Population nutrient intake approaches dietary recommendations: 1991 to 1995 Framingham Nutrition Studies

Exploring Obesity as a Gendered Contagion: Impact on Lifestyle Interventions to Improve Cardiovascular Health

PURPOSE

Obesity increases the risk of cardiovascular disease. Lifestyle interventions such as physical activity and diet are important components for reducing the risk of obesity. Data suggest that lifestyle choices differ between men and women, as well as in groups. The purpose of this review was to explore whether obesity can be considered as a gendered social contagion, associated with differences in lifestyle and response to lifestyle interventions in men and women.

FINDINGS

There are important sex-based differences of obesity to consider. There is evidence that peers have an influence on lifestyle preferences such as physical activity level and dietary habits, but the evidence is inconclusive if the differences exist between men and women. Similarly, data from lifestyle intervention studies are not conclusive whether there are differences between men and women. There is not enough evidence for the notion that obesity is a gendered social contagion.

IMPLICATIONS

More research is needed to understand differences in lifestyle and lifestyle interventions between men and women, especially across the life span, which could have profound public health implications.

Prevalence of low protein intake in 80+-year-old community-dwelling adults and association with dietary patterns and modifiable risk factors: a cross-sectional study

Low protein intake may accelerate age-related loss of lean mass and physical function. We investigated the prevalence of low protein intake (<1·0 g/kg/day) and the associations between dietary patterns, modifiable risk factors and low protein intake in self-reliant community-dwelling adults ≥ 80 years. This cross-sectional study consisted of two home visits. Data collection consisted of physical measurements (e.g. physical function, physical activity) and self-report of nutritional intake (4-d food records), appetite, eating symptoms and medical conditions. Binary analyses were performed to compare participants with low and normal protein intake. Multiple logistic regression analyses were performed to investigate associations between low protein intake, dietary patterns and modifiable risk factors adjusted for age, sex, BMI categories and diseases. One hundred twenty-six were included in the study. Prevalence of low protein intake was 54 %. A greater day-to-day variation in protein intake was associated with low protein intake (adjusted OR 2·5; 95 % CI 1·14, 5·48). Participants with low protein intake had a higher prevalence of nausea, diarrhoea and mouth dryness. Reduced appetite, mouth dryness and pain increased odds of low protein intake (adjusted OR 3·06, 95 % CI 1·23, 7·63; OR 3·41, 95 % CI 1·51, 7·7; OR 1·54, 95 % CI 1·00, 2·36, respectively). There was a high prevalence of low protein intake in community-dwelling adults aged ≥ 80 years. Day-to-day variability, appetite, mouth dryness and pain may be potentially modifiable risk factors. Targeting dietary patterns and risk factors in primary prevention strategies may potentially improve intake of protein and minimise risk of physical frailty.

Neighborhood Food Outlet Access and Dietary Intake among Adults with Chronic Kidney Disease: Results from the Chronic Renal Insufficiency Cohort Study

BACKGROUND

Healthy diet is essential in the management of chronic kidney disease (CKD) and preventing related comorbidities. Food outlet access has been studied in the general population; however, the influence of the local food environment on dietary intake among people with CKD has not been evaluated.

OBJECTIVES

This study examined the associations of food outlet density and type of outlets with dietary intake in a multicenter cohort of racially and ethnically diverse patients with CKD.

METHODS

The Chronic Renal Insufficiency Cohort Study is a multicenter prospective study of patients with CKD that used a validated food frequency questionnaire to capture dietary intake at the baseline visit. This is a cross-sectional analysis of 2,484 participants recruited in 2003-2006 from seven Chronic Renal Insufficiency Cohort Study centers. Food outlet data were used to construct a count of the number of fast-food restaurants, convenience stores, and grocery stores per 10,000 population for each geocoded census block group. Multivariable linear and logistic regression models were used to evaluate the associations between measures of food outlet availability and dietary factors.

RESULTS

The proportion of participants living in zero-, low-, and high-food outlet density areas differed by gender, race or ethnicity, and income level. Among male subjects, living in areas with zero or the highest number of outlets was associated with having the highest caloric intakes in multivariable models. Male subjects living in areas with zero outlets consumed the highest levels of sodium and phosphorous. Female subjects living in areas with zero outlets had the lowest average intake of calories, sodium, and phosphorous. Among low-income female subjects, close proximity to more outlets was associated with higher calorie consumption. Among all participants, access to fast-food restaurants was not associated with an unhealthy diet score, and access to grocery stores was not associated with a healthy diet score.

CONCLUSIONS

Average caloric and nutrient intakes differed by outlet availability; however, there were no strong associations with type of food outlet. This should be considered when developing food-focused public health policies.

Sex differences in macronutrient intake and adherence to dietary recommendations: findings from the UK Biobank

OBJECTIVES

To characterise sex differences in macronutrient intakes and adherence to dietary recommendations in the UK Biobank population.

DESIGN

Cross-sectional population-based study.

SETTING

UK Biobank Resource.

PARTICIPANTS

210 106 (52.5% women) individuals with data on dietary behaviour.

MAIN OUTCOME MEASURES

Women-to-men mean differences in nutrient intake in grams and as a percentage of energy and women-to-men ORs in non-adherence, adjusting for age, socioeconomic status and ethnicity.

RESULTS

There were sex differences in energy intake and distribution. Men had greater intakes of energy and were less likely to have energy intakes above the estimated average requirement compared with women. Small, but significant, sex differences were found in the intakes of all macronutrients. For all macronutrients, men had greater absolute intakes while women had greater intakes as a percentage of energy. Women were more likely to have intakes that exceeded recommendations for total fat, saturated fat and total sugar. Men were less likely to achieve the minimum recommended intakes for protein, polyunsaturated fat and total carbohydrate. Over 95% of men and women were non-adherent to fibre recommendations. Sex differences in dietary intakes were moderated by age and to some extent by socioeconomic status.

CONCLUSIONS

There are significant sex differences in adherence to dietary recommendations, particularly for sugar. However, given the increased focus on food groups and dietary patterns for nutritional policy, these differences alone may not be sufficient for policy and health promotion. Future studies that are able to explore the sex differences in intakes of different food groups that are risk factors for diet-related diseases are warranted to improve the current understanding of the differential impact of diet on health in women and men.

Trends in dietary fat and high-fat food intakes from 1991 to 2008 in the Framingham Heart Study participants

Few longitudinal studies carried out in US adults have evaluated long-term dietary fat intakes and compared them with the national recommendations during the two-decade period when the prevalence of obesity and insulin resistance increased substantively. In the present study, we examined trends in the intakes of dietary fats and rich dietary sources of fats in the Framingham Heart Study Offspring Cohort over a 17-year period. The cohort was established in 1971-75 with follow-up examinations being conducted approximately every 4 years. Dietary data were collected using a semi-quantitative FFQ beginning in 1991 (exam 5). We included 2732 adults aged ≥ 25 years with complete dietary data in at least three examinations from 1991 to 2008. Descriptive statistics were generated using SAS version 9.3, and a repeated-measures model was used to examine trends in macronutrient and food intakes using R. Over the 17 years of follow-up, the percentage of energy derived from total fat and protein increased (27·3-29·8% of energy and 16·8-18·0% of energy, respectively) and that derived from carbohydrate decreased (51·0-46·8% of energy; P-trend < 0·001). Increases in the percentage of energy derived from all fat subtypes were observed, except for that derived from trans-fats, which decreased over time (P-trend < 0·001). Trends were similar between the sexes, although women exhibited a greater increase in the percentage of energy derived from saturated fat and less reduction in the percentage of energy derived from trans-fats (P interaction < 0·05). Trends in fat intake were similar across the BMI categories. The number of weekly servings of cheese, eggs, ice cream desserts, nuts, butter and sausages/processed meats increased, whereas the intake of milk, margarine, poultry, confectioneries, chips and breads decreased (P-trend < 0·001). In this cohort of predominantly Caucasian older adults, the percentage of energy derived from dietary fats increased over time, but it remained within the national recommendations of less than 35 % of total energy, on average.

Stability of the Framingham Nutritional Risk Score and its component nutrients over 8 years: the Framingham Nutrition Studies

BACKGROUND/OBJECTIVES

Diet quality indices are increasingly used in nutrition epidemiology as dietary exposures in relation to health outcomes. However, literature on the long-term stability of these indices is limited. We aimed to assess the stability of the validated Framingham Nutritional Risk Score (FNRS) and its component nutrients over 8 years, as well as the validity of the follow-up FNRS.

SUBJECTS/METHODS

Framingham Offspring/Spouse Study women and men (n=1734) aged 22-76 years were evaluated over 8 years. Individuals' nutrient intake and nutritional risk scores were assessed using 3-day dietary records administered at baseline (1984-1988) and at follow-up (1992-1996). Agreement between baseline and follow-up FNRS and nutrient intakes was evaluated by Bland-Altman method; stability was assessed using intra-class correlation (ICC) and weighted Kappa statistics. The effect of diet quality (as assessed by the FNRS) on cardiometabolic risk factors was evaluated using analysis of covariance.

RESULTS

Modest changes from baseline (15%) were observed in nutrient intake. The stability coefficients for the FNRS (ICC: women, 0.49; men, 0.46; P<0.0001) and many nutrients (ICC 0.3) were moderate. Over half of the women and men (58%) remained in the same or contiguous baseline and follow-up quartile of the FNRS and few (3-4%) shifted >1 quartile. The FNRS was directly associated with body mass index in women (P<0.01) and high-density lipoprotein cholesterol among both women (P<0.001) and men (P<0.01).

CONCLUSIONS

The FNRS and its constituent nutrients remained relatively stable over 8 years of follow-up. The stability of diet quality has implications for prospective epidemiological investigations.

Geophysics and nutritional science: toward a novel, unified paradigm

This article discusses a few basic geophysical processes, which collectively indicate that several nutritionally adverse elements of current Western diets also yield environmentally harmful food consumption patterns. We address oceanic dead zones, which are at the confluence of oceanography, aquatic chemistry, and agronomy and which are a clear environmental problem, and agriculture's effects on the surface heat budget. These exemplify the unknown, complex, and sometimes unexpected large-scale environmental effects of agriculture. We delineate the significant alignment in purpose between nutritional and environmental sciences. We identify red meat, and to a lesser extent the broader animal-based portion of the diet, as having the greatest environmental effect, with clear nutritional parallels.

Increasing trends in incidence of overweight and obesity over 5 decades

PURPOSE

We evaluated trends in the incidence of overweight and obesity over the past 50 years.

METHODS

We evaluated trends in the incidence of overweight (25< or =body mass index [BMI] <30 kg/m2), obesity (BMI > or =30 kg/m2) and stage 2 obesity (BMI > or =35 kg/m2) from 1950 to 2000 in Framingham Study participants (n=6798, 54% women). Individuals aged 40-55 years who attended 2 examinations 8 years apart in each decade were eligible.

RESULTS

The incidences of overweight, obesity, and stage 2 obesity increased across the decades in both sexes (P for trend <.001). For men, the incidence of overweight rose from 21.8% (95% confidence interval [CI], 17.6-26.5) in the 1950s to 35.2% (95% CI, 28.6-42.5) in the 1990s; of obesity from 5.8% (95% CI, 4.4-7.6) to 14.8% (95% CI, 12.2-17.9); and of stage 2 obesity from 0.2% (95% CI, 0.1-0.9) to 5.4% (95% CI, 4.0-7.2). For women, incidence rates of overweight increased from 15.0% (95% CI, 12.3-18.1) to 33.1% (95% CI, 29.0-37.4); of obesity from 3.9% (95% CI, 2.9-5.3) to 14% (95% CI, 11.6-16.7); and of stage 2 obesity from 1.7% (95% CI, 1.1-2.6) to 4.4% (95% CI, 3.2-6.0). Overall, incidence rates of overweight increased 2-fold and that of obesity more than 3-fold over 5 decades, findings that remained robust upon additional adjustment for baseline BMI in each decade.

CONCLUSIONS

The incidence of overweight and obesity increased progressively over the last 5 decades, suggesting that the rising trend in prevalence is not a recent phenomenon.

Antioxidant Vitamin Intake and Subclinical Coronary Atherosclerosis

Numerous studies have evaluated the association between antioxidants and coronary atherosclerosis but have been limited by its study among individuals with advanced atherosclerosis. The authors studied 865 consecutive patients, 39-45 years of age, without known coronary artery disease and presenting for a periodic physical examination. Antioxidant intake was assessed with the Block Dietary Questionnaire, and coronary atherosclerosis was identified by measuring coronary artery calcification using electron beam computed tomography. The mean age was 42 (+/-2), 83% were male, and the prevalence of coronary artery calcification was 20%. Vitamin supplements were used by 56% of the participants, and the mean (+/-SD) daily intake (dietary plus supplemental) of vitamins A, C, and E were 1683 mg (+/-1245), 371 mg (+/-375), and 97 mg (+/-165), respectively. There was no significant correlation between coronary artery calcification score and individual vitamin or total antioxidant vitamin intake, even after adjusting for traditional cardiac risk factors. The highest quartile of vitamin E was positively associated with calcification (odds ratio=1.77; 95% confidence interval, 1.02-3.06). Antioxidant vitamin intake is not significantly related to coronary artery calcification, implying that there is no effect on the development of early coronary atherosclerosis. High doses of vitamin E may confer an increased risk of calcified atherosclerosis.

Diet and personality: Associations in a population-based sample

BACKGROUND

Large portions of the population of the United States of America fail to follow dietary recommendations. Psychological factors may contribute to non-adherence.

OBJECTIVE

Establish the associations between heritable personality styles, attitudes towards food, and habitual eating behavior.

DESIGN

Variables were assessed by questionnaire in a population-based sample of 629 subjects. Associations were established using correlation and regression analysis, taking gender, demographic, lifestyle and other factors into account.

RESULTS

Differences in personality style were reflected in diet. For example, hostility and anxiety-proneness was associated with greater likelihood to continue eating when satiated, while sociability and low impulsivity correlated with greater monitoring and control of dietary intake and body weight. Immaturity, aloofness, self-consciousness and self-gratification were associated with greater susceptibility to hunger and lack of persistence with increased snack and alcohol consumption. These associations differed for the sexes and were stronger for attitudes towards food than actual eating behavior. Taking other factors into account reduced the number of significant associations between diet and personality, particularly for habitual eating behavior.

CONCLUSIONS

Associations exist between personality and diet. However, the strength of these associations is influenced by demographic, lifestyle and other factors. These findings have implications for future studies and efforts aimed at changing unhealthy dietary habits.

Factors that influence adherence to calcium recommendations

To identify barriers to following calcium recommendations among women with reduced bone mineral density (BMD), four focus group sessions were held with 30 postmenopausal women diagnosed with low BMD. Key concepts and themes were derived from transcripts. Participants were aware of the importance of calcium to their bone health, and were attempting to follow calcium intake recommendations. Several major themes associated with the ability to obtain adequate calcium were identified, including knowledge and confidence in actions, lifestyle and food preferences, and side effects and conflict with other health conditions. Participants reported that they obtained information in an effort to make a confident decision about calcium intake, but were easily confused by conflicting information. Daily routines and family and personal food preferences influenced dietary behaviours. Women indicated that side effects, particularly those associated with perceived lactose intolerance, caused them to restrict their calcium intake. Our data provide important insight into factors that women believe affect their ability to reach recommended calcium intakes. To optimize osteoporosis prevention and treatment, dietitians should focus on individualized patient assessments to identify factors affecting adherence to dietary calcium recommendations.

Beta-carotene and the application of transcriptomics in risk–benefit evaluation of natural dietary components

Beta-carotene is a natural food component that is present in fruits and vegetables and is also used as a food colorant and a supplement. Beta-carotene is an anti-oxidant and a source of vitamin A. It is endowed with health beneficial properties, but a number of studies showed that with high intakes it may increase the risk for lung cancer in at risk individuals (heavy smokers, asbestos workers and alcohol users). To establish the window of benefit, it is necessary to identify early markers of effect and to obtain insight in the mechanism of action of beta-carotene, in the absence and presence of environmental risk factors. Genomics technologies are well suited to dissect the mechanisms of action and identify the markers of effect. Human cell lines can be used to analyse the effects of beta-carotene, but exposure studies with beta-carotene show that cell lines display a widely variant behaviour, which hampers translation to the in vivo situation in humans. Alternatively, animal studies can be used. Especially the ferret seems to be a good model, but little sequence information of this species is available. However, heterologous hybridization on human cDNA seems possible and provides and a new tool for molecular analysis of health effects of beta-carotene.

Significance of urinary angiotensinogen in essential hypertension as a function of plasma renin and aldosterone status

OBJECTIVE

This study was performed to test the significance of urinary angiotensinogen (UAGT) in essential hypertensive patients stratified as a function of plasma renin and aldosterone.

METHODS AND RESULTS

A sample of 248 essential hypertensives, investigated under their usual sodium diet and either off-medication or under a standardized treatment, was separated into two groups on the basis of upright plasma active renin and aldosterone medians. Patients with plasma active renin and aldosterone below medians are referred to as the low renin-aldosterone essential hypertensive group (LRA-EH). Others subjects are defined as other essential hypertensives (O-EH). Blood pressure (BP) was recorded by 24-h ambulatory monitoring. UAGT was measured by a specific enzyme-linked immunosorbent assay for total angiotensinogen. Because UAGT was markedly increased in the presence of overt proteinuria (>/= 300 mg/24 h), proteinuric patients (n = 29) were excluded from subsequent analyses. UAGT was a significant predictor of systolic and diastolic BP in LRA-EH females (P < 0.01 and P = 0.05, respectively) but not in males. By contrast, urinary sodium excretion (P < 0.001) and maintenance of treatment (P = 0.002) were significant predictors of systolic BP in males. These correlations were not observed in O-EH, whether males or females.

CONCLUSIONS

In the present study, UAGT stands as a strong predictor of BP in women with low plasma renin/aldosterone, suggesting an involvement of the tubular renin-angiotensin system in these subjects. Higher sodium intake or the need to maintain treatment may account in part for the lack of a similar relationship in males.

Ethnic differences in the nutrient intake adequacy of premenopausal US women: results from the Third National Health Examination Survey

OBJECTIVE

To examine the adequacy of dietary intake of calcium; folate; and vitamins C, D, E, B-6, and B-12 in premenopausal US women of differing ethnicity.

DESIGN

Analyses of single and duplicate 24-hour recalls were conducted to determine dietary intake during the Third National Health and Nutrition Examination Survey.

SUBJECTS

Three thousand five hundred eighty-five randomly selected women aged 20 to 50 years from across the United States who were not pregnant or lactating were examined between 1988 and 1994.

STATISTICAL ANALYSES

Usual nutrient intake distributions were estimated using the Iowa State University method for adjustment of the distribution. The Estimated Average Requirement cut-point method was used to determine the proportion of women with inadequate intake for each nutrient in each ethnic group.

RESULTS

More than 75% of women irrespective of ethnic group had usual intakes of calcium lower than the new Adequate Intake. More than 90% of the women had inadequate intakes of folate and vitamin E from food sources alone. More than half of smokers had inadequate intakes of vitamin C. Intakes of vitamins B-6 and B-12 were low in less than 10% of these women.

APPLICATIONS/CONCLUSIONS

This article provides evidence that a high proportion of premenopausal US women are underconsuming a variety of nutrients. Dietary intakes alone are not currently adequate to meet the new recommended intakes. Nutritional supplement use is widespread and effective, but does not eliminate the concerns for at-risk populations. Awareness of the general inadequacies in intakes of vitamin E and folic acid at large, and in many women vitamin C as well, can help direct individual dietary recommendations and place the emphasis in group counseling on nutrients that are of widespread concern. In addition, foods rich in vitamins B-6 and of general nutritional benefit should be emphasized among African American women in the United States as a substantial proportion of this group is still showing inadequate intakes from foods.

Gender differences in dietary intakes, anthropometrical measurements and biochemical indices in an urban adult population: the Tehran Lipid and Glucose Study

BACKGROUND AND AIM

In order to investigate gender differences in health indices, dietary intakes and obesity in urban Iranian adults, we considered a sub-sample of the adult population of the Tehran Lipid and Glucose Study.

METHODS AND RESULTS

The randomly selected sub-sample consisted of 483 subjects aged 25-50 years (229 men and 254 women) and 153 aged more than 50 years (81 men and 72 women). Their anthropometrical variables were recorded, and their body mass index (BMI) and waist/hip ratio were calculated. Dietary intake was assessed by means of two-day dietary recall and the completion of dietary habit questionnaires during face-to-face interviews. Underreporting was defined as a ratio of energy intake (EI)/basal metabolic rate (BMR) < 1.27. The mean BMI of the women in both age groups was significantly higher than that of the men (p < 0.05). Central obesity was more frequent in the women and among older subjects. The women had higher plasma concentrations of high-density lipoprotein cholesterol, but lower levels of total and low-density lipoprotein cholesterol. Underreporting of EI was more frequent in the women than the men: 34.0% vs 15.4% in the younger group, and 40.3% vs 17.3% in the older group (p < 0.01). There were major gender differences in the mean daily intakes of energy, protein, carbohydrate, fat, fibre, cholesterol, iron, calcium and phosphorus. A higher proportion of women met the cholesterol intake guidelines. Data from the dietary habit questionnaires showed that more men than women usually sprinkle salt on their food.

CONCLUSIONS

The results of this study partially support the hypothesis of gender differences in dietary intakes, and the prevalence of obesity and some health-related indices, and suggest the need for gender-specific, targeted nutrition messages and behavioural interventions in developing prevention strategies for cardiovascular risk factors.

Dietary reference intakes: a comparison with the Nova Scotia Nutrition Survey

The purpose of this study was to compare the newly released dietary reference intakes with the 1990 Nova Scotia Nutrition Survey and identify characteristics that influence compatibility with these new recommendations. For each of 17 nutrient recommendations, we calculated the proportion of participants who consumed intakes within the recommended range. We constructed a score reflecting overall compatibility between the new recommendations and the Nova Scotia Nutrition Survey data. Using this score as the dependent variable, we conducted multivariate regression analysis to evaluate the importance of demographic and behavioural factors for compatibility with the dietary reference intakes. Results indicate that compatibility with the dietary reference intakes was poor among Nova Scotians, particularly for magnesium, vitamins C and E, and macronutrients. Compatibility was lower among females than among males, and differed independently by age, body mass index, socioeconomic factors, smoking status, and alcohol consumption. Dietary intervention is needed in Nova Scotia. Reduced fat intake and increased intake of specific vitamins should be promoted. We recommend that nutrition education campaigns coinciding with the introduction of the dietary reference intakes in Nova Scotia target younger people, those of lower socioeconomic background, smokers, and those who are obese.

Inadequate nutrient intakes among homebound elderly and their correlation with individual characteristics and health-related factors

BACKGROUND

The prevalence of inadequate nutrient intakes among the homebound elderly and their correlation with individual characteristics and health-related factors remain poorly understood.

OBJECTIVE

We assessed the extent of inadequate dietary intakes of key nutrients among the homebound elderly by using the newly released dietary reference intakes and examined the associations of individual characteristics and health-related factors with low nutrient intakes.

DESIGN

This was a cross-sectional examination of data collected during the baseline assessment of a prospective study of nutrition and function among a randomly recruited sample of cognitively eligible recipients of home-delivered meals who completed a home visit and three 24-h dietary recalls (n = 345). Nutrient analysis was performed with the NUTRITION DATA SYSTEM software, and associations were identified through multiple regression models.

RESULTS

In multiple regression models, lower intakes of specific nutrients were associated with subjects who were women, who were black, who reported a low income and limited education, and who did not usually eat breakfast. On the basis of the estimated average requirement standard for nutrient inadequacy, the intake of >/= 6 nutrients was inadequate in 27% of subjects, of 3-5 nutrients in 40% of subjects, and of 1-2 nutrients in 29% of subjects. On the basis of the adequate intake standard, a less than adequate intake of calcium was reported by 96% of subjects and of vitamin D by 99% of subjects.

CONCLUSIONS

The findings suggest that home-delivered meals programs should target specific subgroups of participants with interventions, such as a breakfast meal or more-nutrient-dense meals, tailored to increase nutrient intakes and reduce the prevalence of nutrient inadequacy.

Changes in the intake of vitamins and minerals by men and women with hyperlipidemia and overweight during dietetic treatment

OBJECTIVES

To assess the influence of a low-fat, low-energy diet on the intake of vitamins and minerals in patients with overweight and hyperlipidemia.

SETTING

Outpatient clinic for hyperlipidemia treatment.

SUBJECTS

A total of 134 subjects chosen from patients attending Outpatient Clinic of Metabolic Diseases.

INTERVENTIONS

Patients were assigned to a hypolipidemic, low-energy diet of 4.18-6.27 MJ/day (1000 or 1500 kcal/day), where fat provided less than 30% of energy, saturated fatty acids less than 10% of energy and daily supply of cholesterol was below 300 mg. Dietary assessment with the use of 3 days dietary records were performed at baseline and after 8 weeks of the diet.

RESULTS

The implementation of a low-fat, low-energy diet resulted in a decrease of the intake of nutrients assessed, statistically significant for phosphorus, magnesium, iron and vitamin B(1), B(2) and niacin in men and for iron in women. No marked and statistically significant reduction in the percentage of the RDA was found, except magnesium, thiamin and riboflavin in men and iron in women. Nutritional density was statistically improved for phosphorus, potassium, magnesium and vitamins E, C and B(6) in men and for all nutrients assessed in women.

CONCLUSIONS

In comparison with a habitual diet, the low-fat, low-energy diet did not cause any marked and statistically significant decrease in the intake of minerals and vitamins or in the adherence to the RDA, with the exception of magnesium, thiamin and riboflavin in men and iron in women.

Evaluation of dietary quality in relationship to nutritional and lifestyle factors in elderly people of the US Framingham Heart Study and the European SENECA study

OBJECTIVE

To evaluate dietary quality of European and American elderly subjects using different derivatives of dietary patterns (dietary scores and clusters) and to investigate the relationship of these approaches to nutritional and lifestyle factors.

DESIGN

Data from the cross-sectional SENECA baseline study and Framingham Heart Study (original cohort and offspring) were used for data analysis. Food intake data were summarised into dietary clusters and into dietary scores (Healthy Diet Indicator and Mediterranean Diet Score). These measures of dietary quality were then tested for associations with lifestyle factors and measures of nutritional status.

SUBJECTS/SETTING

The study population, aged 70-77 y, consisted of 828 subjects from Framingham, MA (USA) and 1282 subjects from the following European centres: Hamme, Belgium; Roskilde, Denmark; Padua, Italy; Culemborg, The Netherlands; Vila Franca de Xira, Portugal; Betanzos, Spain; and Yverdon, Burgdorf and Bellinzona, Switzerland.

RESULTS

Dietary intake varied widely across the European and American research centres. In general, Southern European centres and Framingham had higher mean diet scores, indicating a higher dietary quality, than Northern European centres (MD-scores: 4.2-4.4 vs 2.7-3.5). Cluster analysis identified the following five dietary patterns characterised by: (1) sugar and sugar products; (2) fish and grain; (3) meat, eggs and fat; (4) milk and fruit; and (5) alcohol intake. The meat, eggs and fat pattern had significantly lower average dietary quality, as measured with all three diet scores than all other groups except the alcohol group. The fish and grain group had significantly better Mediterranean diet scores than all other groups.

CONCLUSIONS

Dietary scores and dietary clusters are complementary measures to classify dietary quality. The associations with nutritional and lifestyle factors indicate the adequate categorisation into dietary quality groups.

SPONSORSHIP

European Union, US Department of Agriculture, Agriculture Research Service, under agreement (58-1950-9-001), Haak Bastiaanse-Kuneman Foundation.

Association of the Sst-I polymorphism at the APOC3 gene locus with variations in lipid levels, lipoprotein subclass profiles and coronary heart disease risk: the Framingham offspring study

Apolipoprotein (apo) CIII participates in the regulation of the metabolism of triglyceride-rich lipoproteins and it is a major component of chylomicrons and VLDL. The APOC3 gene is on chromosome 11q23 and is highly polymorphic. The less common allele (S2) of the SstI polymorphism on the 3' untranslated region of the APOC3 gene has been previously associated with increased triglycerides, total cholesterol (TC), and apoCIII levels and cardiovascular risk on several, but not all, studies. The aim of this study was to examine the association of this polymorphism with plasma lipid levels, lipoprotein subfractions and coronary heart disease (CHD) risk in a population-based study: The Framingham Offspring Study. The frequency of the S2 allele was 0.086, consistent with previous reports in Caucasian populations. In men, the S2 allele was associated with lower concentrations of high-density lipoprotein cholesterol (HDL-C; P<0.04) and HDL2-C (P<0.02) and a significant increase in apoCIII non-HDL (P<0.05). TG levels were higher in men carriers of the S2 allele, but this association did not reach statistical significance (P=0.30). Conversely, in women, the S2 allele was associated with increased TC (P<0.03), low-density lipoprotein cholesterol (LDL-C; P<0.03), and ApoB levels (P<0.04). Lipoproteins subfractions were also examined using nuclear magnetic resonance (NMR) spectroscopy. S2 male carriers had significantly lower concentrations of large LDL and a significant reduction in LDL particle size (P<0.04). In women, there was a significant increase in intermediate LDL particles (P<0.05) with no significant effect on lipoprotein diameters. We also examined the associations between the S2 allele and biochemical markers of glucose metabolism. In men, the S2 allele was associated with elevated fasting insulin concentrations (P<0.04), whereas no significant associations were observed in women. Despite the described associations with lipid and glucose metabolism related risk factors, we did not find any significant increase in CHD risk associated with the S2 allele in this population.

Facilitating dietary change: the patient-centered counseling model

Recent data indicate that the patient-centered counseling model enhances long-term dietary adherence. This model facilitates change by assessing patient needs and subsequently tailoring the intervention to the patient's stage in the process of change, personal goals, and unique challenges. This article describes this model, including its theoretical foundations, a 4-step counseling process, and applications. This behavioral counseling model can help nutrition professionals enhance patient adherence to nutrition care plans and dietary guidelines.