Dietary fat and adult diseases and the implications for childhood nutrition: an epidemiologic approach

Bioenergetic mapping of 'healthy microbiomes' via compound processing potential imprinted in gut and soil metagenomes

Despite mounting evidence of their importance in human health and ecosystem functioning, the definition and measurement of 'healthy microbiomes' remain unclear. More advanced knowledge exists on health associations for compounds used or produced by microbes. Environmental microbiome exposures (especially via soils) also help shape, and may supplement, the functional capacity of human microbiomes. Given the synchronous interaction between microbes, their feedstocks, and micro-environments, with functional genes facilitating chemical transformations, our objective was to examine microbiomes in terms of their capacity to process compounds relevant to human health. Here we integrate functional genomics and biochemistry frameworks to derive new quantitative measures of in silico potential for human gut and environmental soil metagenomes to process a panel of major compound classes (e.g., lipids, carbohydrates) and selected biomolecules (e.g., vitamins, short-chain fatty acids) linked to human health. Metagenome functional potential profile data were translated into a universal compound mapping 'landscape' based on bioenergetic van Krevelen mapping of function-level meta-compounds and corresponding functional relative abundances, reflecting imprinted genetic capacity of microbiomes to metabolize an array of different compounds. We show that measures of 'compound processing potential' associated with human health and disease (examining atherosclerotic cardiovascular disease, colorectal cancer, type 2 diabetes and anxious-depressive behavior case studies), and displayed seemingly predictable shifts along gradients of ecological disturbance in plant-soil ecosystems (three case studies). Ecosystem quality explained 60-92 % of variation in soil metagenome compound processing potential measures in a post-mining restoration case study dataset. With growing knowledge of the varying proficiency of environmental microbiota to process human health associated compounds, we might design environmental interventions or nature prescriptions to modulate our exposures, thereby advancing microbiota-oriented approaches to human health. Compound processing potential offers a simplified, integrative approach for applying metagenomics in ongoing efforts to understand and quantify the role of microbiota in environmental- and human-health.

Morpho-molecular and nutritional profiling for yield improvement and value addition of indigenous aromatic Joha rice of Assam

Short-grain aromatic Joha rice of Assam is a unique class of specialty rice having tremendous potential in domestic and international markets. The poor yielding ability of Assam's Joha rice demands its systematic characterization for an effective breeding program. This study investigates the morphological, molecular and biochemical profiles of twenty popular Joha (aromatic) rice cultivars indigenous to Assam. Distinctiveness, Uniformity and Stability (DUS) characterization of the cultivars revealed polymorphism in thirty-seven traits, establishing distinctiveness for their utilization in breeding programs. Unweighted Neighbor Joining (UNJ) clustering based on usual Euclidean distances for the polymorphic morphological markers grouped the cultivars into three clusters with eight, eleven, and one genotypes. The Joha rice cultivars showed significant differences for all the quantitative traits except for panicle length. The genotypic and phenotypic coefficients of variability (GCV & PCV) were high for grain yield ha-1 (24.62 & 24.85%) and filled grains panicle-1 (23.69 & 25.02%). Mahalanobis D2 analysis revealed three multi-genotypic and four mono-genotypic clusters of the cultivars. The first five principal components explain 85.87% of the variation among the cultivars for the traits under study; filled grain panicle-1 (0.91) and stem thickness (0.55) positively contributed to the first PC. The cultivars' average polyunsaturated fatty acids were 37.9% oleic acid, 39.22% linoleic acid, and 0.5% linolenic acid. Kon Joha 4 and Ronga Joha contained the highest iron (82.88 mg kg-1) and zinc (47.39 mg kg-1), respectively. Kalijeera, Kunkuni Joha, Kon Joha-5, Manimuni Joha and Kon Joha-2 accorded a strong aroma. PCR amplified 174 alleles with a mean value 2.64 across the 66 polymorphic SSR markers. PIC values ranged from 0.091 to 0.698, with an average of 0.326. The highly informative (PIC > 0.50) markers were RM316, RM283, RM585, RM1388, RM3562, RM171, R1M30, RM118, RM11and RM29 for identification of the twenty aromatic rice cultivars. PCR amplification of 27 SSR markers identified 28 unique alleles (97-362 bp) in 13 Joha rice cultivars, which can help their identification/DNA fingerprinting. The UNJ clustering based on Jaccard's coefficients classified the cultivars into three distinct clusters with eight, ten, and two genotypes. Our study revealed the nutritional richness of these specialty Joha rice cultivars and sufficient scope for yield enhancement through their interbreeding to keep quality intact.

Effects of low carbohydrate diet compared to low fat diet on reversing the metabolic syndrome, using NCEP ATP III criteria: a randomized clinical trial

INTRODUCTION

The purpose of this study is to compare the change in the metabolic syndrome prevalence and risk factors between participants who followed a low carbohydrate diet and those who followed a low fat diet for six months in Erbil city/ Iraqi Kurdistan.

METHODS

Out of 289 apparently healthy obese adults who were chosen by a stratified multistage probability sampling method, 94 of them agreed to participate in the study. They were assigned to low carbohydrate and low fat diet groups. Both groups were followed up for 6 months and the data were taken at baseline, after 3 months and after 6 months of intervention. Ninety-four obese adults completed the intervention. One-way repeated measures ANOVA was used to compare differences of metabolic dependent variables between the two independent variables, the low carbohydrate and low fat diet, at baseline, after 3 months and after 6 months of intervention.

RESULTS

The Participants in low carbohydrate diet group had greater decrease in the prevalence of MetS. At the baseline, according to the ATP III criteria, the prevalence of metabolic syndrome was 44.4% (24/54) in low carbohydrate diet group and 60% (24/40) in low fat diet group. The prevalence of MetS was decreased significantly to 16.7% (9/54) after 3 months and to 3.7% (2/54) after 6 months in low carbohydrate diet (p < 0.001). Moreover, the prevalence of MetS was decreased significantly to 32.5 (13/40) after 3 months and to 22.5% (9/40) after 6 months in low fat diet (p < 0.001). No statistically significant difference was found between low carbohydrate diet & low fat diet at the baseline (p-value = 0.136) and after 3 months and after 6 months of intervention.

CONCLUSIONS

Both low carbohydrate diet and low fat diet have significant effects on reducing the prevalence of MetS in obese adults when followed up for 6 months. Compared to low fat diet, low carbohydrate diet had greater effect in reducing the prevalence of metabolic syndrome. Both diet programs were found to be effective in improving the metabolic state of obese adults.

TRIAL REGISTRATION

The trial is registered retrospectively at the US National Institutes of Health ( ClinicalTrials.gov ). The registration in the US National Institutes of Health was done in 23/12/2020 with the registration number: NCT04681924 .

Prerequisite of a Holistic Blend of Traditional and Modern Approaches of Cancer Management

Background:

With the advent of changes in lifestyle of people all around the world, cancer cases have been showing an exponential rise. Researchers from varied fields have been trying to solve this tricky issue.

Methods:

We undertook a systematic search of bibliographic databases of peer-reviewed research literature to evaluate the holistic blend of modern and traditional approaches, especially the Ayurvedic perspective of treatment of cancer along with the effect of our diet and lifestyle on the management (both prevention and cure) of cancer.

Results:

On the basis of extensive literature survey, it was found that Ayurveda as one of the ancient medicinal systems had been very well documented for utilizing its best practices for the treatment of various diseases including cancer, by utilization of several herbal plants and dietary interventions as therapeutics. Active components present in various herbs, which interfere with certain molecular targets to inhibit carcinogenesis are also summarized. Further, beneficial effects of yoga and exercise on psychological distress, cancer-related fatigue and global side-effects as well as their mechanism of action are also discussed. In addition, we recapitulate an upcoming field of Ayurgenomics to understand the possible correlation of Prakriti with genetics as well as epigenetics.

Conclusion:

Both genetic as well as environmental factors have shown their linkage with cancer. Substantial advancements in the field of targeted therapies have opened new horizons for the cancer patients. To fight with this grave situation, a combination of ancient and modern medicinal systems seems to be the need of the hour.

Macronutrient and fibre intake of young Spanish children with reference to their in utero growth status: Are they eating a healthy diet?

AIM

To compare macronutrient and fibre intake by pre-school children born with intra-uterine growth restriction (IUGR) or as appropriate for gestational age (AGA) and to compare their intake with paediatric nutritional recommendations for identification of potential areas of modification during early life.

METHODS

A parental 3-day dietary record was obtained for children of age 1-6 years, born at Hospital Clinic, Barcelona, Spain (2002-2007) with IUGR (n = 37) or AGA (n = 53). Mean nutrient intake (adjusted for body mass index), nutrient adequacy ratios (NAR) and percentage of energy intake (EI%) were compared.

RESULTS

Macronutrient and fibre intake of the two groups did not differ significantly. However, IUGR children showed significantly higher than the recommended levels of protein EI% (18 (95% confidence interval (CI) 16-19)), NAR for saturated fatty acids (SFAs) (1.2 (95% CI 1.1-1.5)) and NAR for carbohydrate (1.4 (95% CI 1.2-1.6)) and significantly lower than the recommended levels of NAR for unsaturated fatty acids (UFAs) (0.6 (95% CI 0.5-0.8)) and for fibre (0.6 (95% CI 0.5-0.8)). Likewise, children born with AGA showed similar pattern compared to the recommended levels for protein EI% (17 (95% CI 16-18)), NAR for SFAs (1.3 (95% CI 1.2-1.4)), NAR for UFAs (0.6 (95% CI 0.5-0.7)) and NAR for fibre (0.8 (95% CI 0.7-0.9)).

CONCLUSION

Spanish pre-school children consume proteins and SFAs in abundance and UFAs and fibre in moderation. Reinforcement of healthy eating is recommended for long-term health benefits, especially for at-risk children born with IUGR, whose consumption of carbohydrate is additionally greater than that recommended.

Effect on the Metabolic Biomarkers in Schoolchildren After a Comprehensive Intervention Using Electronic Media and In-Person Sessions to Change Lifestyles: Community Trial

BACKGROUND

Obesity is a chronic low-intensity state of inflammation with metabolic alterations that, when acquired during childhood, lead to severe illness in adults. Encouraging healthy eating habits and physical activity is the basis for preventing and treating obesity and its complications.

OBJECTIVE

To evaluate how a comprehensive intervention promoting healthy eating habits and physical activities in schools affects children's metabolic biomarkers.

METHODS

Of four Mexico City primary schools in this study, two groups of children that were recruited at their schools were assigned to a 12-month intervention group (IG) and the other two were assigned to control groups (CGs). The intervention had two components: (1) parents/schoolchildren attended in-person educational sessions promoting healthy eating and physical activity habits, and were provided printed information; and (2) parents were able to seek information through a website, and also received brief weekly mobile phone text messages. Anthropometric measurements and fasting blood samples were taken from both groups of children at baseline and again after 12 months.

RESULTS

The study involved 187 children in the IG and 128 in the CG. Regardless of each child's nutritional status at the beginning of the study, the intervention improved metabolic parameters; the IG showed a negative effect on glucose concentrations (-1.83; CI 95% -3.06 to -0.60), low-density lipoprotein-cholesterol (-2.59; CI 95% -5.12 to -0.06), insulin (-0.84; CI 95% -1.31 to -0.37), and homeostasis model to assess the insulin resistance index (HOMA-IR; -0.21; CI 95% -0.32 to -0.09) in comparison to the CG. HOMA-IR improved in children who had higher than baseline body mass index z-scores.

CONCLUSIONS

Intervention through multiple components that promoted healthier eating and physical activity habits improved the metabolic parameters of the children in the study after one year, regardless of their nutritional status.

Gender differences and typical nutrition concerns of the diets of preschool children - the results of the first stage of an intervention study

BACKGROUND

Nutrition in children has an important influence on health both in childhood and adulthood. Actions aimed at improving children's nutrition are essential, not only to the children and their families, but also to the whole society. The aim of the study was to present the results of nutrient intake before starting a nutrition and physical activity intervention programme, to investigate gender differences in nutrient intake and to discuss whether the preschoolers' nutrient intake is similar to the intake of their peers from other countries.

METHODS

Nutrient intake was estimated from seven-day weighed food records kept by parents and preschool staff individually for 122 4-6-year-old children who attended two preschools in Piła, north-western Poland. Nutrient intake was calculated using Dieta 4.0 computer programme including water intake and intake of nutrients from dietary supplements. Statistical analysis was performed using the IBM SPSS Statistics computer programme, version 21.0, according to gender. The study was approved by the Bioethics Committee of the Poznan University of Medical Sciences (reference number 886/08).

RESULTS

Boys, in comparison to girls, were found to have statistically significantly higher intakes of total protein, total protein per kg of body weight, saturated fatty acids, total carbohydrates, available carbohydrates, lactose, sucrose, total water, vitamin A, beta-carotene, vitamin B2, vitamin B12, vitamin C, calcium, phosphorus, and magnesium. Statistically significantly higher percentage of girls than boys had intakes of vitamin E below AI.

CONCLUSIONS

Gender was a significant factor of nutrient intake in the studied preschool children. The main nutritional concerns in the studied preschoolers' diets, irrespective of gender, are typical of the diets of preschool children from various parts of Europe and indicate the need to work out common nutritional strategies to improve preschoolers' nutrition across Europe to reduce future burden of diet-related diseases to the European societies.

Comprehensive assessment of food and nutrient intake of children and adolescents in Germany: EsKiMo II - the eating study as a KiGGS module

Background

As part of the second wave of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS Wave 2), food and nutrient intake of children and adolescents aged 6–17 years living in Germany is assessed in EsKiMo II – the Eating Study as a KiGGS Module.

Methods

EsKiMo II is a cross-sectional study, conducted from June 2015 until September 2017. The study population comprises 6 to 17-year-old study participants from the cross-sectional sample of KiGGS Wave 2 in 167 KiGGS sample points, which are revisited by trained nutritionists. Dietary intake is assessed by weighted food records during three consecutive days plus one randomly selected day within the following 3 months for children aged 6–11 years. Dietary intake for adolescents aged 12–17 years is assessed by computer-assisted dietary history interviews, reflecting the past four weeks, using the software DISHES. Further information, for example, about specific diets and dietary supplement intake, is reported during a standardised computer assisted interview for all participants. Food items are coded by the German Food Code and Nutrient Database (BLS 3.02).

Discussion

EsKiMo II provides actual data on the dietary behaviour of children and adolescents living in Germany and their determinants. Results of EsKiMo II will be relevant for decision-making, measures, and evaluations within nutrition, consumer and health policy.

Physicochemical and Antioxidant Properties of Rice Bran Oils Produced from Colored Rice Using Different Extraction Methods

This study investigated the physicochemical and antioxidant properties of rice bran oil (RBO) produced from the bran of three rice varities; Khao Dawk Mali 105 (white rice), Red Jasmine rice (red rice) and Hom-nin rice (black rice) using three extraction methods including cold-press extraction (CPE), solvent extraction (SE) and supercritical CO₂ extraction (SC-CO₂). Yields, color, acid value (AV), free fatty acid (FFA), peroxide value (PV), iodine value (IV), total phenolic compound (TPC), γ-oryzanol, α-tocopherol and fatty acid profile were analyzed. It was found that the yields obtained from SE, SC-CO₂ and CPE extractions were 17.35-20.19%, 14.76-18.16% and 3.22-6.22%, respectively. The RBO from the bran of red and black rice samples exhibited high antioxidant activities. They also contained higher amount of γ-oryzanol and α-tocopherol than those of white rice sample. In terms of extraction methods, SC-CO₂ provided better qualities of RBO as evidenced by their physicochemical and antioxidant properties. This study found that RBO produced from the bran of black rice samples using SC-CO₂ extraction method showed the best physicochemical and antioxidant properties.

Dietary quality of the US child and adolescent population: trends from 1999 to 2012 and associations with the use of federal nutrition assistance programs

BACKGROUND

The state of the economy, changes in federal food assistance programs, and policies related to nutrition and the food supply in the United States may influence dietary quality in children and adolescents.

OBJECTIVE

We investigated dietary quality trends from 1999 to 2012 in the US child and adolescent population and their associations with socioeconomic status and participation in federal food assistance programs.

DESIGN

In this study, a nationally representative sample of 38,487 children and adolescents, aged 2-18 y, in the NHANES from 1999 to 2012 were included. Dietary information was collected with the use of a 24-h dietary recall. Dietary quality was measured with the use of the Healthy Eating Index 2010 (HEI-2010).

RESULTS

The mean HEI-2010 increased significantly from 42.5 (95% CI: 41.2, 43.8) to 50.9 (95% CI: 50.0, 51.8) from 1999 to 2012 (P-linear trend < 0.001). The reduction in empty calorie intake contributed to greater than one-third of this improvement in the total HEI-2010. We also observed significant increases in 9 other HEI-2010 component scores. However, the HEI-2010 component score for sodium decreased significantly, which reflected an increase in sodium consumption. We calculated the covariate-adjusted mean HEI-2010 score in subgroups that were defined by sociodemographic status and participation in nutrition assistance program at each NHANES cycle. Non-Hispanic black children and adolescents had a consistently lower HEI-2010 than that of other groups across all NHANES cycles. We observed a trend toward a lower HEI-2010 in Supplemental Nutrition Assistance Program (SNAP) participants than in nonparticipants after the 2003-2004 cycle. We also observed a lower HEI-2010 in participants in the National School Lunch Program (NSLP) and the School Breakfast Program (SBP) than in nonparticipants. In general, participants in the Special Supplemental Nutrition Program for Women, Infants, and Children appeared to have a higher HEI-2010 than that of nonparticipants.

CONCLUSIONS

Although HEI-2010 scores in children and adolescents improved steadily, the overall dietary quality remained poor. Participants in the SNAP and participants in the National School Lunch Program, School Breakfast Program, or both have lower dietary quality than do nonparticipants. Future policy interventions are needed to continue improvement in dietary quality and to address disparities.

The European School Fruit Scheme: impact on children's fruit and vegetable consumption in North Rhine-Westphalia, Germany

OBJECTIVE

To assess the impact of the European School Fruit Scheme (SFS) in North Rhine-Westphalia, Germany, on children's fruit and vegetable (F&V) consumption, in particular frequency.

DESIGN

The study consisted of a pre-test/post-test design with an intervention (eight primary schools) and a control group (two primary schools). Children's F&V consumption frequency was measured prior to the introduction of the SFS in 2010 and after one year's delivery of F&V (2011).

SETTING

Ten primary schools in North Rhine-Westphalia, Germany.

SUBJECTS

In total, 499 primary-school children aged 6-11 years, 390 in the intervention and 109 in the control schools.

RESULTS

Children highly appreciated the SFS. More than 90 % evaluated the programme positively. Children in the intervention group showed a significant increase in F&V intake frequency from baseline to follow-up, from on average 1·26 (sd 1·37) to 2·02 (sd 1·33) times/d (P=0·000). The intervention variable had a highly significant impact on children's F&V consumption frequency, even after controlling for gender, age and stay at school for lunch (β=0·773; 95 % CI 0·59, 0·96). The SFS did not induce a reduction of F&V consumption at home. In the control group a non-significant decline in F&V consumption frequency from 1·31 (sd 1·26) to 1·18 (sd 1·34) times/d (P=0·325) was observed.

CONCLUSION

One year after the programme's implementation, the SFS led to a significant short-term increase in children's F&V consumption.

Effects of low-carbohydrate diets v. low-fat diets on body weight and cardiovascular risk factors: a meta-analysis of randomised controlled trials

The effects of low-carbohydrate (LC) diets on body weight and cardiovascular risk are unclear, and previous studies have found varying results. Our aim was to conduct a meta-analysis of randomised controlled trials (RCT), assessing the effects of LC diets v. low-fat (LF) diets on weight loss and risk factors of CVD. Studies were identified by searching MEDLINE, Embase and Cochrane Trials. Studies had to fulfil the following criteria: a RCT; the LC diet was defined in accordance with the Atkins diet, or carbohydrate intake of <20% of total energy intake; twenty subjects or more per group; the subjects were previously healthy; and the dietary intervention had a duration of 6 months or longer. Results from individual studies were pooled as weighted mean difference (WMD) using a random effect model. In all, eleven RCT with 1369 participants met all the set eligibility criteria. Compared with participants on LF diets, participants on LC diets experienced a greater reduction in body weight (WMD -2·17 kg; 95% CI -3·36, -0·99) and TAG (WMD -0·26 mmol/l; 95% CI -0·37, -0·15), but a greater increase in HDL-cholesterol (WMD 0·14 mmol/l; 95% CI 0·09, 0·19) and LDL-cholesterol (WMD 0·16 mmol/l; 95% CI 0·003, 0·33). This meta-analysis demonstrates opposite change in two important cardiovascular risk factors on LC diets--greater weight loss and increased LDL-cholesterol. Our findings suggest that the beneficial changes of LC diets must be weighed against the possible detrimental effects of increased LDL-cholesterol.

Examining How Adding a Booster to a Behavioral Nutrition Intervention Prompts Parents to Pack More Vegetables and Whole Gains in Their Preschool Children's Sack Lunches

Data from a five-week intervention to increase parents' packing of vegetables and whole grains in their preschool children's sack lunches showed that, although changes occurred, habit strength was weak. To determine the effects of adding a one-week booster three months post-intervention, children's (N = 59 intervention and 48 control) lunches were observed at baseline (week 0), post-intervention (week 6), pre-booster (week 20), and post-booster (week 26). Servings of vegetables and whole grains were evaluated in repeated measures models and results inspected relative to patterns projected from different explanatory models of behavior change processes. Observed changes aligned with projections from the simple associative model of behavior change. Attention in future studies should focus on behavioral intervention elements that leverage stimulus-response associations to increase gratification parents receive from providing their children with healthy lunches.

Dietary intake in 6-year-old children from southern Poland: part 1--energy and macronutrient intakes

Background

The studies on dietary intake in Polish children are sparse and the information about dietary intake in 6-year-olds in Europe is limited. The published studies on dietary intake in children rarely provide information on the intake of animal protein, plant protein and water. The purpose of the study was to analyse energy and macronutrient intakes in 6-year-old children from southern Poland.

Methods

The studied population comprised 120 children, 64 girls and 56 boys. Energy and macronutrient intakes were estimated from a three-day food record. Weight and height were measured, and body mass index was calculated.

Results

Intakes of energy (kJ, kcal), plant protein (g), total fat (g), saturated fatty acids (g, % of energy, g/1000 kcal), monounsaturated fatty acids (g) and starch (g, % of energy, g/1000 kcal) were significantly higher in boys, while intakes of sucrose (% of energy, g/1000 kcal) and total water (g/1000 kcal) were significantly higher in girls. The children’s diets were characterised by excessive intake of total fat, saturated fatty acids, sucrose, and by inadequate intake of polyunsaturated fatty acids, available carbohydrates and starch.

Conclusions

The observed adverse characteristics of the children’s diets are similar to those observed in the diets of children in other European countries and show the need to work out a common educational programme to improve nutrition in young European children. It is also important to provide the lacking information about the intake of animal protein, plant protein and water in young children.

Nutrient intake of European adolescents: results of the HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) Study

OBJECTIVE

An adequate nutritional intake in childhood and adolescence is crucial for growth and the prevention of youth and adult obesity and nutrition-related morbidities. Improving nutrient intake in children and adolescents is of public health importance. The purpose of the present study was to describe and evaluate the nutrient intake in a European sample using the D-A-CH nutrient intake recommendations and the Nutritional Quality Index (NQI).

DESIGN

The HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) Study is a cross-sectional study, the main objective of which is to obtain comparable data on a variety of nutritional and health-related parameters in adolescents aged 12·5-17·5 years.

SETTING

Eight cities in Europe.

SUBJECTS

The initial sample consisted of 3528 European adolescents. Among these, 1590 adolescents (54% female) had sufficient and plausible dietary data on energy and nutrient intakes from two 24 h recalls using the HELENA-DIAT software.

RESULTS

The intakes of most macronutrients, vitamins and minerals were in line with the D-A-CH recommendations. While the intakes of SFA and salt were too high, the intake of PUFA was too low. Furthermore, the intakes of vitamin D, folate, iodine and F were less than about 55% of the recommendations. The median NQI was about 71 (of a maximum of 100).

CONCLUSIONS

The intakes of most nutrients were adequate. However, further studies using suitable criteria to assess nutrient status are needed. Public health initiatives should educate children and adolescents regarding balanced food choices.

Dietary energy intake is associated with type 2 diabetes risk markers in children

OBJECTIVE Energy intake, energy density, and nutrient intakes are implicated in type 2 diabetes risk in adults, but little is known about their influence on emerging type 2 diabetes risk in childhood. We examined these associations in a multiethnic population of children. RESEARCH DESIGN AND METHODS This was a cross-sectional study of 2,017 children predominantly of white European, South Asian, and black African-Caribbean origin aged 9-10 years who had a detailed 24-h dietary recall and measurements of body composition and provided a fasting blood sample for measurements of plasma glucose, HbA1c, and serum insulin; homeostasis model assessment of insulin resistance was also derived. RESULTS Energy intake was positively associated with insulin resistance. After the removal of 176 participants with implausible energy intakes (unlikely to be representative of habitual intake), energy intake was more strongly associated with insulin resistance and was also associated with glucose and fat mass index. Energy density was also positively associated with insulin resistance and fat mass index. However, in mutually adjusted analyses, the associations for energy intake remained while those for energy density became nonsignificant. Individual nutrient intakes showed no associations with type 2 diabetes risk markers. CONCLUSIONS Higher total energy intake was strongly associated with high levels of insulin resistance and may help to explain emerging type 2 diabetes risk in childhood. Studies are needed to establish whether reducing energy intake produces sustained favorable changes in insulin resistance and circulating glucose levels.

Is maternal food security a predictor of food and drink intake among toddlers in Oregon?

Food insecurity has detrimental effects on the mental, physical, and behavioral health of developing children. Few studies, however, have sought to determine whether associations exist between food insecurity and intake of vegetables, fresh or canned fruit, candy or cookies, French fries, fast food, water, milk, fruit juices, fruit drinks, soda, and sports drinks. To identify independent associations that exist between maternal food insecurity and food and drink intake among toddlers, population-based data from the 2006-2008 Oregon Pregnancy Risk Assessment Monitoring System follow-back survey (Oregon PRAMS-2) of 1,522 mothers of 2-year-old children were analyzed. Maternal food insecurity was defined as mothers' report of eating less because of lack of money for food. Typical weekly child food and drink intake was examined using polytomous logistic regression: 0-1 days/week, 2-3 days/week, and 4-7 days/week. Maternal food insecurity prevalence was 11.7 %. Compared to toddlers of food secure mothers, toddlers of food insecure mothers consumed vegetables (adjusted odds ratio [AOR] for 4-7 days/week = 0.31; 95 % confidence interval [CI] 0.12, 0.79) and fruit (AOR for 4-7 days/week = 0.25; 95 % CI 0.08, 0.75) fewer days of the week. Toddlers of food insecure mothers consumed soda (AOR for 4-7 days/week = 3.21; 95 % CI 1.12, 9.14) more days of the week. Maternal food insecurity is associated with weekly intake of certain foods and drinks. Among toddlers, consumption of fewer vegetables and fruit, and more soda may help explain the link between food insecurity and poor health.

Food sources of energy and nutrients among children in the United States: National Health and Nutrition Examination Survey 2003–2006

BACKGROUND

Recent detailed analyses of data on dietary sources of energy and nutrients in US children are lacking. The objective of this study was to identify food sources of energy and 28 nutrients for children in the United States.

METHODS

Analyses of food sources were conducted using a single 24-h recall collected from children 2 to 18 years old (n = 7332) in the 2003-2006 National Health and Nutrition Examination Survey. Sources of nutrients contained in foods were determined using nutrient composition databases. Food grouping included ingredients from disaggregated mixtures. Mean energy and nutrient intakes from the total diet and from each food group were adjusted for the sample design using appropriate weights. Percentages of the total dietary intake that food sources contributed were tabulated by rank order.

RESULTS

The two top ranked food/food group sources of energy and nutrients were: energy - milk (7% of energy) and cake/cookies/quick bread/pastry/pie (7%); protein - milk (13.2%) and poultry (12.8%); total carbohydrate - soft drinks/soda (10.5%) and yeast bread/rolls (9.1%); total sugars - soft drinks/soda (19.2%) and yeast breads and rolls (12.7%); added sugars - soft drinks/soda (29.7%) and candy/sugar/sugary foods (18.6%); dietary fiber - fruit (10.4%) and yeast bread/rolls (10.3%); total fat - cheese (9.3%) and crackers/popcorn/pretzels/chips (8.4%); saturated fatty acids - cheese (16.3%) and milk (13.3%); cholesterol - eggs (24.2%) and poultry (13.2%); vitamin D - milk (60.4%) and milk drinks (8.3%); calcium - milk (33.2%) and cheese (19.4%); potassium - milk (18.8%) and fruit juice (8.0%); and sodium - salt (18.5%) and yeast bread and rolls (8.4%).

CONCLUSIONS

Results suggest that many foods/food groupings consumed by children were energy dense, nutrient poor. Awareness of dietary sources of energy and nutrients can help health professionals design effective strategies to reduce energy consumption and increase the nutrient density of children's diets.

Unbundling outcomes of a multilevel intervention to increase fruit, vegetables, and whole grains parents pack for their preschool children in sack lunches

BACKGROUND: Packing fruit, vegetables, and whole grains in preschool children's sack lunches is a powerful way for parents to teach their children eating habits and food preferences to support a lifetime of good health. A multilevel intervention pilot-tested in childcare settings increased servings of vegetables and whole grains, but the lunches still fell short of the intervention goals. PURPOSE: Secondary analyses were conducted to identify specific behavior changes underlying achieved increases in servings of vegetables and whole grains. METHODS: Food records from direct observation of 769 parent-packed lunches were investigated to unbundle and measure multiple aspects of lunch packing behavior. Changes from baseline to six week follow-up for the intervention (N=81) and comparison (N=51) parent-child dyads were evaluated in multilevel modeling. RESULTS: The increase for whole grains was explained by more parents packing whole grain items whereas increase for vegetables was explained by parents packing vegetables on more days. DISCUSSION: Tailored options were identified for further strategies to increase vegetables and whole grains in parent-packed sack lunches. TRANSLATION TO HEALTH EDUCATION PRACTICE: Linking achieved outcomes to specific behaviors can be an aid in assessing needs and designing interventions to maximize the chances for success.

The age associations of blood pressure, cholesterol, and glucose: analysis of health examination surveys from international populations

BACKGROUND

The age association of cardiovascular disease may be in part because its metabolic risk factors tend to rise with age. Few studies have analyzed age associations of multiple metabolic risks in the same population, especially in nationally representative samples. We examined worldwide variations in the age associations of systolic blood pressure (SBP), total cholesterol (TC), and fasting plasma glucose (FPG).

METHODS AND RESULTS

We used individual records from 83 nationally or subnationally representative health examination surveys in 52 countries to fit a linear model to risk factor data between ages 30 and 64 years for SBP and FPG, and between 30 and 54 years for TC. We report the cross-country variation of the slope and intercept of this relationship. We also assessed nonlinear associations in older ages. Between 30 and 64 years of age, SBP increased by 1.7 to 11.6 mm Hg per 10 years of age, and FPG increased by 0.8 to 20.4 mg/dL per 10 years of age in different countries and in the 2 sexes. Between 30 and 54 years of age, TC increased by 0.2 to 22.4 mg/dL per 10 years of age in different surveys and in the 2 sexes. For all risk factors and in most countries, risk factor levels rose more steeply among women than among men, especially for TC. On average, there was a flattening of age-SBP relationship in older ages; TC and FPG age associations reversed in older ages, leading to lower levels in older ages than in middle ages.

CONCLUSIONS

The rise with age of major metabolic cardiovascular disease risk factors varied substantially across populations, especially for FPG and TC. TC rose more steeply in high-income countries and FPG in the Oceania countries, the Middle East, and the United States. The SBP age association had no specific income or geographical pattern.

Dietary patterns of adolescents in Germany--associations with nutrient intake and other health related lifestyle characteristics

Background

The aim of this study was to identify dietary patterns among a representative sample of German adolescents and their associations with energy and nutrient intake, socioeconomic and lifestyle characteristics, and overweight status.

Methods

In the analysis, data from the German Health Interview and Examination Survey for Children and Adolescents were used. The survey included a comprehensive dietary history interview conducted among 1272 adolescents aged 12 to 17 years. Dietary patterns were determined with principal component analysis (PCA) based on 48 food groups, for boys and girls separately.

Results

Three dietary patterns among boys and two among girls were identified. Among boys, high adherence to the 'western' pattern was associated with higher age, lower socioeconomic status (SES), and lower physical activity level (PA). High adherence to the 'healthy' pattern among boys, but not among girls, was associated with higher SES, and higher PA. Among boys, high adherence to the 'traditional' pattern was associated with higher age. Among girls, high adherence to the 'traditional and western' pattern was associated with lower age, lower SES and more hours watching TV per day. The nutrient density of several vitamins and minerals, particularly of B-vitamins and calcium, increased with increasing scores of the 'healthy' pattern among both sexes. Conversely, with increasing scores of the 'western' pattern among boys, most nutrient densities decreased, particularly of fibre, beta-carotene, vitamin D, biotin and calcium. Among girls with higher scores of the 'traditional and western' pattern, nutrient densities of vitamin A, C, E, K and folate decreased. Among boys, high adherence to the 'traditional' pattern was correlated with higher densities of vitamin B₁₂ and vitamin D and lower densities of fibre, magnesium and iron. No significant associations between dietary patterns and overweight were found.

Conclusions

Higher scores for dietary patterns characterized by higher consumption of take away food, meat, confectionary and soft drinks ('western' and 'traditional and western') were found particularly among 16- to 17-years old boys and among adolescents with lower SES. These patterns were also associated with higher energy density, higher percent of energy from unsaturated fatty acids and lower percent of energy from carbohydrates as well as lower nutrient densities of several vitamins and minerals. Therefore, nutritional interventions should try to focus more on adolescents with lower SES and boys in general.

Psychosocial outcomes of Lunch is in the Bag, a parent program for packing healthful lunches for preschool children

OBJECTIVE

This pilot study evaluated effects of Lunch is in the Bag on behavioral constructs and their predictive relationship to lunch-packing behaviors of parents of young children.

METHODS

Six child care centers were pair-matched and randomly assigned to intervention (n = 3) and comparison (n = 3) groups. Parent/child dyads participated. Constructs of knowledge, outcome expectations, perceived control, subjective norms, and intentions were measured by a pre/post questionnaire. Hierarchical linear regression was used, and P < .05 was considered significant.

RESULTS

There were significant increases in knowledge (P = .01); outcome expectations for whole grains (P < .001); and subjective norms for fruit (P = .002), vegetables (P = .046), and whole grains (P = .02). Perceived control, outcome expectations, and intentions significantly predicted packing vegetables and knowledge predicted whole grains.

CONCLUSIONS AND IMPLICATIONS

Lunch is in the Bag is a feasible intervention to improve the lunch-packing behaviors of parents of preschool-aged children.

High fat diet reduces the expression of glutathione peroxidase 3 in mouse prostate

BACKGROUND

High fat diets are known to be a risk factor for prostate cancer. In this study, we investigated the effect of high fat diet on mouse prostate gene expression.

METHODS

C57BL/6J mice were fed either a control or high fat diet for 12 weeks. Microarray analyses were performed on mouse ventral prostate (VP) and dorsolateral prostate (DLP), followed by canonical pathway analysis and regulatory network identification. mRNA changes were confirmed by real time PCR.

RESULTS

Approximately 2,125, and 1,194 genes responded significantly to the high fat diet in VP, DLP, respectively. Pathways and networks related to oxidative stress, glutathione metabolism, NRF-mediated oxidative stress response and NF-kappaB were all differentially regulated by high fat diet. Glutathione peroxidase 3 (GPx3) mRNA levels were decreased by approximately twofold by high fat diet in all three prostate lobes. In human non-transformed prostate cells (PrSC, PrEC, and BPH-1), cholesterol loading decreased GPx3 expression, and increased H2 O2 levels of culture medium. Troglitazone increased GPx3 expression in three normal prostate cells, and decreased H2 O2 levels. In addition, troglitazone attenuated cholesterol-induced H2 O2 increase. Tissue from prostate cancer biopsies had decreased GPx3 mRNA and its level was inversely related to the Gleason score.

CONCLUSIONS

High fat diet alters pathways related to many genes concerned with oxidative stress. GPx3, a gene identified by this analysis, was found to be down-regulated by high fat diet and appears be decreased in human prostate cancers, suggesting that GPx3 may have a possible role in modulating carcinogenesis. Prostate 71:1499-1509, 2011. © 2011 Wiley-Liss, Inc.

A high-fat diet impairs cardiac high-energy phosphate metabolism and cognitive function in healthy human subjects

BACKGROUND

High-fat, low-carbohydrate diets are widely used for weight reduction, but they may also have detrimental effects via increased circulating free fatty acid concentrations.

OBJECTIVE

We tested whether raising plasma free fatty acids by using a high-fat, low-carbohydrate diet results in alterations in heart and brain in healthy subjects.

DESIGN

Men (n = 16) aged 22 ± 1 y (mean ± SE) were randomly assigned to 5 d of a high-fat, low-carbohydrate diet containing 75 ± 1% of calorie intake through fat consumption or to an isocaloric standard diet providing 23 ± 1% of calorie intake as fat. In a crossover design, subjects undertook the alternate diet after a 2-wk washout period, with results compared after the diet periods. Cardiac (31)P magnetic resonance (MR) spectroscopy and MR imaging, echocardiography, and computerized cognitive tests were used to assess cardiac phosphocreatine (PCr)/ATP, cardiac function, and cognitive function, respectively.

RESULTS

Compared with the standard diet, subjects who consumed the high-fat, low-carbohydrate diet had 44% higher plasma free fatty acids (P < 0.05), 9% lower cardiac PCr/ATP (P < 0.01), and no change in cardiac function. Cognitive tests showed impaired attention (P < 0.01), speed (P < 0.001), and mood (P < 0.01) after the high-fat, low-carbohydrate diet.

CONCLUSION

Raising plasma free fatty acids decreased myocardial PCr/ATP and reduced cognition, which suggests that a high-fat diet is detrimental to heart and brain in healthy subjects.

Diet quality is independently associated with weight status in children aged 9-10 years

Although energy imbalance is key to the development of childhood obesity, the association between different dietary components, reflected in diet quality scores, and children's weight status has not been extensively studied. The current study determined if diet quality, characterized according to 3 predefined scores, was associated with weight status in a population-based sample of 9- to 10-y-old British children, independently of factors previously associated with weight status. In a cross-sectional study of 1700 children (56% girls), data from 4-d food diaries were used to calculate 3 diet quality scores modified to be reflective of children's diets: the Diet Quality Index (DQI), Healthy Diet Indicator (HDI), and Mediterranean Diet Score (MDS). Physical activity was measured with 7-d accelerometery, and height, weight, waist, and bio-impedance were objectively measured and used to calculate weight status variables. After multiple adjustments, including physical activity and overall energy density, higher DQI and HDI scores were significantly associated with improved weight status. Comparing extreme quintiles of the scores revealed the DQI and HDI were associated with lower waist circumference (-3.0%, P = 0.005 and -2.5%, P = 0.033, respectively), and lower body fat (-5.1%, P = 0.023 and -4.9%, P = 0.026, respectively). The DQI was also associated with lower weight (-5.9%; P = 0.002) and BMI (-4.2%; P = 0.004). No significant associations were observed with the MDS. These findings suggest that diet quality is independently associated with children's weight status. Future work should consider if diet quality scores could be key components of interventions designed to reduce obesity in children.

National, regional, and global trends in serum total cholesterol since 1980: systematic analysis of health examination surveys and epidemiological studies with 321 country-years and 3·0 million participants

BACKGROUND

Data for trends in serum cholesterol are needed to understand the effects of its dietary, lifestyle, and pharmacological determinants; set intervention priorities; and evaluate national programmes. Previous analyses of trends in serum cholesterol were limited to a few countries, with no consistent and comparable global analysis. We estimated worldwide trends in population mean serum total cholesterol.

METHODS

We estimated trends and their uncertainties in mean serum total cholesterol for adults 25 years and older in 199 countries and territories. We obtained data from published and unpublished health examination surveys and epidemiological studies (321 country-years and 3·0 million participants). For each sex, we used a Bayesian hierarchical model to estimate mean total cholesterol by age, country, and year, accounting for whether a study was nationally representative.

FINDINGS

In 2008, age-standardised mean total cholesterol worldwide was 4·64 mmol/L (95% uncertainty interval 4·51-4·76) for men and 4·76 mmol/L (4·62-4·91) for women. Globally, mean total cholesterol changed little between 1980 and 2008, falling by less than 0·1 mmol/L per decade in men and women. Total cholesterol fell in the high-income region consisting of Australasia, North America, and western Europe, and in central and eastern Europe; the regional declines were about 0·2 mmol/L per decade for both sexes, with posterior probabilities of these being true declines 0·99 or greater. Mean total cholesterol increased in east and southeast Asia and Pacific by 0·08 mmol/L per decade (-0·06 to 0·22, posterior probability=0·86) in men and 0·09 mmol/L per decade (-0·07 to 0·26, posterior probability=0·86) in women. Despite converging trends, serum total cholesterol in 2008 was highest in the high-income region consisting of Australasia, North America, and western Europe; the regional mean was 5·24 mmol/L (5·08-5·39) for men and 5·23 mmol/L (5·03-5·43) for women. It was lowest in sub-Saharan Africa at 4·08 mmol/L (3·82-4·34) for men and 4·27 mmol/L (3·99-4·56) for women.

INTERPRETATION

Nutritional policies and pharmacological interventions should be used to accelerate improvements in total cholesterol in regions with decline and to curb or prevent the rise in Asian populations and elsewhere. Population-based surveillance of cholesterol needs to be improved in low-income and middle-income countries.

FUNDING

Bill & Melinda Gates Foundation and WHO.

Population trends toward increasing cardiovascular risk factors in Canadian adolescents

OBJECTIVE

To determine prevalence and cross-sectional trends over time for cardiovascular risk factors in Canadian adolescents.

STUDY DESIGN

Cross-sectional trends in cardiovascular risk and lifestyle factors were gathered annually in 14- to 15-year-old students in the Niagara region, Ontario, Canada.

RESULTS

A total of 20 719 adolescents were screened between 2002 and 2008. The proportion of obese adolescents (>95th percentile for body mass index [BMI]) increased significantly, by +0.34%/year (P = .002). The proportions of adolescents with borderline high cholesterol (4.4-5.1 mmol/L) (+0.57%/year; P <.001) and with high cholesterol (≥5.2 mmol/L) (+0.43%/year; P <.001) both increased significantly over time. The proportion of adolescents with prehypertension decreased by -0.23%/year (P = .02), whereas the proportion of those with stage I hypertension (5%-6%) or stage II hypertension (2%-4%) remained constant. The proportion of adolescents classified as being at high cardiovascular risk increased by +0.67%/year (P <.001). Family history, low levels of physical activity, sedentary behaviors, poor nutrition, and lower socioeconomic status were all independently and negatively associated with all aspects of cardiovascular risk.

CONCLUSIONS

A significant proportion of 14- to 15-year-old Canadian adolescents have at least one cardiovascular risk factor, and the cross-sectional trends worsened during the period 2002-2008.

Dietary intakes and food sources of fat and fatty acids in Guatemalan schoolchildren: a cross-sectional study

BACKGROUND

Consumption of healthy diets that contribute with adequate amounts of fat and fatty acids is needed for children. Among Guatemalan children, there is little information about fat intakes. Therefore, the present study sought to assess intakes of dietary fats and examine food sources of those fats in Guatemalan children.

METHODS

The study subjects consisted of a convenience sample of 449 third- and fourth-grade schoolchildren (8-10 y), attending public or private schools in Quetzaltenango City, Guatemala. Dietary data was obtained by means of a single pictorial 24-h record.

RESULTS

The percentages of total energy (%E) from total fat, saturated fat (SFA) and monounsaturated fat (MUFA) reached 29%E for total fat and 10%E for each SFA and MUFA, without gender differences. %E from fats in high vs. low-socio economic status (SES) children were significantly higher for boys, but not for girls, for total fat (p = 0.002) and SFA (p < 0.001). Large proportions of the children had low levels of intakes of some fatty acids (FA), particularly for n-3 FA, with >97% of all groups consuming less than 1%E from this fats. Fried eggs, sweet rolls, whole milk and cheese were main sources of total fat and, SFA. Whole milk and sweet bread were important sources of n-3 FA for high- and low-SES boys and girls, respectively. Fried plantain was the main source of n-3 FA for girls in the high-SES group. Fried fish, seafood soup, and shrimp, consumed only by boys in low amounts, were sources of eicosapentaenoic (EPA) and docosahexaenoic (DHA) acids, which may explain the low intakes of these nutrients.

CONCLUSIONS

alpha-linolenic acid, EPA and DHA were the most limiting fatty acids in diets of Guatemalan schoolchildren, which could be partially explained by the low consumption of sources of these nutrients, particularly fish and seafood (for EPA and DHA). This population will benefit from a higher consumption of culturally acceptable foods that are rich in these limiting nutrients.

Head and neck cancer in India--review of practices for prevention policy

India, with a population of over a billion is likely to increase global concern on cancer, particularly that of head and neck. The increasing immigration of Indians is likely to influence other parts of the world and an analysis of cancer-related practices could serve as a model for defining cancer-prevention strategies across the globe. The objective of this study was to review the anti- and pro-carcinogenic practices in India pertaining to head and neck cancer. The published literature on practices, compounds/chemicals/crude reparations related to the head and neck cancer in India was retrieved for analysis, while unauthentic or local information was discarded. The anti-carcinogenic practices prevalent in India consisted of classically varied diet being predominantly vegetarian, along with spices, condiments, beverages etc. The pro-carcinogenic practices predominantly include all shades of alcoholism and tobacco intake. Moreover, the diverse culture of the country reflects unique regional practices. The enormous diversity in practices related to head and neck cancer in India is very unique and interesting. Cancer prevention strategies need to focus on these trends to define a better global prevention.

4-hydroxynonenal, a lipid peroxidation product of dietary polyunsaturated fatty acids, has anticarcinogenic properties in colon carcinoma cell lines through the inhibition of telomerase activity

The effects of polyunsaturated fatty acids (PUFAs) obtained from the diet on colorectal cancer have been widely explored. However, controversial results have been obtained about the role played by the lipid peroxidation products of PUFAs, such as 4-hydroxy-nonenal (HNE), in the control of colon cancer growth. This aldehyde, indeed, showed both procarcinogenic and protective effects. In an attempt to verify the action of HNE, we studied the effects of a low dose of HNE (1 microM), similar to those "physiologically" found in normal cells and plasma, on telomerase activity, a key parameter of malignant transformation. Caco-2 cells were exposed to HNE and, paralleling cell growth inhibition, we observed the down-regulation of telomerase activity and hTERT expression. Similar effects have also been observed in HT-29 cells, in which HNE inhibited cell proliferation, telomerase activity and hTERT expression, suggesting that the inhibition of telomerase activity could be a general mechanism involved in the antiproliferative effect exerted by this aldehyde. Finally, we elucidated the mechanism of hTERT inhibition by HNE. A reduction of GSH content preceded the decrease of telomerase activity, but this only partially explained the telomerase activity inhibition. The major mechanism of HNE action seems to be the modulation of expression and activity of transcription factors belonging to the Myc/Mad/Max network. Since the presence of PUFAs in the diet exposes epithelial colon cells to HNE, this aldehyde could contribute to cell growth control through the inhibitory action on telomerase activity and hTERT expression, suggesting a protective effect on colon mucosa.

Changes in food and nutrient intake of 6- to 17-year-old Germans between the 1980s and 2006

OBJECTIVE

To compare the food consumption and nutrient intakes of German children and adolescents in the 1980s with present dietary habits.

DESIGN

Two cross-sectional representative surveys, the German National Food Consumption Study (Nationale Verzehrsstudie, NVS) from 1985-8 and the nutrition module 'EsKiMo' of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) from 2006, were analysed for differences in food and nutrient intakes stratified by age and sex groups.

SETTING

Secondary analyses of data from representative observational studies.

SUBJECTS

Children and adolescents aged 6-17 years living in Germany in the 1980s (n 2265) and in 2006 (n 2506).

RESULTS

Food consumption was characterised by higher amounts of vegetables/pulses, fruits/nuts and beverages and less meat products/sausages, butter, fats/oils, potatoes/potato products and bread/pastries in 2006 than in 1985-8. The overall changes in food intake were reflected in improvements of macronutrient composition, increased water intake and lower energy density of the diet. Intake of most vitamins and minerals increased in relation to energy intake, but the nutrient density of the diet for vitamins B12 and D decreased. The most critical nutrients observed in NVS and EsKiMo were folate, vitamin D, vitamin A, vitamin E, Ca and Fe. In addition, dietary fibre intake was relatively low and fatty acid and carbohydrate compositions were not favourable.

CONCLUSIONS

Further efforts will be necessary to improve dietary habits among children and adolescents.

Association of age at menarche with cardiovascular risk factors, vascular structure, and function in adulthood: the Cardiovascular Risk in Young Finns study

BACKGROUND

It is unclear whether age at menarche is an independent determinant of future cardiovascular risk.

OBJECTIVE

We aimed to determine whether menarcheal age is an independent predictor of body mass index (BMI) and a wide range of cardiovascular risk factors in adolescence and adulthood.

DESIGN

We examined the associations of menarcheal age with BMI (in kg/m(2)) and other cardiovascular risk factors in adolescence and adulthood in a population-based sample of 794 female adolescents aged 9-18 y at baseline. Their age at first menstruation was requested at baseline and again 3 and 6 y later. Cardiovascular risk factors were assessed at baseline and at age 30-39 y.

RESULTS

A 1-y decrease in menarcheal age was associated with 0.81 (95% CI: 0.53, 1.08) higher adult BMI as well as greater waist circumference and waist-to-hip ratio, elevated systolic blood pressure, higher insulin resistance, and greater risk of metabolic syndrome (P < 0.05 for all). In multivariable analysis in which these adult risk factors were mutually adjusted for, only the inverse association between age at menarche and adult BMI remained. However, this inverse association was lost after adjustment for premenarcheal BMI (beta: -0.16; 95% CI -0.55, 0.23; P = 0.42). Higher premenarcheal BMI predicted earlier menarche, and the strong association between premenarcheal BMI and adult BMI was robust to adjustment for age at menarche.

CONCLUSIONS

These findings suggest that early menarche is only a risk marker. Greater childhood BMI seems to contribute to earlier age at menarche and, because of tracking, greater adult BMI and associated cardiovascular risk. An independent effect of early menarche on adult adiposity cannot be excluded, but it is likely to be small at best.

Fetal, childhood, and adolescence interventions leading to adult disease prevention

Lifestyle choices result in the development and increased severity of many adult diseases that can cause death (eg, heart disease, stroke, cancer, obesity). Most health-damaging behaviors are learned during childhood and adolescence, making that time period a critical window of opportunity to teach health-promoting behaviors. Primary care physicians can implement their overall commitment to providing comprehensive health care to patients and their families by following the anticipatory guidelines of their discipline (eg, pediatrics, family and internal medicine) and by educating patients and their families about the recommendations included on the Web sites of the Centers for Disease Control and Prevention Office of Women's Health and Office of Strategy and Innovation.

Three-year weight change in successful weight losers who lost weight on a low-carbohydrate diet

OBJECTIVE

The purpose of this study was to evaluate long-term weight loss and eating and exercise behaviors of successful weight losers who lost weight using a low-carbohydrate diet.

RESEARCH METHODS AND PROCEDURES

This study examined 3-year changes in weight, diet, and physical activity in 891 subjects (96 low-carbohydrate dieters and 795 others) who enrolled in the National Weight Control Registry between 1998 and 2001 and reported >or=30-lb weight loss and >or=1 year weight loss maintenance.

RESULTS

Only 10.8% of participants reported losing weight after a low-carbohydrate diet. At entry into the study, low-carbohydrate diet users reported consuming more kcal/d (mean +/- SD, 1,895 +/- 452 vs. 1,398 +/- 574); fewer calories in weekly physical activity (1,595 +/- 2,499 vs. 2,542 +/- 2,301); more calories from fat (64.0 +/- 7.9% vs. 30.9 +/- 13.1%), saturated fat (23.8 +/- 4.1 vs. 10.5 +/- 5.2), monounsaturated fat (24.4 +/- 3.7 vs. 11.0 +/- 5.1), and polyunsaturated fat (8.6 +/- 2.7 vs. 5.5 +/- 2.9); and less dietary restraint (10.8 +/- 2.9 vs. 14.9 +/- 3.9) compared with other Registry members. These differences persisted over time. No differences in 3-year weight regain were observed between low-carbohydrate dieters and other Registry members in intent-to-treat analyses (7.0 +/- 7.1 vs. 5.7 +/- 8.7 kg).

DISCUSSION

It is possible to achieve and maintain long-term weight loss using a low-carbohydrate diet. The long-term health effects of weight loss associated with a high-fat diet and low activity level merits further investigation.

Comparisons of food intake between breast cancer patients and controls in Korean women

The purpose of this study was to compare food intakes between Korean breast cancer patients and a healthy control group. We compared the intake of nutrients of 117 food items between Korean breast cancer patients (n=97) and age matched healthy controls (n=97). Nutrient intake was estimated using a quantitative food frequency questionnaire. The mean caloric intake of breast cancer patients and healthy controls was not significantly different. Breast cancer patients consumed significantly less fat and antioxidant nutrients such as vitamin A, retinol, beta-carotene, vitamin C and vitamin E when compared to the control subjects. Among the food items, the intake of eggs (p<0.01), legumes (p<0.05), vegetables (p<0.05), seasonings (p<0.001), and oils and fats (p<0.01) in breast cancer patients was significantly lower than that in the controls. These results suggest that Korean breast cancer patients consumed less amount of soy and vegetables, which are rich source of antioxidant nutrients and phytosterols. Thus, dietary guidance to increase intake of these foods may be beneficial in the prevention of breast cancer.

Dietary macronutrient intake during the first 10 years of life in a cohort of Italian children

OBJECTIVE

To describe the longitudinal pattern of dietary energy and macronutrient intakes during the first 10 years of life in a sample of healthy Italian children.

PATIENTS AND METHODS

Sixty-one healthy children were followed from birth to 10 years of age. At 1, 5, 8, and 10 years of age, anthropometric measurements were taken and nutritional habits evaluated using a standardized food frequency questionnaire.

RESULTS

Compared to the Italian recommended dietary allowances, the children's diet was high in protein at any age, high in lipids from age 5 onward, and high in calories at 5 years of age. At 1 year, mean (SD) protein, carbohydrate, and lipid intake, expressed as percentage of total energy, was 20% (3%), 48% (7%), and 34% (5%), respectively. Afterward, the corresponding mean value ranged around 14% to 15%, 57% to 60%, and 29% to 32%. The mean glycemic load and overall glycemic index ranged around 143 to 150 and 58 to 59, respectively. A difference between boys and girls was found in the longitudinal pattern for the intake of energy (P < 0.0001) and glycemic load (P < 0.0001). The individual longitudinal dietary pattern varied over time for the intake of total energy (P < 0.0001), any macronutrient (P < 0.0001), and overall glycemic index (P = 0.05).

CONCLUSIONS

Although the amount of energy intake was in accordance with the Italian recommended dietary allowances, children consumed a high-protein and high-lipid diet. Early and continuous dietary education of children and parents may provide support for adequate nutritional habits throughout their childhood.

Effects of fasting and a medium calorie balanced diet during the holy month Ramadan on weight, BMI and some blood parameters of overweight males

Fasting during holy month, Ramadan, is a religious obligation for all adult healthy Muslims. During this month Muslims are allowed to eat and drink between sunset and dawn. However, they are not allowed to eat and drink after dawn. To assess the effects of fasting on weight, BMI (Body Mass Index) and some blood indices, we recruited 28 overweight male volunteers aged 20-26 years. They were on a balanced diet of 2000 calories, containing 70 g protein, 350 g carbohydrate and 35.5 g lipid during Ramadan, while they were on a free diet before Ramadan. Subjects were requested to drink more than 6 glasses (about 1.5 L) of water or fruit juice every night between sunset to dawn during Ramadan. Serum levels of glucose, cholesterol, triglyceride as well as weight and BMI were measured in all subjects one day before and after Ramadan. Fasting resulted in significant (p<0.05) decreases in the mean values of both, weight and the BMI. Similarly, the mean values of glucose and cholesterol were significantly decreased in subjects after Ramadan, although none of these decreases reached to a level with pathological significance. Conversely, no significant changes in serum levels of triglyceride were noted.

Health and nutrition education in primary schools in Crete: 10 years' follow-up of serum lipids, physical activity and macronutrient intake

The current study is a 4-year follow-up after the 6-year-long health and nutrition intervention programme applied in the primary schools of Crete. The aim of the current work was to identify whether the benefits obtained in certain health indices at the end of the intervention period were also present 4 years later. From a representative population of 441 pupils (250 from the intervention schools and 191 from the control schools), biochemical, dietary and physical activity data were obtained at baseline, at the end of the intervention period and after intervention (academic years 1992–1993, 1997–1998 and 2001–2002, respectively). The findings of the current study revealed that the favourable changes in serum lipids observed at the end of the intervention period were maintained from baseline to after intervention for total cholesterol (−24·3 (SE 1·65)V. −9·70 (SE 2·03) mg/dl;P=0·001), LDL-cholesterol (−18·6 (SE 1·41)V. −2·49 (SE 1·75) mg/dl;P<0·001), HDL-cholesterol (−8·34 (SE 0·75)V. −9·60 (SE 1·10) mg/dl;P=0·014) and total cholesterol:HDL-cholestrol ratio (0·31 (SE 0·06)V. 0·04 (SE 0·05);P=0·001). Similar favourable changes for the intervention group were observed in leisure-time physical activities (38·3 (SE 11·7)V. −13·2 (SE 10·9) min/week;P=0·038) and BMI (6·05 (SE 0·18)V. 6·67 (SE 0·21) kg/m2;P=0·014), whereas no changes were observed in the fitness and dietary indices examined. The findings of the current study are encouraging, indicating maintenance of the favourable changes observed in serum lipids, BMI and physical activity 4 years after the programme had ended

Health and nutrition education program in primary schools of Crete: changes in blood pressure over 10 years

OBJECTIVE

To examine the long-term effects of the 'Cretan Health and Nutrition Education Program' on blood pressure.

SUBJECTS

A representative population of 176 pupils (85 from the intervention schools and 91 from the control schools).

DESIGN

Blood pressure, dietary, anthropometrical and physical activity data were obtained at baseline (academic year 1992-1993) and at follow-up examination (academic year 2001-2002).

RESULTS

The findings of the current study revealed that the increase over the 10-year period in systolic (SBP) and diastolic blood pressure (DBP) was higher in the control group (CG) than in the intervention group (IG) (P=0.003 and P<0.001 respectively). Regarding dietary indices, the IG were found to have a significantly higher intake of potassium (P=0.018) and magnesium (P=0.011) compared to the CG. Furthermore, the decrease in body mass index (BMI) z-score observed in the IG was found to differentiate significantly from the increase observed in the CG (P=0.042). On the contrary, the increase in leisure time, moderate to vigorous physical activities (MVPA) observed in the IG, was found to differentiate significantly from the decrease observed in the CG (P=0.032). Intervention's effect on SBP was mediated by changes in MVPA (beta=-0.20, P=0.030) and BMI (beta=0.19, P=0.048). Similarly, intervention's effect on DBP was mediated by changes in MVPA (beta=-0.18, P=0.048), BMI (beta=0.26, P=0.007) and magnesium intake (beta=-0.20, P=0.048).

CONCLUSION

The findings of the current study are encouraging, indicating favorable changes in blood pressure, micronutrients intake, BMI and physical activity over the 10 years of follow-up and 4 years after program's cessation, thus providing some support for the effectiveness of school-based health education programs in successfully tackling certain chronic disease risk factors early in life.

Food items consumed by students attending schools in different socioeconomic areas in Cape Town, South Africa

OBJECTIVE

We investigated the food consumption patterns of adolescent students at schools. Our findings are intended to reveal the overall nutritional quality of foods eaten by students at school, including foods brought to school and foods purchased at school.

METHODS

A questionnaire was completed by 476 students, mostly from grades 7 and 10, from 14 schools in Cape Town, South Africa. The schools were representative of the various ethnic groups and socioeconomic strata of the population. The questionnaire requested information on eating habits at school, foods brought to school and food purchases, and breakfast consumption before school. We also tested whether students knew which foods are healthy and which are less healthy choices.

RESULTS

The students were mostly 12 to 16 y of age (mean age 14.5 y). The large majority had breakfast before school (77.8%) and ate at school (79.7%). Food was brought to school by 41% to 56%, whereas 69.3% purchased food at school, mainly at the school store (tuck shop). Predefined "unhealthy" foods brought to school outnumbered "healthy" ones by 2 to 1. Among students who purchased food at school, 70.0% purchased no healthy items, whereas 73.2% purchased two or more unhealthy items. With six foods 84% of students correctly stated whether they were healthy or unhealthy; however, with cola drinks, samoosas (deep-fried pastry with spicy filling), and pies, only 47% to 61% knew that these were less healthy choices. Students' scores on this question were unrelated to whether they purchased healthy or unhealthy foods. Students who attended schools of high socioeconomic status were twice as likely to bring food to school (64.7% versus 31.0%, P<0.001), scored higher marks on the quiz of healthy versus unhealthy foods (P<0.01), but were no more likely to purchase healthy food.

CONCLUSIONS

The large majority of food eaten by adolescent students in Cape Town is classified as being unhealthy choices. This applies to foods brought to school and food purchases. Consideration needs to be given to policy measures to improve this situation and to improve education of students and their parents.

Laying foundations for health: food provision for under 5s in day care

This study investigated the food offered to children under 5 years of age in UK day care, the influence of the childcare providers on a child's diet and their attitudes towards this role. A postal survey of a randomised quota sample of childcare providers enquired after the range of food on offer and explored attitudes towards the role of food in health and the role of promoting health. Themes emerging from these data were explored by in-depth interviews with a sample of 18 childcare providers and 7 Local Authority Early Years Service staff. We received 194 (56%) responses to 345 copies of the questionnaire. Half (46%) of nurseries and 23% of childminders provided a fruit or vegetable with the main meal 5 days a week. Only 14% of nurseries and 21% of childminders provided a dairy food (i.e. calcium-rich) at the main meal every day. Almost all the childcare providers saw themselves as responsible for promoting healthy diet, but it was rare for them to have had any formal training in nutrition, while current dietary guidance was perceived as too vague to be useful. The study also highlighted tensions on the issue of food provision between those delivering childcare and parents; further research should explore the parents' perspectives. Nursery staff and childminders should have access to carefully designed advice on nutritionally appropriate food and drink services for under-fives.

Dietary fat and risk of breast cancer

BACKGROUND

Breast cancer is one of the major public health problems among women worldwide. A number of epidemiological studies have been carried out to find the role of dietary fat and the risk of breast cancer. The main objective of the present communication is to summarize the evidence from various case-control and cohort studies on the consumption of fat and its subtypes and their effect on the development of breast cancer.

METHODS

A Pubmed search for literature on the consumption of dietary fat and risk of breast cancer published from January 1990 through December 2003 was carried out.

RESULTS

Increased consumption of total fat and saturated fat were found to be positively associated with the development of breast cancer. Even though an equivocal association was observed for the consumption of total monounsaturated fatty acids (MUFA) and the risk of breast cancer, there exists an inverse association in the case of oleic acid, the most abundant MUFA. A moderate inverse association between consumption of n-3 fatty acids and breast cancer risk and a moderate positive association between n-6 fatty acids and breast cancer risk were observed.

CONCLUSION

Even though all epidemiological studies do not provide a strong positive association between the consumption of certain types of dietary fat and breast cancer risk, at least a moderate association does seem to exist and this has a number of implications in view of the fact that breast cancer is an increasing public health concern.

Breakfast habits, nutritional status, body weight, and academic performance in children and adolescents

Breakfast has been labeled the most important meal of the day, but are there data to support this claim? We summarized the results of 47 studies examining the association of breakfast consumption with nutritional adequacy (nine studies), body weight (16 studies), and academic performance (22 studies) in children and adolescents. Breakfast skipping is highly prevalent in the United States and Europe (10% to 30%), depending on age group, population, and definition. Although the quality of breakfast was variable within and between studies, children who reported eating breakfast on a consistent basis tended to have superior nutritional profiles than their breakfast-skipping peers. Breakfast eaters generally consumed more daily calories yet were less likely to be overweight, although not all studies associated breakfast skipping with overweight. Evidence suggests that breakfast consumption may improve cognitive function related to memory, test grades, and school attendance. Breakfast as part of a healthful diet and lifestyle can positively impact children's health and well-being. Parents should be encouraged to provide breakfast for their children or explore the availability of a school breakfast program. We advocate consumption of a healthful breakfast on a daily basis consisting of a variety of foods, especially high-fiber and nutrient-rich whole grains, fruits, and dairy products.

Comparison of high-fat and high-protein diets with a high-carbohydrate diet in insulin-resistant obese women

AIMS/HYPOTHESIS

A diet low in saturated fatty acids and rich in wholegrains, vegetables and fruit is recommended in order to reduce the risk of obesity, cardiovascular disease and type 2 diabetes mellitus. However there is widespread interest in high-fat ("Atkins Diet") and high-protein ("Zone Diet") alternatives to the conventional high-carbohydrate, high-fibre approach. We report on a randomised trial that compared these two alternative approaches with a conventional diet in overweight insulin-resistant women.

METHODS

Ninety-six normoglycaemic, insulin-resistant women (BMI >27 kg/m(2)) were randomised to one of three dietary interventions: a high-carbohydrate, high-fibre (HC) diet, the high-fat (HF) Atkins Diet, or the high-protein (HP) Zone Diet. The experimental approach was designed to mimic what might be achieved in clinical practice: the recommendations involved advice concerning food choices and were not prescriptive in terms of total energy. There were supervised weight loss and weight maintenance phases (8 weeks each), but there was no contact between the research team and the participants during the final 8 weeks of the study. Outcome was assessed in terms of body composition and indicators of cardiovascular and diabetes risk.

RESULTS

Body weight, waist circumference, triglycerides and insulin levels decreased with all three diets but, apart from insulin, the reductions were significantly greater in the HF and HP groups than in the HC group. These observations suggest that the popular diets reduced insulin resistance to a greater extent than the standard dietary advice did. When compared with the HC diet, the HF and HP diets were shown to produce significantly (p<0.01) greater reductions in several parameters, including weight loss (HF -2.8 kg, HP -2.7 kg), waist circumference (HF -3.5 cm, HP -2.7 cm) and triglycerides (HF -0.30 mmol/l, HP [corrected] -0.22 mmol/l). LDL cholesterol decreased in individuals on the HC and HP diets, but tended to fluctuate in those on the HF diet to the extent that overall levels were significantly lower in the HP group than in the HF group (-0.28 mmol/l, 95% CI 0.04-0.52, p=0.02). Of those on the HF diet, 25% showed a >10% increase in LDL cholesterol, whereas this occurred in only 13% of subjects on the HC diet and 3% of those on the HP diet.

CONCLUSIONS/INTERPRETATION

In routine practice a reduced-carbohydrate, higher protein diet may be the most appropriate overall approach to reducing the risk of cardiovascular disease and type 2 diabetes. To achieve similar benefits on a HC diet, it may be necessary to increase fibre-rich wholegrains, legumes, vegetables and fruits, and to reduce saturated fatty acids to a greater extent than appears to be achieved by implementing current guidelines. The HF approach appears successful for weight loss in the short term, but lipid levels should be monitored. The potential deleterious effects of the diet in the long term remain a concern.

Rapid increase in the prevalence of obesity in elementary school children

OBJECTIVE

Three critical periods have been suggested for the development of obesity during childhood: fetal, ages 4-6 y, and adolescence. The prevalence of obesity in elementary school children is increasing in Japan, and the present study examines whether this rising prevalence occurs during the elementary school period (age 6-11 y) or is occurring prior to entry into elementary school.

DESIGN

Repeated cross-sectional sampling of cohorts of children for the prevalence of obesity.

SETTING AND PARTICIPANTS

The data from 81 264 first grade and 87 849 seventh grade children (94 and 87% of the total populations, respectively) between 1989 and 2002 in Kagoshima City were analyzed. Data were also obtained from nationwide surveys published by the Ministry of Japan between 1989 and 2001.

MEASUREMENTS

Obesity was defined by the body mass index for an age- and sex-specific 95th percentile cutoff point in Japanese children. Trends in obesity and odds ratios of the prevalence of obesity were also determined.

RESULTS

The period 1989-2001/2 showed significant increases in the prevalence of obesity for both genders, in both first and seventh grades, and in both Kagoshima City and nationwide. The odds ratios for the prevalence of obesity of 12-y-old children calculated against the prevalence of obesity within the same cohort at 6 y old revealed that a significant risk for development of obesity during the elementary school years applied only to boys from around 1993 onward in Kagoshima City and applied throughout the study period in nationwide Japan.

CONCLUSION

Obesity prevalence increases for boys during elementary school years but does not significantly increase for girls. A rising trend for becoming obese before starting elementary school was present for both boys and girls over the period 1989-2001. Educational programs to improve nutrition and physical activity, especially for boys, are becoming increasingly necessary.