Baseline fat-related dietary behaviors of white, Hispanic, and black participants in a cholesterol screening and education project in New England

Diet and Survival in Black Women With Epithelial Ovarian Cancer

Importance

Ovarian cancer survival among Black women is the lowest across all racial and ethnic groups. Poor dietary quality also disproportionately affects Black populations, but its association with ovarian cancer survival in this population remains largely unknown.

Objective

To examine associations between dietary patterns and survival among Black women diagnosed with epithelial ovarian cancer (EOC).

Design, Setting, and Participants

This prospective cohort study was conducted among self-identified Black women aged 20 to 79 years newly diagnosed with histologically confirmed EOC in the African American Cancer Epidemiology Study (AACES) between December 2010 and December 2015, with follow-up until October 2022. AACES is a population-based study of ovarian cancer risk and survival among Black women in 11 US regions. Data were analyzed from March 2023 to June 2024.

Exposures

Dietary patterns were assessed by the Healthy Eating Index-2020 (HEI-2020) and Alternative Healthy Eating Index-2010 (AHEI-2010), with scores calculated based on dietary intake in the year prior to diagnosis and collected via the validated Block 2005 Food Frequency Questionnaire. Higher scores indicate better dietary quality.

Main outcomes and measures

Hazard ratios (HRs) and 95% CIs were estimated from multivariable Cox models for the association between adherence to dietary recommendations and overall mortality among all participants and those with high-grade serous ovarian cancer (HGSOC).

Results

Among 483 Black women with EOC (mean [SD] age, 58.1 [10.5] years), 310 deaths were recorded during a median (IQR) follow-up of 4.3 (2.0-8.2) years. No association of dietary patterns with mortality was found among women with EOC overall. However, among 325 women with HGSOC, better adherence to HEI-2020 was associated with decreased mortality in later quartiles compared with the first quartile (HR, 0.63; 95% CI, 0.44-0.92 for quartile 2; HR, 0.67; 95% CI, 0.46-0.97 for quartile 3; HR, 0.63; 95% CI, 0.44-0.91 for quartile 4 ). Similar results were observed with AHEI-2010 among women with HGSOC for the second (HR, 0.62; 95% CI, 0.43-0.89) and fourth (HR, 0.67; 95% CI, 0.45-0.98) quartiles compared with quartile 1.

Conclusions and relevance

In this study, women with moderate and high prediagnosis dietary quality had significantly lower mortality rates from HGSOC compared with women with the lowest prediagnosis dietary quality. These findings suggest that even moderate adherence to dietary guidelines prior to diagnosis may be associated with improved survival among Black women with HGSOC, the most lethal form of ovarian cancer.

Exploring the Sustainable Benefits of Adherence to the Mediterranean Diet during the COVID-19 Pandemic in Italy

This study aimed to identify adherence to the Mediterranean diet (MedDiet) and its effect on health and environmental and socioeconomic sustainability during the COVID-19 pandemic among a sample of the Italian population. Notably, it intended to assess the effect of adherence to the MedDiet on ecological footprints and food expenditure. A survey was conducted from the 5th to the 24th of April 2020 on Google Forms. The MEDAS questionnaire was used to determine the level of adherence to the MedDiet. The carbon footprint (CO2), water footprint (H2O), and food cost were calculated. In total, 3353 participants completed the questionnaire, ranging from 18 to 86 years old. A statistically significant difference was observed in the CO2 and H2O among BMI groups (p < 0.001). The low- and medium-MEDAS groups showed higher CO2 (p < 0.001). The food cost (EUR/week) resulted in statistically significant differences among the MEDAS groups. The CO2 results were significantly lower in organic-market buyers compared to non-organic-market buyers (p < 0.001). Public health must promote awareness of how adhering to a healthy lifestyle and making appropriate food choices can positively impact our health and social and economic well-being.

Perceived intrinsic, social, and environmental barriers for weight management in older Hispanic/Latino adults with obesity

Background

The burden of obesity and chronic disease is increasing in the older US Hispanic/Latino adult population. There is limited evidence on successful weight management strategies as perceived by this population. Assessing barriers and opportunities for weight management using mixed methods is a robust approach to collect in-depth information that can be applied to the development of well-tailored weight management interventions for this population.

Objective

The objective of this study was to assess perceived individual, interpersonal, and environmental factors that influence weight management in older Hispanic/Latino adults.

Methods

This community-based cross-sectional study included 23 Hispanic/Latino older (>50y) adults with obesity (BMI >30 kg/m²). Perceived barriers and opportunities for weight management were assessed through validated questionnaires and focus groups. Prospectively registered on ClinicalTrials.gov (NCT03978416) on 7 June 2019.

Results

In this demographically heterogeneous population, language acculturation was generally low, and the frequency of poor dietary behaviors was high. Participants linked financial strain to lower diet quality, as well as anxiety to uncontrolled eating and food cravings. Social support and trust in healthcare professionals were perceived as priorities for healthy eating. Structural and environmental barriers such as affordability and availability of culturally preferred foods were also identified as influences on food choices and eating behavior.

Conclusions

This study revealed opportunities for culturally tailored weight management interventions in older Hispanic/Latino adults with obesity.

Clinical Trial Registry Number

NCT03978416 (ClinicalTrials.gov).

Bile Acids, Gut Microbes, and the Neighborhood Food Environment-a Potential Driver of Colorectal Cancer Health Disparities

Bile acids (BAs) facilitate nutrient digestion and absorption and act as signaling molecules in a number of metabolic and inflammatory pathways. Expansion of the BA pool and increased exposure to microbial BA metabolites has been associated with increased colorectal cancer (CRC) risk. It is well established that diet influences systemic BA concentrations and microbial BA metabolism. Therefore, consumption of nutrients that reduce colonic exposure to BAs and microbial BA metabolites may be an effective method for reducing CRC risk, particularly in populations disproportionately burdened by CRC. Individuals who identify as Black/African American (AA/B) have the highest CRC incidence and death in the United States and are more likely to live in a food environment with an inequitable access to BA mitigating nutrients. Thus, this review discusses the current evidence supporting diet as a contributor to CRC disparities through BA-mediated mechanisms and relationships between these mechanisms and barriers to maintaining a low-risk diet.

Racial differences in dietary choices and their relationship to inflammatory potential in childbearing age women at risk for exposure to COVID-19

Since the ongoing coronavirus disease 2019 (COVID-19) pandemic is linked to chronic inflammation, people with initial lower inflammatory status could have better outcomes from exposure to this disease. Because dietary habits are one of the most important modifiable risk factors for inflammation, identification of dietary components associated with inflammation could play a significant role in controlling or reducing the risk of COVID-19. We investigated the inflammatory potential of diets consumed by African American (AA) and Caucasian American (CA) women of childbearing age (n = 509) who are at high risk for exposure to COVID-19 by being residents of Birmingham, Alabama, a city severely affected by this pandemic. The overall pro- and anti- inflammatory scores were calculated using dietary intake data gathered using Block food frequency questionnaire. The proinflammatory potential of diets consumed by AAs was significantly higher compared to CAs. Several anti- and proinflammatory nutrients and food groups consumed differed by race. With consumption of a greater number of antioxidants and B-vitamins, CAs switched toward an anti-inflammatory score more effectively than AAs while AAs performed better than CAs in improving the anti-inflammatory score with the consumption of a greater number of minerals and vitamin D. Effective race-specific dietary modifications or supplementation with nutrients identified will be useful to improve proinflammatory diets toward anti-inflammatory. This approach could aid in controlling the current COVID-19 pandemic and future pandemics of a similar nature in women at risk for exposure.

Development of an Interactive Outcome Estimation Tool for Laparoscopic Roux-en-Y Gastric Bypass in Mexico Based on a Cohort of 1002 Patients

BACKGROUND

Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) is one of the most commonly performed bariatric procedures. Considering significant differences between populations around the world, surgical outcomes may vary widely. The aim of the study was to develop an educational patient-specific interactive application that may estimate the potential outcomes of LRYGB in the Mexican population.

METHODS

A database with 76 different variables from 1002 patients who underwent LRYGB at two Mexican Institutions between 1992 and 2014 and had a minimum of 6-month follow-up was analyzed. Descriptive and inferential statistics, as well as a multivariate regression analysis, were performed for the primary analysis. Results were based on four statistical models obtained from the cohort outcomes. A tool was designed to provide estimates of absolute weight loss (AWL) and resolution of four major comorbidities: type 2 diabetes (T2D), high blood pressure (HBP), hypercholesterolemia, and the obstructive syndrome of sleep apnea (OSAS).

RESULTS

There were 353 males (35.2%) and 649 females (64.8%) with a mean age of 41.9 ± 12.1 years and a mean preoperative BMI of 45.3 ± 7.9 kg/m². Mean AWL at 2 years was 39.02 ± 12.7 kg. Mean accumulative percentage of resolution for T2D, HBP, and dyslipidemias at the same time period was 78%, 66.2%, and 84.7%, respectively. Based on these results, the educational tool was developed.

CONCLUSIONS

We were able to develop an interactive estimation application to provide a population-based guidance for potential outcomes of LRYGB. This might be useful not only for health professionals but also for patients interested in learning potential outcomes in specific circumstances.

Correlating blood-based DNA methylation markers and prostate cancer risk in African-American men

The objective of this work was to investigate the clinical significance of promoter gene DNA methylation changes in whole blood from African-American (AA) men with prostate cancer (PCa). We used high throughput pyrosequencing analysis to quantify percentage DNA methylation levels in a panel of 8 genes (RARβ2, TIMP3, SPARC, CDH13, HIN1, LINE1, CYB5R2 and DRD2) in blood DNA obtained from PCa and non-cancerous controls cases. Correlations of methylation status and various clinicopathological features were evaluated. Six genes tested achieved significant difference in DNA methylation levels between the PCa compared to control cases (P < 0.05). The TIMP3 loci demonstrated significant correlation of DNA methylation with age for all cases analyzed (p < 0.05). We observed an inverse correlation between CDH13 methylation (p = 0.045; r = -0.21) and serum vitamin D level whereas TIMP3 methylation (p = 0.021; r = -0.24) and DRD2 methylation (p = 0.056; r = -0.201) showed inverse correlation with supplementary vitamin D in the cancer cases. We also observed a direct correlation between methylation of RARβ2 (p = 0.0036; r = 0.293) and SPARC (p = 0.0134; r = 0.20) loci with PSA level in the controls but not the cancer cases. In addition, alcohol cases significantly correlated with higher RARβ2 methylation (p = 0.0314) in comparison with non-alcohol cases. Furthermore, we observed an inverse correlation of DRD2 methylation (p = 0.0349; r = -0.343) and Gleason score. Our data suggests that promoter methylation occurred more frequently in the blood of AA PCa and is associated with various clinicopathological features in AA men with PCa.

Association of Vitamin D3 Level with Breast Cancer Risk and Prognosis in African-American and Hispanic Women

Background: This study investigated the association of vitamin D3 levels with breast cancer risk and progression in African-Americans and Hispanics. Methods: A total of 237 African-American (Cases = 119, Control = 118) and 423 Hispanic women (Cases = 124, Control = 299) were recruited in the study. Blood samples were collected at the time of breast cancer screening and prior to cancer treatment for 4 weeks on average for the cases. The serum 25-hydroxyvitamin D (25(OH)D3) was measured at a Quest-Diagnostics facility. Results: The results showed that 69.2% of African-Americans and 37.8% of Hispanics had 25(OH)D3 levels below 20 ng/mL. The 25(OH)D3 level below 20 ng/mL was significantly associated with breast cancer in both African-Americans (OR = 2.5, 95% CI = 1.3-4.8) and Hispanics (OR = 1.9, 95% CI = 1.1-3.0). However, the predicted probabilities of breast cancer in African-Americans were significantly higher than in Hispanics (p < 0.001). The 25(OH)D3 below 20 ng/mL was significantly associated with triple negative breast cancer (TNBC) in African-Americans (OR = 5.4, p = 0.02, 95% CI = 1.4-15), but not in Hispanics in our cohort of participants. Levels of 25(OH)D3 below 26 ng/mL predicts a decrease in disease-free survival, but it was not an independent predictor. Conclusions: Our data shows an association between 25(OH)D3 levels and the risk of breast cancer. Further studies on the relationship between 25(OH)D3 level and breast cancer risk are warranted.

Dietary Quality and Ovarian Cancer Risk in African-American Women

This study evaluated 3 index-based dietary patterns-Healthy Eating Index (HEI)-2005, HEI-2010, and Alternate Healthy Eating Index (AHEI)-2010-in relation to ovarian cancer risk in African-American women. The study was conducted among 415 ovarian cancer cases and 629 age- and site-matched controls of African-American descent recruited from the population-based African American Cancer Epidemiology Study. Multivariable unconditional logistic regression models were used to estimate odds ratios and 95% confidence intervals between quartiles of dietary quality indices and ovarian cancer risk, adjusting for potential confounders. We found that higher AHEI-2010 scores, but not HEI-2005 or HEI-2010 scores, were associated with lower risk of ovarian cancer (comparing the highest quartile (4th) vs. lowest (1st), odds ratio (OR) = 0.66, 95% confidence interval (CI): 0.45, 0.98; P for trend = 0.05). When stratified by menopausal status, no noteworthy associations were observed among premenopausal women. However, among postmenopausal women, greater adherence to HEI-2010 (quartile 4 vs. quartile 1, OR = 0.57, 95% CI: 0.36, 0.92; P for trend = 0.03) and AHEI-2010 (quartile 4 vs. quartile 1, OR = 0.49, 95% CI: 0.31, 0.78; P for trend = 0.01) were inversely associated with ovarian cancer. Our findings indicate that adherence to an overall healthy dietary pattern may reduce ovarian cancer risk in African-American women, and particularly among postmenopausal African-American women.

The Special Supplemental Nutrition Program for Women, Infants, and Children Fresh Start Randomized Controlled Trial: Baseline Participant Characteristics and Reliability of Measures

BACKGROUND

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) Fresh Start (WFS) is a randomized controlled trial of nutrition education to promote farmers' market fruit and vegetable (F/V) purchases and consumption among women enrolled in WIC.

OBJECTIVES

To describe the baseline characteristics (demographics and F/V intake [including F/V juice]) of WFS participants, compare the characteristics with those of WIC participants in New Jersey and nationwide, and examine the baseline reliability of study measures.

DESIGN

Cross-sectional.

PARTICIPANTS/SETTING

Seven hundred forty-four women served by a New Jersey-based WIC agency located in a densely populated, urban area.

MAIN OUTCOME MEASURES

Demographic characteristics; newly developed measures of farmers' market-related knowledge, attitudes, and skills; and validated measures of F/V intake.

STATISTICAL ANALYSES

Descriptive statistics to characterize the sample. One-sample t and one-sample sign tests to compare the characteristics with reference values. For dietary behaviors, comparisons were with state and national estimates of the frequency and quantity of F/V intake.

RESULTS

Participants had a mean age of 28.9±6.8 years and were predominantly Hispanic (59%), US-born (60%), never married (41%), unemployed (62%), receiving assistance other than WIC (70%), and food insecure (55%). Half reported a high school education or less. Higher proportions of WFS participants than WIC participants nationwide were represented among demographic groups at increased risk of inadequate F/V intake. WFS participants consumed more fruit (2.7 cups/day) but less vegetables (1.4 cups/day) than did women nationwide (1.1 and 1.4 cups/day, respectively; P<0.01). Although participants consumed recommended amounts of fruit, their vegetable intake was below recommended levels. All but two of the measures developed for the study had reliability coefficients at or above 0.60.

CONCLUSIONS

Intervention is warranted to improve participants' vegetable intake. Registered dietitian nutritionists should be aware of F/V intake differences that may require differential intervention strategies.

EFFICACY AND SAFETY OF DULAGLUTIDE IN HISPANIC/LATINO PATIENTS WITH TYPE 2 DIABETES IN THE AWARD CLINICAL PROGRAM

OBJECTIVE

The aim of this post hoc analysis was to assess the efficacy and safety of once-weekly dulaglutide in Hispanic/Latino patients with type 2 diabetes (T2D) in phase 3 AWARD trials 1 to 6.

METHODS

Hispanic/Latino data at Week 26 were pooled across studies for each dulaglutide dose to analyze the change from baseline in glycosylated hemoglobin (HbA1c), percent to HbA1c goal, and adverse events (AEs). Change from baseline in HbA1c, change from baseline in weight and hypoglycemia were analyzed by Hispanic/Latino and non-Hispanic/Latino subgroups for each study.

RESULTS

Of the 3,136 patients randomized to dulaglutide 1.5 or 0.75 mg, 949 were reported as having Hispanic/Latino ethnicity. Baseline characteristics were similar for Hispanic/Latino and overall populations, except there were slightly more Hispanic/Latino females and weight was slightly lower for Hispanic/Latino patients. Hispanic/Latino patients receiving dulaglutide 1.5 mg had a reduction in HbA1c of 1.25% (95% confidence interval [CI]: -1.35, -1.15); dulaglutide 0.75 mg had a reduction of 1.07% (95% CI: -1.18, -0.96). Reductions in HbA1c and percent to goal HbA1c <7% and ≤6.5% were similar between Hispanic/Latino patients and the overall population. Weight change and hypoglycemia were similar between Hispanic/Latino and non-Hispanic/Latino subgroups for all studies. Treatment-emergent AEs were consistent with the overall population.

CONCLUSION

Dulaglutide improved glycemic control with the potential for weight loss in Hispanic/Latino patients with T2D. Dulaglutide was well tolerated and had a low risk of hypoglycemia when used without insulin secretagogues or insulin. In the Hispanic/Latino population, dulaglutide efficacy and safety was consistent with that of the overall population.

ABBREVIATIONS

AE = adverse event AWARD = Assessment of Weekly AdministRation of dulaglutide in Diabetes BID = twice daily CARMELA = The Cardiovascular Risk Factor Multiple Evaluation of Latin America CI = confidence interval GLP-1 RA = glucagon-like peptide-1 receptor agonist HbA1c = glycosylated hemoglobin T2D = type 2 diabetes.

Time-Course Analysis of Flow Mediated Dilation for the Evaluation of Endothelial Function After a High-Fat Meal in African Americans

BACKGROUND

Flow-mediated dilation (FMD) is used to assess endothelial function through changes in vascular diameter after hyperemia. High-fat meal (HFM) has been shown to induce endothelial dysfunction; recent studies, however, reported conflicting results in obese African American women (AAW). Differences in the method used to analyze FMD may explain these discrepancies.

METHODS AND RESULTS

In protocol 1, we assessed the time course of FMD and compared the repeatability of FMD using the individual maximum peak dilation (FMDpeak) and the dilation at 60 seconds (FMD60). Sixteen AAW (age, 42±10.4 years; body mass index [BMI], 39±5.8 kg/m(2)) were studied on 2 occasions, 4 weeks apart, under fasting conditions (study 1 and study 2). In protocol 2, we used the most repeatable measurement from protocol 1 to assess changes in endothelial function after an HFM in 17 AAW (agen 42±11.1 years; BMIn 38±5.6 kg/m(2)). We found that FMDpeak was the most repeatable measurement (N=16; study 1, 5.31±3.12% and study 2, 5.80±2.91%; r=0.94). After an HFM, the baseline brachial artery diameter significantly increased at 2 hours (0.10 mm; 95% confidence interval [CI], 0.01-0.18; P=0.03) and at 4 hours (0.17 mm; 95% CI, 0.09-0.25; P<0.001). At 2 hours, the FMDpeak decreased compared with pre-HFM (-1.76; 95% CI, -3.55-0.02; P≤0.05).

CONCLUSIONS

The individual's maximum peak dilation after hyperemia is the most consistent measure to assess the effect of an HFM on endothelial function. Endothelial dysfunction occurred at 2 hours after an HFM in AAW.

CLINICAL TRIAL REGISTRATION

URL: https://clinicaltrials.gov/ Unique identifiers: NCT01334554 and NCT02126735.

Racial Differences in Blood Lipids Lead to Underestimation of Cardiovascular Risk in Black Women in a Nested observational Study

Background:

During screening for enrollment in a clinical trial, we noticed potential racial disparities in metabolic syndrome variables in women who responded to our study advertisement. We designed a nested observational study to investigate whether metabolic syndrome variables differed between non-Hispanic blacks and non-Hispanic whites.

Methods:

The cohort comprised of women who have met the preliminary clinical trial criteria (body mass index [BMI] 25-45, age 20-75 years, and no use of lipid-lowering medications or supplements). These women, including 116 blacks and 138 whites, provided fasting blood samples for analysis of serum lipid profile.

Results:

Blacks had lower mean triglycerides (81.1 ± 3.3 mg/dL vs 140.6 ± 5.9 mg/dL; P < .0001), total cholesterol (176.1 ± 3.6 mg/dL vs 201.6 ± 3.3 mg/dL; P < .0001), and low-density lipoprotein (111.7 ± 3.3 mg/dL vs 128.2 ± 2.9 mg/dL; P < .001) and higher mean BMI (37.2 ± 0.5 vs 35.2 ± 0.5; P < .01) and diastolic blood pressure (82.4 ± 0.8 mmHg vs 79.4 ± 0.7 mmHg; P < .01) than whites. Only 7% of blacks, compared with 41% of whites, had triglycerides ≥150 mg/dL; as a result, fewer black women met metabolic syndrome criteria than white women. Additionally, in women with waist circumference ≥88 cm (N = 215), high-density lipoprotein was higher in blacks than in whites (48.3 ± 1.5 mg/dL vs 44.2 ±1.3 mg/dL; P < .05).

Conclusions:

Due to racial differences in blood lipids, current metabolic syndrome criteria may result in underestimation of cardiovascular risk in blacks.

Consumer health information technology in an adult public health primary care clinic: a heart health education feasibility study

OBJECTIVE

To explore the feasibility and short term outcomes of using an interactive kiosk integrated into office flow to deliver health information in a primary care clinic.

METHODS

Fifty-one adults with BMI ≥25 were randomly assigned to use a kiosk with attached devices to receive a six-week healthy eating/weight monitoring (intervention) or general health/BP monitoring (attention-control) program. Outcomes were measured at baseline, 8 weeks (post) and three month follow-up.

RESULTS

Participants completed an average of 2.73 weekly sessions, with transportation and time given as limiting factors. They found the kiosk easy to use (97%), liked the touchscreen (94%), and would use the kiosk again (81%). Although there were no differences between groups, the 27 completing all assessments showed reduced weight (p=.02), and decreased systolic (p=.01) and diastolic BP (p<.001) at follow-up. Although healthy eating behaviors increased, the change was not statistically significant.

CONCLUSION

Using a kiosk within a clinic setting is a feasible method of providing health information and self-monitoring. Multi-session educational content can provide beneficial short-term outcomes in overweight adults.

PRACTICE IMPLICATIONS

A kiosk with attached peripherals in a clinic setting is a viable adjunct to provider education, particularly in medically underserved areas.

Challenges to healthy eating for people with diabetes in a low-income, minority neighborhood

OBJECTIVE

This study used qualitative interviews with black and Latino participants with diabetes to further understanding about types of foods eaten, food preparation, sources of foods and meals, communication with providers, and effects of race and ethnicity on eating in this population.

RESEARCH DESIGN AND METHODS

Researchers recruited black and Latino adults from East Harlem, New York, to participate in four English and Spanish focus groups. Discussions were transcribed, coded, and analyzed to uncover prevalent themes, which were interpreted with the Common Sense Model of Self-Regulation.

RESULTS

Thirty-seven adults with diabetes participated in four focus groups. The following four major themes emerged from the analyses: 1) The food environment limited participants' access to healthy foods; 2) understanding of diabetes and communication with clinicians about healthy eating was limited and abstract; 3) the short-term, negative consequences of healthy eating outweighed the benefits; and 4) stress, in large part from poverty and discrimination, was seen as a causal factor for both poor eating and diabetes.

CONCLUSIONS

Participants' responses indicated that using healthy eating to control diabetes does not provide immediate, tangible results. Thus, these participants followed their own common sense to guide their diabetes management and improve their health. Clinicians may be better able to help patients eat healthfully if they consider these factors during medical visits.

Family Support Is Associated With Behavioral Strategies for Healthy Eating Among Latinas

Background. Healthy eating is important for obesity control. Dietary interventions target the adoption of behavioral strategies to increase fiber and decrease fat consumption. However, little is known about the contributions of psychosocial factors to the use of these strategies. Purpose. This study examined psychosocial correlates of behavioral strategies for healthy eating among Latinas. Method. Participants included 361 Latino mothers living along the U.S.–Mexico border in California. Data included measures of sociodemographics, acculturation, and psychosocial determinants of healthy eating. A 30-item dietary behavioral strategies scale assessed strategies to increase fiber and decrease fat consumption. Results. Family interactions regarding dietary habits (β = .224, p < .001) and financial status (β = .148, p = .029) were associated with the use of strategies to decrease fat consumption. Positive family interactions regarding dietary habits (β = .226, p < .001), fewer barriers to obtaining fruits and vegetables (β = −.207, p < .001), and more family support for vegetable purchasing (β = .070, p = .047) were associated with use of strategies to increase fiber consumption. Conclusions. Future interventions would benefit from improving family systems associated with healthy eating.

Examining alcohol's contribution to the US African-American/White cirrhosis mortality differential from 1950 to 2002

AIMS

The aim of this study was to estimate the overall impact of alcohol on US race- and sex-specific age-adjusted cirrhosis mortality rates and to consider beverage-specific effects that represent changes in drinking patterns over time, comparing states with large and small African-American/White cirrhosis mortality differentials.

METHODS

Using series data from 1950 to 2002, the effects of per capita alcohol consumption on cirrhosis mortality for African American and White men and women were estimated using generalized least squares panel models on first-differenced data. Granger causality tests explored geographic patterning of racial differences in cirrhosis mortality.

RESULTS

Cirrhosis mortality was significantly positively related to apparent consumption of alcohol, with an overall impact of 8-14%/l of ethanol. This effect was driven by spirits which were more strongly associated with mortality for African-American women and for African-American men in states with larger mortality differentials. This disparity first emerged in New York and spread through the Northeast and into Midwestern states.

CONCLUSION

Differences in the contribution of alcohol to cirrhosis mortality rates suggest variation by race and gender in life-course patterns of heavy consumption, illicit liquor and spirits use, as well as birth cohort effects.

Diabetes-related behaviors in Latinas and non-Latinas in California

OBJECTIVE

Certain dietary and physical activity behaviors have been associated with the risk of developing type 2 diabetes, yet little is known about the prevalence of these behaviors among Latinas (Latino women). The purpose of this cross-sectional study was to compare the prevalence of diabetes-related behaviors in Latinas and non-Latinas.

RESEARCH DESIGN AND METHODS

Using data from the 2009 California Health Interview Survey, we compared self-reported diabetes-related behaviors of Latinas (n = 4,321) to non-Latinas (n = 21,112) after excluding women who were pregnant or had diabetes. For six behaviors, we determined the cut point for the least healthy tertile: walking, doing moderate to vigorous physical activity, and consuming fried potatoes, sugar-sweetened beverages (SSBs), desserts, and fast food. We used logistic regression to examine the association between Latina ethnicity and being in the least healthy tertile compared with the other two tertiles for each of these behaviors.

RESULTS

In multivariate models adjusted for age, income, education, marital status, health status, smoking, and acculturation, Latinas had a higher risk (odds ratio [95% CI]) of being in the least healthy tertile for the consumption of fast food (1.94 [1.63-2.31]), SSBs (1.53 [1.29-1.82]), and fried potatoes (1.32 [1.18-1.67]), and lower risk for desserts (0.82 [0.70-0.95]). Latinas and non-Latinas had similar physical activity levels.

CONCLUSIONS

Dietary differences between Latinas and non-Latinas (particularly in the consumption of fast food and SSBs) may be the focus of interventions to prevent diabetes in Latinas. Further research among Latinas is needed to understand and modify these dietary behaviors.

Are nutrition knowledge, attitudes, and beliefs associated with obesity among low-income Hispanic and African American women caretakers?

The purposes of this descriptive study were to (1) describe nutrition knowledge, attitudes, beliefs (KAB), and self-efficacy among low-income African American and Hispanic women; (2) identify the associations these variables have on diet quality and weight status; (3) identify barriers to healthy eating. Data from three separate studies were combined and analyzed. The total sample included African Americans (N = 92) and Hispanics (N = 272). Descriptive statistics and bivariate analyses were used to identify associations between KAB and body mass index (BMI) and diet quality. The majority of African Americans had good knowledge in nutrition while Hispanics had fair knowledge. Attitudes toward eating a healthy diet were significantly associated with high fiber intake among African Americans and low fat consumption among Hispanics. A computed KAB score showed no significant relation to individuals' weight status or diet quality. However, attitudes and beliefs about healthy foods strongly correlated with participants' weight or diet consumption among Hispanics. The most common barrier to consuming a healthy diet reported by both groups was the cost of healthy foods. It is therefore recommended to address these variables when addressing obesity and poor dietary intake among low-income minority groups.

An Assessment of nutrition education in selected counties in New York State elementary schools (kindergarten through fifth grade)

OBJECTIVE

To assess the extent to which nutrition education is implemented in selected counties in New York State elementary schools (kindergarten through fifth grade) and explore how nutrition knowledge is presented in the classroom and what factors support it.

DESIGN

Cross-sectional, self-administered survey.

SETTING

New York State elementary schools in selected counties.

PARTICIPANTS

New York State elementary school teachers (n = 137).

MAIN OUTCOME MEASURES

Hours spent teaching nutrition; nutrition topics, methods of teaching, education resources, and aspects of the school environment that may influence nutrition education.

ANALYSIS

Crosstabs with a chi-square statistic and ANOVA.

RESULTS

Eighty-three percent of teachers taught some nutrition (9.0 ± 10.5 hours) during the academic year. Teachers taught lessons about finding and choosing healthy food (61%), relationship between diet and health (54%), and MyPyramid (52%) most often. Suburban teachers (12.4 ± 12.5 hours) taught significantly (P = .006) more hours of nutrition than rural teachers (4.2 ± 3.9 hours). Teachers at schools with fewer than 80% nonwhite students taught significantly (P = .02) more (10.4 ± 11.4 hours) compared to schools with greater than 80% nonwhite students (5.6 ± 6.4 hours).

CONCLUSIONS AND IMPLICATIONS

Teachers reported that nutrition education is important and that they are willing to teach nutrition. Efforts should be made that support integrated nutrition topics, methods of instruction, and availability of resources.

The role of food culture and marketing activity in health disparities

Marketing activities have attracted increased attention from scholars interested in racial disparities in obesity prevalence, as well as the prevalence of other preventable conditions. Although reducing the marketing of nutritionally poor foods to racial/ethnic communities would represent a significant step forward in eliminating racial disparities in health, we focus instead on a critical-related question. What is the relationship between marketing activities, food culture, and health disparities? This commentary posits that food culture shapes the demand for food and the meaning attached to particular foods, preparation styles, and eating practices, while marketing activities shape the overall environment in which food choices are made. We build on prior research that explores the socio-cultural context in which marketing efforts are perceived and interpreted. We discuss each element of the marketing mix to highlight the complex relationship between food culture, marketing activities, and health disparities.

A cross-sectional study of US rural adults' consumption of fruits and vegetables: do they consume at least five servings daily?

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.

Heritabilities of Lipids in Young European American and African American Twins

Twin studies of lipids have almost exclusively involved Caucasians. People of African descent are known to show a healthier lipid profile, but relatively little is known about ethnic differences in genetic and environmental influences on lipids. One hundred and six African American (AA) and 106 European American (EA) twins (30 singletons and 91 complete pairs: 49 monozygotic, 21 dizygotic and 21 opposite-sex) from the south-eastern United States were studied (mean age 17.9 ± 3.2 years; 79% fasting). Lipids were assayed with the Cholestech LDX system. Analyses were adjusted for fasting status. Generalized estimating equations were used to test for the effects of sex and ethnicity on means, controlling for the dependence within twin pairs. Structural equation modeling was used to estimate genetic and environmental effects on each lipid variable. Females showed higher high-density lipoprotein (HDL) values than males (p< .001) and AAs showed higher HDL values than EAs (p< .001). EA males had higher triglyceride values than other groups (p= .02). All parameter estimates could be set equal across sex. Parameter estimates for total cholesterol, triglycerides and HDL could be set equal across ethnicity. The best fitting model for low- density lipoprotein (LDL) showed higher heritability in AAs (.92) than EAs (.69). Heritabilities ranged from 69% to 92%, with remaining variation explained by nonshared environmental effects. Adjustment for body mass index had virtually no effect on the heritability estimates. In this first twin study on lipids to include AAs, no ethnic differences in heritability were found except for LDL, where AAs exhibited higher estimates.

Special considerations on the management of Latino patients with type 2 diabetes mellitus

BACKGROUND

Latinos are the largest minority population in the United States, and are characterized by higher rates of obesity and diabetes compared to Whites. The prevalence of diagnosed diabetes in Latinos is two-fold higher than in Caucasians, and Latinos suffer from higher rates of diabetic complications and mortality. As the diabetes epidemic continues to expand and exert greater socioeconomic strain on national healthcare systems, the success of global and national healthcare initiatives for diabetes prevention and improvement of care will depend upon strategies targeted specifically toward this population. Essential to such strategies is an understanding of success factors unique to the Latino population for diabetes prevention and achievement of optimal treatment outcomes.

METHODS

A PubMed search was conducted for literature describing type 2 diabetes and its complications in Latinos. Specifically, we sought data describing epidemiology, disparities, management considerations, and success factors in this population.

RESULTS

The title search yielded more than 2000 articles, 80 of which were deemed directly relevant to this review. The inherent limitations of this subjective selection process are acknowledged.

CONCLUSIONS

A number of studies have highlighted various ethnic disparities in Latinos with diabetes including higher HbA1c levels, greater rates of obesity and metabolic syndrome, and a larger proportion of individuals with inadequate access to care. While relatively fewer studies describe success factors for redressing cultural disparities in diabetes, the current body of literature supports primary care strategies aimed at effective provider-patient relationships and culturally tailored education and lifestyle modification regimens. Further research demonstrating effective, culturally tailored practices that are suitable to the primary care setting would be of value to providers treating Latinos with diabetes.

Nutrition labels on pre-packaged foods: a systematic review

Objective

To review research on consumer use and understanding of nutrition labels, as well as the impact of labelling on dietary habits.

Design

A systematic review was conducted by searching electronic databases. Relevant articles were screened by two reviewers and included if they met inclusion criteria, including eight methodological criteria. A total of 120 articles were included in the review, including cross-sectional surveys (n96), experimental designs (n17), ‘natural experiments’ (n7) and longitudinal population-based surveys (n2).

Setting

Articles covered seven jurisdictions: USA (n88), Europe (n12), Canada (n9), Australia and New Zealand (n4), Norway (n2), Thailand (n1) and Trinidad (n1).

Subjects

Participants were from a wide range of age groups, socio-economic strata and geographical regions.

Results

Nutrition labels on pre-packaged foods are among the most prominent sources of nutrition information. Nutrition labels are perceived as a highly credible source of information and many consumers use nutrition labels to guide their selection of food products. Evidence also shows a consistent link between the use of nutrition labels and healthier diets. However, the use of labels varies considerably across subgroups, with lower use among children, adolescents and older adults who are obese. Research also highlights challenges in terms of consumer understanding and appropriate use of labelling information.

Conclusions

Nutrition labels on pre-packaged foods are a cost-effective population-level intervention with unparalleled reach. However, to capitalize on their potential, governments will need to explore new formats and different types of information content to ensure that nutrition information is accessible and understandable.

Dietary patterns and cardiovascular risk markers in the UK Low Income Diet and Nutrition Survey

BACKGROUND AND AIM

Dietary patterns have been associated with various disease risk markers. There is presently little representative data about the dietary patterns of adults on low income. The objective was therefore to identify dietary patterns and how they relate to cardiovascular (CVD) risk markers in this specific population.

METHODS AND RESULTS

Exploratory factor analysis was performed to examine dietary patterns in participants from the UK Low Income Diet and Nutrition Survey (n=2931, aged 49.4+/-20.2 years, 65% female). Dietary intake was assessed from three 24h dietary recalls and blood was drawn for the assessment of CVD risk markers (C-reactive protein [CRP], total and high density lipoprotein [HDL] cholesterol, triglycerides, homocysteine). Results of the factor analysis revealed four interpretable principle components accounting for approximately 16.5% of the total variance, with similar patterns across gender. A 'fast food' diet pattern explained the greatest proportion of the variance (5.5%), followed by 'health aware' (4.1%), 'traditional' (3.6%), and 'sweet' (3.3%) factors. Participants consuming more items from the fast food pattern were younger, more likely to be smokers and employed, but not partnered. The 'health aware' diet pattern was inversely associated with concentrations of CRP and homocysteine, and positively with HDL-cholesterol.

CONCLUSIONS

A fast food dietary pattern, high in saturated fat, explained the greatest proportion of the variance in a representative sample of adults on low income from the UK. There was, however, considerable heterogeneity in dietary intake among this socially deprived group and healthy eating was associated with lower CVD risk markers.

The validity and reliability of the Socioeconomic Status Instrument for assessing prostate cancer patients

BACKGROUND

Because of the lack of consistency in the associations of the socioeconomic status (SES) of prostate cancer (PC) patients from diverse racial and ethnic backgrounds with PC health outcomes, I created the Socioeconomic Status Instrument (SESI) from the Demographic and Health Access components of the Behavioral Risk Factor Surveillance System 2004 Questionnaires and the socioeconomic indices of the subjects' residential counties to better assess the SES of PC patients.

METHODS

The SESI was tested on 220 consecutive subjects with pathologically confirmed PC at the Veterans Affairs Medical Center in Houston, TX. A team that included an epidemiologist, a validation statistician/health services research scientist, and PC survivors assessed the content validity of the SESI. The construct validity of the SESI was assessed with factor analysis by extracting and analyzing 5 principal components based on the subjects' individual responses on the assessment: county socioeconomic characteristics, individual socioeconomic characteristics, financial distress, increased domestic burden with limited earnings, and affluence. The internal consistency reliability of the SESI was assessed with Cronbach's alpha coefficients.

RESULTS

Based on the reviews of the SESI, all of the initial 10 items were retained. The correlations between individual responses on the SESI were similar to the results of previous studies. The 5 principal components that I assessed accounted for 71.5% of the variance. Factor loadings ranged from 0.66 to 0.98 and communalities ranged from 0.55 to 0.94. County socioeconomic characteristics accounted for 22.6% of the variance, whereas individual socioeconomic characteristics accounted for 14.6% of the variance. The overall Cronbach's alpha coefficient was 0.78.

CONCLUSIONS

The SESI is valid and reliable. Accurate measurements of the SES of PC patients would provide better guidance for future research and care deliveries.

Behavioral Predictors of Low Fat Intake among Economically Disadvantaged African-American Adolescents

Purpose.

To determine whether five behaviors shown to predict low fat intake in adults predicted low fat intake among economically disadvantaged African-American adolescents.

Design.

Cross-sectional.

Subjects and Measures.

Recruited through youth services agencies serving low-income communities in New York and New Jersey, participants were 265 African-American adolescents aged 10 to 14 years. Participants completed the Block Fat Screener and scales for measuring the following behaviors: avoiding fat as a seasoning, modifying meat to make it lower in fat, substituting high-fat foods with manufactured low-fat equivalents, replacing high-fat foods with fruits and vegetables, and replacing high-fat foods with low-fat foods other than fruits and vegetables.

Analysis.

The reliability and construct validity of the scales were assessed using internal consistency reliability and correlation analyses. Multiple regression analysis was used to determine behavioral predictors of low fat intake.

Results.

Scale coefficient alphas ranged from .60 to .80. Fat avoidance, substitution, and replacement with fruits and vegetables were significantly associated with fat intake. The regression equation containing these behaviors accounted for 12% of the variance in intake. All three behaviors were significant predictors of low fat intake.

Conclusions.

Fewer behaviors have salience for predicting low fat intake among economically disadvantaged African-American adolescents than among adults. Interventions to lower youths' intake should emphasize fat avoidance, substitution, and replacement with fruits and vegetables.

Risk factors for gastrointestinal ulcer disease in the US population

PURPOSE

Gastrointestinal (GI) ulcers are frequently seen in patients with multiple chronic medical conditions. Few studies have described the overall prevalence, comorbidities, or risk factors associated with this diagnosis. We sought to determine among a national dataset if individuals with certain medical comorbidities are at increased risk for gastrointestinal ulcer disease, while controlling for relevant confounders.

RESULTS

The overall prevalence of GI ulcer is 8.4%. A significant increased risk of ulcer history is associated with older age (OR 1.67), African-Americans (OR 1.20) current (OR 1.99) and former (OR 1.55) tobacco use, former alcohol use (OR 1.29), obesity (OR 1.18), chronic obstructive pulmonary disease (OR 2.34), chronic renal insufficiency (OR 2.29), coronary heart disease (OR 1.46), and three or more doctor visits in a year (OR 1.49).

CONCLUSIONS

This large US population-based study reports on a number of demographic, behavioral, and chronic medical conditions associated with higher risk of gastrointestinal ulcer disease.

Lactose intolerance and African Americans: implications for the consumption of appropriate intake levels of key nutrients

Lactose intolerance is a complex condition that is complicated by cultural beliefs and perceptions about the consumption of dairy products. These attitudes about dairy may contribute to inadequate intake of key nutrients that may impact conditions that contribute to health disparities in African Americans. While a complex health problem, lactose intolerance is easy to treat. However, no treatment can improve the body's ability to produce lactase. Yet, symptoms can be controlled through dietary strategies. This position paper emphasizes the importance of using patient and provider-level strategies in order to reduce the risks to the health of African Americans that may accrue as a result of dairy nutrient deficiency. Evaluation and assessment of interventions tested is critical so that evidence-based approaches to addressing dairy nutrient deficiency and lactose Intolerance can be created. Lastly, it is essential for physicians to communicate key messages to their patients. Since dairy nutrients address important health concerns, the amelioration of lactose intolerance is an investment in health. Lactose intolerance is common, is easy to treat, and can be managed. It is possible to consume dairy even in the face of a history of maldigestion or lactose intolerant issues. Gradually increasing lactose in the diet--drinking small milk portions with food, eating yogurt, and consuming cheese--are effective strategies for managing lactose intolerance and meeting optimal dairy needs.

Dietary patterns associated with metabolic syndrome, sociodemographic and lifestyle factors in young adults: the Bogalusa Heart Study

OBJECTIVE

To examine the association between dietary patterns (DP) and risk for metabolic syndrome (MetS); and to identify differences in DP by socio-economic, demographic and lifestyle factors.

DESIGN

Dietary intake (from an FFQ), anthropometric/biochemical parameters and sociodemographic/lifestyle information (from a self-reported questionnaire) were evaluated, using a cross-sectional design. Statistical methods included principal component factor analysis, analysis of covariance and linear regression. All analyses were covariate-adjusted.

SETTING

The Bogalusa Heart Study (1995-1996), USA.

SUBJECTS

Young adults (19-39 years; n 995; 61 % females/39 % males; 80 % whites/20 % blacks) from a semi-rural southern US community were examined.

RESULTS

The 'Western Dietary Pattern' (WDP) consisted of refined grains, French fries, high-fat dairy foods, cheese dishes, red meats, processed meats, eggs, snacks, sweets/desserts, sweetened beverages and condiments. The 'Prudent Dietary Pattern' (PDP) consisted of whole grains, legumes, vegetables, fruits, 100 % fruit juices, low-fat dairy products, poultry, clear soups and low-fat salad dressings. The DP explained 31 % of the dietary intake variance. Waist circumference (P = 0.02), triceps skinfold (P = 0.01), plasma insulin (P = 0.03), serum TAG (P = 0.05), and the occurrence of MetS (P = 0.03) were all inversely associated with PDP. Insulin sensitivity (P < 0.0005) was positively associated with PDP. Serum HDL cholesterol (P = 0.05) was inversely associated with WDP. Blacks consumed more servings from WDP than whites (P = 0.02). Females consumed more servings from PDP than males (P = 0.002). Those with >12 years of education consumed more servings from PDP than their counterparts (P < 0.0001). Current smokers consumed more servings from WDP than current non-smokers (P < 0.0001). Physically very active young adults consumed fewer servings from WDP than their sedentary counterparts (P = 0.02).

CONCLUSIONS

More studies are warranted to confirm these findings in other populations.

Benefits, barriers, self-efficacy and knowledge regarding healthy foods; perception of African Americans living in eastern North Carolina

African Americans in the United States suffer from many health disparities such as obesity, diabetes or hypertension. Lifestyle factors including diet and physical activity play an important role in prevention of these health conditions. The purpose of this research project was to assess beliefs, barriers and self-efficacy of eating a healthy diet and self efficacy of shopping for foods such as whole grains or foods designated as low fat or low sodium. Additionally, the objective was to assess beliefs about healthfulness, appropriate consumption, and protective aspect of specific foods including fruits, vegetables, and whole grains. The assessment was done using a survey instrument developed for this study. Data collection took place at two church locations. Data were obtained from 57 African Americans, mean age 50 years old (SD 12.70) completed the survey. The majority of respondents (58.1%) were females and most (75%) had at least some college education. Generally, benefits of eating healthy foods received considerably higher scores compared to barriers of eating healthy. A belief that healthy foods would help to take care of one's body received the highest mean score while a belief that healthy foods are too expensive had the highest score from all barriers. The results showed high self-efficacy of eating and purchasing healthy foods, high awareness of knowledge regarding foods associated with disease prevention but low awareness of recommendations for fruits and vegetables. The high scores for benefits, self-efficacy and knowledge regarding eating healthy foods did not translate into the perception of intake of such foods. Most participants believed that they do not eat enough of healthy foods. Interventions design to help African Americans make dietary changes should be culturally relevant and should involved working on a community level utilizing messages that are familiar and relevant to African Americans.

Psychosocial correlates of dietary fat intake in African-American adults: a cross-sectional study

Background

Current dietary guidelines recommend that dietary fat should comprise 20–35% percent of total energy intake, with less than 10% of energy from saturated fat. However, many Americans exceed these goals and data suggest that African Americans tend to consume a higher percentage of energy from dietary fat than Whites. Because diets low in dietary fat, particularly saturated fat, are associated with lower risk for many chronic illnesses, it is important to identify strategies to reduce high fat intakes. This study examined associations of psychosocial factors with dietary fat intake in African American adults 18 to 70 years.

Methods

Data are self-reported from a cross-sectional survey of African Americans (n = 658) using an 11-page questionnaire, collected from June to October 2003. Associations of psychosocial (predisposing, reinforcing, and enabling) factors based on the PRECEDE framework, dietary fat-related behaviors, and participant characteristics (e.g., age, sex, education, BMI) with total and saturated fat consumption are described using linear regression and analysis of variance.

Results

The mean age of participants was 43.9 years, 57% were female, 37% were college graduates, and 76% were overweight/obese. Respondents with lower fat intakes were female, older, had high education and very good/excellent perceived health. Among the psychosocial factors, the strongest (inverse) associations with fat intake were with two predisposing factors: belief in the importance of a low-fat diet (both genders) and high self-efficacy (women only). Fat intake was also significantly lower among participants who could count on those close for encouragement to eat healthy foods (a reinforcing factor) and among men who needed more information about preparing healthy foods (an enabling factor).

Conclusion

Dietary interventions to decrease fat intake in African American adults may benefit from incorporating predisposing factors, such as personal beliefs and self-efficacy, in their design and implementation.

Fat avoidance and replacement behaviors predict low-fat intake among urban African American adolescents

Using measures of behaviors shown to predict low-fat intake in previous research, this study examined whether the behaviors would predict low-fat intake among urban African American adolescents. Recruited through youth services agencies in Philadelphia, Pa, participants were 399 African American adolescents (67% female subjects) with a mean age of 13.09 years (range, 10-15 years). Fat-related dietary behaviors were measured using items that were adapted from the Food Habits Questionnaire. Fat intake was measured using the Block Fat Screener. Spearman correlations examined the relationships between fat-related dietary behaviors and fat intake. Seven behaviors were significantly associated with low-fat intake: had chicken that was baked or broiled instead of fried; ordered pasta or pizza served without meat sauce or meat toppings; had a vegetarian dinner; used low-calorie instead of regular salad dressing; ate at least 2 vegetables (not green salad) at dinner; ate bread, rolls, or muffins without butter or margarine; and avoided foods that were fried in oil, shortening, or lard. Using multiple regression, fat intake was regressed on the linear combination of demographic variables and these fat-related dietary behaviors. The regression equation accounted for 17% of the variance in fat intake (adjusted R(2) = 0.13). Fat avoidance (ate bread, rolls, or muffins without butter or margarine) and replacement (ordered pasta or pizza served without meat sauce or meat toppings) behaviors were significant predictors of low-fat intake. Dietary interventions to lower fat intake among urban African American adolescents should promote the adoption of these behaviors.

Dietary total fat intake and ischemic stroke risk: the Northern Manhattan Study

BACKGROUND

Dietary fat intake is associated with coronary heart disease risk, but the relationship between fat intake and ischemic stroke risk remains unclear. We hypothesized that total dietary fat as part of a Western diet is associated with increased risk of ischemic stroke.

METHODS

As part of the prospective Northern Manhattan Study, 3,183 stroke-free community residents over 40 years of age underwent evaluation of their medical history and had their diet assessed by a food-frequency survey. Cox proportional hazard models calculated risk of incident ischemic stroke.

RESULTS

The mean age of participants was 69 years, 63% were women, 21% were white, 24% black and 52% Hispanic. During a mean of 5.5 years of follow-up, 142 ischemic strokes occurred. After adjusting for potential confounders, risk of ischemic stroke was higher in the upper quintile of total fat intake compared to the lowest quintile (HR 1.6, 95% CI 1.0-2.7). Total fat intake >65 g was associated with increased risk of ischemic stroke (HR 1.6, 95% CI 1.2-2.3). Risk was attenuated after controlling for caloric intake.

CONCLUSIONS

The results suggest that increased daily total fat intake, especially above 65 g, significantly increases risk of ischemic stroke.

Dietary behaviors and portion sizes of black women who enrolled in SisterTalk and variation by demographic characteristics

OBJECTIVE

To describe the dietary behaviors of black women who enrolled in the SisterTalk weight control study.

DESIGN

Baseline data collected via telephone survey and in-person screening.

SETTING

Boston, Massachusetts and surrounding areas.

PARTICIPANTS

461 black women completed the baseline assessments.

MAIN OUTCOME MEASURES

Measured height and weight; self-reported demographics, risk factors, and dietary variables including fat-related eating behaviors, food portion size, and fruit, vegetable, and beverage intake.

ANALYSIS

Analysis of variance (ANOVA) models with food habits questionnaire (FHQ) scores as the dependent variable and demographic categories as the independent variables; ANOVA models with individual FHQ item scores as the dependent variable and ethnic identification as the independent variable.

RESULTS

More than 60% reported eating < 5 servings of fruits and vegetables/day. Self-reported portion sizes were large for most food items. Older age, being born outside the United States, living without children, and being retired were significantly associated with a higher prevalence of fat-lowering behaviors. The frequency of specific fat-lowering behaviors and portion size also differed by ethnic identification.

CONCLUSIONS AND IMPLICATIONS

The findings support the need for culturally appropriate interventions to improve the dietary intake of black Americans. Further studies should examine the dietary habits, food preparation methods, and portion sizes of diverse groups of black women.

A systematic review of the relationship between acculturation and diet among Latinos in the United States: implications for future research

Dietary intake is an important determinant of obesity and numerous chronic health conditions. A healthful diet is an essential component of chronic disease self-management. Researchers have indicated that the healthfulness of the Latino diet deteriorates during the acculturation process. However, given the many operationalizations of acculturation, conclusive evidence regarding this relationship is still lacking. This comprehensive and systematic literature review examines the relationship between acculturation and diet by examining national, quantitative, and qualitative studies involving Latinos living in the United States. Studies of diet included those that examined dietary intake using one of several validated measures (eg, food frequency questionnaire, 24-hour dietary recall, or dietary screener) and/or dietary behaviors (eg, away-from-home-eating and fat avoidance). Articles were identified through two independent searches yielding a final sample of 34 articles. Articles were abstracted by two independent reviewers and inter-rater reliability was assessed. Analyses examined the extent to which various measures of acculturation (ie, acculturation score, years in the United States, birthplace, generational status, and language use) were associated with macronutrient intake, micronutrient intake, and dietary behaviors. Several relationships were consistent irrespective of how acculturation was measured: no relationship with intake of dietary fat and percent energy from fat; the less vs more acculturated consumed more fruit, rice, beans, and less sugar and sugar-sweetened beverages. Additional observed relationships depended on the measure of acculturation used in the study. These findings suggest a differential influence of acculturation on diet, requiring greater specificity in our dietary interventions by acculturation status.

Age group differences in diet and physical activity-related behaviors among rural men and women

OBJECTIVES

Age group variations in dietary intake and physical activity have been noted in large epidemiologic studies. In this study, specific measures of behavioral strategies add depth to our understanding of these variations and can contribute to the design of effective behavioral interventions.

DESIGN

Cross-sectional, behavioral epidemiologic study.

SETTING

Rural Midwestern US.

PARTICIPANTS

407 adults.

MEASUREMENTS

Measures included dietary intake, physical activity, body mass index (BMI), and specific behavioral strategies related to diet and physical activity.

RESULTS

Use of most strategies related to diet increased across age groups, which was consistent with declining caloric intake and a decline in the proportion of total caloric intake from fat. The same patterns were not found with regard to physical activity. Greater use of diet-related strategies was noted in the oldest age groups compared to the others even though BMI was lower.

CONCLUSIONS

In the oldest age group at least, strategy use may be more related to attempts to control health conditions than body weight. The findings provide a unique perspective on age group differences in diet and physical activity behavior. Longitudinal tracking of these specific behaviors and their measurement in other populations is warranted.

Assessing fat-related dietary behaviors among black women: reliability and validity of a new Food Habits Questionnaire

OBJECTIVE

To describe the development of the SisterTalk Food Habits Questionnaire (STFHQ).

DESIGN

Formative research was conducted to adapt previous tools for the study's target population. A pilot tool (168 questions) was tested. The new 94-question tool was then used for evaluation of the SisterTalk project. Lastly, a 4-week reliability calibration study of the revised STFHQ was conducted in comparison with a food frequency questionnaire (FFQ).

ANALYSIS

Reliability was assessed using test-retest correlations. Validity was assessed by correlations between STFHQ scores with FFQ calculated calories, total fat (g) and percentage of calories from fat. Three scoring methods (ie, introductory, product, and detail) were calculated along with inclusion or exclusion of dining out questions and alternate methods of scoring for food items not consumed.

RESULTS

Reliability (correlation) was 0.87. Inclusion of dining out questions and imputation of zero for food items never consumed were more highly associated with fat intake than other scoring methods. The introductory score was most highly correlated with fat (g), whereas the product and detail scoring methods correlated highest with percentage of calories from fat. Responsiveness to the SisterTalk intervention was highest with the detail score.

CONCLUSIONS AND IMPLICATIONS

The STFHQ is a reliable and valid tool that may be useful for evaluating dietary change for black women.

Self-efficacy and its association with use of diet-related behavioral strategies and reported dietary intake

The construct of self-efficacy has been widely used in studies of dietary behavior change and is accepted as a helpful process indicator. This study examined associations between self-efficacy and use of specific diet-related behavioral strategies and reported dietary intake over time. Data are from two community surveys of rural adults conducted 1 year apart (n=354). Results indicate that changes in self-efficacy are positively associated with changes in strategy use but not dietary intake. Strategies may be thought of as leading to a particular level of dietary intake but are not the only influence on intake. Findings therefore confirm hypothesized associations between these components of the behavior change process. By attending to and measuring these specific links in the process, researchers and practitioners can better determine where behavioral interventions are succeeding and where they are breaking down.

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.

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

OBJECTIVE

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

DESIGN

Cross-sectional.

SUBJECTS

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

MEASURES

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

STATISTICAL ANALYSES

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

RESULTS

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

CONCLUSIONS

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

Work-to-family spillover and fruit and vegetable consumption among construction laborers

PURPOSE

Spillover is the effect of one role on another as working adults attempt to integrate demands from work and family. We conducted a survey to understand how worker, job, and family characteristics were related to negative work-to-family spillover and how spillover was related to fruit and vegetable consumption to inform intervention design.

DESIGN

A combined mail and telephone survey.

SETTING

A national random sample in the United States.

SUBJECTS

1108 (44% response) unionized construction laborers.

MEASURES

Personal characteristics, job factors, family factors, work-to-family spillover, and fruit and vegetable consumption.

ANALYSIS

Multivariable logistic and least-squares regression.

RESULTS

A range of 20% to 50% of respondents reported negative work-to-family spillover, agreeing that work demands, time, fatigue, and stress interfered with family meals or food choices. Higher spillover was associated with job factors, being of white race/ethnicity, and having children at home. Lower fruit and vegetable consumption was associated with higher work-to-family spillover (p = .002), being of white race or ethnicity (p < .0001), and working the graveyard or day shift (p = .02).

CONCLUSION

Negative experience of work-to-family spillover may link employment to fruit and vegetable consumption and thus to worker health. Understanding the contribution of spillover to fruit and vegetable consumption aids understanding of how work experience affects health.