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The reproducibility of dietary intake data in a prospective study of gastrointestinal cancer.

To test the reproducibility of the dietary questionnaire used in the Japan-Hawaii Cancer Study and to measure the consistency of dietary patterns over time, 109 men were reinterviewed with the same questionnaire after a 6-month interval and 111 men were reinterviewed after a 2-year interval. The responses for intake of the 33 food items in the questionnaire were fairly reproducible. Food items with substantial correlation coefficients in both groups of men tended to be consumed on a more habitual basis. This finding suggests that if habitually consumed foods are linked to specific cancers, it is less likely that such associations occur by chance. This is of particular importance because when many food items are considered in a dietary study, chance association between a specific food and cancer is not an infrequent event.

Aged↗

Methodological challenges in performing targeting: assessing dietary risk for WIC participation and education.

This paper summarizes recent evaluations of indicators of dietary risk used to determine eligibility and nutrition education and counseling within the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). The concept of dietary risk relates to an inadequate dietary pattern or a failure to adhere to the food guide pyramid and, within WIC, is typically assessed based on an individual's intake from a 24-h recall or FFQ. Available evidence suggests, however, that even with a high-quality technique, substantial error exists in these data at the level of the individual, making the likelihood of misclassification high. Such data, with appropriate statistical procedures, can provide valid information at the group or the population level, and this is a future area for indicator development and incorporation into the management of WIC and other nutrition education programs addressing dietary risk.

Child↗

Geographical influences on the association between adherence to the Mediterranean diet and the prevalence of acute coronary syndromes, in Greece: the CARDIO2000 study.

OBJECTIVE: We evaluated the interaction between adherence to the Mediterranean diet and region of Greece on the likelihood of having acute coronary syndromes (ACS). METHODS: During 2000-2001, a random sample of 848 patients (61+/-10 years) with their first coronary heart disease event, and 1078 frequency matched (by age-sex) controls with no cardiovascular disease in their medical history, from all the country, entered into the study. Among several factors, adherence to the Mediterranean diet was assessed by a diet-score that incorporated the inherent characteristics of this diet. RESULTS: The multi-adjusted analysis showed that a 10-unit increase in the diet score was associated with a 27% (95% CI 0.66 to 0.89) decrease of the odds of having ACS. Moreover, a highly significant interaction was observed between region and diet score (p<0.001). The odds ratios varied from roughly 0.5 in Southern to 1.2 or more in Northern Greek regions (p for heterogeneity<0.05). Differences in food patterns consumed did not explain the previous findings. In addition, when we stratified our analysis by rural and urban areas we found significant differences in the estimated odds ratios (p for interaction between diet score and area=0.01), since a 10-unit increase in the diet score was associated with 22% (95% CI 0.63 to 0.96) lower odds n urban areas and 31% (95% CI 0.48 to 0.98) lower odds in rural areas. CONCLUSION: Our findings underline the significance of the Mediterranean diet on the primary prevention of ACS. Moreover, we revealed a geographical variation in the importance of this dietary pattern on coronary risk, independent from the composition of food patterns followed and the prevalence of the common cardiovascular risk factors.

Angina, Unstable↗

Urban small area variation in adolescents' health behaviour.

Our previous study indicated that region plays a relatively small role in adolescents' health behaviour. Here, the regional patterning of health behaviour is studied further by shifting the focus to small areas. First, we test whether small area socioeconomic, demographic and housing characteristics correlate with health behaviour. The analysis then turns to the relationship between these characteristics and their individual level correlates. We wish to ascertain if behaviour is related to small area characteristics similarly for both genders and for adolescents' socioeconomic characteristics. The Adolescent Health and Lifestyle Survey data from 1989-1995 (16- and 18-year-olds, n = 1048, response rate 71%) were linked with data describing 33 subareas of Helsinki, the capital of Finland. Smoking, alcohol use, abstention from dietary fat and physical activity were used as lifestyle indicators. Gender apparently influences the extent to which the area plays a role. Logistic regression demonstrated that prolonged unemployment predicted low prevalence of abstention from dietary fat (traditional dietary patterns) among girls and heavy drinking among boys. High total rate of unemployment predicted lower physical activity among girls. Also owner-occupied housing correlated positively with girls' physical activity. Although the individual level socioeconomic characteristics were not as strongly related to health behaviour as the small area factors, a low level of education predicted smoking and alcohol use and, among girls, decreased physical activity. We conclude that small area characteristics, especially the level of unemployment of the area, may be even more strongly related to health behaviour than individual socioeconomic characteristics.

Adolescent↗

Dietary factors and risk of colon cancer.

The incidence rates of colon cancer are high in North America and northern Europe, lower in southern Europe, and much lower in Asia and Africa. It is widely believed that environmental factors, particularly dietary patterns, account for most of this marked variation in rates. Over the past decade, a large number of case-control and cohort studies have added a substantial body of evidence regarding our understanding of the causes of colon cancer. Although the data are not entirely consistent, several important risk factors have emerged. The epidemiological evidence that physical inactivity or excess energy intake relative to requirements increases risk of this malignancy is quite strong. Intake of red meat appears to increase risk, but protein-rich sources other than red meat probably do not elevate risk and may even reduce the occurrence of colon cancer. Dietary fat, at least that from sources other than red meat, does not appear to increase risk appreciably. High consumption of vegetables and fruits and the avoidance of highly refined sugar containing foods are likely to reduce risk of colon cancer, although the responsible constituents remain unclear. Alcohol intake may enhance risk of cancers of the distal colorectum, although the evidence is not entirely consistent. The influence of alcohol may be particularly strong when combined with a diet low in methionine and folate, suggesting that the effect of alcohol may be through antagonism of methyl-group metabolism. The combined effect of these dietary factors, as well as modifiable non-dietary factors such as cigarette smoking, suggest that the majority of cases of colon cancer are preventable.

Alcohol Drinking↗

Fruit and vegetable availability among ten European countries: how does it compare with the 'five-a-day' recommendation? DAFNE I and II projects of the European Commission.

Recasting the role of fruit and vegetables (F&V) in the diet, and planning national and international campaigns to enhance their consumption are major public health service objectives. The present study seeks to describe F&V availability patterns in ten European countries and examine compliance with current recommendations. The mean and median F&V availability (g/person per d) was estimated based on household budget survey data retrieved from the Data Food Networking (DAFNE) databank. Low F&V consumers were identified based on WHO international recommendations (minimum combined F&V intake of about 400 g/person per d) and current conservative guidelines of a minimum daily intake of three portions of vegetables and two portions of fruit. Considerable disparities in F&V availability were found among the surveyed European populations. Only in Mediterranean countries did the mean daily population intake clearly exceed combined F&V recommendations. Dietary patterns were positively skewed in all populations studied, on account of the presence of exceptionally high values among segments of the populations. Moreover, the correlation was unexpectedly weak between the proportion of low fruit and low vegetable consumers (Spearman's correlation coefficient +0.18). More than 50% of the households in the surveyed populations are likely to consume less than the recommended daily vegetable intake of three portions, and this applies even to the two Mediterranean populations. The efficiency of F&V promoting strategies may be enhanced if F&V are addressed separately; furthermore, interventions that would specifically focus on vegetables are probably needed.

Europe↗

Multicountry estimation of dietary boron intake.

Dietary Reference Intakes are not yet established for boron (B), a naturally occurring trace element in the human diet. Estimated dietary B intakes provide useful information for planning and assessing diets in healthy populations. The countries selected for this study represent a wide variety of dietary patterns and have adequate nutrient databases (with the exception of B) and food consumption data. Large-scale nationwide survey data were provided by the US (1989-1991) and Germany (1985-1989). Survey data from rural agricultural communities of Mexico and Kenya were provided by the Human Nutrition Collaborative Research Support Program (1983-1986). A B nutrient database was created to include B concentrations for the foods consumed in each country. It incorporates B analytical data from various sources in the US, Finland, UK, Italy, Japan, and China. Each person's average daily B intake was estimated by linking the B database with the survey food records. Average dietary intake estimates were then generated for various age and sex groups. The estimates for adults in the US, Germany, Mexico and Kenya, respectively, are 1.11, 1.72, 2.12, and 1.95 mg B/d for males and 0.89, 1.62, 1.75, and 1.80 mg B/d for females. Foods that are major contributors to the B intake of each country were also identified.

Adolescent↗

The geography of chronic digestive disease in southern Africa.

Lifestyle and dietary patterns are in the process of rapid transformation in Soweto. Comparisons with whites indicate differences in bowel behaviour, lactase deficiency and breath methanes. The association between smoking pipe tobacco and cancer of the oesophagus is confirmed, but home-brew consumption has been found to be the major risk factor in this cancer. A recent swing to Western-type alcohol has led to the emergence of alcohol-induced pancreatitis in blacks. Urbanisation and westernisation have also affected the influence of the traditional healer and the incidence of duodenal ulcer disease. The fundamental environmental influence which determines non-infective large-bowel disease is diet. A dietary survey of Sowetans indicates that their present diet is low in fat and fibre. Despite the latter, appendicitis is still relatively uncommon. Other significant differences are observed in colorectal cancer and diverticular disease.

Black or African American↗

Dietary fiber, Hispanics, and breast cancer risk?

The cancer rates of immigrant populations in the United States must be taken into account when looking at the importance of diet and culture as it relates to cancer prevention. Unfortunately, some nutrition studies targeted toward nontraditional white populations have not adequately confronted the issue of cultural meaning in efforts to gather dietary data accurate enough to support nutritional analyses, identify marginal diets, or relate risk to dietary patterns. The study presented here resolves many of the culturally specific issues utilizing awareness, attention, and judicious combination of culturally sensitive qualitative and quantitative research techniques. The importance of such a study in an Hispanic population is based on the fact that the age-adjusted rate of breast cancer in countries such as Mexico is among the lowest in the world. In addition, although one of the fastest-growing minority groups in the United States, Hispanic women living in this country have been shown to have the lowest incidence of the mortality rates from this disease across most geographic regions of the United States. Therefore, one might speculate that dietary factors, which have been shown to play a role in breast cancer prevention, may account for this difference. It is well recognized that the traditional Hispanic diet is rich in protective nutrients such as dietary fiber. It is known that through complex mechanisms, dietary fiber works to reduce the amount of estrogens in the body. Research also indicates that it is the level of endogenous estrogen in the body that may influence the onset of breast cancer. In order to better understand how dietary factors may be associated with breast cancer in Hispanic women, it is important that one develop the proper tools to discern any potential differences. Therefore, we developed an approach to obtaining dietary fiber information from a small cohort of 22 Houston-area Hispanic women as a vanguard study for a larger breast cancer prevention trial. Two separate dietary assessment instruments were utilized, a three-day food record and the Southwest Food Frequency Questionnaire. The mean intake of dietary fiber was 16 g/day according to the food record and 21 g/day according to the SWFFQ. Fruits, vegetables, breads, cereals, and beans provided for most of the participants' dietary fiber intake. These results support evidence that the Hispanic population's dietary fiber intake is higher than that for other groups, and this may help explain the lower incidence of breast cancer among some Hispanic populations.

Aged↗

Trends of food intake in Portugal, 1987-1999: results from the National Health Surveys.

OBJECTIVE: To assess trends of food intake in Portugal. DESIGN: Analysis of three cross-sectional studies: 1987, 1995-1996 and 1998-1999. SETTING: Representative samples of free-living individuals. SUBJECTS: 64 734 men and 71 282 women. INTERVENTIONS: Food intake was assessed by questionnaires inquiring the number of meals and which foodstuffs (fish, meat, milk, rice/pasta/potatoes, soup, vegetables and fruit) had been consumed the day before. RESULTS: Age-adjusted average number of meals decreased from 3.3+/-0.1 in 1987 to 2.9+/-0.1 in 1998-1999 in both genders (P<0.001). In men, the percentage of subjects consuming meat, milk and potatoes/rice/pasta increased from 73, 66 and 91% in 1987 to 83, 74 and 95% in 1998-1999, respectively. The percentage of subjects consuming soup and fish decreased from 70 and 56% in 1987 to 62 and 53% in 1998-1999, respectively. In women, the percentage of subjects consuming meat, milk, potatoes/rice/pasta and vegetable increased from 70, 66, 89 and 71% in 1987 to 78, 77, 93 and 83% in 1998-1999, respectively. The percentage of subjects consuming soup and fish decreased from 70 and 55% in 1987 to 64 and 53% in 1998-1999, respectively. These trends were more pronounced in the younger age, which also displayed a higher frequency of snacking. Multivariate analysis adjusting for age group, region and educational level showed that the consumption of meat, milk and vegetables increased and the consumption of soup, fish and fruit decreased in 1998-1999 relative to 1995-1996. CONCLUSIONS: Within a decade, the Portuguese dietary pattern has changed considerably, shifting from a traditional, south European to a more Westernized, protein-rich diet. SPONSORSHIP: The Unidade de Nutrição e Metabolismo of the Instituto de Medicina Molecular is partially funded by a grant from the FCT (Fundação para a Ciência e a Tecnologia) ref. RUN 437.

Adolescent↗

Putting osteoporosis in perspective.

Osteoporosis is characterized by a reduction in bone mineral density (BMD). Dietary patterns that encourage adequate calcium intake are essential to maximal development and later maintenance of bone mass. The majority of white women are at risk for osteoporosis-related fractures, especially in the wrist, spine, and hip. The degree of fracture risk at a specific bone site is best assessed by measuring BMD with single- or x-ray-photon absorptiometry. BMD in adults of any age is quite variable. Numerous diet and lifestyle factors influence BMD and, in turn, fracture risk. Sufficient evidence exists for a relationship between BMD and diet, particularly calcium and vitamin D; amenorrhea; body weight; alcoholism; smoking; and physical inactivity. Less convincing evidence exists for a relationship with dietary protein, dietary phosphorus, and caffeine intake. To minimize fracture risk, young women should have regular menses, consume a nutritionally adequate diet (according to the principles of the Food Guide Pyramid), perform regular physical activity, only consume a moderate intake of alcohol (if any), and not smoke. Postmenopausal women should follow those same guidelines and should seriously consider estrogen replacement therapy. Elderly persons especially should ensure adequate calcium and vitamin D nutriture. Currently, osteoporosis is the rule, rather than the exception, in old age for many white women. Dietitians can help reduce the prevalence of this disorder.

Aged↗

Deficient dietary vitamin K intake among elderly nursing home residents in Hong Kong.

There is strong evidence supporting the importance of vitamin K in bone health and the aetiological role of vitamin K deficiency in osteoporosis. In view of the common occurrence of osteoporosis among older subjects in Hong Kong, we have studied the dietary vitamin K intakes in 100 residents of a nursing home (43 men, 57 women; median age 81.0 years) and 88 free-living subjects attending a day care centre (13 men, 75 women; median age 71.5 years). The subjects were interviewed and the average vitamin K intake in the preceding week was estimated, using a diet recall questionnaire modified from our previous surveys of dietary patterns in local Chinese people. The median vitamin K intake was much lower in nursing home residents than in free-living subjects (4.50 vs 488.09 microg/day or 0.13 vs 8.74 microg/kg/day, P<0.001). An intake that was below the recommended daily intake was far more common among nursing home residents (86.0 vs 11.4%, P < 0.001). Among nursing home residents, there was a negative correlation between age and vitamin K intake (r = -0.217, P = 0.030), but there was a positive correlation between body weight and vitamin K intake (r = 0.244, P = 0.015). No such relationship was seen among free-living subjects. Elderly nursing home residents in this study generally had a poor dietary vitamin K intake and might therefore be predisposed to osteoporosis. The importance of green leafy vegetables as a rich source of vitamin K should be emphasised.

Adult↗

Using research on the obesity pandemic as a guide to a unified vision of nutrition.

OBJECTIVE: To focus on factors that play a major role in our rapid, global nutritional changes. DESIGN: A range of studies are summarised: these show how an understanding of social, economic and technological change at the global, national and community levels affects diet, activity, and body composition patterns and trends. These studies are used to demonstrate the value of the key global, national, community, household and individual factors that should define the field of nutrition. SETTING: The focus is global. RESULT: Large shifts have occurred in diet and in physical activity patterns--particularly in the last one or two decades of the twentieth century. These changes are reflected in nutritional outcomes such as changes in average stature, body composition and morbidity. Understanding the rapidity of these changes and the underlying factors at the global, national and community levels is critical for creating a science of nutrition that can prevent disease and sustain the health and integrity of humans. CONCLUSION: The vision of the nutrition field is one where scholars who work on many levels will intersect; equal weight in the nutrition profession will be provided to all dimensions as they are welcomed into the field of nutrition--particularly those that will directly or indirectly affect dietary patterns, physical activity patterns, and energetics. This vision of the nutrition field is one where scholars from a range of disciplines and perspectives meet to work together with the goal being a focus on improving nutritional status and the human condition.

Diet↗

Diet, body weight, and colorectal cancer: a summary of the epidemiologic evidence.

Colorectal cancer is the second leading cause of cancer death in the United States, and the number of new cases annually is approximately equal for men and women. Several nutritional factors are likely to have a major influence on risk of this cancer. Physical inactivity and excessive adiposity, especially if centrally distributed, clearly increase the risk of colon cancer. Hyperinsulinemia may be an important underlying risk factor. In conjunction with obesity and physical inactivity, which induce a state of insulin resistance, certain dietary patterns that stimulate insulin secretion, including high intakes of red and processed meats, saturated and trans-fats, and highly processed carbohydrates and sugars, may increase the risk of colon cancer. There is evidence suggesting that some component of red meat may independently increase the risk of colorectal cancer, and some micronutrients may be important as protective agents. Currently, the evidence is strongest for folate and calcium. Folate may be especially important in alcohol drinkers because alcohol appears to increase the risk, particularly when folate intake is low. This interaction may be related to the antifolate properties of alcohol. In contrast to earlier studies, more recent epidemiologic studies have generally not supported a strong influence of dietary fiber or fruits and vegetables, although these have other health benefits, and their consumption should be encouraged. The majority of colon cancers, as well as many other conditions, may be prevented by lifestyle alterations in the intake of these nutritional factors, in addition to other factors, such as smoking.

Calcium↗

The effects of protein intake on blood pressure and cardiovascular disease.

PURPOSE OF REVIEW: Investigators, especially those from western countries, have commonly assumed that there is either no association or a direct association of protein intake with elevated blood pressure and atherosclerosis. In contrast, recent observational studies and clinical trials have suggested that increased protein intake, particularly protein from plant sources, might actually reduce blood pressure and prevent cardiovascular disease. RECENT FINDINGS: In epidemiological studies, an increased intake of protein has been associated with lower blood pressure and an attenuated increase in blood pressure over time. Furthermore, such studies also suggest that the beneficial effects of increased protein intake result from an increased consumption of protein from plant rather than animal sources. In several predominantly small trials, an increased intake of soy protein lowered blood pressure. With respect to clinical outcomes, reports from large cohort studies suggest that increased protein intake is associated with a reduced risk of ischemic heart disease and perhaps intraparenchymal hemorrhage. In other reports, a higher protein intake is one characteristic of a dietary pattern associated with a reduced risk of ischemic heart disease. The mechanisms by which protein could exert its beneficial effects include an increased intake of biologically active amino acids, peptides, or highly correlated nutrients. SUMMARY: Recent evidence suggests that an increased intake of protein, particularly plant protein, may lower blood pressure and reduce the risk of cardiovascular disease. However, the data are not sufficiently compelling to advocate an increased consumption of protein.

Blood Pressure↗

Saturated fatty acids in vegetable oils. Council on Scientific Affairs.

Concern has been expressed about the "atherogenicity" of coconut and/or palm oil in food products. Saturated fatty acids are found primarily in animal products and in "tropical oils" (coconut, palm, and palm kernel oils). Composition of the total diet over an extended period determines nutritional status and contribution to health. Specific foods and/or food ingredients need to be evaluated within the context of a person's total dietary pattern over time. Persons attempting to limit saturated fatty acid intake should be aware of the high content of saturated fatty acids in tropical oils. The American Medical Association is on record as supporting fatty acid labeling when cholesterol content is declared and cholesterol labeling when fatty acid content is declared. The American Medical Association has supported, and continues to support, voluntary efforts to increase public awareness of the composition and nutritional value of foods.

American Medical Association↗

Parental educational level and cardiovascular disease risk factors in schoolchildren in large urban areas of Turkey: directions for public health policy.

BACKGROUND: It is widely accepted that the development of atherosclerosis starts at an early age. However, there are very few studies evaluating the prevalence of the common clinical and behavioral cardiovascular disease (CVD) risk factors among children, especially in developing countries. The aim of the present cross-sectional survey was to evaluate the distribution of blood lipid profile and various behavioral (i.e. dietary habits, physical activity status) factors related to CVD risk and its relationships to paternal (PEL) and maternal educational level (MEL) among primary schoolchildren in Turkey. METHODS: In three major metropolises in Turkey (Istanbul, Ankara and Izmir), a random sample of 1044 children aged 12 and 13 years old was examined. ANOVA was applied to evaluate the tested hypothesis, after correcting for multiple comparisons (Tukey correction). RESULTS: After controlling for energy and fat intake, physical activity status and Body Mass Index (BMI), it was found that mostly PEL had a significant positive effect for most of the subgroups examined (Lower vs. Higher and Medium vs. Higher) on TC and HDL-cholesterol and a negative effect on TC/HDL ratio for both genders. Furthermore, both boys and girls with higher PEL and MEL were found to have higher energy intake derived from fat and protein than their counterparts with Medium and Lower PEL and MEL, while the opposite was observed for the percentage of energy derived from carbohydrates. CONCLUSIONS: Our study provides indications for a possible association between an adverse lipid profile, certain dietary patterns and Higher PEL and MEL among schoolchildren in Turkey. These findings underline the possible role of social status, indicated by the degree of education of both parents, in developing certain health behaviors and health indices among Turkish children and provide some guidance for Public Health Policy.

Adolescent↗

[Study on the current status and trend of food consumption among Chinese population].

OBJECTIVE: To describe the current status and trend of food consumption among Chinese residents. METHODS: 23,470 households including 68,962 subjects were randomly sampled from 132 counties in 31 provinces, autonomous regions and municipalities. A 24-hour dietary recall method for 3 consecutive days was used to collect information on food intake, but the condiment intake was collected by weighting method. RESULTS: The average food consumption per reference man per day of Chinese people included 402 g (urban/rural: 366 g/ 416 g) cereals; 276 g (urban/rural: 252 g/ 286 g) vegetables; 45 g (urban/rural:69 g/36 g) fruits; 79 g (urban/rural: 105 g/69 g) meats; 30 g (urban/rural:45 g/24 g) fishery products; 24 g (urban/rural: 33 g/20 g) eggs; 27 g(urban/rural: 66 g/ 11 g) dairy; 16 g legume; 42 g (urban/rural:44 g/41 g) edible oil; 12 g (urban/rural: 11 g/12 g) salt; 9 g (urban/rural: 11 g/8 g) soy sauce. CONCLUSIONS: For Chinese residents, the quality of diet had been improved and consumptions of animal products, milk, and edible oil had been increased, but the consumptions of dairy and legume products intake was still low which called for improvement. The unbalance was characterized as the downward trend in cereal, vegetable and fruit consumption but significant increased in animal products and oil intake among urban people. Dietary pattern of some subjects adopted a "high energy density" diet. Double burdens from under-nutrition and over-nutrition should both be considered as problems which asked for attention by the government and researchers.

Adolescent↗