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Health status of hostel dwellers. Part VI. Tobacco smoking, alcohol consumption and diet.

Smoking, alcohol consumption and diet were among the criteria selected to screen health status among the residents of the urban migrant council-built hostels of Langa, Nyanga and Gguletu outside Cape Town. Smoking patterns fell within the range found elsewhere. Problems associated with alcohol consumption were exacerbated by the overcrowded hostel living conditions. Dietary patterns were not examined against the concept of an 'ideal diet'. They are understood in the context of the poverty of the hostel dwellers and in the context of limited space available in the hostel environment for cooking and storage. In comparison with a home-based migrant population, the urban migrant hostel dwellers eat more frequently, more regularly and have more variety in their diet. In the light of the findings on the lifestyle indicators of the hostel dwellers, it is concluded that improved living conditions, rather than health education that focuses on individual behaviour, will have a greater impact on improvements in their health status.

Adolescent↗

Infant feeding and dental caries--a longitudinal study of Swedish children.

The aim of the study was to compare dietary habits in children at the age of 12 months with the caries status at the age of 3. In 312 children, residing in 3 different parts of Sweden, a dietary study was carried out at 12 mo. of age, and in 275 (88%) a caries examination was performed at the age of 3. At 12 months of age, higher education of the mother was positively correlated with consumption of bread, vegetables, fruit and meat and negatively with frequency of sucrose-rich foods. At the age of 3, caries was diagnosed in 16% of the children. The prevalence of cavities was related to the level of education of the mother in all 3 areas, cavities being most numerous in children whose mother had received a shorter education. A discriminant analysis showed that the equation discriminating the two a priori defined groups, one with and one without caries at the age of 3, contained a number of sucrose-rich foods. The 3-year-old children with caries had generally consumed cakes, butter, bread and sweet soups more frequently at the age of 12 months than the children in the non-caries group. The analysis thus indicated that - on the group level at least - a dietary pattern, which may be casually linked with future dental caries development, was already established at the age of 12 months. Dietary counselling, when the child is 12-18 mo. of age and based upon information about the dietary habits of the child could thus be of value to prevent caries in the preschool child.

Age Factors↗

Dietary fat and disease patterns in Chukotka Native adults.

It is well documented that dietary patterns have been changing for northern indigenous peoples as they adapt to a contemporary lifestyle. Recent dietary research among Chukotka Native adults showed a higher intake of saturated fatty acids (15% of energy) and sugar, and lower content of polyunsaturated fatty acids (5%) compared with our previous studies. We showed a higher percentage of dietary fat from animal fats (31%) and meat products (28%) than from seafoods and fish, which provide only 11% of daily fat intake. Increasing use of marketed foods and decreasing consumption of traditional foods among Chukotka Native adults contribute to more frequent cases of overweight, diabetes mellitus, and cancer. Dietary recommendations with an emphasis on traditional eating patterns should be considered for promotion of a healthy diet in Chukotka inhabitants. Promoting local foods of high biological value and establishing educational nutrition programs are of great importance.

Adult↗

Mortality trends and past and current dietary factors of breast cancer in Spain.

Spain had one of the lowest breast cancer mortality (BCM) rates in Europe a decade ago but this is no longer the case. A study of the trends of breast cancer mortality in Spain during the last 30 years, and an analysis, at the ecological level, of the current and past dietary patterns associated with breast cancer mortality have been conducted. Age standardized rates and standardized mortality rates (SMR) for this period were calculated. Dietary information about 20 different groups of foods for the 50 Spanish provinces was obtained from two National Household Budget and Expenditure Surveys, conducted in 1964-1965 and 1980-1981. Simple correlation coefficients were calculated, and multiple regression (dependent variables: BCM and breast cancer SMR) with a stepwise procedure was performed. Trends of breast cancer mortality in Spain for the last 35 years indicated a 100% increase in the 35-64 years group. Results indicate important changes in food consumption patterns in Spain, departure from the traditional Spanish diet, and the association of breast cancer mortality with past (15 years period) consumption of beef and total meat and the current consumption of vegetable oils, among other features of interest. Past consumption of meat and particularly beef meat seems to be associated with current breast cancer mortality rates in Spain. However, results at ecological level need to be confirmed in individuals.

Adult↗

Longitudinal dietary change from adolescence to adulthood: perceptions, attributions and evidence.

Dietary patterns and change in eating habits are influenced by multiple factors from an individual's internal and external environment. A longitudinal dietary survey study provided quantitative evidence of dietary change and investigated factors influencing dietary change from adolescence to adulthood, using sociodemographic data and participants' own perceptions of, and attributions for, their dietary change. Longitudinal dietary data were obtained in 1980 and 2000 (average age 11.6 and 32.5 years, respectively). Two questionnaires (2000) and 2 x 3-day food diaries (1980 and 2000) were collected from 198 participants. Foods consumed were assigned to one of the five food groups from The Balance of Good Health (a UK food guide). Questionnaire responses were used to examine how subjects perceived their own dietary change and the factors to which they attributed such change. Six key factors were identified from the questionnaire: parents, partners, children, nutritional awareness, employment and lack of time. Demographic and key factors were associated with degree of change in intake. The complex process of change in food consumption can be linked with an individual's attributions for change.

Adult↗

Tomato products, lycopene, and prostate cancer risk.

Several case-control and large prospective studies focusing on dietary assessment suggest that the intake of tomatoes and tomato products may be associated with a lower risk of prostate cancer [18]. Although less certain at present, the accumulated data suggest that the benefit may be most pronounced in the protection against more advanced or aggressive prostate cancer. It is possible that lycopene is one of the compounds in raw and processed tomato products that may contribute to a lower risk of prostate cancer; however, this hypothesis remains to be further investigated. Other carotenoids and phytochemicals in tomato products may also contribute to the proposed health benefits. Food processing does not seem to reduce the benefits but may, in fact, enhance the bioavailability of beneficial components. The reported correlations or associations between the consumption of tomato products and prostate cancer risk should not be interpreted as causal until additional data are available from a variety of studies in different populations. Ideally, randomized controlled intervention studies would provide an ultimate test of the tomato/lycopene hypothesis; however, the expense, long duration of exposure, and the near universal consumption of tomato products among Americans make a dietary intervention study difficult to undertake. It is reasonable to recommend to the general population the consumption of tomato products at approximately one serving per day or five servings per week as part of an overall healthy dietary pattern that may reduce the risks of prostate cancer, other malignancies, or other chronic diseases. This recommendation is consistent with current dietary guidelines to increase fruit and vegetable consumption to lower the risk of heart disease and many types of cancer [38]. Nutritional prevention of prostate cancer is very different from the use of dietary or nutritional treatments for established prostate cancer. The use of lycopene and other extracts for the treatment of prostate cancer is a separate issue that warrants individual attention and investigation.

Animals↗

Cooking methods, carcinogens, and diet-cancer studies.

A neglect of natural, preservative, and cooking-induced carcinogens or mutagens in food, along with a neglect of dietary patterns during the first portion of a person's lifetime, may be responsible for the many conflicting epidemiological reports dealing with dietary factors and cancer. From animal and occupational studies, we know that the two most important factors in the study of cancer are the dose of carcinogen and allowance for a long latent period. Most of the recent nutrition and cancer studies have ignored both factors. Some bile acids or other endogenous factors may be influenced by diet and may act as cancer-promoting agents, but promoting agents cannot be studied in the absence of knowledge about, or control of, the cancer-initiating events with which they must interact.

Carcinogens↗

Prevention of oxidative stress-mediated neuropathology and improved clinical outcome by adjunctive use of a combination of antioxidants and omega-3 fatty acids in schizophrenia.

Schizophrenia is associated with a broad range of neurodevelopmental, structural and behavioral abnormalities that often progress with or without treatment. Evidence indicates that such neurodevelopmental abnormalities may result from defective genes and/or non-genetic factors such as pre-natal and neonatal infections, birth complications, famines, maternal malnutrition, drug and alcohol abuse, season of birth, sex, birth order and life style. Experimentally, these factors have been found to cause the cellular metabolic stress that often results in oxidative stress, such as increased cellular levels of reactive oxygen species (ROS) over the antioxidant capacity. This can trigger the oxidative cell damage (i.e., DNA breaks, protein inactivation, altered gene expression, loss of membrane lipid-bound essential polyunsaturated fatty acids [EPUFAs] and often apoptosis) contributing to abnormal neural growth and differentiation. The brain is preferentially susceptible to oxidative damage since it is under very high oxygen tension and highly enriched in ROS susceptible proteins, lipids and poor DNA repair. Evidence is increasing for increased oxidative stress and cell damage in schizophrenia. Furthermore, treatments with some anti-psychotics together with the lifestyle and dietary patterns, that are pro-oxidant, can exacerbate the oxidative cell damage and trigger progression of neuropathology. Therefore, adjunctive use of dietary antioxidants and EPUFAs, which are known to regulate the growth factors and neuroplasticity, can effectively improve the clinical outcome. The dietary supplementation of either antioxidants or EPUFAs, particularly omega-3 has already been found to improve some psychopathologies. However, a combination of antioxidants and omega-3 EPUFAs, particularly in the early stages of illness, when brain has high degree of neuroplasticity, potentially may be even more effective for long-term improved clinical outcome of schizophrenia.

Antioxidants↗

Human nutrition and food research: opportunities and challenges in the post-genomic era.

Sequencing of the human genome has opened the door to the most exciting new era for nutritional science. It is now possible to study the underlying mechanisms for diet-health relationships, and in the near future dietary advice (and possibly tailored food products) for promoting optimal health could be provided on an individual basis, in relation to genotype and lifestyle. The role of food in human evolution is briefly reviewed, from palaeolithic times to modern-day hunter-gatherer societies. The aetiology of 'diseases of modern civilization', such as diabetes, heart disease and cancer, and the effect of changes in dietary patterns are discussed. The risk of disease is often associated with common single nucleotide polymorphisms, but the effect is dependent on dietary intake and nutritional status, and is often more apparent in intervention studies employing a metabolic challenge. To understand the link between diet and health, nutritional research must cover a broad range of areas, from molecular to whole body studies, and is an excellent example of integrative biology, requiring a systems biology approach. The annual cost to the National Health Service of diet-related diseases is estimated to be in excess of 15 billion, and although diet is a key component of any preventative strategy, it is not given the prominence it deserves. For example, less than 1% of the pound 1.6 billion budget for coronary heart disease is spent on prevention. The polygenic and multifactorial nature of chronic diseases requires substantial resources but the potential rewards, in terms of quality of life and economics, are enormous. It is timely therefore to consider investing in a long-term coordinated national programme for nutrition research, combining nutritional genomics with established approaches, to improve the health of individuals and of the nation.

Biological Evolution↗

Protein-energy malnutrition in low income elderly Nairobi women.

Nutritional data for two groups of low income elderly women (chi = 64, range 57-74 years) in Nairobi, Kenya were compared. Group I (n = 113), slum dwellers, had an income of < or = $20 Cd per month; Group II (n = 88), poor urban area inhabitants, had an income of < or = $170 Cd per month. Dietary intakes were assessed quantitatively by four 24-h dietary recalls; anthropometric and biochemical data were obtained. Twenty-one women (16% of Group I; 3% of Group II) were classified as having protein-energy malnutrition (PEM) based on abnormal anthropometric measurements or low serum albumin concentration. The malnutrition was marasmic-like; the anthropometric measurements (body weight, triceps, skinfold thickness (TSF), mid-arm muscle circumference (MAMC) of the PEM Group were lower (P < or = 0.05) than those of Groups I and II. The PEM Group was older (chi = 68 years), had lost more teeth, and had more subnormal values than Groups I and II for: serum albumin, hemoglobin, hematocrit, MCHC, MCH, serum transferrin and serum iron. Inferior diets were a contributing factor. Mean energy and protein intakes of the PEM Group were low: 1471 kcal day(-1) (26 kcal kg(-1)) and 42 g day(-1) (0.79 g kg(-1)) respectively. The main protein sources were vegetables (48%) and cereals (36%); only 6 g protein was of high quality. Group II mean protein and energy intakes were greater (P < or = 0.05, P < or = 0.01) than those of the PEM Group and mean dairy product intake was higher (P < or = 0.001). The PEM Group and Group I had low mean energy intakes and an unsatisfactory dietary pattern; they consumed less meat (P < or = 0.01) and less fat (P < or = 0.001) than Group II. For the PEM Group dietary intakes of energy, fat and sugar were significantly correlated with TSF and MAMC; for the PEM Group monthly income was significantly correlated with weight, BMI, TSF and MAMC. Data suggest that elderly women living in Nairobi slums are at high risk of malnutrition, one of the factors contributing to the problem is inadequate food intake.

Aged↗

Traditional diets and disease patterns of the Mediterranean, circa 1960.

The 16 countries that border the Mediterranean sea differ markedly in geography, as well as in the health, political institutions, and economic status of their populations. Although many studies have examined the effects of lifestyle factors on the health of Mediterranean populations, few have investigated nutritional aspects, and even fewer have examined dietary patterns across countries. Few sources of data permit comparison of food and nutrient intakes among the various Mediterranean populations. I explore the concept of a Mediterranean diet through analysis of World Health Organization standardized mortality data and the only available data on food patterns throughout the region, the Food and Agriculture Organization food balance sheets, from the early 1960s to the present. Caveats about the use of food balance data are well known; they reflect disappearance of food groups from the marketplace, and only indirectly indicate information about dietary intake. Even with these limitations, the data indicate some similarities in the food availability patterns of Mediterranean countries: a relatively high proportion of energy from cereals, vegetables, and fruits, relatively less meat consumption than in northern Europe, and greater reliance on vegetable than on animal fats. This pattern is associated with distinctly lower rates of chronic diseases than those found in many developed countries in Europe and elsewhere. Changes in health patterns during the past 30 y reflect changes in food availability patterns during that period toward those more typical of northern Europe and the United States.

Cerebrovascular Disorders↗

Cross-cultural correlations of childhood growth and adult breast cancer.

International differences in breast cancer incidence and mortality, and studies on Japanese migrants to the United States, point to the importance of environmental factors, including diet and nutrition, in the etiology of breast cancer. Some studies have suggested that dietary patterns in early life are important to the long-term risk of breast cancer. Given that human growth is partially a function of early dietary intake, cross-cultural correlations between breast cancer rates and anthropometric variables measured at different times in childhood provide additional information about the association of early nutrition and cancer. In this study, the associations between food consumption and anthropometric variables, and childhood growth patterns (attained size at age) and adult breast cancer rates, were considered. Data from cross-sectional growth studies conducted during the years 1956-1971 on children aged 6-18 years were obtained for age-specific stature, sitting height, weight, triceps skinfold thickness, arm and chest circumferences, and biacromial and biiliac diameters. National food consumption data were obtained from the United Nations Food and Agriculture Organization (FAO) and socioeconomic status indicators from the United Nations Children's Fund (UNICEF). Cancer incidence data for the years 1972-1977 were obtained from regional cancer registries reported by the International Agency for Research on Cancer (IARC), and mortality data for 1978 were obtained from national cancer registries around the world. Significant correlations were seen between national food consumption data and childhood growth (attained size at age); between cancer incidence and age-specific stature (r = 0.68), weight (r = 0.59), triceps skinfold thickness (r = 0.78), and biacromial width (r = 0.84); and between mortality and age-specific stature (r = 0.77), weight (r = 0.75), and biacromial width (r = 0.78). In general, the correlation coefficients of the observed anthropometric variables with breast cancer increase with increasing age and become highly significant at ages 13-14 years, reflecting cumulative childhood nutritional intake.

Adolescent↗

Three score and ten plus more.

The elderly in our society are required to make many social and psychologic adjustments. In addition, they have to cope with the inevitable physiologic changes associated with the aging process. These alterations in lifestyle and in body functioning call for modified dietary patterns during this phase of life. In particular, older persons should reduce caloric intake while maintaining a highly nourishing diet. Other recommended dietary modifications include a shift toward smaller meals eaten more frequently, and the use of generous amounts of fiber and liquid to avoid constipation. As a result of growing community awareness, some programs have been started to assist the elderly in overcoming problems that may cause poor nourishment.

Adaptation, Psychological↗

[Nutrition of the population of Kazakhstan].

Basic results of research on the problem of nutrition in Kazakhstan over the whole period of the Soviet system are reported. In the Republic main attention was focussed on the study of the actual dietary pattern of the population in different geographic zones. The results of investigations served as a background to proposals aimed at rationalizing the dietary for the population of Kazakhstan, at working out standard rates of the foodstuffs consumption, approved by the State Planning Commission of the Kazakh SSR back in 1973. The principal objectives for further research work in the Republic are outlined.

Diet↗

Dietary fiber and risk of breast cancer: a case-control study in Uruguay.

To examine whether dietary fiber modifies breast cancer risk, a case-control study involving 351 newly diagnosed patients with breast cancer and 356 hospitalized controls was conducted in Uruguay. Dietary patterns were assessed in detail by use of a food frequency questionnaire on 64 items, which allowed the calculation of total energy intake. Nutrient residuals were calculated through regression analysis. After adjustment for potential confounders (which included age, residence, family history of breast cancer, prior history of benign breast disease, parity, total energy, red meat, lutein/zeaxanthin and quercetin intake, and menopausal status), dietary fiber and total nonstarch polysaccharides were associated with a strong reduction in risk of breast cancer (odds ratio for uppermost quartile of total dietary fiber = 0.51, 95% confidence limit = 0.31-0.82). Also the dose-response pattern was highly significant (p < 0.001). The inverse association was observed in pre- and post-menopausal women and was similar for soluble and insoluble fiber. Furthermore, dietary fiber displayed a strong joint effect with fat, quercetin, and lutein/zeaxanthin.

Adult↗

Predictors of self-initiated, healthful dietary change.

OBJECTIVE: To examine demographic and psychosocial factors that predict healthful dietary change. DESIGN: A cohort study, examining how factors assessed at baseline predicted change in fat-related dietary habits and fruit and vegetable intakes 2 years later. PARTICIPANTS: Participants were recruited in 1995 and 1996 by random-digit dialing (response rate 0.63), and followed-up in 1997 and 1998 (follow-up rate 0.82). The final sample included 336 men and 502 women. MAIN OUTCOME MEASURES: Fruit and vegetable intake and fat-related dietary patterns, measured by telephone-administered surveys. STATISTICAL ANALYSES: Chi2 tests and linear regression were used to test associations of baseline characteristics with dietary change. RESULTS: Fat intake (energy from fat) decreased by approximately 2 percentage points and fruits and vegetables intake increased by 0.17 servings per day (both P<.001). Changes were significantly larger among women and persons who were well educated. Persons in the maintenance stage of change and persons who believed there was a strong relationship between diet and cancer made the largest dietary changes. Use of food labels was strongly associated with fat reduction, but not with increases in fruits and vegetables. APPLICATIONS: These results suggest that food labels are useful for helping people reduce fat intake, that interventions should target persons at all stages of dietary change, and that new efforts are needed to reach men and persons who are less well educated.

Adolescent↗

High-risk nutrient intakes among low-income Mexican women in Chicago, Illinois.

OBJECTIVES: The Cross-sectional Cooking, Eating, Nutrition, and Shopping (CENAS) Survey was used to obtain data on food consumption patterns of low-income Mexicans living in Chicago, Ill. DESIGN: As part of the CENAS Survey, 186 Mexican women provided 24-hour dietary recall data. OUTCOME MEASURES: Distributions of macronutrient and micronutrient intakes were determined. The proportions of CENAS Survey participants achieving the National Heart Association and National Cancer Institute dietary guidelines were calculated. Intakes of Mexican women in Chicago were compared with intakes of Mexican women of similar socioeconomic status in Texas, Mexican-American women participating in phase 1 of the third National Health and Nutrition Examination Survey (1988-1991), and Mexican-American women participating in the Hispanic Health and Nutrition Examination Survey (1982-1984). STATISTICAL ANALYSIS: Tests were used to compare the nutrient intakes of CENAS Survey respondents with published results from other studies. RESULTS: The proportion of respondents reporting intakes less than two thirds of Recommended Dietary Allowances for nine micronutrients ranged from 11% (thiamin and riboflavin) to 82% (folacin). Respondents also reported median fat (34% of energy) and fiber (16.9 g/day) intakes that departed from recommendations to reduce the risk of heart disease and cancer. APPLICATIONS AND CONCLUSIONS: Half or more of the Mexican women interviewed in Chicago reported inadequate consumption of calcium, folate, zinc, and iron; higher than recommended intakes of fats; and lower than recommended intakes of fiber, indicating the need for nutrition education and intervention. Their nutrient consumptions differed significantly from those of Mexican-American women in the United States, suggesting possible regional or temporal variation in dietary patterns and underscoring the need for population-specific interventions.

Adult↗

Dietary profile of urban south Indians and its relations with glycaemic status.

This study was done to analyse the dietary profile of urban south Indian adults. It was also aimed to study, if the dietary profile influenced the glycaemic and anthropometric data. Dietary details were collected in a representative urban sample of 900 study subjects in the epidemiological survey for diabetes conducted in 1995 in the city of Madras. The details were collected by a 24-h recall method. All the dietary factors were similar in the non-diabetic (NGT) and newly diagnosed diabetic cases, but the values were lower in known diabetic cases due to dietary modifications (P < 0.001 for all compared to NGT and new diabetic cases). For further analysis, known diabetic cases were deleted and the rest were combined as one group. Men consumed higher calories (2066+/-437, range 1028-3662 kcal) than women (1745+/-343, range 870-3260 kcal) (P < 0.01). Older persons consumed lower calories and percentages of the proximate principles in diet were proportionately lower. Higher calorie consumption was due to consumption of higher quantities of food and not any specific dietary factor. BMI, WHR, plasma glucose, serum cholesterol and triglycerides were not significantly influenced by the total calorie consumption. Calorie consumption was higher in persons engaged in strenuous physical activity. Total calories and proportionately the proximate principles of diet were less in the high income group. The similarity in diet in the non-diabetic and the newly diagnosed diabetic persons showed that the development of diabetes was probably not related to changes in dietary habits. Lower consumption of calories and carbohydrates by the known cases of diabetes was due to the dietary modifications introduced in the management of the disease. Lower calorie consumption in women and older people could be related to lower physical activity. This study shows a uniform dietary pattern among the different strata of society with minor variations based on age, gender and physical activity. No difference has been noted in dietary habits of the newly diagnosed diabetic subjects and the non-diabetic adults.

Adult↗