US dietary patterns associated with fat intake: the 1987 National Health Interview Survey

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.

Influence of lifestyle patterns on perceptions of obesity and overweight among expatriates in Abha city of Kingdom of Saudi Arabia

BACKGROUND

We evaluated the influence of lifestyle patterns such as watching TV, working with computer and idle sitting time on perceptions of obesity and beliefs about overweight are associated with obesity and overweight amongst Expatriates in Abha.

MATERIALS AND METHODS

The method used in this study was a cross-sectional survey with a self-administered paper-based questionnaire. The survey collected information on lifestyle choices and the risk factors that contribute to obesity. In addition, height and weight were measured.

RESULTS

Greater number of our study subjects spent over 2 h/day without any physical activity, specifically accounting for over 2 h/day each in viewing TV, computer, and spending idle time. This increased lack of physical activities was significantly associated with overweight. While the overweight subjects were aware of very wide options for treating their condition, a significant number believed in self-effort in managing their diet and exercise regimen as the best efforts to reduce their overweight. Interestingly very few overweight subjects considered medication or surgery as a potential therapeutic option and 75% of the overweight subjects considered overweight to be of no or only slight concern on wellbeing.

CONCLUSIONS

Overweight and obesity among expatriates within Saudi Arabia poses an important public health problem. The lack of awareness about the potential impact of obesity on health and optimal treatment options is a serious concern, which needs to be addressed by appropriate public health programs at national level.

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.

Bacterial vaginosis is associated with variation in dietary indices

Bacterial vaginosis (BV) is a common condition of unknown etiology and has been linked to adverse reproductive and obstetric health outcomes. Prior dietary research on BV has focused on specific macro- and micronutrients, but not dietary indices. We assessed the relationship between BV and selected dietary indicators among a cohort of 1735 nonpregnant women ages 15-44 y from Birmingham, Alabama. Annual intake was assessed with the Block98 FFQ, and the glycemic index, glycemic load (GL), and Healthy Eating Index were calculated by the Block Dietary Data System. The Naturally Nutrient Rich (NNR) score was also calculated. Vaginal flora was evaluated using Nugent Gram-stain criteria. Crude OR and adjusted OR were determined by multinomial and logistic regression in cross-sectional and prospective analyses, respectively. Participants were predominantly African American (85.5%) aged 25.3 ± 6.8 y (mean ± SD). Per 10-unit increase, GL was positively (adjusted OR = 1.01, 95% CI = 1.00-1.03) and NNR was negatively (adjusted OR = 0.93, 95% CI = 0.88-0.99) associated with BV compared to normal vaginal flora. In prospective analyses, only GL was associated with BV progression (adjusted OR = 1.03, 95% CI = 1.00-1.05) and persistence (adjusted OR = 1.02, 95% CI = 1.01-1.04) after adjustment. Both GL and NNR were associated with greater BV prevalence and GL was associated with an increase in BV persistence and acquisition. These results suggest that diet composition may contribute to vaginal flora imbalances and be important for elucidating the etiology of BV.

Design of Video Games for Children's Diet and Physical Activity Behavior Change

Serious video games (VG) offer new opportunities for promoting health related diet and physical activity change among children. Games can be designed to use storylines, characters, and behavior change procedures, including modeling (e.g., engaging characters make changes themselves, and face and overcome challenges related to fruit and vegetable (FV) and physical activity (PA) goal attainment and/or consumption), skill development (e.g., asking behaviors; virtual recipe preparation), self regulatory behaviors (problem solving, goal setting, goal review, decision making), rewards (e.g., points and positive statements generated by the program), immediate feedback (e.g., through characters and/or statements that appear on the computer screen at critical decision points), and personalization (e.g., tailored choices offered at critical junctures, based on responses to baselines questions related to preferences, outcome expectancies, etc). We are in the earliest stages of learning how to optimally design effective behavior change procedures for use in VG, and yet they have been demonstrated to change behavior. As we learn, VG offer more and better opportunities for obesity prevention that can adjust to individual needs and preferences.

Fluid calories and energy balance: The good, the bad, and the uncertain

Energy-yielding fluids are a large and growing proportion of daily energy intake. The specific form and nutrient composition of fluids may hold divergent implications for energy balance. Ethanol elicits a weak compensatory dietary response, resulting in positive energy balance. However, its impact on body weight is unclear, possibly due to metabolic inefficiencies. In contrast, the weak dietary compensation for clear beverages containing other energy sources is associated with weight gain. How these beverages elude satiety mechanisms has not been studied. Soups hold higher satiating value, at least in part, due to cognitive factors. Nutrient dense beverages have been used successfully in meal replacement regimens for weight management, but due to their relatively weak satiety value, are widely consumed for weight gain and as nutrient supplements. A better understanding of the role of fluid calories in the diet is needed to improve dietary guidelines.

Calcium intake trends and health consequences from childhood through adulthood

Issues involving low calcium intake and dairy product consumption are currently the focus of much debate and discussion at both the scientific and lay community levels. In this review, we examine the following major areas of interest: (1). the role of calcium intake and dairy product consumption in chronic diseases, (2). nutritional qualities of milk and other dairy products, (3). trends in calcium intake and dairy product consumption, (4). current status of calcium intakes and dairy product consumption in children, (5). tracking of calcium intake and diary product consumption, (6). the impact of school meal participation on calcium intake and dairy product consumption, (7). concerns related to calcium-fortified foods and beverages and (8). factors influencing children's milk consumption. To date, the findings indicate that calcium intake and dairy product consumption have beneficial roles in a variety of chronic diseases; dairy products provide an abundant source of vitamins and minerals; calcium intakes of children have increased over time, yet intakes are not meeting the current adequate intake (AI) calcium recommendations; dairy consumption has decreased, and soft drink consumption and, possibly, consumption of calcium-fortified products have increased; consumption of dairy products have a positive nutritional impact on diets of children, particularly from school meals, and there are many factors which influence children's milk consumption, all of which need to be considered in our efforts to promote adequate calcium intakes by children. Based on this review, areas that need immediate attention and future research imperatives are summarized in an effort to further our understanding on what we already know and what we need to know to promote healthier eating habits early in life.

Type 2 diabetes and diabetes riskfactors in children and adolescents

Long considered a disease of older adults, type 2 diabetes mellitus (DM) is now affecting children. While the prevalence and incidence of type 2 DM are not yet established in children, the number of affected individuals continues to climb. At the same time, obesity, the primary risk factor for type 2 DM, has become epidemic, affecting all ethnic and demographic groups across the United States. The lifestyle trends contributing to both of these phenomena include changes in dietary patterns and habits, declining levels of physical activity, and increasing sedentary behaviors. In response to these problems, the medical profession must become proactive with its patients and in the community.

Food Away from Home, Sugar-Sweetened Drink Consumption and Juvenile Obesity

OBJECTIVE

To identify if particular foods or food groups may be associated with obesity in children and adolescents and to determine if consuming food away from home (FAFH) has an effect on the nutritional quality of their diets.

DESIGN

One-year cross-sectional study.

SETTING/SUBJECTS

The obese subjects (n = 91) were on the waiting list for a hospital-based weight control treatment program. The non-obese subjects (n = 90) were recruited from community advertisements.

MEASURES OF OUTCOME

Information on food intake was obtained using the dietary history method by a Registered Dietitian. Body fat was determined by bioelectrical impedance analysis.

RESULTS

Obese children and adolescents consumed significantly more servings of meat and alternatives, grain products, FAFH, sugar-sweetened drinks and potato chips which contributed to a higher calorie, fat and sugar intake compared to non-obese children and adolescents. Sugar-sweetened drinks were only significantly greater in boys. The consumption of meat servings, sugar-sweetened drinks and FAFH was positively correlated with percent body fat. The frequency of food consumed outside of the Canada's Food Guide To Healthy Eating was not different between the two groups.

CONCLUSIONS

Obese children and adolescents need to limit their access to food consumed away from home and sugar-sweetened drinks as there is a relationship between these foods and body fatness.

Methods to increase fruit and vegetable intake with and without a decrease in fat intake: compliance and effects on body weight in the nutrition and breast health study

Dietary patterns that involve a decrease in fat and an increase in fruit and vegetable (FV) intake have been suggested to decrease cancer risks. In this study, intervention methods to selectively modify dietary fat and/or FV intakes were developed. Compliance to the diets and the effects on body weight are shown, because both of these dietary changes can impact on and be confounded by changes in energy intake. A total of 122 women with a family history of breast cancer were randomized onto one of four diets for 12 mo. Counseling methods were devised to increase amount and variety of FV consumed with or without a decrease in fat intake using modified exchange list diets. Women on the low-fat and combination low-fat/high-FV diet arms decreased their fat intakes to approximately 16% of energy. Women on the high-FV and the combination low-fat/high-FV diet arms increased FV intakes to approximately 11 servings/day. Despite counseling efforts to maintain baseline energy intakes, mean body weight increased significantly by 6 pounds in women in the high-FV diet arm and decreased significantly by 5 pounds in women in the low-fat diet arm. Percent body fat also was increased in the high-FV diet arm and decreased in the low-fat diet arm. Body weight and percent body fat in the combination diet arm did not change significantly. Control of energy intake, therefore, appears to have been achieved only when the addition of FV to the diet was balanced by a decrease in fat intake and both dietary components were enumerated daily. Maintenance of energy intake, therefore, did not appear to be attained intrinsically when individuals were counseled to make changes in the composition of their diets.

The contribution of foods to the dietary lipid profile of a Spanish population

OBJECTIVE

To identify the food that has the greatest effect on the variation in the percentage of energy intake derived from fat and saturated fatty acids for the consumption of a Spanish population.

DESIGN

A cross-sectional study of food consumption, using the 24-hour recall method for three non-consecutive days, one of which was a non-working day. Subjects were interviewed by trained interviewers in the subjects' homes. We used multiple linear regression for statistical analysis.

SETTING

The citizens of Reus.

SUBJECTS

One thousand and sixty subjects over five years old, randomly selected from the population census of Reus.

RESULTS

In both sexes, the foods that mainly determine a high consumption of fat are oil and red meat while those that determine a lower consumption of fat are bread, savoury cereals and fruit. The foods that mainly determine a high consumption of saturated fatty acids are red meat and whole-fat dairy products while those that determine a low consumption are bread, savoury cereals and fruit.

CONCLUSIONS

In our population, feasible variations in the intake of some foods - less than one portion - would reduce the estimated percentage of energy intake derived from fat and saturated fatty acids by a quantity considered important for cardiovascular disease prevention. The periodic identification and quantification of the food that most affects the dietary fat profile will help in drawing up dietary guidelines with more reasonable strategies for consuming a healthier diet and decreasing the risk of developing nutritional disorders.

Television viewing and its associations with overweight, sedentary lifestyle, and insufficient consumption of fruits and vegetables among US high school students: differences by race, ethnicity, and gender

Television (TV) viewing has been associated with overweight, decreased physical activity, and unhealthy dietary behavior among children and adolescents, and may represent a modifiable cause of childhood obesity. This study examined race, ethnic, and gender-specific differences in these associations among high school students in the United States. The study analyzed data from the 1999 national Youth Risk Behavior Survey, a representative sample (N = 15,349) of US high school students. Logistic regression tested for significant associations. TV viewing on an average school day exceeded 2 hours/day among 43% of students; it was greater among Black (74%) and Hispanic (52%) than White (34%) students. Overall, 11% of students were overweight, 31% of students were sedentary (i.e., did not participate in moderate or vigorous physical activity at recommended levels), and 76% ate less than five servings/day of fruits and vegetables. Watching TV more than 2 hours/day was associated with being overweight, being sedentary, and eating insufficient fruits and vegetables among White females, and with being overweight among Hispanic females. No significant associations were found among Black females. TV viewing was associated with being overweight and eating insufficient fruits and vegetables among White males. No significant associations were found among Hispanic males. Among Black males, TV viewing was associated with greater participation in physical activity. These findings suggest the presence of cultural factors to consider when developing interventions to promote physical activity, healthy eating, and healthy weight through reduced TV viewing among adolescents.

Food-related beliefs, eating behavior, and classroom food practices of middle school teachers

This study examined classroom food practices and eating behavior of middle school teachers from 16 schools in a metropolitan area, located in the upper Midwest. In winter 1999-2000, teachers in sixth, seventh, and eighth grade were surveyed (response rate = 70%; n = 490/701). Questions addressed teachers' classroom food practices, eating behavior while at school, personal health, and attitudes about the school food environment. Use of food as an incentive/reward for students was a common classroom practice in middle schools, and most foods did not support development of health eating patterns by young adolescents. Candy was the most frequently used food item, reported by 73% of teachers, followed by cookies/doughnuts (37%), sweetened drinks (35%), and pizza (28%). Many middle school teachers did not role model healthy eating behavior at school. Prevalent use of vending was a particular concern, with beverage and snack vending use reported by 62% and 35% of teachers, respectively. Most vending items purchased were sweetened drinks (57%) and high-fat or high-sugar snacks (85%). Low perceived personal health, high-fat scores, and low support for the school food environment were some of the significant correlates of teachers' eating behavior. School and health professionals should continue to advocate for schoolwide policies and programs that support students and teachers if the goal of an integrated healthy school food environment is to be realized.

Serum concentrations of retinol, alpha-tocopherol and the carotenoids are influenced by diet, race and obesity in a sample of healthy adolescents

An important part of understanding the functions of vitamin A, vitamin E and the carotenoids in nutritional status assessment, health promotion and disease prevention is knowledge of factors that influence their distribution in human tissues. Our objective was to examine serum concentrations of these nutrients and compounds in a sample of 285 healthy participants, 12-17 y old, from three U. S. cities. Pearson correlations between diet measured with a food frequency questionnaire and serum nutrient concentrations among these adolescents (adjusted for total serum cholesterol, age, sex, race and body mass index) were as follows: retinol, 0.23; alpha-tocopherol, 0.16; alpha-carotene, 0.31; beta-carotene, 0.15; beta-cryptoxanthin, 0.38; lycopene, 0.08; and lutein + zeaxanthin, 0.25. Multivariate linear regression modeled associations of demographic, dietary and physiologic variables with serum concentrations of these nutrients. African-American participants had significantly lower concentrations of serum retinol (P < 0.001), alpha-tocopherol (P < 0.01) and alpha-carotene (P < 0.02), but higher concentrations of lutein + zeaxanthin (P = 0.001) compared with Caucasians. Obese participants had serum nutrient concentrations that were 2-10% (P < 0.05) lower than normal weight participants. Dietary intake was a significant predictor of all serum analytes (P < 0.01) except lycopene. These models explained 20% of the variability in serum retinol, 28% of the variability in serum alpha-tocopherol, and 14-24% of the variability in serum carotenoids.

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.

Activity, dietary intake, and weight changes in a longitudinal study of preadolescent and adolescent boys and girls

OBJECTIVE

To examine the role of physical activity, inactivity, and dietary patterns on annual weight changes among preadolescents and adolescents, taking growth and development into account.

STUDY DESIGN

We studied a cohort of 6149 girls and 4620 boys from all over the United States who were 9 to 14 years old in 1996. All returned questionnaires in the fall of 1996 and a year later in 1997. Each child provided his or her current height and weight and a detailed assessment of typical past-year dietary intakes, physical activities, and recreational inactivities (TV, videos/VCR, and video/computer games).

METHODS

Our hypotheses were that physical activity and dietary fiber intake are negatively correlated with annual changes in adiposity and that recreational inactivity (TV/videos/games), caloric intake, and dietary fat intake are positively correlated with annual changes in adiposity. Separately for boys and girls, we performed regression analysis of 1-year change in body mass index (BMI; kg/m(2)). All hypothesized factors were in the model simultaneously with several adjustment factors.

RESULTS

Larger increases in BMI from 1996 to 1997 were among girls who reported higher caloric intakes (.0061 +/-.0026 kg/m(2) per 100 kcal/day; beta +/- standard error), less physical activity (-.0284 +/-.0142 kg/m(2)/hour/day) and more time with TV/videos/games (.0372 +/-.0106 kg/m(2)/hour/day) during the year between the 2 BMI assessments. Larger BMI increases were among boys who reported more time with TV/videos/games (.0384 +/-.0101) during the year. For both boys and girls, a larger rise in caloric intake from 1996 to 1997 predicted larger BMI increases (girls:.0059 +/-.0027 kg/m(2) per increase of 100 kcal/day; boys:.0082 +/-.0030). No significant associations were noted for energy-adjusted dietary fat or fiber.

CONCLUSIONS

For both boys and girls, a 1-year increase in BMI was larger in those who reported more time with TV/videos/games during the year between the 2 BMI measurements, and in those who reported that their caloric intakes increased more from 1 year to the next. Larger year-to-year increases in BMI were also seen among girls who reported higher caloric intakes and less physical activity during the year between the 2 BMI measurements. Although the magnitudes of these estimated effects were small, their cumulative effects, year after year during adolescence, would produce substantial gains in body weight. Strategies to prevent excessive caloric intakes, to decrease time with TV/videos/games, and to increase physical activity would be promising as a means to prevent obesity.

Comparison of the 60- and 100-item NCI-block questionnaires with validation data

Large epidemiological studies often require short food frequency questionnaires (FFQ) to minimize the respondent burden or to control for confounding from dietary factors. In this analysis, we compared the extensively used National Cancer Institute-Block 60- and 100-item FFQs with one another and with usual intake as estimated from 12 days of validation data. The analysis focused on nutrients from different aspects of the diet, including energy, fat, saturated fat, beta-carotene, dietary fiber, and vitamin C. By use of an errors-in-variables analysis, the correlations of usual intake with the two types of FFQs for these nutrients were not different. Attenuation coefficients, a measure of misclassification error, for both FFQs were of similar magnitude and indicated that substantial attenuation of logistic regression coefficients would result from either FFQ. Our results confirm previous analyses describing the validity and utility of the 60-item FFQ (Epidemiology 1, 58-64, 1990) and indicate that it is essentially equivalent to the 100-item FFQ for epidemiological analyses of major nutrients.

The impact of computer-tailored feedback and iterative feedback on fat, fruit, and vegetable intake

A randomized trial was conducted to study the impact of individualized computer-generated nutrition information and additional effects of iterative feedback on changes in intake of fat, fruits, and vegetables. Respondents in the experimental group received computer-generated feedback letters tailored to their dietary intake, intentions, attitudes, self-efficacy expectations, and self-rated behavior. After the first feedback letter, half of the experimental group received additional iterative feedback tailored to changes in behavior and intentions. The control group received a single general nutrition information letter in a format similar to the tailored letters. Computer-tailored feedback had a significantly greater impact on fat reduction and fruit and vegetable intake than did general information. Iterative computer-tailored feedback had an additional impact on fat intake. The results confirm that computer-generated individualized feedback can be effective in inducing recommended dietary changes and that iterative feedback can increase the longer term impact of computer-tailored nutrition education on fat reduction.

Development of eating behaviors among children and adolescents

The prevalence of obesity among children is high and is increasing. We know that obesity runs in families, with children of obese parents at greater risk of developing obesity than children of thin parents. Research on genetic factors in obesity has provided us with estimates of the proportion of the variance in a population accounted for by genetic factors. However, this research does not provide information regarding individual development. To design effective preventive interventions, research is needed to delineate how genetics and environmental factors interact in the etiology of childhood obesity. Addressing this question is especially challenging because parents provide both genes and environment for children. An enormous amount of learning about food and eating occurs during the transition from the exclusive milk diet of infancy to the omnivore's diet consumed by early childhood. This early learning is constrained by children's genetic predispositions, which include the unlearned preference for sweet tastes, salty tastes, and the rejection of sour and bitter tastes. Children also are predisposed to reject new foods and to learn associations between foods' flavors and the postingestive consequences of eating. Evidence suggests that children can respond to the energy density of the diet and that although intake at individual meals is erratic, 24-hour energy intake is relatively well regulated. There are individual differences in the regulation of energy intake as early as the preschool period. These individual differences in self-regulation are associated with differences in child-feeding practices and with children's adiposity. This suggests that child-feeding practices have the potential to affect children's energy balance via altering patterns of intake. Initial evidence indicates that imposition of stringent parental controls can potentiate preferences for high-fat, energy-dense foods, limit children's acceptance of a variety of foods, and disrupt children's regulation of energy intake by altering children's responsiveness to internal cues of hunger and satiety. This can occur when well-intended but concerned parents assume that children need help in determining what, when, and how much to eat and when parents impose child-feeding practices that provide children with few opportunities for self-control. Implications of these findings for preventive interventions are discussed.

Carotenoids, vitamin A, and estrogen receptor status in breast cancer

Among patients with breast cancer, tumors that contain estrogen receptors (ER) are associated with improved survival and better response to hormone therapy than those not expressing these receptors. The purpose of these case comparison studies was to examine the relationship between carotenoids, vitamin A, and the tumor ER status in women at diagnosis of primary breast cancer. The focus of the first study was the relationship between dietary intake and ER status, and the focus of the second study was the relationship between ER status and the plasma carotenoid, retinol, and tocopherol concentrations. We evaluated tumor ER status and self-reported dietary intake in 142 women and plasma concentrations of carotenoids, retinol, and tocopherols in 149 women, at diagnosis of breast cancer, before any medical or surgical treatment. In the first study the overall odds of ER-positive status were increased in relation to number of mammograms in the past five years, number of breast-fed babies, dietary carotenoid intake, and more frequent intake of yellow and green vegetables. Overall odds of ER-positive status were decreased in relation to years of oral contraceptive use and preformed vitamin A intake. In the second study older women, women with higher plasma lutein concentration, and women not using beta-carotene supplements were more likely to be ER positive, when data were adjusted for body mass index and factors that may influence breast cancer risk or hormonal status. Significant independent relationships between plasma retinol or tocopherol concentrations and ER status were not observed. The strong and independent relationships between carotenoid intake, plasma lutein concentration, and ER status may relate to observations linking a carotenoid-rich diet with improved prognosis after diagnosis of breast cancer.

Determinants of intention to adopt a low-fat diet in men 30 to 60 years old: implications for heart health promotion

PURPOSE

The purpose of the study was to identify the determinants of intention to have a low-fat diet in 30- to 60-year-old men.

DESIGN

The survey design was cross-sectional and consisted of a self-administered questionnaire. The dependent variable was the intention to have a low-fat diet within the next 4 months, and the independent variables were those suggested by the theory of planned behavior.

SETTING

The study population was drawn from three districts representing a modal sample of Laval, the second most populous city (N = 314,398) in the province of Quebec.

SUBJECTS

The sample comprised 3200 people. Of the 3200 questionnaires sent out, 2583 were received and 2269 were eligible (i.e., were answered by 30- to 60-year-old men), giving a response rate of 70.9%. Of the 2269 questionnaires, 430 were incomplete, resulted in 1839 being usable for analysis.

MEASURES

Multiple regression analysis was conducted to determine the influence of the independent variables on the dependent variable, the intention to have a low-fat diet. The independent variables were (1) direct and indirect determinants of intention as suggested in the theory of planned behavior and (2) sociodemographic and concomitant variables and their interactions. Discriminant analysis was used on the significant variables obtained in the regression to establish the cognitive profile of respondents' intention, strong or weak.

RESULTS

In the final model, five variables 51% of the total variance. Respondents who had a stronger intention perceived that their important referents would approve them having a low-fat diet. They scored higher in seeing the advantages of adopting the target behavior and had a more positive attitude toward the behavior. They also perceived themselves as having control over the target behavior, and scored higher in terms of recognizing the perceived power of this control factor.

CONCLUSIONS

The results suggests that the theory of planned behavior can be an effective tool in the planning of heart health promotion. They indicate that low-fat diet programs for men should target the work site and peer-group organizations, and place emphasis on adapting usual recipes. Though accenting the health and nutritional benefits of a low-fat diet, messages should appeal to emotion as well as reason.

Nutrition and lung cancer

Epidemiologic evidence on the relationship between nutrition and lung cancer is reviewed. Observational studies of diet and lung cancer, both prospective and retrospective, continue to suggest strongly that increased vegetable and fruit intake is associated with reduced risk in men and women; in various countries; in smokers, ex-smokers, and never-smokers; and for all histologic types of lung cancer. Prospective studies of blood beta-carotene levels, arguably the best available biomarker of vegetable and fruit intake, indicate that low levels are predictive of increased lung cancer incidence. However, in a randomized, placebo-controlled clinical trial in male smokers, lung cancer incidence and total mortality were increased significantly among the men receiving beta-carotene supplements. If beta-carotene can prevent lung carcinogenesis, which the trial cannot rule out, then the dosage, duration of use, method of administration, and/or subpopulation are critical. Ongoing clinical trials, some of which include women, will provide much-needed information. Other carotenoids, other phytochemicals, and associated dietary patterns may explain the beneficial effects of vegetables and fruits and have not been explored adequately in epidemiologic work. Several observational epidemiologic studies, both prospective and retrospective, have indicated that diets high in fat, saturated fat, and cholesterol may increase the risk of lung cancer and that the effect is not mediated through vegetable and fruit intake. The relationship, although not yet established, merits further investigation. Since beta-carotene can function as an antioxidant, other micronutrients with this potential, specifically vitamins E and C and selenium, also have been proposed to reduce lung cancer risk. However, the totality of the epidemiologic evidence is not, at present, persuasive for any one of these micronutrients.