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PubMed2005

Position of the American Dietetic Association: benchmarks for nutrition programs in child care settings.

It is the position of the American Dietetic Association that all child care programs should achieve recommended benchmarks for meeting children's nutrition and nutrition education needs in a safe, sanitary, and supportive environment that promotes healthy growth and development. Use of child care is the norm for America's families. It is essential, therefore, that nutrition professionals work in partnership with child care providers and with children's families to ensure that meals and snacks consumed in child care settings meet children's nutrition needs and provide them with excellent models of healthy dietary patterns. This position provides guidance and information about resources for nutrition professionals, health care practitioners, child care providers, and parents regarding meal plans, food preparation and food service, physical and social environment, and nutrition consultation and training for child care.

Benchmarking↗
PubMed1995

Physician training for patient-centered nutrition counseling in a lipid intervention trial.

BACKGROUND: We examined the effect of a 3-hr training program on physicians' lipid intervention knowledge, attitudes, and skills. The program teaches physicians skills to conduct a brief dietary risk assessment and provide patient-centered counseling to enable patients with elevated lipids to change their dietary patterns. METHOD: The training is part of a randomized trial of lipid-lowering interventions, the Worcester Area Trial for Counseling in Hyperlipidemia. Primary care internists practicing in a health maintenance organization (HMO) were assessed, before and after training using questionnaires and audiotapes to document changes in knowledge about diet, attitudes about intervention, reported nutrition intervention practices, and counseling and assessment skills. Physicians also rated the value that they thought the training program had to them. RESULTS: After completion of the program the physicians' use of dietary counseling steps, as assessed by blinded evaluation of audiotaped physician-patient interactions, significantly increased (mean pre = 5.4, mean post = 9.2; t = 9.9; P < or = 0.001). In this regard, there were instances in the use of 7 of the 14 specific counseling steps. Physicians also demonstrated increases in self-perceived preparedness as measured by a 5-point scale (mean pre = 3.2, mean post = 4.0; t = 4.25; P < 0.001), confidence in having an effect (mean pre = 3.3, mean post = 3.9; t = 3.16; P < 0.01), perception that materials were available to aid intervention (mean pre = 2.7, mean post = 4.0; t = 5.29; P < 0.001), and perception that they have access to a nutritionist (mean pre = 3.5, mean post = 4.0; t = 2.63; P < 0.01). They rated the value of the program between very good and excellent. CONCLUSION: Results of this 3-hr educational program indicate that physicians in an HMO are responsive to the teaching of specialized skills deemed important for promoting health behavior change in their patients.

Adult↗
PubMedDate not supplied

Lifestyle and hypertension--an overview.

Dietary and other lifestyle factors play a major role in the prevalence of hypertension. Many of the behaviours likely to reduce blood pressure also have independent beneficial effects on other cardiovascular risk factors to general health and survival. This is particularly the case with weight control, exercise, dietary patterns characterised by a low intake of saturated fat and a high intake of fruit, vegetables and fish and moderation of heavy alcohol consumption. High salt intakes remain a major contributor to hypertension, especially when potassium intake is low. Smoking has a dominant effect in increasing cardiovascular risk in hypertensives. Clustering of risk factors is often associated with clustering of unhealthy lifestyle characteristics and both are most prominent in lower socio-economic groups and in Developing Countries adopting a more sedentary lifestyle and Western diet patterns. Recent trials suggest substantial cardiovascular benefits by a combination of weight control and sodium moderation in the elderly, by non-vegetarian diets rich in fruit and vegetables and low in saturated fat, and by incorporation of regular fish meals into weight control diets.

Alcohol Drinking↗
PubMed2006

Low-carbohydrate and high-fat intake among adult patients with poorly controlled type 2 diabetes mellitus.

OBJECTIVE: This study examined baseline dietary intake, body weight, and physiologic status in patients enrolled in a dietary intervention for type 2 diabetes mellitus (T2DM). METHODS: Dietary, physiologic, and demographic information were collected at baseline from 40 adult patients with poorly controlled T2DM (glycosylated hemoglobin >7%) who participated in a clinical trial at an academic medical center in Worcester, Massachusetts, USA. RESULTS: The average age at enrollment was 53.5 y (SD 8.4), average body mass index was 35.48 kg/m(2) (SD 7.0), and glycosylated hemoglobin was 8.3% (SD 1.2). Participants were predominantly white, married, and employed full time. Forty-eight percent were men. Seventy-eight percent had hyperlipidemia, and 68% had hypertension. Reported baseline daily average energy intake was 1778 kcal (SD 814), daily carbohydrate was 159 g (SD 71.5), and dietary fiber was 11.4 g (SD 5.2). The dietary composition was 35% carbohydrate, 45% fat (15% saturated fat), and 20% protein. The American Diabetes Association (ADA) guidelines recommends 45-65% of energy from carbohydrate, 20-35% from fat (<7% saturated), and 20% from protein. CONCLUSION: These patients reported a low-carbohydrate, low-fiber, high-fat (especially saturated) diet, although they stated they are not following any of the popular low-carbohydrate diets. Patients with T2DM may find the current trend toward reducing weight through low-carbohydrate diets attractive for control of blood glucose, despite ADA recommendations. This dietary pattern may represent a popular trend that extends beyond our particular study and, if so, has serious cardiovascular implications in this vulnerable population of T2DM patients.

Body Mass Index↗
PubMed1989

Dietary habits and prognostic factors in breast cancer.

The relationship between dietary habits and prognostic factors for breast cancer was studied in 240 women aged 50-65 years who had surgery for breast cancer between 1983 and 1986. A dietary history interview was conducted within the 4 months following resection of the primary tumor. In the stepwise multivariate analysis, the multiple-odds ratio (OR) for having a tumor greater than or equal to 20 mm in diameter was 0.95 (95% confidence interval, 0.91-0.99) for each 1-g increase in fiber intake per 10 MJ of energy intake. Compared with patients having tumors poor in estrogen receptor (ER), those having ER-rich tumors (greater than or equal to 0.10 fmol/microgram of DNA) were older (P less than .01) and reported carbohydrate intake yielding higher E% (percentage of total energy intake) (P less than .01) and higher retinol intake per 10 MJ (P less than .05). The OR for having an ER-rich tumor was 1.58 (95% confidence interval, 1.08-2.31) for each 1-mg increase in retinol intake per 10 MJ; 1.09 (95% confidence interval, 1.02-1.16) for each additional year of age; and 1.08 (95% confidence interval, 1.02-1.13) for each 1% increment in E% from carbohydrates. These results suggest that the dietary patterns of the western world (e.g., high fat intake and low intake of carbohydrates and fiber) affect certain prognostic factors in breast cancer, such as tumor size and ER content of the tumor.

Age Factors↗
PubMed2003

Optimal nutrition for the prevention of coronary heart disease: a worldwide challenge.

The worldwide spread of the coronary heart disease (CHD) epidemic is, in part, related to unfavorable changes in dietary patterns in the developing world. Much has been learned about optimal nutrition for the prevention of CHD. These lessons can, and should, be applied to countries where the burden of CHD is rapidly increasing, in order to help slow the progression of the CHD epidemic, to save many lives, and to prevent considerable disability worldwide.

Cholesterol, Dietary↗
PubMed2001

Under-reporting in dietary surveys--implications for development of food-based dietary guidelines.

OBJECTIVE: To illustrate issues related to under-reporting in dietary surveys relevant for development of food-based dietary guidelines. SETTING: Food and nutrient intakes in two national dietary surveys are analysed in relation to under-reporting using the concept of cut-off values for the ratio between energy intake and basal metabolic rate as well as biochemical markers of nutritional status. RESULTS: Subjects with an implausibly low EI/BMR ratio had dietary patterns more close to recommended levels, e.g. lower fat intake and higher fibre intake, than those with acceptable energy intakes. Intakes of micronutrients were lower. This was due to both general and selective under-reporting of foods. Under-reporting was due to less frequent consumption, larger proportion of non-consumers and smaller portion sizes. Low EI/BMR ratios did not influence the characterisation of protein and micronutrient intake of low and high consumers of fruit and vegetable intake. CONCLUSIONS: Under-reporting can influence the usefulness of dietary data as a tool for developing food-based dietary guidelines, and the extent of under-reporting should be assessed using appropriate methods.

Basal Metabolism↗
PubMed1992

Attributable risk of breast, prostate, and lung cancer in Hawaii due to saturated fat.

The dietary data from case-control studies of breast, prostate, and lung cancer in Hawaii revealed that saturated fat was a risk factor for these malignancies. The dietary intakes from the three studies were used to calculate the attributable risk (AR) due to saturated fat. For all ethnic groups combined, the ARs for the highest quartiles of intake were 14.9 percent for female breast cancer, 13.0 percent for prostate cancer, and 23.1 percent for male lung cancer. Our results suggested that a reduction of saturated fat to the lowest quartiles of intake could result in a 10 to 20 percent decrease in risk for these three cancers in Hawaii. We also examined the ethnic-specific risks associated with saturated fat consumption among the Japanese and the Caucasians in the three studies. The ARs for the highest quartiles of intake were notably higher among the Caucasians than the Japanese, primarily due to the difference in their dietary patterns. Although the calculated AR due to saturated fat was higher among the Caucasians than among the Japanese, all persons in the population would derive considerable benefit by reducing their intake of this nutrient.

Adult↗
PubMed1998

Diet and risk of breast cancer: major findings from an Italian case-control study.

A large case-control study (2,569 women with breast cancer and 2,588 control women) carried out in Italy between 1991 and 1994 permits elucidation of breast cancer risk in relation to dietary patterns in a southern European population. Major findings include direct associations with the intake of bread and cereal dishes, sugar, and pork meat, and inverse associations with the intake of vegetable oils, raw vegetables, fish, beta-carotene, vitamin E, and calcium.

Adult↗
PubMed2006

Vitamin D receptor gene polymorphisms, dietary promotion of insulin resistance, and colon and rectal cancer.

Modifiable risk factors in colorectal cancer etiology and their interactions with genetic susceptibility are of particular interest. Functional vitamin D receptor (VDR) gene polymorphisms may influence carcinogenesis through modification of cell growth, protection from oxidative stress, cell-cell matrix effects, or insulin and insulin-like growth factor pathways. We investigated interactions between foods (dairy products, red and processed meat, and whole and refined grains) and dietary patterns (sucrose-to-fiber ratio and glycemic index) associated with insulin resistance with the FokI polymorphism of the VDR gene and colon and rectal cancer risk. Data (diet, anthropometrics, and lifestyle) and DNA came from case-control studies of colon (1,698 cases and 1,861 controls) and rectal cancer (752 cases and 960 controls) in northern California, Utah, and the Twin Cities metropolitan area, Minnesota (colon cancer study only). Unconditional logistic regression models were adjusted for smoking, race, sex, age, body mass index, physical activity, energy intake, dietary fiber, and calcium. The lowest colon cancer risk was observed with the Ff/ff FokI genotypes and a low sucrose-to-fiber ratio. Rectal cancer risk decreased with greater consumption of dairy products and increased with red or processed meat consumption and the FF genotype. Modifiable dietary risk factors may be differentially important among individuals by VDR genotype and may act through the insulin pathway to affect colon cancer risk and through fat, calcium, or other means to influence rectal cancer risk.

Adult↗
PubMed1997

Dietary fat and lung cancer: a case-control study in Uruguay.

To examine whether dietary fat and cholesterol modifies lung cancer risk, a case-control study was conducted in Uruguay of 426 men diagnosed from 1993 to 1996 with lung cancer, and 419 hospitalized frequency-matched controls. Dietary patterns were assessed using a 64-item food frequency questionnaire, which allowed the calculation of total energy intake. After adjustment for potential confounders through a model which included tobacco smoking, total energy, a term for all vegetables and fruits, and alpha-carotene intake, an increase in risk for total fat intake for all cell types of lung cancer was observed. Adenocarcinoma of the lung was associated strongly with saturated fat intake (odds ratio [OR] = 2.3, 95 percent confidence interval [CI] = 1.2-4.4), whereas small-cell lung cancer was associated with dietary cholesterol (OR = 2.8, CI = 1.1-7.5). These results suggest that the association of saturated fat and cholesterol could be type-specific, but the high correlation existing between dietary lipids precludes any strong statement about this point.

Adult↗
PubMed1984

Calcium and osteoporosis.

It has become increasingly apparent that the pathogenesis of osteoporosis is complex, poorly understood, and ill-defined. Calcium deficiency and/or calcium malabsorption and the homeostatic response to this biological insult may ultimately prove to be one of the pivotal factors in conditioning or modulating the skeletal response to senescence. Until we know more about the prevention and potential reversibility of age-related changes in bone cell function, hormonal secretion and metabolism, and dietary patterns that prove deleterious to skeletal health, clinicians will be confronted with an ever-increasing population of aging, fracture-prone, osteoporotic patients. Because calcium supplements improve the calcium balance of perimenopausal and postmenopausal women and because improvements in calcium balance can be correlated with increased skeletal mass, it appears desirable to focus our efforts on diets and/or calcium supplements that guarantee an adequate supply of this essential mineral. Because calcium replacement may simply retard bone resorption and may not restore bone already lost by the fracture-prone, osteoporotic female, dietary analyses and appropriate modification of calcium intakes should be made at least in the third and fourth decades of life, with the goal of retarding the inexorable loss of skeletal tissue as early as possible.

Adrenal Cortex Hormones↗
PubMed2000

Commentary on the Women's Health Initiative.

The Women's Health Initiative (WHI), established by the National Institutes of Health in 1991, is a long-term national health study that focuses on strategies for preventing heart disease, breast and colorectal cancer and osteoporosis in postmenopausal women. These chronic diseases are the major causes of death, disability and frailty in older women of all races and socioeconomic backgrounds. The WHI a 15-year multi-million dollar endeavor, and one of the largest U.S. prevention studies of its kind. The study involves over 161,000 women aged 50-79, and is one of the most definitive, far reaching clinical trials of women's health ever undertaken in the U.S. The WHI Clinical Trial and Observational Study will attempt to address many of the inequities in women's health research and provide practical information to women and their physicians about hormone replacement therapy, dietary patterns and calcium/vitamin D supplements, and their effects on the prevention of heart disease, cancer and osteoporosis. Emerging information from the NIH Women's Health Initiative and other studies of women's health begun in the 1990's should be changing the landscape of options for older women in the years to come.

Aged↗
PubMed1989

Coffee, dietary habits, and serum cholesterol among men and women 35-49 years of age.

The relations between coffee and dietary habits and between coffee, dietary habits, and serum cholesterol were examined in 11,912 men and 12.328 women aged 35-49 years in the Cardiovascular Disease Risk Factor Study in Oppland, southern Norway, 1976-1978. Dietary data are based on results from a self-administered questionnaire. In both sexes, the dietary pattern of persons with a high coffee consumption differed from that of persons with a low coffee consumption: Heavy coffee drinkers had a higher consumption of bread, potatoes, and butter or margarine per slice of bread and more frequent use of hard margarine; men had a higher consumption of eggs and a lower consumption of skim milk. These results suggest a higher total food and fat consumption and a lower ratio of polyunsaturated to saturated fatty acids among heavy coffee drinkers. However, only 20% of the variation in coffee consumption was explained by dietary and lifestyle variables. The study confirmed a positive relation between serum cholesterol and use of butter or hard margarine (p less than 0.001) and between serum cholesterol and coffee consumption (p less than 0.001). Bread consumption and milk consumption were negatively correlated to serum cholesterol. The negative association with skim milk was significant only in women (p less than 0.01).

Adult↗
PubMed1997

Plasma arachidonic acid and serum thromboxane B2 concentrations in phenylketonuric children negatively correlate with dietary compliance.

The study addresses the relationship of plasma arachidonic acid and thromboxane production with the dietary compliance in treated phenylketonuric patients, whose vegan-like dietary pattern makes them a useful model to evaluate the effects of the near-total avoidance of animal fats. Thirteen treated phenylketonuric children were compared with twelve healthy controls for arachidonic acid intake, plasma fatty acids and platelet thromboxane B2 production, assessed as accumulation of this eicosanoid in serum. The calculated intake of arachidonic acid was lower in phenylketonurics than in controls and this was associated with lower levels in plasma lipids. Plasma arachidonic acid concentrations and serum thromboxane B2 levels correlated with the last 12 months phenylalanine levels, taken as negative indicator of dietary compliance. A direct relationship between plasma arachidonic acid concentration and thromboxane B2 production was observed only in phenylketonuric patients (r = 0.74, P = 0.01). While well-compliant PKU subjects have low arachidonic acid and thromboxane concentrations in plasma, the low compliance with animal food avoidance, evoking higher phenylalanine levels, results in elevation of both plasma arachidonic acid and serum thromboxane B2. This gives support to the hypothesis that the consumption of animal fats may affect the production of arachidonic acid-derived platelet eicosanoids.

Adolescent↗
PubMed2003

[Nutrition and health--hypertension].

Hypertension, defined as a blood pressure > or = 140/90 mmHg upon repeated measurement or the use of antihypertensive medication, is present in 14% of Dutch adults. A healthy diet plays an important role in both the prevention and treatment of hypertension. Under controlled conditions, very good results have been obtained with the 'Dietary approaches to stop hypertension' (DASH) combination diet, which has recently been developed in the United States. The DASH combination diet contains large amounts of fruit, vegetables, fish and nuts, low-fat dairy products and reduced levels of total and saturated fat. This dietary pattern yielded blood pressure reductions of 11.4/5.5 mmHg in mildly hypertensive patients. Intervention studies have shown a favourable effect of salt reduction on blood pressure in hypertensive patients, even in the case of mild hypertension. Simultaneous increases in potassium and magnesium intake could have an additional beneficial effect. The use of a low-sodium, high-potassium mineral salt could make a useful contribution to the prevention and treatment of hypertension. In case of hypertension, it is further recommended to reduce the intake of liquorice to less than 50 g per day. These dietary measures, combined with weight loss and physical exercise, may prevent drug treatment in patients with mild hypertension.

Diet, Fat-Restricted↗
PubMed2004

Calcaneum broadband ultrasound attenuation relates to vegetarian and omnivorous diets differently in men and women: an observation from the European Prospective Investigation into Cancer in Norfolk (EPIC-Norfolk) population study.

Vegetarian diets have been suggested to be beneficial for bone health due to increased consumption of plant foods, including soya, or reduced consumption of meat. However, meat may also be beneficial for bone health. The evidence relating diet to bone health is based largely on studies of women, often in those at high risk of osteoporosis. Few studies have investigated dietary inter-relationships in men as well as women from general populations. We examined broadband ultrasound attenuation (BUA) of the calcaneum, using a CUBA clinical instrument, in 6,369 men and 5,379 postmenopausal women. The population was divided into four groups according to vegetarian status and frequency of soya consumption, which was defined by response to a food frequency questionnaire that estimates frequency of consumption of food types over the year prior to completion. Regular soya consumers were defined as those who ate soya products with a frequency of between once a day and once a week. Calcaneum BUA in vegetarian men was significantly lower than omnivores by approximately 6% (5 dB/MHz) and was 15% (13.6 dB/MHz) lower in those who were also regular soya consumers. This difference remained after adjustment for age, height, weight, smoking habit, physical activity, selected foods and nutrients and exclusion of those with a prior history of osteoporosis, fractures or cancer. Calcaneum BUA in omnivorous men with regular soya consumption was not lower than the remaining population. In women, there were no significant differences by usual dietary pattern. This surprising finding indicates that regular soya intake is not associated with better bone indices in vegetarian men. The difference in BUA was not explained by the known common covariates; however, it is possible that other aspects of lifestyle associated with these eating behaviors might explain this observation. Plausible mechanisms exist for our findings; soya contains phytoestrogens, likened to naturally occurring estrogens, and meat has been shown to influence levels of IGF-1 and sex hormone binding globulin, which may be related to bone health. Our findings emphasize the need for further research and investigation into dietary inter-relationships and bone health and the effects of vegetarian status, including consumption of soya-based foods, in men as well as women.

Adult↗
PubMed1988

Adolescent nutrition: self-perceived deficiencies and needs of practitioners working with youth.

Sixty-three percent of a random sample of 866 members within three practice groups of The American Dietetic Association responded to a survey designed to assess (a) perceived competency of nutrition management in 20 major areas of adolescent health, (b) desire to increase skill level in each area, and (c) preferred approaches for continuing education activities. Of the 549 respondents, 92% were registered dietitians (R.D.s), 5% were registration-eligible, and more than half (51%) had advanced degrees. Twenty-five percent or more of all practitioners reported deficiencies in 17 of the 20 categories. The five top areas in which respondents believed that they had insufficient skills were psychosomatic problems (87%), handicapping conditions (82%), sports nutrition (81%), alcohol/drug abuse-related nutrition concerns (80%), and anorexia nervosa/bulimia nervosa (72%). The strongest desires to improve skills were in the areas of obesity, poor dietary patterns, sports nutrition, food fads, supplement misuse, alternative diets, and eating disorders. There was low interest in strengthening skills in family planning, psychosomatic problems, and handicapping conditions. The implications of the results are discussed. Continuing education methods respondents believed to be most beneficial for learning were small conferences, lectures with ample discussion, and "hands-on" workshops.

Adolescent↗