Dietary patterns associated with a low-fat diet in the national health examination follow-up study: identification of potential confounders for epidemiologic analyses

Intake of Fruit and Glycemic Control in Korean Patients with Diabetes Mellitus Using the Korea National Health and Nutrition Examination Survey

BACKGRUOUND

Despite the well-recognized health benefits of fresh fruit consumption, there is still substantial uncertainty about its potential effects on glycemic control in patients with type 2 diabetes mellitus (T2DM).

METHODS

We examined the association of fresh fruit consumption and glycemic control in patients with T2DM using data from the 6th Korea National Health and Nutrition Examination Survey. The study sample was divided into three groups based on weekly fruit consumption frequency for the analysis.

RESULTS

Patients with the highest fruit intake were older than those in the other two groups, and women were more likely to consume fruits in general. Being a current smoker and weekly alcohol intake also showed negative correlations according to the fruit intake tertiles. Fruit consumption was positively correlated with better hemoglobin A1c (HbA1c) levels. Moreover, patients in the highest tertile of fruit intake were 3.48 times more likely to be in good glycemic control defined as HbA1c <7%.

CONCLUSION

We observed that fruit consumption can be helpful in glycemic control in Korean patients with T2DM.

Evaluation for the effects of nutritional education on Chinese elite male young soccer players: The application of adjusted dietary balance index (DBI)

OBJECTIVES

To evaluate the effect of nutrition education on Chinese elite male young soccer players through the knowledge, attitude, behavior (KAP) survey and an adjusted dietary balance index (DBI).

METHODS

30 Chinese elite male young soccer players were randomly divided into two groups: lecture group (N = 15, Age: 16.7 ± 1.8 years, Height: 173.9 ± 9.0 cm; Weight: 62.4 ± 13.0 kg; Training years: 5.6 ± 2.7 years) and non-lecture group (N = 15, Age: 16.8 ± 1.7 years, Height: 175.5 ± 7.9 cm; Weight: 62.5 ± 12.3 kg; Training years: 6.2 ± 3.3). The comics book was given to the non-lecture group, while the a four-week nutritional quality education along with comic books were given to the lecture group. Before and after 4 weeks nutritional education, dietary nutritional status of both groups was assessed. The main outcome measurements included the scores for each part of the KAP survey, diet status (food-weighing method) and the dietary index in the adjusted DBI-07 system (DBI-low bound score, LBS; DBI-high bound score, HBS; and DBI-diet quality distance, DQD).

RESULTS

In the lecture group, significant differences were found in the scores of general nutrition knowledge, sports nutrition knowledge and total scores of KAP dietary questionnaire after 4 weeks nutritional education (P < 0.01). However, there is no significant difference in dietary attitude and dietary behavior (P > 0.05) on both two groups. There is no significant change in the DBI-low bound score (LBS), DBI-high bound score (HBS) and DBI-diet quality distance (DQD) of dietary quality index (P > 0.05) in both two groups.

CONCLUSIONS

Four weeks nutritional quality education improved the understanding of dietary nutrition among Chinese elite male young soccer players.

Overall nutrient and total fat intake among Japanese people: The INTERLIPID Study Japan

BACKGROUND AND OBJECTIVES

Total fat intake is linked to the intake of other nutrients. Little data are available on the extent to which total fat affects diet quality in Japanese people. We investigated the relationship between total fat intake and other nutrient intake using INTERLIPID/ INTERMAP data on Japanese people living in Japan.

METHODS AND STUDY DESIGN

The participants included 371 men and 401 women with a healthy body mass index and between the ages of 40 and 59 from 4 population samples in Japan. Nutrient intake data were based on four in-depth 24-hour dietary recalls per person.

RESULTS

Analysis of covariance adjusted for age revealed that total fat intake was positively related to intakes of calcium, thiamine, riboflavin, meat, eggs, and milks and dairy products for both sexes. Total fat intake was inversely associated with carbohydrate and cereals intake for both sexes. On average, men with total fat intake between 25.0 and 27.4% of total energy had saturated fatty acids above 7%, which is the upper limit recommended for preventing lifestyle-related diseases. Men with total fat intake less than 20% of total energy had a higher risk of not meeting the Dietary Reference Intakes for Japanese (2015) for some nutrients.

CONCLUSIONS

Total fat intake was positively associated with calcium, thiamine, and riboflavin intakes and inversely associated with carbohydrate intake. Our results suggest that in 40-59-year-old men with a healthy body mass index, total fat intake between 20 and 27% of total energy may best support adequate intake of other nutrients.

Assessment of dietary pattern and nutritional status of undergraduate students in a private university in southern Nigeria

BACKGROUND

Analysis of dietary patterns gives a more comprehensive impression of the food consumption habits within a population. Poor dietary habits among undergraduate students have been reported as a lifestyle challenge they face while in school. This study was carried out to assess the dietary pattern and nutritional status of undergraduate students in Igbinedion University, Okada.

METHODOLOGY

This study applied a cross-sectional, descriptive study design and 800 undergraduate students selected by multistage sampling method participated in the study. Data were collected using pretested, structured self-administered questionnaires and anthropometric measurements were obtained. Data were analyzed using SPSS statistical package (version 22.0) and level of significance was set at p < 0.05.

RESULTS

Mean age of respondents was 23.5 ± 2.4 years, with a higher proportion being females (468; 58.5%). Over half of the respondents 448 (56.0%) skipped breakfast and 608 (76.0%) ate in between meals. More females 280 (59.8%) compared to males 168 (50.6%) skipped breakfast and the association between gender of respondents and breakfast skipping was statistically significant (p < 0.010). Majority of the respondents 744 (93.0%) ate snacks and the association between age group and snacking status of respondents was statistically significant (p < 0.034). Three hundred and ninety-two (49.0%) of the respondents had high dietary diversity score while 212 (26.5%) had low dietary diversity score. The association between age group and dietary diversity was statistically significant (p < 0.001). More males 172 (51.8%) had a significantly (p < 0.004) higher dietary diversity score compared to the females 220 (47.0%). Over two-thirds of the respondents 564 (70.5%) had normal BMI, 112 (14.0%) were overweight, and 76 (9.5%) were underweight.

CONCLUSION

Skipping of breakfast and eating in-between meals are common among the study population. Regular nutrition education program by the institution with emphasis on adequate dietary practices is recommended.

Pancreatic cancer: A critical review of dietary risk

Pancreatic cancer is a deadly disease. It is estimated that about 90% of pancreatic cancer cases are due to environmental risk factors. Among these, approximately 50% of pancreatic cancer cases may be attributed to diet, which is largely modifiable. Given this large attribution to diet, there have been numerous epidemiological studies assessing the risk of various dietary factors on the incidence of pancreatic cancer. However, many of these studies present conflicting and/or inconclusive findings. The objective of this review is two-fold: (a) to summarize the current evidence on the association between various dietary factors and the risk of developing pancreatic cancer and (b) to discuss what additional studies are needed to better elucidate the role of diet as a potential risk factor for pancreatic cancer. We summarized the evidence by using data primarily from meta-analyses and pooled analysis when available, focusing on the most studied nutrients, foods, and dietary patterns. We observed that, while the association between individual nutrients and pancreatic cancer risk have been heavily studied, the evidence is mostly conflicting and inconclusive. In contrast, the evidence of certain associations among dietary patterns and pancreatic cancer risk is clearer, has more power, and is less conflicting. Therefore, we propose a shift in the focus of nutritional epidemiological research with regards to pancreatic cancer risk. We discourage further epidemiological research studies that focus on single nutrients, whereas we strongly encourage additional studies that investigate how a combination of diet and other lifestyle factors may promote or prevent pancreatic carcinogenesis.

Anti-inflammatory effect of dietary pork extract on proliferation and cytokine secretion using mouse primary splenocytes

The anti-inflammatory effects of boiled pork meat (BPM) and hot water extracts of pork meat (WPM) on splenocyte proliferation and T cell cytokine regulation in BALB/c mice were evaluated. The proliferation of splenocytes in high concentration WPM groups was significantly higher than the control stimulated by LPS and Con A. In the white blood cells, WPM groups had significantly higher counts of lymphocytes and lower counts of neutrophils than the control (p<0.05). The Th1 (IFN-γ, TNF-α, IL-2) and Th2 (IL-4, IL-5, IL-10) cytokine levels in high-concentration WPM groups were higher than those in the control. In addition, TNF-α/IL-10 and IL-2/IL-4 secretions of splenocytes in the high concentration WPM group with LPS or Con A treatment was significantly lower than the control (p<0.05). Therefore, this study suggested that high concentration of WPM had anti-inflammatory effects on the primary splenocyte, which indicating that water extracts of pork meat can enhance the immune system of mice.

Dietary patterns and the risk of obesity, type 2 diabetes mellitus, cardiovascular diseases, asthma, and neurodegenerative diseases

Diet and lifestyle play a significant role in the development chronic diseases; however the full complexity of this relationship is not yet understood. Dietary pattern investigation, which reflects the complexity of dietary intake, has emerged as an alternative and complementary approach for examining the association between diet and chronic diseases. Literature on this association has largely focused on individual nutrients, with conflicting outcomes, but individuals consume a combination of foods from many groups that form dietary patterns. Our objective was to systematically review the current findings on the effects of dietary patterns on chronic diseases. In this review, we describe and discuss the relationships between dietary patterns, such as the Mediterranean, the Dietary Approach to Stop Hypertension, Prudent, Seventh-day Adventists, and Western, with risk of obesity, type-2 diabetes mellitus, cardiovascular diseases, asthma, and neurodegenearive diseases. Evidence is increasing from both observational and clinical studies that plant-based dietary patterns, which are rich in fruits, vegetables, and whole grains, are valuable in preventing various chronic diseases, whereas a diet high in red and processed meat, refined grains and added sugar seems to increase said risk. Dietary pattern analysis might be especially valuable to the development and evaluation of food-based dietary guidelines.

The Mediterranean dietary pattern as the diet of choice for non-alcoholic fatty liver disease: Evidence and plausible mechanisms

Non-alcoholic fatty liver disease (NAFLD) has become a major global health burden, leading to increased risk for cirrhosis, hepatocellular carcinoma, type-2 diabetes and cardiovascular disease. Lifestyle intervention aiming at weight reduction is the most established treatment. However, changing the dietary composition even without weight loss can also reduce steatosis and improve metabolic alterations as insulin resistance and lipid profile. The Mediterranean diet (MD) pattern has been proposed as appropriate for this goal, and was recommended as the diet of choice for the treatment of NAFLD by the EASL-EASD-EASO Clinical Practice Guidelines. The MD has an established superiority in long term weight reduction over low fat diet, but it improves metabolic status and steatosis even without it. However, the effect on liver inflammation and fibrosis was tested only in few observational studies with positive results. Furthermore, considering the strong association between NAFLD and diabetes and CVD, the MD has a highly established advantage in prevention of these diseases, demonstrated in randomized clinical trials. The individual components of the MD such as olive oil, fish, nuts, whole grains, fruits, and vegetables, have been shown to beneficially effect or negatively correlate with NAFLD, while consumption of components that characterize a Western dietary pattern as soft drinks, fructose, meat and saturated fatty acids have been shown to have detrimental association with NAFLD. In this review we will cover the epidemiological evidence and the plausible molecular mechanisms by which the MD as a whole and each of its components can be of benefit in NAFLD.

Healthy and Unhealthy Dietary Patterns Are Related to Depression: A Case-Control Study

OBJECTIVE

Major depressive disorder is the leading cause of disability around the world. The relationship between depression and dietary patterns has been reported in a few studies but with controversial results. This study aimed to investigate this relationship in an Iranian population.

METHODS

In our study, 330 depressed patients (cases) and healthy people (controls) (1:2) were individually matched according to age, sex and area of residence. New cases of depression were recruited from two psychiatric clinics in Tehran. Interviewers went to each patient's residential area, and invited qualified individuals to participate in the study as controls. Food intake over the past year was collected using a validated semi quantitative food frequency questionnaire. Dietary patterns were determined by the principal components method. Binary logistic regression was used to test the effect of dietary patterns on depression.

RESULTS

We identified two major dietary patterns by using factor analysis: the healthy and unhealthy dietary patterns. We categorized the scores of these patterns to quartiles. After adjusting for non-depression drug use, job, marital status, children number, and body mass index, the relations of depression and quartiles of two dietary patterns are significant (p=0.04 & p=0.01, respectively). Compared with participants in the lowest quartile, those in the highest quartile had significantly lower odds ratio (OR) for depression in healthy dietary pattern, and higher OR for depression in unhealthy dietary pattern.

CONCLUSION

This study indicates that healthy and unhealthy dietary patterns may be associated with the risk of depression. The results can be used for developing interventions that aim to promote healthy eating for the prevention of depression.

Comparing dietary patterns of depressed patients versus healthy people in a case control protocol

INTRODUCTION

Major depressive disorder is the leading cause of disability around the world. Because of the high rate of medication discontinuation by patients and the risk of recurrence, factors such as nutrition could be useful for the prevention or treatment of depression. The relationship between depression and dietary patterns has been reported in a few studies but with controversial results. Therefore, we have decided to study the possible effects of cultural, social, racial, geographic and environmental conditions on this relationship in an Iranian population.

METHODS AND ANALYSIS

In our case control protocol, 110 cases and 220 controls will be individually matched based on age, sex and area of residence. New cases of depression, based on the criteria of the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV), will be recruited from two psychiatric clinics in Tehran. Interviewers will then go to each patient's home and invite qualified individuals to participate in the study as controls. Food intakes of all participants will be obtained by semiquantitative food frequency questionnaires covering the past year; these will be transformed into actual food intake (g/day). Dietary patterns will be determined by the principal components method. Conditional logistic regression, as a multivariate analysis, will be used for assessing the relationship between dietary patterns and depression, taking into consideration the potential role of different variables. The results may help to identify differences in dietary patterns between depressed and healthy people.

ETHICS AND DISSEMINATION

The study protocol has been approved by ethics committee of Tehran University of Medical Sciences. At the beginning of the study, a written informed consent form will be signed and dated by subjects and investigators. The results will be published in due time.

Mediterranean dietary pattern and chronic diseases

The study of the relationship between the Mediterranean way of eating and the occurrence of diseases typical of the economically developed countries has been considered the starting point of nutritional epidemiology. From the Seven Countries Study in the 1950s to the recent European EPIC collaboration, the evaluation of the components of diet-affecting chronic diseases such as cardiovascular disease and cancer has been crucially based on the analysis of foods and nutrients characterizing the Mediterranean dietary habits. This long research history has been marked by a consistency of data over time when either single nutrients/food groups or more complex dietary patterns have been analyzed: The Mediterranean way of eating is a protective tool from cardiovascular diseases and many cancers. Italy has been a natural point of observation, starting from cardiovascular disease in the mid-1950s and continuing with major cancers. In spite of unfavorable lifestyle changes in the Italian population mostly due to globalization of unhealthy habits (richer diet and lower levels of physical activity), those individuals still close to the Mediterranean style are significantly protected. The very recent Italian data derived from the observation of about 50,000 individuals, participating in the Italian cohorts of the EPIC study, confirm these findings and are consistent with results from other European populations and in some cases also from North American populations. Moreover, several dietary trials suggest that such a way of eating improves both the metabolic risk condition for chronic disease and the occurrence of those diseases. In conclusion, a way of eating inspired by a Mediterranean dietary pattern is not only based on evidence but is also a palatable style that has contributed to protection from the epidemic of chronic diseases.

Covariability in Diet and Physical Activity in African-American Girls

OBJECTIVE

Our goal was to examine 12-week covariability in diet and physical activity changes among 8- to 10-year-old African-American girls and if these changes predicted percent change in BMI.

RESEARCH METHODS AND PROCEDURES

Covariability among percent changes [(post - pre)/pre x 100] in nutrients, food groups, and physical activity was assessed among 127 8- to 10-year-old African-American girls. Pearson correlation and hierarchical linear regression analyses were performed.

RESULTS

Percent change in percentage kilocalories from carbohydrate was negatively correlated with percent change in both percentage kilocalories from fat (r = -0.85; p < or = 0.01) and protein (r = -0.51; p < or = 0.01). No statistically significant relationships were observed in percent changes among food group variables. Negative relationships were observed between percent changes in fruit/100% juice and percentage kilocalories from fat (r = -0.20; p < or = 0.05) and between percent changes in minutes of moderate-to-vigorous and sedentary activity (r = -0.60; p < or = 0.01). No significant associations were observed between percent change in moderate-to-vigorous physical activity and diet variables or percent change in BMI or waist circumference and percent change in diet or physical activity.

DISCUSSION

No relationships were observed between percent changes in physical activity and dietary variables. Percent change in diet and/or physical activity did not predict percent change in BMI. This may have been due to the small sample size, the small changes in diet or physical activity, the short duration of the intervention, or because data from different interventions were combined. Understanding these relationships could have significant implications for addressing the obesity epidemic.

[A factor of fasting blood glucose and dietary patterns in Korean adults using data from the 2007, 2008 and 2009 Korea National Health and Nutrition Examination Survey]

OBJECTIVES

This study was performed to identify the socioeconomic factors, health behavior factors and dietary patterns that have an influence on the fasting blood glucose in adults.

METHODS

This study used data collected from the 2007, 2008, 2009 Korea National Health and Nutrition Examination Survey. The final sample included 4163 subjects who were 30-59 years old and who had completed the necessary health examinations, the health behaviors survey and nutrition survey.

RESULTS

Eleven dietary patterns emerged from the factor analysis with different factor loading. After controlling for potential confounders, multiple regression analysis of the dietary patterns showed that 'fruits', 'alcohols', and 'starchy foods' affected the fasting blood. Lower consumption of 'fruits' and higher consumption of 'alcohols' and 'starch foods' were significantly associated only with an increased risk of high blood glucose.

CONCLUSIONS

In the light of the results of this study, it appears pretty likely that the risk of developing high blood glucose can be reduced by changing a person's dietary patterns.

Dietary patterns are associated with metabolic syndrome in an urban Mexican population

The role that diet plays in the origin of metabolic syndrome (MetS) is not completely understood. Certain foods and nutrients have been established as dietary risk factors for MetS. However, the dietary patterns associated with MetS risk have been minimally studied with factor analysis. Our objective in this study was to use exploratory factor analysis to examine whether particular dietary patterns are related to risk of MetS in Mexican adults. We characterized the dietary patterns among 5240 men and women aged 20-70 y in the Health Workers Cohort Study. Information on participants' sociodemographic conditions and physical activity was collected via self-administered questionnaires. We also obtained anthropometric and clinical measurements and fasting blood samples for biochemical analyses. In a cross-sectional analysis, we examined dietary patterns in relation to MetS, defined using criteria from the Adult Treatment Panel III. Factor analysis revealed 3 major dietary patterns: prudent, Western, and high protein/fat. The prevalence of MetS was 26.6%. After adjustment for potential confounders, compared with participants in the lowest tertile of the Western pattern, those in the highest tertile had higher odds ratios (OR) for high fasting glucose (OR, 1.67; 95% CI: 1.36-2.06), low serum HDL cholesterol (OR, 1.55; 95% CI: 1.31-1.83), and MetS (OR, 1.56; 95% CI, 1.31-1.88). However, we found no significant associations between other patterns and MetS. In summary, a diet high in soft drinks, refined grains, corn tortillas, pastries, seafood, and whole grains was associated with MetS risk. This result emphasizes the importance of preventive nutrition interventions.

Dietary patterns and risk for Crohn's disease in children

BACKGROUND

Some dietary foods are considered protective (vegetables and fruits), whereas others (fatty foods) are thought to enhance the risk for Crohn's disease (CD). The evidence, however, is inconsistent.

METHODS

We postulated that specific dietary patterns may influence the risk for CD. A case-control study was carried out. Newly diagnosed CD cases with population and/or hospital-based controls < or =20 years were selected from 3 tertiary hospitals across Canada. Pre-disease diet was assessed using a validated food frequency questionnaire (FFQ) administered within 1 month of diagnosis. Factor analyses and unconditional logistic regression (adjusted) was used to determine gender-specific dietary patterns and assess associated risks for CD. Odds ratios (ORs) and corresponding 95% confidence intervals (95% CIs) were estimated.

RESULTS

A total of 149 cases and 251 controls were included. The mean age (range) of the cases was 13.3 (2.6-20 years). There were more boys (61.1%). Four dietary patterns each were observed among both boys and girls. Pattern 1 in girls, characterized by meats, fatty foods, and desserts, was positively associated with CD (OR 4.7, 95% CI 1.6-14.2). Pattern 2, common to both boys and girls, was characterized by vegetables, fruits, olive oil, fish, grains, and nuts and was inversely associated with CD in both genders (girls: OR 0.3, 95% CI 0.1-0.9; boys: OR 0.2, 95% CI 0.1-0.5).

CONCLUSIONS

Our results suggest that specific dietary patterns could be associated with higher or lower risks for CD in children. Larger prospective studies are required to confirm these findings.

Physical activity and sedentary lifestyle in children as time-limited functions: usefulness of the principal component analysis method

This study was designed to examine the hourly variation in and the interplay between physical activity and sedentary behavior (SB) in order to highlight key time periods for physical activity interventions for children. Data for physical activity and SB obtained with ActiGraph in 56 boys and 47 girls aged from 8 to 11 years. These data were divided into sixty minute-time samples for moderate-to-vigorous physical activity (MVPA) and SB, and analyzed using a principal component analysis (PCA) and correlation statistics. The PCA provides 10 factors which account for 80.4% of the inertia. Only two of these factors did not display competition between MVPA and SB. Contrary to some reports, a coefficient of correlation of -.68 (p < 10(-4)) was found between daily time spent at MVPA and SB. Some salient traits of children's behaviors were shown through PCA. The results suggested that efficacy of interventions targeting the morning hours (07:00 AM-11:59 AM) and the afternoon period (02:00 PM-05:59 PM) warrants attention.

Does food group consumption vary by differences in socioeconomic, demographic, and lifestyle factors in young adults? The Bogalusa Heart Study

OBJECTIVE

To examine if food group consumption varies by differences in socioeconomic, demographic, and lifestyle factors in young adults from a semirural setting in Louisiana.

DESIGN

Cross-sectional.

SUBJECTS

Young adults (n=1,266, 74% European American, 26% African American; 39% men, 61% women) aged 20 to 38 years, enrolled in the Bogalusa Heart Study.

MEASURES

Food group consumption was assessed by a food frequency questionnaire. Socioeconomic (eg, income and education), demographic (eg, age, sex, and ethnicity), and lifestyle (eg, marital status and physical activity) information was obtained by a self-administered questionnaire and the subjects were stratified according to these groups.

STATISTICAL ANALYSES

Analysis of covariance (adjusted for covariates) was used to detect differences in the mean servings of food groups consumed per day between the various socioeconomic, demographic, and lifestyle groups.

RESULTS

Compared to income<or=$15,000, those with an income>$45,000 had lower consumption of burgers/sandwiches (P<0.05) and those with income levels from $30,001 to $45,000 had lower consumption of mixed dishes (P<0.05). Intake of cereals/breads (P<0.05), dairy products (P<0.01), fruits/100% fruit juices (P<0.001), and vegetables (P<0.001) was higher in subjects with >12 years of education. European-American men consumed more servings of dairy products (P<0.05) and sweetened beverages (P<0.05) than African-American men. European-American women consumed more servings of dairy products (P<0.05), vegetables (P<0.05), and fats (P<0.05) than African-American women. African Americans (men and women) consumed more servings of fruits/100% fruit juices (P<0.0001) than European Americans (men and women), respectively. Married individuals consumed more servings of snacks/desserts (P<0.05), but fewer servings of alcoholic beverages (P<0.0001) than those who were unmarried. Active individuals consumed more servings of fruits/100% fruit juices (P<0.05) and fewer servings of burgers/sandwiches (P<0.05) than inactive individuals.

CONCLUSIONS

These findings suggest that food group consumption varies by socioeconomic, demographic, and lifestyle factors in young adults from a semirural setting. Food and nutrition professionals who encounter diverse populations need to consider the influence of income, education, sex, ethnicity, marital status, and physical activity on food consumption patterns when planning diets, nutrition education programs, and interventions for young adults.

Who eats four or more servings of fruit and vegetables per day? Multivariate classification tree analysis of data from the 1998 Survey of Lifestyle, Attitudes and Nutrition in the Republic of Ireland

Objective

To identify, using the novel application of multivariate classification trees, the socio-economic, sociodemographic and health-related lifestyle behaviour profile of adults who comply with the recommended 4 or more servings per day of fruit and vegetables.

Design

Cross-sectional 1998 Survey of Lifestyle, Attitudes and Nutrition.

Setting

Community-dwelling adults aged 18 years and over on the Republic of Ireland electoral register.

Subjects

Six thousand five hundred and thirty-nine (response rate 62%) adults responded to a self-administered postal questionnaire, including a semi-quantitative food-frequency questionnaire.

Results

The most important determining factor of compliance with the fruit and vegetable dietary recommendations was gender. A complex constellation of sociodemographic and socio-economic factors emerged for males whereas the important predictors of 4 or more servings of fruit and vegetable consumption among females were strongly socio-economic in nature. A separate algorithm was run to investigate the importance of health-related lifestyle and other dietary factors on compliance with the fruit and vegetable recommendations. Following an initial split on compliance with dairy recommendations, a combination of non-dietary behaviours showed a consistent pattern of healthier options more likely to lead to compliance with fruit and vegetable recommendations. There did, however, appear to be a compensatory element between the variables, particularly around smoking, suggesting the non-existence of an exclusive lifestyle for health risk.

Conclusions

Material and structural influences matter very much for females in respect to compliance with fruit and vegetable recommendations. For males, while these factors are important they appear to be mediated through other more socially contextual-type factors. Recognition of the role that each of these factors plays in influencing dietary habits of men and women has implications for the manner in which dietary strategies and policies are developed and implemented.

Coaching Process Outcomes of a Family Visit Nutrition and Physical Activity Intervention

The purpose of this article is to report the process outcomes of a coaching methodology used in a study designed to increase fruit and vegetable consumption and physical activity in families. Eighty-eight families with second graders were recruited from a rural, biethnic community in Colorado and randomized to intervention and delayed intervention conditions. This article reports on the 27 families in the delayed intervention group. Families received up to 10 home visits over 10 months from a family advisor and completed activities to improve their dietary and physical activity behaviors. Coaching conversations took place during each home visit. Coaching process outcomes were evaluated by analysis of visit documentation, participant survey, and qualitative interviews. Results indicated that coaching, in conjunction with family activities, engaged families in the process of change and facilitated movement toward the achievement of their weekly nutrition or physical activity goals. Coaching methodology may be particularly useful for participatory research.

Changes in the stability of dietary patterns in a study of middle-aged Swedish women

Dietary patterns reflecting food habits may be associated with chronic diseases, yet little is known about the stability of these patterns. The objective of this study was to observe over time the stability of dietary patterns measured with exploratory and confirmatory factor analysis. Four random subsamples of 1000 women between 49 and 70 y old were chosen from >60,000 women included in the Swedish Mammography Cohort. Subjects in these subsamples were administered a FFQ 4, 5, 6, or 7 y after the baseline questionnaire; 3607 of the women responded (90% response rate). The stability of dietary patterns was evaluated with Spearman correlation coefficients between pattern scores at baseline and follow-ups and by a test of internal stability, which evaluated the significance of changes within patterns between baseline and follow-up. We found 3 major dietary patterns: a healthy pattern, a Western pattern, and an alcohol pattern. Correlations between explored dietary pattern scores at baseline and at follow-up decreased from 0.59 (P < 0.01) after 4 y to 0.50 (P < 0.01) after 7 y for the healthy pattern, from 0.47 (P < 0.01) to 0.39 (P < 0.01) for the Western pattern and from 0.54 (P < 0.01) to 0.46 (P < 0.01) for the alcohol pattern. After 4 and 5 y, there was no evidence for internal instability in any of the 3 patterns. The Western pattern became internally unstable after 6 and 7 y and the alcohol pattern was unstable after 7 y. Our findings for this specific population suggest that in longitudinal studies, dietary exposures should be updated after at least 7 y.

Relationship between premenopausal dietary intake and postmenopausal subclinical atherosclerosis

OBJECTIVES

This study examines the association of premenopausal dietary intake with postmenopausal subclinical atherosclerosis.

DESIGN

A prospective population-based cohort of 401 premenopausal women from the Healthy Women Study. Baseline premenopausal dietary intake was determined with the use of single 24-h recall. Coronary and aortic calcium scores were measured by electron beam computed tomography 8 years after menopause, and carotid plaque index was measured by carotid ultrasound scan 5 years after menopause.

RESULTS

Prevalence of coronary, aortic, and carotid subclinical atherosclerosis were 47.3%, 75.4%, and 52.1%, respectively. In unadjusted analysis, the relative risks (RR) of saturated fat intake for coronary calcification in second, third and highest quartile groups compared to the lowest were 1.82 (95% confidence interval, 1.00-3.30), 1.49 (0.82-2.70), and 1.99 (1.09-3.62), while those of carbohydrate intake were 0.48 (95% confidence interval, 0.26-0.88), 0.47 (0.26-0.86), and 0.35 (0.19-0.64), respectively. None of the dietary components were significantly associated with aortic calcification or carotid plaque.

CONCLUSION

The association between premenopausal dietary intake and postmenopausal subclinical atherosclerosis supports the recommended premenopausal dietary intervention for the prevention of cardiovascular disease.

Dairy, calcium, and vitamin D intakes and prostate cancer risk in the National Health and Nutrition Examination Epidemiologic Follow-up Study cohort

BACKGROUND

Dairy intake may increase prostate cancer risk, but whether this is due to calcium's suppression of circulating vitamin D remains unclear. Findings on calcium and vitamin D intake and prostate cancer are inconsistent.

OBJECTIVE

We examined the association of dairy, calcium, and vitamin D intake with prostate cancer.

DESIGN

In a prospective study of 3612 men followed from 1982-1984 to 1992 for the first National Health and Nutrition Examination Epidemiologic Follow-up Study, 131 prostate cancer cases were identified. Dietary intake was estimated from questionnaires completed in 1982-1984. Relative risk (RR) and 95% CIs were estimated by using Cox proportional hazards models adjusted for age, race, and other covariates.

RESULTS

Compared with men in the lowest tertile for dairy food intake, men in the highest tertile had a relative risk (RR) of 2.2 (95% CI: 1.2, 3.9; trend P = 0.05). Low-fat milk was associated with increased risk (RR = 1.5; 95% CI: 1.1, 2.2; third compared with first tertile; trend P = 0.02), but whole milk was not (RR = 0.8; 95% CI: 0.5, 1.3; third compared with first tertile; trend P = 0.35). Dietary calcium was also strongly associated with increased risk (RR = 2.2; 95% CI: 1.4, 3.5; third compared with first tertile; trend P = 0.001). After adjustment for calcium intake, neither vitamin D nor phosphorus was clearly associated with risk.

CONCLUSIONS

Dairy consumption may increase prostate cancer risk through a calcium-related pathway. Calcium and low-fat milk have been promoted to reduce risk of osteoporosis and colon cancer. Therefore, the mechanisms by which dairy and calcium might increase prostate cancer risk should be clarified and confirmed.

What Epidemiologic Studies Tell Us about the Relationship between Fruit and Vegetable Consumption and Body Weight

Clinical evidence shows that combining advice to increase fruit and vegetable consumption with caloric restriction is an effective strategy for weight management. The purpose of this review is to evaluate epidemiologic evidence to determine whether it supports an association between fruit and/or vegetable consumption and body weight. Few studies have been designed to specifically address this issue, and those that are available vary in methodology and offer inconsistent results. We make recommendations on how to strengthen future studies so that the influence of fruit and vegetable consumption on body weight in free-living individuals is better understood.

Dietary fat intake--food sources and dietary correlates in the Malmö Diet and Cancer cohort

OBJECTIVES

To identify food sources of fat, to compare food and nutrient intakes at different levels of relative fat intake, and to examine the contribution of different food groups to the variation in relative fat intake. Relative fat intake was expressed as energy contributed by fat in percentage of non-alcohol energy.

DESIGN

Cross-sectional analysis of baseline data from the Malmö Diet and Cancer

STUDY

An interview-based diet history method, a structured questionnaire and anthropometric measurements were used to obtain data. Analysis of variance compared food and nutrient intakes across quintiles of relative fat intake. Stepwise regression examined the contribution of food groups to the variation in relative fat intake.

SETTING

Baseline examinations were conducted between 1991 and 1996 in the city of Malmö, southern Sweden.

SUBJECTS

A sub-sample of 7055 women and 3240 men of the Malmö Diet and Cancer cohort.

RESULTS

The major fat sources were dairy products, margarines, meat & meat products, and cakes & buns. Most plant foods, especially fruit, vegetables and breakfast cereals, were negatively associated with fat intake. Low fat consumers had significantly higher intakes of dietary fibre, vitamin C, beta-carotene, folic acid, iron, zinc and calcium. Intakes of all types of fatty acids and fat-soluble vitamins were positively associated with fat consumption.

CONCLUSIONS

The results suggest that many food groups and nutrients may confound the associations between relative fat intake and disease. Plant foods, especially, are important to consider in studies of fat intake and disease risk.

Dietary Patterns and Prostate Cancer Risk in the National Health and Nutrition Examination Survey Epidemiological Follow-up Study Cohort

Ecological studies implicate a "Western" diet in prostate cancer development, but whether dietary patterns measured in individuals are associated with risk has not been studied previously. We examined this issue using prospective data from the nationally representative United States Health Examination Epidemiological Follow-up Study. Among 3,779 men followed from 1982-84 to 1992, 136 incident cases were identified. Using principal component analysis on responses to a 105-item dietary questionnaire, the following three distinct patterns were identified: a vegetable-fruit pattern; a red meat-starch pattern characterized by red meats, potatoes, cheese, salty snacks, and desserts; and a Southern pattern characterized by such foods as cornbread, grits, sweet potatoes, okra, beans, and rice. In adjusted proportional hazards models, prostate cancer risk was not associated with the vegetable-fruit or red meat-starch pattern, but higher intake of the Southern pattern showed a reduction in risk (3rd versus 1st tertile relative risk, 0.6; 95% confidence interval, 0.4-1.1; trend P = 0.08) that approached statistical significance. The inverse association was observed in black and non-black men and was not attributable to intake of any individual foods or nutrients. A Southern dietary pattern may reflect a history of living in the South and serve as an integrative marker of sunlight exposure and protection through 1,25-dihydroxyvitamin D production. Further evaluation and better characterization of the pattern would offer more information on potentially beneficial features of the diet or its associated lifestyle.

The role of the carotenoids, lutein and zeaxanthin, in protecting against age-related macular degeneration: a review based on controversial evidence

PURPOSE

A review of the role of the carotenoids, lutein and zeaxanthin, and their function in altering the pathogenesis of age-related macular degeneration (AMD).

METHODS

Medline and Embase search.

RESULTS

Recent evidence introduces the possibility that lutein and zeaxanthin, carotenoids found in a variety of fruits and vegetables may protect against the common eye disease of macular degeneration. This potential and the lack to slow the progression of macular degeneration, has fueled high public interest in the health benefits of these carotenoids and prompted their inclusion in various supplements. The body of evidence supporting a role in this disease ranges from basic studies in experimental animals to various other clinical and epidemiological studies. Whilst some epidemiological studies suggest a beneficial role for carotenoids in the prevention of AMD, others are found to be unrelated to it. Results of some clinical studies indicate that the risk for AMD is reduced when levels of the carotenoids are elevated in the serum or diet, but this correlation is not observed in other studies. Published data concerning the toxicity of the carotenoids or the optimum dosage of these supplements is lacking.

CONCLUSION

An intake of dietary supplied nutrients rich in the carotenoids, lutein and zeaxanthin, appears to be beneficial in protecting retinal tissues, but this is not proven. Until scientifically sound knowledge is available we recommend for patients judged to be at risk for AMD to: alter their diet to more dark green leafy vegetables, wear UV protective lenses and a hat when outdoors. Future investigations on the role of nutrition, light exposure, genetics, and combinations of photodynamic therapy with intravitreal steroid (triamcinolone-acetonide) injections hold potential for future treatment possibilities.

Complex correlation structure in consumption rates of major food groups: implications for the assessment of radiation exposure

OBJECTIVE

An extensive dataset on individual food consumption was analysed in order to study all pairwise correlations between the consumption rates of 11 major food groups. Additionally, the project aimed to examine and quantify the accuracy of a recently proposed estimator of total food consumption to be used for the estimation of radiation exposure by food. Such an inquiry seems justified, because the proposed estimator implicitly presumes an essentially positive correlation structure in food consumption rates.

DESIGN

Statistical analysis using representative data gathered in Germany in a nation-wide food consumption survey.

SETTING

Germany.

SUBJECTS

Individuals aged between 4 and 94 years namely 10,901 males and 12,308 females.

RESULTS

The consumption rates of 11 major food categories showed several significantly positive, but also a number of significantly negative, correlations. Negative associations between cereal and potato products persisted consistently over all age groups, independent of sex. Other significantly negative correlations were limited to certain age groups. Reflecting these negative correlations, a subsequent analysis of relative ranks of consumption revealed that no person in the sample had the highest consumption rates in all food groups simultaneously. Based on representative samples, overestimations of 34 to 53% were obtained if--as recently suggested in the context of radiation exposure prediction--the 95th percentiles of total food consumption were determined as sums of the corresponding percentiles of the food groups.

CONCLUSIONS

The complex correlation structure of food group consumption rates, as identified in this study, bears important implications for various health-related issues. Ignoring them could lead to overly conservative estimations of radiation exposure due to food ingestion or to confounding effects in epidemiological studies on nutritional risk factors of diseases. The results also indicate that a distinction into different dietary patterns might be useful in characterising different consumption habits.

Diversity of dietary patterns observed in the European Prospective Investigation into Cancer and Nutrition (EPIC) project

OBJECTIVE

To describe the diversity in dietary patterns existing across centres/regions participating in the European Prospective Investigation into Cancer and Nutrition (EPIC).

DESIGN AND SETTING

Single 24-hour dietary recall measurements were obtained by means of standardised face-to-face interviews using the EPIC-SOFT software. These have been used to present a graphic multi-dimensional comparison of the adjusted mean consumption of 22 food groups.

SUBJECTS

In total, 35 955 men and women, aged 35-74 years, participating in the EPIC nested calibration study.

RESULTS

Although wide differences were observed across centres, the countries participating in EPIC are characterised by specific dietary patterns. Overall, Italy and Greece have a dietary pattern characterised by plant foods (except potatoes) and a lower consumption of animal and processed foods, compared with the other EPIC countries. France and particularly Spain have more heterogeneous dietary patterns, with a relatively high consumption of both plant foods and animal products. Apart from characteristics specific to vegetarian groups, the UK 'health-conscious' group shares with the UK general population a relatively high consumption of tea, sauces, cakes, soft drinks (women), margarine and butter. In contrast, the diet in the Nordic countries, The Netherlands, Germany and the UK general population is relatively high in potatoes and animal, processed and sweetened/refined foods, with proportions varying across countries/centres. In these countries, consumption of vegetables and fruit is similar to, or below, the overall EPIC means, and is low for legumes and vegetable oils. Overall, dietary patterns were similar for men and women, although there were large gender differences for certain food groups.

CONCLUSIONS

There are considerable differences in food group consumption and dietary patterns among the EPIC study populations. This large heterogeneity should be an advantage when investigating the relationship between diet and cancer and formulating new aetiological hypotheses related to dietary patterns and disease.

The internal validity of a dietary pattern analysis. The Framingham Nutrition Studies

STUDY OBJECTIVES

To examine the internal validity of a dietary pattern analysis and its ability to discriminate clusters of people with similar dietary patterns using independently assessed nutrient intakes and heart disease risk factors.

DESIGN AND PARTICIPANTS

Population based study characterising dietary patterns using cluster analysis applied to data from the semiquantitative Framingham food frequency questionnaire collected from 1942 women ages 18-76 years, between 1984-88.

SETTING

Framingham, Massachusetts.

MAIN RESULTS

Of 1942 women included in the cluster analysis, 1828 (94%) were assigned to one of the five dietary pattern clusters: Heart Healthy, Light Eating, Wine and Moderate Eating, High Fat, and Empty Calorie. Dietary patterns differed substantially in terms of individual nutrient intakes, overall dietary risk, heart disease risk factors, and predicted heart disease risk. Women in the Heart Healthy cluster had the most nutrient dense eating pattern, the lowest level of dietary risk, more favourable risk factor levels, and the lowest probability of developing heart disease. Those in the Empty Calorie cluster had a less nutritious dietary pattern, the greatest level of dietary risk, a heavier burden of heart disease risk factors, and a relatively higher probability of developing heart disease. Cluster reproducibility using discriminant analysis showed that 80% of the sample was correctly classified. The cluster technique was highly sensitive and specific (75% to 100%).

CONCLUSIONS

These findings support the internal validity of a dietary pattern analysis for characterising dietary exposures in epidemiological research. The authors encourage other researchers to explore this technique when investigating relations between nutrition, health, and disease.

Dietary pattern analysis: a new direction in nutritional epidemiology

Recently, dietary pattern analysis has emerged as an alternative and complementary approach to examining the relationship between diet and the risk of chronic diseases. Instead of looking at individual nutrients or foods, pattern analysis examines the effects of overall diet. Conceptually, dietary patterns represent a broader picture of food and nutrient consumption, and may thus be more predictive of disease risk than individual foods or nutrients. Several studies have suggested that dietary patterns derived from factor or cluster analysis predict disease risk or mortality. In addition, there is growing interest in using dietary quality indices to evaluate whether adherence to a certain dietary pattern (e.g. Mediterranean pattern) or current dietary guidelines lowers the risk of disease. In this review, we describe the rationale for studying dietary patterns, and discuss quantitative methods for analysing dietary patterns and their reproducibility and validity, and the available evidence regarding the relationship between major dietary patterns and the risk of cardiovascular disease.

Education, lifestyle factors and mortality from cardiovascular disease and cancer. A 25-year follow-up of Swedish 50-year-old men

BACKGROUND

There is a well-established inverse relation between education and mortality from cardiovascular disease and cancer. The reasons for this are still in part unclear. We aimed to investigate whether differences in traditional vascular risk factors, adult height, physical activity, and biomarkers of fatty acid and antioxidant intake, could explain this association.

METHODS

In all, 2301 50-year-old men in Uppsala, Sweden (82% of the background population) were examined with regard to educational level, blood pressure, blood glucose, body mass index, serum lipids, smoking, body height, physical activity, serum beta carotene, alpha tocopherol, selenium, and serum fatty acids in cholesterol esters. Cause-specific mortality was registered 25 years later.

RESULTS

Low education was associated with a higher rate of mortality from cardiovascular disease (crude relative risk [RR] = 1.67, 95% CI : 1.17-2.39), and from cancer (crude RR = 1.94, 95% CI : 1.21-3.10), compared to high educational attainment. Men with high education had an overall more beneficial risk factor profile concerning traditional cardiovascular risk factors, physical activity, and biomarkers of dietary intake of antioxidants and fat. After adjustment for all examined risk factors, the inverse gradient between education and cardiovascular mortality disappeared (RR in low education = 1.01. 95% CI : 0.67-1.52). Controlling for smoking, physical activity and dietary biomarkers explained less than half of the excess cancer mortality in the lower educational groups. Smoking (adjusted RR = 1.89, 95% CI : 1.37-2.61), and high proportions of palmitoleic acid in serum cholesterol esters (adjusted RR per 1 SD = 1.39, 95% CI : 1.07-1.82) predicted cancer mortality, independently of all other factors. There were no independent relations between serum antioxidants and mortality.

CONCLUSIONS

These data indicate that modifiable lifestyle factors mediate the inverse gradient between education and death from cerebro- and cardiovascular disease. Smoking, physical activity and dietary factors explained half of the excess cancer mortality in lower educated groups. Further studies are needed to explore the proposed association between palmitoleic acid, a marker of high intake of animal and dairy fat, and cancer.

Analysis of patterns of food intake in nutritional epidemiology: food classification in principal components analysis and the subsequent impact on estimates for endometrial cancer

OBJECTIVE

To assess the effect of different methods of classifying food use on principal components analysis (PCA)-derived dietary patterns, and the subsequent impact on estimation of cancer risk associated with the different patterns.

METHODS

Dietary data were obtained from 232 endometrial cancer cases and 639 controls (Western New York Diet Study) using a 190-item semi-quantitative food-frequency questionnaire. Dietary patterns were generated using PCA and three methods of classifying food use: 168 single foods and beverages; 56 detailed food groups, foods and beverages; and 36 less-detailed groups and single food items.

RESULTS

Classification method affected neither the number nor character of the patterns identified. However, total variance explained in food use increased as the detail included in the PCA decreased (approximately 8%, 168 items to approximately 17%, 36 items). Conversely, reduced detail in PCA tended to attenuate the odds ratio (OR) associated with the healthy patterns (OR 0.55, 95% confidence interval (CI) 0.35-0.84 and OR 0.77, 95% CI 0.49-1.20, 168 and 36 items, respectively) but not the high-fat patterns (OR 0.95, 95% CI 0.57-1.58 and OR 0.85, 0.51-1.40, 168 and 36 items, respectively).

CONCLUSIONS

Greater detail in food-use information may be desirable in determination of dietary patterns for more precise estimates of disease risk.

Is principal components analysis necessary to characterise dietary behaviour in studies of diet and disease?

OBJECTIVE

To assess the relative ability of principal components analysis (PCA)-derived dietary patterns to correctly identify cases and controls compared with other methods of characterising food intake.

SUBJECTS

Participants in this study were 232 endometrial cancer cases and 639 controls from the Western New York Diet Study, 1986-1991, frequency-matched to cases on age and county of residence.

DESIGN

Usual intake in the year preceding interview of 190 foods and beverages was collected during a personal interview using a detailed food-frequency questionnaire. Principal components analysis identified two major dietary patterns which we labelled 'healthy' and 'high fat'. Classification on disease status was assessed with separate discriminant analyses (DAs) for four different characterisation schemes: stepwise DA of 168 food items to identify the subset of foods that best discriminated between cases and controls; foods associated with each PCA-derived dietary pattern; fruits and vegetables (47 items); and stepwise DA of USDA-defined food groups (fresh fruit, canned/frozen fruit, raw vegetables, cooked vegetables, red meat, poultry, fish and seafood, processed meats, snacks and sweets, grain products, dairy, and fats).

RESULTS

In general, classification of disease status was somewhat better among cases (54.7% to 67.7%) than controls (54.0% to 63.1%). Correct classification was highest for fruits and vegetables (67.7% and 62.9%, respectively) but comparable to that of the other schemes (49.5% to 66.8%).

CONCLUSIONS

Our results suggest that the use of principal components analysis to characterise dietary behaviour may not provide substantial advantages over more commonly used, less sophisticated methods of characterising diet.

Family and child-care provider influences on preschool children's fruit, juice, and vegetable consumption

Children's intakes of fruit, juice, and vegetables (FJV) do not meet the recommended minimum of five daily servings, placing them at increased risk for development of cancer and other diseases. Because children's food preferences and practices are initiated early in life (e.g., 2-5 years of age), early dietary intervention programs may have immediate nutritional benefit, as well as reduce chronic disease risk when learned healthful habits and preferences are carried into adulthood. Families and child-care settings are important social environments within which food-related behaviors among young children are developed. FJV preferences, the primary predictor of FJV consumption in children, are influenced by availability, variety, and repeated exposure. Caregivers (parents and child-care providers) can influence children's eating practices by controlling availability and accessibility of foods, meal structure, food modeling, food socialization practices, and food-related parenting style. Much remains to be learned about how these influences and practices affect the development of FJV preferences and consumption early in life.

Whole almonds and almond fractions reduce aberrant crypt foci in a rat model of colon carcinogenesis

Almonds and other nuts appear to confer health benefits despite their high fat content. To assess the effect of almonds on colon cancer, whole almond-, almond meal- or almond oil-containing diet effects on aberrant crypt foci (ACF) in azoxymethane-treated F344 male rats were investigated. Six-week-old male F344 rats were fed the various almond and control diets and given subcutaneous injections of azoxymethane (15 mg/kg body weight) twice 1 week apart. After 26 weeks animals were injected with bromodeoxyuridine 1 h prior to sacrifice, after which colons were evaluated for ACF and cell turnover (labeling index, LI). Whole almond ACF and LI were both significantly lower than wheat bran and cellulose diet groups (-30 and -40%, respectively), while almond meal and almond oil ACF and almond meal LI declines were only significant vs. cellulose (P<0.05). These results suggest that almond consumption may reduce colon cancer risk and does so via at least one almond lipid-associated component.

Eating frequency and risk of colorectal cancer

Case-control studies have found elevated risk of colorectal cancer with higher eating frequency. The present analyses, the first to examine this association using prospectively collected information, utilized nationally representative data from the Epidemiologic Follow-Up Study of the First National Health and Nutrition Examination Survey (NHEFS). The study population included 9,978 subjects followed from 1982-84 to 1992. Colorectal cancer cases (n = 141) were identified by self-report, hospital records, and death certificates. Interviews conducted in 1982-84 provided information on meal and snack frequencies and covariates of interest. Relative risk (RR) of colorectal cancer and 95% confidence intervals (CI) were estimated using Cox proportional hazards models adjusted for age, gender, and race and energy, alcohol, total fat, and fiber intake. Compared with those eating < 3 times/day, those eating 3-4 times/day had an RR of 0.66 (95% CI = 0.42-1.03) and those eating > 4 times/day had an RR of 0.74 (95% CI = 0.41-1.32). The association was due to decreased risk with more meals rather than more snacks per day. Given limitations of previous studies as well as the possibility of a protective effect of higher eating frequency through improved glycemic control, the present findings suggest that the influence of eating frequency on colorectal cancer risk is more complex than has been previously supposed and merits additional study.

Nutritional contribution of eggs to American diets

OBJECTIVES

The main purposes of this study were (1) to assess the nutritional significance of eggs in the American diet and (2) to estimate the degree of association between egg consumption and serum cholesterol concentration.

METHODS

Data from the most recent National Health and Nutritional Examination Survey (NHANES III, 1988-94) were utilized to compare the nutritional quality indicators of diets that contained eggs (USDA food grouping system) with those that did not. Nutrient intake (from 24-hour dietary recall), egg intake (from food frequency questionnaire), sociodemographic data and blood cholesterol levels of subjects who met inclusion criteria (n = 27,378) were grouped according to the occurrence and frequency of egg consumption and were analyzed using SUDAAN.

RESULTS

Daily nutrient intake of egg consumers (EC) was significantly greater than that of nonconsumers (NC) for all nutrients studied (except dietary fiber and vitamin B6). Eggs contributed < 10% of daily intake of energy and vitamin B6, 10% to 20% of folate and total, saturated and polyunsaturated fat, and 20% to 30% of vitamins A, E and B12 in EC. Compared to EC, NC had higher rates of inadequate intake (defined by Estimated Average Requirements (EAR) or < 70% Recommended Dietary Allowance (RDA)) for vitamin B12 (10% vs. 21%), vitamin A (16% vs. 21%), vitamin E (14% vs. 22%) and vitamin C (15% vs. 20%). After adjusting for demographic (age, gender and ethnicity) and lifestyle variables (smoking and physical activity), dietary cholesterol was not related to serum cholesterol concentration. People who reported eating > or = 4 eggs/wk had a significantly lower mean serum cholesterol concentration than those who reported eating < or = 1 egg/wk (193 mg/dL vs. 197 mg/dL, p < 0.01). More frequent egg consumption was negatively associated with serum cholesterol concentration (beta = -6.45, p < 0.01).

CONCLUSIONS

In this cross-sectional and population-based study, egg consumption made important nutritional contributions to the American diet and was not associated with high serum cholesterol concentrations.

Vegetable and fruit consumption associated with anthropometric, dietary and lifestyle factors in Spain. EPIC Group of Spain. European Prospective Investigation into Cancer

OBJECTIVE

To evaluate the association of vegetable and fruit intake with several demographic, anthropometric, lifestyle and dietary factors.

DESIGN AND SETTING

Cross-sectional analysis. Information on habitual diet was collected by means of the diet history method. Association of vegetable and fruit intakes with other factors was assessed separately by means of multiple lineal regression and the cumulative odds model.

SUBJECTS

39622 healthy subjects aged 29-69 years from the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort in Spain.

RESULTS

Fruit intake increased with age, education and physical activity and decreased with intake of saturated fatty acids and cholesterol; smoking and alcohol consumption were also negatively associated with fruit, with a very low consumption for current smokers and heavy drinkers. Vegetable intake increased with education and physical activity and with intake of unsaturated fatty acids, mainly monounsaturated. Former smokers consumed more vegetables than never or current smokers and non-consumers of alcohol ate less vegetables than consumers, among whom no differences were observed. All these estimates were adjusted by energy and body mass index (BMI).

CONCLUSIONS

When assessing the association of fruit and vegetables with chronic diseases it is important to take into account confounding factors. Furthermore, it would be useful to study dietary patterns including several interrelated factors.

Smoking, diet, and health behaviors among lead-exposed blue-collar workers

The objectives of the study were to compare dietary intake by smoking levels in blue-collar Israeli workers occupationally exposed to lead and thus identify additional areas for health-enhancing intervention in addition to smoking cessation. One hundred and eighty-seven male industrial employees who were exposed to lead through their work were screened at the worksite to evaluate health status and dietary intake. Smokers had higher intakes of fat, cholesterol, calcium, riboflavin, and vitamin E per day. They were consuming more meat and high-fat dairy products. Dose-response relationships were shown for fat and energy intake by smoking level. Thus, smoking is associated with other adverse health behaviors. When conducting epidemiologic or occupational studies, analyses should include adjustment for the fact that the lifestyles of smokers may also be unhealthy in other ways.

Reproducibility and validity of dietary patterns assessed with a food-frequency questionnaire

BACKGROUND

Recently, the analysis of dietary patterns has emerged as a possible approach to examining diet-disease relations.

OBJECTIVE

We examined the reproducibility and validity of dietary patterns defined by factor analysis using dietary data collected with a food-frequency questionnaire (FFQ).

DESIGN

We enrolled a subsample of men (n = 127) from the Health Professionals Follow-up Study in a diet-validation study in 1986. A 131-item FFQ was administered twice, 1 y apart, and two 1-wk diet records and blood samples were collected during this 1-y interval.

RESULTS

Using factor analysis, we identified 2 major eating patterns, which were qualitatively similar across the 2 FFQs and the diet records. The first factor, the prudent dietary pattern, was characterized by a high intake of vegetables, fruit, legumes, whole grains, and fish and other seafood, whereas the second factor, the Western pattern, was characterized by a high intake of processed meat, red meat, butter, high-fat dairy products, eggs, and refined grains. The reliability correlations for the factor scores between the 2 FFQs were 0.70 for the prudent pattern and 0.67 for the Western pattern. The correlations (corrected for week-to-week variation in diet records) between the 2 FFQs and diet records ranged from 0.45 to 0.74 for the 2 patterns. In addition, the correlations between the factor scores and nutrient intakes and plasma concentrations of biomarkers were in the expected direction.

CONCLUSIONS

These data indicate reasonable reproducibility and validity of the major dietary patterns defined by factor analysis with data from an FFQ.

Nutrient intake and food group consumption of 10-year-olds by sugar intake level: the Bogalusa Heart Study

OBJECTIVE

The effect of total sugar intake on nutrient intake and food group consumption was examined in children.

METHODS

Twenty-four hour dietary recalls were collected on a sample of 568 ten-year-olds from two cross-sectional surveys. The population was stratified according to total sugar intake quartiles: < or = 25th (46 g/1000 kcal), 25-50th (67 g/1000 kcal), 50-75th (81 g/1000 kcal) and > or = 75th (106 g/1000 kcal).

RESULTS

No significant difference was shown in energy intakes across the quartiles and no significant race or gender differences were observed in mean total sugar intakes. However, with increasing total sugar intake, there was a significant linear decrease in mean intakes of protein, fat, saturated fat, starch, cholesterol, sodium, vitamins B6 and E, thiamin, niacin, iron, and zinc; and a significant linear increase in mean intakes of carbohydrate, fructose, lactose, sucrose, vitamin D, and calcium. Eating patterns reflected the differing nutrient intakes, with high sugar consumers having significantly higher intakes of total g of candy, beverages and milk and lower intakes of total g of meats, and cheese than lower sugar consumers. The nutritional quality of children's diets high in total sugar appear to be adequate regarding vitamin and mineral intakes and are closer to meeting current dietary fat recommendations.

A rational approach to treating hypercholesterolaemia in children. Weighing the risks and benefits

Because atherosclerosis is a continuous process throughout life, expert panels have suggested guidelines to reduce the risk of cardiovascular disease, starting from childhood. The guidelines focus on population-based measures and on treating hypercholesterolaemia in individual children. Low-fat diets in children have been widely debated. There is little evidence that growth is stunted or that nutritional deficiencies arise if the energy that is lost by limiting fat intake is substituted with other nutrients. Dietary fibre, plant sterols and fish oils have been used to modify lipid levels in children; however, the efficacy of these dietary adjuncts is limited. Bile acid-binding resins are the only approved drugs to lower cholesterol levels in children and appear to be well tolerated. However, compliance with resins is low because of unpalatability, so low dosages are preferred and vitamin supplementation is prudent. Data on HMG CoA reductase inhibitors and fibrates are insufficient to recommend these drugs at present. Drug treatment should be restricted to children who are at exceptionally high risk of disease, usually those with genetic dyslipidaemias.

Relation between dietary fat and energy and micronutrient intakes

Concern has been raised about the energy and nutrient adequacy of low fat diets for children that aim to prevent cardiovascular disease in Western populations. The diets of 174 randomly chosen schoolchildren aged 8-12 years from middle and high socioeconomic groups were analysed to determine their nutrient composition in relation to fat intake. The mean percentages of energy intake from fat and saturated fat were 31 and 13%, respectively, and 44% of all children reported consuming < 30% of their energy from fat. The energy intake did not change across the spectrum of fat intake. A decreased fat intake was associated with an increased sugar intake, but also with increased nutrient densities of thiamin, niacin, folate, vitamin C, magnesium, and iron, reflecting an increased intake of fruit, vegetables, and grains. Parental educational level was the most important determinant of fat intake (inverse relation). It is concluded that a self selected low fat intake among children from average to high socioeconomic backgrounds does not compromise their intake of major nutrients or energy.

Using cluster analysis to examine dietary patterns: nutrient intakes, gender, and weight status differ across food pattern clusters

OBJECTIVE

This study explored the usefulness of cluster analysis in identifying food choice patterns of three groups of adults in relation to their energy intake.

DESIGN

Food frequency data were converted to percentage of total energy from 38 food groups and entered into a cluster analysis procedure. Subjects in the emerging food group patterns were compared in terms of weight status, demographics, and the nutrition composition of their usual diet.

SETTING

Data were collected as part of three studies in two US metropolitan areas using identical protocols. Participants were university employees (103 women and 99 men) who volunteered for a reliability study of health behavior questionnaires and moderately obese volunteers (223 women and 101 men) to two weight-loss studies who were recruited by newspaper advertisements.

STATISTICAL ANALYSIS PERFORMED

Subjects were clustered according to food energy sources using the FASTCLUS procedure in the Statistical Analysis System. One-way analysis of variance and chi 2 analysis were then performed to compared the weight status, nutrient intakes, and demographics of the food patterns.

RESULTS

Six food pattern clusters were identified. Subjects in the two clusters associated with high consumption of pastry and meat had significantly higher fat intakes (P = .0001). Subjects in two other clusters, those associated with high intake of skim milk and a broad distribution of energy sources had significantly higher micronutrient levels (P = .0001). Body mass index and the distribution of gender were also significantly different across clusters.

CONCLUSIONS

The success of cluster analysis in identifying dietary exposure categories with unique demographic and nutritional correlates suggests that the approach may be useful in epidemiologic studies that examine conditions such as obesity, and in the design of nutrition interventions.

Diet, obesity and risk for renal cell carcinoma: results from a case control-study in Germany

Increasing incidence of renal cell carcinoma in Western countries raises particular attention to its etiology. Diet may be related to risk for renal cell carcinoma since obesity has been linked with this malignant condition. A case-control study with 277 incident renal cell cancer patients (ICD 189.0) and 286 population controls was conducted in the Rhein-Neckar-Odenwald area, Germany, in the period of 1989 to 1991. The core study protocol included a face-to-face interview about demographical parameters, previous diseases, medication, tobacco smoking, occupational history, occupational exposures, beverage consumption, and obesity. In addition, study participants were asked to fill in a self-administered food frequency questionnaire with 122 food items to estimate overall food intake. Fifty-six % of the cases and 74% of the controls participated in this part of the study (n = 155 cases and 212 controls). This was 47% of the original cases (n = 328) and 56% of the controls (n = 381). No selection bias could be identified with regard to age group, gender, educational status or recent BMI in the analyzed group compared with the eligible cases and controls. Relative risk (RR) estimates for tertiles of consumption revealed a significantly increased risk with increasing intake of fat spread (RR of high intake compared to low intake: 1.90 (95% CI 1.08-3.32)). Increased risk was also found for intake of meat and meat products (RR of high intake compared to low intake: 1.71 (95% CI 0.96-3.04)) and energy adjusted fat (RR of high intake compared to low intake: 1.64 (95% CI 0.95-2.83)). A decreased risk was seen with increasing intake of fruit (RR of high intake compared to low intake: 0.40 (95% CI 0.23-0.69)) and of vitamin C (RR of high intake compared to low intake: 0.62 (95% CI 0.37-1.05)). Beverage consumption, preparation of food and eating pattern were not linked with risk of renal cell cancer. The relative risk estimates of spreading fat (sauce and vitamin C intake were tested in two models, with and without including BMI as covariate. In both models significant associations of these nutritional variables with risk for renal cell cancer remained. The current results indicate that specific food pattern associated with obesity explain differences in incidence of renal cell carcinoma in industrialized countries.