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Discrepancies between ecological and individual data on fruit and vegetable consumption in fifteen countries.

Although food supply statistics are commonly used in ecological studies of diet and disease, little information is available on how they compare with reported intakes of foods. The objective of the present study was to compare fruit and vegetable availability with estimates of national mean intakes derived from national food consumption surveys. Food availability statistics from the FAO were used. For each country, mean national supply, based on at least 3 years of FAO data, was calculated. National estimates of mean fruit and vegetable intakes were derived from population-based surveys from fifteen countries, gathered for the World Health Organization Global Burden of Disease Study revision for 2000. Extrapolations were made when survey data did not cover all age groups. For each country, the FAO:survey estimate ratio was calculated. This ratio ranged from 0.93 to 2.70 (median value=1.39). Although there was a tendency for FAO data to overestimate intakes (fourteen out of fifteen countries), the degree of overestimation varied greatly among the countries included in this study (5-270 %). As food supply statistics are the only source of information on dietary patterns in most countries of the world, further information on how they reflect food intakes is needed. Obtaining detailed and valid estimates of dietary intakes in more countries around the world will be essential for such comparisons.

Asia↗

Strategies for cancer prevention: the role of diet.

Linkages between diet habits and cancer risk have surfaced from a multitude of epidemiological and preclinical studies. Collectively these studies provide rather compelling evidence that dietary components modify the incidence and biological behavior of tumors. While the risk of breast, prostate, colon, lung and liver cancers are frequently associated with dietary patterns, inconsistencies are not uncommon. These inconsistencies likely reflect the multi-factorial and complex nature of cancer and the specificity that individual dietary constituents have in modifying cancer related genetic pathways. The complexity of defining the role of diet is underscored by the numerous and diverse essential and non-essential components that may alter one or more phases of the cancer process. The explosive increase in the recognition of genes and pathways for regulating cell growth and development, and evaluating the response to hormones and other chemicals synthesized by the body, offers exciting opportunities for unraveling the molecular targets by which dietary components influence cancer prevention. It is recognized that all cells have unique 'signatures' that are characterized by active and inactive genes and cellular products. It is certainly plausible that bridging knowledge about these unique cellular characteristics with the molecular targets for nutrients can be used to assist in optimizing nutrition and minimizing cancer risk.

Diet↗

Development and validation of a food frequency questionnaire for Korean Americans.

A food frequency questionnaire for Korean Americans (KFFQ) was developed by modifying Block's Health Habits and History Questionnaire (HHHQ). The final KFFQ contained 118 food items taking into account culturally specific dietary patterns. Validation of the KFFQ was conducted to compare the nutrient intakes assessed by the KFFQ against those measured by seven-day dietary records in 73 Korean Americans. The mean nutrient values from the KFFQ differed at most by 25% from those of the dietary records with the exception of vitamin A, and 70% of the nutrients (16 out of 23 nutrients) were within 15%. Adjusted Spearman rank-order correlation coefficients for nutrients ranged between 0.45 and 0.84. The overall degree of agreement between the KFFQ and the dietary records was 68% with a range 56% to 79%. This validation study indicates that the KFFQ gives reasonably accurate estimates of the usual dietary intakes among the study population. The results also verify that it is possible to use a FFQ that is both culturally specific and comprehensive with the benefit of being easy to self-administer. This high degree of correlation between the KFFQ and the dietary records demonstrates that the KFFQ provides an easier yet accurate method in large-scale epidemiological studies of relationships between nutrition intakes and diseases in Korean Americans.

Asian↗

Plasma amino acid responses in humans to evening meals of differing nutritional composition.

The effect of a carbohydrate or a 20% protein (HP) or a carbohydrate + 0.4% tryptophan (TRP) evening meal on plasma amino acids and on plasma neutral amino acid (NAA) ratios was studied in eight healthy men. After consumption of the protein meal, plasma amino acids rose after 1 h and remained at the same level at 2 h. The dietary profile of the essential amino acids, except for TRP, was retained in the plasma. The plasma profile of nonessential amino acids was not related to the dietary pattern. Glutamic acid and aspartic acid increased several-fold less and alanine several-fold more than would be expected from their dietary concentrations. The tyrosine/NAA and phenylalanine/NAA ratios were not altered by any of the meals and the TRP/NAA ratio was increased only by the carbohydrate + 0.4% TRP meal. The leucine/NAA and isoleucine/NAA ratios were decreased by the carbohydrate and carbohydrate + TRP and increased by the 20% protein meals, while valine/NAA was decreased by the carbohydrate + TRP and HP but increased by the carbohydrate meal. From these data it is concluded that if brain neurotransmitter synthesis is controlled by the same mechanisms as in rats, then the evening meal containing added TRP was the only one of the meals likely to affect brain neurotransmitter (serotonin) synthesis.

Adult↗

Vascular nutritional correlates of late-life depression.

OBJECTIVE: The authors sought to examine the association of vascular nutritional factors and depression in an elderly cohort of depression (currently and recently depressed) and comparison (never depressed) subjects. METHOD: Nutrient intake over the past year was assessed in 196 elderly depression and comparison individuals with a Block 1998 food-frequency questionnaire. Nutrient intake, body mass index, and Keys score (a measure of the serum cholesterol-raising capacity of the diet) were determined. Subjects were age 60 and over and were participants in a longitudinal study of major depression. All subjects received psychiatric and medical comorbidity assessments; depression subjects also received psychiatric treatment. RESULTS: Vascular nutritional factors differed between depression and comparison subjects. The depression group had higher intake of saturated fat and cholesterol, higher body mass indices, lower alcohol intake, and higher Keys score than the comparison group. After controlling for age, sex, education, race, and medical comorbidity, associations remained for cholesterol, alcohol, and Keys score. Depression was found to be associated with overall dietary pattern as defined by total kilocalories, saturated fat, cholesterol, body mass index, polyunsaturated fat, sodium, and alcohol. CONCLUSIONS: This study provides evidence that dietary vascular risk factors differ in individuals with current or prior depression when compared with individuals with no history of depression.

Age of Onset↗

Personality and dietary habits.

BACKGROUND: The personality of healthy individuals has not been well studied in relation to health consciousness, dietary habits and actual food intake, simultaneously. OBJECTIVE: Our objective was to study the association between personality and dietary habits. DESIGN: Information on dietary habits, including taste preferences and the frequency of food consumption, was collected through a questionnaire from 76 male and 394 female students. The personality of students was determined by a modified NEO-FFI test. Health status, height, body weight, body fat percentage and blood pressure were measured by physical examination. Main outcome measures were personality scores as indicators of a healthy dietary pattern. RESULTS: Food intake was influenced by neuroticism (N), extraversion (E), openness (O) and agreeableness (A) of personality. Taste preferences and receptivity to dietary advice were also influenced by personality: the odds ratios (ORs) between the high and low tertiary points of the NEO-FFI scores for salty and sweet taste preferences were significantly higher in the group that scored high for neuroticism (N) (salty taste preference: OR = 2.25, NS in males and OR = 2.39, 95%CI = 1.16-4.93 in females; sweet taste preference: OR = 21.00, 95%CI = 2.40-183.99 in males and OR = 3.33, 95%CI = 1.61-6.91 in females). On the other hand, the groups with high scorer for O and A did not like salty tastes. The groups with high scores for A and C were receptive to dietary advice. High scores of each N, E, O, A, and C factor were characterized by distinguishable, dietary habits and lifestyle. For nutritional or health education, group classes are sufficient for high A and O. High C scorer displayed discrepancies between health consciousness and dietary habits, so intervention or a close follow-up by medical professionals would be necessary to improve the health of individuals in this group. High E scorer possessed a confident attitude towards their health, but they were not interested in developing healthy habits. High N scorer was adverse to receiving health information and learning healthy dietary habits. CONCLUSION: Personality determined by NEO-FFI test was related to dietary habits and health attitude. Effective health education methods must take the personality of the targeted individuals into consideration.

Adult↗

Development and validation of the Cholesterol-Saturated Fat Index (CSI) Scorecard: a dietary self-monitoring tool.

OBJECTIVE: The Cholesterol-Saturated Fat Index (CSI) Scorecard was developed and tested as a self-monitoring tool for patients consuming a cholesterol-lowering diet. SUBJECTS/DESIGN: Twelve nutritionists used the CSI Scorecard to estimate the CSI score of the same five food records. Subsequently, using a revised tool, 12 subjects with hypercholesterolemia estimated the CSI score of their 4-day food records and 11 participated in evaluation meetings. STATISTICAL ANALYSES: Two-tailed, one-sample t tests and the Spearman rho correlation test were used, respectively, to compare CSI Scorecard estimates of nutritionists and participants to CSI scores obtained from computer calculations. RESULTS: The CSI scores estimated by the nutritionists were close to the computed scores at the 25th and 75th food record percentiles. The correlation of the estimated CSI scores of participants to the computed scores was rs = .8 (P < .05). APPLICATION: The CSI Scorecard is a new, simple, quick, and accurate dietary self-monitoring tool patients can use in research centers and primary care settings. By numerically illustrating the saturated fat and cholesterol content of foods, the CSI Scorecard facilitates dietary self-monitoring and, thus, self-efficacy in the adoption and maintenance of a cholesterol-lowering dietary pattern.

Adult↗

The role of probiotic cultures in the prevention of colon cancer.

Risk factors for colon cancer include both hereditary and environmental factors. Dietary patterns represent controllable risk factors for the development of colon cancer. Much attention has focused on decreasing colon cancer risk through increasing intake of dietary fiber; recently, this has included interest in the consumption of prebiotics and probiotics. Because factors involved in the initiation and promotion of colon cancer might be separated in time from actual tumor development, it is difficult to choose "outcomes" or "end points" that are definitive indicators of efficacy of probiotics or prebiotics. Studies that have explored the cause-effect relationship directly have used animal models. In this review, we have confined our discussion to animal studies from the last 10 years that have examined most directly the relationship between prebiotic and probiotic consumption and colon cancer development. To present the consensus of these studies first, it appears that probiotics with or without prebiotics have an inhibitory effect on the development of aberrant crypts (precancerous lesions) and tumors in animal models. The effect is not completely consistent and is small in some studies, but this may represent a dose or time effect.

Animals↗

[Nutrition education in dentistry].

Reduction of the number of sugar containing snacks is the most important nutritional measure to prevent dental caries. Frequent use of acid food and drinks can lead to erosion of the enamel. Snacks containing as little fat and as much complex carbohydrates and rough materials as possible are preferred. In nutrition education, general principles of health education, such as attention for personal and social circumstances, have to be kept in mind. Prolonged use of the nursing bottle containing sugar-rich drinks must be prevented. Attention is needed for young people who frequently use soft drinks, sportsmen and women, people with a special dietary pattern, 'grazing' people and people with an illness or handicap.

Dental Caries↗

Compendium of dietary sources of vitamin A in the Thar desert.

The undisputed long term solution to prevent nutritional blindness lies in changing the dietary habits of a given population through nutritional education, nutritional supplementation, and nutritional rehabilitation. Before such strategies can be successfully implemented, it becomes necessary to study the existing dietary pattern of the population and to identify locally grown foods rich in vitamin A. Seventy eight rural women were interviewed to determine the common dietary items in western Rajasthan. These items were then matched with their B-carotene contents, only to discover that, 100 grams of any of them would not provide the RDA for a 1-3 year old child, with the exception of Suva (Peucedanum graveolens) and Bathua (Chenopodium album) leaves. The B-Carotene contents of several food items is unknown at present and there is an urgent need to evaluate them.

Female↗

Early childhood tooth decay. Pediatric interventions.

Pediatricians in the greater Chicago area were surveyed to probe their awareness and approaches to management of dental caries in early childhood. A total of 298 pediatricians (21% of those surveyed) responded to the questionnaire. Ninety-five percent of the respondents stated they examined their patients' teeth; 85% considered dental examinations part of their responsibility for children under 3 years of age. However, our data suggest that many pediatricians are unaware of the decay and the dietary patterns associated with tooth decay in early childhood. Although 96% of the respondents referred patients to a dentist when decay was diagnosed, analysis of diet and dietary counseling were performed by only 61% and 65% of the respondents, respectively. Recommendations for preventive measures that can be adopted by pediatricians are offered.

Bottle Feeding↗

Dietary intake does not account for differences in low iron stores among Mexican American and non-Hispanic white women: Third National Health and Nutrition Examination Survey, 1988-1994.

We used nationally representative data from the third National Health and Nutrition Examination Survey (NHANES III) to examine the relationship between low iron stores (serum ferritin < 12 microg/L) and dietary patterns that might affect iron status among Mexican American (MA) and non-Hispanic white (NHW) girls and women of reproductive age (12-39 y). Dietary data from the qualitative food-frequency questionnaire were used to classify subjects into three categories (using the 25th and 75th quartile values for NHW) for intake of heme iron, nonheme iron, iron absorption enhancers, and iron absorption inhibitors. The prevalence of low iron stores was 17.4% among MA (n = 1368) and 7.9% among NHW (n = 1473). Compared with high intake, the adjusted odds ratio (OR) for low iron stores was 1.80 [95% confidence interval (CI), 1.24-2.62] for medium intake of heme iron and 0.48 (95% CI, 0.25-0.91) for low intake of nonheme iron (plus iron supplement). Compared with no use, use of vitamin C supplements was associated with half the risk of low iron stores (OR = 0.50; 95% CI, 0.29-0.87). Similar results were found after income and parity were controlled for, except that the protective effect of vitamin C supplements was no longer significant. Even after adjustment for sociodemographic and dietary factors, MA women remained at increased risk for low iron stores (OR = 1.80; 95% CI, 1.30-2.49) indicating that the reasons for the higher prevalence of iron deficiency in MA women warrants further investigation.

Adolescent↗

Long-term prospective studies: the only solution?

One of the advantages of prospective studies in nutritional epidemiology is that dietary patterns and nutrient intake data are collected before the occurrence of the disease. With such a design it is possible to study the contribution of dietary variables in explaining the occurrence of diseases between different cultures and within populations. In order to make a good estimate of the relation between a dietary variable and the occurrence of a disease in long-term prospective studies, it is necessary to have insight in the changes of dietary variables with time. For prospective cohort studies also information about the reproducibility of a dietary variable is needed. Long-term prospective studies with repeated dietary measures provide a powerful tool in studying diet-disease relations, but practical limitations may prevent the implementation of such designs.

Cohort Studies↗

Multivariate analysis of dietary habits in 931 elderly Japanese males: smoking, food frequency and food preference.

To define the influence of smoking on dietary patterns and food preference in elderly Japanese, a mail survey was conducted on about 3000 subjects aged 65 years and older. A multivariate analysis of dietary frequency data regarding 15 food items on 931 male respondents suggested that frequency of intake of plant food, including vegetables and fruits, was lower in smokers than in nonsmokers. Another multivariate analysis of food preference data regarding 18 food items on the same subjects suggested that smoking decreased the desire for plant food.

Aged↗

Exploratory study of the relationship between hypertension and diet diversity among Saba Islanders.

The relationship between diet diversity and hypertension was examined in a cross-sectional exploratory study of 82 randomly selected adult residents of Saba Island, Netherlands Antilles, in the eastern Caribbean Basin. Blood pressure measurements, taken over 4 years, and the appropriate use of antihypertensive medications, were used to identify chronic hypertensives. A 24-hour dietary recall, semi-quantitative food frequency interviews, and ethnographic confirmation techniques were used to calculate diet diversity, a measure of the overall dietary pattern. Results suggest hypertension is associated with lack of an overall balance of food groups in the daily diet beyond any imbalance of a particular dietary cation such as sodium, potassium, or calcium. Bivariate analyses found a significant association between a poorly diversified diet and hypertension (odds ratio [OR] = 4.25, 95 percent confidence intervals [CI] = 1.47,12.30). Dietary intake of sodium, potassium, and calcium was also examined and found not to be associated with the presence of hypertension in bivariate analyses. Including these cations individually in logistic regression models, which also included diet diversity, did not diminish the diet diversity-hypertension association. Multiple logistic regression models in which other potential confounding variables were individually entered as a control variable (body fat, skin color, age, sex, perceived stress, alcohol intake, aerobic activity, and socioeconomic status) did not alter this result. Analysis of the presence or absence of individual food groups indicate a lack of legumes in the daily diet is also associated with the diagnosis of hypertension (OR = 4.71, 95 percent CI = [1.71,13.01]).

Adult↗

Diet and physical activity profiles in French preadolescents.

Dietary patterns have been identified in adults, but less is known about children and adolescents. For the first time, we have investigated lifestyle patterns combining diet and physical activity in 12-year-old French preadolescents and examined their association with sociodemographic factors. Physical activity, sedentary activities and dietary habits were assessed by questionnaires given to 2724 students in 2001. Family income tax and parents' educational level, as indicators of socio-economic status, and the size of the residence commune were obtained from parents. After adjusting for socio-economic status, physical activity was positively associated with a consumption of fruit/vegetables/fruit juice on more than four occasions in the previous 24 h (P<0.001). Sedentary activities were positively associated with the consumption of French fries or potato chips (P<0.001), with sweetened drink as the most usual drink (P<0.001) and with nibbling while watching television (P<0.001), and inversely associated with a high consumption of fruit/vegetables/fruit juice (P=0.04). Multiple correspondence analysis identified two independent axes and specific combinations of behaviour: one axis characterised by sedentary activity, sweetened drink as the most usual drink, the consumption of French fries or potato chips and nibbling while watching television; a second one associating physical activity and the consumption of fruit/vegetables/fruit juice. Both socio-economic proxies were associated with the former axis (P<0.001). The size of the residence commune was associated with the latter (P<0.1). Combinations of diet and physical activity habits were identified in adolescents, indicating that prevention programmes targeting both behaviours may have an enhanced outcome.

Beverages↗

Dietary intake of vitamin A precursors by rural Gambian pregnant and lactating women.

In view of the apparent paradox of low dietary intakes of vitamin A by rural Gambian women, which is not accompanied by deficient biochemical or physiological indices (Bates, 1983), a detailed study was undertaken, in which dietary intake was remeasured by direct weighed food intakes, coupled with chemical analysis of the carotene content of key food components. This was combined with recall data on dietary patterns in order to obtain a precise picture of carotene intakes throughout a twelve month period, with supplementary information spanning 4 years. Major contributors to dietary carotene intake were mangos (brief period of local availability during the dry season), leaf sauces (mainly rainly season), and small amounts of red palm oil (purchased by the more wealthy families). Preformed vitamin A made only a very small contribution to the diet. For 35 subjects studied during pregnancy in the village of Manduar, the geometric mean home food carotene intake was 0.81 mg/day, and for 61 pregnant subjects from the village of Keneba, the geometric mean home food carotene intake was 0.62 mg/day. However, there were large individual variations. While the efficiency of conversion of carotene to retinol is not known precisely, it is clear that these intakes are considerably below the current recommended dietary allowance for vitamin A during pregnancy, and especially during lactation.

Carotenoids↗

Intake of fruits, vegetables and selected micronutrients in relation to the risk of breast cancer.

High fruit and vegetable intake has been linked with a reduced risk of breast cancer, but evidence is not consistent. We investigated the associations of breast cancer risk with vegetables, fruits and related micronutrient intake in a population-based case-control study among Chinese women in Shanghai, where dietary patterns differ substantially from other study populations. Included in the study were 1,459 incident breast cancer cases and 1,556 frequency-matched controls. Usual dietary habits were assessed by in-person interviews. Logistic regression was used to compute adjusted odds ratios (ORs) and 95% confidence intervals (CIs) to measure strength of the associations. There was no association between breast cancer risk and total vegetable intake. The risk of breast cancer declined, however, with increasing intake of dark yellow-orange vegetables (trend test, p = 0.02), Chinese white turnips (trend test, p </= 0.001), and certain dark green vegetables (trend test, p </= 0.001) with adjusted OR in the highest quintile being 0.79 (95% CI = 0.60-0.98), 0.67 (95% CI = 0.53-0.85) and 0.65 (95% CI = 0.51-0.83) respectively. Intake of fruits, except watermelons and apples, was inversely associated with breast cancer risk (p-values for trend tests </=0.05). Our study suggests that high intake of certain vegetables and fruits may be associated with a reduced risk of breast cancer.

Adult↗