use of traditional scoring techniques.

OBJECTIVE: This study analyses the risk of coronary heart disease (CHD) associated with food intake patterns. DESIGN: A cohort study with follow-up in 1996 for first admission to hospital for a CHD diagnosis or death caused by CHD (280 cases). Three food patterns were identified from a food frequency questionnaire: (1) a predefined healthy food index; (2) a prudent diet (reflecting frequent intakes of wholemeal cereals, fruit and vegetables); and (3) a Western food pattern (reflecting frequent intakes of meat products, butter and white bread) derived by factor analysis. Both factor scores had a mean of zero and a standard deviation of 1. SETTING: Copenhagen County, Denmark. SUBJECTS: A random sample of 7316 adults participated in health examinations conducted either in 1982-1984, 1987, or 1991-1992. RESULTS: The healthy food index and the Western pattern were not associated with CHD. The prudent pattern was associated with a decreased risk of CHD (Hazard ratio (HR per score unit increase)=0.85; 95% confidence intervals (CI), 0.75, 0.96), but the association vanished (HR=1.06; 95% CI, 0.93, 1.21) after controlling for confounding. Body mass index (BMI) modified the effect of the prudent and the Western patterns on CHD risk, suggesting an inverse association between both patterns and CHD in persons with low BMI, while the risk of CHD seemed to be positively related to the prudent and the Western pattern in those with high BMIs. CONCLUSIONS: This study showed no association between dietary patterns and CHD risk, but suggests that BMI modifies the relation between diet and CHD risk.

Adult↗

The effect of fiber-rich carbohydrates on features of Syndrome X.

There has been much debate among nutritionists and scientists regarding the optimal dietary approach for the treatment of the Insulin Resistance Syndrome, also called Syndrome X. This condition, which may affect as many as 47 million individuals in the United States, significantly increases risk of coronary heart disease and stroke. Major health organizations have historically recommended high-carbohydrate, low-fat (HCLF) diets to reduce chronic disease risk. However, there is evidence that a high intake of carbohydrates may adversely affect one or more of the abnormalities associated with this syndrome. Studies in this area have often had limitations. For example, some studies showing adverse effects of an HCLF diet have not taken into account the dietary fiber content of the diet. This article describes abnormalities often associated with Syndrome X, reviews the beneficial effects of fiber-rich carbohydrates, discusses the effect of fiber-rich carbohydrates on features of this syndrome, and concludes with applications of these findings for those involved in treating individuals with features of this disorder. This review indicates that an HCLF dietary pattern such as that used in the DASH trial, with a level of dietary fiber consistent with the recommendations of the American Dietetic Association (eg, 20-35g/day), containing from 3 to 10 g soluble fiber/day, may be beneficial for treating those with Syndrome X.

Abdomen↗

Dietary advice for patients undergoing coronary artery bypass surgery: falling on deaf ears?

Coronary heart disease (CHD) is the most common cause of death in the UK, accounting for around 125,000 deaths per year. Diet is a CHD risk factor that is modifiable, and therefore has the potential to alter the risk for CHD. At present, little is known about the dietary patterns of CHD patients. The present study aimed to assess the effectiveness of dietary advice administered to patients undergoing coronary artery bypass grafting (CABG) surgery. Dietary intake was assessed on three occasions (pre-operatively, 2 months after surgery and 1 year after surgery) by use of a food amount frequency questionnaire that had been previously validated. Patients were also asked to provide information on any dietary advice they had received. Complete data were available for 15 males, aged 51-79 years, who were admitted for CABG surgery. The absolute mean intakes of total fat, saturated fat and dietary cholesterol significantly increased 1 year after CABG surgery by 21%, 36% and 51%, respectively, and the choice of food items reflected this change in nutrient intake. These undesirable changes occurred despite the provision of dietary advice. This may consequently increase the risk of recurrent problems, and serve to promote further atherosclerosis in the arteries of such patients. The observations highlight the need to better understand the barriers to nutritional advice and compliance seen in CABG patients.

Aged↗

Interaction between nutrition and inflammation in hemodialysis patients.

The excessive cardiovascular mortality of dialysis patients is at least in part related to chronic inflammation, which is associated with the occurrence of malnutrition. The negative effects of chronic inflammation on nutritional status are mediated by proinflammatory cytokines leading to a reduction in appetite and increased muscle catabolism. However, dietary behavior itself may also independently affect inflammation. Reduced dietary supply of vitamins C, B6, B12 and folate, as well as regular coffee consumption and increased intake of dietary advanced glycation end products may trigger chronic inflammation. On the other hand, a Mediterranean dietary pattern and regular soy intake both have been shown to attenuate chronic inflammation. Dietary interventions aiming to attenuate the chronic inflammatory status in dialysis patients need further exploration.

Diet↗

Nutrition and behavioral characteristics and determinants of plasma cholesterol levels in men and women.

The National Cholesterol Education Program advocates dietary interventions in persons with high and moderate blood cholesterol levels and in the general population as a preventive measure for coronary heart disease. For these efforts to be successful, it is necessary to understand consumer characteristics and behaviors, including nutrient intake and dietary patterns. We studied the relationship of plasma cholesterol levels to consumer characteristics and dietary behaviors by examining 127 men (aged 20 through 71 years) and 187 women (aged 18 through 67 years) as part of a cholesterol screening project in the administrative offices and academic departments of Boston University from March 1988 through June 1988. Our results showed that specific consumer characteristics and dietary behaviors significantly differentiated male and female groups with low, moderate, and high cholesterol levels. Factors that should be considered in planning dietary interventions aimed at cholesterol reduction in men include spouse involvement and support in lipid-lowering interventions; weight reduction; increase in exercise; reduction in beef intake; and increases in dietary fiber and carbohydrates, particularly fruits. For women, recommendations include weight reduction; possible interventions aimed at reducing blood pressure (ie, behavioral modification aimed at reducing stress, increasing exercise, and cooking low-salt meals); reduction in beef intake, dietary fat, and saturated fat; and increases in carbohydrates and dietary fiber.

Adult↗

Changes in dietary fiber intake among Japanese in the 20th century: a relationship to the prevalence of diverticular disease.

In view of the fact that Japanese dietary patterns have been undergoing rapid "Westernization," in part characterized by decrease in fiber, we assessed dietary and crude fiber content in the Japanese diet using food consumption tables for the period from 1911 to 1980, and studied the trend in the reported prevalence of diverticular disease of the colon. Fiber content declined in diphasic pattern: the first decline, which probably had started in the late 19th century, progressed until the Second World War. Although records during the war period were unavailable, the high fiber content of the Japanese diet in the period immediately after the war reflects the tendency to supplement rice with more fiber-rich cereals, and to increase the amount of rice through reduced polishing during the war time. The second decline in fiber content in the Japanese diet, which started in the 1950s and progressed throughout the period of "high economic growth," was mainly due to the decrease in cereal consumption. The changes in crude fiber content in the Japanese diet after the Second World War resemble the pattern of rapid decline noted in the United States during the 1930s to the 1950s. The prevalence of diverticular disease in both countries also shows sudden steep upward turns during the period between 1930 and 1950 in the United States and the late 1970s in Japan, suggesting the presence of threshold level(s) of fiber intake for the effective prevention of diverticular disease. The prevalence of diverticular disease is still relatively low in Japan. However, if the current dietary trend continues, it may rise to a level currently found in the "Western" countries in the coming few decades.

Dietary Fiber↗

Eating patterns and cardiovascular disease risk in a Detroit Mexican American population.

The purpose of this study was to examine dietary patterns and cardiovascular risk factors in Hispanic adults living in Southwest Detroit. A descriptive design was used. Self-report baseline data were collected using The Rate Your Plate and Personal Health Risk Assessment questionnaires. A nonrandom sample of 32 Mexican American adults was recruited from a large Roman Catholic Church in Southwest Detroit. Participants were selected if they were enrolled in the larger parent research study to test the effects of a lay health educator intervention and planned to participate in the nutrition education portion of the intervention. Unhealthy eating patterns outnumbered heart healthy eating practices. The majority used higher fat salad dressings; ate fried foods, sweets, and high fat snacks; consumed greater than the desired amounts of regular cheese; drank whole milk; and ate few fruits and vegetables. Lack of physical activity, being overweight, and exposure to second-hand smoke were the most prevalent cardiovascular risk factors. The data suggest that effective community-based heart disease prevention programs that emphasize risk factor screening and cardiovascular risk reduction through heart healthy eating are needed.

Adult↗

Dietary factors associated with physician-diagnosed asthma and allergic rhinitis in teenagers: analyses of the first Nutrition and Health Survey in Taiwan.

The occurrence of asthma and allergy are related to lifestyle factors, and dietary pattern may be one of the contributing factors. To examine the possible association between dietary intake and the prevalence of asthma and allergic rhinitis in teenagers. In a population-based cross-sectional survey, the relationship was sought between food frequency and physician-diagnosed asthma and allergic rhinitis in 1166 adolescents aged 13-17. The prevalence was 4.0% for asthma and 12.4% for rhinitis. Living in an urbanized area was a significant predictor of asthma and rhinitis. In univariate analysis, higher frequencies of oily fish, butcher's meat, liver and deep-fried foods were associated with asthma. Relevant food frequency variables were dichotomized at the 75th percentile for multivariate logistic regression analysis, which included adjustment for two levels of urbanization. Asthma was associated with intakes of liver (OR = 2.32, 95%CI 1.11-4.80), deep-fried foods (OR = 2.13, 95%CI 1.06-4.30) and butcher's meat (OR 1.84, 95%CI 0.89-3.80). In a similar analysis, allergic rhinitis was associated with liver (OR = 1.67, 95%CI 1.06-2.63). No protective effect was demonstrated for any of the food items examined. Protein-rich and fat-rich foods of animal origin were associated with a higher prevalence of asthma in teenagers.

Adolescent↗

NCI dietary guidelines: rationale.

The National Cancer Institute (NCI) believes that the potential for dietary changes to reduce the risk of cancer is considerable and that the existing scientific data provide evidence that is sufficiently consistent to warrant prudent interim dietary guidelines that will promote good health and reduce the risk of some types of cancer. Six interim dietary guidelines and their scientific rationale are discussed herein. The evidence presented for the scientific rationale is based on the 1982 National Academy of Sciences Committee report Diet, Nutrition and Cancer and NCI's own scientific reviews that link long-term dietary patterns with cancer risk. These guidelines to the American public are consistent with other dietary recommendations from the US departments of Agriculture and Health and Human Services, the American Cancer Society, and the American Heart Association.

Diet↗

Diet and socioeconomic position: does the use of different indicators matter?

OBJECTIVES: To describe the association of diet and socioeconomic position and to assess whether two different indicators, education and occupation, independently contribute in determining diet. METHODS: A community-based random sample of men and women residents of Geneva canton, aged 35 to 74, participated in a survey of cardiovascular risk factors conducted annually since 1993. Lifetime occupational and educational history and a semi-quantitative food frequency questionnaire were obtained from 2929 men and 2767 women. RESULTS: Subjects from lower education and/or occupation consumed less fish and vegetables but more fried foods, pasta and potatoes, table sugar and beer. Iron, calcium, vitamin A and vitamin D intake were lower in the lower educational and occupational groups. Both indicators significantly contributed to determining a less healthy dietary pattern for those from low social class. The effects of education and occupation on dietary habits were usually additive and synergistic for some food groups. CONCLUSION: Assessing both education and occupation, improves the description of social class inequalities in dietary habits, as they act, most of the time, as independent factors.

Adult↗

What is the role of diet in the development of cancer in American Indian and Alaska native populations?

BACKGROUND: The associations between diet and cancer in American Indian and Alaska Native (AIAN) populations are not well understood. METHODS: I review current knowledge of the associations between diet and cancer. RESULTS: Studies of diet and cancer are inconsistent. Underlying characteristics of populations could contribute to observed differences. Dietary patterns and energy balance may importantly relate to cancer in AIAN populations. CONCLUSION: Given the differences in cancer incidence and mortality rates in AIAN populations, it is reasonable that diet and lifestyle patterns could contribute to these differences, although we can only speculate as to specific dietary factors in cancer etiology.

Cultural Characteristics↗

Changes in nutrient intake during a behavioral weight control program.

Behavioral modification holds promise of being an effective mode of therapy for obesity. It focuses on changing clients' eating habits and does not always include specific dietary guidance. This study was conducted to learn whether such behavior modification training results in the adoption of nutritionally sound dietary patterns. Originally, the diets of fifteen individuals met two-thirds of all Recommended Dietary Allowances. After a twenty-week program, the only nutrients below this level were iron, thiamin, and calcium. Other changes involved an increase in nutrient density for protein, fiber, phosphorus, iron, vitamin A, thiamin, riboflavin, niacin, ascorbic acid, and cholesterol. Nutrient density for carbohydrates, fat, and calcium decreased.

Adult↗

Assessment of a modified household food weighing method in a study of bone health in China.

OBJECTIVE: A 'modified' household dietary method to estimate individual intakes from total household intakes was evaluated in comparison to the individual food weighing method, i.e. direct weighing of foods consumed by individuals. DESIGN: Foods consumed by the household were weighed and recorded over a 3 day period and were proportionally allocated to a specific person in the household by using energy conversion factors based on age, gender and physical activity. The individual dietary intakes were standardized by body weight (ratio of individual body weight to reference body weight from Chinese Recommended Daily Allowances (Acta Nutr. Sin. 12, 1-9), and were compared with the estimates from the individual food weighing method for both accuracy and associations with bone density. SETTING: The subjects were randomly selected from five rural countries in China, characterized by different dietary patterns. SUBJECTS: A total of 712 women aged 35-75 years participated in the dietary and bone measurements. RESULTS: Nutrient intakes estimated by the modified household method (adjusting for body weight were very similar to those obtained by the individual method (r = 0.53-0.78, P < 0.001), except for sodium which had the largest deviation from the individual methods (r = 0.23, P < 0.001). Calcium intakes were 405 +/- 271 and 409 +/- 323 mg/day, respectively, as estimated by the individual and modified household methods. A very similar degree of correlation with radial bone density also was obtained for both calcium estimates. CONCLUSION: The results indicate that the modified household method is appropriate for assessing food intakes of individuals in large nutritional studies.

Adolescent↗

[Food consumption, habits, and nutritional status of the population of Reus (VIII). Evolution of energy and nutrient intake from 1983 to 1993].

BACKGROUND: Nutritional characteristics of the mediterranean diet, with a high intake of complex carbohydrates, fibre, monounsatured fatty acids and vegetables, are related to a lower prevalence of some nutritional associated diseases. The aim of our study was to perform a longitudinal analysis of the evolution of food intake in a mediterranean population in order to observe its influence on the energy and nutritional intake and their balance. The latter could have some effects on health status. METHODS: Dietary intake was evaluated using the 24 hours recall method in a representative sample (n = 941, age range = 10-69) of a Reus population. This longitudinal study consisted of 70% of the samples studied in 1983 using identical methodology. RESULTS: During this decade (1983-1993), energy intake decreased significantly 180 kcal/day for men and 158 kcal/day for women, carbohydrates being the main cause for this drop (132 and 84 kcal/day less for men and women, respectively). Protein intake decreased significantly in both sexes, 5.6% for men and 8.0% for women. However, the evolution of fat intake was different for men (no changes) and for women (a significant decrease of 5.7%). Saturated and monounsatured fatty acids did not show significant changes in this decade. Cholesterol intake decreased significantly in both sexes. Energy percents obtained from lipids, saturated and monounsaturated fatty acids significantly increased. However, in absolute values very little changes in fat intake in both sexes were observed. CONCLUSIONS: The dietary pattern evolved to a lower energy intake with an increment of the percentage of dietary lipids, but this feature was did not reflect a greater fat intake in absolute values. Moreover, the main characteristics of the typical mediterranean diet (which is basically different to the usual diet of other non mediterranean european countries mainly due to its richness in monounsaturated fatty acids) did not change in the period analyzed.

Adolescent↗

Effects of acculturation and age on the exercise capacities of Solomon Islanders.

Submaximal exercise tests were carried out on 197 females and 290 males from five populations in the Solomon Islands to determine how acculturation affects the fitness of different age and sex groups. Males and females in the least acculturated group show the highest fitness levels, reflecting strenuous work patterns. Subjects from the most acculturated groups exhibit the lowest levels of fitness, a consequence of their more sedentary life-styles. Unexpectedly, older females in these groups show exercise capacities that are equal to those of younger women. This may be a consequence of generational differences in the practice of traditional activities, such as those associated with gardening. Groups ranked intermediate in acculturation show variable patterns. For some age and sex groups, modernization has reinforced and even intensified strenuous activity patterns, resulting in high levels of fitness. For others, modernization has promoted inactivity and/or altered dietary patterns, resulting in increased body fat and low levels of fitness.

Acculturation↗

Fermented dairy products, dietary calcium and colon cancer: a case-control study in The Netherlands.

To examine whether the consumption of fermented dairy products or the dietary intake of calcium decreases colon cancer risk, a case-control study was conducted in the The Netherlands. Dietary patterns were assessed in detail (for cases before diagnosis or symptoms occurred) using a structured dietary history questionnaire. After adjustment for potential confounding variables, consumption of fermented dairy products, hard cheese and unfermented dairy products was not significantly associated with risk of colon cancer: an odds ratio (OR) of 1.1 was found for individuals consuming more than one serving of fermented dairy products per day as compared to those consuming less than 10% of one serving a day. Adjustment for dietary calcium attenuated the associations. Total dietary calcium was positively but non-significantly associated with colon cancer risk after adjustment for age, gender, urbanization level and total energy intake. Additional adjustment for a positive family history of colorectal cancer, cholecystectomy and energy-adjusted intake of total fat, dietary fibre, vitamin C and alcohol increased the association. No differences were observed between calcium from fermented and from unfermented dairy sources. The observed associations for fermented dairy products and dietary calcium differed between men and women: positive significant associations were observed in men, while in women non-significant inverse associations were found. Our results do not support the hypothesis that an increased intake of commercially available, commonly used fermented dairy products or dietary calcium decreases the risk of colon cancer.

Aged↗