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PubMed2002

Nutrition counseling in the promoting cancer prevention in primary care study.

BACKGROUND: Little is known about the influence of personal and practice-level factors on physicians' dietary counseling practices. METHODS: Primary care physicians (n = 130) were surveyed regarding the frequency that they "ask" patients about their diet, "assess" patients' reasons for and against dietary changes, "advise" patients to eat less fat and more fiber, "assist" patients in changing their diet, and "arrange" a follow-up contact to discuss their diet. In addition, physicians were asked their personal dietary practices, counseling confidence, practice demographics, and medical specialty. RESULTS: Physicians who (a) reported consistently avoiding dietary fat, (b) were more confident in their diet counseling abilities, and (c) were sole owners of their practice were more likely to counsel than physicians who were employees or part owners of the practice. For example, physicians who reported consistently avoiding dietary fat (50.7% of physicians) were 3.2 (95% CI: 1.3-7.9) times more likely to "ask" their patients about their diet and 3.5 (95% CI: 1.5-8.6) times likely to "advise" their patients to eat less fat and more fiber. CONCLUSIONS: Given the strong and consistent effects of a physician's dietary pattern on their counseling practices, future studies should examine the impact of modifying a physician's diet on their patients' dietary behavior.

Adult↗
PubMed2001

Development of scales to measure dietary acculturation among Chinese-Americans and Chinese-Canadians.

OBJECTIVE: To develop simple scales to measure a Chinese immigrant's adoption of Western eating patterns (dietary acculturation). STUDY DESIGN AND PARTICIPANTS: Data are from 244 less-acculturated women of Chinese ethnicity living in Seattle, Wash, and Vancouver, British Columbia, Canada. Interviewers collected information on sociodemographic characteristics, acculturation indices, items that reflect Western and Chinese dietary behavior, and consumption of fruits, vegetables, and fat. STATISTICAL ANALYSES: Analysis of variance and linear regression analyses examined associations among dietary measures and acculturation variables, controlling for age, education, and city of residence. RESULTS: We developed 2 scales to assess dietary acculturation: the Western Dietary Acculturation Scale and the Chinese Dietary Acculturation Scale, measuring Western and Chinese eating behavior, respectively. Although the population in this study was a less-acculturated sample, most participants reported some Western dietary practices, such as drinking milk (78%), eating cheese (78%), eating at Western fast-food restaurants (56%), and eating between meals (72%). Younger, highly educated women employed outside the home had the highest Western dietary acculturation scores (P < .001). Women with high scores on the Western scale reported higher-fat dietary behaviors and had increased fruit and vegetable intake since immigration compared to those with lower scores (P < .001). There was good agreement between the dietary acculturation scales and traditional acculturation indicators (P < .001). APPLICATIONS: Nutrition programs for immigrant/minority groups may be more effective if they are tailored to level of dietary acculturation. Therefore, the ability to accurately assess dietary acculturation is an important component of nutrition education, interventions, and counseling in these populations.

Acculturation↗
PubMed1992

Dietary fatty acids, lipoproteins, and cardiovascular disease.

Dietary fat quality and quantity significantly affect the metabolism of all the plasma lipoproteins and probably constitute the most significant dietary determinants of plasma lipoprotein levels. Since the major role of the plasma lipoproteins is the transport of exogenous and endogenous fat, this would be expected of a highly regulated, metabolically homeostatic system. The data clearly show that dietary fat saturation affects all aspects of lipoprotein metabolism, from synthesis to intravascular remodeling and exchanges to receptor-mediated and nonspecific catabolism. The experimental data regarding dietary fatty acid effects on lipoprotein metabolism are complicated and at times contradictory due to the large degree of metabolic heterogeneity in the population, which, when coupled with the known abnormalities of lipoprotein metabolism associated with certain types of hyperlipoproteinemia, can present responses from A to Z. It is clear that the same dietary pattern has different effects in different individuals and that complicating factors of individuality raise some concerns regarding generalized dietary recommendations. As new knowledge of the role of dietary factors and CVD risk develops, and our abilities to characterize the individual patient's response to dietary interventions become more refined, it may be possible to specify dietary fat intervention from a patient-oriented concept rather than a single all-purpose diet approach. Thus it would be possible to design dietary interventions to match patient needs and gain both efficacy and compliance. With the spectrum of approaches possible--low fat, moderate fat with MUFA, n-3 PUFA, etc.--we should be able to approach dietary interventions to reduce CVD risk at both a population-based level and a patient-specific level. There remains much to learn regarding the effects of dietary fatty acids on the synthesis, intravascular modifications, and eventual catabolism of the plasma lipoproteins. The area of lipoprotein metabolism in health and disease, of its modifications by diets and drugs, and of the contributions of genetic heterogeneity to these processes is one of notable advances over the past two decades and continues to be an area of intense investigation.

Animals↗
PubMed1997

High blood cadmium levels are not associated with consumption of traditional food among the Inuit of Nunavik.

High levels of cadmium in the liver and kidneys of caribous and sea mammals of the Canadian Arctic have led to recommendations to remove such offal from the traditional diet. Blood cadmium levels have been found to be very high in samples of Inuit volunteers, hence the hypothesis that the Inuit might be exposed to cadmium through their diet. This survey of a population-based random sample of Nunavik residents (n = 518) confirms that blood cadmium of Inuit is indeed very high by comparison to published reports. Blood cadmium levels are closely associated with the current smoking status and are independent of dietary patterns among nonsmokers. Plasma omega-3 fatty acids concentrations have been used to assess the reliability of the dietary information collected by questionnaires and to test for any association of blood cadmium with the consumption of sea mammals. Blood cadmium levels are not related to the reported consumption of sea mammals. Blood cadmium levels are very high among smokers and are associated with levels of exposure to tobacco. Among nonsmoking Inuit, blood cadmium levels are comparable with those reported in nonsmokers elsewhere in the world. In reference to international standards, blood cadmium concentrations are high enough among the Inuit to warrant energetic public health interventions.

Adolescent↗
PubMed1989

Development of a diet history questionnaire for studies of older persons.

This paper describes the criteria of a simplified diet history method and the procedures for developing a dietary questionnaire for studies of older persons. Suggestions are included on selecting food items representative of the population's dietary patterns, designing objective methods to estimate quantitative and frequency intakes of food items, and collecting information on other dietary practices. Potential problems in dietary surveys among older persons are discussed, along with their prevention or alleviation.

Aged↗
PubMed2001

Fruit and vegetable consumption is lower and saturated fat intake is higher among Canadians reporting smoking.

Understanding differences in dietary patterns by smoking status is important for nutritionists and health educators involved in helping individuals to make healthy dietary and lifestyle choices. Although smokers have a poor quality diet compared with nonsmokers, no study has examined nutritional adequacy and variability in the nutrient intake of smokers. The aim of this study was to compare dietary habits of smokers with nonsmokers in terms of nutrient intake, food groups contributing to nutrient intake, nutritional adequacy and day-to-day variation in nutrient intake. Noninstitutionalized adults aged 18--65 y (n = 1543) who participated in the Food Habits of Canadians Survey (1997--1998) were studied. Subjects, selected from across Canada using a multistage, random-sampling strategy, completed an in-home 24-h dietary recall. Repeat interviews were conducted in a subsample to estimate variability in nutrient intake. Smokers had higher intakes of total and saturated fat, and lower intakes of folate, vitamin C and fiber than nonsmokers. There were no significant differences in calcium, zinc and vitamin A intakes or day-to-day variation in nutrient intake by smoking status. Smokers consumed significantly fewer fruits and vegetables than nonsmokers, leading to lower intakes of folate and vitamin C. In conclusion, smokers have a less healthy diet than nonsmokers, placing them at higher risk for chronic disease as a result of both dietary and smoking habits. Diet may act as a confounder in smoking-disease relationships.

Adolescent↗
PubMed1993

Folate, methionine, and alcohol intake and risk of colorectal adenoma.

BACKGROUND: Reduced methylation of DNA may contribute to loss of the normal controls on proto-oncogene expression. In humans, hypomethylation of DNA has been observed in colorectal cancers and in their adenomatous polyp precursors. Accumulation of DNA methylation abnormalities, observed during progression of human colorectal neoplasia, may be influenced by certain dietary factors. The apparent protective effect of fresh fruits and vegetables, the major folate sources, on colorectal cancer incidence suggests that a methyl-deficient diet contributes to occurrence of this malignancy. Low dietary folate and methionine and high intake of alcohol may reduce levels of S-adenosylmethionine, which is required for DNA methylation. PURPOSE: To determine if dietary factors that may influence methyl availability are related to colorectal adenomas, we prospectively examined the association of folate, methionine, and alcohol intakes and risk of colorectal adenoma. METHODS: We assessed dietary intake for a 1-year period for women of the Nurses' Health Study, started in 1976, and for men of the Health Professionals Follow-up Study, started in 1986--using a semiquantitative food frequency questionnaire. Adenomatous polyps of the left colon or rectum were diagnosed in 564 of 15,984 women who had had an endoscopy between 1980 and 1990 and in 331 of 9490 men who had undergone an endoscopy between 1986 and 1990. RESULTS: High dietary folate was inversely associated with risk of colorectal adenoma in women (multivariate relative risk [RR] = 0.66; 95% confidence interval [CI] = 0.46-0.95 between high and low quintiles of intake) and in men (RR = 0.63; 95% CI = 0.41-0.98) after adjusting for age, family history, indications for endoscopy, history of previous endoscopy, total energy intake, saturated fat intake, dietary fiber, and body mass index. Relative to nondrinkers, drinkers of more than 30 g of alcohol daily (about two drinks) had an elevated risk of adenoma (in women, RR = 1.84, 95% CI = 1.19-2.86; in men, RR = 1.64, 95% CI = 0.92-2.93). Methionine intake was inversely associated with risk of adenomas 1 cm or larger (RR = 0.62; 95% CI = 0.46-0.85, combining men and women). CONCLUSIONS: Folate, alcohol, and methionine could influence methyl group availability, and a methyl-deficient diet may be linked to early stages of colorectal neoplasia. A dietary pattern that increases methyl availability could reduce incidence of colorectal cancer. IMPLICATIONS: These data support efforts to increase dietary folate in segments of the population having diets with low intakes of this nutrient.

Adenoma↗
PubMed1998

Modern life' in the epidemiology of inflammatory bowel disease: a case-control study with special emphasis on nutritional factors.

OBJECTIVE: The rising incidence of inflammatory bowel disease (IBD) since the Second World War coincides with profound changes of the dietary pattern. The aim of the study was to investigate the possible pathogenic role of some characteristic 'modern life' dietary factors in IBD. DESIGN: Case-control, studying risk factors in recently diagnosed cases, 290 with Crohn's disease and 398 with ulcerative colitis, compared with 616 population controls. Smoking, age, gender and education were taken into account by using logistic regression analysis. SETTING: Hospital cases and population controls. INTERVENTIONS: Questionnaires. MAIN OUTCOME MEASURES: Logistic regression-derived odds ratios. RESULTS: A positive association with cola drinks [OR: 2.2 (95% CI 1.5-3.1)], chewing gum [OR: 1.5 (95% CI: 1.1-2.1)] and chocolate consumption [OR: 2.5 (95% CI: 1.8-3.5)] and a negative association with citrus fruit consumption [OR: 0.5 (95% CI 0.3-0.7)] and the development of Crohn's disease were found. Consumption of cola drinks [OR: 1.6 (95% CI 1.1-2.3)] and chocolate consumption [OR: 2.5 (95% CI 1.8-3.5)] were positively associated with developing ulcerative colitis. There was a negative association between the intake of citrus fruits [OR: 0.5 (95% CI 0.4-0.8)] and 'having a stuffed pet' for a period longer than 5 years [OR: 0.6 (95% CI 0.4-0.9)] and developing the disorder. No association with the frequency of tooth brushing and developing IBD was found. CONCLUSION: All the nutritional items mentioned may be true risk factors or they just might be the expression of a modern life-style also involving other risk factors for the development of IBD which at the present are still unknown.

Adult↗
PubMed1993

Epidemiologic studies on Eskimos and fish intake.

Chronic diseases such as coronary heart disease and diabetes mellitus are uncommon in Eskimos. Total cholesterol levels are generally low, whereas HDL cholesterol levels are higher than those in an age- and sex-matched Danish population. It is frequently assumed that this is mainly due to their dietary pattern, especially with its high content of n-3 polyunsaturated fatty acids, derived from fish and other seafoods. Dietary surveys have shown that the intake of n-3 polyunsaturated fatty acids in Eskimos is about 14 g/day, whereas it is 3 g/day in Denmark and about 0.2 g/day in the United States. However, the Eskimo diet also differs from the Western diet in other aspects, especially in the intake of saturated fatty acids which is low (9 energy-%). The intake of dietary cholesterol is rather high because of the large consumption of seafood. Individually based studies are better suited to disentangle the health effects of different nutrients, inasmuch as confounding factors can be taken into account. Several cohort studies have now shown that the consumption of 1-2 fish meals per week is associated with a reduction in the risk of coronary heart disease. Recently, similar results concerning glucose intolerance and stroke were also reported. These combined data suggest that a diet low in saturated fatty acids, in combination with a low or moderate level of fish consumption, may be of importance in the prevention of diseases such as coronary heart disease, ischemic stroke, and diabetes mellitus.

Animals↗
PubMed2004

International variations in the outcome of schizophrenia and the prevalence of depression in relation to national dietary practices: an ecological analysis.

BACKGROUND: Dietary variations are known to predict the prevalence of physical illnesses such as diabetes and heart disease but the possible influence of diet on mental health has been neglected. AIMS: To explore dietary predictors of the outcome of schizophrenia and the prevalence of depression. METHOD: Ecological analysis of national dietary patterns in relation to international variations in outcome of schizophrenia and prevalence of depression. RESULTS: A higher national dietary intake of refined sugar and dairy products predicted a worse 2-year outcome of schizophrenia. A high national prevalence of depression was predicted by a low dietary intake of fish and seafood. CONCLUSIONS: The dietary predictors of outcome of schizophrenia and prevalence of depression are similar to those that predict illnesses such as coronary heart disease and diabetes, which are more common in people with mental health problems and in which nutritional approaches are widely recommended. Dietary intervention studies are indicated in schizophrenia and depression.

Animals↗
PubMed1997

Meal frequency and energy balance.

Several epidemiological studies have observed an inverse relationship between people's habitual frequency of eating and body weight, leading to the suggestion that a 'nibbling' meal pattern may help in the avoidance of obesity. A review of all pertinent studies shows that, although many fail to find any significant relationship, the relationship is consistently inverse in those that do observe a relationship. However, this finding is highly vulnerable to the probable confounding effects of post hoc changes in dietary patterns as a consequence of weight gain and to dietary under-reporting which undoubtedly invalidates some of the studies. We conclude that the epidemiological evidence is at best very weak, and almost certainly represents an artefact. A detailed review of the possible mechanistic explanations for a metabolic advantage of nibbling meal patterns failed to reveal significant benefits in respect of energy expenditure. Although some short-term studies suggest that the thermic effect of feeding is higher when an isoenergetic test load is divided into multiple small meals, other studies refute this, and most are neutral. More importantly, studies using whole-body calorimetry and doubly-labelled water to assess total 24 h energy expenditure find no difference between nibbling and gorging. Finally, with the exception of a single study, there is no evidence that weight loss on hypoenergetic regimens is altered by meal frequency. We conclude that any effects of meal pattern on the regulation of body weight are likely to be mediated through effects on the food intake side of the energy balance equation.

Adolescent↗
PubMed2001

Macronutrient intake and estrogen metabolism in healthy postmenopausal women.

The purpose of this study was to determine if dietary factors could bias estimates of the relationships between estrogen metabolites and breast cancer risk factors. A lower ratio of urinary 2-hydroxyestrone/16alpha-hydroxyestrone (2/16) has been associated with breast cancer diagnosis. However, both estrogen metabolism and breast cancer risk have been associated with dietary intake, and breast cancer patients may have different dietary patterns than healthy controls. An association between urinary 2/16 levels and breast cancer risk may be due to transitory dietary change after diagnosis, or due to other breast cancer risk factors which have been associated to steroid hormone metabolism. Thirty-seven healthy postmenopausal women provided two 24-h urine samples at a two-week interval. Six 24-h diet recalls were administered in this same time period. In linear regression analysis, dietary fat-to-fiber ratio (fat/fiber) and the saturated fat/soluble fiber ratio was inversely associated with urinary 2/16 values (b = -0.22, 95% CI (-0.43, -0.01); b= -0.26, 95% CI (-0.43, -0.09), respectively). The effects of these dietary factors on 2/16 were independent of body mass index or other breast cancer risk factors. These study results suggest that some of the variation in estrogen metabolite levels among postmenopausal Caucasian women may be due to dietary intake, and that dietary factors should be carefully measured and evaluated when investigating the relationship between estrogen metabolites and breast cancer risk.

Aged↗
PubMed1991

Dietary calcium and blood pressure: modifying factors in specific populations.

Epidemiologic findings continue to add to the body of evidence supporting a relationship between calcium intake and blood pressure. These findings also indicate that there is a threshold of the potential protective effect of adequate calcium intake, below which the risk of hypertension increases at a greater rate. The set point of this threshold, estimated at 700-800 mg/d, may be modified by a variety of factors including dietary patterns and components, lifestyle, and genetics. This may explain, at least in part, the heterogeneous response observed in dietary-intervention studies. In animal models of hypertension it was shown that greater amounts of calcium must be given to cause a blood pressure change comparable with that in normal animals, suggesting that in high-risk human populations in which calcium metabolism may be disordered, calcium intake may have to be increased to amounts greater than 700-800 mg/d to demonstrate the blood-pressure-lowering effect. Calcium intake at or above the currently recommended daily allowance of 800 mg could be of potential benefit to certain racial groups, individuals ingesting excessive alcohol, and pregnant women, all of whom generally consume low amounts of calcium and who are at higher risk of developing hypertension.

Animals↗
PubMed2001

Nutritional research within the Framingham Heart Study.

Fifty years of research at the Framingham Heart Study have made important contributions to the diagnosis and treatment of cardiovascular disease (CVD). Within the scope of this prospective population-based cohort study, research investigations from the Framingham Nutrition Studies have developed and advanced nutritional epidemiologic methods, many of which are highlighted here. Ongoing nutrition research explores relationship between diet, nutritional status, and the development of chronic diseases, including CVD. This paper summarizes key findings from decades of nutrition research within the Framingham Heart Study. Cross-sectional and longitudinal investigations are described, including recent research on dietary patterns and coronary heart disease risk among women. Implications for the development of national nutrition policy, population-based dietary guidance for chronic disease prevention, and nutrition-related health promotion campaigns for CVD risk reduction are discussed.

Adult↗
PubMed1984

Diet, nutrition intake, and metabolism in populations at high and low risk for colon cancer. Nutrient intake.

A 3-day diary with portion sizes weighed by the subject and a 24-h recall were obtained on 50 sets of subjects: Seventh-day Adventist lacto-ovo-vegetarians and nonvegetarians, and general population nonvegetarians, matched on age (+/- 5 yr), sex, marital status, education, type of milk preferred, and an index of the frequency of dairy and egg product use. An additional 18 unmatched persons who follow a pure vegetarian dietary pattern (use no meat, fish, fowl, dairy, or egg products) were recruited into the study. The rational for the dietary methods used is presented and details of each of the methods used are given. The results of the nutrient analysis of the 24-h recall and 3-day diary are presented. The 3-day nutrient intake means for the four groups are compared to the sex-specific recommended daily allowance both with and without supplements. The contribution of nutritional supplements to the nutrient intake is discussed. All groups show adequate or excess intake levels of calories, protein, and fat when either the 24-h recall or the 3-day diary values are considered. The higher intake of calories noted among nonvegetarians can be explained by a higher intake of both fat and protein in these groups. A, B, and C vitamin levels (3-day dairy estimates) are adequate both with and without supplements. Calcium intake is much below recommended levels for pure vegetarian females. Iron intake is low for all females. A heme iron source does not improve the intake levels for nonvegetarian females. A comparison of these results with prior reports of nutrient intake among Seventh-day Adventists is presented.

Calcium, Dietary↗
PubMed2001

Diet and coronary heart disease: findings from the Nurses' Health Study and Health Professionals' Follow-up Study.

In the last decade, our understanding of the nutrients and foods most likely to promote cardiac health has improved substantially, owing in part to the data from several large and carefully conducted prospective cohort studies, including the Nurses' Health Study (NHS) and Health Professionals' Follow-up Study (HPFS). Using more refined dietary assessment tools and multiple measurements, the NHS and HPFS have provided a wealth of information not only on major types of fat and different classes of fatty acids, but also other aspects of diet, including antioxidants, folate, fiber, dietary glycemic load, and overall dietary patterns. These studies, along with metabolic, clinical and other epidemiological studies, have provided strong evidence for a major role of dietary modification in the prevention of coronary heart disease (CHD).

Adult↗
PubMed2001

Multiple sclerosis, an autoimmune inflammatory disease: prospects for its integrative management.

Multiple sclerosis (MS) is aptly named for the many scars it produces in the brain and spinal cord. A sometimes fatal, often debilitating disease, MS features autoimmune inflammatory attack against the myelin insulation of neurons. Thymus derived (T) cells sensitized against myelin self-antigens secrete tumor necrosis factor, cytokines, prostaglandins, and other inflammatory mediators that strip away the myelin and sometimes destroy the axons. Familial and twin inheritance studies indicate MS is mildly heritable. No single MS locus has been identified, but an HLA haplotype has been implicated. Unique geographic distribution of the disease is best attributed to some combination of vitamin D abnormality and dietary patterns. No pharmaceutical or other therapies exist that confer prolonged remission on MS, and obvious interrelationships between toxic, infectious, and dietary factors make a persuasive case for integrative management. The time-proven MS diet meticulously keeps saturated fats low, includes three fish meals per week, and eliminates allergenic foods. Dietary supplementation for MS minimally requires potent vitamin supplementation, along with the thiol antioxidants, the anti-inflammatory omega-3 fatty acids, and adaptogenic phytonutrients. Gut malabsorption and dysbiosis can be corrected using digestive enzymes and probiotics. Long-term hyperbaric oxygen therapy can slow or remit the disease. Transdermal histamine offers promise, and adenosine monophosphate may sometimes benefit. Chronic viruses and other infectious load must be aggressively treated and exercise should maintain muscle tone and balance. Early intervention with integrative modalities has the potential to make MS a truly manageable disease.

Autoimmune Diseases↗
PubMed1992

Does beta-carotene explain why reduced cancer risk is associated with vegetable and fruit intake?

Increased intake of vegetables, fruits, and carotenoids and elevated blood levels of beta-carotene are consistently associated with reduced risk of lung cancer in epidemiologic studies. Epidemiologic research also suggests that carotenoids may reduce the risk of other cancers, although the evidence is less extensive and consistent. The simplest explanation is that beta-carotene is protective. However, the possible roles of other carotenoids, other constituents of vegetables and fruits, and associated dietary patterns have not been adequately explored. To evaluate these alternative hypotheses, we are undertaking three lines of research. (a) With dietary data from the 1987 National Health Interview Survey and the 1982-1984 Epidemiologic Follow-up of the first National Health and Nutrition Examination Study, we have determined which food groups and nutrients are highly correlated with vegetable and fruit intake. (b) We have developed and characterized a liquid chromatography method for optimal recovery and resolution of the common carotenoids in blood, specifically lutein, zeaxanthin, beta-cryptoxanthin, lycopene, alpha-carotene, and beta-carotene. (c) In a population-based case-control study of lung cancer in white men in New Jersey, we are assessing whether estimates of the intake of the individual carotenoids might produce stronger inverse associations than estimates of provitamin A carotenoids based on current food composition tables.

Carotenoids↗