Adherence to the Food Guide Pyramid recommendations among Japanese Americans, Native Hawaiians, and whites: results from the Multiethnic Cohort Study

Building Healthy Eating Knowledge and Behavior: An Evaluation of Nutrition Education in a Skill Training Course for Construction Apprentices

Background: Prior research has found poor health among construction workers is related to poor nutrition and low fruit and vegetable consumption. Promoting nutrition knowledge can improve dietary behaviors, but nutrition education among construction workers is limited. We evaluated the effectiveness of nutrition education on fruit and vegetable consumption among construction apprentices. In this pilot evaluative study, 36 construction apprentices enrolled in skill training programs received two 1.5-hour nutrition classes. Twelve questions addressing healthy eating knowledge and behavior were administered at baseline, after intervention, and at three months follow-up. After intervention, daily fruit consumption improved from baseline (mean (s.d.) =1.42 (0.55)) to post intervention (mean (s.d.) =1.72 (0.70)) (p < 0.05) and to three months follow-up (mean(s.d.) =1.94 (0.83)) (p > 0.05). After intervention, daily vegetable consumption improved from baseline (mean (s.d.) =1.67 (0.59)) to post intervention (mean (s.d.) =1.97 (0.74)) (p < 0.05) and to three months follow-up (mean (s.d.) = 2.19 (0.82)) (p > 0.05). Younger construction apprentices showed better healthy eating knowledge at post intervention and three months follow-up (p > 0.05). Working in normal hours showed better healthy eating knowledge at post intervention but not at three months follow up (p > 0.05). Both age groups and working hours did not show significant differences on healthy eating behaviour. Nutrition education implemented as a three-hour session within skill courses may possibly promote fruit and vegetable consumption among construction apprentices. Further research with control group is required to support the findings in this study.

An Examination of Demographic and Psychosocial Factors, Barriers to Healthy Eating, and Diet Quality Among African American Adults

A healthy diet is associated with lower risk of chronic disease. African Americans generally have poor diet quality and experience a higher burden of many chronic diseases. We examined the associations of demographic and psychosocial factors and barriers to diet quality among African American adults. This cross-sectional study included 100 African American adults in a southeastern metropolitan area. Psychosocial factors (social support, self-efficacy), and barriers to healthy eating were assessed with validated measures. Diet quality was assessed using the Healthy Eating Index (HEI-2010). Nested linear regressions were used to examine the association between the variables of interest and HEI scores. Participants reported having social support (M (mean) = 2.0, SD (standard deviation) = 0.6, range 0⁻3), high levels of self-efficacy (M = 3.1, SD = 0.7, range 1⁻4), and low barriers (M = 1.4, SD = 0.6, range 0⁻4) to engage in healthy eating but total mean HEI scores needed improvement (M = 54.8, SD = 10.9, range 27.1⁻70.0). Participants consumed significantly higher empty calories and lower whole fruits, dairy, and total protein foods than the national average. Barriers to healthy eating (b = -12.13, p = 0.01) and the interaction between age and barriers (b = 0.25, p = 0.02) were most strongly associated with lower HEI scores. Younger African Americans with the highest barriers to healthy eating had the lowest HEI scores. Culturally appropriate interventions targeting empty calories, barriers to healthy eating, and knowledge of the Dietary Guidelines for Americans are needed for African Americans.

Testing the Predictive Validity of the Healthy Eating Index-2015 in the Multiethnic Cohort: Is the Score Associated with a Reduced Risk of All-Cause and Cause-Specific Mortality?

The Healthy Eating Index-2015 (HEI-2015) was created to assess conformance of dietary intake with the Dietary Guidelines for Americans (DGA) 2015–2020. We assessed the association between the HEI-2015 and mortality from all-cause, cardiovascular disease (CVD), and cancer in the Multiethnic Cohort (MEC). White, African American, Native Hawaiian, Japanese American, and Latino adults (n > 215,000) from Hawaii and California completed a quantitative food-frequency questionnaire at study enrollment. HEI-2015 scores were divided into quintiles for men and women. Radar graphs were used to demonstrate how dietary components contributed to HEI-2015 scores. Mortality was documented over 17–22 years of follow-up. Hazard ratios (HRs) and 95% confidence intervals (CIs) were computed using Cox proportional hazards models. High HEI-2015 scores were inversely associated with risk of mortality from all-cause, CVD, and cancer for men and women (p-trend <0.0001 for all models). For men, the HRs (CIs) for all-cause, CVD, and cancer comparing the highest to the lowest quintile were 0.79 (0.76, 0.82), 0.76 (0.71, 0.82), and 0.80 (0.75, 0.87), respectively. For women, the HRs were 0.79 (0.76, 0.82), 0.75 (0.70, 0.81), and 0.84 (0.78, 0.91), respectively. These results, in a multiethnic population, demonstrate that following a diet aligned with the DGAs 2015–2020 recommendations is associated with lower risk of mortality from all-cause, CVD, and cancer.

Dietary intake of polyunsaturated fatty acids and fish among US children 12-60 months of age

This study aimed to estimate intake of individual polyunsaturated fatty acids (PUFAs), identify major dietary sources of PUFAs and estimate the proportion of individuals consuming fish among US children 12-60 months of age, by age and race and ethnicity. The study employed a cross-sectional design using US National Health and Nutrition Examination Survey data. Representative sample of US population based on selected counties.

SUBJECTS

2496 US children aged 12-60 months. Mean daily intake of n-6 PUFAs and eicosapentaenoic acid (EPA) varied by age, with children 12-24 months of age having lower average intakes (mg or g day(-1) ) than children 49-60 months of age and the lowest n6 : n3 ratio, upon adjustment for energy intake. Docosahexaenoic acid (DHA) intake was low (20 mg day(-1) ) compared to typical infant intake and did not change with age. Compared to non-Hispanic white children, Mexican American children had higher DHA and arachidonic acid (AA) intake. In the previous 30 days, 53.7% of children ever consumed fish. Non-Hispanic black children were more likely than non-Hispanic white children to have consumed fish (64.0% vs. 53.0%). Results indicate low prevalence of fish intake and key n-3 PUFAs, relative to n-6 fatty acids, which suggests room for improvement in the diets of US children. More research is needed to determine how increasing dietary intakes of n-3 PUFAs like DHA could benefit child health.

A priori-defined diet quality indexes and risk of type 2 diabetes: the Multiethnic Cohort

AIMS/HYPOTHESIS

Dietary patterns have been associated with the incidence of type 2 diabetes, but little is known about the impact of ethnicity on this relationship. This study evaluated the association between four a priori dietary quality indexes and risk of type 2 diabetes among white individuals, Japanese-Americans and Native Hawaiians in the Hawaii component of the Multiethnic Cohort.

METHODS

After excluding participants with prevalent diabetes and missing values, the analysis included 89,185 participants (11,217 cases of type 2 diabetes). Dietary intake was assessed at baseline with a quantitative food frequency questionnaire designed for use in the relevant ethnic populations. Sex- and ethnicity-specific HRs were calculated for the Healthy Eating Index-2010 (HEI-2010), the Alternative HEI-2010 (AHEI-2010), the Alternate Mediterranean Diet Score (aMED) and the Dietary Approaches to Stop Hypertension (DASH).

RESULTS

We observed significant inverse associations between higher DASH index scores and risk of type 2 diabetes in white men and women, as well as in Japanese-American women and Native Hawaiian men, with respective risk reductions of 37%, 31%, 19% and 21% (in the highest compared with the lowest index category). A higher adherence to the AHEI-2010 and aMED diet was related to a 13-28% lower risk of type 2 diabetes in white participants but not in other ethnic groups. No significant associations with risk of type 2 diabetes were observed for the HEI-2010 index.

CONCLUSIONS/INTERPRETATION

The small ethnic differences in risk of type 2 diabetes associated with scores of a priori-defined dietary patterns may be due to a different consumption pattern of food components and the fact that the original indexes were not based on diets typical for Asians and Pacific Islanders.

Recent population adherence to and knowledge of United States federal nutrition guides, 1992-2013: a systematic review

The Dietary Guidelines for Americans dictates the federal nutrition programs, policies, and recommendations of the United States. Corresponding nutrition guides have been established to help educate the public about the dietary intake patterns recommended in these guidelines as well as to ameliorate the US obesity epidemic and its health-related outcomes. The purpose of this systematic review was to summarize population adherence to and knowledge of these guiding US nutrition guides issued since 1992, including the Food Guide Pyramid, MyPyramid, and MyPlate. Of the 31 studies included in the review, 22 examined adherence, 6 examined knowledge, and 3 examined both adherence and knowledge. Across studies, adherence to nutrition guides was low, with participants consuming inadequate levels of fruit, vegetables, and dairy in particular. Knowledge of nutrition guides increased over time since publication and decreased with age of the participants. An association between knowledge of and adherence to nutrition guides was not found. Disparities in knowledge and adherence existed across demographic groups. Based on these findings, it is suggested that federal dietary guidance can be strengthened by increasing dissemination of nutrition guides to the public and tailoring promotional activities to specific demographic and socioeconomic groups.

The effects of coronary artery calcium screening on behavioral modification, risk perception, and medication adherence among asymptomatic adults: a systematic review

OBJECTIVE

To perform systematic review of the effects of screening for coronary artery calcium (CAC), a subclinical marker of coronary artery disease (CAD), on behavioral or lifestyle modification, risk perception, and medication adherence.

METHODS

We searched through CINAHL, PsychInfo, Web of Science, Cochrane Central Register of Control Trials, and PubMed (Medline) for studies on the effects of CAC screening in asymptomatic individuals across three major domains: behavioral modification, risk perception for CAD, and medication adherence. We extracted data from the retrieved studies, assessed and synthesized the information.

RESULTS

Of the 15 retrieved studies, three were randomized control trials and 12 were observational studies. CAC score was ascertained either as total score, quartiles, or standardized Agatston's ordinal scale. While all the 15 studies involved issues related to behavioral and medication adherence, four involved risk perception of CAD. Although no standardized approach was used in these studies, CAC screening enhanced medication adherence in 13 of the 15 studies, while the others were mixed.

CONCLUSION

CAC screening improved medication adherence and could likely motivated individuals for beneficial behavioral or lifestyle changes to improve CAD. The mixed results suggest the need for further research because screening for subclinical atherosclerosis has significant implications for early detection and prevention of future cardiovascular events by aggressive risk factors modification.

Impact of diet on mortality from stroke: results from the U.S. multiethnic cohort study

OBJECTIVES

Stroke is the fourth leading cause of death in the United States and stroke mortality rates vary by ethnicity. The purpose of this study was to examine the associations between food group consumption and risk of death from stroke among 5 ethnic groups in the United States.

METHODS

The Multiethnic Cohort includes >215,000 participants, the majority of whom are African American, Native Hawaiian, Japanese American, Latino, and Caucasian men and women recruited by mail survey in Hawaii and Los Angeles in 1993-1996. Deaths from stroke were identified by linkage to the state death files and the U.S. National Death Index. Diet was assessed using a validated food frequency questionnaire. Associations were examined using multivariable Cox proportional hazards models, stratified by ethnicity and gender.

RESULTS

A total of 860 deaths from stroke were identified among the cohort participants. Vegetable intake was associated with a significant reduction in risk for fatal stroke among African American women (relative risk [RR]=0.60; 95% CI: 0.36-0.99). Among Japanese American women only, high fruit intake was significantly associated with a risk reduction for stroke mortality (RR=0.43; 95% confidence interval [CI]: 0.22-0.85), whereas meat intake increased risk (RR=2.36; 95% CI: 1.31-4.26). Among men, a significant reduction in stroke mortality was observed among Native Hawaiians (RR=0.26; 95% CI: 0.07-0.95). After pooling the data for the ethnic groups, the findings support an elevated risk for high meat intake among women overall (RR=1.56; 95% CI: 1.12-2.16); no significant effects of dietary intake on risk for fatal stroke were observed among men.

CONCLUSIONS

Although some variations were observed for the associations between diet and stroke mortality among ethnic groups, the findings suggest that these differences are not substantial and may be due to dietary intake of specific food subgroups. Additional investigations including dietary subgroups and nutrients sources are needed to clarify these findings.

Association of metabolic risk factors with cartilage degradation assessed by T2 relaxation time at the knee: data from the osteoarthritis initiative

OBJECTIVE

To evaluate the association of metabolic risk factors with severity and 2-year progression of early degenerative cartilage changes at the knee, measured with T2 relaxation times in middle-aged subjects from the Osteoarthritis Initiative.

METHODS

Cartilage segmentation and T2 map generation were performed in knee 3T magnetic resonance images from 403 subjects ages 45-60 years without radiographic osteoarthritis (OA). The influence of risk factors on baseline T2 and longitudinal progression of T2 was analyzed using linear regression, adjusting for age, sex, and other OA risk factors.

RESULTS

Four metabolic risk factors, i.e., high abdominal circumference (P < 0.001), hypertension (P = 0.041), high fat consumption (P = 0.023), and self-reported diabetes mellitus (P = 0.010), were individually associated with higher baseline T2. When the 4 metabolic risk factors were considered in a multivariate regression model, higher T2 remained significantly associated with abdominal circumference (P < 0.001) and diabetes mellitus (P = 0.026), and there was a trend for high fat consumption (P = 0.096). For the individual risk factors, only diabetes mellitus remained associated with higher baseline T2 after adjustment for body mass index (BMI). After adjustment for BMI, baseline T2 increased in a dose-response manner with the number of metabolic risk factors present (P = 0.032 for linear trend), and subjects with ≥3 metabolic factors (versus <3) had significantly higher baseline T2 (mean difference 1.2 msec [95% confidence interval 0.3, 2.1]; P = 0.011). Metabolic risk factors were not significantly associated with increases in T2 during followup.

CONCLUSION

Metabolic risk factors are associated with higher T2, suggesting that increased cartilage degeneration may be caused by modifiable metabolic disorders.

Sources of vegetables, fruits and vitamins A, C and E among five ethnic groups: results from a multiethnic cohort study

OBJECTIVES

Data are limited on how dietary sources of food and nutrients differ among ethnic groups. The objective of this study was to determine the main sources of fruit, vegetables and vitamins A, C and E for five ethnic groups.

SUBJECTS/METHODS

Dietary data were collected using a validated quantitative food frequency questionnaire from participants in a multiethnic cohort in Hawaii and Los Angeles county between 1993 and 1996. Data were analyzed for 186,916 participants representing five ethnic groups: African-Americans, Japanese-Americans, native Hawaiians, Latinos and Caucasians.

RESULTS

Lettuce was the most consumed vegetable (6.0-9.9%) in all ethnic-sex groups, except among African-American women and Mexican-born Latino men and women. Oranges and bananas contributed more than one-quarter to total fruit intake among all groups. Overall, more ethnic variation in food choices was observed for the top 10 vegetables than for fruits. The top sources of vitamins A, C and E were carrots, orange/grapefruit/pomelo and combined dishes, respectively. Among the micronutrients studied, the greatest ethnic variation in foods consumed was observed for the top 10 food sources of vitamin A.

CONCLUSIONS

This is the first study providing data on the main types of fruit and vegetables consumed and the major sources of vitamins A, C and E among these ethnic groups in the U.S. Such data are valuable for developing and implementing public health strategies to meet the USDA dietary recommendations and for guiding ethnicity-specific nutrition education and intervention programs.

Fruit and vegetable consumption, ethnicity and risk of fatal ischemic heart disease

OBJECTIVE

Mortality rates from ischemic heart disease vary among ethnic groups. Dietary intake of fruits and vegetables has been associated with a lower risk of ischemic heart disease, but ethnic-specific data are limited.

DESIGN

Prospective cohort study.

SETTING

Hawaii and Los Angeles County, between 1993 and 1996.

PARTICIPANTS

These analyses included 164,617 adults age 45 to 75, representing five ethnic groups who were enrolled in the Multiethnic Cohort Study. Dietary data were collected at baseline using a validated food frequency questionnaire and fatal ischemic heart disease cases were identified up to December 31, 2001. Associations between fruit and vegetable consumption and fatal ischemic heart disease were examined using multivariate Cox proportional hazard models.

RESULTS

The associations between fruit and vegetable intake and fatal ischemic heart disease were similar among the five ethnic groups. When data for the ethnic groups were combined, higher vegetable intake was associated with a protective effect against ischemic heart disease in men with all intake levels above 3.4 servings per day (over 6.6 servings per day: hazard ratio, 0.73; 95% confidence interval, 0.58-0.92). Inconsistent results were observed for women, where the protective association was observed only at mid-level vegetable intake levels, but not among women with the highest level of vegetable intake. There was no evidence of an association for fruit intake.

CONCLUSIONS

Associations between fruit and vegetable intake and fatal IHD do not appear to vary among ethnic groups. Additional research is needed to clarify associations for fruit versus vegetable intake and impact on cardiovascular outcomes.

Adherence to recommendations for fruit and vegetable intake, ethnicity and ischemic heart disease mortality

BACKGROUND AND AIMS

Ischemic heart disease (IHD) accounts for one-third of annual deaths in the U.S. and mortality rates vary by ethnicity. The association between adherence to dietary guidelines for fruit and vegetable intake with IHD mortality among different ethnic groups has not previously been examined.

METHODS AND RESULTS

A prospective cohort design was used to examine the incidence of fatal IHD among participants in the Multiethnic Cohort Study. Participants included 164,617 men and women from five ethnic groups: African American, Native Hawaiian, Japanese American, Latino, and Caucasian. Cox proportional hazards models, stratified by ethnicity and sex, were used to examine associations between adherence with recommended dietary guidelines for fruit and vegetable intake and risk for fatal IHD. The results did not provide evidence that the association between adherence with dietary recommendations for fruit or vegetable intake and IHD mortality varies by ethnicity. Pooled data did provide evidence that adhering to the recommendations for vegetables lowered risk among men (RR = 0.84, 95% CI: 0.74-0.96) and women (RR = 0.80, 95% CI: 0.69-0.94). No significant effects were observed for fruit intake.

CONCLUSIONS

The effect of dietary intake of fruit and vegetables did not vary by ethnicity, providing evidence that recommendations do not need to be individualized for these special populations. The protective effect observed for vegetable intake among both sexes confirms previous findings and supports the evidence base for promoting diet modification in this direction.

Adherence to the USDA dietary recommendations for fruit and vegetable intake and risk of fatal stroke among ethnic groups: a prospective cohort study

BACKGROUND

Stroke is the fourth leading cause of death in the U.S. and stroke mortality rates differ substantially by ethnic group. The impact of adherence to the USDA dietary guidelines on risk for fatal stroke among different ethnic groups has not previously been examined.

METHODS

A prospective cohort design was used to examine associations between adherence with dietary recommendations for fruit and vegetable intake and risk for stroke mortality among 174,888 men and women representing five ethnic groups; African American, Native Hawaiian, Japanese American, Latino, and Caucasian. Dietary intake was assessed using a mailed quantitative food frequency questionnaire. Associations were examined using Cox proportional hazards models.

RESULTS

There was no evidence that ethnicity modified associations between fruit and vegetable intake and stroke mortality. When data for different ethnicities were combined, a reduced risk for fatal stroke was observed among women who were adherent with the USDA dietary recommendations for vegetable intake, although this result did not reach statistical significance (RR = 0.84, 95% CI = 0.68-1.04). No associations were observed among men.

CONCLUSIONS

The results of this study do not provide evidence that dietary intake of fruits and vegetables differentially impacts risk for stroke mortality among different ethnic groups.

Ethnic differences in grains consumption and their contribution to intake of B-vitamins: results of the Multiethnic Cohort Study

BACKGROUND

Research indicates that a diet rich in whole grains may reduce the risk of prevalent chronic diseases, including cardiovascular disease, diabetes, and some cancers, and that risk for these diseases varies by ethnicity. The objective of the current study was to identify major dietary sources of grains and describe their contribution to B vitamins in five ethnic groups.

METHODS

A cross-sectional mail survey was used to collect data from participants in the Multiethnic Cohort Study in Hawaii and Los Angeles County, United States, from 1993 to 1996. Dietary intake data collected using a quantitative food frequency questionnaire was available for 186,916 participants representing five ethnic groups (African American, Latino, Japanese American, Native Hawaiian and Caucasian) aged 45-75 years. The top sources of grain foods were determined, and their contribution to thiamin, riboflavin, niacin, vitamin B6, and folic acid intakes were analyzed.

RESULTS

The top source of whole grains was whole wheat/rye bread for all ethnic-sex groups, followed by popcorn and cooked cereals, except for Native Hawaiian men and Japanese Americans, for whom brown/wild rice was the second top source; major contributors of refined grains were white rice and white bread, except for Latinos. Refined grain foods contributed more to grain consumption (27.1-55.6%) than whole grain foods (7.4-30.8%) among all ethnic-sex groups, except African American women. Grain foods made an important contribution to the intakes of thiamin (30.2-45.9%), riboflavin (23.1-29.2%), niacin (27.1-35.8%), vitamin B6 (22.9-27.5%), and folic acid (23.3-27.7%).

CONCLUSIONS

This is the first study to document consumption of different grain sources and their contribution to B vitamins in five ethnic groups in the U.S. Findings can be used to assess unhealthful food choices, to guide dietary recommendations, and to help reduce risk of chronic diseases in these populations.

Diet impacts mortality from cancer: results from the multiethnic cohort study

PURPOSE

Cancer is the second leading cause of death in the United States and mortality varies by ethnicity. The objective of this study was to examine the association between cancer mortality and dietary intake among a large multiethnic population.

METHODS

A prospective cohort design was used to examine cancer mortality among 146,389 participants. Multiethnic cohort study participants represent five ethnic groups: African American, Native Hawaiian, Japanese American, Latino, and Caucasian. Hazard ratios for cancer mortality by intake levels of five food groups and discretionary fat were calculated using Cox proportional hazards models stratified by sex and ethnicity.

RESULTS

There were a total of 2,028 male and 1,464 female fatal cancer cases at the end of follow-up. Among Japanese American men only, there was a significant protective effect seen in those reporting a high grain intake (HR = 0.49, 95 % CI 0.35-0.69); there was no effect of grain consumption in any other ethnic-sex group. There was no evidence that ethnicity modified associations between fruit, vegetable, meat, dairy, or discretionary fat intake and cancer mortality among men. Associations between food group consumption and risk for cancer mortality among women were similar across ethnic groups.

CONCLUSIONS

The considerable reduction in cancer risk associated with high grain consumption among a specific ethnic-sex group, Japanese American men, warrants further investigation. Additional research is needed to validate this observation and determine whether this was a chance finding, or possibly due to differential intake of specific grain subtypes, and/or related to a sex-specific cancer type.

A new Japanese vegetarian food guide

Vegetarianism continues to gain popularity in Japan and the Westernized world, in part from decades of science supporting the health advantages of properly planned vegetarian-based diets. Although there are Asian nutritional tools, one specific to a Japanese vegetarian diet is lacking. Thus, the Japanese vegetarian food guide (JVFG) was developed and based in part on the American Dietetic Association position paper for vegetarian diets and the Japanese Food Guide Spinning Top. The JVFG was developed by collecting dietary information from 3 different institutes in Japan that specialize in regularly offering vegetarian meals. The JVFG was divided into 6 groups with respective recommended servings: vegetables (7.5), grains (4.5), protein foods (4), milk (3), fruits (2), and fats, sugar, and seasonings (<3). The JVFG was developed so that it would adequately provide for all nutrients and be structured for practical use by the general public as well as health professionals.

MyPyramid.gov: assessment of literacy, cultural and linguistic factors in the USDA food pyramid web site

MyPyramid.gov, a major national Web site about healthful eating and physical activity, was analyzed for literacy, cultural, and linguistic factors relevant to consumers. The assessment used 4 standardized readability tests, 1 navigational test, availability of non-English content, and new criteria for cultural factors. Readability scores averaged between grade levels 8.8 and 10.8, and half the navigation criteria were met. The Web site was available in Spanish, but it had little cultural tailoring for English speakers. It is recommended that MyPyramid's readability, navigation, and cultural tailoring be improved. References are provided to help educators learn more about assessing and using Internet communication with diverse audiences.

The role of acculturation in nutrition, lifestyle, and incidence of type 2 diabetes among Latinos

Latinos have become the largest ethnic minority group in the U.S. and will become 25% of the population by 2050. The purpose of this critical review is to examine the influence of acculturation on type 2 diabetes and corresponding risk factors, including 1) dietary intake, 2) physical activity patterns, 3) smoking and alcohol consumption, and 4) obesity. Among Latinos, acculturation has been associated with obesity risk, suboptimal dietary choices including lack of breast-feeding, low intake of fruits and vegetables, a higher consumption of fats and artificial drinks containing high levels of refined sugar, smoking, and alcohol consumption. In contrast, acculturation has been positively associated with physical activity and a lower likelihood of type 2 diabetes among Latinos. However, findings have been inconsistent across acculturation indicators and appear to be strongly modified by Latino subethnicity and gender. It is important to improve existing acculturation measures available. Mexican Americans have been the target group in the majority of studies. Research in this group must continue but it is important to conduct additional research with other Latino subgroups that have been left out of most of the acculturation, lifestyles, and health outcomes research. Differences between acculturation and health-related outcomes may be confounded by socio-economic status, age, and movement from urban to rural areas. Longitudinal multivariate acculturation research is essential to disentangle these relations and to develop sound behavioral change theories that adequately predict behavioral change among Latinos.

Introduction of a pyramid guiding process for general musculoskeletal physical rehabilitation

Successful instruction of a complicated subject as Physical Rehabilitation demands organization. To understand principles and processes of such a field demands a hierarchy of steps to achieve the intended outcome. This paper is intended to be an introduction to a proposed pyramid scheme of general physical rehabilitation principles. The purpose of the pyramid scheme is to allow for a greater understanding for the student and patient. As the respected Food Guide Pyramid accomplishes, the student will further appreciate and apply supported physical rehabilitation principles and the patient will understand that there is a progressive method to their functional healing process.

Dietary intakes and health-related behaviours of Korean American women born in the USA and Korea: the Multiethnic Cohort Study

OBJECTIVE

This study assessed and compared heath-related behaviours and nutrient and food group intakes between US-born and Korea-born Korean American women.

DESIGN AND SUBJECTS

Cross-sectional analyses were performed for ethnic Koreans who participated in the Multiethnic Cohort Study in Hawaii and Los Angeles in 1993-1996. The sample included 492 Korean American women aged 45-75 years who were born in the USA (n = 274) or Korea (n = 218). Participants were recruited using driver's license files as a primary sampling source and completed a self-administered questionnaire, including a quantitative food frequency section.

RESULTS

The proportion overweight or obese was 31.4% in US-born and 9.4% in Korea-born women. US-born women had higher intakes of total fat and fat as a percentage of energy, and lower intakes of sodium, vitamin C, beta-carotene and carbohydrate as a percentage of energy, than Korea-born women. Comparing intakes of food group servings from the Food Guide Pyramid, US-born women reported more whole grains, red meat and nuts, and less soy products, than did Korea-born women. US-born women also consumed fewer vegetables and fruit than those born in Korea. Few women in either group reported intakes that met the recommendations for dairy foods. Intake of discretionary fat from the Pyramid tip was higher in US-born than in Korea-born women.

CONCLUSIONS

These findings indicate that the acculturation of Korean immigrants affects dietary intakes in ways that may alter risks of several chronic diseases. Further studies will be necessary to examine the effects of dietary acculturation on disease patterns.

Effect of a nutrition education program on nutrition-related knowledge of English-as-second-language elementary school students: a pilot study

Nutrition programs that target English-as-Second-Language (ESL) students can potentially improve their nutrition knowledge. This pilot study evaluated the effect of a Food Guide Pyramid (FGP) lesson on nutrition knowledge of ESL students (ages 9-12 years) in a refugee after-school program. A pre- and post-FGP lesson one group design was used. A 12-item knowledge questionnaire was administered to students (N = 15) and their opinions about the lesson were obtained. Overall FGP lesson mean knowledge scores did not increase significantly from pretest to posttest; however, scores that measured specific objectives on the ability to identify food groups and the number of servings for food groups increased, while scores on the ability to identify the importance of each food group for health decreased. Overall, students liked the nutrition lesson, described learning mainly about the FGP, and reported no confusing aspects. Findings suggest that nutrition education targeted to ESL students should emphasize foods versus nutrients and promote active learner involvement.

Urinary isoflavone excretion as a compliance measure in a soy intervention among young girls: a pilot study

OBJECTIVE

To investigate the compliance of young girls with a soy intervention.

DESIGN

An 8-week dietary intervention and urine sample collection.

SETTING

Free-living girls.

SUBJECTS

A convenience sample of 8- to 14-y-old girls (20 started and 17 finished the study) recruited through flyers distributed to staff members and previous study participants.

INTERVENTION

The girls consumed one daily serving of soymilk, soy nuts, or tofu, completed 3-day food records, kept daily soy intake logs, and collected weekly urine samples.

MAIN OUTCOME MEASURES

Compliance with the intervention was evaluated by daily soy intake logs, 3-day food records analyzed by the center's Food Composition and Food Groups Servings Databases, and weekly urinary isoflavone excretion using high-pressure liquid chromatography. The statistical analysis included paired t-tests, analysis of variance, and Spearman's rank-order correlation coefficients.

RESULTS

Daily soy intake logs indicated a mean intake of 6.28 servings out of a maximum of 7.0 servings per week. The food records revealed a six-fold increase in isoflavone intake during the study period (P<0.01) which was confirmed by an increase in urinary isoflavone excretion of similar magnitude (23.3-142.1 nmol/mg creatinine, P=0.02).

CONCLUSIONS

This study demonstrated the ability of young girls to consume one daily soy serving and the usefulness of urinary isoflavones as a primary compliance measure. The high urinary isoflavone excretion levels detected in girls as compared to adult women suggest less intestinal degradation and/or greater absorption of isoflavones in nonadult populations. This finding requires further investigations into the pharmacokinetics of isoflavones.

Dietary patterns using the Food Guide Pyramid groups are associated with sociodemographic and lifestyle factors: the multiethnic cohort study

Dietary patterns have been used to identify typical combinations of foods that may be associated with disease risks. We defined dietary patterns among 195,298 participants of the Multiethnic Cohort Study in Hawaii and Los Angeles in 1993-1996. Intakes of Food Guide Pyramid groups were calculated from a quantitative FFQ for subjects of 5 ethnic groups (African Americans, Hawaiians, Japanese Americans, Latinos, and whites). Three distinct dietary patterns, "Fat and Meat," "Vegetables," and "Fruit and Milk," were identified by exploratory factor analysis with a varimax rotation and validated by confirmatory factor analysis. Similar factor loadings were found for each of 10 ethnic-gender groups in stratified analyses. The odds ratios (OR) for being above the median scores for each factor were calculated. Age, gender, and ethnicity had relatively strong associations with dietary patterns whereas education showed only weak associations. BMI > or = 30 was strongly positively associated with the Fat and Meat pattern (OR = 2.14, 95% CI: 2.08-2.20, vs. BMI < 25). Current smokers showed a positive association with the Fat and Meat pattern (OR = 1.67, CI: 1.62-1.72, vs. nonsmokers) and inverse associations with the Vegetables (OR = 0.66, CI: 0.64-0.68) and Fruit and Milk patterns (OR = 0.53, CI: 0.52-0.55). Physical activity was positively associated with the Vegetables and Fruit and Milk patterns but not with the Fat and Meat pattern. These findings support the hypothesis that dietary patterns are influenced by interrelated sociocultural, demographic, and other lifestyle factors and may be useful in investigations of diet-disease relations.

Adherence to the food guide pyramid recommendations among African Americans and Latinos: results from the Multiethnic Cohort

The objective of the study was to determine the degree of adherence to the Food Guide Pyramid recommendations among African Americans, Latinos born in the United States, and Latinos born in Mexico. Subjects were from the Multiethnic Cohort Study in Hawaii and Los Angeles, and completed a self-administered quantitative food frequency questionnaire at baseline in 1993-1996. Dairy recommendations were the least likely of all the food group recommendations to be followed, with 61% to 99% of individuals in the three ethnic groups not consuming the recommended number of servings. African Americans were less likely to adhere to all of the food group recommendations compared to the two Latino groups. A greater percentage of Latinos born in the United States did not adhere to the food group recommendations compared to Latinos born in Mexico. All three groups would benefit from interventions designed to promote healthy food choices.

Nutritional changes among premenopausal women undertaking a soya based dietary intervention study in Hawaii

BACKGROUND

We conducted a 2-year nutritional intervention among premenopausal women. The goal was to incorporate two daily servings of soya into the regular diet. This report describes the dietary modifications and assesses their nutritional adequacy with regard to major nutrients.

METHODS

In this analysis of 100 intervention and 106 control subjects, women completed a validated food-frequency questionnaire at baseline; throughout the study, they participated in at least three unannounced 24-h recalls.

RESULTS

At randomization, both groups were similar in age and body weight, reported low soya intake, and did not differ by intake of major nutrients and foods. According to the 24-h recalls, women in the intervention group consumed nearly two servings of soya per day, while the control women remained at 0.2 servings. In comparison with the control group, the intervention group consumed fewer dairy products, primarily milk, but also less meat, nuts and seeds. As a result of the dietary modification, the intervention women consumed less-saturated fat and cholesterol and more protein, dietary fibre, calcium and vitamins than the control group.

CONCLUSION

These results suggest that women in the intervention group improved the overall quality of their diet by adding two servings of soya per day.