Behavioral variables and education are predictors of dietary change in the Women's Health Trial: Feasibility Study in Minority Populations

Fibre4life: Investigating older adults dietary fibre preferences and the role of targeted educational materials on modulating future dietary fibre intake

The UK has an ever-increasing ageing population; hence, promoting balanced nutrition can have fundamental health and cost benefits. In addition, the majority of older adults' dietary fibre intake is below recommendations and this is despite its well-cited benefits; therefore, more emphasis should be placed on identifying viable age-suitable strategies to overcome the associated dietary fibre-related knowledge gap. Accordingly, one hundred and seventy older adults (65-87 years) were recruited to partake in two survey related studies: (1) initial insights (e.g., dietary fibre-related knowledge, awareness, attitudes and behaviour as well as information preferences) were captured to inform the design of educational materials; and (2) the impact of two targeted educational materials on modulating older adults' future dietary fibre intake was tested. Older adults were willing to learn more about dietary fibre and requested additional information relating to its benefits, recommendations and food-based examples in a clear and accessible format. Therefore, two educational materials (factsheet and practical tips) were developed encompassing key themes. Overall, older adults engaged with the educational materials (regardless of topic and format); thus, demonstrating the potential benefits of this approach going forwards. There was strong agreement with all variables: learning something new, change future dietary fibre intake, format liking, content engaging and share with others as well as the overall experience being cited as useful/helpful. Going forwards, importance should be placed on measuring dietary fibre consumption post engaging with educational materials. In addition, utilising a holistic approach incorporating support from different sources (e.g., health professionals, government, food companies, supermarkets and community) could be fundamental in helping older adults to consume more dietary fibre and subsequently contributing to positive health outcomes.

Whole-diet interventions and cardiovascular risk factors in postmenopausal women: A systematic review of controlled clinical trials

OBJECTIVES

Menopause is accompanied by many metabolic changes, increasing the risk of cardiometabolic diseases. The impact of diet, as a modifiable lifestyle factor, on cardiovascular health in general populations has been well established. The purpose of this systematic review is to summarize the evidence on the effects of whole diet on lipid profile, glycemic indices, and blood pressure in postmenopausal women.

METHODS

Embase, Medline, Cochrane Central Register of Controlled Trials, and Google Scholar were searched from inception to February 2021. We included controlled clinical trials in postmenopausal women that assessed the effect of a whole-diet intervention on lipid profile, glycemic indices, and/or blood pressure. The risk of bias in individual studies was assessed using RoB 2 and ROBINS-I tools.

SUMMARY OF EVIDENCE

Among 2,134 references, 21 trials met all eligibility criteria. Overall, results were heterogenuous and inconsistent. Compared to control diets, some studies showed that participants experienced improvements in total cholesterol (TC), low-density lipoprotein cholesterol (LDL), systolic blood pressure (SBP), fasting blood sugar (FBS), and apolipoprotein A (Apo-A) after following fat-modified diets, but some adverse effects on triglycerides (TG), very low-density lipoprotein cholesterol (VLDL), lipoprotein(a) (Lp(a)), and high-density lipoprotein cholesterol (HDL) concentrations were also observed. A limited number of trials found some effects of the Paleolithic, weight-loss, plant-based, or energy-restricted diets, or of following American Heart Association recommendations on TG, TC, HDL, insulin, FBS, or insulin resistance.

CONCLUSION

Current evidence suggests that diet may affect levels of some lipid profile markers, glycemic indices, and blood pressure among postmenopausal women. However, due to the large heterogeneity in intervention diets, comparison groups, intervention durations, and population characteristics, findings are inconclusive. Further well-designed clinical trials are needed on dietary interventions to reduce cardiovascular risk in postmenopausal women.

Pre-natal nutrition education: Health care providers' knowledge and quality of services in primary health care centres in Lagos, Nigeria

INTRODUCTION

A healthy and balanced diet is very important during pregnancy. By enhancing maternal nutritional status, healthcare providers can lower the risks of pregnancy complications and adverse birth outcomes.

OBJECTIVES

To assess the pre-natal nutrition knowledge and services rendered by healthcare providers in antenatal clinics at Primary Health care Centres in Lagos, Nigeria.

METHODOLOGY

This was a cross-sectional study carried out in June-September 2019. Self-administered questionnaires were used to collect data on nutritional knowledge from 391 nurses and midwives who provided pre-natal nutrition education. Direct observation with checklist was used to assess the nutrition education services at the ANC clinics and covered: adequacy of the venue, availability/use of nutrition education resources, education content and teaching strategies. EPi-Info version 3.5 was used for data analysis. Inferential statistics such as chi square and multiple logistic regression were used to determine associated factors and predictors of nutrition knowledge. The level of significance was set at 5% (p<0.05).

RESULTS

The mean age of respondents was 41.71±10.33years, all were females; 44.8% were Registered Nurses, 12.0% were Registered Midwives, and 23.8% had a B.Sc. in Nursing. Majority (81.3%) had taken a nutrition course in nursing training program, 62.1% as elective classes. Majority (81.1%) had good knowledge of prenatal nutrition. Respondents who were older (51-60years) (p<0.001), single (p<0.001) and Christian (p = 0.001) had significantly better knowledge. Nurses who had University degrees (p<0.001), of higher cadre (p<0.001), more years of practice (p<0.001) and involved in treating severely malnourished children (p = 0.013) were also significantly more knowledgeable. Respondents below 40 years (OR 0.104, CI 0.049-0.218) and those with 10 years or less of practice (OR 0.189, CI 0.092-0.387) had less odds of having good nutrition knowledge. Being single (OR 8.791, CI 3.125-24.731), and Christian (OR = 5.810, CI: 3.321-10.164) predict good nutrition knowledge. In 39% of the 41 PHCs observed, quality of nutrition education services was inadequate. Gaps were mainly in availability of certain nutrition education facilities/resources and teaching strategies.

CONCLUSION

The majority of the respondents had good knowledge of pre-natal nutrition. Overall, however, nutrition education services provided by two-fifths of the facilities were inadequate. Interventions to improve prenatal nutrition knowledge of nurses/midwives should be focused more on those who are younger and have less work experience. All necessary equipment required for health service providers to execute their roles as nutrition counselors and educators should also be provided by the government.

Statistical methodologies to pool across multiple intervention studies

Combining and analyzing data from heterogeneous randomized controlled trials of complex multiple-component intervention studies, or discussing them in a systematic review, is not straightforward. The present article describes certain issues to be considered when combining data across studies, based on discussions in an NIH-sponsored workshop on pooling issues across studies in consortia (see Belle et al. in Psychol Aging, 18(3):396-405, 2003). Several statistical methodologies are described and their advantages and limitations are explored. Whether weighting the different studies data differently, or via employing random effects, one must recognize that different pooling methodologies may yield different results. Pooling can be used for comprehensive exploratory analyses of data from RCTs and should not be viewed as replacing the standard analysis plan for each study. Pooling may help to identify intervention components that may be more effective especially for subsets of participants with certain behavioral characteristics. Pooling, when supported by statistical tests, can allow exploratory investigation of potential hypotheses and for the design of future interventions.

Nutrition and Other Protective Behaviors Motivated by Environmental Health Risk Awareness

Background

Research findings have suggested that exposure to environmental pollutants contributes to increased health risks, which may be modulated by certain nutrition and other protective health behaviors. Nutrition professionals play an important role in effectively disseminating this information and in devising specific community-based nutrition education programs for audiences located in areas with environmental health issues.

Objective

To assess awareness of environmental health problems and motivation to adopt protective health behaviors for use in planning nutrition education programs for communities exposed to environmental pollutants.

Method

Data were collected from a modified, validated Environmental Health Engagement Profile (EHEP) survey instrument administered to adults (n=774) participating in community events in Kentucky based on location relative to hazardous waste sites.

Results

The modified EHEP survey instrument showed good internal consistency reliability, and demographic characteristics were evaluated. Correlation analyses revealed significant positive correlations in all groups, separately and combined, between awareness of environmental pollution in an individual’s surroundings and the extent of concern that pollutants cause adverse health effects (P < 0.01) and between concern that pollutants cause adverse health effects and taking personal actions to protect against such environmental insults (P < 0.01). The groups having the highest level of awareness posed by pollution are those residing near federally designated hazardous waste sites.

Conclusion

These results suggest that determining and expanding an audience’s knowledge and perceptions of environmental health risks will enhance effective nutrition education program planning.

Healthy Diet and Nutrition Education Program among Women of Reproductive Age: A Necessity of Multilevel Strategies or Community Responsibility

BACKGROUND

Reproductive years represent a major proportion of women‟s life. This review focuses on recommended nutritional considerations, physical activity pattern as well as the effect of nutrition education (NE) on behavior modification and health outcomes of women of reproductive age using either single-level, multiple-level or community-level interventions.

METHODS

For this narrative review, numerous searches were conducted on databases of PubMed, Science Direct and Google Scholar search engine using the keywords women, reproductive age, NE, interventions, community-based.

RESULTS

Even though single intervention is effective, multiple intervention programmes in addition to behavior modification components are even more successful in terms of modified behaviors and health outcomes. Moreover, community based interventions using multilevel strategies are further useful for improved health outcomes and behavior modification.

CONCLUSION

NE programmes have been effective in positive behavior modification measured in terms of eating pattern and health quality. Thus, it is recommended that health professionals use multiple intervention strategies at community level to ensure improved outcomes. Political support is also required to create culturally sensitive methods of delivering nutritional programmes. Finally, as policy is dependent on program cost, nutritional programmes need to combine methods of cost analysis to show cost effectiveness of supplying adequate nutrition for women throughout the lifecycle.

Validity, Reliability and Feasibility of the Eating Behavior Pattern Questionnaire (EBPQ) among Iranian Female Students

BACKGROUND

The aim of this study was to assess the validity, reliability and feasibility of eating behavior pattern questionnaire (EBPQ) in female university students.

METHODS

In this study, after forward-backward translation, the questionnaire was reviewed by a panel of nutritionists and a psychologist and further thirty participants for the content validity measurement. The translated and modified questionnaire was completed by 225 female students of Tabriz University in 2013. Principle axis factoring, confirmatory factor analysis and known group analysis were conducted for construct, convergent and discriminant validity. Internal consistency and test-retest reliability were assessed by Cronbach's α coefficient and intra-class correlation coefficient (ICC). Ceiling and floor effects were also performed for evaluating the feasibility of the instrument.

RESULTS

By using exploratory factor analysis, nine factors were extracted. Confirmatory factor analysis confirmed the convergent validity. Cronbach 's αand ICC were ranged between 0.55 to 0.78 and 0.67 to 0.89, respectively. The significant difference for some three subscales between diabetes and healthy subjects determined the discriminant validity. No ceiling and floor effects were found.

CONCLUSION

Our findings demonstrate the initial validity, reliability and feasibility of the Iranian version of EBPQ as a useful tool for eating behavior studies in young females.

Dietary advice for reducing cardiovascular risk

BACKGROUND

Changes in population diet are likely to reduce cardiovascular disease and cancer, but the effect of dietary advice is uncertain. This review is an update of a previous review published in 2007.

OBJECTIVES

To assess the effects of providing dietary advice to achieve sustained dietary changes or improved cardiovascular risk profile among healthy adults.

SEARCH METHODS

We searched the Cochrane Central Register of Controlled Trials, the Database of Abstracts of Reviews of Effects (DARE) and the HTA database on The Cochrane Library (Issue 4, 2010). We searched MEDLINE (Ovid) (1950 to week 2 October 2010) and EMBASE (Ovid) (1980 to Week 42 2010). Additional searches were done on CAB Health (1972 to December 1999), CVRCT registry (2000), CCT (2000) and SIGLE (1980 to 2000). Dissertation abstracts and reference lists of articles were checked and researchers were contacted.

SELECTION CRITERIA

Randomised studies with no more than 20% loss to follow-up, lasting at least three months and involving healthy adults comparing dietary advice with no advice or minimal advice. Trials involving children, trials to reduce weight or those involving supplementation were excluded.

DATA COLLECTION AND ANALYSIS

Two review authors independently assessed trial quality and extracted data. Study authors were contacted for additional information.

MAIN RESULTS

Forty-four trials with 52 intervention arms (comparisons) comparing dietary advice with no advice were included in the review; 18,175 participants or clusters were randomised. Twenty-nine of the 44 included trials were conducted in the USA. Dietary advice reduced total serum cholesterol by 0.15 mmol/L (95% CI 0.06 to 0.23) and LDL cholesterol by 0.16 mmol/L (95% CI 0.08 to 0.24) after 3 to 24 months. Mean HDL cholesterol levels and triglyceride levels were unchanged. Dietary advice reduced blood pressure by 2.61 mm Hg systolic (95% CI 1.31 to 3.91) and 1.45 mm Hg diastolic (95% CI 0.68 to 2.22) and 24-hour urinary sodium excretion by 40.9 mmol (95% CI 25.3 to 56.5) after 3 to 36 months but there was heterogeneity between trials for the latter outcome. Three trials reported plasma antioxidants, where small increases were seen in lutein and β-cryptoxanthin, but there was heterogeneity in the trial effects. Self-reported dietary intake may be subject to reporting bias, and there was significant heterogeneity in all the following analyses. Compared to no advice, dietary advice increased fruit and vegetable intake by 1.18 servings/day (95% CI 0.65 to 1.71). Dietary fibre intake increased with advice by 6.5 g/day (95% CI 2.2 to 10.82), while total dietary fat as a percentage of total energy intake fell by 4.48% (95% CI 2.47 to 6.48) with dietary advice, and saturated fat intake fell by 2.39% (95% CI 1.4 to 3.37).Two trials analysed incident cardiovascular disease (CVD) events (TOHP I/II). Follow-up was 77% complete at 10 to 15 years after the end of the intervention period and estimates of event rates lacked precision but suggested that sodium restriction advice probably led to a reduction in cardiovascular events (combined fatal plus non-fatal events) plus revascularisation (TOHP I hazards ratio (HR) 0.59, 95% CI 0.33 to 1.08; TOHP II HR 0.81, 95% CI 0.59 to 1.12).

AUTHORS' CONCLUSIONS

Dietary advice appears to be effective in bringing about modest beneficial changes in diet and cardiovascular risk factors over approximately 12 months, but longer-term effects are not known.

Dietary advice for reducing cardiovascular risk

BACKGROUND

Changes in population diet are likely to reduce cardiovascular disease and cancer, but the effect of dietary advice is uncertain. This review is an update of a previous review published in 2007.

OBJECTIVES

To assess the effects of providing dietary advice to achieve sustained dietary changes or improved cardiovascular risk profile among healthy adults.

SEARCH METHODS

We searched the Cochrane Central Register of Controlled Trials, the Database of Abstracts of Reviews of Effects (DARE) and the HTA database on The Cochrane Library (Issue 4, 2010). We searched MEDLINE (Ovid) (1950 to week 2 October 2010) and EMBASE (Ovid) (1980 to Week 42 2010). Additional searches were done on CAB Health (1972 to December 1999), CVRCT registry (2000), CCT (2000) and SIGLE (1980 to 2000). Dissertation abstracts and reference lists of articles were checked and researchers were contacted.

SELECTION CRITERIA

Randomised studies with no more than 20% loss to follow-up, lasting at least three months and involving healthy adults comparing dietary advice with no advice or minimal advice. Trials involving children, trials to reduce weight or those involving supplementation were excluded.

DATA COLLECTION AND ANALYSIS

Two review authors independently assessed trial quality and extracted data. Study authors were contacted for additional information.

MAIN RESULTS

Forty-four trials with 52 intervention arms (comparisons) comparing dietary advice with no advice were included in the review; 18,175 participants or clusters were randomised. Twenty-nine of the 44 included trials were conducted in the USA. Dietary advice reduced total serum cholesterol by 0.15 mmol/L (95% CI 0.06 to 0.23) and LDL cholesterol by 0.16 mmol/L (95% CI 0.08 to 0.24) after 3 to 24 months. Mean HDL cholesterol levels and triglyceride levels were unchanged. Dietary advice reduced blood pressure by 2.61 mm Hg systolic (95% CI 1.31 to 3.91) and 1.45 mm Hg diastolic (95% CI 0.68 to 2.22) and 24-hour urinary sodium excretion by 40.9 mmol (95% CI 25.3 to 56.5) after 3 to 36 months but there was heterogeneity between trials for the latter outcome. Three trials reported plasma antioxidants, where small increases were seen in lutein and β-cryptoxanthin, but there was heterogeneity in the trial effects. Self-reported dietary intake may be subject to reporting bias, and there was significant heterogeneity in all the following analyses. Compared to no advice, dietary advice increased fruit and vegetable intake by 1.18 servings/day (95% CI 0.65 to 1.71). Dietary fibre intake increased with advice by 6.5 g/day (95% CI 2.2 to 10.82), while total dietary fat as a percentage of total energy intake fell by 4.48% (95% CI 2.47 to 6.48) with dietary advice, and saturated fat intake fell by 2.39% (95% CI 1.4 to 3.37).Two trials analysed incident cardiovascular disease (CVD) events (TOHP I/II). Follow-up was 77% complete at 10 to 15 years after the end of the intervention period and estimates of event rates lacked precision but suggested that sodium restriction advice probably led to a reduction in cardiovascular events (combined fatal plus non-fatal events) plus revascularisation (TOHP I hazards ratio (HR) 0.59, 95% CI 0.33 to 1.08; TOHP II HR 0.81, 95% CI 0.59 to 1.12).

AUTHORS' CONCLUSIONS

Dietary advice appears to be effective in bringing about modest beneficial changes in diet and cardiovascular risk factors over approximately 12 months, but longer-term effects are not known.

Determinants of low-fat eating behaviors among midlife African American women

OBJECTIVE

The purpose of this study was to explore midlife African American women's low-fat eating habits in the context of health attitudes, social support, and food preferences.

DESIGN

A cross-sectional design was used.

SETTINGS

One Midwestern and 1 national African American women's organization were targeted for data collection.

PARTICIPANTS

African American women between the ages of 45 and 64.

MAIN OUTCOME MEASURES

Health Attitudes Scale, Social Support Scale, Eating Behaviors subscale, and Low-Fat Eating subscale.

ANALYSIS

A hierarchical multiple regression analysis was performed.

RESULTS

Highly educated women did not engage in better eating habits than women with less education. Family members provided more criticism and friends provided more encouragement for healthful eating. However, only family encouragement and criticism for healthful eating and food preferences remained predictive of low-fat eating habits in midlife African American women in the final regression model.

CONCLUSIONS AND IMPLICATIONS

Changing attitudes may not influence changes in behaviors. Women experience family support as a significant influence to eating habits. Future nutrition interventions should be inclusive of women at every educational level and have a multidimensional focus that targets family involvement and changing behaviors.

Randomized controlled experiments in health and social sciences: some conceptual issues

This brief article outlines some difficulties as well as benefits in conducting randomized controlled trials in social science settings especially in developing countries. Some of the historical developments are summarized and certain applications in health sciences are discussed from methodological and policy standpoints.

Challenges to superfund community nutrition programs in kentucky

Since 2000, the University of Kentucky's (UK's) Superfund Basic Research Program (SBRP) Community Outreach Core has provided support and guidance through Superfund Community Action through Nutrition (SCAN) programs, which meet the needs of individuals and communities affected by environmental contaminants. It has been shown that nutrition may modulate the toxicity of Superfund chemicals. SCAN programs integrate nutrition education, nutrition science research, and health communication to increase understanding of health risks associated with residing near Superfund sites. Two critical tasks must be accomplished. SCAN personnel must identify and recruit affected community members, and then, offer meaningful programs. Certain quantitative outcome measures and legal issues presented both challenges and opportunities. Community members preferred qualitative evaluation discussions, which showed increased knowledge and improved attitudes following SCAN programs. SCAN, in full partnership with affected communities, translates safe, effective nutrition information to reduce health risks associated with exposure to Superfund pollutants.

Dietary advice for reducing cardiovascular risk

BACKGROUND

Changes in population diet are likely to reduce cardiovascular disease and cancer, but the effect of dietary advice is uncertain.

OBJECTIVES

To assess the effects of providing dietary advice to achieve sustained dietary changes or improved cardiovascular risk profile among healthy adults.

SEARCH STRATEGY

We searched the Cochrane Central Register of Controlled Trials, DARE and HTA databases on The Cochrane Library (Issue 4 2006), MEDLINE (1966 to December 2000, 2004 to November 2006) and EMBASE (1985 to December 2000, 2005 to November 2006). Additional searches were done on CAB Health (1972 to December 1999), CVRCT registry (2000), CCT (2000) and SIGLE (1980 to 2000). Dissertation abstracts and reference lists of articles were checked and researchers were contacted.

SELECTION CRITERIA

Randomised studies with no more than 20% loss to follow-up, lasting at least 3 months involving healthy adults comparing dietary advice with no advice or minimal advice. Trials involving children, trials to reduce weight or those involving supplementation were excluded.

DATA COLLECTION AND ANALYSIS

Two reviewers independently assessed trial quality and extracted data. Study authors were contacted for additional information.

MAIN RESULTS

Thirty-eight trials with 46 intervention arms (comparisons) comparing dietary advice with no advice were included in the review. 17,871 participants/clusters were randomised. Twenty-six of the 38 included trials were conducted in the USA. Dietary advice reduced total serum cholesterol by 0.16 mmol/L (95% CI 0.06 to 0.25) and LDL cholesterol by 0.18 mmol/L (95% CI 0.1 to 0.27) after 3-24 months. Mean HDL cholesterol levels and triglyceride levels were unchanged. Dietary advice reduced blood pressure by 2.07 mmHg systolic (95% CI 0.95 to 3.19) and 1.15 mmHg diastolic (95% CI 0.48 to 1.85) and 24-hour urinary sodium excretion by 44.2 mmol (95% CI 33.6 to 54.7) after 3-36 months. Three trials reported plasma antioxidants where small increases were seen in lutein and beta-cryptoxanthin, but there was heterogeneity in the trial effects. Self-reported dietary intake may be subject to reporting bias, and there was significant heterogeneity in all the following analyses. Compared to no advice, dietary advice increased fruit and vegetable intake by 1.25 servings/day (95% CI 0.7 to 1.81). Dietary fibre intake increased with advice by 5.99 g/day (95% CI 1.12 to 10.86), while total dietary fat as a percentage of total energy intake fell by 4.49 % (95% CI 2.31 to 6.66) with dietary advice and saturated fat intake fell by 2.36 % (95% CI 1.32 to 3.39).

AUTHORS' CONCLUSIONS

Dietary advice appears to be effective in bringing about modest beneficial changes in diet and cardiovascular risk factors over approximately 10 months but longer term effects are not known.

Socio-economic and behavioural factors are predictors of food use in the National Food Stamp Program Survey

The unhealthy dietary patterns in the USA especially among low-income households demand complex strategies for health promotion. The present paper analysed the proximate determinants of 7 d food use by 919 participants in the National Food Stamp Program Survey conducted in 1996. The households' consumption of dietary energy, carbohydrate, protein, fibre, saturated, monounsaturated and polyunsaturated fats, Ca, Fe, β-carotene and vitamin C were explained by background, socio-economic and behavioural factors. Certain methodological issues arising in modelling food use data were addressed. The results showed that the subjects' knowledge of the US Department of Agriculture food pyramid, reading nutrition labels, adopting a low-fat diet, selecting fruits and vegetables, saving money at grocery stores and frequency of shopping trips were often significantly associated (P>0·05) with the densities of nutrient use. The results identified certain aspects of nutrition education programmes that deserve greater emphasis for improving diet quality. The model for energy intake indicated that disbursing half the food stamp benefits on a 2-week basis and better shopping practices can enhance food availability.

Fighting cancer with fitness: dietary outcomes of a randomized, controlled lifestyle change intervention in healthy African-American women

OBJECTIVES

This study tested the efficacy of an 8-week, culturally targeted community-based nutrition and physical activity promotion intervention, Fight Cancer with Fitness! (FCF).

METHODS

A randomized, controlled trial was conducted in a black-owned commercial gym in a sample of 366 predominantly overweight or obese, healthy African-American women.

RESULTS

Dietary quality as indexed by fruit and vegetable intake improved significantly in the intervention group compared to the control group at 12-month follow-up, and proportion of calories consumed as fat decreased in both groups.

CONCLUSIONS

This individually targeted cancer prevention intervention produced beneficial effects on dietary quality that were sustained for at least 12 months.

Added sugars displaced the use of vital nutrients in the National Food Stamp Program Survey

Recent increases in consumption of added sugars in the US can reduce intake of vital nutrients and increase the overall energy intakes. A comprehensive framework is necessary for addressing the controversy surrounding the effects of added sugars on nutrient intakes while controlling for dietary knowledge, behavioral factors, and total energy intakes, especially among low-income households. This paper analyzed the proximate determinants of 1-wk availability (or use) of added sugars by 913 households participating in the National Food Stamp Program Survey conducted in 1996-97. In addition, households' use of protein; fiber; calcium; iron; beta-carotene; vitamins A, C, E, B-6, and B-12; folic acid; and potassium were explained by socioeconomic and behavioral factors and by added sugars use. Linear programming analyses were conducted for assessing the effects of food prices on added sugars use. Participation in Supplemental Food Program for Women, Infants and Children program, food stamp benefits, and consumption of low-fat diets were associated (P<0.05) with lower added sugars use. Furthermore, greater use of added sugars significantly lowered households' uses of protein; iron; vitamins A, C, B-6, and B-12; and potassium. Behavioral and socioeconomic variables such as adopting a low-fat diet, consuming fruits and vegetables, saving money at grocery stores, frequency of shopping trips, skipping meals, and food insecurity were often important predictors of nutrient use. Overall, the results indicated that added sugars should be discouraged in dietary guidelines, because their adverse effects on diet quality were evident in this low-income population.

Dietary behaviour of pregnant versus non-pregnant women

This study investigates dietary behaviour and the perceived role of food for health of pregnant versus non-pregnant women. Data were collected between 15 January 2003 and 15 March 2003 in Belgium. One hundred and forty-eight pregnant and 130 non-pregnant women aged between 20 and 40 years completed a self-administered questionnaire about their dietary behaviour and nutritional attitudes. Both sub-samples match with respect to individual factors such as relevant socio-demographics and general food perceptions. Pregnant women report higher consumption of fruits, which results in a better score for fibre intake. They also report higher consumption of beef and dairy products, as well as a higher fat intake. No difference in fish consumption between pregnant and non-pregnant women is observed. In line with recommendations, pregnant women report reduced consumption of food products with heightened safety-related risks, lower use of alcohol and tobacco, and safer food handling practices. Reduced intake of raw vegetables for food safety reasons is not compensated by higher intake of cooked vegetables. Pregnant women also report a lower frequency of moderate physical activity. Most differences in food choice by pregnant versus non-pregnant women pertain to the avoidance of specific, potentially harmful food groups. A substantial share of pregnant women does not follow upon recommendations with respect to alcohol use and exposure to tobacco. Personal medical sources for pregnant women and personal social sources for non-pregnant women are reported as the most attended sources of diet-related information. The perceived role of food for health is not different between pregnant and non-pregnant women, and there were no significant interaction effects between pregnancy and presence of children, which indicates that the observed differences in dietary behaviour can be attributed to the state of being pregnant.

Nutrition education in postmenopausal women: Changes in dietary and cardiovascular indices

OBJECTIVE

The aim of the current study was to examine whether a diet rich in dairy products followed by a nutrition education program for the prevention of osteoporosis could have any adverse effect on certain cardiovascular disease (CVD) risk factors over a 5-month intervention period.

METHODS

A total sample of 82 women (55-65 years old) was randomized to a dietary intervention group (IG: n=42), attending biweekly nutrition education program and provided with low-fat, fortified dairy products and to a control group (CG: n=40). Changes in dietary, biochemical and clinical indices related to CVD were determined at the end of the 5-month intervention period.

RESULTS

The IG was found to have a higher decrease in the percentage of energy intake derived from total fat and a higher increase in the intake of calcium, phosphorus, magnesium and potassium compared to the CG (p<0.05). Furthermore, the IG subjects were found to have a lower increase in BMI (0.7+/-0.1 versus 1.4+/-0.2 Kg/m(2), p=0.011) and systolic blood pressure (SBP) (2.5+/-2.9 versus 7.8+/-2.2 mmHg, p=0.040) and a higher decrease in serum total cholesterol (-5.2+/-3.3 versus 6.9+/-5.1 mg/dl, p=0.042) and LDL-cholesterol levels (-20.0+/-2.6 versus -12.4+/-4.2 mg/dl, p=0.034) compared to the CG.

CONCLUSIONS

The findings of the current study indicate that a dietary intervention aiming to minimize the risk for osteoporosis did not have any adverse effects on CVD risk factors. On the contrary, it has induced favourable changes in BMI, serum lipids and SBP.

Older Black Women Differ in Calcium Intake Source Compared to Age– and Socioeconomic Status–Matched White Women

Racial disparity in osteoporosis between older black and white women is well established; however, less is known regarding daily dietary and supplemental calcium intake in these populations. Moreover, racial differences in calcium intake are confounded by differences in socioeconomic status (SES). The objective of this study was to assess calcium intake and source in older black women (n=33) and white women (n=33), matched in age and SES. Calcium intake and source were evaluated by interview using a 46-item calcium food frequency questionnaire including all food groups and supplements. Black and white women were identical in SES and matched on age (black women 66.9+/-6.2 years vs white women 67.1+/-5.5 years [mean+/-standard deviation], P=0.85). No significant difference existed for dietary calcium intake between black and white women (974+/-524 vs 1,070+/-600 mg/day; P=0.65) or total calcium intake between black and white women (1,485+/-979 vs 1,791+/-887 mg/day; P=0.15). Dairy foods contributed most to dietary calcium intake in black and white women and differed by race (black women 402+/-269 mg/day, white women, 603+/-376 mg/day; P=0.02). Calcium intake from grains differed by race (black women 205+/-201 mg/day vs white women 130+/-234 mg/day; P=0.010) and fortified cereals were a major source of calcium for black women. Calcium supplementation contributed substantially to total calcium intake in both groups, with more white women (n=23, 70%) using supplements than black women did (n=19, 58%). However, no racial difference existed in supplemented calcium intake (black women, n=19; 889+/-605 vs white women, n=23; 1,034+/-460 mg/day; P=0.20). Our data suggest that total daily dietary and supplemental calcium intakes do not differ, but calcium intake from dairy foods and from grains differ in older black and white women matched in age and SES.

Physical and Emotional Health Effects and Social Consequences After Participation in a Low-Fat, High-Carbohydrate Dietary Trial for More Than 5 Years

Purpose

Little is known about the potential adverse effects of interventions to reduce dietary fat. We examined the physical and emotional health effects, and social consequences experienced by women at high risk for breast cancer who had participated in a low-fat diet intervention, randomized, controlled trial for at least 5 years.

Methods

Participants in the Canadian Diet and Breast Cancer Prevention Trial from British Columbia were mailed a survey questionnaire that included the validated Medical Outcomes Study 36-item Short Form Health Survey (SF-36) and Women's Health Questionnaire (WHQ), and a series of questions on health-related and social constructs. Responses were compared between the diet intervention and control groups by menopausal status.

Results

Completed questionnaires were returned by 359 women in the diet intervention group and 382 in the control group. No significant differences were found between these groups for SF-36 and WHQ health outcomes, hair/nail changes, physical activity levels, family/friend support levels, and doctor visits. Significantly more women in the intervention group reported taking products for arthritis (other than pain medication), greater difficulty in maintaining eating habits in social situations and at work, greater stress, and guilt related to personal eating habits. These findings persisted for both premenopausal and postmenopausal women.

Conclusion

Changes resulting from a low-fat diet intervention can be incorporated into women's daily lives with limited long-term negative effects.

Biological monitoring of exposure to organophosphate pesticides in children living in peri-urban areas of the Province of Quebec, Canada

OBJECTIVE

This study was undertaken to assess the exposure to organophosphate (OP) pesticides in children from peri-urban areas of the Province of Quebec, Canada, through measurements of semi-specific alkylphosphate (AP) metabolites.

METHODS

Eighty-nine children aged between 3 and 7 years were recruited via pamphlets sent to day-care centers. A first morning urine void was collected early in the spring of 2003 prior to summertime, which is the usual period of outdoor pesticide use. During summertime, up to five more first morning voids were repeatedly collected, at 72-h intervals, over a 13-day period. The potential determinants of exposure were assessed by a questionnaire at the time of urine collection.

RESULTS

Methylphosphate metabolites were detectable in 98.2% of the 442 samples analyzed while ethylphosphates were detected in 86.7% of the samples. The geometric mean concentration (GM) of the total AP metabolites was 61.7 mug/g creatinine (range: 2.7-1967.3 mug/g creatinine). The difference in urinary AP concentrations between samples collected during spring and summer was non-significant (P=0.08). There was also no significant difference in the mean AP concentrations between summer samples of individuals living in municipalities where outdoor pesticide use is or is not restricted (P=0.25). However, the presence of a pet in the house was associated with an increase in AP concentrations during spraying season (P=0.02). Pesticides were seldom used, as reported by the questionnaire. A significant correlation was also observed (P<0.001) between the urinary AP concentrations in samples provided by siblings at the same time period.

CONCLUSIONS

Mean concentrations of AP were generally higher than those reported in other studies. The observed exposure apparently occurred mainly through the dietary ingestion of OP residues. These data raise questions on the levels of OP residues in Quebec food and the possibility that our participants consumed more fruits and vegetables than those in other studies.