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Werts SJ, Robles-Morales R, Bea JW, Thomson CA. Characterization and efficacy of lifestyle behavior change interventions among adult rural cancer survivors: a systematic review. J Cancer Surviv 2023:10.1007/s11764-023-01464-4. [PMID: 37768420 DOI: 10.1007/s11764-023-01464-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 09/09/2023] [Indexed: 09/29/2023]
Abstract
PURPOSE Little is known about the intersection between age and rurality as characteristics that impact lifestyle behavior change for cancer survivors. This review aims to summarize the current literature on lifestyle behavior change interventions conducted among rural survivors of cancer, with an emphasis on older survivors. METHODS A systematic search of five databases identified randomized controlled trials and controlled clinical trials that targeted diet, physical activity, alcohol consumption, or tobacco use change in adult cancer survivors living in rural areas of the world. RESULTS Eight studies met the inclusion criteria. Most studies were conducted in either Australia or the USA, included survivors at least 6 weeks post-treatment, and half included only breast cancer survivors, while the other four included a mix of cancer types. All but one had a physical activity component. No articles addressed changes in alcohol or tobacco behavior. Seven (87.5%) had a fully remote or hybrid delivery model. Most of the physical activity interventions showed significant changes in physical activity outcomes, while the dietary interventions showed changes of clinical but not statistical significance. CONCLUSIONS Few studies have been conducted to implement and evaluate the effectiveness of lifestyle behavior change interventions among older rural survivors of cancer. Future research should evaluate the acceptability and relevancy of adapted, evidence-based intervention with this population. IMPLICATIONS FOR CANCER SURVIVORS Effective diet and physical activity interventions exist, albeit limited in terms of effective lifestyle behavior change intervention tailored to older, rural survivors of cancer, particularly in relation to alcohol and tobacco behaviors.
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Affiliation(s)
- Samantha J Werts
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA.
- University of Arizona Cancer Center, University of Arizona, Tucson, AZ, USA.
| | - Rogelio Robles-Morales
- University of Arizona Cancer Center, University of Arizona, Tucson, AZ, USA
- Department of Clinical Translational Sciences, College of Medicine, University of Arizona, Tucson, AZ, USA
| | - Jennifer W Bea
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
- University of Arizona Cancer Center, University of Arizona, Tucson, AZ, USA
| | - Cynthia A Thomson
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
- University of Arizona Cancer Center, University of Arizona, Tucson, AZ, USA
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Anderson T, Herrera D, Mireku F, Barner K, Kokkinakis A, Dao H, Webber A, Merida AD, Gallo T, Pierobon M. Geographical Variation in Social Determinants of Female Breast Cancer Mortality Across US Counties. JAMA Netw Open 2023; 6:e2333618. [PMID: 37707814 PMCID: PMC10502521 DOI: 10.1001/jamanetworkopen.2023.33618] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 08/04/2023] [Indexed: 09/15/2023] Open
Abstract
Importance Breast cancer mortality is complex and traditional approaches that seek to identify determinants of mortality assume that their effects on mortality are stationary across geographic space and scales. Objective To identify geographic variation in the associations of population demographics, environmental, lifestyle, and health care access with breast cancer mortality at the US county-level. Design, Setting, and Participants This geospatial cross-sectional study used data from the Surveillance, Epidemiology, and End Results (SEER) database on adult female patients with breast cancer. Statistical and spatial analysis was completed using adjusted mortality rates from 2015 to 2019 for 2176 counties in the US. Data were analyzed July 2022. Exposures County-level population demographics, environmental, lifestyle, and health care access variables were obtained from open data sources. Main Outcomes and Measures Model coefficients describing the association between 18 variables and age-adjusted breast cancer mortality rate. Compared with a multivariable linear regression (OLS), multiscale geographically weighted regression (MGWR) relaxed the assumption of spatial stationarity and allowed for the magnitude, direction, and significance of coefficients to change across geographic space. Results Both OLS and MGWR models agreed that county-level age-adjusted breast cancer mortality rates were significantly positively associated with obesity (OLS: β, 1.21; 95% CI, 0.88 to 1.54; mean [SD] MGWR: β, 0.72 [0.02]) and negatively associated with proportion of adults screened via mammograms (OLS: β, -1.27; 95% CI, -1.70 to -0.84; mean [SD] MGWR: β, -1.07 [0.16]). Furthermore, the MGWR model revealed that these 2 determinants were associated with a stationary effect on mortality across the US. However, the MGWR model provided important insights on other county-level factors differentially associated with breast cancer mortality across the US. Both models agreed that smoking (OLS: β, -0.65; 95% CI, -0.98 to -0.32; mean [SD] MGWR: β, -0.75 [0.92]), food environment index (OLS: β, -1.35; 95% CI, -1.72 to -0.98; mean [SD] MGWR: β, -1.69 [0.70]), exercise opportunities (OLS: β, -0.56; 95% CI, -0.91 to -0.21; mean [SD] MGWR: β, -0.59 [0.81]), racial segregation (OLS: β, -0.60; 95% CI, -0.89 to -0.31; mean [SD] MGWR: β, -0.47 [0.41]), mental health care physician ratio (OLS: β, -0.93; 95% CI, -1.44 to -0.42; mean [SD] MGWR: β, -0.48 [0.92]), and primary care physician ratio (OLS: β, -1.46; 95% CI, -2.13 to -0.79; mean [SD] MGWR: β, -1.06 [0.57]) were negatively associated with breast cancer mortality, and that light pollution was positively associated (OLS: β, 0.48; 95% CI, 0.24 to 0.72; mean [SD] MGWR: β, 0.27 [0.04]). But in the MGWR model, the magnitude of effect sizes and significance varied across geographical regions. Inversely, the OLS model found that disability was not a significant variable for breast cancer mortality, yet the MGWR model found that it was significantly positively associated in some geographical locations. Conclusions and Relevance This cross-sectional study found that not all social determinants associated with breast cancer mortality are spatially stationary and provides spatially explicit insights for public health practitioners to guide geographically targeted interventions.
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Affiliation(s)
- Taylor Anderson
- Department of Geography and Geoinformation Science, George Mason University, Fairfax, Virginia
| | - Dan Herrera
- Department of Environmental Science and Technology, University of Maryland, College Park
- Department of Environmental Science and Policy, George Mason University, Fairfax, Virginia
| | - Franchesca Mireku
- Department of Geography and Geoinformation Science, George Mason University, Fairfax, Virginia
| | - Kai Barner
- Department of Geography and Geoinformation Science, George Mason University, Fairfax, Virginia
| | - Abigail Kokkinakis
- Department of Environmental Science and Policy, George Mason University, Fairfax, Virginia
| | - Ha Dao
- Department of Statistics, George Mason University, Fairfax, Virginia
| | - Amanda Webber
- Department of Geography and Geoinformation Science, George Mason University, Fairfax, Virginia
| | - Alexandra Diaz Merida
- Department of Global and Community Health, George Mason University, Fairfax, Virginia
| | - Travis Gallo
- Department of Environmental Science and Technology, University of Maryland, College Park
- Department of Environmental Science and Policy, George Mason University, Fairfax, Virginia
| | - Mariaelena Pierobon
- School of Systems Biology, Center for Applied Proteomics and Molecular Medicine, George Mason University, Manassas, Virginia
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Montez De Sousa ÍR, Bergheim I, Brombach C. Beyond the Individual -A Scoping Review and Bibliometric Mapping of Ecological Determinants of Eating Behavior in Older Adults. Public Health Rev 2022; 43:1604967. [PMID: 35992753 PMCID: PMC9381692 DOI: 10.3389/phrs.2022.1604967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 06/27/2022] [Indexed: 11/20/2022] Open
Abstract
Objectives: The objective of this scoping review was to summarize and provide a visual overview of the present-day knowledge on ecological determinants of eating behavior in community-dwelling elderly persons in relation with nutrition communication, considering the evolution of the field. The second objective was to integrate results in recommendations for the development of nutrition communication strategies. Methods: A literature review was performed on Medline, PubMed and Google Scholar, according with the PRISMA protocol for scoping reviews. An a-priori analysis was executed by categorizing determinants from the literature according with the different levels represented in the ecological framework and an a-posteriori analysis by using VosViewer for a chronological bibliometric mapping analysis. Results: Of 4029 articles retrieved, 77 were selected for analysis. Initial publications focused more on individual determinants of eating behavior. Over time, there was a shift towards a holistic view of eating behavior considering the “food environment”, including social networks, physical settings and public policy. Conclusion: Beyond the individual, all ecological levels are relevant when targeting eating behavior in the elderly. Nutrition communication strategies should be structured considering these influences.
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Affiliation(s)
- Íris Rafaela Montez De Sousa
- Institute of Food and Beverage Innovation, Life Sciences and Facility Management, Zurich University of Applied Sciences, Wädenswil, Switzerland
- Molecular Nutritional Science, Department of Nutritional Sciences, University of Vienna, Vienna, Austria
- *Correspondence: Íris Rafaela Montez De Sousa,
| | - Ina Bergheim
- Molecular Nutritional Science, Department of Nutritional Sciences, University of Vienna, Vienna, Austria
| | - Christine Brombach
- Institute of Food and Beverage Innovation, Life Sciences and Facility Management, Zurich University of Applied Sciences, Wädenswil, Switzerland
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Little RB, Murillo AL, Van Der Pol WJ, Lefkowitz EJ, Morrow CD, Yi N, Carson TL. Diet Quality and the Gut Microbiota in Women Living in Alabama. Am J Prev Med 2022; 63:S37-S46. [PMID: 35725139 PMCID: PMC9219556 DOI: 10.1016/j.amepre.2022.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 02/21/2022] [Accepted: 02/23/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION The gut microbiota is associated with obesity and modulated by individual dietary components. However, the relationships between diet quality and the gut microbiota and their potential interactions with weight status in diverse populations are not well understood. This study examined the associations between overall diet quality, weight status, and the gut microbiota in a racially balanced sample of adult females. METHODS Female participants (N=71) residing in Birmingham, Alabama provided demographics, anthropometrics, biospecimens, and dietary data in this observational study from March 2014 to August 2014, and data analysis was conducted from August 2017 to March 2019. Weight status was defined as a BMI (weight [kg]/height [m2]) <30 kg/m2 for non-obese participants and ≥30 kg/m2 for participants who were obese. Dietary data collected included an Automated Self-Administered 24-Hour recall and Healthy Eating Index-2010 (HEI-2010) score. Diet quality was defined as having a high HEI score (≥median) or a low HEI score (<median). The fecal microbiota was collected, and the 16S ribosomal RNA gene was amplified to profile the microbiota composition. Differences in diet quality based on weight status were assessed using 2-sample t-tests. The associations between diet quality, gut microbiota, and weight status were analyzed using negative binomial models. RESULTS Participants (43 Black, 28 White) aged 40.39±13.86 years who were non-obese (56%) and obese (44%) were studied. Greater alpha diversity was observed among those with higher Healthy Eating Index scores (p=0.037) but did not differ by weight status. Higher abundances of Bacteroidetes (p=0.006) and Firmicutes (p=0.042) were associated with a higher HEI score. Higher Bacteriodetes levels were observed among non-obese (p=0.006). CONCLUSIONS Diet quality measured by the HEI was associated with alpha diversity of the gut microbiota among adult females. Abundances of phyla that have been linked with weight status (Bacteroidetes and Firmicutes) were positively associated with diet quality.
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Affiliation(s)
- Rebecca B Little
- Division of Preventive Medicine, Department of Medicine, Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Anarina L Murillo
- Department of Biostatistics, School of Public Health, The University of Alabama at Birmingham, Birmingham, Alabama; Department of Pediatrics, Warren Alpert Medical School, Brown University, Providence, Rhode Island; Center for Statistical Sciences, School of Public Health, Brown University, Providence, Rhode Island.
| | - William J Van Der Pol
- Biomedical Informatics, UAB Center for Clinical and Translational Science, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Elliot J Lefkowitz
- Biomedical Informatics, UAB Center for Clinical and Translational Science, The University of Alabama at Birmingham, Birmingham, Alabama; Department of Microbiology, School of Medicine, Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Casey D Morrow
- Department of Cell, Developmental and Integrative Biology, Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Nengjun Yi
- Department of Biostatistics, School of Public Health, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Tiffany L Carson
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida; Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa, Florida
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Kaur H, Fernández JR, Locher JL, Demark-Wahnefried W. Rural and Urban Differences in Vegetable and Fruit Consumption Among Older Cancer Survivors in the Deep South: An Exploratory Cross-Sectional Study. J Acad Nutr Diet 2022; 122:1717-1724.e4. [PMID: 35017097 PMCID: PMC9271124 DOI: 10.1016/j.jand.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 11/21/2021] [Accepted: 01/06/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND Cancer survivors, especially those who are older, experience increased comorbidity and risk for secondary cancers. A varied dietary pattern, rich in vegetables and fruit (V&F) is recommended to improve health. However, V&F intake may differ by rural versus urban status. OBJECTIVE To assess differences in V&F consumption among older cancer survivors residing in urban- and rural-designated areas, and explore whether differences exist by sex, race, and cancer type. DESIGN This was a cross-sectional secondary analysis. PARTICIPANTS/SETTING Screening data from the Harvest for Health trial were obtained from October 2016 to November 2019 on 731 Medicare-eligible cancer survivors across Alabama. MAIN OUTCOME MEASURES V&F consumption was measured by 2-items from the Eating at America's Table NCI Dietary Screener. Rural and urban residence was coded at the zip-code level using the USDA's Rural-Urban Commuting Area (RUCA) coding schema using five different classifications (A-E). Sex, race and cancer-type were dichotomized as male/female, Non-Hispanic White (NHW)/Non-Hispanic Black (NHB) and gastro-intestinal/other cancers, respectively. STATISTICAL ANALYSES Kruskal Wallis rank sum and post-hoc tests were performed to detect differences in V&F consumption (α<0.05). RESULTS The study sample was largely female (66.2%), NHW (78.1%), of mean age 70 years and reported an average V&F intake of 1.47 cups/day. V&F consumption of cancer survivors living in isolated, small, rural towns was roughly half that consumed by survivors living elsewhere; thus, statistically significant rural-urban differences were found in models that accounted specifically for this subgroup, i.e., RUCA categorizations A and E.V&F consumption also was significantly lower in NHB (1.32 ± 0.98 cups/day) than NHW survivors (1.51 ± 1.10 cups/day) (p=0.0456); however, no statistically significant differences were detected by sex and cancer type. CONCLUSION Analyses that address the variability within "rural" designated areas are important in future studies. Moreover, a greater understanding is needed of factors that adversely affect V&F consumption of those most vulnerable, i.e., older NHB cancer survivors as well as those living in isolated, small, rural towns to best target future interventions.
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Affiliation(s)
- Harleen Kaur
- Department of Nutrition Sciences, University of Alabama at Birmingham (UAB), 1675 University Boulevard, Webb Nutrition Sciences Bldg., Room 604A Birmingham, AL 35294-3360.
| | - José R Fernández
- Professor and Vice Chair for Education, Department of Nutrition Sciences, UAB, 1675 University Boulevard, Webb Nutrition Sciences Bldg., Room 522 Birmingham, AL 35294-3360
| | - Julie L Locher
- Professor Emerita, Department of Medicine, UAB, CH19-Room 218F; Birmingham, Alabama 35294-2041
| | - Wendy Demark-Wahnefried
- Associate Director for Cancer Prevention and Control for the O'Neal Comprehensive Cancer Center at UAB, Professor and Webb Endowed Chair of Nutrition Sciences, American Cancer Society Clinical Research Professor, Department of Nutrition Sciences, UAB, 1675 University Boulevard, Webb Nutrition Sciences Bldg., Room 650 Birmingham, AL 35294-3360
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Dietary Intake Quality Is Affected by Knowledge and Dietary Intake Frequency among Pregnant Women in Muntinlupa, Philippines: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312306. [PMID: 34886028 PMCID: PMC8656981 DOI: 10.3390/ijerph182312306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 11/19/2021] [Accepted: 11/19/2021] [Indexed: 11/16/2022]
Abstract
Improving the nutrition of pregnant women is essential in reducing maternal and child mortality, which is one of the global nutritional goals of 2025. This study evaluated the factors related to the quality of dietary intake among pregnant women in Muntinlupa, Philippines. We conducted a cross-sectional study of 280 pregnant women at a hospital in Muntinlupa from March 2019 to August 2019 using questionnaires. After the primary aggregation, multivariate logistic regression analysis was used to identify factors associated with the quality of dietary intake in pregnant women. Approximately half of the women (46.4%, n = 130) had a low dietary diversity during pregnancy. Less than 30% of the respondents consumed beans, soybean products, and nuts. In the logistic regression analysis, poor maternal knowledge of nutritional sources to prevent anemia (odds ratio (OR) 4.25, 95% confidence interval (CI) 1.47-12.32, p = 0.01) and less frequent meal consumption (OR 2.15, 95% CI 1.08-4.29, p = 0.03) were significantly associated with poor dietary diversity. Our findings are crucial because they suggest that increasing the knowledge of pregnant women about good nutrition and ensuring that dietary intake is frequent and adequate through antenatal care can improve the nutrition of pregnant women.
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Jailani M, Elias SM, Rajikan R. The New Standardized Malaysian Healthy Eating Index. Nutrients 2021; 13:3474. [PMID: 34684475 PMCID: PMC8541309 DOI: 10.3390/nu13103474] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 09/01/2021] [Accepted: 09/14/2021] [Indexed: 12/15/2022] Open
Abstract
Healthy Eating Index (HEI) is a diet quality measure that assesses the population's compliance towards dietary guidelines. In Malaysia, diet quality measure, though existing, has some limitations in terms of application and relevance. This study aims to develop a new standardized Malaysian Healthy Eating Index (S-MHEI) that can measure the diet quality of all Malaysians regardless of their energy requirement level. The Malaysian Dietary Guidelines (MDG) 2010 and MDG for Children and Adolescents (MDGCA) 2013 were used as main references in developing the index components. In addition, the latest Malaysian Adults Nutrition Survey (MANS) and Adolescent Nutrition Survey (ANS) were also referred to ensure the relevance of the components selected. For adequacy components, the least restrictive method was used in setting the standard for the scoring system. Meanwhile, the scoring system for moderation components was built based on the Recommended Nutrient Intake (RNI) 2017. The new S-MHEI comprises of 11 components with a maximum total score of 100. The least restrictive method allowed the index to be used across energy requirement levels. However, the index will not be sensitive towards adhering to the specific recommended amount of intake-which in effect, made the index focus on measuring diet quality rather than diet quantity.
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Affiliation(s)
- Marhamah Jailani
- Faculty of Science and Technology, Universiti Sains Islam Malaysia, Nilai 71800, Malaysia;
| | - Siti Masitah Elias
- Faculty of Science and Technology, Universiti Sains Islam Malaysia, Nilai 71800, Malaysia;
| | - Roslee Rajikan
- Faculty of Health Science, Universiti Kebangsaan Malaysia, Kuala Lumpur 50300, Malaysia;
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Stosovic D, Vasiljevic N, Jovanovic V, Cirkovic A, Paunovic K, Davidovic D. Dietary Habits of Older Adults in Serbia: Findings From the National Health Survey. Front Public Health 2021; 9:610873. [PMID: 34497788 PMCID: PMC8419354 DOI: 10.3389/fpubh.2021.610873] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 07/19/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: Adults aged 65 years and older comprise one fifth of the Serbian population. Many of them have multiple, often diet-related comorbidities. We aimed to investigate their dietary habits by comparing them with younger adults' and to determine the relation of the differing ones to demographic, socioeconomic and health factors. Methods: We performed a secondary analysis of 2013 Serbian National Health Survey data on 14,082 adults. Binary logistic regression was used to determine dietary habits associated with older age (≥65 years) compared to younger age (18-64 years) and to assess their independent predictors in older adults. Results: Older adults more often reported everyday breakfast (OR = 2.085, 95%CI = 1.622-2.680) and brown/wholegrain bread consumption (OR = 1.681, 95% CI = 1.537-1.839), while using margarine (OR = 0.578, 95%CI = 0.397-0.839), discretionary salt (sometimes: OR = 0.648, 95%CI = 0.596-0.705, almost always: OR = 0.522, 95%CI = 0.445-0.614) and consuming fish (two or more times a week: OR = 0.465, 95%CI = 0.383-0.566) less frequently than younger adults. This was mainly positively related to urban environment, affluence, higher education and poor health. Conclusion: Using nationally representative data, we found that older adults reported healthier dietary habits compared to younger adults, which requires timely public health action.
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Affiliation(s)
- Dragana Stosovic
- Centre for Hygiene and Human Ecology, Institute of Public Health of Serbia "Dr Milan Jovanovic Batut", Belgrade, Serbia
| | - Nadja Vasiljevic
- Institute of Hygiene and Medical Ecology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Verica Jovanovic
- Centre for Disease Control, Institute of Public Health of Serbia "Dr Milan Jovanovic Batut", Belgrade, Serbia
| | - Andja Cirkovic
- Institute of Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Katarina Paunovic
- Institute of Hygiene and Medical Ecology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Dragana Davidovic
- Institute of Hygiene and Medical Ecology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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Fastring D, Nadorff D, DeShong H. The Influence of Rurality on Fruit and Vegetable Intake and BMI: Findings in Mississippi Are Not Consistent with Those at the National Level. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18095021. [PMID: 34068555 PMCID: PMC8126059 DOI: 10.3390/ijerph18095021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 04/29/2021] [Accepted: 05/05/2021] [Indexed: 11/16/2022]
Abstract
Sixty percent of Americans have at least one chronic disease that is both diet-related and preventable. Those living in rural areas often experience a greater burden of disease than those who live near a city center. The purpose of this study is to determine the influence of rurality on fruit and vegetable (FV) consumption and BMI. Additionally, the study compares national results to those in Mississippi, a state with an aging population, and high rates of poverty, rurality, poor diet, and obesity. Data utilized were from the 2017 Behavioral Risk Factor Surveillance System. One-way analyses of covariance were performed to determine impact of rurality on nutritional intake and BMI, while controlling for age, income, education, race, and the presence of children in the home. At the national level, rurality had a significant impact on BMI, and the daily intake of fruit juice, fruits, dark green vegetables, French fries, potatoes, other vegetables, and total daily vegetable intake. BMI and nutritional intake of those living in Mississippi was significantly poorer than those living in other states. More research is needed to determine how to best facilitate access to healthy FVs for those living in rural communities.
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Affiliation(s)
- Danielle Fastring
- College of Osteopathic Medicine, William Carey University, Hattiesburg, MS 39401, USA
- Correspondence:
| | - Danielle Nadorff
- Department of Psychology, Mississippi State University, Starkville, MS 39762, USA; (D.N.); (H.D.)
| | - Hilary DeShong
- Department of Psychology, Mississippi State University, Starkville, MS 39762, USA; (D.N.); (H.D.)
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The Intersection of Rural Residence and Minority Race/Ethnicity in Cancer Disparities in the United States. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041384. [PMID: 33546168 PMCID: PMC7913122 DOI: 10.3390/ijerph18041384] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 01/29/2021] [Accepted: 01/30/2021] [Indexed: 12/15/2022]
Abstract
One in every twenty-five persons in America is a racial/ethnic minority who lives in a rural area. Our objective was to summarize how racism and, subsequently, the social determinants of health disproportionately affect rural racial/ethnic minority populations, provide a review of the cancer disparities experienced by rural racial/ethnic minority groups, and recommend policy, research, and intervention approaches to reduce these disparities. We found that rural Black and American Indian/Alaska Native populations experience greater poverty and lack of access to care, which expose them to greater risk of developing cancer and experiencing poorer cancer outcomes in treatment and ultimately survival. There is a critical need for additional research to understand the disparities experienced by all rural racial/ethnic minority populations. We propose that policies aim to increase access to care and healthcare resources for these communities. Further, that observational and interventional research should more effectively address the intersections of rurality and race/ethnicity through reduced structural and interpersonal biases in cancer care, increased data access, more research on newer cancer screening and treatment modalities, and continued intervention and implementation research to understand how evidence-based practices can most effectively reduce disparities among these populations.
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Martínez Valero AP, Amo-Saus E, Pardo-García I, Escribano-Sotos F. [Diet quality in a population aged over 65 and related socioeconomic factors]. Aten Primaria 2021; 53:27-35. [PMID: 32143973 PMCID: PMC7752958 DOI: 10.1016/j.aprim.2019.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 11/19/2019] [Accepted: 12/19/2019] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION The consumption of certain foods and healthy eating habits are related to preventing and suffering from a number of chronic diseases. These foods tend to be included in food pyramids, such as that proposed by the Spanish Society for Community Nutrition. One method of analysing diet quality is the use of indices that assess the frequency of consumption of different food groups. AIM To analyse diet quality in a Spanish population of persons aged over 65years using the Healthy Eating Index and to determine how sociodemographic factors affect scores on the index. DESIGN A cross-sectional, descriptive study was conducted on the diet followed at home by Spanish population aged over 65years, using the Healthy Eating Index and taking information from the 2014 European Health Interview Survey in Spain. Multiple linear regression analysis was used to determine the socioeconomic factors associated with diet quality. RESULTS Of the study population, 89.6% need to make changes in their diet, while only 8.2% follow a healthy diet. Suffering from chronic diseases, overweight and occasional physical exercise were associated with higher scores on the Healthy Eating Index. CONCLUSION Most of the population aged 65years or over need to make changes in their dietary patterns. Those with potential health risks are more careful about their diet. These findings confirm the need to promote guidelines for healthy eating in the non-clinical population.
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Affiliation(s)
- Ana Pilar Martínez Valero
- Centro de Estudios Sociosanitarios, Universidad de Castilla-La Mancha (UCLM), Cuenca, España; Servicios de Salud de Castilla-La Mancha (SESCAM), Albacete, España
| | - Elisa Amo-Saus
- Facultad de Ciencias Económicas y Empresariales, Universidad de Castilla-La Mancha (UCLM), Albacete, España.
| | - Isabel Pardo-García
- Centro de Estudios Sociosanitarios, Universidad de Castilla-La Mancha (UCLM), Cuenca, España; Facultad de Ciencias Económicas y Empresariales, Universidad de Castilla-La Mancha (UCLM), Albacete, España
| | - Francisco Escribano-Sotos
- Centro de Estudios Sociosanitarios, Universidad de Castilla-La Mancha (UCLM), Cuenca, España; Facultad de Ciencias Económicas y Empresariales, Universidad de Castilla-La Mancha (UCLM), Albacete, España
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Hossain S, Beydoun MA, Weiss J, Kuczmarski MF, Evans MK, Zonderman AB. Longitudinal associations between dietary quality and Alzheimer's disease genetic risk on cognitive performance among African American adults. Br J Nutr 2020; 124:1264-1276. [PMID: 32248879 PMCID: PMC7541564 DOI: 10.1017/s0007114520001269] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Poor diet quality (DQ) is associated with poor cognition and increased neurodegeneration, including Alzheimer's disease (AD). We are interested in the role of DQ on cognitive functioning (by sex and increasing genetic risk for AD), in a sample of African American (AA) middle-aged adults. We analysed a sub-group of participants (about 55 % women; mean follow-up time of about 4·7 years) from the Healthy Aging in Neighborhoods of Diversity across the Life Span study with a genetic risk score for AD (hAlzScore). The Healthy Eating Index-2010, Dietary Approaches to Stop Hypertension and the mean adequacy ratio computed at baseline (2004-2009) and follow-up visits (2009-2013) were used to assess initial DQ and change over time. Linear mixed-effects regression models were utilised, adjusting for select covariates, selection bias and multiple testing. DQ change (ΔDQ) was associated with California Verbal Learning Test-List A - overall (0·15 (se 0·06), P = 0·008) and in women (0·21 (se 0·08), P = 0·006), at highest AD risk, indicating protective effects over time. Greater AD risk was longitudinally associated with poorer Clock Command Test scores in men. Poor DQ was positively and cross-sectionally associated with Trails B scores, but in women only. Better-quality diet was associated with a slower decline in verbal memory among AA women, with greater AD risk. Insufficient clinical evidence and/or mixed findings dictate that more studies are needed to investigate brain morphology and volume changes in relation to DQ in an at-risk population for AD, over time.
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Affiliation(s)
- Sharmin Hossain
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIA/NIH/IRP, Baltimore, MD
| | - May A. Beydoun
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIA/NIH/IRP, Baltimore, MD
| | - Jordan Weiss
- Population Studies Center and the Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - Marie F. Kuczmarski
- Department of Behavioral Health and Nutrition, University of Delaware, Newark, DE, USA
| | - Michele K. Evans
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIA/NIH/IRP, Baltimore, MD
| | - Alan B. Zonderman
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIA/NIH/IRP, Baltimore, MD
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Dietary intake and diet quality by weight category among a racially diverse sample of women in Birmingham, Alabama, USA. J Nutr Sci 2020; 9:e58. [PMID: 33354329 PMCID: PMC7737174 DOI: 10.1017/jns.2020.51] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 10/23/2020] [Accepted: 11/06/2020] [Indexed: 11/07/2022] Open
Abstract
Diet is a modifiable contributor to health. The lack of adherence to recommended dietary guidelines may contribute to the disproportionate burden of obesity and other chronic conditions observed in the Deep South region of the United States. The objective of this cross-sectional study was to describe food group intake and diet quality by race and weight status of women in the Deep South. Study participants were eighty-nine healthy female volunteers (56 % black, 44 % white, mean age 39⋅7 ± 1⋅4 years) recruited from Birmingham, AL, USA. Body Mass Index (BMI) determined weight status (non-obese/obese). Healthy Eating Index-2010 (HEI-2010) calculated from dietary recalls assessed diet quality. Wilcoxon sum-rank test compared HEI-2010 scores by race and weight status. χ 2 analysis compared the percentage of women who achieved maximum points for HEI-2010 index food components by subgroup. Caloric and macronutrient intake did not differ by race or weight status (mean kcal 1863⋅0 ± 62⋅0). Median Total HEI-2010 Score for the sample was 51⋅9 (IQR: 39⋅1-63⋅4). Although there was no statistical difference in diet quality by race, more whites achieved the maximum score for vegetable intake compared to blacks, while blacks reported higher total fruit intake. Non-obese women reported better diet quality (56⋅9 v. 46⋅1; P = 0⋅04) and eating more whole fruits, and more achieved the maximum score for protein from plant and seafood sources. In summary, differences in diet quality were observed by weight status, but not race among this sample. These results point to tailored dietary interventions for women in metropolitan areas of Alabama, USA.
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Poor Medication Adherence in African Americans Is a Matter of Trust. J Racial Ethn Health Disparities 2020; 8:927-942. [PMID: 33215358 DOI: 10.1007/s40615-020-00850-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 08/13/2020] [Accepted: 08/17/2020] [Indexed: 12/30/2022]
Abstract
The purpose of this paper was to explore the lack of medication adherence in the African American patient community. The paper will address myths that many African American patients believe related to type 2 diabetes, hypertension treatment, and natural remedies. Research has shown that the disparities in the acceptance of healthcare provider advice and prescriptions are a significant concern particularly in African American patients. The acceptance of a provider's diagnosis and subsequent intervention can vary based on several issues including healthcare access, patient preferences, trust of a provider, and treatment recommendations. Patient influences can range from their ability to trust the provider (and what he/she says) to following through with their advice. Several studies have looked at the beliefs and misconceptions some African Americans hold regarding the treatment of hypertension and diabetes with some showing a preference for "natural remedies." This paper will leverage a literature review to seek out myths from African American patients to understand why they are dealing with challenges related to adherence with medication. The searches identified 58 research papers. The study applied an inductive content analysis approach to assess the research papers and identify themes. The barriers identified in this study include disbelief of the diagnosis, distrust for medication, mistrust for physicians and healthcare system, belief in alternative medicine, cultural/generation norms, and access/affordability of care. One of the most prominent factors that crossed all barriers was medical mistrust.
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15
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Ratcliff CG, Torres D, Tullos EA, Geng Y, Lu Q. A systematic review of behavioral interventions for rural breast cancer survivors. J Behav Med 2020; 44:467-483. [PMID: 32813192 DOI: 10.1007/s10865-020-00174-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 08/06/2020] [Indexed: 12/21/2022]
Abstract
Rural breast cancer survivors (RBCS) are at greater risk for poorer health outcomes and face greater treatment barriers compared to their urban counterparts, necessitating behavioral interventions tailored for the unique needs of RBCS. A systematic review of studies examining behavioral interventions delivered to RBCS living in the United States from 2000 to 2020 was conducted following PRIMSA guidelines. Nineteen unique studies were included: eight randomized controlled trials, two matched-control studies, six pre-post intervention feasibility studies, and three post-intervention satisfaction studies. Thirteen interventions aimed to improve psychosocial support, three to improve weight management, and three to improve education. Results indicate interventions' feasibility and acceptability. Six out of eight intervention conditions reported favorable outcomes compared to control conditions, suggesting promise for efficacy. However, variability in intervention objective, duration, delivery, and follow-up timing, and small sample sizes prevent overarching conclusions. Research involving larger sample sizes, higher quality control groups, and longer follow-up data is needed.
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Affiliation(s)
- Chelsea G Ratcliff
- Department of Psychology, Sam Houston State University, Campus Box 2447, Huntsville, TX, 77341-2447, USA. .,Baylor College of Medicine, Houston, TX, USA.
| | - Debbie Torres
- Department of Psychology, Sam Houston State University, Campus Box 2447, Huntsville, TX, 77341-2447, USA
| | - Emily A Tullos
- Department of Psychology, Sam Houston State University, Campus Box 2447, Huntsville, TX, 77341-2447, USA
| | - Yimin Geng
- Research Medical Library, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Qian Lu
- Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Angeles-Agdeppa I, Sun Y, Tanda KV. Dietary pattern and nutrient intakes in association with non-communicable disease risk factors among Filipino adults: a cross-sectional study. Nutr J 2020; 19:79. [PMID: 32746858 PMCID: PMC7397579 DOI: 10.1186/s12937-020-00597-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 07/27/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND This study evaluated the relationship between dietary quality and food patterns of Filipino adults and the rising prevalence of selected cardiometabolic non-communicable disease (NCD) risk factors. METHODS This is a cross-sectional study that examined the association of dietary pattern and NCDs using data collected in the 2013 National Nutrition Survey. A total of 19,914 adults aged 20 years and above were included in the analyses. The Alternative Healthy Eating Index (AHEI-2010) was used to characterize the dietary quality, and principal component analysis (PCA) was used to identify dietary patterns specific to the study population. Logistic regression models were applied to assess the association between the dietary pattern scores and selected cardiometabolic NCD indices including diabetes, hypertension, dyslipidemia and overweight and obesity with adjustment for potential confounders. RESULTS The mean AHEI-2010 score was 19.7 for women and 18.9 for men out of a total possible score of 100. Three major dietary patterns were identified through PCA: 1) meat and sweetened beverages (MSB); 2) rice and fish (RF) and 3) fruit, vegetables and snack (FVS). After adjustment for potential confounding factors, the AHEI pattern was associated with higher odds of overweight/obesity [extreme-tertile odds ratio (OR) 1.10, 95% confidence interval (CI) 1.02-1.21]. Subjects in the highest tertile of the MSB pattern had greater odds for overweight/obesity, diabetes, high total cholesterol, low HDL-cholesterol, high LDL-cholesterol, and high triglycerides (OR ranging 1.20 to 1.70, all p-value < 0.001). The RF pattern was associated with higher probability of overweight/obesity (OR 1.20, 95% CI 1.08-1.32) high LDL-cholesterol (OR 1.20, 95% CI 1.07-1.37), and less likelihood of diabetes (OR 0.87, 95% CI 0.77-0.98). The FVS pattern was associated with lower probability of overweight/obesity, diabetes, high triglycerides, and hypertension (OR ranging 0.85 to 0.90, all p-value < 0.05). CONCLUSIONS Diet quality of Filipino adults is extremely poor. MSB and RF patterns were associated with a higher risk of cardiometabolic NCD indices, while FVS pattern was associated to lower risks. Identifying healthy and detrimental dietary patterns in the local diet could be informative for future local-based dietary recommendation and area-specific intervention programs.
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Affiliation(s)
- Imelda Angeles-Agdeppa
- Department of Science and Technology, Food and Nutrition Research Institute, Bicutan, Taguig, Philippines.
| | - Ye Sun
- Nestlé Research Singapore Hub, Singapore, Singapore.
| | - Keith V Tanda
- Department of Science and Technology, Food and Nutrition Research Institute, Bicutan, Taguig, Philippines
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Kirkpatrick SI, Reedy J, Krebs-Smith SM, Pannucci TE, Subar AF, Wilson MM, Lerman JL, Tooze JA. Applications of the Healthy Eating Index for Surveillance, Epidemiology, and Intervention Research: Considerations and Caveats. J Acad Nutr Diet 2018; 118:1603-1621. [PMID: 30146072 PMCID: PMC6730554 DOI: 10.1016/j.jand.2018.05.020] [Citation(s) in RCA: 175] [Impact Index Per Article: 29.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 05/23/2018] [Indexed: 12/31/2022]
Abstract
The Healthy Eating Index (HEI) is a measure of diet quality that can be used to examine alignment of dietary patterns with the Dietary Guidelines for Americans. The HEI is made up of multiple adequacy and moderation components, most of which are expressed relative to energy intake (ie, as densities) for the purpose of calculating scores. Due to these characteristics and the complexity of dietary intake data more broadly, calculating and using HEI scores can involve unique statistical considerations and, depending on the particular application, intensive computational methods. The objective of this article is to review potential applications of the HEI, including those relevant to surveillance, epidemiology, and intervention research, and to summarize available guidance for appropriate analysis and interpretation. Steps in calculating HEI scores are reviewed and statistical methods described. Consideration of salient issues in the calculation and interpretation of scores can help researchers avoid common pitfalls and reviewers ensure that articles reporting on the use of the HEI include sufficient details such that the work is comprehensible and replicable, with the overall goal of contributing to knowledge on dietary patterns and health among Americans.
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Abstract
Alongside declining activity levels, energy needs fall in older age and eating less is expected. However, as total food consumption declines, intakes of many nutrients are also likely to fall; while energy requirements may be met, other nutrient needs may not. Although this highlights the importance of nutrient-dense foods and overall diet quality in older age to ensure nutrient intakes are sufficient, maintaining or increasing diet quality may be difficult at a time when food access and preparation are becoming more challenging, and diets may be more monotonous. Poor nutrition, even in developed settings, is common. Older malnourished adults are more likely to have poorer health outcomes, longer hospital stays and increased mortality. Thus, apart from the evident personal costs, the economic burden of disease-related malnutrition is significant, and effective preventive strategies to promote good nutrition among older populations are needed. In particular, there is a need for wider recognition of malnutrition risk among older adults, including implementation of routine screening of nutritional status and early diagnosis. Design of future interventions to support older community-dwelling adults requires a clear understanding of the personal and contextual influences that affect patterns of food choice and consumption, including consideration of the importance of social and psychological factors. In addition, there are opportunities to intervene earlier in the lifecourse; the most effective preventive efforts to promote good nutrition in older age may need to start ahead of age-related changes in physiology and function, including younger adulthood and at the retirement transition.
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Aparicio-Ugarriza R, Rumi C, Luzardo-Socorro R, Mielgo-Ayuso J, Palacios G, Bibiloni MM, Julibert A, Argelich E, Tur JA, González-Gross M. Seasonal variation and diet quality among Spanish people aged over 55 years. J Physiol Biochem 2017; 74:179-188. [PMID: 29143243 DOI: 10.1007/s13105-017-0599-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 11/06/2017] [Indexed: 01/13/2023]
Abstract
There is evidence supporting the importance of a healthy diet; however, there are few studies analyzing the seasonal variation of food intake. The present study was aimed to evaluate seasonal variation of food and energy intake in Spanish elderly also to investigate diet quality based on the Healthy Eating Index (HEI) score. From a cross-sectional study, 28 individuals (39% males) aged over 55 years volunteered for a longitudinal follow-up. Dietary assessment was evaluated through 24-h dietary recalls. Energy and nutrient intake were calculated using DIAL software. Furthermore, diet quality was measured using HEI. Data was analyzed considering the interaction of sex, age, fitness status, and body composition. Cereals intake was significantly lower in summer than in winter and autumn (both p < 0.05); whereas, drinks intake was significantly higher in summer than in winter, spring, and autumn (all p < 0.01). Daily energy intake was significant higher in spring than in summer, and in autumn than in summer (p < 0.05), and energy intake from lunch was also statistically higher in spring than in summer (p < 0.01). The HEI was classified as good; however, a negative and significant association was observed between HEI and cholesterol, alcohol, and monounsaturated fatty acids intake (p < 0.01). Cereals and drinks intake and total daily energy intake changed according to seasons. This should be considered in nutritional studies. Diet quality seems not to be affected by these seasonal changes, and HEI did not show a good association with the majority of foods and macro- and micronutrients.
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Affiliation(s)
- R Aparicio-Ugarriza
- ImFINE Research Group, Department of Health and Human Performance, Faculty of Physical Activity and Sport Science-INEF, Universidad Politécnica de Madrid, C/Martin Fierro no. 7, E-28040, Madrid, Spain
| | - C Rumi
- ImFINE Research Group, Department of Health and Human Performance, Faculty of Physical Activity and Sport Science-INEF, Universidad Politécnica de Madrid, C/Martin Fierro no. 7, E-28040, Madrid, Spain
| | - R Luzardo-Socorro
- ImFINE Research Group, Department of Health and Human Performance, Faculty of Physical Activity and Sport Science-INEF, Universidad Politécnica de Madrid, C/Martin Fierro no. 7, E-28040, Madrid, Spain
| | - J Mielgo-Ayuso
- ImFINE Research Group, Department of Health and Human Performance, Faculty of Physical Activity and Sport Science-INEF, Universidad Politécnica de Madrid, C/Martin Fierro no. 7, E-28040, Madrid, Spain
| | - G Palacios
- ImFINE Research Group, Department of Health and Human Performance, Faculty of Physical Activity and Sport Science-INEF, Universidad Politécnica de Madrid, C/Martin Fierro no. 7, E-28040, Madrid, Spain.,CIBEROBN (Physiopathology of Obesity and Nutrition CB12/03/30038), Madrid, Spain
| | - M M Bibiloni
- CIBEROBN (Physiopathology of Obesity and Nutrition CB12/03/30038), Madrid, Spain.,Research Group on Community Nutrition and Oxidative Stress (NUCOX), University of the Balearic Islands, Palma de Mallorca, Spain
| | - A Julibert
- Research Group on Community Nutrition and Oxidative Stress (NUCOX), University of the Balearic Islands, Palma de Mallorca, Spain
| | - E Argelich
- CIBEROBN (Physiopathology of Obesity and Nutrition CB12/03/30038), Madrid, Spain.,Research Group on Community Nutrition and Oxidative Stress (NUCOX), University of the Balearic Islands, Palma de Mallorca, Spain
| | - J A Tur
- CIBEROBN (Physiopathology of Obesity and Nutrition CB12/03/30038), Madrid, Spain.,Research Group on Community Nutrition and Oxidative Stress (NUCOX), University of the Balearic Islands, Palma de Mallorca, Spain
| | - M González-Gross
- ImFINE Research Group, Department of Health and Human Performance, Faculty of Physical Activity and Sport Science-INEF, Universidad Politécnica de Madrid, C/Martin Fierro no. 7, E-28040, Madrid, Spain. .,CIBEROBN (Physiopathology of Obesity and Nutrition CB12/03/30038), Madrid, Spain.
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20
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Abshire DA, Lennie TA, Chung ML, Biddle MJ, Barbosa-Leiker C, Moser DK. Body Mass Index Category Moderates the Relationship Between Depressive Symptoms and Diet Quality in Overweight and Obese Rural-Dwelling Adults. J Rural Health 2017; 34:377-387. [PMID: 28686799 DOI: 10.1111/jrh.12255] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 04/09/2017] [Accepted: 05/26/2017] [Indexed: 11/27/2022]
Abstract
PURPOSE This study was conducted to (1) compare diet quality among depressed and nondepressed overweight and obese rural-dwelling adults and (2) determine whether body mass index (BMI) category moderates the relationship between depressive symptoms and overall diet quality. METHODS Rural adults in Kentucky (n = 907) completed the 9-item Patient Health Questionnaire (PHQ-9) that assessed depressive symptoms and a food frequency questionnaire that generated 2005 Healthy Eating Index (HEI) scores. Participants were grouped into overweight (BMI 25-29.9 kg/m2 ) and obese (≥30 kg/m2 ), and nondepressed (PHQ-9 < 10) and depressed (PHQ-9 ≥ 10) groups. Bootstrapped ANCOVAs were used to compare diet quality among the 4 groups. Ordinary least-squares regression using PROCESS was used to determine whether BMI category (overweight vs obese) moderated the association between depressive symptoms and overall diet quality. RESULTS Overall diet quality was poorer in the obese depressed group than in the obese nondepressed group. Intake of fruit and dark green/orange vegetables and legumes was lower in the obese depressed group than in the overweight nondepressed group. Depressive symptoms predicted poor overall diet quality (B = -0.287, P < .001) and the relationship was moderated by BMI category (coefficient of BMI category* depressive symptom interaction term = 0.355, P < .049). A significant inverse relationship between depressive symptoms and overall diet quality was observed in the overweight group but not in the obese group. CONCLUSION Components of diet quality vary according to BMI category and depressive symptom status. The relationship between depressive symptoms and diet quality is influenced by BMI category.
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Affiliation(s)
| | - Terry A Lennie
- College of Nursing, University of Kentucky, Lexington, Kentucky
| | - Misook L Chung
- College of Nursing, University of Kentucky, Lexington, Kentucky
| | - Martha J Biddle
- College of Nursing, University of Kentucky, Lexington, Kentucky
| | | | - Debra K Moser
- College of Nursing, University of Kentucky, Lexington, Kentucky
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Batai K, Murphy AB, Ruden M, Newsome J, Shah E, Dixon MA, Jacobs ET, Hollowell CMP, Ahaghotu C, Kittles RA. Race and BMI modify associations of calcium and vitamin D intake with prostate cancer. BMC Cancer 2017; 17:64. [PMID: 28103838 PMCID: PMC5248493 DOI: 10.1186/s12885-017-3060-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 01/12/2017] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND African Americans have disproportionately higher burden of prostate cancer compared to European Americans. However, the cause of prostate cancer disparities is still unclear. Several roles have been proposed for calcium and vitamin D in prostate cancer pathogenesis and progression, but epidemiologic studies have been conducted mainly in European descent populations. Here we investigated the association of calcium and vitamin D intake with prostate cancer in multiethnic samples. METHODS A total of 1,657 prostate cancer patients who underwent screening and healthy controls (888 African Americans, 620 European Americans, 111 Hispanic Americans, and 38 others) from Chicago, IL and Washington, D.C. were included in this study. Calcium and vitamin D intake were evaluated using food frequency questionnaire. We performed unconditional logistic regression analyses adjusting for relevant variables. RESULTS In the pooled data set, high calcium intake was significantly associated with higher odds for aggressive prostate cancer (ORQuartile 1 vs. Quartile 4 = 1.98, 95% C.I.: 1.01-3.91), while high vitamin D intake was associated with lower odds of aggressive prostate cancer (ORQuartile 1 vs. Quartile 4 = 0.38, 95% C.I.: 0.18-0.79). In African Americans, the association between high calcium intake and aggressive prostate cancer was statistically significant (ORQuartile 1 vs. Quartile 4 = 4.28, 95% C.I.: 1.70-10.80). We also observed a strong inverse association between total vitamin D intake and prostate cancer in African Americans (ORQuartile 1 vs. Quartile 4 = 0.06, 95% C.I.: 0.02-0.54). In European Americas, we did not observe any significant associations between either calcium or vitamin D intake and prostate cancer. In analyses stratifying participants based on Body Mass Index (BMI), we observed a strong positive association between calcium and aggressive prostate cancer and a strong inverse association between vitamin D intake and aggressive prostate cancer among men with low BMI (<27.8 kg/m2), but not among men with high BMI (≥27.8 kg/m2). Interactions of race and BMI with vitamin D intake were significant (P Interaction < 0.05). CONCLUSION Calcium intake was positively associated with aggressive prostate cancer, while vitamin D intake exhibited an inverse relationship. However, these associations varied by race/ethnicity and BMI. The findings from this study may help develop better prostate cancer prevention and management strategies.
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Affiliation(s)
- Ken Batai
- Division of Urology, Department of Surgery, The University of Arizona College of Medicine, University of Arizona Cancer Center, 1515 N. Campbell Ave, P.O. Box 245024, Tucson, AZ, 85724, USA.
| | - Adam B Murphy
- Department of Urology, Feinberg School of Medicine, Northwestern University, 303 E. Chicago Ave, Chicago, IL, 60611, USA
| | - Maria Ruden
- Department of Medicine, University of Illinois at Chicago, 840 South Wood Street, Suite 1020 N (MC 787), Chicago, IL, 60612, USA
| | - Jennifer Newsome
- Center for Clinical and Translational Science, University of Illinois at Chicago, 914 S Wood Street (MC 595), Chicago, IL, 60612, USA
| | - Ebony Shah
- Division of Urology, Department of Surgery, The University of Arizona College of Medicine, University of Arizona Cancer Center, 1515 N. Campbell Ave, P.O. Box 245024, Tucson, AZ, 85724, USA
| | - Michael A Dixon
- Department of Urology, Feinberg School of Medicine, Northwestern University, 303 E. Chicago Ave, Chicago, IL, 60611, USA
| | - Elizabeth T Jacobs
- Division of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N. Martin Ave, PO Box 245210, Tucson, AZ, 85724, USA
| | - Courtney M P Hollowell
- Division of Urology, Cook County Health and Hospitals System, 1900 W. Polk Ave., Suite 465, Chicago, IL, 60612, USA
| | - Chiledum Ahaghotu
- Carney Hospital-Steward Health System, 2100 Dorchester Avenue, Dorchester, MA, 02124, USA
| | - Rick A Kittles
- Division of Urology, Department of Surgery, The University of Arizona College of Medicine, University of Arizona Cancer Center, 1515 N. Campbell Ave, P.O. Box 245024, Tucson, AZ, 85724, USA
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Li W, Youssef G, Procter-Gray E, Olendzki B, Cornish T, Hayes R, Churchill L, Kane K, Brown K, Magee MF. Racial Differences in Eating Patterns and Food Purchasing Behaviors among Urban Older Women. J Nutr Health Aging 2017; 21:1190-1199. [PMID: 29188879 PMCID: PMC5726305 DOI: 10.1007/s12603-016-0834-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To examine differences in diet and food purchasing behaviors between Black and White older women living in urban neighborhoods. DESIGN Cross-sectional observational study. SETTING Urban neighborhoods in Washington, DC, USA. PARTICIPANTS Community-dwelling White and Black women of age 65 and older. MEASUREMENTS Participants were queried on diet via 24-hour recalls, food purchasing habits, their use of neighborhood resources and local travel patterns. Frequency and location of self-reported food purchasing and consumption were compared by race. RESULTS In 2014 and 2015, 49 White and 44 Black older women were enrolled in the study. Compared to Whites, Blacks reported lower daily caloric intake (mean (SD) 1314 (404) vs. 1529 (448), p=0.02), with a higher percent of calories from protein and fat 1.8 (7.0), p=0.03), and a slightly higher polyunsaturated to saturated fat ratio (p=0.05). Blacks had substantially lower alternate healthy eating index (AHEI) (33.5 (10.2) vs. 43.9 (10.8) of 80 possible points, p<0.001), daily intake (grams) of total fiber (15.3 (8.1) vs. 22.9 (8.5), p<0.001), insoluble fiber (10.8 (6.9) vs. 15.9 (6.5), p<0.001), and soluble fiber (4.5 (2.0) vs. 6.9 (2.8), p<0.001). Blacks had lower intake of micronutrients, alcohol and caffeine. Blacks shopped for groceries less often (4.4 (3.0) vs. 6.2 (3.0) monthly; p=0.006) and spent a longer time traveling to stores (15.8 (9.1) vs. 11.5 (7.2) minutes per trip, p=0.02). A lower percent of Blacks walked to stores (14% vs. 40%, p=0.003) and a higher percent of Blacks rode in a car with someone else (33% vs. 6%, p<0.001). CONCLUSIONS In an urban setting, food consumption and purchasing behaviors differed substantially between older Black and White women, which should be further investigated and considered to promote healthy eating in older populations.
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Affiliation(s)
- W Li
- Wenjun Li, PhD, Health Statistics and Geography Lab, Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School S4-314, 55 Lake Avenue North, Worcester, MA 01655, Phone: 774-455-4215 Fax: 508-856-4543,
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Vilaro MJ, Barnett TE, Mathews A, Pomeranz J, Curbow B. Income differences in social control of eating behaviors and food choice priorities among southern rural women in the US: A qualitative study. Appetite 2016; 107:604-612. [PMID: 27612560 DOI: 10.1016/j.appet.2016.09.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Revised: 09/01/2016] [Accepted: 09/04/2016] [Indexed: 02/07/2023]
Abstract
The role of social influences on rural women's food choice is not well understood. Rural adults experience high rates of obesity and poor diet quality prompting exploration of how social factors influence food choice in this population. Semi-structured qualitative interviews were conducted with 20 women in rural North Central Florida. Women were purposively sampled and stratified by race and income. Lower income was defined as household income at or below 185% of the federal poverty level (FPL). Women at or below 185% poverty level (BPL) experienced direct social control of their eating behaviors, which occurred when social network members explicitly regulated or otherwise sanctioned eating behaviors or food choices. Women above 185% of the federal poverty level (APL) internalized social norms and self-regulated their eating behaviors to maintain healthy habits. APL women described choosing foods for health reasons whereas BPL women offered a variety of reasons including taste, convenience, family history, price, health, and routine. Findings suggest that women in different income groups have different social influences working to help them regulate eating behaviors as well as diverse priorities influencing their food choices. Future interventions to promote healthy eating may be more effective by incorporating social network members and framing intervention messages so they are consistent with priorities.
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Affiliation(s)
- Melissa J Vilaro
- Department of Behavioral Science and Community Health, University of Florida, College of Public Health and Health Professions, 1225 Center Drive, P.O. Box 100175 HSC, Gainesville, FL 32610-0175, USA.
| | - Tracey E Barnett
- Department of Behavioral Science and Community Health, University of Florida, College of Public Health and Health Professions, 1225 Center Drive, P.O. Box 100175 HSC, Gainesville, FL 32610-0175, USA
| | - Anne Mathews
- Food Science and Human Nutrition Department, University of Florida, Institute of Food and Agricultural Sciences, P.O. Box 110370, 359 FSHN Bldg., 572 Newell Dr., Gainesville, FL 32611-0370, USA
| | - Jamie Pomeranz
- Department of Behavioral Science and Community Health, University of Florida, College of Public Health and Health Professions, 1225 Center Drive, P.O. Box 100175 HSC, Gainesville, FL 32610-0175, USA
| | - Barbara Curbow
- Department of Behavioral Science and Community Health, University of Florida, College of Public Health and Health Professions, 1225 Center Drive, P.O. Box 100175 HSC, Gainesville, FL 32610-0175, USA
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Hardin-Fanning F, Ricks JM. Attitudes, social norms and perceived behavioral control factors influencing participation in a cooking skills program in rural Central Appalachia. Glob Health Promot 2016; 24:43-52. [PMID: 27312335 DOI: 10.1177/1757975916636792] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A focus group session, using the Theory of Planned Behavior to guide questions and discussion, was conducted at midpoint of a 12-month cooking skills program in a rural Appalachian food desert. The purpose of this qualitative study was to determine the attitudes, subjective norms and perceived behavioral control beliefs that influenced participation in these classes. Participants viewed the classes as opportunities for social interaction and to have new experiences. Subjective norms were influenced by family members and traditional cooking. Perceived behavioral control was influenced by the opportunity to try new foods without concern of food waste, acquisition of the knowledge to introduce healthy foods into family meals and enhanced food preparation skills. During the evaluation, a strong sense of participant appreciation of researcher presence was discovered. This unexpected positive component of the program will be promoted using motivational interviewing techniques to enhance adherence to healthy eating behaviors during and after cooking skills programs.
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Affiliation(s)
| | - JaNelle M Ricks
- 2. Department of Behavioral Sciences and Health Education, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
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Jomaa L, Hwalla N, Itani L, Chamieh MC, Mehio-Sibai A, Naja F. A Lebanese dietary pattern promotes better diet quality among older adults: findings from a national cross-sectional study. BMC Geriatr 2016; 16:85. [PMID: 27093883 PMCID: PMC4837523 DOI: 10.1186/s12877-016-0258-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 04/13/2016] [Indexed: 12/25/2022] Open
Abstract
Background Proper nutrition is critical for healthy aging and maintaining functional independence. Limited research has been done on the assessment of dietary patterns of older adults and their association with diet quality indices. This study was conducted to identify, characterize, and evaluate the dietary patterns and diet quality of older adults in Lebanon, a middle-income country undergoing nutrition transition. Methods A cross-sectional population-based study was conducted on a nationally representative sample of community-dwelling older adults aged >50 years (n = 525). Socio-demographic, anthropometric, and lifestyle variables were collected through interviews, and dietary intake was assessed using a semi-quantitative food frequency questionnaire (FFQ). Five commonly used diet quality indices (DQIs) were calculated, including the Alternative Healthy Eating Index (AHEI), the alternate Mediterranean diet score (aMed), the Dietary Approach to Stop Hypertension (DASH) style diet score, and the Lebanese Mediterranean Diet index. Dietary patterns (DPs) were derived using exploratory factor analysis. Associations of identified DPs with energy, energy-adjusted nutrients, and DQIs were evaluated by Pearson’s correlations. Multiple linear regression analyses were used to examine correlates of DPs. Results Three DPs were derived: Lebanese, Western, and High Protein/Alcohol patterns. The Lebanese pattern had highest correlations with fiber, folate, vitamin C, and all five DQIs. The Western was positively associated with energy and sodium and was inversely correlated with fiber, most vitamins, and a number of DQIs, namely AHEI, aMED, and DASH-style diet score. Highest correlations with intakes of proteins and fat were observed for the High Protein/Alcohol pattern. The Lebanese pattern was associated with female gender, education, nonsmoking and physical activity, whereas the Western pattern was associated with adverse health behaviors, including smoking, skipping breakfast, and physical inactivity. Conclusions Of the three identified patterns, the Lebanese DP was associated with better diet quality and healthier lifestyle behaviors while the Western pattern implicated a lower quality diet. Public health programs promoting prudent diets, including the Mediterranean and Lebanese DPs, are needed to improve the diet quality of middle-aged and older adults in an attempt to improve their functionality and quality of life.
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Affiliation(s)
- Lamis Jomaa
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, P.O. Box 11-0.236, Riad El Solh 11072020, Beirut, Lebanon
| | - Nahla Hwalla
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, P.O. Box 11-0.236, Riad El Solh 11072020, Beirut, Lebanon
| | - Leila Itani
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Beirut Arab University, Beirut, Lebanon
| | - Marie Claire Chamieh
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, P.O. Box 11-0.236, Riad El Solh 11072020, Beirut, Lebanon
| | - Abla Mehio-Sibai
- Department of Epidemiology and Public Health, Faculty of Health Sciences, American University of Beirut, P.O. Box 11-0.236, Riad El Solh 11072020, Beirut, Lebanon
| | - Farah Naja
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, P.O. Box 11-0.236, Riad El Solh 11072020, Beirut, Lebanon.
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Clum G, Gustat J, O'Malley K, Begalieva M, Luckett B, Rice J, Johnson C. Factors Influencing Consumption of Fruits and Vegetables in Older Adults in New Orleans, Louisiana. J Nutr Health Aging 2016; 20:678-84. [PMID: 27499299 DOI: 10.1007/s12603-016-0695-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND OBJECTIVES The objective of this study was to identify demographic, social and structural factors associated with intake of fruit and vegetables in older adults in New Orleans, Louisiana. DESIGN A cross-sectional randomly sampled, address-based telephone survey of households in Orleans Parish, Louisiana was conducted with the household's main grocery shopper. SETTING All participants were in the New Orleans metro area and were surveyed in 2011. PARTICIPANTS Participants were 2,834 residents identified as the households' main grocery shopper in Orleans Parish, Louisiana. Participants were primarily female (75%), African-American (53%), approximately 10 percent of the sample reported receipt of government assistance. Approximately 37% of the sample was age 65 and older. MEASUREMENTS Measures included a telephone administered survey assessing demographic characteristics, food intake, access to supermarkets and other food sources, transportation, self-reported health, and frequency of grocery shopping. RESULTS Older adults consumed fewer fresh fruits and vegetables (FV) than younger adults (p<0.01). Bivariate associations with decreased FV included older age, receipt of government assistance, African American race, use of mobility aid, and poorer health. Multivariate factors associated with lower consumption include age, African American race, and poorer self-reported health. Women reported more fruit and vegetable consumption than men. CONCLUSIONS FV consumption is associated with improved health and reduced mortality. Older adults are less likely to consume fruits and vegetables, therefore addressing reduced FV consumption in older adults is a potential target for improving health outcomes in older adults. Specifically targeting African Americans and those with poorer health, as well as males may be an important focus for interventions.
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Affiliation(s)
- G Clum
- Gretchen Clum, 1440 Canal st tw 19, New Orleans, LA 70112, USA,
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Moreira OC, Oliveira RARD, Oliveira CEPD, Doimo LA, Amorim PRDS, Marins JCB. Anthropometric, cardiovascular and functional variables as indicators of health related physical fitness in university professors. FISIOTERAPIA EM MOVIMENTO 2015. [DOI: 10.1590/0103-5150.028.003.ao13] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
AbstractObjective To verify the behavior of anthropometric, cardiovascular and functional variables as indicators of health-related physical fitness in university professors and perform a comparison of these variables between sexes.Materials and methods We conducted an observational epidemiological cross-sectional study in 145 professors (45.86 ± 9.7 years), 103 men (71.03%), which were evaluated by measuring heart rate (HR) and systolic (SBP) and diastolic (DBP) pressure at rest, body weight, height, body mass index (BMI), body fat percentage (BF%), handgrip strength (HGS), flexibility and cardiorespiratory fitness (CRF). We proceeded to the descriptive analysis, Student t-test for comparison between sexes and multiple regression analysis to verify the association between the variables analyzed. It was adopted a significance level of p < 0.05.Results The sex affected all variables. Women had better levels of BMI, flexibility, SBP and DBP. The BF% and CRF were associated with SBP and BMI in both sexes.Conclusion The behavior of anthropometric, cardiovascular and functional variables indicated unsatisfactory values for flexibility, HGS and BMI, with the worst levels among men. Furthermore, the variables that showed better association with HRPF were BF% and CRF.
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Hosseini SA, Farsi Zaban M. Risky behaviors and life status as risk factors for spontaneous abortion. INTERNATIONAL JOURNAL OF HIGH RISK BEHAVIORS & ADDICTION 2014; 3:e17635. [PMID: 25741478 PMCID: PMC4331652 DOI: 10.5812/ijhrba.17635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Revised: 05/28/2014] [Accepted: 06/16/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND The Health outcomes of an individual depend on his /her life position. OBJECTIVES The purpose of the present paper aimed to study spontaneous abortion (as a high risk factor among rural pregnant) due to their life status. PATIENTS AND METHODS The study was conducted among 40 young rural pregnant women, 12 to 20 years old by implementing a questionnaire during 2012 to 2013 in four villages in southeast of Iran. The women were exposed to high-risk factors such as shortage or lack of drinking water, high pressure electric power sources and chemicals released from burning gas both from cooking and cars as a fuel. The data were collected from the pregnant women coming into clinics. Results of the t-test and chi-square identified significant (P < 0.05; 95% CI) and adjustment for birth variables. RESULTS The findings revealed that pregnant women were without spontaneous abortion (100%) in villages of Iranshahr; while the pregnant women in Sarbaz villages experienced spontaneous abortion (30%). The houses were built from brick (80%), wood (15%) and fiber (5%) in villages of Iranshahr district; and from brick (45%), and stone (55%), in villages of Sarbaz district. Twenty percent of residents in the villages of Iranshahr were exposed to high-risk situations, while none in Sarbaz villages. Although all villages had 100% electric power source, pregnant women had 95% and 20% piped drinking water in villages of Iranshahr and Sarbaz, respectively. No houses in both villages were equipped with the gas fuel system. CONCLUSIONS The findings suggest that a completely programmed surveillance program should be undertaken to implemented remedy in environmental shortages for pregnant rural women.
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Affiliation(s)
- Seyed Abbas Hosseini
- Department of Medicine, Zahedan University of Medical Sciences, Zahedan, IR Iran
- Corresponding author: Seyed Abbas Hosseini, Department of Medicine, Zahedan University of Medical Sciences, Zahedan, IR Iran. Tel: +98-9155408625, E-mail:
| | - Masoumeh Farsi Zaban
- Department of Medicine, Zahedan University of Medical Sciences, Zahedan, IR Iran
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Rurality and dietary patterns: associations in a UK cohort study of 10-year-old children. Public Health Nutr 2014; 18:1436-43. [DOI: 10.1017/s1368980014001864] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractObjectiveDespite differences in obesity and ill health between urban and rural areas in the UK being well documented, very little is known about differences in dietary patterns across these areas. The present study aimed to examine whether urban/rural status is associated with dietary patterns in a population-based UK cohort study of children.DesignDietary patterns were obtained using principal components analysis and cluster analysis of 3 d diet records collected from children at 10 years of age. Rurality was obtained from the 2001 UK Census urban/rural indicator at the time of dietary assessment. General linear models were used to examine the relationship between rurality and dietary pattern scores from principal components analysis; multinomial logistic regression was used to assess the association between rurality and dietary clusters.SettingThe Avon Longitudinal Study of Parents and Children (ALSPAC), South West England.SubjectsChildren (n 5677) aged 10 years (2817 boys and 2860 girls).ResultsAfter adjustment, increases in rurality were associated with increased scores on the ‘health awareness’ dietary pattern (β=0·35; 95 % CI 0·14, 0·56; P<0·001 for the most rural compared with the most urban group) and lower scores on the ‘packed lunch/snack’ dietary pattern (β=−0·39; 95 % CI −0·59, −0·19; P<0·001 for the most rural compared with the most urban group). The odds ratio for participants being in the ‘healthy’ compared with the ‘processed’ dietary cluster for the most rural areas was 1·61 (95 % CI 1·05, 2·49; P=0·02) compared with those in the most urban areas.ConclusionsThere is evidence to suggest that differences exist in dietary patterns between rural and urban areas. Similar results were found using two different methods of dietary pattern analysis, showing that children residing in rural households were more likely to consume healthier diets than those in urban households.
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Hardin-Fanning F, Gokun Y. Gender and age are associated with healthy food purchases via grocery voucher redemption. Rural Remote Health 2014; 14:2830. [PMID: 25063239 PMCID: PMC4331127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
INTRODUCTION Grocery vouchers that specifically target foods associated with reduced cardiovascular disease (CVD) risk result in increased consumption of those foods. In regions with disproportionately high CVD rates, there is little research concerning the impact of vouchers on purchases of risk-reducing foods when there are no restrictions placed on grocery voucher redemption. Since many food assistance programs place few restrictions on type of foods that can be purchased, identifying demographic factors associated with purchasing habits is a prerequisite to promoting healthy eating. The purpose of this study was to determine the associations of age, gender, education and income level with purchasing of healthful foods through the use of a grocery voucher in a rural food desert (poverty rate of ≥20% and ≥33% of residents living >16 km from a large grocery store) with high rates of chronic disease. METHODS The effectiveness of an intervention that included a media campaign, a $5 grocery voucher, local heart healthy food branding and a grocery store event was tested. Brief nutritional articles were published in both local newspapers during four consecutive weeks. These articles explained the physiological actions of healthy foods and listed a health-promoting recipe. During the fourth week of the media campaign, a voucher for a $5 grocery gift card redeemable at one of either community grocery stores was also printed in both local newspapers. In each store, foods that are known to be associated with a reduced risk of CVD were marked with a blue logo. Participants (N=311) completed a questionnaire that assessed demographics and usual servings of fruits, vegetables and grains. Participants received a $5 grocery card and a list of labelled foods. Returned grocery receipts were stapled to the questionnaires to analyse the relationship between demographics and food choices. RESULTS Participants who bought at least one labelled food item were older (M=48.5, SD=14.7) than those who did not buy any of these items (M=42.3, SD=16.4; p=0.0008). There was a significant association between labelled food purchases and gender, with 47% of male participants purchasing at least one labelled food item compared with 63% of females in the study (p = 0.008). There were no significant associations between purchase of labelled food items and either education or income. The significant predictors were age (p=0.003) and gender (p=0.01). For every 10 year increase in age, there was a 29% increase in the likelihood that at least one labelled food item would be purchased. Male participants were 48% less likely to purchase at least one designated food item than female participants were. CONCLUSIONS Younger adults and men may be less responsive to media-based educational strategies, heart-healthy food labelling and grocery vouchers to defray the cost of healthy eating than older adults and women. Previous studies show that concerns about cost and availability of foods are greater factors in the decision to purchase these foods than demographic characteristics. However, age and gender are associated with the likelihood of using grocery vouchers for the purchase of healthful foods. Additional research is needed to determine whether different educational strategies paired with food labelling and grocery vouchers may be successful strategies to promote purchase of healthful foods, particularly for men and younger adults.
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Affiliation(s)
| | - Yevgeniya Gokun
- University of Kentucky College of Nursing, Lexington, Kentucky , USA.
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Teufel-Shone NI, Jiang L, Beals J, Henderson WG, Zhang L, Acton KJ, Roubideaux Y, Manson SM. Demographic characteristics and food choices of participants in the Special Diabetes Program for American Indians Diabetes Prevention Demonstration Project. ETHNICITY & HEALTH 2014; 20:327-40. [PMID: 24954106 PMCID: PMC5108238 DOI: 10.1080/13557858.2014.921890] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
OBJECTIVE American Indians and Alaska Natives (AI/ANs) suffer a disproportionate burden of diabetes. Identifying food choices of AI/ANs at risk of type 2 diabetes, living in both rural and urban settings, is critical to the development of culturally relevant, evidence-based education strategies designed to reduce morbidity and mortality in this population. DESIGN At baseline, 3135 AI/AN adults participating in the Special Diabetes Program for American Indians Diabetes Prevention Demonstration Project (SDPI-DP) completed a socio-demographic survey and a 27-item food frequency questionnaire (FFQ). The primary dietary behavior goal of SDPI-DP education sessions and lifestyle coaching is changes in food choices, i.e., increased fruits, vegetables and whole grains, decreased high sugar beverages, red meat, and processed foods. Subsequently, program assessment focuses on changes in food types. Foods were delineated using a 'healthy' and 'unhealthy' classification as defined by the educators advising participants. Urban and rural differences were examined using χ(2) tests and two sample t-tests. Multiple linear regressions and linear mixed models were used to assess the association between socio-demographic factors and food choice. RESULTS Retired participants, those living in urban areas and with high income and education selected healthy foods most frequently. Young males, those with low income and education consumed unhealthy foods most frequently. Selection of unhealthy foods did not differ by urban and rural setting. CONCLUSIONS The ubiquitous nature of unhealthy food choices makes them hard to avoid. Food choice differences by gender, age, income, and setting suggest that nutrition education should more effectively target and meets the needs of young AI/AN males.
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Affiliation(s)
| | - Luohua Jiang
- Department of Epidemiology and Biostatistics, Texas A&M Health Science Center, College Station, TX, USA
| | - Janette Beals
- Center for American Indian and Alaska Native Health, University of Colorado Denver, Aurora, CO, USA
| | - William G. Henderson
- Colorado Health Outcomes Program, University of Colorado Denver, Aurora, CO, USA
| | - Lijing Zhang
- Center for American Indian and Alaska Native Health, University of Colorado Denver, Aurora, CO, USA
| | - Kelly J. Acton
- US Department of Health and Human Services, Office of the Assistant Secretary for Health – Region IX, San Francisco, CA, USA
| | | | - Spero M. Manson
- Center for American Indian and Alaska Native Health, University of Colorado Denver, Aurora, CO, USA
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Hsiao PY, Mitchell DC, Coffman DL, Allman RM, Locher JL, Sawyer P, Jensen GL, Hartman TJ. Dietary patterns and diet quality among diverse older adults: the University of Alabama at Birmingham Study of Aging. J Nutr Health Aging 2013; 17:19-25. [PMID: 23299373 PMCID: PMC3574872 DOI: 10.1007/s12603-012-0082-4] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To characterize dietary patterns among a diverse sample of older adults (≥ 65 years). DESIGN Cross-sectional. SETTING Five counties in west central Alabama. PARTICIPANTS Community-dwelling Medicare beneficiaries (N=416; 76.8 ± 5.2 years, 56% female, 39% African American) in the University of Alabama at Birmingham (UAB) Study of Aging. MEASUREMENTS Dietary data collected via three, unannounced 24-hour dietary recalls was used to identify dietary patterns. Foods were aggregated into 13 groups. Finite mixture modeling (FMM) was used to classify individuals into three dietary patterns. Differences across dietary patterns for nutrient intakes, sociodemographic, and anthropometric measurements were examined using chi-square and general linear models. RESULTS Three dietary patterns were derived. A "more healthful" dietary pattern, with relatively higher intakes of fruit, vegetables, whole grains, eggs, nuts, legumes and dairy, was associated with lower energy density, higher quality diets as determined by healthy eating index (HEI)-2005 scores and higher intakes of fiber, folate, vitamins C and B6, calcium, iron, magnesium, and zinc. The "western-like" pattern was defined by an intake of starchy vegetables, refined grains, meats, fried poultry and fish, oils and fats and was associated with lower HEI-2005 scores. The "low produce, high sweets" pattern was characterized by high saturated fat, and low dietary fiber and vitamin C intakes. The strongest predictors of better diet quality were female gender and non-Hispanic white race. CONCLUSION The dietary patterns identified may provide a useful basis on which to base dietary interventions targeted at older adults. Examination of nutrient intakes regardless of the dietary pattern suggests that older adults are not meeting nutrient recommendations and should continue to be encouraged to choose high quality diets.
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Affiliation(s)
- P Y Hsiao
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA 16802, USA.
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Asaad G, Chan CB. Relationship of Diet Quality to Food Security and Nutrition Knowledge in Low-Income, Community-Dwelling Elders with Type 2 Diabetes Mellitus: A Pilot Study. Can J Diabetes 2012. [DOI: 10.1016/j.jcjd.2012.10.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Lutfiyya MN, Chang LF, Lipsky MS. A cross-sectional study of US rural adults' consumption of fruits and vegetables: do they consume at least five servings daily? BMC Public Health 2012; 12:280. [PMID: 22490063 PMCID: PMC3365871 DOI: 10.1186/1471-2458-12-280] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2011] [Accepted: 04/10/2012] [Indexed: 11/26/2022] Open
Abstract
Background Rural residents are increasingly identified as being at greater risk for health disparities. These inequities may be related to health behaviors such as adequate fruits and vegetable consumption. There is little national-level population-based research about the prevalence of fruit and vegetable consumption by US rural population adults. The objective of this study was to examine the prevalence differences between US rural and non-rural adults in consuming at least five daily servings of combined fruits and vegetables. Methods Cross-sectional analysis of weighted 2009 Behavioral Risk Factor Surveillance Survey (BRFSS) data using bivariate and multivariate techniques. 52,259,789 US adults were identified as consuming at least five daily servings of fruits and vegetables of which 8,983,840 were identified as living in rural locales. Results Bivariate analysis revealed that in comparison to non-rural US adults, rural adults were less likely to consume five or more daily servings of fruits and vegetables (OR = 1.161, 95% CI 1.160-1.162). Logistic regression analysis revealed that US rural adults consuming at least five daily servings of fruits and vegetables were more likely to be female, non-Caucasian, married or living with a partner, living in a household without children, living in a household whose annual income was > $35,000, and getting at least moderate physical activity. They were also more likely to have a BMI of <30, have a personal physician, have had a routine medical exam in the past 12 months, self-defined their health as good to excellent and to have deferred medical care because of cost. When comparing the prevalence differences between rural and non-rural US adults within a state, 37 States had a lower prevalence of rural adults consuming at least five daily servings of fruits and vegetables and 11 States a higher prevalence of the same. Conclusions This enhanced understanding of fruit and vegetable consumption should prove useful to those seeking to lessen the disparity or inequity between rural and non-rural adults. Additionally, those responsible for health-related planning could benefit from the knowledge of how their state ranks in comparison to others vis-à-vis the consumption of fruits and vegetables by rural adults---a population increasingly being identified as one at risk for health disparities.
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Affiliation(s)
- M Nawal Lutfiyya
- Essentia Institute of Rural Health, Division of Research, 502 East 2nd Street, Duluth, MN, 55805, USA.
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Miller PE, Morey MC, Hartman TJ, Snyder DC, Sloane R, Cohen HJ, Demark-Wahnefried W. Dietary patterns differ between urban and rural older, long-term survivors of breast, prostate, and colorectal cancer and are associated with body mass index. J Acad Nutr Diet 2012; 112:824-31, 831.e1. [PMID: 22709810 PMCID: PMC3378989 DOI: 10.1016/j.jand.2012.02.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2011] [Accepted: 02/22/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND Older adult cancer survivors are at greater risk of cancer recurrence and other comorbidities that can be prevented through improved diet and weight management. The tertiary prevention needs of rural-dwelling survivors can be even greater, yet little is known about rural and urban differences in lifestyle factors among this high-risk population. OBJECTIVES To compare dietary patterns of urban and rural cancer survivors and to examine associations of dietary patterns with body mass index (BMI). DESIGN A secondary analysis was performed of baseline data from the Reach Out to Enhance Wellness (RENEW) trial, a diet and exercise intervention among overweight, long-term (≥5 years), older survivors of colorectal, breast, and prostate cancer. Survivors in the present analysis (n=729) underwent two 45- to 60-minute telephone surveys, which included two 24-hour dietary recalls. Principal components analysis and multivariable general linear models were used to derive dietary patterns and to evaluate associations between dietary patterns and BMI, respectively. RESULTS Principal components analysis identified three primary dietary patterns among rural dwellers (high sweets and starches, high reduced-fat dairy, cereal, nuts, and fruits, and mixed) and three among urban dwellers (high fruits and vegetables, high meat and refined grains, and high sugar-sweetened beverages). Among rural survivors, greater adherence to the high reduced-fat dairy, cereal, nuts, and fruits pattern was positively associated with lower BMI (P trend <0.05), whereas higher scores on the mixed pattern was associated with greater BMI (P trend <0.05). Greater adherence to the high fruits and vegetables pattern among urban survivors was inversely associated with BMI (P trend <0.05). CONCLUSIONS Urban and rural differences in dietary intake behavior should be considered in designing public health interventions among the increasing population of older cancer survivors. In addition, targeting overall dietary patterns might be one approach to help reduce the burden of obesity among this population.
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Affiliation(s)
- Paige E. Miller
- Cancer Prevention Fellowship Program, National Cancer Institute, National Institutes of Health, 6130 Executive Boulevard, EPN 4081, Rockville, MD 20852, Phone: (301) 594-2822, Fax: (301) 435-3710
| | - Miriam C. Morey
- Geriatric Research, Education, and Clinical Center, Durham VA Medical Center, Associate Professor, Department of Medicine, Duke University School of Medicine, 508 Fulton St. GRECC (182), Durham, NC 27705, Phone: (919) 286-0411 ext 6776, Fax: (919) 286-6823
| | - Terry J. Hartman
- Department of Nutritional Sciences, The Pennsylvania State University, 110 Chandlee Laboratory, University Park, PA 16802, Phone: 814-865-8747, Fax: 814-863-6103
| | - Denise C. Snyder
- Duke University School of Nursing, Box 3322 DUMC, Durham, NC 27710, Phone:: (919) 660-7580, Fax: (919) 660-8022
| | - Richard Sloane
- Duke Center for the Study of Aging and Human Development, Box 3003 DUMC, Durham, NC 27710, Phone: (919) 660-7515, Fax: (919) 684-8569
| | - Harvey Jay Cohen
- Duke Center for the Study of Aging and Human Development, Associate Professor, Department of Medicine, Duke University School of Medicine, Box 3003 DUMC, Durham, NC 27710, Phone: (919) 668-1755, Fax: (919) 681-5400
| | - Wendy Demark-Wahnefried
- Department of Nutrition Sciences, University of Alabama at Birmingham (UAB), Associate Director, UAB Comprehensive Cancer Center, 1675 University Boulevard, Webb Nutrition Sciences Bldg, Room 346, Birmingham, AL 35294, Phone: (205) 975-4022, Fax: (205) 975-2592
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Kirkpatrick SI, Dodd KW, Reedy J, Krebs-Smith SM. Income and race/ethnicity are associated with adherence to food-based dietary guidance among US adults and children. J Acad Nutr Diet 2012; 112:624-635.e6. [PMID: 22709767 PMCID: PMC3775640 DOI: 10.1016/j.jand.2011.11.012] [Citation(s) in RCA: 285] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2010] [Accepted: 11/22/2011] [Indexed: 12/29/2022]
Abstract
BACKGROUND Income and race/ethnicity are associated with differences in dietary intakes that may contribute to health disparities among members of the US population. OBJECTIVE To examine alignment of intakes of food groups and energy from solid fats, added sugars, and alcohol with the 2005 Dietary Guidelines for Americans and MyPyramid, by family income and race/ethnicity. DESIGN Data from the National Health and Nutrition Examination Survey, a cross-sectional, nationally representative survey, for 2001-2004. PARTICIPANTS/SETTING Persons aged ≥2 years for whom reliable dietary intake data were available (n=16,338) were categorized by income (lowest, middle, and highest) and race/ethnicity (non-Hispanic white, non-Hispanic black, and Mexican American). STATISTICAL ANALYSES PERFORMED The National Cancer Institute method was used to estimate the proportions of adults and children in each income and race/ethnic group whose usual intakes met the recommendations. RESULTS Higher income was associated with greater adherence to recommendations for most food groups; the proportions meeting minimum recommendations among adults in the highest income group were double that observed for the lowest income group for total vegetables, milk, and oils. Fewer differences by income were apparent among children. Among the race/ethnic groups, the proportions meeting recommendations were generally lowest among non-Hispanic blacks. Marked differences were observed for milk-15% of non-Hispanic black children met the minimum recommendations compared with 42% of non-Hispanic white children and 35% of Mexican-American children; a similar pattern was evident for adults. One in five Mexican-American adults met the dry beans and peas recommendations compared with approximately 2% of non-Hispanic whites and non-Hispanic blacks. Most adults and children consumed excess energy from solid fats and added sugars irrespective of income and race/ethnicity. CONCLUSIONS The diets of some subpopulations, particularly individuals in lower-income households and non-Hispanic blacks, are especially poor in relation to dietary recommendations, supporting the need for comprehensive strategies to enable healthier dietary intake patterns.
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Affiliation(s)
- Sharon I. Kirkpatrick
- Fellow, Risk Factor Monitoring and Methods Branch, Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, 6130 Executive Boulevard, EPN 4005 Bethesda, MD 20892, Tel: 301-435-1638, Fax: 301-435-3710,
| | - Kevin W. Dodd
- Statistician, Biometry Research Group, Division of Cancer Prevention, National Cancer Institute, 6130 Executive Boulevard, EPN 3131 Bethesda, MD 20892, Tel: 301-496-7461, Fax: 301-402-0816,
| | - Jill Reedy
- Nutritionist, Risk Factor Monitoring and Methods Branch, Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, 6130 Executive Boulevard, EPN 4005 Bethesda, MD 20892, Tel: 301-594-6605, Fax: 301-435-3710,
| | - Susan M. Krebs-Smith
- Branch Chief, Risk Factor Monitoring and Methods Branch, Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, 6130 Executive Boulevard, EPN 4005 Bethesda, MD 20892, Tel: 301-496-4766, Fax: 301-435-3710,
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Yates BC, Pullen CH, Santo JB, Boeckner L, Hageman PA, Dizona PJ, Walker SN. The influence of cognitive-perceptual variables on patterns of change over time in rural midlife and older women's healthy eating. Soc Sci Med 2012; 75:659-67. [PMID: 22365936 DOI: 10.1016/j.socscimed.2012.01.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2011] [Revised: 11/10/2011] [Accepted: 01/04/2012] [Indexed: 01/15/2023]
Abstract
Although studies demonstrate that dietary interventions for healthy adults can result in beneficial dietary changes, few studies examine when and how people change in response to these interventions, particularly in rural populations. The purpose of this study was to examine patterns of change over time in healthy eating behaviors in midlife and older women in response to a one-year health-promoting intervention, and to examine what predictors (perceived benefits, barriers, self-efficacy, and family support for healthy eating) influence the changes during the intervention and follow-up. Data for this secondary analysis were from the Wellness for Women community-based trial. Women (N = 225) between the ages of 50-69 in rural Nebraska, U.S.A., were recruited. A repeated-measures experimental design was used with randomization of two rural counties to intervention (tailored newsletter) or comparison (standard newsletter) groups. Eating behavior was measured by the Healthy Eating Index. The predictor variables were assessed using standard measures. Data analysis was done using latent growth curve modeling. The tailored newsletter group was successful in improving their healthy eating behavior compared to the standard newsletter group during the one-year intervention, at the end of the intervention, and during the follow-up phase. Family support at the end of the intervention was positively associated with healthy eating at the end of the intervention. Perceived barriers had the strongest impact on healthy eating behavior at all time points. Compared to participants in the standard newsletter group, those in the tailored newsletter group perceived more family support and fewer barriers for healthy eating at the end of the intervention (mediation effects). Based on these findings, both family support and perceived barriers should be central components of interventions focused on healthy eating behavior in rural midlife and older women.
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Affiliation(s)
- Bernice C Yates
- College of Nursing, University of Nebraska, 985330 Nebraska Medical Center, Omaha, NE 68198-5330, USA.
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Huffman FG, De La Cera M, Vaccaro JA, Zarini GG, Exebio J, Gundupalli D, Shaban L. Healthy Eating Index and Alternate Healthy Eating Index among Haitian Americans and African Americans with and without Type 2 Diabetes. J Nutr Metab 2011; 2011:398324. [PMID: 22187639 PMCID: PMC3236495 DOI: 10.1155/2011/398324] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2011] [Revised: 08/16/2011] [Accepted: 09/30/2011] [Indexed: 12/18/2022] Open
Abstract
Ethnicities within Black populations have not been distinguished in most nutrition studies. We sought to examine dietary differences between African Americans (AA) and Haitian Americans (HA) with and without type 2 diabetes using the Healthy Eating Index, 2005 (HEI-05), and the Alternate Healthy Eating Index (AHEI). The design was cross-sectional N = 471 (225 AA, 246 HA) and recruitment was by community outreach. The eating indices were calculated from data collected with the Harvard food-frequency questionnaire. African Americans had lower HEI-05 scores β = -10.9 (-8.67, 13.1); SE = 1.12, P < .001 than HA. Haitian American females and AA males had higher AHEI than AA females and HA males, respectively, (P = .006) adjusting for age and education. Participants with diabetes had higher adherence to the HEI-05 β = 3.90 (1.78, 6.01), SE = 1.08, P < .001 and lower adherence to the AHEI β = -9.73 (16.3, -3.19), SE = 3.33, P = .004, than participants without diabetes. The findings underscore the importance of disaggregating ethnicities and disease state when assessing diet.
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Affiliation(s)
- Fatma G Huffman
- Department of Dietetics and Nutrition, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL 33199, USA
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Thomson JL, Tussing-Humphreys LM, Onufrak SJ, Zoellner JM, Connell CL, Bogle ML, Yadrick K. A simulation study of the potential effects of healthy food and beverage substitutions on diet quality and total energy intake in Lower Mississippi Delta adults. J Nutr 2011; 141:2191-7. [PMID: 22031664 PMCID: PMC4584395 DOI: 10.3945/jn.111.144659] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The majority of adult diets in the United States, particularly the South, are of poor quality, putting these individuals at increased risk for chronic diseases. In this study, simulation modeling was used to determine the effects of substituting familiar, more healthful foods and beverages for less healthy ones on diet quality and total energy intake in Lower Mississippi Delta (LMD) adults. Dietary data collected in 2000 for 1689 LMD adults who participated in the Foods of Our Delta Study were analyzed. The Healthy Eating Index-2005 (HEI-2005) was used to measure diet quality. The effects of substituting targeted foods and beverages with more healthful items on diet quality were simulated by replacing the targeted items' nutrient profile with their replacements' profile. For the single food and beverage groups, 100% replacement of grain desserts with juice-packed fruit cocktail and sugar-sweetened beverages with water resulted in the largest improvements in diet quality (4.0 and 3.8 points, respectively) and greatest decreases in total energy intake (98 and 215 kcal/d, respectively). The 100% substitution of all food and beverage groups combined resulted in a 12.0-point increase in HEI-2005 score and a decrease of 785 kcal/d in total energy intake. Community interventions designed to improve the diet of LMD adults through the use of familiar, healthy food and beverage substitutions have the potential to improve diet quality and decrease energy intake of this health disparate population.
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Affiliation(s)
- Jessica L. Thomson
- USDA Agricultural Research Service Southern Regional Research Center, Baton Rouge, LA 70803,Corresponding Author and Reprints: Jessica L. Thomson, USDA Agricultural Research Service, 284 Knapp Hall, Human Nutrition and Food, LSU AgCenter, Baton Rouge, LA 70803, Telephone: 225-892-3662, Fax: 225-578-4443,
| | | | - Stephen J. Onufrak
- CDC National Center for Chronic Disease Prevention and Health Promotion, Atlanta, GA 30341-3717
| | - Jamie M. Zoellner
- Virginia Tech Department of Human Nutrition, Foods and Exercise, Blacksburg, VA 24061
| | - Carol L. Connell
- University of Southern Mississippi Department of Nutrition and Food Systems, Hattiesburg, MS 39406
| | - Margaret L. Bogle
- USDA Agricultural Research Service Delta Obesity Prevention Research Unit, Little Rock, AR 72211
| | - Kathy Yadrick
- University of Southern Mississippi Department of Nutrition and Food Systems, Hattiesburg, MS 39406
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Ross LJ, Tapsell LC, Probst Y. Optimizing dietary fat in a weight-loss trial requires advice based on a structured “whole-of-diet” model. Nutr Res 2011; 31:683-90. [DOI: 10.1016/j.nutres.2011.08.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2011] [Revised: 08/23/2011] [Accepted: 08/24/2011] [Indexed: 10/16/2022]
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Ralston PA, Cohen NL, Wickrama K(KAS, Kwag K. Social Support and Dietary Quality in Older African American Public Housing Residents. Res Aging 2011. [DOI: 10.1177/0164027511410548] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study examined the role of social support in influencing dietary quality in older African American public housing residents, specifically investigating individual (age, education, gender, marital status, and living arrangement), social support (help with meals, social network size, frequency of contact, and proximity or distance from network), and dietary factors (number of meals consumed daily, dietary quality). A random sample ( n = 80) of public housing residents age 55+ living in a Northeastern community was interviewed. Data were analyzed using Pearson correlation coefficients, multiple regression analyses, and structural equation modeling (SEM). Given the limited sample size, a SEM path model was developed based on observed associations in correlation and regression analyses. Results show that number of meals, frequency of contact, and proximity significantly influenced dietary quality. However, dietary quality was indirectly influenced by education, marital status, having a housemate, and help with meals, highlighting influence of both individual and social factors.
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Watts ML, Hager MH, Toner CD, Weber JA. The art of translating nutritional science into dietary guidance: history and evolution of the Dietary Guidelines for Americans. Nutr Rev 2011; 69:404-12. [DOI: 10.1111/j.1753-4887.2011.00408.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
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Quandt SA, Savoca MR, Leng X, Chen H, Bell RA, Gilbert GH, Anderson AM, Kohrman T, Arcury TA. Dry mouth and dietary quality in older adults in north Carolina. J Am Geriatr Soc 2011; 59:439-45. [PMID: 21391935 DOI: 10.1111/j.1532-5415.2010.03309.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To quantify prevalence of dry mouth, association between dry mouth and beverage intake and dietary quality, and association between dry mouth and self-reported dietary accommodations to oral health deficits. DESIGN Cross-sectional study; data from self-reports. SETTING Rural North Carolina counties with substantial African-American and American Indian populations. PARTICIPANTS Six hundred twenty-two participants aged 60 and older. MEASUREMENTS Data included the 11-item Xerostomia Inventory (higher scores connote greater effect from dry mouth), a food frequency questionnaire (converted into Health Eating Index-2005 scores), and survey items on foods modified before consumption or avoided because of oral health problems. RESULTS Dry mouth was associated with being female, lower education, and income below the poverty level. Although overall beverage consumption did not vary with dry mouth, consumption of certain sugar-sweetened beverages was positively associated with dry mouth. Overall dietary quality did not differ with dry mouth, but more-severe dry mouth was associated with lower intake of whole grains and higher intakes of fruits. Dry mouth was strongly associated with self-reported modification and avoidance of foods. Those in the highest tertile of dry mouth were more likely to modify several foods than those in the lowest tertile and were more likely to avoid three or more foods. CONCLUSION Older adults appear to modify foods or selectively avoid foods in response to perceived dry mouth. Despite these behaviors, dry mouth does not result in poorer dietary quality.
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Affiliation(s)
- Sara A Quandt
- Department of Epidemiology and Prevention, School of Medicine, Wake Forest University, Winston-Salem, North Carolina, USA.
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August KJ, Sorkin DH. Racial/ethnic disparities in exercise and dietary behaviors of middle-aged and older adults. J Gen Intern Med 2011; 26:245-50. [PMID: 20865342 PMCID: PMC3043172 DOI: 10.1007/s11606-010-1514-7] [Citation(s) in RCA: 134] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2010] [Revised: 08/30/2010] [Accepted: 09/02/2010] [Indexed: 12/02/2022]
Abstract
BACKGROUND Differences in health behaviors may be important contributors to racial/ethnic disparities in the health status of adults. Studies to date have not compared whether there are health behavior differences in exercise and dietary behaviors among middle-age and older adults in the four largest racial/ethnic categories. OBJECTIVE To investigate racial/ethnic differences in exercise and dietary behaviors of middle-aged and older adults. DESIGN We used data from the 2007 California Health Interview Survey. Multivariable logistic regression was used to examine interactions between age and race/ethnicity in predicting two categories of health behaviors. Analyses were conducted adjusting for sociodemographic characteristics, health insurance status, and healthcare utilization. PARTICIPANTS A population-based sample of 33,189 California adults 45 years old and older: 26,522 non-Hispanic whites, 1,686 African American/blacks, 2,565 Asian/Pacific Islanders (1,741 English-proficient; 824 limited English-proficient), and 2,416 Latinos (1,538 English-proficient; 878 limited English-proficient). MAIN MEASURES Self-report leisure-time physical activity (moderate and vigorous) and daily consumption of fruits and vegetables. KEY RESULTS Racial/ethnic minorities generally engaged in less healthy exercise and dietary behaviors than whites, with differences more pronounced in middle adulthood. The disparities were the greatest among English-proficient minorities. Specifically, among middle-aged respondents, all racial/ethnic minorities engaged in less vigorous physical activity than whites (ORs range = 0.28 to 0.73; 95% CI range = 0.16-1.00). Additionally, middle-aged, English-proficient minorities engaged in less moderate physical activity compared to whites (ORs range =0.57 to 0.67; 95% CI range = 0.45-0.79). Furthermore, middle-aged, English-proficient Latinos had a poorer diet than whites (OR = 0.54; 0.39-0.75). Few significant racial/ethnic differences emerged in the exercise and dietary behaviors of older adults. CONCLUSIONS Racial/ethnic disparities in exercise and dietary behaviors are most notable among middle-aged, acculturated minorities. Results highlight the need to promote positive exercise and dietary behaviors during critical preventive ages, when racial/ethnic disparities are large and the potential to prevent chronic disease is great.
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Affiliation(s)
- Kristin J August
- Division of General Internal Medicine and Primary Care and Health Policy Research Institute, University of California Irvine, 100 Theory, Suite 110, Irvine, CA 92617, USA
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Chandran U, Bandera EV, Williams-King MG, Paddock LE, Rodriguez-Rodriguez L, Lu SE, Faulkner S, Pulick K, Olson SH. Healthy eating index and ovarian cancer risk. Cancer Causes Control 2011; 22:563-71. [PMID: 21286802 DOI: 10.1007/s10552-011-9728-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2010] [Accepted: 01/12/2011] [Indexed: 11/27/2022]
Abstract
The evidence for a role of diet on ovarian cancer prevention remains inconclusive. While many studies have evaluated individual foods and food groups, the evaluation of a comprehensive dietary quality index for predicting cancer risk has received little attention. This study investigates the association between the Healthy Eating Index (HEI), which reflects adherence to the current USDA Dietary Guidelines for Americans and ovarian cancer risk in a population-based case-control study in New Jersey. A total of 205 cases and 390 controls completed the Block 98.2 food frequency questionnaire (FFQ) in addition to reporting on potential risk factors for ovarian cancer. FFQ data were then utilized to calculate the HEI score, and cup, ounce, gram, or caloric equivalents for the 12 different food groups comprising the index. In multivariate models, the OR for the highest tertile of the HEI score compared with the lowest (reflecting a better diet compared with a worse diet) was 0.90 (95% CI: 0.55-1.47). There was limited evidence for a statistically significant association between any of the 12 individual food components and ovarian cancer risk. Based on this study's results, neither individual food groups nor dietary quality showed potential for preventing ovarian cancer.
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Affiliation(s)
- Urmila Chandran
- The Cancer Institute of New Jersey, Robert Wood Johnson Medical School, 195 Little Albany St, New Brunswick, NJ 08903, USA
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Food intake of Kansans over 80 years of age attending congregate meal sites. Nutrients 2010; 2:1297-1307. [PMID: 22254010 PMCID: PMC3257629 DOI: 10.3390/nu2121297] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2010] [Revised: 12/09/2010] [Accepted: 12/17/2010] [Indexed: 02/06/2023] Open
Abstract
As the population of the United States continues to age, it has become increasingly more important to recognize the food intake and eating habits of older adults. The objective of this study was to describe the food group intake, factors predicting food group intake, and the food choices of community-dwelling Kansans, 80 years of age and older who participate in congregate meal programs. Participants completed a short questionnaire querying demographic information, current health status, and dietary supplement use. Participants (n = 113) were then followed up via telephone to complete two 24-hour diet recalls. Data were analyzed to determine adequacy of food group intake and mean intake. Regression analyses were used to determine factors predicting intake and frequency analysis established food typically consumed. Female participants were significantly more likely to consume more fruit servings than males. Intake was low for all five of the food groups, especially dairy. Chronic health conditions and dietary supplement use were consistently predictive factors of the amount of each food group consumed.
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Chandran U, Bandera EV, Williams-King MG, Sima C, Bayuga S, Pulick K, Wilcox H, Zauber AG, Olson SH. Adherence to the dietary guidelines for Americans and endometrial cancer risk. Cancer Causes Control 2010; 21:1895-904. [PMID: 20652737 PMCID: PMC3065196 DOI: 10.1007/s10552-010-9617-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2010] [Accepted: 07/09/2010] [Indexed: 11/26/2022]
Abstract
The Healthy Eating Index (HEI) was developed by the US Department of Agriculture with the goal of quantifying adherence to the Dietary Guidelines for Americans. The purpose of this study was to evaluate the impact of the HEI-2005 score and each of its components on endometrial cancer risk in a population-based case-control study in New Jersey. A total of 424 cases and 398 controls completed a Food Frequency Questionnaire, which was used to derive the HEI-2005 score. Odds ratios (OR) and 95% confidence intervals (CI) were calculated using unconditional logistic regression while adjusting for potential covariates, which included all major endometrial cancer risk factors. The adjusted OR for women in the highest quartile when compared to the lowest quartile was 0.83 (95% CI: 0.52-1.34). For the meat and beans component comprising meat, eggs, poultry, fish, and beans, the OR was 0.70 (95% CI: 0.45-1.11; p for trend: 0.07), with little evidence of an association with any of the individual foods. There was no indication of an association for any of the other components of the HEI or of effect modification by body mass index. This study suggested limited value for the HEI-2005 in predicting endometrial cancer risk.
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Affiliation(s)
- Urmila Chandran
- The Cancer Institute of New Jersey, Robert Wood Johnson Medical School, 195 Little Albany St., New Brunswick, NJ 08903, USA
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Savoca MR, Arcury TA, Leng X, Chen H, Bell RA, Anderson AM, Kohrman T, Gilbert GH, Quandt SA. Association between dietary quality of rural older adults and self-reported food avoidance and food modification due to oral health problems. J Am Geriatr Soc 2010; 58:1225-32. [PMID: 20533966 PMCID: PMC3098620 DOI: 10.1111/j.1532-5415.2010.02909.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To quantify the association between food avoidance and modification due to oral health problems, to examine the association between food practices and dietary quality, and to determine foods associated with these self-management behaviors. DESIGN Cross-sectional. SETTING Rural North Carolina. PARTICIPANTS Six hundred thirty-five community-dwelling adults aged 60 and older. MEASUREMENTS Demographic and food frequency data and oral health assessments were obtained during home visits. Avoidance (0, 1-2 foods, 3-14 foods) and modification (0-3 foods, 4-5 foods) due to oral health problems were assessed for foods representing oral health challenges. Food frequency data were converted into Healthy Eating Index-2005 (HEI-2005) scores. Linear regression models tested the significance of associations between HEI-2005 measures and food avoidance and modification. RESULTS Thirty-five percent of participants avoided three to 14 foods, and 28% modified four to five foods. After adjusting for age, sex, ethnicity, poverty, education, and tooth loss, total HEI-2005 score was lower (P<.001) for persons avoiding more foods and higher for persons modifying more foods (P<.001). Those avoiding three to 14 foods consumed more saturated fat and energy from solid fat and added sugar and less nonhydrogenated fat than those avoiding fewer than three foods. Those who modified four to five foods consumed less saturated fat and solid fat and added sugar but more total grains than those modifying fewer than four foods. CONCLUSION Food avoidance and modification due to oral health problems are associated with significant differences in dietary quality. Approaches to minimize food avoidance and promote food modification by persons having eating difficulties due to oral health conditions are needed.
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Affiliation(s)
- Margaret R Savoca
- Department of Nutrition, University of North Carolina at Greensboro, Greensboro, NC 27402, USA.
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