Manganese-Enhanced MRI of the Brain in Healthy Volunteers

BACKGROUND AND PURPOSE

The manganese ion is used as an intracellular MR imaging contrast agent to study neuronal function in animal models, but it remains unclear whether manganese-enhanced MR imaging can be similarly useful in humans. Using mangafodipir (Teslascan, a chelated manganese-based contrast agent that is FDA-approved), we evaluated the dynamics of manganese enhancement of the brain and glandular structures in the rostral head and neck in healthy volunteers.

MATERIALS AND METHODS

We administered mangafodipir intravenously at a rate of 1 mL/minute for a total dose of 5 μmol/kg body weight. Nine healthy adult volunteers (6 men/3 women; median age, 43 years) completed baseline history and physical examination, 3T MR imaging, and blood work. MR imaging also followed mangafodipir administration at various time points from immediate to 7 days, with delayed scans at 1-3 months.

RESULTS

The choroid plexus and anterior pituitary gland enhanced within 10 minutes of infusion, with enhancement persisting up to 7 and 30 days, respectively. Exocrine (parotid, submandibular, sublingual, and lacrimal) glands also enhanced avidly as early as 1 hour postadministration, generally resolving by 1 month; 3 volunteers had residual exocrine gland enhancement, which resolved by 2 months in 1 and by 3 months in the other 2. Mangafodipir did not affect clinical parameters, laboratory values, or T1-weighted signal in the basal ganglia.

CONCLUSIONS

Manganese ions released from mangafodipir successfully enable noninvasive visualization of intra- and extracranial structures that lie outside the blood-brain barrier without adverse clinical effects, setting the stage for future neuroradiologic investigation in disease.

Resistance training to counteract the catabolism of a low-protein diet in patients with chronic renal insufficiency. A randomized, controlled trial

BACKGROUND

Chronic renal insufficiency leads to muscle wasting, which may be exacerbated by low-protein diets prescribed to delay disease progression. Resistance training increases protein utilization and muscle mass.

OBJECTIVE

To determine the efficacy of resistance training in improving protein utilization and muscle mass in patients with chronic renal insufficiency treated with a low-protein diet.

DESIGN

Randomized, controlled trial.

SETTING

Tufts University, Boston, Massachusetts.

PATIENTS

26 older patients with moderate renal insufficiency (17 men, 9 women) who had achieved stabilization on a low-protein diet.

INTERVENTION

During a run-in period of 2 to 8 weeks, patients were instructed and their adherence to the low-protein diet (0.6 g/kg of body weight per day) was evaluated. They were randomly assigned to a low-protein diet plus resistance training (n = 14) or a low-protein diet alone (n = 12) for 12 weeks.

MEASUREMENTS

Total body potassium, mid-thigh muscle area, type I and II muscle-fiber cross-sectional area, and protein turnover.

RESULTS

Mean protein intake was 0.64 +/- 0.07 g/kg per day after stabilization. Total body potassium and type I and II muscle-fiber cross-sectional areas increased in patients who performed resistance training by a mean (+/-SD) of 4% +/- 8%, 24% +/- 31%, and 22% +/- 29%, respectively, compared with those who did not. Leucine oxidation and serum prealbumin levels also improved significantly. Patients assigned to resistance training maintained body weight compared with those who were not. Improvement in muscle strength was significantly greater with resistance training (32% +/- 14%) than without (-13% +/- 20%) (P < 0.001).

CONCLUSION

By improving muscle mass, nutritional status, and function, resistance training seems to be effective against the catabolism of a low-protein diet and uremia in patients with renal failure.

Nutrition guidelines and education of the public

Guidelines on diet and nutrition serve two important purposes: to guide policy makers and to educate consumers, be they healthy or ill, about healthful ways to eat. Other lifestyle behaviors such as weight, physical activity and smoking status are sometimes also included. The soundness of the resulting guidelines depends on the strength of the evidence attesting to the presence of diet-health relationships. Precedent and the larger environment also have powerful influences. The degree to which guidelines are used will depend on how well they are crafted with respect to communication and how the recommendations are publicized. Holistic approaches rather than single silver bullet approaches that are targeted to reduction in risks of dietary deficiencies, food-borne illnesses and multiple chronic degenerative diseases are probably the most useful for the nutrition education of the public. The Dietary Guidelines for Americans are one example. Such dietary and nutritional recommendations based on sound science, reviewed periodically and communicated effectively have a positive and helpful role in cancer prevention and risk reduction.

Do adolescent vitamin-mineral supplement users have better nutrient intakes than nonusers? Observations from the CATCH tracking study

OBJECTIVE

Describe whether users of vitamin-mineral supplements differed from nonusers in micronutrient intakes or in nutrition awareness.

DESIGN

Cross-sectional, observational study.

SUBJECTS

One thousand five hundred thirty-two students now in grade 8, who participated in the Third Child and Adolescent Trial for Cardiovascular Health tracking study and who also provided a single 24-hour dietary recall.

STATISTICAL ANALYSES PERFORMED

Mixed-model analysis of covariance was used to ascertain if supplement users had higher vitamin and mineral intakes from food sources, and to examine if supplement users had better nutrition awareness than nonusers.

RESULTS

The 24-hour recall showed that 17.6% of the students reported using vitamin-mineral supplements. Users reported a mean of 1.4 supplements, of which 47% were multivitamin or multimineral preparations, 37% were single nutrients, and 16% were combinations. White persons and residents of Minnesota and California were more likely to be supplement users. Users had higher micronutrient intakes from food sources for 16 of the 20 nutrients studied after adjusting for gender, race/ethnicity, site, treatment condition, and within-school variability. Users had higher scores on a health behavior survey for food choice and slightly but not significantly higher nutrition knowledge scores.

CONCLUSIONS

Vitamin-mineral supplement use is prevalent among eighth-grade students. Users have higher nutrient intakes from foods, higher total intakes for several micronutrients, higher nutrition awareness, and differ in their demographic characteristics from nonusers.

An assessment lexicon: assessment of dietary trends, physical activity patterns and nutritional status in the elderly

This article discusses the use of nutritional assessment to improve the health and nutritional status of older persons. A three pronged approach is suggested. First, the emphasis is on screening for poor nutritional status. This involves a search for both biological and social factors that influence diet, physical activity and other determinants of nutritional status. The Determine Checklist is helpful in doing this. Second, after those elders potentially at risk are identified, the goal is to address risks to nutritional status more definitively. The nutritional status lexicon (ABCDEF's) must be assessed in this regard. Finally, it is critical to prevent or treat problems which have been discovered. Without follow-up,b screening and assessment are useless.

Chronic disease and dietary management in the elderly: alive and kicking!

The paper reviews progress in chronic disease prevention and dietary management strategies in the elderly to help them remain independent with a high quality of life for as long as possible. Progress in public health over the past century is briefly reviewed. The similarities and differences in preventive measures for elders and younger adults are summarized. The goals for the prevention and management of chronic disease in the elderly are similar, but the strategies may differ, and quality of life is especially important. Especially effective preventive strategies for the elderly are discussed. Selected strategies to manage conditions already present by delaying or controlling diet-related disease progression while maintaining an acceptable quality of life are discussed. Finally, selected new research on managing chronic disease in elders is reviewed. Taken together, these strategies promise to keep our elders "alive and kicking" for as long as possible.

Serum cystatin C is an independent predictor of total homocysteine levels in stable Korean renal transplant recipients with normal serum creatinine

OBJECTIVES

To examine the determinants of fasting plasma total homocysteine (tHcy) levels such as cystatin C, serum creatinine (SCr), estimated glomerular filtration rate (GFR) from Cockroft-Gault equation, albumin, plasma folate, vitamin B12, and pyridoxal-5'-phosphate (PLP) among Korean renal transplant recipients (RTR) with normal SCr levels (< or =1.4 mg/dL).

DESIGN

Cross-sectional study.

SETTING

Nephrology and Transplant Service, Catholic University Kangnam St. Mary's Hospital, Seoul, Korea.

PARTICIPANTS

Fifty-one chronic stable Korean RTR with normal SCr levels (< or =1.4 mg/dL) 6 months or more following transplantation.

MEASURES

Medical record review, anthropometric measurements, and overnight (10 to 14 hours) fasting blood samples for measurement of plasma tHcy, folate, vitamin B12, PLP, SCr, albumin, and cystatin C.

RESULTS

General linear regression model including age, gender, vitamin status, and measurements of renal function showed that cystatin C and folate were independent predictors of tHcy levels. The partial regression coefficient for folate was -0.444 (P <.01) and for cystatin C, it was +0.334 (P <.05). SCr, estimated GFR, vitamin B12, PLP, age, and gender were not independent predictors of tHcy levels in this model.

CONCLUSION

Both cystatin C and folate status were major independent determinants of fasting tHcy levels in the subgroup of Korean RTR with normal SCr.

Reliability and validity of the Child and Adolescent Trial for Cardiovascular Health (CATCH) Food Checklist: a self-report instrument to measure fat and sodium intake by middle school students

OBJECTIVE

To develop a scoring algorithm and evaluate the reliability and validity of scores from the Child and Adolescent Trial for Cardiovascular Health (CATCH) Food Checklist (CFC) as measures of total fat, saturated fat, and sodium intake in middle school students.

DESIGN

Randomized, controlled trial in which participants were assigned to 1 of 3 study protocols that varied the order of CFC and 24-hour dietary recall administration. Criterion outcomes were percent energy from total fat, percent energy from saturated fat, and sodium intake in milligrams.

SUBJECTS/SETTING

A multiethnic sample (33% ethnic and racial minorities) of 365 seventh-grade students from 8 schools in 4 states.

STATISTICAL ANALYSES

Multivariable regression models were used to calibrate the effects of individual food checklist items; bootstrap estimates were used for cross-validation; and kappa statistics, Pearson correlations, t tests, and effect sizes were employed to assess reliability and validity.

RESULTS

The median same-day test-retest reliability kappa for the 40 individual CFC food items was 0.85. With respect to item validity, the median kappa statistic comparing student choices to those identified by staff dietitians was 0.54. Test-retest reliability coefficients ranged from 0.84 to 0.89 for CFC total nutrient scores. Correlations between CFC scores and 24-hour recall values were 0.36 for total fat, 0.36 for saturated fat, and 0.34 for sodium; CFC scores were consistent with hypothesized gender differences in nutrient intake.

APPLICATIONS/CONCLUSIONS

The CFC is a reliable and valid tool for measuring fat, saturated fat, and sodium intake in middle school students. Its brevity and ease of administration make the CFC a cost-effective way to measure middle school students' previous day's intake of selected nutrients in school surveys and intervention studies.

Development of a self-assessment instrument to determine daily intake and variability of dietary vitamin K

OBJECTIVE

To develop and validate a brief, self-assessment instrument (K-Card) to determine daily variations in dietary vitamin K1 (phylloquinone) intake for use in patients receiving oral warfarin anticoagulant therapy.

METHODS

The K-Card was designed to include a checklist of selected common foods and beverages providing > or = 5 microg vitamin K per serving in American diets and items with lower vitamin K content typically consumed in quantities which contribute significantly to total vitamin K intake. The K-Card was validated against records of weighed food intake from thirty-six healthy volunteers, 20 to 40 and 60 to 80 years of age, whose phylloquinone intakes and plasma concentrations had been previously measured by the Metabolic Research Unit, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA USA. Future use of the K-Card by patients was simulated by a single investigator using 108 one-day weighed food records to estimate phylloquinone intakes. Dietary phylloquinone calculated from the K-Card was compared to the values of phylloquinone intake from the diet records collected on the same days, and to fasting plasma phylloquinone concentrations obtained from the same individuals on the following day.

RESULTS

The mean dietary phylloquinone intake (+/- SEM) was 138.8 +/- 15.7 microg for the K-Cards compared to 136.0 +/- 15.8 microg for the diet records (p = 0.067). Bland-Altman limits of agreement between quantities of dietary phylloquinone calculated from the K-Card and values obtained from the weighed food records were +/- 38 microg.

CONCLUSION

In this simulation, the K-Card provided an accurate estimate of dietary phylloquinone intake and therefore deserves further testing for use by patients receiving coumarin-based anticoagulant therapy to determine whether variability in dietary patterns contributes to disruptions in anticoagulant drug efficacy and safety.

Determinants of plasma total homocysteine levels in Korean chronic renal transplant recipients

OBJECTIVE

Study the determinants of plasma total homocysteine (tHcy) levels, such as fasting levels of serum creatinine (SCr), albumin, plasma tHcy, folate, B(12), and pyridoxal-5'-phosphate (PLP) in chronic Korean renal transplant recipients (RTR).

DESIGN

Cross-sectional study.

SETTING

Nephrology & Transplant Service in Catholic University Kangnam St. Mary's Hospital, Seoul, Korea.

PARTICIPANTS

Ninety-one chronic Korean RTR with stable renal function who were > or =6 months post-transplant.

MEASURES

Used medical record review and anthropometric measurements, and overnight (10 to 14 hours) fasting blood samples were measured for plasma tHcy, PLP, folate, B(12), SCr, and albumin.

RESULTS

The prevalence of hyperhomocysteinemia (tHcy > 12 micromol/L) was 56%, and 47% had low plasma folate levels (<3 ng/mL). Linear modeling with analysis of covariance adjusted for age, sex, albumin, SCr, and plasma B-vitamin status revealed that only SCr (standard regression coefficient R = +0.663, P<.001), plasma folate (R = -0.276, P =.001), and B(12) (R = -0.149, marginal, P =.08) were independent determinants of fasting tHcy levels in this patient population.

CONCLUSION

Renal function is the major independent determinant of the fasting tHcy levels among chronic, stable Korean RTR, and that B-vitamin status plays a secondary role among such patients.

Prevalence of marked overweight and obesity in a multiethnic pediatric population: findings from the Child and Adolescent Trial for Cardiovascular Health (CATCH) study

OBJECTIVE

Determine the prevalence of marked overweight and obesity among children in the Child and Adolescent Trial for Cardiovascular Health (CATCH), identify high risk groups, and compare findings to other recent studies.

DESIGN

Cohort study.

SUBJECTS/SETTING

Five thousand one hundred-six school children who were participants in CATCH at baseline (age approximately 9 years) during 1991 and 4,019 of those children who had follow-up data from 1994 (age approximately 1 years) available.

METHODS

Body mass index (BMI), triceps and subscapular skinfolds, subscapular to triceps skinfold (S/T) ratio, and an estimate of body fat distribution from skinfolds was calculated. Findings were compared to population-based reference data from the First National Health and Nutrition Examination Survey, 1971 to 1973 (NHANES I), to data from the Bogalusa Heart Study, and to data from the Third National Health and Nutrition Examination Survey, 1988 to 1994 (NHANES III).

RESULTS

Children in CATCH were markedly heavier and fatter than the NHANES I population and more comparable to the NHANES III population, especially those in the upper percentiles. The prevalence of obesity based on BMI and triceps skinfolds >95th percentile among CATCH children was higher in boys than in girls at both baseline (boys 9.1%, girls 8.6%) and follow-up (boys 11.7%, girls 7.2%). It was higher among African-Americans and Hispanics than whites for both sexes. S/T ratios did not differ appreciably from those observed in the NHANES I reference population, suggesting that body fat distribution was more stable over time than BMI and skinfolds.

APPLICATIONS

Our findings support other recent reports that American children, especially African-American and Hispanic children, are becoming heavier and fatter. Preventive measures are warranted, especially for high-risk youth.

Assessment of healthcare professionals' knowledge about warfarin-vitamin K drug-nutrient interactions

OBJECTIVE

Dietary vitamin K can interact with oral anticoagulant drugs and interfere with their therapeutic safety and efficacy. Therefore, knowledge about drug-nutrient interactions involving vitamin K possessed by physicians, pharmacists, dietitians and nurses practicing anticoagulant therapy was assessed.

METHODS

Healthcare practitioners were surveyed using a 30-question, 98-item questionnaire on the most common and/or important food interactions with warfarin, drug interactions with warfarin and general drug-nutrient interactions involving vitamin K. The study sample included 160 randomly selected healthcare providers (40 physicians, pharmacists, dietitians and nurses) from 10 hospitals with 200 to 1000 beds from six Massachusetts regions. Random selection was conducted from a pool of selected healthcare providers practicing anticoagulant therapy who counsel patients receiving warfarin.

RESULTS

All surveys were completed within three months of the start of the study, and all participants provided usable data for statistical analysis. The mean scores (+/- SD) on the overall test were 72.5+/-9.0 for pharmacists, 62.51+/-10.6 for physicians, 56.9+/-8.8 for dietitians and 50.2+/-9.3 for nurses, with 100 being a perfect score. Pharmacists scored significantly higher in the area of drug interactions (75.9+/-11.3, p<0.05). Dietitians scored higher in the area of food interactions (73.0+/-10.3). No significant differences between physicians and pharmacists were evident on general drug-nutrient interactions. While over 87% of the healthcare professionals correctly identified some common foods containing large amounts of vitamin K, such as broccoli and spinach, fewer than 25% were able to identify others such as pea soup, coleslaw and dill pickles.

CONCLUSIONS

Although the healthcare professionals surveyed in this study appear to have demonstrated some proficiency in their respective areas of expertise, they exhibited less knowledge in others. Therefore, additional training and integration of knowledge and expertise about drug-nutrient interactions among healthcare professionals are essential to provide appropriate patient counseling and optimal therapeutic outcomes.

Atherosclerotic cardiovascular disease risks in chronic hemodialysis patients

BACKGROUND

Cardiovascular diseases are the most common causes of death among chronic hemodialysis patients, yet the risk factors for these events have not been well established.

METHODS

In this cross-sectional study, we examined the relationship between several traditional cardiovascular disease risk factors and the presence or history of cardiovascular events in 936 hemodialysis patients enrolled in the baseline phase of the Hemodialysis Study sponsored by the U.S. National Institutes of Health. The adjusted odds ratios for each of the selected risk factors were estimated using a multivariable logistic regression model, controlling for the remaining risk factors, clinical center, and years on dialysis.

RESULTS

Forty percent of the patients had coronary heart disease. Nineteen percent had cerebrovascular disease, and 23% had peripheral vascular disease. As expected, diabetes and smoking were strongly associated with cardiovascular diseases. Increasing age was also an important contributor, especially in the group less than 55 years and in nondiabetic patients. Black race was associated with a lower risk of cardiovascular diseases than non-blacks. Interestingly, neither serum total cholesterol nor predialysis systolic blood pressure was associated with coronary heart disease, cerebrovascular disease, or peripheral vascular disease. Further estimation of the coronary risks in our cohort using the Framingham coronary point score suggests that traditional risk factors are inadequate predictors of coronary heart disease in hemodialysis patients.

CONCLUSIONS

Some of the traditional coronary risk factors in the general population appear to be also applicable to the hemodialysis population, while other factors did not correlate with atherosclerotic cardiovascular diseases in this cross-sectional study. Nontraditional risk factors, including the uremic milieu and perhaps the hemodialysis procedure itself, are likely to be contributory. Further studies are necessary to define the cardiovascular risk factors in order to devise preventive and interventional strategies for the chronic hemodialysis population.

Is fruit juice a "no-no" in children's diets?

In addition to milk and other beverages, juices in reasonable quantities (12 fl oz/day or less) provide nutrients infants need while keeping sugar and food energy intakes adequate.

Meta-analysis of dietary essential fatty acids and long-chain polyunsaturated fatty acids as they relate to visual resolution acuity in healthy preterm infants

OBJECTIVE

To derive combined estimates of visual resolution acuity differences between healthy preterm infants consuming different compositions and ratios of essential fatty acids (EFAs) and docosahexaenoic acid (DHA), an omega-3 (n-3) long-chain polyunsaturated fatty acid (LCPUFA).

DATA SOURCES

Electronic biomedical reference database (Medline and Health Star from 1965 to July 1999) searches with index terms omega-3, n-3, infant, vision, acuity, and human. Current review article, monograph, and book chapter bibliography/reference section hand searches.

STUDY SELECTION

A total of 5 original articles and 4 review chapters were reviewed for details on study design, conduct, and outcome. Four prospective trials of EFA/LCPUFA supplementation were included in these analyses. For behaviorally based outcomes, there were 2 randomized comparisons each at </=1, 2, 6, 9, and 12 months of corrected age and 4 randomized comparisons at 4 months of corrected age. For electrophysiologically based outcomes (visual-evoked potential), there were 2 randomized comparisons each at </=1 and approximately 4 months of corrected age.

DATA EXTRACTION

Dietary composition and EFA/LCPUFA balance, study design, and analytic characteristics (duration of feeding, source of EFAs/LCPUFAs, number of subjects in study population, number of subjects analyzed, and basis for estimating age), and experiment-based characteristics (location, number or sites, design, vision tests employed, testing protocol, and ophthalmic examination) were recorded independently by 2 researchers with a standardized protocol.

DATA SYNTHESIS

The relative difference in visual resolution acuity between groups of infants who received a source of dietary EFAs/LCPUFAs and groups who did not was computed and then analyzed with the DerSimonian and Laird random-effects method.

RESULTS

Analysis of the randomized comparisons (DHA-supplemented formula vs DHA-free formula) showed significant differences in visual resolution acuity at 2 and 4 months of age. Combined estimates of behaviorally based visual resolution acuity differences at these ages were.47 +/-.14 octaves and.28 +/-.08 octaves, respectively. A 1-octave difference is a reduction in the width of the stimulus elements by 50%.

CONCLUSION

These results support efficacy of n-3 LCPUFA intake in early visual system development, although supplementation safety issues still must be addressed through larger randomized trials. Whether n-3 intake confers lasting advantage in visually based process development across the life-span is still to be determined.

Dietary essential fatty acids, long-chain polyunsaturated fatty acids, and visual resolution acuity in healthy fullterm infants: a systematic review

BACKGROUND

Biologically active neural tissue is rich in docosahexaenoic acid (DHA), an omega-3 long-chain polyunsaturated fatty acid (LCPUFA). We conducted a systematic review to examine the nature of discordant results from studies designed to test the hypothesis that dietary DHA leads to better performance on visually-based tasks in healthy, fullterm infants. We also conducted a meta-analysis to derive combined estimates of behavioral- and electrophysiologic-based visual resolution acuity differences and sample sizes that would be useful in planning future research.

STUDY DESIGN AND METHODS

Twelve empirical studies on LCPUFA intake during infancy and visual resolution acuity were identified through bibliographic searches, examination of monograph and review article reference lists, and written requests to researchers in the field. Works were reviewed for quality and completeness of information. Study design and conduct information was extracted with a standardized protocol. Acuity differences between groups consuming a source of DHA and groups consuming DHA-free diets were calculated as a common outcome from individual studies; this difference score was evaluated against a null value of zero and then used, with the method of DerSimonian and Laird (Meta-analysis in clinical trials. Control Clin Trials 1986;7:177-188), to derive combined estimates of visual resolution acuity differences within seven age categories. RESULTS OF RANDOMIZED COMPARISONS: The combined visual resolution acuity difference measured with behaviorally based methods between DHA-supplemented formula fed groups and DHA-free formula fed groups is 0.32+/-0.09 octaves (combined difference+/-S.E.M., P=0.0003) at 2 months of age. The direction of this value indicates higher acuity in DHA-fed groups. RESULTS OF NON-RANDOMIZED STUDY DESIGNS: The combined visual resolution acuity difference measured with behaviorally based methods between human milk fed groups and DHA-free formula fed groups is 0.49+/-0.09 octaves (P< or =0.000001) at 2 months of age and 0.18+/-0.08 octaves (P=0.04) at 4 months of age. Acuity differences for electrophysiologic-based measures are also greater than zero at 4 months (0.37+/-0.16 octaves, P=0.02).

CONCLUSION

Some aspect of dietary n-3 intake is associated with performance on visual resolution acuity tasks at 2, and possibly, 4 months of age in healthy fullterm infants. Whether n-3 intake confers lasting advantage in the development of visually based processes is still in question.

What can industry do to facilitate dietary and behavioural changes?

The food industry has five important roles in facilitating needed dietary and behavioural changes. Two of these roles are direct ones. Industry can increase the availability of a wide variety of basic commodities and new foods that help consumers meet dietary recommendations. It is also responsible for developing and formulating appealing, healthy and effective food products that decrease risks of chronic degenerative disease. Industry also plays an indirect role in facilitating dietary change by motivating consumers to select and prepare foods that will result in healthy dietary patterns. It can also participate in coalitions to facilitate other behaviours that decrease risks. Finally, it can collaborate actively in applied and fundamental research to further our understanding of the associations between food and health.

Lack of efficacy of a food-frequency questionnaire in assessing dietary macronutrient intakes in subjects consuming diets of known composition

BACKGROUND

We compared the validity of a semiquantitative food-frequency questionnaire in assessing intakes of macronutrients (absolute amounts and percentages of energy) by 19 subjects fed natural-food diets of known composition. In small subsets (n = 5 or 6), we also tested 3-d diet records.

OBJECTIVE

The objective of this study was to investigate the efficacy of food-frequency questionnaires and diet records in subjects fed natural-food diets of known composition.

DESIGN

Each subject consumed 3 different diets for >/=6 wk and self-reported his or her food intake by using a food-frequency questionnaire and a diet record. The diets varied in their chemically analyzed contents of fat (15-35% energy), saturated fat (5-14%), monounsaturated fat (5-14.5%), polyunsaturated fat (2.5-10.5%), carbohydrate (49-68%), and cholesterol (108-348 mg/d).

RESULTS

The food-frequency questionnaire significantly underestimated fat, saturated fat, monounsaturated fat, and protein intakes and significantly overestimated carbohydrate intake with the high-fat diet. The percentage of energy from fat was significantly underestimated for the high-fat diet and significantly overestimated for the very-low-fat diet. Estimates from the food-frequency questionnaire differed significantly from actual intakes for fat (absolute and percentage), saturated fat (absolute and percentage), monounsaturated fat (absolute and percentage), and protein (percentage) in the high-fat diet and for polyunsaturated fat (absolute and percentage), saturated fat (percentage), fiber (absolute), and cholesterol (daily absolute; in mg/d) in the lower-fat diet. Estimates from the diet records better agreed with actual intakes than did estimates from the food-frequency questionnaire except for monounsaturated fat (absolute and percentage) in the high-fat diet and polyunsaturated fat (percentage) in the lower-fat diet and the very-low-fat diet.

CONCLUSION

Our data indicated that the food-frequency questionnaire did not provide reliable estimates of absolute amounts of dietary fats or cholesterol.

Genetic and environmental influences on eating patterns of twins aged >/=50 y

BACKGROUND

Clinicians and researchers could benefit from a greater understanding of the role of genetic and environmental factors in human eating behavior.

OBJECTIVE

Our aim was to estimate the relative influence of genetic and environmental factors on habitual eating patterns in middle-aged and elderly men and women.

DESIGN

Male and female twins (n = 4640) aged >/=50 y completed a mailed version of the National Cancer Institute food-frequency questionnaire. Factor analysis was performed to identify eating patterns among respondents. Estimates of genetic, common environmental (shared by family members), and specific environmental (unique to an individual) influences were obtained for food use, serving size, and consumption frequency by comparing monozygotic and dizygotic twin-pair groups with structural equation analysis.

RESULTS

Two independent eating patterns were identified: the first consisted of items high in fat, salt, and sugar, and the second reflected healthful eating habits. Although the influence of environmental factors was larger, between 15% and 38% of the total variation in pattern 1 and between 33% and 40% in pattern 2 were explained by genetic influences. Models accounting for sex differences in genetic and environmental estimates fit the data significantly better for food use and serving size of foods in eating pattern 1 and for food use in eating pattern 2.

CONCLUSION

Although 60-85% of the variability in eating patterns was associated with environmental factors, genetic influences were also apparent and there was some evidence of sex specificity. These findings may be important in crafting dietary interventions and predicting adherence to these interventions.

Guidelines for nutrition screening, assessment, and intervention in the dental office

Patients with complicated disease and medication histories are being seen with increasing frequency in the dental office. Many are at high nutritional risk, which can impact their oral health status. Nutrition is an integral part of health promotion and prevention, but it often is a poorly utilized component of preventive dentistry. This article provides the dental hygienist with a systematic approach to determining which patients are in need of nutrition intervention, and discusses screening, assessment, counseling, and referral. Dental hygienists, as part of a multidisciplinary healthcare team, are in an ideal position to identify patients at nutritional and oral health risk, help them attain optimal oral and general health, and improve overall quality of life.

Managing oral health related nutrition issues of high risk infants and children

Dental professionals are in an ideal position to recognize children at high nutritional and oral health risk and provide early intervention. Some of the children at highest risk for nutritional and oral health problems include those born prematurely, children with failure to thrive, those on multiple medications, special needs children with developmental delays, children with gastroesophageal reflux, and those with lactose intolerance. Nutrition and oral health guidelines are provided to aid the dental practitioner in providing preventive nutrition intervention to these high risk children.

Effect of a ketoacid-aminoacid-supplemented very low protein diet on the progression of advanced renal disease: a reanalysis of the MDRD feasibility study

BACKGROUND

We reanalyzed the data of the Modification of Diet in Renal Disease (MDRD) feasibility study to ascertain the effects of ketoacid- and aminoacid-supplemented very low protein diets.

METHODS

Sixty-six patients with advanced renal disease (Study B, baseline glomerular filtration rate (GFR) 7.5-24 ml/min/1.73 m2) were randomly assigned to a low protein diet (L, 0.575 g/kg/d), or a very low protein diet (0.28 g/kg/d) supplemented either with a ketoacid-aminoacid mixture (diet K) or with a mixture of essential aminoacids (diet J). Thirty patients with moderate renal disease (Study A, baseline GFR 25-80 ml/min/1.73 m2) were randomly assigned to a usual protein diet (M, 1.2 g/kg/d), diet L, or diet K. Mean follow-up was 14 months.

RESULTS

In Study B, GFR decline differed among the three diets (p = 0.028). Pairwise comparisons showed that the mean +/- SE GFR decline in ml/min/mo in diet K [-0.250+/-0.072] was slower than in diet J [-0.533+/-0.074] (p = 0.008) despite similar achieved protein intakes. The mean GFR decline in diet L [-0.394+/-0.068] was intermediate between, and did not differ significantly from the rates of decline in the other two groups. In Study A, consistent with a hemodynamic effect, the mean GFR decline varied directly with the reduction in protein intake in diets M, L and K (p = 0.028) during the first four months of follow-up, but thereafter did not differ among the diet groups (p = 0.76).

CONCLUSION

The study suggests that supplementation of a very low protein diet with the ketoacid-aminoacid mixture used in this feasibility study slowed the progression of advanced renal disease more than supplementation with an amino acid mixture.

Nutritional implications of dental and swallowing issues in head and neck cancer

Tumors of the head and neck account for 4% of cancers in the United States. Both the disease process itself and side effects of cancer treatment, such as xerostomia, dysphagia, and malnutrition, compromise oral health, swallowing ability, and nutritional status. Optimal treatment of dental, swallowing, and nutritional problems of head and neck cancer patients requires practical strategies that address these problems. These strategies should include appropriate referrals to the dentist, speech/language pathologist, and registered dietitian to enhance patient comfort, prevent secondary malnutrition and dental disease, and improve treatment outcomes. Since dental, swallowing, and nutritional issues are interrelated, appropriate therapeutic strategies hinge on timely, integrated input from each discipline. A better understanding of the dental and swallowing therapies used in patients with head and neck cancer by health professionals will help promote the comprehensive care of these patients.

Predictors of overweight and overfatness in a multiethnic pediatric population. Child and Adolescent Trial for Cardiovascular Health Collaborative Research Group

The goal of the study was to determine whether overweight or overfatness were predicted from sex, race or ethnicity, school site, and intervention or control status for children who were 9 y old at the outset of the Child and Adolescent Trial for Cardiovascular Health (CATCH). In this ethnically and geographically diverse group of 5106 students, height, weight, and triceps skinfold thickness were measured at 9 (baseline) and 11 y (follow-up) of age. The strongest predictors of status at follow-up were baseline overweight (odds ratio: 69.0; 95% CI: 54.9, 96.3) and overfatness (odds ratio: 27.4; 95% CI: 22.4, 33.4); site, African American race or ethnicity, and male sex were also significant independent associations. Children in the overweight (> 85th percentile for body mass index) group had significantly higher adjusted means for total blood cholesterol, higher apolipoprotein B concentrations, lower mean HDL-cholesterol concentrations, and lower performance on the 9-min run than those in other groups (< 15th, 15-49th, or 50-85th body mass index percentiles). Similar results were found for these factors for those subjects with greater triceps skinfold-thickness measurements. Groups of children who were overweight and overfat at baseline were more likely to be overweight and overfat at follow-up and to have more cardiovascular risk factors than their peers.

Nutrition and oral health guidelines for pregnant women, infants, and children

Good oral health care and nutrition during pregnancy, infancy, and childhood are essential but often overlooked factors in the growth and development of the teeth and oral cavity. Pregnant women and parents and caregivers of infants and children often receive little guidance about proper preventive dental and oral health care, including fluoride and dietary measures. Pregnant women can maintain their health through proper diet, good oral hygiene, and appropriate use of fluoride. An adequate diet during gestation is important for optimal oral development of the fetus. To promote good oral health in infancy, caregivers need to provide the infant with appropriate amounts of fluoride in addition to a healthful diet. As the teeth erupt into the mouth, the caregiver needs to clean the teeth thoroughly on a daily basis. When solid foods are introduced in later infancy, it is also important to limit the frequency of caries-promoting fermentable carbohydrates between meals. Good oral hygiene habits and dietary practices that emphasize minimum exposure to retentive, fermentable carbohydrates; use of fluoridated water; and a varied, balanced diet should continue throughout childhood to set the stage for optimal oral health for a lifetime.

The hemodialysis pilot study: nutrition program and participant characteristics at baseline. The HEMO Study Group

OBJECTIVE

Describe the nutrition program (assessments and interventions) and the participants' baseline nutritional characteristics in the Hemodialysis Pilot Study.

DESIGN

Cross sectional survey in which hemodialysis patients were examined during 10 weeks of baseline (BL), before randomization study interventions (dose and flux).

SETTING

Four hemodialysis centers (eight dialysis units in total).

PATIENTS

Twenty-nine male (mean age, 63 years; range, 34 to 75) and 20 female (mean age, 61 years; range, 29 to 73) hemodialysis patients.

INTERVENTIONS

None during BL.

MAIN OUTCOME MEASURES

Feasibility of implementing the proposed nutrition program before conducting the full-scale trial, and description of baseline characteristics related to nutrition.

RESULTS

A nutrition program was developed to assess nutritional status during BL and follow-up periods and to intervene in patients with weight loss or decreasing serum albumin. Methods for collecting biochemical, dietary and anthropometric data were implemented at four clinical centers. At baseline, mean protein intake estimated by single pool normalized protein catabolic rate was 0.95 +/- 0.21 gm/kg adjusted body weight (ABW) (n = 42) and by diet record assisted recalls (n = 47) 0.94 +/- 0.36 gm/kg ABW/d, respectively. Mean energy intake was 22.8 +/- 8 kcal/kg ABW/day (n = 39). Mean serum albumin concentration using the bromcresol green method was 3.8 +/- 0.4 gm/dL (n = 40). Mean body mass index was within the normal limits of 19-27 kg/m2. Mean skinfold thicknesses in females, but not males, were shifted toward the lower end of usual distributions for healthy individuals.

CONCLUSIONS

The goal of designing, developing, and implementing the diet and nutrition component, and related data collection for the HEMO pilot study was accomplished at four separate clinical centers. Baseline mean protein and energy intake were low, suggesting that continuing dietary surveillance is needed. The ongoing full-scale HEMO study will provide the first prospective analysis of dietary intake, nutritional status, and outcome in maintenance hemodialysis patients as a function of dialysis dose and membrane flux.

Human studies on the effects of fatty acids on cancer: summary, gaps, and future research

Both the goal of understanding the basic biology of cancer development as well as the practical considerations involving public health, marketing, and nutrition education have stimulated interest on the effects of individual fatty acids on cancer. Data on diet-disease relations must meet the standard of significant scientific agreement based on the totality of publicly available scientific evidence. The process of arriving at significant scientific agreement begins by collecting data accumulated from epidemiologic associations, animal studies, and clinical trials. This supplement represents one useful effort toward that end. Questions raised include: 1) What stage of the disease is being studied, what are the relevant characteristics of the study participants, how well characterized was the diet, and were appropriate experimental designs used; 2) Is there is a significant role for markers of disease and, if so, are the markers available; 3) Is there consistency, strength, and quality of evidence for establishing basic scientific relations; 4) Do dose-response relations, biological plausibility, and temporal relations (with special attention to clinical trials) exist; 5) What is the level of specificity of the data for the health claim or posited relation; and 6) What are the effective amounts of fatty acids in foods and diet? More complete food-composition data with respect to fatty acids and more comprehensive food tables are needed, as are better methods for measuring fat intakes, better markers of progression, and more definitive epidemiologic and clinical studies. At present there is insufficient evidence to conclude that specific fatty acids are associated with cancer development in humans.

Nutritional implications of xerostomia and rampant caries caused by serotonin reuptake inhibitors: a case study

Serotonin reuptake inhibitors, such as fluoxetine, fenfluramine, and dexfenfluramine, are frequently used to treat obesity, depression, and bulimia. A common side effect of these medications is xerostomia, or dry mouth. A case study demonstrating the impact of drug-induced xerostomia on oral health and subsequent nutrition implications is presented. Rampant caries can result from a combination of xerostomia and inappropriate dietary and oral hygiene habits. Preventive dietary and dental guidelines are presented to assist nutrition and dental professionals in treating and counseling patients with xerostomia.

Breast cancer: weighing the evidence for a promoting role of dietary fat

It has been hypothesized that a high-fat diet promotes the development of postmenopausal breast cancer. This contention is supported by data showing high international correlations between fat intake and breast cancer rates, modest positive associations with a high-fat diet in case-control studies, and animal model studies that have consistently demonstrated that dietary fat influences mammary cancer development at several stages in the carcinogenic process. A number of plausible biologic mechanisms have been suggested that may explain such promotional effects. In contrast, dietary fat intake is unrelated to the risk of breast cancer in cohort studies. The conflicting findings from cohort studies have created uncertainty regarding nutritional recommendations and breast cancer prevention. After reviewing key scientific findings that are relevant to this issue, the following conclusion is drawn: In the absence of data from dietary intervention trials, the weight of available evidence suggests that the type and amount of fat in the diet is related to postmenopausal breast cancer and that the inability to detect associations within populations (cohort studies) is because of measurement error and the relative homogeneity of diets measured. It is expected that the results from intervention trials will clarify this issue.

Insights into dietary recall from a longitudinal study: accuracy over four decades

We studied the validity and consistency of memory of foods consumed decades earlier in a longitudinal population of 91 persons. The memory of middle-aged persons for food intake years earlier did not decline invariably over time, although median correlations between actual and recalled consumption decreased. Time-related memory loss varied greatly from food to food. Neither analyses of group mean differences and SDs over all foods nor those for individual foods provided clearcut evidence of time-related memory loss. Systematic biases in memories of dietary intakes in the distant past were evident, depending on current diet and varying according to individual foods and food groups. These discrepancies may represent either misremembering or the effects of inferential processes. Examination of the consistency (reliability) and validity of reports of food intake indicated that validity estimates provided by mean differences between recalled and actual intakes were more revealing than correlation coefficient. Consistent reports were not necessarily valid, as indicated by memories of food intake. Correct inferences may have been made even when the actual memory was lost.

You are what you eat: healthy food choices, nutrition, and the child with juvenile rheumatoid arthritis

Children with juvenile rheumatoid arthritis (JRA) often experience nutrition related concerns. Growth abnormalities are common. Protein-calorie malnutrition and inadequate intake of other nutrients result from aspects of the disease process, treatment (including drug treatment), and dietary choices. Mechanical feeding difficulties can also compromise adequate intake. Because nursing assessments usually explore eating habits and family issues, the registered nurse is in a good position to identify nutrition concerns, to provide intervention recommendations, or to act as a referral source.

Improving school breakfasts: effects of the CATCH Eat Smart Program on the nutrient content of school breakfasts

BACKGROUND

This paper describes the impact of the Eat Smart School Nutrition Program, the food service component of the Child and Adolescent Trial for Cardiovascular Health (CATCH), on the percentage of calories from total fat and saturated fat and the sodium content of school breakfasts.

METHODS

Fifty-nine of the 96 CATCH schools offered breakfast. We collected 5 consecutive days of school breakfast menu, recipe, and vendor product information at three periods to assess the nutrient content of the school menus as offered.

RESULTS

At baseline (Fall 1991), intervention school breakfasts provided 28% of calories from total fat and control schools 30%. Decreases occurred over time in both groups, but no significant differences were attributable to the intervention (adjusted mean difference = -0.4; P = 0.77). Saturated fat exceeded the Eat Smart goal at baseline in all schools and by follow-up (Spring 1994), the reduction in mean percentage of calories from saturated fat was greater in intervention than in control schools (adjusted mean difference = -1.6%; P = 0.052). Sodium goals were not achieved. Mean calorie levels were maintained at or above Eat Smart goals throughout the study in both groups. Differences over time in other dietary variables (percentage of calories from protein and carbohydrate and mean levels of protein, carbohydrate, calcium, iron, vitamin A value, vitamin C, total sugars, and dietary fiber) were not statistically significant between groups. No significant reductions in student participation in the School Breakfast Program (SBP) occurred.

CONCLUSIONS

The Eat Smart food service intervention improved school breakfast composition, but not significantly more so than in control schools. Fat and saturated fat in school breakfasts were lowered while maintaining calories, other essential nutrient levels, and student participation in the SBP. Secular trends and also the possibility that control schools were affected by the Eat Smart intervention may account for these findings.

Changes in nutrient intakes of elementary school children following a school-based intervention: results from the CATCH Study

BACKGROUND

Twenty-four-hour recalls were used to assess the change in nutrient intake among elementary-age school children exposed to the Child and Adolescent Trial for Cardiovascular Health (CATCH). The purpose of this paper is to compare changes in nutrient intakes between treatment groups, sexes, ethnic groups, and the four CATCH sites.

METHODS

Twenty-four-hour recalls were administered to a subsample of the CATCH cohort at baseline in third grade and following the intervention in fifth grade (n = 1,182). Changes in nutrient levels for total energy, dietary cholesterol, and dietary fiber and changes in the proportion of energy from fat, protein, carbohydrate, and fatty acids were studied looking at differences by treatment group, sex, ethnicity, and site. Mixed-model analysis of variance was used to examine the change in nutrient intake, defined as intake at follow-up minus intake at baseline.

RESULTS

Students in the intervention schools showed statistically significant differences in the changes in total energy and proportion of energy from total fat, saturated fat, protein, and monounsaturated fat compared with students in the control group. Students in the intervention group decreased their total fat intake from 32.7% of energy to 30.3% of energy and saturated fat from 12.8% of energy to 11.4% of energy. There were no significant differences in intervention effects by ethnic group, sex, or site. Differences in nutrient change between the school-only and the school-plus-family intervention groups were nonsignificant.

CONCLUSION

The results show that a school-based intervention can positively influence children's intakes of total fat and saturated fat, suggesting that population-based approaches for reducing cardiovascular risk factors in children are feasible and effective. The results are also important in showing that the intervention was effective in Caucasian, African-American, and Hispanic students, in boys and girls, and across four regions of the United States.

Nutrition measures for managed care report cards

Health plan "report cards," that is, published summaries of health plan performance, are a new way to help consumers select a health plan on the basis of cost and quality. The Health Plan Employer Data and Information Set (HEDIS) includes a set of health plan performance measures, standardized definitions, and methods for data collection. HEDIS is used as the basis for many report card initiatives and is the preferred tool of the managed care industry for measuring health plan performance. Nevertheless, the current list of HEDIS performance measures omits many health services, including medical nutrition therapy. Nutrition measures have the potential for wide appeal among health care stakeholders (ie, payers, consumers, and providers). Four measures related to medical nutrition therapy are proposed for managed care report cards: staffing for nutrition services and medical nutrition therapy for high cholesterol level, gestational diabetes, and cardiovascular disease. Barriers to adopting medical nutrition therapy measures in HEDIS include the need to address technical issues before considering new measures and competition from other potential measures. Steps to create support for medical nutrition therapy measures in HEDIS should focus on influencing representatives of health plans and employers to include these measures. The involvement of registered dietitians in the dynamic process of health plan evaluation is an important extension of ongoing efforts for strategic positioning in the managed care market.

Dietary fiber for children: how much?

BACKGROUND

Dietary fiber intakes of most American children are lower than current American Academy of Pediatrics recommendations. Intakes of vegetarian children come closer to these levels.

RESULTS

We summarize dietary fiber recommendations for children based on existing evidence. The general public needs guidance on appropriate fiber intake levels for children and adolescents. It is important to ensure that energy intakes are adequate by monitoring child weight, growth, and size, especially when fiber intakes are very high. At levels of "age plus 5 g" there seem to be few problems.

CONCLUSIONS

Age plus 5 g is a reasonable recommendation and is easier to remember than others by weight or energy level, although it never exceeds them. Age plus 15 g is clearly excessive; there is less evidence about ill effects arising with age plus 10 g. Delivery of dietary fiber in food rather than by supplements is suggested to ensure intakes of other nutrients and to avoid medicalizing dietary intake. In addition to dietary fiber recommendations for the general population of healthy children, individualized recommendations may be necessary for some high-risk groups. Practical steps to increase child fiber intakes from food sources are provided. The article concludes with suggestions for further research. Age plus 5 g is a reasonable minimum recommendation for dietary fiber intakes for children older than 3 years of age.

Registered dietitian time requirements in the Modification of Diet in Renal Disease Study

OBJECTIVE

To assess time expended by registered dietitians to conduct clinical and research activities during the Modification of Diet in Renal Disease (MDRD) Study.

DESIGN

Two randomized, controlled clinical trials among persons with diminished levels of renal function using a factorial design to evaluate effects of dietary protein restriction and blood pressure control on progression of renal disease. In study A, subjects with moderate renal insufficiency were randomly assigned to a diet of usual protein (1.30 g/kg per day) or low protein (0.58 g/kg per day) and to either a usual or low blood pressure level. Study B involved subjects with advanced renal insufficiency who were randomly assigned to the low-protein diet or a very-low-protein prescription (0.28 g/kg per day) with a ketoacid-amino acid supplement (0.28 g/kg per day) and to either the usual or low blood pressure level. A time-log form designed by MDRD Study dietitians was completed for each participant at 36 monthly follow-up visits.

SETTING

Fifteen clinical centers throughout the continental United States.

SUBJECTS

Eight hundred forty adults aged 18 to 70 years with chronic renal diseases participated in the MDRD Study--585 in study A and 255 in study B.

STATISTICAL ANALYSES

One-way analyses of variance and t tests were used to evaluate significant time requirement differences by diet groups, diagnosis, and sociodemographics.

RESULTS

Mean total time for all participant visits declined from 183 +/- 1 minutes per visit during months 1 through 4 to 116 +/- 41 minutes per visit during months 25 through 36. Significantly more dietitian time was required for participants consuming the low-protein and very-low-protein diets than for those consuming the usual-protein diet. Age, gender, race, marital status, and renal diagnosis did not influence time requirements. A significant inverse association between education level and dietitian time was apparent.

APPLICATIONS

The MDRD Study time-log data should be useful when determining staffing patterns for nutrition management in clinical and research settings.

Hyperhomocysteinemia as a risk factor for cardiovascular disease in patients undergoing hemodialysis

Hyperhomocysteinemia exists among patients both in end-stage renal disease and on dialysis and may represent an additional risk factor for increased cardiovascular disease. Supplementation with folic acid may reduce, but not correct, hyperhomocysteinemia. Evidence that lowering blood homocysteine will lessen cardiovascular risk is being sought.

Changes in plasma lipoprotein concentrations and composition in response to a low-fat, high-fiber diet are associated with changes in serum estrogen concentrations in premenopausal women

We have investigated the effects of a low-fat, high-fiber diet on plasma lipid and lipoprotein levels and serum sex hormone concentrations in 22 normal premenopausal women (mean age, 25.8 +/- 3.8 years). Participants consumed a baseline diet for 4 weeks (40% of calories as fat, 16% as saturated fatty acids, 8% as polyunsaturated fatty acids, 400 mg/d cholesterol, and 12 g/d dietary fiber) and then a low-fat, high-fiber diet for 8 to 10 weeks (16% to 18% of calories as fat, 4% as saturated fatty acids, 4% as polyunsaturated fatty acids, 150 mg/d cholesterol, and 40 g/d fiber). Blood samples for determination of plasma lipids and serum hormones were obtained during the follicular and luteal phases of the menstrual cycle during both diets. Compared with the baseline diet, the low-fat, high-fiber diet resulted in significant decreases in total cholesterol (TC), low-density lipoprotein (LDL) cholesterol, and high-density lipoprotein (HDL) cholesterol concentrations during both the follicular and luteal phases (TC, -14% and -16%; LDL cholesterol, -14% and -17%; and HDL cholesterol, -15% and -18%, respectively). During the follicular phase but not the luteal phase on the low-fat, high-fiber diet, women exhibited significant increases in plasma triglyceride ([TG] 22%) and very-low-density lipoprotein (VLDL)-TG (36%) concentrations. During the follicular phase, serum estrone sulfate concentrations decreased by 25% (P < .0001) when subjects were fed the low-fat, high-fiber diet.(ABSTRACT TRUNCATED AT 250 WORDS)

Relationship of diet to root caries

A Nutrition and Oral Health Study was conducted on 141 middle-aged and elderly adults (54% female and 46% male; aged 47-83 y, mean = 67; 51% college educated; and 89% white). This study reports on the relationship between root caries and diet. Nutritional composition was derived from two 3-d food diaries. Root caries was measured according to the 1985 Adult Survey Diagnostic Criteria of the National Institute of Dental Research. When the individuals were segregated by their root DFS (decayed and filled surfaces) status into highest (> or = 7) and lowest (< or = 1) quartiles, the sucrose consumption was significantly higher in the higher DFS group. Mean energy consumption and mean number of teeth were the same in both groups. When the individuals were segregated by sucrose consumption into highest (> or = 89 g) and lowest (< or = 31 g) quartiles, DFS root status was significantly higher (P < 0.01) in the highest quartile group (7 g) vs the lowest group (4 g). By using data from subjects with two food diaries, a stepwise-linear-regression model for root caries showed that 4.2% of the variance for root caries was explained by sucrose, 2.8% by plaque, 3.8% by total number of teeth, and 5.6% by gingival recession. These data suggest that root caries has a similar dietary etiology to coronal caries.

The use of unconventional remedies among HIV-positive men living in California

This study compared use of unconventional remedies in two groups of HIV-positive men (N = 63). Employing a multiple-choice questionnaire, the authors assessed the use of and attitudes toward unconventional remedies among two groups of white HIV-positive men similar in age, socioeconomic status, and severity of illness, all of whom lived in Northern California. One group (n = 36) participated in AIDS clinical trial protocols; the other group (n = 27) received health care at a community health center. Participants at all sites expressed positive views upon increasing unconventional remedies. Individuals enrolled in the clinical trial protocols for investigational drugs used unconventional remedies significantly less than the community health center participants, who were enrolled in an open clinical trial of hypericin, an unproven remedy.

Relationship between dietary intake, lipoproteins, and apolipoproteins in Taipei and Framingham

To determine whether the lower rates of heart disease in Taiwan than in the United States could be related to associations between plasma lipoproteins and dietary intake, we assessed these indexes in 423 adults in Taipei matched with 420 adults in Framingham, MA. Concentrations of LDL cholesterol were 14% lower, HDL cholesterol 9% higher, and LDL cholesterol: HDL cholesterol 27% lower in Taipei than in Framingham. Dietary intakes of total fat (34%), saturated fatty acids, and cholesterol (338 mg) were, respectively, 16%, 41%, and 19% lower in Taipei men, whereas polyunsaturated fatty acid intake was 89% higher than in Framingham men. Similar differences were seen for women except for total fat and cholesterol intakes, which were similar. From stepwise analyses of all subjects, we observed significant associations of lower LDL cholesterol: HDL cholesterol with higher polyunsaturated fatty acid intakes and lower body mass indexes in both men and women. Our data indicate that the more favorable lipoprotein profiles observed in Taipei subjects may be partly due to differences in type of dietary fat consumption as well as in body mass index.